H5N1

India: Two H1N1 patients in critical condition

We have largely forgotten H1N1 ("swine flu"); amnesia is a common sequel of influenza, even in those who don't catch it. But in some countries like India, it's still a clear and present danger. Via The Times of India: Two patients with swine flu critical. Excerpt:

PUNE: Two patients infected with swine flu in Pune city are critical. They have been put on ventilator support at different hospitals, said civic health officials on Sunday. 

"The condition of both the patients is critical. They have been put on ventilator support at Deenanath Mangeshkar Hospital and Ruby Hall Clinic," said S T Pardeshi, medical officer of health (MoH), Pune Municipal Corporation (PMC). As many as 23 people have succumbed to swine flu infection in Pune city, so far, this year. 

The health department of Pune Municipal Corporation screened over 3.42 lakh [342,000] people for swine flu so far. Of these, 5,115 people were administered Tamiflu on suspicion of being infected with the H1N1 virus. 

"We have set up screening facility at all PMC-run hospitals and dispensaries. A total 342,225 people who had influenza like illness have so far been screened at these centres since January," Pardeshi said. 

Taking medicine without consultation and delaying treatment can aggravate the condition. Health officials said the increase in swine flu cases could be due to widely fluctuating and erratic climate and temperatures characterised by hotter days and colder nights as experienced in the region.

CDC begins actively looking for H7N9 in the United States

Via Scott McPherson's blog: CDC begins actively looking for H7N9 in the United States. Excerpt:

In a conference call this afternoon with clinicians, the U.S. Centers for Disease Control and Prevention has officially asked hospitals and doctors to begin looking for signs of human infection with H7N9 avian flu. 

Some takeaways from the 2PM EDT conference call: 

Persons exhibiting influenza-like illness and/or severe respiratory distress, and who have either traveled to China or have had close contact with someone who has traveled to China, need to be considered in a separate category and closely monitored. 

Any Influenza-Like Illness within this subset that cannot be conclusively diagnosed as seasonal influenza needs to be considered suspected H7N9, and samples are to be sent to the CDC immediately. 

Suspected patients should be put into isolation, preferably in an appropriate environment, negative-air-pressure room (AII). 

It is unknown whether rapid office tests could detect avian influenza.  Therefore, all commercially available influenza tests should be disregarded when testing for H7N9. It should be assumed they are inaccurate. 

The CDC is currently the only testing facility in the United States that can test reliably for H7N9.  This will change as the CDC certified states with the ability to detect H7N9. 

The CDC is advising organizations to review and revise their pandemic plans. 

International airports with frequent travel to and from China have begun listing H7N9 information on their electronic signs, particularly in Customs areas. 

Limited human-to-human transmission has occurred in China. Which is a) not surprising and b) probably expected.

Hong Kong: 20 pupils treated for flu

Via the Hong Kong government website: 20 pupils treated for flu.

The Centre for Health Protection is investigating an influenza-like illness outbreak at a kindergarten in Sha Tin affecting 20 pupils.   

The 15 boys and five girls, aged three to five, have fallen ill since February 19.   

None of them required hospitalisation. They are stable.   

The centre’s officers have visited the school and advised the management to adopt measures against respiratory tract infection.

When I taught in my college's early childhood education program, my poor students were often ill; they spent their days in daycares and preschools, wiping gooey little noses, and then dragged themselves in to their evening classes. It was just another reason why people who work with small children deserve hazard pay.

Butler: When Google got flu wrong

Via Nature News & Comment, a fascinating report by Declan Butler: When Google got flu wrong. Excerpt (but read the whole thing):

When influenza hit early and hard in the United States this year, it quietly claimed an unacknowledged victim: one of the cutting-edge techniques being used to monitor the outbreak. A comparison with traditional surveillance data showed that Google Flu Trends, which estimates prevalence from flu-related Internet searches, had drastically overestimated peak flu levels. 

The glitch is no more than a temporary setback for a promising strategy, experts say, and Google is sure to refine its algorithms. But as flu-tracking techniques based on mining of web data and on social media proliferate, the episode is a reminder that they will complement, but not substitute for, traditional epidemiological surveillance networks. 

“It is hard to think today that one can provide disease surveillance without existing systems,” says Alain-Jacques Valleron, an epidemiologist at the Pierre and Marie Curie University in Paris, and founder of France’s Sentinelles monitoring network. 

“The new systems depend too much on old existing ones to be able to live without them,” he adds.

US: CDC FluView for week 2

CDC has published its Weekly Report: Influenza Summary Update for week 2 (January 6-12). The synopsis of a very long and detailed report:

During week 2 (January 6-12), influenza activity remained elevated in the United States, but decreased in some areas. 

• Viral Surveillance: Of 12,360 specimens tested and reported by collaborating laboratories, 3,638 (29.4%) were positive for influenza. 

• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold. 

• Influenza-Associated Pediatric Deaths: Nine influenza-associated pediatric deaths were reported. 

• Influenza-Associated Hospitalizations: A cumulative rate for the season of 18.8 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Among all cases, 49.6% were in adults 65 years and older. 

• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.6%; this is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Thirty states and New York City experienced high ILI activity; 10 states experienced moderate activity; 7 states experienced low activity; 3 states experienced minimal activity, and the District of Columbia had insufficient data. 

• Geographic Spread of Influenza: Forty-eight states reported widespread geographic influenza activity; 2 states reported regional activity; the District of Columbia reported local activity; Guam reported no influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

Hong Kong: Flu warning issued

Via the Hong Kong government website: Flu warning issued.

The Centre for Health Protection today called on the public to guard against influenza and urged high-risk target groups and those eligible to receive influenza vaccination as soon as possible.  

The centre said flu cases increased from 48 in the week ending January 5, to 84 in the week ending January 12.   

Two institutional influenza-like illness outbreaks, affecting five to 20 people, were recorded in the week ending January 12, compared to no outbreaks in the preceding week.

Target groups including pregnant women receiving Comprehensive Social Security Assistance and long-stay residents of institutions for the disabled are advised to receive influenza vaccinations under the Government Vaccination Programme as soon as possible.   

Meanwhile, subsidised vaccination has also been provided through private doctors to eligible children and the elderly under the Childhood Influenza Vaccination Subsidy Scheme and the Elderly Vaccination Subsidy Scheme.

Canada: Influenza update for week 1

The Public Health Agency of Canada has published 2012-2013 FluWatch report: December 30, 2012 to January 11, 2013 (Week 1). Click through to download the full report as a PDF. The summary:

• Although the percentage of positive laboratory tests for influenza declined slightly in week 01, more regions across Canada reported widespread and localized influenza activity and 107 new influenza outbreaks were reported. 

• A total of 3864 laboratory detections of influenza were reported, of which 98.1% were for influenza A viruses, predominantly A(H3N2). 

• 69 new paediatric influenza-associated hospitalizations were reported through the IMPACT network. 

• 26 new adult influenza-associated hospitalizations were reported through the PCIRN-SOS network. 

• The ILI consultation rate decreased, but is above the expected range for this time of year.

US: CDC influenza season update, week 1

Via the CDC FluView page: CDC - Seasonal Influenza (Flu) - Weekly Report: Influenza Summary Update. Click through for the full report and many links. Excerpt:

As a result of the end of year holidays and elevated influenza activity, some sites may be experiencing longer than normal reporting delays and data in previous weeks are likely to change as additional reports are received. 

Synopsis: 

During week 1 (December 30-January 5), influenza activity remained elevated in the U.S., but may be decreasing in some areas. 

Viral Surveillance: Of 12,876 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 4,222 (32.8%) were positive for influenza. 

Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was slightly above the epidemic threshold. 

Influenza-Associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported. One was associated with an influenza A (H3) virus and one was associated with an influenza A virus for which the subtype was not determined. 

Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.3%; above the national baseline of 2.2%. Nine of 10 regions reported ILI above region-specific baseline levels. Twenty-four states and New York City experienced high ILI activity; 16 states experienced moderate ILI activity; 5 states experienced low ILI activity; 5 states experienced minimal ILI activity, and the District of Columbia had insufficient data. 

Geographic Spread of Influenza: Forty-seven states reported widespread geographic influenza activity; 2 states reported regional activity; the District of Columbia reported local activity; 1 state reported sporadic activity; Guam reported no influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

Mexico: Looking for an answer to the Yajalón deaths

Via La Jornada: En Yajalón, analizan qué causó muerte de 5 bebés. [In Yajalón, identifying what caused the deaths of 5 babies] Excerpt, with my translation:

El director del Centro Nacional para la Salud de la Infancia y la Adolescencia (Censia), Ignacio Villaseñor, informó que luego que se realicen los cultivos para la identificación del virus o la bacteria, se conocerá la causa del fallecimiento de cinco niños del municipio de Yajalón, Chiapas. 

Ignacio Villaseñor, director of the National Centre for Child and Adolescent Health, says that after tests have been completed to identify the virus or bacteria, we will know what caused the deaths of five children in the municipality of Yajalón, Chiapas.

Ratificó que, de los primeros análisis clínicos de 22 muestras de exudado faríngeo que se tomaron a un total de 40 menores con infección de vías respiratorias en aquella localidad –de menos de 14 años–, el laboratorio estatal de Chiapas descartó que fuera tosferina. 

He said that after the first clinical tests of 22 samples taken from 40 children with respiratory infections, the Chiapas state laboratory excluded the possibility of whooping cough.

Agregó que el siguiente paso es iniciar nuevos estudios en búsqueda del agente causal de la enfermedad, entre otros, influenza. En entrevista, el funcionario designado al frente del Censia el pasado 18 de diciembre comentó que los niños menores de un año, como los fallecidos, tienen mayor riesgo de presentar complicaciones graves de alguna enfermedad y más aún si viven en comunidades de alta marginación como Yajalón.

He added that the next step is to begin new studies in search of the cause of the disease, including the possibility of influenza. In an interview, the director (appointed on December 18) commented that children under the age of one year, like the victims, are under greater risk of serious complications from any disease, and even more so when they live in highly marginalized communities like Yajalón.

Canada: Possible influenza A outbreak probed at Victoria hospital

Via CBC News: Possible Influenza A outbreak probed at Victoria hospital. Excerpt:

Health officials are trying to cope with what they believe is an outbreak of Influenza A at a small hospital near Victoria. 

The director of infection prevention and control for the Vancouver Island Health Authority says 11 people at the Saanich Peninsula Hospital became sick with flu-like symptoms over the weekend. 

Dr. Pamela Kibsey says the hospital is acting fast to try to contain the outbreak. 

"We've restricted visitors. We've restricted patients to their rooms and common activities and so forth,” she said. 

“If it is Influenza A, then we will be going further to treat the patients affected with Tamiflu and also offer Tamiflu to all of the health care providers that work there." 

Kibsey says the hospital is already short-staffed due to illness and may find it difficult to cope if more staff members fall ill.