A(H1N1) fears hit Wimbledon

[FrenchieGirl]

A (H1N1) fears hit Wimbledon, drug resistance reported

Agence France-Presse | 06/30/2009 1:51 AM

LONDON - Swine flu fears hit the Wimbledon tennis tournament Monday as global cases topped 70,000 and Denmark reported the first case of resistance to the key Tamiflu drug used to treat the virus.

With the death toll from the pandemic at 311 and total cases at 70,893, according to the WHO, more countries reported their first A(H1N1) infections and Indonesia planned to ask some people arriving there to wear masks.

Australian researchers said a vaccine could be ready in months. However, later Monday there was a report that a Danish patient showed resistance to Tamiflu, which has been considered an effective anti-viral treatment for the disease by the World Health Organisation.

The Danish woman is no longer suffering from the illness and is not displaying symptoms, the Danish Institute of Serology said in a statement.

After showing resistance to Tamiflu, the patient was given another type of medication, Relenza, made by British pharmaceutical giant GlaxoSmithKline.

Nils Strandberg, the institute's director, said he was satisfied with methods used to monitor swine flu, adding that "the spontaneous mutation of a flu virus is not unusual."

The worries at Wimbledon came with play intensifying as the tournament entered its second week. Organisers said some staff members have reported "flu-like" symptoms but the competition would continue as normal.

Ian Ritchie, the chief executive of the All England Lawn Tennis and Croquet Club, which runs the annual grand slam in southwest London, sent a message to staff to inform them.

Club sources told AFP a handful of ball boys and girls were affected but nobody had been confirmed as having contracted the virus.

Venus Williams, the defending Wimbledon ladies' singles champion, said she was not worried.

"I just got a letter. I haven't read it. But I guess there's sicknesses all around. Hopefully the players won't get sick," the US tennis champ said.

Nearly 6,000 swine flu cases have been diagnosed in Britain, the Department of Health reported, and a hospital said Monday a nine-year-old girl had become the third person with the virus to die.

The girl had underlying health problems and it was unclear whether swine flu had contributed to her death, Birmingham Children's Hospital said.

Elsewhere, the virus first discovered in late March continued its spread.

According to the WHO figures released Monday, the United States showed the largest increase in cases, bringing the total to 27,717, including 127 deaths -- but that count may be massively low.

US health authorities said Friday that at least one million people in the United States have had swine flu.

The US Centers for Disease Control and Prevention (CDC) arrived at its figure based on computer models and surveys of communities known to have been hard hit by the flu strain.

Australian researchers said Monday a vaccine could be ready in months as the country, the worst-hit in Asia-Pacific, reported two more deaths linked to the virus, taking the total to six.

University of Queensland scientists said they had produced the country's first batch of a vaccine developed in the United States.

Researcher Anton Middelberg said the company behind the FluBlok vaccine -- Connecticut-based Protein Sciences Corporation -- planned to run clinical human trials in the United States, Mexico and Australia.

"It all depends on the regulatory process but I'd say we are months away from a swine flu vaccine," Middelberg said.

Highlighting the virus's spread, Nepal, the Indian Ocean island of Mauritius and Kenya all reported their first cases Monday.

In Indonesia, the health minister said the government planned to ask all those arriving from swine flu-affected countries to wear masks for at least three days.

The presence of the virus was confirmed in Indonesia only last week and so far four of the eight known cases have been foreigners.

Health Minister Siti Fadilah Supari said the government had no intention of enforcing the precaution, which could damage the country's stuttering tourism industry.

"You can't expect people to wear masks when they're swimming," Supari said.

 

[Chuck]

Predicting swine flu deaths

Predicting swine flu deaths

http://www.nhs.uk/news/2009/07July/Pages/Predictingswineflumortality.aspx

Predicting swine flu deaths

Better data is needed to predict the number of swine flu deaths, the BBC has reported. It said that scientists have called for improved data to map the spread of swine flu and to make accurate estimates of the number of people likely to die from the virus.

Key points

The researchers say that current estimates of the projected number of deaths may be innaccurate for several reasons:

* Death rates are overestimated because only the most severe cases are counted, while mild cases do not appear because they do not present to medical care.
* Death rates are underestimated because deaths are attributed to other causes besides swine flu, or because of the delay between symptom onset and death.

The researchers suggest several ways to minimise these biases:

* If information on hospitalisation rates from cases confirmed early in the epidemic is combined with sampling of hospitalised cases later in the epidemic, this can indicate fatality rates among severe cases.
* Adjusting total cases of H1N1 for time delay between symptoms and death/recovery can minimise the underestimation of the fatality rate.
* Studies involving sampling of selected population groups and H1N1 screening are important to gain accurate numbers of those with asymptomatic or mild infection.


Where was the article published?

This research was carried out by Dr Tini Garske and colleagues from the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London. The study was published in the British Medical Journal, and supported by the Medical Research Council.


What does the research say?

This article discusses the methods used to estimate the proportion of deaths caused by infection from the pandemic (H1N1) 2009 virus, known as the case-fatality ratio. The authors say that early data suggests that the new virus appears to be fairly mild, and the case-fatality ratio is similar to seasonal flu (around 0.5%). However, they say that this ratio seems to vary considerably between countries and, notably, a younger population appears to be affected compared with seasonal flu.

The authors say that the current method of calculating the case-fatality ratio could result in inaccurate estimates. They say that this standard calculation - dividing the number of deaths by the total number of cases ? could be inaccurate for a number of reasons:

* The fatality rate is overestimated because people with milder symptoms or no symptoms are not visiting their doctor. Therefore only the most severe cases are reported and taken into account, i.e. there are more actual cases than those confirmed, so the ratio of deaths to cases is less than estimated. (They cite Mexico as a possible example where fatality rates have been overestimated due to an underestimation of the total number of people being infected).
* The present calculation does not take into account the time delay between infection and death, i.e. cases alive at the time of assessment may go on to die, making the death rate higher than estimated.
* That the number of deaths attributable to swine flu are being underestimated because the person has died from an apparently unrelated cause, e.g. cardiovascular death, when in fact this complication may have been precipitated by swine flu.


What do the researchers suggest?

A new way of calculating the case-fatality ratio. They suggest that data from the first few hundred cases confirmed in the UK (when cases were more closely followed) can be used to estimate the early hospitalisation ratio. This can be combined with an estimate of the case-fatality ratio in selected cases that were admitted later during the epidemic.

The researchers point out that it is important to obtain data on the reasons for hospital admission in order to gain an accurate measure of disease severity. Large-scale testing for the virus on a selected population group would also give a better indication of the number of people with clinical symptoms who are actually infected with the virus. They say that such studies need to be set up alongside household studies to assess the extent of asymptomatic infection, so that changing patterns of virulence are detected rapidly.

To counter the bias introduced by the time delay between onset of symptoms and death, the researchers propose either dividing the number of deaths by the total number of cases for whom the outcome was known (both deaths and recoveries), or, more reliably, by adjusting the total number of cases for the delay from symptom onset to death (using information taken from existing data or past epidemics).


What is the implication and importance of this?

Accurately estimating the severity of the pandemic (H1N1) 2009 virus is important for planning the most effective healthcare and social measures (such as school closures) to reduce the number of deaths caused by the virus.

The current methods of estimation of case fatality and hospitalisation ratios may involve some inaccuracies. Reliable population level estimates of the prevalence and case-fatality ratio will help to identify populations at risk and to determine which groups are given priority for vaccination when a vaccine becomes available.

At this early stage in the epidemic, many confirmed cases have been in young people, and so it is important to collect age-specific data to know whether this trend will continue with the spread of the virus. Carefully implemented systems of data collection such as these will be of great value in improving estimates of case-fatality ratio. It will also ensure that any changes in H1N1 virulence are rapidly detected.