Rhiza Labs FluTracker Forum

http://abcnews.go.com/blogs/health/2011 ... ack-again/

Swine Flu Back Again?

The U.S. Centers for Disease Control and Prevention is heightening its surveillance of a specific subtype of swine flu, according to a report from the agency. The report says that state public health labs across the country should notify the CDC immediately if they suspect someone is infected with the virus.

The CDC reports that since August, 12 people have been infected with the virus, called H3N2, in five states: Indiana, Iowa, Maine, Pennsylvania and West Virginia. Of the total, 11 were children, three were hospitalized and all have fully recovered.

The report said officials have observed two different scenarios of transmission: workers getting the virus from pigs and humans catching it from one another, which was the cause of two of the newest cases at a West Virginia day care.

“Nonhuman influenza virus infections rarely result in human-to-human transmission, but the implications of sustained ongoing transmission between humans is potentially severe,” the report said.

Swine flu swept the globe beginning in 2009, when the H1N1 subtype of the virus was first detected in the United States. An estimated 43 million to 89 million Americans caught swine flu during the pandemic, and 8,870 to 18,300 people died from it, according to the CDC.

The government launched a major initiative to get the public vaccinated, giving $1.6 billion to pharmaceutical companies and vaccine makers to ensure there was enough vaccine to go around. But vaccine supplies exceeded demand as public interest dwindled.

The World Health Organization officially declared an end to the H1N1 pandemic in August 2010.

The flu vaccine available this year includes the H3N2 virus, along with the H1N1 virus. Officials are again encouraging people to get vaccinated. The CDC recommends that anyone age 6 months and older be vaccinated for the flu.

“We should remember that [seasonal] flu causes 36,000 deaths on average each year,” Dr. William Schaffner, professor and chair of preventive medicine at Vanderbilt University in Nashville, Tenn., told ABC News. “It remains a serious illness.”

ABC News’ Courtney Hutchison and Lauren Cox contributed to this report.

_________________
www.twitter.com/hniman

No week 50 report yet

http://new.paho.org/hq/index.php?option ... 69&to=2246

_________________
www.twitter.com/hniman

http://www.cidrap.umn.edu/cidrap/conten ... dance.html

Novel flu cases prompt new CDC guidance
Lisa Schnirring Staff Writer


Dec 28, 2011 (CIDRAP News) – Alongside last week's confirmation of another novel flu infection with an H3N2 variant, the US Centers for Disease Control and Prevention (CDC) launched a series of documents to advise health and lab workers on how to identify and report new cases.

On Dec 23 the CDC confirmed two more novel flu infections, including in a West Virginia child with a swine-origin H3N2 reassortant strain (H3N2v) that includes the M gene from the 2009 H1N1 virus. The youngster was a daycare contact of an H3N2v case reported on Dec 9, and the newly confirmed case pushed the nation's H3N2v total to 12 so far.

The other novel flu infection involved a swine-origin H1N1 variant (H1N1v) that had also acquired the M gene from the 2009 H1N1 virus. The CDC said the patient, an adult from Wisconsin who had occupational exposure to swine, was the first detection of the H1N1v strain in a human.

On the same day the CDC announced the two novel flu cases, it released documents that address preventing seasonal and H3N2v in healthcare settings, interim guidance on H3N2v specimen collection and testing, and interim case definitions for investigating H3N2v infections.

Most H3N2v infections have been mild, and only 3 of the 12 patients were hospitalized, the CDC said. Though it's not clear if cases will become more common, it's possible that healthcare providers will care for patients who have H3N2v infections, it added.

So far there is no evidence that H3N2v transmission characteristics are different from seasonal flu, so the CDC advises that facilities use the same infection control procedures as for seasonal flu to help guard against the spread of H3N2v, including the vaccination of healthcare workers. However, it added that the seasonal flu vaccine may provide limited protection against H3N2v in adults and no protection in children.

Given that limited person-to-person spread of H3N2v seems to be occurring, especially in children, the CDC released interim guidance designed to streamline its detection and investigation. It advised state and local health departments to use the CDC's real-time reverse transcriptase polymerase chain reaction (rRT-PCR) panel to screen for influenza A, influenza B, and ribonuclease P (an indicator of specimen adequacy), then use its influenza A subtyping kit, employing all primer and probe sets.

The CDC recommended that states increase the collection of respiratory specimens from patients with flulike illnesses who fall into certain high-priority groups, including children in childcare and school settings, unusual or severe flulike illness presentations (especially in kids), and medically attended flulike illnesses and acute respiratory infections in children.

Interim recommendations for collecting respiratory specimens for patients with suspected H3N2v infections are consistent with those for seasonal flu, the CDC said. It added that the duration of H3N2v shedding is unknown, and until more data are available, infected patients should be assumed to be contagious for up to 7 days from illness onset.

It said molecular assays may detect novel influenza A viruses but will not differentiate them from seasonal strains and may give an unsubtypable result, which should be forwarded to state or local labs for additional testing. Molecular assays may give a false-positive result for human H3 viruses, according to the CDC.

Rapid and immunofluorecense tests have unknown sensitivity and specificity to the H3N2v virus, and negative results from either test don't rule out flu infections in patients with signs and symptoms that suggest influenza.

The CDC said H3N2v viruses will be positive for the nucleoprotein (NP) gene (pdmInfA), influenza A, and seasonal influenza A (H3) targets of the CDC's rRT-PCR diagnostic panel. All suspected novel influenza A and H3N2v samples should be sent to the CDC for confirmational testing, it said. "Confirmation of influenza A (H3N2)v virus is performed only at CDC at this time."

The agency urged health departments to conduct contact tracing of confirmed, probable, or suspected H3N2v cases and provided definitions for the three levels of cases in a separate document. It asked health departments to notify the CDC about all suspected and probable H3N2v infections within 24 hours of identification.

The CDC defined a suspected H3N2v case as an acute respiratory illness in a patient who has an epidemiologic link to a confirmed case or got sick within 7 days of swine exposure.

It said a probable case is in a patient whose respiratory sample tested positive on the CDC RT-PCR flu panel for influenza A, pandemic influenza A, and H3, but negative for influenza B, pandemic H1, and H1. Also, a probable case could be in a person who has an acute respiratory infection and a link to a confirmed H3N2v case and whose diagnostic test is positive for influenza A (H3) or influenza A (no subtype tested or detected).

In a related development, the CDC updated its background information on swine influenza for pork producers and farmers, incorporating the latest information about novel influenza A viruses, urging people to take precautions when pigs and animal handlers have respiratory illnesses.

See also:

Dec 23 CDC prevention strategies for seasonal and H3N2v influenza in healthcare settings

Dec 23 CDC interim guidance for H3N2v specimen collection

Dec 23 CDC interim guidance for testing patients who have a suspected H3N2v infection

Dec 23 CDC interim guidance on H3N2v case definitions

Dec 23 CDC information for pork producers and farmers

Dec 23 CIDRAP News story "CDC reports two more novel flu infections"

_________________
www.twitter.com/hniman

A new strain of the swine flu virus called A(H3N2) may now be spreading through person-to-person contact, the Public Health Agency of Canada says.

The announcement comes after a number of warnings concerning the H3N2 virus by U.S. authorities in recent months.

The virus is a variant of the swine flu virus H3N2.

Though it usually infects pigs, the A(H3N2) virus has infected 12 people in the U.S. since July 2011, according to the U.S. Centre of Disease Control and Prevention. Most cases have been mild respiratory illnesses, though three people with underlying conditions were hospitalized and recovered.

While in earlier cases the virus had spread from pigs to humans, the most recent cases were spread through limited person-to-person contact, according to PHAC. No cases of the virus have been reported in Canada.

PHAC said it is monitoring the situation closely and increasing its surveillance.

It is also urging Canadians to get the flu shot and to practice proper sneezing and coughing etiquette, as well as frequent hand washing to prevent the spread of the virus.

http://www.cbc.ca/news/health/story/201 ... -phac.html

_________________
www.twitter.com/hniman

In recent weeks, a new variant of the influenza A H3N2 virus, now referred to as
A(H3N2)v has been identified in the United States. A(H3N2)v is a swine origin influenza virus which also has genes from birds and humans, and usually infects pigs.

The U.S. Centre for Disease Control and Prevention (CDC) has detected 12 cases of human influenza infection caused by the A(H3N2)v since July 2011. According to the CDC, most infections with the virus have resulted in mild, self-limited respiratory illnesses; three people, all with underlying medical conditions, were hospitalized, but have since recovered.

Early cases of infection with A(H3N2)v were associated with contact with pigs, but more recent cases were not, suggesting that A(H3N2)v is now capable of limited human to human spread.

No cases of the A(H3N2)v influenza virus have been identified in Canada. As is the case for all new variant influenza strains however, the Public Health Agency of Canada is working with provinces and territories to closely monitor the situation and has increased its surveillance for A(H3N2)v in Canada.

The Public Health Agency of Canada continues to encourage Canadians to get the flu shot and to take the usual precautions such as regular hand washing and coughing or sneezing into your arm, to protect themselves from the flu.

In collaboration with the Public Health Agency of Canada, the Canadian Food Inspection Agency has also issued information for the food production industry to help protect animal and human health during the flu season.

There are other steps Canadians can take to protect themselves and others from the flu. For more information visit fightflu.ca or get a copy of Fight Flu: Your Seasonal Flu Guide.

http://www.phac-aspc.gc.ca/influenza/h3n2-eng.php

_________________
www.twitter.com/hniman

An outbreak of a new strain of swine flu sent BiondVax stock soaring Wednesday. Shares of the universal flu vaccine developer rocketed up 26% during the day, with gains moderating and the share closing up 6.6%.

BiondVax's universal influenza vaccine, Multimeric-001, is meant to protect against the vast majority of flu strains, including avian and swine flus, as well as seasonal viruses. The firm's development is based on research done by Prof. Ruth Arnon, one of the three original developers of Teva's Copaxone drug for multiple sclerosis.

The vaccine is currently in the second stage of Phase II trials with Phase III trials scheduled for next year.

The subtype H3N2 flu virus in the new outbreak is resistant to Tamiflu - the leading treatment today for swine flu of the H1N1 strain, which broke out in April 2009 and caused 38,000 deaths around the world. The U.S. Center for Disease Control already has found 12 deaths as a result of the new strain in five U.S. states.

http://english.themarker.com/swine-flu- ... g-1.405560

_________________
www.twitter.com/hniman

Tomorow's (week 51) MMWR reportable disease page (last report for 2011) has no updates on novel influenza (remains at 8 reported in 2011, which includes 6 cases infected in 2011).
Novel influenza A infection virus *** - 8 0 4 43,774 2 4 NN

http://wonder.cdc.gov/mmwr/mmwr_reps.as ... wr_table=1

Last entries were cases from Maine in October. The following cases have yet to be reported:
Indiana/10/2011 (October) H3N2pdm11 (H3N2v)
Iowa/07/2011 (November) H3N2pdm11 (H3N2v)
Iowa/08/2011 (November) H3N2pdm11 (H3N2v)
Iowa/09/2011 (November) H3N2pdm11 (H3N2v)
West Virginia/06/2011 (December) trH3N2 (H3N2v)
West Virginia/07/2011 (December) trH3N2 (H3N2v)
Minnesota/19/2011 (December) trH1N2 (H1N2v)
Wisconsin/28/2011 (December) trH1N1 (H1N1v)
Northern California (December) trH3N2/H3N2pdm11 (H3N2v)

IHR regulations require reporting within 48 hours of lab confirmation. All of the above (with the possible exception of Northern California) have been lab confirmed (and likely reported to the WHO website on notifiable diseases), but the lag in CDC MMWR reporting remains curious.

_________________
www.twitter.com/hniman

Tomorrow's MMWR also has week 52 update, which also does NOT update data on novel infleunza cases in 2011
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6052md_w

_________________
www.twitter.com/hniman

A new flu virus thought to have originated in pigs has agricultural producers on alert two years after a swine flu pandemic caused sales to drop and disrupted U.S. pork exports.

Twelve people in five states have been infected, with three hospitalized, according to the Centers for Disease Control and Prevention in Atlanta. At least six reported no recent exposure to pigs, suggesting “limited human-to-human transmission,” according to the report. Eleven of those stricken were children.

The virus may not become as prevalent as the 2009 variant, known as H1N1, which led to as many as 89 million cases and 18,300 deaths in the United States in the first flu pandemic in more than 40 years, according to the CDC. Still, livestock producers are concerned that consumers may fear they can get a potentially lethal disease from eating pork. Flu is transmitted through droplets of i nfected body fluids when people cough, sneeze or talk.

“It’s always something that we need to keep an eye on, that it doesn’t get more severe or spread more quickly,” Liz Wagstrom, chief veterinarian with the National Pork Producers Council, which has offices in Des Moines, Iowa, and Washington. “It’s very important the public understand you can’t get flu from eating pork.”

During the H1N1 pandemic, China and Russia closed their markets to U.S. pork and industry revenue was estimated to have fallen by nearly $2.2 billion in the last eight months of 2009, according to the council. The H1N1 strain contained genetic material from five different flu viruses, including North American swine and bird flu and two swine flu viruses found in Europe and Asia.

The Des Moines, Iowa-based National Pork Board, which conducts research on pork and promotes the food, has sent out alerts, said Wagstrom. Veterinary labs that test samples from sick pigs are on the lookout for the strain, she said.

Federal agencies are not referring to the new strain as swine flu, mindful of the popular description of H1N1 that upset markets and producers. Such illnesses contain a genetic mix of viruses seen in pigs, birds and people and get the moniker because the overall structure is the type that affects pigs.

“We are aware of the pork industry’s concerns,” said Jeff Dimond, an agency spokesman, in an interview. CDC has “gone overboard” not to use the description, he said.

The new virus, called H3N2v, contains a gene from the 2009 variant, according to the CDC. The agency is “taking this situation very seriously” and has increased surveillance in areas where cases occurred, according to a Dec. 9 CDC report. As a precaution, a candidate vaccine has been developed and provided to manufacturers so they can begin production if necessary, according to the report.

The strain has been detected in Indiana, Iowa, Maine, Pennsylvania and West Virginia, according to the Atlanta-based health agency.

Despite the added surveillance, government scientists haven’t made conclusions about the durability of the new strain.

All the people sickened have recovered and no continuing transmission has been detected, according to the CDC. Human immunity may be a concern because it’s a new virus.

“This particular strain could get legs, so to speak, or just die out,” Dimond said.

The strain isn’t too worrisome because it doesn’t seem to be spreading quickly, said Peter Katona, associate clinical professor of infectious diseases at UCLA.

The reported cases have prompted “concern, but I wouldn’t say it’s super high,” said John Treanor, chief of the infectious disease division at the University of Rochester Medical Center in New York.

It’s important to track such viruses so the U.S. can respond if they begin spreading rapidly and become more virulent, he said.

“Will the viruses be able to emerge from pigs into humans and cause another pandemic in humans?” said Treanor. “That’s why we keep track of what kinds of viruses are emerging.”

http://bangordailynews.com/2012/01/05/h ... -on-alert/

_________________
www.twitter.com/hniman

January 5, 2012 — A precautionary vaccine against the novel swine influenza virus, which has sickened 12 people in 5 states since July, is in development and will likely be ready for clinical trials this spring, a spokesperson for the Department of Health and Human Services (HHS) told Medscape Medical News.

HHS has contracted with pharmaceutical companies Novartis and Sanofi Pasteur to develop investigational lots of the vaccine. Novartis will produce its supply using cell-culture technology at its plant in Holly Springs, North Carolina, and Sanofi Pasteur will grow the vaccine in chicken eggs (a slower method of production) at its plant in Swiftwater, Pennsylvania.

The influenza virus being targeted is a variant of the A(H3N2) virus found in pigs. There is also a human A(H3N2) virus that circulates on a seasonal basis. The trivalent seasonal vaccine for 2011 to 2012 guards against the human A(H3N2) virus, but the US Centers for Disease Control and Prevention (CDC) does not expect it to offer significant protection against the variant of the swine-origin version, which has been dubbed A(H3N2)v.

What accounts for the variance is a gene from the pandemic 2009 influenza A(H1N1) virus that codes for matrix proteins found in the viral shell.

Eleven of the 12 people infected with the A(H3N2)v virus were children, according to the CDC. All recovered, although 3 were hospitalized. The illness produced by the novel influenza virus is generally no more severe than that associated with seasonal influenza.

In 3 of the 5 states where the virus has emerged (Pennsylvania, Maine, and Indiana), the virus apparently spread from pigs to humans. What concerns influenza watchers is evidence of limited human-to-human transmission in Iowa and West Virginia. The CDC is urging public health agencies and clinicians to collect more nasopharyngeal swabs from patients presenting with influenza-like illness for testing to ascertain whether the virus is spreading on a sustained basis among humans.

HHS routinely develops vaccines to test against novel influenza viruses "with potential pandemic potential," said Gretchen Michael, director of communications for the department's Office of the Assistant Secretary for Preparedness and Response. Examples of other novel viruses that have triggered precautionary vaccine development, said Ms. Michael, include avian influenza viruses such as A(H9N2) and A(H7N5).

"This is part of HHS' ongoing pandemic planning," she said.

http://www.medscape.com/viewarticle/756 ... 38?src=rss

_________________
www.twitter.com/hniman