Updating the H1N1 Update
by ilene - December 31st, 2009 1:58 pm
Updating the H1N1 Update
Watching and Waiting
Ukraine
Vaccines
Tamiflu Resistance
Dr. Niman vs. WHO, ECDC and CDC
by Ilene with guest expert Dr. Henry Niman at Recombinomics
Watching and Waiting
While the numbers of new cases of swine flu have been declining in many regions, including the United States, it is too early to know whether or not there will be subsequent waves of disease.
"Based on my experience with new diseases and the lessons learned from past pandemics, I think we should remain cautious and observe the evolution of the pandemic over the next six to 12 months before declaring victory," World Health Organization Director General Margaret Chan tells Swiss newspaper Le Temps. (World Health Official Says Swine Flu Still a Threat)
Although the WHO is remaining "cautious," changes in the virus’s genome that increase its virulence and resistance to Tamiflu are becoming more common. Dr. Henry Niman, expert in flu virus evolution, believes another wave of illnesses will occur in early 2010. In addition, he believes resistance to Tamiflu will become "fixed," similarly to how this genetic change evolved in the seasonal H1N1 virus. (See Flu Update: Tamiflu resistance and Ukraine update, and Efficacy of Roche’s Flu Drug Tamiflu In Doubt, by David Phillips.)
WHO: H1N1 swine flu pandemic will stick around for another year
The World Health Organization warned government health authorities to remain vigilant on the H1N1 swine flu pandemic, saying the virus could mutate before vaccines can help it dissipate.
The World Health Organization is confident that the H1N1 swine flu pandemic will be under control in a year’s time – however, WHO officials warned global governments to remain vigilant for any mutations in the troublesome bug.
Dr. Niman believes this wave will be more severe than the previous two--but not due to random mutations. Rather, this will result from the process of recombination. Due to recombination, increasingly greater transmission of aggressive variants (D225G, D225E and D225N) and Tamiflu-resistant viruses will occur.
Ukraine
I’ve reprinted two recent articles at Recombinomics, with my comments in blue.
The WHO Surprise on D225G / D225N H1N1 Fatalities, Recombinomics Commentary
After considering the current available virological, epidemiological and clinical findings and following discussions on an earlier draft with WHO and its European-based
Flu News: D225G Follow-up
by ilene - November 28th, 2009 2:56 pm
In case you missed my latest update on the flu, I’ve added to it here. – Ilene
Flu News: D225G Follow-up
By Ilene with guest expert Dr. Henry Niman
Dr. Henry Niman heads the research company Recombinomics Inc. Recombinomics has a small group of researchers who analyze the sequence data from viral samples isolated from patients diagnosed with swine flu.
I spoke with Dr. Niman last week about the evolution of the H1N1 virus as it circulates through the world’s population. These changes are natural—and Dr. Niman’s research on the subject allowed him to predict how the virus would change as infection rates increase and time goes on. The outbreak in Ukraine was initially described in many media reports as a new lung-blackening "mystery disease," leading to many false and misleading Internet stories. According to Dr. Niman, it was clear from the start that H1N1 was killing an unusually high number of previously healthy young adults.
H1N1 infection seemed to cause more severe illness in Ukraine, and Ukraine officials asked the WHO for assistance. The WHO interfaced with Ukraine labs in Kiev and sent groups into western Ukraine to survey the problem and gather information. As part of the investigation, the WHO sent samples to Mill Hill in London, one of several regional centers that performs genetic analysis for the WHO.
Subsequently, the WHO issued several non-informative reports but held the sequences at Mill Hill for analysis. Dr. Niman wrote a number of commentaries on the rising death toll and the need to make the sequences public. He predicted the deaths would be associated with a receptor binding domain change in the wild-type H1N1 virus (the predominant virus) to a variant form, characterized by the D225G genetic marker. Wild-type H1N1 has a D at position 225 of the viral protein Hemagglutinin (HA), and is referred to as D225. The variant protein, D225G, has a genetic change causing a change in position 225 of the protein. "D" is the symbol for the aspartic acid which is present at position 225 of the wild-type protein. Glycine, symbol G, replaces aspartic acid in D225G variants. Hemagglutinin is one of two surface proteins projecting out from the surface of the virus. The function of the HA protein is to bind viral particles to susceptible cells in the host animal.
Swine Flu News
by ilene - November 20th, 2009 8:11 pm
Swine Flu News
By Ilene
The good news is that the number of new cases appears to be dropping off in most of the United States. More good news is that the swine flu vaccine appears to be reasonably safe, with no increases in serious events, including death, above the expected baseline rate. The not-so-good news is that a currently noted "peak," in flu language, is temporary. Additional waves of increasing illness are expected. Other bad news is that pediatric deaths from the swine flu are already considerably higher than in seasonal flues, and the numbers are expected to continue rising. In addition, viruses with specific mutations, D222G or D225G, and a mutation resulting in tamiflu resistance, are being isolated from cases in multiple locations.
Estimated Statistics:
Update from the CDC, Weekly 2009 H1N1 Flu Media Briefing, Anne Schuchat, director of vaccination and respiratory disease at the C.D.C:
these estimates will give a single number and then a range, a lower and upper estimate around each number…. So for April through October 17th, we estimate the 22 million people have become ill from pandemic influenza. We estimate 98,000 people have been hospitalized so far through October 17th. And the upper and lower estimates on hospitalizations are from 63,000 to 153,000. We estimate that 3,900 people have died so far in the first six months of the pandemic from this virus. And the estimates there are from 2,500 up through 6,100 people having died so far. We’ve been talking a lot about this pandemic being a younger person’s disease, that it’s disproportionately affecting children and young adults and relatively sparing the elderly, very different from seasonal flu… [In] children under 18, we estimate 8 million children have been ill with influenza, 36,000 hospitalized, and 540 children have died…
I do believe that the pediatric death toll from this pandemic will be extensive and much greater than what we see with seasonal flu…The numbers I’m giving are through the first six months through October. We have had a lot of disease since then and we’ll probably have a lot of disease going forward…
What does this look like compared to previous pandemics. The estimates I’m giving you are the first six months. This is April through the middle of October. We have a long flu season ahead of us. In typical seasonal flu we see disease from