Posted on 10/30/2009 4:42:41 AM PDT by Uncle Ike
Ukraine
Over the last night of complications from the flu in Ukraine 11 people died
22/Nov/09
Over the last night of complications from the flu in Ukraine 11 people died. Reported the press office of the Ministry of Health of Ukraine. In Kiev and the Kiev region died three people in the Lviv region - two people, one man died in Kiev, Kirovograd, Kharkiv, Ivano-Frankivsk, Volyn and Khmelnytsky oblasts of Ukraine.
Influenza epidemic began in Ukraine in late October. During this time, more than 1,576 became ill million people were hospitalized 93,8 thousand people. In recent days hospitalized 2,4 thousand people, 225 patients are in intensive care, 28 - mechanical ventilation. Total flu epidemic and ARI claimed the lives of 374 Ukrainians.
http://www.regnum.ru/news/1227592.html
Ukraine
23/Nov/09
The Ministry of Health of Ukraine met with the leadership of the MOH with representatives of the European office of WHO and representatives of the UN Children’s Fund (UNICEF) in Ukraine. Participation in the meeting were Minister of Health of Ukraine V. Knyazevich, Deputy Minister I. Yakovenko, V. Yurchenko, heads of structural units of the MOH. From international experts were present: Deputy Regional Director of WHO / Europe NV Menabde, Program Director of Health WHO / Europe NV Emirohlu, UNICEF Representative in Ukraine Nakama Moku, Director WHO Office in Ukraine II Pokanevich,
Health Minister of Ukraine Vasyl Knyazevich thanked the experts of the World Health Organization for the speed of advice. He said that the government worked around the clock to resolve the problems facing the country during the outbreak of influenza A/H1N1 California. With the help of WHO could fix many things, but still several problems that must still be resolved. Vasily Knyazevich said that last year antyvaktsynalna company today has echoes and complicates the work of doctors to protect the population from infectious diseases. The Minister expressed hope that society has made findings and now the country’s leadership will not be on the sidelines to observe another popularization antyvaktsynalnyh slogans, and will inform the public about the real risks of infectious diseases. He recalled that shortly the scheduled meeting of the Academic Council, which is an advisory body to the Ministry of Health of Ukraine and composed of leading scientists on infectious diseases, epidemiology, virology, etc.. In addition, the Ministry of Health working together representatives of the Academy of Medical Sciences of Ukraine, offering their assistance in making decisions.
Deputy Regional Director of WHO / Europe NV Menabde expressed concern about the situation in Ukraine illness of influenza A/H1N1 California and noted the speed and professionalism with which Ukraine solves the problem. “You have the desire and ability to mobilize forces to keep the situation under control. We believe that adequate and proper measures taken by Ukraine in the treatment of patients,” - said Mrs. Menabde. She noted the need and importance of information support component of the theme of vaccination against influenza.
Menabde She noted that from a technical point of view of WHO recommendations on the need to give a vaccination against influenza A/H1N1 California. However, Ukraine as a country should itself decide whether or unreasonableness of its holding. This should be a political solution to the Government, the president and parliament to protect its citizens against pandemic influenza. International experts believe that there are no perfect solutions, and will always be forces that will use the counter, so the choice is less likely to challenge not only the Ministry of Health, but state leaders. In the state should be organized system of monitoring vaccination reactions and complications, focus on laboratory diagnosis. Menabde She said that the world is ahead of many problems, they are ambiguous and difficult in terms of any guarantees.
Asked whether Ukraine could rely on humanitarian assistance in the event of a decision on the need for vaccination, the WHO experts stressed that this issue difficult. Any manufacturer whose vaccine supplied to Ukraine would have to guarantee that vaccine will not be discredited, as happened with humanitarian aid last year, and will remain unused in warehouses at a time when other countries ask for help.
According to WHO, currently the world uses 65 mln.doz vaccine in 16 countries. In Europe, vaccination process began all countries that had its own production or purchase access. In addition, vaccination is continuing in Russia, Turkey and soon it begins in Macedonia, and Serbia.
Chief State Sanitary Doctor of Ukraine Alexander Bilovol, referring to international experts, said: “We ask a special advisory support from WHO to make a decision on the issue of vaccination to prevent a repetition of the situation that occurred in Kramatorsk, and a radically changed attitude toward immunization in the state” . He noted that the repetition of the scenario around the theme of vaccination would mean that the country will remain completely unprotected in front of infectious diseases.
To improve the situation of informing the public about risks associated with vaccines and infectious diseases, to be able to match these risks, UNICEF Representative in Ukraine Nakama Moku offered assistance to Ukraine to conduct an information campaign so that was a conscious choice of citizens and sober.
Health Minister of Ukraine Vasyl Knyazevich at the end of the meeting thanked for the assistance of international experts invited to participate in the operational headquarters and expressed hope for further fruitful cooperation in the combat pandemic influenza in Ukraine. Particular support line ministries in matters pending legislative support immunization, laboratory diagnostics, and improved registration of post-reactions, and many others.
http://www.moz.gov.ua/ua/main/press/?docID=14167
Recombinomics Commentary 07:39
November 24, 2009
http://www.recombinomics.com/News/11240901/Spontaneous_MM.html
The mutations appear to occur sporadically and spontaneously. To date, no links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread.
The above comment from the WHO briefing on D225G (aka D222G) in Norway describes how the “mutations appear”. However, this appearance is based on an outdate view of influenza evolution, which maintains that all newly acquired drift “mutations” are based on copy errors. For D225G, this would require the same copy error to occur again and again on multiple backgrounds, which simply is not reality based.
Although the “random mutation” explanation is one of the basic tenets of the WHO and CDC view of influenza evolution, this explanation is only viable in the absence of data. Widespread sequence data moved this hypothesis into the indefensible category years ago, but it remains at the core of WHO explanations of drift variants, such as the comments above.
The “random mutation” and failure to spread would require each detection to be an independent event. Thus, in Norway, the same copy error would have been made in of the three patients with D225G. Similarly, the same error would be required for each of the four fatal cases in Ukraine. Moreover, the same error would be made in the vaccine target, A/California/7/2009 because one of the 2:6 reassortants also had D225G. As the number of sequences with D225G increase, the likelihood that the same error happens again and again, among a very small number of differences (for HA in Ukraine, the only non-synonymous chnage was D225G), becomes untenable.,
The appearance of D225G on multiple genetic backgrounds of H1N1 parallels the sudden appearance of H274Y on multiple backgrounds of pandemic H1N1, which follows the same scenario of H274Y on multiple seasonal flu backgrounds in patients not taking Tamiflu. The acquisition of H274Y was readily explained by recombination, which led to the acquisition of key changes that were on clade 2C and then jumped to a clade 2B background. In addition to the H274Y jump to seasonal flu in patients not taking Tamiflu, silent changes were also observed, which also discounted heavy selection pressure favoring these changes.
Instead, the jumping was readily explained by recombination. For D225G, the change was present in one of the earliest isolates in the United States. It could jump from one background to another via recombination between sequences that are closely related. As a result, the new acquisitions lead to a new single nucleotide polymorphism, which looks like a point mutation, but is really recombination between closely related sequences.
Thus, both H274Y and D225G move from one genetic background to another via recombination. A new spontaneous mutation is not required for each isolate and the same sequence in a given area is just due to clonal expansion of an isolate with the new acquisition. This could be seen in the sequences from Ukraine. The Ternopil isolates had a marker found in all Ternopil isolates, including those from nasal washes that did not have D225G. The receptor binding domain change was appended onto this background. The same change was also on Lviv sequences from fatal cases which did not have the Ternopil marker. Thus, D225G moved from a Lviv to a Ternopil background via recombination (or vice verse). Moreover, the frequent jumping of the same polymorphism from one background to another allowed fro the prediction that D225G would be found on the Ukraine sequences. This type of current acquisition has also been described for a silent mutation in H5N1, which again would be widespread in the absence of an obvious clear selection pressure.
Thus, the movement of the same polymorphism via recombination is common. It explains the sudden appearance of the same marker on multiple genetic backgrounds, and forms a basis for predicting changes.
However, the reliance on a “random mutation” produces “surprise after surprise” among indfluenza “exoerts” and creates appearances such as spontaneous mutations and lack of transmission, which are not based on reality.
WHO to provide 5 million doses of vaccine against swine flu to Ukraine
Today at 13:30 | Interfax-Ukraine
http://www.kyivpost.com/news/nation/detail/53469/
The World Health Organization will provide five million doses of the vaccine against the pandemic H1N1 flu virus to Ukraine, the Ukrainian president’s press service reported on Nov. 24.
The WHO experts said this during their meeting with Ukrainian President Victor Yushchenko.
During the meeting, the Ukrainian president thanked the WHO experts for their work in Ukraine on helping the country to analyze the situation with the flu outbreak and create the conditions for fighting the current epidemic and anticipated new waves of infection.
An outbreak of a type of viral pneumonia has plunged the Ukraine and its neighboring countries into a state of panic. A potentially lethal combination of three different viruses are reported to have mutated into a single pneumonic plague, which is believed to be far more dangerous than swine flu. The death toll has reached 189, and as many as one million people have been infected, most of them within regions of Western Ukraine.
Oh, and this is the title of the article: Ukrainian Super Flu: Real or Hoax?
Commentary
Ukraine Dead Approach 400 - D225G Spreads
Recombinomics Commentary 23:30
November 24, 2009
http://www.recombinomics.com/News/11240903/Ukraine_397.html
1,679,237 Influenza/ARI
99,661 Hospitalized
397 Dead
The above figures from the latest daily update from the Ukraine Ministry of Health support a decline in the rate of increases of cases and deaths, but the total is now almost 400 fatalities (see map). The spread was likely slowed by the country-wide closing of schools along with warmer weather. However, it is likely that the virus will return as temperatures drop and the traditional flu season begins, although it is unclear if seasonal flu will be in circulation in 2010.
The receptor binding domain change, D225G, was in four of four sequence from fatal cases, raising concerns that the 2,3 alpha specificity of D225G drove the H1N1 to the lungs and the total destruction. Three patients in Norway were said to also have D225G, and two of the three died while the third had been in serious condition. 25 HA sequences from Norway were deposited at Genbank, but only one had D225G, and it was a mixture. In Brazil both patients with D225G in lung samples had died, and the case in China had been in serious condition.
However, the severity of the infection may be related to the ratio of sequences with and without D255G, as well as viral load, because milder cases involving D225G have also been reported in the United States and Hong Kong.
More detail on additional cases, including sequences from upper and lower respiratory tract from the same patient would be useful.
Commentary
H1N1 Re-infections Raise Pandemic Concerns
Recombinomics Commentary 02:30
November 25, 2009
http://www.recombinomics.com/News/11250901/H1N1_X2.html
Dr. Debra Parsons, a pediatrician at Kid Care West in Cross Lanes, was met with reactions of doubt from local health officials last month when she said two flu tests had come back positive for H1N1, or swine flu.
Parsons first came down with the virus, complete with all the telltale symptoms, in August.
Her son became ill at the same time with the same symptoms. Figuring they had the same bug, Parsons tested herself to see what it was.
The test came back positive for Influenza A, so the lab at Charleston Area Medical Center sent it to be sub-typed. Parsons was positive for H1N1.
Parsons and her son recovered, but in October they started having the same symptoms, but they became much worse.
They were both tested this time, and the results were the same — they were positive for Influenza A and then H1N1.
“It was swine flu both times,” Parsons said.
The above comments on lab confirmed re-infection of two family members two months apart by swine H1N1. These confirmations are supported by many anecdotal reports of similar re-infections. The timing of these infections allowed for easy identification, because at the time there was no seasonal flu, so identification of infections was straight-forward. Moreover, such infections in school aged children and parents are common because H1N1 infections exploded when school began.
At the time however, the H1N1 virus was evolving slowly, reflecting an ease of infection of a naïve population. The jump from swine H1N1 into humans allows for infections with low doses of virus. Low concentration of virus produces a mild infection and a weak antibody response. The rapid spread creates widespread antibody, but the low level allows for re-infection from individuals with a higher viral load. A higher viral load can be created in a school environment, where some students could be infected multiple times because of frequent contact with infected students.
Thus, the increased viral load could overcome the weak immune-response and re-infect those infected earlier, leading to a second wave. However, the higher viral load leads to more serious infections, especially for these not infected in the first wave. Consequently more previously health young adults develop more serious symptoms, leading to an increase in hospitalizations and deaths. The higher viral load, especially when combined with receptor binding domain changes such as D225G can lead to the type of cases seen in Ukraine, where a high percentage of young adults develop infections that destroy both lungs in a matter of a few days.
In many areas, including Ukraine, this wave is subsiding, but the holiday season will lead to new infections by viruses with regional markers, leading to a third wave in early 2010.
Ukraine
Swine flu pandemic peaks in Ukraine
1.6 million fall ill, while 388 die in three weeks
25/Nov/09
After three weeks of panic, pandemonium and politics, the initial swine flu pandemic in Ukraine has peaked.
Today the government is expected to end a nationwide ban on public gatherings, lift travel restrictions and order the reopening of parliament, schools and universities in all but 11 regions.
But the country, with its anemic health-care system, is still reeling from having 1.6 million people fall sick with the flu, resulting in the hospitalization of 97,000 people and the deaths of 388 in three weeks.
At the height of the frenzy, tens of thousands were becoming ill each day, dozens were dying and the Ukraine navy said it could not carry out combat duty because of a lack of manpower.
The National Security & Defence Council said there were constitutional prerequisites to declare a state of emergency and politicians briefly talked of postponing presidential elections, scheduled for Jan. 17.
A rising death toll added fear to the emotions rattling Ukraine as it ran out of essential medicines and supplies.
Pharmacies looked like Soviet-era shops with long lines of customers queuing for nonexistent surgical masks and cold medicines. The Health Ministry’s stock of Tamiflu, an anti-viral designed to slow the spread of influenza, was used up in days and people began to hoard lemons and garlic for homemade cures.
Ukraine’s fragile health system was soon paralyzed and rumours proliferated that people were dying of a new, more lethal strain of influenza virus.
As the World Health Organization rushed a nine-member outbreak assessment team to Ukraine in early November, politicians rounded on each other, predicting mass illness and death.
President Viktor Yushchenko declared his country had been hit simultaneously by two seasonal flus and the “California” (swine) flu, and blamed his political arch-rival, Prime Minister Yulia Tymoshenko for failing to prepare for the outbreak.
Ms. Tymoshenko, who is running for president, provided daily television updates on the pandemic and appeared in public swathed in hospital gowns and wearing a surgical mask. She criticized her rivals for hindering her efforts to end the pandemic.
When parliament voted to spend US$125-million to fight the flu, Mr. Yushchenko refused to authorize it, saying it would fuel inflation. Instead, he launched his own appeal for foreign aid.
Not to be outdone, presidential frontrunner Viktor Yanukovich, a former prime minister and leader of the Regions’ Party, pledged to use election campaign donations to buy flu medicine and 20 million surgical masks.
“Ukrainian politicians, including the two main presidential candidates, do not really care about the fate of their people,” columnist Kateryna Grushenko wrote in the Kyiv Post. “They allowed themselves to turn the H1N1 epidemic into a PR show during days when educational, medical, and society-oriented coverage should have been provided to the population.”
As the pandemic entrenched itself, straining hospitals and emergency rooms to the breaking point, Ukraine’s panic grew. With no authoritative explanation for what was happening, bloggers and conspiracy theorists suggested the country was in the grip of a mysterious, more lethal virus.
The government and WHO were deliberately playing down the pandemic’s death toll, some suggested.
When Norwegian scientists announced they had found a mutated form of the swine flu virus that could infect deeper into the airways and cause more severe disease, Ukraine’s news media began reporting that doctors conducting postmortems on some patients had found their lungs had virtually disintegrated.
The WHO tried to temper the sensational reports saying “viruses with similar mutations had been detected in several other countries, including Brazil, China, Japan, Mexico, Ukraine and the United States.”
“No links between the small numbers of patients infected with the mutated virus have been found and the mutation does not appear to spread,” it added.
By last week, the WHO said its preliminary analysis of Ukraine’s pandemic showed “the virus is very similar to other strains causing the current influenza A(H1N1) pandemic elsewhere in Europe.”
This virus is the main cause of Ukraine’s problems and current pandemic vaccines will provide protection, it added.
Only Ukraine doesn’t have any vaccine. Short of cash and hoping to combat any pandemic with Tamiflu, it did not order vaccine.
Now, it is appealing to foreign countries, including Canada, for vaccine donationsy.
The United States has already volunteered to deliver one million vaccine doses in December.
But the WHO is recommending 10% of Ukraine’s 46 million people be inoculated by January.
http://www.nationalpost.com/news/world/story.html?id=2262341
Commentary
D225G Ukraine Norway Link and China Spread
Recombinomics Commentary 14:15
November 25, 2009
http://www.recombinomics.com/News/11250902/D225G_Norway_China.html
The same mutation has been found in both fatal and mild cases elsewhere, including in Brazil, Japan, Mexico, Ukraine, and the United States, said the WHO.
WHO’s spokeswoman in Beijing, Vivian Tan, said the agency is aware of three such cases in China that occurred in June and July that were similar to the cases being investigated in Norway. Tan said WHO had no information on the cases mentioned in the Xinhua report Wednesday.
There is no evidence the mutated swine flu virus is circulating widely in the world, Tan said, but since it has been linked to deaths in Norway and elsewhere, investigators are focusing on whether this mutation could be a marker for more severe disease.
The above comments are associated with a report of eight D225G isolates with in China. Genbank has three of the sequences, as noted earlier. The increase in examples to eight is not surprising since D225G was in four of four fatal cases in Ukraine and reports from Norway cited detection in three isolates, 2 fatal and 1 severe case who had recovered.
However, 25 HA sequences deposited at Genbank had an HA sequence that contained D225G, A/Norway/2924/2009, but also had the wild type sequence, raising concerns that D225G was circulating as a mixture that was most easily detected in lung samples because the D225G was more than a “marker”. It is a polymorphisms that was found in 1918 and 1919 samples which were well characterized for receptor binding properties which indicated the change conferred increased binding to gal 2,3 receptors which are present in lung.
Concern that this receptor binding domain change was widely circulating were increased because an HA marker on the Norway isolate with D225G was found on additional isolates in Norway and worldwide (see list here). This marker was also in the HA sequences from the fatal cases in Ukraine. Full sequences from one of the Norway isolates, A/Norway/3364-2/2009, were deposited, and a marker on the NA sequence matched isolates with the HA marker, linking this broader set of isolate from Norway with the Ukraine sequences, which also had the NA marker, as did multiple other isolates (see list here).
These associations link Ukraine to Norway, but the D225G polymorphism has jumped onto multiple genetic backgrounds, which are widespread, increasing concerns the D225G is circulating undetected because it is concentrated in lung tissues and is poorly represented in nasopharyngeal swabs.
Release of full sequences from China, as well as Norway, would be useful.
Swine flu pandemic peaks in Ukraine
1.6 million fall ill, while 388 die in three weeks
Peter Goodspeed, National Post
Published: Wednesday, November 25, 2009
http://www.nationalpost.com/news/story.html?id=2262341
After three weeks of panic, pandemonium and politics, the initial swine flu pandemic in Ukraine has peaked.
Today the government is expected to end a nationwide ban on public gatherings, lift travel restrictions and order the reopening of parliament, schools and universities in all but 11 regions.
But the country, with its anemic health-care system, is still reeling from having 1.6 million people fall sick with the flu, resulting in the hospitalization of 97,000 people and the deaths of 388 in three weeks.
At the height of the frenzy, tens of thousands were becoming ill each day, dozens were dying and the Ukraine navy said it could not carry out combat duty because of a lack of manpower.
The National Security & Defence Council said there were constitutional prerequisites to declare a state of emergency and politicians briefly talked of postponing presidential elections, scheduled for Jan. 17.
A rising death toll added fear to the emotions rattling Ukraine as it ran out of essential medicines and supplies.
Pharmacies looked like Soviet-era shops with long lines of customers queuing for nonexistent surgical masks and cold medicines. The Health Ministry’s stock of Tamiflu, an anti-viral designed to slow the spread of influenza, was used up in days and people began to hoard lemons and garlic for homemade cures.
Ukraine’s fragile health system was soon paralyzed and rumours proliferated that people were dying of a new, more lethal strain of influenza virus.
As the World Health Organization rushed a nine-member outbreak assessment team to Ukraine in early November, politicians rounded on each other, predicting mass illness and death.
President Viktor Yushchenko declared his country had been hit simultaneously by two seasonal flus and the “California” (swine) flu, and blamed his political arch-rival, Prime Minister Yulia Tymoshenko for failing to prepare for the outbreak.
Ms. Tymoshenko, who is running for president, provided daily television updates on the pandemic and appeared in public swathed in hospital gowns and wearing a surgical mask. She criticized her rivals for hindering her efforts to end the pandemic.
When parliament voted to spend US$125-million to fight the flu, Mr. Yushchenko refused to authorize it, saying it would fuel inflation. Instead, he launched his own appeal for foreign aid.
Not to be outdone, presidential frontrunner Viktor Yanukovich, a former prime minister and leader of the Regions’ Party, pledged to use election campaign donations to buy flu medicine and 20 million surgical masks.
“Ukrainian politicians, including the two main presidential candidates, do not really care about the fate of their people,” columnist Kateryna Grushenko wrote in the Kyiv Post. “They allowed themselves to turn the H1N1 epidemic into a PR show during days when educational, medical, and society-oriented coverage should have been provided to the population.”
As the pandemic entrenched itself, straining hospitals and emergency rooms to the breaking point, Ukraine’s panic grew. With no authoritative explanation for what was happening, bloggers and conspiracy theorists suggested the country was in the grip of a mysterious, more lethal virus.
The government and WHO were deliberately playing down the pandemic’s death toll, some suggested.
When Norwegian scientists announced they had found a mutated form of the swine flu virus that could infect deeper into the airways and cause more severe disease, Ukraine’s news media began reporting that doctors conducting postmortems on some patients had found their lungs had virtually disintegrated.
The WHO tried to temper the sensational reports saying “viruses with similar mutations had been detected in several other countries, including Brazil, China, Japan, Mexico, Ukraine and the United States.”
“No links between the small numbers of patients infected with the mutated virus have been found and the mutation does not appear to spread,” it added.
By last week, the WHO said its preliminary analysis of Ukraine’s pandemic showed “the virus is very similar to other strains causing the current influenza A(H1N1) pandemic elsewhere in Europe.”
This virus is the main cause of Ukraine’s problems and current pandemic vaccines will provide protection, it added.
Only Ukraine doesn’t have any vaccine. Short of cash and hoping to combat any pandemic with Tamiflu, it did not order vaccine.
Now, it is appealing to foreign countries, including Canada, for vaccine donationsy.
The United States has already volunteered to deliver one million vaccine doses in December.
But the WHO is recommending 10% of Ukraine’s 46 million people be inoculated by January.
Flu, pneumonia kill 404 people in Ukraine, says health ministry
00:42
http://www.interfax.com.ua/eng/main/26114/
A total of 404 people have died of flu and flu-like illnesses in Ukraine as of late on Wednesday, November 25. Seven people have died of flu and its complications (pneumonia) over the past 24 hours, the Ukrainian Health Ministry reported.
Since the outbreak of the epidemic, over 1.716 million people have contracted flu and respiratory infections, including 37,327 people over the past 24 hours.
A total of 102,030 people have been hospitalized since the start of the epidemic (October 29), including 2,369 over the past 24 hours. Of those hospitalized, 76,739 people have been discharged from hospitals.
The epidemic threshold was exceeded in Zakarpattia, Kirovohrad, Luhansk, Lviv, Sumy, Khmelnytsky, Chernivtsi, Chernihiv regions, and the city of Kyiv
Not exactly English, but you get the idea:
Each deputy will be personally responsible for the death of Ukrainians
http://en.for-ua.com/analytics/2009/11/26/140000.html
The Cabinet of Ministers has registered in the Verkhovna Rada a draft Resolution “On main directions of the distribution of state budget funds allocated to prevent the spread of the flu epidemic and acute respiratory infections in Ukraine,” which proposes to approve the allocation of funds to prevent the spread of influenza and acute respiratory diseases and establish appropriate controls for their use.
Prime Minister Yulia Tymoshenko personally presented this document in the Rada today, Tymoshenko’s web-site reported.
“The government registered the draft resolution of the Verkhovna Rada which outlines in detail what this money (one billion UAH) will be spent on... and in the Law and the decision of parliament it states that the distribution of funds will be approved by relevant committees,” Yulia Tymoshenko said.
According to her, “this money is needed for banal things.” “Firstly, the WHO requires that we equip every raion and city hospital with special oxygen generators and place them in emergency rooms. This means that if a person receives oxygen in the first minutes of illness, this can help protect their health,” explained the head of government.
Yulia Tymoshenko also informed that the second item is the purchase of the drug Tamiflu. “We have to buy enough Tamiflu to supply all those who could potentially get sick,” she said
Thirdly, according to the Prime Minister, the country needs to buy intensive care equipment - respirators, artificial kidney machines, etc.
Yulia Tymoshenko stressed: “This billion is the minimum needed. And if we don’t go for the minimum, then this billion isn’t even close to enough.” She urged parliament to create the appropriate commission to control the use of this money.
Before the vote for the Law “On amending the Law of Ukraine “On the State Budget of Ukraine for 2009” in the plenary hall of parliament, Yulia Tymoshenko noted that each people’s deputy will be held personally liable for the death of every child, pregnant woman and in general – Ukrainians, because of the country’s unpreparedness for the epidemic.
“You will all be responsible depending on the vote. You will be responsible for every child’s life, for every pregnant woman, young person, because if you read the transcript of the statements made by the head of the WHO mission, then ... if this pace of the epidemic continues, the WHO’s forecasts will become reality,” explained the head of government
According to her, based on the most optimistic forecast by the WHO, 34,000 people in Ukraine may die from the epidemic, and worst forecast – 240,000 people.
Yulia Tymoshenko at the same time stressed: “To help us prepare for the potential second and third waves of the pandemic that the WHO is talking about, we need not one billion, but billions, tens of billions.”
The Prime Minister has once again said that the President deliberately waited 15 days to make a decision on the law and then vetoed it “for one reason only - because if the epidemic gets worse, he will be able to declare a state of emergency…and remain President for at least another six months.”
However, the Verkhovna Rada failed to override the veto of the Law “On amending the Law of Ukraine “On the State Budget of Ukraine for 2009” which would provide all hospitals with essential drugs and equipment to diagnose the illness and counter the spread of the flu epidemic. 231 people’s deputy out of the necessary 300 voted to override the veto.
People’s deputy Serhiy Sas introduced a proposal to send the Law to the profile committee for revision; 251 parliamentarians voted for this.
Ukraine
Ukraine:
1.716.564 ILI/ARI cases reported.
37.327 new cases today
102.030 hospitalizations total
2.369 hospitalizations today
1.207 children
83 pregnant woman
404 deaths reported
Source: http://www.moz.gov.ua/ua/main/press/?docID=14199
Very close to people dropping in the streets.
Death stats likely under reported.
Commentary
Worldwide Transmission of D225G
Recombinomics Commentary 06:45
November 27, 2009
http://www.recombinomics.com/News/11270901/D225G_WWT.html
The recently released sequences from patients in Ukraine provided valuable insight into the pathogenicity of H1N1 and the genetic change associated with the total destruction of both lungs in fatal cases. The description of the patients and the spread of receptor binding domain change, D225G, to multiple genetic bakgrounds via recombination led to the prediction that D225G would be found in the lung samples from fatal cases. The release of the sequences by Mill Hill confirmed the prediction. Sequences from 10 isolates were released and all four fatal cases had D225G. Moreover, all 9 cases from western Ukraine, which were from three Oblasts (Ternipol, Lviv, and Khmelnitsy) were from the same sub-clade as the fatal cases, but the samples from the upper respiratory tract did not have D225G. The absence of D225G from the upper respiratory tract is not a surprise because the specificity of D225G included alpha 2,3 receptors which are present in the lungs. Thus, the sub-clade with D225G can expand and cause a cytokine storm which destroys the lungs. Moreover, sequences with D225G have been designated as low reactors by Mill Hill, raising concern that immune responses and vaccine will select for D225G.
Although D225G transmits from patient to patient, only the samples from the fatal cases, which were from lung and throat samples were positive for D225G. The sequences from Ukraine led other countries to more fully investigate samples. Norway, which had seen an increase in fatalities announced the detection of D225G in two fatal and one severe case. Although those sequences have not been released, 25 HA sequences were subsequently released and one sequence had D225G as a mixture, confirming the mixed nature of samples with D225G.
Moreover, the sequence with D225G was the same sub-clade as Ukraine, and several matching sub-clades were in subsequent samples, but those samples did not contain D225G, again pointing to a requirement for sampling of appropriate tissues.
The implication of this sub-clade in the increase in deaths in Norway was the finding that the first fatality was also linked to the same sub-clade. The patient, 43F, was in previously good health and given a prescription for Tamiflu after visiting the hospital. However, she was sent home and died two days later. This type of rapid death had been noted for many of the Ukraine cases. Full sequences were generated confirming that the NA sequence was closely related to the NA sequences from western Ukraine, but the sample was from the trachea and did not have the D225G. However, the association of this sub-clade with the first patients death and the finding of D225G in the first isolate matching this sub-clade support D225G transmission as a mixture, with detection in appropriate sampling of the lower respiratory tract.
Phylogenetic analysis of public sequences indicate that the Norway/Ukraine is widespread, strong suggesting that D225G has sread worldwide. However, detection of D225G, as was seen in Ukraine requires that the proper samples are tested.
The finding of D225G in four of four fatal cases in Ukraine leaves little doubt that the polymorphism is transmitting and the recent classification of Ukraine sequences wirg D225G suggests the spread will accelerate. The finding of the same change in unlinked patients in two Oblasts in western Ukraine is similar to the finding of swine H1N1 in two counties in southern California in April. The fact that the two California cases had no link to swine or each other, and were collected from patients over 100 miles apart conclusively demonstrated that the swine H1N1 was efficiently transmitted human-to-human and many more cases would be identified.
The data from Ukraine conclusively demonstrate that D225G is efficiently transmitting and the transmission traces back to earlier isolates from Norway of the same sub-clade with D225G.
Since D225G is frequently not detected in samples from the upper respiratory tract, another method of tracking is through phylogenetic analysis, which shows that the Norway/Ukraine sub-clade is widespread, even though all HA sequences do not have D225G, as was seen in Ukraine.
The worldwide transmission of the Norway/Ukraine sub-clade, or other sub-clades with D225G raises concerns that associate hospitalizations and fatalities will have a significant uptick as an increasing number of patients get exposed to this sub-clade linked to D225G.
More surveillance of low respiratory tract infections would be useful.
Ukraine
Knyazevich: There is no guarantee that tomorrow Ukrainian will not die because they do not have vaccination
27/Nov/09
Health Minister Vasily Knyazevich not exclude the possibility of failure of the vaccination campaign against influenza A/H1N1 in connection with mistrust of the population and discrediting of such preventive measures after the case of the death of student from Kramatorsk.
He said in an interview with Government courier.
“Such threats (failure of the vaccination campaign) are real. After the campaign we have problems even with mandatory vaccines, not to mention the voluntary, were not very popular among our citizens ... today all afraid outbreak of influenza, but no guarantee that Ukrainian tomorrow will not only die from infections that were exposed antyvaktsynalnykiv “- Kniazevych said.
Commenting on the situation of unplanned (optional) immunization against measles and rubella Knyazevich said that her top was still scheduled for autumn 2007. “... Health of Ukraine confirmed its readiness to host the 2007 campaign, additional immunization and consented to the importation and use of 9 million doses of vaccine (measles and rubella vaccine production of the Indian Institute of sera) without its registration as a humanitarian aid that meets current legislation, - he informed, adding that the quality of the vaccine by the WHO Prequalification guaranteed.
However, according to the minister, an order was signed in 2007. Instead, signed an order approving a plan additional immunization against measles and rubella in 2008.
Knyazevich once again assured that the death of a schoolboy Anton Tishchenko Kramatorska not associated with the vaccine or vaccination.
Head of the Ukrainian Ministry of Health also commented on the response of WHO and UNICEF for the decision on the impossibility of use in Ukraine in 2009, measles and rubella, given as humanitarian aid. In particular, he recalled that previously the Minister of Economy and Finance, Gordon Brown has put much effort to persuade international donors to provide funds Ukraine to campaign for additional immunization, while dozens of countries much poorer than the Ukrainian state, also expected the vaccine.
“I’m hard to say whether WHO will go toward Ukraine as it was before, and to provide free vaccine. While we stand in line for flu vaccine from California, as hundreds of other countries. To date only two countries (Russia and Canada ) provided us with materials for early registration of influenza vaccines, “- said Knyazevich.
According to the minister, an additional vaccination against measles and rubella in 2009 will, according to predictions of epidemiologists, can lead to outbreaks of measles and rubella in 2010-2011.
As reported, the Cabinet of Ministers of Ukraine approved a plan to target the population against influenza for the 2009-2010 and created a coordinating council to reform the health system.
Experts from the World Health Organization investigation found no causal connection between the death of a schoolboy with his Kramatorska vaccination.
http://ua.korrespondent.net/tech/1021919
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