News Reports for September 22, 2012

CDC study suggests many H3N2v cases may be missed

Sep 21, 2012 (CIDRAP News) - An investigation of one of the first swine-origin H3N2 influenza cases detected in the United States in 2011 suggests that for each confirmed case, there may be many more that go undetected.

The investigation, triggered by a case related to a Pennsylvania fair in August 2011, revealed 3 confirmed cases, 4 probable cases, and 82 suspected cases of variant H3N2 (H3N2v), all of them in people who had attended the fair, according to a report published yesterday in Emerging Infectious Diseases.

The virus could not be confirmed in most cases because most of those with suspected infections had recovered before the investigation, the report says. But among six children under age 4, an age-group in which retrospective serologic testing for novel flu viruses is more useful than for older groups, four tested positive for antibodies to the virus.

"This finding suggests that illness in at least some suspected case-patients can be attributed to A(H3N2v) virus infection," says the report by investigators from the Centers for Disease Control and Prevention (CDC), the Pennsylvania departments of health and agriculture, and the Allegheny County Health Department in Pittsburgh.

The investigators also found signs that greater exposure to pigs increased the risk of having a suspected case, though this finding was not statistically significant. They found no clear evidence of efficient or sustained human-to-human transmission of the virus.

The three confirmed cases discussed in the report were among 12 that were identified in 2011. So far this year more than 300 cases have been found, nearly all of them over the summer in people who had exposure to pigs at county and state fairs. Also, a few cases of variant H1N2 and one case of variant H1N1 have cropped up recently, also associated with fairs.

All of these variant strains have picked up the M (matrix) gene from the 2009 H1N1 virus.

The first infection in the 2011 Pennsylvania cluster was confirmed by the CDC 6 days after the fair closed, and it prompted the CDC and state and local officials to launch a hunt for other cases and possible risk factors, according to the new report.

The investigators cast a wide net to find possible cases. They interviewed swine exhibitors at the fair and members of a national children's agricultural club in the county where the fair occurred. They used the media to encourage people to contact the state health department if they were sick after attending the fair. Also, they encouraged clinicians to obtain samples from patients with flu-like illness after swine or fair exposure.

In addition, the researchers questioned sick contacts of case-patients, and they interviewed visitors at another, later fair in the same county to find out if they had gotten sick after attending the earlier fair. Finally, they used regular flu surveillance to find cases. The team defined a suspected case-patient as a person who, within 7 days after attending the fair, had one or more flu signs or symptoms from at least two categories, such as fever, respiratory, gastrointestinal, and "constitutional" (fatigue, joint pain). Confirmation of a case was based on reverse-transcriptase polymerase chain reaction (RT-PCR).

Serologic (antibody) testing of suspected case-patients was used to define probable cases. Children age 13 and younger were asked to undergo such testing, because it was assumed they would have little previous exposure to viruses like H3N2v and therefore fewer cross-reactive antibodies, which make results hard to interpret. Previous studies indicated that no children younger than 4 have antibodies to H3N2v, but some children between 4 and 13 have cross-reactive antibodies, the report says.

Consequently, a probable case-patient was defined as a suspected case-patient younger than 4 who had an H3N2v antibody titer over 40. Because of possible cross-reactive antibodies, children between 4 and 13 were considered seronegative if they had an antibody titer under 10 and indeterminate if titers were higher than that.

On this basis, the investigation yielded 3 confirmed, 4 probable, and 82 suspected cases. The three confirmed cases included the initial case and are included in the official total of 12 H3N2v cases the CDC has listed for 2011, said Michael Jhung, MD, a medical epidemiologist in the CDC's Influenza Division and senior author of the study.

Of the 89 total case-patients, 19 (21%) were from households of exhibitors at the original fair, 29 (33%) were from households of ag club members, 4 (4%) had attended both the earlier and the later fair, 34 (38%) had called the state health department to report an illness, 10 (11%) were identified by another case-patient, and 2 (2%) were found through state flu surveillance. Some were identified by more than one method.

Illnesses followed swine exposure The patients ranged in age from 6 months to 60 years, with a median of 12 years. Most of them got sick within 4 days after the swine show or the swine auction at the fair. The patients spent a median of 6 days at the fair, and 80 of 87 patients with available information reported direct or indirect exposure to swine there.

Continued with much more on this:  http://www.cidrap.umn.edu/cidr...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Sat Sep 22, 2012 at 06:46:47 AM UTC

India: Four more cases of swine flu reported (Madhya Pradesh)

Of the 10 samples sent to the Regional Medical Research Centre at Jabalpur from the State capital on Thursday, four samples have been confirmed positive for swine flu. This has raised the total number of swine flu cases in the State capital to 20 this year.

"The condition of three patients is stable and there is no matter of worry in this regards, while condition of one patient is critical. Out of the four patients, three are residents of nearby districts and one is a resident of Gandhi Nagar locality of the city," (Snip).

(Snip) the department is taking strict action to prevent spread of the disease. Fresh instructions have been issued in this regard. He also said that all the medical practitioners and paramedical staff getting in touch with swine flu patients will be vaccinated.

(Snip)

Meanwhile, 11 fresh samples suspected for swine flu have been dispatch to the laboratory for tests on Friday. Within six weeks more than 5 persons have lost their lives to swine flu in the State capital. http://www.dailypioneer.com/st...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Sat Sep 22, 2012 at 06:59:16 AM UTC

US: Schools unprepared for pandemics

When health disasters strike, schools can easily exacerbate the emergency. With so many kids crammed into one place for so many hours of the day, infectious diseases can spread rapidly.

Still, fewer than half of schools around the United States have adequate plans in place to deal with the next pandemic, found a new study.

To assess school readiness for bioterrorist attacks or flu outbreaks, researchers at St. Louis University Medical Center surveyed about 2,000 nurses in 26 states who worked with kids of all ages, ranging from elementary to high school.

Eighty-five percent of schools had a written disaster plan as recommended by the American Academy of Pediatrics (Snip). Plans for health emergencies were particularly lacking.

Fewer than half of the plans specifically addressed pandemic preparedness. Continued: http://www.foxnews.com/health/...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Sat Sep 22, 2012 at 07:06:44 AM UTC

Good article, Carol.

With so many funding cuts, I'm sure that pandemic preparedness is far down the list on the budgets of most school districts.

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

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by: History Lover @ Sat Sep 22, 2012 at 13:40:21 PM UTC

[ Parent ]

Will the most dangerous strain of avian bird flu be compromised? (Pennsylvania)

The world's most dangerous strain of the H5N1 virus, or avian bird flu, may only exist inside laboratories, but the medical community still fears the virus will wind up in the wrong hands.

The "Birds, Biology and Bioterrorism" discussion hosted by Dickinson College on Oct. 9 will delve directly into this controversy, bringing to light the ethical and moral implications of the publication of scientific data on artificially created, mutated avian flu viruses.

Kathleen Vogel, a professor from Cornell University, will lead the discussion. Vogel received her doctorate in biochemistry from Princeton University and researches the social and technological impact of biochemical weapons, as well intelligence assessments involving weapons of mass destruction.

Earlier this year, the results of a study, sponsored by the World Health Organization, to genetically modify the H5N1 virus to increase transmission rate among mammals was published, causing an international uproar over the bio-security threat. In the article, researchers described the five mutations necessary for creating a virus that easily transmitted through the air between a group of ferrets, a discovery that if compromised, could potentially trigger a pandemic.

Continued with time and place of the discussion: http://cumberlink.com/news/loc...  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Sat Sep 22, 2012 at 19:42:48 PM UTC

Please post new news stories to...

News Reports for September 23, 2012

Thank you!

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by: AlohaOR @ Sun Sep 23, 2012 at 04:28:08 AM UTC