University of Michigan researchers have found that patients with severe cases of the H1N1 virus are at risk for developing severe complications, including pulmonary emboli, according to a study published today in the American Journal of Roentgenology.A pulmonary embolism occurs when one or more arteries in the lungs become blocked. The condition can be life-threatening. However, if treated aggressively, blood thinners can reduce the risk of death.
“The high incidence of pulmonary embolism is important. Radiologists have to be aware to look closely for the risks of pulmonary embolism in severely sick patients,” said Prachi P. Agarwal, M.D., assistant professor of radiology at the U-M Medical School and lead author of the study.
“With the upcoming annual influenza season in the United States, knowledge of the radiologic features of H1N1 is important, as well as the virus’s potential complications. The majority of patients with H1N1 that undergo chest X-rays have normal radiographs. CT scans proved valuable in identifying those patients at risk of developing more serious complications as a possible result of the H1N1 virus,” says Agarwal.
Working with Agarwal on the research were Ella Kazerooni, M.D., director of U-M’s division of cardiothoracic radiology and professor of radiology and Sandro K. Cinti, clinical assistant professor in U-M’s Department of Internal Medicine. The research included 66 patients diagnosed with the H1N1 flu. Of those, 14 were patients that were severely ill and required Intensive Care Unit admission.
All 66 patients underwent chest X-rays for the detection of H1N1 abnormalities. Pulmonary emboli were seen in CT scans on five of the 14 ICU patients.
Another important finding is that initial chest radiographs were normal in more than half of the patients with H1N1, says Kazerooni.
“These findings indicate that imaging studies would have to be repeated in severely ill patients to monitor disease progression,” said Kazerooni. “It’s important to heighten awareness not only among the radiologists, but also among the referring clinicians.”
There was no outside funding for the research.
The study will be published in the December issue of the AJR.
Those With Severe H1N1 At Risk For Pulmonary Emboli, Researchers Find
Anti-swine flu drug Tamil flu now available across India
In an attempt to fight the menace of Swine Flu, an anti-swine flu drug Tamil flu is being launched by the Govt of India in the licenced shops across the country.
The launch of the drug came at a time when the deadly virus has claimed 257 lives and affected 8,153 people in the country.
The drug is sold under the trade name Tamiflu and is taken orally in capsules or a drink.
The ministry of health and family welfare issued a notification on Tuesday allowing “restricted sale” of tamiflu (Oselatamivir) the only available drugs that are used for the treatment of Swine Flu.
Taking into account the current spread of the Influenza A(H1N1) in the country, the health ministry decided that retail sale of tamiflu should be allowed in the country but in a regulated manner.
The retail sale of tamiflu was banned by the central government and its distribution was permissible only through public health institutions.
A 10-tablet strip of tamiflu costs Rs.280.
New iPhone App 'Outbreaks Near Me' Locates H1N1 (Swine Flu), Infectious Diseases
A new iPhone application, created by researchers at Children's Hospital Boston in collaboration with the MIT Media Lab, enables users to track and report outbreaks of infectious diseases, such as H1N1 (swine flu), on the ground in real time.The application, "Outbreaks Near Me," builds upon the mission and proven capability of HealthMap, an online resource that collects, filters, maps and disseminates information about emerging infectious diseases, and provides a new, contextualized view of a user's specific location – pinpointing outbreaks that have been reported in the vicinity of the user and offering the opportunity to search for additional outbreak information by location or disease.
Additional functionality of Outbreaks Near Me is the ability to set alerts that will notify a user on their device or by e-mail when new outbreaks are reported in their proximity, or if a user enters a new area of activity.
"We hope individuals will find the new app to be a useful source of outbreak information – locally, nationally, and globally," says HealthMap co-founder John Brownstein, PhD, assistant professor in the Children's Hospital Informatics Program (CHIP). "As people are equipped with more knowledge and awareness of infectious disease, the hope is that they will become more involved and proactive about public health."
The new application also features an option for users to submit an outbreak report. This will enable individuals in cities and countries around the world to interact with the HealthMap team and participate in the public health surveillance process. Users may take photos – of situations and scenarios of, and/or leading to, disease – with their iPhone and submit them to the HealthMap system for review and eventual posting as an alert on the worldwide map.
"This is grassroots, participatory epidemiology," says HealthMap co-founder Clark Freifeld, a PhD student at the MIT Media Lab and research software developer at CHIP. "In releasing this app we aim to empower citizens in the cause of public health, not only by providing ready access to real-time information, but also by encouraging them to contribute their own knowledge, expertise, and observations. In enabling participation in surveillance, we also expect to increase global coverage and identify outbreaks earlier."
HealthMap was founded in 2006 and mines the Internet – searching disparate data sources such as news reports, curated personal accounts, official alerts, blogs and chat rooms – to track and map infectious disease outbreaks. While the data have been shown to provide early information on new outbreaks, users are encouraged to interpret the data appropriately as it is drawn from both official and unofficial sources.
The HealthMap Web site (http://www.healthmap.org) averages 10,000 unique visits a day, including regular users from the World Health Organization, the CDC, and the European Centre for Disease Prevention and Control. During the peak of H1N1 swine flu this spring, visits to the site rose substantially, with as many as 150,000 visitors coming to the Web site to search for information.
Outbreaks Near Me was developed with support from Google.org and is available at no cost for download in the iTunes App Store. For more information on Outbreaks Near Me, visit: http://healthmap.org/iphone.php.
H1N1 Virus: Common Symptoms & Precautions
The H1N1 virus has created a panic among people across the world, however, the deadly flu has very common symptoms to that of a normal influenza and can be prevented from by following some simple steps.
Common Symptoms of the H1N1 Flu Infection:
* Fever, moderately high, but unlike seasonal flu, can be absent in some cases too
* Non productive Cough
* Runny or stuffy nose
* Sore throat
* Body ache
* Headache
* Chills
* Fatigue/tiredness that can be extreme
* Nausea/diarrhoea
* Signs of a more serious swine flu infection might include pneumonia and respiratory failure
Precautions to keep the H1N1 flu at bay -
The deadly Swine Flu has reached the Indian shores following the global outbreak and now, claimed four lives. However, Swine Flu is certainly one of those diseased where an ounce of prevention is worth a pound of cure. Here are few tips for you to keep away from the pandemic.
1. If you think you have the H1N1 virus, stay at home and avoid travelling to public places like school and offices; seek medical care IMMEDIATELY.
2. Wash your hands frequently: Use the antibacterial soaps to cleanse your hands. Wash them often, for at least 15 seconds and rinse with running water.
3. Get enough sleep: Try to get 8 hours of good sleep every night to keep your immune system in top flu-fighting shape.
4. Drink sufficient water: Drink 8 to10 glasses of water each day to flush toxins from your system and maintain good moisture and mucous production in your sinuses.
5. Always try to cover your nose and mouth with a tissue while coughing or sneezing to avoid passing on infection of any kind to others around you.
6. Avoid touching your eyes, nose and mouth to prevent the spread of the virus.
7. Try and maintain contact with ill persons or someone who is showing symptoms of the flu.
8. Boost your immune system: Keeping your body strong, nourished, and ready to fight infection is important in flu prevention. So stick with whole grains, colorful vegetables, and vitamin-rich fruits.
8. Keep informed: The government is taking necessary steps to prevent the pandemic and periodically release guidelines to keep the pandemic away. Please make sure to keep up to date on the information and act in a calm manner.
Keep Swine Flu away From You
Here are eight measures that Horton thinks students and families should consider as they prepare for the opening of classes.
1. Have a physical exam before starting college. Washington and Lee requires all students to have a physical, and Dr. Horton believes it’s an important part of preparing for college.
2. Talk to your doctor about recommended immunizations for adolescents and young adults and make sure all of your vaccinations are up to date. Make plans to get a flu shot in the fall. Dr. Horton cautions that this will be the year when student health centers will be doing more outreach than ever to see that students get vaccinated against the flu — both the normal seasonal shot and the H1N1 vaccine when it becomes available.
3. Have a parents-student conversation about expectations regarding alcohol, other drugs and sexual activity.
4. Check your health insurance. Families need to be aware, says Horton, of what kind of coverage the student will have on campus, including whether or not the prescription drug plan will be honored at pharmacies in the area.
5. Bring a first aid kit with common, over-the-counter medications.
6. Do what your mom always told you. Wash your hands, cover your cough, dispose of used tissues.
7. Watch your diet. Unhealthy eating habits are easy to pick up when no one is there to make sure you eat your veggies.
8. Get plenty of sleep. “For some reason, students get to college and their clock seems to shift, and they stay up too late, and they still have 8 o’clock classes,” said Horton. “They stay up talking to friends in the hall, and they don’t start their work until 11 or 12, and they’re up half the night doing their homework. Sleep deprivation among students is a very unhealthy habit.”
One more swine flu case; India says US should screen passengers
A nine-year-old boy on Tuesday tested positive for swine flu taking the total number of cases to 31 in the country even as the govt said the US should "suo motu" start screening outbound passengers for symptoms of the disease.
New Delhi has also asked the developed countries to take action to contain and check the spread of swine flu at their end which would help stop the spread of the infection to the developing nations.
The fresh case was reported from Hyderabad where the boy arrived on 14th June from from New Jersey via London. "He has tested positive. He is on treatment. All his contacts are being traced," a Health Ministry official said.
Three passengers, including a staffer of a leading international airlines, have been quarantined at a hospital in Bangalore while a 22-year-old passenger was hospitalised in Kochi with symptoms of swine flu.
Of the 31 cases, 11 have been discharged. Rest of the passengers are all stable, the official said.
With mounting cases of swine flu in people coming from US, the Health Ministry said the US should "suo motu" start screening outbound passengers for symptoms of the disease.
Minister of State for Health and Family Welfare Dinesh Trivedi said the US is the "main source" of the virus for India with many travellers from that country testing positive for the flu.
Swine Flu Origins Revealed
A new analysis of the current swine-origin H1N1 influenza A virus suggests that transmission to humans occurred several months before recognition of the existing outbreak.The work, published online in Nature June 10, highlights the need for systematic surveillance of influenza in swine, and provides evidence that new genetic elements in swine can result in the emergence of viruses with pandemic potential in humans.
'Using computational methods, developed over the last ten years at Oxford, we were able to reconstruct the origins and timescale of this new pandemic,' said Dr Oliver Pybus of Oxford University's Department of Zoology, an author of the paper. 'Our results show that this strain has been circulating among pigs, possibly among multiple continents, for many years prior to its transmission to humans.'
Dr Pybus, along with Andrew Rambaut from the University of Edinburgh and colleagues, used evolutionary analysis to estimate the timescale of the origins and the early development of the epidemic. They believe that it was derived from several viruses circulating in swine, and that the initial transmission to humans occurred several months before recognition of the outbreak.
The team conclude that 'despite widespread influenza surveillance in humans, the lack of systematic swine surveillance allowed for the undetected persistence and evolution of this potentially pandemic strain for many years.'
The team included researchers from Oxford, the University of Edinburgh, the University of Hong Kong and the University of Arizona.
WHO Declares Pandemic In Response To Ongoing Global Spread Of Novel Influenza A (H1N1) Virus
On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus, which causes swine flu. A Phase 6 designation indicates that a global pandemic is underway.More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.
WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus. It’s uncertain at this time how serious or severe this novel H1N1 pandemic will be in terms of how many people infected will develop serious complications or die from novel H1N1 infection. Experience with this virus so far is limited and influenza is unpredictable. However, because novel H1N1 is a new virus, many people may have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against novel H1N1 virus.
In the United States, most people who have become ill with the newly declared pandemic virus have recovered without requiring medical treatment, however, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the coming days and weeks. In addition, this virus could cause significant illness with associated hospitalizations and deaths in the fall and winter during the U.S. influenza season.
Background
Novel influenza A (H1N1) is a new flu virus of swine origin that first caused illness in Mexico and the United States in March and April, 2009. It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth. Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.
The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency and has been actively and aggressively implementing the nation’s pandemic response plan.
Since the outbreak was first detected, an increasing number of U.S. states have reported cases of novel H1N1 influenza with associated hospitalizations and deaths. By June 3, 2009, all 50 states in the United States and the District of Columbia and Puerto Rico were reporting cases of novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics. The Southern Hemisphere is just beginning its influenza season and the experience there may provide valuable clues about what may occur in the Northern Hemisphere this fall and winter.
Face Protection Effective In Preventing The Spread Of Influenza, Study Suggests
A new article in the journal Risk Analysis assessed various ways in which aerosol transmission of the flu, a central mode of diffusion which involves breathing droplets in the air, can be reduced. Results show that face protection is a key infection control measure for influenza and can thus affect how people should try to protect themselves from the swine flu.Lawrence M. Wein, Ph.D., and Michael P. Atkinson of Stanford University constructed a mathematical model of aerosol transmission of the flu to explore infection control measures in the home.
Their model predicted that the use of face protection including N95 respirators (these fit tight around the face and are often worn by construction workers) and surgical masks (these fit looser around the face and are often worn by dental hygienists) are effective in preventing the flu. The filters in surgical masks keep out 98 percent of the virus. Also, only 30 percent of the benefits of the respirators and masks are achieved if they are used only after an infected person develops symptoms.
"Our research aids in the understanding of the efficacy of infection control measures for influenza, and provides a framework about the routes of transmission," the authors conclude.
This timely article has the potential to impact current efforts and recommendations to control the so-called swine flu by international, national and local governments in perspective.
This study is published in the journal Risk Analysis. Media wishing to receive a PDF of this article may contact .net.
New Way Of Treating The Flu
What happens if the next big influenza mutation proves resistant to the available anti-viral drugs? This question is presenting itself right now to scientists and health officials this week at the World Health Assembly in Geneva, Switzerland, as they continue to do battle with H1N1, the so-called swine flu, and prepare for the next iteration of the ever-changing flu virus.Promising new research announced by Rensselaer Polytechnic Institute could provide an entirely new tool to combat the flu. The discovery is a one-two punch against the illness that targets the illness on two fronts, going one critical step further than any currently available flu drug.
"We have been fortunate with H1N1 because it has been responding well to available drugs. But if the virus mutates substantially, the currently available drugs might be ineffective because they only target one portion of the virus," said Robert Linhardt, the Ann and John H. Broadbent Jr. '59 Senior Constellation Professor of Biocatalysis and Metabolic Engineering at Rensselaer. "By targeting both portions of the virus, the H and the N, we can interfere with both the initial attachment to the cell that is being infected and the release of the budding virus from the cell that has been affected."
The findings of the team, which have broad implications for future flu drugs, will be featured on the cover of the June edition of European Journal of Organic Chemistry.
The influenza A virus is classified based on the form of two of its outer proteins, hemagglutinin (H) and neuraminidase (N). Each classification – for example H5NI "bird flu" or H1N1 "swine flu" – represents a different mutation of hemagglutinin and neuraminidase or H and N.
Flu drugs currently on the market target only the neuraminidase proteins, and disrupt the ability of the virus to escape an infected cell and move elsewhere to infect other healthy cells. The new process developed by Linhardt is already showing strong binding potential to hemagglutinin, which binds to sialic acid on the surface of a healthy cell, allowing the virus to entire the cell.
"We are seeing promising preliminary results that the chemistry of this approach will be effective in blocking the hemagglutinin portion of the disease that is currently not targeted by any drug on the market," he said.
In addition, Linhardt and his team have shown their compound to be just as effective at targeting neuraminidase as the most popular drugs on the market, according to Linhardt.
The approach can also be modified to specifically target the neuraminidase or the hemagglutinin, or both, depending on the type of mutation that is present in the current version of the flu, according to Linhardt.
In the next steps of his research, Linhardt will look at how their compounds bind to hemagglutinin, and he will test the ability to block the virus first in cell cultures and then in infected animal models.
"It is still early in the process," he said. "We are several steps away from a new drug, but this technique is allowing us to move very quickly in creating and testing these compounds."
The technique that Linhardt used is the increasingly popular technique of "click chemistry." Linhardt is among the first researchers in the world to utilize the technique to create new anti-viral agents. The process allows chemists to join small units of a substance together quickly to create a new, full substance.
In this case, Linhardt used the technique to quickly build a new derivative of sialic acid. Because it is chemically very similar to the sialic acid found on the surface of a cell, the virus could mistake the compound as the real sialic acid and bind to it instead of the cell, eliminating the connections to hemagglutinin and neuraminidase that are required for initial infection and spread of the infection in the body. The currently available drugs are translation-state inhibitors whose chemical structure allows them to only effectively target the neuraminidase.
The research was funded by the National Institutes of Health. Linhardt was joined in the research by Michel Weïwer, Chi-Chang Chen, and Melissa Kemp of Rensselaer.
Swine Flu Outbreak Illuminated By Avian Flu Research
A new study by University of Maryland researchers suggests that the potential for an avian influenza virus to cause a human flu pandemic is greater than previously thought. Results also illustrate how the current swine flu outbreak likely came about. As of now, avian flu viruses can infect humans who have contact with birds, but these viruses tend not to transmit easily between humans. However, in research recently published in the Proceedings of the National Academy of Sciences, Associate Professor Daniel Perez from the University of Maryland showed that after reassortment with a human influenza virus, a process that usually takes place in intermediary species like pigs, an avian flu virus requires relatively few mutations to spread rapidly between mammals by respiratory droplets.
"This is similar to the method by which the current swine influenza strain likely formed," said Perez, program director of the University of Maryland-based Prevention and Control of Avian Influenza Coordinated Agricultural Project, AICAP. "The virus formed when avian, swine, and human-like viruses combined in a pig to make a new virus. After mutating to be able to spread by respiratory droplets and infect humans, it is now spreading between humans by sneezing and coughing."
In his study, Perez used the avian H9N2 influenza virus, one that is on the list of candidates for human pandemic potential. Using reverse genetics, a technique whereby individual genes from viruses are separated, selected, and put back together, Perez and his team created a hybrid human-avian virus. Their research hybrid has internal human flu genes and surface avian flu genes from the H9N2 virus. Though it comes from a different strain of avian flu than the one that contributed to the hybrid virus now causing the swine flu outbreak, Perez's research virus is similar in origin to the swine flu virus, in that both involved a combination of avian and human influenza viruses.
Perez infected ferrets (considered a good model for human influenza transmission) with the virus he created, and allowed the virus to mutate in the species. Before long, healthy ferrets that shared air space but not physical space with the infected ferret had the virus, showing that the virus had mutated to spread by respiratory droplets.
When the genetic sequences of the mutant virus and original hybrid virus were compared, the only differences were five amino acid mutations, three on the surface, and two internally. Two of the surface mutations were determined to be solely responsible for supporting respiratory droplet transmission. Because so few mutations were necessary to make the hybrid H9N2 transmissible this way, they concluded that after an animal-human hybrid influenza virus forms in nature, a human pandemic of this virus is potentially just a few mutations away.
"We do not know if the mutations we saw in the lab are the same that have made the H1N1 swine flu transmissible by respiratory droplets," Perez said. "We will be doing more research on the current swine flu strain to study its specific genetic mutations."
Perez found that one of the two of the genetic mutations in his lab strain that enabled respiratory transmission between mammals was on the tip of the HA surface protein, one of the sites where human antibodies created in response to current vaccines would bind.
"Because the binding site of the mutant virus is different from the virus upon which the vaccine is modeled, it may mean that current vaccine stocks would not be as effective against the H9N2 mutant strain as previously anticipated," said Perez. "We should keep this in mind when designing vaccines for an avian flu pandemic in humans."
However, scientists cannot predict what the actual mutations will look like if and when they occur in nature, or even which strain of avian influenza will mutate to infect mammals.
"This is just the tip of the iceberg," said Perez. "Many more studies have to be done to see which combinations of mutations cause this type of transmission before we can design the appropriate vaccines."
Perez will be talking this week with the NIH and the CDC to discuss his team's role in researching the current swine flu virus strain. Perez will likely do studies related to vaccine development, virus transmission between humans and animals, and the pathogenesis of the virus.
A virus vaccine is derived from the virus itself. The vaccine consists of virus components or killed viruses that mimic the presence of the virus without causing disease. These prime the body's immune system to recognize and fight against the virus. The immune system produces antibodies against the vaccine that remain in the system until they are needed. If that virus, or in some cases a closely similar one is later introduced into the system, those antibodies attach to viral particles and remove them before they have time to replicate, preventing or lessening symptoms of the virus.
The immune system also retains antibodies to a virus after being infected with it, so humans have general immunity to human strains of avian influenza strains. But humans do not generally have immunity to avian flu strains because they have not been infected by them before. The surface proteins are sufficiently different to escape the human immune response. Avian flu strains are therefore more dangerous for humans because the human immune system cannot recognize the virus or protect against it.
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