What to Watch in Ukraine H1N1 Severity

Recombinomics had a good article today detailing that while the WHO is so far indicating they see no "big" mutations or changes in the sampling they've done in the Ukraine so far, Recombinomics reminds us that even "small" changes can lead to dramatic results - quoted below:

However, the changes seen in Ukraine do not require "big" mutations. Small mutations, such as SNP can have profound effects for a virus like pandemic H1N1.

That virus normally circulates in swine, and has recently jumped to humans. It already has many characteristics with the 1918 pandemic strain. Both are swine H1N1 that jumped to humans. Such species jumpers can increase efficiencies with small changes. One good example is position 627 in the PB2 gene. That position comes in two forms. When there is glutamic acid (E) at that position, the PB2 enzyme copies the viral genetic material most efficiently at 41 C, the body temperature of a bird. However, if that position has a lysine (K), the enzyme is most active at 33 C, the temperature of a human nose in the winter. The swine H1N1 has an E, which may be why it goes well in lung, which is 37 C and closer to the optimal replication temperature of 41C. However, a single change that produced the most efficient replication at 37C would lead to even higher levels in the lungs, which could lead to frequent cytokine storms, like those in 1918, instead of the less frequent level seen in Ukraine.

Just in case you haven't been following the severity of H1N1 in the Ukraine, here's today's update from Recombinomics:

Reported Cases in Ukraine Double Again To 871,037
Recombinomics Commentary 22:54
November 6, 2009

871,037 Influenza/ARI Cases

39,603 Hospitalized

135 Deaths

The above numbers from the latest update from Ukraine (see map) continue to alarm. More than half of the Oblasts and cities listed exceed the epidemic threshold, including Kiev and Kiev Oblast, raising concerns that the increase in case numbers will accelerate. Moreover, hospitalization of 39,603 raises concerns that the number of deaths will also accelerate, since 11% of hospitalized cases in California died.

Click the link for more detail about the hemorrhagic pneumonia being seen there. Granted, these people have very sub-standard living and medical care conditions that can cause delayed or non-existent medical care, but we still need to be aware of any mutations or changes in the H1N1 virus if it is found in this region.

Swine Flu Contagious After Fever Stops Per Research

Found this article today that suggests the swine flu is still contagious long after fever stops - perhaps as long as the patient is still coughing:

When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away.

The federal Centers for Disease Control and Prevention has been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer _ especially at home where the risk of spreading the germ is highest.

Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said.

“This study shows you’re not contagious for a day or two. You’re probably contagious for about a week,” said Gaston De Serres, a scientist at the Institute of Public Health in Quebec.

Link: National Terror Alert.com - Swine Flu Spreads Long After Fever Stops

Signs To Watch For in Pediatric Swine Flu

Physician researchers across the U.S. are noting that about 2/3rds of the pediatric deaths from swine flu so far have had underlying conditions such as asthma, diabetes, epilepsy, MD or other diseases that suppress the immune or respiratory systems.

In 1/3rd of pediatric cases, however, they are unsure why otherwise normal, healthy children have died from this virus.

They do note that these seem to be exacerbated by a bacterial infection:

But they did say that when influenza combines with a bacterial infection, such as pneumonia, the patient often follows a pattern in which his symptoms start to subside but then suddenly worsen. That pattern — which includes symptoms such as vomiting, chest pain, a racing pulse, breathing trouble, bluish skin or trouble staying awake — is an indication that the flu has turned deadly, and it means a sufferer should talk to a doctor immediately.

So don't panic, treat this flu as you would any other, but pay attention for the trend noted in the quote above. We definitely don't want to overwhelm our Emergency Room facilities unnecessarily, but you should take your child immediately if you notice any of the symptoms above.

How and Why to Prepare for Swine Flu

This is a bit long, but for those of you who are interested, I hope it contains information that will help you in your preparedness efforts for Swine Flu.

By now, most people are well aware of the fact that swine flu is still making its way across the country and picking up speed in the Southeast where schools have been in session since early August.

Just last week in TN alone, a 5 year old died in Nashville (sick on Friday, died on Monday – that’s quick folks), a 5 year old died in Chattanooga and a 13 year old has died in Memphis. Pediatrics are being hard-hit by this virus, so we must be vigilant in our preparedness actions.

Most of what is causing deaths is not the swine flu itself, but a viral pneumonia that hits some people along with the swine flu. Some also are getting a bacterial pneumonia that is very antibiotic resistant. And some perfectly healthy people are experiencing what is known as a cytokine storm – their immune system goes to work too well and overwhelms their lungs fighting off the virus - in essence they drown. Research so far is showing that in many of those who have died due to “swine flu”, their lungs look remarkably like those who died from Bird Flu (H5N1). There are avian components to this flu, in addition to swine and human.

Overall, the death rate from this particular strain of H1N1 is very low. In reality, there is little you can do other than the usual good hygiene to try to avoid getting this virus. However, you just never know when you are going to touch a door handle, shopping cart, ATM touch pad, bank ink pen, gas pump handle or something else that has the flu virus on it.

Even if you homeschool and are relatively out of the mainstream, you need to consider all the opportunities for exposure you still have: church, the grocery store, the bank, the post office, the gas station, homeschool events, etc. And if there are children in your neighborhood who attend public or private school and your children play with them, they might as well be in the same classroom with them, because they will be exposed to whatever is in that school.

I’ve been tracking and researching this virus daily since it first appeared this April. I’ve watched what happened in the southern hemisphere – to our neighbors in Australia – during our summer (their winter). The unique thing about this H1N1 virus is that it is ideally suited for both summer and winter due to its unique genetic makeup with swine and avian flu components.

Also unique is that over 50% of the people who get the H1N1 flu never have fever. H1N1 flu is a form of Influenza A. At this time of year, approximately 99% of the flu being seen in our country is H1N1, since seasonal flu likes the cold and hasn’t gotten started yet.

In Australia, although deaths were relatively low, the flu did overwhelm their medical facilities in many places because everyone was going to the doctors and emergency rooms. Elective surgeries were canceled. Physicians and nurses got sick. Some refused to come to work. Some orderlies refused to clean up after flu patients.

In Europe, some children have died after being misdiagnosed OVER THE PHONE on a medical hotline.

Think about this for a minute – if you were pregnant and planning a hospital birth, would you really want to have to go to a hospital inundated with swine flu to give birth? If ambulances are backed up taking sick flu patients to the hospital, what happens to the severe traffic accident on the way to work in the morning? You need to think about the greater impact of the flu than just the sickness. You must think about the overall impact to your way of living, because this flu might cause some minor to major disruptions in the way you are accustomed to doing things.

That said there are several ways we can prudently prepare for the swine flu in our areas this fall and winter.

First, you need to make sure that you have everything you need at your home to care for a family member that might get sick with this flu. Medications, soothing foods and drinks for rehydration, disinfectants, laundry detergent, dishwashing detergent, perhaps gloves for cleaning, N95 face masks to protect those in the family who aren’t sick, separate toothpaste tubes for each family member, separate hand towels for each family member, a working thermometer, a humidifier – anything that comforts you when you are sick – make sure you have it on hand NOW. You don't want to wait until you need it and you certainly don't want to wait for tons of people to get sick and stores to be out of what you need.

Basically, think about what you might need to get through 2-4 weeks of flu making the rounds of your family. If someone gets the flu in your family, the CDC recommends that all other family members who have been exposed plan to stay at home from school and work for at least 5 days to avoid transmitting the virus to others. If you do get the flu, the CDC recommends staying at home for a full 24 hours after your last fever (without fever meds) before going back out into public.

If you like to scratch cook, you might want to consider taking a weekend and making a few foods to put in the freezer that could be pulled out and heated by any family member – things like meatloaf, lasagna, soup, stew and the like. Have easy breakfast items like oatmeal or cereal. Keep some powdered milk on hand. If you run out of fresh milk, believe me you can use powdered milk in oatmeal and cereal and hardly tell the difference.

Mom or Dad, if you are the primary cook, think about what your family can make for themselves if you get sick. Perhaps you want to get some easy to make or heat items that even younger children can make – cans of soup, ravioli, fruit cocktail, peanut butter and jelly or peanut butter and crackers, cheese sandwiches and the like. This is the time to have some easy to make meals on hand.

Having someone sick in the home means you will be doing more laundry. Make sure you have plenty of soap, laundry detergent, dishwashing detergent and/or liquid, hand sanitizer, toothpaste. You’ll want to make sure you have new toothbrushes on hand to give everyone after illness runs through your family. It is a good idea for everyone to have their own tube of toothpaste anyway to keep germs from spreading. Don’t keep all the toothbrushes all together in one place bumping into each other. Keep them separated so germs aren’t being passed from one to the other.

Have plenty of towels and washcloths on hand and ready to go. Cold washcloths on the throat and forehead help with nausea. And for little children, we line their beds and the hallway with towels all the way to the bathroom. Believe me, it is much easier if someone gets sick to pick up a towel and wash it then have to strip the whole bed and remake it.

You can get small buckets or waste cans that children can use by their bed as sick pans if you don’t want them trying to make it down the hall to get sick and spread their germs everywhere.

If your whole family ends up at home for several days, you will want to have things on hand to keep everyone occupied. CDs, DVDs, books, readers, workbooks, coloring books, pencils, crayons, sticker books – we keep several items such of these tucked away so we can pull out something new whenever the need might arise.

Remember that if you aren’t leaving the house, you might need to have some cash at home – you never know when you might need something delivered; perhaps a neighbor or relative is willing to run an errand for you and you’ll need to be able to reimburse them.

Make sure to keep gas in the tanks of your cars. If someone needs to go to the emergency room in the middle of the night, you certainly don’t want to have to stop for gas first. We never let our tanks get below ½ full in case an emergency comes up.

It also pays to think about what might happen if the flu takes a severe turn and there are quarantines in your area. Imagine that your city or county is placed under a 7-14 day quarantine. No going out of your homes for any reason. How prepared are you for something like that to happen?

Even if there are no mandatory quarantines in your area, are you prepared to self-quarantine if necessary to protect your family? What are your parameters? What has to happen to trigger a self-quarantine for your family? It pays to think some of these things through.

If you have questions about the risk factors for flu for any of your family members, be sure to talk to your family doctor. Have a plan. Know what you need to do for those in your family who are in a higher risk group (those with asthma, diabetes or pregnancy). Know ahead of time what your parameters are for going to the doctor or hospital if someone in your family gets sick. Obviously, if we all rush to the doctor at the first sign of a cough and muscle aches or fever, our medical facilities will be over-run.

Know if your doctor will prescribe Tamiflu or Relenza over the phone. Know whether or not you even want to take either of these medications to begin with. Do your research. The FDA has a warning letter about Tamiflu use in pediatrics. You can read it here: Tamiflu Warning Letter. Know that there have been many identified cases of Tamiflu-resistant H1N1. Know that Tamiflu and Relenza are not cures for the flu – they are just supposed to reduce the severity and duration.

Right now it appears that the H1N1 vaccine will not be available until sometime between mid-October and November. It is planned for 2 doses, approximately one month apart. It is estimated that it will then take approximately 2 weeks for immunity after both vaccines. This means late this year for most people - around the end of December or so. You need to be prepared that swine flu might visit you before you are ever able to get in line for a vaccine. Know that even if you get the vaccine, you might still get H1N1 flu – especially if the virus mutates so that it is significantly different from what is contained in the vaccine. Know if the vaccine is even the right choice for you or your family – do your research and be an informed consumer.

Remember that it is important that we don’t panic, but that we arm ourselves with knowledge and do the preparations NOW that are necessary to keep our families as safe and healthy as possible.

Tracking Flu in TN Schools

Here's a good forum board resource for tracking H1N1 flu in Tennessee - go to the bottom of the page to the forum area, click on School-Specific Reports, then select your state:

http://flutracker.rhizalabs.com/

This forum board is FANTASTIC for keeping up with the status of H1N1 in schools in your area. People are doing a fabulous job of keeping the information current; doing what would take one of us hours of internet searching. I highly recommend that you follow this forum if you want to keep tabs on what is going on in schools in your area.

Also, if you zero in to TN on the FluTracker Map, it is interesting to me to note there is a lot of flu in middle and eastern parts of TN being reported, but virtually none in West TN. I for one find this very difficult to believe and wonder why it seems as though there is very little in the West TN area. I would tend to think it is because of lack of reporting and or testing.

Especially given this:

190 Students at One Shelby County School Sick with Flu Symptoms

Excerpt:

(Memphis 9/4/2009) - The student population at Shadowlawn Middle School is the latest to feel the effects of the flu.

Twenty percent of the students have been out sick the last few days.

"Today they did have 190 students out. That's out of a population of 880. That's approximately 20%, which is high." says Mike Tebbe, spokesperson for Shelby County Schools.

Shawdowlawn alerted parents by letter, saying many of the absences were due to flu-like symptoms, such as cough, sore throat,, runny or stuffy nose, body aches and fever.

Parents are told if your child is ill or shows any of the above symptoms, keep them home.

"A little nervous because I have two children here. Then I have two in elementary and one in high school, so you know it could spread through all of them, so it's very concerning." says Paula Csap, a Shadowlawn parent.

With the H1N1 threat, parents at Shadowlawn are being urged to take precautions.

"Students do need to stay home if they are ill. If they do have flu like symptoms, they need to seek medical attention for that." says Tebbe.

Parents, whose kids are ok right now, are doing what they can to keep it that way.

"Make sure they wash their hands. Anybody coughing, try not to be so close. If they have to cough, cover their mouth and everything." says Csap.

Shelby County school officials say during the flu season, it's normal to have 140 students miss school.

So 190 out is very high.

Anyone in West TN have first-hand experiences to report? Also, others from around the state are welcome to comment about what you are seeing in your areas.

Tennessee Flu Tracking Map

Link is Here:

FluTrackers H1N1 Interactive Map for Tennessee

(although you can get the tracker for any state in the U.S.)

Notice how the explosion of cases is moving up from the south - where schools started in early August.

And read this link:

Explosion in Student Deaths Link to School Openings from Recombinomics

US Pediatric Deaths Raise Pandemic Concerns from Recombinomics

What are my fellow Tennesseans seeing out there in your communities?

TN Schools Closing Due To Swine Flu

Didn't hear this on any of our local news of course, but found this morning that schools in Alcoa, TN are being closed through Labor Day due to 30% absenteeism due to swine flu and "other" illnesses (which are probably mis-diagnosed swine flu).

Here's the link from Recombinomics, 02 Sep 2009:

Tennessee School Closings Raise Pandemic Concerns

Excerpt:

Mounting illnesses have forced the Alcoa City Schools to close through Labor Day.

The 1,800-student system decided Tuesday to extend the holiday for its elementary school, middle school and high school after the absentee rate hit 30 percent. Normally it's around 5 percent.

According to Director of Schools Tom Shamblin, some of the illnesses are confirmed flu cases. Other illnesses included stomach viruses, fevers and upper respiratory infections. Shamblin said middle schoolers were impacted the most, with a nearly 30% absentee rate.

The above comments describe a large pandemic H1N1 outbreak in schools in Alcoa, TN, which is just south of Knoxville (see zoomed map). Although other schools in the area also have high absenteeism rates (see broader view), they have followed the CDC recommendations on keep schools open. These other schools also cite a wide range of symptoms, as noted above. All of these symptoms have been previously reported for swine flu, and it is likely that the vast majority of these students are H1N1 infected. The number of infected students is much high than confirmed cases, due to limited testing of patients who meet the CDC case definition, as well as the high frequency of infections which not not develop a fever (and therefore do not meet the H1N1 case definition).

The absence of fever has been reported previously in Mexico and Chile, but a fever is included in the CDC case definition, so the symptoms listed for hospitalized H1N1 confirmed cases is 93%, leading many to assume the lack of a fever signals the lack of infection. Consequently, a runny nose is frequently diagnoses as allergies, and gastro-intestinal problems are called "stomach flu", and other flu-like symptoms are called "upper respiratory infections" and in some cases an influenza A positive result is interpreted as seasonal or "normal" flu, even though 99% of influenza A positive patients at this time are swine flu because the traditional flu season has not begun.

Thus, the swine flu cases are easily noticed, even though the diagnosis, as seen above, is incorrect. These mis-diagnosis, especially those which attribute symptoms to allergies, lead to more H1N1 infections because students come to school, and remain in school because they have no fever. Moreover, the lack of testing leads to misconceptions about the H1N1 frequency in the area.

This lack of testing has been prevalent for months, so confirmed cases suggest that H1N1 levels in the region are low, and the explosion of cases creates "sticker shock" for returning students and parents. The high level of infections cited above is not limited to Tennessee. H1N1 is widespread throughout the south because the school year began in early August. However, high levels are being reported elsewhere. Almost 30% of students are also absent in Iowa, were there were large outbreaks last spring and around Marshalltown (see map). However, the limited number of swine flu testing kits shipped by the CDC precluded testing of the hundreds of symptomatic patients at the local clinic. Therefore these patients were not confirmed, even though attending physicians were certain that the patients were H1N1 infected.

Swine Flu or Stomach Virus In US Schools?

I found a very interesting article in my daily readings about the H1N1 Swine Flu today and wanted to share it with you all here, so you can have the most recent information at your fingertips.

From: Recombinomics - August 26, 2009

Link: Misinformation Linked to Explosion of Swine Flu in US Schools

Excerpt:

A high number of students at Sylacauga city schools are reporting being sick, but it appears to be a stomach virus doing most of the damage right now instead of the H1N1 strain of influenza that has worried health officials around the world.

Lisa McGrady, the school system's registered nurse, said students are fighting off strep throat, the flu and a stomach virus which are all making the rounds right now.

McGrady said her main complaint has been the stomach virus with students complaining of headaches and being nauseated but without any signs of fever.

The above comments describe a rapidly spreading pandemic H1N1 outbreak in Alabama (see map), but similar statements have been made by others regarding other swine flu outbreaks. 10-20% of the schools population is ill, and only a portion of the illnesses is attributed to swine flu. However, swine flu causes sore throats, has a gastrointestinal component, and over 50% of infections have no fever. Consequently, the above comments suggest there is little swine flu, even though step throat and upset stomachs generally do not affect 10-20% of the student population in August.

In addition to the above outbreak, there are similar outbreaks throughout Alabama, as well as other states in the south (see map) where the school season started several weeks ago. These other outbreaks include students that are influenza A positive and have flu-like symptoms. However, even in those outbreaks officials are stating that swine flu hasn't been confirmed, even though there is little seasonal flu in August, and over 99% of influenza A positive infections are swine H1N1.

Thus, although it is clear that swine flu is spreading rapidly, the general public is confused by false statements by officials, testing limited to influenza A determinations, or the lack of any testing.

However, at this time of the year, it is clear that swine flu is accounting for the vast majority of absenteeism, and the infections include college as well as younger students. The older students are told to remain in their rooms and avoid health care centers because those facilities are being overwhelmed, and therefore cannot treat the more serious cases.

Because of the lack of testing, it remains unclear how many students are infected with Tamiflu resistant H1N1. Many schools are now recommending prophylactic Relenza, suggesting that Tamiflu resistance is more widespread than reported. Indeed the resistance may be contributing to the rapid spread and may be causing more significant problems in cases at risk patients.

The confusion caused by media broadcasts of misinformation should be addressed now, when diagnosis of swine flu can be accurately made in the absence of lab confirmation, and students lacking fever can be isolated.

Swine Flu Must Read

This is a very interesting article that brings up excellent points that we all need to be thinking about and fleshing out regarding mandatory vaccinations.

Take a read and decide for yourself.

WHO 'recommend' global mandatory vaccination, Canada prepares

Excerpt:

Why are health ministers in places like British Columbia, Australia and Greece telling the public that ’swine flu’ is just ordinary H1N1 type A seasonal flu, while at the same time they are preparing to vaccinate their entire populations against H5N1 avian flu using untested vaccines that contain live avian flu?

Why are pandemic plans being laid to combat a more serious second wave of ’swine flu’ when it is already clear that such an outbreak is not happening in the southern hemisphere, where the flu season is already under way? Both Australia and Argentina report a normal flu season with no mutation of the ’swine flu’ virus.

If the world is really so concerned about a ’swine flu pandemic’ this fall, why has the World Health Organization stopped counting cases?

These are just some of the many questions being asked in the growing controversy over the safety of ‘pandemic flu’ vaccinations that health officials everywhere are planning for the entire global population.

The World Health Organization has issued a binding ‘recommendation’ to all member countries requiring them to institute mandatory vaccination programs.

and

The global pandemic vaccination program will begin somewhere around the end of September and last about two months. Many countries are in the process of acquiring from Baxter, Novartis, GlaxoSmithKline and other pharmaceutical companies enough doses of vaccine to vaccinate their entire population twice. They remain quiet about mandatory vaccination, simply saying they will make vaccination ‘available’ to all on a priority basis. But Greece and Switzerland have already announced that their programs will be mandatory and enforced by the military. There are unconfirmed reports that Norway and Israel have done the same. The United States is preparing for military ‘assisted’ mandatory vaccination but has not explicitly declared its intentions to the public.

CDC Changes Tracking - Again

This is almost too incredible for words. The CDC has yet again announced that it is changing the way it tracks the H1N1 Swine Flu virus in the U.S.

Excerpt from CDC Website:

CDC discontinued reporting of individual confirmed and probable cases of novel H1N1 infection on July 24, 2009. CDC will report the total number of hospitalizations and deaths weekly, and continue to use its traditional surveillance systems to track the progress of the novel H1N1 flu outbreak.

In the past, they had reported confirmed cases and deaths by state in a spreadsheet format.

Excerpt from CDC Website regarding reporting changes:

In addition, because of the extensive spread of novel H1N1 flu within the United States, it has become extremely resource-intensive for states to count individual cases.

I'm not sure why this should be too difficult to continue for the Center that is tasked with keeping up with these types of issues. This is incredible.

They currently are reporting a nation-wide 5,514 hospitalizations and 353 deaths. So now to keep up with the increase in illness and deaths, you'll have to check the website every Friday and do the math yourself to see how many new illnesses and deaths there were from the previous week.

So, in the middle of a brand new pandemic, lets not have our governmental agency tasked with keeping our health safety at the forefront even bother to let us know on a state level what is going on.

They have a link to all the states (found here) where you can go and get an estimate of the activity in your state. The link will take you to the Department of Health website for each individual state. But not all states are created equally. Some states are doing a fabulous job of breaking down information for their residents, others leave a lot to be desired.

A click on the CDC link for TN now takes you to the State of TN flu website. It is not readily apparent anywhere on the first page of the TN Link what the numbers are for H1N1 in our state.

There used to be a box at the very top of this page with the total number of confirmed cases to date. This box is no longer there. I had to click and click on links that I thought might give me numbers; then I found a link that led me through 5 additional links to finally find a map that had an estimate of the number of confirmed cases in my state. Ridiculous. Here's the link for TN - not found anywhere on the TN state website, but linked through to the federal pandemic website, to their state information, to a map. Well, finally - it says there are 283 confirmed cases in TN. Is the average person going to take this much effort to get this information? No. They are going to assume that it must not be worth much concern if the numbers aren't readily listed.

I for one would like to know a little more specifically, on a state and local level, how this new pandemic is progressing. Especially with school about to start, sporting events getting underway, the seasonal flu season approaching - and instead of providing us with more detailed information to make good decisions for our family, we are getting generalities.

If you go to the Mississippi state link, for example, they have a nice little map on their first page showing the number of cases by county. Now that is much more useful information to have in my opinion. They even have a statistics link that provides the numbers by county. This is good reporting of the information that their residents need to have available.

Most state sites also have a disclaimer:

Individual case reporting is resource-intensive, and because people with respiratory illnesses now are not always tested for flu, case counts represent a significant underestimate of the true number of novel H1N1 flu cases.

So even for those sites with excellent reporting, we are told that the numbers are significantly underestimated. Hmm. How much is significantly???

Another excerpt from the CDC website:

What monitoring system will CDC use to replace counting confirmed and probable novel H1N1 flu cases?
Instead of reporting confirmed and probable novel H1N1 flu cases, CDC has transitioned to using its traditional flu surveillance systems to track the progress of both the novel H1N1 flu pandemic and seasonal influenza. These systems work to determine when and where flu activity is occurring, track flu-related illness, determine what flu viruses are circulating, detect changes in flu viruses and measure the impact of flu on hospitalizations and deaths in the U.S

Does this mean that they are going to track H1N1 in with regular seasonal flu instead of separating it out? Who knows?

The Texas state website says something very similar:

Texas is returning to using its standard seasonal flu surveillance network to track and report flu activity.

It is apparent that the work will now be shifted to our shoulders to keep up with what is going on across the nation and the world so we can be prepared should a more severe version of this pandemic show up at our door this fall.

Other interesting quotes from the CDC's 24 July 2009 transcript:

We are continuing to see transmission here in The United States in places like summer camps, some military academies and similar settings where people from different parts of the country come together. You know, I think this is very unusual to have this much transmission of influenza during the season, and I think it's a testament to how susceptible people are to this virus. We as a country or as a population have protection. So in these special circumstances, like camps or close quarters in the military academies, we're seeing the virus spread. This week we have posted the latest numbers for case counts, but I want to mention this will be the last where you will see that kind of reporting. Our website shows, as of today, 43,771 laboratory identified cases of the new H1N1 virus. And 302 deaths that have been reported to us here from The United States. But as we've been saying, that's really just the tip of the iceberg, so we're no longer going to expect the states will continue this individual reporting and we're going to transition to other ways of describing the illness and the pattern.

Another:

But I want to turn to the southern hemisphere where a lot is going on. You probably heard about this in the media. Based on the information that's been shared with us and the laboratory findings and our people on the ground, we think that the circumstances are quite similar in different places and that this virus is capable of causing a range of illness. Severe life-threatening disease that requires intensive care unit and mechanical ventilation and also milder illness that gets better on its own. And this is really important for people to know this virus is out there, it's circulating, it causes a range of illness and we in The United States have to get ready for the fall.

Regarding illness in some children:

Yesterday we provided a little update about the clinical patterns that we were seeing with the H1N1 virus. There was a report about four children who had severe neurologic complications. Fortunately, most of these children have done well. But it's just a reminder that seizure, encephalitis and other neurologic complications can occur in influenza. This is reported in the literature -- quite a bit for seasonal influenza -- and now it's also occurring with this new H1N1 virus. We don't know whether neurologic problems will be more common with this virus, but we want clinicians to be on the lookout for that and to think about testing and treating for influenza in such circumstances.

All this to say - stay informed, do your homework, know what is going on in your state, know what the pandemic plans are for your state, know what you'll do if a family member becomes ill, know what you'll do to care for children who need to stay home from school, know how you'll handle the possibility of weeks off from work due to family illness, know that you have food, water, and medications on hand to care for your family for an extended period of time - in short, think it through and be prepared.

Best case this will pass us by like nothing more than seasonal flu. But I for one don't want to be caught unprepared.

Another good article:

Are We Prepared for Flu Outbreak?

Swine Flu: Getting Ready For Fall

Okay. We're about 2 weeks away from school starting here in my "neck of the woods" in West Tennessee. Registration starts August 4th - city and county schools back in full swing on August 10th. Are you ready for a possible surge in swine flu in your area as school and school activities get underway?

What have you done to prepare? Have you given it any thought? Made any plans about self-quarantine issues or what you'll do if your children can't go to school or parents can't go to work?

Even if this is not a very deadly version of the pandemic flu, have you thought about the impact it could have on medical services in your area? If the hospitals start to get over-run with people with flu symptoms and start to shut down services due to lack of beds, or start delaying surgeries due to lack of beds - how could that impact you? Think it won't happen? It is already happening in Australia and New Zealand, where they've been in the midst of their winter season.

What if you are in a car accident and need surgery? What if you go into labor - would you really want to head to a hospital full of swine flu patients to give birth? Are you in a "high risk" category for this strain of flu? (High risk for H1N1 are children under 5, those who have obesity, those who have diabetes, those who have asthma, and those who are pregnant. It is hitting young, healthy adults particularly hard.)

Following are some things to think about. This list is not all inclusive, there could be lots more, but this should get you started. Please don't wait until the last minute to try to think this through. Be prepared in advance. Best case you won't need to use any of your preparations, but it would be certainly nice to have them already in place should you need them.

Considerations:

~ Do I have enough food and water on hand for at least 30 days if I had to stay in place and could not get to the store? (Minimum water usage is considered 1 gallon of water per day per person and this would not include any washing, laundry, etc. which you most certainly might need to do with a sick person in your home). How will you store it? Where will you store it?

~ Do I have enough of my usual prescription medications on hand for at least 30 days if I am unable to go out and get more? Do I have the usual prescriptions for any of my family members for at least 30 days?

~ Do I have enough over-the-counter medications on hand for my family to help treat the signs/symptoms of flu? Things like ibuprofen, acetaminophen, electrolytes (Emergen-C and the like), Vitamin D, Vitamin C, cough drops, etc.

~ Do I have items on hand to make a "quarantine" room for a sick family member if needed? Things like plastic drop cloth or shower curtains to cover doorways, N-95 or better masks to protect caregivers and to cover the sick to help contain spreading of the virus, rubber gloves, rubbing alcohol and other disinfectants, plenty of linens, laundry detergent, and the like?

~ Do I have enough cash on hand to make any needed purchases should I be unable to get to the bank?

~ Is there a point when I would decided to "self-quarantine" my family because of swine flu in my area? What is that "tipping point"? How will I define "self-quarantine" for my family?

~ If both parents work, what is our plan for childcare in the event schools close? What if one or both parents become ill?

~ What if a "worst-case" scenario hits and there are travel restrictions? What if you can't even cross from one county to the next in your home state? What if you work in one county, but live in another - could you get home if needed?

Take a little time to think some of these issues through and have a game plan ready, just in case you need it. I'd much rather be prepared and not need to use it, than not be prepared at all.

Here are some recent news articles that you might also want to review:

Officials Scramble to Prepare Swine Flu Vaccine - Vaccine Strain Growth in Culture Much Slower Than Expected

WHO: Swine Flu Epidemic Still In Early Stages (100,000 cases in England last week alone)

Swine Flu Vaccine Poses Challenges to FDA

Explosion of UK Pandemic H1N1 Cases Causes Concern

Up to 40% in US Could Get Swine Flu

US: 160M doses of swine flu vaccine due in October

Swine Flu Fears Prompt Run on UK Pharmacies

Stay on your toes and don't wait until the last minute to get prepared.

Swine Flu Hits Lungs Hard

An excellent article to read from the National Post. Remember, school starts up again in many places in about 5-6 weeks:

Link:

Swine Flu Virus Unpredictable, Scientists Warn

Excerpt:

Anyone who develops serious flu-like symptoms should seek immediate medical attention, because no one can predict when the H1N1 flu virus, or swine flu, will turn life-threatening in otherwise healthy people, infectious disease experts are warning.

Severe cases are occurring, in which the infection starts off like regular seasonal flu, with fever and cough, but then the lungs rapidly become inflamed and stop functioning.

"It looks to most of us like a primary viral pneumonia that deteriorates five or six days into therapy," says Dr. Allison McGeer, director of infection control at Toronto's Mount Sinai Hospital. "It's really severe illness."

"If you're young and healthy, you can recover from that severe lung injury. People do. But it takes a very long time," Dr. McGeer said.

"Sometimes we're talking about a month, five weeks on a ventilator before you are breathing on your own. Some people can be left with so much residual lung damage, they will have abnormal lungs for their lifetime."

More . . . .

Declaration of Medical Emergency in Buenos Aires

Most recent on H1N1 (Swine) Flu:

From Recombinomics
Saturday, June 27, 2009

Link: Medical Emergency Declared in Buenos Aires

Quoted:

Some hospitals began to strengthen measures, including the case of Posadas Hospital, one of the largest hospitals in the province of Buenos Aires that concentrates a large number of internees from the flu. Through a press release, the hospital reported that it declared a state of emergency by the Institution that "all staff will be available to the agency needs to be addressed" after the epidemic of influenza A.

In addition, the Posadas created through Resolution No. 640/09 an Internal Crisis Committee itself, with the aim of ensuring compliance and monitoring of the actions that the hospital must develop to deal with the situation posed by an outbreak of Influenza A .

Meanwhile, health authorities in Buenos Aires and Buenos Aires have some alternatives to strengthen the system, including the use of military hospital in Campo de Mayo, the release of bed in the hospital's intensive care Malvinas Argentinas, the installation of sanitary units in campaign Buenos Aires and mobile primary care close to railway stations and Eleven Constitution.

The above translation describes the declaration of a medical emergency in Buenos Aires. The Buenos Aires Ministry of Health website lists 15 confirmed fatalities, 180 confirmed cases, and 559 suspect cases as of Friday (see Buenos Aires map), but media reports suggest the actual number of cases is higher. Recent reports out of Argentina also described the rapid decline of relative young patients (15-50), with descriptions similar to those used to describe dying patients in 1918. In addition, there has been an outbreak of H1N1 at a pig farm northwest of Buenos Aires (see map).

The sudden jump in cases and fatalities are cause for concern. In the country the number of confirmed fatal cases rose to 27, but there are reports of 15 more fatalities that are suspect. There have also been reports of travelers from Argentina testing positive at airport checks in multiple countries. These travelers should provide multiple samples for sequencing studies to determine if there have been changes in the virus.

Recently PB2 E627K was reported in a traveler from the United States. However, the sequence suggested the change was acquired in China. Although the E627K was present in the original samples and confirmed in the initial clone, and subsequent sub-clone had reverted back to the wild type sequence, raising concerns that some key changes may not be stable under certain culture conditions, and important changes could be lost especially if the virus is cultured in chicken eggs, which could select against important changes associated with adaptation to human hosts.

Therefore, analysis by multiple labs of these sequences would be useful. The flu season is just beginning in the southern hemisphere, providing a favorable environment for rapid adaptive changes. The movement of a swine H1N1 into a human host parallels the 1918 pandemic, which also was associated with mild infections in the later spring, followed by a much more virulent and lethal H1N1 in the fall.

The rapid developments in Buenos Aires bear close scrutiny and active sequence analysis as H1N1 increases its gene pool transmitting through human hosts. Many countries worldwide, including those in the southern hemisphere are experiencing explosive growth, and the developments in Buenos Aires may signal a new wave of Pandemic H1N1.

Crystal Ball? Fall Flu Thoughts

There has been some great reading this morning (heck, actually all week) over at The Market Ticker. If you don't regularly read that blog, I cannot express strongly enough how much I encourage you to do so. You'll get some straight-forward analysis of the current goings-on of our economy, the bailouts, the markets, unemployment, the banks - everything. And it is in plain English, so you'll know and understand what you are reading and walk away having time well-spent learning something new or understanding something more fully.

Okay, fresh from The Market Ticker this morning I found this little gem of information about the H1N1 flu virus (click on the H1N1 link to read the full blog post). I know, lots of people seem tired of hearing about this and think it is just another "no big deal" flu bug.

But not so fast. We know that this virus is different from our "usual" flu viruses because it seems to prefer warm temperatures. That's why we're still seeing increasing numbers of infection of this virus in the U.S. even though it is summer.

I do have to say here that I'm very disappointed in the way the CDC is posting statistics on this virus - they are woefully behind and it has been stated publicly on many forums that most states are hardly doing any testing at all for this virus except on the most severe, hospitalized cases. So the numbers could be much higher and we just don't know it.

There are reports now coming out from Shanghai that the virus has mutated there and has now also picked up a viral sequence (E627K) that makes it also well-suited for cold climates - which has scientists now a bit worried about how this virus will hit those in the Northern Hemisphere this fall/winter. If the virus mutates enough, those who might have gotten it here in the U.S. this spring/summer could get the "new" version of it again this fall/winter.

Also, this particular flu strain is hitting those in the age range of 30-50 years old particularly hard. It is causing something called a cytokine storm in some of these individuals that are otherwise normal and healthy - basically their immune system ends up working too well when attacking this bug causing a fatal reaction.

Scientists are closely watching the development and evolution of this virus in the Southern Hemisphere that is now experiencing their normal winter cold/flu season. They hope to glean some information from the behavior of the virus that might let us have a peek into what to expect in our hemisphere this fall.

Their thoughts on what the virus will be like this fall are not optimistic. Taken from the Utah Public Health Situation Report Dated 24 Jun 2009:

CDC is now estimating that the novel H1N1 virus will be “Category 2” in severity. They are closely watching the situation in the Southern Hemisphere for validation of this estimate.
A category 2 pandemic has the following characteristics:
~Case fatality ratio of 0.1 percent to less than 0.5 percent.
~Between 90,000 and 450,000 deaths in the U.S. (compared with estimated 36,000 deaths during a typical influenza season).
~Excess death rate of between 30 to less than 150 per 100,000 people.
~Illness rate of between 20 and 40 percent.
~Similar to 1957 pandemic.

All this to say, continue to pay attention to this virus and how it is behaving. I recently found a whole forum board dedicated to international discussion and information sharing on H1N1 - you can go here: Pandemic Flu Information Forum.

If you don't already have a plan of action for your family for this fall in case this virus turns very ugly, you should. You should be prepared to "self-quarantine" if needed and stay put in your home for at least 2 weeks to 30 days, possibly longer, because of waves of infection.

Start thinking now about the items you would need to have on hand to do that. Make your lists and start gradually making your purchases now, so it is not such a big hit on your budget all at one time. I'll post soon on what we think some of the essential items are to have on hand and what we've done to prepare for just such a possibility.

Feel free to share any first-hand experiences you've had with this virus, or preparations you've taken for your family.

Hand Sanitizer Recall

The FDA has recalled various lots of skin/hand sanitizer and other skin products made by Clarcon because of contamination in their products with high-levels of disease-causing bacterias. A recent inspection of the Good Manufacturing Practices of the company led to this finding.

Here is the article:

FDA Warns Against Using Clarcon Skin Products

I know that many of us have purchased extra hand sanitizer to have on hand since April's news about the H1N1 (swine) flu virus - so please take a few moments to do your research, check your stocks and make sure that you don't keep any of these products around. Discard any that you find.

TN Pandemic Influenza Preparedness Plan

I thought you all might be interested in having a few links to the State of TN pandemic influenza preparedness plans. Here they are:

Tennessee Department of Health Pandemic Influenza Preparedness Plan

Here's the State of TN website that updates the number of cases for the state:

TN Department of Health H1N1 Information

TN Department of Health Communicable and Environmental Disease Services

Case count for TN as of 11:00 central today (26 May 2009) was 98 confirmed with 1273 cases submitted for testing.

Don't Ignore H1N1 Yet

Most of the mainstream media has dropped much following on the H1N1 (swine) flu, but you need to know that researchers, the CDC and the WHO haven't dropped their following of it. This virus, while not showing itself to be particularly severe here in the US - at least not yet- is still one that demands our attention and respect.

Here are a few updates you should be aware of:

from BBC News/UK: Warning over new threat from MRSA - antibiotic resistant pneumonia

from Recombinomics: Suspect Swine H1N1 in Toddler Death in New York Raises Concerns - this one you should definitely read - here's a partial quote:

The evolution of the H1N1 is being closely monitored by sequencing labs across the world, and most isolates to date are closely related. However, the presence of avian PB2 raises concerns that the frequency of cases will not decline in the summer in the northern hemisphere, because the avian PB2 is optimal at 41 C, which would lead to efficient transmission in the summer. Moreover, the seasonal flu has the mammalian version of PB2, which has optimal activity at 34 C. However, the swine H1N1 transmitting in the summer hemisphere may acquire E627K, leading to a virus efficiently transmitting in the winter also.

Similarly, swine H1N1 in the southern hemisphere may acquire H274Y, leading to Tamflu resistance, which could complicate treatment of the more severe cases, which may involve previously healthy young adults.

from Fox 2 Now: St. Louis Man with Swine Flu Dies

from eKantipur.com - One with Suspected Swine Flu Dies in Thailand

from Fox News: CDC: 100,000 Americans Likely Infected with H1N1 - now think - if each of those 100,000 infect 2-4 others, then they infect 2-4 others - do the math and see why pandemics spread so quickly.

Continue to pay attention, keep your hands washed, stay at home if you or any family members are ill, and have items on hand to make yourself and your family more comfortable if you become ill.

H1N1 + H5N1 = ????

Most of you have heard of St. Jude Children's Research Hospital in Memphis, TN. In addition to all the research and treatment done yearly on childhood cancers, it is one of the TOP 5 Influenza research centers in the world.

Dr. Robert Webster at St. Jude, often referred to as the "Pope of Influenza" has been studying influenza strains his entire career. When he speak about influenza, people listen - or should.

He is commenting recently that even though we've only seen what has turned out to be a very mild disease in this new strain of H1N1 (swine) flu, it is very important that we diligently watch how this virus begins to interact with other viruses as it travels the globe.

Other reports have indicated that research shows this new strain of H1N1 is particularly adept at grabbing onto genetic material from other flu viruses.

What Dr. Webster is watching carefully is whether the H1N1 virus, at it begins to travel in areas where Bird Flu is endemic (Indonesia, Egypt, and others), will combine with Bird Flu to produce something that could be very nasty indeed.

While many are now acting as though the "boy cried wolf" on this current H1N1 outbreak, I for one, as a prepper, will keep this in my sights for quite some time to watch how it acts throughout the world as it continues to travel.

The Southern Hemisphere is just starting winter. Egypt and Vietnam each had a case of Bird Flu just this week - the person in Egypt survived, the person in Vietnam did not. In the case of these viruses, we cannot be too careful.

Many who have studied pandemics of the past are aware that they often first appeared at the end of a flu season and were mild, but came back for the next couple of years during the winter flu season with a vengeance.

As H1N1 travels through Asia, Africa and 3rd World countries we should keep a close eye on the outcomes and have our preparedness plans already in place for what could happen this fall or winter - or some winter in the near future.

Part of being prepared is keeping an eye and ear open to what is going on and making sure you have the essentials in place to get through whatever might be necessary to keep you and/or your family safe for the duration. One thing we cannot afford to be is lax - we aren't worried or fearful or anxious, but prepared.

Additional Reading:

Fox News: Top Flu Expert Warns of Swine Flu-Bird Flu Mix

Dr. Robert Webster - Influenza, World-Class Expertise

Scott McPherson: Why Egypt Wants To Kill All The Pigs

Little Ones With Flu

Here are a few tips to help when taking care of young children who might get the flu - this new one or any other one that comes along. This is not an exhaustive list, just a quick posting of things we've found helpful to our family. Be sure to leave a comment if you have a great tip to help the rest of us out!

1. We all hate to change those sheets in the middle of the night or all day long after a little one has gotten sick on them. So, we put a large beach towel or bath towel under them and on their pillows and keep a large stash at the ready. This way, if they get sick and can't make it to the bathroom or even the bag/bucket by their bed, it is so much easier to quickly replace a towel than wash all the sheets and completely remake a bed. We also put towels on the furniture, having learned that lesson the hard way as well!

2. Along the same lines, we line the floor to the bathroom with large towels or washable throws, so those that try to make it to the bathroom but don't quite succeed hit a washable target instead of the carpet.

3. We know that Sprite seems to help settle a stomach. We put a twist of lemon in ours to keep them drinking and going to the potty. Sometimes we add some Emergen-C powder to boost their Vitamin C (not a whole packet for little ones though).

4. We also sometimes freeze a little Sprite in our popsicle molds so they can have something cool on their throats that won't come back to haunt us!

5. For some sore throats, I've found that an immediate gargle with straight colloidal silver does wonders. Nature's antibiotic - but it only works on bacteria, not viruses.

6. We've found that the Bolthouse brand of C-Boost drink does wonders. The girls love the apricot flavor and it is full of vitamins and minerals. They like it much better than those electrolyte drinks.

7. We avoid dairy during fevers at all costs. It seems that anything dairy related just sours instantly on a feverish stomach and you will be seeing it again (ugh!).

8. Instead of paper tissue products which are rough on little noses and cheeks, I give them a cloth diaper, soft washcloth or even soft handtowel for their running noses. When using a washcloth or towel, I can give each one a different color and then there is no confusion over who has which one.

9. For those inevitable chapped little noses and cheeks, I love the Weleda Calendula Oil. Calendula is a very healing herb and this little oil is one of my favorites for many uses.

Caring For Flu Sickness In Your Home

In light of the breaking news this evening in Tennessee that there is a likely case of H1N1 flu virus in a child who lives in Williamson County who attends Harding Academy in Nashville, and 10 other cultures awaiting confirmation as H1N1 in our state, here is some information that you might want to have just in case you have someone in your home who comes down with flu symptoms.

The Centers for Disease Control and Prevention have a very good web page set up that tells you the best steps you can take when caring for someone with the flu in your home. You might want to bookmark this page for quick reference:

CDC: Interim Guidance: Taking Care of a Sick Person In Your Home

Another link for reference: PandemicFlu.gov