Another new swine flu virus has made the leap to humans, though U.S. officials say it seems almost certain the virus hit a dead end.

The Centers for Disease Control reported Friday that a child from Iowa became infected with a new swine flu virus in September, though the case didn’t come to light until November.

The unnamed boy didn’t need to be hospitalized and recovered fully from the illness.

Testing later showed he’d been infected with a swine influenza virus of the H3N2 subtype, different both from the pandemic H1N1 virus and from the seasonal H3N2 viruses that have been circulating in people for decades.
…
It isn’t clear how the boy became infected with the virus. He had no known contact with pigs, an eerie echo of the emergence last spring of the pandemic H1N1 virus. H1N1 was first spotted in two children from California who had had no contact with pigs or with each other.

Source/Full Story: Yahoo! Canada News

H1N1 influenza kills Native Americans and Alaskan Natives at four times the rate of the rest of the population, making immunizations critical for native people, say national health experts.

“The virus has hit Indian Country especially hard,” said Kathleen Sebelius, U.S. Health and Human Services secretary.

Sebelius joined Dr. Yvette Roubideaux, director of Indian Health Services, and Dr. Ralph Bryan of the Centers for Disease Control and Prevention, in a teleconference Tuesday to introduce HHS’s new public service announcements. The announcements, starring Cherokee actor Wes Studi, focus on promoting H1N1 immunization in Native populations.

Sebelius said more Native Americans die from H1N1 complications because the population has a higher rate of underlying health issues, such as asthma, diabetes and heart disease.

Source/Full Story: rapidcityjournal.com

About 22 million Americans have become ill with pandemic H1N1 influenza in the past six months and 3,900 have died, according to new estimates by the Centers for Disease Control and Prevention.

The number of pediatric deaths — about 540 — is four times as high as the number that physicians, hospitals and health departments had reported to the public health agency in Atlanta.

The new estimates, drawn from detailed surveillance and record-checking in 10 states, sketch the most detailed picture by far of the national toll from the new flu strain that emerged in California and Mexico in April.

“We feel we’re finally able to update the public on how big a toll this virus is having so far,” Anne Schuchat, a CDC physician helping to run the federal government’s pandemic response, said Thursday. “I am expecting all these numbers, unfortunately, to continue to rise.”

The total number of people who have been hospitalized is 98,000, with 36,000 of them age 17 and younger. The vast majority of deaths — about 2,920 — have been in people age 18 to 64.

In an average flu season, the seasonal virus contributes to the deaths of about 36,000 people — 90 percent of whom are 65 or older. Many are close to death, with flu being only one factor leading to their demise. That is not the case with H1N1’s victims, most of whom are much younger, and about 20 to 30 percent of whom were healthy before contracting the virus.

Source/Full Story: washingtonpost.com
Technorati Tags: H1N1

Lone Simonsen is Research Professor and Research Director in the Department of Global Health.

COHEN: Well, it’s an interesting question, though. Would you be against mandating?

SIMONSEN: Well, I think this is very interesting because, I mean, especially for the health-care worker example. I mean, there are many, many good reasons why health care workers should be considering immunization for their own safety but also to protect and, first, do no harm to the patients that they are treating. Having said that, does it work to mandate?

I think what would work better would be to say that there was a shortage and people tend to buy more of something that’s in demand. (Laughter.) We saw that — there was one season where, really, people lined up all night to get a flu shot.

COHEN: Right.

SIMONSEN: And I mean —

COHEN: Well, there is shortage.

SIMONSEN: No, actually, because we thought we were going to need two doses for every adult and since we are – only one dose, so, actually, we have twice as many doses and enough for the whole population at this point, I understand.

Source/Full Story:: Session I of a Council On Foreign Relations Symposium on Pandemic Influenza: Science, Economics and Foreign Policy – Council on Foreign Relations

President Obama has declared a national emergency to deal with the “rapid increase in illness” from the H1N1 influenza virus.

“The 2009 H1N1 pandemic continues to evolve. The rates of illness continue to rise rapidly within many communities across the nation, and the potential exists for the pandemic to overburden health care resources in some localities,” Obama said in a statement.

“Thus, in recognition of the continuing progression of the pandemic, and in further preparation as a nation, we are taking additional steps to facilitate our response.”

The president signed the declaration late Friday and announced it Saturday.

Calling the emergency declaration “an important tool in our kit going forward,” one administration official called Obama’s action a “proactive measure that’s not in response to any new development.”

Another administration official said the move is “not tied to the current case count” and “gives the federal government more power to help states” by lifting bureaucratic requirements — both in treating patients and moving equipment to where it’s most needed.

Source/Full Story:  CNN.com

Three state public health laboratories perform antiviral resistance testing and report their results to CDC. An additional two oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified by these laboratories, bringing the total number to nine.

The above comments from the latest CDC update (week 34) describe two more cases of oseltamivir resistance in states that do their own antiviral resistance (CA, NY, WI). WI’s week 34 report had no resistance in swine H1N1 and NY has not updated its site since the end of seasonal flu reporting in April, so it is likely that the two new cases are from California. California has already reported resistance in an H1N1 hospitalized case in northern California, and the CDC has not identified a Tamiflu linkage, raising concerns that the H1N1 in this case is evolutionarily fit. Moreover, the first evolutionarily fit pandemic H1N1 identified in Hong Kong was from a traveler from San Francisco, increasing concerns that evolutionarily fit H1N1 with H274Y is circulating in northern California. The latest two cases are also likely form California, and although the week 34 report indicated these new cases had a Tamiflu linkage, the relationship between the collection date of the H274Y positive samples and the start of Tamiflu treatment remains unclear.

These nine cases in the US are in addition to three cases in Japan, three in Hong Kong and at least one each from Denmark, Canada, Thailand, China, and Singapore. Thus, 20 cases have been made public, including at least two were evolutionarily fit.

Source/Full Story @: recombinomics.com
Technorati Tags: oseltamivir, Tamiflu, H1N1

by Michel Chossudovsky
Global Research, September 4, 2009

 

Iowa public health officials have acknowledged the existence of a blank template entitled FACILITY QUARANTINE ORDER in the case of a Novel Influenza A H1N1 pandemic. The official press release states, however, that there is no draft or text of  a “Quarantine Order” by the Iowa Department of Public Health. 
Reported by the Iowa Independent:

“A quarantine template created by the Iowa Department of Public Health and accessible through the Centers for Disease Control Web site should not be of great concern, according to a press release from health department officials. ‘IDPH wants to make it clear that Iowa has not issued any isolation and quarantine orders for novel influenza A (H1N1), and has no plans to issue any this fall,’ officials wrote in the press release. See Health officials: Iowa quarantine document not cause for concern, Iowa Independent, Sept 1, 2009‎

The IDPH suggests in this regard that the drafting of public health templates is a routine undertaking, while also confirming that “in preparation for public health emergencies,” …“isolation and quarantine orders are only very rarely used in very specific situations.” (emphasis added). 
The last statement of the IDPH is notoriously ambiguous: If indeed isolation and quarantine orders are rarely used, why then was a template prepared which explicitly contemplates an ORDER pertaining to a QUARANTINE FACILITY? Moreover, the template was issued on May 1st, at the very outset of the H1N1 swine flu crisis in Mexico, barely two days after the WHO declared a level 5 pandemic advisory on April 29th. 
Are we playing on words?
The template already contains the essential features of a formal QUARANTINE ORDER, which suggests that quarantine procedures are contemplated within the Iowa Department of Public Health. The result of these procedures have led to the formulation of the blank template. 
The issue, therefore, is not whether a quarantine order has been activated. The issue is
1) the State of Iowa has contemplated a policy of “forced confinement”,
2) at some future date, in the next few months, the blank template entitled FACILITY QUARANTINE ORDER could be activated with a view to actually implementing the quarantine precedures.  

Also of significance is the fact that this template entitled FACILITY QUARANTINE ORDER has been endorsed by the Atlanta based Center for Disease Control (CDC), which has published the document on its website.The CDC is the main federal agency responsible for H1N1 pandemic preparedness in coordination with other governmental agencies including FEMA, Homeland Security, State and municipal governments, as well as in liaison with the WHO.    

There are two quarantine documents on the CDC’s website. The first refers to HOME QUARANTINE ORDER, the second to FACILITY QUARANTINE ORDER. (pdf) 
Click to access the CDC page, which identifies both templates as CDC reference documents. Media reports pointed to “rumors swirling after a quarantine form was found by someone on the internet…” (See report on kimt.com, September 1, 2009)
We are not dealing with rumors. The FACILITY QUARANTINE ORDER document posted on the website of the CDC, a federal government agency, envisages quite explicitly “forced confinement” in the case of the H1N1 swine flu: 

“The Department has determined that it is necessary to quarantine your movement to a specific facility to prevent further spread of this disease. The Department has determined that quarantine in your home and other less restrictive alternatives are not acceptable because [insert the reason home quarantine is not acceptable, the person violated a previously issued home quarantine order, the person does not have an appropriate home setting conducive to home quarantine, etc.] The Department is therefore ordering you to comply with the following provisions during the entire period of quarantine:

1. Terms of confinement. You are ordered to remain at the quarantine facility, _____________________ [insert name and address of facility], from ___________ to ____________ [insert dates of quarantine].

….

4. Legal authority. This order is issued pursuant to the legal authority contained at Iowa Code chapters 135, 139A and 641 Iowa Administrative Code chapter 1, a copy of which is labeled Attachment B and is attached to this order for your review. The Department shall comply with the principles for quarantine contained in subrule 1.9(3) of this attachment when issuing and implementing this order.

5. Ensuring compliance. In order to ensure that you strictly comply with this Quarantine Order the Department or persons authorized by the Department may regularly inspect the quarantine facility.

6. Violations of order. If you fail to comply with this Quarantine Order you may be ordered to be quarantined in a more restrictive facility. In addition, failure to comply with this order is a simple misdemeanor for which you may be arrested, fined, and imprisoned.”

This is an official document of the Iowa State government, which has also been endorsed by the Centre for Disease Control (CDC). If it were a preliminary or internal draft, it would not have been published by the CDC. The question is whether similar quarantine procedures are being replicated in other states across America.  

---

The full text of the controversial Iowa Template is indicated below: To access the pdf version of the Template on the CDC website, click FACILITY QUARANTINE ORDER

BEFORE THE IOWA DEPARTMENT OF PUBLIC HEALTH

DIRECTED TO: [insert full name and address of subject of order]

[insert case #]

FACILITY QUARANTINE ORDER

The Iowa Department of Public Health (Department) has determined that you have had contact with a person with Novel Influenza A H1N1. Novel Influenza A H1N1 is a disease which is spread from person to person and is associated with fever (greater than 100.0 F), cough, sore throat, rhinorrhea (runny nose), nasal congestion, body aches, headache, chills and fatigue. Novel Influenza A H1N1 presents a risk of serious harm to public health and if it spreads in the community severe public health consequences may result.

The Department has determined that it is necessary to quarantine your movement to a specific facility to prevent further spread of this disease. The Department has determined that quarantine in your home and other less restrictive alternatives are not acceptable because [insert the reason home quarantine is not acceptable, the person violated a previously issued home quarantine order, the person does not have an appropriate home setting conducive to home quarantine, etc.] The Department is therefore ordering you to comply with the following provisions during the entire period of quarantine:

1. Terms of confinement. You are ordered to remain at the quarantine facility, _____________________ [insert name and address of facility], from ___________ to ____________ [insert dates of quarantine].

2. Requirements during confinement. During the period of quarantine:

a. You must not leave the quarantine facility at any time unless you have received prior written authorization from the Department to do so.
b. You must not come into contact with anyone except the following persons:
(i) other persons who are also under similar quarantine order at the quarantine facility;
(ii) authorized healthcare providers and other staff at the quarantine facility;
(iii) authorized Department staff or other persons acting on behalf of the Department; and
(iv) such other persons as are authorized by the Department.
c. Your daily needs, including food, shelter, and medical care, will be provided for you during the period of quarantine at the quarantine facility. You should bring clothing, toiletries, and other personal items with you to the quarantine facility. You will have limited access to a telephone at the quarantine facility. You may bring your cell phone with you should you desire to have greater access to a means of communication.
d. You should inform your employer that you are under quarantine order and are not authorized to physically come to the work place, although you may work from the facility via electronic or other means if appropriate. You should be aware that Iowa law prohibits an employer from firing, demoting, or otherwise discriminating against an employee due to the compliance of an employee with a quarantine order issued by the Department. (Iowa Code Section 139A.13A)

3. Information about Novel Influenza A H1N1. You should review the information contained at Attachment A for information about Novel Influenza A H1N1. You should refer to information provided at the quarantine facility to address specific concerns and questions you have about Novel Influenza A H1N1. In order to find out more information about Novel Influenza A H1N1 and its symptoms and spread, you may also access the Department’s web-page at www.idph.state.ia.us. If you do not have access to the internet from the quarantine facility, you may contact the Department at 1-800-362-2736.

4. Legal authority. This order is issued pursuant to the legal authority contained at Iowa Code chapters 135, 139A and 641 Iowa Administrative Code chapter 1, a copy of which is labeled Attachment B and is attached to this order for your review. The Department shall comply with the principles for quarantine contained in subrule 1.9(3) of this attachment when issuing and implementing this order.

5. Ensuring compliance. In order to ensure that you strictly comply with this Quarantine Order the Department or persons authorized by the Department may regularly inspect the quarantine facility.

6. Violations of order. If you fail to comply with this Quarantine Order you may be ordered to be quarantined in a more restrictive facility. In addition, failure to comply with this order is a simple misdemeanor for which you may be arrested, fined, and imprisoned.

7. Your rights B appeal rights. While under quarantine you have the rights as described in subrule 1.9(8) of Attachment B. In addition, you have the right to appeal this order pursuant to subrule 1.9(7) of Attachment B.

(signed & dated)
DIRECTOR or MEDICAL DIRECTOR
IOWA DEPARTMENT OF PUBLIC HEALTH
Lucas State Office Building
Des Moines, IA 50319

Attachments to this Order:
Attachment A — Facts About Novel Influenza A H1N1
Attachment B — 641 Iowa Administrative Code chapter 1
To access the second document click HOME QUARANTINE ORDER

Some 2,000 students at Washington State University have reported symptoms of H1N1 flu, university officials said, in one of the largest reported outbreaks of the virus on a US college campus.

Washington state’s Whitman County, where the school is located said that tests at a state laboratory late last week “confirmed that the influenza outbreak at Washington State University (WSU)… is indeed caused by the novel 2009 H1N1 Influenza A.”

The west-coast school last week instituted a blog to help provide information to students about the sudden and dramatic spread of the A(H1N1) virus on campus just days into the new school term.

“We estimate that we have been in contact with about 2,000 students with influenza-like illness in the first 10 days of our fall semester,” the latest online posting said. “At this time of year, we would typically only see a handful of patients with influenza-like illness. Health care providers in the local community have also seen WSU students with influenza-like illness, but we have no way of knowing how many.

“We also have no way of estimating how many students are self-caring at home without contacting us,” school officials said.

Source/Full Story: channelnewsasia.com

Doctors are reporting a severe form of swine flu that goes straight to the lungs, causing severe illness in otherwise healthy young people and requiring expensive hospital treatment, the World Health Organization said on Friday.

Some countries are reporting that as many as 15 percent of patients infected with the new H1N1 pandemic virus need hospital care, further straining already overburdened healthcare systems, WHO said in an update on the pandemic.

“During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services,” it said.

“Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.”

Earlier, WHO reported that H1N1 had reached epidemic levels in Japan, signaling an early start to what may be a long influenza season this year, and that it was also worsening in tropical regions.

“Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections,” WHO said.

“In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.”

Source/Full Story: Yahoo! News

Healthy people who catch swine flu need not be given Tamiflu, the World Health Organisation (WHO) has announced. The advice appears to contradict the UK’s policy of making the antiviral drug readily available to those who call the national pandemic helpline or approach their GPs.

Hundreds of thousands of doses have been given to British patients although the majority have not been severely ill. Fears have been voiced that mass use of Tamiflu will make the virus resistant to it.

The latest advice from the WHO said: “Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.”

Previously the WHO had said antivirals should be given to patients with “serious progressive illness”. The new guidance is the first time it has specifically advised against otherwise healthy individuals being given the drug.

The recommendation is based on the conclusion of an international panel of experts that includes representatives from the UK. The advice added that Tamiflu, also called oseltamivir, and the similar drug Relenza, also called zanamivir, should be given quickly to seriously ill or deteriorating patients.

The WHO guidance said at-risk groups should receive the drugs. “For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir.

“These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests. As pregnant women are included among groups at increased risk, WHO recommends that they receive antiviral treatment as soon as possible after symptom onset.”

Source/Full Story: guardian.co.uk

The government rejected advice from its expert advisers on swine flu, who said there was no need for the widespread use of Tamiflu and suggested that the public should simply be told to take paracetamol.

An independent panel set up by the Department of Health warned ministers that plans to make the stockpiled drug widely available could do more harm than good, by helping the flu virus to develop resistance to the drug.

But ministers pressed ahead with a policy of mass prescription, fearing the public would not tolerate being told that the millions of doses of Tamiflu held by the state could not be used during a pandemic, one of the committee members has told the Guardian.

“It was felt … it would simply be unacceptable to the UK population to tell them we had a huge stockpile of drugs but they were not going to be made available,” Professor Robert Dingwall, a member of the Committee on Ethical Aspects of Pandemic Influenza, said.

Today one of the country’s foremost flu experts called for the national helpline to be shut down to stop hundreds of thousands of doses of Tamiflu going out in an unregulated way, which could render it useless when a more dominant strain returns in the autumn.

Source/Full Story: The Guardian

Grab it at Wikileaks

Limited distribution report on pandemic vaccines was prepared for the WHO in early 2009, shortly before the emergence of swine flu. It details tough problems that most of the world’s governments face in acquiring adequate supplies of pandemic flu vaccines, as well as the problems caused by the patent claims of huge corporations.

Possibly because of the frank presentation and potential controversy, the WHO designated the paper “Limited Distribution”, meaning it has only been available to select government officials in paper form. This scanned version makes the paper available electronically and to the general public for the first time.

This is an intergovernmental organization document with no “primary country” of origin. India has been selected as the WHO Regional Office that published the paper is based there.

The full scanned PDF may be downloaded from the “download” link.

A text version (suitable for copy and paste) appears at the end of this page.

Ten percent of the freshman class at the U.S. Coast Guard Academy has swine flu, and that number could rise in the coming days as more test results come in.

”We were expecting to see the number go up before it came back down because we had a lot of tests out still,” Petty Officer Ryan Doss, an academy spokesman, said Monday. “The flipside is that the number of people coming into the clinic feeling symptomatic has gone down. We hope it’s an indication that this is going to keep declining, but we’re going to stay prepared for anything.”

By last Friday, there were eight confirmed cases of swine flu, also called novel H1N1 influenza, with 22 more on Sunday, three early Monday and four more Monday afternoon. The total, 37, consists of 31 out of a class of 285 “swabs,” the newest students at the school currently taking part in a mandatory summer session, four cadets who were training them and two clinic staff members.

The academy submitted five more samples to the Centers for Disease Control and Prevention for testing Monday. Thirteen tests are pending.

”We’re sending more samples in for testing than we originally did because we’ve seen cases of H1N1 that are not as severe,” Doss said. “People are not showing all the symptoms that medical staffs have seen throughout the country.”

Source/Full Story: TheDay.com

Neurologic complications, including seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders, have been described previously in association with respiratory tract infection with seasonal influenza A or B viruses (1–2), but not with novel influenza A (H1N1) virus. On May 28, 2009, the Dallas County Department of Health and Human Services (DCHHS) notified CDC of four children with neurologic complications associated with novel influenza A (H1N1) virus infection admitted to hospitals in Dallas County, Texas, during May 18–28. This report summarizes the clinical characteristics of those four cases. Patients were aged 7–17 years and were admitted with signs of influenza-like illness (ILI) and seizures or altered mental status. Three of the four patients had abnormal electroencephalograms (EEGs). In all four patients, novel influenza A (H1N1) viral RNA was detected in nasopharyngeal specimens but not in cerebrospinal fluid (CSF). Antiviral therapy included oseltamivir (four patients) and rimantadine (three patients). All four patients recovered fully and had no neurologic sequelae at discharge. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus. For children who have ILI accompanied by unexplained seizures or mental status changes, clinicians should consider acute seasonal influenza or novel influenza A (H1N1) virus infection in the differential diagnosis, send respiratory specimens for appropriate diagnostic testing, and promptly initiate empirical antiviral treatment, especially in hospitalized patients.

Source/Full Story:: cdc.gov
Technorati Tags: H1N1, CDC, encephalitis, encephalopathy, Reye syndrome

Sixty-seven cadets at the Air Force Academy have confirmed cases of H1N1 influenza — the so-called swine flu — and another 30 are showing symptoms of the highly contagious virus, the academy said Tuesday.

None of the cadets has required hospitalization.

All 97 are incoming freshmen, known as “Doolies” in academy slang. They are in isolation while the rest of the class of about 1,300 is in outdoor training in the mountains around the Colorado Springs academy.

Academy officials say Air Force medical personnel are treating the cadets, and they hope to have everyone out of isolation before the beginning of classes August 6.

Another 70 showed symptoms of the swine flu but tested negative and have recovered enough to return to training.

Cadets in the class of 2013 arrived at the academy June 25. By July 6, academy medical staff began noticing an increase in cadets complaining of upper respiratory problems. As cadets have begun showing symptoms, they are moved into a separate dormitory away from other cadets.

Laboratory tests are conducted at an Air Force lab in Texas, and results are forwarded to the Centers for Disease Control and Prevention.

The outbreak forced academy officials to modify “Doolie Day Out” on Saturday. Traditionally, it is the first day off for cadets, and they are allowed to leave the academy grounds. This year, cadets stayed on grounds.

Source/Full Story:: CNN.com