HEALTH 11/2-11/10/09 Weekly Bird&Other Flus Thread:Ukraine H1N1 Deaths and Hospitalizations

JPD

Inactive
Link to last weeks thread:

10/25-10/31/09 Bird, Other Flu Weekly Thread:Company Says it Developed Super Vaccine

http://www.timebomb2000.com/vb/showthread.php?t=346841

Kris Gandillon

Board Still Mucho FUBAR'D

As others have observed, missing about 6 weeks of threads in a lot of areas.

Even those threads that appear to be there are often empty.

If you try to post to any of those "empty" threads you get an error that "this forum is not allowing posting" or something to that effect.

Kris

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
 

JPD

Inactive
Ukraine H1N1 Deaths and Hospitalizations Spike Higher

http://www.recombinomics.com/News/11020902/Ukraine_Spike.html

255516 Influenza/ARI
15810 Hospital Admissions
235 Intensive Care
70 deaths

The above numbers reflect the latest government update on cases in the Ukraine. They are dramatically higher than those reported in the past few days and raise concerns that the death toll will increase significantly over the next several days.

Some wire service reports and comments from WHO have downplayed these numbers, noting that the death rate for Ukraine is similar to other countries in Europe. However, the deaths in the other countries accumulated over the entire pandemic flu season, while the deaths in the Ukraine were in the past few weeks, with most cases reported in the past few days.

About 5% of patients admitted with H1N1 infections have died in other countries, so that rate in the patients currently hospitalized would increase the deaths in Ukraine 10 fold, which would be markedly higher than any other European country. Moreover, the vast majority of the cases, hospitalizations, ICU admissions, and deaths are in three Oblasts in western Ukraine. Lviv, Ternopil, and Ivano-Frankivsk (see map).

This concentration of H1N1, including serious and fatal cases, raises concerns that the virus in this region has changed. Samples have been sent to London for analysis and prompt release of that data would be useful.
 

JPD

Inactive
WHO Team to Investigate Ukraine H1N1 Outbreaks

http://www.recombinomics.com/News/10300903/Ukraine_WHO.html

Gregory Hartl said the team was being pulled together by the WHO's Global Outbreak Alert and Response Network, which goes by the acronym GOARN.

The team will travel early next week to the eastern European country, which has closed schools and banned public meetings in response to a spike in cases of acute respiratory illness believed to be H1N1.

"This is something that certainly needs investigating," Hartl said from Geneva.

He said the government of Ukraine is being forthcoming with information on the outbreak, which is said to centre on three regions in the western part of the country.

The above comments describe a WHO investigational team being formed in response to the outbreak in Ukraine (see map). Although the story is evolving, some reports describe a dramatic spread of the virus to 80,000 people, with as many as 100 fatalities. The early reports describing 100 fatalities mentioned 10,000 infections, which would create an alarming case fatality rate of 1%. The newer cases would lower the rate, assuming the most recent cases don't follow the pattern described in the first 10,000 cases.

Media reports included descriptions of blood filled lungs, raising visions of the 1918 pandemic, which also involved swine H1N1 that jumped to humans and was efficiently transmitted. Samples have already been sent to London for analysis, and immediate release of initial sequence data would be useful.

Small changes can have dramatic effects when viruses jump species, and the rapid spread of the H1N1 in western Ukraine is clearly cause for concern.


H1N1 Attack Rate Explodes In Ukraine

http://www.recombinomics.com/News/11010901/Ukraine_Attack.html

In the Lviv region at 9.00 am on November 1 the number of deaths due to epidemics of influenza and SARS is 23 people. Of these, two children under 14 years old and 21 adults.

It is reported by the official web portal of the Lviv regional state administration.

According to official figures, the number of patients with influenza and SARS in the Lviv region is 78 thousand 102 persons (including children under the age of 14 - 38 thousand 450 adults - 39 thousand 652).

The number of hospitalized - 1 thousand 799 persons (including children under the age of 14 - 639, adults - 1 thousand 160).

In general, the incidence rate in the area is 312.4 per 10 thousand people (with children under 14 years - 967.8 per 10 thousand population).

The above translation describes the latest data on the H1N1 outbreak in the Ukraine. The updated government website has 53 fatalities (see updated map) and breaks down cases by region, including data for influenza and acute respiratory illness (see table here). The number of fatalities suggests that most ARI cases are swine flu, because in some instances the number of fatalities is between 0.5 and 1% of listed influenza cases. The ARI cases are 10-20 fold higher, which would significantly lower the Case Fatality Rate (CFR), but even with the listed ARI cases, the CFR would be alarmingly high. Thus, the number of ARI cases may be higher, or the virus is producing a significantly higher CFR.

However, as seen above, the incidence level in children has reached an alarming high rate of 10% in those under 14. If true, this rate would indicate the virus is spreading rapidly and raise additional concerns that the virus has changed and has a very high attack rate.

Thus, the data is still quite fluid, and information on the sequence of the virus is critical. Prompt release of these sequences would be useful.
 

JPD

Inactive
H1N1 Doctor Deaths In Ukraine Raise Concerns

http://www.recombinomics.com/News/11010902/Ukraine_HCW.html

Four doctors died of flu in Ukraine's Ternopol and Lvov regions, Health Minister Vasily Knyazevich said at the Sunday meeting of the operative headquarters for the prevention and treatment of A/H1N1 flu.

The above comments describe the death of four health care workers (HCWs) at two sites in western Ukraine. The government website shows a total of 53 deaths (see map), which is quite low if four HCWs have already died. HCW are trained in methods to minimize infections from patients, and they are likely to get prompt medical attention, yet four have already died. These numbers add to the confusion in Ukraine.

Initial reports denied the outbreak was due to H1N1 even though there was virtually no seasonal flu circulating in Europe (or North America). The explosion in cases of acute respiratory illness (ARI), in view of the exploding H1N1 pandemic throughout the northern hemisphere, would signal involvement in the cases in Ukraine.

However, even after H1N1 was confirmed in influenza and ARI patients in western Ukraine, Kiev was still maintaining that the cases there were not H1N1, even though 300,000 doses of Tamiflu are scheduled to arrive today, and a WHO investigative team is scheduled to arrive tomorrow.

The denials of H1N1 in obvious cases raise concerns that the number of fatalities is markedly higher that the 53 acknowledged, especially when 4 of the 53 are HCWs.

More details on the HCW deaths and on those hospitalized would be useful.
 

JPD

Inactive
Hospitalized Students at Romanian Convention Raise Concerns

http://www.recombinomics.com/News/11020901/Romania_Convention.html

A hotel in the mountain resort of Sinaia was closed Sunday after 40 Romanian and foreign law students meeting for a conference caught swine flu, officials said.

Health state secretary Adrian Streinu-Cercel said 40 people were hospitalized Sunday at the Matei Bals Institute for Infectious Diseases in Bucharest, suffering from medium to severe forms of the flu.

The hospitalization of 40 students in Romania (see map) with medium to severe forms of H1N1 raises concerns. Although outbreaks of H1N1 among students are common, hospitalization of 40 at a conference is not, especially when they have medium to severe forms of the flu.

The conference was attended by 240 students from 31 countries, so hospitalization of 40 represents a high attack rate, which was seen in Ukraine, where over 7383 have been hospitalized (see table). In the United States about 5% of hospitalized H1N1 patients die, so these high numbers raise concerns that the death rates in these countries will climb sharply in the upcoming days or weeks.

WHO has sent a team to Ukraine to investigate, and samples have been sent to London for analysis. Sequence data from both outbreaks would be useful.

The sudden rise in fatal and hospitalized patients across the northern hemisphere in general and Eastern Europe in particular, raises concerns.
 

JPD

Inactive
Bird flu reoccurs in northern province of Vietnam

http://news.xinhuanet.com/english/2009-11/02/content_12371936.htm

HANOI, Nov. 2 (Xinhua) -- Bird flu has re-emerged in the northern province Dien Bien of Vietnam, according to a report of the Animal Health Department under Vietnam's Ministry of Agriculture and Rural Development on Monday.

The bird flu broke out in nine local farms from Oct. 21 to 23, killing hundreds of poultry, said the report.

Poultry samples tested by provincial animal health agency showed positive for the H5N1 virus, said the report.

Local animal health authorities have been implementing measures to curb the spread of the bird flu virus to nearby areas, including the culling of over 2,200 remaining poultry, said the department.

Dien Bien currently is the only province of Vietnam being re-hit by the avian flu after the province was confirmed of being free of the H5N1 virus for several months this year.

Vietnam has reported five human infection cases of bird flu so far this year, and four of them died.
 

JPD

Inactive
S. Korea raises flu alert to highest level to prepare for emergency

http://english.yonhapnews.co.kr/national/2009/11/03/54/0302000000AEN20091103005800320F.HTML

SEOUL, Nov. 3 (Yonhap) -- South Korea on Tuesday raised its flu alert status to the highest "red" level to prepare for a possible national emergency caused by the rapid spread of Influenza A (H1N1).

The Ministry for Health, Welfare and Family Affairs said in a news briefing the number of H1N1 flu cases has shot up recently with the onset of cold weather and may peak in three or four weeks.
 

JPD

Inactive
Guangdong woman ill with avian flu

http://www.news.gov.hk/en/category/healthandcommunity/091103/txt/091103en05003.htm

The Centre for Health Protection is investigating an imported case of H9 influenza A infection involving a 47-year-old Guangdong woman.



She came down with breathlessness and a cough October 26. She came to Hong Kong for medical treatment and was admitted to Queen Mary Hospital October 28. She is stable and staying in isolation.



She had an underlying medical condition requiring regular medication. Her family members have been put under medical surveillance.



As she was in Guangdong during the incubation period, the centre has informed health authorities there and the World Health Organisation, the Ministry of Health and Macau's health authorities of the development.



H9 Influenza A is a mild form of avian flu. Infection in humans is rare.



This is the sixth time H9 viruses have been found in humans in Hong Kong. Four girls and a boy were confirmed to have suffered from H9 infection in 1999, 2003, 2007 and 2008.



People should avoid contact with live poultry to minimise the chance of being infected with avian flu.
 

JPD

Inactive
Thailand Warns Of A/H1N1, H5N1, Normal Human Flu Outbreak

http://www.bernama.com/bernama/v5/newsworld.php?id=450509

BANGKOK, Oct 28 (Bernama) -- Thailand's Public Health Ministry on Wednesday warned health stations across the country to closely monitor the situation of the A/H1N1, H5N1 or bird flu, and normal human flu as it is nearing winter season, China's Xinhua news agency reported.

As the raining season is going to end very soon, Thailand is about to enter into the winter season which will take about four months from now.

The A/H1N1 influenza has already spread across the country, while it is expected during the forthcoming winter the normal human flu will also spread, Public Health Minister Witthaya Kaewparadai said.

Witthaya was speaking in a central province of Ayudhya nearby Bangkok, where he presided over a meeting of medical staff from 11 central provinces in a move to discuss about preparedness against the influenzas.

Moreover, involved parties will still need to be careful about the H5N1 flu (bird flu) though the disease has not existed in Thailand for over three years, Witthaya said.

Health permanent secretary Doctor Phaijit Varachit said health volunteers across the country have been instructed to educate people about the three viral diseases.

Also, each hospital nationwide has to isolate rooms for A/H1N1 and H5N1 patients from other patients in a bid to prevent the spread of the two diseases within hospitals, said Doctor Phaijit.
 

Jefiner

Inactive
JMHO, but . . . I think the news coming out of Ukraine is what spurred the declaration of a national emergency here in Estados Unidos. :shr:
 

JPD

Inactive
WHO Targets Hemorrhagic H1N1 Cases in Lviv Ukraine

http://www.recombinomics.com/News/11030902/Ukraine_Hemor.html

Work will initially begin in Lviv region, where reported numbers of cases showing severe manifestations of acute respiratory illness have been especially high. Two virologists on the team have started working at the National Influenza Centre and the laboratories of the Central Sanitary and Epidemiological Station in Kyiv to provide diagnostic support.

The above comments from the WHO update on Ukraine strike a more serious tone than yesterday's quotes from WHO spokespersons playing down the alarming number of hospitalized and fatal cases, as well as media reports spinning political considerations, or politicians claiming only 15 confirmed H1N1 cases. As the WHO update clearly states, the dominant influenza circulating worldwide is swine H1N1 and it is assumed that most cases in the Ukraine (see map) are swine H1N1. Since the official government website lists 19,189 influenza cases (in addition to more than 235,000 ARI cases), the willingness of politicians to cite 15 confirmed cases, as well as media support in the distribution of the propaganda, is unfortunate.

The more severe manifestation of ARI cases are clearly hemorrhagic disease that fills lungs with blood and produces bleeding at all orifices, which are stark reminders of 1918 pandemic cases which were also linked to a swine H1N1.

Samples have arrived at Mill Hill in London, and sequence data should be available shortly. Since current swine H1N1 produced lethal infections in previously healthy young adults, and produced hemorrhagic disease, changes in the viral genome may be absent or minor. Therefore, release of the sequences to the entire scientific community would be useful.

Similarly, an update on the number of hemorrhagic cases would be useful. Rumors have suggested that such the number of such cases is significantly higher than the six described in media reports.
 

JPD

Inactive
Clusters of Hemorrhagic H1N1 Pneumonia in Ukraine

http://www.recombinomics.com/News/11040901/Ukraine_Hemor_Clusters.html

Ivano-Frankivsk Oblast

All the six dead young people had symptoms of severe hemmorhagic pneumonia. The disease starts slowly, with temperature rising to 37.2 - 37.3 degrees, slight cough and pain in joints. Nasal catarrh developed at the end of the second or third day. Autopsy revealed that the lungs were soaked with blood, the oblast chief specialist said.

The above comments are from an early story describing cases in Ukraine. The clustering of hemorrhagic cases raised concerns. The concern was increased by anecdotal reports citing a high frequency of such cases in Lviv (see map). The recent WHO announcement that they were initially focusing of severe acute respiratory illness in Lviv also increased concerns.

Hemorrhagic pneumonia was also observed in the 1918 pandemic and was thought to be linked to cytokine storm. Consequently, those with robust immune systems (previously health young adults) disproportionately died, which has also been seen in the current outbreak (Mexico, US, and worldwide). However, the cases in Ukraine appear to be clustered, raising concerns that the virus has changed.

However, the change may be minor, since the current H1N1 has produced the above symptoms in earlier cases. More severe cases may be linked to a higher viral load, which could be linked to minor genetic changes, or simply due to concentration of virus in schools. In the US the spread of the virus has been linked to school openings, which lead to an explosion of cases and subsequent student deaths. However, now there are increases in fatalities in teachers and administrators, increasing concerns worldwide.

In Ukraine, weather changes and heating issues may have led to a surge in cases, and increased concentrations of virus could have produced conditions favoring high viral loads and increased cytokine storms.

Samples have been sent to Mill Hill, and sequence data should be released shortly. Similarly, investigations on hemorrhagic pneumonia in lviv should help resolve the mechanism for the high concentration of such cases in western Ukraine.

However, H1N1 spread in Kiev has been noted, and other countries such as Belarus have announced additional H1N1 suspect or confirmed fatalities.

Sequence analysis of these cases and an update on the frequency of hemorrhagic pneumonia in Ukraine and worldwide would be useful.
 

JPD

Inactive
WHO team arrives to assist with Ukraine flu probe

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/nov0309ukraine.html

Nov 3, 2009 (CIDRAP News) – The World Health Organization (WHO) said its team arrived in the Ukraine last night and met with the country's health ministry today to discuss a dramatic spike in flulike illnesses and deaths, particularly in the western part of the country.

The Ukrainian health ministry has recorded more than 250,000 flulike illnesses, of which 235 patients needed treatment in intensive care units, the WHO said in a statement today. As of yesterday, 70 deaths had been reported.

The high level of illnesses activity and severe cases, combined with reports of hemorrhagic pneumonia cases, have raised some speculation that the virus might be behaving differently in the Ukraine, but further testing is just getting under way.

Laboratory testing at labs in the Ukraine have confirmed the pandemic H1N1 virus in samples taken from patients in two regions, the WHO said, adding that because the pandemic virus has become dominant throughout the world, most of the Ukrainian respiratory illnesses are probably caused by the novel H1N1 strain.

Though the highest illness rates have been seen in the western part of the country, illness activity is increasing rapidly in Kiev, the WHO reported.

The WHO's field investigation team will start in the Lviv region, where the number of cases of severe respiratory illness has been especially high. Virologists from the WHO have started working with Ukrainian scientists at the National Influenza Centre and the Central Sanitary and Epidemiological Station, both in Kiev.

Ukraine's health ministry has sent viral samples to the WHO collaborating center in London, where laboratory experts will conduct confirmatory tests and further characterize the virus.

The outbreak raises several questions and may provide clues about how the virus will circulate in the Northern Hemisphere during the winter months, particularly in areas such as Eastern Europe that have healthcare challenges.

The WHO commended Ukrainian officials for their transparent reporting and open sharing of viral samples. It also said border closures and international travel restrictions are not warranted.

Lawmakers in the Ukraine today approved legislation freeing up $1 billion UAH (about $131 million) in reserve funds for flu response actions, according to a report from UNIAN, the country's independent news agency.

The country's head sanitary inspector today, in a television interview, denied that the country was experiencing an outbreak of pandemic flu and said only 14 cases had been confirmed, including three deaths, according to another UNIAN report today.

Meanwhile, two of Ukraine's top leaders, who are opponents in a January presidential election, scrambled to respond to the flu outbreak, UNIAN reported. President Victor Yuschenko instructed the military to prepare portable military hospitals, and Prime Minister Yulia Tymoshenko promised to provide all of the country's residents with masks to reduce their flu exposure.

An official from the Ukraine's flu and respiratory disease center, Oleksandr Hrynevych, today projected that pandemic H1N1 vaccination could begin in a month or two after regulators approve two vaccines that are undergoing testing, according to a report from the National Radio Company of Ukraine (NRCU). He said the vaccine supply will come from the WHO and from individual country donations.

A warden message posted on the US State Department's Ukrainian embassy Web site said US officials are aware of the outbreak and are monitoring the situation. Though the country has imposed several social-distancing measures, such as a 3-week school closure, Ukrainian officials have told the State Department that no general quarantine is in effect.

The US embassy said that, because of legal restrictions and lack of resources, it is not able to provide private citizens with pandemic supplies, medication, medical treatment, or medical advice.
 

JPD

Inactive
Avian Flu On The Rampage – Lombi

http://leadershipnigeria.com/index.php/news/headlines/8014-avian-flu-on-the-rampage--lombi

The Executive Director, National Veterinary Research Institute (NVRI), Dr. Lami Hannatu Lombi, has disclosed that avian influenza known as bird flu, the highly pathogenic H5N1 subtype has ravaged the poultry industry world- wide as it has caused several- human fatalities, particularly in South- East Asia and part of North Africa, Egypt.

Dr Lombi made this disclosure at the opening ceremony of the European Union Flutrain International Workshop on avian influenza in Jos, the Plateau State capital.

According to her, these development has negatively affected food security and caused severe human psychosocial stress associated with the loss of several millions of poultry and sources of lively-hood worldwide.

She said when the H5N1 avian influenza virus was first reported in the country in January 2006 and was subsequently confirmed both in NVRI Vom, Nigeria and the FAO/0IE reference laboratory in Pandova, Italy, NVRI Avian influenza laboratory was re-equipped with the building of a new laboratory, provision of suitable facilities and better trained manpower to meet the challenges.

The executive director added that currently, the situation of HPA1 H5N1 in the country is under control with the last outbreak reported in July 2008. She added that there are ongoing expanded surveillance programme in the country.

She further said since avian influenza is trans-boundary, the institute has continued to maintain important linkages and collaboration across the globe and with key international organisation and staff serving as resource person in several local and international meetings and conferences.

In his remarks, the co-ordinator of EU-FLUTRAIN, William Dundun, said that NVRI will benefit from the research programme of EU-Flutrain and that since the institute is the only one in sub-Saharan, it is imperative that the workshop is held in Vom.

Similarly, the Commissioner of Agriculture in Plateau State, Hon.Na'Allah Mutbam, said NVRI is not just a regional laboratory for West and Central Africa but a global institution, urging them to strive to breake new grounds in the world.

According to him, Plateau State government, in partnership with an Israeli company, SEC Equipment and Communication Nigeria Limited, is establishing agricultural services and training centres in each senatorial zone of the state.
 

JPD

Inactive
Some Good Information:

As posted by Terriannie

Spanish Doctor Reveals Important Info on Flu
I am in the middle of a very, very good video from a Dr. from Spain (Who also happens to be a nun.) explain from A - Z on the history of the H1N1 flu, the vaccine maker Baxter's almost catastropic "mix-up" role with it and what the WHO's reason in changing the requirements of what make a pandemic. Very New World Orderish.

It's in Spanish but very clear English subtitles.

http://www.disinfo.com/2009/11/spanish-doctor-reveals-important-information-about-swine-flu/
 

JPD

Inactive
Govt Warns Farmers to be on Alert to Bird Flu

http://www.thepoultrysite.com/poultrynews/18851/govt-warns-farmers-to-be-on-alert-to-bird-flu

ZAMBIA - Zambia should not relax on avian flu prevention, warns the government.

The Zambian government says there is need for the country to continue putting in place measures to effectively prevent and control the spread of the Highly Pathogenic Avian Influenza (HPAI), commonly known as bird flu.

Lusaka Times reports that Central Province Permanent Secretary, Denny Lumbama, warned that if not properly managed, the disease had the potential to spread rapidly and escalate to pandemic proportions.

Mr Lumbama said this is the reason why government has continued to play a proactive role and was paying great attention to the preparedness programmes.

He was speaking at the Influenza Rapid Response Training programme held at Tuskers hotel and supported by STOP-AI, an organization based in the US.

Mr Lumbama noted that although Zambia was free of the disease, the country was at high risk of getting bird flu because of the migratory birds that visited Zambia from other parts of the world.

He said trade in poultry and poultry products and increased human traffic also put the country at high risk.

Mr Lumbama said government created an Avian Influenza Task Force whose mandate was to put in place measures to prevent the spread of the disease. He said that in the case that the country is affected, the task force should prevent the disease from further spreading to other parts of the country.
 

JPD

Inactive
AI kills tens of poultry in Banda Aceh, Aceh

http://www.waspada.co.id/index.php?...nda-aceh-aceh&catid=30:english-news&Itemid=94

BANDA ACEH, ACEH - An Avian Influenza (AI) case occurred in Banda Aceh recently in which tens of poultry had suddenly died, necessitating their immediate destruction, a local animal husbandry official said.

"Some 23 poultry belonging to Siti Rohana, a resident of the Ateuk Jawo area in Banda Aceh were positively infected with the AI virus and had to be annihilated," said Mustafa, head of the animal health section of Banda Aceh's animal husbandry office, said here on Wednesday (Nov.4).

He said an animal health team was deployed to the site of the infected poultry to burn them and collect samples of their body fluids for laboratory tests.

"We promptly sent a team to the location after receiving a report on the poultry's sudden death and samples of their body fluids were taken for the laboratory," he said.

He said that until November 2009, a total of 14 AI cases had happened in Banda Aceh. seven cases occurred in Kutaraja, two in Meuraxa and Jaya Baru sub-districts, one each in Ulee Kareng, Baiturahman and Kuta Alam sub-districts. As many as 385 ducks and chickens were destroyed in the 14 AI cases.

The number of AI cases in Banda Aceh in 2009 had increased compared to 2008 when only four cases were recorded. Banda Aceh was one of the 10 districts or cities in Aceh where AI cases happened in 2008.

Until now, no AI case involving humans had occurred in Aceh. The H5N1 virus that causes the Avian Influenza epidemic was rife in Indonesia in 2007 when a number of people also died of the disease.

Based on data from related institutions, in the period June 2005 - March 2008, AI outbreaks happened in 11 of of Aceh province's 23 districts and cities, and in 41 of its 76 sub-districts.
 

JPD

Inactive
Reported Cases in Ukraine Double in Two Days

http://www.recombinomics.com/News/11040902/Ukraine_Double.html

478,456 Influenza/ARI

24,003 Hospitalized

60 Ventilators

81 Deaths

The above numbers are from the latest update from Ukraine. The number of infected patients has almost doubled to just under ½ million, compared to the report two days ago (see map). Hospitalized patients also have spiked higher, to 24K from 15K. ICU cases are not listed, but 60 on ventilators are. However, most (37) of those on ventilators are Chernivisti Oblast, but Lviv, which has the most fatalities and cases, has none, suggesting the data is incomplete or there are significant shortages of ventilators. The number of dead has risen to 81, but media reports describe additional fatalities, include those in the Kiev Oblast.

The explosion of cases again raises concerns that the number of fatalities is significantly higher than the 81 listed. Media reports have described an equal number of pneumonia fatalities which were not considered flu related. The basis of these exclusions remains unclear. Similarly, anecdotal reports suggest the number of fatalities is markedly higher than the 81 in the table.

The rapid rise in reported infections, hospitalizations, and deaths in the past few days raise concerns that the virus is transmitting very efficiently. Spikes in cases have been reported throughout the northern hemisphere, but the spike in fatalities and the frequency in hemorrhagic cases in Ukraine have raised concerns.

Earlier media reports suggest that an update by WHO might be issued today and include preliminary analysis of samples sent to Mill Hill in London.

Daily updates on the rapidly evolving situation in Ukraine, including sequence analysis, would be useful.
 

JPD

Inactive
Swine Flu Death Toll Rises In Ukraine

http://www.rferl.org/content/Swine_Flu_Death_Toll_Rises_In_Ukraine/1870018.html

KYIV -- Four more Ukrainians have been confirmed to have died of swine flu, with more than 70 other respiratory deaths still being investigated, RFE/RL's Ukrainian Service reports.

Ukrainian Health Ministry official Oleksandr Belovol said today that the number of flu patients in the country is 450,000, though it has not been determined how many of those people are suffering from swine flu.

He added that additional flu medicine arrived in the country on October 28.

On November 1, Tamiflu was delivered to Kyiv from Switzerland and Ukrainian clinics began distributing the medicine for free.

A World Health Organization delegation came to Kyiv this week to discuss the situation in the country and possible measures to tackle the spread of the flu virus.

Ukrainian authorities declared last week that there was a swine-flu epidemic in the country.

Neighboring Russia and Slovakia announced that they have increased medical monitoring of people crossing the border with Ukraine.
 

JPD

Inactive
Swine Flu Outbreak Sparks Mutation Fears

http://news.sky.com/skynews/Home/Wo...ars-Virus-Has-Mutated/Article/200911115439464

British scientists are examining samples of a strain of swine flu behind a deadly Ukrainian outbreak to determine whether the virus has mutated.

Dynamo fans wear face masks during Champions League match against Inter Milan in Kiev

Fans at the Champions League match between FC Dynamo and Inter Milan in Kiev

More than 80 people have died in Ukraine in the last two weeks and there have been 450,000 cases of respiratory illness.

The World Health Organisation has sent an emergency team to monitor the epidemic and says it assumes most of the illness in the country has been caused by H1N1 swine flu.

The Ukrainian government has closed schools and universities for three weeks, and many public events have been banned.

President Viktor Yushchenko said experts fear the simultaneous existence of three types of flu viruses within the country "may lead to the emergence of an even more aggressive new virus".

Ukraine's Prime Minister Yulia Tymoshenko wears a protective mask as she visits a hospital

Ukrainian PM Yulia Tymoshenko visiting children in hospital

The WHO team of nine experts dispatched samples from infected patients for examination at the World Influenza Centre at Mill Hill, in London.

"Many questions remain to be answered," the organisation said in a statement.

"The outbreak in Ukraine may be indicative of how the virus can behave in the northern hemisphere during the winter season, particularly in health care settings typically found in Eastern Europe."

The epidemic is concentrated in the west of the country, which has borders with four European Union states, but a growing number of cases are being reported in the capital Kiev.

The European Union is working closely with health experts in Ukraine, and member states are preparing to provide logistical and medical support if required.

Swine Flu

Austria, Hungary and Slovenia have already said they will send disinfectants, vaccines and respirators.

Slovakia has closed two of its five border crossings with Ukraine, against WHO advice, in an attempt to stop the virus from spreading.

Ukrainians have complained of their struggle to access medical supplies, and many pharmacies have sold out of face masks as people try to protect their families from infection.

However, with elections in January there is concern that President Yushchenko and Prime Minister Yulia Tymoshenko, who are fierce rivals, are making political capital out of the outbreak.
 

Lost Patriot

Inactive
Confirmed 100 % Pneumonic Plague in Ukraine

http://www.kavkazcenter.com/eng/content/2009/11/02/11155.shtml


Ukrainian News Agency "Fraza" reported that, according to informed sources, "it has been confirmed 100 % Pneumonic Plague in Ukraine".



The Agency asserts that "the head physician of the medical institutions has sent out an informal disposal - not to sow panic, to refute the information about the plague, and to speak only of swine influenza".



It is also required to distribute masks at health facilities with 8 levels of protection and anti-plague protection costumes. There is also an informal order not to allow any visitors to see the patients.



According to the "Fraza" agency, "today in Ukraine pneumonic plague is going in parallel with swine flu. The plague has killed over 60 people, and about 14 from the flu.



Meanwhile, the press service of the Ministry of Health of Ukraine reported that there is only one death from "California" virus A/N1N1 in Ukraine.



"In Ukraine there are 22 cases recorded of the virus A/N1N1 disease and there is only one fatal consequence as a result. All other cases of death from influenza has only a speculative attitude to "California" virus," press service reports.



The situation with the epidemic of influenza is a complex and unpredictable because of the propensity of influenza A/H1N1 virus to mutation, said First Deputy Minister of Health Mr. Lazoryshynets on Monday, November 2.



"The situation is complicated and unpredictable. We found a strain of this virus in our laboratory ... This virus is dangerous because it can mutate, and we can get a very different kind of virus, which was in Latin America or in Mexico, now it is European ", - said Lazoryshynets at a press conference, the "Correspondent" magazine informs.



At a press conference Lazoryshynets also said that there are 22 officially confirmed cases of influenza A/H1N1 in Ukraine.



First Vice Prime Minister Oleksandr Turchinov previously stated that as of Monday morning, November 2, there are 64 registered deaths in Ukraine from flu and acute respiratory viral infections.



Meantime, according to official information the highest level of epidemiological risk is declared in Ivano-Frankivsk (Stanislav) area, from 2 November. This decision was made by Ivano-Frankivsk Regional emergency epidemiological commission at the extended session on November 2.



In accordance with the Commission, quarantine will last for all educational institutions in the area until 20 November, a commission to monitor the distribution of medicines is also made, which come in the region as humanitarian aid.



The commission agreed that health workers will provide individual first aid kit. There will be extra transport allocated to visit patients by the district doctors.



According to the Ministry of Health, today in Ukraine there are 255 000 registered cases of influenza and SARS, of whom 15 000 were hospitalized.



Ministry of Transport and Communications of Ukraine introduced a permanent monitoring of the situation on a clear implementation of the planned anti-epidemic measures in public transport.



A special monitoring group studied the transport department on November 2, how the anti-epidemiological measures were applied at the Kiev railway station, central bus station of the capital and the International airport "Borispol".



Polish epidemiologists November 3 arrive in Ukraine for obtaining specimens from patients with the Ukrainians. The experts will arrive in Lviv, where it is supposed to take 190 samples.



Polish epidemiologists are expected to arrive in Ukraine on November 3 to obtain samples from patients. The experts will arrive in Lviv, where 190 samples are to be taken.



Lithuanian Foreign Ministry on November 2 recommended to the residents of Lithuania to refrain from unnecessary trips to the Ukraine.



Department of Monitoring,
Kavkaz Center
 

JPD

Inactive
Bird Flu Not Over in Nigeria

http://allafrica.com/stories/200911060155.html

Abuja — Recently, the World Bank passed what could be described as a vote of confidence on Nigeria for its ability to control and manage the dreaded Avian Influenza (H5N1) virus popularly called bird flu.

The World Bank Country Director Onno Ruhl said of the 84 countries the Bank has assisted in the containment of the disease, Nigeria remains the only country with a success story.

The dreaded bird flu was first confirmed to be in Nigeria in 2006. The last outbreak of the disease was recorded in 2008 in Kano and Katsina. They were quickly contained. Nigeria has enjoyed 14 months without an outbreak of the virus.

It is worth noting that even with this success, the game is not yet over. There is the need for the government to do more to contain the virus. Efforts put so far to minimise the impact of the disease be maintained. Sustaining the status quo are the keywords.

Speaking at a two day capacity building for media practitioners organised by the National Animal Disease Information and Surveillance (NADIS) under the federal department of Livestock in Jos, recently, Dr Sulaiman Haladu of the Nigeria Field Epidemiology and Laboratory Training Program said studies have shown 1, 407 emerging diseases. He said 73 percent of them are zoonotic.

Zoonotic diseases or zoonoses are diseases that can be transmitted from animal to human and vice visa. This means that the increase in emerging diseases threaten not only animals but humans. Experts are saying that nipping the trend in the bud would be the best bet in combating the menace. So, the control and containment of zoonotic diseases like the influenza virus is equal in effect to promoting good health of the people. It is easier and less expensive to manage at that level experts say.

In fact, Health experts are warning of outbreak of pandemic of huge proportion in the nearest future in the world, with a worst case scenario projected at 150 million globally. Best case scenario is estimated at 40 million.

'The coming of a pandemic is no longer a question of "IF" but "WHEN,"' Dr Gashash Ahmed of the Epidemiology unit of the Live Stock Department said.

The impacts of emerging diseases are potentially dangerous. Morbidity and mortality in man and animals, loss of labour productivity due to illness, reduced travel and tourism to affected areas, death and destruction of affected animals and serious drain on a country's economy are among the flip side of a pandemic occasioned such occurrences.

In the family of influenza is the Novel Influenza virus, A (H1N1), called swine flu. The virus began in Mexico on April 21, it later moved to the United States of America but the first Africa case was recorded in Egypt on 3rd June, 2009. Kudos must be given to the Nigerian authorities especially the ministry of health and the Federal Department of Livestock in the Agric and water Resources ministry for being able to manage the situation despite the supposedly porous borders. Until November4, when the federal ministry of health announced a single case recorded in Lagos of a nine year old American girl, it has not been heard of in the country. The girl was treated and she is doing fine.

So far, about 27 countries are known to have been hit by the swine flu, with a record of 14, 109 cases and 76 deaths.

Influenza A (H1N1) is a highly contagious respiratory illness with such symptoms as fever, sneezing, coughing, headache, running nose, sore throat and sometimes diarrhoea and vomiting.

At present, experts said the main route of human to human transmission of the virus is by exposure to infected droplets expelled by sneezing or coughing that can be inhaled or that can contaminate surfaces.

Genetic and biological factors, climate and weather change, human-animal-environment interface, international travels and commerce, poverty and social inequality have been identified as responsible for emerging and re-emerging diseases.

Studies in Africa and Asia have shown the transmission of Ebola, Lassa fever, SARS, monkey pox virus, anthrax, salmonella to mention a few through the consumption of bush meat.

Records have equally shown of increasing global trade in exotic animals. For instance, the wildlife conservation society put annual global trade on exotic animal at 4 million birds, 640, 000 reptiles, 40, 000 primates while illegal trades are unknown but estimated to be worth £4-6 million.

Still speaking at the media capacity workshop, Dr Gashash Ahmed said Agriculture contributes 10% to Nigeria's GDP while livestock contributes 20% to Agric GDP.

He said out of the 4, 835 registered veterinarians, only 162 are the civil service, a figure down to low for a population like Nigeria. There are estimated 7, 500 paravets/laboratory scientists. On the other hand, animal population in the country are believed to huge.

Dr Ahmed said based on projections from the 1990 animal census, 159 million poultry presently are in the country, sheep-28 million, pigs-6.6 million, cattle-15.16 million while goats are 45.06 million.

Although, there are no statistics of wild life, but several species abound in national parks and other natural environment and studies have shown strong possibilities of the wildlife being the carriers of diseases across borders especially the migratory ones.

Already, the World Health Organisation's (WHO) phase of pandemic alert of flu is at phase six having declared the phase five. This is characterised by community outbreaks in at least one country in WHO region.

Earlier in his opening remarks, Acting Director of the federal Department of Livestock, Dr Joseph Nyager represented by Dr Gashash noted that the workshop was "an intervention to inform, partner and mobilise the media to promote in-depth and well and well informed reporting on issues relating to Highly Pathogenic Avian Influenza (HPAI) and other Transboundary Animal Diseases (TADs)."

He said the first avian influenza outbreak in the country in 2006 "greatly challenged us to review our overall strategies in disease control and change the approaches to interventions which will help to map out the social economic/cultural epidemiology of the disease, the control measures and its impact on communities."

Mrs Olubunmi Ojo an Assistant Director in the federal ministry of Health at the workshop said the above scenario suggests a strong signal that a pandemic is imminent and "the time to finalise the organisation, communication and implementation of the planned mitigation measures is now."

She however assured of government preparedness to contain any outbreak of influenza A (H1N1) with series of measures already put in place. Among them is the receipt of 184, 800 doses of vaccines from WHO, making the total in store so far 250, 000 doses. A good number of it has been distributed to states and designated federal health institutions.

Although influenza pandemic is known to be rare but was a recurrent event in the 20th century. In 1918, the 'Spanish Influenza' occurred, the 'Asian Influenza' in 1957 while the 'Hong Kong Influenza' occurred in 1968.

About 53 million people were estimated to have died worldwide in the three pandemics.

Studies have shown that when diseases re-emerge, they come with more resistant variant, and more dangerous too. For instance, in 1997, there was pandemic threat of avian flu in Hong Kong. Few hundred people were infected with the highly pathogenic A/H5N1. Six of the hospitalised died. It was different because it moved directly from chicken to people instead of being altered by infecting pigs as an intermediate host.

To stop the impending scourge, chicken, approximately 1.5 million, were slaughtered in Hong Kong. The same slaughtering took place in 2006 when bird flu broke out. Again the emergence of a novel flu virus A/H9N2 still in Hong Kong in 1999, causing illness in two children is a reason to worry and giving concern that pandemic is in the offing.

This call for caution and adequate preparation anchored by the federal government while the state governments are expected to wake up from its slumber. No serious minded nation allows its human population to be at risk, not even fauna and flora. They are two dependent entities.

Dr Ahmed in his presentation further noted that "Monitoring of abattoir rests more on the shoulders of state governments but they do not seem to be carrying out this responsibility as required. Animal health is in the concurrent list," he said. "The federal government is supposed to play a supervisory role. In some states, we have only one veterinarian and few other paravets who are supposed to oversee millions of livestock. This will not take us to the desired level."

This is appalling to say the least of the state governments. This is probably why the abattoirs in the country are in such a mess such that when foreigners visit them, they automatically turn vegetarians.

More fund need to be put into animal and human health care. These funds should be monitored with all necessary mechanism to ensure they are utilised for the purpose for which they are appropriated. Only then can we expect positive change to happen to our lives and the generation unborn.
 

JPD

Inactive
Russia Finds Bird Flu Virus in Wild Bird

http://www.thepoultrysite.com/poultrynews/18876/russia-finds-bird-flu-virus-in-wild-bird

RUSSIA - The veterinary authorities have sent a report to the World Organisation for Animal Health (OIE) about a sick dove in Moscow region, which was found to be infected with highly pathogenic avian influenza (HPAI).

The Russian veterinary authority sent an Immediate Notification dated 5 November to OIE.

The report describes the finding of a sick rock dove (Columba livia) on the balcony of an apartment in Serpukhov in the Moscow region.

The bird was destroyed and the presence of the H5N1 sub-type of the HPAI virus was subsequently confirmed.
 

JPD

Inactive
Viet Nam Reports Another HPAI Outbreak in Poultry

http://www.thepoultrysite.com/poultrynews/18877/viet-nam-reports-another-hpai-outbreak-in-poultry

VIET NAM - The veterinary authorities have sent a report to the World Organisation for Animal Health (OIE) about a new outbreak of highly pathogenic avian influenza (HPAI) in village poultry.

The Vietnamese veterinary authority sent Follow up Report No. 33 dated 5 November to OIE.

The report describes the latest outbreak in a village flock of around 2,300 birds in Noong Luong in Lai Chau province in the north of the country, near the border with Lao PR. Around 450 of the birds were affected, and 327 died; the rest of the flock was destroyed.

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

JPD

Inactive
Death toll still rising in Ukraine's flu outbreak

http://www.monstersandcritics.com/n...h-toll-still-rising-in-Ukraine-s-flu-outbreak

Kiev - The death toll in Ukraine's flu outbreak continued to rise on Thursday.

A total of 95 persons have died from flu-related symptoms since the disease struck Ukraine's western provinces late last month, said Zinovy Mytnik, vice health minister, in comments reported by the Interfax news agency.

A total of 633,877 Ukrainians nationwide have registered with health authorities as suffering from the flu, though some have recovered since the disease's late October outbreak, Mytnik said.

Ukraine's Ministry of Health on Wednesday gave a total of currently infected at some 470,000.

The particularly virulent A/H1N1 flu strain, or swine flu, was likely responsible for a significant proportion of the infections, based on laboratory testing thus far, Mytnik said, speaking at a Kiev press conference.

Since the beginning of the flu outbreak, Ukraine's Health Ministry had sent 31 samples from persons infected with flu to a British laboratory to be checked for the presence of swine flu, of which 15 tested positive.

A former Soviet republic, Ukraine lacks a modern public health infrastructure and, since the beginning of the flu outbreak in late October, has seen severe shortages of even simple medical supplies such as protective masks and flu remedies.

No Ukrainian laboratory is capable of testing for the presence of swine flu, Mytnik said.

International medical assistance continued arriving in Ukraine on Thursday, with European Union nations taking the lead. Top contributors were Slovakia, Austria, Hungary and Poland - the last being the first country to respond to a Ukrainian October 31 appeal for foreign aid, according to an Intefax report.

EU-donated medical supplies en route or already in Ukraine included protective masks, respiration equipment and surgical gloves.

Emergency shipments of the swine flu treatment Tamiflu, produced in Switzerland, first began arriving by cargo plane to Ukraine on Sunday.

Ukrainian Prime Minister Yulia Tymoshenko, on a visit to the western city of Chernovtsy, near the epicentre of the flu outbreak, said government efforts to control the flu's spread were working.

'There is no need to to invoke a national emergency,' she said, according to a Korrespondent website report.

Tymoshenko's government has attempted to control the flu outbreak with the imposition of a partial quarantine of eight western provinces most badly hit by the disease, a military-style mobilization of state-owned fabric and clothes factories to mass-produce protective masks, and limits to allowable public gatherings.

In the midst of a campaign for Ukraine's presidency, Tymoshenko has, since the beginning of the flu outbreak, repeatedly attacked the private health industry, accusing drug manufacturers of inflating prices artificially and pharmacists of hoarding medical supplies.

A government consumer protection agency in Lviv, one of the worst-hit cities in the flu outbreak, on Thursday filed a class-action suit against local health officials, accusing them of conspiring with private health suppliers to price-gouge consumers of medical supplies, the Unian news service reported.

Read more: http://www.monstersandcritics.com/n...ising-in-Ukraine-s-flu-outbreak#ixzz0W5PqnOGn
 

JPD

Inactive
WHO calls for 'close' watch on flu in farmers, animals

http://www.google.com/hostednews/afp/article/ALeqM5hVhyOI4e9xsbZT9c234MwuCtJCVA

GENEVA — The World Health Organisation on Friday called for close monitoring of farm workers and animals for influenza A viruses, following recent cases in a wider range of creatures than pigs.

Although the WHO stressed that the cases were isolated and had no impact on the way the A(H1N1) swine flu pandemic evolved in humans, it said recent findings may indicate greater potential for flu viruses to mix and mutate.

Pigs have traditionally acted as virtual mixing vessels for different flu viruses, allowing them to mutate into new forms that could be passed to humans.

"These recent findings further suggest that influenza A viruses in animals and humans increasingly behave like a pool of genes circulating among multiple hosts, and that the potential exists for novel influenza viruses to be generated in animals other than swine," the WHO said in a briefing note.

"This situation reinforces the need for close monitoring and close collaboration between public health and veterinary authorities," it added.

"When influenza infections are detected in farmed animals, WHO recommends monitoring of farm workers for signs of respiratory illness, and testing for H1N1 infection should such signs appear."

The UN health agency emphasised that extensive tests by laboratories had not detected signs that the A(H1N1) pandemic virus had mutated to a more virulent form.

"These isolated events have had no impact on the dynamics of the pandemic, which is spreading readily via human-to-human transmission," it added.

The recently detected cases involving animals have included swine flu appearing in pigs, with "limited evidence" indicating that they were directly infected by humans.

"As human infections become increasingly widespread, transmission of the virus from humans to swine is likely to occur with greater frequency," the WHO noted.

Other A(H1N1) infections been reported in turkeys in Chile and Canada and in pets in the United States, and the WHO also highlighted the progress of highly virulent H5N1 bird flu in recent years.
 

JPD

Inactive
Reported Cases in Ukraine Double Again To 871,037

http://www.recombinomics.com/News/11060901/Ukraine_4X.html

871,037 Influenza/ARI Cases

39,603 Hospitalized

135 Deaths

The above numbers from the latest update from Ukraine (see map) continue to alarm. More than half of the Oblasts and cities listed exceed the epidemic threshold, including Kiev and Kiev Oblast, raising concerns that the increase in case numbers will accelerate. Moreover, hospitalization of 39,603 raises concerns that the number of deaths will also accelerate, since 11% of hospitalized cases in California died.

Although WHO has suggested that these alarming number may reflect sub-standard medical and housing conditions, the numbers remain alarming. Mill Hill indicated that at least 15 samples were H1N1 positive, indicating they now have a small database of Ukraine sequences. Although initial reports indicated there were no "major" changes, which presumably referred to reassortment, and no Tamiflu/Peramivir resistance, further analysis was required to rule out significant changes which were presumably linked to SNPs.

However, because the virus already has demonstrated an ability to cause fatal infections in a disproportionate number of children and previously healthy adults, small changes in the virus could lead to increases in viral load leading to an increase in cytokine storm frequency and hemorrhagic pneumonia, as reported for earlier cases.

Therefore release of full sequences at this time is warranted.

Similarly, more detail on the number of fatal and hospitalized cases with hemorrhagic pneumonia would be useful.
 

JPD

Inactive
Withheld Ukraine Sequences Raise Pandemic Concerns

http://www.recombinomics.com/News/11070901/Ukraine_Seq_NOT.html

Right now we know that many clinical specimens and viruses have been sent to one of the WHO collaborating centres for further study. We don't know the results of those studies, and it will probably take a couple of days for the full analysis of those viruses to be available. But in the meantime, what we do not have is any evidence of viruses there or anywhere else as showing any big mutations. I raise this point because I have seen in some media reports that there are reports that WHO or other groups are saying that there are mutations and I want to point out that these are rumours and factually, untrue.

The above comments from Keiji Kukuda offer some general comments on the Ukrainian H1N1 sequences at Mill Hill in London. He specifically says WHO doesn't see any "big" mutations in the samples being sequenced, which would refer to reassortment or Tamiflu resistance. However, the changes seen in Ukraine do not require "big" mutations. Small mutations, such as SNP can have profound effects for a virus like pandemic H1N1.

That virus normally circulates in swine, and has recently jumped to humans. It already has many characteristics with the 1918 pandemic strain. Both are swine H1N1 that jumped to humans. Such species jumpers can increase efficiencies with small changes. One good example is position 627 in the PB2 gene. That position comes in two forms. When there is glutamic acid (E) at that position, the PB2 enzyme copies the viral genetic material most efficiently at 41 C, the body temperature of a bird. However, if that position has a lysine (K), the enzyme is most active at 33 C, the temperature of a human nose in the winter. The swine H1N1 has an E, which may be why it goes well in lung, which is 37 C and closer to the optimal replication temperature of 41C. However, a single change that produced the most efficient replication at 37C would lead to even higher levels in the lungs, which could lead to frequent cytokine storms, like those in 1918, instead of the less frequent level seen in Ukraine.

However, the rapid spread of H1N1 in Ukraine (see map), coupled with the high frequency of hemorrhagic pneumonia raise concerns that a small change is leading to a more virulent virus. Similarly, the rapid spread of the virus could also be affected by a small change in another gene, such as HA, which controls entry of the virus to cells and influences tissue tropism.

Mill Hill has acknowledged that they have at least 15 H1N1 positive samples from Ukraine, which would identify a Ukranian specific change. The delay in the announcement of sequence results raises concerns that such changes have been detected, and such changes are undergoing further analysis.

The number of cases in Ukraine continues to expand. The number of patients with H1N1 symptoms is now approaching 1 million. Cases have been increasing at almost 200,000 per day, so it is likely that tomorrow's report will have over 1 million cases. This rapid spread increases concern that the 15 sequences at Mill Hill contain one or more of these small changes, which has led to a delay in the announcement of sequence results.

More detail on the sequences at Mill Hill is overdue. The rapid spread of H1N1 in Ukraine demands rapid sequence results. Continued delay will only increase concerns.
 

JPD

Inactive
National H1N1 Epidemic Declared in Bulgaria

http://www.recombinomics.com/News/11070902/Bulgaria_Epi.html

The Health Ministry made the decision based on the grounds that the number of people with swine flu has reached 210 per 10 000.

Thus, all schools in Bulgaria will be in a swine flu break all of next week (9-14 November). The Health Ministry recommends limiting the number and scope of public events.

The above comments describe the declaration of a national swine flu epidemic in Bulgaria. Earlier this week an epidemic level of H1N1 had been reported in a select number of Oblasts and municipalities (see map). However, this level was subsequently reported for the entire country, so an epidemic was declared.

Although the number of fatalities reported this far are markedly below the levels reported for Ukraine, the rapid spread of H1N1 in Bulgaria raises concerns that there will be a dramatic increases in cases and deaths in the area. Spikes in deaths have already been reported in Turkey and Italy, although none have approached the numbers reported in Ukraine, where influenza/ARI cases are approaching 1 million, and will likely surpass that number in the next report.

The explosion of cases in Ukraine raise concerns that the H1N1 virus has subtly changed, with associated increase in cases and deaths.

Sequence data on these recent fatalities in Bulgaria and neighboring countries would be useful.
 

JPD

Inactive
Kyiv mayor insists on imposing quarantine in capital

http://www.kyivpost.com/news/city/detail/52064/

The mayor's office of Kyiv is insisting on imposing a quarantine on the capital, Kyiv Mayor Leonid Chernovetsky has said at a briefing on Nov. 6.

According to him, the Health Ministry has refused to impose quarantine in Kyiv.

"I don't understand the reasons why quarantine wasn't imposed. I think that we will continue the fight so that a quarantine is announced in Kyiv, until the Health Ministry decides on the vaccination of Kyiv residents," Chernovetsky said.

"I think, while we are finding out what we are facing with, this is a pandemic and quarantine should have been imposed in Kyiv, as well as in other regions," he added.

"A quarantine regime will let me close night clubs and other mass, scale events in Kyiv, and the person who doesn't understand that this should be done could be held responsible for the consequences," the mayor said.

Chernovetsky explained that quarantine is needed because every day hundreds of people arrive in Kyiv, in particular, via railway stations, bus terminals and airports.

At the same time, according to him, the number of people on public transport has decreased by 30%, many people are using gauze masks.

He also reported that in Kyiv, as well as in other cities, there is a problem with medication, as "the two month reserve of medicines has been purchased from drugstores," but currently the government is doing everything possible so as to import medications.

Chernovetsky also said that Kyiv mayor's office had asked cities abroad to provide humanitarian aid.
 

Be Well

may all be well
copying this two place so people see it

If you go to NS1's blog there is a Glossary that explains terms, plus previous articles - well worth reading

http://pf11-trends-and-issues.blogspot.com/2009/11/ukraine-expected-to-surpass-1-million.html

Ukraine Expected to Surpass 1 Million Infections in Only 10 Days; the U.S. took 10 weeks.

A day in the Ukraine is like a week in the United States . . .

for Pandemic Influenza spread, that is.


On October 29, the Ukraine officially reported an uptick in Influenza-like-Illness (ILI) and a surge in hospitalisation. Concomitant deaths were reported from hemorrhagic pneumonia and four doctors were soon included in the fatality pool. The situation was recognised and immediate action was taken. Very early in the process, a nationwide alert was issued and the situation came under central management. In mere days, the healthcare infrastructure was stressed and supplies were exhausted. Resources have been redirected and escalations continue. Citizens are cutting their own clothing to make masks.

Tommorow will mark 10 days since that spark.

Based on the most recent daily case increases trending upward from 32% to 37%, we expect the Ukraine to surpass one million reported infections by Saturday afternoon, November 7, 2009. If the reporting trend continues with the weekend and the rates hold, just under 1.2 million cases will be cataloged. We cannot speculate if a report will be made publicly available on Saturday.

The official reports from the United States indicated that 1 million infections were reached in late June 2009, 10 weeks after the initial sparks of PF11 began to ignite the populations and burn through the major cities.

The Ukraine progression defines a new method for PF11. In the early phases of any catalyst event, all statistics are suspect, but the trending is often useful. Official numbers, upon some minor calculations, demonstrate that the daily increase in hospitalisation and deaths is rapidly climbing. Yesterday the increase in daily hospitalisations was 20% and today the increase is 37%, almost a doubling in day-to-day velocity. Yesterday the increase in deaths was 17% and today the increase is 42%, more than a doubling in day-to-day velocity.

Data reporting cut-offs are always at issue in these early inflows, but over the next two weeks an exacting pattern will be defined. Researchers must be given access to the raw data to determine causality and vectoring. A significant library of samples has been received and sequenced in a prestigious European coordinating laboratory. No data at this time has been released.

Timeliness is essential when a virus has marched to 1 million suspect cases in only 10 days in one country of less than 50 million people. 1 of 50 ill across 10 days. Clinical and environmental data matching the sequences will be critical to deduce and weight the parameters driving this regional escalation. Those who will writeoff these flashpoints as medical infrastructure failures and sub-standard housing problems endemic to the third world are not intellectual Titans. A pandemic is by definition unpredictable in phase shift timing and degree. To discount this Ukrainian surge in suffering to poverty is simply academically irresponsible in a pandemic era. These data points requested, if made public today, may save the lives of many in the area and exponentially more in the coming months around the globe.

The Ukraine is bordered by the countries of Russia, Belarus, Poland, Slovakia, Hungary, Romania and Moldova. The southern area of the Ukraine is involved in several bird migration routes being bordered by the Black Sea. Sequence examination of late summer specimens from these bordering areas and Eastern Europe demonstrates a trend equal to the United States with a significant Hydra Effect and substantial Antigenic Diversity delivered via Influenza Flux. US sequences certainly match and even advance the polymorphisms in Eastern Europe and these border nations.

Our studies clearly demonstrate a one to three week lag at maximum in transport time and acquistion into new geographic areas of trait-enhancing genetic material within ÓPF11. The stage is already set with similar sequences existing in most parts of the world. 225E has continued to penetrate in dozens of nations and is a factor in our present working hypothesis for this Ukraine spark.

If the Ukraine has variant genetic specimens, the information is primary to world health. Singapore was recently courageous enough to release 600 sequences that widely demonstrate movement in the reservoir. Only an immediate evaluation of the full dataset of Ukrainian sequences and matched clinical information will provide countries the opportunity to prepare if this incident does mark an inflection point or catalyst event in the pandemic.

Is the US only one cold winter week from the situation today in the Ukraine? Is the base of Pandemic 2.0 now widening in countries that have some point of susceptability? If so, the landing strips are presently in place for these new polymorphisms to land on the existing PF11 strains in every basic geographic area of the world.

We may all be one week from seeing a million new cases in our homelands or, worse yet, watching 2% of our population stricken in only 10 days. You do the math for your nation and then decide if we need data transparency and academic honesty.
 

JPD

Inactive
H1N1 Jumps to Pets Raise Pandemic Concerns

http://www.recombinomics.com/News/11070903/H1N1_Pets.html

As human infections become increasingly widespread, transmission of the virus from humans to swine is likely to occur with greater frequency.

In addition, pandemic H1N1 infections have been reported in turkeys in Chile and Canada and in a few pet animals in the USA. Again, these infections were isolated events and pose no special risks to human health.

The above comments from the WHO update on H1N1 in farmed animals suggests the infections in turkeys and pets pose no special risks to human health, However, this statement would be true only in the narrowest sense. Pandemic H1N1 is widespread in humans and the vast majority of infections of humans are from virus in other humans. However, the ability of this virus to jump species increases viral interactions that can result in the exchange of genetic information via recombination and reassortment.

Transmission to swine has been reported at an increasing frequency. Yesterday a jump to swine in Taiwan was reported and today a jump to swine in Hong Kong was reported. Multiple examples in North and South America, as well as Europe, Asia, and Australia have been reported previously, and as the level of H1N1 in humans increases, the frequency of such jumps will likely increase.

However, the pandemic H1N1 is a swine virus, so there have been prior opportunities to acquire genetic information from viruses that co-infect swine. The report of jumps to turkeys however, increased concern that the virus was quite promiscuous and could jump to multiple species.

The concerns were increased by two reports of jumps to pet ferrets. Last year a virus from the first reported natural infection in ferrets was found to be an H1N1 classical swine virus. Therefore, a jump of swine H1N1 to pet ferrets was not unexpected. However, these jumps were accompanied by assurances about jumps in other pets, since H1N1 had not been previously reported in cats or dogs. However, the ability of the virus to jump to other mammals was increased by the reports of jumps to avian species , such as the turkeys described above.

Moreover, the pandemic H1N1 had a high attack rate. The explosion of cases in the fall was tightly linked to school openings. The virus would quickly spread in schools leading to double digit absenteeism and associated infections of teachers and staff. In schools that had absences in the range of 20-30% for periods of 1-2 weeks attack rates approaching 100%. This high attack rate in schools has also been reported in anecdotal reports of family attack rates of 100%.

The high attack rates are facilitate by multiple exposures within a families residence. However, this frequent exposure would also apply to family pets that were kept indoors.

The concerns were supported by the recent report of H1N1 in a pet cat. This was the first reported case because of the availability of testing and not due to a unique association / exposures. Concerns that such transfers might be common were supported by anecdotal reports of cats and dogs developing flu-like symptoms following infection in owners and family members. These anecdotal reports suggest that testing of these symptomatic pets will identify a number of such jumps, which raises concerns of interactions with other animal virus.

These interactions can lead to rapid evolution, and the proximity and transmissibility of pandemic H1N1 will lead to frequent transmission to humans.

Extended surveys of sequences from pet isolates should be a top priority
 

JPD

Inactive
Death toll from flu outbreak in Ukraine rises to 144

http://en.rian.ru/exsoviet/20091108/156753650.html

KIEV, November 8 (RIA Novosti) - The death toll from the flu outbreak in Ukraine has risen to 144 cases, the country's Health Ministry reported on Sunday.

According to the ministry, 15 regions in the ex-Soviet republic had already crossed the flu epidemic threshold while 11 provinces were close to it.

The Ukrainian government imposed quarantine in nine western provinces in late October in an attempt to curb the spread of flu. All education establishments in Kiev were closed, and people were obliged to wear medical masks in all catering establishments, shops and social services facilities across the former Soviet republic.

Ukrainian President Viktor Yushchenko earlier requested help from other countries over the outbreak of flu.

The Ukrainian Health Ministry said on Monday 255,000 flu cases had been registered in the country, with some 15,000 people receiving treatment in hospital.

The Health Ministry has confirmed the death of 14 people from swine flu and 32 swine flu cases in the country.

The Ukrainian parliament has approved the allocation of 1 billion hryvnias ($125 million) on measures to fight swine and seasonal flu.
 

JPD

Inactive
Reported Ukraine Cases Approach One Million

http://www.recombinomics.com/News/11080901/Ukraine_Million.html

936,804 Influenza/ARI

43,762 Hospitalized

144 Deaths

The above figures are from the latest update in Ukraine. The increase in the reported cases slowed and have not quite broken 1 million, but the increases in the latest report put all reporting locations above or near the epidemic threshold (see map). Moreover, deaths have now been reported at most locations, although the Lviv Oblast still has a significant lead in each of the above, with 152,242 cases, 6,313 hospitalized, and 61 deaths.

Although these numbers are well above historical blimps in cases in Ukraine at this time of year, the local media is still focused on confirmed cases and a role for seasonal flu in the numbers. However, as has been reported throughout Europe, levels of seasonal influenza A are near zero. Moreover, the decline in H3N2 in eastern Asia suggests that swine H1N1 may crowd out seasonal H1N1 and H3N2 and swine H1N1 may be the only influenza A remaining in circulation in humans worldwide.

Anecdotal reports indicate there is also significant levels of virus and deaths in Belarus and other countries in the region, raising concerns that the death toll will rapidly increase, which leaves open the possibility of a genetic change.

Although Mill Hill has reported at least 15 positive samples, no sequences have been released and comments on the sequences have been sketchy. The isolates are said to be anti-viral sensitive and have no "large changes".

However, changes in the receptor binding domain position 225 have been reported, with D225E being most dominant (see list here). However, other changes have also been noted, including D225G (see list here) and D225N (see list here). D225N was linked to the global expansion of seasonal H3N2, so changes at this position can have significant effects on transmission.

Release of sequences from Ukraine is now overdue.
 

JPD

Inactive
H1N1 Genetic Changes in RBD Raise Pandemic Concerns

http://www.recombinomics.com/News/11080902/H1N1_D225.html

Right now we know that many clinical specimens and viruses have been sent to one of the WHO collaborating centres for further study. We don't know the results of those studies, and it will probably take a couple of days for the full analysis of those viruses to be available.

The above comments are from Thursday's WHO press conference and raise concerns that the sequences from Ukraine (see map) have small changes which may include receptor binding domain changes. Several such changes have been seen in previously published sequences and position 225 has been of concern. That position was linked to the establishment of amantadine resistance in seasonal H3N2 and raises concerns that such a change in swine H1N1 could make the virus more virulent. In seasonal flu, the change was D225N, and that change is in at least three swine flu sequences, including two from fatal cases in San Paulo, Brazil collected in August (see list here).

The same position has also changed to D225G, which was also found in other fatal cases in San Paulo, Brazil. It is also in more recent (September) isolates from China (see list here).

The new polymorphism most widely reported in sequences in Genbank is D225E, which is common in recent sequences from Italy (see list here).

Thus, similar changes in sequences from Ukraine would be of most interest, and such changes have not been ruled out by WHO statements thus far.

The release of these sequences from Ukraine is now overdue, and these delays increase pandemic concerns.
 

JPD

Inactive
Reported Ukraine Fatalities Increase To 155

http://www.recombinomics.com/News/11090901/Ukraine_155.html

969,247 Influenza/ARI

48,972 Hospitalized

155 Dead

The above numbers represent the latest figures from Ukraine. The increases over the weekend have slowed, but it is unclear if this reduction in the rate of increases is due to an improving situation, or just fewer reports received because of the weekend. Although Lviv still has a wide lead in all categories (see map), including 155,895 cases, the city of Kiev is now up to 60,366 and when combined with the 47,802 cases in the Kiev Oblast, the Kiev city/oblast has increased to more than 100,000 cases, which is higher than any oblast, other than Lviv. The low number of deaths there, 5, may just be a trailing number, since the largest increases in Kiev were in the past few days.

Poland is now reporting schools with high absenteeism, although media reports and government comments continue to cite contributions from seasonal flu, even though all countries in Europe are reporting seasonal flu levels at less that 1% of flu positives. Worldwide, seasonal H1N1 has been crowded out, and low levels of H3N2 in eastern Asia are rapidly declining, suggesting the H1N1 swine flu will be the dominant influenza A in humans for years or decades.

The lack of a more detailed report on the sequences generated by Mill Hill continues to cause concern. Initial reports suggested there was no reassortment or anti-viral resistance markers identified, but reports did not exclude small changes, including acquisition of receptor binding domain changes such as polymorphisms at HA position 225 (D225E, D225G, and D225N). D225N was linked to the global expansion of amantadine resistant H3N2, and D225G was isolated from lungs of fatal cases in Sau Paulo, Brazil, as well as pandemic isolates from 1918 (A/New York/1/1918) and 1919 (A/London/1/1919).
 

JPD

Inactive
1918 RBD Polymorphsm in Ukraine H1N1?

http://www.recombinomics.com/News/11090902/Ukraine_1918.html

The recent explosion of H1N1 cases in Ukraine (see map) has focused attention on sequences linked to the outbreak, especially those in the lungs of patients who developed a cytokine storm. This hemorrhagic pneumonia has been described previously in other fatal swine flu infections, but that rapid increase in reported deaths in Ukraine has raised concerns that the virus is transmitting more efficiently, or is replicating at higher levels in lung tissue.

These changes are frequently linked to changes in the receptor binding domain (RBD) in the HA protein. Changes in this domain can affect affinity for receptors and also modify tissue tropism. The recent expansion of seasonal H3N2 with M2 S31N was linked to two changes in or near the receptor binding domain, S193F and D225N.

Recent isolates from Sao Paulo, Brazil, collected from necropsy tissue from fatal cases had two changes at position 225. Two of the isolates, A/Sao Paulo/53845/2009 and A/Sao Paulo/53838/2009) had D225N (see list), the same change seen in seasonal H3N2. Interestingly, the swine H1N1 is a triple reassortant with flu genes from swine, humans, and birds. The human gene is PB1 and it was acquired in swine infected with a human H3N2. The initial isolates had three human genes, the H3 and N2 as well as the PB1. Thus, the prior association of the human PB1 in isolates with human H3,may increase the advantage offered by D225N.

However, two other isolates from Sau Paulo, A/Sau Paulo/53225/2009 and A/Sau Paulo/53206/2009, collected from the lungs of fatal cases, had another change at position 225, D225G. This polymorphism is more widespread and recent isolates have been found in Japan, Italy, and China (see list ). Moreover this polymorphism has been found in two isolates from the 1918/1919 pandemic, A/New York/1/1918 and A/London/1/1919. Thus, in 1918 the H1N1 virus usually had a D at position 225, but some of the later isolates had D225G, which parallels the data from the 2009 swine H1N1 isolates.

These RBD changes in recent isolates from Sao Paulo, as well as the presence of D225G in sequences from 1918/1919 raise concerns that the swine H1N1 is adapting to its human host by acquisition of RBD polymorphisms.

The explosion of cases in Ukraine, and delays in the release of sequences from fatal cases in Ukraine is a cause for increasing concern. Recent accelerations of deaths have been widespread across the northern hemisphere, raising concerns that receptor binding domain changes described above, as well as a third polymorphism at position 225, D225E, (see list) are gaining traction as the swine H1N1 adapts to human hosts.

An update on the Mill Hill sequences and deposit of such sequences at a public database such as GISAID, where Mill Hill recently deposited sequences from Europe, would be useful.
 

JPD

Inactive
Total Destruction of Lungs in Ukraine Fatal H1N1 Cases

http://www.recombinomics.com/News/11090903/Ukraine_Lungs.html

The symptoms are observed at different stages of disease - a fever with a temperature over 38 C, cough, respiratory disorders. When cough was characterized by negligible allocation phlegm or dry unproductive cough with blotches of blood. All the patients come to hospital on average by 3-7 days of onset, were in serious condition. Period of time from onset to death averaged from 4 to 7 days. In all patients during a hospital for signs of respiratory insufficiency of various degrees, which quickly rose and manifested accelerated respiration rate, shortness of breath and effectiveness of independent breathing. X-ray studies were performed on 1-2 day hospitalization. Most patients experienced a double-headed particles of lower lung lesion, followed by a trend towards total destruction.

The above translation is from an announcement today from the Ukraine Ministry of Health describe 90 fatalities (see map) associated with community acquired pneumonia. The full report included the age distribution, which exactly match distribution reported previously by other countries for swine H1N1. 52/90 fatalities were in the age group of 19-40, followed by 26/90 in the 41-55 age group.

Coughing up blood followed the "total destruction" of lungs again gives a clinical picture of hemorrhagic pneumonia caused by H1N1 swine flu.

However, although the 90 recent fatalities described above are clearly due to H1N1, many reports continue to cite a low number of H1N1 lab confirmed cases, which is more reflective of limited testing than actual cases.

Earlier reports cited pneumonia deaths not associated with the influenza/ARI category and the basis for the classification of approximately half of such deaths into a separate category remains unclear.

The above description of these fatalities increase the need for the immediate release of sequences from H1N1 isolated from the lungs of these fatal cases.

Samples were sent to Mill Hill a week ago and only a minimal description (no "large" changes and no anti-viral resistance) of the sequence data. As the number of reports of sequences with receptor binding domain changes in isolates from lungs of fatal H1N1 cases increase, the need for full and rapid disclosure of sequences from large outbreaks such as the one in Ukraine become a major health care imperative.
 
Top