Penumbra Pandemia

"Vical H1 Influenza Vaccine Delivers Robust Preclinical Results With 100% Response
http://www.newspress.com/Top/Article/article.jsp?Section=BUSINESS&ID=565605450364616717
SAN DIEGO,
30 June 2009
GLOBE NEWSWIRE
Vical Incorporated (Nasdaq:VICL) announced today that the company's vaccine against A/H1N1 pandemic influenza (swine flu) produced robust immune responses well above the accepted protection threshold in 100% of vaccinated mice and rabbits after a standard two-dose vaccine regimen. In addition, at least 75% of vaccinated animals achieved or exceeded the protection threshold after a single dose of vaccine. The company is ready to advance directly to large-scale cGMP manufacturing of the vaccine for human clinical trials, subject to securing external funding for this program. ---"
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Editor's note: Sounds too good to be true. But what may be the side effects and adverse effects? Does the law require the corporation to tell them?

"Indonesia: all aircraft passengers to get masks
The mask for pendatang
BBC
By editorial staff of 29/06/2009 @ 22:57
The Indonesian government will distribute the mask to all the aircraft passenger from the country that it was known was collided with H1N1 or pig flu. The government also obliged each aircraft passenger and the ship from overseas to fill up the health card. These efforts were carried out to stem spread him the virus H1N1 in Indonesia, after the influenza patient H1N1 that came from overseas to improve to eight people.
One of the important decisions of results of the interdepartmental co-ordination of the meeting related today was, more increased the supervision procedure in all the international airports. The government stressed this, because eight patients who were known were infected by the virus H1N1, was ascertained tertular overseas. Health Minister Siti Fadilah Supari said, one of the steps in his prevention was to distribute the mask to aircraft passengers from the country that was collided with by the virus of pig flu. Was not explained when the mask will be distributed in each international airport. The official of the Department of the Health said, technical the implementation of these efforts will be discussed in the other opportunity. Apart from distributing the mask, the government according to Transport Minister Menteri Perhubungan Jusman Sjafii Djamal, also will tighten the supervision in the airport and the international port.
Each passenger from overseas his plan will be obliged to fill up the health card. The official in all the international airports also will tighten the use of the implement pemindai hot. Up until last Sunday, the number of influenza patients of A H1N1 or pig flu in Indonesia that has been it was confirmed positive totalling eight people, four among them the foreign citizen and Indonesian citizen who just came from the country to be collided with by this virus."

toggletext translated
orginal article

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"Masker buat para pendatang
oleh Redaksi 29/06/2009 @ 22:57
BBC
http://www.infeksi.com/newsdetail.php?lng=in&doc=3571
Pemerintah Indonesia akan membagikan masker kepada seluruh penumpang pesawat dari negara yang diketahui terdampak H1N1 atau flu babi.
Pemerintah juga mewajibkan setiap penumpang pesawat dan kapal laut dari luar negeri untuk mengisi kartu kesehatan.
Upaya ini dilakukan untuk membendung merebaknya virus H1N1 di Indonesia, setelah pasien influenza H1N1 yang datang dari luar negeri bertambah menjadi delapan orang.
Salah-satu keputusan penting hasil rapat koordinasi antar departemen terkait hari ini adalah, lebih meningkatkan prosedur pengawasan di semua bandar udara internasional.
Pemerintah menekankan hal ini, karena delapan orang pasien yang diketahui terinfeksi virus H1N1, dipastikan tertular di luar negeri.
Menteri Kesehatan Siti Fadilah Supari mengatakan, salah-satu langkah pencegahannya adalah membagikan masker kepada penumpang pesawat dari negara yang terdampak virus flu babi.
Tidak dijelaskan kapan masker itu akan dibagikan di setiap bandar udara internasional.
Pejabat Departemen Kesehatan mengatakan, teknis pelaksanaan upaya ini akan dibahas pada kesempatan lain.
Selain membagikan masker, pemerintah menurut Menteri Perhubungan Menteri Perhubungan Jusman Sjafii Djamal, juga akan memperketat pengawasan di bandar udara dan pelabuhan internasional.
Setiap penumpang dari luar negeri rencananya akan diwajibkan mengisi kartu kesehatan.
Petugas di semua bandar udara internasional juga akan memperketat penggunaan alat pemindai panas.
Sampai hari Minggu kemarin, jumlah pasien influenza A H1N1 atau flu babi di Indonesia yang sudah dikonfirmasi positif sebanyak delapan orang, empat diantaranya warga negara asing dan sisanya warga negara Indonesia yang baru datang dari negara terdampak virus tersebut."

"Air Traffic Patterns To Predict Infectious Disease Spread: Researchers
Bernama
Ottawa
30 June 2009
http://www.bernama.com/bernama/v5/newsindex.php?id=421769
Canadian researchers have designed a system using air travel patterns to predict how infectious diseases will spread around the world, and by taking preventive measures as soon as an outbreak occurs, local media reported Monday.
The system known as BIO.DOASPORA system, is developed by a physician Dr. Kamran Khan of St. Michael's Hospital in Toronto and his colleagues, accurately to predict how the A/H1N1 flu virus would circulate worldwide after arising in Mexico earlier this year, reports China's Xinhua news agency.
Using their BIO.DIASPORA system, the team analyzed the flight itineraries of more than 2.3 million passengers who departed Mexico on commercial flights during March and April 2008 to predict the spread of the A/H1N1 flu.
The findings show the international destinations of air travellers leaving Mexico were strongly associated with confirmed importations of the virus around the world.
"We know that infectious diseases don't respect national boundaries, but if there is one thing they have to respect as they're spreading around the globe, it's the architecture of the airline transportation system," said Khan.
"This is their mechanism for spreading around the globe."
Khan said he came up with the idea of using the air traffic grid to better understand the global transmission of infectious disease after the 2003 SARS crisis. That outbreak killed more than 770 people, including 44 Canadians.
"It just became so obvious how the airline transportation network was a major conduit of the spread of infectious diseases," he said.
Days before Khan and his team were to deliver a report on BIO. DIASPORA to the Public Health Agency of Canada, news began trickling out about a new flu virus in Mexico. Their system allowed them to track its spread as it quickly infiltrated populations in one country after another.
"The movement of passengers out of Mexico aligned very nicely with the observed spread of H1N1," said Khan, principal author of a paper on the initiative published this week in the New England Journal of Medicine.
"I see this publication as being an important point now where we can say: OK, this is proof of principle that where people move, infectious disease of people will follow, that that principle now is validated in this A/H1N1 outbreak."
Co-author Dr. Michael Gardam, director of infectious diseases prevention and control for the Ontario Agency for Health Protection and Promotion, said the system provides for the first time an accurate picture of not only where diseases will travel, but how often and when.
"This work provides the world with a potent early-warning system for emerging infectious diseases," he said."

"Silent Spread of Tamiflu Resistant Pandemic H1N1
Recombinomics Commentary 13:05
June 30, 2009
http://www.recombinomics.com/News/06300901/H274Y_Swine_Silent.html
He had to start with no ill. That was in the preventive treatment with Tamiflu, because he had been in close contact with a swine influenza hit abroad. Since there had been five days of Tamiflu, the person suddenly ill with H1N1, but it not appear that the medicine worked. It appeared as through the samples here and in England that the person had been resistance, "says Nils Strandberg.

The above translation provides additional information on the patient who developed a pandemic H1N1 infection while taking a prophylactic dose of oseltamivir (Tamiflu). The five days suggests the patient was infected after her contact, who was infected overseas, returned. The patient was given Tamiflu because of her infected contact and developed flu-like symptoms while taking Tamiflu, which led to the isolation of the virus and sequence data (generated in Denmark and England) showing resistance (which was almost certainly H274Y).
The above description made no mention of an isolate from the patient who traveled overseas and no indication that an isolate was collected. Therefore, it is highly unlikely that a wild type sequence from the overseas traveler or the patient with resistant H1N1 exist. This absence was also signaled by statements from Roche and other agencies who used the qualifiers of "appears" and "probably" when describing the develop of resistance, because there is no evidence that resistance developed in the patient in Denmark.
A more likely scenario involves the silent spread of oseltamivir resistant H1N1. Denmark, like most countries in Europe, has focused on detection of H1N1 in travelers and contacts. Consequently, the number of H1N1 positive cases has been low. Although countries have been making sequences public shortly have collection of isolates, the number of public pandemic H1N1 sequences from Denmark at Genbank or GISAID remains at one. The NA sequence has been released and it is wild type. However, the isolate was collected from a patient in April, so there are no recent public sequences from Denmark.
Similarly, sequences from other countries are also limited and in many cases the public sequences do not include NA, so even if H274Y was in the isolate, it would not be in the database. The publicity associated with the Danish case will likely lead to more isolates and more sequences, and the explosion of cases in England, may lead to a more serious approach toward testing for community spread in European countries like Denmark, which are focused on airport travelers and contacts.
Airport screening will only detect a small subset of infected patients, because those infected shortly prior to travel will not yet have symptoms and about 30% of infected patients don't develop a high fever. Moreover, others take medication for flu-like symptoms, which lowers fevers. Thus, infected patients have been flying into these countries undetected for months, and community spread is significant, but not reported because of a lack of testing.
The detection of H274Y in pandemic H1N1 has parallels with H274Y in seasonal H1N1. The resistance was widely reported in early 2008 in Norway, but subsequent testing demonstrated that the resistance was widespread in the fall of 2007 and had silently circulated for months prior to detection. The limited number of NA sequence for most countries outside of North America allows for a repeat of silent spread of Tamiflu resistantant pandemic H1N1 at this time.
More detail on the current case and contact who was infected overseas would be useful, as would serious testing and for community spread in countries reporting low levels of infections, which includes most countries in Europe, and rapid release of associated sequences."

"Roche Comments on Tamiflu Resistant H1N1 Raise Concerns
Recombinomics Commentary 16:11
June 29, 2009
http://www.recombinomics.com/News/06290903/H274Y_Swine_Roche.html
While receiving the drug, the patient appeared to develop resistance to it," David Reddy, Roche's pandemic taskforce leader, told reporters on a conference call on the Danish case. "This is the first report we have of it in H1N1."
The Danish patient, who has since recovered, was taking the drug as a prevention to avoid the contraction of swine flu, Reddy said. He was probably already infected with the virus, and resistance to the drug emerged because he was given the lower prevention dose

The above comments in media reports following the Roche conference call raise serious doubts about the claim that the osletamivir (Tamiflu) resistance arose in the Danish female patient because if prophylactic treatment. The patient had been exposed to an H1N1 positive contact outside of Denmark and was given a prophylactic dose of Tamiflu as a precaution. She subsequently developed symptoms and recovered when treated with Relenza.
However, there has been no data presented to show that wild type H1N1 infected the Danish patient or the patient who infected the Danish patient. Moreover, the use of the qualifiers "appear" and "probably" suggests that no such data exists.
Patients have been know to develop resistance in response to treatment. In Vietnam, a contact (sister) of a patient developed resistance at two NA positions (H274Y and N294S), which are two changes known to confer resistance and which were not detected in H5N1 from her brother, supporting development of resistance in response to treatment of his sister.
However, in the Danish case, no such evidence was presented. If resistance was present in the contact that infected the Danish case, the result would have been as described, The prophylactic treatment would have had little effect, and the resistant H1N1 would still have been sensitive to Relenza.
Therefore, the report of Tamiflu resistance (which was probably H274Y) raises concerns that resistance will spread via recombination, as happened fro H274Y in seasonal flu. Initially, the polymorphism was rare. It was first in clade 2C in China, followed by clade 1 in the US and UK, followed by clade 2B. In each sub-clade the polymorphism appeared on multiple genetic backgrounds in the absence of Tamiflu treatment.
The hitch hiking led to an expansion of H274Y, and when it paired up with HA A193T, the subclade expanded and both acquistions became fixed.
The large reservoir of H274Y in seasonal flu provides donor sequences for H274Y acquisition in swine H1N1. The report of resistance in the Danish patient raises concerns that the resistance can rapidly spread under the section pressure of Tamiflu treatment.
Information on the contact location for the Danish patient, as well as sequence data on samples collected before and after treatment would be useful. However, since some media reports suggest she was on prophylactic Tamiflu for five days prior to symptoms, there probably is no isolate collected prior to treatment. However, H1N1 from her contact would be useful, although the existence of such material is doubtful, based on the qualifiers in the Roche statements, as well as the failure to provide any hard data supporting the contention that the resistance developed in response to treatment in Denmark.
Absent such evidence, the resistance is likely to have developed prior to treatment, and represents an evolutionarily fit H1N1.
Sequence data from the patient will help trace this sub-clade to provide additional evidence on the likelihood that the resistance emerged in Denmark, which, at this point, appears to be doubtful."

"Cruise ship with A/H1N1 outbreak onboard arrives in Russia
RIA Novosti
Moscow
29 June 2009
http://en.rian.ru/russia/20090629/155385779.html
A cruise ship with 14 A/H1N1-infected people onboard arrived in Russia's second city of St. Petersburg on Monday, Russia's chief sanitary official Gennady Onishchenko said.
Swine flu was confirmed in 13 crew members and one passenger of the Emerald Princess cruise liner, which sailed from the Finnish capital, Helsinki. The infected have been quarantined in their cabins and are being treated with the anti-viral drug Tamiflu.
"A/H1N1 flu has been confirmed in all quarantined people," Onishchenko said. "Their condition does not require hospitalization."
Other passengers and crew passed medical checks. The ship had 3,243 passengers and 1,201 crew members onboard.
The first case of the highly pathogenic virus, which infected at least 70,893 people worldwide, was confirmed in several crew members on June 18. When the vessel arrived to St. Petersburg, 16 people had already recovered and tested negative for the virus."
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Editor's note: How come the cruise ship came from Finland, there's no confirmed epidemic in Finland (say the officials,...)

"Dane resistant to Tamiflu
Indland
29 une 2009 15.20
http://www.dr.dk/Nyheder/Indland/2009/06/29/151411.htm?rss=true
Det første tilfælde i verden af resistens over for influenzamedicinen Tamiflu hos folk med influenza H1N1 er fundet i Danmark.
Personen er nu rask, og der er ikke påvist yderligere smitte med det resistente virus, oplyser Statens Serum Institut.
Den smittede havde været i tæt kontakt med en anden smittet person, og var derfor i forebyggede behandling med Tamiflu. Alligevel fik personen influenzasymptomer og er i stedet behandlet med en anden type influenzamedicin, Relenza.

Muteret virus i Danmark
Verdens sundhedsorganisationen WHO opfordrer efter det danske tilfælde til mere opmærksomhed på mulighed for udvikling af resistens hos viruset.
Det er ikke usædvanligt, at en influenzavirus muterer spontant, og i en pressemeddelelse kalder Statens Serum Institut det "Velkendt og forventeligt."
De understreger desuden, at det ikke udgør en trussel mod folkesundheden."
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Briefly in English: The first case in the world of resistance to influenza drug Tamiflu (oseltamivir) in people with influenza H1N1 has been found in Denmark. The person had been in close contact with another infected person and was for that reason on prophylactic Tamiflu medication. Despite this the person got influenza symptoms an is on influenza medication of another type, Relenza (zanamivir).
The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

"STM ja THL tiedottavat: Suomessa ensimmäinen maan sisäinen influenssa A(H1N1)-tartunta
STM ja THL
29.6.2009
http://www.thl.fi/fi_FI/web/fi/tiedote?id=14473
Suomessa varmistui viikonlopun aikana yhdeksän uutta influenssa A(H1N1)-tartuntaa. Lähes kaikki tartunnan saaneet olivat Yhdysvalloista palanneita matkailijoita. Lisäksi yksi henkilö on Suomessa saanut tartunnan Yhdysvalloista palanneelta sairastuneelta lähiomaiseltaan. Tartunnan saaneet voivat hyvin ja ovat kotihoidossa.
Suomessa nyt varmistettu maan sisäinen tartunta ei ole yllättävä, koska kyseessä on lähikontakti epidemia-alueelta palanneeseen oireiseen potilaaseen. Pidempiä tartuntaketjuja tai yhteisötartuntoja ei ole Suomessa todettu. Niiden estämiseksi jatketaan entisenkaltaisia torjuntatoimia tunnistamalla ulkomailta tuodut influenssatapaukset sekä paikalliset hengitystieinfektioiden ryppäät.
Maan sisäinen tartunta todettiin Helsingin ja Uudenmaan sairaanhoitopiirissä HUS:ssa. Sairaanhoitopiirissä todettiin kaiken kaikkiaan kahdeksan uutta influenssa A(H1N1)-tapausta viikonlopun aikana.
Oulussa tartunta varmistui yhdeltä puolisonsa kanssa niinikään USA:ssa käyneeltä matkailijalta. Matkakumppani saattoi sairastaa taudin jo matkan aikana. Terveyden ja hyvinvoinnin laitos (THL) ottaa tartunnan saaneiden kanssa samoilla lennoilla olleisiin entiseen tapaan yhteyttä. Oulun pariskunta matkusti 27.6. myös junalla (Pendolino 845, Vaunu 4, paikat 67 ja 68, lähtö klo 16).
Suomessa on nyt influenssa A(H1N1)-tartunnan saaneita varmistettu kaikkiaan 36.
Meksikosta, Yhdysvalloista, Kanadasta, Etelä- ja Väli-Amerikasta (erityisesti Argentiina ja Chile), Australiasta, Uudesta-Seelannista sekä Hongkongista, Thaimaasta ja Filippiineiltä palaavia matkustajia kehotetaan edelleen tarkkailemaan terveyttään matkan jälkeen noin viikon ajan ja tarvittaessa ottamaan yhteyttä puhelimitse terveyskeskukseen."
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Briefly in English: First confirmed human-to-human H1N1 infection found in Finland

"US passes million swine flu cases
BBC News
Page last updated at 11:15 GMT, Saturday, 27 June 2009 12:15 UK
http://news.bbc.co.uk/2/hi/americas/8122262.stm
US health officials estimate that at least one million Americans have been infected with swine flu since the H1N1 virus emerged nearly three months ago.
The number is far higher than cases actually reported to the authorities.
The Centers for Disease Control and Prevention (CDC) said many cases were mild, although 127 people had died.
The CDC based its figures on surveys, rather than laboratory evidence, but the numbers suggest the death rate from swine flu is lower than thought.
'We're saying that there have been at least a million cases of the new H1N1 virus so far this year in the United States,' said Anne Schuchat of the CDC.
'Reported cases are really just the tip of the iceberg.'
The CDC has based its estimate on mathematical modelling, based on surveys by health officials.
If the figures are correct, it is reassuring news, because it indicates that the fatality rate from swine flu is even lower than thought, says BBC medical correspondent Fergus Walsh.
However, Dr Schuchat warned that swine flu might exhibit higher infection rates than seasonal flu and could return in a more virulent form in the autumn.

Argentina election
According to the CDC, there have been 27,717 confirmed or probable cases; some 3,000 people have needed hospital treatment and there have been 127 deaths.
Swine flu continues to affect mainly people under 50 years of age, with many of those worst affected having underlying health problems such as asthma or diabetes. The average age of those who died in the US is 37.
Officials from the CDC and the World Health Organization are watching outbreaks in the southern hemisphere, in particular in Argentina, Chile and Australia, to see how the H1N1 virus has been spreading during the winter months and whether it is likely to become more virulent.
Argentina's health ministry has registered 26 deaths attributed to swine flu, and 1,587 cases. Officials are advising people to try to leave space between each other as they line up to vote in legislative elections on Sunday.
Chilean health authorities say there have been 6,211 cases and 12 deaths.
In Australia, there have been five swine-flu related deaths, all of patients with existing medical conditions, and 3,677 cases, according to official figures.
The H1N1 virus first emerged in April in Mexico, which has recorded 116 deaths and 8,279 cases, according to the WHO.
On 11 June, the WHO declared a global flu pandemic, meaning that swine flu virus was spreading in at least two regions of the world.
Officials stressed that this did not mean the virus was causing more severe illness or more deaths.
According to the latest figures from the WHO, there have been 263 deaths and nearly 60,000 cases in some 100 countries and territories. "
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Editor's note: If the mathematical modelling of CDC is accurate, in Finland there should be well over 800 swine flu cases.

"Soaring Death Rate in Buenos Aires Raises Pandemic Concerns
Recombinomics Commentary 18:03
June 27, 2009
http://www.recombinomics.com/News/06270901/H1N1_Buenos_Aires.html
"We're seeing the placement of young patients, between 15 and 50 years with pneumonia, some rapidly evolving towards a gravity which for many is unusual, in which the lung is' fire 'in a matter of hours," said Dr. Jorge San Juan, head of the Department of Intensive Care Hospital Muñiz.
This has led to patients with these characteristics begin to be treated in an increasingly aggressive. THE NATION As reported yesterday, doctors from the Ministry of Health received the directive to take, from now on, all cases of influenza and potential influenza A (H1N1), with the recommendation to perform chest radiographs for patients with symptoms of fever and fatigue and internal quickly to all suffering from pneumonia.
"The bodies were viscera, meninges and brain swollen, a little common factor in death from influenza. Additionally, the lungs were in bad shape, with some spots we could not identify. The studies sent pathology, "said the coroner who asked not to publicize his name until the health authorities take note of it found.

The above translation describes patients in and around Buenos Aires (see updated map). In the past few days 26 confirmed fatalities have been reported as well as 15 additional probable fatalities. H1N1 infections of swine on a nearby farm (see map) has also been described in an OIE report.
The targeted population, as well as the description of the rapid deterioration sounds remarkable like reports on the 1918 pandemic.
Sequence data on these patients and swine would be useful. It is the beginning of flu season in Argentina, and the potential for the evolution of a more virulent Pandemic H1N1 looms large."

"Medical Emergency in Buenos Aires Raises Pandemic Concerns
Recombinomics Commentary 23:43
June 27, 2009
http://www.recombinomics.com/News/06270902/H1N1_Buenos_Aires_Emergency.html
Some hospitals began to strengthen measures, including the case of Posadas Hospital, one of the largest hospitals in the province of Buenos Aires that concentrates a large number of internees from the flu. Through a press release, the hospital reported that it declared a state of emergency by the Institution that "all staff will be available to the agency needs to be addressed" after the epidemic of influenza A.
In addition, the Posadas created through Resolution No. 640/09 an Internal Crisis Committee itself, with the aim of ensuring compliance and monitoring of the actions that the hospital must develop to deal with the situation posed by an outbreak of Influenza A .
Meanwhile, health authorities in Buenos Aires and Buenos Aires have some alternatives to strengthen the system, including the use of military hospital in Campo de Mayo, the release of bed in the hospital's intensive care Malvinas Argentinas, the installation of sanitary units in campaign Buenos Aires and mobile primary care close to railway stations and Eleven Constitution.

The above translation describes the declaration of a medical emergency in Buenos Aires. The Ministry of Health website lists 15 confirmed fatalities, 180 confirmed cases, and 559 suspect cases as of Friday (see Buenos Aires map), but media reports suggest the actual number of cases is higher. Recent reports out of Argentina also described the rapid decline of relative young patients (15-50), with descriptions similar to those used to describe dying patients in 1918. In addition, there has been an outbreak of H1N1 at a pig farm northwest of Buenos Aires (see map).
The sudden jump in cases and fatalities are cause for concern. In the country the number of confirmed fatal cases rose to 27, but there are reports of 15 more fatalities that are suspect. There have also been reports of travelers from Argentina testing positive at airport checks in multiple countries. These travelers should provide multiple samples for sequencing studies to determine if there have been changes in the virus.
Recently PB2 E627K was reported in a traveler from the United States. However, the sequence suggested the change was acquired in China. Although the E627K was present in the original samples and confirmed in the initial clone, and subsequent sub-clone had reverted back to the wild type sequence, raising concerns that some key changes may not be stable under certain culture conditions, and important changes could be lost especially if the virus is cultured in chicken eggs, which could select against important changes associated with adaptation to human hosts.
Therefore, analysis by multiple labs of these sequences would be useful. The flu season is just beginning in the southern hemisphere, providing a favorable environment for rapid adaptive changes. The movement of a swine H1N1 into a human host parallels the 1918 pandemic, which also was associated with mild infections in the later spring, followed by a much more virulent and lethal H1N1 in the fall.
The rapid developments in Buenos Aires bear close scrutiny and active sequence analysis as H1N1 increases its gene pool transmitting through human hosts. Many countries worldwide, including those in the southern hemisphere are experiencing explosive growth, and the developments in Buenos Aires may signal a new wave of Pandemic H1N1."

"WHO: Sikainfluenssavirus ei näytä muuntuvan
25.6.2009 22:50
STT–REUTERS
Moskova. Sikainfluenssavirus on vakaa, eikä se näytä risteytyvän lintuinfluenssan tai muiden influenssavirusten kanssa, kertoi maailman terveysjärjestö WHO torstaina.
WHO:n johtaja Margaret Chan sanoi torstaina Moskovassa, että H1N1-virus on yhä erittäin vakaa.
Chan kuitenkin korosti, että influenssavirukset ovat luonteeltaan hyvin arvaamattomia ja mutaatioalttiita. Sikainfluenssan on pelätty risteytyvän erityisesti lintuinfluenssan kanssa nykyistä vaarallisemmaksi.
Chanin mukaan tutkijat ovat seuranneet viruksen käytöstä ympäri maailmaa. Tällä hetkellä WHO keskittyy varmistamaan, ettei H1N1 muutu eteläisen pallonpuoliskon maissa, joissa kiertää tavallinen kausi-influenssa.
Maailman terveysjärjestö WHO on julistanut sikainfluenssan pandemiaksi eli maailmanlaajuiseksi kulkutaudiksi. Tartunnan on saanut järjestön tilastojen mukaan lähes 56 000 ihmistä, joista 238 on kuollut."
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Editor's note: Jos sikainfluenssavirus on vakaa eikä muunnu, miten se ylipäänsä ilmaantui? Kolmen eri lajin virusten rekombinantti.

"Sikainfluenssatartunnat levinneet potilaista lääkäreihin ja hoitajiin
Mari Heikkilä
MediUutiset
klo 10:57 Wednesday 24 June 2009
http://www.mediuutiset.fi/uutisarkisto/article303172.ece?s=u&wtm=medi-24062009
Yhdysvaltain tartuntatautiviranomaisjärjestö CDC on huolissaan sikainfluenssan leviämisestä terveydenhuoltohenkilöstön parissa. Osa laiminlyö oman suojautumisensa.
Järjestö patistaa potilaiden kanssa työskenteleviä käyttämään hengitystieinfektioiden rutiinisuojautumiskeinojen lisäksi hyvin sopivia N95-hengityssuojaimia ja silmäsuojaimia sekä tekemään aerosoleja synnyttävät tutkimukset alipaineistetussa eristyshuoneessa.
Sikainfluenssa siirtyi Yhdysvalloissa toukokuun 12. päivään mennessä 48 terveydenhuoltohenkilöstöön kuuluvalle. Näistä kaksi sai sairaalahoitoa, mutta kukaan ei kuollut.
Tarkemmin analysoiduissa 26 tapauksen joukossa oli 4 lääkäriä, 9 hoitohenkilökuntaan kuuluvaa ja 12 muuta terveydenhuollossa toimivaa. Näistä puolet (13) oli hyvin todennäköisesti saanut tartunnan työpaikallaan sikainfluenssapotilaalta. Yksi tartunta lienee siirtynyt terveydenhuoltohenkilöltä toiselle. Sairastuneista kuusi kertoi olleensa sairastuneen läheisensä kanssa tekemisessä ja neljä matkustaneensa Meksikoon.
Suojautuminen jää puolitiehen
Työpaikallaan todennäköiseseti tartunnan saaneet eivät olleet suojautuneet aina sikainfluenssapotilaiden kanssa työskennellessään viranomaissuositusten mukaisesti.
Vain kolme kertoi käyttäneensä hengityssuojainta. Viisi kertoi käyttäneensä hanskoja. Silmäsuojaimia ei käyttänyt kukaan. Hanskoja, pukua ja hengityssuojaimia ei kukaan käyttänyt aina.
Yksi lääkäreistä, joka oli luultavasti saanut tartunnan potilaalta, kertoi aina käyttäneensä N95-hengityssuojainta. Hengityssuojaimen sopivuutta ei kuitenkaan oltu koskaan testattu eikä ole tiedossa, käyttikö kyseinen lääkäri myös pukua ja silmäsuojaimia.
Viime talven kausi-influenssarokotus ei estänyt tartuntoja. Rokotuksen viime syyskuun jälkeen oli saanut kahdeksan kuudestatoista sairastuneesta.
Tartunnat leviävät avohoidossa
Toukokuun loppuun mennessä vain 653 (6 prosenttia) 10 053 Yhdysvaltain sikainfluenssapotilaasta oli saanut sairaalahoitoa. CDC muistuttaakin, että terveydenhuollon henkilökunta on suuressa vaarassa saada tartunnan avohoidossa olevilta potilailta. Myös avohoidossa työskentelevien tulee noudattaa suojautumisohjeita.
Raportissa puolet mahdollisesti potilaalta tartunnan saaneista kertoi työskennelleensä avohoidossa ennen oireiden ilmenemistä."

"Pandemic H1N1 Cluster in Buffalo New York Raises Concerns
Recombinomics Commentary 12:44
June 22, 2009
Davis was an eighth grader at Harvey Austin School 97 on Sycamore Street.
News 4 talked to the 15-year-old's mother Lucretia Belton. Matthew attended Harvey Austin School 97.
His mother said complications from swine flu included pneumonia and MRSA.
She said his kidneys were failing, and he was being kept alive by machines.
A nine-year-old girl is also at Women and Children's Hospital with the H1N1 virus.
She's a fourth grader at Charles Drew Science Magnet School 59's museum campus.

The above comments describe two students of magnet schools in Buffalo, NY that are a mile apart (see updated map). Both students were on life support yesterday, and the middle school student (15) died after life support was withdrawn. The elementary school student (9F) remains on life support. The clustering of two critically ill students raises concerns about the emergence of a more lethal strain of Pandemic H1N1.
The two serious cases may simply reflect the high level of H1N1 infections in the area. 37 Buffalo area zip codes have registered at least one confirmed H1N1 case (see map and list below). Moreover adjacent Niagara County announced clusters of cases in two elementary schools, and clusters were also described for Hamilton Ontario, just across the border from Buffalo and Niagara county (see map). Moreover, H1N1 has been widespread in the Halton area, where infections have been confirmed in more than 30 schools in Oakville.
However, the state agency and media reports do not describe any pre-existing conditions for either student and these two cases follow two announcements by the city of New York of 14 deaths in May. Seven were announced on Tuesday, and seven more were announce on Friday, but these announcements lacked detail. All had died in May and all were between the ages of 25-64. However, there was no additional information and no mention of pre-existing conditions.
The significance of the failure to mention pre-existing remains unclear. Many of the prior death were said to have pre-existing conditions, but there was little evidence pointing to a strong role of these conditions in the deaths. In Mexico, most of the fatalities were in young adults who did not have pre-existing conditions. Although reports of US cases have stated that 70% of fatalities had pre-existing conditions, it remains unclear if such figures include the 14 cases announced by NYC or other cases that have been confirmed but not announced.
Recent comments in press conferences by WHO and the CDC have added to the uncertainty. At the WHO press release introductory remarks by Kieji Fukuda cited 249 deaths worldwide, which raised questions, since the official tally at the time was only 140 deaths. Last week at the CDC press conference, opening remarks by Dan Jerrnigan indicated that 40% of the fatal cases had pre-existing conditions, which was much lower than the 70% cited for the released cases. In both instances the press conference transcript was edited to reflect the numbers for the released cases. However, the delay in the acknowledgement of the cases in New York raises concerns that the higher number of fatal cases and the lower percentage of cases with pre-existing condition reflects the current number of confirmed cases, which includes a high percentage of fatal cases without pre-existing conditions.
The clustering of the critical cases in Buffalo raises concerns of a Pandemic strain that is evolving and becoming more lethal. The 2009 Pandemic is tracking with the 1918 Pandemic, which produce mild disease in the spring, and was more lethal in the fall when previously healthy young adults.
One such change that could increase lethality is PB2 E627K. This polymorphism is present in seasonal influenza A, including the 1918 pandemic strain. It allows for optimal replication at lower temperatures, which may lead to a more transmissible and lethal Pandemic strain. This change has been reported for an isolate from Shanghai from a patient (22F) who recovered. The collection date, location, age and gender, suggests that the isolate came from a Chinese national who was a student in the US and flew to Shanghai on a flight that originated in New York with a lay-over in Hong Kong. Thus, the virus could have originated in New York, Hong Kong, or Shanghai, since the student developed symptoms shortly after arriving in Shanghai. The sequencers in China promptly released full sequences on all eight gene segments, and sequenced a clone to confirm that the E627K was not a sequencing error. The sequence of the clone exactly matched the original sequence.
However, this change may not offer much advantage at this time of the year in the northern hemisphere, but the change could appear in the southern hemisphere or could signal a change that is more widespread and circulating in the Hong Kong area. In any event, the presence of E627K in pandemic H1N1 strongly suggests that it will emerge in the fall, which is cause for concern.
The Buffalo cluster however raises concerns of additional changes, so sequencing of the isolate from the fatally infected middle school student would be useful.

Buffalo Area Zip Codes with at least 1 confirmed H1N1 case
14031; 14032; 14043; 14051; 14059; 14068; 14072; 14075; 14086; 14127; 14150; 14201; 14203; 14204; 14206; 14207; 14208; 14209; 14210; 14211; 14212; 14213; 14214; 14215; 14216; 14217; 14218; 14219; 14220; 14221; 14222; 14223; 14224; 14225; 14226; 14227; 14228"

H1N1 flu (Swine flu) linked to French fries sold in fast food restaurants
examiner.com
21 June 2009, 7:38 AM
http://www.examiner.com/x-672-Disease-Prevention-Examiner~y2009m6d21-H1N1-flu-linked-to-French-fries-sold-in-fast-food-restaurants
Russian researchers have made a link between the H1N1 flu and the French fries that are sold in our fast food restaurants. The link sounds a bit far-fetched, but worth investigating. The world of gentically modified foods is extremely secretive and evil in many ways because it undermines our health.
The Russian report states, "Scientists from Russia’s Ministry of Health are warning in a secret report to Prime Minister Putin that they have discovered a ‘critical link’ between the H1N1 influenza (Swine Flu) virus and genetically modified amylopectin potatoes that are consumed in massive quantities nearly exclusively by Westerners and sold in fast food restaurants as French Fries."
According to the report, the protease enzyme (the enzyme that begins the digestion of proteins) of the potatoes in question has been altered to make them more hardy and less vulnerable to the Potato virus X, a dangerous plant disease that can cause devastating losses of potato crops. This genetic change causes an “explosive” replication of the H1N1 influenza virus."
This proposed link between the H1N1virus and French fries would explain why a vast number of cases of H1N1 are common to the young. A US News and World Report states that "Of the 5,000 confirmed and more than 100,000 probable cases of swine flu, the average age of infected people is 15; two thirds are younger than 18." The youngest are, by far, the largest consumers of fast food.
In addition, the countries that are reporting large numbers of H1N1 cases are those countries that grow these genetically modified potatoes: the US, Australia, Canada, United Kingdom, and Chile, a country that grows large quantities of potatoes for the US. Large countries that do not allow planting of genetically modified potatoes, such as Russia, China, and India, report few H1N1 case, 3, 318, and 16, respectively."
**************
Editor's note: Quite a thought!

"H1N1-virus leviää rivakammin kuin kausi-influenssa
Etelä-Suomen Sanomat / STT
http://www.ess.fi/?article=236179
11 May 2009 klo 21:43 (Päivitetty klo 22:04)
Meksikosta maailmalle kulkenut sikainfluenssa näyttää tarttuvan helpommin kuin kausi-influenssa, arvioi Maailman terveysjärjestön WHO:n tutkijaryhmä.
Meksikon tartuntoja selvittänyt ryhmä laski, että ärhäkimmillään virus tarttuu ihmisestä toiseen 73 kertaa. Tarttuvuus on siten paljon korkeampi kuin kausi-influenssalla, ryhmä raportoi Science-lehdessä tänään. Kausi-influenssaan menehtyy vuosittain 250 000-500 000 potilasta.
Ryhmä arvioi jopa 23 000 meksikolaiseen sairastuneen H1N1-viruksen aiheuttamaan infektioon helmikuun puolivälin jälkeen. Tutkimus vahvisti otaksumaa siitä, että tartunnan lähde olisi pieni La Glorian kylä Veracruzissa Etelä-Meksikossa. Kylän lähistöllä on miljoonan elikon jättisikala.
Uusi H1N1-virus saattaisi aiheuttaa WHO:n ryhmän arvion mukaan osapuilleen yhtä ankaran infektion kuin vuonna 1957 kaksi miljoonaa ihmistä tappanut influenssa. Uusi influenssa ei ole yhtä ankara kuin ensimmäinen tiedetty H1N1-viruksen aiheuttama influenssa, vuonna 1918 puhjennut tuhoisa espanjantauti."

"25:s sikainfluenssatapaus varmistui
YLE Uutiset
julkaistu tänään klo 17:30, päivitetty tänään klo 17:35
http://yle.fi/uutiset/kotimaa/2009/06/25s_sikainfluenssatapaus_varmistui_817089.html
Suomessa on varmistunut 25:s sikainfluenssatapaus. Uusin tautiin sairastunut on nuori, Oulusta kotoisin olevan mies. Myös hän oli tullut vastikään Yhdysvalloista.
Kaikki Suomessa tähän mennessä sikainfluenssaan eli H1N1-tautiin sairastuneista ovat olleet matkailijoita. Uusia tapauksia on todettu erityisesti Yhdysvalloissa matkanneiden piiristä.
Tartuntojen määrä on viime päivinä vastannut jo likipitäen sitä, että keskimäärin jokaisella Yhdysvaltain-lennolla tulee yksi taudin saanut Suomeen.
Terveyden ja hyvinvoinnin laitoksen tutkimusprofessori Ilkka Julkusen mukaan tartuntariski Yhdysvalloissa vaikuttaakin olevan nyt melkoisen korkea.
- Suomessa tauti ei ole tarttunut ihmisestä toiseen, tutkimusprofessori Ilkka Juntunen kertoo.
Kaikkiaan Suomessa on nyt tutkittu noin parisataa sikainfluenssaepäilyä, joista siis noin kymmenesosa on osoittautunut positiiviseksi.
THL kehottaa Meksikosta, Yhdysvalloista, Kanadasta, Australiasta ja Etelä-Amerikasta palaavia matkailijoita tarkkailemaan terveyttään viikon ajan matkan jälkeen ja tarvittaessa soittamaan terveyskeskukseen.
Lisääntyneistä tautitapauksista huolimatta Suomen lentokentillä ei ole päätetty lisätoimista taudin leviämisen estämiseksi.
Maailman terveysjärjestö WHO arvioi, että maailmalla varmistuneiden sikainfluenssatapausten määrä on jo yli 44 000."
********************
Miten ihmeessä Suomessa olisi voinut löytyä ihmisestä toiseen tapahtuneita tautitapauksia, kun Suomessa viranomaiset eivät suostu testaamaan muita kuin suoraan tietyistä endeemisen taudin maista tulleita ja niitä, jotka ovat olleet suorassa useiden tuntien kontaktissa sellaisten endeemisiltä alueilta palanneiden kanssa, jotka ovat sairastuneet laboratoriovarmennettuun tautiin? Tietenkään, tietenkään Suomessa ei ole löytynyt ihmisestä toiseen tarttunutta tautia.

"Authorities baffled how man from isolated community contracted swine flu
The West Australian
20th June 2009, 15:30 WST
http://www.thewest.com.au/default.aspx?MenuID=77&ContentID=149391
Health authorities are trying to establish how a 26-year-old WA man from the most remote Indigenous community in the world contracted swine flu to become the first person in Australia to die with the virus.
The man from the isolated community of Kiwirrkurra, in the Gibson Desert, died in the Royal Adelaide Hospital late yesterday.
He was just 26 and suffering existing health conditions.
Kiwirrkurra is home to around 300 people and lies 1200 km east of Port Hedland and 700km west of Alice Springs.
It is understood members of the community have been told not to leave the area because of the potential danger of spreading the virus.
It has yet to be established if the man actually died of swine flu but it has been confirmed that he had the virus.
The man had been sick for three weeks and had been in a critical condition since Monday after being transferred to Royal Adelaide Hospital from Alice Springs."

Canada(MB): Swine flu patients in ICU tough to manage, 'just really, really sick': doctors
Helen Branswell Medical Reporter
THE CANADIAN PRESS
18/06/2009 9:29 PM
http://www.winnipegfreepress.com/breakingnews/Swine-flu-patients-in-ICU-tough-to-manage_-_just-really_-really-sick__-doctors.html
In a typical flu season, the Winnipeg hospitals where Dr. Anand Kumar works might see one, maybe two life-threatening cases of viral pneumonia caused by influenza.
So seeing 10, 15 and more flu patients in those same hospitals' intensive care beds in June is still a shock, suggests Kumar, a critical care specialist who works at three different hospitals in the city.
"You just don't see this many of them," Anand says of the patients, struggling to survive swine flu infections.
"You don't see rows and rows of patients on ventilators because they have respiratory failure, a viral pneumonia kind of thing. It's unusual."
At last count, Manitoba hospitals had 30 respiratory distress patients in the ICU, some confirmed swine flu cases, others for whom tests are still pending---"
---"People who end up getting admitted to hospital are generally presenting with shortness of breath. And by the time they get to the ICU, swine flu patients - most much younger than your average hospitalized flu patient - are gravely ill from a viral assault on their lungs.
"They're getting very bad, bad respiratory failure," says Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency---"
---"In addition to trying to keep these patients alive, clinicians like Anand and Dean are gathering data. The case studies they are writing, and which will shortly be competing for space in medical journals, will help doctors who haven't yet see severe swine flu cases know how to handle them when they do.
Likewise, autopsies that have been performed on a number of people who died of their infections will help scientists figure out what the virus does in the body, information physicians may be able to mine for clues on how to improve a severely ill person's chances of survival---"
---"He says the emerging evidence - confirmed by Anand's and Dean's observations - is that at least a portion of the sickest of the sick are suffering from an aggressive viral pneumonia---"
************
Editor's note:
Hospitals and clinics are not testing any mild cases so it is impossible to know how many are actually infected in the population as a whole. Only the worst cases are being tested and compiled in statistics.
What we can easily see is that there are many more serious cases period than in the 'regular' flu season.

"Vuorokauden sisällä varmistui viisi uutta H1N1-tartuntaa Suomessa
julkaistu 19 June 2009 klo 14:51, päivitetty 19 June 2009 klo 17:43
YLE Uutiset
http://yle.fi/uutiset/kotimaa/2009/06/vuorokauden_sisalla_varmistui_viisi_uutta_h1n1-tartuntaa_suomessa_816146.html
Suomessa on hoidettu nyt yhteensä 18:aa sikainfluenssapotilasta. Torstai-illasta alkaen on varmistettu viisi uutta tapausta Turussa, Kuopiossa, Pohjois-Karjalassa ja pääkaupunkiseudulla.
Kolme heistä oli vastikään palannut Yhdysvalloista, yksi Meksikosta ja yksi Hongkongista, kertoo THL:n tutkimusprofessori Ilkka Julkunen. Kaikki uudet potilaat ovat hyväkuntoisia, eivätkä he sairasta influenssan vakavaa muotoa.
Suomessa sikainfluenssaan sairastuneet ovat olleet matkailijoita. THL kehottaa Meksikosta, Yhdysvalloista, Kanadasta, Australiasta ja Chilestä palaavia matkailijoita tarkkailemaan terveyttään viikon ajan matkan jälkeen ja tarvittaessa soittamaan terveyskeskukseen."
*************
Editor's comment: It is a reat shame that the officials in Finland do not test for novel H1N1 unless the patient has ILI fever over 38 C AND a laboratory confirmed contact with novel H1N1 patient that stayed in endemic countries.

"Kuopiossa varmistui sikainfluenssatartunta
19.6.2009 14:27
STT
http://www.hs.fi/kotimaa/artikkeli/Kuopiossa+varmistui+sikainfluenssatartunta/1135247045963
Savon Sanomat kertoi perjantaina nettisivuillaan, että Kuopion yliopistollisessa sairaalassa on varmistunut sikainfluenssatartunta. Tartunnan saanut nuori mies hakeutui hoitoon keskiviikkona. Positiivinen testitulos varmistui torstai-iltana.
Mies matkusti Torontosta Lontoon kautta Helsinkiin ja edelleen Kuopioon alkuviikosta, Savon Sanomat kertoo. Tapaus on jo 14. sikainfluenssatartunta Suomessa, mutta ensimmäinen Pohjois-Savon sairaanhoitopiirissä. Kuopion yliopistollinen sairaala oli kuitenkin osannut varautua tartuntaan.
Savon Sanomien haastatteleman infektiolääkärin mukaan potilaan kanssa samalla lennolla olleet eivät ole tartuntavaarassa, sillä potilas oli lentojen aikana oireeton. Mies on tällä hetkellä kotikaranteenissa. Hänen oireensa ovat lievät, joten hän toipuu hyvää vauhtia.
Sairaalasta ei perjantaina haluttu vahvistaa tietoa STT:lle."

"Suomessa varmistui 13. influenssa A(H1N1) -tapaus
Thursday 18.6.2009
THL
http://www.thl.fi/fi_FI/web/fi/uutinen?id=14289
Suomen 13. influenssa A(H1N1) -tapaus varmistui keskiviikko-iltana 17.6. Etelä-Pohjanmaan sairaanhoitopiirissä.
Tartunnan saanut nainen oli palannut Helsinkiin maanantaina 15.6. lennolla AY 006 New Yorkista Yhdysvalloista. Potilas toipuu jo kotonaan ja voi hyvin. Perheenjäsenet ovat saaneet suojalääkityksen.
Kaikki Suomessa tähän saakka influenssa A(H1N1) -tartunnan saaneet ovat olleet matkailijoita. Viime viikon tartunnoista viisi oli saatu New Yorkin matkalla.
Meksikosta, Yhdysvalloista, Kanadasta, Australiasta ja Chilestä palaavia matkustajia kehotetaan edelleen tarkkailemaan terveyttään matkan jälkeen noin viikon ajan ja tarvittaessa ottamaan yhteyttä puhelimitse terveyskeskukseen.
Näytteitä mahdollisista epäilyistä on tutkittu yhteensä 180.
Lisätietoja:
Tutkimusprofessori Ilkka Julkunen, THL, puh. 020 610 8372 (virustutkimukset, immuunivaste ja rokotukset)
Tartuntatautilääkäri Antti Alitalo, THL, puh. 020 610 8557 (tapausten seuranta)"
*************

Briefly in English: 13th novel H1N1 case found in Finland. The case was a woman that came on flight AY 006 back to Finland from New York last Monday 15 May 2009. The patent is in home quarantine and her condition is getting better now. The family members have been receiving the protection medication.

"Suomen yhdestoista sikainfluenssa varmistui
16.06.2009 23:08
http://www.verkkouutiset.fi/index.php?option=com_content&view=article&id=6094:suomen-yhdestoista-sikainfluenssa-varmistui&catid=2:kotimaa&Itemid=4

Yhdysvalloista Chigagosta lauantaina palanneella keski-ikäisellä miehellä on varmistunut influenssa H1N1-influenssatartunta.
Mies sairastuit lentomatkan aikana ja hän on saanut influenssalääkityksen Suomeen palattuaan. Sairastuneen miehen oireet ovat olleet lieviä, ja hän on hyväkuntoisena kotihoidossa.
Miehen lähipiiri ja matkakumppanit ovat saaneet tartunnasta tiedon ja ennaltaehkäisevän lääkehoidon. Samalla lennolla olleita pyritään informoimaan tartunnan mahdollisuudesta.
Kyseessä on yhdestoista varmistettu uuden influenssan eli sikainfluenssan aiheuttama tartunta Suomessa.
Asiasta kertoi Helsingin ja Uudenmaan sairaanhoitopiiri HUS tiistaina."

"Finland confirms 11th A/H1N1 flu case
Xinhua
Helsinki
16 June 2009
http://news.xinhuanet.com/english/2009-06/16/content_11552328.htm
Finland has confirmed the eleventh case of A/H1N1 flu, local media reported Tuesday.
The patient, a middle-aged man, returned to Finland from Chicago, the United States on Sunday.
Typical A/H1N1 flu symptoms have showed up during his trip. The patient is now in good condition and quarantined at home."

"Sikainfluenssarokote valmistui
AP, DPA, Reuters
julkaistu 12 June 2009 klo 11:00, päivitetty 13 June 2009 klo 08:52
http://yle.fi/uutiset/ulkomaat/2009/06/sikainfluenssarokote_valmistui_800618.html
Sveitsiläinen lääkeyhtiö Novartis on ilmoittanut, että se on testannut onnistuneesti ensimmäisen erän rokotteita, jotka on tarkoitettu H1N1-influenssan hoitoon. Yhtiön mukaan ensimmäinen erä valmistui viikkoja aikaisemmin kuin ennakolta oletettiin.
Novartis antoi ilmoituksensa vain päivä sen jälkeen, kun kansainvälinen terveysjärjestö WHO oli julistanut sikainfluenssan pandemiaksi.
Novartiksen mukaan rokotteen ensimmäinen tuotantoerä siirtyy jatkotestaukseen ja arviointiin. Yhtiö aloittaa rokotteen kliiniset testaukset heinäkuussa.
Lääkeyhtiöt Novartis, Sanofi-Aventis, GlaxoSmithKline ja Solvay käyvät kovaa kisaa siitä, kuka onnistuu ensimmäinä tuomaan markkinoille toimivan rokotteen. Yhtiöt yrittävät saada rokotteet markkinoille ennen syksyä, jolloin flunssakausi alkaa pohjoisella pallonpuoliskolla.
WHO:n on arvioinut, että ensimmäiset rokotteet tullevat myyntiin vasta syksyllä. Maailman suurin flunssarokotteiden valmistaja Sanofi-Aventis on arvioinut, että ensimmäisen myyntierän valmistumiseen mennee ainakin neljä kuukautta.
Novartiksen mukaan yli 30 maan hallitukset ovat pyytäneet yhtiötä toimittamaan niille rokotteita. Esimerkiksi Yhdysvaltain terveysvirasto on tehnyt tilauksensa jo toukokuussa. Tilauksen arvo on noin 289 miljoonaa dollaria."

"Kaksi kouluikäistä sairastui sikainfluenssaan
YLE Uutiset
julkaistu 14 June 2009 klo 14:27, päivitetty 14 June 2009 klo 19:13
http://yle.fi/uutiset/ulkomaat/2009/06/sikainfluenssarokote_valmistui_800618.html
HUS:n tiedotuspäällikkö Riitta Lehtonen vahvistaa, että Suomessa on todettu kaksi uutta A(H1N1)-tapausta. Potilaat ovat kouluikäisiä lapsia, joiden oireet ovat lieviä. Perhe palasi Yhdysvalloista viime perjantaina.
Suomessa on nyt varmistettu seitsemän ns. sikainfluenssatapausta. Tiedotuspäällikkö Lehtonen korostaa, että kaikki tapaukset ovat lieviä. Uusimmatkin potilaat ohjattiin Jorvin sairaalasta nopeasti kotihoitoon."

Secretary of HHS Sebelius declaring the USA response to H1N1 pandemic.
June 11, 2009http://www.blogger.com/img/blank.gif
http://www.cdc.gov/h1n1flu/webcast061109.htm

"Current phase of alert in the WHO global influenza preparedness plan
11 June 2009
http://www.who.int/csr/disease/avian_influenza/phase/en/
In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.
The current WHO phase of pandemic alert is 6. ---"
**********
Editor's note: One of the steps of history has been taken today, 11 June 2009.

"WHO declares swine flu pandemic
CNN
11 June 2009
http://edition.cnn.com/2009/HEALTH/06/11/swine.flu.who/index.html
The World Health Organization raised the swine flu alert Thursday to its highest level, saying H1N1 has spread to enough countries to be considered a global pandemic.
Increasing the alert to Level 6 does not mean that the disease is deadlier or more dangerous than before, just that it has spread to more countries, the WHO said.
As of Wednesday evening, the virus had spread to 72 countries, the health agency said. There were 25,288 confirmed cases and 139 deaths. The United States had 13,217 cases and 27 deaths, the Centers for Disease Control and Prevention said Friday.
Also Thursday, authorities in Hong Kong ordered the closure of all elementary schools, kindergartens and day care centers in the city after 12 students were found to be infected with the virus.
Authorities have not determined the source of the infection, said Hong Kong's Chief Executive Donald Tsang. This makes it the first cluster of swine flu cases in the city without a link to someone who had traveled overseas.
The number of cases continues to grow in Britain, Japan and Australia -- all of them outside the Americas, where the virus was first detected in April.
Thursday's declaration of a pandemic by the WHO made this the first flu pandemic in 41 years.
In Hong Kong, the schools and day care centers were told to close for 14 days as investigators tried to identify the source of the infection, said Tsang, the chief executive.
The health department will decide after two weeks whether or not to continue the shutdown.
A month ago, Hong Kong quarantined about 300 hotel guests for a week after the first case of the virus was confirmed there.
Hong Kong's abundance of caution stems from the government's unwillingness to see a repeat of the SARS epidemic in 2004, which killed nearly 300 people.
Also on Thursday, Israel's health ministry announced that the number of people diagnosed with swine flu there was 68.
Health officials have begun using the virus' clinical name -- H1N1 -- to reflect that it's actually a combination of several different types of flu and to reduce confusion about whether eating pork can spread the virus. It cannot."

"WHO julisti sikainfluenssan pandemiaksi
julkaistu tänään klo 17:02, päivitetty tänään klo 17:52
http://yle.fi/uutiset/ulkomaat/2009/06/who_julisti_sikainfluenssan_pandemiaksi_799273.html
Maailman terveysjärjestö WHO on julistanut sikainfluenssan pandemiaksi. WHO päätti torstaina nostaa influenssan varoitustason korkeimpaan eli 6. luokkaan.
WHO ilmoitti asiasta jäsenmailleen sen jälkeen, kun oli neuvotellut asiasta influenssa-asiantuntijoiden kanssa.
Pandemiajulistus tarkoittaa sitä, että uusi virus leviää nopeasti maailmalla. Taudin vakavuudesta se ei sinänsä kerro. WHO:n mukaan suurin osa A(H1N1)-influenssatartunnoista on ollut tähän mennessä lieviä.
Julistuksen odotetaan tehostavan sekä rokotteen kehittämistä että hallitusten toimia viruksen pitämiseksi aisoissa.
Ensimmäisenä Meksikossa pari kuukautta sitten todettu tauti leviää nyt Amerikan lisäksi Aasiassa ja Euroopassa. Myös Australiassa sikainfluenssa on levinnyt viime päivinä nopeasti.
Maailman terveysjärjestön WHO:n eilen julkaisemien tietojen mukaan kaikkiaan 74 maasta on löytynyt liki 28 000 sikainfluenssatartuntaa. Tautiin on kuollut 141 ihmistä.
Noin puolet kuolleista on ollut nuoria ja muutoin terveitä. Sikainfluenssa myös jatkaa leviämistään kesäkautena pohjoisella pallonpuoliskolla, kun tavallisesti influenssavirukset katoavat lämpimän sään myötä.
Edellisen kerran WHO julisti pandemian vuonna 1968 hongkongilaisen influenssan takia.
Sikainfluenssa leviää Saksan ja Hongkongin kouluissa
Saksassa ja Hongkongissa on puolestaan todettu tartuntoja koululaisilta.
Düsseldofin japanilaisessa koulussa sikainfluenssa on tarttunut 30 koululaiseen. Ensimmäinen saksalaiskoulun sairaustapaus paljastui jo maanantaina, kertovat viranomaiset. Loput lapsista diagnosoitiin keskiviikkona. Valtaosa tartunnan saaneista lapsista on japanilaisia.
Lapset ja heidän perheensä on määrätty karanteeniin. Koulu pysyy suljettuna ainakin tiistaihin asti. Tapaukset nostavat sikainfluenssatartuntojen määrän Saksassa 116:een.
Hongkong puolestaan vahvisti aamulla ensimmäiset sikainfluenssatapauksensa. Hongkongilaisesta koulusta löytyi 12 tartuntapausta. Alueen hallinto ilmoitti sulkevansa kaikki päiväkodit ja ala-asteen koulut kahdeksi viikoksi taudin leviämisen ehkäisemiseksi."

"Manitoba Ventilator Request Raises H1N1 Pandemic Concerns
Recombinomics Commentary 23:51
June 8, 2009
http://www.recombinomics.com/News/06080901/H1N1_MB_Vents.html
Manitoba has experienced an increased concentration of severe respiratory illness admitted to the intensive-care units, which is higher in number than previous influenza outbreaks. The majority of the cases are in people of Aboriginal descent.
The Public Health Agency of Canada has provided three epidemiologists to Manitoba to assist in assessing Manitoba's cases of influenza-like illness.
The Winnipeg Regional Health Authority (WRHA) is taking steps to provide enough support in intensive-care units (ICUs) and prioritizing patients for personal-care home beds. There are also 15 additional ventilators that have arrived and will be put to use as needed. The WRHA may also defer non-urgent surgical procedures that would normally require ICU care.

The above comment from a Manitoba press release today describes an increasing problem of severe disease in First Nation residents. The increase in number of cases began 1-2 weeks ago and is evident in multiple provinces (see updated map). Last week the medevacing of patients to Winnipeg was detailed this afternoon's press release strongly suggests the problem is growing.
Although it is unclear if these more severe cases are linked to poor health conditions and overcrowding, of if there is a genetic component in the target population or circulating swine H1N1 that is exacerbating the problem, but it is a growing problem and many expand as swine H1N1 spreeads through less developed areas of Asia and Africa.
The circulation of a swine H1N1 in a heterogeneous human population is likely to cause problems, which can grow as the virus adapts to its new host or the virus spreads through populations at greater risk.
Although many local agencies in the United States and Canada have limited testing of mild cases and have begun focusing on the more severe hospitalized cases, the number of frequency of positives continues to grow, even though the flu seasonal has ended in the northern hemisphere.
The spread of the swine H1N1 during the off season may be linked to an avan PB2, which optimizes viral replication at 41C, which may contribute to the rapid spread of the virus.
Most cases have been mild, and the spread of the virus has been largely silent. However, deaths are beginning to mount with five announced today (PA, OK, QB, OR, CA), in addition to three on Friday (TX, WA, NY), six on Thursday (AZ, PA, UT, IL, CA, WI) and seven on Wednesday (3 NY, MI, CT,VA).
These increase in fatalities among a population that is largely under 65, and the increasing admissions to hospitals and ICU's, continue to increase pandemic concerns."

"Pohjois-Suomessa asuvalla sikainfluenssatartunta
maanantaina 1.6.2009
Etelä-Suomen Sanomat
http://www.ess.fi/?article=238634
Yksi suomalainen on saanut sikainfluenssatartunnan (H1N1) New Yorkissa Yhdysvalloissa. Hän asuu Pohjois-Suomessa.
Kyseessä on nyt neljäs suomalainen, joka sairastunut influenssa A-infektioon.
Sairastuneen lähikontaktit on selvitetty, ja heille on annettu hoito-ohjeet.
Tartunta varmistui viime lauantaina. Terveyden ja hyvinvoinnin (THL) laitoksen mukaan sairastunutta hoitava sairaanhoitopiiri ei potilaan pyynnöstä tiedottanut julkisesti asiasta. Tämän takia tieto tartunnasta tuli julki vasta maanantaina.
THL kehottaa niitä matkailijoita, jotka palaavat Meksikosta, Yhdysvalloista tai Kanadasta, tarkkailemaan terveyttään viikon ajan matkan jälkeen. Jos matkalta palannut sairastuu kuumeiseen hengitystieinfektioon, hänen tulisi ottaa yhteyttä terveyskeskukseen.
Viruksen aiheuttamaan H1N1-influenssaan on maailmalla sairastunut yhteensä noin 17 000 ihmistä, joista suurin osa on Meksikossa ja Yhdysvalloissa.
Neljännestä varmistetusta tartunnasta kertoi ensimmäisenä Suomen Lääkärilehti."