Posted on 06/24/2009 8:04:24 AM PDT by metmom
Within minutes, six-year-old Rubjit Thindal went from happily chatting in the back seat of the car to collapsing and dying in her father's arms.
"If we had known it was so serious, we would have called 911,'' Kuldip Thindal, Rubjit's distraught mother, said in Punjabi yesterday. "She just had a stomach ache -- she wasn't even crying.''
Rubjit was pronounced dead at hospital barely 24 hours after showing signs of a fever. Later, doctors told her parents she had the H1N1 influenza virus. She is believed to be the youngest person in Canada with the virus to have died.
(Excerpt) Read more at news.guelphmercury.com ...
Fit Tamiflu Resistant Cluster in Hong Kong
Recombinomics Commentary 19:09
September 9, 2009
http://www.recombinomics.com/News/09090901/H274Y_HK_Cluster.html
The virus was isolated from the specimen taken from a 38-year-old man who had no history of taking Tamiflu.
The patient developed flu-like symptoms on July 26 and his respiratory specimen taken at a Designated Flu Clinic was tested positive to HSI on July 30.
Investigation revealed that four other family members also suffered from laboratory confirmed HSI including his wife, son, and two younger brothers sequentially at end of July. One of his younger brothers, aged 32, who had onset of flu like symptoms on July 23 had received a full course of Tamiflu treatment.
Except for this patient, all available isolates from other members of the family, including the specimen taken from the younger brother before he received Tamiflu treatment, were tested to be sensitive to Tamiflu.
The patient and all other affected members had mild illnesses and recovered.
The spokesman said that there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The spokesman said that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.
The above comments describe pandemic H1N1 with H274Y that is evolutionarily fit enough to transmit. This is the second such case identified in Hong Kong. The earlier case was a traveler form San Francisco who also had no history of Tamiflu use, but was infected with a mild strain of H1N1 with H274Y. The appearance of Tamiflu resistance in patients not taking Tamiflu was recently described in seasonal H1N1. The resistance was due to the same genetic change, H274Y, and prior to becoming fixed in the seasonal H1N1 flu population (clade 2B), it jumped from one genetic background to another via recombination. The H274Y was not only present in multiple clade 2B genetic backgrounds, but had been detected earlier in clade 2C and clade 1 in patients who had not taken Tamiflu.
The two examples in Hong Kong raise concerns that the same scenario is developing in pandemic H1N1 (swine flu), except at this time, most transmission is via a minor population that quickly appears after Tamiflu treatment. This minor population transmits silently, because it is below the detection limits of sequencing or sensitivity assays. It is most frequently detected in patients who have been treated with Tamiflu.
The results cited above support that interpretation. The cluster of cases is likely linked to the index case for the familial cluster. Initially, his sample was Tamiflu sensitive. However, the treatment quickly led to a mixture, including sequences with H274Y which infected the older brother (38M), while other family members were infected with the sensitive strain. The three day time frame between symptoms in the two brothers supports H274Y in a significant percentage of sequences, and after the short treatment, the mixtures produced a resistant infection in one family member and Tamiflu sensitive infections in others.
Although there is no evidence of further spread in this cluster, the ability of H1N1 with H274Y to infect the older brother indicates it was evolutionarily fit, and under circumstances that did not include close monitoring, further spread would be likely.
The detection of both fit H1N1 isolates in Hong Kong is likely linked to their testing program, which routinely tests H1N1 positive samples. It is likely that similar transmissions are happening worldwide, but are not detected because of testing limitations.
Thus far, the public sequences with H274Y have been heterogeneous’ However, parental sequences lacking H274Y are widespread, leading to concerns that such sequences with H274Y will be detected at increasingly high frequencies.
The release of the sequences from the latest case of evolutionariiy fit pandemic H1N1 would be useful. Nineteen other cases have been described, but sequences from cases in Canada, Japan, Thailand, and multiple sequences from North Carolina, California, and Texas have not been released. Release of these sequences would be useful.
( Safe for the kids but the school cancels for the Queen? )
Queen cancels school visit over swine flu outbreak
London, September 09, 2009
First Published: 23:11 IST(9/9/2009)
Last Updated: 23:14 IST(9/9/2009)
http://www.hindustantimes.com/special-news-report/world-news/Queen-cancels-school-visit-over-swine-flu-outbreak/Article1-452054.aspx
Britain’s Queen Elizabeth II cancelled a visit to one of the country’s top schools due to a suspected outbreak of swine flu there, Buckingham Palace said on Wednesday.
She had been due to open a new sports hall at Gordonstoun School in northeast Scotland, where her husband Prince Philip, the Duke of Edinburgh, and children including eldest son and heir Prince Charles were educated.
But the visit scheduled for next Tuesday was cancelled on the suggestion of the school.
“At the request of the principal of Gordonstoun School following a suspected outbreak of the H1N1 virus (swine flu), with regret the Queen and the Duke of Edinburgh have postponed a visit to the school,” said a royal spokeswoman.
Britain is the worst hit country in Europe by the A(H1N1) virus, a global pandemic which the World Health Organisation says has killed 2,837 people around the world since it emerged in Mexico in April.
The kids can go to school but it’s not safe for the queen...
Hmmmm...
10. September 2009 05:39
http://www.news-medical.net/news/20090910/Swine-flu-more-lethal-than-seasonal-flu.aspx
Pandemic swine flu can infect cells deeper in the lungs than seasonal flu can, according to a new study published today in Nature Biotechnology. The researchers, from Imperial College London, say this may explain why people infected with the pandemic strain of swine-origin H1N1 influenza are more likely to suffer more severe symptoms than those infected with the seasonal strain of H1N1. They also suggest that scientists should monitor the current pandemic H1N1 influenza virus for changes in the way it infects cells that could make infections more serious.
Influenza viruses infect cells by attaching to bead-like molecules on the outside of the cell, called receptors. Different viruses attach to different receptors, and if a virus cannot find its specific receptors, it cannot get into the cell. Once inside the cell, the virus uses the cell's machinery to make thousands more viruses, which then burst out of the cell and infect neighbouring ones, establishing an infection.
Seasonal influenza viruses attach to receptors found on cells in the nose, throat and upper airway, enabling them to infect a person's respiratory tract. Today's research, which was funded by the Wellcome Trust, the Medical Research Council and the Engineering and Physical Sciences Research Council, shows that pandemic H1N1 swine flu can also attach to a receptor found on cells deep inside the lungs, which can result in a more severe lung infection.
The pandemic influenza virus's ability to stick to the additional receptors may explain why the virus replicates and spreads between cells more quickly: if a flu virus can bind to more than one type of receptor, it can attach itself to a larger area of the respiratory tract, infecting more cells and causing a more serious infection.
Professor Ten Feizi, a corresponding author of today's paper from the Division of Medicine at Imperial College London, said: "Most people infected with swine-origin flu in the current pandemic have experienced relatively mild symptoms. However, some people have had more severe lung infections, which can be worse than those caused by seasonal flu. Our new research shows how the virus does this - by attaching to receptors mostly found on cells deep in the lungs. This is something seasonal flu cannot do."
The researchers found that pandemic H1N1 influenza bound more weakly to the receptors in the lungs than to those in the upper respiratory tract. This is why most people infected with the virus have experienced mild symptoms. However, the researchers are concerned that the virus could mutate to bind more strongly to these receptors.
"If the flu virus mutates in the future, it may attach to the receptors deep inside the lungs more strongly, and this could mean that more people would experience serious symptoms. We think scientists should be on the lookout for these kinds of changes in the virus so we can try to find ways of minimising the impact of such changes," added Professor Feizi.
The researchers compared the way seasonal and pandemic H1N1 flu viruses infect cells by identifying which receptors each virus binds to. To do this, the researchers used a glass surface with 86 different receptors attached to it, called a carbohydrate microarray. When viruses were added to the glass surface, they stuck to their specific receptors and the corresponding areas on the plate 'lit up'. This meant the researchers could see which receptors the different viruses attached to.
Pandemic H1H1 influenza could bind strongly to receptors called α2-6, which are found in the nose, throat and upper airway, and it could also attach more weakly to α2-3 receptors, which are found on cells deeper inside the lungs. However, seasonal H1N1 influenza could only attach to α2-6.
"Receptor binding determines how well a virus spreads between cells and causes an infection," said Professor Feizi. "Our new study adds to our understanding of how swine-origin influenza H1N1 virus is behaving in the current pandemic, and shows us changes we need to look out for."
http://www3.imperial.ac.uk/
Zambian nurses contract swine flu
http://www.postzambia.com/content/view/13417/
TWO nurses at the University Teaching Hospital (UTH) who were attending to Swine flu patients have been diagnosed with the AH1N1 virus, Ministry of Healthspokesperson Dr. Rueben Mbewe has confirmed. The two are among the latest four cases identified to have the deadly Swine flu virus yesterday and adds to the earlier six cases which were reported on Monday this week.
Speaking in an interview this morning, Dr Mbewe said the total number of confirmed cases had now risen to 15 since July 23, 2009 when the first three cases were reported.
“We have received four more cases and among them are health providers, we have confirmed that one of them was attending to the patients while the other one must also have contracted the virus from the patients.” “This brings the total number of confirmed cases to 15,” he said.
Dr Mbewe said the spread of the virus was worrying because the new cases could not be linked to victims having recently travelled out side the country.
“The problem is that we can’t link these knew cases to having traveled abroad recently or having been in contact with swine flu patients who recently traveled. This means it is a local transmission of the virus and the recent six plus four cases are all from within Lusaka,” Dr Mbewe said.
He said from the previously diagnosed six patients, two had been discharged after recovering while the rest including the latest four victims had been quarantined for medication.
He further said the ministry was awaiting a third consignment of Tami-flu tablets which cures Swine flu from the World Health Organisation (WHO).
“We have intensified our sensitization programmes on TV and radio through adverts but we are also waiting for a third consignment of Tami-flu. A lab has been set up at UTH which is handling the cases,” he said.
Zambia recorded the first five cases in July through Copperbelt University Students and lecturer who returned from a sports tournament in Belgrade.
Thanks for the update, DvdMom
Ping.
South Carolina
http://www.thecarolinaforestchronicle.com/v2/content.aspx?ID=122288&MemberID=1598
Quote:
Several swine flu cases confirmed in Horry County,
Sept. 8, 2:40 p.m.
First reported on the Chronicle’s Facebook fan page at 10:40 a.m.
By Michael Smith, Charles Perry and Kathy Ropp
The Chronicle
Sharon Daisey knew something was amiss last week when one by one, her daughter’s classmates at Socastee High School began falling ill.
The Myrtle Beach area mom suspected swine flue, but said school officials told her swine flu wasn’t to blame.
The school attributed it to a simple case of “kids talking,” she said.
But when her daughter started running a fever two days later, Daisey took her daughter to the doctor, who diagnosed it as H1N1, or swine flu.
In the days that followed, her son who attends school at Forestbrook Middle was also diagnosed with swine flu. He has since recovered, while Daisey said her daughter is still fighting the illness.
The two Daisey family cases represent are among hundreds of swine flu cases statewide.
An exact count doesn’t exist because the S.C. Department of Health and Environmental Control (DHEC) only records a case when a patient is hospitalized or if a doctor reports it, officials say.
Although DHEC has confirmed more than 500 swine flu cases statewide, the agency no longer tracks every case.
In April and May, the agency tested every specimen that came its way. But because the disease is “grossly underreported,” the numbers didn’t mean anything, said Adam Myrick, a DHEC spokesman.
“It [swine flu] is here and it’s going to stay here,” Myrick said. “It’s no surprise that it’s [in Horry County]. We are in the middle of a pandemic.”
The Horry County swine flu cases contradict previous reports from state health officials and other media outlets that the sickness was confined to a couple of cases in Georgetown County.
The lack of an official swine flu count creates an unsafe situation by needlessly exposing school children to the disease, Daisey said.
She blames DHEC for not requiring tighter reporting procedures, and also Horry County Schools for apparently downplaying the growing swine flu problem, saying there are at least 10 likely cases of swine flu at Socastee High alone.
“My daughter was freaking out because one kid who sits in front of her is out with swine flu,” Daisey said. “Legally, they should have to report it. And you should be allowed to pull your kid out of school and not worry about them failing because of swine flu.”
Several Horry County school board members have asked to discuss swine flu and reporting policies at the board’s next meeting Sept. 14, said District 3 board member Joe DeFeo.
Meantime, DeFeo said parents should report confirmed cases of swine flu to the school and/or district office immediately.
Read the full story in the Sept. 10 edition of the Carolina Forest Chronicle.
Form of swine flu resilient to Tamiflu discovered in Israel
Sep. 10, 2009
JPost.com Staff , THE JERUSALEM POST
http://www.jpost.com/servlet/Satellite?cid=1251804536883&pagename=JPost%2FJPArticle%2FPrinter
Camper to Camper Transmission of Tamiflu Resistant H1N1
Recombinomics Commentary 22:21
September 10, 2009
http://www.recombinomics.com/News/09100902/H274Y_Camper_H2H.html
On July 8, she experienced cough and headache without fever, and on July 9 she experienced chills, worsening headache, and loose stools. Despite these symptoms, her oseltamivir dose was not increased to a therapeutic treatment dose. On July 10, the last day of the first camp session, she traveled away from camp with three family members while ill, returning on July 12, afebrile and with a cough, to attend the second session. On July 12, a rapid influenza detection test was positive for influenza A.
A second previously healthy adolescent girl, who resided in the same cabin as patient A, began oseltamivir chemoprophylaxis at a dose of 75 mg daily on July 7 after exposure to patient C. On July 10, patient B left camp for a home visit during the break between camp sessions. The next day, while at home, she experienced onset of fever (101.9ºF [38.8ºC]), sore throat, and cough. She continued to engage in normal activities while ill, including visiting a shopping mall and movie theater. She returned to camp for the second session on July 12 with fever, headache, cough, malaise, and myalgias. On July 12, a rapid influenza detection test was positive for influenza A.
On August 14, CDC testing of viral RNA detected H275Y and I223V mutations
The above comments are from tomorrow’s MMWR and describe two summer campers who were infected with oseltamivir (Tamiflu resistant) pandemic H1N1 while on prophylactic Tamiflu. Since the campers shared the same cabin, and developed symptoms four days apart, it is likely that one camper infected the other. The scenario is also supported by the detection of the same rare marker, I223V, which has not been reported in other human or swine pandemic H1N1 isolates, but is present in two avian H1N 1isoaltes (see list here).
The report of this human to human transmission follows a similar report in Hong Kong, reported yesterday. In that case a younger (32M) brother was treated with Tamiflu, and his older brother (38M) developed symptoms and was positive for Tamiflu resistant pandemic H1N1 even though he had no Tamiflu exposure. Other family members were also infected, and like the younger brother, were Tamiflu sensitive, suggesting the index case was infected with a mixture and the brother was infected by the H274Y positive version, while other family members were infected with wild type H1N1.
These resistant sequences are most easily detected in patients taking prophylactic Tamiflu, because they are being monitored and symptoms while on Tamiflu raises suspicions of resistance. The Hong Kong case was discovered because of an aggressive surveillance program, which detected H274Y in an earlier traveler from San Francisco , who also had no Tamiflu exposure increasing concerns of transmission by evolutionarily fit H1N1 with H274Y.
These repeated outbreaks of H274Y on multiple genetic backgrounds of pandemic H1N1 raise concerns that the fixing of H274Y in seasonal flu, which was driven by recombination and genetic hitchhiking, will be repeated in pandemic H1N1 in the near future.
New Wisconsin swineflu article
UW-Madison takes steps to prevent massive outbreak of swine flu
http://www.lacrossetribune.com/news/local/article_ee352a7a-9ec7-11de-8bce-001cc4c002e0.html
DEBORAH ZIFF September 11, 2009
The entryway to the basement of Carson Gulley Commons on the University of Wisconsin-Madison campus isn’t blocked off with hazard tape, but visitors might want to enter at their own risk.
The Lakeshore lounge area has been transformed into an “isolation room,” as officials call it, or a space where students with flu-like symptoms can stay to avoid infecting other students.
Furnished spartanly, but stocked with thermometers, cable TV and water bottles, UW-Madison has designated a handful of such rooms across campus in an attempt to avoid a massive outbreak of swine flu, or H1N1.
College campuses are especially susceptible to such an outbreak. Like petri dishes for disease, the close quarters of dormitories create an environment where viruses are easily passed from one student to the next.
Universities across the country are creating these facilities for students to “self isolate,” as recommended by the Centers for Disease Control and Prevention, with some schools reportedly setting aside whole buildings to quarantine the sick.
Already, officials at UW-Madison’s University Health Services (UHS) are seeing more flu cases than usual for this time of year. The campus clinic reported this week roughly 200 students with flu-like symptoms since the start of school, with more than 80 percent testing positive for swine flu.
Even members of the Badgers football team missed practice because they felt ill.
Craig Roberts, an epidemiologist at UHS, said the 200 cases likely only represent a portion of the total cases on campus, because many people don’t call or visit the clinic.
And although the university has been preparing for an outbreak of the flu all summer, Roberts said the timing and number of cases was surprising.
“Across the country, most of us are quite shocked at how suddenly it started,” Roberts said. “There was nothing gradual about it.”
Students who begin to have symptoms - a fever greater than 100 degrees and a sore throat or cough - are encouraged to go home to recuperate if they live close enough to do so without taking public transportation.
But if they can’t, UW-Madison has 23 beds in six rooms across campus where contagious students can get better without coughing on healthy ones.
“The idea with isolation is you want sick people to be separated from well people, which is difficult to do in a residence hall,” Roberts said.
Only a handful of students have stayed in the isolation rooms so far, said Paul Evans, director of university housing.
The rooms have private bathrooms, and students who stay there don’t go to class and get food delivered to them. The downside, Evans said, is students tend to get bored.
UHS officials said the university is planning to hold swine flu vaccine clinics at the union, recreation centers and dorms likely beginning in October.
Amber Cook, a 19-year-old sophomore at UW-Madison, spent the second week of classes on her mother’s couch in Oregon, Wis.
After she started getting a scratchy throat and a fever on Monday, she called UHS, where a doctor told her over the phone that she had the flu and should go home. Her mom came to pick her up at her room in Tripp Hall.
“It’s really frustrating for me to sit here and know I can’t go to classes,” she said. “It’s hard enough to keep up.”
But Cook said she e-mailed her professors about her absence. Faculty and staff have been instructed in a memo from Provost Paul DeLuca not to pressure sick students into going to class.
Leniency in the face of swine flu applies to faculty and staff, too.
The University of Wisconsin System is scheduled to vote today to suspend a rule that requires sick employees to turn in doctors’ notes if they’re out for at least five consecutive days. The exemption would only apply to employees with flu-like symptoms.
Many Who Get Flu Won’t Get Prescribed Antivirals
Daniel Novick-KFOX News Weekend Anchor/Reporter
Posted: 6:16 pm MDT September 12, 2009
Updated: 9:07 pm MDT September 12, 2009
http://www.kfoxtv.com/news/20878820/detail.html
EL PASO, Texas — As fall and winter is just around the corner, doctors are gearing up for a long year dealing with the flu — particularly the swine flu. And in their preparations, doctors are getting guidance from the federal government to not prescribe antiviral medication like Tamiflu and Relenza to patients who are not considered high-risk.
“If I had the swine flu, I would be very worried that I’m not going to get medication,” said Carlos Payan, from East El Paso.
Payan, like most of us, would not be considered high-risk.
“It’s going to be really sad that people are affected by not having medication for the swine flu,” Payan told KFOX.
So who is high risk? Pregnant women, children younger than five, adults 65 or older and people with certain chronic conditions such as asthma and heart disease.
“I don’t think I am one of the more dangerous classifications by my age, so I really don’t think it’s a problem for me,” said Bill Filetti, from East El Paso.
Filetti believes he’ll be OK this flu season.
“I don’t really have any problem with it. From what I’ve heard, it doesn’t seem like it’s much stronger than any other flu,” he said.
Federal authorities said they hope to prevent overuse, hoarding and shortages of drugs like Tamiflu and Relenza. Last spring during the swine flu scare, there were reports of these issues popping up across the country.
NV:
Widow urges others to take swine flu seriously
Sep. 12, 2009
By CARRI GEER THEVENOT
LAS VEGAS REVIEW-JOURNAL
http://www.lvrj.com/news/59120037.html
Elizabeth MacDowell says she wants people to take the H1N1 virus seriously. Her husband Richard, who contracted swine flu, died Aug. 31.
Photo by Jerry Henkel/Las Vegas Review-Journal
Richard and Elizabeth MacDowell didn’t live under a rock.
They had heard news reports about the swine flu pandemic. They had even discussed the topic.
“It was one of those nebulous things that happened to someone else,” Elizabeth MacDowell said Friday. “Maybe that’s why I’m so determined to come public with it.”
On Aug. 31, the swine flu claimed her husband’s life and changed hers forever. She is telling their story because she wants others to take the disease seriously.
The Southern Nevada Health District has reported 11 deaths related to the swine flu, formally known as the H1N1 virus, since the respiratory disease first hit the area this spring. That total includes a 70-year-old New York woman who was ill when she arrived in Nevada.
As of Sept. 4, the health district had confirmed 337 cases. Two patients remained hospitalized with severe illness.
Health district spokeswoman Jennifer Sizemore said the number of confirmed cases probably represents a small percentage of the actual cases in Clark County, “because testing isn’t recommended on a widespread basis.”
“For the most part, H1N1 is causing mild illness, and people are recovering on their own and don’t need to seek medical treatment,” Sizemore said.
At 51, Richard MacDowell didn’t fall into a high-risk group. When the health district reported his death, along with the death of a 41-year-woman, a spokeswoman did not identify them by name but said both had underlying medical conditions.
Elizabeth MacDowell insists that her husband of 10 years suffered from nothing more serious than arthritis before he began feeling sick on Aug. 14. That day, a Friday, Richard MacDowell said he felt a little tired and had a sore throat.
“Nothing alarming,” Elizabeth MacDowell said.
He felt a little worse on Saturday but went to work on Sunday. His job as a shuttle bus driver involved transporting tourists between McCarran International Airport and the hotels.
After work that day, he went to an urgent care center and received a prescription for an antibiotic. “He told me it was pneumonia,” Elizabeth MacDowell said.
By Thursday, he was feeling worse. He returned to the urgent care center and was sent home with a prescription for cough syrup.
“His cough at this point was outrageous,” Elizabeth MacDowell said.
The coughing kept both of the MacDowells awake at night. On Saturday, Aug. 22, Richard MacDowell returned to the urgent care center with a 102-degree fever.
This time, he was sent home with oxygen tanks and a prescription for a different antibiotic.
Richard MacDowell still couldn’t sleep, and he made his fourth trip to the urgent care center the following morning. He still had a 102-degree fever.
“He’s walking like a little old man,” Elizabeth MacDowell recalled. “He could barely move.”
This time he returned home with a nebulizer, a device used in treating respiratory diseases.
“By Monday night, he was gasping for air and choking,” Elizabeth MacDowell said.
That’s when she decided to take her husband to Valley Hospital Medical Center.
At the hospital, Richard MacDowell told his wife to go home and get some rest. He knew he had kept her awake the previous four nights.
Elizabeth MacDowell remembers how her husband’s skin felt — sweaty and clammy — as she kissed him on the forehead before leaving. When she returned the next morning, she found him attached to a ventilator.
“I never spoke to him again after Monday night,” she said.
A doctor told Elizabeth MacDowell that her husband might not recover. He also told her a swine flu test had come back negative. A few days later, she learned that a different type of swine flu test had a positive result.
Elizabeth MacDowell’s phone rang early on the morning of Aug. 31. Medical professionals were trying to resuscitate her husband. She made it to the hospital within 10 minutes, but Richard MacDowell was already dead.
“It just wore him out,” his widow said.
Now she is on a mission to spread her message about the swine flu.
“Maybe that’s why I’m not crying,” she said. “He’s not going to die in vain.”
Elizabeth MacDowell said she doesn’t want to scare Clark County residents; she just wants them to be vigilant, especially if they work with the public or find themselves feeling sicker than they’ve ever felt before. If necessary, insist on a swine flu test, she said.
Most swine flu patients survive, Elizabeth MacDowell said, “but you’ve got to take it seriously.”
She said she hadn’t considered the possibility that swine flu was causing her husband’s symptoms until a doctor raised the issue at the hospital. She believes he would be alive today if he had been diagnosed earlier.
Embassies stockpile flu drugs
Sep 12, 2009 04:30 AM
Joanna Smith
OTTAWA–Canada is strengthening emergency stockpiles of antiviral drugs at its overseas missions so embassy and consular officials can get the same treatments for the swine flu pandemic as fellow citizens back home.
The federal government is buying 1,750 doses of the inhalable antiviral drug zanamivir (brand name Relenza) from GlaxoSmithKline Inc. for the foreign affairs department, according to a public procurement notice.
The contract gives the government the option to buy another 245,000 doses in the next two years for other departments.
Government contracts generally give a variety of vendors a chance to compete, but since this contract asks specifically for Relenza – which only GlaxoSmithKline can provide – firms that make other antiviral drugs are left out on this one.
That includes Roche Canada and its oseltamivir (brand name Tamiflu).
Rodney Moore, a spokesman for the Department of Foreign Affairs, said there have been stockpiles abroad since 2005 but, until now, only of Tamiflu.
Those drugs are expiring next February and as the government refreshes the supply it is also diversifying it to resemble the mix found in emergency stockpiles across Canada, which contain Tamiflu, Relenza and an older and inexpensive flu drug called amantadine.
“The choice of antiviral is based on the medical professional’s analysis of each person’s individual need and no particular antiviral is `favoured’ over another,” said Moore.
Moore said the Tamiflu and amantadine were ordered earlier this year.
Canada began adjusting its stockpiles this spring in response to concerns the H1N1 influenza virus was developing resistance to Tamiflu.
Chief Public Health Officer Dr. David Butler-Jones said most stockpiles around the world contain Tamiflu because it’s a pill, which makes it easier to administer and store than Relenza, which is inhaled.
http://www.thestar.com/newsfeatures/swineflu/article/694722
12/Sep/09
S. Korea Reports 5th Death From Flu
A South Korean woman infected with influenza A died Saturday, raising the local death toll from the H1N1 virus to five.
The 73-year-old woman, who suffered from high blood pressure, was presumed to have died from complications stemming from the new flu, Yonhap News Agency reported quoting health officials.
The woman, who recently visited the United States, was confirmed infected with influenza A on Aug. 25, after showing symptoms of high fever and coughing. The exact cause of the death was still under investigation.
On Aug. 15, South Korea reported its first H1N1 virus-related death — a man in his 50s who had recently returned from a trip to Thailand.
South Korea reported its first new flu outbreak in early May, with the number of infections reaching more than 7,000. Most have fully recovered, but health experts say the disease could spread at a more rapid pace in the fall.
The government earlier said that it will vaccinate around 10 million people against the virus by the end of this year. Full-scale vaccination will begin in November and aims to inoculate 27 percent of the nation’s 49 million people by February next year, it added.
http://www.koreatimes.co.kr/www/news/nation/2009/09/113_51718.html
7th swine flu death in Louisiana
Associated Press - September 12, 2009 10:54 AM ET
BATON ROUGE, La. (AP) - Louisiana’s Department of Health and Hospitals says a northwest Louisiana man has died of swine flu - Louisiana’s seventh death from the H1N1 virus.
The department confirmed his death Saturday, but did not say when he died.
It says he lived in Region 7, which runs from Caddo to Claiborne and south to Sabine and Natchitoches parishes.
Because coughs and sneezes spread the virus, the department recommends covering nose and mouth with a tissue when you cough or sneeze, throwing out the tissue, and washing hands often.
It also recommends staying home if you get the flu and staying at least three to six feet from anyone who has it. And, if you get flulike symptoms and have other high-risk conditions such as pregnancy, diabetes or heart or lung problems, see a doctor.
http://www.wxvt.com/Global/story.asp?S=11118618
Swine flu seems here to stay in Northeast Florida
For first time, young adults seen as a high-risk group.
By Jeremy Cox Story updated at 5:08 AM on Saturday, Sep. 12, 2009
SWINE FLU
As flu cases pick up, hospital officials using math to help predict surges
Health department asking day cares to voluntarily report absences as health officials seek new surveillance tools uncover flu.
By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Saturday, September 12, 2009
In the waning days of April — the month swine flu hit the U.S. — the emergency room at Dell Children’s Medical Center was so overrun that the staff set up cots in a covered parking garage to handle the load.
They were too late. Patient volumes fell, and the cots went back into storage. Too bad the staff couldn’t predict the future.
But the self-titled numbers geeks at the Seton Family of Hospitals — the owner of Dell Children’s — say they are close to developing a mathematical model that could help them predict patient surges from day to day. That algorithm is one of the new tools local health officials are using to better prepare for a challenging flu season that will feature the novel H1N1 virus and regular flu, both causing fever, body aches and coldlike symptoms.
As area schools report more flu after wrapping up a third week of classes, Dell Children’s has been inundated with so many patients that Dr. Pat Crocker, chief of emergency medicine, said he is beefing up staffing: six additional doctor hours a day, an extra physician during peak hours starting Oct. 1 and a request for 14 traveling nurses before everyone else in the country tries to nab them first.
“Getting more staff on short notice takes a lot out of your resource pool, and doing that in a state with a nurse shortage and a doctor shortage means making people work extra shifts,” Crocker said. “We don’t like to make people do that unless it’s something you can’t plan for.”
Busy ERs at Central Texas hospitals and facilities across the country — a signal of a tough flu season — have led to other changes in surveillance to give officials a heads-up on a spreading illness.
The Austin/Travis County Health and Human Services Department sent letters to 370 licensed day care centers — including all those in Travis County, according to Dr. Philip Huang, the department’s medical director — asking them to voluntarily report absences twice a week.
Huang said he’s working with the Department of State Health Services on the project, which started getting its first reports this week. “We’re (also) definitely monitoring school absentee data,” he said.
Like day cares, schools are gold mines of community health information.
Thousands of Central Texans have contracted swine flu, which remains similar to seasonal flu in severity and is causing mild or moderate illness in most people. Since April, 18 people in Travis County have been hospitalized, and two have died, according to Austin/Travis County health department spokeswoman Carole Barasch. Forty people in Texas out of 593 nationally had died by Aug. 30; most of those were younger people. Those older than 50 are thought to have some immunity.
The most recent flu status for Texas was bumped up a notch to “regional,” meaning that there are increases in laboratory-confirmed flu and flu-like illnesses in at least two regions but in less than half of the state’s 11 regions. The two regions that include far South Texas and Central Texas, which includes Travis, Williamson and Hays counties, reported increased flu activity the last week of August compared with the preceding week.
Universities have been hit hard, but classes have generally not been disrupted. Hundreds of students in the Austin school district — mainly in elementary and middle schools — have gotten the flu, but most recovered quickly, and schools are functioning normally, said Tracy Lunoff, coordinator of student health services.
In Round Rock, elementary school absentee rates were two to three times higher than normal, but attendance is better than average at the other levels, spokeswoman JoyLynn Occhiuzzi said. In Hays County, absenteeism at Lehman High School and Barton Middle School this week was twice the normal rate, spokeswoman Julie Jerome said, but like elsewhere, there were no plans to close a school.
“Kids are usually two weeks ahead” of the rest of a community when it comes to a potential outbreak, said Ryan Leslie, special assistant to the chief operating officer of Seton and one of its data gurus.
Central Texas’ two largest hospital systems, Seton and St. David’s, are collaborating with the Austin/Travis County health department by sharing information about ER volumes and admissions of flu patients to help beef up surveillance, hospital officials said.
The state health department also is trying new approaches. It has a $35,000 contract with University of Texas biologist Lauren Ancel Meyers to analyze data from hospitals and an estimated 130 Texas doctors and other health providers, said Doug McBride of the state health department.
The goal is “to see if there is a way to produce a tool in predicting ... more accurately health care needs, hospitalizations and deaths,” McBride said.
Seton officials also have been in touch with Meyers about helping them perfect their data once various approvals have been given. Seton is testing several predictive models now, said Dr. Thomas Erlinger, Seton’s director of research administration and infection control.
Like Seton, St. David’s hospitals saw an increase in patients complaining of flu this week, mostly in children, but none required hospitalization, said Dr. Steve Berkowitz, chief medical officer for St. David’s. Many had gastrointestinal symptoms, a common feature of swine flu that is not nearly as common with regular flu.
“We’re trying to find a way to automate the process” of collecting data, he said.
Doctors can make educated guesses, but there are some things that “are hard to see when you’re surrounded by patients,” Leslie said. The algorithm can plug in variables such as day of the week, which has an impact on ER flow, and allergens, which can affect respiratory illnesses, Leslie and Erlinger said.
Based on sheer volume, officials at Dell Children’s seemed to have every reason in April to set up cots.
On April 25, more than 70 patients came in complaining of flu, nearly a third of the total ER patients that day. By April 30, that number had swelled to 174 of 366 patients, nearly double the normal load, Crocker said.
Beyond helping with staffing, supplies and medications, advance warning can alert public health authorities of spikes in hospitalization and death rates so they can monitor whether the virus is changing in severity, a concern with the H1N1, Erlinger said.
What happened in April, Leslie said, “was a perfect dry run. ... We are now interpreting our data almost as fast as it is coming in.”
maroser@statesman.com; 445-3619
http://www.statesman.com/news/content/news/stories/local/2009/09/12/0912swineflu.html
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