Swine flu may have hit one peak; more to come

The pandemic of swine flu may be hitting a peak in the Northern Hemisphere, global health officials said on Friday, but they cautioned it was far from over.

Officials also said they were investigating several troubling outbreaks of drug-resistant H1N1 but noted they were limited so far and that there were no indications yet the virus was mutating in a sustained way.

The World Health Organization said H1N1 flu was moving eastward across Europe and Asia after appearing to peak in parts of Western Europe and the United States.

At least 6,770 deaths have been recorded worldwide since the swine flu virus emerged in April -- but officials always stress the confirmed count represents only a fraction of the actual cases, as most patients never get tested.

There are "early signs of a peak in disease activity in some areas of the northern hemisphere," the WHO said in a statement.

Transmission keeps intensifying in Canada, with the highest number of doctor visits by children. But U.S. officials saw signs of a slowdown.

SOME DECLINES

"We are beginning to see some declines in flu activity around the country but there is still a lot of influenza," the Centers for Disease Control and Prevention's Dr. Anne Schuchat told a news conference.

"It is still much greater than we would normally see this time of year."

A team at flu test maker Quest Diagnostics analyzed 142,000 U.S. flu tests and found a similar pattern, with tests showing a decline in flu-like illness since October 27.

WHO said Norway and countries farther east including Georgia, Lithuania, Moldova and Serbia were reporting sharp increases in influenza-like illness or acute respiratory infection.

Kazakhstan, Uzbekistan and parts of Afghanistan -- particularly the capital, Kabul -- are reporting higher numbers of flu cases. Israel is also reporting sharp increases.

"Essentially what is happening is that it is spreading eastward," Anthony Mounts of WHO's influenza team told Reuters. "Typically, seasonal influenza always starts west and moves eastward. It seems to be following that pattern except it is coming very early this year."

Influenza can hit several peaks in a single season. Experts said weeks or months more of disease could be expected and noted that during the 1957 pandemic, a busy autumn was followed by a lull and then infections surged again starting in January.

Vaccination campaigns are beginning in many countries but companies reported some trouble making vaccine from the H1N1 virus. The United States was still struggling to distribute vaccines but Canadian Health Minister Leona Aglukkaq said enough vaccine for almost half of Canada's population would have been shipped out by the end of the next week.

MUTANT VIRUSES

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British health officials said they were investigating the likely person-to-person spread of a drug-resistant strain of swine flu.

The Health Protection Agency reported five confirmed cases in Wales of patients infected with H1N1 resistant Roche AG and Gilead Sciences Inc's antiviral drug Tamiflu.

Another antiviral, GlaxoSmithKline and Biota Inc's Relenza, were effective in the patients, the HPA said.

The patients had serious conditions that suppressed their immune systems, which can give the virus a better than usual opportunity to develop resistance, the HPA added.

U.S. CDC officials also said they were investigating four cases of H1N1 resistant to Tamiflu at Duke University hospital in North Carolina. "All four patients were very ill with underlying severely compromised immune systems and multiple other complex medical conditions," Duke said in a statement.

Health experts are looking for any sign that H1N1 is mutating into a drug-resistant form. Last year, the seasonal version of H1N1, a distant cousin of the pandemic strain, developed resistance to Tamiflu.

In Norway, officials were investigating a mutated strain in some patients that they said could be responsible for causing severe symptoms.

"The mutation could be affecting the virus' ability to go deeper into the respiratory system, thus causing more serious illness," the Norwegian Institute of Public Health said in a statement.

WHO said the mutation did not appear to be widespread in Norway and the virus remained sensitive to antivirals and pandemic vaccines.

A similar mutation had been detected in H1N1 viruses in several other countries, including China and the United States, in severe as well as in some mild cases, it said.

U.S. sees rise in secondary infections after flu

U.S. health officials said on Wednesday they are seeing a worrying pattern of serious bacterial infections in swine flu patients, mostly among younger adults not normally vulnerable to them.

The pattern is typical of pandemics such as the current H1N1 pandemic but shows the need for patients and doctors to keep an eye out for the infections and treat them quickly, Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention told reporters.

"We are seeing an increase of serious pneumococcal infections around the country," Schuchat told a telephone briefing.

"That is the serious type of pneumococcal disease where the bacteria invades the blood and other internal sites." These so-called secondary infections can follow infection with a virus such as flu and often are seen among people who die from influenza.

A close look in Denver showed 58 cases of serious Streptococcus pneumonia infections in October, a month when usually about 20 cases are seen, Schuchat said. And while such infections normally affect people over 65, these were almost all among people under 60, she said.

"The findings in Denver probably reflect infections that are occurring in other parts of the country where surveillance hasn't been as invasive," Schuchat said.

Merck makes a vaccine called Pneumovax to protect adults against 23 strains of these streptococcal bacteria, which is recommended for adults with diabetes, asthma, cancer and other conditions, as well as smokers. But only about a quarter of adults who should get it ever do, Schuchat said.

Children are protected against seven strains of these bacteria with Pfizer Inc's Prevnar.

Strep infections can be treated with antibiotics and the symptoms are often clear, Schuchat said.

"Having a high fever and cough and then feeling miserable and then feeling better and then suddenly taking a turn for the worse -- that is a serious warning sign," she said.

The U.S. government is trying to vaccinate as many as 160 million high-priority people but companies are having trouble making and packaging vaccine. As of Wednesday, Schuchat said 61.2 million doses of H1N1 vaccine had been used or were ready to order.

She said surveillance so far had shown the H1N1 vaccine was as safe as the seasonal flu vaccine

"We don't see any problems at all," Schuchat said. Ten cases of a rare neurological condition called Guillain Barre Syndrome have been reported among people who got vaccinated, which is no more than would be seen among people not vaccinated, she said.

"So far, the vaccine data suggests that this is a safe vaccine," Schuchat said.

"We are expecting to see vaccination efforts really step up as we head into December," Schuchat added.

The CDC estimates swine flu has infected at least 22 million Americans and killed 3,900. The World Health Organization says the pandemic is moving from west to east and appears to have made one peak in the United States and the westernmost parts of Europe.

Globally, WHO estimates that 80 million doses of influenza vaccine have been distributed.

WHO probing drug resistant swine flu

The World Health Organization is looking into reports in Britain and the United States that the H1N1 flu may have developed resistance to Tamiflu in people with severely suppressed immune systems, a spokesman said Tuesday.
Britain's Health Protection Agency (HPA) said five cases have been confirmed in Wales of patients infected with H1N1 resistant to oseltamivir -- the generic name of Roche and Gilead Sciences Inc's antiviral drug Tamiflu.
The patients had serious conditions that suppressed their immune systems, which can give the virus a better than usual opportunity to develop resistance, the HPA said. It said the drug-resistant strain had probably spread person to person.
"We have seen the reports, we need to look into them," WHO spokesman Thomas Abraham said in Geneva.
The U.S. Centers for Disease Control and Prevention last week also reported four cases of H1N1 resistant to Tamiflu at Duke University Hospital in North Carolina. All were said to be very ill with underlying severely compromised immune systems and multiple other complex medical conditions.
The WHO spokesman said both the reports involved Tamiflu resistance in people with severely compromised immune systems.
"We'll see if we need to put any additional measures in place to protect this vulnerable group of patients. It might mean that they are at more serious risk than others," Abraham said.
People with suppressed immune systems, such as those undergoing chemotherapy or suffering from HIV are more likely to fall ill from infections.
The WHO has previously reported cases of the pandemic virus being resistant to oseltamivir but says these are rare.
Abraham, asked whether the cases in Wales would be the first instance of person-to-person transmission of a Tamiflu-resistant form, replied: "As far as I know there have been possibilities but it never has been conclusively shown."
H1N1, a mixture of swine, bird and human viruses, has killed at least 6,770 people globally, according to the WHO. Most people suffer mild symptoms such as aches or fever, but recover without special treatment, it says.
Separately, the WHO said it was still probing whether a mutation in the H1N1 influenza strain, detected most recently in Norway last week, is causing the severest symptoms among those infected.
The Norwegian Institute of Public Health said last Friday the mutation could affect the virus' ability to go deeper into the respiratory system, causing more serious illness.
"It is a major issue we are looking at," Abraham said.
"If the mutation in fact is associated with severe cases then we really need to know about it. This might be a signal. We need to investigate," he said. "As of now there is no evidence of a particular association with severe cases."
So far, antiviral drugs and vaccines have been effective against the mutated form, he said.
There have now been four cases of mutated virus in patients in Norway, following a similar mutation in H1N1 viruses circulating in several other countries since April, he said.
The other countries are Brazil, China, Japan, Mexico, Ukraine and the United States.
"What we've seen has been pretty much equal in terms of severe and non-severe cases," Abraham said.

The facts Facts About Seasonal Influenza (Flu)

The Facts About Seasonal Influenza (Flu)

What is Influenza (Also Called Flu)?
The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent seasonal flu is by getting a seasonal flu vaccination each year.
Every year in the United States, on average:
• 5% to 20% of the population gets the flu;
• more than 200,000 people are hospitalized from flu-related complications; and
• about 36,000 people die from flu-related causes.
Some people, such as older people, young children, pregnant women and people with certain health conditions (such as asthma, diabetes, or heart disease), are at increased risk for serious complications from seasonal flu illness.
This flu season, scientists believe that a new and very different flu virus (called novel 2009 H1N1) may cause a lot more people to get sick than during a regular flu season. It also may cause more hospital stays and deaths than regular seasonal flu.
Symptoms of Flu
Symptoms of seasonal flu include:
• fever (often high)
• headache
• extreme tiredness
• dry cough
• sore throat
• runny or stuffy nose
• muscle aches
• Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults. Some people who have been infected with the new H1N1 flu virus have reported diarrhea and vomiting.
Complications of Flu
Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.
How Flu Spreads
Flu viruses are thought to spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5-7 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.
Preventing Seasonal Flu: Get Vaccinated
The single best way to prevent seasonal flu is to get a seasonal flu vaccination each year. There are two types of flu vaccines:
• The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The seasonal flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.
• The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy* people 2-49 years of age who are not pregnant.
About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.
Some medics consider the usage of "tamiflu" as one of the way to prevent the flu.
When to Get Vaccinated Against Seasonal Flu
Yearly seasonal flu vaccination should begin in September, or as soon as the seasonal flu vaccine is available, and continue throughout the flu season into December, January, and beyond. This is because the timing and duration of flu seasons vary. While seasonal flu outbreaks can happen as early as October, most of the time seasonal flu activity peaks in January or later.
Who Should Get Vaccinated Against Seasonal Flu?
In general, anyone who wants to reduce their chances of getting seasonal flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons. During flu seasons when vaccine supplies are limited or delayed, the Advisory Committee on Immunization Practices (ACIP) makes recommendations regarding priority groups for vaccination.
People who should get a seasonal flu vaccination each year include:
1. Children aged 6 months up to their 19th birthday
2. Pregnant women
3. People 50 years of age and older
4. People of any age with certain chronic medical conditions
5. People who live in nursing homes and other long-term care facilities
6. People who live with or care for those at high risk for complications from flu, including:
a. Health care workers
b. Household contacts of persons at high risk for complications from the flu
c. household contacts and caregivers of children <5 size="4">
Use of the Nasal Spray Seasonal Flu Vaccine
Vaccination with the nasal-spray flu vaccine is an option for healthy* people 2-49 years of age who are not pregnant, even healthy persons who live with or care for those in a high risk group. The one exception is healthy persons who care for persons with severely weakened immune systems who require a protected environment; these healthy persons should get the inactivated flu vaccine.
Who Should Not Be Vaccinated Against Seasonal Flu
Some people should not be vaccinated without first consulting a physician. They include:
• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination in the past.
• People who developed Guillian-Barre syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
• Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.