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This is a reposting of my notes from yesterdays briefing and gives a good insight into the emerging situation.
12 May 2009 press briefing
Listen to Dr Nikki Shindo, Medical Officer, WHO Global Influenza Programme [mp3 41Mb]
No transcript yet
5251 cases in 30 countries
<link rel="File-List" href="file:///D:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTe mp%5%20%20Cmsohtml1%5C01%5Cclip_filelist.xml"><o:s marttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="stockticker"></o:smarttagtype><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-GB;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:632755843; mso-list-type:hybrid; mso-list-template-ids:-197766182 1443125718 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-start-at:0; mso-level-number-format:bullet; mso-level-text:-; mso-level-tab-stop:36.0pt; mso-level-number-position:left; text-indent:-18.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} ol {margin-bottom:0cm;} ul {margin-bottom:0cm;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--> This was an excellent briefing and well worth listening to as it is the first to really give an authoritative overview from the clinical team.
They are working on an ‘Initial Guidance for Clinical Management’ document for release soon
Key points
<!--[if !supportLists]-->-<!--[endif]-->Regarding numbers: they are likely to be skewed as they are based on lab confirmed cases while <st1:country-region><st1:place>Mexico</st1:place></st1:country-region> and the <st1:country-region><st1:place>USA</st1:place></st1:country-region> have been prioritising the testing of samples from severe cases. All of the following should be read with this in mind.
<!--[if !supportLists]-->-<!--[endif]-->About 10% are requiring hospitalisation & the preliminary <st1:stockticker>CFR</st1:stockticker> is 1.4% (remember based on skewed confirmed data) also remember this is with current high levels of health care access at this pre-pandemic stage.
<!--[if !supportLists]-->-<!--[endif]-->The above, plus the fear of antiviral resistance acquisition, mean vaccine production should be pursued.
<!--[if !supportLists]-->-<!--[endif]-->Clinical cases do not follow the seasonal flu pattern. Seasonal flu death rates include all deaths in which flu is a factor.
<!--[if !supportLists]-->-<!--[endif]-->Most cases are mild but, of the severe cases/deaths, they fall into two groups those that have other medical conditions and a group of young healthy adults. The high risk factors include pregnancy, the immunocompromised & and those that would be regarded as high risk for seasonal flu. They are looking hard at the young healthy group for a common factor but numbers are small and no pattern yet.
<!--[if !supportLists]-->-<!--[endif]-->Current guidance for treatment of general population: Do not use antivirals and do not hospitalise. Do use antipyretics, analgesics, analgesics (but not aspirin), antibiotics & oxygen as required - also build up stockpiles of these.
<!--[if !supportLists]-->-<!--[endif]-->Pneumonia: Primary in severe cases, little secondary (but expect this to change), some ventilator associated case.
<!--[if !supportLists]-->-<!--[endif]-->They are urgently seeking data from physicians regarding treatment results with antivirals, especially zanamivir. While resistance is confirmed in vitro little is known about clinical efficacy.
<!--[if !supportLists]-->-<!--[endif]-->Due to the complex developing system of strains and resistance they are building a matrix – along with rapid regional strain prevalence detection – more clinicians to use in choosing treatment options.
12 May 2009 press briefing
Listen to Dr Nikki Shindo, Medical Officer, WHO Global Influenza Programme [mp3 41Mb]
No transcript yet
5251 cases in 30 countries
<link rel="File-List" href="file:///D:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTe mp%5%20%20Cmsohtml1%5C01%5Cclip_filelist.xml"><o:s marttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="stockticker"></o:smarttagtype><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-GB;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:632755843; mso-list-type:hybrid; mso-list-template-ids:-197766182 1443125718 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-start-at:0; mso-level-number-format:bullet; mso-level-text:-; mso-level-tab-stop:36.0pt; mso-level-number-position:left; text-indent:-18.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} ol {margin-bottom:0cm;} ul {margin-bottom:0cm;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--> This was an excellent briefing and well worth listening to as it is the first to really give an authoritative overview from the clinical team.
They are working on an ‘Initial Guidance for Clinical Management’ document for release soon
Key points
<!--[if !supportLists]-->-<!--[endif]-->Regarding numbers: they are likely to be skewed as they are based on lab confirmed cases while <st1:country-region><st1:place>Mexico</st1:place></st1:country-region> and the <st1:country-region><st1:place>USA</st1:place></st1:country-region> have been prioritising the testing of samples from severe cases. All of the following should be read with this in mind.
<!--[if !supportLists]-->-<!--[endif]-->About 10% are requiring hospitalisation & the preliminary <st1:stockticker>CFR</st1:stockticker> is 1.4% (remember based on skewed confirmed data) also remember this is with current high levels of health care access at this pre-pandemic stage.
<!--[if !supportLists]-->-<!--[endif]-->The above, plus the fear of antiviral resistance acquisition, mean vaccine production should be pursued.
<!--[if !supportLists]-->-<!--[endif]-->Clinical cases do not follow the seasonal flu pattern. Seasonal flu death rates include all deaths in which flu is a factor.
<!--[if !supportLists]-->-<!--[endif]-->Most cases are mild but, of the severe cases/deaths, they fall into two groups those that have other medical conditions and a group of young healthy adults. The high risk factors include pregnancy, the immunocompromised & and those that would be regarded as high risk for seasonal flu. They are looking hard at the young healthy group for a common factor but numbers are small and no pattern yet.
<!--[if !supportLists]-->-<!--[endif]-->Current guidance for treatment of general population: Do not use antivirals and do not hospitalise. Do use antipyretics, analgesics, analgesics (but not aspirin), antibiotics & oxygen as required - also build up stockpiles of these.
<!--[if !supportLists]-->-<!--[endif]-->Pneumonia: Primary in severe cases, little secondary (but expect this to change), some ventilator associated case.
<!--[if !supportLists]-->-<!--[endif]-->They are urgently seeking data from physicians regarding treatment results with antivirals, especially zanamivir. While resistance is confirmed in vitro little is known about clinical efficacy.
<!--[if !supportLists]-->-<!--[endif]-->Due to the complex developing system of strains and resistance they are building a matrix – along with rapid regional strain prevalence detection – more clinicians to use in choosing treatment options.