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AFD - Testing & Surveillance

sharon sanders

Editor-in-Chief & President
Seeing The Bear




# 2042



http://afludiary.blogspot.com/



I've a good many Internet friends, and so my email inbox fills up each day with a variety of jokes, photos, conspiracy theories, and links to videos. As a 12 year veteran of the Internet, and a BBS user for more than a decade prior to that, I'm pretty jaded when it comes to most of these submissions.

Every once in awhile something comes around that not only impresses or entertains me, but that has some (unintentional) application in the world of bird flu and EIDs (Emerging Infectious Diseases).


Today I have example. A short public service video, available on Youtube here, and on this UK website.

It only takes one minute, so `take the test'.

I'll wait.


If you are like most people, you failed miserably. Don't feel too bad. If you passed, well congratulations!


What, you might ask, does this have to do with EIDs?


Simply that we may miss something important by focusing too hard on what we expect to happen. We may not see `the bear' until it is already upon us.


Every day I receive several email notifications and updates from ProMed Mail, a service of the International Society of Infectious Diseases. Covering emerging infectious disease outbreaks and toxins, ProMed is one of the best resources on the net.


We also have scores of newshounds working on the various flu forums who scan foreign language newspapers and newscasts looking for reports that might indicate an outbreak somewhere in the world.


While most of the time these reports will turn out to be something tragically familiar, such as Dengue, Chikungunya, Lhassa fever, Ebola, or even plague . . . they can also be the harbinger of a bird flu outbreak, SARS, or perhaps something as yet unknown.

SARS after all, had never been described before 2003. H5N1 had never been known to infect humans before 1997. Over the past 30 years we've seen nearly one new infectious disease emerge each year; Nipah, Hanta, Hendra, XDR-TB . . . the list goes on.

Today we have one such report, posted on Flutrackers by Ironorehopper, and carried by Yonhap News out of South Korea. It describes an `unknown epidemic' in North Korea which, it says, is killing children.


There have been rumors coming out of North Korea for years regarding disease outbreaks, and of course, famine. Last year we heard of an epidemic of what was believed to have been Scarlet Fever. Most of these are hard to verify, however, as North Korea is both a repressive and closed society.


While this article repeatedly mentions `bird flu' as a possible diagnosis, there doesn't seem to be any data available as yet to support that assumption.

It also mentions HFMD (Hand Foot Mouth Disease), which given the demographics (only children affected), would seem a far more likely culprit.

Early news reports such as this one, while important to note, need to be viewed with healthy skepticism. Frankly the reporting here appears based mostly on rumor and speculation.

Caveat Lector.




Epidemic spreads in N.K. border towns: aid group


SEOUL, June 3 (Yonhap) -- An unidentified epidemic is spreading along some North Korean towns bordering China, placing North Korean health authorities on high alert, a local aid group said Tuesday.


The disease, suspected to be avian influenza by some North Korean doctors or hand-foot-mouth disease (HFMD) by some others, has already taken the lives of many North Korean children under seven years old, the Buddhist group Good Friends said in its newsletter.


Every day since April 27, five to six children have died of the unidentified epidemic in Hoeryong, North Hamgyong Province, the group said, quoting a doctor of a hospital in the city.


The disease is already common among young children in the neighboring city of Musan, according to the group.


North Korean health authorities, however, are poorly handling the spread of the epidemic, without even giving an exact diagnosis or cure, the group said.


"We diagnose the disease as avian influenza," it quoted a North Korean doctor in Hoeryong as saying. Patients show flu-like symptoms such as fever, cough, sore throat and no appetite, the doctor added.


"Yes, right. Bird flu is spreading," another doctor in Musan was quoted as saying. The disease is spreading mainly among state-run daycare centers and kindergartens, although no cases of adult infections have been reported, he added.


"I understand the authorities are trying to trace the root of the disease," he said.


But a third North Korean doctor was quoted as saying that HFMD from China may be spreading to North Korea's border areas, the aid group said.


HFMD has struck over 10,000 people resulting in 26 fatalities, all of them children, in recent months, according to China's official Xinhua News Agency.


In all probability, this is something other than bird flu. But it should be monitored until we know for sure.

But more importantly, this is a reminder that the we dare not focus exclusively on the H5N1 bird flu threat. The next pandemic could come from a completely different direction.

We need to be watchful.

And so, from time to time this blog will devote some of its space to other emerging infectious diseases.

Not because bird flu has gone away, but because H5N1 isn't the only game in town.

posted by FLA_MEDIC @ 7:50 AM
 
Re: AFD - Surveillance - Seeing the Bear

Re: AFD - Surveillance - Seeing the Bear

CDC Funds Rapid Tests To Sort Avian/Seasonal Flu




# 2080



Pandemics don't happen in a vacuum.

In fact, there is a pretty good chance that a novel pandemic virus will emerge at the same time that a less lethal strain of seasonal flu (or other respiratory ailment) is circulating.

This, as you might guess, makes it very difficult to determine who has pandemic flu, and who has something else.

With limited antivirals and other medical resources available, having a rapid method of sorting out pandemic flu cases from regular flu becomes a major concern.

The CDC has announced contracts with two firms to produce a rapid flu test.


This report from CIDRAP News.



CDC funds tests to sort seasonal, avian flu

Jun 17, 2008 (CDIRAP News) ? The Centers for Disease Control and Prevention (CDC) has awarded two contracts worth a total of $12.9 million to develop influenza tests, with the aim of making it possible to distinguish seasonal from avian flu viruses within 3 hours.

Contracts worth about $6.5 million each were awarded to Nanogen Inc., San Diego, and Meso Scale Diagnostics, LLC, Gaithersburg, Md., the Department of Health and Human Services (HHS) announced last week.

The contracts are for "initial phased development," HHS officials said in a news release. Possible additional funds under the contracts could bring the total for Nanogen to $10.4 million and the total for Meso Scale Diagnostics to $12.1 million over 3 years, the statement said.

Testing for H5N1 avian influenza now can take up to 24 hours, according to HHS. The contracts will support the advanced development of tests that could be used in hospital or commercial laboratories and "would expedite the diagnosis of large numbers of patients," the agency said.
(Continue reading. . .)
posted by FLA_MEDIC @ 5:30 PM
 
Re: AFD - Testing & Surveillance

Sept 30, 2008

New Diagnostic Flu Test Wins Approval



# 2344


It's called the Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel (it just sorta rolls off the tongue, doesn't it?) or the rRT PCR Flu Panel for short, and it uses a molecular biology technique to detect and differentiate between various influenza A viruses.

It is being hailed as a major step forward in our ability to do laboratory testing for seasonal and novel influenza A viruses.

Here is the press release from the HHS.







FOR IMMEDIATE RELEASE
Tuesday, September 30, 2008

Contact: FDA Press Office, CDC Press Office
(301) 827-6242, (404) 639-3286

FDA Clears New CDC Test to Detect Human Influenza


The U.S. Food and Drug Administration (FDA) today cleared a new test developed by the U.S. Centers for Disease Control and Prevention (CDC) to diagnose human influenza infections and the highly pathogenic influenza A (H5N1) viruses.

The device, called the Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel (rRT-PCR Flu Panel), uses a molecular biology technique to detect flu virus and differentiate between seasonal and novel influenza.

The device is used to isolate and amplify viral genetic material present in secretions taken from a patient?s nose or throat. The viral genetic material is labeled with fluorescent molecules, which are then detected and analyzed by a diagnostic instrument called the Applied Biosystems 7500 Fast Dx, also cleared today by the FDA for diagnostic use simultaneously with the CDC?s rRT-PCR Flu Panel.

The test panel and diagnostic system can detect and identify commonly circulating human influenza viruses as well as influenza A (H5N1) viruses. Results can be available within four hours and the system can test multiple samples at once.

?This is a significant achievement for public health surveillance,? HHS Secretary Mike Leavitt said. ?The test allows us to better support laboratories on the front line of influenza testing in the United States and abroad.?

?The application of the test to detect an emergent influenza virus would be especially important in the early stages of a pandemic,? Secretary Leavitt added. ?This breakthrough allows for a more timely detection of a pandemic virus, which helps in determining when to begin broad control strategies as well as life-saving mitigation measures, such as closing schools, cancelling social gatherings and informing businesses to begin work-at-home policies.?

The test will be available to CDC-qualified laboratories for diagnosing influenza this fall, and some laboratories will be able to obtain reagents (certain substances used in the testing process) at no cost. This test should help ensure the accuracy of influenza testing results among the different qualified laboratories that conduct influenza subtype testing.

?This new test provides us another tool in our toolbox to fight seasonal influenza, a virus that unfortunately kills thousands of people each year in the United States,? said CDC Director Dr. Julie Gerberding. ?We?ll now be able to detect influenza in the community faster, which allows us to take steps more quickly to protect and save lives.?

Since influenza viruses are always changing, test reagents need to be evaluated regularly against circulating viruses to ensure the sensitivity and specificity of the test to diagnose current influenza viruses.

?Because the test can tell the difference between seasonal human influenza viruses and novel viruses, it will also provide qualified laboratories with a means to rapidly detect new influenza viruses that have not been identified yet and that could pose a pandemic risk," said FDA Principal Deputy Commissioner and Chief Scientist Dr. Frank Torti, M.D., M.P.H.

The CDC, Applied Biosystems of Foster City, Calif., and the Association of Public Health Laboratories collaborated on the development of this new test. State public health laboratories in Virginia, Iowa, California, Massachusetts, Wisconsin, and Washington performed clinical evaluations of the new flu panel.

Scientists around the world are concerned that the H5N1 virus could one day mutate and acquire the properties needed to quickly spread between people, resulting in a pandemic. H5N1 viruses circulate widely in birds in Asia, Africa and Europe and have caused human illness and death. These viruses have never been detected in the Americas.

For more information, please visit www.pandemicflu.gov, and www.cdc.gov
 
Re: AFD - Testing & Surveillance

The Surveillance Gap



# 3235


Disease surveillance, even in developed countries, isn?t as sophisticated as many might believe.

We don?t know, for instance, how many people are infected with the West Nile Virus, or Lyme Disease, each year in the United States.

About the best we can do is make estimates.

During the recent Salmonella outbreak, fewer than 1,000 cases were laboratory confirmed, even though the assumption is that thousands more were affected.




As I pointed out this morning, we even have to `guesstimate? the number of deaths that occur each year due to influenza. And during flu season, only a tiny fraction of suspected influenza cases in this country are tested and typed.

Now . . . imagine what it is like in other, less developed countries.

While certainly not `news?,this next story is a welcome official reminder that an absence of documented H1N1 cases in developing countries is certainly not proof that they don?t exist.



Most developing nations unable to track flu: WHO official

<hr> Agence France-Presse | 05/21/2009 10:15 PM

GENEVA - Most developing countries are not in a position to track seasonal flu, let alone a potentially pandemic strain of swine flu, a World Health Organisation official said Thursday.

"Obviously what we're worried about is that most of the developing countries don't have the systems in place that will even tell us whether H1N1 flu is there," said Ties Boerma, director of health statistics at WHO.

"In most countries there is no good cause of death reporting system, so we do not get any data on any cause of death," Boerma said. "So there is still a big gap in information there that we and our partners are working on but that's a huge undertaking."

The WHO annual health statistics report released on Thursday lists H5N1 bird flu among 18 selected infectious diseases.

But it points out that bird flu, as well as malaria or Japanese encephalitis, is difficult to identify without laboratory testing that is often not available in developing countries.

Mexico had to resort to Canadian testing to detect the swine flu virus. Even in middle income countries, flu cases are often listed as pneumonia.
(Continue . . .)
 
Re: AFD - Testing & Surveillance

Japan: Rapid Influenza Test Sensitivity



# 3149


The Japanese, who generally regard influenza far more seriously than a lot of other societies, have taken the extra step of PCR testing a number of H1N1 patients who initially tested negative for Influenza A using the rapid influenza tests routinely found in doctors offices.

About 30% (range 12%-47%) of people they double-checked actually had the H1N1 virus.
This isn?t a complete surprise (see Case Counts, Testing, And Feeding the Beast) , although this is the first preliminary data I?ve seen on the sensitivity of the rapid influenza test on this novel H1N1 virus.

As I wrote in that blog:

The first test, usually applied in a doctor?s office when someone presents with ILI (Influenza-like-Illness) is a rapid Influenza test.

In order for most samples to be `sent up the chain? for additional testing, a patient must first test positive for influenza A using a rapid test kit.

This rapid test is designed to show if someone tests positive for the Influenza A or B virus, but generally not the type.

According to the CDC:

The rapid tests vary in terms of sensitivity and specificity when compared with viral culture or RT-PCR. Product insert information and research publications indicate that:

  • Sensitivities are approximately 50-70%
  • Specificities are approximately 90-95%



Sensitivity is defined as the ability of a test to correctly identify individuals who have a given disease or condition.
Here in the United States, trying to detect all swine flu cases is a moot point, and so the lack of sensitivity of these rapid tests no longer really impacts us with this outbreak.



But for countries trying to utilize these tests to detect, and contain, the spread of the H1N1 virus (or H5N1 for that matter) it does pose a problem.


My thanks to Shiloh on Flutrackers for posting this article from the Yomiuri Shimbum.


30% of new-flu cases initially tested negative

The Yomiuri Shimbun
About 30 percent of people infected with the new strain of influenza initially tested negative in a commonly used screening procedure for the new flu, according to a survey by the National Institute of Infectious Diseases.

The error reportedly is due to variances in the amount of virus in a person's body after symptoms first appear.

The test almost always proved accurate when conducted the day after symptoms first appeared.

But in cases where the test was performed on the day symptoms first manifested, or two days later, about 40 percent of people infected with the virus were judged not to be infected.

The institute points out that negative test results do not necessarily mean a person is not infected with the new flu. The Health, Labor and Welfare Ministry has instructed medical institutions to use the test kit at appropriate times.

The testing kits, which are used at medical institutions and public health centers, includes cotton swabs used to obtain mucus from inside the nose and other places. Changes in the color of mucus-bearing test paper show about 10-15 minutes later whether infection exists and whether it is type A or type B virus.

(Continue . . .)
 
Re: AFD - Testing & Surveillance

Official Doesn?t Necessarily Mean Accurate




# 3252


In the same vein as my last blog on this morning?s WHO totals, we get this excellent reporting from Jason Gale of Bloomberg news on the widening gap between `official? swine flu numbers and reality.

This is a long article, but is well worth reading in its entirety.




Swine Flu Is Spreading Wider Than Official Data Show (Update2)
By Jason Gale
data

May 25 (Bloomberg) -- Swine flu is spreading more widely than official figures indicate, with outbreaks in Europe and Asia showing it?s gained a foothold in at least three regions.

One in 20 cases is being officially reported in the U.S., meaning more than 100,000 people have probably been infected nationwide with the new H1N1 flu strain, according to the Centers for Disease Control and Prevention. In the U.K., the virus may be 300 times more widespread than health authorities have said, the Independent on Sunday reported yesterday.

Japan, which has reported the most cases in Asia, began reopening schools at the weekend after health officials said serious medical complications had not emerged in those infected. The virus is now spreading in the community in Australia, Jim Bishop, the nation?s chief medical officer, said yesterday.

<snip>

Already a Pandemic

Community spread of the new virus in a second region means WHO?s criteria for a pandemic has been met, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy of the University of Minneapolis.
(Continue . . . )

My thanks to Florida1 on Flutrackers for the heads up on this article.
 
Re: AFD - Testing & Surveillance

Proving Anything With Numbers



# 3307


Just about everyone, it seems, wants to take the numbers we get on confirmed H1N1 cases, hospitalizations, and fatalities in order to somehow quantify the severity of this novel influenza virus.

Depending on what numbers you decide to use, you can generate a wide spectrum of results.

Yesterday, in Premature Extrapolations, I highlighted one newspaper columnists opinion that seasonal flu kills 250 times more people than swine flu based on 2,000 NYC estimated deaths each year and only 8 swine flu deaths to date.

Today we?ll attempt to play with several larger sets of numbers, and demonstrate why these calculations aren?t terribly reliable.

In their 45th update on the H1N1 global situation, the World Health Organization today announced that there have been 25,288 confirmed cases of the virus globally and 139 deaths.

One of the things we want to figure out is the virulence of this virus.

Just how deadly is it?

Seasonal flu is thought to kill about 1 person out of every 1,000 who contract it (.1%). So we naturally want to see how this new virus compares.

Using the `official numbers? from the WHO, we can divide the total number of cases by deaths (25,288/139) and get 1 death out of every 181 cases.

Or about 5 times higher than seasonal flu.

But . . . is this estimate reasonable?

It certainly sounds reasonable. We are, after all, using the official WHO numbers.

But I can hear many of you saying that this incorporates the early high fatality numbers of Mexico, and that those numbers skew the results for the rest of the world.

In Mexico, the `official numbers? are 5717 cases and 106 deaths (5717/106=53). This suggests a CFR (Case fatality ratio) of nearly 2%.
If you remove Mexico from the mix, you have 19571 cases and only 33 deaths. Or about 1 death in every 593 cases (not quite double the CFR of seasonal flu).

So . . .is that our answer?


Well . . . maybe. But the United States shows 13217 confirmed cases and 27 deaths. And that gives one death out of every 489 cases.


It becomes more complicated when you add in the deaths reported, but not yet added to the US tally.

That number (last I checked) was 37 deaths.


So . . . 13217/37= 357.

Or about 3.5 times deadlier than seasonal flu.
But of course, this doesn?t take into account the untested and unconfirmed cases, now does it?
Here in the United States the CDC has acknowledged that the actual number of cases is probably 20 times higher than the official count. Most states are only testing those hospitalized or otherwise seriously ill with influenza-like illnesses.

So . . . can we safely divide the mortality rate of .35% by 20?

If so, then the true CFR of H1N1 would be about 1/6th that of seasonal flu.
It would therefore be a gift from god if H1N1 supplanted the other seasonal viruses, because it would cut our yearly death toll from 36,000 a year to only about 6,000 a year!

This doesn?t seem terribly likely. So we must be missing something.

The problem here is, every day in the United States more than 6,000 people die. That?s about 180,000 deaths a month. Most are never tested for the H1N1 virus (most, as in 99%).

It is not only possible, but it is likely, that we are missing some H1N1 related deaths here. How many?

We don?t know.

Just like we don?t know how many people actually die as a result of seasonal influenza each year.

Doctors routinely sign death certificates for their patients as long as they had some underlying condition (or were of an age) where death wasn?t totally unexpected.

Quite often the cause of death put on the death certificate is something generic, based on the patient?s history of chronic illness, not on a post-mortem exam.
Unless someone dies in the hospital while being treated for influenza and/or pneumonia, there is a good chance that influenza will not be directly blamed for their death.

And their death won?t end up in the official statistics.

That is why, instead of counting the number of death certificates listing influenza/pneumonia as the cause of death each year, the CDC relies on mathematical models and estimates.
It is probably fair to say, that even with these gaps in our surveillance, that the United States does a better job of monitoring the causes of deaths than does 90% of the rest of the world.

So if we are missing cases, other nations are missing cases too.


So what is the answer? How virulent is this novel H1N1 virus?
Based on the few examples above, we can show this virus as being anywhere from 1/6th the virulence of seasonal flu to 5 times deadlier.

And if we wanted to skew the numbers even more, we could take the Australian experience, where they?ve had more than 1,200 cases and NO Fatalities!

Based on that sizeable dataset, you could argue that H1N1 flu isn?t deadly at all.

But we know that isn?t true.

There?s a reason why the CDC, the WHO, and virologists around the world have been slow to put a number on the virulence of this virus.

Given the vagaries of global testing, surveillance, and reporting, it simply isn?t easy to calculate.
Professor Neil Ferguson, who uses considerably more sophisticated methods than I?ve demonstrated today, published Pandemic Potential of a Strain of Influenza A (H1N1) : Early Findings last month giving a preliminary CFR of about .4% or about 4 times greater than seasonal flu.

The CDC continues to refer to this virus as being on a par with seasonal flu, or perhaps a bit more virulent. They admit that small, but important increments in virulence, would be very difficult to detect.

Obviously, I don?t know what the CFR of this virus is. Nobody does, and it is likely to vary considerably from one population to the next.

My sense of it is, based on what we?ve seen thus far, mirrors that of the CDC.

That it is currently comparable ? or perhaps a little greater than ? seasonal flu. That could change, of course.
That isn?t to say that this virus isn?t a serious threat.

As a novel influenza virus, it is expected that it could infect double or even triple the number of people over the next year than we would expect to be stricken by seasonal flu.

So even at the virulence level of seasonal flu, it could have double or triple the impact. Any increase in virulence would compound the effect.

With a health care delivery system plagued by a serious lack of surge capacity, that could prove a real problem this fall.

As time goes by we?ll probably get a better handle on all of this, although I expect the number to remain elusive, and vary considerably over time.

While these back-of-the-envelope calculations are interesting, I don?t recommend putting much faith in them.


* * * * *

Note: Due to a family medical emergency (not me, this time), I will be away from my desk a good deal for the next couple of days.
 
Re: AFD - Testing & Surveillance

Premature Extrapolations



# 3304


Yes, I know they can be embarrassing - and difficult to control - particularly when the victim is overly excited.

But we?re adults here, and it?s time we bring this little talked about subject out into the light.
I?ve seen examples of PE (Premature Extrapolation) on practically a daily basis since I began writing about influenza, but lately, with the emergence of H1N1 swine flu . . . we?ve been flooded with them.

This morning I find this headline from The Daily News on their columnists page.

Swine flue may be scary, but 250 times as many die from regular flu


Really?


Wow, aren?t we a bunch of fools for spending BILLIONS of dollars trying to contain and control this virus. The article goes on to assure . . .



The recent outbreak of swine flu throughout New York City has cause fear and panic among teachers, parents and more. All this, despite the much higher number of people who die from regular flu.
Ok, time to give these statements, and the math and methods utilized, a closer look.

First, their rationale. In their own words.

Swine flu has killed eight people in New York this year, sparking panic in schools, fear in hospitals and unease on the subways.

Yet that's a tiny fraction of the up to 2,000 New Yorkers who die every year from seasonal flu - with barely a public murmur.

Believe it or not, that?s the sum total of the argument here.

Regular Flu (2,000)/Swine Flu (8) = 250
Proving (according to the Daily News) that regular flu kills 250 times as many people as swine flu.

Shooting their numbers in the foot, just slightly, is the admission near the end of the article that:

Mathematical models predict that 1,000 to 2,000 New Yorkers will die of flu-related illness every year, Harper said.

The true death toll of seasonal flu is unknown, because it typically kills through its side effects and may never be tracked back to influenza.
So, in order to prove their point, they chose the highest predicted number of flu deaths (2000) in a year, even while admitting that the true death toll of seasonal flu is unknown.

And of course, they are comparing 1 month?s counted Swine Flu deaths against 1 YEAR of estimated regular flu deaths.

And a off-flu-season month, at that!
That seems fair.

And we are also expected to believe that while we can only estimate the number of seasonal flu deaths, we know with certainty how many people have died from swine flu.

This my friends is the heartache of PE.

The point of this article, I?m sure, is to try to reduce the `fear and panic? of the populace over swine flu, and to push people to get seasonal flu shots.

The all-too-frequently used pejoratives of `Fear and Panic? appear to be code words for the public asking awkward questions and demanding answers.
But I digress . . .

We were dissecting the suggestion (postulated by The Daily News) that we shouldn?t worry about swine flu because Regular Flu kills 250 times as many people.


Granted, the author doesn?t actually say it, he only intimates that the swine flu virus is far less deadly than seasonal flu. But we?ll go with that idea, since the author went to so much trouble to promote it.

That?s going to come as a genuine surprise to the CDC, the WHO, and Professor Neil Ferguson who calculated that the CFR (Case Fatality Ration) for the new H1N1 was roughly 1 in 250.

Or 4 times higher than seasonal flu.
This desire by the media to try to put hard numbers to the Swine flu outbreak is understandable since this is a novel virus and people are legitimately concerned.

In their article It Is Never Too Soon to Speculate Peter M. Sandman and Jody Lanard write:

Officials and experts should speculate responsibly. That means paying due attention both to worst case scenarios and to likelier and less dire possibilities; it means putting strong emphasis on the uncertainty of the data and the tentativeness of the conclusions; it means addressing explicitly the question of which actions should wait for better data and which should be undertaken now.

Responsible speculation is fine, but we gain little by promoting cherry picked numbers like the ones in this Daily News article.

To review . . .


  • The real number of deaths due to swine flu in New York (or anyplace else) is unknown. The idea that while we can only estimate regular flu deaths, but we can accurately count swine flu deaths, is patently ridiculous.

  • You can?t (actually, you can . . .but you shouldn?t) take the (highest) number of estimated flu deaths over a full year and divide it by an off-flu-season month (May) swine flu tally and come up with a ratio that has any scientific merit.


The Daily News would do well to spend some time reading Peter M. Sandman?s Risk Communication Website. There they would learn that you don?t gloss over, minimize, or trivialize a legitimate threat.

You tell the truth in plain language, and admit it when you don?t have all the answers.

The public will respect that.

Dr. Sandman recently wrote on the subject:


We won?t know, probably for at least a year, what the real impact of this novel H1N1 virus is going to be.

If it remains in circulation (and it appears poised to do so), it will probably claim at least as many lives as seasonal flu strains do, and likely more.

It also appears to have a predilection for younger people, making its impact on society all that much harder.

Points that the author of this article failed to make.
While the CDC, the HHS and READY.GOV are all urging Americans to prepare for what could be a very rough flu season, we continue to get articles like today?s that seek to minimize ? indeed, trivialize ? the swine flu threat.

Proving once again the old adage.

Caveat Lector.
 
Re: AFD - Testing & Surveillance

An Inconvenient Proof



# 3300



For well over a month reporters, bloggers, scientists, and even some public health officials from around the world have called into question the testing guidelines used in Europe to detect the novel H1N1 virus.

The criteria in most countries was that in order to be tested, a symptomatic patient had to of recently returned from Mexico, America, or Canada ? or have been exposed to someone diagnosed with the virus.

This policy very neatly excluded exactly the people you?d want to test to see if community spread of the virus was taking place.

People who were sick, but had not traveled abroad.

Admittedly, if you actually looked for community spread, there is always a danger you might find it.

So one can understand their reluctance.

Now, after a month of media criticism and a considerable loss in faith of the numbers being reported, the WHO today has urged:


  • That all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.

Over the past month I?ve featured a number of calls to do exactly that, including:


Only a few hours after the WHO IHR meeting ended, we get this report from Reuters indicating that EU countries will now broaden their criteria for testing for the H1N1 virus.


EU countries broadening H1N1 flu tests: officials

Fri Jun 5, 2009 5:51pm BST
By Michael Kahn
LONDON (Reuters) - European Union countries have begun casting a wider net when deciding who to test for the new H1N1 flu virus as health authorities are concerned they may have been missing cases, officials said.

Flu experts began emergency talks on Friday to discuss the spread of the H1N1 virus and introducing a severity index into the World Health Organization's top level of pandemic alert.

The effects of the new flu have been mainly mild apart from in Mexico, where it is known to have killed 103 people.

Testing strategies for the most part had relied on looking for cases of the so-called swine flu among travelers returning from affected countries and their close contacts, European and British health officials said.

But that could mean some people may not have been tested for the new virus even if they showed symptoms.
(Continue . . . )


image%5B3%5D.png

?I'm shocked, shocked to find that we may have been missing swine flu cases in Europe!? ? Captain Renault (Casablanca)
 
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