Mysterious U.S. Swine Flu Probe Widens as Mexico Finds Swine Flu *updated*

www.dailystar.co.uk...

Britain suffered its fourth swine flu death yesterday as experts warned there could be more than 40 fatalities a day by the end of the summer.


And more than 100,000 people a day could contract the disease after the Government admitted this week its spread was out of control.

And health chiefs are terrified on learning that a major drug used to combat the virus may now no longer be effective.

Health Secretary Alan Burnham said yesterday: “We have always known it would be impossible to contain the virus indefinitely.

“We need to hope for the best and prepare for the worst.”

All four Brits killed by the virus – including the 19-year-old Londoner who died yesterday – had suffered other health problems. But the speed at which the disease is spreading means that healthy young people will also be under threat before long.

And with one death occurring every 2,500 cases, the illness could be claiming 40 lives a day by the autumn.

.

Chile's A/H1N1 flu deaths rise to 19, with 7,342 infections

SANTIAGO, July 3 (Xinhua) -- Chilean health authorities on Friday reported two newly-confirmed A/H1N1 flu deaths, which brought the country's overall flu-related deaths to 19, out of a total of 7,342 infections.

One of the victims, a 36-year-old student paramedical technician, was viewed as an unusual case, because he did not have any pre-existing conditions. He died of pneumonia after being hospitalized on June 28 in the Conception Regional Hospital, where he had been doing his medical practice.

The other victim, a 38-year-old truck drier named Anselmo Urrutia, had suffered complications relating to obesity. He died of multiple organ failure in Santiago's Chest Hospital in the early hours of Friday.

Urrutia was transferred to the hospital on June 20 from the southern city of Puerto Montt. He had been breathing with the help of a respirator since June 17, when he was diagnosed with pneumonia.
.

Uruguay's confirmed A/H1N1 flu deaths rise to four

MONTEVIDEO, July 3 (Xinhua) -- A 56-year-old woman has died of A/H1N1 flu, raising Uruguay's total death toll in the new flu outbreak to four, hospital authorities said on Friday.

The patient had suffered from diabetes and severe obesity, and was a smoker. Both factors were believed to have helped worsen the situation, said Guido Manini, director of the Military Hospital in Uruguay's capital, Montevideo.

Two other patients, one 54-year-old in Montevideo and the other60-year-old in Maldonado, 140 km from the capital, died of A/H1N1 flu on Thursday. Both had suffered health problems before contracting the flu, Uruguay's Public Health Ministry said earlier.

Uruguay's first confirmed death from the flu occurred on Monday, said the ministry, adding that the country now has a total of 132 confirmed infections.

Buenos Aires - The number of swine flu cases in Argentina rose drastically on Friday, with the new government health minister reporting an estimated 100,000 cases of of the A(H1N1) virus.

At least 44 people have died, including two new deaths in the province of Santa Fe, the country's new Health Minister Juan Luis Manzur said. The estimate of infected includes those who have already recovered, minor cases and those without symptoms, he said.

The last official figure released last week stood at 1,587 infected and 26 dead. Argentina has seen the third most deaths from the virus after Mexico and the United States.

The country has closed most public facilities, including schools and universities. Many cities and towns have also ordered the closure of shops, restaurants, cafes, sports centres and dance halls.

Read more: www.monstersandcritics.com...&C

Hawaii report first death of A/H1N1 flu

Earlier this week, the Hawaii state department of health confirmed that an Oahu woman in her late 60s is Hawaii's first fatality linked to the A/H1N1 flu virus.

The woman died on June 19 at Tripler Army Medical Center, the department said in a news release on Monday, adding that the A/H1N1 flu infection had contributed to underlying medical conditions that caused the death.

.

June 19 ? Took them a long time to report it.

An American flu expert – one of many watching the way that A(H1N1) swine flu is behaving in New Zealand, Australia and South America during the local flu season – predicts it will return to the Northern Hemisphere as the dominant strain of seasonal flu.

Professor William Schaffner told the Centre for Infectious Disease Research and Policy the degree of transmission "has surprised me and frankly most of my colleagues also".

Prof Schaffner, of the department of preventive medicine at Vanderbilt University School of Medicine, added: "I think the ongoing transmission this (Northern Hemisphere) summer and what we know is happening in the Southern Hemisphere - in Argentina and in Australia and New Zealand - is going to be a harbinger of what is going to happen this next influenza season in the United States.

"We all anticipate that H1N1 will be a dominant if not the dominant influenza strain."

He commented as the journal Science published two new animal studies which show the novel H1N1 (swine) influenza now spreading in New Zealand can cause more serious lung disease than seasonal flu strains and sheds infective material from the lung and throat tissue, where it reproduces at higher rates.

The studies - in ferrets and mice - could explain autopsies and case reports of severe pneumonia as well as the virus's rapid spread.

A team from Erasmus Medical Centre in the Netherlands found that the virus transmits easily between ferrets housed in cages whose walls are 10cm apart.

But a team from the Massachusetts Institute of Technology (MIT) and the Centres for Disease Control and Prevention (CDC) found that the novel virus only transmitted well when the ferrets shared direct contact – a sign, that team said, that the new virus has not yet fully adapted to mammals.

The European team, though, warned that the new H1N1 is adapted enough to compete with seasonal flu strains for turf in humans.

It "has the ability to persist in the human population, potentially with more severe clinical consequences," they wrote.

Both studies were published online today by the journal Science. In the study from the CDC and MIT group, investigators tested the ability of three different novel H1N1 isolates to cause disease in ferrets and mice and assessed the transmissibility of the new virus in ferrets by comparing it to a seasonal H1N1 virus.

The animals that received the novel flu viruses lost more weight than the ones that were infected with the seasonal flu strain. Viral shedding patterns were similar for the novel flu groups and the seasonal flu group.

Investigators found high levels of viruses in the lower respiratory tracts of animals infected with two of the three novel H1N1 viruses but not the seasonal flu virus.
Ad Feedback

The group also found the novel flu virus in the intestinal tracts of the novel-H1N1-infected animals, consistent with gastrointestinal symptoms, such as diarrhoea, that have been reported in humans infected with the new virus.

In the transmission comparisons, the researchers found that the seasonal H1N1 virus transmitted quickly and completely by droplet transmission and direct contact among the ferrets. But the novel H1N1 viruses did not spread by droplets to all ferrets, and transmission was delayed by five or more days in two of six infected pairs.

This lack of efficient respiratory droplet transmission suggested that additional virus adaptation in mammals may be required to reach the highly contagious behaviours of seasonal H1N1 flu or the 1918 pandemic virus, the group wrote.

Terrence Tumpey, the study's author and senior microbiologist in the CDC's influenza division, said the study shows that the new virus is transmitting, but not quite as well as seasonal strains.

"Seasonal strains transmit like clockwork as soon as we push the cages together," he added.

"We think it (the new virus) could still make additional changes to become more transmissible," Dr Tumpey said. "We need to keep a close eye on the virus and monitor for changes."

An Osaka health official found a genetic mutation of swine flu that is resistant to Tamiflu on June 18 — nearly two weeks before the "first" finding was reported in Denmark — but failed to disclose it, the health ministry said Thursday.

The mutation, found in a woman in her 40s in Toyonaka who caught the H1N1 influenza A virus in May, is the first reported case of Tamiflu-resistant swine flu in Japan.

The World Health Organization declared the new flu a pandemic on June 11.

The case "is considered to pose no public health threat, given no infections have been confirmed around her," an official of the Health, Labor and Welfare Ministry said.

Nationwide, swine flu cases have topped 1,500, surfacing in 44 prefectures, but none has been fatal, the ministry said.

At an unscheduled press conference called around midnight Wednesday, Tetsuro Noda, chief of health issues related to infectious diseases at the Osaka Prefectural Institute of Public Health, was inundated with questions about why he failed to promptly report the discovery.

"The virus was dead in the patient and we judged it unnecessary to report it swiftly," Noda said. "In terms of public health, I didn't think it was a serious case and I feel sorry for the delay in the disclosure."

Osaka Prefecture said the woman carrying the Tamiflu-resistant strain recovered after being treated with Relenza, another antiviral drug.

The prefecture confirmed the genetic mutation on June 18 but did not report it to the health ministry until Wednesday, even though no other cases of Tamiflu-resistance had been reported worldwide. It was told to tell the public the next day.

A Second South Dakotan Hospitalized For Swine Flu

A second South Dakotan is now hospitalized because of the swine flu.

This means across the state eight new cases have been reported in just a week including a case in brown county.

Hospital officials in Aberdeen have not confirmed whether the person in the hospital is the same case coming out of brown county.

There are now 33 cases of the H1N1 virus in South Dakota. Here is a breakdown by county:

Minnehaha county leads the state with 11 confirmed cases of the swine flu virus. The next county with many cases is Pennington County where six cases of the swine flu have been confirmed.

Lincoln, Beadle, Dewey, and Yankton counties all have two cases each of the swine flu.

The rest of these counties have one confirmed case each---Brown, Butte, Davison, Fall River, Haakon, Spink, Turner, and Union.

Avera St. Luke's officials in Aberdeen will have a statement about the swine flu on Monday.

.

Cancun, Mexico: Swine flu is running wild in the Southern Hemisphere and is spreading rapidly through Europe and the US, with Britain projected to reach 100,000 daily cases by the end of August. The virus is even showing signs of rebounding in Mexico.

The World Health Organisation said on Friday the number of officially confirmed swine flu cases worldwide has reached 89,921 in about 125 countries.

The global body said 12,720 new cases have been reported since Wednesday - about half of them in the United States. Britain, Chile, Mexico and the Philippines also reported large numbers of new cases.

WHO Director-General Dr Margaret Chan and health ministers from around the globe huddled in Cancun last week for a two-day summit to design strategies for battling the pandemic. Nations attending include the United States, Canada, China, Britain and Brazil.

"As we see today, with well over 100 countries reporting cases, once a fully fit pandemic virus emerges, its further international spread is unstoppable," Chan.

She also warned that officials are concerned about the virus mutating.

Mexico is starting to see an increase in swine flu cases in isolated areas. To date, it has confirmed a total of 10,687 cases, including 119 deaths.

With the Southern Hemisphere in the midst of its winter flu season, Chan said officials are keeping a close watch on those countries.

In Washington, the White House said it would hold a high-level meeting next week bringing together top government officials to prepare for the possibility of a more severe outbreak of A(H1N1) influenza.

The meeting was called after the US Centers for Disease Control and Prevention (CDC) estimated that at least one million people in the United States have had swine flu, basing the projection partly on computer models.

Britain, which has officially reported 7,447 swine flu cases, is the hardest-hit nation in Europe. Health minister Andy Burnham said Thursday that Britain will now only give the antiviral to people with the virus after forecasting 100,000 new swine flu cases a day by the end of August.

Australia has the most cases in the Asia-Pacific region, with more than 4,568 confirmed.

H1N1 resistant to Tamiflu

3 cases: Japanese doctors identified a woman who was resistant to Tamiflu. A teenager in Hong Kong too did not respond to the antiviral drug. A similar case was found in Denmark.

Slow spread: The virus has a protein on its surface that is inefficient at binding with receptors in people's respiratory tracts, restricting its ability to spread quickly.

Suit filed: The family of a Moroccan woman who became the first fatality in Europe will sue two Madrid hospitals for failing to recognise the condition.

The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.

The above comments from a Hong Kong DOH press release on Tamiflu resistance in pandemic H1N1 highlight severe limitations in worldwide surveillance. Although this case was identified by routine surveillance of H1N1 positive patients in Hong Kong, it is an effort largely focused on travelers. Like countries outside of the Americas, most efforts have focused on travelers and largely ignored local community spread. The recent explosion in cases in the UK has led to a focus on the community spread there, but many other counties in Europe are reporting low numbers of confirmed pandemic H1N1 because of limited testing in the community.

In the US, efforts are focused on the community, but severe cases are targetted. Most states have stopped reporting and testing mild cases, so real monitoring of this group is minimal. However, the case in Hong Kong originated in San Francisco and was mild. The United States has not reported any Tamiflu resistance. The CDC has tested over 200 isolates and failed to identify H274Y.

This may be due in part to virus mixtures. In Denmark and Japan the H274Y was discovered in patients undergoing Tamiflu prophylactic treatment. The Tamiflu treatment would reduce wild type H1N1 and allow a minor population with H274Y to expand and be detected. Therefore, it is likely that the H274Y is spreading silently and under the radar of the sequencing efforts, which are focused on the dominant (consensus) sequence.

The acquisition of H274Y by pandemic H1N1 was not unexpected. H274Y has a history of jumping from one sub-clade to another, as well as jumping to multiple different backgrounds within a subclade via recombination and genetic hitchhiking. This has produced resistance that is limited to H1N1 and H274Y within H1N1. The co-circulation of human H1N1 seasonal flu with swine H1N1 in humans, has created a favorable environment for the jump of H274Y from seasonal flu to pandemic flu. Moreover, the widespread use of Tamiflu in patients infected with pandemic H1N1 will drive the rate of spread in pandemic H1N1.

Although countries have been placing sequences on deposit in a timely manner, there are still major deficiencies in the surveillance program, as described above. Moreover, the recent reports of Tamiflu resistance in isolates in Denmark, Japan, and Hong Kong have not lead to the release of these sequences.

An increase in surveillance and release of full sequences is still necessary. The pandemic H1N1 is now rapidly spreading in the southern hemisphere, which is just beginning its flu season. Sequences from fatal and mild cases are required to determine important changes in pandemic H1N1 associated with increased virulence as well as increased spread.

A serious comprehensive surveillance program is long overdue.

Swine flu progression graph

Wikipedia article

H1N1 has certainly gained steam. Last week this table read 50k cases and I was shocked to see 93k when I looked today. It would be scary to see the actual number of cases at this point

oh and here is a nifty time line that I'm sure has been posted a lot already but I might as well bring it up again...
Time line

[edit on 7/4/09 by MoothyKnight]

TWO women from South Wales are among the first people to contract swine flu while in Wales.

The pair, aged 36 and 38, who both live in Caerphilly County Borough, have caught the virus from others infected in their homes.

It was revealed yesterday they were among three people in Wales to catch the disease here – rather than contracting it in England, Scotland or countries abroad, and bringing it into Wales.

Experts last night (fri)said the emergence of secondary spread in Wales was an expected progression of the virus.

Dr Roland Salmon, director of the communicable disease surveillance centre at the National Public Health Service for Wales, said: “We have a disease that is infectious – quite efficiently infectious – and under these circumstances, short of all social and economic activity stopping, it was going to spread from person to person.

“We were never under any illusion that we thought we wouldn’t see this kind of spread because that’s what happens.”

The emergence of secondary spread between close household contacts does not signify that there is community transmission of the virus in Wales. This happens when sporadic cases occur in people unrelated to each other, occurs. And it does not suggest that the virus is causing more severe symptoms.

Of the nine new cases reported yesterday(fri), three are laboratory confirmed – including a 21-year-old woman from Cardiff – and six are clinically presumed.

The other people presumed to have swine flu include a 22-year-old man in the Vale of Glamorgan.

Wales’ chief medical officer, Dr Tony Jewell, said: “We knew that there would be an increase in the number of cases and we have robust plans in place to deal with it.

“Scientific advice now is that there will continue to be a rise in the number of cases across the UK and, knowing the infection is circulating, we should move to treatment rather than trying to slow the spread of disease.

“We will now rely on clinical symptoms for diagnosing the illness rather than laboratory tests. Some patients will still be tested as part of our monitoring to get more information about the virus.

“We will also stop giving preventative medicine to people the patient has been in contact with, unless clinicians determine it is appropriate due to their medical conditions.

“The focus for anti-virals will be for at-risk groups – those with chronic conditions, or pregnant women or those under five – and getting anti-virals to these groups within 48 hours to maximise their effectiveness.”www.walesonline.co.uk...

[edit on 4-7-2009 by wizardwars]

Swine flu has killed more people in Argentina than in any other country in South America, where the winter flu season is just beginning. The death rate of 1.6 percent is more than three times the world average, Claudio Zin, the health minister of Buenos Aires Province, said Friday. www.nytimes.com...

About 40 people will die of swine flu in Britain every day by the end of next month if the current fatality rate stays the same.

The stark assessment came as a 19-year-old man was confirmed yesterday as the first person in London to die after contracting swine flu, taking the UK death toll to four.

The teenager, who had underlying health problem, tested positive for the virus following his death on Wednesday.

London, a "swine flu hot spot", is the second-worst affected area in the UK. West Midlands is the worst hit, with Scotland third.

The youth's death came as UK Health Secretary Andy Burnham warned Britain could have more than 100,000 new cases a day by the end of next month.

There are 7,447 confirmed cases of swine flu in the UK. Four patients have died, all of whom had underlying health problems. If the death toll stays at that level (roughly one in 2,500), the disease could kill about 40 people a day by September.

The Scottish Government has said 10,000 people a day north of the Border were expected to contract the virus by next month. A Scottish Government spokesman said: "It is too early at this stage to know how the pandemic will progress over the coming months; therefore any estimates as to the number of infections or deaths can only be conjectural.

"For example, it is entirely possible that during the summer transmission rates may fall and we will not continue to see the significant rises in cases each week that has been the case in the hot spots in the UK so far."

We are going to have to be very careful about projections. If pandemics have anything in common, it's that their impacts vary from place to place.

I've just checked today's WHO tally of confirmed H1N1 cases and done a few simple calculations.

They show that Argentina has the highest case fatality ratio: 1,587 cases, 26 deaths, CFR of 1.6 percent. (This is much lower than the percentage I came up with yesterday.)

Next is Mexico, with 10,262 cases, 119 deaths, and a CFR of 1.15 percent.

The United States has the most cases, 33,902, and 170 deaths for a CFR of 0.5 percent. Canada has a CFR of 0.3 percent, and Chile a CFR of 0.18 percent. The UK's CFR is 0.05 percent.

So far, Mexico, the US and Canada account for 314 of the 382 deaths worldwide: 82 percent. For the vast majority of countries tying themselves in knots about H1N1, it's a trivial annoyance.

The worldwide CFR, given WHO's numbers, must be 0.42 percent: One case in 238 is fatal. If the UK does indeed see 100,000 cases a day by the end of August, and its CFR is indeed 0.05 percent, then 40 deaths a day is a reasonable projection.news.scotsman.com...

About 800 San Quentin State Prison inmates have been quarantined - banned from having visitors starting this weekend - as officials await testing on 30 inmates suspected of having swine flu, authorities said Thursday.

[edit on 4-7-2009 by wizardwars]

New Zealand reports first swine flu deaths

Wellington, July 4 (DPA) Three people have died of swine flu in New Zealand, the Ministry of Health announced Saturday, reporting the country’s first fatalities from the H1N1 virus.

It said the chief coroner had reported that it was “strongly probable” the H1N1 virus was a major factor in the death of a 19-year-old man in Hamilton Sunday and a 42-year-old man in Christchurch Thursday.

A ministry statement said that a young girl with underlying medical conditions died Saturday morning in Wellington Hospital after testing positive for swine flu.

Health Minister Tony Ryall said swine flu was continuing to spread throughout the community, but there was no cause for alarm.

Mark Jacobs, director of public health, said: “For most New Zealanders, swine flu will be a mild illness, but in some instances, the infection can cause more severe illness and, in a few tragic instances, death.”

He said that 945 confirmed cases had now been reported in New Zealand, up from 912 on Friday.

.

www.swineflunews.org...

Swine Flu Kills Three , Youngest Aged 8

[edit on 4-7-2009 by JBA2848]

Harry Potter star 'had swine flu'

Harry Potter actor Rupert Grint is recovering from a "mild bout" of swine flu, his publicist has said.

Grint, who plays Ron Weasley, took a few days off filming but has now returned to the set of Harry Potter and the Deathly Hallows.

And he is well enough to attend the world premiere of Harry Potter and the Half-Blood Prince in London on Tuesday.

"He has now recovered and is looking forward to joining his fellow cast members," his publicist said.

.

SEVENTH VICTIM DIES FROM A(H1N1) VIRUS

BANGKOK, July 4 - Thailand‘s Ministry of Public Health confirmed Saturday that one more fatality has occurred from influenza A(H1N1), raising the country‘s death toll from the new virus strain to seven.

Deputy Public Health Minister Manit Nopamornbodhi said the seventh victim was a 37 year-old woman from Ratchaburi who died on Friday night.

He said the victim suffered fever since June 25-26 and was admitted to hospital in Ratchaburi on July 2 with a lung infection.

She was not on an earlier observation list, he said, as the medical professionals were unaware that she had contracted A(H1N1) until lab tests indicated the virus after she had died.

The victim’s six family members were put under doctor's observation.

MANILA, Philippines -- Almost half of the people in the Philippines confirmed to have contracted the A(H1N1) virus are young people in their in their teens or pre-teens, Department of Health statistics shownewsinfo.inquirer.net...

Is Canada ready for a second wave of H1N1 (swine flu) that may hit in the fall? Britain says it may have 100,000 new cases a day by late August, based on the current doubling each week of the number of people falling ill. If Canada is hit proportionately, that would be roughly 50,000 cases a day.

The Public Health Agency of Canada is now ordering hundreds of ventilators in case the provinces do not have enough. Based on current expectations for the influenza's spread, there may not be enough ventilators.www.theglobeandmail.com...