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New swine flu cases point to invisible pandemic

FluBossie

Well-known member
NewScientist Health

New swine flu cases point to invisible pandemic

13:17 29 May 2009 by Debora MacKenzie

Hospitals in Greece have identified H1N1 swine flu in two students who had no contact with known cases of the virus and had not been in countries with widespread infection. The infections were discovered even though the students should not have been tested for swine flu under European rules. The Greek authorities say this shows the rules must change.

Indeed, an investigation by New Scientist earlier this month showed that the EU rules would exclude exactly such cases and could make H1N1 appear much less widespread in Europe than it is.

Takis Panagiotopoulos of the Hellenic Centre for Disease Control and Prevention in Athens and colleagues reported on 28 May in Eurosurveillance, a weekly bulletin published by the European Centre for Disease Prevention and Control (ECDC) in Stockholm, Sweden, that two Greek men returning home from Scotland had tested positive this week for H1N1 swine flu.

Chance test
The two go to university in Edinburgh and had attended term-end parties at the end of last week. Both developed coughs and fevers at the weekend before flying back to Greece, where one went to hospital in Athens on Tuesday.

"The examining physician decided to take a pharyngeal swab, which was tested at the National Influenza Reference Laboratory for Southern Greece, although the patient did not meet the European Union and national criteria for the new influenza A (H1N1) testing," the team reports.

The swab was tested with a kit for H1N1 distributed by the US Centers for Disease Control and Prevention (CDC), and was positive for swine flu. The student in Athens warned the second student, who was now in Thesaloniki. He also tested positive. Both cases were mild.

Contacts of the two in Greece and Scotland and on the flights are being traced.

'Missing cases'
The Greek cases are "community acquired" ? one of the requirements for declaring H1N1 swine flu an official pandemic, which the WHO has not done.

"It is of concern that with the present EU [testing criteria] we are by definition going to miss cases infected locally in the event of established community transmission," the Greek team warns. "It is probably necessary to modify the present EU definition ? to also include clusters of patients with influenza-like illness, irrespective of travel history," they say, especially as the tourist season is getting under way.

Officially, swine flu has increased very slowly in Britain, even though the virus appears to be as contagious as ordinary flu. John Oxford of the University of London says the UK may have tens of thousands of mild, untested cases. The US CDC says there could be 100,000 cases in the US, even though only a few thousand, mostly severe, cases have been tested.

http://www.newscientist.com/article/dn17212-new-swine-flu-cases-point-to-invisible-pandemic.html
 
Re: New swine flu cases point to invisible pandemic

#1: "The two go to university in Edinburgh"


The educational flu proliferation net ...
 
Re: New swine flu cases point to invisible pandemic

NewScientist Health

Europe may be blind to swine flu cases

20 May 2009 by Debora MacKenzie
Magazine issue 2709. Subscribe and get 4 free issues.
For similar stories, visit the Epidemics and Pandemics Topic Guide
Editorial: Ignoring flu won't make it go away

EUROPE might have more H1N1 swine flu than it knows. The virus could be circulating widely but not being spotted simply because people are not being tested.

As New Scientist went to press, the World Health Organization was still undecided about declaring a full-blown pandemic, despite a surge in swine flu cases in Japan. To do this it needs evidence of "sustained transmission" outside the Americas, where the virus originated. This means finding cases in the general population that have not had known contact with places or people confirmed to have the virus. Japan found H1N1 this week in over 100 people, many without known contact.

But European countries are using a case definition from the European Centre for Disease Prevention and Control (ECDC) in Stockholm, Sweden, that virtually precludes discovering such cases. It recommends testing people with symptoms only if they have been to affected countries or had contact with a known or suspected case in the past seven days.

"We can't test every mild case of flu symptoms," says Johan Giesecke, chief scientist at ECDC. "But it's true, we might not be seeing community spread because we aren't looking." On 18 May, the UK had 101 confirmed cases of H1N1, of which only three fell outside the case definition.

The UK Health Protection Agency's criteria are similar (see diagram). Doctors "are encouraged to use this algorithm", an HPA spokesperson told New Scientist, but they can "use their clinical discretion" to test anyone.

An anonymous UK New Scientist reader, and two family members, had flu symptoms after one returned ill from New York on 10 April. They were not tested for H1N1. "My general practitioner is horrified that I am not even eligible for a test because I have not returned from Mexico in the last seven days, nor been in contact with someone who has been diagnosed."

A New Scientist reader had flu symptoms on returning from New York but was not tested for H1N1

Tests may simply be unavailable. "I was given only two swabs [for H1N1] initially," says Laurence Buckman, head of the GP committee of the British Medical Association. More are available now, "but if you can't do many tests you save them for people who meet the case definition".

Any others, says Buckman, will be picked up by "sentinel" clinics that compile weekly statistics. The ECDC claims this system "would detect circulation of the new H1N1 virus before any major outbreaks occur".

However, such sentinel systems are designed to track ordinary flu, not to detect a new infection that is initially highly localised. "It may take weeks before the numbers indicate an epidemic," warns Dick Wenzel of Virginia Commonwealth University in Richmond, past president of the International Society for Infectious Diseases. He advises testing clusters of flu and all severe cases.

Hong Kong is testing all hospitalised cases of flu and pneumonia. Belgium, departing from ECDC advice, is testing flu-like clusters and deaths. But without more tests, Europe may be missing an epidemic.

Editorial: Ignoring flu won't make it go away

http://www.newscientist.com/article/mg20227094.400-europe-may-be-blind-to-swine-flu-cases.html
 
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