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Online Discussion: Tracking new emerging diseases and the next pandemic; Now tracking the Aussie Flu.

WHO: Australia Flu may be pandemic

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    Posted: September 30 2017 at 2:19pm


Australia flu 'may tip pandemic'

Margaret Chan
The World Health Organization last declared a pandemic 41 years ago

A sharp increase in swine flu cases in Australia may mean the infection has become a pandemic, the World Health Organization says.

For that to happen, officials would have to verify that the disease had become established outside North America, where the crisis began.

"Once I get indisputable evidence, I will make the announcement," said WHO director general, Margaret Chan.

More than 1,200 people have contracted the virus in Australia - none fatally.

The total means Australia has seen a four-fold increase in a week.

Less than a month ago the country had only a handful of cases of the H1N1 virus but it now has the highest number of infections outside North America.

Victoria and the state capital, Melbourne, are the worst-hit with more than 1,000 confirmed cases.

Evolving

Most of those affected are suffering only a mild illness, but the Health Minister of Australia's Queensland state, Paul Lucas, has warned that the contagious respiratory condition would inevitably claim lives.

It does not mean that the severity of the situation has increased
WHO's Keiji Fukuda

The head of the WHO's global influenza programme, Keiji Fukuda, said the situation had "evolved a lot" in recent days.

"We are getting close to knowing that we are in a pandemic situation," he said.

But Dr Fukuda urged calm. "It does not mean that the severity of the situation has increased or that people are getting seriously sick at higher numbers or higher rates than before," he said.

Following the major outbreaks in North America the flu alert is currently at phase five of a six-level scale.

The virus has infected more than 26,500 people in 73 countries.

The WHO held a conference call with governments on Wednesday, but afterwards said no decision had been taken on moving to phase six - the pandemic stage - at the moment.

Gregory Hartl, WHOs spokesperson for epidemic and pandemic diseases, said if a pandemic was announced it would not be the "apocalyptic situation" envisaged when bird flu looked liked it would be the cause.

"What we are seeing now with H1N1 is that in most cases the disease is self-limting, lets say 98-98% of the people we know to be affected recover without any need for hospitalisation, as far as we can tell.

"We do understand that the natural reaction of people if and when we declare phase six could be very strong.

"But we would hope that there would be quiet quickly an adjustment reaction, as happened in the US, when people realised they weren't getting seriously ill."

Fergus Walsh
The media must play a part here, emphasising the facts about this virus and not over-reacting
Fergus Walsh
BBC medical correspondent

BBC medical correspondent Fergus Walsh says it is true that the word "pandemic" sounds scary. But it simply means a global epidemic of an infectious disease.

He says it is not a signal that the virus is getting more virulent - only a measure of its geographical spread.

As the number of H1N1 cases in Australia passes 1,200, Singapore has urged its citizens to avoid travel to Victoria.

Authorities in New South Wales and South Australia, as well as the national capital, Canberra, have told children who have recently travelled to Melbourne to stay away from school for a week on their return home.

The entire squad and staff of the Brisbane Broncos rugby league club have been put into quarantine as tests are carried out on a player suspected of contracting swine flu.






http://news.bbc.co.uk/2/hi/asia-pacific/8092474.stm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 2:36pm
Australia's killer flu: Calls for more immunisations as virus mutates

A fast-mutating strain of the flu is defying medical experts' efforts to stop it and has already killed at least 73 people in Australia this year. 

Victorian Infectious Diseases Reference Laboratory figures showed that the number of notified laboratory-confirmed flu cases in Victoria for the year to July 2 was more than 90 per cent higher than those for the same period last year.

http://www.smh.com.au/victoria/australias-killer-flu-calls-for-more-immunisations-as-virus-mutates-20170907-gyd2fm.html




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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 3:13pm
Dreaded Aussie flu heading towards Britain could kill as many people as the Hong Kong pandemic of 1968, public health expert warns

The dreaded Aussie flu outbreak that the NHS is preparing for will be the worst in 50 years, experts have warned.


Some A&E units in Australia had 'standing room only' after being swamped by more than 100,000 cases of the H3N2 strain.

Professor Robert Dingwall, a public health expert at Nottingham Trent University, said it is 'inevitable' it will reach Britain.

He said it could claim as many lives as the Hong Kong flu outbreak in 1968, which killed at least one million people. ...

http://www.dailymail.co.uk/health/article-4916664/Aussie-flu-kill -1968-Hong-Kong-pandemic.html

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 3:20pm
MORE than half the patients in western Sydney diagnosed with the influenza A virus have also been carrying the mutant strain of the virus, widely known as the killer flu.

The flu season which began in June, placed a strain on nurses at Blacktown Hospital as it filled up hospital beds and emergency departments... 

http://www.dailytelegraph.com.au/newslocal/blacktown-advocate/thousands-are-hit-by-virus-flu-strain-not-covered-by-vaccine/news-story/e56ca01057827806dfcfb613ac078eac?nk=28c38d958a0d474c552639d5d6259aeb-1506808352

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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 3:37pm
So...pandemics have a periodicity of three per century, with two of those being minor and one major. Last major pandemic was in 1918, and that was an upstart H1N1 strain.

Yeah, we're good Confused


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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 3:46pm
Nearly 100 years ago, in 1918, the world experienced the greatest tidal wave of death since the Black Death, possibly in the whole of human history. We call that tidal wave the Spanish flu, and many things changed in the wake of it. One of the most profound revolutions took place in the domain of public health.

The world was a very different place in the first decades of the 20th century. Notably, there was no real joined-up thinking when it came to healthcare. Throughout the industrialized world, most doctors either worked for themselves or were funded by charities or religious institutions, and many people had no access to them at all.


Public health policies—like immigration policies—were colored by eugenics. It was common for privileged elites to look down on workers and the poor as inferior categories of human being, whose natural degeneracy predisposed them to disease and deformity. It didn’t occur to those elites to look for the causes of illness in the often abject living conditions of the lower classes: crowded tenements, long working hours, poor diet. If they sickened and died from typhus, cholera and other killer diseases, the eugenicists argued, then it was their own fault, because they lacked the drive to achieve a better quality of life. In the context of an epidemic, public health generally referred to a suite of measures designed to protect those elites from the contaminating influence of the disease-ridden rabble.

The first wave of the Spanish flu struck in the spring of 1918. There was nothing particularly Spanish about it. It attracted that name, unfairly, because the press in neutral Spain tracked its progress in that country, unlike newspapers in warring nations that were censored. But it was flu, and flu as we know is transmitted on the breath—by coughs and sneezes. It is highly contagious and spreads most easily when people are packed together at high densities—in favelas, for example, or trenches. Hence it is sometimes referred to as a “crowd disease.”

image: https://public-media.smithsonianmag.com/filer/97/4b/974b09a3-48fc-4833-a866-2d83bfa045bd/165-ww-269b-25-police-l.jpg

165-WW-269B-25-police-l.jpgPolicemen in Seattle wearing masks made by the Red Cross during the influenza epidemic, December 1918. (National Archives)

That first wave was relatively mild, not much worse than seasonal flu, but when the second and most deadly phase of the pandemic erupted in the autumn of 1918, people could hardly believe that it was the same disease. An alarmingly high proportion of patients died—twenty-five times as many as in previous flu pandemics. Though initially they reported the classic symptoms of flu—fever, sore throat, headache—soon they were turning blue in the face, having difficulty breathing, even bleeding from their noses and mouths. If blue turned to black, they were unlikely to recover. Their congested lungs were simply too full of fluid to process air, and death usually followed within hours or days. The second wave receded towards the end of the year, but there was a third and final wave—intermediate in virulence between the other two—in early 1919.

Flu is caused by a virus, but virus was a novel concept in 1918, and most of the world’s doctors assumed they were dealing with a bacterial disease. This meant that they were almost completely helpless against the Spanish flu. They had no flu vaccine, no antiviral drugs, not even any antibiotics, which might have been effective against the secondary bacterial infections that killed most of its victims (in the form of pneumonia). Public health measures such as quarantine or the closing of public meeting places could be effective, but even when they were imposed this often happened too late, because influenza was not a reportable disease in 1918. This meant that doctors weren’t obliged to report cases to the authorities, which in turn meant that those authorities failed to see the pandemic coming.

The disease claimed between 50 and 100 million lives, according to current estimates, or between 2.5 and five percent of the global population. To put those numbers in perspective, World War I killed about 18 million people, World War II about 60 million. Rates of sickness and death varied dramatically across the globe, for a host of complex reasons that epidemiologists have been studying ever since. In general, the less well-off suffered worst—though not for the reasons eugenicists proposed—but the elites were by no means spared.

The lesson that health authorities took away from the catastrophe was that it was no longer reasonable to blame an individual for catching an infectious disease, nor to treat him or her in isolation. The 1920s saw many governments embracing the concept of socialized medicine—healthcare for all, delivered free at the point of delivery. Russia was the first country to put in place a centralized public healthcare system, which it funded via a state-run insurance scheme, and others in Western Europe followed suit. The United States took a different route, preferring employer-based insurance schemes, but it also took measures to consolidate healthcare in the post-flu years.

In 1924, the Soviet government laid out its vision of the physician of the future, who would have “the ability to study the occupational and social conditions which give rise to illness and not only to cure the illness but to suggest ways to prevent it.” This vision was gradually adopted across the world: the new medicine would be not only biological and experimental, but also sociological. Public health started to look more like it does today.

The cornerstone of public health is epidemiology—the study of patterns, causes and effects in disease—and this now received full recognition as a science. Epidemiology requires data, and the gathering of health data became more systematic. By 1925, for example, all U.S. states were participating in a national disease reporting system, and the early warning apparatus that had been so lamentably lacking in 1918 began to take shape. Ten years later, reflecting the authorities’ new interest in the population’s “baseline” health, U.S. citizens were subjected to the first national health survey.

Many countries created or revamped health ministries in the 1920s. This was a direct result of the pandemic, during which public health leaders had been either left out of cabinet meetings entirely, or reduced to pleading for funds and powers from other departments. But there was also recognition of the need to coordinate public health at the international level, since clearly, contagious diseases didn’t respect borders. The year 1919 saw the opening, in Vienna, Austria, of an international bureau for fighting epidemics—a forerunner of today’s World Health Organization.

By the time the WHO came into existence, in 1946, eugenics had been disgraced and the new organization’s constitution enshrined a thoroughly egalitarian approach to health. It stated that, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” That philosophy wouldn’t eliminate the threat of flu pandemics—the WHO has known three in its lifetime, and will surely know more—but it would transform the way human beings confronted them. And it was born of an understanding that pandemics are a social, not an individual problem.By 

smithsonian.com 

Read more: http://www.smithsonianmag.com/history/how-1918-flu-pandemic-revolutionized-public-health-180965025/#OA3eQAEV1AshfrS3.99
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Read more: http://www.smithsonianmag.com/history/how-1918-flu-pandemic-revolutionized-public-health-180965025/#OA3eQAEV1AshfrS3.99
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 3:53pm
It's a little surreal that we should be looking at a couple of very real pandemic candidates as we close in on Spanish Flu's centennial anniversary.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 3:54pm
Clap
Absence of proof is not proof of absence.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 4:06pm
Very true JD, and this one appears to be rapidly mutating.  Don't remember seeing the word "mutated" thrown around this much in the past.   
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 4:06pm

More flu deaths expected as debate over vaccine ensues

By Caroline Winter on PM

There's a dire warning from Australia's Chief Medical Officer today, that the death toll from this year's flu outbreak is expected to rise.

One-hundred-and-seventy-thousand formally diagnosed flu cases have been recorded already this year, and at least 100 people have died.

An eight-year-old girl died from flu last week, another woman is fighting for life in a coma, while the elderly have been hardest hit.

It's raised questions about the effectiveness of the vaccine and what is being done about future immunisation programs.

Duration: 4min 32sec
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 4:27pm

Flu epidemic: Experts explain the reasons behind Australia's bad season

Updated Friday at 08:21
First posted Thursday at 13:31

If you've escaped flu this year, there's some good news: the peak of our bad flu season seems to have passed in most, if not all, parts of Australia.

But because there have been significantly more influenza cases than usual, there's still a lot of illness around.

We asked infectious diseases experts Professor Peter Collignon from the Australian National University's Medical School, and Professor Allen Cheng from Monash University and The Alfred Hospital to answer some common questions.

How bad has this year's flu season been?

If you look at the result of lab tests, there's been more than 2.5 times the number of confirmed cases of influenza compared to last year, Professor Collignon says.

But this figure is misleading because some of the rise is due to an increase in the availability of rapid testing for flu.

The number of hospital and GP visits for influenza is a much better guide and these suggest about a 50 per cent rise in flu cases, he says.

But it's hard to say for sure until the flu season is over and all the data is collated.

Professor Cheng estimates in total, about 5 per cent of Australians will have had flu this year.

The total number of flu deaths is not yet known.

Figures collected by ABC 7.30 last week showed there had been more than 370 confirmed influenza deaths recorded in four states so far. Many of these were in aged care facilities.

Why has it been a bad flu season?

A key factor seems to be that the flu vaccine has been less effective than expected this year.

Preliminary data suggests it offered only 15 to 20 per cent protection, Professor Collignon says.

This means as many as 85 per cent of people who were vaccinated and then exposed to the virus still got infected.

"For whatever reason, the vaccine has been very ineffective this year."

On average, over the past 10 years, the flu vaccine protected about 40 to 50 per cent of people from infection (this is substantially less than other vaccines, like say, measles, which is about 90 per cent effective).

One reason for this is the influenza virus can mutate rapidly.

Because the vaccine has to be planned and manufactured many months ahead of the start of the flu season, the strains on which the vaccine are based may end up not being a good match with the strains of flu virus circulating.

"A lot of seasons there's a mismatch. But even if there isn't, the vaccine often just isn't as effective as you'd expect it to be. We don't know why," Professor Collignon said.

"We really need a better vaccine. We need a different design of vaccine that … gives us protection for the next five or 10 years, no matter what strains come."

Were the flu viruses unusually severe this year?

It seems not. It was a bad season because there were a lot more cases of flu, rather than because the viruses circulating were especially severe.

"I'm not aware of any data that shows [this year's flu] is more virulent or aggressive," Professor Collignon said.

The most recent Australian Influenza Surveillance Report described the clinical severity of flu this year was "low to moderate".

Is it worth bothering with a flu shot each year?

Flu is a serious illness which can sometimes kill even apparently healthy people.

"Even though we've got a vaccine that's not predictable in how well it works each year and on average might have only a 40 per cent efficacy, we'd still recommend it because that reduction is better than nothing," Professor Collignon said.

That's particularly important if you're in an 'at risk' group for whom flu can cause very serious effects.

"If you've got really bad heart disease or diabetes, the last thing you need is another serious infection. It could be like the straw that breaks the camel's back."

Why is flu deadly?

It's known influenza by itself can kill people because it can have overwhelming effects on your body. (This is especially the case if you have an underlying disease that already strains vital organs.)

But secondary bacterial infections are actually the most common cause of death in people with flu, Professor Collignon says.

"From all the data I've seen, if you die of influenza there's around a 70 per cent chance it was a secondary bacterial infection that killed you rather than the virus by itself."

Having flu can make a secondary bacterial infection more likely by damaging the natural mechanisms your airways use to expel bacteria when you inhale them in air.

This can make it more likely you will get infections like pneumonia, which damages your lungs so you can't breathe properly.

What can we do to reduce secondary bacterial infections?

Taking antibiotics to reduce the risk of a secondary bacterial infection "would be a really bad idea", Professor Collignon says.

Less than one to 2 per cent of people who get influenza will end up with a complication from it.

For everyone who gets flu to take antibiotics would lead to more bacteria being resistant to antibiotics.

That means when people really needed antibiotics, the drugs would be less likely to help them.

"We need better data to work out how we identify the small percentage who will get that secondary bacterial infection and [we also need to know] is there a rapid test we can do?

"If you're sick with what might be influenza and, after four to five days, you start to get sicker, you should go and see a doctor and ask the specific question, 'Could I have a bacterial secondary pneumonia?' That is the most common life-threatening complication."

If your doctor suspects pneumonia, he or she may organise a chest x-ray and blood test.

Has this year's flu affected younger people versus older people differently?

There's no evidence the proportion of younger people affected is greater this year. But absolute numbers are likely higher because of the higher number of infections overall.

It is the elderly who seem hardest hit. And it seems the vaccine was particularly ineffective in this age group.

"We've got essentially the same vaccine as England and Europe had last year. That vaccine appears to have been virtually completely ineffective in over 65s there. It just didn't work at all. We don't know why," Professor Collignon says.

"It looks like the vaccine efficacy [in this age group] is going to be no better for us than it was in England and Europe."

In general, older people produce a less effective immune response to vaccines than younger people.

But this year, the strain of flu that dominated in Australia (H3, a type of influenza A) is one known to cause more significant illness in the elderly. As well, it's known this strain underwent some changes this season.

These factors may have contributed to the large number of cases in older people who had been vaccinated, Australia's Chief Medical Officer, Professor Brendan Murphy, says.

Are we through the worst of it?

Probably yes, although in tropical regions of Australia there tends to be two flu seasons a year and the second season may not have hit there yet, Professor Cheng says.

"The ACT has less activity. It's well and truly passed the peak," he said.

Victoria and NSW still have, "quite a lot of flu activity" and Tasmania, Queensland and South Australia still have, "a reasonable amount of activity".

For reasons not fully understood, Western Australia and the Northern Territory have not had as many cases of flu this year.

Professor Collignon says: "I would think in most places we are passed the peak. We still have large numbers [in some areas] though because even on the downside of the mountain, it's still quite high compared to base [levels]."

Is it too late to get the vaccine now?

Every individual has to weigh up the potential risks and benefits of the flu vaccine for themselves. A discussion with your doctor may be helpful.

"My own personal view is you've missed the boat," Professor Collignon says. "The vaccine takes at least two weeks to work.

"I would think it's very unlikely we're going to have large numbers of flu cases two to three weeks from now."

Editor's note: This article has been edited to clarify Professor Collignon’s comment about the rate of infection for people who got this year’s vaccine: 85 per cent of those who were vaccinated and then exposed still got infected, rather than 85 per cent of all people vaccinated.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 30 2017 at 4:41pm
I saw that article from last Thursday, and what's interesting is, during the time (week) of that story, flu cases increase 4-fold in that last week.   
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Post Options Post Options   Thanks (0) Thanks(0)   Quote John L. Quote  Post ReplyReply Direct Link To This Post Posted: October 01 2017 at 1:10am
This is a strange situation.  So my claim the current flu vaccine is already obsolete and near useless is only trending stronger.  However, note that the "Aussie Flu," which is a severe flu, is an H3.  The pandemic swine flu, which is thus far mild in severity, is an H1.  If this H1 displaces the H3 (as most years, one or the other dominates,) then this could actually be a good thing, in effect protecting us from a severe H3 flu for which the vaccine already made is useless.  I will be monitoring this situation closely with you all.
Also there are indications the H3 mutations that reduce vaccine efficacy may primarily effect egg based vaccines.  Flucelvax is a cell based vaccine, so I will be seeking this to hope it may work better than 20%.
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