The Deadly Flu

Recent D225G Swine Flu mutation

noreply@blogger.com (Andrew Mason) — Mon, 23 Nov 2009 15:29:00 +0000

'According to analysis of genetic testing done by the World Health Organization, the Ukraine flu virus is an H1N1 mutation that is similar to the 1918 Spanish flu epidemic. The two flu virus outbreaks both have changes in the receptor binding domain D225G, and similar symptoms, which include bleeding in the lungs. Current estimates of the deaths attributed to the Ukraine flu outbreak is as many as 400, and increasing daily.'

See the full article on Examiner.com here.

This follows World Health Organization Pandemic (H1N1) 2009 briefing note 17 ('Public health significance of virus mutation detected in Norway') here. The note begins thusly: 'The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness.'

According to the WHO, 'The significance of the mutation is being assessed by scientists in the WHO network of influenza laboratories. Changes in viruses at the genetic level need to be constantly monitored.'

Swine flu vaccination - What you need to know

noreply@blogger.com (Andrew Mason) — Mon, 09 Nov 2009 13:54:00 +0000

By Lorena Tonarelli MSc

Swine flu vaccination is finally under way. And just in time. After a period of slower activity, at the end of the summer, the 2009 H1N1 virus has started spreading again, and the number of swine flu cases is climbing.

Priority groups

Millions of doses of the vaccine are now available – nearly 11.5 million in the US, as of mid-October, according to the Centers for Disease Control and Prevention (CDC). They will be offered first to:

Health care staff.
Pregnant women.
People who care for, or live with, babies younger than six months. This is particularly important, as babies below six months of age cannot receive the vaccine, so they are among the most vulnerable, because they are unprotected.
Babies and young children aged 6 months to 4 years.
Children and adults aged 5 to 18 years with underlying medical problems (asthma, diabetes, liver disease, etc.) or damaged immune systems (chemotherapy patients, AIDS sufferers, and those on steroids).

Then, it will be the turn of everyone aged 18 to 64.

Two types

The H1N1 flu vaccine can be administered with an injection, usually in the upper arm, or with a nasal spray. Remember, the nasal spray vaccine is indicated only for people aged between 2 and 49, who are not pregnant, and have no chronic health problems, like asthma, diabetes, heart conditions, and kidney failure.

Most people will need only one dose. However, the CDC recommends that children aged nine years or under be given two doses, four weeks apart.

Contraindications

Only a few people cannot receive the 2009 H1N1 vaccine. These include those who previously had

the paralytic disorder Guillain-Barré Syndrome (GBS); or
an allergic reaction to the seasonal flu vaccine.

Also, the vaccine cannot be given to people who are allergic to

eggs and egg-derived products; and/or
any component of the vaccine.

People with fever, or other illness, may be asked to wait until they recover, before being vaccinated. There are, usually, no contraindications in case of a mild cold.

Swine and seasonal flu vaccines

The swine flu vaccination campaign, which is estimated to take not less than eight weeks to complete, is being undertaken at the same time as the seasonal flu vaccination campaign. This is generating some confusion, particularly among those who need both vaccines, like pregnant women and people with underlying health problems.

According to the CDC, the 2009 H1N1 flu vaccine and the seasonal flu vaccine can be given at the same time, either as two flu shots or one shot and one nasal spray dose. They cannot be given at the same time, if both are in nasal spray form.

Why should you get the vaccine?

Because

vaccination will protect you from infection, and its serious, potentially fatal complications, like pneumonia; and
will prevent you from passing it onto your family–your children. So, they will less likely to get ill, too.

And because the more people are vaccinated the less the swine flu will spread. This will reduce the risk of infection for those who cannot receive the vaccine, like babies younger than six months. It will also avoid disruption to hospitals and physician’s offices, allowing doctors and nurses to care for those who become ill.

Justified concerns over availability

The vaccination program is voluntary. So, people will have to make their own decision as to whether they want to be vaccinated. The hope is that most of them will, so as reduce the spread of the virus and to avoid unnecessary deaths.

Some argue this is highly unlikely, because there won’t be enough vaccine for everybody. This may sound like alarmism, but, according to Dr. Anne Schuchat, of the CDC, a shortage of the 2009 H1N1 vaccine is a real possibility.

In a briefing, held October 16, Dr. Schuchat said: “It's very difficult to predict exactly how many doses we'll have in the weeks ahead… some of the manufacturers have let us know that the production of the vaccine is likely to be a bit delayed in terms of the number of doses they were expecting to have out… [so] it doesn't look like we're going to be able to make those estimates that we had projected for the end of this month.”

She added: “We had hoped … we might be around 40 million doses … [now] we think at most it might be about a 10 to 12 million doses fewer than that.”

No shortcut taken

Shortage is not the only factor that could undermine this vaccination campaign. There’s another problem. Recent polls have shown that a large number of people don’t intend to receive the swine flu vaccine. They think it’s too risky.

There are fears that the 2009 H1N1 vaccine may be unsafe because it has been rushed. But, health officials say these worries are unfounded, and assure that the vaccine has undergone all the necessary safety and efficacy tests.

“It's important for people to know that the H1N1 influenza vaccine is being made exactly the same way that seasonal flu vaccines are made,” said Dr. Schuchat. “100 million people get those every year and we believe there's a very strong safety record for them including many pregnant women… and many children…”

“We have [also] increased our safety monitoring efforts… we’re not taking that for granted. No shortcuts are being taken… in the way this vaccine is being produced.”

Side effects are mild

In fact, several clinical trials are currently being carried out to constantly monitor the effects of the 2009 H1N1 vaccine in children and adults. The preliminary results of a study published in the New England Journal of Medicine show no deaths or serious adverse events among individuals aged 18 to 64 years, who received the vaccine. Only mild side effects, mostly tenderness or pain at the site of injection, were reported.

Other data, from the vaccination program that is being conducted in China, show that only 4–out of 39,000–people who received the vaccine experienced side effects. These were minor problems, such as muscle cramps and headache.

What about Guillain-Barré Syndrome?

Probably the biggest worry in terms of side effects is the paralytic disorder Guillain-Barré Syndrome, for which some research suggests a possible association with the H1N1 vaccine.

There are two things to consider in this regard. First, the supposed association between Guillain-Barré Syndrome and the H1N1 vaccine refers to data from studies conducted on the swine flu outbreak of 1976. No flu vaccine has been associated with GBS, in studies, since then.

Second, according to scientists, the risk of developing GBS from the H1N1 vaccine is approximately one case per million people vaccinated. This should be balanced against the number of deaths from flu-related complications, which is 1 in 8,300 each year.

Preservative-free version available

Another concern is the possible link between thimerosal (a mercury-based preservative contained in the 2009 H1N1 vaccine) and autism. Dr. Schuchat said “there’s no scientific basis for those concerns.” However, in order to not deter people from wanting to be vaccinated because of the preservative, the vaccine also comes as a thimerosal-free nasal spray. Thimerosal-free pre-filled single syringes will soon be available.

Adjuvant free

Dr. Schuchat also confirmed that the 2009 H1N1 vaccine does not contain squalene-based adjuvants, or any other adjuvant.

Squalene is a natural oil found in humans, animals and plants. It is used in substances called ‘adjuvants’, which are added to vaccines to increase their efficacy. Squalene has been linked with incurable autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis and lupus.

“None of the [H1N1] vaccine being shipped out has adjuvants,” said Dr. Schuchat, “and we’re not expecting to use it this season.”

The “best protection”

“[This] vaccine is the best protection against this virus,” said Dr. Schuchat. And this is the first time in history that people have a vaccine against a pandemic flu. It just seems irresponsible not to vaccinate and, by doing so, allow the same devastation of past pandemics to occur.

References

Evans D., Cauchemez S., Hayden F.G. “Prepandemic immunization for novel influenza virus, swine flu vaccine, Guillain-Barré syndrome, and the detection of rare severe adverse events,” Journal of Infectious Diseases, August 1, 2009, 200(3):321-8.
Greenberg M.E., Lai M.H., Hartel G.F., Wichems C.H., Gittleson C., Bennett J., Dawson G., Hu W., Leggio C., Washington D., Basser R.L. “Response after one dose of a monovalent influenza A (H1N1) 2009 vaccine – preliminary report,” New England Journal of Medicine, September 10, 2009. DOI: 10.1056/NEJMoa0907413.
Centers for Disease Control and prevention (CDC), H1N1 flu vaccination resources. http://www.cdc.gov/h1n1flu/vaccination. [Accessed 10.18.09]
Centers for Disease Control and prevention (CDC), U.S. Department of Health and Human Services, Press Briefing Transcript, October 16, 2009.
Centers for Disease Control and prevention (CDC), U.S. Department of Health and Human Services, Vaccine information statement – 2009 H1N1 inactivated influenza vaccine, October 2, 2009.
U.K. Department of Health (DH) H1N1 swine flu vaccination program 2009-2010, October 2, 2009.
World Health Organization (WHO), Squalene-based adjuvants in vaccines. www.who.int/vaccine_safety/topics/adjuvants/squalene/questions_and_answers/en/index.html. [Accessed 10.20.09]

Iowa Department of Public Health: 'Protecting Pets from Illness'

noreply@blogger.com (Andrew Mason) — Thu, 05 Nov 2009 15:03:00 +0000

'The Iowa Department of Public Health (IDPH) and the Iowa Department of Agriculture and Land Stewardship (IDALS) remind Iowans that in addition to protecting their families, friends and neighbors from the spread of the 2009 H1N1 influenza virus, it’s important to remember to protect family pets from the illness, as well. People who are sick with H1N1 can spread the virus not only to humans, but to some animals.

'The Departments are sharing this message following the confirmation of a case of H1N1 in an Iowa cat.

'The 13-year-old indoor cat in Iowa was brought to the Lloyd Veterinary Medical Center at Iowa State University’s College of Veterinary Medicine, where it tested positive for the H1N1 virus. The diagnosis is the culmination of collaborative efforts between IDPH, Iowa State University College of Veterinary Medicine, Center for Advanced Host Defenses, Immunobiotics and Translational Comparative Medicine, USDA, and IDALS Animal Industry Bureau.'

Tips on how to spot and prevent infection in your cat (and dog), as well as much more, is available in Chapter 13: Keeping influenza A(H1N1) at Bay of our comprehensive swine flu preparedness manual.

Read the full article from the Iowa Department of Public Health's website here.

Critical Infrastructure Guide

noreply@blogger.com (Andrew Mason) — Mon, 26 Oct 2009 15:11:00 +0000

'According to the Congressional Budget Office, a severe pandemic might cost the U.S. economy more than $600 billion, or about 5 percent of the Gross Domestic Product.'

If you run a small or medium business, and/or are responsible for business continuity planning, grab a free download of the Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources PDF, published by the US Department of Homeland Security.

To jump immediately to help with the initial Planning Phase, where you discover actions and supporting actions (as well as further issues to consider) for your business, head straight to section 5.6 COP-E Phases: Planning, Preparedness, Response, and Recovery on page 34. Download it here and print if you can. Every prudent business should keep a printed copy.

Swine Flu worsens in U.S. as child deaths rise to 102

noreply@blogger.com (Andrew Mason) — Mon, 26 Oct 2009 14:17:00 +0000

By Salim Jiwa (October 2009)

ATLANTA – Child deaths from Swine Flu continued to escalate as the U.S. Centers for Disease control reported a “steep” rise in number of visits to doctors across 46 states from the flu epidemic.

Swine Flu has been confirmed to be the cause of death of 9 children during the week of Oct. 11 to Oct. 17 while two other children also died from influenza A but the virus was not sub typed, although it is suspected to be Swine Flu.

The new reported deaths take laboratory confirmed child deaths across the U.S. to 95 with an additional seven child deaths proven to be from influenza A but not subtyped in labs, the CDC said on Friday.

“Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States and overall, are much higher than what is expected for this time of the year,” said the CDC, indicating a full blown epidemic across most of the U.S.

During an analysis of the previous week (identified as week 40) the CDC reported 11 children dead from Swine Flu.

In a briefing last week, Dr. Anne Schuchat of the CDC called the spread of the virus an epidemic.

“And for the first week this fall, we’re seeing that the amount of influenza and pneumonia mortality is above the epidemic threshold,” she said.

“All of these things may suggest it’s a very busy and difficult flu season and we are seeing very high levels of activity around the country,” she said during the briefing last week.

“We are also having updates on the pediatric deaths. Unfortunately those are going up as well. There are now a total of 86 children under 18 who died from this H1N1 influenza virus, the 2009 H1N1 influenza virus,” she said before the tally of child deaths increased this week as she predicted.

“We had 11 more influenza pediatric deaths reported in week 40, which is the week that ends October 10. Ten of those are confirmed to be due to the new strain, the 2009 H1N1 strain and the 11th is probably due to that but the typing hasn’t been completed,” said Dr. Schuchat.

“About half of the deaths that we’ve seen in children since September 1st have been occurring in teens between the ages of 12 and 17. These are very sobering statistics, unfortunately, they are likely to increase,” she correctly predicted.

The latest data released by the CDC on Friday shows an even more dramatic turn for the worse in the U.S. Swine Flu spread. Thousands across the U.S. are sick from the virus.

The highlights of finding released on Friday are as follows:

Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States, and overall, are much higher than what is expected for this time of the year. ILI activity now is higher than what is seen during the peak of many regular flu seasons.
Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year.
The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and has been higher than what is expected at this time of year for two weeks. In addition, 11 flu-related pediatric deaths were reported this week; 9 of these deaths were confirmed 2009 H1N1, and two were influenza A viruses, but were not sub typed. Since April 2009, CDC has received reports of 95 laboratory-confirmed pediatric 2009 H1N1 deaths and another 7 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined.
Forty-six states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu.
Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses.
These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Used with permission: http://license.icopyright.net/creator/use.act?n=vancouverite-997
99

President Obama Signs Emergency Declaration for H1N1 Flu

noreply@blogger.com (Andrew Mason) — Mon, 26 Oct 2009 13:41:00 +0000

Details at US Federal Government level, from flu.gov, discussing the Section 1135 waivers invoked by President Obama after recently declaring a National Emergency:

'Section 1135 of the Social Security Act [42 USC §1320b–5] permits the Secretary of Health and Human Services to waive certain regulatory requirements for healthcare facilities in response to emergencies. Two conditions must be met for the Secretary to be able to issue such “1135 waivers”: first, the Secretary must have declared a Public Health Emergency; second, the President must have declared a National Emergency either through a Stafford Act Declaration or National Emergencies act Declaration. If these conditions are met, then healthcare facilities may petition for 1135 waivers in response to particular needs, and only within the geographic and temporal limits of the emergency declarations.'

Full details at http://www.flu.gov/professional/federal/h1n1emergency10242009.html.

BBC: US swine flu vaccines 'delayed'

noreply@blogger.com (Andrew Mason) — Sat, 17 Oct 2009 10:34:00 +0000

Latest update on the US A(H5N1) vaccine situation:

'US officials have warned of delays in the delivery of swine flu vaccines just as deaths from the H1N1 virus climb above epidemic level in some states.

Only 28-30 million doses would be available by the end of the month, said Anne Schuchat of the US Centers for Disease Control and Prevention (CDC).

That was down from an earlier estimate of 40 million.'

See the full BBC article here: http://news.bbc.co.uk/1/hi/world/americas/8311891.stm

Top 10 Travel Tips to Protect You from the H1N1 Swine Flu Pandemic

noreply@blogger.com (Mark Farrell) — Wed, 07 Oct 2009 07:59:00 +0000

At last, you have some well-earned leave for a winter vacation. Perhaps it’s your last opportunity to take advantage of those recession-buster bargain flight deals.

There’s just one major problem to consider. Whether you’re planning a family ski venture in a winter wonderland, or escaping to sunnier climates in the Southern Hemisphere, you’ll need to take special care when travelling...

Because this winter, the H1N1 swine flu is also enjoying a successful world tour – of pandemic proportions. And you could be on its hit list!

So here’s your instant top 10 travel-tip checklist, to help you and your loved ones enjoy a happy and healthy vacation, while reducing your risk of infection by the H1N1 virus.

If you exhibit possible H1N1 symptoms close to your departure date, STAY AT HOME! Don’t put others at risk. Should you fall ill while abroad, contact your Embassy, High Commission or Consulate for advice on English-speaking doctors and local medical services.
Check out the health status of your destined country – before you depart. You can do this online, via the World Health Organisation website. On arrival, some countries screen passengers for H1N1 symptoms and quarantine suspected cases. Get all appropriate vaccinations required for your destination (including seasonal flu).
Make sure you have comprehensive travel/health insurance, check for exclusions and special clauses. Also find out your tour operator’s policy for assisting clients exposed to the H1N1 virus.
Prepare an emergency flu prevention and medical travel kit, small and light enough to pack into your luggage. If you’re flying, check the current airport security restrictions for items you can carry in hand luggage – particularly liquids. Include adequate supplies of alcohol-wipes, hand cleaning gel, disposable tissues, basic medical supplies for flu symptoms (ibuprofen, etc.)
While en-route, by plane: use antibacterial wipes to clean surrounding surfaces (chair-arms, seatbelt, light button, etc.) Avoid touching shared magazines. Take your own pillow and blanket. By train/bus, try to keep windows open for maximum ventilation. (Likewise hotel rooms or apartments.)
KEEP WASHING YOUR HANDS, properly and frequently. Ideally use warm, running water and soap. When travelling, this isn’t always an option. So keep a supply of antibacterial wipes and hand cleaning gels. Shower regularly, especially after journeys. Change into fresh clothes and discard or wash worn garments. When washing is unavailable, refrain from touching eyes, nose and mouth.
Drink lots of bottled water, it’s essential you keep your body rehydrated.
Avoid crowded gatherings or close confinement with other people – especially anyone showing flu-like symptoms. Wipe public surfaces before touching (like door handles, counters, washroom seats, etc.)
Avoid contact with animals – particularly on livestock markets. Animal to human transmission is extremely rare, perhaps impossible at present. But animals may carry the virus. So the less you expose yourself to it, the better.
After returning from an affected area, closely monitor your health for one to two weeks for flu-like symptoms (sore throat, cough, runny nose, headache, muscle aches, etc.) Should you show symptoms, contact your physician or local hospital – by phone, immediately.

All of these tips are recommended by health officials. Although there is no magic formula that can protect you from swine flu, by following these recommendations, you’ll reduce the chance of infection significantly.

Enjoy a fun and relaxing vacation, and stay healthy.

Will it be chaos?

noreply@blogger.com (Andrew Mason) — Fri, 02 Oct 2009 13:29:00 +0000

As winter approaches, the number of swine flu cases requiring hospitalization is expected to increase considerably. Experts say patients will fill up wards and intensive care units, placing healthcare services under unprecedented strain. Will hospitals be able to cope?

While we can’t say for certain what will happen, an interesting insight into the likely scenario comes from a study in the Journal of Hospital Infection.

The study is based on a real-time pandemic simulation exercise conducted in a hospital in England. For 24 hours, all staff at a general medical ward adopted special infection control measures, as required during a full-blown influenza pandemic. These measures include such things as washing hands and wearing surgical masks at all times, even if there is no contact with patients. They also involve major changes in the way care is provided, and are crucial to contain the spread of the H1N1 virus.

The ward chosen for the study is of the kind used for flu patients during a pandemic. All beds were occupied, as expected at the height of the outbreak.

Here are the key findings:

Staff felt uncertain about what to do. The study lead researcher, Dr. Nick Phin, of Cheshire and Merseyside Health Protection Unit, Chester, UK, says: “While staff had a good grasp of basic infection control precautions, they were unsure about the additional measures recommended in the pandemic situation, despite training in the two weeks before the exercise.”
There were too many unnecessary visits to the ward by staff from non-flu areas of the facility, with consequent increased risk of the infection spreading.
Tasks took much longer than usual. “This was particularly obvious at night,” says Phin, “when the drug round took twice as usual to complete.” Staff felt this was due to the increased use of protective equipment – surgical masks, gowns, gloves and respirators – compared to a normal situation.
Staff did not always communicate effectively with each other and with patients, as a result of wearing surgical masks, which also seemed to affect their hearing.

What does all this mean? This study suggests that we should expect to see at least some problems in areas that are key to quality hospital care. For example, overwhelming scientific evidence shows that poor communication and insufficient staff training increase significantly patient recovery time and the risk of medical errors. So, there is a reasonable possibility that care and safety in hospitals might be somehow compromised at the height of the pandemic.

Of course, these findings cannot be generalized to every hospital or country, but they do raise a red flag. What’s more, they support the need to ensure that hospital staff are more adequately trained in pandemic protocols, and to find effective solutions to specific practical problems, like improving communication while wearing surgical masks.

Reference
Phin N.F., Rylands A.J., Allan J., Edwards C., Enstone J.E., Nguyen-Van-Tam J.S. “Personal protective equipment in an influenza pandemic: a UK simulation exercise,” Journal of Hospital Infection, 2009, 71, 15-21.

By Lorena Tonarelli MSc

Analyzing the Effects of Swine Flu in the Southern Hemisphere

noreply@blogger.com (Mark Farrell) — Thu, 24 Sep 2009 08:40:00 +0000

"We need to be prepared for whatever surprises this capricious new virus delivers next"

Margaret Chan, Director General, World Health Organisation

Winter is drawing to a close in the southern hemisphere and as flu season comes to an end, experts in the northern hemisphere are analyzing the impact of the H1N1 swine flu virus. Government agencies and infectious disease experts in northern countries report primarily good news based on the effects of swine flu in Australia, New Zealand, Chile, Argentina and Uruguay.

At the height of flu season, health care systems in the southern hemisphere were stressed, but managed to handle and recover an increase in patients hospitalized for health problems related to influenza. Experts are calling the H1N1 flu virus pandemic "moderately severe" based on the flu season in the southern hemisphere. The duration of the season was similar in length to average flu seasons, and although swine flu does spread quickly and easily, it's not associated with higher rates of hospitalizations, deaths or health complications than other types of seasonal flu viruses.

Despite high rates of infection, swine flu is a mild disease for the vast majority of the population. Since its outbreak last spring, the virus hasn't changed. It appears to dominate other seasonal flu virus strains, but isn't mixing with any or becoming stronger or more aggressive. While more deaths are being attributed to swine flu than in the past, this reflects a massive increase in infection rates rather than a more deadly virus.

Experts have been able to glean some new information on swine flu based on the recent season in the southern hemisphere. According to the Ministry of Health in Peru, as many as one third of those infected with swine flu have cold-like symptoms without a fever, while others that are infected have no symptoms at all. This indicates that while the virus may spread very easily, many people who acquire it may not even notice. It's also an indication that the infection rate is widely underestimated due to unreported cases.

Although in the past, seniors over the age of 60 weren't believed to be as susceptible to swine flu due to prior exposure to the A(H1N1) virus strains, statistics related to seniors infected in the southern hemisphere are alarming. While fewer seniors may be infected, there is a higher death rate among those who do contract swine flu than was previously realized. Seniors who are infected seem to suffer more complications and be impacted by them more severely.

School age children are most at risk for becoming seriously ill with swine flu, and death rates among infected children are higher than those associated with seasonal flu. Many parents in the northern hemisphere are planning to have their kids vaccinated as soon as possible. Pregnant women, obese people and those with chronic illnesses are all susceptible to higher rates of serious complications from swine flu infection. Experts are recommending those at high risk consider vaccination once it becomes available.

"We cannot say for certain whether the worst is over the worst is yet to come"

Margaret Chan, Director General, World Health Organisation

Despite the relative consistency of the behavior of the H1N1 virus across countries, many flu experts are advising the northern hemisphere to be prepared for surprises. Health care facilities and hospitals should be prepared for the worst, experts warn, so they're truly capable of handling whatever the flu season brings. Based on the experience of hospitals in the Southern Hemisphere, experts warn that ICU (Intensive Care Unit) units in hospitals in particular should be prepared to take on a large number of patients with swine flu complications. The World Health Organisation cites that several countries have reported that nearly 15% of hospitalized cases have required intensive care.

Given that the upcoming flu season in the northern hemisphere represents a second wave of exposure, experts are hopeful that this time around, at least some of the population has already developed immunity. It's also expected that widespread vaccination may curtail the spread of the virus in the north in the coming months. At the very least, it's thought that swine flu isn't likely to have any worse of an impact on the northern hemisphere than it had during the southern hemisphere's flu season.

What advice for pregnant women?

noreply@blogger.com (Andrew Mason) — Wed, 09 Sep 2009 15:43:00 +0000

Recently, there has been increasing confusion among pregnant women about how to protect themselves against H1N1, as health officials and the media have been giving conflicting advice over the past few weeks. And yet, in August, the World Health Organization (WHO) reiterated that pregnant women are a high-risk group, so one would expect at least a minimum of clear and consistent information.

Avoiding crowds: yes or no?

One area of doubt concerns measures to reduce infection risk. Take, for example, the advice to avoid travels and crowed places. This has been given and dismissed, in different countries, several times. In England, the website of the Department of Health (DH), at one point, was even recommending pregnant women to leave their workplace earlier or later than usual, to avoid journeys on trains during the rush hour. This recommendation was then removed, and the DH now says, “mothers-to-be are not advised to curtail normal activities such as going to work, travelling on public transport, attending events and family gatherings.”

So, what should pregnant women do? Experts agree that there is no real need for them to avoid non-essential journeys and crowded settings at all costs. However, if you are pregnant, you should take the sensible precaution to stay away from large groups of people in communities known to have outbreaks of swine flu. This practice is called ‘social distancing.’

Hand washing is your best defense

As simple as it may seem, good hand hygiene remains the one, and most important, thing you can do to minimize your risk of infection.

Current guidelines recommend washing hands well for at least 20 seconds with soap and water or an alcohol-based handrub. Wash your hands frequently, particularly after touching things likely to be contaminated with the virus, both inside and outside the house. For example, door handles, telephones, ATM machines, and so on. If you have young children, remember to wash your hands after blowing their nose.

Other things you can do to protect yourself include the following:

Stay at an arm-length distance from people.
Avoid contact with those who have swine flu.
Ask family, friends and colleagues to cover their mouth and nose when coughing or sneezing, and to stay home if they are ill.

These seemingly simple strategies may sound obvious but, since research increasingly shows that pregnant women with swine flu have a greater risk for potentially fatal complications, they may in fact help save your life and that of your baby.

Ask for prompt treatment

The elevated risk for complications is also the reason why you should be treated promptly if you become ill. Commonly observed complications of H1N1 are pneumonia and distress respiratory syndrome, occurring mostly in previously healthy young to middle-aged patients.

A study published in The Lancet by researchers of the Centers for Disease Control and Prevention (CDC) suggests that “pregnant women might be at increased risk for complications from pandemic H1N1 virus infection” and that these complications might be associated with death.

The researchers write: “From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states… between April 15 and June 16, 2009 six deaths… were reported… all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation.”

This doesn’t mean you should panic. Just use common sense. If you feel unwell, call the doctor right away, and ask for treatment with antivirals. Remember, you don’t have to wait to be tested for H1N1 or wait for the test results to initiate treatment. Treatment should begin immediately, says the CDC, because it “is most effective when started as early as possible [i.e., within 24 to 48 hours] after the onset of symptoms.”

“The drug of choice for pregnant women is oseltamivir [Tamiflu].” You should be prescribed two 75mg capsules per day for five days.

You will also be given an antipyretic medication–usually acetaminophen–if you have high temperature, as fever during pregnancy has been associated with birth defects.

If someone in your household has swine flu, or you have been otherwise exposed to H1N1, you need to take an antiviral medication, even if you are not ill. In this case, the CDC recommends taking zanamivir (Relenza) for ten days. Relenza is the best option because is given by inhalation. Therefore, compared to Tamiflu, which is taken orally, it reaches lower concentrations in the blood, which minimizes unnecessary risks to your unborn baby. If you have respiratory problems, you will be given Tamiflu.

Be vaccinated for H1N1 and seasonal influenza

So, antivirals are important, not only to treat the illness and avoid related complications, but also to prevent infection after exposure to the virus. However, they don’t replace the vaccine. And since the vaccine for seasonal flu, which also carries risk of complications during pregnancy, does not protect against H1N1 – and vice versa – health officials advice pregnant women to receive both vaccines, as soon as they become available. Make sure you do.

What if you have a healthcare job?

Lastly, if you work in a hospital, nursing home, or a physician’s office you are, for obvious reasons, at greater risk of exposure to H1N1. The general advice by the CDC is that, in addition to the above recommendations, you adopt the same standard precautions as for your non-pregnant co-workers.

Here are some important reminders:

Wear gloves, masks and protective eyewear.
Wash hands with an alcohol-based handrub or, if your hands are visibly soiled, with soap and water – before and after patient contact, even if you wear gloves.
Place soiled linen in a plastic bag in the patient’s room avoiding shaking, as this might contaminate the environment and yourself.
Handle waste and needles safely, according to your facility’s policy.

Follow the above guidelines with all patients, regardless of whether or not they have swine flu. If you are likely to be in close contact with patients with known or suspected H1N1, the CDC recommends reassignment to tasks that involve lower risk of exposure to the virus, like administrative activities.

References

Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/h1n1flu/guidance/pregnanthcw-educators.htm. [Accessed 09.01.2009]

Jamieson D.J., Honein M.A., Rasmussen S.A., Williams J.L., Swerdlow D.L., Biggerstaff M.S., Lindstrom S., Louie J.K., Christ C.M., Bohm S.R., Fonseca V.P., Ritger K.A., Kuhles D.J., Eggers P., Bruce H., Davidson H.A., Lutterloh E., Harris M.L., Burke C., Cocoros N., Finelli L., MacFarlane K.F., Shu B., Olsen S.J. “H1N1 2009 influenza virus infection during pregnancy in the USA,” The Lancet, August 8, 2009, 374(9688):451-8. doi:10.1016/S0140-6736(09)61304-0

Occupational Safety and Health Administration (OSHA), US department of Labor, Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers, 2009. http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. [Accessed 09.02.2009]

Perez-Padilla R., de la Rosa-Zamboni D., Ponce de Leon S., Hernandez M., Quiñones-Falconi F., Bautista E., Ramirez-Venegas A., Rojas-Serrano J., Ormsby C.E., Corrales A., Higuera A., Mondragon E., Cordova-Villalobos J.A. “Pneumonia and respiratory failure from swine-origin influenza A9H1N1) in Mexico,” New England Journal of Medicine, August 13, 2009, 361(7):680-9.

World Health Organization (WHO). WHO guidelines for the pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. August 20, 2009. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/index.html [Accessed 09.03.2009].

By Lorena Tonarelli, MSc

OH NO! We're All Going to Die...

noreply@blogger.com (Chris Barber) — Tue, 08 Sep 2009 12:37:00 +0000

Deadlier Second Wave of New H1N1 Killer Virus Is Coming Your Way Now...

Not Another News Media Frenzy!

For the last five years or so, once a year like clockwork, our favourite daily newspapers catch front-page killer flu hysteria. For a few weeks (until we get bored of reading it or another silly story comes along) we’re bombarded by prophesies of impending doom; warned that the final apocalypse is upon us. When the deadly scourge is an avian influenza strain, we can count on an extra special treat – a splendid colour portrait photo of a fine feathered duck or goose, whose shabby, ‘sick’ appearance bears an uncanny resemblance to Daffy Duck in flustered mode... “Suffering headline photo-calls!”

OK, we all understand the threat is real and things could get quite nasty for many of us, this fall. This is precisely why we really need factual and sober information, telling us what we can expect to occur, and what we can practically do to prepare and protect our communities. Now that would be real news! But what did we actually read?

One Flu Over the Goose’s Nest

This year offered unique tabloid scaremongering opportunities. The revival of an H1N1 swine flu substrain and accompanying body count in Mexico inspired a plethora of sensationalist doomsday scenarios.

What’s more, the high-profile Pandemic awareness programme, propagated by the World Health Organisation, ensured there has been an excess of serious health and medical information in the public domain. So for once, even the usually ill-informed tabloid hacks, could pepper their salacious scare stories with some carefully selected key facts.

Thus, a couple of historical references to the 1918/1919 H1N1 Pandemic, with its astounding 50 to 100 million, worldwide body count. Further, it is remembered this virus recurs in two or three waves, over the course of a year or so. In most regions, it was the ‘second wave’ that proved to be most deadly.

What the Papers Say

So even the more serious broadsheets couldn’t resist cutting-in on this opportunity...

“Swine flu: the worst is yet to come in autumn, warns Alan Johnson. Doctors are being warned to prepare for a second, "much worse" wave of swine flu hitting Britain in the autumn, the Health Secretary has disclosed... Alan Johnson said the current swine flu outbreak... That the lesson of past pandemics was that initially mild outbreaks had been followed by something ‘much more serious’....”

Said, The Daily Telegraph (John Bingham & Auslan Cramb, 3rd May 2009).

While in May, Google reported on alarming coverage in the Financial Times:

“WHO chief warns of second wave of swine flu... The head of the World Health Organization warned in a newspaper interview that swine flu may re-emerge stronger than ever even if the current outbreak appears to be declining.

Margaret Chan told Britain's Financial Times that an apparent decline in mortality rates did not mean the pandemic was coming to an end ... and a second wave may strike ‘with a vengeance... If it's going to happen it would be the biggest of all outbreaks the world has faced in the 21st century’.”

Or:

“As swine flu wanes, U.S. preparing for second wave.

A report by the ... Trust for America's Health...found that... Recent cuts in public health departments have meant many did not have adequate resources to carry out flu plans.
It also found problems in plans for school closings and limiting mass gatherings, and even with a mild outbreak...emergency departments and other parts of the healthcare delivery system were overwhelmed.”

(From Reuters.com: Jun 4, 2009 EDT By Julie Steenhuysen)

As ever, there’s no shortage of eminent experts, prepared to leap at the chance to share their lofty theories with a wider audience...

Is it worth considering what Dr. Howard Markel, of the University of Michigan, has to say? “...There may be a case fatality rate of 1 or 2 percent and it doesn’t sound like very much, but seasonal flu kills about 35,000 a year (in the United States) and has a case fatality rate of .01 to .02 percent.” Dr. Markel is a professional expert on panic during pandemics, and has published several books on the subject.

And another very important expert:

“Dr. Jeffery K. Taubenberger, an influenza investigator in the Laboratory of Infectious Diseases at the National Institutes of Health, said...

‘When it got cool enough to spread well, the virus exploded’.”

(Quotes JoNel Aleccia, for msnbc.com; May 4, 2009)

No News Is New News

There’s nothing new under the sun, as they say. Back in 1918, at the height of the government’s wartime propaganda campaign, the ‘patriotic’ press was always willing to back the government and war effort, by misleading and lying to us. This censorship of information during that pandemic, surely made things much worse; people were living (or dying) amidst this horrific plague, but nobody knew what on earth was going on around them. When newspapers did mention the influenza, it was to mislead people. The presses started a popular rumour concerning the origin of the virus; propagating that a U-boat sent by Germany’s Kaiser had smuggled the deadly virus into Boston harbour.

Facing the Worst, Better

Currently the virus has already reached pandemic status but killed only a relatively small number of people. Furthermore, its state has fortuitously remained stable, allowing a vaccine to be developed. Just a few weeks ago, scientists feared the strain might wildly mutate, perhaps becoming more lethal. But the real doomsday scenario is that the current virus will combine with another, different mutating substrain, to create a new, super killer strain. It’s certainly a scary possibility. But is it actually likely to happen?

According to a press briefing by UK Health Minister, Sir Liam Donaldson on 2009-06-25; the government “expects” the second wave to manifest one-of-three possible scenarios:

A recurrence of the last H1N1 virus.
A much more lethal strain of H1N1 virus will evolve.
A variant H1N1 strain will merge with another flu sub strain, creating a new super killer strain.

Yes and no, is the simple answer; by the mathematical rules of scientific probability, there is a reasonable likelihood of this third option occurring. But there is not a strong likelihood of a ‘super killer strain’ evolving, capable of affecting a worldwide body count comparable to 1918/1919. Well, not this time at least. Sooner or later, such a strain certainly will manifest itself. But this time around, those men in white coats, in their underground laboratories, seem to have managed to keep pace with the cunning gyrations of this pernicious virus.

Besides, while there remains much that today’s medical science can’t prevent, many more discoveries have been made that can help. Most importantly, there is a great deal we can do to empower ourselves, to prepare for and to confront this threat. That starts by understanding and learning the real facts about this menace. And when the ‘real’ facts are inconclusive, so be it; we are all the better equipped for knowing this.

Swine Flu Treatment Update | Pandemic Preparedness

noreply@blogger.com (Mark Farrell) — Wed, 02 Sep 2009 11:21:00 +0000

WHO says healthy children over five don’t need Tamiflu

New WHO guidelines for the pharmacological treatment of pandemic H1N1 recommend that healthy children with swine influenza not be given Tamiflu.
The medication, which continues to represent the mainstay of treatment for the illness, should be administered only if the sick child

develops a severe form of swine flu;
starts deteriorating;
has an underlying medical condition, like asthma or diabetes; or
is under the age of five.

Children who require treatment should be given Tamiflu immediately. Those with underlying conditions or under five years of age should be treated as soon as possible, even if they have mild symptoms.

Evidence-based recommendations

The WHO says the new guidelines, issued August 20, 2009, have been developed keeping in consideration the results of two studies that recently raised doubts about Tamiflu’s safety in children. The findings had been published early this month in the British Medical Journal by researchers of Oxford University, UK, led by Dr. Matthew Thompson.

Thompson’s team found that children on Tamiflu not only experience slight benefits–those who receive the drug recover up to one day earlier than those who don’t–one in 20 also suffer from side effects like vomiting, which may lead to potentially life-threatening conditions like dehydration. What’s more, treatment with Tamiflu seems ineffective in reducing the occurrence and/or severity of ear infections, asthma flare-ups or the need for antibiotics. In other words, say the researchers, the risks associated with Tamiflu outweigh the benefits; therefore, widespread use of the drug in children in unjustified and potentially harmful.

As the WHO points out, these findings “were considered by … its expert panel when developing the current guidelines and are fully reflected in the recommendations.”

Treat mild cases like ordinary seasonal flu

The advice, for clinicians and parents, is to give healthy children with swine flu, who are older than five paracetamol, as well as plenty of rest and fluids–just like for seasonal flu.

Be alert for worsening

However, as the vast majority of severe cases of swine flu develop in previously healthy individuals, it is important to monitor the child for signs of worsening, so that Tamiflu can be administered promptly.

“In children,” the WHO says, “danger signs include

fast or difficult breathing;
lack of alertness;
difficulty in waking up; and
little or no desire to play.”

Any of these signs may indicate that the child is progressing towards a more severe form of swine flu and needs hospital care. Call the doctor right away, as deterioration may occur very rapidly.

Know the side effects of Tamiflu

For children who need Tamiflu treatment, consider that some may experience side effects other than vomiting. Two studies conducted in England by researchers of the Health Protection Agency (HPA) found that more than 50 percent of a group of children aged 11 to 12, who were given Tamiflu had side effects, such as nausea, headache and stomach pains. Diarrhea and problems sleeping were also reported as well as poor concentration and nightmares.

References

Shun-Shin M., Thompson M., Heneghan C., Perera R., Harnden A. “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials,” British Medical Journal, August 10, 2009, 339:b3172. doi: 10.1136/bmj.b3172

World Health Organization (WHO). WHO guidelines for the pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. August 20, 2009. [Accessed 23.08.09].

World Health Organization (WHO). Recommended use of antivirals. Pandemic (H1N1) 2009. Briefing note 8. August 21, 2009. http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html. [Accessed 23.08.09].

By Lorena Tonarelli, MSc

Tamiflu Update | Pandemic Preparedness

noreply@blogger.com (Mark Farrell) — Wed, 02 Sep 2009 11:12:00 +0000

Frontline defense against swine flu... but for how long?

There are now several confirmed cases of swine flu resistant to Tamiflu. Overall, more than ten have been reported, as of August 2009, in various countries, including Canada, China, Japan, Hong Kong, Denmark, Singapore and the US. Further spread could result in the medication becoming ineffective–a worrying scenario, given that Tamiflu is the most widely used medicine for the prevention and treatment of swine flu.

Dangers of stopping treatment

The growing concern over Tamiflu resistance is supported by evidence that, in the past two years, the seasonal flu H1N1 virus has changed into a form almost completely resistant to the drug. Why and how, exactly, this happened is unknown, but it is reasonable to expect that the same thing might occur with the swine flu H1N1 virus.

One suggested reason for resistance is patients not finishing their treatment course; a phenomenon also referred to as medication noncompliance.

The recommended treatment course for swine flu is two 75mg capsules a day for five days. When patients start taking Tamiflu, the first H1N1 strains to die are those highly susceptible to the medication, followed by those less susceptible – that is, the more resistant.

A whole treatment course ensures that both highly and less susceptible strains are killed. But, if patients stop taking Tamiflu, the less susceptible strains survive in the body, where they continue to replicate and may, potentially, originate a strain completely resistant to the drug.

Patients, who don’t finish their treatment course are about 20 percent of all those on Tamiflu, according to researchers at Imperial College London, UK. These patients could be the key agent for transmission of resistant forms of the virus, enabling them to rapidly spread through populations. The good news is there is no evidence, so far, indicating that Tamiflu-resistant strains of H1N1 can be transmitted from person to person.

A single-dose alternative?

A solution to the problem of compliance could be a treatment that is taken only once. A strong candidate, in this regard, is Laninamivir, a swine flu medication administered through inhaler, which, according to recent findings from clinical trials conducted in Asia, is also effective at treating seasonal and avian influenza.

Manufactured by the Australian pharmaceutical company Biota Holdings Limited, Laninamivir – like Tamiflu and the other medication used for swine flu, Relenza – belongs to a class of drugs called neuraminidase inhibitors, which act early in the virus’ replication cycle, “so effectively creating a ‘still birth’ of the new virus,” says the company’s chief executive, Peter Cook.

Laninamivir, which Cook expects to be licensed for marketing in Japan, Europe and the US by next year, could represent a significant improvement in the treatment of swine flu. Not only has it been shown, in studies, to be as effective as Tamiflu, it also has the advantage that, as a single-dose medication, it is easier and less costly to stockpile, and–most importantly–potentially crucial in preventing the virus from becoming resistant due to patients not finishing their treatment.

Widespread use not the best strategy

An important contributing factor to the development to Tamiflu-resistant strains of H1N1 is the mass use of the drug, which is given for prophylaxis (prevention) also to individuals with no symptoms of swine flu.

In the attempt to make it easier for the public to obtain the medication, and avoid placing further strain on already stretched healthcare services, some governments have implemented measures to ensure access to Tamiflu for everyone. For example, in the Netherlands, the drug is distributed for free to anyone with a physician’s prescription and, in the UK, it is sold over the counter in most any store.

But, experts urge caution. Widespread access to Tamiflu may not be the best strategy. Why? Because it speeds up the spread of resistant mutations, increasing the risk of the virus becoming resistant – globally. As a result, Tamiflu would become useless. And if this happens in the fall, when a more powerful strain of H1N1 is likely to circulate, the consequences could be disastrous.

Strategies have been put forward that could, potentially, help prevent the phenomenon of Tamiflu resistance from becoming global. These, according to findings in the journal BioMed Central Infectious Diseases, include not giving Tamiflu to people over 65 – the age group supposedly at least risk of swine flu.

However, mass Tamiflu use is causing another problem. People on the drug develop side effects for which they require medical attention. And this puts additional pressure on healthcare systems worldwide.

A study published this month in the British Medical Journal shows children are a category particularly at risk. The researchers, from Oxford University, say the side effects (mostly vomiting, which may lead to potentially life-threatening complications, like dehydration) are so severe and frequent that physicians should consider giving Tamiflu only to children with underlying health problems. Those with a mild form of the infection should be given paracetamol.

What’s the advice?

In summary, swine flu has been found resistant to Tamiflu in sporadic cases, which may indicate that the threat of a global resistance to the drug is real and that strategies – like improving the drug’s compliance and limiting its use to certain patient groups – to prevent, or delay, H1N1 from becoming completely resistant may be worth considering. However, currently most patients respond well to the drug.

So, what’s the advice? In a briefing note issued on August 21, the World Health Organization (WHO) says: “Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. [Thus] healthy patients with uncomplicated illness need not be treated with antivirals.”

However, “for patients who initially present with severe illness or whose condition begins to deteriorate WHO recommends treatment with oseltamivir [Tamiflu] as soon as possible. Studies show that early treatment, preferably within 48 hours after symptoms onset, is strongly associated with better clinical outcome. For [these patients] treatment should be provided even if started later.”

The same recommendation applies to all children younger than five years, pregnant women and individuals with pre-existing health problems. These, too, should be given Tamiflu as soon as possible.

Since approximately 40 percent of cases of progression to severe illness occur in previously healthy individuals – mostly adults younger than 50 and children – the WHO recommends that clinicians, caregivers, and the patients themselves be particularly alert for signs of deterioration of the infection (e.g., chest pain, confusion, difficult breathing, blue skin, low blood pressure, persistent high temperature, colored sputum) “and take urgent action, which should include treatment with oseltamivir.”

“In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.”

References

Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/h1n1flu [Accessed 08.18.2009].

Merler S., Ajelli M., Rizzo C. “Age-prioritized use of antivirals during an influenza pandemic,” BMC Infectious Diseases, July 28, 2009, 9:117.

Shun-Shin M., Thompson M., Heneghan C., Perera R., Harnden A. “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials,” British Medical Journal, August 10, 2009, 339:b3172. doi: 10.1136/bmj.b3172

World Health Organization (WHO). http://www.who.int/csr/disease/swineflu/en/. [Accessed 08.18.2009].

World Health Organization (WHO). Recommended use of antivirals. Pandemic (H1N1) 2009 briefing note 8. August 21, 2009. http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html. http://www.who.int/csr/disease/swineflu/en/. [Accessed 08.26.2009].

By Lorena Tonarelli, MSc

Pandemic Preparedness Affects Us All, Learn The Facts About Swine Flu

noreply@blogger.com (Mark Farrell) — Thu, 27 Aug 2009 11:26:00 +0000

Influenza A ( H1N1) or swine flu may have been a term that was rarely heard until recently. Now it never seems to out of the news. The reason for this is simple, it is a new strain of an existing influenza virus that affects and kills humans. It is easily transmitted and as such poses a real threat, which is why the current swine flu pandemic level has been raised to its highest level, which means a global pandemic is underway. So what can be done, as an individual, to ensure you and your loved ones are able to deal with the eventuality of swine flu.

The governments of the world are already putting into action their respective swine flu pandemic planning scenarios, but there is much more the consumer can find out and do to help themselves, which is why an ingenious website has brought out an informative eBook which tells all. The eBook is available from www.thedeadlyflu.com.

The website has become a repository of information about swine flu. The global reaction has sparked panic in some countries and the pandemic preparedness plans have been put into action, with a variety of elements, some of which have included closing schools and amenities in which the general public congregate. The stage has now been elevated in some countries with containment no longer an option, the swine flu pandemic planning strategy is now to immunise and deal with the infected as quick as possible. In the northern hemisphere, a second more virulent wave is expected in autumn, with many hospitals and health authorities on high alert.

With so much information floating about it can be difficult to ascertain what the truth is and what is myth. The authoritive eBook from www.thedeadlyflu.com is an excellent resource whose aim is to provide detailed and informative advice on the subject of swine flu. The eBook offers salutary advice on a range of related items and ensures that the visitor is fully informed about the aspects of this new virus and the implications for them and their families. The website puts the global pandemic into context and provides relevant and pertinent information about the oncoming swine flu pandemic.

For anyone looking for effective information about the swine flu virus and what can be done about it, a visit to www.thedeadlyflu.com should be undertaken, where they will find useful and informative details which will ensure they are fully aware of the circumstances and details of this new deadly flu virus.

For further information visit http://www.thedeadlyflu.com

School Absenses Set To Rise Due To Swine Flu

noreply@blogger.com (Mark Farrell) — Wed, 19 Aug 2009 08:14:00 +0000

Children are shortly due back into schools after the summer break and reports show that in the USA alone they can expect an increase of approximately 30% over the first few months of school absences due to Swine Flu.

The standard expected absence rate is as low as 6%, so 30% is quite scary. The presence of Swine Flu within our schools is unavoidable especially as children and teens between the ages of 15 and 19 are amongst the most susceptible to the fast spreading virus.

Pandemic Preparedness has never been more important especially when your children are involved.

Swine Flu Vaccine Effective After One Shot?

noreply@blogger.com (Mark Farrell) — Tue, 18 Aug 2009 16:02:00 +0000

Reports have come in that a new vaccine has been produced by Chinese company Sinovac that allegidely is effective after only one dose. Their shares rose 10% in just one day after the news.

There are fears that the more conventional vaccines are to thin on the ground to administer to everybody as they generally need two shots. If Sinovacs vaccine proves OK then this will greatly stretch to a lot more people.

Testing is stuill underway so check back again for further updates. There are still no guarantees that this or any other vaccine will be effective when Swine Flu returns for its second wave so lets hope that scientists are working on something a little stronger????

For more information Click Here For general information on Swine Flu please visit our website and learn all you need to know about Pandemic Preparedness

US government facemask advice

noreply@blogger.com (Andrew Mason) — Tue, 18 Aug 2009 15:40:00 +0000

Spotting the article entitled Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic located here, there is a wealth of useful information on mask usage during the current pandemic. The main point being, don't rely on them, and don't forget common sense. Avoidance and good hygiene form a larger part of infection control.

'Facemasks and respirators should be used in combination with other preventive measures, such as hand hygiene and social distancing [i.e. the U.S. Occupational Safety and Health Administration defines 'close contact' as being 'within 6 feet'], to help reduce the risk for influenza infection during a pandemic.'

If you're in a crowded setting, or looking after someone with flu, and you have to use a mask, use and remove it correctly:

'Prior to putting on a facemask or respirator, wash hands thoroughly with soap and water. Use an alcohol-based hand sanitizer if soap and water are not available.
'Avoid touching the outside of the facepiece during and after use to help prevent contamination of hands with infectious material that may have collected there.
'Once worn, the disposable facemask or respirator should be removed carefully using the elastic bands or ties at the back of the head (avoid touching the facepiece) and appropriately discarded in the regular trash. If disposable facemasks and respirators are unavailable and a reusable fabric mask is used, it should be removed in the same way and laundered with normal laundry detergent and tumble-dried in a hot dryer. [No] reusable fabric masks have been evaluated by the FDA for use in preventing transmission of infectious agents, and none are legally marketed in the United States for use in infection control.
'After the facemask or respirator has been removed and discarded, wash hands thoroughly with soap and water. Use an alcohol-based hand sanitizer if soap and water are not available.'

noreply@blogger.com (David Mason) — Thu, 13 Aug 2009 18:45:00 +0000

Just heard that a teenage girl who flew in from Hong Kong to San Francisco was hospitalised after a routine airport screening. Apparently she's not dangerously ill and she's recovered okay but some news released last week by the Hong Kong authorities showed that the viral sequencing had a mutation.

Experts have said it is the H274Y that could make swine flu resistant to Tamiflu. There have also been cases in Thailand, Singapore and China with reports coming in of patients developing resistance, and according to Prof Henry L Niman who founded www.recombinomics.com "These latest results signal global spread of Tamiflu resistance, which may be associated with evolutionarily fit pandemic H1N1". I suppose the worrying thing here is that the samples were collected in May and mid-June but not actually reported until this week.

H1N1 Pandemic Travelblog

noreply@blogger.com (Chris Barber) — Thu, 13 Aug 2009 13:04:00 +0000

H1N1 Pandemic Travelblog

As the winter season passes in the Southern Hemisphere, along with the peak rate of H1N1 flu infections, many countries breathe a sigh of relief.

Argentina jumps into first place, with the world’s highest Pandemic body count (per quota of population). Reaching 337 mortalities, the death toll more than doubled during the last month. A further 400 Argentinean deaths are currently being investigated – most of which are expected to be virus related.

Last month Argentina’s unexpectedly high infection rate, caused havoc across the country, overwhelming hospitals which lacked enough beds and medical services to cope with demand.

Scientists contemplated that Argentina’s shocking death rate, might have been caused by a substantial genetic shift, in the H1N1strain. Such a development at this late stage, could have thrown back vaccine development, as the new strain spread across the northern hemisphere.

Thankfully test results show the virus remains virtually unchanged from its original Mexico/US strain. So the current vaccine should work fine. Also there are no signs of resistance to Tamiflu (based on 2 million doses given to public hospitals).

Chile was also surprisingly hard hit by the pandemic. The population is much smaller then Argentina’s. But official figures reported 8/6/09, record 104 deaths and 12030 infections, with 1126 cases hospitalised.

The final surprise is Australia. Despite a recent sharp rise in the number of infections, by 8/7/09, the country reported only 50 deaths and over 10,000 infections. These figures are running lower than expectations, which predicted the death rate could reach 6000 by the end.

'Flu drugs 'unhelpful' in children' reports BBC

noreply@blogger.com (Andrew Mason) — Mon, 10 Aug 2009 10:48:00 +0000

'The antiviral drugs being used to treat swine flu do not appear to work well in children, say UK researchers.

'Their work in the British Medical Journal shows Tamiflu and Relenza rarely prevent complications in children who have normal seasonal flu.

'Although it is hard to generalise this to the current swine flu pandemic, they say these drugs are unlikely to help children who catch the H1N1 virus.

'Side effects and the risk of resistance developing may negate their use.'

See the full story at http://news.bbc.co.uk/1/hi/health/8193012.stm.

noreply@blogger.com (Andrew Mason) — Fri, 07 Aug 2009 13:19:00 +0000

A clear heads-up to pregnant women found on the BBC News website:

'A recent study carried out by the US Centre for Disease Control and Prevention, published on Wednesday, suggests that pregnant women are far more likely to need hospital treatment after contracting H1N1.

'They are four times more likely to be hospitalised from swine flu than the general public and can risk complications without speedy anti-viral treatment, the study warned.'

Don't take risks, and take authoritative advice on swine flu treatment if you are pregnant.

Ref: Swine flu vaccine for 'half US', http://news.bbc.co.uk/1/hi/health/8175750.stm.

noreply@blogger.com (Andrew Mason) — Fri, 24 Jul 2009 12:33:00 +0000

Blog number one for me - starting with interesting stats on BBC News last night, concerning the UK's National Flu Service..

'The number of new swine flu infections in England has doubled in the past week, the government says.

'It comes as the National Flu Service was launched, offering sufferers access to drugs on the phone and via the internet without the need to see a GP.

'Calls have already started flooding in and in the first few hours the website was receiving 2,600 hits a second - or 9.3m an hour.'

Now that's a lot of concern about swine flu.

Swine influenza A(H1N1) pandemic update

noreply@blogger.com (Mark Farrell) — Mon, 13 Jul 2009 07:12:00 +0000

The threat of a second infection wave needs to be taken seriously

The current swine flu pandemic has, so far, turned out to be less severe than expected, with most infected people experiencing mild symptoms, and only a relatively limited number of deaths.

Will it stay this way and slowly fade away?
Health officials say this is unlikely, and warn that swine flu may re-emerge, next fall, more deadly than ever. There remains, however, uncertainty about what could happen should this relatively mild outbreak be followed by a more severe one later this year.

Dr. James McCaw, of the Vaccine & Immunization Research Group (VIRGo), in the School of Population Health at the University of Melbourne, Australia, is involved in major math modeling projects related to pandemic influenza transmission, immunity and threat.

We asked McCaw: What is the likelihood of a second wave of swine flu? And what should we expect over the coming months?

Flu pandemics historically come in waves
“We know from past pandemics that multiple waves can, and do, occur,” says McCaw. A defining feature of pandemics, like the ones of 1918-19, 1957 and 1968, is their tendency… to occur ‘out-of-season’, not necessarily over the winter period.”

The 1918-19 pandemic (i.e., the Spanish flu), which was also caused by the H1N1 virus, provides the best example of this type of behavior, he says. At that time, the United States and the United Kingdom experienced three distinct H1N1 flu waves, within just 12 months.

McCaw notes that “Each wave was more severe than seasonal influenza, both in terms of the proportion of the population infected and the case fatality rate. The second wave in the United Kingdom was the most severe, contributing the most deaths of any of the three waves. And the severity of influenza remained high for a number of seasons following the pandemic.”

Beyond a second wave
Thus, it appears that the wave behavior might extend beyond a second flu outbreak into possible further flu pandemic waves. There is clear evidence that this happened in the past, says McCaw, as shown by an increase in the numbers and severity of the seasonal flu outbreaks that occurred after a pandemic. This was the case, for example, for many populations around the world after the Spanish flu and the flu pandemics of 1957 and 1968.

Predictions are difficult to make
“In terms of the 2009 outbreak,” he says, “we have very little data that would allow prediction of a second wave, let alone its severity. As such, we cannot specify a ‘probability’ or the ‘likely characteristics’ of a second wave.”

New research confirms: swine flu could turn deadlier
For a lethal fall swine flu pandemic wave to occur, the A(H1N1) virus needs to mutate into a form capable of infecting and killing more people, more rapidly. Although, there is no firm evidence that the swine flu virus in already undergoing such a transformation, a study published is Science by researchers of the National Influenza Center and Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands, shows that it has indeed the potential of becoming more deadly.

Compared to previous seasonal influenza A(H1N1) forms, which only replicate in the upper airways (i.e., the nasal cavity), 2009 A(H1N1) has the ability, in animals, of reproducing in the lower airways (i.e., trachea, bronchi, and lungs). What this means to us is that 2009 A(H1N1) could trigger a highly deadly form of viral pneumonia capable of killing people in just a few hours, as it occurred during the Spanish flu of 1918. Most at risk would be healthy 20- to 40-year-old individuals, whose immune system reacts more vigorously to the infection.

H1N1 and H5N1 may co-mingle
Mutations are not the only concern. Scientists are worried about the possibility that the swine flu virus might co-mingle with the highly deadly bird flu A(H5N1) virus.

Looking at the Southern Hemisphere
Important clues about the likelihood of a lethal swine flu pandemic in the fall may come from the Southern Hemisphere, where the influenza season is just about to begin. Scientists and healthcare officials are actively monitoring the virus’ behavior in those countries, with particular attention to Colombia, Costa Rica, Guatemala and El Salvador. This would enable them to determine whether the swine flu outbreak is actually becoming more severe. The hope is to use such information to develop more effective pandemic plans.

Pandemic Preparedness may help reduce mortality
One thing’s for sure: “Putting in place systems that will quickly detect any sign of increasing severity or an upsurge in cases following the first wave is a priority,” says McCaw. “Pandemic planning, including antiviral distribution strategies and vaccination preparation efforts, need to work on the assumption that a second wave may occur. And that it may be more severe than the first.”

Of particular relevance, in this regard, are the findings of a 2006 re-analysis of the Spanish pandemic influenza of 1918, led by professor John Oxford, of the Centre for Infectious Diseases, Bart’s and the London, Queen Mary’s School of Medicine and Dentistry, London, UK.

Oxford’s team found that, contrary to common belief, most of the people infected with the swine flu A(H1N1) virus during the 1918 Spanish flu survived. This, despite the fact that vaccines and antiviral medications were not available at that time. If this tells us anything, it’s that “judicious and careful planning… could help reduce mortality in a new pandemic to figure significantly less than 1918,” says Oxford.

“There is every reason as we face the first pandemic of the 21st century that we can be optimistic,… turn again to history… and return to Churchill for inspiration ‘give us the tools and we will finish the job.’”

Major differences between then and now
A vaccine to protect us in the event of a deadlier swine flu outbreak in the fall is being prepared in countries across the globe. As mentioned above, together with the availability of antiviral medications, this is one major difference between now and the Spanish flu pandemic of 1918-19. However, there is no guarantee that the vaccine will be ready in time, or even effective, because the virus may change in the meantime. And, almost certainly, there will not be enough of it for everyone.

There is also the likelihood that, by fall, the swine flu A(H1N1) virus might become resistant to antiviral medications, hampering any effort of treatment when most needed, as millions of people will likely be infected.

Probably not better off than in 1918
What is the most likely scenario for the world in the eventuality of a second, more severe, wave of swine flu? Experts say this may be more similar than expected to what was experienced during the 1918 Spanish flu pandemic. Of particular concern is hospitals’ supposedly inability to cope with increasingly large numbers of patients, at a time in which a severe shortage of healthcare professionals, due to sickness, and lack of adequate medical supplies and medications are highly likely. Fear may play a role, as well.

“[During the Spanish flu], fear of contagious kept caregivers from performing their duties,” says Dr. Monica Schoch-Spana, of the Center for Civilian Biodefense Strategies at the Johns Hopkins University, in Baltimore. “Hospitals were crippled by influenza’s hold on urban population… shortage of… linens, mattresses, bedpans, and gowns arose in some instances.”

“Despite 80 years of medical advances and expansive growth in the health care industry, there remains great uncertainty about our capacity to respond to an infectious disease emergency,” says Schoch-Spana. “In many respects, we may be at a disadvantage today compared with 1918. Then, most people were cared for by family members. Patients did not rely heavily on paid health professionals, nor did they expect today’s sophisticated standards of care.”

Intentional exposure to the A(H1N1) virus should be avoided
Lastly, health officials warn that getting swine flu, now, does not necessarily give immunity to further more severe infections. One reason for this is that the virus may not be the same in a few months, as a result of mutations.

Another, and most important, reason is that too little is known about how the swine flu A(H1N1)virus reacts in any one individual. It may cause severe disease and death. Consequently, intentionally mixing with people who have swine flu in the hope of being infected should be avoided.

FLU PANDEMIC DÉJÀ VU. In 1918, the A(H1N1) outbreak began in the spring, with a relatively small and localised death rate, from a mild strain of the flu virus, which spread rapidly. Known as Spanish flu, its infection and mortality rate slowed during the summer, but come fall, as temperatures cooled, a much more lethal strain of the virus evolved, killing millions, around the globe. All the signs now suggest the same will happen again soon, this year. In the US alone, the WHO is predicting a possible 7 percent swine flu infection rate. And that could be a conservative estimate. Dr. Howard Markel, of the University of Michigan, an eminent expert on pandemics, says: “...There may be a case fatality rate of 1 or 2 percent and it doesn’t sound like very much, but seasonal flu kills about 35,000 a year (in the United States) and has a case fatality rate of .01 to .02 percent.”

References
Mathews J.D., McCaw C.T., Mcvernon J., McBryde E.S., Mccaw J. “A biological model for influenza transmission: pandemic planning implications of asymptomatic infection and immunity,” PLoS ONE, 2007, 2(11): e1220. doi:10.1371/journal.pone.0001220
Munster V.J., de Wit E., van den Brand J.M.A, Herfst S., Schrauwen E.J.A., Bestebroer T.M., van de Vijver D., Boucher C.A., Koopmans M., Rimmelzwaan G.F., Kuiken T., Osterhaus A.D.M.E., Fouchier R.A.M. “Pathogenesis and transmission of swine–origin 2009 A(H1N1) influenza virus in ferrets,” Science, July 2, 2009, 10.1126/science.1177127.
Oxford J.S., Lambkin R., Elliot A., Daniels R., Sefton A., Gill D. “Scientific lessons from the first influenza pandemic of the 20th century,” Vaccine 2006, 24:6742-6746.
Schoch-Spana M. “’Hospital’s full-up’” The 1918 influenza pandemic,” Public Health Reports, 2001, 116(suppl.2):32-3.

Swine Flu Information

noreply@blogger.com (Mark Farrell) — Sat, 11 Jul 2009 11:56:00 +0000

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