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INFLUENZA (12): NAMIBIA (KARAS)
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Date: Tue 9 Nov 2010
Source: Kudu FM [edited]
<http://www.kudufm.com/site/index.php?op ... &Itemid=65>


H1N1 virus outbreak in Keetmanshoop
-----------------------------------
Of 6 blood tests sent in for testing 5 came back positive for the H1N1
swine flu virus [that is, pandemic 2009 influenza A/(H1N1) virus] in
Keetmanshoop last week [week of 2 Nov 2010]. Between Mon 1 Nov and Sat 6
Nov 2010 some 1300 people have shown the same flu symptoms, with a [large
proportion] of those being schoolchildren. According to Dr Jack Vries,
chairman of the National Committee For Health Emergencies, only the
Caprivi, Omaheke, and Kavango regions remain unaffected by the flu
outbreak. People showing symptoms, which include headache, high fever, a
sore throat, and persistent coughing should visit a clinic or their doctor
for a check up. In spite of the high number of people infected, no deaths
have been reported and there is no cause for panic.

--
communicated by:
FluTrackers
<flutrackers@earthlink.net>

[Previously on 3 Nov 2010 (see ProMED-mail Undiagnosed illness,
schoolchildren - Namibia: (KA), RFI 20101105.4012) it was reported that
this outbreak of febrile illness affected about 90 people, most of whom
were schoolchildren. One of 6 diagnostic samples had tested negative for
influenza A/(H1N1) virus. It now transpires that the other 5 pending
samples have tested positive for influenza A/(H1N1) virus, and about 1300
people have now contracted this infection. Fortunately, as elsewhere, the
2009 pandemic (H1N1) virus is causing relatively mild disease.

The map at <http://en.wikipedia.org/wiki/File:Namib ... lFinal.jpg> shows
the location of Keetmanshoop in the southern Karas region of Namibia. The
HealthMap/ProMED-mail interactive map of Namibia can be accessed at
<http://healthmap.org/r/0frH>. - Mod.CP]

„Schweinegrippe“: Mini-Mutation bewirkt tödlichen Verlauf
Austausch nur einer Aminosäure ermöglicht schweren Befall von bewimperten Atemwegszellen
22.11.2010 - scinexx

Der Austausch eines einzigen Proteinbausteins genügt, damit das Schweinegrippe-Virus H1N1 neue Zielzellen befallen und lebensbedrohliche Atemwegsbeschwerden auslösen kann. Das haben jetzt Wissenschaftler aus Marburg und London herausgefunden. Die abgewandelten Viren infizieren bevorzugt bewimperte Zellen in Lunge und Bronchien. der aktuellen Studie in der jüngsten Ausgabe der Fachzeitschrift „Journal of Virology“ ... mehr

Gruß
Birgitt

INFLUENZA (16): ZIMBABWE (MASVINGO)
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<http://www.isid.org>

Date: Wed 24 Nov 2010
Source: The Herald, Zimbabwe [edited]
<http://allafrica.com/stories/201011250516.html>


Nearly 200 cases of swine flu reported
--------------------------------------
A suspected swine flu (H1N1) [influenza A/(H1N1) 2009] outbreak has hit
Ngomahuru communal lands in Masvingo [where] nearly 200 cases of the
disease having been reported in the area over the past 3 weeks. Health
experts are on the ground to assist communities and have also been
conducting awareness campaigns in affected areas.

Some of the worst affected areas, according to health officials, are
Gunikuni and Mushawasha West and small-scale farming areas in Ngomahuru.
Several people were treated at Masvingo General and Ngomahuru Psychiatric
hospitals.

Masvingo provincial medical director, Dr Robert Mudyiradima, yesterday said
they had sent samples to South Africa for testing. "There was an outbreak
of what we suspect is swine flu in Ngomahuru communal lands. We have
recorded about 191 suspected cases over the past 3 weeks. "At the moment we
are on high alert and have deployed our officials in the Ngomahuru area as
part of efforts to stop the spread of the disease," said Dr Mudyiradima.
The Masvingo provincial medical director said the situation was under control.

--
communicated by:
HealthMap Alerts via
ProMED-mail <promed@promemail.org>

[The diagnosis of H1N1 influenza virus infection is based on symptoms and
confirmation by laboratory testing in South Africa is awaited. The most
recent FluNet report does not list Zimbabwe -- see: Influenza (15): WHO
update 20101124.4243.

A map of the provinces of Zimbabwe showing the location of Masvingo can be
accessed at
<http://www.mapsofworld.com/zimbabwe/zim ... l-map.html>. The
HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/r/00aK>. - Mod.CP]

INFLUENZA (19): EUROPE, ISRAEL, YEMEN
*************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Europe
[2] Israel
[3] Yemen

******
[1] Europe
Date: Thu 16 Dec 2010
Source: Eurosurveillance, Volume 15, Issue 50 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19753>


The influenza season 2010-11 in Europe has started with increasing
transmission in 11 countries [1]. The currently circulating strains
are predominantly the 2009 pandemic influenza A(H1N1) and influenza B
viruses [1], strains that are included in the current trivalent
seasonal influenza vaccine. The United Kingdom (UK), so far the most
affected country, has seen a number of outbreaks. Although the
majority of cases in the UK are mild, a significant number of severe
hospitalised cases and several deaths have occurred, some in patients
belonging to risk groups, including pregnant women [2]. This has
resulted in an increased demand for intensive care treatment and
respiratory support including extracorporeal membrane oxygenation
(ECMO). Most patients are under 65 years of age.

In the past, epidemics have most often progressed from west to east in
Europe [3]. There is a rapidly closing window of time during which
public health and clinical interventions can mitigate the impact of
this season's influenza epidemics on morbidity and mortality.
Countries should be prepared for increased demand for healthcare
assistance and promote early sample collection and testing for
patients with influenza-like-illness.

Influenza vaccination with the 2010 trivalent seasonal influenza
vaccine is the most effective prevention measure and is recommended in
particular for those at risk of developing severe disease [4]. There
is strong evidence suggesting that the A(H1N1) component of the
seasonal vaccine will be highly effective against influenza-like
illness caused by the pandemic influenza A(H1N1) virus. Good
protection was achieved as early as 8 days after vaccination [5].

Early use of antiviral drugs for individuals belonging to risk groups
will also be of value. The currently circulating variant can be
expected to be sensitive to oseltamivir and zanamivir, as the old
oseltamivir-resistant influenza A(H1N1) virus has been displaced by
the pandemic strain, and very few viruses so far have been reported as
being resistant [6]. However, isolates should be monitored for the
emergence of antiviral resistance, particularly in immunocompromised
patients.

References
----------
(1) Weekly influenza surveillance overview. Stockholm: European Centre
for Disease Prevention and Control; 10 Dec 2010. Available from:
<http://ecdc.europa.eu/en/publications/P ... erview.pdf>.

(2) HPA Weekly National Influenza Report - week 49. London: Health
Protection Agency; 9 Dec 2010; Available from:
<http://www.hpa.org.uk/web/HPAwebFile/HP ... 7146267647>.

(3) The 2009 A(H1N1) pandemic in Europe. Stockholm: European Centre
for Disease Prevention and Control; 2010; Available from:
<http://www.ecdc.europa.eu/en/publicatio ... rience.pdf>.

(4) Start of the Influenza season 2010/11 in Europe - severe influenza
cases in the UK. Stockholm: European Centre for Disease Prevention and
Control; 15 Dec 2010. Available from:
<http://www.ecdc.europa.eu/en/activities ... %20Reviews>.

(5) Kissling E, Valenciano M, Moren A, Ciancio B. Estimates of
pandemic influenza vaccine effectiveness in Europe, 2009-10: results
of the I-MOVE multicentre case-control study. European Scientific
Conference on Applied Infectious Disease Epidemiology; 2010; Lisbon.
Abs N 43; Available from:
<http://ecdc.europa.eu/en/ESCAIDE/ESCAID ... iancio.pdf>.

(6) Global Alert and Response. Influenza update. Geneva: World Health
Organization; 2 Dec 2010; Available from:
<http://www.who.int/csr/disease/influenz ... index.html>.

[Byline: The Influenza Team of the European Centre for Disease
Prevention and Control (ECDC), Stockholm, Sweden]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[2] Israel
Date: Thu 16 Dec 2010
Source: The Jerusalem Post [edited]
<http://www.jpost.com/Headlines/Article.aspx?id=199764>


50 cadets at the IDF's [Israel Defense Force] Officer Training School
-- known as Bahd 1 -- were diagnosed on Thursday [16 Dec 2010] with
swine flu [influenza A/(H1N1) virus infection].

The soldiers, who were staying at Har Gilo for an education seminar,
complained in recent days of flu-like symptoms, and after being tested
were found to all be sick with H1N1, otherwise known as swine flu
[influenza A/(H1N1) virus infection].

The IDF Medical Corps has launched an investigation to locate the
source of the flu in the IDF.

[Byline: Yaakov Lappin]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The HealthMap/ProMED-mail interactive map of Israel can be accessed
at <http://healthmap.org/r/00aH>. - Mod.CP]

******
[3] Yemen
Date: Tue 14 De 2010
Source: Yemen Post [edited]
<http://www.yemenpost.net/Detail12345678 ... &MainCat=3>


New influenza (H1N1) virus infection cases have been detected in
Yemen, raising fears the pandemic could strike again after its end
early this year [2010] was not so clear.

The News Yemen [website] quoted sources at a private hospital as
saying that 9 people were admitted to the hospital and diagnosed with
influenza (H1N1) virus infection in early November [2010]. Four of the
9 have died so far, the website said, but did not publish the name of
the hospital.

The National H1N1 Monitoring and Surveillance Commission said it had
received reports about the cases, adding: "We called the commission,
but it did not confirm or deny H1N1 cases had been detected in the
country."

The hospital contacted the commission over the cases, but it was told
to keep them secret while Yemen was preparing for hosting the 20th
Gulf Soccer Cup, it said.

The commission also visited the infected and supplied the hospital
with necessary medications, the sources were quoted as saying.

[Byline: Yemen Post Staff]

--
Communicated by:
HealthMap Alerts via
ProMED-mail <promed@promedmail.org>

[In the case of the outbreak in Yemen, it is likely that the H1N1
virus detected is the influenza A/(H1N1) 2009 pandemic strain rather
than the previously circulating seasonal H1N1 strain. The final match
of the 20th Gulf Soccer Tournament (between Kuwait and Saudi Arabia)
was held before a crowd of 55 000 fans in Aden on Sun 5 Dec 2010, so,
presumably, the patients had been hospitalised and diagnosed with H1N1
influenza prior to that date, and the information has only now been
released. The HealthMap/ProMED-mail interactive map of Yemen can be
accessed at: <http://healthmap.org/r/01Gk>.

It is clear that the influenza season is now upon us in parts of
Europe and the Middle East and that the predominant virus is the
influenza (H1N1) 2009 strain. It is too soon to assess whether it has
retained its relative virulence, but that should become clear very
shortly. - Mod.CP]

[Maps
Europe: <http://year5.skola.edu.mt/wp-content/up ... pe-map.gif>
Israel: <http://www.israelmapxl.com/images/israe ... on-map.gif>
Yemen: <http://www.yamanat.com/common/about-yem ... -yemen.jpg>
- Mod.JW]

INFLUENZA (23): EGYPT, SRI LANKA
***********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


*****
Egypt & Sri Lanka
Date: Tue 21 Dec 2010
Source: CIDRAP News [abbreviated, edited]
<http://www.cidrap.umn.edu/cidrap/conten ... sscan.html>


Egypt's health ministry said it received reports of 218 cases of
influenza A/(H1N1) virus infection last week, bringing the country's
total to 533, including 30 deaths, since October [2010], Daily News
Egypt reported today [21 Dec 2010].

Abdel Rahman Shahin, the Health Ministry spokesman, said clinical
studies indicate the rate is normal for seasonal influenza and should
rise as outdoor temperatures cool. He said the 2009 H1N1 activity in
Egypt is an example of periodic outbreaks of the virus that the World
Health Organization (WHO) said it expected to see in the post-pandemic phase.

In England, which has also reported a spike in 2009 H1N1 infections,
302 people are being treated in intensive care units for influenza infections.

Elsewhere, Sri Lanka's health ministry yesterday [20 Dec 2010] issued
an alert advising pregnant women, healthcare workers, transportation
employees, armed forces, and law enforcement personnel to get
vaccinated against the 2009 H1N1 virus as a precaution, the Asian
Tribune reported today.

The WHO said in its latest update that 2009 H1N1 activity had
recently peaked in Sri Lanka, one of the few tropical countries
reporting flu transmission. Dr Sudath Peiris, a senior epidemiologist
at the health ministry, said Sri Lanka had already distributed the
400 000 doses of 2009 H1N1 vaccine from the WHO and is requesting one
million more.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Now that the northern hemisphere influenza epidemic is progressing
rapidly, ProMED-mail will not report data on a single locality basis
unless there are exceptional features. Future reporting will be in
the form of regional updates. - Mod.CP]

Virologe zur Schweinegrippe
"Ganz verschwunden war sie nie"
04.01.2011 - tagesschau

Die Schweinegrippe ist wieder da. In Deutschland sind zwei Menschen gestorben, die mit dem Virus infiziert waren. Der Virologe Hofmann warnt aber im Gespräch mit tagesschau.de vor Panik: Eine neue Welle sei in der jetzigen Grippezeit erwartet worden - und es gebe keine Hinweise auf eine gefährliche Veränderung des Virus ... mehr

Gruß
Birgitt

INFLUENZA (07): ISRAEL
**********************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Thu 13 Jan 2022
Source: Jweekly.com [edited]
<http://www.jweekly.com/article/full/604 ... ts-israel/>


At least 13 Israelis are hospitalized in critical condition with
swine flu [influenza A/(H1N1) 2009 virus infection], including 5
children, and at least 4 Israelis have died from swine flu in recent
weeks, according to the Health Ministry.

On 10 Jan 2011, a 6-year-old-girl became what seemed to be the 4th
victim of the flu when she died at the Assaf Harofe Medical Center,
Israel Radio reported. Her death was probably due to complications
related to swine flu, doctors said.

Some 8000 Israelis have reported symptoms of swine flu already this
winter [2010-2011], the Ministry said. About 15 percent of Israel's
general population [circa 7.5 million], and a little more than half
of those in the high-risk categories have been vaccinated, the
Jerusalem Post reported.

--
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ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Fri 14 Jan 2011
Source: Daily Maariv [in Hebrew, machine trans. & summ., edited]
<http://www.nrg.co.il/online/1/ART2/200/ ... 8&tmp=7257>


To date, 28 patients have been hospitalized in serious condition as a
consequence of the outbreak [of influenza A/(H1N1) 2009 virus
infection] and 4 have died. Beginning next week [week of 16 Jan 2011]
doctors are expected to petition the High Court because of shortage
of beds. Of the 28 hospitalised patients, 24 are on respirators and 3
are in serious condition. 4 patients are reported to have died [as a
result of influenza A/(H1N1) 2009 virus infection]. "I do not
remember we had such a situation [previously]," stated Dr Eyal Porat,
director of Cardiac Surgery at Beilinson Hospital in Petah Tikva.

3 days ago the number of patients in intensive care was 23, including
19 on respirators. However on the basis of current data the Ministry
of Health has concluded that the outbreak had peaked. 3 of the
patients on respirators have now been transferred to Beilinson
hospital which has facilities to undertake ECMO [extracorporeal
membrane oxygenation]. Dr Porat explained that influenza infection
affects gas exchange in the lungs and the ECMO procedure facilitates
oxygenation of the blood. It is a complex procedure requiring a
dedicated team at the Beilinson hospital and for transfer of the
patients from other hospitals. During Tuesday and Wednesday [11,12
Jan 2011] several other hospitals sought ECMO treatment for their
patients at Beilinson hospital.

"This case certainly an unusual situation, because 3 of the younger
patients with no perceptible risk factors were among these severely
affected patients, said Dr Porath. "Last year we encountered such
morbidity only among those who had serious underlying health
problems. This year it's different." According to the hospital, their
chances of recovery are over 50 percent, but "without ECMO they had
no chance of recovery."

[Byline: Littal Grossman]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[ProMED-mail no longer routinely posts individual country data, but
as Israel was omitted from the most recent WHO update, these reports
are posted to remedy this omission.

The information above suggests that the influenza outbreak in Israel
is having more severe consequences than in most countries in the
Northern Hemisphere. However, the vaccination uptake has been low.

The HealthMap/ProMED-mail interactive map of Israel can be accessed at
<http://healthmap.org/r/00aH>. - Mod.CP]

INFLUENZA (49): H1N1 PANDEMIC MORTALITY ESTIMATE
************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Mon 25 Jun 2012
Source: Reuters [edited]
http://af.reuters.com/article/commoditi ... 9Y20120625


Study indicates 2009 swine flu outbreak was 15 times deadlier
--------------------------------------------------------------
The swine flu pandemic of 2009 [A/H1N1 pdm09 virus infection] killed an estimated 284 500 people, some 15 times the number confirmed by laboratory tests at the time, according to a new study by an international group of scientists. The study, published on Tuesday [19 Jun 2012] in the London-based journal Lancet Infectious Diseases, said the toll might have been even higher -- as many as 579 000 people. The original count, compiled by the World Health Organisation (WHO), put the number at 18 500. Those were only the deaths confirmed by lab testing, which the WHO itself warned was a gross underestimate because the deaths of people without access to the health system go uncounted, and because the virus is not always detectable after a victim dies.

The new study also shows the pandemic's impact varied widely by region, with 51 percent of swine flu deaths occurring in Africa and southeast Asia, which account for only 38 percent of the world's population. "This pandemic really did take an enormous toll," said Dr. Fatimah Dawood of the U.S. Centers for Disease Control and Prevention, who led the study. "Our results also suggest how best to deploy resources. If a vaccine were to become available, we need to make sure it reached the areas where the death toll is likely to be highest."

Swine flu, caused by the H1N1 influenza virus, infected its 1st known victim in central Mexico in March 2009. By April it had reached California, infecting a 10-year-old, and then quickly spread around the world, triggering fears and even panic. The CDC warned Americans not to travel to Mexico if they could avoid it. Egypt ordered the slaughter of all the country's pigs in a misguided attempt to contain the virus, which was in fact spread from person to person. The fears reflected the unusual nature of the virus, which contained bits and pieces of bird, swine and human flu viruses, a combination never before detected.

Scientists were unsure how transmissible or deadly this mongrel flu [virus] would be, but early signs were ominous: the World Health Organisation declared swine flu a pandemic in June 2009, when labs had identified cases in 74 countries. Such lab-based identification is the gold standard, but every expert acknowledges that it misses more cases than it catches. One reason is that "some people who contract flu do not have access to health care," said CDC's Dawood, so their illness and even death goes unnoticed by authorities. Another reason is that the virus is not always detectable by the time a victim dies.

To get around these obstacles, epidemiologists resort to statistical models. They typically take the number of deaths from pneumonia and complications of underlying cardiovascular disease -- both caused by influenza -- during non-flu periods, count the number during a pandemic, and attribute the excess to the flu. Unfortunately, "vital statistics data are non-existent or sparse in many lower-resource countries," said Dawood, making this approach infeasible. Dawood and her colleagues -- from Vietnam, Kenya, New Zealand, Denmark and 5 other countries -- tried a different method.

They started with hard data, such as numbers from health workers going door to door in rural villages and asking about flu-like symptoms and testing nasal and throat swab samples, to estimate the proportion of a country's population infected with 2009 H1N1. Such data were available from 13 countries -- wealthy, such as Denmark, and poor, like Viet Nam. Then the scientists estimated the fraction of patients who died in each country. They started with solid data on death rates from respiratory illnesses in 5 wealthy nations. Since someone with, say, pneumonia has a lower chance of dying if treated in a top hospital in Hong Kong than at a rural clinic in Viet Nam, the scientists applied a "multiplier" to the raw data from poor countries. That is, they assumed that more people with flu-caused pneumonia died in developing nations than developed ones.

Such estimates and assumptions can introduce errors, critics note. Newly released mortality data from Mexico, for instance, show that H1N1 killed even more people than the new study estimates, said Lone Simonsen of George Washington University School of Public Health, co-author of a commentary on the study. Estimates of deaths from Japan and Singapore, in contrast, may be too high. Overall, however, the under- and over-estimates probably even out, said Simonsen, making the global estimate -- of 15 times more deaths than those confirmed at the time -- about right.

The results paint a picture of a flu virus that did not treat all victims equally. It killed 2 to 3 times as many of its victims in Africa than elsewhere. Overall, the virus infected children most (4 percent to 33 percent), adults moderately (0 to 22 percent of those 18 to 64) and the elderly hardly at all (0 to 4 percent). Even though the elderly were more likely to die once infected, so few caught the virus that 80 percent of swine flu deaths were of people younger than 65. In contrast, the elderly account for roughly 80 percent to 90 percent of deaths from seasonal influenza outbreaks. They were probably spared the worst of 2009 H1N1 because the virus resembled one that had circulated before 1957, meaning people alive then had developed some antibodies to it. The relative youth of the victims meant that H1N1 stole more than 3 times as many years of life than typical seasonal flu: 9.7 million years of life lost compared to 2.8 million if it had targeted the elderly as seasonal flu does.

H1N1 had begun petering out by November 2009, and the WHO declared the epidemic at an end the following August [2010].

(Byline: Sharon Begley, reporter; editing by Michele Gershberg and Xavier Briand)

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[The paper is available on line on 25 Jun 2012: http://www.sciencedirect.com/science/ar ... 9912701214.

Title: Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study

Authors: Fatimah S Dawood, and 29 others
"Summary
-------
"Background: 18 500 laboratory-confirmed deaths caused by the 2009 pandemic influenza A H1N1 were reported worldwide for the period April 2009 to August 2010. This number is likely to be only a fraction of the true number of the deaths associated with 2009 pandemic influenza A H1N1. We aimed to estimate the global number of deaths during the first 12 months of virus circulation in each country.

"Methods: We calculated crude respiratory mortality rates associated with the 2009 pandemic influenza A H1N1 strain by age (0-17 years, 18-64 years, and >64 years) using the cumulative (12 months) virus-associated symptomatic attack rates from 12 countries and symptomatic case fatality ratios (sCFR) from 5 high-income countries. To adjust crude mortality rates for differences between countries in risk of death from influenza, we developed a respiratory mortality multiplier equal to the ratio of the median lower respiratory tract infection mortality rate in each WHO region mortality stratum to the median in countries with very low mortality. We calculated cardiovascular disease mortality rates associated with 2009 pandemic influenza A H1N1 infection with the ratio of excess deaths from cardiovascular and respiratory diseases during the pandemic in 5 countries and multiplied these values by the crude respiratory disease mortality rate associated with the virus. Respiratory and cardiovascular mortality rates associated with 2009 pandemic influenza A H1N1 were multiplied by age to calculate the number of associated deaths.

"Findings: We estimate that globally there were 201 200 respiratory deaths (range 10 700 - 395 600) with an additional 83 300 cardiovascular deaths (46 000 - 179 900) associated with 2009 pandemic influenza A H1N1. 80 percent of the respiratory and cardiovascular deaths were in people younger than 65 years and 59 percent occurred in southeast Asia and Africa.

"Interpretation: Our estimate of respiratory and cardiovascular mortality associated with the 2009 pandemic influenza A H1N1 was 15 times higher than reported laboratory-confirmed deaths. Although no estimates of sCFRs were available from Africa and southeast Asia, a disproportionate number of estimated pandemic deaths might have occurred in these regions. Therefore, efforts to prevent influenza need to effectively target these regions in future pandemics."

A podcast related to this publication is available at: http://download.thelancet.com/flatconte ... f_july.mp3. - Mod.CP]

INFLUENZA (92): INDIA (MADHYA PRADESH, MAHARASHSTRA), H1N1 FATALITIES
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[1]

Date: Tue 25 Sep 2012
Source: PTI via Hindustan Times [edited]
http://www.hindustantimes.com/India-new ... 35279.aspx


Madhya Pradesh
--------------
...The high mortality rate among those afflicted by swine flu in Madhya Pradesh (MP), is actually alarming. Bhopal tops the death toll with 7 out of 28 patients testing positive for the H1N1 virus succumbing during treatment. Indore is not far behind, where 5 of 5 patients have died of the dreaded virus.

In fact, the [doctor] in charge of the swine flu [group] at the directorate of health, Dr K K Thassu, issued a circular some days ago asking people not to be afraid of swine flu, as it is no longer an epidemic but only an endemic disease which can be cured through medication. At that time, swine flu fears seemed to be receding as most of the suspected swine flu patients were testing negative, and those admitted for treatment were responding well at both government and private hospitals. But in the past few days, the situation has changed dramatically. On Saturday [22 Sep 2012], 9 out of 11 samples sent for confirmation of swine flu tested positive, giving a clear indication that the infection was on the rise and facilities for its treatment grossly inadequate.

Another remarkable aspect of the swine flu scare this season [2012-2013] is the fact that a number of doctors are also catching the infection. Two doctors of LBS Hospital in Bhopal tested positive for swine flu on Monday [24 Sep 2012]. In Jabalpur, 2 doctors including the dean of Netaji Subhash Chandra Bose Medical College are being treated for swine flu. Another doctor in the city, who had tested positive for the disease, has since been discharged. But to their credit, doctors in Jabalpur have not allowed any swine flu patient to die, though the number of persons testing positive in the confirmation test is more or less the same as Bhopal and Indore, 26 to be precise. In the wake of a growing number of doctors catching the infection, the directorate of health has made it mandatory for all doctors and paramedical staff coming into direct contact with swine flu patients to get themselves vaccinated.

"We are calling it [a] focal outbreak, as the disease is prevalent more in specific pockets while not so in other areas. In MP the situation is worsening. Climate is also conducive for growth [spread] of H1N1 virus, but to say that we are ill-prepared wouldn't be correct. Had it been so, there would have been more patients and more casualties," Dr Thassu stated.

The chief medical and health officer (CMHO), Dr Pankaj Shukla, said the situation was not so bad in Bhopal as it appeared because patients from all over the state were coming here for treatment. "This season is conducive for spread of infectious diseases, but we are keeping a tight leash on the situation, and constant monitoring is being carried out," he added.

Maharashtra
-----------
In Maharashtra, the situation is worse. Over 1100 people have tested positive and 68 deaths have been reported due to swine flu, and there it has been declared an epidemic.
[Byline: M. Poornima]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[2]
Date: Thu 27 Sep 2012
Source: Press Trust of India via Business Standard [edited]
http://www.business-standard.com/genera ... -17/61488/


One more person succumbed to the H1N1 virus in Bhopal, taking the death toll due to the infection in Madhya Pradesh [MP] to 17 this year [2012]. A 45-year-old man from Sagar, who had been undergoing treatment at a private hospital here, succumbed due to the virus yesterday [26 Sep 2012], health officials said today. Among the 17 swine flu victims, 8 died in Bhopal, 6 in Indore, 2 in Ujjain and one in Gwalior. 10 samples of suspected H1N1 cases in the state had been sent to the ICMR Laboratory at Jabalpur for examination, officials said. Of the 10 samples, 5 are from Bhopal, 3 from Vidisha and 2 from Sehore districts.

On Tue 25 Sep 2012, Chief Secretary R Parsuram, while reviewing the situation following a fresh outbreak of the disease in MP, had advised people as well as doctors and paramedical staff to remain alert while dealing with the infection. He directed officials to speed up sample testing at labs to ensure prompt medical attention to the patients.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[The above information is supplementary to the WHO report on influenza virus activity in the world,
http://www.who.int/influenza/gisrs_labo ... index.html, which does not include information from India.

According to the WHO, as of 14 Sep 2012, influenza activity continued to decrease compared to recent weeks in the southern hemisphere. Influenza A(H3N2) viruses remained the predominant subtype globally, followed by influenza B and A(H1N1)pdm viruses http://www.who.int/influenza/gisrs_labo ... index.html.

Influenza activity decreased in the Oceania region. Australia and New Zealand reported fewer laboratory confirmed influenza positives of the circulating subtypes, while sporadic activity was reported from New Caledonia.

Influenza B viruses were the predominant viruses detected in the African region, and sporadic detections of A(H3N2) viruses were also reported from the region. Influenza activity remained high in South Africa with co-circulation of A(H3N2) and influenza B viruses.

In southern mainland China, influenza activity began to decrease. Influenza A(H3N2), A(H1N1)pdm09, and influenza B viruses were reported from the region, while A(H3N2) remained the predominant subtype in the region.

Influenza activity remained low in central and South America with fewer detections of A(H1N1)pdm, A(H3N2), and influenza B viruses reported by the region.

Sporadic detections of A(H3N2) and influenza B viruses were reported from the European region. Two independent cases of A(H1N1)pdm viruses carrying the H275Y mutation associated with oseltamivir resistance were reported from Netherlands. Partial sequencing of the NA, HA, PB2 and M genes revealed that the viruses were identical.

In North America, influenza activity remained low. To date, 296 cases of infection with the variant A(H3N2)v viruses have been detected in the United States of America, with 16 cases hospitalized and one death reported.

A(H1N2) variant viruses have also been recently reported from Minnesota in the USA. These A(H1N2) variant viruses are very similar to those found in humans previously but differ as they have the M gene derived from the A(H1N1)pdm09 virus.

***This is the 1st time this variant virus has been isolated from humans.***

The Indian state of Madhya Pradesh can be located on the interactive ProMED/HealthMap at: http://healthmap.org/r/00Vk. - Mod.CP]

UNDIAGNOSED RESPIRATORY INFECTION - ALGERIA: (EL OUED) FATAL, REQUEST FOR INFORMATION
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Date: Wed 30 Jan 2013
Source: El Watan (Algerie) [in French, machine trans. edited]
http://www.elwatan.com/actualite/el-oue ... 89_109.php


Reliable sources have reported that during the past 2 weeks, 3 people have died as a consequence of a suspected virulent, flu-like virus infection. Three others were similarly affected and survived after resuscitation in the Infectious Diseases Department of the El Wadi Hospital. Medical sources have confirmed this report and further stated that the deceased were admitted to hospital in serious condition, with a dry cough, high fever, and difficulty in breathing, adding that the exact cause of death remains unknown.

The dead patients included one woman and were 49, 47 and 28 years of age living in Hassani Abdelkarim, El Oued, and Bayadha. Our source stated further that blood samples from the victims of "this strange virus" have been sent to the Pasteur Institute for further analysis.

The 3 surviving patients were between 40-58 years of age and originated from El Oued province.

[Byline: Rezzag Salem Youce]

--
Communicated by:
ProMED-mail <promed-fra@promedmail.org>

[The information provided is not sufficient to identify the virus involved, if indeed these cases of severe acute respiratory infection (SARI) are caused by virus infection. The outcome of the diagnostic tests at the Algerian Pasteur Institute is awaited. The affected victims and patients appear to be unrelated and to originate from different communities, which suggests that they may be particularly vulnerable individuals affected by a relatively common respiratory virus.

According to the current WHO Global Influenza update: "Algeria, Israel, the Islamic Republic of Iran, and Pakistan have noted increases in influenza activity. In the Northern Africa region, Tunisia also reported transmission increases. Algeria, The Islamic Republic of Iran, and Iraq reported mostly influenza A(H1N1)pdm09."

El Oued is located 400 miles southeast of Algiers (the capital city of Algeria), near the Tunisian border. The population of El Oued was 139 362 as of the 1998 census.

The interactive ProMED-mail HealthMap of Algeria can be accessed at: http://healthmap.org/r/01*0. - Mod.CP]

INFLUENZA (15): INDIA (RAJASTHAN) MORTALITY
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Date: Sun 3 Feb 2013
Source: The Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 312155.cms


Almost one out of 5 people testing positive for swine flu [presumably influenza A /(H1N1)pdm09] died in the past 46 days in the state [Rajasthan]. Ever since influenza has reared its head again, the Health Department has been concerned about the high death rate. Figures show that from 13 Dec 2012 to 28 Jan 2013, nearly 378 people were tested positive for swine flu, 70 of whom had died. The death rate is as high as 18.51 per cent, which is much higher than the death rate in 2009-10 and 2010-11. Most of the swine flu cases reported to date were detected in 2009-10 and 2010-11, when swine flu struck in the state first, but the death rate in 2009-10 was just 5.87 per cent and in 2010-11, it was 7.58 per cent. So far, nearly 452 people have been tested positive for swine flu since 2009. Among them, as many as 427 have died. The death rate due to swine flu since 2009 till date remained at 7.83 per cent.

In comparison with the previous year [2012], the swine flu cases reported this year are much higher, which keeps the health department on its toes to find more information about the trait [genetic properties] of the virus. In 2011-12, only 100 cases were reported and 20 of them died. But from 1 Apr 2012 till date, already 595 swine flu cases have been reported. Deaths due to swine flu have increased 5-fold this financial [April to March?] year in comparison with last year.

In 2010-11, as many as 105 swine flu deaths were reported and 1384 people tested positive. During the current financial year [April to March?], 104 deaths have already been reported while 595 people have tested positive.

The state government has swung into action to prevent the spread of swine flu and also to reduce the death rate due to influenza in the state. Recently, chief secretary CK Mathew directed the divisional commissioners and the district collectors to review swine flu status twice a week in their respective areas. Mathew said there is no need to panic but it is necessary to go for a swine flu test and if tested positive, treatment is available at government hospitals. He also directed health department officials to put efforts into preventing the spread of swine flu. The chief secretary also directed the officials concerned to take the necessary measures for treatment of swine flu patients in the government hospitals.

[byline: Syed Intishab Ali]

--
communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[This report is difficult to evaluate. No information is presented regarding the ages of the hospitalised patients, or the vaccination status of these patients or of the general population. It is not clear whether the high mortalities are a statistical anomaly or represent an increase in virulence of the virus. The declaration of influenza virus statistics relative to the financial year is a curiosity.

According to the current WHO Global Influenza Update [see ProMED-mail Influenza (14): WHO global update 20130202.1526486], dated 31 Jan 2013, "Influenza activity in India remained at inter-seasonal levels, with low detections of mainly influenza A(H1N1)pdm09 and some influenza B."

A HealthMap/ProMED-mail interactive map of India can be seen at http://healthmap.org/r/2Arc.

Jaipur is the capital and largest city of the Indian state of Rajasthan. The city has a population of 3.1 million. A map of Rajasthan can be found at http://www.besttofind.com/img/Map-of-Rajasthan.jpg. - Mod.CP]

INFLUENZA (16): INDIA (RAJASTHAN)
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Date: Sun 3 Feb 2013
Source: The Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 312146.cms


Jodhpur highly vulnerable to swine flu
--------------------------------------
With the deaths of 22 people in January [2013], the city has become highly vulnerable to the H1N1 virus. According to the data available from the SN Medical College [Dr Sampurnanand Medical College], as many as 17 people died of swine flu from September to December [2012]. And in January [2013], flu cases increased significantly. SN Medical college principal Dr Arvind Mathur said the majority of patients had died within 2 to 48 hours of being admitted to hospital and even before their swab testing reports had been issued. He said people should not be negligent if they suffer from symptoms suggestive of swine flu.

Dr Mathur also said the low temperature and low humidity provide a favourable environment for the virus to spread. Mostly, pregnant women are getting infected with the virus. Out of the 45 deaths reported in the recent past, 20 were pregnant women. Among the 22 deaths reported in January [2013], one belonged to Jodhpur city, 11 to Jodhpur rural area, 5 were from Barmer, 3 from Jaisalmer, and one each from Pali and Nagaur.

Taking note of the situation, senior officials of the state medical and health department visited Jodhpur on 26 and 27 Jan 2013. They discussed the issue with the hospital and the college administrations. A team of 2 doctors from SMS Hospital has also visited the hospitals here on the direction of the state government and have submitted its report to the government.

The All India Institute of Medical Sciences (AIIMS) and the Ayurved University has extended helping hands to curb the disease. Dr Mathur said the issue has been discussed with the AIIMS director and he has [proposed] solutions to check this trend. "We have also spoken to the Ayurved University and they also have assured help," Mathur said. Meanwhile, the facility for testing of the swab samples has been made available at the medical college and the Desert Medical Research Centre (DMRC). "We are facing the deficiency of diagnostic test kits. When our stock of the kits is exhausted, we forward the samples to DMRC," he said.

Though most of the cases are coming from rural areas, the district administration has not yet put in adequate efforts to identify patients and get them treated in their respective areas to avoid delay. The district collector, who also has taken charge of the divisional commissioner of Jodhpur, was not available for comment.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Jodhpur is the 2nd largest city in the Indian state of Rajasthan. It is located 335 km (208 mi) west from the state capital, Jaipur and can be located on the HealthMap/ProMED-mail interactive map of India at http://healthmap.org/r/5ePD. A map of Rajasthan can be seen at http://rajasthanfoundation.gov.in/image ... an-map.gif.

ProMED-mail thanks Caroline Davies for drawing attention to this additional report concerning the outbreak of severe respiratory virus infection in Rajasthan state.

This report does not confirm directly that the (H1N1) influenza virus responsible for this outbreak is in fact the swine derived A/(H1N1) pdm09 influenza virus, as suggested in the previous report. The results of specific tests are still awaited. A significant feature of the outbreak in Rajasthan is the high frequency of pregnant women among the fatal cases. No information is provided regarding the vaccination status of the Rajasthan population. - Mod.CP]

UNDIAGNOSED RESPIRATORY INFECTION - ALGERIA (02): (EL OUED) INFLUENZA
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Date: Mon 4 Feb 2013
Source: Flutrackers.com [machine trans. edited]
http://www.flutrackers.com/forum/showth ... p?t=199266


The Pasteur Institute in Algiers has confirmed that the deaths of 3 people attributed to a strange, undiagnosed respiratory infection were the result of seasonal flu virus infection.

According to hospital sources, the undiagnosed respiratory infection responsible for the deaths of 3 people, general panic, and the admission of others to the intensive care unit at Omar Jilali Infectious Diseases Hospital were consequences of seasonal influenza virus infection. Samples of blood from others have been taken for further analysis.

--
communicated by:
Gert van der Hoek
Senior Moderator
FluTrackers.com
http://www.flutrackers.com/forum/index.php

[ProMED-mail thanks Gert van der Hoek for this rapid response to our request for information.

According to the current WHO Global Influenza Update, released on 1 Feb 2013, influenza A(H1N1)pdm09 is the predominant influenza virus in the area and likely to be responsible for the outbreak of respiratory disease in Algeria. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A_U.]

UNDIAGNOSED DEATHS - LIBYA: REQUEST FOR INFORMATION, H1N1 SUSPECTED
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Date: Tue 12 Mar 2012
Source: Libya Herald [edited]
http://www.libyaherald.com/2013/03/12/t ... infection/


So far, 3 people have died in Derna from a viral infection that the authorities suspect could be a form of the H1N1 virus. A post on the Health Ministry's Facebook page states the deaths were the result of a respiratory tract infection, causing shortness of breath, high fever, and unconsciousness.

According to a statement from the Health Ministry, the cases did not respond to conventional treatment methods used internationally.

Confirming the 3 deaths today, Tuesday [12 Mar 2013], while speaking at the press conference in Tripoli on the mass poisoning crisis, the director general of the National Centre for Disease Control, Dr Mohammed Abughalah, said 3 others in the town have fallen ill with similar symptoms. They are currently stable and receiving medication at an isolation unit to help prevent the virus from spreading.

According to Abughalah, there have been 23 similar cases in Libya in addition to the 6 in Derna -- 2 each in Beida and Benghazi, one in Marj, 3 in Misurata, 2 in Khoms, 10 in Tripoli, and 2 in Zawia. In addition to the 3 deaths in Derna, one person had died in Tripoli and another in Zawia.

However, he also said that 3 cases in Tripoli had been diagnosed as H1N1 influenza. The other cases were still being analysed.

There are suggestions that those in eastern Libya could be cases of novel coronavirus (NCoV), also known as Saudi SARS. The 1st case [of nCoV] was discovered [confirmed] in September last year [2012] in a Qatari man who had traveled to Saudi Arabia [the virus was first identified in specimens from a Saudi Arabian national who died in June 2012. The 2nd confirmed case was in a Qatari man who had traveled to Saudi Arabia and was being treated in a hospital in the UK. See prior ProMED-mail posts listed in the "see also" section for the chronology of confirmations. - Mod.MPP]. Out of the 14 cases worldwide so far, there have been 6 cases [in Saudi Arabia], 4 of them fatal. [As of 12 Mar 2013, there have been 15 confirmed cases and 9 deaths attributable to nCoV infection. Of these, 8 cases and 6 deaths have been reported from Saudi Arabia. - Mod.MPP]

In its statement today [12 Mar 2013], the Health Ministry said that "upon communication with relevant authorities, it was confirmed that other similar cases were reported in some parts of Libya as well as in some Arab countries".

It added that an isolation unit had been established and an emergency team consisting of specialised doctors and nurses formed and equipped with all necessary medical supplies. Nearby hospitals had also been contacted to cooperate and exchange information.

The World Health Organization (WHO) does not list Libya among the countries displaying the infection. However, it cautions "member states to continue surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns".

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[From the newswire above it appears as though there may be an outbreak of H1N1 associated with fatalities in Libya. Cases have been confirmed in the capital (Tripoli), and specimens are being processed at present on cases that have occurred outside the capital.

It also appears there are concerns that some of the severe respiratory deaths outside Tripoli may not be due to H1N1 but rather due to the novel coronavirus (nCoV) known to be affecting individuals elsewhere in the Middle East sporadically. Thus far, there has only been one instance of documented person-to-person transmission of the nCoV in 2 individuals who had close contact with one of the cases in the UK, with a negative history for other potential exposures. In addition to this cluster, there was a probable cluster (though not confirmed to be person-to-person transmission) of cases in ICU staff in Jordan in May 2012, and a possible family cluster in Saudi Arabia in November 2012 (in this case, it is possible there was a common exposure history of the family members). Thus, given the presently known epidemiology of nCoV cases it is less likely that a country-wide outbreak of severe acute respiratory illness (SARI) in Libya would be due to nCoV, and more likely would be due to H1N1.

There have been reports of increased fatalities associated with H1N1 infection this current flu season in the northern hemisphere (see prior ProMED-mail posts listed below), so the occurrence of increased respiratory illness associated fatalities in Libya might well be due to H1N1 activity. ProMED-mail would greatly appreciate information on the epidemiologic and microbiological investigations of these SARI associated fatalities in Libya, including possible illnesses that might predispose for more severe disease with influenza virus infection.

For a map of Libya showing all of the cities mentioned in the report above, see http://www.nationsonline.org/maps/libya-map.jpg. Derna, Al Beida, Marj, and Benghazi are on the Eastern Coast near the border with Egypt.

For the HealthMap/ProMED-mail interactive map of Libya, see http://healthmap.org/r/1_fL. - Mod.MPP]

UNDIAGNOSED DEATHS - LIBYA (02): INFLUENZA A (H1N1) CONFIRMED
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Date: Wed 13 Mar 2013
Source: The Tripoli Post [edited]
http://www.tripolipost.com/articledetai ... =12&i=9988


A number of flu cases reported recently in Libya have been found to be of the type H1N1 [influenza] virus that leads to death when not treated properly, the director of the National Centre for Disease Control (NCDC), Dr Mohamed Aboughalia, told journalists in Tripoli on Tuesday morning [12 Mar 2013].

Infected cases so far have reached 29. Five deaths have been reported, including one in Tripoli, one in Zawia, and 3 in Darna in eastern Libya. Infected cases have been distributed in Libyan cities: 6 in Darna, 2 in Benghazi, 3 in Baiyda, one in Marj, 3 in Misurata, 2 in Khums, 10 in Tripoli, and 2 in Zawia. Three cases in Tripoli have been diagnosed as being infected with the H1N1 [influenza] virus, while the remaining cases are being tested.

Aboughalia also said that the health authorities were prepared to respond to the situation, and the cases have been isolated to protect the rest of the population from getting in contact with the virus. He said Tamiflu medicine and spray ampoules have been distributed to all NCDC branches in the country.

Influenza A (H1N1) virus is the subtype of influenza A virus that was the most common cause of human influenza (flu) in 2009. Some strains of H1N1 are endemic in humans and cause a small fraction of all influenza-like illness and a small fraction of all seasonal influenza. H1N1 strains caused a small percentage of all human flu infections in 2004-2005. Other strains of H1N1 are endemic in pigs (swine influenza) and in birds (avian influenza).

In June 2009, the World Health Organization declared the new strain of swine-origin H1N1 as a pandemic. This strain is often called swine flu by the public media. This novel virus spread worldwide and had caused about 17 000 deaths by the start of 2010. On 10 Aug 2010, WHO declared the H1N1 influenza pandemic over, saying worldwide flu activity had returned to typical seasonal patterns.

--
communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

[Previously, it was suggested in archived ProMED-mail post: "Undiagnosed deaths - Libya: RFI, H1N1 susp. 20130313.1584077" that: "It also appears there are concerns that some of the severe respiratory deaths outside Tripoli may not be due to H1N1 [influenza] but rather due to the novel coronavirus (nCoV) known to be affecting individuals elsewhere in the Middle East sporadically." While the current diagnoses of influenza A(H1N1) virus infection have only been confirmed for a proportion of the patients, there is no evidence to confirm involvement of the new coronavirus in this outbreak of respiratory illness. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1_fL.]