H5N1

Branswell: Flu reminds Canada what it can do

Via The Province, a report by Helen Branswell of The Canadian Press: With crowded ERs and some cancelled surgeries, flu reminds Canada what it can do. Excerpt:

In some places it's surging, in others it's plateaued, and in other parts of the country it may actually be on the wane. 

But in most parts of Canada this winter, influenza has been reminding Canadians what a real flu season feels like. 

Emergency departments are reporting heavy traffic. Some hospitals have cut back on surgeries. Sales of antiviral drugs have been strong enough to create the possibility of a shortage, prompting the federal government to lend stores of Tamiflu from the national emergency drug stockpile back to the manufacturer, Roche Canada. 

After a couple of years of ho-hum flu seasons, some people may be tempted to cast this year as the worst in a decade. This early in the winter it's too soon to predict what the final picture will look like. But it is fair to say this is an active year, flu-wise. 

"I think we may have forgotten what real influenza feel like, because for whatever reasons in the post-pandemic period, for us anyway in B.C. the seasons have been quite mild," Dr. Danuta Skowronski, a flu expert at the BC Centre for Disease Control, said Wednesday. 

"This season is more like what we expect from an influenza A — H3 in particular — season." 

Skowronski was referring to the fact that much of the illness this year in Canada is being caused by the influenza A virus H3N2. (Flu viruses that infect humans are mainly from either the influenza A or B family. There are two subtypes of A viruses — H3N2 and H1N1.) 

Winters when H3N2 viruses predominate are generally harder flu seasons because this subtype hits the elderly with particular severity.

US: Flu season creates public health emergency in Boston (and everywhere else)

Thanks to the reader who sent the link to this MSNBC report: Flu season creates public health emergency in Boston. It's a three-minute video that shows the impact of the flu outbreak.

Meanwhile The Globe and Mail here in Canada warns: The flu: It's coming for you this year.

ECDC: Seasonal influenza continues to rise in Europe

Via ECDC: Seasonal influenza continues to rise in Europe: still time to protect yourself and others. Click through for links and more resources. Excerpt:

The activity of seasonal influenza continues to rise in a number of European countries, especially in western Europe, concludes the latest Weekly Influenza Surveillance Overview, Week 52. There is still time to protect yourself from getting or spreading the flu by being vaccinated.   

Influenza season on the rise 

Four countries (France, Italy, the Netherlands and Norway) have reported medium intensity influenza transmission; geographic spread of influenza activity was reported as widespread by five countries (Belgium, Denmark, France, Norway and the UK (England)); and nine countries have reported increasing trends. 

The proportion of sentinel specimens that are positive for influenza has exceeded 20% for two consecutive weeks. Countries undertaking surveillance of laboratory-confirmed severe influenza cases are starting to report increasing numbers of such individuals having to be hospitalised. 

So far the detected viruses remain well-matched to the vaccine strain and there has been no change in the viruses from what was seen last season. Since week 40/2012, 46% of sentinel specimens were type A and 54% were type B, though the proportion of B viruses has decreased somewhat in recent weeks. Subtying of type A viruses has shown proportions of 56% A(H3) and 44% A(H1).   

Influenza should be taken seriously 

Influenza comes to Europe every winter – each year, around 10% of us are infected, and influenza-related complications cause hundreds of thousands of hospitalisations all across Europe. We can reduce the risk of getting influenza or transmitting it to others by a number of preventive measures, from applying better hand hygiene and not sneezing on others to staying at home when sick. 

Older people as well as those with chronic conditions suffer the most, but even perfectly healthy young people are at risk of developing serious complications, which can be fatal. 

Influenza-related deaths seen in recent weeks, for example, in Norway and Poland, have been reported in the media; sadly, they highlight what is unfortunately to be expected. Therefore people whose symptoms of the flu are worsening should seek medical advice as recommended by their national or local authorities.

UK: Flu activity continuing to increase

Via HPA: Flu activity continuing to increase. Excerpt:

Latest figures from the Health Protection Agency (HPA) indicate that increases in flu activity continue to be seen across several indicators, including GP consultation rates, the proportion of calls to NHS Direct and new admissions to intensive care or high dependency units. 

Children aged five to 14 in particular have been the group most affected by flu so far this season. 

Dr Richard Pebody, head of seasonal flu surveillance at the HPA said: “We are continuing to see an increase in flu activity across several of our indicators but historically flu rates go up at this time of year so this is not unusual. 

“Vaccination against flu is still the most effective way of preventing the virus in people who are in an ‘at risk’ group, as they are more vulnerable to developing complications from flu. This includes people with underlying conditions such as heart problems, diabetes, lung, liver or renal diseases and those with weakened immune systems, as well as older people and pregnant women.  

“Latest vaccine uptake figures for one of the ‘at risk’ groups – the over 65 age group – are encouraging, with more than 70 per cent taking up the offer of the flu vaccine. Among those in an ‘at risk’ group under 65 years of age, uptake is just under 50 per cent and around 40 per cent of pregnant women and healthcare workers have accepted the offer of vaccination this season.”

Canada: Flu outbreak strains Calgary emergency rooms

Via the Calgary Herald: Flu outbreak strains local emergency rooms. Excerpt:

Alberta Health Services is urging people to get the influenza vaccine as hospitals see a spike in emergency room visits. 

It’s not unusual to see a jump in flu cases in December, but the volume of patients is up by as much as 20 per cent at the Alberta Children’s Hospital. 

“It is busy. The big difference this year is the flu started earlier than it did last year,” said Dr. Francois Belanger, medical director for the Calgary zone. 

So far, there are 151 lab-confirmed influenza cases in the city. Health officials have launched an extensive, $6.5-million campaign in an effort to boost immunization rates and reach two of the most vulnerable patient groups — children and seniors. 

Parents who have taken their kids to community health centres in the past are being contacted by phone with a reminder to safeguard family members against the flu. 

For the first time this year, Alberta is offering a nasal spray vaccine — Flutist — for eligible children between two and 17 years old. 

Belanger characterizes this year’s immunization campaign as “very aggressive.” While more than 442,000 people have been inoculated in Alberta since the start of the flu season, the province hopes to more than double that number by April. 

Last year, just 28.5 per cent of infants from six to 23 months were immunized and 61 per cent of Alberta seniors got their shots, only slight increases over the year before. 

In the meantime, pediatricians say their offices are crowded with tots and teenagers suffering from fever, body aches and other influenza-type symptoms.

ECDC: Better seasonal influenza vaccines to improve coverage in Europe

Via ECDC: Better seasonal influenza vaccines to improve coverage in Europe. Click through for several related links. 

To achieve increased and sustainable influenza vaccine coverage in Europe, the effectiveness of seasonal influenza vaccines should be improved, especially for the clinical risk groups and older people. 

In their Lancet commentary published yesterday, ECDC Director Dr Marc Sprenger and Head of Influenza and other Respiratory Viruses Programme Dr Angus Nicoll look at effectiveness studies of seasonal influenza vaccines and suggest several areas for improvement. 

While effectiveness of the influenza vaccine is influenced by the type of viruses circulating each season, independent observational studies led by ECDC and other European experts also show that, in Europe, seasonal vaccine effectiveness in the old and clinical risk groups has regularly been less than 70%. In 2009, the Council of the EU pledged regional political commitment to improve vaccine coverage, and set a national target of 75% coverage for older age groups (ie, aged 65 years and older), individuals with chronic ill health, and health-care workers. 

From the public perspective and a public health standpoint, more effective vaccines are needed to encourage their use and reach towards the target of vaccination coverage. 

Importantly, since vaccine effectiveness is highest among healthy adults, a way to protect the most vulnerable groups – young children, older people and those with chronic diseases – could be by vaccinating those around them. Therefore, it is especially important for healthcare workers to get vaccinated (external link), to protect their patients as well as themselves. 

The authors conclude by stating that vaccination remains the single most effective preventive measure against seasonal influenza, and the use of present vaccines should be strongly advocated among those for whom they are recommended.

Mike Coston at Avian Flu Diary also has this report, with useful comments and links.

Influenza virus hits Australia

Via Xinhua: Influenza virus hits Australia. Excerpt:

The influenza virus has hit Australia hard this winter, with Queensland recording the highest number of cases in the country, health experts warned on Wednesday. 

The Influenza Specialist Group (ISG), which consists of medical and scientific specialists on influenza from around Australia and New Zealand, said on Wednesday that more than 5,000 cases of the H3N2 and Type B strains have already been diagnosed across Australia. 

Experts are warning that there is worse to come and this is only the tip of the iceberg as thousands more cases go undiagnosed. 

ISG said Queensland was the worst affected state with 2,536 diagnosed cases, while New South Wales was next with 2,391. 

The infection rate for Queensland was ten percent higher than the same period a year ago, the ISG said. 

Children under nine years old have been the hardest hit by the flu virus and the number of elderly people and those between 35 and 44 years old contracting the virus has also increased. 

ISG Chair Dr Alan Hampson said that the fact that the H3N2 and the Type B strains hadn't been prominent in the community for the past few years could increase this season's severity. 

"When we see high levels of H3N2, which is the predominant strain this season, there is significant impact, especially in high-risk groups," he said.

Survey: At peak of H1N1 pandemic, people worried more about seasonal flu

Via CIDRAP, a report by Robert Roos: Survey: At pandemic's peak, people worried more about seasonal flu. Excerpt:

Survey data from the Centers for Disease Control and Prevention (CDC) suggest that at the peak of the H1N1 influenza pandemic in the fall of 2009, Americans were more worried about seasonal flu than the pandemic virus, according to a study published in Influenza and Other Respiratory Viruses. 

The study is an analysis of findings from the CDC's 2009 H1N1 Flu Survey, a telephone poll that targeted about 6,000 people per month from October 2009 through June 2010. Respondents were asked whether they had received pandemic H1N1 (pH1N1) and seasonal flu shots, their level of concern about getting sick if not vaccinated, their views on the vaccines' effectiveness, and their level of concern about getting sick from the pH1N1 vaccine. 

"Surprisingly, our data found that the perception of risk from pH1N1 was lower than for seasonal influenza, even in October and November, and this perception of risk decreased after November," says the team of CDC investigators, with Tammy A. Santibanez, PhD, as first author. 

Overall, 26.1% (95% confidence interval, plus or minus 0.9%) of respondents thought the chance of getting sick with pH1N1 if not vaccinated was "very high" or "somewhat high," compared with 38.5% (plus or minus 0.9%) for seasonal flu. 

The report notes that pH1N1 was by far the dominant flu strain in the United States in October and November 2009. It says there was a big increase in demand for seasonal flu vaccine at that time, "which could indicate some confusion about what strains were included in the seasonal influenza vaccine and a mistaken belief the seasonal vaccine would provide protection from pH1N1."

CIDRAP: Flu news scan for April 2

Via CIDRAP: FLU NEWS SCAN: H5N1 death in Cambodia, WHO flu review, cell-based flu vaccines, seasonal flu vaccine effectiveness. Excerpt:

Researchers have published thousands of studies on influenza in the past 2 years, but major puzzles and knowledge gaps persist, according to articles published in the April Bulletin of the World Health Organization, which is dedicated to flu. The issue presents a wide range of news, commentary, and research articles on developments in the field. 

In an editorial, flu consultant Michael Perdue, PhD, and Tim Nguyen of the WHO note that in November 2009 a WHO-hosted consultation identified five major flu-research "streams," and last year the agency commissioned more than 20 literature reviews covering the WHO's top research recommendations. A group of experts that met in November 2011 found more than 4,000 relevant publications from 2010 and 2011. 

The panel reported important progress in each of 16 research "substreams" listed by the WHO. One area where science has progressed is that of the survival of flu viruses in the environment and the role of close contact and aerosols in transmission, Perdue and Nguyen write. They say the WHO will soon publish several of the commissioned reviews along with a progress report. 

The theme issue also includes a news report noting that "our understanding of the fundamental epidemiology of influenza remains far from complete," despite many advances. The unsolved mysteries and problems, it says, include the highly variable pattern of seasonal flu outbreaks in the tropics, the geographic origins of seasonal flu strains, the shortage of surveillance data on flu in animal populations, and the need for more broadly protective vaccines. 

Among other items, the special issue also includes four research articles and four reports on "lessons from the field."

China: Flu cases hit Guangzhou, Xinjiang

Via People's Daily Online, a report from Shanghai Daily: Flu cases hit Guangzhou, Xinjiang. Excerpt:

Guangzhou reported nine flu outbreaks in schools since February and the Xinjiang Uygur Autonomous Region announced the resumption of morning checks in kindergartens and schools after many students suffered swine flu. 

But officials from the Shanghai Health Bureau said yesterday that the flu situation in the city remains stable, for adults and children. Shanghai entered its peak season of respiratory diseases on November 15, and authorities enhanced monitoring and supervision of pneumonia, severe acute respiratory syndrome and human avian flu. 

According to Xinhua news agency, Guangzhou has had nine flu outbreaks since February, all in schools. Experts said the outbreaks were closely related to the recent humid weather. 

Wang Ming, director of the Guangzhou Center for Disease Control and Prevention, said the city's flu epidemic was accelerating. 

Patients with flu accounted for 7.12 percent of total outpatient cases last week, higher than the 5.11 percent in the previous week. The figure for the last two weeks was higher than the same period last year. 

Wang said Guangzhou had five flu outbreaks in February and four in the first ten days of March. One school had 300 students with flu. Experts said the rising cases were related to poor ventilation amid very humid weather. 

"People don't open windows for fear of the humid air," Wang said. "Flu virus spreads easily in rooms with many people and poor ventilation, if one sick person coughs." 

The Guangzhou Health Bureau has ordered schools and kindergartens to enhance flu control and urged regular cleaning and disinfection on public transport. Staff should open windows of buses and office buildings after work.