H1N1 cases just the tip of the iceberg, warns virologist

We feel that We have to address the most serious issue at hand. Today the most important priority should be given to the H1N1 influenza and how we go about dealing with this. Below is an article from Malaysiakini.com.

The number of reported H1N1 cases could be higher than what is estimated, claimed a virologist from the United Kingdom who urged the Malaysian government to adopt his country’s surveillance system.

Dr John McCauley from the National Institute for Medical Research UK said though it takes time to set up the system, the government should adopt the UK’s “influenza sentinel surveillance programme” to monitor the situation.

“Reported cases of infection are bound to increase but what I am unsure of is whether current figures given are accurate. There can be yet more undetected cases.

“There might be some kind of systematic underestimation of the number of cases. If it is always mild, you can always underestimate the cases you have got,” said McCauley (above).

He explained that under those circumstances some people might not get vaccinated on time. For the vaccination to be effective it has to be administered as soon as the symptoms appear.

Fire brigade approach

He spoke to reporters after delivering a keynote address entitled Pandemic H1N1 – Background and Update at the Kuala Lumpur Convention Centre yesterday.

He said as those below the age of 24, are more susceptible to greater impact from the illness. However, he said, there may a slight degree of immunity for those born before 1957.

He also said that the drugs should only be used in serious cases, this especially so for those not in good health and, pregnant women.

“At the pandemic stage, what you really want the drugs for is to control serious complications arising from the infection,” he said.

Meanwhile, Institute of Bioscience deputy director Prof Dr Abdul Rahman Omar who was also present urged the government to adopt a proper disease control approach.

“We should not practise the ‘fire brigade’ approach but have active surveillance in more places,” he said.

Currently, 51 patients confirmed with the virus, are being warded, with 29 others admitted to intensive care units.

Of the 29, 16 are in the high-risk group with 12 suffering from chronic diseases.

Whose fault is it that leads to the high mortality? – Lim Sue Goan

THE MALAYSIAN INSIDER

AUG 13 – The influenza A (H1N1) mortality rate in Malaysia is close to 2 per cent instead of the 0.1 to 0.4 per cent estimated by the Health Ministry. It reflects an unusual phenomenon.

Without finding out the crux of the problem, assuming that 5 million of people are infected, probably 100,000 of them will die, instead of 5,000 to 28,000 estimated by the World Health Organization (WHO).

If we compare to other countries, we can see the inadequacy of prevention and control in Malaysia.

Vietnam reported 1,211 confirmed cases with one death and the mortality rate of 0.08 per cent. Hong Kong reported 5,991 confirmed cases with four deaths and the mortality rate of 0.067 per cent. Australia reported 27,663 confirmed cases with 95 deaths and the mortality rate of 0.34 per cent.

Even Singapore, which reported deaths earlier than Malaysia, has recorded only nine deaths.

The Health Ministry believed that the domestic confirmed cases are far less than the announced figure, and said it should be multiply by 20 to get the correct data.

But if we compare it to other countries calculated based on the announced confirmed cases, their rates are still lower than ours.

Why has our death toll shot up to 44 people within three weeks after the first death case reported on July22 ?

And why are we having over 200 new cases each day, causing the epidemic to fall out of control?

Such a high mortality rate might be caused by a variation of the virus, weak immune system of Malaysians, poor public health system and ability to deal with an emergency.

The former two causes have very low probability. If there is a variation or a new virus, the Health Ministry would have recognised it through the autopsy reports. And no matter how weak is the Malaysians immune system, it would not have killed six to eight people every day.

The key should be the public health system and the mobility of medical personnel.

Hong Kong, Japan and Australia no longer take the quarantine measures, but they are still having a low mortality rate because of their sound public health systems in which their medical personnel treat the high-risk patients first.

Many people complaint that government hospitals have been reacting too slow to the influenza, including spending a lot of time waiting for tests and long testing time. Many patients might have missed the golden time for treatment during the waiting period and died.

In addition, during the early stage, the government treated the epidemic with neglect, low efficiency and it did not see it as a serious infectious disease.

If the government has held a large-scale awareness and hygiene campaign, including stopping assemblies, the epidemic would not have lost control.

The people lost the sense of crisis because the government did not propagate it through the media at that time as they took into account the impact of it on the national economy, especially on tourism.

Such a serious epidemic has tested Prime Minister Datuk Seri Najib Tun Razak’s governing philosophy of “people first, performance now”.

The government must take urgent measures and emergency means, including having early school holiday and a general mobilisation of medical resources, to prevent the spread of the influenza. Any hesitation will further push up the death toll.  – mysinchew.com

10 life-and-death questions on H1N1

MALAYSIAKINI.COM

However, from sentinel testing and surveillance by the Ministry of Health the last few weeks have shown that almost 95% of all flu-like illness are now caused by the H1N1 virus. Earlier some months ago, seasonal flu variants caused by the B and other A virus were the main causes, the bug causing most flu these few days is the A(H1N1). This appears to be the case also in neighbouring countries, meaning that the new virus is causing more havoc and symptomatic illness than previous types of flu (which are still in the community).

Because almost every flu-like illness (influenza-like illness or ILI) is due to H1N1, the MOH is now recommending that no testing to confirm this H1N1 will now be offered. 

Treat as if this is H1N1 for ILI—symptom relief for mild symptoms (paracetamol, hydration, cough medicines, etc) and self-quarantine, social distancing, be alert for complications. 

Most (~70%) do not need any anti-viral medications such as Tamiflu or Relenza. Only severe cases need to be referred to hospital for further treatment.

2) How should doctors decide if a person be given further specific treatment for H1N1?

If after 2-3 days, fever and cough symptoms do not improve, a recheck with the doctor is recommended, especially if there are features of difficulty breathing, severe weakness and giddiness, or, if the following risk factors are present:

• obesity (fatter patients seem to have poorer outcome and more complications)

• those with underlying diabetes, heart disease

• those with asthma, or chronic lung disease

• pregnant women

• those with reduced immunity, cancer patients, etc

• those with obvious pneumonia features

3) Many anxious people with flu-like symptoms want to be tested or treated for suspected H1N1, but are kept waiting or sent home, without being tested. Is this practice right?

There is no right or wrong practice as this outbreak is extensive and is stretching our resources to the limit. This is also the case not just here in Malaysia, but also elsewhere around the entire world!

The recommendation is now not to spend too much time and effort trying to get tested at designated hospitals or clinics—there is probably no need to do so. I have been informed that as many as 1,000 patients queue anxiously at Sg Buloh hospital for testing, due to fear of the H1N1 flu.

So the message must be made clear: Most flu illness do not require confirmatory testing, and are mild and self-limiting. More than 90 percent will get better on their own, with symptomatic treatment—just watch out for possible complications, and risk factors as mentioned above.

Our resources are limited especially for testing. This is not just for Malaysia, but globally as well. The global demand for test kits and reagents for the H1N1 (PCR) is overextended and are rationed due to this extreme demand. 

Some 200 million test kits have been deployed worldwide, but this supply is critically short because of excessive demand, so most countries have to ration testing to confirm only the worst cases, so as to monitor the pandemic better.

4) Are doctors confused as to what to do in this outbreak, especially when they do not have ready access to confirmatory lab tests?

Not really. Earlier on there was some confusion as to what to do next and who to test or who to refer for further testing and admission. Now the rules are clearer.

There is no need to do any testing to confirm the H1N1 virus for any ILI—just assume that this is the case in the majority of cases. Treat symptomatically when symptoms are mild, reassure the patients and ensure that these infected patients practice good personal hygiene, impose self-quarantine and social distancing, wear masks if their coughing or sneezing become troublesome, and keep a watchful eye on whether the infection is getting better or worse.

If there is difficulty breathing and gross weakness, then patients should quickly present themselves for admission. Understandably this phase of worsening is not always clear or easily understood by everyone… But there is not much more that we can do—otherwise we will be admitting too many patients and this will totally overwhelm our health services.

But prudent caution would help to determine which seriously ill patients need more attention and more intensive care. Unfortunately however, there will be that odd patient who will progress unusually quickly and collapse even before anything can be planned – hopefully these will be few and far between.

A more important note, is that all doctors and nursing personnel should be very aware that they too have to take precautions, and employ barrier contact practices, if there are patients with cough and cold during this period of H1N1 outbreak, which is expected to last a year or two. Carelessness can result in the physician or nurse or nurse-aide becoming infected!

5) Are there sufficient guidelines from the Ministry of Health to address this situation?

I think there are sufficient guidelines from the MOH. Although some politicians have blamed the MOH and the minister for being inept at handling this pandemic – in truth this is not the case. 

It is useful to remember that this is an entirely new or novel virus, which no one previously had encountered before – thus its infectivity and contagiousness is quite high and almost no one is immune to this virus.

Perhaps, there will come a time when all the resources from both public and private sectors can be put to more efficient use. Some logistic problems will invariably occur, because human beings differ in their capacity to understand or follow directives, whatever the source or authority.

Also patient demands have been extraordinarily high and at times very difficult to meet – every patient necessarily feels that his flu is potentially the worst possible type and therefore requires the most stringent measures and testing.

Doctors are also unsure as to the seriousness or severity of this new ailment – and we are only now beginning to understand this better – so our less than reassuring style when encountering this new H1N1 flu is sometimes detected by an equally anxious patient and/or their relatives.

But there is only so much that we can do under such a pressure cooker of an outbreak which is spreading like wildfire! But nevertheless we should not panic, and remember that most >90% of infected people will recover with very little after effects. Possibly only one in 10 patients develop more serious problems which necessitate hospitalisation.

6) Is limiting H1N1 testing only to those who have been admitted to hospital justifiable?

I have explained the worldwide shortage of such testing kits and reagents. Also it is near impossible to test everyone, the world over. Besides, knowing now that almost all the flu-like illness in the country is due to H1N1 makes it a moot point to want to test for this, especially when most are mild.

The rationale for testing only those who need hospitalisation is to ensure that we are dealing with the true virus, and also help to isolate possible changes or mutations to this viral strain. The MOH is also constantly doing sentinel surveillance (random spot-testing at various sites around the country to determine more accurately the various virus types and spread that are causing ILI)

7) Are we short of anti-virul drugs (Tamiflu, Relenza)? Should I take Tamiflu?

These antiviral drugs were available to most doctors during the earlier scare of the bird flu virus, but now are severely restricted, although some orders are still entertained from individual doctors, clinics or hospitals. Remember that these have been block-booked by more than 167 countries who have been shown to have been penetrated by the H1N1 flu bug.

Our MOH has actually stockpiled some 2 million doses of the Tamiflu or its generic form. In the last inter-ministerial Pandemic Influenza task force meeting, this stockpile will be bumped up to 5.5 million doses to cover some possible 20% of the population.

Right now there is no shortage in the country. It is just that it is not readily available on demand for anyone just yet. The MOH is still of the opinion that this antiviral drug be used prudently and would like to register every patient given this drug.

The private sector on the other hand would like to have a looser control over the use of this drug—but we acknowledge that we should be meticulously prudent in its use. There is a genuine fear that resistant strains to this drug may develop with indiscriminate and unnecessary use—then we will all be in trouble with a drug-resistant H1N1 virus run amok!

Drug-resistant strains have been detected in Mexico, border-towns in USA, Vietnam, UK, Australia even. So we have to be vigilant and closely monitor the situation. Right now, the very limited usage of Tamiflu gives us good reason to be optimistic.

However, because of some unusual patterns of seemingly well people dying or having very critical infections, some people and doctors are wondering if these new strains have already reached our shores… or have we been too late in instituting proper treatment…?

The rising number of deaths to 14 now, is quite worrisome, but our health authorities are watching this development very closely and are also checking the virus strain to see if this has mutated. We can only hope that this is not the case, for now.

8) What are some of the problems faced by doctors in dealing with the H1N1 problem?

It would be good if every medical practitioner keeps a close tab on the H1N1 pandemic, and remain fully aware of the developments and changes, which are evolving daily. Every doctor has to be learning on the trot, so to speak, to keep up with the progress of this outbreak and its management, so that we can serve our patients better.

Logging-in to the internet regularly, for more updated information will certainly help, instead of lamenting that not enough is being disseminated via the media thus far… Every doctor has to be more proactive and practice more responsible and cautious medicine during this trying period which is expected to run into at least one to two years. Importantly look out for lung complications, and the above stated higher risk profiles, and refer these patients quickly for further care.

Easier access to antiviral drugs and their responsible use and monitoring would help allay public fears of delay in treatment, but this should be tempered with care and not over-exuberance to dish out to one and all, the precious antiviral drug, just for prevention—this may be a very bad move which can inadvertently create a worse outcome of drug-resistant bugs.

However, in the light of the very quick deterioration of some young patients who have died, it might be prudent to use antiviral treatment earlier and more aggressively.

We look forward to the specific H1N1 vaccine, when it does come our way, probably towards the end of the year. In the meantime, encouraging those in the front-line, heart or lung patients and frequent travellers to have the seasonal flu vaccination is a useful adjunct to help stem the usual problems from other flu types.

9) Are we doing everything that should or needs to be done?

Yes, if you check what other nations are doing, we are doing relatively well. We are not overstating the dangers and we have been quite transparent on the possibilities of this pandemic. Earlier, many agencies and even the public and doctors have accused us of exaggerating the pandemic, and our response was dismissed as being too much, even over the top! Unfortunately, it was only when some deaths occur that many are now decrying that we have done too little!

Also if you are quite honest about it, just compare with the countries globally, and you will notice that no one health or government authority has got this right, spot on.

We are all learning about this novel flu pandemic, and each country’s response is coloured by its past experiences. In Hong Kong, China, Vietnam, Singapore and Malaysia we have had the SARS outbreak, so we are necessarily more paranoid! Also here the experience is that flu does not usually cause death in our community, unlike the west where seasonal flu kills some hundreds of thousands every year!

So the fear factor for this H1N1 flu is not nearly as great in the west, although it is slowly sinking in that its contagiousness and infectivity is far greater, and fears of its reassortment to a more virulent mutant form is growing, into the so-called second and/or third wave of this pandemic, but we will not know until a year or so down the line.

10) Is the public in general doing enough to help in controlling the outbreak? 

I think the public is now reasonably well-informed as to this H1N1 pandemic. Perhaps, they are too well-informed, that they have a fearful approach to this virus. But the proper thing is not too over-react and to panic, although I know this does sound easier said than done.

It is almost a certainty that this flu will spread within the community—in schools, universities, academies, factories, work places, offices, etc. WHO has projected that possibly some 20 to 30% of the population worldwide will become infected by this novel flu bug, after studying various models of spread of past infections—the huge and very rapid spread worldwide is mainly due to air-travel. While older flu pandemics took 6 months to extend to so many countries, this H1N1 flu did so in less than 6 weeks!

In the worst case scenarios of course, this outbreak will be alarming—hospitalisations may be required for 100,000 up to 500,000 Malaysians, with perhaps as many as 5000 to 27000 infected patients (depending on the case fatality rate or either 0.1 to 0.5%) succumbing to this illness.

But because we have been monitoring closely and containing the outbreak thus far, with heightened awareness and greater social responsibility, it is possible to ameliorate the infectivity, spread and fatality that will unfortunately accompany this pandemic… Just how successful we will be in limiting these adverse outcomes remains to be seen, but we can be hopeful.

How can the public help? First learn and acquire good personal hygiene. If sick, please be responsible and stay at home, even in your own room where possible, wear a face mask (a cheap 3-ply surgical mask will do, because large droplet spread is the main danger).

Do not go out, practice what is now known as social distancing (about 3 metres from anyone), and be socially responsible, don’t go to public places and infect others – for young people this would be hard, but absolutely necessary – the spread is most rampant in this age group between 16 to 25 years.

When the illness does not go away after a few days or when you are deteriorating, get to the nearest hospital. Most importantly, be very aware and responsible!

Finally, keep abreast of all new developments, because these are evolving all the time. With keen awareness, prudent care, early detection and social responsibility, correct and prompt use of antiviral and other support medical care, and later mass specific vaccination, we can overcome this novel H1N1 flu! But it will take time, patience, public cooperation, much concerted effort and consume great resources.

DAVID KL QUEK is president of the Malaysian Medical Association (MMA).

New flu may not spread like regular flu

Rueters

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – The new H1N1 influenza strain may be just a little less catching than seasonal flu, but seems a little better able to cause stomach upsets, researchers reported on Thursday.

Genetic analysis and lab experiments with the virus show it lacks a piece of genetic material that makes ordinary flu viruses so transmissible, a team of U.S. researchers found.

Researchers in the Netherlands, meanwhile, found it lives very well in the nose and their findings suggest it has the ability to stay around for a long time — and get worse.

Both studies, published in the journal Science, show that H1N1 swine flu needs to be closely watched, said Dr. Terrence Tumpey of the U.S. Centers for Disease Control and Prevention.

“I think the take-home message is that we really need to keep a close eye on this virus,” Tumpey said in a telephone interview.

Last month the World Health Organization declared a pandemic of the new swine flu. It has been confirmed in more than 77,000 people globally and has killed at least 332 people, but U.S. officials have said there are likely a million or more cases in the United States alone.

Although flu season usually ends in April in the Northern Hemisphere, the new virus is still causing widespread illness and it is actively in the mix of seasonal flu viruses now circulating during the Southern Hemisphere’s winter.

Tumpey and colleagues tested samples of the new virus from a California child who recovered from a mild bout with the new flu, a Texas child who died and a Mexican woman who had severe disease.

They compared it to ordinary, seasonal H1N1 flu, testing it in ferrets, which develop flu in ways similar to humans.

The ferrets did not catch the new swine flu from one another as easily as they catch ordinary viruses, Tumpey said. Usually, if a ferret is infected with human flu, it infects all other ferrets in nearby cages. But with the new H1N1, only six out of nine animals became infected.

HOUSEHOLD SPREAD

Usually 20 percent to 30 percent of household members are infected by a single flu patient but H1N1 swine flu may have a lower transmission rate, Tumpey said.

In addition, all previous pandemic flu strains — from 1918, 1957 and 1968 — have had a specific genetic sequence in a gene called PB2. The new H1N1 does not have this particular mutation, Tumpey said.

He said health officials should keep an eye out for it, as the change may signal the virus is gaining the ability to spread more quickly and easily than it already does. Researchers are also watching for signs the virus has developed mutations that allow it to resist antiviral drugs — and have found two instances so far, one in Japan and one in Denmark.

In addition, Tumpey’s team found mutations that let the new H1N1 virus live in the small intestine — something seasonal influenza cannot do. This may explain why so many swine flu patients have stomach upsets such as nausea and diarrhea, the researchers said.

In the other report, Ron Fouchier and colleagues at Erasmus Medical Center in Rotterdam found the virus lived well in ferrets and spread very easily from one to another.

In fact, ferrets shed more virus with new H1N1 than with seasonal flu — meaning more of it came out of their noses, Fouchier’s team found.

Ferrets inoculated with the new swine flu virus were a little sicker and took a little longer to recover than ferrets infected with seasonal H1N1.

“These data suggest that the 2009A(H1N1) influenza virus has the ability to persist in the human population, potentially with more severe clinical consequences,” they wrote.

(Editing by Mohammad Zargham)

Influenza A(H1N1): 48 new cases bring total to 244

NEW STRAITS TIMES

KUALA LUMPUR, Thu: Forty-eight new cases of Influenza A(H1N1), comprising 40 imported and eight locally-transmitted cases, were detected until 8am today, bringing the total number of cases in the country to 244.

Health Minister Datuk Seri Liow Tiong Lai said of the 48 new cases, 36 involved Malaysians and the other 12 were foreigners.

“Of the 12, four are Indonesians, two each from Singapore, the Philippines and Australia, and one each from China and Italy,” he told reporters at the Parliament lobby today.

Of the local cases, five are students of Sekolah Menengah Tsun Jin, Jalan Loke Yew, here, while one person contracted the flu from the 213th imported case while the other two cases are still being investigated.

Liow said 128 of the total 244 cases have fully recovered from the flu after receiving anti-viral treatment and were discharged from hospital. “The other 116 are still being treated, with 85 of the cases confirmed positive while 31 are still waiting for the results of the laboratory tests. All the confirmed cases have responded well to treatment.”

He said four of the 739 who were in close contact with those infected and were then home-quarantined, had developed symptoms and were admitted to hospital for examination.

“The number of investigated cases for suspected Influenza A(H1N1) came to 2,471, with 244 of them confirmed positive while 64 cases are still awaiting the results of the tests.”

On the issue of saliva tests on local and foreign tourists with flu symptoms at the country’s entry/exit points, Liow said it was just a precautionary measure and not to inconvenience them.

“Malaysia is a safe place to visit and we welcome tourists. We will not simply quarantine or cause difficulties to visitors to our country.

“We have to take strict precautions due to the fast-rising number of cases but at home, our number (of cases) is still small compared to the figures in other parts of the world,” he said.

Liow advised those having a cold or cough to use a face mask to prevent the virus from spreading to others.

“I also hope that the private sector will provide free face masks to the people as a corporate social responsibility,” he said.

Earlier, Liow held a dialogue session with 26 members of parliament and briefed them on the latest Influenza A(H1N1) situation in the country.

“The MPs will bring back all the information to the people, and they will be organising activities at the community level to inform the people on Influenza A(H1N1),” he said. – BERNAMA

Sending pigs into the living halls of Malaysians

MYSINCHEW.COM

 

Is it influenza A or is it swine flu?

 

This is a question of taste.

Just like the modern parents who will never call their kids “Doggie,” “Piggy” and the like. When people get educated and learn some basic etiquette, there will become more cultured and understand what “taste” is.

Similarly, a society with the right “taste” will not allow the use of lowly, despicable and provocative wordings in the mass media.

Besides, “swine flu” is an utter misnomer and unfounded scientifically.

Any among the hundred-odd flu cases in this country has been infected by pigs?

Whenever I turn on the TV, words such as “babi,” “kinzir” and “swine” are repeatedly blasted into my hears, and shock me into shutting off the TV immediately.

As a matter of fact, I do symphathise with these broadcasters. Being Muslims, they are naturally sensitive to pigs. However, the instructions from their superiors have forced them to repeat these few words on a daily basis.

As non-Muslims, even we find it extremely discordant to the ears hearing it, and I wonder whether our Muslim audience would feel comfortable being bombasted by “babi.”

This has inevitably raised a question what information minister Datuk Seri Rais Yatim has in his mind that he must enforce that the media switch to the term “selsema babi” or “swine flu”!

Is the mission of the information ministry to arouse disgust among the public, or to create linguistic pollution, lower the country’s broadcasting standards or to smear the Malaysian society?

Of course, in this multicultural society of Malaysia, forcing the pigs into living halls of Malaysians of various ethnic groups could only accentuate the repulsion between the races.

I was thinking the obligation of the information ministry is to promote inter-racial unity.

Rais has his explanation. He said A(H1N1) was too tough on the mouth, and that “Influenza A” sounded awkward.

If a news broadcaster could not get the pronunciation right, I think they should go through renewed training.

As if that is not enough, no countries in the world could offer so ridiculous reasons to change A(H1N1) into swine flu.

I’m curious how Rais thinks, and is perplexed why he has a unique passion for this word. (By TAY TIAN YAN/Translated by DOMINIC LOH/Sin Chew Daily)

Did a lab leak cause the H1N1 pandemic?

THE MALAYSIAN INSIDER

 

LONDON, June 30 — It has swept across the world killing at least 300 people and infecting thousands more. Yet the swine flu pandemic might not have happened had it not been for the accidental release of the same strain of influenza virus from a research laboratory in the late 1970s, according to a new study.

 

Scientists investigating the genetic make-up of flu viruses have concluded there is a high probability that the H1N1 strain of influenza “A” behind the current pandemic might never have been re-introduced into the human population were it not for an accidental leak from a laboratory working on the same strain in 1977.

 

Yesterday, the Department of Health announced a further surge in the number of cases in Britain with another 1,604 confirmed over the weekend, and the death of a nine-year-old girl in Birmingham with underlying medical complications; the third death in Britain from swine flu-related problems.

 

Almost 6,000 Britons have now been infected with the H1N1 strain of swine flu. But two medical researchers believe that this strain of the virus had been extinct in the human population for more than 20 years until it was unwittingly reintroduced by scientists working in a research lab somewhere in the world, leading to a pandemic in 1977 that began in Russia and China.

 

“Careful study of the genetic origin of the [1977] virus showed that it was closely related to a 1950 strain, but dissimilar to H1N1 strains from both 1947 and 1957. This finding suggested that the 1977 outbreak strain had been preserved since 1950. The re-emergence was probably an accidental release from a laboratory source,” according to the study published in The New England Journal of Medicine.

 

Shanta Zimmer and Donald Burke from the University of Pittsburgh in Pennsylvania said that H1N1 disappeared completely from humans after a pandemic of another strain of flu in 1957. H1N1 was not detected in annual surveillance until an outbreak of H1N1 swine flu in January 1976 at a US Army base in Fort Dix, New Jersey.

 

This outbreak affected 230 military personnel, killing one person, but it was successfully contained and was almost certainly caused by the direct transmission of swine flu from pigs. Nevertheless, the global anxiety caused by the Fort Dix outbreak led to a surge in research into H1N1 around the world, with experiments on frozen samples of the virus stored in labs since the 1950s, Zimmer said.

 

“I would imagine that most labs researching into influenza would have had the 1950s strain. We cannot actually pinpoint which lab had it or accidentally released it, but the re-emergence of H1N1 in 1977 made it potentially a man-made pandemic,” she said.  “It’s a reminder that we need to be continually vigilant in terms of laboratory procedures. The identical virus in the current pandemic would not have occurred because a component of it comes from the H1N1 strain of 1977 — but it doesn’t mean to say that we wouldn’t have had another one causing a pandemic,” she added.

 

One of the most likely routes for the release of the 1950s virus is that laboratory workers became infected accidentally and then infected families and friends, Zimmer explained. After the 1977 pandemic, the H1N1 strain of flu re-appeared annually as seasonal flu but this year it underwent a radical genetic change to become another pandemic strain.

 

Professor John Oxford of the Royal London Hospital said that the accidental release of the 1950s strain of H1N1 in 1977 is entirely plausible, but it may have been a good thing as it would have given many older people alive today some measure of immunity to the current pandemic. “We can look upon it now as a stroke of good luck,” he said. — The Independent

 

12 more H1N1 cases confirmed

THE MALAYSIAN INSIDER

KUALA LUMPUR, June 28 — Twelve newly confirmed cases of influenza A(H1N1), including 11 imported cases, have been reported up to 8am, bringing the total to 124 cases.

Health director-general Tan Sri Dr Mohd Ismail Merican said a 15-month-old boy was the only local infection and his condition was stable after being given an antiviral medication.

The child, who never gone abroad, is a son of an influenza A (H1N1) patient, he said in a statement today.

He said six other family members of the toddler have been prescribed with antiviral prophylaxis and were in good health.

Mohd Ismail said five of the imported cases involved three Indonesians, including two siblings, and two American siblings.

The Indonesian siblings, aged six and 11, who were on holiday with their family arrived on AirAsia flight JT282 two days ago.

The American siblings, a boy aged eight and a girl aged 11, were also on holiday with their family. They arrived on Malaysia Airlines (MAS) flight MH604 from the Philippines via Singapore two days back.

The Indonesian student aged 11, who travelled with her father, arrived here from Jakarta via Singapore on Sri Wijaya Air SJ 104 on Thursday. She plans to spend her school term holiday with her family in Johor.

Mohd Ismail said of six imported cases involving Malaysians, three of them were on AirAsia flight D7 2723 from Melbourne on Wednesday.

They were a 22-year-old female student, who had since been admitted to the

Sungai Buloh Hospital and two male siblings aged 30 and 29, both had been warded at the Tuanku Bahiyah Hospital in Alor Setar.

Two other cases involved a 22-year-old man from Seremban who was on AirAsia flight D7 2725 from Melbourne six days ago and a 25-year-old male passenger on MAS flight MH722 from Jakarta and later boarded MAS flight MH1194 to Penang four days ago.

A 32-year-old woman, who returned from a holiday in London, Paris and Rome, was also confirmed with the flu.

The woman, who is related to the 95th and 96th victims, returned on MAS flight MH001 six days ago.

SWINE FLU AND YOU

BBC NEWS

As the number of UK swine flu cases rise, a whole host of social questions arises if a person is infected. When exposed to the virus, you may find yourself temporarily shunned by friends and family, says the BBC’s Bella Hurrell, whose five-year-old daughter recently had the virus. How should you behave?

Medical advice can be pretty confused as health authorities adjust their containment policy on the hoof in a frantic attempt to stop the spread of the virus.

One minute you can find yourself being told it’s fine to carry on as normal, only to be advised a short time later by someone else that you shouldn’t be setting foot outside your house.

Here are some of the dilemmas you may face if you find yourself exposed to swine flu.

HOW TO GREET A FRIEND WHO DOESN’T KNOW

People are scared of this virus, probably more scared than they would be if you said you had TB, but maybe not quite as worried as they would be if you said you had Ebola.

If you meet a friend in the street, a clear announcement is best, before your acquaintance gets too close. It’s a great opportunity to avoid any awkward continental cheek-kissing.

Do be prepared for people to take a step back and suddenly remember an urgent appointment elsewhere.

If you have had the virus and your friend stays around long enough to ask: “But how are you?” the correct response is a small sigh, a martyrish smile and: “Well, through the worst…”

SHOULD YOU GO TO WORK?

Having a child with swine flu, or even getting it yourself, is currently the perfect excuse for a leisurely week or two off work, no questions asked.

Once through the initial illness, which if you are very lucky may just be a couple of days of feeling a bit feverish, the days stretch ahead in a sunshiny haze.

For the childless that may mean a festival of homemade lattes and catching up with holiday reading but for those with children who have been forced into a netherworld of exclusion from school and playgrounds, the time can be a little more fraught.

Medical advice can vary wildly depending on whether you are speaking to the Health Protection Agency, a flu centre, your GP or some other vaguely medical person who doesn’t really have that much idea, but will try to be helpful anyway.

So despite Health Protection Agency (HPA) guidelines which state that if you have no symptoms you can carry on as normal, others may advise if you have been exposed that you take the antiviral Tamiflu and stay off work for up to 10 days, just to be on the safe side. So, the choice is yours.

SHOULD YOU GO SHOPPING?

It would be madness to trek to the shops if there is the remotest chance that you or your child is contagious, wouldn’t it?

However, being trapped in the house with no interesting food and apparently healthy children who are trying to pull each other’s ears off is no fun and a trip to a supermarket can seem like an exciting adventure. After all, who is going to know?

Well, there is some anecdotal evidence that at least one shop in the Midlands, where swine flu has been most acute, took to banning shoppers with swine flu, though how this would work in practice is a bit unclear.

The HPA says that if you have no symptoms you pose no risk to fellow shoppers, but this advice is complicated by the fact that it is possible to be contagious for up to 24 hours before the onset of symptoms.

So just remember, if you do choose to go to the shops, try to prevent panic by not mentioning the S-word in public or popping your Tamiflu in the produce aisle.

SHOULD YOU GO TO THAT PARTY/BBQ/WEDDING?

Potentially infecting people you don’t know is one thing, but possibly infecting those you do seems like another.

The HPA advises that if you no longer have symptoms then it is unlikely you are still contagious.

Symptoms can last up to seven days after the onset of the illness in adults and a day or two longer for children.

So theoretically there is no reason why you can’t socialise if you feel fine, but fear is never rational, and your friends may not feel quite so confident in your recovery.

Even if you or your family members are no longer symptomatic, you may want to consider that good manners should prevent you from ruining a social gathering by turning up like Typhoid Mary.

And finally, although no-one really knows for sure, if you haven’t developed any symptoms a week after close contact with a person infected by the virus it is likely you are completely in the clear. At least, for now.

ONE MILLION PEOPLE IN USA INFECTED WITH H1N1 FLU

THE MIGHT OF THE PEN WEBSITE

CHICAGO 27/06/2009:  – MORE than 1 million people in the United States may have been infected with the new H1N1 flu, US health officials said on Friday, and infections continue to rise. The new H1N1 influenza virus that has triggered a global pandemic is infecting people in the United States well beyond the normal period for influenza season, Dr Anne Schuchat of the US Centres for Disease Control and Prevention told reporters in a telephone briefing.

‘The key point is this new infectious disease is not going away,’ Dr Schuchat said. ‘In the US, we’re still experiencing a steady increase in the number of reported cases, with 6,000 new cases reported just this week.’ That represents the largest number of cases to be reported in a one-week span since the beginning of the outbreak in April.

The World Health Organisation is now reporting more than 67,000 confirmed cases of H1N1 flu and some 300 deaths worldwide. In the United States, there have been 27,717 laboratory-confirmed cases, including more than 3,000 hospitalisations and 127 deaths.

‘We are estimating about a million people in the US or more have gotten this virus at a time of year when people really aren’t continuing to get the seasonal influenza viruses,’ Dr Schuchat said. ‘A big question that everybody really has is what kind of illness, hospitalisation and deaths will we see when our winter flu season begins?’

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