Entries in Politics and government (199)

Norwegian mutations, Zhong Nanshan warning remind us H1N1 swine pandemic is anything from "mild" 

Posted on Wednesday, November 25, 2009 at 10:31AM by Registered CommenterScott McPherson in , | Comments2 Comments

First came the headlines, Dateline Norway: 

UPDATE 1-Norway says found H1N1 mutation in flu victims

Fri Nov 20, 2009 2:01pm EST

* 3 H1N1 cases found with potentially significant mutation * Two cases found among first fatalities in Norway

* Says disease's mutation could cause more serious illness

* WHO says mutated virus sensitive to antivirals, vaccines

(Adds WHO statement in new paras 4-6; CDC comment paras 15-17)

OSLO, Nov 20 (Reuters) - Norwegian health authorities said on Friday they have discovered a potentially significant mutation in the H1N1 influenza strain that could be responsible for causing the severest symptoms among those infected.

"The mutation could be affecting the virus' ability to go deeper into the respiratory system, thus causing more serious illness," the Norwegian Institute of Public Health said in a statement.

There was no reason to believe the mutation had any implication for the effectiveness of flu vaccines or antiviral drugs made by groups such as Roche , GlaxoSmithKline, Novartis (NOVN.VX: and AstraZeneca, the authorities said. ( I would add BioCryst as well, makers of peramivir).

The World Health Organisation said that the mutation did not appear to be widespread in Norway and the virus in its mutated form remained sensitive to antivirals and pandemic vaccines.

A similar mutation had been detected in H1N1 viruses circulating in several other countries, including China and the United States, in severe as well as in some mild cases, it said.

"Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases," the WHO said in a statement.

H1N1, a mixture of swine, bird and human viruses, has killed at least 6,770 people globally, according to its latest update.

In Norway the mutation was found in the bodies of two people killed by the virus and of one person made seriously ill. The two infected by the mutated virus who died were among the first fatalities from the H1N1 pandemic in Norway, the institute said.

It was unclear whether the mutated virus was transmitted among humans, the health authorities said.

"Based on what we know so far, it doesn't seem like the mutated virus is circulating in the population, but rather that spontaneous changes have happened in the three patients," director Geir Stene Larsen at the public health institute said in the statement.

Norway has seen relatively more fatalities in the flu pandemic compared to the size of the population versus other European countries, with 23 confirmed deaths.

Public health authorities have said this could be due to the country being hit early in the pandemic's northern hemisphere winter wave, before a mass vaccination programme got underway.

"Nevertheless, it is important to study if there's still something about the Norwegian fatalities that separate us from other countries, and that make us learn something that strengthens our treatment of the seriously ill," director Bjorn-Inge Larsen at the Norwegian Directorate of Health said.

Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said, "This mutation has been seen sporadically."

She said it is sometimes seen in patients who have mild influenza symptoms.

"I think it is just too soon to say what this might mean long term," Schuchat told reporters in a telephone briefing. (bold mine) (Reporting by Richard Solem; Additional reporting by Stephanie Nebehay in Geneva and Maggie Fox in Washington; Editing by Matthew Jones and Louise Ireland)

Then the attention turned to Wales and North Carolina, where Tamiflu-resistant H1N1v has apparently spread person-to-person.  Now Chinese superscientist and national hero Zhong Nanshan warns that the conditions are ripe for an H1/H5 hybird to emerge, possibly from China itself.  From the Reuters story:

Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases in China's southern Guangdong province, said the presence of both viruses in China meant they could mix and become a monstrous hybrid -- a bug packed with strong killing power that can transmit efficiently among people.

"China, as you know, is different from other countries. Inside China, H5N1 has been existing for some time, so if there is really a reassortment between H1N1 and H5N1, it will be a disaster," Zhong said in an interview with Reuters Television.

"This is something we need to monitor, the change, the mutation of the virus. This is why reporting of the death rate must be really transparent."

And finally, China itself reports at least eight cases of mutant H1N1v within its borders.

And our response should be:  So tell me something I didn't already expect?

Tamiflu-resistant H1N1 seasonal flu runs about 99%.  Of course, there is no seasonal flu right now of any kind, anywhere in the world.  that is one of the key differences between seasonal H1 and pandemic H1:  Pandemic H1 can be beaten back by Tamiflu.

As for mutant H1N1v:  Of course we would see mutations in the virus!  That is why we need annual flu shots!  Seasonal flu mutates beyond the ability of vaccines to protect us.  This is referred to as "antigenic drift" and is well-known to all who have read this blog for any duration.  I only mention it for all the new readers who are picking this blogsite up every day.

But the mutations in Norway are of special concern.  That is because these mutations cause the virus to penetrate deeper into the lungs of its victims.  And as you probably can guess, deeper is much, much worse.  Once the virus lodges itself in the bottom of the lungs, it becomes much harder to eradicate. 

This is one of the hallmark signs associated with H5N1 bird flu.  Yes, bird flu is exceedingly hard to catch.  But once caught, if medical help and liberal doses of antivirals are not immediately administered, there is diminished hope of recovery.

So the revelation that the "Norwegian mutation" caused death in two patients and severe illness is disconcerting.  But to me, not unexpected.  After all, what disease is moderating itself these days?  This virus is already pretty "mild" in the overwhelming number of cases. Down for a few days and then back to work, or school, or whatever.  So anyone who thought this virus might become even milder has, at best, a 50% chance of being right. 

Or a 50% chance of being wrong.

I err on the side of a tougher disease in the long run.  I ask the question again:  What disease is moderating itself these days?  Ebola?  SARS?  MRSA?  Dengue?  Adenovirus? They have even detected a relatively new strain of rhinovirus, called Rhinovirus C, in Pennsylvania.  A newspaper in Philadelphia reported that tests showed a roughly equivalent number of people catching rhinovirus as catching influenza.  Only this rhinovirus (C) is quite a doozy.  And I have often wondered how many of the people testing negative for H1N1v might actually been suffering from Adenovirus 14. 

In what is an interesting revelation, the WHO is also reporting that similar mutations to the Norwegian Mutation have been detected in Mexico, the United States, Brazil, Japan, and the --- Ukraine.

If you did not notice how the WHO parsed its language during the Ukranian Outbreak, it said:

17 November 2009 -- Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine. Analyses are being performed by two WHO influenza collaborating centres as part of the global influenza surveillance network.

Preliminary genetic sequencing shows that the virus is similar to the virus used for production of the pandemic influenza vaccine, reconfirming the vaccine's efficacy at this time.

The parsing of those words is important.  Saying there were no significant changes means there were changes but not changes that, in the opinion of two collaborating WHO centers, meant anything.  They also said that the virus had not drifted beyond the target as specified by the original virus used for the manufacture of vaccine.

Now here is the AP story on China:

China reports 8 cases of mutated swine flu virus

BEIJING — China has detected eight people infected with mutated forms of the swine flu virus, a health official said Wednesday, but flu drugs and vaccines still work against it.

Flu viruses mutate easily, and scientists have been closing watching for signs that the swine flu virus is changing, which could make it more dangerous or more infectious.

Shu Yuelong, director of the Chinese National Influenza Center, told the official Xinhua News Agency that the mutated swine flu virus found in China was in "isolated" cases in the mainland, is not resistant to drugs and can be prevented by vaccines.

The report did not provide any more details, such as when the cases were detected and if they were linked to any deaths. Calls to the National Influenza Center rang unanswered while the Health Ministry did not immediately respond to a faxed list of questions.

The World Health Organization's spokeswoman in Beijing, Vivian Tan, said the agency had no information on the cases mentioned in the Xinhua report Wednesday.

On Friday, the WHO said it was looking into two deaths and one severe case linked to variant swine flu in Norway, after that country's Institute of Public Health announced that the mutation could possibly cause more severe disease because it infects tissue deeper in the airway than usual.

The same mutation has been found in both fatal and mild cases elsewhere, including in Brazil, Japan, Mexico, Ukraine, and the United States, said the WHO. (bold mine)

Tan said the agency is aware of three such cases in China that occurred in June and July that were similar to the cases being investigated in Norway.

"We are concerned, but realize that influenza viruses, including A/H1N1, are relatively unstable and change easily, especially as they infect more people," Tan told The Associated Press. "Some mutations can have minimal effects on how a virus functions, while other mutations can create important changes with significant public health impact."

China's Health Ministry said Wednesday that 51 swine flu deaths were reported last week, bringing the total number of fatalities in the country to 104.

 OK, let's recap.  This is the kind of informed analysis you come to this site for, right?

H1N1v produces mutant offspring practically every time it replicates itself.  That is because, as an RNA virus, it does not have the double helix quality control of a DNA virus.  That is why there is no universal flu vaccine.  And that is why, eventually, even the H1N1v pandemic vaccine will become ineffective.  Be it three months from now, or three years, it will inevitably be ineffective.

But there have been key mutations spotted in multiple nations almost simultaneously.  These mutations have the effect of pushing H1N1v deeper into the human lung, similar to the effect of H5N1 bird flu.  It is not known if any of the 4,000 deaths in this country are due to this mutant strain of H1N1v, although that should be the very next question anyone asks the CDC. 

In order for this mutation to become more pronounced, it must have some sort of indefinable quality that makes it the preferred strain of virus.  It has to break out more frequently, in more places, and infecting more people.  It has to move efficiently -- something the Norwegian doctors do not think is happening.  Remember that influenza's goal is coexistence, not slaying its host.  Inasmuch as you can ascribe any thought process to something that science does not even want to classify as a life form!

But if this mutation becomes more pronounced, and happens in more and more places, the potential exists for it to make some headway and become the dominant substrain of H1N1v.  I don;t know what we call it at that point; I think the protocol would be to call it A/H1N1/Norway/2009 or something along those lines.

All this serves as a reminder that this pandemic is a looooong way from being over.  Weekly case numbers are misleading and produce false hope.  The Florida Department of Health is not even producing an update until December 3, which I think is a jolly good idea.  By the way, Florida's average age at death from swine flu is now north of 55.  Seven died last week in the Sunshine State, and none of them were under the age of 38. 

So do not be surprised if you continue to hear about mutations, especially mutations that seem to cause more serious disease.  There was a 50/50 chance it would wind up that way.  It should ,however, spur you and your loved ones, co-workers, friends and teammates to all seek the H1N1v vaccine.  It is safer than the virus.

But scientists need to tell us where those mutations took place, and how it affected the death totals.  For instance, southern Brazil had a mutation in the early stages of the pandemic, specifically in Sao Paulo.  Brazil also had a higher case fatality rate in the southern portion of the nation, where Sao Paulo is located.  Coincidence? 

Likewise, in the United States, were any deaths attributable to this mutation?  How about in the Ukraine, where there was something akin to panic in the streets and their public health people were claiming a fusion of H1N1v with parainfluenza and pneumonic plague?

Lots of unanswered questions.  Lots of room for speculation.  And lots of pandemic activity remaining to be played out on the global stage.

We would be wise to heed Zhong's words.  And we need to recognize this pandemic is anything but "mild."

Kawaoka, UW-Madison receive $9.5 million from Bill Gates for flu research

The Bill and Melinda Gates Foundation has given Yoshihiro Kawaoka and the University of Wisconsin at Madison an extremely impressive grant of $9.5 million to continue its research into what makes influenza, well, influenza.

This is both a significant achievement (and validation) for Professor Kawaoka as well as further evidence that Bill Gates is putting his billions to work to try and both understand and eradicate infectious diseases all over the planet.

From the story, via Cap Times:

One of the world's biggest charitable foundations has awarded close to $10 million to the University of Wisconsin-Madison for influenza virus research.

The Bill and Melinda Gates Foundation has awarded $9.5 million in a five-year grant to UW-Madison research scientists who are studying viral mutations that could be early warning signs of potential pandemic flu viruses.

The grant was announced Thursday in a news release from the UW-Madison communications office.

"Early intervention is critical to the control of influenza virus outbreaks," said Yoshihiro Kawaoka, a UW-Madison School of Veterinary Medicine virologist and principal investigator in the project.

"In order to intervene, we rely on early recognition of the pandemic potential of newly emerging influenza viruses," Kawaoka said.

The international team of scientists working on the project will look for mutations in viral proteins that allow avian influenza, commonly called bird flu, to bind to human receptors.

Avian viruses, the release said, don't generally infect humans, but a mutation happens every now and then that could allow the virus to adapt to human cells.

By identifying mutations that might allow this to happen, the project team hopes an early warning system could be developed to make it easier to predict pandemic potential of influenza viruses.

"The improved ability to predict whether a virus has pandemic potential would be an invaluable asset to the global community," Kawaoka said.

"Millions of lives might be saved if intervention methods, such as social distancing, anti-viral compound distribution and vaccine development and production could be implemented early," Kawaoka said.

H5N1 reminds us it's still here, despite swine flu pandemic

Recent reports confirm the return of H5N1 bird flu in poultry in Thailand and Vietnam.  And in today's proMED report, a 21-year old Egyptian college student has a case of confirmed H5N1 bird flu.  

The reports of the return of bird flu should not be surprising.  Just because we're in the (so far, mild) grip of the first pandemic of the information age (I coined that term, as everyone knows) does not mean other flu strains cannot also continue infecting animals.

What is interesting is the case of the Egyptian college student.  He reportedly had slaughtered poultry just days before his onset of symptoms, and it is to the Egyptian doctors' credit that they had the presence of mind to test the lad for H5N1 as well as H1N1.

There is no word if a co-infection was present, but this does confirm the concern that Egyptian authorities have expressed ever since they ordered the slaughter of every pig in the nation (overkill, to be sure).  Namely, they were worried about Egypt becoming the mixing vessel for an H1/H5 mutant virus.

This makes the third time and third locale that H5 and H1 have rubbed elbows.  In Vietnam and in Indonesia, the two viruses were in extremely close physical proximity to one another.  Now, in the midst of the current (first?) wave of swine flu in Egypt, a young adult acquired bird flu.

I don't have the stats on seasonal flu in Egypt currently, but here in the US, of some 5,400 suspected flu samples submitted to the CDC for testing, only four -- FOUR! -- were seasonal flu.  The remaining positive samples were confirmed H1N1v, influenza B, or the nefarious "untyped" influenza A. 

Is it possible, then, that there are more diagnosed and undiagnosed H5N1 human cases in Egypt currently than there are cases of human seasonal flu?  Interesting speculation.  I leave it to you.

As winter approaches, we know we will get more H5N1 cases in birds and in people.  And we know this H1N1v pandemic has a long way to go.  So settle in for the long haul.

WTF? Wall Street firms get swine flu vaccine before you do

Today's news coming out of Wall Street was so preposterous I had to read it three times before it really sunk in.  Here, I will let you read it yourself.  From the AP:

Large NYC employers getting swine flu vaccine

NEW YORK — Some of New York City's largest employers — including Wall Street firms like Goldman Sachs and big universities — have started receiving doses of the much-in-demand swine flu vaccine for their at-risk employees.

The government-funded vaccine is being distributed to states, where health departments decide where to send the limited doses. In New York, health officials are allowing businesses with onsite medical staff to apply for the vaccine.

Doctors for large companies can ask for the vaccine along with other doctors but must agree to vaccinate only high-risk employees like pregnant women and those with chronic illnesses, said Jessica Scaperotti, a spokeswoman for New York City's Department of Health and Mental Hygiene.

Last month, the city began offering vaccine to schoolchildren, as well as pediatricians and obstetricians who asked for it. Scaperotti said only half of the pediatricians in New York City have requested vaccine

"As the vaccine became more available we expanded it to adult providers," Scaperotti said. She called the large employers "a great avenue for vaccinating people at risk."

But a critic said Wall Street firms shouldn't have access to the vaccine before less wealthy Americans.

"Wall Street banks have already taken so much from us. They've taken trillions of our tax dollars. They've taken away people's homes who are struggling to pay the bills," union official John VanDeventer wrote on the Service Employees International Union Web site. "But they should not be allowed to take away our health and well-being."

The union has about 2 million members, including health care workers.

The swine flu vaccine has been in short supply nationwide because of manufacturing delays, resulting in long lines at clinics and patients being turned away at doctor's offices. The vaccine started trickling out in early October, and there are now nearly 32 million doses available.

The government, which ordered 250 million doses, has recommended that the limited supply go first to high-risk groups: children and young people through age 24, people caring for infants under 6 months, pregnant women and health care workers.

Swine flu — which scientists call the 2009 H1N1 strain — is widespread throughout the country now, much earlier than seasonal flu usually hits.

Nationwide, about 90,000 sites are expected to receive vaccine — mainly hospitals, clinics, doctors' offices, county health departments and pharmacies.

Other big New York City employers that have received doses of the vaccine include Columbia University, Time Inc., the Federal Reserve Bank and several hospitals. The distribution was first reported by Business Week.

Goldman Sachs has received 200 doses and Citigroup has received 1,200, health officials said. So far, 800,000 doses have been delivered to 1,400 health-care providers in New York City, including public schools, pediatricians and hospitals.

Citigroup, "like many other large New York City employers, has partnered with the Department of Health to act as a distribution site for the H1N1 vaccine through the company's health clinics," the company said in a statement Thursday. "The vaccine is being provided only to employees in high-risk categories as defined by the CDC."

Goldman Sachs spokesman Ed Canaday said Thursday that the city's health department "decides in its sole discretion who receives the H1N1 vaccine — both the amount and timing."

"Goldman Sachs, like other responsible employers, has requested vaccine and will supply it only to employees who qualify," Canaday said.

While vaccinating children is a top priority for health officials, Scaperotti said only half of the pediatricians in New York City have asked for it.

Some pediatricians' offices that have received the vaccine, though, said the supply is not meeting the demand.

Manager Linda O'Hanlon at Uptown Pediatrics in Manhattan, said the office has received 500 doses so far — not enough for a practice with almost 7,000 patients.

"We have about 800 appointments" set up for patients who want to get vaccinated, she said.

Associated Press writers Stephen Barnard and Sara Lepro in New York City and Valerie Bauman in Albany, N.Y., contributed to this report.

Gee, I wonder just how many toddlers and children ages 2 to 24 that Goldman Sachs will find in their corporate HQ?  I am not one to ordinarily agree with unions, but I think the head of the union quoted in the story hit the nail upon the head.

There have been myriad stories, including one in the New York Times, about New Yorkers waiting hour upon hour to get their children vaccinated.  Just Google 'vaccine delay shortage" and you'll get national and local stories by the hundreds. 

So children get passed by while Wall Street fatcats get vaccine? Just exactly what target group do they belong to, overweight, bloated, overpaid executives? 

This adds to a vaccine credibility problem entirely of the Obama Administration's creation.  They have succeeded in creating a caste system for vaccine.  And I do not care how many hundred doses Citigroup or other banking firms got and how small that might be compared to the general public.  Perception is reality. 

If Wall Street bankers want vaccine, they can bloody well stand in line for it with the rest of humanity.

Rethinking seasonal flu death counts

I have had a blog idea for a few weeks, specifically regarding the nagging feeling in the back of my mind regarding seasonal deaths attributed to influenza.  Just how reliable are those numbers? 

It is like the statement that every day the Florida Legislature is in session, it costs the taxpayers of the Sunshine State $45,000 per day to keep the 160 members in Tallahassee.  As a former Member of the Florida House, the Peoples' Chamber, I recalled that in 1982, when I served, the same figure was recited.  The $45,000 figure was repeated over and over and over again so often that it took on this bulletproof reputation.

Except that it is not bulletproof.  Costs have (at least) doubled since those days, and I can find no one who has actually taken the time to Question Authority and recalculate those numbers. 

Therefore, I am inclined to question the Conventional Wisdom whenever I hear a figure thrown out by everyone as if it were gospel.  It is with a great sense of personal relief that someone had the same idea regarding deaths from seasonal flu; but, unlike me, that person actually acted upon that idea and wrote a mighty fine blog about it as well.

The source is the blogsite Pandemic Information NewsThe blog in question, which was reprinted from the Website HealthSentinel.com, questions the validity of the CDC's claim that "36,000 people die every year from influenza."  This mantra is repeated over and over again until it takes on this granitelike stature of absolute correctness.

As the PIN/HealthSentinel blog points out, the 36,000 figure is a recent change from the previous estimates that only 20,000 or so actually die every year from seasonal flu.  Without trying to explain it, I defer to the actual blog itself.  It is so well written and so well-sourced it makes me jealous!