H1N1 flu activity down, H1N1 flu-associated deaths up-Is H1N1 getting more deadly?

The latest U.S. Centers for Disease Control and Prevention (CDC) swine flu update shows that H1N1 flu activity is decreasing once more, for the 6th week in a row. H1N1 swine flu-associated deaths, however, are going up. At the same time, reports of an H1N1 mutation that attacks the lungs and is resistant to the antiviral medication Tamiflu are circulating here in the U.S., as well as other locations around the world.

CDC swine flu update

According to the CDC swine flu update for December 11, 2009, key flu indicators are all decreasing, except for H1N1 flu-related deaths. Doctor's visits for flu and hospitalizations for flu have gone down for the 6th week in a row, and there are now only 14 states reporting widespread flu activity. At the same time, swine flu-related deaths have increased. This may result from the spread of a deadlier strain of H1N1 mutation that attacks the lungs and is resistant to the antiviral medication Tamiflu.

H1N1 mutation D225G/D225N

Learn more about the H1N1 mutation that attacks the lungs here:

New York swine flu victims show lung damage

Utah patient with lung hemmorhaging

Source of swine flu samples may explain low numbers of D225G

Swine flu vaccine ineffective against D225G in Ukraine

H1N1 deaths increase as mutations combine

Fatality in France due to mixture of swine flu mutations

Iowa medical examiner reports local H1N1 lung damage

Demographic information in Ukraine fatalities linked to D225G receptor binding domain

D225G swine flu mutation same as Spanish flu

Swine flu mutation H274Y/H274Y

Learn more about the swine flu mutation that is resistant to Tamiflu here:

Tamiflu-resistant H1N1 spreading

Swine flu pandemic complicated by antiviral resistance

Tamiflu doesn't work anymore

Tamiflu-resistant strain of H1N1 found around the world


P.S. BOOST your immunity by eating Vitamin C and Vitamin D rich foods and fruits.



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H1N1 Swine Flu Less Severe Than Feared

H1N1 swine flu won't be as severe as was feared, but the pandemic is nothing to sneeze at, new predictions suggest.

When the fall/winter wave of H1N1 swine flu is over, it will have been no more severe than an average flu season, predict Harvard researcher Marc Lipsitch, DPhil, and colleagues from the U.K. Medical Research Council and the CDC.

"The good news is that ... the severity of the H1N1 flu may be less than initially feared," Lipsitch says in a news release.

There are some big asterisks next to that prediction:

* Most of the deaths and hospitalizations in a typical flu season are elderly people. Most of those killed or hospitalized in the H1N1 swine flu pandemic are children and young adults.
* Deaths attributed to seasonal flu include heart attacks, strokes, and other fatal conditions triggered by the flu. Nearly all deaths attributed to H1N1 flu are due to flu or to bacterial complications of flu.
* The new predictions would be four or five times higher in populations without access to mechanical ventilation or intensive care.
* All bets are off if the H1N1 swine flu shifts to older populations.

Even so, the new numbers are cause for relief if not for celebration. Before the 2009 H1N1 swine flu came along, planners were preparing for a pandemic with a case/fatality ratio of 0.1% -- that is, for one death in every 1,000 symptomatic infections.

The Lipsitch team now calculates that the H1N1 swine flu has a case/fatality ratio no higher than 0.048% -- and maybe seven to nine times lower, depending on the methods used for calculation.

"This is a serious disease," Lipsitch says in the news release. He noted that between one in 70 and one in 600 people who fall ill with H1N1 swine flu will be hospitalized.

The CDC has been careful not to characterize the severity of the 2009 H1N1 pandemic. The new predictions are very much in line with CDC's working estimates, says Beth Bell, MD, MPH, associate director for science at the CDC's immunization and respiratory disease center.

"This study sends the message that this is primarily a young person's disease and highlights the importance of taking advantage of this window of opportunity to get the vaccine and take preventive measures," Bell tells WebMD. "While most people who get this illness do OK, it can be very severe -- and the severity is concentrated in younger people."
H1N1 Swine Flu: Same Lung Damage as 1918 Flu

Highlighting the H1N1 flu's ability to turn deadly is a new study from James R. Gill, MD, from the New York City Medical Examiner's office, and Jeffrey Taubenberger, MD, PhD, of the National Institutes of Health.

Detailed autopsies of 34 people who died of H1N1 swine flu show that the virus typically kills by damaging the upper airways, although damage in the lower airways and deep lung was not uncommon.

Strikingly, the damage was very familiar.

"This pattern of pathology in the airway tissues is similar to that reported in autopsy findings of victims of both the 1918 and 1957 influenza pandemics," Taubenberger says in a news release.


P.S. Boost your immunity by eating Vitamin C and Vitamin D rich foods and fruits.



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Obama Declares Swine Flu a National Emergency

President Barack Obama has declared the H1N1 swine flu a national emergency.

His proclamation, signed Friday night and released by the White House Saturday morning, will allow hospitals and doctors' offices to get legal waivers of federal rules so they can handle large numbers of sick people as the outbreak spreads.

"The H1N1 is moving rapidly, as expected. By the time regions or health-care systems recognize they are becoming overburdened, they need to implement disaster plans quickly," White House spokesman Reid Cherlin said Saturday, according to the Washington Post.

The waivers, which will be issued by U.S. Health and Human Services Secretary Kathleen Sebelius, still require individual requests by the hospitals, Cherlin noted.

The goal, according to the Associated Press, is to remove bureaucratic roadblocks and make it easier for sick people to seek treatment and for medical personnel to provide it immediately. That could mean fewer hurdles involving Medicare, Medicaid or health privacy regulations, the AP added.

The H1N1 swine flu is now widespread in 46 states, and there have been 1,000 laboratory-confirmed deaths since April, according to the latest estimates released Friday by U.S. health officials.

Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, told a news conference Friday, "We have already had millions of cases of pandemic influenza in the United States, and the numbers continue to increase."

At the same time, he said, production delays continue to hamper distribution of the H1N1 swine flu vaccine.

The vaccine is growing more slowly in egg-based cultures than manufacturers had anticipated, resulting in fewer available doses at this time, Frieden explained.

As of Friday, there were 16.1 million doses on hand nationwide, up from 14.1 on Wednesday, Frieden said. And there will be far fewer than the 40 million doses originally planned for the end of October, he added.

"Vaccine availability is increasing steadily, but far too slowly," Frieden said. "It's frustrating to all of us. We are nowhere near where we thought we would be by now. We are not near where the vaccine manufacturers predicted we would be."

The vaccine that is available comes in both nasal mist and injectable forms. The first doses were only the nasal spray, called FluMist, designed for healthy people 2 to 49 years of age. But now, more than half the doses are injectable, he said.

While children continue to be particularly vulnerable to the disease, Freiden said, "we are seeing it increasingly affect young adults as well as children. We are still not seeing significant numbers of cases among the elderly, and that's characteristic of this virus."

That's also a marked difference from run-of-the-mill seasonal flu, which typically poses a much bigger threat to the elderly.

There is encouraging news, Frieden said. The genetic makeup of the H1N1 virus hasn't changed, meaning the swine flu vaccine and the antiviral drug Tamiflu are a good match.

Frieden said the H1N1 flu would probably occur in waves, but "we can't predict how high, how far or long the wave will go, or when the next will come."

"We are now in the second wave of pandemic influenza and whether this will continue through the fall into the winter, whether it will go away and come back in traditional flu season, only time will tell," he said.


P.S. Boost your resistance against swine flu by eating lots of Vitamin C and Vitamin D rich foods and fruits.



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Novartis Says Most U.S. Swine Flu Shots Ready in 2010

Most of Novartis AG’s swine flu vaccine may not reach the U.S. until the first quarter of 2010, almost at the end of flu season, Chief Executive Officer Daniel Vasella said today in an interview on CNBC.

“I feel compassion for those people who are waiting,” he said.

The Basel, Switzerland, drugmaker is the biggest U.S. supplier of the new vaccine, and U.S. health officials have reported the country’s overall supply will reach 28 million doses by the end of the month after previously projecting 40 million to 50 million by mid-October. H1N1 is widespread in 41 states, has hospitalized more than 5,000 and has caused the deaths of 292 people since Sept. 1, 90 percent of whom were younger than 65, the U.S. Centers for Disease Control and Prevention reported Oct. 20.

Production at Novartis is not being held up now, Vasella said today. The initial problem was the lack of antigen, the key ingredient that induces immunity, he said.

“There was one-fifth of the normal yield,” Vasella said.

Novartis received the first seed strains from the CDC and Geneva-based World Health Organization and was forced to go back and get others, Sarah Coles, a spokeswoman for the company, said in an e-mail.

Half the Yield

All the other vaccine makers with contracts to supply to the U.S. -- Paris-based Sanofi-Aventis SA, London-based GlaxoSmithKline Plc and AstraZeneca Plc, and CSL Ltd. based in Melbourne -- received seed strains at the same time to develop the shots, CDC officials have said. The strains yielded half as much antigen as that for a typical seasonal flu, Aphaluck Bhatiasevi, a WHO spokesman, said Sept. 18.

Novartis is moving swiftly to increase the pace of its output including transferring 300 workers to the swine flu vaccine production lines, Vasella said.

U.S. Health and Human Services Secretary Kathleen Sebelius said yesterday there were “manufacturing glitches” because new production lines were set up to accommodate the swine flu vaccine. Sebelius didn’t specify which companies had the glitches. Novartis is contracted to deliver about 35 percent of the 250 million doses ordered by the U.S. government, according to statements from HHS.

Novartis Statement

“Novartis has taken steps to accelerate the post- production process and delivery of vaccine,” according to a statement from the company released after Vasella’s interview. “Among other things, we have prioritized production of pre- filled syringes despite substantially slower filling rates. Along with the low yields, these efforts have led to delays in vaccine supply.”

Novartis began a large-scale fill-and-finish operation on the swine flu vaccine in early September after completing its seasonal flu campaign, the company said in its statement.

AstraZeneca’s MedImmune Inc., producer of a nasal spray version of the vaccine, was about 300,000 doses behind in its production, Karen Lancaster, a company spokeswoman, said Oct. 20. MedImmune, based in Gaithersburg, Maryland, had shipped at least 6.5 million doses to the U.S. government and planned to send a total of 11 million by the end of October, she said.

Sanofi said it began shipping its vaccine on Sept. 29, “a little bit earlier than anticipated,” and was tracking “pretty much on schedule,” Donna Cary, a spokeswoman, said Oct. 20.

CSL was “on schedule” to delivery its 36 million doses, Sheila Burke, a spokeswoman, said Oct. 20.



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Benefits of swine flu vaccine greatly exceed the risks

In a typical year, seasonal flu kills about 36,000 people — nearly all of them older than 65 and many with underlying health problems. But that's not the way the H1N1 swine flu will look this year. It strikes hardest at children and young adults, who have none of the immunity to the strain that older people apparently have. And though only a fraction of 1% of sufferers is likely to get seriously ill, almost a third of those who die may be otherwise healthy and robust.

Such an outcome, says Anthony Fauci, the federal government's top infectious disease expert, is "almost unheard of." Fauci told USA TODAY's editorial board this week that he has been dealing with infectious diseases for decades, "and I've never seen, in seasonal flu, a normal, robust healthy person die from influenza."

Yet, that tragic scenario is already playing out around the nation with swine flu. H1N1 influenza has killed 28 pregnant women and 60 children since April, according to the Centers for Disease Control and Prevention. Officials don't know why some otherwise healthy people die from H1N1, and they won't predict how many more might. But the trends suggest that thousands of young lives are at stake.

This picture, based not on conjecture but on science and observation, is not meant to frighten. It is meant as a sobering counter to those who apparently have no use for science, government or vaccines and are warning people to forgo protection against a very real threat.

Typical of the skeptics is political pundit Bill Maher, who tweeted this sage advice to thousands of Twitter followers last month: "If u get a swine flu shot ur an idiot."

As the H1N1 vaccine is about to become widely available, the saddest thing is that many people seem to be listening to the Mahers of the world. A University of Michigan poll in August found that only 40% of parents planned to get the H1N1 shot for their children. Some parents are even holding ill-advised "flu parties" to expose their children to H1N1 — a potentially fatal disease.

Some of the antipathy to the shots no doubt dates to the 1976 swine flu outbreak at Fort Dix, N.J., which caused one death and sent the government into overdrive down a tragic path. President Ford pledged to vaccinate everyone in the USA against an expected epidemic. But the flu never escaped Fort Dix. More than 500 of the 45 million people vaccinated got a rare neurological illness, Guillain-Barré. Dozens died.

Whether that was related to the vaccine is still unclear. But the program, quickly suspended, left many Americans with a fear of vaccines. Little wonder. The episode involved all risk and no benefit, because the flu turned out to be no threat.

That is clearly not the case today. Around the world, H1N1 has sickened millions, and 4,100 deaths have been reported. In the USA, since Aug. 30, more than 16,000 people have been hospitalized and nearly 1,400 have died from H1N1 or seasonal flu. The benefits of the vaccine, which authorities say is as safe as the seasonal flu shot, far outweigh any risk of side effects.

The decision whether to get it, for yourself or your children, should be driven by facts and science, not advice from people who play doctors on TV or the Internet.


P.S. Boost your immune system by taking Vitamin C rich foods and fruits.




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Objections over swine flu vaccine

THE OBJECTIONS

Some are suspicious of the new vaccine because the government's swine flu vaccine in 1976 caused some people to contract Guillain-Barré syndrome, a sometimes deadly nervous-system disorder. (They are different vaccines based on two different viruses).

Others see this as an issue of workers' rights, that the government should not be allowed to require vaccinations.

SHUNNING THE VACCINE

Several groups are opposed to vaccination of any kind, often citing philosophical reasons. Here is a look at some of the vaccine objectors.

Some health care workers are opposed to mandatory vaccination, but not to all vaccines.

Parents of children with autism spectrum disorders have long objected to vaccinations, based on the widely disputed notion that autism-related conditions are caused by vaccines and vaccine additives.

People with allergies to eggs oppose flu shots because eggs are used in vaccine production.

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Flu Can Raise Chances of Heart Attack

People suffering from the flu may be at higher risk for having a heart attack, especially those with heart disease and diabetes, British researchers report.

Because both seasonal and the pandemic H1N1 swine flu are circulating this fall and winter, people at risk for heart attacks are urged to get a seasonal flu shot and an H1N1 flu shot, which may reduce the chance of getting the flu and thereby lower the risk for a heart attack, experts say.

"Influenza is most concerning because of its secondary complications," said Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City.

"Most of the time with influenza, death or hospitalization isn't because of the influenza, it's because influenza puts you in a weakened state -- it's a stress on the system," he said. "So, it is not surprising that you would have the increased risk of a myocardial infarction during or right after an influenza infection."

In addition, the flu virus may have a negative effect directly on the heart, Siegel said. "Flu stresses and strains the system," he added.

To determine the risk of heart attack among those with flu, a research team led by Andrew C. Hayward, a senior lecturer in infectious disease epidemiology at the UCL Centre for Infectious Disease Epidemiology in London, looked at 39 studies conducted between 1932 and 2008.

The studies showed an increase in deaths from heart disease and more heart attacks during flu season. In fact, excess deaths because of heart disease averaged 35 percent to 50 percent, according to the report in the October issue of The Lancet Infectious Diseases.

But the studies also showed that getting a flu shot reduced the risk of dying from heart disease or suffering a heart attack, Hayward's group found.

"We believe influenza vaccination should be encouraged wherever indicated, especially in those people with existing cardiovascular disease. Further evidence is needed on the effectiveness of influenza vaccines to reduce the risk of cardiac events in people without established vascular disease," Hayward's team concluded.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, agreed that flu shots appear to reduce the risk of heart attacks.

"It has long been hypothesized that influenza infection results in an acute inflammatory response that can also trigger the onset of cardiovascular events such as heart attack and stroke in vulnerable individuals," Fonarow said.

A number of observational studies have suggested more cardiovascular events occur in patients with influenza than otherwise expected and that individuals who receive annual flu shots are much less likely to have fatal or nonfatal cardiovascular events or be hospitalized for heart failure, he said.

"Guidelines from the American Heart Association and American College of Cardiology strongly recommend that all individuals with cardiovascular disease receive annual influenza vaccination," Fonarow said.

However, Dr. Pascal James Imperato, dean and distinguished service professor at the School of Public Health at the State University of New York Downstate Medical Center in Brooklyn, said the role of flu shots in preventing heart attack has not been proven conclusively.

"The role of severe respiratory infections in precipitating myocardial infarctions in vulnerable individuals is well-established," Imperato said. "However, the role of influenza vaccines in protecting such individuals is less clear from the limited scientific evidence available."

WHO Warns Of Severe Form Of Swine Flu

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

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

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

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

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

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

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


MINORITIES AT RISK

Minority groups and indigenous populations may also have a higher risk of being severely ill with H1N1.

"In some studies, the risk in these groups is four to five times higher than in the general population," WHO said.

"Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension."

WHO said it was advising countries in the Northern Hemisphere to prepare for a second wave of pandemic spread. "Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases," it said.

Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population.

It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and thus may cause more severe illness and deaths among young adults and children than seasonal flu does.

"Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression," WHO said.

"When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people."

WHO estimates that more than 230 million people globally have asthma, and more than 220 million have diabetes. Obesity may also worsen the risk of severe infection, WHO said.

The good news -- people infected with AIDS virus do not seem to be at special risk from H1N1, WHO said.


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RP’s swine flu death toll rises to 6

Philippine health officials say three more people have died of A(H1N1)- or swine flu-related illnesses, bring the country's death toll to six.
(Read More.....)

P.S. it's about time to boost our immune system. (click here)

DOH: 2 more flu patients die

MANILA, Philippines - The Department of Health (DOH) yesterday reported two more deaths from Influenza A(H1N1), bringing to three the total number of Filipinos who have died from the virus.

Dr. Yolanda Oliveros, director of the DOH’s National Center for Disease Prevention and Control, said the fatalities were a 74-year-old man and a 19-year-old man who had asthma. The two patients died last week.

Oliveros told The STAR that the older man had underlying illnesses like chronic obstructive pulmonary disorder, emphyzema, hypertension, cardio-vascular disease and tuberculosis.

“He was multiple high-risk... That is why in our mitigation strategy, we primarily focus on the severe cases and those with underlying conditions,” she added.

The country’s first death from A(H1N1) was a 49-year-old mother who was working at the House of Representatives.

Based on autopsy, the old man died from “congestive heart failure secondary to acute myocardial infraction aggravated by severe pneumonia either bacterial, viral or both.”

It turned out that the septuagenarian also had tuberculosis, enlarged liver, kidney and spleen, tumor in the uterus and tyromegaly or goiter.

Records of DOH’s Hotline for H1N1 showed that as of last week, there were 2,668 confirmed cases but 2,543 of these have already recovered.

On the recommendation of the World Health Organization (WHO), the DOH had shifted its anti-A (H1N1) program from containment to mitigation after establishing that the virus is “mild in nature.”

And while the virus is easily spread through air droplets or respiratory discharges, most infected patients have recovered even before they started taking medication.

But Oliveros warned that while A(H1N1) is mild, the public should not let their guard down.

She reiterated the DOH’s call for the strict observance of personal hygiene, particularly the covering of mouth when sneezing and coughing and constant washing of the hands, as the virus can survive on wet or moist surfaces for up to six hours.

Under the mitigation strategy, the DOH had done away with contact tracing and the mandatory 10-day quarantine.

Interim guidelines of the DOH showed that anti-viral treatment with Oseltamivir is “only for confirmed cases with severe progressive illness or concurrent medical condition that compromise their immune system.”

“Those with stable clinical manifestations or those identified when they were in the recovery state of the illnesses... are for home care,” the guidelines stated.

Laboratory diagnosis or throat swab sampling is done as part of the investigation of first suspected cases in a specific area or community and of a person with influenza-like illnesses (ILI) who are at risk of developing complications because of existing medical conditions.

The guidelines showed that swab testing could also be done randomly in clusters “with ILI manifesting with unusual symptoms or severity.”

OFW from Tarlac

Meanwhile, the Philippine Consulate General in Hong Kong yesterday reported that a 37-year-old female Overseas Filipino Worker (OFW) from Tarlac is currently confined at the United Christian Hospital in Kwun Tong, Kowloon, in what Hong Kong health authorities described as a “serious case of human swine influenza.”

The Consulate urged Filipinos working in or intending to travel to Hong Kong to exercise the highest vigilance against the A(H1N1) flu.

The Consulate said in a report to the Department of Foreign Affairs (DFA) that the Filipina, who arrived in Hong Kong on June 28, was reported to have flu-like symptoms on June 29 and was admitted to the hospital on July 7, initially diagnosed with “severe pneumonia”.

On July 11, the Consulate was informed by the attending doctor that a “molecular” test had confirmed her to be an A(H1N1) case.

The Health Emergency Management Staff (HEMS) of the Department of Health (DOH), which runs the DOH 24-hour A(H1N1) hotline, was immediately contacted by the Consulate to brief them about the case and provide appropriate medical bulletin to the patient’s family and other close contacts in the Philippines.

The Consulate continues to be in constant touch with the patient’s family members and friends in Hong Kong and advised those who came in contact with the OFW to consult a doctor as a precautionary measure.

The Consulate has also talked to the patient’s husband in the Philippines and assured him of the government’s support.

He was also informed that he and other family members and relatives in the Philippines should immediately consult a doctor to check if they were infected.
With Pia Lee-Brago

By Sheila Crisostomo

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