The Discovery of the 2009 A/H1N1 Pandemic - Mexico: April 17 New Respiratory Illnesses - Including Mexico City & Oaxaca

[Laidback Al]

Re: Mexico: Respiratory Illnesses - Including Mexico City & Oaxaca

And one more.

http://www.eluniversal.com.mx/nacion/167414.html

The Ministry of Health issued a national alert, the infuenza recorded 20 deaths in the first three weeks of April, which is considered atypical or unusual.
. . .

En constraste, en seis meses, de octubre del 2008 a marzo de 2009, fallecieron sólo 30 personas por influenza, según cifras de la dependencia. By contrast, in six months, from October 2008 to March 2009, only 30 people died from influenza, according to the agency. . .

From the above post-
<o:p> </o:p>
Average number of deaths per week October 2008 to March 2009: 1+
<o:p> </o:p>
Average number of deaths per week since April 1, 2009: 6+

Keep in mind that the mention of SARS here is a mistranslation of atypical pneumonia.

http://www.exonline.com.mx/diario/noticia/primera/pulsonacional/influenza_atipica_mata_a_10_en_un_dia/578187

Atypical influenza kills 10 in one day

. . . .Yesterday, only in the Instituto Mexicano del Seguro Social (IMSS) ten people died from SARS presumably caused by seasonal influenza virus, and six deaths were recorded in the Federal District.

If 10 people died in Mexico yestersday (6 in the Federal District), the death rate is increasing. Futher immediate official clarification of the number of deaths, number infections, locations of infections, and results of testing are critical.

[jasonfoster]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

#132:
"influenza-like symptoms that rapidly progressed to severe respiratory distress in about 5 days, with many requiring mechanical ventilation"


The researchers knows better, but seems to me that ordinary seasonal flu could not do that.

This is more like to the China/Russia/... recent strange outbreaks.

The ressembling of SARS or BF "one week to mechanical ventilation" shape seems to point to an serious agent.

I have no doubt this is not seasonal flu.

What I was getting at is that as far as I know, most seasonal flu is not sensitive to Tamiflu. H5N1 has more resistance at this time. Some initial tests suggest influenza A involvement but it hasn't been typed yet indicating that it is a novel strain (if flu). If the strain has come from H1N1 seasonal flu, wouldn't you have thought that it would be Tamiflu resistant? That was the reason for the question.

If it is not resistant to Tamiflu, it "might" have evolved from H5N1.

[HenryN]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

I have no doubt this is not seasonal flu.

What I was getting at is that as far as I know, most seasonal flu is not sensitive to Tamiflu. H5N1 has more resistance at this time. Some initial tests suggest influenza A involvement but it hasn't been typed yet indicating that it is a novel strain (if flu). If the strain has come from H1N1 seasonal flu, wouldn't you have thought that it would be Tamiflu resistant? That was the reason for the question.

If it is not resistant to Tamiflu, it "might" have evolved from H5N1.

The swine flu H1N1 in southern California is Tamiflu sensitive.

[Shiloh]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

Source: http://www.elmanana.com.mx/notas.asp?id=117125

Reportan 500 casos en la Ciudad de M&#233;xico
Jueves, 23 de Abril de 2009
El contagio de trabajadores ha afectado ya a empleados de los principales hospitales p&#250;blicos de la Capital , tales como el Hospital Ju&#225;rez, el Hospital General, el Instituto Nacional de Enfermedades Respiratorias, y los hospitales de la zona de Tlalpan

Google translation:

500 cases reported in Mexico City
Thursday, April 23, 2009
The contagion has affected workers and employees of major public hospitals in the Capital, such as the Juarez Hospital, General Hospital, National Institute of Respiratory Diseases, and hospitals in the area of Tlalpan

MEXICO CITY .- At least 500 employees of the Health sector in Mexico City are infected with influenza virus, reported Antonio Sanchez Arriaga, general secretary of the National Independent Union of Health Workers.

The contagion has affected workers and employees of major public hospitals in the Capital, such as the Juarez Hospital, General Hospital, National Institute of Respiratory Diseases, and hospitals in the area of Tlalpan, where the National Institute Cardiology, the National Nutrition Institute and the Hospital Manuel Gea Gonz&#225;lez, in addition to the Red Cross Polanco.

The union leader warned that the number of infections could triple this week not to take necessary health measures

"Last Friday we learned of the infection and ask our representatives in the various hospitals who send us reports of patients, and found that the focus of infection and reached 500 partners," said Sanchez Arriaga.

The leader of the guild said that the authorities are overcome by the presence of influenza in hospitals and only palliative measures have been implemented to try to prevent further infections.

"Right now we are being vaccinated and are taking a week leave to employees who are sick, but this is already an epidemic, and again we believe that if this continues this week we could have more than 1,500 infected," he said.

Sanchez Arriaga explained that it is essential to vaccinate personnel working in the areas of neonatology, pediatrics, gynecology and pulmonology, and who have the most potential for spreading infection in high risk populations.

(Imelda Garcia / Agency Reform)

[Laidback Al]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

This comment needs to be emphasized; its implications are overwhelming.

Right now we are being vaccinated and are taking a week leave to employees who are sick, but this is already an epidemic, and again we believe that if this continues this week we could have more than 1,500 (mil 500 contagiados) infected," he said.

[Shiloh]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

Source:http://www.diariodespertar.com.mx/Ag...ipe-aviar.html

Oaxaca, sin gripe aviar
23/04/2009 04:00:00 Luis Ram?rez / Staff DESPERTAR

Google translation:
Oaxaca, not bird flu
23/04/2009 04:00:00 Luis Ramirez / Staff WAKE
Take the Health Services Oaxaca preventive measures, said Martin Vasquez Villanueva. Decontaminate the area of Civil Emergency Hospital, there is no epidemic, say

The National Center of Epidemiological Surveillance and Disease Control confirmed that in Oaxaca there has been no epidemic or outbreak of Avian and explained that in Mexico there are no recorded cases of this disease.
The agency acknowledged that in March and April 2009 has been observed in the country increased the number of cases of seasonal influenza, which is unusual since, in previous years, the peak of disease has been presented in December.
Reported that, according to the laboratory, the virus circulating in Mexico is not avian influenza, is an endemic virus that causes outbreaks every year. In addition, there have been some outbreaks of rapidly evolving severe pneumonia in adults of reproductive age.
In this situation, the National Epidemiological Surveillance reported that the National Health System launched an operation in the country intensified epidemiological surveillance.
He noted that respiratory infection, influenza virus, affects the entire world population with seasonal outbreaks. This is generally a mild infection, however, can cause serious complications in susceptible individuals (persons with respiratory diseases or with previous chronic illnesses and seniors).

The case
Last Thursday was admitted to Civil Hospital "Dr. Aurelio Valdivieso "in this capital, Mar?a Adela Guti?rrez Cruz with symptoms of cough, fever, color, headaches and breathing problems, which are characteristic of pneumonia, but with the difference that day that was treated with medication including antibiotics, never had a favorable response, "which is not the case with pneumonia," until finally, three days ago, died.
In this case of atypical pneumonia and died Mrs Maria Adela Guti?rrez Cruz, aged 39, reported the results of laboratory diagnosis were negative for avian influenza.
For its part, the National Institute of Epidemiological Diagnosis and Reference (Indre) revealed that, according to the results obtained in the Laboratory of Respiratory Viruses, samples sent by the State Laboratory of Public Health in Oaxaca were negative for influenza A and B, Parainfluenza types 1,2 and 3, respiratory syncytial virus, adenovirus, influenza types A and B, and Metapneovirus coronavirus.


Negative results
"According to the diagnostic algorithm was established by a panel viral immunofluorescence, and molecular testing for some respiratory viruses. The results obtained so far are described as negative, "said Indre.
Meanwhile, the head of the Health Services in Oaxaca, Mart?n V?squez Villanueva, reiterated that what happened in the Civil Hospital "Dr. Aurelio Valdivieso" is not a case of Avian Influenza, warned that so far no evidence epidemiological support that may be concerned that the suffering of this evil from Asia.
Therefore, he said, the Health Services of the state of Oaxaca (SSO) are conducting a decontamination throughout the area of emergency medical service, but was assured that the initial state epidemiologists did not want to pay due attention to case.

Various diseases
Vasquez Villanueva reported that until the 15th epidemiological week have been reported in the state a total of 75 outbreaks in six health jurisdictions.
Explained that type of diagnosis, outbreaks are more frequent acute diarrheal disease with 21 cases, chickenpox, 18 cases, viral hepatitis type A, 14 cases; probable enterovirus infection (hand-foot-bit), and 7 cases of dengue fever 8 cases.
The official explained that the outbreaks are spread over 45 municipalities, 24 of the Valleys, 7 of the Isthmus, 3 Tuxtepec, 2 Coast, 5 and 4 of the Mixteca de la Sierra. The cases relate to the Health Services of Oaxaca, ISSSTE and IMSS-Oportunidades.

Under surveillance
Therefore, the National Epidemiological Surveillance Committee met in special session on Thursday April 16 to define a tactical plan and intensify epidemiological surveillance.
It instructed all units of the epidemiological surveillance of the country to implement the following operational plan:
Supervising person of any age who had fever, cough and headache accompanied by rhinorrhea, coryza, arthralgia, myalgia, prostration, odynophagia, chest pain, abdominal pain, nasal congestion, because they could be infected with influenza.
They will also have to define the acute respiratory distress syndrome from pneumonia; everyone present feeling of difficulty breathing, accompanied by fever, cough, chest pain and polipnea (rapid breathing).
In cases in which a death from acute respiratory distress syndrome due to pneumonia, which will notify all cause death is acute respiratory distress syndrome from pneumonia.

[terrafirma]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

Re: posting # 139.. what city had acting city Crown Attorney Guy D. Simard been to? We have not be given that information, but wondering if that is how the Canadian Gov't became aware of the problem..

[Shiloh]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

Source: http://www.theglobeandmail.com/servl.../National/home


Canadians returning from Mexico warned of illness
CAROLINE ALPHONSO

Globe and Mail Update

April 23, 2009 at 12:40 PM EDT

Canadians who have returned from Mexico within the past week should be on alert for flu-like symptoms connected to a severe respiratory illness than has killed 20 Mexicans, health officials say.

Allison McGeer, an infectious-diseases expert at Toronto's Mount Sinai Hospital, said that Canadians who have been back for two weeks need not worry. Those back for about four days and are feeling sick enough to go to the hospital should let doctors know they were in Mexico. "If you've got a cold, you don't need to worry about it. It's just a cold," Dr. McGeer said.

The Public Health Agency of Canada contacted health agencies across the country to put them on alert for possible infections. The respiratory illness in Mexico resulted in 20 deaths in the first three weeks of April, and has hospitalized many others.

Dr. McGeer said the affected regions appear to be Mexico City and San Luis Potos?. The cause of the illness has not been confirmed. Dr. McGeer said the cases could be seasonal influenza.

"Pneumonia and influenza are the third most common cause of death, and 60,000 Canadians die every year. So we're talking about 20 deaths in the last three weeks in Mexico, which has considerably more people than Canada," Dr. McGeer said. "This is not to say that when you hear this you don't get panicky and worried." But she cautions that there is no reason to be worry.

Before the 2003 SARS outbreak, Mexico, like other countries, would have investigated the incident, but not alerted other countries. Lessons have since been learned. Dr. McGeer said health officials are constantly on alert for the next pandemic.

"One of these alerts is going to be the beginning of the next pandemic. Does this sound like that's what it is? Probably not. Can I guarantee that? Well, no," she said. "Something's going on, and until we sort out what it is, all of us need to be watching for it and trying to figure it out."

There's no reason for Canadians to change their plans to travel to Mexico, Dr. McGeer said.

[Cygnet]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

This comment needs to be emphasized; its implications are overwhelming.

In regards to the estimated 500,000 infections, that may be a mistranslation. I'm not sure if it's saying 500,000 or more than a thousand 1000 (mas de mil) plus the original 500, in the context of the article. 1000 plus 500 would be triple the infections, also, which is referenced earlier in the same article.

My Spanish is very rusty. Maybe someone else could check that? There's a HUGE difference there.

[Laidback Al]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

In regards to the estimated 500,000 infections, that may be a mistranslation. I'm not sure if it's saying 500,000 or more than a thousand 1000 (mas de mil) plus the original 500, in the context of the article. 1000 plus 500 would be triple the infections, also, which is referenced earlier in the same article.

My Spanish is very rusty. Maybe someone else could check that? There's a HUGE difference there.

Thanks. I just copied the English translation from the post. I corrected my post. It should be 1,500, still a threefold estimate.

[sharon sanders]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

"Ahorita nos est&#225;n vacunando y est&#225;n dando permisos de una semana a los empleados que est&#225;n enfermos; pero esto ya se volvi&#243; una epidemia y creemos que si esto sigue esta semana podr&#237;amos tener a m&#225;s de mil 500 contagiados", manifest&#243;.

My translation - and I am rusty too - is:

Now we are vaccinating and they are giving permission for a week leave to workers that are sick: but if an epidemic is returning, we think that the following week we will have more than one thousand five hundred contagious.

[Laidback Al]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

500,000 = quinientos mil

[Giuseppe]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

Canada, Mexico: Severe Respiratory Illness (SRI) Advisory Date: April 21, 2009.

Severe Respiratory Illness (SRI) Advisory Date: April 21, 2009

[Full PDF Document at this LINK. EDITED.]


From the office of the Medical Officer of Health


SRI Context:


The Public Health Agency of Canada (PHAC) has advised us of two recent situations of severe respiratory illness that remind us of the need for ongoing SRI surveillance and response. The first is in south and central Mexico where clusters of severe respiratory illness are occurring, with a high case fatality rate.


Individuals primarily affected are healthy young adults 25-44 years of age, including some HCWs.

Some cases have tested positive for influenza A and B.

The second situation involves the detection of two unrelated cases of swine influenza A (H1N1) in children in California ? the cases have recovered and did not require hospitalization. Human cases of avian H5N1 influenza continue to occur in Egypt, China and Vietnam (25 to date in 2009).

We are being asked by PHAC and Alberta Health & Wellness to continue to carry out surveillance for SRI as outlined below.


Phase Level: No Change
Pandemic Phase 3, SRI Phase 0

SRI Case Definition:
? Respiratory symptoms including history of fever >38?C and new onset of cough or breathing difficulty, with severe illness progression (pneumonia, acute respiratory distress syndrome (ARDS), encephalitis or other severe and life-threatening complications) and no alternate diagnosis within the first 72 hours of hospitalization;
AND
? A positive response to one of the following questions:
o ?Did you travel outside of Canada in the past 10 days?? OR
o ?Do you live with or were you in close contact with someone who has a similar illness and who traveled outside of Canada in the 10 days before he/she became sick??


Reporting Requirements: No Change
Emergency Departments, acute care facilities, urgent care centres ? Please report all suspect SRI cases to the Medical Officer of Health on Call at (403)264-5615 for further investigation and management.


Laboratory Rule-Out/Rule-In Tests: No Change
Notify receiving laboratory and arrange urgent transport of specimens, marking them as high priority with positive travel history. Copy all results to the Medical Officer of Health by fax (403)955-6755.
? NP Swab (Aspirate): Order Respiratory Virus Panel (DFA, NAT) on ProvLab requisition. Send in M5 Viral Transport medium (pink) that is stored at room temperature.
? Blood: Order Aerobic/Anaerobic Culture on CLS requisition. Order Mycoplasma IgM (collected in SST tube) on ProvLab requisition.
? Sputum: Order Gram Stain, Aerobic Culture on CLS requisition; order AFB (if indicated), Legionella on ProvLab requisition.
? BAL (if clinically indicated): Order Gram stain, micro C&S on CLS requisition; order AFB (if indicated), Legionella culture, Respiratory Virus Panel (DFA, NAT), CMV and HSV culture on ProvLab requisition.


Infection Control Recommendations: No Change
EMS Setting: Droplet and Contact Precautions
Acute Care Facility Setting: Droplet and Contact Precautions
For patients presenting with fever and cough:
? Advise to: cover mouth and nose when coughing or sneezing; do frequent hand hygiene; stay 1 metre distant from others in waiting room (or isolate in private room); wear surgical/procedure mask if isolation not possible
For patients with fever/cough and more severe respiratory symptoms (e.g., shortness of breath), ask about:
? travel outside Canada within the last 10 days, or
? contact within last 10 days with a person with a similar illness who had traveled outside of Canada in the 10 days before they became ill.
If Yes to either question:
? Isolate immediately - negative pressure isolation is not required. If unable to isolate immediately, ask patient to wear a procedure/surgical mask and to minimize contact with others by staying 1 metre (3 feet) away from them.
? In addition to standard practice, staff in direct contact with the patient should don appropriate Personal Protective Equipment (PPE) for organisms spread by droplet and contact:
? Gloves, gowns, mask. [Procedure/surgical masks are considered adequate for routine care. N95 respirators should be used by staff for aerosol-producing procedures (e.g., intubation, bronchoscopy)].
? Hand hygiene must be done before and after use of gloves.
? Eye protection should be worn as standard practice to prevent exposure to respiratory droplets.


Additional References:
? Public Health Agency of Canada Travel Advisories: http://www.phac-aspc.gc.ca/tmp-pmv/pub-eng.php
? Nasopharyngeal Swab Collection: (videos on how to collect these specimens are available at http://www.provlab.ab.ca/education.htm). Information sheet is at http://www.calgaryhealthregion.ca/mo...s_version2.pdf
-
-----

[Cygnet]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

"Ahorita nos est&#225;n vacunando y est&#225;n dando permisos de una semana a los empleados que est&#225;n enfermos; pero esto ya se volvi&#243; una epidemia y creemos que si esto sigue esta semana podr&#237;amos tener a m&#225;s de mil 500 contagiados", manifest&#243;.

My translation - and I am rusty too - is:

Now we are vaccinating and they are giving permission for a week leave to health care workers that are sick: but if an epidemic is returning, we think that the following week we will have more than one thousand five hundred contagious.

Thanks, Florida. I wasn't sure on that. I was trying for optimism ... I have a pretty good Spanish vocabulary, but the word order sometimes gives me fits!

Meh. We'll know in a week or so, yes?

-- Leva

[Shiloh]

Re: Mexico: Respiratory Illnesses - Including Mexico City &amp; Oaxaca

Source: http://www.google.com/hostednews/can...e6_7gtuplU31Fw

Doctors warned to look out for illness in tourists returning from Mexico

38 minutes ago

TORONTO ? Public health units and medical officials across the country have been warned to be on the lookout for illness in Canadians returning from Mexico.

The warning follows reports from the country of cases of severe respiratory illness, which in some cases has led to death. A spokesperson for the Public Health Agency of Canada says Canadian authorities are aware of the reports and are looking into them.

And the Pan American Health Organization - the World Health Organization's Americas branch - is also working with Mexican authorities to look into the reports.

The illnesses are said to have been occurring in south and central Mexico.

A warning to health officials says the cases, which have largely involved young, previously healthy adults, start as flu-like illness and rapidly progress to respiratory distress.