HEALTH 11/19-11/26/09 Weekly Bird&Other Flus Thread:Ukraine Dead Increase to 344 - Sequences

Link to last weeks thread:

11/1-11/18/09 Weekly Bird&Other Flus Thread:189 Deaths Ukraine - Belarus 223K Cases

http://www.timebomb2000.com/vb/showthread.php?t=348122

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

Ukraine Dead Increase to 344 - Sequences Released
​

http://www.recombinomics.com/News/11180904/Ukraine_344.html

1,502,345 Influenza/ARI

85,904 Hospitalized

344 Dead

The above tally is from the latest update from the Ukraine Ministry of Health. The 344 dead represents an increase of 16 from yesterday's total, which is similar to recent daily increases (see map). The steady climb in fatal cases highlights the importance of the release of sequences by Mill Hill a WHO regional center in London.

Included in the sequences from 10 isolates were four HA sequences with the receptor binding domain change, D225G, which was found in the one throat and three lung samples. The change was not found in isolates from nasopharyngeal washes, suggesting D225G may lead to high concentrations of H1N1 in patient's lungs. The high concentration of virus leads to a cytokine storm that destroys the lungs in a few days.

The finding of D225G in lung tissues raises concerns rergarding sequencing of isolates from nasopharyngeal swabs. The monitoring of this important genetic change in the receptor binding domain may require sampling of lung tissues or fluids.

The relationship between the negative nasopharyngeal washes and the lung samples would be useful.

Kudos to Mill Hill and WHO for the prompt release of the panel of H1N1 sequences from Ukraine patients.

RBD Change D225G in Ukraine Lungs Raises Concerns​

http://www.recombinomics.com/News/11180903/Ukraine_D225G_Lung.html

Mill Hill, a WHO regional center in London has placed sequences from 10 isolates from Ukraine (see map) on deposit at GISAID (see list below). They are to be commended for the prompt deposit of these important sequences. The availability of the sequences should put an end to wild speculation on the origins of the Ukraine outbreak.

All H and N sequences are typical for H1N1, as indicated in early WHO announcements. There are no large changes. Additional gene segments have been deposited from a subset of these isolates (but not analyzed below). There are silent changes that are in all or most Ukraine sequences, but the only HA polymorphism was the receptor binding domain change, D225G. This polymorphism was in the three lung, as well as the one throat sample. It was not in the nasopharyngeal washes or the isolate grown in MDCK cells suggesting the D225G may have a tissue tropism component and may allow for high levels of virus in the lung.

D225G was also found in necropsy lung tissue from fatal cases in Sao Paulo, further supporting tissue tropism associated with this polymorphism. The polymorphism has recently appeared on a series of different genetic backgrounds, supporting acquisition by recombination. The genetic backgrounds were geographically diverse. It was appended onto a genetic background specific for China as well as another distinct background found in Singapore and Japan. It has also recently appeared on backgrounds from Spain and Brazil. In addition, it was in isolates from last spring collected in the United States and Mexico.

The appearance of D225G on multiple recent genetic backgrounds raises concerns that the polymorphism is offering a selective advantage in association with multiple genetic backgrounds, and the selective detection of the polymorphism in lung and throat samples may indicate it is more widespread because of its absence from nasopharyngeal washes. Lung and throat sampling may be required for detection and determination of the true geograpohical reach of this change..

More information on outcomes for these patients, as well as results for lung and nasopharyngeal samples from the same patient, would be useful.

The prompt release of these sequences should help guide further analysis of the evolving swine H1N1.

A/Khmelnitsky/1/2009 EPI_ISL_62017
A/Ternopil/19/2009 EPI_ISL_62016
A/Ternopil/11/2009 EPI_ISL_62015
A/Ternopil/6/2009 EPI_ISL_62014
A/Ternopil/5/2009 EPI_ISL_62013
A/Lviv/N6/2009* EPI_ISL_62012
A/Ternopil/N11/2009* EPI_ISL_62011
A/Ternopil/N10/2009* EPI_ISL_62010
A/Lviv/N2/2009* EPI_ISL_62009
A/Kyiv/N1/2009 EPI_ISL_62008

* D225G

All Fatal Ukraine Cases at GISAID Have RBD D225G
​

http://www.recombinomics.com/News/11190901/Ukraine_Fatal_D225G.html

The patient data associated with the 10 Ukraine isolates sequenced by Mill Hill and deposited at GISAID has been updated with demographic information, suggesting that the samples were from 10 individuals and four of the samples were from deceased patients. These are the same four samples that have D225G (see list below). This association suggests that swine H1N1 with D225G is more aggressive and is cause for concern.

As noted earlier, D225G has been appended onto multiple genetic backgrounds via recombination, and the data from Ukraine adds further support. Samples from Ternopil and Khmelnitsky (see updated map) have a regional marker that is found in swine but no other human isolates. This marker is on all 6 Termopil isolates, indicating it was an early acquisition, but only the two fatal cases have D225G indicating it was appended onto the Ternopil genetic background. However, it is also found in the two fatal cases from Lviv, which do not have the regional marker. Similarly, earlier isolates with D225G represent distinct genetic backgrounds with D225G.

It was the jumping of D225G that allowed for prediction of the marker in Ukraine prior to release of the sequences by Mill Hill. This type of jumping has been described in detail for H5N1 and seasonal H1N1. This type of jumping via recombination and identification of markers that make frequent jumps are the underlying concepts that allow for the D225G prediction.

However, it is likely that D225G jumps will continue and the lethal marker will spread via Ukraine-like viruses, as well as virus that acquire D225G by recombination. Moreover, the absence of D225G in the nasal washes may signal mixtures of H1N1, with wild type dominating in the upper respiratory tract, and versions with D225G being expressed at highest levels in the lung, leading to false negatives in nasopharyngeal swabs, and cytokine storms in lung tissues where the aggressive virus with D225G is at high concentrations.

A/Khmelnitsky/1/2009
A/Ternopil/19/2009
A/Ternopil/11/2009
A/Ternopil/6/2009
A/Ternopil/5/2009
A/Lviv/N6/2009*#
A/Ternopil/N11/2009*#
A/Ternopil/N10/2009*#
A/Lviv/N2/2009*#
A/Kyiv/N1/2009

* D225G

# Deceased

Swine flu in Ukraine: the truth about epidemic​

http://globalist.org.ua/eng/144171-swine-flu-in-ukraine-the-truth-about-epidemic

Passing over swine flu does not mean the person is healthy. People can reveal serious lung injury later after passing over disease. According to the report of the chief pulmonologist of the Lvov region people passed over pneumonia have a risk to obtain chronic lung diseases such as bronchial asthma or fibrous changes. And it is hard to forecast their effects.

Doctors are going to monitor regularly their patients passed over swine flu in order to avoid complications. All diseased people have weakened immune. Thus there is a risk to get any disease. Children passed over flu have got back in it with strong fever of 40°C. Some patients have been reanimated with meningitis or myocarditis.

New research helps explain why bird flu has not caused a pandemic​

http://www.eurekalert.org/pub_releases/2009-11/icl-nrh111809.php

Bird flu viruses would have to make at least two simultaneous genetic mutations before they could be transmitted readily from human to human, according to research published today in PLoS ONE.

The authors of the new study, from Imperial College London, the University of Reading and the University of North Carolina, USA, argue that it is very unlikely that two genetic mutations would occur at the same time. Today's new study adds to our understanding of why avian influenza has not yet caused a pandemic. Earlier this year, the Imperial researchers also showed that avian influenza viruses do not thrive in humans because, at 32 degrees Celsius, the temperature inside a person's nose is too low.

H5 strains of influenza are widespread in bird populations around the world. The viruses occasionally infect humans and the H5N1 strain has infected more than 400 people since 2003.

H5N1 has a high mortality rate in humans, at around 60 per cent, but to date there has been no sustained human to human transmission of the virus, which would need to happen in order for a pandemic to occur.

Today's study suggests that one reason why H5N1 has not yet caused a pandemic is that two genetic mutations would need to happen to the virus at the same time in order to enable it to infect the right cells and become transmissible. At present, H5 viruses can only infect one of the two main types of cell in the mouth and nose, a type of cell known as a ciliated cell. In order for H5 to transmit from human to human, it would need to be able to infect the other, non-ciliated type of cell as well.

To infect a cell, the influenza virus uses a protein called HA to attach itself to a receptor molecule on the cell's surface. However, it can only do this if the HA protein fits that particular receptor. Today's research shows that H5 would only be able to make this kind of adaptation and fit the receptor on the cells that are important for virus transmission if it went through two simultaneous genetic mutations.

Professor Wendy Barclay, corresponding author of the study from the Division of Investigative Science at Imperial College London, said: "H5N1 is a particularly nasty virus, so when humans started to get infected with bird flu, people started to panic. An H5N1 pandemic would be devastating for global health. Thankfully, we haven't yet had a major outbreak, and this has led some people to ask, what happened to bird flu? We wanted to know why the virus hasn't been able to jump from human to human easily.

"Our new research suggests that it is less likely than we thought that H5N1 will cause a pandemic, because it's far harder for it to infect the right cells. The odds of it undergoing the kind of double mutation that would be needed are extremely low. However, viruses mutate all the time, so we shouldn't be complacent. Our new findings do not mean that this kind of pandemic could never happen. It's important that scientists keep working on vaccines so that people can be protected if such an event occurs," added Professor Barclay.

Professor Ian Jones, leader of the collaborating group at the University of Reading, added: "It would have been impossible to do this research using mutation of the real H5N1 virus as we could have been creating the very strain we fear. However, our novel recombinant approach has allowed us to safely address the question of H5 adaptation and provide the answer that it is very unlikely."

In addition to explaining why bird flu's ability to transmit between humans is limited, the new research also gives scientists a better understanding of the virus. They believe that this could help the development of a better vaccine against bird flu, in the unlikely event that one was needed in the future.

The researchers used a realistic model of the inside of a human airway to study H5 binding to human cells. They made genetic changes to the H5 HA protein to change its shape, to see if they could make the virus recognise and infect the right types of cells. Results showed that the virus would need two genetic changes occurring at once in its genome before it could infect these cells.

The researchers then investigated intermediate forms of the virus, with one or the other mutation, to see if the change could occur gradually. They found that intermediate versions of the virus could not infect human cells, so would die out before they could be transmitted. The researchers say this means the two genetic mutations would need to occur simultaneously.

H1N1 infection found in second feline ​

http://www.examiner.com/x-801-Pet-Care-Examiner~y2009m11d19-H1N1-infection-found-in-second-feline

After the recent news of 2009 H1N1 infection in an Iowa cat and ferrets in Nebraska and Oregon (see H1N1 found in a feline and ferrets), another feline has tested positive for H1N1 infection. A thirteen year old DSH (Domestic Short Haired) Utah cat is the most recent report of 2009 H1N1 infection in species other than birds, humans, and pigs. As with the Iowa cat, a family member living with the Utah cat showed flu-like clinical signs and was likely the source of infection for the cat. 2009 H1N1 infection has not been confirmed in any family member sharing the cat’s household. Additionally, the cat with whom the H1N1 infected Utah cat has not shown any clinical signs of illness.

The Utah cat’s geriatric immune system may factor into the likelihood of zoonotic transfer of H1N1 from human to feline. Zoonotic organisms, like 2009 H1N1 are capable of infecting members of different species. Senior cats are often less able fight off infection as readily as their more juvenile counterparts. Illness often seen in adult and elderly cats, such as periodontal disease, can contribute to immune system deficiency and leave the body more susceptible to infectious disease. Additionally, the immune system’s competence in combating invading organisms can be compromised by preexisting infection (Feline Herpesvirus Type 1, Feline Leukemia, FIV, etc), cancer or other ailments.

As with the Iowa cat, the Utah cat presented a veterinarian displaying respiratory tract clinical signs and an overall appearance of illness. Fortunately, both cats have recovered from their illness.

At this time, there have been no reported 2009 H1N1 infections in dogs, yet multiple viral (and bacterial) agents can cause flu like symptoms in your pooch. Viruses include Canine Distemper, Influenza, and Parainfluenza. In 2004, Canine Influenza was first isolated from racing greyhounds in Florida and has subsequently been reported in virtually every state. The Canine Influenza virus is genetically related to Equine Influenza, therefore it is speculated that the virus jumped species from horses to dogs. Recently, the USDA approved a Canine Influenza vaccination, which reduces the severity of clinical signs and shortens the virus’ shedding interval.

The Centers for Disease Control and Prevention (CDC) reports the genetic makeup of the 2009 H1N1 virus includes portions of the North American avian (bird) and swine influenza viruses, and human and swine influenza viruses originating in both Asia and Europe.

What can you do as a pet owner to deter infectious disease transmission among people and pets? Perceive human illness from the perspective that your pet may be at risk for infection with your illness. Practice good sanitary habits by frequently washing your hands and covering your mouth and nose when coughing or sneezing. Additionally, avoid close contact with pets (and people) when you are sick.

If your pet manifests symptoms of illness that concern you, please schedule an examination with your veterinarian, however, every cough or sneeze your cat or dog exhibits should not cause you to break out your biohazard suit.

Man-made swine-bird flu supervirus: What's French for "apocalypse"? ​

http://shanghaiist.com/2009/11/19/man-made_swine_flu_supervirus_whats.php

Since up until now, we've only seen the third case of serious swine flu emerged in Shanghai, you may well be wondering, “how bad could all this hullabaloo get anyway?"

Pretty bad. Do you remember Avian Flu? The one that had a high mortality rate but was difficult to contract? What would you say about the creation of a supervirus that was as contagious as the swine flu and as deadly as the avian flu?

It may not be as far-fetched a scenario as you'd think, as French scientists at the Jean Mérieux/INSERM facility in Lyon are splicing genetic material from both viruses to see if the two could possibly recombine, and whether the resulting virus would be deadlier than either.

There's a reason for the madness: this scenario tries to anticipate pandemics, attempting to see what potential paths they might take. And at least according to the facility, chances of the virus leaving the lab and entering the world ala Outbreak are very, very low - they're categorized as Level-4 Biohazards, the same level as that freaky-scary Ebola virus - so they're being handled as such.

We've got Dustin Hoffman on speed dial, though, just in case.

Media Myths Cloud Joint Hearings on Pandemic Vaccine
​

http://www.recombinomics.com/News/11190902/Hearings_MM.html

Look at Ukraine, for example, where public awareness went from "zero" this summer to "panic" this autumn. Late last month, politicians began to speak of mass illness and mass death. The government quarantined several provinces, shut down parliament and banned mass gatherings. When the dust began to settle last week, it appeared that, yes, there had been a small outbreak of swine flu, but also that, no, most of the people who got sick didn't have the H1N1 virus. Swine flu death rates in Ukraine are no higher than those for flu or pneumonia in other years.

The above Ukraine comments are from a Washington Post story cited by Senator Joe Lieberman on the first day of joint hearings on the pandemic vaccine shortfall. He was "surprised" that there were an estimated 22 million cases in the United States and the emphasis was on shortfalls linked to over promises on delivery dates and amounts of vaccine.

However, the hearings failed to capture the events in Ukraine, which was deemed a "non-event" in the above piece by op-ed writer Anne Applebaum, even though the importance of Ukraine was hard to miss. Even the most casual observer could look at the WHO H1N1 updates and see that some in Ukraine was attracting significant attention. WHO began issuing updates last April, when H1N1 was discovered in patients in Mexico and the United States. Thus the first two updates named the two countries in the title. However, subsequent updates were just number, with no county named. Initially these updates came out daily and then settle down to one update a week. The 72nd update was on Oct 30, but two days later a new update was issued on Ukraine. Another Ukraine update was issued on Nov 3 Two days later a second Ukraine update was released and on Nov 17, the date of the above article a third Ukraine update was issued.

In addition to media reports quoting WHO spokesperson, Ukraine also came up in WHO weekly teleconferences on Nov 5 and 12. These notices were carefully worded to exclude large changes in the virus, but left open small changes, including receptor binding domain changes. Such changes were of interest because hundreds of patients had died at a rate and level markedly higher than any other European country, and the descriptions of the fatal cases were detailed, noting severe hemorrhage, as well as the total destruction of both lungs. Patients had been arriving at emergency departments coughing up blood and dying within a few days. Moreover, most of the patients were previously healthy young adults.

The gruesome descriptions and the large number of fatal cases led to wild speculation by conspiracy theorists on one hand and media and political reports such as the one above, claiming that the Ukraine outbreak was small and not unusual.

However, the careful wording of WHO updates clearly left open the possibility of small changes including the receptor binding domain and the D225G change had been predicted, based on the high number of fatalities involving lung hemorrhaging and disintegrating.

Yesterday, the sequences from 10 isolates were released at GISAID by Mill Hill and the predicted change, D225G was confirmed. This change had been "in play" and was appearing on multiple H1N1 genetic backgrounds signaling recombination and selective advantage. The recent update of demographics for the 10 patients demonstrated that the four isolates with D225G were the four patients who had died, further raising concerns that D225G on a Ukrainian H1N1 background, or other H1N1 backgrounds could lead to more severe cases and deaths. Moreover the same change had been observed during the 1918-1919 pandemic, which also involved swine H1N1 jumping and adapting to humans.

Thus, the genetic change(s) in H1N1 in Ukraine is of considerable concern, media reports and Senator comments, notwithstanding.

D225G Lung Tropism Driving H1N1 False Negatives?​

http://www.recombinomics.com/News/11190903/D225G_False_Neg.html

The recently released H1N1 Ukraine sequences by Mill Hill provide additional insight into the evolution of H1N1. Ten isolates were sequenced, including HA from all 10. Four had the predicted receptor binding domain change D225G, which has been found on multiple H1N1 genetic backgrounds. All four of the sequences with D225G were from the four fatal cases. Although it is possible that there are two distinct H1N1 viruses in circulation, it is more likely that the virus is present as a mixture and those with higher concentration of D225G produce high concentrations of virus in lungs, leading to cytokine storms and deaths. Isolates with mixed signals coding for position 225 in H1N1 have been deposited at Genbank, supporting the mixture hypothesis.

These mixtures could be generating false negatives in cases where the level of D225G is high. Virus with D225G would quickly move to the lower respiratory tract and the low levels of wild type in the upper respiratory tract would be clear by the host's immune response. These patients would be infected and seriously ill, but the reduction or absence of virus in the upper respiratory tract would test negative. The CDC has warned that rapid tests have a sensitivity of 10-70% . Thus, in some circumstances only 10% of H1N1 infected sample test positive. This low sensitivity seems to be somewhat linked to H1N1 samples.

The negative data would lead to more testing for other respiratory viruses, which may explain the data reported for rhinoviruses in the Philadelphia area. No unusual strain has emerged, suggesting that the viruses may simply represent opportunistic infections associated with the H1N1 infection that is testing negative.

The detection of such opportunistic infections is similar to results generated when SARS first emerged. Since there was no direct test for the SARS CoV initially, many additional tests were run, and different labs would find different candidate respiratory viruses. However, after the SARS CoV was discovered and developed into a diagnostic test it was clear that SARS was cause by SARS CoV and the other viruses were just opportunistic passengers.

The rapid movement of influenza virus to the lungs has parallels with the H5N1 outbreak in Turkey in late 2005/early 2006. In that outbreak another receptor binding domain change, S227N was predicted and it was found in the first confirmed H5N1 cases. However, the index case had initially tested negative, as did his sibling, on nose and throat swab. H5N1 was confirmed from lung samples in each case. However, that infection also appeared to involve mixtures. Although the index case was positive for S227N, his sister was negative. Eventually 4 sequences were released and one of the two subsequent isolates also had S227N, further suggesting that mixtures were in circulation and collection/isolation issues determined if S227N was detected.

A tissue specific D225G in swine H1N1 could be generating higher frequencies of false negatives if the ratio of D225G to wild type was high.

More testing of post-mortem samples would be useful to better understand the true level of D225G in circulation.

Situation with influenza stabilized. 344 people died (updated at 06:47 pm)​

http://mignews.com.ua/en/articles/379628.html

Deputy Secretary of the National Security and Defense Council of Ukraine Stepan Havrysh confirms statements made by Prime Minister Yulia Tymoshenko that an epidemic of influenza and acute respiratory viral infections is diminishing in Ukraine.

"The situation with influenza is diminishing. The curve of influenza, which was the highest on November 4, now has reached its lowest point. Although the number of cases has been increased during Tuesday, we believe that it is situational position" - he said in the air of 5th channel.

According to Stepan Gavrish, last year on average 18 people died of influenza and pneumonia every day.

According to the Ministry of Health, over previous day 18 people died of influenza and acute respiratory viral infections in Ukraine, reports Ukrainskaya pravda. In addition, referring to the results of the examinations which were held in London and tin he United States, Stepan Havrysh said that pandemic influenza has not mutated in Ukraine. However, he noted that the second wave of the epidemic may occur either “in December or January”. Now, according to the first Deputy Secretary of the National Security and Defense Council, "the epidemiological threshold is exceeded in 20 regions".

The Ministry of Health has confirmed 344 deaths of influenza and acute respiratory viral infections as of November 18 in 23 Regions, Kyiv, Sevastopil and Crimea.

Beginning from October 29, 89 deaths recorded in the Lviv Region, 39 – in the Ivano-Frankivsk Region, 25 - in the Chernivtsi Region, 22 - in the Ternopil Region, 20 - in the Khmelnytsky Region, 18 - in the Donetsk Region, 16 - in the Kyiv Region, 15 - in the Chernihiv Region, in 14 - in the Volyn Region and in Kyiv, 10 - in the Rivne Region.

9 people died in the Transcarpathian Region, 7 - in the Poltava Region, and 6 - in the Vinnytsa Region, Kharkiv Region and Sumy Region, 4 people - in the Dnipropetrivsk, Zhytomyr and Kherson Regions, 3 people - in the Zaporizhzhya and Kirovograd regions. 2 people died of influenza and acute respiratory viral infections in Crimea, including 1 in Sevastopil, and 1 died- in the Mykolayiv and Odessa Regions, reports Ukrainian News.

In general, beginning from October 29, 1 mn 502,345 people have become sick with influenza and acute respiratory viral infections, over the past day – 44,781 people became ill. Since the beginning of the epidemic 85,904 people were hospitalized and 54,407 are discharged.

06:39 p.m. Beginning from Monday, November 23 quarantine will be abolished in the Ivano-Frankivsk and Lviv Regions.

Education in the educational institutions of Ternopil will resume on Monday, November 23.

Ukraine is in the pandemic of swine influenza, but there is an epidemic of seasonal influenza and acute respiratory diseases in the country , said Deputy Minister of Health Vasyl Lazoryshynets.

"We have a pandemic of A/N1N1 influenza today, because we live in a territory where it exists. And we have an epidemic of acute respiratory infections, seasonal and pandemic influenza," - he said at a press conference in Kyiv on Thursday.

According to Vasyl Lazorishynets, 1,168 samples have been examined in Ukraine, and A influenza is confirmed in 265 cases. 225 cases out of them are diseases of pandemic influenza A/N1N1. All of the dead, according to the deputy head of the Ministry of Health, were sampled.

Total, according to Vasyl Lazorishynets, since the beginning of the epidemic 1 mn 502,345 people became sick with influenza and acute respiratory diseases, including 44,000 yesterday. Also 2,878 people were hospitalized during the previous day, 233 people are in the reanimation, 42 people have artificial pulmonary ventilation. 13 people died during the previous day.

Chief sanitary doctor Oleksandr Bilovol noted that to date the epidemic threshold is not exceeded n 12 regions out of 27 (24 regions, Crimea, Kyiv and Sevastopil). Thus, he noted, the situation has been stabilized in Ukraine, Interfax-Ukraine reports.

06:47 p.m. The Kyiv city sanitary epidemiological station recommends the Kyiv City State Administration to abolish quarantine in kindergartens, schools and higher educational institutions beginning from 25 November, reported the press service of the Kyiv City State Administration.

The sanitary epidemiological station argues its proposal by reduction in rate of illness of influenza and acute respiratory viral infections. The sanitary epidemiological station predicts that on November 23 the epidemiological threshold will be exceeded only by 4 percents in the capital (94-96 patients per 10,000 population).

However, the Kyiv City State Administration stresses that the final decision to cancel the quarantine will be made by anti-epidemic commission under the Cabinet of Ministers, Ukrainian News reported.

Avian influenza - situation in Egypt - update 24​

http://www.who.int/csr/don/2009_11_20/en/index.html

20 November 2009 -- The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza A(H5N1).

The case is a 21 year-old male from Sedy Beshir District, Alexandria Governorate. His symptoms started on 11 November. He was admitted to Maamoura Chest Hospital on 15 November, where he received oseltamivir treatment. The patient is in a stable condition.

Investigations into the source of infection indicated that the case had close contact with dead and/or sick poultry and was involved in slaughtering sick birds.

The cases were confirmed by the Egyptian Central Public Health Laboratories.

Of the 88 cases confirmed to date in Egypt, 27 have been fatal.

Bird flu human-to-human spread unlikely​

http://www.upi.com/Health_News/2009...-to-human-spread-unlikely/UPI-12751258699930/

LONDON, Nov. 20 (UPI) -- Bird flu would need two simultaneous mutations to spread from human to human, British and U.S. researchers say.

The study, published in PLoS One, finds the unlikelihood of two mutations occurring at the same time makes sustained human-to-human transmission less probable.

"Our new research suggests that it is less likely than we thought that H5N1 will cause a pandemic, because it's far harder for it to infect the right cells," corresponding author Wendy Barclay of the Imperial College London says in a statement. "However, viruses mutate all the time, so we shouldn't be complacent. Our new findings do not mean that this kind of pandemic could never happen. It's important that scientists keep working on vaccines so that people can be protected if such an event occurs."

The researchers say H5 strains of influenza are widespread in bird populations around the world and occasionally infect humans. The H5N1 strain has infected more than 400 people since 2003. The mortality rate in humans is at around 60 percent, the study says.

Ukraine Dead Increase to 354 - Fatal H1N1 Cases Have D225G
​

http://www.recombinomics.com/News/11200901/Ukraine_354.html

1,540,514 Influenza/ARI

88,744 Hospitalized

354 Dead

The above numbers represent the latest figures from the Ukraine Ministry of Health. The increase in deaths is 10, which is lower than recent increases and more Oblasts have fallen below the epidemic threshold, but Live still leads in daily increases in cases (from 114,211 to 118,256) suggesting the outbreak has moved east (see map). Similarly, Kiev recorded the largest increase in fatalities (14 to 18).

Recently, Mill Hill in London released sequences from 10 patients in Ukraine and most were in the areas hit hard at the beginning of the outbreak, Ternopil and Lviv. Four of the ten were sequences from deceased patients and all four had D225G, which was not present in the six HA sequences from patients who survived.

This correlation between the receptor binding domain change, D225G and fatal cases is cause for concern, and recent reports describe large increases in cases and fatalities in Poland, raising concerns that this change has significantly spread to the west of western Ukraine also.

WHO Confirms D225G in Lung Cases in Norway and Ukraine
​

http://www.recombinomics.com/News/11200906/D225G_Norway_Ukraine_WHO.html

Norway reported finding a mutated virus in three people who died or were severely ill. The mutation, known as D222G on the receptor binding domain, allow the virus to grow deeper in the lungs.

The mutation does not appear to be circulating and may have spontaneously arisen in the three patients, said Geir Stene-Larsen, director of the Norwegian Institute of Public Health. Only 3 of Norway's 70 tested samples had it.

Asked about that, Dr. Schuchat said the same mutation had also been found in mild cases in several countries, and it did not make the virus resistant to vaccine or to treatment with drugs like Tamiflu. She said she did not want to "underplay" it, adding that "it's too soon to say what this will mean long term."

The D222G mutation allows the virus to bind to receptors on cells lining the lungs, which are slightly different from those in the nose and throat. Henry L. Niman, a flu tracker in Pittsburgh, has been warning for a week that D225G - the same mutation under a different numbering system - has been repeatedly found in Ukraine, which is in the grips of a severe outbreak and where surprising numbers of people have died with lung hemorrhages - the kind of pneumonia that can be caused by an immune system's "cytokine storm" attacking a new virus.

The above comments from the Donald McNeil update in tomorrow's New York Times are the first direct acknowledgement that the receptor binding domain change in Norway and Ukraine are the same. Earlier the WHO had put out an update on the change in Norway and noted that a similar change had been seen elsewhere, and included Ukraine in the list of countries.

In earlier Ukraine updates WHO did not acknowledge any receptor binding domain changes, but the sequences released at GISAID by Mill Hill had D225G in four of the ten HA sequences, which precisely matched the four fatalities, raising concern that the previously described "destruction of both lungs" was driven by the acquisition of D225G. The group in Norway also found the change in dead or dying patients, further supporting a significant role of this change the the cytokine storm associated with this acquisition.

This change has been reported in a number of recently described cases including two fatal cases in Sao Paulo, a seriously ill case in China, and cases in Sydney, Australia and Vladivostok. The polymorphism had also been seen in earlier isolates in the United States, Mexico, Spain, and Japan.

The role of this change in fatal cases may be dependent on the viral load. The cytokine storm is precipitated by high levels of virus, and lower levels may produce milder disease.

The above report, noting the identity between Norway and Ukraine should lead to more detailed analysis of tissue samples from fatal cases, which may contain an increased frequency of D225G, a receptor binding domain change identified in 1918 and 1919 samples.

Evidence on H1N1 D225G in Lung Cases in Norway and Ukraine
​

http://www.recombinomics.com/News/11210901/D225G_Evidence.html

The WHO said the mutation does not appear to spread and the public health significance of the finding is unclear.

"Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases," the agency said.

The above WHO comments on the receptor binding domain change D225G (cited as position 222 in some reports using H1 numbering) is curious. Although WHO claimed that there were no significant changes in the sequences from Ukraine, none of the Ukraine situation updates excluded a receptor binding domain change, and when 10 HA sequences were published at GISAID by WHO regional lab Mill Hill, there was clear evidence of an association of D225G with fatal cases. Of the 10 sequences released, four were listed as deceased, and all four had D225G. None of the six samples which came from patients that were labeled with age and gender but had no deceased designation had D225G. Moreover, three of the four samples from deceased patients were lung samples and all three lung samples had D225G. The samples which had closely related sequences but lacking D225G were predominantly nasal washes, which also presented concerns that the swine H1N1 was differentially detected, due in part to changes in receptor binding specificity.

This concern was based on published data on sequences from samples from 1918 patients. In 1918 the same change occurred. Most samples had a D at position 225, while two samples had D225G (from 1918 and 1919). The tested sample with D225G had a different binding specificity, which would be expected to show differential binding to various tissue types.

Moreover, the D225G identified from Ukraine was in both of the hard hit areas, Ternopil and Lviv. Two samples from each area were positive, indicating the change had spread. Ukraine has already acknowledged over 350 dead patients and initial reports described hemorrhagic lungs that were totally destroyed. This destruction was in multiple media reports as well as an agency report describing 90 fatal cases.

Moreover, the evidence was not limited to Ukraine. Earlier samples from lung tissues from deceased patients in Sao Paulo also had D225G, as did patients in multiple countries. Most cases were not described in detail, but the case from China was from the first severe case in Zheijiang Province and although the patient survived, she was hospitalized for several weeks.

In addition, the presence of the same change on multiple backgrounds indicated the polymorphism was being acquired via recombination. The sudden appearance of the same polymorphisms on multiple backgrounds has been described previously, including a silent change in H5N1 and H274Y in seasonal flu. These changes allowed for the prediction of D225G in the Ukraine patients prior to release of the sequences.

The above comments were made after D225G was found in samples from deceased or severe cases in Norway, which provided further evidence of spread and association with lung samples.

Thus, there was and is ample evidence of D225G in severe and fatal cases. Like 1918, it is not in all samples from fatal cases, and as with all infectious disease, not all infections are fatal. If the initial dose is low, or the hosts mounts and effective early defense, the clinical course may be mild, as has been seen with virtually all influenza infections, including H5N1 infections such as those in Egypt.

Thus, the presence of the 1918 receptor binding domain change in an H1N1 swine virus that has jumped to humans is cause for concern, and a more comprehensive survey of lung samples is useful, as well as release of new receptor binding data.

1918 RBD D225G in Lung Cases in Ukraine and Norway
​

http://www.recombinomics.com/News/11210902/D225G_1918.html

For the two 1918 HA variants, the South Carolina (SC) HA (with Asp190, Asp225) bound exclusively alpha2-6 receptors, while the New York (NY) variant, which differed only by one residue (Gly225), had mixed alpha2-6/alpha2-3 specificity, especially for sulfated oligosaccharides.

The above description is from a paper analyzing receptor binding domain differences in sequences from the 1918 pandemic. The New York variant had D225G, the same change found in lung tissues from fatal swine H1N1 sequences in Brazil, Ukraine, and Norway. The above result clearly demonstrated a change in receptor specificity for D225G, which was present in A/New York/1/1918 and A/London/1/1919, demonstrating the same change I 1918 that has been described in 2009. Although WHO stated that this change was "not significant" in the Ukraine samples, it was associated with the fatal cases and is cause for concern. The concern was increased by the announcement from Norway indicating the same change was found in fatal H1N1 lung infections there also.

Although there have been comments that this change was "spontaneous" and did not spread, the finding of the same change in all four deceased patients in Ukraine from two distinct locations, indicates it did spread, as did the finding of the same change in multiple cases in Brazil and Norway. Although the concept of "random mutation" has been used to explain away the sudden appearance of the same polymorphism on multiple backgrounds, the appearance via recombination is a much stronger argument for the same change to appear at multiple locations at the same time.

The spontaneous mutation theory, which is the foundation of WHO policy and statements on significance of changes relies heavily on a "selection" component, arguing that the same change keeps appearing on different backgrounds because of string selection pressure. However, this same phenomenon was described for a silent mutation on H5N1, which offers no clear selection pressure. Similarly, a silent change was also found in seasonal H1N1 in sequences that had acquired the Tamiflu resistance marker, H274Y. Thus, these silent (synonymous) changes string argue against a coincidental spontaneous mutation, and instead argue that this acquisition is concurrently acquired because of a widespread common donor.

The concept of acquisition via recombination has serious implications for the current pandemic. It was used to predict the D225G change, in part because the change was "in play" and appearing in July/August sequences at increasing frequency, even though the H1N1 sequences represented different genetic backgrounds. Similarly the clusters of Tamiflu resistance in Wales and North Carolina are also driven by recombination, as happened when the identical change was acquired in H1N1 seasonal flu in patients who were not taking Tamiflu (oseltamivir).

Thus, the concept of recombination predicts that the D225G receptor binding domain change, and the H274Y Tamiflu resistance change, which continue to spread via recombination

Large Tamiflu Resistant Cluster in Wales UK​

http://www.recombinomics.com/News/11200904/H274Y_Wales.html

The cases have been reported among nine patients in a hospital in Wales. Five cases are "known to be resistent to oseltamivir", the generic name for Tamiflu, the HPA said today in an e-mailed statement.

The above comments describe a large cluster of Tamiflu resistant swine H1N1 in a hospital in Wales. Earlier reports had described resistance in 2 immuno-compromised patients, but the updated report of 5-9 patients leaves little doubt that the virus is transmitting human to human. All prior examples of resistance in swine H1N1 involved H274Y, which is almost certainly the case for this outbreak. Previously there have been multiple reports of clusters of two, including recent outbreak in Edinburgh, and this large outbreak raises concerns that H1N1 with H274Y will become far more common.

Although prior cases were said to be due to "spontaneous mutation, by Roche and agency reports, there was little data to support that conclusion. All resistance involved the same change, H274Y, on multiple H1N1 backgrounds and appearance was too soon to support a spontaneous origin. Instead the rapid appearance supported circulation of H274Y as a minor population which was below detection limit in the absence of Tamiflu selection, but rapidly appeared after treatment. The appearance of 5-9 cases at the same facility indicates the detected H274Y was not due to independent mutations and reinforces concerns that H274Y is widespread and efficiently transmitting..

H1N1 D225G in Russia Raises Pandemic Concerns
​

http://www.recombinomics.com/News/11200903/Russia_D225G.html

A new sequence from Russia, A/Vladivostok/1/2009, was just placed on deposit at Genbank. The HA sequence has D225G which has come into focus because it was in all four fatal cases from Ukraine. This polymorphism has also been in recently released sequences from Australia and China. Although the date of collection for the Russian sequence was not included its recent appearance adds to concern that D225G is becoming more common, as death rates throughout the northern hemisphere increase.

Moreover, today Norway is holding a news conference on a "mutation" found in dead or dying patients, which may also be D225G.

The detection of this change may be more frequent in necropsy lung tissues.

Release of sequences from such samples would be useful. The D225G has been found on multiple genetic backgrounds, indicating it is spreading via recombination.

Mutated Swine Flu Strains Block Drugs, Worsen Illness (Update2) ​

http://www.bloomberg.com/apps/news?pid=20601087&sid=ab0royU2paW4



By Michelle Fay Cortez and Marianne Stigset

Nov. 20 (Bloomberg) -- Swine flu infections in which the virus mutated to a form that’s more severe or less sensitive to drug treatment are being investigated by European and U.S. public health officials.

Five patients at a hospital in Wales contracted swine flu that resisted treatment with Roche Holding AG’s Tamiflu, and three more infections are being analyzed, the U.K. Health Protection Agency said today. Four patients had resistance in a North Carolina hospital. A separate mutation that may trigger more severe illness was found in Norway among two patients who died of the flu and one who was severely ill.

While there is little risk posed by the mutations, investigators are monitoring the new clusters closely, according to health officials from the U.S. Centers for Disease Control and Prevention and the World Health Organization. Influenza activity decreased last week in the U.S. and was widespread in 43 states compared with 46 states the week earlier, the CDC’s Anne Schuchat said today in a briefing. Since swine flu was identified in April, there have been 57 U.S. cases of Tamiflu resistance and “sporadic” reports of mutations similar to those in Norway, she said.

“We take this development seriously, but the HPA currently considers that the risk to the general healthy population is low,” the U.K. officials said in a statement about the Wales cases. “The Tamiflu-resistant virus has emerged in a group of particularly vulnerable individuals. These patients are known to be at increased risk of developing resistance to the drug.”

Spread Since April

Swine flu, also known as H1N1, infected about 22 million people in the U.S. and killed 3,900 people from April to Oct. 17, according to the CDC’s most recent estimate. Norway has had an estimated 700,000 infections, with 21 reported deaths. The disease has killed at least 6,770 people worldwide, according to an estimate today from the Geneva-based WHO. The agency no longer keeps an up-to-date count of global cases.

In the U.S., patient visits to doctors for flu-like symptoms declined the week of Nov. 8 to Nov. 14 from the week earlier as did the rate of influenza hospitalizations, said Schuchat, head of the CDC’s National Center for Immunization and Respiratory Diseases.

“We are beginning to see some declines in influenza activity,” she said. “But it is still much greater than we would ever see at this time of year” compared with typical seasonal flu that runs from November to March.

Difficult to Transmit

The swine flu mutation discovered in Norway is difficult to pass from person to person, said David Mercer, acting head of the communicable diseases unit of the WHO’s European region, and Geir Stene-Larsen, the head of the Oslo-based Institute of Public Health. The mutation was found in 3 of 70 patients tested, the institute said.

The infections in Wales may have passed from a person using Tamiflu to patients who haven’t taken the drug, raising the possibility that a hard-to-treat form of the disease may spread, according to the U.K. health agency. The U.S. cases occurred in October and November, according to the Atlanta-based CDC.

The patients in Wales had blood diseases that weakened their immune systems, either because of the condition itself or the chemotherapy used to treat it, according to the U.K. agency. Resistance to Tamiflu is known to occur in patients with weak immune systems. All the Welsh patients remain sensitive to GlaxoSmithKline Plc’s Relenza, another antiviral treatment, the agency said.

In Norway, the changes seen in the virus may allow it to penetrate deeper into the airways and cause more severe disease.

“It seems that the mutated virus does not circulate in the population but might be a result of spontaneous changes which have occurred in these three patients,” Stene-Larsen said in a statement. “There is no indication that this change in the virus is of any importance for the effect of the vaccine or the effect of antiviral treatment.”

Sensitive to Drugs

The virus in Norway appears to be sensitive to Tamiflu and the vaccine now being offered in some areas to prevent swine flu infection, said Mercer of the WHO.

“I don’t think it yet has the public health implications that we would wonder about,” said Schuchat of the CDC. Similar mutations have been seen elsewhere and haven’t necessarily led to a more virulent disease, she said.

“It’s most likely that the virus’ capability to mutate is not just specific to Norway, it will occur in other countries as well,” Stene-Larsen said in an interview on broadcaster TV2.

Tamiflu-resistant H1N1 cluster found in N. Carolina hospital​

http://www.thetimes-tribune.com/news/health_and_science/1.434828



ATLANTA - Four North Carolina patients at a single hospital tested positive for a type of swine flu that is resistant to Tamiflu, health officials said Friday.

The cases reported at Duke University Medical Center over six weeks make up the biggest cluster seen so far in the U.S. Tamiflu - made by Switzerland's Roche Group - is one of two flu medicines that help against swine flu, and health officials have been closely watching for signs that the virus is mutating, making the drugs ineffective.

More than 50 resistant cases have been reported in the world since April, including 21 in the U.S. Almost all in the U.S. were isolated, said officials with the U.S. Centers for Disease Control and Prevention.

The BBC reported another cluster of five Tamiflu-resistant cases this week in Wales, in the United Kingdom.

The CDC has sent three disease investigators to North Carolina to help in the investigation there, said Dave Daigle, a CDC spokesman. CDC testing confirmed the Tamiflu-resistant cases.

All four cases at the hospital were very ill patients in an isolated cancer unit on the hospital's ninth floor, and it is believed they all caught the flu while at the hospital, said Dr. Daniel Sexton, professor of medicine and director of the Duke Infection Control Outreach Network.

Three of the four patients died and one is recovering, he said. Flu seems to have been a factor in each death, but they were very sick so it was hard to say that it was the primary cause, he added.

North Carolina health officials did not disclose details about the four patients, other than that three of them - including the survivor - were women and their flu illnesses occurred last month and this month.

WHO: Flu mutation found in Norway

GENEVA - The World Health Organization said Friday it is investigating samples of variant swine flu linked to two deaths and one severe case in Norway, but that so far the significance of the mutation is unclear.

Norway's Institute of Public Health said the mutation "could possibly ... cause more severe disease" because it infects tissue deeper in the airway than usual.

The mutation was found in three of 70 analyzed swine flu cases, said Dr. Geir Stene-Larsen, the institute's director.

Dr. Stene-Larsen said he does not believe the mutant virus is circulating in the general population in Norway, where about 680,000 people are estimated to have been infected with swine flu to date and 23 have died.

The same mutation has been found in both fatal and mild cases elsewhere, including in Brazil, China, Japan, Mexico, Ukraine and the United States, said WHO.

In addition, "worldwide, viruses from numerous fatal cases have not shown the mutation," the global body said. "The public health significance of this finding is thus unclear."

H1N1 cases down, but holiday looms

Pandemic H1N1 influenza activity declined slightly last week, with only 43 states reporting widespread activity, compared with 46 states the week before, officials at the Centers for Disease Control and Prevention said Friday.

Even though levels have declined, they are still "higher than peak activity in many years," said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

Officials fear, moreover, that flu activity will pick up as people travel around the country for the holidays. Unfortunately, she said, there are little data from seasonal flu on which to base predictions because such data usually are not prevalent so early in the year. Respiratory disease in general, however, does tend to increase early in the year after the holiday travel season.

"We don't really know what is going to happen," Dr. Schuchat said.

There were an additional 21 laboratory-confirmed pediatric deaths last week, bringing the total for the year to 171 - compared with 40 to 50 in a normal flu season. Fifteen of the deaths were confirmed to be caused by swine flu, and the other six were confirmed to be caused by influenza A and are assumed to be swine flu. Overall, about two-thirds of the children who have died suffered from underlying conditions.

Experts say vaccines are effective against H1N1 virus mutation​

http://www.digitaljournal.com/article/282524

Reacting to the announcement from Norwegian scientists that the H1N1 swine flu virus has successfully mutated, a number of experts reassured the public - saying the vaccine is effective against the new strain.
Friday's announcement of the discovery of a potentially more virulent mutation in H1N1 swine flu samples in Norway was further qualified by a number of experts over the weekend. While the mutation story in Norway was also coupled with reports of Tamiflu-resistant clusters of swine flu, scientists believe the mutated bug remains susceptible to the H1N1 swine flu vaccine.

In reaction to the Norwegian announcement, the World Health Organization said that they have seen this mutation before in numerous countries - including the United States, Ukraine, Brazil, Mexico, China, and Japan.

The disturbing reality on the fact of this mutation is that we do not know if the virus is replicating toward more virulence or simply making sloppy copies of itself. While the surveillance is there, we do not necessarily know what we are seeing.

However, a number of experts have come out to say specifically that the vaccine is effective against the mutated virus and that the new strain is also kept in check by anti-virals.

In a radio interview on Saturday, France's health chief, Didier Houssin reiterated that the vaccine remains effective against the mutation. In anticipation of a mutation event, "a certain number of our vaccines are vaccines with an additive," which allow for a broader range of impact against modifications in the H1N1 virus, Houssin said.

It was unclear what the percentage of H1N1 vaccines contain that additive.

A Ticking Time Bomb​

http://www.heise.de/tp/r4/artikel/31/31549/1.html

The real danger behind the H1N1 virus
On Wednesday the Hungarian government announced that the country was officially in the grip of a flu epidemic. Hungary is well into this year's flu season and, despite all efforts, concern over the H1N1 virus still hasn't affected most people. Several schools have already been closed because of the virus, and although people have been inundated with news related to the disease (another infection here, another death there) only about 10% of the population have been vaccinated against the virus, with another 28% considering it. According to experts, however, about 60% of the population needs to be vaccinated against the virus in order for the population to be adequately protected.

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The seeming lack of concern in Hungary over swine flu isn't to say that people aren't aware of it or the dangers that it poses. Yet, judging by the demand for the vaccine it's quite clear that the vast majority of Hungarians feel that the hype is more prevalent than the risk.

Since going on the market, there has been little interest in the vaccine. There are several reasons for this. First and foremost, there is deep mistrust toward the influence of big business in the government vaccine program. Most are convinced that there is collusion between the government and multinational corporations to force upon them something that they don't want and most probably don't really need.

As in most other areas of the world, Hungarians feel that the H1N1 virus is nothing more than a scare campaign in order to help generate profits for multinational pharmaceutical corporations. Sadly, this view is often reinforced by some sober facts. For example, according to a market research report entitled [extern] Global H1N1 2009 Influenza Vaccine published by Markets and Markets, it is estimated that the global H1N1 influenza vaccine market will be worth over $7,000 billion by 2011, growing at a rate of 222.4 %. Some of the key players in this market are GlaxoSmithKline, Novartis, CSL, MedImmune, Sanofi-Pasteur, Solvay, Sinovac Biotech and Hualun Biologicals.

Already, pharmaceutical companies have felt the effects of the virus on their share price: GlaxoSmithKline has seen its share price rise by about 35% as a result of the swine flu virus, while in China the company Sinovac Biotech Ltd. has seen a resounding 650% increase. Meanwhile, those who aren't already involved in the manufacture or distribution of vaccines have been eager to get on the bandwagon. The company Johnson and Johnson, for instance, although not directly involved in the swine flu cash cow, has nevertheless already bought itself into a company which is.

"The shares are going up and up, but why?"

Aside from the production and distribution of vaccines, an operation that is exclusively controlled by a few giant multinationals (also known as Big Pharma), there are other ways capitalism seeks to exploit this disease in order to make money – even for small time investors. For example, the investment newsletter Free Retirement Planning Tips offering advice on [extern] H1N1 Vaccine Investments noted that "companies that are able to respond quickly and effectively in providing influenza vaccines could be excellent investments."

In some cases, this capitalist fervor has gone to the extreme. In mid September [extern] Sun Worldwide Asset Management initiated a telemarketing campaign in Hungary and other countries within the region offering the deal of a lifetime. Their campaign tried to entice potential investors by offering futures in the purchase of vaccines produced by Sinovac which would be then later sold at an enormous profit. According to Sun Worldwide telemarketers, the demand for Sinovac vaccines was growing by leaps and bounds and profits which were to be made were more or less "guaranteed".

The deal sounded too good to be true and no doubt many were swayed by the logic of the telemarketers. As one outsider remarked on September 19th in the [extern] Investor Village blog, "is there somebody who knows what is going on with Synovac [sic!], the shares are going up and up, but why?"

What the telemarketers at Sun Worldwide failed to mention was that their campaign was nothing more than an elaborate scam to keep the demand for Sinovac vaccines at an elevated level. In mid September the share price for Sinovac peaked as the demand for the company's vaccines began to decrease. This is because on September 15th the company had fulfilled its initial order from the Chinese government for its stockpiling plan. During this peak period the share price for Sinovac Biotech Ltd was over 10 dollars a share; at present it's below eight and has been stuck there for some time. While those who invested in the company during the peak period may not be too happy at the moment, those taken in by the futures scam are even worse off as they don't even own shares in the company; instead, their investment is in millions of vials of vaccine that no-one really wants. Although the company has received further orders for the vaccine from the Chinese government and local authorities, its share price has stubbornly remained off their September highs, thus it's quite unlikely that small time investors will realize the enormous profits that were promised them any time soon.

Fear, Rumours, Conspiracy Speculations …

All this has, naturally, led people around the world to be increasingly skeptical about the motives behind the campaign of governments to stockpile vaccines. For some, it appears that Big Pharma wanted to avoid the problems that occurred during the panic over bird flu. Then, a drug against the virus called Tamiflu was produced in large quantities. When the scare over bird flu quickly subsided, large amounts of Tamiflu were left unused. Ironically, when swine flu made its appearance, these surplus stockpiles of Tamiflu were quickly thrown back on to the market and used up, much to the relief of the authorities and Big Pharma, even though it was obvious that Tamiflu is virtually ineffective against the present swine flu virus.

Aside from the view that the H1N1 virus is being used by government authorities to help generate profits for Big Pharma, some feel that the H1N1 vaccines ordered by governments are actually dangerous. To this extent, there is a feeling that both the government and Big Pharma are involved in a conspiracy of sorts. According to an article by F. William Engdahl entitled [extern] Swine Flu Vaccine Linked to Paralysis, the purpose behind this collusion between governments and Big Pharma is not to safeguard public health, but to push forward "a long-term agenda of political control of populations through deliberate means of making them ill, weak, partly paralyzed or otherwise too weak to focus on the increasingly obvious social crisis facing us all, the global breakdown of the dollar system." Along these lines, some also regard government vaccine programs as nothing more than an elaborate form of corporate welfare. Hence, stockpiling vaccines are a way to help cushion the effects of the overall financial crisis by lifting the sector, much in the same way that scrapping bonuses have been used to help buoy the automobile sector,

Others, meanwhile, note that we have been down this road before. In 1976 fears over a similar swine flu epidemic led to a mass vaccination program in the US through an equally massive propaganda promoting a vaccine which, as it soon turned out, ended up severely hurting thousands of people and even led to some two dozen deaths (http://scamspams.com/world-wide-scam/swine-flu-vaccine-scam/). Many regard this as a typical example of government attempts to "cure the disease but kill the patient".

In Hungary questions pertaining to the safety of the H1N1 vaccine is one of the main reasons for skepticism over the government vaccine program. Thus, along with selling out to big business, many Hungarians feel that the whole process has been rushed and, as a result, the vaccine (produced by the company Omninvest) isn't safe.

Without a doubt, mistakes attributed to the rush to get the vaccine to market had severely shaken people's confidence. For example, the expiry date was missing on initial batches of the vaccine; therefore it can't be clearly determined how old a certain vial of the vaccine really is. Likewise, information leaflets included with the vaccine claimed that the drug had been approved for use on children when in reality it had not yet been officially approved by the government (the vaccine has since received official approval). These and other such mistakes have been put down to simple administrative errors; even so, this has not allayed public fears or concerns over the safety of the vaccine.

In conjunction with this, there have been several rumors circulating that the vaccine is actually based on a decades old strain and therefore is useless against the present virus. The fact that many doctors are also skeptical over the reliability of the vaccine has added to public mistrust. Furthermore, a recent death in where a person died two days after being vaccinated reinforced the feeling among some that the vaccine itself is not safe.

The Health Minister threatened legal action against anyone propagating negative information against the vaccine

Given these and other mistakes and mishaps, it's not surprising that the government vaccination program has not been going very well. In the beginning only a few percent of the overall population had themselves vaccinated, despite a massive propaganda campaign through state media and other outlets. The numbers of those who have been willing to get vaccinated has increased in recent days, however, but the number is still well off target.

Because of the popular resistance against the vaccine, the government has done all it can to promote it – including the use of force through the threat of legal action. Unfortunately, old habits die hard in Hungary, and in such circumstances the government often resorts to methods it was fond of using during the communist era, albeit in a slightly modified form. Thus, the Health Minister threatened legal action against anyone propagating negative information against the vaccine. Indeed, the government even attempted to bring a case against a few doctors. The case was duly thrown out of court and subsequently the government was forced to retreat from its position, in effect acknowledging that people had the right to express their views whether the authorities liked it or not.

Apart from brute force, the government has tried others ways to cajole people into getting the vaccine. This includes the use of tax incentives for enterprises that have their employees vaccinated. Additionally, with the announcement that Hungary is now officially in the grips of an epidemic, the government has set up vaccination points where people can get the vaccine immediately without having to go through the process of first visiting their doctor and then purchasing it at the pharmacy.

Given the government's past record on the use of statistics and creative bookkeeping (especially in the financial field), there is some doubt over the government's claim that Hungary is officially in the grips of an epidemic. Firstly, the government announcement of the epidemic refers to a flu epidemic in general. In other words, the number of people with the H1N1 virus was mixed together with the number of people with a seasonal flu virus. In addition to this, some note that these numbers also include those people who simply visited their doctor because of flu-like symptoms; this doesn't mean that they actually have the flu, whether it is the H1N1 strain or any other kind.

Ironically, while much attention and resources have been focused on the H1N1 virus, the seasonal flu virus has been largely ignored. As a result, although the country is still not through the peak period of the flu season, seasonal flu vaccines have already run out. To make matters worse, there won't be more of this type of vaccine available since all production had been geared toward the production of the H1N1 vaccine.

What this means is that Hungary may find itself in a peculiar position in where more people will be sick and even die of the seasonal flu because it has been neglected to the deference of swine flu. So far seven people in Hungary have died as a result of the H1N1 virus. This number is not much higher than the number usually killed by a seasonal flu virus.

To make matters worse, neighboring countries throughout the region – especially Romania and the Ukraine – have seen a dramatic increase in the number of flu victims. With the number of infections in neighboring countries is spreading rapidly, the pressure of the flu crossing over into Hungary is immense as these countries are generally short of medication, let alone vaccines against the H1N1 virus or the seasonal flu.

Indeed, in some cases people from Slovakia and Romania have been crossing over into Hungary in order to purchase medication. This includes the H1N1 vaccine. Subsequently, the Hungarian government has been criticized for turning a blind eye to this in order to sell the surplus vaccines that Hungarians apparently don't seem to want. This only reinforces the view of those who feel that the government vaccine program is about money, as officially the vaccines have been stockpiled for domestic use only.

The H1N1 virus is actually nothing new

There is no doubt that the authorities in Hungary and various other countries are deeply concerned about the effects of the H1N1 virus. Yet often it's the way in which these governments conduct themselves that raises suspicion. Take, for instance, the scandal in Germany where government officials were given a different vaccine than the one on offer for the rest of the population.

Not only this, although there has been much talk about swine flu or H1N1, not many people, including government ministers and so-called experts, really know what they are talking about. Indeed, if they really knew what they were talking about then there wouldn't be so much of an emphasis on stockpiling vaccines; rather, the focus would be more on stockpiling anti-biotic medications instead.

This is because the H1N1 virus is actually nothing new. We have been down this road before and based on past experience we know what would happen if a global epidemic did occur. Hence, the actions which should be taken need to be based on a review of past mistakes (which were mostly due to our limited knowledge and access to technology at the time) rather than a knee-jerk reaction to a problem.

First and foremost, the present outbreak of H1N1 is part of a group of diseases which, sadly, have been gradually becoming all too familiar. Other such diseases include AIDS (which stemmed from an adaptation of simian immunodeficiency virus to humans), SARS, bird flu and BSE, better known as mad cow disease. Although mad cow disease is not actually caused by a virus, what all these diseases have in common is that they appear to have crossed what is commonly known as the "species barrier" and have shaken our faith in the infallibility of this natural form of protection. Thus, even though swine fever, which kills pigs very rapidly, never infects their human contacts, swine influenza is perfectly capable of crossing the species barrier. Not only this, one of the mechanisms thought to be responsible for the new variants of human influenza is a recombination of bird viruses that infect pigs and are then passed from pigs to humans.

From a molecular standpoint, whether or not someone contracts influenza depends on the haemagglutinin (H) number used to classify the different influenza A viruses. Numerous antigenic subtypes exist that are defined on the basis of two membrane glycoproteins of Type A influenza viruses (haemagglutinin, 'H', and neuraminidase, 'N'). These two groups determine the virulence of the infection: either the mortality rate is close to 100% (mainly from subtypes H5 and H7) or the infection is mild and of a respiratory nature. Since early 2003, there have been a number of epizootics involving humans: H5N1, H7N7 and H7N3.

At present, we are aware of 16 virus variants, only three of which are fully adapted to humans and infect us with our familiar seasonal influenzas. Haemagglutinin is the so-called "key" which the virus uses to enter its host's cells. According to our present knowledge, only the H1, H2 and H3 viruses have caused pandemics in the entire history of humankind.

Even though events formerly thought to be impossible have in fact become possible today, scientists argue that the species barrier against influenza viruses is still extremely robust. These viruses have been circulating for a very long time and, despite the close proximity in which birds, poultry and humans live in some countries of the world, there is no record of an epidemic outbreak of H5N1 in humans occurring in the 20th century, although there were several episodes of avian influenza.

Yet influenza is more organ-dependent than species-dependent, as the virus can cross the species barrier between warm-blooded animals with similar organs. The H5N1 virus, which is optimal at 39°C, has still not adapted to humans, who have a body temperature 2 to 3 degrees lower than that of birds. Even so, scientists have warned that it would take only one element in the H5 structure to change to remove the avian specificity of H5N1 viruses. Humanization of the virus, which could occur by the recombination of H5N1 with other strains, would then open the door to a pandemic. For some, the likelihood of this happening is only a matter of time.

The problem at present is that leading experts and government officials are either intentionally or unintentionally confusing the situation

There appears to be a fear that the world is on the verge of being struck by another pandemic on the scale of the one in 1918 (the "Spanish Flu"), which claimed between 20 and 40 million lives. Then, the 1918 virus was a new strain (which we now know to be H1N1) with which humans may never have previously come into contact. Herein lays the main difference between seasonal and pandemic influenza: in the case of the former, only a fraction of the population is susceptible because of acquired immunity; in the case of the latter, the entire population is susceptible to a strain that is new to the human race.

While the 1918 pandemic appears to be used as the basis for the present concern over H1N1 (in essence history appears to be repeating itself) lessons from the 1918 pandemic apparently have not been learned. As doctor and bio statistician Antoine Flahault, who helped the WHO develop its Global Influenza Surveillance Network (FluNet), noted earlier this year in an article entitled [extern] Should we be afraid?, "in 1918, between 80 and 85% of deaths arose from bacterial complications. Infected people died en masse from pneumonia, whereas nowadays they would be given antibiotics." This means that to guard against an influenza pandemic of this kind it would be necessary to stockpile not vaccines but antibiotics.

Along these lines, it appears that governments are actually taking the wrong approach in dealing with the present outbreak of H1N1. For some, the reason for this is quite obvious: since vaccines have a shorter shelf-life than antibiotics, it makes better business sense to stockpile vaccines and not antibiotics since the former has a higher rate of redundancy. This, in turn, helps to ensure that the cash cow is not killed off too early.

As many seem to be either fully or partially aware of all this, it should come as no surprise that there is much public skepticism about government attempts to vaccinate entire populations against the H1N1 virus. This skepticism has much deeper roots, however. In effect, it's part of a more general trend of growing public opposition toward the use of immunizations and vaccinations as a means to safeguard our health.

This trend is clearly evident in North America where some people are refusing to have their children immunized against common diseases. In many ways, the western world has become a victim of its own success as some are now beginning to feel that immunizations and vaccinations are useless. This, in turn, has led to a fear among scientists that those diseases in the western world which were once thought to have been forever eradicated, such as smallpox (which was eradicated in 1979) could soon reappear. Similarly, although Europe only became polio-free in 2002, many experts feel that if present conditions continue then it is highly likely that it will soon make its reappearance.

Yet the problem isn't simply that a few people have made a foolhardy decision based on a lack of understanding. Rather, the problem is that state health care has become too closely aligned with private interests, nurturing a feeling of suspicion and mistrust within the general public. Simply put, governments such as Hungary suffer from a creditability gap. This is why most governments are having a hard time in convincing people to get vaccinated against the H1N1 virus.

This creditability gap looks set to widen further as people become increasingly skeptical about government programs aimed at protecting their health. Ultimately, this will lead to a tragedy of enormous consequences when a disease - one which really does threaten society as a whole - is able to spread unabated because of this creditability gap. The only way to narrow and eventually eliminate this creditability gap is to decouple public health care from the private sector. Unless this is not done soon, it will only be a matter of time when a simple epidemic mushrooms into a global pandemic of catastrophic proportions.

1918 RBD D225G in Lung Cases in the United States​

http://www.recombinomics.com/News/11230901/D225G_1918_US.html

Betsy McKay: I just wanted to follow-up on the question about the mutation in norway. I wondered if you could talk a little bit more about is it possible that this mutation has produced a more virulent form and what has CDC uncovered through its own work?

Anne Schuchat: this mutation has been seen sporadically here and there around the world. Sometimes it's been seen in patients who had very mild disease and sometimes it's been seen in people who had more severe or fatal disease. And, of course, lots of virus without this mutation has been seen in the fatal as well as the milder forms of H1N1 influenza. There's some theoretical reasons why this particular mutation might lead an influenza virus to live easier in the deep part of the lungs and cause lower respiratory infections, but we've actually seen lower respiratory infections in a severe viral pneumonia without this mutation. So I think it's too soon to say what this will mean long term. It's an important finding and they're looking into it, but I don't think it has the public health implications that we would wonder about. Did you have a second question? Oh, what have we seen so far? I believe it's been seen in the U.S. But associated with mild disease. I believe. I might need to verify that. Do we have another from the room? Okay. We'll go back to the phone.

The above comments are from the latest CDC update and regard the receptor binding domain change, D225G, which has recently been reported in Ukraine and Norway. This change was also identified in 1918 and 1919 fatal lung cases and the change has been targeted in receptor binding domain studies. These studies showed that the 1918 H1N1 with D225G was able to bind to gal alpha 2,3 and gal alpha 2,6, in contrast to the 1918 sequences with wild type D225, which targeted alpha 2,6.

Recent studies have also demonstrated that alpha 2,3 receptors are on alveolar epithelial type II cells, which regulate lung surface tension as well as immunological defenses which include the release of cytokines. Binding of H1N1 to these cells could have significant clinical implications, which is supported by the recently published sequences which identifies D225G in lung and trachea samples form fatally infected patients. The cases in Ukraine were also linked to hemorrhagic disease and the CDC sent out a warning on such cases due to sporadic reports in the United States.

The above response fails to note the identity between the receptor binding domain change in Norway and Ukraine and responses to that alert. Moreover, media reports on fatal cases that develop ARDS in association with hemorrhagic disease in the United States continue to increase.

Details on the number and location of cases reported in response to the CDC alert would be useful.

Explosion of Swine Flu Tamiflu Resistance in the United States
​

http://www.recombinomics.com/News/11230902/H274Y_Explode.html

The majority of 2009 influenza A (H1N1) viruses are susceptible to the neuraminidase inhibitor antiviral medication oseltamivir; however, rare sporadic cases of oseltamivir resistant 2009 influenza A (H1N1) viruses have been detected worldwide. A total of 21 cases of oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States since April 2009. In specimens collected since September 1, 2009, 11 cases have been identified in the United States, including seven newly identified cases since last week and one case reported during a previous week that was reclassified. All tested viruses retain their sensitivity to the neuraminidase inhibitor zanamivir. Of the 21 cases, 12 patients had documented exposure to oseltamivir through either treatment or chemoprophylaxis, eight patients are under investigation to determine exposure to oseltamivir, and one patient had no documented oseltamivir exposure.

The above comments from the week 45 CDC update, describe an explosion of oseltamivir resistant cases in the United States. Moreover, a linkage to Tamiflu has not been established for these cases, raising concerns that an evolutionarily fit H1N1 is circulating in the US. Reports of four seriously ill patients at Duke developing resistance also was disclosed Friday. However, these four cases were said to have developed over a six week period and some media reports indicated the patients were taking prophylactic Tamiflu, which would suggests that those four patients were not included the above tally. In addition an outbreak at a Wales hospital was also describe Friday, which followed a cluster at Edinburgh increasing concerns that H274Y is transmitting and detection is becoming increasingly common.

Although Roche and others have maintained that the H274Y was due to a spontaneous mutation, there is little evidence to support this interpretation. Like seasonal H1N1, all resistance involved the same genetic change which coded for H274Y. Moreover, the rapid appearance of H274Y indicated it was not due to a spontaneous de novo mutation, but was circulating as a minor species which was more easily detected after Tamiflu treatment.

However, reports of H274Y in patients who were not treated with Tamiflu suggested an easily detected fit version was also circulating, an the number of new cases without a demonstrated link to Tamiflu treatment raised concern that the more easily detected H274Y was becoming more common. The more easily detected H274Y was described for seasonal flu and the appearance on multiple genetic backgrounds suggested the movement form one genetic background to another was due to recombination. Recombination was supported by similar jumps by other important changes from clade 2C to clade 2B, including at least one silent change.

Similarly, the detection receptor binding domain change D225G on multiple backgrounds indicates that key change is "in play" also and is moving from one background to another via recombination, although statements have been made that the polymorphism was "spontaneous" and not transmitting, which, like H274Y, is not supported by the data.

Release of sequences from these recent cases would be useful to determine if a dominant H274Y species is emerging.

Swine flu virus mutation detected​

http://www.news.gov.hk/en/category/healthandcommunity/091123/txt/091123en05006.htm

The Department of Health has found the same mutation in a human swine influenza virus sample as the one detected in Norway recently.



The department has examined the genetic sequence of human swine flu viruses in its monitoring system. Out of the 123 sequences studied, one sample showed the same mutation as the Norway strain.



The virus was taken from a year-old boy who developed flu-like symptoms July 22. He was admitted to Prince of Wales Hospital July 25 and discharged three days later. He has recovered.



Mutations are frequently encountered in influenza viruses. According to the World Health Organisation the same mutation of the virus has been found on the Mainland and in other countries, including Brazil, Japan, Mexico, Ukraine and the US.



The virus with this mutation remained sensitive to antiviral drugs, Tamiflu and Relenza. No evidence suggests these mutations are leading to an unusual increase in the number of human swine flu infections or a greater number of severe or fatal cases.

All That I am Reading - 1918 Spanish Flu Has Been
Recreated and is around the World in Cases​

http://ukraineplague.blogspot.com/2009/11/all-that-i-am-reading-1918-spanish-flu.html

It seems to me the 1918 Spanish Flu was successfully recreated and is around the world showing up in cases as a "mutated Swine Flu". This is what I can gather from many news reports. But, this is not being said as What is going on in the Ukraine.

The CDC, WHO and governments are saying a mutated swine flu resistant to Tamiflu results have been detected in Norway, North Carolina, U.S., Brazil, Japan, Mexico, Ukraine and the U.K.

There are many articles about this today. I am going to insert the links to them.

Here is what Wikipedia says about the 1918 Spanish flu:

Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.[9]

The second wave of the 1918 pandemic was much deadlier than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. But in August, when the second wave began in France, Sierra Leone and the United States,[41] the virus had mutated to a much deadlier form. This has been attributed to the circumstances of the First World War.[42] In civilian life evolutionary pressures favour a mild strain: those who get really sick stay home, and those mildly ill continue with their lives, go to work and go shopping, preferentially spreading the mild strain. In the trenches the evolutionary pressures were reversed: soldiers with a mild strain remained where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus. So the second wave began and flu quickly spread around the world again.[43] It was the same flu, in that most of those who recovered from first-wave infections were immune, but it was now far more deadly, and the most vulnerable people were those who were like the soldiers in the trenches—young, otherwise healthy adults.[44] Consequently, during modern pandemics, health officials pay attention when the virus reaches places with social upheaval, looking for deadlier strains of the virus.[43]

One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms – genetic drift and antigenic shift – in viruses in poultry and swine which the fort bred for food; the soldiers were then sent from Fort Riley to different places around the world, where they spread the disease. However, evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine.[55][56] This suggestion is slightly controversial,[57] and other research suggests that the strain originated in a mammalian species.[58]

An effort to recreate the 1918 flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, Southeast Poultry Research Laboratory and Mount Sinai School of Medicine in New York City; the effort resulted in the announcement (on October 5, 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered by pathologist Johan Hultin from a female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers.[59]

On January 18, 2007, Kobasa et al. reported that monkeys (Macaca fascicularis) infected with the recreated strain exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm[60]—an overreaction of the immune system. This may explain why the 1918 flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction.[61]

On September 16, 2008, the body of Yorkshireman Sir Mark Sykes was exhumed to study the RNA of the Spanish flu virus in efforts to understand the genetic structure of modern H5N1 bird flu. Sykes had been buried in 1919 in a lead coffin which scientists hope will have helped preserve the virus.[62]

In December 2008, research by Yoshihiro Kawaoka of the University of Wisconsin linked the presence of three specific genes (termed PA, PB1, and PB2) and a nucleoprotein derived from 1918 flu samples to the ability of the flu virus to invade the lungs and cause pneumonia. The combination triggered similar symptoms in animal testing.[63]

The original date of appearance of this virus is not clear. An estimated date for its appearance in mammalian hosts has been put at the period 1882–1913.[64] This ancestor virus diverged about 1913–1915 into two clades which gave rise to the classical swine and human H1N1 influenza lineages. The last common ancestor of human strains dates to between February 1917 and April 1918. Because pigs are more readily infected with avian influenza viruses than are humans, it is likely that they were the original recipient of the virus. This in turn suggests that the virus was introduced into humans sometime between 1913 and 1918.



A 2005 National Geographic Article about How the 1918 Virus was dug up and the U.S. government was reproducing it to "study it".

The purpose was to get at questions relating to the 1918 pandemic," said Jeffery Taubenberger, of the Armed Forces Institute of Pathology (AFIP) in Rockville, Maryland. Taubenberger co-authored one of several related papers in this week's issues of the journals Nature and Science.

"How did this particular virus form and get into humans? How did a pandemic start?" Taubenberger said. "Why was this particular virus so virulent? And in a broader sense what can we learn from the lessons of 1918 that can help us in the future?"

Influenza viruses were unknown in 1918, so there was no way for doctors or scientists to directly study the flu during or after the outbreak.

But some institutions, like the AFIP, preserved tissue samples from 1918 flu victims. Those 87-year-old samples—and others from a victim who was buried in, and preserved by, Alaskan permafrost—yielded tiny fragments of genetic material that were used to piece together the virus's genetic coding signature.

The final genes of the virus's genome sequence are being published this week. Scientists used the completed, full viral sequence to create a live virus with the eight viral genes of the Spanish flu, named for an early, devastating outbreak in Spain.

Even if somehow released, that virus would be unlikely to cause a pandemic like that of 1918, because humans have likely acquired some immunity in the intervening decades. Nonetheless, it is currently contained at Atlanta, Georgia's Centers for Disease Control and Prevention (CDC) under extremely strict security.


I want to make sure People also KNOW - A GROUP OF PEOPLE WHO NEVER GOT THE SPANISH FLU DURING THAT TIME - WERE PEOPLE WHO WORKED IN CINNAMON FACTORIES!!

Please put Cinnamon on your List of "Must Get Items" - along with Vitamins C, D, Garlic and Kombucha Tea.

D225G Swine flu mutation - Same receptor as 1918
Spanish flu pandemic found in Ukraine virus​

http://www.examiner.com/x-29228-LA-...8-Spanish-flu-pandemic-found-in-Ukraine-virus

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

Spanish flu pandemic

In 1918, the Spanish flu pandemic killed between 20 million and 40 million people. The pandemic took place during the end of World War I, but ten times as many Americans died from the Spanish Flu as died in the war - nearly 700,000. The most severely struck regions were in areas of high humidity. Some speculation existed that the Spanish flu was an early attempt at a biological weapon due to the extremely high death rate, and symptoms that included bleeding in the lungs.

H1N1 Mutation in the Ukraine

The H1N1 mutation in the Ukraine also includes the symptoms of bleeding in the lungs, and has been described as an infection that completely destroys the lungs.

Fatal H1N1 Cluster in Texas Raises Pandemic Concerns​

http://www.recombinomics.com/News/11230903/Texas_Cluster_Fatal.html

A hospital spokesman has confirmed the second recorded H1N1 related death in Nacogdoches County. The 53-year-old oil rig worker from Enid, Oklahoma died Friday at 3:50 p.m.

The victim checked into Nacogdoches Memorial Hospital last week when he began experiencing severe symptoms.

This update follows the death of his roommate, a 55-year-old oil rig worker from Mississippi, who passed away Thursday morning as a result of H1N1.

The above comments describe the deaths of roommates infected with H1N1. Since the vast majority of H1N1 infections are mild, the death of two roommates within 24 hours of each others raises concerns that they were infected with a lethal contagious form of the virus. Recent reports out of Ukraine has raised concerns that H1N1 with the receptor binding domain change D225G, is such a virus.

Ukraine has reported 388 pneumonia deaths in the past several weeks and agency reports described 90 cases which involved total destruction of both lungs. Recently released sequences from Mill Hill in London included 4 fatal cases and all four cases had D225G, which was not present in the other six sequences which appear to be from milder cases.

D225G was identified during the 1918 pandemic in lung samples from victims in New York in 1918 and London in 1919. This change was also detected during 2009 pandemic target reassortants, indicating D225G is present as mixtures in various individuals. These mixtures can segregate during passage through hosts since D225G is a receptor binding domain that influences tissue tropism and allows the virus to target alpha 2,3 receptors, such as those seen in type II lung alveolar cells. Many of the fatal cases in the United States have also involved ARDS and hemorrhagic lungs, raising concerns that isolates with high levels of D225G can produce the increasing levels of such fatalities being reported throughout the northern hemisphere, including cases in Norway.

Since the D225G can circulate as a mixture, transmission and lung targeting can be facilitated by pseudo-typing. Moreover, D225G was identified in the vaccine target, A/California/7/2009, indicating claims of "spontaneous mutations" in patients in Norway or Ukraine are false.

The increasing number of deaths, including the cluster described in Texas raises concerns that D225G is gaining traction. More sequencing of samples near lung tissues in severe and fatal cases would be useful.

Spontaneous Mutation Media Myth
​

http://www.recombinomics.com/News/11240901/Spontaneous_MM.html

The mutations appear to occur sporadically and spontaneously. To date, no links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread.

The above comment from the WHO briefing on D225G (aka D222G) in Norway describes how the "mutations appear". However, this appearance is based on an outdated view of influenza evolution, which maintains that all newly acquired drift "mutations" are based on copy errors. For D225G, this would require the same copy error to occur again and again on multiple backgrounds, which simply is not reality based.

Although the "random mutation" explanation is one of the basic tenets of the WHO and CDC view of influenza evolution, this explanation is only viable in the absence of data. Extensive influenza sequence data moved this hypothesis into the indefensible category years ago, but it remains at the core of WHO explanations of drift variants, such as the comments above.

The "random mutation" and failure to spread would require each detection to be an independent event. Thus, in Norway, the same copy error would have been made in each of the three patients with D225G. Similarly, the same error would be required for each of the four fatal cases in Ukraine. Moreover, the same error would be made in the vaccine target, A/California/7/2009, because one of the 2:6 reassortants also had D225G. As the number of sequences with D225G increases, the likelihood that the same error happens again and again, among a very small number of differences (for HA in Ukraine, the only non-synonymous change was D225G), becomes untenable.,

The appearance of D225G on multiple genetic backgrounds of H1N1 parallels the sudden appearance of H274Y on multiple backgrounds of pandemic H1N1, which follows the same scenario of H274Y on multiple seasonal flu backgrounds in patients not taking Tamiflu. The acquisition of H274Y was readily explained by recombination, which led to the acquisition of key changes that were on clade 2C and then jumped to a clade 2B background. In addition to the H274Y jump to seasonal flu in patients not taking Tamiflu, silent changes were also observed, which also discounted heavy selection pressure favoring these changes.

For D225G, the change was present in one of the earliest isolates in the United States. It could jump from one background to another via recombination between sequences that are closely related. As a result, the new acquisitions lead to a new single nucleotide polymorphism, which looked like a point mutation, but was really recombination between closely related sequences.

Thus, both H274Y and D225G move from one genetic background to another via recombination. A new spontaneous mutation is not required for each isolate and the same sequence in a given area is just due to clonal expansion of an isolate with the new acquisition. This could be seen in the sequences from Ukraine. The Ternopil isolates had a marker found in all Ternopil isolates, including those from nasal washes that did not have D225G. The receptor binding domain change was appended onto this background. The same change was also on Lviv sequences from fatal cases which did not have the Ternopil marker. Thus, D225G moved from a Lviv to a Ternopil background via recombination (or vice verse). Moreover, the frequent jumping of the same polymorphism from one background to another allowed fro the prediction that D225G would be found on the Ukraine sequences. This type of concurrent acquisition has also been described for a silent mutation in H5N1, which again would be widespread in the absence of an obvious clear selection pressure.

Thus, the movement of the same polymorphism via recombination is common. It explains the sudden appearance of the same marker on multiple genetic backgrounds, and forms a basis for predicting changes.

However, the reliance on a "random mutation" produces "surprise after surprise" among influenza "experts" and creates "appearances" such as spontaneous mutations and lack of transmission which are not based on reality.

Video of the Doctor in Iowa talking About the Bleeding Lungs​

http://ukraineplague.blogspot.com/2009/11/video-of-doctor-in-iowa-talking-about.html

WHO warns of resurgence of avian flu virus ​

http://www.earthtimes.org/articles/show/296043,who-warns-of-resurgence-of-avian-flu-virus.html

Manila - The World Health Organization (WHO) warned Tuesday of a possible resurgence of bird flu amid new cases of the disease in poultry in Egypt, Indonesia, Thailand and Vietnam. The Manila-based WHO Western Pacific Office said the presence of the H5N1 virus in poultry placed those in direct contact with the birds at risk of getting infected with the disease.

It added that it was also closely monitoring the risk of the H5N1 virus combining with the H1N1 swine-flu virus to produce a new and deadlier strain.

"We don't know if this is possible, but we are certainly aware of the risk," said Shin Young-Soo, WHO regional director for the Western Pacific. "We are on alert for this development."

The WHO noted that the H1N1 virus that killed more than 6,000 people around the world since April was a new strain that resulted from "reassortment" or combination of the avian, swine and human strains of flu in pigs in Mexico.

Urging countries to remain on alert against bird flu, Shin stressed that influenza viruses were unpredictable.

"In areas where the H1N1 is endemic, we and our partners and national governments are working to build surveillance systems to identify changes in the behaviour of the virus," he said.

"We are also focusing on early-response capacity to reduce the potential threats to human health," Shin added.

Since 2003, outbreaks of H5N1 have been reported in poultry flocks in 60 countries in Asia, Europe and North Africa, leading to the culling of millions of birds.

Germany Reports New Outbreak of Low-Path AI​

http://www.thepoultrysite.com/poultrynews/18988/germany-reports-new-outbreak-of-lowpath-ai

GERMANY - The veterinary authorities have reported a new outbreak of low pathogenic avian influenza (LPAI).

The German veterinary authority sent an Immediate Notification to the World Organisation for Anima Health (OIE) on 20 November.

It reports a new outbreak of LPAI at a farm in Grosswechsungen in Thuringen in central Germany. Twenty-five birds from a flock of 2,420 birds died and another 10 have been destroyed.

The H5 sub-type of the avian flu virus has been identified, a low-pathogenic type.

The last outbreak of LPAI in Germany was in April this year.

New Wave of Bird Flu Outbreaks Shows Threat to Humans, WHO Say ​

http://www.bloomberg.com/apps/news?pid=20601202&sid=aM.uCL0W1ewU

Nov. 24 (Bloomberg) -- A fresh wave of bird flu outbreaks in Egypt, Indonesia, Vietnam and Thailand highlights the threat to public health caused by the H5N1 virus, which risks swapping genes with other influenza strains to spawn new variants, the World Health Organization in Manila said in a statement today.

Epidemic: first wave diminishes. 388 cases of death​

http://mignews.com.ua/en/categ186/articles/380260.html

President Viktor Yushchenko said the first wave of incidence of influenza and acute respiratory viral infections has completed. He said this during a meeting with representatives of the mission of the World Health Organization.

"The first wave has come to the end. The second and third waves are expected to be sterner," - he said.

The President thanked the World Health Organization for assistance in overcoming the epidemic of influenza and acute respiratory viral infections, and noted that research and findings of the organization regarding the epidemic are important for the country, Ukrainian News reported.

As a reminder, the Ministry of Health predicts the second wave of the epidemic of influenza virus A (H1N1) "Californian" in December 2009 - January 2010.

Ministry of Health has confirmed 388 deaths from influenza and acute respiratory viral infections as of November 23 in 24 regions, Kyiv, Sevastopil and the Crimea.

Since November 3 in Ukraine a working group of WHO experts worked to combat the flu. The experts studied the causes of the spread of the disease. The group consisted of 9 persons, including an anesthesiologist, infection disease doctor, 2 epidemiologists, 2 virologists and specialist in the organization of care.

A(H1N1) flu virus variant appears in HK ​

http://life.globaltimes.cn/health/2009-11/487341.html

An A(H1N1) flu virus variant appeared in Hong Kong Monday. It was the same strain as the one that recently appeared in Norway, according to the Department of Health of the Hong Kong Special Administrative Region. The virus variant did not appear to be resistant to the antiviral drug Tamiflu and Relenza.

The virus variant was extracted from the fluids taken from a one-year-old boy. The boy got the flu on July 22, and went to Prince of Wales Hospital. He was discharged from hospital July 28 after recovering.

The same A(H1N1) flu virus variant has also appeared in the Chinese mainland, Brazil, Japan, Mexico, Ukraine and the US, according to the World Health Organization (WHO).

H1N1 RBD Changes D225G and D225E in Norway
​

http://www.recombinomics.com/News/11240902/Norway_D225E_D225G.html

Twenty-five HA sequences from Norway have been released at Genbank. The isolates were collected between May and October and include six sequences with receptor binding domain changes. All changes are at position 225, but 5 of the 6 have D225E, while the sixth has D225G as well as wild type D225. Outcomes are not included in the characterization sheet, but it is not likely that the two fatal and one serious cases described in media releases last week were samples with D225E because the WHO briefing on Norway presented a country list that matched D225G reports.

D225E is not as well characterized as D225G, which was in 1918/1919 isolates and was characterized in receptor binding studies which demonstrated that D225G targeted alpha 2,3 receptors, like those in lung, as well as alpha 2,6 receptors. D225G was also found in four of four fatal cases in Ukraine.

The finding of D225G in Norway (A/Norway/2924/2009) as a mixture with wild type sequences confirms that isolates with receptor binding domain changes can be circulating as mixtures and the sequence identified will be dependent on the tissue sampled and when it is sampled. Thus, Infections with a high frequency of D225G will likely be quickly cleared from the upper respiratory tract because viruses with D225G will quickly go to the lungs, which wild type sequences will be more quickly cleared from the upper respiratory tract. Thus a nasopharyngeal swab may be negative if all not cleared virus has moved to the lungs, or be positive for the wild type if depleted wild type H1N1 is remaining at the time of swabbing. Thus, the true level of D225G may be grossly under estimated by nasopharyngeal swabs, and the one sample positive for D225G may reflect the rare instances where D225G could still be detected in a nasopharyngeal swab.

These recent sequences provide additional data for widespread isolates with receptor binding domain changes at position 225, but the true distribution may require sampling more representative of virus that has infected the lower respiratory tract, including lung.

D225E
gb|CY052015.1 A/Norway/4023/2009
gb|CY052007.1 A/Norway/3478/2009
gb|CY051991.1 A/Norway/3059/2009
gb|CY051987.1 A/Norway/2690/2009
gb|CY051986.1 A/Norway/2674/2009

Ukraine Dead Approach 400 - D225G Spreads​

http://www.recombinomics.com/News/11240903/Ukraine_397.html

1,679,237 Influenza/ARI

99,661 Hospitalized

397 Dead

The above figures from the latest daily update from the Ukraine Ministry of Health support a decline in the rate of increases of cases and deaths, but the total is now almost 400 fatalities (see map). The spread was likely slowed by the country-wide closing of schools along with warmer weather. However, it is likely that the virus will return as temperatures drop and the traditional flu season begins, although it is unclear if seasonal flu will be in circulation in 2010.

The receptor binding domain change, D225G, was in four of four sequence from fatal cases, raising concerns that the 2,3 alpha specificity of D225G drove the H1N1 to the lungs and the total destruction. Three patients in Norway were said to also have D225G, and two of the three died while the third had been in serious condition. 25 HA sequences from Norway were deposited at Genbank, but only one had D225G, and it was a mixture. In Brazil both patients with D225G in lung samples had died, and the case in China had been in serious condition.

However, the severity of the infection may be related to the ratio of sequences with and without D255G, as well as viral load, because milder cases involving D225G have also been reported in the United States and Hong Kong.

More detail on additional cases, including sequences from upper and lower respiratory tract from the same patient would be useful.

H1N1 Re-infections Raise Pandemic Concerns​

http://www.recombinomics.com/News/11250901/H1N1_X2.html

Dr. Debra Parsons, a pediatrician at Kid Care West in Cross Lanes, was met with reactions of doubt from local health officials last month when she said two flu tests had come back positive for H1N1, or swine flu.

Parsons first came down with the virus, complete with all the telltale symptoms, in August.

Her son became ill at the same time with the same symptoms. Figuring they had the same bug, Parsons tested herself to see what it was.

The test came back positive for Influenza A, so the lab at Charleston Area Medical Center sent it to be sub-typed. Parsons was positive for H1N1.

Parsons and her son recovered, but in October they started having the same symptoms, but they became much worse.

They were both tested this time, and the results were the same -- they were positive for Influenza A and then H1N1.

"It was swine flu both times," Parsons said.

The above comments on lab confirmed re-infection of two family members two months apart by swine H1N1. These confirmations are supported by many anecdotal reports of similar re-infections. The timing of these infections allowed for easy identification, because at the time there was no seasonal flu, so identification of infections was straight-forward. Moreover, such infections in school aged children and parents are common because H1N1 infections exploded when school began.

At the time however, the H1N1 virus was evolving slowly, reflecting an ease of infection of a naïve population. The jump from swine H1N1 into humans allows for infections with low doses of virus. Low concentration of virus produces a mild infection and a weak antibody response. The rapid spread creates widespread antibody, but the low level allows for re-infection from individuals with a higher viral load. A higher viral load can be created in a school environment, where some students could be infected multiple times because of frequent contact with infected students.

Thus, the increased viral load could overcome the weak immune-response and re-infect those infected earlier, leading to a second wave. However, the higher viral load leads to more serious infections, especially for these not infected in the first wave. Consequently more previously health young adults develop more serious symptoms, leading to an increase in hospitalizations and deaths. The higher viral load, especially when combined with receptor binding domain changes such as D225G can lead to the type of cases seen in Ukraine, where a high percentage of young adults develop infections that destroy both lungs in a matter of a few days.

In many areas, including Ukraine, this wave is subsiding, but the holiday season will lead to new infections by viruses with regional markers, leading to a third wave in early 2010.

A Doctor Has Come Out in the Opened About Belarus -
Situation is Bad - Lung Destruction - Bleeding​

http://ukraineplague.blogspot.com/2009/11/doctor-has-come-out-in-opened-about.html

This doctor says the pneumonic plague is also in Belarus, Please see his description of the lungs and the problems - with the carbon dioxide is the exact description of the Omaha kids on the ECMO machines. That information is below in other postings today. Do we have the same thing happening in Iowa and Omaha at this point as what is happening in Belarus - due to the description matching the other articles?

Gomel physician Eugene Lopan the first time openly spoke about the epidemic of swine flu in Belarus.

В Беларуси с пневмонией в больницы за один день попало 895 человек. In Belarus, with pneumonia in the hospital for one day got 895 people. Медицинские чиновники дают официальную информацию дозировано и крайне редко. Health officials give official information dosage and extremely rare. Врачи же ушли в подполье и выкладывают свое видение ситуации разве что в интернете на личных блогах. Doctors also went underground and spread its vision of the situation except that in the internet on personal blogs. И то анонимно. And it anonymously. Но с корреспондентом «Комсомольской правды в Беларуси» согласился встретиться один из таких медиков, что днями напролет дежурят в клиниках, а потом вместо отдыха включают компьютер и пишут «сводки с мест боя». But the correspondent of Komsomolskaya Pravda in Belarus "agreed to meet one of these doctors, that the days away on duty in the clinics, and then instead of facilities includes a computer and write" reports from the field of battle. " Ни то сами для себя, ни то в надежде быть услышанными обществом. Neither for themselves, nor is hoping to be heard by society. С нашим собеседником мы связались через его «Живой журнал». With our interlocutor, we contacted through its "Living Magazine". Доктор согласился на встречу, не скрывая свое имя и место работы. The doctor agreed to a meeting, not concealing his name and place of work. Врач-реаниматолог Добрушской районной больницы Евгений Лопанов рассказал о клинической картине опасного вируса и о том, что помогает пациентам выжить. Pediatric Dobrush regional hospital Eugene Lopan described the clinical picture of a dangerous virus and that helps patients survive.

За три часа поступили 30 человек с пневмонией Three hours received 30 people with pneumonia

– Евгений, скажите, как медик, которому приходится принимать на себя удар свиного гриппа, есть ли в Беларуси эпидемия? - Eugene, tell me, as a doctor who has to take the blow of swine flu, is there an epidemic in Belarus?

– Эпидемия есть — это бесспорно. - The epidemic is - is indisputable. Появилось большое количество обращений с вирусной инфекцией, никто не знал сначала, что это такое, потом выяснилось, что имеем дело с гриппом A/H1N1. A large number of appeals with a viral infection, no one knew at first what it is, then it turned out that we are dealing with avian influenza A/H1N1. В Добруше все началось с двух больных в первых числах ноября. In Dobrush all started with two patients in early November. А потом – как снежный ком. And then - like a snowball. В принципе, успели среагировать. In principle, the time to react. Когда появился первый больной, я понял, что это такое. When the first patient, I realized what it was. Главврача предупредили, развернули дополнительный блок в терапевтическом отделении. Senior doctor warned deployed additional block in the therapeutic department. Решили, что с легкой степенью пневмонии будем класть в инфекционное отделение, с тяжелой – в роддом, а самых тяжелых - в реанимацию. We decided that with mild pneumonia will be put in the infectious disease clinic with a heavy - to the hospital, and the worst - in intensive care. Хорошо помню свое дежурство, это было где-то 7 ноября. I well remember his duty, it was somewhere on November 7. За три часа поступили тридцать человек с пневмонией. Three hours and thirty men arrived with pneumonia. Учитывая, что Добруш – город небольшой... Given that Dobrush - a small town ...

– У всех были одинаковые симптомы? - They all had the same symptoms?

– Да, симптомы гриппа. - Yes, the symptoms of influenza. А на клинике все выглядело как бронхопневмония. And at the clinic all looked like pneumonia. Поступил больной, мы могли думать что угодно, вплоть до того, что у больного тромбоэмболия легочной артерии. Joined patient, we could think of anything, to the extent that the patient's pulmonary embolism. Но почему-то кровянисто-пенистая мокрота шла в большом количестве — такого никто раньше не видел. But for some reason krovjanisto-foamy sputum was in a large number - this one has never seen before. Мы поняли, что это вирусная инфекция. We realized that this is a viral infection. А в соседней палате лежал точно такого же телосложения больной. In the next chamber lay exactly the same physique of the patient. Полные, здоровяки, крепыши – их положили с одинаковой клиникой! Complete, sturdy, stalwart - they put the same clinic!

– Как протекает эта вирусная инфекция? - How is this a viral infection?

– Как обычный грипп, ОРВИ. - As usual flu, SARS. Начинается со слабости, недомогания. Begins with weakness, malaise. Температура может повыситься у всех по-разному – до 37, 38, 39 градусов. Одышка нарастает, появляется кашель, боли между лопаток, в суставах, диарея может быть, нарушение со стороны пищеварительной системы. STemperature may rise to all different ways - to 37, 38, 39 degrees.hortness of breath increases, there is a cough, pain between the shoulder blades, arthralgia, diarrhea may be a violation of the digestive system. Люди, как правило, обращались, когда начинала мучить одышка, появлялся кашель. People tend to, when you begin to torment the shortness of breath, cough appeared. Самое плохое, когда приходили уже с мокротой, содержащей кровь — это отягощающий фактор, говорит о том, что легочная ткань стала разрушаться. The worst thing, when they came already with sputum containing blood - this is aggravating factor, suggests that lung tissue was destroyed.

Работали как в военных условиях Worked in war conditions

– Первый удар пришелся на участковых терапевтов, – продолжает Евгений. - The first blow fell on the precinct therapists - continues to Eugene. – Важно, чтобы болезнь не прогрессировала. - It is important that the disease has progressed. Больных осматривали, никому не отказывали, нагрузка пошла большая – практически все население нужно обслужить. The patients were examined, no one denied, the load went great - virtually the entire population to serve. А условия – военные. And the conditions - war. Нет средств, возможностей, времени. No, facilities and time. Некоторые люди себя неадекватно ведут — кто-то не хочет лечиться, думает, что его это обойдет. Some people are themselves inadequately - someone does not want to be treated, thinking that it is cost. А потом начинается паника, родственники прибегают в стрессе. And then the panic starts, relatives have resorted to stress.

А все от незнания. And all because of ignorance. Если бы выступили врачи по телевизору, сказали: то-то делайте на первом этапе, – все более сглажено прошло бы. If doctors were on TV, said: then do something in the first stage - all would have passed over smoothed. К примеру, практически все, кто к нам поступали, пили жаропонижающие. For example, almost everyone who came to us, drank antipyretic. А они блокируют все процессы выработки иммунитета организмом. And they block all the processes of developing immunity. Нельзя принимать таблетки, если температура ниже 39! You can not take pills, if the temperature is below 39! Организм должен бороться. Body must fight. Мы элементарно сбиваем температуру физическим охлаждением: обтираем больного, кладем лед в области магистральных сосудов, если надо и вентилятором можем подуть. We bring down the temperature of an elementary physical cooling: wipe the patient, put the ice in the area of major vessels, if necessary, and the fan can blow.

Тамифлю у нас хватало все время, изначально был запас. Tamiflu we lacked all the time, was originally a reserve. Но когда уже болезнь начала прогрессировать, пить Тамифлю особой необходимости нет. But when the disease has already started to progress, especially drink Tamiflu is not necessary. Тогда уже надо другое лечение, потому что начинают присоединятся микробы и нарастает полиорганная недостаточность. Then, already have another treatment, because the microbes begin to join and growing multiorgan failure. На данный момент мало полезной информации по новому гриппу, мало результатов исследований. Currently, little useful information on the new flu, little research findings. Благо есть интернет и замечательные данные статистики, собранные профессором в Мексике, доктором Guillermo Dominguez-Cherit. Good is the Internet and the remarkable statistics collected by a professor in Mexico, Dr. Guillermo Dominguez-Cherit. Мы поняли структуру заболеваемости, кто более подвержен заболеванию, какие принципы лечения и какой результат они дали. We understand the structure of morbidity, who are more susceptible to disease, what principles of treatment and what results they gave. На своей практике поняли, что необходим уход за больным, стимуляция иммунитета – чтобы организм начинал бороться. At his practice to understand that need nursing care, stimulation of immunity - that the body begins to fight. А Тамифлю, Реленса, Арпетол может выступать помощником лишь на ранней стадии заболевания. But Tamiflu, Relensa, Arpetol assistant may act only at the early stage of the disease.

– Опишите, что происходит с организмом при вирусной пневмонии и чем она отличается от обычного воспаления легких. - Describe what happens to the body during viral pneumonia and how it differs from ordinary pneumonia.

– Процесс поражает практически всю ткань легких, у больного появляется кровянистая мокрота, наступает респираторный дистресс синдром (РДС), когда возникает проблема доставки кислорода к тканям, а из ткани не утилизируется углекислый газ. - The process affects virtually the entire fabric of the lungs, the patient appears bloody sputum, respiratory distress syndrome occurs (RDS), when there is a problem of oxygen delivery to tissues, and tissues from non-recyclable carbon dioxide. У некоторых больных отмечается молниеносное течение, сходное по скорости с аллергической реакцией. Some patients noted a lightning current, similar to the rate of allergic reaction. На снимках это выглядит как полисегментарная пневмония. In the pictures it looks like polisegmentarnaya pneumonia. У больных возрастает нагрузка на сердце, печень, почки. Patients increases the load on the heart, liver, kidneys. Если не лечить — человек умирает. If left untreated - a person die. На первой стадии — по статистике до 28 дней - от дыхательных расстройств, позже смерть обычно наступает от полиорганной недостаточности. At the first stage - Statistics up to 28 days - from respiratory disorders, and later death usually occurs from multiple organ failure. Процесс очень быстрый, от момента заболевания до обращения к врачу проходит где-то 6 дней, а после попадания в больницу до реанимации всего 1-2 дня. The process is very fast, from the moment of the disease before treatment to the doctor is somewhere for 6 days, and after entering the hospital to the intensive care unit only 1-2 days. То есть человек попал в больницу, а на следующий день он в реанимации с РДС. That is, people in hospital, and the next day he was in intensive care unit with RDS. Заболевание как пожар — если вовремя не потушить, сгорит все. The disease is like a fire - if not extinguished in time, will burn everything.

Заметил, что каждый по-своему переносит этот вирус. Note that each in its own way carries the virus. Все зависит от иммунитета, большую роль играет психосоматика: как человек к жизни относится, чем питается, насколько он оптимистичен. Everything depends on immunity, plays an important role Psychosomatics: a man to life is, what to eat, how much he is optimistic. Тяжело болеют, в основном те, кто по жизни какую-то отрицательную энергию несет на себе. Hard to get sick, mostly those who are living on some kind of negative energy bears. Либо что-то сделал не так. Or did something wrong. Допустим, начальником был и поступил как-то подло. For example, the head was, and acted like a mean way. От кого-то ушел муж. From someone left her husband. В общем, те, кого совесть мучает. In general, those who are tormented conscience.

И раньше были пневмонии, но протекали они гораздо легче. Before I had pneumonia, but they flowed much easier. Ну, переохладился кто-то или в гараже полежал. Well, supercooled someone or lay in the garage. А тут заболевают молодые люди 20-40 лет при полном здоровье. And then ill young people 20-40 years in full health. Бах – и вирусная пневмония. Bach - and viral pneumonia. В принципе, это и есть та же самая «испанка». In principle, this is the same "Spanish flu". Но не легочная чума – это точно. But pneumonic plague - that's for sure. Структура вируса один к одному – «испанка», это тоже H1N1. The structure of the virus one to one - "Spanish flu", is also H1N1. Только произошли мутации, вирус стал немножко по-другому присоединяться к клетке. Only the mutation occurred, the virus has a slightly different way to join the cell.

Кстати, по мировой статистике, смертность у данного вируса достигает 2,5% от заболевших, а у сезонного гриппа 0,1%. By the way, according to world statistics, deaths from the virus reaches 2,5% of the sick, and in seasonal influenza 0,1%.

– В медицинской среде рассуждают о том, откуда, вообще берутся вирусы? - In the medical environment, talk about where, generally come from viruses?

– Этого никто точно не знает, а рассуждения доходят до того, что это военное оружие. - Nobody really knows, but the arguments go as far as that is a military weapon. Есть мнение, что вирусом заболевают животные, а потом он приобретает свойства заражать людей. It is argued that the virus become sick animals, and then it acquires the properties of infecting people. Некоторые говорят, что это вообще не вирус гриппа, а процесс естественного отбора. Some say that this is not the flu virus, but a process of natural selection.

– Что происходит сейчас, поток людей в больницы по-прежнему большой? - What is happening now, the flow of people in hospital are still big?

– Спад есть. - Recession is. Потому что многие уже заболели. Because many are already sick. Кто-то иммунитет приобрел, кто-то еще не заразился. Someone got immunity, someone is not infected.

– Были ли случаи счастливого выздоровления? - Have you a happy recovery? Из реанимации, из-под аппарата ИВЛ – на поправку? From resuscitation, from the ventilation apparatus - the amendment?

– Насколько знаю, только у нас в Добруше был такой случай. - As far as I know, only in our Dobrush was such a case. Пока не слышал, чтобы еще кто-то живым из-под аппарата ИВЛ выходил после заболевания. While not heard that someone else is living from the ventilator out after the disease. Мужчина поступил в реанимацию в сознании. The man admitted to the intensive care unit in mind. Потом на ИВЛ пролежал около недели. Then lay on the ventilator for about a week. В таких случаях важен уход. In such cases, care is important. Смотрели за мужчиной серьезно, все родственники морально поддерживали. We looked for the man seriously, all the relatives of moral support. И главное – верили. And most importantly - believe. Они просто сжали кулаки и говорили, что он должен жить. They simply clenched his fists and said that he must live. И сам он хотел жить. And he himself wanted to live. На многих больных смотришь и понимаешь, что они уже в другом мире. Many patients look and realize that they're in another world. Разговаривают как будто не с тобой. They talk as if not to you. А этот явно хотел остаться здесь. And this obviously wanted to stay here. Пока в сознании был, к окну все бегал, смотрел. While in the mind was all ran to the window, watching. Рассказывал, когда его интубировали, ему казалось, что крышка гроба закрывалась и последние гвоздики забивали. He told me when he was intubated, he felt that the coffin lid was closed and the last nails were killed. Было такое, что никто уже не надеялся. Was such that no one had hoped. И вдруг просто чудо какое-то. And suddenly a miracle for some. Мужчину уже перевели из реанимации в терапию, он в сознании. A man has been transferred from the intensive care therapy, he is in the mind. У него лабораторно подтвердился грипп A/H1N1. He has a laboratory-confirmed influenza A/H1N1. Сделали снимок, картина разрешилась, легкие воздушны, остались маленькие очажки. Took a shot, the picture was resolved, light aircraft, were small foci. Пневмония пока сохраняется, антибиотики получает. Pneumonia still persists, antibiotics receives.

Выявляемость свиного гриппа – всего 10 процентов The detection of swine influenza - only 10 per

– Какие-то разнарядки по лечению больных вирусной пневмонией из Минздрава поступали? - Some sort of quota for the treatment of patients with viral pneumonia from the Ministry of Health do?

– Да, где-то через неделю, как у нас все началось. - Yes, somewhere in a week, as we all began. Написали, как правильно лечить больных с H1N1 — рекомендации по препаратам. Wrote how to treat patients with H1N1 - advice on drugs. В принципе, то, что мы и делали с самого начала. Basically, what we did from the beginning. Большую роль сыграли вовремя назначенные антибиотики. Important role played by time antibiotics. Это тоже такая случайность, все как-то эмпирически возникало: один антибиотик не пошел – другой назначили. This is also such a coincidence, somehow empirically exist: one antibiotic did not go - another appointed.

Вообще, политика Минздрава направлена на то, чтобы не было паники. General, the policy of the Ministry of Health aims to ensure that there was no panic. Чтобы люди не скупали лекарства и не занимались самолечением. That people are not bought drugs and do not engage in self-medicate. Это правильно. That is correct. Проблема в том, что лечат не врачи, а аптекари. The problem is that doctors do not heal, and pharmacists. Но о том, что эпидемия есть, молчать не стоит. But the fact that the epidemic is, you should not be silent. Проблема существует на самом деле, люди болеют, есть смертельные случаи. The problem exists in reality, people get sick, there are fatalities.

– Что вам известно о выявленных случаях гриппа A/H1N1 и смертности от вирусных пневмоний? - What do you know of any cases of influenza A/H1N1 and mortality from viral pneumonia?

– Сразу скажу, что выявляемость в лабораториях этого гриппа по мировой статистике около 10 процентов. - I must say that the detection in the laboratories of the flu for the world statistics about 10 percent. То есть, болеют свиным гриппом раз в десять больше, чем выявляет лаборатория. That is, the sick swine influenza is ten times more than identify laboratory. Причины неподтверждения анализа – неправильно взятый мазок, плохие условия транспортировки и так далее. The reasons for not approving the analysis - misguided smear, poor transport conditions and so on. В Добруше точно знаю о двух подтвержденных H1N1. In Dobrush do know of two confirmed H1N1. Но тех, что поступают с одинаковой клиникой, мы считаем заболевшими одним и тем же вирусом, и лечим всех одинаково — подтвердила лаборатория или не подтвердила. But those that come from the same clinic, we feel sick by the same virus, and treat everyone equally - a laboratory confirmed or not confirmed.

Смертей у нас, слава Богу, не было. Deaths from us, thank God, no. А в Гомеле тяжесть состояния пациентов намного выше — не хватало аппаратов ИВЛ. And in Gomel severity of patients is much higher - not enough ventilator. Большую роль играет качество самих аппаратов для вентиляции. Important role played by the quality of the apparatus for ventilation. Замечено, что больные не подвергаются энцефалопатии в результате воздействия вируса, поэтому рекомендовано проводить ИВЛ в сознании, с использованием вспомогательных режимов, что практически недоступно белорусским аппаратам. It is noticed that the patients are not subjected encephalopathy as a result of exposure to the virus, therefore, recommended to mechanical ventilation in mind, with the support of regimes that virtually inaccessible Belarusian machines. О смертельных случаях сам узнаю из новостей, если что-то говорят. On the fatal cases, he learned from the news if something they say. Единственное, около недели назад нам говорила главный пульмонолог о том, что в Гомельской области умерли более 20 человек. Only about a week ago we told chief pulmonologist that in the Gomel region had died more than 20 people. Слышал, про смерть беременной женщины. I heard about the death of a pregnant woman. Вполне возможно, что такое было, потому что у беременных организм ослаблен. It is possible that this was because the pregnant body is weakened.

– А сами медики болеют свиным гриппом? - Do you think doctors are ill with swine flu?

– Считаю, тут ничего не поможет, когда кругом больные с вирусом. - I believe there is nothing to help, when all around sick with the virus. Хоть 10 масок надеть и менять через 5 минут, но все равно надо защищаться. At least 10 masks to wear and change in 5 minutes, but still have to defend. Каким-то образом все равно инфекция тебя найдет. Somehow, all the same disease you will find. Весь наш медперсонал реанимации в какой-то степени перенес инфекцию, и я тоже. Our entire medical staff of reanimation to some extent, suffered an infection and I too. От человека зависит, насколько у него иммунитет сильный. From man depends how he has a strong immunity. Вообще, нагрузка на врачей возросла колоссально. In general, the load on doctors has increased tremendously. В принципе силы на исходе у всех: и медсестер, и врачей, и младшего персонала. In principle, the forces at the end of all: the nurses and doctors and paramedical staff. Всем очень тяжело работать. All very hard work.

– По вашим прогнозам, как будет развиваться эпидемия в ближайшее время? - Your forecasts, as the epidemic will develop in the near future?

– Очень трудно сказать, все непредсказуемо. - Very difficult to say, everything is unpredictable. «Испанка» свирепствовала два года. "Spanish Flu" raged for two years. Эта эпидемия началась весной в Мексике. The epidemic began in the spring in Mexico. Сейчас есть препараты, какие-то знания — процесс должен быть более быстрый. Now there are drugs, some knowledge of - the process should be faster. Многие дома сидят, но кто-то еще не заболел, да и повторные инфекции пойдут. Many homes sit, but someone else got sick, and will re-infection. Смертность скоро возрастет, потому что сейчас много больных на ИВЛ, у кого РДС – процесс перешел в неконтролируемый. Mortality will increase soon, because now a lot of patients on mechanical ventilation who have RDS - went into an uncontrollable process. В общем, это больные с неблагоприятным прогнозом. In general, these patients with a poor prognosis. Но главное верить и молиться, что все будет хорошо. But the main thing to believe and pray that everything will be fine.