CDC To Monitor Children's Flu Complications: Drug-Resistant Staph A New Wrinkle

SFgate ^ | 12-8-2003 | Daniel Yee

[torstars]

WHO Update:

Northern Hemisphere: Influenza Epidemic Spreads to More Countries - WHO
Update 3

---

Significant increases in influenza activity associated with influenza
A(H3N2) viruses continue in some countries in Europe (Finland, France, and
Norway) and North America (United States); in other European countries
(Portugal and Spain), widespread influenza A(H3N2) activity persists. In
some parts of Canada and United Kingdom (UK), where influenza activity was
first noted this season, the number of cases has started to decline,
although it is too early to predict the trend.

A rising trend has also been observed in a number of European countries
(Czech Republic, Denmark, Italy, Latvia, Russian Federation, and
Switzerland), although influenza activity remains low at present.

Influenza B viruses are most frequently reported from Asia (Hong Kong
Special Administrative Region of China, Republic of Korea, and Thailand);
sporadic cases have been detected in Europe and North America. With the
exception of an outbreak in Iceland between weeks 41 and 46, very few
influenza A(H1) cases have been reported worldwide.

This season, most influenza outbreaks are being attributed to influenza
A(H3N2) virus, and most viruses antigenically characterized so far have
been confirmed to be A/Fujian/411/2002-like, with the rest being
A/Panama/2007/99-like.

Austria (29 Nov 2003)

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Influenza A virus was first detected in week 48.

Canada (29 Nov 2003)

---

During week 48, influenza activity declined in Alberta and Saskatchewan but
increased in other parts of Canada, particularly British Columbia, Ontario,
and Nunavut. Influenza-like illness (ILI) consultation rate was 42 cases
per 1000 consultations, which is above the national baseline level for week
48. During the same week, 18 percent of 2567 laboratory tests were positive
for influenza A and no influenza B virus was detected. Of the 155 influenza
viruses antigenically characterized by the National Microbiology Laboratory
to date, 128 (83 percent) are A/Fujian/411/2002-like, 25 (16 percent) are
A/Panama/2007/99-like and one is an A/New Caledonia/20/99-like virus.

Denmark (29 Nov 2003)

---

ILI activity started to increase in week 47. In week 48, the ILI
consultation rate was above the national baseline, with one influenza
A/Fujian/411/2002-like virus detected.

Finland (6 Dec 2003)

---

Increased influenza activity has been observed since week 47. During week
49, influenza activity was widespread, with 30 influenza A viruses detected.

France (29 Nov 2003)

---

Increased influenza activity has been observed. In week 48, regional
activity of influenza A/Fujian/411/2002-like viruses was reported in 13
regions.

Morocco (22 Nov 2003)

---

So far this season, influenza activity has remained low, with one influenza
A(H1N1) and one A(H3N2) virus detected.

Norway (29 Nov 2003)

---

Influenza activity continued to increase. In week 48, widespread activity
of influenza A(H3N2) was reported throughout the country. All of the 21
A(H3N2) viruses antigenically characterized so far are A/Fujian/411/2002-like.

Portugal (29 Nov 2003)

---

In week 48, influenza A(H3N2) activity was reported as widespread for the
3rd consecutive week. All influenza viruses antigenically characterized so
far this season are A/Fujian/411/2002-like.

Republic of Korea (29 Nov 2003)

---

The first influenza viruses for the season ­ two influenza B viruses ­ were
detected in week 48.

Russian Federation (29 Nov 2002)

---

The ILI incidence rate continued to rise in week 48 and exceeded the
epidemic threshold in Moscow and St Petersburg. All 3 influenza virus
subtypes ­ A(H1N1), A(H3N2) and B ­ were detected. During the same week, 5
influenza A(H3N2) viruses were antigenically characterized and confirmed as
A/Panama/2007/99-like.

Spain (29 Nov 2003)

---

Influenza activity continued to be widespread during week 48. However, ILI
incidence rate slowed down in the Castilla y Leon autonomic community.

Switzerland (29 Nov 2003)

---

Increased influenza activity was observed in week 48, particularly in the
western part of the country where 9 influenza A viruses were detected.

United Kingdom (29 Nov 2003)

---

Influenza activity appears to have levelled off but the trend remains
unclear. In week 48, ILI consultation rate remained almost the same as in
week 47 in England, continued to decrease in Northern Ireland and Scotland,
and kept rising in Wales (although it remained below the baseline level).
During week 48, 44 influenza A(H3) viruses and one B virus were detected.
Of the viruses antigenically characterized so far, 35 have been confirmed
as A/Fujian/411/2002-like and 3 as A/Panama/2007/99-like.

United States (29 Nov 2003)

---

Influenza activity continued to increase during week 48. Overall ILI
consultation rate was 5.1 percent, which is above the national baseline of
2.5 percent. Widespread influenza activity was reported in 13 states and
regional activity was reported in 16 states during week 48; 39.1 percent of
the specimens tested were positive for influenza with 1302 influenza A
viruses and 7 B viruses identified. Since week 40, the Centers for Disease
Control and Prevention in Atlanta have antigenically characterized 157
influenza A(H3N2) viruses, of which 45 (29 percent) are
A/Panama/2007/99-like and 112 (71 percent) are A/Fujian/411/2002-like.

Other reports

---

Low influenza activity was reported in Czech Republic, Germany, Hong Kong
SAR, Italy, Thailand, and Ukraine. No influenza activity was reported in
Croatia, Iceland, Japan, or Poland.

[Bob J]

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[Free Trapper]

I thought so,this may be a long winter. :(

[torstars]

I would really like to know, in the end, what killed these otherwise healthy children.

I think most are pneumonia, some with staph A.

[torstars]

Yes, the update by WHO shows that most of the problems in Europe and North America are due to Fujian and getting one of the other strains probably won't help much.

Fujian clearly was in the US last season because A/Wyoming/3/2003 was isolated last Feb and it clearly is Fujian-like. The virus really began to take off over the summer, when it was rapidly spreading in the southern hemisphere. Australia and New Zealand had particularly severe outbreaks, which were primarily Fujian (all sequences deposited so far isolated in 2003 from Australian, South Africa, US, and Oslo are Fujian).

It has taken hold in the northern hemisphere, and none of the countries in Europe or North America will benefit this season from the vaccine in production, which includes a Fujian-like isolate because it won't be ready until the current season in the north is over.

[torstars]

The list keeps growing:

College student dies from flu; strain of virus being tested

The Associated Press

WORCESTER, Mass. --
A Worcester State College student has died from the flu, but state public health officials do not yet know if it was the strain of influenza that has killed children in Colorado, Texas, Oklahoma and New Mexico.

Dr. Al DeMaria, the state's director of communicable disease control, said the student was diagnosed with strain A-type influenza. The Centers for Disease Control and Prevention is testing to see if it was the so-called "Fujian" strain.

DeMaria said influenza is becoming widespread in Massachusetts and needs to be taken seriously.

New England Cable News reported the student, a Winthrop resident, died at Massachusetts General Hospital on Tuesday.

State health officials are urging all people over 65 and those between six months and 23 months to get a flu vaccine.

DeMaria says several hundred people die each year from influenza in Massachusetts, and 36,000 will died nationwide.

[torstars]

Advocate Says Government Should Release Flu Shot Data
NewsMax.com Wires
Thursday, Dec. 11, 2003
Washington, D.C. - A leading vaccine safety and informed consent advocate is calling on federal health officials and flu vaccine makers to be honest with the American people about the effectiveness of this year's flu vaccine.
"Public health officials knew last spring that it was highly likely that the A/Panama strain in the current vaccine was not going to protect against the mutated, more dangerous A/Fujian strain of flu. If there is solid new evidence that the vaccine is protective against Fujian, then it should be released. If there is no such evidence, then it is not right to lead people to believe that if they get vaccinated now, they will be protected against it," said Barbara Loe Fisher, president, National Vaccine Information Center (NVIC).

Federal officials were prevented from replacing the A/Panama strain with the Fujian strain emerging out of Asia and being detected in Europe and the U.S.last spring because scientists in labs around the world were unable to isolate and grow the virus in a way that would allow vaccine production.

Transcripts from the February 20 and March 18, 2003 meetings of the FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) reveal that health officials around the world knew the genetically mutated Fujian strain was associated with significant morbidity and mortality and that last year's vaccine showed little protection against it.

Fisher, who was the consumer voting member of the FDA Advisory Committee, abstained from the strain selection vote on March 18, saying "I feel uncomfortable voting for inclusion of an A/Panama-like virus, when what may really be needed is an A/Fujian-like virus. So I am going to abstain and urge that the public be informed that next year's flu vaccine may not be protective against an emerging strain."

The National Vaccine Information Center is a non-profit, educational organization founded in 1982 by parents whose children were injured or died from reactions to the DPT vaccine. Dedicated to preventing vaccine injuries and deaths through public education, NVIC also advocates for the inclusion of informed consent protections in national vaccine policies and laws.

"This is a matter of the public's right to have full and truthful information about the benefits and risks of a particular vaccine in order for us to make an informed choice. Although there were technological limitations with making the switch this year to the new emerging strain, it does not serve either public health officials, industry or the public to not be honest about what the current vaccine can and can't do. At the end of the day, it is a matter of respecting the public trust," she said.

Every year, health officials at the World Health Organization (WHO) and the U.S. Department of Health and Human Services (DHHS) gather information about influenza activity around the world in order to try to make an educated guess about which three flu strains to include in the current year's flu vaccine.

Nasal Vaccine

This year, in addition to the inactivated (killed) flu vaccine, which is injected, a new live virus nasal flu vaccine is available in the U.S. Both the inactivated and live virus vaccines contain the same three flu strains.

Neither flu vaccine this year contains the mutated Fujian strain that is causing the most severe flu in the U.S. this season. The new live virus vaccine (FLUMIST), which is squirted up the nose, was licensed by the FDA in June 2003 for use in healthy individuals between the ages of five and 50. It is not recommended for pregnant women or those with asthma, chronic lung or heart disease; chronic underlying medical conditions such as diabetes or kidney disorders; immune suppression or immune system problems; children or adolescents receiving aspirin therapy, anyone allergic to eggs; or those with a history of Guillain Barre syndrome.

It should not be given simultaneously with other vaccines. FLUMIST's vaccine live virus is shed after vaccination so the vaccinated are advised to avoid close contact with immune compromised individuals for at least 21 days.

Some hospital personnel are asking those recently vaccinated with FLUMIST to avoid visiting patients in hospitals to prevent the risk of transmitting the vaccine strain virus to sick patients. The most common reactions to the live flu vaccine are similar to the flu: runny nose, nasal congestion, cough, sore throat, headache, muscle aches, fever, chills, and weakness.

The killed flu vaccine, which is injected, has historically been used in individuals over 60 years old who are at high risk for dying or becoming seriously ill during a bout with the flu. However, in recent years, the CDC has been asking all age groups to get an annual flu shot and now recommends that all healthy children older than 6 months of age get an annual flu shot.


Contraindications for the killed flu vaccine are: fever, an impaired immune system, egg allergy, mercury allergy or a history of Guillain Barre syndrome.


Pregnancy


In the past, pregnancy was a contraindication but now the CDC recommends flu vaccine for women more than 14 weeks pregnant. However this recommendation is controversial since most flu vaccines still contain the mercury preservative, Thimerosal, and mercury has been associated with brain damage and developmental delays in fetuses whose mothers were exposed to high levels of mercury during pregnancy.

The most common reactions to killed flu vaccine are fever, fatigue, painful joints and headache. The most serious reported reaction, which usually occurs within two weeks of vaccination, is Guillain Barre syndrome, an immune mediated nerve disorder characterized by muscle weakness, numbness, pain and paralysis.

Flu vaccine only protects against the three specific viruses which are included in any given year's flu vaccine formulation and does not protect against throat, respiratory, gastrointestinal and ear infections caused by bacteria and other kinds of viruses. When the match between the vaccine and circulating viruses is close, the flu vaccine is thought to provide a 70 to 90 percent chance of temporary immunity to selected strains in healthy persons less than 65 years old.

For those over 65 years old, the efficacy rate drops to 30 to 40 percent, although it is considered to be 50 to 60 percent effective in preventing hospitalization or pneumonia and 80 percent effective in preventing death from flu caused by the covered strains. For more information on flu vaccine and selection of this year's flu vaccine strains, go to NVIC's website at www.NVIC.org/Diseases/Influenza.htm.

[Free Trapper]

NONE of the other countries?

I really can't quite fathom at this time what we may be up against,I don't think.This will take a while to soak in.

Considering other diseases and possibilities....

[torstars]

NONE of the other countries?

Based on what WHO and CDC have posted, I don't think any vaccine anywhere includes Fujian at this time.

[vetvetdoug]

Thanks for the information. I understood that one could have immunity for the three strains that the vaccine contained AND the strain of the flu one first encountered in one's life. This is considering the doctrine of original antigenic sin and the body's immune response to the Orthomyxo viruses. Has there been a strain of Orthomyxo virus Influenza infecting the general public within the last 25 years that could confer immunogenicity against the current Fujian strain? Even if there has been a significant shift is it possible that there is an older strain that could be a drift from the current Fujian strain?

[torstars]

Flu hits University of Wyoming students



scho

LARAMIE, Wyo. (AP) - The University of Wyoming is the latest to be hit by this year's severe flu outbreak.

As of Tuesday, at least 20 UW students have tested positive for the A-Fujian-H3N2 strain, part of a class of flu viruses that caused severe outbreaks in the United States in the 1990s.

University officials say the actual numbers are likely much higher.

''We have no had enough kits to test everyone we have diagnosed with flu, so the actual number of positive results is much less than the number of students who have influenza,'' said Joanne E. Steane, director of the school's Student Health Service.

According to Steane, the university has been seeing flu cases since early November.

''In the week after Thanksgiving, 5.5 percent of the students seen at the Student Health Service were diagnosed with influenza, which is more than twice as many as the national baseline,'' she said.

This year's flu outbreak started between six and eight weeks early and shows no sign of reaching its peak, Steane said.

''At present, it looks as if we are in the midst of an outbreak with no estimation of when the incidence will peak,'' she said.

http://www.trib.com/AP/wire_detail.php?wire_num=5466

[torstars]

Fujian has quite a few mutations. If you look hard enough, you can find them in other sequenced strains, but they go from some fairly recent mutations to those that stopped circulating some time ago, to those found primarily in animals (ducks and pigs).

Fujian is clearly something worth avoiding.

[torstars]

Flu Victim Explains His Story
Dec. 10, 2003

Variant or drifting strains of influenza are still popping up in people even though they've had flu shots. One man, hospitalized at LDS Hospital, had a flu shot in September but the bug still took him down. Ed Yeates is there live with more on the story.

Like many others who've been getting sick, the gentleman here at LDS Hospital is considered a high risk patient. David Morrison is missing a third of his left lung from lung cancer, something he fought off more than a year ago, even though he's never smoked in his life. So at high risk for respiratory infections, David got his flu shot in September. He was scheduled for a second booster shot this month. But it didn't come soon enough.

http://tv.ksl.com/index.php?nid=39&sid=63455

[Palladin]

Thanks for all the information.

Are you a microbiologist?

[Judith Anne]

Thanks, torstars. Since I'm allergic to eggs, I won't be getting any vaccine, including the Flumist which is also based on an egg culture.

Anyway, the articles you've posted seem to say that there's no effective vaccine against the Fujiian strain, anyway, and if I read correctly, that's the one with the most significant morbidity and mortality.

Just a quick question, if you know--is there a quick test specifically for the Fujiian strain, so it can be differentiated from, say, emerging SARS or other flu strains?

[TaxRelief]

The kid in NC who died apparently had impetigo before catching the flu. The impetigo blew up out of control and settled into his lungs when his immune system was compromised by the flu.

[Free Trapper]

I just heard a TV news clip that reported epidemic status for Okla. according to (flu watch dot com),if I understood correctly.

I can't link but it might have something interesting if anyone cares to look and you haven't already seen it.

Everyone have a good FReep,I think I'm out of here for a while.:)

[torstars]

My background is Biochemistry.

[torstars]

There is a quick test for the flu. Subtyping the virus isn't as quick.

[torstars]

Parents Scramble For Shots After Two Flu Deaths

POSTED: 10:51 p.m. EST December 10, 2003


Charlotte -- A mother in Charlotte said Wednesday night she's been "all over town" looking for a flu shot for her baby.

Another mom said she's desperate to find vaccine for her teenager who has asthma.


Parents said they're worried after officials in North and South Carolina reported their first confirmed flu deaths of 2003 involving children.

Kelly Kellam, age 6, died Saturday at a hospital in Moore County, NC.

Kelly's father, who lives in Montgomery County, said late Monday night that doctors acted very professionally, but something went wrong.

Health officials in South Carolina confirmed Monday night that flu complications caused the death of 8-year-old Jamia Shumpert of Orangeburg County, SC.

http://www.wsoctv.com/news/2697692/detail.html