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  • Ecdc Weekly Influenza News, Excerpts

    ECDC INFLUENZA NEWS - EXCERPTS
    [In this post: (1) European Centre of Diseases Prevention and Control (ECDC), Influenza News, Excerpts. See original texts at the source site. EDITED.]

    Contents:
    -- Antibodies derived from the B cells of 1918 influenza pandemic survivors may help reduce the impact of future pandemic strains.

    -- Spanish flu in Denmark – a historic case study


    -- ECDC presentational tool to help visualise actions to achieve National Pandemic Preparedness

    -- Oseltamivir Resistant Influenza Viruses - Technical advisory consultation by ECDC and WHO Regional Office for Europe – Portugal

    -- International workshop on ethical issues in European national preparedness for pandemic influenza: from principles to policy coherence. Paris, 20-21st November 2008

    -- International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.

    ----------
    -

    (1) [PANDEMIC PREPAREDNESS, ECDC, UPDATES, RESEARCH] EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL (ECDC), INFLUENZA NEWS, EXCERPTS

    * SCIENTIFIC ADVANCES – PANDEMIC INFLUENZA - IMMUNOLOGY

    -- Antibodies derived from the B cells of 1918 influenza pandemic survivors may help reduce the impact of future pandemic strains.

    Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors. Yu X. et al - Nature, doi: 10.1038/nature07231

    Description:
    The researchers in this studyobtained blood from 32 volunteer subjects in the US who had been alive in 1918 at the time of the Spanish influenza pandemic.(1)

    They were aged between 2 and 12 years at the time of the pandemic but a number of them could still recall family members having being ill during the pandemic. When the subjects sera were tested against antigens derived from recently recovered gene sequences of the 1918 virus(2) all showed serum neutralising activity- that is nearly 90 years after the pandemic. Peripheral blood mononuclear cells were isolated from eight of the subjects. Several of these samples had circulating B cells that secreted antibodies that bound the 1918 HA.

    Antibody producing B cells were isolated from the peripheral blood of seven of the individuals and these were used to produce monoclonal antibodies which in turn were able to protect naive mice against infection from the reconstructed 1918 flu virus.

    In summary the study has shown that, nine decades on, survivors of the pandemic retain the ability to produce effective, virus neutralizing antibodies to the uniquely virulent Spanish Influenza virus. There is some speculation at the end of the paper about the isolated memory cells being used to produce therapeutic antibodies for use in a pandemic very close to the Spanish flu virus.

    ECDC Comment (18/09/08):
    This study provides laboratory evidence of how people that have recovered from infection with a specific pandemic strain of influenza can retain protection for decades in the future. This has previously been inferred from epidemiologic observations where it has been seen how older people are spared in a pandemic when they have been infected by a pandemic of the same strain many decades previously.

    For example this happened with the H2N2 pandemic in 1957 when older people infected in the H2 pandemic of 1889-90 were relatively spared.

    This effect occurs through B memory cells. The feasibility of the suggestion for therapeutic antibodies is theoretically attractive but the practicalities would be daunting on any scale.

    1. Taubenberger JK, Morens DM. 1918 influenza: the mother of all pandemics. Emerg Infect Dis [serial on the Internet]. 2006 Jan [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm
    2. Taubenburger et al Nature (October 6th) 2005 437: 887-893 doi:10.1038/nature04320

    Comment to influenza@ecdc.europa.eu

    * SCIENTIFIC ADVANCES –PANDEMIC INFLUENZA - EPIDEMIOLOGY

    -- Spanish flu in Denmark – a historic case study

    The Spanish flu in Denmark - Kolte I.V. et al - Scandinavian Journal of Infectious Diseases, 2008, 40: 538-546

    Description:
    This article describes the specific effects of Spanish flu pandemic in Denmark in the period of 1917-1921. Using Danish historic records of both mortality and morbidity the authors show that the pandemic didn’t hit affect all areas of even this small European country at the same time. The early wave was more pronounced in more easily accessible towns and less in remote areas. At the population level authors didn’t find evidence that infection during the first wave gave full or partial immunity to the second wave. This is counter to some but not all previous studies of the USA. Although the first wave characterized with lower crude incidence rate that the second, the first one had a was deadlier. The study showed a sharply elevated influenza incidence in children aged between 1-15 years, but not similarly elevated influenza mortality, which is contrary to some other studies, what suggest that both the cause specific and the total mortality must be examined.

    ECDC Comment (18/09/08):
    The papers adds to the body of literature that records the behaviour of this most dangerous pandemic.(1) The paper is notable because of the relatively high quality datasets that were available to the researchers. However all such retrospective analysis must be viewed critically given the lack of confirmatory diagnosis, and possible inconsistency and anomalies in data reporting, including in this case between regions in Denmark.

    The conclusions suggest that in 1918, being infected in first wave of epidemic did not offer much protective immunity to the second wave. This is consistent with other observations which have suggested that the pandemic virus became more rather than less virulent in its first year. (2)

    This is of importance as it reminds us of how unpredictable pandemics are and how the three pandemics of the 20th Century different.(3)

    However there remains difficulties in extrapolating conclusions to future pandemic events given that protective immunity between pandemic waves will be highly dependant on the host/virus dynamics, including level of immune response from the first infection, the extent of virus divergence and levels of cross protection conferred between the viruses in the first wave and subsequent waves.

    The level of cross protection is important however, because there is the expectation that a pandemic-specific vaccine derived form an initial circulating pandemic strain, when administered, will then confer lasting protection from subsequent pandemic waves.

    The work here is perhaps suggestive that this may not necessarily be the case, particularly if the is a significant divergence in strain between pandemic waves.

    The demonstration of variable incidence levels, and timing of infection, and the correlation between incidence and accessibility is perhaps not surprising given that more isolated communities will receive less seeding of virus, and hence are less likely to be affected. It is debatable how relevant such data is given the changes in society, and particularly the increased interconnectivity between urban and rural populations though contemporary modelling analyses emphasise that the pandemic waves will not have uniform manifestation across countries with local peaks that will be steeper and higher than what is experienced on average across countries. An area that is appreciated to be controversial is whether or not the Spanish Flu has a ‘W’ shaped age-mortality. That is with three peaks in the youngest (under age one year), middle-aged and elderly age-groups.

    The complication is that there were and are ‘natural’ peaks in infants and elderly and unless these are allowed for by modelling it should not be presumed that these observed peaks are attributable to the pandemic.(3) However it remains certain that the peak mortality seen here for the 20-34 years old was due to the pandemic.(1)

    1. Kolte IV, Skinhoj P, Keiding N, Lynge E. Scandinavian Journal of Infectious Diseases, 2008, 40: 538-546
    2. Taubenberger JK, Morens DM. 1918 influenza: the mother of all pandemics. Emerg Infect Dis [serial on the Internet]. 2006 Jan [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm
    3. Andreasen V, Viboud C, Simonsen L. Epidemiologic characteization of the 1918 influenza pandemic summer wave in Copenhagen: implications for pandemic control strategies. JID 2008; 197: 290-8.

    Comment to influenza@ecdc.europa.eu

    * P.H. DEVELOPMENTS –PANDEMIC INFLUENZA-PREPAREDNESS

    -- ECDC presentational tool to help visualise actions to achieve National Pandemic Preparedness

    At recent meetings, the Eurogrippe workshop in Angers, France and the ESWI conference in Vilamoura, ECDC representatives have shown a simple presentational tool to visualise the multi-dimensional aspects needed to ensure adequate preparedness for a pandemic. It was also used on a Joint Pandemic Preparedness Self Assessment visit of the Turkish Republic, September 8th-11th 2008.

    This tool highlights aspects that national authorities need to consider in order to move towards full preparedness across in three crucial dimensions:

    * from plans through practise (exercises) to preparedness
    * from national level along through regions to local and front line staff
    * from involving the health sector alone to being multisectoral.

    The tool can be used to qualitatively describe the current state of preparedness and also to identify areas where further work is needed. An important limitation is that the presentation does take into account interoperability, the extent to which features of preparedness are coordinated (or not) between countries or between regions in a country. A power point presentation with this tool can be found via the link below.

    See: http://ecdc.europa.eu/en/Health_Topi...ment_tool.aspx.

    Comment to influenza@ecdc.europa.eu

    * P.H. DEVELOPMENTS – SEASONAL INFLUENZA-ANTIVIRAL RESISTANCE

    -- Oseltamivir Resistant Influenza Viruses - Technical advisory consultation by ECDC and WHO Regional Office for Europe – Portugal

    On September 13th ECDC and the WHO Regional Office for Europe convened a global technical consultation to review data, findings and the public health implications of the recent emergence of influenza A(H1N1) viruses resistant to oseltamivir.

    Unusually high prevalence of high-level oseltamivir resistant influenza A(H1N1) virus has recently emerged. These were first detected in European countries by the EU VIRGIL Project Influenza Laboratories, the WHO Collaborating Centre in London and the European WHO National Influenza Centres, which are part of the Community Network of Reference Laboratories for Human Influenza in Europe working together in the European Influenza Surveillance Scheme (EISS) which since the start of this month is part of ECDC.

    Subsequently the viruses have been found in many countries across the rest of the world through the Global Influenza Surveillance Network.

    On September 13th ECDC and the WHO Regional Office for Europe convened a global consultation of specialists to review the situation and discuss the public health implications of the phenomenon. The meeting was attended by six European countries that have performed detailed investigation of these viruses and their clinical impact (France, Germany, Luxembourg, the Netherlands, Norway and the UK), staff from WHO’s Global Influenza Programme, the EU EISS and ViRGil projects, as well as the heads of the four WHO Collaborating Centres for Reference and Research on Influenza in Australia, Japan, the UK and the USA.

    The meeting reviewed the data and scientific findings gathered during the 2007-2008 influenza season in the Northern Hemisphere and new data from the Southern Hemisphere 2008 season. The specialists addressed what is known so far on the virological, epidemiologic, and clinical features of infections caused by these viruses, their genetic and biologic properties and the options for prevention and treatment.

    There was discussion and agreement on the public health questions needing to be addressed, which will shape the future research agenda, and a meeting is planned to develop protocols to improve clinical data collection on infections caused by these as well as other novel viruses.

    A record of the meeting will now be prepared and published in a form widely accessible to the medical community. Information on these new viruses will continue to be published on the relevant section of the ECDC website and on the EISS and WHO websites.

    Comment to influenza@ecdc.europa.eu

    * Meetings and workshops

    -- International workshop on ethical issues in European national preparedness for pandemic influenza: from principles to policy coherence. Paris, 20-21st November 2008.

    The conference, organized by Espace éthique of the AP-HP (Parisian Public Hospital Group) and the Department of Research in Ethics of University Paris-Sud, aims to contribute to the dialogue around the ethical issues in pandemic planning, including highlighting the convergences and divergences of varying ethical approaches.

    The meeting is being held within the framework of the French presidency of the European Union, and includes WHO as a partner.

    Conference information can be found at: http://www.espace-ethique.org/fr/pan...ember_2008.php

    -- International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.

    This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007).

    The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.

    The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.

    A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting.

    Its last report is available at http://www.undg.org/docs/8097/12-18-...port-final.doc

    A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
    <cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_080918.aspx">http://ecdc.europa.eu/en/Health_Topi...za_080918.aspx</cite>

  • #2
    Re: Ecdc Weekly Influenza News, Excerpts

    1889 was H2 ?

    > Serologic and epidemiologic data
    >suggest that the 1889 pandemic virus was of an H3 subtype (conceivably
    >with an N8 gene), and that the 1847 pandemic virus could have
    >been of either the H1 subtype, neuramindase (NA [N1]) subtype,
    > or both.

    Taubenberger,Fauci,Morens
    http://www.flutrackers.com/forum/showpost.php?p=79766
    I'm interested in expert panflu damage estimates
    my current links: [url]http://bit.ly/hFI7H[/url] ILI-charts: [url]http://bit.ly/CcRgT[/url]

    Comment


    • #3
      Re: Ecdc Weekly Influenza News, Excerpts

      I has the same idea : H3 and perhaps N8 in 1889.
      I m waiting since one year for a paper of taubenberger about it.

      Comment

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