Surveillance
revere | April 26, 2009If 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…
revere | April 25, 2009A 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…
revere | April 25, 2009Canadian 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…
revere | April 25, 2009There 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…
revere | April 25, 2009CDC 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…
revere | April 25, 2009There 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…
revere | April 24, 2009Some 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…
revere | April 24, 2009Two 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…
revere | April 24, 2009Friday 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…
revere | April 24, 2009Late 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…
revere | April 23, 2009This 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…
revere | April 22, 2009Late 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…
revere | April 17, 2009This 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…
revere | April 15, 2009The Wall Street Journal (WSJ) calls it a "reality check," meaning, in their terms, a check against the mistaken idea that there is more foodborne illness these days. That's one way to look at it. Another is a look that is reality based. The reality is that there is a tremendous health burden from tainted food that is unaddressed, at least going by the same CDC Morbidity and Mortality (MMWR) report the WSJ was citing. MMWR was reporting on 2008 data from FoodNet on the incidence of infection from enteric pathogens commonly transmitted via food:
Despite numerous activities aimed at preventing…
revere | April 9, 2009A tantalizing Reuters story yesterday called attention to the uptick in human bird flu cases in Egypt, the African country with more cases than any other (although far behind Asian countries like Indonesia). The observation prompting renewed expressions of concern are that new cases seem to be in the very young (toddlers) but adult cases have almost disappeared. So where are these toddlers picking up the virus? A possibility that is consistent with the observations is that adults are giving it to the toddlers but are themselves symptomless carriers. It's not impossible, because we know that…
revere | March 6, 2009Flu season is in full swing and cases of bird flu seem to follow the same kind of seasonal pattern as "ordinary" flu. Last year more than half the reported human bird flu cases were in Indoesia. But the Indonesian health minister has already warned the world she was only going to tell us what was happening with human bird flu in her country when she felt like it, and apparently she doesn't feel like telling anyone. In December of 2007 (last flu season) Indonesia officially reported 4 cases of bird flu and the following month, January 2008, 9 more. February 2008 brought another 3. This flu…
revere | March 3, 2009The 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…
revere | March 1, 2009The 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,…
revere | February 13, 2009People who make products containing peanut butter are seeing a dramatic drop in sales because of the salmonella problem (other posts here, here, here, here, here, here, here). That includes jarred peanut butters found in supermarkets (down 22% over the same period last year), although none are known to be contaminated. The Peanut Corporation of America (PCA) only sold peanut butter in bulk, to institutions and as an ingredient (peanut paste). Consumers aren't differentiating. This seems like a fairly prudent behavior, since everyday new products are being recalled, now surpassing a stunning…
revere | February 11, 2009The Chinese like chicken. The biggest restaurant chain in China is Kentucky Fried Chicken (2300 in 500 cities). The source of supply is always close. China raises more poultry than any nation on earth. But that poultry also has outbreaks of bird flu, and there have been eight human cases in the last month. Any relationship? The eight cases are not clustered and appear sporadic. But the Ministry of Health has said the human cases appeared in areas where there was no reported bird flu, which puzzled them, since it is conventional wisdom that human cases result from close interaction with…