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 ...
Swine flu science update: 30 June 2009
Carol Campbell
30 June 2009 | EN
The first sign of potential resistance to Tamiflu has emerged in Denmark. A patient with influenza A(H1N1) appeared to show resistance to the antiviral drug, which has been used to prevent the virus spreading in communities. But David Reddy — executive director of Roche Holding AG, who confirmed the case — says that there are no other signs of a Tamiflu-resistant strain of influenza A(H1N1) circulating in the community.
Meanwhile, a small US pharmaceutical company says it has developed a vaccine against swine flu, using insect cell technology, the Agence France-Presse (AFP) said.
Dan Adams, CEO of the Connecticut-based Protein Sciences Corporation, said his company had produced 100 000 doses of the vaccine on a US $35 million contract from the US Department of Health and Human Services.
AFP said Protein Sciences made the flu vaccine by infecting caterpillar cells with a baculovirus carrying the gene for hemagluttinin, a molecule that sticks out of the surface of the influenza virus. Insect cell technology does not need a “seed strain”, which is used in the normal production of vaccines.
Elsewhere, French drug maker Sanofi-Aventis announced that it has begun production of a vaccine for swine flu at its facilities in the United States and France. The vaccine has been developed using conventional egg-based vaccine technology, the company said.
In India, scientists have begun to issue warnings about the widely held fears that a second, more deadly wave of the disease may occur later this year.
In an interview with the Times of India Naresh Gupta — a senior doctor at Maulana Azad Medical College in New Delhi — pointed out that the 1918 Spanish influenza pandemic began with a mild wave in March followed by a more lethal second wave later in the year, going on to kill 40 million people.
Gupta’s comments were reinforced by Vineet Chawdhry — joint secretary in the Ministry of Health and Family Welfare — who told the newspaper that a second wave of the flu would be “more potent”.
Nature China reports that a researcher from the University of Hong Kong, working with British scientists, has found further evidence that the virus developed over a number of years. The researchers concluded that the virus originated from several viruses in pigs and that it contained “genetic elements of avian, human and classical swine origins”.
Meanwhile, researchers studying who is most at risk from severe illness as a result of swine flu infection say in the New England Journal of Medicine that prevention efforts should be focused on younger people, if resources or vaccines are limited. They have produced evidence showing that those exposed to strains of H1N1 that were circulating around the world before 1957 seem to have some protection against severe illness.
http://www.scidev.net/en/news/swine-flu-science-update-30-june-2009.html
Argentina: Health Minister Resigns Over Handling of Flu Cases
ALEXEI BARRIONUEVO
Published: June 29, 2009
http://www.nytimes.com/2009/06/30/world/americas/30flubrief.html?scp=7&sq=flu&st=cse
Australia:
Doctors brace as flus run rampant
TORY SHEPHERD
July 01, 2009 12:01am
http://www.news.com.au/adelaidenow/story/0,22606,25715307-2682,00.html
DOCTORS are preparing for a killer winter season as the common flu strikes early and swine flu cases increase.
SA Health has confirmed about 700 cases of common or seasonal flu, compared with a total of about 450 for the whole of last year, and about 360 cases of swine flu.
The dramatic increase in seasonal flu notifications is partly due to more people being tested because of swine flu fear, and also because influenza only became an officially notifiable disease in May last year.
However, it is likely the actual numbers are much higher, because many cases go unreported.
Australian Medical Association state president Dr Andrew Lavender said that having two flu viruses in circulation would put increased pressure on doctors.
He said people could catch both viruses in a season – sometimes at the same time.
“While we have a good immunisation program to protect some people from seasonal flu, we have no protection from swine flu,” he said.
Nationally, there are about 300,000 general practitioner visits, 18,000 hospital admissions and 2500 deaths from seasonal influenza each year. The season usually peaks in August or September.
Dr Lavender said GPs were “coping” at the moment, but that waiting times would “blow out” as the season peaked.
SA Health chief medical officer Professor Paddy Phillips said most people who died or were hospitalised had complicating illnesses, and that normal precautions to stop the flu spreading should be followed.
He said it was not too late to get a flu vaccination to ward off seasonal flu. Professor Phillips said it was possible the flu season would be worse than usual this year because it appeared to have started earlier.
However, it could also just appear to be starting earlier because more testing was being done, he said.
Adelaide Northern Division of General Practice chief executive officer Barbara Magin said waiting times to see a doctor normally increased to two or three weeks in winter, and that it would be even worse this year.
“Times have already blown out for GP practices, and the numbers are increasing on a daily basis,” she said.
Commentary
Silent Spread of Tamiflu Resistant Pandemic H1N1
Recombinomics Commentary 13:05
June 30, 2009
He had to start with no ill. That was in the preventive treatment with Tamiflu, because he had been in close contact with a swine influenza hit abroad. Since there had been five days of Tamiflu, the person suddenly ill with H1N1, but it not appear that the medicine worked. It appeared as through the samples here and in England that the person had been resistance, “says Nils Strandberg.
The above translation provides additional information on the patient who developed a pandemic H1N1 infection while taking a prophylactic dose of oseltamivir (Tamiflu). The five days suggests the patient was infected after her contact, who was infected overseas, returned. The patient was given Tamiflu because of her infected contact and developed flu-like symptoms while taking Tamiflu, which led to the isolation of the virus and sequence data (generated in Denmark and England) showing resistance (which was almost certainly H274Y).
The above description made no mention of an isolate from the patient who traveled overseas and no indication that an isolate was collected. Therefore, it is highly unlikely that a wild type sequence from the overseas traveler or the patient with resistant H1N1 exist. This absence was also signaled by statements from Roche and other agencies who used the qualifiers of “appears” and “probably” when describing the develop of resistance, because there is no evidence that resistance developed in the patient in Denmark.
A more likely scenario involves the silent spread of oseltamivir resistant H1N1. Denmark, like most countries in Europe, has focused on detection of H1N1 in travelers and contacts. Consequently, the number of H1N1 positive cases has been low. Although countries have been making sequences public shortly have collection of isolates, the number of public pandemic H1N1 sequences from Denmark at Genbank or GISAID remains at one. The NA sequence has been released and it is wild type. However, the isolate was collected from a patient in April, so there are no recent public sequences from Denmark.
Similarly, sequences from other countries are also limited and in many cases the public sequences do not include NA, so even if H274Y was in the isolate, it would not be in the database. The publicity associated with the Danish case will likely lead to more isolates and more sequences, and the explosion of cases in England, may lead to a more serious approach toward testing for community spread in European countries like Denmark, which are focused on airport travelers and contacts.
Airport screening will only detect a small subset of infected patients, because those infected shortly prior to travel will not yet have symptoms and about 30% of infected patients don’t develop a high fever. Moreover, others take medication for flu-like symptoms, which lowers fevers. Thus, infected patients have been flying into these countries undetected for months, and community spread is significant, but not reported because of a lack of testing.
The detection of H274Y in pandemic H1N1 has parallels with H274Y in seasonal H1N1. The resistance was widely reported in early 2008 in Norway, but subsequent testing demonstrated that the resistance was widespread in the fall of 2007 and had silently circulated for months prior to detection. The limited number of NA sequence for most countries outside of North America allows for a repeat of silent spread of Tamiflu resistantant pandemic H1N1 at this time.
More detail on the current case and contact who was infected overseas would be useful, as would serious testing and for community spread in countries reporting low levels of infections, which includes most countries in Europe, and rapid release of associated sequences.
http://www.recombinomics.com/News/06300901/H274Y_Swine_Silent.html
New Jersey Reports 6th Swine Flu Death
http://wcbstv.com/local/swine.flu.new.2.1065337.html
Six people have died from swine flu in New Jersey.
Connecticut governor signs infectious disease bill
http://www.smartbrief.com/news/ahip/storyDetails.jsp?issueid=CF45B0B6-B971-4762-AD05-CC7D64008F2F©id=DED61E4F-0D87-47D5-9BA7-D544B27F25E4
Connecticut Gov. M. Jodi Rell has signed into law a bill that mandates hospitals in the state to inform emergency service personnel when a patient has been diagnosed with AIDS, hepatitis, pandemic flu or other infectious diseases. “With all the privacy laws surrounding health care now, it is essential to preserve the rights and health of our emergency responders,” Rell said.
Three more people die of Influenza A, source (Argentina)
http://www.buenosairesherald.com/BreakingNews/View/5268
Three more people died in Argentina after contracting influenza A, reported the chief of medicine at the Italian Hospital in Buenos Aires Alejandra Valledor during an interview to a local radio.
The physician said the victims have “not been included” in the lists of influenza A fatalities made by the Health Ministry. Valledor claimed the government is “underreporting” the number of deaths and cases. The Health Minister has confirmed 29 deaths.
She added that hospitals in different parts of the country have been “overcrowded” due to the large number of patients who contacted the deadly illness.
Sources of the Emergency Room of the Argerich hospital told The Herald it had “collapsed” as a result of the large number of cases, and added that breathing machines might not be enough to cope with the growing demand.
At least people have died of swine flu in that hospital in the city of Buenos Aires, including a 25-year-old man, the source added, describing the “incredibly speed of the illness, which leads people to cough to death in a matter of days.”
As part of the measures to combat the illness, six provinces have suspended classes: Santa Fe, Santago del Estero, Corrientes, San Luis, Neuquén and Entre Ríos. The province of Chaco is reportedly analyzing to suspend the activities of the provincial public servants to prevent combat the spreading illness among employees of the provincial government.
neverdem is a doctor. He’d probably get more out of this than anyone else.
Has anyone found any pattern to being able to determine who is susceptible to serious reactions to this virus?
It seems that it’s either really mild or it’ll kill you.
Is there any rhyme or reason to this yet?
Changes in the influenza virus are creating painful symptoms
http://www.infobae.com/contenidos/45...-s%C3%ADntomas
Hospital director Malvinas Argentinas, Graciela Bonfigli, C5N explained that patients who are now in serious condition suffering from acute renal failure and hematologic disorders
Graciela Bonfigli, director of the Hospital Malvinas Argentinas, instead aiming only to patients who have the virus AH1N1 spoke exclusively with C5N and explained that, in very serious cases, two new diseases in patients.
According to the doctor, the influenza A virus affects more than a common flu because it brings additional tables.
Those who are in serious condition for being victims of the virus AH1N1 Two new symptoms that were not being taken into account. The first is acute renal failure, which has to be helped by dialysis. The second consequence is the occurrence of hematological abnormalities, such as when blood clots form throughout the body.
Bonfigli explained that may not yet have an explanation because the virus continues to MUTATE CONSTANTLY. Furthermore argued that if patients have no prior history, they are generally healthy adults who have a fall with pneumonia and respiratory failure. “
Measures by the Government, all health personnel will be pre-medicated because they are in permanent contact with the sick
And speaking of the specturm of illness..,
http://afludiary.blogspot.com/2009/06/wide-spectrum-of-illness.html
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jun2909h1n1nejm.html
Quote:
The patients had a difficult course, with renal failure in 1 survivor and 5 of the deceased and multi-organ failure in all 7 of the dead. Pathological examination of the lungs of one of the dead patients showed severe damage to lung tissue, but, with no bacterial infection evident, the researchers ascribed it to the primary viral pneumonia caused by the new flu. No evidence was found of co-infection with any other virus.
If you can find the link , On Drudge there’s an article about a dog flu virus going around :(((
Health Dept ‘failed’ to protect against swine flu (Australia)
http://www.abc.net.au/news/stories/2009/06/29/2610916.htm
“The ordinary flu this year is expected to be a bad year, so that worse than usual, coupled with the swine flu, will mean there will be intense pressure on emergency departments and other admittance areas.
“The people who work in there deserve, and indeed are entitled to get the very, very maximum level of protection that’s available, and at the moment that’s not being done.”
This *mutating constantly* is not good.
The severe organ damage is not either.
There’s got to be some factor that makes some more vulnerable than others but until they find out, people will find out what happens when they get it.
Novel H1N1 flu can cause severe respiratory illness
Maryn McKenna * Contributing Writer
Jun 29, 2009 (CIDRAP News) – Novel H1N1 influenza can cause severe respiratory illness, profound lung damage, and death even in patients with no underlying conditions to make them vulnerable, a team of physicians from Mexico report in a rush article published online today by the New England Journal of Medicine (NEJM).
The analysis of 18 patients hospitalized with H1N1 (swine) flu at the National Institute of Respiratory Diseases (INER) in Mexico during the pandemic’s earliest days reveals that fewer than half had underlying medical conditions, but more than half needed mechanical ventilation within a day of admission. Seven of the 18 died.
In a companion article, also published in advance online today, a multi-national team from Mexico and the United States document the age distribution of the first month of the H1N1 pandemic in Mexico, where the disease appears to have struck first, and confirm its unusual pattern of severe pneumonia among younger patients. Matching the pattern to those of earlier pandemics, the team speculates on the “biologic plausibility of partial protection” in older people exposed to mid-20th century strains of seasonal flu.
The case series of 18 patients, written by researchers from INER, the Mexican Secretariat of Health and BIRMEX, Mexico’s state-owned vaccine-production laboratories, documents the severe illness of the first patients admitted with lab-confirmed H1N1 infection and x-ray–confirmed bilateral pneumonia during the pandemic’s first wave.
The 18, of whom 7 died, are a subset of 98 patients hospitalized at the institute with pneumonia or influenza-like illness between March 24, the presumed onset date of the first known case, and April 24. Those 98 were a subset of 214 patients who came to the institute’s emergency room with influenza-like illness or severe respiratory distress.
The 18 patients were evenly divided by gender but ranged widely in age, from 9 months to 61 years, with a median age of 38. They were all at least moderately ill, with fever of at least 38°C (100.4°F), cough, and difficulty breathing; 4 of the 5 children had diarrhea.
Most had bloodwork findings that indicated acute viral infections, inflammation and cardiac distress. Half had low blood pressure that persisted after emergency treatment, and 10 of the 18 needed to be put on ventilators within 24 hours of arrival at the hospital.
Eight of the 10—5 of the 11 survivors and 3 of the 7 who died—had a pre-existing medical condition: asthma, sleep apnea, diabetes, or high blood pressure. (In the United States, “The vast majority of the fatalities … do occur in people with underlying conditions,” Dr. Anne Schuchat of the Centers for Disease Control and Prevention said in a press briefing Friday. “It’s not 100%. It’s more on the on order of three-fourths.”)
“We did not find a factor that, before the onset of illness, predicted a worse outcome or death among our patients,” the researchers said.
In a finding that is likely to fuel an ongoing debate, the researchers found that none of the 18 patients had concomitant bacterial pneumonia, a finding that has been replicated in the United States and that differs from cases recorded during the 1918 pandemic. However, 9 of the survivors and 4 of the deceased received antibiotics during outpatient visits before they reached the institute, and 17 were given antibiotics after admission there, making it unlikely that any bacterial infection would be discovered.
Fourteen of the 18 received the antiviral drug oseltamivir (Tamiflu), either at admission or within a few days of being admitted—in all cases, many days after the 2-day window when flu antivirals are most likely to have an effect.
The patients had a difficult course, with renal failure in 1 survivor and 5 of the deceased and multi-organ failure in all 7 of the dead. Pathological examination of the lungs of one of the dead patients showed severe damage to lung tissue, but, with no bacterial infection evident, the researchers ascribed it to the primary viral pneumonia caused by the new flu. No evidence was found of co-infection with any other virus.
And as evidence of the way the novel H1N1 took Mexico and the world by surprise, the researchers found that the 18 patients passed the flu to their families, with 82 people potentially exposed and 20 ill. Four required hospital treatment, and 1 died. Plus, 22 of the 190 healthcare workers who came in contact with the first 3 patients admitted to the institute also came down with the novel flu, but were sent home with oseltamivir and were only mildly ill.
Like the first set of patients, the healthcare workers and family members who fell ill in the second generation of cases were primarily younger, a situation mirrored in the second paper published today in NEJM. The analysis is by scientists from Arizona State University, the University of California, Berkeley, and the US National Institutes of Health, along with the Mexican Ministry of Health and National Institute of Public Health.
They found that, out of 2,155 reported cases of severe pneumonia and 2,582 lab-confirmed samples of the new flu submitted in Mexico during the pandemic’s first month, 71% of severe pneumonias and 87% of deaths occurred in those between the ages of 5 and 59. That pattern is unlike any observed during seasonal flu in Mexico but matches records from the three pandemics of the 20th century, they said.
http://www.cidrap.umn.edu/cidrap/con...9h1n1nejm.html
new info from Mexico
ping
HIGHLIGHTED REMINDER!!
“People need to know that we are continuing to see H1N1 activity pretty much parallel to what we were seeing in April, May and even June,”....
Because this is a novel virus that no one has been exposed to before, people have little or no immunity to it. That could be one of the reasons the virus is continuing to circulate during the summer months.
Swine flu symptoms are similar to the standard flu, including a fever, coughing, shortness of breath, fatigue and chills. Some people also report vomiting and diarrhea.
.....Children are among those who have been hit the hardest....Now that schools are out, children have another place where they can easily become infected — summer camps.
There is still a lot happening elsewhere with H1N1, and the virus appears to be taking on some nasty, if still relatively localized, attributes. If you haven't checked this thread lately, you might read through and become familliar with some of the developments.
As always, Thanks to DvdMom for doing a tremendous job of posting new information!
Canada-U.S. may go differently on vaccine production
Updated Tue. Jun. 30 2009 4:49 PM ET
The Canadian Press
TORONTO — Canada and the United States may go separate ways when deciding whether powerful boosting compounds called adjuvants should be added to swine flu vaccines, experts suggest.
Canada will likely use adjuvanted swine flu vaccine, says Dr. David Butler-Jones, head of the Public Health Agency of Canada.
[snip]
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