Seasonal Flu 2008 - 2009

[ironorehopper]

USA. W.Va. teen dies of flu complications - UPI.com

W.Va. teen dies of flu complications

Published: March 20, 2009 at 4:08 PM
CHARLESTON, W.Va., March 20 (UPI) --

A 15-year-old girl has died in South Charleston, W.Va., of complications from the flu, health officials say.


Kanawha-Charleston Health Department officials said Emily Kaitlyn Sims became the state's first reported pediatric influenza death since 2004 with her death on March 5, the Charleston (W. Va.) Daily Mail said Friday.

Rahul Gupta, the health department's director, said the teen died shortly after being showing signs of the flu and visiting her family physician.

Sims was freshman and an honor student at St. Albans High School at the time of her death.

Gupta said Thursday that tests are being conducted to determine if methicillin-resistant Staphylococcus aureus bacteria had anything to do with Sims' death.

"One of the things we have to worry about is MRSA, or the super-bug," Gupta told the Daily Mail. "There is no proof at this point that this is what this young lady had. We're waiting on future testing."
-

W.Va. teen dies of flu complications - UPI.com

[HenryN]

INFLUENZA VIRUSES ISOLATED BY
WHO/NREVSS Collaborating Laboratories
2008 - 2009 Season

Week	A(H1)	A(H3)	A(Unk)	B	Total # Tested	% Positive
40	3	0	8	6	2598	0.65
41	4	4	8	6	2632	0.84
42	13	3	15	6	2746	1.35
43	22	0	24	14	3198	1.88
44	12	3	21	5	3320	1.23
45	32	2	23	11	3920	1.73
46	25	2	23	12	4145	1.5
47	27	1	31	23	4540	1.81
48	40	1	46	24	4636	2.39
49	41	5	57	14	5355	2.18
50	71	9	66	37	5788	3.16
51	73	18	107	56	6057	4.19
52	71	11	152	51	5828	4.89
53	113	17	168	48	6185	5.59
01	164	26	281	81	6623	8.33
02	194	20	419	95	6717	10.84
03	337	44	618	184	7463	15.85
04	537	71	894	345	8881	20.8
05	619	44	1351	642	11190	23.74
06	770	59	1300	875	12094	24.84
07	745	58	1031	844	11068	24.2
08	574	52	865	977	10678	23.11
09	301	29	731	861	8754	21.96
10	107	13	402	580	5076	21.71

Return to Current Report

[ironorehopper]

CIDRAP >> Type B viruses rise as overall flu activity declines

Type B viruses rise as overall flu activity declines

Robert Roos * News Editor
Mar 23, 2009 (CIDRAP News) –

The second week of March brought a slight decline in influenza activity across the country, with 30 states still reporting widespread cases, down from 35 states a week earlier, according to the Centers for Disease Control and Prevention (CDC).


As overall activity has decreased, however, the season has seen an increase in the proportion of influenza B viruses, the one type of flu that is not very well-matched by this year's vaccine, the CDC reported. The spread of B viruses also poses a challenge for decisions about antiviral treatment, the agency said.

Eighteen states reported regional flu activity, and two—Utah and West Virginia—reported only local activity. Seven percent of all deaths reported through the CDC's mortality reporting system were attributed to pneumonia and influenza, which is below the epidemic threshold of 8%.

However, the proportion of medical visits attributed to flu-like illness in the CDC's flu surveillance network was 2.9%, still above the national baseline of 2.4%.

Six more flu-related deaths in children were reported, bringing the total for the season to 32, the CDC report said. That compares with 88 fatal cases in children in 2007-08 and 78 in 2006-07. The six deaths occurred between Feb 15 and Mar 7.

Influenza A viruses have predominated through the season overall, making up 70.8% of those that have been typed, the CDC reported. But type B viruses have increased lately: of 1,102 lab-confirmed flu cases for the week, 580 (52.6%) were type B.

Of 210 type B viruses that have been antigenically tested by the CDC this season, only 44 belonged to the Yamagata lineage targeted by the B strain in this year's vaccine. The other 166 isolates belonged to the Victoria lineage and are not related to the vaccine, the agency said. However, all the A/H1N1 and A/H3N2 isolates tested so far have been related to the corresponding strains in the vaccine.

Among type A viruses, H1N1 has been predominant this season. That pattern continued in the latest report, with 107 of 120 type A isolates that were subtyped identified as H1N1. Nearly all H1N1 isolates (98.9%) tested for drug resistance this season have been resistant to the antiviral oseltamivir (Tamiflu) but sensitive to zanamivir and to the adamantine drugs.

In contrast, all A/H3N2 viruses have been susceptible to oseltamivir and zanamivir but resistant to the adamantanes. Type B viruses are also susceptible to oseltamivir and zanamivir, but the adamantanes are not effective against them.

Given the differences in drug sensitivity among the three types of flu, the growing proportion of B viruses "presents challenges for the selection of antiviral medications for the treatment and prophylaxis of influenza," the CDC report said. "Health care providers should be aware of the possibility of increased influenza B circulation in their area, and continue [to] test patients for influenza and consult local surveillance data when evaluating patients with acute respiratory infections during the influenza season."

The CDC revised its recommendations on antiviral treatment for flu last December, after discovering the high rate of oseltamivir resistance in H1N1 viruses.In other developments, the Rapid City Journal in South Dakota today reported a flood of patients with flu-like symptoms in local clinics and said many of them had received flu shots early in the season.

A physician's assistant at an urgent care center said about half of her patients who tested positive for flu had been vaccinated, but most of the shots were early in the season, the report said. A physician quoted in the story suggested that the immunity conferred by vaccination starts to wane after about 3 months, though it can still lessen the severity of flu after that.

However, online CDC information says the protection provided by a flu vaccine lasts the whole season. Researchers have found no benefit from getting a second shot later in the season, it says.

William Schaffner, MD, a flu immunization expert and chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, agreed.

"Immunization even in September ought to have you protected throughout the flu season," he told CIDRAP News. "What we're seeing is a very late influenza season. We know that the vaccine is a pretty good vaccine but not a perfect one. So some people will acquire a milder case despite vaccination. Because it's occurring so late in the season, the question arises about the duration of protection."

If flu activity had peaked in December or January, there would have been cases in people who had been vaccinated and were only partially protected, he said. But in that case the question of duration wouldn't have come up, simply because of the date.

Schaffner also allowed that the recent increase in type B viruses, many of which are not well-matched by the vaccine, may be playing a role in cases in vaccinated people. "A late season tends to be Bs, and indeed we only have one [b] strain in the vaccine. So the vaccine once again may provide only partial protection," he said.

He noted that there has been considerable discussion of putting both type B lineages in the flu vaccine, making a quadrivalent (four-strain) vaccine. "I'm in favor of that," he said.

See also:
CDC flu update http://www.cdc.gov/flu/weekly/
Mar 23 Rapid City Journal report http://www.rapidcityjournal.com/arti...c839895916.txt
-

CIDRAP >> Type B viruses rise as overall flu activity declines

[Commonground]

Japan
March 24 17:52

B flare-up on the flu virus

The number of patients reporting flu to the country's medical institutions nationwide, an increase of three days this month to 15 consecutive weeks, the epidemic has rekindled the National Institute of Infectious Diseases 24, according to preliminary figures released Sunday . B appears to be on the virus.

Annual prevalence of type B virus, A behind-the spread, as the lead in the overall resurgence of the epidemic since the survey started in 1987, the first time.

Senior Researcher Yasui Yoshinori call infectious disease information center "for more travel on spring break, could also spread to areas not in vogue," and has cautioned.

According to the call of infection, an epidemic season, the patients reported a decrease in the peak of late, increased again in late February. Sunday February 22 to report a patient of the week was 12.05 per point is, next week (March 1) is 13.49, next week (8 day) and 14.85 increase. The latest 15 weeks before an increase of 16.50, and three weeks in a row.

By prefecture, 15 to a fixed point of the number of reports per week, the top angle 46.25. Miyagi (37.48), Niigata (28.94), Chiba (28.85), Shizuoka (26.29) and more, have a big epidemic in the Tohoku region. (Joint)

http://64.233.161.132/translate_c?hl...PwACHmKnUkTuCw

[HenryN]

Originally Posted by ironorehopper

CIDRAP >> Type B viruses rise as overall flu activity declines

Type B viruses rise as overall flu activity declines



The CDC revised its recommendations on antiviral treatment for flu last December, after discovering the high rate of oseltamivir resistance in H1N1 viruses.In other developments, the Rapid City Journal in South Dakota today reported a flood of patients with flu-like symptoms in local clinics and said many of them had received flu shots early in the season.

A physician's assistant at an urgent care center said about half of her patients who tested positive for flu had been vaccinated, but most of the shots were early in the season, the report said. A physician quoted in the story suggested that the immunity conferred by vaccination starts to wane after about 3 months, though it can still lessen the severity of flu after that.

However, online CDC information says the protection provided by a flu vaccine lasts the whole season. Researchers have found no benefit from getting a second shot later in the season, it says.


See also:
CDC flu update http://www.cdc.gov/flu/weekly/
Mar 23 Rapid City Journal report http://www.rapidcityjournal.com/arti...c839895916.txt
-

CIDRAP >> Type B viruses rise as overall flu activity declines

Vaccine failures or lowered activity have been widely reported for Tamiflu resistant H1N1 (in Japan, Taiwan, and Italy). Those reports specifically tested the influenza that produced a reduced titer or was isolated from vaccinated patients.

[HenryN]

Flu lurking for people who got shots early
By Lynn Taylor Rick, Journal staff
A later-than-usual flu season is flooding Rapid City clinics with aching, coughing, sneezing, miserable patients, many who got their flu shots early in the season.
Deb Brandt, a physician assistant at Rapid City Medical Center's Urgent Care, said that on Wednesday, the clinic checked in 106 people in 11 hours. There were cases of strep, mono and plenty of influenza. Three other Rapid City clinics report a similarly busy schedule.
Brandt said about half of her patients who tested positive for influenza had their shots, but "most of the flu shots were early."
The Centers for Disease Control and Prevention says the flu season generally runs October through May and recommends getting the influenza vaccine before December to ensure the antibodies developed from the shot are ready when flu activity is at its highest.
Oftentimes, however, flu vaccines become most readily available in early October, so that's when people get them. Then, if flu season comes later, as it has this year, some of the best protection may have worn off.
But that doesn't mean it won't do them any good, said Dr. Kevin Weiland, a Rapid City physician. The influenza vaccine tends to provide the strongest protection for the first three months after it is given, but it can help lesson the severity of the flu even after that time, Weiland said.
Brandt said most of the patients with influenza who had their shot were much less sick than their counterparts who didn't get vaccinated.
Weiland said that although it is most important to get the flu shot when it becomes available -- even if it's very early in the season -- he believes that people who have the luxury of choosing when they get their shot might be better off getting vaccinated later in the fall.
"Personally, I don't give myself the flu shot until I hear about the first case of flu in the state," he said. "Then, when the flu season peaks out, my vaccine is peaked out at the same time."
Beth Boersma, infection control nurse with Rapid City Regional Hospital, said the flu vaccine is designed to get people through the entire influenza season. But because no one can predict when the peak will be, she recommends sticking to the CDC recommendations of getting it "before December."
"It's just the smart thing to do before the flu season arrives, and we never know if it's going to be early or late," she said.
Boersma said in most cases, people won't be given a second flu shot during the same season, even if they received a vaccination early. The CDC reports no benefit to receiving more than one dose per influenza season, even among the elderly and people with weakened immune systems.
Even though flu season is under way in Rapid City, it isn't too late to be immunized. Boersma said people should expect that the vaccine will take two weeks to fully protect them.
And anyone can improve the odds of not getting the flu by practicing good hygiene: Wash hands thoroughly and often, avoid touching your face and cover your mouth and nose with a tissue when sneezing or coughing.
And perhaps most important, avoid other people if you have the flu.
State Department of Health weekly flu update
This week's influenza activity ranks as "widespread" in South Dakota.

• 643 of 2,845 reported rapid antigen tests (23 percent) positive this week (532 A and 111 B); total 2,257 positive tests for the season.
• 37 confirmed cases of influenza reported this week (32 A and 5 B) from 11 counties (Brown, Codington, Davison, Dewey, Hutchinson, Lincoln, Meade, Minnehaha, Pennington, Shannon, Todd). A total of 267 confirmed cases so far this season (242 A and 25 B).
• 40% of confirmed influenza cases are children 0-9 years old; 3 percent of cases are people 60 years and older.
• 10 influenza hospitalizations reported this week (69 reported for this season).
• 48 percent of hospitalizations are children 0-9 years old; 16 percent of hospitalizations are people 60 years and older.
• One influenza-associated death; three deaths this season.
• Schools: 3 percent of students absent due to illness in 226 reporting schools.

Contact Lynn Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com.


http://www.rapidcityjournal.com/arti...rue#commentdiv

[tropical]

#426:
"Boersma said in most cases, people won't be given a second flu shot during the same season, even if they received a vaccination early. The CDC reports no benefit to receiving more than one dose per influenza season, even among the elderly and people with weakened immune systems."

Why is that?

Vaccine flu strains body immunity response "fatigue", or something else

[HenryN]

Originally Posted by tropical

#426:
"Boersma said in most cases, people won't be given a second flu shot during the same season, even if they received a vaccination early. The CDC reports no benefit to receiving more than one dose per influenza season, even among the elderly and people with weakened immune systems."

Why is that?

Vaccine flu strains body immunity response "fatigue", or something else

Vaccines fail because viruses CHANGE (to survive). Giving the same shot again against the target that is no longer a match doesn't protect any better than the first shot that failed.

[tropical]

Originally Posted by niman

Vaccines fail because viruses CHANGE (to survive). Giving the same shot again against the target that is no longer a match doesn't protect any better than the first shot that failed.

Thank you Dr. Niman for the answer.

The answer is correct in a case of missed vaccination strain if there is that what's happened, and it is clear.

But I wonder with my question because of an statement in the cited post text #426 where seems that the CDC, and in the previous post #425, the "researchers" from the Iron. text released the statement:
"Researchers have found no benefit from getting a second shot later in the season, it says"

The above sentence can be fited in a visure of the whole text, which claim an "early vaccination" as the possible reason of flu infections of already vaccinated persons, because of the deminish valence of the immune system response after the max. at the 3th month from vaccination.

So, the general reading impression is that the news text statements authors, wants to point to an early time of vaccination as the main reason of not wanting to revaccinate such persons, instead to point to an missed vacc. strain, or an flu strain changing after the first months of circulation through the population.

Apart the case of strain changing or missed vaccine, I wonder what can be the reason to not revaccinate the already vaccinated population after the first 4-5 months passed (10)/11/12/1/2/(3)?

[HenryN]

Originally Posted by tropical

Thank you Dr. Niman for the answer.

The answer is correct in a case of missed vaccination strain if there is that what's happened, and it is clear.

But I wonder with my question because of an statement in the cited post text #426 where seems that the CDC, and in the previous post #425, the "researchers" from the Iron. text released the statement:
"Researchers have found no benefit from getting a second shot later in the season, it says"

The above sentence can be fited in a visure of the whole text, which claim an "early vaccination" as the possible reason of flu infections of already vaccinated persons, because of the deminish valence of the immune system response after the max. at the 3th month from vaccination.

So, the general reading impression is that the news text statements authors, wants to point to an early time of vaccination as the main reason of not wanting to revaccinate such persons, instead to point to an missed vacc. strain, or an flu strain changing after the first months of circulation through the population.

Apart the case of strain changing or missed vaccine, I wonder what can be the reason to not revaccinate the already vaccinated population after the first 4-5 months passed (10)/11/12/1/2/(3)?

The article from South Dakota presents STRONG evidence for vaccine mismatch (failure), if indeed 50% of the flu cases had been vaccinated, because the vaccination rate of the population is well below 100%. Thus, if 100% of the target population was vaccinated, then 50% of the vaccinations would have failed, as indicated in the article. However, if only 50% of the target population was vaccinated, the finding of prior vaccinations in 50% of the flu patients would mean that vaccinations failed in 100% of the vaccinated population.

[tropical]

Than we can rely on that if the vaccine is well matched and the flu strains at the field would not change enaugh from the vaccine during the first 6 months, the vacc. population can be successfully revaccinated - but in that case it would not be neccessary.

Thank you for the clearing Dr. N.

[HenryN]

Commentary

http://www.recombinomics.com/News/03..._Failures.html

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/03..._Failures.html

Commentary

Tamiflu Resistant H1N1 Vaccine Failures Raise Concerns

Recombinomics Commentary 16:53
March 24, 2009

Deb Brandt, a physician assistant at Rapid City Medical Center's Urgent Care, said that on Wednesday, the clinic checked in 106 people in 11 hours. There were cases of strep, mono and plenty of influenza. Three other Rapid City clinics report a similarly busy schedule.
Brandt said about half of her patients who tested positive for influenza had their shots, but "most of the flu shots were early."

The above comments suggest that 50% of the flu patients in the Rapid City area served by the medical center had been vaccinated this season, and the vaccine failed to prevent infection. This figure is alarming, since the vaccination rate of the population is likely much lower than 100%, so the failure rate in those receiving the vaccine would be much higher than 50%.

The article suggested that the high failure rate was due a reduction in antibody levels in vaccinated patients, but vaccines fail because the circulating virus evolves away from the vaccine strain.

A media report on the article suggested that the failure rate may have been due to a resurgence of influenza B, which is not well matched with the current vaccine. However, South Dakota influenza data indicates that the level of influenza A is about 10 fold higher than influenza B for the season, and in the week prior to the report, the level of influenza A was still five fold higher than influenza B, suggesting that most patients were influenza A. Moreover, since the level of H1N1 is ten fold higher than H3N2, most of the cases would be oseltamivir resistant H1N1, because the levels of H274Y in H1N1 are near 100%.

Vaccine failure for H1N1 is supported by reports from other countries. In Italy, the first five confirmed H1N1 cases were Tamiflu resistant, and three of the five isolates were from vaccinated patients, supporting the failure rate described above in South Dakota.

Indirect evidence came from South Korea, were the vast majority of influenza cases are oseltamivir-resistant H1N1. Influenza exploded at the beginning of 2009, with ILI visits jumping to levels that were twice as high as last season.

Similar results were also reported in Japan, were school closings were widespread, and investigation sin the fall identified oseltamivir resistant H1N1 as the etiological agent. Moreover, H1N1 testing of isolates produced reduced titers relative to Brisbane/59, the vaccine strain for this season.

Reports from Taiwan also indicated that vaccines failed in 70% of the H1N1 cases and Tamiflu resistant H1N1 dominated in collections after December, 2008.

Although vaccine failures in H1N1 have not been discussed in weekly reports fvrom the CDC, a disclaimer was added in 2009, noting that cross reactivity with ferret reference sera was not always predictive of vaccine protection, and failures had already been reported in Asia.

This failure was not unexpected. Last season the H1N1 vaccine target changed from New Caledonia/20/1999 (clade 1) to Solomon Island/3/2006 (clade 2A). However, last season circulating clade 2A had been replaced by clade 2B (Brisbane/59/2007) and clade 2C (Hong Kong/2652/2006), but the vaccine was called a “match” because the ferret reference sera was made against the Solomon Island virus grown in eggs, and there was significant cross reactivity with clade 2B and 2C. Consequently, all of the clade 2 viruses were called “Solomon Island-like” and antigenically indistinguishable. However, the three clade 2 sub-clades were easily distinguished phylogenetically because of a large number of synonymous and non-synonymous changes, and the antigenic differences were confirmed when a new reference sera was made using Brisbane/59 grown in mammalian cells. That reference sera had a titer of 320 against Brisbane, which fell to 40 for Hong Kong, and was <40 for Solomon Island. Consequently, virus that was called “Solomon Island-like” at the beginning of last season, was called “Brisbane-like” in early 2008. In addition, the vaccine target from this season was changed from Solomon Island to Brisbane, acknowledging that the targets were anigenically distinct.

However, the Brisbane target was isolated in the summer of 2007 and by the fall, the clade 2B in circulation had already evolved away from the vaccine target, which was likely accelerated by the vaccine mismatch last season. Included in the evolution was H274Y, which was not present in the Brisbane strain. In addition, a second NA change, D354G, was also in the dominant strain that was oseltamivir resistant. Both of these changes had been reported previously in clade 2C, but not clade 2A.

Moreover, a subset in the osletamivir resistant strain also acquired A193T in HA. This change had been in earlier H1’s, including H1N1 in circulation in the 1940’s as well as H1N2 in 2003. However, it was also in clade 2C, including the prototype, Hong Kong strain, but none of the recent strains had been selected as the H1N1 vaccine target, so the acquisition of A193T in clade 2B signaled a significant change in US and UK isolates in late 2007. This change was also spreading to other countries in early 2008, prior to vaccine target selection for this season.

However, the 2007 Brisbane isolate was the target for the current season, as well as the upcoming 2009 season in the southern hemisphere. The importance of A193T became more obvious in the summer of 2008, when osletamivir resistance went to 100% in South Africa. The dominant strain evolved from the dominant oseltamivir resistant strain in the northern hemisphere and contained A193T, as well as two adjacent changes, N187S and G189N. This strain was also widespread in Australia, where oseltamivir resistance was also approaching 100%, yet these changes were not incorporated into the 2009 target for the southern hemisphere.

The importance of A193T and adjacent changes was more obvious in isolates from this season. Oseltamivir resistance in clade 2B was close to 100% and those isolates with H274Y also had A193T as well as 1 or 2 changes at flanking positions (187, 189, and 196). Each position had two or more changes in the 2008/2009 isolates. The version dominant in Japan, South Korea, Taiwan, and Italy had A193T paired up with G189A. The dominant strain in the US had A193T with G189V and H196R. Other versions were similar to the South African / Australia strain, but had G189S instead of G189N. Others had A193T with N187D or H196N. Thus, although all of the reported sequences for H274Y positive H1N1 this season had A193T plus one or two flanking changes, none were in the H1N1 target for 2008 or 2009, and the recently announced target for the 2009/2010 season is unchanged.

Thus, the failure to note the significant H1N1 changes last season and this season, in association with H274Y hitch-hiking, and in the selection of the vaccine target for next season, is cause for concern.

.

[AlaskaDenise]

Given the incidences of seasonal vaccine mismatches, how can we be confident that any pandemic influenza vaccine selection would not be a mismatch? Under pressure for fast results, would the mismatch possibility increase?


How often are mismatches theoretically avoidable vs. unavoidable?

.

[SuperNova1987A]

SORRY! THIS IS THE SAME ARTICLE AS #424 ABOVE.
I DIDN'T KNOW UNTIL I POST.


Influenza is revived – B type virus spreading.
Source:http://www.47news.jp/CN/200903/CN2009032401000729.html

According to the preliminary figure issued by the National Institute of
Infectious Diseases (NIID) on March 24, the number of flu patients reported
by medical institutions accross the country increased for three consecutive
weeks (until March 15). Flu infection is revived and influenza B virus is
presumably spreading.

While B type usually spreads after A type, it is for the first time since the
survey started in 1987 that B type revives the flu infection as a whole.

“As travelors increase during spring vacation, infection may spread further in
the area which is not affected so far.” warns Yoshinori Yasui, chief
researcher in the Infectious Disease Surveillance Center of the NIID.

According to the NIID, this season’s influenza peaked in the 2nd half of
January; the number of reports decreased since then, but started to increase
again in the 2nd half of February.

The number of patients per survey point was 12.05 in the 3rd week of
February (until Feb. 22) and has been increasing in the following three
weeks; 13.49 in the week until Mar. 1, 14.85 in the week until Mar. 8, and,
finally in the latest report, 16.50 in the week until Mar. 15.

On the prefecture basis, Yamagata is at the top with 46.25 patients per
survey point, followed by Miyagi (37.48), Niigata (28.94), Chiba (28.85) and
Shizuoka (26.29). Spread is obvious in Tohoku (North East) area.

2009/03/24 17:53 [Kyodo News]

Number of Patients per Survey Point: NIID



ML Flu DB supports the above.



*ML flu database (http://ml-flu.children.jp/) is a private online
database of influenza information, started in winter 2000. 300 volunteers of
doctors now provide clinical level information to the database in order to
share quick information on influenza.


_______________________
SN1987A

[tropical]

Originally Posted by AlaskaDenise

Given the incidences of seasonal vaccine mismatches, how can we be confident that any pandemic influenza vaccine selection would not be a mismatch?
Under pressure for fast results, would the mismatch possibility increase?
...
.

There would be not "any pandemic influenza vaccine" for the majority of population in time realy.

For the esigue quantities created "in time" during the "few months" rising schedule of the first pand. phase, the match could be enaugh good because of the real pand. virus taken onto the vaccines, instead of an "6 months - 1 year old" guessing strain used for the seasonal flu vaccination.


AD.: "How often are mismatches theoretically avoidable vs. unavoidable?"

That's an probability question of input bio-variables for the math. comp. branch, the actual data probably exists somewhere ...

[Commonground]

Japan:
● flu has been reported.

Arakawa Ward, a point of 11 per week reported at 10.25 and 10.25 last week and did the same. Tokyo has a number of reported 11.46 per point (11 weeks), similar to the previous week was 11.63.
Some schools in the district, school delay action by the flu, some are closed and classes. When you go out to the crowds will ensure prevention of infection.
The flu, the first symptoms is 2-7 days to excrete the virus and infect others. The heat goes, where many people congregate is a good idea to avoid. If you go to work or school is a mask, so please consider UTSUSANAI to people around him.
http://64.233.161.132/translate_c?hl...yuM-Mcthm6ZUCQ

[ironorehopper]

Recent Italian Influenza Type B viruses: phylogenetic tree.

From Italian Ministry of Health: see original PDF document (in Italian) at http://www.ministerosalute.it/influe...r_25-03-09.pdf

From TABLES

[Shiloh]

Source: http://www.bclocalnews.com/vancouver.../41919757.html

(B.C. Canada) Flu season makes a nasty return
Flu sufferers in the Capital Region have been battling a rather virulent strain of the virus lately.

By Vivian Moreau - Victoria News
Updated: March 26, 2009 10:25 AM

Chief medical health officer says doctors need to
re-think treatment

Odd spikes in flu outbreaks, more resistant viruses, and more sick Canadians than Americans – just some of the strange trends that played out this winter.

“It’s been a curious year,” said Dr. Richard Stanwick, chief medical health officer for the Vancouver Island Health Authority. This season’s unusual flu patterns have scientists scratching their heads.

Influenza traditionally hits the population hardest in January. This year, according to data from the B.C. Centre for Disease Control, the flu has staged a late season comeback through March.

Surrey has particularly suffered with doctors there reporting 40 per cent more patients with the flu than usual for the first week of March. Greater Victoria has not been as hard hit as Surrey but still has seen higher than usual numbers for March. Capital region physicians saw about one flu patient a day in past weeks, while B.C. numbers overall were slightly higher.

“While cold weather and snow have somewhat ruined the flower count it’s also kept people indoors and in closer contact. As a consquence it’s given viruses (greater) opportunity to pass from person to person,” Stanwick said.

Canadians in general have been sicker with the flu than U.S. citizens in the past few weeks. Rates of American flu patients visiting their doctors has remained at 3.5 per cent. Across Canada the rate increased from 28 cases per 1,000 patient visits in the last week of February to 48 per 1,000 cases in the first week of March.

“I can’t say that Canadians are inherently different from Americans or there’s an Obama factor (people feeling more optimistic therefore feeling healthier),” Stanwick said. “We have not seen anything to explain this phenomenon.”

To complicate matters, medications that ease flu symptoms are not working as well as they have in recent years.

Oseltamivir, also known as Tamiflu, has proven to not work as well, putting it in almost the same category as Amantadine, a drug that doctors have decreased prescribing because viruses are proving resistant.

That certain strains appear to be more resistant to Tamiflu is worrisome, Stanwick said.

“We’re really seeing a curious pattern of sensitivity. Of course, our fear is that viruses swap intelligence,” he said, “and that, at some point, we’re going to (have to use) Relenza, which is the only drug that can hold out to address this.”

The medical and pharmaceutical communities need to re-examine resistance patterns, he added.

“Perhaps people are using it (anti-flu medication) more liberally than they should. We don’t have a lot of weapons and we certainly don’t want to squander them in terms of managing outbreaks.”

Lastly, what has the medical community most puzzled is that an Influenza B strain of flu was the more virulent virus this winter. Although most vaccines had been prepared to deal with Influenza A/Brisbane and Influenza B/Florida, it was Influenza B/Malaysia that struck 62 per cent of Canadians who came down with the flu this winter. (Viruses are named for the flu’s point of origin.)

“This (B/Malaysia) is supposed to be an annoying little virus that plays a minor role and it certainly played a bigger role,” Stanwick said. “People who are clearly the experts are looking at the fact that we might have to put not one, but two Influenza B into the vaccine.”

This anomaly demands examination, he said.

“We have to go back and think about what does all this mean and are there trends or facts or some subtleties we have not realized? It will give scientists lots of fodder for the hypotheses mill.”

vmoreau@saanichnews.com

[AlaskaDenise]

...our fear is that viruses swap intelligence....

Good terms.

.

[tropical]

Quote:
Quote:

...our fear is that viruses swap intelligence....

Good terms.
___

Yes, the "microscopic level bug intelligence" (uhm maybe, but where is it sited ...)

Comparing the above with some folks unwillingness of admiting that animals also have intelligence it is a big step forward ...

[ironorehopper]

EISS - Weekly Electronic Bulletin Week 12 - 27 March 2009: Influenza activity high in the Russian Federation while continuing to decline or remain low in most western, central and northern European countries.

EISS - Weekly Electronic Bulletin Week 12 : 16/03/2009-22/03/2009 - 27 March 2009, Issue N° 298 Influenza activity high in the Russian Federation while continuing to decline or remain low in most western, central and northern European countries


-- Summary:

In week 12/2009, the Russian Federation continued to report high influenza activity in four of seven regions. Several other countries in eastern, central, northern and southern Europe reported medium intensity activity, while in all countries in western Europe the seasonal epidemic is over. While influenza A(H3) continues to be the predominant circulating virus overall this season, influenza B virus detections are currently dominant in over 50% of the countries. However, total weekly virus detections have declined to 22% of peak level detections in week 05/2009.


-- Epidemiological situation - week 12/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Croatia and in four of seven regions of the Russian Federation, medium in 13 countries, and low in the other 25 countries that reported this indicator. In the Russian Federation, the Northwest, Urals and Siberian regions, but not Volga, all reported an increasing trend; all other countries reporting high or medium intensity reported a stable or decreasing trend.

For the geographical spread indicator, widespread influenza activity was reported in four countries, regional activity in five countries, local activity in six countries and sporadic or no activity in the remaining 23 countries.


-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-12/2009):

Since week 49/2008 consultation rates for ILI and/or ARI have risen above baseline levels in most western and central European countries following a general west to east progression. High influenza intensity, again with peak activity following a general west to east progression, has been reported in 15 countries since week 51/2008. Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group. In most countries in western, central, northern and southern Europe the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels.


-- Virological situation - week 12/2009:

The total number of respiratory specimens collected by sentinel physicians in week 12/2009 was 1261, of which 274 (22%) were positive for influenza virus: 89 type A (48 subtype H3, one subtype H1 and 40 not subtyped) and 185 type B. In addition, 533 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 396 type A (171 subtype H3, 67 subtype H1 and 158 not subtyped) and 137 type B. Compared to week 11, the number of type B detections has increased slightly, accounting for 322 (40%) of 807 influenza-positive sentinel and non-sentinel specimens overall and exceeded type A detections for the week in 20 countries. Influenza B was the only virus type detected in 16 out of 27 (59.2%) countries reporting influenza virus detections. Overall, total weekly virus detections have now declined to 22% of the peak level detections in week 05/2009.


-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-12/2009):

Of 26457 virus detections (sentinel and non-sentinel) since week 40/2008, 23289 (88%) were type A (10294 subtype H3, 1142 subtype H1 and 11853 not subtyped) and 3168 (12%) were type B. Based on the antigenic and/or genetic characterisation of 3110 influenza viruses, 2337 (75.1%) were reported as A/Brisbane/10/2007 (H3N2)-like, 161 (5.2%) as A/Brisbane/59/2007 (H1N1)-like, 24 (0.8%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 588 (18.9%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage). More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses were either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76).

Influenza isolates from 18 countries were assessed for antiviral drug susceptibility.

All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, but resistant to M2 inhibitors.

Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive. One A(H1N1) virus was M2 inhibitor resistant, but sensitive to the neuraminidase inhibitors. The small number of influenza B viruses analysed were sensitive to oseltamivir and zanamivir.


-- Comment:

High intensity influenza activity has been maintained in four of the seven regions of the Russian Federation, with an increasing trend reported in three of these regions. Medium intensity influenza activity, with a decreasing trend is reported in the central region while the far eastern and southern regions both report low intensity activity.

While A(H3N2) is still the dominant influenza virus circulating in the European region, including the Russian Federation, the proportion of type B influenza virus detections per week remains substantial in a few countries (Estonia, Finland, France, Germany and Spain). Of the influenza B viruses that were antigenically and/or genetically characterised, 96% (588/612) were B/Victoria lineage. With the exception of these B/Victoria lineage viruses, the viruses circulating are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance and overall this season’s vaccine is expected to be effective.


-- Background:

The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 35 reported both clinical and virological data, one reported virological data only and four reported clinical data only to EISS in week 12/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).


-- Other bulletins:

The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza.


-- Map

The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.

From MAPS

From MAPS

From MAPS

From MAPS

Europe Year 2009 / Week 12

A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions witha population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a populationcomprising 50% or more of the country's population. Laboratory confirmed.
Finland : Where available, the epidemiological data are provided by a health-care district in South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).


-- Network comments (where available)

- Denmark. Note: Week 12, shift from influenza A to influenza B Victoria-like as dominant influenza in Denmark.
- Italy. Low influenza activity is reported. One influenza B virus has been detected during this week.
- The former Yugoslav Republic of Macedonia. Mandatory data.
- Switzerland. Influenza activity is below threshold now.
-

EISS - Bulletin Review

[HenryN]

INFLUENZA VIRUSES ISOLATED BY
WHO/NREVSS Collaborating Laboratories
2008 - 2009 Season

Week	A(H1)	A(H3)	A(Unk)	B	Total # Tested	% Positive
40	3	0	8	6	2598	0.65
41	4	4	8	6	2632	0.84
42	13	3	15	6	2746	1.35
43	22	0	24	14	3198	1.88
44	12	3	21	5	3320	1.23
45	32	2	23	11	3920	1.73
46	25	2	23	12	4145	1.5
47	27	1	31	23	4540	1.81
48	40	1	46	24	4636	2.39
49	43	5	57	14	5355	2.22
50	71	9	66	37	5788	3.16
51	73	19	108	56	6057	4.23
52	71	12	152	51	5829	4.91
53	113	19	170	48	6237	5.61
01	165	26	281	82	6678	8.3
02	196	22	419	96	6775	10.82
03	340	44	618	186	7517	15.8
04	556	76	894	359	8954	21.05
05	674	52	1357	670	11402	24.14
06	811	63	1335	909	12334	25.28
07	806	64	1037	884	11159	25.01
08	647	57	913	1031	10983	24.11
09	408	43	811	995	9501	23.76
10	223	32	577	827	7941	20.89
11	158	27	339	580	5161	21.39

Return to Current Report

[ironorehopper]

From Italy (Centro Interuniversitario per lo Studio dell'Influenza, CIRI, link: http://www.influciri.it ).

[SuperNova1987A]

Increase in reports of Influenza B, Peak in mid March
Source: http://www.cabrain.net/news/article/newsId/21311.html

According to the surveillance of the National Institute of Infectious Diseases
(NIID), reports of influenza B virus isolation was in increase and presumably
peaked in the 11th week (March 9-15).

As of February 15, reports of influenza A-H1N1 (A Soviet) virus isolation is on
the top with 1576 cases or 56.1%, followed by A-H3N2(A Hongkong) with 898
cases or 32.0% and B type with 335 cases or 11.9%.
As of March 15, B type increased to 761 cases or 16.3% of 4671 reports in
total. (See graph below)

In this flu season, the number of patients per survey point peaked at 37.45
(total number of reports at 178,991) in the 4th week (Jan. 19-25). Then it
decreased to reach 12.05 in the 8th week (Feb. 16-22) but increased again
in 9th week (Feb. 23- Mar. 1) to reach 16.50 in the 11th week, and
decreased again to 15.63 in the 12th week (Mar. 16-22).

It seems that in the first wave (peak in the 4th week ), A-H1N1 was
predominant while B type was predominant in the 2nd wave (peak in the
11th week).


Percentage by type


ML Flu DB supports the above article.



______________________________
SN1987A

[ironorehopper]

EISS - Bulletin Review. Two regions of the Russian Federation report high influenza activity, while activity has returned to out of season levels or further declined in the rest of Europe

EISS - Weekly Electronic Bulletin Week 13 : 23/03/2009-29/03/2009 - 03 April 2009, Issue N° 299 Two regions of the Russian Federation report high influenza activity, while activity has returned to out of season levels or further declined in the rest of Europe


-- Summary:

In week 13/2009, only two (North Western and Urals) of the seven regions of the Russian Federation reported high influenza activity and four countries (Belarus, Croatia, Hungary and Lithuania) reported decreased intensity compared to the previous week.

While most countries have indicated decreasing trends, associated with the seasonal epidemic being effectively over in western European countries, several countries in eastern, central, northern and southern Europe reported medium influenza activity.

Influenza A(H3) continues to be the predominant circulating virus in week 13/2009 as for the season as a whole, while the observed increase in proportion of influenza B virus detections since week 4/2009 has decreased in week 13/2009.


-- Epidemiological situation - week 13/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were medium in 11 countries and low in the other 27 countries that reported this indicator.

While the Russian Federation reported medium intensity as a whole two regions, North Western and Urals, continued to report high intensity, but with decreasing trends for consultation rates. All other countries (and regions) reported decreasing or stable trends.

For the geographical spread indicator, widespread influenza activity was reported in three countries, regional activity in three countries, local activity in six countries and sporadic or no activity in the remaining 27 countries.


-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-13/2009):

Since week 49/2008 consultation rates for ILI and/or ARI rose above baseline levels in most European countries following a general west to east progression. High influenza intensity has been reported in 15 countries, also following a general west to east progression, since week 51/2008. Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group.

In most countries in western, central, northern and southern Europe the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels.


-- Virological situation - week 13/2009:

The total number of respiratory specimens collected by sentinel physicians in week 13/2009 was 1126, of which 238 (21%) were positive for influenza virus: 111 type A (71 subtype H3, four subtype H1 and 36 not subtyped) and 127 type B. In addition, 377 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 281 type A (119 subtype H3, 48 subtype H1 and 114 not subtyped) and 96 type B.

The number of influenza detections dropped by 24% (807 to 615) compared to week 12 and was approximately 20% of the peak level in week 05/2009.

The proportion of type B detections has decreased from 40% (week 12) to 36% (223 of 615 influenza-positive sentinel and non-sentinel specimens) but exceeded type A detections in 20 countries and was the only virus type detected in eight out of 32 (25%) countries.


-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-13/2009):

Of 27247 virus detections (sentinel and non-sentinel) since week 40/2008, 23748 (87%) were type A (10544 subtype H3, 1202 subtype H1 and 12002 not subtyped) and 3499 (13%) were type B.

Based on the antigenic and/or genetic characterisation of 4999 influenza viruses, 3974 (79%) were reported as A/Brisbane/10/2007 (H3N2)-like, 196 (4%) as A/Brisbane/59/2007 (H1N1)-like, 43 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 786 (16%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage).

More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses were either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76).

Influenza isolates from 19 countries were assessed for antiviral drug susceptibility.

All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, and all but one of 415 tested were resistant to M2 inhibitors.

Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive. One A(H1N1) virus was M2 inhibitor-resistant, but sensitive to the neuraminidase inhibitors.

The small number of influenza B viruses analysed were sensitive to oseltamivir and zanamivir.


-- Comment:

While weekly detections of influenza virus in all countries have continued to fall, A(H3N2) remains the dominant influenza virus circulating in the European region, including the Russian Federation. The proportion of type B influenza virus detections, which showed a rising trend since week 4/2009 (4%) to week 12/2009 (40%), has now dropped to 36% in week 13/2009. Of influenza B viruses that have been antigenically and/or genetically characterised, 95% (786/829) were B/Victoria lineage. With the exception of these B/Victoria lineage viruses, most of the viruses characterised are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance and overall vaccine used this season is expected to have been effective.


-- Background:

The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 36 reported both clinical and virological data, two reported virological data only and two reported clinical data only to EISS in week 13/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).


-- Other bulletins:

The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza.


-- Map

The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.

From Drop Box

From Drop Box

From Drop Box

From Drop Box

Europe Year 2009 / Week 13

A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions with a population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a population comprising 50% or more of the country's population. Laboratory confirmed.
Finland : Where available, the epidemiological data are provided by a health-care district in South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately one percent of the Finnish population).


-- Network comments (where available)

- Bulgaria. During last week the number of positive for influenza viruses samples is increasing. From total of 25 samples obtained from hospitalized children up to age of five, three A/H3 and two B positive for influenza were detected. The detection of RSV continues.

- Italy. Low influenza activity is reported. Only 1 A/H3 influenza virus has been detected during this week.

- Switzerland. Influenza B viruses continued to be detected. However, medical consultations are below threshold now.
-

EISS - Bulletin Review

[Shiloh]

Source: http://www.stuff.co.nz/dominion-post...strains-of-flu

Kiwis catch drug-resistant strains of flu
By REBECCA PALMER - The Dominion Post
Last updated 05:00 06/04/2009

Four people have been found to have flu viruses resistant to the drug Tamiflu and health experts say growing anti-viral resistance underlines the importance of immunisation.

Environmental Science and Research virologist Sue Huang, head of the WHO national influenza centre in Upper Hutt, said none of the four Kiwis had taken Tamiflu, which is used to treat the disease within the first two days after symptoms appear.

That suggested they had contracted the drug-resistant virus from someone who had travelled overseas.

"It's most likely the virus travelled down to New Zealand."

The first New Zealand cases of resistance were picked up last August, the most recent in January.

Dr Huang said resistance had so far been limited to the H1N1 strain, which is one of the most common flu viruses in humans. In Hong Kong and the United States, the proportion of Tamiflu-resistant H1N1 had grown from 10 per cent to nearly 100 per cent in a year, she said.

The rapid increase in resistance overseas suggested New Zealand would experience a similar pattern.

That reinforced the message that vaccinations were the primary method of protection.

"It doesn't really matter about the Tamiflu-resistant strains if you have the vaccination."

This year's vaccine contains:

* Influenza A/Brisbane (H1N1)-like strain

* Influenza A/Brisbane (H3N2)-like strain

* Influenza B/Florida

It is available from doctors and is free until the end of June for people over 65 and those under 65 with long-term conditions such as heart disease, diabetes, cancers and asthma.

In recent years, fears of an H5N1 "bird flu" epidemic have prompted thousands of Kiwis to stock up on Tamiflu, which is available over the counter at pharmacies.

But Dr Huang said that this year it would be important for people to check which strains of the flu were dominant in a community before taking Tamiflu.

People should ask their doctors which strain they had. Those who had H3N2 or B strains would still find the drug effective, but there was no point using it against a drug-resistant H1N1 strain.

The National Influenza Strategy Group, which promotes immunisation, has warned this flu season could be deadlier than usual, after several mild seasons. The Brisbane strains killed six Australian children last year.

Dr Huang said there was no evidence yet of a "super nasty" strain. "But the virus changes are very fast and very unpredictable."

The Government has a stockpile of more than 1.2 million doses of Tamiflu, as one of the country's main defences in a pandemic. Health Ministry national emergency planning co-ordinator Steve Brazier said the ministry was aware of `resistance issues" but did not believe any action was warranted yet.

[tropical]

Originally Posted by Shiloh

Kiwis catch drug-resistant strains of flu
By REBECCA PALMER - The Dominion Post
Last updated 05:00 06/04/2009
...
"It doesn't really matter about the Tamiflu-resistant strains if you have the vaccination."
...
But Dr Huang said that this year it would be important for people to check which strains of the flu were dominant in a community before taking Tamiflu.

People should ask their doctors which strain they had. Those who had H3N2 or B strains would still find the drug effective, but there was no point using it against a drug-resistant H1N1 strain.
...
"But the virus changes are very fast and very unpredictable."
...

"if you have the MATCHED vaccination"

"People should ask their doctors which strain they had."


Maybe at NZ are better fast-ready to lab it, but to got the information of the exact flu (sub)strain name of the infected in the Tamiflu 24-48h schedule (after the first signs) from your GP (or else but some chip fast test) would be imaginary or fogging only ...

[ironorehopper]

EISS - 10 April 2009, Issue N° 300 Influenza activity in Europe is coming to an end for the 2008-2009 season.

EISS - Weekly Electronic Bulletin Week 14 : 30/03/2009-05/04/2009 - 10 April 2009, Issue N° 300 Influenza activity in Europe is coming to an end for the 2008-2009 season: only two regions of the Russian Federation report high influenza activity while activity has returned to out of season levels


-- Summary:

In week 14/2009, only two (Northwestern and Urals) of the seven regions of the Russian Federation reported high influenza activity. All other countries (and regions) in Europe, including all of the EU/EEA, reported decreasing influenza activity or baseline activity. Total weekly influenza virus detections have been declining since week 04/2009, indicating that influenza activity is coming to an end in Europe for the 2008-2009 season.


-- Epidemiological situation - week 14/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were medium in eight countries and low in the other 27 countries that reported this indicator. While the Russian Federation reported medium intensity as a whole two regions, Northwestern and Urals, continued to report high intensity, but with decreasing trends for consultation rates. All other countries (and regions) reported decreasing or stable trends at baseline levels of clinical activity, with the exception of Luxembourg which reported an increase in consultation rates but still had baseline levels of influenza actvity.

For the geographical spread indicator, widespread influenza activity was only reported in Croatia, regional activity in three countries, local activity in six countries and sporadic or no activity in the remaining 25 countries.


-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-14/2009):

Since week 49/2008 consultation rates for ILI and/or ARI rose above baseline levels in most European countries following a general west to east progression. High influenza intensity has been reported in 16 countries, also following a general west to east progression, since week 51/2008.

Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group.

In most countries in western, central, northern and southern Europe the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels.


-- Virological situation - week 14/2009:

The total number of respiratory specimens collected by sentinel physicians in week 14/2009 was 875, of which 167 (19%) were positive for influenza virus: 70 type A (21 subtype H3, four subtype H1 and 45 not subtyped) and 97 type B. In addition, 306 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 204 type A (94 subtype H3, 53 subtype H1 and 57 not subtyped) and 102 type B.


-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-14/2009):

Of 28158 virus detections (sentinel and non-sentinel) since week 40/2008, 24261 (86%) were type A (10681 subtype H3, 1272 subtype H1 and 12308 not subtyped) and 3897 (14%) were type B.

Based on the antigenic and/or genetic characterisation of 3220 influenza viruses, 2268 (70%) were reported as A/Brisbane/10/2007 (H3N2)-like, 154 (5%) as A/Brisbane/59/2007 (H1N1)-like, 33 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 765 (24%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage).

More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses were either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76).

Influenza virus isolates from 19 countries were assessed for antiviral drug susceptibility.

All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, and all but one of those tested were resistant to M2 inhibitors.

Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive.

One A(H1N1) virus was M2 inhibitor-resistant, but sensitive to the neuraminidase inhibitors.

The small number of influenza B viruses analysed were sensitive to oseltamivir and zanamivir.


-- Comment:

Influenza activity in Europe is coming to an end. Only two regions of Russia (Northwestern and Urals) reported high influenza activity in week14/2009. In all other countries (and regions), influenza activity is declining and in many areas of Europe (e.g. Western Europe) the seasonal epidemic is effectively over with consultation rates for ILI and/or ARI at baseline levels.Influenza A(H3N2) has been the dominant virus in Europe, accounting for an estimated 77% of total viruses typed/subtyped this season.

Detections of influenza A virus peaked in week 04/2009 and influenza B virus detections peaked around week 11/2009. Of influenza B viruses that have been antigenically and/or genetically characterised, 96% (765/798) were B/Victoria lineage.

With the exception of these B/Victoria lineage viruses, most of the viruses characterised are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance and vaccine used this season is expected to have been effective.


-- Background:

The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 32 reported both clinical and virological data, four reported virological data and four reported clinical data only to EISS in week 14/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).


-- Other bulletins:

The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza.


-- Map

The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.

From MAPS

From MAPS

From MAPS

From MAPS

Europe Year 2009 / Week 14

A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions witha population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a population comprising 50% or more of the country's population. Laboratory confirmed.
Finland : Where available, the epidemiological data are provided by a health-care district in South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).


-- Network comments (where available)

- Italy. Low influenza activity is reported. During this week 2 A/H3 and 5 B influenza viruses have been detected.

- The former Yugoslav Republic of Macedonia. Mandatory data

- Russian Federation. On the week 14 morbidity decrease was observed in all regions of Russia, that was partly connected with school holidays. However, in 2 regions of the country, the Urals and the North-West, morbidity was qualified as high, because its level exceeded 900 cases per 100 000 of population.

- Slovenia. Higher number of influenza A/H1 in week 14 are due to the localized outbreak in one nursing facility for the handicapped children. No A/H1 was detected outside this facility.
-

EISS - Bulletin Review

[Commonground]

14.04.2009

Onishchenko told about the epidemic of influenza

Influenza epidemic in Russia is declining, and its recurrence is unlikely. Such information-sharing supervisor Rospotrebnadzor, Chief State Sanitary Doctor of Russia Gennady Onishchenko.

"Incidence of influenza in Russia's regions has continued to fall. Excess epidemic threshold is currently observed in the 11 cities and three Russian regions. As compared to last week, so at nine cities and two smaller entity," - he said.

There are currently exceeding a threshold incidence of epidemic influenza noted in Ryazan, Barnaul, Astrakhan, Ulyanovsk, Irkutsk, Arkhangelsk, Chelyabinsk, Nizhny Novgorod, Ivanovo, Tula, Chelyabinsk Oblast and Belgorod, Smolensk, and Kemerovo.

In Ryazan, where the epidemic period of recovery lasted for 4 weeks - from mid-February to mid-March - the reduction of morbidity began with the 3rd decade of March and the end of the month the situation was characterized as neepidemicheskaya.

According to Rospotrebnadzor of the Chelyabinsk region, last week was nearly 23 thousand cases of respiratory infections. Of these, 641 cases of influenza. High levels of morbidity continues to occur in Chelyabinsk. They noted the excess of thresholds for all age groups except for children aged 7-14 years. In the regional center registered 10.7 thousand cases of ARI. In medical institutions admitted 77 people, including 72 children.

According to Onishchenko, in St. Petersburg exceeded the epidemic threshold is saved at the expense of morbidity in children. "In Moscow, the situation with influenza is calm," - said Onischenko. He noted that the medical prognosis, the epidemic of influenza in Russia will be completed in April, said Interfax.

http://74.125.93.132/translate_c?hl=...sB8p5rSnbuwfQw