Influenza treatment

The White House briefing today had Obama written all over it. It's themes were Obama, it's tone of quiet, serious confidence were Obama. The sense of total command of the situation was Obama. There was the Obama-ese call for "personal responsibility." Government can't do everything. There are things we each have to take personal responsibility for. Fine. I don't disagree. But I think there are some things missing from this frame. One is that it isn't a binary choice, government or the individual. We all live in a set of overlapping communities: work, home, neighborhood, civic organizations,…

If there was ever a graphic illustration of how global interconnectedness affects public health, it's the swine flu affair. Wherever it started, the current crop of cases seems related to Mexico, either as the epicenter or via travelers. Four US states have cases. Those not on the Mexican border are related to travel to Mexico. Kansas, New York City, the suspect cases in secondary school teachers and students in Auckland, New Zealand just returned from Mexico. And France has two suspect cases also just returned from Mexico, as does Spain. We've discussed the problem of infectious disease on…

A concise summary of some additional developments, courtesy Bloomberg: Three teachers and 22 students from Auckland’s Rangitoto high school are being tested for swine flu after returning to New Zealand’s most populous city from Los Angeles following a three week trip to Mexico, Stuff.co.nz reported on its Web site. Some of the travelers had symptoms of flu-like illness and were being isolated as a precaution pending test results, it said, citing the Auckland’s public health service. In the U.K., a British Airways Plc crewmember with flu-like symptoms was taken to Northwick Park Hospital…

Canadian Press (Helen Branswell, with contributions from AP reporters) AP has a piece up about how Mexicans are coping that is worth a read, but we were drawn to this description of how the Mexican authorities first recognized something was amiss:. Health authorities started noticing a threefold spike in flu cases in late March and early April, but they thought it was a late rebound in the December-February flu season. Testing at domestic labs did not alert doctors here to the new strain, although U.S. authorities detected an outbreak in California and Texas last week. Perhaps spurred by the…

There may not have been much news at the CDC briefing, but it is coming thick and fast now. The CDC works through state health departments and defers to them on information about what is going on in their localities. Hence all questions about this were deflected at the 1 pm CDC briefing. I think I understand the thinking behind this but it doesn't serve the goal of getting the information out there quickly. CDC needs to be the information clearing house for all the swine flu news going on around the country and they need to do with absolute transparency. Here's what has developed since that…

CDC has just concluded a press briefing and the big news is there is no big news. In fact there was hardly any small news. The major questions have been identified -- how transmissible, what is the epidemic curve, are there more cases in the US, are there subtle genetic differences in the US and Mexican versions to account for the apparent difference in clinical and epidemiological features, etc. -- but answering them will take longer. Meanwhile, no new cases have been identified in the US, but CDC in collaboration with state and local health departments and the academic and medical sectors…

There will be an update from CDC later today and WHO's expert committee established under the new International Health Regulations (IHR) meets via teleconference this morning North American east coast time at 10 am (4 pm Geneva time) to consider whether the swine flu situation merits declaring it “a public health event of international concern.” If they do, WHO Director General Margaret Chan may respond by raising the pandemic threat alert level from the current phase 3 (new virus: no or limited human to human transmission) to phase 4 (new virus, evidence of increased human to human…

Some end-of-the day (but not end-of-the-world) bits and pieces in the emerging swine flu story. From Helen Branswell (Canadian Press): In Mexico, Secretary of Health Jose Angel Cordova Villalobos said in a television interview that there have been 45 deaths, but only 16 of those were directly related to the flu in question. An estimated 943 people are ill, the television report said. The majority of the cases are occurring in young, previously healthy adults in their mid 20s to mid 40s, reports suggest. Experts aren’t certain if all of those people are sick with this virus or if other flu or…

Two recent sources of information, a conference call for clinicians and a just concluded media conference call held by CDC Acting Director Richard Besser. Clinician call: An emergency conference call for the Clinician Outreach and Communication Activity (COCA) was announced just hours ago on the Clinicians Terrorism and Emergency Preparedness listserv. It was "live blogged" via the Comments Thread by reader Abigail, MD. Here's the gist (lightly edited), as typed by her in real time (thanks!): Update on current emergency situation - 8 individuals in US with swine flu, the hospitalized patient…

Friday April 24, 1:40 pm: AP and NYT reporting that Mexican authorities are saying that they have determined that 16 of 60 deaths are "swine flu," with 44 more being tested. They have yet to confirm whether it is the same as the California/Texas cases, but that's a bit irrelevant since either way it sounds like a very worrisome development. There are already a reported 930 plus cases, with schools closed in Mexico City and contemplation of closing government offices. Obama has been notified and the White House is following the situation. WHO and CDC have activated their emergency centers and…

Late yesterday we summarized a CDC media briefing about the developing investigation of cases of influenza in California and Texas with a previously unknown flu virus with genetic components from pigs ("swine flu", humans and birds). At the same time reports were surfacing of an especially virulent respiratory disease outbreak in central and southern Mexico that had resulted in 20 deaths and hospitalizations with acute respiratory failure. 137 cases have been reported, including health care workers. When asked yesterday, CDC said they were in close touch with their Mexican counterparts but at…

This afternoon CDC held a "media availability" on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are "new," with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father - daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial…

Late yesterday afternoon a Morbidity and Mortality Weekly Report (MMWR) Dispatch appeared on CDC's website that is unique in my experience. MMWR is usually heavily vetted and edited and nothing gets out of there fast. Indeed, in recent years, nothing at all got out of CDC very fast. And yet here is this Dispatch, with text referring to the same day of issue (April 21), reporting on two young patients with febrile respiratory illnesses, one of whose cases CDC only learned about on April 13, 8 days earlier. April 17 CDC determined that the two children, both from the San Diego, California area…

This year's flu season isn't over, but it's almost over, and it was fairly typical and much better than last year, which was nasty. It began at the end of September but didn't take off until early January, peaking in mid Februrary. New cases are still appearing but much less frequently and they are mainly influenza B, which tends to be milder than influenza A. Most of flu/A this year was also of the milder H1N1 sort, which probably contributed to the better outcomes. Here's where we are (source for all charts here): Comparing this year with previous years shows it to be relatively typical of…

"The Stupid. It Burns!" I don't know where this Simpson-esque phrase comes from, but The Stupid burns pretty bright in the brains of Republican Governors Mark Sanford and Bobby Jindal who are refusing stimulus money for unemployment compensation even though their states have some of the highest unemployment rates in the nation. That's stupid. Like refusing help with avian influenza even if you have more cases of the disease than anywhere in the world. The Stupid isn't just an American disease. Take Indonesian Health Minister Siti Fadillah Supari. Please. Source: plognark Indonesian Health…

I'm just getting around to reading the Brief Report by Blachere et al., "Measurement of airborne influenza virus i a hospital emergency department" (Clinical Infectious Diseases 2009:48:483-440) but it's quite interesting. We've noted fairly often here that we still don't know for sure what the main modes of transmission of influenza are, something that surprises many people. We "know" that flu can be passed from person to person via the respiratory secretions from runny noses, coughs and sneezes but we often don't think more deeply about this. We know that viral material can remain viable…

The United States has an influenza surveillance system composed of five overlapping parts. You can get an overview of each here. In 2004 laboratory confirmed deaths from influenza in children (persons less than 18 years old) was made a notifiable cause of death by the states and through this we have been able to get a statistical snapshot of this most tragic kind of influenza mortality. There were 8 such deaths in four states reported this past week, occurring from February 1 to February 18, making the total for this flu season 17. Bacterial co-infection with Staph was seen in 10 of the 17…

The scientific literature is full of specialized papers that on their face would seem to be of little interest. Here's a title like that: "Prevalence and seasonality of influenza-like illness in children, Nicaragua, 2005-2007" (Gordon et al., Emerging Infectious Diseases 2009 Mar). Over 4000 Nicaraguan children, aged 2 to 11 years old and living in the capital of Managua were followed for 2 years, April 2005 to April 2007 and observed for development of ILI (influenza-like illness). We know a lot about influenza in major industrialized countries in the northern and southern temperate zones,…

I'm not sure what to make of the report that scientists in Boston, California and the CDC in Atlanta have made monoclonal antibodies that protect mice against many different flu subtypes. Monoclonal antibodies are antibodies made by the descendants of a single immune cell (that is a single clone, hence monoclonal). Thus unlike natural antibodies, these are also monospecific, i.e., they are directed against one specific target. Our natural immune system "sees" a protein on the surface of the virus called hemagglutinin (HA), of which there are 16 broad subtypes and many, many variations within…

Nature has just published another new paper on the basic biology of influenza virus. Unlike other recent papers it doesn't purport to reveal the secret of why some flu (e.g., H5N1, 1918 H1N1) is so virulent and "normal" seasonal influenza much less so. Instead it involves a process and structures that are the same in both bird and human influenza viruses, which is one reason to pay special attention to it. The structural mechanism is important enough to be retained unaltered in viruses with diverse host preferences and it also becomes a potential target for drugs or vaccines that would work…