Swine Flu

This was almost an if-you-blink-you’ll-miss-it story, but it appears to be growing quickly. Being a political junkie like I am, torture revelations since the April 16th release of the Office of Legal Counsel memos by the Obama administration have heavily dominated the news. But that is most definitely not the only news out there. My previous post was about the increased possibility for health care reform this year due to choices made about how to conduct the legislative process. This story hasn’t been percolating in the background like health reform, but there have been precursors (SARS and bird flu). I might have skipped over the story entirely but for an off-hand posting by a friend suggesting a Mexico trip was no longer going to happen.

The New York Times and Washington Post reported stories Friday of a few cases of flu outbreak along the U.S.-Mexico border region that were novel because they contained strains of human, avian, and swine flu viruses. The cases in the U.S. have been mild, with all patients so far tracked in the U.S.  having recovered. In Mexico, the virus has not been as benign, with at least 81 dead so far and over 1000 sickened.

At this point, Mexican President Felipe Calderón has taken steps to isolate flu victims, cancel public events, have health officials and soldiers pass out masks, and check travelers for symptoms before they leave the country. President Obama has been briefed and the administration is actively watching the situation. Australia, New Zealand, and Isreal are also monitoring. In the initial stories in the New York Times and the Washington Post, Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases was quoted saying that they didn’t think it was time for major concern. But I’ll tell you what, they”ve certainly got my attention now.

In this case, I’m actually looking to sources in addition to traditional media to keep up with developments. DemFromCT on Daily Kos is excellelent; Hilzoy on Political Animal has a good post with links to additional resources; and there’s also the Flu Wiki forum which DemFromCT contributes to.

Many more links with excerpts below the fold.

Friday DemFromCT Brief Swine Flu Update

There are 6 documented cases of swine H1N1 in the San Diego area and Imperial County, and 2 in the San Antonio area, all relatively mild (one case was hospitalized, but not primarily for flu.) Seasonal H1N1 is an antigenically distinct virus which means that rapid flu tests cannot tell them apart (CDC will be issuing guidance to clinicians on this), and the current vaccine may not be protective. Tamiflu works, as does Relenza. while there are likely more cases in the US, there are no large scale outbreaks. Mexico is having a larger problem, but details are sketchy and will likely remain so.

Saturday DemFromCT What Does The Swine Flu Outbreak Mean?

This is is a fairly detailed discussion with several good points.

Point number one: this is a novel, never before seen virus. Humans do not have protection, though there may be some cross protection. So, that makes it dangerous and worth watching.

Saturday DemFromCT UPDATE: More Swine Flu Cases: KS and NYC

Friday Donald G. McNeil Jr., New York Times: Unusual Strain of Swine Flu Is Found in People in 2 States

The A (H1N1) flu strain they had was quite unusual, said Dr. Nancy Cox, the chief of the agency’s flu division. It contained gene segments from North American swine, bird and human flu strains as well as one from Eurasian swine.

Like some human strains, it is resistant to two older flu drugs, amantadine and rimantadine. It is not resistant to Tamiflu or Relenza. However, Tamiflu resistance is common in the H1N1 human flu strain circulating this year, so the swine strain could become resistant to Tamiflu if the viruses mixed in humans or, possibly, in pigs.

[…]

The unusual strain this year was noticed, Dr. Schuchat said, only because the agency was trying out a new diagnostic test at a Navy laboratory and doing more testing than usual through a new Border Infectious Disease Surveillance Project along the Mexican border.

Friday Rob Stein, Washington Post: In California and Texas, 5 New Swine Flu Cases

Genetic analysis of the virus indicates it is highly unusual: It is a hybrid that resulted from a combination of four different viruses — one that typically infects people, one that originated in North American birds and two from pigs in Europe and Asia.

“This combination has not been recognized before in the U.S. or elsewhere,” Schuchat said.

Saturday Rob Stein and David Brown, Washington Post: Swine Flu Found in Mexican Outbreak, Illness Raises Alarm Among U.S. Officials

President Obama has been briefed about the illness, spokesman Reid Cherlin said, adding: “The White House is taking the situation seriously and monitoring for any new developments.”

The illness appeared to be primarily striking young, healthy adults, a highly unusual pattern that conjured images of the devastating 1918 flu pandemic.

Saturday Donald G. McNeil Jr., New York Times: Students Fall Ill in New York, and Swine Flu Is Likely Cause

The president in Mexico assumed emergency powers to deal with the crisis, which has killed at least 81 people and infected about 1,300 others. All public gatherings have been banned, including more than 500 concerts and sporting events and the popular bicycle rides on closed boulevards.

Dr. Margaret Chan, the director-general of the World Health Organization, said the events in Mexico “constitute a public health emergency of international concern.”

The W.H.O. convened an emergency meeting of experts on Saturday, but the panel adjourned without raising the global pandemic alert level, saying it wanted more information. Some experts expressed surprise that no action was taken since the Mexico outbreak seems to meet the definition of a Level 4 alert — sustained human-to-human transmission of a new virus. The alert has been at Level 3 for years because of small clusters of human cases of avian flu.

Saturday Marc Lacey and Elisabeth Malkin, New York Times: Mexico Takes Powers to Isolate Cases of Swine Flu

This sprawling capital was on edge Saturday as jittery residents ventured out wearing surgical masks and President Felipe Calderón published an order that would give his government emergency powers to address a deadly flu outbreak, including isolating those who have contracted the virus, inspecting the homes of affected people and ordering the cancellation of public events.

White-coated health care workers fanned out across the international airport here to look for ailing passengers, and thousands of callers fearful they might have contracted the rare swine flu flooded government health hot lines. Health officials also began notifying restaurants, bars and nightclubs throughout the city that they should close.

[…]

Epidemiologists want to know exactly when the first cases occurred in Mexico. Mexican health officials said they first noticed a huge spike in flu cases in late March. In mid-April, they began noticing that otherwise healthy people were dying from the virus. But it was only on Thursday night that officials first sounded an alarm to the population by closing schools, after United States health officials announced a possible swine flu outbreak.

[…]

Even Sunday Mass will probably be affected. The Roman Catholic Church gave worshipers the option to listen to Masses on the radio and told priests who decided to hold services to be brief and put Communion wafers in worshipers’ hands instead of their mouths.

[…]

“This is no joke,” said Servando Peneda, 42, a lawyer who ventured out to pay a bill, but left his two sons home. “There’s 20 million of us in this city and I’d say half of us have these masks on today. I know all of us will die one day, but I want to last out the week.”

Saturday Mike Stobbe, for the AP in the Washington Post: Swine flu worse in Mexico than US, but why?

Why has the swine flu engulfing Mexico been deadly there, but not in the United States?

Nearly all those who died in Mexico were between 20 and 40 years old, and they died of severe pneumonia from a flu-like illness believed caused by a unique swine flu virus.

The 11 U.S. victims cover a wider age range, as young as 9 to over 50. All those people either recovered or are recovering; at least two were hospitalized.

Sunday David Brown, Washington Post: U.S. Slow to Learn of Mexico Flu: Canadian Officials Knew of Rare Strain Before Americans Did

U.S. public health officials did not know about a growing outbreak of swine flu in Mexico until nearly a week after that country started invoking protective measures, and didn’t learn that the deaths were caused by a rare strain of the influenza until after Canadian officials did.

The delayed communication occurred as epidemiologists in Southern California were investigating milder cases of the illness that turned out to be caused by the same strain of swine flu as the one in Mexico.

In the wake of the 2001 terrorist attacks, the outbreak of severe acute respiratory syndrome (SARS) in 2003 and the more recent emergence of H5N1 bird flu in Asia, national and local health authorities have done extensive planning for disease outbreaks that could lead to global epidemics, or pandemics. Open and frequent communication between countries and agencies has been a hallmark of that work.

Sunday Joshua Partlow and Rob Stein, Washington Post: WHO Cites Potential for Swine Flu Pandemic: Mexico’s Leader Orders Sweeping Measures As Cases Exceed 1,000

The director general of the World Health Organization, Margaret Chan, said the “situation is evolving quickly.”

“We do not yet have a complete picture of the epidemiology or the risk, including possible spread beyond the currently affected areas,” said Chan, who cut short a trip to the United States so she could rush back to the WHO’s headquarters in Geneva to convene an emergency meeting of expert advisers to formulate a response to the virus. It is the first time the committee has been called upon since it was created two years ago to help handle disease outbreaks after the SARS, or severe acute respiratory syndrome, epidemic.

“In the assessment of the WHO, this is a serious situation that must be watched very carefully,” she said. “It has pandemic potential.”

[…]

The Mexico deaths are of particular concern to authorities because the victims have tended to be young, healthy adults, whereas ordinary flu mostly kills infants and the elderly.

[…]

Chan stressed that a pandemic was not yet underway or inevitable, and she noted that no outbreaks had been reported elsewhere.

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