India - H1N1 strain turns virulent?: Health officials

[Treyfish]

Our Bureau

Hyderabad, Sept. 14
Has the virus A (H1N1) influenza undergone mutation? Health officials in Andhra Pradesh have said that they have observed a second strain of the influenza, a virulent one than the first strain noticed in the first bout of the influenza in May.
This, perhaps, casts doubt on the efficacy of the upcoming vaccine which is likely to hit the markets in a couple of months from now.
Mr L.V. Subrahmanyam, Principal Secretary (Health), told a press conference here that the vaccine might be useful for one season. ?The protection is not life-long,? he said. ?We have seen two strains so far. The one that infected people during May-Septemberwas one H1N1 strain. While the vaccine might be useful for the first strain, the second one that is prevalent now is found to be virulent,? he said.:tiphat:http://www.thehindubusinessline.com/2009/09/15/stories/2009091550891700.htm

 

[marcovth]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

All the more reason to get rid off egg based vaccine production.

 

[Treyfish]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

3 more die of swine flu in AP
Suresh Dharur
Tribune News Service
Hyderabad, September 13
The spurt in swine flu cases is causing alarm in Andhra Pradesh. Three persons died of the deadly virus today, the highest number of casualties on a single day.
With this, the swine flu toll in the state rose to nine. Two women, Usha and Madhavi, died while undergoing treatment at a private hospital in the city. Another person, Narsimha of Nalgonda district, succumbed died at the state-run Gandhi Hospital here.
The condition of four others, undergoing treatment at a private hospital in the city, is said to be serious. Three swine flu deaths were reported in Hyderabad over the past two days. The victims J Raja Babu and Sunil Kumar, died at a private hospital, while Srikanth died at Gandhi Hospital yesterday with symptoms of swine flu.
K Subhakar, swine flu coordinator in the state, said all victims were brought to the hospital in critical condition. ?They could have been saved had they come to hospital well in advance,? he said.
Andhra Pradesh, which reported the country?s first confirmed case of swine flu on May 16, has so far recorded 256 confirmed cases. Chief Minister K Rosaiah held an emergency meeting here with officials of the medical and health department to review the situation. He directed private hospitals to earmark separate wards for treatment of swine flu cases and assured there would be no shortage of Tamiflu tablets and other medicines. In addition to eight swine flu
screening centres in the city, six more would be set up soon, he said.:tiphat:http://www.tribuneindia.com/2009/20090914/nation.htm#20

 

[Snowy Owl]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

I will call Mr L.V. Subrahmanyam in India early tomorrow morning EST.

I have his coordonnates

Please help me in specific precise question.

Thank you

Snowy Owl

 

[Treyfish]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

(H1N1) gets more virulent



HYDERABAD: The A(H1N1) virus is showing signs of getting ?mutated? into a more virulent form.
Clinical observation of experts in the State capital indicate that the genetic make up of A(H1N1) virus has ?changed? and is now more ?potent? after coming into contact with the local existing viral forms.
?Second wave?


This is the ?second wave? of swine flu virus, coinciding with the rainy season, which is still active. There is a possibility of onset of a third and more virulent form in the upcoming winter season. The virus is getting more ?time? to stay in the atmosphere because of low temperatures, experts opine.
A pattern, among the swine flu fatalities in twin cities, has been detected. ?Patients are dying within 24 to 48 hours after getting infected with A(H1N1). The virus is not giving any chance to the doctors to treat the patient. The virus has become virulent and that?s why we are losing patients who have good immunity,? said Gandhi Hospital Superintendent E.A. Ashok Kumar.
Between May and August, when A(H1N1) virus was imported from other countries, it did not cause severe illness to patients. ?These days, the patient?s condition is deteriorating within 24 hours. There is a definite shift in the genetic make up of the virus. It might have genetically changed after coming into contact with local influenza virus,? Superintendent of Chest Hospital S.V. Prasad.
Experts assert that authorities and the public should be prepared for the onset of a third wave of swine flu in winter. :tiphat:http://www.hindu.com/2009/09/15/stories/2009091553320800.htm

 

[kiwibird]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

Do "clinical observations" mean they have actually mapped a change in the virus or just that the virus is causing more severe illness. If it is just observation of symptoms, an environmental factor may be the cause. You can't just assume it has mutated because you are having more fatalities.

 

[Treyfish]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

"Clinical observation of experts in the State capital indicate that the genetic make up of A(H1N1) virus has ?changed? and is now more ?potent? after coming into contact with the local existing viral forms"

huh.. maybe they know somthing?

 

[kiwibird]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

Or maybe they don't...

 

[Commonground]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

I will call Mr L.V. Subrahmanyam in India early tomorrow morning EST.

I have his coordonnates

Please help me in specific precise question.

Thank you

Snowy Owl

Snowy, you need to ask if a lab has confirmed a "genetic mutation".
Also, ask who in the State capital has made the "observations".
Ask if this "emergency meeting" has to do with this change in the virus:

Chief Minister K Rosaiah held an emergency meeting here with officials of the medical and health department to review the situation.

Apparently, it is now in the Twin Cities. So it is not throughout India.
Maybe find out if they feel it will eventually spread throughout the Country.

A pattern, among the swine flu fatalities in twin cities, has been detected.

Ask why now it has changed when mixing with the local existing viral forms. Are the existing viral forms all year long? Like Egypt & Indonesia?

and is now more ?potent? after coming into contact with the local existing viral forms.

 

[Okieman]

Hyderabad, India - Second Wave Mutation?

Hyderabad, India - Second Wave Mutation?

Comment: Hat-tip to DennisC over at the FluWiki Forum

HYDERABAD: The H1N1 virus, imported to Hyderabad from overseas, is showing signs of getting ?mutated? into a more virulent form. Clinical observation of experts in the State capital indicate that the genetic make up of H1N1 virus has ?changed? and is now more ?potent? after coming into contact with the local existing viral forms.

This is the ?second wave? of swine flu virus, coinciding with the rainy season, which is still active. There is a possibility of onset of a third and more virulent form in the upcoming winter season. The virus is getting more ?time? to stay in the atmosphere because of low temperatures, experts opine. A pattern, among the fatalities has been detected. ?Patients are dying within 24 to 48 hours after getting infected with H1N1. The virus is not giving any chance to the doctors to treat the patient. That?s why we are losing patients who have good immunity,? said Gandhi Hospital Superintendent E.A. Ashok Kumar.

Between May and August, when H1N1 virus was imported from other countries, it did not cause severe illness to patients. ?These days, the patient?s condition is deteriorating within 24 hours. There is a definite shift in the genetic make up of the virus. It might have genetically changed after coming into contact with local influenza virus,? Superintendent of Chest Hospital S.V. Prasad.

http://www.thehindu.com/2009/09/15/stories/2009091554730100.htm

 

[Treyfish]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

Hospitals let H1N1 flu patients die
TNN 15 September 2009, 06:32am IST


are being treated as social outcasts and shunted from one hospital to another. The latest H1N1 flu victim, 25-year-old Ashish Raj, who succumbed to the infection on Sunday night was made to shift three hospitals before he was given treatment at Osmania General Hospital, that too after much persuasion by his relatives.

Vanasthalipuram resident Ashish Raj was suffering from acute respiratory distress (ARDS) and pneumonia. He was first admitted to Mahaveer Hospital but doctors asked him to move to Gandhi Hospital on Saturday as it does not have a facility to treat H1N1 flu patients. At Gandhi, he was not only denied admission but even a stretcher. “The staff refused to take up the case on grounds that there was no vacancy. When we took him to Chest Hospital, even they refused to take up the case citing the same reason and asked us to go to Osmania General Hospital (OGH). At OGH, after much persuasion, he was admitted. He died later on Sunday at around 8.30 pm,” said Vinay Verma, a relative. Ashish died due to multi-organ failure.

Since a stretcher was not given, relatives said that the critical patient’s father and brother had to run from pillar to post with the struggling boy on their shoulder. At both Gandhi and Chest Hospital, officials said that admission was denied as there was no space to accommodate more patients.

When asked why a critical patient was treated in this manner, Gandhi hospital superintendent E A Ashok Kumar said he wasn’t aware of this. “It has not come to my notice. I will inquire into it and take action,’’ he said. Chest Hospital officials said that all three ventilators were in use and there was no way they could accommodated another patient.

Ashish’s case is not an isolated one with as many as six to eight such cases being denied admission at Chest Hospital on a daily basis, according to hospital sources. While Chest Hospital is referring the patients to Gandhi and OGH, most of these cases are not being admitted by the two government hospitals as well, say sources.:tiphat: http://timesofindia.indiatimes.com/...H1N1-flu-patients-die/articleshow/5012189.cms

 

[somebodyoutthere]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

I spoke to someone from India yesterday who told me the same thing about public hospitals in India -- they let you die. The standard of care is very low. Our conversation didn't have anything to do with H1N1 or these media reports--we were just having a general conversation about the state of health care in India.

 

[kiwibird]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

"Twin cities"

The original city of Hyderabad was founded on the banks of river Musi.[17] Now known as the historic Old City, home to the Charminar and Mecca Masjid, it lies on the southern bank of the river. The heart of the city saw a shift to the north of the river, with the construction of many government buildings and landmarks there, especially south of the Hussain Sagar lake. The rapid growth of the city, along with the merging of Secunderabad, 12 municipal circles and the Cantonment has resulted in a large, united and populous area. Still so many villages near by are getting a facelift to merge in the twin cities in the near future.[18]

is Hyderabad in Andhra Pradesh then? (from wikipedia)
which, from my very rustic calculations, seems to have a fatality:confirmed percentage rate of around 2%. This is less than Maharashta (4%) and Karnataka (7%) which all share the same water source.

The river Krishna originates from
the Western Ghats near Mahabaleswar, Maharashtra. After
covering a distance of 480 km in Maharashtra, 291 km in Karnataka
and 510 km in Andhra Pradesh (a total distance of 1281 km) it
emerges into the Bay of Bengal and forms a delta (Figure 1). A
large number of townships such as Tenali, Vijayawada, Guntur,
Machlipatnam, Nizampatnam and Repalle are located in the delta
region.

You could ask if he thinks that these high figures, in neighbouring areas, might be related to the environment. As it takes 10 to 20 years to clear up any environmental damage to the aquifers, he might be reluctant to look into this idea, but it is worth asking.

 

[rikkitikkitavi]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

is Hyderabad in Andhra Pradesh then?

Yes, Hyderabad is the capital of Andhra Pradesh.

As for the main topic here, my surmise is that the Indian doctors are finally encountering the kinds of cases we've been seeing for some time here in the US and elsewhere - that of a healthy person, usually a teenager or a young adult in his/her twenties, who has a severe progression of disease in 1-2 days. We've been tracking several of these cases for a while; fluwiki even had a diary devoted to this earlier called "Influenza Sudden Death Syndrome." So, frankly, I don't think what the Indian doctors are seeing is anything new; they're simply coming up with a more alarming explanation of it than really seems warranted at this point.

 

[Roehl_JC]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

I think these 'concerns of a more virulent form' of H1N1 could be early indicators of greater CFRs in the developing nations and this report is a warning about the cytokine storm stage in the 1-2% who show more serious symptoms early on. For those unlucky one, whether they're infections among poorer nations or richer ones, the complications tell who lives and dies. Thus, for those insufficiently resourced to provide intensive care, to rush appropriate care, to provide the right meds, and especially this: the lack of ventilators...thus a plausible explanation for any early increase of deaths among those patients.

Although that's my opinion as to reading between the lines of what he's saying, but I'm keen to learn more on this matter.
I will be curious to see what happens in the time frame of the next month or two when the number of infected patients requiring hospitalization and ICU-care will be substantially higher than today, and when winter weather patterns complicate matters further. IMO If this virus does evolve higher virulence, it's likely to come out of patients from Indonesia to Egypt and all points in between where substandard animal husbandry practices, and seasonal flu viruses and bird flu H5N1 and H3N2 and other diseases have the maximum chance of co-infections in substandard rural medical facilities.

 

[Roehl_JC]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

K'taka health dept to carry out clinical study to assess pattern on spread of H1N1 virus
Tuesday, September 15, 2009 08:00 IST
Nandita Vijay, Bangalore

Karnataka healthcare department is gearing up to carry out a clinical study on the pattern of spread of the H1N1 virus causing swine flu. The findings of the study will help mapping a pattern that can alert both the doctors and the patients. The private hospitals have been asked to share the clinical data of patients' blood samples to facilitate a collective analysis of the high number of deaths in the state.

The state health department has appointed Usha Wasunkar, director, Karnataka directorate of Health and Family Welfare to head the clinical study committee of experts. Other members of the committee are Dr V Ravi, had, department of Neuro-Virology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Dr TS Chelavuraj, joint director, communicable diseases, Karnataka Directorate of Health and Family Welfare and Dr Shashidar Buggi, director, Rajiv Gandhi Institute of Chest Diseases.

The experts will study the reason for each of the deaths. The audits will reveal whether there was a delay in administrating Tamiflu. It will also look into the clinical conditions.

The study will assess the cases and the deaths along with the treatment modalities case by case...

http://www.pharmabiz.com/article/detnews.asp?articleid=51673&sectionid=

Here they're already putting on the PR and saying this study will alleviate any panic. Sounds like they think the higher CFR has to do w/ poorer facilities and levels of care.
But I still appreciate the scoops Treyfish finds. Amazingly, their could be more than one H1N1 strain at work, and only careful sequencing of ALL SAMPLES will catch evolutionary changes. It's good if they really will have a higher oversight committee of experts to ajudge the situation in a timely way...that's why all states need to collect samples and perform sequencing of all samples so as to CATCH at the EARLIEST possible moment any such changes.

 

[Snowy Owl]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

OK I did my best to contact Mr L.V. Subrahmanyam and I couls not reach him then I try to reach Sri K. Rosaiah, the contact person.

The Institute of Preventive Medicine (IPM) start testing blood and other samples of patients suspected to have contracted swine flu. The institute has been designated as a testing laboratory for swine flu and the Government has imported primers and other equipment for testing the samples. Other infrastructure has been positioned at the institute to avoid delay in testing the samples which are now being sent to New Delhi.



The Centre for Cellular and Molecular Biology (CCMB) has also been roped in to test samples so that the reaction time for treating a positive case would increase significantly and this would, in turn, enable steps to check the spread of swine flu.


A for the emergency meeting I invited you to read the following,


Hospitals let H1N1 flu patients die

TNN 15 September 2009, 06:32am IST

HYDERABAD: The city is witnessing a rash of swine flu deaths but hospitals have turned their backs on H1N1 flu patients, even critical cases,who are being treated as social outcasts and shunted from one hospital to another. The latest H1N1 flu victim, 25-year-old Ashish Raj, who succumbed to the infection on Sunday night was made to shift three hospitals before he was given treatment at Osmania General Hospital, that too after much persuasion by his relatives.

Vanasthalipuram resident Ashish Raj was suffering from acute respiratory distress (ARDS) and pneumonia. He was first admitted to Mahaveer Hospital but doctors asked him to move to Gandhi Hospital on Saturday as it does not have a facility to treat H1N1 flu patients. At Gandhi, he was not only denied admission but even a stretcher. “The staff refused to take up the case on grounds that there was no vacancy. When we took him to Chest Hospital, even they refused to take up the case citing the same reason and asked us to go to Osmania General Hospital (OGH). At OGH, after much persuasion, he was admitted. He died later on Sunday at around 8.30 pm,” said Vinay Verma, a relative. Ashish died due to multi-organ failure.

Since a stretcher was not given, relatives said that the critical patient’s father and brother had to run from pillar to post with the struggling boy on their shoulder. At both Gandhi and Chest Hospital, officials said that admission was denied as there was no space to accommodate more patients.

When asked why a critical patient was treated in this manner, Gandhi hospital superintendent E A Ashok Kumar said he wasn’t aware of this. “It has not come to my notice. I will inquire into it and take action,’’ he said. Chest Hospital officials said that all three ventilators were in use and there was no way they could accommodated another patient.

Ashish’s case is not an isolated one with as many as six to eight such cases being denied admission at Chest Hospital on a daily basis, according to hospital sources. While Chest Hospital is referring the patients to Gandhi and OGH, most of these cases are not being admitted by the two government hospitals as well, say sources.

http://timesofindia.indiatimes.com/...H1N1-flu-patients-die/articleshow/5012189.cms

In all cases I am told, Pune Institute will share datas once available as agreed by their government.

Snowy Owl

 

[Ronan Kelly]

Re: H1N1 strain turns virulent: Health officials

Re: H1N1 strain turns virulent: Health officials

Any information in Karnataka will be difficult to come by;

Docs hold monthly reports, send health plans for a toss
Nirmala M Nagaraj, TNN 15 September 2009, 02:19am IST


BANGALORE: The Karnataka health department is in limbo. Thousands of unhappy government doctors have failed to submit their monthly reports to the
government, resulting in glitches in many health schemes. Procurement of medicines, supply of drugs to hospitals and preventive measures to check the spread of diseases are affected.
These monthly reports are crucial: they enable the government to take important decisions. But the doctors, unhappy with low wages and that their demands are not met, set September 29 as the deadline for the government, and have already started submitting their resignations.

Karnataka State Government Medical Officers? Association president Dr K Mohan said: ?Almost a month ago, we met health secretary I R Perumal, who made us wait for almost five hours and insulted us by calling us mosquitoes. As it is, we are annoyed with the government?s failure to meet our demands. This angered us further. The association received 90% resignations from doctors and most of them mention this insult.?? Shockingly, KSGMO directed doctors not to submit any report to the government from August 25. As per rules, each primary health care medical officer submits 26 reports per month.

?Only government doctors provide both curative and preventive care. For instance, if one malaria case is identified in the area, the doctor treats the patient and also ensures that the disease does not spread by initiating fogging and other preventive activities. If one polio-positive case is found, the area medical officer dedicates a whole year working to eradicate the disease. While private doctors only provide curative service, for preventive care, the state is dependent on government doctors,? said Dr Rajanna, resident medical officer, Bowring and Lady Curzon Hospital. At a time when the state is battling diseases like chikungunya, dengue and the dreaded H1N1 flu, this could spell further doom to healthcare.
http://timesofindia.indiatimes.com/...alth-plans-for-a-toss/articleshow/5011914.cms

 

[Treyfish]

Re: India - H1N1 strain turns virulent: Health officials

Re: India - H1N1 strain turns virulent: Health officials

India's swine flu vaccine likely by March '10

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AP FROM MASKS TO VACCINES: India's battle against the A(H1N1) virus appears to have taken a turn for the better with prospects of Indian vaccines available by next year. Photo: AP


The Indian vaccine against the pandemic strain of swine flu would be commercially available by March next with the authorities planning to fast-track the clinical trials in humans in accordance with international protocols.
Vishwa Mohan Katoch, Director-General, Indian Council of Medical Research (ICMR) told The Hindu from New Delhi on Tuesday that it was proposed to combine the first and second phases for safety and immuno-genicity.
He said the three Indian companies, Bharat Biotech, Panacea Biotec and Serum Institute of India, which were taken "on board" to produce the vaccine would be completing animal trials by December. Following this the first and second phases in human trials would be combined in a fast-track mode to make the vaccine available by March next as otherwise it would be ready only by the end of next year if a normal schedule were to be followed.
He said the entire exercise of finalising the fast-track protocol would be completed in next two to three weeks after the issue is examined by the committee for drugs and vaccines and another special committee on A(H1N1) Influenza virus.
Dr. Katoch, however, said the question whether to administer one or two doses would be decided after the completion of human trials.
He said Novartis and Glaxo Smith Kline too have expressed interest to conduct short trials in India and the protocols for the same would be finalised soon. "We are talking to them".
Replying to a question, he denied that the virus had become more virulent and said the patients, whose flu-like symptoms persist even after 48 hours, were responding to Tamiflu and there was a case in which even a 72-year-old person had recovered. There was a need to create awareness about this among people and even medical fraternity.
Meanwhile, Krishna Ella, Chariman and Managing Director Bharat Biotech, which will produce the WHO strain of the vaccine along with the other two firms, said his company would be ready with the vaccine for animal trials by this month end. Urging ICMR to allow the first and second phases of human trials to be conducted in a fast track mode, he said it was planned to produce five to six million doses in the next three to four months. The production would be scaled up depending on the requirement:tiphat:http://beta.thehindu.com/sci-tech/science/article20430.ece?homepage=true



Sure change that around quik..Panic control I am thinkin.

 

[Treyfish]

Re: India - H1N1 strain turns virulent: Health officials

Re: India - H1N1 strain turns virulent: Health officials

That's 6 months from now.