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H5N1/H1N1 co-infection, NOT! (Thankfully!), Canine Influenza & WHO guidance for the surveillance of H1N1 (swine flu) human infections

September 6, 2009

H5N1/H1N1 CO-INFECTION – NOT! (THANKFULLY!!)

The world took a collective gulp when September 1 on ProMed, a request for more information was asked for about a suspected H5N1 /H1N1 co-infection in Egypt.  Both viruses are freely circulating in that country and Egypt continues to report regular human infections of H5N1 (the highly pathogenic avian flu).  On surveying the reliable websites all day, I saw no medical validations.  On surveying the “general flu websites” they were on fire…good cause to lay low and wait….

As of August 31, there has been 85 cases of human H5N1 in Egypt and 27 deaths

As of August 31, there has been 85 cases of human H5N1 in Egypt and 27 deaths

Thankfully, the next day the claim was refuted and the real story came out. “It now appears that the co-infection is believed to be between 2 low virulence viruses (pandemic H1N1 & H3N2) and *not* between a highly virulent, poorly transmissible, virus (pandemic H5N1) and a highly transmissible strain of low virulence (H1N1)…” Whew!  Now, it is never good when two viruses are cohabitating in anyone (human, pig or bird) because there is always a chance for recombination to occur…however, two low virulent viruses are less likely to cause damage if they create something new….

As they say in the world of viruses…anything is possible…when you take into account this is influenza, all bets are off.

ProMed Mail # 413 www.Promedmail.org

VETS ON ALERT FOR CANINE FLU, ARE WE FACING A DOG PANDEMIC TOO?!?

It seems as now if man’s best friend is caught up in the influenza matrix!!!  Thankfully not the same H1N1 as we humans have grown to love and loathe…but a disease that is uniquely canine and is yes…influenza!  Looks like it is going to be a busy flu season…for everybody!

The ability of influenza to change! It is thought that the equine influenza virus mutated to produce the canine influenza virus.

The ability of influenza to change! It is thought that the equine influenza virus mutated to produce the canine influenza virus.

As the nation braces for what could be a rough flu season, dog owners wonder whether their households might get hit with a second threat: canine influenza virus (CIV) or canine flu!  A much-publicized outbreak of dog flu in Northern Virginia the end of August — has put the spotlight on the highly contagious canine disease, which thankfully doesn’t infect humans. The concern level has escalated high enough that “don’t-panic statements” are being issued by a variety of organizations such as the American Veterinary Medical Association American Veterinary Medical Association (AVMA) and University of Florida College of Veterinary Medicine.

What is canine influenza?

Canine influenza is a highly contagious respiratory infection of dogs that is caused by a virus. The canine influenza virus is closely related to the virus that causes equine influenza and it is thought that the equine influenza virus mutated to produce the canine influenza virus.

A Dog Pandemic? How bad is it?

This will sound strangely familiar if you are following the novel H1N1 pandemic. Because CIV is a newly emerging disease, almost all dogs, regardless of breed or age, are susceptible to infection and have no immunity. Virtually all dogs that are exposed to the virus become infected and nearly 80% show clinical signs of disease. Fortunately, most affected dogs have the mild form. Two clinical syndromes have been seen in dogs infected with the canine influenza virus—a mild form of the disease and a more severe form that is accompanied by pneumonia.

About the mild form—Dogs suffering with the mild form of canine influenza develop a soft, moist cough that persists for 10 to 30 days. Some dogs have a dry cough similar to the “kennel cough” caused by Bordetella bronchiseptica/parainfluenza virus complex.

For this reason, canine influenza virus infections are frequently mistaken for “kennel cough.” Dogs with the mild form of influenza may also have a thick nasal discharge, which is usually caused by a secondary bacterial infection.

About the severe form—Dogs with the severe form of canine influenza develop high fevers (104ºF to 106ºF) and have clinical signs of pneumonia, such as increased respiratory rates and effort. Pneumonia may be due to a secondary bacterial infection.

Do dogs die from canine influenza?

Fatal cases of pneumonia resulting from infection with canine influenza virus have been reported in dogs, but the fatality rate (5% to 8%) has been low so far.

How is a dog with canine influenza treated?

As with any disease caused by a virus, treatment is largely supportive. Good animal care practices and nutrition assist dogs in mounting an effective immune response. In the milder form of the disease, a thick green nasal discharge, which most likely represents a secondary bacterial infection, usually resolves quickly after treatment with a broad-spectrum bactericidal antimicrobial. In the more severe form of the disease, pneumonia is thought to be caused by bacterial super infection, and responds best to hydration (sometimes via intravenous administration of fluids) and a broad-spectrum bactericidal antimicrobial.

Is canine influenza virus transmissible from dogs to humans?

To date, there is no evidence of transmission of canine influenza virus from dogs to people.

CIV Vaccine

Cynda Crawford, a University of Florida College of Veterinary Medicine infectious-disease specialist who was instrumental in identifying the virus in racing greyhounds in 2004, says: Unless your dog is regularly in close contact with other dogs, especially if you live in what she calls a “hot zone” where there’s an outbreak or where there have been multiple past outbreaks — the vaccination probably isn’t necessary. Dogs with weakened health or those traveling to hot zones are special cases that require discussion with a veterinarian.

The first vaccine was conditionally licensed in May by the U.S. Department of Agriculture. The vaccine developer Intervet/Schering-Plough says it significantly reduces the duration and severity of symptoms and dramatically curbs the flu’s spread. The cost is about $20 for each of the series of two shots, given two to four weeks apart.

The American Veterinary Medical Association is not recommending vaccinating all dogs. But dogs that receive the Bordetella vaccine, the association says, should be considered strong candidates for flu vaccination because they’ve been determined to be at risk for the much-less-serious kennel cough through regular contact with many dogs, and that puts them at higher risk for CIV.

How widespread is the disease?

The first recognized outbreak of canine influenza in the world is believed to have occurred in racing greyhounds in January 2004 at a track in Florida.

Dogs from 30 states and the District of Columbia have fallen ill with the canine influenza virus in recent years. But some areas have experienced protracted or repeated outbreaks and are called hot zones or hot spots.  Those include:

  • South Florida (which is in a quiet phase right now)
  • Colorado Springs-Denver-Cheyenne, Wyo., corridor
  • Philadelphia to eastern parts of New York and New Jersey

The AVMA says two additional spots Pittsburgh and surrounding environs and the Lexington, Ky., area “may be emerging as endemic” areas, meaning the virus seems to be well-established and showing up in relatively higher numbers.

USA Today http://www.usatoday.com/life/lifestyle/pets/2009-08-30-canine-flu_N.htm

AVMA http://www.avma.org/public_health/influenza/canine_guidelines.asp

INTERIM WHO GUIDANCE FOR THE SURVEILLANCE OF HUMAN INFECTION WITH A(H1N1) VIRUS

WHO just issued new guidance to assist in reporting novel H1N1 qualitative indicators, which is to be reported by all Member States.   I found this guidance for trying to get my arms around the definitions that are used by the WHO.  Hopefully everyone will adopt the same definition.  Please note these are for human infections as we have seen, this virus has jumped from humans to pigs and birds…we aren’t keeping track of those.  Keep these nearby for future translations!

As you can see, the new novel H1N1 is totally pushing out the other circulating influenza viruses!  Totally!

As you can see, the new novel H1N1 is totally pushing out the other circulating influenza viruses! Totally!

Geographical spread

Geographical spread refers to the number and distribution of sites reporting influenza activity.

  • No activity: no laboratory-confirmed case(s) of influenza, or evidence of increased or unusual respiratory disease activity.
  • Localized: limited to one administrative unit of the country (or reporting site) only.
  • Regional: appearing in multiple but <50% of the administrative units of the country (or reporting sites).
  • Widespread: appearing in ≥50% of the administrative units of the country (or reporting sites).
  • No information available: no information available for the previous 1-week period.

Trend

Trend refers to changes in the level of respiratory disease activity compared with the previous week.

  • Increasing: evidence that the level of respiratory disease activity is increasing compared with the previous week.
  • Unchanged: evidence that the level of respiratory disease activity is unchanged compared with the previous week.
  • Decreasing: evidence that the level of respiratory disease activity is decreasing compared with the previous week.
  • No information available.

Intensity

The intensity indicator is an estimate of the proportion of the population with acute respiratory disease, covering the spectrum of disease from influenza-like illness to pneumonia.

  • Low or moderate: a normal or slightly increased proportion of the population is currently affected by respiratory illness.
  • High: a large proportion of the population is currently affected by respiratory illness.
  • Very high: a very large proportion of the population is currently affected by respiratory illness.
  • No information available.

Impact

Impact refers to the degree of disruption of health-care services as a result of acute respiratory disease.

  • Low: demands on health-care services are not above usual levels.
  • Moderate: demands on health-care services are above the usual demand levels but still below the maximum capacity of those services.
  • Severe: demands on health care services exceed the capacity of those services.
  • No information available.

WHO http://www.who.int/csr/disease/swineflu/en/index.html

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