Watchout: Pandemic Flu H1N1

[AL]

Trying to stay aware. I have to go to Sacramento next week. I am checking the flu conditions. Taking my N95 masks too.

AL

Sacramento health official calls for H1N1 flu emergency declaration
http://www.sacbee.com/latest/story/2300558.html

By Bobby Caina Calvan
Published: Monday, Nov. 2, 2009 - 2:50 pm

Sacramento County's chief public health official said she will recommend that a state of emergency be declared in the county because of the dramatic rise in the number of cases of H1N1 flu.

Sacramento County's board of supervisors is expected to consider the request at its meeting tomorrow.

Increased concern over the spread of the novel flu comes on heels of the latest H1N1-related death in Sacramento County - the 15th since last April, when the virus first appeared in the region.

County officials could not provide specific details on that fatality.

On Monday Health Official Dr. Glennah Trochet said the flu matter is now "urgent" and expressed alarm at the accelerating rate of H1N1 flu infections. But Trochet stopped short of calling the situation a public health disaster.

Trochet explained the declaration would give her department flexibility in working with hospitals to address the spread of the virus. It would allow hospitals, for example, to put into play many of the planned emergency measures - such as increasing the number of beds in hospital emergency departments. It also grants the county health department authority to shut down schools, if necessary. Trochet said there are no immediate plans to do that, although the declaration would allow her to open discussions with school officials should the virus spread.

"If you see a train coming toward you, you want to slow it down," Trochet said of her request for an emergency declaration.

Trochet said she also is concerned about the delayed shipment of thousands of doses of anti-viral vaccine for the H1N1 virus.

The county was expected to receive at least 50,000 doses of the vaccine, but has yet to receive that amount. The county has already used up the initial 10,000 doses of spray vaccine it received to give to children. The vaccine has been trickling in, Trochet said, but the county is not sure the full number of doses now available.

The county is slated to open the first open H1N1 vaccine clinic on Nov. 16th, at Hiram Johnson High School in Sacramento.

The proposed declaration of an emergency also comes as the county health department is reeling from cuts forced by a dwindling Sacramento County budget. The department's staff has shrunk by 30 percent since June, and has relied on volunteers from area hospitals to cope with the increasing flu problem.

[stringtown]

Obesity puts swine flu sufferers at greater risk, study suggests

Obesity appears to be a risk factor on a par with pregnancy for developing complications from an infection with pandemic H1N1 influenza, according to the most comprehensive look yet at swine flu hospitalizations.

About a quarter of those hospitalizations have been for people who were morbidly obese, even though such people make up less than 5% of the population. That fivefold increase in risk is close to the sixfold increase observed in pregnant women, according to the report published today in the Journal of the American Medical Assn.

When the merely obese are included with the morbidly obese, they make up 34% of the American population. Yet they accounted for 58% of the hospitalizations in the study.

"It makes intuitive sense," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, who noted that obese people have a higher risk of many diseases and thus a lower life expectancy. "It should be added as one of the underlying conditions."

Read more...http://www.latimes.com/features/heal...,2242205.story

One fact I found interesting was that in a study on obese vs. lean mice, the obese mice failed to produce cytokine cells.

http://www.wildlandfire.com/docs/fai...disclaimer.htm

[stringtown]

H1N1 mutation found in some flu fatalities
Change in virus could cause severest symptoms, Norwegian scientists said

OSLO - Norwegian health authorities said Friday they have discovered a potentially significant mutation in the H1N1 influenza strain that could be responsible for causing the severest symptoms among those infected.

"The mutation could be affecting the virus' ability to go deeper into the respiratory system, thus causing more serious illness," the Norwegian Institute of Public Health said in a statement.

The concern over mutation of the H1N1 virus came as health officials said the H1N1 virus is moving eastwards across Europe and Asia after appearing to peak in parts of western Europe and the United States, the World Health Organization (WHO) said on Friday.

http://www.msnbc.msn.com/id/34065140...-cold_and_flu/

Tamiflu-resistant H1N1 cases reported in N.C.
First U.S. cluster of resistance; overall, swine flu may be peaking nationally

ATLANTA - Four patients at a single hospital tested positive for a type of swine flu that is resistant to Tamiflu, health officials said Friday.

The cases reported at Duke University Medical Center in Durham, North Carolina, over six weeks make up the biggest cluster seen so far in the U.S.

Tamiflu — made by Switzerland's Roche Group — is one of two flu medicines that help against swine flu, and health officials have been closely watching for signs that the virus is mutating, making the drugs ineffective.

About 52 resistant cases have been reported in the world since April, including 15 in the U.S. Almost all in the U.S. were isolated, said officials with the U.S. Centers for Disease Control and Prevention.

The BBC reported another cluster of five Tamiflu-resistant cases this week in Wales, in the United Kingdom.

http://www.msnbc.msn.com/id/34066494...-cold_and_flu/


http://www.wildlandfire.com/docs/fai...disclaimer.htm

[rmm]

Many had asked why the WHO was dragging its feet on Ukraine and I had said they had two major problems. One was "mutation" and the other was Tamiflu resistance and both were happening when deaths were climbing and vaccine was is short supply. Therefore, they would try to keep those two shoes from dropping for as long as possible.

Now both shoes have dropped. The D225G in Ukraine was disclosed, followed by Norway, so the "mutation" shoe has dropped, and now the clsuters of Tamiflu resistance in the UK and NC have come out, so the other shoe has dropped.

Most of the world is as lost as ever. Media hasn't yet figured out that the same "mutation" is in Ukraine and Norway (and worldwide), and they also haven't figured out that the cat was out of the bag on Tamiflu resistance.

In both cases, agencies are still trying to spin "spontaneous mutation" and lack of spread, but those dogs won't hunt.

A vaccine panic is next, followed by real panic.

Dr. Henry L Niman, virologist
http://fluboard.rhizalabs.com/forum/...php?f=5&t=3206

Interesting discussions are taking place on fluboards right now and during the last couple of days due to these discoveries and developments regarding severity and antiviral resistance. (See Stringtown's post)

The above link is one place to check out. That link takes you to a particular thread, but if you click "view latest posts" you'll find a lot more. http://www.flutrackers.com/forum/ is another good source, as has been mentioned before. http://pf11.blogspot.com/ is a reliable source for more technical discussion on the genetics - and well worth visiting.

Now is as good a time as ever to keep yourself up to date on what is going on! (While I was writing this note Flutrackers reported more cases of Tamiflu resistance were discovered in Italy. http://www.flutrackers.com/forum/sho...408#post321408)

My point is, no matter what your initial thoughts are on this flu stuff, keep your heads up and remain situationally aware. Note that it takes time for genetic sequences to be studied and released. It takes little time for virus to spread.

[rmm]

2009-11-23

This report is preliminary and will be reviewed for corroboration as the official documents become available.

Although confirmation is not yet complete on this item, the American CDC has apparently issued an alert to physicians concerning hemorrhagic pneumonia in the United States. The North Carolina Medical Society has published a description of the CDC alert and has identified a reporting point in their state.

The PF11 viral reservoir is extending and revising in important areas concerning trait enhancements. Since the early part of the pandemic, this viral reservoir has exhibited exceptional abilities to damage the human body due to Influenza Flux; however, we may now be moving into deeper water if this alert is validated. While no one may say exactly where this virus is going, we are able to track the genetics and the human clinical outcomes correlated to those genetics.

Deep lung involvement appears to be supported as a trait enhancement via the D225G polymorphism on the viral Hemagglutinin. 225G is not a new incursion into ΣPF11, but now paired with 206T is becoming a higher concern. The US and Mexico demonstrated 225G with 206S early in the pandemic. 206T, as predicted, has now become fixed or consensus in many geographies. Recent studies on the Ukraine, Russia, China and Norway show 225G in the Hemagglutinin to be circulating alongside the dangerous 225E and the wildtype 225D bearing strains.

Heightened surveillance is being required from the medical community while the general public is receiving communications with an alternate message? Moms and Dads will want to get ahead of this issue by gathering accurate and complete information as soon as possible. PF11 will be with us for a long time.

Gather and Solve.

For additional background on the clinical and epidemiological observational facts concerning Pandemic Influenza H1N1, please refer to the Table of Contents for PF11 Trends & Issues, Mid-Term.

http://pf11-trends-and-issues.blogsp...ues-alert.html

An alert was also issued in September on this. (http://www.ncmedsoc.org/blog/wp-cont...cPneumonia.pdf ) It hits home a little bit more now with these cases becoming more prevalent. It's not something brand new, however. It's reason to remain informed and to take precautions, but certainly not to panic. Call it a red flag watch?

[stringtown]

I'm wondering about a pneumonia vaccine- would it be prudent to get one if it is available? Are they just for adults, or can children get them too? Would it prevent this hemorrhagic pneumonia?

[Mellie]

I can't recommend (primarily because I'm not an MD, only involved on the global epidemiology pandemic side).

That said, adult members in our family have gotten the pneumovax. I'm sure the CDC has some kind of recommendation somewhere, but I'm too busy right now to look.

Pneumovax is given at places like Costco and local drugstores without a physician's Rx to those over 60. Most physicians are more than willing to authorize it if you have trouble walking in somewhere and getting it. But, it's best to call ahead and set up an appointment with the pharmacist of nurse administering the vaccine...

Could be especially important if you or folks in your family have any kind of chronic lung condition like asthma.

The coughing camp crud everyone gets at the end of the fire season also does not bode well if you get H1N1.

If you're a smoker you're at risk.

Good questions. Our kids haven't gotten it, but I might look into it for them. Viruses are notorious for changing, as with the antiviral resistant strain(s) that are showing up.

M

[rmm]

I've seen in several spots where the pneumonia vaccine is recommended as a precaution against secondary infections with pandemic H1N1 for those with one or more of several pre-existing conditions. (Be sure to read up on it before trying to get one.) Here is CDC recommendation and information as posted at http://www.cdc.gov/h1n1flu/vaccinati...umococcal.htm:

How can High-Risk Individuals Protect Themselves from Pneumococcal Disease?

There is a vaccine to protect high-risk individuals 2 through 64 years of age against serious pneumococcal disease. The vaccine, pneumococcal polysaccharide vaccine (PPSV), is safe and effective. Most people need a single dose of the pneumococcal vaccine in a lifetime. All children less than 5 years of age should receive a different vaccine called pneumococcal conjugate vaccine (PCV7); high risk children 2 to 4 years of age need both pneumococcal vaccines.

Who should get Pneumococcal Polysaccharide Vaccine (PPSV)?

Approximately 70 million people who should be receiving PPSV are not yet vaccinated (National Health Interview Survey, 2007). View chart showing who is not yet vaccinated.

PPSV is recommended for:

People who are 65 years of age and older
People 2 years of age and older who have a chronic illness such as:
cardiovascular or lung disease
sickle cell disease
diabetes
alcoholism
chronic liver disease
cerebrospinal fluid (CSF) leak
a cochlear implant
People 2 years of age and older with a weakened immune system
Due to illnesses such as:
HIV infection
AIDS
chronic renal failure
nephrotic syndrome
organ or bone marrow transplantation
Hodgkin’s disease
leukemia
lymphoma
multiple myeloma
generalized malignancy
Those receiving immunosuppressive therapy (e.g., steroids)
Those who have had their spleen removed or whose spleen is dysfunctional due to an illness such as sickle cell disease.
Residents of nursing homes or long-term care facilities
People 19 through 64 years of age who smoke cigarettes or have asthma.

During the 2009-2010 influenza season, vaccinating people 2 through 64 years of age who have the above risk conditions is most important because people in this group may be more likely to develop secondary bacterial pneumonia after an influenza infection.

Healthy persons less than 65 years of age are not recommended to receive PPSV.
Can Adults get Pneumococcal (PPSV) and Influenza Vaccines at the Same Time?

Yes, pneumococcal vaccine may be given at the same time as influenza vaccine. Pneumococcal vaccine can be given at any time during the year. Because the adult groups for whom pneumococcal and seasonal influenza vaccines are recommended are similar, the need for pneumococcal vaccination should be evaluated at the time of annual influenza vaccination. The need for pneumococcal vaccination should also be evaluated at the time of 2009 H1N1 influenza vaccination. Persons who cannot remember if they’ve ever had pneumococcal vaccine should still be vaccinated.

During the 2009-2010 influenza season, work with your healthcare provider to determine when you can get your pneumococcal, seasonal influenza, and 2009 H1N1 influenza vaccines.

See the rest of this article at the link given.

[stringtown]

For anyone with children- the pneumoccocal PCV7 vaccine is currently given as part of their regular vaccine schedule. As far as I can figure, this started becoming standard in 2000, so check your kid's vaccine cards, they probably have had this vaccine. The info from the CDC (posted by rmm) does say that some high risk children may also need the PPSV vaccine- ask your physician if you think they might fall into this category.

[rmm]

Rhabdomyolysis has been discussed on this website and in doing a search for when those discussions took place, I found that the discussions have been during the last 18 months or so since pandemic H1N1 surfaced.

I came across this today and am wondering if it is coincidence. Whether it is or not, it is still good to know since H1N1 has not left us at all even though it is no longer considered a pandemic.

"Rhabdomyalysis is uncommon but potentially life-threatening. We present a 17-year-old patient who developed rhabdomyalysis following pandemic influenza A (H1N1/09) infection. With aggressive hydration her renal function remained normal throughout the entire disease course, and she steadily improved clinically. Although pneumonia and acute respiratory distress syndrome are the most common severe complications of H1N1/09 infection, clinicians should be aware that H1N1/09 infection may be complicated by rhabdomyolysis." http://www.ncbi.nlm.nih.gov/pubmed/20739729 (credit Flutrackers.com where this was posted.)