CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

[Shiloh]

Source: http://www.cidrap.umn.edu/news-perspective/2013/08/news-scan-aug-06-2013

News Scan for Aug 06, 2013
Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu
Filed Under:
Influenza, General; Meningitis; Pandemic Influenza


2009 H1N1 flu virus continues circulating globally

Influenza activity increased in several areas of the Southern Hemisphere and was dominated by the 2009 pandemic H1N1 strain over the 2-week period from Jul 7 through Jul 20, according to World Health Organization (WHO) updates.

Data were reported from 73 countries. The Global Influenza Surveillance and Response System (GISRS) tested 24,825 specimens. Of the 1,884 specimens positive for influenza, 1,590 (84.4%) were influenza A and 294 (15.6%) were influenza B. Of the 1,310 type A specimens that were subtyped, 719 (54.9%) were 2009 H1N1 and 590 (45%) were H3N2.

Increased cases of H3N2 were seen in Australia and increased influenza B in New Zealand, although the numbers are lower than in previous years. Flu activity decreased in much of tropical Asia, although several countries in Southeast Asia reported higher levels of H3N2. Much of Central America and the Caribbean region reported increased activity, and tropical South America reported increased 2009 H1N1 and H3N2 activity.

Northern Hemisphere temperate zones continue to see interseasonal levels of flu.
Aug 5 WHO GISRS update
Aug 2 WHO update


Two more deaths tied to steroid-linked fungal infections

Two more patients have died in the outbreak of infections linked with contaminated steroid injections that emerged last fall, raising the toll to 63, though the overall case count stayed steady at 749, according to numbers reported yesterday by the Centers for Disease Control and Prevention (CDC).

The state with the most cases is Michigan with 264, followed by Tennessee with 153. The 749 cases include 233 of meningitis only, 333 of paraspinal or spinal infection only, 151 of meningitis plus paraspinal or spinal infection, 33 with peripheral joint infection only, 2 with paraspinal or spinal plus peripheral joint infection, and 7 of stroke without lumbar puncture only.

The steroid injections implicated contain preservative-free methylprednisolone acetate produced by the New England Compounding Center of Framingham, Mass.
Aug 5 CDC update


Study: Mortality pattern in 1918 flu pandemic related to 1889 pandemic

A team of Canadian and US scientists says that 28-year-olds had the highest mortality during the 1918 flu pandemic, and they suggest that the high death rate in young people was related to childhood exposure to flu during the pandemic of 1889-90.

Writing in PLoS One, the authors say they used historical records from Canada and the United States to determine that 28-year-olds had the highest risk of death during the 1918 pandemic. The team was headed by Joaquin Madrenas of McGill University as senor author.

The scientists suggest that the vulnerability of young adults in 1918 was shaped by their exposure to the "Russian flu," which spread from Russia to Western Europe in the fall of 1889 and reached North America in the winter of 1889-90.

They speculate that the 1889 pandemic was caused by an influenza A/H3 virus, and argue that "commitment very early in life to this subtype would have led to an immune profile offering little or no humoral protection to the antigenically dissimilar H1N1 subtype that emerged in 1918," resulting in an increased risk of death.

The scientists also suggest that exposure to a virus in utero or infancy may permanently affect later health and mortality by causing changes in the T cell repertoire, impairing lung maturation, or affecting metabolism.

"Yet, despite compelling evidence, these explanations remain incomplete," they add. "At a minimum, more detailed analyses using exact ages derived from historical birth and death records for 1889-90 and 1918 are needed."
Aug 5 PLoS One report

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

> "commitment very early in life to this subtype would have led to an immune profile
> offering little or no humoral protection to the antigenically dissimilar H1N1 subtype
> that emerged in 1918," resulting in an increased risk of death.



hmm, sounds totally silly to me at first sight, but I haven't read
the paper yet. (9 pages, .pdf)

if exposure to 1989-flu was the reason, then why does it slowly
decrease at age > 28 and not suddenly ?

----------------edit--------------------
OK, I read it now and I stay with totally silly for their speculation
that it was original antigenic sin in 1918.

----------------edit--------------------
On the bottom of page 5 they try to explain why the age curve
continues to go down after age 30 (=birth before 1888) in that
the ~1878 virus was maybe antigenically closer to 1918 than the
1888 virus. Well, even if, that effect should have been small.
And it doesn't explain why the peak would be at age 28.
Why would that OAS effect be biggest if first meeting H3Nx at birth ?
Rather than -say- at age 10. And then decreasing linearly.
Or why would the effect be smaller if born in -say- 1900 ?
Also linear decrease.
I go with Hypothesis 1 on page 1, that it was immunity to a H1-strain
that circulated before 1889 but then was killed by the 1889 pandemic.
We saw this "killing" before. H1N1 was killed in the years after 1957
by H2N2, which in turn was killed by H3N2 after 1968.
Seasonal H1 was killed by ****** in 2009, and we often saw
H1 and H3 diminishing each other in USA in seasons since 1968,
although they re-emerged the years later. (probably from Asia).
They say this "antigenic history" does not explain the high mortality rates
among young adults. I say, it does.
Without antigenic history the age-mortality curve, as e.g. shown in their figure 2,
would havecontinues to go straight up after age 28, as seen in seasonal years
i.e. with H3N2, but also with that same H1N1 in later years and i.e. in
Liverpool in 1951. Although, of course not to that dramatic extent.
1918 was bad enough, but without antigenic history it would have been
~3 times more deadly !! We were just lucky in 1918, that the elderly were
immune from <1889.
Now, imagine such a thing would happen today, and without.antigenic history,
as would be expected with H5 or H7 , and with the many people at high age !
Horrible deathrates !

This Hypothesis 1 interpretation is also, what you usually see by others.
E.g. Mamelund (17) who examined populations lacking that <1889 immunity.
Or the recent papers from Mexico,Peru,Columbia that saw significant
deaths in the elderly in 1918, other than what we saw in North-America or Europe
or India. This could be because of worse railway connections in seasons <1889.

While the Taubenberger-group is still indifferent,undecided about which Hypothesis to take.

That the peak was at 26y in Kentucky could be because of a recurrent wave
of H1, which was not completely killed in 1889, I speculate.
Or an animal reservoir in horses.The peak was also at 26 years in Sweden and Norway,
they had a 3rd wave in 1892.

Deaths in Oct.1918 by exact date of birth would be useful to further examine this.
Many of the deathcertificates do exist and are partially available at pictures
from the genealogy databases.

This should have been examined long ago.
And this very paper should have been written in 2006, when H5N1 concern was so big,
Bush spent the $7B.
Or before the 1918 sequences were published and there was the
NSABB-ethical-debate about it.

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

those aged 28 in Oct 1918 were born between Oct.1889 and Oct.1890.
For most of them their first season was 1890/1891, presumably the first season
in most locations which had no H1.
In 1889/1890 panflu only arrived in Toronto,Montreal in Feb.1890,
they may well have had some seasonal H1 before that, protecting those
aged 29 in 1918 and catching that H1.
H1 before 1889 was mild, it is hardly seen in the statistics of that time
which just recorded flu-deaths, no ILI as we see it today.


http://www.flutrackers.com/forum/showthread.php?t=179236


Massachusetts in 1890/91 may have had flu-B, appearing late in the season
as is typical for flu-B. No H3Nx (or H2 or whatever panflu 1889 was), since there
was immunity from the previous season.
While 1886/7 looks like H1 followed by B

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

http://digitalcommons.mcmaster.ca/anthro_coll/5
shows a quicker spread of 1889-flu to/in Canada
and makes it less likely that there was room for a H1-wave
in 1889 in Canada.
They found hardly any mention of flu in Hamilton
in the decades before 1889.
It's the same for England, with one little exception in 1882

It is also possible that 1889/1890 gave some protection for
H1N1 in 1918, although smaller, and therefore the 29-year-olds
were a bit more protected than the 28-year olds.

The possible H1 before 1889 would have been very mild, few deaths,
and so it was undetected. There should still be some reports
from doctors or seasonal absenteism in schools or such ?!

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

flu was amost absent in England 1860-1889

Hirsch,Vaughan,Newsholme

there was an outbreak 1874/1875 which some authors even
call pandemic, but it completely spared England.

However, flu at that time was mainly measured by deathcertificates,
could it be that they had mild seasonal H1-waves, maybe mainly in Children ?

But how do they enter the island, maybe the sick-lists from the ships
may tell us. These should be available in London libraries/archives/microfilms.

Flu in other cities did happen, but far from being considered regular
seasonal waves. 1850-1889 was generally a time with little flu.
And that despite railways being built during that time.

The 1889 pandemic did spread along the railways and probably
the railways were the main reason for its success.
Infecting ~40% of the world population in just a year
with CFR ~0.15%.

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

India is still my favorite place, where flu persists year around, where new seasonal
waves emerge and from where they spread around the world.
Several mutations first appeared in India, mainly Colcata.
In ~1850 India came to England, Raj, Victoria queen of India,
railways built.
There must have been many ships from India bringing flu.
http://www.nationalarchives.gov.uk/...t-shipping-crewlists-agreements-1747-1860.htm
Maybe England had so little flu because they had so much
flu. People became immune, it was mild.
We even know it from nowadays H1 : it kills much fewer
people than H3 or even B.
Apropos B. Where was B in 1850-1889 ?
Hidden in India or China ? The first reported outbreak of B was in 1936 in USA

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

Hirsch gives:

1860 June & July . Australian Continent and Tasmania (1, 2).
1861 December North America: Philadelphia (1).
1862 January . Bermudas (1). Netherlands: Rotterdam (2).
1862 April . Cape of Good Hope(3)
1862 May . Iceland (4).
1863-64 Winter . New Caledonia(1). France: Paris and else-where (2).
California, along the Pacific coast (3).
1864 February . Switzerland : Canton Zurich (4).
1866 March. . France: Paris, Dpt. de FAisne (1), Bains en Vosges (2).
1866 May . England: London (3).
1866 December Reunion and Mauritius(4).
1867 February . France: Paris (1, 2, 3), Strasburg (4).
1867 March . Germany : Stuttgart(5).
1867 April . Belgium: Ghent (6).
1868 December Turkey: Constantinople (1).
1871 December Cape of Good Hope (1).
1873 Jan.—March Universally in North America : Pennsylvania, Ohio, Virginia, Illinois,Iowa,
Michigan, Wisconsin, Minnesota, Missouri, Alabama, Louisiana, Texas, and other States (1).
1874—75 Winter . Widely spread over the Western and Eastern Hemispheres.
North America : Texas, New York, South Carolina, Ohio, Iowa, and other States (1).
Germany: Austria (2). France: Paris, Bordeaux, Toulouse, Havre, &c.(3),
Dpt. des Ardennes(4),Lyons (5). Sweden (6).
.......................................................................
1860.—1. Hall,1. c (ad ann. 1852).2.Statist. Report on the Health of
the Brit. Navy for the year 1860, 181.
1861.—1. Levick in Amer. Journ. of Med. Sc, 1864, Jan. 65.
1862-—1.Statist. Rep. of the British Army for the year 1862, 61.
2.In Nederl. Tijdschr. voor. Geneesk. 1S63, vii, 461.
3. Lawson in Transact,of the London Epidemiol. Soc, 1867, ii, 290.
4. Hjaltelin,1. c
1863-1864.—1. In Arch, de med.nav.,1866,v, 23.
2. Union med.,1864.
3.In San Francisco Med.Press, 1864,April.
4.Jahresbericht über die Verwaltung der Medicinalwesens des Cantons Ziirich im J. 1864, 115.
1866.—i. Guignon in Bee. de mcd. milit.
2. Bailly in Bull de l'Acad.de Mcd., xxxiii, 1868, 471.
3. Mcrcurin, Eelation med. d'un hivemage a l'ile Maurice (1866-67). Montpell., 1868, 9.
1867-— I. Moutard-Martin in Gaz. des hopit.,1867. Nr. 26, 29.
2. Petit, ib. Nr. 37.
3. Besnier, Union med., 1867. Nr. 19, 31.
4. Eissen, Gaz. med de. Strasb., 1867. Nr.5, 7.
5. Kostlin in Wörttb. med. Cor-respdzbl., 1868, 351.
6. In Bull, de la Soc. de med. de Gand 1868, Janv.
1868-—1. Marroin in Arch, de med. navale 1869, xii, 464.
1871-—1. Egan in Med. Times and Gaz., 1872, i, 112.
1873.—In Ehilad. Med. and Surg. Eeporter, xxviii, 1873, i, 275.
1874-1875.—1. Ibid., xxxii, 1875, i, 119,201.
2. Carriere in l'Union med., 1875, i, 713, 738.
3. Besnier, ib. 1875, i, 622.
4. Lapie, Eelation d'une epidemie de grippe abdominale. Earis, 1876.
5. Meynet in Lyon medical, 1875, i, 469.
6. Sveriges Sundhets-Collegii Berattelse for Sr 1875, 25.



------------------------------------------------------------------------------------
Vaughan: Leichtenstern
small local epidemics reported by Kormann in Coburg in 1878
and by O. Seifert in Wiirzburg in 1883
swelling of the neck glands, and especially frequently parotitis, purpura,
scurvy, indicate that the epidemic in Russia,in 1856-1858, reported by Kasin,
was not the true influenza.
W. Zulzer writes in 1886 of an epidemic in Berlin in which
many thousands of individuals were attacked,
epidemic reported by von den Velden in 1874-75.
It is very doubtful whether epidemics described in 1855 and
1862 in Iceland,in 1870 in Philadelphia,in 1875 in Scotland,in 1876
in the Fiji Islands,in 1887 in several places of England,in October,
1889 in Natal, in November, 1889 in Jamaica and Prince Edward
Island, was the true influenza,
the influenza epidemic which attacked specially the school
children of Pleshey and Great-Waltham and from which fifty percent,
became ill in November and December, 1889, whereas the pandemic
was known to have begun there in January,1890 the high percentage
of school children that were attacked renders the conclusion that this
was influenza very doubtful.
in many places of Germany the 'first case' of even small epidemic
outbreaks was observed as early as the summer and autumn of 1889


------------------------------------------------------------------------------

Vaughan:

"As early as May, 1889, influenza began in Athabasca (British North America)
and in the summer of 1889, in Greenland.
It is especially interesting to hear of an extensive influenza epidemic which
in the middle or toward the end of December, 1889,broke out in the
Northwest Territory of British North America,in Manitoba,in the
Island of Vancouver,similar to that in the east of Canada and Quebec.
A spread of the epidemic,which attacked Boston and New York on
December 17th,to the above territories,far away and connected by
very poor transportation facilities,is certainly improbable, especially
in consideration of the time at which the two epidemics occurred.

We are told that the invasion and the outbreak of influenza in
these vast territories occurred at practically the same time at such
widely separated places as Fort MacLeod,Saskatchewan,Prince Albert
and other military posts,and furthermore in isolated Indian camps and tribes
between which there was little or no communication.
"These facts also indicate that we are considering primary endemic
pandemics analagous to the one which broke out in July, 1889, in Central Asia."

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

my current favourite theory is, that 1889ff panflu itself provided protection from death
from H1N1 in 1918.
And this protection was the better (almost linearly), the older you were when infected in 1889-1892.
I don't know so much about cells and immunology to judge whether this makes sense.
Maybe we can find someone to review this theory.
The idea is, that this immunity would have waned faster in children where cell-growth
and cell replacement is faster and maybe longterm immunological memory is handicapped.
The body that would be 30 in 1918 won't be much the same as the body that was
2y in 1990, While growing in the same time from 20y to 48y doesn't change as much
and better preserves the immunity from 1889.
That theory would still mean that we were lucky in 1918 and that without 1889
it would have been much worse. (2-3 times more deaths ?)


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It was observed that young adults were most affected and
that persons who had previously had the disease in a severe
form in 1890 escaped in 1918. (in Mexico)


It was
mentioned by some of the older French veterinary surgeons that
in 1889 there was a recrudescence of the " gourme " affections
among horses at the time that influenza was epidemic among
the human population

--------------------------------------------------------------
http://www.medscape.com/viewarticle/760086

http://wwwnc.cdc.gov/eid/article/18/2/10-2042_article.htm

 

[gsgs]

Re: CIDRAP NEWS SCAN: Global flu update; Fungal meningitis deaths; Age pattern in 1918 flu

a similar protection of the elderly from death was observed in the
1968/9 and 1957 pandemics.
(links,references,pics from e:\hmd)

Together with a subsequent ageshift in the following seasons
where the youngerly had gained immunity and outperformed
the elderly again.

Serology (dowdle-pic)

England age-distribution of deaths in 1957 shows a protection
for those born in 1874-1885

European age-distribution of deaths in 1969 shows a protection
of those born in ~1891-1897


------------------------------------------------
Pandemic versus Epidemic Influenza Mortality: A Pattern of Changing Age Distribution
----------------------------------------------------
Multinational Impact of the 1968 Hong Kong Influenza Pandemic:
Evidence for a Smoldering Pandemic
--------------------------------------------------
The age distribution of mortality due to influenza: pandemic and peri-pandemic
----------------------------------------------------
Influenza Pandemics of the 20th Century
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The age distribution of excess mortality during A2 Hong Kong influenza epidemics
compared with earlier A2 outbreaks
----------------------------------------------------
1918 influenza : the mother of all pandemics
-------------------------------------------------------
searching for sharp drops in the incidence of pandemic A/H1N1 influenza by single year of age
------------------------------------------------------