Swine flu

tallaght01

Anyone else wondering how this is going to pan out? The Mexicans seem to be taking the right steps, but it's in the states now! The Americans will be able to nail it if they find the cases before it's disseminated throughout the community.

Anyone started wearing their virus particle masks yet? :P

fishtastico

I'm going to cross my fingers that it stays in the news until my oral microbiology exam in June. It'll defininitely be something worth talking about! That's not to say I want more people infected, etc...

derry

I only got the news today from a USA internet site


http://www.gcnlive.com/mediaPlayers/...ram=whatReally
more info this thread

<SNIP: that link is not info, it's irresponsible information that could lead to people not taking treatment if offered - Tallaght01 SNIP>


whats your news sources
NB found this one at bbc
http://news.bbc.co.uk/2/hi/americas/8016909.stm

Derry

Vorsprung

I told my ex-girlfriend 2 years ago to buy shares in the company that made Tamilflu, she was doing a fantasy stock market thing as part of a course.

If only I had followed my own advice

On a more serious note, the extremes of age haven't been hit in the US cases (http://www.cdc.gov/media/transcripts/2009/t090423.htm), the range being 9-54, almost evenly split between men and women. All have recovered, with one hospitalisation. The Mexican cases though have resulted in a good few fatalities (I saw a figure like 6% mortality rate being mentioned somewhere). It'll be interesting to see what the difference in the strains is (if that is what's causing the difference in morbidity/mortality). Unless it's mutating really quickly - uh oh!

tallaght01

Go straight to the horse's mouth. This is what we've been using:

http://www.who.int/csr/don/2009_04_24/en/index.html

http://www.cdc.gov/swineflu/investigation.htm

I can't help feel that there could be human to human transmission here, seeing as the cases in the states have no obvious links to infected animals, nor to any of the cases in mexico.

blackgold>>

I can't help feel that there could be human to human transmission here, seeing as the cases in the states have no obvious links to infected animals, nor to any of the cases in mexico.

It already is human to human.

tallaght01

blackgold>> wrote: »

It already is human to human.

That's not been confirmed yet, has it?

blackgold>>

http://www.cdc.gov/swineflu/investigation.htm


Residents of California and Texas

CDC has identified human cases of swine influenza A (H1N1) virus infection in people in these areas. CDC is working with local and state health agencies to investigate these cases. We have determined that this virus is contagious and is spreading from human to human. However, at this time, we have not determined how easily the virus spreads between people. As with any infectious disease, we are recommending precautionary measures for people residing in these areas.

Pretty nasty virus.

tallaght01

We've just had a meeting where the CDC advice given to us was that there's only limited evidence of person to person transmission.

There has been occasional human to human transmission of the traditional swine flu virus, but I don't know how they've confirmed it in these cases.

There's a meeting going on in the WHO in geneva now looking at the cases to see if there's an epidemiological link suggesting person-to-person transmission.

I've no real doubt that the virus will have some ability to pass between humans, but when it starts acting like human flu A then it's gonna become a real problem.

fishtastico

Isn't H1N1 just your bog-standard flu? It's kind of in the name, right?

SomeDose

bigjimthefirst wrote: »

I told my ex-girlfriend 2 years ago to buy shares in the company that made Tamilflu, she was doing a fantasy stock market thing as part of a course.

If only I had followed my own advice

Interesting you should mention that. A few years back (2005/6?), when the avian H5N1 flu was threatening to become epidemic, there was a lot of controversy over allegations that Roche were deliberately dragging their heels in ramping up production of Tamiflu (oseltamivir). Basically a lot of wealthy western countries stockpiled it whilst poorer nations were deprived of it. The irony of this, of course, is that poor countries (with their high population densities, underdeveloped healthcare, crappy sanitation etc) will get hammered far worse than western nations by any outbreak. Classic health inequality right there, on a global scale. Great news for the manufacturer though, as it's share price went up by about 60% and 2006 sales were about $2billion. Compare this to sales of $266million in 2004, before the media frenzy of a potential epidemic took hold. So you can understand why people might be suspicious of Roche's reticence to increase production and outsource it to generic manufacturers.

I notice this swine flu is currently sensitive to oseltamivir, so maybe it's not too late to invest you money Jim! Although in saying that, many western countries have reached saturation point with their stockpiles so I'd imagine the potential for more sales is limited. Watch this space I guess.

Chardee MacDennis

local news in mexico is reporting 1000+ infected with over 200 fatalities.

http://news.bbc.co.uk/2/hi/talking_point/8018428.stm

the flu seems to be a combination of swine, bird and human flu. anyone care to explain the implications of this? one person on that BBC page says people who were vaccinated recently have died. authorities seem to be doing a good job so far, shutting down football games and the like.

tallaght01

Well, there's no vaccine against this particular strain. So people may well have been vaccinated against normal seasonal flu and still died.

406C

Thought you might enjoy these snippets Tallaght01

The Great Flu Pandemic of 1918 was the greatest plague of modern times. It is estimated to have killed between 25 million and 40 million people worldwide. History shows us that those under chiropractic care during the flu pandemic had a far better chance of survival.

One example: medical doctors in Davenport, Iowa, treated 93,590 patients, with 6,116 deaths ‑‑ in other words, 1 out of 15 under medical care succumbed to the flu. At the Palmer College of Chiropractic in Davenport, 1,635 flu cases were adjusted, with only one fatality. Outside of Davenport, chiropractors adjusted 4,735 flu cases, with only six deaths ‑‑ 1 out of 866. In 1919, Palmer published "The Flu and You." The ratio of flu cases cared for versus deaths were as follows: Medical care: 1 out of 17 died. Osteopathic care: 1 out of 36 died. Chiropractic care: 1 out of 886

You might be surprised to read that an osteopath helped my flu. After all, aren't they just glorified chiropractors? Not by a long shot. Osteopathy has a long history of treating the flu effectively. In fact, during the worst flu pandemic to ever strike globally in 1918, osteopathy greatly outperformed conventional medicine in this country.

In the worldwide bird flu pandemic of 1918-1919, 1% of the world's population--nearly 30 million people--died! More than 500,000 people in the U.S. alone succumbed. Osteopathy saved more lives than conventional medicine. Only 0.25% of osteopathic patients died. Once the patients of conventional doctors progressed to pneumonia, their mortality soared to from 33% to 78%! In fact, the death rate of osteopathic patients was one-fortieth that of people treated by conventional doctors.

tallaght01

I've no doubts those figures come from a reputable source.

I've also noooooo doubt whatsoever that they weren't affected by "severity bias"...where the sickest people attend hospital, so docs deal with he most severe cases, that are also more likely to die.

Those kinds of figures are also used by people to show that homecare is superior to hospital care. So, the people with mild flu stay at home to be cared, and not many die. An the ones with flu pneumonia etc, the stuff that kills people, all go to hospital, and some of them die.

Red Sleeping Beauty

Is this really that serious ?
And if it is , has Ireland any sort of ability for vaccination ? Ye know, erm, what with the poor health service and all that.

Prime Mover

Chiropractor or oseltamivir? Tough call.....

RobFowl

Prime Mover wrote: »

Chiropractor or oseltamivir? Tough call.....

Whats wrong with Homeopathy

406C

tallaght01 wrote: »

I've no doubts those figures come from a reputable source.

I've also noooooo doubt whatsoever that they weren't affected by "severity bias"...where the sickest people attend hospital, so docs deal with he most severe cases, that are also more likely to die.

Those kinds of figures are also used by people to show that homecare is superior to hospital care. So, the people with mild flu stay at home to be cared, and not many die. An the ones with flu pneumonia etc, the stuff that kills people, all go to hospital, and some of them die.

No doubt Tallaght01 but they may have a part to play...

Prime Mover wrote: »

Chiropractor or oseltamivir? Tough call.....

Chiropractic/Osteopathy = Maintenance of robust good health and all that.

oseltamivir?

http://en.wikipedia.org/wiki/Oseltamivir

Neurological effects
There are concerns that oseltamivir may cause dangerous psychological, neuropsychiatric side effects including self harm in some users. These dangerous side effects occur more commonly in children than in adults.[13] This stems from cases in Japan, where the drug is most heavily prescribed. Concern has focused on teenagers, but problems have also been reported in children and adults.
In March 2007, Japan's Health Ministry warned that oseltamivir should not be given to those aged 10 to 19. [5] The Ministry had previously decided, in May 2004, to change the literature accompanying oseltamivir to include neurological and psychological disorders as possible adverse effects, including: impaired consciousness, abnormal behavior, and hallucinations.
According to Japan's Health Ministry, between 2004 and March 2007, fifteen people aged 10 to 19 have been injured or killed by jumps or fallen from buildings after taking oseltamivir, and one 17-year-old died after he jumped in front of a truck.[6][7][8] A renewed investigation of the Japanese data was completed in April 2007. It found that 128 patients had been reported to behave abnormally after taking oseltamivir since 2001. Forty-three of them were under 10 years old, 57 patients were aged 10 to 19, and 28 patients were aged 20 or over. Eight people, including five teens and three adults, had died from these actions.[9] (For more on Japan, also see:[14][15])
In November 2006, the United States Food and Drug Administration (FDA) amended the warning label to include the possible side effects of delirium, hallucinations, or other related behavior.[16] This went further than the FDA's previous pronouncement, from a year before, that there was insufficient evidence to claim a causal link between oseltamivir use and the deaths of 12 Japanese children (only two were from neurological problems, although more have died since then).[17] The change to a more cautionary stance was attributed to 103 new reports that the FDA received of delirium, hallucinations and other unusual psychiatric behavior, mostly involving Japanese patients, received between August 29, 2005 and July 6, 2006. This was an increase from the 126 similar cases logged between the drug's approval in 1999 and August 2005. [10]
In October 2006, Shumpei Yokota, a professor of pediatrics at Yokahama City University, released the results of research involving around 2,800 children which found no difference in the behavior between those who took oseltamivir and those who did not. A media source notes that Chugai Pharmaceutical Co. (which produces Tamiflu in Japan) gave Yokota's department 10 million yen ($85,000) over five years.[11][12]
Roche points out that Tamiflu has been used to treat 50 million people since 1999, and states that influenza may itself cause psychological problems.[13][14]
In March 2007, the European Medicines Agency said that the benefits of oseltamivir outweighed the costs, but that it would closely monitor reports from Japan. [15]
In April 2007, South Korea issued a safety warning against prescribing tamiflu to teenagers except in special cases.[16]

Vorsprung

SomeDose wrote: »

Interesting you should mention that. A few years back (2005/6?), when the avian H5N1 flu was threatening to become epidemic, there was a lot of controversy over allegations that Roche were deliberately dragging their heels in ramping up production of Tamiflu (oseltamivir). Basically a lot of wealthy western countries stockpiled it whilst poorer nations were deprived of it. The irony of this, of course, is that poor countries (with their high population densities, underdeveloped healthcare, crappy sanitation etc) will get hammered far worse than western nations by any outbreak. Classic health inequality right there, on a global scale. Great news for the manufacturer though, as it's share price went up by about 60% and 2006 sales were about $2billion. Compare this to sales of $266million in 2004, before the media frenzy of a potential epidemic took hold. So you can understand why people might be suspicious of Roche's reticence to increase production and outsource it to generic manufacturers.

I notice this swine flu is currently sensitive to oseltamivir, so maybe it's not too late to invest you money Jim! Although in saying that, many western countries have reached saturation point with their stockpiles so I'd imagine the potential for more sales is limited. Watch this space I guess.

With the current trend of poorer countries going out of their way to make generic versions of drugs (like anti-retrovirals in Brazil and India), you'd wonder whether they'd just crack on and just make them. In the face of a pandemic, you couldn't really argue with it.

406C

bigjimthefirst wrote: »

With the current trend of poorer countries going out of their way to make generic versions of drugs (like anti-retrovirals in Brazil and India), you'd wonder whether they'd just crack on and just make them. In the face of a pandemic, you couldn't really argue with it.

maybe they are afraid of the health care costs that would accompany the side effects outlined

Chardee MacDennis

Alan Rouge wrote: »

Is this really that serious ?
And if it is , has Ireland any sort of ability for vaccination ? Ye know, erm, what with the poor health service and all that.

from AH of all places:

Quartet wrote: »

http://www.dohc.ie/issues/flu_pandemic/
Dept of Health & Children

An emergency supply of over 45,000 treatment packs of antivirals (Tamiflu®) was purchased in 2004. A further 1 million treatment packs of antivirals (Tamiflu®) have been stockpiled. This quantity is sufficient to treat 25% of the population.

Tamiflu® capsules are not suitable for young children. The health services have, therefore, also stockpiled a supply of the active pharmaceutical ingredient (API) which will allow for treatment of almost 110,000 children.

Recommendations for the stockpiling of antivirals are kept under constant review by the Pandemic Influenza Expert Group. The Expert Group advised that a quantity of zanamivir (Relenza®) should be stockpiled in addition to oseltamivir (Tamiflu®). 706,000 courses of Relenza® have now been stockpiled by the HSE.

The quantity of antivirals in stock or on order is enough to treat almost 2 million people. This compares very favourably with other countries across Europe and beyond.

Plans for the distribution of antivirals in the event of a pandemic are being finalised. In a pandemic situation antivirals will primarily be used for treatment of influenza cases:


At the start of a pandemic in Ireland (when isolated cases or small outbreaks are occurring, and when transmission is not occurring efficiently), antivirals will be used for treatment of influenza cases and short-term prophylaxis to prevent infection developing in close contacts including family members and health care workers.
In the event of a full scale pandemic, antivirals will be used for treatment only

RobFowl wrote: »

Whats wrong with Homeopathy

you're joking right?

tallaght01

406C wrote: »

maybe they are afraid of the health care costs that would accompany the side effects outlined

Thanks for your insight.

I think you're wasted here. You need to be in a major decision-making role during this outbreak.

You're so right to say that the big concern of a developing country being hit with a virus that has an 8% mortality, and the potential to infect large numbers, is the side-effects of Tamiflu, and it's effects on their health system lol

You should also get in contact with the WHO straight away and tell them there may be side effects from an anti-viral drug. Quick, tell them. Don't delay...there are lives at stake!!!!!!!!!!!!!

Prime Mover

406C wrote: »

maybe they are afraid of the health care costs that would accompany the side effects outlined

Just skimmed through that but it looks like 128 out of 35 milliion Japanese treated?

Tell you what, if Swine flu gets here, I'll trade you your antivirals for a back rub.

tallaght01

Prime Mover wrote: »

Just skimmed through that but it looks like 128 out of 35 milliion Japanese treated?

Tell you what, if Swine flu gets here, I'll trade you your antivirals for a back rub.

LOL I'll trade him his bed in ICU for a bunk in the osteopath college when my pneumonia starts to engulf me :P

Red Sleeping Beauty

So erm, if it does get to Europe , how much danger are we in ?
When I first saw the headlines on Sky I brushed it off (60 dead from flu ? ) as they usually lead with the scariest headline.

Hmm... are them iodine tablets we got in 2001 any use ?

SomeDose

With the current trend of poorer countries going out of their way to make generic versions of drugs (like anti-retrovirals in Brazil and India), you'd wonder whether they'd just crack on and just make them. In the face of a pandemic, you couldn't really argue with it.

Morally, no. Legally, yes. In saying that, Roche have already reached sub-licensing agreements with Chinese and Indian generic manufacturers to produce Tamiflu for developing nations. Although it's debatable whether or not this would meet demand in the event of an epidemic. Most likely not, I suspect.

406C wrote: »

maybe they are afraid of the health care costs that would accompany the side effects outlined

No, more likely they're afraid of the legal implications.

With regard to adverse reactions, yes there have been rare reports of neurological effects with Tamiflu, but please don't reference wikipedia for anything scientific. Ever. It's just not credible or reliable. Besides, nobody is suggesting oseltamivir is a magic bullet. It's designed to reduce replication of the virus and hence decrease duration of symptoms, reduce infectivity and minimise any associated complications. It is by no means a cure for influenza.

tallaght01

We just need to wait an d see what happens in terms of how nasty it could be. It will spread to developed contries by the looks of it. It looks like human to human transmission is happening, but it doesn't look like it's as highly contagious as normal flu, but that might be because of good isolation procedures in the states and NZ.

We haven't seen this strain of virus before, so not sure how dangerous it will be. We know that, historically, influenza hammers through populations when there's a new strain (if there's a big enough change in the virus). That's the worry here. The mexicans reported about 7 or 8% mortality rate. But we're wondering if there's a severity bias......in poorer countries, a lot of people don't have access to hospitals. So, sometimes only the sickest people are the only ones who make it to hospital. That means a load of people who have the disease never get reported are sitting at home because they're not that bad.

So, this messes about with your figures. the fact that those people in america and NZ who have the disease are reasonably well, suggests this might be the case. But we'll just have to wait and see.

Alan Rouge wrote: »

So erm, if it does get to Europe , how much danger are we in ?
When I first saw the headlines on Sky I brushed it off (60 dead from flu ? ) as they usually lead with the scariest headline.

Hmm... are them iodine tablets we got in 2001 any use ?

Red Sleeping Beauty

Tallaght, do you think this situation warrants the media coverage it's getting ? Especially the sky news style coverage with accompanied death toll?

tallaght01

Alan Rouge wrote: »

Tallaght, do you think this situation warrants the media coverage it's getting ? Especially the sky news style coverage with accompanied death toll?

Absoloutely. If it's highly virulent, combined with a high mortality (and I emphasise the word "if") then this could be a huge public emergency.

But it may just fade away.

It's the unknown that is scary at the moment. But there's a LOT of stuff going on in most countries behind the scenes with planning commitees, trying to stop it spreading.

I would imagine Ireland have a reasonably good plan in place to deal with this if it becomes an issue.

Red Sleeping Beauty

tallaght01 wrote: »

I would imagine Ireland have a reasonably good plan in place to deal with this if it becomes an issue.

you're a funny guy, this is why I like you

s8n

folks I'm going on a trip to Mexico in 2 weeks, should I be really worried about this and where should I look for info ?

Red Sleeping Beauty

Department of Foreign Affairs should have appropriate info.

balu

s8n wrote: »

folks I'm going on a trip to Mexico in 2 weeks, should I be really worried about this and where should I look for info ?

In two weeks we will know more about how dangerous it really is.

Russia recommends not to:
http://en.rian.ru/russia/20090426/121317947.html

Vorsprung

Just in case people think the Governement haven't planned on the issue, the health authorities have been working on a few things over the last few years.

http://www.dohc.ie/press/releases/2007/20071126.html
http://www.dohc.ie/issues/flu_pandemic/
http://www.hse.ie/eng/Publications/Emergency_Management/National_Plan_for_Pandemic_Influenza_January_2007_.pdf

The Emergency Dept in my hospital has a few meetings a year to update the local plans for a pandemic. I've also seen a bank of DVDs and books dealing with influenza pandemics.

Vorsprung

s8n wrote: »

folks I'm going on a trip to Mexico in 2 weeks, should I be really worried about this and where should I look for info ?

Talk to the people you booked your trip with, as well as watching the DoFA site.

DrIndy

The difficulty with influenza is the virulence of the virus as well as its high infectivity.

The two markers people talk about are H&N
Haemaglutinin and Neuraminidase

These mutate on their own - so if you have a new H or a new N - you get the flu - but you recover because your body is already immune to one of the markers and the virus is not fully active.

BUT - get a new H AND a new N then things change rapidly - you have no immunity and no means of holding the virus back for 2 weeks when the full immune response kicks in - and this is when influenza kills the old, sick and young - and leaves everyone else very ill.

The issue with avian flu and swine flu is these are animal vectors with new H/N types - so they are high lethality with low infectivity and only people in close proximity get the disease. However - if you happen to be coinfected with a strain of human flu or the virus manages to mutate other proteins which allow it to have higher infectivity - you get a high lethality and high infectivity. Instant pandemic.

Spanish flu killed more people than the 1st world war if I recall correctly - not to be trifled with.

Chardee MacDennis

s8n wrote: »

folks I'm going on a trip to Mexico in 2 weeks, should I be really worried about this and where should I look for info ?

most stuff is will be shut down until may the 6th of May in Mexico City. just got to wait till we hear more, if i was supposed to be going to Mexico tomorrow i wouldnt...

Chardee MacDennis

US CDC saying it cannot be contained

http://www.abc.net.au/news/stories/2009/04/26/2552700.htm

fishtastico

DrIndy wrote: »

The issue with avian flu and swine flu is these are animal vectors with new H/N types

Swine flu is H1N1... Which, as the name may suggest, has already been around before. People are already vaccinated for it here. Anyway, isn't the mortality rate like, 6%?

Chardee MacDennis

20% from local reports in mexico. it isnt responding to vaccines apparently. it also isnt just swine flu but a combination of human,avian and swine. so i wouldnt be so sure...

fishtastico

There have been 1347 cases in Mexico with 80-odd deaths. And no deaths from the US patients yet.

Chardee MacDennis

fishtastico wrote: »

There have been 1347 cases in Mexico with 80-odd deaths. And no deaths from the US patients yet.

80 odd confirmed, local reports are saying over 200 dead...

fishtastico

BastardPrince wrote: »

80 odd confirmed, local reports are saying over 200 dead...

Luckily all the locals are doctors and virologists... But seriously, I think it's really being blown out of proportion here. Like SARS. Obviously steps need to be taken by authorities, but the media really are going a bit overboard with the whole near-apocalyptic element to this.

DrIndy

Influenza killed up to 100 million in 1918-1919!

More than a million were killed in 2 later outbreaks after the second world war - so its big stuff and potentially very serious - however, I do agree - when there is something serious like this going on it should not be sensationalised.

fishtastico

Oh, I agree that it's serious business, but I think it's just been blown out of all proportion, and people are jumping to all kinds of conclusions. If they start bringing out the dead on carts, with mass graves and the like, then I'll worry :cool:. But yeah, I'd like to just wait and see what happens and not be swayed too much by the papers, the internet.

Petelomejor

Unfortunately its the commercial famers who have hijacked the world again. As if the economies werent bad enuf.
I have no gripe against farmers in the main, but when its negligence , I have little patience
We had our problems with the feed for pigs in Ireland with the processor in Carlow adding their imput. But now its much worse. The root of the problem is being traced back to Carroll Farms in Jalapa Veracruz Mexico.
They are a pig rearing enterprise who I am surmising dont have any Best Practice Awards

It appears that faecel waste piled up outside in the searing sun has worked its way into the water table and hence the food chain. Its deplorable that it has such huge implications. :mad:


I think heads will roll in Mexico, and I mean literally roll

Chardee MacDennis

fishtastico wrote: »

Luckily all the locals are doctors and virologists... But seriously, I think it's really being blown out of proportion here.

i meant local media, not local people. to anyone saying it is being sensationalized, from everything i have read it is being played down. see here for example http://imgur.com/ESAq.jpg

also the US CDC has said it cannot be contained so it seems to be serious enough!

luckat

One small teenshy thing that may or may not be apposite - I understand that viruses are vulnerable to strong alkalais, and even simple washing soda can have quite an effect if you use it for washing down much-touched surfaces.

Combined with not shaking hands, air-kissing, embracing, etc in social situations, and not going into unnecessary crowds - planes, buses, trains, cinemas - this can be one tiny precaution.

DrIndy

avoiding close contact with someone infected is also a good method to prevent infection.

The trouble is influenza is very very good at spreading itself by droplet form and can survive for a reasonable period outside the human body. It is killed by standard disinfectants however.

The issue is a virulence mutation making human-human spread easy instead of pig to human or co-infecting someone who already has a human flu will allow it to change sufficiently.

Hospitals will be flooded if this happens, we are barely able to cope as it is!

Kwekubo

The main WHO website is down. See http://www.euro.who.int/communicablediseases/outbreaks/20090425_1