Swine flu update

Oh, SH!%

Is it possible, Revere, that the Mexican strain and the US strain are identical, or nearly, and the relatively mild cases experienced here are the result of this year's vaccine variant of the H1N1 component conferring a degree of protection, here, that is not being duplicated in Mexico?

Ongoing CDC Emergency clinician call - my notes - skipping parts generally known

call being given by Dr. Ewicke and Michael Bell

Update on current emergency situation - 8 individuals in US with swine flu, the hospitalized patient was immunosuppressed because of autoimmune hepatits. Unrelated to any swine influenza virus that has ever been identified in North America. Incubation period unknown but probably 1-7 days, most likely 2-5 day. Mexico virus studied by CDC appears the same. US cases have been uncomplicated, Mexico cases involve severe lower respiratory symptoms. I'll post more as we go.

More from the COCA call in real time. Clinical recommendations: Expect secondary bacterial infections and exacerbation of underlying conditions. More on CDC website.

Now opening to questions. Sorry this is disorganized, I'm listening and typing.

BTW, this COCA call was announced 2 hours ago, usually they are announced well in advance. The announcement went to the CDC Clinicians Terrorism and Emergency Preparedness listserv. They are declining to answer a question about travel restrictions in California and Mexico.

Is there any explanation for the high fatality rate in mexico as opposed to US? Answer: Don't know, but it is "quite a concern." "Current diagnostics... for seasonal influenza ... will not be able to tell you if individual has swine flu or seasonal flu." Thus it's hard to know how to treat patients with influenza sx in US - since swine flu is amantadine resistant and seasonal is resistant to Tamiflu.

Question: Is there discussion of upgrading WHO phase? "Stay tuned" - discussions are ongoing.

More from Q&A: Current vaccine - 1 of the 8 US cases received current vaccine. Others either not vaccinated or unknown. Looking at cross-reactivity with seasonal H1N1. Preliminary evidence is that the current vaccine is not a good match. Vaccine development is underway - traditional and reverse genetics - and live virus vaccine.

No good info yet about infection in animals in US. It's "h2h ongoing transmission."

First known Mexican case onset 3/22

Any plan for a CDC health advisory? MMWR dispatch to be released today.

There are parallel calls going on with Canada and Mexican clinicians and WHO right now. They repeat that the situation is evolving. There will be a number of documents posted on the CDC website in the next 24-48 hours. "This is just the beginning of this event."

They will have another COCA call on this subject on Monday. (Note not from the call: they also have posted an announcement of a special 2 hour COCA call on Federal Public Health Emergency Law - Implications for State and Local Preparedness and Response - you can sign up for alerts for these calls at http://www.emergency.cdc.gov/coca/callinfo.asp)

Q: "Where on the epidemic curve are we?" A: "Can't say." But 8 cases is expected to be an underestimate.

Q about duration of flu? Duration of illness: 4-6 days.

Call ended. Transcript of call will be posted to coca website by Monday. Next call Monday 2 pm Eastern Time.

is it responding to antivirals?

Steinn: US version (which CDC thinks is same as Mexican) sensitive to Tamiflu and Relenza but not Amantidine and Rimantidine. That's all I know at the moment.

did prices for Tamiflu on the black market respond ?

Anon, "[Did] prices for Tamiflu on the black market respond ?"

Amazing how one can find comedy midst unfolding tragedy -- cheers Anon:*)

Antiviral drugs are the only medical intervention we have against the influenza virus... Our best and only hope in pandemic preparedness (irrespective of transgenic viral composition) is the mass generic manufacture of current antivirals for national government stockpiling...

Turning once again to Crof's H5N1-Blog "Branswell: Canada plans changes in pandemic-drug mix" (April 19, 2009) posting a few days ago!?! The news article was a reprint of a Canadian Press report by Helen Branswell, "Canada planning to change breakdown of flu drugs in pandemic stockpile".

Quoting Dr. Arlene King, the senior official responsible for pandemic influenza planning at the Public Health Agency of Canada, the article expressed current epidemiological understandings of H5N1 and stated that nation will adjust the mix of antiviral drugs in an emergency pandemic stockpile -- a response to scientific concerns over the vulnerability of the main drug, Tamiflu, to the development of viral resistance.

The article went on to state that only up to a quarter of a given Western nation population (except Great Britain at fifty percent) can be treated with antiviral drugs from government stockpiles during the first pandemic wave. This would mean, as Australia's Dr. Buddhima Lokuge et.al. states (see eMJA article), Australian government stockpiled antivirals "will be limited and reserved for those on a confidential rationing list." The United States public are in the same boat and face an identical government policy situation -- selective rationing:*)

So, it is up to us -- everyday folk -- to put our collective hands up and sing loudly to our elected political representatives an 80s GenX song (parental demographic undeniably with the most to lose from a novel transgenic disease with a high CFR in those under the age of fifty). Yes, Moving Pictures' classic tune "What about me" (1981) is an "Aussie battler" anthem appropriate to this incredibly serious public health issue -- "what about the generic antiviral manufacturing option:*?"

eMJA -- "Pandemics, antiviral stockpiles and biosecurity in Australia: what about the generic option?" By Dr. Buddhima Lokuge, Peter Drahos and Warwick Neville. The Medical Journal of Australia 2006; 184 (1): 16-20 http://www.mja.com.au/public/issues/184_01_020106/lok10852_fm.html

Excerpt: "The Doha Declaration on the TRIPS Agreement and Public Health, signed by trade ministers of all WTO member countries on 14 November 2001, states in paragraph 4 that âthe TRIPS Agreement does not and should not prevent members from taking measures to protect public healthâ. The same paragraph continues: â[T]he Agreement can and should be interpreted and implemented in a manner supportive of WTO membersâ right to protect public health and, in particular, to promote access to medicines for all.â

Currently, antiviral agents are the only medical intervention available for influenza-affected patients. Privately, therefore, Australians are likely to demand universal access to this therapy and have a high level of willingness to pay. Clearly, if the manufacturers cannot meet demand at cost-effective prices, then there are health, economic and ethical arguments for a âgovernment useâ licence to be issued and for generic capacity to be developed and deployed rapidly in Australia.

To date, decision-makers have determined not to pursue this option or to even publicly discuss it. Furthermore, in view of limited supplies and likely overwhelming demand, a rationing system has been developed to determine a priority allocation list for these limited resources. For reasons of security, and also because of political pressures, the list of recipients has not been made publicly available. However, this process raises procedural and ethical questions in view of the fact that options for expanding access (eg, generic manufacture) are not being pursued by decision-makers, who are likely to be included in the list of essential public servants with access to national stockpiles.

The policy of not pursuing generic production is further complicated by the fact that Australian taxpayers contributed to the early research that led to the discovery of the influenza target enzyme and subsequent development of antiviral therapies. (A 2003 study by Allens Consulting found that nearly 20% of the output of the biotechnology firm Biota, which developed the first neuraminidase inhibitor, could be attributed to Australian Government funding.)

Ultimately, the questions of how to ensure adequate stockpiles, whether the generic antiviral option should be pursued, and whether governments have the resolve to use compulsory licences that are available under international and national laws to protect the health of nations is a contest of principles.

It is a contest between patent monopolies, involving intellectual property rights, and the right to optimal access to essential medicines.

Currently, decision-makers appear reluctant to challenge the interests of patent owners and the pharmaceutical industry.

At a time of [international] pandemic alertness, they have, in a self-censoring fashion, failed to put the issue of compulsory licences and generic production on the table. We hope this article initiates an alternative debate..."

Hi,
I have not posted in a--long time.
Swine flu aside, if it has the chance to meet with h5n1 in your professional judgement do you think it has a much greater chance of co-mingling?
Thx
dd

"Currently, decision-makers appear reluctant to challenge the interests of patent owners and the pharmaceutical industry."

A dead patient buys no drugs, patent or otherwise! I think rather than see their best current/future customers dead, come the pandemic, the pharm companies will 'see the light'. At least for a while.

But I have always thought stockpiling basic medical supplies and using them 'first in first out' makes much more sense than 'just in time'. If the anti-virals run out and the ventilators are in use, having lots of IV fluids, administration sets, oxygen, cots, and blankets could save a lot of lives. If not the most affected, at least some of the stronger patients. I'm sure most of us would take a cot and an IV over nothing at all.

Basic medical supplies work for other things too...they get used up every day...they should be made HERE not just overseas, and we have so MANY unemployed who could be given jobs...

another argument for border control,see coverage on my site
http://www.earthquakeinfo.net

Brief history of 'Swine-Influenza' in the US:

1976: President Gerald Ford orders a nationwide vaccination program to prevent a swine-flu epidemic.
Ford was acting on the advice of medical experts, who believed they were dealing with a virus potentially as deadly as the one that caused the 1918 Spanish influenza pandemic.
The virus surfaced in February at Fort Dix, New Jersey, where 19-year-old Pvt. David Lewis told his drill instructor that he felt tired and weak, although not sick enough to skip a training hike. Lewis was dead with 24 hours.

This 2009 outbreak will innevitably serve as a response exercise following the Baxter International H5N1/H3N2 episode of December when Live vectors were 'accidentally' exported from their Austrian plant to upto 18 EU nations. WHO were notified and the vaccine community went into panic.
http://www.aphroditewomenshealth.com/forums/ubbthreads.php?ubb=showflat…

It is my estimation that this outbreak will only serve as a test of civil resilience & Military Resilience intervention response. The big outbreak will not come for a year or two, I estimate.

Is anyone testing the Mexican flu fatalities for bacterial infections? There are a number of bacterium that are typically the actual cause of death when coupled with seasonal cases of 'the flu'. Or the recovered people (both countries) of those positive for the A-H1N1 strain for secondary bacterial infections? I bet if they did, the fatalities will show they had secondary bacterial infection present, and those who have recovered, did not.