H1N1 flu victim collapsed on way to hospital [Latest H1N1 updates downthread]

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.

Smokin’ Joe I pinged your list and some other freepers to some new h1n1 news ...

CDC Investigates Spike In H1N1 Hospitalizations In Georgia

Recombinomics Commentary 23:00
March 29, 2010
http://www.recombinomics.com/News/03291001/H1N1_GA_CDC.html

Today the CDC held a tele-briefing on the spike in H1N1 hospitalizations in Georgia. CDC had been asked to investigate on March 4 because the number of hospitalized cases was spiking toward levels seen last fall, when H1N1 was widespread in GA and much of the country. At this time the level remains at regional, even though the 152 hospitalizations for the two most recent weekly entries represents the largest number even recorded by GA for pH1N1,

The CDC investigation confirmed that the hospitalized cases were H1N1 and that the demographic was similar to last fall, adults with underlying conditions. The CDC noted that most had not been vaccinated and expressed a concern that the public was not taking pH1N1 seriously and the low vaccination rate would lead to unnecessary hospitalizations and deaths. The geographic distribution of the current cases may be slightly different than the fall, but that data was preliminary and the CDC suggested similar outbreaks may appear nationwide and the start of a third wave could not be ruled out.

The H1N1 was said to have not changed, but small differences can have large effects. The CDC was also involved in the H1n1 investigation in Ukraine last fall and the WHO issued a press release stating that there were no significant changes, but Mill Hill released sequences the following day, which showed that 4 of 4 fatal cases had D225G, a receptor binding domain change that was linked to increased affinity of gal 2,3 receptors, which are at high levels in human lung, and D225G had been found in two of the five 1918/1919 autopsy lung samples, including the only 1919 sequence. The CDC has also not commented on D225G/N in the Duke death cluster where 3 of the 4 patients died, so it would be useful if the CDC would simply release sequences from the recent hospitalized patients. To date there is only one public sequence from Georgia in 2010, A/Georgia/01/2010 (27F collected 2/6/2010 deposited by the CDC at GISAID), which has 8 newly acquire synonymous changes.

Georgia Cases Put Swine Flu Back On Radar

6:38 pm
March 29, 2010
By Richard Knox
http://www.npr.org/blogs/health/2010/03/georgia_cases_put_swine_flu_ba.html?ft=1&f=1001

Most people may think the new flu strain that popped up about a year ago has gone away. Largely, it has. But it’s still putting some Americans in the hospital.

Just like last spring, the nation’s influenza hot spot -— well, call it a warm spot — is in the southeastern part of the country.

In the last week, swine flu has put more than 40 Georgians in the hospital. In fact, this is the third week in a row that Georgia has had more flu hospitalizations than any other state.

H1N1 suspected in death

By Kristi L. Nelson
Posted March 28, 2010 at midnight
http://www.knoxnews.com/news/2010/mar/28/h1n1-suspected-in-death-vaccine-is-available/

Cathy Briscoe-Graves and her 23-year-old daughter both got very sick on a Friday with serious, flu-like symptoms: coughing, headaches, body aches.

Their primary-care physician suspected the H1N1 influenza strain, Briscoe-Graves said, though he didn’t test them, because that’s the most common flu strain circulating in this area.

In fact, the national Centers for Disease Control and Prevention has noted a recent spike in H1N1 activity - and the number of related deaths - in Tennessee and the Southeast region.

By a Tuesday, Briscoe-Graves was feeling significantly better. Her daughter was worse.

Briscoe-Graves took her to Parkwest Medical Center’s emergency department.

“I thought they’d give her an IV and some antibiotics,” Briscoe-Graves said. “I thought maybe she had walking pneumonia.”

Instead, a chest X-ray showed filled lungs, a life-threatening case of pneumonia, probably caused by the young woman coughing so hard with the flu that she aspirated stomach acid.

On March 19, Briscoe-Graves’ young, vibrant daughter - who loved painting, drawing, genealogy and scrapbooking and looked forward to being a bridesmaid in her brother’s October wedding - died of pneumonia, despite specialists’ valiant efforts to save her, her mother said.

Several recent deaths in local hospitals could be linked to H1N1, said Knox County Medical Director Martha Buchanan.

“It’s hard to say” exactly how many, Buchanan said. “They may get sick at home and come to the hospital with something else and not even know they have” the flu.

Health officials think the recent rise in the number of H1N1 cases in this region could represent the expected “third wave” of the pandemic.

As with the previous two waves, the virus is claiming younger, healthier people than does regular seasonal flu, which typically kills babies and elderly people. About a third had no serious health problems before.

The CDC estimates as many as 17,160 people nationwide have died from H1N1, though only about 2,500 deaths have been confirmed; Tennessee has reported 40 H1N1 deaths, including nine children.

This was the first U.S. region to see a peak in H1N1 cases during the first wave, Buchanan said, so it’s not surprising that it’s peaking again before other parts of the country.

Of the local H1N1-linked deaths, Buchanan said, none of the victims had been vaccinated “that we know of.” She urged people to get the H1N1 vaccination, available at all four Knox County Health Department locations: “We have plenty of it. It’s free. Come and get it, please.”

Neither Briscoe-Graves nor her daughter had had the H1N1 vaccine. She regrets not taking her daughter to the hospital sooner, although pneumonia can set in as quickly as an hour.

“If you do think you’ve gotten the flu and you do think you might have pneumonia, get a chest X-ray,” she said. “You hear about everyone else having it, but you don’t think it’s going to be you or one of your family members.”

Her daughter, who lived with her, “was just a wonderful person,” Briscoe-Graves said. “I’m sorry she’s gone so soon.”

Kristi L. Nelson may be reached at 865-342-6434.

H1N1 more like 1918 flu than modern cousins

Health experts say similarity explains infection patterns

By Helen Branswell
THE CANADIAN PRESS
Published Saturday March 27th, 2010
http://timestranscript.canadaeast.com/lifetimes/article/998320

TORONTO - The pandemic H1N1 virus more closely resembles the 1918 Spanish flu virus than more modern cousins in the same flu family, new research shows — a finding which helps explain the age pattern of H1N1 infections.

Like the Spanish flu virus, the pandemic H1N1 lacks two sugar coats seen on contemporary viruses from the same family, the work reveals.

The two studies, released this week, confirm that antibodies which protect against the pandemic virus also fight the virus that caused the 1918 pandemic. But they are not able to neutralize seasonal H1N1 viruses, nor are 2009 H1N1 viruses stopped by antibodies generated in response to those recent viruses.

The fact that two viruses that emerged 91 years apart would be so similar that antibodies which fight one can fight the other came as a surprise, admitted Dr. Gary Nabel, senior author of one of the papers.

“It’s very rare for viruses that are separated by more than a couple of years to cross-neutralize,” said Nabel, a scientist with the U.S. National Institute of Allergy and Infectious Diseases (NIAID).

The findings help explain why older individuals seem to have a degree of immunity to the pandemic H1N1 and why years of exposure to seasonal H1N1 viruses didn’t protect younger people from the new virus when it started spreading last year.

The work, published in the journals Science Translational Medicine and Science, was done by researchers from NIAID and the U.S. Centers for Disease Control on the one hand and from Scripps Research Institute in La Jolla, Calif., on the other.

Seasonal H1N1 viruses and the pandemic virus that emerged last spring descend from the same ancestor — the 1918 Spanish flu virus. But where seasonal viruses have evolved in people over decades, the pandemic H1N1 emerged from pigs — a host that doesn’t push flu viruses to change as rapidly as they do in humans.

The human immune system learns to mount defences against flu viruses, forcing the viruses to alter themselves in order to evade those defences. In the interplay between flu viruses and pigs, it’s the pigs that keep changing because of their short lifespan. Since they change, the viruses don’t need to.

In essence, it’s like the pandemic H1N1 virus was frozen in pigs, said Adolfo Garcia-Sastre, a flu expert at Mt. Sinai Hospital in New York City who published a study in January showing that a vaccine against the 1918 virus protected against the 2009 H1N1.

Nabel’s lab was coming to the same conclusion around the same time and decided to try to figure out why. So he and his group — and the Scripps group led by Ian Wilson — looked at the structure of the key protein on the outside of flu viruses, the hemagglutinin. While looking at the head of that protein, they found striking similarities between the 1918 virus and the 2009 H1N1.

When they compared them to contemporary seasonal H1N1 viruses, they noticed the seasonal viruses all had developed a pair of sugar coats on the head of the hemagglutinin (generally the H in a flu virus’s name).

It is something flu viruses are known to do to help them evade the immune system. Those small changes and others render the virus unrecognizable to antibodies generated by related flu viruses.

“It’s kind of like a celebrity wearing a hat on the airplane,” Nabel explained.

Antibodies against the 1918 and 2009 viruses couldn’t recognize H1N1s that had those sugar coats. When Nabel’s group gave the 2009 virus a sugar coat, the pandemic H1N1 vaccine was not effective against the altered virus. But antibodies to previous seasonal H1N1 viruses didn’t kill the sugar-coated 2009 virus, either.

This may show the path the pandemic virus will take as it starts to evolve to evade human defences, Nabel said, noting that as his group was submitting their paper for publication, they discovered four pandemic viruses with this change have already been seen by labs in Russia and China.

He suggested that may be evidence the virus is changing in the way seasonal flu viruses do.

“Well, it’s certainly a warning sign, yes. We were actually amazed when we saw that,” he said.

“When you make a prediction like that and within the course of a month or two you see those mutations occurring, you need to take those seriously.”

Nabel suggested vaccine manufacturers may need to take the first steps to prepare an updated H1N1 vaccine, making the starter virus that could be used as the production seed when a new vaccine is needed.

Further, he said, the finding suggests how pandemic viruses might evolve into seasonal ones, providing a road map for vaccine makers so they could try to get ahead of the virus.

But Garcia-Sastre wasn’t sure, noting that sugar coating isn’t the only trick flu viruses have up their sleeves. There are other changes viruses undergo as they evolve: Science can’t currently foretell which will happen and in which order, he said.

“Which direction the virus is going to go, I think everybody would like to know. Nobody has been able yet to predict it,” he said. “There are many different possibilities.”

There is another implication of the finding of the similarity between the 1918 and 2009 pandemic viruses and the fact that antibodies against one protect against the other, experts agree. Humans who’ve been infected with or vaccinated against the 2009 virus are protected against an accidental return of the 1918 virus.

When CDC scientists reconstituted that virus from genetic sequences several years ago, some people voiced concerns that the work was too dangerous. A lab accident could lead to the release of the virus that killed upwards of 50 million people in 1918 and 1919, they argued.

The more people who have natural or vaccine-induced protection against the 2009 pandemic virus, the less damage a 1918 virus could cause, suggested Dr. John Treanor, a flu vaccine expert at the University of Rochester in New York State.

“In the extremely unlikely event that a 1918 virus somehow escaped from the lab, this experience would probably provide some measure of protection against that,” he said.

Thanks so much for the ping. Prayers for the folks in Georgia - even the milder cases are no fun for this nasty “Chimera” flu, and definitely downright scary when the flu knocks down your defenses and you end up susceptible to secondary bronchial and respiratory infections...

When my daughter was in the hospital in mid-February here in Central Wisconsin (a regional “magnet”/higher-level hospital) the Peds ward was literally filled with children suffering from infectious diseases with flu-like symptoms (you could tell by looking at them frankly - and hearing the coughing of course). I will admit that I do not know how many were suffering from H1N1 other than two children who were on respirators in the PICU, or how many had other similar viruses and/or infections (I know two of them had Blastomycosis like my daughter, but the more normal respiratory pneumonia-like presentation. I think the real name is Pulmonary Blastomycosis. But that was 2 of perhaps 40-50 children if I do the math counting two beds per room as it looked like all if not most had.)

Now, I don’t know all of the thinking that went into the decision, but my daughter was automatically given a room in the Pediatric Oncology Ward — the reason we were told is because the children in the regular ward were very sick and contagious, and in the oncology section all parts have special airborne ventilation units with alarms on the patient rooms when too much “non-clean” air enters the room. The best way to prevent her from catching anything in the other section while we figured out what was wrong with her leg.

(To tell you the truth the way the nurses were talking made me a little wary at times to breath while passing through the regular ward, or while needing to be in that section for any extended period of time, as I had to do numerous times of the day while we were there! I made good use of the hand sanitizer conveniently placed in many spots around the ward.)

I also wanted to mention to you (forgot to ping you the other day), that the Pediatricians and my daughter’s Infectious Disease doctor discussed our family’s illness from last April with me for a while. They all agree that we most likely did have H1N1, and they also said that although it’s too soon to tell definitively that my family most likely had built up immunity to at least the original strain.

Also, despite hanging out in the family lounge with relatives of these infectious sick children, and walking through the regular ward numerous times a day (and definitely touching the counters and such in there when speaking with the docs and nurses...) none of us fell ill after my daughter’s hospitalization.

I know it’s all anecdotal information, but thought you may be interested to know... I feel fairly confident that due to getting this illness - unless it mutates a lot - those exposed and who became ill do have some sort of immunity which is good news. As I said about the mutation — that’s the only thing that worries me at this point... But then that’s a risk we face every year even with the more common flu viruses...

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