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

Link to last weeks thread:

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

http://www.timebomb2000.com/vb/showthread.php?p=3596511#post3596511

Please See:

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

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

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

Useful Links:

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

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

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

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

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

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

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

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

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

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

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

Ukraine Fatalities Spike to 698 - One Day Total 23​

http://www.recombinomics.com/News/12300904/Ukraine_698.html

3,722,314 Influenza/ARI

210,136 Hospital

698 Dead

The above update is the latest report from the Ukraine Ministry of Health. The increase of 23 dead in the past 24 hours is similar to the prior two days, bringing the three day total for this week to 65, which is similar to the rate at the beginning of the outbreak in October. The largest jump in the past 24 hours was in Donetsk, where the five fatalities raised the season total to 85 (see map). Although cases and deaths are decline across much of the northern hemisphere, the high death rate in Ukraine provides support for another wave of H1N1 in early 2010.

The high death rate also raises concerns about receptor binding domain changes. Sequences released from four fatal cases by Mill Hill had D225G. Two more sequences, released by the CDC had D225N and were also likely from fatal cases. Recent reports of D225G and D225N in the same patients raise concerns that both changes were in these patients and sample selection or virus isolation procedures led to detection of one of the two receptor binding domain changes.

However, the high death rate associate with either or both of these receptor binding domain changes raises concerns of the emergence of the changes at a higher frequency. Therefore, release of additional sequences from early as well as recent fatalities would be useful.

Fatal D225G / D225N H1N1 Co-Infections Raise Concerns
​

http://www.recombinomics.com/News/12300903/D225G_D225N_Co.html

Current data suggests that the cases involving variant viruses in different parts of the world are unrelated and the underlying mutation events probably occurred independently from each other in the infected individuals as a consequence of the natural variability of influenza viruses and their inability to correct random coding
errors.

The above comment from the ECDC report on D225G and D225N is false. The current data suggests just the opposite and indicates these changes are transmitting and jumping from one genetic background via recombination. The frequency of D225G/N in public HA sequences (about 3000) is near 1% yet in Ukraine D225G/N is in six of six isolates from fatal cases, which has a chance of a trillion to one if events are independent and random. Moreover, the association of H225G/N with fatal or severe cases extends well beyond Ukraine.

In Sao Paulo there are four examples and all four are also from fatal cases. The published sequences have two with D225G and two with D225N. However, recent sequences with D225G and D225N in the same sample in Sweden, Mexico, and the United States have raised the possibility that the mixture is common, but selection in the sample collected or isolation of the virus leads to detection of one or the other.

For the US (Utah) case the CDC published two sequences. One, A/Utah/42/2009, was taken directly from the clinical sample and it contained mixed signals at position 1 and 2 of the codon for position 225. The other sequence was a clone from the sample which had the D225G codon at position 225, indicating the mixed signals were due to two sequences in equal proportions which had D225G and D225N. All five sequences from patients, as well as a sequence from swine in Mexico, have these tandem mixed signals, indicating the hosts are co-infected with sequences containing D225G and D225N.

In Mexico, two patients in San Luis Potosi have the mixed signals in isolates which were collected within a day of each other. The WHO working hypothesis would require that both patients were independently infected by wild type H1N1 and the H1N1 in both patients would make the same two errors in adjacent positions to generate the fatal combination of D225G and D225N. The likelihood of this happening independently in two patients in the same location at the same time is beyond remote.

This combination is also seen in Ukraine samples. Four sequences generated by Mill Hill have D225G, while two sequences generated by the CDC have D225N raising the possibility that all six fatal cases have both D225G and D225N, which would make the WHO/ECDC working hypothesis even less tenable because it would require two changes at position 225 to happen in the same patient and have those two changes as the only non-synonymous changes in these patients relative to sequences isolated from survivors.

The reliance of the WHO and ECDC on such an unlikely explanation of the data raises serious questions about data analysis by consultants so wedded to such an outdated view invoking random mutations, which is not supported by the data.

This reliance is extremely hazardous to the world's health.

Indonesia ::: H5N1 situation update 2009​

http://birdflucorner.wordpress.com/

Since 1 January to 28 December 2009, a total 20 H5N1 cases reported in Indonesia. Of those confirmed cases, 19 have been fatal. First H5N1 case was reported from Bogor on 9 January, and latest was reported from South Jakarta on 23 September 2009.

Total cumulative number of H5N1 in Indonesia since 2005 to 2009 is 161 with 134 deaths.

This information is broadcasted by Public Communication Center, General Secretary Ministry of Health. Further information is available at: phone 021-52907416-9, fax 52921669, call center 021-30413700, or e-mail puskom.publik@yahoo.co.id, info@puskom.depkes.go.id, kontak@puskom.depkes.go.id.

H1N1 D225G in Lungs of Patients Across Russia​

http://www.recombinomics.com/News/12310901/D225G_Russia.html

Vector labs in Novosibursk, Russia has submitted a full set of sequences from lung isolates from patients at three distinct locations in Russia (A/Salekhard/01/2009, A/Tomsk/07/2009, A/Abakan/02/2009). Although each isolate represents a seperate H1N1 genetic background, all three have D225G. Since all three isolates came from lung, it is likely that the three infections were fatal, or at least severe, which extends the linkage of D225G with severe or fatal H1N1 cases. These are the first public HA sequences from Russia with D225G and raise concerns that the establishment of the polymorphism, and/or the related associated polymorphism D225N raises concerns of a new pandemic wave that is markedly more severe that prior pandemic H1N1 waves.

Recent comments by ECDC on the WHO working hypothesis that these changes were due to random mutations generated by uncorrected copy errors and that H1N1 with these changes do no transmit, are not consistent with public data. In Ukraine, six of six fatal cases have D225G or D225N. Since these markers are only reported in about 1% of pandemic H1N1 HA sequences, the chances of these markers randomly appearing in 6 of 6 fatal cases is in the trillion to one range. Similarly, several recently released sequences have both D225G and D225N, including two samples in San Luis Potosi that were collected within one day of each, again creating an event that would require two independent changes at adjacent codon positions for residue 225 in two individuals in the same location at the same time. The likelihood of these two sets of changes happening independently, when only four samples in the Genbank and GISAID database have both changes, so also extremely unlikely, once again raising serious questions about the scientific basis for the WHO position that these changes are independently generated and are copy errors. The only data in support of this hypothesis is an attribution to WHO in the ECDC report, which has no scientific basis.

The movement of D225G from one H1N1 genetic background is consistent with homologous recombination, and the clustering in western Ukraine, Sao Paulo, or San Luis Potosi is consistent with transmission. These developments continue to raise concerns that H1N1 with these receptor binding domain changes will emerge in the next wave.

Today's report from Ukraine has 29 more fatalities in the past 24 hours, raising the increase in the past 4 days to 94 fatalities. The report of D225G in lung patients from three different regions in Russia on three different genetic backgrounds increases concerns of an emerging lethal pandemic H1N1, WHO proclamations notwithstanding

Tamiflu Resistance Continues to Expand in the United States​

http://www.recombinomics.com/News/12310902/H274Y_US_51.html

A total of 50 cases of oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States since April 2009, including four newly identified cases since last week. In specimens collected since September 1, 2009, 40 cases have been identified in the United States.

The above comments from the latest (week 51) influenza update by the CDC indicates that the detection rate of H274Y in the United States remains high. Only 61 new cases were tested in the past week, yet four had H274Y. The rate has exploded in the past 6 weeks in the US and across the northern hemisphere, raising concerns that H274Y will pair up with receptor binding domain changes at position 225, leading to widespread resistance as was seen in H1N1 seasonal flu.

Pandemic H1N1 rates continue to decline in the US, setting the stage for a new variant in the next several weeks as temperatures drop across the northern hemisphere. Once again there were no cases of seasonal H1N1 or H3N2 detected, and influenza B detection also fell to zero, increasing concerns that the pandemic H1N1 will crowd out influenza A, as well as influenza B, paving the way for the emergence of multiple variants of pandemic H1N1, which is far more dangerous than seasonal flu.

The steady rise in H274Y, coupled with increases in D225G/N increase those concerns.

Ukraine Fatalities Spike to 727 - One Day Total 29
​

http://www.recombinomics.com/News/12310903/Ukraine_727.html

3,753,896 Influenza/ARI

212,349 Hospitalized

727 Dead

The above totals are from the Ukraine Ministry of Health website, indicating the spike in deaths is incrasing. The 727 dead are 29 higher than yesterday's report and brings the total deaths in the past 96 hours to 94. The rate of one death per dour for the past four days is similar to the rate at the beginning of the outbreak in October.

The five deaths in Donetsk again were the highest, but four deaths in Crimea was associated with the curtailing of holiday activities in an attempt to control the spread (see map). The increases in deaths in Ukraine has attracted international attention because sequences from initial cases had receptor binding domain changes at position 225 (D225G and D225N). These results have led to further analysis by other countries, and sequences released from lung samples for patients in three regions of Russia also had D225G, raising concerns that the change was becoming more widespread, which could lead to a catastrophic wave in the upcoming weeks.

The recent sequences from Russia are distinct from each other signaling continued expansion of D225G/N via recombination, which is also happening with the Tamiflu resistance marker H274Y. Patients with both markers have increased concerns that a much more virulent H1N1 could also be resistant to Tamiflu and Peramivir.

These evolving developments continue to increase concerns, WHO proclamations notwithstanding.

I believe these figures to be inaccurate: In places such as
Indonesia it has been more widespread than reported by the WHO.

WHO Reports 72 Cases of Bird Flu in Humans in 2009​

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_12_30/en/index.html

GLOBAL - The WHO reports that there have been 72 cases of H5N1 bird flu in humans so far this year, including 32 deaths. Egypt, China, Viet Nam and Cambodia have reported cases in 2009. The cumulative total since 2003 is 467 cases, of whom 282 have died.

H1N1 D225G and D225N in Russian Cases Near Ukraine
​

http://www.recombinomics.com/News/01021001/D225G_D225N_Russia.html

The Ivanosky Virology Institute has released sequences at Genbank from trachea (A/Orenburg/IIV2974/2009 ) and lung (A/Bryansk/IIV2971/2009) samples suggesting these are from fatal cases. The trachea sample yielded an HA sequence with D225N, while the lung had D225G. The sequences followed three sequences released yesterday, which were also from Russia lung samples and all three had D225G. It is unclear if these recent release represent an increased detection of these changes, but they are the first receptor binding domain chnages from Russia and now there are five such sequences. Some match the clade in Ukraine, which also had samples with D225G and D225N.

It is unclear if these sequences indicate one or the other change is in the patient, or detection is based on tissue source or isolation procedures. Both polymorphisms have been reported in the same patient in the United States, Mexico, and Sweden. In all cases the signals were mixed, suggesting these samples had similar levels of each polymorphism.

These additional isolates further discount the WHO working hypothesis that these sequences are generated independently by random mutations. The finding of a position 225 change (D225G or D225N) on six of six fatal cases in Ukraine supports transmission of both changes, which have been appended onto the same genetic background which appears to be spilling over into Russia, based on the latest sequences.

In Ukraine, 94 fatalities have been reported in the past 96 hours, raising concerns that these changes will continue to spread. One of the western Ukraine isolates with D225G was tested for reactivity with ferret reference sera and was characterized as a low reactor, raising concerns that these changes will evade host immune responses and become dominant.

Thus far only partial sequences have been released by Mill Hill and the CDC for the initial cases. Full sequences from these and additional early cases as well as those in the current wave, which has spread across the country, including regions adjacent to Russia, would be useful.

Spreading H1N1 Ukraine Sequences in Russia Raise Concerns​

http://www.recombinomics.com/News/01021002/Ukraine_Russia_Spread.html

The close relationship between sequences in Ukraine and those recently released from Russia raise pandemic concerns. In addition to the five sequences with D225G and D225N, a larger series was released by the Bioinformatics Group at the Institute for Physical-Chemical Medicine in Moscow from samples collected in Moscow and Novouralsk.

Earlier Mill Hill and the CDC had deposited sequences at GISAID from patients in western Ukraine. The nine HA sequences deposited by Mill Hill fell into two closely related sub-clades. The largest sub-clade had 6 samples from Ternopil and one from Khelnitsy. Two of the seven were deceased and both had D225G. All seven had the same marker, which was not in the other sub-clade, defined by two sequences from Lviv. Both were from deceased Lviv patients and both had D225G. The CDC deposited sequences from five patients, but three were from the five survivors sequenced by Mill Hill. The two unique sequences were also from the large sub-clade and were likely fatal cases. Both had D225N, one of which was a mixed signal with wild type.

The 9 HA sequences from the larger sub-clade shared one marker which was in three other sequences at Genbank. All three (A/Salekhard/01/2009, A/Russia/178/2009, A/Russia/190/2009) had just been deposited at Genbank, two were from Novouralsk, which is adjacent to Ukraine's eastern border (see map). The Salekhard, which is north of Moscow and it had D225G. Other isolates in the broader sub-clade include A/Bryansk/IIV2871/2009, which has D225G, and A/Orenburg/IIV2974/2009, which has D225N. Thus, in Russia and Ukraine there are 9 isolates which are likely fatal, and all 9 have D225G or D225N.

This association of D225G/N with fatal cases in this sub-clade is cause for concern. These sequence support transmission of this sub-clade over a large area in Russia and Ukraine, which could prodiced a marked jump in severe and fatl cases if these changes become more common, and tracking of this sub-clade should receive a high priority.

Release of recent sequences from Ukraine and other eastern European countries like Poland and Bulgaria would be useful.

Ukraine Fatalities Jump to 759 - Two Day Total 32​

http://www.recombinomics.com/News/01031001/Ukraine_759.html

3,789,200 Influenza / ARI

217,056 Hospitalized

759 Dead

The above numbers are the latest update from the Ukraine Ministry of Health and show 32 more fatalities in the past 2 days. Reporting is typically lower over the weekend, so a rise of 12 on January 1 and 20 more on Saturday likely represents a rate similar to the one death per hour in the prior four days. Once again the largest jump was in Donetks with a jump of 6 to 97. In the upcoming week Donetks will likely pass Lviv for the oblast with the highest number of deaths which is at 102, but where deaths have only increased slight in the past several weeks.

Eastern Ukraine is adjacent to Rostov-On-Dom, where cases have also been high. Recently released sequences from Novouralsk, also adjacent to Ukraine, matched the sub-clade circulating in western Ukraine, where deaths jumped significant two months ago. Additional sequences indicate this sub-clade was circulating throughout European Russia and recent reports from Romania have cited a dramatic increase in deaths, including 15 in the past few days (see map).

The increase in deaths in Ukraine, and spread of the same sub-clade throughout eastern Russia raise concerns that this sub-clade will become more dominant in the upcoming weeks and may increase the severity of deaths in the northern hemisphere.

Fatal H1N1 RBD Change S188N in Hunan China?​

http://www.recombinomics.com/News/01031002/S188N_Hunan.html

November 21 evening 7:30 Xiu Zhang boy was admitted to hospital in Shaoyang city, the hospital in critical condition on the next notice, right chapter Xiu oxygen, infusion, and ECG. "7:30 admitted to hospital after my son and I have been chatting, chat to 10:30, when he suddenly froth at the mouth, unconscious."

"People from normal to death is only about half an hour." Lijun Ze said the son died suddenly so suddenly, the hospital 23:30 began to organize rescue, It was found that Xiu Zhang digestive tract, lungs or brain hemorrhage, the body appears black spots, had no blood pressure, no heartbeat, "the time to save a child is already dead."

He died a hospital at 4:45 on the 22nd Xiu Zhang declared dead. Shaoyang City CDC blood samples confirmed as Influenza A H1N1 influenza testing. Family belongs to at 10 o'clock on the 23rd to see the hospital medical records issued reads, "preliminary diagnosis" is "influenza, encephalitis, pulmonary hemorrhage, and a stream."

The above translation describes the rapid death of a 10 year old boy in Shaoyang city in Hunan, China. Recent media reports have warned of the rapid spread of H1N1 in the Chinese countryside and three HA sequences from Hunan were just released at Genbank by the Changsha CDC, which is slightly northeast of Shaoyang city. The three Hunan sequences (A/Hunan Changsha/SWL4346/2009, A/Hunan Furong/SWL4224/2009, A/Hunan Kaifu/SWL4142/2009) were collected in late November from sections of Changsha city (see map) and each was distinct. The Furong sequence has closely related to a series of sequences recently released from Changdu, to the west of Hunan, but the other two sequences were unique.

The Kaifu sequence was collected on the date of hospital admission for the above patient, who may have been the source. It has a number of non-synonymous changes, including a receptor binding domain change S188N, which is also present in a number of isolates from the United States (primarily Texas, but also New York - see list here), as well as Mongolia, Japan, and Spain.

The co-circulation of multiple H1N1 sequences in a small region in Changsha is cause for concern. A full set of sequences and more information on patients associated with these sequences would be useful.

Pekanbaru, Riau ::: Bird flu suspect girl is recovering​

http://birdflucorner.wordpress.com/

Pekanbaru, Riau – A bid flu suspect (H5N1) toddler from Desa Bongkal Malang, Kecamatan Simpang Kelayang, Kabupaten Indragiri Hulu, Riau, is recovering. This is stated by Head of Bird Flu Control Team of Arifin Achmad hospital, dr Azizman Saad.

Patient, named An Nisha (4) is currently in normal state, with body temperature about 36℃ and breathing rate 36 per minute.

Before receive intensive treatment at isolation unit for infectious disease patient, the girl was in critical condition with breathing difficulty.

At time of admission she had breathing rate 60 per minute, body temperature up to 39.8℃ with leukocyte count was 3,200 and thrombocyte count was 77,000.

Blood and throat samples are still under evaluation of Ministry of Health laboratory, in mean time, patient has not been discharged from the hospital. Samples were sent to Jakarta last Saturday (2/1).

An Nisha was stated as bird flu suspect patient after developing high fever and having contact history with dead birds within a radius of 10 meters from her house.

She was previously treated at Indrasari regional hospital, and then transferred to Pekanbaru.

Source: Indonesia news office, ANTARA. http://antaranews.com/print/1262563003

Pekanbaru, Riau ::: Outbreak rises in Kabupaten Indragiri Hulu​

http://birdflucorner.wordpress.com/

Pekanbaru, Riau – Livestock service is still waiting H5N1 confirmation result from Veterinary Investigation and Diagnostic Center (BPPV) that suspected to have attacked birds in Kabupaten Indragiri Hulu, said Head of Livestock Service Riau, Patrianov.

Previously, dozens of backyard chickens suddenly died in two separated areas in Kabupaten Indragiri Hulu. Following to the case, at the end of December 2009, two toddlers from Kabupaten Indragiri Hulu were suspected of having bird flu infection.

One of the child – resident of Dusun Tuo Pelang, Kecamatan Kelayang – has died, while the other, resided in Desa Bongkal Malang, Kecamatan Simpang Kelayang is still under intensive treatment in Arifin Achmad hospital, Pekanbaru.

Initial rapid test to the dead chickens showed negative H5N1, however Livestock Service is still waiting more valid result from the BPPV . “We hope to get the result by Monday (4/1),” said Patrianov.

Indragiri Hulu has been stated as H5N1 endemic area since 2007.

Until November 2009, Livestock Service of Riau have recorded total 17,353 birds in Riau died of bird flu virus. The virus has infected 8 people where six of them died.

Source: Indonesia cybernews. http://lifestyle.id.finroll.com/com...nak-riau-tunggu-bppv-pastikan-flu-burung.html

Oriental Magpie Robin tested H5N1 positive in HK​

http://english.cctv.com/program/worldwidewatch/20100104/103573.shtml

Hong Kong's Agriculture Department has announced that a common bird species in the city has tested positive to A-H5N1. The carcass of the Oriental Mapie Robin was discovered on December 29th in a country park in the New Territories.

A department spokesman reminded people to avoid contact with wild birds or live poultry, and warned them to clean their hands thoroughly afterwards if they do. Influenza A-H5-N1 is also known as "bird flu". It can cause illness in humans and other animals.

Ukraine Fatalities Spike to 805 - One Day Record of 38​

http://www.recombinomics.com/News/01041001/Ukraine_805.html

3,802,945 Influenza/ARI

222,205 Hospitalized

805 Dead

The above update is from the Ukraine Ministry of Health. The number of deaths was 38 more than Sunday's report. Donetks had the largest increase. The 11 deaths in the past two days in the oblast brings the season total to 108, which is the highest in Ukraine. Donetks shares a border with Russia (see map), where there have also been a high number of cases. Recently released sequences from Russia match the initial sequences from western Ukraine.

Although the number of reported cases has declined in recent days, the jump of 38 deaths in 24 hours is the highest reported to date for Ukraine and raise concerns that sequences with D225G and D225N are becoming more common and are linked to the rise in deaths.

Sequences from recent fatalities in eastern Ukraine would be useful.

Kapuas, South Kalimantan ::: Mass chicken deaths confirmed H5N1 positive​

http://birdflucorner.wordpress.com/

Kuala Kapuas – Thousands of chickens confirmed to have died of bird flu H5N1 virus in Kabupaten Kapuas. Confirmation test to dead bird specimens, such as organ, serum and swab, was done by Veterinary Investigation and Diagnostic Center (BPPV) Regional V, Banjarbaru, South Kalimantan.

Total 82 specimens were collected from dead chickens in several sub-districts (kecamatan), i.e. Kecamatan Pulau Petak, Selat, Kapuas Timur and Basarang.

For Desa Batu Nidan, Kecamatan Basarang, 3 backyard chicken samples tested positive bird flu infection.

For Kuala Kapuas, 1 of broiler chicken samples tested positive bird flu infection.

Sudden deaths in chickens in Kuala Kapuas were started at beginning of December 2009 until 3 January 2010. Total chicken deaths in 7 sub-districts are 6,615 chickens. Numbers in detail according to sub-districts are: Kecamatan Basarang 3,909, Selat 360, Petak 953, Kapuas Hilir 422, Kapuas timur 255, Kapuas Murung 500 and Kapuas Kuala 16 chickens.

So far, bird flu H5N1 virus only attack chickens in South Kalimantan. No bird to human virus transmission is reported.

Source: Indonesia local newspaper, Kapuas Zone.

http://www.kapuaszone.co.cc/2010/01/ribuan-ayam-mati-mendadak-positif-flu.html

JPD said:

Ukraine Fatalities Spike to 805 - One Day Record of 38​

http://www.recombinomics.com/News/01041001/Ukraine_805.html

3,802,945 Influenza/ARI

222,205 Hospitalized

805 Dead

The above update is from the Ukraine Ministry of Health. The number of deaths was 38 more than Sunday's report. Donetks had the largest increase. The 11 deaths in the past two days in the oblast brings the season total to 108, which is the highest in Ukraine. Donetks shares a border with Russia (see map), where there have also been a high number of cases. Recently released sequences from Russia match the initial sequences from western Ukraine.

Although the number of reported cases has declined in recent days, the jump of 38 deaths in 24 hours is the highest reported to date for Ukraine and raise concerns that sequences with D225G and D225N are becoming more common and are linked to the rise in deaths.

Sequences from recent fatalities in eastern Ukraine would be useful.

Click to expand...

It's really picked up steam there again. Soon they'll have a couple deaths every hour. I wish we could get more information out of that area. They seem pretty closed mouthed.

D225E and D225N H1N1 RBD Changes in Turkey
​

http://www.recombinomics.com/News/01051001/D225E_D225N_Turkey.html

The Refik Saydam National Public Health Agency has released 29 HA sequences from Ankara, Turkey. Several were partial sequences, but 26 covered the receptor binding domain and 8 had D225E (see list below), while one had D225N, A/Ankara/26/2009. The outcomes of these patients were not given but media reports have described a rapid in increase in H1N1 fatalities in Turkey. A large number of HA sequences with D225E has been published from Spain, and recently released GISAID sequences from Sweden and the UK also haveD225E, including three fatal cases from Sweden. The prior reports of D225G and D225N associations with fatal cases has raised concerns that changes at position 225 could alter tissue tropism or aid in immune escape, leading to more severe and fatal cases.

In addition, the first reported cases of H274Y in an H1N1 patient who had not been treated with Tamiflu also had D225E as did another H274Y isolate from Tennessee, raising concerns that H274Y would pair up with receptor binding domain changes and become fixed, as happened with H274Y in seasonal H1N1.

In addition to the large number of isolates with D225E, the isolate with D225N has an additional marker that matches recent sequences from Russia and Denmark. Two of the Russian isolates were fatal and those sequences had D225G. The presence of D225G and D225N on similar backgrounds raises concerns that these isolates are mixtures, as seen in patients in Mexico, United States, and Sweden, where both D225G and D225N were present.

The presence of both sequences could lead to pseudo-types which use D225N to infect the upper respiratory tract and D225G to infect the lower respiratory tract. The increasing presence in these changes at position 225 continue to raise concerns that these changes will lead to increased Tamiflu resistance, severe cases, and fatalities in the next pandemic H1N1 wave, which may begin in the next few weeks.

A/Ankara/05/2009
A/Ankara/08/2009
A/Ankara/12/2009
A/Ankara/14/2009
A/Ankara/15/2009
A/Ankara/16/2009
A/Ankara/18/2009

Indonesia records 15 new bird flu deaths in 2009 ​

http://news.xinhuanet.com/english/2010-01/06/content_12765870.htm

JAKARTA, Jan. 6 (Xinhua) -- Indonesian Health Ministry reported 15 new deaths of bird flu (H5N1) in 2009, putting the total death toll to 134 out of 161 cases, a director at the ministry said here Wednesday.

Director General of Communicable Disease at the ministry Tjandra Yoga Aditama told Xinhua over phone that during the year there were 19 fatalities of bird flu in the year and 15 of them have not been reported.

Indonesia had been hit hardest by H5N1 virus in recent years.

The country has stopped announcing the case since last March.

Ukraine Fatalities Jump to 827 - 100K New Cases in One Day
​

http://www.recombinomics.com/News/01061001/Ukraine_827.html

3,905,542 Influenza/ARI

225,925 Hospitalized

827 Dead

The above update is from the Ukraine Ministry of Health. The 24h increases included 22 more deaths and over100,000 new cases. Much of the activity is in the eastern half of the country, with the biggest increases in cases, 6,563 to 343,583, and deaths 5 to 113 in Donetsk. However, Kiev had a large increase in cases , 4,945 to 327,003 and deaths, 3 to 40), and there were another 4,355 new cases in the surrounding Kiev oblast (see updated map)..

Media reports have described a deteriorating situation in Donetsk, with severe cases and fatalities in doctors and health care workers. Yesterday's report had an increase of 8 fatalities in Donetsk, and today's total of 113 is well ahead of Lviv, which has 102 fatalities and had been the highest oblast prior to yesterday.

New sequences from Russia, Turkey, and Sweden highlight changes at position 225 and early sequences from Ukraine had D225G or D225N in all fatal cases. These same changes have now been reported in fatal cases in Russia, which continues to raise concerns that such sequences may become more widespread.

Release of additional sequences from fatal cases in Ukraine, including multiple samples from collections from different tissues would be useful.

H1N1 Re-Infections Confirmed​

http://www.recombinomics.com/News/01061002/H1N1_Reinfect.html

We report on 3 patients with confirmed influenza A pandemic (H1N1) 2009 reinfection after successful treatment with oseltamivir.

The above comments are from a report in the current EID of re-infections by H1N1 in lab confirmed cases treated with Tamiflu in Chile. This report follows media reports of other cases in the United States with at least two lab confirmed infections in individual patients. The other reports had larger gaps in disease onset dates and those re-infections are similar to many anecdotal reports.

Many of these re-infections can be explained by a weak response to infections with low viral loads. The above group of three patients had recurrences within a few weeks of recovery, which may have been too soon for optimal protective immunity. However, other media reports describe lab confirmed cases that are 6 weeks to 3 months apart. Since H1N1 has only recently begun to evolve at a more rapid pace, it is unlikely that the re-infections were due to significant genetic changes.

Additional evidence for weak responses comes from the pandemic H1N1 clinical trial in Australia over the summer. Although prior pandemic H1N1 infections were among the exclusion criteria, 31% of patients enrolled had titers of 40 or higher at baseline, suggesting that many cases were mild and the patient did not get tested for H1N1 and did not associate the symptoms with H1N1.

However, these patients were vaccinated in the trial and a high percentage had a significant response, increasing titers four fold or higher. These data provided addition evidence that these initial infections produced sub-optimal immune response and protection.

Thus, several sources suggest initial immune responses to pandemic H1N1 are sub-optimal, so re-infections with similar or identical H1N1 are common, suggesting subsequent pandemic waves can be driven by an increase in viral load or minimal genetic changes.

This is from a reliable Blog I follow:

Ukraine Situation is Still Bad - Also a Forum - I would Get Real information from - is now Down! 1/7/10 ​

http://ukraineplague.blogspot.com/2010/01/ukraine-situation-is-still-bad-also.html

The numbers for those who have been sick in Ukraine is now almost 4 Million - with almost 900 dead.

BUT, is that the real story?

A medical forum, of which I have inserted information in previous posts from, is now down!

The other day, it was completely off line, now the service is not available for people to post on anymore!

There were a few very telling postings about what is still going on there, people are still getting Very sick!

People in Ukraine, had posted at the end of December - how many of their family members died between Christmas and New Years, yet the Doctors have put "heart problems and complications" on the death certificates - NOT a "flu sickness".

Sample of a post - written on the 26th of December, before the site became "unavailable":

Yesterday they buried a good man who died from influenza, the day before, too, was buried, and also from the flu. Они умерли в одной больнице. They died in a hospital. Почему в свидетельстве о смерти, врачи пишут, СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ?????? Why the death certificate, doctors write, heart failure ??????

Another from the end of December:

My friend works in the Infectious Diseases Hospital, a lot of people are sick, many lying in intensive care with pneumonia. и умирают больше чем говорят в новостях, вот только врачи не знают каким именно гриппом болеют. and die more than in the news, only the doctors do not know exactly what flu sick.

Remember - a Ukraine politician had stated last year, that mid January they expect a Third more intense wave of the flu in Ukraine.

Ukrainian Black Lung Killed 675 In 2009​

http://www.businessinsider.com/ukrainian-black-lung-finishes-off-2009-by-killing-675-people-2010-1

What a year 2009 was. Everyone was up in arms over the H1N1 "Swine Flu" virus, but the oft-ignored Ukrainian mutation of the disease has really taken its toll.

From October 29th to December 29th, over 675 people died from the virus, with as many as 21 in just one day.

BSANNA News: The Health Ministry of Ukraine has confirmed 675 deaths of flu and acute respiratory virus infections over the October 29 - December 29 period in all 24 regions of Ukraine, the cities of Kyiv and Sevastopol, and the Autonomous Republic of Crimea.

21 people have died in the past 24 hours, the ministry says.

Since October 29, a total of 3,669,751 men have contracted flu and ARVIs, including 74,972 over the past 24 hours.

More bird flu deaths in Indonesia​

http://www.omaha.com/article/20100107/LIVING07/100109796

JAKARTA, Indonesia (AP) — Indonesia on Wednesday reported 15 more bird flu fatalities in 2009, taking the human death toll in the country worst hit by the illness to 134.

Officials recorded 20 cases of the illness last year, 19 of them fatal, the Health Ministry said in a statement.

The figures are the first to be released by Indonesia since March, when four deaths were announced. They show that while avian influenza is still active, the number of cases is on the decline.

Last year saw the lowest number of human fatalities since 2005, when 13 were reported.


The ministry said that the most recent death was on Sept. 23, but gave no details about who had died or where.

Bird flu has killed 282 people worldwide since it began ravaging poultry stocks in 2003, the WHO said on its Web site. Indonesia is the worst affected country, with 161 infections since 2005, 134 of them fatal.

Indonesia came under strong criticism last year when it stopped announcing individual cases of the disease and ceased sharing virus samples with international health experts working on a vaccine.

Indonesia's former health minister had argued that the global system for a vaccine was unfair because her country's bird flu specimens could be used for a cure that would ultimately be too expensive for most Indonesians.

Japan Bans Texas Poultry on Avian Influenza Concerns (Update1) ​

http://www.bloomberg.com/apps/news?pid=20601087&sid=atpw1d5NvSm4

Jan. 6 (Bloomberg) -- Japan has banned imports of poultry and eggs from Texas after tests showed possible avian influenza in a flock of ducks in the state, U.S. federal and state officials said.

Meat from birds slaughtered in Texas as of Dec. 1 is ineligible for export to Japan, the U.S. Department of Agriculture’s Food Safety and Inspection Service said today on its Web site. Texas is the sixth-largest U.S. producer of chicken meat.

The Texas Animal Health Commission restricted movement of about 1,000 domesticated ducks in the north-central part of the state after routine tests at an associated live bird market found a “weak positive” result for avian flu, the state agency said in an e-mailed statement.

The live bird market slaughters and processes animals on site as they are purchased, and the ducks were not part of a commercial flock, the commission said.

“No clinical illness at the market or in the flock” has been discovered, the state agency said.

Additional samples from the duck flock are being tested, according to state officials. Flocks near the market are also under surveillance, they said.

Fresno turkeys recover from bout with swine flu​

http://www.sacbee.com/capitolandcalifornia/story/2443646.html

A flock of commercial turkeys in Fresno County tested positive for H1N1 in December and have since recovered, according to the California Department of Food and Agriculture.

They were the first Californian turkeys to catch the current strain of swine flu.

Several members of the flock were tested at a California Animal Health and Food Safety laboratory after workers noticed a decrease in egg production count, according to the American Veterinary Medical Association.

The flock is now back to normal, hatching eggs or being processed for the consumer market, said Jay Van Rein, a California Department of Food and Agriculture spokesman.

Federal and state experts said it is not possible for humans to catch H1N1 flu from eating the meat of an infected turkey. "The virus doesn't actually get into the meat of the bird," Van Rein said.

He did not know how many turkeys in the flock were infected or how large the affected flock is. Because turkey flocks already live in separate barns, there was no need to quarantine the infected flock, Van Rein said.

Turkeys have tested positive for H1N1 in Virginia, Canada and Chile, according to the American Veterinary Medical Association.

In addition, the novel flu virus has been identified in pigs, ferrets, dogs and cheetahs.

On Wednesday, experts at the California Animal Health & Food Safety Laboratory on the UC Davis campus said they had diagnosed a cat from Los Angeles with the H1N1 flu. News of the diagnosis was delivered to Los Angeles County Veterinary Public Health officials on Dec. 22. The owner had the H1N1 flu before the cat became ill, researchers said.

Denpasar, Bali ::: Sanglah hospital treats five bird flu suspect patients​

http://birdflucorner.wordpress.com/

Denpasar – Five bird flu suspect patients are being treated at Sanglah hospital. Their blood samples have been sent to Jakarta for further test, stated Head of Health Service Bali, Nyoman Suteja. However, Nyoman did not mention the identity of patients in details.

Those patients showed signs such as rising of body temperature and breathing difficulty. The symptoms are not specific for bird flu infection, in particular whether change recently may influence one’s health condition, added Nyoman. Currently, those patients are still treated at isolation unit.

One of bird flu suspect patients, with initial WR (65), resident of Banjarangkan , Kabupaten Klungkung has been suspected of contracting bird flu infection after number of chickens found to have suddenly died in close proximity of her resident.

Since the first time bird flu emerged in Bali, numbers of patients have been treated in Sanglah hospital and two have died in 2007. The fatal cases came from Tabanan and Jembrana.

Source: Indonesia national newspaper, Media Indonesia. http://www.mediaindonesia.com/read/...-Pasien-Suspect-Flu-Burung-Dikirim-ke-Jakarta

Diarrhea May Be Source of Influenza Infection, Researchers Say​

http://www.businessweek.com/news/20...e-of-influenza-infection-researchers-say.html

Jan. 8 (Bloomberg) -- Diarrhea in flu-infected children may harbor the virus, scientists found, pointing to a previously unrecognized source of infection.

Tests on 733 children with influenza-like illness and an upset tummy found a minority of patients had seasonal strains in their stool and live viral particles were retrieved from one case. The finding, published yesterday in the journal BioMed Central, suggests that flu may invade the gastrointestinal tract, potentially acting as a mode of transmission.

The research may help explain why gastric symptoms, including diarrhea and vomiting, afflicts about one in five people with swine flu, the H1N1 strain that emerged last year and touched off the first influenza pandemic in 41 years. The study is believed to be the largest to investigate flu virus detected in the gastrointestinal tract of children with flu-like illness and diarrhea, the authors wrote.

“To date, limited autopsy data have not indicated detection of 2009 H1N1 virus outside the respiratory tract in humans, but further studies are needed,” said Tim Uyeki, a study author and flu epidemiologist at the U.S. Centers for Disease Control and Prevention in Atlanta. The presence of viable virus particles in the gut “has implications for transmission and infection control,” he said in an e-mail today.

Uyeki and colleagues at Indonesia’s National Institute of Health Research and Development and the U.S. Naval Medical Research Unit No. 2 in Jakarta tested the children, who were all younger than 6 years. Genetic material from the flu virus was found in 12 percent of nose and throat swabs and 3 percent of stool samples, the authors wrote in the open-access publication.

Live Virus

Viable type-B flu particles were recovered in the stool of one child, a finding possibly explained by active infection in the gastrointestinal tract, the researchers said. The patient could also have swallowed the virus from an infection in the nose or throat, they said.

It’s possible flu might infect and actively replicate within cells in the gastrointestinal tract similar to the way in which influenza viruses replicate in bird species, they said.

“It has been known for quite a long time that young children with seasonal influenza experience diarrhea more frequently than adult patients, especially with influenza B virus infection,” Uyeki said.

Link to next weeks thread:

1/9-1/16/10 Weekly Bird & Other Flu Thread:H1N1 D225G D225N D225A in Ukraine Lungs

http://www.timebomb2000.com/vb/showthread.php?t=352392