Prepared Citizens

Do unto others as you would have them do unto you.

  • Previous Posts

  • Michael Osterholm Quotes:

    “What we need to be doing now is the basic planning of how we get our communities through 12 to 18 months of a pandemic.”

    “Ninety-five out of 100 will live. But with the nation in crisis, will we have food and water? Are we going to have police and security? Will people come to work at all?”

    “It's the perfect setup. Then you put air travel in and it could be around the world overnight.”

    “We can predict now 12 to 18 months of stress of watching loved ones die, of wondering if you are going to have food on the table the next day. Those are all things that are going to mean that we are going to have to plan -- unlike any other crisis that we have had in literally the last 80-some years in this country.”

  • US Health and Human Services

    Secretary Michael Leavitt

    "If there is one message on pandemic preparedness that I could leave today that you would remember, it would be this:

    Any community that fails to prepare with the expectation that the federal government or for that matter the state government will be able to step forward and come to their rescue at the final hour will be tragically wrong,

    not because government will lack a will, not because we lack a collective wallet, but because there is no way that you can respond to every hometown in America at the same time."
  • Joseph C. Napoli, MD of Resiliency LLC

    "I think a new meaning is evolving for resiliency and resilience.

    In some contexts the words are being used to mean the strength to resist being impacted by an adverse event rather than either the “capacity to rebound” or “act of rebounding” from adversity.

    Therefore, resiliency and resilience appear to be assuming the meaning of fortitude, that is, “the strength or firmness of mind that enables a person to encounter danger with coolness and courage or to bear pain or adversity without despondency” as defined in the Webster’s Third New International Dictionary.

    If so, we are coming full circle with science accepting a religious moral virtue – fortitude – as written in the Bible’s Book of Wisdom"




  • Faith Based Resources

    John Piper
    Jonathan Edwards
    Reformation
    Pink-Saving Faith
    Pink-Christian Ethics

    "Examine yourselves, whether ye be in the faith; prove your own selves"
    (2 Corinthians 13:5).

    Why Faith Groups Must Care

    When the Darkness Will Not Lift by John Piper

    Stand

    Be Not Afraid
    Overcoming the fear of Death
    by Johann Christoph Arnold







    While I am not a professional journalist, I do embrace the code of ethics put forth by the Society of Professional Journalists and the statement of purpose by the Association of Health Care Journalists and above all else I strive to "do no harm".


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  • Definitions

    from Wikipedia



    Pandemic Influenza


    An influenza pandemic is an epidemic of the influenza virus that spreads on a worldwide scale and infects a large proportion of the human population.

    In contrast to the regular seasonal epidemics of influenza, these pandemics occur irregularly, with the 1918 Spanish flu the most serious pandemic in recent history.

    Pandemics can cause high levels of mortality, with the Spanish influenza being responsible for the deaths of over 50 million people.

    There have been about 3 influenza pandemics in each century for the last 300 years. The most recent ones were the Asian Flu in 1957 and the Hong Kong Flu in 1968.



    Seasonal Influenza


    Flu season is the portion of the year in which there is a regular outbreak in flu cases.

    It occurs during the cold half of the year in each hemisphere.

    Flu activity can sometimes be predicted and even tracked geographically. While the beginning of major flu activity in each season varies by location, in any specific location these minor epidemics usually take about 3 weeks to peak and another 3 weeks to significantly diminish.

    Individual cases of the flu however, usually only last a few days. In some countries such as Japan and China, infected persons sometimes wear a surgical mask out of respect for others.



    Avian (Bird) Flu
    Avian influenza,

    sometimes Avian flu, and commonly Bird flu refers to "influenza caused by viruses adapted to birds."


    "Bird flu" is a phrase similar to "Swine flu", "Dog flu", "Horse flu", or "Human flu" in that it refers to an illness caused by any of many different strains of influenza viruses that have adapted to a specific host.

    All known viruses that cause influenza in birds belong to the species: Influenza A virus.

    All subtypes (but not all strains of all subtypes) of Influenza A virus are adapted to birds, which is why for many purposes avian flu virus is the Influenza A virus (note that the "A" does not stand for "avian").
    Adaptation is non-exclusive.

    Being adapted towards a particular species does not preclude adaptations, or partial adaptations, towards infecting different species.

    In this way strains of influenza viruses are adapted to multiple species, though may be preferential towards a particular host.

    For example, viruses responsible for influenza pandemics are adapted to both humans and birds.

    Recent influenza research into the genes of the Spanish Flu virus shows it to have genes adapted to both birds and humans; with more of its genes from birds than less deadly later pandemic strains.

    H5N1 Strain


    Influenza A virus subtype H5N1, also known as A(H5N1) or simply H5N1, is a subtype of the Influenza A virus which can cause illness in humans and many other animal species.

    A bird-adapted strain of H5N1, called HPAI A(H5N1) for "highly pathogenic avian influenza virus of type A of subtype H5N1", is the causative agent of H5N1 flu, commonly known as "avian influenza" or "bird flu".

    It is enzootic in many bird populations, especially in Southeast Asia. One strain of HPAI A(H5N1) is spreading globally after first appearing in Asia.

    It is epizootic (an epidemic in nonhumans) and panzootic (affecting animals of many species, especially over a wide area), killing tens of millions of birds and spurring the culling of hundreds of millions of others to stem its spread.

    Most references to "bird flu" and H5N1 in the popular media refer to this strain.



    As of the July 25, 2008 FAO Avian Influenza Disease Emergency Situation Update, H5N1 pathogenicity is continuing to gradually rise in wild birds in endemic areas but the avian influenza disease situation in farmed birds is being held in check by vaccination.

    Eleven outbreaks of H5N1 were reported worldwide in June 2008 in five countries (China, Egypt, Indonesia, Pakistan and Vietnam) compared to 65 outbreaks in June 2006 and 55 in June 2007.

    The "global HPAI situation can be said to have improved markedly in the first half of 2008 [but] cases of HPAI are still underestimated and underreported in many countries because of limitations in country disease surveillance systems".





    Pandemic Severity Index


    The Pandemic Severity Index (PSI) is a proposed classification scale for reporting the severity of influenza pandemics in the United States.

    The PSI was accompanied by a set of guidelines intended to help communicate appropriate actions for communities to follow in potential pandemic situations. [1]

    Released by the United States Department of Health and Human Services (HHS) on February 1, 2007, the PSI was designed to resemble the Saffir-Simpson Hurricane Scale





    From the Massachusetts Health and Human Services



    Isolation


    refers to separating people who are ill from other people to prevent the spread of a communicable disease.



    Quarantine


    refers to separating and restricting the movement of people who have been exposed to a communicable disease and are not yet ill.
  • Additional Information

    Creative Commons License
    Prepared Citizens by Catherine "Jackie" Mitchell is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.
    Based on a work at http://www.preparedcitizens.org.




    The posts on this site are subject to change. Mostly due to errors in spelling or grammar. I never said I am a professional journalist. I have new appreciation for the job that they do. Also, not all comments made by others will make it onto this site. Comments that advertise a commercial product do not get posted most of the time.


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  • standingfirm

Extolling The Virtues Of Flu Shots Even With A Mismatched Component

Posted by preparedcitizens on January 12, 2009

According to the CDC website the formulations for the 2008-2009 flu seasons for both the injectable and intranasal flu vaccine  2008-09 include protection against

  • A/Brisbane/59/2007 (H1N1),
  • A/Brisbane/10/2007 (H3N2), and
  • B/Florida/4/2006 strains.

If you had influenza B Malaysia last year and a flu shot this year kudos to you, you may have the antibodies to resist this years circulating strain. Oddly enough, B/Malaysia/2506/2004-like virus was the 2007-2008 component.

A little bit about Influenza B viruses…Influenza B has a limited host range only infecting humans and seals. Influenza A viruses have a much greater host range. More about influenza B infection toward the end of this post.

Influenza B viruses also mutate by genetic drift and reassortment at a much slower rate (2 to 3 times slower) than A viruses. This is important because when they get the vaccine right, it will typically stay right for the entire flu season. Influenza A viruses are highly mutable so at the tail end of any flu season we are at more risk even though immunized.

What my response is: Non pharmaceutical interventions must also remain in the forefront of all of our efforts. And forced vaccinations of children or anyone else is not a guarantee of safety. It is an overreaction. Education and awareness are the best weapons in our arsenal.

 

So what is being discussed….

According to the website FluWatch Canada this is what is currently circulating in Canada:

December 28, 2008 to January 3, 2009  (Week 53)

Overall influenza activity in Canada remains low; an influenza outbreak in a hospital was reported in Ontario

During week 53, influenza activity in Canada remained low overall with the majority of the influenza surveillance regions still reporting no activity.

Sixteen regions (in BC, AB, ON & QC) reported sporadic influenza activity and localized activity was reported in 2 regions (central region in AB and in Toronto, ON) (see map).

Note that no data for 2 regions in SK were received this week. Eighty-seven specimens tested positive for influenza in Canada this week (percentage positive = 3.3%; 87/2,633) (see table).

The majority of influenza virus detections to date this season were influenza A viruses (54% or 165/304); however influenza B detections have slowly increased over the last several weeks.

In week 53, the ILI consultation rate increased to 23 ILI consultations per 1,000 patient visits (see ILI graph), however it remains below the expected range for this week. The sentinel response rate was low at 37%. An outbreak of influenza in a hospital in ON was reported in week 53.

Other Respiratory Viruses: RSV detections for Canada as a whole continue to increase while detections for adenoviruses and parainfluenza viruses remain at fairly low levels (see graph).

Antigenic Characterization:
Since 1 September 2008, the NML has antigenically characterized 33 influenza viruses:

10 influenza A/Brisbane/59/2007(H1N1)-like (from BC, AB, ON & NS),

1 influenza A/Brisbane/10/2007(H3N2)-like (from BC),

3 influenza B/Florida/4/2006-like (from ON and AB) and

19 B/Malaysia/2506/2004-like (from ON and AB).

A/Brisbane/59/2007(H1N1), A/Brisbane/10/2007(H3N2) and /Florida/4/2006 are the influenza A and influenza B components recommended for the 2008-09 influenza vaccine.

****B/Malaysia/2506/2004 was the influenza B component for the 2007-2008 season vaccine

Regarding Antiviral Resistance, this was noted in Canada…

Antiviral Resistance:

Results from the NML: (my note: National Microbiology Lab of Canada)

Since the start of the season, the NML has tested 11 influenza A isolates (6 H1N1 and 5 H3N2) for amantadine resistance. All of the H1N1 isolates were susceptible; however all of the H3N2 isolates were resistant to amantadine (resistance = 100% or 5/5). The resistant isolates were from ON, AB and BC.

The NML has also tested 24 influenza isolates (5 A/H1N1, 2 A/H3N2 & 17 B) for oseltamivir (Tamiflu) resistance. All of the A/H3N2 and B isolates were sensitive; however all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 5/5). The resistant isolates were from NS, ON and BC.

All 22 influenza isolates (3 A/H1N1, 2 A/H3N2 & 17 B) tested for zanamivir resistance to date were sensitive to zanamivir.

Oseltamivir resistance findings from Provincial laboratories:

To date this season, 24 influenza isolates in BC have been sub-typed as A/H1 and were assessed genotypically for oseltamivir resistance using an SNP assay. Eighteen isolates tested positive for the H274Y mutation (resistance = 100% or 18/18), with the other 6 specimens still pending confirmatory testing.

Influenza-associated Paediatric Hospitalizations:
No laboratory-confirmed influenza-associated paediatric hospitalizations have been reported through the Immunization Monitoring Program Active (IMPACT) network for the 2008-09 season.

It is interesting to note that last flu season there was a mismatch to the circulating B strains. According to CIDRAP last year, “93% of the circulating influenza B viruses analyzed so far belong to the Yamagata lineage, which doesn’t match the influenza B component of this year’s vaccine. The B component is a B/Malaysia/2506/2004-like virus, which belongs to the Victoria lineage.”

More on Seasonal Flu Activity around the world…

from the WHO

Seasonal influenza activity in the world, weeks 51-52 (as of 7 January 2008)

During the weeks 51-52, the overall level of influenza activity in the world began to increase in some countries in Europe. Ireland, Portugal and the United Kingdom of Great Britain and Northern Ireland reported widespread activity with influenza-like illness (ILI) above threshold levels. France also reported increased activity while regional activity was reported in the Netherlands, Spain and local activity in Italy. Activity in many other countries remained low. The majority of viruses identified this season have been influenza A (H3N2).

Ireland: Widespread influenza A activity has been reported.

Italy: Three influenza A H3N2 influenza isolates were reported during week 52.

Netherlands: In week 52 a substantial proportion of specimens from sentinel ILI patients contained influenza virus. To date all influenza viruses detected in specimens from sentinel ILI patients were A(H3N2).

Portugal: Widespread influenza A (H3N2) activity was reported.

Spain: Regional activity was reported. Influenza A (H3N2) viruses were detected.

United Kingdom of Great Britain and Northern Ireland: Influenza activity continued to be widespread across the country with GP consultation rates above the threshold levels in England and Scotland in week 52. The majority of the specimens have been positive for influenza A (H3N2), with low numbers of H1N1 and B detected.

Sporadic influenza activity was observed in Belgium (A), Cameroon (A, B), Canada (A,B), China (H1, H3, B), China Hong Kong Special Administrative Region (H1,H3,B), Finland (A,B), Germany (H1,H3, B), Greece (A) , Iran (H3), Israel (A;B), Japan (H1,H3, B), Latvia (A) , Luxembourg (A), Morocco (H1,B), Netherlands (H3), Norway (H1,H3,B), Russian Federation (H1,H3,B), Slovenia (H1,H3), Switzerland (H3), Tunisia (H1,B) and the United States of America (H1,H3,B).

Croatia, Czech Republic, Estonia, Greece, Lithuania, Malta, Poland, Romania and Serbia reported no influenza activity.

What is the difference to us between Influenza A infection, Influenza B infection and even Influenza C infection?

Influenza A can infect a wide range of hosts. Pigs, horses, cats, ferrets, wild birds, humans. This highly mutable virus is divided into subtypes and is named according to the two proteins on the surface of the virus – Hemagglutinin (HA) and Neuraminidase (NA). So when someone says H5N1 or H3N2 or H1N1 they are describing with specificity the two proteins that are in the Influenza A strain. There are 16 known HA subtypes and 9 known NA subtypes, not all infect humans. And currently only H1N1, H3N2 and H1N2 are circulating in humans. Rarely some of these subtypes cross the species barrier. H3N8, an influenza A virus that typically infects horses has recently infected dogs.

H5N1 is the subtype that scientists have their eyes on because it is crossing the species barrier from birds to humans, with other species also being infected from time to time. Only influenza A viruses infect birds. Some are low pathogenic and some are highly pathogenic. Of the H5 influenza A viruses there are nine subtypes. There are also nine know subtypes of the H7 influenza A virus. H7 infection in humans is a rare event. It is also broken down into high path. and low path subtypes. And then there is the H9 subtype which also has nine subtypes. This virus is only found in a low pathogenic form.

Pathogenesis:

Highly pathogenic or low pathogenic
Pathogenic means the ability to cause disease. A flu virus can be highly pathogenic or it can have low pathogenicity. A highly pathogenic flu virus can cause severe illness and death. A low pathogenic flu virus is much less likely to cause severe disease.

Typically H1, H2 and H3 subtypes are what have caused illness in humans. When each subtype first emerged it caused a human pandemic because people did not have antibodies to fight off the newly emerged subtype. This is what we are watching for with the H5 subtype. It is increasingly infecting more humans demonstrating that it is adapting to the human host.

An infection with an influenza A virus is pretty well known as to what we experience. It’s hallmark is high fever, cough, muscle aches, and frequently we develop secondary infections like pneumonia.

~~~~~~~~~~~~~

Influenza B viruses as I mentioned above are found in humans and seals. Influenza B viruses are not classified by subtype. They typically cause less severe epidemics than Influenza A and they do not cause pandemics.

Infection with a B virus usually causes less severe symptoms but it is still nothing to take lightly. Influenza B does have the potential to cause more severe disease in older persons and the very young.

Influenza C virus causes mild respiratory illness and is not thought to cause epidemics.

~~~~~~~~~~~~~~~~

 

So what is circulating in the US right now?

2008-2009 Influenza Season Week 53 ending January 3, 2009

Antigenic Characterization:

CDC has antigenically characterized 110 influenza viruses [68 influenza A (H1), 13 influenza A (H3) and 29 influenza B viruses] collected by U.S. laboratories since October 1, 2008.

All 68 influenza A (H1) viruses are related to the influenza A (H1N1) component of the 2008-09 influenza vaccine (A/Brisbane/59/2007). All 13 influenza A (H3N2) viruses are related to the A (H3N2) vaccine component (A/Brisbane/10/2007).

Influenza B viruses currently circulating can be divided into two distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Nine influenza B viruses tested belong to the B/Yamagata lineage and are related to the vaccine strain (B/Florida/04/2006). The remaining 20 viruses belong to the B/Victoria lineage and are not related to the vaccine strain. Seventeen of the 20 viruses belonging to the B/Victoria lineage were from two states.

Data on antigenic characterization should be interpreted with caution given that:

  1. Few U.S. isolates are available for testing because of limited influenza activity thus far.
  2. The majority of viruses antigenically characterized to date come from only three states and may not be nationally representative.
  3. Antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination.

Annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses.

 

 

In other words….A flu shot for the 2008-2009 Flu Season is still a very good idea. And in the case of H5N1 causing a pandemic during this flu season (along with seasonal flu) the N1 component of the flu shot may offer us a little bit of benefit against the N1 part of H5N1. I will take any advantage I can get. We can do the best we can to avoid getting the flu by becoming aware of what it is that is circulating throughout the entire flu season, knowing what strains we have been vaccinated against (if that was our decision) and to keep our hands away from our mucous membranes. There is so much that we don’t know about the world of virology and infectious disease control, but there are some things that we do know. Let’s make the best use of what we do know in order to keep as many people safe and healthy as possible.

 

 

Resources:

Respiratory Virus Detections/Isolations in Canada – Quite a document!

DemFromCt is currently writing a three part series about the complicated nature of what we are dealing with. Dem is a good friend (for a Democrat :-) ). He is an excellent writer and can really explain much better than I can the ins and outs of all of this. His series is called “Flu and You” part 1 is here.

Mike at Avian Flu Diary has great information and he quotes medical writer extraordinaire Helen Branswell.

 

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