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Author Topic: H1N1 - Swine Flu - Novel Flu - Information  (Read 66203 times)
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« Reply #380 on: October 28, 2009, 12:17:04 PM »

FDA - Emergency Use of Intravenous Antiviral Peramivir - Press Announcement

FDA Authorizes Emergency Use of Intravenous Antiviral Peramivir for 2009 H1N1 Influenza for Certain Patients, Settings

The U.S. Food and Drug Administration announced today that, in response to a request from the U.S. Centers for Disease Control and Prevention, it has issued an emergency use authorization (EUA) for the investigational antiviral drug peramivir intravenous (IV) in certain adult and pediatric patients with confirmed or suspected 2009 H1N1 influenza infection who are admitted to a hospital.
Specifically, IV peramivir is authorized only for hospitalized adult and pediatric patients for whom therapy with an IV drug is clinically appropriate, based on one or more of the following reasons:

the patient is not responding to either oral or inhaled antiviral therapy, or
when drug delivery by a route other than an intravenous route -- e.g., enteral (absorbed by the intestines) or inhaled -- is not expected to be dependable or feasible;
for adults only, when the clinician judges IV therapy is appropriate due to other circumstances.
The FDA has reviewed the available scientific data and has concluded that the criteria for authorizing the emergency use of IV peramivir have been met.

There are no FDA-approved intravenously administered antivirals for the treatment of influenza. Peramivir is the only intravenously administered influenza treatment currently authorized for use under EUA for 2009 H1N1 infections.

The EUA authority allows the FDA, based on the evaluation of available data, to authorize the use of unapproved or uncleared medical products or unapproved or uncleared uses of approved or cleared medical products following a determination and declaration of emergency, provided certain criteria are met. The authorization will end when the declaration of emergency is terminated or the authorization is revoked by the agency.

For more information, see http://www.cdc.gov/h1n1flu/eua/ or call 1-800-CDC-INFO (1-800-232-4636).



Click on this link for entire article:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187813.htm
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« Reply #381 on: October 28, 2009, 12:22:10 PM »

CDC - Prevention Of Pneumococcal Infections

Prevention Of Pneumococcal Infections Secondary To Seasonal And 2009 H1N1 Influenza Viruses InfectionOctober 23, 2009, 5:00 PM ET

Pneumococcal Disease Complicating Influenza
Influenza predisposes individuals to developing bacterial community-acquired pneumonia. During each of the influenza pandemics of the 20th century, secondary bacterial pneumonia was a frequent cause of illness and death and Streptococcus pneumoniae (pneumococcus) was reported as the most common etiology. These findings also apply to seasonal influenza.

S. pneumoniae remains a leading cause of vaccine-preventable illness and death in the United States. Recently, pneumococcal infections have been identified as an important complication in severe and fatal cases of 2009 H1N1 influenza virus infection. Importantly however, approximately 70 million persons with existing pneumococcal polysaccharide vaccine (PPSV) indications (Table) are unvaccinated (National Health Interview Survey, 2007).


See entire article at this link.  It includes much more material as well as columns which do not format well when copied to this thread and related links...

http://www.cdc.gov/h1n1flu/vaccination/provider/provider_pneumococcal.htm
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« Reply #382 on: October 28, 2009, 12:25:55 PM »

CDC - Antivirals - Clinicians Considering the Use of Peramivir IV


Clinicians Considering the Use of Peramivir IV

Currently there is no intravenous formulation of antiviral product approved by the U.S. Food and Drug Administration (FDA) for the treatment of hospitalized patients with influenza. Peramivir, a neuraminidase inhibitor, is an unapproved (investigational) antiviral drug available in an intravenous (IV) formulation. Peramivir IV is currently under development for treatment of acute influenza in patients who require hospitalization due to the severity of influenza virus infection. The efficacy and safety of Peramivir have not yet been established. The FDA has issued an Emergency Use Authorization (EUA) to allow the use of Peramivir IV to treat certain adult and pediatric patients with suspected or laboratory confirmed 2009 H1N1 virus infection or infection due to nonsubtypable influenza A virus suspected to be 2009 H1N1 based on community epidemiology. The authorized use of Peramivir IV under EUA is subject to the scope, conditions, and terms of FDA-issued EUA.


Entire article at link below:

http://emergency.cdc.gov/h1n1antivirals/
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« Reply #383 on: October 28, 2009, 12:27:34 PM »

Emergency Use Authorization of Peramivir IV
October 26, 2009 5:00 PM ET

FDA-Issued Peramivir IV EUA Letter 

Fact Sheet for Health Care Providers 
To request Peramivir IV (licensed clinicians with prescribing privileges ONLY), CLICK HERE. For any questions, call 1-800-CDC-INFO (1-800-232-4636).
For questions relating to this Emergency Use Authorization, contact: EUA.OCET@fda.hhs.gov
Fact Sheet for Patients and Parents/Caregivers 

Intravenous Peramivir


***Note: For information on recognizing and reporting adverse events (side effects) of Peramivir IV, please refer to the applicable Fact Sheet.

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« Reply #384 on: October 28, 2009, 12:30:00 PM »

Emergency Use Authorization of Peramivir IV
October 26, 2009 5:00 PM ET

FDA-Issued Peramivir IV EUA Letter 

Fact Sheet for Health Care Providers 
To request Peramivir IV (licensed clinicians with prescribing privileges ONLY), CLICK HERE. For any questions, call 1-800-CDC-INFO (1-800-232-4636).
For questions relating to this Emergency Use Authorization, contact: EUA.OCET@fda.hhs.gov
Fact Sheet for Patients and Parents/Caregivers 

Intravenous Peramivir


***Note: For information on recognizing and reporting adverse events (side effects) of Peramivir IV, please refer to the applicable Fact Sheet.



Information for clinicians only

http://www.cdc.gov/h1n1flu/eua/peramivir.htm
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« Reply #385 on: October 28, 2009, 12:36:03 PM »

CDC - Situation Update

 More images 2009 H1N1 Flu (Swine Flu)


Site last updated October 23, 2009, 4:00 PM ET

Situation Update
During the week of October 11-17, 2009, influenza activity continued to increase in the United States as reported in FluView. Flu activity is now widespread in 46 states. Nationwide, visits to doctors for influenza-like-illness are increasing steeply and are now higher than what is seen at the peak of many regular flu seasons. In addition, flu-related hospitalizations and deaths continue to go up nation-wide and are above what is expected for this time of year.
See More On Key Flu Indicators >>

Entire article at this link as well as other related links...
http://www.cdc.gov/h1n1flu/
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« Reply #386 on: October 29, 2009, 10:03:04 AM »

FDA - Vaccines - Pregnant Women

Use of Influenza A (H1N1) 2009 Monovalent Influenza Vaccine in Pregnant Women
October 27, 2009


Why do the Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) recommend that pregnant women receive seasonal and influenza A (H1N1) 2009 Monovalent vaccines?

Pregnant women, compared to the general population, are at increased risk for severe disease and serious complications, including death, from influenza.  Pregnant women who are otherwise healthy have been severely impacted by the pandemic 2009 H1N1 influenza virus (formerly called “novel H1N1 flu” or “swine flu”). In comparison to the general population, a greater proportion of pregnant women infected with the pandemic 2009 H1N1 influenza virus have been hospitalized and died.  This is why pregnant women are among the highest priority groups for immunization. 
The CDC and its ACIP recommend that pregnant women receive both the inactivated Influenza A H1N1 (2009) monovalent vaccine and the inactivated seasonal influenza vaccine during any stage of pregnancy.  These recommendations are based on the increased risks of influenza and its complications for pregnant women, the protection that the influenza vaccines can provide for both pregnant women and their newborns, and the track record of safety of the licensed inactivated seasonal influenza vaccines.
 
What do the product labels state regarding use of influenza A (H1N1) Monovalent vaccine in pregnant women? 
 
All seasonal influenza vaccines as well as the Influenza A (H1N1) 2009 monovalent vaccines are approved for adults.
Influenza vaccines, both seasonal and the recently licensed Influenza A (H1N1) 2009 monovalent vaccines, are not contraindicated for use in pregnancy.  As with many other vaccine products, the manufacturers did not conduct clinical studies specifically to evaluate the influenza vaccines in pregnant women prior to approval of these vaccines.  Therefore, the pregnancy section of the prescribing information for the licensed influenza vaccines carry either a Category B or C.  This allows influenza vaccines to be given to pregnant women if there is a determination that the vaccine is clearly needed, as recommended by the ACIP.

What type of seasonal influenza vaccine should pregnant women receive?

There are two types of influenza vaccines.  One is the inactivated influenza vaccine (“flu-shot”) that is given with a needle, usually in the arm.  This is the type of vaccine that ACIP recommends pregnant women should receive.
The other type of influenza vaccine, “nasal - spray” influenza vaccine (sometimes called LAIV for “live attenuated influenza vaccine”) is made with live weakened influenza virus.  The live attenuated influenza vaccine is not recommended by the ACIP for use in pregnancy.
 
Does FDA support the CDC and ACIP recommendations to vaccinate pregnant women to help prevent influenza disease?

Yes. FDA supports the recommendation of CDC and the ACIP that pregnant women receive vaccinations to help protect them against both the pandemic 2009 H1N1 influenza virus and seasonal influenza.

What is known about the safety of influenza vaccines in pregnant women?

Studies of several thousand pregnant women in the scientific literature have shown that inactivated seasonal influenza vaccines are safe during pregnancy.  They have shown no evidence for harm to pregnant women, the pregnancy or to newborns of vaccinated women.  In addition, FDA and CDC’s routine monitoring of adverse events has not raised safety concerns.

The FDA-approved Influenza A (H1N1) 2009 monovalent vaccines are made in the same licensed facilities and with the same manufacturing processes used to safely produce hundreds of millions of doses of seasonal influenza vaccine every year. 
 
In addition, before they can be used, all Influenza A (H1N1) 2009 monovalent vaccines must undergo the same rigorous FDA manufacturing oversight, product quality testing and lot release procedures that apply to seasonal influenza vaccines.

Because of the scientific information in the literature, the fact that FDA-licensed manufacturers are producing the Influenza A (H1N1) 2009 monovalent vaccine following the same processes as for their seasonal influenza vaccines, and FDA-oversight of manufacturing, product quality testing and lot release procedures, FDA has a high degree of assurance of the safety of both seasonal and Influenza A (H1N1) 2009 monovalent vaccines for pregnant women. 

Potential side effects of the Influenza A (H1N1) 2009 monovalent vaccines are expected to be similar to those of seasonal influenza vaccines. The most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation.  As with any medical product, unexpected or rare serious adverse events may occur. 

The Influenza A (H1N1) 2009 inactivated (flu-shot) vaccines that have been licensed are available in both single dose and multi-dose preparations.  Multi-dose preparations are formulated with thimerosal, a mercury-containing preservative used to ensure that the vaccine does not become contaminated after the vial has been opened.  Single dose preparations contain no thimerosal, or only trace amounts.  Studies have shown that there is no known harm from thimerosal preservative-containing vaccines. In 1999, FDA conducted a review of thimerosal in childhood vaccines and found no evidence of harm from the use of thimerosal as a vaccine preservative, other than local hypersensitivity reactions. 

The Institute of Medicine’s Immunization Safety Review Committee reached a similar conclusion in 2001, based on a review of available data, and again in 2004, after reviewing studies performed after its 2001 report.  Since then, additional studies have been published confirming these findings.  Thus, pregnant women may receive either preservative-free or thimerosal preservative-containing influenza vaccine.
 
All influenza vaccines continue to be produced using eggs.  For this reason, a previous history of severe, life threatening allergies to eggs are a contraindication to the use of influenza vaccine.

How will the Influenza A (H1N1) 2009 Monovalent vaccines be monitored for safety?

FDA and CDC will closely monitor the safety of the Influenza A (H1N1) 2009 vaccines.  FDA is collaborating with CDC, HHS, private partners and other government agencies to enhance adverse event safety monitoring during and after the Influenza A (H1N1) 2009 vaccination program in all populations, including pregnant women.  In addition, while no safety concerns have been identified to date, a project will be initiated this fall to focus on the safety of the pandemic (H1N1) influenza vaccine and of antiviral medicines for pregnant women and their newborns.

Will the seasonal influenza vaccine provide protection against the 2009 H1N1 influenza virus?

No. This year’s seasonal influenza vaccine is not expected to provide protection against the 2009 H1N1 influenza virus.  Therefore, it is recommended that pregnant women receive both the 2009 H1N1 and seasonal vaccines.
     

Click on link to view entire article...
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm188099.htm
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« Reply #387 on: October 29, 2009, 10:08:29 AM »

H1N1 Influenza A (H1N1) 2009 Monovalent Vaccine Dosage Chart
Mon, 26 Oct 2009 16:30:00 -0500


A printable chart which notes age, dose, manufacturer, number of doses, and route.


http://www.cdc.gov/h1n1flu/pdf/monovalent_vaccine_dosage_chart.pdf
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« Reply #388 on: November 01, 2009, 10:55:47 AM »

Article read this morning in Flu Trackers Forum and link provided by Alaska Denise, an Editor and Senior Moderator

UCSF scientists track swine flu virus for tiny changes that would cause big problems
By Lisa M. Krieger


lkrieger@mercurynews.com

Posted: 10/31/2009 08:55:00 PM PDT
Updated: 11/01/2009 03:16:01 AM PST


SAN FRANCISCO — As the H1N1 flu virus spreads at breakneck speed, a team of local scientists are close behind. They are watching its evolution through a cutting-edge technology in hopes of answering the question: Where did it come from — and where is it going?

Their lab at the University of California-San Francisco holds a growing international collection of viral samples, including some from San Jose swabbed from the noses of sick people, since the first days of the swine flu epidemic. Genetic analysis of each sample will alert researchers to any tiny change that would create a giant problem.

So far, the swine flu virus seems to be evolving slowly. But a small mutation could create resistance to drugs.

The scientific sleuths are most worried about a big genetic leap — such as in 1918, when a mild virus turned deadly, killing 20 million to 40 million people. If such a leap does happen, the lab hopes to detect it early, triggering more aggressive treatment, quarantining and prevention measures.

Locked inside a large, $14,000 freezer, kept at 7 degrees below zero, are trays of plastic vials holding specimens of the H1N1 virus from California, Canada and Mexico. Some of the viruses came from dead patients; others caused merely an annoying cough.

"So far, we have no evidence that this virus is any more virulent than seasonal flu," said Dr. Charles Chiu, director of the Viral Detection and Discovery Center. Instead,
what seems to matter is the immune response of the infected person; while some people shrug it off, others go into lethal overdrive. There is also new evidence suggesting that co-infection with another virus, such as the common cold, may worsen illness.

"What we're worried about is the possibility, because it is a fundamentally new virus, that it may mutate into a strain that is more virulent," said Chiu.

The ambition of the new center, just a half block from AT&T Park, is to hunt down viruses whose identities and origins baffle doctors. And its team wants to understand these mystery viruses at the most essential level: the sequence of its genes.

Upon opening in January, one of the center's first projects was to study H1N1. Its first specimen, from a young girl in Mexico, is now known to be one of the first cases of swine flu. Since then, the virus has spread to 190 countries.

But its researchers have also detected a new virus linked to a rare type of prostate cancer and another virus that causes diarrheal disease in children. In yet another project, they are collecting unusual strains of HIV from Cameroon, Africa.

While at least 20 other labs are studying the genetic structure of the flu virus through conventional sequencing, the San Francisco lab is one of two in the entire nation engaged in viral discovery and "deep sequencing," seeking mutations that occur at very low frequencies. The other is the Center for Infection and Immunity at Columbia University in New York City. "They're doing a great job. What they do is very important," said molecular virologist Paul Luciw of the University of California-Davis.

"The technology enables analysis of strain variation. If you find something very different, then you have to pay more attention — isolating that patient and looking at the patient's contacts."

The collection now includes about 100 samples sent from the California Department of Health Services, 100 from Canada and 100 from various sites in Mexico.

More specimens arrive every day.

Long ago, scientists had to peer through microscopes to figure out what was killing people — a process that could take 10 to 20 years.

Modern surveillance is improved not only through use of "deep sequencing," but another novel detection tool called the virochip, designed by the center's Joseph DeRisi.

The technology uses tiny glass slides dotted with thousands of fragments of DNA from 2,500 known viruses. The tool can study an entire genome at once — so experiments that used to be impossible are now being performed in days or hours.

All the viral sequences are stored in a huge computer database.

A flu virus is thought to reproduce about every eight hours. Within one day, it's spawned several generations. As it breeds, it mixes and morphs.

By comparing H1N1's genetic code with other influenzas, scientists have found a new combination of elements of previously known viruses. Three flu strains — from pigs, birds and humans — combined in one animal to create an unusual "triple re-assortment."

It's not known how, when or where this happened. Then it jumped into humans.

Chiu's team is watching its continued evolution, a gradual accretion of minor mutations called genetic "drift."

"There are changes," he said. "Not a lot of changes — but there are changes. Now we're investigating the significance of these changes."

What he's worried about is a big change called genetic "shift," when there's a dramatic re-assortment and exchange of strands of genetic material that trigger hard-to-predict epidemic trajectories.

Such a shift could build a virus that is fast-growing, adept at infecting lungs, unfamiliar to the immune system — and highly contagious.

"That would be a big deal," he said.

For now, they're waiting and watching, so that a catastrophe like 1918 need never happen again.

http://**/breaking-news/ci_13683182
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« Reply #389 on: November 01, 2009, 11:15:56 AM »

CDC

Page 1 of 1
CMS Free Care Rule for 2009 H1N1 Influenza Vaccination
October 27, 2009

MEDICAID

Medicaid’s long-standing policy is that Medicaid is not liable for services that are available
without charge to the beneficiary or other legally liable third parties. In general, Medicaid
is obligated to ensure that other legally liable third parties pay primary to Medicaid.
In the face of the national healthcare emergency presented by the 2009 H1N1 flu, the free
care and third party liability policies will be applied in the following way:

• Consistent with the Centers for Disease Control (CDC) guidelines, health care
providers accepting CDC funds to immunize all patients, regardless of insurance,
will rely on those CDC funds and will not bill Medicaid for the cost of administering
2009 H1N1 flu vaccines.

• Health care providers accepting CDC funds to immunize only patients without
other coverage will be permitted to bill Medicaid for the cost of administering 2009
H1N1 flu vaccines to Medicaid beneficiaries based on the following criteria:
o Providers with systems capabilities to bill legally liable third party private
insurance or other coverage of non-Medicaid eligibles and Medicaid
beneficiaries must continue to do so.

o Providers without systems capabilities to bill legally liable third party
private insurers or other coverage of non-Medicaid eligibles and Medicaid
beneficiaries may bill Medicaid for services provided to Medicaid-eligible
individuals, but must include in the bills sufficient information to facilitate
Medicaid billing of those legally liable third parties of Medicaid
beneficiaries.

MEDICARE

Q1:
The CDC is awarding funds to State or local government funded (or operated)
public clinics and local public health departments for a mass vaccination
campaign for the 2009 H1N1 flu virus. In order to make the vaccine available to
all, the CDC has instructed public health departments and local clinics to only bill
third party payers for those patients who have coverage for administration of the
vaccine. Can Medicare cover the administration of the 2009 H1N1 flu vaccine
given to Medicare beneficiaries, when non-Medicare patients who demonstrate no
ability to pay receive the vaccine free of charge?

A1: Yes. Although Medicare payment is generally prohibited when a service is paid for
by another governmental entity (see section 1862(a)(3) of the Social Security
Act), in light of the 2009 H1N1 influenza pandemic we have determined that these
administration services meet one of the exceptions to the payment exclusion
concerning governmental entities. Pursuant to title 42, Part 411, section 8(b)(4) of
the Code of Federal Regulations (42 C.F.R. § 411.8(b)(4), Medicare payment may
be made for "services furnished in a hospital or elsewhere, as a means of
controlling infectious diseases or because the individual is medically indigent."

ALL OTHER MEDICARE RULES WILL STILL APPLY TO ANY CLAIM SUBMITTED FOR VACCINE ADMINISTRATION.

(The complete Medicare Q&A from which this information is drawn is available at:
http://www.cms.hhs.gov/Emergency/Downloads/H1N1_Medicare_FFS_Emergency_QsAs.pdf)

http://www.cdc.gov/h1n1flu/vaccination/statelocal/pdf/H1N1_CMS_Free_Care_Rule_for_2009_H1N1_Flu_Vac.pdf
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« Reply #390 on: November 01, 2009, 11:19:45 AM »

CDC - Q&A - EID article "Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April-July 2009"


Questions and Answers about an article on Modeling of Estimated Number of H1N1 Flu-Infected Persons in the U.S. from April - July 2009
Thu, 29 Oct 2009 09:00:00 -0500


Through July 2009, a total of 43,677 laboratory-confirmed cases of 2009 H1N1 were reported in the United States, which is likely a substantial underestimate of the true number.

Entire article.....
http://www.cdc.gov/h1n1flu/eid_qa.htm
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« Reply #391 on: November 01, 2009, 11:22:27 AM »

WHO - Update 72

Pandemic (H1N1) 2009 - update 72
Weekly update
As of 25 October 2009, worldwide there have been more than 440,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and over 5700 deaths reported to WHO.


As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

Situation update:

In the temperate zone of the northern hemisphere, influenza transmission continues to intensify marking an unusually early start to winter influenza season in some countries. In North America, the US, and parts of Western Canada continue to report high rates of influenza-like-illness (ILI) and numbers of pandemic H1N1 2009 virus detections; Mexico has reported more confirmed cases since September than during the springtime epidemic. In Western Europe, high rates of ILI and proportions of respiratory specimens testing positive for pandemic H1N1 2009 have been observed in at least five countries: Iceland, Ireland, the UK (N. Ireland), Belgium, and the Netherlands. Many other countries in Europe and Western and Central Asia are showing evidence of early influenza transmission, including in Spain, Austria, parts of Northern Europe, Russia, and Turkey. In Japan, influenza activity has also increased sharply, especially on the northern island, approximately 10 weeks ahead the usual start of the winter influenza season.

Pandemic influenza transmission remains active in many parts of the tropical zone of the Americas, most notably in several Caribbean countries. Overall transmission continues to decline in most but not all parts of the tropical zone of South and Southeast Asia

Little influenza activity has been reported in temperate region of the southern hemisphere since the last update.

Entire article at this link....
http://www.who.int/csr/don/2009_10_30/en/index.html
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« Reply #392 on: November 01, 2009, 11:24:59 AM »

   
 
 
National Institute of Allergy and
Infectious Diseases (NIAID)
 

--------------------------------------------------------------------------------
 
 Embargoed for Release
Thursday, October 29, 2009
2 p.m. EDT

 E-mail this page
Subscribe    Contact:
Anne A. Oplinger
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NIAID Scientists Propose New Explanation for Flu Virus Antigenic Drift

Influenza viruses evade infection-fighting antibodies by constantly changing the shape of their major surface protein. This shape-shifting, called antigenic drift, is why influenza vaccines — which are designed to elicit antibodies matched to each year's circulating virus strains — must be reformulated annually. Now, researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have proposed a new explanation for the evolutionary forces that drive antigenic drift. The findings in mice, using a strain of seasonal influenza virus first isolated in 1934, also suggest that antigenic drift might be slowed by increasing the number of children vaccinated against influenza.

Scott Hensley, Ph.D., Jonathan W. Yewdell, M.D., Ph.D., and Jack R. Bennink, Ph.D., led the research team, whose findings appear in the current issue of Science.
 
 
Entire article at this link.....
http://www.nih.gov/news/health/oct2009/niaid-29.htm
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« Reply #393 on: November 01, 2009, 09:24:53 PM »

Interesting Article Read at Flu Trackers dot Com - Why Some People Become So Ill

Why H1N1 isn't just the seasonal flu
 
 
By Tom Blackwell, National PostOctober 30, 2009


  Some of the ultrastructural morphology of an H1N1 "swine flu" virus culture. It is clear now that the vast majority of people who catch the H1N1 flu will suffer relatively mild illness and recover quickly.

For that small subset of otherwise healthy individuals who become desperately sick or even die, however, the blame may lie in a seemingly distinctive trait of the H1N1 virus — an ability to bind itself to tissue deep within the lungs, causing dangerous viral pneumonia, some scientists believe.

Dr. Anand Kumar says the bug’s reported biological attributes — different from those of the seasonal flu — would help explain what he has seen among dozens of critically ill H1N1 patients in the intensive-care unit of his Winnipeg hospital.

“It is a very different virus,” he said. “It does attach to the deep lung tissue in people. When it does, it creates a very bad viral pneumonia, one of the worst we’ve ever seen. ... This is the sickest bunch of people I’ve seen, as a group.”

Other experts speculate that deaths are occurring when the body essentially turns on itself with an extreme immune response to the virus, a phenomenon sometimes called a “cytokine storm,” and often seen with seasonal flu, too. Ironically, robust young people with strong immune systems may be more susceptible to such a reaction, scientists theorize.

“In essence, they die because their own body, in its attempt to fight off the influenza virus, actually kills them,” said Dr. Gerald Evans, the Kingston ,Ont.,-based president of the Association of Medical Microbiology and Infectious Disease.

“The problem is we have absolutely no way to predict who is going to have an over-exhuberant response and die of a cytokine storm and who is going to handle the virus in a nice, normal fashion.”

But, the death of a seemingly healthy 13-year-old Toronto boy this week has underlined questions about how the new pathogen can prove so lethal for a tiny minority of patients, and fairly run of the mill for others. Dr. Evans cautions that that tragic case and the demise a few days earlier of a 10-year-old Ottawa girl should not overly alarm people.

“Every year, young, healthy people do die of influenza, but they never get on the front page.”

Many questions remain, though, about the characteristics of H1N1 and why an unlucky few are felled by it.

Experts agree on a few of its attributes — it is particularly contagious, a disproportionate number of young people are becoming infected by it and a small number of those young patients are getting seriously ill. A recent study of cases that ended up in Canadian ICUs found that the average age was 32. The seasonal flu seriously affects mainly the very elderly and very young.

Dr. Michel Laverdière, an infectious disease specialist at Montreal’s Hôpital Maisonneuve-Rosemont, argues that the deaths this week of 13-year-old Evan Frustaglio and the Ottawa girl would rarely be seen in seasonal flu outbreaks.

The differences are likely a result of the fact that this is a novel flu: the first time, in fact, that the genetics of swine, bird and human influenzas have combined in one bug, he said. People over 65 seem less affected, perhaps because they were exposed to a similar virus in the 1940s or 50s and developed some immunity. The rest of the population has none.

A British study published last month suggests H1N1 acts differently in other ways, too. Based on unique laboratory tests, the research at Imperial College London found the new strain bound strongly to cell “receptors” found in the upper respiratory tract — the nose, throat and upper airway — and more weakly to receptors deep inside the respiratory tract. Seasonal viruses, on the other hand, stuck only to the upper-tract receptors.

“We believe this is a clue to the more serious illness in some people,” Prof. Ten Feizi, who led the study, said in an interview.

Dr. Kumar said seasonal pneumonia tends to kill elderly or very young patients by exacerbating existing medical conditions, like the respiratory illness COPD, or causing secondary, bacterial pneumonias. He said more than 80% of deaths from H1N1 in contrast are caused by viral pneumonia.

Dr. Evans is less convinced by the importance of the British research, though, saying that he believes most serious cases are related to the exaggerated inflammatory response. He also notes the majority of people who have died from H1N1 worldwide had some kind of underlying health problem, though the ICU study showed that many of the problems were relatively minor, such as mild hypertension.

Meanwhile, what about the fact that pregnant women are so disproportionately affected by the virus?

That phenomenon likely stems from the fact that expectant mothers’ immune systems are essentially at a reduced level, an automatic response of the body to prevent women from rejecting a fetus whose genetic makeup derives partly from someone else, said Dr. Laverdière.

National Post

tblackwell@nationalpost.com
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« Reply #394 on: November 02, 2009, 11:17:46 AM »

Read this morning at FluTrackers New York Forum

New York Assists Local Governments With H1N1 Vaccination Response

Source: Office of the Governor of New York
Posted on: 2nd November 2009

Governor’s State Disaster Emergency Declaration Together with President Obama’s

National Emergency Declaration Provide Increased Flexibility to Local Health Departments and Hospitals to Respond to H1N1 Flu

In response to requests for assistance from local governments across New York State including New York City, Governor David A. Paterson today issued Executive Order 29 declaring a State Disaster Emergency, which will provide additional personnel and flexibility to local governments as they work to implement a statewide vaccination campaign to protect New Yorkers from H1N1 influenza.

“The nationwide H1N1 vaccination campaign represents the first time in 33 years that the United States has attempted to conduct a mass vaccination campaign of this proportion for influenza,” Governor Paterson said. “Local governments are reporting that the current public health workforce is not sufficient to thoroughly execute a vaccination campaign of this magnitude. Those local governments and health care providers specifically requested that we issue this emergency declaration to give them flexibility to use additional personnel and resources in New York’s vaccination campaign.”

Under existing law, physicians, certified nurse practitioners and nurses may administer vaccinations. The Governor’s Executive Order will suspend Section 6902 of the Education Law to permit other health care workers – including physician and specialist assistants, pharmacists, dentists, certain dental hygienists, midwives and emergency medical personnel – to administer vaccinations after they receive training. They will work under the direction of the State or county health departments as part of their sponsored mass vaccination clinics.

To assure local governments’ ability to immunize in the school setting, the Executive Order also authorizes school-based health centers to vaccinate adults and children, and allows hospitals to operate part-time immunization clinics on school campuses.

Governor Paterson’s declaration follows the announcement on Saturday that President Barack Obama has declared a National Emergency related to H1N1 flu. With the President’s declaration in place, the federal government is permitted to waive specific hospital-related legal requirements – allowing hospitals to implement procedures in their emergency disaster plans that allow them to increase their ability, or surge capacity, to triage, treat and care for increased numbers of persons with the flu.

“I commend President Obama for declaring H1N1 a national emergency,” the Governor added. “By doing so, he is providing much-needed federal assistance to states as we respond to this influenza pandemic. Lifting certain legal health care requirements at both the federal and state levels will give local governments and health care facilities the support they need to effectively respond to an influenza pandemic of this magnitude.”

H1N1 flu activity is now considered widespread in New York, with more than 50 percent of counties reporting flu activity. Currently, vaccination in New York and all other states is hindered by a nationwide shortage of the H1N1 flu vaccine due to unexpected delays in vaccine production, according to the federal Centers for Disease Control and Prevention (CDC). The President’s declaration does not increase the pace at which the H1N1 vaccine will become available to the public.

“The next few weeks are critical to countering this H1N1 pandemic,” the Governor said. “While we cannot do anything about the current vaccine shortage, we are doing everything we can to ensure that public health officials around the State can mobilize and vaccinate New Yorkers as more vaccine becomes available. My Executive Order will not only give State and local authorities more access to professionals authorized to administer vaccinations, but it will help significantly increase the number of vaccinators in areas of the State that need them the most.”

Approximately 10 million New Yorkers fall into the priority groups established by the CDC for H1N1 vaccination, including 4.3 million in New York City alone. So far, 460,300 doses of the H1N1 vaccine – the total available to date from the CDC — have been distributed to clinical sites in New York State outside of New York City, including hospitals, community health centers, physician offices, colleges and universities, and county health departments. Distribution of vaccine within New York City is coordinated by the New York City Department of Health and Mental Hygiene.


The priority groups established by CDC to receive the H1N1 influenza vaccine are:
Pregnant women, who experience four times the rate of hospitalization and six times the rate of death from H1N1 flu compared to the general population;
Persons who live with or provide care for infants under six months of age (infants under 6 months cannot be vaccinated);
Children and young people ages 6 months through 24 years;
Persons age 25 through 64 years old who have medical conditions that put them at higher risk for serious illness and influenza-related complications, including cancer, blood disorders, chronic lung disease (including asthma or heart disease), diabetes, heart disease, kidney disorders, liver disorders, neurological disorders neuromuscular disorders and weakened immune systems; and
Health care workers and emergency medical services personnel.


 Due to shortages of both H1N1 and seasonal flu vaccine, Governor Paterson announced last week that State Health Commissioner Richard F. Daines, M.D., has suspended the State Health Department’s requirement that health care workers in certain facilities be vaccinated against the flu.

“The vaccination of health care workers continues to be an important patient safety measure, and I urge hospitals and other health care facilities to continue to encourage employees to be vaccinated against the flu,” Commissioner Daines said. “But with available vaccine in New York State far below the CDC’s original projections, we are adapting to this change in supply so that vaccines can be made available first to individuals in groups at highest risk for serious illness and death.”

With this declaration of a State Disaster Emergency, New York joins nine other states that have already taken emergency action or are in the process of declaring a public health emergency related to the H1N1 outbreak during this fall influenza season. Governor Paterson noted that it is within his power to declare an emergency by Executive Order when a current or imminent threat to public safety hinders local governments’ ability to respond adequately.

Additional information about seasonal and H1N1 flu, including educational resources and direct links to CDC’s website, is available on the New York State Department of Health’s website at www.nyhealth.gov.


http://thegovmonitor.com/world_news/...nse-13236.html
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« Reply #395 on: November 03, 2009, 01:42:23 AM »

Swine Flu Causes Brawl On NYC Subway
Lawrence Delevingne|Nov. 2, 2009, 8:53 AM | 3,796 |24
PrintTags: The Way We Live Now, Health, New York
If you think tensions over swine flu are exaggerated, think again.

We saw a violent altercation between two women this morning on the New York City subway because of H1N1.

The D train was traveling south from Rockefeller Center (50th Street) to Bryant Park (42nd Street) shortly after 8:00 am. One woman, perhaps 5'7", slightly overweight and with dyed reddish blond hair, was coughing without covering her mouth. Maybe it was swine flu, maybe not.

Another woman, roughly 5'2", stocky, with her blond hair in a slicked-back bun, was nearby, clearly displeased. She made a curt comment to the first woman, something to the effect of "you need to cover your mouth -- I don't want swine flu."

The second woman continued to yell at the cougher, berating her until she reacted, beginning to curse back. It escalated, and the accosting woman yelled "get the conductor!"

No one got the conductor -- it just seemed like a shouting match -- but as the train pulled into 42nd Street, the coughing woman spit on the other, provoking what sounded like a punch from the reaction of the crowd (we didn't directly see it). Then the cougher attempted to exit the train as the doors were open, but the second woman grabbed her by the back of the hair, violently yanking her down to the floor.

The last action happened directly in front of us. The cougher got up, yelling and cursing, but was escorted out of the train by what appeared to be a friend. Your correspondent, who had been sleepily reading about CIT's bankruptcy filing, held the shorter woman back, who kept screaming as the second woman left the train.

Mercifully, the train doors closed, seperating the two women, and continued to 34th Street.

Most passengers shook their heads at the absurdity of the situation.

But more than a few sympathized with the woman who was coughed on. "She wasn't even covering her mouth," said one woman. "That sh-t was going all over the train."

Added a male witness: "I could have decked her too. That swine flu is treacherous."

Note: the image here is not of the actual train this morning.

Article read at FluTrackers New York Forum


http://www.businessinsider.com/fight...ne-flu-2009-11
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« Reply #396 on: November 03, 2009, 10:50:56 AM »

Read this morning on FluTrackers Louisiana forum..... www.flutrackers.com

6 new deaths bring Louisiana swine flu toll to 30


Posted: Tuesday, 03 November 2009 7:20AM


Associated Press Reporting


 
The state Department of Health and Hospitals says Louisiana's swine flu death toll is now at 30, with six deaths related to the virus in the past week.

Four - two boys and two women - were in the seven-parish Lafayette area.

The other two are a boy from the five-parish Lake Charles area and a woman from the five-parish area on the North Shore.

The department says more vaccine is coming every week, and people should keep in touch with their doctors so they'll know when to make an appointment.

Officials say the state has ordered 332,700 doses, and the Centers for Disease Control and Prevention in Atlanta had sent about 253,800 doses by last Wednesday.

They say 544 providers in Louisiana have administered 31,094 doses.

For more info... www.FightTheFluLA.com



http://www.wwl.com/6-new-deaths-brin...-to-30/5586490
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« Reply #397 on: November 03, 2009, 11:09:16 AM »

H1N1 - Pets - Ferrets

Read at www.FluTrackers.com this morning......2nd Ferret dies of H1N1

Pet ferret dies of H1N1 in Nebraska


Quote:
(10/29/2009)
By Ginger ten Bensel

Several Nebraskans have died from complications of the H1N1 Virus. Countless others have gotten sick. Now we are hearing from one Hastings family who said their pets have gotten sick. One of them has died.

Four members of the DeVoll family came down with the flu three weeks ago. They are recovering. The outcome was not so good for their pet ferret. The family has 4 ferrets. All the animals became sick with H1N1 when family members did. Ferrets have the same respiratory system as humans. That allows them to get the virus. Birds and pigs can get it as well.

The DeVoll family said they had no idea their ferrets were at risk. "It was definitely a shock it was unexpected. I just never thought that Stormy would die from the H1N1," said Kristine DeVoll. The state public health veterinarian said it is not unexpected, but it is rare. Only 2 ferrets in the nation have died from H1N1. That includes Stormy.

"The respiratory system of ferrets and people are quite similar and they are used as a laboratory model for influenza virus research in humans," said Dr. Annette Bredthauer. Testing was done by the University of Nebraska Veterinary Diagnostic Lab where the ferret tested positive for H1N1. Now a sample has been forwarded on to the National Lab in Ames, Iowa for confirmation. Dr. Bredthauer went on to say the H1N1 virus does not affect dogs and cats. So those pets are safe. 


Source:
http://new.khastv.com/modules/news/a...6&storytopic=4
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« Reply #398 on: November 03, 2009, 11:21:43 AM »

 


Use link below to find your region and your State for information, including vaccine availability...


http://www.flutrackers.com/forum/forumdisplay.php?f=48
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« Reply #399 on: November 04, 2009, 11:45:19 AM »

Interesting article I read this morning at FluTrackers - Statins and relationship to flu, if any...
a tough read if you are not a clinician.....but the idea is there and we should keep digging...

Florida1 
Editor-in-Chief & President   Join Date: Feb 2006
Posts: 14,033 
 
EM - Statins for influenza. Why don't we know if it works yet?

--------------------------------------------------------------------------------

Statins for influenza. Why don't we know if it works yet?

Category: Infectious disease • Influenza treatment
Posted on: October 31, 2009 6:49 AM, by revere

Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We'll get to it in a moment, but first a little background.

Statins are cholesterol lowering drugs that are taken by tens of millions of people (including me; I take 20 mg of generic simvastatin a day). The statins are a group of drugs that competitively inhibit an enzyme, 3 hydroxy 3 methylglutaryl coenzyme A reductase (HMG-CoA reductase).

They are quite effective in lowering cholesterol and have an excellent safety profile (not perfect, but no drug is perfect except the ones that don't do anything, and even then a placebo effect can give an adverse reaction).

But these drugs also seem to do a lot of other things beside lower cholesterol, some of which seem to modify the way your immune system works. That's why they are also referred to as immunomodulators.

One immune system effect seems to prevent activation of a transcription factor (a signal to your DNA to make specific proteins) called NF-kappaB. Somehow this produces an anti-inflammatory effect.

Some severe cases of influenza are complicated by an immune dysregulation (sometimes called a cytokine storm) characterized by runaway production of inflammation-associated chemicals in the lung and other organs. Hence the thought that an immunomodulator might be of use
.
 

Keep on reading..........
www.flutrackers.com     Pandemic Communication, Effect Measures
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