North American Flu Epidemic Spreading

New Scientist ^ | 11-28-2003 | Shaoni Bhattacharya

[blam]

North American flu epidemic spreading

18:20 28 November 03

NewScientist.com news service

The flu epidemic is continuing to spread across North America, with the first child to die in Canada this season being reported in Ontario on Friday.

Influenza is already known to have killed four children in Colorado, US, and five in the UK, as well as many adults. US health officials are particularly concerned as flu has arrived earlier than for many years, raising concern that there may be a more severe epidemic.

The main strain of flu virus seen has also only recently emerged and is not specifically covered in the make-up of the 2003 flu vaccine.

"We're very concerned [by the] earlier onset, and some parts of the country are having very high levels of widespread flu infection," Julie Gerberding of the US Centers of Disease Control and Prevention warned earlier in November.

Because of the early onset and different flu strain, CDC is particularly urging those over 50 to get a flu jab, as well as recommending it for children aged six to 23 months.

Children are likely to be more vulnerable this year. "When flu strains change over time, they are more likely to affect the young who will have less immunity to them," says John Watson, a respiratory expert at the UK's Health Protection Agency. However, UK government advisers say the deaths in children are not above the numbers normally expected in the annual flu epidemic.

'At-risk' groups

In the UK, vaccination is recommended for those above 65 and children in "at-risk" groups such as those with asthma, diabetes or heart conditions. But following the deaths this season, the UK's Joint Committee on Vaccination and Immunisation convened its influenza panel in November to discuss the situation.

"The group concluded that the current level of reported deaths in children was not unexpected, but that the situation should be closely monitored," the meeting concluded.

A spokeswoman for the HPA notes two or three children die of flu every week in the UK during a normal outbreak. Many children get the flu, partly because they frequently mix with other children and partly because they are too young to have built up strong immunity, she told New Scientist.

The HPA also points out that the flu seasons of the last three years have been "unusually quiet".

Animal experiments

The main flu strain circulating in North America and the UK this year is the Fujian strain of influenza A (H3N2). It was detected in extremely small numbers in the UK in winter 2002. But the HPA notes it was the main flu strain in Australia during that country's winter earlier in 2003.

Gerberding says that although CDC is concerned about the new strain, animal experiments show the flu vaccine prepared in advance for the 2003 to 2004 season offers some protection against the Fujian strain. This is because the vaccine protects against another strain of influenza A (H3N2), known as the Panama strain.

Flu evolves constantly, which is why a new flu vaccine must be developed every year to try to match new strains. The World Health Organization decides on the composition of the following winter's flu vaccine in February.

Deep trouble

But producing the vaccine is a time-consuming process, as the viral genes are "grown" in chicken eggs. Scientists warned on Friday that the time lag would leave the world vulnerable in the event of a flu pandemic.

"The world will be in deep trouble if the impending influenza pandemic strikes this week, this month, or even this year," argue Richard Webby and Robert Webster of St Jude Children's Research Hospital in Memphis, Tennessee, writing in Science (vol 302, p1519).

They suggest the US government should facilitate the use of a new technique called "reverse genetics" which produces vaccines much faster. They also suggest stockpiling antiviral drugs.

The last flu pandemic in 1918 is believed to have killed 50 million people worldwide.

Shaoni Bhattacharya

[blam]

Ping

[blam]

US Poorly Prepared For Flu Pandemic, St Jude Experts Warn

[jocon307]

"[T]wo or three children die of flu every week in the UK during a normal outbreak."

Are these children that were healthy before they get the flu, or are these people whose health is already compromised in some way?

[Harmless Teddy Bear]

Good question! Here's another one, these "many adults" that died, would they be classified as elderly or young healthy?One would be sad but not panic material the other could be a real problem.

The 1918 pandemic was so devastating because it didn't hit the high risk groups (elderly/children) but hit the young healthy adult group like a ton of bricks.

[jocon307]

"The 1918 pandemic...hit the young healthy adult group like a ton of bricks."

Yes, in my own family 3 of the people that were living in the US (and that was only a few people, maybe 20) died in that epidemic. I read somewhere recently that a person would be fine in the morning and dead by the end of the day. A young, healthy person. I don't see what modern medicine could do to help that kind of a situation.

[glock rocks]

It's hitting pretty hard in my state.

[pabianice]

"I had a little bird

"Her name was Enza

"I opened up the window

"And In flew Enza"

Nursery rhyme, 1918

"Ring around rhe rosey (praying on the rosary for help)

"A pocket full of posies (flowers were used to mask the smell of rotting corpses>

"Jump up, jump up (convulsions)

"All fall down" (all died)

Nursery rhymn, the Black Death, England, 14th century

[Cicero]

The 1918 pandemic killed more people than the First World War, even in Great Britain, which lost far more in that war than we did.

Such a pandemic CAN be dealt with. Vaccines would be developed to match the new mutated strains. The problem is the time lag. Many people would die before the vaccines were produced and distributed.

[Harmless Teddy Bear]

The pandemic traveled east to west across the US. Those on the west coast sent a telegram to the east coast asking what they could do to prepare. The grim answer was, "Dig graves and build coffins now. Once it reaches you they will all be needed."

[templar]

The 1918 pandemic killed more people than the First World War, even in Great Britain, which lost far more in that war than we did.

I've heard it claimed that the flu was the reason for the end of the first world war. Not enough men left to both keep fighting and maintain the homefront. I have no idea if this is actually true ... anyone?

[steve86]

I had no idea the "Ring around the rosey" poem had that etymology: shocking. The slightly lighter Enza poem (even if set during the macabre Spanish flu), seems cute to me. Thanks for posting.

[Harmless Teddy Bear]

A lot of poems that we now classify as nursery rhymes were once historical and political commentary.

It is interesting because it shows how powerful oral tradition can be in that it continues to live long after the reason behind it is forgotten.

[blam]

I have a little different take on that little 14th century:

Ring around the rosie
pocket full of posies
Upstair, downstairs, all fall down

I asked an English friend of mine about the upstairs/downstairs part. He said that the affluent would live upstairs and the poor downstairs and what was meant by that was that everyone, rich or poor were dying equally.

[Palladin]

What's the latest on this flu epidemic? I can't find any articles tonight.

[Palladin]

I just found this...don't feel like starting a new thread:

After 42 Kids Die, CDC Opens Emergency Flu Center

Friday, December 19, 2003

ATLANTA — The nation's top health agency on Friday stepped up its response to the unusually early outbreak of flu, launching response teams to states and asking all health departments nationwide to report flu deaths of children.



Characterizing the outbreak as a likely epidemic, the Centers for Disease Control and Prevention (search) also sought postmortem tissue samples, autopsy reports and flu virus samples from fatally stricken children.

Earlier Friday, Dr. Julie Gerberding, the CDC director, said 42 children have died from the flu this season.

She said the CDC field teams will help states deal with the outbreak and evaluate the effectiveness of this year's flu shot. The CDC also activated its emergency operations center to coordinate its efforts.

Gerberding said it's too soon to determine how severe this flu season will turn out to be. But in response to a question at a news conference, she said the number of cases -- and the child deaths -- indicate the outbreak could be classified as an epidemic. She said the season has followed "typical" flu patterns but started much earlier than usual.

The CDC has never required states to report flu deaths, largely because it's hard to distinguish flu from other winter viruses. But the agency has been concerned about the number of normally healthy children dying from this year's flu strain.

The agency has estimated that about 92 children under age 5 typically die each year from flu, but that is based on computer models and "in fact is a ballpark estimate," Dr. Keiji Fukuda, the CDC's top flu epidemiologist, said this week.

The child deaths from flu are "very sobering and very worrisome," Gerberding said, adding that at least 16 of the children who died were ill prior to catching the flu and that more than half the deaths involved children under 5.

Twenty-one of the children were previously healthy and three developed a drug-resistant bacterial infection that complicated their flu treatment. The CDC said they had flu shot data on only seven of the deaths; only two of those children had received a flu shot.

At least 36 states have been labeled by the agency as having widespread flu activity, and no state has been untouched.

The emergency operations center was used earlier this year to help the agency manage SARS (search) and West Nile virus (search) activity in the United States.

Gerberding urged people not to crowd emergency rooms. The agency posted information on its Web site Friday to help people decide when they need to go to the hospital and when they should stay home.

"Flu is something that for the vast majority of people can be managed at home," Gerberding said. "It's not necessary to seek medical attention unless there is concern."

With the flu season hitting early, many areas have reported shortages of flu shots as demand outpaced supply. The federal government is trying to purchase remaining flu shot supplies for states.

The state of Georgia, meanwhile, has turned to a private vendor for 100,000 doses of flu vaccine -- a sixth of what the federal government has been able to scrounge for all the states.

Under the $1.65 million deal, Georgia will pay more than double what the vaccine would have cost before the season started. At $16.50 a dose, it's also double what the government recently paid for additional flu shots for states.

The vaccine purchased by Georgia was made by a subsidiary of Chiron Corp. (search) The selling company is Carter Trading Co. (search) of Springdale, Ark., health officials said. A call to Carter not immediately returned on Friday.

Some health officials voiced concern over the fairness of the Georgia deal, when many harder-hit states have been able to find far fewer doses. Colorado, for example, recently was able to buy only 6,060 doses from a private vendor, officials said.