H1N1: WHO Admit drug resistance in influenza mutation

The World Health Organisation said Friday that a mutation had been found in samples of the swine flu virus taken following the first two deaths from the pandemic in Norway. This is not unusual in itself because viruses, by their nature, will and do, mutate.

However, the WHO denied that the mutation had created a more contagious or more dangerous form of influenza A(H1N1) and they admitted that some similar cases observed elsewhere, had been mild. That was certainly the case for the people who did not die from it.

"The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses," the WHO said in a briefing note. Realistically, influenza viruses are continually undergoing mutations.

It is important to note that some of these are unsustainable and that some of these will succeed in not only being sustained but also in being drug resistant. It is their nature and follows the normal course of natural variation and selection, that all living things are prone to.

"The viruses were isolated from the first two fatal cases of pandemic influenza in the country (Norway) and one patient with severe illness," the report continued, although it added that no further instances were found in tests.

"Norwegian scientists have analysed samples from more than 70 patients with clinical illness and no further instances of this mutation have been detected (in the lab). This finding suggests that the mutation may not be widespread in the country," the UN health agency assumed, optimistically.

WHO spokesman Gregory Haertl said that the global health watchdog did not believe "that this has any significant impact, for the time being." Presumably, if the mutation proliferates over time, then it will become significant.

However, despite their blind faith and optimism, the agency admitted that a similar mutation had been observed in Brazil, China, Japan, Mexico, Ukraine, and the United States, as early as April 2009. Thus, contradicting themselves, whilst confirming the true nature of influenza viruses.

"The mutations appear to occur sporadically and spontaneously (you think!). To date, no links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread," the WHO statement said. Some of those cases also produced mild symptoms, Haertl noted.

The WHO also underlined that there was no evidence of more infections or more deaths as a result, while the antiviral drugs used to treat severe flu, oseltamivir (Tamiflu) and zanamivir (Relenza), were still effective on the mutated virus.

Thus defending their single minded determination to follow this contraversial course of treatment, sponsored by the pharmaceutical agencies involved. Presumably to appear to be doing something in the face of an uncontrollable force of nature.

"Studies show that currently available pandemic vaccines confer(?) protection," it added, as mass vaccine campaigns were slowly gaining ground in the northern hemisphere amid signs of public skepticism in several European nations. (and growing profit margins of pharma companies)

Informed scientists naturally fear that mutations in flu viruses could cause more virulent and deadly pandemic flu. The global health watchdog reiterated a call for close monitoring.

The WHO was still assessing the significance of the latest observation, but it stressed that many such changes in the flu virus do not alter the illness it causes in patients.

"Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases," it added.

Norwegian authorities reported the country's first swine flu death on September 3, a 52 year-old Danish truck driver who died just over a week earlier.

On Friday, WHO data showed reported that around 6,750 people had died from swine flu since the virus was first uncovered in Mexico and the United States in April.

That represented an increase of about 500 more than a week ago, as the pandemic took hold in the northern hemisphere during the cold season

The WHO estimates that some 250,000 to 500,000 people die every year from standard seasonal variants of swine flu. Oh well! That's alright then. Sorry we troubled you guys. Let's just let you go back to sleep, whilst the rest of the world sits quietly by, watching people suffer and die.

Npw, the only question left in our minds is whether the WHO's approach to the pandemic is based on blatant incompetence or cynical corruption.

H1N1: Rules of Contact and Engagement

“In Samoa, people do not touch when they greet each other,” the linguistic anthropologist Alessandro Duranti says.

There is, of course, a catch: “When people whom they respect highly come into a house, they sit down across from you, and there is an elaborate ceremonial greeting: mentioning each person’s titles and social connections, one at a time, usually for an extended period.”

For those outside Samoa, the era of swine flu poses the thorny challenge of how to express cordiality, friendship, even love — while staying, as the authorities recommend, at least three to five feet away from anyone who coughs, sneezes or might otherwise show signs of infection with the H1N1 virus. Let's hope good sense prevails.

H5N1 Bird flu virus linked to inflamation of the brain

As if fever, aching muscles and a sore throat were not enough, researchers have found that flu may also lead to chronic neurodegenerative diseases like Parkinson's and Alzheimer's.

Most influenza infections affect the respiratory system, but there have long been suspicions that they are also linked to neurological disorders. The H1N1 flu pandemic in 1918 was followed by an outbreak of encephalitis and later by an unusually high number of cases of Parkinson's disease.

Hard evidence of such a link has been hard to find, however. So Richard Smeyne of the St Jude Children's Research Hospital in Memphis, Tennessee, sprayed a solution containing a highly pathogenic subtype of H5N1 avian flu into the noses of 225 mice. The team found that the virus infected nerves in the gut, then entered the brain stem and finally reached the brain. In the brain, it led to chronic activation of the immune system, even long after the viral infection had been cleared.

This immune system activity later led to protein aggregation and neuron loss in the brain, and to symptoms like tremor and loss of coordination – the hallmarks of Parkinson's and Alzheimer's.

Brain strains

"Infection with influenza virus might leave the brain vulnerable to damage from future infections with new influenza strains," says Smeyne, adding that this is more likely to happen in young children or during an flu pandemic.

Smeyne suspects that all flu viruses, including the current H1N1 swine flu pandemic, could cause symptoms of encephalitis, or inflammation of the brain. But he says that there is currently no proof that flu viruses other than the H5N1 he worked with can enter the central nervous system.

Reports of extra encephalitis during outbreaks of seasonal flu in Japan and the US, and most recently of swine flu-infected children hospitalised with neurological symptoms in Dallas, Texas, hint at a related mechanism, however.

"The link between flu infection and neurological disorders has been the elephant in the room [ever since 1918]," says virologist John Oxford, a virologist at Barts and The London School of Medicine and Dentistry, Queen Mary, University of London.

Journal reference: Proceedings of the National Academy of Sciences, DOI: 10.1073/pnas.0900096106

Confusion over giving antivirals to children with flu

Another pertinent study from the BMJ casts doubt over the UK's strategy to combat H1N1 Swine Flu, is well founded.

Specifically, whether all children suspected of having H1N1 Swine flu, should be given antiviral drugs such as oseltamivir (Tamiflu) or zanamivir (Relenza).

The UK government Health Ministers, insist that everyone suspected of having H1N1 Swine flu should be offered antivirals as part of a "safety first" strategy but the BMJ study, published in their journal, suggests the strategy is misguided, at best.

Small help
It concludes that treating children under 12 with antivirals does very little, shortening the duration of disease by just a day or so, and decreasing by just 8 per cent the likelihood that an infected child will spread it to others.

Also, Tamiflu causes additional vomiting in 5 per cent of children already vomiting because of their illness. Nor does it bring any benefits for asthmatics, as implied by advice from the UK government's Health Protection Agency.

"The results show the beneficial effect is fairly small for most children," says Matthew Thompson of the University of Oxford, who led the research.

His team's advice is for parents to treat mild flu symptoms with the usual medicines and the priority is in controlling the high fever, ensuring the patient gets plenty of rest and their fluid intake is maintained.

Beneficial Value unknown
Even if complications develop, the beneficial value of giving antivirals to children is unknown, the researchers say. "What we need are studies large enough to let us know if antivirals reduce the risks of serious complications such as pneumonia or hospitalisation in children," Thompson says.

Another bonus of limiting treatment in children is that it will reduce the risk of the mutating virus developing resistance to the drugs.

UK Government's response
Responding, the British government's Department of Health said that the BMJ study is based on seasonal flu and so may not apply to swine flu. This is a very weak knee-jerk response with little substance.

"Whilst there is doubt about how swine flu affects children, we believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward," said a spokesperson. "However, we will keep this policy under review as we learn more about the virus and its effects."

The government can see their ass-covering strategy diminishing in the face of evidence based criticism.

Viral Influenza A
Thompson accepts that his review only looked at seasonal flu. "But about two-thirds of the studies were influenza A, which is what the current strain is," he says. "So we would expect our results to be applicable to swine flu."

Sharp shooting
Thompson says that other countries are deploying a more considered and targeted approach, unlike the scattergun approach in the UK. "Canada, Ireland and the US are only recommending antivirals for patients at particularly high risk, or with severe illness," he says.

Good Advice
"It may be worth the UK Department of Health taking the new research on board and consider having a more targeted approach to the use of antivirals, or urgently conducting randomised controlled trials of children and adults to identify whether there are subgroups of children who will benefit from antivirals, and whether they do have an impact on severe complications such as pneumonia or hospitalisation," says Thompson.

Fortunately, the decisions lie not only with the UK Government. "I hope the evidence from such trials will help parents and family doctors make sensible decisions about which children to treat."

Results and Conclusions from BMJ Study: BMJ, DOI: 10.1136/bmj.b3172

Review methods: Eligible studies were randomised controlled trials of neuraminidase inhibitors in children aged 12 in the community (that is, not admitted to hospital) with confirmed or clinically suspected influenza. Primary outcome measures were time to resolution of illness and incidence of influenza in children living in households with index cases of influenza.

Results: We identified four randomised trials of treatment of influenza (two with oseltamivir, two with zanamivir) involving 1766 children (1243 with confirmed influenza, of whom 55-69% had influenza A), and three randomised trials for postexposure prophylaxis (one with oseltamivir, two with zanamivir) involving 863 children; none of these trials tested efficacy with the current pandemic strain. Treatment trials showed reductions in median time to resolution of symptoms or return to normal activities, or both, of 0.5-1.5 days, which were significant in only two trials. A 10 day course of postexposure prophylaxis with zanamivir or oseltamivir resulted in an 8% (95% confidence interval 5% to 12%) decrease in the incidence of symptomatic influenza. Based on only one trial, oseltamivir did not reduce asthma exacerbations or improve peak flow in children with asthma. Treatment was not associated with reduction in overall use of antibiotics (risk difference –0.30, –0.13 to 0.01). Zanamivir was well tolerated, but oseltamivir was associated with an increased risk of vomiting (0.05, 0.02 to 0.09, number needed to harm=20).

Conclusions: Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.

Tamiflu not suitable for Children: TV Personality's daughter 'almost died'

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Health Secretary Andy Burnham has defended giving swine flu drug Tamiflu to children as TV presenter Andrew Castle said his daughter "almost died" after taking it.

Mr Burnham was confronted by Castle on GMTV after research cast doubt that the anti-viral drug's benefits outweighed its side-effects.

The presenter said: "I can tell you that my child - who was not diagnosed at all - she had asthma, she took Tamiflu and almost died."

Fatal Consequences

Castle said his daughter, Georgina, had a severe reaction, "respiratory collapse" and "suffered very heavily" after being "just handed" the drug without having been properly diagnosed.

All this is in the light of last week, when a 2 yr old child died of Meningitis, after being wrongly diagnosed as having Swine Flu. She and her parents were dismissed and turned away by off-hand, hospital, medical staff.

Sympathy on Offer

Mr Burnham sympathised with Castle, saying it must have been "very worrying", but maintained that the current advice being given to parents to treat swine flu with Tamiflu, remained unchanged, despite the wave of severe doubts and criticisms coming from consultants and specialists alike.

Given that swine flu had a "disproportionate effect" on children, he maintained that Tamiflu was "our only line of defence" or, the only line of defense being considered. A policy that puts children in as much danger from the cure as from the disease.

Specialists Warn against Tamiflu

On Monday, Oxford University researchers made a serious announcement that children should NOT be given the anti-viral drug to combat swine flu. They urged the Department of Health to urgently rethink its policy on giving the drug to youngsters affected by the current flu pandemic.

The study, published in the British Medical Journal (BMJ), warned that Tamiflu can cause severe vomiting in some children, which can lead to dehydration and the need for emergency hospital treatment.

Cure worse than Disease

The researchers stated strongly that children should NOT be given the drug if they have a mild form of the illness. In such cases the cure is worse than the disease. They urged parents and GPs to remain vigilant for signs of complications and to avoid 'off the shelf' solutions and knee-jerk reactions.

50% of Young Children Suffer Side Effects from Tamiflu

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More than half of children taking Tamiflu suffer side-effects such as nausea, insomnia and nightmares, researchers have said.

Two studies from experts at the Health Protection Agency (HPA) showed a "high proportion" of British schoolchildren reporting problems after taking the anti-viral drug.

Data was gathered from children at three schools in London and one in the South West who were given Tamiflu earlier this year after classmates became infected.

The researchers behind one study said that, although children may have attributed symptoms that were due to other illnesses to the use of Tamiflu, "this is unlikely to account for all the symptoms experienced".

Their research, published in Eurosurveillance, looked at side-effects reported by 11 and 12-year-old pupils in one school year in a secondary school in South West England. The school was closed for 10 days in response to a pupil being confirmed with swine flu on return from a holiday in Cancun, Mexico.

A total of 248 pupils took part in the study and were given Tamiflu prophylactically. Compliance with prophylaxis was high, with 77% of children taking the full course, the researchers said. But they added: "Fifty-one per cent experienced symptoms such as feeling sick (31.2%), headaches (24.3%) and stomach ache (21.1%).

The researchers said "likely side-effects were common" and the "burden of side-effects needs to be considered" when deciding on giving Tamiflu to children prophylactically. The researchers concluded that a "high proportion of school children may experience side-effects of oseltamivir (Tamiflu) medication".

No Swine Flu Vaccine for the Elderly

What has happened to the normal adage of Woman and Children first?

Elderly swine flu victims should be sacrificed and sent to the back of the queue for anti-viral treatment, when supplies of the drugs are limited, according to new research in Italy.

Scientists found there were circumstances in which anti-virals such as the relatively ineffective Tamiflu, should be rationed in favour of younger adults.

The controversial strategy could be the most effective way to save lives and prevent illness, it was claimed.

Priorities
It is very interesting because it is not only indicative as to how these organisations think now but it is also how they will respond in the face of a fully blown Pandemic, when lives will be sacrificed and priorities will be established.

Italian Research
The research focused on Italy, which was said to have only enough anti-virals to treat seven million people, or 12% of the population.

Mathematical modeling showed that governments should stockpile enough drugs to treat at least a quarter of their populations, assuming moderate levels of infection. This in itself may lead to strategic prioritisation against the poor and elderly.

If supplies were lower than this, it made sense to ration the anti-virals according to age-specific fatality rates.

Historical Influence
When swine flu followed the pattern of the great 1918 pandemic and was most lethal to younger adults, treatment should not be targeted at the elderly, said the researchers. Instead, it should be reserved for the young.

This is the reverse of the policy adopted during outbreaks of normal seasonal flu, when priority is given to the over-65s. It is also academic because a new and effective ant-viral vaccine has yet to be developed and tested safely, prior to its distribution.

New Vaccine Risks
On release of the new vaccine, the risks are clear; the priority will be given to those deemed to be the youngest and most important; economically and politically powerful and influencial.

Unfortunately, if the vaccine is flawed, this will damage these very same people and cause a shift in the balance of power across the globe, affecting a tidal change in a large number of countries, organisations and populations.

Weathering the Storm
The first ones into the lifeboats to save their sinful souls, may find themselves in further peril at sea. Like rats jumping off the Titanic onto the iceberg for safety. Their fate remains unchanged, just the method is different.

We are all victims in a Pandemic but the great benefit of being economically and politically powerful and influencial is that you can make choices, whereas others can only wait, endure and accept, with stoicism and dignity.

Swine flu - UK absentees from work 'triple in a week'

The number of people calling in sick with swine flu symptoms has tripled in a week, with 130,000 people staying away from work.

Worldwide, 700 people have died!

News of the increase in absenteeism came as the British death toll from the virus rose to 31, with a 51-year-old woman from Wiltshire and the 15-year-old from Glasgow the latest victims.

Greatest Challenge to NHS
Sir Liam Donaldson, the chief medical officer, yesterday warned that swine flu “almost certainly” posed the biggest challenge to the NHS for a generation. Fears of swine flu crisis grow as six-year-old girl and doctor dieAlmost 130,000 people stayed off work with flu, coughs and colds on July 14, up from 45,000 a week before, according to FirstCare, an absence management company.

Absentees triple
While absences tripled, the number of people who have actually contracted the virus is thought to have only doubled over the same period, highlighting how fear of infection is damaging business.

Septic Shock
Meanwhile, it has emerged that Chloe Buckley, the girl thought to have been the first healthy young victim of swine flu, died from septic shock after a bout of tonsillitis, a post mortem examination indicated. The death of Chloe, six, from West Drayton, west London, alarmed parents of young children.

Dr Simon Tanner, London’s regional director of public health, said it was impossible “to say to what degree swine flu contributed to her death”.

Andrew McCombe, a leading surgeon, said it was rare for a child to die from septic shock after contracting tonsillitis. “Normally septic shock affects old people,” he said.

Human Vaccine Trials to Begin
Human trials of a vaccine to protect against the H1N1 swine flu virus have begun in Australia.
Vaxine and CSL have both started injecting human volunteers this week, but it will be at least six weeks before the initial results are known.

Morbidity rate increases
The overall morbidity figure is likely to climb on Thursday when the Department of Health gives its weekly update. Worldwide, more than 700 people have died.

Woman with swine flu dies 'after giving birth'

A woman in the UK who had contracted swine flu, died shortly after giving birth prematurely.

The woman, who died in Whipps Cross Hospital, was named by her brother as Ruptara Miah.She is thought to be from Bangladesh.

Abdul Malik told BBC News his sister had used a wheelchair for 15 years after a road traffic accident but had led a normal life and had brought up six daughters. "We are very, very upset as a family. It has really taken me by shock," he said. "We thought she was going to recover."

His sister, the eldest of 10 children, was admitted to hospital three weeks ago with a cough and chest infection, he said. She was treated in intensive care, where she gave birth to a son prematurely, but never regained full consciousness, he added.

The baby is now in intensive care as a precaution

A spokesman for Whipps Cross said: "Whipps Cross University Hospital NHS Trust can confirm that a 39-year-old woman passed away on July 13 2009, and that she was infected with pandemic H1N1. The trust can confirm that she had underlying health conditions. No further comments can be made at this time."

H1N1 Pandemic in UK: Sudden Increase in Cases

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GPs have seen a leap of almost 50% in the numbers of people contacting them with fears they have swine flu in the last week, new figures reveal.

Around 40,000 people a week in England and Wales are now complaining to their doctor of "flu-like illness", with a dramatic rise in the number of young children being affected.

The Royal College

The figures, from the Royal College of GPs' monitoring system, showed 50.3 people per 100,000 were reporting flu-like illness between June 29 and July 5, but this leapt by 46% to 73.4 people per 100,000 between July 6 and 12.

Financial Times

Almost one in eight workers are likely to be kept at home with the virus in the next few weeks, according to Government figures. This could leave many businesses struggling to run as normal, the Financial Times reported.

Sir Liam Donaldson is expected to announce that 30% of the population is likely to be infected during this first wave of the pandemic, the FT newspaper said.

Young at most Risk
Wednesday's weekly report from the Royal College of GPs said: "National incidence of influenza-like illness increased for all regions and is now evident in all age groups but remains highest in five to 14 age groups."

Central England Hotspot
The study said the highest number of cases was being seen in central England but the North had seen "a marked increase compared to previous weeks".

There has been a small decrease in the number of cases being seen in London although the capital remains a major hot spot for the virus.

Statistics
The rate of influenza-like illness is highest among those aged five to 14, at 159.57 per 100,000 population. The next most affected group is youngsters and babies aged up to four, at 114.12 per 100,00 population. This is followed by people aged 15 to 44, those aged 45 to 64 and then people aged 65 and over.

Ant-viral Vaccine
The Government has insisted that the swine flu vaccine should begin arriving at the end of August, amid genuine fears of a delay in this delivery date, and further delay before people receive jabs.

The UK claims, it is in line to get around 60 million doses of the vaccine - enough to cover half the population - by the end of December, with the rest of the doses following next year.

Vaccine Production Delayed
This is a substantial turn around in their earlier claims and the first phase of the virus should have run its course by then. The mutated second phase will take over and the vaccine will be ineffective against it.

Virus Dictates Timeline
It is impossible to determine how the H1N1 virus will mutate, so scientists are unable to prepare in advance for this strain. Only when the new strain is identified will they be able to start on development of a new anti-viral vaccine.

So, the development, testing and distribution of a second antiviral vaccine will need to start after January 2010 and is therefore unlikely to be in production before the Spring 2010.

H1N1: How Swine Flu kills

As the H1N1 swine flu pandemic continues to spread around the world, most cases are still mild but reports are starting to emerge of people who sicken and die very quickly of what appears to be viral pneumonia. Now two independent groups of scientists have now found out why and it's all down to where the virus binds within the body.

H1N1 swine flu comes from pigs, so it binds well to cell-surface molecules in the respiratory tracts of other mammals, including humans but there are slight differences in the way different flu proteins bind to these receptors.

Two separate teams – one led by Ron Fouchier at Erasmus University in Rotterdam, the Netherlands, and the other by Terrence Tumpey at the Centres for Disease Control in Atlanta, Georgia – both report that the pandemic virus binds deeper than ordinary flu in the respiratory tract of ferrets, the animal most like humans when it comes to flu.

A virus of the same H1N1 family as the pandemic flu has been circulating as ordinary seasonal flu since 1977. Both groups found that the seasonal virus binds almost exclusively to cells in the ferrets' noses. But, the pandemic H1N1 binds deeper, in the lung's trachea, bronchi and bronchioles. The pandemic virus also replicated more, and caused more damage, though none of the ferrets were severely ill.

'New' H1N1 Brazilian flu strain! Don't panic - false alarm

Take a jumpy media, throw in a statement hastily translated from Portuguese, and what have you got? A "new" and potentially deadly strain of H1N1 influenza in Brazil, according to a rash of news stories that appeared earlier today.

"It was not yet known whether the new strain was more aggressive than the current A(H1N1) virus which has been declared pandemic by the World Health Organization," reported Agence France Presse, setting the mood for a new round of pandemic panic.

But this "new" strain is nothing of the sort. In fact, the sequence of its gene for the haemagglutinin surface protein, deposited in the GenBank database, is the same as isolates from several other countries.

"There is nothing new and surprising about it. It is identical to the others," said Richard Webby of St Jude Children's Research Hospital in Memphis, Tennessee.

The scare seems to be based on a misunderstanding of a "technical note" posted on the website of the Adolfo Lutz Institute in Saõ Paulo. It states that researchers led by Terezinha Maria de Paiva sequenced the haemagglutinin and matrix protein genes from a virus isolated from a 26-year-old man who was hospitalized in Brazil in April after a trip to Mexico, finding subtle differences for the haemagglutinin gene from a single reference strain of H1N1 isolated in California.

The note doesn't mention that the sequence is the same as other isolates found elsewhere. Even so, subtle changes from a single reference strain are nothing to get terribly excited about, given the normal rates of mutation in influenza viruses. "It's what you'd expect for influenza," says Adolfo García-Sastre of the Mount Sinai School of Medicine in New York.

Airport Swine Flu (H1N1) Detectors - Smoke and Mirrors

WHEN aviation officials chose Mexico City for a meeting to discuss their response to pandemic outbreaks, they could scarcely have predicted swine flu would intervene. "The irony was amazing," says Tony Evans of the International Civil Aviation Organization (ICAO) in Montreal, Canada. "The meeting will probably go ahead in June unless we get another wave of H1N1."

Future pandemics will almost certainly be spread via air travel, with flights capable of carrying a pathogen across the world in hours. The UN's Convention on International Civil Aviation requires nations to "prevent the spread of communicable diseases by means of air navigation". That is easier said than done, given the confined space of modern aircraft and the use of re-cycled unscrubbed cabin air on all flights, as a fuel and cost saving measure.

CAPSCA - the Cooperative Arrangement for the Prevention of the Spread of Communicable diseases by Air travel.

CAPSCA aims to help airports in developing nations prepare for a pandemic, and its schemes are now getting off the ground in the Americas, Asia-Pacific and Africa. They will be expected to install US manufactured devices and follow the advice of their consultants.

Optimistically CAPSCA state; "When an aircraft arrives with a suspected disease case on board, CAPSCA will make sure you've thought about where you are going to park the plane, how you will deal with the luggage and how are you going to keep in touch with the passengers that haven't got any symptoms (when they boarded the plane)."

All this does is extend the time by which the other passengers and air crew are exposed to the virus and increase the likelihood of them contracting the disease, if they have not already done so on the flight.

Evans says. "You also have to work out which people on the plane are most likely to be infected (if not all) and whether they need prophylactic treatment or admission to hospital. How will you protect air crew and customs officers? Careful planning is crucial and CAPSCA will promote that", Evans explains.

Frankly, this is nothing but hype, rhetoric and grandstanding

Frankly, this is nothing but hype, rhetoric and grandstanding. People who gather in confined spaces and share the same breathing air for hours on end, will contract the disease. Air crew, airport staff and customs officers, will contract the disease.

Immunisation with Tamiflu and other so-called anti-viral inoculations, is less than effective and will not act as a 'barrier' for air crew and airport staff. The virus, by its nature, mutates regularly and the time taken to develop effective anti-viral drugs and put them into large scale production, is 4 - 6 months. The same time taken for the pandemic to burn itself out, without any human or pharmaceutical intervention. Again, it is the nature if viruses.

In the case of an increasing pandemic, effective anti-viral drugs will only be available on a priority basis. Those who decide the priority, will be the first to receive the drugs. The second priority will be given to the forces that will protect the decisions and decision makers. This is what is meant by 'careful planning'. Everyone else should prepare for a long wait.

H1N1: The Hidden or Concealed Pandemic

H1N1 swine flu continues to roam the planet. In the US, cases are thought to be in the hundreds of thousands. In Japan, hundreds of teenagers have caught it, despite no obvious connections with Mexico or the US.

Yet in Europe, health authorities are not testing widely for it and are prescribing drugs as though they could still contain it. And in Geneva, health ministers have fought this week to keep the World Health Organization from following its own rules and calling this a pandemic.

There has been a phenomenal mismatch between quite sensible rules about how to declare a flu pandemic, and equally sensible rules about how to respond. The mismatch was wholly predictable, yet somehow no one saw this coming.

The WHO rules for declaring different degrees of flu pandemic threat are based on epidemiology (how the virus is spreading) for good reasons. This is because any new flu virus to which most of the world has little immunity, and which spreads well enough person-to-person to escape its continent of origin, is very likely to go global, and to cause more sickness and death than flu usually does. That is the definition of a flu pandemic.

The virus's ability to spread is what matters. H5N1 bird flu has travelled across Eurasia, mainly in birds, but it hasn't spread readily in people, so it isn't a pandemic.

The Mexican swine flu H1N1, however, has. When it spread across the Americas, the WHO followed its rules and declared it a level 5 situation; one down from a pandemic. When it starts spreading outside the Americas, through "community transmission" - meaning it crops up generally, not just in people who have visited Mexico or New York recently or their contacts - that means it's got a foothold globally.

A flu that can do that is very unlikely to stop there. The WHO rules make that a full-blown level 6 pandemic.

And frankly, that is starting to happen. As I write, the number of confirmed cases in Japan (and that's just people sick enough to see a doctor and get tested) has jumped by 35 in the past 24 hours, to nearly 300, mostly due to that perennial vector of flu, the gregarious teenager. The main cluster started without any known links to the Americas.

In Europe, countries are deliberately not testing cases that could be community acquired, almost as if someone doesn't want to trigger - 'LEVEL 6'

In fact, Britain, Japan and other countries spent this past week pleading with the WHO not to go to level 6 yet, at least while the virus is still causing mostly mild disease. WHO boss Margaret Chan has now agreed to make the call when she sees "more signals coming from the virus itself or the spread of the disease, including severity."

The problem is, countries have pandemic plans that, rightly, prepare for the worst. Until recently we were worried about H5N1 (we still are) and there seemed a good chance that if it went pandemic, it might start off severe, necessitating major controls from the start.

H1N1 Swine Flu pandemic update

Chinese health inspectors and officials prepare to transport quarantined Mexican passengers to Pudong International Airport, ready for repatriation (Image: View China Photo / Rex)

Swine Flu Panic conceals surge of Q fever

No! I don't mean Desmond Llewelyn aka 'Q' from the James Bond movies

Q fever is a disease caused by infection with Coxiella burnetii, a bacterium that affects both humans and animals. This organism is uncommon but may be found in cattle, sheep, goats and other domesticated animals, including cats and dogs. It is the most infectious diseases known to man!

The infection results from inhalation of contaminated air-borne particles, and from contact with the milk, urine, feces, vaginal mucus, or semen of infected animals. The incubation period is 9-40 days. It can be considered the most infectious disease in the world, as a human being can be infected by a single bacterium.

The bacteria is an obligate pathogen and was difficult to study because it could not be reproduced outside a host. Therefore it is more common in the rural areas but can be transferred from human to human.

The number of cases of Q fever reported among humans in the Netherlands has risen 'explosively' over the past few weeks, the Volkskrant reports on Wednesday. The paper says that over 200 cases have been reported in recent days, half of them in Noord-Brabant province.

Q fever was rarely known among humans until 2007, when 168 cases were reported. Last year there were more than 1,000 instances in the Netherlands.

The disease, which leads to spontaneous abortion in sheep and goats, causes flu-like symptoms in humans but can lead to lung infections. Therefore it is dangerous to vulnerable groups e.g. asthmatics, cystic fibrosis sufferers, the elderly and infirm.

The dose needed to infect 50% of experimental subjects is one, via inhalation — i.e. inhalation of one organism will yield disease in 50% of the population. This is an extremely low infectious dose, making C. burnetii the most infectious organism known to man.

The disease occurs in two stages: an acute stage that presents with headaches, chills, and respiratory symptoms, and an insidious chronic stage. Anyone who feels they may have been exposed should consult their doctor and discuss appropriate treatment.

Executive Pandemic Preparation

With the H1N1 swine influenza spreading across the world, it's a good time to discuss and update your pandemic plan. If you do have a plan. If you don't have one, you are putting your organisation at great risk.

There are measures that can help organisations and that will guarantee the continuity of their operations but for organisations with outdated or without pandemic preparedness plans, the first step is for the executive management team to establish 'the policy'; guiding principles for the coming weeks and months which address duty of care responsibility and then to communicate this policy and those decisions, to the workforce.

There are also policies and protocols that can have a strong impact in countering a pandemic emergency.

Organisations should ask themselves the following ten questions:

1. Have you defined reliable information sources that you will monitor for situational awareness in the event of an influenza pandemic?

It is essential to ensure that the information sources you choose are reliable, appreciate nuances and bring a degree of expertise and analysis to these types of events. The information gathered from these sources will be critical for your decision-making process and you want to make good decisions based on the best possible knowledge available.

2. Has top management documented a "policy"? A set of guiding principles that outlines:

• The commitments the firm will make to protect employees and ensure duty of care
• The types of programs the firm will keep in place
• The budget available for planning
• The executive person responsible for implementing these programs

When considering guiding principles during a pandemic, there is a variety of options companies can take. It is important for companies to confirm their guiding principles early on, to control and guide the planning effort.

3. Does the firm have in place a robust Crisis Management & Communications program that will allow executives to make key decisions on a timely basis and communicate messages to both internal and external stakeholders?

Influenza pandemic is a prolonged event and will require management not only to assess and make decisions in response to changing conditions, but to also accurately and effectively communicate these decisions to all necessary parties. Pandemic crisis management requires a completely different perspective, analysis and action-plan than natural disaster crisis planning. The question in pandemic planning, is not how do we pick up the pieces; rather it is how do we live with this emerging situation over the course of the next 18 months?

4. Is there a Business Continuity program in place that documents key products and services that will receive prioritised attention during a time of reduced staff availability?

If only 50 percent of staff is in the workplace on a particular day, which business activities will be conducted and which will be deferred?

Traditional business continuity is based on putting people back to work after sustaining a loss to a building, equipment or other operational systems. Pandemic business continuity planning completely turns this concept on its ear; the building is intact, the systems are functioning but there is a shortage of people. In this scenario, you will have to establish priorities for your reduced workforce and you will have to consider what functions are not absolutely essential to your organization at that moment and defer these functions.

5. Has the firm implemented a robust employee health program that will guide safe workplace protocols, such as facility access, social distancing, and surface cleaning?

In the event of an influenza pandemic, the goal is preventing the virus from spreading. This prevention is applicable for public systems, such as trains and buses, to households and to businesses. Surface cleaning and social distancing both prove effective and can have a major impact. The conventional perspective is that people are universally susceptible to influenza pandemics and we must rely on these approaches to limit contagion.

6. Has the firm documented HR provisions that outline actions employees should take if they become ill and how to handle sick leave and family care issues?

Just as with any other company initiative, people need to know what to do. It sounds so simple, but if you don't provide clear instruction regarding sick leave, employees will show up to work sick and ask whether they should stay or go. You need to remove any uncertainty in the mind of the employee so that they can stay home and get better without risk of spreading the virus to other employees.

7. Are key strategies for remote connectivity of workers backed up by actual IT capabilities in terms of VPN bandwidth and hardware availability?

The 'go-to' solution for many companies during a pandemic is simply to have employees work from home. However, more often than not, there are real IT limitations to this strategy. You need to be realistic and ask whether your existing IT infrastructure can support your entire workforce working from home at once. I can tell you now that the answer will be a resounding 'No'. Business plans need to take into account how the IT systems work.

8. Has the firm prepared guidance for expatriate employees and mobile workers? Does the firm have the ability to re-create travel patterns for employees, to support investigation into risk exposure?

This goes back to ensuring that your sources of information are reliable and establishing your guiding principles. In normal circumstances, the need for travel policies is clear, but you have to determine whether you will restrict all non-essential travel for employees. When considering expatriate employees, you must decide what care you will offer them and at what point will remove them from their current location.

9. Has the firm discussed its pandemic preparedness efforts with key vendors, suppliers and other business partners?

Even the strongest in-house pandemic preparedness program can be rendered worthless if the company has a dependence on a third-party that is compromised. This is true not only for manufacturers, but also for professional services providers. Companies with an outsourced IT call centres or outsourced legal support, etc., could be left without critical business functions if their outsourced operations are compromised.

10. What is the firms position on the procurement and stockpiling of both pharmaceutical and non-pharmaceutical protective measures? If there is a formal program, who is responsible and are all key provisions up to date?

Stock piled Anti-viral treatments are receiving so much attention right now that it is almost tempting to mistake them for a pandemic preparedness program. They are not. You are advised to look closely at your guiding principles, to determine whether these treatments fit your needs and whether you will procure either or both protective measures. The decisions on both pharmaceutical and non-pharmaceutical protective measures will vary from firm to firm and will vary with circumstances.

Remember, a Business Continuity Plan (BCP) normally prepares an organisation for disasters that have a sudden onset but a limited scope, duration and geographic location. A pandemic outbreak by nature is unpredictable, so the plan must be much more flexible.

We know that pandemics are not limited by geographic location. Most pandemics come in waves that can last from four to six months and that absenteeism is the single most serious threat to businesses.

Most official guidelines recommend the following as a starting point:

• Develop communication strategies as well as preventative and mitigating measures. These should include sourcing supplies to protect employees, pandemic monitoring, and employee education.
• Have a documented strategy that deals with a pandemic outbreak in emerging stages (detection, regional outbreak, local outbreak, etc.)
• Have a documented policy and strategy that includes the facilities, procedures, people and systems that are needed to keep your business up and running.
• Don't just have a plan, test it and update it.
  
• Monitor and review the plan regularly to keep it up to date.
• Secure the services of a Pandemic BC expert and take head of good advice.
  

The current H1N1 swine flu is not thought to be the most virulent of pandemics, which is great news but it does give us a 'wake-up' call. Let's dust off those old plans and bring them up to date and don't forget the demand on scarce resources that will occur during a 'real' pandemic outbreak.

H1N1: Egypt pig slaughter prompts religious discourse

Egyptian police have clashed with pig farmers after announcing a cull to allegedly combat swine flu. Egypt has ordered the slaughter of 300,000 to 400,000 pigs as a so called, "precaution" against the effect of H1N1 virus, a move the United Nations said was "a real mistake"

These drastic and extreme measures have been taken by the north African country, although it has yet to report any H1N1 cases. This over-reaction could be due to the fact that Egypt was hit hard by bird flu in 2005/6 or there could be different, more fundamental reasons.

In Cairo, police fired tear gas at farmers and protesters who pelted them with rocks and bottles over fears they had come to seize their pigs. At least ten people were injured in the clashes in Manshiet Nasr, a shantytown on the outskirts of the capital city. Residents burned tyres and rubbish in the street to keep police at bay. Three officers were also injured in clashes with pig farmers in other areas of the capital.

The sad truth is that the H1N1 virus is being spread by people, not pigs. Destroying innocent and valuable livestock and the devastating effect this will have on the owners and their families, is beyond measure. In this poverty stricken area, these people are fighting for their lives.

Some political commentators say that culling swine, which are mainly raised by the Christian minority and viewed as unclean by Muslims, could have different and more sinister undertones, rather than simply being an extremely puzzling and foolish measure to quell rising public panic.

If this is the case, then a more severe backlash will develop over the coming days and weeks. Loosely targeted at the pigs, their owners and their livelihood, it may well plunge Egypt into increased levels of civil disobedience, fueled by bigotry, extremism and political unrest.

Tamiflu & Relenza Resistance is a certainty rather than a risk

Two anti-flu drugs are commonly stockpiled for use in a flu pandemic: oseltamivir, which is sold as Tamiflu, and zanamivir, which is sold as Relenza. Both work by inhibiting an enzyme called neuraminidase (the 'N' in H1N1). The virus needs this enzyme to break down normal cell walls and to replicate using a mutated version of the victims own RNA.

The 2 drugs act on different parts of the enzyme and resistance to one drug does not confer resistance to the other. The Mexican H1N1 strain is currently classed as being 'sensitive' to both drugs. This is not a 'cure' it is simply a 'treatment' and no one knows how long this 'sensitivity' will last.

The Wu team conducted their study after noticing that despite concerns about resistance, many countries stockpile just one drug, usually oseltamivir. There are some exceptions, however, including Australia and the UK, which stockpile both drugs.

Viruses are notorious for their ability to develop resistance to drugs. Last year, an H1N1 flu strain that caused some seasonal flu rapidly developed resistance to oseltamivir. By December, "close to 100 per cent of H1N1 in Australia and the US, and many other parts of the world, were resistant to Tamiflu", says Raina MacIntyre, an infectious disease expert at the University of New South Wales in Sydney, Australia.

H1N1 Swine Flu: very weak viral strain

First genetic analysis of how well this virus transmits from person to person concludes that it spreads barely well enough to keep itself going.

The analysis also suggests the virus may have started circulating as long ago as January. But because there have been so few cases to analyse, the calculation is uncertain. It could have started more recently, or as far back as September.

Nicholas Grassly of Imperial College London and Andrew Rambaut of the University of Edinburgh, UK, have analysed the rate of spread. Their analysis is based on the small mutations that have accumulated in almost two dozen genetic sequences produced so far, from viruses collected from patients in Mexico and the US.

Freely available

In contrast to H5N1 bird flu, all the genetic sequences of this H1N1 are being posted on bulletin boards like GISAID, where scientists can access them and compare preliminary analyses.

The GISAID system was set up in 2006 by scientists who protested that H5N1 sequences were not being made freely available.

"The limited sampling so far gives rise to considerable uncertainty in the estimate," cautions Rambaut. But if the rate at which genes mutate is about the same for this virus as for other H1N1 viruses, the number of mutations that have accumulated so far suggests it has been circulating since January – or even September 2008.

Weak virus

If the new virus spreads from one infected person to the next at about the same speed as ordinary flu, that gives an idea of how many cases there may have been in that time. A mathematical model permits the calculation of an important variable called R₀ – the number of additional people infected, on average, by each case. If R₀ is less than one, an infection dies out.

Grassly also cautions that the estimate is very preliminary. But with the data available now, he gets an R₀ of 1.16 – enough for the virus to keep going, but only just.

This could be good news. In epidemiological theory, at least, the lower the R₀, the easier it may be to snuff the virus out by further hindering its spread.

But it may be too early for celebrations. The 1918 flu pandemic, caused by another H1N1 virus, started with a mild, early wave in spring and early summer. The flu lab at the Los Alamos National Laboratory in the US estimates that the R₀ of the 1918 virus in spring was only 1.45. That shot up, they estimate, to 3.75 when the virus began its lethal second wave the following autumn.

Much may now depend on how quickly the new H1N1 virus from swine adapts to people.