[CanadaSue]

Time to wait for the weekly reports & post them as they come in. The first is from the principle European monitering agency - they cover close to 450 million in population & a good range of countries. Their URL:

http://dev.eiss.org/cgi-files/bulletin_v2.cgi?display=1&code=129&bulletin=129

Significant news from there...

Flu levels are still at or below baseline although slowly, more countries are reporting lab confirmed cases. 5.3% of tested samples are positive for flu - note that few are tested or tested as far as to see the exact strain. Of 38 positives, 7 were B strain & 31 were A strain. 11 of the A samples were subtypes & of those, 5 were H1, 3 were H3 & the rest were H3N1.

Interestingly, a drift varuiant of A/Wellington has cropped up in Switzerland. It's known as A/Shangtou/1219/2004. EISS had this short statement about it:

***The influenza A/Shantou/1219/04-like virus reported by the Swiss network is a drift variant relative to the A/Wellington/1/04 strain, but closely antigenically related. After consulting the WHO Collaborating Centre in London, it was decided that at present too few isolates have been characterized this season to conclude that the A/Shantou/1219/04-like virus represents a major drift variant. Until further notice, these virus strains will be defined as Wellington-like by the EISS network. Regarding the 2004/2005 season vaccine, based on the evidence available so far, antibodies induced against the A/Wyoming/3/03 vaccine strain are expected to protect against infection with the A/Wellington/1/04- and A/Shantou/1219/04-like viruses.***

RSV reports are ramping up too.

I have found another European network which covers a few more countres but so far, all I can access are their maps. It may be subscription - I'll check. TILL looking for something reliable out of Russia.

[booger]

http://www.gazetteonline.com/article.aspx?art_id=93821&cat_id=1

Iowa sees season's first flu case

By Cindy Hadish
The Gazette
Friday, December 10, 2004, 12:20:47 PM

The state's first flu case of the season has been confirmed in a child from Eastern Iowa, the Iowa Department of Public Health announced Friday.

University Hygienic Laboratory, at the University of Iowa's Oakdale campus, determined the strain is influenza A (H3N2), one of the many types of influenza covered by this year 3/8s vaccine.

Iowa is sticking to flu vaccine guidelines issued by the U.S. Centers for Disease Control and Prevention.

Only people in high-risk categories have been offered the injectable vaccine, though the nasal vaccine, FluMist, is available for healthy people ages 5 through 49.

High risk categories include adults 65 and older; children 6 to 23 months old; people with chronic medical conditions; pregnant women, nursing home residents; health-care workers with direct patient care; children on chronic aspirin therapy and caregivers of infants younger than 6 months old.

For more on this story, see Saturday's Gazette.

[booger]

(Hope you don't mind me posting today's flu stories here, CSue. I figured it's probably an easier read than 20 separate threads. Holler if I'm wrong. :) )

http://www.lenconnect.com/articles/2004/12/10/news/news02.txt

Flu shot restrictions removed

By Dennis Pelham

Daily Telegram Staff Writer

ADRIAN: Flu shots are being offered again to people who do not meet criteria for priority groups identified by health agencies during this fall's vaccine shortage.

A state order limiting who could legally be given flu vaccine was lifted Thursday by Michigan Department of Community Health Director Janet Olszewski. The Lenawee County Health Department announced Thursday that its remaining vaccine supply will be available to anyone who calls to schedule an appointment at several clinics being held this month.


"The most important thing is to make use of the vaccine that we have remaining," said Lenawee County Health Officer Michael Kight.

"We've got quite a bit of vaccine and we're getting into the flu season. We want to make sure it's used," he said.

Kight obtained an additional 1,600 doses of vaccine from several other county health departments several weeks ago, doubling the supply his agency ordered for this fall before the national shortage developed in early October.

There are 1,175 doses of vaccine left at the health department, he said, and 350 people are scheduled so far to receive shots at a clinic next week. Appointments are still being taken for that clinic and for two additional clinic days this month, he said.

A waiting list of more than 2,000 people was compiled from a telephone recording system at the health department during October and November.

Health department officials have not been able to contact everyone who called and left their names for the waiting list, Kight said.

Anyone who is on the waiting list and has not yet been contacted by the health department should call the agency at 264-5226 by 4:30 p.m. on Tuesday to schedule a clinic appointment, Kight said.

Priority is still being given to those who meet high-risk criteria that includes children 6 months to 2 years of age, adults 65 and older, women who will be pregnant during the flu season, anyone with chronic health conditions, residents of nursing homes and long-term care facilities, health care workers with direct patient contact and care givers who have contact with children younger than 6 months.

Lenawee County health officials said they are also now encouraging shots for anyone older than 50, those living with someone who has a chronic disease and groups of professionals that include teachers, police officers and firefighters.

Appointments will also be scheduled for others so long as the health department's supply of vaccine lasts, Kight said.

Flu shots were restricted to high priority groups since Oct. 14 following announcement that nearly half the country's supply of flu vaccine was lost due to contamination at a Chiron Corp. plant in England. Michigan's available supplies were increased several weeks ago, leading to the order being lifted Thursday.

Kight noted it is important to use the remaining supplies of vaccine before the flu season reaches a peak in January and February. Eight cases of influenza have so far been confirmed in Michigan.

[booger]

http://www.contracostatimes.com/mld/cctimes/living/health/10386326.htm?1c

Posted on Fri, Dec. 10, 2004

Now there's a surplus of flu vaccine

By Sandy Kleffman

CONTRA COSTA TIMES

It seemed unthinkable just a few weeks ago, but California now has so much flu vaccine that some health care officials worry it may actually go to waste.

As a result, state officials are considering revising rules on who can get the shots.

Contra Costa County has 5,000 doses left over from its flu clinics last week, and some grocery stores and retailers that previously canceled clinics are once again offering vaccinations.

"The demand curve is down and the supply is picking up," said Dr. Anthony Iton, Alameda County health officer.

Kaiser Permanente still has 200,000 doses available for its Northern California members. In the past two weeks, only a handful of people got shots.

"We have really made efforts to make sure our high-risk people come in," said Dr. Randy Bergen, pediatric infectious disease specialist at Kaiser Walnut Creek.

Iton and others have talked to state officials about easing restrictions to allow more people to get vaccinated.

"What we don't want to end up with is flu vaccine that gets wasted this year," Iton said. "That could be tragic.

"This is almost like a retailer trying to get rid of the Christmas merchandise in a timely fashion."

State officials are analyzing vaccine supply and demand and will decide soon whether to ease restrictions, said state health department spokesman Ken August.

In some ways, the situation illustrates the success of the nation's rationing program.

As federal officials sought to distribute vaccine to areas where it is most needed, those who weren't in high-priority groups abandoned plans to get injections.

Some regions now appear to have surpluses because even many of the high-risk people refrained from getting immunized.

The nation has nearly 100 million high-risk people and about 61 million doses of flu vaccine to distribute this year, Iton noted. During a typical year, only about 35 percent to 45 percent of high-risk people get the shots.

Some are forgoing shots for altruistic reasons, deciding that because they are healthy, they can leave vaccine for those who are older or more frail, said Francie Wise, Contra Costa's communicable disease chief.

Others may have lost interest because of the slow start to this year's flu season or the long lines and hassles at early flu clinics.

Health care providers are now rushing to distribute vaccine because more is on the way.

Aventis Pasteur plans to ship additional doses through January. Federal officials also announced this week that they have agreed to allow GlaxoSmithKline to import up to 4 million doses of foreign vaccine.

Health care experts are in a race against time to deliver the shots before it is too late. It takes 10 to 14 days for people to develop immunity after the vaccination.

Thus far, this flu season is off to a much slower start than last year.

New York now has regional flu activity with outbreaks in less than half of the state.

Washington and Minnesota each have an outbreak in a single region, while 35 states, including California, report only sporadic flu activity. Other states have none at all.

Health care experts caution that it is still too early to declare this a mild season. In some years, flu activity doesn't peak until February.

The national Centers for Disease Control and Prevention is not considering revising its high-risk categories, which include people over age 65, nursing home residents, those with chronic medical conditions, health care workers with direct patient contact, and children age 6 to 23 months.

But the CDC has told doctors with excess vaccine that they could consider loosening the categories and giving it to people age 50 or older, for example, or those who live with high-risk people, said spokeswoman Bonnie Hebert.

Contra Costa County had adopted even tighter restrictions than the CDC, but has since loosened its criteria to conform with state and federal guidelines.

"Certainly we don't want to be here with a lot of vaccine left over and people wanting it and not getting it," Wise said.

Kaiser will abide by whatever state officials decide, Bergen said.

"We would be hopeful that the state would (loosen restrictions) so that we can open it up to some of the moderate-risk categories and use our vaccine."

[CanadaSue]

Personally I find it easier to track one thread. I often forget which I've resd or responded to when they're scattered - lol.

I figured that would happen with shots. 'Traditionally' flu picks up right after the Xmas holidays & peaks in early February - 9 of the last 20 or so years it happened that way. Last year was oddball because A/Fujian was new, hit mostly kids & they don't generally prectice flu avoidance behaviours as much as we'd like to think they do. They're in day care, school, other relatively crowded situations...

I have an article bookmarked from a few days ago where the toll of flu, (I think specifically A/Fujian), on some Canadian kids is detailed. Makes for provocative reading & helped me understand why they're reccomending kids over 6 months get the vax. I'm not on my computer so that one will have to wait unless I can find a way to access that papers' archives.

In the meantime, more reporting agencies should be coming out with wekly numbers...

[booger]

Thanks, Sue. :)

Lots of little reports about first confirmed cases in several states but no particular flavors mentioned other than the H3N2 noted above. Also a lot of states are loosening the eligibility requirements for getting the vaccine now, or are least talking about it.

[booger]

http://www.gulf-daily-news.com/Story.asp?Article=98475&Sn=BNEW&IssueID=27265

Vol XXVII NO. 265 Friday 10 December 2004

Experts play down increase in colds

By ROBERT SMITH

PEOPLE are being told not to worry following a sharp increase in the number of patients in Bahrain suffering from the common cold.

Experts say it is normal at this time of year and blamed a rapid drop in temperatures, which has encouraged the spread of viruses that thrive in colder climates.

There are no official records of the number of people reporting to health centres with cold symptoms.

However, doctors are reporting a significant increase in the number of cases.

"We know how many people are coming to health centres, but we don't keep records of how many are suffering from a particular illness," said Health Ministry head of health education Dr Amal Al Jowder.

"But we know that a lot of people are catching colds - you hear it from doctors, friends and people in the community."

People are said to be more susceptible at this time of year because of the rapid change in climate.

However, Dr Al Jowder said it was possible for people to prevent themselves catching a cold in the first place.

She urged people to avoid exposing themselves to sharp changes in body temperature and encouraged them to take steps to increase their immunisation levels.

"For example, if you take a shower, don't go outside straight away," said Dr Al Jowder.

"But the most important thing is to raise your immunity.

"How do you do this? First of all, you should eat a balanced diet with lots of vitamins, fruit and vegetables.

"You should also try to reduce stress. There is a relationship between stress and immunity.

"If you don't manage the stress factor in your life - by resting and getting enough sleep - then your levels of immunity will drop a little and you are more prone to infection.

"You should also maintain your personal hygiene - if you shake hands with someone with a cold don't touch your nose or mouth."

Once somebody catches a cold, the symptoms can be seen within a matter of hours due to the short incubation period.

Smokers are said to be more prone to infection because tobacco irritates the throat.

However, it could take up to a week for the symptoms to pass - with or without medication. "It is not the first time in Bahrain that we have seen this," said Dr Al Jowder.

"At this time of year we do see more cases, but the reassuring thing is that it is a viral illness.

"With or without treatment, it will go by itself.

"If it does develop into a bacterial infection, the doctors will prescribe antibiotics."

Meanwhile, the Health Ministry has been offering flu vaccinations to high-risk patients - such as those with chronic chest or heart problems - since October.

They are also available to Haj pilgrims aged 65 and above, who are due to set off on the annual Mecca pilgrimage next month.

"There is a little bit of an overload on doctors and nurses at this time of year," admitted Health Ministry disease control section chief Dr Muna Al Musawi.

"We are seeing lots of people with colds, but not the flu."

[CanadaSue]

it's necessary to make a statement about 'common colds'? It may be citizens of Bahrain are simply more concerned this year. Good catch.

[CanadaSue]

http://www.phac-aspc.gc.ca/fluwatch/04-05/w49_04/index.html


So far, so good here too. This week the national Microbiology lab has identified 63 A/Fujian speciems & 2 B/Shanghai. British Columbia, Manitoba & Ontario are seeing localized outbreaks, (including near me), while most other provinces are seeing little or no flu yet. Bear in mind out population is 1/10 of yours so that may be a factor in some of the geographically large provinces which are sparsely populated. We've had 18 outbreaks this year. The interesting point there is that 12 of them have been in Long Term Care Facilities/Retirement Homes, 3 in HOSPITALS & 3 in schools. Places where there already young, sick, weak etc. are the first to see outbreaks. The workplace college ones happen later in the season. But THOSE are the places that act as canaries in a flu mine - any group seeing. That's also where more than 1 strain tends to circulate at once & where reassortment is statistically more likely to happen.

Since October 9th - THREE kids have been hopitalized due to flu - probably A/Fujian & that ties in with that blasted news article from last year I'm still trying to find... I will & comment on it this evening. We're doing the same thing CDC is doing - tacking kids this year for admissions due to flu & complications. Awfully early for three kids as the season is off to such a light start.

Booger posted the latest news on flu in the US & interestingly, the same number US children had to be hospitalized yet. They moniter the 0 - 4 age group for that. None have died.

The death rate for pneumonia due to flu so far, is below epidemic threshold levels at 5.9% of ALL deaths. Epidemic threashold is considered for the week last characterized as 7.5%

Only about 2.5% of our flu tests are coming back positive, a very slight increase over last week.

Now RSV REALLY ramped up here last week & I wonder if your numbers are high too. I'll check with CDC as it may explain a few things... Overall though, we're off to a very 'low normal' start. Nope, CDC mentions they surveil but I haven't found anything on case rates this year.

[CanadaSue]

First, before I 'misplace' the danged thing again, is the URL:

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20041208/HFLU08/TPNational/?query=influenza

Last year Canada began, on a trial basis, to moniter the admissions of kids for flu/complications at 9 hospitals. Once they ironed out any problems with the process they planned to expand on it - which apparently they have done this year. Not sure how many kids' hospitals of childrens' wards are participating this year - I'll pop off an e mail & ask - why not? Understand we don't have that many kids' hospitals or wards but I'm guessing that 9 would represent roughly 10% of potential reporting entities.

The summary from last year was disturbing considering how few such places reported in. 500 kids had to be hospitalized & 3 subsequently died of pneumonia secondary to flu. Extrapolate that out over the country & it might be as high as 5000 - 30. Multiply that by 10 for US population numbers - scary if those numbers hold.

More than half of these kids had NO underlying medical conditions. That, according to the article, challenges the popular conception that healthy kids are not at risk. This is what led - here - to new recommendations that all kids over 5 months be vaxed for flu, save for those who can't take the vax. The hospitalization rate for the very smalls, 2 & under I think is EQUAL to that for the elderly.

Only cases that were lab confirmed for flu were included. Quite a number of others in hospital may also have had it but for whaver reasons, (I'm guesing money), those tests were not always performed. With severe pneumonia, sampling for influenza is hardly a priority yet it's supected that was initially the problem with some of these sick kids who were NOT counted in these data.

The illness was surprisingly bad. 1 in 4 kids developed pneumonia & 1 in 10 had seizures. To the best of my knowledge, A/Fujian was overwhelmingly the strain present last year - I'll confirm that in a bit. Among the known cases, 4 developed encephalitis, 1 meningitis, 1 year old infant went into septic shock & a young teen developed heart failure. Not said whether any of these had pre-existing conditions.

More stats on these 500:


Average length of stay in hospital: 5.2 days

42% required oxygen

12% ended up in ICU

6% needed mechanical ventilation

150 were identified as high risk groups kids who should have been vaxed. Only 22 of them had been

2/3 were aged 2 or under


Okay, that's disturbing. These stats apply to a relatively small number of kids who 'only' contracted a new substrain of a KNOWN human strain of flu, (H3N2). I don't want to THINK what H5N1 or a novel H1N1 might do - either one could cause complete carnage. I tossed in H1N1 because we've seen little of it in recent decades & kids' bodies would treat it as a completely novel strain.

I'm going to be keeping a very close eye on the stats from the very smalls this year. At the 2 clinics I attended & 3 others I passed by, I saw very few of the toddler/preschool age group. Perhaps that needs to change.

These poor little kids consumed a lot of resources - no not being cold here, simply stating fact & we had a LIGHT flu year, just an early cluster with A/Fujain - a nation wide cluster if you will but it only lasted a few weeks. I shudder at the prospect of a worse strain hitting just as quickly nation wide. Nursing really littles is a lot tougher for many reasons. They crash fast & the emotional toll on everyone involved is really hard to cope with. Plus, in an epidemic, we might not have enough of the right sized kit.

Worth thinking about if you have preschoolers & toddlers.