Entries in influenza and infectious diseases (378)

Elderly Central Florida woman dies of swine flu and why that bears closer inspection

This week, an elderly Central Florida woman named Catherine "Cay" Thompson died of swine (H1N1/2009) influenza.

The news report, a capsule of which can be found here, says the Lake County (just north of Orlando) woman had recently traveled to California.  the new report also says local health officials are "shocked" that a flu case should come so early in the season.

A more detailed Orlando Sentinel account can be found here.

There are a few takeaways to these articles that just jump out at me.

First, are we surprised that a (previously) pandemic virus would still be circulating in the United States outside of flu season?  Pandemic viruses do not follow the seasonal pattern.  When do we determine that a pandemic virus loses its characteristic ability to infect people outside of "flu" season?  We all know the WHO said "stand down, please" to the H1N1/2009 pandemic, declaring it over well before now.  But when exactly does a virus lose its ability to infect outside of flu season?  I would imagine that occurs when the virus burns through the population enough to establish more of a seasonal-looking infection pattern.  I would also imagine that occurs due to natural mutations in the virus itself.  But since the WHO declared the 2010 vaccine formula would be used again in 2011, it would seem that any evolution in the virus, to this point, and based on surveillance, was very minor.

The Sentinel article states the woman and her church group traveled to California, and she fell ill while there.  She then returned early back to Florida.  It does not state how long she was in California before she fell ill, but we all know that influenza takes several days to manifest symptoms.  She died on August 25th, and I cannot find a church calendar that would shed light on when she might have first been exposed to the virus.

Even with these gaps in the travel calendar, I think we can draw up a theory.  The answer to how this unfortunate woman contracted influenza may be found, not from the visit to California, but much, much closer to home.  Orlando, as everyone knows, is a massive tourist destination.  South Americans love Disney just as much as the Brits and the Europeans and the Chinese and the Japanese.  And, indeed, India is struggling with swine flu right now.  But it is amazing how we fail to look south and, instead, default to looking to our left and right for answers.  It's flu season right now in the Southern Hemisphere.  And it is officially Hot as &@%%$ in Florida right now.  Well, actually, pretty much everywhere.  So the chances of a flu virus circulating in 90-degree-plus temperatures is remote.

In my opinion, it is far more likely that this woman actually contracted influenza at the Orlando International Airport, rather than being infected in California.  One sneeze from a Chilean or Argentine would have done the trick.

The other takeaway from this story is the woman's apparent lack of immunity to H1N1.  We all know that pandemic viruses disproportionately attack the young, sparing the elderly, who -- hypothetically -- have been previously exposed to a similar strain of the returning pandemic virus.

But this was not the case with Mrs. Thompson.  There are references in the stories to her immune system, and how the virus overtook it.  But Mrs. Thompson, being 80 years of age, would have had to have lived through the transformation of the Spanish Flu (1918 A/H1N1) and its many mutations.  She would have lived through the near-pandemic 1943, 1947 and 1951 attacks of H1N1.  She would have lived through the transition from H1N1 to H2N2 in 1957.  And she would have gone through two waves of the swine flu, which attacked Orlando pretty hard, precisely because of its status as a global vacation destination. She also appeared to be in relatively good health, based on her levels of activity within the church.

Where I am going with this blog entry is that we should take a closer look at the virus that felled Mrs. Thompson.  It would be wise for public health experts and scientists to tke a look at Mrs. Thompson's killer through an electron microscope, because the death of an otherwise-healthy 80-year old woman from swine H1N1 should not be simply relegated to statistic status.

FAO warns of spread of Fujian H5N1 mutation

Back in 2008, flublogia announced the origins of a new clade, or substrain, of bird flu.  And I joined right in, proclaiming that the new clade -- nicknamed "Fujian," after the province where it was subtyped -- would eventually cause major problems.  The best blog of mine that I could remember on the topic, from 2008, can be read here.  You might also be entertained by my original blog on the Chinese H2H case involving Fujian H5N1, here.  I know I was; I have forgotten half of this stuff! 

Fujian H5N1 was the cause of the father-to-son (or was it son-to-father) Chinese H2H infection back in 2008.  The arrival of simultaneous Fujian B2B and H2H bird flu was extremely troubling to all of us.

Well, it took awhile (just over three years), but Fujian H5N1 is on the lips of television announcers and copy editors the world over.  The reason?  The FAO (think WHO for animals) released a statement today, proclaiming great worry over this "new" mutant strain of bird flu, and imploring the world to monitor it carefully.

Now the timing of such stories is interesting.  We have been monitoring Fujian for years, as I mentioned earlier.  But with the release of the film "Contagion," we may be seeing where the world's public health authorities see an opportunity to raise awareness just when bird flu is about to become a household word again.

Make no mistake:  I am all about awareness.  Consider my own "pandemic fatigue" following the aftermath of the first wave of the swine flu/H1H1 pandemic of 2009-11.  This story woke me up and caused me to go back and retrace my own experiences writing about Fujian 2.3.x H5N1.  So let's review what has been happening in the months since I last blogged seriously about H5N1. 

As of August 19th of this year, there were more confirmedhuman bird flu cases than in all of 2004, 2008 or 2010.  Keep in mind that this includes an alarming increase in Egyptian human cases and accompanying deaths.  But most distressing is the sudden re-emergence of Cambodia as a bird flu incubator.  While Egypt has had 32 cases and 12 deaths to date, Cambodia has had 8 cases -- all fatal.  Of course, we shrug our shoulders at Indonesia, which continues to befuddle Western experts with its distressing lack of transparency. 

So 2011 already ranks as the fifth-worst year for human H5N1, and we have the beginnings of flu season in which to add to that total.  It would take a huge, but not impossible, acceleration of human cases to move it past 2009's 73 totals.  that is the good news.  But the FAO apparently sees a cause-and-effect relationship between the initial discovery of a new clade, the distribution of that new clade, its ability to overtake the existing clade as the dominant substrain, and then extend its reach back into humanity.  Now it is hard to calculate an accurate Case Fatality Rate (CFR) based on such low numbers, but it is safe to say that of all the documented H5N1 human cases, we are still at a reliable 50% figure, meaning that half of all human bird flu patients either die of the disease or its byproducts.  In Egypt, that figure is currently 37%; in Cambodia and Indonesia, it is much, much higher.

The FAO is signaling that it fully expects bird flu cases in poultry and in humans to accelerate in 2011.  The efforts to vaccinate poultry, while admirable, have failed to eradicate the disease (did we ever really expect this effort to be successful?).  Pockets of H5N1 remained and pockets remain today.  While migratory wildfowl (laden with virus) are the primary culprit, humans and their myriad and almost universally bad ways of moving poultry from area to area are also culpable.    Perhaps even more so, when humans smuggle sick and dying poultry across borders, as happens hourly from the Bird Flu Ho Chi Minh Trail from Vietnam into China.

In my next blog, we will take a look at the Australian situation with Tamiflu-resistant H1N1.

Contagion shows bird flu is still alive in the Hollywood psyche (good!)

Contagion Stills & Gallery

Hello, whatever-is-left-of-my-personal-blogosphere!  I know I have not blogged on disease in quite some time.  For that, I plead guilty, with an explanation. 

My day job -- my career as an incomparably-talented and world-renowned IT leader -- has been very demanding over the past year or so.   Plus, to be honest, I think I have been suffering from "post-pandemic shutdown."

I know other bloggers have been dealing with the aftermath of the H1N1 swine flu pandemic.  We all have sort of branched out to engage other diseases.  But influenza is what got me into blogging, and influenza is still at the core of all disease bloggers' interest.

We are all grateful that H1N1/2009 was the relatively mild event that it was.  But we also know that another pandemic always lurks around the corner, behind the building and out of view.  We also know that at least one pandemic each century is a real humdinger, death-wise.

Nonetheless, like Y2K before it, the H1N1/2009 pandemic was surely viewed by the global mainstream media as a sort of nonevent.  Never mind how much work we all put into preparedness.  never mind how much money went into culling poultry (and compensating farmers worldwide).  never mind how much Tamiflu and Relenza we stockpiled around the world.  And never mind how much went into drilling exercises and preparedness messages into our citizens' heads. 

So it was a great and pleasant surprise to stumble upon this trailer for the upcoming film Contagion.  I am a huge film buff, and I was reading about the progress of filming the Max Brooks zombie masterpiece World War Z in Malta and Scotland when I saw a link for a trailer for some film called Contagion.

WHOA!

This is what we thought we would see from Hollywood back in 2006 and 2007.  Instead, we got the passable but still pedestrian Bird Flu: Fatal Contact Movie of the Week.  How this film's existence got by me is unknown, me being such a big EOTWAWKI (End of the World as We Know It) film kinda-guy. Especially with it being a BIRD FLU MOVIE!

The film is directed by Steven Soderberg, he of the Oceans (Clooney-Pitt) movies and Out of Sight, The Limey, Traffic, and Erin Brockovich.  It stars Matt Damon, Gwyneth Paltrow, Kate Winslet, Jude Law and Lawrence Fishbourne.  After watching this trailer, I think we can agree that this should be one helluva scary film.  Listen closely to Fishbourne's character deliver one of the best lines in recent cinematic history.  Post a comment and let me know which line I am talking about.

http://www.youtube.com/watch?v=4sYSyuuLk5g

 

CDC warns of zombie apocalypse!

Faithful readers of this blog (do I HAVE faithful readers anymore?) know that I have taken about a year's sabbatical from blogging on disease.  that does not mean I have neglected the topic entirely; it just means that I have left the topic to those bloggers (Crof, FLA_MEDIC, maryn, others) who have much more informed comment than I.

But I am happy to report that I have returned to blogging on a topic with which I am intimately familiar:

ZOMBIES.

Today, the Centers for Disease Control has issued a warning to prepare for a Zombie Apocalypse. 

http://www.foxnews.com/health/2011/05/18/cdc-warns-public-prepare-zombie-apocalypse/?test=latestnews

The actual CDC warning appears here:

http://emergency.cdc.gov/socialmedia/zombies_blog.asp

Zombies have always been a curse upon humanity, as chronicled by Max Brooks in his important and long-suppressed historical work, The Zombie Survival Guide:  Recorded Attacks.

Of course, what the CDC is trying to do is capitalize on the tremendous success of the comic and TV show The Walking Dead and the wonderful films of George A., Romero in an effort to promote planning and preparedness for disasters.

Their message is a simple one:  If you've planned for the Zombie Apocalypse, you've planned for pretty much everything. 

Oh yeah -- that's me, just right of center, and toward the top of the photo.

Making sense of the recent flu news

It has been a long time since I blogged anything about the flu.  For starters, I am busier than ever at work, which cuts severely into my blogging time.  But also because I just have not felt the muse.  The swine flu pandemic was blessedly mild overall, although there are thousands of families still coping with the loss of a loved one due to H1N1/2009 who would harshly disagree with my assessment. But it wasn't 1918, so we breathed a sigh of relief.

There are many seemingly divergent storylines currently out there, which I will just list at random.  I am not so sure they are not somehow interconnected, however.

First has to be the continued number of human bird flu infections and deaths in Egypt.  Overlaying this ongoing problem is the sudden departure of Mubarak, the takeover by the Egyptian military, and what this portends for both transparency and NAMRU's operations within the nation. 

Second is the realization that this year's seasonal flu vaccine was way off the mark.  I began to notice last month that my employees were getting sick from flu, and I knew they had received their vaccinations in the late fall.  My deputy, in fact, was tested type A-positive last month.  That's pretty specific.  Here in Tallahassee, doc-in-the-box and emergency rooms were positively overrun with flu cases.  Things are looking better, but the WHUMP! of flu cases in January was much more severe than at the same time last year.  And last year was the dang pandemic!  Almost everyone who got flu this year who I am personally acquainted with, had, in fact, received the vaccine months prior.

Third is the ongoing Siege of Japan by H5N1 in poultry.  We all have read the articles about the culling of hundreds of thousands of birds in Japanese poultry farms.  this has spread to the mainland, especially South Korea.

What is clear to me is that the H1N1/2009 pandemic was not sufficient to push the other subtypes off the radar.  This runs contrary to previous pandemics where a dominant substrain was capable of, and able to, sufficiently supplant  the previous Big Dog of Flu.  H1N1 was replaced by H2N2, which was replaced by H3N2, and so on.  Swine flu was not able to eradicate H3N2, nor was it able to eradicate B.  for that matter, I do not know what research existed prior to the mid-1950s to actually track Influenza B.  for all I know, Influenza B has been around since the Chinese domesticated ducks some 4,000 years ago. 

Or, since B mutates more slowly than A, and is therefore not capable of producing pandemics (so says Wikipedia), it is not subject to the King of the Mountain game like Influenza A.

But someone apparently blew the call on the vaccine this season.  I get the feeling the only strain they got right was, in fact, the pandemic strain! 

The other strain that H1N1/2009 did not push off the radar is H5N1.  In fact, so far this year, bird flu activity seems to be much more intense than at the same time last year.  Human cases and deaths in Egypt seem to be at the same levels as last year, but H5N1's overrunning of the Japanese poultry industry is disconcerting.

Finally, there seems to be some concern that this year's flu outbreaks are more severe than last year's.  Again, this is not scientific, but my people got hit and hit hard by the virus.  Their symptoms were severe, with one person requiring hospitalization.  In one case Tamiflu did nothing, although there is a chance it was not administered in time.

H1N1 had a comeback in the late 1940s and early 1950s, with several epidemics (the Liverpool Flu of 1951, for instance) that were considered equal to, or more severe than, the 1918 pandemic, depending on location.  Shortly afterward, H2N2 (re)appeared, seemingly wiping H1N1 off the face of the Earth.

I openly wonder if the appearance of swine flu in 2009 was, in fact, the Beginning of the End of H1N1 as it was in the 1950s, and we are at the brink of the introduction of a different substrain of flu.