Pandemic Plan

Dr. Niman: Is D225G in severe swine flu?

Concerning the surge in severe suspected swine flu cases in parts of Europe, Dr. Henry Niman suggests it may indicate that D225G or other receptor binding domain changes are on the rise. Last season the acquisition of D225G was linked to severe and fatal cases, but the level of D225G in circulation was relatively low. However, the virus with D225G was deemed a "low reactor" and there were concerns that, once global immunity to wild type pH1N1 was established, the level of D225G could increase substantially in a variant that emerged between seasons.

WHO global pandemic update 61

The World Health Organization (WHO) says pandemic influenza H1N1 has now been reported in over 170 countries and territories worldwide.

As for the temperate countries of the Southern Hemisphere, now experiencing winter:

The obvious becomes official: WHO declares Phase 6 flu pandemic

Based on mounting evidence, the World Health Organization today declared that "the scientific criteria for an influenza pandemic have been met" and raised the pandemic alert level from Phase 5 to Phase 6. As WHO Director-General Dr. Margaret Chan stated, "The world is now at the start of the 2009 influenza pandemic."

Actually, it likely will end up being the 2009-2010 pandemic or the 2009-2011 pandemic, because historically that's how long pandemics last. Spreading across the globe in multiple waves usually. (Indeed, Dr. Chan today cautioned, "Countries where outbreaks appear to have peaked should prepare for a second wave of infection.")

Dr. Chan's prepared statement to the press was pretty concise and paints the picture as well as the experts can see it for now. So, I'm reproducing her statement in full below.

However, if you don't want to read it all, I've summarized these highlights:

* This particular influenza A H1N1 strain is entirely new and spreads easily from one person to another.

* Nearly 30,000 cases have been confirmed in 74 countries. [Those are just laboratory-confirmed cases. Actual case count may be in the hundreds of thousands. -Chirp]

* "The virus writes the rules" and the situation "can change very quickly."

* At least initially, the pandemic is expected to be of moderate severity, although that can vary from place to place.

* Thusfar, the overwhelming majority of patients have mild symptoms.

* This H1N1 virus prefers young people. In major outbreaks, most cases have been under the age of 25. Most severe and fatal cases have been in ages 30 to 50. (This is unlike typical seasonal flu, where most fatalities are elderly.)

* Many cases have occurred in people with underlying chronic conditions. HOWEVER, "one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people."

* Pregnant women are at increased risk of complications.

* We do not yet know how this virus will behave under conditions typically found in the developing world. Unlike the "moderate" severity in well-off countries, "it is prudent to anticipate a bleaker picture as the virus spreads" to less-developed countries.

* A characteristic of pandemics is their rapid spread to all parts of the world. "Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection."

* Vaccine manufacturers will soon finish production of vaccine for seasonal flu and will then have full capacity available to produce pandemic vaccine. [Caution: Don't overly rely on pharmaceutical solutions. The vaccine may not be ready to begin production for weeks/months. Even then, production is limited, given a world population of 6.7 billion. Initially, vaccine will be allocated to people in critical roles/conditions. There will be no vaccine for many, especially in developing countries. -Chirp]

* Until vaccine is available, use non-pharmaceutical interventions for some protection.

* WHO recommends no restrictions on travel and no border closures.

* "Influenza pandemics ... are remarkable events because of the almost universal susceptibility of the world's population to infection. We are all in this together, and we will all get through this, together."

WHO's Chan addresses Exec Bd of World Food Program

In an opening address today at the Annual Session of the Executive Board of the World Food Program, Dr. Margaret Chan, the Director-General of the World Health Organization, included these comments concerning the imminent flu pandemic and its impact on less-developed countries:

We are near the start of the first influenza pandemic of this century. Up to now, cases of the new H1N1 virus have been detected, investigated, closely tracked, and reported in well-off countries.

On present evidence, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity in countries with good health infrastructure and adequate resources.

WHO assesses the severity of a flu pandemic

The World Health Organization today released a discussion titled "Assessing the severity of an influenza pandemic." For those of you who've been following the flu pandemic threat - and preparing, accordingly - this document is mostly old information. But if you're new to the topic, pay close attention; it summarizes numerous key concepts.

One principle of special importance: Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today's highly mobile and closely interdependent societies. Having large numbers of people sick at the same time is one reason why pandemics are socially and economically disruptive. In particular, it has the potential to temporarily overburden health services.

As H1N1 swine flu spreads, exact case counts become less important

As the H1N1 swine flu virus spreads and the number of cases increases, tracking the specific number of cases becomes less important. Instead, the focus shifts to general trends and locations of outbreaks.

Another factor at play: At some point, there are more cases than labs can screen.

Lab tests confirm H1N1 swine flu in Alberta, Canada pig herd

From ProMED-mail (International Society for Infectious Diseases) comes the report of gene sequencing confirming H1N1 swine flu in a herd of pigs in Alberta, Canada. As reported earlier, this is noteworthy because the pigs appear to have contracted the flu from a farm worker who had recently visited Mexico, returning to Canada April 12. The farm worker, the farm producer, and the producer's family all had been ill with flu-like symptoms between April 14-29.

ProMED-mail moderators commented:

"This is an absolutely fascinating report as it clearly indicates how the proverbial zoonotic bridge is a 2-lane highway. Humans and animals can interface and transmit disease through many varied and unpredictable scenarios as illustrated by the events described here."

Minnesota changes its approach to H1N1 swine flu

Similar to the CDC's revision to its guidelines for closing schools due to H1N1 swine flu, the State of Minnesota is changing to reflect new information about the virus.

Officials at the Minnesota Department of Health (MDH) will now be asking health care providers to submit lab specimens only when a patient has been hospitalized for influenza-like symptoms. The MDH lab will also continue to accept specimens from the state's 29 sentinel influenza surveillance sites, and for ill health care workers.

WHO declares Pandemic Alert Phase 5

The World Health Organization today raised the Pandemic Alert level to Phase 5. It was just two days ago the Pandemic Alert Phase was raised from Level 3 to 4. Phase 6 would be a pandemic.

Excerpts from today's statement by WHO Director-General, Dr Margaret Chan:

Sniffing out contraband poultry

To some degree, the spread of the bird flu virus among domestic poultry is caused by the commercial transport of disease-carrying birds or bird products. Agence France Presse reports one novel tactic to intercept such contraband on plane flights:

Dutch customs have deployed two special bird flu dogs at Amsterdam's Schiphol airport to check flights from high-risk countries for poultry, the authorities said Saturday.

The dogs are trained to sniff out all kinds of poultry (alive or dead), feathers, and eggs. They check flights from countries where the bird flu virus has been found, such as China, Thailand, Egypt, Russia and Turkey.

Since they began using the dogs at Schiphol airport in May, authorities have confiscated 1,626 kilos of prepared poultry meat, 203 kilos of raw poultry meat, and 245 eggs.

Czech customs are also using specialized bird flu dogs, the authorities told AFP.