ALERT Comprehensive Flu Thread, Latest reports, States, Countries, Closings.

Mutation seems to be sporadic and does not appear to be spreading, says ministry. -

Does not appear to be spreading ? Ukraine, Norway, NC, Iowa, Italy, Poland.

Info sought on Mainland dog flu reports

November 30, 2009
Surveillance

http://www.news.gov.hk/en/category/healthandcommunity/091130/html/091130en05002.htm

The Centre for Health Protection and the Agriculture, Fisheries & Conservation Department will follow up on the reports that some Mainland dogs tested positive to human swine flu virus, Secretary for Food & Health Dr York Chow says.

Speaking to reporters this morning, Dr Chow said it is difficult to judge whether dog owners will face a higher risk at this stage because health officials need to collect more data.

"There are always opportunities for the virus to spread from species to species. The occurrence of that might not be that unpredictable. Our concern is what exactly happens to the dogs, and whether it is transmitted from humans to dogs or between dogs.

"The other thing is whether the viral genetic structure has changed after the transmission. So there are many questions that need to be answered before we can make a judgement of the implication of these transmissions."

In response to reports that a number of human swine flu patients in Shenzhen have developed encephalitis, Dr Chow said the Government will ask the Mainland authorities for more information.

Noting the Government will announce details of its H1N1 swine flu vaccination programme this afternoon, he expected that the first half a million doses of vaccine will be given to the high-risk groups.

"Depending on the take-up rate of the high-risk groups, we will decide whether we will give some to the non high-risk groups. But I think for the first few weeks we will concentrate on the high-risk groups."


and

H1N1 flu infected dogs "no threat to humans": experts
www.chinaview.cn
2009-11-30 09:11:17

http://news.xinhuanet.com/english/2009-11/30/content_12562856.htm



BEIJING, Nov. 30 -- Health experts in China have assured pet-lovers they need not panic following the discovery of two dogs infected with the deadly H1N1 flu at the weekend.

The animals were diagnosed in Beijing and, while it is possible for pets to transfer viruses to their owners, scientists said there is no evidence to suggest pets are already spreading the illness.

"If animals can get infected from humans, then the reverse is also true," said Feng Zijian, director of emergency response for the Chinese Center for Disease Control and Prevention.

"But there is no need to panic in this case."

He explained that so far, across the world, the virus has only been passed from humans to pets.

However, if the virus spreads among dogs, it could potentially be passed on when the animal sneezes or through its waste.

"Only when the virus mutates within dogs will it be a new threat to humans," Feng said.

The virus found in dogs in Beijing was a 99-percent match for the flu currently infecting humans, according to the Ministry of Agriculture, which announced the canine infection on Saturday but did not elaborate on the breed.

"The role of dogs in the virus

Health experts in China have assured pet-lovers they need not panic following the discovery of two dogs infected with the deadly H1N1 flu at the weekend.

The animals were diagnosed in Beijing and, while it is possible for pets to transfer viruses to their owners, scientists said there is no evidence to suggest pets are already spreading the illness.

"If animals can get infected from humans, then the reverse is also true," said Feng Zijian, director of emergency response for the Chinese Center for Disease Control and Prevention.

"But there is no need to panic in this case."

He explained that so far, across the world, the virus has only been passed from humans to pets.

However, if the virus spreads among dogs, it could potentially be passed on when the animal sneezes or through its waste.

"Only when the virus mutates within dogs will it be a new threat to humans," Feng said.

The virus found in dogs in Beijing was a 99-percent match for the flu currently infecting humans, according to the Ministry of Agriculture, which announced the canine infection on Saturday but did not elaborate on the breed.

"The role of dogs in the virus' mutation is still unknown. However, pigs provide a better environment for virus mutation," Feng said.

"Pigs are regarded as the gene mixer."

The canines, which were probably infected by their owners, are contagious to other dogs, an expert at the Beijing Agricultural Bureau told Beijing Times on Saturday.

On Nov 19, four pork samples tested positive for H1N1 at a slaughterhouse in Shuangcheng, Heilongjiang province. The animals were also infected by humans, according to reports.

Meanwhile, as China rushes to vaccinate people against the flu, the H1N1 virus is picking up speed.

Eight infected children are in critical condition at a hospital in Shenzhen, Guangdong province. Two of them, aged 9 and 11, have been diagnosed as brain dead.

"I believe the H1N1 virus led to white matter lesions in the children," said Li Chengrong, president of Shenzhen Children's Hospital, who added that the illness attacks the nervous system and can cause dementia, coma and even death.

He said parents should pay close attention to a child's mental state if they become ill.

Symptoms include delays in responding, incoherence in speech, restlessness and insomnia.

"Once a child starts to convulse or goes into a coma, it's too late," Li said.' mutation is still unknown. However, pigs provide a better environment for virus mutation," Feng said.

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India

Delhi: 2nd wave of swine flu feared
New Delhi November 30, 2009

The Capital's swine flu statistics and the daily temperature have shown an interesting trend: both the figures are inversely proportional to each other. The temperature has dipped over the past one week and the number of flu cases shot up, raising fears among Delhiites whether the second wave of the deadly disease is round the bend. Swine flu cases - on the decline in the past few months - have risen sharply in the past week in the Capital.

On November 24, 42 fresh cases were reported in the Capital. The next day, 68 fresh cases were reported and 82 more the next. On November 27, the number of fresh cases stood at 109. On Saturday, when the city experienced the coldest day of the season so far at 7.9 degrees Celsius, the figure of fresh flu cases rose to an alarming 111.

The number of confirmed cases of swine flu in Delhi till Saturday was 4,454, the highest in the country followed by 3,973 cases in Maharashtra. Health authorities did not discount the possibility of a second wave of swine flu sweeping the Capital.

"A sudden rise in the number of cases was expected. The World Health Organisation (WHO) had also said that with winter, cases will rise. That is what is happening," said Dr Anjan Prakash, the additional nodal officer for swine flu.

"For the past three days, the figure has stayed above 100 but the situation is still not alarming," she added. Doctors warned that the virus this time might change its form and become more dangerous for the human population.

The influenza virus mutates quickly. Occasionally, the virus undergoes a major change, giving rise to a radically different virus, So far, it hasn't mutated.

The Delhi government has decided to spread awareness through pamphlets and other means in order to prevent the spread of the disease. The government will also issue advisories for people in newspapers and TV channels. "The advisories will list steps one needs to take to check the spread of swine flu and will carry details of all government hospitals where one can get tested free of charge, hospitals where one will be treated but for a fee and also the contact details of private diagnostic facilities," Health Minister Kiran Walia said.

Doctors claimed like in normal influenza, people who contracted the diseases in the past had developed immunity to swine flu. Yet if a person is above 60, pregnant, diabetic, suffered from tuberculosis or is HIV+, the person needs to be more careful.

Unlike other cities, cases in the national capital are pouring in from various areas, making it difficult to focus on a particular area to check the disease.

Delhi has already reported 22 deaths so far.


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H1N1 Evolution Outpacing Vaccine and Host Defenses
Recombinomics Commentary 13:32
November 30, 2009

http://www.recombinomics.com/News/11300901/225_Evolution.html


The designation of one of the Ukraine D225G isolates as a "low reactor" raises concerns that the H1N1 evolution is outpacing the vaccine as well as immune responses from unvaccinated hosts. This concern was present early when changes began to appear at position 225, a known antigenic site.

One of the highest profile isolates was the San Francisco traveler to Hong Kong, who was reported (in July) to have Tamiflu resistant H1N1, even though she had not taken Tamiflu. Her case was mild and she recovered without antiviral treatment, but the virus had a receptor binding domain change, D225E. A survey of D225E at the time demonstrated that it was first reported in the US in New Jersey, but not subsequently. However, it had spread to many other countries, raising concerns that the US surveillance was missing this widespread sub-clade.

Moreover, there were soon examples of D225G and D225N in other early samples supporting the use of position 225 to escape host defenses. The concern of multiple changes at the same position increased when sequences from fatal cases in Sao Paulo were released recently. The July/August collections had D225G in two of two fatal cases, and D225N in two of two other fatal cases, with 3 of 4 samples coming from lung.

These concerns increased when sequence data from Ukraine was released and 4 of 4 fatal cases had D225G.

The above data reinforced concerns that the changes at position 225 were becoming more prevalent, especially in samples collected from affected organs of fatal cases.

The concerns ratcheted up another notch when one of the four cases was characterized antigenically, and was reported to be a "low reactor". Since the low reactor had only one amino acid change in HA, the role of D225G in the reduced titers raised the level of concern higher.

However, WHO has yet to address this result. The "low reactor" status was quietly added to the characterization sheet at GISAID and there has been little comment in the mainstream media, other than a sentence in the New York Times on Friday.

Comment form WHO and other agencies, including Mill Hill and the CDC, who were conducting testing of the Ukrainian samples, is long overdue.


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U.S. finds pandemic H1N1 virus in turkey flock
Mon Nov 30, 2009 5:53pm EST

http://www.reuters.com/article/internal_ReutersNewsRoom_ExclusivesAndWins_MOLT/idUSTRE5AT5P720091130

WASHINGTON (Reuters) - The pandemic H1N1 flu virus was confirmed in a flock of breeder turkeys in Virginia -- the first U.S. case involving turkeys, the U.S. Agriculture Department said on Monday.

The virus also has been found in hogs, three house cats, pet ferrets and a cheetah in California. USDA said infections of turkeys have been reported in Canada and Chile.

"This is the first detection of 2009 pandemic H1N1 influenza in turkeys in the United States," said a USDA spokesperson.

"There is a possibility that a worker, who was sent home ill with flu-like symptoms, could have infected the turkeys as a result of the artificial insemination processes, as the worker was a member of the insemination crew."

USDA said people cannot get the flu from eating turkey meat.

Swine flu viruses are known to affect quails and turkeys periodically, said USDA. USDA's Agricultural Research Service conducted two studies this year to see if the H1N1 pandemic virus could affect turkeys or other domestic fowl. Five turkey samples collected in mid to late November contained the virus.

(Reporting by Charles Abbott; Editing by Marguerita Choy)


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Breeder Turkeys, third time now.

Great timing on the announcement....

Yep, let me reach up and scrape a little of the lungs they missed out before we stuff it.


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!

.....

nooooooooooo, they are just laying the ground work for when swine flu with bird flu shows up in a serious manner............."well, it started mixing with dogs, and cats, and ferrets, and, and, and.........."


is all this flu mixing with this great a variety of animals 'normal'?


as for this:

'The Higher Institute of Health has examined around 100 strains (of the virus) found in recent months in patients from all over Italy and up to now the mutation has only been found in one patient,' the ministry said in a statement.

'Italian data suggest that at the moment the mutation in question is not dominating serious and fatal cases of the virus. Furthermore, the mutation seems to be sporadic and does not appear to be spreading,' the ministry said.

Vaccination and anti-viral treatments were still effective against the mutation, the ministry said.



This is good news, if it is accurate. However, I don't see any mention of WHAT the mutation is. There have been several mutations. Just which one are they talking about?

dragonslayer- actually, influenza *often* infects many species- it's one of the few diseases I know of (and I'm sure there are others, but I don't think many) which can infect many different mammals as well as birds. Very adaptable bug.

Most people who have pets and children have noticed an occasional "coincidence" where both the kids and pets were sick- they usually wrote it off as "a cold", but in fact, it was likely the URI (upper respiratory infection) was a milder form of influenza. However, I've known of both dogs and cats (and horses) which have died of influenza - usually from secondary pneumonia.

So, it's not unusual in the way you may fear- it's unlikely it's a nefarious plot, it's just a virus which is A: quite aggressive, and B: on the current radar, so when pets are tested and found to have it, it makes the news.

But it certainly does provide "extra vessels" for possible mixing and recombination...

Summerthyme

H1N1 Flu Strain Found in Canadian Turkey Flock

Tuesday, December 01, 2009

http://www.foxnews.com/story/0,2933,578294,00.html


WINNIPEG, Manitoba — Turkeys in the Canadian province of Ontario have become infected with the H1N1 flu virus, but no birds or eggs from the farm entered the food supply, provincial government officials said on Tuesday.

The infection poses minimal risk to human health, Dr. Arlene King, Ontario's chief medical officer of health, said in a news conference in Toronto.

However, she noted the discovery highlights the need for those who work with farm animals to be vaccinated for both seasonal flu and the pandemic H1N1 flu strain.

The risk of the virus passing between people and animals is that the virus could evolve into a form against which humans have little or no immunity, King said. There is no evidence that the virus has changed, she added.

The discovery in a single Ontario barn by the Canadian Food Inspection Agency is the second known incident of turkeys becoming infected with the H1N1 virus, also called swine flu. The first was in a flock in Chile.

The Ontario case comes just over a week after the Canadian Thanksgiving holiday, which traditionally involves a turkey dinner.

Health officials are following up with people who had contact with the infected turkeys. One person with contact had shown flu-like symptoms.

The turkeys' owner has voluntarily agreed to quarantine the infected birds, but they aren't likely to be prematurely slaughtered, said Dr. Deb Stark, Ontario's chief veterinarian.

The outbreak of H1N1 flu among turkeys in Chile was discovered in August. It was also the first case of the virus being found outside humans and pigs.

Earlier this year the strain was found in hog herds in the Western Canadian provinces of Alberta and Manitoba.

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Montana - Probably not related?

Bitterroot bighorn pneumonia outbreak worsens

By PERRY BACKUS of the Ravalli Republic | Posted: Tuesday, December 1, 2009 3:30 am

http://www.missoulian.com/news/state-and-regional/article_b1b6d874-de40-11de-ad1f-001cc4c03286.html


DARBY – An outbreak of pneumonia in bighorn sheep from the East Fork Bitterroot herd worsened over the past week.

State wildlife biologists collected almost 30 infected bighorn sheep from the area south of Darby. Some of the infected animals were shot in an effort to slow the spread of the disease. Others were found already dead.

“Any hope for a moderate infection rate is waning,” said Craig Jourdonnais, the Bitterroot-based biologist for Montana Fish, Wildlife and Parks. “I think we are in full blown die-off mode.”

Last week, biologists confirmed that sheep from the herd were infected with the nearly always fatal respiratory disease after two rams were discovered dead along the road.

In the past, some bighorn herds infected with pneumonia in Montana have seen dramatic die-offs in the 60 percent to 70 percent range.

The East Fork bighorn sheep herd was established in 1972 when 35 sheep were transplanted there. Last spring, Jourdonnais counted 185 during an aerial survey.

Jourdonnais and other state biologists will continue to cull sick sheep from the herd this week and collect biological samples for testing.

“It appears to be pretty extensive at this point,” Jourdonnais said. “On Sunday, we headed up into nearby draws. We found a lot of coughing sheep.”

The disease is impacting the entire herd.

“It’s an all-age thing,” he said. “We’re finding infected lambs all the way up to mature ewes and rams. It’s across the board.”

Necropsies found lesions on the animals’ lungs. In some of the worst cases, the animal’s lung lining was adhered to the rib case.

Jourdonnais said he’s found sheep that were too weak to stand. Others in earlier stages of infection are able to take just a few steps before stopping.

“They are laboring just to move,” he said.

The biologist has found a few small herds away from the main wintering area that appear healthy at this point.

“We’re holding hope that maybe they’ll keep to themselves and not get infected,” he said.

Jourdonnais said the public has been helpful in helping biologists locate the ailing sheep.

“The Doyle family has been top notch to work with,” he said.

Local sportsmen have offered to help collect samples from dead bighorns over the next few weeks.

“Logistically, we can use the help,” Jourdonnais said. “It takes a good deal of time to collect the samples we need.”

The samples are sent to the FWP laboratory in Bozeman where they are used to identify the pathogen and could potentially help biologists locate the source of the disease.

There are no known vaccines to prevent pneumonia in wild sheep.

“At this point, direct removal of infected animals is our best tool,” Jourdonnais said. “We’re going to try to contain it as best we can.”

It’s a bad time of the year for the disease to show up in bighorn sheep. The rams are in the rut and are on the move.

“They are highly social animals,” Jourdonnais said. “They are touching each other, licking each other and combating with each other. Behavior-wise they are not helping themselves at all.”

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It will be of interest to see what the lab in Bozeman finds.

I'm not so sure it'd be a good thing to be a sample collector.

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The ram thing certainly bears watching. Thx Tom.

Hi Leska,

It's 99.9 % co-incidence and usually a bacteria.

At the same time - pneumonia is having a banner year.

Storyline is starting to read like Captain Tripps, without the mass fatalities.

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Cascadians said:

Sky, it was a really tough decision, and each person is going to have to weigh all factors. I've gotten a lot better the last few months but am permanently spooked by almost dying every day, not being able to breathe, for several years.

I've felt weird since vaccination but the swimmy dizzy feeling is going away. Spent 3 hours yesterday out in the sun, took my lafuma out to the vacant school parking lot across the street and just soaked in that sun and it did make me feel a lot more normal. Add another star to redneck status

Arm muscle still sore. Small price to pay considering the zzzzzlorp of lungs possibility.

Been reading more about 1918 and the similarities are blood curdling.

Click to expand...

Been offline a few days and catching up reading posts tonight.

Leska thanks for sharing your post vaccine experience. BTW.. the sun always makes me feel better... I soak up the desert sun on ab lounge

Nice to see you back Sky. Seems there's been a drop off the cliff of posters. I know I'm really busy in the yard and now have my new computer (iMac i7 wheeeee!) and have to learn how to use it.

Yesterday was clear and warm here, sat across the street in the sun babysitting the garbage collection (and they still didn't take the leaf pile). I'm convinced humanimals need normal sun to be healthy. The baby trees in my yard have grown to the point where their skeletons now block full sun in winter. Good for summertime, too hot here, but have to go across the street. No problem, big empty school and playground, lots of space. Makes it really tempting to get a dog.

Speaking of which, read an article yesterday about dogs getting this flu ...

Cascadians said:

I know I'm really busy in the yard and now have my new computer (iMac i7 wheeeee!) and have to learn how to use it.

Click to expand...

I want a Mac :-( . I guess I don't know that for certain as I have never used one before. How different from a PC?

Not sure what's happening out here, but the cases of flu that we are admitting are definitely dwindling down. Could be for a lot of reasons though, less hysteria as people become more accustomed to seeing H1N1, the doctors aren't feeling the need to "rule out H1N1" on every patient admitted with a respiratory illness that is more than likely not the flu but something else. Of course it is also less flu as well. But regardless the reason, I am happy and haven't been in isolation in a week or more.

Of course now that I posted this, tonight I will be smitten.

rcstew said:

I want a Mac :-( . I guess I don't know that for certain as I have never used one before. How different from a PC?

Click to expand...

OMG. Get thee to your nearest official Apple retail store and play. You have to experience itself under your tender fingertips and before your astonished eyeballs.

27" screen, super high resolution, lightning fast, ease, marvelous magical ease, elegance, just works perfectly, everything logical, intuitive, joyous. Total pleasure using it, giddy satisfaction. (iMac i7)

A PC is cumbersome and annoying and distracts one from the work to be accomplished. PC asks to be cursed and smashed. A Mac is a wonder tool, a brain high that enhances creativity and supercharges a person to happy productivity.

A Mac is built to precise synchronized hardware specifications that optimize the most amazing delightful powerful software possible. Apple manufactures and writes the whole shebang so it is seamless perfection, the ultimate machine.

It is the joyous experience of falling in love with this tool and feeling ones fingers caressing the keys and mouse while the computer gives back and nourishes ones best thought processes.

And now for something different:

http://fluboard.rhizalabs.com/forum/viewtopic.php?f=5&t=3503
Swine Flu: Best Sex Positions to Fight H1N1

http://blog.newsweek.com/blogs/theh...lu-so-hot-right-now-cosmo-dishes-on-h1n1.aspx
Swine Flu: So Hot Right Now! Cosmo Dishes on the Best Sex Positions to Fight H1N1

H1N1 vaccine used on US swine
//02 Dec 2009

http://www.vetsweb.com/news/h1n1-vaccine-used-on-us-swine-709.html

The only swine vaccine available for the H1N1 virus has been sent to vaccinate a swine herd infected with the virus. The vaccination marks the first time vaccine has been sent to a swine herd diagnosed with the pandemic flu.

Iowa State University's Hank Harris, professor of animal science, developed the vaccine this summer and has been shipping preventive doses to swine producers in Iowa, Kansas and Illinois for several weeks.

The latest vaccines were shipped to a swine producer in Indiana that had H1N1 diagnosed in the herd. "This is the first time we've had a confirmed diagnosis and the farmer wanted to vaccinate," said Harris. "We shipped about 20,000 with about another 11,000 doses to go out to them later."

Vaccinating a herd that has already been infected should have some effect on the spread, but Harris isn't sure how much. Harris' vaccinations have recently been reviewed and published by the online journal PLoS Current Influenza.

"It isn't uncommon for vaccinations to be used in what we call 'the face of an outbreak,'" he said. "They (producers) may think the virus is spreading slowly in the herd, and they want to vaccinate the entire herd."

Harris thinks the Indiana vaccinations may indicate swine producers around the country are eager to vaccinate. "Since these pigs got sick and had a confirmed diagnosis, I think more farmers are going to want to vaccinate," he said.

Harris says that the virus may have gotten into the Indiana swine herd from humans who had flu-like symptoms while working with the pigs. "It's one of those things we'll probably never know for sure. The history is that the virus can go from people to pigs and from pigs to people just as easily," he said.

The vaccine is being manufactured through Iowa State University and Harris' startup company Harrisvaccines, Inc. d/b/a SirrahBios, Inc.

Related research article: Rapid Development of an Efficacious Swine Vaccine for Novel H1N1, Vander Veen et.al. (freely accessible on PLoS Currents Influenza)

Related website: Iowa State University

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UK

Swine flu' confirmed in Norfolk pig herd

2 December 2009 | By Alistair Driver

http://www.farmersguardian.com/news...u-confirmed-in-norfolk-pig-herd/29250.article

THE H1N1 swine flu virus has been confirmed in a herd of pigs in Norfolk.

Routine scanning surveillance has confirmed that the strain of the virus found is virtually identical to strains currently circulating in humans.

This is the sixth case of pandemic H1N1 2009 influenza virus found in pigs in the UK, and follows cases earlier this year in Northern Ireland.

Defra is stressing that the discovery was not unexpected and has no implications as far as the safety of pigmeat is concerned.

“It is not uncommon for pigs to be affected by influenza. Influenza in pigs is not a notifiable disease,” a Department spokesperson said.

“There is no food safety risk, pandemic H1N1 2009 has not been shown to be transmissible to people through eating properly handled and cooked pork or pork products.”

Voluntary measures set out in a new Code of Practice on influenza in pigs drawn up by the pig industry, Defra, Devolved Administrations and other government bodies are in place on the farm.

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Transmission of Novel D225G in Norway and Sweden
Recombinomics Commentary 12:57
December 2, 2009

http://www.recombinomics.com/News/12020901/D225G_Norway_Sweden.html

Recently release HA sequences from Norway and Sweden at Genbank and GISAID have D225G and support the spread of the polymorphism, but raise additional questions about the true frequency of the change. Although D225G was present as a mixture in one of the first swine H1N1 isolates, A/California/7/2009, which is the source of the current vaccine, only about 1% of published HA sequences have D225G. Since D225G can grow in cells with alpha 2,3 receptors, which include lung cells, the detection of D225G may be tissue specific and detection in the upper respiratory tract, which is dominated by cells expressing 2,6 receptors, may be limited.

The two recent sequences represent isolates from each area. In Norway, the sample is from a Danish truck driver who was the first reported fatal cases of H1N1 and the HA sequence, A/Norway/3206-3/2009, was from post mortem lung. In Sweden, the isolate A/Stockholm/48/2009 was from a nasopharyngeal swab from a recovered case. However, both sequences contained tandem polymorphisms usually associated with D225G or D225E. This tandem set of polymorphisms is also found in two earlier isolates from Spain (A/Catalonia/NS2001/2009 and A/Catalonia/NS2008/2009). The presence of the rare coding of D225G in four unrelated cases suggests D225G is widespread, but detection is usually associated with infected tissue samples, so the low frequency is largely linked to collection of nasopharyngeal samples from milder cases.

This distribution is most evident in the sequences from Ukraine, which had 10 HA sequences from 10 cases. 9 of the10 were from western Ukraine and belonged to the same sub-clade. However, D225G was not in the 5 nasopharyngeal washes from survivors, but was in four of four tissue samples (3 from lung) from fatal cases.

This differential detection suggests that D225G is transmitting as a mixture. In addition to California/7, other isolates have given mixed signals at position 225 (coding for D225G and D225E).

This situation is analogous the upcoming paper on detection of Tamiflu resistance (H274Y) in a San Francisco traveler who was not taking Tamiflu. The patient was identified at the entry point to Hong Kong and the sequence containing H274Y was published. However, the upcoming paper indicates that the H274Y was present as a mixture. In the sequence from the virus grown in MDCK cells, the consensus was H274Y, but the tracing showed a small signal for the wild type sequence for codon 274. Cloning from the original tissue sample showed that the H274Y and wild type sequences were present in almost equal amounts. The mixture also explains the rapid appearance of H274Y in patients treated with Tamiflu, supporting the silent spread of the polymorphism.

The same is true for D225G, which is likely transmitting in at a frequency that is much higher than the reported 1%. Moreover, as the viral load increases, the likelihood of the minor population with D225G establishing itself at high levels in the lung increases, leading to more hospitalizations and deaths.

Therefore a more aggressive campaign of testing lower respiratory tract samples, especially at autopsy, would be useful. Currently, the vast majority of sequences are from the upper respiratory tract, producing a false reading on virus causing the more serious disease.

In addition, the Ukraine sample with D225G was classified as a "low reactor", raising concern that natural immunity to wild type H1N1, as well as immunity generated by the killed vaccine, which does not have D225G, will lead to high ratios of D225G to wild type, leading to more serious disease.


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The Swine Flu, as of Now
December 1, 2009
Editorial


http://www.nytimes.com/2009/12/01/opinion/01Tue1.html


So far, the news about swine flu is better than expected. The pandemic may have reached its peak and is heading downward in all regions of the country; weekly deaths from swine flu have started to decline; the virus remains relatively mild; there seem to be few claims of serious side effects from the vaccine; and despite widespread complaints about shortages, vaccine supplies are steadily building up.

By mid-October, the latest estimates available, the swine flu had infected some 22 million Americans, sent roughly 98,000 to the hospital and killed roughly 3,900. Those numbers may sound high, but they are not apt to reach the levels of harm caused by a normal flu season. One big unknown is whether we will see a normal flu epidemic on top of the swine flu outbreaks or whether the swine flu will crowd out the seasonal flu, which has barely been detected here.

Supplies of seasonal flu vaccine have also been running short. The five companies licensed to make flu shots for this country had expected to make more than 118 million doses, but manufacturing glitches and the need to convert production to swine flu vaccine cut the supply of seasonal flu vaccine to 114 million doses. Even 118 million would not have been enough to meet demand that was revved up this year by all the publicity surrounding the new swine flu. (The vaccines are not interchangeable.)

Even as the swine flu seemed to be waning last week, health officials voiced concerns that Thanksgiving travels and get-togethers could lead to new outbreaks. And there were a few hints of troubling developments.

Some swine flu patients have developed serious bacterial infections in their lungs, including pneumococcal infections that invade the blood and other internal sites. The victims are mostly those with underlying chronic health problems like asthma, diabetes, heart disease and other longstanding ailments. There is a vaccine that can protect them from 23 strains of pneumococcal infection, and health officials are urging adults with chronic conditions to get it from their doctors now.

There have also been scattered reports of mutations in the swine flu virus that cause harm deep in the lungs of some patients or make the virus resistant to one of the standard drug treatments. However, neither mutation seems to be spreading widely.

This is no time for Americans to let down their guard. The number of children and teenagers killed by the flu continues to rise. Even if it is past its peak, the swine flu will go on to infect many millions more before it disappears. And if the swine flu follows the pattern of some previous pandemic strains, it could return in a new wave early next year.

As of last Wednesday, some 61 million doses of the swine flu vaccine had been used or were available to order, far less than needed to vaccinate the original target groups of 159 million Americans. As vaccine supplies build up, those who are at highest risk or could endanger others at high risk — pregnant women, people caring for infants less than 6 months old, health care workers with direct patient contact, children 6 months through 4 years old, and children 5 through 18 with chronic medical problems — would be wise to get immunized. So would others deemed at some risk, like young adults and older adults with medical problems.

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Canada

H1N1 flu putting more children in hospital than seasonal variety

Number of hospitalizations is 'much larger than anything we've ever seen before,' doctor says

By Sharon Kirkey, Canwest News ServiceNovember 26, 2009

Human swine flu is hospitalizing three to four times as many children than regular seasonal influenza, new data from a nationwide surveillance system shows.

Since October, 526 H1N1-related hospitalizations were reported by 12 pediatric teaching hospitals across Canada that together represent almost 90 per cent of all tertiary care pediatric beds in the country.

During the week of Nov. 7 alone, 264 children were in hospitals -- about half the total number of Canadian children hospitalized during last year's entire flu season, and three to four times as many flu-related admissions during any week since the network began collecting data five years ago.

At the Children's Hospital of Eastern Ontario in Ottawa, as of Wednesday, 108 children had been admitted with laboratory-confirmed H1N1 since the beginning of the second wave of H1N1 in early October. That compares to 40 children admitted during the entire 2007-08 flu season, and 37 children admitted during the 2006-07 flu season.

In the first wave of pandemic H1N1 this spring, 32 children were admitted to CHEO with confirmed H1N1.

"Children across Canada are being hospitalized in very large numbers for influenza this year, much larger than anything we've ever seen before," says Dr. Wendy Vaudry, a pediatric infectious disease specialist at the University of Alberta in Edmonton and co-principal investigator of IMPACT, an immunization monitoring program administered by the Canadian Paediatric Society and funded by the Public Health Agency of Canada. "It is causing significant illness in children all across Canada."

Vaudry, a mother of four, said vaccination is the best way to protect children against H1N1. "If I were a parent hearing this, I'd walk out this afternoon and go to your closest clinic and get your baby immunized," she said.

It is not yet known how many children admitted to hospital during the second wave have required intensive care. Normally, about 15 per cent of children admitted with flu end up in intensive care. It is also not yet known how many of them had underlying health conditions.

Usually the majority of flu admissions in children are in children under age two. But older children are being hospitalized with H1N1. "We're seeing more children in the two to five, and five to nine age groups than we usually do in a normal flu season," Vaudry says.

Federal officials said Wednesday that while the number of H1N1 cases is "levelling off" in some parts of the country, the peak of the second wave has not yet been reached. And they warned Canadians about becoming complacent.

- - -

Canadian News updated 24/7 go to vancouversun.com



===


.

......

Summerthyme,

I should have worried my question more specifically:


dragonslayer- actually, influenza *often* infects many species- it's one of the few diseases I know of (and I'm sure there are others, but I don't think many) which can infect many different mammals as well as birds. Very adaptable bug.

Most people who have pets and children have noticed an occasional "coincidence" where both the kids and pets were sick- they usually wrote it off as "a cold", but in fact, it was likely the URI (upper respiratory infection) was a milder form of influenza. However, I've known of both dogs and cats (and horses) which have died of influenza - usually from secondary pneumonia.

So, it's not unusual in the way you may fear- it's unlikely it's a nefarious plot, it's just a virus which is A: quite aggressive, and B: on the current radar, so when pets are tested and found to have it, it makes the news.

But it certainly does provide "extra vessels" for possible mixing and recombination...



I am quite aware that colds and flus can be transmitted between animals and humans. I also know that specific types of virii do NOT transmit well between all animals. I also am aware that swine and humans can pass virii back and forth, and that humans can pick up flus from fowl.


My question was, because I don't have time to research it, IS HOW COMMON CROSS INFECTIONS BETWEEN SWINE FLU AND OTHER ANIMALS ARE?

If anyone can provide answers with specific proofs I'd be interested in reading about it.


Thanks

It's starting to take off in Russia and Belarus - like it did in Ukraine.

Belarus:

Mikalai Shaulau: We have faced completely inexplicable illness. WHO’s aid is needed urgently важная новость?

16:16, — society

http://www.charter97.org/en/news/2009/12/1/24184/

Health professionals affirm that because of flu epidemic Belarus should seek help from the world medical community.

An open letter of an infectious disease specialist, assistant of Infectious diseases chair of the Belarusian Academy of postgraduate education Mikalai Shaulau, where he writes about an epidemic of atypical pneumonia in Belarus, has evoked a wide response, and it makes him address the Health Care Ministry again, “Belorusskiye novosti” write. The doctor underlines that it couldn’t be claimed that there is no atypical pneumonia in Belarus only because relevant diagnostics is not held in our country.

By “atypical pneumonia” Mikalai Shaulau means malignant, uncharacteristic development of the disease.

The term “atypical pneumonia” appeared long before the outbreak of the recent pandemic in the beginning of the century, and is used for naming lungs disease not caused by one of the more traditional microorganisms, but by other pathogens including viruses. SARS (severe acute respiratory syndrome) is the accepted name which better reflects the specifics of the illness.

Indeed, the Health Care Ministry is right when they say that atypical pneumonia is not recorded in the country, but they a right just formally. As Mikalai Shaulau underlines, none of the patients was tested for this virus, as well as for other possible causes of pneumonia development.

“I am not a functionary in a white coat, I am a doctor,” Mikalai Shaulau said. He believes that at present experts should primarily find out what virus causes community-acquired pneumonia, which kills people in three-five days. He underlines that development of the disease, as the age of the deceased, most of them were young people, are atypical.

The health Care Ministry does not reveal figures, however, visiting hospitals with consultations, M. Shaulau saw four persons dying in intensive care department in one night, including a young pregnant woman. Pneumonia has so grave development that artificial pulmonary ventilation does not give an expected result, as its regime is hard to choose: “We have faced an absolutely inexplicable illness. We have managed to save some people certainly. Unfortunately, I know individual cases when patients were alive after artificial respirating unit was used for them. Most of them die”.

He underlines that the world medical community must be addressed for help, in particular, the World Health Organization.

Mikalai Shaulau believes that like the population of our country, the WHO at the moment has no information about the real situation with pneumonia rate in Belarus. In case we address the WHO, we could be offered aid in diagnostics: “After all, we have Moscow not far from us, and there is a laboratory of new and newly discovered infections there. There are powerful laboratories in London. The WHO won’t deny help to any state. I should note that only a state can address this organisation, not some doctor”.

In order to realize the complexity of the situation, Mikalai Shaulau offered to recall the case history. The flu A (H1N1) is diagnosed in Belarus since August 19, 2009. “I should note that it happened only after on August 14 the chief sanitary officer of Russia Gennady Onishchenko put in doubt that no cases of flu A (H1N1) had appeared in Belarus”.

All swine flu cases were benign or moderately grave cases. There were no lethal outcomes. M. Shaulau wonders: “Why people started to die in late October, in November? What has changed: a virus, or people? I would like to have an answer to this question from the leadership of the Health Care Ministry”.

= = =

Russia

In Saratov, reduced the number of flu
02/Dec/09

In the Administration of Saratov December 1 held a meeting at headquarters in the town to combat diseases caused by highly pathogenic influenza virus, the correspondent of IA REGNUM-VolgaInform. Chief medical officer for the city of Saratov Nikolai Pavlov described the epidemiological situation regarding the incidence of ARI and influenza, as a complex, but drew attention to the fact that in Saratov, a decrease in number of cases of ARI and influenza. If during the period from 16 to 22 November in the city have been registered 20 thousand 838 cases, during the period from 23 to 29 November - 15 thousand 519 cases.

The results of autopsies Saratov inhabitants who died of swine flu, which was made public, have created panic: According to witnesses, the destruction of lung pattern was similar to those described in the medical literature, the autopsy of patients with pneumonic plague. However, Pavlov reassured the audience, saying that cases of pneumonic plague in Saratov have been identified: "There have been carried out all necessary studies, analysis of cases studied carefully. No signs of the disease were observed, there is no cause for panic," - said Nikolay Pavlov.

The meeting recognized that the joint measures taken by the city administration, Rospotrebnadzor, had a positive effect. This children's groups and dividing by the dissolution of the students of secondary institutions in the city for extraordinary holidays, and a further extension of the quarantine in schools, and termination of employment in most universities and secondary specialized educational institutions of Saratov, and rapid introduction of anti-epidemic measures, and active health education among the population.

Currently, the six hospitals in Saratov deployed 912 beds for hospitalization of cases. If necessary, additional base Hospital will work 12-th city hospital. According to participants, the situation with the incidence and treatment of ARI and influenza in Saratov controlled.

Today, 2 December, became aware of the termination of work in most universities in Saratov: to quarantine until 7 December joined the Agrarian University and the Academy of Law.

http://www.regnum.ru/news/1230905.html

and

Comment: A new major outbreak for us to watch, the Saratov oblast in Russia (http://en.wikipedia.org/wiki/Saratov). Judging from the symptoms (presence of "pneumonic plague"), the D225G strain of the virus is active there.

Russia

The question of the closure of Saratov on the quarantine of pulmonary plague is being decided
02/Dec/09

At the meeting held on December 2 in the Saratov Regional Duma, chaired by the Speaker of the Legislative Assembly Valeria Radaeva, discussed issue of sanitary-epidemiological situation in Saratov. Participated in the meeting Deputy Minister of Health Dmitry Kidron, chief medical officer for the region Alexey Danilov, Leonid Pisnoy deputies, Sergei Kurihin, Oleg Galkin, Marina Aleshin and others, the correspondent of IA REGNUM-VolgaInform.

Consideration was given to the possibility of introducing a regional center of the state of emergency in connection with the epidemic of "swine" influenza and a suspected outbreak of pneumonic plague. The meeting discussed the possibility of overlap of all exits from the city, the mass disinfection of the city. However, the decision is not accepted. Chief Sanitary Doctor of the region Alexei Danilov categorically stated that "Saratov closed will not be anything sprayed from the air will not be a plague in the city, no!".

The meeting finally admitted the unreliability of official information on the staffing of pharmacies and medicines. According to the Minister of Health of the Saratov region of Larissa Tverdokhleb, pharmacies no more Tamiflu, Arbidol, other antiviral drugs.

Meanwhile, residents of Saratov region, without waiting for assistance from the leadership themselves have begun to influenza and Antiplague activities. Engels plant in a matter of hours adjusted release gauze bandages, to enterprises in the region conducted a massive disinfection, the prosecutor's office checks sanitary regime in health care.

http://www.regnum.ru/news/1231243.html

The above was copied directly from PFIF posted by Helblindi. Helblindi consistently posts from Poland.

===


.

You'd think there would be better communication so each country doesn't freak out, call it "inexplicable" and "pneumonic plague" and go thru a long learning curve while 1000s die. In 2009 the wheel only has to be invented once. Sheeeesh.

I pray I'm never without the Internet and the ability to research. Really not difficult.

FRENCH GOVERNMENT ABOUT TO IMPLEMENT FULL SCALE MARTIAL LAW IN PANDEMIC CRACKDOWN

The French government is about to move the country to the highest pandemic alert level allowing the implementation of full-scale martial law, according to a report in Le Figaro.

Measures allowed under the country's highest pandemic level, 6, include

*forced vaccination
*forced quarantine/isolation
*compulsory wearing of face masks/respirators for health personnel
*the distribution of plastic body bags for the "deceased"
*a ban on public gatherings
*a ban on transporting documents by courrier
*closure of all schools and education establishments
*restricted movement
*restricted access to hospitals, old people's homes, prisons and other social institutions
*restrictions in transport, also of food and other supplies



The move to pandemic level 6 under WHO's instructions will strip French people of their basic civic rights at a time when the government has set up the infrastructure for the mass vaccination of the entire population by force mobilising military units to work in the special vaccine centers.

Only about 85 people in France have died from the swine flu according to the authorities, far fewer than for the regular flu.

There are no reliable figures for how many of these deaths were really due to the swine flu and how many were seasonal flu deaths reclassified as swine flu deaths by the government as has been proven to have occured in Scotland.

According to the French government, two to three million people have visited their doctor and are suspected of having the swine flu - and this is enough to enact the draconian legislation and move to compulsory vaccination with an untested and toxic jab for which the pharma companies have no liability.

However, this is clearly a fraudulent manipulation of scientific data to justify an illegal and criminal power grab.

People vaccinated in the special vaccine centers in Laxou en Lorraine have left comments on Le Figaro, saying they had to sit for 2 hours on the floor of a gymnasium before being given the swine flu jab in a box measuring one meter by one meter without any curtains and in full of view of everyone else.

"It is shameful!" says the person.

Are the people of France to be subjected to a degrading vaccination with toxic substances causing long term damage and death -- in many cases, indeed, immediate death -- by force in the full sight of the entire world?

And does the government of France, specifically President Nicolas Sarkozy, Health Minister Roselyne Bachelot and Defence Minister Herve Morin, really think they can get away with this mass murder by closing borders and shutting down the internet?

They can not.

We, the People, of The World refuse to allow this crime to occur, and the people responsible to go unpunished.

We refuse to let it occur in France or any country of the globe.

It is time to End the WHO, End the EU, and bring these criminals in the French and other governments to trial.

http://www.lefigaro.fr/sante/2009/1...23-grippe-a-passage-au-niveau-6-envisage-.php

http://www.theflucase.com/index.php...implement-full-scale-martial-law-in-pandemic-

Illinois

PBL sixth-grader dies after experiencing flu-like symptoms
By Will Brumleve
Wednesday December 2, 2009

http://www.news-gazette.com/news/lo...der_dies_after_experiencing_flu-like_symptoms

PAXTON — Grief counseling is being provided to students and staff at Paxton-Buckley-Loda Junior High School after the unexpected death of a sixth-grade student who had been ill with flu-like symptoms.

“The PBL school community is deeply saddened by the unexpected death of Natalie Johnson, a sixth-grade student,” said Superintendent Cliff McClure. “Our hearts and prayers go out to the Johnson family at this time.”

Natalie died Tuesday after being taken to Carle Foundation Hospital in Urbana, Paxton Police Chief Bob Bane confirmed.

The cause of her death was not immediately known. Officials with the Ford-Iroquois Public Health Department said the child had been ill with a fever, but they are awaiting an autopsy report from the Champaign County Coroner’s Office to determine if there is a community health concern.

Meanwhile, as a precaution, the health department is encouraging parents of children who possibly had been in contact with Natalie in recent days to seek medical attention immediately and also to call the health department if their children display any flu-like symptoms or high fevers.

“If the autopsy comes back as a confirmed communicable disease, and we have people that have called in with the symptoms of that disease, then we can go to those people as opposed to finding them in the crowd ... which will help us put the puzzle pieces together,” said public information officer Julie Clark.

Clark said the coroner’s office has indicated that the autopsy results would not be finished until Monday. Coroner Duane Northrup did not immediately return an e-mail and calls made to his cell phone.

Preventative medication has been provided to Natalie’s family, “in case certain things come out through the autopsy,” Clark said. Preventative medication is not being given to students at PBL Junior High School, Clark said, but she said the health department is “doing some research as far as what students sat around her and maybe had close contact with her.”

McClure said he will continue to keep in close contact with the health department as more information becomes available. He added that the school district continues to monitor symptoms of students and be “very vigilant” in its efforts to limit the spread of diseases within its four schools, through stressing “the three Cs” — clean, cover, contain — to students and staff.

“We have a containment plan everyday. We started that from day one, for any illness,” McClure said.

Natalie’s father, Michael Allan Johnson of Loda, in a post on Facebook on Wednesday morning, said his daughter “was the sweetest, most innocent child you could hope to meet, and I am devastated.”

“I know she is in Heaven now, but I wish I could have her back with me and her family.”

McClure said the school district is providing grief counseling to students and staff and will continue to do so as long as it is needed.

Funeral services are scheduled for 11 a.m. Saturday at the Evangelical Covenant Church, Paxton. Visitation is Friday from 4-8 p.m. at Baier Family Funeral Services, 406 E. Pells St., Paxton.


===

Pro-Active!

===
.

North Carolina

H1N1 suspected in death of 22-year-old nursing student


By Vicky Eckenrode
Vicky.Eckenrode@StarNewsOnline.com

Published: Wednesday, December 2, 2009 at 4:43 p.m.
Last Modified: Wednesday, December 2, 2009 at 4:43 p.m.

http://www.starnewsonline.com/article/20091202/ARTICLES/912029962/1004


Allison Blackstone Sewell, shown here with her husband and 2-year-old daughter, died this week.


With a pediatrician for a father and an intensive care nurse for a mother, it was no surprise Allison Kay Blackstone Sewell wanted to work in medicine, her father said Wednesday.

Sewell, a 22-year-old wife and mother from Wilmington, died this week from what is suspected to be complications from the H1N1 virus.

She died Monday at New Hanover Regional Medical Center, days after suddenly getting sick and being put on a ventilator at the hospital’s intensive care unit.

Tests at the hospital showed she had influenza A, Blackstone said.

New Hanover County Health Department officials said a test is pending at the state public health lab to subtype the sample and to confirm if the flu strain was the H1N1 virus.

Blackstone, a pediatrician at Cape Fear Pediatrics, has been well aware of the virus since it began circulating in the spring, seeing the impact it’s had on sick patients.

He said he had an H1N1 vaccine available for Sewell, who because of her age and the fact she was asthmatic was considered to be in a high-risk group and eligible for the shot.

“She had been too sick to get her vaccine,” Blackstone said. “I had one for her, but she was ill.”

Suffering from side pains, Sewell had an outpatient gallbladder surgery two weeks ago, her father said.

She started showing signs of serious flu-like symptoms.

“Within 48 hours, she was coughing up blood,” Blackstone said.

His daughter’s death was a shock for the family.

“That’s our baby,” he said about Sewell, the youngest of five children.

He described his daughter as a straight-A student at the college and devoted mother of a 2-year-old girl.

“This was probably the happiest she’s ever been,” he said. “She was vivacious and full of life, never a loss for ideas or words.”

Family members had planned to make H1N1 vaccines available to those attending Sewell’s memorial service Thursday to raise awareness for the shots, but they have changed their mind.

Blackstone said it would be logistically impossible to do at the church and they did not want to bump ahead of area residents who are on lengthy waiting lists for the vaccine.

Instead, Blackstone said he hopes an upcoming vaccine clinic will be organized in Sewell’s honor.

He said he recognized some people still are hesitant about receiving the inoculation.

“Some people are afraid of vaccines,” he said. “When you consider that it prevents this, what’s the choice?”

Nearly 70 people have died and more than 700 people have been hospitalized in North Carolina this year from flu-like illnesses, predominately the H1N1 virus, according to statistics updated Tuesday from the state Department of Health and Human Services.

At least four other people in Southeastern N.C. have died from complications caused by the virus.

Vicky Eckenrode: 343-2339

On Twitter.com: @vickyeckenrode

======




Let that sink in a while.




====






!

Tamiflu Resistant Cluster in Maryland / Virginia USA
Recombinomics Commentary 22:45
December 2, 2009

http://www.recombinomics.com/News/12020902/H274Y_MD_VA.html

Two swine flu patients in Maryland and one in Virginia were hospitalized with a form of the virus resistant to a commonly used medicine, prompting infectious disease specialists to call for renewed caution

Click to expand...

The above comments describe a Tamiflu resistant cluster in the Washington, DC area. This cluster follows recent clusters at Duke, Wales and Edinburgh signaling efficient transmission of H274Y.

Silent spread of H274Y has been suggested by the short time period between the start of Tamiflu and symptoms. In the spring these examples were relatively rare, which was likely due to the relatively low level of H274Y. In most cases the host immune system would control H274Y positive virus, so most selection was sub-clinical. However, there have been dramatic jumps in reported cases in the past several weeks, suggesting the viral load or circulating levels of H274Y have increased.

These increased levels has led to more efficient transmission; leading to more cases and clusters.

In addition to the indirect evidence for mixtures, an upcoming report on the first reported case of resistance in the absence of Tamiflu treatment indicated that the patient was infected with equal levels of wild type and H274Y positive virus. In most cases however, the ratio of H274Y to wild type was lower, allowing H274Y to silently spread.

WHO has issued an update, noting that the number of H274Y reports in the past two weeks has almost doubled from 57 to 96, leaving little doubt that such dramatic increase would continue and likely accelerate, creating a significant public health issue, which WHO has denied.

The denial of the significance of spreading Tamiflu resistance follows a denial that the receptor binding domain change, D225G, reported in all fatal cases in Ukraine, is also not significant. More recent statements have left the significance open, but statements on "spontaneous" changes involving D225G follow similar statements on H274Y in seasonal and pandemic H1N1.

The reliance of spontaneous mutations to explain influenza evolution stems from an outdated paradigm based on random mutations fueled by copy errors, which is not supported by a growing sequence database. However, WHO and consultants, including the CDC continue to base policy and press releases on the fatally flawed concept, which is hazardous to the world's health.

This hazard is increasing daily.


====


!

Tom McDowell said:

H1N1 suspected in death of 22-year-old nursing student


By Vicky Eckenrode
Vicky.Eckenrode@StarNewsOnline.com

Published: Wednesday, December 2, 2009 at 4:43 p.m.
Last Modified: Wednesday, December 2, 2009 at 4:43 p.m.

http://www.starnewsonline.com/article/20091202/ARTICLES/912029962/1004

Allison Blackstone Sewell, shown here with her husband and 2-year-old daughter, died this week.


With a pediatrician for a father and an intensive care nurse for a mother, it was no surprise Allison Kay Blackstone Sewell wanted to work in medicine, her father said Wednesday.

Sewell, a 22-year-old wife and mother from Wilmington, died this week from what is suspected to be complications from the H1N1 virus.

She died Monday at New Hanover Regional Medical Center, days after suddenly getting sick and being put on a ventilator at the hospital’s intensive care unit.

Tests at the hospital showed she had influenza A, Blackstone said.

New Hanover County Health Department officials said a test is pending at the state public health lab to subtype the sample and to confirm if the flu strain was the H1N1 virus.

Blackstone, a pediatrician at Cape Fear Pediatrics, has been well aware of the virus since it began circulating in the spring, seeing the impact it’s had on sick patients.

He said he had an H1N1 vaccine available for Sewell, who because of her age and the fact she was asthmatic was considered to be in a high-risk group and eligible for the shot.

“She had been too sick to get her vaccine,” Blackstone said. “I had one for her, but she was ill.”

Suffering from side pains, Sewell had an outpatient gallbladder surgery two weeks ago, her father said.

She started showing signs of serious flu-like symptoms.

“Within 48 hours, she was coughing up blood,” Blackstone said.

His daughter’s death was a shock for the family.

“That’s our baby,” he said about Sewell, the youngest of five children.

He described his daughter as a straight-A student at the college and devoted mother of a 2-year-old girl.

“This was probably the happiest she’s ever been,” he said. “She was vivacious and full of life, never a loss for ideas or words.”

Family members had planned to make H1N1 vaccines available to those attending Sewell’s memorial service Thursday to raise awareness for the shots, but they have changed their mind.

Blackstone said it would be logistically impossible to do at the church and they did not want to bump ahead of area residents who are on lengthy waiting lists for the vaccine.

Instead, Blackstone said he hopes an upcoming vaccine clinic will be organized in Sewell’s honor.

He said he recognized some people still are hesitant about receiving the inoculation.

“Some people are afraid of vaccines,” he said. “When you consider that it prevents this, what’s the choice?”

Nearly 70 people have died and more than 700 people have been hospitalized in North Carolina this year from flu-like illnesses, predominately the H1N1 virus, according to statistics updated Tuesday from the state Department of Health and Human Services.

At least four other people in Southeastern N.C. have died from complications caused by the virus.

Vicky Eckenrode: 343-2339

On Twitter.com: @vickyeckenrode

======




Let that sink in a while.




====






!

Click to expand...

Yoo Hoo! Anybody out there? This is a terrifying article! In 48 hrs. she was coughing up blood. There is something seriously wrong with this picture! If this is that mutated virus then how far has it spread in this country and nobody is talking.

(Oh. I forgot. We are much more interested in the sex life of Tiger Woods.)

Anybody out there?

I watch trends, they're tracking negative.

Since Monday as notated here, there's a lot to chew on.

We're still losing lots of people daily and there's a real lack of reporting on those losses.

There seems to be a lull here in the USA while in - what is it week two or three of flu season?

Then there's a possible spike brought on by US holiday travel, could start any day.

Meanwhile Eastern Europe and Russia are beginning to see it take hold with lethality.

Something is happening in Turkey many deaths in the last few days.

China is announcing a climbing death rate.

The Haj is ending and 3 million people are returning home from Saudi Arabia.

More animals infected, USA -Turkeys and note the infection was discovered over a week before Thanksgiving, information released to the public Monday after the Holiday. USA again we learn after the fact - pigs have been and are being; vaccinated for H1N1.

We learn in the USA of the seven (as of May) or more families (sub-clades) of Novel H1N1 Swine, several may be mixing simultaneously while infecting their human hosts.

And - the end of Tami-flu treatment is getting closer. It was expected, yet it does save a lot of lives. And if the Tami-flu blanket disappears during an outbreak - it's a game changer.

Then there's more on the change in the virus which allows a new path to the lungs, D225G. Aside from the controversy as a low reactor (possibly vaccine resistant), under counted, and still reported in more localities every day - it may be working as a mixture too.

Not too mention it can possibly kill both dogs and cats now.

That's just since Monday.

Elegant Designs - Bad Trends.


===


.

Calm before the storm. 2nd wave approaching.

Indonesia

Another 25 Indonesian hajj pilgrims die


Thursday, December 3, 2009 09:27 WIB

http://www.antara.co.id/en/news/1259807247/another-25-indonesian-hajj-pilgrims-die

Jedda (ANTARA News) - Twenty-five more Indonesian hajj pilgrims have died since Sunday, bringing to 161 the number of the country`s hajj pilgrims who died during their journey of worship in Saudi Arabia this year.

Some of the hajj pilgrims died of heart disease and respiratory failure, the Religious Affairs Ministry`s integrated hajj communications system (Siskohat) unit said on Thursday.

More than 196,100 Indonesians performed hajj pilgrimage this year. They were flown to the Holy Land in 475 batches.

Islam obliges its adherents who can afford to it to perform hajj pilgrimage once during their lifetime.(*)

===

What The Heck?

Is this normal?

===


.

.....

you are going to have to do the math. Having 196,100 people traveling, and having 196 die, doesn't seem all that big to me, and they are not stating WHAT they are dying from. I am not being flippant when I state that I HAVE seen numerous reports of 50-120 people dying from a single bus crash in places like India or Bangledesh, where people hang off, from the OUTSIDE on the windows, the roofs of the bus are packed with people, etc.


Give it another month for bugs to spread.

I don't know the stats, but a lot of people die during the Hajj. People packed together in hot, rather unsanitary conditions, many of them from fairly backward cultures, and they are not all young - some people save for their entire lives to be able to complete the Hajj. So, conditions of stress contribute to a lot of deaths. Usually fires and stampedes are at the top of the list. There is some ritual where they "stone the devil" where participants don't seem to be able to hit old scratch and end up bonking members of the crowd, which then touches off stampedes where people get trampled. Good times.

well

I did ask about the mammals.......................



Cat swine flu: H1N1 latest illness shared by owner, pet

Cat with H1N1 was nothing to sneeze at
Animal Science
Iowa By William Mullen

Tribune reporter

November 8, 2009


A 16-pound orange cat in Ames, Iowa, did something last month that will now and forevermore have a lot of cat lovers taking care to sneeze into their sleeves.

The 13-year-old tabby came down with H1N1 swine flu, proving that humans ill with the flu virus should take pains not to spread it to cats as well as humans.

The case surprised human and animal health authorities, who hadn't seen a human flu virus passed to a cat before, though passionate cat lovers were shaking their heads when it was reported last week.

"The guy talking on the television news acted so surprised by the story," said Judy Coffey, who runs Catworld, a Berwyn business that sells carpeted "cat trees" for felines to climb on, "but I think knowledgeable cat owners are well aware that our cats catch things from owners all the time.

"If we come down with a cold, pretty soon we see our cats sneezing," she said.Though that association could be a bit of a stretch, veterinary medical experts and zookeepers say there are a number of diseases that humans can share with the rest of the animal world, and the list seems to get a little longer every year.

The study of zoonotic diseases -- diseases transmissible between people and animals -- has become an important research area in recent decades with the appearance of deadly new emergent diseases like Ebola, HIV/AIDS and West Nile virus.

But finding a cat sick with H1N1 flu -- as that disease spreads to pandemic proportions -- surprised health experts.

"This cat is a new development in the H1N1 panic," said Kimberly May, a veterinary doctor and assistant director of professional services at the American Veterinary Medical Association.

"In general, cats are not considered susceptible to human flu viruses, but this cat got H1N1 flu from his owners. There seems to be no doubt about that, and from our understanding, it seems to be the first time a cat caught flu from a human."

But experts say there is no evidence as of now that cats or other pets can pass the flu virus onto humans.

The Iowa tabby is an indoor cat never allowed outside, said a report from the Illinois Department of Public Health. It had not been around any humans other than its owners, and in the last week of October, the owners came down with the flu, assumed to be H1N1.

On Oct. 27, the cat fell ill too. The owners called friends who are veterinary researchers at Iowa State University in Ames. The researchers brought in the cat to be studied, and it tested positive for H1N1. It has since recovered and is back home.

Cats now join a small list of other animals known to be susceptible to H1N1, including ferrets, domestic turkeys and pigs. Though sometimes called swine flu, the current strain does not come from swine.

No dogs are known to have caught H1N1, but that possibility can no longer be ruled out, said May.

"Cats and dogs and people all are prone to respiratory diseases," she said. "Obviously if H1N1 went into a cat, it is not impossible that it could go into a dog," though she cautioned that it is not likely that H1N1 will become very common in pets like cats and dogs.

"If a cat gets a runny nose, people should not jump to the conclusion that it is H1N1. It probably is not. Cats and dogs have their own little bugs running around, and if they get sick, almost all the time it is due to those bugs, not things passed on by humans," she said.

In 2004, a new illness showed up in dogs, canine influenza, thought to be a virus that jumped from horses to dogs. Humans and other animals do not get it, but it spread so rapidly in the canine world that last May virologists introduced a vaccine to protect dogs.

At zoos, keepers maintain distance and barriers between humans and animals as much to stop germs from spreading between the two as to protect against any physical dangers.

"While the protection goes both ways, most of our biosecurity protocols are there to keep animals from catching bugs from humans, both from keepers and the public," said Dominic Travis, a veterinary epidemiologist who is Lincoln Park Zoo's vice president for conservation and science.

Primates especially are susceptible to human respiratory diseases like flu, so in flu season, keepers wash their hands every time they leave an animal's station.

As for protecting pets from catching flu from infected humans, animal health authorities recommend humans take the same steps they would to protect family and friends. That includes sneezing into the sleeve of your crooked arm to avoid spreading the flu virus.

"You should wash your hands frequently, cover your coughs and sneezes and don't let the cat or dog lick your face, which of course isn't recommended at any time, though hard to avoid," said May.

For cats, Coffey jokingly offers another possible protection. "I have a cat that likes to sit on a high perch and greet people coming in. Some just go nose-to-nose nuzzling him," she said. "I have been thinking I should make him one of those little hospital masks you see doctors and nurses wearing around patients in hospitals."

http://www.chicagotribune.com/health/chi-flu-pets_mullennov08,0,7440266.story

Canada

H1N1 pandemic ending with a whimper, not a bang

By Sharon Kirkey, Canwest News Service
December 4, 2009 8:36 PM

http://www.montrealgazette.com/health/H1N1+pandemic+ending+with+whimper+bang/2304630/story.html

With H1N1 poised to enter history as the least deadly of four global flu pandemics, some experts are calling for an end to Canada's mass vaccination program.

Nature is already achieving what we would hope to achieve by vaccinating, they say.

H1N1's "reproductive number" — the number of people each infected person passes the virus to — was above one when the epidemic began, which led to the explosive initial increase in cases.

Now it is less than one, because many people have become immune, and each old case is making less than one new case. When the reproductive number falls below one, the epidemic can't sustain itself, and fades away.

The drop in cases suggests Canada has hit the critical fraction of the population that needs to be vaccinated to control the pandemic, says Dr. David Fisman, a University of Toronto expert in infectious disease dynamics.

Fisman can't understand the rational for continuing mass vaccinations. He said that for a virus as contagious as H1N1, fewer than 30 per cent of the population needed vaccination to reach a critical level of immunity.

"I'm sure that the vaccine has prevented some deaths. I'm sure that there are people who are alive right now who would not have been alive if we hadn't vaccinated," he says. But the pandemic was already peaking, and then subsiding before the vaccination was rolling out in force.

"That's nobody's fault, that's just how long it took to make a vaccine against a brand new virus. Those were the cards we were dealt," says Fisman, an associate professor of infectious diseases epidemiology at the University of Toronto's Dalla Lana School of Public Health.

Despite that view, Canada's top doctor this week pleaded with Canadians to get vaccinated if they have not already done so. Chief public health officer David Butler-Jones said that, while 30 per cent of the population is now immune to H1N1, either because they have been vaccinated or because they have already been infected, "millions" of people are still at risk of infection.

Someone vaccinated today may be protected against infection two weeks from now, "if there is still enough of (H1N1) kicking around," Fisman says. But the benefit diminishes the further into the future we go, and he says other public health programs have suffered as staff and resources were redeployed to the H1N1 campaign. In some jurisdictions, breastfeeding support programs, sexually transmitted diseases clinics and other usual activities were cancelled or postponed as public health was forced to bear the brunt of delivering the largest immunization program in Canada's history.

"At this point, in terms of saying everybody must get vaccinated because there is a pandemic abroad, it's kind of done," Fisman says.

H1N1 will likely die out with a death rate lower than that for regular seasonal flu.

Harvard University infectious disease expert Marc Lipsitch is pegging H1N1's case fatality rate — the proportion of people infected with a disease who die of it — at less than 0.1 per cent, placing human swine flu in a category 1 pandemic, the lowest level of severity for a worldwide disease outbreak. Swine flu's case fatality rate is less than what was seen for the three worldwide flu outbreaks in the 20th century: 1918, 1957 and 1968.

Unless the virus mutates, and there is no strong sign H1N1 is becoming noticeably different, "it's almost certainly going to be the mildest of the four (pandemics) that we have good data on," says Lipsitch, a professor of epidemiology at the Harvard School of Public Health.

When the World Health Organization declared the pandemic in June, officials warned the rogue virus threatened all of humanity. The reality is so far proving strikingly different from what was expected.

The world agency, and Canada, had done their pandemic planning with a different flu virus in mind. They spent five years watching H5N1, or "bird flu," which kills up to 60 per cent of those it infects.

We got off lucky when the real pandemic hit, WHO says, but the public doesn't always understand that.

"Adjusting public perceptions to suit a far less lethal virus has been problematic," WHO said in a statement Thursday, issued in response to media reports that ties with the drug industry among expert advisers may have influenced WHO's policy decisions related to H1N1.

"Given the discrepancy between what was expected and what has happened, a search for ulterior motives on the part of WHO and its scientific advisers is understandable, though without justification.

"WHO has consistently assessed the impact of the current influenza pandemic as moderate. WHO has consistently reminded the medical community, public and the media that the overwhelming majority of patients experience mild influenza-like illness and recover fully within a week, even without any form of medical treatment."

But some critics say WHO set itself up for blame.

"They had been talking for years about the possibility of some kind of reprise of the 1918 pandemic," says Philip Alcabes, author of Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to the Avian Flu. "A huge amount of money and person power was devoted to preparing" for the next outbreak, he says.

But, "there was never any evidence, not from Day 1, and not anytime since, that this strain of flu was going to be a particularly dangerous strain, either in terms of its capacity to make people sick or its capacity to kill people," says Alcabes, associate professor in urban public health at Hunter College's School of Health Sciences in the City University of New York.

"Yet that's the story that's always been told, almost every single day since it appeared in April. 'We don't know what's going to happen.' Essentially, 'the sky might fall.'"

Lipsitch, of Harvard, says that when the first reports were coming out of Mexico, the case fatality rate estimates were as high as four per cent, which is twice the rate for the 1918 Spanish flu.

"If you don't know how bad your enemy is, you plan as if it's bad, and you hope that you're over-planning. In this case, that's exactly what was done," he says.

"I think the response has been appropriate for what we knew at each stage, but what we know has changed, because the data gets better."

skirkey@anwest.com

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Meanwhile official death numbers for the week were low in Canada, 3-5 people.

News reports at deaths around 47.

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California

latimes.com
Nearly 800 in California hospitalized with H1N1 flu
It's the largest one-week total since flu cases began escalating this fall, state officials say.

By Rong-Gong Lin II

December 4, 2009

latimes.com/features/health/la-me-swine-flu4-2009dec04,0,6835413.story


Nearly 800 people in California were hospitalized with the H1N1 flu last week, the largest one-week number of hospitalizations since flu cases began escalating this fall, state officials said Thursday.

The number indicates that H1N1 flu, also known as swine flu, continues to be widespread throughout California and remains a significant threat to public health. Health experts have said there could be a second wave of cases in the coming months.

"Pandemics are very unpredictable. . . . We cannot turn our back and be complacent," said Dr. Gil Chavez, deputy director of the California Department of Public Health's Center for Infectious Diseases.

In the week that ended Nov. 28, 794 people in California were hospitalized or had died, according to reports received by the state that week. The figures were higher than the previous week's total of 405, and topped the previous high -- 773 -- recorded for the week that ended on Halloween.

Reported deaths, however, decreased last week compared with the previous week. There were 12 H1N1 deaths reported last week and 36 the previous week.

Local hospital officials have attributed the decline in new H1N1 cases in part to vaccination efforts and to immunity in individuals who have survived an H1N1 infection.

Chavez urged the public to continue to seek inoculations, even though many people have been frustrated by widespread vaccine shortages. An estimated 3 million Californians have been sickened by the H1N1 virus, and Chavez estimated that 8 million doses of H1N1 vaccine have been given in the state.

So far this year, more than 7,000 Californians have been hospitalized because of H1N1 flu.

A total of 366 people have died from the strain, including 42 children and 13 pregnant women.

Earlier this week, federal officials said H1N1 flu continued to exact a heavy toll in hospitalizations and deaths, especially among children. From April to Nov. 21, there were 234 pediatric deaths from the flu; a normal flu season is marked by about 30 to 40 pediatric deaths.

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North Carolina

Swine flu leaves student on life support

Friday, December 04, 2009

Tamara Gibbs

http://abclocal.go.com/wtvd/story?section=news/local&id=7151820



CHAPEL HILL (WTVD) -- Just two short weeks ago, Lillian Chason was like any other UNC student: bright eyed, busy, and the picture of perfect health.

Now, she's on life support at UNC Hospitals.

"She's gravely ill," said Doctor Charles Van der Horst.

Van der Horst says the freshman took a turn for the worse while stricken with the H1N1 virus, and state-of-the art medical technology is keeping her alive.

"She's got a very strong heart," said Van der Horst. "And she's young and that's in her favor."

Also in her favor are friends, family, even strangers, who are rallying behind her on Facebook. Thousands have posted messages - checking daily for Chason's parents to update her condition. This week, they write "things have been stable."

"I've really appreciated seeing people's comments such as, 'I haven't had the opportunity to meet you yet, but I'm praying for you,' and I just feel like that's so encouraging to the family and to Lillian," classmate Rachel May said.

May along with fellow classmate Will Barbour, say Lillian Chason's illness is the grief of their drama class.

"I sit next to her in drama 120 and I just think she's brilliant especially when it comes to drama," May said.

"A lot of people have really come together to go see her," Barbour said, "We all wrote, signed a note in our drama class &..sending our best wishes to her."

Lillian's grave condition - doctors say - is hardly uncommon. Her young age puts her in the high risk group.

"The important thing that the parents want to say is that it's important to get vaccinated," said Van der Horst.

Van der Horst specializes in infectious diseases and firmly believes the H1H1 vaccine prevents the spread of the virus.

"Protecting people like Lillian," he said.

Right now's a wait and see situation. The hope is Lillian's lungs will grow stronger and she will recover.

"I'm praying for her and I really believe that she's going to pull through," May said.

Anyone who'd like to wish her well can send cards or a note to the hospital or go to her Facebook page.


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Her parents are updating her facebook page on her condition.

One of the most detailed descriptions of treatment, from parents I've yet to see.

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Update: 12/4, 5pm (from her father Eric's post)
"Lil has had another quiet stable day but still no improvement. We are still waiting for her lungs to start working but they remain very stiff. She is handling the ECMO machine well but she can;t stay on it forever. So we'd like to see her lung volume start to increase when the venitlator blows air into them.

Right ...now the volume increases to around 90 mL with each puff of the machine. If you'd like to visualize something, think about that number increasing to 200 or 300 mL for each cycle. Ultimately, it needs to get up to about 500 mL.

Those who know Lil know how much she likes the holiday season. So we've started playing Christmas music in her room (one of the chaplain's brought a CD over when I told her). Let's hope she'll be home by Christmas."

Update: 12/4, 3pm
There have been quite a few news stories coming out about Lillian's case. Last night, our local ABC new channel did a 2-minute story. Now, Elon University has some students working on the story for Phoenix 14 news.

Update: 12/3, 9pm (from her father Eric's post)
"Lillian has had a very nice, quiet, stable day. Dr. Charles decided to try to let her rest - he didn;t do any bronchoscopies or turn her today. Her oxygentation didn;t improve but it stayed steady. Her lung volumes also didn;t change much but may have improved incrementally. Same with her xrays. So it's still a matter of waiting for Lil to heal but she seems strong while she waits.

Also, her sedation seemed to be lighter today and she seemed aware of our presence. I sang her all the songs I know and Cate, Hannah and other visitors talked to her all day. Her heart rate was also more stable and her blood pressure didn;t go through periods of high values like yesterday. We'd like to think it was because she was more aware."

Update: 12/2, 9pm (From her father Eric's post)
"Lil spent the day on her stomach and then they rolled her back onto her back around 6 PM. It's quite a production because of all the tubes but they do it carefully with a lot of cooperation among the team. It went smoothly and then Dr Charles cleaned up her dressings. They gave her some more surfactant and looked in...to her lungs with a bronchioscope.

Things have been stable but still no significant improvement in her lung function. But she's resting comfortably and we're just waiting for her own healing process to make her lungs start to work.

Thanks for all your thoughts and prayers. She's started to receive cards and we read them to her earlier today."

Update: 12/1, 11pm (From her mother Cate's post)
"The past 48 hours have been easier. There have been no set backs.
Last night Lillian was turned over and she slept on her tummy with her head in a head rest. The nurses propped her up on pillows and she looked incredibly comfortable, like she had just recieved a massage. It was great being able to massage her back.
Her color is normal and the swelling is down....Most importantly I feel as though she is coming into her body, even though her stats are only slightly better. I sense that she is listening to us again. She has "been away" for days.
There is a change for the better that is profound, yet difficult to explain.
As I write I feel afraid to say these words, afraid that my perceptions are not really true, but as her mother I just know what I know.
Sweet Dreams Ms. Lillian."

Update: 11/30, 10:30pm (From her father Eric's post)
"Nothing new to report. Her lungs still aren't working on their own to help oxygenate her body. They tried a few things today (surfactant, steroids) and turned her so she is lying on her stomach (most of your lungs are on the back side of your body so this will give them a chance to open up). No changes yet but she was stable and resting quietly when we left her tonight."

Update: 11/29 night (From Eric's post)
We left Lil for the night in the care of her nurses. She had a stable day - no improvements but no major setbacks. However, Dr Charles is looking for some improvement soon in her lung volume or they will be thinking of more aggressive (and potentially risky) approaches. We hope that she will start to improve soon as... she kicks out the virus that is infecting her, but time is an important factor.

Thank you all for your comments - it is so comforting to check up on them during the day and know people are thinking about her.

UPDATE: 11/29 3 p.m. (From Cate's post)
Lillian has had helium added to her oxygen mix to make it all "lighter". (You chemistry people know about this.) She is not making the progress that we were expected, here on day 6 on ECMO. If her lungs do not heal enough to start taking in oxygen in the next two days, there is discussion that she will have to go under more invasive proceedures on Tuesday.

Update: 11/28 at 9:30pm (from Eric's post)
Today has had some ups and downs. Her heart rate has spiked a couple of times but they've handled it with increased sedation and medication. On the positive side, her lungs are showing a bit more volume and Dr Charles is hoping to start seeing some improvement in the next 3-4 days. And we've been hearing other stories that make us realize the recovery can be even slower so we must be patient.

UPDATE: 11/27 at 5:15
Lillian has been in critical care for one week today, and on ECMO for four days. This morning Dr. Charles changed machines because there was a slight crack in the oxygenator. This proceedure created a slight setback, but it was necessary. She is recovering from that proceedure and seems to be stable. It is a blessing to get through the day with no real glitches.

UPDATE: As of 10:00 am on Friday, Lil stayed stable throughout the night. Nothing major to report, and for now this is good news.

Address/Update: Lil is still stable at 4 pm on Thanksgiving.

UPDATE: As of 8:00 am this morning, Lillian is steady on the ECMO machine after a terrifying night. She had a bleed in her lungs, which becomes incredibly dangerous when she is on this much blood thinner. Her amazing doctor, Doctor Charles, found and fixed the problem, and she is stable once again. She had received her first dose of the new and most successful known drug for H1N1 at 7:00 pm last night, and the Chasons believe this may have been vital in allowing her to heal. The Chasons would also like to invite anyone who feels inspired to write a note or letter of encouragement which can be hung in her room. The hospital address is:
UNC Hospital, ICU, 101 Manning Drive, Chapel Hill, NC 27514
It would be great if she could wake up to a stack of notes from everyone who is thinking of her.


UPDATE: As of 4:30pm Wednesday, Lillian was still steady on the ECMO machine. The sign they are looking for is that she will start to show improvement and responsiveness over the next 48 hours. Right now, we pray for her condition to take a turn for the better.

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Quite a story - I'd encourage people to visit her facebook page and if inclined ~ participate. Her life is hanging by a thread.

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H1N1 Tamiflu Resistance Crosses Tipping Point
Recombinomics Commentary 03:07
December 4, 2009

http://www.recombinomics.com/News/12040902/H274Y_Tip.html

Within the past two weeks, the number of documented cases of oseltamivir resistance in H1N1 viruses has risen from 57 to 96. Around one third of these cases occurred in patients whose immune systems were severely suppressed by haematological malignancy, aggressive chemotherapy for cancer, or post-transplant treatment. The clusters in the two hospital wards should be viewed in the context of these overall trends. Although all incidents of oseltamivir resistance merit investigation, no evidence suggests that events to date constitute a public health threat.

Click to expand...

The above comments from the WHO update on transmission of H1N1 with H274Y in hospitals in Wales and North Carolina, claims no evidence suggests that the sharp spike in cases, or the clear human to human transmission, is a public health threat, but the evidence in the report alone clearly identifies a threat. Moreover, the numbers in the report appear to represent only a subset of associated evidence, which raises concerns that a tipping point has been reached and readily detectable H274Y will be reported in the upcoming weeks, signaling the early stages of fixing H274Y in pandemic H1N1, as happened in seasonal H1N1.

The rapid appearance of H274Y in patients receiving Tamiflu suggested that H274Y was transmitting as a minor species and was largely undetected in untreated cases. However, there was concern that the H274Y level would rise, leading to readily detected transmission. The reports of transmission in clusters of immuno-suppressed patients indicate the concern has been realized, and transmission resembles the early stages of fixing of H274Y in H1N1 seasonal flu.

In addition to the clusters in Wales and North Carolina, smaller clusters have been reported and recent sequences show that H274Y in earlier sub-clades is appearing more frequently, which represents fit sub-clades.

The sub-claded linked first examples of H274Y in a patient not receiving Tamiflu has now also been reported in an H274Y case in Tennessee, while recent cases in Georgia and Spain represent another sub-clade with multiple examples of H274Y. The lack of linkage in these examples suggests that the level of H274Y is much wider than reported, which may be linked to limited testing of milder cases.

Thus, the explosion of cases with H274Y is expected to continue to rise and create more problems in the management of patients. H274Y will eliminate Tamiflu and Peramivir and limit anti-virals to Relenza, which will further strain the health care system.


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