Tag Archives: flu

Pandemic Woes: Weather Influences Influenza and Pneumonia

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No duh…they already knew this but for those who do not study history it is new to them.

From 2009:  Pandemic Woes:  Bad Weather Ahead? (1918 & 2009)

The Impact of Weather on Influenza and Pneumonia Mortality in New York City, 1975-2002:

A Retrospective Study

The substantial winter influenza peak in temperate climates has lead to the hypothesis that cold and/or dry air is a causal factor in influenza variability. We examined the relationship between cold and/or dry air and daily influenza and pneumonia mortality in the cold season in the New York metropolitan area from 1975-2002. We conducted a retrospective study relating daily pneumonia and influenza mortality for New York City and surroundings from 1975-2002 to daily air temperature, dew point temperature (a measure of atmospheric humidity), and daily air mass type. We identified high mortality days and periods and employed temporal smoothers and lags to account for the latency period and the time between infection and death. Unpaired t-tests were used to compare high mortality events to non-events and nonparametric bootstrapped regression analysis was used to examine the characteristics of longer mortality episodes. We found a statistically significant (0.003) association between periods of low dew point temperature and above normal pneumonia and influenza mortality 17 days later. The duration (0.61) and severity (0.56) of high mortality episodes was inversely correlated with morning dew point temperature prior to and during the episodes. Weeks in which moist polar air masses were common (air masses characterized by low dew point temperatures) were likewise followed by above normal mortality 17 days later (0.019). This research supports the contention that cold, dry air may be related to influenza mortality and suggests that warning systems could provide enough lead time to be effective in mitigating the effects.

 

Robert E. Davis1*, Colleen E. Rossier1, Kyle B. Enfield2

1 Department of Environmental Sciences, University of Virginia, Charlottesville, Virginia, United States of America, 2 Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States of America

 

Editor:  Viboud, National Institutes of Health, United States of America

Pandemic Woes: Bad Weather Ahead?

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The Island Queen in distance being pushed down the Ohio River by the ice. Source: http://www.cincinnativiews.net/images/Flood%20&%20Ice%20Gorge%2017rp.jpg; accessed July 23, 2009.

Fair Use Access Suburban Emergency Management Project,July 5, 2009

(now purged from the internet)

From the trenches,

Celeste

Biot #637: July 23, 2009

Meteorologist Preston C. Day (1859-1931) wrote in December 1918, “The severity of the weather experienced during December and January of the winter of 1917-1918 over the greater part of the United States east of the Rocky Mountains, and also over much of Canada and Alaska during the early part of the period, was so unusual as to the length of time the low temperatures persisted, the great area involved, and the degree of cold maintained, that some discussion of the contributing factors, and comparison with similar occurrences of previous years, seems desirable.” (1-2)

 

The sinking of the Princess in the Ohio River, winter of 1917-1918. Source: http://www.cincinnativiews.net/images/Flood%20&%20Ice%20Gorge%2018rp.jpg Continue reading →

Sinusitis Relationship to Influenza

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Influenza Sinusitis and its Relation to Epidemic Influenza

Free Access from Suburban Emergency Management Project August 4, 2009, Biot #638

(This has been purged from the internet)

July 27, 2009

H.E. Robertson, M.D. of Minneapolis, Minnesota, became a major in the U.S. Army in 1917, serving overseas in the Central Medical Department Laboratory of the American Expeditionary Force in France. In May 1918, he published an article titled “Influenza-sinus disease and its relation to epidemic influenza” in the Journal of the American Medical Association, based on his observations of patients in the hospital of the British Expeditionary Forces in France. May 1918 was during the first wave of pandemic influenza (see graph below). His observations are astute.

Graph showing three pandemic waves: weekly combined influenza and pneumonia mortality, United Kingdom, 1918-1919. Source: http://www.cdc.gov/ncidod/eid/vol12no01/05-0979-G1.htm; accessed July 27, 2009.

Robertson wrote, “A typical attack of influenza usually beings as a rhinitis and spreads from the nasal mucosa throughout the respiratory tract. As the chief symptoms are produced by the involvement of the bronchial tree, attention is naturally directed to the lungs and bronchi as the most important foci for the infection. However, in studying acute cases one is often impressed by the fact that the severity of the disease, best evidenced by the general prostration of the patients, is out of all proportion to the physical signs. Tracheo-bronchitis with abundant muco-purulent sputum, a particularly distressing and often spasmodic cough, and moist rales [wet sounds] uniformly present in both lungs, almost exhaust the positive findings of the respiratory tract. It becomes difficult to understand why a vigorous, previously healthy young adult, should succumb to an infection which in many cases appears to be almost wholly confined to the tracheo-bronchial mucosa. It might even be questioned whether such an individual should die from a primary bronchitis and broncho-pneumonia. In the opinion of many clinicians and pathologists, such a combination is rather rare. (1)

Robertson believed that “in addition to the infection of the respiratory tract per se, “other lesions, almost uniformly neglected by writers on the subject and rarely noted by clinicians or pathologists, may prove to be very seriously important factors both in the clinical picture and in the often fatal outcome of the disease.” (1) What are these lesions?

In October 1917, Robertson says he visited the base hospital zone of the British Expeditionary Forces in France, at which time “Captain Rolland of the Royal Army Medical Corps mentioned his observations in a series of cases of this disease, which had occurred in epidemic proportions and which was highly fatal. The influenza bacillus seemed without doubt to be the causal agent, though pneumococci and streptococci were often also isolated [in the laboratory].” Robertson, however, was most surprised at the “involvement of the sinuses at the base of the skull” during autopsies of patients who had succumbed to influenza.

Robertson noted, “Infection of the accessory sinuses of the nose and skull have [sic] often been noted. As early as 1837, Petrequin stated that frontal sinus involvement produced the headache so often present in [influenza]. Bronchin, in 1884, distinguished the ‘cephalic’ form of influenza by localizations in the nasal fossae, and the frontal and maxillary sinuses. Pfeiffer, however, in his classic description of the etiology and pathology of influenza, does not mention the sinuses. [2]…[Pfeiffer] evidently did not encounter or missed the significance of any sinus complications,” declared Robertson. “In short, sinus disease in epidemics of influenza is either totally disregarded or described as an accidental complication or sequel of the infection of the pulmonary tract.” Robertson believed otherwise.

Location of human sinuses. Source: http://ent.med.nyu.edu/files/ent/u3/nose_anatomy_front.gif; accessed July 27, 2009.

“When, therefore, our first fatal case of influenza tracheo-bronchitis and broncho-pneumonia showed, at postmortem examination, an empyema [collection of pus] of both sphenoid [sinus] cavities, and the pus from these revealed both smears and cultures typical influenza bacilli, the condition was regarded as an interesting but unusual complication. However, as case after case coming to necropsy showed similar or comparable lesions, the circumstances warranted more careful and detailed study,” Robertson noted.

Robertson summarizes fourteen necropsies showing involvement of the sinuses.

In his comment section, he wrote, “It would, of course, be unreasonable to assert that all cases of influenza are accompanied by sinus complications…The number of cases is altogether too small to justify any sweeping conclusions. They do serve most emphatically to emphasize the importance of the sinuses in the respiratory type of influenza.” Why?

First, infection of the sinuses “constantly menaces the pulmonary system, only awaiting suitable conditions of exposure and lowered resistance for hostile invasion, but also furnishes continued sources of toxic absorption, not to mention the direct effect on the well being of the patient from the presence of these local conditions.”

Second, and more important, “is the bearing that these local infections have on prophylaxis and treatment. When their attention had been called to the possible constant presence of sinus disease in patients suffering from influenza bronchitis, the attending physicians adopted local measures of treatment for these conditions, even when their presence could not be diagnosed with any degree of certainty. Local applications to the nasal passage of cocaine and epinephrine solutions often resulted in copious discharges of thick, muco-purulent exudates from the sinuses, with marked relief to the patient, such as amelioration of headache and pain in the eyes, as well as definite betterment of the conditions in the bronchi and trachea.” (1)

Detail of human sinuses. Source: http://www.sinustreatmentcenter.com/scfig3_500.jpg; accessed July 27, 2009.

Robertson summarizes his findings, as follows (two have been omitted):

1. “Epidemics of respiratory influenza (purulent tracheo-bronchitis) have been fairly severe in both the American and the British Expeditionary Forces.
2. In the investigation of cases, both clinically and at postmortem, little attention in the past has been give to the question of accompanying sinus disease.
3. Of eight fatal cases of purulent tracheo-bronchitis due to the influenza bacillus, all but one showed involvement of one or more of the sinuses at the base of the skull by inflammatory processes, probably, in all cases, directly due to the invasion of these sinuses by the influenza bacillus.
4. Appropriate treatment of the sinuses in patients suffering from influenza often served to relieve the symptoms and apparently to hasten convalescence.
5. Investigation of the sinuses during epidemics of influenza is strongly recommended and urged not only on therapeutic but also on prophylactic grounds.” (1)

Robertson’s findings are relevant to today. Effective treatment of influenza sinusitis may prevent spread to the lungs. Treatment, however, is possible only with awareness of the disease entity, i.e., influenza sinusitis.

Notes:

1. H.E. Robertson: “Influenzal sinus disease and its relation to epidemic influenza.” JAMA, May 1918, Volume 70, Number 21, pp. 1533-1535. Available at
2. Pfeiffer’s bacillus, subsequently named Hemophilus influenza, was shown by Martha Wollstein, M.D., in 1919, to be “at least a very common secondary invader in influenza, and that its presence influences the pathological process.” However, patients’ serological reactions that she studied were not “sufficiently stable and clean-cut to signify that Pfeiffer’s bacillus is the specific inciting agent of epidemic influenza.” Source: Martha Wollstein: “Pfeiffer’s bacillus and influenza: A serological study.” The Journal of Experimental Medicine, Volume 30, pp. 555-568, 1919. Abstract available at http://jem.rupress.org/cgi/content/abstract/30/6/555; full text is available at http://jem.rupress.org/cgi/reprint/30/6/555; accessed July 27, 2009.

http://www.semp.us/publications/biot_reader.php?BiotID=638
Copyright 2009 – SEMP INC., All Rights Reserved.

From the trenches,

Celeste

Pandemic Woes: Who Does What? A Simple Org Chart

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Who are the lead agencies for what during a flu event?  We also are under the UN direction since the declared Level 6 .

Don’t forget the get your Freedom Packs Ready and No Constitutional No Trespassing Signs up and ready for ‘visitors’.  Have some way to copy or reproduce individual identification to accompany the Public Servant Questionnaire.

DEPARTMENTS LEADING REVIEW GROUPS

Priority # Priority Title Lead Department

1 Mass Vaccination    HHS/CDC
2 Public Health Continuity of Operation Plan   HHS/CDC
3 Surveillance and Laboratory   HHS/CDC
4 Communication   HS/CDC
5 Community-Wide Healthcare Coalitions to meet Patient Surge Expected from Pandemic Influenza     HHS/ASPR/HRSA
6 Facilitating Medical Surge  HHS/ASPR/HRSA
7 Fatality Management  HHS/ASPR/HRSA
8 Antiviral Drug Distribution Plan – submitted separately  HHS/CDC
9 Community Containment Plan – submitted separately   HHS/CDC
10 Policy Process for School Closure and the Communication Plan for this Decision ED
11 Education and Social Services in the Face of School Closures  ED
12 Sustain/Support 17 Critical Infrastructure Sectors & Key Assets DHS
13 Working with the Private Sector to Ensure Continuity of Operations for Critical Essential Services so that Critical Infrastructure Operations are as “Near Normal” as Possible for Social and Economic Well-Being DHS
14 State Plans Must Conform to all NRP/NIMS Requirements   DHS
15 Mitigate the Impact of an Influenza Pandemic on Workers in the State DHS
16 Assisting Employers in the State   DHS
17 Employment Policies during an Influenza Pandemic  DHS
18 Human Resource Policies for State Employees DHS
19 Coordination of Law Enforcement  DOJ
20 Critical Essential Function for Food Safety  USDA, HHS/FDA
21 Operational Status of State-Inspected Slaughter and food Processing Establishments Including Talmadge Aiken Plants  USDA, HHS/FDA
22 Communication Strategy for Interface with USDA food Safety Inspection Service and FDA’s Federal State Relations   USDA, HHS/FDA
23 Ensure Adequate Reporting Systems Regarding Food Safety USDA, HHS/FDA
24 State Advisories Regarding Diplomatic Missions  DOS

From the trenches,

Celeste

Pandemic Woes: Army (Feds) Seize Nursing?

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Courtesy Photo US Army

Nursing is an honorable profession which may go under federal control if this influenza event deepens.  In 1901, in response to the acute lack of trained nurses in the Spanish-American War, Congress established the Army Nurse Corp. The ANC assumed the professional nursing duties from the Hospital Corp.  The Army Medical Department celebrated 234 years of service July 27, 2009.

Sounds like the Army is gearing-up to assist with the flu pandemic.

Let’s see how many dots we can connect!

  • Acute lack of trained nurses (if nursing is not sustainable then they must be terminated and replaced)
  • Spanish, Spanish, Spanish…where have I heard that word before?  Ah! The 1918 Spanish Flu!  That’s it!
  • The Army (ANC) assumed the role of professional nurses in the Hospital Corp. Sounds ominous to me….Maybe they don’t know what they are doing?  Oh that’s right…remember ‘Hot Lips’ in MASH?…. You trust your health care to gallivanting young ladies who have other things on their mind… yeah right.
  • The Medical Reserve Corp (MRC) has been established and is ready and waiting….

For the flu event.

From the trenches,

Celeste


Swine Flu (H1N1) Economic Update

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Potential economic impacts of the A H1N1flu outbreak

Fair Use Access June 23, 2009 World Bank June 22, 2009 GDF Report

For Educational Purposes Only

Although the spread of H1N1 appears to have eased, its spread is likely to pick up as the flu season begins in the southern hemisphere and again when it returns in the northern hemisphere. Even if it does not mutate into a more deadly form, a second wave of the flu in low-income countries’ could have serious consequences-given poor countries limited capacity to monitor and treat an outbreak and the higher incidence of chronic disease within their populations (the  re-existence of chronic health conditions and delays before medical intervention appear to be among the factors that have contributed to deaths where they have occurred). More worrisome is the possibility that H1N1 could mutate into or combine with a more aggressive form of the flu-such as H5N1 (avian influenza). As a flu for which much of the world’s population has limited pre-existing immunity (WHO 2009), A H1N1 could infect as much as 35 percent of the world’s population (WHO 2006)-spreading throughout the world in as few as 180 days during flu season. Continue reading →

The Politically Correct Quarantine

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Biosecurity Emerges

Fair Use Access

The term quarantine elicits a negative connotation that most of us shy away from. The fact of the matter the notion of quarantine is unpalatable so how do decision-makers make the concept socially acceptable?

The testing ground to see what works and what does not began with the Wild-land Project in the environmental movement. Social engineers applied the science know as ‘fuzzy math’ to contentious issues. Fuzzy math takes an ideology and applies an algorithm to the issue. Through this mathematical mechanism an incremental plan is formulated to get your ideology changed. For instance you goal is to make the mountains off limits to human activity. You have a comment period and record peoples objections. You then apply the algorithm which will give you the plan to incrementally change people’s perception of wilderness areas. One might first put up a small gate, then a larger gate, then add cameras, the add patrols, add warning signs, lastly incrementally make the distance between the wilderness area and humans larger and larger. Tests reveal after time people will look at the wilderness areas, but in a Pavlovian response, not even think of going near the off limit areas.

Link: Wild-lands Fuzzy Math

This type of model is now being applied to the concept of quarantine. This week a series of social distancing articles were posted online. The whole premise of biosecurity is to distance the disease including the farm, ill person or whatever needs to be quarantined from the others. The tool of fear of disease is utilized to ensure compliance. Unfortunately some interesting dynamics occur when social distancing or quarantine occurs. Studies in the mid-twentieth century showed that humans and animals alike suffered various types of trauma due to the isolation (quarantine) factor.

The Pit of Despair: http://en.wikipedia.org/wiki/Pit_of_despair

Implementation of Social Distancing (Quarantine)

Distancing Teenagers

BMC Public Health 2008, 8:61doi:10.1186/1471-2458-8-61

Published: 14 February 2008

Influenza is a viral infection that primarily spreads via fluid droplets from an infected persons coughs and sneezes to others nearby. Social contact networks and the way people interact within them are thus important to its spread. We developed a method to characterize the social contact network for the potential transmission of influenza and then applied the method to school aged children and teenagers.

[...]

Conclusions

High-school students may form the local transmission backbone of the next pandemic. Closing schools and keeping students at home during a pandemic would remove the transmission potential within these ages and could be effective at thwarting its spread within a community. Social contact networks characterized as groups and public activities with the time, level of contact and primary links within each, yields a comprehensive view, which if extended to all ages, would allow design of effective community containment for pandemic influenza.

Utilizing fear and social stigma in a pandemic response

The Journal of Infectious Diseases2008;197:SS7

 2008 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2008/19704S1-0008 ( pay for view $15.00)
DOI: 10.1086/524986
SUPPLEMENT ARTICLE

Ron Barrett1 and Peter J. Brown2

1School of Nursing and 2Department of Anthropology, Emory University, Atlanta, Georgia

  • Potential conflicts of interest: none reported.

    Financial support: supplement sponsorship is detailed in the Acknowledgments.

Reprints or correspondence: Ron Barrett, School of Nursing, Emory University, 1520 Clifton Rd., Atlanta, GA 30322 ().

This article examines the role of stigma in social and institutional responses to infectious disease emergencies, to better understand and minimize these dynamics in the event of a pandemic of virulent influenza. In addition to their impact on human suffering, fear and stigma can seriously delay detection and treatment efforts, cooperation with contact tracing and isolation measures, and the effective distribution of resources for the prevention and control of infectious diseases. These dynamics are illustrated by the Indian plague epidemic of 1994, which occurred in a region where H5N1 influenza has been detected recently. Public fear and stigma also played a significant role in the social and institutional responses to the 1918 influenza pandemic. These historical models provide important lessons for pandemic preparedness and global health policy.

Introduction of biosocial approach to the prevention for and control of pandemic

 The Journal of Infectious Diseases2008;197:S1S3

2008 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2008/19704S1-0001 (pay for view 15.00)
DOI: 10.1086/524992
SUPPLEMENT ARTICLE INTRODUCTION

Arthur M. Kleinman,1,4; Barry R. Bloom,5; Anthony Saich,2,3; Katherine A. Mason,1 and Felicity Aulino1

1Department of Anthropology, 2John F. Kennedy School of Government, and 3Harvard Asia Center, Harvard University, Cambridge, and 4Department of Social Medicine, Harvard Medical School, and 5Harvard School of Public Health, Boston, Massachusetts

  • Potential conflicts of interest: none reported.

    Presented in part: Harvard University Asian Flus and Avian Influenza Workshop, Cambridge, Massachusetts, 8–10 December 2006.

    Financial support: supplement sponsorship is detailed in the Acknowledgments.

Reprints or correspondence: Dr. Arthur M. Kleinman, Dept. of Anthropology, Harvard University, William James Hall, 33 Kirkland St., Cambridge, MA 02138 ().

The Harvard University Asian Flus and Avian Influenza Workshop, held in December 2006, introduced a biosocial approach to the preparation for and control of pandemics. A biosocial approach brings together the biological and social sciences to develop an integrative, collaborative response to the threat of pandemic influenza. The articles in this supplement provide a representative sampling of some of the ways in which the workshop worked toward this biosocial vision. These articles address the historical “siting” of epidemics, political and structural pandemic preparedness in China, lessons to be taken from the 1976 “swine flu affair,” possibilities for genetic engineering as an alternative to poultry vaccination, issues to be considered in the control of infectious disease in swine and avian species, the ecology of influenza in migratory birds, and issues of stigma and trust during the control of epidemics. The need to build public trust and public health infrastructure is one of the primary messages of this collection.

As we see this idea of social distancing and quarantine unfold take a serious look at the consequences of such actions though they may appear to be a good idea.
From the trenches,
Celeste

 

The Human Herd & Norovirus

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We all knew that we were referred to as the “human herd” but I have never seen it in writing. The term is buried in technically dense documents where few tread:

Mechanisms of GII.4 Norovirus Persistence in Human Populations

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.005003

Lisa C. Lindesmith1, Eric F. Donaldson1, Anna D. LoBue1, Jennifer L. Cannon1,2, Du-Ping Zheng2, Jan Vinje2, Ralph S. Baric1*

1 University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America, 2 Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Conclusions

“Our data suggest that the surface-exposed carbohydrate ligand binding domain in the norovirus capsid is under heavy immune selection and likely evolves by antigenic drift in the face of human herd immunity. Variation in the capsid carbohydrate-binding domain is tolerated because of the large repertoire of similar, yet distinct HBGA carbohydrate receptors available on mucosal surfaces that could interface with the remodeled architecture of the capsid ligand-binding pocket. The continuing evolution of new replacement strains suggests that, as with influenza viruses, vaccines could be targeted that protect against norovirus infections, and that continued epidemiologic surveillance and reformulations of norovirus vaccines will be essential in the control of future outbreaks.”

From the trenches,

Celeste

Pandemic Plans

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Health & Human Services has released their annual report on our pandemic and all hazards.

Pandemic November Progress Report2007

The Pandemic and All Hazard ACT 2006

Title I: National Preparedness and Response, Leadership, Organization, and Planning

Title II: Public Health Security Preparedness

Title III: All-Hazards Medical Surge Capacity

Title IV: Pandemic and Biodefense Vaccine and Drug Development

From the trenches,

Celeste

Biosecurity/Pandemic/Avian Resource Guide

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Do ya think they just might be serious about this? If they are, what does that mean for you? Are you prepared?

I just received a government report that the influenza level is currently slightly higher than epidemic, ummm…..

The National Animal Identification System is not just about tagging animals, it is under the biosecurity umbrella of surveillance, Phase III of NAIS. The plans involve zoontic (animal-human) transmission. Therefore, might you be next in the tagging scheme? The UN definition of animal does include humans. As there is scientific-evidence of aggressive cancer developing from tags (chips) which would you prefer….cancer…or the flu?

Please do your homework on the dangers of vaccinations and anti-virals before we get begin hearing big news on the epidemic and pandemic. Weigh your choices carefully. Healthy living, good food, and natural healing remedies should be evaluated as you decide how you will deal with future flu seasons.

Continue reading →