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Pandemic Usurps Seasonal Flu as Doctors Swab Noses (Update1)
By Jason Gale
June 24 (Bloomberg) -- Virus samples swabbed from noses and throats of flu sufferers across the Asia-Pacific streaming into Anne Kelso?s Melbourne laboratory may hold clues about how virulent swine flu will be when it resurfaces in Europe and North America this year.
Dozens of germ-laden vials arrive daily at a four-story brick building in inner Melbourne via courier from as far away as the Pacific island of Palau and the Philippines. Inside, Kelso and colleagues are analyzing the microbes to determine whether they are mutating into a strain resistant to drugs like Roche Holding AG?s Tamiflu.
Kelso?s lab, the only World Health Organization collaborating center for influenza research south of the equator, identified in 2007 all three strains in the 2009/10 seasonal flu vaccine. Now it may play an even more important role: gauging whether swine flu will become a more deadly threat as it spreads during the Southern Hemisphere winter.
?All eyes are on Australia, Chile and the other countries where there?s been a big rise in cases and as our flu season starts to show its face,? Kelso, the center?s director, said in an interview last week. ?We expect the season will be getting going now because of the time of the year and particularly the fact that it?s a lot colder in Melbourne.?
Already swine flu is starting to supplant seasonal strains during the Southern Hemisphere winter, WHO Director-General Margaret Chan told reporters on a June 11 conference call, a ?typical feature of previous pandemics.?
Germ War
Tens of thousands of Melbournians are estimated to have caught the new bug, known as A/H1N1, in the past two months, according to Lindsay Grayson, director of infectious diseases at Melbourne?s Austin Hospital, which has diagnosed hundreds of people with the virus.
Health officials in Melbourne?s home state of Victoria stopped counting cases more than two weeks ago and say the virus is starting to crowd out the three flu strains that usually circulate in winter. Disease trackers say a similar pattern might emerge in the Northern Hemisphere later this year.
?What is important for us is to watch what is going on during the Southern Hemisphere season in terms of the behavior of the virus,? Massimo Ciotti, deputy head of the European Centre for Disease Prevention and Control?s preparedness and response unit, told a media briefing from Stockholm today. ?This is most important for us to be prepared next autumn.?
Pandemic Declared
The spread of swine flu in Melbourne, a city of 3.8 million people, contributed to a decision by the Geneva-based WHO on June 11 to declare the first pandemic since 1968. The virus has since taken hold in Argentina, Hong Kong, New Zealand, the Philippines, Singapore and Thailand.
The pandemic virus, which causes little more than a fever and cough in most cases, has infected almost 56,000 people in more than 90 countries, killing 238 of them, since its discovery in Mexico and the U.S. in April, according to WHO. Drugmakers including Sanofi-Aventis SA, GlaxoSmithKline Plc and Novartis AG are preparing vaccines against the new bug to have them ready by the time the weather turns colder later this year.
Pandemics tend to encircle the globe in multiple waves. The 1918 Spanish flu, the most deadly of all, started out so mild that the warning signal was missed, Chan told the United Nations General Assembly last month. It eventually killed more than 40 million people.
More Virulent Foe
?The big worry is that there is going to be a change in the virus,? said Gregory Tannock, emeritus professor of virology at Melbourne?s Burnet Institute, who has studied flu for 30 years. ?As they go through populations, sometimes viruses become more adapted and more attenuated, or sometimes they can go the other way like what happened in 1918.?
The first sign of the virus becoming a more potent pathogen would probably be detected by doctors seeing a sudden jump in flu cases or changes in disease patterns, said Kelso, who is also an honorary professorial fellow at the University of Melbourne, located 400 meters (a quarter mile) up the street from her lab.
?If such changes were to occur, we could isolate viruses from those patients and look specifically at whether there were changes in the viruses,? she said.
Doctors at the Royal Melbourne Hospital, Australia?s busiest, are so far seeing a broad spectrum of illness in swine flu patients, none of whom have died. Two fatalities have been recorded at another Melbourne hospital and one in Adelaide.
?We?re not so much seeing an increase in the virulence but we are getting a better understanding of just how mild this infection can be,? said Mike Richards, director of the Victorian Infectious Diseases Service, located at the hospital.
Silent Spreaders
Awareness of flu in the community is prompting doctors to look for the bug in patients who wouldn?t usually be tested for it, such as people hospitalized for heart failure with only a negligible change in the frequency of their cough, Richards said.
?When we do a throat swab on these patients because they?d had a fever for 24 hours, we find they in fact have swine flu,? he said. ?Just because they have mild disease, it doesn?t mean they won?t transmit it to health-care workers and have the potential for ongoing transmission to other patients subsequently.?
Unlike seasonal flu, from which the elderly suffer the most death and disease, the new bug is targeting the young and causing potentially fatal complications in otherwise healthy people aged 30 to 50, pregnant women and those with asthma, diabetes and obesity, according to the WHO.
Younger Victims
?It?s more infectious than seasonal flu, but also it?s hitting a different age band,? said Grayson at Austin Hospital. ?What?s really notable about this outbreak so far is that it hasn?t got into the nursing homes. Usually they are very hard hit.?
Understanding how the virus interacts with seasonal strains, including a widely circulating Tamiflu-resistant bug, will become clearer over the next two months, Kelso said. Australia?s flu season usually peaks in late August.
Kelso?s team is also monitoring how widely antibody- inducing surface proteins on swine flu diverge from those of a reference strain collected from a patient in California that drugmakers are using to make the pandemic vaccine.
If major differences emerge, the inoculation?s ability to protect people from the contagion could be reduced and vaccines may need to be updated, similar to the annual tweaks that seasonal flu shots undergo, Kelso said.
?It may be that it?s not until the virus circulates widely and starts coming up against an increasing level of population immunity that we see its evolution,? said Lance Jennings, a clinical virologist with Canterbury Health Laboratories in Christchurch, New Zealand, who has studied flu since the early 1970s.
To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net
Last Updated: June 24, 2009 08:36 EDT
Pandemic Usurps Seasonal Flu as Doctors Swab Noses (Update1)
By Jason Gale
June 24 (Bloomberg) -- Virus samples swabbed from noses and throats of flu sufferers across the Asia-Pacific streaming into Anne Kelso?s Melbourne laboratory may hold clues about how virulent swine flu will be when it resurfaces in Europe and North America this year.
Dozens of germ-laden vials arrive daily at a four-story brick building in inner Melbourne via courier from as far away as the Pacific island of Palau and the Philippines. Inside, Kelso and colleagues are analyzing the microbes to determine whether they are mutating into a strain resistant to drugs like Roche Holding AG?s Tamiflu.
Kelso?s lab, the only World Health Organization collaborating center for influenza research south of the equator, identified in 2007 all three strains in the 2009/10 seasonal flu vaccine. Now it may play an even more important role: gauging whether swine flu will become a more deadly threat as it spreads during the Southern Hemisphere winter.
?All eyes are on Australia, Chile and the other countries where there?s been a big rise in cases and as our flu season starts to show its face,? Kelso, the center?s director, said in an interview last week. ?We expect the season will be getting going now because of the time of the year and particularly the fact that it?s a lot colder in Melbourne.?
Already swine flu is starting to supplant seasonal strains during the Southern Hemisphere winter, WHO Director-General Margaret Chan told reporters on a June 11 conference call, a ?typical feature of previous pandemics.?
Germ War
Tens of thousands of Melbournians are estimated to have caught the new bug, known as A/H1N1, in the past two months, according to Lindsay Grayson, director of infectious diseases at Melbourne?s Austin Hospital, which has diagnosed hundreds of people with the virus.
Health officials in Melbourne?s home state of Victoria stopped counting cases more than two weeks ago and say the virus is starting to crowd out the three flu strains that usually circulate in winter. Disease trackers say a similar pattern might emerge in the Northern Hemisphere later this year.
?What is important for us is to watch what is going on during the Southern Hemisphere season in terms of the behavior of the virus,? Massimo Ciotti, deputy head of the European Centre for Disease Prevention and Control?s preparedness and response unit, told a media briefing from Stockholm today. ?This is most important for us to be prepared next autumn.?
Pandemic Declared
The spread of swine flu in Melbourne, a city of 3.8 million people, contributed to a decision by the Geneva-based WHO on June 11 to declare the first pandemic since 1968. The virus has since taken hold in Argentina, Hong Kong, New Zealand, the Philippines, Singapore and Thailand.
The pandemic virus, which causes little more than a fever and cough in most cases, has infected almost 56,000 people in more than 90 countries, killing 238 of them, since its discovery in Mexico and the U.S. in April, according to WHO. Drugmakers including Sanofi-Aventis SA, GlaxoSmithKline Plc and Novartis AG are preparing vaccines against the new bug to have them ready by the time the weather turns colder later this year.
Pandemics tend to encircle the globe in multiple waves. The 1918 Spanish flu, the most deadly of all, started out so mild that the warning signal was missed, Chan told the United Nations General Assembly last month. It eventually killed more than 40 million people.
More Virulent Foe
?The big worry is that there is going to be a change in the virus,? said Gregory Tannock, emeritus professor of virology at Melbourne?s Burnet Institute, who has studied flu for 30 years. ?As they go through populations, sometimes viruses become more adapted and more attenuated, or sometimes they can go the other way like what happened in 1918.?
The first sign of the virus becoming a more potent pathogen would probably be detected by doctors seeing a sudden jump in flu cases or changes in disease patterns, said Kelso, who is also an honorary professorial fellow at the University of Melbourne, located 400 meters (a quarter mile) up the street from her lab.
?If such changes were to occur, we could isolate viruses from those patients and look specifically at whether there were changes in the viruses,? she said.
Doctors at the Royal Melbourne Hospital, Australia?s busiest, are so far seeing a broad spectrum of illness in swine flu patients, none of whom have died. Two fatalities have been recorded at another Melbourne hospital and one in Adelaide.
?We?re not so much seeing an increase in the virulence but we are getting a better understanding of just how mild this infection can be,? said Mike Richards, director of the Victorian Infectious Diseases Service, located at the hospital.
Silent Spreaders
Awareness of flu in the community is prompting doctors to look for the bug in patients who wouldn?t usually be tested for it, such as people hospitalized for heart failure with only a negligible change in the frequency of their cough, Richards said.
?When we do a throat swab on these patients because they?d had a fever for 24 hours, we find they in fact have swine flu,? he said. ?Just because they have mild disease, it doesn?t mean they won?t transmit it to health-care workers and have the potential for ongoing transmission to other patients subsequently.?
Unlike seasonal flu, from which the elderly suffer the most death and disease, the new bug is targeting the young and causing potentially fatal complications in otherwise healthy people aged 30 to 50, pregnant women and those with asthma, diabetes and obesity, according to the WHO.
Younger Victims
?It?s more infectious than seasonal flu, but also it?s hitting a different age band,? said Grayson at Austin Hospital. ?What?s really notable about this outbreak so far is that it hasn?t got into the nursing homes. Usually they are very hard hit.?
Understanding how the virus interacts with seasonal strains, including a widely circulating Tamiflu-resistant bug, will become clearer over the next two months, Kelso said. Australia?s flu season usually peaks in late August.
Kelso?s team is also monitoring how widely antibody- inducing surface proteins on swine flu diverge from those of a reference strain collected from a patient in California that drugmakers are using to make the pandemic vaccine.
If major differences emerge, the inoculation?s ability to protect people from the contagion could be reduced and vaccines may need to be updated, similar to the annual tweaks that seasonal flu shots undergo, Kelso said.
?It may be that it?s not until the virus circulates widely and starts coming up against an increasing level of population immunity that we see its evolution,? said Lance Jennings, a clinical virologist with Canterbury Health Laboratories in Christchurch, New Zealand, who has studied flu since the early 1970s.
To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net
Last Updated: June 24, 2009 08:36 EDT