HEALTH 12/23-12/30/09 Bird, Other Flu Weekly Thread:Researchers new patterns in H1N1 deaths

Link to last weeks thread:

12/15/-12/22/09 Bird, Other Flu Weekly Thread:Bird flu reappears in N Vietnam

http://www.timebomb2000.com/vb/showthread.php?t=350548

Please See:

Confirmed cases of Swine Flu and maps
http://www.timebomb2000.com/vb/showthread.php?t=330689

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

http://www.timebomb2000.com/vb/showthread.php?t=330395

Useful Links:

Avian Influenza (Bird Flu)
http://www.cdc.gov/flu/avian/gen-info/facts.htm

Johns Hopkins on influenza:
http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

National Avian Influenza Surveillance Information:
http://wildlifedisease.nbii.gov/ai/

CDC
http://www.cdc.gov/flu/avian/index.htm

WHO
http://www.who.int/csr/disease/avian_influenza/en/index.html

CIDRAP
http://www.cidrap.umn.edu/

Official U.S. Government Web site
http://www.pandemicflu.gov/

FAO
http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/avian_qa_e.html

European Union
http://ec.europa.eu/dgs/health_consumer/dyna/influenza/country_en.htm

The World Bank
http://web.worldbank.org/WBSITE/EXT...68427~piPK:64168435~theSitePK:1793593,00.html

Researchers find new patterns in H1N1 deaths​

http://www.eurekalert.org/pub_releases/2009-12/ats-rfn121609.php

Brazilian researchers have performed the first-ever autopsy study to examine the precise causes of death in victims of the H1N1 swine flu.

"The lack of information on the pathophysiology of this novel disease is a limitation that prevents better clinical management and hinders the development of a therapeutic strategy," said lead author, Thais Mauad, M.D., Ph.D., associate professor of the Department of Pathology at São Paulo University, in Brazil.

The results of their study will be published in the January 1 issue of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

The researchers examined 21 patients who had died in São Paulo with confirmed H1N1 infection in July and August, 2009. Most were between the ages of 30 and 59. They found that three-quarters (76 percent) of the patients had underlying medical conditions such as heart disease or cancer, but there was no clear complicating medical condition in the remaining quarter. All presented a progressive and rapidly fatal form of the disease.

While previous data has shown that most patients with a non-fatal infection have fever, cough and achiness (myalgia), Dr. Mauad noted that "most patients with a fatal form of the disease presented with difficulty breathing (dyspnea), with fever and myalgia being less frequently present."

All patients died of severe acute lung injury, but there were three distinct patterns of the damage to their lungs, indicating that the infection killed in distinct ways. "All patients have a picture of acute lung injury," said Dr. Mauad. "In some patients this is the predominant pattern; in others, acute lung injury is associated with necrotizing bronchiolitis (NB); and in others there is a hemorrhagic pattern."

"Patients with NB are more likely to have a bacterial co-infection. Patients with heart disease and cancer are more likely to have a hemorrhagic condition in their lungs. It is important to bear in mind that patients with underlying medical conditions must be adequately monitored, since they are at greater risk of developing a severe H1N1 infection," said Dr. Mauad. In these patients, H1N1 infection may present as a potential fatal disease, requiring early and prompt intensive care management, including protective ventilation strategies and adequate hemodynamic management. "We found that 38 percent of these patients had a bacterial infection (bronchopneumonia). This has important consequences because these patients need to receive antibiotic therapy, in addition to antiviral therapy."

The researchers also found evidence of an influenza-associated "cytokine storm," an aberrant immune response in the lungs of certain individuals, which was almost certainly involved in the pathogenesis in these fatal cases of the H1N1 infection. "[This] suggests that an overly vigorous host inflammatory response triggered by the viral infection may spill over to and damage lung tissue, thereby causing acute lung injury and fatal respiratory failure," noted John Heffner, M.D., past president of the ATS.

Further research is needed to understand precisely how and why certain patients succumb to a fatal progression when infected with H1N1. While most patients experience a mild illness with no lasting effects, this research lays important groundwork for future efforts by defining the histological patterns associated with a fatal infection.

"We would like to deepen our efforts into the understanding of the immune responses in cases of severe infection," said Dr. Mauad. "This could ultimately lead to new therapeutic approaches."

Toddler's bird flu infection under study​

http://www.news.gov.hk/en/category/healthandcommunity/091224/txt/091224en05001.htm

The Centre for Health Protection is investigating a mild form of avian influenza A H9N2 found in a 35-month-old girl.

The toddler lives in Sha Tin. Since late November, she had developed a cough, fever and runny nose and was admitted to Prince of Wales Hospital. She has since recovered, and was discharged on December 11.

Lab tests found the bird flu virus in samples from her respiratory system. The World Health Organisation will be alerted. Such H9N2 infections in people are rare, and are usually mild.

This is the seventh time that H9 viruses were found in people in Hong Kong since 1999.

As a precautionary measure, people are reminded to avoid contact with live poultry to minimise the chance of being infected. For more information about bird flu, visit the centre's website.

Indonesia- Small boy dies of bird flu.​

http://www.farminguk.com/PopularNews/Indonesia--Small-boy-dies-of-bird-flu._13861.html

INDONESIA-BIRD FLU.
In Indonesia, a 2-year old boy, who has been treated for a suspected case of bird flu, died in isolation in Pekanbaru, Riau, yesterday.

A member of the hospital’s bird flu handling team said that the boy had trouble breathing and lost consciousness before dying. It was further reported that the boy’s condition was relatively stable on Wednesday morning, but quickly deteriorated during the evening.

The child was admitted as a bird flu suspect last week Friday. Reports state, however, that the hospital has yet to announce whether the boy died of bird flu, as it is still waiting for the result of nasal and throat swab tests form the Health Ministry’s laboratory in Jakarta.

Qatar: Ban on meat, poultry from Spain ​

http://www.zawya.com/Story.cfm/sidZAWYA20091228032732/Qatar: Ban on meat, poultry from Spain

DOHA: Qatar has imposed a temporary ban on the import of meat and poultry products from Spain, following the discovery of a new strain of bird flu virus- H7N7- in the country.

The decision was taken at a meeting of the Joint Committee for Food Inspection held in the premises of the Supreme Council of HealthSupreme Council of Health
Supreme Council of Health
SCH
Qatar | Governmental Institutions
News | Profile | Officers
.

The ban applies to all meat and poultry products from Spain fresh and frozen including eggs. H7N7 is a subtype of Influenzavirus A, the pathogens responsible for influenza. H7N7 can infect humans, birds, pigs, seals, and horses in the wild; and has infected mice in laboratory studies.

The virus was detected in farms in Netherlands and the UK in 2003, 2006 and 2008 and most recently in a farm in Almoguera, Guadalajara, Spain last October. Some countries have already suspended imports of poultry from Spain.

The ban, however, is not likely to have a significant impact on the local market, since Spain is not a major exporter of poultry products to Qatar. Most of the imported poultry products in Qatar come from Brazil, France, the US and the neighbouring GCC countries while meat is imported from a number of other countries including Sudan, Syria, Australia, India and Pakistan.

The Joint Committee which has representatives of the Supreme Council of HealthSupreme Council of Health
Supreme Council of Health
SCH
Qatar | Governmental Institutions
News | Profile | Officers
, Ministry of Environment, Ministry of Business and Trade and the Ministry of Environment, also looked into several other issues concerning public health.

The Committee discussed follow-up measures to be taken over commodities confiscated by the authorities recently for further investigations. The Committee decided to release some of these consignments into the market including an olive oil brand and roasted watermelon seeds having found fit for consumption.

The meeting, however, decided not to release a particular brand of salt.

D225G / D225N H1N1 in Case from Sweden
​

http://www.recombinomics.com/News/12280901/D225G_D225N_Sweden.html

The Swedish Institute for Infectious Disease Control has released a series of H1N1 sequences at GISAID. Included was an isolate, A/Stockholm/92/2009, which has an HA sequences with mixed signal at adjacent codons allowing for the synthesis of D225G and D225N. The same chnages were reported previously for a fatal case in Utah, A/Utah/42/2009, as well as two fatal cases (25M and 40M) in San Luis Potosi, A/Mexico/InDRE50625/2009 and A/Mexico/InDRE50617/2009) which were collected a day apart. The same mixture was also in a swine sequence, A/swine/4/Mexico/2009 in the adjacent province, Quertaro.

The outcome of the infection in Sweden is unclear, but the patient was on ECMO, indicating it was a severe case. Thus, all 4 cases with the tandem polymorphisms are from fatal or severe cases, even though the markers are on different H1N1 backgrounds.

This movement of adjacent changes from one background to another is most easily explained by recombination, which is also seen for the individual changes. The same jumping from one genetic background to another was also seen for H274Y in seasonal as well as pandemic H1N1.

The appearance of these tandem polymorphisms as mixed signals on multiple genetic backgrounds may signal an advantage for having wild type as well as the polymorphisms encoding D225G and D225N in the same cells. Alternatively, the mixed signals may signal D225S, although the changes in the absence of the wild type sequence have not been reported. D225S would represent stronger evidence for recombination leading to acquisition of both sequences through one cross over event.

The increased frequency of these changes and strong association with fatal or severe cases raises concerns for this combination becoming more frequent. These sequences were from a nasopharygeal swab, which is the most common source for sequences.

Thus, although the tandem changes remain rare, the increasing frequency raises concerns that such combinations could be catastrophic.

New Weapon May Help Battle Bird Flu​

http://news.yahoo.com/s/hsn/20091225/hl_hsn/newweaponmayhelpbattlebirdflu

THURSDAY, Dec. 24 (HealthDay News) -- Based on findings in animals, researchers are reporting that a new compound may be a better choice for treating bird flu -- also known as avian influenza (H5N1) -- than the antiviral Tamiflu.

"H5N1 virus is so pathogenic even Tamiflu doesn't protect all the infected animals. This compound works much better, even three days after infection," study senior author Yoshihiro Kawaoka, a University of Wisconsin-Madison virologist, said in a university news release.

The researchers tested the compound in mice and found that it was effective against H5N1, seasonal flu and the H1N1 virus. But tests in humans aren't complete: the third phase of testing, in Japan, has yet to begin.

The compound, known as T-705, could give doctors a new weapon against strains of flu that are resistant to Tamiflu, the study authors noted.

The findings are published online in this week's issue of the Proceedings of the National Academy of Sciences.

New Low-Path Bird Flu Virus Found in Korean Ducks​

http://www.thepoultrysite.com/poultrynews/19208/new-lowpath-bird-flu-virus-found-in-korean-ducks

SOUTH KOREA - The veterinary authority has reported finding H5N2 low pathogenic avian influenza (LPAI) in ducks following routine surveillance.

The South Korea veterinary authority has sent an Immediate Notification dated 28 December to the World Organisation for Animal Health (OIE).

The report describes the finding of LPAI in a flock of 26,800 ducks in 1,216 birds in Gobuk-myeon in Seo-san city in the province of Chungchong-namdo on the western coast of the country. Forty of the ducks tested positive for the virus, and all were destroyed.

According to the report, as part of the yearly surveillance programme, a member of the Livestock Health Control Association collected samples from a duck raising farm in Seo-san city and requested the test for avian influenza to the Chungchong-namdo Veterinary Research Institute (VRI) on 7 December 2009.

After it was positive by haemagglutination test, the sample was sent to the National Veterinary Research and Quarantine Service (NVRQS) on 22 December. In the course of the confirmatory test, the isolated virus was confirmed as H5 avian influenza virus on 24 December and finally confirmed as low pathogenic avian influenza virus (H5N2) by gene sequencing.

On the affected farm, all 26,800 ducks were culled and 176,000 eggs kept in the farm were destroyed. The whole procedure for burial and burning was completed on 26 December. Traceback investigation of epidemiologically related farms and enhanced surveillance on neighbouring farms are underway.

Bird Flu Strikes Cambodia​

http://www.thepoultrysite.com/poultrynews/19207/bird-flu-strikes-cambodia

CAMBODIA - The veterinary authority has reported a new case of highly pathogenic avian influenza (HPAI).

The Cambodian veterinary authority has sent an Immediate Notification dated 28 December to the World Organisation for Animal Health (OIE).

The report describes a new outbreak of HPAI in a village poultry flock of 1,216 birds in La-ak in the province of Kg. Cham, which is in the south-east of the country, near to the border with Viet Nam. The disease broke out on 16 December. In all, 143 birds died and the rest were destroyed.

According to the report, the affected population were backyard poultry comprising 1,012 chickens and 204 ducks. Of the birds culled, 751 were chickens and 124 were ducks.

The presence of the H5N1 sub-type of the virus has been confirmed.

The last case of HPAI in the country was in December 2008.

One More H5N1 Outbreak Reported in Viet Nam​

http://www.thepoultrysite.com/poultrynews/19206/one-more-h5n1-outbreak-reported-in-viet-nam

VIET NAM - A new case of highly pathogenic avian influenza (HPAI) has been reported in the north of the country.

The Vietnamese veterinary authority has sent Follow Up Report No. 36 dated 27 December to the World Organisation for Animal Health (OIE).

The report describes a new outbreak of HPAI in a village poultry flock of 53 birds in Binh Lang in Cao Bang province in the far north of the country, near the border with China. The disease broke out on 12 December. Around half of the birds died, and the rest were destroyed.

The presence of the H5N1 sub-type of the virus has been confirmed.

The WHO Surprise on D225G / D225N H1N1 Fatalities
​

http://www.recombinomics.com/News/12290901/D225G_D225N_Surprise.html

After considering the current available virological, epidemiological and clinical findings and following discussions on an earlier draft with WHO and its European-based Collaborating Centre ECDC has come to a preliminary formulation namely that the G222D/N variants exist in a small proportion of sporadic severe, as well as mild cases of 2009 pandemic
influenza A(H1N1) infection and that these represents natural variation of the virus with no special association with severity of the disease course. As such and while they do not transmit they should have a minimal impact on public health and pandemic response. Current data suggests that the cases involving variant viruses in different parts of the world are unrelated and the underlying mutation events probably occurred independently from each other in the infected individuals as a consequence of the natural variability of influenza viruses and their inability to correct random coding
errors. However because of that inherent variability and ability to surprise the 2009 A(H1N1) will need on-going combined virological, epidemiological and clinical surveillance and study.

The above comments in the latest ECDC report confirm attempts by WHO consultants to explain the strong association of D225G and D225N (aka D222G and D222N) with fatal and severe H1N1 cases as "random coding errors" even though the WHO regional lab in Mill Hill found D225G in four of four fatal cases, while the WHO region lab in Atlanta (CDC) found D225N in two of two additional cases, which were almost certain fatal cases also.

D225G and D225N are rare and have been reported in about 1% of H1N1 HA sequences, yet they have a 100% case fatality rate in sequences from Ukraine. This 100% CFR was matched in several additional countries, including two D225G and two D225N sequences in Brazil (Sao Paulo), as well as two D225G sequences in France and three recent sequences (1 D225G and 2 D225N) in Mexico. Moreover, recent sequences with mixed signals for both D225G and D225N have been found in 1 fatal case in the US (Utah), 2 fatal cases in Mexico (San Luis Potosi) and one severe case in Sweden (Stockholm). Similarly, Denmark, who filed a formal notification when three examples were identified and two were fatal while the third was severe, has a high rate.

Although there were a few mild cases with D225G in the US at the start of the pandemic last spring, including the vaccine target California/7, mild cases are common at the start of a pandemic because there is little immunity in the target population, and infections and symptoms can be caused by low viral loads which are effectively contained by a weak host response. The association of D225G and D225N is severe and fatal cases since the summer has been remarkable, especially since the vast majority of pandemic H1N1 infections are mild and resolve without treatment. In contrast, nearly 100% of recent cases with D225G, D225N, or both have been fatal or severe.

In Ukraine five isolates from patients who recovered had a wild type receptor binding domain, while six patients who were infected by the same sub-clade had either D225G in the four known fatal cases or D225N in the two likely fatal cases. This rate of 100% of six patients is not associated with six independent random errors in six patients, who died in the same general area at the same time, and only affects the position 225 codon.

This "random mutation" paradigm constantly produces "surprises", for which the above "experts" readily acknowledge on a very regular basis. They were surprised and baffled by H274Y Tamiflu resistance in patients infected with seasonal H1N1, and will again be surprised and baffled by the same result in pandemic H1N1.

WHO's reliance on consultants who try to use random mutation to explain these examples of 100% case fatality rates in multiple countries is cause for increasing concern.

Ukraine Fatalities Spike to 675 - Two Day Total 42
​

http://www.recombinomics.com/News/12290902/Ukraine_675.html

3,669,751 Influenza / ARI

207,013 Hospitalized

675 Dead

The above figures are from the Ukraine Ministry of Health and represent a spike of 42 fatalities in the past 48 hours. Oblast reporting 5 or more fatalities in the past 2 days includes Donetsk (7 to 80), Kharkiv (6 to 29), Dnipropetrovsk (5 to 32), Cherkasy (5 to 25) and Crimea (5 to 13). The increases to 20 fatalities per day are close to the levels when the outbreak was first reported in late October (see map).

Samples collected from the fatal cases had two receptor binding domain changes, D225G and D225N, which have also been associated with fatality rates of 100% in Brazil, Mexico, and France. However, the results from the first 6 cases in Ukraine represents the largest number from any country and additional examples are expected since the six cases were from at least two Oblast and were in individuals who were not contacts of each other.

A preliminary report by WHO and ECDC has suggested that the presence of D225G and D225N in the fatal cases is due to random copy errors, even though the cases in Ukraine involve two different changes, which represent the only non-synonymous HA differences between the fatal and recovered cases, and recently patients with both changes have been identified in the United States (Utah), Sweden (Stockholm), and Mexico (San Luis Potosi). The samples from the two cases in San Luis Potosi were collected within a day of each other. The same clustering in time and space was seen Ukraine, but on a different H1N1 genetic background.

The recent surge in fatal cases should allow for additional sample collection over a two moth time frame to allow for more extensive analysis, which will highlight the failure of random mutations to explain the dangerous polymorphisms, D225G and D225N, on multiple genetic backgrounds.

H1N1 Tamiflu Resistance Lesson Not Learned​

http://www.recombinomics.com/News/12300901/H274Y_LNL.html

Dr. Nancy Cox isn't convinced H3N2 is going away. But the head of the influenza division of the U.S. Centers for Disease Control would be happy with a one-for-one exchange, with the pandemic H1N1 replacing the seasonal virus of the same name.

That's because seasonal H1N1 viruses are resistant to oseltamivir (Tamiflu), the main drug used to fight flu.

The pandemic H1N1 viruses are susceptible to Tamiflu, though they are resistant to two older flu drugs, amantadine and rimantadine. Those two drugs aren't widely used anymore because resistance to them develops easily.

Swapping viruses that are immune to Tamiflu for ones the drug works against would be a bargain, Cox suggests. "Getting rid of resistance in circulating H1N1 viruses would be a real silver lining."

The above comments on replacing seasonal H1N1 where H274Y is fixed, with pandemic H1N1 where H274Y is becoming fixed, signals a lesson not learned. H274Y in seasonal H1N1 went from 0% to 100% in one season in several countries. In the US it went from 10% to 100%. Although the process began in 2006 when H274Y was first identified in seasonal H1N1 in patients who had not been treated with Tamiflu. H274Y jumped from one seasonal flu genetic background to another via recombination, as did severall additional polymorphism which jumped from clade 2C to clade 2B to create the strain that emerged in 2008.

The repeat in pandemic H1N1 may be much quicker because the widespread use of Tamiflu creates additional selection pressure for H274Y to pair with receptor binding domain changes that also drive selection. The recent reports of H274Y transmission in Vietnam and hospitals in North Carolina and Wales, along with an explosion in the detection of H274Y worldwide, suggest that the fixing of H274Y may be well on its way in the next wave, which may begin in the upcoming weeks.

The latest CDC weekly report on influenza does provide support for the crowding out of seasonal H1N1, as well as seasonal H3N2. No isolates of either sero-type were identified, and there were only 3 influenza B isolates. In contrast, a year earlier there were 103 isolates, most of which were H1N1, but even influenza B was 10 fold higher than this year.

However, most flu cases usually appear in the winter, when the virus is stable and host resistance is compromised by cold weather and other respiratory diseases. Thus, it is likely that an influenza virus will emerge, but seasonal flu is virtually absent throughout the northern hemisphere. Thus although swine H1N1 in the US and across the northern hemisphere is declining, there are still high levels of pandemic H1N1 in circulation. In the US the week 50 levels of swine H1N1 were still three fold higher than seasonal flu last year, and 100 fold higher than seasonal flu this year. In Ukraine, deaths have spiked higher raising concerns of multiple pockets of pandemic H1N1 that can fill the seasonal flu void in the upcoming months.

Thus, the potential for H274Y to become fixed in the next wave is quite real because competing seasonal flu strains are not circulating, and competing swine H1N1 that is Tamiflu sensitive is on the decline. However, not only can swine H1N1 fill the upcoming void with H274Y, there are additional signs that receptor binding domain changes at position 225 are also emerging. Mill Hill has reported H1N1 with D225G as a low reactor, signaling a selective immunological advantage over wild type. Both D225G and D225N have been associated with severe and fatal cases, so the emergence of swine H1N1 with H274Y and D225G/N could be catastrophic.

This, the silver-lining in the replacement of seasonal H1N1 with pandemic H1N1 may lead to a result that contains no silver lining, other than another example of influenza evolution via recombination, instead of the random mutation explanation of the detection of D225G/N on multiple H1N1 genetic backgrounds.

Fatal H1N1 Tamiflu Resistance in New Brunswick Canada​

http://www.recombinomics.com/News/12300902/H274Y_NB_Canada.html

New Brunswick public health officials are reporting the province's first death related to a drug-resistant H1N1 strain.

A 27-year-old Quispamsis man died in hospital on Monday after nearly a month in intensive care, public health officials said. Doctors tried treating him with the anti-viral drug Tamiflu but those efforts failed.

According to Van Buynder, the H1N1 strain the man contracted was resistant to drugs such as Tamiflu that are used to fight the virus.

The above comments describe another fatal case linked to Tamiflu resistant H1N1. Although the explosion in Tamiflu resistance has been reported across the northern hemisphere, there has also been a spike in fatal cases linked to H274Y. The fixing of H274Y in seasonal flu was tied to hitchhiking of H274Y with receptor binding domain changes. A193T was in all isolates, and was associated with one of more additional changes at positions 187, 189, and 196.

In pandemic H1N1, H275Y has been found in association with receptor binding domain changes at position 225 (D225E and D225G). D225G has been closely linked to fatal and severe cases, so H274Y linked fatalities raise concerns that such outcomes signal H274Y on a sequence that not only is fit, but is also lethal.

Recent fatal cases of Tamiflu resistance include three patients at Duke Medical Center and addition deaths in Delaware, South Korea, the Netherlands, and France. The death in France also had D225G.

Bird flu suspected to make a comeback ​

http://www.bolohealth.com/news/2333-bird-flu-suspected-to-make-a-comeback

Mumbai, December 30: Avian or bird flu, might make a comeback with more than 2,000 birds including domestic poultry found dead in the remote village of Durmoth at Mongolkot, Burdwan district in West Bengal. This news has prompted the state animal resources development department to send a team to collect samples and investigate. The findings of this investigation will be announced in a few days.

Though the reasons of the death of these birds could be anything else, however, a awareness program has been started in the village, which had already experienced the bird flu scare in January 2008. The villagers have also been asked to dispose of the remaining of the dead birds from the area.

Countries worldwide are still facing the outbreak of the H1N1 pandemic flu with the increasing number of confirmed swine flu cases everywhere. The need for vaccinations is widely felt to protect from suffering due to the mutating gene. Following proper safety measures like not having chicken too often and living in a hygienic environment can help.

Practices like washing hands after touching contaminated areas, covering mouth while sneezing and coughing, keeping the house properly disinfected and having a healthy diet to build immunity can safeguard from coming in contact with the influenza viruses.

WHO: H1N1 May Not Be Conquered Until 2011​

http://www.redorbit.com/news/health/1803672/who_h1n1_may_not_be_conquered_until_2011/

According to the head of the World Health Organization on Tuesday, the H1N1 flu pandemic may not be conquered until 2011, and continued attention to the virus will be need to be regarded as it still can mutate.

WHO Director Margaret Chan also warned that although countries have raised their defenses against the first flu pandemic in more than 40 years, they remain unprepared for mass outbreaks of the even deadlier bird flu virus. “It is still premature and too early for us to say we have come to an end of the pandemic influenza worldwide.” Chan stated in a year-end news conference. It would be wise to “continue to monitor the evolution of this pandemic for the next six to 12 months,” she added.

The worst of the swine flu outbreak is over in the United States, Canada, Britain and some other countries in the northern hemisphere, but there is still widespread flu activity in Egypt, India and elsewhere, Chan said. Many more people could become sick with H1N1 this winter even though it has peaked in North America and Europe. So far, over 11,000 people are known to have died from the virus since the outbreak began in April. Between 250,000 and 500,000 people die from regular flu each year.

H1N1 has now spread to more than 200 countries, and the death toll could rise, especially in under-developed countries where it could spread like wildfire. Since swine flu was declared a pandemic back in June, the U.N. health agency has described the outbreak as “moderate.” It could take more than two years to tally the true death toll that may occur from this outbreak.

Most people, however, that contract this particular strain of the swine flu, have recovered without any special treatment. Although officials are seeing some severe cases in people under the age of 65 that are usually not at high risk during regular flu seasons. Those with underlying health problems, young people, and pregnant women are at highest risks for medical treatment from swine flu.

The WHO has warned that the virus could have a major impact in countries across Africa where high numbers of people have health issues such as malnutrition, AIDS, and malaria. Also, flu viruses are notoriously unpredictable and can mutate into severe forms that are more and more harmful.

Some drug companies and rich countries have vowed to donate 190 million doses of the H1N1 vaccine to areas of 90 developing countries around the world. The WHO plans to start distributing the first doses in Azerbaijan and Mongolia in early January, to be followed by Afghanistan, according to Chan.

There has been a recent recall on some flu vaccines due to a weak formula. The weak vaccines posed no health risk, Chan said. With the current financial crisis, and weak health systems in many countries, Chan noted that “the fact that the long overdue influenza pandemic is so moderate in its impact is probably the best health news of the decade.”

Although, now with the new outbreak of bird flu cases reported in poultry in Egypt, Indonesia, Thailand and Vietnam, there is a risk that bird flu and swine flu may hybridize into a new strain of super-virus. Scientists fear that bird flu, which remains hard for people to catch but kills about 60 percent of those infected, could combine with the current swine flu virus, which spreads easily among people but kills a low percentage.

Chan said that although countries are now better prepared to cope with global disease and virus outbreaks than they were just a few years ago, the swine flu pandemic has shown that there remain numerous gaps in healthcare systems in many countries. She said she hopes the world can avoid a pandemic triggered by the avian flu virus, which was more toxic and deadlier than swine flu. “The world is not ready for a pandemic caused by H5N1,” Chan said, referring to the scientific name of bird flu.

Link to next weeks thread:

12/31-1/8/10 Weekly Bird & Other Flu Thread:Ukraine Fatalities Spike to 698

http://www.timebomb2000.com/vb/showthread.php?t=351703