View Full Version : Pandemic Flu
Peramivir: this was the first I've heard of it, ItB. It looks promising in studies, but I can't imagine how they are going to handle an IM-administered drug in the middle of a pandemic, especially when they say they are planning to administer it "at the first sign of infection." If you're sick, go line up outside the Piggly Wiggly and wait your turn?
I'd be interested in seeing how it does vs. the recent Qinhai strain from SW Asia/Africa...that's the one that has binding to upper respiratory receptors and Tamiflu resistance.
I'm pretty skeptical nowadays of anything with a long logistical tail that requires organization and social order to work. (From what I can tell, clinical trials and manufacturing have been farmed out to a South Korean company.)
Update:
Nothing extremely worrying, but the usual winter uptick is occurring. There's been a death with confirmed H5N1 in a health-care worker who worked at an Indonesian hospital that handles H5N1 cases. This is causing excitement because his family members insist he had no contact with poultry, infected or otherwise. H2H? Who knows?
There's been a steady drip of Indonesian deaths with confirmed H5N1 over the last month. The background rate appears to be picking up. There have been two confirmed milder cases where children have survived. Paradoxically, this riles people up because they fear a mutation that results in easier transmission and lower mortality (the mortality rate has 'dropped' to around 48%). To my simple mind, this is sort of like the stock market, where good is bad for the market and bad new is good. Whatever.
Still in Indo, there are rumbles about the press and hospitals being pressured to not report H5N1 deaths. This is rumor via the Indonesian-cleaning-lady-in-Singapore grapevine, which has been right, and wrong, in the past. My public health contacts also speculate that there are scores of H5N1 deaths for every confirmed case, so who knows.
Avian H5N1 is reoccurring in Egypt and the Caucasus and remains endemic in Indo and SE Asia. It's also rife in Bangladesh and India. Speculation runs high that it's also endemic in wild birds in Europe now.
So, bottom line: the chair is not against the wall, the lid is still on the pot, and watchful waiting is still the name of the game.
Hope for the best and plan for the worst.
The Reaper
11-13-2007, 11:02
This is NOT good news....
http://news.bbc.co.uk/2/hi/uk_news/7092988.stm
TR
Suffolk bird flu is H5N1 strain
All the birds at the farm are being culled as a precaution.
The type of bird flu found in turkeys on a Suffolk farm is the virulent H5N1 strain, according to government vets. The virus was discovered on Sunday at Redgrave Park Farm near Diss, where all 6,500 birds, most of them turkeys, are being slaughtered.
A 3km protection zone and a 10km surveillance zone have been set up and the farm is co-operating with vets.
Environment Secretary Hilary Benn said that there might be further undisclosed cases of the disease in the area.
Mr Benn told the House of Commons: "I'm not going to speculate as to whether this outbreak is going to get larger.
"What we're doing is working our darndest to make sure that it stays where it is.
"The most important thing, having locked it down, is to trace the contacts and movements so we can take appropriate action."
All birds at the affected premises - including approximately 5,000 turkeys, 1,000 ducks and 500 geese - will be slaughtered.
The Department for Environment Food and Rural Affairs (Defra) said some 10% of birds in one shed at the farm had died during one night.
Acting Chief Veterinary Officer Fred Landeg said there was "still some uncertainty" over the situation.
"We are at a very early stage of the investigation," he said.
"The initial sequence data suggests that it's closely related to outbreaks in the Czech Republic and Germany, which does suggest a possible wild bird source.
"However, at this stage we are looking with an open mind as to the origin and all potential sources of the origin will be investigated."
Mr Landeg also said there was a lake at the affected site with a number of wild fowl on it.
"We are still at a very early stage of the investigation and no two outbreaks of the disease are ever the same.
"This will not be a quick exercise. This is a particularly challenging site and our priority is to adhere to strict bio-security, and the health and safety of staff on site is paramount.
"It is extremely important that poultry keepers, particularly in the locality, are vigilant and on the lookout for disease and reported quickly.
"In addition we want every poultry keeper in the area to be well aware of bio-security."
Earlier, Mr Landeg had said the risk of bird flu spreading was increased during the autumn months because of wild bird migration.
The affected birds were free-range - meaning they had access to the outdoors and may have been of greater risk of catching the disease.
Cull preparations
There was a H5N1 outbreak at a turkey farm, also in Suffolk, in February.
The BBC's Andrew Sinclair, who is at the farm in Suffolk, said large trucks and gas canisters had been moved on to the premises earlier in preparation for the cull.
It is expected that all the birds will be gassed and then put in sealed containers.
Officials said further local surveillance work would happen before deciding on any culls on neighbouring farms.
Heather Peck, Defra's regional operations manager for animal health, said: "The top priority is to get controls in place, to inform people of the controls in place and that's largely done electronically these days.
"The immediate priority for us here is both to cull the affected birds on the infected premises and to establish any possible contact or any potential traces of movement between those premises, or related premises or premises in the immediate vicinity."
InTheBlack
11-13-2007, 14:06
Reaper- you beat me to the post on that one. Here's a link to a timeline of British H5 and H7 outbreaks in birds. Significant snips from it below, my comments in ALL CAPS:
http://news.bbc.co.uk/2/hi/uk_news/4882824.stm
FIRST EVENT TAKES 3 WEEKS TO FIGURE OUT THE SOURCE:
16 September 2005 A consignment of parrots arrives in quarantine in Essex from Surinam, in South America.
27 September 2005 A group of finches arrives at the same quarantine premises in Essex as part of a mixed consignment of birds from Taiwan.
21 October 2005 The lethal H5N1 strain is confirmed in one of the parrots
15 November 2005 Subsequent tests show the disease is most likely to have come from the finches rather than the parrot. A government report blames the confusion on a mix-up of tissue samples.
SECOND EVENT ONLY TAKES 6 DAYS
29 March 2006 A mute swan found dead in the harbour at Cellardyke, near Anstruther, Fife
5 April 2006 Laboratory tests confirm the presence of highly-pathogenic H5 avian flu in the dead swan. Further tests are carried out to establish whether it is the lethal H5N1 strain.
A two-day exercise to test the UK's bird flu plans is abandoned so that resources can be switched to the Scotland incident.
11 April 2006 Dead bird identified as a whooper swan, not native to the UK, but scientists remain unsure whether it contracted the disease abroad or after it arrived in Britain.
CULLING AFTER AN EVENT:
26 April 2006 Chickens test positive for bird flu - early tests suggests the H7 strain - at a farm near Dereham, Norfolk, leading to the slaughter of 35,000 birds.
EU TRADE REGULATIONS PRECLUDE PRUDENT IMPORT RESTRICTIONS:
1 February 2007 Vets are called to the Bernard Matthews farm, in Holton, Suffolk.
3 February 2007 The European Commission says tests confirm that the avian flu is the H5N1 virus.
8 February 2007 The Suffolk outbreak may be linked to imports from the Bernard Matthews plant in Hungary
11 February 2007 Environment Secretary David Miliband defends the government's handling of the outbreak. He says a ban on imports from Hungary, where the virus is thought to have originated, would have breached EU rules.
13 February 2007 Scientists say the strains of H5N1 bird flu found in England and Hungary are "essentially identical"
16 February 2007 Imported poultry from Hungary is the "most plausible" cause of the UK bird flu outbreak
27 May 2007 Following the death of chickens at a farm in Conwy, North Wales, the low pathogenic H7N3 strain is confirmed.
7 June 2007 The low pathogenic H7 strain of bird flu is found at found at a smallholding near St Helens in Merseyside.
12 November 2007 About 5,000 birds slaughtered after the H5 strain of avian flu is confirmed in turkeys at Redgrave Park Farm, Suffolk.
*****
It seems to me that drive-through flu shot clinics are being promoted heavily this year, and used as a drill for practicing pandemic immunization techniques. Things like stadium parking lots as the venue. Good idea.
The Suffolk outbreak is just one of many more to come in Europe. As I implied in my post on the 9th, those who don't have a vested interest in a 'blanket of reassurance' are stating that H5N1 is endemic in the wild bird population in Europe.
As the temperature falls and the relative humidity drops during the winter, the H5N1 virus lives longer and is easier to track into 'bio-secure' areas. That said, the last Brit outbreak was due to importation of sick birds from Eastern Europe and criminally poor isolation/quarantine TTPs prior to mixing flocks.
While any new avian infection outbreak represents another 'roll of the dice' in the pandemic roulette game, I'm fairly convinced that human infections are actually coming from somewhere else...probably a mammal vector like dogs or cats or pigs.
Those of us here who have seen a third-world poultry 'wet-market' know what a bloody place it is. All of these human cases in Indo/Viet Nam/China/Azerbaijan/Egypt are not found in the people working the wet-markets, where the workers are literally covered in poultry blood and feces (and remember, up to 30% of those chickens have 'silent' H5N1 infections). Strange, eh?
I think the virus has jumped into mammals after a mutation that allows it to live at the lower temperature of the mammalian respiratory tract. People are picking it up from there. For that reason, if they dispose of the culled poultry properly and keep it out of the food chain I don't see this as a huge risk to humans. Just an educated guess; I could easily be wrong.
One of the guys who still talks to me (I'm being 'shunned' for posting here...we need a middle-finger smiley :p) is still betting on H7 being the 'big one' and not H5.
It seems to me that drive-through flu shot clinics are being promoted heavily this year, and used as a drill for practicing pandemic immunization techniques. Things like stadium parking lots as the venue. Good idea.
Funny you should mention this, the entire State of Colorado will be holding it's first attempt at mass immunizations this Saturday, Nov. 17, 2007. from 09:00 to 12:00.
Free Flu shots will be administered in almost every county (some counties will charge). Colorado guys can go to www.whatifcolorado.com for more details.
Here's your chance to get a free flu shot and help out the READYColorado with their pandemic flu test. I plan to adopt a persona of the belligerent jerk who is also afraid of needles , feel free to make up your own. ;)
Lanyard
We just got a letter from our county telling us that in case of a pandemic our respective polling places will be vaccine administration sites.
InTheBlack
11-14-2007, 21:49
Infecting schools and churches with a deadly virus is such a good idea. Who's gonna pay to disinfect the air handling systems afterwards?
Infecting schools and churches with a deadly virus is such a good idea. Who's gonna pay to disinfect the air handling systems afterwards?
Won't matter...everyone will be exposed anyway in one wave or another. By the time the schools reopen, H5N1 (or H7, whatever) will just be another flu, like H1N1 is now (that was the killer strain in 1918-1919). And anthrax this ain't...under ideal conditions the flu virus only survives for weeks on surfaces--usually less.
Dub:
I know that it seems like a lot of work to you, but since the info is all here, you could just read the entire thread.
TR
Milestone: I've just passed on this quote for the tenth time. Pithy.:)
Rushing OCONUS for a while so no real update. Just a reminder for you and yours to get a flu shot. There is evidence starting to accumulate that cities which were least affected in 1918 had been hit by a strong wave of seasonal flu prior to the emergence of H5N1. The theory goes that many folks were cross-immunized, at least partially, by the normal flu strain. To my mind this argues pretty strongly that a "normal" seasonal flu vaccine may provide partial protection. Previous posts have cited additional evidence. Do it. Look into the Hib (H influenzae) vaccine as well. Before I'm asked, read the thread, it's been discussed before.
I'm surprised this info got out of China and, as always, initial reports tend to be innacurate.
http://news.bbc.co.uk/2/hi/asia-pacific/7124263.stm
Chinese man dies of H5N1 bird flu
A man in China's eastern province of Jiangsu has died from the deadly H5N1 strain of bird flu, state media says.
China's Xinhua news agency said the man, named only as Mr Lu, died after being admitted to hospital on 27 November with severe chills and fever.
It said he had no known contact with dead poultry, and no outbreaks of bird flu were reported nearby.
A total of 17 people have died in China from the H5N1 virus and millions of birds have been culled.
As a precaution, 69 people with close contacts to Mr Lu were put under medical observation, Xinhua said.
Since the H5N1 virus emerged in South East Asia in late 2003, it has claimed some 200 lives around the world. Indonesia has been hardest hit, with more than 90 deaths.
Scientists fear the virus could mutate to a form which could be easily passed from human to human, triggering a pandemic and potentially putting millions of lives at risk.
I'm surprised this info got out of China and, as always, initial reports tend to be innacurate.
http://news.bbc.co.uk/2/hi/asia-pacific/7124263.stm
Chinese man dies of H5N1 bird flu
A man in China's eastern province of Jiangsu has died from the deadly H5N1 strain of bird flu, state media says....
Just got back...
Stay alert. The WHO have confirmed that the father of the guy above is also infected and there are rumbles that others under surveillance are also quite ill. They are talking about h2h, which is very unusual for the WHO. They can find no obvious vector, which may mean that Chinese poultry surveillance is extremely poor, a mutation has occurred in their vaccinated poultry, the vector is a cat/dog/pig or other mammal, or <shudder> this is going h2h and the infection is from someone/somewhere else.
"The father of a Chinese man who died of bird flu has also been infected and may have caught it directly from his son, health experts have said.
The World Health Organisation said it could not rule out the possibility of human-to-human infection of the deadly H5N1 strain of the virus."
'Human-to-human' bird flu alert (http://www.channel4.com/news/articles/world/humantohuman+bird+flu+alert/1154777)
Checked into the above report with a few folks...
WHO are officially reporting no others with H5N1 symptoms, which runs counter to reports/rumors I've heard from rather lowly public health officials with contacts in the area (a better source than the muck-mucks IMHO). There is also a severe seasonal flu outbreak in the area, so who knows.
My take? I'm not really worried yet but I am watching this closely. WHO are twitchy that there is no local poultry infection to blame this on, but I have come to believe that the human cases in Indo and elsewhere are not caught from poultry anyway. Maybe this will give them a kick in the pants to look for mammal vectors.
Here is a link to another story.
http://www.reuters.com/article/healthNews/idUSSP21628720071207?feedType=RSS&feedName=healthNews&rpc=22&sp=true
I'll go read now to see if it's talking about the same person.
Edited to add - It was the first man's dad.
There's no change in the chair/wall status and nothing to indicate that efficient h2h is going on, but the following is interesting nonetheless because it appears to demonstrate how China continues to stonewall this issue...
Local Chinese press reports stated -- before they fell silent -- that the father has died and that the mother and girlfriend were moved out of "observation" and into "medical quarantine." The official Chinese press organ Xinhua is stating that the father is "improving" and no others have symptoms.
The closer we get to the Olympics the more they will lie, IMO.
Hmmm...several missing posts here. All were sent from OCONUS, wonder what happened.
Anyway, WHO are investigating what looks like a four-person h2h chain in Pakistan. Brother #1 was culling H5N1 chickens and got sick (recovered). Brothers 2, 3, and 4, who had no contact w/ poultry but who visited sick brother #1, all came down w/ H5N1 and 2 died.
Still no efficient transmission, apparently.
Note that there will probably be more clusters this winter (there are rumbles coming out of Egypt and Azerbaijan for instance). I'm going to stop with the "he died" reports unless the pace picks up or transmissibity has appeared to change.
Interesting...Just goes to show how this will go down, if it does go down. I have 8 neighbors on my cul-de-sac, three of whom have visited China/SE Asia on business in the last 2 months.
A third brother who lives in the United States but was visiting Manshera at the time also tested positive for bird flu, but survived and has since returned to the US, Akhtar told dpa.
'The two brothers died and we suspect that they might have died because of the human transmission of the H5N1 virus,' he said. 'We have requested the World Health Organization (WHO) send a team to the area so we can find out exactly what happened there.'
I was looking into the Paki cases a bit more and noted discrepancies in the reports. Some said the brothers had no contact w/ poultry and others said they worked on a poultry farm. It now appears that there may be two distinct clusters, both in brothers. You can see a summary from Niman, who follows these things pretty closely, here -->Clusters in Pakistan Raise Pandemic Concerns (http://www.recombinomics.com/News/12140703/H5N1_Pakistan_Pandemic.html)
His index page is here, it also details the first human case in Burma--> Niman's index page (http://www.recombinomics.com/whats_new.html)
Hmmm...several missing posts here. All were sent from OCONUS, wonder what happened.
There was a problem the other day and all posts were lost.
Thanks for your updates.
Scuttlebutt has it that NAMRU-3 has both of their field teams in Pakistan and WHO is marshaling resources for a Tamiflu blanket. More suspected cases with links to the two clusters have been identified.
Duh, searched on NAMRU-3 and found http://chealth.canoe.ca/channel_health_news_details.asp?news_id=23782&news_channel_id=1020&channel_id=1020 a great summary of recent events from Helen Branswell. Appears that the NAMRU rumor is true, but no confirmation of the oseltamavir blanket.
Interesting paper from JID. There is a strong indication that predisposition towards death from flu is inherited. This finding appears to jibe with the high death rate in family clusters that has bee seen w/ H5N1. Pure speculation on my part, but it may also mean that the H5N1 death rate is far lower than it appears, given the difficulty in sampling. The paper is here Evidence for a Heritable Predisposition to Death Due to Influenza (http://www.journals.uchicago.edu/doi/full/10.1086/524064?cookieSet=1)
Animal model studies and human epidemiological studies have shown that some infectious diseases develop primarily in individuals with an inherited predisposition. A heritable contribution to the development of severe influenza virus infection (i.e., that which results in death) has not previously been hypothesized or tested. Evidence for a heritable contribution to death due to influenza was examined using a resource consisting of a genealogy of the Utah population linked to death certificates in Utah over a period of 100 years. The relative risks of death due to influenza were estimated for the relatives of 4855 individuals who died of influenza. Both close and distant relatives of individuals who died of influenza were shown to have a significantly increased risk of dying of influenza, consistent with a combination of shared exposure and genetic effects. These data provide strong support for a heritable contribution to predisposition to death due to influenza.
On a scale of 1 to 10, my pucker factor is at 6; above level 5 for the first time in two years. There may be a fundamental change in the Pakistani H5N1 that is leading to more efficient transmission. Note that I said more efficient, not efficient. From what I've heard so far, there is not a breakout in process. But, things are getting sporty and the WHO and the US are very active in the region. The Tamiflu blanket that I reported as being rumored is now confirmed (there were actually two blankets, a first one thrown by Paki and another, wider one with the assistance of the WHO).
While this doesn't look like the breakout, consider if this was the big one. I don't know if you've been following the saga of the brothers who died, but they had a bro living on Long Island who they called for help ("...everyone's sick, please help.") He stayed in Paki and visited his bro's while they were sick, attended their funerals, etc. There are conflicting reports about whether he was sick or not during his flight back to the US-- some reports say he visited his doctor upon his return because he had flu symptoms, some say as a precaution. It is confirmed that he received Tamiflu in Paki, and that he was placed under "voluntary" quarantine and given high-dose Tamiflu upon his return to Nassau County. His tests were negative in the US, but that means nothing at this stage because the Tamiflu would mask the infection. They'll know more in 2-3 weeks when antibody tests are valid (more to satisfy curiosity than anything else)
Now, consider if he had highly contagious H5N1 as he passed through Heathrow, JFK, and visited his clinic on Long Island. There would be worldwide outbreaks right now, maybe in your home town. (I've been through Heathrow four times in the last few weeks...think about it, I certainly do.)
It's not Katie-bar-the-door time, but I think it would be prudent to do a review of your preps and look for holes.
If and when this hits, it's going to be like your door being smashed down by home invaders in the middle of the night. Not a good time to be plotting strategy. If you are not prepared, you'll be one of the billions fighting for resources.
Oh and BTW, the top recommended story on Google News is Pamela Anderson trying to save marriage.
The good news is that there are no reports of flu spreading in Pakistan, so that confirms yesterday's post that this doesn't look like the start of a breakout.
The bad news is another Pakistani doctor is reported to have come down with H5N1. This would indicate h2h, and a quite long transmission chain (maybe 5-6 generations). I still have a gut feel that something has changed with the virus.
Reports continue to be contradictory and downright silly (the Pakis are saying that the existence of clusters 'prove' that there is no h2h, which is ridiculous) but there are now enough feet on the ground to hopefully identify any further spread.
Who knows what's happening in the Karen refugee camps in and around Burma, in Bangladesh, or in the boonies of sub-equatorial Africa.
Yes, it's all fun and games until someone gets poked in the eye...
UN: Avian Flu Not as Serious as First Feared (http://www.voanews.com/english/Science/2007-12-19-voa38.cfm)
Nabarro has pretty consistently been the 'good cop' in the UN flu game, with the WHO being the 'bad cop.'
anythingrandom
12-31-2007, 01:04
Mugwump - I'm listening. I'm working on my M.S. in Genetics and I recently took a virology class. Much of our class was spent on H5N1 and H1N1. If you haven't already, take a look at "Flu" by Gina Kolata. She examines how we excavated in Siberia to find intact 1918 flu. But yea, pucker factor is elevating. Several companies are working on vaccines, but the thing about H5N1 is that we won't know WHAT it will look like, or WHERE it will first hit H2H. My virology professor was great friends with Joan Brugge (discoverer of sarc protein fragment) and is very reputable in her field. She would end most classes heckling us and telling is "IT'S GONNA GET YA! IT'S COMIN FOR YA!" Also, I know a virologist from another university nearby is stocking up and planning for pandemic. She's scared shitless.
I've got some decent literature on H5N1, if anyone wants to read anything and make a decision for themselves. On the good note, the WHO in 2005 MORE THAN DOUBLED their staff working on H5N1. They went from 5 to 12. Influenza-related research brought in $119 million in 2005, while R&D drawings for the JSF (Joint Strike Fighter) cost $4.5 billion.
History repeats itself, with devastating results. One interesting corollary about H5N1 is that it seems to overactivate the immune system. Potentially, AIDS/HIV patients may be conferred some sort of resistance.
Anyway guys, pay attention to mugwump, he certainly seems to know what he's talking about. This bug is nasty, and it's getting nastier.
It's still ticking away out there.
http://www.breitbart.com/article.php?id=080101122226.eanbezkd&show_article=1
You're right Pete. Five confirmed cases in Egypt (four of whom died) and twenty-one suspect cases including one health care worker. There are several clusters: many suspects and one confirmed death in Cairo, a family of four, and a father and daughter. Unsustained h2h is suspected in several cases.
A spike in cases is expected in the winter months, but there are sober folks who are openly speculating about a mutation that may be causing increased transmission. This thing hasn't broken out yet, but no one who works in this field would be stunned if reports began surfacing about hundreds of deaths in Pakistan, Bangladesh, Egypt or Nigeria.
I also wouldn't be surprised if this thing kept sputtering along for years at the present pace. It's literally a crap shoot, with the dice being rolled in every human infection.
The pucker factor is still 6. There is near-panic in some quarters over current events in Egypt: an additional 16 people were put under quarantine today, on top of a similar number yesterday. This is worrying, but I don't think the chair is against the wall.
Here's why...The Egyptians are really on top of this and the local press is whipping up a frenzy. It's flu season, normal seasonal flu I mean, and people are very worried. Add to that a widespread H5N1 poultry die-off in backyard flocks and you can imagine the results. NAMRU-3 is based in Cairo, so we also get better and quicker reporting of positives. I think we are seeing the result of hypervigilance. A good thing.
The recent pultry outbreaks and culls in Israel have also fueled the usual conspiracy theories.
I suspect that what is going on in Egypt -- a spike in H5N1 deaths -- is also occurring in Somalia, Nigeria, etc. as well. We're just not hearing about it.
Now, none of this is good but I'm not seeing a qualitative change in the outbreaks from what we've seen recently in Pakistan. There are more cases being reported but the h2h chains are still very short. I still think that something has changed in the virus to make b2h transmission more efficient (or mammal-human or some other vector; whatever) but h2h is still relatively inefficient.
Note that my calm demeanor is backed by 4 months of food and water, meds for 8, etc.
And no, you can't come over if it hits. :)
Is this the same shot we were talking about a while back?
http://news.bbc.co.uk/2/hi/health/7171118.stm
Looks to be something that may work.
I think we talked about this type of "silver bullet" vaccine but not recently. This is THE hot field right now. They've hooked a part of the type A flu virus that doesn't change from variant to variant onto an inactivated Hep B virus. It needs an adjuvant to stimulate the immune system (just like the Glaxo and Sanofi vaccines) but it seems to produce antibodies. The next leap is to see if it actually prevents the disease.
You're right, Pete, it looks promising. Every month that we go by without a pandemic gets us closer to a possible solution to this specific problem, and the techniques being developed will go a long way to help mitigate the "unknown unknowns" that are bound to crop up in the future.
Some new general flu info about transmission.
http://www.reuters.com/article/healthNews/idUSN0326764520080106?feedType=RSS&feedName=healthNews&rpc=22&sp=true
Interesting.
I hadn't seen that. Thanks.
I'm out of town for a week or so and posting will be problematic.
The situation in Egypt and Pakistan remains muddled, with little or no official information coming out. My back channel sources are no help because no one seems to know anyone on the ground in these locales right now. The flu blogs are combing through local media reports and are finding references to many suspect H5N1 cases, especially in Egypt.
I can't summarize the situation better than this (http://scienceblogs.com/effectmeasure/2008/01/the_egyptian_bird_flu_conundru.php#more) so take a look.
brownapple
01-07-2008, 10:07
The article you linked talks about "back of the envelope" calculations which seem to be based (at least partly) on an assumption that Egypt has a 6-month flu season. Is that correct? I did a search in an attempt to find out what the flu seasons for various countries were, but was unable to find much outside of articles that focused on issues related to bird flu. None of which actually defined the flu seasons. Not even on the un-influenza.org site could I find any information on when the flu season occurs in various countries. CDC gives information on the flu season in the United States, but nowhere else. UNDG and others seem to be focusing on Avian flu as a pandemic flu. WHO also doesn't seem to have information on different flu seasons, but states that each year influenza spreads rapidly around the world... and then uses as an example the death toll in Mozambique in July-August of 2002 (clearly not during the time period that the US has its flu season).
After a lot of digging, I did find this: http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct1907influenza.html
This indicates that cold, dry air favors the spread of flu (at least in lab animals), so I would take it that the flu season in various nations would match up with their coolest temps and lowest humidity.
OK, interesting...
Indonesia is currently in the 80s (Fahrenheit) and having rain showers. Yet, Indonesia is one of the countries that I found mentioned (and sometimes attacked) in the discussion of Avian flu. Including current concerns.
Does the Avian flu favor a different temperture/humidity pattern than seasonal flu?
"A new study sponsored by the World Health Organization (WHO) shows children with severe pneumonia can be effectively treated at home and do not need to be hospitalized. The World Health Organization calls this finding hugely significant for developing countries. It says the change of treatment will save many children's lives and take pressure off health systems. Lisa Schlein reports for VOA from WHO headquarters in Geneva."
Source here (http://www.voanews.com/english/2008-01-05-voa24.cfm).
I the event of panflu, many will die of secondary bacterial infection after surviving the viral flu infection (if the disease follows the 1918 historical pattern). This has been discussed higher in the thread. The study cited above used amoxicillin syrup and found good success. I speculated earlier that Augmentin would be one of the good antibiotics to have on hand for home care of pneumonia and this study bears that out (Augmentin is amoxicillin and clavulanic acid, a combination that is more effective than amoxicillin alone).
Note that this combo (amoxicillin and clavulanic acid ) is off patent and relatively cheap. If you have a Walgreens with an in-house clinic in the neighborhood they hand this stuff out like M&Ms. If you can't get your family doc to cooperate, go into the clinic the next time you have a cold and squirrel away the pills in the fridge. (If you overplay your symptoms you'll get Z-Pac, which is excellent but very pricey.)
Note: I am not thrilled with the wholesale dispensing of ABs for trivial complaints, but we might as well work the system as it currently exists.
The article you linked talks about "back of the envelope" calculations which seem to be based (at least partly) on an assumption that Egypt has a 6-month flu season. Is that correct? I did a search in an attempt to find out what the flu seasons for various countries were, but was unable to find much outside of articles that focused on issues related to bird flu. None of which actually defined the flu seasons. Not even on the un-influenza.org site could I find any information on when the flu season occurs in various countries. CDC gives information on the flu season in the United States, but nowhere else. UNDG and others seem to be focusing on Avian flu as a pandemic flu. WHO also doesn't seem to have information on different flu seasons, but states that each year influenza spreads rapidly around the world... and then uses as an example the death toll in Mozambique in July-August of 2002 (clearly not during the time period that the US has its flu season).
After a lot of digging, I did find this: http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct1907influenza.html
This indicates that cold, dry air favors the spread of flu (at least in lab animals), so I would take it that the flu season in various nations would match up with their coolest temps and lowest humidity.
OK, interesting...
Indonesia is currently in the 80s (Fahrenheit) and having rain showers. Yet, Indonesia is one of the countries that I found mentioned (and sometimes attacked) in the discussion of Avian flu. Including current concerns.
Does the Avian flu favor a different temperture/humidity pattern than seasonal flu?
This has always puzzled me also. I don't know the answer. I've heard from people, and I've read people repeating this, that cases in Egypt spike in our springtime, say March-April. That's when the spike in H5N1 cases occurred in Egypt last year. There's speculation that this year's early spike may bode for a very bad spring, if last year's pattern is repeated.
I know that cool temps favor longer virus viability, but not necessarily lower humidity. Speculation holds that flu survives in ice in frozen northern lakes and that's how it survives year to year in waterfowl...they get reinfected when they return in the spring.
There's some new work focusing on vitamin D and light levels and sun exposure being linked to seasonal disease outbreaks. The theory being that tens of thousands of units of vitamin D are created by even short-term sun exposure (far in excess of the FBA MDRs) and vit D is crucial to immune health. Many docs are pulling back from the 'sunlight is evil' mantra and recommending 15 mins of unblocked sun exposure per day for that reason. Ironically, the highest survival rates in melanoma are in those who had the greatest sunlight exposure.
There's a herd (statistical) factor involved as well. If a greater proportion of a population becomes more suseptible then your chances of infection increase as well, even if your sunlight exposeure is higher.
I also know that UV light is death to all flu viruses...they like the dark/shade.
I never bought that explanation of 'people are more cooped up in the winter with denser populations and higher exposure.' Folks take the subway even in the summer, and still go to work in cube farms, movies, etc.
So, maybe it's sunlight and not temps...who knows.
The Reaper
01-10-2008, 12:51
New cure!
http://www.reuters.com/article/worldNews/idUSL1088475320080110?feedType=RSS&feedName=worldNews&rpc=22&sp=true
Sorry, couldn't resist.
TR
So far.
http://www.breitbart.com/article.php?id=080118092911.ym20y0t6&show_article=1
Tick, Tick, Tick
New Helen Branswell article. (http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080117/birdflu_cases_080117/20080117?hub=Health)
Looks like Tamiflu is still working, and reinforces the fact that the latest pronouncement from the UN that the virus is "remarkably stable" is utter BS.
InTheBlack
01-23-2008, 00:03
This might prove very useful if it can distinguish between seasonal and H5N1 (and profitable).
FDA Clears for Marketing Real-Time Test for Respiratory Viruses* - FDA - Jan.18
The FDA has cleared for marketing a test that simultaneously detects four common respiratory viruses, including the flu, in a patient’s respiratory secretions. The ProFlu+ test provides results in as few as three hours. Other diagnostic tests for respiratory viruses are fast but not as accurate or are accurate but not as rapid. The real-time test employs a multiplex platform that allows several tests to be processed using the same sample to detect influenza A virus, influenza B virus, and respiratory syncytial virus A and B (RSV). These viruses can cause influenza, an infection of the airways called bronchiolitis, and pneumonia. All are among the leading causes of lower respiratory tract infections.**
<http://www.fda.gov/bbs/topics/NEWS/2008/NEW01780.html>http://www.fda.gov/bbs/topics/NEWS/2008/NEW01780.html
Surf n Turf
01-23-2008, 10:58
Interesting Article --- If this is fact, do we have H2H contagion ?
Expressindia
http://www.expressindia.com/latest-news/Over-2000-complain-of-fever-govt-says-it-means-nothing/264604/
Kolkata, January 22 About 2,324 cases of people suffering from fever have been reported from the Birbhum district — Ground Zero of the bird flu outbreak in the state — in the last five days.
“The West Bengal Government is failing to understand the gravity of the situation,” said Union Minister of State for Health and Family Welfare P Lakshmi, during a visit to Birbhum on Tuesday.
Lakshmi, who is currently in the state to get a first hand assessment of the culling operations, did not find adequate health infrastructure to combat the bird flu threat. She criticised the state government for acting irresponsibly and lacking seriousness to fight the disease.
“There is no infrastructure, not even qualified doctors. We have sent pills and gear but the required equipment is not in place till date. They do not understand that this is an emergency situation and they should be prepared for it,” she added.
She blamed the state Animal Resource Development department for the spread of the virus to new areas, as it did not carry out culling operations in a swift manner.
The state government, however, maintained that there has been no case of H5N1 virus infecting humans, and tried to play down its own figures of fever cases in Birbhum.
“There is no need to panic. We do not have any reports of humans being infected. Therefore, a few hundred fever cases means nothing,” said Sanchita Bakshi, state director health services.
According to the status report, as many as 707 fever cases were reported from Birbhum district on January 18.
A day later and another 304 people were added to the list.
For January 20, which happened to be a Sunday, the report does not give any figures.
On January 21, 707 more cases were added to the existing figures and today an additional 613 cases of fever were recorded.
The report further stated that that six central rapid response teams are assisting the state government in culling operations.
Five human blood samples taken from South Dinajpur district have tested negative, the report added.
SnT
Interesting Article --- If this is fact, do we have H2H contagion ?
...
SnT
I don't think there's been extensive h2h in India -- not from what I've heard so far -- but it certainly merits close attention.
A certain amount of human H5N1 is inevitable in W Bengal, although they vehemently deny it currently exists. Conditions on the ground are horrendous. Sick birds are being hidden, poultry is routinely eaten after dieing of H5N1, birds that are culled are being dumped into bodies of water used for drinking water, etc. The full conflation of ignorance, poverty, fear and disease.
There are suspect cases -- many of them -- in Bengal. When the WHO visited the 'isolation wards' where many were being held they found them on sheets on the floor. Not even mattresses, much less masks/gloves/protective gear. The staff were in full panic mode and wouldn't even approach the patients.
The guy is right: fever is as common as dust in India. Dengue, chickungunya, CA pneumonia, seasonal flu, intestinal disease, etc are rampant. That's part of the problem, because documented human H5N1 cases have been initially diagnosed as each of these. This flu can present with gut, CNS, skin and/or respiratory symptoms in humans.
"MARGRAM (BIRBHUM): Hundreds of goats have died of an unknown disease over the past four days in Birbhum's Rampurhat block II.
Some experts warned that if the H5N1 virus — which causes bird flu — has jumped from birds to mammals, it could be the turn of humans next. "
Cite here. (http://timesofindia.indiatimes.com/Cities/Flu_panic_rises_as_goats_drop_dead/rssarticleshow/2729526.cms)
This is the same locale where the poultry flocks have been wiped out.
Note that there are no deaths reported among the 150 or so suspect cases, which is very good news.
InTheBlack
02-29-2008, 21:18
CDC calls it a "small increase" and minimize the figure by including Type B samples, which have never been resistant.
The actual resistance figure is 8.7% for the type which displays resistance, and I'd like to know what change that represents from previous years in order to get a clue as to how fast it's becoming resistant.
Looks like having some Relenza in the fridge would be a good diversification.
Date: Fri, 29 Feb 2008 14:28:41 -0500
From: "Clinician Outreach and Communication Activity (CDC)" <coca@CDC.GOV>
Subject: CDC Clinician Communication: CDC Health Advisory - Influenza Antiviral
Use for Persons at High Risk for Influenza Complications or Who have Severe
Influenza Illness
Sender: CDC's Clinician's Terrorism Update Listserv
For more information, please see the CDC website: <http://www.cdc.gov/flu/professionals/antivirals/>http://www.cdc.gov/flu/professionals/antivirals/
>>>
During this influenza season, a small increase in the number of influenza viruses resistant to oseltamivir has been observed in the United States.
Among the 471 influenza A and B viruses tested during the 2007–08 influenza season to date, 27 (5.7%) have been found to be resistant to oseltamivir, compared with 0.7% during the 2006-07 season.
All of the oseltamivir-resistant viruses have been influenza A viruses of the H1N1 subtype; 8.7% of the 310 H1N1 viruses tested are resistant to oseltamivir.
No resistance to oseltamivir has been observed among the 161 influenza A (H3N2) and influenza B viruses tested to date, and no antiviral resistance to zanamivir has been detected in any subtype.
InTheBlack
03-10-2008, 21:35
Tamiflu Label Updated with Neuropsychiatric Warning - FDA - March 4
Roche and FDA informed healthcare professionals of neuropsychiatric events associated with the use of Tamiflu, in patients with influenza. The label has been revised as follows: Influenza can be associated with a variety of neurologic and behavioral symptoms which can include events such as hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes.
These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease. There have been postmarketing reports (mostly from Japan) of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving Tamiflu.
Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on Tamiflu usage data. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution.
The contribution of Tamiflu to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behavior. If neuropsychiatric symptoms occur, the risks and benefits of continuing treatment should be evaluated for each patient.
http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tamiflu <http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tamiflu?s_cid=ccu031008_seasonalinflu enza3_e>
The Reaper
04-03-2008, 11:54
http://www.foxbusiness.com/markets/industries/retail/article/south-korea-takes-aggressive-steps-contain-bird-flu_547726_7.html
South Korea Takes Aggressive Steps To Contain Bird Flu
Sue Chang
SAN FRANCISCO -- The South Korean government said late Thursday it will take all necessary steps to contain the spread of the avian flu, including culling 308,000 chickens within 500 meters of the farm where the H5N1 strain of the avian flu was discovered. The Ministry for Food, Agriculture, Forestry and Fisheries has also ordered 3.57 million fowls on 265 farms within 10 kilometers of the farm to be quarantined as well as the destruction of all eggs within a 3-kilometer radius. The ministry is urging all poultry farms in the country to sanitize their facilities and close the farms to outside traffic. "We are doing all we can to prevent the spread of the virus to humans, including vaccinating staff involved in the culling and the sanitation process," said the ministry in a statement.
http://www.timesonline.co.uk/tol/life_and_style/health/article3701724.ece
Interesting.
Moving Target
04-07-2008, 19:07
Bad news, and unfortunately far enough away that I doubt you'll be seeing this on the nightly broadcasts anytime soon.
I came across this piece about triage planning. Interesting implications.
Article (http://news.yahoo.com/s/ap/20080505/ap_on_he_me/pandemic_rationing_care)
Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.
Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.
The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.
The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.
The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.
Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.
"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.
To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:
_People older than 85.
_Those with severe trauma, which could include critical injuries from car crashes and shootings.
_Severely burned patients older than 60.
_Those with severe mental impairment, which could include advanced Alzheimer's disease.
_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.
Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.
Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."
The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.
If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."
James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.
He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.
Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."
While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.
Devereaux said compiling the list "was emotionally difficult for everyone."
That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.
"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."
frostfire
05-05-2008, 23:37
To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:
_People older than 85.
_Those with severe trauma, which could include critical injuries from car crashes and shootings.
_Severely burned patients older than 60.
_Those with severe mental impairment, which could include advanced Alzheimer's disease.
_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.
sounds about right. Took BDLS course a few months back. The instructor was a big fan of Grossman books. Learnt so very much, and I was the only one who could answer questions thrown about bioterrorism ie. how the Aum sect utilized sarin and HCN, how to make ricin, botulism, and so on :lifter
InTheBlack
06-04-2008, 01:39
This company might have a novel method of finding and, more importantly, quickly producing quantities of a vaccine. Mug, have you any info on this? A 5 ug effective dose is quite small, right?
Which vaccine has the US Govt ended up contracting for; whats its stockpile situation?
http://www.medicago.com/en/about/overview/
Corporate overview
Medicago is a publicly-traded biotechnology company focused on the development, production and commercialization of protein-based vaccines and biopharmaceuticals using a proprietary manufacturing system developed from its expertise in the genetic engineering of plants.
To face pandemic and seasonal vaccine supply challenges, Medicago has developed a proprietary transient expression system which produces recombinant vaccine antigens in the cells of non-transgenic plants. This technology offers significant advantages of speed and cost over competitive egg-based and cell culture technologies. It can deliver a vaccine for testing in about a month after the identification and reception of genetic sequences from the pandemic strain. This production time frame has the potential to allow vaccination of the population before the first wave of the pandemic strikes and to supply large volumes of vaccine antigens to the world market including developing countries.
The Company is developing its own proprietary pipeline of influenza vaccines.
***
Jun 03, 2008 08:00 ET
Medicago's H5N1 Pandemic Flu Vaccine Effective in Key Ferret Animal Model With Single Dose
QUEBEC CITY, QUEBEC--(Marketwire - June 3, 2008) - Medicago Inc. (TSX VENTURE:MDG) today announced positive results from a preclinical immunogenicity study of the Company's H5N1 Avian Influenza VLP vaccine that was performed in ferrets, the most predictive animal model for the effectiveness of influenza vaccines in humans. Results demonstrated that a single 5-microgram dose of the Company's H5N1 VLP vaccine induced high levels of antibodies in 100% of ferrets and met all required immunogenicity criteria of the European Union Committee for Medicinal Products for Human Use (CHMP).These criteria set by the CHMP for the approval of seasonal flu vaccines in the European Union are widely used to assess immune responses of new pandemic influenza vaccines in humans. In the case of ferrets, these criteria are useful to predict effective doses that should be tested in humans.
SNIP rest of press release
*****
This company is continuing to research a vaccine adjuvant that also seems to make Tamiflu more effective; but I don't know if the blurb about possible cross-protection against H5N1 from a seasonal vaccine is just blue sky hype aimed at investors.
http://www.hemispherx.net/
Recent News:
*
6/2/2008
Hemispherx Biopharma, Inc. Completes Enrollment in Phase II Study of Ampligen® as Seasonal Flu Vaccine Enhancer
Six-month study will also assess potential cross-protection against H5N1 avian influenza
SNIP
Such cross-protection is suggested by animal studies conducted by the Company’s clinical collaborators in Japan at the Japanese National Institutes of Health.
InTheBlack
06-04-2008, 01:47
Here's the original press release (2 years ago) WRT boosting Tamiflu effect:
Hemispherx Biopharma's Ampligen Boosts Tamiflu Potency
Peter Kang, 02.16.06, 9:02 AM ET
Hemispherx Biopharma announced today its experimental immune system booster Ampligen can enhance the effects of the avian influenza drug Tamiflu by a factor of up to 100.
SNIP
also reported the potency of Relenza was increased by 500 times in lab experiments.
*****
Given rising Tamflu resistance, the fact that it may also boost Relenza is another optimistic point. If we need to switch to Relenza, maybe this stuff can prevent resistance long enough to fight a pandemic.
The Reaper
06-11-2008, 12:45
http://www.bloomberg.com/apps/news?pid=20601087&sid=agvlncJxgyGA&refer=worldwide
Hong Kong Slaughters Chickens After Bird Flu Found (Update2)
By Kyunghee Park and Nipa Piboontanasawat
June 11 (Bloomberg) -- Hong Kong ordered the slaughter of all chickens in the city's markets and retail outlets after the H5N1 bird flu virus was detected in three more markets.
The H5N1 avian influenza virus has been found in four markets since the first outbreak last week, the government said at a press briefing today. Hong Kong banned poultry imports from mainland China and suspended exports from local farms for as long as 21 days on June 7.
Public health officials' concerns about a worldwide outbreak of lethal influenza among humans have risen as the H5N1 virus spreads among birds from Asia to Europe, Africa and the Middle East. The deadly strain may spark a global outbreak if it mutates to become as infectious to humans as seasonal flu.
``Public health is a major concern for the government,'' said Alice Lau, deputy director of the Food and Environmental Hygiene Department. ``We need to make sure the message, the need to preserve hygiene, gets through to the public.''
About 3,500 chickens are being killed at about 470 stores, with vendors paid HK$30 ($3.84) for each bird, according to the government. Tests are being conducted at bird farms to determine whether further action is needed, it said.
The government has stepped up efforts to halt the spread of the virus after ordering the culling of 2,700 chickens from nine stalls at the Po On Road Market on June 7. The virus was detected in bird feces, and no animal or human deaths have been linked to the disease, the government said.
None of the samples taken from chicken farms in Hong Kong have shown the virus, said Cheng Siu-hing, director of Agriculture, Fisheries and Conservation. Culls will be conducted on farms should the virus be detected, she said.
The government said it may extend the 21-day suspension of poultry imports from China and exports from local farms should the situation require it.
To contact the reporters on this story: Kyunghee Park in Hong Kong at kpark3@bloomberg.net; Nipa Piboontanasawat in Hong Kong at npiboontanas@bloomberg.net
Last Updated: June 11, 2008 09:24 EDT
http://www.biologynews.net/archives/2008/07/09/pandemic_mutations_in_bird_flu_revealed.html
They are looking at the way it adapts
The Reaper
07-21-2008, 15:22
http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/world-warned-over-killer-flu-pandemic-872809.html
World warned over killer flu pandemic
By Ben Russell, Political Correspondent
Monday, 21 July 2008
The world is failing to guard against the inevitable spread of a devastating flu pandemic which could kill 50 million people and wreak massive disruption around the globe, the Government has warned.
In evidence to a House of Lords committee, ministers said that early warning systems for spotting emerging diseases were "poorly co-ordinated" and lacked "vision" and "clarity". They said that more needed to be done to improve detection and surveillance for potential pandemics and called for urgent improvement in rapid-response strategies.
The Government's evidence appeared in a highly critical report from the Lords Intergovernmental Organisations Committee, which attacked the World Health Organisation (WHO) as "dysfunctional" and criticised the international response to the threat of an outbreak of disease which could sweep across the globe.
The Government said: "While there has not been a pandemic since 1968, another one is inevitable." Ministers said it would could kill between two and 50 million people worldwide and that such an outbreak would leave up to 75,000 people dead in Britain and cause "massive" disruption.
Peers joined ministers calling for urgent action to build up early warning systems across the Third World that can identify and neutralise outbreaks of potentially deadly new strains of disease before they are swept across the globe by modern trade and travel. Peers also called for new action to monitor animal diseases, warning of the potentially disastrous effects of conditions such as the H5N1 bird flu virus jumping to humans and demanded that Britain step up funding for the WHO to tackle the threat.
With international tourist journeys now reaching 800 million a year, giving unprecedented potential for epidemics to spread across borders, and many cities rapidly growing in developing countries, which would provide "fertile ground" to spread disease, peers on the committee warned that conditions such as Sars, avian influenza and ebola "have the potential to cause rapid and devastating sickness and death across much of the world if they are not detected and checked in time".
Their report said: "We have been warned that an influenza pandemic is overdue and that when – rather than if – it comes the effects could be devastating, particularly if the strain of the virus should be of the H5N1 variety that has been seen in south-east Asia in recent years.
"While much progress has been made in the past 10 years in improving global surveillance and response systems, much remains to be done if we are to detect new strains of the virus and counter them before they have had the chance to spread."
The report called for a fundamental overhaul of the WHO's regional offices around the world. "Given the threats to global health that we face from newly emerging infectious diseases, a dysfunctional organisational structure within the world's principal policy-making, standard-setting and surveillance body simply cannot be afforded."
A government briefing given to the committee warned: "Not all countries have the resources or capacities to put in place a seasonal influenza vaccination policy and, in the event of an influenza pandemic, it is also recognised that current stock will not meet world-wide demand.
"There needs to be an improvement to rapid response strategies in poorer, more vulnerable, countries."
Ministers warned that there was "no agreed vision or clarity over roles" among the international bodies working in the field.
Lord Soley, the committee's chairman, welcomed efforts to guard against a flu pandemic but warned: "They are not good enough. We have a pandemic twice every century. If something developed in a country with a developed healthcare system you would stop it and stop it before it went round the world. You cannot have that confidence about the developing world," it warned.
Norman Lamb, the Liberal Democrats' health spokesman, likened the threat from a pandemic to the threat of international terrorism. He said: "Globally there has been massive attention to the threat from terrorism and rightly so. But the potential for loss of life from a pandemic is massive, enormous and yet we stare a disaster in the face and we see a chaotic, uncoordinated and incoherent international response to it.
"Disease can spread like wildfire. We have to dramatically step up the response."
A spokeswoman for the Department of Health acknowledged that "more clearly needs to be done improve detection, surveillance and general response capacity building". She said Britain was working to improve the international response to bird flu and a potential pandemic and was working to improve international co-ordination on the issue.
She added: "We agree that there is considerable scope to improve the effectiveness and coherence of intergovernmental organisations working in this area."
Here is a little info from Australia in the last few months.
June 17, 2008
Australian-made vaccine will protect against bird flu
An Australian-made vaccine which now has approval from the Therapeutic Goods Administration (TGA) could be used in the event of a bird flu pandemic.
The new vaccine, Panvax, will offer protection to people against avian flu but can only be used once a pandemic is officially declared by the World Health Organisation (WHO).
The Federal Health Minister Nicola Roxon says the new vaccine, developed over three years by biopharmaceutical company CSL, can now be manufactured to respond to any new strain of the H5N1 virus.
More than $7 million of government money has gone into Panvax's development and trials; the vaccine can be adjusted in a similar way that flu vaccines are changed throughout the year to combat new strains but can be manufactured within weeks of a new strain being identified - the safety of the vaccine had been assessed for adults aged 18-64 and those aged over 65.
As new approvals would not be needed for each new manufacture of the vaccine to be used against a different strain Ms Roxon says it will, along with the 1.2 million doses of vaccine already in stock, provide Australians with more security and protection.
Ms Roxon says the trigger will be the identification by the WHO of human-to-human transmission, then the vaccine will be rolled out to keep the virus offshore for as long as possible.
Ms Roxon says frontline health workers would receive the vaccine first; chief medical officer John Hovarth says Australia has a major flu plan which focuses on vaccines, anti-virals and protective equipment and none can be taken in isolation.
The plan is however being revised and a new plan will be ready by the end of the year.
http://www.news-medical.net/?id=39298
However, the local Nobel Laureate says that it's not really necessary. :confused:
July 1, 2008
Bird flu virus 'unlikely to reach Australia'
An international conference in Brisbane has been told that it is unlikely a deadly strain of the bird flu virus will ever reach Australia.
It is the first time Australia has hosted the World Poultry Congress, with more than 2,000 delegates attending the first day.
Immunologist and Nobel prize-winner Peter Doherty says although the deadly H5N1 bird flu strain has killed 240 people overseas, Australia's dry climate and isolation will help prevent the virus entering the country.
"It's not something we have to worry about," he said.
But virus expert Dr Andrew Turner says there is still a slight risk.
"We have to be prepared, it may not be H5N1 which starts the pandemic - there are other viruses circulating in birds at the moment," he said.
However he says Australia's strict quarantine system is helping keep bird flu out of the country.
An inquiry into last year's horse flu outbreak blamed weak quarantine procedures for the spread of the virus.
Dr Turner says poultry is monitored more closely than horses.
"The restrictions on birds coming in, poultry genetics coming in, are much much stronger than horses," he said.
"It's a very strict quarantine regime and they come from birds in very highly protected flocks overseas."
http://www.abc.net.au/news/stories/2008/07/01/2290851.htm
As this is winter time in Austrailia, they can offer a glimpse of what we may be in for this flu season.
July 19, 2008
Australia Reports Influenza Cases up 30% From Last Year and Trending Higher
According to Australia's National Notifiable Diseases Surveillance System, there has been an alarming jump in confirmed influenza cases across Australia that has prompted an urgent "get vaccinated" warning - especially for those considered high risk. Reported cases are currently up 30% from last year, and according to
The Sydney Morning Herald (July 19, 2008), doctors fear the worst is still to come.
Have a nice day and remember, it's only hoarding if you don't share with your friends. http://www.rifle-company.com/phpbb/viewtopic.php?t=431
Indonesia: Three dead in feared bird flu outbreak (http://www.vnanet.vn/Home/EN/tabid/119/itemid/262001/Default.aspx)
Eleven more bird flu suspects detected in North Sumatra (http://www.thejakartapost.com/news/2008/08/06/eleven-more-bird-flu-suspects-detected-north-sumatra.html)
Suspect H5N1 Cluster In Sumatra Indonesia Raises Concerns (http://www.recombinomics.com/News/08060801/H5N1_Sumatra_Suspect.html)
There have also been several other suspect clusters within the last several weeks, some with case onset chronologies which suggest h2h. Several recent H5N1 deaths have received incorrect initial diagnoses of TB, dengue, etc.
Note that August typically has few cases.
9798
http://www.breitbart.com/article.php?id=080813210710.1u3dk61t&show_article=1
New concerns about mutation and spreading.
A study on cause of death in the 1918 Flue.
http://www.eurekalert.org/pub_releases/2008-08/nioa-bpc081908.php
It seems that a possible mutation and a little smuggling may have helped get this out break going. Don't forget your flu shots.
Hong Kong finds H5N1 bird flu virus on chicken farm
HONG KONG (AFP) — Hong Kong's government confirmed Thursday that the deadly H5N1 virus was found at a poultry farm, the first outbreak on a farm here in nearly six years.
"We have identified the virus as H5N1 this afternoon following a series of tests," a spokeswoman for the Agriculture, Fisheries and Conservation Department told AFP.
The government announced Tuesday that bird flu was found at the farm near the border with China, and ordered the slaughter of more than 90,000 chickens by end of this week.
Initial tests revealed the H5 virus and the results of follow-up tests announced Thursday identified it as the H5N1 strain. Authorities said they have not found any positive sample from the other farms they have tested so far.
The World Health Organization said Thursday it would monitor the outbreak.
"We are watching it very carefully," Peter Cordingley, a spokesman for WHO's Western Pacific regional office, told AFP.
Cordingley said they were not surprised by the outbreak because the virus is very versatile and tended to be more active in winter.
The origin of the outbreak remains unclear. The government on Wednesday said it had commissioned scientists to find out if the vaccine they have been using since 2003 to protect chickens against bird flu remains effective, after acknowledging the virus has "changed slightly".
Some experts have criticised the government for not having considered the problem of mutation earlier, Chinese newspapers reported Thursday.
Meanwhile, Hong Kong Poultry Wholesalers Association said that the outbreak could be linked to the illegal smuggling of fertilised eggs from China containing infected chicken embryos.
"There is a very big connection between the outbreak and smuggled fertilised eggs," Tsui Mingtuen, the association chairman, told AFP following a meeting with his members Thursday.
Tsui claimed he had evidence and witnesses to support his allegation.
York Chow, the city's Secretary for Food and Health, said they had not detected any smuggling of fertilised eggs but that it could be a possible reason for the outbreak.
"I think theoretically this can happen, but we do not have any evidence so far. I would appeal to the trade to give us any evidence if they can actually provide information," Chow said in a statement issued Thursday.
Wong Yeechuen, owner of the farm where the outbreak occurred, denied having smuggled any fertilised eggs from China and asked the association for evidence to substantiate its allegation.
"The allegation is ridiculous," he told Cable TV.
"There is no chance for a chicken to survive after hatching from infected embryos. If their allegation is true, how come some of the infected chickens in my farm were as old as 40 to 50 days?" he said.
Hong Kong was the scene of the world's first reported major H5N1 bird flu outbreak among humans in 1997, when six people died.
The last outbreak in a poultry farm took place in 2003, since when the government has required farmers to vaccinate their birds against the flu.
The deadly virus has killed about 250 people worldwide since late 2003.
http://www.google.com/hostednews/afp/article/ALeqM5hXemJJ95HUiKf6DxGYEqoLEkQ1HQ
http://www.breitbart.com/article.php?id=081212201016.knmswvgh&show_article=1
Perhaps this discovery can assist in preventing the spread of the avian flu...
http://news.yahoo.com/s/nm/20081229/sc_nm/us_flu1918
Researchers unlock secrets of 1918 flu pandemic
1 hr 8 mins ago Reuters –
WASHINGTON (Reuters) – Researchers have found out what made the 1918 flu pandemic so deadly -- a group of three genes that lets the virus invade the lungs and cause pneumonia.
They mixed samples of the 1918 influenza strain with modern seasonal flu viruses to find the three genes and said their study might help in the development of new flu drugs.
The discovery, published in Tuesday's issue of the Proceedings of the National Academy of Sciences, could also point to mutations that might turn ordinary flu into a dangerous pandemic strain.
Yoshihiro Kawaoka of the University of Wisconsin and colleagues at the Universities of Kobe and Tokyo in Japan used ferrets, which develop flu in ways very similar to humans.
Usually flu causes an upper respiratory infection affecting the nose and throat, as well as so-called systemic illness causing fever, muscle aches and weakness.
But some people become seriously ill and develop pneumonia. Sometimes bacteria cause the pneumonia and sometimes flu does it directly.
During pandemics, such as in 1918, a new and more dangerous flu strain emerges.
"The 1918 influenza pandemic was the most devastating outbreak of infectious disease in human history, accounting for about 50 million deaths worldwide," Kawaoka's team wrote.
It killed 2.5 percent of victims, compared to fewer than 1 percent during most annual flu epidemics. Autopsies showed many of the victims, often otherwise healthy young adults, died of severe pneumonia.
"We wanted to know why the 1918 flu caused severe pneumonia," Kawaoka said in a statement.
They painstakingly substituted single genes from the 1918 virus into modern flu viruses and, one after another, they acted like garden-variety flu, infecting only the upper respiratory tract.
But a complex of three genes helped to make the virus live and reproduce deep in the lungs.
The three genes -- called PA, PB1, and PB2 -- along with a 1918 version of the nucleoprotein or NP gene, made modern seasonal flu kill ferrets in much the same way as the original 1918 flu, Kawaoka's team found.
Most flu experts agree that a pandemic of influenza will almost certainly strike again. No one knows when or what strain it will be but one big suspect now is the H5N1 avian influenza virus.
H5N1 is circulating among poultry in Asia, Europe and parts of Africa. It rarely affects humans but has killed 247 of the 391 people infected since 2003.
A few mutations would make it into a pandemic strain that could kill millions globally within a few months.
Four licensed drugs can fight flu but the viruses regularly mutate into resistant forms -- just as bacteria evolve into forms that evade antibiotics.
(Reporting by Maggie Fox, editing by Will Dunham and John O'Callaghan)
The Reaper
01-05-2009, 11:45
Still out there.
http://www.latimes.com/news/nationworld/world/la-fg-birdflu4-2009jan04,0,3010223.story
New bird flu cases revive fears of human pandemic
By Mary Engel
January 4, 2009
Just when you thought you could scratch bird flu off your list of things to worry about in 2009, the deadly H5N1 virus has resurfaced in poultry in Hong Kong for the first time in six years, reinforcing warnings that the threat of a human pandemic isn't over.
India, Bangladesh, Vietnam and mainland China also experienced new outbreaks in December. During the same period, four new human cases -- in Egypt, Cambodia and Indonesia -- were reported to the World Health Organization. A 16-year-old girl in Egypt and a 2-year-old girl in Indonesia have died.
The Chinese are uncharacteristically forthright lately: Chinese Health Expert Warns of Human Bird Flu Epidemic (http://www.transworldnews.com/NewsStory.aspx?storyid=73643); Bird flu situation 'grim' as teen boy dies from H5N1 (http://www.shanghaidaily.com/sp/article/2009/200901/20090121/article_388783.htm); 227 people under observation in bird flu scare (http://news.xinhuanet.com/english/2009-01/20/content_10691813.htm). The fact that these messages are coming from official conduits is at least as notable as the content.
Niman continues to provide reasoned and composed interpretation of events: Sustained H5N1 Transmission in Shanxi China Raises Concerns (http://www.recombinomics.com/News/01200901/H5N1_Shanxi_H2H2H.html). See running updates here (http://www.recombinomics.com/whats_new.html).
The chair is not against the wall, but widespread use of poorly-matched poultry vaccine in China has created a powderkeg. Large percentages of poultry are infected with H5N1 and are actively shedding virus, yet remain asymptomatic.
While there is nothing like a consensus among my contacts, the Charter House probability for a breakout this year seems to be averaging close to 15%-20% (with a historical probability of 3% per annum over the last 300 years). In any event...significantly higher than background probability.
While this slow-motion train wreck continues to be a high impact/low probability event, the probability is currently rising. It would be prudent to review your plans and preparations at this point.
Ret10Echo
01-27-2009, 09:20
January 25, Xinhua – (International) SW province reports China’s sixth human bird flu case in 2009. A 29-year-old man had been confirmed as infected with bird flu in southwest China’s Guizhou Province, the sixth case of human bird flu found in China this year, local authorities said Sunday. The man, who tested positive for the H5N1 strain of avian influenza, fell ill on January 15 in Guiyang City, the provincial capital. He was then sent to Guizhou Provincial People’s Hospital, said a provincial health department official. The man is still in a critical condition, the official said. Guizhou has launched an emergency response against the virus. Those who had close contact with the patient are under medical observation. No one has been found ill so far.
Source: http://news.xinhuanet.com/english/2009-01/25/content_10718224.htm
January 25, Canwest News Service – (International) Avian flu found on BC farm; 60,000 turkeys to be killed. Nearly 60,000 turkeys from a British Columbia farm will be killed after positive test results for avian flu. The Canadian Food Inspection Agency (CFIA) confirmed the presence of H5 avian flu virus after initial tests showed the turkeys from E&H Farms, in Abbotsford, British Columbia, were infected. Abbotsford is about 43 miles southeast of Vancouver, near the U.S. border. The CFIA said further tests will be done to confirm the precise subtype of the virus; some subtypes of H5are more virulent than others. Twenty-two farms within a 2-mile radius of E&H Farms have been under quarantine since January 21. “In order to limit any potential virus spread, the CFIA is applying restrictions on the movement of poultry and poultry products within three kilometers of the infected premises,” said the CFIA news release. Any recent movement of birds, bird products, and equipment involving the infected property will be probed by the CFIA, which is also conducting a thorough epidemiological investigation of the farm.
Source: http://www.nationalpost.com/news/story.html?id=1216692
Still out there - Egypt this time
http://www.independent.co.uk/news/science/new-bird-flu-cases-suggest-the-danger-of-pandemic-is-rising-1667526.html
InTheBlack
04-16-2009, 12:38
Progress...
FDA Clears Rapid Test for Avian Influenza A Virus in Humans - FDA - April 7
The U.S. Food and Drug Administration cleared for marketing a new, more rapid test for the detection of influenza A/H5N1, a disease-causing subtype of the avian influenza A virus that can infect humans.
<http://www.fda.gov/bbs/topics/NEWS/2009/NEW01987.html>http://www.fda.gov/bbs/topics/NEWS/2009/NEW01987.html
***
Interim Guidance for Cargo Trucking Crews for the Prevention of Pandemic Influenza – HHS – March 23
Cargo trucking is part of the critical infrastructure essential to maintaining the Nation’s continuity of operations in the event of an influenza (flu) pandemic (a worldwide outbreak of a novel flu virus). This draft interim guidance is meant to inform and educate cargo trucking management and crew personnel about precautions and appropriate work practices to minimize exposure and prevent workplace-related transmission of flu in the event of a pandemic.
<http://pandemicflu.gov/health/cargo_trucking.html>http://pandemicflu.gov/health/cargo_trucking.html
***
Scientists Identify Lab-Made Proteins That Neutralize Multiple Strains of Seasonal and Pandemic Flu Viruses - NIH - Feb. 22
Scientists have identified a small family of lab-made proteins that neutralize a broad range of influenza A viruses, including the H5N1 avian virus, the 1918 pandemic influenza virus and seasonal H1N1 flu viruses. These human monoclonal antibodies, identical infection-fighting proteins derived from the same cell lineage, also were found to protect mice from illness caused by H5N1 and other influenza A viruses.
<http://www3.niaid.nih.gov/news/newsreleases/2009/flu_mab.htm>http://www3.niaid.nih.gov/news/newsreleases/2009/flu_mab.htm
***
NIAID Media Availability: Flu Virus Foiled Again: Second Research Team Finds Same Common Achilles’ Heel in Seasonal and Pandemic Flu Viruses - NIH - Feb. 26
Researchers at The Scripps Research Institute in La Jolla, California, supported in part by the National Institutes of Health, have identified a common Achilles’ heel in a wide range of seasonal and pandemic influenza A viruses.
<http://www3.niaid.nih.gov/news/newsreleases/2009/flu_universal.htm>http://www3.niaid.nih.gov/news/newsreleases/2009/flu_universal.htm
"A rare outbreak of human swine flu has killed at least 60 people in Mexico and spread to the United States where authorities are on alert, the World Health Organisation said on Friday.
"To date there have been some 800 suspected cases with flu-like illness, with 57 deaths in the Mexico City area," Chaib added.
Twenty four suspected cases and three deaths were also recorded in San Luis Potosi in central Mexico."
I've been hearing reports for the last week or so about a new variant of H1N1 Type A influenza discovered in California and tracked back to Mexico, which is now thought to be its point of origin. This version of H1N1 appears to have reassembled from the garden-variety seasonal H1N1 and a swine variant of H1N1.
H1N1 is the strain which caused the Great Pandemic in 1918. As I said, it also causes seasonal flu as well. The version circulating in Mex/Cali/Texas is appearing to be easily transmitted, like seasonal flu, and deadly, like the pandemic flu. FOGs may remember the swine flu debacle in the Ford years when several soldiers at Ft. Dix contracted swine flu and a national inoculation campaign was mounted. Pray that this is like that.
There appear to be several small associated clusters of this flu in California and Texas with no reported contact with swine in any of the cases. This implies efficient transmission. The high fatality rate in Mexico is ominous if confirmed.
Canada went on alert on Wednesday, I believe, and the US CDC is going into full fire drill mode.
Watch what they do and not what they say. If you start hearing about Tamiflu blankets in Mexico or the Southwest, top off your preps immediately.
If I wasn't clear enough in my previous post...
If the reports coming out of Mexico are confirmed, the chair may be against the wall. Given the speed at which pandemic flu travels (review the previous posts on pandemic models), the source is Mexico, and our ridiculously porous borders allow efficient transport of all sorts of diseases, you couldn't come up with a worse scenario for rapid spread.
If this is a false alarm, accept my apologies. This is not an exact science and the reports could be garbled (although the new variant was confirmed from two cases in CA earlier in the week).
If it isn't: Good Luck to you and yours.
And Yes, this is not H5N1 and Yes, this H1N1 has come totally out of left field.
Check out the annual numbers of flu deaths - another reason to be thankful to be living in the land of the well-fed and well-vaccinated. ;)
Richard's $.02 :munchin
Mexico shuts schools around capital in flu scare
Noel Randewich And Armando Tovar, Reuters, 24 Apr 2009
Mexico canceled classes for millions of children in its sprawling capital city and surrounding area on Friday after influenza killed more than 20 people in recent weeks.
The World Health Organization said it was concerned over what it called 800 "influenza-like" cases in Mexico, and also about a confirmed outbreak of swine flu in the United States.
U.S. health authorities were unsure whether the outbreak of a new kind of swine flu in California and Texas, which have borders with Mexico, was related to the unusually late and severe flu season in that country.
Mexican authorities say the flu outbreak has killed around 20 people, but WHO said about 60 people have died in the country.
The Geneva-based U.N. agency said it was in daily contact with U.S., Canadian and Mexican authorities and had activated its Strategic Health Operations Center (SHOC) -- its command and control center for acute public health events.
There have been some 800 suspected cases with flu-like illness, with 57 deaths in the Mexico City area, and a further 24 suspected cases and three deaths in San Luis Potosi in central Mexico, WHO spokeswoman Fadela Chaib said.
Mexican Health Minister Jose Angel Cordova said schools and universities in Mexico City and the surrounding area would be temporarily closed on Friday and advised people with flu symptoms to stay home from work.
"We're dealing with a new flu virus that constitutes a respiratory epidemic that so far is controllable," Cordova said late on Thursday.
Some 20 million people live in Mexico City and the surrounding metropolitan area.
Canada's government advised doctors to be on the alert for reports of illness from people who recently traveled to Mexico, although it did not advise against visiting the country, a popular destination for beach vacations.
FLU SEASON USUALLY ENDS EARLIER
Mexico's flu season normally ends in February or March, but it has lasted longer this year, the government said.
"We recommend avoiding places or events with a lot of people unless strictly necessary," Cordova said in an unusual late-night live statement to media.
About 79 people, possibly ill with the flu, are being treated in Mexico and that number has not increased in recent days, the health ministry said.
Worldwide, seasonal flu kills between 250,000 and 500,000 people in an average year.
In the United States, seven people have been diagnosed with a new kind of swine flu in California and Texas, the U.S. Centers for Disease Control and Prevention reported.
All seven people there have recovered but the virus itself is a never-before-seen mixture of viruses typical among pigs, birds and humans, the CDC said.
"We are likely to find more cases," the CDC's Dr Anne Schuchat said. "We don't think this is time for major concern around the country.
Canadian officials have been particularly sensitive to the international spread of respiratory illnesses since Toronto was hit by the SARS epidemic in 2003, which was blamed partly on a slow response to early disease reports.
http://news.yahoo.com/s/nm/20090424/ts_nm/us_flu_5
jasonglh
04-24-2009, 12:39
The swine flu virus contains four different gene segments representing both North American swine and avian influenza, human flu and a Eurasian swine flu, CDC said.
Not Seen Before
“We haven’t seen this strain before, but we haven’t been looking as intensively as we are these days,” Schuchat said. “It’s very possible that this is something new that hasn’t been happening before.”
http://www.bloomberg.com/apps/news?pid=20601087&sid=aWVM4e9IDstg&refer=worldwide
That is a hell of a combination.
So if does come to my door step up here in MD. What does one do to protect his clan?
we talking about faces masks, keeping meds, OTC type on hand, etc.
:munchin
So if does come to my door step up here in MD. What does one do to protect his clan?
we talking about faces masks, keeping meds, OTC type on hand, etc.
:munchin
This thread was started 03/18/2006 and is 39 pages long. Almost a book.
A fast read through skipping chat stuff still covers a lot of ground.
ZooKeeper
04-24-2009, 16:28
Thanks for the updates! I received this email today from corporate...
Effective immediately, employee travel to Mexico City, Mexico, is suspended until further notice. This means that absolutely no travel to Mexico City will be permitted.
In recent days, an outbreak of a flu-like virus has occurred in Mexico City. The World Health Organization (WHO) advises that several hundred people have been infected thus far, with the majority of cases being reported in central Mexico City.
Employees in Mexico City are advised to remain in Mexico--and refrain from traveling to areas of Mexico that are disease free. The Center for Disease Control recommends that personnel practice good hygiene procedures, such as frequent hand washing, respiratory etiquette, disinfection of communal areas and cleaning shared equipment between users. Sick employees are encouraged to stay home. In addition, personnel are advised to avoid locations where there are large gatherings. In particular restaurants, public transportation and commercial centers should be avoided to the extent possible. It is important that employees in Mexico City monitor the latest media reports for current updates on the virus.
So if does come to my door step up here in MD. What does one do to protect his clan?
we talking about faces masks, keeping meds, OTC type on hand, etc.
:munchin
What Pete said. RTFM. There are a host of recommendations.
I've been told, for whatever that's worth, that the genetics of the US strains indicate probable amantadine/rimantadine resistance but it's still probably susceptible to Tamiflu at this point. Recent historical analysis of the 1918 pandemic suggest that meds for secondary bacterial pneumonia would be the best prep; several of us speculated on that strategy earlier in this thread.
Since I stopped actively posting here: social distancing (hunker down, no social contact) has been modeled to be effective; the use of statins to moderate or prevent cytokine storm has been confirmed; efficacy of closing borders has been shown ineffective in pandemic modeling.
I've moved away from the vaccine research arena but I'm still in contact with several NIH and corporate researchers. A couple referenced a CDC conference call that seems to correspond with what is described here (http://scienceblogs.com/effectmeasure/2009/04/latest_on_swine_flu_from_cdc.php). One guy in on the conference call got the impression that they wouldn't try to contain this either in the US or Mexico because there are too many clusters out there for containment to work. If this is it, the horse is out of the barn. There are additional reports of Mexico City travelers sick and in isolation in Canada, China (ironic, eh?) and the US.
When I asked the question "Is this it?" no one said no. I got one rather smug "I told you H5N1 wasn't going to be the one", one "it's sure walking and quacking like a duck" and two maybes.
Thankfully the H5N1 scare has jump-started the US vaccine infrastructure. The current swine strain is already distributed as a vaccine candidate. Shows how serious they're taking this. From isolation to distribution in one week.
incarcerated
04-24-2009, 17:23
From Reuters:
http://in.reuters.com/article/worldNews/idINIndia-39236120090424
WHO calls emergency meeting on swine flu
Fri Apr 24, 2009 10:53pm IST
GENEVA (Reuters) - The World Health Organisation said on Friday it was calling an emergency committee to advise whether outbreaks of swine flu in humans in the United States and Mexico constituted an international public health threat.
A deadly strain of swine flu never seen before has broken out in Mexico, killing as many as 60 people and raising fears of a possible spread across North America.
"WHO will convene, sometime in the very near future, an emergency committee under the International Health Regulations, which will consider whether or not this event constitutes a public health event of international concern," WHO spokesman Gregory Hartl told Reuters in Geneva.
Hartl also said that 12 of 18 samples taken from victims in Mexico showed the virus had a genetic structure identical to that of a swine flu virus found in California.
But more epidemiological information was needed before any change to the WHO's pandemic alert level, currently at '3' on a scale of 1 to 6, he said.
"The technical people in our organisation are saying that before we know how pandemic a virus can be, we need to know how efficiently it is transmitting and how widespread it is," Hartl said.
From the CDC:
http://www.cdc.gov/flu/weekly/
Synopsis:
Human Infections with Swine Influenza A Virus:
On April 17, 2009, CDC and the California Department of Public Health determined that two cases of febrile respiratory illness occurring in children who reside in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus. On April 22, CDC confirmed an additional three cases of swine influenza among residents of the two counties, two adults and one adolescent. All case-patients had symptoms of ILI. Additional testing at CDC identified swine influenza A (H1N1). All five had self-limited ILI and have recovered; one required hospitalization. Two additional cases were identified from Texas and confirmed as swine influenza at CDC on April 23.
Of the five case-patients with swine influenza A (H1N1) infection from California, two are a father and daughter and other than the father-daughter, the five case-patients have no known epidemiologic link or contact with pigs. The two new case-patients from Texas are schoolmates and an epidemiologic investigation is currently underway.
The viruses from all seven cases are closely related genetically and contain a unique combination of gene segments that have not been reported in the United States or elsewhere. Viruses from 6 cases are all resistant to amantadine and rimantidine and sensitive to zanamivir and oseltamivir, and sensitivity testing is underway for the remaining virus.
Vaccination with seasonal influenza vaccine containing human influenza A (H1N1) would not be expected to provide protection against swine influenza A (H1N1) viruses.
Additional information on swine influenza is available at http://www.cdc.gov/flu/swine/index.htm
Swine Influenza (Flu)
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented. See General Information about Swine Flu.
From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States. Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California and Texas have been identified. An investigation into these cases is ongoing. For more information see Human Swine Flu Investigation.
Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who:
1. Live in San Diego County or Imperial County, California or San Antonio, Texas or
2. Have traveled to San Diego and/or Imperial County, California or San Antonio, Texas or
3. Have been in contact with ill persons from these areas in the 7 days prior to their illness onset.
If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
I was two years early on my stock market meltdown timing too; I got out in late 2006. If I ever pull another Chicken Little warning, add 2-3 years to my estimate. Oh well, like with the market I can now sit back and hope for the best, having prepared for the worst.
From Reuters:
http://in.reuters.com/article/worldNews/idINIndia-39236120090424
From the CDC:
http://www.cdc.gov/flu/weekly/
Synopsis:
Human Infections with Swine Influenza A Virus: ... Viruses from 6 cases are all resistant to amantadine and rimantidine and sensitive to zanamivir and oseltamivir, and sensitivity testing is underway for the remaining virus.
Vaccination with seasonal influenza vaccine containing human influenza A (H1N1) would not be expected to provide protection against swine influenza A (H1N1) viruses. .
Thanks, confirms what I was told. I thought my Tamiflu was useless (all H5N1 has turned Tamiflu resistant) -- maybe not. Too bad about the vaccine cross immunity.
I was at work so I guess I did the lazy thing and asked the question first. :D
I will read though it all. :munchin
Thanks
From Reuters:
http://in.reuters.com/article/worldNews/idINIndia-39236120090424
From the CDC:
http://www.cdc.gov/flu/weekly/
Synopsis:
Human Infections with Swine Influenza A Virus: ... Viruses from 6 cases are all resistant to amantadine and rimantidine and sensitive to zanamivir and oseltamivir, and sensitivity testing is underway for the remaining virus.
Vaccination with seasonal influenza vaccine containing human influenza A (H1N1) would not be expected to provide protection against swine influenza A (H1N1) viruses. .
Thanks, confirms what I was told. I thought my Tamiflu was useless (all H5N1 has turned Tamiflu resistant) -- maybe not. Too bad about the vaccine cross immunity.
I was at work so I guess I did the lazy thing and asked the question first. :D
I will read though it all. :munchin
Thanks
Well, it was a pretty good question if taken from the perspective of "What should I do if I'm working from a standing start?" Deserved a better answer.
My take on if you are starting from scratch: if this is truly the next pandemic then plan on being totally on your own. The feds have flat out stated that is the case. There's no way to help if there are 500 simultaneous Katrinas. Health services will be overwhelmed. Distribution of food, water, and civil services may be disrupted. (If this is not a pandemic, there will be one sooner or later. Work to make your community more resilient.)
1) My first prep would be to attempt to get courses of Tamiflu (antiviral), Augmentin (get the generic) and a macrolide like z pack, biaxin, or just plain old erythromycin for each member of my family. The tamiflu might blunt the flu infection and the augmentin+macrolide would be for the follow-on bacterial pneumonia that often occurs, and is often the cause of death. 2) Get the OTC meds and oral rehydration stuff for homecare detailed in the thread. 3) Lay in a 30 day supply of canned food and stuff that needs little cooking. Prepare to disinfect your drinking water. Lay in a supply of H2O, especially if you live in a dry area. Make sure you have emergency lighting for home care at night (head lights as priority). 4) Make sure you know where the vaccine distribution point is in your area. Every state has made plans for this with varying degrees of success. Make sure you have a battery powered radio to keep in touch if the power goes down 5) hand soap, disinfectant, tp, paper plates etc.
There is much speculation of supply chain collapse if the case fatality rate exceeds 2% (similar to 1918). There have been several studies that speculate on the potential of civil unrest and several state NGs have gamed scenarios where they have to protect vaccine/food/medical care distribution points. Think of the implications of that in your area.
I don't have much faith in masks/gloves/booties, although I have all three (but I didn't purchase them, sort of a gift).
There are a whole host of additional preps if you have the time. The Red Cross, www.pandemicflu.gov, and www.flutrackers.com all have 2 week, 30 day, and 90 day prep lists.
I just topped off my preps: a box of Padrons, a box of Pepin Blues, and three handles of Jack (roughing it).
Thanks..I did the fast read ..wow
AL
Watching the storms :munchin
Yes, I do think that the chair is against the wall, and probably has been for at least two weeks (oops!) based on the recent reports of cases in NYC (unconfirmed) and Kansas (confirmed). I have to assume that this virus was circulating in Mexico during the recent spring break season, so it's likely that the virus is already at a location close to you already.
Yes, I think we're at pandemic level 6 already, even as the WHO and CDC grapple with the decision to go from 3 to 4.
Yes, we should be grateful that the disease course in the US (mild) is different from that in Mexico (severe).
In the beginning stages of the Great Pandemic in 1917 there was a brief and intense "hot spot" of disease in France that burned out. Then the "first wave" of the disease was very mild and was nearly lost in the background chatter of the typical season flu. About a year later the second wave hit like a hammer. Even within the US, some cities were devastated and others only slightly touched. It's a weird disease that probably first infected the dinosaurs, and we still know very little about it.
And finally, yes we are in better shape than if this hit 3-5 years ago. The H5N1 scare has left us better prepared, both collectively and individually. Isolates have been distributed and vaccine production is already in preliminary stages. That's an amazing feat in and of itself.
Here's hoping this burns out quickly and is just another warning tremor that leaves us better prepared for when the big one does hit.
CoLawman
04-25-2009, 21:36
QUOTE=mugwump;261832
Yes, I think we're at pandemic level 6 already, even as the WHO and CDC grapple with the decision to go from 3 to 4.
Yes, we should be grateful that the disease course in the US (mild) is different from that in Mexico (severe).
Mugwump,
Any thoughts on why the difference in severity USA vs Mexico?
Second, If you think we are at level 6, then I assume you believe WHO and CDC are making the call from a political perspective. Their concerns are based on fear of further damaging Mexicos economy, air industry, fanning the immigration issue, and swamping our health facilities. ( I see there is already a run on health facilities in Mexico). No offense intended toward our esteemed epidemiologist from CDC. I am talking about the decision thought process at the top of CDC and WHO.
Just wanting your perspective.
6.8SPC_DUMP
04-25-2009, 22:26
Symptoms of influenza are:
Fever
Dry cough
Sore throat
Body aches
Headache
Chills
Fatigue
Diarrhea
Vomiting
http://www.youtube.com/watch?v=NgQizqwKHII&feature=related
CoLawman
04-25-2009, 22:30
Okay found the matrix for determination of level 6 from the link Mugwump provided.
http://www.cdphe.state.co.us/epr/Public/InternalResponsePlan/Attachment1.pdf
InTheBlack
04-26-2009, 00:58
What Pete said. RTFM. There are a host of recommendations.
I've been told, for whatever that's worth, that the genetics of the US strains indicate probable amantadine/rimantadine resistance but it's still probably susceptible to Tamiflu at this point. Recent historical analysis of the 1918 pandemic suggest that meds for secondary bacterial pneumonia would be the best prep; several of us speculated on that strategy earlier in this thread.
Please clarify - are you referring to H5N1 in general, or to this Swine Flu strain in particular, or both?
Is Tamiflu proven to be useful for this Swine Flu, or might they call for a blanket in any case?
InTheBlack
04-26-2009, 01:07
Date: Sat, 25 Apr 2009 19:07:33 -0400
From: "Clinician Outreach and Communication Activity (CDC)" <coca@CDC.GOV>
Subject: CDC Health Advisory 000281 - Investigation and Interim
Recommendations: Swine Influenza (H1N1)
Sender: CDC's Clinician's Terrorism Update Listserv
This is an official
CDC Health Advisory
Distributed via Health Alert Network
April 25, 2009, 3:00 EST (03:00 PM EDT)
CDCHAN-000281-2009-04-25-ALT-N
Investigation and Interim Recommendations:
Swine Influenza (H1N1)
CDC, in collaboration with public health officials in California and Texas, is investigating cases of febrile respiratory illness caused by swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, *8 laboratory confirmed cases of Swine Influenza infection have been confirmed in the United States. Four cases have been reported in San Diego County, California. Two cases have been reported in Imperial County California. Two cases have been reported in Guadalupe County, Texas. Of the 8 persons with available data, illness onsets occurred March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.
The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses.
CDC has also been working closely with public health officials in Mexico, Canada and the World Health Organization (WHO). Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. CDC is assisting public health authorities in Mexico by testing specimens and providing epidemiological support. As of 11:00 AM (EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested positive for the same strain of swine influenza A (H1N1) as identified in U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. WHO is monitoring international cases. Further information on international cases may be found at: <http://www.who.int/csr/don/2009_04_24/en/index.html>http://www.who.int/csr/don/2009_04_24/en/index.html
Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who 1) live in San Diego or Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.
Patients who meet these criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. CDC requests that state public health laboratories promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory.
Persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness.
CDC has not recommended that people avoid travel to affected areas at this time. Recommendations found at <http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx>http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx will help travelers reduce risk of infection and stay healthy.
Clinical guidance on laboratory safety, case definitions, infection control and information for the public are available at:<http://www.cdc.gov/swineflu/investigation.htm>http://www.cdc.gov/swineflu/investigation.htm.
Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers: <http://www.cdc.gov/swineflu/guidelines_labworkers.htm>http://www.cdc.gov/swineflu/guidelines_labworkers.htm
Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting: <http://www.cdc.gov/swineflu/guidelines_infection_control.htm>http://www.cdc.gov/swineflu/guidelines_infection_control.htm
Interim Guidance on Case Definitions for Swine Influenza A (H1N1) Human Case Investigations: http://www.cdc.gov/swineflu/casedef_swineflu.htm
Morbidity and Mortality Weekly Reports Dispatch (April 24) provide detailed information about the initial cases at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm
For more information about swine flu: <http://www.cdc.gov/swineflu>http://www.cdc.gov/swineflu
Additional information is also available by calling 1-800-CDC-INFO (1-800-232-4636)
jasonglh
04-26-2009, 01:31
I read that report earlier here at work in the CCU.
Oseltamivir (Tamiflu) or Zanamivir (Relenza) for this new Swine Variant.
Reading the WHO guidlines for their Phases it would seem to me we should be at level 4.
I'm interested to see what happens with the cases at the high school in New York. I understand the student population is 2700 so it has potential for a serious outbreak with 8 probable swine and over 100 reporting flu like symptoms.
I have been trying to find out our prep here at work but has as of yet found nothing. I suppose when it hits I will be using all my sick days at once and they can rehire me when the rest of the unit is sick and or dead.
incarcerated
04-26-2009, 02:30
http://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/index.html
Statement by WHO Director-General, Dr Margaret Chan
25 April 2009
In response to cases of swine influenza A(H1N1), reported in Mexico and the United States of America, the Director-General convened a meeting of the Emergency Committee to assess the situation and advise her on appropriate responses.
The establishment of the Committee, which is composed of international experts in a variety of disciplines, is in compliance with the International Health Regulations (2005).
The first meeting of the Emergency Committee was held on Saturday 25 April 2009.
After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses.
The Committee advised that answers to several specific questions were needed to facilitate its work.
The Committee nevertheless agreed that the current situation constitutes a public health emergency of international concern.
Based on this advice, the Director-General has determined that the current events constitute a public health emergency of international concern, under the Regulations.
Concerning public health measures, in line with the Regulations the Director-General is recommending, on the advice of the Committee, that all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.
The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3.
The situation is developing rapidly, however, at present, WHO is reluctant to raise the current phase designation above level 3.
From the Los Angeles Times:
http://www.latimes.com/features/health/la-fg-mexico-swineflu26-2009apr26,0,389929.story
Swine flu outbreak declared 'public health emergency'
By Tracy Wilkinson and Thomas H. Maugh II
April 26, 2009
Reporting from Los Angeles and Mexico City -- International officials Saturday declared the swine flu outbreak in Mexico and the U.S. a "public health emergency" as new cases were reported on both sides of the border and fears grew of a possible global epidemic....
….At the national Centers for Disease Control and Prevention in Atlanta, Dr. Anne Schuchat said the agency expected more cases and that containment was "not feasible."….
Though mentioned elsewhere in this thread, this video is a superb overview:
http://www.wilsoncenter.org/index.cfm?event_id=142787&fuseaction=topics.event_summary&topic_id=116811
Though prepared for H5N1 (Avian Flu), the information in this presentation is pertinent to H1N1 Swine Flu.
jasonglh
04-26-2009, 03:42
WHO may have to raise the level now as it has spread to New Zealand as well
This is an extremely interesting read - CAFOs and the potential for development and spread of such disease.
Richard's $.02 :munchin
Swine Flu Outbreak -- Nature Biting Back at Industrial Animal Production?
David Kirby, 25 Apr 2009
Officials from the CDC and USDA will soon arrive in Mexico to help investigate the deadly new influenza virus that managed to jump from pigs to people in a previously unseen mutated form that can readily spread among humans.
One of the first things they will want to look at are the hundreds of industrial-scale hog facilities that have sprung up around Mexico in recent years, and the thousands of people employed inside the crowded, pathogen-filled confinement buildings and processing plants.
Industry calls these massive compounds "confined animal feeding operations," or CAFOs (KAY-fohs), though most people know them simply as "factory farms." You have seen them before while flying: Long white buildings lined up in tightly packed rows of three, four or more. Within each confinement, thousands of pigs are restricted to indoor pens and grain-fed for market, while breeding sows are kept in small metal crates where they spend most of their lives pregnant or nursing piglets.
In the last several years, U.S. hog conglomerates have opened giant swine CAFOs south of the border, including dozens around Mexico City in the neighboring states of Mexico and Puebla. Smithfield Foods also reportedly operates a huge swine facility in the State of Veracruz, where the current outbreak may have originated. Many of these CAFOs raise tens of thousands of pigs at a time. Cheaper labor costs and a desire to enter the Latin American market are drawing more industrialized agriculture to Mexico all the time, wiping out smaller, traditional farms, which now account for only a small portion of swine production in Mexico.
"Classic" swine flu virus (not the novel, mutated form in the news) is considered endemic in southern Mexico, while the region around the capital is classified as an "eradication area" - meaning the disease is present, and efforts are underway to control it. For some reason, vaccination of pigs against swine flu is prohibited in this area, and growers rely instead on depopulation and restriction of animal movement when outbreaks occur.
U.S. and Mexican epidemiologists and veterinarians will surely want to take swine samples from Mexican CAFOs and examine them for the newly discovered influenza strain (No one knows exactly how long it has been in circulation). And though it is too early to know if this new virus mutated and incubated on Mexican hog CAFOs, the industrialized facilities unquestionably belong on the list of suspects.
Pigs are nature's notorious "mixing bowls" for inter-species infections, and many swine flu viruses have long contained human influenza genetic components. Then, in the late 1990's - when industrialized swine production really took off in North America - scientists were alarmed to find that avian influenza genetic material was also mixed into the continent's viral soup (see below). Fortunately, it was not the dreaded and lethal H5N1 strain, which most people know of as "bird flu."
So where did this new, virulent and highly infectious influenza emerge from? According to Mexico's Health Minister, Jose Angel Cordova, the virus "mutated from pigs, and then at some point was transmitted to humans." It sure sounds like something happened on some farm, somewhere.
For years, leading scientists around the world have worried that large-scale, indoor swine "factories" would become breeding grounds for new pathogens that could more easily infect humans and then spread out rapidly in the general population - threatening to become a global pandemic.
We know that hog workers in Europe and North America are far more likely than others to be infected with potentially lethal pathogens such as MRSA (Methicillin-resistant Staphylococcus aureus), drug-resistant E. coli and Salmonella, and of course, swine influenza. Many scientists also believe that people who work inside CAFOs are more at risk of contracting and spreading these and other "zoonotic" diseases than those working in smaller-scale operations, with outdoor pens or pasture and far lower animal density.
But until now, hog workers with swine flu have rarely gone on to infect other people, save for close family members. And that is why this new strain of swine influenza virus is so vexing - and alarming. It seems to spread quite easily through casual human contact.
This new strain making headlines and killing people contains genetic components of human flu virus, avian flu virus and - for the first time ever - two types of swine flu virus: American and Eurasian. "Such a combination of components (genes) was not found so far, neither among humans nor among pigs (as far as we know)," CDC spokesman Tom Skinner said in an email.
Nobody yet knows whether the mysterious mixing of two continents' swine flu genes is what made this outbreak so deadly, and so infectious among people, but you can bet that the world's best labs are already on the case. Another possibility is that a new and more aggressive strain of avian influenza got into the new mix as well.
How could this happen? There are several plausible explanations.
(cont'd) http://news.yahoo.com/s/huffpost/20090425/cm_huffpost/191408
The author is currently completing a new book on industrial animal production for St. Martins Press.
Mugwump,
Any thoughts on why the difference in severity USA vs Mexico?
I haven't seen anyone even speculating on this yet. The only thing I can think of is that the cases in the US might represent a "snapshot" of the virus when it was less virulent, ie the cases in the US were contracted from a version of the virus from weeks ago -- a more laid back spring break version. Maybe there's been some more recent mutation or recombination in Mexico that's made it more deadly and that strain hasn't reached here yet.
Another likely possibility is that these are just the typically mild infections that many people will get from this. There are 1300 cases in Mexico and 80 deaths. Most people don't die, or even need hospital care.
I certainly hope the figures coming out of Mexico are skewed by under reported mild cases. A 6% CFR would be catastrophic.
Second, If you think we are at level 6, then I assume you believe WHO and CDC are making the call from a political perspective. Their concerns are based on fear of further damaging Mexicos economy, air industry, fanning the immigration issue, and swamping our health facilities. ( I see there is already a run on health facilities in Mexico). No offense intended toward our esteemed epidemiologist from CDC. I am talking about the decision thought process at the top of CDC and WHO.
Just wanting your perspective.
Agree, totally political decision. Osterholm flat out said that if they don't raise the pandemic level then WHO have lost all credibility. Hell, H5N1 should be at level 4/5. This H1N1 is clearly easily transmitted.
Please clarify - are you referring to H5N1 in general, or to this Swine Flu strain in particular, or both?
Is Tamiflu proven to be useful for this Swine Flu, or might they call for a blanket in any case?
They won't blanket, a total waste of the drug. The blanket tries to contain the fire. This is in the wild already and has already spread around the world.
Tamiflu and Relenza seem useful (at least right now) in this version of H1N1 that they are calling swine flu in the press. That's a good thing, because H5N1 and the normal seasonal H1N1 are both nearly 100% resistant to the drug.
Watch Roche's (tamiflu) and Glaxo's (relenza) share prices tomorrow.
I read that report earlier here at work in the CCU.
Oseltamivir (Tamiflu) or Zanamivir (Relenza) for this new Swine Variant.
Reading the WHO guidlines for their Phases it would seem to me we should be at level 4.
We shouldbe at 5/6. Right now the virulence is in question; the transmissibility is not.
<snip>
I have been trying to find out our prep here at work but has as of yet found nothing. I suppose when it hits I will be using all my sick days at once and they can rehire me when the rest of the unit is sick and or dead.
Good luck on the prep TTPs.
This is an extremely interesting read - CAFOs and the potential for development and spread of such disease.
Richard's $.02 :munchin
Well I can't argue with the facts of this, but how does the author account for the approximately 3 pandemics per century, every century, since the beginning of recorded history? Factory farming is a recent invention. Flu is not a 'human' disease but is a zoonotic (so is bubonic plague, various poxes, most diseases). This whole shebang started when we domesticated animals and started sleeping/eating/working in close proximity. You'd probably find Guns, Germs, and Steel interesting.
I don't have a dog in the "food factory" hunt, but the PETA-leaning crowd (like Obama: "A crisis is a terrible thing to waste.") will use this crisis to further their goals. You could argue that wide distribution of protein has raised levels of nutrition so that folks are better able to fight off the inevitable pandemics. See earlier in the thread the different CFRs in India/US in 1918.
This cycle will not be broken until a "universal" flu vaccine is developed and widely distributed. Right now flu vaccines target the portion of the flu virus that rapidly mutates, meaning we have to guess which flu type to guard against each year.
It appears that the press accounts are wrong. See the reader comments in http://news.bbc.co.uk/2/hi/talking_point/8018428.stm I've selected a couple below:
"I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.
Yeny Gregorio Dávila, Mexico City"
"I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.
There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.
Antonio Chavez, Mexico City "
Direct reports suggest that the Mexican strain is Tamiflu resistant despite what the genetics indicate. There may be two swine strains co-circulating with the Mexican being more virulent. If the virulent strain is not here yet, it will inevitably arrive soon.
Deaths among doctors is ominous. They are well-fed, immunized, and receive heroic treatment efforts when they fall ill.
Statins may be your best bet. I am starting my kids on a regime now. I won't make recommendations beyond what's in this thread already. Do not PM me please.
http://news.yahoo.com/s/ap/us_swine_flu_states
The story states it's the same strain as in Mexico and lists that around 100 lids complained of flu like symptoms.
100ish symptoms, 9ish sick no deaths yet.
Is that good news or did they make a mistake on the strain? Thats the big question.
Statins may be your best bet. I am starting my kids on a regime now. I won't make recommendations beyond what's in this thread already. Do not PM me please.
You probably mentioned this somewhere in this thread, but since I didn't want to PM you to ask if you meant statins, aka cholesterol meds, I googled. Interesting.
I guess I'm "lucky" in that I'm already taking one.
http://www.medpagetoday.com/InfectiousDisease/URItheFlu/5411
Statins Linked to Lower Risk of Flu and COPD Deaths
By Michael Smith, Senior Staff Writer, MedPage Today
Published: April 10, 2007
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Earn CME/CE credit
for reading medical news
ALBUQUERQUE, N.M., April 10 -- The moderate use of statins is associated with a sharply reduced risk of death from chronic obstructive pulmonary disease, researchers here found.
Use of statins also was linked to a 40% reduced risk of death from pneumonia or flu, according to Floyd Frost, Ph.D., of the Lovelace Respiratory Research Institute here, and colleagues.
The findings were confirmed in two separate case-control studies -- one each for COPD and for pneumonia and flu -- which yielded similar risk reductions, Dr. Frost and colleagues said.
The study provided additional evidence that statins, in addition as lowering LDL levels, also can modulate the immune system -- a property that may be important in the event of a new flu pandemic, Dr. Frost and colleagues said.
The Lovelace study is "extremely valuable because it suggests that statin therapy may well be efficacious in real-world application to COPD patients and possibly for acute influenza," said John Mancini, M.D., of the University of British Columbia in Vancouver, in an accompanying editorial.
The findings provide a "compelling rationale for executing randomized clinical trials that will more clearly define the magnitude of effect and the characteristics of patients that will benefit the most," Dr. Mancini said.
The current findings come from the medical records of several health management organizations in the Albuquerque area, Dr. Frost and colleagues said.
The researchers identified 19,058 patients who each had at least 90 days of statin use from Jan. 1, 1992, to Dec. 31, 2003 -- the cases -- and matched each of them with three HMO patients who did not use statins.
Statin use was stratified into low-dose (less than 4 mg/day) and moderate-dose (4 mg/day or more).
For patients using a moderate dose of statins, a logistic regression analysis of causes of death showed that:
The risk of death from pneumonia was reduced 51%. The odds ratio was 0.49, with a 95% confidence interval from 0.26 to 0.76, which was significant at P<0.05.
The risk of death from unspecified pneumonia or flu was reduced 40%. The odds ratio was 0.60, with a 95% confidence interval from 0.26 to 0.82, which was significant at P<0.05.
The risk of death from COPD was reduced 83%. The odds ratio was 0.17, with a 95% confidence interval from 0.07 to 0.42, which was significant at P<0.05.
For the case-control studies, the researchers identified 397 HMO members who died in a hospital with a diagnosis of unspecified pneumonia or flu, as well as 54,136 people with the same diagnosis who survived. They also found 207 who died of COPD, as well as 9,622 with COPD who survived.
Patients were grouped into three age cohorts -- those born in or before 1920, from 1921 to 1945, and from 1946 to 1955 -- with the youngest group serving as a reference.
For moderate statin users analysis found that:
The risk of death from unspecified pneumonia or flu was again reduced. The odds ratio was 0.62, with a 95% confidence interval from 0.43 to 0.91, which was significant at P<0.05.
The risk of death from COPD was similarly reduced. The odds ratio was 0.19, with a 95% confidence interval from 0.08 to 0.47, which was significant at P<0.05.
Although the three studies cannot show cause and effect, Dr. Frost and colleagues said, the results "are in general agreement with prior studies" and are unlikely to be artifacts of study design.
The authors declared they had no conflicts of interest. They made no statement about sponsorship of the study.
Primary source: Chest
Source reference:
Frost FJ et al. "Influenza and COPD Mortality Protection as Pleiotropic, Dose-Dependent Effects of Statins." CHEST 2007; 131:1006-12.
http://www.cdc.gov/swineflu/whatsnew.htm?s_cid=tw_epr_68
http://news.yahoo.com/s/ap/us_swine_flu_states
The story states it's the same strain as in Mexico and lists that around 100 lids complained of flu like symptoms.
100ish symptoms, 9ish sick no deaths yet.
Is that good news or did they make a mistake on the strain? Thats the big question.
That's the $64k question right now. The tests that they are using may indicate that they are the same when there may actually be very slight differences. The only way to tell is to do a complete gene map of the US and Mexican isolates and I'm sure that's being done right now. We'll hear in the coming days is my guess. This is the kind of thing where I used to be in the loop...these guys have a 'need to know' policy of their own and I no longer need to know.
What we really have to hope for -- and this is possible -- is that the less deadly strain is the one that flourishes and those that get it have immunity from the 'bad' strain in Mexico. Then we have to get the universal flu vaccine developed and fielded so we don't get into this siuation again, at least with the flu virus.
DinDinA-2
04-26-2009, 21:13
So...here I sit in Mazatlan, with my wife, with a departure date of May 4 for Los Angeles then onto Anchorage. I am thinking that it is possible there will be many people in Mexico City exiting and going elsewhere...including here. We may be more at risk in an airplane (with the wonderful recycled air) and going through crowded customs in Los Angeles, than staying here.
However, at this stage of the situation I must consider...should I get out NOW, or not panic and remain as planned and practice exceptional hygiene. Los Angeles is probably already seeing major traffic so that remains a consideration.
In a perfect world I would just "beam" us home.
incarcerated
04-26-2009, 23:55
So...here I sit in Mazatlan, with my wife, with a departure date of May 4 for Los Angeles then onto Anchorage...
PM inbound.
A New York City school where eight cases were confirmed will be closed Monday and Tuesday, and 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week. Some schools in California and Ohio also were closing after students were found or suspected to have the flu.
MSM is reporting the common denominator in all these cases is their recent return from Spring Break trips to Mexico and that they are all recovering well. Guess they shoulda gone to Aruba. :D
Richard's $.02 :munchin
A couple of San Antonio school districts have closed their school for at least this week.
http://www.mysanantonio.com/news/local_news/Schertz-Cibolo-Universal_City_ISD_shut_this_week.html
Interested to see if they have a connection with spring break in Mexico?
Someone smarter than me dropped a note overnight...She speculates that there are two clades (sub-types) of this flu. The US version is the milder and older version and the current, more virulent, MEX version is a more recent mutation of the one circulating in the US. Same as my "snapshot" theory several posts back.
I seem to remember posting about co-circulating strains here or somewhere...
I guess logic dictates that either one could take over or they could both continue to be simultaneously transmitted. Here's hoping the mild one takes over.
The Reaper
04-27-2009, 07:18
Someone smarter than me dropped a note overnight...She speculates that there are two clades (sub-types) of this flu. The US version is the milder and older version and the current, more virulent, MEX version is a more recent mutation of the one circulating in the US. Same as my "snapshot" theory several posts back.
I seem to remember posting about co-circulating strains here or somewhere...
I guess logic dictates that either one could take over or they could both continue to be simultaneously transmitted. Here's hoping the mild one takes over.
If these two clades are that closely related, would people who have survived the milder version have any immunity toward the more serious one?
TR
Retired W4
04-27-2009, 07:40
...in an airplane (with the wonderful recycled air)
I understand your concern about being in an enclosed environment with people who could be infected with dangerous contagious diseases, but I would like to dispel the myth that the air in a pressurized aircraft is "recycled". LSS, high pressure air is tapped from the turbine engines, cooled and filtered and pumped under pressure into the pressure vessel (cabin). That air will leak out through many small imperfections (holes) in the vessel, and is also released in a controlled manner through outflow valves which maintain the correct altitude in the cabin. Air goes in, air goes out.
None of that helps to mitigate the risk of sitting next to an infected person in such close quarters. By the way, the outflow valves are normally located in the very aft portion of a fusalage. That's why they used to put the smokers in the back of the airplane, if you catch my drift.
Red Flag 1
04-27-2009, 07:42
It appears that the press accounts are wrong. See the reader comments in http://news.bbc.co.uk/2/hi/talking_point/8018428.stm I've selected a couple below:
"I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.
Yeny Gregorio Dávila, Mexico City"
"I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.
There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.
Antonio Chavez, Mexico City "
The unsaid part about medical staff is that workload is likely overwhelming. Short cuts in taking proper hand washing and other steps to limit risk can be overlooked, leaving the staff at prime risk. With co-workers opting out, the demands on the remaining staff spirals up. Fatigue also becomes a factor in attention to detail tasks as well as hampering immune response.
If there are two seprate mutations to this flu, I don't think exposure to one would necessarly provide protection from the other.
My $.02.
RF 1
If these two clades are that closely related, would people who have survived the milder version have any immunity toward the more serious one?
TR
My educated guess is yes. They are so similar that they appear identical to pretty sophisticated tests. The outside capsule of the virus (the binding sites) are what these tests look at and are what your immune system recognizes as well. If there are two versions (and we don't know if that is truly the case) the difference may be in the expression of viral proteins that influence the cytokine storm (where your immune system goes into overdrive and kills you). So they look the same but act differently.
So yes, if you catch it now you may be one of the lucky ones. So many unknowns.
If there are two seprate mutations to this flu, I don't think exposure to one would necessarly provide protection from the other.
My $.02.
RF 1
My only argument against this is that in testing they can't see a difference via PCR testing, which suggests the viral coat is identical at this stage. So infection with one would likely render immunity to the other for these two clades. But nothing says a third clade couldn't form that renders the immunity moot. Flu viruses reassemble in the wild and mutate as they replicate. It's what makes them so dangerous.
Note that in the 1918 pandemic some people were infected in the second wave and then again in the final third wave. But those waves were almost a year apart and the virus had most likely mutated enough to escape recognition by the immune system.
We don't even know what is causing the difference in severity or if there are even two clades. I'm wild-ass guessing so I should probably stop here...
Thanks for the insight.
AL
InTheBlack
04-27-2009, 08:06
Real time map of cases as they are declared by WHO:
http://gizmodo.com/5229314/follow-the-deadly-swine-flu-pandemic-in-real-time-with-google-maps
Red Flag 1
04-27-2009, 08:13
My only argument against this is that in testing they can't see a difference via PCR testing, which suggests the viral coat is identical at this stage. So infection with one would likely render immunity to the other for these two clades. But nothing says a third clade couldn't form that renders the immunity moot. Flu viruses reassemble in the wild and mutate as they replicate. It's what makes them so dangerous.
Note that in the 1918 pandemic some people were infected in the second wave and then again in the final third wave. But those waves were almost a year apart and the virus had most likely mutated enough to escape recognition by the immune system.
We don't even know what is causing the difference in severity or if there are even two clades. I'm wild-ass guessing so I should probably stop here...
Thanks mugwump!
RF 1
The Reaper
04-27-2009, 08:19
I understand your concern about being in an enclosed environment with people who could be infected with dangerous contagious diseases, but I would like to dispel the myth that the air in a pressurized aircraft is "recycled". LSS, high pressure air is tapped from the turbine engines, cooled and filtered and pumped under pressure into the pressure vessel (cabin). That air will leak out through many small imperfections (holes) in the vessel, and is also released in a controlled manner through outflow valves which maintain the correct altitude in the cabin. Air goes in, air goes out.
None of that helps to mitigate the risk of sitting next to an infected person in such close quarters. By the way, the outflow valves are normally located in the very aft portion of a fusalage. That's why they used to put the smokers in the back of the airplane, if you catch my drift.
Negative.
That is how the plane air is pressurized and pressure maintained.
Because of the additional fuel required to pressurize the cabin air, civilian aircraft are allowed to recirculate cabin air (as much as 80%) to reduce the engine load.
The air is filtered, ostensibly by up to HEPA filters that can even catch virii, but if you are sitting beside a person with a cough, sneeze, etc., or touch an armrest, seatback tray, etc., you are potentially being exposed to whatever bug they are carrying, regardless of the filtration or recirc.
http://www.scientificjournals.com/sj/espr/Pdf/aId/2518
TR
Retired W4
04-27-2009, 09:15
That is an interesting article, and I don't propose to know the systems of all commercial aircraft. I guess in these times, one would be lucky to be booked on an aircraft in the 50% of the fleet (as stated in the linked article) that does not recirculate some of the air. Quoting from the article; "Supporting these recommendations are data relating to the nominal air exchange rates and ventilation capacities of some representative aircraft passenger cabins are presented. This, and the statistical data relating to air quality may be useful flight selection features for prospective aircraft passengers." When I fly commercially I concider the equipment I will be boarding and the record of the carrier, and other parameters. When traveling in an area, or during the time of an outbreak such as we have now, people might well concider the above quote. Sometimes the cheapest ticket is not the best ride.
SCG International just reported the Mexican US Embassy has been closed for the rest of the week.
(Sorry, lost the link for info)
If anyone sees an explanation of the difference in severity between the US and MEX cases please post it here. I don't think I'll hear from anyone actually working on this stuff for quite a while.
Retired W4
04-27-2009, 09:45
Contained here is some more information for the concerned travelers or potential travelers during this outbreak. Scroll down to the paragraph titled Aircraft Environmental Control Systems. No offence, but it might be a little more down to earth than ivory tower statistical analysis.
http://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/media/Section%20II.4.1%20Airline%20Operations.doc
I have to get back to work and make a living, but from my cursory look today there are more cases being reported in MEX but not a logarithimic increase. Maybe this is burning itself out.
InTheBlack
04-27-2009, 12:28
FYI. I subscribe to this listserve but I'm a biologist not a medical person:
Date: Mon, 27 Apr 2009 11:01:38 -0400
From: "Clinician Outreach and Communication Activity (CDC)" <coca@CDC.GOV>
Subject: CDC Updates for Clinicians: Swine Influenza A (H1N1)
Sender: CDC's Clinician's Terrorism Update Listserv
<CDC-CLINICIANTERRORISMANDEMERGRESPUPDATES@LISTSERV.CDC .GOV>
April 27, 2009
This edition of the CDC Update for Clinicians provides specific information on the ongoing CDC investigation on Swine Influenza A (H1N1). *A COCA Update will be sent tomorrow addressing all other topics. If you have any questions on these or other clinical issues, please write to us at <mailto:coca@cdc.gov>coca@cdc.gov.
If you have received this update from a colleague and would like to subscribe to the listserve, please visit <http://emergency.cdc.gov/clinregistry/>http://emergency.cdc.gov/clinregistry/.
Today's topics Include:
<#1>COCA Conference Call
<#2>Swine Influenza A (H1N1)
<http://emergency.cdc.gov/rss/>Subscribe to RSS
<http://twitter.com/cdcemergency>Follow CDCEmergency on Twitter
COCA Conference Call - TODAY at 2:00PM ET
TITLE:*Swine Influenza Investigation Update
SPEAKER: Timothy Uyeki, MD MPH MPP
DATE: TODAY!!! Monday, April 27, 2009
TIME: 2:00 - 3:00 PM ET
CALL-IN NUMBER: 888-283-2960
PASSCODE: 1360172
There will be no PowerPoint Presentation for this call and no Continuing Education Credits/Contact Hours available.
This COCA call will also be available via listen-only audio web site at <http://www.emergency.cdc.gov/coca/callinfo.asp>http://www.emergency.cdc.gov/coca/callinfo.asp.
When feasible please call in as groups to allow as many people as possible to listen to the call. If you do not get through on your first attempt please call back and try again. The audio recording of the call should be posted to our website a couple of hours after the call has ended."
Swine Influenza A (H1N1)
As of 9:00 AM on April 26, 2009 CDC has confirmed 20 human cases of Swine Influenza in the U.S. Investigations and surveillance are ongoing. As this situation unfolds, the Centers for Disease Control and Prevention (CDC) is committed to providing information to its partners, so that you can stay informed and communicate accurate information about this viral illness to your constituents.
General Information
Swine Flu and You Apr 26, 2009 6:45 PM EDT
Swine Flu Video Podcast Apr 25, 2009
Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM EDT
Swine Influenza in Pigs and People
Brochure
Información en español
<http://www.cdc.gov/swineflu/general_info.htm>http://www.cdc.gov/swineflu/general_info.htm
Press Briefing
Transcript - CDC Media Availability on Human Swine Influenza Cases
<http://www.cdc.gov/media/transcripts/2009/t090426.htm>http://www.cdc.gov/media/transcripts/2009/t090426.htm
Health Advisory (HAN)
CDC Health Advisory Investigation and Interim Recommendations: Swine Influenza (H1N1)
PDF - <http://www.cdc.gov/swineflu/pdf/HAN_042509.pdf>http://www.cdc.gov/swineflu/pdf/HAN_042509.pdf
Swine Influenza A (H1N1) Update: New Interim Recommendations and Guidance for Health Directors about Strategic National Stockpile Materiel
<http://www.cdc.gov/swineflu/HAN/042609.htm>http://www.cdc.gov/swineflu/HAN/042609.htm
Guidance Documents
To assist you in your efforts, please see the following set of materials and resources:
Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected - April 26, 2009
<http://www.cdc.gov/swineflu/masks.htm>http://www.cdc.gov/swineflu/masks.htm
Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers Apr 24, 2009
This guidance is for laboratory workers who may be processing or performing diagnostic testing on clinical specimens from patients with suspected swine influenza A (H1N1) virus infection, or performing viral isolation.
<http://www.cdc.gov/swineflu/guidelines_labworkers.htm>http://www.cdc.gov/swineflu/guidelines_labworkers.htm
Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus
<http://www.cdc.gov/swineflu/mitigation.htm>http://www.cdc.gov/swineflu/mitigation.htm
Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A (H1N1) Cases - April 26, 2009
<http://www.cdc.gov/swineflu/casedef_swineflu.htm>http://www.cdc.gov/swineflu/casedef_swineflu.htm
Risk of Swine Flu Associated with Travel to Affected Areas - April 26, 2009
<http://wwwn.cdc.gov/travel/contentSwineFluTravel.aspx>http://wwwn.cdc.gov/travel/contentSwineFluTravel.aspx
Travel Notices
Risk of Swine Flu Associated with Travel to Affected Areas - April 26, 2009
<http://wwwn.cdc.gov/travel/contentSwineFluTravel.aspx>http://wwwn.cdc.gov/travel/contentSwineFluTravel.aspx
Outbreak Notice: Swine Influenza in the United States - April 25, 2009
<http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx>http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx
Travel Health Precaution: Swine Influenza and Severe Cases of Respiratory Illness in Mexico - April 25, 2009
<http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx>http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx
jasonglh
04-27-2009, 15:24
http://news.yahoo.com/s/ap/20090427/ap_on_re_la_am_ca/lt_swine_flu_mexico;_ylt=AlQrpLtGyZEjED1pTMN_NubVJ RIF
WHO said the new phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country, signaling a significant increase in the risk of a global epidemic, according to Mexico health department spokesman Carlos Olmos. Phase 4 doesn't mean a pandemic is inevitable, but many experts think it may be impossible to contain a flu virus already spreading in several countries.
That Google map is popping now.
jasonglh
04-27-2009, 16:09
The blue ones are usually 3M N95 (http://multimedia.3m.com/mws/mediawebserver?_____BbGSLn9tEAaveOaVFA_mcbymLbGPc0 _mc0_m______--) that we wear for airborne precautions like TB
@ mugwump:
Quick piece of advice, please. The wife and two small boys (3 1/2 and 1 year) were planning on going to San Diego at the end of the week. Should I advise they cancel? I have to go to drill and will be out of town in the opposite direction...
Patriot007
04-27-2009, 17:47
So on the news, they show people wearing these blue face masks because of the flu, however, do those really offer any protection? I would think only something like a gas mask would actually stop a flu bug....?
Remember, the virus doesn't spread from the body without a medium. The masks are intended to block inhalation of the aerosoled respiratory droplets from the coughing and breathing of infected individuals.
In a quick literature search the most recent data I could find on masks for protection from respiratory viruses yielded this study, Jan 2008:
Source: "Physical Interventions to interrupt or reduce the spread of respiratory viruses" http://www.ncbi.nlm.nih.gov/pubmed/18042961?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus
Here is the synopsis: Studies suggest frequent hand washing good (>10 times daily), surgical masks good, N95 masks may be better than surgical masks.
Me, I've gone with the N95.
incarcerated
04-27-2009, 23:54
Today (Monday) between 11:00 A.M. and 12:30 P.M. Pacific Time, our medical supply vendor’s (which happens to be a large national concern, and a Fortune 20 company) district warehouse went from 69 boxes in stock of a popular, medium size N95 mask, to a stock level of minus 220. N95 masks made by Technol, 3M, Inovel, and Kimberly Clark were out of stock in normal sizes (extra-small was still available in limited quantities) by 1:00 P.M.
InTheBlack
04-28-2009, 01:07
Hardware stores have P95 masks. Usually they are the more expensive version that is cup shaped & may have a valve. About twice as expensive as the flat surgical type. IMO worth it for comfort & a better facial seal.
@ mugwump:
Quick piece of advice, please. The wife and two small boys (3 1/2 and 1 year) were planning on going to San Diego at the end of the week. Should I advise they cancel? I have to go to drill and will be out of town in the opposite direction...
Sorry, just saw this Retread.
I don't know how to advise you. My son is flying to training this weekend and I am not horribly concerned. As Patriot007 summarized, frequent hand washing -- get small bottles of hand sanitizer less than 3 oz for TSA -- is the way to go. Horrible to think of, I know, but your wife is more at risk than the kids with this type of flu. That said, the mild nature of the US infections is very reassuring.
This is starting to feel more and more like a 'first wave' scenario. We are not seeing a geometric increase in cases as you do when a pandemic is really blazing through the population. I'm starting to think winter '09/'10 is going to be the bad time.
I've talked to a couple of people much smarter than me and it's apparent that nobody knows anything. In fact, it's pretty apparent that they don't even know what they don't know -- Rumsfeld's "unknown unknowns". They don't know the Ro (transmission rate), the CFR, mortality rate, why there's a difference in virulence between MEX and the rest of the world, etc.
They state what they don't know in a very authoritative way, so it's easy to be fooled. But they are arguing whether this is a first wave, whether there's a co-circulating strain in MEX we haven't seen here yet, if a vaccine can be produced in time for a second wave, if there will be a second or third wave, whether this represents a pandemic at all, and if the sun is currently in the sky.
Finally, it seems there have been a lot of eyeballs on this thread lately. The regulars know this but I just want to make it clear to new readers: I am just an interested amateur and not an authority on this stuff. Any advice I've given on travel etc. is just a WAG. I answered a recent "should they travel" question because I had skin in the game but I'm totally unqualified otherwise. I honestly don't know if people should fly, wear masks, start hunkering down, etc.
Huh. As a perfect example, I just got an email from a guy saying I'm FOS regarding this wave burning out and he says that there's historical precedence for strong summer pandemic waves. Then he goes on to say that I might be right after all.
So...I'm going to back away from this rather than contribute further to the blather ("infodemic"). Definitive answers to the above questions will come in due time, and the MSM is interested enough at this point to get the information out. If I see anything that I think is BS or being missed I'll add a post.
incarcerated
04-28-2009, 08:45
http://www.stratfor.com
Mexico's Flu Mortality Rate
April 28, 2009 | 0154 GMT
STRATFOR continued to monitor the spread and effects of the so-called “swine flu” Monday, as the World Health Organization raised its pandemic alert level from 3 to 4 (6 is the level for a full-blown pandemic). While many things have become clearer, there are a number of questions that remain unanswered. First and foremost among them is: Why have deaths from this outbreak been limited to Mexico?
Mexico faces obvious challenges from its infrastructure, including accessibility of health care and availability of water in Mexico City (water has recently been cut off completely for days at a time for much of the Mexican capital). However, the Mexican government has organized a formidable response to the outbreak and has substantial resources at its disposal. In short, infrastructural challenges do not offer satisfactory explanations for the fact that so many people have died in Mexico in such a short time span, while no deaths have yet been reported in other countries.
As the apparent location of first infection, Mexico was at a serious informational disadvantage in combating the virus. The disease was first noted as early as February in Mexico, but at the time there was no reason to suspect that it was anything other than an isolated, severe case of the normal flu. Mexican health officials attributed an increase in respiratory infections in mid- to late March to seasonal weather changes.
It has become clear that the majority of individuals who have been hospitalized in Mexico arrived at the hospital with pneumonia, which is a common complication of the flu and is caused by a bacterial infection of the lungs. That the hospitalized Mexican patients were already suffering from complications leads us to some very tentative conclusions.
First, individuals who arrive at the hospital with pneumonia certainly do not qualify as cases of “early detection.” This makes it much more likely that the cases that are appearing in the Mexican health system will result in fatalities. Second, Mexico’s method of testing individuals has focused on patients who have been hospitalized, and thus individuals who are testing positive for the new flu strain are already much more susceptible to severe complications and death. Finally, because Mexico has had time to internalize the effect of the disease, there has been a great deal of back-checking on the records — including plans to exhume the bodies of suspected swine flu victims from February — which allows for post-hoc discovery of flu victims.
In contrast to the Mexican testing protocols, STRATFOR medical contacts have advised that the United States has been testing patients who are still ambulatory (and seems to be trending toward testing those with risk factors such as having recently traveled to Mexico). This means that the patients are more likely to receive proper medical care and recover. It also means that the United States has not necessarily been in a position to identify cases of the new virus that have already caused individuals to be hospitalized; instead, medical professionals might have assumed that the disease was simply a bad case of the seasonal flu.
The distinction between the two different testing methods means is that there is no way to clearly assess how many people have been infected, and thus impossible to gauge the rate of mortality associated with this new strain of the flu with any certainty….
It’s possible that enough time has not passed in the United States and elsewhere for the flu to have its full effect. Additionally, according to the Centers for Disease Control and Prevention (CDC), the median age for infection in the United States is 16. Because younger people appear to be recovering from this disease more quickly than older people, the low median age for the United States could result in faster apparent U.S. recovery rates.
Very little is known about the nature of this virus. Until the health officials at the CDC have finished their analysis, there is no real way to even know if it is a single disease that we are dealing with, or if sufficient mutations have taken effect to mitigate the effects of the disease on populations outside Mexico.
There is still the distinct possibility that mortality rates could increase outside Mexico, or perhaps that the early warning from Mexico will be sufficient for the global medical community, allowing for an effective response. At present, however, the aggregate knowledge that passes as situational awareness on this topic is mercurial at best, and the medical community is making educated guesses. This issue is outside of STRATFOR’s expertise, but we will continue to watch the situation as it evolves, including the outbreak’s effects on global markets, which were shaky enough to begin with.
I have no idea who Greg is but there are two family trees (?) for the flu bug.
http://www.gregcontreras.us/
Over my head.
The Reaper
04-28-2009, 09:07
Huh. As a perfect example, I just got an email from a guy saying I'm FOS regarding this wave burning out and he says that there's historical precedence for strong summer pandemic waves. Then he goes on to say that I might be right after all.
So...I'm going to back away from this rather than contribute further to the blather ("infodemic"). Definitive answers to the above questions will come in due time, and the MSM is interested enough at this point to get the information out. If I see anything that I think is BS or being missed I'll add a post.
Not sure if that email was from a member here. Having said that, let me provide a little guidance for exchanges.
Professional discussions and disagreement on PS.com are tolerated and in most cases, encouraged.
Telling someone who is knowledgable and trying to contribute that they are FOS, in an email, PM, or publicly, will lead to some unfortunate consequences.
We do not need posters here who would take that tone with another contributing member.
mugwump, feel free to let me know if someone is participating in namecalling, personal attacks, or is becoming abusive.
As anyone who has been on a military jump goes, there are sometimes a lot of racetracks and standing in the door before the JM releases you. False alarms are a way of life, and I would rather get ready a few times without exiting and get the opportunity to check my gear rather than hear the one long ring on the alarm bell, if you get my drift.
Thanks for your comments and insight, BTW.
TR
6.8SPC_DUMP
04-28-2009, 10:02
I hospitalized my mother yesterday (45 min north of NYC) with disorientation, exhaustion, dehydration and low blood pressure do to a virus that gave her severe vomiting and diarrhea. She was put on a liquid diet w/ a fluid and potassium IV injection. She sounds fine on the phone aside from not thinking clearly.
She got it from me on Sat when I showed up briefly for a BBQ w/ old friends of the family. Surprisingly I didn't pass it to my GF who I was with twice in the last week but I'm staying clear of now.
I started having mild diarrhea and vomiting about a week ago (IIRC). My symptoms are currently mild to moderate forms of: fatigue, weakness, coughing and repertory congestion for which I'm on an antibiotic (Azithromycin). It's odd b/c the symptoms seem to come and go, but make me feel "really out of it" the whole time and also not feeling well after eating meat. I'm "kind of spacy" and with a feeling of "water in the brain", some of the time, if that makes sense.
I don't want to be an alarmist to anyone and I'm 99% sure we will both be fine. But it does seem odd b/c my mom has never been hospitalized for a flu and this is the first time that I have felt ill for more than 24 hours (aside from food poisoning) since HS (I'm 28 now).
P.S - Thanks for taking the time to write here Mugwump.
UPDATE:
she was negitive for tests on Flu A and Flu B. The Dr. said it is an undetermined virus. At home and feeling better.
Mugwump,
Thanks for your time and effort that you have contributed for quite some time here at PS, please keep the information coming. There are a bunch of folks here who appreciate your input, anyone who does not can take a quick hike.
S/F
Stan
Mugwump:
Tango Yankee.
My wife has decided to go to the Grand Canyon instead. We figured that exercising caution until we found out what this thing is doing was the best course of action. We live 6 hours from 'Diego and can go anytime.
Interesting article on vitamin D deficiency and influenza.
Epidemic Influenza and Vitamin D Deficiency. (http://www.medicalnewstoday.com/articles/51913.php)
Any thoughts? Some interesting points being brought up...
I've talked to a couple of people much smarter than me and it's apparent that nobody knows anything. In fact, it's pretty apparent that they don't even know what they don't know -- Rumsfeld's "unknown unknowns". They don't know the Ro (transmission rate), the CFR, mortality rate, why there's a difference in virulence between MEX and the rest of the world, etc.
They state what they don't know in a very authoritative way, so it's easy to be fooled. But they are arguing whether this is a first wave, whether there's a co-circulating strain in MEX we haven't seen here yet, if a vaccine can be produced in time for a second wave, if there will be a second or third wave, whether this represents a pandemic at all, and if the sun is currently in the sky.
Finally, it seems there have been a lot of eyeballs on this thread lately. The regulars know this but I just want to make it clear to new readers: I am just an interested amateur and not an authority on this stuff. Any advice I've given on travel etc. is just a WAG. I answered a recent "should they travel" question because I had skin in the game but I'm totally unqualified otherwise. I honestly don't know if people should fly, wear masks, start hunkering down, etc.
Huh. As a perfect example, I just got an email from a guy saying I'm FOS regarding this wave burning out and he says that there's historical precedence for strong summer pandemic waves. Then he goes on to say that I might be right after all.
So...I'm going to back away from this rather than contribute further to the blather ("infodemic"). Definitive answers to the above questions will come in due time, and the MSM is interested enough at this point to get the information out. If I see anything that I think is BS or being missed I'll add a post.
Mugwump,
I can only speak for myself. I have looked forward to your posts on this subject. You have knowledge and perspective that can benifit many others. I become more educated with each of your posts.
Please continue.
abc
I'm flying to Scotland on Saturday.
FWIW - although I was exposed to it annually, I never had the flu while growing up - I've had the flu one time in my life - the result of a weakened live virus injection by the Army when I was drafted - wiped me out for 72 hours - never took another flu vaccination and have never had the flu since.
My latest annual wellness test gave me an overall "1" - the only negative on my report was a 'mention' for me being slightly overweight (230#) for my height (6'5").
I guess I'm a case study for the theory of natural selection.
Richard's $.02 :munchin
Peregrino
04-28-2009, 20:33
My latest annual wellness test gave me an overall "1" - the only negative on my report was a 'mention' for me being slightly overweight (230#) for my height 6'5".
Richard's $.02 :munchin
In case your doctor hasn't kept up with the news - Pritikin is DEAD. IIRC he starved. 6'5" and 230#s is a little light. Heck, that's not enough meat to play basketball today, let alone football. :p
Mugwump,
I echo abc_123 and offer that many of us have not only learned from your posts over the years, but prepared for the possibility as well. While people are scrambling to find N95 masks, I’ve got enough to supply my family and my neighbors.
I regret that I didn’t heed your statin advice. I’m borderline in needing cholesterol meds and my doc keeps offering them. I should probably have opted for them just as a flu precaution.
Salute!
Pat
ZooKeeper
04-28-2009, 21:04
Interesting article on vitamin D deficiency and influenza.
Epidemic Influenza and Vitamin D Deficiency. (http://www.medicalnewstoday.com/articles/51913.php)
Any thoughts? Some interesting points being brought up...
Interesting...maybe I will start taking an extra spoon full of Cod Liver Oil just in case.
ZonieDiver
04-28-2009, 21:20
I guess I'm a case study for the theory of natural selection.
Well... with your current avatar, wouldn't it be "natural selection" in reverse? :)
jasonglh
04-28-2009, 21:24
Interesting article on vitamin D deficiency and influenza.
Epidemic Influenza and Vitamin D Deficiency. (http://www.medicalnewstoday.com/articles/51913.php)
Any thoughts? Some interesting points being brought up...
Looks like some of his ideas were recently backed up with research.
Vitamin D deficiency linked to more colds and flu (http://www.sciam.com/blog/60-second-science/post.cfm?id=vitamin-d-deficiency-linked-to-more-2009-02-23)
InTheBlack
04-28-2009, 23:02
This is an opportunity to do a "real time" drill...
Can anyone point me to instructions for calculating the actual number of cases of flu in a defined "local" geographic area given the number of confirmed cases?
And where can one find the data to plug into that equation, on the net, in real time, when something is happening? Realizing that much is estimation; you can still bracket it.
nicc8268
04-29-2009, 04:14
Here is an article that really goes in depth with this topic. It makes some excellent points and is well worth the read. It is unfortunate that this article ,and this Doctor will not make it to the mainstream media. He is top notch when it comes to anything regarding health.
http://articles.mercola.com/sites/articles/archive/2009/04/29/Swine-Flu.aspx
Red Flag 1
04-29-2009, 09:14
I've talked to a couple of people much smarter than me and it's apparent that nobody knows anything. In fact, it's pretty apparent that they don't even know what they don't know -- Rumsfeld's "unknown unknowns". They don't know the Ro (transmission rate), the CFR, mortality rate, why there's a difference in virulence between MEX and the rest of the world, etc.
They state what they don't know in a very authoritative way, so it's easy to be fooled. But they are arguing whether this is a first wave, whether there's a co-circulating strain in MEX we haven't seen here yet, if a vaccine can be produced in time for a second wave, if there will be a second or third wave, whether this represents a pandemic at all, and if the sun is currently in the sky.
Finally, it seems there have been a lot of eyeballs on this thread lately. The regulars know this but I just want to make it clear to new readers: I am just an interested amateur and not an authority on this stuff. Any advice I've given on travel etc. is just a WAG. I answered a recent "should they travel" question because I had skin in the game but I'm totally unqualified otherwise. I honestly don't know if people should fly, wear masks, start hunkering down, etc.
Huh. As a perfect example, I just got an email from a guy saying I'm FOS regarding this wave burning out and he says that there's historical precedence for strong summer pandemic waves. Then he goes on to say that I might be right after all.
So...I'm going to back away from this rather than contribute further to the blather ("infodemic"). Definitive answers to the above questions will come in due time, and the MSM is interested enough at this point to get the information out. If I see anything that I think is BS or being missed I'll add a post.
Mugwump,
Please keep us posted. I personally feel you are providing the best insight to be found regarding this flu!!
Thank you for your posts!!!
RF 1
CoLawman
04-29-2009, 09:28
This might be encouraging.
http://www.theage.com.au/national/who-says-only-seven-confirmed-swine-flu-deaths-20090429-amlk.html
InTheBlack
04-29-2009, 10:28
The noon news showed a Government person saying "we are preparing as if it were a pandemic."
Shocking words.
As a precautionary measure, Texas just announced they've cancelled all scholastic athletic and academic competitions until further notice.
Richard's $.02 :munchin
temsmedic
04-29-2009, 13:37
We have a disease that sweeps across the US infecting 25-50 million citizens, and kills 30-40k. This happens EVERY year [seasonal influenza]. H1N1 doesn't seem to have the lethality [at this time] to get overy concerned [those reports from Mexico can't be verified].
I look at this as a wake-up call, and a good test of our system in case something really nasty like H5N1 [Bird] flu acquires good human-human transmission. H5N1 has, as of 4/23, killed 61% of those we know to be infected [actual lethality much lower since we aren't capturing the full denominator in the data].
I still have a stash of Tamiflu/Relenza/masks/respirators/alcohol gel in case it's needed. In addition, we've got enough food that we could not leave the house except to go to the lake to get water in case we need to completely isolate [I'd sleep in a tent since I can't avoid the hospital]. FYI, Relenza is about $20 cheaper per course of therapy than Tamiflu. Influenza A this year was resistant to Tamiflu though, so new viruses can pick up that gene pretty easily, since it is so wide-spread.
Yesterday, Fox News stated that two deaths in Caliornia (one on April 22) are believed to be swine flu related but autopsies are still ongoing. (Have not heard anything new thus far).
Today, it was confirmed that the 22 month old visiting Mexican boy died in Houston of swine flu. His family is not showing signs of infection; however, it was said that the little boy was sick when he came to the US on April 7th.
TODAY at 1607 EST, W.H.O. has now raised the pandemic threat level to 5 (6 beng the highest).
Let's hope that good sense, proper actions and good medical help prevails.
Snaquebite
04-29-2009, 14:55
Here's an information paper my parent company released today. while not a medical company, they make probably the best respirators and SCBA products around.
Info Paper
incarcerated
04-29-2009, 16:25
Yesterday, Fox News stated that two deaths in Caliornia (one on April 22) are believed to be swine flu related but autopsies are still ongoing. (Have not heard anything new thus far).
.
Today from VOA:
http://www.voanews.com/english/2009-04-28-voa40.cfm
…. The Los Angeles Times says the local coroner's office has concluded that two flu-related deaths in the Los Angeles area do not appear to be linked to swine flu….
This also:
http://uk.reuters.com/article/topNews/idUKTRE53S8JY20090429
California Marine has swine flu; 30 quarantined
Wed Apr 29, 2009 10:56pm BST
LOS ANGELES (Reuters) - About 30 U.S. Marines on a Southern California military base, the nation's largest, have been quarantined after one of them was confirmed to have contracted the swine flu virus, the Marine Corps said on Wednesday.
The case was identified at the Twentynine Palms Marine Corps Air Ground Combat Centre and was confirmed by the U.S. Centres for Disease Control, the base said in a statement.
InTheBlack
04-29-2009, 18:41
HiB vaccine is not on the recommended list for adults.
Can someone direct me to a military document outlining why it is administered & what the dosage/schedule is?
AFAIK one dose is used on adults vs a course of 3 pediatric, but I can find no data on whether it is a different amount or just one dose of the pediatric.
HiB is still in short supply, and convincing them to give it to an adult may be difficult.
HiB is often mixed with some other pediatrics; is there anything in the others generally contraindicated for adults?
temsmedic
04-29-2009, 18:47
Here's an information paper my parent company released today. while not a medical company, they make probably the best respirators and SCBA products around.
Info Paper
Since you work for that company, I'd like to see what your thoughts are on using something like the 3M Half Facepiece respirator. I strongly suspect that any of the standard hospital type masks, within minutes, are so saturated with water that the only way anyone inhales is from around the sides of the mask. The tiny exhalation port on some of the masks is so small, I suspect it isn't much better.
http://solutions.3m.com/wps/portal/3M/en_US/Health/Safety/Products/Catalog/?PC_7_RJH9U5230GE3E02LES9MG812H2_nid=F2K7PDDKMJbeF 3RH7CD92Ngl
These masks aren't certified for medical use, but if they fit well, I suspect that they are probably better than a saturated mask. They would certainly be more likely to be used. They may also still be found locally.
Also, it is important to remember that you'll need some dorky safety glasses. If the virus containing particle hits the mucous membranes of the eye, you'll be infected also.
Snaquebite
04-29-2009, 19:28
I work for the Ballistics side of the house for MSA (Paraclete) so can't offer up much on your question. I did forward it to one of our reps in that department.
incarcerated
04-29-2009, 19:49
Since you work for that company, I'd like to see what your thoughts are on using something like the 3M Half Facepiece respirator. I strongly suspect that any of the standard hospital type masks, within minutes, are so saturated with water that the only way anyone inhales is from around the sides of the mask. The tiny exhalation port on some of the masks is so small, I suspect it isn't much better.
http://solutions.3m.com/wps/portal/3M/en_US/Health/Safety/Products/Catalog/?PC_7_RJH9U5230GE3E02LES9MG812H2_nid=F2K7PDDKMJbeF 3RH7CD92Ngl
These masks aren't certified for medical use, but if they fit well, I suspect that they are probably better than a saturated mask. They would certainly be more likely to be used. They may also still be found locally.
Also, it is important to remember that you'll need some dorky safety glasses. If the virus containing particle hits the mucous membranes of the eye, you'll be infected also.
temsmedic,
our mfgr training on N95s was that they have a two hour working life in mild environments before saturation. A P100 or half face mask w/ replaceable cartridges will provide a much better fit and seal to the face, while filtering to 99.5%, rather than the N95's 95% filtration performance. The P100s were rated for a six hour working life in a mild environment. IMHO, the N95's chief virtue is that it is cheap. OTOH, an N95 is better than nothing.
Procedure masks (and those things that you see the people in Mexico wearing), of course, are intended for the containment of droplets and particles emitted from an infected wearer, not for filtration.
Local news is carrying that there are 6 cases that are suspected to be swine flu, where ID'ed here in Maryland. All 6 cases the person(s) went to Mexico, or have contact with someone that was in Mexico. All are at home recovering.
:munchin
Are the daily reported case on the decrease in Mexico?
AL
www.FOXBALTIMORE.COM
They've traced the origins of this to a kid in Mexico - he's doing fine - it'll be interesting to see what they eventually find out.
I'm surprised the Goracle crowd hasn't been on the air claiming it's all due to global warming or some such thing. :rolleyes:
Richard's $.02 :munchin
Peregrino
04-29-2009, 20:17
Procedure masks (and those things that you see the people in Mexico wearing), of course, are intended for the containment of droplets and particles emitted from an infected wearer, not for filtration.
Thanks for reiterating this point - it's something the average "consumer" looking for the cheapest alternative either doesn't know or ignores because it's "just a precaution". I haven't checked lately (already got mine!) but I've found http://www.safetycompany.com/index.php to be a good company to deal with for other "safety" supplies. Personally, I got my last batch of N95 masks from Lowe's; AO Safety is OTC, reliable and the convenience/instant gratification plus not paying S&H made up for the price difference.
temsmedic
04-29-2009, 20:17
HiB vaccine is not on the recommended list for adults.
Can someone direct me to a military document outlining why it is administered & what the dosage/schedule is?
AFAIK one dose is used on adults vs a course of 3 pediatric, but I can find no data on whether it is a different amount or just one dose of the pediatric.
HiB is still in short supply, and convincing them to give it to an adult may be difficult.
HiB is often mixed with some other pediatrics; is there anything in the others generally contraindicated for adults?
Haemophilus influenzae type b (Hib) is predominantly a disease of children. I don't believe that the Hib vaccine has any place in pandemic preparedness for adults.
A substantial portion of those that died from the 1918-19 pandemic died from bacterial infection, after their lungs were damaged by the virus, and the secondary "immune storm" that is believed to have led to the death of so many young patients. I DO believe that the Pneumococcus vaccine is an important part of pandemic preparedness. I've got a multi-dose vial due to arrive shortly.
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-ppv.pdf
I also would respectfully disagree with the post that implied that the standard influenza vaccine wasn't necessary. The '08-09 influenza vaccine did have a H1N1 component. It doesn't cover the current H1N1, but it could have. I work in an ER, and my immune system is constantly being challenged. I firmly believe that I have far fewer infections/year than I should because my immune system is revved up to a higher level. I strongly support the yearly flu vaccine [30-40k dead/yr from the seasonal influenza].
I found the Vitamin D papers very interesting. I had been ignoring them because they aren't relevant to Emerg Med, but I'll get my sun lamp ready if the big one hits. [we don't see the sun up here in the NW corner of the country]
armymom1228
04-30-2009, 11:38
This was posted on a local sailing board today.. I have not verified the reccomendations..but it is worth sharing.
Quote:
Dr. Marcus Gitterle, M.D.600 N Union Ave
Christus Santa Rosa Hospital - New Braunfels
New Braunfels, TX 78130
Specialties
·Family Practice
·Emergency Medicine
After I returned from a public health meeting yesterday with community leaders and school officials in Comal County and Hays County, Heather suggested I send an update to my patients in the area, because what we are hearing privately from the CDC and Health Department is different from what you are hearing in the media. Some of you know some of this, but I will just list what facts I know.
- The virus is infectious for about 2 days prior to symptom onset
- Virus spreads more than 7 days after symptom onset (possibly as long as 9 days) (this is more unusual than ordinary flu)
- Since it is such a novel (new) virus, there is no "herd immunity," so the "attack rate" is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatic. That is much higher than seasonal flu, which averages 10-15%. The "clinical attack rate" estimation from CDC and WHO may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of this to those outside of the medical fields.
- The virulence (deadliness) of this virus is as bad here as in Mexico, and there are folks on ventilators here in the US, right now. This has not been in the media, but a 23 month old in Houston is fighting for his life, and a pregnant woman just south of San Antonio is fighting for her life. In Mexico, these folks might have died already, but here in the US, folks are getting Tamiflu or Relenza quickly, and we have ready access to ventilators. What this means is that within a couple of weeks, regional hospitals will likely become overwhelmed.
- Some of the kids with positive cases in Comal County have had more than 70 contacts before diagnosis as a minimum figure.
- There are 10-25 times more actual cases (not "possible" cases -- actual), than what is being reported in the media. The way they fudge on reporting this is that it takes 3 days to get the confirmatory nod from the CDC on a given viral culture, but based on epidemiological grounds, we know that there are more than 10 cases for each "confirmed" case right now.
- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.
- They are advising President Obama to declare an emergency sometime in the next 72-96 hours. This may not happen, but if it doesn't, I will be surprised. When this happens, all public gathering will be cancelled for 10 days minimum.
- I suggest all of us avoid public gatherings. Outdoor activities are not as likely to lead to infection. It is contained areas and close contact that are the biggest risk.
- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed for law enforcement and first responders as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.
- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER's south of here are becoming overwhelmed today-- and I mean that -- already. It is coming in waves, but the waves are getting bigger.
- It appears that this flu produces a distinctive "hoarseness" in many victims. The symptoms, in general, match other flu's; namely, sore throat, body aches, headache, cough, and fever. What is not too common in regular flu cycles is vomiting and diarrhea which seems to be associated with this, further dehydrating victims. Some have all these symptoms, while others may have only one or two.
- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.
- Oscillococinum, a homeopathic remedy, has been vindicated as quite effective in a large clinical trial in Europe, with an H1N1 variant. You can buy this at Hill Country Natural Foods, or the Wimberley Pharmacy.
I will try to keep everyone posted if I have any new information. Meanwhile, don't be afraid, stay informed and try to avoid infection. The fewer people infected the easier it will be for our public officials to manage it.
If any of my patients become ill, or suspect infection, call the office, do not come without calling and DO NOT go to the ER. If one member in a family is identified all would be given the Tamiflu or Relenza (that is normal course of action) if there is enough distributed to fill prescriptions. Public health stated that one family member identified or suspected to have contracted the flu it will require the whole family to be ‘quarantined’ in their own home until enough time has passed for the remaining household to have contracted it or be considered infection free ( 7 to 10 days per person). As another suggestion, if any member of the family is on routine medication- fill those prescriptions now. Have plenty fluids, Motrin, soups, etc available and make contingency plans in case your family is affected.
Marc
http://www.who.int/csr/disease/swineflu/en/index.html
AM, thanks for sharing this with us. But I think Dr. Gitterle needs to make sure he doesn't sit on the edge of invoking hysteria. Even as I listen to the press, their tone is on the edge of hysteria. However, at this point we only have 109 confirmed cases (out of a population of 304,059,724 - Jul 2008). One confirmed death, the poor lil guy in Texas (a Mexican national visiting our country). I am not saying there aren't more cases; however, that will be up to health officials and the CDC to confirm and release that information. This doctor's posting could have been worded much more carefully. As a health care professional, he has an obligation to the public ...YES...but there are ways to go about it. If I weren't a learned person (who endeavors to stay as informed as possible) I would be freaking out right now. Just my $.02
- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.
Level of influenza pandemic alert raised from phase 4 to 5 --29 April 2009 -- Based on assessment of all available information and following several expert consultations, Dr Margaret Chan, WHO's Director-General raised the current level of influenza pandemic alert from phase 4 to 5. She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities. http://www.who.int/en/
- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed for law enforcement and first responders as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.
I sure would love to know where he is getting his information. Making blanket statements like this can induce an even bigger problem than people getting the flu....mass hysteria is not fun to deal with!
A friend of mine gave me this little tidbit to share and while the numbers are broad (these are estimations) it does help put things in perspective:
http://www.flufacts.com/impact/statistics.aspx
INFLUENZA STATISTICS
The flu isn’t always thought of as a serious or life-threatening illness. Because of the dangers and complications it can have in older people, children, and people with health problems, the perception of flu severity is changing.
In the U.S., an estimated 25–50 million cases of the flu are currently reported each year — leading to 150,000 hospitalizations and 30,000–40,000 deaths yearly. If these figures were to be estimated incorporating the rest of the world, there would be an average of approximately 1 billion cases of flu, around 3–5 million cases of severe illness, and 300,000–500,000 deaths annually.
Flu-related deaths can result from pneumonia and from exacerbations of cardiopulmonary conditions and other chronic diseases. Deaths of older adults account for more than 90% of deaths attributed to pneumonia and influenza.
BMT (RIP)
04-30-2009, 12:14
A member of the security advance team for President Obama's recent trip to Mexico is suspected of having contracted the swine flu, a senior White House official says.
BMT
Has anyone heard of this :
- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that. :munchin
How sound is this?
AL
AM, thanks for the post, and I'm not killing the messenger.....but i'm calling BS on some of his facts. This "doctor" and I use the term loosely, is sparking hysteria. New Braunfels is 13 miles from my house and currently they have maybe 3 probable cases of swine flu. San Antonio, a top 10 in population, may have 1 probable case.
So this knucklehead saying New Braunfels is past Stage/Phase 6 of the CDC is full of crap! If that was true, the local SA newspaper would have that on the front page and it would be in bold letters. Instead, it talks about how the schools are closed in New Braunfels/ Comal county until 11 May and how kids are going to skateboard parks and still socializing in large groups else where.
1000s of people die every year from regular influenza, we have 1 death of a young Mexiacn national in a Texas hospital. I don't see this type of hysteria with any other flu.
doctom54
04-30-2009, 13:31
Has anyone heard of this :
- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that. :munchin
How sound is this?
AL
Here is the latest data on it in "critically ill" patients from www.medscape.com
N-acetyl-cysteine
"N-acetyl-cysteine, a precursor of glutathione, is a sulfhydryl donor that has been used extensively for preventing hepatocellular damage from acetaminophen toxicity. Due to its detoxifying effects, N-acetyl-cysteine has been studied in critically ill patients.[18] Although intracellular levels of glutathione increased with the administration of N-acetyl-cysteine, there was no difference seen in the total antioxidant potential, length of inotropic support, mechanical ventilation, or length of intensive care unit stay. Some study limitations were noted, including the low dose of N-acetyl-cysteine used (much lower of a dose when compared to the dose used in patients with acetaminophen toxicity). The use of N-acetyl-cysteine cannot be recommended at this time."
It is a mucolytic that is also used to treat acetaminophen overdoses.
NOTHING I've seen in the legitimate medical literature has any effect on H1N1 (the politically correct term for swine flu) except the prescription antiviral drugs oseltamivir and zanamivir
jasonglh
04-30-2009, 15:58
N-acetyl-cysteine aka Mucomyst ?
Thats the stuff we give cath lab patients with slow GFR to help them excrete the dye? Smells like rotten eggs and I usually serve it in a medicine cup to be chased with OJ.
We also use it for Tylenol overdose and for vent patients with heavy secretions.
IF you were in ARDS I could see the benefit but otherwise.....:munchin
ZooKeeper
04-30-2009, 16:01
We also use it for Tylenol overdose and for vent patients with heavy secretions.
That is the only thing I've ever seen/heard it used for.
armymom1228
04-30-2009, 17:06
Has anyone heard of this :
- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that. :munchin
How sound is this?
AL
I have always felt this sort of stuff falls under YMMV genre.
OTOH, I have long been into Vitamin therapy.
http://www.advance-health.com/nacetylcysteine.html
OTOH, my favorite resource, Medline Plus has numerous articles
about this particular 'drug'.
http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=N-Acetyl-Cysteine+&x=105&y=8
It is supposed to boost the immune system..
armymom1228
04-30-2009, 17:07
N-acetyl-cysteine aka Mucomyst ?
Thats the stuff we give cath lab patients with slow GFR to help them excrete the dye? Smells like rotten eggs and I usually serve it in a medicine cup to be chased with OJ.
We also use it for Tylenol overdose and for vent patients with heavy secretions.
IF you were in ARDS I could see the benefit but otherwise.....:munchin
Apparently it is under research as an AIDS drug and for pulmonary fibrosis and other stuff. see the links I posted.
This Link covers talk by laurie Garrett on the H5N1 Virus Pandemic. It is instructional in what we are not prepared for and are unable to prepare for. Easily extended to the Swine virus.
http://www.ted.com/index.php/talks/laurie_garrett_on_lessons_from_the_1918_flu.html
Monsoon65
04-30-2009, 19:45
AM, thanks for sharing this with us. But I think Dr. Gitterle needs to make sure he doesn't sit on the edge of invoking hysteria.
I found this about Dr Gitterle on another site:
http://www.successguidelines.com/international/international_marketing_11.htm
Can anyone tell me what "Karmic Surgery" is? :confused:;)
InTheBlack
05-01-2009, 01:33
CDC guidance on this H1N1 outbreak has this:
>
For antibacterial treatment of pneumonia, clinical guidance for community-acquired pneumonia should be followed and can be accessed at
http://www.journals.uchicago.edu/doi/pdf/10.1086/511159
>
The link is a pdf file, it wants to open in your browser. It may be easier to "download linked document" than to view it.
It names drugs & dosages -- big boy rules apply.
InTheBlack
05-01-2009, 01:44
It looks like one course of
Relenza
Augmentine
Zitromax
Zocor
for two people is about $600 from Goldpharma.com
Insurance isn't cheap.
It looks like one course of
Relenza
Augmentine or amoxacillin/clauvulate - $4
Zitromax or erythromycin - $4
Zocor or any statin $30
for two people is about $600 from Goldpharma.com
Insurance isn't cheap.
This figure can be cut dramatically by shopping the $4 prescription stores. I've been told Relenza and Tamiflu have been withdrawn from general distribution in the EU (and it's definitely been done in France). You would have better luck talking to a doc here in the US.
A beta-lactam + erythromycin (a primary recommendation the the paper you cite) can be really cheap. I've worked on some of the new, flashy, expensive antibiotics and trust me, in many case (most?) they are no better than the ones they replace. The only advantage to the expensive (Biaxin, Zithromax) erythromycins is once-per-day dosing. A $2 scrip for erythromycin works just as well (maybe better!) but you have to give it 3 times per day. Don't fall into the $$$ = better trap.
A recent survey found that the level of pandemic anxiety among physicians is now comparable to the average citizen. If you were poo-pooed before, you may not be now. Do your homework and then approach your family physician. Review the contraindications of the meds and dosages you propose (including interactions with other meds your family is taking) so you don't come off like an idiot. InTheBlack's excellent article discusses drugs, dosages, and length of treatment (tx termination dependent upon symptoms). Be prepared to explain the statin-ARDS links and print off and take with you at least the summaries of the studies that showed a positive effect. Explain your plan, present the WalWart/Target/CVS generics list and ask for alternate recommendations.
When you get the meds, use them responsibly. Only use it in an emergency situation where you can't leave the house or meds are not available. Know how to ID a case of community acquired pneumonia. Be prepared to render other supportive measures...antibiotics are not a magic bullet.
It appears that this is leveling off in MEX -- I'd expect the same here as the seasons are in our favor -- and with any luck you have another 2-3 months to prep and get meds in line.
Even if it does fade out, you'll see confirmed numbers rise in both the US and Mexico as the CDC catches up with it's testing (I'm told they can currently test only 100 samples/day and they have suspended testing of presumptive cases from an existing cluster; they are focusing on new regions and serious cases.)
So, it will probably take a while before we see new cases stop in the US but, to me (and again, what do I know?) this feels as if this is a "mild first wave" scenario.
But don't be fooled if this dies out over the summer. If it does tail off, hope that it doesn't come back in the fall (unlikely) or that it comes back and is milder than 1918 (likely, as 2/3 in 20th century were) but prepare as if the virulence will be at 1918 levels (at least a 1/3 chance?).
Regarding the FOS post up above...I didn't mean to start a flap and was only using it as an example to demonstrate I am expressing my opinions here and not hard truths. I strive to make them informed opinions, but...you see where I'm going.
And I most certainly am FOS from time to time and I'm very aware that people are using the information here to try to protect their families. I encourage everyone to challenge anything I say, or anything anyone else says, whenever thay can back it up.
InTheBlack
05-01-2009, 08:47
If this is a wave that tails off, how can the data be used to predict the features of the next wave?
I ask the MD for a scrip to keep in hand. They expire in 6 months, but if the balloon goes up you can get it filled.
I need a good glossary of epidemiologic terms (Ro, CFR etc)... Normally I go looking before asking but there is an acute family medical situation that will probably last for the next month or so (Mom is starting a memory drug & shouldn't live alone until she can remember to TAKE it... Catch-22 !!!).
A short simple explanation of what the two different classes of antibiotic do & why both are recommended would be useful. I recollect Gram Positive vs Negative bacteria but that's it. Haven't read the entire pneumonia treatment article yet myself.
EDIT: WRT once a day dosages -- how long until they are 100% absorbed? If you throw up or have diarrhea you might lose a lot of the pill ???
The Reaper
05-01-2009, 08:54
Not a medical professional, but I would remind everyone that this would be an excellent time to go get your pneumonia vaccination.
No point in surviving pandemic influenza to die from a secondary infection you could have been vaccinated for in advance.
TR
I found this about Dr Gitterle on another site:
http://www.successguidelines.com/international/international_marketing_11.htm
Can anyone tell me what "Karmic Surgery" is? :confused:;)
Monsoon, I did some searching myself on this Dr. Gitterle. While I am not opposed to using eastern medicines (have used some of them myself for pain management). I think Karmic surgery is nothing more than some heavy duty praying but in the Indian use of it, they chant mantras as well. But I also think that the person receiving that sort of treatment has to "believe" as well. I don't want to hijack this thread talking too much about the good doctor (tongue in cheek). Dr. Gitterle should be more responsible in how he presents information and he should use the facts, no bogus information and suppositions that run the posssibility of inducing panic!
Mugwump...nice to see you back and thanks for the latest information!
Penn... back in the late 90's, PBS ran a documentary about the 1918 Pandemic. As was my job at the time (I worked for a risk management PR firm on Long Island), I monitored information via the web and TV/radio regarding "outbreaks" of any kind... past/present and possible future. In the documentary, researchers went to a small graveyard (Alaska). They were allowed to autopsy the frozen remains of some of the 1918 victims. They took samples from the bodies and found that the virus was still present.
That link is here: http://www.pbs.org/wgbh/amex/influenza/sfeature/latest.html
If this is a wave that tails off, how can the data be used to predict the features of the next wave?
I ask the MD for a scrip to keep in hand. They expire in 6 months, but if the balloon goes up you can get it filled.
I need a good glossary of epidemiologic terms (Ro, CFR etc)... Normally I go looking before asking but there is an acute family medical situation that will probably last for the next month or so (Mom is starting a memory drug & shouldn't live alone until she can remember to TAKE it... Catch-22 !!!).
A short simple explanation of what the two different classes of antibiotic do & why both are recommended would be useful. I recollect Gram Positive vs Negative bacteria but that's it. Haven't read the entire pneumonia treatment article yet myself.
EDIT: WRT once a day dosages -- how long until they are 100% absorbed? If you throw up or have diarrhea you might lose a lot of the pill ???
RE: predicting next wave...nobody knows anything, everybody is guessing. Believe it or not, this is like Christmas to epidemiologists and public health wonks. They've never seen a pandemic unfold before and the 'net is giving very fine-grained access to breaking events. Some of the won't admit it but they're all like kids in a candy store.
The next wave might be mild, it might be horrible. As with earthquakes and hurricanes, prepare for the worst and hope for the best.
Monsoon65
05-01-2009, 14:07
Mugwump/InTheBlack:
What should people that are completely clueless tell their family doc if they want a scrip for meds "just in case"? As you said, Mugwump, you don't want to sound like an idiot, but I know I'll get looks like I have lobsters crawling out of my ears if I tried.
Red Flag 1
05-01-2009, 15:19
Mugwump/InTheBlack:
What should people that are completely clueless tell their family doc if they want a scrip for meds "just in case"? As you said, Mugwump, you don't want to sound like an idiot, but I know I'll get looks like I have lobsters crawling out of my ears if I tried.
Mugwump is lead on this thread, and I do not want to suggest that I know more about this flu strain than he does. As to talking to your doc, well IMHO, you tell him your symptoms. You present as you present. To suggest words may mislead your doc, and be of no value to you or your doc. You may or may not have the flu. Let your doc decide what "script", if any, is indicated for you!!
When I was seeing sick call in the early 70's, it was good to read The Readers Digest. Readers Digest was not a medical publication, but it was good to know what medical problem was in print for the month. It did muddy the waters a bit in trying to determine what, if anything, was going on. Readers Digest did bring me more than a few patients each month.
My $.02.
Be well.
RF 1
ZonieDiver
05-01-2009, 15:48
I found these reminders of the 1976 "Swine Flu" on YouTube. So far, I guess that we are lucky President Obama and his fearless, feckless HSA chief have not (yet) subjected us to this.
http://www.youtube.com/watch?v=ASibLqwVbsk
I do recall my reserve unit having a formation and then moving to the Med Detachment to get our swine flu shots - under orders.
InTheBlack
05-01-2009, 17:29
I have a degree in Biology, but when I read medical literature its like reading the King James Bible -I grok the gist of it, but need to go to a Concordance to figure out details.
This thread is a long primer on how pandemic flu will kill you. SO you must be able to explain the worst case hypothesis which you are willing to fight, and ask for scrips to hold in hand.
My worst case:
Pandemic flu with high mortality rate strikes my family.
Doctors are not quickly available to diagnose.
Can't send victim to the hospital because there is no space, all the ventilators are in use.
Meds might not be available, or its too risky to go get them.
Have to treat at home using antivirals, drugs to fight ARDS (acute respiratory distress syndrome) and the "cytokine storm." After surviving that, I need antibiotics to prevent a pneumonia infection. Of varieties that my family member is not allergic to.
Monsoon65
05-01-2009, 17:47
This thread is a long primer on how pandemic flu will kill you. SO you must be able to explain the worst case hypothesis which you are willing to fight, and ask for scrips to hold in hand.
My worst case:
Pandemic flu with high mortality rate strikes my family.
Doctors are not quickly available to diagnose.
Can't send victim to the hospital because there is no space, all the ventilators are in use.
Meds might not be available, or its too risky to go get them.
Have to treat at home using antivirals, drugs to fight ARDS (acute respiratory distress syndrome) and the "cytokine storm." After surviving that, I need antibiotics to prevent a pneumonia infection. Of varieties that my family member is not allergic to.
That's just what I was looking for! Without being sick, I wanted a good, convincing argument about getting meds prior to getting sick.
6.8SPC_DUMP
05-01-2009, 23:51
Sharp Corp.'s Plasmacluster Ion Generators have proved to be effective in fighting H1N1 and H5N1.
H1N1 Inactivation ratio: 99.7%
H5N1 Inactivation ratio: 99.0%
Link (http://www.sharp-world.com/corporate/news/080827.html)
The technology has been adapted to portable home units, air conditioning systems, car air conditioners, duct systems, public transportation and light fixtures.
Link (http://prextra.sharp-eu.com/pr/eu/download.php?DWID=172&PR=corporate_worldwide)
avianfludefence.com (http://www.avianfludefence.com/Display.aspx?MasterId=35ee2ae8-4756-42be-bf15-355b8293267e&NavigationId=841) writes (about H5N1 not Swine Flu H1N1):
What is Plasmacluster technology?
Originally developed as an air quality technology, Plasmacluster Ion attacks impurities and diseases in the air.
How does it work?
Plasmacluster Ion generates positive and negative ions in the air. These ‘cling’ to airborne impurities and diseases, attacking the cell membranes of their bacteria. In turn, this neutralizes them.
So where could Plasmacluster be put to work?
Plasmacluster could play an important role in removing the H5N1 virus if it is present in doctors’ surgeries, hospitals, offices, homes and confined spaces such as airplanes.
Could Plasmacluster be the answer to the risk of a pandemic?
Not on its own, no. Influenza viruses are complex, but Plasmacluster would provide a valuable extra layer of defence against H5N1, complementing retro-viral drugs, vaccines, hygiene practices and ‘social distancing’ measures to keep people away from the infection.
InTheBlack
05-02-2009, 15:06
Something to clean the air in the sickroom can't hurt - ions, UV light, or just a big fan with a big HEPA filter. I try to sneeze into the trash can; the used kleenex absorbs the air burst & droplets.
Coughs & sneezed produce mostly aerodynamically large droplets which fall out quickly (IIRC 60 seconds) so you need to disinfect surfaces.
Hmmm... maybe just old fashioned draping around the sickbed to contain aerosols, with a HEPA filtered fan to aim your sneezes into...
All the US Via Bloomberg News...I think its the last thing the BHO admin wants to announce. The article notes the coming fall flu season....
http://www.bloomberg.com/apps/news?pid=20670001&sid=a11JbSV5RlwI
temsmedic
05-04-2009, 00:36
All the US Via Bloomberg News...I think its the last thing the BHO admin wants to announce. The article notes the coming fall flu season....
http://www.bloomberg.com/apps/news?pid=20670001&sid=a11JbSV5RlwI
This article states:
"The CDC says people with the swine flu are more likely to have diarrhea"
The CDC Case Definition for H1N1 [Swine] flu does not mention diarrhea.
Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV)
A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests:
real-time RT-PCR
viral culture
A probable case of S-OIV infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PCR
A suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset
within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or
within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or
resides in a community where there are one or more confirmed cases of S-OIV infection.
Infectious period for a confirmed case of swine influenza A (H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset.
Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine-origin influenza A (H1N1) virus infection during the case’s infectious period.
Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness) [no mention of diarrhea]
temsmedic
05-04-2009, 12:27
Interesting, Fox News is now reporting diarrhea as a symptom. A google search showed some state health depts listing vomiting and diarrhea as a symptom. I reviewed again this AM, the CDC and WHO case definitions, and they still do not list diarrhea.
This is pretty important because if it doesn't meet the case definition, I don't order the Influenza tests, and send a sample off to the health dept. I've already had one pt that had returned from CA, and had vomiting and diarrhea. I did not run the test, because he didn't meet the case definition.
If vomiting and diarrhea is part of the illness, the CDC/WHO are NOT getting the word out, which means that this is being under-reported, and the numbers are likely even bigger. Also, it will spread more rapidly, because we aren't isolating those with vomiting & diarrhea, except for the usual infectious diarrhea precautions.
InTheBlack
05-04-2009, 16:13
The seasonal flu "culls the herd" by killing the already weak & infirm. Comparing this to seasonal flu might be a misrepresentation to the public; the pandemic we are on the alert for kills people whom you would not _expect_ to die from a bad infection.
I'm hoping to soon see statistics on _who_ is being killed by H1N1, so we can determine which this is.
The local health department has for the very first time made use of the emergency telephone notification system, with a tape recording saying to wash hands & stay home if you have symptoms. This is a great drill for the government. I don't expect the sheeple to pay any attention beyond this wave, though.
6.8SPC_DUMP
05-04-2009, 23:00
Interesting, Fox News is now reporting diarrhea as a symptom. A google search showed some state health depts listing vomiting and diarrhea as a symptom. I reviewed again this AM, the CDC and WHO case definitions, and they still do not list diarrhea.
This is pretty important because if it doesn't meet the case definition, I don't order the Influenza tests, and send a sample off to the health dept. I've already had one pt that had returned from CA, and had vomiting and diarrhea. I did not run the test, because he didn't meet the case definition.
If vomiting and diarrhea is part of the illness, the CDC/WHO are NOT getting the word out, which means that this is being under-reported, and the numbers are likely even bigger. Also, it will spread more rapidly, because we aren't isolating those with vomiting & diarrhea, except for the usual infectious diarrhea precautions.
You bring up a very interesting point about the definition not matching the symptoms Sir.
I do know that the CDC has consistently mentioned diarrhea and severe or persistent vomiting at the end of their list of symptoms when giving brief broadcasts - saying: "people have reported diarrhea and vomiting".
CDC has recently advised ppl with the following symptoms to immediately seek medical care:
difficulty breathing / shortness of breath
pressure or pain in the chest or abdomen
sudden dizziness
confusion
The general symptoms:
fever
cough
sore throat
body aches
headache
chills
fatigue
with some people reporting severe or persistent vomiting and diarrhea
http://www.youtube.com/watch?v=scGMU7TU8Cw
I don't understand how at first it was thought it was a never before seen bird/swine/human flu and now it's a pig/pig flu from both over seas and N. America pigs.:confused:
Several researchers are working to calculate the Ro (the number of new cases produced from each infection) of the H1N1 virus currently circulating around the world. Remember that if Ro < 1 then the disease will burn out. A Ro > 1 means there is ongoing spread of the disease. The larger the Ro the faster the spread.
I'm told that one published result (haven't found it yet) puts the Ro at 1.16 and two other, unpublished, calculations put the Ro between 1.2 and 1.39. If the estimates are correct, the new H1N1 virus is spreading, but barely enough to keep it going.
As the MSM are reporting pretty extensively, the 1918 flu pandemic also started with a mild, first wave in late spring. The folks at Los Alamos National Laboratory (the ones who created the pandemic model posted early in the thread) estimate the R0 of the 1918 first wave at 1.45. When the second, lethal wave hit in the fall they think the Ro was 3.75.
greenberetTFS
05-05-2009, 16:36
Ist person to die from swine flu is a lady in Texas.......................:boohoo
GB TFS :munchin
temsmedic
05-05-2009, 20:37
Second pt of the morning, 2 y/o hisp male with temp of 39.5, cough, and runny nose. He had spent two hours in the waiting room, and was in a shared room. He lived in a home with two families, two of whom were ill. Not very ill looking, when I peaked in, he was playing and smiling with mom. Influenza A positive, sent to health dept for confirmation. News reporting tonight that over 90% of the "probable's" are coming in positive for H1N1. He had normal lung sounds, oxygen level high normal, not dehydrated. He was discharged to home on tamiflu, health dept notified. Interestingly, I asked the health dept if I should drag in the person from the second family in the home, they told me not to bother. I treated the father of my pt.
incarcerated
05-05-2009, 21:37
Coughs & sneezed produce mostly aerodynamically large droplets which fall out quickly (IIRC 60 seconds) so you need to disinfect surfaces.
Great editorial liberties have been taken with this article in the interest of brevity.
Reminder: μm = micron (.001 millimeter)
http://www.cdc.gov/ncidod/EID/vol12no11/06-0426.htm
Volume 12, Number 11 November 2006
Perspective
Review of Aerosol Transmission of Influenza A Virus
By Dr. Raymond Tellier
In theory, influenza viruses can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites).
Several authors have stated that large-droplet transmission is the predominant mode by which influenza virus infection is acquired. As a consequence of this opinion, protection against infectious aerosols is often ignored for influenza, including in the context of influenza pandemic preparedness.
Influenza Virus Aerosols
By definition, aerosols are suspensions in air (or in a gas) of solid or liquid particles, small enough that they remain airborne for prolonged periods because of their low settling velocity. For spherical particles of unit density, settling times (for a 3-m fall) for specific diameters are 10 s for 100 μm, 4 min for 20 μm, 17 min for 10 μm, and 62 min for 5 μm; particles with a diameter <3 μm essentially do not settle. Settling times can be further affected by air turbulence.
The median diameters at which particles exhibit aerosol behavior also correspond to the sizes at which they are efficiently deposited in the lower respiratory tract when inhaled. Particles of >6 μm diameter are trapped increasingly in the upper respiratory tract; no substantial deposition in the lower respiratory tract occurs at >20 μm. Many authors adopt a size cutoff of <5 μm for aerosols. This convenient convention is, however, somewhat arbitrary, because the long settling time and the efficient deposition in the lower respiratory tract are properties that do not appear abruptly at a specific diameter value. Certainly, particles in the micron or submicron range will behave as aerosols, and particles >10 to 20 μm will settle rapidly, will not be deposited in the lower respiratory tract, and are referred to as large droplets.
Coughing or sneezing generates a substantial quantity of particles, a large number of which are <5 to 10 μm in diameter. In addition, particles expelled by coughing or sneezing rapidly shrink in size by evaporation, thereby increasing the number of particles that behave as aerosols. Particles shrunken by evaporation are referred to as droplet nuclei. This phenomenon affects particles with a diameter at emission of <20 μm, and complete desiccation would decrease the diameter to a little less than half the initial diameter. Droplet nuclei are hygroscopic. When exposed to humid air (as in the lungs), they will swell back. One would expect that inhaled hygroscopic particles would be retained in the lower respiratory tract with greater efficiency, and this hypothesis has been confirmed experimentally. Because aerosols remain airborne, they can be carried over large distances, which may create a potential for long-range infections. The occurrence of long-range infections is affected by several other factors. These include dilution, the infectious dose, the amount of infectious particles produced, the duration of shedding of the infectious agent, and the persistence of the agent in the environment. Inferring an absence of aerosols because long-range infections are not frequently observed is incorrect.
Humans acutely infected with influenza A virus have a high virus titer in their respiratory secretions, which will be aerosolized when the patient sneezes or coughs.
In natural infections, the postulated modes of transmission have included aerosols, large droplets, and direct contact with secretions or fomites because the virus can remain infectious on nonporous dry surfaces for <48 hours.
Whereas UV irradiation is highly effective in inactivating viruses in small-particle aerosols, it is ineffective for surface decontamination because of poor surface penetrations. It is also ineffective for large droplets because the germicidal activity sharply decreases as the relative humidity increases. Furthermore, because the installation of UV lights was set up in such a way as to decontaminate the upper air of rooms only, large droplets would not have been exposed to UV, whereas aerosols, carried by thermal air mixing, would have been exposed. So in effect in this study only the aerosol route of infection was blocked, and this step alone achieved near complete protection.
Dr Tellier is a microbiologist for the Hospital for Sick Children; senior associate scientist, Research Institute, Hospital for Sick Children; and associate professor, Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto.
InTheBlack
05-06-2009, 00:50
Very interesting cite. Wonder how the UV lights were set up -- how many watts or candlepower per cubic meter of room size? In 1958 they probably emitted a more dangerous spectra than what you can easily obtain today.
Footnote 10 seems to be the source of the aerosol size distribution data but its not free online:
http://www.informaworld.com/smpp/content~db=all?content=10.1080/15459620590918466
Anyway, putting a mask on the patient or tenting him, with negative ventilation into a filter, are methods to think about.
incarcerated
05-06-2009, 21:51
This is pretty important because if it doesn't meet the case definition, I don't order the Influenza tests, and send a sample off to the health dept. I've already had one pt that had returned from CA, and had vomiting and diarrhea. I did not run the test, because he didn't meet the case definition.
.
Temsmedic,
at any time during this event, have you had any difficulty obtaining M4RT viral transport kits with which to conduct the test?
Anyone else have any shortage of these?
temsmedic
05-07-2009, 19:27
Temsmedic,
at any time during this event, have you had any difficulty obtaining M4RT viral transport kits with which to conduct the test?
Anyone else have any shortage of these?
I've only sent one sample off as a "probable H1N1", and we seemed to have the transport medium. I haven't heard of any shortage at our hospital. The CDC has a new test, not sure what kind of sample they need.
CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has now distributed test kits to all states in the U.S. and Puerto Rico. The test kits are being shipped internationally as well. This will allow states and other countries to test for this new virus. This increase in testing capacity is likely to result in an increase in the number of reported confirmed cases in this country, which should provide a more accurate picture of the burden of disease in the United States.
I called to check on my 2 y/o pt, last night. He is doing well, afebrile, taking fluids, and very active.
temsmedic
05-07-2009, 19:34
Our latest hlth dept directive:
Please test and treat depending on the severity of illness of your patients. There is no more need to test or treat because of the novel influenza than there was during typical influenza seasons. We are continuing to get specimens from patients with influenza-like illness to send to the state lab to determine the presence of novel influenza in our community. DOH plans to limit its confirmatory testing once we have confirmed a case in Whatcom County. Testing will then focus on severity surveillance. We believe the virus is of low virulence now, but will continue to test patients hospitalized for severe acute respiratory infections or ARDS to detect the proportion of these cases positive for the novel influenza. DOH will require a positive rapid influenza test, or other commerical influenza test (IFA, culture, RT-PCR), as a condition for testing, except for fatalities that are suspected of being due to influenza. Public health will continue to monitor the extent and severity of this novel influenza, and guidelines will be revised as we gather new information.
InTheBlack
05-08-2009, 11:39
>DOH plans to limit its confirmatory testing...
So this means that the final statistics will under-report the number of cases in Washington State ???
I wonder if the CDC takes policies like that into account when it consolidates the statistics ???
Red Flag 1
05-08-2009, 14:33
>DOH plans to limit its confirmatory testing...
So this means that the final statistics will under-report the number of cases in Washington State ???
I wonder if the CDC takes policies like that into account when it consolidates the statistics ???
Or input frrom the White House:confused:
incarcerated
05-13-2009, 02:03
http://www.bloomberg.com/apps/news?pid=20601082&sid=aShZig0Cig4g&refer=canada
Swine Flu May Be Human Error; WHO Investigates Claim (Update1)
By Jason Gale and Simeon Bennett
May 13 (Bloomberg) -- The World Health Organization is investigating a claim by an Australian researcher that the swine flu virus circling the globe may have been created as a result of human error.
Adrian Gibbs, 75, who collaborated on research that led to the development of Roche Holding AG’s Tamiflu drug, said in an interview that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs scientists use to grow viruses and drugmakers use to make vaccines. Gibbs said he came to his conclusion as part of an effort to trace the virus’s origins by analyzing its genetic blueprint.
“One of the simplest explanations is that it’s a laboratory escape,” Gibbs said in an interview with Bloomberg Television today. “But there are lots of others.”
The World Health Organization received the study last weekend and is reviewing it, Keiji Fukuda, the agency’s assistant director-general of health security and environment, said in an interview May 11. Gibbs, who has studied germ evolution for four decades, is one of the first scientists to analyze the genetic makeup of the virus that was identified three weeks ago in Mexico and threatens to touch off the first flu pandemic since 1968.
A virus that resulted from lab experimentation or vaccine production may indicate a greater need for security, Fukuda said. By pinpointing the source of the virus, scientists also may better understand the microbe’s potential for spreading and causing illness, Gibbs said.
Possible Mistake
“The sooner we get to grips with where it’s come from, the safer things might become,” Gibbs said by phone from Canberra yesterday. “It could be a mistake” that occurred at a vaccine production facility or the virus could have jumped from a pig to another mammal or a bird before reaching humans, he said.
Gibbs and two colleagues analyzed the publicly available sequences of hundreds of amino acids coded by each of the flu virus’s eight genes. He said he aims to submit his three-page paper today for publication in a medical journal.
“You really want a very sober assessment” of the science behind the claim, Fukuda said May 11 at the WHO’s Geneva headquarters.
The U.S. Centers for Disease Control and Prevention in Atlanta has received the report and has decided there is no evidence to support Gibbs’s conclusion, said Nancy Cox, director of the agency’s influenza division. She said since researchers don’t have samples of swine flu viruses from South America and Africa, where the new strain may have evolved, those regions can’t be ruled out as natural sources for the new flu.
No Evidence
“We are interested in the origins of this new influenza virus,” Cox said. “But contrary to what the author has found, when we do the comparisons that are most relevant, there is no evidence that this virus was derived by passage in eggs.”
The WHO’s collaborative influenza research centers, which includes the CDC, and sites in Memphis, Melbourne, London and Tokyo, were asked by the international health agency to review the study over the weekend, Fukuda said. The request was extended to scientists at the Food and Agriculture Organization in Rome, the World Organization for Animal Health in Paris, as well as the WHO’s influenza network, he said.
“My guess is that the picture should be a lot clearer over the next few days,” Fukuda said. “We have asked a lot of people to look at this.”
Virus Expert
Gibbs wrote or co-authored more than 250 scientific publications on viruses during his 39-year career at the Australian National University in Canberra, according to biographical information on the university’s Web site.
Swine flu has infected 5,251 people in 30 countries so far, killing 61, according to WHO data. Scientists are trying to determine whether the virus will mutate and become more deadly if it spreads to the Southern Hemisphere and back. Flu pandemics occur when a strain of the disease to which few people have immunity evolves and spreads.
Gibbs said his analysis supports research by scientists including Richard Webby, a virologist at St. Jude Children’s Research Hospital in Memphis, who found the new strain is the product of two distinct lineages of influenza that have circulated among swine in North America and Europe for more than a decade.
In addition, Gibbs said his research found the rate of genetic mutation in the new virus was about three times faster than that of the most closely related viruses found in pigs, suggesting it evolved outside of swine.
Gene Evolution
“Whatever speeded up the evolution of these genes happened at least seven or eight years ago, so one wonders, why hasn’t it been found?” Gibbs said today.
Some scientists have speculated that the 1977 Russian flu, the most recent global outbreak, began when a virus escaped from a laboratory.
Identifying the source of new flu viruses is difficult without finding the exact strain in an animal or bird “reservoir,” said Jennifer McKimm-Breschkin, a virologist at the Commonwealth Science and Industrial Research Organization in Melbourne.
“If you can’t find an exact match, the best you can do is compare sequences,” she said. “Similarities may give an indication of a possible source, but this remains theoretical.”
The World Organization for Animal Health, which represents chief veterinary officers from 174 countries, received the Gibbs paper and is working with the WHO on an assessment, said Maria Zampaglione, a spokeswoman.
Genetic Patterns
The WHO wants to know whether any evidence that the virus may have been developed in a laboratory can be corroborated and whether there are other explanations for its particular genetic patterns, according to Fukuda.
“These things have to be dealt with straight on,” he said. “If someone makes a hypothesis, then you test it and you let scientific process take its course.”
Gibbs said he has no evidence that the swine-derived virus was a deliberate, man-made product.
“I don’t think it could be a malignant thing,” he said. “It’s much more likely that some random thing has put these two viruses together.”
Gibbs, who spent most of his academic career studying plant viruses, said his major contribution to the study of influenza occurred in 1975, while collaborating with scientists Graeme Laver and Robert Webster in research that led to the development of the anti-flu medicines Tamiflu and Relenza, made by GlaxoSmithKline Plc.
Bird Poo
“We were out on one of the Barrier Reef islands, off Australia, catching birds for the flu in them, and I happened to be the guy who caught the best,” Gibbs said. The bird he got “yielded the poo from which was isolated the influenza isolate strain from which all the work on Tamiflu and Relenza started.”
Gibbs, who says he studies the evolution of flu viruses as a “retirement hobby,” expects his research to be challenged by other scientists.
“This is how science progresses,” he said. “Somebody comes up with a wild idea, and then they all pounce on it and kick you to death, and then you start off on another silly idea.”
To contact the reporters on this story: Jason Gale in Geneva at j.gale@bloomberg.net; Simeon Bennett in Singapore at sbennett9@bloomberg.net.
Last Updated: May 13, 2009 01:36 EDT
incarcerated
05-15-2009, 21:47
http://www.bloomberg.com/apps/news?pid=20601082&sid=aShZig0Cig4g&refer=canada
Swine Flu May Be Human Error; WHO Investigates Claim (Update1)
http://www.nytimes.com/2009/05/15/health/policy/15flu.html
Swine Flu Not an Accident From a Lab, W.H.O. Says
By DONALD G. McNEIL Jr.
Published: May 14, 2009
The swine flu virus did not result from a laboratory accident, the World Health Organization said Thursday, working to debunk rumors started by an Australian virologist and circulated by news outlets all over the world.
“We took this very seriously,” Dr. Keiji Fukuda, the agency’s deputy director general, said of the virologist’s assertion. “But the evidence suggests that this is a naturally occurring virus, not a laboratory-derived virus.”
....The virus rumor was started by Adrian J. Gibbs, a retired plant virologist from the Australian National University, who previously published work in the journal Science questioning the idea, now accepted, that the 1918 pandemic started as a bird flu.
Dr. Gibbs, who had studied the gene sequences of the swine flu virus posted on public data banks, argued that it must have been grown in eggs, the medium used in vaccine laboratories. He reached that conclusion, he said, because the new virus was not closely related to known ones and because it had more of the amino acid lysine and more mutations than typical strains of swine flu.
His theory was reported by Bloomberg News on Tuesday. Even though scientists at the Centers for Disease Control and Prevention were skeptical and some prominent virologists openly derisive, news outlets have repeated and magnified the theory, adding speculation about bioterrorism that even Dr. Gibbs repudiated. He was also interviewed Thursday on the ABC News program “Good Morning America.”
Dr. Fukuda said a W.H.O. panel of experts had concluded that “the hypothesis does not really stand up to scrutiny.” The lysine residues and mutation rates were typical, he said, and many swine flus seem unrelated because not enough pigs are tested each year.
But he added that he doubted that the rumor would prove damaging, and he said he would not want genetic sequences kept off public databases.
“This is healthy,” he said. “This is much better than dealing with rumors where you don’t know where the mistake comes from and can’t correct it.”
....Scientists have yet to pinpoint the origin of the swine flu virus, the earliest cases of which were found in Veracruz, Mexico. It contains genes from flu viruses that normally circulate in pigs in Europe and Asia, as well as avian and human genes.
Late Thursday, Smithfield Foods reported that the Mexican health authorities had not found the new virus in herds at its huge hog-fattening operations in Veracruz, which some have blamed for the outbreak. But it was not clear what test was used; only blood tests for antibodies would show whether pigs had the virus in February, when the human outbreak is thought to have begun.
....The swine flu may cause the W.H.O. to cut short its nine-day annual conference of world health ministers so they can get home to fight the disease, Reuters reported.
6.8SPC_DUMP
05-19-2009, 03:42
U.S. health officials troubled by new flu pattern
Mon May 18, 2009 4:12pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - The new influenza strain circulating around most of the United States is putting a worrying number of young adults and children into the hospital and hitting more schools than usual, U.S. health officials said on Monday.
The H1N1 swine flu virus killed a vice principal at a New York City school over the weekend and has spread to 48 states. While it appears to be mild, it is affecting a disproportionate number of children, teenagers and young adults.
This includes people needing hospitalization -- now up to 200, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.
"That's very unusual, to have so many people under 20 to require hospitalization, and some of them in (intensive care units)," Schuchat told reporters in a telephone briefing.
"We are now experiencing levels of influenza-like illness that are higher than usual for this time of year," Schuchat added. "We are also seeing outbreaks in schools, which is extremely unusual for this time of year."
New York City Health Commissioner Dr. Thomas Frieden agreed with Schuchat.
"We're seeing increasing numbers of people going to emergency departments saying they have fever and flu, particularly young people in the 5 to 17 age group, " Frieden, who has been named by U.S. President Barack Obama as the new CDC director, told a news conference.
About half of all cases of influenza are being diagnosed as the new H1N1 strain, while the rest are influenza B, or the seasonal H1N1 and H3N2 strains. Flu season in the United States is usually almost over by May.
CDC officials say around 100,000 people are likely infected with the new flu strain in the United States and Schuchat said the 5,123 confirmed and probable cases and six deaths in the United States were "the tip of the iceberg."
MORE ILLNESS OVERALL
"We are seeing more reports of influenza-like illness from outpatient visits that we monitor than is typical for this time of year," Schuchat said.
Because doctors usually treat symptoms and only occasionally give flu tests to patients, the CDC must monitor reports of symptoms such as fever, cough and muscle aches to track flu activity. Some centers are doing actual influenza tests to confirm the patterns that are seen.
Influenza is a factor in 36,000 deaths a year in the United States and 250,000 to 500,000 deaths globally, the CDC says.
"Unlike the seasonal flu, we are seeing relatively few cases or hospitalizations in people over 65," Schuchat said. Usually flu kills the elderly and people with chronic diseases.
There is no evidence that a second, bacterial infection is worsening the H1N1 cases, Schuchat said.
When family members are questioned, it seems clear that children and teens are more prone to infection than older adults, Schuchat said. "People under 18 are more likely to have infections when another person in the family is infected," she said.
"One of our working hypotheses is that older adults may have some pre-existing protection against this virus due to their exposure long ago to some virus that may be distantly related," Schuchat said.
An alternative hypothesis is that it just has not had a chance to make its way into the older population yet.
http://www.reuters.com/article/domesticNews/idUSTRE54H3QO20090518?feedType=RSS&feedName=domesticNews&rpc=22&sp=true
200 people in the hospital and 6 dead is NO justification for any infraction of civil liberties.
incarcerated
05-20-2009, 18:55
Two Egyptian boys contract bird flu - agency
Wed May 20, 2009 11:58am EDT
CAIRO, May 20 (Reuters) - Two Egyptian boys have contracted the highly pathogenic H5N1 bird flu virus, bringing the total number of cases in the most populous Arab country to 74, state news agency MENA said on Wednesday.
Egypt, hit harder by bird flu than any other country outside Asia, has seen a surge in cases in recent weeks with 14 new human infections and four deaths reported since April 1 -- more than the country saw in all of 2008.
The children -- a 4-year-old boy from Daqahlia in the Nile Delta and a 3-year-old boy from Sohag in the south -- were admitted to hospital with high fever and were in a stable condition after being treated with Tamiflu, MENA said.
It quoted a health ministry spokesman as saying that both boys had been in contact with birds suspected of being infected with the disease.
The new infections came just days after a 4-year-old girl died of the virus on Monday. Overall, 27 Egyptians have died after contracting the virus.
Most Egyptians who contracted the disease fell ill after coming into contact with infected domestic birds in a country where roughly 5 million households depend on domestically raised poultry as a significant source of food and income.
While the H5N1 virus only rarely infects people, experts fear it could mutate into a form that humans could easily pass to one another, sparking a pandemic that could kill millions. (Writing by Alastair Sharp; editing by Philippa Fletcher)
http://www.reuters.com/article/middleeastCrisis/idUSLK285452
incarcerated
05-24-2009, 15:09
WHO chief warns H1N1 swine flu likely to worsen
Fri May 22, 2009 5:33pm EDT
By Laura MacInnis and Stephanie Nebehay
GENEVA, May 22 (Reuters) - The world must be ready for H1N1 swine flu to become more severe and kill more people, World Health Organization chief Dr. Margaret Chan said on Friday.
A genetic analysis of the new virus showed it must have been circulating undetected for some time, in pigs or perhaps in other animals….
An international team of researchers who analyzed all eight genes of the new virus confirmed its sneakiness, saying it was so different from its ancestral strains that it must have been circulating undetected for years. [ID:nN22387017]
They confirmed it is a hybrid of two other mixtures -- one a so-called triple reassortant of pig, bird and human viruses, and another group of swine viruses from Europe and Asia….
http://www.reuters.com/article/asiaCrisis/idUSN22387871
incarcerated
05-28-2009, 10:09
British scientists make H1N1 flu strain for vaccine
Thu May 28, 2009 8:58am EDT
LONDON, May 28 (Reuters) - British scientists have produced a strain of H1N1 flu virus which could be used for large scale production of a vaccine, health authorities said on Thursday.
The virus strain is being made available to the pharmaceutical industry and other flu laboratories, the Health Protection Agency (HPA) said, describing it as "a crucial step towards large scale production of a vaccine against swine flu"….
It said the vaccine was produced by its National Institute for Biological Standards and Control (NIBSC) -- one of several laboratories around the world belonging to a World Health Organisation (WHO) network racing to produce a strain suitable for manufacturing vaccine.
NIBSC director Stephen Inglis said WHO network laboratories in the United States and Australia were "also making good progress and we expect there soon to be a number of possible strains to use for large scale manufacture of swine flu vaccine. (Reporting by Kate Kelland. Editing by Jon Hemming)
http://www.reuters.com/article/middleeastCrisis/idUSLS990265
Slantwire
06-11-2009, 09:56
Okay, so the WHO is making it official. (Per Yahoo News (http://news.yahoo.com/s/ap/un_un_swine_flu).)
There's intensive genetic analysis of H1N1 isolates going on around the world and several worrisome mutations have been identified to date. There will be more found as this virus passes through its hosts and adapts.
One mutation is in the hemagglutinin molecule (the H part of the H1N1 designation). This change could render obsolete the vaccines under development even before their release. There's feverish testing going on as you might imagine, with lives (and billions of $$) at stake.
Another mutation makes transmission of the virus more efficient at cooler temperatures [see earlier posts in this thread on the implications of adaptation to "human nose temperature" from "avian gut temperature"]. More efficient transmission at cooler temperatures also carries the risk of higher virus replication rates in the infected host. More viruses, potentially more cytokine storm.
There's a virtual consensus among my contacts that this flu will return this winter with very high infection rates. As far a severity of infections go, most think the severity will be moderate (as it is right now, used to be mild) but none would be really surprised by a 1918 severity.
Surf n Turf
07-04-2009, 14:57
Mugwamp,
As the three (3) cases of Tamiflu resistance have been found so geographically dispursed, is it possible there are multiple strains evolving
SnT
HONG KONG, July 3 (Reuters) - Hong Kong's health department said on Friday it had detected a case of human swine influenza virus that was resistant to Tamiflu, the main antiviral flu drug.
The World Health Organisation has declared a pandemic is under way from the new H1N1 virus, also known as swine flu.
"This is the first time Tamiflu resistance in HSI virus (was) found in Hong Kong," a spokesman for the health department said in a statement.
Only two other cases of Tamiflu-resistant H1N1 have been found so far, in Denmark and Japan.
http://www.reuters.com/article/rbssHealthcareNews/idUSHKG30741920090703
Mugwamp,
As the three (3) cases of Tamiflu resistance have been found so geographically dispursed, is it possible there are multiple strains evolving
SnT
[/url]
It's a certainty. The WHO have stated that the virus is "stable" with no mutations found, but that's a total crock. See my 6/18 post. The strain circulating in Argentina is getting particularly close attention.
That Hong Kong case you cite was in a passenger returning from the USA on a non-stop flight, BTW. She was described as asymptomatic, so I don't know how she was flagged at the airport.
My daughter was put into quarantine several weeks ago after landing in Sydney with a 102F fever (she was feeling fine when she took off from LA). She was ID'd by an infrared camera in the airport that was screening arrivees. She was positive for swine flu and was a guest of the Oz gov't for a week. Her course was notable for "epic" (her word) diarrhea and moderate vomiting. She had a very mild cough as her only respiratory symptom. Total bill was $70US for a week's stay with Tamiflu and IV fluids.
In my opinion she won the lottery...just hope when it hits in the fall that it hasn't acquired too many mutations and she's still immune.
The Reaper
07-09-2009, 11:57
Hmm.
Where is the media coverage of this?
TR
http://www.reuters.com/article/topNews/idUSTRE5685ER20090709?feedType=RSS&feedName=topNews&rpc=22&sp=true
Parts of Britain "near an H1N1 epidemic"; 14 dead
Thu Jul 9, 2009 12:30pm EDT
LONDON (Reuters) - Fourteen Britons who had contracted H1N1 flu have died and the rapid spread of infection in two areas of the country is close to epidemic level, health officials said on Thursday.
The Department of Health said Britain now had 9,718 laboratory-confirmed cases, the third most in the world behind the United States and Mexico.
Britain's Chief Medical Officer Liam Donaldson said the actual number of cases was likely to be higher.
All 14 who have died had underlying health issues and it was not clear in how many cases the patients had died as a direct result of the virus, known as swine flu.
"In London and the West Midlands we are getting pretty close to epidemic levels. We've seen big surges there," Donaldson told
BBC TV.
"For the country as a whole, the average is about the level of the flu season but in some parts of the country the levels are getting pretty big."
The World Health Organization declared on June 11 that the outbreak of the virus was a pandemic and more than 94,500 cases have been reported worldwide.
Health Minister Andy Burnham said last week the government was projecting more than 100,000 new cases a day of the flu by the end of August.
While most people who have caught the infection have suffered mild symptoms, in a small minority it has proven more severe.
The Department of Health said that 335 people in Britain were currently in hospital after contracting the infection, with 43 of those described as critical.
Donaldson said there were no signs the virus was becoming more virulent, although he warned it could mutate.
"It does tend to affect people with underlying illnesses quite severely and a small number of healthy adults can get the severe complications of flu but the majority of them get a mild illness," he said. (Reporting by Michael Holden; Editing by Louise Ireland and Steve Addison)
Donaldson said there were no signs the virus was becoming more virulent, although he warned it could mutate.
"It does tend to affect people with underlying illnesses quite severely and a small number of healthy adults can get the severe complications of flu but the majority of them get a mild illness," he said.
"It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change."
- Charles Darwin
Richard's $.02 :munchin
And there are worse things going on in Argentina, flu-wise, than in the UK.
The press has lost interest. They can't use the issue to flog Bush anymore and hey, there's Michael Jackson to eulogize. They will wake up in the fall when we first exceed respirator capacity and hospitals implement their triage protocols.
What I find interesting is how they always repeat the mantra about the dead having underlying conditions. Pretty broad category, because the WHO list of underlying conditions for H1N1 includes individuals who are overweight (not obese, just outside the ideal range for height), pregnant, have ever had a single episode of asthma, have metabolic syndrome (basically sloppy and pre-diabetic), are sedentary, and on and on.
My guess is that 50% of the US population qualifies as having underlying conditions according to the guidelines.
Sent: Thu 7/9/2009 10:25 AM
From: John O. Brennan, The White House [info@messages.whitehouse.gov]
Subject: Preparing for H1N1 and the upcoming flu season
As the President's advisor on Homeland Security, I am passing along the following message from Kathleen Sebelius, Secretary of Health and Human Services, Janet Napolitano, Secretary of Homeland Security, and Arne Duncan, Secretary of Education, who are leading the efforts to prepare our Nation for the coming flu season.
Fellow Americans,
This spring we were confronted with an outbreak of a troubling flu virus called 2009-H1N1. As the fall flu season approaches, it is critical that we reinvigorate our preparedness efforts across the country in order to mitigate the effects of this virus on our communities.
Today, we are holding an H1N1 Influenza Preparedness Summit in conjunction with the White House to discuss our Nation's preparedness. We are working together to monitor the spread of 2009-H1N1 and to prepare to initiate a voluntary fall vaccination program against the 2009-H1N1 flu virus, assuming we have a safe vaccine and do not see changes in the virus that would render the vaccine ineffective.
But the most critical steps to mitigating the effects of 2009-H1N1 won't take place in Washington — they will take place in your homes, schools and community businesses.
Taking precautions for this fall's flu season is a responsibility we all share. Visit Flu.gov to make sure you are ready and learn how you can help promote public awareness.
We are making every effort to have a safe and effective vaccine available for distribution as soon as possible, but our current estimate is that it won't be ready before mid-October. This makes individual prevention even more critical. Wash your hands regularly. Take the necessary precautions to stay healthy and if you do get sick, stay home from work or school.
We are doing everything possible to prepare for the fall flu season and encourage all Americans to do the same — this is a shared responsibility and now is the time to prepare. Please visit Flu.gov to learn what steps you can take to prepare and do your part to mitigate the effects of H1N1.
Take Care,
Kathleen, Janet and Arne
I can't wait to see what the PLAN.
...She was positive for swine flu and was a guest of the Oz gov't for a week. ... Total bill was $70US for a week's stay with Tamiflu and IV fluids.
I got the rest of the bill yesterday. :eek: Any Australians following this thread can rest assured that the gov't made a profit on her stay.
doctom54
07-09-2009, 19:15
NEJM
http://content.nejm.org/cgi/content/full/361/2/112?query=TOC
Has a good article on how hard it is to make good policy when hard data is difficult to come by. Especially early in an epidemic of a new influenza when the true mortality rate isn't known.
I had an employee return from Mexico Monday with fever and chills starting 12 hours after returning and about 8 hours before reporting to work. After many phone calls and other crap I got a rapid (8 hours later) result of positive for Influenza A. Only the state lab can type for H1N1. They refused to type it.
Makes me wonder how this one will be reported. CDC says 99% of influenza A's in week 25 are H1N1.
A pithy report on new research with clarifying quotes from the principal investigator: New flu resembles feared 1918 virus: study (http://uk.reuters.com/article/idUKTRE56C3K120090713?rpc=401&) They report primary H1N1 viral infection deeper in the lungs, which also implies (at least to me) a higher risk of follow-on bacterial pneumonia.
On a different tack, it's instructive to look at the reports coming right now out of Argentina. It's a mess down there and the southern hemisphere season is just starting to get into full swing. Some reports have some regional death rates at over 2% (which is 1918 levels) but I strongly suspect that is due to under-reporting the total number of cases. But who knows? Schools closed, H1N1 "bank holidays", sporting events canceled, etc. Masks, gloves, hand sanitizer, Tamiflu all nonexistent and fights breaking out in stores when anything does become available. Flights from Brazil and Venezuela cancelled. Land routes closed by Uruguay, Paraguay.
The Argie gov't did a horrible job of informing the populace and instead tried to cover up the true severity of the problem. Lots of lessons, hope we're learning. And I hope an effective vaccine arrives in time for our season.
30 More Swine Flu Cases Reported At AF Academy
Fewer In Isolation Thursday
Written by Wayne Harrison, Web Editor
POSTED: 9:16 am MDT July 16, 2009
AIR FORCE ACADEMY, Colo. -- Thirty more cases of the H1N1 virus, also known as swine flu, have been reported by the Air Force Academy, bringing the total number of confirmed cases on the campus to 97. Of those, 93 cadets remained isolated with influenza-like symptoms.
Academy spokesman said the outbreak has probably reached its peak.
"We're having less in isolation now," John Van Winkle said. "We're on the downward trend."
The academy outbreak is the largest so far in Colorado, which reported 146 confirmed cases through last week.
Those showing symptoms were placed in a separate dormitory on the base near Colorado Springs late last week.
The "doolies," or members of the incoming freshman class, are among about 1,300 recent arrivals for their first weeks of military training.
http://www.thedenverchannel.com/health/20073855/detail.html
incarcerated
07-16-2009, 23:04
http://www.mercurynews.com/california/ci_12854623
Calif reports 55 swine flu deaths, 23 in last week
The Associated Press
Posted: 07/16/2009 06:43:10 PM PDT
Updated: 07/16/2009 06:43:10 PM PDT
SAN DIEGO—The total of people who have died of swine flu in California is up to 55, an increase of 23 over the past week, state health officials said Thursday as they warned of more serious cases on the way.
"We expect to continue to see more cases of swine flu, more serious cases and, unfortunately, more deaths," said Ken August, spokesman for the California Department of Public Health.
Though health officials expected the spread of swine flu to slow in the hot summer months, as influenza viruses often do, the virus hasn't gone away, August said.
"While the majority of cases have been mild so far, public health officials remain very concerned that the virus could evolve into a more serious strain of influenza," he said.
In San Diego County, health officials said Thursday that two more people with underlying health problems died of swine flu. The latest victims there were a 57-year-old man who died on Monday and a 25-year-old man who died Wednesday.
No other details were released. The latest deaths bring the county's death toll to 9.
Swine flu symptoms are like a typical flu, which causes infected people to experience fever, cough, sore throat, body aches, headache, chills and fatigue.
We're a service economy dontcha know -- manufacturing is sooo 20th century. And I think the number is "only 16%" but I guess they're rouding up...
Fight for swine flu vaccine could get ugly (http://news.yahoo.com/s/ap/20090716/ap_on_he_me/eu_med_vaccine_fight)
LONDON – An ugly scramble is brewing over the swine flu vaccine — and when it becomes available, Britain, the United States and other nations could find that the contracts they signed with pharmaceutical companies are easily broken.
Experts warn that during a global epidemic, which the world is in now, governments may be under tremendous pressure to protect their own citizens first before allowing companies to ship doses of vaccine out of the country.
That does not bode well for many countries, including the United States, which makes only 20 percent of the flu vaccines it uses, or Britain, where all of its flu vaccines are produced abroad.
"This isn't rocket science," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "If there is severe disease, countries will want to hang onto the vaccine for their own citizens."
Red Flag 1
07-17-2009, 10:08
Tic, tic, tic......
RF 1
The Reaper
07-22-2009, 11:22
Could it be we have more reported cases because we actually test and report, to some greater degree?
TR
http://www.time.com/time/health/article/0,8599,1912087,00.html
Think H1N1 Is Bad Now? Wait Till Flu Season
By Bryan Walsh Wednesday, Jul. 22, 2009
When the World Health Organization announced on July 16 that it would stop issuing global counts of confirmed cases of the H1N1/09 virus (the new WHO-approved name differentiates the virus from older versions of H1N1), it wasn't because the disease had burned out. Far from it.
Since the new flu virus was officially declared a pandemic on June 11, the disease has spread faster in six weeks than past pandemics had spread in six months. Virtually every nation in the world has been infected, with the U.S. alone — which has 263 confirmed deaths, more than any other country — estimated to have logged more than 1 million cases. Although the good news is that most H1N1/09 illnesses have been extremely mild, the rapidity of its spread — and the fact that young people seem to be especially vulnerable — still worries global health officials. "We don't know if it will actually ever completely go away," says David Butler Jones, the public health chief of Canada, which has been unusually hard-hit. "We're still seeing new cases, so nobody should let down their guard."
(cont. at link)
"......Experts warn that during a global epidemic, which the world is in now, governments may be under tremendous pressure to protect their own citizens first before allowing companies to ship doses of vaccine out of the country.
That does not bode well for many countries, including the United States, which makes only 20 percent of the flu vaccines it uses, or Britain, where all of its flu vaccines are produced abroad...."
I seem to recall that a long time ago we talked about vaccine product and why it moved out of the US.
I seem to recall the D's fingerprints all over it. I seem to recall years ago that many talked about this darm same thing happening if an epidemic hit.
incarcerated
07-22-2009, 23:54
This is a blinding flash of the obvious, but the study dimension is worth noting in passing.
http://www.ethiopianreview.com/articles/15700
Air Traffic Patterns Predict Swine Flu Spread
Posted by Desta Bishu | July 19th, 2009 at 1:46 pm
Countries that received the most airline passengers from Mexico this spring were the most likely to see H1N1 swine flu infection, new research says.
The finding confirms that tracking global flight patterns to determine where an infectious disease may strike next could provide governments and public health officials with a means of preventing and dealing with such threats, according to an analysis by researchers in Canada.
“Infectious diseases don’t respect national boundaries, and we live in an incredibly interconnected world,” said Dr. Kamran Khan, an infectious disease physician and scientist at St. Michael’s Hospital in Toronto. “Yet, infectious diseases do follow airline flight routes. If we can understand how people move around the world, we can understand how infectious diseases are likely to spread around the world.”
The findings were published online June 29 in a letter to the editor in the New England Journal of Medicine....
The database used in the study, called the Bio.Diaspora Project, includes world air-travel patterns that represent 99 percent of the world’s commercial air traffic, Khan said. The information, which was collected with the cooperation of several international airport and airline associations, includes itineraries from 2.2 billion passengers and flight schedules from 3,500 airports in about 250 nations and territories worldwide dating to January 2000.
Researchers plan to use the database, which does not connect itineraries with specific passenger names, to help determine where newly emerging infectious diseases are most likely to turn up....
I for one will not be raising my hand for this one. http://www.umm.edu/news/releases/H1N1_flu_vaccine.htm. A news report (CBS) said yesterday that 8 facilities were chosen around the U.S. for preliminary trials of 2 new vaccines for H1N1. I'm just hoping that these work, and don't wind up spreading the love to the populace.
The Reaper
07-24-2009, 09:15
http://www.foxnews.com/story/0,2933,534735,00.html?test=latestnews
CDC: Up to 40 Percent of Americans May Get Swine Flu Over Next 2 Years
Friday, July 24, 2009
U.S. health officials say swine flu could strike up to 40 percent of Americans over the next two years and as many as several hundred thousand could die if a vaccine campaign and other measures are not successful.
Those estimates from the Centers for Disease Control and Prevention mean about twice the number of people who usually get sick in a normal flu season would be stricken by swine flu. Officials said those projections would drop if a new vaccine is ready and widely available, as U.S. officials expect.
The U.S. may have as many as 160 million doses of swine flu vaccine available sometime in October, and U.S. tests of the new vaccine are to start shortly, federal officials said this week.
The infection estimates are based on a flu pandemic from 1957, which killed nearly 70,000 in the United States but was not as severe as the infamous Spanish flu pandemic of 1918-19. But influenza is notoriously hard to predict. The number of deaths and illnesses would drop if the pandemic peters out or if efforts to slow its spread are successful, said CDC spokesman Tom Skinner.
A CDC official said the agency came up with the estimate last month, but it was first disclosed in an interview with The Associated Press.
"Hopefully, mitigation efforts will have a big impact on future cases," Skinner said.
In a normal flu season, about 36,000 people die from flu and its complications, according to American Medical Association estimates. Because so many more people are expected to catch the new flu, the number of deaths over two years could range from 90,000 to several hundred thousand, the CDC calculated. Again, that is if a new vaccine and other efforts fail.
First identified in April, swine flu has so far caused about 263 U.S. deaths, according to the latest numbers. CDC officials say it's likely that more than 1 million Americans have become sick from the virus, although many were probably mild cases never reported.
Because the swine flu virus is new, most people have not developed an immunity against it. So far, most of those who have died from it in the United States have had other health problems, such as asthma.
The virus has caused an unusual number of serious illnesses in teens and young adults; seasonal flu usually is toughest on the elderly and very young children.
New swine flu illness have erupted through the summer, which is also unusual, though cases were less widespread this month. Officials fear an explosion of cases in the fall, when children return to school and the weather turns cold, making the virus easier to spread.
http://www.foxnews.com/story/0,2933,534735,00.html?test=latestnews
CDC: Up to 40 Percent of Americans May Get Swine Flu Over Next 2 Years
Friday, July 24, 2009
U.S. health officials say swine flu could strike up to 40 percent of Americans over the next two years and as many as several hundred thousand could die if a vaccine campaign and other measures are not successful.
<snip>
The working number I've heard in meetings is 434,000 excess deaths if the vaccines don't work or are significantly delayed. That represents a case fatality ratio (CFR) of 0.35%. If the virus mutated to a more virulent strain and produced a CFR of 2.5% as in 1918, there'd be 3,100,000 excess deaths.
310,000,000 pop x 40% infection rate x 0.0035 case fatality rate = 434,000 deaths.
Right now the worldwide CFR seems to be averaging about 0.1%, which would produce 124,000 excess deaths in the US. There are pockets where we currently see a CFR of 0.35% (Argentina) and maybe the expectation is that those numbers represent a more virulent strain that we can expect to see in the fall. I'm not really in the position to ask -- I have more of a shut-up-and-listen role -- and I'm not really interested enough right now to pore through the flu blogs and find out.
Right now it's anybody's guess, but if I were a betting man I'd wager on the lower end of the scale - say 0.1%-0.2% or 124K - 248K excess deaths. That's very mild by pandemic standards but unfortunately the young will be disproportionately represented.
6.8SPC_DUMP
07-31-2009, 03:03
Could anyone knowledgeable please clarify:
Why the CDC stopped counting Swine flu deaths when there were an est. 800 world-wide?
http://www.reuters.com/article/GCA-SwineFlu/idUSTRE56N3PQ20090724
Would taking a non-effective Swine Flu vaccine, be likely more dangerous than contracting a mediem level Swine Flu, for the avg. person?
Thanks for all the information so far Gentlemen.:lifter
Also...
Military planning for possible H1N1 outbreak http://edition.cnn.com/2009/US/07/28/military.swine.flu/
Story Highlights:
Military wants to establish regional teams to help civilian authorities respond in the event of a significant outbreak of the H1N1 virus this fall
Proposal awaiting final approval from Defense Secretary Robert Gates
Military could provide support such as air transport, large-scale testing
Could anyone knowledgeable please clarify:
Why the CDC stopped counting Swine flu deaths when there were an est. 800 world-wide?
http://www.reuters.com/article/GCA-SwineFlu/idUSTRE56N3PQ20090724
Would taking a non-effective Swine Flu vaccine, be likely more dangerous than contracting a mediem level Swine Flu, for the avg. person?
Thanks for all the information so far Gentlemen.:lifter
1. a) Because the count is wildly inaccurate (most now think there were ~600 deaths just in the initial outbreak in Mexico) b) labs around the world are overwhelmed with testing and most have stopped 3) even a very mild pandemic (0.1% CFR) will produce 2.4 million excess deaths worldwide. You gotta stop counting some time.
2. As you set this up: don't take the vaccine. Every vaccine has risks and if you know it doesn't work and you know you'll survive then why take it? If you are trying to judge whether or not to take a possibly ineffective vaccine, then you are stuffed. You need to know the effectiveness level of the vaccine (unknown, and will vary from person to person in any case), the vaccine's toxicity profile (unknown), the virulence of the flu you catch (40,000 die from 'mild' flu in the US every year), and that you are average. Have you ever smoked? Over your ideal weight for height? Ever had pneumonia or a single asthma attack? Aged 12-22? Pregnant? Then you are not average (there are dozens more risk factors).
incarcerated
08-03-2009, 12:03
Fortunately this is more of a rodent vector problem than an airborne/respiratory one, and should remain localized. While not strictly flu related, I post it here for its public health value and general SA.
http://www.latimes.com/news/nationworld/nation/la-fg-china-plague4-2009aug04,0,3851857.story
Pneumonic plague reported in remote western China
Three deaths and several illnesses are attributed to the disease. Health officials close access to Ziketan, a town of 10,000 in Qinghai province that is mostly populated by Tibetans.
By Barbara Demick and Joshua Frank
10:15 AM PDT, August 3, 2009
Reporting from Beijing -- Chinese health officials have cordoned off a remote western town after three deaths caused by the rare but deadly pneumonic plague.
The victims all lived in Ziketan, a town of 10,000 in Qinghai province that is mostly populated by Tibetans.
The first victim was a 32-year-old herdsman who died Thursday, four days after falling ill with a fever and cough. State radio reported that the man contracted the illness from his dog, which apparently was infected after being bitten by a flea. The herdsman's 37-year-old neighbor died Sunday and a 64-year-old man died today.
Another nine people were reported to be ill or under observation, one of them in critical condition, at the Tibetan Hospital of Xinghai county.
"Experts continue to carry out disinfecting and pest control work and are tracing people in contact with victims for quarantine purposes," the New China News Agency reported today.
Pneumonic plague is the even deadlier relative of the notorious bubonic plague, which killed millions in Europe in the Middle Ages. Spread person to person through the air, it usually kills all its victims unless they are treated with antibiotics....
1. The second wave is expected to start in late August (coinciding with the start of the school year).
2. There won't be enough vaccine for the early-mid second wave under even the most optimistic projections. Distribution will be targeted. I assume Congress will be first in line, followed by lobbyists...
3. Projected CFR for planning purposes remains at 0.35%. I'm still hoping it stays at 0.1%.
4. Masks and handwashing appear to work at preventing the spread of flu within a household (see below -- by extension this implies to me that they would also prevent initial infections if used outside the home). If someone in your house comes down with the flu it is not cowardly or demoralizing to the patient to wear masks and religiously wash hands. Even with mild virulence, the healthcare system will be overwhelmed with flu cases; you may be the only caregiver your loved ones will have. Do your best not to go down, especially if you have children or young adults under your care. Make sure you have adequate supplies for home care.
A synopsis of a study of the effects of masks/handwashing on flu transmission with households is cited here (http://scienceblogs.com/effectmeasure/2009/08/the_hand_washingface_mask_pape.php#more). And here's the money shot:
...An adjusted odds ratio for households of .33 was found for the hand plus mask group compared to control. This means that the odds of having a secondary case was one third of what it would be if you were in a household in the hand plus mask group compared to the control group... <snip > ...Said another way, there was evidence that being in a household in the hand plus mask group made it less likely you would have a secondary case in the house, given that you had one person sick. The intervention was effective.
N95 masks are currently plentiful and relatively cheap (get ones with an exhalation valve if possible and your pocketbook allows). You know what will happen when the flock lifts its head in unison.
Monsoon65
08-05-2009, 16:18
Mugwump:
A few pages back, you and InTheBlack were discussing these meds:
Originally Posted by InTheBlack
It looks like one course of
Relenza
Augmentine or amoxacillin/clauvulate - $4
Zitromax or erythromycin - $4
Zocor or any statin $30
What is a good substitute for Augmentine/Amoxacillin if you have someone with a PCN allergy?
InTheBlack
08-06-2009, 02:36
How many gallons of pedialyte might one desire to have on hand to last through one person's infection?
Is there a good way to flavor the expedient electyrolyte mix formula?
InTheBlack
08-06-2009, 02:53
My daughter was put into quarantine several weeks ago after landing in Sydney with a 102F fever ... She was positive for swine flu and was a guest of the Oz gov't for a week. Her course was notable for "epic" (her word) diarrhea and moderate vomiting. She had a very mild cough as her only respiratory symptom.
By now, is there a recognized symptomology for H1N1 versus the intestinal illness / diarrhea caused by other pathogens (like the bug that hits cruise ships)? Not much fever & lack of respiratory problems don't seem like the flu.
Back around April/May I had a real bad stomach bug that was very "active" for 5-7 days and still "waning" for another week, but no respiratory problems in comparison. Felt much better after ~5 days when I finally managed to vomit. I couldn't go out sick so it was worse than if I took care of myself.
Then I came back home (at around 1 week) & gave it to the wife; she had lots of vomiting and much less lower intestinal problems, but it lasted a long time too. Figured maybe she upchucked enough that it didn't infect her gut so much.
Mugwump:
A few pages back, you and InTheBlack were discussing these meds:
Originally Posted by InTheBlack
It looks like one course of
Relenza
Augmentine or amoxacillin/clauvulate - $4
Zitromax or erythromycin - $4
Zocor or any statin $30
What is a good substitute for Augmentine/Amoxacillin if you have someone with a PCN allergy?
A respiratory fluoroquinolone: moxifloxacin, gemifloxacin, or levofloxacin. I am not a doctor -- just a reminder. Check the contraindications for the drugs before you choose.
By now, is there a recognized symptomology for H1N1 versus the intestinal illness / diarrhea caused by other pathogens (like the bug that hits cruise ships)? Not much fever & lack of respiratory problems don't seem like the flu.
Back around April/May I had a real bad stomach bug that was very "active" for 5-7 days and still "waning" for another week, but no respiratory problems in comparison. Felt much better after ~5 days when I finally managed to vomit. I couldn't go out sick so it was worse than if I took care of myself.
Then I came back home (at around 1 week) & gave it to the wife; she had lots of vomiting and much less lower intestinal problems, but it lasted a long time too. Figured maybe she upchucked enough that it didn't infect her gut so much.
Symptomology is variable. Fever is usually present, usually high, but there are cases reported without fever. See pandemicflu.gov.
InTheBlack
08-06-2009, 21:12
This means that people need to stay home an extra day to avoid spreading the Mexican Swine Novel Influenza 2009 H1N1 Flu.
Date: Thu, 06 Aug 2009 19:50:48 -0400
From: "Clinician Outreach and Communication Activity (CDC)" <coca@CDC.GOV>
Subject: CDC Health Advisory - August 6,
2009 - CDC Updates Recommendations for the Amount of Time Persons with
Influenza-Like Illness should be Away from Others
This is an official
CDC Health Advisory
Distributed via Health Alert Network
August 06, 2009, 19:00 ET (7:00 PM ET)
CDCHAN-00297-09-08-06-ADV-N
CDC Updates Recommendations for the Amount of Time Persons with Influenza-Like Illness should be Away from Others
On August 5, 2009, CDC changed its recommendation related to the amount of time people with influenza-like illness should stay away from others (the exclusion period).
New guidance indicates that people with influenza-like illness should stay home for at least 24 hours after their fever is gone (without the use of fever-reducing medicine).
A fever is defined as having a temperature of 100° Fahrenheit or 37.8° Celsius or greater.
This is a change from the previous recommendation that ill persons stay home for 7 days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer.
SNIP
How many gallons of pedialyte might one desire to have on hand to last through one person's infection?
Is there a good way to flavor the expedient electyrolyte mix formula?
You could look up a mix on Google, its just salt, sugar, and sometimes sodium bicarbonate. Kool-Aid if you need flavor.
InTheBlack
08-08-2009, 00:01
kool aid has sugar, which would unbalance the mix. If artificial -- that stuff usually promotes the runs, so might be counterproductive.
Peregrino
08-08-2009, 11:54
kool aid has sugar, which would unbalance the mix. If artificial -- that stuff usually promotes the runs, so might be counterproductive.
Use the original KoolAid packets (the ones you have to add the sugar to). There's enough sugar in the electrolyte mix to make it palatable and they provide a wider range of flavors. Experiment before you need to feed it to a sick family member, some of them are undrinkable even before adding the electrolytes.