As soon as Homeland Security declared a health emergency, 25 percent -- about 12 million doses -- of Tamiflu and Relenza treatment courses were released from the nation's stockpile. However, beware that the declaration also allows unapproved tests and drugs to be administered to children. Many health- and government officials are more than willing to take that chance with your life, and the life of your child. But are you?
Remember, Tamiflu went through some rough times not too long ago, as the dangers of this drug came to light when, in 2007, the FDA finally began investigating some 1,800 adverse event reports related to the drug. Common side effects of Tamiflu include:
* Nausea
* Vomiting
* Diarrhea
* Headache
* Dizziness
* Fatigue
* Cough
All in all, the very symptoms you're trying to avoid.
More serious symptoms included convulsions, delirium or delusions, and 14 deaths in children and teens as a result of neuropsychiatric problems and brain infections (which led Japan to ban Tamiflu for children in 2007). And that's for a drug that, when used as directed, only reduces the duration of influenza symptoms by 1 to 1 ½ days, according to the official data.
But making matters worse, some patients with influenza are at HIGHER risk for secondary bacterial infections when on Tamiflu. And secondary bacterial infections, as I mentioned earlier, was likely the REAL cause of the mass fatalities during the 1918 pandemic!
Where did This Mysterious New Animal-Human Flu Strain Come From?
Alongside the fear-mongering headlines, I've also seen increasing numbers of reports questioning the true nature of this virus. And rightfully so.
Could a mixed animal-human mutant like this occur naturally? And if not, who made it, and how was it released?
Not one to dabble too deep in conspiracy theories, I don't have to strain very hard to find actual facts to support the notion that this may not be a natural mutation, and that those who stand to gain have the wherewithal to pull off such a stunt.
Just last month I reported on the story that the American pharmaceutical company Baxter was under investigation for distributing the deadly avian flu virus to 18 different countries as part of a seasonal flu vaccine shipment. Czech reporters were probing to see if it may have been part of a deliberate attempt to start a pandemic; as such a "mistake" would be virtually impossible under the security protocols of that virus.
The H5N1 virus on its own is not very airborne. However, when combined with seasonal flu viruses, which are more easily spread, the effect could be a potent, airborne, deadly, biological weapon. If this batch of live bird flu and seasonal flu viruses had reached the public, it could have resulted in dire consequences.
There is a name for this mixing of viruses; it's called "reassortment," and it is one of two ways pandemic viruses are created in the lab. Some scientists say the most recent global outbreak -- the 1977 Russian flu -- was started by a virus created and leaked from a laboratory.
Another example of the less sterling integrity of Big Pharma is the case of Bayer, who sold millions of dollars worth of an injectable blood-clotting medicine to Asian, Latin American, and some European countries in the mid-1980s, even though they knew it was tainted with the AIDS virus.
So while it is morally unthinkable that a drug company would knowingly contaminate flu vaccines with a deadly flu virus such as the bird- or swine flu, it is certainly not impossible. It has already happened more than once.
But there seems to be no repercussions or hard feelings when industry oversteps the boundaries of morality and integrity and enters the arena of obscenity. Because, lo and behold, which company has been chosen to head up efforts, along with WHO, to produce a vaccine against the Mexican swine flu?
Baxter!11 Despite the fact that ink has barely dried on the investigative reports from their should-be-criminal "mistake" against humanity.
According to other sources,12 a top scientist for the United Nations, who has examined the outbreak of the deadly Ebola virus in Africa, as well as HIV/AIDS victims, has concluded that the current swine flu virus possesses certain transmission "vectors" that suggest the new strain has been genetically-manufactured as a military biological warfare weapon.
The UN expert believes that Ebola, HIV/AIDS, and the current A-H1N1 swine flu virus are biological warfare agents.
In addition, Army criminal investigators are looking into the possibility that disease samples are missing from biolabs at Fort Detrick -- the same Army research lab from which the 2001 anthrax strain was released, according to a recent article in the Fredrick News Post.13 In February, the top “biodefence” lab halted all its research into Ebola, anthrax, plague, and other diseases known as "select agents," after they discovered virus samples that weren't listed in its inventory and might have been switched with something else.
Factory Farming Maybe Source of Swine Flu
Another theory as to the cause of Swine Flu might be factory farming. In the United States, pigs travel coast to coast. They can be bred in North Carolina, fattened in the corn belt of Iowa, and slaughtered in California.
While this may reduce short-term costs for the pork industry, the highly contagious nature of diseases like influenza (perhaps made further infectious by the stresses of transport) needs to be considered when calculating the true cost of long-distance live animal transport.
The majority of U.S. pig farms now confine more than 5,000 animals each. With a group of 5,000 animals, if a novel virus shows up it will have more opportunity to replicate and potentially spread than in a group of 100 pigs on a small farm.
With massive concentrations of farm animals within which to mutate, these new swine flu viruses in North America seem to be on an evolutionary fast track, jumping and reassorting between species at an unprecedented rate.
Should You Accept a Flu Vaccine -- Just to be Safe?
As stated in the New York Times14 and elsewhere, flu experts have no idea whether the current seasonal flu vaccine would offer any protection whatsoever against this exotic mutant, and it will take months to create a new one.
But let me tell you, getting vaccinated now would not only offer no protection and potentially cause great harm, it would most likely be loaded with toxic mercury which is used as a preservative in most flu vaccines..
I've written extensively about the numerous dangers (and ineffectiveness) of flu vaccines, and why I do not recommend them to anyone. So no matter what you hear -- even if it comes from your doctor -- don't get a regular flu shot. They rarely work against seasonal flu...and certainly can't offer protection against a never-before- seen strain.
Currently, the antiviral drugs Tamiflu and Relenza are the only drugs that appear effective against the (human flu) H1N1 virus, and I strongly believe taking Tamiflu to protect yourself against this new virus could be a serious mistake -- for all the reasons I already mentioned above.
But in addition to the dangerous side effects of Tamiflu, there is also growing evidence of resistance against the drug. In February, the pre-publication and preliminary findings journal called Nature Precedings published a paper on this concern, stating15:
The dramatic rise of oseltamivir [Tamiflu] resistance in the H1N1 serotype in the 2007/2008 season and the fixing of H274Y in the 2008/2009 season has raised concerns regarding individuals at risk for seasonal influenza, as well as development of similar resistance in the H5N1 serotype [bird flu].
Previously, oseltamivir resistance produced changes in H1N1 and H3N2 at multiple positions in treated patients. In contrast, the recently reported resistance involved patients who had not recently taken oseltamivir.
It's one more reason not to bother with this potentially dangerous drug.
And, once a specific swine flu drug is created, you can be sure that it has not had the time to be tested in clinical trials to determine safety and effectiveness, which puts us right back where I started this article -- with a potential repeat of the last dangerous swine flu vaccine, which destroyed the lives of hundreds of people.
Topping the whole mess off, of course, is the fact that if the new vaccine turns out to be a killer, the pharmaceutical companies responsible are immune from lawsuits -- something I've also warned about before on numerous occasions.
Unfortunately, those prospects won't stop the governments of the world from mandating the vaccine -- a scenario I hope we can all avoid.
How to Protect Yourself Without Dangerous Drugs and Vaccinations
Watch the video above to see ridiculous 1976 commercials promoting Swine Flu shots.
For now, my point is that there are always going to be threats of flu pandemics, real or created, and there will always be potentially toxic vaccines that are peddled as the solution. But you can break free of that whole drug-solution trap by following some natural health principles.
I have not caught a flu in over two decades, and you can avoid it too, without getting vaccinated, by following these simple guidelines, which will keep your immune system in optimal working order so that you're far less likely to acquire the infection to begin with.
Optimize your vitamin D levels. As I've previously reported, optimizing your vitamin D levels is one of the absolute best strategies for avoiding infections of ALL kinds, and vitamin D deficiency is likely the TRUE culprit behind the seasonality of the flu -- not the flu virus itself.
This is probably the single most important and least expensive action you can take. I would STRONGLY urge you to have your vitamin D level monitored to confirm your levels are therapeutic at 50-70 ng. ml and done by a reliable vitamin D lab like Lab Corp.
For readers who are in the U.S., we [original writers of the article] hope to launch a vitamin D testing service through Lab Corp that allows you to have your vitamin D levels checked at your local blood drawing facility, and relatively inexpensively. We hope to offer this service by June 2009.
If you are coming down with flu like symptoms and have not been on vitamin D you can take doses of 50,000 units a day for three days to treat the acute infection. Some researchers like Dr. Cannell, believe the dose could even be as high as 1000 units per pound of body weight for three days.
However, most of Dr. Cannell's work was with seasonal and not pandemic flu. If your body has never been exposed to the antigens there is chance that the vitamin D might not work. However the best bet is to maintain healthy levels of vitamin D around 60 ng/ml.
BUT to keep this in perspective the regular flu, not the swine flu, has killed 13,000 in the US since January. But there is strong support that these types of figures are grossly exaggerated to increase vaccine sales. However, the fact remains that the regular flu at this point in time is FAR more dangerous than the swine flu and were you worried about the regular flu before the media started talking this up?
Avoid Sugar and Processed Foods. Sugar decreases the function of your immune system almost immediately, and as you likely know, a strong immune system is key to fighting off viruses and other illness. Be aware that sugar is present in foods you may not suspect, like ketchup and fruit juice.
Get Enough Rest. Just like it becomes harder for you to get your daily tasks done if you're tired, if your body is overly fatigued it will be harder for it to fight the flu. Be sure to check out my article Guide to a Good Night's Sleep for some great tips to help you get quality rest.
Have Effective Tools to Address Stress . We all face some stress every day, but if stress becomes overwhelming then your body will be less able to fight off the flu and other illness.
Exercise. When you exercise, you increase your circulation and your blood flow throughout your body. The components of your immune system are also better circulated, which means your immune system has a better chance of finding an illness before it spreads. You can review my exercise guidelines for some great tips on how to get started.
Take a good source of animal based omega-3 fats like Krill Oil. Increase your intake of healthy and essential fats like the omega-3 found in krill oil, which is crucial for maintaining health. It is also vitally important to avoid damaged omega-6 oils that are trans fats and in processed foods as it will seriously damage your immune response.
-- Wash Your Hands. Washing your hands will decrease your likelihood of spreading a virus to your nose, mouth or other people. Be sure you don't use antibacterial soap for this -- antibacterial soaps are completely unnecessary, and they cause far more harm than good. Instead, identify a simple chemical-free soap that you can switch your family to.
-- Eat Garlic Regularly. Garlic works like a broad-spectrum antibiotic against bacteria, virus, and protozoa in the body. And unlike with antibiotics, no resistance can be built up so it is an absolutely safe product to use. However, if you are allergic or don't enjoy garlic it would be best to avoid as it will likely cause more harm than good.
-- Avoid Hospitals and Vaccines. In this particular case, I'd also recommend you stay away from hospitals unless you're having an emergency, as hospitals are prime breeding grounds for infections of all kinds, and could be one of the likeliest places you could be exposed to this new bug. Vaccines will not be available for six months at the minimum but when available they will be ineffective and can lead to crippling paralysis like Guillain-Barré Syndrome just as it did in the 70s.
Thursday, April 30, 2009
Pandemic Influenza Planning Scenarios issued by NZ Ministry of Health
Issued by NZ Ministry of Health
http://www.med.govt.nz/upload/27552/planning-guide.pdf
Appendix 2: Pandemic Influenza Planning Scenarios
These scenarios are produced for planning purposes only. Scenarios deliberately represent extremes and are not predictions.
Scenario 1 – Pandemic Disease Recognised Overseas
It is a Friday before a holiday weekend, with fine weather forecast over the whole country.
For several weeks there have been many rumours and unconfirmed reports of large clusters of person-to-person spread of H5N1 in two south-east Asian countries – Sealand and Beeland. The situation in neighbouring countries is quiet, but in some regions the situation is unknown, with a total communications blackout from some provinces. The World Health Organisation (WHO) is intensively investigating, but has not yet confirmed person-to-person spread of H5N1 in any region, although the level of suspicion is high and increasing all the time. Nothing much else is happening in the world, so there has been intense and increasing interest in these developments from the world and New Zealand media.
Intensive surveillance in New Zealand has not found any evidence of H5N1 among the influenza-like illnesses that are normally present at low levels in the general population.
The Ministry of Health (MoH) has been monitoring the situation and has informed the health sector of the domestic and overseas situations through Code White (information) messages to District Health Boards (DHBs).
At 1200 on Friday, MoH receives information from the WHO in Manila that H5N1 influenza appears to have been responsible for a number of sudden deaths among Beeland citizens in the large capital city, Beeville. The people who died had no known exposure to infected poultry, or connection with the areas where H5N1 spread is suspected.
From Southern Beeland, there are unconfirmed reports of the sudden deaths of three German tourists who recently took a bus trip to the interior, and of influenza-like illnesses among other tourists. Some tourists are thought to have flown to Singapore or other regional destinations while unwell.
At 1230, while the MoH is attempting to verify the information received, CNN reports that “pandemic influenza has broken out in Beeland, and is causing many deaths in the slums of Beeville and the villages in the interior. Tourists have died, and many are ill”. The report also says that the Beeland government has denied that pandemic influenza is present.
MoH assembles its crisis team and identifies people for Co-ordinated Incident Management System (CIMS) team roles. By 1430 a Code Yellow (standby/warning) message has gone out to the health sector informing them of the situation. Also by this time, the WHO in Manila has confirmed the information received earlier that 120 people are ill in hospital, a further 30 are thought to have died of a new form of influenza and an unknown but “large” number are thought to be affected. It adds that a pandemic declaration will be made at 1600 New Zealand time.
Advice from the Australian Health Disaster Management Committee states that Australia has closed borders to all incoming flights.
MoH issues a Code Red message (pandemic alert) to the health sector at 1615, following the WHO declaration.
At 1630 the MoH national controller issues the first pandemic advice to the government.
The advice is:
. • To enable an effective response to be mounted, the Minister of Health should immediately unlock the special powers available to Medical Officers of Health, in the Health Act; and
. • To immediately close the border, for an indefinite period, to all incoming flights.
At 1800, the Government’s Ministerial-level Domestic and External Security Committee accepts all the Ministry of Health’s recommendations and directs the appropriate agencies to action them immediately.
Outline of likely Health Sector Actions
After unlocking of powers, Medical Officers of Health (MOoHs) have a wide range of special powers available to detain, quarantine or isolate people who have, or may have, infectious diseases.
At the time the border was closed there were 7 aircraft in the air enroute to New Zealand. For safety reasons they may land in New Zealand if the Captain decides that it is inappropriate to divert or turn back. All elect to continue, with 5 to land in Auckland and 2 for Christchurch.
Using the MOoH’s special powers, incoming passengers and aircrew will be held at the airports until health services carry out risk assessments and decide the most appropriate actions.
Outcomes could include:
1. 1. Encouragement of incoming foreign nationals to leave on the next available aircraft without entering New Zealand.
2. 2. Release of some low-risk incoming New Zealanders, with medication as required and arrangements for intensive follow-up by Public Health Units.
3. 3. Quarantine all the remaining passengers and aircrew for 8 days before allowing entry to New Zealand.
Planners should assume that it might take up to 24 hours, and possibly longer, to complete the processing of the people held at the airport, and/or make the necessary arrangements and dispositions. Health services will also review the health declarations of all passengers arriving from South East Asian airports within the last 4-5 days to assess the risks to New Zealand.
Passenger and contact tracing will be done if there are any grounds for suspicion. Surveillance will be stepped up to the highest possible state, especially in communities close to airports and on the normal tourist pathways.
MoH will make supplies of anti-viral medication available to assist with border management operations. Health staff resources will be made available by the appropriate District Health Board(s).
Scenario 2 – Cluster(s) in New Zealand
It is Mid-February. H5N1 influenza is now spreading person-to-person in Western Sealand. The virus is not yet an efficient spreader so there is no widespread outbreak, although several thousand people have been infected. The case fatality rate is very high, at about 20%. Many of the fatalities collapse and die within a short time of becoming symptomatic, mostly with cyanotic mottling and/or subcutaneous haemorrhage. WHO and the Sealand government are making strenuous efforts to contain the situation, with internal travel restrictions in place and draconian penalties for non-compliance with government directives.
H5N1 is known to exist in birds in many other parts of Asia, but intensive surveillance of these regions has not provided evidence of person-to-person spread. It appears the pandemic strain is contained in Sealand. WHO has not yet issued a world pandemic alert, although it has issued a regional alert for South East Asia and Sealand.
New Zealand borders are closed to Sealand nationals except for those who demonstrate that they are from unaffected regions, pass an exit screening examination in Sealand, and undergo health assessments on arrival in New Zealand. These people are mostly students, business people, and those with family in New Zealand. The flow of people from Sealand is low, because of Sealand government restrictions.
General tourist traffic from Asia is substantially reduced from normal because of uncertainties associated with the pandemic situation. Tourists from Asian countries other than Sealand are not undergoing health assessments at the border, although all aircraft are now required to inform authorities of the health status of people on board before arrival in New Zealand.
In New Zealand there is intensive surveillance concentrated on regions surrounding airports and the normal tourist trails.
On a Saturday afternoon, a Medical Officer of Health (MOoH) of Crossville (in the North Island) contacts the MoH. Two people of Asian extraction turned up at a local GP medical centre on Friday with influenza-like illnesses. They were assessed and swabs taken. They were provided with advice and then discharged.
At about 1100 on Saturday morning, one of these people was found dead in their motel. The hotelier rang the police as part of normal process. The other person cannot be found, and the car in which they came is missing, not having been seen since the night before. The two people had been in the motel for two days since arriving in the country.
The MOoH has seen the body, and noted cyanotic mottling and the fact that the person had been dead for some hours. He is very concerned. He has directed that the unit be sealed for the time being until full infectious disease precautions can be provided for the removal of the body to the morgue.
MoH assembles a CIMS team and informs the Minister of developments. As a number of conditions could be involved, it is decided to wait until results from swabs and a post-mortem become available before making any decisions. MoH liaises
with Police about the missing person and advises that if found, the person should be treated as infectious and appropriate precautions taken. MoH also alerts all DHBs and PHUs via a Code Yellow message.
During Sunday, several people present at a nearby Emergency Department (ED) had influenza-like illnesses. Most are itinerant market garden workers and backpacking tourists, living in various hostels and similar accommodation. None require admission. ED is taking full infection control precautions on MoH recommendation.
MoH also recommends that the after-hours surgery takes full infection control precautions, but can only recommend this, as primary care is essentially private business. MoH learns that about a dozen people have turned up at the after-hours surgery with flu-like symptoms, an unusual number for this time of year.
At 2300 on Sunday, the MOoH contacts the Ministry again. After complaining of being unwell in the early evening a receptionist from a local GP medical centre collapsed and died on arrival at the ED. During an attempted resuscitation, infection control precautions were inevitably less than perfect. Another person, whom relatives state went to the after-hours surgery earlier in the day because of the ‘flu’, is now seriously ill in intensive care.
The Ministry re-convenes its CIMS team. In conversations with the local hospital the MoH learns that at around midnight, two more patients turned up at the ED with respiratory and circulatory collapse. At 0300 on Monday morning, the team advises the government that:
. • An unknown disease causing respiratory collapse and death is present in the district;
. • It may be H5N1 pandemic influenza, but this cannot yet be confirmed;
. • The Ministry will put regional DHBs on full pandemic alert through Code Red messages;
. • Local hospital staff and facilities, and other medical staff and facilities in the area have probably been exposed;
.• The Ministry recommends that:
a. o The Minister unlocks the special powers available to Medical Officers of Health under the Health Act;
b. o That the Medical Officer of Health in charge establishes travel restrictions for the area;
c. o Until appropriate medical screening arrangements can be made, no people or goods should be allowed to move into or out of the area without the express permission of the Medical Officer of Health in charge;
d. o Public gatherings in the area should be prohibited until further notice;
e. o Schools, kindergartens, crèches, play-centres, educational campuses of all kinds, public libraries, video stores, game arcades and casinos in the area should not open on the Monday morning, and may be required to remain closed for an indefinite period; and
o All possible efforts are made to find the missing Asian person, and to track anybody who is known to have left the area since Saturday.
The Government accepts all the Ministry’s recommendations and expects them to be actioned immediately by the appropriate agencies.
Outline of Health Sector Actions
After a declaration of a national Health Emergency, Medical Officers of Health (MOoHs) have a wide range of powers available to detain, quarantine or isolate people who have or may have infectious diseases.
MoH will immediately issue a Code Red pandemic alert message, informing all health practitioners of the situation.
MoH, through their Regional Co-ordinators, will direct relevant DHBs to prepare for the release of PPE to identified hospitals, primary health care centres and first responders
No hospital-to-hospital transfers will be made from the Hospital to places outside the infected area. Surveillance will be stepped up to the highest possible state, both in the area and in the rest of the country.
Intensive investigations of the cases in the Hospital will be made, with rapid PCR investigations to confirm or rule out H5N1 avian influenza. Initial results are likely to be available within 12 hours.
MoH will make ready-use supplies of anti-viral medication available to assist with the management of the situation.
MoH’s CIMs team will advise the government on appropriate courses of action as the situation develops.
Scenario 3 – Severe Pandemic in New Zealand
It is mid-July. About eight weeks ago, H5N1 pandemic influenza achieved an explosive breakout from South East Asia, appearing in Europe, North and South America, Africa and India within a couple of weeks. The disease is impacting heavily on all age groups, but particularly on younger adults. The case fatality rate is about 2% over all age groups but up to 8-10% for people under 30. The pandemic disease has a high reproductive rate and spreads very rapidly once the first few cases have appeared in any country or region. International trade and travel is more or less at a standstill as all impacted countries attempt to adjust to the new situation. Very limited amounts of airfreight are still moving, but flights are arranged more or less as required, rather than to a timetable, and even so it is very difficult to find aircrew willing to fly to some countries. Very few passengers are being carried. Merchant ships at sea on the way to New Zealand when the pandemic broke out, have either turned around and gone home, have berthed and are unable to leave, or are remaining offshore, waiting to assess the onshore situation before berthing. One of the ships that turned around was a tanker carrying a large shipment of petrol, and there has not been a petrol delivery at Marsden Point for over six weeks now. Despite strenuous border control efforts, pandemic influenza appeared suddenly in one urban area a bit over four weeks ago. Efforts at containment were abandoned, as many other cases were reported throughout the country over the next week. Health authorities shifted efforts to attempt to ameliorate the impacts of the pandemic. Medical Officers of Health have directed all crèches, kindergartens, schools, colleges, universities, public libraries, video stores, game arcades and casinos to close indefinitely. Public gatherings are prohibited, and people are advised to avoid crowded places as much as possible. Wherever practical, people are working from home, or have taken leave – either paid or unpaid. So far, the epidemiology of the disease in New Zealand appears much the same as in other countries, with the heaviest impact on young adults. Over 100,000 people have become ill since the development of the pandemic in New Zealand, and nearly 3,000 have died. About 2,000 of these are under the age of 30. Case numbers are still increasing very fast. Initial forecasts indicate that this wave could involve up to 40% of the population, implying that there may be another 1.5 million people becoming ill over the next six weeks or so, with a peak in about another 2-3 weeks. Given the current epidemiology, this may result in between 30,000 – 35,000 deaths in total. The Ministry of Health has directed DHBs to release their PPE supplies to hospitals, the primary health care sector (in previously agreed locations), and to local services to support first responders.
The Ministry of Health has released the national reserve of anti-viral medication for use. The medication is being distributed through about 80 special temporary facilities. It is strictly prioritised to people who meet clinical criteria for influenza and time since onset of symptoms. After several incidents at the distribution stations the Ministry asked for Police or Defence Force assistance with security as civilian security firms could not manage this. Anti-viral medication has been allocated for all health services, Police and Defence Force, and staff from some other organisations providing direct pandemic responses. This guarantees treatment for any staff from these services that become ill. Despite this, there is a degree of absence in both the health sector and Police force that is not related to direct illness. Between 10%-15% of the Police force is not available for duty. The overall absence rate is still increasing, and may reach about 40%-50% in a few weeks time – around the expected peak of the current pandemic wave. The Army has about 10% of its troops not available for duty from illness, and the Air Force about the same. The Navy has one frigate on its way back from the Persian Gulf, and doesn’t have enough crew available to man the other, currently moored in Auckland. Navy volunteers are assisting health services in Auckland. Primary health services in most districts are shifting priorities, as case numbers climb, and are mostly still functioning although increasingly in a directive and support role. Secondary hospitals and DHBs in most affected areas are moving to a coordination
and logistic supply role for primary and volunteer groups while attempting to maintain hospital services as much as possible. Hospitals are hampered by very high rates of sickness and absences among their staff, and are down to between 50% and 60% of their normal capacity. Hardly any influenza patients are being admitted to hospitals. It is probable that things will get worse for hospitals before they get better. Health services in the most affected urban area and much of the surrounding region are no longer functioning in a co-ordinated manner. Here, the primary and secondary health workforce has been very heavily impacted, with only about 40% of the normal staff available for duty. The pandemic is developing very fast in some population sub-groups, and there have been a large number of deaths. A number of very young children have been orphaned by the deaths of both their parents. Several hundred bodies are in freezer storage in the district, and more containers are being brought in. People of all ages who live alone, and solo parents with small children, are especially vulnerable, as the disease comes on suddenly and is extremely incapacitating. Sufferers can do very little for themselves for several days. People who have few supplies or resources at home, or who have no support, are quickly in dire straits. Some very young children are attempting to look after their sick parents with little or no support. A number of people have died alone in their homes, and it is feared that many more may follow.
In all affected areas people are at home looking after sick children and spouses, and in many cases friends and neighbours in their homes. Some areas have quickly organised networks to support this initiative, but in others people are working as individuals with little co-ordination or support. Many people in the most affected urban area have moved to rural areas. Rapidly increasing case numbers are being reported from these districts. Health service capacity in these areas is very limited, and cannot manage anything remotely approaching the demand now being experienced. Availability of supplies varies across the country, but everywhere there are shortages of fuel and some foodstuffs, partly as a result of people buying up large quantities of basic foods in the early days. Anybody with reserve food or petrol is hoarding it for an uncertain future. Telephone, text and email communication is heavy as people try to keep in touch with each other and keep checking on their friends and relatives in New Zealand and overseas. So far, water, electricity, gas and sewerage systems are still operating, although some are becoming more vulnerable to breakdown and interruptions because of unusual demand patterns and a progressive lack of routine maintenance, as staff availability dwindles. Postal services have stopped providing daily deliveries because so many staff are absent, and courier services are severely handicapped by shortages of fuel. Many New Zealand citizens and residents overseas are stranded, unable to return to New Zealand. People who were overseas on holiday have run out of money, and businessmen overseas are in great difficulty as their incomes have often dried up completely. They are appealing to the government for assistance. About 150,000 tourists and other transient people are stranded in this country. Many are out of money, or their currencies now have virtually no value. International electronic banking is still mostly operating, as are telecommunications and media links. However currency fluctuations are extreme and nobody knows what their money will be worth tomorrow. Many of the tourists and transients are living more or less on the goodwill of moteliers and accommodation suppliers, who are now vociferously demanding the government “do something” to help the critical business situation developing in the sector from both the downturn in normal business and accommodating people with no funds. Around 100,000 overseas students are likewise stuck. Although most have enough money to last a while, they are mostly not normally eligible for publicly funded health services in New Zealand, although they are in an age group that is being heavily impacted.
Outline of Health Sector Actions
Generally, the health sector is shifting from provision of direct care to the coordination, direction, logistic support and assistance of care provision by volunteers, community groups and individuals caring for sick family members.
Nation-wide, direction of release of PPE to primary and secondary sectors occurs when Code Red alerts are issued.
The health sector will be providing direct care to only a very small proportion of all people who get sick.
Anti-virals will be released to the general population early in the wave, but there will not be sufficient to provide treatment for everybody who gets sick in a large wave. It is possible more stringent prioritisation may be adopted (in this case likely to be age-based), which may exacerbate issues around the distribution of the medication.
http://www.med.govt.nz/upload/27552/planning-guide.pdf
Appendix 2: Pandemic Influenza Planning Scenarios
These scenarios are produced for planning purposes only. Scenarios deliberately represent extremes and are not predictions.
Scenario 1 – Pandemic Disease Recognised Overseas
It is a Friday before a holiday weekend, with fine weather forecast over the whole country.
For several weeks there have been many rumours and unconfirmed reports of large clusters of person-to-person spread of H5N1 in two south-east Asian countries – Sealand and Beeland. The situation in neighbouring countries is quiet, but in some regions the situation is unknown, with a total communications blackout from some provinces. The World Health Organisation (WHO) is intensively investigating, but has not yet confirmed person-to-person spread of H5N1 in any region, although the level of suspicion is high and increasing all the time. Nothing much else is happening in the world, so there has been intense and increasing interest in these developments from the world and New Zealand media.
Intensive surveillance in New Zealand has not found any evidence of H5N1 among the influenza-like illnesses that are normally present at low levels in the general population.
The Ministry of Health (MoH) has been monitoring the situation and has informed the health sector of the domestic and overseas situations through Code White (information) messages to District Health Boards (DHBs).
At 1200 on Friday, MoH receives information from the WHO in Manila that H5N1 influenza appears to have been responsible for a number of sudden deaths among Beeland citizens in the large capital city, Beeville. The people who died had no known exposure to infected poultry, or connection with the areas where H5N1 spread is suspected.
From Southern Beeland, there are unconfirmed reports of the sudden deaths of three German tourists who recently took a bus trip to the interior, and of influenza-like illnesses among other tourists. Some tourists are thought to have flown to Singapore or other regional destinations while unwell.
At 1230, while the MoH is attempting to verify the information received, CNN reports that “pandemic influenza has broken out in Beeland, and is causing many deaths in the slums of Beeville and the villages in the interior. Tourists have died, and many are ill”. The report also says that the Beeland government has denied that pandemic influenza is present.
MoH assembles its crisis team and identifies people for Co-ordinated Incident Management System (CIMS) team roles. By 1430 a Code Yellow (standby/warning) message has gone out to the health sector informing them of the situation. Also by this time, the WHO in Manila has confirmed the information received earlier that 120 people are ill in hospital, a further 30 are thought to have died of a new form of influenza and an unknown but “large” number are thought to be affected. It adds that a pandemic declaration will be made at 1600 New Zealand time.
Advice from the Australian Health Disaster Management Committee states that Australia has closed borders to all incoming flights.
MoH issues a Code Red message (pandemic alert) to the health sector at 1615, following the WHO declaration.
At 1630 the MoH national controller issues the first pandemic advice to the government.
The advice is:
. • To enable an effective response to be mounted, the Minister of Health should immediately unlock the special powers available to Medical Officers of Health, in the Health Act; and
. • To immediately close the border, for an indefinite period, to all incoming flights.
At 1800, the Government’s Ministerial-level Domestic and External Security Committee accepts all the Ministry of Health’s recommendations and directs the appropriate agencies to action them immediately.
Outline of likely Health Sector Actions
After unlocking of powers, Medical Officers of Health (MOoHs) have a wide range of special powers available to detain, quarantine or isolate people who have, or may have, infectious diseases.
At the time the border was closed there were 7 aircraft in the air enroute to New Zealand. For safety reasons they may land in New Zealand if the Captain decides that it is inappropriate to divert or turn back. All elect to continue, with 5 to land in Auckland and 2 for Christchurch.
Using the MOoH’s special powers, incoming passengers and aircrew will be held at the airports until health services carry out risk assessments and decide the most appropriate actions.
Outcomes could include:
1. 1. Encouragement of incoming foreign nationals to leave on the next available aircraft without entering New Zealand.
2. 2. Release of some low-risk incoming New Zealanders, with medication as required and arrangements for intensive follow-up by Public Health Units.
3. 3. Quarantine all the remaining passengers and aircrew for 8 days before allowing entry to New Zealand.
Planners should assume that it might take up to 24 hours, and possibly longer, to complete the processing of the people held at the airport, and/or make the necessary arrangements and dispositions. Health services will also review the health declarations of all passengers arriving from South East Asian airports within the last 4-5 days to assess the risks to New Zealand.
Passenger and contact tracing will be done if there are any grounds for suspicion. Surveillance will be stepped up to the highest possible state, especially in communities close to airports and on the normal tourist pathways.
MoH will make supplies of anti-viral medication available to assist with border management operations. Health staff resources will be made available by the appropriate District Health Board(s).
Scenario 2 – Cluster(s) in New Zealand
It is Mid-February. H5N1 influenza is now spreading person-to-person in Western Sealand. The virus is not yet an efficient spreader so there is no widespread outbreak, although several thousand people have been infected. The case fatality rate is very high, at about 20%. Many of the fatalities collapse and die within a short time of becoming symptomatic, mostly with cyanotic mottling and/or subcutaneous haemorrhage. WHO and the Sealand government are making strenuous efforts to contain the situation, with internal travel restrictions in place and draconian penalties for non-compliance with government directives.
H5N1 is known to exist in birds in many other parts of Asia, but intensive surveillance of these regions has not provided evidence of person-to-person spread. It appears the pandemic strain is contained in Sealand. WHO has not yet issued a world pandemic alert, although it has issued a regional alert for South East Asia and Sealand.
New Zealand borders are closed to Sealand nationals except for those who demonstrate that they are from unaffected regions, pass an exit screening examination in Sealand, and undergo health assessments on arrival in New Zealand. These people are mostly students, business people, and those with family in New Zealand. The flow of people from Sealand is low, because of Sealand government restrictions.
General tourist traffic from Asia is substantially reduced from normal because of uncertainties associated with the pandemic situation. Tourists from Asian countries other than Sealand are not undergoing health assessments at the border, although all aircraft are now required to inform authorities of the health status of people on board before arrival in New Zealand.
In New Zealand there is intensive surveillance concentrated on regions surrounding airports and the normal tourist trails.
On a Saturday afternoon, a Medical Officer of Health (MOoH) of Crossville (in the North Island) contacts the MoH. Two people of Asian extraction turned up at a local GP medical centre on Friday with influenza-like illnesses. They were assessed and swabs taken. They were provided with advice and then discharged.
At about 1100 on Saturday morning, one of these people was found dead in their motel. The hotelier rang the police as part of normal process. The other person cannot be found, and the car in which they came is missing, not having been seen since the night before. The two people had been in the motel for two days since arriving in the country.
The MOoH has seen the body, and noted cyanotic mottling and the fact that the person had been dead for some hours. He is very concerned. He has directed that the unit be sealed for the time being until full infectious disease precautions can be provided for the removal of the body to the morgue.
MoH assembles a CIMS team and informs the Minister of developments. As a number of conditions could be involved, it is decided to wait until results from swabs and a post-mortem become available before making any decisions. MoH liaises
with Police about the missing person and advises that if found, the person should be treated as infectious and appropriate precautions taken. MoH also alerts all DHBs and PHUs via a Code Yellow message.
During Sunday, several people present at a nearby Emergency Department (ED) had influenza-like illnesses. Most are itinerant market garden workers and backpacking tourists, living in various hostels and similar accommodation. None require admission. ED is taking full infection control precautions on MoH recommendation.
MoH also recommends that the after-hours surgery takes full infection control precautions, but can only recommend this, as primary care is essentially private business. MoH learns that about a dozen people have turned up at the after-hours surgery with flu-like symptoms, an unusual number for this time of year.
At 2300 on Sunday, the MOoH contacts the Ministry again. After complaining of being unwell in the early evening a receptionist from a local GP medical centre collapsed and died on arrival at the ED. During an attempted resuscitation, infection control precautions were inevitably less than perfect. Another person, whom relatives state went to the after-hours surgery earlier in the day because of the ‘flu’, is now seriously ill in intensive care.
The Ministry re-convenes its CIMS team. In conversations with the local hospital the MoH learns that at around midnight, two more patients turned up at the ED with respiratory and circulatory collapse. At 0300 on Monday morning, the team advises the government that:
. • An unknown disease causing respiratory collapse and death is present in the district;
. • It may be H5N1 pandemic influenza, but this cannot yet be confirmed;
. • The Ministry will put regional DHBs on full pandemic alert through Code Red messages;
. • Local hospital staff and facilities, and other medical staff and facilities in the area have probably been exposed;
.• The Ministry recommends that:
a. o The Minister unlocks the special powers available to Medical Officers of Health under the Health Act;
b. o That the Medical Officer of Health in charge establishes travel restrictions for the area;
c. o Until appropriate medical screening arrangements can be made, no people or goods should be allowed to move into or out of the area without the express permission of the Medical Officer of Health in charge;
d. o Public gatherings in the area should be prohibited until further notice;
e. o Schools, kindergartens, crèches, play-centres, educational campuses of all kinds, public libraries, video stores, game arcades and casinos in the area should not open on the Monday morning, and may be required to remain closed for an indefinite period; and
o All possible efforts are made to find the missing Asian person, and to track anybody who is known to have left the area since Saturday.
The Government accepts all the Ministry’s recommendations and expects them to be actioned immediately by the appropriate agencies.
Outline of Health Sector Actions
After a declaration of a national Health Emergency, Medical Officers of Health (MOoHs) have a wide range of powers available to detain, quarantine or isolate people who have or may have infectious diseases.
MoH will immediately issue a Code Red pandemic alert message, informing all health practitioners of the situation.
MoH, through their Regional Co-ordinators, will direct relevant DHBs to prepare for the release of PPE to identified hospitals, primary health care centres and first responders
No hospital-to-hospital transfers will be made from the Hospital to places outside the infected area. Surveillance will be stepped up to the highest possible state, both in the area and in the rest of the country.
Intensive investigations of the cases in the Hospital will be made, with rapid PCR investigations to confirm or rule out H5N1 avian influenza. Initial results are likely to be available within 12 hours.
MoH will make ready-use supplies of anti-viral medication available to assist with the management of the situation.
MoH’s CIMs team will advise the government on appropriate courses of action as the situation develops.
Scenario 3 – Severe Pandemic in New Zealand
It is mid-July. About eight weeks ago, H5N1 pandemic influenza achieved an explosive breakout from South East Asia, appearing in Europe, North and South America, Africa and India within a couple of weeks. The disease is impacting heavily on all age groups, but particularly on younger adults. The case fatality rate is about 2% over all age groups but up to 8-10% for people under 30. The pandemic disease has a high reproductive rate and spreads very rapidly once the first few cases have appeared in any country or region. International trade and travel is more or less at a standstill as all impacted countries attempt to adjust to the new situation. Very limited amounts of airfreight are still moving, but flights are arranged more or less as required, rather than to a timetable, and even so it is very difficult to find aircrew willing to fly to some countries. Very few passengers are being carried. Merchant ships at sea on the way to New Zealand when the pandemic broke out, have either turned around and gone home, have berthed and are unable to leave, or are remaining offshore, waiting to assess the onshore situation before berthing. One of the ships that turned around was a tanker carrying a large shipment of petrol, and there has not been a petrol delivery at Marsden Point for over six weeks now. Despite strenuous border control efforts, pandemic influenza appeared suddenly in one urban area a bit over four weeks ago. Efforts at containment were abandoned, as many other cases were reported throughout the country over the next week. Health authorities shifted efforts to attempt to ameliorate the impacts of the pandemic. Medical Officers of Health have directed all crèches, kindergartens, schools, colleges, universities, public libraries, video stores, game arcades and casinos to close indefinitely. Public gatherings are prohibited, and people are advised to avoid crowded places as much as possible. Wherever practical, people are working from home, or have taken leave – either paid or unpaid. So far, the epidemiology of the disease in New Zealand appears much the same as in other countries, with the heaviest impact on young adults. Over 100,000 people have become ill since the development of the pandemic in New Zealand, and nearly 3,000 have died. About 2,000 of these are under the age of 30. Case numbers are still increasing very fast. Initial forecasts indicate that this wave could involve up to 40% of the population, implying that there may be another 1.5 million people becoming ill over the next six weeks or so, with a peak in about another 2-3 weeks. Given the current epidemiology, this may result in between 30,000 – 35,000 deaths in total. The Ministry of Health has directed DHBs to release their PPE supplies to hospitals, the primary health care sector (in previously agreed locations), and to local services to support first responders.
The Ministry of Health has released the national reserve of anti-viral medication for use. The medication is being distributed through about 80 special temporary facilities. It is strictly prioritised to people who meet clinical criteria for influenza and time since onset of symptoms. After several incidents at the distribution stations the Ministry asked for Police or Defence Force assistance with security as civilian security firms could not manage this. Anti-viral medication has been allocated for all health services, Police and Defence Force, and staff from some other organisations providing direct pandemic responses. This guarantees treatment for any staff from these services that become ill. Despite this, there is a degree of absence in both the health sector and Police force that is not related to direct illness. Between 10%-15% of the Police force is not available for duty. The overall absence rate is still increasing, and may reach about 40%-50% in a few weeks time – around the expected peak of the current pandemic wave. The Army has about 10% of its troops not available for duty from illness, and the Air Force about the same. The Navy has one frigate on its way back from the Persian Gulf, and doesn’t have enough crew available to man the other, currently moored in Auckland. Navy volunteers are assisting health services in Auckland. Primary health services in most districts are shifting priorities, as case numbers climb, and are mostly still functioning although increasingly in a directive and support role. Secondary hospitals and DHBs in most affected areas are moving to a coordination
and logistic supply role for primary and volunteer groups while attempting to maintain hospital services as much as possible. Hospitals are hampered by very high rates of sickness and absences among their staff, and are down to between 50% and 60% of their normal capacity. Hardly any influenza patients are being admitted to hospitals. It is probable that things will get worse for hospitals before they get better. Health services in the most affected urban area and much of the surrounding region are no longer functioning in a co-ordinated manner. Here, the primary and secondary health workforce has been very heavily impacted, with only about 40% of the normal staff available for duty. The pandemic is developing very fast in some population sub-groups, and there have been a large number of deaths. A number of very young children have been orphaned by the deaths of both their parents. Several hundred bodies are in freezer storage in the district, and more containers are being brought in. People of all ages who live alone, and solo parents with small children, are especially vulnerable, as the disease comes on suddenly and is extremely incapacitating. Sufferers can do very little for themselves for several days. People who have few supplies or resources at home, or who have no support, are quickly in dire straits. Some very young children are attempting to look after their sick parents with little or no support. A number of people have died alone in their homes, and it is feared that many more may follow.
In all affected areas people are at home looking after sick children and spouses, and in many cases friends and neighbours in their homes. Some areas have quickly organised networks to support this initiative, but in others people are working as individuals with little co-ordination or support. Many people in the most affected urban area have moved to rural areas. Rapidly increasing case numbers are being reported from these districts. Health service capacity in these areas is very limited, and cannot manage anything remotely approaching the demand now being experienced. Availability of supplies varies across the country, but everywhere there are shortages of fuel and some foodstuffs, partly as a result of people buying up large quantities of basic foods in the early days. Anybody with reserve food or petrol is hoarding it for an uncertain future. Telephone, text and email communication is heavy as people try to keep in touch with each other and keep checking on their friends and relatives in New Zealand and overseas. So far, water, electricity, gas and sewerage systems are still operating, although some are becoming more vulnerable to breakdown and interruptions because of unusual demand patterns and a progressive lack of routine maintenance, as staff availability dwindles. Postal services have stopped providing daily deliveries because so many staff are absent, and courier services are severely handicapped by shortages of fuel. Many New Zealand citizens and residents overseas are stranded, unable to return to New Zealand. People who were overseas on holiday have run out of money, and businessmen overseas are in great difficulty as their incomes have often dried up completely. They are appealing to the government for assistance. About 150,000 tourists and other transient people are stranded in this country. Many are out of money, or their currencies now have virtually no value. International electronic banking is still mostly operating, as are telecommunications and media links. However currency fluctuations are extreme and nobody knows what their money will be worth tomorrow. Many of the tourists and transients are living more or less on the goodwill of moteliers and accommodation suppliers, who are now vociferously demanding the government “do something” to help the critical business situation developing in the sector from both the downturn in normal business and accommodating people with no funds. Around 100,000 overseas students are likewise stuck. Although most have enough money to last a while, they are mostly not normally eligible for publicly funded health services in New Zealand, although they are in an age group that is being heavily impacted.
Outline of Health Sector Actions
Generally, the health sector is shifting from provision of direct care to the coordination, direction, logistic support and assistance of care provision by volunteers, community groups and individuals caring for sick family members.
Nation-wide, direction of release of PPE to primary and secondary sectors occurs when Code Red alerts are issued.
The health sector will be providing direct care to only a very small proportion of all people who get sick.
Anti-virals will be released to the general population early in the wave, but there will not be sufficient to provide treatment for everybody who gets sick in a large wave. It is possible more stringent prioritisation may be adopted (in this case likely to be age-based), which may exacerbate issues around the distribution of the medication.
Dr Horowitz: Mexican”Swine” Flu Made in Lab
Author of Emerging Viruses: AIDS And Ebola: Nature, Accident or Intentional?, Horowitz says the swine-bird-human flu strain, reported to be found first in Mexico in late-March 2009, could have only come from Dr James S. Robertson and his colleagues in association with the US Centre for Disease Control and vaccine manufacturer Novavax, Inc, which was ready to profit from the release he says. Nobody else takes H5N1 Asian-flu infected chickens, takes them to Europe, extracts their DNA, combines their proteins with H1N1 viruses from the 1918 Spanish flu isolate, additionally mixes in some swine-flu genes from pigs, then reverse engineers them to infect humans, he said.
A report in Medical News Today revealed that Novavax was working on a vaccine for an avian flu pandemic in 2005 and an article at News-Medical.net mentioned they began human clinical testing of a pandemic flu vaccine in August 2007. Also, in a news release dated the 14th of April 2009, shortly after the first reported case of “swine flu”, their vaccine was being touted as being able to protect against the “highly pathogenic H5N1 avian influenza strain.” Stated the Vice President of Vaccine Development for Novavax in this report, the vaccine “has significant implications for both pre-pandemic and pandemic preparedness.”
A report in Medical News Today revealed that Novavax was working on a vaccine for an avian flu pandemic in 2005 and an article at News-Medical.net mentioned they began human clinical testing of a pandemic flu vaccine in August 2007. Also, in a news release dated the 14th of April 2009, shortly after the first reported case of “swine flu”, their vaccine was being touted as being able to protect against the “highly pathogenic H5N1 avian influenza strain.” Stated the Vice President of Vaccine Development for Novavax in this report, the vaccine “has significant implications for both pre-pandemic and pandemic preparedness.”
1918 Swine Flu outbreak
'Mother of pandemics'
But, during the last century, the virus has shown a deadly ability to change beyond recognition.
In 1918, an influenza pandemic started that became a global disaster - eventually killing more people than the Great War.
Estimates of the death toll from the 1918 outbreak of Spanish flu range from 20 million to 40 million. Some historians argue it could have been as high as 100 million.
"There was a mild wave in the spring, but the very serious, lethal wave was in the autumn to the winter," says Professor Markel. "Then a third wave in January to April 1919, and a fourth wave in the winter of 1920."
This tendency for "waves" of infection and re-infection makes the virus yet more unpredictable.
New vaccines for circulating strains are now designed every year
At the time the medical consensus was that the disease was caused not by a virus, but by a bacterium called Haemophilus influenzae.
So some countries, including the US and UK, distributed vaccinations against the wrong disease-causing agent.
"Another problem was that the authorities stuck their heads in the sand," says Mr Honigsbaum.
"Their priority was the war and they didn't have the resources to deal with the health crisis.
"There's an argument that if they'd been more proactive, and diverted doctors and nurses from the front to civilian needs, they could have saved more lives."
Dr Morens refers to the 1918 H1N1 strain as "the mother of all pandemics".
"In the category of Influenza A, which is the category of virus that has caused all human epidemics and pandemics, every virus circulated since 1918 has been a descendent of this virus in one way or another," he says.
"Descendants of the 1918 pandemic are still infecting human beings, but they have mutated again and again and again to be able to survive."
Hybrids and mutants
The 1918 influenza pandemic gripped a vulnerable, unprepared human population, but its ability to "reassort" - or exchange its genes with other viruses - was what made it "dangerously novel".
We had two lineages of the disease, both of which have persisted
David Morens
National Institute of Allergy and Infectious Diseases
"Every species has its own flu - when those species live together, and they can transmit their flu to different species, the virus itself changes its structure," says Professor Markel.
Since our immune systems recognise and respond mainly to the H and N part of the molecule, scientists suspect that pandemics arise when a strain emerges with a big change in the structure of one of these proteins.
But how exactly the virus adapts to enable it to attach to receptors on the cells of a different species, is an "unanswerable" question, says Dr Morens.
"With only four pandemics in over 100 years, our sample size is too small to say, but it seems that a new H [on the surface of the virus] has been the major factor," says Dr Morens.
"We don't know where the 1918 virus came from, but the evidence is that it was a new virus.
"At the same time that it infected humans, it also infected pigs. And at that point, we began to have two lineages of that disease - the human virus, and the pig virus, which persisted too," he adds.
The progeny of the 1918 influenza strain evolved and mutated as they were transmitted from one host to another.
And on two further occasions, these strains incorporated completely new genes and spread globally once again.
Controlled outbreak
"That's what happened in 1957 and 1968 - a hybrid formed of the 1918 virus with genes that were never part of it before," says Dr Morens.
In the case of the 1957 Asian flu outbreak, a human H2N2 virus combined with the genes of a strain found in wild ducks.
The pandemic killed an estimated one million people worldwide.
An outbreak of H3N2 Hong Kong flu in 1968, when avian and human virus genes combined once again, claimed another million lives.
In both cases, the impact was minimised by health authorities, who identified the virus, and made vaccines available.
"Now, every year, around summer time, a group of flu experts get together and see what strains are circulating so they can design an appropriate vaccine," says Dr Markel.
And in the last few years, principally because of the global concern about avian flu, anti-viral drugs that target influenza, such as Tamiflu, have been introduced.
The emergence of a virus that crosses a species barrier is extremely rare
But Professor Markel points out that, despite having reached new levels of medical preparation, "we live in a world of emerging infectious diseases".
"We have learned to take avian flu very seriously, and we have learned to take the animal kingdom very seriously," he says.
But in the rare event that a virus does develop that is able to cross the species barrier, he points out that the close proximity of domestic farm animals to humans provides an opportunity for human infection.
"Human beings travel farther and faster than ever before. All of this means that we are set up for a potential epidemic or pandemic," concludes Professor Markel.
"We learn more every time, but the story of flu pandemics is still very much a story in progress."
But, during the last century, the virus has shown a deadly ability to change beyond recognition.
In 1918, an influenza pandemic started that became a global disaster - eventually killing more people than the Great War.
Estimates of the death toll from the 1918 outbreak of Spanish flu range from 20 million to 40 million. Some historians argue it could have been as high as 100 million.
"There was a mild wave in the spring, but the very serious, lethal wave was in the autumn to the winter," says Professor Markel. "Then a third wave in January to April 1919, and a fourth wave in the winter of 1920."
This tendency for "waves" of infection and re-infection makes the virus yet more unpredictable.
New vaccines for circulating strains are now designed every year
At the time the medical consensus was that the disease was caused not by a virus, but by a bacterium called Haemophilus influenzae.
So some countries, including the US and UK, distributed vaccinations against the wrong disease-causing agent.
"Another problem was that the authorities stuck their heads in the sand," says Mr Honigsbaum.
"Their priority was the war and they didn't have the resources to deal with the health crisis.
"There's an argument that if they'd been more proactive, and diverted doctors and nurses from the front to civilian needs, they could have saved more lives."
Dr Morens refers to the 1918 H1N1 strain as "the mother of all pandemics".
"In the category of Influenza A, which is the category of virus that has caused all human epidemics and pandemics, every virus circulated since 1918 has been a descendent of this virus in one way or another," he says.
"Descendants of the 1918 pandemic are still infecting human beings, but they have mutated again and again and again to be able to survive."
Hybrids and mutants
The 1918 influenza pandemic gripped a vulnerable, unprepared human population, but its ability to "reassort" - or exchange its genes with other viruses - was what made it "dangerously novel".
We had two lineages of the disease, both of which have persisted
David Morens
National Institute of Allergy and Infectious Diseases
"Every species has its own flu - when those species live together, and they can transmit their flu to different species, the virus itself changes its structure," says Professor Markel.
Since our immune systems recognise and respond mainly to the H and N part of the molecule, scientists suspect that pandemics arise when a strain emerges with a big change in the structure of one of these proteins.
But how exactly the virus adapts to enable it to attach to receptors on the cells of a different species, is an "unanswerable" question, says Dr Morens.
"With only four pandemics in over 100 years, our sample size is too small to say, but it seems that a new H [on the surface of the virus] has been the major factor," says Dr Morens.
"We don't know where the 1918 virus came from, but the evidence is that it was a new virus.
"At the same time that it infected humans, it also infected pigs. And at that point, we began to have two lineages of that disease - the human virus, and the pig virus, which persisted too," he adds.
The progeny of the 1918 influenza strain evolved and mutated as they were transmitted from one host to another.
And on two further occasions, these strains incorporated completely new genes and spread globally once again.
Controlled outbreak
"That's what happened in 1957 and 1968 - a hybrid formed of the 1918 virus with genes that were never part of it before," says Dr Morens.
In the case of the 1957 Asian flu outbreak, a human H2N2 virus combined with the genes of a strain found in wild ducks.
The pandemic killed an estimated one million people worldwide.
An outbreak of H3N2 Hong Kong flu in 1968, when avian and human virus genes combined once again, claimed another million lives.
In both cases, the impact was minimised by health authorities, who identified the virus, and made vaccines available.
"Now, every year, around summer time, a group of flu experts get together and see what strains are circulating so they can design an appropriate vaccine," says Dr Markel.
And in the last few years, principally because of the global concern about avian flu, anti-viral drugs that target influenza, such as Tamiflu, have been introduced.
The emergence of a virus that crosses a species barrier is extremely rare
But Professor Markel points out that, despite having reached new levels of medical preparation, "we live in a world of emerging infectious diseases".
"We have learned to take avian flu very seriously, and we have learned to take the animal kingdom very seriously," he says.
But in the rare event that a virus does develop that is able to cross the species barrier, he points out that the close proximity of domestic farm animals to humans provides an opportunity for human infection.
"Human beings travel farther and faster than ever before. All of this means that we are set up for a potential epidemic or pandemic," concludes Professor Markel.
"We learn more every time, but the story of flu pandemics is still very much a story in progress."
swine flu could jump start new drugs
More from Fortune
Swine flu could jump start new drugs
True obsessions
When will the economy recover?
FORTUNE 500
Current Issue
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NEW YORK (Fortune) -- The rush to respond to the swine-flu outbreak could provide an opportunity for vaccine and antiviral developers to showcase new biotechnologies sooner than expected.
There's no vaccine for the exact strain of swine flu yet, so the immediate course of action lies with currently available flu antivirals. The Centers for Disease Control and Prevention have 50 million treatment courses of such drugs as Tamiflu and Relenza. The agency says lab tests show the swine flu virus is "sensitive" to those treatments. The Department of Homeland Security has asked for $1.5 billion from the government to "acquire antivirals and invest in a vaccine," though officials haven't decided whether to produce a vaccine yet. The pharma maker Roche had $530 million in Tamiflu sales last year while GlaxoSmithKline (GSK) had sales of $105 million for Relenza.
The availability of flu-specific vaccines has a lag time, typically four to six months after a new strain appears, because scientists must grow millions of copies of the virus strain in chicken eggs. But several pharmaceutical and biotechnology companies are experimenting with quicker ways to produce vaccines, cutting the incubation period down to as little as 10 weeks.
These newer vaccines are far from reaching the market, with many of them still in clinical trials and unapproved by the Food and Drug Administration. But investors seem ready to bet on their potential. Since the swine flu hit, the stocks of some anti-flu drugmakers soared; Roche and GlaxoSmithKline saw boosts because of Tamiflu and Relenza, while smaller vaccine creators like Novavax (NVAX) and BioCryst (BCRX) saw share prices rise more than 70% in one day.
Here's a look at a few of the up-and-coming potential medicines and technologies that could help with swine and other types of flu strains in the future.
Baxter International: The drug giant, based in suburban Chicago, requested a sample of the swine flu from the World Health Organization to develop a candidate vaccine through vero-cell cultures, which creates the vaccine by growing the virus in animal cells instead of eggs.
Baxter (BAX, Fortune 500) used this method to develop Celvapan, a bird-flu vaccine that could be used if the WHO declared such a pandemic. It has already received approval for use in Europe and is awaiting approval in the U.S. A Baxter spokesman says a swine-flu vaccine made through vero-cell technology could take only 13 to 16 weeks to provide initial doses.
Novavax: Using technology based on recombinant virus-like particles, the same method used to develop Gardasil, the women's HPV vaccine, Novavax is developing treatments for seasonal and bird flu. CEO Rahul Singhvi says the company could make a vaccine for swine flu within 10 to 12 weeks using VLP technology because scientists need only the genetic sequence of the virus (the swine flu sequence was released last week), instead of the virus itself, to create the vaccine.
"It's a proven technology with Gardasil," Singhvi says. "Therefore it's not a leap of faith that we could test one for swine flu." Singhvi estimates it would cost $100 million to create a vaccine and says Novavax has offered its services to the government.
BioCryst Pharmaceuticals: Instead of a vaccine, BioCryst is developing a flu antiviral that's currently in clinical trials in Japan and the U.S. The medicine, which would differ primarily because it would be taken orally or inhaled (like Relenza), could prevent a "broad range of strains," according to a spokesman. The 80-person company is developing the antiviral, called Peramivir, through a $103 million research grant from the U.S. Department of Health and Human Services.
First Published: April 30, 2009
Swine flu could jump start new drugs
True obsessions
When will the economy recover?
FORTUNE 500
Current Issue
Subscribe to Fortune
NEW YORK (Fortune) -- The rush to respond to the swine-flu outbreak could provide an opportunity for vaccine and antiviral developers to showcase new biotechnologies sooner than expected.
There's no vaccine for the exact strain of swine flu yet, so the immediate course of action lies with currently available flu antivirals. The Centers for Disease Control and Prevention have 50 million treatment courses of such drugs as Tamiflu and Relenza. The agency says lab tests show the swine flu virus is "sensitive" to those treatments. The Department of Homeland Security has asked for $1.5 billion from the government to "acquire antivirals and invest in a vaccine," though officials haven't decided whether to produce a vaccine yet. The pharma maker Roche had $530 million in Tamiflu sales last year while GlaxoSmithKline (GSK) had sales of $105 million for Relenza.
The availability of flu-specific vaccines has a lag time, typically four to six months after a new strain appears, because scientists must grow millions of copies of the virus strain in chicken eggs. But several pharmaceutical and biotechnology companies are experimenting with quicker ways to produce vaccines, cutting the incubation period down to as little as 10 weeks.
These newer vaccines are far from reaching the market, with many of them still in clinical trials and unapproved by the Food and Drug Administration. But investors seem ready to bet on their potential. Since the swine flu hit, the stocks of some anti-flu drugmakers soared; Roche and GlaxoSmithKline saw boosts because of Tamiflu and Relenza, while smaller vaccine creators like Novavax (NVAX) and BioCryst (BCRX) saw share prices rise more than 70% in one day.
Here's a look at a few of the up-and-coming potential medicines and technologies that could help with swine and other types of flu strains in the future.
Baxter International: The drug giant, based in suburban Chicago, requested a sample of the swine flu from the World Health Organization to develop a candidate vaccine through vero-cell cultures, which creates the vaccine by growing the virus in animal cells instead of eggs.
Baxter (BAX, Fortune 500) used this method to develop Celvapan, a bird-flu vaccine that could be used if the WHO declared such a pandemic. It has already received approval for use in Europe and is awaiting approval in the U.S. A Baxter spokesman says a swine-flu vaccine made through vero-cell technology could take only 13 to 16 weeks to provide initial doses.
Novavax: Using technology based on recombinant virus-like particles, the same method used to develop Gardasil, the women's HPV vaccine, Novavax is developing treatments for seasonal and bird flu. CEO Rahul Singhvi says the company could make a vaccine for swine flu within 10 to 12 weeks using VLP technology because scientists need only the genetic sequence of the virus (the swine flu sequence was released last week), instead of the virus itself, to create the vaccine.
"It's a proven technology with Gardasil," Singhvi says. "Therefore it's not a leap of faith that we could test one for swine flu." Singhvi estimates it would cost $100 million to create a vaccine and says Novavax has offered its services to the government.
BioCryst Pharmaceuticals: Instead of a vaccine, BioCryst is developing a flu antiviral that's currently in clinical trials in Japan and the U.S. The medicine, which would differ primarily because it would be taken orally or inhaled (like Relenza), could prevent a "broad range of strains," according to a spokesman. The 80-person company is developing the antiviral, called Peramivir, through a $103 million research grant from the U.S. Department of Health and Human Services.
First Published: April 30, 2009
Wednesday, April 29, 2009
Background to influenza Epidemic
Background to influenza Epidemic
From a presentation given by Dr Karen Poutasi on Influenza Planning
(Compiled for Dr Poutasi by Dr Andie Forde)
What is influenza? Influenza is an acute debilitating viral disease that affects the respiratory tree. Every word in that definition is important. It is acute, comes on suddenly, debilitating, it will knock you for six, and affects the respiratory tree. The respiratory tree includes the tissues that run through the nose, the back of the throat, the sinuses, the bronchi and the lungs. It is a virus that spreads from person to person in droplets and by hand to mouth transmission. So this rather complex picture encompasses everything you need to know about the influenza virus. The outer coat composed of haemaglutinin, and neuraminidase, are what enable our bodies both to recognise and to mount an immune response to the virus. This also enables us to classify influenza A viruses. There are 16 ‘H’s and 9 ‘N’s so you can immediately see the amount of combinations that arise. The Genome is composed of 8 pieces of RNA. These are not transmitted together but can be transmitted separately and therefore gives rise to the tremendous differences that can emerge and unpredictable nature of this virus. This of course, leaves aside the point mutations that can also occur within this virus.
So seasonal influenza or classical influenza comes on abruptly with the development of symptoms, and secondary complications of pneumonia, sinusitis, meningitis, and otitismedia arise. Influenza A viruses, because of their genetic instability, are exceedingly well adapted to elude body defences. With subtle changes that occur to the outer protein coat, the manufacture of a new vaccine each year to seasonal influenza is required. If a major change occurs to these proteins, if there are new ‘H’s and new ‘N’s’, this process is called antigenic shift. The population will have no immunity to this virus and pandemic may result.
Moving on to the ubiquitous nature of viruses. The range of species affected by influenza include Avian, mammals, and also some reptiles. Clearly from this, we can see the potential for a new virus to arise.
What will make pandemic influenza different to seasonal influenza? First, it may come at any time of the year, it may come, as seasonal influenza does, during the cold wintery months. It may come in spring or summer. It is likely that it will come in waves and it may impact on any age group not just the very young and the very elderly. The attack rate may be very high, we do not know what the mortality rate will be – it is possible that it may also be high. What we do know is that it will come, one day, possibly sooner rather than later.
How do we know this? Pandemic Influenza has been recognised since the 12th Century. On average, there have been three pandemics in each century. In the 20th Century Pandemic Influenza occurred in 1918 (the Spanish flu) and we know that the estimated death range runs between 50 – 100 million people. We have no more precise figure than that, because of course the case attack rate and the fatalities were not recorded in large parts of the globe – for example China, the Indian Subcontinent or Africa. This virus was an ‘H’ 1 ‘N’ 1 virus. In 1957, the globe experienced the pandemic of asian flu. This came as one large wave with an attack rate of approximately 70%. The mortality rate was very much reduced and the estimates are around 1 – 4 million dead around the globe, but within new Zealand during this pandemic, we know that at one time 40% of all Christchurch hospital nurses were bed ridden. The third pandemic of the last century occurred in 1968, the Hong Kong flu. Again, a small mortality rate but a lot of sickness. Where do these viruses come from?
In 1918, 1957, and 1968 the evolution was from wild waterfowl. The 1918 virus has had its genome reconstructed. The virus is an Avian virus that adapted to humans. The 1957 and 1968 viruses contained both avian genome and human genome. In 1977 the ‘H1’ ‘N1’ virus re-emerged. Nobody knows why or understands its re-emergence.
However, we also know that there have been a number of pandemic threats and there are lessons to be learned from the threats that did not create Pandemic Influenza. For example, the 1976 swine influenza in the United States. At this time, the Government of the United States applied force majeure to all vaccine manufacturing capacity within its borders. Influenza vaccine could not be exported, and so as it could not move north into Canada, as a consequence the Canadian Government developed its own influenza vaccine capacity.
The first appearance of ‘H5’ ‘N1’ was in Hong Kong in 1997. During this outbreak in poultry, 18 humans were infected, 6 died. This was recognised as being a significant threat and the Hong Kong authorities took what would initially be draconian steps. All poultry within the risk area were culled over a three-day period. This measure is widely believed to have averted the pandemic threat, and indeed, the virus was not seen again for six years. It re-emerged in 2003 at the same time as SARS.
However, there are other avian influenza viruses that have also caused human infection and human death. Of particular interest is the ‘H7’ ‘N7’ outbreak in the Netherlands in 2003. One vet died during this outbreak, and there was documented human to human transmission.
To pick up the ‘H5’ ‘N1’ story. The virus now is endemic throughout South East Asia, North & Central Asia, Africa and has moved into Europe. There are areas of geographic and epidemiological silence. However, as we all know, absence of evidence is not evidence of absence.
How is it possible that a pandemic influenza strain may develop? Clearly, as is happening at present, the virus can move into domestic birds, and secretions and excretions of domestic birds contain virus that can infect a human being. Within that human being the virus can mutate and develop the ability to spread easily human to human. Alternatively, there may be a mixing vessel traditionally mixing vessels have been considered to be pigs. The pig can be infected simultaneously with both an avian and a human influenza virus. The virus could recombine and the progeny may be able to move human to human. Of course a human being can also act as the mixing vessel.
We know that there has been human to human transmission of ‘H5’ ‘N1’. This has not been sustained and in effect has occurred after prolonged close contact of an uninfected and infected person.
What is the risk to New Zealand?
It is extremely unlikely that migratory birds will carry this virus to New Zealand. It is possible that smuggled birds or poultry products could bring the virus into New Zealand.
However, the real risk arises from human travel. To circumnavigate the globe used to take months. Vasco de Gama took three years. The modern traveller and their ancillary passengers will take 36 hours. What are the potential impacts upon New Zealand?
There may be very high morbidity and mortality. We have no living memory of anything remotely similar that would require a whole community commitment to a response. The impacts upon society, the economy and people are likely to be immense. The health services will be under extreme pressure and we know the pressures that a bad seasonal influenza epidemic have upon the sector. There is no surge capacity, as we do not have the fever hospitals waiting with their empty beds and their nurses to respond to such a situation that were available decades ago. The health services will have to be reconfigured. The role will become one of co-ordination, support and leadership. Doctors and Nurses may not be able to deliver individual patient care and attention. The whole of Government will be involved.
Business and government activity will be affected, in some cases severely.
In 1918, the Public Health Department had a depot for the treatment of influenza. People lined up for inhalation treatments. The modern thinking or the old thinking is that we will again have community based assessment centres to diagnose, treat and manage influenza.
The whole of the community responds. The boy scouts delivered food to those who are too ill to prepare it for themselves.
So what is the structure of Pandemic Planning?
The whole of the health sector is involved. There is a Technical Advisory Committee and a group that encompasses the health sector. Both these feed into the Ministry’s Pandemic Emergency Group.
The whole of Government response sits under a standing cabinet committee – Domestic & External Security (DES). The Department of Prime Minister and Cabinet provides a strategic oversight for the interagency pandemic group. And this approach is taken because of the potential impacts. It may well be New Zealand’s most serious crisis. The use of the interagency group, and the DES process engages all of society. Work groups are set up and there are lead agencies in each work group. The work group that is addressing the broad economic aspects is led by Treasury. Similarly, as we have seen in Hurricane Katrina, the maintenance of law and order is vital. The police lead this work group. Some of the issues that are being considered in the interagency Pandemic group include:
• Border Management
• The possibility of closing educational institutions.
• Restrictions on public gatherings.
• Possibly there may be restrictions on internal travel for example we know that the Coromandel closed itself to travellers from Auckland in 1918. With good effect.
• The impact on infrastructure has to be considered.
• And most importantly educating, informing and empowering people to look after themselves and each other at home.
Within the Ministry of Health itself these are some of the projects.
• The purchase of anti-virals.
• The role of anti-virals and the prioritisation of their use.
• Vaccination of the population will give close to 100% protection, once vaccine becomes available.
• Community based assessment centres.
• The role of personal protective equipment.
• The importance of surveillance and monitoring obtaining that evidence which we know will be vital to inform the decisions that must be made once we have a virus.
The New Zealand Influenza Pandemic Action Plan has 3 broad strategic phases.
1. • To plan for it which is the current phase.
• To keep it out, and clearly there is a case for intensive border management and border controls.
• Every day that the entry of the virus is delayed brings us one day closer to total protection of the population by vaccination.
We acknowledge and the World Health Organisation (WHO) acknowledges that border controls are not a long-term strategy. They will delay the entry of the virus but will not exclude it for the six months or so that we may have to wait to obtain supplies of vaccine.
2. If clusters break out within New Zealand, then the Health Sector will initiate a stamping out process to control and eliminate infection within that cluster. The overall strategic response is scalable both up and down.
3. If Pandemic Influenza becomes wide spread within New Zealand then clearly we move into the ‘manage it’ phase and ultimately the ‘recovery phase’. The overall objective throughout all these phases being to exclude, block, suppress, delay and obstruct spread of pandemic influenza until the population can be protected by vaccination.
Throughout all phases critical services and functions must be maintained. For example within the Health Sector there will still be motor vehicle accidents, women will still have babies, and there will still be heart attacks and acutely ill people requiring surgery.
We know that New Zealand has some advantages. As an island nation distance and isolation become one of those. We have few entry points. Most of those are under very good control and those that are not are often isolated from other parts of New Zealand. This geography enables considerations of restrictions on travel, and internal isolation – the raising of a cordon sanitaire around regions that can be protected.
We have good surveillance mechanisms within New Zealand and most importantly we have the full engagement of the whole of Government and we hope that Pandemic Influenza will have several stages to pass through before arriving in New Zealand.
To conclude with some key take home messages, based on the definition of influenza. It is an acute debilitating viral disease spread by large and small droplets or hand to mouth transmission.
There are some simple measures that can be taken every day to protect not just against pandemic influenza but other infectious diseases as well.
Wash and dry the hands before preparing food, after going to the toilet, after wiping children’s noses or your own, cover the mouth when coughing and sneezing, and most importantly if you are sick stay home from work. We must initiate this behavioural change, because influenza is transmitted in large and small droplets - knowing this we can break the chain of transmission from person to person.
Part 2
Epidemic Preparedness Act 2006
Introduction
With a threat of pandemic influenza coming at any unknown time, Cabinet wished to ensure that if and when a pandemic eventuated, New Zealand had appropriate powers to manage the effects. This management, by addressing legislative powers, arose out of the development of the New Zealand Influenza Pandemic Action Plan.
The role to address those gaps fell to Health Legal of the Ministry, to identify and seek to fill in, any gaps in the legislative framework for managing in a potentially very difficult pandemic situation. We had the invaluable assistance of Dr Mark Jacobs, Director of Public Health, and his colleague, Dr Andrea Forde.
Work began to identify current legislative powers, to identify what was needed to manage in a pandemic, and to identify the gaps. This was unplanned work for that financial year. We were fortunate to be able to obtain a secondee from Buddle Findlay to assist us in analysing the current legislative powers, matched to expectations under the Pandemic Plan.
From that work the gestation of the Epidemic Preparedness Bill began. During that gestation the issue of not only health management, but also management of impacts on society in general arose.
After the necessary Cabinet decisions, and helpful involvement from many departments, particularly DPMC, Justice, and Parliamentary Counsel, the Bill was developed and proceeded through Select Committee with the normal public submissions process. A key element of the ultimate success came from the advice from the Law Commission (provided by Sir Geoffrey Palmer), which helped address concerns that arose on a number of issues, and in particular over the balance to be struck between assertion of individual rights over population and community rights, and over the mechanisms for Parliamentary scrutiny.
The Law Commission recommended a number of positive changes to the Bill, and almost all were adopted. The Bill had implications for Parliament itself, and we received helpful and positive assistance from the Office of the Clerk.
The resulting Epidemic Preparedness Act 2006 received unanimous cross party support as a result. It is very unusual to obtain all party support in Parliament on controversial legislation. The Government and Administration Select Committee, led by Shane Adern, was very receptive to ensuring NZ had a solution to managing a pandemic situation. All members contributed to the discussion and debate, and all were very pragmatic in attempting to reach a workable outcome. Compromises were made to accommodate various concerns of political parties. The government itself was very pragmatic also, and so a workable outcome resulted that all parties could support.
What did the resulting legislation achieve?
Arising out of the Epidemic Preparedness Bill were:
• One substantive Act – the Epidemic Preparedness Act 2006
• 6 amendment Acts – to the Health Act, the Immigration Act, the Parole Act, the Sentencing Act, the Social Security Act, and the Summary Proceedings Act.
Epidemic Preparedness Act
This Act is mainly related to managing in society should a pandemic become a real threat or reality.
It allows the making of an epidemic notice by the Prime Minister with the agreement of the Minister of Health upon advice received from the Director General of Health (s.5).
For an epidemic notice to be issued requires the Prime Minister to be satisfied that the effects of an outbreak of the disease (a quarantinable disease within the meaning of the Health Act) are likely to disrupt or continue to disrupt essential government and business activity in New Zealand (or parts of NZ) significantly.
The pandemic outbreak could occur in New Zealand or overseas.
The notice lasts for 3 months maximum but can be renewed.
Once this epidemic notice is given, Parliament must meet within 7 days of the notice being issued.
Associated with the issue of the notice is the ability to invoke modification orders under an epidemic management notice (and invoke powers given in some of the Amendment Act).
Modification orders can be made in advance (called prospective modification orders), ready for invocation if needed, or can be made during the epidemic (called immediate modification orders).
Modification orders allow requirements or restrictions in any Act to be modified (except the Bill of Rights Act 1988, the Constitution Act 1986, the Electoral Act 1993, the Judicature Amendment Act 1972, the NZ Bill of Rights Act 1990, and the Epidemic Preparedness Act itself).
Examples of proposed modification orders for the health and disability sectors are relaxation of requirements relating to crossing professional boundaries under the Health Practitioners Competence Assurance Act 2003, of requirements relating to the prescribing dispensing and provision of medicines to people who are ill (under the Medicines Act 1981), and of requirements under the Health and Disability Services (Safety) Act should hospitals be unable to comply with strict standards (for example in relation to staff who may be ill).
Examples of proposed modification orders in other Acts are the proposals in the Bill (that were taken out) for amendments to the Births Deaths & Marriages Act 1995, the Holidays Act 2003, the Income Tax Act 2004, the Resource Management Act 1991, the Student Loan Scheme Act 1992, and the Tax Administration Act 1994.
These involved matters like nurses signing death certificates instead of doctors, relaxing timing around paying taxes (particularly for businesses that may have to cease operations), being able to carry out necessary activities without first obtaining a resource consent, and relief from due dates to pay student loans. Essentially the modification orders are designed to help society continue to operate by recognising that strict compliance with many laws will not be possible if society is devastated by a pandemic event.
Modification orders are not to go further than reasonably necessary in the circumstances. There are also some matters in respect of which such orders cannot be made (eg, postponing the release of a person from custody, or review of a persons detention).
All modification orders will receive Parliamentary scrutiny with fast track consideration for immediate modification orders (6 sitting days for disallowance).
Modification orders, like an Epidemic notice, can be geographically area specific.
Modification of Court Rules
Provision is made to allow Judges to modify Court rules so they can appropriately meet requirements. This is anticipates that Court staff or the judiciary itself may be adversely affected by pandemic flu.
The judiciary is eminently capable of ensuring any modifications are balanced and fair, so no controls on that power were seen as necessary.
Reading people their rights
For the sake of completeness a provision was inserted to ensure that if rights are modified and people have to be advised of their rights, they are advised of the rights as modified.
Health Act Changes
1. Emergency powers
Amendments made to the emergency powers (sections 70/71/72). These powers are not restricted pandemics only, but can apply to any emergency within the scope of these provisions, one of which is the issuing of an epidemic notice.
The amendments are:
- to provide for medical testing in addition to medical examination, as well as testing of places, buildings, craft etc
- instead of only being able to close premises if concerns arise, provision was made for allowing them to remain open with infection control procedures in place (eg, supermarkets – covering fruit and veges, issuing masks and gloves etc, to help towards avoiding the potential for people in a desperate position helping themselves)
- forbidding people congregating together where there are no infection control procedures operating
- requisition powers have been extended (noting provision already exists in s.71 for compensation)
- Police can provide back up the exercise of emergency powers through the new s.71A (noting that health officers will be concentrating on disease control so cannot be expected to chase the non-compliant people).
2. Non-emergency provisions – new additions
Provision is also made for:
- Results from lab tests results to be notified to a medical officer of health when an epidemic is in force.
- A policy on medicine prioritisation to be put in place to manage appropriate distribution of medicines in short supply (and protection to people who comply with that policy)
3. Border provisions
New provisions for use at the Border have been inserted. Historically border control has related to traditional quarantinable diseases recognised by the WHO (yellow fever, plague, and cholera). Avian influenza has been added, and the ability to add more diseases by order in council has also been provided for – this allows any mutation of the flu virus to be catered for, or for example if an ebola kind of virus mutates into an easily transmissible disease.
Specific amendments made are:
- Clarification of applying quarantine (s.97)
- Requiring compliance with health measures at the border (s.97A) – to separate the well from the unwell to prevent risk of disease transmission, to provide necessary information so as to determine risk profiles for disease transmission.
- Detention of craft for inspection and lifting of detention.
- Examination and testing of arrivals who may show signs of the disease
- Allowing people to pass through the border but subject to quarantine, isolation, or surveillance at large (depending on the risk profile)
- Clarifying that emergency powers can apply at the border.
Amendments to other legislation
Amendments have been made to the Immigration Act, Parole Act, Sentencing Act, Social Security Act, and Summary Proceedings Act. These were made because they concern fundamental rights and freedoms, so were not considered appropriate for modification orders.
I do not propose to cover them here but if you are interested in them, they can be viewed in the relevant Amendment Acts.
From a presentation given by Dr Karen Poutasi on Influenza Planning
(Compiled for Dr Poutasi by Dr Andie Forde)
What is influenza? Influenza is an acute debilitating viral disease that affects the respiratory tree. Every word in that definition is important. It is acute, comes on suddenly, debilitating, it will knock you for six, and affects the respiratory tree. The respiratory tree includes the tissues that run through the nose, the back of the throat, the sinuses, the bronchi and the lungs. It is a virus that spreads from person to person in droplets and by hand to mouth transmission. So this rather complex picture encompasses everything you need to know about the influenza virus. The outer coat composed of haemaglutinin, and neuraminidase, are what enable our bodies both to recognise and to mount an immune response to the virus. This also enables us to classify influenza A viruses. There are 16 ‘H’s and 9 ‘N’s so you can immediately see the amount of combinations that arise. The Genome is composed of 8 pieces of RNA. These are not transmitted together but can be transmitted separately and therefore gives rise to the tremendous differences that can emerge and unpredictable nature of this virus. This of course, leaves aside the point mutations that can also occur within this virus.
So seasonal influenza or classical influenza comes on abruptly with the development of symptoms, and secondary complications of pneumonia, sinusitis, meningitis, and otitismedia arise. Influenza A viruses, because of their genetic instability, are exceedingly well adapted to elude body defences. With subtle changes that occur to the outer protein coat, the manufacture of a new vaccine each year to seasonal influenza is required. If a major change occurs to these proteins, if there are new ‘H’s and new ‘N’s’, this process is called antigenic shift. The population will have no immunity to this virus and pandemic may result.
Moving on to the ubiquitous nature of viruses. The range of species affected by influenza include Avian, mammals, and also some reptiles. Clearly from this, we can see the potential for a new virus to arise.
What will make pandemic influenza different to seasonal influenza? First, it may come at any time of the year, it may come, as seasonal influenza does, during the cold wintery months. It may come in spring or summer. It is likely that it will come in waves and it may impact on any age group not just the very young and the very elderly. The attack rate may be very high, we do not know what the mortality rate will be – it is possible that it may also be high. What we do know is that it will come, one day, possibly sooner rather than later.
How do we know this? Pandemic Influenza has been recognised since the 12th Century. On average, there have been three pandemics in each century. In the 20th Century Pandemic Influenza occurred in 1918 (the Spanish flu) and we know that the estimated death range runs between 50 – 100 million people. We have no more precise figure than that, because of course the case attack rate and the fatalities were not recorded in large parts of the globe – for example China, the Indian Subcontinent or Africa. This virus was an ‘H’ 1 ‘N’ 1 virus. In 1957, the globe experienced the pandemic of asian flu. This came as one large wave with an attack rate of approximately 70%. The mortality rate was very much reduced and the estimates are around 1 – 4 million dead around the globe, but within new Zealand during this pandemic, we know that at one time 40% of all Christchurch hospital nurses were bed ridden. The third pandemic of the last century occurred in 1968, the Hong Kong flu. Again, a small mortality rate but a lot of sickness. Where do these viruses come from?
In 1918, 1957, and 1968 the evolution was from wild waterfowl. The 1918 virus has had its genome reconstructed. The virus is an Avian virus that adapted to humans. The 1957 and 1968 viruses contained both avian genome and human genome. In 1977 the ‘H1’ ‘N1’ virus re-emerged. Nobody knows why or understands its re-emergence.
However, we also know that there have been a number of pandemic threats and there are lessons to be learned from the threats that did not create Pandemic Influenza. For example, the 1976 swine influenza in the United States. At this time, the Government of the United States applied force majeure to all vaccine manufacturing capacity within its borders. Influenza vaccine could not be exported, and so as it could not move north into Canada, as a consequence the Canadian Government developed its own influenza vaccine capacity.
The first appearance of ‘H5’ ‘N1’ was in Hong Kong in 1997. During this outbreak in poultry, 18 humans were infected, 6 died. This was recognised as being a significant threat and the Hong Kong authorities took what would initially be draconian steps. All poultry within the risk area were culled over a three-day period. This measure is widely believed to have averted the pandemic threat, and indeed, the virus was not seen again for six years. It re-emerged in 2003 at the same time as SARS.
However, there are other avian influenza viruses that have also caused human infection and human death. Of particular interest is the ‘H7’ ‘N7’ outbreak in the Netherlands in 2003. One vet died during this outbreak, and there was documented human to human transmission.
To pick up the ‘H5’ ‘N1’ story. The virus now is endemic throughout South East Asia, North & Central Asia, Africa and has moved into Europe. There are areas of geographic and epidemiological silence. However, as we all know, absence of evidence is not evidence of absence.
How is it possible that a pandemic influenza strain may develop? Clearly, as is happening at present, the virus can move into domestic birds, and secretions and excretions of domestic birds contain virus that can infect a human being. Within that human being the virus can mutate and develop the ability to spread easily human to human. Alternatively, there may be a mixing vessel traditionally mixing vessels have been considered to be pigs. The pig can be infected simultaneously with both an avian and a human influenza virus. The virus could recombine and the progeny may be able to move human to human. Of course a human being can also act as the mixing vessel.
We know that there has been human to human transmission of ‘H5’ ‘N1’. This has not been sustained and in effect has occurred after prolonged close contact of an uninfected and infected person.
What is the risk to New Zealand?
It is extremely unlikely that migratory birds will carry this virus to New Zealand. It is possible that smuggled birds or poultry products could bring the virus into New Zealand.
However, the real risk arises from human travel. To circumnavigate the globe used to take months. Vasco de Gama took three years. The modern traveller and their ancillary passengers will take 36 hours. What are the potential impacts upon New Zealand?
There may be very high morbidity and mortality. We have no living memory of anything remotely similar that would require a whole community commitment to a response. The impacts upon society, the economy and people are likely to be immense. The health services will be under extreme pressure and we know the pressures that a bad seasonal influenza epidemic have upon the sector. There is no surge capacity, as we do not have the fever hospitals waiting with their empty beds and their nurses to respond to such a situation that were available decades ago. The health services will have to be reconfigured. The role will become one of co-ordination, support and leadership. Doctors and Nurses may not be able to deliver individual patient care and attention. The whole of Government will be involved.
Business and government activity will be affected, in some cases severely.
In 1918, the Public Health Department had a depot for the treatment of influenza. People lined up for inhalation treatments. The modern thinking or the old thinking is that we will again have community based assessment centres to diagnose, treat and manage influenza.
The whole of the community responds. The boy scouts delivered food to those who are too ill to prepare it for themselves.
So what is the structure of Pandemic Planning?
The whole of the health sector is involved. There is a Technical Advisory Committee and a group that encompasses the health sector. Both these feed into the Ministry’s Pandemic Emergency Group.
The whole of Government response sits under a standing cabinet committee – Domestic & External Security (DES). The Department of Prime Minister and Cabinet provides a strategic oversight for the interagency pandemic group. And this approach is taken because of the potential impacts. It may well be New Zealand’s most serious crisis. The use of the interagency group, and the DES process engages all of society. Work groups are set up and there are lead agencies in each work group. The work group that is addressing the broad economic aspects is led by Treasury. Similarly, as we have seen in Hurricane Katrina, the maintenance of law and order is vital. The police lead this work group. Some of the issues that are being considered in the interagency Pandemic group include:
• Border Management
• The possibility of closing educational institutions.
• Restrictions on public gatherings.
• Possibly there may be restrictions on internal travel for example we know that the Coromandel closed itself to travellers from Auckland in 1918. With good effect.
• The impact on infrastructure has to be considered.
• And most importantly educating, informing and empowering people to look after themselves and each other at home.
Within the Ministry of Health itself these are some of the projects.
• The purchase of anti-virals.
• The role of anti-virals and the prioritisation of their use.
• Vaccination of the population will give close to 100% protection, once vaccine becomes available.
• Community based assessment centres.
• The role of personal protective equipment.
• The importance of surveillance and monitoring obtaining that evidence which we know will be vital to inform the decisions that must be made once we have a virus.
The New Zealand Influenza Pandemic Action Plan has 3 broad strategic phases.
1. • To plan for it which is the current phase.
• To keep it out, and clearly there is a case for intensive border management and border controls.
• Every day that the entry of the virus is delayed brings us one day closer to total protection of the population by vaccination.
We acknowledge and the World Health Organisation (WHO) acknowledges that border controls are not a long-term strategy. They will delay the entry of the virus but will not exclude it for the six months or so that we may have to wait to obtain supplies of vaccine.
2. If clusters break out within New Zealand, then the Health Sector will initiate a stamping out process to control and eliminate infection within that cluster. The overall strategic response is scalable both up and down.
3. If Pandemic Influenza becomes wide spread within New Zealand then clearly we move into the ‘manage it’ phase and ultimately the ‘recovery phase’. The overall objective throughout all these phases being to exclude, block, suppress, delay and obstruct spread of pandemic influenza until the population can be protected by vaccination.
Throughout all phases critical services and functions must be maintained. For example within the Health Sector there will still be motor vehicle accidents, women will still have babies, and there will still be heart attacks and acutely ill people requiring surgery.
We know that New Zealand has some advantages. As an island nation distance and isolation become one of those. We have few entry points. Most of those are under very good control and those that are not are often isolated from other parts of New Zealand. This geography enables considerations of restrictions on travel, and internal isolation – the raising of a cordon sanitaire around regions that can be protected.
We have good surveillance mechanisms within New Zealand and most importantly we have the full engagement of the whole of Government and we hope that Pandemic Influenza will have several stages to pass through before arriving in New Zealand.
To conclude with some key take home messages, based on the definition of influenza. It is an acute debilitating viral disease spread by large and small droplets or hand to mouth transmission.
There are some simple measures that can be taken every day to protect not just against pandemic influenza but other infectious diseases as well.
Wash and dry the hands before preparing food, after going to the toilet, after wiping children’s noses or your own, cover the mouth when coughing and sneezing, and most importantly if you are sick stay home from work. We must initiate this behavioural change, because influenza is transmitted in large and small droplets - knowing this we can break the chain of transmission from person to person.
Part 2
Epidemic Preparedness Act 2006
Introduction
With a threat of pandemic influenza coming at any unknown time, Cabinet wished to ensure that if and when a pandemic eventuated, New Zealand had appropriate powers to manage the effects. This management, by addressing legislative powers, arose out of the development of the New Zealand Influenza Pandemic Action Plan.
The role to address those gaps fell to Health Legal of the Ministry, to identify and seek to fill in, any gaps in the legislative framework for managing in a potentially very difficult pandemic situation. We had the invaluable assistance of Dr Mark Jacobs, Director of Public Health, and his colleague, Dr Andrea Forde.
Work began to identify current legislative powers, to identify what was needed to manage in a pandemic, and to identify the gaps. This was unplanned work for that financial year. We were fortunate to be able to obtain a secondee from Buddle Findlay to assist us in analysing the current legislative powers, matched to expectations under the Pandemic Plan.
From that work the gestation of the Epidemic Preparedness Bill began. During that gestation the issue of not only health management, but also management of impacts on society in general arose.
After the necessary Cabinet decisions, and helpful involvement from many departments, particularly DPMC, Justice, and Parliamentary Counsel, the Bill was developed and proceeded through Select Committee with the normal public submissions process. A key element of the ultimate success came from the advice from the Law Commission (provided by Sir Geoffrey Palmer), which helped address concerns that arose on a number of issues, and in particular over the balance to be struck between assertion of individual rights over population and community rights, and over the mechanisms for Parliamentary scrutiny.
The Law Commission recommended a number of positive changes to the Bill, and almost all were adopted. The Bill had implications for Parliament itself, and we received helpful and positive assistance from the Office of the Clerk.
The resulting Epidemic Preparedness Act 2006 received unanimous cross party support as a result. It is very unusual to obtain all party support in Parliament on controversial legislation. The Government and Administration Select Committee, led by Shane Adern, was very receptive to ensuring NZ had a solution to managing a pandemic situation. All members contributed to the discussion and debate, and all were very pragmatic in attempting to reach a workable outcome. Compromises were made to accommodate various concerns of political parties. The government itself was very pragmatic also, and so a workable outcome resulted that all parties could support.
What did the resulting legislation achieve?
Arising out of the Epidemic Preparedness Bill were:
• One substantive Act – the Epidemic Preparedness Act 2006
• 6 amendment Acts – to the Health Act, the Immigration Act, the Parole Act, the Sentencing Act, the Social Security Act, and the Summary Proceedings Act.
Epidemic Preparedness Act
This Act is mainly related to managing in society should a pandemic become a real threat or reality.
It allows the making of an epidemic notice by the Prime Minister with the agreement of the Minister of Health upon advice received from the Director General of Health (s.5).
For an epidemic notice to be issued requires the Prime Minister to be satisfied that the effects of an outbreak of the disease (a quarantinable disease within the meaning of the Health Act) are likely to disrupt or continue to disrupt essential government and business activity in New Zealand (or parts of NZ) significantly.
The pandemic outbreak could occur in New Zealand or overseas.
The notice lasts for 3 months maximum but can be renewed.
Once this epidemic notice is given, Parliament must meet within 7 days of the notice being issued.
Associated with the issue of the notice is the ability to invoke modification orders under an epidemic management notice (and invoke powers given in some of the Amendment Act).
Modification orders can be made in advance (called prospective modification orders), ready for invocation if needed, or can be made during the epidemic (called immediate modification orders).
Modification orders allow requirements or restrictions in any Act to be modified (except the Bill of Rights Act 1988, the Constitution Act 1986, the Electoral Act 1993, the Judicature Amendment Act 1972, the NZ Bill of Rights Act 1990, and the Epidemic Preparedness Act itself).
Examples of proposed modification orders for the health and disability sectors are relaxation of requirements relating to crossing professional boundaries under the Health Practitioners Competence Assurance Act 2003, of requirements relating to the prescribing dispensing and provision of medicines to people who are ill (under the Medicines Act 1981), and of requirements under the Health and Disability Services (Safety) Act should hospitals be unable to comply with strict standards (for example in relation to staff who may be ill).
Examples of proposed modification orders in other Acts are the proposals in the Bill (that were taken out) for amendments to the Births Deaths & Marriages Act 1995, the Holidays Act 2003, the Income Tax Act 2004, the Resource Management Act 1991, the Student Loan Scheme Act 1992, and the Tax Administration Act 1994.
These involved matters like nurses signing death certificates instead of doctors, relaxing timing around paying taxes (particularly for businesses that may have to cease operations), being able to carry out necessary activities without first obtaining a resource consent, and relief from due dates to pay student loans. Essentially the modification orders are designed to help society continue to operate by recognising that strict compliance with many laws will not be possible if society is devastated by a pandemic event.
Modification orders are not to go further than reasonably necessary in the circumstances. There are also some matters in respect of which such orders cannot be made (eg, postponing the release of a person from custody, or review of a persons detention).
All modification orders will receive Parliamentary scrutiny with fast track consideration for immediate modification orders (6 sitting days for disallowance).
Modification orders, like an Epidemic notice, can be geographically area specific.
Modification of Court Rules
Provision is made to allow Judges to modify Court rules so they can appropriately meet requirements. This is anticipates that Court staff or the judiciary itself may be adversely affected by pandemic flu.
The judiciary is eminently capable of ensuring any modifications are balanced and fair, so no controls on that power were seen as necessary.
Reading people their rights
For the sake of completeness a provision was inserted to ensure that if rights are modified and people have to be advised of their rights, they are advised of the rights as modified.
Health Act Changes
1. Emergency powers
Amendments made to the emergency powers (sections 70/71/72). These powers are not restricted pandemics only, but can apply to any emergency within the scope of these provisions, one of which is the issuing of an epidemic notice.
The amendments are:
- to provide for medical testing in addition to medical examination, as well as testing of places, buildings, craft etc
- instead of only being able to close premises if concerns arise, provision was made for allowing them to remain open with infection control procedures in place (eg, supermarkets – covering fruit and veges, issuing masks and gloves etc, to help towards avoiding the potential for people in a desperate position helping themselves)
- forbidding people congregating together where there are no infection control procedures operating
- requisition powers have been extended (noting provision already exists in s.71 for compensation)
- Police can provide back up the exercise of emergency powers through the new s.71A (noting that health officers will be concentrating on disease control so cannot be expected to chase the non-compliant people).
2. Non-emergency provisions – new additions
Provision is also made for:
- Results from lab tests results to be notified to a medical officer of health when an epidemic is in force.
- A policy on medicine prioritisation to be put in place to manage appropriate distribution of medicines in short supply (and protection to people who comply with that policy)
3. Border provisions
New provisions for use at the Border have been inserted. Historically border control has related to traditional quarantinable diseases recognised by the WHO (yellow fever, plague, and cholera). Avian influenza has been added, and the ability to add more diseases by order in council has also been provided for – this allows any mutation of the flu virus to be catered for, or for example if an ebola kind of virus mutates into an easily transmissible disease.
Specific amendments made are:
- Clarification of applying quarantine (s.97)
- Requiring compliance with health measures at the border (s.97A) – to separate the well from the unwell to prevent risk of disease transmission, to provide necessary information so as to determine risk profiles for disease transmission.
- Detention of craft for inspection and lifting of detention.
- Examination and testing of arrivals who may show signs of the disease
- Allowing people to pass through the border but subject to quarantine, isolation, or surveillance at large (depending on the risk profile)
- Clarifying that emergency powers can apply at the border.
Amendments to other legislation
Amendments have been made to the Immigration Act, Parole Act, Sentencing Act, Social Security Act, and Summary Proceedings Act. These were made because they concern fundamental rights and freedoms, so were not considered appropriate for modification orders.
I do not propose to cover them here but if you are interested in them, they can be viewed in the relevant Amendment Acts.
NZ begins swine flu tests
ESR scientists have begun testing swine flu samples in New Zealand as suspected cases rise and officials remind Kiwis they can only buy Tamiflu over the counter if they are unwell.
Specialist scientists have been co-opted to assist with the testing process at ESR's National Influenza Centre, a statement said today. "Now the swine flu has been confirmed in New Zealand and the molecular structure of the virus has been identified, ESR's WHO National Influenza Centre can perform the testing."
Meanwhile, at a press conference this morning health officials said while Tamiflu could be purchased over the counter from tomorrow, patients needed to be exhibiting symptoms before they would be sold the anti-viral medication.
"[Buyers] need to be in the early stages of influenza," Deputy Director of Public Health Dr Fran McGrath said.
"If they're not in the early stages then they need to see their doctor for a prescription."
More test results are expected today from patients suspected of having swine flu. The tests will confirm whether they have Influenza A and once this is established more complicated tests will be carried out for swine flu. All suspected patients are however being treated as if they have swine flu and are being isolated for 72 hours and given a course of Tamiflu.
The World Health Organisation this morning raised the pandemic threat level from swine flu to phase 5.
In New Zealand, the number of suspected cases of swine flu has grown to 104.
Included in the isolation tally is Grey District Mayor Tony Kokshoorn. He is under quarantine at home today - one day before a scheduled meeting with Prime Minister John Key.
Mr Kokshoorn and his family flew home from a holiday in Hawaii and North America a day before the "swine flu flight" that carried the flu strain to New Zealand.
A family member was now taking Tamiflu as a precaution and being tested for influenza A after becoming sick five days later, Mr Kokshoorn said today. "[But] I want to stress - I haven't got the flu. I've never been better."
NEW ZEALAND'S RESPONSE
Health officials moved today to establish a "community-based assessment centre", most likely at Auckland's Middlemore Hospital.
Officials said this morning there were still 13 probable cases of swine flu, with three confirmed by the WHO's Melbourne testing centre. But the number of suspected cases had increased to 104.
"The growth in suspect numbers is primarily from close family contacts from passengers on flights," Health Minister Tony Ryall told a press conference today.
Numbers in isolation have also likely increased, with health officials now dealing with 101 cases. "[But] you can assume that many of them will have two, or three or more family members," Mr Ryall said.
There are 72 isolation cases in Auckland, 16 in Wellington, eight in Nelson, seven in Wanganui. Several other regions also have one or two cases.
Director General of Public Health Stephen McKernan said a community assessment facility would likely be established at Middlemore, so clinical assessments for swine flu could be conducted away from the airport.
Treatment could also be given and patients could be put in isolation in the unit.
It is possible other similar centres will be established in other parts of the country if the flu spreads, he said.
Mr Ryall said New Zealand had moved to a phase 5.1 in its plan but "this is not an escalation in New Zealand's epidemic planning."
Officials were still working to "contain and mitigate" swine flu, he said.
Mr Ryall said 32 countries had now notified WHO of suspected or confirmed cases of swine flu.
"As you know we are working hard to identify people potentially with swine flu so we can provide them with treatment and support and limit the spread of the flu."
The Health Ministry said at least 10,000 people arrived here from North America each week and all were subject to screening.
Eleven people on a flight that stopped off in Auckland yesterday en route to Australia were taken to hospital, suspected of having the virus. Five of those were in transit.
Mr Ryall, said the Government had made an order-in-council making non-seasonal influenza a notifiable disease.
The Canterbury District Health Board has also set itself up at Christchurch International Airport to help passengers from overseas that are unwell.
PANDEMIC ALERT
Earlier today, the World Health Organisation has raised the pandemic threat level from swine flu to phase 5 as the virus spread and killed the first person outside Mexico, a toddler in Texas.
WHO Director-General Margaret Chan made the decision to raise the alert level from phase 4 - signifying transmission in only one country - after reviewing the latest scientific evidence on the outbreak.
"I have decided to raise the level of influenza pandemic alert from phase 4 to phase 5," Chan told a news briefing.
Phase 5 is the WHO's second highest level of warning that a pandemic, or global outbreak of a serious new illness, is imminent. Phase 6 means a pandemic has begun.
Chan said she hoped to reassure governments but urged them to prepare for the worst.
"The world is better prepared for an influenza pandemic than at any time in history," Chan said. "For the first time in history we can track the pandemic in real time."
The H1N1 swine flu virus has spread around the world, killing an estimated 159 people in Mexico, claiming the life of a Mexican toddler in the United States, and infecting people in at least eight other countries.
It is a never-before-seen mix of swine, avian and human viruses and it is not clear how deadly it is or how easily it transmits from one person to another.
"No matter what the situation is, the international community should treat this as a window of opportunity to ramp up ... response," Chan said.
"It is really all of humanity that is under threat during a pandemic."
Pharmaceutical companies should ramp up manufacturing she said. Two antiviral drugs- Relenza, made by GlaxoSmithKline and Tamiflu, made by Roche AG- have been shown to work against the H1N1 swine flu strain.
Nearly a week after the H1N1 virus, or swine flu, first emerged in California and Texas and was found to have caused deaths in Mexico, Spain reported the first case in Europe of swine flu in a person who had not been to Mexico, illustrating the danger of person-to-person transmission.
Germany and Austria reported cases, bringing the number of affected countries to 9. US officials said a 22-month-old boy had died in Texas – the first confirmed US swine flu death – while on a family visit from Mexico.
Specialist scientists have been co-opted to assist with the testing process at ESR's National Influenza Centre, a statement said today. "Now the swine flu has been confirmed in New Zealand and the molecular structure of the virus has been identified, ESR's WHO National Influenza Centre can perform the testing."
Meanwhile, at a press conference this morning health officials said while Tamiflu could be purchased over the counter from tomorrow, patients needed to be exhibiting symptoms before they would be sold the anti-viral medication.
"[Buyers] need to be in the early stages of influenza," Deputy Director of Public Health Dr Fran McGrath said.
"If they're not in the early stages then they need to see their doctor for a prescription."
More test results are expected today from patients suspected of having swine flu. The tests will confirm whether they have Influenza A and once this is established more complicated tests will be carried out for swine flu. All suspected patients are however being treated as if they have swine flu and are being isolated for 72 hours and given a course of Tamiflu.
The World Health Organisation this morning raised the pandemic threat level from swine flu to phase 5.
In New Zealand, the number of suspected cases of swine flu has grown to 104.
Included in the isolation tally is Grey District Mayor Tony Kokshoorn. He is under quarantine at home today - one day before a scheduled meeting with Prime Minister John Key.
Mr Kokshoorn and his family flew home from a holiday in Hawaii and North America a day before the "swine flu flight" that carried the flu strain to New Zealand.
A family member was now taking Tamiflu as a precaution and being tested for influenza A after becoming sick five days later, Mr Kokshoorn said today. "[But] I want to stress - I haven't got the flu. I've never been better."
NEW ZEALAND'S RESPONSE
Health officials moved today to establish a "community-based assessment centre", most likely at Auckland's Middlemore Hospital.
Officials said this morning there were still 13 probable cases of swine flu, with three confirmed by the WHO's Melbourne testing centre. But the number of suspected cases had increased to 104.
"The growth in suspect numbers is primarily from close family contacts from passengers on flights," Health Minister Tony Ryall told a press conference today.
Numbers in isolation have also likely increased, with health officials now dealing with 101 cases. "[But] you can assume that many of them will have two, or three or more family members," Mr Ryall said.
There are 72 isolation cases in Auckland, 16 in Wellington, eight in Nelson, seven in Wanganui. Several other regions also have one or two cases.
Director General of Public Health Stephen McKernan said a community assessment facility would likely be established at Middlemore, so clinical assessments for swine flu could be conducted away from the airport.
Treatment could also be given and patients could be put in isolation in the unit.
It is possible other similar centres will be established in other parts of the country if the flu spreads, he said.
Mr Ryall said New Zealand had moved to a phase 5.1 in its plan but "this is not an escalation in New Zealand's epidemic planning."
Officials were still working to "contain and mitigate" swine flu, he said.
Mr Ryall said 32 countries had now notified WHO of suspected or confirmed cases of swine flu.
"As you know we are working hard to identify people potentially with swine flu so we can provide them with treatment and support and limit the spread of the flu."
The Health Ministry said at least 10,000 people arrived here from North America each week and all were subject to screening.
Eleven people on a flight that stopped off in Auckland yesterday en route to Australia were taken to hospital, suspected of having the virus. Five of those were in transit.
Mr Ryall, said the Government had made an order-in-council making non-seasonal influenza a notifiable disease.
The Canterbury District Health Board has also set itself up at Christchurch International Airport to help passengers from overseas that are unwell.
PANDEMIC ALERT
Earlier today, the World Health Organisation has raised the pandemic threat level from swine flu to phase 5 as the virus spread and killed the first person outside Mexico, a toddler in Texas.
WHO Director-General Margaret Chan made the decision to raise the alert level from phase 4 - signifying transmission in only one country - after reviewing the latest scientific evidence on the outbreak.
"I have decided to raise the level of influenza pandemic alert from phase 4 to phase 5," Chan told a news briefing.
Phase 5 is the WHO's second highest level of warning that a pandemic, or global outbreak of a serious new illness, is imminent. Phase 6 means a pandemic has begun.
Chan said she hoped to reassure governments but urged them to prepare for the worst.
"The world is better prepared for an influenza pandemic than at any time in history," Chan said. "For the first time in history we can track the pandemic in real time."
The H1N1 swine flu virus has spread around the world, killing an estimated 159 people in Mexico, claiming the life of a Mexican toddler in the United States, and infecting people in at least eight other countries.
It is a never-before-seen mix of swine, avian and human viruses and it is not clear how deadly it is or how easily it transmits from one person to another.
"No matter what the situation is, the international community should treat this as a window of opportunity to ramp up ... response," Chan said.
"It is really all of humanity that is under threat during a pandemic."
Pharmaceutical companies should ramp up manufacturing she said. Two antiviral drugs- Relenza, made by GlaxoSmithKline and Tamiflu, made by Roche AG- have been shown to work against the H1N1 swine flu strain.
Nearly a week after the H1N1 virus, or swine flu, first emerged in California and Texas and was found to have caused deaths in Mexico, Spain reported the first case in Europe of swine flu in a person who had not been to Mexico, illustrating the danger of person-to-person transmission.
Germany and Austria reported cases, bringing the number of affected countries to 9. US officials said a 22-month-old boy had died in Texas – the first confirmed US swine flu death – while on a family visit from Mexico.
Scientists fear flu could mutate
Scientists fear flu could mutate
By RUTH HILL and REBECCA PALMER - The Dominion Post Last updated 05:00 30/04/2009SharePrint Text Size Related LinksGermany reports first case of swine flu New Zealand begins swine flu tests Relevant offers
Scientists fear swine flu could mutate into a strain resistant to Tamiflu at present the only defence against the deadly virus with a vaccine still several months away.
As the Mexican death toll rose above 150 last night, New Zealand health authorities confirmed 14 definite or probable cases.
Eleven international travellers arriving here from the Americas with suspected swine flu symptoms were picked up at border screening yesterday and put into isolation.
Authorities are still trying to contact 15 passengers from flight NZ1, which carried the infected Rangitoto College pupils from Mexico via Los Angeles on Saturday.
The Government has ramped up its powers to deal with a potential epidemic by making swine flu a "notifiable disease" through a special order-in-council giving it the ability to forcibly quarantine suspected carriers if necessary.
Environmental Science and Research virologist Sue Huang, head of the WHO national influenza centre in Upper Hutt, said swine flu strains were changing so rapidly that there was a threat one could combine with a Tamiflu-resistant virus already in circulation.
"This virus really caught us by surprise," Dr Huang said.
It was vital health authorities took advantage of the fact swine flu had not yet become resistant to the retro-viral drug, she said.
Five cases of Tamiflu-resistant seasonal influenza have been diagnosed in New Zealand in the past nine months. Tamiflu-resistant H1N1 flu strains were becoming more prolific in Hong Kong and the US.
Test swabs for the killer virus are now being analysed at the ESR's Upper Hutt laboratory.
Dr Huang said it usually took about six months to develop a vaccine for a particular strain and "get it on to the shelves".
Health Minister Tony Ryall said the move to make swine flu a notifiable disease was "a precautionary measure".
"It is now on the schedule for the Epidemic Preparedness Act, so if there's any need to bring in that act it's much more straightforward."
Under the 2006 act passed when fears of a bird flu pandemic were at their height the prime minister can grant "special powers" to government ministers, the chief of police and judges.
The Health Ministry is enforcing strict border controls, screening every international flight from affected areas.
The quarantined travellers identified yesterday were initially treated in Middlemore Hospital but were last night in isolation at a hotel.
About 200 people were still in voluntary isolation last night. Those who had no symptoms and had had three days of Tamiflu treatment were expected to leave isolation today.
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By RUTH HILL and REBECCA PALMER - The Dominion Post Last updated 05:00 30/04/2009SharePrint Text Size Related LinksGermany reports first case of swine flu New Zealand begins swine flu tests Relevant offers
Scientists fear swine flu could mutate into a strain resistant to Tamiflu at present the only defence against the deadly virus with a vaccine still several months away.
As the Mexican death toll rose above 150 last night, New Zealand health authorities confirmed 14 definite or probable cases.
Eleven international travellers arriving here from the Americas with suspected swine flu symptoms were picked up at border screening yesterday and put into isolation.
Authorities are still trying to contact 15 passengers from flight NZ1, which carried the infected Rangitoto College pupils from Mexico via Los Angeles on Saturday.
The Government has ramped up its powers to deal with a potential epidemic by making swine flu a "notifiable disease" through a special order-in-council giving it the ability to forcibly quarantine suspected carriers if necessary.
Environmental Science and Research virologist Sue Huang, head of the WHO national influenza centre in Upper Hutt, said swine flu strains were changing so rapidly that there was a threat one could combine with a Tamiflu-resistant virus already in circulation.
"This virus really caught us by surprise," Dr Huang said.
It was vital health authorities took advantage of the fact swine flu had not yet become resistant to the retro-viral drug, she said.
Five cases of Tamiflu-resistant seasonal influenza have been diagnosed in New Zealand in the past nine months. Tamiflu-resistant H1N1 flu strains were becoming more prolific in Hong Kong and the US.
Test swabs for the killer virus are now being analysed at the ESR's Upper Hutt laboratory.
Dr Huang said it usually took about six months to develop a vaccine for a particular strain and "get it on to the shelves".
Health Minister Tony Ryall said the move to make swine flu a notifiable disease was "a precautionary measure".
"It is now on the schedule for the Epidemic Preparedness Act, so if there's any need to bring in that act it's much more straightforward."
Under the 2006 act passed when fears of a bird flu pandemic were at their height the prime minister can grant "special powers" to government ministers, the chief of police and judges.
The Health Ministry is enforcing strict border controls, screening every international flight from affected areas.
The quarantined travellers identified yesterday were initially treated in Middlemore Hospital but were last night in isolation at a hotel.
About 200 people were still in voluntary isolation last night. Those who had no symptoms and had had three days of Tamiflu treatment were expected to leave isolation today.
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Half a million school days lost to asthma
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FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans
FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans
The U.S. Food and Drug Administration, in response to requests from the U.S. Centers for Disease Control and Prevention, has issued Emergency Use Authorizations (EUAs) to make available to public health and medical personnel important diagnostic and therapeutic tools to identify and respond to the swine flu virus under certain circumstances. The agency issued these EUAs for the use of certain Relenza and Tamiflu antiviral products, and for the rRT-PCR Swine Flu Panel diagnostic test.
The EUA authority allows the FDA, based on the evaluation of available data, to authorize the use of unapproved or uncleared medical products or unapproved or uncleared uses of approved or cleared medical products following a determination and declaration of emergency, provided certain criteria are met. The authorization will end when the declaration of emergency is terminated or the authorization revoked by the agency.
Currently, Relenza is approved to treat acute uncomplicated illnesses due to influenza in adults and children 7 years and older who have been symptomatic for less than two days, and for the prevention of influenza in adults and children 5 years and older. Tamiflu is approved for the treatment and prevention of influenza in patients 1 year and older.
The EUAs allow for Tamiflu also to be used to treat and prevent influenza in children under 1 year, and to provide alternate dosing recommendations for children older than 1 year. In addition, under the EUAs, both medications may be distributed to large segments of the population without complying with the label requirements otherwise applicable to dispensed drugs, and accompanied by written information pertaining to the emergency use. They may also be distributed by a broader range of health care workers, including some public health officials and volunteers, in accordance with applicable state and local laws and/or public health emergency responses.
In authorizing an EUA for the rRT-PCR Swine Flu Panel diagnostic test, the FDA has determined that it may be effective in testing samples from individuals diagnosed with influenza A infections, whose virus subtypes cannot be identified by currently available tests. This EUA allows the CDC to distribute the swine flu test to public health and other qualified laboratories that have the needed equipment and the personnel who are trained to perform and interpret the results.
The test amplifies the viral genetic material from a nasal or nasopharyngeal swab. A positive result indicates that the patient is presumptively infected with swine flu virus but not the stage of infection. However, a negative result does not, by itself, exclude the possibility of swine flu virus infection.
The EUA authority is part of Project BioShield, which became law in July 2004.
Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.
--Online: www.fda.gov/MedWatch/report.htm
--Regular Mail: use postage-paid FDA form 3500 available at: www.fda.gov/MedWatch/getforms.htm and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
--Fax: (800) FDA-0178
--Phone: (800) FDA-1088
The U.S. Food and Drug Administration, in response to requests from the U.S. Centers for Disease Control and Prevention, has issued Emergency Use Authorizations (EUAs) to make available to public health and medical personnel important diagnostic and therapeutic tools to identify and respond to the swine flu virus under certain circumstances. The agency issued these EUAs for the use of certain Relenza and Tamiflu antiviral products, and for the rRT-PCR Swine Flu Panel diagnostic test.
The EUA authority allows the FDA, based on the evaluation of available data, to authorize the use of unapproved or uncleared medical products or unapproved or uncleared uses of approved or cleared medical products following a determination and declaration of emergency, provided certain criteria are met. The authorization will end when the declaration of emergency is terminated or the authorization revoked by the agency.
Currently, Relenza is approved to treat acute uncomplicated illnesses due to influenza in adults and children 7 years and older who have been symptomatic for less than two days, and for the prevention of influenza in adults and children 5 years and older. Tamiflu is approved for the treatment and prevention of influenza in patients 1 year and older.
The EUAs allow for Tamiflu also to be used to treat and prevent influenza in children under 1 year, and to provide alternate dosing recommendations for children older than 1 year. In addition, under the EUAs, both medications may be distributed to large segments of the population without complying with the label requirements otherwise applicable to dispensed drugs, and accompanied by written information pertaining to the emergency use. They may also be distributed by a broader range of health care workers, including some public health officials and volunteers, in accordance with applicable state and local laws and/or public health emergency responses.
In authorizing an EUA for the rRT-PCR Swine Flu Panel diagnostic test, the FDA has determined that it may be effective in testing samples from individuals diagnosed with influenza A infections, whose virus subtypes cannot be identified by currently available tests. This EUA allows the CDC to distribute the swine flu test to public health and other qualified laboratories that have the needed equipment and the personnel who are trained to perform and interpret the results.
The test amplifies the viral genetic material from a nasal or nasopharyngeal swab. A positive result indicates that the patient is presumptively infected with swine flu virus but not the stage of infection. However, a negative result does not, by itself, exclude the possibility of swine flu virus infection.
The EUA authority is part of Project BioShield, which became law in July 2004.
Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.
--Online: www.fda.gov/MedWatch/report.htm
--Regular Mail: use postage-paid FDA form 3500 available at: www.fda.gov/MedWatch/getforms.htm and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
--Fax: (800) FDA-0178
--Phone: (800) FDA-1088
Monday, April 27, 2009
What Is Swine Flu? How Is Swine Flu Treated?
What Is Swine Flu? How Is Swine Flu Treated?
Swine flu (swine influenza) is a disease of pigs. It is a highly contagious respiratory disease caused by one of many Influenza A viruses. Approximately 1% to 4% of pigs that get swine flu die from it. It is spread among pigs by direct and indirect contact, aerosols, and from pigs that are infected but do not have symptoms. In many parts of the world pigs are vaccinated against swine flu.
Most commonly, swine flu is of the H1N1 influenza subtype. However, they can sometimes come from the other types, such as H1N2, H3N1, and H3N2.
The current outbreak of swine flu that has infected humans is of the H1N1 type - this type is not as dangerous as some others.
Avian Influenza (Bird Flu) can also infect pigs
Avian flu and human seasonal flu viruses can infect pigs, as well as swine influenza. The H3N2 influenza virus subtype, a virulent one, is thought to have come from pigs - it went on to infect humans.
It is possible for pigs to be infected with more than one flu virus subtype simultaneously. When this happens the genes of the viruses have the opportunity to mingle. When different flu subtypes mix they can create a new virus which contains the genes from several sources - a reassortant virus.
Although swine influenza tends to just infect pigs, they can, and sometimes do, jump the species barrier and infect humans.
What is the risk for human health?
Outbreaks of human infection from a virus which came from pigs (swine influenza) do happen and are sometimes reported. Symptoms will generally be similar to seasonal human influenzas - this can range from mild or no symptoms at all, to severe and possibly fatal pneumonia.
As swine flu symptoms are similar to typical human seasonal flu symptoms, and other upper respiratory tract infections, detection of swine flu in humans often does not happen, and when it does it is usually purely by chance through seasonal influenza surveillance. If symptoms are mild it is extremely unlikely that any connection to swine influenza is found - even if it is there. In other words, unless the doctors and experts are specifically looking for swine flu, it is rarely detected. Because of this, we really do not know what the true human infection rate is.
Examples of known swine flu infecting humans
Since the World Health Organization's (WHO's) implementation of IHR (2005) in 2007, they have been notified of swine influenza cases from the USA and Spain.
In March/April 2009 human cases of influenza A swine fever (H1N1) were first reported in California and Texas. Later other states also reported cases. A significant number of human cases during the same period have also been reported in Mexico - starting just in Mexico City, but now throughout various parts of the country. More cases are being reported in Canada, Europe, and New Zealand - mainly from people who have been in Mexico.
How does a human catch swine influenza?
From contact with infected pigs (most common way)
From contact with infected humans (much less common way)
In cases when humans have infected other humans close contact was necessary with the infected person, and they nearly always occurred in closed groups of people.
Can I eat pork meat and pork products?
If the pork meat and pork food products have been handled properly transmission of swine influenza to humans is not possible. Cooking pork meats to a temperature of 70C (160F) kills the virus. So the answer is YES, pork meat and pork food products are safe to eat.
Where have pigs been infected?
As swine influenza infection among pigs is not an internationally notifiable disease we cannot be completely sure. Swine influenza infection among pigs is known to be endemic in the USA. Outbreaks have also occurred in other parts of North America, South American, Europe, Africa, China, Japan, and other parts of Asia.
Is there a pandemic risk?
People who are not in close contact with pigs generally have no immunity to the swine influenza viruses - they are less likely to be able to prevent a virus infection. If the virus infects enough people in a given area, the risk of an influenza pandemic is significantly greater. Experts say it is very hard to predict what impact a flu pandemic caused by a swine influenza virus would have on the global human population. This would depend on how virulent the virus is, what existing immunity among humans there already is, plus several other factors.
Do we have a specific swine flu vaccine?
No - not for humans.
Will current human flu vaccines help protect people from swine influenza infection?
We really don't know. Influenza viruses are adapting and changing all the time. If a vaccine was made, it would have to be specifically for a current strain that is circulating for it to be effective. The WHO says it needs access to as many viruses as possible so that it can isolate the most appropriate candidate vaccine.
What are the signs and symptoms of swine influenza in humans?
They are similar to those of regular flu, and include:
Body aches
Chills
Cough
Diarrhea (less common)
Headache
Sore throat
Temperature (fever)
Tiredness (fatigue)
Vomiting (less common)
What medications are there?
There are some drugs around that can effectively treat swine flu infection in humans - and many types of flu infections in humans. There are two main types:
adamantanes (amantadine and remantadine)
inhibitors of influenza neuraminidase (oseltamivir and zanamivir)
Most previous swine influenza human cases recovered completely without the need for medical attention.
What can I do to protect myself?
Wash your hands regularly with soap
Try to stay healthy
Get plenty of sleep
Do plenty of exercise
Try to manage your stress
Drink plenty of liquids
Eat a well balanced diet
Refrain from touching surfaces which may have the virus
Do not get close to people who are sick
Stay away from crowded areas if there is a swine flu outbreak in your area
If I am infected, how can I stop others from becoming infected?
Limit your contact with other people
Do not go to work or school
When you cough or sneeze cover your mouth with a tissue. If you do not have a tissue, cover your mouth and nose.
Put your used tissues in a waste basket
Wash your hands and face regularly
Keep all surfaces you have touched clean
Follow your doctor's instructions
Swine flu (swine influenza) is a disease of pigs. It is a highly contagious respiratory disease caused by one of many Influenza A viruses. Approximately 1% to 4% of pigs that get swine flu die from it. It is spread among pigs by direct and indirect contact, aerosols, and from pigs that are infected but do not have symptoms. In many parts of the world pigs are vaccinated against swine flu.
Most commonly, swine flu is of the H1N1 influenza subtype. However, they can sometimes come from the other types, such as H1N2, H3N1, and H3N2.
The current outbreak of swine flu that has infected humans is of the H1N1 type - this type is not as dangerous as some others.
Avian Influenza (Bird Flu) can also infect pigs
Avian flu and human seasonal flu viruses can infect pigs, as well as swine influenza. The H3N2 influenza virus subtype, a virulent one, is thought to have come from pigs - it went on to infect humans.
It is possible for pigs to be infected with more than one flu virus subtype simultaneously. When this happens the genes of the viruses have the opportunity to mingle. When different flu subtypes mix they can create a new virus which contains the genes from several sources - a reassortant virus.
Although swine influenza tends to just infect pigs, they can, and sometimes do, jump the species barrier and infect humans.
What is the risk for human health?
Outbreaks of human infection from a virus which came from pigs (swine influenza) do happen and are sometimes reported. Symptoms will generally be similar to seasonal human influenzas - this can range from mild or no symptoms at all, to severe and possibly fatal pneumonia.
As swine flu symptoms are similar to typical human seasonal flu symptoms, and other upper respiratory tract infections, detection of swine flu in humans often does not happen, and when it does it is usually purely by chance through seasonal influenza surveillance. If symptoms are mild it is extremely unlikely that any connection to swine influenza is found - even if it is there. In other words, unless the doctors and experts are specifically looking for swine flu, it is rarely detected. Because of this, we really do not know what the true human infection rate is.
Examples of known swine flu infecting humans
Since the World Health Organization's (WHO's) implementation of IHR (2005) in 2007, they have been notified of swine influenza cases from the USA and Spain.
In March/April 2009 human cases of influenza A swine fever (H1N1) were first reported in California and Texas. Later other states also reported cases. A significant number of human cases during the same period have also been reported in Mexico - starting just in Mexico City, but now throughout various parts of the country. More cases are being reported in Canada, Europe, and New Zealand - mainly from people who have been in Mexico.
How does a human catch swine influenza?
From contact with infected pigs (most common way)
From contact with infected humans (much less common way)
In cases when humans have infected other humans close contact was necessary with the infected person, and they nearly always occurred in closed groups of people.
Can I eat pork meat and pork products?
If the pork meat and pork food products have been handled properly transmission of swine influenza to humans is not possible. Cooking pork meats to a temperature of 70C (160F) kills the virus. So the answer is YES, pork meat and pork food products are safe to eat.
Where have pigs been infected?
As swine influenza infection among pigs is not an internationally notifiable disease we cannot be completely sure. Swine influenza infection among pigs is known to be endemic in the USA. Outbreaks have also occurred in other parts of North America, South American, Europe, Africa, China, Japan, and other parts of Asia.
Is there a pandemic risk?
People who are not in close contact with pigs generally have no immunity to the swine influenza viruses - they are less likely to be able to prevent a virus infection. If the virus infects enough people in a given area, the risk of an influenza pandemic is significantly greater. Experts say it is very hard to predict what impact a flu pandemic caused by a swine influenza virus would have on the global human population. This would depend on how virulent the virus is, what existing immunity among humans there already is, plus several other factors.
Do we have a specific swine flu vaccine?
No - not for humans.
Will current human flu vaccines help protect people from swine influenza infection?
We really don't know. Influenza viruses are adapting and changing all the time. If a vaccine was made, it would have to be specifically for a current strain that is circulating for it to be effective. The WHO says it needs access to as many viruses as possible so that it can isolate the most appropriate candidate vaccine.
What are the signs and symptoms of swine influenza in humans?
They are similar to those of regular flu, and include:
Body aches
Chills
Cough
Diarrhea (less common)
Headache
Sore throat
Temperature (fever)
Tiredness (fatigue)
Vomiting (less common)
What medications are there?
There are some drugs around that can effectively treat swine flu infection in humans - and many types of flu infections in humans. There are two main types:
adamantanes (amantadine and remantadine)
inhibitors of influenza neuraminidase (oseltamivir and zanamivir)
Most previous swine influenza human cases recovered completely without the need for medical attention.
What can I do to protect myself?
Wash your hands regularly with soap
Try to stay healthy
Get plenty of sleep
Do plenty of exercise
Try to manage your stress
Drink plenty of liquids
Eat a well balanced diet
Refrain from touching surfaces which may have the virus
Do not get close to people who are sick
Stay away from crowded areas if there is a swine flu outbreak in your area
If I am infected, how can I stop others from becoming infected?
Limit your contact with other people
Do not go to work or school
When you cough or sneeze cover your mouth with a tissue. If you do not have a tissue, cover your mouth and nose.
Put your used tissues in a waste basket
Wash your hands and face regularly
Keep all surfaces you have touched clean
Follow your doctor's instructions
Swine flu ‘debacle’ of 1976 is recalled
LA Times
April 27, 2009
Warren D. Ward, 48, was in high school when the swine flu threat of 1976 swept the U.S. The Whittier man remembers the episode vividly because a relative died in the 1918 flu pandemic, and the 1976 illness was feared to be a direct descendant of the deadly virus.
"The government wanted everyone to get vaccinated," Ward said. "But the epidemic never really broke out. It was a threat that never materialized."
What did materialize were cases of a rare side effect thought to be linked to the shot. The unexpected development cut short the vaccination effort -- an unprecedented national campaign -- after 10 weeks.
The episode triggered an enduring public backlash against flu vaccination, embarrassed the federal government and cost the director of the U.S. Center for Disease Control, now known as the Centers for Disease Control and Prevention, his job.
The pandemic fears of the time and the resulting vaccine controversy may be fueling some of the public's -- and media's -- anxiety about the current outbreak, said health officials who recalled the previous event.
Ward said his family discussed the vaccine in 1976 and decided not to get it. If a vaccine is ordered for this latest threat, he said, "I'm not getting it. I felt back then like it was a bunch of baloney."
The swine flu brush of 1976 -- some call it a debacle -- holds crucial lessons for the government and health officials who must decide how to react to the new swine flu threat in the days and weeks ahead.
For starters, officials must keep the public informed. They must admit what they know and don't know. They must have a plan ready should the health threat become dangerous. And they must reassure everyone that there is no need to worry in the meantime.
It's a tall order. Doubts about the government's ability to handle a possible flu pandemic linger, said Dr. Richard P. Wenzel, chairman of internal medicine at Virginia Commonwealth University, who diagnosed some of the early cases in 1976.
"I think we're going to have to be cautious," Wenzel said. "Hopefully, there will be a lot of good, honest public health discussion about what happened in 1976."
Officials should be prepared for plenty of second-guessing, especially for any decisions regarding vaccination, which was at the core of the 1976 controversy, said Dr. David J. Sencer, the CDC director who led the government's response to the threat and was later fired.
"There were good things and bad things about it," said Sencer, who is retired and lives in the Atlanta area. "People have to make science the priority. They have to rely on science rather than politics."
The question of whether politics overtook science in 1976 has been the fodder of books, articles and discussions for 33 years.
The panic in 1976 was partly because of the belief -- now known to be erroneous -- that the 1918-19 flu pandemic, which killed half a million Americans and as many as 50 million worldwide, was caused by a virus with swine components. Recent research suggests instead that it was avian flu, but that seems unlikely to assuage the current anxiety.
The episode began in February 1976, when an Army recruit at Ft. Dix, N.J., fell ill and died from a swine flu virus thought to be similar to the 1918 strain. Several other soldiers at the base also became ill. Shortly thereafter, Wenzel and his colleagues reported two cases of the flu strain in Virginia.
"That raised the concern that the original cluster at Ft. Dix had spread beyond New Jersey," said Wenzel, former president of the International Society for Infectious Diseases.
At the CDC, Sencer solicited the opinions of infectious disease specialists nationwide and, in March, called on President Ford and Congress to begin a mass inoculation.
The $137-million program began in early October, but within days reports emerged that the vaccine appeared to increase the risk for Guillain-Barre syndrome, a rare neurological condition that causes temporary paralysis but can be fatal.
Waiting in long lines at schools and clinics, more than 40 million Americans -- almost 25% of the population -- received the swine flu vaccine before the program was halted in December after 10 weeks.
More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died. No one completely understands the causes of Guillain-Barre, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people or their families.
However, the pandemic, which some experts estimated at the time could infect 50 million to 60 million Americans, never unfolded. Only about 200 cases of swine flu and one death were ultimately reported in the U.S., the CDC said.
The public viewed the entire episode as political farce, Sencer said. But at the time, he said, the government erred on the side of caution.
"If we had that knowledge then, we might have done things differently," Sencer said. "We did not know what sort of virus we were dealing with in those days. No one knew we would have Guillain-Barre syndrome. The flu vaccine had been used for many years without that happening."
Wenzel also recommended vaccination in 1976. "It was a great effort," he said. "It just had unexpected, unfortunate side effects."
In Mexico, where 22 people have died from the current swine flu outbreak, government officials are under fire for their handling of the situation. But people fail to understand the challenges faced by health officials with such a mysterious threat, said Dr. Peter Katona, an infectious disease expert at UCLA.
"You have to look at not only 1976 but 1918," he said. "The pandemic flu that occurred in 1918 lasted a year and a half. In 1976, we didn't know what was going to happen. The virus might burn out. It might proliferate. These viruses have a mind of their own, and we don't know how to predict what will happen."
CDC officials have been wisely circumspect in their comments about the current outbreak, Sencer said.
"I like the fact that they have said, 'We may change our minds,' " he said. "Don't expect health officials to have the answers overnight. These things need time to be sorted out. We're still in the learning curve."
Dr. Richard Krause, who headed the National Institute of Allergy and Infectious Diseases in 1976, has noted drolly that public health officials involved in the next pandemic flu threat "have my best wishes."
April 27, 2009
Warren D. Ward, 48, was in high school when the swine flu threat of 1976 swept the U.S. The Whittier man remembers the episode vividly because a relative died in the 1918 flu pandemic, and the 1976 illness was feared to be a direct descendant of the deadly virus.
"The government wanted everyone to get vaccinated," Ward said. "But the epidemic never really broke out. It was a threat that never materialized."
What did materialize were cases of a rare side effect thought to be linked to the shot. The unexpected development cut short the vaccination effort -- an unprecedented national campaign -- after 10 weeks.
The episode triggered an enduring public backlash against flu vaccination, embarrassed the federal government and cost the director of the U.S. Center for Disease Control, now known as the Centers for Disease Control and Prevention, his job.
The pandemic fears of the time and the resulting vaccine controversy may be fueling some of the public's -- and media's -- anxiety about the current outbreak, said health officials who recalled the previous event.
Ward said his family discussed the vaccine in 1976 and decided not to get it. If a vaccine is ordered for this latest threat, he said, "I'm not getting it. I felt back then like it was a bunch of baloney."
The swine flu brush of 1976 -- some call it a debacle -- holds crucial lessons for the government and health officials who must decide how to react to the new swine flu threat in the days and weeks ahead.
For starters, officials must keep the public informed. They must admit what they know and don't know. They must have a plan ready should the health threat become dangerous. And they must reassure everyone that there is no need to worry in the meantime.
It's a tall order. Doubts about the government's ability to handle a possible flu pandemic linger, said Dr. Richard P. Wenzel, chairman of internal medicine at Virginia Commonwealth University, who diagnosed some of the early cases in 1976.
"I think we're going to have to be cautious," Wenzel said. "Hopefully, there will be a lot of good, honest public health discussion about what happened in 1976."
Officials should be prepared for plenty of second-guessing, especially for any decisions regarding vaccination, which was at the core of the 1976 controversy, said Dr. David J. Sencer, the CDC director who led the government's response to the threat and was later fired.
"There were good things and bad things about it," said Sencer, who is retired and lives in the Atlanta area. "People have to make science the priority. They have to rely on science rather than politics."
The question of whether politics overtook science in 1976 has been the fodder of books, articles and discussions for 33 years.
The panic in 1976 was partly because of the belief -- now known to be erroneous -- that the 1918-19 flu pandemic, which killed half a million Americans and as many as 50 million worldwide, was caused by a virus with swine components. Recent research suggests instead that it was avian flu, but that seems unlikely to assuage the current anxiety.
The episode began in February 1976, when an Army recruit at Ft. Dix, N.J., fell ill and died from a swine flu virus thought to be similar to the 1918 strain. Several other soldiers at the base also became ill. Shortly thereafter, Wenzel and his colleagues reported two cases of the flu strain in Virginia.
"That raised the concern that the original cluster at Ft. Dix had spread beyond New Jersey," said Wenzel, former president of the International Society for Infectious Diseases.
At the CDC, Sencer solicited the opinions of infectious disease specialists nationwide and, in March, called on President Ford and Congress to begin a mass inoculation.
The $137-million program began in early October, but within days reports emerged that the vaccine appeared to increase the risk for Guillain-Barre syndrome, a rare neurological condition that causes temporary paralysis but can be fatal.
Waiting in long lines at schools and clinics, more than 40 million Americans -- almost 25% of the population -- received the swine flu vaccine before the program was halted in December after 10 weeks.
More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died. No one completely understands the causes of Guillain-Barre, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people or their families.
However, the pandemic, which some experts estimated at the time could infect 50 million to 60 million Americans, never unfolded. Only about 200 cases of swine flu and one death were ultimately reported in the U.S., the CDC said.
The public viewed the entire episode as political farce, Sencer said. But at the time, he said, the government erred on the side of caution.
"If we had that knowledge then, we might have done things differently," Sencer said. "We did not know what sort of virus we were dealing with in those days. No one knew we would have Guillain-Barre syndrome. The flu vaccine had been used for many years without that happening."
Wenzel also recommended vaccination in 1976. "It was a great effort," he said. "It just had unexpected, unfortunate side effects."
In Mexico, where 22 people have died from the current swine flu outbreak, government officials are under fire for their handling of the situation. But people fail to understand the challenges faced by health officials with such a mysterious threat, said Dr. Peter Katona, an infectious disease expert at UCLA.
"You have to look at not only 1976 but 1918," he said. "The pandemic flu that occurred in 1918 lasted a year and a half. In 1976, we didn't know what was going to happen. The virus might burn out. It might proliferate. These viruses have a mind of their own, and we don't know how to predict what will happen."
CDC officials have been wisely circumspect in their comments about the current outbreak, Sencer said.
"I like the fact that they have said, 'We may change our minds,' " he said. "Don't expect health officials to have the answers overnight. These things need time to be sorted out. We're still in the learning curve."
Dr. Richard Krause, who headed the National Institute of Allergy and Infectious Diseases in 1976, has noted drolly that public health officials involved in the next pandemic flu threat "have my best wishes."
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