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

Widespread Evolutionarily Fit Tamiflu Resistant Pandemic H1N1
Recombinomics Commentary 06:41
July 10, 2009
The NA sequence of the first pandemic isolate in Sapporo, Japan (A/Sopporo/1/2009) was released at Genbank today. Since Hokkaido's first report case was June 15, the isolate is relatively recent. It exactly matches the first isolate from New Jersey, A/New Jersey/1/2009, which was from a patient (22F) in Bergen county (see map) and collected in April. Both of these isolates match the California traveler who was tested at Hong Kong airport on June 11 and was found to be infected with oseltamivir resistant H1N1 (A/Hong Kong/2369/2009) based on H274Y, which was the only difference between the Hong Kong sequence and those form Bergen, New Jersey and Sopporo. The same sequence in these three locations indicates the evolutionarily fit H1N1 is widespread and has been circulating for months, but the number of pubic sequences remains low.

The Hong Kong, ex-San Francisco case was mild. The patient recovered without taking any antivirals, raising concerns that the resistance is circulating worldwide. The same genetic change, H274Y, has also been reported in patients receiving prophylactic levels of Tamiflu in Denmark and Osaka, Japan. The Osaka sequence, other than H274Y, matches multiple isolates from Japan, and is distinct from the Hong Kong/San Francisco/Sapporo/Bergen sub-clade. The sequence from Denmark has not been made public.

However, other countries are reporting suspect Tamiflu resistance in patients who have been treated for at least a month and are symptom free, but shed detectable H1N1. These reports raise concerns that H274Y is more widespread than the 3 confirmed cases and one presumed case in San Francisco.

The finding of H274Y in all confirmed cases raises concerns that the pattern in pandemic H1N1 will follow the pattern seen for seasonal flu, where H274Y increased to almost 100% in the Brisbane/59 strain of seasonal flu. The spread of H274Y in the Brisbane strain was facilitated by the acquisition of key polymorphisms from the Hong Kong (clade 2C) strain of H1N1. However, H274Y had also been reported in clade 1 and clade 2c isolates from patients who were not receiving Tamiflu, and in countries where Tamiflu suage was low. The H274Y jumped from one sub-clade to another via genetic hitchhiking and recombination explaned the pattern of acquisitions.'

The spread of H274Y in pandemic flu may be accelerated by widespread Tamiflu usage, levels approaching 100% in H1N1 seasonal flu, and the novel H1N1 reported in Canadian farm workers infected with an H3N2 triple reassortant that has acquired Brisbane/59 H1 and N1, with H274Y.

Thus, the detection of H274Y in pandemic H1N1 from patients who were and were not taking Tamiflu, as well as Brisbane N1 in H1N1 seasonal flu and H1N1 novel flu raises concerns that the levels of H274Y will markedly increase in the near term.

BANGKOK, July 10 (Xinhua) -- Thailand's Public Health Ministry on Friday reported one more death case due to the A/H1N1 virus contraction, bringing the country's death toll to 15.

The latest victim is a 63-year-old woman in Paknam district of Sa-moot-bra-karn province, next to capital Bangkok, the Bangkok Post's website quoted the ministry's Bureau of Epidemiology as saying.

The victim had had the valvular heart disease and high blood pressure prior to the new deadly virus infection, the Bureau of Epidemiology said.

Earlier, the ministry reported that the country had 146 more confirmed A/H1N1 virus infected patients, bringing the country's total number of the patients to 3,071.

Thailand had its first two confirmed patients on May 12news.xinhuanet.com...

HOUSTON, July 9 (Xinhua) -- Maryland health officials on Thursday reported a second A/H1N1 death.

"Once again, we extend our sympathy to the family and friends of the second Maryland resident to pass away from an H1N1 flu-related illness," John Colmers, secretary of the Maryland Department of Health and Mental Hygiene (DHMH), said.

Colmers did not give any details about the case, in order to protect the privacy of the man and the family.

The state's first death from A/H1N1 flu was an elderly Baltimore resident who also had significant health issues before contracting the virus.

The DHMH reported 95 new cases of A/H1N1 for the past week, bringing the total number of confirmed cases to 686 in the state.

That figure is considered a fraction of the A/H1N1 flu cases according to the department.

Many people who become ill with flu-like symptoms are not tested and recover within a week's time, much like seasonal flu, the department said.

Colmers said the A/H1N1 will continue to be around through the summer and into the fall. "We expect more flu and unfortunately as with seasonal flu, that will mean more deaths," he said. news.xinhuanet.com...

NAIROBI, July 10 (Xinhua) -- The Thirty-four young guests from Britain are not ordinary visitors at the Duke of Breeze hotel in Kisumu and in fact they can't just park and leave.

They will not leave the hotel until a quarantine imposed on them is lifted by the Ministry of Health because some of them are suffering from the contagious A/H1N1 flu. At least one has tested positive so far.

This is the shook that Kenyans woke up to after the first case of swine flu was reported among this student from Britain and this is the tenth case to be reported in the continent since the first was reported in Egypt.

The outbreak of the A/ H1N1 influenza has drawn major global attention, owing to its rapid spread and high initial mortality rates. In response to the ongoing community level outbreak in various regions and the emergence of a global pandemic, the World Health Organization (WHO) has declared it a pandemic news.xinhuanet.com...

HOUSTON, July 9 (Xinhua) -- Texas health authorities on Thursday reported four more deaths and 473 new confirmed and probable cases of A/H1N1 flu for the past week, bringing the death toll to 21 and the number of total cases to 4,464 in the southwest U.S. state.

The state health and human services department also said that, among the 21 deaths, 15 reported and confirmed in June, comparing to five in May and one in April, a Mexican kid died in a Houston hospital in late April as the first death of the A/H1N1 flu virus in the United States.

Bordering with Mexico, Texas and California were the two U.S. states which reported first seven confirmed cases of A/H1N1 flu virus -- two in Texas and five in California -- on April 23.

Since then, the new type flu has been circulating in both states, where reports of more deaths and widespread cases have been a common phenomenon in every week and every month.

In Texas, the state health and human services department reported 28 confirmed cases on May 1, compared with 1,403 cases on June 1 and 3,991 cases on July 2, a remarkable jump for each month.

As of Thursday, confirmed cases of the A/H1N1 flu virus reported in 120 of the state's 254 counties, with eight counties reporting their first confirmed cases for past week.

Hidalgo County, near the border with Mexico, has been the hardest-hit with four deaths as well as 1,121 confirmed cases.

Both state and federal health officials and experts believe those cases -- which sought treatment and underwent testing -- are just the tip of the iceberg. They estimate more than one million Americans have been infected with the virus so far, though many probably had only a mild illnessnews.xinhuanet.com...

The Ministry of Health announced on Thursday that 11 new cases of swine flu had been registered in the Kingdom, according to a report.

The Saudi Gazette reported that the virus was detected in three Saudis and eight foreign nationals, bringing the total number of registered cases in the Kingdom to 160.

The Ministry of Health added in its statement that 134 persons had so far made complete recoveries from the virus and returned to their daily lives.www.arabianbusiness.com...

Peru will close its state schools next week in an effort to prevent the spread of swine flu in the Andean nation, President Alan Garcia said Thursday.

Peru's schools will take vacations previously scheduled for the end of July three weeks early as temperatures drop during the Southern Hemisphere's winter, Garcia told reporters in Lima. Peru, which reported its first case of the H1N1 virus in May, has recorded 1,331 cases of swine flu and three deathswww.rep-am.com...

KUALA LUMPUR, July 8 (Bernama) -- The Health Ministry on Wednesday reported that an influenza-like outbreak was detected at Akademi Laut Malaysia (ALAM) in Kuala Sungai Baru, Melaka, with some 50 trainees affected.

Director-General of Health Tan Sri Dr Mohd Ismail Merican in a statement on the Influenza A ((H1N1) situation in the country, said laboratory tests confirmed six of eight samples taken for testing were Influenza A (H1N1) cases.www.swineflunews.org...

As the World Health Organization prepares to recommend that most countries assume their flu cases are due to the novel H1N1 virus, officials are seeing the first signs of resistance to the commonly used antiviral drug Tamiflu.

Meanwhile, the virus is continuing its spread through the Northern Hemisphere this summer -- even though flu viruses normally do not spread well in hot weather -- and its effect is escalating in the southern half of the globe, where it is the traditional winter flu season.

Within the next few days, the WHO will suggest that countries with large outbreaks of H1N1, or swine flu, move away from laboratory confirmation of cases and toward larger, national indicators of disease, such as numbers of influenzalike symptoms and pneumonia cases, Dr. Keiji Fukuda, the WHO assistant director-general, said Tuesday in a telephone news conference.

The flood of cases in such countries is overwhelming laboratories and making it "very hard to keep up" with testing, he said. In most countries with large outbreaks, 95 percent or more of all flu cases are now caused by the new virus.www.chicagotribune.com...

Confirmed cases of swine flu in Indonesia have nearly doubled, with the national total standing at 52, Health Minister Siti Fadilah Supari said on Thursday.

Three foreigners were among 24 new cases of (A)H1N1, which included a dozen confirmed human-to-human transmissions, Supari told reporters.

All the patients were being treated in hospitals in the capital Jakarta, the tourist island of Bali and Balikpapan city in East Kalimantan province, she said.

"Indonesia will keep screening at all airports for foreigners who have travelled to areas where (the virus) is endemic," she said.

"We haven't found any mixing yet of the H1N1 and H5N1 (bird flu) viruses.news.brisbanetimes.com.au...

ATLANTA (AP) — Some swine flu cases in America are raising questions about obesity's role in why some people with infections become seriously ill.

A high proportion of those who have gotten severely ill from swine flu have been obese or extremely obese, but health officials have said that might be due to the fact that heavy people tend to have asthma and other conditions that make them more susceptible. Obesity alone has never been seen as a risk factor for seasonal flu.www.usatoday.com...

Saudi Arabia's warning to elderly Muslims, pregnant women and children against undertaking Hajj/Umrah pilgrimage this year in view of rapidly spreading swine flu worldwide sent a shock wave amongst Muslim community in Britain.www.medicalnewstoday.com...

The DoH has announced it is developing a 'pressure rating' mechanism to identify primary care organisations (PCOs) under extreme pressure from swine flu, as estimated new cases pass 1,000 a day.

England's chief medical officer Sir Liam Donaldson announced that the pressure rating would examine the effect of swine flu on primary and secondary care services, PCT by PCT.

The announcement comes after the GPC confirmed that suspension of QOF would be triggered on a PCT by PCT basis.

Further details on how the rating system would work have yet to be determined, however. No such scheme currently exists and so the NHS would be starting from scratch, Sir Liam said.

GP consultations for influenza-like illness (ILI) have reached 51.9 per 100,000 per week, equivalent to around 27,000 across the UK, Sir Liam said.

Around 28% of sampled cases of ILI have so far been confirmed as swine flu cases, suggesting that over 7,500 people are contracting swine flu every weewww.healthcarerepublic.com...

LONDON (AFP) – A patient at a hospital in southern England has become the first person in Britain without underlying health problems to die from swine flu, officials said Friday.

The patient died at Basildon and Thurrock University Hospital in Essex, health authorities said, adding the individual's family had requested that no further details be released.

Fourteen other people have died in Britain after contracting swine flu, but they all had underlying health problems.

Although the nature of these conditions has not been revealed, Chief Medical Officer Liam Donaldson has said people who suffer breathing problems or are clinically obese are at high risk.

The government said Wednesday that 9,718 cases of swine flu had been confirmed in Britain since the disease reached the country in late April.

It said last week that Britain could soon face more than 100,000 cases a day if the current rate of infection is maintainednews.yahoo.com...

The Department of State alerts U.S. citizens to the quarantine measures imposed by the Government of China in response to the 2009-H1N1 pandemic that may affect travel to China. This Travel Alert updates the June 19, 2009 Travel Alert in order to address the potential for quarantine of unaccompanied minors. This Travel Alert expires on September 30, 2009.

In May 2009, China implemented a policy that allows it to quarantine arriving passengers who exhibit fever or flu-like symptoms if they are arriving from a country which has cases of 2009-H1N1, including the U.S. Although the overall percentage of Americans being quarantined remains low, the seemingly random nature of the selection process makes it almost impossible to predict when a traveler may be placed into quarantine. Travelers with even a slightly elevated body temperature risk being placed into hospital quarantine, while passengers sitting in close proximity to another traveler with fever or flu-like symptoms may be taken to a specially-designated hotel for a quarantine of approximately seven days, even if they show no symptoms themselves.

The Department of State has received reports of minors traveling without a parent or adult guardian being taken into quarantine upon arrival. Some of the children were under 10 years of age. Parents considering sending their children unaccompanied to China are urged to consider postponing their travel until the quarantine policy ends or until 2009-H1N1 Influenza subsides. In addition, there have been some instances where children have been separated from their parents during quarantine because only the parent or the child tested positive for 2009-H1N1 or exhibited symptoms. Travelers are advised that Chinese health authorities have not issued a country-wide policy on keeping family members together in quarantine, and the practice of keeping young children with their parents or guardians varies by quarantine facility. In some hospitals, parents have been denied access to their children who were in isolated quarantine. In these situations, there exists the possibility of Chinese medical personnel administering medications to minors without parental permission. travel.state.gov...

Georgia has its first death from the novel influenza A H1N1 virus, health officials announced this afternoon.

A 43-year-old Cobb County woman with underlying health problems died from the new virus, said Rhonda Medows, Commissioner of the Department of Community Health and Acting Public Health Director.

There was no other information about the patient in the news release from the state. There have been 211 deaths in the United States as of 11 a.m. today, not including the new Georgia death, according to the Centers for Disease Control and Prevention. There have been 37,246 confirmed cases in the U.S., including 143 in Georgia and 176 in South Carolina, according to the CDCchronicle.augusta.com...

SAN DIEGO — Three Navy ships had to remain off the coast of Guam this week after reports of crew members were suspected of having swine flu.

The flu-like cases forced Navy and Marine Corps commanders with the naval force to cancel their planned tiger cruise for families scheduled for the leg home from Hawaii.

Reaching Guam, the ships — amphibious assault ship Boxer, dock landing ship Comstock and guided missile cruiser Lake Champlain — instead were resupplied off the coast of the Southwest Pacific island after some crew members had flu-like symptoms, Lt. Jodie Cornell, a Navy public affairs officer with Naval Forces-Marianas, told the Pacific Daily News.

Cmdr. Dora Lockwood, a Third Fleet spokeswoman in San Diego, said Friday that Navy officials had not confirmed any cases of the H1N1 virus, which causes the illness known as the swine flu.

Cornell told the newspaper that Navy officials decided to keep the ships away from port as a “precautionary measure” after service members aboard the ships, which include Marines with the Camp Pendleton, Calif.-based 13th Marine Expeditionary Unit, came down with flu-like symptoms. The affected service members were treated with Tamiflu and were quarantined aboard their ships.www.navytimes.com...

A south Auckland hospital is restricting visitors in a bid to stop the spread of swine flu and other flu-like illnesses.

Middlemore Hospital has introduced the new measures following the deaths of two patients on Wednesday - a woman who tested positive for swine flu and a man suspected of having the virus.

Seven other confirmed swine flu patients are also in the hospital.

Counties Manukau District Health Board said on Friday there would be no more than two visitors per patient in wards, and only one visitor per patient in the emergency department. The restrictions also applied to the Manukau Surgical Centre.

The board's chief medical officer Don Mackie said the hospital brought in the restrictions to reduce the risk patient exposure to the flu.

"Our patients, who are in hospital with other diseases of one kind or another, don't need to catch the flu as well.

"The secondary thing is trying to keep a lid on exposure for our staff. If our staff start going off with the flu, we've got a problem.tvnz.co.nz...

[edit on 10-7-2009 by wizardwars]

The number of quarantined prisoners at San Quentin has ballooned from 800 last week to 2,100 over the weekend. That is nearly half the prison's total population of 5,200 men.

That's according to Luis Patino, the communications director for health services receiver for the California state prisons.

"We're assessing the situation continuously," said Patino, "This is a rapidly changing situation and we'll have updates as time goes by."

Patino told us the quarantine had expanded because additional prisoners beyond the solo quarantined block have fallen ill, although they haven't yet been confirmed as having H1N1. Of the prisoners who've fallen ill, 35 are suspected and four are probable. The prison is still awaiting final confirmation on the four probables.

The quarantine includes all prisoners that are found in an area of suspected flu. The men that are healthy will be confined to their cells and the sick individuals will be isolated. No visitors will be allowed during the quarantine.

BUENOS AIRES, Argentina (AP) — Millions of Argentines stayed home from work, churches in Bolivia canceled Mass and Ecuador announced its first fatalities from swine flu on Friday, as the virus continues its spread during the South American winter season.

Businesses including banks, exchange houses, courts and even the stock exchange were shuttered for 24 hours across Argentina. Combined with Thursday's Independence Day holiday, Argentines effectively got a four-day weekend during which many stayed home and avoided contact with strangers.

President Cristina Fernandez decreed a day off for federal public employees, and a number of regional governments also observed the break — including Buenos Aires province, home to nearly two-fifths of the country's population.

The goal was to "avoid public gatherings," provincial Health Minister Claudio Zin said, and lessen the person-to-person spread of the virus blamed for 86 deaths so far in the country. At least 2,677 cases of swine flu have been confirmed.

The government has already doubled the winter vacation to a month for schools, sent pregnant women and other vulnerable workers home for 15 days and urged people to avoid crowds whenever possible.

But not everyone agrees on what measures are necessary.

Some cities shut all cinemas, others halted all public events and at least one ordered restaurants to leave a 3-yard (2.5-meter) space between tables. The government has not banned all large gatherings, saying such a drastic measure is not necessary.

Argentina has more confirmed swine flu deaths than any nation on the continent and trails only the U.S. and Mexico worldwide.

The virus has been found across South America, however, and neighboring Chile has reported far more cases of people sickened: more than 9,000 cases.

Ecuador became the latest to confirm fatalities from swine flu within its borders on Friday, with Health Minister Caroline Chang saying the virus was found in a 28-year-old woman and a 30-year-old man, both of whom died this week in the Andean nation's highlands.

The Bolivian Roman Catholic Church, meanwhile, canceled all non-Sunday Masses.

In the eastern city of Santa Cruz, home to more than two-thirds of the country's swine flu caseload, the diocese recommended that worshippers avoid church altogether and instead tune in to radio and TV broadcasts of Mass.

Bolivian authorities have suspended a number of public events including concerts by Puerto Rican reggaeton star Daddy Yankee planned for three cities. The government also approved a second extension of students' winter holiday, until July 20.

Peru, which on Friday announced the country's fourth fatality from the virus — a 27-year-old woman — has said that winter break for students will start a week early, because of fears that schools could serve as an incubator for the disease. The country has 1,580 confirmed swine flu cases.

In Uruguay on Friday, health officials confirmed nine fatalities from swine flu.