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PostPosted: Tue Feb 16, 2010 4:49 pm 
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gsgs wrote:
on Feb.14 you said:
> indicating the ratio of D225G to wild type was increasing with time
http://www.recombinomics.com/News/02141 ... ative.html

on Feb.15 you say:
> Disease onset dates play no role.
viewtopic.php?f=5&t=4582&start=30

contradiction here.

If 225G transmits then it should be present at high concentration early
in the disease in some cases.


Please. Are you saying that all of the Ukraine sequences with D225G and D225N each developed independently, but its only a random error for D225G and D225N but not D225E.

This is beyond nonsense (WHO tried this BEFORE the sequences came out).

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PostPosted: Tue Feb 16, 2010 6:54 pm 
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gsgs wrote:
with clustering I mean, that it mainly appears on one background, that you can spot an ancestor
and a marker-creation time.
Best example with mexflu is the Cancun-substrain, created ~mid April 2009 with 11 markers.
>60% of mexflu viruses meanwhile are this strain with the 11 mutations (markers).

Rarely will you find 2 mexflu viruses which share one of the 11 markers but not the others.

Each of the markers "clusters". They are obviously progeny from the same ancestor,
April 2009.


The above is a clade, NOT a cluster. When WHO talks about clusters, they are are talking about what happened in Ukraine. All of the isolates were the same clade, and D225G/N was CLUSTERED in the clade. WHO tried to say that D225G/N didn't transmit, so it was not found CLUSTERED in time, space, or clade. They said this in the Dec 28 paper, which was BEFORE the UKRAINE data came out, but the data after the paper showed that they were WRONG on ALL counts.

The paper was a propaganda piece and has NO scientific basis. It only works when the is little data. Now it is just a failed attempt to shore up random mutations. The idea that Ukrainians keep dying from an H1N1 that keeps making the same two mistakes over and over and all at the same time is as wacky as trying to say that at Duke one patient had wild type RBD, and another made ONE mistake and it coded for D225G, while a thrid made ONE mistake and it coded for D225N, all at the same time on the SAME WARD!

That's not science. That's VERY poor propaganda.

WHO and the CDC know it is not science so they try to say Duke is all a lab artifact. No one is trying to claim all of the coincidnece required to keep random mutations viable.

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PostPosted: Tue Feb 16, 2010 9:50 pm 
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gsgs wrote:

So the Lviv viruses are similar.

Since they preferrably tested viruses from lethal infection and 225G often is in lethal infection,
so you have many with 225G.
They may still have developed independently in each host.

There is no evidence that viruses with 225G from Duke,Ukraine,Norway,California...
share a common ancestor as for other markers.

The H1N1 in Ukraine forms a single clade (which is also found in Norway and Russia and on occasion in the US) and the D225G/N levels are EXTREMELY high in fatal cases and virtually absent in mild cases. The high frequency in Ukraine is clustering, which WHO said didn't happen. Of course they said it BEFORE the sequences came out. Now they look like fools because they should have known about the data prior to issuing the report, since the samples were collected in October and early November and they almost certainly had the data prior to the Dec 28 report becasue it was WHO regional centers (Mill Hill and CDC) that generated the data.

The fatal cases were NOT preferably tested. About an equal number of mild cases were tested and only one had D225G.

Trying to explain to Ukriane data with independent copy errors is absurd. There were 33 cases with D225G, D225N, or both, which were all collected over a two week period in western/central Ukraine.

However, copy errors is equally absurd for Duke, since all were infected with the same virus and three were infected at about the same time, but one sequence was wild type, one had D225G, and one had D225N.

These two markers are usually transmitting as mixtures and were formed by recombination, leading to jumps from one subclade to another.

Random mutations are DOA.

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PostPosted: Wed Feb 17, 2010 2:27 am 
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gsgs wrote:

There is no evidence that viruses with 225G from Duke,Ukraine,Norway,California...
share a common ancestor as for other markers.

Please. The Ukraine/Norway/Russia sequences with D225G form a large clade. D225G has jumped to many clades, but the one in Ukraine is easily the largest and shows that D225G and D225N is transmitting, although the sub-set within the sub-clade with D225G is almost exclusively from fatal cases (D225G/N is rare in non-fatal cases in genreral, including the Ukraine clade). This clade also has PB2 K340N, although K340N is in samples from fatal and non-fatal cases.

Your "no evidence" remark above is simply false.

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PostPosted: Sat Mar 20, 2010 5:31 pm 
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http://www.dukehealth.org/health_librar ... e_hospital

Final Report Confirms A Cluster of Oseltamivir (Tamiflu)-Resistant H1N1 Influenza at Duke Hospital

Here you go Dr. Niman :hello:


Quote:
By Duke Medicine News and Communications

An outbreak last fall of oseltamivir (Tamiflu)-resistant H1N1 influenza at Duke University Hospital may have been the result of viral transmission between patients.

Four patients in a hematology-oncology ward at Duke Hospital became symptomatic of fever and respiratory symptoms during a six-day period from Oct. 6-11, 2009. They were subsequently diagnosed with oseltamivir-resistant H1N1 Influenza. All four patients were ill with underlying severely compromised immune systems and other complex medical conditions.

Duke and a team of experts from the Centers for Disease Control and Prevention (CDC) and the State of North Carolina Public Health Department collaborated to investigate the nature of these cases. Their findings were presented at the Fifth Decennial International Conference on Healthcare-Associated Infections on March 20 in Atlanta, Ga.

“We found that the oseltamivir-resistant H1N1 influenza were isolated to the four patients. There was no evidence of spread to additional patients or caregivers on the affected ward,” said Luke Chen, M.D., an infectious diseases specialist at Duke University Medical Center.

The team carried out an epidemiologic investigation and extensively reviewed patients’ medical records, infection control measures, and interviewed visitors and health care personnel.

“We were not able to establish that health care workers or visitors had a role in the transmission.”

“We found that our infection control plans were properly implemented,” Chen said. “The compliance to hand hygiene is monitored by objective auditors at Duke Hospital. The hand hygiene compliance on the affected ward was greater than 92 percent during the study period – much higher than reports from other institutions. We also implemented contact isolation in addition to droplet precautions for severely immunocompromised patients. At the time of the four infections, the hospital was also operating with a visitor restriction policy, which recommended visits only from adult members of the patient’s immediate family or designated caregivers.”

Among hospitalized patients, influenza can often be hidden under other conditions and the suspicion for influenza might be low because many patients have other medical problems that could be causing their fever or respiratory symptoms, according to Chen.

“One key thing we can learn from this outbreak is that all clinicians and health care workers should suspect the diagnosis of influenza even among very ill patients, who have multiple medical problems,” Chen said. “We should include influenza in the diagnostic thought process early on and act on it by doing specific tests and placing these patients in appropriate isolation prior to obtaining the results of these tests.”

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PostPosted: Sun Mar 21, 2010 1:23 am 
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Quote:
“One key thing we can learn from this outbreak is that all clinicians and health care workers should suspect the diagnosis of influenza even among very ill patients, who have multiple medical problems,” Chen said. “We should include influenza in the diagnostic thought process early on and act on it by doing specific tests and placing these patients in appropriate isolation prior to obtaining the results of these tests.”


Littlebird, perhaps you can share this tidbit of information with your co-workers. :this:


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PostPosted: Sun Mar 21, 2010 2:39 am 
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> Four patients in a hematology-oncology ward at Duke Hospital
> became symptomatic of fever and respiratory symptoms during
> a six-day period from Oct. 6-11, 2009

the first known sample is from Oct.14

the first patient had symptoms Oct. 6 and on Oct. 14 or later
he/she had H275Y

other patients got symptoms between Oct.6 and Oct.11,
to decide who did transmit it to whom it would be useful
to have the individual symptom onset dates and the
assignments of the samples to the people.

Duke and CDC probably know this, so it's apparant that
they don't want us to know it.
Also the sequences are at GISAID but not at genbank as is
usual for US-sequences. Why ?

Did the mutations (239G,275Y) develope in one of the patients
and then was transmitted to other patients ?
Or did the first patient catch a virus (or mixture) which already
contained those mutations ?
Were the other patients infected by that first patient ? And when ?

They examined this. They probably know the anwer to this.

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PostPosted: Sun Mar 21, 2010 2:57 am 
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Duke and a team of experts from the Centers for Disease Control and Prevention (CDC) and the State of North Carolina Public Health Department collaborated to investigate the nature of these cases.
The team carried out an epidemiologic investigation and extensively reviewed patients’ medical records, infection control measures, and interviewed visitors and health care personnel.


They did extensive and careful examination.
But it took from Oct. to March, 5 months, wave over, that they decided to publish that (partial?) info. And this is even USA, they give usually better and more
informations than other countries.

The onset dates and likely transmission chain is still unknown to us.
The sequences are not published.
Where did the first patient get it from ?

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PostPosted: Sun Mar 21, 2010 3:09 am 
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all 4 patients had 275Y(NA), several samples from some patients.
So it looks likely that 275Y(NA) was either present at introduction
or passed from the first infected patient to all the others.

But apparantly not so 239G(HA), some have it , some not.
This can only be explained by independent development.
Or transmission of mixed populations - but then you have to wonder
why only that one mutation has mixtures.

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PostPosted: Sun Mar 21, 2010 3:22 am 
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Gator Flu Watcher wrote:
Quote:
“One key thing we can learn from this outbreak is that all clinicians and health care workers should suspect the diagnosis of influenza even among very ill patients, who have multiple medical problems,” Chen said. “We should include influenza in the diagnostic thought process early on and act on it by doing specific tests and placing these patients in appropriate isolation prior to obtaining the results of these tests.”


Littlebird, perhaps you can share this tidbit of information with your co-workers. :this:


~ Sigh.... I had at least four patients the other day, who were all over 60 years old, who had Chronic lung problems (with pneumonia), and all of them had classic flu symptoms. The sickest one had a history of Asthma. When I looked at his chart, he was diagnosed with community acquired pneumonia. He presented with high fever, nausea, chills, wheezing, and in severe respiratory distress. When I went in to do his treatment, I asked him non-chalantly... "So... you've got the flu?" He said "yes... I think I do." and then he added "I'm aching all over."

He was never given a flu test, nor was he given an antiviral. He wasn't in isolation. His doctor never even considered influenza, but did add in his chart that he had had a seasonal flu shot last fall.) I told his nurse that he had classic flu symptoms. She said "really?" (and nothing came of it)

Whenever you enter a hospital, with an underlying condition... your diagnosis is going to be related to that underlying condition. I'm starting to think THAT's why people with underlying conditions have a harder time... because NOBODY diagnoses them in a timely manner! :glare:

People at work think I'm weird because I KNOW this stuff. The majority of the healthcare workers I work with, don't even know about 1918.

They are starting to "look" at me weird lately, whenever I bring up influenza. Whenever I speak up, and ask if a patient has been tested... or when I point out that a certain patient has classic flu symptoms, and isn't in isolation, they act like they don't want to get involved. I'm actually getting paranoid. I find myself just keeping quiet.

Everybody is SO scared to admit that this virus is actually REAL.

I honestly feel like I'm in that movie "Invasion of the Body Snatchers" and somebody is going to point me out one day soon and start screaming! :shock:
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