Waking up to even more stories. It does make one want to panic, but let’s not do that. If you feel like doing that, go prep shopping, work on your home preps, but please channel this uneasiness in a positive way. There is always things to be done with prepping, home security, work on gardens, ect. Until the situation says “O.K. you can panic now” let’s focus on our home preps. I’m making a prep run today. I also need to pick up some lamp oil, and seeds for the garden. I’m getting low in the medical items, so I’ll stock some of that. O.K. for this mornings update, here we go.
Swine flu cases in US, mystery ailment in Mexico have experts scrambling
Laboratories in Atlanta and Winnipeg are looking at clinical specimens trying to determine if the mounting number of human cases of swine flu – seven and counting – in California and Texas, and an unusual explosion of severe respiratory illnesses in Mexico are pieces of the same puzzle or confusing coincidences. Even on its own the human infections with swine flu viruses are significant enough to have experts wondering whether the world is watching the start of a flu pandemic.
But official pronouncements are being crafted with caution by authorities, who remember all too well the 1976 swine flu scare – a feared pandemic that didn’t materialize. The World Health Organization, which has been monitoring the situation, said at this point it does not believe the threat of a pandemic – the first since the 1968 Hong Kong flu – has risen. “We would not see any evidence yet for this being a phase change,” said WHO spokesman Gregory Hartl, referring to the organization’s six step pandemic alert scale. The world is currently at phase 3 – occasional human cases with a novel flu virus – because of ongoing sporadic human infections with the H5N1 avian flu virus.
“We never want to overestimate or underestimate something, so we’re following it closely,” Hartl said from Geneva. “But as of the moment we see no evidence to change the global pandemic phase.” The U.S. Centers for Disease Control, which earlier in the week revealed they had found two human cases of swine flu, announced Thursday that the number of confirmed cases has risen to seven. There are two clusters, a father-daughter pairing and two 16 year old boys who attended the same school. Symptoms are similar to seasonal flu, though there are more reports of vomiting and diarrhea that is seen with regular flu. All of the cases have recovered, though one person required hospitalization. It appears none of the cases had contact with pigs.
“We believe at this point that human-to-human spread is occurring,” said Dr. Anne Schuchat, director of the CDC’s national centre for immunization and respiratory diseases. “That’s unusual. We don’t know yet how widely it’s spreading. And we certainly don’t know the extent of the problem.”
Genetic sequencing done to date reveals a seemingly unique influenza A virus of the H1N1 subtype made up of a distinctive mix of swine, bird and human flu virus genes.
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. Continued:
Swine flu cases up to 7; officials expand probe
ATLANTA – Health officials are investigating a never-before-seen form of the flu that combines pig, bird and human viruses and which has infected seven people in California and Texas. All the victims recovered, but the cases are a growing medical mystery because it’s unclear how they caught the virus. None of the seven people were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other, according to the U.S. Centers for Disease Control and Prevention.
Still, health officials said it’s not a cause for public alarm: The five in California and two in Texas have all recovered, and testing indicates some mainstream antiviral medications seem to work against the virus.
Dr. Anne Schuchat of the CDC said officials believe it can spread human-to-human, which is unusual for a swine flu virus. The CDC is checking people who have been in contact with the seven confirmed cases, who all became ill between late March and mid-April. Because of intensive searching, it’s likely health officials will find additional cases, said Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases.
CDC officials detected a virus with a unique combination of gene segments that have not been seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia. Health officials have seen mixes of bird, pig and human virus before, but never such an intercontinental combination with more than one pig virus in the mix.
Scientists keep a close eye on flu viruses that emerge from pigs. The animals are considered particularly susceptible to both avian and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of pandemic flu, said Dr. John Treanor, an infectious disease specialist at the University of Rochester Medical Center.
The virus may be something completely new, or it may have been around for a while but was only detected now because of improved lab testing and disease surveillance, CDC officials said. Continued:
Sustained Human Transmission of Swine H1N1
it is reassuring that international reporting has been rapid, there vigorous case finding is underway and that apart from some history of possible upper respiratory infections there is no indication of sustained human-to-human transmission or widespread infection of contacts of the two ill patients
The above comments by the European Centere for Disease Control and Prevention on the confirmed H1N1 swine flu in southern California ignore the glaring indication of sustained human-to-human transmission, which is the distance between the two confirmed cases.
There was no direct connection with swine or each other, so the confirmation of the same virus at distant locations was the indication, because both clusters were almost certainly caused by transmission from other humans.
Moreover, each confirmed case was linked to family members who developed symptoms before and after the confirmed case, supporting transmission within the family. However, because the symptoms were mild, none of the family members sought medical attention and were not tested. Thus, the lack of evidence is simply due to the lack of testing, not the lack of transmission.
Yesterday there were reports of suspect cases in the Imperial Valley. It is likely that these cases will be confirmed and additional cases will be identified in both counties.
Moreover, it is also likely that there are additional cases in Mexico, which borders both counties. The relationship of the US cases to reported outbreaks of influenza and atypical pneumonia in Mexico remain to be determined, but the confirmed cases in California represent sustained transmission of a swine influenza in the human population, which is cause for concern.
Unusual Strain of Swine Flu Is Found in People in 2 States
By DONALD G. McNEIL Jr.
Published: April 24, 2009
New York Times
An unusual strain of swine flu is circulating among people in the Southwest but is not known to have caused any deaths, the Centers for Disease Control and Prevention said Thursday.
The agency, which has found only seven cases, expects to find more now that it has begun looking intensively for them.
“We don’t yet know the extent of the problem,” said Dr. Anne Schuchat, the director of respiratory diseases for the agency, “but we don’t think this is a time for major concern.”
Five of the people infected were in Imperial and San Diego Counties in California and two were in San Antonio. They were 9 to 54 years old.
None had any contact with pigs, and in two sets of cases – involving a father and daughter and two 16-year-old schoolmates – those infected had contact with each other. That convinced the authorities that the virus was being transmitted from person to person.
The seven people were apparently infected from late March to mid-April. Only one was hospitalized, and all recovered.
The A (H1N1) flu strain they had was quite unusual, said Dr. Nancy Cox, the chief of the agency’s flu division. It contained gene segments from North American swine, bird and human flu strains as well as one from Eurasian swine.
Like some human strains, it is resistant to two older flu drugs, amantadine and rimantadine. It is not resistant to Tamiflu or Relenza. However, Tamiflu resistance is common in the H1N1 human flu strain circulating this year, so the swine strain could become resistant to Tamiflu if the viruses mixed in humans or, possibly, in pigs.
Swine flus rarely infect humans. There have been about a dozen cases since 2005, but almost all were in farm workers or others in contact with pigs.
In 1976, there was a cluster of swine flu cases among soldiers at Fort Dix, in New Jersey, one of whom died. That led to a rush to make a new vaccine and administer it to 40 million Americans. No epidemic materialized, but thousands of people claimed that the vaccine had given them Guillain-Barré syndrome, which can cause lethargy or paralysis. The episode led to the resignation of the director of the disease control center, and the agency has been wary of causing panic over influenza cases ever since.
The unusual strain this year was noticed, Dr. Schuchat said, only because the agency was trying out a new diagnostic test at a Navy laboratory and doing more testing than usual through a new Border Infectious Disease Surveillance Project along the Mexican border.
Officials at the public health agency in Canada said their Mexican counterparts had warned them this week of a “relatively high” fatality rate for people in Mexico who have had respiratory illnesses this season, some of whom had tested positive for flu. Asked about that, American officials said they had no information. A spokesman said the disease control center had asked Mexican officials to send samples for testing.
The United States flu season is tailing off now. It has been relatively mild; the major surprise had been the widespread Tamiflu resistance in the circulating human H1N1 strain.
Dr. Cox of the disease control center said officials did not yet know whether the flu shot this year protected against the new swine strain
Mexico shuts schools around capital in flu scare
MEXICO CITY (Reuters) – Mexico is canceling classes for millions of children in the heart of the country on Friday after influenza killed around 20 people in recent weeks. [snip]
Mexican Health Minister Jose Angel Cordoba said on Thursday schools and universities in Mexico City and the surrounding area would be closed on Friday and advised people with flu symptoms to stay home from work. “We recommend avoiding places or events with a lot of people unless strictly necessary,” Cordoba said. [snip]
About 79 people in Mexico are being treated for flu and that number has not increased in recent days, the Health Ministry said. (continued)
California and Texas Swine Flu Clusters Raise Concerns
April 24, 2009
Two of the new cases were among 16-year-olds at the same school in San Antonio “and there’s a father-daughter pair in California,” Schuchat said. The boy whose case was reported on Tuesday had flown to Dallas, but the CDC has found no links to the other Texas cases.
The above comments describe four of the five new swine flu cases (see updated map) recently confirmed by the CDC. The two high school students near San Antonio, Texas were friends and not linked to the San Diego case who flew to Dallas. Similarly there was no indication that the father daughter pair in San Diego Country were linked to the earlier cluster.
The two initial confirmed cases were also linked to clusters, but the relatives were not tested. However, it is almost certain that the two sets of contacts for the first two cases were also infected, creating four distinct clusters. The only individual case was the fifth new case, a female from Imperial County. Thus, of the 11 confirmed or suspect cases, only one was not in a cluster.
This clustering signals efficient transmission, but none of the cases have links to swine or the other clusters. The efficient transmission signals extensive silent transmission. As noted earlier, only two of the six initial cases were tested, and the testing was linked to a border surveillance program.
Thus, without the border surveillance, none if these cases would have been identified, with the possible exception of the hospitalized patient who was on a ventilator. However, the swine flu would have only been identified if the sample was sub-typed. The swine flu would test positive for influenza A, and treatment and symptoms would be the same for seasonal or swine flu.
Although all cases were in locations close to the Mexican border, no cases in Mexico have been confirmed. However, without the border surveillance no case in the United States would have been confirmed.
It is likely that there are swine flu cases in Mexico, and it is likely that the current influenza outbreak includes a high number of swine flu cases. There have been 20 fatalities due to atypical pneumonia, and cases have been unusually high for mid to late April. Samples have been sent to Canada for analysis, and the CDC said they were also investigating. However, there is little doubt that a high percentage of cases in Mexico are swine flu. School closings throughout southern Mexico, affecting millions of students were just announced.
As flu season ends in the northern hemisphere, identifying swine flu cases should be easier. However, the mild nature of the illness will likely lead to spread into the southern hemisphere increasing the frequency of co-infections with H1N1seasonal flu and acquisition of Tamiflu resistance (H274Y).
Aggressive testing of patients throughout the Americas is warranted, as well as testing in other areas.
The number of flu cases in Mexico, coupled with the high frequency of clusters in California and Texas, raises concerns that the swine flu will spread worldwide and expand into a major pandemic.
As news comes in I’ll update when I can. Hope everyone has a great day.
Just came across this:
The evolving Swine Flu story
Posted on: April 23, 2009 5:50 PM, by revere
This afternoon CDC held a “media availability” on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are “new,” with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father – daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial cases. Those counties are also where there has been the most intense looking. CDC expects more cases to be recognized with the ramped up index of suspicion. They promise to update the situation daily at 3 pm on its website. None of the cases gives a history of contact with pigs, so together with the two “doubles” (the schoolmates and family pair), this strongly suggests active person to person spread. Moreover, the initial two viruses have been completely sequenced and are very similar. Partial information on some of the additional viruses from California are also similar, which reinforces the idea that the virus is in active circulation. How widely we don’t yet know. But this isn’t all the news.
It turns out this virus is highly unusual, a quadruple reassortant. The genes of a flu virus are packaged in eight discrete segments. When two flu viruses infect the same host cell, the segments of each are copied and repackaged, 8 at a time, in new viral particles which then bud off from the infected cell. They then may infect a new host cell. In this repackaging process the segments of the two different viruses may mix and match, so that new virus particle will have segments from two different viruses. The new virus is, in a sense, not just a swine flu virus. It does have viral segments characteristic of two different families of swine flu, one typical of North America, where swine flu is endemic, and one typical of pig flu viruses from Europe and Asia. But we learned today that it also has viral segments seen in North American birds and in human seasonal influenza. Which of the segments is a bird segment and which is humans wasn’t discussed in today’s briefing, but the fact that the genetic sources comprise widely different geographies and species is highly unusual — unusual at least as far as we know. We have little systematic information on swine viruses, so how common this really is we don’t know for sure, nor do we know how recent. The virus is resistant to the older adamantane antivirals but sensitive to both oseltamivir (Tamilfu) and zanamivir (Relenza).
Whatever this is, it isn’t seasonal influenza. The reported cases range from 9 years old to 54 years old, 3 females, 4 males. All have recovered and only one required hospitalization. The earliest case is from late March, the most recent just days ago. Symptoms are typical for influenza-like illness except that there seems to be a greater prominence of gastrointestinal symptoms (nausea, vomiting, diarrhea) along with the respiratory symptoms and fever. CDC emphasized they were in an active investigation mode and will keep sharing information as it develops. Clearly there is a lot more to learn about this.
Could this be the harbinger of an influenza pandemic? A pandemic is a global sized outbreak from a single strain of influenza. We believe that there are several necessary conditions for this to happen with influenza. One is the ability of the viral strain to infect humans (there are many influenza viruses but most don’t infect humans). Another is the ability to be transmitted from person to person. While bird flu can infect humans, it still has not acquired the ability to spread easily from person to person. Yet another is an influenza virus which is sufficiently different that there is little natural immunity in the human population. As far as I can tell, this virus seems to have all of these characteristics. The most important part, though, is what the virulence of the virus is. Virulence doesn’t refer to the ability to cause disease, but the ability to cause severe disease it does cause. We don’t yet know how virulent infections with this virus are because there aren’t enough cases to make that judgment. But if most cases are relatively mild, like all so far reported, then even if this becomes a pandemic it isn’t the kind of global catastrophe that would ensue if H5N1 became pandemic at any where near its current virulence (H5N1 has a case fatality ratio in excess of 60%, versus a case fatality ratio, so far, of 0% for this virus). When asked if this event is causing any change in pandemic warning levels, CDC said it was not.
Finally, reports have been circulating of severe respiratory disease in central and southern Mexico. A question was asked at the briefing whether these two events might be related. CDC could only say that they were in contact with their counterparts in Mexico and at the Pan American Health Organization (PAHO, the WHO regional entity). In other words, CDC left the door open to the possibility, although they seemed to have no specific information one way or the other.
That’s what we know at this point. We can all continue to follow it through CDC’s daily updates on their website.