World Health Organization gearing up its response planning to trH3N2

[alert]

http://www.winnipegfreepress.com/arts-and-life/life/health/who-trying-to-hit-the-sweet-spot-in-responding-to-puzzling-new-flu-virus-134525253.html

The Canadian Press - ONLINE EDITION

WHO trying to hit the sweet spot in responding to puzzling new flu virus
By: Helen Branswell, The Canadian Press

Posted: 11/26/2011 3:31 AM


THE CANADIAN PRESS/ho-Centers for Disease Control and Prevention
The spread of an odd new flu virus that has been jumping from pigs to people in parts of the United States has the World Health Organization gearing up its response planning, a senior official of the agency says.

The UN health body is figuring out what needs to be done if the virus continues to spread and a global response is required, Dr. Keiji Fukuda, assistant director-general for health security and environment said in an interview from Geneva.

The WHO wants to be ready to make recommendations and issue guidance to countries if the need arises ? though Fukuda stressed at this point it is far from certain there will be that need.

"We're very aware that we don't want to over-play or under-play. We're trying to get that right," says Fukuda, a leading influenza expert.

"(We're) trying to make sure that we're ready to move quickly, if we have to move quickly, but also trying not to raise alarm bells."

The desire to be prepared without raising alarm is a legacy of the 2009 H1N1 pandemic. The WHO was heavily criticized in Europe for declaring that event a pandemic when the outbreak turned out to be far milder than originally feared.

But what exactly the agency ? and the world ? might need to prepare for now is very unclear. With the public relations problems of the 2009 outbreak fresh in the minds of health officials, no one is using the "p" word these days.

Yet in some respects the parallels to 2009 are striking.

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[Giuseppe]

Re: WHO trying to figure out how to respond to trH3N2

With all my sympathy to the authors of the above piece, but I have the impression that: 1) a lot of individuals have been taken by surprise again; and 2) in front of all Stock Exchanges around the World there is a red-blinking message: 'Do Not Disturb, Please'.

(IOH)

[sharon sanders]

Re: World Health Organization gearing up its response planning to trH3N2

Surveillance is lacking world wide for all influenza strains.

Local and regional public health budgets are being cut all over the world due to the global depression.

My questions is - If this strain is in the U.S., is it anywhere else in the world with a less robust surveillance and reporting system? Why the US only? Really?

[sharon sanders]

Re: World Health Organization gearing up its response planning to trH3N2

We again make a request for all entities to release influenza information, including but not limited to, the genetic sequences of the various strains in circulation.

Peace for Public Health

[alert]

Re: World Health Organization gearing up its response planning to trH3N2

Surveillance is lacking world wide for all influenza strains.

Local and regional public health budgets are being cut all over the world due to the global depression.

My questions is - If this strain is in the U.S., is it anywhere else in the world with a less robust surveillance and reporting system? Why the US only? Really?

The 2009 H1N1 pandemic has taught us that flu really does spread person-to-person from it source. While it often appears to appear in more than one place at once, that is just the result of undetected H2H transmission. Given that the US has found the trH3N2 virus in at least one pig (and no other country has), it is reasonable to assume that the virus has jumped from pigs to people within the US. It remains unclear whether this virus might be mistaken for seasonal H3N2 in some cases.

You may be right; one of the surest signs that this is a circulating virus would be if some other country detected it in a traveler from the US. I would expect reports from Canada and Hong Kong fairly quickly if this was indeed that widespread.

It remains unclear to me what effect it would have if this virus was indeed circulating. Would it wipe out the old seasonal H3N2 as the 2009 virus did to the old H1N1? Might we have three circulating influenza A strains? Might it reassort or recombine with one of the other circulating strains, replacing it in that manner? It certainly does appear that this virus may be milder than circulating strains, although our current sample to judge that is currently limited.

Assuming that infection with the circulating viruses from the 1990s really is protective against this strain, if this virus does indeed circulate, it might look a bit more like 1977 than 2009 as predominantly children would be infected. Keep in mind also that in 1976, a swine H1N1 jumped from pigs to humans, transmitted effiicently for several generations to produce a couple hundred cases, including a fatality, and then disappeared. Is this 1976? 1977? 2009?

Unfortunately, at this point we have far more questions than answers.

[Giuseppe]

Re: World Health Organization gearing up its response planning to trH3N2

The characteristics of this S-OtrH3N2 virus are quite exciting.

It is not a result of the well-known pandemic making mechanism called 'antigenic shift': when a novel Influenza A subtype emerges from animals and adapts to humans, with no or very low cross-reactive immunity against it.

It is not a result of a multi-intrasubtypic drift changes as it has resulted from reassortment from human, swine and human-adapted pandemic strain.

It is however not a wholly new 'antigen' as a not known but likely substantial portion of human population born after 1968/69 A(H3N2) pandemic should have some degree of immunity against its surface glycoproteins, that are similar to the donor seasonal strain derived from 1968/69 precursor strain.

The role of Matrix influenza virus subunit is not well understood for its ability to stimulate immunity in humans.

Human seasonal influenza virus A(H3N2) in its winter outbreaks affects mainly the elderly and children in contrast with the old seasonal A(H1N1) that affected mainly young adults.

The role of internal subunits of the reassortant S-OtrH3N2 is at this point unknown so that the exact clinical patterns of illness is no known also.

Finally, we have an 'antigen' toward humans should have some immune protection and this could be seen as an opportunity to tune the response should a multi-country outbreak happen: a vaccine-seed strain from antigen libraries may speed greatly the preparation of a front-line vaccine without waiting the drugs agency approval hurdles.

For this purpose I think researchers around the world should conduct experiment to see whether the immune response elicited by 1990-like H3N2 human seasonal virus in libraries is enough to protect from the novel strain or lessen the viral load and shedding in affected people.

(IOH)

[Laidback Al]

Re: World Health Organization gearing up its response planning to trH3N2

. . . For this purpose I think researchers around the world should conduct experiment to see whether the immune response elicited by 1990-like H3N2 human seasonal virus in libraries is enough to protect from the novel strain or lessen the viral load and shedding in affected people.

This would be a prudent and cost effective way of preparing a vaccine strain for mass distribution, if it worked and if it became necessary.

[gsgs]

Re: World Health Organization gearing up its response planning to trH3N2

remember ... in 2001 we had a human H1N2 ... until Fujian H3N2 took over
in 2003

http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H1N2

4 from H1N1 N.Caled., rest from 1997 H3N2


an H1N2 still circulates in swine but these are different from the human H1N2 from 2002-2003

[Amish Country]

Re: World Health Organization gearing up its response planning to trH3N2

My questions is - If this strain is in the U.S., is it anywhere else in the world with a less robust surveillance and reporting system? Why the US only? Really?

It is more of a challenge to find something you are not looking for. It may be stumbled over by accident while looking for something completely different and if we are really lucky reported.

[Giuseppe]

Re: World Health Organization gearing up its response planning to trH3N2

As for the surveillance issue, CDC writed in its MMWR Dispatch: http://www.cdc.gov/mmwr/preview/mmwr...=mm60d1123a1_x

It is anticipated that commercially available diagnostic tests, including point-of-care rapid tests, will detect infection with the S-OtrH3N2 virus; however, these tests will not differentiate S-OtrH3N2 from seasonal influenza A viruses. Clinicians who suspect swine influenza virus infections in humans should treat with oseltamivir when indicated (7), obtain a nasopharyngeal swab from the patient, place the swab in viral transport medium, and contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory, using the CDC RT-PCR assay cleared by the Food and Drug Administration. CDC requests that state public health laboratories send all suspected novel influenza A specimens, such as these S-OtrH3N2 viruses, to the CDC Influenza Division's Virus Surveillance and Diagnostics Branch Laboratory.