Penumbra Pandemia

"Australian swine flu infections over 300
Radio Australia News
Last Updated: 31 May 2009
http://www.radioaustralianews.net.au/stories/200905/2585653.htm?desktop
The number of Australians diagnosed with swine flu has risen to 303.
Cases have been diagnosed in every state and territory, with the majority 212 in Victoria and 57 in New South Wales.
Schools have been closed in several states, as a way of minimising the impact on communties where people have come down with swine flu.
Health Minister, Nicola Roxon, says work has to continue to reduce the spread of the disease.
She says, "The aim is to make sure that we delay that for as long as possible in order to be able to ensure that when the disease really does attack the broadest number in the community that we are closer to the date of having a vaccine produced."
She says "That way we can make sure that we can protect those that are most likely to be particularly vulnerable to the harder edge of this disease.""

"Suomessa kolmas sikainfluenssatapaus
YLE Uutiset
julkaistu 27 May 2009 klo 11:41, päivitetty 27 May 2009 klo 20:17
http://yle.fi/uutiset/kotimaa/2009/05/suomessa_kolmas_sikainfluenssatapaus_759877.html
Suomessa on varmistunut kolmas sikainfluenssatapaus. Sairastunut on Yhdysvalloista Suomeen palannut 30-vuotias mies. Hänellä todettiin influenssa A(H1N1)-infektio myöhään tiistai-iltana.
Mies on hyväkuntoinen ja kotihoidossa. Miehen lähikontaktit on selvitetty, ja he ovat saaneet estolääkityksen. Tartunta todettiin Helsingin ja Uudenmaan sairaanhoitopiirissä.
Potilaan kanssa samoilla lennoilla olleisiin matkustajiin otetaan yhteyttä ja heitä kehotetaan tarkkailemaan mahdollisia oireita sekä hakeutumaan hoitoon tarvittaessa.
Suomessa on otettu näytteitä yhteensä noin 80 ihmiseltä. Aiemmin on varmistettu kaksi tartuntaa Meksikosta palanneilta suomalaisilta.
Maailman terveysjärjestön WHO:n mukaan uuteen influenssaan on sairastunut tähän mennessä noin 13 400 ihmistä. Tautiin on kuollut noin sata ihmistä, joista lähes kaikki Meksikossa ja Yhdysvalloissa."
*****
Briefly in English:
Male, 30 years, in good and stable condition in home quarantine in Helsinki region in Finland. This is the third confirmed novel H1N1 case in Finland.

[Editor's note: In Finland they test only suspected patients that
1) have had contact with a confirmed novel H1N1 case AND
2) develop fever higher than 38,5 degrees Celsius with respiratory symptoms

"Sikainfluenssan kohtalonhetki on syksyllä
UTUonline.fi
TN
Julkaistu 14.05.2009 11:34, päivitetty 14.05.2009 19:11
http://www.utuonline.fi/sisalto/argumentti/PenttiHuovinen09.html
Uuden influenssaviruksen A(H1N1) aiheuttamia tapauksia on ilmennyt nyt myös Suomessa ja tauti leviää edelleen. Sen mahdollista muuntautumista entistä ärhäkämmäksi myös pelätään. Mitä siitä tiedetään, THL:n tutkimusprofessori ja Turun yliopiston bakteriologian dosentti Pentti Huovinen?
- Influenssan käyttäytymisen arviointi perustuu edellisten influenssapandemioiden yhteydessä saatuihin kokemuksiin. Jos uusi virus käyttäytyy odotetusti, kesän aikana uusia tautitapauksia kyllä ilmenee jonkin verran, mutta varsinaista taudin leviämistä odotetaan vasta syksyksi tai talveksi. Influenssavirus leviää parhaiten kylmässä ja kuivassa ilmanalassa. Suomi on jo tilannut rokotteen uutta influenssavirustyyppiä vastaan. Rokote saataneen 4-6 kuukauden kuluttua ja toivottavasti ennen oletettua viruksen leviämistä.
Miten uuden viruksen aiheuttamaan taudin leviämiseen suhtaudutaan, riippuu olennaisesti siitä, kuinka suuri on vakavien tautitapausten määrä. Toistaiseksi kuolleisuus on ollut onneksi normaalien kausi-influenssojen luokkaa. Hyvä uutinen on myös, että ainakin toistaiseksi viruslääkkeet tehoavat kyseiseen virukseen.

Käsihygienia on parasta pandemian torjuntaa
- Pandemiauhkan yhteydessä on kiinnitetty suurta huomiota käsihygieniaan, mikä on erinomainen asia. Tästä hyötyvät yksilöt ja koko yhteiskunta. Hyvällä käsihygienialla torjutaan kaikkia käsien välityksellä leviäviä mikrobeja. Maskien käytöstä on hyötyä vasta sitten kun yskiviä ihmisiä on ympärillä. Silloinkin yskivien ihmisten maskin käyttö on tärkeämpää kuin terveiden, jotteivät pisarat leviä ympäristöön. Maskien käyttö ilman hyvää käsihygieniaa antaa kuitenkin valheellisen turvallisuuden tunteen.
Influenssakohun keskellä kannattaa muistaa, että parin vuoden kuluttua nykyisestä uudesta influenssaviruksesta on tullut normaali kausi-influenssavirus, joka kiertänee maailmaa muiden influenssa A H3N2- ja H1N1-kausi-influenssavirusten kanssa. Samalla se on liitetty osaksi joka vuosi valmistettavaa kausi-influenssarokotusta.
Lintuinfluenssavirus H5N1 on edelleen yhtä suuri uhka kuin kuukausi sitten. Jos se muuntuu ihmisestä toiseen tarttuvaksi, on mahdollista, että saamme vielä toisen pandemiauhkan nykyisen päälle. Runsaat kymmenen vuotta kaikki ovat odottaneet H5N1-pandemiaa. Uusi virus tulikin yllättäen Meksikosta ja oli ennen näkemätöntä H1N1-alatyyppiä, kahden sikaviruksen, yhden lintuviruksen ja ihmisen viruksen kombinaatio. Tämä osoittaa influenssavirusten arvaamattomuutta. Mikrobit tanssittavat ihmistä!"

"Two more confirmed with swine flu
BBC News
Page last updated at 16:18 GMT, Saturday, 16 May 2009 17:18 UK
http://news.bbc.co.uk/2/hi/health/8053632.stm#map
Two new cases of swine flu have been confirmed in England, bringing the total number in the UK to 87, the Health Protection Agency has said.
Both are adults, one is a man from the Reading area and the other is from the east of England.
The news came as the Foreign Office lifted its advice against non-essential travel to Mexico.
The UK government has signed a deal to secure up to 90 million doses of a new H1N1 flu vaccine by December.
Health Secretary Alan Johnson said the vaccine - which would provide immunity from the virus - will be available regardless of whether a pandemic is officially declared.
Of the new cases, one affects a patient who has recently returned from overseas. The source of the second new infection is still being investigated.
The HPA said there were 172 possible cases of swine flu currently under laboratory investigation in the UK.
Around the world, more than 7,500 cases of swine flu - also known as H1N1 - have been confirmed and 66 people have died.
The Foreign Office said it was lifting its travel restrictions to Mexico because of a decline in the number of reported new cases.
However, it said British nationals should continue to follow local advice on precautions to avoid exposure to the virus.
A spokeswoman for the Department of Health said the localised cases of swine flu found in the UK have so far been mild, and anti-virals had been effective in reducing symptoms and preventing the spread of infection.
But she warned against complacency: "It is right to prepare for the possibility of a global pandemic. The UK's arrangements are continuing to ensure that we are well-placed to deal with this new infection."

"Jump in swine flu cases in Japan
BBC News
Page last updated at 08:52 GMT, Monday, 18 May 2009 09:52 UK
http://news.bbc.co.uk/2/hi/asia-pacific/8054881.stm
The number of swine flu cases in Japan has risen rapidly - with more than 120 cases now confirmed.
Nearly 2,000 schools and companies have closed, and the government has discouraged unnecessary travel to quell the spread of the disease.
Just four cases had been confirmed in Japan as of Friday - people who had returned from Canada.
The first case in someone who had not been abroad - a 17-year-old student in Kobe - was reported on Saturday.
Call for calm
Japanese media said the new wave in infections would make Japan the fourth-most infected country in the world, after Mexico, the United States and Canada.
None of those infected are thought to be in danger of their lives, officials say, but the government is taking no chances.
"We must be careful, but with quick treatment patients can recover," said Prime Minister Taro Aso. "We must respond calmly and appropriately."
Most of those infected are thought to be students in the Hyogo and Osaka prefectures in western Japan.
Experts believe the virus spread quickly between the two urban areas after high schools in Kobe and Osaka met for a volleyball tournament.
Kobe High School, along with nearly 1500 other schools in Hyogo, has now been closed, and several hundred more are closed in Osaka.
Japan has also established testing centres at airports, and is encouraging high risk groups to wash their hands frequently and wear masks.
Even in the sporting arena, steps have been taken to reduce the potential for infection.
At a national sumo wrestling competition in Tokyo on Sunday, officials sprayed disinfectant on the hands of every spectator as they arrived.
The outbreak has caused alarm in Japan, which with its aging population is exceptionally anxious about flu, the BBC's Roland Buerk in Tokyo says.
People routinely wear face masks on public transport to prevent the spread of coughs and colds."

"New York principal's death linked to flu virus, hospital says
CNN
NEW YORK
updated 18 May 2009
http://edition.cnn.com/2009/HEALTH/05/17/ny.flu.death/index.html
An assistant principal of a New York middle school who was hospitalized with the H1N1 virus, commonly known as swine flu, died Sunday from flu complications, hospital and state officials said.
It's the sixth death in the United States that health authorities have linked to the virus.
"It is with great sadness tonight that we learn that New York has lost one of its residents to an illness related to H1N1," New York Gov. David Paterson said.
Mitchell Wiener, 55, assistant principal at Intermediate School 238 in Queens, died at 6:17 p.m. Sunday, said Andrew Rubin, a spokesman at Flushing Hospital.
"We believe he had complications of the swine flu," Rubin told CNN Radio, adding that once Wiener was admitted to the hospital, he was listed in critical condition. However, he wouldn't say whether Rubin had any pre-existing medical conditions.
Last week, when city and state officials announced that four students were infected and that a school official in Queens was "critically ill" with the virus, Mayor Michael Bloomberg did not name the official but described the staffer as an assistant principal who "may have had other health problems."
"We're trying to identify that and ascertain whether those problems were exacerbated by the flu or whether it's totally unrelated," Bloomberg said at the time.
Since the H1N1 outbreak surfaced last month, the Centers for Disease Control and Prevention has linked four U.S. deaths to swine flu: a Mexican toddler who was visiting with her family in Texas; a pregnant Texas woman who had been on life support since April; a Washington state man with heart problems who died from flu complications; and an Arizona woman with lung disease.
The Texas Department of State Health Services said Friday that the death of a Nueces County man in his 30s was linked to swine flu. Wiener's case is the sixth U.S. death linked to H1N1.
All had pre-existing medical problems.
Wiener's school is one of eight temporarily closed in New York due to flu concerns.
"We are now seeing a rising tide of flu in many parts of New York City," Thomas R. Frieden, the city's health commissioner, said earlier Sunday. "With the virus spreading widely, closing these and other individual schools will make little difference in transmission throughout New York City, but we hope will help slow transmission within the individual school communities."
The flu strain, which originated in Mexico, killed dozens of people there, causing U.S. officials to worry that it could take a similar toll after spreading across the border. But it has thus far acted similar to typical seasonal influenza, which usually can be treated successfully but can be deadly among the very old, very young and people with pre-existing health problems."

"Transmission of Swine H1N1 In Japan Signals Phase 6
Recombinomics Commentary 14:46
May 18, 2009
http://www.recombinomics.com/News/05180901/Swine_H1N1_Japan_6.html
Japan's four earlier suspected swine flu cases came from travelers inbound from North America, but this new bout appears to be wholly domestic. Most of the cases involve teenagers - the first confirmed infected on Saturday were high-school students on a volleyball team - but those sick with the new strain of flu now range from as young as 5 years old to 60. "It circulated silently without anybody thinking of it," says Peter Cordingley, spokesman for the WHO in Manila. "The virus is highly transmittable and signs of it breaking out of a contained area into the greater community must be watched and taken very seriously."
The above comments on community transmission of H1N1 in Japan (see updated map) again indicate that the pandemic is at phase 6. Early definitions of pandemic phases used sustained transmission as the definition of phase 6. However, the new definition used sustained transmission as the definition of phase 4, while phase 5 represent transmission in a region, and phase 6 was transmission worldwide.
Swine H1N1 has been transmitting worldwide for over a month. Testing outside of North America was largely limited to travelers from North America, but H1N1 was seeding prior to the enhance surveillance at airports, and transmission would have been largely undetected.
The levels in the United States (see updated map) are approaching the reported levels in Mexico, and travel from the US would increase seeding. However, these increases would also be prior to enhanced surveillance at airports. However, such testing is destined to fail, because travelers infected within a day or two of travel would not be detected. Similarly, as many as 1/3 of cases have no fever.
Although the CDC estimated that the number of true cases in the US was 100,00, that estimate is likely to be 1-2 orders of magnitude too low. Surveillance in the US detects about 0.1% of true cases, so the 1500 cases in the CDC weekly report would represent 1.5 million cases in the US alone, and this estimate may be low because many cases are mild, and those in regions not reported to have high levels are not tested.
Nationwide, the number of confirmed cases of swine H1N1 (including cases that are influenza A positive and non-typable) is close to the level reported for H3N2 for the entire season. The number of swine H1N1 cases is rapidly increasing, and in week 18 was almost 3 times the level of influenza A (1097 vs 401).
Thus, the widespread transmission in North America (Mexico, US, and Canada) insures worldwide transmission. Community transmission has already been reported in Scotland, and now there is confirmed transmission in Japan, leaving no doubt that the spread in North America has been extended to Europe and Asia.
The raising of the pandemic level to 6 is long overdue."

Japan's total cases of new flu reach 129
www.chinaview.cn
Xinhua
TOKYO
18 May 2009 09:53:51
http://news.xinhuanet.com/english/2009-05/18/content_11393534.htm
The total number of cases of new flu infections, both domestic and those contracted aboard, reached 129 in Japan, Kyodo News reported.
The number, calculated by Kyodo, means 33 more infections were confirmed Monday. The latest tally from the government stood at 96.
Japanese government on Monday convened an emergency meeting to discuss countermeasures on the spread of the epidemic.
Prime Minister Taro Aso called for public calm, saying the Japanese government has no plans to ask citizens to refrain from holding meetings or scale down corporate activity.
************

Editor's note: This should definitely mark pandemic phase 6.

Arvostettu virologi: Sikainfluenssaan yhä suhtauduttava valppaasti
YLE Uutiset
julkaistu 17 May 2009 klo 17:31, päivitetty 17 May 2009 klo 19:12
http://yle.fi/uutiset/kotimaa/2009/05/arvostettu_virologi_sikainfluenssaan_yha_suhtauduttava_valppaasti_742019.html
Sikainfluenssaan on edelleen syytä suhtautua valppaasti, sanoo yksi maailman johtavista virustutkijoista, hollantilainen Albert Osterhaus. Osterhaus luennoi illansuussa sikainfluenssatilanteesta Helsingin Messukeskuksessa, jonne on kokoontunut noin 7 000 mikrobiologian ja tartuntatautien asiantuntijaa Euroopasta ja muualta maailmasta.
- Virus jatkaa leviämistään. Virusta ei ole enää ainoastaan Meksikossa, Yhdysvalloissa ja Kanadassa. Se on levinnyt myös esimerkiksi Kiinaan ja Japaniin. Eli virus jatkaa leviämistään, Osterhaus huomautti YLE Uutisten haastattelussa sunnuntaina.
H1N1-influenssan on vahvistettu tarttuneen yli 8 000 ihmiseen lähes 40 maassa. Siihen on kuollut yli 70 ihmistä, heistä suurin osa Meksikossa. Huhtikuussa Meksikossa epidemiaksi puhjennut tauti on osoittautunut toistaiseksi pelättyä vaarattomammaksi sairastuneille, mutta suunta voi vielä kääntyä, virologi uskoo.
- Tiedämme, että kausi-influenssaan kuolee vuosittain jopa puoli miljoonaa ihmistä. Se on paljon, ja kuolemien estämiseksi olisi tehtävä nykyistä enemmän. Mutta on kuitenkin olemassa melko suuri mahdollisuus, että uusi virus aiheuttaa influenssapandemian, jossa voi kuolla yksi tai kaksi miljoonaa ihmistä. Ja vielä vakavamman skenaarion mukaan virus voi muuntua sitäkin tappavammaksi.
Aihetta vakavaan suhtautumiseen antaa Osterhausin mukaan sekin, että kuolonuhreista monet ovat nuoria.
- Suurin osa sairastuneista tai kuolleista on ollut suhteellisen nuoria, 20 ikävuoden molemmin puolin. Sekin on huolestuttava piirre. Yleensä influessa iskee kohtalokkaasti iäkkäisiin ihmisiin.
Yksi selitys virustutkijan mukaan tälle voi olla, että nuoret eivät ole aiemmin altistuneet vastaaville viruksille, kuten vanhemmat ikäluokat mahdollisesti ovat.
”Ihmiset tarvitsevat tietoa taudista”
Tiedotusvälineitä on arvosteltu liiallisesta sikainfluenssan uutisoinnista. Osterhaus korostaa tasapainoista uutisointia. Hänen mukaansa median on oltava vastuullinen, sillä paisuttelu voi kostautua.
- Voi käydä niin, että ihmiset eivät lopulta ota uutisia vakavasti. Toisaalta, jos on pienikin mahdollisuus, että tautiin voi kuolla jopa miljoonia, ihmisten täytyy saada tietoa.
Osterhaus kauhistelee eurooppalaisen median vaikenemista sen jälkeen, kun yksi meksikolaisministeri sanoi vaaran olevan ohi.
- Meksikon terveysministeri sanoi, että nyt se on ohi. Se oli poliittinen lausunto, jolla ei ollut mitään tekemistä todellisuuden kanssa. Sitten monet eurooppalaiset tiedotusvälineet totesivat, että selvä, palataanpa muihin töihin, Osterhaus päivittelee.
Alan johtavia tutkijoita
Hollantilainen Albert Osterhaus johtaa Erasmus-sairaalan virologian osastoa Rotterdamissa sekä Alankomaiden kansallista influenssakeskusta. Hän on taustaltaan eläinlääkäri, ja hän on tutkimusryhmineen ollut tunnistamassa useita eläinperäisiä viruksia, kuten sarsia vuonna 2003.
Helsingin Messukeskuksessa Albert Osterhaus puhui ajankohtaisesta sikainfluenssatilanteesta, muun muassa pandemian todennäköisyydestä ja mahdollisuuksista estää taudin leviämistä."

"Sikainfluenssa leviää edelleen
YLE Uutiset / Reuters
julkaistu 16 May 2009 klo 17:50, päivitetty 16 May 2009 klo 17:51
http://yle.fi/uutiset/ulkomaat/2009/05/sikainfluenssa_leviaa_edelleen_741631.html
Maailman terveysjärjestö WHO ilmoittaa, että maailmassa on todettu yli 8000 sikainfluenssa tartuntaa. Kuolleiden määrä on noussut yli seitsemäänkymmeneen.
WHO:n tuorein selvitys kertoo, että H1N1-influenssatartunnan on saanut maailmassa 8.451 ihmistä. Heistä 72 on kuollut. Tautia on todettu kaikkiaan 36 maassa. Eniten tautia esiintyy Meksikossa ja Yhdysvalloissa. Yhdysvallat, kuten myös Suomen ulkoministeriö, on kuitenkin lieventänyt varoituksiaan Meksikoon matkustamisesta.
Tieto tartuntojen määrän kasvusta kertoo osittain siitä, että varmistukset tartunnoista valmistuvat yhdessä sumassa sekä osittain siitä, että tauti leviää edelleen.
Sikainfluenssan aiheuttama virus käyttäytyy kuten ns. normaalit influenssat. Tavallisiin influenssoihin kuolee maailmassa vuosittain noin puoli miljoonaa ihmistä, erityisesti vanhuksia ja heitä, joilla on hengitystiesairauksia.
WHO:n pääjohtajan Margaret Chanin mukaan sikainfluenssan muuntuneesta, uudesta kannasta vallitsee vielä epävarmuus. Se kuitenkin leviää ja saattaa olla erityisen uhkaava Kaakkois-Aasiassa."

"Hong Kong wants US to screen outgoing passengers at airports
By Channel NewsAsia's Leslie Tang
CNA/vm
14 May 2009 1957 hrs
HONG KONG
http://www.channelnewsasia.com/stories/southeastasia/view/429252/1/.html
Hong Kong wants the US to screen outgoing passengers at its airports to prevent the H1N1 flu from spreading to other countries.
Hong Kong's second confirmed case is a student who had flown in from San Francisco. This has put the city on high alert as the 24-year-old patient remains under quarantine in Princess Margaret Hospital.
The Hong Kong resident, travelling from San Francisco, boarded his Cathay Pacific flight, though he was feeling unwell.
Health officials have written a letter to their US counterparts, urging them to medically screen departing airport passengers to prevent spreading the virus to other countries.
Hong Kong Health Secretary, York Chow, said: "We have not received any response right now. But what we have informed the American government is, since they are a representative of the WHO and a signatory to the International Health Regulations, I think that everyone has the responsibility to ensure that they do not allow any infection to go outside their country or territory.
"I think that Hong Kong is fulfilling that duty and responsibility and I hope that other countries will do that too."
Just last week, more than 300 people were released from a week-long quarantine in response to the city's first case, which was also imported.
Hotel guests and staff were under lockdown after a Mexican traveller who checked into the Metropark Hotel tested positive for H1N1. The government was accused of going overboard in trying to contain the virus.
Health authorities met with headmasters of various schools today to discuss measures to deal with a possible pandemic.
They have said schools will only be closed if a local H1N1 case occurs, meaning it cannot be traced to a source outside of Hong Kong.
Health officials said the risk of an H1N1 outbreak in the community is higher during the summer. That's when many students studying overseas will return, possibly bringing back more imported cases."

”Mexico denies swine flu cover-up
BBC News
21:30 GMT, Tuesday, 12 May 2009 22:30 UK
http://news.bbc.co.uk/2/hi/americas/8047052.stm
Mexico's health minister has denied allegations by Fidel Castro that the country intentionally failed to reveal the existence of swine flu last month.
The former Cuban leader accused Mexico of covering up the outbreak in order to avoid missing out on a visit by US President Barack Obama.
The minister, Jose Angel Cordova, said Mexico had been extremely forthcoming and proactive over the outbreak.
It has been doing all it can to combat the H1N1 virus ever since, he added.
Mr Castro's comments came after Cuba reported its first confirmed case of swine flu on Monday. Correspondents say his remarks may contribute to a further worsening of relations between the two countries.
Cuba cancelled all flights to Mexico when news of the outbreak first emerged.
Mexico has confirmed the deaths of 58 people from swine flu and the spread of the virus caused a national crisis, with restrictions on public gatherings only relaxed last week.

'Not the CIA'
Mexican President Felipe Calderon said last week he might cancel a planned trip to Cuba "as one of the unforeseen consequences of decisions that have no technical basis" - a clear reference to Cuba's ban on flights.
Mr Castro responded late on Monday in an internet column in which he referred to President Obama's visit to Mexico in mid-April, which came days before a spreading flu outbreak in the country was officially diagnosed as swine flu.
"The Mexican authorities did not inform the world of [the outbreak], awaiting the visit of Obama," the former Cuban leader wrote.
"Now they threaten us with suspending Calderon's trip."
A Mexican was diagnosed with swine flu in Mexico on Monday. He had become ill after returning from a trip home in late April.
"The only thing that can be confirmed now is that [the flu] wasn't brought here by the CIA," Mr Castro added in his column.
"It came from Mexico."

"NHS flu absence 'may reach 85%'
BBC News
23:01 GMT, Wednesday, 13 May 2009 00:01 UK
http://news.bbc.co.uk/2/hi/health/8048554.stm
NHS may struggle to cope if there is a flu pandemic because of the number of staff who will fail to turn up for work, a report suggests.
Birmingham University researchers quizzed more than 1,000 health workers and found as many as 85% may be absent.
This is more than double the official predictions and the experts believe such a scenario could put too much strain on the health service.
But leading doctors said the NHS would cope because of the excellent planning.
Under contingency plans already drawn up, protocols are in place to allow the NHS to cancel non-emergency treatment such as elective operations.
NHS may struggle to cope if there is a flu pandemic because of the number of staff who will fail to turn up for work, a report suggests.
Birmingham University researchers quizzed more than 1,000 health workers and found as many as 85% may be absent.
This is more than double the official predictions and the experts believe such a scenario could put too much strain on the health service.
But leading doctors said the NHS would cope because of the excellent planning.
Under contingency plans already drawn up, protocols are in place to allow the NHS to cancel non-emergency treatment such as elective operations."

”Flu bans heighten trade tensions
BBC News
16:42 GMT, Tuesday, 5 May 2009 17:42 UK
http://news.bbc.co.uk/2/hi/americas/8034284.stm
Mexico says it has written to the World Trade Organization (WTO), demanding an explanation from countries which have restricted its imports over swine flu.
Economy Minister Gerardo Ruiz Mateos said such bans lacked a basis in science and would not be permitted.
Among others, Russia and China have banned pork products or pigs from Mexico and other affected countries.
Of 1,490 infections verified in 20 countries, 30 people have died - 29 in Mexico, and one in the US.
The World Health Organization (WHO) is urging nations to remain vigilant, saying a global pandemic still threatens.
It is shipping 2.4 million anti-flu treatments donated by Tamiflu manufacturer Roche to 72 countries "most in need" of them, including Mexico and countries finding it hard to pay to stockpile adequate supplies.
Normal life is beginning to resume in Mexico, with traffic returning to the streets of the capital and some bars reopening.
Schools and universities are set to reopen on Thursday.

In other developments:
* China extends its ban on pork products to 17 more US states, bringing the total number to 36, reports Reuters news agency
* Dozens of Mexicans are being flown home from China on a specially-chartered Mexican plane. They are among about 70 Mexicans confined despite just one confirmed case of the virus. The issue sparked a diplomatic row, with Mexico accusing China of targeting its citizens unfairly, and Beijing saying it was a "purely medical" issue
* The UK is delivering specially-produced leaflets offering advice on swine flu and advice on how to prevent its spread

'Unjustified barriers'
Mr Ruiz Mateos said a complaint had been sent to the WTO regarding eight countries which have imposed restrictions on Mexican exports, arguing the restrictions lack a scientific basis.
The trade restrictions are among tough measures imposed by some countries in an apparent bid to tackle the spread of swine flu, which the WHO currently rates as a level five threat - meaning a pandemic is "imminent".
The eight identified by Mr Ruiz Mateos are China, Russia, the UAE, Ukraine, Bolivia, Ecuador, Honduras and Azerbaijan.
"We won't permit unjustified barriers on Mexican exports," Mr Ruiz Mateos told a news conference.
He said the countries he had singled out were not big trading partners with Mexico, but the action sought to ward off similar measures by other countries.
Mexican Finance Minister Agustin Carstens said the government was set to offer measures such as temporary tax relief to companies hit by the crisis, and that this would likely cost the economy some 17.4bn pesos ($1.3bn; £873m) overall.
Several of the countries which have found their pork exports banned as a result of swine flu have argued there is no proof that the infection can be caught by eating pork - a stance backed by scientists, says BBC business reporter Rodney Smith.
The tough measures taken by some countries have already increased some tensions, particularly in the areas of trade and travel links.
But, speaking after imposing a ban on British pork, Nikolai Vlasov, Russia's chief veterinary inspector, defended the measures.
"We are constantly told that pork is not dangerous," Mr Vlasov said, according to Associated Press news agency.
"But at the same time, nobody has proved that it is safe."
As well as the UK, Russia has banned pork products from Spain, parts of Canada and the United States. It has banned all meat imports from Mexico, Central American and Caribbean countries.
China has banned imports of live pigs and pork products from 15 countries including several in central Asia, central America and Europe, as well as several US states and the Canadian province of Alberta.”

"Recommended composition of influenza virus vaccines for use in the 2009-2010 northern hemisphere influenza season
WHO
14 May 2009
http://www.who.int/csr/disease/influenza/recommendations2009_10north/en/index.html

It is recommended that vaccines for use in the 2009-2010 influenza season (northern hemisphere winter) contain the following:
— an A/Brisbane/59/2007 (H1N1)-like virus;*
— an A/Brisbane/10/2007 (H3N2)-like virus;**
— a B/Brisbane/60/2008-like virus.#

* A/Brisbane/59/2007 is a current vaccine virus; A/South Dakota/6/2007 (an A/Brisbane/59/2007-like virus) is a current vaccine virus used in live attenuated vaccines.
** A/Brisbane/10/2007 and A/Uruguay/716/2007 (an A/Brisbane/10/2007-like virus) are current vaccine viruses.
# B/Brisbane/33/2008 is a B/Brisbane/60/2008-like virus."

"WHO ei vielä päättänyt sikainfluenssan vastaisesta rokotteesta
AP, AFP, Reuters
julkaistu tänään klo 20:00
http://yle.fi/uutiset/ulkomaat/2009/05/who_ei_viela_paattanyt_sikainfluenssan_vastaisesta_rokotteesta_739023.html
Maailman terveysjärjestön WHO:n asiantuntijat eivät ole päässeet yksimielisyyteen siitä, pitääkö lääketehtaiden ryhtyä tuottamaan sikainfluenssarokotetta tavallisten kausi-influenssarokotteiden sijaan.
WHO:n varatoimitusjohtaja Keiji Fukuda sanoi, että WHO, lääketeollisuus ja terveysviranomaiset eivät saaneet päätöstä aikaan telekonferenssissaan. Influenssarokotteita valmistavia lääkeyhtiöitä on maailmassa runsaat 20.
Maailman terveysjärjestö aloittaa vuosikokouksensa maanantaina Genevessä Sveitsissä. Kymmenpäiväinen kokous muutettiin viisipäiväiseksi sikainfluenssan aiheuttaman pandemian uhan vuoksi. Näin kansalliset viranomaiset pääsevät nopeammin toteuttamaan sikainfluenssan vastaisia toimia kokouksen jälkeen.
Puoli miljoonaa kuolee kausi-influenssaan vuosittain
Tavalliseen kausi-influenssaan kuolee vuosittain maailmassa puoli miljoonaa ihmistä, joten sen vastaiset rokotuskampanjat ovat hyvin perusteltuja. Epävarmoja ollaan nyt siitä, onko syytä keskittyä kausi-influenssan sijaan sikainfluenssaa aiheuttavan H1N1-viruksen torjuntaan. Lääketehtailla ei ole voimavaroja satsata vahvasti molempiin yhtä aikaa.
Influenssarokotteiden kehittelyyn ja tuotantoon kuluu aikaa kuukausia, ja tehtyä päätöstä - keskittymistä sikainfluenssa- tai kausi-influenssarokotteisiin - eivät lääketehtaat voi muuttaa matkan varrella.
WHO arvioi, että H1N1-rokotetta voitaisiin valmistaa kaksi miljardia annosta vuosittain. Aikaa rokotteen valmistumiseen WHO ennustaa kuluvan neljästä kuuteen kuukauteen.
Asiantuntijat: "Rokotteen valmistus alkaa"
Lääketehtaiden työtä vaikeuttaa se, että virus muuttaa koko ajan muotoaan. Poliittisia linjauksia pitäisi tehdä siitä, kuinka paljon rokotetta valmistettaisiin, kuinka se jaeltaisiin ja ketkä rokotettaisiin.
Jotkut asiantuntijat arvelevat, että päätös on käytännössä jo tehty - sikainfluenssarokotetta ryhdytään heidän mielestään valmistamaan. Näin ajattelee yhdysvaltalainen rokoteasiantuntija ja entinen lääketieteen professori David Fedson Virginian yliopistosta.
- Jos sikainfluenssarokotteeseen ei satsata, meillä ei ole käsissämme mitään, jos tauti saa myöhemmin katastrofin mittasuhteet, hän sanoo. - Toisaalta sikainfluenssa voi ilmaantua uudelleen myös lievässä muodossa.
Sairastuneita yli 6600, kuolleita lähes 70
Sikainfluenssaan sairastuneiden määrä kasvaa maailmalla edelleen. Eri maiden terveysviranomaisten ilmoitusten perusteella sairastuneita on jo yli 6600, heistä Yhdysvalloissa 3352 ja Meksikossa 2656 henkilöä uutistoimisto AP:n mukaan. Kanadassa sairastuneita on 389.
Sairastuneita on löytynyt 34:stä maasta. Suomessa tautitapauksia on kaksi. Euroopassa H1N1-viruksen sairastuttamia on eniten Espanjassa, sata tapausta. Britanniassa sairastuneita on 78.
Sikainfluenssa on aiheuttanut maailmalla 69 kuolemaa. Meksikossa on kuollut 64 tautiin sairastunutta, Yhdysvalloissa menehtyneitä on kolme, Kanadassa ja Costa Ricassa kummassakin yksi."

INFLUENZA A (H1N1) - WORLDWIDE (27): CASE COUNTS
Archive Number 20090514.1800
Published Date 14-MAY-2009
Subject PRO/AH/EDR> Influenza A (H1N1) - worldwide (27): case counts
http://www.promedmail.org/pls/otn/f?p=2400:1001:676739511774982::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,77486
************************************************
A ProMED-mail post http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
[Please note that there may be discrepancies between the various sources of
information due to different times of "closure" of daily figures reported.
Times of daily report closures where known are listed in the table of
contents below. Newswires may mention a confirmed case in a location that
has not been on the official reporting entity list as the confirmation
arrived after closure of the day's report. - Mod.MPP]
In this update:
[1] WHO - global updates (06:00 GMT)
[2] PAHO - Americas regional update (17:00 GMT-4)
[3] CDC - USA update (11:00 GMT -4)
[4] Mexico - MOH update (08:40 GMT -5)
[5] Canada - Public Health Agency of Canada (15:00 GMT -4)
[6] News brief
******
[1] WHO - global updates (06:00 GMT)
Date: Wed 13 May 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) [edited]

Influenza A (H1N1) - update 27 -- 13 May 2009
---------------------------------------------
As of 06:00 GMT, 13 May 2009, 33 countries have officially reported 5728
cases of influenza A (H1N1) infection.
Mexico has reported 2059 laboratory confirmed human cases of infection,
including 56 deaths. The United States has reported 3009 laboratory
confirmed human cases, including 3 deaths. Canada has reported 358
laboratory confirmed human cases, including one death. Costa Rica has
reported 8 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no
deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3,
comprising 1 in China, Hong Kong Special Administrative Region, and 2 in
mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4),
Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel
(7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2),
Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98),
Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68).

Summary table of cases reported to WHO 30 Apr -- 13 May 2009
------------------------------------------------------------
Country: No. cases (deaths) Apr 30 / May 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13
Argentina: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1
Australia: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1
Austria: 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
Brazil: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 4 / 6 / 6 / 8 / 8 / 8
Canada: 19 / 34 / 51 / 85 / 101 / 140 / 165 / 201 / 214 / 242(1) / 280(1) / 284(1) / 330(1) / 358(1)
China, Hong Kong, SAR, mainland: 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 2 / 2 / 3
Colombia: 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 3 / 3 / 6
Costa Rica: 0 / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 8(1) / 8(1) / 8(1) / 8(1)
Cuba: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1
Denmark: 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
El Salvador: 0 / 0 / 0 / 0 / 2 / 2 / 2 / 2 / 2 / 2 / 2 / 4 / 4 / 4
Finland: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2
France: 0 / 0 / 2 / 2 / 4 / 4 / 5 / 5 / 12 / 12 / 12 / 13 / 13 / 13
Germany: 3 / 4 / 6 / 8 / 8 / 9 / 9 / 10 / 11 / 11 / 11 / 11 / 12 / 12
Guatemala: 0 / 0 / 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 3
Ireland: 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
Israel: 2 / 2 / 3 / 3 / 4 / 4 / 4 / 6 / 7 / 7 / 7 / 7 / 7 / 7
Italy: 0 / 0 / 0 / 1 / 2 / 5 / 5 / 5 / 6 / 6 / 9 / 9 / 9 / 9
Japan: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 3 / 4 / 4 / 4
Mexico: 97(7) / 156(9) / 397(16) / 506(19) / 590(25) / 822(29) / 942(29) / 1112(42) / 1204(44) / 1364(45) / 1626(45) / 1626(48) / 2059(56) / 2059(56)
Netherlands: 1 / 1 / 1 / 1 / 1 / 1 / 1 / 2 / 3 / 3 / 3 / 3 / 3 / 3
New Zealand: 3 / 4 / 4 / 4 / 6 / 6 / 5 / 5 / 5 / 5 / 7 / 7 / 7 / 7
Norway: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2 / 2 / 2
Panama: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2 / 3 / 15 / 16 / 29
Poland: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1
Portugal: 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
Republic of Korea: 0 / 0 / 1 / 1 / 1 / 2 / 2 / 3 / 3 / 3 / 3 / 2 / 3 / 3
Spain: 13 / 13 / 13 / 40 / 54 / 57 / 73 / 81 / 88 / 88 / 93 / 95 / 95 / 98
Sweden: 0 / 0 / 0 / 0 / 0 / 0 / 1 / 1 / 1 / 1 / 1 / 2 / 2 / 2
Switzerland: 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
Thailand: 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2
United Kingdom: 8 / 8 / 15 / 15 / 18 / 27 / 28 / 32 / 34 / 34 / 39 / 47 / 55 / 68
United States: 109(1) / 141(1) / 160(1) / 226(1) / 286(1) / 403(1) / 642(2) / 896(2) / 1639(2) / 2254(2) / 2532(3) / 2600(3) / 3009(3)
Total No. countries reporting cases: 11 / 13 / 16 / 18 / 21 / 21 / 23 / 24 / 25 / 29 / 30 / 30 / 33
Total cases reported: 257(8) / 367(10) / 658(17) / 898(20) / 1085(26) /
1490(30) / 1893(31) / 2371(44) / 2500(46) / 4379(49) / 4694(53) / 5251(56) / 5728(61)
--
communicated by:
ProMED-mail rapporteur Marianne Hopp"

"China's Shandong quarantines 23, declares health emergency over A/H1N1 flu
www.chinaview.cn 2009-05-14 12:21:35
JINAN, May 14 (Xinhua)
http://news.xinhuanet.com/english/2009-05/14/content_11372650.htm
Health authorities in east China's Shandong Province put 23 people under home or hospital quarantine Thursday morning to check for symptoms of A/H1N1 influenza, the provincial health department said.
The 23 had been in close contact in a Beijing-Jinan train with a male resident of Shandong who health officials said Wednesday had tested positive for the disease.
The provincial health authorities are seeking 20 other passengers who were in the same car of train D41, from Beijing to the provincial capital of Jinan, on Monday.
After the man was diagnosed, Shandong Province declared China's first swine-flu health emergency at about 6 p.m. Wednesday.
Wang Suilian, vice governor of the eastern province, said Shandong declared the second-level health emergency, which will involve many departments coordinating to contain the disease and keep the public informed.
Shandong's flu case, the second known case on the Chinese mainland, involved a 19-year-old student surnamed Lv who arrived in Beijing from Canada on May 8 and traveled to Jinan three days later.
Lv was hospitalized Monday. He was recovering with a normal body temperature on Wednesday, when he was taken off intravenous feeding.
"We only prescribed some anti-influenza medicine like Tamiflu for Lu," Dr. Ma Jiren, who is also deputy director of Jinan's Health Bureau, said Thursday.
Lv is in an isolation ward in the Jinan Hospital of Infectious Diseases.
Zong Lin, chief of the disease control and prevention section of the Shandong Provincial Health Bureau, said health officials were sending text messages and running notices on TV to find the remaining passengers.
A health official surnamed Zhang said that the second-degree emergency declaration was the highest-level response available to provincial governments. A first-degree emergency declaration would be up to the central government.
Beijing launched a second-degree emergency response against bird flu in January after a 19-year-old woman died of the disease in the capital. The city's poultry markets were closed and disinfected, and disease control staff went door-to-door in suspected infection areas to check flu patients.
"A second-degree emergency can be declared when an A-class infectious disease is confirmed. The A/H1N1 influenza is currently classified as B-class infectious disease in China.
"However, the health department proposed the emergency be declared immediately, because the scientific community is still unclear about how the virus spreads and there is a high risk of a mass outbreak," he said.
The mainland's first A/H1N1 flu patient, who has been at the Chengdu Infectious Diseases Hospital in southwest Sichuan Province for four days, was making a rapid recovery.
All 147 passengers who had been exposed to that patient on Northwest Airlines flight NW029 from Tokyo to Beijing, had been contacted by the Beijing Health Department, said the department on Wednesday."

WHO definition of phase 6 of pandemic alert as in 14 May 2009:
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
"Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way."

Transmission of Swine H1N1 In Scotland Signals Phase 6
Recombinomics Commentary 13:13
May 14, 2009
http://www.recombinomics.com/News/05140902/Swine_H1N1_Scotland_6l.html
A 16-YEAR-OLD girl is being classed as the latest "probable" case of swine flu in Greenock.
However, Deputy First Minister Nicola Sturgeon, who is also Scottish Health Secretary, said there was "no obvious connection" between the teenager and any other confirmed or probable cases in the town.
She said if no link emerges between the girl and any other cases, it could be the first evidence of "community transmission" in Scotland.
The news follows the closing of a nursery school and a primary for a week.
As reported in yesterday's Evening Times, Ladybird Nursery shut its doors to pupils less than 24 hours after Ravenscraig Primary became the first school in Scotland to close because of the swine flu outbreak.
A total of 80 youngsters at the nursery are being given the anti-viral drug Tamiflu as a precaution after a three-year-old was diagnosed as a "probable" case.
Ms Sturgeon said the three-year-old, and a five-year-old boy who attends Ravenscraig, are both linked to a 19-year-old man from Greenock who tested positive for swine flu.

The above comments describe a large cluster of confirmed and probable H1N1 swine flu cases in the Greencock region of Scotland (see updated map). In addition to the large cluster, there is an unlinked case, signaling community transmission in Scotland, Community transmission of swine H1N1 outside if North America paves the way for a phase 6 declaration.
Swine H1N1 is spread widely throughout North America (see updated map). In the United States, the incidence of swine flu outpaced the combined cases of H1N1 and H3N2 seasonal flu. The explosion in cases led to a significant backlog at the CDC, which was confirming swine flu cases. Recently, the confirmatory kits were distributed to state labs, but the shortage of kits has led to limited testing, which is primarily focused on severe cases.
However, although swine H1N1 was widespread in Mexico, the United States, and Canada, the WHO maintained the pandemic level at phase 5 because community transmission was not confirmed outside of North America.
This confirmation was largely dependent on testing. The virus has been sequenced worldwide, and the various isolates are closely related (well over 99% identity). Thus, the efficient human to human transmission in North America would be present worldwide, but many cases are mild are go unreported or tested.
The confirmed community transmission in Scotland, fulfills the WHO requirement of community transmission in two or more regions to rause the pandemic level from 5 to 6..
Therefore, a phase 6 designation should be announced in the near term."

"Sikainfluenssaan sairastuneiden kontaktit tiedossa
YLE Uutiset
julkaistu 13 May 2009 klo 17:38, päivitetty 13 May 2009 klo 21:24
Sikainfluenssaan sairastuneiden suomalaisten kanssa tekemisissä olleet suomalaiset ovat terveysviranomaisten tiedossa. Lähellä sairastuneita olleet henkilöt on selvitetty, jotta heidät voidaan tarvittaessa ohjata hoitoon.
Kaksi A (H1N1)-viruksen aiheuttaman influenssan saanutta suomalaista toipuu parhaillaan taudistaan. Kaikki heidän kanssaan lähikontaktissa olleet on selvitetty sairastuneiden kanssa käydyissä keskusteluissa. Lähikontaktilla tarkoitetaan esimerkiksi samassa taloudessa asuvia perheenjäseniä tai samoissa tiloissa yli neljä tuntia oleskelleita henkilöitä.
Toinen sairastuneista töissä Sanoma Newsissa
Suomessa on jäljitetty esimerkiksi ne henkilöt, jotka olivat tekemisissä toisen sairastuneen kanssa hänen käydessään Laurea-ammattikorkeakoulun Keravan toimipisteessä viime viikon torstaina ja perjantaina.
Keskiviikkona vahvistui, että tiistaina sairastuneista henkilöistä yksi on töissä mediakonserni Sanoma Newsissä. Toimitusjohtaja Mikael Pentikäinen kertoi YLE Uutisille, että sairastunut ei ole kuitenkaan ehtinyt käydä työpaikallaan lomamatkansa jälkeen, vaan hän on jäänyt kotiin työtoverin ja työterveyshuollon suosituksesta. Henkilö on kotihoidossa ja voi Pentikäisen mukaan hyvin. Sanoma-konserni ei ole myöskään ryhtynyt mihinkään erityisjärjestelyihin tapauksen takia, vaan on kehottanut työtekijöitä noudattamaan viranomaisten yleisiä hygieniaohjeita.
Tartunnan saaneista suomalaisista toinen sairastui viime viikon keskiviikkona KLM:n lennolla Meksikon pääkaupungista Mexicosta Amsterdamiin. Tieto on toimitettu myös Hollannin terveysviranomaisille, jotka jäljittävät samalla lennolla lähipenkkiriveissä istuneita matkustajia.
Sairastuneiden kanssa tekemisissä olleille on annettu ohjeet käsihygieniasta ja oireiden seurannasta. Oireita on kehotettu tarkkailemaan viikon ajan kontaktin jälkeen. Mikäli tänä aikana ilmenee kuumetta yli 38°C sekä hengitystieoireita, kuten yskää tai nuhaa tai kurkkukipua, tulee ottaa yhteyttä omaan terveyskeskukseen tai työterveyshuoltoon."
************
Briefly in English:
The two Finnish coonfirmed swinefluenza cases flew in KLM airplane from Mexico City to Amsterdam. KLM is now contacting only people who sat in the next rows in the airplane.

" WHO: Sikainfluenssa pysyvään seurantaan
julkaistu 4 May 2009 klo 22:53, päivitetty 5 May 2009 klo 11:01
AFP, AP, Reuters
http://yle.fi/uutiset/ulkomaat/2009/05/who_sikainfluenssa_pysyvaan_seurantaan_719991.html
Maailman terveysjärjestö WHO tahtoo sikainfluenssan pysyvään seurantaan. Tauti ei ole maailmanlaajuisessa eläintautiseurannassa samalla tavalla kuin esimerkiksi lintuinfluenssa. Tarkempi syyni tarvitaan, koska sikainfluenssa on muuntuneessa muodossaan mahdollisesti vaarallinen ihmisille.
WHO:n asiantuntija Peter Ben Embarek sanoo, että sikainfluenssaan ei ole suhtauduttu toistaiseksi vakavasti, koska sitä ei ole pidetty erityisenä vaarana. Se on hyvin yleinen sioilla, ja sitä on siksi hoidettu vain eläintautina.
Nyt epidemiana oleva uuden tyypin influenssa tarttuu ihmiseen ja ihmisestä ihmiseen. Siksi myös sikainfluenssalle tarvitaan tarkempi seuranta, arvioi WHO:n Embarek.
Tartunnan on WHO:n mukaan saanut tähän mennessä yli 1 100 ihmistä ja siihen on kuollut 26 ihmistä. Vahvistettuja tartuntoja on 21 maassa. WHO ei vielä tässä vaiheessa katso tarpeelliseksi nostaa hälytysvalmiuttaan korkeimmalle eli kuudennelle asteelle."

" Suomalainen H1N1-virustartunnan saaneen lennolla
julkaistu 11 May 2009 klo 07:33, päivitetty 12 May 2009 klo 11:29
YLE Uutiset, Reuters, DPA, AP
http://yle.fi/uutiset/ulkomaat/2009/05/suomalainen_h1n1-virustartunnan_saaneen_lennolla_731252.html
Suomalainen mies on matkustanut avovaimonsa kanssa samassa lentokoneessa kuin sikainfluenssaan sairastunut mies. Kiinalaisen virustartunta vahvistettiin maanantaina maan ensimmäiseksi tautitapaukseksi. Suomalaismies kuuli vasta maanantaina YLEn kirjeenvaihtajalta olleensa samalla perjantaisella lennolla sairastuneen kiinalaismiehen kanssa.
Suomen suurlähetystö on ollut yhteydessä suomalaismieheen. Mies odottaa nyt soittoa kiinalaisviranomaisilta.
Suomalaismies lensi perjantai-iltana Tokiosta Pekingiin samassa koneessa sikainfluenssaan sairastuneen kiinalaismiehen kanssa. Tokion lentokentällä matkustajat oli tarkastettu huolellisesti, mutta tautia ei ollut havaittu.
Jatkolennolla Pekingistä Sichuaniin mukana olleet matkustajat on eristetty, mutta Pekingiin jääneitä matkustajia ei.
Yli sata matkustajaa tavoittamatta
Kiinan terveysministeriö ilmoitti, että Sichuanin maakunnassa on varmistettu maan ensimmäinen sikainfluenssatartunta.
Tartunnan saanut 30-vuotias miespotilas palasi äskettäin Yhdysvalloista, missä hän on opiskellut Missourin yliopistossa. Hän on nyt sairaalahoidossa Chengdun kaupungissa lounaisessa Sichuanin maakunnassa, kertoi virallinen uutistoimisto Xinhua.
Miehen kanssa samalla lennolla Chengduun saapuneista 150 matkustajaa on paikannettu ja kymmenet heistä on eristetty, ja he ovat terveysviranomaisten seurannassa. Myös muut hänen kanssaan läheisessä kosketuksessa olleet on eristetty viranomaisten tarkkailuun. Viranomaiset jäljittävät vielä 150:tä muuta, jotka ovat matkustaneet tartunnan saaneen kanssa samassa koneessa.
Kiinan viranomaiset ovat pyrkineet estämään viruksen pääsyn maahan, koska sen arvioidaan leviävän nopeasti tiheästi asutussa maassa."

"Co-pilot suspected of carrying H1N1
The Jakarta Post , Jakarta
Tue, 05/12/2009 2:32 PM
National
http://www.thejakartapost.com/news/2009/05/12/copilot-suspected-carrying-h1n1.html
Hasan Sadikin Hospital in Bandung, West Java, is treating a co-pilot suspected of having contracted the H1N1 virus, a hospital spokesman said to state news agency Antara.
"We have received a patient sent from Husein Sastranegara airport. He arrived at the hospital at 5.26 pm on Monday. He is suspected to have been infected with the type A influenza virus [H1N1]," Dr Pirmal Soedjana, a member of the hospital's Special Infections Handling Team, said.
He said that the patient, before being admitted to the hospital, had made several overseas trips including to Singapore and Malaysia. (dre)"

"Lentokentällä lisätty ohjeistusta sikainfluenssan takia
julkaistu 12 May 2009 klo 13:59
YLE Uutiset
Helsinki-Vantaan lentokentällä on lisätty matkustajien terveysohjeistusta sikainfluenssan takia. Muuten lentokenttä toimii kuten ennenkin, eikä kentällä ole ryhdytty erityistoimiin.
Helsinki-Vantaan lentokentällä on tänään jaettu terveysviranomaisten ohjeita siitä, miten pitää toimia, jos epäilee mahdollista sikainfluenssaa tai -tartuntaa.
- Olemme laittaneet matkustajia varten esille Terveyden ja hyvinvoinnin laitoksen painattamia ohjeita tautiin liittyen, kertoo Finavian apulaisjohtaja Heini Noronen-Juhola.
Muuten lentokentän toiminnassa ei ole mitään tavallisesta poikkeavaa.
- Meillä ei esimerkiksi ole käytössä desinfiointialtaita tai lämpökameroita, Noronen-Juhola jatkaa.
Samalla hän kertoo, että kentällä seurataan tilannetta koko ajan ja ollaan jatkuvassa valmiudessa toimia viranomaisten ohjeiden mukaisesti.
- Meillä on useita eri suunnitelmia eri tilanteiden varalta. Jos viranomaisilta tulee ohje tai määräys tehdä jotain, niin me toimimme ohjeen mukaisesti, apulaisjohtaja Heini Noronen-Juhola jatkaa."

"Sikainfluenssaa nyt myös Suomessa
julkaistu 12 May 2009 klo 09:23, päivitetty 12 May 2009 klo 18:48
YLE Uutiset
http://yle.fi/uutiset/kotimaa/2009/05/sikainfluenssaa_nyt_myos_suomessa_733629.html
Suomessa on löytynyt kaksi vahvistettua sikainfluenssatapausta. Tartunta on löydetty kahdelta pääkaupunkiseudulla asuvalta nuorelta aikuiselta, jotka palasivat samalla lennolla Meksikosta Amsterdamin kautta 6. toukokuuta.
Potilaat ovat olleet kotihoidossa ja voivat hyvin, eikä heillä ole vakavaa vaaraa.
Sairastuneet olivat olleet kahden viikon lomamatkalla Méxicossa ja Cancúnissa. Toinen heistä sairastui lentopäivänä 6. toukokuuta ja toinen pari päivää myöhemmin, kerrottiin sosiaali- ja terveysministeriön tiedotustilaisuudessa.
Sairastuneiden lento Suomeen lähti Amsterdamista kello 18.15 ja saapui Helsinkiin 21.45. Toinen sairastuneista ehti olla koulussa kaksi päivää ennen kuin hänen sairautensa vahvistettiin. Hän opiskelee Laurea-ammattikorkeakoulun Keravan yksikössä. Opiskelija on nyt kotona, ja muille opiskelijoille on annettu ohjeet mahdollisia oireita ja käsihygieniaa varten.
Sairastuneet ovat läheistensä ruokahuollon varassa, kertoo Terveyden ja hyvinvoinnin laitoksen (THL) ylijohtaja Juhani Eskola.
- Ystävät tai sukulaiset voivat toimittaa sinne ruokaa. Ei se sen monimutkaisempaa ole, Eskola sanoo.
Eskolan mukaan sairastuneita on pyydetty rajoittamaan tiiviitä kontakteja muihin ihmisiin, ja heille on annettu hygienianhoito-ohjeet. Näin ollen tartuntavaaraa ei ole.
- Heille on käyty läpi käsihygieniaa ja yskimis- ja aivastushygieniaa, aivan tällaisia perusasioita. Se riittää tällaisessa tapauksessa, Eskola vakuuttaa.
Terveyskeskukset ja neuvontapuhelin auttavat
Keravan kaupungin terveydenhuollon johtaja Minna Helenius kertoo, että kaupunkilaisten kyselyt sikainfluenssasta on ohjattu pääkaupunkiseudun kuntien ja Helsingin ja Uudenmaan sairaanhoitopiirin HUSin yhteiseen terveysneuvonta-puhelinpalveluun. Suurin osa yhteydenotoista menee sinne ja loput omaan terveyskeskukseen, kertoo Helenius.
- Laurea-ammattikorkeakoulun Keravan yksikössä opiskelevia ulkopaikkakuntalaisia on kehotettu ottamaan yhteyttä omaan terveyskeskukseen, jos kysyttävää ilmenee.
Vahvistetut sikainfluenssatapaukset eivät kuitenkaan toistaiseksi ole ruuhkauttaneet terveysneuvonnan puhelinpalvelua. Sairaanhoitaja Merja Thölix arvelee kuitenkin, että illan aikana yhteydenottoja alkaa tulla enemmän.
- Aikaisemmin soittoja on tullut parisenkymmentä päivässä, Thölix kertoo.
Tyypillinen soittaja haluaa Thölixin mukaan tietää, voisivatko hänellä olevat flunssan oireet viitata sikainfluenssaan.
Amsterdamin-lennolla olleet ottaneet yhteyttä lääkäriin
Ministeriö kehotti tiistaiaamuna sairastuneiden suomalaisten kanssa samalla lennolla olleita ihmisiä ottamaan yhteyttä terveyskeskukseensa, jos heillä ilmenee kuumeisia hengitystieinfektion oireita. Ministeriön mukaan varoaika mahdolliselle tartunnalle on noin viikko. Jos samalla lennolla olleille ilmenee oireita 13. toukokuuta mennessä, pitää ottaa yhteyttä terveyskeskukseen.
Tiistaina kello 16:een mennessä samalla lennolla olleet ovat ottaneet yhteyttä lääkäriin ainakin Pohjois-Savossa, Keski-Suomessa ja Etelä-Pohjanmaalla. Työikäinen kuopiolainen tarkistutti yliopistollisessa sairaalassa lievät hengitystieinfektio- ja kuumeoireensa. Keskiviikkona selviää, oliko kyseessä sikainfluenssavirus.
Lennolla ollut keskisuomalainen perhe otti yhteyttä Keski-Suomen sairaanhoitopiiriin. Perheellä ei ollut oireita. Oireeton henkilö on ollut tarkkailtavana myös Etelä-Pohjanmaalla Seinäjoen keskussairaalassa. Keski-Pohjanmaan keskussairaalassa on puolestaan otettu näytteet New Yorkista tulleesta potilaasta. Potilas on kotihoidossa.
Viranomaiset luottavat matkustajien tavoittamisessa tiedotusvälineisiin
Suomen terveysviranomaisilla ei ole tietoa siitä, kuinka paljon Amsterdamin-lennolla oli suomalaisia ja mistä päin maata he ovat kotoisin. THL:n ylijohtajan Juhani Eskolan mukaan lennolla olleita ei yritetä tavoittaa, vaan viranomaiset luottavat tiedottamisessa tiedotusvälineisiin.
- Lennolla mukana olleiden jäljittämisessä joudumme nyt luottamaan aika paljon tietoon, joka on mennyt tiedotusvälineiden kautta tänä aamuna.
Aamulla tiedotusvälineiden välityksellä annetun ohjeen mukaan lennolla mukana olleiden pitää ottaa puhelimitse yhteyttä terveyskeskukseen, jos he sairastuvat kuumeeseen tai hengitystieinfektioon.
Lentoyhtiöltä ei ole yritetty saada tietoa matkustajista, koska matkustajaluetteloiden ja istumajärjestyksen saaminen olisi liian hidasta. Eskolan mukaan tiedonsaanti muilta lentoyhtiöiltä on vaikeampaa kuin Finnairilta.
- Meillä on varsin hyvät ja toimivat suhteet Finnairiin, mutta muiden lentoyhtiöiden kanssa yhteistyö on vähän kimuraisempaa. Kyllä mielestäni kaikki lentoyhtiöt ovat yhteistyöhaluisia, mutta tällaiset pikaisesti tehtävät jäljitystehtävät ovat varsin uusia haasteita.
Ministeriö rauhoittelee
Sosiaali- ja terveysministeriön mukaan H1N1-tapausten esiintyminen myös Suomessa oli odotettavissa, koska virus on levinnyt laajalti eri puolilla maailmaa. Suomessa tilanteeseen on kuitenkin varauduttu hyvin, eikä ihmisillä ole syytä huolestua.
Myös Thaimaa on ilmoittanut tänään ensimmäisestä sikainfluenssatapauksestaan. Thaimaa on ensimmäinen Kaakkois-Aasian maa, josta on löydetty sikainfluenssaa. Maailmalla sikainfluenssaan on sairastunut 5 000 ihmistä."
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In English:
"Finland Confirms First Two Swine Flu Cases
published 12 May 2009 10:05 AM, updated 12 May 2009 01:02 PM
http://yle.fi/uutiset/news/2009/05/finland_confirms_first_two_swine_flu_cases_733734.html
On Tuesday morning health officials confirmed the country's first two cases of swine flu. The two infected Finns returned from a trip to Mexico City and Cancun via Amsterdam on May 6. Their flight arrived at Helsinki-Vantaa Airport at 9:45 p.m. Health officials urge people who were on the same flight to contact their health care provider if they begin to show symptoms of fever or respiratory illness.
The first of the patients became ill on May 6, and the second a couple of days later, according to officials speaking at a Ministry of Health and Social Affairs press conference on Tuesday.
The patients live in the capital region and are nursing flu-like symptoms at home, not in hospital, officials said.
The risk of infection to H1N1 lasts about a week from exposure to the virus, health authorities said.
Passengers on the Helsinki-bound flight from Amsterdam who develop flu-like symptoms by Wednesday, May 13 are asked to contact their health care providers if they develop flu-like symptoms.

Officials Urge Calm
The Ministry of Social Affairs and Health says the spread of the virus to Finland was expected and that authorities are well prepared to combat with the virus. The ministry added that people should not worry unnecessarily.
The spread of the flu to Finland follows the first confirmed Nordic cases being found this month in Denmark, Sweden and Norway.
The World Health Organisation has confirmed some 5,000 infections of H1N1 flu virus worldwide."
**************
Editor's note:
The other patient was let to go to school for two days before the illness was confirmed to be swinefluenza.

New York Confirms Swine H1N1 High School Spread
Recombinomics Commentary 14:39
May 10, 2009
http://www.recombinomics.com/News/05100902/Swine_H1N1_NY_HS.html
As I reported previously, on Monday Wadsworth Laboratories received a large batch of 102 specimens from the North Shore Long Island Jewish Health System (North Shore-LIJ) for laboratory confirmatory testing. These are specimens collected about 10 days ago when the outbreak in Queens connected to St. Francis Preparatory School was in the news. These older specimens underwent preliminary testing at North Shore-LIJ laboratories. The clinical needs of these patients were appropriately addressed.
Today I have the results of New York City specimens in that batch, which include 75 patient specimens from New York City now confirmed with H1N1. Fifty of these 75 cases, or over 65 percent, have a direct link to the St. Francis School outbreak, and represent students and faculty there.
The remaining 25 cases involve children under high-school age and could represent siblings of the St. Francis students, but that cannot be fully determined until the epidemiological investigations are completed.
Because these specimens are from the first days of the outbreak in New York State more than a week ago, they do not indicate active cases, and we believe these individuals have fully recovered. However, we felt it important to brief you on the results of the large batch of older specimens from North Shore-LIJ, as these numbers when added to our current map graphic on our web site will indicate a rather substantial jump in the overall New York City cases.
At this point in the outbreak, reporting daily numbers of new cases is not important because the illness continues to be mild to moderate, similar to seasonal influenza. The numbers are also not particularly significant because they only represent lab-tested specimens, and many individuals with mild symptoms do not go to a physician or hospital, but instead, recover at home - as has been our advice for some time.
As we go forward, the focus of our monitoring and reporting will be more on identifying new locations, trends, and patterns of the H1N1 virus, as well as watching for more severe disease. The test results from the North Shore-LIJ specimens will help us to better understand the early phase of H1N1 in New York and how it has spread geographically over time.
As I mentioned earlier, we are entering a new phase in our response to this outbreak, and Governor Paterson has asked that I only provide updates when there are important new developments.

The above comments from the State of New York swine flu website confirm the spread of H1N1 in the Queens high school last month. Although only 25 students vacationed in Mexico, on April 23 and 24 there were 150 students with flu-like symptoms. 28 were initially confirmed and 17 were suspect based on lab results. The number of cases created a backlog, and the results have now been released for the samples collected last month.
However, there is concern that the swine H1N1 is still silently spreading (see updated map), because the vast majority of cases are mild, and require enhanced surveillance for detection, although a simple influenza A test will be more predictive of swine flu as the seasonal flu season ends in the northern hemisphere.
The above announcement by the NY lab has been echoed across the country. The testing will be selective, and a complete picture of the H1N1 spread will be lacking. This focus on the more severe cases mimics confirmations in Mexico, where the lab confirmed cases significantly underestimates the level of infections.
The focus on severe cases increases the case fatality rate. In the US there have been three reported H1N1 deaths and there has also been a death in Alberta , Canada, raising concerns that the number of fatal infections will climb significantly over the near term.
The identity between H1N1 in Mexico and the US (as well as all other countries submitting sequence data - see list of isolates here), raises concerns that the silent spread will produce frequent co-infections between swine and seasonal H1N1. These co-infections can produce genetic exchanges between human and swine isolates via reassortment and recombination.
This type of rapid genetic evolution between human and swine H1N1 raises concerns that a more virulent H1N1 will emerge in the near term, and lead to a significant rise on severe cases in the fall, when the flu season begins in the northern hemisphere."

Kanadassa ensimmäinen sikainfluenssakuolema
AFP, Reuters
julkaistu 8 May 2009 klo 18:56, päivitetty 9 May 2009 klo 01:21
http://yle.fi/uutiset/ulkomaat/2009/05/kanadassa_ensimmainen_sikainfluenssakuolema_729248.html
"Kanadassa on todettu esimmäinen sikainfluenssakuolema.Terveysviranomaiset kertoivat perjantaina naisen kuolleen tautiin Albertan provinssissa. Aiemmin A H1N1 -influenssa on vaatinut kuolonuhreja Meksikossa ja Yhdysvalloissa.
Nainen ei viranomaisten mukaan ollut käynyt Meksikossa. Kaikkiaan Kanadassa on vahvistunut tähän mennessä runsaat 200 A H1N1 -tartuntaa.
Ennen Kanadan ilmoitusta sikainfluenssa oli vaatinut 46 ihmisen hengen. Kuolemantapauksista 44 on Meksikossa ja kaksi Yhdysvalloissa.
Tartuntoja on löydetty 26 maasta kaikkiaan 3 238. Epäiltyjä tartuntoja on 1 843, laskee uutistoimisto Reuters.
Yhdysvaltain tartuntatautivirasto ilmoitti perjantaina, että maassa olisi jo yli 1 600 varmistettua sikainfluenssatapausta 43 osavaltiossa. Aiemman laskennan mukaan tartuntatapauksia oli alle 900.
Virasto arvioi, että sikainfluenssa leviää vähitellen Yhdysvaltain kaikkiin osavaltioihin.
Japani vahvisti lauantaina maan kolme ensimmäistä tautitartuntaa. Opettaja ja kaksi oppilasta olivat saaneet tartunnan opintomatkalla Kanadassa.
Myös Britanniassa kerrottiin loppuviikosta uusista tartunnoista. Viiden ihmisen oireiden todettiin olevan sikainfluenssaa. Maassa on nyt kaikkiaan 39 vahvistettua sikainfluenssatapausta.
WHO ei nosta valmiustasoa
Maailman terveysjärjestö WHO ei nosta maailmanlaajuista valmiustasoa sikainfluenssan takia. WHO ilmoittaa pitävänsä pandemian valmiustason edelleen tasolla viisi kuusiportaisella asteikolla. Tartuntojen määrä kasvaa kuitenkin odotetusti edelleen.
WHO:n mukaan suurin osa Meksikon ulkopuolella influenssa A-H1N1:n tartunnan saaneista on käynyt vastikään Meksikossa tai henkilöt ovat olleet tekemisissä Meksikosta tulleiden kanssa. WHO:n mukaan ei ole edelleenkään merkkejä, että tauti leviäisi yhteisöjen sisällä muualla kuin Meksikossa ja Pohjois-Amerikassa.
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Briefly in English:
The first swine flu death in Canada. Also total 39 cases in United Kingdom. WHO still doesn't rise pandemic phase from 5 to 6.

Lapin sairaanhoitopiiri
7.5.2009
http://www.lshp.fi/default.aspx?contentid=2020&nodeid=9469&contentlan=1
"Miehen kuume- ja muut flunssaoireet sekä matkustushistoria täyttävät H1N1-influenssan eli sikainfluenssan tunnusmerkit. Lisäksi oireissa on ilmennyt sellaisia viitteitä, joita ei tavalliseen influenssaan liity. Potilaalle on tehty laboratoriotutkimuksia, joista tulokset saadaan ensiviikon alkupäivinä. Mies on hyväkuntoinen.
Lisätietoja: Infektiolääkäri Markku Broas, p. 040 8447243"
************
Briefly in English:
One uspect swinefluenza case in the Lapland Central Hospital. A man living in Ivalo area is ill with influenza symptoms, and his travel history full the criterion to suspect swinefluenza. There are also symptoms that do not occur in regular influenza. The confirmatory laboratory tests will be available in the beginning of the next week. The man is in good condition.

Ruotsissa varmistui sikainfluenssatapaus
Suomen Lääkärilehti
07.05.2009
Marianne Jansson
"Ruotsissa on varmistettu yksi tapaus influenssa A(H1N1) -viruksen aiheuttamaksi ns. sikainfluenssaksi. Tukholman seudulla asuva keski-ikäinen nainen oli sairastunut tautiin Yhdysvaltain-matkalta palattuaan, joskin parantunut vain kolmen päivän lievän oireilun jälkeen. Merkkejä tartunnan leviämisestä muihin ei ole.
Lapin keskussairaalassa odotetaan alustavia tuloksia kuumeisen ja hengitystieoireisen potilaan testeistä. Potilas on vastikään palannut Yhdysvalloista.
Kaikkiaan 22 maassa on varmistettu uuden viruksen aiheuttamia tautitapauksia eiliseen mennessä yhteensä 1 893.
Rokotetuotantoon valmistaudutaan
WHO on pyytänyt kaikkia rokotevalmistajia valmistautumaan laajaan rokotetuotantoon uutta virusta vastaan. Järjestön rokotetutkimusohjelman johtaja Marie-Paule Kieny arvelee rokotteiden olevan saatavilla 4–6 kuukaudessa.
WHO:n asiantuntijaryhmä kokoontuu ensi viikolla pohtimaan perusteita, joilla järjestö pyytää rokotevalmistajia vaihtamaan kausi-influenssarokotteen tuotannon uuteen A(H1N1)-rokotteeseen. Ratkaisuja pohjoisen pallonpuoliskon seuraavaa influenssakautta varten saatetaan joutua tekemään kauan ennen kuin uuden viruksen laaja leviäminen on varmaa. Tämä voi myös vaikuttaa kausi-influenssarokotteen saatavuuteen."
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Briefly in English:
One confirmed swinefluenza in Stockholm area, Sweden.
One suspect swinefluenza case in the Lapland Central Hospital, Finland. Tests pending.

Lahtelaisnaisen sikainfluenssaepäily aiheeton
YLE Uutiset
julkaistu 5 May, 2009 klo 19:30, päivitetty 5 May, 2009 klo 19:36
http://yle.fi/uutiset/kotimaa/2009/05/lahtelaisnaisen_sikainfluenssaepaily_aiheeton_722117.html
Suomessa ei ole edelleenkään yhtään todettua sikainfluenssatapausta, kertoo Terveyden ja hyvinvoinnin laitos.
Lahdessa influenssaan sairastuneeksi epäilty nainen on todettu terveeksi ja hänen takiaan aloitetut suojatoimet on purettu. Jo eilen maanantaina lahtelaisnaisen läheiset vapautettiin kotikaranteenista.
Meksikossa matkaillut ja flunssaoireita saanut nainen oli hoidossa Päijät-Hämeen keskussairaalassa, mutta potilaan infektio-oireet loppuivat vähitellen. Naisen läheisille oireita ei ilmaantunut lainkaan.
**************

Briefly in English: No TexMex virus in Finland. The confirmatory tests negative for the flu symptomatic woman that was quarantined after prolonged stay in Mexico.

Tamiflun teho hiipuu
Mediuutiset
Katja Palhus, 3.3.2009, 17:03
http://www.mediuutiset.fi/uutisarkisto/article239916.ece?s=l&wtm=mediuutiset/-03032009
"Influenssalääke Tamiflu ei enää taltuta influenssaa entiseen tapaan, kertoo Reuters. Tiedot perustuvat amerikkalaisen lääketieteen julkaisun Jaman artikkeliin. Uudet analyysit osoittavat influenssavirusten kehittäneen vastustuskyvyn oseltamiviiriin perustuvan lääkkeelle. Lääkkeen teho varsinkin lapsilla on heikentynyt.
Suomessakin Tamifluta on ostettu varastoon lintuinfluenssaepidemian varalle. Euroopan lääkevirasto EMEA suositteli viime vuonna, etteivät jäsenmaat enää jatkossa varastoisi vain Tamifluta, vaan myös vastaavaa kilpailevaa Relenza-lääkettä.
Asiantuntijat varoittavat maailmanlaajuisesta terveyskatastrofista ja vaativat tehokkaita toimia muun muassa uusien influenssalääkkeiden kehittämiseen. Vanhojen lääkkeiden tehon ehtyminen osoittaa, että pandemioihin varautumista on päivitettävä jatkuvasti.
Uutta lääkettä luvataan idästä. Hongkongin yliopiston ja yhdysvaltalaistutkijoiden mukaan lintuinfluenssaan on kehitetty entistä edullisempi ja tehokkaampi rokote, kertovat Ylen nettisivut.
Rokote on kehitetty isorokon vastaista rokotetta muuntelemalla. Sen ansiosta rokote vaikuttaa nopeammin kuin muut lintuinfluenssaa vastaan tähän mennessä kehitetyt lääkkeet. Tutkijoiden mukaan uutta rokotetta on helppoa ja edullista tuottaa, joten rokotteen valmistus onnistuu myös köyhissä maissa.
Maailman ensimmäinen lintuinfluenssatapaus paljastui Hongkongissa vuonna 1997. Vuoden 2003 jälkeen tauti on vaatinut maailmanlaajuisesti noin 250 uhria."
***************
Briefly in English:
Tamiflu (oseltamivir) is losing it's efficiency against influenza.

"Swine H1N1 Transmission From Human to Swine
Recombinomics Commentary 07:10
May 3, 2009
http://www.recombinomics.com/News/05030901/Swine_H1N1_H2S.html
The pigs in Alberta were thought to be infected by a farm worker who returned from Mexico on April 12 and began working on the farm two days later. Officials noticed the pigs had flu-like symptoms April 24, Evans said.
Approximately 10 percent of the 2,200 pigs on the farm have been infected, Evans said.

The above comments describe the transmission of the H1N1 swine flu from an infected farm worker to swine in Alberta, Canada. This efficient transmission from human to swine suggests that much of the speculation in the past week is overly optimistic.
The virus is swine, WHO newspeak notwithstanding, and contains six swine gene segments as well as a human PB1 and an avian PB2 that have been in swine for more than a decade. Therefore, although swine to swine transmission is not unexpected, the trans mission from human to swine is striking. The H1N1 is called swine H1N1 for scientific reason. It is not a “nickname” as some media accounts mis-report, but a descriptive name that defines its normal host. The species differences in sequence are easily determined, and species jumps are rare, but can be deadly. Usually the virus replicates most effectively in is host species.
The jump to humans is cause for concern. The last time as swine flu jumped to human and was efficiently spread in the new host was in 1918.
The fact that the virus can jump from human to swine as well as swine to humans suggests this virus is not going to fade away. It has already moved into the southern hemisphere. Suspect cases have been reported in Brazil, Australia, and New Zealand, where the seasonal flu season is just beginning.
Co-circulation of human and swine H1N1 provide significant opportunities for adaptation to the human host via recombination. Two polymorphisms are already fixed in seasonal flu, H274Y for Tamiflu resistance, and E627K in PB2 which allows the virus to more efficiently replicate at lower temperatures.
These changes can lead to adaptation in humans, as well antiviral resistance. Therefore, the evolution of the H1N1 over the summer will be closely monitored. The current H1N1 has already acquired tandem human H1N1 polymorphism in HA, which may have led to the species jump from swine to human.
Thus, the efficient transmission from swine to human and vice verse, raises concerns that further adaptation to humans can lead to a fall pandemic similar to 1918. The species jump indicates the virus can adapt to a new host, and additional acquisitions over the summer continue to be a cause for concern."

Alberta pigs believed to be infected with swine flu; officials say food safe
The Canadian Press
Steve Rennie And Helen Branswell And Bob Weber
OTTAWA
http://ca.news.yahoo.com/s/capress/090502/national/flu_cda
"Pigs at an Alberta farm caught the same swine flu strain that has sickened hundreds of humans around the world, federal officials said Saturday.
A farmhand who travelled to Mexico and fell ill upon his return apparently infected the pigs with the H1N1 influenza virus, said Dr. David Butler-Jones, Canada's chief public health officer.
"So far, basically what we're seeing in the pig is the same strain as we see in the humans," Butler-Jones said.
"The concern is that if it's circulating in a pig herd, that any other humans that come onto the farm might be exposed and be at risk."
This is the first time this swine flu virus has been found in pigs.
The farm worker returned to Canada from Mexico on April 12 and had contact with the pigs two days later. About 220 pigs in the herd of 2,200 began showing signs of the flu on April 24, said the country's top veterinary officer, Dr. Brian Evans of the Canadian Food Inspection Agency.
All of the pigs are recovering or have recovered and the farm worker has also recovered.
One other farm worker subsequently fell ill. It's not yet known if that person caught the swine flu.
Bulletins were sent to Alberta pork producers warning them of the possible danger that swine flu could present to their herds on April 24, said Gerald Hauer, the province's chief provincial veterinarian. But by that time, the farm worker was already back from Mexico and on the job at the 2,200-hog operation.
"He was in the barn, doing his work on April 14," Hauer said.
The farmer notified provincial officials that an unspecified number of his animals were showing flu symptoms on April 28. The barn was quarantined later that day and remains under quarantine.

No other area hog barn has been affected.
Alberta Agriculture Minister George Groeneveld said the outbreak shouldn't affect Alberta's export markets.
"Border closures are certainly unwarranted," he said. "We'll see what transpires.
"(The Americans) at this point have no problems with the export of our pork."
Alberta farmers raise about 1.6 million hogs. They exported about 600,000 of them last year, for sales of about $50 million.
Still, Saturday's news was a chilling reminder of the 2003 BSE outbreak, which shut down exports of Canadian cattle for more than a year.
"Food safety is not an issue in this case so hopefully we'll deal with science here and not emotional issues," said Groeneveld.
The virus has shown no signs of mutation when passing from human to pig, Evans said.
"At this point in time, the issue of this being a human virus, having been introduced to the pigs, and the characterization of this virus, shows it is still that virus," he said.
"There's been no adaptation identified through the transfer from humans to pigs at this time."
The herd in question has been placed under quarantine. It's not yet known what will happen to the pigs.
It's common to see influenza in pigs and human transmission to pigs is known to occur, Evans said.
Normally detecting influenza in pigs would not generate a response from food safety officials, but with an international flu outbreak, the current circumstances are different, Evans told a news conference in Ottawa.
"The chance that these pigs could transfer virus to a person is remote," said Evans.
The swine H1N1 virus, a never-before-seen combination of swine, avian and human genes, is believed to have jumped to humans a while ago and has been passing person to person.
The World Health Organization has insisted there is no evidence that pigs are passing the virus to humans, or that eating pork products poses an infection risk.
Herman Simons, a spokesman for Alberta Pork, a producer's group, said the main worry is the possible effect of the discovery on exports.
"That's our big concern," Simons said. "The biggest concern is it may impact exports of live animals into the U.S."
In 2008, total Canadian pork exports were valued at $2.7 billion, including nearly $527 million worth of Canadian live swine exports.
In a statement, Agriculture Minister Gerry Ritz said met with his American counterpart, who assured him the U.S. will not close its borders to Canadian pork exports.
Jurgen Preugschas, president of the Canadian Pork Council, said some countries have already closed their borders to pork from North America, but he said those decisions have little to do with food safety.
"Don't confuse trade issues with health issues," he warned. "Countries are often looking for an excuse to close borders or to put tariffs on trade. It has nothing to do with protecting their people; it's got everything to do with politics.
"It's a market access issue. It's an excuse to close the border for a period of time and possibly, in many cases, lower the prices so they can come in and buy products at a cheaper price."
Earlier this week, the World Health Organization dropped the term "swine flu" - a nickname that angered pork producers and led to a drop in pork sales - in favour of its scientific name: "H1N1 influenza A."
Meanwhile, Canada's swine flu caseload swelled Saturday to 85 cases as health officials confirmed a host of new cases in Nova Scotia, Alberta and Quebec.
Public health officials say Nova Scotia has 17 new cases of swine flu, as jurisdictions across Canada are starting to report the widening spread of the illness.
Dr. Robert Strang, chief medical officer of Nova Scotia, said at a news conference Saturday that of the new cases in the province, 11 are students who were exposed to the virus at the private King's Edgehill school in Windsor, N.S.
The other six were tested in doctors' offices in the Halifax area, suggesting the virus has jumped from being isolated in a small town to Atlantic Canada's most densely populated city.
There are now 31 cases in Nova Scotia, making it the province with the largest number of confirmed cases in the country.
Meanwhile, seven new cases have been reported in Alberta, doubling that province's count to 15.
Two women, one man and a girl became Edmonton's first to come down with the disease. One woman and a boy were also diagnosed with swine flu in northern Alberta.
Another woman in Calgary has also come down with the disease.
None of the cases have required hospitalization, said Alberta Health.
Strang said he is uncertain whether any of those infected in Halifax had contact with students from the private school, or if they contracted the illness from other sources.
He said further tests are needed, and he'll know more in a few days.
"This is not a surprise. We fully expected to see more cases, as I've been saying all week. We also expected it would spread beyond King's Edgehill school," said Strang, after announcing the new numbers.
He added there have been no reports that any of the people with the flu have been hospitalized.
Though he emphasized that to date most cases are mild, he also urged Canadians to be cautious.
"I ask people to be extra vigilant and to take precautions around general hygiene. That means washing hands thoroughly and often, coughing and sneezing into your sleeve and disinfecting tables and worktops," he said.
Meanwhile, new cases have also been confirmed in British Columbia, Ontario and Quebec.
Health officials in Quebec confirmed the province's second case of the flu strain, a school-age child who recently returned from a trip to Mexico. Quebec's first case was confirmed in Montreal earlier this week.
British Columbia reported three more confirmed cases Saturday bringing the total in the province to 22. All the cases have been mild and the patients have either recovered or are recovering.
Two more confirmed cases were reported in Ontario, bringing that province's total to 14 cases.
The new Canadian cases came as the WHO announced it will release 2.4 million anti-viral doses to 72 countries.
The federal government, meanwhile, has expanded its swine-flu prevention campaign to Facebook, Twitter and YouTube, with a new "citizen-readiness campaign." ---"

--- More behind the link
http://ca.news.yahoo.com/s/capress/090502/national/flu_cda

"Tartuntoja ihmisestä toiseen Saksassa, Britanniassa ja Kanadassa
Helsingin Sanomat
1.5.2009 20:19
http://www.hs.fi/ulkomaat/artikkeli/Tartuntoja+ihmisest%C3%A4+toiseen+Saksassa+Britanniassa+ja+Kanadassa/1135245628428
STT–Reuters
Sikainfluenssa on tarttunut ihmisestä toiseen myös Saksassa, Britanniassa ja Kanadassa. Aiemmin tartuntoja on ilmennyt vain niillä, jotka ovat oleskelleet Meksikossa.
Britanniassa Skotlannin hallitus on vahvistanut, että 24-vuotias mies sai tartunnan pelattuaan jalkapalloa yhdessä miehen kanssa, joka oli hiljattain ollut häämatkalla Meksikossa. Britanniassa vahvistettuja tartunnan saaneita on kymmenen.
Saksassa Baijerissa nainen sai tartunnan oltuaan tekemisissä yhden vahvistetun tartunnan saaneen kanssa. Viranomaisten mukaan sairaanhoitajana toiminut nainen on jo täysin toipunut. Saksassa vahvistettuja tartuntoja on yhteensä neljä.
Kanadassa on ilmennyt tähän mennessä yli 30 tartuntaa, jotka ovat olleet kaikki lieviä. Ainakin yksi sairastuneista on saanut tartunnan Kanadassa."
*****
Briefly in English:
Sustained transmission of TexMex virus has now occurred in Germany, United Kingdom and Canada.

"Swine flu: two human-to-human transmissions confirmed in UK
Telegraph.co.uk
Last Updated: 10:05PM BST 01 May 2009
http://www.telegraph.co.uk/health/swine-flu/5259627/Swine-flu-two-human-to-human-transmissions-confirmed-in-UK.html
Two cases of human to human transmission of swine flu within Britain have been confirmed, including Graeme Pacitti, a close contact of couple Iain and Dawn Askham.
As well as Mr Pacitti, another case passed on from one person in Britain to another has been confirmed in the South West of England.
Previously all cases here had been in people who had been to Mexico recently.
Sir Liam Donaldson, the UK Government's Chief Medical Advisor, said: “The first non imported cases of swine flu have been confirmed in England and Scotland. The infection appears to have been acquired by person to person spread within the United Kingdom. Until now, cases were confined to people who had themselves recently come back from Mexico. The person in the South West is being treated with Tamiflu."
Mr Pacitti, a 24-year-old NHS health worker's positive test results were made public by the Scottish government this afternoon.
He has been receiving antiviral drugs since falling ill and his condition is not serious. His family are being kept with him in isolation at their Falkirk home but have not displayed any symptoms.
"In the past couple of days I've started to feel a lot better," he told the BBC immediately after the news was announced.
"I've still got a sore throat and an upset stomach but it's a lot better than it was earlier this week.
"I've been told to remain indoors and keep taking Tamiflu."
There are now 13 confirmed cases in the UK - 10 in England and three in Scotland.
Children at Downend School near Bristol were sent home after the headteacher wrote to parents saying that an 12-year-old girl in year seven who had just returned from Mexico had been confirmed with swine flu.
A spokesman for Avon Health Incident Co-ordination Centre later said that tests on the girl - who is said to be "at home and well” - were still ongoing, and that she was still a suspected case.
"Early indications are inconclusive and strictly as a matter of precaution, pupils at the secondary school have been issued with the anti-viral medication Tamiflu," the centre said in a statement.
The technology college is due to remain closed until the end of next week.
In total 642 cases are still under investigation by the Health Protection Agency.
Mr Pacitti is only the second patient outside the US to have contracted swine flu without visiting Mexico, following a German woman whose condition was confirmed this morning.
Although medical experts say that human-to-human transmission of the virus in Britain is to be expected and is not cause for concern while the symptoms are mild, the diagnosis will further heighten fears of an imminent pandemic.
"Increased and sustained" transmission between human populations in different continents would see the World Health Organisation raise its alert level from five to six, meaning that a pandemic is underway.
But Dr Alan McNally, senior lecturer and influenza diagnostics researcher at Nottingham Trent University, said: "We know that it is transmitted from human to human, it has happened in other parts of the world and we know it will happen here.
"I know that there will be interest in it because members of the public will see that they don't need to have been to Mexico to get it."
Meanwhile, the Danish authorities have announced the first confirmed case of swine flu in Scandinavia, while 343 cases have now been confirmed in Mexico, 15 of them fatal.
The first victim in Asia has been diagnosed in Hong Kong. The sufferer is a Mexican citizen who flew in to Hong Kong via Shanghai yesterday.
Mr Pacitti, who works at Falkirk Royal Infirmary, is now in quarantine at his home in the town along with his mother and other members of his family.
He plays football on the same six-a-side team as Mr Askham and fell ill after they went for a team night out at a local pub.
He was initially cleared but continued to show symptoms and further tests confirmed he was suffering from Type A flu, the strain that includes swine flu.
---
A draft forecast prepared last September warned that up to half the British population – or 30 million people – could get influenza if the bug outbreak turns into a pandemic.
---
The document, seen by The Daily Telegraph, also warns that hospitals could be "rapidly overwhelmed" and forced to turn away critically ill patients in a pandemic.
---
The document says cuts in the number of beds since Britain last underwent a pandemic in 1969 – combined with an ageing population and changes in the way patients are treated – mean intensive care units "could be rapidly overwhelmed"."
**************
Comment: This would initially meet the criteria for phase 6 pandemic.

INFLUENZA A (H1N1) - WORLDWIDE (03)
***********************************
A ProMED-mail post http://www.promedmail.org
ProMED-mail is a program of the International Society for Infectious Diseases
http://www.isid.org
http://www.promedmail.org/pls/otn/f?p=2400:1001:6322064978324504::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,77310
"--- For the avian and human sequences we have to step back 10 years to 1998, actually. Chris Olsen is one of the first that saw it, and we saw the same in a virus from Nebraska and Richard Webby and Robert Webster in Memphis saw it, too. There were unprecedented outbreaks of influenza in the swine population. It was an H3 virus. The disease was not very severe in healthy pigs. Everyone was very curious about these H3 viruses. Since 1918, normally it's only H1N1 in swine. Then all of a sudden there's H3N2 in swine in the Midwestern US. When people analyzed what was inside those viruses, they realized there were 3 different things. The PB1 gene, that was human. H3 and N2 also were human. The PA and PB2, the 2 polymerase genes, were of avian flu. The rest were typical North American swine viruses. Those strains were the so-called triple reassortants.

The reality is good molecular surveillance in the pigs started in the 1970s. So if there were strains that were not very dominant between the 1930s and the '70s, we wouldn't have detected them. This triple reassortant was very successful and took over and dominated the picture-to the point where the classical H1N1 was almost extinct. H3 was a different subtype, so there was no immunity in the pigs. It was probably that they had new polymerase genes, too. The neuraminidase
and the matrix are the newest to be seen in North America. They were not part of the team -- I talk about flu virus as teams of genes. There are 8 players. They have these 2 new players from Asia.

One little detail we haven't discussed is [that] these Midwestern viruses were exported to Asia. Korea and many countries import from the US. Swine flu is economically not such a big deal that many countries don't check for it. There are some parts of the puzzle I don't have the answer to [such as the European lineage contributions]. The genetic lineages of Asia and Europe mix quite a
bit.

[The question of the appearance of this virus in Mexico is unresolved], but the mixing probably did not occur in Mexico. The amazing thing is the hemagglutinins we are seeing in this strain are a lonely branch that has been evolving somewhere and we didn't know about it.

We have [a] 6 percent or higher percentage difference in neuraminidases. You have multiple amino acids that differ. And single amino acid changes can change receptor specificity. When you have so many changes, you don't know which ones are responsible.
[The current outbreak strains] from Mexico and North America are
very, very similar. Many genes are identical. In the 8 or 9 viruses
we've sequenced, there is nothing different. We've received 300
samples from Mexico, and these cover the span of February, March, and
April [2009]. And you look at flu A, traditionally it's A/H1 or A/H3
or it's B up until the end of March. There are 2 or 3 cases up to
[the] last days of March that are swine. Then in April they
skyrocket. So all the cases in the DF [Mexico City] areas, where most
samples came from, it really transmits very efficiently. Flu is a
seasonal disease that peaks in winter. Maybe this will end in the
United States with the end of the flu season.
---
[--- The complete version of this interview in its question and answer
format can be viewed at the source URL above. - Mod.CP] ---"

"WHO Confirms Sustained Swine H1N1 Transmision in Humans
Recombinomics Commentary 23:53
April 29, 2009

Apr 27, 2009 (CIDRAP News)
The World Health Organization (WHO) today raised its official pandemic alert level from the current phase 3 to phase 4 on its 6-phase scale, saying the newly identified swine influenza virus has made a pandemic more likely but not inevitable.

The above comments describe the phase increase from 3 to 4, which left little doubt that the phase would be raised to 6 within a few days because of the spread of H1N1 swine flu out of Mexico (see updated map). The earlier definitions used sustained transmission as the definition of phase 6. This change was due in part to limited human to human transmission of H5N1. The repeated reports of smaller clusters dictated a change from 3 to 4, but such a change was linked to significant increases in pandemic preparedness.
The new definition, that required sustained transmission, made it clear that the progress of phases from 4 to 6 would just be a matter of days as noted in yesterday’s lengthy interview.
The pandemic is quite predictable, as detailed in the video above, has much in common with the 1918 outbreak, including the start in the late spring as a mild infection, the targeting of previously healthy adults, and the origin as swine H1N1. Over the summer the swine H1N1 will proliferate in the southern hemisphere and recombine with H1N1 seasonal flu, leading to a much more virulent H1N1 in the fall.
Active surveillance and the developing a vaccine that targets the predicted product is critical. Tamiflu resistance will almost certainly develop in swine H1N1, leading to a heavy reliance on a well matched vaccine.
The CDC has been quickly released swine H1N1 in humans. Similar release of seasonal flu H1N1 in the southern hemisphere, as well as the private swine sequence database maintained by WHO consultants should also be made public immediately
Phase 6 should be announced within the next few days.
It is time for serious vaccine targeting of emerging sequences."