H1N1(Swine Flu): Illness Keeps Blood Donors Away, Worries About Whether Transfusions Spread Infection

If it’s not one thing then its another…now some blood centers are reporting an unusual drop in collections because too many potential donors are sick with the H1N1 virus. Blood drives in some high schools and corporate offices have had to be scaled back or canceled because of high levels of absenteeism.  And to make the situation even a bit worse some centers say a growing number of donors are calling a day or two after giving blood to say they’ve come down with flu-like symptoms, forcing the centers to dispose of the blood as part of government regulations. Researchers in a government-funded study are testing samples of these donors’ blood for viremia, the medical term for virus in the blood.

Unlike infectious diseases such as HIV/AIDS, hepatitis C and West Nile virus, colds and flu aren't believed to be transmitted by blood. But some studies indicate that more virulent strains can be present in the blood before flu symptoms show up. "When you get into strains that are pandemic, the rules don't necessarily apply," says Matthew Kuehnert, director of the Office of Blood, Organ and other Tissue Safety at the Centers for Disease Control and Prevention.

Medical officials say there is enough blood to comfortably supply the 15 million units used annually in trauma units, operating rooms and elsewhere. But blood centers have begun working with the federal government and hospitals to put emergency planning measures in place, such as allocating blood only to the sickest patients, should the pandemic worsen or return in a more virulent form next spring.

Once blood is collected, it is separated into red blood cells, platelets and plasma, and then undergoes 14 different tests, including 11 for infectious agents such as HIV to ensure its safety. Blood is then labeled by type, stored at appropriate temperatures, and distributed to hospitals as needed. Centers are concerned that the supply they keep on hand—typically three to five days’ worth of blood—could quickly become stretched if more donors fall ill.

America's Blood Centers, an association of independent facilities that collects about half of the U.S. blood supply, says that 27% of its member centers are reporting a decrease in overall collections due to swine flu.

Nearly a quarter of the centers reported that collections have dropped at high schools, which have been one of the fastest-growing sources of blood donations in recent years as more states allow students as young as 16 to donate. And more than 15% of centers reported declines in blood collections from colleges and from corporations, where layoffs and plant closings have hurt blood drives.

Partly offsetting the reduced collections is lower blood demand as more people put off costly elective surgeries due to the tough economy, says Richard Benjamin, medical director of the Red Cross, which supplies about 43% of the nation’s blood. But a looming worry is the upcoming holiday season, when it is traditionally harder to recruit donors.

Medical experts generally don't believe colds and flu can be transmitted by blood, and no case of seasonal influenza transmitted by blood has ever been reported in the U.S. But there also has been little active surveillance for flu in the blood supply.

The National Institutes of Health since the late 1980s has funded studies of blood safety through a program known as the Retrovirus Epidemiology Donor Study, or Reds, to determine the prevalence of HIV among blood donors and the risks of transmitting HIV and other viruses via transfusions. As part of a second phase of that study, researchers in 2006 began examining whether influenza virus could be detected in blood. Philip Norris, associate director of the Blood Systems Research Institute in San Francisco, and a lead investigator on the project, says testing of hundreds of blood donors at risk for seasonal influenza hasn’t revealed any evidence of influenza virus in the blood. He says his group is repeating the study with new blood samples “in case our assumption that H1N1 will behave like seasonal influenza is wrong.”

Food and Drug Administration regulations require blood centers to turn away would-be donors who have any symptoms of illness. And any donor who falls ill shortly after giving blood is asked to notify the center where they donated so their blood can be removed from inventory. So far, the swine flu has turned out to be less infectious than medical experts at first feared. Still, because many patients who get blood transfusions have weak immune systems, a flu infection transmitted through the blood could be extremely dangerous, increasing their risk of death.

http://online.wsj.com/article/SB10001424052748703808904574525570410593800.html

H1N1(Swine Flu): Influenza…A Humbling Virus – And Always, Always Unpredictable

Most people don’t really understand the nature of influenza…I mean after all, it is only the flu!  But that is exactly the problem; it is the flu!  As is now being played out on the world stage, influenza continues to show that it is in charge and is always, always unpredictable.  WHO’s top flu scientist Dr. Keiji Fukuda, often describes the virus he’s studied for years as “humbling.” And he is not the only one who marvels at the disease. Like a mantra, flu scientists repeat almost the only thing predictable about flu is its unpredictability.

In spite of this, myths begin to take hold and people begin to think that they really understand and have “figured out” the virus. Everyone is trying to find the pattern that will show predictability. In the late ’60s it was held that pandemic viruses emerged in 11-year cycles, after the closely spaced 1957 Asian flu and 1968 Hong Kong flu outbreaks. And then 41 years passed. It used to be accepted that only H1, H2 and H3 viruses could infect humans. And then viruses from the H5, H7 and H9 subtypes jumped from birds to infect people. Wrong again.

Helen Branswell the award winning Canadian Medical Reporter has pulled together the current flu assumptions that are being redrawn seven months into our current pandemic. Here are some:

• Pandemic viruses emerge from Asia, the cradle of flu viruses. Years of focus on H5N1 avian influenza viruses left experts convinced Asia was the birthplace of new flu viruses and would be the source of the next pandemic.

Despite the fact that there's good evidence the 1918 Spanish flu virus may have emerged in Kansas, no one was looking to North America as ground zero for the first pandemic of the 21st century.

• Pandemics are triggered by “antigenic shift.” Flu viruses evolve constantly via small mutations, a process called antigenic drift. But once in a blue moon an entirely new virus bursts out of nature, an event known as antigenic shift. Because most people are vulnerable to the new virus, it ignites a pandemic. It used to be thought pandemics could only be started by a virus with a new hemagglutinin – the H number in the virus’s name – or a virus with a hemagglutinin that hadn’t spread recently among people, such as the H2N2 viruses that circulated from 1957 to 1968. The current pandemic is caused by an H1N1 virus, which is startling because almost everyone alive has antibodies to H1 viruses. They’ve been circulating among people since 1918, except for a 20-year gap between 1957 and 1977. So few scientists would have predicted a new H1 virus could cause a pandemic at this point in history.

• Emerging pandemics can be extinguished with quick use of antiviral drugs. Landmark modeling studies published in August 2005 suggested that with good surveillance, rapid response capacity and enough Tamiflu, a flu virus that was just starting to spread person-to-person could be snuffed out. And while flu experts were watching the spread of H5N1 avian flu viruses from Asia, pigs got infected with some viruses that swapped genes and created the H1N1 virus we call swine flu. By the time we knew it was spreading, containment was out of the question. “This cat was not only out of the bag, but this cat had nine litters before we realized what had happened,” says Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.

• We’d know it when we saw it. Pandemics are rare. And before this one, only two had occurred in the era of virology. So what would a pandemic look like? Experts insisted it was a bit like pornography – we’d know it when we saw it. And then a new virus of swine-avian-and-human genes started to spread. It wasn’t from a new subtype (see above). And but for the fact it was spreading in the off-season and causing severe illness in younger people, it might have been mistaken for plain old flu. Did I mention we were confused?

• There would be little time between the spotting of an emerging pandemic virus and the declaration of a pandemic. The WHO’s pandemic alert scale goes from Phase 1 (no threat) to Phase 6 (pandemic). For years the world had been at Phase 3, which means a non-human virus (H5N1) posed a pandemic threat and was triggering occasional cases, but person-to-person transmission was rare and limited. Most experts assumed when a pandemic virus started to take off, the world would race through Phases 4 and 5 to 6. Within 10 days of the first announcement that human swine flu infections had been found, the WHO raised the alert level from 3 to 4 and then to 5. And then the world waited. The virus spread as expected. What wasn’t anticipated was political resistance to the declaration of a pandemic caused by such a mild strain. The gap between Phase 5 and Phase 6 stretched for six weeks – not because of the virus, but because of political wrangling and perceived need to ease the world into the first pandemic in 41 years.

• A mutation at position 627 on the PB2 gene means trouble. After years of study, flu scientists believe they’ve found a number of signature motifs in viruses that can predict characteristics like disease severity or transmissibility. One is a mutation at the 627 position on a gene called PB2. For as far back as molecular biology can see, all flu viruses known to have spread among humans had the mutation. That has led flu scientists to peg it as essential to transmission in humans. But this virus doesn’t have that mutation.

Flu virologists have been on the lookout for pandemic H1N1 viruses with this change, believing it would confer greater transmissibility and maybe greater severity of disease. But when it was found in a few cases in the Netherlands, there were no nightmare changes in the illness pattern.

• People would clamor for pandemic vaccine. Much of the recent pandemic planning was done with H5N1 flu in mind. The virus is a monster in humans, killing around 60 per cent of those infected. Planners assumed people would be desperate for pandemic vaccine.

But until recently, it seemed H1N1 wouldn't scare many people into vaccine queues. Instead, polls showed a surprising number were more nervous about the vaccine than the virus.

• People would need two shots of vaccine to be protected against a pandemic virus. The assumption was that a pandemic virus would be so new our immune systems wouldn’t be able to protect us against it with just one shot. One jab would be needed to “prime” our immune systems and a second to “boost.” Those assumptions were based on the idea a pandemic virus would be a new virus subtype, foreign to our immune systems. Clinical trials of H1N1 vaccine show most people respond to a single shot of vaccine as if it’s a booster, not a primer.

• Vaccine would be ready in time to combat the second wave of infections. Planners expected more time between the emergence of the virus and a proper first wave of activity. And they thought there would be enough time before the second wave to make and deploy vaccine. This virus has followed a different timetable, with a rapid and heavy first wave in the spring, continued activity over the summer and an early start to the flu season in the fall. Public health officials are in a race with the virus, trying to get vaccine into people before they can catch the bug. But it takes about 10 days for an immune response to develop after vaccination and in some cases, the virus is winning the race.

• Hospitals would be crippled. Pandemic planners thought hospitals would be overwhelmed. Emergency departments would be swamped. Overflow facilities might be needed. Surgeries would be cancelled. No one knows what this winter has in store and that scenario could still materialize. But so far, hospitals haven’t been overwhelmed – except intensive care units. Severe cases of H1N1 are rare, but people who develop bad disease are profoundly ill. ICU staff has to take extraordinary measures to oxygenate the blood of these people because their embattled lungs cannot do the work for them. ICUs in a number of hard hit places during the spring wave reported nearing the point of overflow. If they reach that point, experts say, death rates will rise and other hospital services will need to be rationed. But that hasn’t been the case to date.

So what is the net-net to all of this…we think we know a lot but in reality we still don’t know much about this foe known as influenza! The score stands at Influenza 1 and Humans 0.

http://www.google.com/hostednews/canadianpress/article/ALeqM5gQJKPs4cD29K5qHQFiM3q5sYUI

H1N1(Swine Flu): Does Exercise Build Immunity? And Truck Carrying Flu Vaccine Supply Is Stolen

DOES EXERCISE BUILD IMMUNITY?

What can we do to stay healthy this flu season besides hand and cough hygiene, avoid large crowds and eat well?  What about exercise as a way to beat the flu!  Two experiments addressed this issue and were written about recently in the NY Times.

The first was from the publication Brain, Behavior, and Immunity, where researchers divided mice into two groups. Over achievers – take notice! (I am also speaking about myself) One rested comfortably in their cages. The other ran on little treadmills until they were exhausted. This continued for three days. The mice were then exposed to an influenza virus.

After a few days, more of the mice that’d exhausted themselves running came down with the flu than the control mice. They also had more severe symptoms.

The second experiment (published in the same journal) had scientists from the University of Illinois and other schools first infect laboratory mice with flu. One group then rested; a second group ran for a leisurely 20 or 30 minutes, an easy jog for a mouse; the third group ran for a taxing two and a half hours. Each group repeated this routine for three days, until they began to show flu symptoms. The flu bug used in this experiment is devastating to rodents, and more than half of the sedentary mice died. But only 12 percent of the gently jogging mice passed away.

Meanwhile, w hopping 70 percent of the mice in the group that had run for hours died, and even those that survived were more debilitated and sick than the control group.

Is this good news or bad? This is a particularly relevant question as two important human events converge: the peaking of the fall marathon and other sports seasons and the simultaneous onset of the winter cold and flu term. Scientists are diligently working to answer that question, perhaps because they are as interested as the rest of us in avoiding or lessening the severity of colds and the flu.

The bulk of the new research, including these mouse studies reinforce a theory that physiologists advanced some years ago, about what they call “a J-shaped curve” involving exercise and immunity.

In this model, the risk both of catching a cold or the flu and of having a particularly severe form of the infection “drop if you exercise moderately,” says Mary P. Miles, PhD, an associate professor of exercise sciences at Montana State University and the author of an editorial about exercise and immunity published in the most recent edition of the journal Exercise and Sport Sciences Review. But the risk both of catching an illness and of becoming especially sick when you do “jump right back up” if you exercise intensely or for a prolonged period of time, surpassing the risks among the sedentary. (Although definitions of intense exercise vary among researchers, most define it as a workout or race of an hour or more during which your heart rate and respiration soar and you feel as if you are working hard.)

Why exercise should affect either your susceptibility to catching an illness or how badly a particular bug affects you is still unclear. It appears that intense workouts and racing suppress the body’s immune response for a period of time immediately after you’ve finished exercising and that “the longer the duration and the more intense” the exercise, “the longer the temporary period of immunosuppression lasts — anything from a few hours to a few days has been suggested,” says Nicolette Bishop, an associate professor of sport and exercise sciences at Loughborough University and the author of a review article about exercise and immunity published in January.

Lastly this is NOT an excuse to become a couch potato! Moderate exercise is a good thing for your health and immunity!

NY Times http://well.blogs.nytimes.com/2009/10/14/phys-ed-does-exercise-boost-immunity/?scp=1&sq=Does%20Exercise%20Build%20Immunity?%20&st=cse

Exercise stress increases susceptibility to influenza infection http://www.ncbi.nlm.nih.gov/pubmed/18616997

Acute and chronic effects of exercise on markers of mucosal immunity. http://www.ncbi.nlm.nih.gov/pubmed/19273362

TRUCK CARRYING FLU VACCINE SUPPLY IS STOLEN

The H1N1 vaccine which, is very difficult to find, has become a coveted commodity all over the country.  It appears that someone in Milwaukee decided one way to get it was to steal a refrigerated truck that was hauling 930 doses.

The doses were being returned to Milwaukee’s main storage facility on Thursday evening after a public vaccination clinic when one or more people took off in the truck, which had been left idling and unattended only for moments, the authorities said.

The police found the truck 40 minutes later, and said the crime appeared to have been inspired more by the easily available vehicle than by the H1N1 vaccine inside. In fact, the vaccine was all found, apparently untouched and perhaps even unnoticed. The doses will now be sent back to their manufacturers, although Milwaukee, like seemingly every other city, has plenty of people hoping to get one. “Given that it was out of our chain of custody, we cannot validate the integrity of that vaccine,” said Bevan K. Baker, the city health commissioner.

As prosecutors considered charges against a man suspected in the theft, there was other fallout: the department will no longer employ the transport company involved, Mr. Baker said, and trucks bearing H1N1 doses will now be escorted by a police squad car. “We’re prepared to give this precious cargo its appropriate resting place” — in arms and noses, he said

http://www.nytimes.com/2009/11/07/us/07truck.html?_r=1

H1N1(Swine Flu): The Hajj and The Flu; Pet Ferret Dies of H1N1 in Nebraska

As the H1N1 flu continues to move around the globe infecting large numbers of people and causing deaths many of use are looking into the crystal ball of the fall and wondering what it will bring.  One way of dealing with the flu is to avoid large crowds…something that is  of course not possible at the hajj Every year, the single largest gathering on the planet is the annual pilgrimage to Mecca where approximately 2.5 million people from 160 countries will pack into a small city in Saudi Arabia for five days. No doubt, some of the pilgrims will be bringing the flu.

The Saudi authorities, fearing that the hajj could turn their holy city into a petri dish for viral mutations and a hub for spreading a new pandemic wave around the world, are working hard to head that off. They have asked some worshipers, including pregnant women and the elderly, not to make the trip, which is scheduled for the last week of November.

“The hajj is a central ritual of Islam, and our country tries to make it easy for everyone to come,” said Dr. Ziad A. Memish, the country’s assistant deputy minister for prevention “We’ve said we won’t turn away anyone who arrives at our borders. But we are recommending to other countries whom they should let come.” Although the Saudis have turned to the WHO and other health agencies for help in previous public health threats to the hajj, this year the CDC is more deeply involved because it has so much experience with the new flu.

While religious pilgrimages feed the souls of those who attend, they have in the past endangered the health of those who attend. Diseases that have been an issue in the past include meningitis and polio.

The hajj offers many opportunities to a virus that spreads through the air and lingers on surfaces: Pilgrims crowded into planes, boats, buses and tent cities; the endless ranks of the faithful praying shoulder to shoulder and touching their hands to the floors around the Kaaba, to handrails as they run between the hills Safa and Marwah, or to cups of water from the Zamzam Well.

The Journal of Science last week published a paper that describes the many the obstacles to fighting flu transmission at the Hajj. Dr. Memish, the Saudi official, is a co-author with several Centers for Disease Control experts. For example, pilgrims are advised to wash their hands frequently and bring their own surgical masks and hand sanitizers. The first is easy: Islamic law requires washing the hands and face five times a day before prayers. But male pilgrims may not wear anything with stitches in it; they wrap themselves in two lengths of unhemmed white cloth. And women on the hajj — even those who wear chadors at home — are forbidden to cover their faces. Also, since Islam forbids alcohol, some believers reject most hand sanitizers.  Senior religious leaders have issued fatwas declaring that masks and sanitizers “are not a problem,” Dr. Memish said, but every religion has some conservatives who believe in keeping up standards.

The Saudi government has made many preparations, like buying stockpiles of generic Tamiflu. The country has 76 health facilities staffed for the hajj, and intensive-care units have been expanded. For pilgrims, all medical care for problems they develop during their visit is free. “Saudi Arabia’s reputation rests on how the hajj is conducted,” Dr. Shahul H. Ebrahim, a Centers for Disease Control epidemiologist who advises the Saudi government, said in the Science article. “It’s a rich country, they take a lot of national pride in it and the king is responsible. I don’t think anything is lacking here except vaccines.”

In countries with large Muslim populations, many applicants get one or two chances in a lifetime at the pilgrimage that every Muslim is supposed to make, and “some people save money for their whole lives to do it,” he said. More than half of all pilgrims are over 50. In a normal year, many of those desperate to come before they die are pushed in wheelchairs or carried around the Kaaba and through the other rituals.

Pandemic H1N1 and the 2009 Hajj http://www.sciencemag.org/cgi/content/abstract/1183210

http://www.nytimes.com/2009/10/30/world/middleeast/30flu.html?_r=1&scp=2&sq=hajj&st=cse

Pet Ferret Dies of H1N1

A news station in Hastings, Nebraska has reported that Stormy the ferret, one of four ferrets in a family of humans sick with the flu, has died from the H1N1 virus. Testing was done by the University of Nebraska Veterinary Diagnostic Lab where the ferret tested positive for H1N1. The state public health veterinarian said it is not unexpected, but it is rare.

This continues to point out the fact that when a human is sick in a household with pets that the pets should be kept apart from the sick individual and good hand and cough hygiene is important to prevent disease transmission – to any species!

http://vetmedicine.about.com/b/2009/11/01/h1n1-swine-flu-ferret-dies-in-nebraska.htm

H1N1(Swine Flu): Gargling and Nasal Irrigation – Will It Help You Avoid The Flu?

A friend of mine sent me an email asking me if gargling with saltwater could be helpful for overall health and flu prevention.  From my nursing background I remembered of course that is was often recommended for sore throats and “colds” and is very effective…so that sent me on a search…could salt water could be effective as a gargle or a nasal wash to prevent or treat colds or the flu???

So What Does Gargling With Saltwater Do Anyway?

There are a variety of theories about this… most of them draw from the same chemical theory of osmosis (remember your high school chemistry??). The basic premise of osmosis is that water will move through a thin membrane into another fluid of a higher concentration. This movement happens until the concentration inside the membrane is the same of that outside of it. The two theories on how gargling salt water helps a sore throat deals with osmosis in two very different ways.

Water tends to follow salt. Have you ever salted slices of raw eggplant for a recipe? The salt draws moisture from the eggplant. After a few minutes, you can see beads of fluid on the surface of the eggplant. Well, think of your throat a bit like that eggplant.

Osmosis and Bacteria

One premise is that bacteria cause most cases of sore throat. Bacteria are simple one-celled organisms that group together and often cause illness. Although bacteria are sometimes helpful to the human body,  they are the catalyst behind many human illnesses, including sore throats. These single-celled organisms are full of fluid, and the saltwater is highly concentrated, more so than the fluid inside the bacteria. While gargling, the saltwater stays in contact with the bacteria long enough to start osmosis. The fluid inside the bacteria moves across its membrane into the briny salt water, until the concentration of fluid inside the bacteria is the same as outside. Of course, this leaves the bacteria sufficiently lacking in the fluid it needs to operate therefore the saltwater works by dehydrating the bacteria. Clever no?

Osmosis and Edema

Another school of thought is that the immediate relief from gargling salt water wouldn’t come from killing the bacteria, but eliminating the swelling. This theory uses osmosis the same way, however. It holds that the salt water, while gargling is in contact with the swollen throat. The fluid in the throat tissue causing the edema or swelling is of a lower concentration than the briny salt water. Therefore, the edema fluid passes through the throat tissue into the brine until the fluid on both side of that tissue is of the same concentration. Since the soreness is caused by the edema and the edema by the fluid buildup, eliminating the fluid eliminates the sore throat.

Everyone has a different recipe for a saltwater gargle, but all recipes tend to be fairly salty. If the gargle has a higher salt concentration than your cells' salt concentration, it will tend to draw out some of the edema fluid from the mucosa of the throat. This will relieve some of the sore throat symptoms. The relief is real, but short-lived, since the gargle has done nothing to remove the cause of the sore throat.

Gargling with saltwater may also has a cleansing action. If you are suffering from postnasal drainage due to a bacterial sinus infection or allergies, the mucus that drains from your nasal cavity tends to promote an inflammatory response. As this stuff drains down the back of your throat, it leaves a trail of inflamed tissues in its wake. Frequent gargling with saltwater will help minimize this problem.

You need to be a bit careful…if the solution is too salty you will dry out the mucosa of the throat…not good. This could lead to even greater irritation than what you started with. A good recipe is the salt solution should taste a little salty, but not overwhelmingly so. Begin with one teaspoon of salt per pint of water. Once the salt has dissolved, taste it. If it tastes like spit, add a bit more salt until it begins to taste salty.

Nasal Irrigation

Neti Pot Used In Nasal Irrigation

This is the same practice except now we are discussing the nose.  In Ayurvedic Medicine (India), a common practice is nasal irrigation with a salty water.  A common tool to use to deliver this solution is called a neti pot and has the same principals as gargling.  This method has received a lot of study in the western world and is now recommended by many western ENT physicians as a way to maintain sinus health.

So keeping your throat, larynx and nose might be a good practice to take up!

http://yourtotalhealth.ivillage.com/why-gargle-with-saltwater.html

http://www.ehow.com/how-does_4607558_salt-water-help-sore-throat.html

H1N1(Swine Flu): This Weeks Flu View In US – Very Close to Last Week – No Relief In Cases

This week – week 43 – shows no slow down in cases as the US enters deeper into the fall and the weather that promotes the flu.  Here is the net-net of the flu action in the US.

• Over 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• 18 influenza-associated pediatric deaths were reported.
  • 15 of these deaths were associated with 2009 influenza A (H1N1) virus infection
  • 3 were associated with an influenza A virus for which the subtype was undetermined (but remember that 99% of the virus in the US is H1N1)
  • The proportion of outpatient visits for influenza-like illness (ILI) was above the national baseline. All 10 regions reported ILI above region-specific baseline levels.
  • Forty-eight states reported geographically widespread influenza activity,
    • Two states reported regional influenza activity (Hawaii and Mississippi)
    • District of Columbia reported local influenza activity
    • Puerto Rico and Guam reported sporadic influenza activity, and the U.S. Virgin Islands did not report.

Influenza-Associated Pediatric Mortality

18 Pediatric Flu Deaths This Week

• Eighteen influenza-associated pediatric deaths were reported to CDC during week 43 (California [8] , Indiana, Louisiana [2], Mississippi, New York, Oklahoma, Texas [2], Virginia, and West Virginia).”

Outpatient Illness Surveillance:

On a regional level, the percentage of outpatient visits for ILI ranged from 5.0% to 10.7% during week 43, and decreased (a tiny bit) in five of the 10 surveillance regions compared to the previous week. All 10 regions reported a proportion of outpatient visits for ILI above their region-specific baseline levels.

Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:

Remember the influenza activity reported by state and territorial epidemiologists indicates geographic spread of both seasonal influenza and 2009 influenza A (H1N1) viruses and does not measure the severity of influenza activity. And 99% of the cases are H1N1.

http://www.cdc.gov/flu/weekly/

H1N1 (Swine Flu): What Should Be In A Business Pandemic Plan? It Is Built On Four Pillars

The Four Pillars of Pandemic Planning

I am what is called an “all-hazards” planner, which means that my firm writes plans that are appropriate for all/most disasters.  Pandemics however are much different and require a different approach.  We have written hundreds of pandemic plans since 2003 and believe that pandemic plans are built upon four basic and distinct pillars:

1. Education and communication.
2. Personal protective equipment (PPE).
3. Facility cleaning.
4. Social distancing.

I recently wrote an article that has just appeared in the Disaster Resource Guide that is now available to download.  Although this article was written for business it is just as applicable for a public sector agency, a not-for-profit or faith-based group.  Take a look at the article and compare our recommendations to your current plan and see how it measures up.

http://disaster-resource.com/newsletter/2009/subpages/v309/meettheexperts.pdf

It is never too late to tweak your plan to make it more effective.

H1N1 (Swine Flu): WHO Ukraine Update #2; Family Pet Cat Infected with H1N1

Today’s report is on the continuing story in the Ukraine and domestic cats catching H1N1.  WHO has long warned that developing nations would have the most difficult time in this pandemic…mild as it might be…Developing nations don’t have the health care infrastructure to meet possible demands for basic and advanced care in the sheer numbers that are likely to ensue.  I am afraid the Ukraine is a good example of that fear manifested.

UKRAINE UPDATE #2

According to the Ukraine Ministry of Health (UMH) the country has now recorded more than 250 000 cases of influenza-like illness, with 235 patients requiring intensive care. As of 2 November, 70 deaths from acute respiratory illness have been reported. Regions in western Ukraine continue to show the highest rates of acute respiratory illness/influenza-like illness. The level of activity in the Kyiv area is also increasing rapidly.

A family in the Belarusian capital, Minsk, wears surgical masks in an attempt to prevent infection with the H1N1 virus. Experts say such masks are of limited value.

Laboratory testing in Ukraine has confirmed pandemic H1N1 influenza virus in samples taken from patients in two of the most affected regions. As the pandemic virus has rapidly become the dominant influenza strain worldwide, it can be assumed that the H1N1 virus causes most cases of influenza in Ukraine.  As elsewhere, WHO strongly recommends early treatment with the antiviral drugs, oseltamivir or zanamivir, for patients who meet treatment criteria, even in the absence of a positive laboratory test confirming H1N1 infection.

Two Ukrainian deputies wear protective masks during a parliament session in Kyiv.

At the request of the government, a WHO multi-disciplinary team of nine experts has been deployed. Team members will now begin field investigations to characterize the clinical and epidemiological features of the outbreak. Given the potential significance of this outbreak as an early warning signal, WHO commends the government of Ukraine for its transparent reporting and open sharing of samples.

http://www.who.int/csr/don/2009_11_03/en/index.html

DOMESTIC FAMILY CAT INFECTED WITH H1N1

Humans, and pigs and birds and ferrets and now domestic cats...oh my!

The Iowa Department of Public Health (IDPH) and the Iowa Department of Agriculture and Land Stewardship (IDALS) have confirmed a case of H1N1 in a domestic Iowa cat. The 13-year-old indoor cat in Iowa was brought to the Lloyd Veterinary Medical Center at Iowa State University’s College of Veterinary Medicine, where it tested positive for the H1N1 virus. The diagnosis is the culmination of collaborative efforts between IDPH, Iowa State University College of Veterinary Medicine, Center for Advanced Host Defenses, Immunobiotics and Translational Comparative Medicine, USDA, and IDALS Animal Industry Bureau.

“Two of the three members of the family that owns the pet had suffered from influenza-like illness before the cat became ill,” said IDPH Public Health Veterinarian, Dr. Ann Garvey. “This is not completely unexpected, as other strains of influenza have been found in cats in the past.” Both the cat and its owners have recovered from their illnesses.

People can keep their pets healthy by washing hands, covering coughs and sneezes, and minimizing contact with their pets while ill with influenza-like symptoms. If your pet exhibits signs of a respiratory illness, contact your veterinarian.

“Indoor pets that live in close proximity to someone who has been sick are at risk and it is wise to monitor their health to ensure they aren’t showing signs of illness,” said Dr. David Schmitt, State Veterinarian for Iowa.  It’s important to remember to protect family pets from the illness, as well. People who are sick with H1N1 can spread the virus not only to humans, but to some animals. Birds, pigs and ferrets and now cats have all been infected with H1N1 by sick humans.

PS – the cute kitties in the photo above are mine…Annie and Musie…. 

http://www.idph.state.ia.us/IdphNews/Reader.aspx?id=8FBE90B3-4667-4960-9AF5-1B9B477A3805

H1N1(Swine Flu): Cases In California Shows Hospitalization Can Occur At All Ages, With Severe Results

I read with great interest the online version of JAMA (Vol. 302 No. 17, November 4, 2009), which painted a very different picture of our “mild pandemic”.  It is mild yes, but when its bad, its really bad.

In contrast with some common perceptions regarding the pandemic novel strain H1N1 infections, an examination of cases in California indicates that hospitalization and death can occur at all ages, and about 30 percent of hospitalized cases have been severe enough to require treatment in an intensive care unit.

“Since April 17, 2009, when the first 2 cases of pandemic H1N1 virus infection were reported in California, the virus has rapidly spread throughout the world,” the authors write. They add that preliminary comparisons with seasonal influenza suggest that this influenza infection disproportionately affects younger ages and causes generally mild disease.

Janice K. Louie, M.D., M.P.H., of the California Department of Public Health, Richmond, Calif., and colleagues examined the clinical and epidemiologic features of the first 1,088 hospitalized and fatal cases due to pandemic H1N1 infection reported in California, between April 23 and August 11, 2009. On April 20 of this year the California Department of Public Health and 61 local health departments initiated enhanced surveillance for hospitalized and fatal cases of this infection.

The researchers found that of the 1,088 H1N1 cases:

• 344 (32 percent) were children younger than 18 years
• Infants having the highest rate of hospitalization
• Persons age 50 years or older having the highest rate of death once hospitalized
• The median (midpoint) age of all cases was 27 years.
• Fever, cough, and shortness of breath were the most common symptoms. Underlying conditions previously associated with severe influenza were reported in 68 percent of cases.
  • Other underlying medical illnesses recorded included obesity, hypertension, hyperlipidemia and gastrointestinal disease.
• The median length of hospitalization among all cases was 4 days.
• Three hundred forty cases (31 percent) were admitted to intensive care units
  • 297 intensive care cases with available information, 65 percent required mechanical ventilation.
• Of the 884 cases with available information, 79 percent received antiviral treatment, including 496 patients (71 percent) with established risk factors for severe influenza.
• Of the 833 patients who had chest radiographs, 66 percent had infiltrates (evidence of infection involving the lungs), suggestive of pneumonia or acute respiratory distress syndrome.
• Rapid antigen tests were falsely negative in 34 percent of cases evaluated.
• Overall fatality was 11 percent (118/1,088) and was highest (18 percent — 20 percent) in persons aged 50 years or older.
• Of the deaths, 8 (7 percent) were children younger than 18 years.
• Among fatal cases, the median time from onset of symptoms to death was 12 days.”
• The most common causes of death were viral pneumonia and acute respiratory distress syndrome.

“In the first 16 weeks of the current pandemic H1N1 appears to be notably different from seasonal influenza:

• With fewer hospitalizations and fatalities occurring in elderly persons.
• Hospitalization and death occurred at all ages, and up to 30 percent of hospitalized cases were severely ill.
• Most hospitalized cases had identifiable established risk factors; obesity may be a newly identified risk factor for fatal pandemic H1N1 infection and merits further study.”

"Clinicians should maintain a high level of suspicion for pandemic H1N1 infection in patients presenting currently with influenza-like illness who are older than 50 years or have known risk factors for influenza complications, regardless of rapid test results. Hospitalized infected cases should be carefully monitored and treated promptly with antiviral agents," the authors conclude.

http://jama.ama-assn.org/cgi/content/short/302/17/1896?home

H1N1(Swine Flu): Ukraine Update; Panic in Iraq Schools

UKRAINE UPDATE

WHO has issued an assessment of the situation in the Ukraine.  Here is the timeline of events:

• October 28 – The Ukraine Ministry of Health (UMH) informed WHO about an unusually high level of acute respiratory illness activity in the western part of the country, associated with an increased number of hospital admissions and fatalities.
• October 20 – UMH announced the confirmation of pandemic (H1N1) 2009 virus infection by RT-PCR in eleven out of 30 samples obtained from patients presenting with acute respiratory illness in two of the most affected regions. Tests were performed in two laboratories in Kyiv, including the National Influenza Centre. Confirmatory tests will be performed at one of the WHO Collaborating Centers for Influenza.
  • The situation is quickly changing with increasingly high levels of acute respiratory illness (ARI)/Influenza-like-illness (ILI) activity being observed in Ternopil, Lviv, Ivano-Frankivsk, and Chernivtsi regions. The higher levels of transmission in these regions correspond to an increased number of hospital admissions and fatalities associated with severe manifestations of acute respiratory illness.
• October 30 – Over 2,300 individuals have been admitted to hospital, including over 1,100 children. One hundred and thirty one (131) cases have required intensive care, including 32 children.
• October 31 – A total of 38 fatalities associated with severe manifestations of ARI have been registered. Preliminary epidemiological data analysis indicates that severe cases and deaths primarily occur among previously healthy young adults aged 20 – 50 years. Fatal and severe cases are reported to have sought medical attention 5 to 7 days after onset of symptoms.

International experience of the (H1N1) 2009 pandemic to date, especially from the Southern Hemisphere, has shown that poor clinical outcomes are associated with delays in seeking health care and limited access to supportive care. In addition, this virus has also shown its ability to cause rapidly progressive overwhelming lung disease that is very difficult to treat.

Public health measures recommended by the UMH across the entire country include: social distancing (school closures and cancellation of mass gatherings); enhancement of surveillance activities; increased respiratory hygiene; and continuation of the vaccination campaign against seasonal influenza targeting at risk groups.

The Government of the Ukraine has activated coordination mechanisms to respond to the rapidly evolving situation, including the harmonization of response plans across all administrative levels.  In response to the request from the UMH, WHO is deploying a multi-disciplinary team of experts to assist national authorities in mitigating the impact of the pandemic. The team comprises of the following expertise: health emergencies coordination, case management, epidemiology, laboratory diagnostics, logistics, and media/risk communications.

As per WHO’s communication in May 2009, there is no rationale for travel restrictions because such measures will not prevent the spread of the disease. Travelers can protect themselves and others by following simple recommendations aimed at preventing the spread of infection such as attention to respiratory hygiene. Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures that can limit the spread of many communicable diseases and not only the pandemic (H1N1) 2009 virus.

http://www.who.int/csr/don/2009_11_01/en/index.html

IRAQ: SWINE FLU PANIC SHUTS DOWN 2,000 SCHOOLS

Panic over the possible spread of H1N1 influenza has prompted the closure of more than 2,000 schools in Iraq, according to officials.  Education Minister Khudhair Al-Khuzaie said the unauthorized closure of schools was “illegal and unprofessional” and blamed “exaggerated media reports that have created such a panic”.

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“Over the past week, we diagnosed four cases of H1N1 influenza among school students in the southern province of Kut, then the number increased to 25 cases and that prompted us to quarantine and shut down the school [where the cases were detected ,” said Ihsan Jaafar, a senior Health Ministry official."

A few days later, other cases were confirmed in six Baghdad schools. “We’ve also closed them and that brings the total number of schools closed based on decisions issued by the Health Ministry to seven,” Jaafar told IRIN.

 

“Unjustified panic” had prompted some officials in southern Iraq to close schools where no H1N1 cases had been detected, a measure “unacceptable to the Health Ministry,” Jaafar said.  Schools should only be closed for a week if a teacher and 2-3 students have the disease, Jaafar said. Those infected would be quarantined and the school sterilized. Students and infected students’ families would be closely monitored, he added.

http://www.irinnews.org/Report.aspx?ReportId=86693