A CDC flu expert estimates that without a swine flu vaccine, current trends suggest 12% to 24% of Americans might get swine flu this fall and winter.
Over the spring and summer, H1N1 flu never went away. That's very unusual, as seasonal flu bugs don't like to spread during these warm, humid months.In the spring, H1N1 swine flu infected 6% to 8% of people in U.S. communities that had outbreaks, says Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases.
"We think in a longer winter season, attack rates would probably reach higher levels than that, maybe more two or three times as high," Schuchat today said in a CDC teleconference. "We need to be ready for it to be challenging."
Two or three times the summer attack rate would mean 12% to 24% of people getting sick with the flu. That's a range of over one in 10 to just under one in four U.S. residents.
"We have lots of ways that we can limit the impact that it has, but it's going to take us working together," Schuchat said. "We know that our emergency rooms are often crowded in the regular year, particularly in the winter season. This particular virus might crowd the emergency department season more."
Some media have misreported Schuchat as saying that 40% of Americans would get swine flu. But Schuchat was referring to a worst-case-scenario war game in which CDC officials looked at the impact of 40% of the workforce being unable to work because they were sick or taking care of an ill family member. This is not the most likely scenario, Schuchat said.
"Worst-case scenarios we don't want to take us by surprise," Schuchat said. "A more likely scenario ... is the kind of patterns we saw in the spring in the most affected communities like New York City or Seattle, for instance."
Schuchat said the CDC is urging the medical community to help people understand that when they really need emergency care they'll need to make room for the larger-than-usual number of severe flu cases expected to occur during a wave of pandemic flu.
An effective flu vaccine would put a dent in the pandemic, if large enough numbers of people get the vaccine before the next waves of the pandemic sweep the nation. Schuchat says the CDC is telling state and local authorities to plan to start getting H1N1 swine flu vaccine in mid-October.
Swine Flu Causes Seizures in Kids
While H1N1 swine flu isn't a killer flu, a recent CDC publication warned that some kids who got the pandemic flu had seizures or other severe neurologic problems such as Reye's syndrome.
It was a scary warning, but similar neurologic complications are seen with seasonal flu, too. It's not yet known whether H1N1 swine flu is more or less likely to cause these rare but severe complications. Fortunately, all of the kids in the CDC report recovered without long-term consequences.
"We know that neurologic problems like seizures are very concerning for parents, and we want them to [know] that is one more thing to be on the lookout for in conjunction with influenza," Schuchat said. "It's another reason that we're taking this new H1N1 virus so seriously."
Saturday, July 25, 2009
'Best chance' for swine flu woman
Nicola Sturgeon said she had had a very rare reaction to the H1N1 virus.
Sharon Pentleton, 26, who is critically ill, was taken to Crosshouse Hospital, in Kilmarnock, last week, where she had been put on a ventilator.
She was transferred to Stockholm on Thursday because no beds were available in the UK for the procedure she needed.
Ms Pentleton, from North Ayrshire, needs a procedure in which her blood will be circulated out of her body and oxygen added artificially.
It is known as extra corporeal membrane oxygenation (ECMO) and involves a machine taking over the function of the patient's heart and lungs.
The UK has a national ECMO unit in Leicester, to which Scottish patients would normally be sent.However, all five beds in the unit were in use.
Before Ms Pentleton was transferred, a medical team from Sweden came to Scotland to assess her. She was then accompanied by the Swedish doctors on a private flight from Prestwick in Ayrshire.
Ms Sturgeon told BBC Scotland: "She is now getting treatment that gives her the best possible chance of survival."
She said doctors were pleased with how the pregnant woman had coped with the journey and she said the treatment "might and hopefully will save her life".
She added: "It is a highly-specialised procedure and that is why given a bed was found for her in Sweden the decision was taken by her clinical team to recommend transfer there."
Family hopes
A family statement, issued through NHS Ayrshire and Arran, went on: "We are grateful for the care and support we have received from intensive care staff at Crosshouse Hospital and, of course, to the medical care team who travelled from Sweden to start the specialist treatment that we hope will make her well.
"Sharon continues to receive the best possible treatment but is still gravely ill.
"For this reason we will not be making any further statement and we would ask that we are left alone to concentrate on Sharon."
Dr Palle Palmer, from Karolinska University Hospital in Stockholm, told the BBC the treatment would take pressure off the patient's lungs.
"We buy some time for the lungs to get better . . . but she has to get better by herself," he said.
Patient swaps
He added it was common for patients to be transferred to Sweden from other countries and they also sent patients abroad for this procedure.
"We have been swapping patients for 10 years.
"We send about 10 patients per year out and bring in 10-15 patients."
Dr Robert Masterton, executive medical director of NHS Ayrshire and Arran said: "Once an ECMO bed was identified in Sweden, our intensive care specialists worked closely with our Swedish colleagues to make sure the patient was stable before being transferred."
He added: "The family have been fully involved in this decision and support this referral. They have asked for privacy while they concentrate on the patient's treatment and recovery."
The health secretary stressed this particular case was unusual.
Ms Sturgeon said: "It remains the case that for the overwhelming majority of people who get this virus the symptoms are very mild and they will make a full recovery within a matter of days without any complications whatsoever."
Sharon Pentleton, 26, who is critically ill, was taken to Crosshouse Hospital, in Kilmarnock, last week, where she had been put on a ventilator.
She was transferred to Stockholm on Thursday because no beds were available in the UK for the procedure she needed.
Ms Pentleton, from North Ayrshire, needs a procedure in which her blood will be circulated out of her body and oxygen added artificially.
It is known as extra corporeal membrane oxygenation (ECMO) and involves a machine taking over the function of the patient's heart and lungs.
The UK has a national ECMO unit in Leicester, to which Scottish patients would normally be sent.However, all five beds in the unit were in use.
Before Ms Pentleton was transferred, a medical team from Sweden came to Scotland to assess her. She was then accompanied by the Swedish doctors on a private flight from Prestwick in Ayrshire.
Ms Sturgeon told BBC Scotland: "She is now getting treatment that gives her the best possible chance of survival."
She said doctors were pleased with how the pregnant woman had coped with the journey and she said the treatment "might and hopefully will save her life".
She added: "It is a highly-specialised procedure and that is why given a bed was found for her in Sweden the decision was taken by her clinical team to recommend transfer there."
Family hopes
A family statement, issued through NHS Ayrshire and Arran, went on: "We are grateful for the care and support we have received from intensive care staff at Crosshouse Hospital and, of course, to the medical care team who travelled from Sweden to start the specialist treatment that we hope will make her well.
"Sharon continues to receive the best possible treatment but is still gravely ill.
"For this reason we will not be making any further statement and we would ask that we are left alone to concentrate on Sharon."
Dr Palle Palmer, from Karolinska University Hospital in Stockholm, told the BBC the treatment would take pressure off the patient's lungs.
"We buy some time for the lungs to get better . . . but she has to get better by herself," he said.
Patient swaps
He added it was common for patients to be transferred to Sweden from other countries and they also sent patients abroad for this procedure.
"We have been swapping patients for 10 years.
"We send about 10 patients per year out and bring in 10-15 patients."
Dr Robert Masterton, executive medical director of NHS Ayrshire and Arran said: "Once an ECMO bed was identified in Sweden, our intensive care specialists worked closely with our Swedish colleagues to make sure the patient was stable before being transferred."
He added: "The family have been fully involved in this decision and support this referral. They have asked for privacy while they concentrate on the patient's treatment and recovery."
The health secretary stressed this particular case was unusual.
Ms Sturgeon said: "It remains the case that for the overwhelming majority of people who get this virus the symptoms are very mild and they will make a full recovery within a matter of days without any complications whatsoever."
Younger People at Greater Risk of Catching Swine Flu, WHO Says
Younger people are at greater risk of catching swine flu, with most cases occurring in teenagers, the World Health Organization said.
The median age of those infected with the pandemic H1N1 virus is 12 to 17 years, WHO said in a statement yesterday, citing data from Canada, Chile, Japan, U.K. and U.S. Patients requiring hospitalization and those with fatal cases may be slightly older, the Geneva-based United Nations agency said.
“As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly,” WHO said. “This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community.”
World health officials are trying to determine which groups are most likely to get severely ill so measures to best protect them can be taken. Drugmakers are developing vaccines to fight the scourge, which WHO says may result in 2 billion infections.
Cardiovascular and respiratory diseases, diabetes and cancer put people infected with the new H1N1 virus at greater risk of developing severe complications, the UN agency said. Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with more severe illness in several countries, it said.
Obesity has also been reported as a risk factor, and there is mounting evidence that pregnant women are at higher risk for more severe symptoms, WHO said. Some minority populations may also be more vulnerable, “but the potential contributions of cultural, economic and social risk factors are not clear.”
Vaccine Supply
Humans trials of a pandemic vaccine began in Australia this week, helping regulators gauge the safety and efficacy of shots.
The most common way to make flu vaccine is by growing the virus in fertilizer chicken eggs. The virus is then extracted, purified and killed for injection into humans, prompting the immune system to generate antibodies that fend off any infection.
WHO said yesterday that the yields for pandemic vaccine viruses are 25 percent to 50 percent of those of normal seasonal flu viruses for some manufacturers.
A network of WHO collaborators is trying to develop higher- yielding vaccine virus candidates, the agency said, adding that it will be able to revise its estimate of pandemic vaccine supply once it has the new yield information.
The median age of those infected with the pandemic H1N1 virus is 12 to 17 years, WHO said in a statement yesterday, citing data from Canada, Chile, Japan, U.K. and U.S. Patients requiring hospitalization and those with fatal cases may be slightly older, the Geneva-based United Nations agency said.
“As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly,” WHO said. “This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community.”
World health officials are trying to determine which groups are most likely to get severely ill so measures to best protect them can be taken. Drugmakers are developing vaccines to fight the scourge, which WHO says may result in 2 billion infections.
Cardiovascular and respiratory diseases, diabetes and cancer put people infected with the new H1N1 virus at greater risk of developing severe complications, the UN agency said. Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with more severe illness in several countries, it said.
Obesity has also been reported as a risk factor, and there is mounting evidence that pregnant women are at higher risk for more severe symptoms, WHO said. Some minority populations may also be more vulnerable, “but the potential contributions of cultural, economic and social risk factors are not clear.”
Vaccine Supply
Humans trials of a pandemic vaccine began in Australia this week, helping regulators gauge the safety and efficacy of shots.
The most common way to make flu vaccine is by growing the virus in fertilizer chicken eggs. The virus is then extracted, purified and killed for injection into humans, prompting the immune system to generate antibodies that fend off any infection.
WHO said yesterday that the yields for pandemic vaccine viruses are 25 percent to 50 percent of those of normal seasonal flu viruses for some manufacturers.
A network of WHO collaborators is trying to develop higher- yielding vaccine virus candidates, the agency said, adding that it will be able to revise its estimate of pandemic vaccine supply once it has the new yield information.
Swine flu claims state's fourth victim
A fourth person has died of swine flu in Maryland - but unlike previous deaths in the state, the person did not appear to also have an underlying medical problem, health officials said Friday.
Officials gave few details on the death, saying only that the person was an adult from the Eastern Shore with no "immediately apparent underlying medical condition or risk factors."
State health officials said the death of someone without pre-existing illness should serve as a reminder to the public of how serious this flu, known as H1N1, can be - even in otherwise healthy people.
"We are saddened to report yet another death that has been associated with the novel H1N1 influenza," said John M. Colmers, Maryland's health secretary. "More H1N1 flu-related deaths are expected, as we would normally see with seasonal flu. While we wait for the development and delivery of a vaccine, everyone should remain vigilant and take precautions to protect themselves and their loved ones."
While not common, it's not unheard of for healthy people to die of the flu - either this new swine flu or the seasonal variety, said Andrew Pekosz, a professor of microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. "A certain number of healthy people will succumb to the flu," he said.
Since the outbreak this spring, 302 people have died nationwide of the virus, according to the Centers for Disease Control and Prevention. Of the 151 people whose deaths the CDC has studied, 86 percent were at higher risk because they had some underlying medical issue - including people with compromised immune systems, chronic diseases like asthma and even obesity.
While the virus has been described as "mild," it appears to be reacting differently in people, causing a wide range of problems, said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.
"We've seen people with high fever and cough and respiratory illness and really not able to do much more than four or five days," she said. "Then we've seen people who have difficulty breathing, severe respiratory failure and need to be in intensive care unit for weeks. So I think there's really a spectrum."
Infectious disease experts have been concerned that the virus could mutate into a deadlier strain this fall, and Pekosz said experts will be closely examining the deaths of healthy people to determine whether the virus they died from has become more lethal.
Some 36,000 people are killed by seasonal flu each year in the United States. But Pekosz noted that those deaths happen in a nation with widespread vaccinations, with many people who have antibodies against influenza to protect them from the disease.
"If this one emerges like a seasonal flu, the number of people who could potentially be infected will be much larger than what we will have in a normal flu season," he said. "Since there is very little pre-existing immunity, vaccines are going to be an important way to limit the large number of cases that will happen."
Earlier this week, the government announced it would begin testing two H1N1 vaccines on adults and children at eight centers nationwide, including the University of Maryland's Center for Vaccine Development. It is the start of what could be a mass vaccination campaign to start in mid-October.
Meanwhile, yesterday, the CDC strengthened its recommendation that all children aged 6 months to 18 years get vaccinated against seasonal flu. In previous years, the agency has only encouraged the shots.
Maryland has 766 documented cases of the new flu virus, but officials say that figure is likely a fraction of the total cases. Most people who become ill with flulike symptoms aren't tested and recover within a week, much like seasonal flu.
Officials gave few details on the death, saying only that the person was an adult from the Eastern Shore with no "immediately apparent underlying medical condition or risk factors."
State health officials said the death of someone without pre-existing illness should serve as a reminder to the public of how serious this flu, known as H1N1, can be - even in otherwise healthy people.
"We are saddened to report yet another death that has been associated with the novel H1N1 influenza," said John M. Colmers, Maryland's health secretary. "More H1N1 flu-related deaths are expected, as we would normally see with seasonal flu. While we wait for the development and delivery of a vaccine, everyone should remain vigilant and take precautions to protect themselves and their loved ones."
While not common, it's not unheard of for healthy people to die of the flu - either this new swine flu or the seasonal variety, said Andrew Pekosz, a professor of microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. "A certain number of healthy people will succumb to the flu," he said.
Since the outbreak this spring, 302 people have died nationwide of the virus, according to the Centers for Disease Control and Prevention. Of the 151 people whose deaths the CDC has studied, 86 percent were at higher risk because they had some underlying medical issue - including people with compromised immune systems, chronic diseases like asthma and even obesity.
While the virus has been described as "mild," it appears to be reacting differently in people, causing a wide range of problems, said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.
"We've seen people with high fever and cough and respiratory illness and really not able to do much more than four or five days," she said. "Then we've seen people who have difficulty breathing, severe respiratory failure and need to be in intensive care unit for weeks. So I think there's really a spectrum."
Infectious disease experts have been concerned that the virus could mutate into a deadlier strain this fall, and Pekosz said experts will be closely examining the deaths of healthy people to determine whether the virus they died from has become more lethal.
Some 36,000 people are killed by seasonal flu each year in the United States. But Pekosz noted that those deaths happen in a nation with widespread vaccinations, with many people who have antibodies against influenza to protect them from the disease.
"If this one emerges like a seasonal flu, the number of people who could potentially be infected will be much larger than what we will have in a normal flu season," he said. "Since there is very little pre-existing immunity, vaccines are going to be an important way to limit the large number of cases that will happen."
Earlier this week, the government announced it would begin testing two H1N1 vaccines on adults and children at eight centers nationwide, including the University of Maryland's Center for Vaccine Development. It is the start of what could be a mass vaccination campaign to start in mid-October.
Meanwhile, yesterday, the CDC strengthened its recommendation that all children aged 6 months to 18 years get vaccinated against seasonal flu. In previous years, the agency has only encouraged the shots.
Maryland has 766 documented cases of the new flu virus, but officials say that figure is likely a fraction of the total cases. Most people who become ill with flulike symptoms aren't tested and recover within a week, much like seasonal flu.
Swine flu: Correspondents' round-up
Courtesy:BBC
Swine flu has spread around the world and will almost inevitably reach every country, the World Health Organization has said. But there remains uncertainty about its threat.
The number of swine flu cases in India has continued to rise. With 23 new cases reported on Friday from eight cities, the number of people who have tested positive for the flu has risen to 371, according to the federal health ministry. Of this, 237 patients have been discharged, while the rest of them remain admitted in special hospital wards. Some patients who have been quarantined in special wards have complained of poor facilities.
Last month the government issued an alert against swine flu and announced health screening of incoming passengers from affected countries: nearly four million passengers flying into India's 22 international airports have been screened so far.
The federal health minister has also urged people not to travel abroad until swine flu in the country is under control.
When the first cases of the flu were detected, it made the front pages of all the Indian newspapers but since then coverage has been muted.
In the last week, however, there has been an upsurge in coverage because at least one school in Delhi has had to be shut down for a few days because of suspected swine flu cases. This has led to fresh anxiety among parents and school authorities, leading to a revival of interest in the story.
AUSTRALIA
There have been more than 15,000 cases in Australia, and 46 deaths.
All of the victims have had underlying medical conditions.
The number of cases jumped two weeks ago, but there has not yet been the really fast acceleration, an exponential increase, that public health officials feared.
Children have been on their winter holidays here and their return to school is expected to make things worse. Kids are seen as the super-spreaders of the virus.
There has been a lot of pressure on intensive care units, with some patients spending as long as three weeks in intensive care.
There is also a potential shortage of special ventilation machines which oxygenate the blood of sufferers whose lungs are too diseased or damaged for normal mechanical ventilation.
Doctors say the very sick have tended to be the young, the pregnant and the overweight.
There is also a concern about outbreak in Aboriginal communities, where the quality of health care is not always that good and because people often suffer from different conditions.
Human trials for a vaccine started this week in Melbourne and Adelaide, the first in the world. If successful - and the expectation is that the trials will be - the government is hoping to start vaccinating people by October.
By then the winter will be over, but as countries in the northern hemisphere have shown, the virus can spread at the height of summer.
GERMANY
According to the latest figures, Germany has 2,844 confirmed cases of swine flu.
On Friday German officials reported that the virus had started spreading rapidly through the country. "The numbers have doubled in the last few days," says Professor Reinhard Burger, Vice-President of the Robert Koch Institute in Berlin. His institute is leading the battle against swine flu in Germany.
"There is no cause for panic, but this is serious and it causes us some concern," Professor Burger told me. On Friday the German authorities ordered 50 million doses of vaccine, enough to protect around a third of the population this autumn.
Worried by the spread of the virus, some companies have taking steps to improve hygiene.
At Deutsche Telekom's headquarters in Berlin, disinfectant machines have been installed in the company cafeteria.
USA
In the United States, swine flu has dropped out of the headlines in recent weeks, although the number of cases has increased steadily. Over one million Americans are likely to have been infected, according to the Centers for Disease Control and Prevention. There have been 302 deaths, although most reported cases have been mild.
There is, however, a growing sense of unease as the autumn flu season approaches. The main focus of the authorities is the development and distribution of an effective vaccine.
Officials have said the illness could hit up to 40% of Americans over the next two years, if a vaccine campaign and other measures are not successful.
Swine flu has spread around the world and will almost inevitably reach every country, the World Health Organization has said. But there remains uncertainty about its threat.
The number of swine flu cases in India has continued to rise. With 23 new cases reported on Friday from eight cities, the number of people who have tested positive for the flu has risen to 371, according to the federal health ministry. Of this, 237 patients have been discharged, while the rest of them remain admitted in special hospital wards. Some patients who have been quarantined in special wards have complained of poor facilities.
Last month the government issued an alert against swine flu and announced health screening of incoming passengers from affected countries: nearly four million passengers flying into India's 22 international airports have been screened so far.
The federal health minister has also urged people not to travel abroad until swine flu in the country is under control.
When the first cases of the flu were detected, it made the front pages of all the Indian newspapers but since then coverage has been muted.
In the last week, however, there has been an upsurge in coverage because at least one school in Delhi has had to be shut down for a few days because of suspected swine flu cases. This has led to fresh anxiety among parents and school authorities, leading to a revival of interest in the story.
AUSTRALIA
There have been more than 15,000 cases in Australia, and 46 deaths.
All of the victims have had underlying medical conditions.
The number of cases jumped two weeks ago, but there has not yet been the really fast acceleration, an exponential increase, that public health officials feared.
Children have been on their winter holidays here and their return to school is expected to make things worse. Kids are seen as the super-spreaders of the virus.
There has been a lot of pressure on intensive care units, with some patients spending as long as three weeks in intensive care.
There is also a potential shortage of special ventilation machines which oxygenate the blood of sufferers whose lungs are too diseased or damaged for normal mechanical ventilation.
Doctors say the very sick have tended to be the young, the pregnant and the overweight.
There is also a concern about outbreak in Aboriginal communities, where the quality of health care is not always that good and because people often suffer from different conditions.
Human trials for a vaccine started this week in Melbourne and Adelaide, the first in the world. If successful - and the expectation is that the trials will be - the government is hoping to start vaccinating people by October.
By then the winter will be over, but as countries in the northern hemisphere have shown, the virus can spread at the height of summer.
GERMANY
According to the latest figures, Germany has 2,844 confirmed cases of swine flu.
On Friday German officials reported that the virus had started spreading rapidly through the country. "The numbers have doubled in the last few days," says Professor Reinhard Burger, Vice-President of the Robert Koch Institute in Berlin. His institute is leading the battle against swine flu in Germany.
"There is no cause for panic, but this is serious and it causes us some concern," Professor Burger told me. On Friday the German authorities ordered 50 million doses of vaccine, enough to protect around a third of the population this autumn.
Worried by the spread of the virus, some companies have taking steps to improve hygiene.
At Deutsche Telekom's headquarters in Berlin, disinfectant machines have been installed in the company cafeteria.
USA
In the United States, swine flu has dropped out of the headlines in recent weeks, although the number of cases has increased steadily. Over one million Americans are likely to have been infected, according to the Centers for Disease Control and Prevention. There have been 302 deaths, although most reported cases have been mild.
There is, however, a growing sense of unease as the autumn flu season approaches. The main focus of the authorities is the development and distribution of an effective vaccine.
Officials have said the illness could hit up to 40% of Americans over the next two years, if a vaccine campaign and other measures are not successful.
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