Tonka
Well-known member
Source: ProMed :tiphat:
http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,90240
Archive Number 20110913.2789
Published Date 13-SEP-2011
Subject PRO/AH> Influenza (54): (PA) swine-origin H3N2 reassortant, comment
INFLUENZA (54): (PENNSYLVANIA), SWINE-ORIGIN H3N2 REASSORTANT, COMMENT
**********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 12 Sep 2011
From: James Wilson <jim.wilson@praecipiointernational.org> [edited]
A comment in response to: "Influenza (52): (PA), swine-origin H3N2
reassortant, 3 cases 20110906.2723"
---------------------------------------
What would be far more helpful to ProMED readers who are clinically
practicing are specific recommendations for when to report such cases
and how to distinguish them clinically (or epidemiologically) from
other cases of influenza. This appears to be especially problematic
when this virus does not appear to produce clinical findings much
different from seasonal influenza.
Given swine H3N2 has been circulating for years now, it would probably
be helpful to understand in this instance how these cases came to the
attention of the PA Dept. of Agriculture. Was there an influenza
surveillance system already in place where virus samples were being
collected passively and sequenced? If so, this does not bode well for
clinically-based recognition of "unusual" morbidity versus mortality,
given the number of areas in the country without such capabilities.
Thus, these warnings of swine H3N2/pandemic H1N1 recombinants have
limited practical value for the reporting base that public health
depends on: the clinicians.
As a nation (and indeed, the world), this places us in a "fall-back"
position of waiting for an abrupt, unusual influx of morbidity into
the healthcare infrastructure, with the attendant occasional high
morbidity/mortality seen in the ICU setting. In such acute
presentations, as we have seen with the pandemics of 1889, 1918, 1957,
1968, other seasons of "bad influenza (vaccine drift)," and the recent
pandemic of 2009, human recognition of such signature patterns is NOT
based on laboratory surveillance. Indeed, such bias prevented rapid
recognition of the 2009 pandemic influenza signature patterns in
Mexico in early 2009 and the surprised, reactive response observed.
Minimization of surprise is essential for a well-considered response.
What I am attempting to highlight here is the operational difference
between laboratory surveillance that highlights a potential threat of
public health significance and event-based surveillance that
highlights the "so what"/verification of significance. Finding a way
to bridge different surveillance approaches that feed into a proactive
warning system remains an essential need for our country and, indeed,
the world.
--
James M. Wilson V, MD
Executive Director
Praecipio International
Washington-Houston-Port au Prince
<jim.wilson@praecipiointernational.org>
[ProMED-mail welcomes the opportunity to communicate James Wilson's
observations and questions to a wider readership. This moderator does
not have information to contribute at this stage. Interested readers
should communicate directly with Dr. Wilson, and any outcomes may be
posted. - Mod.CP]
[see also:
Influenza (52): (PA), swine-origin H3N2 reassortant, 3 cases
20110906.2723
Influenza (51): swine-origin H3N2 reassortant, children 20110902.2685
Influenza (47): ECDC report, virus characterization 20110816.2477]
.................................................cp/msp/mpp
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
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############################################################
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http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,90240
Archive Number 20110913.2789
Published Date 13-SEP-2011
Subject PRO/AH> Influenza (54): (PA) swine-origin H3N2 reassortant, comment
INFLUENZA (54): (PENNSYLVANIA), SWINE-ORIGIN H3N2 REASSORTANT, COMMENT
**********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 12 Sep 2011
From: James Wilson <jim.wilson@praecipiointernational.org> [edited]
A comment in response to: "Influenza (52): (PA), swine-origin H3N2
reassortant, 3 cases 20110906.2723"
---------------------------------------
What would be far more helpful to ProMED readers who are clinically
practicing are specific recommendations for when to report such cases
and how to distinguish them clinically (or epidemiologically) from
other cases of influenza. This appears to be especially problematic
when this virus does not appear to produce clinical findings much
different from seasonal influenza.
Given swine H3N2 has been circulating for years now, it would probably
be helpful to understand in this instance how these cases came to the
attention of the PA Dept. of Agriculture. Was there an influenza
surveillance system already in place where virus samples were being
collected passively and sequenced? If so, this does not bode well for
clinically-based recognition of "unusual" morbidity versus mortality,
given the number of areas in the country without such capabilities.
Thus, these warnings of swine H3N2/pandemic H1N1 recombinants have
limited practical value for the reporting base that public health
depends on: the clinicians.
As a nation (and indeed, the world), this places us in a "fall-back"
position of waiting for an abrupt, unusual influx of morbidity into
the healthcare infrastructure, with the attendant occasional high
morbidity/mortality seen in the ICU setting. In such acute
presentations, as we have seen with the pandemics of 1889, 1918, 1957,
1968, other seasons of "bad influenza (vaccine drift)," and the recent
pandemic of 2009, human recognition of such signature patterns is NOT
based on laboratory surveillance. Indeed, such bias prevented rapid
recognition of the 2009 pandemic influenza signature patterns in
Mexico in early 2009 and the surprised, reactive response observed.
Minimization of surprise is essential for a well-considered response.
What I am attempting to highlight here is the operational difference
between laboratory surveillance that highlights a potential threat of
public health significance and event-based surveillance that
highlights the "so what"/verification of significance. Finding a way
to bridge different surveillance approaches that feed into a proactive
warning system remains an essential need for our country and, indeed,
the world.
--
James M. Wilson V, MD
Executive Director
Praecipio International
Washington-Houston-Port au Prince
<jim.wilson@praecipiointernational.org>
[ProMED-mail welcomes the opportunity to communicate James Wilson's
observations and questions to a wider readership. This moderator does
not have information to contribute at this stage. Interested readers
should communicate directly with Dr. Wilson, and any outcomes may be
posted. - Mod.CP]
[see also:
Influenza (52): (PA), swine-origin H3N2 reassortant, 3 cases
20110906.2723
Influenza (51): swine-origin H3N2 reassortant, children 20110902.2685
Influenza (47): ECDC report, virus characterization 20110816.2477]
.................................................cp/msp/mpp
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/ProMEDMail_Donations.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://www.isid.org/promedmail/subscribe.lasso>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################