Newsletter 22 Januari 2010

New Issue
Serologic study finds H1N1 infections surged past official estimates
In one of the first large serologic studies of pandemic H1N1 infection, British researchers found that in areas hit hard during the first wave, one in three children were infected by the virus, ten times higher than surveillance estimates.
Serologic studies, such as this report by scientists from England's Health Protection Agency (HPA) published today in The Lancet, are needed to help public health officials gauge the true burden of disease. Flu surveillance captures only the number of people who seek medical care for illnesses, missing asymptomatic or mild infections.
Public health officials also use serologic studies to assess the effectiveness of vaccination and other strategies and to fine-tune their modeling assumptions for future flu outbreaks.
Source: CIDRAP
Read more: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jan2110serology-jw.html

Research
Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection
Abstract
Background: In the context of 2009 pandemic influenza (H1N1) virus infection (pandemic H1N1 influenza), identifying correlates of the severity of disease is critical to guiding the implementation of antiviral strategies, prioritization of vaccination efforts and planning of health infrastructure. The objective of this study was to identify factors correlated with severity of disease in confirmed cases of pandemic H1N1 influenza.
Methods:This cumulative case–control study included all laboratory-confirmed cases of pandemic H1N1 influenza among residents of the province of Manitoba, Canada, for whom the final location of treatment was known. Severe cases were defined by admission to a provincial intensive care unit (ICU). Factors associated with severe disease necessitating admission to the ICU were determined by comparing ICU cases with two control groups: patients who were admitted to hospital but not to an ICU and those who remained in the community.
Results: As of Sept. 5, 2009, there had been 795 confirmed cases of pandemic H1N1 influenza in Manitoba for which the final treatment location could be determined. The mean age of individuals with laboratory-confirmed infection was 25.3 (standard deviation 18.8) years. More than half of the patients (417 or 52%) were female, and 215 (37%) of 588 confirmed infections for which ethnicity was known occurred in First Nations residents. The proportion of First Nations residents increased with increasing severity of disease (116 [28%] of 410 community cases, 74 [54%] of 136 admitted to hospital and 25 [60%] of 42 admitted to an ICU; p < 0.001), as did the presence of an underlying comorbidity (201 [35%] of 569 community cases, 103 [57%] of 181 admitted to hospital and 34 [76%] of 45 admitted to an ICU; p < 0.001). The median interval from onset of symptoms to initiation of antiviral therapy was 2 days (interquartile range, IQR 1–3) for community cases, 4 days (IQR 2–6) for patients admitted to hospital and 6 days (IQR 4–9) for those admitted to an ICU (p < 0.001). In a multivariable logistic model, the interval from onset of symptoms to initiation of antiviral therapy (odds ratio [OR] 8.24, 95% confidence interval [CI] 2.82–24.1), First Nations ethnicity (OR 6.52, 95% CI 2.04–20.8) and presence of an underlying comorbidity (OR 3.19, 95% CI 1.07–9.52) were associated with increased odds of admission to the ICU Abstract (i.e., severe disease) relative to community cases. In an analysis of ICU cases compared with patients admitted to hospital, First Nations ethnicity (OR 3.23, 95% CI 1.04–10.1) was associated with increased severity of disease.
Interpretation: Severe pandemic H1N1 influenza necessitating admission to the ICU was associated with a longer interval from onset of symptoms to treatment with antiviral therapy and with the presence of an underlying comorbidity. First Nations ethnicity appeared to be an independent determinant of severe infection. Despite these associations, the cause and outcomes of pandemic HINI influenza may involve many complex and interrelated factors, all of which require further research and analysis.
Source: Canadian Medical Association
Read more: http://www.cmaj.ca/cgi/content/abstract/cmaj.091884v1

Mask Use, Hand Hygiene, and Seasonal Influenza‐Like Illness among Young Adults: A Randomized Intervention Trial
Abstract
Background: During the influenza A(H1N1) pandemic, antiviral prescribing was limited, vaccines were not available early, and the effectiveness of nonpharmaceutical interventions (NPIs) was uncertain. Our study examined whether use of face masks and hand hygiene reduced the incidence of influenza‐like illness (ILI).
Methods: A randomized intervention trial involving 1437 young adults living in university residence halls during the 2006–2007 influenza season was designed. Residence halls were randomly assigned to 1 of 3 groups—face mask use, face masks with hand hygiene, or control— for 6 weeks. Generalized models estimated rate ratios for clinically diagnosed or survey‐reported ILI weekly and cumulatively.
Results: We observed significant reductions in ILI during weeks 4–6 in the mask and hand hygiene group, compared with the control group, ranging from 35% (confidence interval [CI], 9%–53%) to 51% (CI, 13%–73%), after adjusting for vaccination and other covariates. Face mask use alone showed a similar reduction in ILI compared with the control group, but adjusted estimates were not statistically significant. Neither face mask use and hand hygiene nor face mask use alone was associated with a significant reduction in the rate of ILI cumulatively.
Conclusions: These findings suggest that face masks and hand hygiene may reduce respiratory illnesses in shared living settings and mitigate the impact of the influenza A(H1N1) pandemic.
Source: University of Chicago Press
Read more: http://www.journals.uchicago.edu/doi/abs/10.1086/650396

Comment
Swine flu wasn't overhyped – research meant we had to play it safe
Simon Jenkins's distaste for scientists leads him to declare that they deliberately overstate risks, and make panic predictions (Swine flu was as elusive as WMD. The real threat is mad scientist syndrome, 15 January). In reality, scientists worked calmly – not "frantically" as Jenkins asserts – to predict the progress of the disease and to understand risk.
Jenkins says of the initial predictions about the spread of swine flu: "The chief medical officer, Sir Liam Donaldson, bandied about any figure that came into his head, settling on '65,000 could die', peaking at 350 corpses a day."
Worst-case predictions are not figures plucked out the air "to convey plausibility", but result from well-researched computer simulations. Margins of error are high; no one pretends otherwise. Yet Jenkins is delighted when a worst-case scenario isn't met, as though he were right and everyone else wrong.
Source: Guardian
Read more: http://www.guardian.co.uk/commentisfree/2010/jan/21/swine-flu-panic-health-tamiflu?

Risk Communication
Parents and Children Can Take Steps to Avoid H1N1
Ways to make the swine flu less fearsome for your family.
Your child has symptoms that used to just upset you: runny nose, sore throat, cough.
Now those same symptoms terrify you.
You know they may be signs of the H1N1 "swine flu" influenza strain.
That flu has already swept through many parts of the country and experts fear a resurgence this fall.
Parents now have to sift through a swirling mass of information about this new health threat. Younger children may be even more confused.
"What I'm hearing is that parents are fearful because of the unknown, because it's something new. People get the feeling that it's a changing playing field where recommendations are changing, which is true," says David Ulery, pediatrician at Aurora Wilkinson Medical Clinic in Oconomowoc, Wisconsin.
Kids cope with flu fears in their own way.
"Kids are fearful of the shots. But some of our children say, 'I'm not afraid of the shot, so can I get one for my sister because she's afraid and then she doesn't have to get one?' " says John R. Meurer, associate professor of pediatrics and chief of general pediatrics at the Medical College of Wisconsin, and medical director of Milwaukee's Downtown Health Center.
There are ways to make the swine flu less fearsome for both parents and children. Here are some ideas.
FLU-FIGHTING TIPS FOR PARENTS

• Raise your family's general health level. Make sure everyone gets enough sleep, eats right and exercises to improve immunity.
• Know the contagion timetable. According to the Centers for Disease Control and Prevention, people with H1N1 virus may infect people from one day before getting sick to five to seven days after. This "infection window" may be longer for children.
• Remember the swine flu's method of operation to outfox it. The swine flu spreads through the same viral techniques as seasonal flu: through the coughs and sneezes of flu sufferers and by touching something with flu viruses on it and then touching your mouth or nose.
• Stay informed on swine flu vaccination techniques. Current data suggests that people ages 10 and older will need one injection; ages 9 and younger might need two. You may also be given the option of getting your child vaccinated with a nasal spray, usually recommended for children older than 2 who do not have chronic health problems. "We feel the spray is better," Ulery says.

And the old saying about sugar making "the medicine go down" holds with shots, too. "Tell your child he or she will be rewarded after getting the shot, maybe with a sticker or a little book or treat," Meurer says.

• Focus on prevention. "Avoid people who are sick," Meurer says. The CDC recommends staying at least 6 feet away from flu sufferers. Keep surfaces such as kitchen counters and toys clean by wiping them down with household disinfectant according to product directions. Avoid touching your eyes, nose or mouth with unwashed hands. Wash your hands frequently or use a hand sanitizer that contains alcohol.
• Know the swine flu symptoms. The H1N1 virus symptoms are mainly the same as the seasonal flu: fever, cough, sore throat, runny nose, body aches, headaches, chills and fatigue. However, health experts say that H1N1 sufferers also often experience vomiting and diarrhea.
• Recognize signs of an emergency. Call the doctor immediately if your child has fast or troubled breathing, bluish or gray skin color, won't drink fluids, has severe or persistent vomiting, or will not wake up or interact.
• Make sure young flu victims drink plenty of fluids.
• Talk to your kids about the swine flu. "Let them know the risk is low and prevention works," Meurer says.

WHAT TO TELL YOUR KIDS

• Avoid touching your eyes, nose and mouth without washing your hands first. Germs spread this way.
• Stop a germ. Cough into your inner elbow sleeve or into a tissue to prevent spreading the virus on your hands.
• Learn the best - and most fun - way to wash your hands. The trick is to wash them for at least 20 seconds. How long is that? "Sing 'Happy Birthday to You' to yourself twice while washing," Ulery says.
• For more fun, you can wash your hands to a new song by Grammy-winner Bill Harley that just happens to be called - what else? - "Wash Your Hands." Download a free copy at www.billharley.com.
• Flu shots aren't so bad. "When you get an injection, hold still and look away," Meurer says.
  

Sources: Daily Press - Centers for Disease Control and Prevention, Journal Sentinel files

Read more: http://www.dailypress.com/health/sns-health-avoid-h1n1-flu,0,6217957.story

Photo

Six-year-old Michael Gray spent six days in a Manitoba hospital with the H1N1 flu.
Source: CTV News
Read more: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20100121/aboriginal_h1n1_100121/20100121?hub=Health&s_name=

Quote
"Predicting disease and mitigating hazard in at-risk populations is an important aim of public health epidemiology, and in preparation for future waves of H1N1, determining the correlates of disease severity is incredibly important".
Source: Science Daily
Read more: http://www.sciencedaily.com/releases/2010/01/100121140326.htm

News Flash
'Two thirds' of London nurses without swine flu jab
BBC News
A BBC London Freedom of Information request has shown the majority of medical staff remain unprotected against the virus.
Read more: http://news.bbc.co.uk/2/hi/uk_news/england/london/8471304.stm

Vaccine additive broadens flu protection
Emerging Health Threats Forum
An adjuvant currently used in European pandemic flu vaccines elicits a greater variety as well as a greater number of antibodies than non-adjuvanted vaccines, according to a study published this week in Science Translational Medicine.
Read more: http://www.eht-forum.org/news.html?fileId=news100121041342&from=home&id=0

It's official: You can't get swine flu from barbecue, feds say
Ledger Enquirer
You can't get the novel virus commonly called "swine flu" by pigging out on barbecue, even if the boar or sow you used for chow had the disease, the federal government has confirmed.
Read more: http://www.ledger-enquirer.com/news/breaking_news/story/984195.html

Awareness programme on A(H1N1) held
The Hindu
An awareness programme on A (H1N1) influenza was organised by the District Field Publicity Office at Darbar High School here on Thursday.
Read more: http://www.thehindu.com/2010/01/22/stories/2010012256690300.htm

High H1N1 rates in aboriginals not caused by genetics
CTV News
A new study says genetic susceptibility is unlikely to be responsible for increased rates of severe H1N1 cases in aboriginal people.
Read more: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20100121/aboriginal_h1n1_100121/20100121?hub=Health&s_name=

Disclaimer: Newsletter ini hanya merupakan kumpulan dari artikel/liputan/tulisan yang diambil dari berbagai sumber mengenai situasi terkini pandemi influenza di seluruh dunia termasuk Indonesia. Namun demikian isi/ilustrasi/foto tidak mewakili kepentingan atau kebijakan KOMNAS FBPI secara langsung