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I’m sure your medical knowledge is quite more impressive then Dr. Sherif Zaki .....

Dr. Sherif Zaki is only the chief of infectious diseases pathology at the U.S. Centers for Disease Control .

Lungs of fatal swine flu patients badly damaged
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090903/h1n1_lungs_090903/20090903
Sep. 3 2009

The lungs of people who have died from swine flu look more like those of the victims of H5N1 avian influenza than those of people who succumb to regular flu, the chief of infectious diseases pathology at the U.S. Centers for Disease Control says.

Study of about 70 fatal H1N1 cases so far also reveals there may be more incidences of co-infections with bacteria than was earlier thought, Dr. Sherif Zaki told The Canadian Press in an interview.

The damage to lung tissue is consistent with that inflicted by ARDS or acute respiratory distress symptom, Zaki says, referring to an often-fatal, difficult-to-treat syndrome that can have a number of causes. The U.S. National Heart, Lung and Blood Institute estimates about 30 per cent of people who develop ARDS die.

“In terms of the disease, yes, it (H1N1) is remarkably different than seasonal flu,” Zaki says. “The pathology looks very similar to H5(N1).”

The dangerous avian flu virus has killed 60 per cent of the 440 people known to have been infected with it. To date, though, the virus hasn’t acquired the capacity to spread easily from person to person.

The swine flu patients who went on to die suffered lung damage and changes in the lungs that would have made it difficult to deliver enough oxygen into their bloodstreams, Zaki says.

That reflects the observation of intensive care doctors who’ve struggled to save these profoundly ill patients.

“That’s what they saw in Winnipeg,” Dr. Paul Hebert, an intensive care physician and editor of the Canadian Medical Association Journal, said recently of how hard it is to oxygenate swine flu patients who become gravely ill.

“They have everybody on experimental ventilators and techniques. They can barely keep them alive.”

A number of doctors who have treated novel H1N1 patients — and colleagues who haven’t yet — were meeting in Winnipeg this week discussing what steps hospitals and ICUs need to take to get ready for an expected increase in pandemic flu cases this fall and winter.

Zaki says finding ways to prevent cases from progressing to severe illness should be the goal, “because once it happens in these patients . . . it’s very difficult to treat.”

Strikingly high levels of virus were spotted in the lungs of people who died rapidly from swine flu, he says, though less is seen in those who die after a longer battle with the virus.

“Some people die very quickly of it, within days. And some have more protracted illness, maybe two, three weeks,” he says.

“It’s surprising the amounts (of virus) that you see.... But it’s not unheard of,” he adds, pointing to what was seen with SARS.

Earlier studies conducted in tissue culture and in ferrets — the best animal model for human flu — found the new virus is drawn to tissue found deep in the lung. That’s a penchant it shares with H5N1. Seasonal flu viruses attack the upper airways.

Zaki says about a third of the fatal cases his team has reviewed involved co-infection with a bacterium, though the culprit varies.

Sometimes it is Staphylococcus aureus — the drug-resistant kind, known by the nickname MRSA and antibiotic-sensitive varieties as well. Some cases have involved group A Streptococcus. And some have been co-infection with Streptococcus pneumoniae.

“Those are the main three that we found.”

“It was not very clear initially,” Zaki adds of the frequency with which co-infection seems to occur in these cases. “But the more we studied, the more we realized that these do happen.”

He suggests pneumococcal vaccine, used in the elderly to lower the risk of pneumonia, could be a useful tool if given to younger people. The highest numbers of deaths so far have been in people in their late 30s and 40s.

Some of the cases of co-infection have been in people who were hospitalized for an extended period, which wouldn’t be all that surprising. But some were seen in people who weren’t hospitalized.

With the new virus causing severe disease in only a small portion of cases, public health authorities have been criticized for overreacting and overhyping the threat swine flu poses. Some critics have suggested the new flu isn’t really much worse than seasonal influenza.

From Zaki’s vantage point, however, this is not regular flu.

“This is a new virus. It causes a different disease than what we’re used to,” he says. “So I don’t think anybody can predict exactly, but it would be foolish not to be trying to study the disease more.”

Swine flu infects cells deep in lungs: study

PARIS (AFP) –- Swine flu can infect cells deeper in the lungs than seasonal flu, thus helping to boost the severity of the illness, a study said.

The paper provides the first laboratory corroboration of reports from front-line doctors that some patients with A(H1N1) virus suffer worse symptoms compared to those with run-of-the-mill seasonal flu.

Influenza viruses penetrate cells by attaching themselves to molecules called receptors, located on the outside of the cell wall.

The virus’ docking spike and the receptor are like a key and a lock. Some viruses only open a few cells, while others have something rather closer to a pass key, making it possible to infect a larger cell variety.

Once inside, the virus uses the cell’s machinery to replicate, eventually bursting the cell and going on to attack others.

Seasonal strains attach themselves almost exclusively to cells found in the nose, throat and upper airway, producing a some of influenza’s signature symptoms: runny nose, scratchy throat, a dry cough.

But the new research, published in the journal Nature Biotechnology, shows that the new swine flu — by sticking to a greater range of receptors — can also breach cells deep in the lungs.

Lab-dish experiments were carried out by Ten Feizi of Imperial College London and colleagues in which 86 different receptors were exposed to both seasonal and pandemic flu.

The seasonal strains only locked onto the kind of receptors found in the upper respiratory track.

But the swine flu virus was also able to latch onto receptors found deep inside the lungs, albeit more weakly. The adhesion results in a more severe lung infection.

Feizi spelt out the risk of what could happen if natural selection encourages viral strains that favor this deep-lung penetration.

“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 severe symptoms,” said Feizi.

“We think scientists should be on the lookout for these kinds of changes in the virus so we can try to find ways to minimize the impact.”

Using a statistical technique, epidemiologists sifting through data from other countries have found similarly disquieting patterns.

French epidemiologist Antoine Flahault has reported a 100-fold increase, compared to seasonal flu, in the number of swine flu deaths in Mauritius and New Caledonia attributed directly to the virus itself rather than secondary bacterial infections or underlying conditions.

Many of those deaths were caused by acute respiratory disease syndrome (ARDS), which requires intensive-care treatment for an average of three weeks. Only 50 percent of ARDS patients survive.

http://www.tehrantimes.com/index_View.asp?code=203357

Freeper DoughtyOne Why don’t you contact this newspaper , the writer , & the doctor Dr. Sherif Zaki who commented in this article who is ( the chief of infectious diseases pathology at the U.S. Centers for Disease Control )

Have you contacted the CDC and taken them to task for the two studies they use for claiming 36,000 deaths per year from influenza and complications brought on by it?

I’m sure your medical knowledge is quite more impressive then Dr. Sherif Zaki...

I've never made that claim, but it doesn't surprise me to see you jump to one more eronious conclusion.

Dr. Sherif Zaki is only the chief of infectious diseases pathology at the U.S. Centers for Disease Control.

That's impressive. Let's see what he has to say.

Lungs of fatal swine flu patients badly damaged
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090903/h1n1_lungs_090903/20090903
Sep. 3 2009

The lungs of people who have died from swine flu look more like those of the victims of H5N1 avian influenza than those of people who succumb to regular flu, the chief of infectious diseases pathology at the U.S. Centers for Disease Control says.

What of the lungs of the people who didn't die? Why didn't those people die too?

Study of about 70 fatal H1N1 cases so far also reveals there may be more incidences of co-infections with bacteria than was earlier thought, Dr. Sherif Zaki told The Canadian Press in an interview.

Does this mean that there were pre-existing condiditons that it would be hard to identify? Or does this mean that the H1N1 lowered the immune system so that the barriers to these bacteria were lowered? That's an important question. I don't see it addressed. Do you?

The damage to lung tissue is consistent with that inflicted by ARDS or acute respiratory distress symptom, Zaki says, referring to an often-fatal, difficult-to-treat syndrome that can have a number of causes. The U.S. National Heart, Lung and Blood Institute estimates about 30 per cent of people who develop ARDS die.

This would be interesting if the percentage of patients contracting H1N1 who died, was similar to that of ARDS. It isn't. 60% of the people who contracted ARDS, died. That being the case, it's somewhat irresponsible to compare H1N1 to ARDS, without clarifying the differences.

“In terms of the disease, yes, it (H1N1) is remarkably different than seasonal flu,” Zaki says. “The pathology looks very similar to H5(N1).”

The pathology is not the same. If it were, the mortality rates for the two would be similar. The mortality rates I have been able to find, peg the number at less than 1% for H1N1, but even that esitmation is noted to exclude the people who never reported having contracted the H1N1, that saw it through and returned to good health. Therefore the actual mortality rate is thought to be much lower than can be documented. Is that mentioned here?

The dangerous avian flu virus has killed 60 per cent of the 440 people known to have been infected with it. To date, though, the virus hasn’t acquired the capacity to spread easily from person to person. The swine flu patients who went on to die suffered lung damage and changes in the lungs that would have made it difficult to deliver enough oxygen into their bloodstreams, Zaki says. That reflects the observation of intensive care doctors who’ve struggled to save these profoundly ill patients. “That’s what they saw in Winnipeg,” Dr. Paul Hebert, an intensive care physician and editor of the Canadian Medical Association Journal, said recently of how hard it is to oxygenate swine flu patients who become gravely ill. “They have everybody on experimental ventilators and techniques. They can barely keep them alive.”

Mortality rates are nowhere near comparable for H1N1 to H5N1, yet here the two are discussed at length, just no disqualifiers inclued to remind folks or inform the public that mortality rates are vastly different for the two.

A number of doctors who have treated novel H1N1 patients — and colleagues who haven’t yet — were meeting in Winnipeg this week discussing what steps hospitals and ICUs need to take to get ready for an expected increase in pandemic flu cases this fall and winter. Zaki says finding ways to prevent cases from progressing to severe illness should be the goal, “because once it happens in these patients . . . it’s very difficult to treat.” Strikingly high levels of virus were spotted in the lungs of people who died rapidly from swine flu, he says, though less is seen in those who die after a longer battle with the virus. “Some people die very quickly of it, within days. And some have more protracted illness, maybe two, three weeks,” he says. “It’s surprising the amounts (of virus) that you see.... But it’s not unheard of,” he adds, pointing to what was seen with SARS. Earlier studies conducted in tissue culture and in ferrets — the best animal model for human flu — found the new virus is drawn to tissue found deep in the lung. That’s a penchant it shares with H5N1. Seasonal flu viruses attack the upper airways. Zaki says about a third of the fatal cases his team has reviewed involved co-infection with a bacterium, though the culprit varies. Sometimes it is Staphylococcus aureus — the drug-resistant kind, known by the nickname MRSA and antibiotic-sensitive varieties as well. Some cases have involved group A Streptococcus. And some have been co-infection with Streptococcus pneumoniae. “Those are the main three that we found.” “It was not very clear initially,” Zaki adds of the frequency with which co-infection seems to occur in these cases. “But the more we studied, the more we realized that these do happen.” He suggests pneumococcal vaccine, used in the elderly to lower the risk of pneumonia, could be a useful tool if given to younger people. The highest numbers of deaths so far have been in people in their late 30s and 40s. Some of the cases of co-infection have been in people who were hospitalized for an extended period, which wouldn’t be all that surprising. But some were seen in people who weren’t hospitalized. With the new virus causing severe disease in only a small portion of cases, public health authorities have been criticized for overreacting and overhyping the threat swine flu poses. Some critics have suggested the new flu isn’t really much worse than seasonal influenza.
From Zaki’s vantage point, however, this is not regular flu.

This is a clever ploy used to make H1N1 sound more ominious. Zaki says, "...this is not regular flu." Okay. I agree. It's not. The writer wrote this to make it seem that H1N1 was worse than it might be. Note: Some critics have suggested the new flu isn't really much worse than season influenza. Zaki: This is not regular flu. Note that Zadi didn't say, this will kill many more than the seasonal flu. What he said did not contradict the premise that H1N1 isn't really much worse, or will not cause more deaths.

Once again, all this talk about H1N1 in conjumction with H5N1 and SARS as it related to the people who actually died. There's no mention of the vast differences in mortal outcomes in the separate groups. H1N1 is tied to the much more devistating influenza versions, without bringing it all into perspective. PERSPECTIVE

“This is a new virus. It causes a different disease than what we’re used to,” he says. “So I don’t think anybody can predict exactly, but it would be foolish not to be trying to study the disease more.”

I wouldn't argue with that. What I would do is caution these public physicians to be careful what they say in public. Linking two infectuous diseases (even if some similarity can be sited) with vastly different overall mortaility outcomes is only appropriate if the mortaility rate differences are clarified as part of the process. Linking H1N1 with a mortality rate less than 1% to an infectuous disease with mortality rates around 60%, without clarification is negligent to the max.

This guy should know better than that.

What he says behind closed doors to people in the field who have background information, should be considerably different that what he would say for public desminination to people who have no background with which to judge this information rationally.

A casual parousel of this information, could easily cause someone to come away with a very distorted perception of H1N1.