…In Fact, It’s Coming Here

From ProMED this morning:

INFLUENZA A (H1N1) – WORLDWIDE (60): EGYPT (CAIRO)

**************************************************

A ProMED-mail post

Date: Tue 9 Jun 2009
Source: Angola Press Agency (Angop) [in French, trans. Mod.FE, edited]

The influenza A (H1N1) virus has been detected in 2 foreign students of the American University of Cairo while [another 140 students] have been placed in quarantine, as we learnt from the medical services and the establishment.

Police officers wearing masks were stationed in front of their university dormitory in the Zamaleck area between the 2 arms of the Nile. Nobody was allowed either to go in or to come out.

“Two students were confirmed positive for the H1N1 virus.  Consequently, the residence was placed under quarantine for 24 hours,” a representative of the university declared, adding that a 3rd student who had fever, had been hospitalized for precautionary motives. All the students shall be subjected to a screening test.

The 1st Egyptian case of influenza A was detected last Tuesday [2 Jun 2009]. It is a 12-year-old American girl who arrived on holiday in Cairo. It is equally the 1st case detected in Africa.

Communicated by: ProMED-mail

[This is an update providing some details of the 1st case of influenza A (H1N1) in Egypt and Africa as a whole. Despite all the awareness of this novel virus raised in the last month in most countries in the world, it seems the disease is spreading steadily across the globe.

This new outbreak is particularly concerning as there is concurrent circulation of H5N1 virus in both human and poultry populations, increasing the pathways by which a highly transmissible and high mortality virus could evolve. [EPR: my bold]

ProMED-mail will be interested in the sequence of events following the detection of cases of influenza A (H1N1) in Egypt. – Mods.FE/PC]

And so it begins….  While a lot of people are eagerly watching the unfolding, essentially in real time, of what MUST be termed a pandemic whether the WHO wants to call it that or not, there is a very real human element to this unfolding phenomenon.

That is, a LOT of people in Africa and elsewhere in the developing world will get sick – and many may die, whether or not this is a “mild” flu.  Declan Butler, writing in the 27th May online version of Nature, says this:

“With the influenza season over in the temperate Northern Hemisphere, and just getting under way on the other side of the world, scientists are watching the A(H1N1) swine flu virus to see where it goes next and whether it will reassort with other flu viruses, or mutate, to cause more severe disease or acquire resistance to antiviral drugs.

Some researchers are warning, however, that such changes might be more likely to occur not in the northern or southern temperate zones where flu is seasonal, but in the narrow, often-overlooked belt of tropical countries where flu circulates all year round.”

And later:

“Surveillance is not just academic; it is key to getting early warnings of events that call for swift adaptations of control strategies. Swine flu is currently sensitive to the antiviral drug oseltamivir (Tamiflu), for example, but seasonal H1N1 is resistant. Were the new virus to acquire resistance, that would render redundant the Tamiflu stockpiled by many nations as part of their pandemic plans.

Tropical countries may be pivotal in such changes. “Tropical zones are the black box of influenza,” says Antoine Flahault, dean of the French School of Public Health in Rennes and Paris. Tropical southeast Asian countries in particular are a hotbed of flu viruses, ranging from H9N2 in children in Hong Kong and China, to H6N1 in birds and, by far the most prevalent, H4N6 in ducks and other waterbirds. The threat of reassortments occurring in poor tropical countries is compounded by the fact that humans tend to live in close proximity with livestock. “If it reassorts, who knows what could result,” says Shortridge.”

What a pleasant prospect…!  As for the sociopolitical side, the WHO is holding off declaring this to be Stage 6 of a pandemic – for who knows what reason, given that human-to-human sustained chains of transmission have been amply demonstrated outside of the place of origin.

Debora MacKenzie, writing in the 22nd May issue of New Scientist, says the following:

“The WHO rules for declaring different degrees of flu pandemic threat are based on epidemiology (how the virus is spreading) for good reasons. This is because any new flu virus to which most of the world has little immunity, and which spreads well enough person-to-person to escape its continent of origin, is very likely to go global, and to cause more sickness and death than flu usually does. That is the definition of a flu pandemic.

The virus’s ability to spread is what matters. H5N1 bird flu has travelled across Eurasia, mainly in birds, but it hasn’t spread readily in people, so it isn’t a pandemic.

The Mexican swine flu H1N1, however, has. When it spread across the Americas, the WHO followed its rules and declared it a level 5 situation; one down from a pandemic. When it starts spreading outside the Americas, through “community transmission” – meaning it crops up generally, not just in people who have visited Mexico or New York recently or their contacts – that means it’s got a foothold globally.

A flu that can do that is very unlikely to stop there. The WHO rules make that a full-blown level 6 pandemic.

And frankly, that is starting to happen. As I write, the number of confirmed cases in Japan (and that’s just people sick enough to see a doctor and get tested) has jumped by 35 in the past 24 hours, to nearly 300, mostly due to that perennial vector of flu, the gregarious teenager. The main cluster started without any known links to the Americas.

Meanwhile in Europe, countries are deliberately not testing cases that could be community acquired – almost as if someone doesn’t want to trigger level 6.”

I wonder why….  Global economic meltdown, possibly?  We watch and wait.  Meantime, the last word from New Scientist again – from an editorial in the June 6th issue:

Just do the swine flu tests
06 June 2009

GREEK doctors and flu scientists are saying what New Scientist revealed two weeks ago: swine flu could be spreading round Europe undetected because people without known links to flu aren’t being tested (see “Europe should test more broadly for swine flu”).

Maybe countries worry that if they test, they’ll be forced to use precious antiviral medicines on a mild strain. Maybe they just want this virus to spread quietly, so people will become immune to its successors. Maybe a basic understanding of epidemiology is lacking, though that seems unlikely.

But we know one thing: the only item of faith you need in science is that it’s better to know than not to know. If Europe’s leaders want everyone’s trust – trust they will need if this virus really does go global – it should emulate Australia, and do the tests.”

Amen.

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One Response to “…In Fact, It’s Coming Here”

  1. …In Fact, It’s Coming Here | swine flu pandemic Says:

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