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