HEALTH 11/27-12/5/09 Weekly Bird&Other Flus Thread:Worldwide Transmission of D225G

Link to last weeks thread:

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

http://www.timebomb2000.com/vb/showthread.php?t=348711

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

Worldwide Transmission of D225G
​

http://www.recombinomics.com/News/11270901/D225G_WWT.html

The recently released sequences from patients in Ukraine provided valuable insight into the pathogenicity of H1N1 and the genetic change associated with the total destruction of both lungs in fatal cases. The description of the patients and the spread of receptor binding domain change, D225G, to multiple genetic bakgrounds via recombination led to the prediction that D225G would be found in the lung samples from fatal cases. The release of the sequences by Mill Hill confirmed the prediction. Sequences from 10 isolates were released and all four fatal cases had D225G. Moreover, all 9 cases from western Ukraine, which were from three Oblasts (Ternipol, Lviv, and Khmelnitsy) were from the same sub-clade as the fatal cases, but the samples from the upper respiratory tract did not have D225G. The absence of D225G from the upper respiratory tract is not a surprise because the specificity of D225G included alpha 2,3 receptors which are present in the lungs. Thus, the sub-clade with D225G can expand and cause a cytokine storm which destroys the lungs. Moreover, sequences with D225G have been designated as low reactors by Mill Hill, raising concern that immune responses and vaccine will select for D225G.

Although D225G transmits from patient to patient, only the samples from the fatal cases, which were from lung and throat samples were positive for D225G. The sequences from Ukraine led other countries to more fully investigate samples. Norway, which had seen an increase in fatalities announced the detection of D225G in two fatal and one severe case. Although those sequences have not been released, 25 HA sequences were subsequently released and one sequence had D225G as a mixture, confirming the mixed nature of samples with D225G.

Moreover, the sequence with D225G was the same sub-clade as Ukraine, and several matching sub-clades were in subsequent samples, but those samples did not contain D225G, again pointing to a requirement for sampling of appropriate tissues.

The implication of this sub-clade in the increase in deaths in Norway was the finding that the first fatality was also linked to the same sub-clade. The patient, 43F, was in previously good health and given a prescription for Tamiflu after visiting the hospital. However, she was sent home and died two days later. This type of rapid death had been noted for many of the Ukraine cases. Full sequences were generated confirming that the NA sequence was closely related to the NA sequences from western Ukraine, but the sample was from the trachea and did not have the D225G. However, the association of this sub-clade with the first patients death and the finding of D225G in the first isolate matching this sub-clade support D225G transmission as a mixture, with detection in appropriate sampling of the lower respiratory tract.

Phylogenetic analysis of public sequences indicate that the Norway/Ukraine is widespread, strong suggesting that D225G has sread worldwide. However, detection of D225G, as was seen in Ukraine requires that the proper samples are tested.

The finding of D225G in four of four fatal cases in Ukraine leaves little doubt that the polymorphism is transmitting and the recent classification of Ukraine sequences wirg D225G suggests the spread will accelerate. The finding of the same change in unlinked patients in two Oblasts in western Ukraine is similar to the finding of swine H1N1 in two counties in southern California in April. The fact that the two California cases had no link to swine or each other, and were collected from patients over 100 miles apart conclusively demonstrated that the swine H1N1 was efficiently transmitted human-to-human and many more cases would be identified.

The data from Ukraine conclusively demonstrate that D225G is efficiently transmitting and the transmission traces back to earlier isolates from Norway of the same sub-clade with D225G.

Since D225G is frequently not detected in samples from the upper respiratory tract, another method of tracking is through phylogenetic analysis, which shows that the Norway/Ukraine sub-clade is widespread, even though all HA sequences do not have D225G, as was seen in Ukraine.

The worldwide transmission of the Norway/Ukraine sub-clade, or other sub-clades with D225G raises concerns that associate hospitalizations and fatalities will have a significant uptick as an increasing number of patients get exposed to this sub-clade linked to D225G.

More surveillance of low respiratory tract infections would be useful.

D225G Evades Immune Response
​

http://www.recombinomics.com/News/11270902/D225G_Evade.html

Antigenic characterisation: A/California/7/2009 like. Low reactor

The above comment is for the updated characterization sheet for A/Lviv/N6/2009, one of the four isolates from fatal cases in Ukraine. All four isolates had D225G, and in the above isolate that was the only non-synonymous change in HA, indicating the polymorphism was escaping from the immune response.

D225G is in the receptor binding domain and therefore at the surface of HA, and several different polymorphism were noted at that position (D225G, D225E and D225N) suggesting the changes were to escape from the immune response. Moreover the change was appearing on multiple different genetic backgrounds. This is not surprising, since position 225 is in an antigenic site and D225N was linked to the establishment of S31N in the H3N2 population.

However, this low reactor status is in marked contrast to earlier studies on vaccine target clones, which indicated D225G produce no difference in titer, highlighting the vagaries of reference anti-sera data.

This escape could also explain the increases in reported D225G cases as well as increases in hospitalizations and death.

More information on the discrepancy in results from two reference anti-seras would be useful.

WHO Silence on D225G Immune Escape Raises Concerns
​

http://www.recombinomics.com/News/11270903/D225G_Escape_WHO.html

The recent upgrade of the characterization sheet for A/Lviv/N6/2009 to "low reactor" status has created significant pandemic concern. The change affects receptor binding specificity and allows the virus to bind alpha 2,3 targets which are on the lung, and also affects the antigenic site. However, early data on the development of the attenuated vaccine target indicated that there was no difference between the response to wild type and D225G. These differences have not been explained, although the testing of the candidate vaccine target would be on the cold adapted background, while the testing that produced the "low reactor" designation would be on the D225G on its natural swine H1N1 background. Initial investigations were carried out by Mill Hill, but then the CDC in Atlanta was also involved, possibly to confirm the "low reactor" results.

However, WHO has not issued any updates on this development. They have said that the D225G change in Ukraine was "not significant" even though it was in four of four fatal cases and now has been designated a low reactor. The only indication is at the GISAID database, which is public, but requires membership and is password protected. This designation has serious implications because there is direct and circumstantial evidence that D225G is circulating as a mixture, and immune responses that fail to target D226G can shift the ratio in favor of D225G, which could lead to a significant rise in severe and fatal cases.

It was the rise in severe and fatal cases that led Norway to closely examine cases there, and D225G was found in three cases (2 fatal and 1 severe). However, release of sequences from Norway identified a fourth case, where D225G was identified as a mixture with wild type. Moreover this mixture was the earliest sub-clade in Norway that matched the sub-clade in Ukraine. This sub-clade was isolated prior to the first reported fatal cases in Norway, which was also the same sub-clade, although D225G was not present in the sequence from a throat swab from that patient.

The failure of the WHO or CDC to comment on the low reactor status of the Ukraine sequences from fatal patients is also cause for concern. More detail on this designation, and vaccine plans to address this issue, would be useful.

Bleeding Lungs and Tamiflu-resistance -Do H1N1
mutations make the swine flu vaccine less effective?​

http://ukraineplague.blogspot.com/2009/11/bleeding-lungs-and-tamiflu-resistance.html

H1N1 mutations are being found all over the world, including in the United States. From the strain found in Norway and the Ukraine that is said to totally destroy the lungs, to a Tamiflu-resistant strain found in various locations, including a cluster in North Carolina, it is clear that the H1N1 virus is changing. The vaccines created to prevent an influenza infection are only effective for the particular strain of virus used in their creation. Does this mean that the swine flu vaccine will not be effective against the H1N1 mutations?

Tamiflu-resistance

The H1N1 virus has begun to develop a resistance to Tamiflu, also known as oseltamivir phosphate, a commonly used antiviral drug. The swine flu is still sensitive to another antiviral medication, and responds to treatment with Relenza, the prescription form of zanamivir.

D225G receptor binding change

The D225G H1N1 mutation affects the way the H1N1 virus attaches to host cells. This pattern is similar to the 1918 Spanish flu outbreak, which killed as many as 40 million people. Both types of influenza were highly contagious, fast-acting, and attack the deep tissues of the lungs. This causes a total destruction of the lungs, according to Dr. Victor Bachinsky, the head of the Chernivtsi regional forensic bureau.

Testing of MedImmune intranasal vaccine

Flu vaccines currently produced for use in the United States are made by injecting a flu virus into chicken eggs, where the virus replicates for use in the vaccine. During production, it was discovered that the swine flu virus that was reverse engineered for the vaccine did not replicate well in the eggs. In order to improve replication, and increase the amount of vaccine to be produced, genetic material from different viruses was mixed. During the testing process, changes in the receptor binding that resulted from the genetic manipulation did not affect the effectiveness of the vaccine.

Effects of H1N1 mutation on vaccine effectiveness

In an interview with Dr. Henry Niman, President and Founder of Recombinomics, Inc., a company devoted to research in the area of virus evolution, I asked about the potential for H1N1 mutations reducing the effectiveness of the swine flu vaccine. Dr. Niman explained that the D225G mutation was less likely to interfere with vaccine effectiveness. He had this to add:

"Theoretically, one change could significantly impact the vaccine. New isolates are routinely tested with reference antisera for "low reactors". So far one such low reactor was identified in the US, but the virus is beginning to change more rapidly, so more could appear over a short time frame."

*Antisera is the singular form of antiserum. A reference antisera is a sample of blood containing antibodies. Testing is done to see if the antibodies present in the blood react to the new virus.

Someone is finally questioning in the media, what we have already been questioning. With the change in the virus - it makes the current vaccine worthless!

Rise in pneumonia cases linked to H1N1​

http://news.xinhuanet.com/english/2009-11/26/content_12549867.htm

BEIJING, Nov. 26 (Xinhuanet) -- Health officials are finding that bacterial pneumonia cases are rising along with instances of the A/H1N1 virus. Doctors are seeing an increase in flu complications leading to pneumonia.

At the same time, cases of seasonal flu are at record levels because of the new A/H1N1 virus. The number of cases is outpacing the typical number of regular flu cases at this time of year. Cases of regular flu usually peak between December and May.

"We're seeing an increase in serious pneumococcal infectious around the country," said Dr. Anne Schuchat, who heads the U.S. National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

A flu infection thins the lining of the respiratory tract, making the lungs more vulnerable to bacteria that can cause pneumonia. CDC officials in America are urging high-risk adults to obtain vaccinations against both pneumonia and A/H1N1.

Smokers and people with diabetes, chronic heart, lung and liver disease, or HIV are considered particularly high-risk. Only 25 percent of high-risk U.S. adults under age 65 have received a pneumonia vaccination, Dr Schuchat said at a news briefing Wednesday. "It's a vaccine you pretty much get once as an adult, not every year, the way the flu vaccine works," she said.

During a regular flu season, most serious cases of flu and flu-related pneumonia occur in people 65 or older. However, people younger than 65 are far more vulnerable to A/H1N1, because the virus is unlike any other flu their bodies have come in contact with.

The CDC also announced that 7 million more doses of the A/H1N1 vaccine have been made available since Friday, bringing the total doses available so far to 61.2 million in America. The health organization has also studied safety data since A/H1N1 vaccinations were started in early October. "So far, everything we've seen is very reassuring," Dr Schuchat said, " ... we're seeing patterns that are pretty much exactly what were seeing with the seasonal flu vaccine."

There have been some side effects though it counts for a very small percentage of those receiving the inoculation. Most of the reported side effects include sore arms and tenderness at the injection site. But health officials are particularly interested in a side effect that can cause a rare neurological illness called Guillain-Barre syndrome.

In 1976, there was an alarming rise in Guillain-Barre cases following a large-scale pandemic vaccination program. However Dr Schuchat said only 10 potential cases of Guillain-Barre have so far been reported in the U.S.

Two weeks ago it was been reported that a French woman suffered a crippling illness after receiving the A/H1N1 vaccine. The woman, identified only as a health worker, was diagnosed with the crippling illness Guillain-Barre Syndrome (GBS) after a flu shot. It followed other reports about an American teenager from Virginia who was similarly struck down by the disease hours after receiving the A/H1N1 vaccine.

According to the French health ministry the woman became ill within 6 days of being inoculated. Health Minister Roselyne Bachelot said the case diagnosed was light and that the woman was recovering. The Deutsche Press-Agenture said, news of the apparently vaccine-related illness is likely to dampen enthusiasm here for getting vaccinated against A/H1N1 flu.

There has also been outrage after it was reported in Germany that some ministers as well as the armed forces there received a special additive-free H1N1 vaccine that didn’t contain ingredients such as mercury and squalene that were included in shots for the general public.

France’s H1N1 flu vaccination program has barely even begun and reports of side-effects may shake the confidence of the public. According to the French paper Le Monde around 83 percent of the French public say they would not take the vaccine.

Similar resistance to taking the vaccine is widespread throughout the continent, from Scandanavia to Bulgaria to the Netherlands. In Germany only 13 percent of respondents to a survey said they would take the vaccine. There have only been a few reported deaths connected to the vaccine.

Meanwhile there was concern recently in the Ukraine where nearly two hundred died in what's been described as an outbreak of a new "super flu". The Sunday Express in Britain said that a "cocktail of three flu viruses" were reported to have mutated into a single pneumonic plague.

The death toll has reached 189 and more than 1 million people may have been infected, most of them in the nine regions of Western Ukraine, the Express reported. President of Ukraine Viktor Yushchenko called in the World Health Organization and a team of nine specialists carried out tests in Kiev and Lviv to identify the virus, samples of which were sent to London for analysis.

However, the World Health Organization says tests on the samples from Ukraine showed no significant mutation of the virus. WHO had sent an expert team to Ukraine last week after reports of the unusual flu outbreak.

The global body said Tuesday that preliminary genetic sequencing at laboratories in Britain and the United States showed that the virus in Ukraine was similar to that used for production of the pandemic flu vaccine. The Ukrainian Health Ministry has registered some 1.4 million cases of flu and respiratory illness since the start of the A/H1N1 flu outbreak. The WHO says most cases are likely to be the A/H1N1 virus and the infection rate is in line with neighbouring countries such as Russia and Poland.

Has the Ukraine swine flu mutation spread to the United
States? Hemorrhaged lungs found in autopsies​

http://www.examiner.com/x-29228-LA-...d-States-Hemorrhaged-lungs-found-in-autopsies

A county medical examiner in Iowa has come forward to inform the public of the results of autopsies that point to bleeding in the lungs, just as in the fatal cases in the Ukraine and Norway. Many of these cases went undiagnosed as H1N1 due to the acute condition of the patients, and the invasive nature of testing.

Norway/Ukraine flu in the United States

The H1N1 mutation found in the Ukraine and in Norway is characterized by acute respiratory distress. According to Professor Victor Bachinsky, PHD, head of the Chernivtsi regional forensic bureau, the mutated form of the swine flu present in the Ukraine cause the lungs to bleed, and in essence, the total destruction of the lungs.

In an interview with Des Moines, Iowa KCCI News, Dr. Gregory Schmunk states, "In the autopsy, what we're seeing is very heavy, wet hemorrhagic lungs, lungs with a lot of blood in them."

H1N1 mutations around the world

H1N1 mutations have been identified around the world, including Brazil, China, the United Kingdom, Norway, the Ukraine, and here in the United States. Currently identified mutations include a strain that is resistant to Tamiflu, an antiviral medication, and the strain that causes bleeding in the lungs.

Moreover, sequences with D225G have been designated as low reactors by Mill Hill, raising concern that immune responses and vaccine will select for D225G.

Click to expand...

Oh, crap.


Helpful (and frightening) articles. Thanks for posting, JPD.

D225G and H274Y in Fatal Infection in France​

http://www.recombinomics.com/News/11270904/D225G_H274Y_France.html

In a statement, the Institute suggests "Reference of mutations in the genome of influenza virus A-H1N1" from these two people who had no relationship and were hospitalized in two different cities. InVS was that for one of these patients, in addition to this mutation, another known mutation that is resistant to Tamiflu, the drug used to treat people infected with the virus.

The above translation describes two fatal cases in France with D225G. Moreover, one of the two cases also had Tamiflu resistance, presumably H274Y.

The presence of D225G in unrelated patients at distinct locations mirrors the results in southern California in April, when swine H1N1 was initially reported in the United States. The same strain in two patients who had no link to swine or each other signaled efficient transmission. The same is true for D225G. It is in multiple patients in multiple countries and appearing at increasing frequencies at the same time.

The finding of Tamiflu resistance in one of the fatal infections raises additional concerns. The circumstances surround the resistance would be useful. The number of reports of H274Y have spiked in the past week, suggesting it too is efficiently spreading at a detectable level.

WHO Mis-statements in D225G and H274Y Raise Concerns
​

http://www.recombinomics.com/News/11270905/WHO_Mis.html

Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine. Analyses are being performed by two WHO influenza collaborating centres as part of the global influenza surveillance network.
Preliminary genetic sequencing shows that the virus is similar to the virus used for production of the pandemic influenza vaccine, reconfirming the vaccine's efficacy at this time.

The above WHO comments in their latest Ukraine outbreak update are unfortunate. The comments were made after sequences had been generated which showed that four of four fatal cases in Ukraine had the receptor binding domain change D225G. This change had been predicted because it is the type of change expected for the large number of deaths which were linked to the rapid destruction of both lungs. D225G had been identified in 1918 and 1919 lung samples from fatal infections and analysis of the change identified a change in receptor binding specificity, which included alpha 2,3 receptors found on human lung epithelium. The failure of WHO to consider such a change significant raises serious concerns about the agency's credibility and scientific underpinnings.

Moreover position 225 is in one of the known antigenic sites, so to declare a confirmation of vaccine efficiency was false. H1N1 sequences with three changes at position 225 (D225G, D225E, and D225N) had already been reported and D225N on H3N2 was associated with the fixing of S31N (Adamantane resistance) in seasonal H3N2. Thus, a change at that position did not confirm the efficiency of the vaccine and the characterization sheet for one of the four sequences from the fatal cases was just declared a "low reactor" indicating the efficacy of the vaccine was not confirmed and the cause was likely to be D225G since it is the only non-synonymous HA change on the Ukraine sequences from fatal cases.

The failure of WHO to correctly report on the receptor binding domain after the sequences had been generated destroys confidence in the agency at a most crucial time. In addition to targeting of the lungs and a reduction in vaccine efficiency,Tamiflu resistance is on the rise and one of the fatal D225G cases in France also has H274Y, raising concerns at a time when WHO is posting situation updates which are not credible.

They then compound this lack or credibility by claiming that the D225G, which is four unrelated cases in Western Ukraine are "spontaneous" which is also the characterization of oseltamivir resistance, H274Y. These claims have no scientific basis and are simply absurd.

These statements by WHO, at a time of extremely peril, are both scandalous and hazardous to the world's health.

WHO Confirms D225G Vaccine Failure
​

http://www.recombinomics.com/News/11280901/WHO_D225G_Vac.html

One isolate from Ukraine with the mutation had changed so that swine flu vaccine probably would not protect against it well, Britain's national medical laboratory reported Friday.

Flus mutate so fast, Dr. Fukuda cautioned, that announcing each change is "like reporting changes in the weather."

The above quote from tomorrow's NY Times piece by Donald McNeil, acknowledges the vaccine failure for viruses with D225G. However, although WHO has publicly confirmed the failure, they don't think an announcement is required. Thus, they continue to offer altering opinions on the significance of D225G, which directs H1N1 to the lung and was present in four of four fatalities in Ukraine.

The associate of D225G with the Ukraine fatalities led to a survey of samples in Norway, where D225G was found in three patients (two who died and 1 who was in serious condition). Similarly, France found D225G in two fatal infections, including one who was Tamiflu resistant.

However, even though this change is drawing additional attention daily, WHO has taken a position that the vaccine failure against H1N1 with this D225G is not worthy of an announcement.

This mindset is significant cause for concern and is hazardous to the world's health.

WHO advisors paid by H1N1 vaccine makers profiting on fear? ​

http://www.youtube.com/user/RussiaToday#p/u/27/fHr90s4YeAA

You Tube Video

From: RussiaToday | November 25, 2009
It's the kind of information that fuels conspiracy theorists everywhere... Danish journalists claim several World Health Organisation advisers are on the payroll of leading pharmaceutical companies that make swine flu vaccines. RT talks to Louise Volle, a journalist at the Danish Daily Information newspaper and a co-author of the report.

Belarus Ministry Of Health Can Not Say How Many Are
Sick Or Dead from Bleeding Lungs - Lungs Disintergrating!​

http://ukraineplague.blogspot.com/2009/11/belarus-ministry-of-health-can-not-say.html

While the general background of reducing morbidity in the country doctors extinguish the fire of pneumonia, the chief sanitary doctor still says that the country is under control. Цифр смертности не называет. Mortality figures are not called. И надеется на «иммунную прослойку» переболевших граждан, пишет naviny.by . And hopes for "the immune stratum" recover from citizens who wrote naviny.by.

В интервью ток-шоу «Выбор» на канале ОНТ главный санитарный врач Беларуси Валентина Качан выразила удивление тем, что работающие непосредственно в больницах врачи говорят о большом количестве тяжелых пневмоний и неожиданно большом числе госпитализированных: «Когда говорят, что медики были в растерянности, они все-таки немного лукавят». In an interview with talk show "The Choice" on ONT chief medical officer Valentina Kachan expressed surprise that working directly in the hospital doctors say the high number of severe pneumonia and a surprising number admitted: "When they say that doctors were perplexed, they Still a little cunning.

На днях были опубликованы откровения врача-реаниматолога Добрушской районной больницы Евгения Лопанова, по словам которого, рост числа заболевших пневмонией напоминает снежный ком. Recently published revelations Pediatric Dobrush regional hospital Eugenia Lopanova, according to which, the increase in the number of cases of pneumonia resembles a snowball.

Врач объяснил, что болезнь протекает как обычный грипп – начинается со слабости, недомогания, повышения температуры, нарастает одышка, появляется кашель, боли между лопаток, в суставах, могут быть нарушения со стороны пищеварительной системы – рвота, тошнота, отсутствие аппетита, диарея. The doctor explained that the disease is like a normal influenza - begins with weakness, malaise, fever, shortness of breath increases, there is a cough, pain between the shoulder blades, joints may be a violation of the digestive system - vomiting, nausea, anorexia and diarrhea. «Человек обращается, когда его мучает одышка, он не может дышать, сухой кашель, и самое плохое – когда он обращается с мокротой с содержанием крови, это уже отягощающий фактор, говорит о том, что легочная ткань начала разрушаться», – перечислил симптомы реаниматолог. "Man is drawn when he was tormented by shortness of breath, he can not breath, dry cough, and the worst - when it deals with sputum containing blood, is already aggravating factor, suggests that lung tissue began to disintegrate," - listed the symptoms of resuscitator .

Валентина Качан заверила: «Нельзя говорить, что все пневмонии в Беларуси теперь вирусные». Valentine Cachan assured: "We can not say that all the pneumonia virus in Belarus now. Проблема, по ее словам, скорее в том, что выделяется несколько микроорганизмов, устойчивых к антибиотикам и противовирусным препаратам. The problem, according to her, rather that single out a few microorganisms that are resistant to antibiotics and antivirals.

Валентина Качан сослалась на пакет документов, который нарабатывался с апреля и корректировался в течение всего периода эпидемического подъема заболевания, когда ежедневно заседал штаб по борьбе с гриппом. Valentine Cachan referred to the documents, which is accumulating in April and adjusted during the period of epidemic rise of the disease, when the day met at the headquarters to fight the flu. Она также напомнила, что были перепрофилированы койки, привлечены к работе в медучреждениях студенты, «никто не остался без консультации», а во всех сложных случаях дополнительно привлекались различные специалисты. She also recalled that there have been redeveloped beds, brought to work in the hospitals of the students, "no one was left without consultation, and in all difficult cases, in addition to bring in different specialists.

При этом Валентина Качан подчеркнула, что говорить о том, что перепрофилировались места в спешном порядке, неправильно. This Valentine Cachan stressed that say that retrained place in a hurry, wrong. «Другое дело, что время требовало быстрого принятия решений, и мы присоединили койки в Аксаковщине, Городище для тех больных, которые уже выздоравливали», – сказала она. "Another thing is that the time required rapid decision-making, and we joined in bed in Aksakovschina, City for those patients who have recovered," - she said.

По данным Минздрава, на 23 ноября в Беларуси лабораторно подтверждены 179 случаев свиного гриппа, в том числе за период эпидемического подъема заболеваемости – 153 случая. According to the Ministry of Health, on November 23 in Belarus, 179 laboratory confirmed cases of swine flu, including the period of epidemic rise of morbidity - 153 cases. Всего за период мониторинга грипп типа А (в том числе свиной грипп) был выявлен в 22,3% случаев, В – в 3,3%, вирусы парагриппа в 8,2%, аденовирусы – в 21%, респираторно-синтициальный вирус – в 17,7%. During the period of monitoring influenza type A (including the swine flu) was detected in 22.3% of cases in - in 3,3%, parainfluenza in 8.2%, adenoviruses - 21%, respiratory syncytial virus -- in 17,7%.
По состоянию на 19 ноября вирус свиного гриппа был обнаружен у 13 человек, умерших от пневмонии. As of November 19 swine flu was detected in 13 people who died of pneumonia. У всех этих людей была смешанная инфекция. All these people had a mixed infection. Другую информацию о случаях смерти от пневмоний Минздрав не предоставляет. Further information on deaths from pneumonia in the Ministry of Health does not provide.

Валентина Качан подчеркнула необходимость учитывать, что лабораторно на свиной грипп в Беларуси обследуются заболевшие ОРВИ дети до двух лет и лица, которые переносят грипп в тяжелой форме. Valentine Cachan stressed the need to take into account that the laboratory at the swine flu in Belarus are examined acute respiratory ill children up to two years and those who suffer a severe flu. Поэтому точно сказать, сколько белорусов переболели гриппом А/H1N1, не может даже Минздрав. So to say exactly how many Belarusians chickenpox influenza A/H1N1, not even the Ministry of Health.

При этом конкурс на поставку вакцины от свиного гриппа в Беларусь уже объявлен. In this competition for the supply of vaccine against swine flu in Belarus has already declared. Ожидается, что вакцина поступит в конце ноября – начале декабря. It is expected that the vaccine will do in late November - early December.

«Белорусские новости» уже задавались вопросами – как можно говорить о конкурсе на закупку вакцин, не называя при этом объем поставок? "Belarusian News" has already asked the question - how can one talk about the competition for the purchase of vaccines, without naming the volume of supply? Как люди могут принять решение о вакцинации, когда не владеют информацией о количестве случаев заболеваемости, его осложнениях? How can people decide to vaccinate, when not possess information on the incidence of disease, its complications?

Валентина Качан частично ответила на них во время интервью «Выбору». Valentine Cachan partially responded to them during the interview "Choice". По ее словам, сегодня есть опыт других стран и рекомендации ВОЗ, которые позволяют и без точной статистики о количестве переболевших проводить расчеты по вакцинации. According to her, today there are other countries' experiences and recommendations of WHO, which allow and without accurate statistics on the number of payments to recover from the vaccination.

По состоянию на 21 ноября против сезонного гриппа в Беларуси привито 1 010 632 человек, что на 35,9% больше, чем в 2008 году. As of November 21 against seasonal influenza in Belarus vaccinated 1 010 632 people, which is 35,9% more than in 2008. При этом ВОЗ рекомендует вакцинацию 20% жителей. At the same time, WHO recommends vaccination of 20% of the population. Если к привитому миллиону прибавить миллион переболевших ОРВИ, то это количество, по словам В.Качан, создаст в обществе иммунную прослойку, которая позволит надеяться, что вторая волна заболеваемости «не будет такой тяжелой». If the grafted million to add a million recover from SARS, this quantity, according to V. Cachan, create a society immune layer, which will hope that the second wave of disease "will not be this difficult.

Валентина Качан подчеркнула, что по тому количеству людей, которые выздоровели, получив в полном объеме лечение, можно судить, что рост заболеваемости гриппом не стал неожиданностью для белорусской системы здравоохранения. Valentine Cachan underlined that according to the number of people who have recovered, having received the full treatment can be judged that the increase in the incidence of influenza was not a surprise for the Belarusian health care system. «Если бы это было неожиданностью, наши потери были бы гораздо больше. "If it was a surprise, our losses would have been much greater. Мобилизация всех средств и сил, начиная с мая, позволила оказать необходимую помощь. The mobilization of all means and forces, beginning in May, allowed to assist. Однако врачи не боги», – сказала она. However, doctors are not gods ", - she said.

They plainly say above, very few people have gotten the Swine Flu - Yet ALL the people who are sick or have died of Bleeding Lung and the Destruction of the Lungs - which they admit IS HAPPENING - They WILL NOT SAY HOW MANY?

I am completely lost here, I still continue to be in amazement that the WHO and governments of the world who are having these "pneumonic plague" type sickness and deaths are NOT coming out in the opened about them!

People need to be Educated on what is happening in the world, so they then can take steps to help themselves in prevention of it!

Isn't that what WHO's job is? Prevention of Diseases? So why are they NOT doing their job? They keep denying there is anything else wrong, even when Government Officials acknowledge Bleeding Lungs and disintegration of lungs!

Ukraine Cross-Linked HA and NA Silent Changes Circle the Globe​

http://pf11.blogspot.com/2009/11/ukraine-cross-linked-ha-and-na-silent.html

Cross-Linked HA and NA from Norway to the Ukraine

* HA:syn413K encoded from A1281G, AAa->AAg *
* NA:syn407V encoded from T1221C, GTt->GTc *

* SNP Matches the 4 fatal flashfire cases

* Ukraine LvivN2
* Ukraine LvivN6
* Ukraine TernopilN10
* Ukraine TernopilN11
* HA and NA Norway3364-2
* HA and NA CatS1096
* HA and NA CatS1162
* HA and NA CatS1179
* HA and NA CatS1181
* HA and NA CatS1267
* HA and NA CatS1268
* HA and NA CatS1402
* HA and NA CatS1501
* HA and NA CatS1687
* HA and NA CatS1748
* HA and NA CatS1751
* HA and NA CatS1761
* HA and NA Guangdong02
* HA and NA Guangdong05
* HA and NA SingaporeON1156
* HA and NA Stockholm31
* HA and NA Omsk02
* HA and NA NY3702
* HA and NA NY3715
* HA and NA NY3828
* HA and NA RhodeIsland08

26 sequences have encircled the globe carrying a cross-segment paired set of background markers matching and potentially contributing to the Ukraine fatal cases. Areas covered include the Northeastern United States, China, Singapore, Russia, Norway, Sweden and extensive penetration in Spain (almost half of the dual matches, 12 sequences). This particular background pattern may precurse 225G and mixtures of 225D / 225G. If LvivN6 is officially confirmed as a vaccine escape event, these cross-segment pairs may be surveilled as potential future effectors of vaccine efficacy failure.

Publication of the remaining Neuraminidase segments for the 34 Norwegian and Japanese specimens bearing HA syn413K would allow a more precise review. Although 9 of the recent sequences from Norway carry syn413K, none of the 225E strains from Norway have the syn413K. The patterns are highly suggestive that all of the 225G strains do.

France Follows Suit on Continent with 225G in Fatalities,
Including a 225G Case with TamiFlu Resistance​

http://pf11.blogspot.com/2009/11/france-follows-suit-on-continent-with.html

France announces the presence of 225G associated with fatalities and indicates that one of the 225G strains is also TamiFlu Resistant.

Less than one week after the first official announcement from Norway, western Europe has a growing coverage of confirmed and probable 225G cases. As we mentioned on the 23rd of November, many countries will now open their databases concerning this RBD change. Those databases will confirm not that 225G is spreading, but that 225G was already widely dispersed and is spreading faster than we had previously been led to believe.

A glaring signal is apparent concerning the public's right to information that may protect their health. Release of important policy-making and family protection information has been blocked as the taxpayer-funded research centers and public health officials continue to withhold even the sparse data from the limited surveillance that has been conducted.

The leading world health agency reports a rise in TamiFlu Resistant sequences to 75 cases, geographically dispersed, while continuing to read the script of "spontaneous mutation, not transmitting" over the increasing set of clustered cases. All TamiFlu Resistant cases from PF11 have had the same Single Nucleotide Polymorphism coding for 275Y in the Neuraminidase and this French case is expected to follow suit. Not random and not spontaneous. We have tracked the details of the 13 available public anti-viral resistant sequences for variation.

225G is now being reported widely as countries increase transparency concerning the antigenic diversity and transmissibility of strains carrying this important Receptor Binding Domain change that has, on lab examination of the 1918 strains, conferred dual receptor specificity for tissue in the upper respiratory system and the deep lung tissue.

Countries with Probable * or Confirmed 225G

* United States
* Brasil
* Spain
* Japan
* Hong Kong *
* China
* Mexico
* Russia
* Australia
* Saudi Arabia
* Ukraine
* France *
* Norway
* Sweden *
* Finland *
* Singapore (4 with 225X encoded from aNy nucleotide) *

This drug resistant strain with antigenic diversity in France, an international travel hub, is one Hydra head that merits deep scrutiny.

Several questions come to mind concerning the French report considering the paired cross-segment changes on the Norway3364 sample from September, HA syn413K and NA syn407V. At the instant that research centers are identifying cross-segment linkages, we are now presented with a second set of pairs crossing the same two segments, HA 225G and NA 275Y.

Are the French cases contemporary? What are the clinical details? Note also that France published one of the first 225E sequences with Paris2591 from a 23M on 2009-05-01.

225G and 225E strains are co-circulating around the world, in one French case with TamiFlu Resistance, killing hosts quickly by destroying the lungs. Of deepest interest is the exhibition of clear vaccine escape signals if the low reactor status update of one recent Ukraine 225G, LvivN6, is validated. Antigenic diversity, whether due to viral response to human immunity, anti-viral selection pressure or vaccine pressure, is a certainty.

ΣPF11 is now officially Hydra.

WHO Silence on D225G Vaccine Mismatch Confuses Media
​

http://www.recombinomics.com/News/11280902/WHO_D225G_Silence.html

The vaccine can still prevent the virus from entering body cells to reproduce. These new changes should instead encourage all French to go to be vaccinated with adjuvant.

The above translation is from a French story on the discovery of D225G in two fatal French cases, one of which was also Tamiflu resistant. Because of the failure of WHO to disclose the "low reactor" status of Ukraine H1N1 with D225G, media reports are distributing the false information, stating that the activity of the vaccine is unaffected by D225G.

This misinformation is fueled by the WHO update on Ukraine, which stated that the vaccine appeared to be unaffected based on the sequence. For the "low reactor" the HA only had one amino acid difference, which was D225G.

As has been noted daily in new media reports, D225G is widespread, and phylogenetic analysis shows that the sub-clade in Norway and Ukraine is even more widespread than reported isolates with D225G, raising concerns that the D225G is circulating undetected because most samples are collected from the upper respiratory tract, while D225G is largely in the low respiratory tract.

The designation of a "low reactor" means that the titer of a reference anti-sera is reduced by at least 4 fold. A four fold reduction in titer is typically called a mis-match and mismatched vaccines are a concern because a vaccination will not eliminate the new changes that reduced the titer, but will eliminate the wild type that competes with the variant. Therefore the use of a poorly matched vaccine leads to increased vaccine resistance and in this case would select for D225G.

The failure of WHO to address this issue is the height of irresponsibility. Although the NY Times noted the Ukraine low reactivity due to D225G, it is not clear that the WHO comments were in response to the vaccine failure, since similar statements were made at the WHO virtual press conference and the reactivity of the vaccine was not addressed in statements or answers to questions, although the weatherman comment was in responce to questions about D225G..

Therefore a statement by WHO is long overdue to end that false information distributed through media reports and the WHO needs to address plans to deal with the vaccine failure against D225G and potential similar failures against D225E and D225N which are also widespread.

WHO Weather Report on Ukraine H1N1 D225G Required​

http://www.recombinomics.com/News/11280903/WHO_D225G_Weather.html

The question is whether this mutation again suggests that there is a fundamental change going on in viruses out there or whether there is a turn for the worse in terms of the severity. I think that the answer right now is that we are not sure. I want to answer why we are not sure in a way which explains why more investigations are needed. As you know these influenza viruses change frequently. Their gene properties change because these are viruses which frequently undergo mutations and so mutations in and of themselves are not necessarily important and in fact, if every mutation was reported out there, it would be like reporting changes in the weather -

The above comments from Keiji Fukuda at Thursday's virtual press conference are in context, which highlights the need for additional data on D225G. However there is a large body of evidence on this change and the Ukraine data is the most current and quite compelling. Ten samples were collected from ten patients and nine represented the same sub-clade. However, only four were from tissues from fatal cases, but all four had D225G. In contrast, nasopharyngeal washes were collected from the five surviving patients in western Ukraine and all sequences were the same sub-clade, but did not have D225G. The finding of D225G in 100% of the fatal cases raises concerns, but the number of such cases is small. However, well over 400 people have died in Ukraine, so additional samples from fatal cases should not be a problem, and collection of samples from both upper and respiratory tracts in the same patient would be useful.

An aggressive campaign on this change is warranted because the only reported tested sample for antigenicity was found to be a low reactor, and the only amino acid change in the HA sequence was D225G. Since the same sub-clade was found in earlier collections in Norway, and the cases positive forD225G were fatal or severe, more interest in the change has been generated, but media reports state that the vaccine is effective against D225G, when the data presented on the Mill Hill characterization sheet at GISAID cites the antigenicity as being "low reactor", signaling a need for a new vaccine.

It has now been a month since the reported Ukraine samples were collected and hundreds have since died, so additional sequence data on fatal cases, including upper and lower respiratory tract origins from the same patient, should be available at this time.

Therefore, release of these sequences and a statement on the initial results, including the vaccine low reactor status of isolates from fatal cases in Ukraine, would be useful.

Finding a receptor binding domain change which alters specificity in 100% of fatal cases is cause for concern, and release of additional sequence data is overdue, since some still need a weatherman to know which way the wind is blowing.

Week 46 Sets Record H1N1 US Pediatric Fatalities​

http://www.recombinomics.com/News/11280904/Pediatric_178.html

There were 35 influenza associated pediatric deaths reported week 46: NH (1), MA (1), RI (2), PA (2), MN (1), MO (1), NC (2), FL (3), TN (1), TX (2), CO (1), NM (8), WA (1), CA (1), IL (3), IN (1), KY (1), NY (1), SC (2)

The above description of the 35 fatal pediatric deaths in week 46 in the US will be published on Monday. The 35 ties that daily record set two weeks ago, and the new entries raise the 2009/2010 season total to 178, which is a new record. The 138 last week represented the highest tally since adolescent fatalities became mandatory, when 142 died in 2003/2004. 178 is a new all time high, but it will be broken each week until there is a break, which may not happen in 2010.

The pediatric deaths allow for a true comparison of swine flu to seasonal flu, because the tally represents lab confirmed cases for both, in contrast to the much cited 36,000 seasonal flu casualties which is an estimate and largely (90%) represents fatalities who are over 65.

However, week 46 is still the beginning of the traditional flu season, and since the start of mandatory reporting, the first reported fatality for the season is in January, so the season total for week 46 has always been zero.

H1N1 swine flu mutation spreads, deaths worldwide on the rise​

http://www.digitaljournal.com/article/282843

As health officials seek to smooth concerns over the prospect of a more voracious H1N1 swine flu mutation, evidence mounts that the mutated strain is spreading.
With the World Health Organization reporting an increase of over 1,000 swine flu deaths in one week, health officials have been grappling with public awareness of the pandemic's potency - saying the mutations do not pose any significant threat to public health.

However, with the deaths of two French patients infected by the same mutation as that recently found in Norway, there is growing evidence that the more virulent mutated strain is spreading. The two Frenchmen who were reported on Saturday to have died from the H1N1 mutation did not appear to be in communication with each other prior to their infection, and both had been hospitalized in two different cities - supporting the concern that the mutation is arriving in an organic manner from the general flu ecology.
"The mutation could increase the ability of the virus to affect the respiratory tracts and, in particular, the lung tissue," France's Health Surveillance Institute said. However, it said that the vaccine remains effective against the mutation.

The World Health Organization has reported a swine flu death toll of nearly 8,000 people worldwide, with surges in deaths reported in the Americas and across Europe. Additionally, European nations are reporting the presence of a more dangerous mutation of the H1N1 influenza virus - with observations now seen in the Ukraine, Norway and France.

"The question is whether the mutations again suggest that there is a fundamental change going on in viruses out there - whether there's a turn for the worse in terms of severity," WHO's special adviser on pandemic influenza Keiji Fukuda said, according to Gulf Daily News. "The answer right now is that we are not sure."

Southeast Sulawesi ::: H1N1 detected in pigs​

http://birdflucorner.wordpress.com/

Southeast Sulawesi – A farm in Kecamatan Uepai, Kabupaten Konawe allegedly infected by H1N1 virus and might be transmitted to birds.

Head of Agriculture Service of Southeast Sulawesi, Mansur, confirmed swine flu case has been spreading in pig farm in Langgomea village. Of 24 pig samples sent to Veterinary Research Center in Maros, one has been tested positive H1N1 virus, Mansur said.

The pig samples were derived from a farm which showed sickness and flu symptoms in pigs. Prompt actions have been done by disinfection and isolation to surrounding area.

“We isolated the suspected are within a radius of 200 meters. Any animal transportation in and out is prohibited to prevent transmission from pigs to birds,” said Mansur.

However, possibility of disease transmission is low because pig farms in Southeast Sulawesi are centralized only in transmigration area resided by Balinese. As a moslem country, pig farming is not common in Indonesia, and it is usually done by non-moslems such as Balinese.

Health Service officials has distributed Tamiflu to local public health center to anticipate any transmission to human.

Source: Indonesia local newspaper, Jurnal Nasional. http://www.jurnalnasional.com/show/search?id=newspaper&page=1&rubrik=Nusantara&berita=112546

Egypt confirms Bird flu case ​

http://bikyamasr.com/?p=6153

CAIRO: Egypt has confirmed a new case of the deadly H5N1 Avian flu virus, commonly known as bird flu, in an announcement that has left global health workers worried that an outbreak of the virus could lead to a mutation and joining with the H1N1 virus, or Swine flu. If that were to happen, experts say, it could trigger a massive pandemic the world has yet to see, but despite the worries, the ministry of health in Egypt has said the case is isolated and does not pose a major threat.

The 3-year-old boy from the Minya governorate, was admitted to a local hospital on November 21 and after the ministry and hospital officials conducted tests, it was confirmed on Friday that the boy had the bird flu virus.

According to the ministry, the young boy is currently in stable conditions after he was given the anti-viral drug, Tamiflu. The ministry said that he had come into close contact with dead, or sick, poultry.

Egypt has been struggling to educate its population over how to protect oneself from the virus, which until this case, had become nearly dormant, but the ministry said in a statement that the risk remains real.

His sickness was confirmed by the Egyptian Central Public Health Laboratories. The World Health Organization has confirmed 89 cases of the deadly bird flu in Egypt, which first surfaced in early 2006. Of those cases, some 27 people have died as a result of the virus, nearly three times as many deaths compared to Swine flu.

Egypt has seen over 3,000 reported cases of the Swine flu and has taken extreme measures in order to halt the spread of the virus. All the country’s pigs were culled last summer after initial reports of the virus arriving in the country was reported on June 2.

According to the Mayo Clinic, health officials worry that a global outbreak could occur if a bird flu virus mutates into a form that transmits more easily from person to person. Researchers are working on vaccines to help protect people from bird flu.

H1N1 RBD Changes at 225 Create Vaccine Mismatch Concerns
​

http://www.recombinomics.com/News/11290901/RBD_225_Mis.html

Originating Laboratory provider of clinical specimen(s)
and/or virus isolate(s)
[Ukraine, Kiev] Ministry of Health of Ukraine

Address:
Central Sanitary Epidemiological Station 41 Yaroslavskaya str. 04071 Kiev Ukraine

Sample ID given by the sample provider

Submitting Laboratory generator of data
[UK, London] WHO Collaborating Centre

Address:
The National Institute for Medical Research (NIMR) The Ridgeway - Mill Hill London NW7 1AA, UK

Sample ID given by the sequencing lab:

Antigenic characterisation:
A/California/7/2009 like. Low reactor

The above characterization of A/Lviv/N6/2009, which was placed on deposit at GISAID by Mill Hill, raises concerns about the evasion of pandemic H1N1 sequences which change position 225. The above isolate has only one amino acid change in HA, D225G, which strongly implicates D225G in the low reactor results. A low reactor reduces the titer by four fold or more, which signals a mismatch. Mismatched vaccine create the potential for the section of the variant, which could create problems since D225G was found in four of four fatal cases in Ukraine, and several countries (Brazil, Ukraine, Norway, France, China) found D225G in fatal and or severe cases.

Moreover, since D225G changes receptor specificity, it may transmit undetected because of an emphasis on nasal pharyngeal samples where levels would be expected to be lower. This was seen in five additional nasopharyngeal washes from Ukraine survivors, who were infected with a sub-clade that matched the fatal cases, but lacked the D225G.

Similarly, the first matching sub-clade isolate in Norway was a mixture of D225G and wild type. Public sequences from subsequent sub-clades were negative, but the sequence from the first reported fatal cases appears to be one of multiple collections, and the WHO briefing on the situation in Norway stated that D225G was detected in the first fatal cases, suggesting this case was also infected with a mixture. The ratio of D225G to wild type would increase under vaccine selection pressure, as indicated by the "low reactor" status of the isolate above. Although the sequence databases under-represent the transmitting levels of D225G, the positive samples have been collected throughout the world, and these levels may be increasing.

Moreover, position 225 has undergone additional changes in pandemic H1N1. D225E and D225N have been detected worldwide also raising concerns that these isolates will also be low reactors and also increase because immunological escape. Similarly, mixed signals have been seen for D225E and multiple codons encode D225E, suggesting it too may be selected by immune response. Since most of these isolates were collected prior to the distribution of the exiting vaccine, it is likely that selection was being driven by host's immune e response.

More information on the antigenic characterization of additional receptor binding domain isolates, especial those that alter postion 225, would be useful.

Trying last-ditch lung bypass for worst H1N1 cases​

http://www.omaha.com/article/20091129/LIVING07/711259979

WASHINGTON (AP) — A technology originally developed for premature babies may be helping to save some of the sickest H1N1 flu patients by rerouting their blood so their lungs can rest.

It's a risky approach using equipment that only certain specialized hospitals have. But faced with children and young adults struggling to breathe despite ventilators has intensive-care doctors dusting off these machines, named ECMO, that they often consider last-ditch and almost never use for influenza.

“It was pretty scary knowing that was his blood flowing through those tubes in and out of his body,” says Susie Damm of Omaha, Neb., whose 19-year-old son Ryan survived a life-threatening bout after 10 days on ECMO.

“I was one of the people sick and tired of hearing about the swine flu, thinking people were making a big deal of it,” she adds. “Now I've had a different look, and I'm very, very thankful” he survived.
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No one knows which patients are most likely to benefit — not everyone does. But ECMO is gaining attention after Australian researchers reported that the machines helped during that country's outbreak of what scientists call the 2009 H1N1 flu strain. A voluntary U.S.-based registry counts 107 critically ill swine flu patients recently treated with ECMO, most from this country.

In Omaha, Dr. Jeff DeMare credits the technique with saving Ryan Damm and 7-year-old Tania Romero-Oropeza after both patients' lungs went from clogged to nearly useless in a stunning matter of hours. Tania's care was complicated by a drug-resistant staph infection.

“You wonder, ‘OK, we've got a lot of folks who get this disease and why is it so bad in some cases?' We don't have a real good handle on that,” says DeMare, a critical care specialist at Children's Hospital & Medical Center.

Whatever the reason, “your body needs time to fight the infection,” he adds, and he gambled that the pricey equipment could buy that time.

Estimates from the federal Centers for Disease Control and Prevention suggest that swine flu has hospitalized 98,000 Americans in the past six months, and killed nearly 4,000. For most, standard treatment works.

But the sickest often need ventilators to pump their lungs, and ventilators damage lung tissue, especially as they're turned up to higher pressures as patients worsen.

Hospitals are “exhausting all measures” on those patients, says Dr. Pauline Park, a University of Michigan ICU co-director who's helping to analyze the ECMO registry in hopes of determining best candidates. “Physicians don't want to give false hope to families, but also don't want to stand by if a life can be saved.”

Enter ECMO, decades-old technology that essentially offers a temporary lung bypass. Tubes carry blood out of the body so a filter can remove carbon dioxide and reinfuse oxygen, and then dump the blood back.

It's a twist on the heart-lung machine used for open-heart surgery, modified so that patients can stay on the machine for weeks instead of just hours and, key here, so that blood doesn't have to bypass the heart if only the lungs need a rest.

There are many cautions. It's risky, requiring blood thinners to avoid clots and posing the potential for additional infection. It can double the cost of ICU care. Only about 120 hospitals in the U.S. offer it, most just a few times a year for newborns with respiratory failure, its primary use.

ECMO in adults is hugely controversial because past research couldn't prove that it significantly increased survival.

Here's what's new:

—Australian researchers reported last month that they used ECMO in 68 critically ill swine flu patients who failed standard care, and about 71 percent survived. That research predicted some 800 people might be ECMO candidates if the U.S. experienced similar rates of swine flu.

—Coincidentally, a British study also published last month found that nearly two-thirds of adults randomly assigned to ECMO survived other types of respiratory failure — before swine flu hit — while just 47 percent survived with regular ICU care. It's the most rigorous study of ECMO performed in adults and one that has lung specialists debating wider use.

—Preliminary data from the Michigan-run ECMO registry suggests survival can reach 72 percent if recipients get it within six days of using a ventilator. With longer ventilator use, the survival rate plummets.

Back in Omaha, DeMare agrees ECMO shouldn't be last-ditch, noting his own patients were on ventilators for just hours before getting it. Still, Tania had a monthlong hospital stay, including her eight days on ECMO.

“Thank God the doctor took that decision to use this machine,” said Tania's mother, Antonieta Oropeza, speaking in Spanish through an interpreter.

Avian influenza - situation in Egypt - update 25​

http://www.who.int/csr/don/2009_11_27/en/index.html

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

The case is a 3 year-old male from Minia Governorate. His symptoms started on 21 November 2009.

He was admitted to hospital on 22 November and his condition is stable. Investigations into the source of infection indicated that the case had close contact with dead and/or sick poultry.

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

Of the 89 cases confirmed to date in Egypt, 27 have been fatal.

Lhoksukon, North Aceh ::: Government contributed poultries die of bird flu​

http://birdflucorner.wordpress.com/

Lhoksukon – Avian influenza (AI) rapid response team of Livestock Service and Animal Health Service in North Aceh culled number of bird flu infected chickens. Those chickens were contributed by local government for community in Calong, Kecamatan Syamtalira Aron.

AI team coordinator, dr Muzakir Anwar on Monday (29/11) said depopulation was done last Wednesday (25/11) after receiving report that 330 of 400 contributed chickens suddenly died. Further check to survived and dead chickens showed positive bird flu infection.

Previously, 90 of 400 contributed chickens were reported to have died of bird flu infection in Simpang Empat, Kecamatan Simpang Keuramat. Same incidents occurred in Matang Kuli, Baktiya, dan Muara Batu at the following day.

Currently, livestock service is waiting for report from three other sub-district (Kecamatan) which received same contributions; Cot Girek, Langkahan and Saenuddon. So far no report from those three sub-districts, but there is high possibility that same incident may happen.

The program of poultry support for people in North Aceh has been continuing without any dialogue with local health service. North Aceh has been stated as bird flu endemic area, therefore government should put concern in poultry traffic to this area, added Muzakir.

At the end of 2008, Veterinary Disease Investigation Center Regional 1, North Sumatera conducted avian influenza surveillance in North Aceh, and found avian influenza antibody in chickens.



Source: Indonesia local newspaper, Serambi News. http://www.serambinews.com/news/disnak-kembali-musnahkan-ayam-bantuan

Research: More effective bird flu vaccine​

http://www.worldpoultry.net/news/research-more-effective-bird-flu-vaccine-4607.html

University of Guelph scientists have made a discovery that may lead to more effective vaccines to protect poultry and humans from the avian influenza virus.

"We have found one of the molecular determinants of the H5N1 avian influenza virus that can induce immune responses in chickens," said Prof. Shayan Sharif, a researcher in the Department of Pathobiology and lead author of the study published recently in the journal PLoS ONE.

“This molecular structure may be used in the future for protecting chickens against avian flu and possibly for control of transmission of the virus from birds to humans,” said Sharif.

Public concern about this year’s H1N1 flu pandemic has overshadowed the potential threat of its close cousin – H5N1 avian influenza virus, reports the University of Guelph. But scientists and public health officials have been keeping a close watch on a deadly strain of H5N1 virus. The World Health Organization reports that since 2003, there have been 442 confirmed cases of people being infected with H5N1 virus; of those, 262 have died.

While the numbers seem small in comparison to the thousands of people infected by H1N1 worldwide, H5N1 is far more lethal, reports state. While most H1N1 infections result in only mild illness, about 60% of people infected by the H5 virus have died. Luckily, so far the virus cannot be easily transmitted from person to person, Sharif said. But that could change.

“Influenza viruses are constantly changing and it is possible that the H5 virus could develop into something that is more efficiently transmitted from birds to humans and, more importantly, from person to person,” he said. “If that happens, then we may face a pandemic of massive proportions.”

The H5 avian influenza virus is commonly found in wild birds such as migratory waterfowl that are usually unaffected by the virus. They can, however, transmit the virus to a variety of domestic birds including chickens, in which it can cause a range of illness from no signs of disease at all to a severe epidemic that kills all infected birds.

Vaccines are available to protect domestic poultry from H5N1 virus. However, very little is known about how the chicken’s immune system interacts with the virus.

The molecular region identified by Sharif’s research team is a small peptide contained in the hemagglutinin (HA) antigen, a protein found on the surface of the flu virus. The researchers showed that the peptide is recognized by the chicken’s T-cells, which attack the virus directly and also trigger the production of antibodies that help the immune system fight the infection. This is the first time scientists have identified a T-cell epitope of an influenza virus– a protein on a virus particle recognized by the immune system – in chickens.

“This is an important step toward developing more efficacious vaccines against H5 avian influenza in chickens,” said Sharif. “We may be able to use this epitope in future vaccines to not only protect domestic flocks but also to prevent or control the spread of the virus from birds to humans. However, this still needs to be confirmed experimentally and that will be the focus of our future research.”

Chicks from France suspended in Sri Lanka owing to bird flu​

http://www.dailymirror.lk/DM_BLOG/Sections/frmNewsDetailView.aspx?ARTID=69405

Sri Lanka has suspended importing live chicken from France owing to the threat of bird flu, the Animal Production and Health Department said.

The Animal Production and Health Department said that chicken imported from France has been suspended following a warning that had been issued by the World Animal Health Organization (WAHO), due to the spread of bird flu in the country.

General Manager at the Animal Production and Health Department Dr. Swarna Herath speaking to Daily Mirror online said that following the warning issued by the WAHO Sri Lanka had stopped all orders placed for the next three months.

She went on to say that if within the next three months bird flu was not been effectively curbed by France that it was likely that importing chicken from the country would be further suspended.

Sri Lanka imports live fowl from a number of countries for breeding including the Netherlands, China, New Zealand, England, Australia and India.

Link to next weeks thread:

12/7-12/14/09 Weekly Bird&Other Flus Thread: D225G and D225N In Utah Patient

http://www.timebomb2000.com/vb/showthread.php?t=349918