situation on Ukraine

niman · **Posted:** Sat Jan 23, 2010 10:28 pm

ms4920 wrote:

stephensons wrote:

ms i wish i could read and understand sequences too. is the pot just starting to boil? leave it to the experts and they will inform us, i hope!! :thumbsup:

I do not think so, but who knows. 225G has been here and everywhere since the beginning, but it is the other mutations I do not understand. So we will leave up to the professionals. :shock:

The pot is beginning to boil as more sequences with D225G are reported. Frequency is clearly rising.

spentitall · **Joined:** Wed Nov 04, 2009 2:14 am **Posts:** 337

http://www.kyivpost.com/news/nation/detail/57842/

Quote:

Ukraine health officials expect new flu surge for runoff
Yesterday at 16:47 | Interfax-Ukraine

A second surge of flu and respiratory infections is looming in Ukraine, heath officials believe.

"We believe there will be a second wave. We expect the second surge to strike early in February," Director of Ukraine's center for influenza and acute respiratory infections Oleksandr Hrynevych said at a press conference on Friday.

Nevertheless, the temperature drop can contribute to the spread of influenza and acute respiratory diseases, and the number of people applying for medical assistance will increase.

According to him, a combination of viruses that causing respiratory diseases will remain the same - seasonal and pandemic influenza, as well as acute respiratory infections, but the pandemic H1N1 flu will prevail.

neuromedia · **Joined:** Wed Aug 26, 2009 4:15 pm **Posts:** 580

neuromedia wrote:

gsgs wrote:

Ukraine: http://www.euroflu.org/cgi-files/figure ... ine&type=c
neighbors:
Belarus: http://www.euroflu.org/cgi-files/figure ... rus&type=c
Poland(week1): http://www.euroflu.org/cgi-files/figure ... and&type=c
Moldovia: http://www.euroflu.org/cgi-files/figure ... ova&type=c
Romania:(week1) http://www.euroflu.org/cgi-files/figure ... ia&type=c1
Russia: http://www.euroflu.org/cgi-files/figure ... ion&type=c
Turkey(week1) http://www.euroflu.org/cgi-files/figure ... key&type=c

Russia,Belarus,Moldova going up again
[... ...]
but almost 100% of flu in Europe is still mexflu

[... ...] I just checked Russia and Belarus and, as you pointed out, like Ukraine the ARI consultations, are going up again.
What's more, at least in the case of Ukraine and Belarus, the trend mimics previous 2009/10 flu season shape.

Is is worth noting that the pH1N1 in South Hemisphere 1st wave occurred essentially with the same timing as precedent standard seasonal "waves".
Therefore I can see no ad hoc reason to expect an absence of a pH1N1 "wave" on the standard seasonal flu timing in the North Hemisphere.

On the other hand, both Australian an Brazilian 1st wave were "seeded" with the "1.0 version" of pH1N1, closer to early California strains, which gradually outspaced seasonal strains.
viewtopic.php?f=26&t=1897&start=0
The pH1N1 presented a number of relevant genetic acquisitions since then, and its epidemiological behavior may be less predictable.

I feel it it may be illustrative to post the Euroflu ARI consultation graphics briefly discussed earlier on this thread:

EuroFlu: ARI consultations per 100,000 population. Week 02-2010 - Russian Federation
http://www.euroflu.org/cgi-files/figure ... ion&type=c

EuroFlu: ARI consultations per 100,000 population. Week 02-2010 - Ukraine

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Euroflu_ARI_Ukraine_Week_02.gif [ 7.75 KiB | Viewed 507 times ]

EuroFlu: ARI consultations per 100,000 population. Week 02-2010 - Moldova

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Euroflu_ARI_Moldova_Week_02.gif [ 7.21 KiB | Viewed 455 times ]

EuroFlu: ARI consultations per 100,000 population. Week 02-2010 - Belarus

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Euroflu_ARI_Belarus_Week_02.gif [ 8.3 KiB | Viewed 507 times ]

neuromedia · **Joined:** Wed Aug 26, 2009 4:15 pm **Posts:** 580

Ryan wrote:

According to the The Press Association their was 3,770 cases in the UK. Their was also 26 new deaths reported this week, which would give a fatality rate of 0.7% for the week. Normally the fatality rate is way below 0.1%. Surely this is a bit worrying ?

Not sure I really get your question, anyway the WHO press release issue 22 January states:

World Health Organization - Weekly epidemiological record
22 january 2010, 85th year / 22 janvier 2010, 85e année
No. 4, 2010, 85, 21–28
[… …]
"Based on currently available data shared with WHO, the prevalence of D222G substitution is <1.8%
(52 detections among >2755 HA sequences).
Of 364 fatal cases analysed to date, viruses from 26 cases (7.1%) had the D222G substitution.
The clinical information about potential underlyingmedical conditions in these cases is limited. Surveillance and laboratory analysis efforts to study
this substitution have given priority to specimens from hospitalized and severely ill patients, leading to potential biases in the data. [… …]"
http://www.who.int/wer/2010/wer8504/en/index.html

There are at least 3 different ratios or quocients involving the change D225G and fatalities number:
1- From all pH1N1 sequences, which percentage had the change D225G?
2- Among all actual pH1N1 fatal outcomes which percentage had the change D225G?
3- From all detected D225G sequences, how many are associated with a fatal outcome?

All these 3 figures can be calculated from the WHO Weekly epidemiological record data,
although the release focus on the ratios 1 and 2:
Ans # 1 : <1.8% [= 52/2755]
Ans # 2: 7.1% [= 26/364]
Ans # 3: 50 % [= 26/52]

These ratios may or may not rise concern depending on the reader premises.
NOTE-The ratio # 3 was termed by Dr Niman a CFR (Case Fatality Ratio), a common medical term,
tagged on the research context to the specific case deffinition as [H3 HA D225G] change detection.
The usual medical use to CFR ratio is the overall average of fatalities per infected person for a given disease, a less specific use.

neuromedia · **Joined:** Wed Aug 26, 2009 4:15 pm **Posts:** 580

January 22, 2010
4 447 820 Influenza/ARI
262 992 Hospitalized
1 030 Dead
http://www.moz.gov.ua/ua/main/press/?docID=14662

January 23, 2010
4 468 203 Influenza/ARI
264 614 Hospitalized
1 036 Dead
http://www.moz.gov.ua/ua/main/press/?docID=14663

January 24, 2010
4 475 370 Influenza/ARI
265 752 Hospitalized
1 037 Dead
http://www.moz.gov.ua/ua/main/press/?docID=14664

niman · **Posted:** Sun Jan 24, 2010 8:50 pm

neuromedia wrote:

Ryan wrote:

These ratios may or may not rise concern depending on the reader premises.
NOTE-The ratio # 3 was termed by Dr Niman a CFR (Case Fatality Ratio), a common medical term,
tagged on the research context to the specific case deffinition as [H3 HA D225G] change detection.
The usual medical use to CFR ratio is the overall average of fatalities per infected person for a given disease, a less specific use.

No. The case is defined and then the CFR is determined. When the novel coronavirus SARS emerged, case fatality rates for SARS (lab confirmed) were calculated (incorrectly because cases had no outcome were included as survivors, leading to an arificial rise as the patients died), even though it was a coronavirus and the CFR for coronaviruses (which includes the common cold) was far low than SARS. The same is true for H5N1. It is an influenza serotype, and case fatality rates were determined for the serotype (not for infleunza, which includes seasonal flu). Similarly, sub-clades such as clade 2.1 in Indonesia were calculated seperately (the latest CFR in Indonesia was 95%, although that is an artificial number created by Indonesia gaming the system).
There has been nonsense posted on this thread based on a dictionary definition of CFR, which uses the term "disease". The "disease" is defined by the case definition and for H1N1 with D225G, the CFR is 50%, based on the WHO report (misinterpretations of dictionary definitions notwithstanding).
The key word in Case Fatality Rate is CASE, not "disease".

Denis · **Joined:** Wed Nov 11, 2009 10:17 am **Posts:** 140

neuromedia:
"The usual medical use to CFR ratio is the overall average of fatalities per infected person for a given disease, a less specific use."

This is not correct. The CFR is the number of people killed by a pathogen divided by the number of people infected by that pathogen. This is not an average. It is a ratio.

You could define your pathogen in different ways. You could say it's all pH1N1. Or you could say it's the subset of H1N1 with D225G. Whatever. But then the definition of "case" is all of those who have been infected by that reference pathogen -- not just those who got really sick or died. A mortality rate is different, too. It is the number of people killed by the pathogen divided by the total population -- those infected and those not infected.

Again niman tries to distort the definition of CFR by defining a "case" as someone who dies. Or as a situation in which the only isolates come from dead or very sick people and so he calls those sick and dead people the "cases" and ignores the rest of the individuals were were infected but recovered without becoming very sick or dying. Not surprisingly he gets a very high CFR -- 1.0 in at least one post. That is meant to be scary.

Because of an early prediction about the lethality of D225G, niman's agenda seems to be to make D225G out to be as terrible as possible so that he can appear to be prescient. He may well be, but jerking around with the definition of CFR is not making his case for him.

niman · **Posted:** Mon Jan 25, 2010 12:12 am

Denis wrote:

neuromedia:

Again niman tries to distort the definition of CFR by defining a "case" as someone who dies. Or as a situation in which the only isolates come from dead or very sick people and so he calls those sick and dead people the "cases" and ignores the rest of the individuals were were infected but recovered without becoming very sick or dying. Not surprisingly he gets a very high CFR -- 1.0 in at least one post. That is meant to be scary.

Because of an early prediction about the lethality of D225G, niman's agenda seems to be to make D225G out to be as terrible as possible so that he can appear to be prescient. He may well be, but jerking around with the definition of CFR is not making his case for him.

Please stop posting nonsense. A case is H1N1 with D225G PERIOD. It has NO requirement for being fatal or extremely ill. Many of the sequences are from milder cases.

You have no undestanding of CFR or how it is used. The CFR is based on KNOWN cases, not some hypothetical guess/extrapolation.

As shown in the WHO publications, there have been 52 D225G cases and 26 have died, giving a CFR of 50%.

WHO has issued press releases on Ukraine, D225G in Norway, and two recent publications on D225G. It is a major concern and was a major concern as soon as 4 of 4 fatal cases in Ukraine were shown to have D225G.

The danger is quite clear to almost all paying attention (which is why WHO is working so hard on head pats).

Dave in NM · **Joined:** Fri Oct 02, 2009 2:36 pm **Posts:** 32

Denis wrote:

Again niman tries to distort the definition of CFR by defining a "case" as someone who dies. Or as a situation in which the only isolates come from dead or very sick people and so he calls those sick and dead people the "cases" and ignores the rest of the individuals were were infected but recovered without becoming very sick or dying. Not surprisingly he gets a very high CFR -- 1.0 in at least one post. That is meant to be scary.

Because of an early prediction about the lethality of D225G, niman's agenda seems to be to make D225G out to be as terrible as possible so that he can appear to be prescient. He may well be, but jerking around with the definition of CFR is not making his case for him.

You seem to be saying that D225G should be frequently found in mild flu cases. What evidence supports that hypothesis? The available data currently indicates that D225G appears half the time in fatal cases.

niman · **Posted:** Mon Jan 25, 2010 12:29 am

Denis wrote:

neuromedia:
"The usual medical use to CFR ratio is the overall average of fatalities per infected person for a given disease, a less specific use."

This is not correct. The CFR is the number of people killed by a pathogen divided by the number of people infected by that pathogen. This is not an average. It is a ratio.

You could define your pathogen in different ways. You could say it's all pH1N1. Or you could say it's the subset of H1N1 with D225G. Whatever. But then the definition of "case" is all of those who have been infected by that reference pathogen -- not just those who got really sick or died. A mortality rate is different, too. It is the number of people killed by the pathogen divided by the total population -- those infected and those not infected.

Again niman tries to distort the definition of CFR by defining a "case" as someone who dies. Or as a situation in which the only isolates come from dead or very sick people and so he calls those sick and dead people the "cases" and ignores the rest of the individuals were were infected but recovered without becoming very sick or dying. Not surprisingly he gets a very high CFR -- 1.0 in at least one post. That is meant to be scary.

Because of an early prediction about the lethality of D225G, niman's agenda seems to be to make D225G out to be as terrible as possible so that he can appear to be prescient. He may well be, but jerking around with the definition of CFR is not making his case for him.

Actually Mill Hill tried jacking up the milder cases with twenty two additional HA sequences from Ukraine (Lviv, Cherkasy, Dniproptetrovsk) and came up with ONE mixture (D225G and wild type) and my guess is that it was severe (none were lsited as fatal and all were swabs, or isolates from MDCK cells or eggs).

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