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 H1N1 - scientific news 
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Post H1N1 - scientific news
Severely Ill H1N1 Patients At Risk Of PE





# 3833







One of the remarkable findings over the summer regarding the novel H1N1 Swine flu virus has been that, in a very small subset of patients, it can produce absolutely devastating symptoms.



Not only are some patients experiencing ARDS (Acute respiratory distress syndrome), and requiring ventilator or ECMO support (see The ECMO Option), others are experiencing multi-organ failure and lung damage comparable to what has normally been associated with the H5N1 `bird flu’ virus.



Very early on we began hearing reports of some H1N1 cases involving Pulmonary Emboli. Pulmonary embolism (PE) is a blockage of a major artery in the lung by a thrombus (blot clot), or commonly, by an air or fat emboli.


PE can frequently produce a fatal outcome, particularly if untreated. Diagnosing PE, particularly in patients already experiencing severe respiratory distress from a viral infection, can be difficult.



The July 10, 2009 / 58(Dispatch);1-4 MMWR (Morbidity & Mortality Weekly Report) of the CDC described 5 such cases observed in Michigan in: Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection --- Michigan, June 2009



Today, we get a pair of follow up studies in American Journal of Roentgenology, which describe (in detail of most interest to pulmonologists and radiologists) computed tomography (CT) scans of patients with severe H1N1 infection.


First the press release, where the authors warn clinicians to be watchful for signs of PE in H1N1 patients, and then links to the two studies.



A hat tip to Dutchy on FluTrackers for Posting this link.



American Roentgen Ray Society



CT scans show patients with severe cases of H1N1 are at risk for developing acute pulmonary emboli found here: http://www.eurekalert.org/pub_releases/ ... 101309.php

http://afludiary.blogspot.com/2009/10/s ... sk-of.html

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Wed Oct 14, 2009 8:28 am
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Post Re: H1N1 - scientific news
Hat tip to FLA_MEDIC


FDA faces decision about use of peramivir for H1N1



Oct 15, 2009 (CIDRAP News) – In response to questions from citizens at a meeting yesterday, a Food and Drug Administration (FDA) official said the agency would make a decision "fairly soon" about permitting emergency use of the experimental antiviral drug peramivir to help patients severely ill with pandemic H1N1 influenza.



The FDA has been reviewing a possible emergency use authorization (EUA) for peramivir, which, like the licensed drugs oseltamivir (Tamiflu) and zanamivir (Relenza), is a neuraminidase inhibitor. Peramivir can be given intravenously (IV) or intramuscularly (IM), whereas oseltamivir is taken orally and zanamivir is inhaled as a powder.



During a public teleconference of the National Biodefense Science Board (NBSB) yesterday, Aubrey Miller of the FDA Office of Counterterrorism was asked to comment on the status of the FDA's review of an EUA for peramivir for H1N1 patients. The NBSB is an advisory board to the Department of Health and Human Services (HHS).



"There should be information or decisions being made fairly soon. That amongst other medical countermeasures are currently being evaluated by the agency," Miller said. "I don't have a specific time frame at this time, because things are under review."

(Continue . . . )
http://www.cidrap.umn.edu/cidrap/conten ... mivir.html

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Thu Oct 15, 2009 8:39 pm
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Post Re: H1N1 - scientific news
Those With Severe H1N1 At Risk For Pulmonary Emboli, Researchers Find

http://www.sciencedaily.com/releases/20 ... 111549.htm

ScienceDaily (Oct. 18, 2009) — University of Michigan researchers have found that patients with severe cases of the H1N1 virus are at risk for developing severe complications, including pulmonary emboli, according to a study published today in the American Journal of Roentgenology.

A pulmonary embolism occurs when one or more arteries in the lungs become blocked. The condition can be life-threatening. However, if treated aggressively, blood thinners can reduce the risk of death.

“The high incidence of pulmonary embolism is important. Radiologists have to be aware to look closely for the risks of pulmonary embolism in severely sick patients,” said Prachi P. Agarwal, M.D., assistant professor of radiology at the U-M Medical School and lead author of the study.

“With the upcoming annual influenza season in the United States, knowledge of the radiologic features of H1N1 is important, as well as the virus’s potential complications. The majority of patients with H1N1 that undergo chest X-rays have normal radiographs. CT scans proved valuable in identifying those patients at risk of developing more serious complications as a possible result of the H1N1 virus,” says Agarwal.

Working with Agarwal on the research were Ella Kazerooni, M.D., director of U-M’s division of cardiothoracic radiology and professor of radiology and Sandro K. Cinti, clinical assistant professor in U-M’s Department of Internal Medicine. The research included 66 patients diagnosed with the H1N1 flu. Of those, 14 were patients that were severely ill and required Intensive Care Unit admission.

All 66 patients underwent chest X-rays for the detection of H1N1 abnormalities. Pulmonary emboli were seen in CT scans on five of the 14 ICU patients.

Another important finding is that initial chest radiographs were normal in more than half of the patients with H1N1, says Kazerooni.

“These findings indicate that imaging studies would have to be repeated in severely ill patients to monitor disease progression,” said Kazerooni. “It’s important to heighten awareness not only among the radiologists, but also among the referring clinicians.”

There was no outside funding for the research.

The study will be published in the December issue of the AJR.
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Sun Oct 18, 2009 1:39 pm
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Post Re: H1N1 - scientific news
Will Peramivir help?
Thanks to the reader who sent the link to this CBS News report: Life-Saving H1N1 Drug Unavailable to Most. Excerpt:

Last month, 51-year-old John Boudrot was so sick from the H1N1 virus he was in intensive care, on a ventilator and suffering organ failure. Not in 30 years of practice had his doctor seen a patient decline so quickly - from perfect health to the doorstep of death.

"He was going on a curve like this," said Dr. Robin Dretler, indicating a steep decline. "Life in immediate danger."

As a last resort, Dretler got the Food and Drug Administration's permission to try a promising, but still experimental, drug called Peramivir.

Peramivir is an antiviral drug like Tamiflu and Relenza. But unlike those drugs, it's being specifically studied as an intravenous treatment for critically ill patients. Human clinical trials in the U.S. and Japan have called Peramivir safe and effective.

Sure enough, four days after John Boudrot got Peramivir he began to improve.

"I am a lucky son of gun to be here, no question about it," Boudrot said.

Dretler said he strongly believes it was Peramivir that made the difference.

The FDA tells CBS News that it has approved 20 similar requests for experimental Peramivir nationwide under laws allowing the "compassionate use" of unapproved drugs.

Patient records are not public, but an unofficial CBS News count found at least eight critically ill patients who recovered or are still recovering on Peramivir. We found two who died.

But among the survivors is 11-year-old year Dalila Gonzalez, who was deathly ill with H1N1. She's an important case because of the alarmingly high number of children, 86, killed so far by the flu.

http://crofsblogs.typepad.com/h5n1/2009 ... -help.html

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Mon Oct 19, 2009 7:44 pm
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Post Re: H1N1 - scientific news
WHO: Clinical features of severe cases of pandemic influenza
On October 16, WHO published Briefing Note 13: Clinical features of severe cases of pandemic influenza. Excerpt:

To gather information about the clinical features and management of pandemic influenza, WHO hosted a three-day meeting at the headquarters of the Pan American Health Organization in Washington, DC on 14–16 October.

Findings and experiences were presented by around 100 clinicians, scientists, and public health professionals from the Americas, Europe, Asia, Africa, the Middle East and Oceania.

The meeting confirmed that the overwhelming majority of persons worldwide infected with the new H1N1 virus continue to experience uncomplicated influenza-like illness, with full recovery within a week, even without medical treatment.

However, concern is now focused on the clinical course and management of small subsets of patients who rapidly develop very severe progressive pneumonia. In these patients, severe pneumonia is often associated with failure of other organs, or marked worsening of underlying asthma or chronic obstructive airway disease.

Treatment of these patients is difficult and demanding, strongly suggesting that emergency rooms and intensive care units will experience the heaviest burden of patient care during the pandemic.

http://crofsblogs.typepad.com/h5n1/2009 ... uenza.html

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Mon Oct 19, 2009 7:54 pm
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Post Re: H1N1 - scientific news
Swine flu may increase MRSA cases
Via Pharmacy Europe.net: Swine flu may increase MRSA cases. Excerpt:

An increasing number of swine flu patients being treated in hospitals may lead to a rise in cases of MRSA, according to experts, as higher bed occupancy can equal higher infection rates.

The MRSA Working Group, together with National Concern for Healthcare Infection and the Patients Association have recommended that hospitals discharge patients as early as possible to prevent the spread of infection.

The group has written to all NHS hospitals asking them to review their early discharge policies for patients of the superbug, and to remind them not to let standards slip if pressure on staff increases.

Research from the Department of Health has shown that when a hospital's bed occupancy rate exceeds 90%, MRSA rates can rise to as much as 40% above average. Dr Matthew Dryden, consultant microbiologist at the Royal Hampshire County Hospital and General Secretary of the British Society of Antimicrobial Chemotherapy, said:

"What we don't want to see is an increase in infections such as MRSA, which have been linked to high bed occupancy rates. "A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship."

http://crofsblogs.typepad.com/h5n1/2009 ... cases.html

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Wed Oct 21, 2009 1:17 pm
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Post Re: H1N1 - scientific news
Lessons from the outbreak at the US Air Force Academy
Via Reuters, Maggie Fox writes: July 4 swine flu outbreak shows pattern of virus. Excerpt:

More than 100 new cadets at the U.S. Air Force Academy got infected with swine flu at July 4 barbecue and fireworks display but quick isolation measures got it under control within two weeks, researchers reported on Tuesday.

The outbreak provided a unique opportunity to study the virus closely and Dr. Catherine Takacs Witkop and colleagues say they discovered some surprising things. Among them:

* Nearly a quarter, or 24 percent, of patients still had virus in their noses seven days after getting sick, including 19 percent who had been well for at least 24 hours

* Tamiflu, the drug used to treat influenza, did not help any of the previously healthy young men and women get better any quicker.

* Most cadets were sick for five days or longer

* Eleven percent of the cadets became infected.

http://crofsblogs.typepad.com/h5n1/2009 ... ademy.html

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Wed Oct 21, 2009 1:19 pm
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Post Re: H1N1 - scientific news
US: Scientists study pig farming for answers on swine flu

Via the Washington Post: Scientists study pig farming for answers on swine flu. Excerpt:

Little is known about the origin of the novel H1N1. But one thing is virtually certain: The bug now infecting the people of more than 190 countries began in a pig.

Detecting such cross-species transfers quickly -- or, better yet, preventing them -- is an urgent priority in a field that has spent most of its energy in recent years worrying about the emergence of flu from birds in Asia.

A major concern now is what might happen if the pandemic H1N1 virus spreads widely in pigs, and then out again into the human population.

"We really need to know more about what is happening in the pig population in the United States," said Robert G. Webster, a leading avian influenza virologist.

Scientists at the University of Minnesota and the University of Iowa revealed last week they had identified the H1N1 strain in seven pigs at the Minnesota State Fair in late summer as part of a study of virus exchange between swine and people.

Some of those animals may have caught the bug from the hordes of visitors at the 12-day event. But not all: One infected animal was swabbed while being unloaded and almost certainly arrived with the virus, said Gregory C. Gray, a physician and epidemiologist at the University of Iowa who helped run the study.

What worries virologists is the mixing of human and swine flu strains -- or, worse, human, swine and bird strains. That can lead to "reassortment," in which strands of genetic material are exchanged to yield a new virus, often with behavior not seen in its parents. Those features can include higher contagiousness, rapid growth, the ability to infect the lungs and, most important, an unfamiliar appearance to the immune system.

Reassortment is rare, and it is even rarer when the product is a strain that can spread like wildfire. That is one reason influenza pandemics occur only a few times a century. (The last one was in 1968.)

A major goal of public health is to make such events even more rare. One way is to keep pigs and humans away from each other's flu viruses. It has been clear for a while, however, that there is a small but steady traffic of virus between America's 110 million pigs and the 120,000 people who care for them.

http://crofsblogs.typepad.com/h5n1/2009 ... e-flu.html

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Sun Oct 25, 2009 2:17 pm
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Post EID article "Estimates of the Prevalence of Pandemic
EID article "Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April-July 2009"
October 28, 2009, 4:30 PM ET

http://www.cdc.gov/h1n1flu/eid_qa.htm

Summary
Through July 2009, a total of 43,677 laboratory-confirmed cases of 2009 H1N1 were reported in the United States, which is likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, researchers in this study estimate there may have been between 1.8 million and 5.7 million cases during this time period, including 9,000-21,000 hospitalizations.


Questions & Answers
What was the main purpose for conducting this study?
It is likely that the 43,677 laboratory-confirmed cases of 2009 H1N1 reported between April and July of 2009 are a substantial underestimation of the true number of cases for this time period. The current study, which used a relatively quick and simple approach, was conducted to help estimate the true number of cases, and the human health impact of 2009 H1N1 during the first four months of the pandemic.

How was this study conducted?
To estimate the total number of cases from April-July 2009, researchers built a probabilistic multiplier model that adjusts the count of laboratory-confirmed cases for each of the following steps: medical care seeking, specimen collection, submission of specimens for confirmation, laboratory detection of 2009 H1N1, and reporting of confirmed cases.

This statistical model was based on a widely accepted technique that has been used previously to estimate the actual number of cases of food-borne illness. 1This model collected information on the number of 2009 H1N1 laboratory-confirmed cases, hospitalizations and deaths in the United States reported to CDC from April – July 2009. These numbers were then adjusted using multipliers to correct for factors that can lead to under-counting. These multipliers and adjustments were made based on analysis of community surveys, outbreak investigations and published data.

What did the study’s findings indicate?
Using the model, researchers estimate that from April-July 2009 the number of people infected with 2009 H1N1 may have been up to 140 times greater than the reported number of laboratory confirmed cases. They estimate that between 1.8 million and 5.7 million cases, including 9,000 – 21,000 hospitalizations, may have occurred during the time period. This indicates that every case of 2009 H1N1 reported from April – July represents an estimated 79 total cases, and every hospitalized case reported may represent a median of 2.7 total hospitalized persons.


1. Mead PS et al. “Food-related illness and death in the United States.” Emerg Infect Dis. 1999 Sep-Oct; 5(5):607-23.

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Wed Oct 28, 2009 5:32 pm
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Post Re: H1N1 - scientific news
Antiviral cocktail shows promise against resistant H1N1
Via Medical News Today.com: Triple-combo Drug Shows Promise Against Antiviral Resistant H1N1. Excerpt:

An experimental drug cocktail that includes three prescriptions now widely available offers the best hope in developing a single agent to treat drug-resistant H1N1 swine flu, says a virology researcher in the University of Alabama Birmingham (UAB) Division of Pediatric Infectious Diseases.

In laboratory testing, the triple combination of oseltamivir (Tamiflu), amantadine (Symmetrel) and ribavirin showed a significant capacity to stop flu-virus growth, says Mark Prichard, Ph.D, who serves on the board of directors of the International Society for Antiviral Research.

The combo drug works better in the test tube than currently recommended single or double antiviral therapies used to treat both seasonal and swine flu strains, he says.

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Wed Oct 28, 2009 8:26 pm
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Post Re: H1N1 - scientific news
INFLUENZA PANDEMIC (H1N1) 2009 (78): USA OSELTAMIVIR RESISTANCE
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 29 Oct 2009
Source: The Atlanta Journal-Constitution (ajc), HealthDay News report [edited]
<http://www.ajc.com/health/content/shared-auto/healthnews/flu-/632578.html>


Tamiflu-resistant swine flu [influenza A (H1N1)] passed person-to-person in US
------------------------------------------------------------------------------
US researchers say they've spotted the 1st case of a Tamiflu
[oseltamivir]-resistant influenza pandemic (H1N1) 2009 virus passing
between 2 people -- raising the specter that more widespread
resistance will render the antiviral drug [oseltamivir] less useful in
combating the pandemic.

The pandemic (H1N1) 2009 virus is spreading rapidly, although it has
not changed from the typically mild illness observed last spring and
summer [2009], experts said at a press conference held Thursday [29
Oct 2009] at the Infectious Diseases Society of America's annual
meeting in Philadelphia. "We have the same [pandemic (H1N1) 2009]
disease from the spring and summer but just a lot more of it right
now," said Rear Admiral Dr Stephen Redd, director of the Influenza
Coordination Unit at the US Centers for Disease Control and Prevention
[CDC]. "An increasing proportion of people are visiting doctors with
influenza-like illness, the disease is widespread and we are seeing
more deaths in children in particular, and we would expect that to
continue as the number of cases increases," he said. Antiviral drugs
have been dispatched from the US government stockpile to treat
children, Redd added.

So far, almost all strains of H1N1 have responded to both oseltamivir
(Tamiflu) and another antiviral, zanamivir (Relenza), while displaying
resistance to amantadine, a drug in a different class. As a result,
Tamiflu and Relenza have been used widely for both the prevention and
treatment of H1N1. However, in June and July 2009, 65 campers and
staff at a summer camp in North Carolina became ill with H1N1 and were
treated with Tamiflu, while 600 other campers and staff took the
antiviral to prevent the illness. 2 females who shared a cabin
developed symptoms after starting on Tamiflu and were later found to
have a virus with 2 viral mutations that rendered them resistant to
the drug. The mutated virus was not found in other people tested.

What's troubling is that one of the females appears to have
transmitted the mutated virus to her cabin mate. "It is likely that
this resistant virus was passed from one camper to the other based on
the timing between the illnesses and 2 genetic mutations found in the
virus in both campers," explained Dr Natalie Janine Dailey, lead
author of the study and an epidemic intelligence service officer with
the North Carolina Division of Public Health Communicable Disease
Branch. "A small number of cases of oseltamivir-resistance have been
seen in the USA so far, but these were the 1st cases reported in
otherwise healthy individuals and the 1st which appeared to have
spread from one person to another."

"This suggests that using oseltamivir to prevent influenza in healthy
people may increase the risk of resistance," she said. "If resistance
became widespread, oseltamivir would no longer be effective." With
this in mind, Dailey believes that the H1N1 vaccine, instead of
antivirals, should be used for prevention as it becomes available,
although treatment with antivirals should begin immediately in people
who are hospitalized or who are at high risk, such as pregnant women,
children under the age of 2, and people with underlying health
conditions.

A 2nd team of researchers looked at 26 elementary-school students in
Pennsylvania and their household contacts who had tested positive for
H1N1 to assess virus "shedding patterns." "We found the median
duration of shedding to be 6 days, with a minimum of one day and a
maximum of 13 days," said study author Dr Achuyt Bhattarai, an
epidemic intelligence service officer with the CDC. The same numbers
were found in children over the age of 9, representing a longer time
frame that is typically seen in adults. Bhattarai said, "This is
consistent with earlier studies of seasonal flu." This and future data
should help officials decide when children should be allowed to return
to school.

The teleconference also addressed the current delays and shortages in
available H1N1 vaccine. "We're all disappointed and frustrated by the
current situation with the vaccine supply but we need to recognize
we're not alone. The situation is true globally," said Dr Bruce
Gellin, director of the US Department of Health and Human Services'
National Vaccine Program. The situation points up problems in the
current vaccine production system, which relies on eggs as incubators
of the virus. "There's certainly lots of room for improvement in these
systems," Gellin said. "Some of the early issues are resolving,
particularly real difficulties with yield and variability among
manufacturers. Some yields were half what was expected, some were less
than half. That was a large part of the issue. We're encouraged that
many of these things are being optimized and it's the same with the
seasonal vaccine every year. We continue to do tune-ups which are
going to translate to more doses over the coming weeks and hopefully
then, the lines will get shorter."

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[A comprehensive account of oseltamivir-resistant pandemic (H1N1) 2009
influenza virus, as of 22 Oct 2009 has been published in the WHO
Weekly Epidemiological Record, 30 Oct 2009; 84(44): 453-68 (available at
<http://www.who.int/wer/2009/wer8444/en/index.html>.)
This document gives a detailed account of 39 recorded cases of
oseltamivir resistance, including 7 still under investigation, that
have been reported globally. In general, cases of oseltamivir
resistance have been geographically dispersed, sporadic, and not
linked to one another. Extensive susceptibility testing of clinical
samples and virus isolates suggests that such viruses are not
circulating at a community level.

The 32 isolates for which information is available share several
features: namely, all have a mutation in the neuraminidase gene
resulting in an amino acid change from histidine to tyrosine at amino
acid 275 (referred to as H275Y). Where enzyme-inhibition assays have
been undertaken, the viruses have been shown to be resistant to
oseltamivir, but they remain sensitive to zanamivir. Most of the 13
cases associated with prophylaxis have been isolated events with no
epidemiological linkages. The following comment relates to the 2 cases
at the summer camp in North Carolina described in the HealthDay News
report above.

'Two girls, staying in the same cabin at a summer camp in North
Carolina (USA), developed influenza-like illness three days apart. The
viruses had the H275Y mutation as well as another mutation in the
neuraminidase gene (I223V). There are insufficient data to determine
whether the resistant virus in these cases arose independently in the
2 individuals, was transmitted from a common source or passed from one
girl to the other."

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Sat Oct 31, 2009 11:32 am
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Post Re: H1N1 - scientific news
People with Rheumatoid Arthritis Are at High Risk for Serious Flu Complications and Should Get Vaccinated

October 19, 2009

Click here to find out where

The CDC has an important message for people with immune systems compromised by diseases such as rheumatoid arthritis. You are at risk for both seasonal and 2009 H1N1 flu complications and should be vaccinated as soon as the vaccine becomes available in your community. To find a vaccination location near you, click here.

In guidelines for health care professionals, the CDC suggested that patients with inflammatory rheumatic disease receive the 2009 H1N1 vaccine and the seasonal flu vaccine.
More information on the guidelines can be found here.

http://www.flu.gov/news/blogs/blog20091019.html

Great, I was just recently diagnosed with RA - but you won't catch me getting shot.

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Thu Nov 05, 2009 1:01 pm
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Post Re: H1N1 - scientific news
Hat tip to Effect Measure for pointing the way!

Flu dogma being rewritten by a strange virus no one pegged to trigger a pandemic
By Helen Branswell Medical Reporter (CP) – 1 day ago

TORONTO — The World Health Organization's top flu scientist often describes the virus he's studied for years as "humbling."

And Dr. Keiji Fukuda isn't alone in marvelling at the mercurial nature of influenza. Flu scientists repeat almost as a mantra that the only thing predictable about flu is its unpredictability.

Yet despite decades of evidence that influenza will repeatedly rewrite the rules, flu dogma emerges and takes hold. Scientists keen to sift patterns from chaos agree X is true about Y - until the virus sets them straight yet again.

In the late '60s it was held that pandemic viruses emerged in 11-year cycles, after the closely spaced 1957 Asian flu and 1968 Hong Kong flu outbreaks.

It used to be accepted that only H1, H2 and H3 viruses could infect humans. And then viruses from the H5, H7 and H9 subtypes jumped from birds to infect people. Wrong again.

Though the world is not quite seven months into this pandemic, a number of widely held assumptions about flu and pandemics seem destined for the redrawing board when the dust from this outbreak settles.

Here are some:

-Pandemic viruses emerge from Asia, the cradle of flu viruses.

Years of focus on H5N1 avian influenza viruses left experts convinced Asia was the birthplace of new flu viruses and would be the source of the next pandemic. Despite the fact that there's good evidence the 1918 Spanish flu virus may have emerged in Kansas, no one was looking to North America as ground zero for the first pandemic of the 21st century. :hmm

It's a valuable lesson, says Dr. Nancy Cox, who has been pushing for a number of years for more flu surveillance in Latin America.

"You can't take your eye off the other possible threats. You can't focus too much on one area of the world because influenza - a new virus - can emerge from anywhere," says Cox, head of the influenza division at the U.S. Centers for Disease Control.

-Pandemics are triggered by "antigenic shift."

Flu viruses evolve constantly via small mutations, a process called antigenic drift. But once in a blue moon an entirely new virus bursts out of nature, an event known as antigenic shift. Because most people are vulnerable to the new virus, it ignites a pandemic.

It used to be thought pandemics could only be started by a virus with a new hemagglutinin - the H number in the virus's name - or a virus with a hemagglutinin that hadn't spread recently among people, such as the H2N2 viruses that circulated from 1957 to 1968.

The current pandemic is caused by an H1N1 virus, which is startling because almost everyone alive has antibodies to H1 viruses. They've been circulating among people since 1918, except for a 20-year gap between 1957 and 1977.

So few scientists would have predicted a new H1 virus could cause a pandemic at this point in history.

Some, in fact, still question whether this outbreak is a pandemic, at least by the definition science currently applies. The retired head of virology for the U.S. Centers for Disease Control is one of the doubters.

"There's no precedence for this," says Dr. Walter Dowdle, who now works for the non-profit Task Force on Global Health, based at Emory University in Atlanta. "Nobody had really thought that . . . the virus would re-emerge with this much background immunity."

But Dowdle cautions about dismissing the potential of this virus just because it defies our assumptions.

"We're the ones that make the definitions. And if the virus doesn't behave according to the definitions, well, it's our fault, not the virus's fault. So I think we have to be very careful about forcing the viruses into our definition, which can only be made based on what we've seen in the past. Now we've seen something different. And so therefore we've got to go back and rethink this."

-Emerging pandemics can be extinguished with quick use of antiviral drugs.

Landmark modelling studies published in August 2005 suggested that with good surveillance, rapid response capacity and enough Tamiflu, a flu virus that was just starting to spread person-to-person could be snuffed out.

The late Dr. J.W. Lee, then director general of the WHO, committed the agency to try. Experts at the agency and elsewhere spent untold person-hours honing a plan for trying to stop a pandemic at source.

And while flu experts were watching the spread of H5N1 avian flu viruses from Asia, pigs got infected with some viruses that swapped genes and created the H1N1 virus we call swine flu. By the time we knew it was spreading, containment was out of the question.

"This cat was not only out of the bag, but this cat had nine litters before we realized what had happened," says Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy.

-We'd know it when we saw it.

Pandemics are rare. And before this one, only two had occurred in the era of virology. So what would a pandemic look like? Experts insisted it was a bit like pornography - we'd know it when we saw it. :roflmao

And then a new virus of swine-avian-and-human genes started to spread. It wasn't from a new subtype (see above). And but for the fact it was spreading in the off season and causing severe illness in younger people, it might have been mistaken for plain old flu. :hmm

Confusion ensued.

-There would be little time between the spotting of an emerging pandemic virus and the declaration of a pandemic.

The WHO's pandemic alert scale goes from Phase 1 (no threat) to Phase 6 (pandemic). For years the world had been at Phase 3, which means a non-human virus (H5N1) posed a pandemic threat and was triggering occasional cases, but person-to-person transmission was rare and limited.

Most experts assumed when a pandemic virus started to take off, the world would race through Phases 4 and 5 to 6.

Within 10 days of the first announcement that human swine flu infections had been found, the WHO raised the alert level from 3 to 4 and then to 5.

And then the world waited.

The virus spread as expected. What wasn't anticipated was political resistance to the declaration of a pandemic caused by such a mild strain. The gap between Phase 5 and Phase 6 stretched for six weeks - not because of the virus, but because of political wrangling and perceived need to ease the world into the first pandemic in 41 years. :gah

-A mutation at position 627 on the PB2 gene means trouble.

After years of study, flu scientists believe they've found a number of signature motifs in viruses that can predict characteristics like disease severity or transmissibility. One is a mutation at the 627 position on a gene called PB2.

For as far back as molecular biology can see, all flu viruses known to have spread among humans had the mutation. That has led flu scientists to peg it as essential to transmission in humans. But this virus doesn't have that mutation.
:hmm
Flu virologists have been on the lookout for pandemic H1N1 viruses with this change, believing it would confer greater transmissibility and maybe greater severity of disease. But when it was found in a few cases in the Netherlands, there were no nightmare changes in the illness pattern.

-People would clamour for pandemic vaccine.

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

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

And even after the recent death of 13-year-old Evan Frustaglio of Toronto received widespread attention, a Canadian Press Harris-Decima poll showed only 55 per cent of Canadians want this vaccine.

Meanwhile in Europe, response to vaccination efforts has been indifferent.

"It's funny because I would not have predicted us to be in this situation a year ago. Because it's a no-brainer that you'll get the vaccine out and you'll want to vaccinate as many people as possible," says Dr. Michael Gardam, of the Ontario Agency for Health Protection and Promotion.

-People would need two shots of vaccine to be protected against a pandemic virus.

The assumption was that a pandemic virus would be so new our immune systems wouldn't be able to protect us against it with just one shot. One jab would be needed to "prime" our immune systems and a second to "boost."

Those assumptions were based on the idea a pandemic virus would be a new virus subtype, foreign to our immune systems.

Clinical trials of H1N1 vaccine show most people respond to a single shot of vaccine as if it's a booster, not a primer.

-Vaccine would be ready in time to combat the second wave of infections.

Planners expected more time between the emergence of the virus and a proper first wave of activity. And they thought there would be enough time before the second wave to make and deploy vaccine.

This virus has followed a different timetable, with a rapid and heavy first wave in the spring, continued activity over the summer and an early start to the flu season in the fall.

In Canada, the first supplies of vaccine have arrived as activity is really taking off in many parts of the country. Public health officials are in a race with the virus, trying to get vaccine into people before they can catch the bug. But it takes about 10 days for an immune response to develop after vaccination and in some cases, the virus is winning the race.

"I think most of us were hoping that there was going to be a longer gap between the initial identification and even a first wave," says Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai Hospital.

The head of the CDC has been surprisingly blunt in his assessment of the existing system's capacity to make pandemic vaccine in a timely way. "The technology we are using, although tried and true, is not well suited for pandemics," Dr. Tom Frieden has said.

-Hospitals would be crippled.

Pandemic planners thought hospitals would be overwhelmed. Emergency departments would be swamped. Overflow facilities might be needed. Surgeries would be cancelled.

No one knows what this winter has in store and that scenario could still materialize. Certainly after high profile cases like the Frustaglio death, emergency departments have reported heavy use.

But so far, hospitals haven't been overwhelmed - except intensive care units.

Severe cases of H1N1 are rare, but people who develop bad disease are profoundly ill. ICU staff have to take extraordinary measures to oxygenate the blood of these people because their embattled lungs cannot do the work for them.

ICUs in a number of hard hit places during the spring wave reported nearing the point of overflow. If they reach that point, experts say, death rates will rise and other hospital services will need to be rationed. But that hasn't been the case to date.

Follow Canadian Press Medical Writer Helen Branswell's flu updates on Twitter at CP-Branswell

http://www.google.com/hostednews/canadianpress/article/ALeqM5gQJKPs4cD29K5qHQFiM3q5sYUIjA

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Fri Nov 06, 2009 8:07 am
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Post Re: H1N1 - scientific news
Is DAS181 the next big antiviral?
Via ElectroIQ.com, a news release about two PLoS ONE articles on NDAS181. Excerpt:

One published paper entitled "Novel Pandemic Influenza A(H1N1) Viruses are Potently Inhibited by DAS181, a Sialidase Fusion Protein" evaluated the antiviral activity of DAS181 against multiple Pandemic Influenza A(H1N1) viral clinical isolates in a number of preclinical models. DAS181 inhibited all of the pandemic viral strains in each study model. It demonstrates significant antiviral activity against the H1N1 viruses in primary human respiratory cells as well as in fresh human bronchial tissue.

In studies performed at the CDC, DAS181 treatment given after infection by a Pandemic Influenza A(H1N1) virus completely prevented animal death. It also successfully prevented viral replication and weight loss in these animals.

In the second published paper entitled "Inhibition of Neuraminidase Inhibitor-Resistant Influenza Virus by DAS181, a Novel Sialidase Fusion Protein", the activity of DAS181 against clinical isolates of seasonal H1N1 influenza virus collected from influenza patients during 2004, 2007, and 2009 was studied. The isolates from 2007 and 2009 are all resistant to TamifluA as all contain the H274Y mutation known to cause such resistance.

Notably, all isolates were strongly inhibited by DAS181. Additionally, NexBio has data to demonstrate that a laboratory strain of influenza which is resistant to all three NAIs (oseltamivir, zanamivir, peramivir) in vitro was inhibited by DAS181 in cell culture and in animals in the study

http://crofsblogs.typepad.com/h5n1/2009 ... viral.html

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Fri Nov 06, 2009 10:55 pm
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Post Re: H1N1 - scientific news
INFLUENZA PANDEMIC (H1N1) 2009 (105): RHINOVIRUS INTERFERENCE
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 12 Nov 2009
Source: The New Scientist, issue 2734 [edited]
<http://www.newscientist.com/article/mg20427345.100-common-cold-may-hold-off-swine-flu.html>


Common cold may hold off swine flu
----------------------------------
A virus that causes the common cold may be saving people from swine
flu [pandemic (H1N1) 2009 influenza virus infection]. If this
intriguing idea turns out to be true, it would explain why swine
flu's autumn wave has been slow to take off in some countries and
point to new ways to fight flu.

"It is really surprising that there has not been more pandemic flu
activity in many European countries," says Arnold Monto, an
epidemiologist at the University of Michigan, Ann Arbor. In France,
flu cases rose in early September [2009], then stayed at about 160
per 100 000 people until late October, when numbers started rising again.

The delayed rise was puzzling, says Jean-Sebastien Casalegno of the
French national flu lab at the University of Lyon. He reports that
the percentage of throat swabs from French respiratory illnesses that
tested positive for swine flu fell in September, while at the same
time rhinovirus, which causes colds, rose. He told New Scientist that
in late October, rhinovirus fell -- at the same time as flu rose. He
suspects rhinovirus may have blocked the spread of swine flu via a
process called viral interference. This is thought to occur when one
virus blocks another.

"We think that when you get one infection, it turns on your antiviral
defences, and excludes the other viruses," says Ab Osterhaus at the
University of Rotterdam in the Netherlands.

How important such interference is in viral epidemics is unclear.
However, there are also cases in which there is no interference, and
people catch 2 viruses at the same time. Normally, we don't get a
chance to see how rhinovirus affects flu, because flu epidemics
usually strike in winter; whereas rhinovirus hits when schools start
(late summer in the northern hemisphere). But this year the pandemic
meant flu arrived early -- and France isn't the only country in which
rhinovirus seems to have held it at bay.

In Eurosurveillance last month [see reference below}, Mia Brytting of
the Swedish Institute for Infectious Disease Control in Solna
reported a rise in rhinovirus coupled with a swine flu lull just
after school resumed in Sweden at the end of August [2009]. She too
says rhinovirus has now fallen, as flu has climbed. Researchers in
Norway report rhinovirus rose there as flu fell in August, while Ian
Mackay at the University of Queensland found the same trend in
Australia. What's more, in March, Mackay reported that people with
rhinovirus are less likely to be infected with a 2nd virus than
people with other viruses, and are just one-third as likely to have
simultaneous seasonal flu (Journal of Clinical Virology, DOI:
10.1016/j.jcv.2009.03.008).

So why hasn't the US, for example, seen a dip in pandemic cases
during a back-to-school rhinovirus outbreak? Mackay speculates that
interference from rhinovirus may not be enough to fend off flu if
someone is exposed repeatedly. There were far more cases of swine flu
in the US in September than in Europe. The effects of rhinovirus,
often dismissed as "only" a cold, are too poorly understood, say all
the researchers. Its seeming ability to block swine flu may already
have saved lives in France by buying the nation time before the
vaccine arrived. It may even lead to a drug that induces the
antiviral state, but without the sniffles.

[Byline: Debora MacKenzie]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The reference for the Eurosurveillance publication cited above is
the following: Eurosurveillance, Volume 14, Issue 40, 08 October 2009
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19354>.
This paper by A Linde et al. is titled: Does viral interference
affect the spread of influenza. The summary reads: "This short
communication hypothesis that rhinovirus epidemics occurring after
start of school may interfere with the spread of influenza during the
period when warm and humid climate decreases the influenza spread by
aerosol. Limited laboratory data supporting this hypothesis are
included in the article, but the report is written mainly to
stimulate interest and research concerning the possibility that viral
interaction may affect influenza epidemiology."

There are many viral respiratory pathogens and it is not unreasonable
to hypothesize that some or all of these might interfere with the
replication of influenza virus, which is itself susceptible to
auto-interference by the generation defective interfering particles
during replication (Indeed such defective interfering particles may
in time be harnessed as specific therapeutic agents). The
identification of rhinoviruses as interfering agents is partly a
consequence of the surveillance activities associated with this
virus. Interference by other viral respiratory pathogens will remain
unrecognised in the absence of systematic surveillance. - Mod.CP]

_________________
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Wed Nov 18, 2009 8:31 pm
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Post Re: H1N1 - scientific news
Quote:
Ukraine Flu Outbreak: Virus Is a Mixture of H1N1 and Parainfluenza, Causes Cardiopulmonary Failure

http://mikechamberslive.com/?p=2502#


November 19th, 2009
admin

Based on autopsies, we have come to the conclusion: it’s not pneumonia, but cardiopulmonary insufficiency and cardiogenic shock… The virus enters directly into the lungs, there is bleeding… Antibiotics should not be used…

Why do we have such a high mortality rate in the country?

Because people are going to pharmacies to get medicine instead of going to their doctors to be treated… No it is not pneumonic plague. It’s all nonsense… antibiotics do not help… Those with strong immune systems will survive. People with weak immune systems will succumb to the illness… Face Masks provide 30% extra protection. Wearing glasses gives an additional 10% protection, that is 40%, because the virus penetrates the mucose membranes.

The Head of the Chernivtsi regional forensic bureau, Professor Victor Bachinsky M.D. makes a strong statement: all the victims of the virus in Bukovina (22 persons aged 20 to 40 years) died not from bilateral (double) pneumonia, as previously thought, but as a result of viral distress syndrome, i.e. the total destruction of the lungs. We caught up with Professor Bachinsky, to find out how he came to this conclusion, and how people can protect themselves from this disease.

Professor, you said earlier that the virus, from which many people have died – is a mixture of types of parainfluenza and influenza A/H1N1. How do you cure this disease?

The question of how to treat this virus is not up to me. I am a pathologist. I just found out what it is and made an exact diagnosis. It is important to provide the correct treatment based on diagnosis.

There are strict protocols and standards of treatment in medicine. If a doctor treats a patient who dies, their relatives can make a complaint that they were not treated properly (misdiagnosed). The Ministry of Health has set the protocols and standards of treatment for each diagnosis. If diagnosed correctly, the treatment should be correct…

In the Chernivtsi region 18 people have died. We studied all the history and evidence from this disease, preclinical, clinical, resuscitation. When we perform an autopsy organs and tissues have histological studies (cell analysis) and we concluded that it was not pneumonia, and has no relation to pneumonia whatsoever.

These results are the foundation to ensure that doctors who treat this disease all over Ukraine, change their tactics and standards of care.

Can this new virus be cured?

It depends on the immune system. If a person’s immune system is strong, they will overcome it. There are people who carry this strain of H1N1 and remain on their feet and don’t even realise they are sick.

Antibiotics definitely should not be taken. Antibiotics are the reason we have such a high mortality and infection rate in this country, because people go to the pharmacy, describe their symptoms to the pharmacist and ask for drugs. They buy antibiotics, take them, this lowers their immune system and as a result they become sick. If prescriptions were required to buy these medications, like in other countries, this would not have happened. It is the ability to buy antibiotics over the counter without a prescription which has done so much harm to the State.

During autopsies, what did the lungs look like? Were they really black, which gave rise to so much talk of pulmonary plague?

No, they are not black… This is not pneumonic plague. It’s all nonsense. Pneumonic plague has a very different morphology. We have, for example, 60 thousand people who became sick and 23 have died. With pulmonary plague, we would now have a mortality rate of 59 thousand…

This is a viral attack that destroys the lungs.

It turns out that not only in Bukovina, but also throughout the Ukraine people did not die from pneumonia, but from this toxic strain?

Yes, It’s not pneumonia! This destruction of the lungs. This strain is very toxic, and if the immune system is weak, there is bleeding in the lungs. In the lungs there is a tiny structure – acinus, which looks like a bunch of grapes. When you breathe, oxygen enters this tiny “bunch of grapes” ( pulmonary alveoli ). On the surface of the acinus are the capillaries, where red blood cells saturate with oxygen and give blood, which supplies all tissues and organs in the body.

And once the virus enters the lungs – hemorrhaging begins immediately in the acinus. A continuous hemorrhage… It takes several hours. In the blood fibrin is formed, and from it – giolinovaya membrane, resembling a plastic bag. It envelops the acinus, and the person breathes in oxygen, but it is not transferred to the tissues. And people just gasp. There is a cardio-pulmonary insufficiency and cardiogenic shock. People die of cardiogenic shock. And there is no pneumonia. Pneumonia – an inflammation, which is treated with antibiotics. Antibiotics cannot help at any stage. There should be absolutely different treatment.

And how about Tamiflu – does it help?

This is not an antibiotic, it is an antiviral drug, which should be applied on the second or third day of the disease. But you can not use Tamiflu as a preventitive, because it is toxic.

What are the best measures to resist the disease? Is it advisable to use a mask, garlic, vitamin C?

The primary method of prevention is a face mask. This give 30% extra protection. If you wear glasses [goggles] – it is 40%, because the virus enters through the mucous membranes.

It is necessary to improve the human immune system. Not only now, but in general. Garlic, onions, wild rose, viburnum (guelder rose), raspberries, citrus fruit, honey, and other fruits and vegetables – whatever you want. Those with a strong immune system will survive. Those with weaker immune systems will succumb to the disease.

We have a lot of people in Ukraine who like shopping at the open markets. If we can avoid open markets, the less people will be in contact with each other and more lives will be saved.

You have contacted the Health Ministry and advised them to review the standards for treatment of patients. What did they say?

We sent them all our data, the necessary protocols and standards of treatment, our diagnosis. But it is clear that decisions cannot be instantaneous.

And why until now has nobody else known about this disease? What were the leading specialists in the Ministry of Health doing all this time?

Perhaps this is due to the fact that there are scientists who are working on a purely theoretical basis. And there are scientists who have seen the autopsy results. I practice as head of the regional forensic bureau and as a professor. The fact that we have established this diagnosis – it is not just to my credit, and this is not my personal opinion. This is the opinion of specialists, morphologists and doctors in Bukovina. There are five professors in our group – I just head the group.

Professor Victor Bachinsky, M.D. is a coroner in the Chernivtsi region of Ukraine. He also teaches at the Department of Anatomical Pathology and Forensic Medicine of Bukovynian State Medical Academy.

Original interview in Russian by Anna Yashchenko published by Unian: www.unian.net/rus/news/news-346721.html

[Translated from Russian, first published in English by Infowars Ireland]

Global Research Articles by Anna Yashchenko

Ukraine Flu Outbreak: Virus Is a Mixture of H1N1 and Parainfluenza, Causes Cardiopulmonary Failure.



Thu Nov 19, 2009 10:29 am
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Post Re: H1N1 - scientific news
INFLUENZA PANDEMIC (H1N1) 2009 (116):: ORIGIN
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 24 Nov 2009
Source: Bloomberg.com [edited]
http://www.bloomberg.com/apps/news?pid= ... 2AS.d1wK8#

Scientist Repeats Swine Flu Lab-Escape Claim in Published Study


Adrian Gibbs, the virologist who said in May [2009] that swine flu
may have escaped from a laboratory, published his findings today [24
Nov 2009], renewing discussion about the origins of the pandemic
virus. The new pandemic (H1N1) 2009 virus, which was discovered in
Mexico and the U.S. in April [2009], may be the product of 3 strains
from 3 continents that swapped genes in a lab or a
vaccine-manufacturing plant, Gibbs, and fellow Australian scientists
wrote in Virology Journal [see comment below]. The authors analyzed
the genetic makeup of the virus and found its origin could be more
simply explained by human involvement than a coincidence of nature.
Their study, published in a free, online journal reviewed by other
scientists, follows debate among researchers 6 months ago, when Gibbs
asked the World Health Organization to consider the hypothesis. After
reviewing Gibbs' initial 3-page paper, WHO and other organizations
concluded the pandemic strain was a naturally occurring virus and not
laboratory-derived.

"It is important that the source of the new virus be found if we wish
to avoid future pandemics rather than just trying to minimize the
consequences after they have emerged," Gibbs and colleagues John
Armstrong and Jean Downie said in today's 8-page study.

Gibbs and Armstrong are on the emeritus faculty at the Australian
National University in Canberra and Downie is affiliated with the
Centre for Infectious Diseases and Microbiology Laboratory Services
at Sydney's Westmead Hospital. While the exact source of the new H1N1
strain is a mystery, their research has "raised many new questions,"
they said. The authors compared the genetic blueprints of flu strains
stored in the free database GenBank and found the pandemic virus's
nearest ancestors circulate in pigs. While migratory birds may have
acted as conduit for their convergence, human involvement in bringing
them together is "by far the simplest explanation," Gibbs said in a
telephone interview today [24 Nov 2009].

Gibbs wrote or coauthored more than 250 scientific publications on
viruses, mostly pertaining to the plant world, during his 39-year
career at the Australian National University, according to
biographical information on the university's Web site. "Knowing
Adrian Gibbs, he will have thought through it pretty logically and
come to that conclusion," Lance Jennings, a clinical virologist with
Canterbury Health Laboratories in Christchurch, New Zealand, said in
a telephone interview. "It's up to someone else to try and prove it
or disprove it."

[Byline: Simeon Bennett]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The publication referred to above is entitled: "From where did the
2009 'swine-origin' influenza A virus (H1N1) emerge?" By Adrian J.
Gibbs(1), John S. Armstrong(1) and Jean C. Downie(2), at (1)
Australian National University Emeritus Faculty, ACT, 0200,
Australia, and (2) CIDMLS, ICPMR, Westmead Hospital, NSW, 2145,
Australia.

The Abstract reads: "The swine-origin influenza A (H1N1) virus that
appeared in 2009 and was 1st found in human beings in Mexico, is a
reassortant with at least 3 parents. 6 of the genes are closest in
sequence to those of H1N2 'triple-reassortant' influenza viruses
isolated from pigs in North America around 1999-2000. Its other 2
genes are from different Eurasian 'avian-like' viruses of pigs; the
NA gene is closest to H1N1 viruses isolated in Europe in 1991-1993,
and the MP gene is closest to H3N2 viruses isolated in Asia in
1999-2000. The sequences of these genes do not directly reveal the
immediate source of the virus as the closest were from isolates
collected more than a decade before the human pandemic started. The 3
parents of the virus may have been assembled in one place by natural
means, such as by migrating birds, however the consistent link with
pig viruses suggests that human activity was involved. We discuss a
published suggestion that unsampled pig herds, the intercontinental
live pig trade, together with porous quarantine barriers, generated
the reassortant. We contrast that suggestion with the possibility
that laboratory errors involving the sharing of virus isolates and
cultured cells, or perhaps vaccine production, may have been
involved. Gene sequences from isolates that bridge the time and
phylogenetic gap between the new virus and its parents will
distinguish between these possibilities, and we suggest where they
should be sought. It is important that the source of the new virus be
found if we wish to avoid future pandemics rather than just trying to
minimize the consequences after they have emerged. Influenza virus is
a very significant zoonotic pathogen. Public confidence in influenza
research, and the agribusinesses that are based on influenza's many
hosts, has been eroded by several recent events involving the virus.
Measures that might restore confidence include establishing a unified
international administrative framework coordinating surveillance,
research and commercial work with this virus, and maintaining a
registry of all influenza isolates."

On the basis of a wide ranging analysis of the available genome
sequence data, the authors conclude the following. Influenza virus is
a very significant zoonotic pathogen. Public confidence in influenza
research, and the agribusinesses that are based on influenza's many
hosts, has been eroded by several recent events. Measures that might
restore confidence include establishing both a unified international
administrative framework coordinating all surveillance, research and
commercial work with this virus, and also a detailed registry of all
influenza isolates held for research and vaccine production. The
phylogenetic information presently available does not identify the
source of S-OIV [the nomenclature in the paper, ProMED uses pandemic
(H1N1) 2009 virus or H1N1pdm], however it provides some clues, which
can be translated into hypotheses of where and how it might have
originated. Two contrasting possibilities have been described and
discussed in this commentary, but more data are needed to distinguish
between them. It would be especially valuable to have gene sequences
of isolates filling the time and phylogenetic gap between those of
H1N1pdm and those closest to it. We believe that these important
sequences are most likely to be found in isolates from
as-yet-unsampled pig populations or as-yet-unsampled laboratories,
especially those holding isolates of all 3 clusters of viruses
closest to those of H1N1pdm, and involved in vaccine research and
production. Quarantine and trade records of live pigs entering North
America could probably focus the search for the unsampled pig
population. It is likely that further information about H1N1pdm's
immediate ancestry will be obtained when the unusual features of its
PB1-F2 gene are understood.

In the end, thus, the authors come to no firm conclusions, and
perhaps the most interesting part of their analysis is that which
relates to the "laboratory error theory". They claim that there are
clear historical precedents for most of the events described in the
above scenarios. Viruses do 'escape' from laboratories, even high
security facilities. The H1N1 influenza lineage that circulated in
the human population for 4 decades after the 1918 Spanish influenza
epidemic, disappeared during the 1957 Asian influenza pandemic, was
absent for 2 decades, but then reappeared in 1977. Gene sequences of
the 1977 isolate and others collected in the 1950s were almost
identical, indicating that the virus had not replicated and evolved
in the interim, and had probably been held in a laboratory freezer
between 1950 and 1977 and 'escaped' during passaging.

The suggestion that persistently infected cells might be involved is
also not outlandish; influenza virus can persistently and latently
infect MDCK cells, and viruses do travel between laboratories in
cells. Multivalent 'killed' vaccines are widely used to control swine
influenzas, particularly in North American piggeries; indeed, one of
the viruses identified by us and others as closest to H1N1pdm,
A/swine/Indiana/P12439/2000 (H1N2), seems to be the "2000 Indiana
strain" used in commercial vaccines in North America. We also note
that isolates selected from the 3 clusters of viruses we find to be
closest to H1N1pdm would probably make a useful trivalent vaccine for
international use as they would provide a mixture of haemagglutinins
of the swine H3, H1 'classical swine' and H1 'Eurasian avian-like'
lineages.

The patchy occurrence of H1N1pdm infections in piggeries over the
past 6 months is interesting and may be significant. Pigs have been
shown to be fully susceptible to H1N1pdm. They shed the virus and
readily transmit it between themselves, but whereas H1N1pdm has been
reported in humans worldwide, it has not yet been reported from a pig
farm in the USA (October 2009). By contrast, it has been found in 2
piggeries each in Australia, Canada and Ireland, and one each in
Argentina, Indonesia and Japan. In the outbreaks in Argentina,
Australia and Canada, the apparent immunity to H1N1pdm of pigs in the
USA and Mexico, but not elsewhere, may indicate that the swine
influenza vaccines currently used in the USA and Mexico contain an
immunogen that either protects against H1N1pdm infection or mitigates
its symptoms.

Circumstantial evidence must always be treated with caution. One
major uncertainty in trying to determine the origin of H1N1pdm is
that one cannot predict which characters of the parental viruses have
remained or changed during the reassortment process that produced
H1N1pdm. If, for example, the significant infectiousness of H1N1pdm
is an 'emergent' property of H1N1pdm, and not shown by its parents,
then one could conclude that the final reassortment probably occurred
at about the time it emerged in early 2009. However, it is not yet
known whether H1N1pdm's infectiousness is novel; the reassortment may
have occurred a decade ago, and a recent mutation may have enhanced
its infectiousness. Another widely reported feature of H1N1pdm is
that it replicates poorly in embryonated eggs, but again this may be
merely a specific feature of H1N1pdm and not its immediate parents.
Similarly, the fact that the evolutionary rate of all of the genes of
H1N1pdm seem to be 'normal' during their unsampled pre-emergent
period does not prove that the virus or its parents have been
maintained in "unsampled" pig herds and precluded the possibility of
human involvement, as viruses grown for vaccines evolve, and indeed
might be expected to show an increased evolutionary rate, while
adapting to eggs, a new host, although such an increase may have been
offset by the practice of storing 'seed stocks' for use in several
'production cycles' in vaccine production, so that the evolutionary
age of a vaccine virus may be less than its sidereal age, and the
average could then appear to be 'normal'.

Finally, there is the report that the 1st human H1N1pdm infections
were in Perote, a small Mexican town with a very large number of
large piggeries, although it was also reported that none of the pigs
showed signs of influenza. Among the earliest cases were some in
Oaxaca, 290 km to the south [34]. Perote is an unlikely place for an
infected migratory pig to arrive from an intercontinental trip, as
the town is in a remote high valley surrounded by mountains, 200 km
to the east of Mexico City, where there is the nearest major airport,
and 130 km from the nearest port at Vera Cruz. The 4-month difference
between 'The Most Recent Common Ancestor' date for H1N1pdm estimated
from its phylogeny, and its earliest detection in the human
population, makes it more difficult to make specific conclusions
about its provenance.

For a more balanced account, readers are recommended to read the full
paper in Virology Journal, which is freely available on line at:
<http://www.virologyj.com/content/6/1/207>. - Mod.CP]

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Fri Nov 27, 2009 9:32 pm
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Post Re: H1N1 - scientific news
Hat tip to Scott McPherson

Tuesday November 24, 2009
CDC confirms Kanawha County pediatrician had swine flu -- twice
Health officials say chance of getting swine flu twice rare, but possible

by Zack Harold

Daily Mail staff

CHARLESTON, W.Va. -- A West Virginia physician who claimed to have contracted the H1N1 virus twice now has proof -- from the Centers for Disease Control in Atlanta, no less -- that her claims were true.

Dr. Debra Parsons, a pediatrician at Kid Care West in Cross Lanes, was met with reactions of doubt from local health officials last month when she said two flu tests had come back positive for H1N1, or swine flu.

Parsons first came down with the virus, complete with all the telltale symptoms, in August.

Her son became ill at the same time with the same symptoms. Figuring they had the same bug, Parsons tested herself to see what it was.

The test came back positive for Influenza A, so the lab at Charleston Area Medical Center sent it to be sub-typed. Parsons was positive for H1N1.

Parsons and her son recovered, but in October they started having the same symptoms, but they became much worse.

They were both tested this time, and the results were the same -- they were positive for Influenza A and then H1N1.

"It was swine flu both times," Parsons said.

Dr. Rahul Gupta, director of the Kanawha-Charleston Health Department, and John Law, spokesman for the West Virginia Division of Health and Human Resources, were skeptical of Parsons' claim.

Law said the possibility of getting the flu twice was "very, very, very rare." Gupta said he was "aware of no data or scientific body of research or case reports" that indicated someone could contract H1N1 more than once.

So the specimen from the Parsons' second flu test was sent to the CDC in Atlanta, where it underwent a preliminary strain reaction test. Parsons says that test is the "gold standard" in differentiating between seasonal and swine flu.

That sample came back a couple weeks ago, and it was positive for H1N1. The CDC then requested a specimen from Parsons' August flu test.

Last Friday, the results of that test came back positive for H1N1.

http://www.dailymail.com/News/Kanawha/200911230838

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Fri Nov 27, 2009 9:36 pm
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Post Re: H1N1 - scientific news
China: Dogs test positive for H1N1
Via Xinhua: China urges intensified supervision on A/H1N1 flu in animals. Excerpt:

China's Ministry of Agriculture has called for intensified monitoring and investigation of A/H1N1 flu in animals after two samples from sick dogs were tested positive for the virus.

The veterinary clinic of College of Veterinary Medicine at the China Agricultural University reported Wednesday that two out of 52 samples from sick dogs were tested positive for A/H1N1 flu virus, the ministry said late Friday.

Analysis of genetic composition found the virus detected in the samples and those found on human A/H1N1 flu cases were 99 percent homologous, it said.

http://crofsblogs.typepad.com/h5n1/2009 ... -h1n1.html

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Fri Nov 27, 2009 9:51 pm
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Post Re: H1N1 - scientific news
Hat tip to truthEXISTS at GLP

TESTS CONFIRM ECHINACEA KILLS AVIAN & SWINE FLU

Anti-viral properties and mode of action of standardized Echinacea purpurea extract against highly pathogenic avian Influenza virus (H5N1, H7N7) and swine-origin H1N1 (S-OIV)

Stephan Pleschka1 email, Michael Stein1 email, Roland Schoop2 email and James B Hudson3 email
1Institute for Medical Virology, Justus-Liebig-University Giessen, Frankfurterstr. 107, D-35392 Giessen, Germany
2Bioforce AG, Gruenaustr, CH-9325 Roggwil, Switzerland
3Department of Pathology & Laboratory Medicine, University of British Columbia, 2733 Heather Street, Vancouver V5Z 3J5, Canada

excerpt

Quote:
Human H1N1-type IV, highly pathogenic avian IV (HPAIV) of the H5- and H7-types, as well as swine origin IV (S-OIV, H1N1), were all inactivated in cell culture assays by the EF preparation at concentrations ranging from the recommended dose for oral consumption to several orders of magnitude lower.


Full report as well as rest of abstract here:

http://www.virologyj.com/content/6/1/197

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Fri Dec 04, 2009 7:31 am
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Post Re: H1N1 - scientific news
Japan: New swine flu fighter discovered
Via the Japan Times: New swine flu fighter discovered. Excerpt:

Researchers at Hokkaido University said Thursday they have found a combination of substances that is effective at combating swine flu.

The group led by professor Tadaaki Miyazaki of the university's Research Center for Zoonosis Control found that a combination of lactic acid bacteria and aureobasidium culture is more effective than the commonly used flu medication Tamiflu in increasing the survival rate and alleviating weight loss for mice infected with the A/H1N1 strain.

The find could lead to the development of new drugs for treating the new flu, which in Japan has claimed about 70 lives and left an estimated 10,000 people hospitalized.

The new combination is thought to enhance the body's natural ability to protect itself, whereas antiviral drugs like Tamiflu and Relenza are designed to curb the growth of the flu virus.

http://crofsblogs.typepad.com/h5n1/2009 ... vered.html

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Sat Dec 05, 2009 2:10 pm
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