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90/10/13 (12:32)
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19
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87/11/3 (03:22)
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W.H.O. Issues Higher Alert on Swine Flu, With Advice
Published: April 27, 2009
While confirmed cases of swine flu increased only slightly on Monday, the World Health Organization voted to raise its global pandemic flu alert level, but at the same time it recommended that borders not be closed nor travel bans imposed.
he W.H.O.’s emergency committee, after meeting until 10:30 p.m. in Geneva, also recommended abandoning efforts to contain the flu’s spread.
Because the virus is already quite widespread in different locations, containment is not a feasible option,” said Dr. Keiji Fukuda, the organization’s deputy director general.
The W.H.O. also recommended that vaccine makers keep making the seasonal flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.
Dr. Fukuda emphasized that the committee thought that “a pandemic is not inevitable — the situation is fluid and will continue to evolve.”
The W.H.O.’s emergency committee, after meeting until 10:30 p.m. in Geneva, also recommended abandoning efforts to contain the flu’s spread.
“Because the virus is already quite widespread in different locations, containment is not a feasible option,” said Dr. Keiji Fukuda, the organization’s deputy director general.
The W.H.O. also recommended that vaccine makers keep making the seasonal flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.
Dr. Fukuda emphasized that the committee thought that “a pandemic is not inevitable — the situation is fluid and will continue to evolve.”
In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world’s largest pork producer.
Mexico’s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister José Ángel Córdova. The case involved a 5-year-old boy who recovered.
But a spokesman for the plant said the boy was not related to a plant worker, that none of its workers were sick and that its hogs were vaccinated against flu.
American officials said their response to the epidemic was already aggressive, and the W.H.O.’s decision to raise its pandemic alert to level 4 from level 3 would not change their plans. Level 4 means that there has been sustained human-to-human transmission.
The W.H.O. decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those in pharmaceutical companies rose.
Pharmacies in New York reported runs on Tamiflu, an antiflu drug — something that public health officials badly want to avoid because the drug could eventually be needed for the truly ill.
The W.H.O.’s emergency committee, after meeting until 10:30 p.m. in Geneva, also recommended abandoning efforts to contain the flu’s spread.
“Because the virus is already quite widespread in different locations, containment is not a feasible option,” said Dr. Keiji Fukuda, the organization’s deputy director general.
The W.H.O. also recommended that vaccine makers keep making the seasonal flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.
Dr. Fukuda emphasized that the committee thought that “a pandemic is not inevitable — the situation is fluid and will continue to evolve.”
In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world’s largest pork producer.
Mexico’s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister José Ángel Córdova. The case involved a 5-year-old boy who recovered.
But a spokesman for the plant said the boy was not related to a plant worker, that none of its workers were sick and that its hogs were vaccinated against flu.
American officials said their response to the epidemic was already aggressive, and the W.H.O.’s decision to raise its pandemic alert to level 4 from level 3 would not change their plans. Level 4 means that there has been sustained human-to-human transmission.
The W.H.O. decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those in pharmaceutical companies rose.
Pharmacies in New York reported runs on Tamiflu, an antiflu drug — something that public health officials badly want to avoid because the drug could eventually be needed for the truly ill.
For now supplies of Tamiflu and Relenza, another antiflu drug, remain adequate, the manufacturers said, but both were increasing production and expressed anxiety that shortages could develop if governments placed huge orders.
The travel issue was the most confusing. On Monday morning, the European Union appeared to issue and then rescind a ban on travel to the United States, drawing a rebuke from American officials, who themselves later suggested that Americans drop all nonessential travel to Mexico.
The number of deaths in Mexico for which flu is believed responsible climbed to 149. The number of confirmed cases in the United States increased to 45, with 28 of them from one New York City school.
None of the American cases have been serious, but Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said he “would not rest on that fact.”
The W.H.O.’s emergency committee, after meeting until 10:30 p.m. in Geneva, also recommended abandoning efforts to contain the flu’s spread.
“Because the virus is already quite widespread in different locations, containment is not a feasible option,” said Dr. Keiji Fukuda, the organization’s deputy director general.
The W.H.O. also recommended that vaccine makers keep making the seasonal flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.
Dr. Fukuda emphasized that the committee thought that “a pandemic is not inevitable — the situation is fluid and will continue to evolve.”
In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world’s largest pork producer.
Mexico’s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister José Ángel Córdova. The case involved a 5-year-old boy who recovered.
But a spokesman for the plant said the boy was not related to a plant worker, that none of its workers were sick and that its hogs were vaccinated against flu.
American officials said their response to the epidemic was already aggressive, and the W.H.O.’s decision to raise its pandemic alert to level 4 from level 3 would not change their plans. Level 4 means that there has been sustained human-to-human transmission.
The W.H.O. decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those in pharmaceutical companies rose.
Pharmacies in New York reported runs on Tamiflu, an antiflu drug — something that public health officials badly want to avoid because the drug could eventually be needed for the truly ill.
For now supplies of Tamiflu and Relenza, another antiflu drug, remain adequate, the manufacturers said, but both were increasing production and expressed anxiety that shortages could develop if governments placed huge orders.
The travel issue was the most confusing. On Monday morning, the European Union appeared to issue and then rescind a ban on travel to the United States, drawing a rebuke from American officials, who themselves later suggested that Americans drop all nonessential travel to Mexico.
The number of deaths in Mexico for which flu is believed responsible climbed to 149. The number of confirmed cases in the United States increased to 45, with 28 of them from one New York City school.
None of the American cases have been serious, but Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said he “would not rest on that fact.”
“I expect that we will see additional cases, and I expect that the spectrum of disease will expand,” he said at a news conference.
Asked why the W.H.O. had waited so long to raise its alert level, Dr. Fukuda said it was done on technical grounds, that there was evidence of sustained human-to-human transmission of a new virus and movement of that virus to new areas. But he conceded that “the committee is very aware that changes have quite significant political and economic effects on countries.”
The W.H.O. has no power to enforce any policies on member states, but different countries may have their own pandemic flu plans that are triggered by changes in the alert level.
Spain and Scotland became the first countries outside North America to confirm cases. Suspected cases appeared in Brazil, Australia, Israel and New Zealand, but confirmation is slow because most nations’ laboratories lack the test kit the C.D.C. is developing for the new virus.
The C.D.C. began sending out the new kits on Monday, meaning that soon some states and foreign countries would be able to make their own diagnoses — a development that could lead to a sharp increase in confirmed cases.
Confusion regarding Europe’s position on travel arose when the European Union’s health commissioner, Androulla Vassiliou, was questioned on a visit to Luxembourg and said Europeans “should avoid traveling to Mexico or the United States unless it’s very urgent.”
Early reports of those remarks led both Dr. Besser and Mayor Michael R. Bloomberg of New York City to publicly disagree.
“We don’t think there is any reason not to travel and come to New York,” the mayor said.
Ms. Vassiliou’s office later denied she had issued any travel advisory and said she was only offering her personal opinion. “She didn’t want to insinuate risk where we’re not sure,” a spokesman said, adding that formal advice would be offered later.
Mayor Bloomberg confirmed that there were now 28 cases in New York, all connected to St. Francis Preparatory School in Fresh Meadows, Queens. He said there had been no suspected cases in any of the city’s intensive-care units. He acknowledged an increase in emergency-room visits, but he said his preliminary information indicated that there were more people who were worried rather than seriously ill.
New York’s public health situation does not now resemble Mexico City’s, the mayor said, and the public does not need to don masks.
In Europe, a spokesman for the Stockholm-based European Center for Disease Prevention and Control said there were about 40 suspected cases beyond the confirmed case in Spain.
The United States pork industry continued trying to allay consumer concerns about their products. Many companies and hog farmers complained that the “swine flu” name was unfortunate and perhaps inaccurate because, so far, the virus appears to be spreading without any contact with pigs.
“I guess everything has got to have a name,” said Kyle Stephens, who raises show pigs in Amarillo, Tex. “The biggest thing we are up against is people thinking the worst, instead of checking into it more.”
Reporting was contributed by Marc Lacey from Perote, Mexico; Elisabeth Malkin from Mexico City; Ian Austen from Ottawa; Keith Bradsher from Hong Kong; Victoria Burnett from Madrid; Reed Abelson, Sewell Chan, Denise Grady, Anemona Hartocollis, Michelle Higgins, Andrew Martin, Patrick McGeehan and Elisabeth Rosenthal from New York; Andrew Pollack and Rebecca Cathcart from Los Angeles; James C. McKinley Jr. from Laredo, Tex.; and Miguel Helft and Malia Wollan from San Francisco.
Mayor Bloomberg confirmed that there were now 28 cases in New York, all connected to St. Francis Preparatory School in Fresh Meadows, Queens. He said there had been no suspected cases in any of the city’s intensive-care units. He acknowledged an increase in emergency-room visits, but he said his preliminary information indicated that there were more people who were worried rather than seriously ill.
New York’s public health situation does not now resemble Mexico City’s, the mayor said, and the public does not need to don masks.
In Europe, a spokesman for the Stockholm-based European Center for Disease Prevention and Control said there were about 40 suspected cases beyond the confirmed case in Spain.
The United States pork industry continued trying to allay consumer concerns about their products. Many companies and hog farmers complained that the “swine flu” name was unfortunate and perhaps inaccurate because, so far, the virus appears to be spreading without any contact with pigs.
“I guess everything has got to have a name,” said Kyle Stephens, who raises show pigs in Amarillo, Tex. “The biggest thing we are up against is people thinking the worst, instead of checking into it more.”
Reporting was contributed by Marc Lacey from Perote, Mexico; Elisabeth Malkin from Mexico City; Ian Austen from Ottawa; Keith Bradsher from Hong Kong; Victoria Burnett from Madrid; Reed Abelson, Sewell Chan, Denise Grady, Anemona Hartocollis, Michelle Higgins, Andrew Martin, Patrick McGeehan and Elisabeth Rosenthal from New York; Andrew Pollack and Rebecca Cathcart from Los Angeles; James C. McKinley Jr. from Laredo, Tex.; and Miguel Helft and Malia Wollan from San Francisco.
http://www.nytimes.com/2009/04/28/health/28flu.html?ref=europe
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DIFFERENCES BETWEEN COLD, SEASONAL FLU & H1N1 SYMPTOMS | ||||||
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SYMPTOM |
COLD |
SEASONAL FLU |
H1N1 |
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FEVER |
Fever is rare with a cold. |
Fever is common with the seasonal flu. |
Fever is usually present with H1N1 in up to 80% of all flu cases. A temperature of 101° |
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COUGHING |
A hacking, productive (mucus-producing) cough is often present with a cold. |
A dry and hacking cough is often present with the seasonal flu. |
A non-productive (non-mucus producing) cough is usually present with H1N1 (sometimes referred to as dry cough).* |
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ACHES |
Slight body aches and pains can be part of a cold. |
Moderate body aches are common with the seasonal flu. |
Severe aches and pains are common with H1N1.* |
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STUFFY NOSE |
Stuffy nose is commonly present with a cold and typically resolves spontaneously within a week. |
A runny nose is commonly present with the seasonal flu. |
Stuffy nose is not commonly present with H1N1. |
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CHILLS |
Chills are uncommon with a cold. |
Chills are mild to moderate with the seasonal flu. |
60% of people who have H1N1 experience chills. |
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TIREDNESS |
Tiredness is fairly mild with a cold. |
Tiredness is moderate and more likely referred to as a lack of energy with the seasonal flu. |
Tiredness is moderate to severe with H1N1.* |
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SNEEZING |
Sneezing is commonly present with a cold |
Sneezing is common present with the seasonal flu. |
Sneezing is not common with H1N1. |
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SUDDEN SYMPTOMS |
Cold symptoms tend to develop over a few days. |
Symptoms tend to develop over a few days and include flushed face, loss of appetite, dizziness and/or vomiting/nausea. Symptoms usually last 4-7 days, depending on the individual. Diarrhea is common. |
H1N1 has a rapid onset within 3-6 hours. H1N1 hits hard and includes sudden symptoms like high fever, aches and pains. Symptoms usually last 4-7 days, depending on the individual. Diarrhea is common. |
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HEADACHE |
A headache is fairly uncommon with a cold. |
A headache is fairly common with the seasonal flu. |
A headache is very common with H1N1 and present in 80% of cases.* |
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SORE THROAT |
Sore throat is commonly present with a cold. |
Sore throat is commonly present with the seasonal flu. |
Sore throat is not commonly present with H1N1. |
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CHEST DISCOMFORT |
Chest discomfort is mild to moderate with a cold. |
Chest discomfort is moderate with the seasonal flu. If it turns severe seek medical attention immediately! |
Chest discomfort is often severe with H1N1. |
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PREVENTION TIPS: |
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ücough & sneeze into your elbow |
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üwash hands with soap and warm water for a minimum of 15 -20 seconds. Sing your abc's or happy birthday to you |
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üuse hand sanitizer when soap & water are not available |
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üavoid touching eyes, nose or mouth without washing or using hand sanitizer first |
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“دكتر وینای گویال”
در هنگام اپیدمی جهانی یك بیماری، امكان عدم تماس با عامل آن بیماری تقریباً غیرممكن است در حالیكه امكان پیشگیری از ابتلاء به آن وجود دارد.
هنگامی كه هنوز سالم هستید و بدن شما علائمی از ابتلاء به آنفولانزای نوع A را نشان نمیدهد، رعایت چند دستورالعمل ساده از ابتلاء به بیماری و یا توسعه آن جلوگیری مینماید.
تنها راه ورود ویروس آنفولانزای نوع A از طریق دهان یا بینی میباشد. برای پیشگیری از بیماری كافیست نكات زیر را رعایت نمائید:
1) دستهای خود را چندین بار در روز بشوئید.
2) هیچیك از اجزاء صورت خود را لمس نكنید و در مقابل این وسوسه مقاومت نمائید. (مگر برای خوردن، نوشیدن، شستشو و سایر امور ضروری)
3) دوبار در روز با آب نمك ولرم قرقره نمائید (میتوانید از محلول لیسترین نیز استفاده نمائید.) ویروس آنفولانزای نوع A از هنگام ورود از طریق دهان یا بینی به مدت 2 الی 3 روز در گلو باقیمانده و همانجا تكثیر میشود. با قرقره محلولهای ضدعفونی كننده مانند آب نمك یا لیسترین میتوانید از تكثیر ویروس و ابتلاء به بیماری جلوگیری نمائید. این توصیه ساده را بیاهمیت تلقی ننمائید.
4) همانند بند 3، بینی خود را نیز حداقل یك بار در روز با آب نمك شستشو نمائید. این موضوع ممكن است برای برخی افراد كمی مشكل بنظر برسد اما با كمی تمرین موفق خواهید شد.
5) مصونیت خود را از طریق مصرف غذاها و میوههای حاوی ویتامین C افزایش دهید. چنانچه ناچار از مصرف قرصهای ویتامین C میباشید، از وجود روی (Zinc) در آنها اطمینان حاصل نمائید.
6) هرچه میتوانید مایعات گرم مانند چای،قهوه و .... بنوشید. اثر نوشیدن مایعات گرم مشابه قرقره نمودن آب نمك اما بصورت معكوس میباشد. با قرقره نمودن، ویروس را از بدن خارج مینمائیم و با نوشیدن مایعات گرم، ویروس را به داخل معده انتقال میدهیم كه در آنجا امكان تكثیر ندارد.
پیشنهاد میكنم این دستورالعملها را برای سایرین لیست نمائید. شما نمیدانید چه اشخاصی ممكن است با توجه به آن زنده بمانند.
Influenza A/Mexico/2009 (H1N1) update
There are some interesting statistics on influenza in the current issue of CDC’s Morbidity and Mortality Weekly Report. The first is this map showing the number of confirmed cases (N = 1,882) of novel influenza A (H1N1) virus infection worldwide as of May 6, 2009:
With the exception of a few countries, the vast majority of confirmed cases have been in the northern hemisphere. I suspect this situation will change rapidly - flu season is winding down in the northern hemisphere, and is about to begin in the south. The fact that there are already confirmed cases in the southern hemisphere means the virus is already there, and likely to spread further. CDC says as much, although with considerably more uncertainty:
Summertime influenza outbreaks in temperate climates have been reported in closed communities such as prisons, nursing homes, cruise ships, and other settings with close contact. Such outbreaks typically do not result in community-wide transmission, but they can be important indicators of viruses likely to circulate in the upcoming influenza season. The novel influenza A (H1N1) virus has been circulating in North America largely after the peak influenza transmission season. For that reason, the epidemiology and severity of the upcoming influenza season in the southern hemisphere or in the northern hemisphere cannot be predicted. The imminent onset of the season for influenza virus transmission in the southern hemisphere, coupled with detection of confirmed cases in several countries in the southern zone, raise concern that spread of novel influenza A (H1N1) virus might result in large-scale outbreaks during upcoming months. Countries in the southern hemisphere that are entering the influenza season should anticipate outbreaks and enhance surveillance accordingly. Influenza virus can circulate year round in tropical regions; therefore, these countries should maintain enhanced surveillance for novel influenza A (H1N1) virus.
Also shown in bar graph form are the number of confirmed (N = 822) and suspected (N = 11,356) cases of novel influenza A (H1N1) virus infection, by date of illness onset in Mexico, from March 11 - May 3, 2009:
These data suggest several interesting possibilities. Infection with the new H1N1 strain might have begun as early as March 11, although the early cases are suspected, not laboratory confirmed. After a period of relatively few infections, the number of cases rapidly climbed to a peak and then quickly declined. Of course, new outbreaks are still possible. If we take the number of deaths in Mexico (42) and divide them by the number of laboratory confirmed cases (949), the mortality rate is 4.4% - higher than the 2.5% observed during the 1918-19 pandemic. However, if we divide the number of deaths by the number of suspected cases (11,932), the fatality rate is more in line with typical seasonal influenza - 0.4%. Which number is correct awaits determination of the actual number of cases.
It is also informative to examine CDC’s case definition for influenza - fever plus cough or sore throat. This definition is very broad and could easily include infections caused by other respiratory viruses, such as rhinoviruses, coronaviruses, adenoviruses, and paramyxoviruses. Indeed, I have heard that some of the suspected cases of H1N1 influenza in New York are in fact a consequence of rhinovirus infection. Analyzing an outbreak by using the suspected number of cases is dangerous - akin to a scientist ‘wasting clean thoughts on dirty data’.
MEXICO CITY – The swine flu epidemic spread deeper into the United States, Europe and Latin America — and in Canada, back to pigs — even as Mexico's health chief hinted Sunday it may soon be time to reopen businesses and schools in the nation where the outbreak likely began.
The virus spread to Colombia in the first confirmed case in South America, worrisome because flu season is about to begin in the Southern Hemisphere. More cases were confirmed in Europe and North America; health officials said at least 999 people have been sickened worldwide.
Dr. Richard Besser, acting chief of the U.S. Centers for Disease Control and Prevention, said swine flu is spreading just as easily as regular winter flu.
"The good news is when we look at this virus right now, we're not seeing some of the things in the virus that have been associated in the past with more severe flu," Besser said. "That's encouraging, but it doesn't mean we're out of the woods yet."
On Sunday, health officials raised the number of confirmed U.S. swine flu cases to 244 in 34 states. The new number, up from 160 on Saturday, reflects streamlining in federal procedures and the results of tests by states, which have only recently begun confirming cases, said Dr. Anne Schuchat of the CDC.
Mexican Health Secretary Jose Angel Cordova said late Sunday that the virus that has killed 22 people in Mexico, raising the toll from 19. The last confirmed death occurred on April 29, he said.
Cordova added that the virus had sickened at least 568 and apparently peaked in Mexico between April 23 and April 28. A drastic nationwide shutdown appears to have helped prevent the outbreak from becoming more serious, he said.
"The evolution of the epidemic is now in its declining phase," Cordova said.
He said officials would decide Monday whether to extend the shutdown or allow schools and businesses to reopen on Wednesday.
Pablo Kuri, an epidemiologist advising Cordova, told The Associated Press on Sunday that tests have confirmed a swine flu death in Mexico City on April 11, two days earlier than what had been believed to be the first death.
Kuri also said there have been no deaths among health care workers treating swine flu patients in Mexico, an indication that the virus may not be as contagious or virulent as initially feared.
The closed events made for a surreal Sunday in Mexico, as parishioners celebrated Mass via television, camera operators were the only ones in stadium bleachers and parks, museums, restaurants, theaters and other attractions were closed.
Sunday also marked the official start of campaigning for July 5 congressional elections — but all public campaigning was banned to prevent gatherings where the virus could spread.
Gabriela Cuevas Barron of the conservative National Action Party giddily claimed she was launching Mexico's first virtual campaign, promising in a Webcast to work for a cleaner and safer Mexico City — for now, through Twitter, Facebook and YouTube. Meanwhile, the leftist Democratic Revolution Party was already up with a Facebook page for its candidates.
The United States said it had sent 100,000 protection kits worth $1 million to Mexico for use by first responders. The kits include respiratory masks, protective goggles and overalls. In all, the U.S. has sent $16 million in aid to Mexico since the emergency began, the U.S. Embassy said.
Officials in New Mexico announced Sunday that 14 schools in four towns were being closed for at least a week after the state's first swine flu case was confirmed, and the New Mexico Activities Association suspended all athletic and activity programs until further notice at member schools across the state.
In Arizona, all 10 public schools in the border city of Nogales canceled classes this week after a student tested positive for swine flu.
California officials, meanwhile, suspended all visitations at prisons pending results of tests on an ill inmate at Centinela State Prison.
In the Canadian province of Alberta, officials quarantined about 220 pigs that became infected from a worker who had recently returned from Mexico. It was the first documented case of the H1N1 virus being passed from a human to another species. Canada stressed that pigs often get the flu and there's no danger in eating pork.
Egypt has ordered all pigs in the country slaughtered as a precaution, sparking riots Sunday by pig farmers who threw stones at police.
According to tallies by the CDC, World Health Organization and governments, there were 101 confirmed cases of swine flu in Canada; 40 in Spain; 18 in Britain; eight in Germany; four in New Zealand; two each in Italy, France, Israel, and South Korea; one each in Colombia, Costa Rica, Ireland, Switzerland, Austria, Hong Kong, Denmark and the Netherlands.
Fear spread in other parts of the globe, much of it directed at Mexican nationals or those who have traveled to Mexico.
China quarantined more than 70 Mexican travelers in hospitals and hotels there, and Mexicans on arriving flights were being taken into isolation, said Mexico's ambassador, Jorge Guajardo. Even the Mexican consul in Guangzhou was briefly held after returning from a vacation in Cambodia, Guajardo said.
"In many cases we have gotten reports that they were being quarantined for the sole fact that they had a Mexican passport, whether or not they came from Mexico, whether or not they had been in Mexico, whether or not they had been in contact with someone else from Mexico," Guajardo said.
Hong Kong isolated 350 people in a hotel after a Mexican traveler there was determined to have the swine flu.
In Trinidad, crew aboard a Mexican tanker had been isolated since Friday at the Point Lisas Port. The Ministry of Health said Sunday they were tested and cleared of any flu infection and that the vessel was expected to be released.
Health officials around the world cautioned that despite encouraging signs, swine flu still poses a very real threat.
"Most experts would agree that the current outbreak that we are experiencing is mild to moderate in severity," Dr. Jon Andrus of the Pan American Health Organization said in a teleconference from Washington. "That is not to say that things cannot change very rapidly and very dramatically."
Under one scenario, the virus could peter out now, only to roar back in the fall when flu seasons begins. That's why health officials are watching the Southern Hemisphere so closely.
"Certainly, maybe, this current round of activity has peaked, but we are only 10 days into this outbreak," WHO spokesman Gregory Hartl told reporters in Switzerland. "I think we would want to wait a while before making a definitive decision
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Posted: 02 May 2009 02:28 PM PDT Peter Palese has written an excellent opinion piece for the Wall Street Journal on why swine flu is not that scary. His arguments may bring some comfort for those readers of virology blog who are worried about the impact of the new influenza H1N1 strain. Even if you are not worried, the scientific basis for his arguments are compelling and answer some of the many questions I have been receiving in the past week. I can’t think of anyone’s opinion on influenza virus that I value more - and it’s not just because I did my Ph.D. research in his laboratory. He’s an outstanding scientist with balanced, well-informed opinions. Herewith are some excerpts from his piece. First, Palese reviews the concerns about the new H1N1 viruses:
Next, he argues why we should be optimistic:
In closing, he notes that we have a vastly improved infrastructure to deal with novel emerging diseases:
Coming from such a well-informed and experienced source, these arguments are compelling. Please pass them on to anyone you know who might be worried by the recent emergence of the new influenza H1N1 virus. |
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Influenza A/Mexico/2009 (H1N1): Absence of crucial virulence marker Posted: 02 May 2009 01:49 PM PDT
During influenza virus infection, PB1-F2 is targeted to the mitochondria, where it induces a form of cell death known as apoptosis. Experiments in a mouse model of influenza virus infection have shown that PB1-F2 regulates lethality of the virus. By comparing the infection of mice with two strains of influenza virus, one of which produces much lower levels of the PB1-F2 protein, it was found that the protein enhances inflammation and increases frequency and severity of secondary bacterial pneumonia. A specific amino acid at position 66 of this protein appears to be an important determinant of viral virulence. This amino acid is a serine in the 1918 H1N1 influenza virus, in a 1997 avian H5N1 isolate from the Hong Kong outbreak, and in the H2N2 (1957) and H3N2 (1968) pandemic strains. Other less pathogenic influenza virus isolates have an asparagine at this position. Two viruses were constructed which differ at amino acid 66 of the PB1-F2 protein, and the virulence of these viruses was determined in mice. The influenza virus with a serine at amino acid 66 was pathogenic in mice, while the virus with an asparagine was significantly less virulent. Increased pathogenicity of the virulent virus was associated with higher levels of virus replication in the lungs. The results of these studies show that the PB1-F2 protein affects pathogenicity in a mouse model, and that position 66 plays an important role.  Truncated PB2-F2 Because the amino acid change N66S of PB1-F2 is present in the three previous pandemic influenza virus strains - 1918 H1N1, 1957 H2N2, and 1968 H3N2 - it would be of interest to determine which amino acid, N or S, is present in the new H1N1 influenza virus strain that is spreading globally. However, examination of the nucleotide sequence of RNA from the current H1N1 isolates shows that these viruses do not even produce a PB1-F2 protein - a stop codon is present after amino acid 11 (see figure). In fact, many other influenza virus strains do not produce the protein. While the PB1-F2 protein is not the only determinant of influenza virus virulence, we can at least eliminate any contribution of this viral protein to increased lethality. As Peter Palese has written in today’s Wall Street Journal, “If this virulence marker is necessary for an influenza virus to become highly pathogenic in humans or in chickens, then the current swine virus doesn’t have what it takes to become a major killer.” Conenello, G., Zamarin, D., Perrone, L., Tumpey, T., & Palese, P. (2007). A Single Mutation in the PB1-F2 of H5N1 (HK/97) and 1918 Influenza A Viruses Contributes to Increased Virulence PLoS Pathogens, 3 (10) DOI: 10.1371/journal.ppat.0030141 MCAULEY, J., HORNUNG, F., BOYD, K., SMITH, A., MCKEON, R., BENNINK, J., YEWDELL, J., & MCCULLERS, J. (2007). Expression of the 1918 Influenza A Virus PB1-F2 Enhances the Pathogenesis of Viral and Secondary Bacterial Pneumonia Cell Host & Microbe, 2 (4), 240-249 DOI: 10.1016/j.chom.2007.09.001 |
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Influenza virus RNA: Translation into protein Posted: 02 May 2009 12:57 PM PDT  figure 1 Let’s resume our discussion of the influenza virus genome. Last time we established that there are eight negative-stranded RNAs within the influenza virion, each coding for one or two proteins. Now we’ll consider how proteins are made from these RNAs. Figure 1 shows influenza RNA segment 2, which encodes two proteins: PB1 and PB1-F2. The (-) strand viral RNA is copied to form a (+) strand mRNA, which in turn is used as a template for protein synthesis. Figure 2 (below) shows the nucleotide sequence of the first 180 bases of this mRNA. The top line, mostly in small letters, is the nucleotide sequence of the viral mRNA. During translation this sequence is read in triplets, each of which specifies an amino acid (the one-letter code for amino acids is used here). Translation usually begins with an ATG which specifies the amino acid methionine; the next triplet, gat, specifies aspartic acid, and so on. Only the first 60 amino acids of the PB1 protein are shown; the protein contains a total of 758 amino acids. Most of the influenza viral RNAs code for only one protein. However, RNA 2 (and two other RNAs) code for two proteins. In the case of RNA 2, the second protein is made by translation of what is known as an overlapping reading frame. On the second line of the RNA sequence in figure 2 is an atg highlighted in red. You can see that this atg is not in the reading frame of the PB1 protein. However, it is the start codon for the second protein encoded in RNA 2, the PB1-F2 protein (F2 stands for frame 2, because the protein is translated from the second open reading frame). Figure 3 shows how PB1-F2 is translated. The sequence of the viral RNA is shown from the beginning, except that reading frame 1, which begins at the first ATG, is not translated. Rather, we have begun translation with the internal atg, which is in the second reading frame. This open reading frame encodes the PB1-F2 protein which, in this case, is 90 amino acids in length (its length varies in different isolates). The protein is much shorter than PB1 because translation stops at a termination codon (tga) long before the end of the RNA. Because PB1-F2 is encoded in reading frame 2, its amino acid sequence is completely different from that of PB1.  figure 2  figure 3 The sequences used for this example are from the 1918 H1N1 strain of influenza. Notice the amino acid of PB1-F2 which is highlighted in blue. This amino acid has an important role in the biological function of the protein, which we will consider in a future post. My apologies if the figures and text are not optimally aligned. A blot post is not the optimal format for such information, but in the interest of time I have not explored other options. Suggestions for improvement are welcome. Send your questions to virology@virology.ws. |
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Influenza A/Mexico/2009 (H1N1): Questions and answers Posted: 01 May 2009 07:55 PM PDT
A reader from Mexico shared the following numbers with virology blog, then asked a question about hog cholera. Q: There are 312 confirmed cases of swine virus here in Mexico and 12 of them have died. This means 3.8%. In the rest of the world there are 159 confirmed cases of swine virus infection, but no deaths. It gets even worse, there have been reported 176 deaths by pneumonia in this past two weeks, but only 12 are positive for the swine virus, this means that only 6.8% of the fatalities can be blamed on the swine virus. Three states San Luis Potosi, Oaxaca and Aguascalientes have together reported 195 cases of pneumonia with 24 deaths, that is 12.3% die. While three other states (Tlaxcala, Veracruz and Coahuila) have together reported 154 cases of pneumonia with no deaths…(a similar situation as the rest of the world). I have read that hog cholera can increase the death toll of influenza virus above 10%. What is hog cholera and why does this worsen flu? A: Hog cholera is an infectious disease of pigs caused by a virus known as classical swine fever virus. Infection with this virus leads to fever, skin lesions, convulsions and often death. It is also immunosuppressive, therefore worsening influenza in swine. Q: How risky is it to travel internationally (to places other than Mexico) at this time? How likely is one to pick up a flu on an airplane, in an airport, while staying at a hotel or hostel, etc? I am supposed to be visiting Spain for a month - my travel insurance company says they won’t cover any cancellation costs because no one has issued a travel advisory against Spain. Does this mean that it is more or less safe to visit Spain, although there are cases reported there as well? I am confused. How likely is one to become sick while travelling? Would it be better to stay home at this point? A:At this point the new influenza virus strain seems to be nearly everywhere, even in the US, based on suspected cases. Therefore travel poses no increased risk. However, travel is a good way to become infected - airports, hotels, airplane, are all good venues for transmission by aerosol or contact (see an earlier virology blog post on transmission - the airplane transmission story is particularly interesting). So in my view, you probably have a higher risk of being infected because you will be in contact with more people while traveling than if you stayed at home. But if you take precautions like cleaning hands with an alcohol-based cleaner, refrain from touching mouth/eyes/nose, you can minimize the likelihood of exposure. I doubt there will be travel advisories issued for Spain because by the time there are many cases there, the virus will be elsewhere as well. If your trip is not imminent, you can delay and make a decision later. Q: Is Vitamin D effective against influenza? And does this also help explain seasonality? A: It has been hypothesized that vitamin D was effective against influenza (see this paper), but this has never been rigorously proven. Seasonality better correlates with temperature and humidity. Q: Your note that CDC does not recommend use of face masks for reducing viral spread is somewhat inaccurate. In addition, the posted article titled “Influenza Viral Transmission” does not take transmission through contact with GI substances into account. In CDC’s Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H!N!) Virus Transmission has been detected, it is stated, “When crowded settings and close contact with others cannot be avoided, the use of facemasks or respirators in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered. The documents then gives three circumstances. A: Thank you for your comments and support. I understand that in some cases facemasks/respirators are recommended. As I pointed out in virology blog, on the front page of CDC, which most laypersons will see, there is no recommendation for the use of such protection. As you know, when not use properly, face masks do not function as intended and most laypersons will not have the opportunity to use respirators (by layperson I mean someone not involved in health care). As for GI spread, influenza cannot and does not replicate in the GI tract of humans (although it does so in birds). Concurrent infections with other pathogens (e.g. norovirus) may lead to GI symptoms. Q: Our elite team of news reporters (who still refer to this as Swine flu) listed vomiting and diarrhea as symptoms. This seems peculiar for flu. During the regular flu season, I remember telling patients to look out for fever, arthralgias, cough etc…never anything about vomiting and diarrhea. Is this a legitimate symptom, or just the media being as vague as possible? A: Influenza cannot and does not replicate in the GI tract of humans (although it does so in birds). Concurrent infections with other pathogens (e.g. norovirus) may lead to GI symptoms. Q: ALL OF US WILL GOING TO BE IN CONTACT WITH THE VIRUS IN THE NEXT MONTHS OR YEARS WHAT IS THE BEST TO GET SICK NOW OR LATER I THINK WE MUST RESIST ALL WE CAN BECAUSE I THINK ON DECEMBER THE VACCINE COULD BE DISPONIBLE. A: Do not attempt to become infected now; the outcome of influenza infection may not be benign. Q: I’d like to know the potential lethality of swine influenza as compared with other types of influenza viruses. IS THERE ANY REFERENCE ABOUT THE RISK OF INFECTION IN OPEN OR CLOSED SPACES?? A: There is no reason to believe that the current H1N1 virus, which originated in swine, is any more lethal than any other influenza virus, with the exception of avian H5N1 strains and the 1918-19 strain. Transmission is likely to be more efficient in closed spaces (such as an airline cabin; see this post). Q: How long would you expect human immunity to exist within an individual infected with H1N1 virus? A: I would expect immunity to be lifelong against that specific strain. However, immunity will not completely protect agains future antigenically drifted viruses of the same lineage. Q: One small correction. N-95s are respirators, not face masks. Respirators must meet specifications for filtering out specific types and sizes of particles. An N-95 is a particulate respirator that when fitted properly filters 95% of particles 0.3 microns or larger. Face masks generally refer to medical and surgical masks that need only provide a physical barrier. Thank you. Q: At the end of a recent interview with Science magazine, Dr. Donis of the CDC states that the USA has received 300 samples of this virus from Mexico. Why has the CDC failed to publish the sequences of any of these 300 Mexican samples Dr. Donis says have been received from Mexico? Doesn’t this seem to be an intentional act? A: I’m not sure. It’s been suggested that the Mexican government wants to keep rights to the use of the viruses as a vaccine and therefore do not want the sequence released. I suspect we’ll find out in the coming week. Q: Regarding Dr. Schuchat’s statement, could it be that if you trace the lineage of certain viral genome segments that their origin could be avian, for example? i.e., perhaps the A/swine/Indiana/P12439/00 isolate was/is a reassortant originally containing some segments of avian origin? Just a thought, I have not personally looked closely at these sequences… and also: Q: But you still agree that this virus appears to contain genetic pieces from from four virus sources, correct? (one avian influenza viruses, one human influenza viruses, and two swine influenza viruses). A: In 1998, recombinant viruses arose in pigs that were a combination of human, pig, and avian influenza virus RNAs. See Dr. Donis’ statement in yesterday’s Science interview. Today they look like swine viruses because they have been evolving in this animal for so many years. Q: How do we account for the April 24 comments of Dr. Marie Gramer below, who has perhaps the largest library of swine flu virus isolates in the nation the day after Schuchat’s comments? “There have been no reports of this virus in pigs, said Dr. Marie Gramer, a swine flu expert with the University of Minnesota’s college of veterinary medicine. “It doesn’t seem to be very similar to anything that is currently circulating, from what I have,” said Gramer, who has an extensive library of swine flu virus isolates.” A: I believe she is wrong. Q: I do not understand why you are morally certain that the German and New York isolates arose from Mexico. A: I am not certain, I only assume that because the New York and German tourists visited Mexico, that there were infected there and returned with the virus. However the point is moot if the Mexican viruses are very similar to all the others. Q: Mexico’s chief epidemiologist insists this virus did not begin in a Mexican pig farm. “Miguel Angel Lezana, Mexico’s chief epidemiologist, told reporters…. the presence of Eurasian swine flu genes in the H1N1 virus makes it unlikely that the disease originated in a Mexican pig farm.” A: Chief Epidemiologist? He should be fired. The fact that Eurasian swine flu genes are present in no way makes a Mexican origin more unlikely than any other. Q: It’s taken me a while to digest the fact that the Mexican flu viruses haven’t been sequences. Shouldn’t this be bigger news? Why is it confined to a relatively obscure blog? (No offense, Dr. Racaniello.) (I could not resist printing the preceding question. Not offended at all!) Q: Canine influenza emerged a few years ago in Florida in greyhounds, and was found to have come from an equine influenza strain. However, after entering the canine population, the virus is no longer able to infect horses. Perhaps a similar thing is occurring here. A: Swine are readily infected with human influenza viruses. So there is no reason to believe that the new human H1N1 virus would not be able to go back into pigs. We’ll see. Q: Fucoidan is a sulfated polysaccharide primarily found in brown seaweeds. Although the specific shape/sugar to sulfate compositions vary from seaweed to seaweed, the fucoidan used in this paper is from Undaria pinnatifida, one of the most popular dietary seaweeds consumed in Japan and Korea. The sporophyll contains 8-12% fucoidan (the part of the Undaria used in this study, also called Mekabu in Japanese). Is it possible that people in Japan will be protected from H1N1 if they eat Mekabu? A: The concentrations of fucoidan used in the studies you provided are rather high and would not be present at such levels in Mekabu. Therefore eating the seaweed would not likely be of value in preventing infection. |
HONG KONG, May 1 (Reuters) - When millions of people started dying around the world in 1918, doctors and scientists hadn't a clue what was happening. As the epidemic spread, people blamed it on everything from tiny plants to old dusty books.
Then again, they couldn't have known because the influenza virus was only identified in 1933, by a British research team.
But how times have changed.
Just over a month after people started falling ill in Mexico, experts have identified the culprit to be a novel H1N1 flu virus, which carries genetic material that is mostly swine with the rest being human and avian.
Scientists in Mexico, the United States and New Zealand have since posted full sequences of its DNA taken from 34 virus samples in an online public library. And the list is growing.
What this means is scientists everywhere can now use these descriptions to create new tools to fight the virus, such as rapid diagnostic test kits and vaccines.
While the fastest conventional tests take up to two days, scientists are designing highly specific ones that can pick up this swine H1N1 flu virus in four to six hours.
Explaining the "polymerase chain reaction" technique used in the test kit, a scientist with a top government hospital in Asia said: "A well-designed rapid (real time) PCR test should be able to detect specific swine H1N1 virus in a sample by detecting gene sequences that are unique to this virus and no other."
Mark von Itzstein, director of the Institute for Glycomics in Australia's Griffith University, said: "It will rapidly let us indentify if it is swine H1N1, and if it is, we will want to treat the patients within a 48 hour period (after symptoms begin) with Tamiflu, quarantine them and monitor their recovery."
Hong Kong scientists hope to design a PCR kit by next week. The U.S. Centers for Disease Control and Prevention is sending test kits to U.S. states and Mexico but other countries don't want to wait.
"The genetic sequences have just been made available ... many laboratories are rushing to find the best test, it will take one to two weeks (for us to design one), but we need a lot of validation, we need hundreds of specimen to do that," said microbiologist Yuen Kwok-yung at the University of Hong Kong.
MANY MYSTERIES
The virus has killed 176 people in Mexico and spread to at least 10 other countries but most of the cases outside Mexico have been mild, an observation that has intrigued everyone.
Nobody knows for sure how this virus came to be, which animal passed it to the first human patient and when that occurred.
But experts expect to find out a little more through analysing its samples and tracking its DNA changes over time.
"The current analysis indicates this is mainly a swine virus, but further whole genome sequencing throughout the pandemic period and comparison with previous purely swine viruses (isolated from pigs) will be able to tell us which genes are mutating to allow pig-to-human transmission and then more efficient human-to-human transmission," said the scientist with the government hospital in Asia.
"If you can sequence full viral genomes at regular time points during the pandemic, you can see how the pandemic strain is evolving with the human pandemic and which genes are evolving in parallel with new clinical and epidemiological developments, for example, say patients now do not get diarrhoea as a routine feature of the current virus strain, but later on, they start to develop diarrhoea -- which gene mutation may have lead to this new clinical feature?"
The virus, which had never been seen until it turned up in people in Mexico, is designated H1N1, within the same family as the seasonal human H1N1 flu virus. But curiously, the H1N1 component in the current human flu vaccine offers no protection.
"We need a new vaccine (to fight the new flu virus), it only takes one amino acid change in the whole protein makeup of the virus to escape the vaccine," said Itzstein.
The CDC is making available virus samples for manufacturers to make a vaccine as needed.
"We will quickly get hold of the seed of the new flu virus ... and produce a vaccine," Japan's Health Minister Yoichi Masuzoe told a news conference on Thursday.
However some experts doubt if that is practical. A vaccine is not expected to be commercially available until 3 to 6 months after licensing, by which time a pandemic may have entered another phase, or may just be over. The World Health Organisation will decide later whether one is needed. (Editing by Andrew Marshall)
اجتماعی. انگلیس. آنفلوآنزای خوكی
لندن - با مثبت اعلام شدن نتیجه آزمایشهای پزشكی بر روی سه بیمار دیگر در نقاط مختلف انگلیس، تعداد مبتلایان به آنفلوآنزای خوكی در این كشور به ۱۱ نفر افزایش یافت.
به گزارش ایرنا، این ۱۱مبتلا به آنفلوآنزای خوكی در نقاط مختلف انگلیس و اسكاتلند از جمله لندن پراكنده هستند و همین مساله مقامات بهداشتی انگلیس را نسبت به احتمال شیوع گسترده این بیماری نگران كرده است.
در میان سه فرد جدیدی كه ابتلای آنان به بیماری آنفلوآنزای خوكی عصر روز جمعه تایید شد، یكی از آنان از فرد بیمار دیگری این بیماری را گرفته است و این نخستین انتقال انسان به انسان آنفلوآنزای خوكی در انگلیس به شمار می رود. بقیه بیماران اخیرا به مكزیك سفر كرده بودند.
یكی از بیماران جدیدا شناسایی شده، یك دانش آموز دختر است كه در نزدیكی بریستول زندگی میكند. به دنبال تایید بیماری وی، مدرسه او به مدت ده روز تعطیل شد.
پیشتر یك مدرسه دیگر به دلیل بیماری یكی از دانش آموزان آن در منطقه توربی در نزدیكی شهر دوون تعطیل شده بود.
موارد ابتلا به آنفلوآنزای خوكی درحالی در انگلیس افزایش مییابد كه وزارت بهداشت این كشور ۶۰میلیون ماسك صورت و مقادیر زیادی از داروهای ضدویروسی برای مقابله با وضعیت اضطراری خریداری كرده است. با وجود اینكه ذخیره كنونی داروهای پیشگیری موسوم به تامیفلو و رلنزا در انگلیس برای پوشش ۳۳میلیون نفر كافی است اما آلن جانسون وزیر بهداشت انگلیس اعلام كرده است وزارتخانه وی در حال تدارك دارو برای تحت پوشش قرار دادن ۵۰ میلیون نفر (سه چهارم جمعیت انگلیس) است.
وزارت بهداشت انگلیس تاكنون ۵۰۰میلیون پوند برای آماده باش، خرید دارو، واكسن و دیگر امكانات و تجهیزات اورژانسی هزینه كرده است.
مقامات بهداشتی و درمانی انگلیس در حال حاضر سرگرم بررسی و انجام آزمایش های پزشكی بر روی دهها بیمار مشكوك هستند و احتمالا طی روزهای آینده موارد بیشتری از ابتلا به آنفلوآنزای خوكی در این كشور تایید خواهد شد.
WHO to stop using term 'swine flu' to protect pigs
GENEVA – The World Health Organization announced Thursday it will would stop using the term "swine flu" to avoid confusion over the danger posed by pigs. The policy shift came a day after Egypt began slaughtering thousands of pigs in a misguided effort to prevent swine flu.
WHO spokesman Dick Thompson said the agriculture industry and the U.N. food agency had expressed concerns that the term "swine flu" was misleading consumers and needlessly causing countries to ban pork products and order the slaughter of pigs.
"Rather than calling this swine flu ... we're going to stick with the technical scientific name H1N1 influenza A," Thompson said.
Egypt began slaughtering its roughly 300,000 pigs Wednesday even though experts said swine flu is not linked to pigs and not spread by eating pork. Angry farmers protested the government degree.
In Paris, the World Organization for Animal Health said Thursday "there is no evidence of infection in pigs, nor of humans acquiring infection directly from pigs."
Killing pigs "will not help to guard against public or animal health risks" presented by the virus and "is inappropriate," the group said in a statement.
China, Russia, Ukraine and other nations have banned pork exports from Mexico and parts of the United States, blaming swine flu fears.
Most in the Muslim world consider pigs unclean animals and do not eat pork because of religious restrictions. The farmers in Egypt raise the pigs for consumption by the country's Christian minority.
WHO also reported the number of confirmed swine flu cases rose to 257 worldwide Thursday, with cases in Mexico rising to 97 from 26, with seven deaths. The WHO confirmed tally from the United States now stands at 109, with one death.
Other confirmed cases include 19 in Canada, 13 in Spain, eight in Britain, three each in Germany and New Zealand, two in Israel and one each in Austria, Switzerland and the Netherlands.
Thompson told reporters in Geneva that at least one of the Spanish cases involved a person who had not traveled to Mexico. Spanish officials said that was a man who apparently got the virus from his girlfriend, who recently returned from Mexico.
WHO raised the pandemic flu alert to phase 5 on Wednesday, one step away from the highest level indicating a global outbreak. WHO flu chief Keiji Fukuda said Thursday there were no indications in the past day that would prompt the U.N. body to raise the alert further.
To move from pandemic alert level 5 to level 6 means that WHO believes there is evidence of big outbreaks in at least two world regions and a pandemic is under way.
Fukuda said the jump in confirmed cases from Mexico was probably the result of scientists working their way through a backlog of untested samples from suspected cases.
"They are going through several thousands of laboratory specimens right now," he said.
WHO has started distributing its stockpile of 2 million courses of the antiviral drug Tamiflu to regional offices, which will decide where to send them next.
Many of those drugs will go to developing countries that don't have stockpiles of their own and some will be sent to Mexico, Fukuda said, without providing figures
http://www.cdc.gov/swineflu/key_facts.htm
What is Swine Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.
How many swine flu viruses are there?
Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.
Can humans catch swine flu?
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.
What are the symptoms of swine flu in humans?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.
Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.
How does swine flu spread?
Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.
What do we know about human-to-human spread of swine flu?
In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.
In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.
What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.
What other examples of swine flu outbreaks are there?
Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).
How does swine flu spread among pigs?
Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.
What are signs of swine flu in pigs?
Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.
How common is swine flu among pigs?
H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.
While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.
Is there a vaccine for swine flu?
Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.
A novel strain of H1N1 swine influenza virus has now also been isolated from cases of respiratory disease in Mexico City, New York City, and two locations in Canada. Clearly I was wrong in hypothesizing that the five mild cases in Texas and California reported last week were not a cause for alarm.
In Mexico City there have been over 1,000 cases of respiratory illness, with 86 fatalities. The influenza virus isolated from these individuals is similar to the H1N1 virus found in the American children last week. This virus has caused four cases of influenza in Nova Scotia, and two in British Columbia, Canada. It has also been isolated in Kansas and New York City. All American and Canadian infections have so far been mild.
There isn’t much information yet available about the genetic and antigenic composition of the virus, but CDC has said that it contains genetic material from North American swine and avian influenza viruses, human influenza virus, and swine influenza viruses found in Asia and Europe. The specific combination of viral RNA segments has not been observed previously.
The extent of spread of the swine virus has sent news organizations, governments, and health agencies into a full-tilt pandemic preparedness mode. It’s certainly advisable to be cautious when dealing with a potentially lethal virus, but is it likely that this is the next pandemic strain?
The influenza season is nearly over in the northern hemisphere - it usually does not continue beyond May. Increasing temperature and humidity are likely to curtail transmission of the virus very rapidly. The same virus could return in the fall, but by then a vaccine could be produced and distributed.
The southern hemisphere is another story - the influenza season there is just starting. It is certainly possible that this swine virus might cause extensive epidemics.
Remember that the virus that is scaring everyone is of the H1 subtype. One of the currently circulating human influenza viruses is also of the H1 subtype - the human H1N1 virus. Although the swine H1N1 virus is antigenically different from the human H1N1 virus, it is possible that those who have been infected with the human strain could be partially protected from the swine strain. Such individuals might experience less severe disease than those with no immunological memory of an H1 virus. I have not seen immunological data that would allow assessment of this possibility.
Pandemic influenza has always been a consequence of viruses of a new subtype - for example the 1968 pandemic was caused by a virus of the H3N2 subtype, which replaced the H2N2 virus. The swine virus is of the same subtype as the currently circulating human H1N1 strain. Of course, if the swine H1 HA protein is sufficiently different from the human H1 HA protein it could lead to a pandemic despite being of the same subtype.
Infection of a Spanish woman with a swine H1N1 virus was reported in February of 2009. That virus appears to be phylogenetically close to European swine influenza viruses. Such infections have been reported from time to time, and most likely represent dead-end transmission of a pig virus to a human. The H1N1 swine influenza virus circulating in the Americas has acquired the ability to be transmitted among humans. Within the next few weeks we should learn whether it has the capability of spreading throughout the entire southern hemisphere.
Van Reeth, K, & Nicoll, A (2009). A human case of swine influenza virus infection in Europe - Implications for human health and research Eurosurveillance, 14 (7), 19124-19125
Dosing Administration and storage of TAMIFLU
Taking TAMIFLU with Other Medications
TAMIFLU has been shown to have a minimal chance of negatively interacting with other medications. Over-the-counter medications may be prescribed to reduce severity of symptoms while the antiviral action of TAMIFLU takes effect. 1
The concurrent use of TAMIFLU and live attenuated influenza vaccine (LAIV) intranasal has not been evaluated. However, due to the possibility for interference between these products, LAIV should not be given within 2 weeks before or 48 hours after taking TAMIFLU, unless it is deemed appropriate by your doctor. Trivalent inactivated influenza vaccine can be administered at any time relative to use of TAMIFLU. 1
How to Store TAMIFLU
TAMIFLU capsules should be stored at room temperature (77°F [25°C]) and kept in a dry place. Refrigerate constituted liquid TAMIFLU at 36° to 46°F (2° to 8°C). Do not freeze. As with all medications, keep out of the reach of children.
