H1N1 Flu Perspective

H1N1 Flu Perspective

By Ilene at Phil’s Stock World

Below are excerpts from a number of articles regarding the H1N1 flu pandemic in the Ukraine and the Norway mutation.  The "Norway" mutation was found in three cases in Norway, and throughout other countries as well. Due to its ability to bind to receptors deeper in the respiratory tract, it is speculated that it may confer greater virulence to the H1N1 virus.  It has not been proven to be spreading wildly throughout the Ukraine and other regions – it may be endemic however, as part of the mixture of circulating flu.  More research needs to be done to learn the extensiveness, communicability of, and significance of this form of the H1N1 virus.

First, for perspective, here’s a entry in Wikipedia about deaths in the 1918 flu pandemic:

Here’s Mr. Pan’s view of the Ukraine situation, with my yellow highlighting.  

In Ukraine, H1N1 pandemic sets off panic and politicking
Fear pervades nation where government is mistrusted, health system is weak

By Philip P. Pan
Washington Post Foreign Service
Saturday, November 21, 2009

KIEV, UKRAINE — One night at the height of the panic over what people here call the California flu, as 24-hour news stations tracked a rising death toll and politicians speculated about a mystery lung plague, Ukraine’s prime minister rushed to the airport to greet a shipment of Tamiflu as if it were a foreign dignitary. Not to be outdone, the president, a bitter political foe, dispatched a top aide to meet the plane, too.

In neighboring Belarus, the government took an opposite tack, accusing drug companies of fanning hysteria over swine flu to boost profit. In Poland, the health minister is under fire for refusing to stock up on a vaccine, while doctors in Hungary are resisting orders to administer the shot…

As the pandemic H1N1 influenza surges with the onset of winter, the nations of Eastern Europe and the former Soviet Union appear particularly vulnerable to the deadly virus. Burdened with weak health-care systems, relatively inexperienced news media outlets and shaky governments that have little public trust, the region also seems ripe for panic and political strife over the flu.

The potential for trouble is already on display in Ukraine, where 1.5 million of its 46 million people have had diagnoses of flu and respiratory illnesses since the start of the outbreak and 356 have died,…

More telling than the numbers, however, has been the widespread fear the virus has caused in Ukraine, and the outsize impact it has had on the nation’s political landscape.

In the weeks since Prime Minister Yulia Tymoshenko announced measures against the spread of the flu — shutting the nation’s schools and banning public gatherings — anxious residents have overwhelmed hospitals and pharmacies, buying up supplies of medicine, gauze masks and home remedies such as lemons and garlic. Rumors have proliferated that people are dying of a new, more lethal strain of the virus.

Semyon Gluzman, a psychiatrist and Soviet-era dissident in Kiev, said the fear was a rational response in a nation with a dysfunctional health-care system and a corrupt, ineffective government. Hopes soared in Ukraine after the mass pro-democracy demonstrations known as the Orange Revolution, he said, but the five years of political infighting since have undermined the public’s faith in the nation’s leaders and political institutions.

"What we’re seeing is a normal, psychological reaction to the complete incompetence of the state authorities," he said. "People are scared, and they don’t know who to trust anymore."…

Ukraine has one of the weakest health-care systems in Europe, being a Soviet relic that has barely changed despite 18 years of independence. Medical care is supposed to be free, but quality is poor, with underpaid state doctors surviving by taking bribes and selling unnecessary drugs. Life expectancy is a decade lower than in the European Union…

The WHO says the beleaguered system has held up fairly well, because advanced equipment or training isn’t needed to fight swine flu. But the organization also identified problems here that could arise throughout Eastern Europe…

Conveying accurate information to the public is another challenge in the region, he said. In some countries, especially the authoritarian states of Central Asia, officials are accustomed to concealing disease outbreaks, while in others, the free press is a relatively new institution and media outlets dwell on conspiracy theories. "It’s like dealing with English tabloids all the time," Mercer said.

Yevgeny Komarovsky, a pediatrician and popular author in Ukraine, said the media here so sensationalized the outbreak that "we should also be counting casualties from heart attacks and high blood pressure due to the panic." He recalled a five-hour television special in which a series of ill-informed politicians were interviewed instead of medical experts, calling it "a concentration of stupidity."

"I felt ashamed for my country," he said, noting that one presidential candidate complained about shortages of an ointment with no proven effect and another suggested that the plague had hit Ukraine.

One result of the mistrust in government is deep skepticism about immunization in general and the swine flu vaccine in particular. The sentiment is common in Eastern Europe and Russia, where people express doubts about the safety of state supplies and suspicions of corrupt deals with drug firms. But it is particularly intense in Ukraine, with parents often paying doctors to falsify their children’s immunization records. 

Full article here.

D225G Swine flu mutation – Same receptor as 1918 Spanish flu pandemic found in Ukraine virus

According to analysis of genetic testing done by the World Health Organization, the Ukraine flu virus is an H1N1 mutation that is similar to the 1918 Spanish flu epidemic. The two flu virus outbreaks both have changes in the receptor binding domain D225G, and similar symptoms, which include bleeding in the lungs. Current estimates of the deaths attributed to the Ukraine flu outbreak is as many as 400, and increasing daily…

The receptor binding proteins present in the Spanish flu and in swine flu mutations that result in bleeding lungs and death are the same. A virus attaches to charged molecules on cells. Some attach to proteins and others to lipids, but the type of molecule differs between viruses. The virus samples analyzed by the World Health Organization from the Ukraine flu showed a different receptor binding pattern than the original swine flu virus, but the same as the receptor binding pattern as the 1918 Spanish flu.

My comment: Rather than calling the virus the "Ukraine virus," it is more accurate to call the mutation or variant the "D225G mutation" or "D225G variant" –noting the specific change in the genetic code. This change has been detected in viral isolates from patients in many locations. According to Dr. Henry Niman, an expert in viral evolution, the D225G variant is present along with the "wild-type" viruses (the most common virus currently being isolated) in many countries, and may simply co-exist with the "wild-type" H1N1 strain. The D225G change confers the ability to bind cells in the lungs, and this may increase the virus’s virulence. Other factors affect virulence as well, and more research needs to be conducted to determine the prevalence of this viral subclone, and it significance. (See my recent article, Flu News: What’s the significance of D225G?, for a more detailed explanation.)

See WHO investigating Norway swine flu mutations: 

The same mutation has been found in both fatal and mild cases elsewhere, including in Brazil, China, Japan, Mexico, Ukraine, and the United States, said WHO.

In addition, "worldwide, viruses from numerous fatal cases have not shown the mutation," the global body said. "The public health significance of this finding is thus unclear."

CDC Press Briefing November 20th:

Operator: Betsy McKay,  the Wall Street Journal, your live is open. 

Betsy McKay: I just wanted to follow-up on the question about the mutation in norway. I wondered if you could talk a little bit more about is it possible that this mutation has produced a more virulent form and what has CDC uncovered through its own work? 

Anne Schuchat: this mutation has been seen sporadically here and there around the world.  Sometimes it’s been seen in patients who had very mild disease and sometimes it’s been seen in people who had more severe or fatal disease. And, of course, lots of virus without this mutation has been seen in the fatal as well as the milder forms of H1N1 influenza. There’s some theoretical reasons why this particular mutation might lead an influenza virus to live easier in the deep part of the lungs and cause lower respiratory infections, but we’ve actually seen lower respiratory infections in a severe viral pneumonia without this mutation. So I think it’s too soon to say what this will mean long term…

Panic over hundreds of flu deaths exploited by Ukraine’s politicians
The Guardian, Tracy McVeigh

The onslaught of the virus has seen all the major political figures eagerly exploiting the outbreak. Prime minister Yulia Tymoshenko announced the arrival of an epidemic on 30 October, when only one case had been reported, and has closed all schools and banned public gatherings including campaigning political rallies – for the past three weeks…

"This is very dangerous,’ said Igor Shkrobanets, chief of the health ministry in the western district of Chernivtsi. "One or another politician will gain from this situation, but the doctors and their patients certainly will not."

He said the level of fear was such that people were calling out ambulances when they felt the first touch of a fever and hospitals were "overloaded".

In such uneasy times, bloggers and conspiracy theorists have whipped up fears by suggesting that bubonic plague, or a new, more lethal strain of the flu, was sweeping Ukraine and that there was a massive cover-up of the numbers of deaths.

"We are seeing reports of bodies lying in the streets," said one. Others claim to have seen reports of doctors mystified by the state of a patient’s lungs after death. But with no authoritative medical analysis of the cases available, such amateur diagnosis has run riot.

The isolation of many Ukrainian towns, especially as winter closes in, combined with the lack of public trust in the weak government and the inexperience of many of the new, 24-hour media outlets, was fuelling the rumour-mongering and the scare stories, said one of the staff at the English-language Kyiv Post.

Semon Gluzman, a psychiatrist in the capital, Kiev, told the Washington Post: "What we’re seeing is a normal psychological reaction to the complete incompetence of the state authorities. People are scared and they don’t know who to trust any more."… 

H1N1 Deaths Rise in Europe; Toll Below Seasonal Flu
Bloomberg, by Jason Gale

Nov. 23 – Swine flu deaths have doubled almost every two weeks since mid October in Europe, with 169 occurring in the past week, the European Center for Disease Control and Prevention said.

Across the region, 670 people infected with the new H1N1 influenza strain have died, the Stockholm-based ECDC said today in a report on its Web site. Cases are being reported in all European Union and European Free Trade Association countries.

“While the most deaths have to date been in Western Europe, there are increasing numbers of deaths being reported from Central and Eastern Europe,” the ECDC said in its daily report.

Europe’s toll accounts for a tenth of the fatal cases reported globally by the World Health Organization last week and so far is a fraction of the 40,000 to 220,000 deaths that the ECDC estimates are caused by seasonal flu in the region each year. Unlike the usual winter strains that predominantly kill the frail elderly, swine flu is targeting younger people who rarely succumb to influenza.

Although the author of the Bloomberg article describes the H1N1 flu strain as "new," perhaps causing some confusion, I believe he is referring to the swine flu virus itself and not differentiating between the various mutated strains that have been isolated.

ECDC: DAILY UPDATE
European Centre for Disease Prevention and Control, November 23

Pandemic (H1N1) 2009

Main developments in past 72 hours

• The number of confirmed deaths reported by EU & EFTA countries as due to the pandemic rose by two thirds in one week to 169;
• Routine surveillance reports from primary care indicate that almost all European countries reported intensity above baseline levels. Seventeen countries showed increasing trends mostly counties in Eastern Europe. But some countries are now reported decreasing trends;
• EMEA’s Committee on Human Medical Products has strengthened its previous statement that a single injection of the vaccines Focetria and Pandemrix may be sufficient to protect children over age 10 and adults to age sixty;
• EMEA also sees no evidence to date that any of the licensed vaccines have side effects more than those expected from the clinical trials;
• A mutation in the Haemagglutinin gene of the pandemic virus has been reported from Norway;
• Two clusters of possible transmission of oseltamivir resistant Pandemic Influenza A(H1N1)v among hospitalized patients in the United Kingdom and United States;
• Episouth update from countries of the Mediterranean and the Balkans included.

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 – as of 22 November 2009 – 16:00 hours CEST, for the world, and 23 November 2009 – 09:00 hours CEST, for Europe.  Update 23 November 2009, 09:00 hours CEST. 

I encourage people to read the full ECDC report themselves.

See also my previous update of the Flu News here.