H5N1

Flu News Europe, week 2

Flu News Europe has published its week 2 update. Excerpt:

Week 2/2019 (7–13 January 2019) 

• Influenza activity continued to increase in the European Region. Samples collected from individuals presenting with ILI or ARI to sentinel primary health care sites yielded an influenza-positivity rate of 42.2%. 

• Influenza type A virus detections dominated with A(H1N1)pdm09 viruses being slightly more prevalent than A(H3N2). Very few influenza B viruses were detected. 

• Data from the 23 Member States and areas reporting to the EuroMOMO project indicated that all-cause mortality was at expected levels for this time of year, but with a few countries starting to observe some excess mortality in elderly populations. 

2018/19 season overview  

• Influenza activity in Europe is increasing, with both subtypes of influenza A viruses circulating widely. Countries should continue to encourage vaccination. In addition, countries are encouraged to use antivirals in accordance with national guidelines. 

• The influenza A(H1N1)pdm09 viruses that have been characterized are antigenically similar to the 2018–2019 northern hemisphere influenza vaccine virus. Fewer influenza A(H3N2) viruses have been antigenically characterized. The effectiveness of vaccines in the population will be evaluated by vaccine effectiveness studies when data becomes available later in the season.

Canada: Influenza has killed three unvaccinated Saskatchewan preschoolers so far this season

Via CBC News: Influenza has killed 3 unvaccinated Sask. preschoolers so far this season: public health officials. Excerpt:

Katelyn Hansen has spent the past month mourning her two-year-old daughter.  

"There was a lot of people who loved her," said Hansen, who lives in Wollaston Lake, Sask. "She loved to dance and to jig." 

On Dec. 2, Hansen's daughter became so sick that she was flown to La Ronge, more than 350 kilometres to the southwest, where the girl tested positive for the H1N1 virus.  

After three days of watching her daughter fail to respond to antibiotics, Hansen and two-year-old Kaelynn were flown by air ambulance to the pediatric intensive care unit at Saskatoon's Royal University Hospital.  

"The X-rays showed her lungs were cloudy," said Hansen. "She couldn't breathe."

On Dec. 8, 2018, Kaelynn Angel Hansen died, making her the first preschool-aged casualty of this season's influenza outbreak in Saskatchewan.  

The virus has since killed two more unvaccinated children under the age of five, public health officials say. There have been a total of six flu-related deaths this season in Saskatchewan, according to the province's latest report. 

"Any hospitalization death is sad but especially when it's under the age of five, it's very concerning," said Dr. Saqib Shahab, Saskatchewan's chief medical health officer.  

So far, 1,723 cases of influenza have been confirmed this year in Saskatchewan, although Shahab said that's an underestimate. To date, the virus has sent 14 people to intensive care units, the province's flu report for the week of Dec. 29 says.

Another tough flu season hits Canada, affecting children harder

Via The Globe and Mail: Another tough flu season hits Canada, affecting children harder. Excerpt:

Canadian pediatric hospitals are seeing a surge in flu-related admissions as H1N1 re-emerges as the dominant strain of influenza this season.  

The number of children admitted to hospital for the viral illness so far this season is more than twice as high as it was at this time last year, and more than three times as high as it was at this point in the 2016-2017 flu season, according to the Public Health Agency of Canada (PHAC.) 

More children have also been sent to the intensive-care unit to fight severe incarnations of the flu than at this time in recent seasons, the figures show. 

The reason influenza is hitting children and adolescents harder than usual is the return of H1N1 after two seasons in which another type of influenza A, known as H3N2, prevailed.  

There is, however, a silver lining to that change: While H1N1 is tough on kids, it’s easier on the elderly, the group most prone to serious complications and deaths from influenza. 

Public-health experts also say the flu shot tends to work better against H1N1 than it does against H3N2, which means that influenza could wind up taking a gentler toll overall in the 2018-2019 season than in the past couple of seasons.  

“Generally, H1N1 seasons can be milder. The reason they can be milder is that seniors who lived through H1N1 when they were younger have better immunity against H1N1," said Michelle Murti, a public-health physician with Public Health Ontario. “What we do see is a shift to a younger age group in H1N1 years where children and young adults tend to be more susceptible."

One child and seven adults die in space of five days as flu season gets off to deadly start in Hong Kong

Via the South China Morning Post: One child and seven adults die in space of five days as flu season gets off to deadly start in Hong Kong. Excerpt:

The flu season got off to a deadly start in Hong Kong claiming the lives of one child and seven adults in the space of five days, health authorities said on Friday. 

Another 18 adults reportedly have severe cases of influenza, while a 6-year-old girl is critically ill with severe paediatric influenza, according to the Department of Health. Two other children have also been taken ill with the disease.  

The department’s Centre for Health Protection had warned of a surge in the rate of infection in the week the city entered the flu season, about a week earlier than last year. It said it had received a report of the death of a child under the age of 18 from flu, but had no more details.  

According to figures provided by the department, which cover the period between Sunday and Thursday, six of the adults who died were aged 65 or over, while the seventh was over 50, while 84 per cent of the severe cases are related to influenza A (H1). 

The department noted that the deaths “may be due to other acute medical conditions or underlying diseases”. Two of the children who are sick had reportedly not been vaccinated.

In the second week of 2018, when the winter peak season was announced, the department recorded 14 adults deaths among 23 severe cases.  

The 6-year-old, who is in the paediatric intensive care unit at the United Christian Hospital in Kwun Tong, fell sick on New Year’s Day, and according to authorities had not been vaccinated. 

Meanwhile, a boy and a girl, both four years old, are also in serious condition, with the influenza A infection, and severe pneumonia.

Despite being vaccinated, the boy was admitted to hospital on December 31. He had travelled to Britain over Christmas. 

The girl, who did not get the flu jab either, was admitted to Princess Margaret Hospital on December 26.  

Officials said they are investigating the three cases.

100 years ago, a train carrying Spanish flu pulled into Calgary. Within weeks, Alberta was in crisis

Via CBC News: 100 years ago, a train carrying Spanish flu pulled into Calgary. Within weeks, Alberta was in crisis. Excerpt:

Exactly one century ago, the Spanish flu was sweeping through Alberta, and Edna Traunweiser felt she had to do something to help. 

Her only brother was one of about 6,000 Albertans who had been killed on the front lines of the war. He died in spring 1918.  

The 29-year-old Calgarian had some training as a nurse but had yet to graduate. Still, she registered to help ailing soldiers at Sarcee camp hospital, located north of the Elbow River in what's now Signal Hill. 

Within one week, she'd contracted the illness. Within two weeks, she had pneumonia, and was buried a day after the war's end.  

"It killed nearly as many Canadians as the First World War did," said Janice Dickin, professor emeritus at the University of Calgary. "But when you start looking at histories of the country, they will go on and on and tell you about what happened in the war, but you get one line for the flu epidemic."  

While people in the prime of their lives were the main victims of both the war and the flu, the war primarily claimed young men. Women (mainly volunteer nurses and expectant mothers), Indigenous people, and members of the working class were hit hard by influenza.  

4,000 Albertans died, 38,000 fell ill 

Traunweiser's grave is one of 384 in Calgary, and more than 4,000 across the province, each marking a victim of the Spanish influenza between 1918 and 1920.  

Alberta had a population of just about 500,000 at the time. More than 38,000 fell ill — around seven per cent of the population back then. 

Those are just the recorded cases — some historians estimate the death toll may be even higher. 

As much as five per cent of the global population is estimated to have died from the flu, far more than the number of people who died in the war.  

"[Traunweiser's] death coming so soon after the loss of her brother is an almost insupportable grief to her parents," read an article from the Calgary Herald, reproduced in the Grand Forks Sun in 1918. "The death … will come as a great shock to a large number of friends with whom Miss Traunweiser was very popular." 

Historian Harry Sanders visited Traunweiser's grave in Calgary's Union Cemetery on Armistice Day — now known as Remembrance Day — to pay his respects and see if anybody had placed a stone to remember her by. 

"You go there, and you can read it's the Traunweiser family plot, but nothing marks her grave," he said. 

The flu, which was a strain of H1N1, first appeared in Alberta a little more than a month before Traunweiser's death.  

Troops were being mobilized to join the Siberian Expeditionary Force. 

Sick soldiers, returning from the front, encountered healthy ones who were boarding trains headed for Vancouver to depart for Russia. 

Train travel enabled the illness to spread across crowded barracks and hospitals in a matter of days, wrote historian Mark Humphries, in a book on the impact of the First World War and the Spanish influenza on Canadians.

New Year's Eve, 2008

Just out of curiosity, I've checked what I'd been blogging about here on December 31, 2008...ten short years ago.

It was mostly bird flu; the H1N1 "swine flu" pandemic was almost six months in the future, and I hadn't yet realized that bird flu could not be considered apart from an enormous range of global-health issue. (Also in the future: Haiti's cholera, MERS, H7N9, Zika, and urban Ebola.)

So I was reporting on a two-month-old baby in Shenzhen who was recovering from H9N2. The case provoked authorities in Guangdong to tighten inspection of poultry markets.

Indian doctors in Manipur were working "round the clock" to prevent the spread of H5N1 to their city after an outbreak in Assam state.   

In Nigeria, the Bauchi state ministry of health was on the alert for H5N1 as well; it was about that time, I seem to recall, that Nigeria had one human case of H5N1, which had been fatal.

Here in Canada, Ontario was finally making public the rates of hospital-acquired infections from superbugs like C. diff and MRSA.

On New Year's Day, I was reporting a health scare about possible H5N1 in an Indonesian village. And I posted links to the old Flu Wiki Forum (no longer online) and Mike Coston at Avian Flu Diary (still very much online).

Ten years later we're watching a slightly different mix of bacteria and viruses, but the war goes on. It has been my good fortune to follow the war from a safe vantage point, while gaining ever deeper respect for the men and women fighting it from the villages of Asia and Africa and Latin America to the hospitals of Europe and North America. I hope my posts have accurately reported their extraordinary efforts.

ECDC: Influenza virus characterisation, Summary Europe, November 2018

ECDC has published Influenza virus characterisation, Summary Europe, November 2018. Excerpt from the executive summary:

This is the second report for the 2018–19 influenza season. As of week 48/2018, only 2 061 influenza detections across the WHO European Region had been reported. Detections were made up of 90.4% type A viruses, with A(H1N1)pdm09 prevailing over A(H3N2), and 9.6% type B viruses, with 10 (90.9%) of 11 ascribed to a lineage being B/Yamagata. 

One EEA country, Norway, has shared influenza-positive specimens with the London WHO CC, the Francis Crick Worldwide Influenza Centre (WIC), since week 40/2018. Hence, the main focus of this report is phylogenetic analyses of HA genes of globally collected seasonal influenza viruses with recent collection dates (1 June 2018 or later) that international laboratories had submitted to the GISAID EpiFlu database by 10 December 2018.  

HA genes of A(H1N1)pdm09 viruses continue to fall within subclade 6B.1, defined by HA1 amino acid substitutions S84N, S162N and I216T, represented by the vaccine virus A/Michigan/45/2015, with all recently circulating viruses having additional substitutions of S74R, S164T and I295V. The six characterised viruses from Norway all fell in subclade 6B.1 and were antigenically similar to the vaccine virus. 

The great majority of recently circulating A(H3N2) viruses have HA genes falling in subclade 3C.2a2 and subgroup 3C.2a1b, as seen for the seven viruses characterised by the WIC (six 3C.2a1b and one 3C.2a2). Due to a lack of HA activity, the seven viruses could not be characterised antigenically by HI assay; however, based on previous HI analyses performed with post-infection ferret antisera raised against similar viruses, those raised against subgroup 3C.2a1b viruses induced responses that gave cross-subclade reactivity while those raised against subclade 3c.2a2 viruses gave more subclade-specific reactivity.

ECDC: Influenza virus characterisation, Summary Europe, September 2018

ECDC has published Influenza virus characterisation, Summary Europe, September 2018. The summary:

This is the eighth, and final, report of the 2017–18 influenza season. 

As of week 39/2018, over 240 000 influenza detections across the WHO European Region have been reported. Forty-four percent of the detected viruses were type A, with A(H1N1)pdm09 and A(H3N2) viruses being detected in equal numbers. Type B viruses accounted for 56%; B/Yamagata viruses prevailed over B/Victoria viruses at a ratio of over 50:1.

ECDC: Seasonal influenza - Annual Epidemiological Report for 2017 - 2018

ECDC has published Seasonal influenza - Annual Epidemiological Report for 2017 - 2018. The executive summary:

Influenza activity started in week 47/2017 and returned to baseline levels in week 18/2018.  

In northern and south-western Europe (EU/EEA) , the activity started to increase between mid-December and early January, similar to the timing of the 2016–2017 season but earlier than in the previous five seasons.  

The peak in activity was in early January in south-western Europe and in mid-February 2018 in northern Europe (EU/EEA). In some countries in Eastern Europe, influenza activity did not peak until mid- to late March. 

The majority of influenza viruses detected were of type B, representing a higher level of circulation of influenza B viruses compared to recent seasons. Of all subtyped influenza B viruses detected in sentinel samples, 97% were B/Yamagata and 3% were B/Victoria viruses. Both influenza A subtypes, A(H3N2) and A(H1N1)pdm09 co-circulated in the region. Of all subtyped A viruses detected in sentinel samples, 38% were A(H3N2) viruses and 62% were A(H1N1)pdm09 viruses. 

Influenza viruses circulated at high levels between weeks 51/2017 and 13/2018. This is longer than in recent seasons and may have contributed to the high severity of the 2017/18 season. Especially influenza B activity was detected for a longer period of the season and at a greater magnitude than in the previous seasons. Severe cases were observed in hospital settings due to B virus, but also due to A(H3N2) and A(H1N1)pdm09 viruses. 

Overall, the majority of severe cases were due to influenza virus type B infection and mostly were persons 40 years of age or older. Patients in intensive care units were mostly infected by influenza type A virus.  

Overall, excess mortality from all causes was reported by the majority of 21 reporting countries during the influenza season and was mainly observed in people aged 65 years or older.

Spanish flu: The killer that still stalks us, 100 years on

Via The Guardian: Spanish flu: the killer that still stalks us, 100 years on. Excerpt:

One hundred years ago this month, just as the first world war was drawing to a fitful close, an influenza virus unlike any before or since swept across the British Isles, felling soldiers and civilians alike. One of the first casualties was the British prime minister and war leader, David Lloyd George. 

On 11 September 1918, Lloyd George, riding high on news of recent Allied successes, arrived in Manchester to be presented with the keys to the city. Female munitions workers and soldiers home on furlough cheered his passage from Piccadilly train station to Albert Square. But later that evening, he developed a sore throat and fever and collapsed. 

He spent the next 10 days confined to a sickbed in Manchester town hall, too ill to move and with a respirator to aid his breathing. Newspapers, including the Manchester Guardian, underplayed the severity of his condition for fear of presenting the Germans with a propaganda coup. But, according to his valet, it had been “touch and go”. 

Lloyd George, then aged 55, survived, but others were not so lucky. In an era before antibiotics and vaccines, the “Spanish influenza” – so-called because neutral Spain was one of the few countries in 1918 where correspondents were free to report on the outbreak – claimed the lives of nearly 250,000 Britons. Cruelly for a nation that had seen the flower of British male youth mown down by German guns, the majority were adults aged 20 to 40. The mortality was the inverse of most flu seasons, when deaths fall most heavily on the elderly and the under-fives. 

The global death toll was inconceivable: according to the most recent estimates, between 50 million and 100 million people worldwide perished in the three pandemic waves between the spring of 1918 and the winter of 1919. Adjusting for population growth, that is equivalent to between 200 million and 425 million today.  

Unlike now, when reports of new bird flu outbreaks in south-east Asia are closely monitored by the World Health Organisation, there was no early warning system. Consequently, when it was reported in May 1918 that King Alfonso XIII was ill in Madrid, most people dismissed the Spanish flu as a joke. The main advice was to gargle with salt water and to isolate yourself until the fever had passed. However, these rules did not apply to munitions workers who were urged to “carry on” for the sake of the war effort.  

As in other 20th-century epidemics and pandemics, such as HIV/Aids, Africans and Asians suffered proportionately more than Europeans and north Americans. Thus, while the average case mortality in the developed world was about 2%, in India, where 18.5 million perished, it was 6%, and in Egypt, where 138,000 died, it was 10%. In isolated regions with “virgin” populations with no immunity to flu, the impact was truly astonishing – in Western Samoa, for example, a quarter of the population was wiped out. By contrast, American Samoa recorded no casualties. 

The severity of the pandemic and the peculiar death pattern puzzle scientists to this day. Few epidemiologists believe the pandemic began in Spain, pointing instead to pre-pandemic waves in Copenhagen and other northern European cities in the summer of 1918. Where the virus first leapt from birds to humans or some other mammal is even more perplexing, with some scientists favouring a Kansas point of origin and others northern France or China.