Swine flu: From nowhere to pandemic Phase 5 in less than a month
Helen Branswell
1 hour ago
http://www.google.com/hostednews/ca...0C2bUjQ2ilA53Mg


TORONTO — Scientists have been anxiously watching H5N1 avian flu for more than a decade, fearing the virulent virus will take hold in humans and cause a pandemic.

But out of nowhere, a new virus has emerged and rocketed the world to within a hair of the first pandemic since 1968. Some important points on the timeline of H1N1 swine flu.

1998:

An H1N1 swine flu virus containing swine, avian and human genes is recognized in pig populations in North America. This virus will later be recognized as a parent of the new swine flu.

2009:

March 31 - A clinical trial designed to assess the efficacy of a new rapid diagnostic test for influenza finds an untypeable flu virus in a sample from a person from the San Diego area. Public health is alerted and the virus is sent for testing in Wisconsin and later to the U.S. Centers for Disease Control.

April 17 - The CDC informs the World Health Organization it has found a case where an H1N1 swine flu virus infected a person in California. The virus is similar to the triple reassortant but with two swapped genes. Human infection with animal flu viruses signals a pandemic threat and WHO alerts member states.

April 17 - The head of Mexico's national microbiology lab emails Dr. Frank Plummer, head of Canada's national lab in Winnipeg, asking for help figuring out what is behind outbreaks of severe respiratory disease in parts of Mexico. Plummer offers assistance.

April 20 - The Public Health Agency of Canada warns quarantine services to be on the lookout for sick travellers returning from Mexico.

April 21 - The CDC issues an advisory revealing it has found two human swine flu cases in California. The WHO says it is watching.

April 22 - Specimens from Mexico arrive at the Winnipeg lab shortly before lunch. Within 24 hours researchers there realize at least some of the Mexican cases are human infections with the H1N1 swine flu virus.

April 23 - The CDC says they've found seven swine flu infections, in California and Texas.

April 24 - Mexico informs the WHO the Winnipeg lab has confirmed H1N1 swine flu is causing disease in Mexico.

April 26 - Officials in Nova Scotia and British Columbia announce Canada's first swine flu cases.

April 27 - The WHO raises the pandemic alert level to Phase 4 for the first time since the scale was created. Five countries have cases.

April 29 - The WHO raises the pandemic alert level to Phase 5, one away from a pandemic. It says the virus is spreading from person to person in both Mexico and the United States.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

CP Exclusive: WHO says prepping for a bad pandemic has to be considered
2 hours ago
http://www.google.com/hostednews/ca...xZzXVvpgsJvklfg


TORONTO — The world may not know for quite some time how the outbreak of swine flu will play out, the scientist leading the World Health Organization's response to the situation warned Friday.

And given that the future path of the virus is unknowable and the possibilities run the gamut from fizzling out to causing a global outbreak of severe disease and death, preparing is the prudent course of action, Dr. Keiji Fukuda told The Canadian Press in an interview.

By late Friday, at least 592 cases, including 16 deaths, had been reported in 15 countries in North America, Europe, the Middle East and Asia.

Even as the new swine H1N1 virus continues to pop up in more countries and the confirmed case count grows, so too does the criticism that the mild cases of disease seen outside Mexico don't warrant the kind of attention the outbreak is garnering.

But Fukuda defended the WHO's call to arms, saying the world cannot know at this point what this new virus has in store.

"And so if we go ahead and we spend a fair amount of time getting ready and it remains mild and not so many people die or get seriously ill from it, then we are lucky and we should just be happy," Fukuda, the WHO's acting assistant director general of health security and environment, said from Geneva.

"If on the other hand it turns very severe and we have simply stopped preparing and we haven't pushed ahead with the preparations . . . that would really be the worst of all possibilities."

"To have had an opportunity to really do something and then to have lost it and then to have a significant number of people get really sick and to die - that would really be the worst of all possibilities."

Fukuda is an influenza expert and been involved for years in planning to help prepare the world to face the first pandemic since 1968.

For much of that time, the virus he and others feared would be the cause was the worrisome H5N1 avian flu virus. Endemic in poultry flocks in large parts of Asia and Africa, that virus has been known to have infected upwards of 420 people in 15 countries, killing 60 per cent of them.

Deep anxiety about what that virus would do if it acquired the ability to spread easily to and among people has fuelled pandemic preparations around the globe. In many quarters the mantra has been: "Hope for the best but prepare for the worst."

If the swine H1N1 virus does trigger a pandemic and continues to mostly cause mild illness, those in public health who've slaved over pandemic preparedness would feel the first part of that prayer had been answered.

Apart from Mexico's puzzlingly different disease picture, infections seem to be mild. Few hospitalizations have occurred. Most people are recovering without the need for antiviral drugs.

In many ways, this virus is acting like a garden variety flu - and not a very bad one at that. The problem is, there is virtually no way to gauge its future behaviour by its present actions, Fukuda said.

Influenza is notoriously unpredictable. The RNA viruses mutate continuously. Flu dogma is constantly being rewritten. People who've spent years studying the virus marvel at its ability to confound; this out-of-left-field emergence of a swine flu outbreak serves as a perfect example of that.

"It's just amazing how often you are so completely taken by surprise by flu," Fukuda said with wonder in his voice.

So where will it lead? He laid out the options as they currently appear:

-The virus could fizzle out. Though it seems to have no problem transmitting from person to person now, it might lose that ability and melt back into nature.

Should that happen, it might take months or longer for experts to feel confident it is truly gone.

If it died down in the northern hemisphere over the summer months, it might come back in the fall. Or next winter. Or even further down the road. After all, H5N1 first exploded out of nature in 1997, then disappeared for six years. But it roared back with a vengeance in 2003.

"There's no way we can predict it, no way we can know, even if it disappears, that it's not going to reappear later on," Fukuda said. "So it really takes a significant amount of time to know whether that would happen or not."

If the swine H1N1 virus does subside in coming weeks in the northern hemisphere, experts will be watching the southern hemisphere winter very closely to see what happens during flu season there.

-The virus could cause a mild pandemic.

-Or it could trigger a pandemic that starts out causing mild disease, but change over time. Viruses can ratchet up in virulence as they mutate. That's what happened with the 1918 Spanish flu, the worst infectious disease outbreak in known history. Memories of the Spanish flu weigh heavily on the minds of those trying to strike the right course for the response to this virus.

Ironically the Spanish flu was caused by an H1N1 virus, but one that was thought to have jumped from birds to humans. That pandemic had a mild spring wave, disappeared for the summer and returned as a killer in the fall of 1918. It is estimated that upwards of 50 million people died in that pandemic.

Too little is yet known about the dynamics of flu viruses for anyone to be able to predict which of these possibilities is most likely, though given the efficiency of spread to date Fukuda thinks fizzling out is unlikely.

That uncertainty is what is driving the WHO and governments to respond with such aggression to this outbreak.

"We are trying to sound a note that the situation is serious, but there are things that you can do and we ought to do them," Fukuda said.

"We are not trying to present an overblown picture about the dangers or anything. But you know, we are very mindful of the historical patterns in the past and the different effects in different populations and the ability of this virus just to change for reasons we don't understand or in ways that we can't predict."

He said he doesn't worry about the public seeing this as a "crying wolf" situation, should the outbreak fizzle out or cause only a mild pandemic.

"If you explain things in the right way, this situation can be understood," he insisted.

"And so it's really: How do we convey the situation in a way which people can understand there's a lot of uncertainty in it, and there are definitely choices to be made about how we approach things?

"But there are also some very serious considerations that have to be taken into account. And that is one of the things that we are wrestling with to steer the right course for this."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

As experts try to figure out path of swine flu
By Helen Branswell,
Medical Reporter, THE CANADIAN PRESS
http://cnews.canoe.ca/CNEWS/Politic...9348431-cp.html


TORONTO - As the world wonders what the new H1N1 swine flu virus has in store for humankind, attention is shifting to south of the equator.

The Southern Hemisphere is going into its winter, a time best suited to the spread of influenza viruses, leading experts to wonder whether the virus will take off there and what the pattern of illness will be like if it does.

Lots could be learned in the Southern Hemisphere's winter about this newly emerged virus and the impact it will have on global health, Dr. Richard Besser, acting director of the U.S. Centers for Disease Control, said Monday.

"That will tell us a lot about whether the virus is changing, whether it's becoming more severe, and measures we might want to take in the fall," he said from Atlanta during a media teleconference.

It's not just the Southern Hemisphere that bears watching, said Dr. Scott Dowell, director of the CDC's division of global disease detection and emergency response.

"A lot of the disease burden that we're talking about in the off-season for the Northern Hemisphere is happening not just in the Southern Hemisphere, but also in the tropics," said Dowell, who noted the CDC has been helping a number of tropical countries set up and maintain surveillance systems for flu.

If the virus spreads to larger populations in more countries, the disease pattern or patterns - there may be more than one, experts caution - should start to come into focus.

Among the questions that could be answered are how many people become infected when the virus sweeps through an area - something scientists call the attack rate.

Another is whether this new virus will crowd out the current crop of influenza A strains because more people are susceptible to it. It is flu dogma that a pandemic strain should sweep old influenza A subtypes off the board. But flu dogma is rewritten often enough that it's anyone's bet whether or how this new virus will co-exist with older ones.

Scientists also want to know whether the virus remains sensitive to the two main flu drugs, Tamiflu and Relenza, Besser said, as well as whether the virus mutates in ways that could affect attempts to make a vaccine against it.

Answering some of these questions may be a challenge if the illness caused by the virus remains largely mild. While Australia and New Zealand have sophisticated flu surveillance systems, the same cannot be said of large parts of Africa and South America.

Spotting mild flu cases in areas where other illnesses are a more likely cause of fever and flu-like symptoms could be difficult.

"If this new swine flu comes in some countries like Mauritania or Guinea or something, nobody will really see this," said Dr. Ousmane Diop, head of the unit of medical virology at the Institut Pasteur in Dakar, Senegal.

"Because the surveillance is so weak right now ... I think that the majority of the countries, if the disease remains mild, many of these countries won't detect it."

Diop said in Senegal, where flu surveillance has been underway for a number of years, people don't typically see a doctor for mild flu. And if they do, doctors don't generally test for flu, because influenza season - June and July - is also malaria season. Someone with fever would be more likely to get anti malarial medication than be tested for flu, he said.

But that may change this season, he admitted. News coverage of the spread of the swine flu virus may drive people to doctors. And the ministry of health is urging doctors to investigate cases that could be flu, Diop said.

"My opinion is that in the next few weeks, we'll have more and more people that are requesting diagnosis, even if it is mild... because they maybe think that this is the pandemic or something," he said from Dakar.

Joel Montgomery, director of the department of epidemiology at the U.S. Naval Medical Research Center in Lima, Peru, also wondered about the ability to spot this virus in parts of South America.

Montgomery, who is on detail from the CDC, said historically there hasn't been a lot of emphasis put on doing surveillance for influenza in parts of Central and South America.

Brazil does quite a bit of surveillance, he said, as do Argentina and Chile. But beyond that "surveillance is kind of sparse."

Peru monitors for severe acute respiratory illnesses, known as SARIs, but does not do surveillance for influenza-like illnesses, which would pick up milder cases of flu.

"It seems like the vast majority of the (H1N1) cases are more mild," Montgomery noted. "Would we have picked those up in SARI surveillance? Maybe not."

But of course that assessment changes if the virus starts to trigger more severe disease as it evolves over time.

As well, if the experience in Mexico is actually the norm, not the exception, large numbers of cases in the tropics and the southern hemisphere could mean a lot more evidence of severe disease, Dowell said.

He suggested the leading hypothesis as to why Mexico had more severely ill cases is because they had many times more cases than other countries have yet had.

"If you've got a big enough outbreak like Mexico did, you will also have that severe tip of the iceberg," Dowell said. "I think we in Canada and the U.S. don't have enough to see that tip yet. But we'll see."

Dowell suggested the stress should not just be on learning from the tropical and Southern Hemisphere experiences, but helping countries in those parts of the world cope with the illness if the virus continues to spread.

"What can be done about it?" he said. "We may have vaccine, but most of the world won't."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Pandemic primer: The P word means broad spread, not necessarily bad disease
4 hours ago
http://www.google.com/hostednews/ca...RUhlHINNE-WEOHA


TORONTO — After repeated dire warnings of a possible outbreak of H5N1 avian flu and references to the disastrous 1918 Spanish Flu, it may seem like the words "pandemic" and "severe" have to go hand in hand.

That makes the current situation with the H1N1 swine flu virus that much more puzzling - authorities warn the world is poised on the brink of a pandemic, but it doesn't seem like such a big deal, disease-wise.

To help clear up the confusion, let's look at what a pandemic is, and is not.

Definition: The word comes from the Greek words pan (all) and demos (people). While for different diseases the word may be used different ways, when used in reference to influenza it means a global outbreak of disease.

The WHO's definition: The World Health Organization says a flu pandemic is a worldwide epidemic of a disease that occurs when a new influenza virus to which people have little or no immunity starts to spread.

What that means: As pathogens go, flu is pretty contagious. It spreads easily from person to person. If a new flu virus that is unrecognizable to immune systems emerges, it can slip past the body's protective sentries, making a lot of people sick as it passes through an area.

Severity: A pandemic does not have to be severe, but it can be severe. The last pandemic, in 1968, was considered very mild by pandemic terms; about one million people globally died. But in the 1918 Spanish Flu, it is estimated that upwards of 50 million people succumbed to the infection.

Scope: Public health planners aren't just worried about the severity of future pandemics; they are worried about the impact of having a lot of people ill at the same time. They fear the possibility of supply chain disruptions and overtaxed hospitals, among other things.

Quote: "With influenza viruses, if they spread around the world, you will see hundreds of millions of people get infected. You'll see a very large number of people get infected. So if even relatively small percentages of people die or develop serious respiratory disease, spread around the world can mean very large numbers." - Dr. Keiji Fukuda, the WHO's top flu expert.

Follow Canadian Press Medical Writer Helen Branswell's flu update on Twitter at CP-Branswell"."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Developing countries should share first batches of swine flu vaccine: WHO
15 minutes ago
http://www.google.com/hostednews/ca...NRubgB9LXBs0WcQ



TORONTO — Vaccine makers and countries with standing orders for pandemic flu vaccine will be asked to share with developing countries from the moment the first batches are ready if an H1N1 vaccine is made, the World Health Organization said Wednesday.

The Geneva-based agency's director of initiative for vaccine research said the WHO wants to secure "real time production for the benefit of developing countries" if an H1N1 pandemic is declared.

At least some of the production capacity is already locked up. Canada, the United States, the United Kingdom, Iceland, Malta, the Netherlands, Australia, New Zealand, Sweden and others have contracts that guarantee vaccine production for their citizens when a pandemic occurs.

Dr. Marie-Paule Kieny said the WHO is aware of these advance purchase agreements, as they are called, but believes there is remaining capacity within the industry and wants to snag part of it for developing countries before it is snapped up by other, wealthier countries.

"We know . . . most of them at least still have some window of opportunity in their orders," she said during a teleconference from Geneva.

"And we want to make sure that we don't wait until this window has completely closed. And this is why we're taking steps now . . . to try to ensure access for developing countries."

In Canada's case, a long-standing contract with vaccine maker GlaxoSmithKline ensures Canada first dibs when vials of pandemic vaccine start rolling off the production line at GSK's plant at Ste-Foy, Que. The contract guarantees Canada the right to buy enough product to vaccinate all citizens who want to roll up their sleeves, regardless of the number of doses required to protect each individual.

The United States has contracts with four vaccine manufacturers with facilities in the U.S.; in at least one of those contracts, with Sanofi-pasteur, the agreement gives the U.S. first access.

Some countries' contracts stipulate a specified number of doses; others have signalled they have contracts but have not made the details public. As a consequence, it is difficult to determine how much of the production capacity available to make vaccine in the event a pandemic is declared has already been locked up.

"We don't know," Kieny said when asked that question.

She said the heads of all the pharmaceutical companies that make flu vaccine have been invited to a meeting on May 19 where UN Secretary General Ban Ki-moon and WHO Director General Margaret Chan will make a plea for early access for the developing world.

"So this will be a high-level discussion with the manufacturers appealing to corporate responsibility and working together to increase equitable access," she said.

The knowledge that they will lack access to the tools wealthy countries will use to fight a pandemic has been a source of contention among some developing countries in recent years, particularly some of those which have been fighting endemic outbreaks of H5N1 avian flu in poultry flocks.

Indonesia, the country hardest hit by H5N1, has for several years withheld virus samples from the WHO, its influenza laboratories and vaccine manufacturers, using them as a lever to try to gain access to affordable vaccine for its citizens.

The WHO has taken up the cause, arguing there should be benefits from virus sharing.

Those talks all related to the H5N1 virus and perhaps did not envisage a pandemic strain first being spotted in the United States. (The first sample virus of this new H1N1 swine variant was isolated from a patient in California.)

But recent comments made by Chan, Kieny and other WHO officials have signalled the agency will use its bully pulpit to try to get pharmaceutical companies to provide vaccine and antiviral drugs to developing countries - either through donation, at cut-rate costs or purchased with the help of funding from wealthier countries or charities.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

People on Alberta pig farm where virus found test negative
By Helen Branswell, THE CANADIAN PRESS
http://cnews.canoe.ca/CNEWS/Politic...9373686-cp.html


TORONTO - Canada's chief public health officer says the people who live on an Alberta pig farm where pigs were found to be infected with swine flu have tested negative for the virus.

A number of people living on the unidentified pig farm experienced flu-like symptoms after the pigs fell ill and were tested to see if they too were infected.

But Dr. David Butler-Jones says tests suggest the people were not infected with the H1N1 swine virus.

Butler-Jones says, though, that there may have been "sampling issues" and blood samples from the people will be tested for antibodies to look for a definitive answer on whether they were infected.

He won't say how many people were tested or what he means by sampling issues.

The pigs are thought to have been infected by a worker who had been in Mexico and was ill on his return to work in mid-April. The unidentified carpenter also tested negative for the virus, but it is believed that is because he was too far along in his recovery to be still shedding virus.

A nasal swab from the man was only collected after the pigs started falling sick and that was more than 10 days after his return from Mexico. Officials intend to test his blood too looking for antibodies to the new H1N1 swine flu virus.

The antibody test was developed at Canada's National Microbiology Laboratory, which has played a key role in the investigation into this new flu virus.

It was the Winnipeg lab that determined that an unusual outbreak of severe respiratory illness in Mexico was being caused by a new swine flu virus U.S. researchers had found was infecting people in the United States.

On Wednesday, Canadian officials announced the Winnipeg lab has completed full virus sequencing of three sample viruses - two from Canadian swine flu cases and one from Mexico. They say the viruses are virtually identical.

The full genetic sequences of viruses retrieved from the pigs have not yet been completed. That work is being done at the National Centre for Foreign Animal Diseases, the National Microbiology Laboratory's animal health counterpart. The two labs are co-located.

Experts will be keen to study the genetic sequences of the viruses isolated from the pigs to determine if there are an mutations that arose when the virus went back into swine.

Butler-Jones says the sequences of those viruses will be posted in open access databases once the work is done.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

As case counts rise and virus spreads, specific numbers become less helpful
2 hours ago
http://www.google.com/hostednews/ca...z6NRGXR7wjqFGDw


TORONTO — Are there roughly 200 swine flu cases in Canada? Or about 1,800 cases in the United States? Or nearly 2,400 cases globally?

Do the numbers really matter?

With the new swine flu virus spreading quickly through many parts of North America and beyond, firm numbers of cases have less and less relevancy to public health efforts to respond to the outbreak, experts say.

While good estimates of the scope of disease activity are important in the early days of an outbreak, once a bug like this new H1N1 virus is spreading in a community, putting a figure on how many people are actually sick is, well, a guessing game.

"This counting of cases is some kind of 'folie a deux' or maybe 'folie a trois' that happens between politicians, public health people and the media," influenza expert Dr. Allison McGeer says, using a French phrase that means "madness shared by two" (or three).

"In an outbreak, you need to know whether it's going up or down. You need to know where you're going. But somehow - and I don't fully understand the source or the psychology of this - somehow we've evolved into: You have to have numbers."

"The result is people spend an unbelievable amount of time worrying about what the numbers are."

Trying to keep firm counts is especially futile with influenza, which is one of those tip-of-the-iceberg diseases. The vast majority of infected people never seek a doctor's help; and most doctors, in Canada at any rate, do not test for influenza.

That said, given the high level of public awareness about swine flu, more of the iceberg may be poking above the surface these days.

"People are getting tested that in a regular flu season ... wouldn't bother going to their doctor because they didn't have a travel history and ... if they did go to the doctor, would not necessarily have had a (diagnostic) swab," says Dr. David Butler-Jones, Canada's chief public health officer.

"We don't have any evidence to say that for sure, but that's likely."

While we're still counting, Canada has reported 214 cases in nine provinces.

In the United States, where authorities reported Thursday they have 1,823 confirmed and probable cases in 44 states, a move toward qualitative rather than quantitative descriptions of the scope of the outbreak is on the horizon.

"At some point, reporting on individual cases no longer has value from a public health perspective," says Dr. Richard Besser, acting head of the U.S. Centers for Disease Control. "But knowing where in the country we're seeing large amounts of flu activity does remain important."

Besser says the CDC will soon move to the type of reporting language it uses for seasonal flu, describing H1N1 swine flu activity in terms like "widespread," "localized" or "isolated."

Once transmission is happening in communities a case count "doesn't become as useful as being able to talk about widespread activity in a given place, limited activity, isolated activity. The kinds of terms that we've used in seasonal flu," Besser says.

Part of the issue is how much testing is being done and how quickly tests are being processed. As more laboratories take possession of the kits needed to test for this virus, case counts spike.

The virus is still spreading, so some of that rise in cases represents new infections. But some represent infections that have already occurred but for which testing is only now being done.

Besser uses an anecdote to explain the testing phenomenon. "Yesterday we had a visit from the mayor of New York who said: 'You want 200 more cases? Let me know and we'll test 200 more people."

Knowing where the virus is present and spreading is important, and that's where counting helps at the start of an outbreak. It also helps to show if cases are growing or if transmission is petering out.

But after a point, it makes no sense to jam up laboratories doing multiple tests that confirm the obvious - the virus is here.

Butler-Jones says at some point soon, Canada may pull back on testing in some places. "I think we're close."

"We'd like to be able to have some confidence that things are really diminishing," he says. "And so if you're still picking up new cases, then it may or may not be. But if you're doing testing and you're not finding it, then you're more confident that it is diminishing."

McGeer, who is head of infection control at Toronto's Mount Sinai Hospital, says when she teaches she tells medical students the blunt facts of the numbers game.

"Every day you have to have a number for public consumption. No matter what you do, that number will not be right, for just an innumerable number of reasons," she explains.

"It's got to be close, but it's never going to be perfect. And it really doesn't matter. It's just to tell people whether we're going up or down and give them a rough idea of (by) how much. ..."

"Is it getting worse? Is it getting better? Is it getting a lot worse? Or a lot better? Those are the questions. And if you answer those questions, that's what you need from the number."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

The pandemic is expanding, and it is undergoing a metamorphosis, in the course of this process, as it continues to "mature." So, necessarily, is the media and medical coverage of it, also, going through a parallel process. Surprised? Who, here, would have thought that this might be otherwise?

__________________ 
For the country of death is the heart's size
And the star of the lost the shape of the eyes.

Dylan Thomas (Vision And Prayer)

Circumstantial evidence the only proof of person-to-pig H1N1 infection: CFIA
By HELEN BRANSWELL, Medical Reporter, The Canadian Press
http://www.edmontonsun.com/News/Swi...09/9407816.html


TORONTO — There is no smoking gun in the case of the H1N1 infected pigs — and authorities investigating the first known infections of pigs with this new swine flu virus may not be able to unearth one, a senior Canadian Food Inspection Agency official admits.

Testing of people on the Alberta farm — some of which was done too late, some of which may not have used the best technique to get an answer — has turned up no solid proof people brought the virus to the pigs. And it remains to be seen whether blood testing will be able to fill the evidence gap.

Officials announced the cull of 500 pigs on the Alberta farm Saturday to deal with overcrowding. Provincial authorities said the decision was a result of discussions between the producer and federal and provincial officials.

Because of the quarantine the producer was unable to ship hogs to market and as a result the farm had reached maximum capacity, officials said.

The CFIA still strongly believes the pigs were infected by people, but all the evidence is circumstantial, says the agency’s Dr. Jim Clark.

“That’s absolutely it. Without a laboratory result that clearly says one of those people that had exposure to the pigs was infected with this novel H1N1, it’s simply taking probabilities and looking at what is the most likely source of the infection,” says Clark, the national manager for disease control for CFIA’s animal health division.

Clark, who is also serving temporarily as planning chief of the national emergency response team, says he thinks the chances of finding an answer in blood samples taken from people on the farm is “fairly remote” — though the director of Canada’s National Microbiology Laboratory is more optimistic.

“We think we probably will be able to make a call based on the antibody levels in this individual,” Dr. Frank Plummer said during a recent news conference. Plummer was speaking of the so-called index case, the man believed to have introduced the virus into the pig farm.

He said there isn’t a lot of cross reaction between antibodies created by exposure to human H1N1 viruses and those provoked by infection with the new swine H1N1, so it might be possible to tease out an answer using a blood test — once one is designed.

If that doesn’t work, Plummer said, there are other techniques to probe the immune system’s memory that might show that the man had been infected.

The news this novel H1N1 virus had been found in pigs made international headlines when it broke on May 2. Though genetic analysis of the new virus shows it is the product of reassortment (gene swapping) between two swine flu viruses, the virus had not been found in pigs to that point.

Making the story more fascinating still was the fact that the infection seemed to have passed from person to pig, not the other way around, though there was some suspicion the pigs might have returned the favour and infected some members of the farm family.

It’s believed the virus was introduced to the farm — a closed operation with no recent introduction of pigs — by a carpenter who had just returned from Mexico. The man showed up to work on April 14, but left after only half a day because he was ill, Clark says.

CFIA was only notified of a problem with the pigs on April 28. But looking back, the farm’s owner believed pigs started falling sick within a few days of the carpenter’s brief appearance, Clark says.

“The owner thinks anecdotally that he noticed some difference in the general demeanour of the pigs and the amount of coughing that was going on about three to four days after the carpenter was there,” he says, adding that a chronic respiratory problem that had plagued the herd may have masked the first signs.

Several members of the farm family were ill, though whether it was with the new flu virus or something else remains a mystery. Clark says several family members were sick over the Easter weekend, a few days before the sick carpenter turned up on the farm.

By the time investigators arrived at the farm and testing began on pigs and people, easy answers were no longer within reach for at least some of the people. It was too late to expect to find flu viruses in the upper respiratory tract of the carpenter, who had recovered.

But the farmer was still suffering flu-like symptoms.

Provincial health investigators used a nasal swab, not a nasal pharyngeal swab to test the farmer, and it came back negative for the new flu virus, Clark says.

A nasal pharyngeal test, which scrapes cells deeper into the respiratory tract, would have been more likely to produce a positive result if there is influenza virus present, infectious diseases experts say.

“In terms of what was infecting the farmer, we don’t know if he was infected with exposure to his family that had been experiencing influenza-like illness, to the carpenter — that’s a really long ... latency period — to the pigs, or to something external to the farm entirely,” Clark admits.

Still, genetic analysis of virus retrieved from the pigs shows it is a match for the new H1N1 flu virus. And the evidence available on how the pigs caught it all points to the scenario the CFIA has sketched out, Clark says.

“The only history we have of anything entering the herd or having exposure to the herd is on the human side.” —

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

If what some believe is true, that the virus has been around weeks or perhaps even months before it was identified, is there the possibility that it was introduced on the farm before the man described above? Was he the only person who had traveled to Mexico in the past couple months?

__________________ 
.
.

Roscoe and Miss Priss

I think it is also possible that the virus didn't originate in Mexico, but who knows if there will ever be definitive answers to the many questions surrounding the genesis of this bug.

I suppose at the end of the day the most important questions are about what it does from here.


MomCares

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

That's right. I remember an early article postulating it might have originated in California.

I was just looking at some cases from the UK (dont remember if I was reading recent posts or early ones - some of this has become a blurr) and they were saying some of them hadnt had contact with anyone from Mexico. No surprise really, this likely has been around for some time and is H2H.

And as you say, where and when it originated, while academically interesting, isnt as important to most of us as where and how it proceeds from here.

__________________ 
.
.

Roscoe and Miss Priss

WHO working on a severity scale to accompany pandemic alert phases
1 hour ago
http://www.google.com/hostednews/ca...njqQR6tHe-kf5tw


TORONTO — The World Health Organization is devising an index to gauge the severity of the threat posed by a potential pandemic influenza virus, the agency's top flu expert said Monday.

The WHO hopes to introduce the new scale soon, said Dr. Keiji Fukuda, who said the tool could help national authorities make decisions about how aggressively they want to respond with measures like closing schools and discouraging public gatherings.

"These are hard decisions for country authorities to make. And so they really want as much guidance as possible," Fukuda, acting assistant director general for health security and environment, said in an interview.

"And I think this provides some guidance, some help. But they're still difficult decisions to make."

Shortly after revealing a severity scale was in the works, the WHO posted an assessment of the situation to date with the new H1N1 swine flu virus. It noted that outside of the outbreak in Mexico - which is still not completely understood - the new virus typically causes "very mild illness in otherwise healthy people."

According to the WHO, there are about 4,800 confirmed cases in 30 countries, including 330 in Canada.

The WHO has faced criticism from some quarters that its pandemic alert scale has no mechanism to reflect the fact that a flu pandemic might cause mild, moderate or severe illness and trigger varying levels of societal disruption.

The agency has been stressing since the swine flu incident began that the term pandemic relates to the scope of transmission, not the severity of disease caused by a new spreading virus.

But after years of media focus on the dangerous H5N1 avian flu virus - which draws parallels to the 1918 Spanish Flu - there may be a mistaken public perception that high levels of severe disease and deaths must go hand-in-hand with a pandemic strain.

In reality, the two most recent pandemics - 1957 and 1968 - caused widespread illness and higher-than-normal numbers of deaths. But they were not catastrophic.

"Pandemics are not created equal," said Dr. Peter Palese, a leading influenza expert at Mt. Sinai Medical Center in Manhattan.

Fukuda said a group of experts that helped the WHO rewrite its pandemic preparedness guidelines has been working on a severity scale. While the aim is to have something simple - with categories such as mild, moderate and severe - the WHO is aware that outbreaks may play out differently in different places.

"On the one hand, it is important to have a very straightforward simple approach to describing it. On the other hand, one shoe doesn't necessarily fit all feet," Fukuda said.

And even in mild pandemics, such as the 1968 Hong Kong flu, lots of people will get infected. Of those, an as-yet unknown proportion will become severely ill and some will die.

"In a sense, it is almost illogical to be describing something like a pandemic as mild when you're spreading it over the number of people that will get infected," Fukuda said.

An infectious diseases expert welcomed the effort to try to make the situation clearer.

"The current pandemic phase model really needs one additional piece, namely that of disease severity," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"By combining both transmission and severity characteristics it will provide for a much more accurate assessment of the status of any emerging pandemic."

Some countries already have a severity index in their pandemic plans. The U.S. Centers for Disease Control, for instance, use a scale similar to a five-point hurricane index, with the Spanish Flu (which killed upwards of 50 million people in 1918-19) at the low end of five.

The CDC hasn't yet determined where the H1N1 outbreak lies on that scale, said Dr. Francisco Averhoff, chief of quarantine and border health services in the division of global migration and quarantine.

But based on what has been seen to date, the CDC has dialled down some of its recommendations on so-called social distancing measures. Where initially it recommended closing schools when H1N1 cases were found, now it says infected kids should stay home but schools should stay open.

Meanwhile, disease investigators have been trying to get a clearer picture of just how bad an actor the new virus is.

An article published electronically on Monday by the journal Science estimated that 23,000 people in Mexico had been infected with the new virus by the end of April and that the case fatality rate - the proportion of cases that end in death - was about 0.4 per cent. In comparison, the case fatality rate for the Spanish flu was upwards of 2.5 per cent.

The authors, from a number of universities and the WHO, said the early signs were that the disease severity with the new virus was in the range of that seen during the 1957 and 1968 pandemics.

"The transmissibility looks like the less severe pandemics of '57-'58 and '68-'69, not a 1918 - at least currently," said Dr. Ira Longini, an expert in mathematical modelling at the University of Washington. Longini was not involved in the study.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

WHO, flu experts looking into claim H1N1 swine flu evolved in lab, not nature
4 hours ago
http://www.google.com/hostednews/ca...Lyo-yETVjbOFroQ


TORONTO — The World Health Organization and leading influenza research groups are investigating unpublished claims that the new H1N1 swine flu virus may have evolved in a laboratory, not in nature.

The Geneva-based agency was informed of the pending publication over the weekend by the author, a retired Australian virologist named Adrian Gibbs.

It scrambled to draw in researchers from leading human and animal influenza laboratories around the world in a bid to determine if the claim has merit and if it does, whether that changes the advice WHO gives member countries on the threat posed by the new H1N1 swine flu virus.

The WHO's leading flu scientist said the consultation is still ongoing and a conclusion hasn't been reached, but the weight of evidence so far suggests the theory isn't correct.

"I think the preliminary analyses certainly suggest there are other explanations and that the explanation suggested by the author is not the best one," Dr. Keiji Fukuda, acting assistant director general for health security and environment, said in an interview from Geneva.

Fukuda said at least one WHO collaborating centre for influenza, the U.S. Centers for Disease Control in Atlanta, has done an extensive analysis of available genetic sequence data for swine influenza viruses. That work does not support the claim made by Gibbs, he said.

Researchers at Cambridge University who specialize in the evolution of influenza viruses also challenge the hypothesis, Fukuda said. "They also feel that there are alternate explanations for this."

Bloomberg News reported Tuesday that Gibbs plans to publish online a scientific report saying the never-before-seen virus may have evolved in eggs.

Eggs are used in laboratories and in vaccine manufacturing to grow up quantities of influenza viruses.

If the virus had spent time evolving in eggs, it would suggest it was not solely the creation of nature but may have been accidentally or deliberately engineered in a lab.

If that were the case, it would of course raise questions about how something constructed in a lab ended up circulating in humans in at least 30 countries around the globe.

"If there was evidence that it was an egg-derived isolate, then that means it's been handled in a laboratory. And if it's been handled in a laboratory, then there are different possibilities that you have to think of," Fukuda said.

"Was this developed in part as a vaccine virus? Was this developed as some sort of research project? And in those instances, was it released on purpose? Was it an accidental release? What would be the circumstances?"

Gibbs apparently claims that the virus bears the hallmarks of having undergone "accelerated evolution" such as what happens when flu viruses try to adapt to growth in eggs.

But the head of the CDC's influenza division, Dr. Nancy Cox, said her labs and others cannot find evidence to support the claim that the virus has undergone accelerated evolution.

Italian influenza researcher Dr. Ilaria Capua said there is too little known about swine influenza virus evolution to make the claim in the first place.

Capua, who runs an international reference laboratory for avian influenza in Padua, said Gibbs argues that the virus had accumulated mutations known to be seen in laboratory manipulation of viruses, specifically growth in eggs.

But she said the same mutations have been noted in a swine flu virus isolated from a pig in Italy. "So it can occur spontaneously in nature."

"There is not enough scientific evidence to build this reasoning," Capua said. "This virus could have generated itself by many ways: In swine or in another host or God or laboratory manipulation or whatever. But we just cannot say."

"This is not how science works. Science works by building a case. And in this case, at least from what I've read, there isn't enough information to build that case."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Tough choices on table as experts meet to advise WHO on swine flu vaccine

5 hours ago
http://www.google.com/hostednews/ca...DERZ2mMoQqYCSrQ


TORONTO — It will be a while yet before decisions are reached on whether to make swine flu vaccine and how much should be made if the go-ahead is given, the World Health Organization signalled Thursday after a meeting of vaccine experts and industry representatives.

Last week the head of the agency's vaccine research initiative, Dr. Marie-Paule Kieny, had indicated a decision might come this week. But after the teleconference Thursday, the WHO's top flu expert said more time is needed to work through a number of difficult issues.

"No big decisions, no announcements," said Dr. Keiji Fukuda, acting assistant director general for health security and the environment.

"These are enormously complicated questions, and they are not something that anyone can make in a single meeting."

Further, he refused to project when a decision might be made.

"I think it is not possible to say that there will be a decision made by this (certain) date. It really is going through this I think painstaking and difficult process. But that's what's going on," Fukuda said.

Tough choices face the WHO and governments which will purchase swine flu vaccine. Most experts believe it will be made, but in what quantities remains unclear.

It is also unclear how much will be available for developing countries.

At least 16 of the wealthiest nations, such as Canada, already have standing contracts for the purchase of vaccine once a pandemic is declared. A substantial portion of the world's combined pandemic vaccine production capacity is believed to be already sold through these advance purchase agreements.

The WHO has been publicly pressuring vaccine manufacturers to donate a portion of their early output for use in less affluent countries. Next week heads of vaccine producing companies have been invited to meet UN Secretary General Ban Ki-moon and WHO Director General Margaret Chan to discuss the issue.

A source familiar with Thursday's discussions said six companies agreed to donate a total of 27 million doses of vaccine, but at least eight major vaccine manufacturers signalled they were not ready to make a commitment.

Meanwhile, though some companies that work with so called "wild type" viruses (viruses not modified for growth in eggs) are already doing preliminary research with the new virus, most of the major producers are waiting for governments to tell them to start producing this vaccine.

They are unlikely to make product on spec, said Len Lavenda, a spokesperson for sanofi pasteur, the world's biggest producer of flu vaccine.

"We operate our facilities based on market demand. And we have no idea what the market demand will be. The market demand for pandemic vaccine will be determined by the government," he said from Swiftwater, Pa.

Do manufacturers have a sense of how aggressively they will be asked to produce H1N1 vaccine? "Not yet," Lavenda said.

The dilemma of how much swine flu vaccine to make is significant, and is rooted in the fact that science cannot predict what will happen with this new virus.

Will it continue to spread or peter out? If spread persists, will the virus cause mainly mild disease? Or is it gathering strength to come back in the fall as a more potent force, as the Spanish flu virus did in 1918?

Will the new H1N1 virus co-circulate with the human flu viruses that kill half a million people around the globe every year, meaning the world needs protection against both seasonal viruses and this new bug? Or will this new swine-derived virus act as previous pandemic viruses have done and crowd out the other influenza A viruses?

If the answers to those questions were known, it would be easy to decide which route to take. But there are no easy answers, only risk assessments and tradeoffs.

"It's certainly conceivable that there would be some impact on seasonal vaccine manufacturing if you start trying to make large amounts of the H1 vaccine," said Dr. John Treanor, an influenza vaccine expert at the University of Rochester in New York State.

"So you've got to decide: Is that on balance worth going ahead and accepting that issue so that you have an H1 vaccine ready?"

Treanor said he expects most governments will tell manufacturers to divert "some of their resources to making an H1 vaccine."

Exacerbating the problem is the fact that it takes months to make influenza vaccine. Assuming manufacturers aren't told to stop making seasonal flu vaccine, the window of opportunity in which they would make a swine flu vaccine would come during our summer. But it may not be clear until the fall or winter whether the vaccine is essential, advisable or unnecessary.

"There are some difficult decisions that people will need to make," Treanor said.

Fukuda and others have suggested vaccine decisions can and should be made on a step-wise basis. The first step - telling vaccine makers to get ready to receive the order to make vaccine by securing eggs, for instance - has already been taken.

Several laboratories are making seed strains, the modified viruses most manufacturers use to start growing commercial lots of vaccine in eggs. It is believed at this point none of the seed strains will be ready to transfer to manufacturers before the end of this month.

Once the seed strains are available, manufacturers have to start working with the new virus, a process that invariably demands that they tweak their procedures to ensure high yield. Then they will have to produce pilot lots that can be used in clinical trials to determine that the vaccine is safe, how large a dose is required and whether people need one dose or two to be protected.

Those processes buy time for the WHO and governments to watch the new virus and see how it behaves as flu season moves from the Northern to the Southern Hemisphere.

"As the H1 situation unfolds we will get a better and better handle on what is the severity, what is the impact on people," Fukuda said.

"And it will give us more information (with which) to make these difficult decisions. Because what is really going to be wrestled with is that seasonal influenza itself has a significant impact on people."

"This is not a benign infection," he said of seasonal flu.

"This is an infection which again is estimated to kill some hundreds of thousands of people each year around the world. So there's a real tradeoff if you just say: We are going to stop making that vaccine."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

H1N1 virus in pigs on Alta farm close to human virus
Updated Fri. May. 15 2009 5:33 PM ET
The Canadian Press
http://www.ctv.ca/servlet/ArticleNe...0515?hub=Health


TORONTO -- The flu virus retrieved from a pig on an Alberta farm closely matches the swine flu viruses that have been retrieved from humans, an expert in genetic sequencing said Friday.

The genetic blueprint of the H1N1 virus, decoded at the Canadian Food Inspection Agency's National Centre for Foreign Animal Diseases in Winnipeg, was posted Thursday in Genbank, on an open access genetic sequence database maintained by the U.S. National Center for Biotechnology Information.

The Canadian Food Inspection Agency would not answer questions Friday about the posting of the genetic sequence or the agency's analysis of the sequence data.

But Steven Salzberg, director of the University of Maryland's centre for bioinformatics and computational biology, examined the sequences of two of the genes at the request of The Canadian Press.

"It's 99 per cent identical to one of the Mexican sequences," Salzberg said of the genetic code for the hemagglutinin, the gene that gives the virus the H in its name.

The hemagglutinin is considered the most important gene in the virus; it is the one that must lock onto the cells of the respiratory tract to initiate infection. It is also the gene most prone to mutation, because it has to evolve to evade the human immune system.

Salzberg also looked at the genetic sequence for PB1, which is the single gene in this unusual hybrid virus that derives from human flu viruses. It too closely resembles the ones that are now spreading in at least 34 countries.

"It's definitely the same strain. From looking at these two (gene) segments, it's clearly the same strain. Ninety-nine per cent identical. That's what they all are," Salzberg said.

The discovery of this novel virus in pigs in an Alberta farm was the first and to date only finding of the virus in pigs.

Despite the fact that the virus is the offspring of two swine viruses which may have reassorted in pigs, it has not been found to be spreading among pig populations. And officials do not believe pigs are playing a role in its continued spread; at this point, the virus is a person-to-person pathogen, they say.

They are, however, keen to keep the virus from becoming entrenched in pig populations because of the risk it might acquire further mutations if given the chance to cycle back and forth between people and pigs.

It is believed the virus was introduced to the farm -- a closed operation near Rocky Mountain House, Alta., -- on April 14 by a carpenter who had just returned from Mexico.

The carpenter, who was only tested after he had recovered, tested negative. In fact while a number of people on the farm were reportedly ill around the time the pigs were sick, so far none of the humans on the farm have tested positive for the virus.

Last week Alberta's chief veterinarian announced that 500 pigs from the farm were to be culled to ease overcrowding at the operation, which remains under quarantine.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Odd late season surge of seasonal flu activity accompanies swine flu surge
2 hours ago
http://www.google.com/hostednews/ca..._PBiLSrhiVOA7kg


TORONTO — Doctors testing patients for the new swine flu virus are finding lots of cases of seasonal flu too, an odd development so late in the flu season, the U.S. Centers for Disease Control said Friday.

About half of people testing positive for influenza in the United States these days are infected with the new virus, the CDC's Dr. Dan Jernigan said during a media teleconference.

But that means the other half are testing positive for seasonal flu viruses at a time when flu activity generally wanes sharply in the Northern Hemisphere.

The CDC said part of the increase is certainly due to the fact that much more influenza testing is going on these days, because of concerns about swine flu. But the agency said it seems that it's not just a case of more testing, but more flu too.

"We would be expecting to see the season slowing down or almost completely stopped from the kinds of surveillance systems that we normally monitor," said Jernigan, deputy head of the CDC's influenza division.

"But what we're seeing is that there are some areas that actually have reports of the amounts of respiratory disease that are coming into their clinics that are equivalent to peak influenza season, and so that's an indicator to us that there's something going on with the amount of influenza disease out there."

A spokesperson for the agency said flu season in the U.S. got off to a late start this past winter and that may be playing a part in this late season surge.

"For this time of year the level of activity we're seeing is unusual," Tom Skinner admitted.

"The bottom line is we are seeing an unusual level of flu activity for this time of year right now. That's the bottom line."

Parts of Canada are also seeing this unexpected late surge in seasonal flu cases.

Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai Hospital, said about 20 per cent of people who are being tested for influenza-like illness in Toronto are testing positive for flu.

Twenty per cent is about the level of positive tests one would see during the peak of flu season, she said.

About half of those positive tests are for the new swine flu virus, McGeer said, but the other half are for H3N2, one of the seasonal flu subtypes.

Others aren't as certain there is an unusually high level of flu activity now, feeling the surge in detected cases is mainly due to the fact that many more people are seeking medical care if they are suffering from flu-like symptoms.

Dr. David Patrick of the British Columbia Centre for Disease Control said his centre's surveillance shows a sharp increase in doctor visits, but no increase in things like deaths due to pneumonia or influenza, which would be expected if there was an increase in cases.

"Those haven't budged," he said of the mortality statistics. "What has budged has been a lot more people going to their doctors and from the labs for a period of about a week, 10 times the test volume we would have expected at this time of year."

"So if you just go on numbers of flu picked up, I think there's a pretty good explanation."

And influenza expert Dr. Arnold Monto also felt the answer to the puzzling increase may lie in heightened influenza surveillance.

"We've never looked this hard," said Monto, of the University of Michigan's School of Public Health.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Swine flu spread in North America may extend into summer, experts say
http://www.google.com/hostednews/ca...dqewmsjcki232nw


TORONTO — Spread of swine flu in North America may not dampen down in coming weeks as was first expected, some health officials and flu experts are now suggesting.

Some are now planning for the possibility the new virus may continue to trigger infections into the summer, not petering out in the way seasonal flu strains typically do as temperatures rise in the Northern Hemisphere.

"This is what worries me," says Dr. Arnold Monto, an influenza expert at the University of Michigan's School of Public Health.

"We are seeing a fair amount of circulation of the swine flu virus. And I'm not yet convinced that it's going to go away completely."

"It may dampen down a bit as schools close. But I think we're still seeing increasing transmission in the U.S. And I think in addition you have far more transmission in Canada than some people are saying - it's not just imported cases and circles around imported cases."

Monto's concern is echoed by Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai Hospital.

McGeer says abnormal flu activity levels for this time of year are making her question "the delusion that this was actually going to quiet down and we weren't going to have a first wave" over the late spring and summer.

"On a relative scale there's not a lot of it," she says of swine flu transmission in Canada's largest city.

"But it's very clearly starting to increase. I suppose it could shut itself off at any given time. But the last couple of days look like we're going to see a (flu) season," McGeer said.

"In Toronto, at least, I think we're gone."

If the virus were to take a summer hiatus in the Northern Hemisphere, it would give public health officials more time to plan for a possible surge in cases in the fall. The swine flu virus is now causing mild illness in the vast majority of cases, but experts fear that could change as the new virus evolves.

It would also buy time on the vaccine front. Vaccine production has not yet begun and it is expected it would take between four and six months before the first doses would be ready.

The U.S. Centers for Disease Control is now working the possibility of a summer wave into its planning, a senior official with the agency admits.

"CDC is preparing for the possibility that influenza may continue to circulate at present levels through the summer," says Dr. Daniel Jernigan, deputy director of the influenza division.

"For seasonal influenza, activity (during summer) generally drops to a very low level, however, with this new H1N1 strain, we may see some continued activity."

"One strong possibility is that the new strain will begin increasing in activity early this fall, and we want to be prepared for that."

Sunday marked one month since the CDC sounded an international alarm about a new swine flu virus potentially spreading among humans.

The agency had received a virus sample retrieved from a boy in San Diego, Calif., who had been sick with influenza like illness. Testing suggested he was infected with an influenza A virus. But standard diagnostics that look for known human flu strains could not subtype the virus.

The CDC labs confirmed the boy - who had had no contact with pigs - had been infected with a never-before-seen swine flu virus. On April 17, American authorities notified the World Health Organization that a virus with pandemic potential might be circulating in the U.S. Southwest.

In short order the WHO raised the global pandemic alert level to Phase 5, the brink of a pandemic.

By Sunday, laboratories in 39 countries around the globe had confirmed nearly 8,500 cases, a figure that is without doubt only a fraction of the actual infections that have occurred. Late last week the CDC's Jernigan estimated upwards of 100,000 people in the U.S. may have been infected already.

To date four countries have reported a total of 75 deaths due to swine flu infection.

Initially the WHO and authorities in North America predicted rising temperatures and the approaching end of the school year might mean transmission in the Northern Hemisphere would slow to a trickle, with action shifting to the Southern Hemisphere, where the start of flu season is imminent.

For reasons that science can't yet fully explain, human flu viruses don't transmit well during the summers of the Northern or Southern Hemisphere - hence the term "seasonal" influenza viruses.

But it's known from previous pandemics that pandemic viruses can rewrite the rules when they first emerge.

The virus responsible for the Spanish flu pandemic, first spotted in some places in the spring of 1918, returned with a vengeance in late August and early September of that year on the east coast of North America.

That was abnormally early for influenza. Though flu activity can start to pick up in late November, transmission typically takes off around Christmas and peaks sometime in January or February.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Is swine flu a pandemic or pandemic-in-the-making? Experts offer varying opinions
By Helen Branswell, Medical Reporter, THE CANADIAN PRESS
http://cnews.canoe.ca/CNEWS/Politic...9518076-cp.html


TORONTO - Even among microbiologists and virologists, characterizing an influenza pandemic is a bit like, well, defining pornography.

"The old saying is: 'What's the definition of a pandemic strain?' 'Well, you can't really be sure but you'll know when you see one,"' says Dr. Walt Dowdle, a long-time head of the influenza laboratories at the U.S. Centers for Disease Control, now retired from that post.

That may have seemed a truism at one point. But with the current outbreak of swine flu, it may not seem so anymore.

Though the global count of confirmed cases has crested 10,000 in more than 40 countries on five continents, some politicians say they don't see a pandemic in the offing.

Some argued at the World Health Assembly in Geneva over whether the World Health Organization should rewrite the definition of a pandemic in ways that would exclude this virus. A number - among them several affluent countries with antiviral stockpiles and pandemic vaccine contracts - insisted the lack of severity associated with this new strain of flu means it doesn't merit the name.

The job of defining what constitutes a pandemic belongs to scientists, not politicians. But even scientists have divergent views about what is unfolding with the new H1N1 virus.

"I think it is a pandemic already," says Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai Hospital, which this week admitted two H1N1 patients. On Wednesday, Ontario's confirmed case count jumped 45 per cent, to 272 from 187.

But Dr. Peter Palese, head of microbiology at Manhattan's Mt. Sinai School of Medicine, offers a differing opinion.

"In the past we talked about a 1918 pandemic, a 1957 and a 1968. And if you use it in that sense, in the classical sense of serious pandemic, then obviously (with) the swine H1N1, the name is not justified."

After years of fearing the next pandemic would be triggered by the dangerous H5N1 avian flu virus with its 60 per cent case fatality rate, flu scientists were as taken aback as everyone else by the out-of-left-field emergence of this swine flu virus.

It's an H1N1 virus, meaning it bears hemagglutinin (H) and neuraminidase (N) proteins on its surface that are distant relatives of those found on a human flu strain - also called H1N1 - that has been circulating for most of the last century.

It used to be thought that to cause a pandemic, a virus with a new hemagglutinin had to break out of nature.

This virus's hemagglutinin is not brand new - but it is new enough to a wide segment of society to be able to infect a lot of people, especially young people, quite easily. But there are hints that exposure to H1N1s that circulated before 1957 may have given people in their 60s and older some protection against this new virus.

That fact, combined with the mildness of most cases and the low number of deaths, has some scientists wondering if this really is a pandemic strain in the making.

However, the WHO's criteria for a pandemic deliberately don't take severity into account, focusing instead on spread of a new virus to which a large portion of the population has no immunity. Severity, the WHO says, will likely vary from place to place, depending on the vulnerabilities of different populations. As well, it could change over time as a new virus spreads in waves around the world.

By the WHO's definition, a virus crosses the pandemic threshold when there is evidence of spread in the community in two WHO regions. With the virus galloping through schools in Japan, many observers believe the call is imminent - if the WHO does not bow to pressure to change the rules.

Infectious diseases expert Dr. Michael Osterholm says the agency will hurt its own credibility if it bends scientific reality to political will.

"You know, you can decide not to call a house burning down a fire because it can only be a fire if it's so many acres big. But it's still a fire," says Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy.

"I'm worried that if we get into this pandemic, not pandemic debate, we're only going to see WHO suffer miserably in terms of their scientific integrity. That's what I think would be really unfortunate. Because we need to have a strong international public health agency whose credibility rests on its scientific word."

To Osterholm's eyes, the situation is clear: The novel H1N1 virus is causing a pandemic.

He believes the WHO and public health leaders should be helping governments, companies and individuals understand they can scale back their pandemic plans to deal with a - blessedly - milder pandemic.

"They have a fait accompli approach that says: 'If we get to this point in the road, we have to pull the trigger,"' he says, referring to actions that organizations had planned to take when a pandemic is called.

"And I'm saying: 'No, you don't. We have new information. We have better information. And even if we hadn't planned this before, why are we locking ourselves into a system that we realize is inadequate to deal with today's problems?"'

One of the grand old men of flu agrees this virus will earn pandemic moniker, though he says swine flu will probably go down in the annals of pandemics as a minor event.

"My prediction would be that it's going to be further transmitted and will become pandemic in the sense of global in distribution," says Dr. Edwin D. Kilbourne, who played key roles in the responses to the 1968 pandemic and the 1976 swine flu incident.

"But it's not going to be a very important disease in terms of mortality," predicts Kilbourne, who lives in Madison, Conn. "And perhaps not even in terms of total morbidity."

Dr. Ian Gust, former director of the WHO's Collaborating Centre for Reference and Research on Influenza in Australia, says this virus is unlikely to match most people's mental picture of a pandemic.

"The term pandemic as it's used in a popular sense relates to those occasions when there's an abnormal level of influenza activity around the world associated with significant additional illness and significant additional deaths and representing a major strain change," he says from Melbourne.

"I think that this is likely to be somewhat less than that. That it's likely to be pretty much like a regular flu season. More like (the mild pandemic of) '68 than anything else."

But again, the WHO's definition of pandemic doesn't demand severity. Nor do flu text books' or the dictionary's, says Dr. Malik Peiris, a noted influenza expert at the University of Hong Kong.

"Influenza continues to confound us even in semantics," Peiris says via email.

"When the (swine) H1N1 is confirmed to have spread globally, it is a pandemic. ... Severity is immaterial in that definition," he says, acknowledging, though, that for the public, a pandemic without severity may seen like a "why bother?" kind of event.

Peiris suggests the problem is one of communications, not science.

"I think this is really one for the communication experts," he says. "So I shall wait for the WHO to decide."

"Whichever way they go, we are redefining the meaning of the word pandemic."

Some opinions and prognostications from experts on whether H1N1 swine flu will ultimately be seen as a pandemic strain:

"A pandemic doesn't have to mean that people die like flies. So even if you have a limited number of fatal cases, but still a virus causing disease and spreading around the world, you have a pandemic by definition." - Dr. Albert Osterhaus, director of the institute of virology at Erasmus Medical Centre in Rotterdam, the Netherlands.

-

"This current one actually sits somewhere between normal seasonal and normal pandemic - if there's any such thing as a normal pandemic. And ... we don't know exactly where it sits. Whether it's sort of half way in between or more towards the seasonal or leaning more towards the pandemic." - Dr. Alan Hampson, editor of the journal "Influenza and Other Respiratory Viruses" and former deputy head of Australia's national influenza laboratory.

-

"Should it be called a pandemic? I believe it probably should be, if not now, in the very near future if there's continued spread. Because it is a novel virus and it is spreading." - Dr. Lance Jennings, virologist, University of Otago, Christchurch, New Zealand.

-

"I've heard their (the WHO's) definition. But to me a pandemic is a global outbreak and this is not yet a global outbreak. It's an outbreak in the Northern Hemisphere. And my personal view is to wait and see what happens." - Dr. John Oxford, virologist, Barts and the London School of Medicine.

-

"If we go by the dictionary definition, we are in a pandemic now. The question is the sustainability of human-to-human transmission and case severity. I think we have to assume in our planning that it will continue. Whether the severity of disease will increase is unknown." - Dr. David Sencer, who directed the U.S. Centers for Disease Control during the 1976 swine flu scare.

-

"A new strain which spreads to all but one continent is by definition pandemic. But it's qualitatively different from what people have been thinking of as a pandemic." - Dr. Ian Gust, retired head of Australia's WHO Collaborating Centre for Reference and Research on Influenza.

-

"To me, a novel virus that spreads globally is a pandemic, irrespective of mortality." - Dr. Malik Peiris, influenza expert, the University of Hong Kong.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Not sure this goes here, but this string seemed like the best place to post it.

The Nieman Foundation for Journalism at Harvard University has announced Nieman fellows for the 2009-2010 year. Helen Branswell, medical reporter for The Canadian Press has been awarded a Nieman Fellows in Global Health Reporting.

http://www.nytimes.com/aponline/200...an-Fellows.html

No big surprise here. She is an excellent journalist.

Tami-Flu --

Thanks so much for sharing the great news... as you say, Helen Branswell is most deserving of this honor!! She and Laurie Garrett have both done such a great job with medical journalism... particularly in their coverage of infectious disease.

Hats off to these fine journalists!!


MomCares

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

So glad she got the award, I always read hers and Laurie's articles. Congratulations =Ms. Branswell!!!

Reason behind possible partial immunity of older adults to swine flu unclear
By Helen Branswell – 4 hours ago
http://www.google.com/hostednews/ca...S5nmnyGL8CM5iRw


TORONTO — Flu viruses that circulated decades ago may be protecting older adults from the new swine flu virus, scientists at the U.S. Centers for Disease Control suggested Thursday.

Blood samples from U.S. children don't produce any antibodies when exposed to the new H1N1 virus, but antibodies were detected in about one third of the samples from older adults, the study shows. But whether those antibodies would block infection with the new virus can't be revealed by this kind of testing.

"We don't yet understand what that means in terms of protection, if anything at all," said Dr. Jacqueline Katz, first author and chief of the immunology and pathogenesis branch of the CDC's influenza division.

Others remarked, though, that the laboratory finding is intriguing because it mirrors what is being seen in the real world as the virus spreads.

Children and young adults make up the bulk of confirmed swine flu cases. People over 60, who are normally among the most vulnerable to flu and its complications, account for a small portion of infections.

More work is underway to try to tease out what might account for this response in older adults. If it is felt the immune systems of older adults have been primed to respond to this virus by exposure to similar viruses in the past, that information could help set vaccination policies for older adults when H1N1 vaccine is ready.

"It's conceivable that potentially some age groups may have essentially been primed through exposure to H1N1 in the past and may not need two doses," Katz said in an interview.

The study appears in Friday's issue of the CDC journal Morbidity and Mortality Weekly Report.

The CDC scientists tested stored blood samples from people who had taken part in previous vaccine trials in the U.S. and Europe, though the blood samples from older adults came exclusively from the United States, said Dr. Anne Schuchat, the agency's director of immunizations and respiratory diseases.

The scientists were looking for what are called cross-reactive antibodies - not antibodies specific to that particular virus, but ones created by exposure to earlier viruses that are nonetheless able to recognize the new invader.

Schuchat said the CDC is wondering if human H1N1 viruses that circulated in the 1930s, '40s or '50s might have been closer to this new virus than contemporary human H1N1s.

The notion is "plausible" given the findings, said Dr. Donald Kennedy, an infectious disease specialist with St. Louis University's Center for Vaccine Development.

"If these viruses that were around in people that are over 60 - i.e. back in the '30s and '40s - are closer to this present swine flu virus, there would be some ... immunologic memory for that particular virus and that particular strain," Kennedy said.

The CDC researchers were looking at blood samples drawn before and after vaccination with seasonal flu shots, which also allowed them to test whether vaccine made to protect against human H1N1 viruses might offer some protection against the new swine viruses.

Though the viruses carry the same name - H1N1 - they are distant relatives. So distant, in fact that in children the flu shot generated no antibody rise against the swine virus. Adults showed a two-fold increase in cross-reactive antibodies, but that is a meager effect, suggesting seasonal flu shots don't protect against these viruses.

Interestingly, though, where a third of blood samples from adults over 60 showed significant levels of antibodies before the seasonal flu shot, that rose to 43 per cent after the vaccination. While that looks a bit like a booster effect, Schuchat cautioned that it's too soon to draw that conclusion.

Influenza expert Dr. Arnold Monto suggested that while the findings are interesting, he'd like to see a similar study done in another country.

That's because the United States vaccinated more than 40 million people in 1976 against a swine flu virus that was feared to be poised to start a pandemic. Until a similar study is done in a locale that didn't vaccinate against swine flu in 1976, one cannot rule out the possibility that antibodies generated by that vaccine are influencing the results of this study, Monto said.

"That (1976) swine virus is more closely related to the current (swine) virus than a lot of what's been transmitting more recently in humans," he said from Ann Arbor, Mich., where he teaches at the University of Michigan.

Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai Hospital, said Canadian scientists are embarking on just such a study here. And she offered another possible explanation for the findings.

McGeer suggested the antibodies seen in the blood of older adults may not have been generated by long ago exposure to viruses similar to the new swine H1N1. Rather, she said, it might be that the human immune system amasses protection against H1N1 viruses by years of exposure to influenza viruses and flu shots.

"It's beginning to look to me like it's more sensible to think that there's something about H1N1s that means that you accumulate antibody in a way that you just don't do for other influenza viruses," she said.

Katz said another possibility is that because older adults would have had their first influenza A infection with H1N1 viruses - H1N1s were the only influenza A viruses circulating before 1957 - their immune systems might be more responsive to flu viruses of this subtype.

"That may also be playing a role in making a very robust response," she said.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

WHO under pressure from member states to rewrite pandemic requirement
By Helen Branswell – 31 minutes ago
http://www.google.com/hostednews/ca...fnKeFxmE7FLmrUQ


TORONTO — The World Health Organization, under pressure from member states not to declare the swine flu outbreak a pandemic, said Friday it will rework the criteria by which a pandemic is called.

A number of countries have been pressing the global health agency not to move to Phase 6 - a pandemic - from the current Phase 5. They have argued that while the virus is clearly spreading to many parts of the world, the mild illness it is causing in the vast majority of cases doesn't merit pandemic status.

The WHO's acting assistant director-general said a number of countries attending this week's World Health Assembly in Geneva asked for more flexibility in the pandemic alert scale than the tool currently provides - and the WHO agreed to rethink the criteria.

"Rigidly adhering to something which is not proving to be useful in fact would not be very helpful to anybody," Dr. Keiji Fukuda said during a media teleconference from Geneva following the end of the assembly, the annual meeting of the WHO's governing counsel.

"What has become clear is that it's not just the spread of the virus which is considered important by countries who really have to act upon the phase changes. It's really the impact on the populations."

The existing scale, recently approved after three years of consultations and drafting, was drawn up while the WHO and the influenza experts who advise it were nervously watching the H5N1 avian flu virus. H5N1 has killed 60 per cent of the people it has been known to infect.

Under the scale's criteria, the WHO would declare a pandemic if a new virus was found to be spreading in the community in countries in two WHO regions. That condition seemed to be on the verge of being met, with the virus spreading rapidly in Japan.

As of Friday 42 countries had confirmed more than 11,000 cases of the infection, with 86 deaths. Canada has confirmed 805 cases and one death.

A leading U.S. public health official, who earlier this week said he believes the world is already in a pandemic, said the decision is about "semantics."

"They are entitled to create whatever criteria they wish to define their terms," said Dr. Jeff Duchin, head of the communicable disease division of Seattle and King County Public Health in Seattle, Wa.

"I think Bob Dylan had a point when he said you don't need a weatherman to know which way the wind blows."

However, a professor of international law at Indiana University said the WHO had little choice but to agree to change the pandemic phase levels.

Further, David Fidler said the decision was a "politically and epidemiologically prudent call, even if some critics will characterize it as caving into political pressure."

"Countries, out of fear or for ulterior motives, may use the declaration of a pandemic to take actions that are unnecessary for this milder virus and would cause political, economic, or human rights damage that would create no public health benefit," said Fidler, who is director of the Center on American and Global Security.

"I think that is the message the countries were sending WHO in counselling the Director General" - Dr. Margaret Chan - "not to raise the level to Phase 6."

But a leading risk communications expert who has worked with the WHO and other public health organizations in the past criticized the decision.

"I think it is unnecessary and even foolish for WHO to change its definition of 'pandemic' in order to avoid frightening people with the word," said Peter Sandman, of Princeton, N.J.

"The concern that people will over-react to a pandemic declaration and demand unwise, futile, and costly precautions (like border closings) is overwrought. It is what I call 'panic panic' - unreasoning fear on the part of governments that their people won't be able to cope."

Sandman did, however, support the notion of adding additional phases to the alert scale to reflect pandemics of escalating levels of severity. "It would be better to invent new phases for worse pandemics than to redefine 'pandemic' itself."

Fukuda couldn't say Friday how soon the new criteria will be drawn up, by what process they'll be devised or what they'll entail.

And in an interview, he hinted it may not be an easy task.

"It is far beyond just wordsmithing a couple of criteria in or something," Fukuda said. "And so I think that requires a fair amount of thinking through."

He suggested severity of disease caused by a new virus will likely be worked back into the equation, though it won't be the only new factor. Severity had been in an earlier version of the pandemic phase scale.

"But I can tell you that what we are looking for and what we will be looking for is . . . events which signify a really substantial increase in risk of harm to people," Fukuda said. "I think this is the sense of what Phase 6 is meant to convey. And this is what we will be focusing on."

Previously the WHO had said weighing severity as part of the decision of whether to call a pandemic was problematic. History shows pandemics don't play out the same way in each location, and a virus that starts out inflicting only mild disease could evolve to become a more dangerous foe.

Countries from the Association of Southeast Asian Nations had called on the WHO at a recent meeting not to declare the swine flu outbreak a pandemic. And at this week's World Health Assembly, in discussions Fukuda described as "intense," a number of countries argued that calling a pandemic would instill a level of fear in the public that isn't warranted by the illness caused by this virus.

Fukuda suggested it is "entirely reasonable" to revisit when to declare an outbreak a pandemic, given the current circumstances.

"Over and over again we rethink things through. And as more information comes in, we change, we adapt to those realities and those things that we think are going to be more helpful."

But he admitted the situation is "fraught with difficulties" and could hurt the credibility of the WHO, depending on how it is characterized.

An infectious diseases expert who earlier this week warned the WHO's reputation could be battered by a debate over whether to call swine flu a pandemic welcomed the agency's decision to revisit the criteria for declaring a pandemic.

Dr. Michael Osterholm said it doesn't really matter what the WHO calls the swine flu outbreak, as long as countries monitor it closely and report openly and quickly about what it is doing within their borders.

"I think all we want to do is motivate people to provide the most clear and compelling picture of what's happening in our communities around the world," said Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy.

"I don't want to see a nomenclature debate become the reason why people do or don't try to understand what's happening with the disease."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Ontario man in his 40s dies after being infected with swine flu
By Helen Branswell – 1 hour ago

TORONTO — A 44-year-old Toronto man with an unspecified chronic medical condition may be Canada's second swine flu fatality, Ontario's acting chief medical officer of health said Monday.

Dr. David Williams said the man died Saturday after undergoing a rapid physical decline at home. An ambulance was called and the man was transported to hospital. But Williams did not know whether the man died at home, en route to hospital or once he got there.

Williams said it was certain, though, that the man had not been admitted to a hospital.

He did, however, test positive for the novel H1N1 swine flu virus. But Williams said it would be premature to attribute the death to H1N1 infection at this point.

"Right now we don't know whether that had anything to do with the person's death or has contributed in any extent," Williams said during a media teleconference. "We'll have to wait for the coroner's office to investigate that."

"It is atypical," he said of the man's rapid death. "And we'd like to know what that is (about)."

Williams said he did not know how long it would take for the coroner to report on the case.

The death is the second in Canada linked to the virus. In late April a 39-year-old woman from northern Alberta died after being infected with H1N1. She too had pre-existing medical conditions. A subsequent autopsy failed to show whether the virus played a role in her death.

People with some chronic medical conditions such as heart disease and obesity appear to be at greater risk of dying from swine flu if they catch it. But the World Health Organization says about half of known deaths at this point have been in previously healthy young adults.

Ontario announced it had diagnosed 58 new confirmed cases of H1N1 since its last case update, which was issued last Friday. But Williams said that figure, which only accounts for new cases confirmed as of Friday, does not include the man who died on Saturday.

The increased cases bring the total number of confirmed infections in the province to 352, the highest by far of any province in Canada.

There are currently two people hospitalized with swine flu in Ontario, Williams said. Since the outbreak began, eight people have been treated in Ontario hospitals for swine flu infection.

The Public Health Agency of Canada issued updated figures Monday, reporting 921 cases, up 116 since the last report which was issued on Friday. The agency noted the Ontario death was not included in that figure but would be in the next update, scheduled for Wednesday.

Cases have been reported in all but one province, Newfoundland and Labrador, and two territories, Nunavut and the Northwest Territories. Other provinces with case counts in the three-digit range are Quebec with 185 and British Columbia with 115.

Williams said the most recent date of onset for a confirmed H1N1 case is May 14. But he admitted that is more a reflection of how long it is taking for tests to work their way through the system than a suggestion that transmission of the virus has stopped.

In fact, he said it appears there is still ongoing spread, though he said he believes the rate at which new cases are occurring is slowing down.

"It certainly is still circulating and we're seeing it there," he said. "It's like waves coming ashore - they tend to get shallower and shallower as you move into the summer season."

Williams said that Ontario and other jurisdictions across the country plan to continue to conduct influenza surveillance during the summer in light of the H1N1 situation. Normally sampling for influenza ceases during the summer months.

http://www.google.com/hostednews/ca...89Q8xL3j5yhCnow

http://www.google.com/hostednews/ca...6A5ZXK6wWoGS-gQ

Swine flu vaccine decisions likely to be delayed as long as possible: experts
By Helen Branswell – 14 hours ago

TORONTO — International public health officials signalled Tuesday they are playing for time on the thorny questions of how much swine flu vaccine to make and then whether to use it.

Officials of the World Health Organization and the U.S. Centers for Disease Control acknowledged they hope to put off for as long as possible these difficult decisions, made more challenging by the mildness of the H1N1 swine flu virus.

The WHO's top flu expert said he doesn't expect the Geneva-based agency to make any recommendations on whether manufacturers should go into widescale production until early summer.

And the director of the CDC's national centre of immunization and respiratory diseases said the U.S. may not take a decision on who to vaccinate until late summer or early fall.

"It is going to be a very difficult and complicated discussion if the situation remains as it does at the time when decisions have to be made," admitted Dr. Keiji Fukuda, the WHO's acting assistant director general of health security and environment.

Fukuda was referring to the fact that while the new virus has shown itself adept at spreading from person to person and country to country, the illness it causes is mild in the overwhelming majority of cases.

Dr. Anne Schuchat, the CDC's director of immunization and respiratory diseases, said the U.S. will proceed in a step-wise manner, separating out the making of vaccine from the decision to use it.

"We don't intend to make a decision about immunization until as late as possible," she said during a media briefing.

"The idea would be to learn all that we can from the Southern Hemisphere about the ongoing severity and problems associated with this virus and ... to understand whether a vaccine that is tested is even safe and beneficial."

Vaccine makers cannot turn to widescale production of H1N1 vaccine until late June or early July, Fukuda said from Geneva, adding he doesn't expect the WHO to pronounce on what it thinks is advisable before then.

Given the production limitations faced by the vaccine manufacturing sector, these decisions come at a cost. Full-bore production of swine flu vaccine would limit future supplies of seasonal vaccine. And it would likely shelve efforts by a number of countries to stockpile vaccine to protect against the dangerous H5N1 avian flu virus.

"It is not a no-brainer about what to do with vaccine," Fukuda said in a recent interview, referring to the fact that the unexpected mildness of what may be the century's first flu pandemic has thrown a spanner into the works of years of pandemic planning.

"It's clear that there's going to be a lot of wrestling about how much might be made for seasonal, how much might be made for H5(N1), how much might be made for H1(N1)."

Canadian officials have been largely silent on whether this country will make H1N1 vaccine and who will be vaccinated if it does.

Chief Public Health Officer Dr. David Butler-Jones said early in the outbreak that the Public Health Agency of Canada was in discussions with vaccine giant GlaxoSmithKline and others about potentially ordering vaccine.

Canada has a long-standing contract with GSK, guaranteeing Canada first access to pandemic vaccine made at the manufacturing facility in Ste-Foy, Que.

While Canada deliberates on whether to activate the contract, U.S. officials have already asked GSK and several other manufacturers to make enough vaccine to protect 20 million Americans. GSK will make its portion of the U.S. contract at the Ste-Foy plant, a company spokesperson has confirmed.

But the Public Health Agency said Canada is still first in line for production at that plant - even though a decision to order vaccine has not yet been taken.

"Our contract with GSK requires the manufacturer to develop and produce vaccine for Canadians on a priority basis, which means Canada will be the first to receive the vaccine produced in this country," the agency said in an emailed statement.

In Europe, several countries have announced they will buy vaccine from GSK, made at a facility in Dresden, Germany.

Britain, France, Belgium and Finland have announced they will buy H1N1 vaccine, but in the case of Belgium and Finland at least, the contract is for vaccine to stockpile, and use if necessary.

Fukuda said the WHO would reconvene its expert panel on vaccine issues and ask it to weigh the evidence before the WHO makes any decisions. But that could still be several weeks away.

"Giving some indications from WHO in terms of H1 (vaccine) production will be important, I think, sometime during the summer. But right now I don't think I can be much more precise than that," he said.

The WHO will also survey experts on another issue - how to rewrite the criteria by which it would declare a pandemic, Fukuda revealed Tuesday. He said the consultations, by phone and video links, will take place over the next few weeks.

He did not close the door to WHO declaring a pandemic before that process is complete, saying if there were "very large outbreaks with very large numbers of people, then I think that in and of itself could well be enough to take us up to pandemic Phase 6."

The WHO announced last Friday that in response to pressure from a number of member states, it would rework its pandemic criteria to reflect disease severity and magnitude of spread.

Currently the move to Phase 6 - a pandemic on the WHO scale - only requires evidence of community spread in two WHO regions. The experience with H1N1 has revealed that community spread is not well defined, and that a number of countries don't feel spread of a mild virus necessarily qualifies as a pandemic.

While those countries want the Phase 6 criteria to reflect severity of the disease, the WHO had previously resisted the notion. And Fukuda warned working it into the alert scale will not be easy.

"Capturing this is really a very difficult activity to do," he insisted. "How you capture severity so that it is relevant for all countries at the same time is a very difficult concept to capture."

Perhaps declaring an official pandemic is like pornography. It's difficult to define with words, but you know it when you see it.

__________________ 
.
.

Roscoe and Miss Priss

Anteaters caught (human) H1N1 flu in zoo outbreak, expanding range of wily virus
Helen Branswell, Medical Reporter, THE CANADIAN PRESS
1/06/2009 6:30 PM
http://www.winnipegfreepress.com/li...wily-virus.html


TORONTO - Chalk up another species for the wily flu virus.

Humans, horses, dogs, whales, seals, birds, cats, ferrets and even raccoons are known to be susceptible to the tiny eight-gene viruses. Researchers in Tennessee have now added giant anteaters to that list.

"Who would have thunk it?" senior author Dr. Melissa Kennedy says with a laugh. "We were pretty amazed."

The February 2007 outbreak, involving 11 adult giant anteaters at Tennessee's Nashville zoo, is reported in an article that will be published in the July issue of the journal Emerging Infectious Diseases. All the anteaters survived the illness.

Beyond the initial "Even anteaters?" reaction, some who study influenza profess to be less taken aback than Kennedy and her co-authors. The virus is so unpredictable, scientists who work in the field expect the unexpected.

"Mainly it's an indication of how much we don't know, and the promiscuity of flu in terms of being able to change hosts and infect and adapt to new situations," says Dr. Jeffrey Hall, who last November added raccoons to the lengthening list of flu's hosts.

The description of the illness in the article creates a vivid mental picture. The extraordinary looking animals suffered "severe" nasal discharge, congestion, loss of appetite and lethargy.

Knowing those nasal discharges could provide hints as to what was afflicting the animals, veterinary staff at the zoo took diagnostic samples and sent them off to the University of Tennessee's college of veterinary medicine in Knoxville.

"Now that's a nasal swab, yes indeed," says Kennedy, who is the clinical virologist at the college.

The zoo's staff didn't know what the animals were suffering from. So Kennedy's team applied bits of the nasal secretions to a variety of different cell cultures, hoping something would grow.

"We had no idea what an anteater is most closely related to, and what cell lines to use. So we threw it on absolutely everything," she explains.

To their surprise, two of three samples produced influenza A viruses of the H1N1 subtype - the human type, not the new swine flu virus.

Sequencing of the genetic blueprints of four of the eight genes of the viruses showed they were virtually identical to the human H1N1 viruses circulating in Tennessee at the time.

Kennedy says there were some small mutations - a few amino acid changes - but it's unclear if they contributed to the virus's ability to jump to a new species. Testing of blood samples taken later from two of the animals confirmed they had antibodies to the virus.

Because it had been an unusually cold winter, the animals had been housed indoors when the outbreak happened. They had no contact with other animals, and limited contact with people.

Though the theory hasn't been proven, the investigation into the source of the sickness points to their main caregiver, who was working at the time with an undiagnosed respiratory illness.

It's not clear whether all the animals caught the flu from the zoo worker, or if some of the spread was anteater to anteater.

"There are many confounding variables to define how this particular virus spread so I can not state beyond speculation how that happened or may have happened at this point," Dr. Sally Nofs, the veterinary services director for the zoo and the first author of the study, says via email.

On the surface of it, it seems unlikely the anteater findings would have any implications for human health. Few of us consort with giant anteaters, which are either endangered or extinct in some regions of the world.

But Hall and others wonder whether, given these findings, there may be undiscovered pools of influenza viruses that circulate among mammals that haven't been identified as natural hosts for flu viruses. If that's the case, might an interplay of viruses among animals species - anteaters to feral pigs, for instance - contribute to the rise of new genetic variations that eventually work their way into humans?

"Clearly they get human influenza so right now we would say that the risk is to the anteaters," says Hall, a research virologist with the U.S. Geological Survey's National Wildlife Health Center in Madison, Wisc., who admits he's no expert on the natural ecology of anteaters.

"But is there an anteater flu out there that we don't know about?"

An avian influenza expert at the University of Minnesota says science assumes viruses from birds and pigs are the major players in the evolution of new flu viruses that make their way into humankind. But Dr. David Halvorson says maybe that's because that's what has been studied.

"So who's to say that maybe we don't have more work to do?" Halvorson says.

"We don't really know how many species of animals are susceptible to these flu viruses. We've only just looked in a few."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

WHO will stick with criteria for declaring pandemic, but also assess severity
By Helen Branswell
http://www.google.com/hostednews/ca...jOmHBa9O23D6IXg


TORONTO — The World Health Organization signalled Tuesday it will not attempt to rewrite the definition of a pandemic to make disease severity part of the criteria for a pandemic declaration - something it hinted is coming soon because of swine flu.

But the Geneva-based agency said it will try to help countries mitigate anxiety over the declaration of a pandemic by devising a severity index and issuing advice on what countries should and shouldn't do in response to it.

The WHO's top flu expert said the idea is to help countries - some of which appear to feel locked into pandemic plans designed to respond to a far more severe pandemic - to "better calibrate their actions."

"One of the things that we hope to do by providing this kind of tailored guidance is really to help reduce some of the more drastic actions which may be uncalled for, but also to provide guidance to countries as to what steps they can take," Dr. Keiji Fukuda, WHO's acting assistant director general of health security and environment, said in a media teleconference.

"I think that some of the things that we would like to do is improve how we're able to communicate information, how we're able to provide guidance on what can be done in this situation so that actions that are really unnecessary and potentially anxiety provoking and unhelpful can really be modified or curtailed," he said.

Asked for examples of drastic or unhelpful actions, Fukuda pointed to the culling of pigs and shunning of pork products seen earlier in the swine flu outbreak.

The WHO's criteria for declaring a pandemic is based on the geographic spread of a new virus to which people have little or no immunity. The six-step pandemic alert scale says a pandemic will be declared when it is clear such a virus is spreading in the community in countries in two different WHO regions.

Currently the WHO says only North America has sustained community spread, though a number of countries appear to be on the cusp. Fukuda, who said a Phase 6 call is edging closer, mentioned Britain, Spain, Japan, Australia and Chile by name.

Confirmed community spread in any one of those, except Chile, would tip the balance for a pandemic call. (Though it is in the Southern Hemisphere, Chile is in the same WHO region as North America.)

However, recently a number of countries - some attending the meeting of the Association of Southeast Asian Nations, some attending the recent World Health Assembly in Geneva - urged the WHO to add severity to the criteria for a pandemic, suggesting the mild swine flu virus shouldn't make the cut.

On Monday, the WHO held a day-long series of consultations with more than 30 flu and public health experts from 23 countries around the globe.

In the end, Fukuda said, the consensus was that the current definition of Phase 6 should stand. But it was also agreed that a statement on severity should accompany the call, one that would hopefully help people understand that all pandemics aren't like the 1918 Spanish Flu.

He said the WHO will try to find a useful way to assess severity, suggesting a three-point scale is under consideration. The severity rating could change over time, he said, if the virus begins to behave differently or it takes a higher toll in different parts of the world.

An American influenza expert who was involved in the discussions said this is the right way to go to try to deter countries from taking actions that would cause more harm than good in the current circumstances.

Dr. Arnold Monto of the University of Michigan said pandemic planning was driven by concerns over the dangerous H5N1 avian flu virus. Consequently some countries have plans that may require them to take steps they don't need to take in response to this virus at this time.

"And that's the reason why a Phase 6 call has to be mitigated by a statement about the severity - even though it is difficult to do," Monto said from Ann Arbor.

"Even though most of us kept saying that H5N1 and a 1918-like pandemic is of questionable probability ... we really had little way of saying exactly what it was going to be," he said.

"We'd come up with predictions, but only on the basis of the knowns. And flu always surprises us in coming up with unknowns. Things that were unrecognized before."

The consultation also revealed that so far in the Southern Hemisphere - which is going into its winter - the virus is behaving as it has in the Northern Hemisphere. The disease patterns and unusual age distribution of cases appears to be the same, Fukuda said.

But there is early evidence which, if borne out, may support the experts' belief swine flu is a pandemic strain.

Fukuda said initial testing from Chile suggests the new virus has virtually crowded out the previous human strains of influenza.

"This has been one of the patterns that has been seen with the earlier pandemics. So I think that it bears very close watching," he said.

New strains have a biological advantage, because so many people are susceptible to them. In the 1957 pandemic, the new H2N2 virus became dominant, forcing the previous virus, an H1N1, back into nature. When H3N2 emerged in the 1968 pandemic, H2N2 disappeared.

This is one of several features about this virus that gives flu experts pause, Fukuda said, pointing also to sustained spread in the Northern Hemisphere in what is typically flu's off season and high attack rates and severe illness in a demographic group - young healthy adults - not typically at high risk from flu. These features too were seen in earlier pandemics.

"We have an unusual situation right here," he said.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

WHO's Chan aims for balance as agency steers world toward possible pandemic
By Helen Branswell – 6 hours ago
http://www.google.com/hostednews/ca...odd7ZakE6uVYs8g


TORONTO — The head of the World Health Organization has defended the agency's handling of the swine flu outbreak, insisting its credibility as a science-driven organization has not been compromised.

Dr. Margaret Chan suggested that while she has listened to concerns of member countries and tried to give them political cover under which to dial back pandemic plans, she has withstood pressure to redefine a pandemic to exclude the relatively mild new H1N1 virus.

"There is no question of WHO compromising science," Chan said from Geneva on Thursday in a wide-ranging interview with The Canadian Press.

"I did not compromise."

Chan also revealed: she thinks swine flu needs a new official name; that WHO thinks it can secure 10 per cent of pandemic vaccine doses from the start of production for developing countries; and that she's struggling to strike the right balance in messages about the risks of swine flu for all her various audiences.

She confirmed that she has convened a teleconference for Friday of the WHO's emergency committee - a group of experts that advises her on issues, including the declaration of a pandemic.

The intent, Chan said, is to inform the group about what the WHO learned Monday in round-the-world consultations with the various WHO regional groups as well as influenza and public health experts.

Based on the information and advice it received, the organization rejected a call from some countries to redefine its pandemic alert scale to make disease severity part of the criteria for declaring Phase 6, a pandemic.

"I don't want to keep them (the emergency committee) in the dark," said Chan, her voice raspy from an ongoing battle with laryngitis {signature symptom of swine flu...}.

Asked if she'll ask the committee's advice on whether or when to call a pandemic, she replied:

"Well, if the evidence is getting closer, I may also take the advantage. But the whole idea was to update them first," Chan said.

Earlier this week media reports suggested the agency has decided to declare swine flu a pandemic and Chan would announce that step within 10 days. But on Thursday, she said she's following the virus's timetable, not vice-versa.

"Well, you take it from me, because in the organization we have real scientists and we have people who think they know what is going on. But of course I need to look at everything," Chan said.

"And if I don't push the button, we're not going to (Phase) 6. The virus will dictate the timing - not Margaret Chan and not Margaret Chan's staff."

The world has been one step away from a pandemic for over a month, despite spread of the virus in that time to 66 countries from eight when the WHO raised the alert level to Phase 5 on April 29.

That delay has brought criticism from some quarters that politics, not science, are driving the WHO's decisions on what to do about this outbreak.

"As long as we sit at Phase 5, given what the virus is doing . . . it's an issue that looms largely on WHO's credibility as a science organization," said Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy.

The agency's top flu expert, Dr. Keiji Fukuda, has said the WHO is looking for evidence of real community spread of the virus in a country outside of the Americas. But he has been vague about how much community spread is enough community spread to trigger the call.

Chan too avoided locking in to a definition.

"This is not solid science," she said, adding she would feel confident of the call if the WHO starts hearing reports of "many cases" in people who haven't travelled to affected countries, haven't ties to schools where transmission is occurring and haven't attended large functions, like weddings, with confirmed cases.

"I have a high level of respect for science," Chan said.

"But having said that, especially in times of uncertainty, if you go too fast people will say that you cried wolf or you overreacted. If you go too slow people will say that you're complacent, are you dillydallying? No."

"And that is why I'm saying: Managing a new disease by definition is very difficult to understand and you need to find the right balance."

She said she has to listen to member countries, some of which reportedly seem to feel they must follow to the letter pandemic plans drawn up with a far more severe virus in mind.

Chan said she tried to give them political cover for scaling back pandemic responses by adding a line not written by her speech writer in her closing address to last month's World Health Assembly. Countries should be able to gauge their plans and actions to their own situations and the behaviour of the virus, she said.

Chan is constantly consulting with experts and public health authorities on the ground in affected countries. The voices that have denied this new virus has pandemic potential are growing fainter, she noted.

"I ask the question: 'Do you feel that this virus will burn out?' I don't get a positive answer."

Chan also defended the WHO's decision to agree to stop calling the virus "swine flu" - a point pressed on her personally and strenuously by her counterparts at the UN's Food and Agriculture Organization and the World Organization for Animal Health, better known as the OIE.

Pork sales were plummeting and at least one country, Egypt, culled several hundred thousand pigs in a misplaced belief pigs posed a transmission risk.

The WHO declared it would call the virus influenza A/H1N1, a problematic decision given the fact that there is already a family of human flu viruses with the same name.

The difficulty created by having two viruses - a human and a new-to-humans one - sharing a name is becoming increasingly evident. Last week editors of the journal Eurosurveillance called for a quick renaming of the new virus.

"On my part, I'm absolutely convinced that we need to do that," Chan said, adding WHO staff have had some consultations with experts on what a scientifically correct label would be.

Some thoughts on the swine flu situation from WHO Director General Dr. Margaret Chan:

On what consultations with scientists suggest about the future of the virus:

"I ask the question: Do you feel that this virus will burn out? I don't get a positive answer. Nobody tells me yes, yes, yes, yes."

On why she's holding off declaring a pandemic:

"I have a high level of respect for science. But having said that, especially in times of uncertainty, if you go too fast people will say that you cried wolf or you overreacted. If you go too slow people will say that you're complacent.... And that is why I'm saying: Managing a new disease by definition is very difficult to understand and you need to find the right balance."

On how much community spread of the virus in a new WHO region would be required to convince her the definition of a pandemic has been met:

"This is not solid science."

On when a pandemic call might come:

"If I don't push the button, we're not going to (Phase) 6. The virus will dictate the timing - not Margaret Chan and not Margaret Chan's staff."

On whether swine flu's official name - H1N1 - should be changed to avoid confusion with the seasonal virus of the same name:

"I think that is an appropriate thing to do.... On my part, I'm absolutely convinced that we need to do that."

On whether the WHO can ensure there will be some pandemic vaccine for developing countries:

"All in all I think it is reasonable to expect that we would get about 10 per cent of the real time production for me, to be channelled to developing countries."

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

WHO: Swine flu 'very close' to pandemic
Tue, June 9, 2009
By Helen Branswell, THE CANADIAN PRESS
http://lfpress.ca/newsstand/News/Ca...09/9738991.html


TORONTO — The World Health Organization is very close to declaring that the swine flu outbreak is a pandemic, the agency’s senior influenza expert said Tuesday.

In fact, Dr. Keiji Fukuda all but acknowledged that a pandemic is underway, saying there is a great deal of community spread in the virus in at least one part of Australia — a fact which under the WHO’s definition should trigger a pandemic call.

Fukuda said the agency is working hard in the time before a pandemic declaration to help countries and people understand the significance of moving to Phase 6 — a pandemic — on its pandemic alert scale.

“It does not mean that the severity of the situation has increased or that people are getting seriously sick at higher numbers or higher rates than they are right now,” Fukuda, the WHO’s acting assistant director general for health security and the environment, said from Geneva during a media teleconference.

“It’s a little bit paradoxical. You would think that by going up a scale, that it would mean that the level of concern should go up. But really what the going up the scale would mean is that we are seeing greater spread of the virus.”

Fukuda said the WHO wants to avoid a “blossoming of anxiety“ which might lead to reactions — he pointed to earlier culling of pigs — that would do more damage than good.

The WHO’s pandemic alert scale — which has come under a lot of criticism since the emergence of the swine flu outbreak — says that a pandemic will be underway when there is evidence of sustained community spread in countries in two different WHO regions.

Confirmation of community spread in Australia or in a European country would therefore put this virus over the pandemic threshold.

Fukuda also suggested the pandemic declaration, when it comes, will be accompanied by a statement describing the pandemic as being of moderate severity.

He said a pandemic is likely to cause varying degrees of severity of disease, depending on the health status of the people infected.

Fukuda noted the WHO is very concerned about reports from Manitoba of severe illness among aboriginal people who have contracted swine flu, saying that is the type of development that was seen in previous pandemics.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Analysis suggests first cases of swine flu happened months before spotted
By Helen Branswell – 1 day ago
http://www.google.com/hostednews/ca...5Hps_-_tYIjooug


TORONTO — A new analysis of swine flu viruses suggests the first cases in humans probably started several months before authorities recognized there was an outbreak.

The study, the second to try to pinpoint from genetic data when this strain of viruses emerged, also said the viruses may been circulating in swine, possibly in Asia, for about 10 years before making the jump into people.

First author Gavin Smith, a virologist and evolutionary biologist at the University of Hong Kong, said there are still too many missing links in the genetic data to draw firm conclusions, but the viruses may have jumped into people in late 2008 or early 2009, or even as far back as last August.

"But basically the underlying message is the amount of missing data means we can't answer most of these questions," Smith said from Hong Kong.

"And it's really going to take more (genetic) sequence data, particularly from North America and probably from quite a number of years before we can fully answer these questions."

Whether those data exist is not yet clear, he admitted. But scientists with unstudied swine flu viruses in their lab freezers have been urged to dig out their neglected collections and look for viruses that could fill in the gaps in this virus's family tree.

Smith said he and his co-authors found the nearest relatives of the viruses uncovered to date, 15 H1N2 swine flu viruses isolated in Hong Kong. The new pandemic virus is an H1N1 virus, which shares seven of its eight genes with those H1N2s.

They reported the finding and their analysis in a letter to the journal Nature which was published electronically on Thursday.

Smith said all the various pieces of the H1N1 genetic puzzle - the previously unseen constellation of genes - have not been found in North America.

The swine flu virus is what is called a reassortant, a virus containing genes swapped among several previous viruses. It is made up of flu genes from pigs, birds and people and the swine flu genes come from viruses circulating in North America and in Eurasia.

"The only place where you've got the necessary (genetic) diversity so far from what's being described basically has been in Asia," he said. "It raises the possibility that the reassortant was generated here."

The lack of evidence of these different genes in swine viruses in North America may mean they didn't or don't all exist here. Or it may simply mean that there hasn't been enough surveillance for flu viruses in North American pigs to pick up viruses containing these genes.

The international team of authors said the work highlights the need for ongoing and systematic surveillance of influenza in swine herds.

And they suggested movement of live pigs between Eurasia and North America seems to have facilitated the merging of a variety of flu viruses, culminating in the new pandemic strain.

Smith said that even though the Hong Kong viruses are closer to the outbreak virus than others spotted so far, "they're still very, very, very divergent."

The authors also said their findings do not support an earlier hypothesis that the virus might have been engineered in a laboratory and released by mistake. That theory was also dismissed by the World Health Organization and a number of leading influenza experts.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Blood tests rule out prime suspect in pig farm swine flu case
By Helen Branswell – 4 hours ago
http://www.google.com/hostednews/ca...6O5clVSltHUFP5A


TORONTO — Officials have ruled out the prime suspect in the mystery over how a herd of Alberta pigs was infected with the new swine flu virus sweeping the globe.

A spokesperson for Alberta Health and Wellness says blood tests have shown that a carpenter who worked for half a day on the farm before heading home with flu-like illness did not introduce the virus to the herd.

"We've determined it wasn't the carpenter," says spokesperson Howard May.

The workman, Adrian Blaak, declined to be interviewed about the findings. Previously he'd said he did not believe he had infected the pigs, which were raised on a farm near Rocky Mountain House.

Blaak had just returned from a trip to Mexico when he went to do a job at the farm on April 14. At that point the new H1N1 virus was already circulating in parts of the Mexico, but the world was not yet aware a new flu virus was on the move.

The World Health Organization declared Thursday that the new virus has triggered a pandemic, the first in 41 years.

May says provincial health officials are starting to believe they may never find out how the virus made its way into the herd, the only pigs anywhere in the world to have tested positive for the new virus to this point.

"Since serological (blood) tests indicated the carpenter had not had H1N1, someone else must have brought it in, but it is unlikely we will ever be able to pinpoint exactly who," says May.

Officials had earlier said several members of the family that owned the farm were sick a couple of days before Blaak worked there briefly.

Others fell ill after the pigs started to display signs of being sick, leading authorities to suggest the virus may have gone from a person to pigs and back to people. Nasal swabs taken from people on the farm tested negative, but blood samples were taken to look for antibodies to the virus.

Whether that work is completed and what the tests showed if it is hasn't been made public.

Recently the farmer who owned the herd announced he had destroyed his pigs, because he could not sell the animals. The farm had been under quarantine since late April, when the outbreak first came to the attention of the Canadian Food Inspection Agency.

Sporadic tests continued to find evidence of possible ongoing circulation of virus in the herd, says Dr. Jim Clark, the national manager for disease control for CFIA's animal health division.

Over the course of the weeks of quarantine, testing found diminishing but still present viral DNA, which may or may not have meant infectious viruses were still spreading among the pigs, Clark says.

He says the CFIA's lab in Winnipeg was only able to isolate live viruses from the pigs when they were sampled at the beginning of the investigation. Genetic sequencing of those viruses showed they are virtually identical to the swine flu viruses circulating in humans.

Clark says CFIA would like to be able to determine how the pigs got infected. But he says the agency isn't getting much co-operation from human health counterparts responsible for testing the people involved.

"So far we haven't been able to get a whole lot of information from them," he says, adding that while he's not sure why that is, privacy concerns may play a role.

"There's a need to know from a scientific perspective, to try and I guess to get a complete understanding of the epidemiology behind this, but at the same time not wanting to put this (farm) family under any more duress than they've already suffered."

Clark says he expects there will be other opportunities to learn about how this virus behaves when it gets into pig populations. With continued spread around the world, he suggests, "it's invariably going to result in the exposure of pigs in other countries and in other places."

But whether farmers will admit to it is another issue. The family who owned the Alberta herd has reportedly paid a heavy price, financially and personally. Pork sales are down, even though health officials have repeatedly stressed people can't get swine flu from eating pork.

Though the CFIA has asked swine producers and veterinarians to be on the lookout for possible infection in herds and to submit any unusual flu viruses for further testing, "very little" is coming forward, Clark admits.

"As soon as there's a disease outbreak, everybody gets real nervous about what might be happening," he says.

The lengthy quarantining of the Alberta farm - and the unfortunate outcome - may discourage farmers from reporting flu-like symptoms in their pigs. There are a variety of influenza virus subtypes that infect pigs and outbreaks, while common, are not a long-term threat to the health of pigs.

"I think right now the production community is looking and saying 'OK, when you can tell us what you specifically want to do about the situation, then we might be in a situation to want to submit samples to find out what's going on,"' says Clark, who admits he has some sympathy for that position.

"From a purely scientific perspective, I'd love all the samples in the world to be coming in and get as much background information as we can about where this virus may currently be occurring anywhere in the swine population," he says.

"On the practical side, without having a clearly defined policy that is able to get us out of the situation as quickly as possible and define all the risk factors, I'm saying 'Well, maybe I don't really want to know about too many things that are going on right now until we can get more definitive information about what we need to be concerned about."'

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Swine flu hitting northern Ont. First Nations; Lots of flu, Sandy Lake chief says
By Helen Branswell – 14 hours ago
http://www.google.com/hostednews/ca..._jYgamcSstF1rQQ


TORONTO — Swine flu has started to circulate in First Nations communities in northern Ontario, with hundreds of people falling ill on the Sandy Lake First Nation reserve.

Chief Adam Fiddler said Sunday that an enhanced contingent of nurses and a doctor were distributing the antiviral drug Tamiflu to people who were ill.

"We do have a lot of sick people... 120 yesterday alone and they saw many last night and all day today," Fiddler said by phone from the community.

He said people don't seem to be suffering more severe disease than is seen during regular flu seasons. The challenge for the community is the fact that a lot of people are sick at the same time, which is why extra nurses and a doctor were flown in to help.

"So far I don't see anything more severe than a bad case of influenza," Fiddler said.

The community is located on Sandy Lake in northwestern Ontario, near the Manitoba border.

Fiddler said half of the kids attending the community's school were out sick bthis week and a decision was taken to close the school.

Local authorities are urging people try to avoid exposure to those who are sick, but that's easier said than done in the fly-in community of nearly 2,700 people.

"When ... you're in the city you may have two or three people and it's easy to say: Stay home," Fiddler said.

"But when you have three families living in one house, you're all going to be in contact. And it's more difficult to contain here in the community."

Authorities have also asked people in Sandy Lake not to travel to other First Nations communities along the lake, Kee-Way-Win and Koochiching, so as not to spread the virus.

Sandy Lake First Nations is a community is Oji-Cree, a combination of Ojibwa and Cree. It is not far from St. Theresa Point, the Manitoba community that hit the news last week with seemingly a serious outbreak of swine flu.

More than two dozen people from St. Theresa Point have been flown to Winnipeg for treatment.

Fiddler said five or six people from Sandy Lake have also been evacuated for treatment, though none was suffering from life-threatening illness. His 11-year-old son was one of them. The boy, who has severe asthma, was flown out for care early last week, but has since returned home - as have most of the people who were flown out for treatment.

The new flu virus has probably been circulating in the community for a couple of weeks, Fiddler said, but was only confirmed through laboratory testing mid-way through last week.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Flu drugs relatively safe for breastfeeding women, should be used: Study
Published Wednesday June 17th, 2009
By Helen Branswell
The Canadian Press
http://dailygleaner.canadaeast.com/.../article/701811


TORONTO - The antiviral drugs Tamiflu and Relenza are relatively safe for use in pregnant and breastfeeding women, say the authors of review of data that includes previously unpublished evidence.

The analysis, published electronically on Monday by the Canadian Medical Association Journal, suggested Tamiflu is the best bet for pregnant women, but either drug can be used safely by breastfeeding women who come down with influenza.

The review may assuage concerns of women who contract swine flu and are worried about whether or not to use antiviral drugs. Pregnant women are at higher risk of complications than their non-pregnant peers when they catch seasonal flu. Evidence from some previous pandemics suggests they can be hit disproportionately hard by a strain of pandemic influenza.

"During the current pandemic, we shouldn't hesitate to treat those patients at increased risk," said senior author Dr. Shinya Ito, head of the division of pharmacology and toxicology at Toronto's Hospital for Sick Children.

"In terms of risk-benefit ratio I think it's very clear that the benefit is much more significant to use the drug for pregnant women, even in the first trimester."

The authors, from the Motherisk Program at Sick Kids and the Japan Drug Information Institute in Pregnancy, examined the available data on antiviral drug use in pregnant and breastfeeding women.

They admitted the evidence is limited and said it will be important to monitor what happens with antiviral drug usage by pregnant women during the pandemic.

In addition to looking at reports of use filed to the drugmakers after the fact, they found unpublished Japanese data that followed 90 pregnant women who took Tamiflu during the first trimester of their pregnancies. The first trimester is the period when concern is greatest that chemicals or drugs a mother is exposed to or takes could have a detrimental effect on the developing fetus.

Of those women, only one gave birth to a child with a birth defect. The rate of birth defects in the general population is between one to three per cent. Given that the rate among Tamiflu users isn't higher, it suggests the single case occurred by chance, not as a result of exposure to the drug.

In another study, scientists used a human placenta to see if Tamiflu introduced to the placenta would flow to the fetus. Ito said it took a high concentration of Tamiflu to see even small concentrations of drugs coming out the other end.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Asthma, diabetes, obesity may lead to dire outcomes
Fri, June 19, 2009
By HELEN BRANSWELL, THE CANADIAN PRESS
http://lfpress.ca/newsstand/Today/2...850061-sun.html


TORONTO -- Whether speaking of a 58-year-old man or a 38-year-old woman or a little boy of nine, officials announcing swine flu deaths are almost always quick to note "underlying health conditions" may have contributed to the fatal outcome.

Asthma, heart disease, diabetes, maybe even obesity are among the conditions used to help explain why swine flu infection is hospitalizing and killing younger people, people who would be expected to make a full recovery from seasonal flu.

It could create the impression only the sickly are dying from the new H1N1 flu virus -- a claim no one is making. To the contrary, many, including the World Health Organization, say between one-third and one-half of swine flu deaths have occurred in people who were previously healthy.

But how healthy is previously healthy? The answer depends on who you ask.

Dr. Anand Kumar is a critical care specialist who has been treating swine flu cases in embattled intensive care units in several Winnipeg hospitals.

He says a small portion of the ICU patients look like flu's typical victims, people with health conditions known to be badly exacerbated by influenza. But more are younger and -- until they got sick -- healthier than flu patients hospitals typically see during a regular influenza season.

"For the most part, these young, relatively healthy people aren't marathon runners," he admits. "They're normal people. If you asked them 'Are you healthy?' they'd say 'Yeah, pretty healthy.'"

Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency, believes the constant refrain of "underlying conditions" bespeaks a sort of wishful thinking, an attempt to explain away the unusual age range of the people the new virus is sending to hospital or to the morgue.

"That's the story that I think people haven't really registered," says Gardam. "We're clinging to these 'Oh, they had underlying illness, therefore it's OK.'"

"But . . . I would argue the 30-year-old with mild asthma -- how big of an underlying illness is that compared to, again, the 80-year-old with bad lung disease from smoking, who's got heart disease? That's the usual group that unfortunately gets really sick with flu, not this healthy adult group."

You'll find little argument this virus is causing more severe disease in people far younger than those normally hospitalized and killed by flu.

"This is not a disease of older adults. There's no question," says Dr. Allison McGeer, an influenza expert with Toronto's Mount Sinai Hospital.

"For people under 50, this is a significantly more severe disease than seasonal flu. For people over 50, it's much better," she notes.

But are the people under 50 who are being badly hit by the virus specimens of perfect health or are many of them shaded by the broad umbrella known as "pre-existing health conditions?" "A lot of that is about labelling people," McGeer admits.

"Half of me doesn't want you to think you're diseased if you have asthma, and the other half of me wants you to get your flu vaccine because you're at increased risk."

One such potential new risk factor is obesity. An early study from the U.S. Centers for Disease Control suggested it may be contributing to poor outcomes in people who contract the new H1N1.


Flu risk factors

A number of health conditions and lifestyle behaviours are known to increase a person's risk of becoming severely ill and even dying from influenza. They include:

Lung conditions: Flu is tough on people with chronic obstructive pulmonary disorder or COPD. Likewise asthma -- 41 per cent of hundreds of hospitalized swine flu patients in New York City were asthma sufferers.

Heart disease, diabetes and diseases that compromise the immune system: People with these conditions have a harder time fighting off flu.

Pregnancy: Not an illness, but a time when a woman's immune system must strike a fine balance between protecting her and not rejecting the foreign tissue she's carrying. Past pandemics have been hard on pregnant women and a number have already died from swine flu.

Smoking: Anything that weakens the lungs makes flu a more dangerous foe.

Obesity: Not traditionally recognized as raising one's risk from flu, obesity is on the table as a potential complicating factor with swine flu. Anecdotally doctors treating patients say they are seeing more obese people among the severe cases. Some say it's just the morbidly obese, others say even people 20 or 30 pounds overweight seem harder hit. Experts are watching, but a link hasn't been confirmed.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Bringing pandemic vaccine to flu clinics first requires animal, human testing
By Helen Branswell – 2 hours ago
http://www.google.com/hostednews/ca...LVFM4Lz_K0huWFg


TORONTO — If you went by statements from the pharmaceutical industry, you might be tempted to think it was nearly time to roll up your sleeve for a swine flu shot.

In the so-called race to produce pandemic vaccine, several companies have declared themselves frontrunners, suggesting their products are on the verge of being ready.

But are they on the verge of being ready for use? Maybe not just yet.

"I've seen a couple of press releases ... saying `By early summer we're going to have something.' They may have something off the production line," Halifax vaccinologist Dr. Scott Halperin says with a chuckle.

Making vaccine and convincing regulatory agencies that the stuff is safe to inject into humans are separate matters. That is always the case but is especially true when the vaccine in question is to protect against swine flu.

The last time mass vaccination against a swine flu virus was undertaken, a spike in cases of Guillain Barre syndrome among those vaccinated led U.S. authorities to abandon the program.

It is still not known why that 1976 vaccine seemed to trigger an elevated number of cases of the paralyzing condition. (The syndrome, which is linked to several natural infections and to some vaccines, generally reverses itself over time.)

That incident casts a long shadow over discussions about a 2009 swine flu vaccine.

"Yes, it does," Halperin says. "Certainly it makes people plan to monitor very carefully with the new vaccine."

There are lots of questions regulators like Health Canada or the U.S. Food and Drug Administration will want answered before they give the go-ahead to pandemic H1N1 vaccines. And the clinical trials needed to get those answers take time.

"We can't hasten the time frame that you need to do clinical trials to get the fundamental, basic information that you generally need," says Dr. Tony Fauci, head of the U.S. National Institute for Allergy and Infectious Diseases.

NIAID is one of the U.S. National Institutes of Health. It will be working with the FDA and with U.S. licensed flu vaccine manufacturers to determine research needs for the new vaccine. The aim is to fill data gaps individual companies won't or can't undertake to plug.

Those include looking at vaccine safety in potentially more vulnerable groups like infants, people who are immunocompromised and pregnant women.

Another question NIAID may try to answer is whether it would be possible to compress the interval between two swine flu shots, if, as suspected, two shots are needed.

Companies will likely test a regime that would see two shots given with a 21- or 28-day interval. But if the pandemic starts to worsen and it appears waiting so long would be unwise, could the same effect be achieved with two shots given closer together? Companies probably won't do that research, but NIAID could, Fauci says.

The types of studies companies will need to do are the ones that answer the core questions about a vaccine. Is it safe to use in humans? Does it elicit an immune response - rising levels of antibodies - that would suggest it will be protective? What sized dose, and how many doses, does it take to do so?

Getting those answers means weeks of work by individual companies. They'll start by injecting their products first into animals, then into small numbers of human volunteers to determine that the vaccines are safe.

Once that is clear, larger trials will be needed to determine how large a dose people need to get a good immune response. That could take a couple of months, says an expert who has done many trials on flu vaccine.

"No matter how quickly you enrol the subjects in the study, even if everybody was enrolled on the same day, it's still going to take time to get the study done and get the data," says Dr. John Treanor, who teaches at the University of Rochester in northern New York.

That work should answer the question of whether people might get enough protection from a single shot or whether, because this is a new virus for our immune systems, two shots will be required. Experts hope for the former, but suspect the latter.

The industry has years of experience making flu shots and there is a high degree of confidence a successful swine flu vaccine can be made. But each flu virus has its own quirks and no one knows yet how well this new one will do at eliciting an immune response in people.

"Until they actually get it and start putting it into some animals and humans, they're not going to know for sure," says Halperin, a professor at Dalhousie University and principal investigator of the newly formed Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network.

Because seasonal flu shots have to be updated on a regular basis, regulatory agencies have a sort of fast-track process in place for these vaccines.

As long as nothing about the production of the vaccine changes, vaccine against a new strain or subtype of flu virus can be switched in under an existing licence with minimal additional information required.

That may not be the case here, however.

Some manufacturers - including GlaxoSmithKline, which has Canada's pandemic vaccine contract - have indicated they want to use adjuvants in their vaccines. Adjuvants are boosting chemicals that allow smaller doses to be used, which would speed up the time it takes to make enough vaccine for a country.

But there are no existing flu vaccines in Canada that contain adjuvants, so adding one could require an entirely new licence - and substantially more safety data based on clinical trials.

It is believed Canada will purchase adjuvanted vaccine. But what testing it will require to assure itself of the product's safety isn't currently known.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Those cautious statements hold true in a normal new vaccine environment; an environment where there is lots of time for testing and months, if not years, of trials.

All that goes out the window if the world is hit with a killer Pandemic. At that point any effective vaccine is better than none, and the small risk of Guillain Barre syndrome or some other bad outcome is outweighed by the prospect of a high case fatality rate (CFR) of a fast spreading flu.

Already Canada's indigenous peoples are being hard hit by the Swine Flu H1N1 virus that is considered "mild" in most populations (see the Canada Thread). This can be expected to happen in other isolated populations that were not exposed to the winnowing effects of the plagues and diseases of the Middle Ages. If the Swine Flu becomes more lethal in the Fall, these populations will be additionally threatened and any vaccine will be better than none.

But once again we're in that difficult middle position, where the virus is NOT currently a killer pandemic.

So what will/should most governments do? Will they allow manufacturers to sell untested vaccine in case the virus gets more virulent and risk a repeat of swine-flu-vaccines-past, or will they require normal testing?

And given the current level of severity, would you sign your family up for an untested vaccine?


MomCares

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

No, but I got this dark notion that the virus isn't done yet. Against the general 'mutation noise' some remarks by people I use to listen too, such as Niman, Jörg Hacker and a couple of well known virologists are not particularly optimistic.

Also, the growth of the number of 'infected' appears to stabilize, but that is mainly due to the fact that people aren't actually tested anymore, in a lot of cases. It is assumed to be the new strain and the patients are given tamiflu. So the growth 'slows down' because the numbers rise too fast.

With that many infections, there's a statistical significant number of co-infections with other strains, as we speak.

It's a witches' brew out there.