H5N1

Canada: Flu carries higher risk of paralytic disease than flu shot

Via The Globe and Mail, a report by André Picard: Flu carries higher risk of paralytic disease than flu shot. Excerpt:

There are long-standing concerns that a small number of people develop a paralytic illness after getting a flu shot. But a new study shows that the risk of developing the condition, Guillain-Barré syndrome, is actually 16 times higher after contracting influenza than after vaccination. 

In the general population, about one in 100,000 people develop GBS, a baffling and potentially fatal condition that resembles polio. 

The new findings, published in the medical journal The Lancet Infectious Diseases, show that one additional case of GBS occurs after every million people who get a flu shot. But an additional case of GBS springs up in every 60,000 people who are treated for the flu. 

Dr. Jeff Kwong, a scientist at the Toronto-based Institute for Clinical Evaluative Sciences and lead author of the research, said the findings should reassure people about the safety of influenza vaccination and remind them the flu itself carries many more health risks. 

“The message here is that people shouldn’t worry so much about GBS,” he said. “We’re actually comparing two very small risks, but the risk of not getting vaccinated is higher.”

Synthetic generation of influenza vaccine viruses for rapid response to pandemics

Thanks to Greg Folkers for sending the link to this just-published article in Science Translational Medicine: Synthetic Generation of Influenza Vaccine Viruses for Rapid Response to Pandemics. The abstract:

During the 2009 H1N1 influenza pandemic, vaccines for the virus became available in large quantities only after human infections peaked. To accelerate vaccine availability for future pandemics, we developed a synthetic approach that very rapidly generated vaccine viruses from sequence data. 

Beginning with hemagglutinin (HA) and neuraminidase (NA) gene sequences, we combined an enzymatic, cell-free gene assembly technique with enzymatic error correction to allow rapid, accurate gene synthesis. We then used these synthetic HA and NA genes to transfect Madin-Darby canine kidney (MDCK) cells that were qualified for vaccine manufacture with viral RNA expression constructs encoding HA and NA and plasmid DNAs encoding viral backbone genes. 

Viruses for use in vaccines were rescued from these MDCK cells. We performed this rescue with improved vaccine virus backbones, increasing the yield of the essential vaccine antigen, HA. 

Generation of synthetic vaccine seeds, together with more efficient vaccine release assays, would accelerate responses to influenza pandemics through a system of instantaneous electronic data exchange followed by real-time, geographically dispersed vaccine production.

If nothing else, these stupid viruses are provoking some remarkable technological progress.

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.

Influenza in pregnancy increases chance of bipolar disorder in children

Via Forbes.com: Influenza in Mom During Pregnancy Linked to Increased Bipolar Risk in Children. Excerpt:

According to new research, if a woman develops influenza during pregnancy, her child has almost a 4-fold increased risk of developing bipolar disorder later in life. 

This new study suggests that maternal influenza is linked to an elevated risk of bipolar disorder in children and implies that efforts to prevent influenza during pregnancy may potentially reduce the risk of bipolar disorder later in life. 

Findings from the research were published in JAMA Psychiatry online on May 8. 

This data further suggests a possible link to a viral etiology of certain psychiatric disorders. In fact, previous research by the lead study author, Dr. Alan Brown and his colleagues, found that the risk of developing schizophrenia increases with fetal exposure to maternal influenza virus. 

The new research by Dr. Alan Brown was a case-control study which evaluated a population-based birth cohort from 1959 to 1966 in pregnant women receiving obstetric care from Kaiser Permanente Health Plan’s Northern California region. 

Information was collected through medical records at Kaiser Permanente and at a county behavioral healthcare facility as well as through a mailing to the mothers and adult offspring in the birth cohort. 

The investigators confirmed the diagnosis of bipolar disorder through interviews of 214 individuals and found 72 cases of the disorder. They found another 23 interview-confirmed cases of bipolar disorder from an earlier study, the Prenatal Determinants of Schizophrenia Study, which also had asked individuals about bipolar disorder. 3 of the 95 case patients were excluded because of incomplete influenza information.

The link to JAMA will actually take you to a search results page, with the new report fourth from the top. I was surprised to see that the role of influenza in mental illness has been such a lively topic of research and debate.

Apart from confirming the importance of vaccination for pregnant women, this research also suggests that influenza was a major factor in the burden of mental illness in the pre-vaccination era. Much of human history may reflect the influenza-related illness of kings, warlords, and ordinary people.

Flu infections rising among pigs in southern China, says study

Via South China Morning Post, another worry to deal with: Flu infections rising among pigs in southern China, says study. Excerpt:

Scientists said on Wednesday that flu infections were rising among pigs raised for slaughter on farms in south and southeastern China, also plagued by bird flu. 

And the risk of spillover to humans was “constant or growing”, according to one of the authors of a study published in Proceedings of the Royal Society B. 

Pigs are an important source of new human strains of influenza A, such as the 2009-10 H1N1 pandemic that emerged in Mexico and infected an estimated fifth of the world’s population. 

Pigs can act as a “mixing vessel” in a process known as re-assortment, brewing new flu strains from swine, poultry and human viruses in areas where they live in close proximity. 

Such new hybrids can be deadly – tens of millions of people died in flu pandemics in 1918, 1957 and 1968. 

Luckily, the 2009 strain was about as lethal as the ordinary seasonal flu, though highly infectious. 

China is currently in the grips of a deadly H7N9 bird flu virus that has killed 27 people since March, mainly in the country’s east – overlapping with the study area. 

H7N9 has not been traced to pigs and has not been shown to jump from person to person, but is being closely watched for genetic changes that may make this possible. 

An article in the science journal Nature last month highlighted that H7N9 seems to be circulating in areas of China that have large populations of pigs and humans “providing opportunities for further adaptation to mammals and for re-assortment with human- or pig-adapted viruses”. 

For the new study, an international team of disease experts analysed data collected at an abattoir in Hong Kong over a 12-year period from 1998 to 2010, to learn more about the spread of flu among pigs. 

Such information may be useful to prevent future pandemic jumps from animals to humans. 

The team analysed the results of tests for virus infection at time of slaughter, as well as tests for antibodies which would indicate the pig had previously been infected and was now immune. 

They observed a drop in positive virus tests by the time the pigs reached the abattoir but, worryingly, concluded this did not mean there was less infection. 

“Instead, it reflects higher rates of influenza circulation on the farms where pigs are raised, so that they have already been infected [and so they’re immune] by the time they’re going to slaughter,” co-author James Lloyd-Smith of the University of California in Los Angeles said by e-mail. 

The conclusion was derived from a corresponding rise in positive antibody tests. 

“The prevalence of infection in swine has not decreased and so the risk of spillover to humans or birds is constant or growing,” added Lloyd-Smith.

I couldn't find the article in the Proceedings, but this sounds like a development worth watching.

Potential new drug found in the treatment of severe influenza

Via Digital Journal: Potential new drug found in the treatment of severe influenza. Excerpt:

As the H7N9 bird flu virus continues to spread through China, scientists at the University of Maryland School of Medicine have reported the discovery of a new drug to aid in the treatment of severe influenza infection. 

Scientists operating out of the University of Maryland School of Medicine may have uncovered a breakthrough drug in the treatment of the most dangerous and deadly influenza infections. 

The discovery of the novel treatment was reported first in the journal Nature and picked up by Science Daily and demonstrates how the drug, known as Eritoran, functions in mice. In the studies, mice were given a lethal dose of influenza virus and were shown to have fully recovered after Eritoran as administered. 

Aside from being able to reverse what would otherwise be a deadly outcome, Eritoran was shown to work for up to six days after the initial exposure to the influenza virus. Current anti-viral drugs are effective only within two days of initial infection, and most patients are not seen by doctors in time for anti-viral treatments to be viable. 

Seasonal influenza kills between 250,000 and 500,000 people worldwide annually. 

The drug's promise comes amid the backdrop of a deadly new bird flu strain emerging out of China. The H7N9 virus has claimed 27 lives in China, and experts believe it will emerge around the world. 

"We are at the start of a very long haul with H7N9," Professor Angus Nicoll from the European Centre for Disease Prevention and Control (ECDC) said, according to a Reuters report on the possibility of the virus making its way to Europe. 

It is unclear whether or not Eritoran could be effective against coronaviruses.

Pandemic preparedness: Coming, ready or not

Via The Economist: Pandemic preparedness: Coming, ready or not. Excerpt:

The threat of a global pandemic is rising again. In China an influenza virus never before seen in people had, as The Economist went to press, infected at least 82 and killed 17. Meanwhile a new type of coronavirus, the family that brought severe acute respiratory syndrome (SARS), is festering in the Middle East. 

The risk of such an outbreak turning into a pandemic is low, but the danger, if it does, is huge: in 1918 50m-100m people were killed by Spanish flu, compared with 16m in the first world war and 30m so far from AIDS. 

Fortunately, the world is better prepared for an outbreak than ever before (see article). SARS in 2003, the H5N1 bird flu of 2005 and the H1N1 swine flu of 2009 have prompted action. By 2011, 158 countries had pandemic-preparedness plans. America has poured money into the development of new vaccines and antiviral drugs. Researchers have a better understanding of influenza and other risky pathogens. Rapid amplification of DNA segments helps scientists identify viruses quickly. Full genomic sequencing allows them to explore worrying strains. Mathematical models predict where a new disease might emerge and how it might spread. 

Going viral 

Yet all this may not be enough. No one has yet managed to predict an influenza outbreak. H1N1 exposed many problems, from the slow deployment of vaccines to simple breakdowns in communication. Thankfully that virus was not especially deadly. 

But an independent commission, charged with reviewing the response of the World Health Organisation (WHO), issued a bleak assessment: “The unavoidable reality is that tens of millions of people would be at risk of dying in a severe pandemic.” 

Reducing that risk means, among other things, more government spending—an unwelcome prescription at a time of austerity, but a necessary one, for protection against pandemics is a valuable public good.

Click through to see the magazine's recommendations on how the money should be spent.

ECDC: Current threat report for week 15

ECDC has published its Communicable Disease Threats Report for week 15. Click through to download the PDF. The summary:

An outbreak of hepatitis A infection has been reported in Denmark, Finland, Norway and Sweden over the last six months with 66 cases as of 11 April 2013. The source of the outbreak has not been identified but epidemiological investigations in the affected countries point towards frozen berries as vehicle of infection. 

In relation to measles, large outbreaks are currently on-going in the North-East of England and in Wales. Denmark reported a small outbreak in the Silkesborg area. 

Influenza activity across Europe continues to decline or has already returned to baseline levels. 

The CDTR also reports about the recent cases of avian influenza A(H7N9) in China. During the last week 24 additional cases were confirmed by Chinese authorities, including two deaths, for a total of thirty-eight cases of human infection. At this point, there is no evidence of on-going human-to-human transmission and there has not been further geographical spread.

ECDC: Threat report for week 14

ECDC has published Monitoring current threats, week 14/2013. Click through for the PDF and many links. Apart from detailed information on seasonal flu, the Swansea measles outbreak, and Madeira's dengue, it has this to say about H7N9:

On 31 March 2013, the Chinese authorities announced the identification of a novel influenza A virus, A(H7H9), in three seriously ill people from two provinces presenting with respiratory infections. When testing for the influenza virus, the Chinese Center for Disease Control and Prevention identified genes from both A(H7N9) and A(H9N2) viruses, thus indicating a novel reassortant avian influenza A virus. 

By 5 April 2013, 16 cases were confirmed, including six deaths. In its initial assessment of the situation, the ECDC rapid risk assessment concludes that the risk of the spread of the virus in Europe can be considered low at this stage. 

There is currently no evidence of sustained human-to-human transmission of the influenza A(H7N9) virus. 

ECDC continues to monitor the situation closely. More cases are expected to be reported.

ECDC: Current threats in week 12/2013

ECDC has published Monitoring current threats in week 12/2013. Click through to read the full report. The summary:

Overall, the influenza situation reported for week 11/2013 suggests a declining activity in an increasing number of countries. Only Romania reports increasing trends. ECDC monitors influenza activity in Europe during the winter seasons and publishes the results in the Weekly Influenza Surveillance Overview. 

There is an on-going outbreak of rubella in Poznan and since the beginning of March 2013 there has been approximately 200 cases. Another outbreak is reported in Wielkopolska where 854 cases of rubella were notified during the first quarter of 2013, almost five times more than in the past two years. 

There were 27,267 cases of rubella reported during 2012 by the 26 EU and EEA countries which contribute to the enhanced surveillance for rubella. Poland and Romania accounted for 99% of all reported rubella cases in the 12-month period.