MMWR: Tornado Fatalities During April 2011 Outbreak

 

Credit FEMA

# 6445

 

During a three day period (Apr 25th-28th) of 2011 a storm system of epic proportions spawned 351 confirmed tornadoes across five southern states, killing 338 persons in Alabama, Arkansas, Georgia, Mississippi, and Tennessee. 

 

This was the the third deadliest tornado outbreak in U.S. History. More than a dozen of these twisters reached intensities of 4 or 5 on the Enhanced Fujita [EF] scale, which can produce near total devastation.

 

NOAA releases aerial imagery of Tuscaloosa, Ala. tornado damage

April 30, 2011

Before and after imagery depicting tornado damage in the vicinity of the intersection of 15th St. E. and McFarland Blvd. E. in southeast Tuscaloosa, AL. The before imagery is courtesy of Google, the after imagery was acquired from an altitude of 5,000 feet above ground level by the NOAA King Air April 29, 2011.

 

Despite an early and accurate forecast, and the issuance of timely tornado watches and warnings, the death toll from this super-swarm of tornadoes was woefully high. 

 

Late last week the CDC released an analysis of these storm fatalities in their MMWR that stresses the importance of safe rooms.  Due to the length of the report, I’ve only reproduced the synopsis and a few excerpts. 

 

Follow the link to read:

 

 

Tornado-Related Fatalities — Five States, Southeastern United States, April 25–28, 2011

Weekly

July 20, 2012 / 61(28);529-533

(Media Synopsis)

Individuals who work or live in a tornado-prone area should develop a tornado safety plan prior to severe weather.

During April 25–28, 2011, the third deadliest tornado disaster occurred in the southeastern U.S. despite modern advances in tornado forecasting, advanced warning times, and media coverage.  CDC reviewed data from the American Red Cross, death certificates and the National Weather Service to describe the fatalities by demographic characteristics, shelter used, cause of death, and tornado severity in the affected states of Alabama, Arkansas, Georgia, Mississippi and Tennessee. Of the 338 deaths, approximately one-third were older adults, almost half occurred in single-family homes, and a quarter happened in mobile homes.  One-half of the 27 tornadoes were rated powerful (EF-4 or EF-5) and were responsible for almost 90 percent of the deaths. The use of safe rooms is crucial to preventing tornado-related deaths.

 

 

What is already known on this topic?

Known risk factors for death and injury from tornadoes are sheltering in mobile homes, proximity to the path of a tornado registering 4 or 5 on the Enhanced Fujita (EF) scale, being an older adult (aged ≥65 years), lack of accessibility to a safe room (e.g., a basement or reinforced shelter), and night-time tornado impacts. The southeastern United States is considered particularly vulnerable to tornado fatalities because of the high concentration of mobile homes and frequency of EF-4 and EF-5 tornadoes. Traumatic injury, including head injury, is the leading cause of death during tornadoes.

What is added by this report?

Although extensive public health warnings were broadcast before the tornadoes touched down, this was the third-deadliest tornado disaster in U.S. history, with 338 confirmed fatalities. Head injury was the cause of death in nearly 22% of fatalities. Approximately 47% of the fatalities were in single-family homes. A composite of the multistate deadly tornado tracks was created from the National Weather Service's tornado survey points in a geographic information system (GIS); more than 90% of the geocoded addresses were spatially linked to a deadly tornado.

What are the implications for public health practice?

To prevent tornado-related fatalities, public health messaging needs to specify what constitutes a safe room and to increase awareness that these should be used during all tornadoes. Spatial analysis of health impacts of tornadoes using GIS provides a better understanding of risk factors and the underlying characteristics of the affected population for public health preparedness and response.

 

 

Thankfully, this year has provided a far less violent spring storm season in the United States, although during the first 6 months of the year we have seen 68 storm-related fatalities (cite).

 

While I preach preparedness, there is admittedly one potentially fatal gap in my preparedness plan.  I have no `safe room’ in my current dwelling, and frankly, no good way to create one in what we euphemistically call a `manufactured home’.

 

When I lived in Missouri – which gets its fair share of tornadoes – having a full basement/storm shelter was both practical and a great comfort.

 

But here in Florida – where the water table is so high – basements are largely impractical. Luckily, Florida is less at risk for the really big tornadoes. We are, however, are a frequent target for hurricanes.

 

EF-3 or Greater Tornado Threat – Credit FEMA

 

Those living in tornado prone areas should seriously consider the possibility of creating one of these potentially life-saving additions to their home. To that end, FEMA has a good deal of advice on exactly how to construct a safe room – either above or below ground.

 

Residential Safe Rooms

• Building a Safe Room in Your House
• Residential Funding Opportunities
• Examples and Case Studies

Having a safe room in your home can protect your family and save the lives of those you care about.

Find answers to your Questions about Building a Safe Room, including:

• What is the cost of installing a safe room?

• Can I install a safe room in an existing home?

• Can I build the safe room myself?

• Where is the best location for the safe room?

• Where can I find plans for safe room construction?

• And more....

Building a Safe Room in Your House

For more details about how you can build a safe room in your home, go to the Taking Shelter From the Storm: Building a Safe Room For Your Home or Small Business (FEMA 320) page before downloading it from the FEMA Library.

Residential Funding Opportunities

Grants, funding opportunities and various initiatives are available for individuals wishing to build a residential safe room.  See the resources below for additional information:

• Residential Funding

• Residential Initiatives

Examples and Case Studies

Learn how others have benefited from safe rooms.  See the following resources on the best practices case study web page.

 

Having a good (and well rehearsed) family emergency plan is essential for any emergency. Even with a safe room, family members could become separated (they may be sent to different hospitals or shelters) in the post-disaster chaos.

 

Some may be injured and unable to provide information about their families.

 

So it is important to set up a plan, including meeting places and out-of-state contacts, and individual wallet information cards -  before you need it. To that end READY.GOV has some advice, and tools, to help you do just that.

 

Plan to Protect Yourself & Your Family

 
Family Emergency Plan

(PDF - 3Mb)

Prepare yourself and your family for a disaster by making an emergency plan.

 

Download the Family Emergency Plan (FEP) (PDF - 3 Mb), print the pages and fill them in offline.

 

Your emergency planning should also address the care of pets, aiding family members with access and functional needs and safely shutting off utilities.

 

You may also want to inquire about emergency plans at work, daycare and school. If no plans exist, consider volunteering to help create one. Read more about school and workplace plans.

 

Once you’ve collected this important information, gather your family members and discuss the information to put in the plan. Practice your plan at least twice a year and update it according to any issues that arise.

 

Together with adequate emergency supplies, a solid first aid kit, and an emergency battery operated NWS Weather Radio, these steps will go a long ways to protecting you, and your family, from a wide variety of potential disasters.

 

For more on all of this, a partial list of some of my preparedness blogs include:

 

Inside My New Bug Out Bag

Picking Up The Pieces

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift Of Preparedness 2011

 

But the time to make these preps is now, before the storm clouds gather.

 

»» Read More

WHO: Egypt Reports Another Bird Flu Fatality

 

 

# 6234

 

 

For the sixth time since the start of the year Egypt has reported a human H5N1 infection - and as in the case of two others this year from that nation - this one proved fatal.

 

This update from the World Health Organization’s GAR (Global Alert & Response) page.

 

 

Avian influenza – situation in Egypt – update

19 March 2012 - The Ministry of Health and Population of Egypt has notified WHO of a new cases of human infection with avian influenza A (H5N1) virus.

The case is a 40 year-old female from Dakahlia Governorate. She developed symptoms on 6 March 2012, was hospitalised on 12 March 2012. She was in critical condition and received oseltamivir upon admission. She died on 15 March 2012.

The case was laboratory confirmed by the Central Public Health Laboratories(NIC).

Investigations into the source of infection indicate that the case had exposure to sick backyard poultry.

Of the 164 cases confirmed to date in Egypt, 58 have been fatal.

 

 

Up until the `Arab Spring’ revolution of a year ago, we often caught wind of H5N1 cases in the press – sometimes days before the Ministry of Health would make an official announcement.

 

That happens far less often today, although the newshounds on the flu forums continue to scour the Arabic press, looking for reports.

 

While we’ve seen 19 confirmed cases from 6 countries already this year, bird flu remains very difficult for humans to contract. The concern is that the virus will mutate, and better adapt to humans, over time.

»» Read More

China Reports 2nd Bird Flu Fatality In A Month

 

 

# 6093

 

 

On the heels of recent human H5N1 infections reported in Indonesia, Egypt, Vietnam, and Cambodia -  China has announced their second bird flu fatality in less than a month.

 

This time it reportedly involves a 39-year-old man living in Guizhou, a province in southern China.

 

The AP and AFP are reporting this patient, who was described as being in critical condition several hours ago, as having died on Sunday (AP link)

 

Here is the official notification from the Hong Kong Centre For Health Protection.

 

Notification of a human case of H5N1 in Guizhou

The Centre for Health Protection (CHP) of the Department of Health received notification from the Ministry of Health (MoH) today (January 22) concerning a confirmed human case of influenza A (H5N1) in Guizhou.

A CHP spokesman said the patient was a 39-year-old man living in Guizhou. He developed symptoms on January 6 and was admitted to a hospital on the same day. He is now in critical condition. The man did not report obvious exposure history to poultry before the onset of symptoms.

 

Laboratory tests on the patient's specimen by the Chinese Centre for Disease Control and Prevention yielded a positive result for H5N1.

 

The CHP is maintaining close liaison with the MoH to obtain more information on the case. We will heighten our vigilance and continue to maintain stringent port health measures in connection with this development, the spokesman said.

 

The spokesman reminded members of the public to remain vigilant against avian influenza infection and to observe the following measures:

• Avoid direct contact with poultry and birds or their droppings; if contacts have been made, they should wash hands thoroughly with soap and water;
  
• Poultry and eggs should be thoroughly cooked before eating;
  
• Wash hands frequently;
  
• Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins;
  
• Avoid crowded places and contact with sick people with fever;
  
• Wear a mask when you have respiratory symptoms or need to take care of patients with fever;
  
• When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, you should consult doctors promptly and reveal your travel history.

 

For further information on avian influenza, please visit the CHP website: www.chp.gov.hk.

Ends/Sunday, January 22, 2012
Issued at HKT 15:44
NNNN

 

Despite the standard cautions about exposure to poultry listed above, the AFP report indicates - that like the case in Guangdong province in late December - this victim claimed no known contact with poultry over the past 30 days.

 

The report goes on to say that 71 contacts of this victim are being monitored, but none have developed any signs of illness.

 

This recent spate of cases comes amid the traditional Lunar New Years celebration, a 6-week period which sees hundreds of millions of Asians returning to home and family to celebrate each year.

 

The Lunar New Year occurs on January 23rd this year, and as they do every year, public health officials will be on the lookout for any signs of unusual disease outbreaks in the wake of this mass migration.

 

The recent spike in human H5N1 infections is something we see each winter, but fortunately we’ve yet to see any signs of sustained human-to-human transmission of this virus.

 

Nevertheless, as these cases continue to trickle in scientists keep watch for any signs that might indicate the virus is adapting better to humans.

»» Read More

MOH: 3rd Bird Flu Fatality in Bali

 

 

# 5960

 

 

Just over a month ago we learned of the deaths of two young siblings on the island of Bali from the H5N1 virus (see Bird Flu Claims Two Lives On Bali).

 

A week later, their mother (who had previously tested negative for the virus) was briefly hospitalized, but left the hospital against medical advice.

She died within 24 hours at home.  For details see here.

 

Although the H5N1 bird flu virus was strongly suspected in the mother’s death, up until now we’ve had no official confirmation of that fact.

 

Today, Depkes – the Indonesian Ministry of Health – has posted an announcement (curiously back dated to Nov. 3rd)  announcing that lab tests confirmed the mother died from the virus as well.

 

Ida at BFIC has a translation for us.

 

Indonesia ::: MOH confirms 180th H5N1 case

Posted by Ida on November 14, 2011

Indonesia Ministry of Health, the General Directorate of Infectious Disease and Environmental Health, through the National Institute of Health Research & Development laboratory, confirmed an additional H5N1 case in human.

 

Victim is a 29-year-old female with initial NP, resident of Bangli regency, Bali province. She is a mother of 2 former H5N1 cases (5-year-old female, and 10.5-year-old male).

 

Victim felt weakness, coughing and breathing difficulty on 15 Oct 2011, and sought for help to an emergency unit in nearby regional hospital. While she was about to be transferred to referral hospital, victim escaped and was found in a place of alternative healer on the next day.

 

Her condition was getting worse and died in her house on 17 Oct.

 

Epidemiological investigation showed that victim lived in area where many people rearing poultries. Also, large number of poultries belong to victim’s family and their neighbors died recently.

 

(Continue . . .)

 

The details of epidemiological investigations out of  Indonesia often read as if they were part of the same boilerplate press release; almost always pointing to possible contact with sick or dying poultry in the neighborhood.

 

While 8-days between the first child’s death and the mother’s is consistent with secondary transmission of the virus, it alone does not constitute proof. 

 

The mother was treated with antivirals after her children were hospitalized, which might have delayed the onset of her illness.

 

It is also possible that she was infected at a later date by the same source (ie. neighborhood chickens) as were the children.

 

Despite the suspicious circumstances surrounding this cluster, proving H-2-H (human to human) transmission is always difficult, even with rigorous investigation. Frankly, if any other plausible explanation is available, it is usually embraced by the MOH.

 

As we’ve seen in the past, clusters in Indonesia often involve blood relatives, suggesting some sort of inheritable trait may affect susceptibility to the H5N1 virus (see Host Genetic Susceptibility to Avian Influenza).

 

But regardless of the manner in which this cluster evolved, it appears to have died out with these three victims. No epidemiologically linked cases have been reported on the island since then.

 

Although we continue to see isolated human infections around the world, and the virus continues to evolve (see H5N1: An Increasingly Complex Family Tree), for now H5N1 is primarily a threat to poultry.

 

The concern, of course, is that over time that could change.

 

For more on the potential for the H5N1 virus to adapt to humans, you may wish to revisit a couple of these recent blogs.

 

New Scientist: Five Easy Mutations

Professor Peter Doherty On Bird Flu

Robert Webster on The Bird Flu Threat

»» Read More

Indonesia Announces Bird Flu Fatality

 

 

 

# 5553

 

A brief announcement from Depkes, the Indonesian Ministry of Health, on the death of an 8 year-old girl last month from the H5N1 bird flu virus.

 

IDA at BFIC has more.

 

West Jakarta ::: H5N1 confirmed

Posted by Ida on May 12, 2011

Center of Health Research and Development Laboratory, Indonesia Ministry of Health confirmed a bird flu H5N1 patient on April 2011.Victim is an 8 years old female from West Jakarta.

 

Victim started to develop signs such as fever, cough and chest pain on 1 April 2011. She was then admitted to a bird flu referral hospital in Jakarta on 8 April 2011. She received treatment according to the standard procedure and died on 8 April 2011 in the hospital.

 

Source: Indonesia Ministry of Health website. http://www.depkes.go.id/index.php?Itemid=1

 

 

A machine translation of the announcement reads:

 

BIRD FLU CASE UNTIL APRIL 2011

Based on the results of Research and Development Laboratory of Health Ministry of Health, JZ (P, 8 years), who West Jakarta has tested positive for H5N1 virus (bird flu).

 

JZ (P, 8 years) experienced onset of illness on April 1, 2011 with symptoms of fever, cough and chest pain. Patients treated at AI referral hospitals in Jakarta on 8 April 2011 and have handled cases

 

 

Although we continue to see isolated human infections around the world, for now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

 

Nevertheless, the H5N1 virus has an extraordinarily high mortality rate (50%+), and so we watch it carefully for any signs that it may be adapting to humans.

»» Read More

Cambodia Reports 5th Bird Flu Fatality

 

UPDATED (See bottom) 13:30 EDT 4/21/11

 

# 5510

 

 

AFP is reporting this morning on Cambodia’s 5th bird flu cae of 2011, once again a child (age 5) , who died on April 16th in Prey Veng province.

 

Of the 5 cases this year, 4 have been in children. All of the cases this year have been fatal.

 

Prey Veng Province was the site of the 2nd and 3rd cases, reported back in February.

 

 

It was just Monday of this week that IRIN carried a report called CAMBODIA: Bird flu risk "under control", say health experts.

 

While the appearance of a 5th case doesn’t necessarily negate that assessment, after several years of little reported H5N1 activity, in less than 3 months Cambodia has tripled their total number of known bird flu cases.

Making Cambodia well worth keeping an eye on.

 

 

UPDATE:   The World Health Organization has posted an update on this latest case, reported earlier today in the media.

 

 

Avian influenza – situation in Cambodia - update 3

21 April 2011 - The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

The case was a 5 year old girl from Pea Raing district, Prey Veng Province. She developed symptoms on 11 April, was initially treated by local private practitioners with no effect and was later admitted to Kantha Bopha Children Hospital on 13 April. Despite all intensive care, she died on 16 April, four days after admission.

There have been reports of poultry die off in her village. The girl is the fifteenth person in Cambodia to become infected with the H5N1 virus and the thirteenth to die from complications of the disease. All five cases of H5N1 infections in humans in Cambodia this year have been fatal.

Specimens from 53 contacts of the cases were collected and are being tested by the National Institute for Public Health laboratory.

 

»» Read More

Japan: Investigating Pediatric Vaccines

 

 

UPDATED:  0850hrs EST  03/08/11

Reuters is reporting that while the Japanese suspension on the use of both vaccines remains in effect, a government panel has been unable to find any apparent link between the use of these two vaccines and the four deaths.  

 

Japan panel finds no link to vaccines, deaths: report

 

They state, however, that further investigation is warranted.

 

 

# 5361

 

 

Over the past couple of days concerns have been raised in Japan – and around the world - over the safety of two widely used pediatric vaccines (Pfizer’s Prevnar & Sanofi’s ActHIB) after the sudden deaths of four recently vaccinated children.

 

Prevnar is a pneumococcal conjugate vaccine, while ActHib is a Haemophilus influenzae type b vaccine.

 

Both are viewed as highly successful in the prevention of serious childhood infections.

 

The four children – aged 6 months to 2 years – all died within a day or two of receiving one or both vaccines, although no direct link between their deaths and the vaccines has been established. 

 

Both vaccines have been given to millions of children over the past decade, and both have an excellent safety profile. 

 

But when you give tens of millions of vaccinations each year, a small number of unexpected – and most probably unrelated – serious medical events are apt to occur within a few days among those receiving a shot.

 

And it should be noted that at least two of these children reportedly had serious underlying medical conditions.

 

Nevertheless, Japan has suspended the use of both vaccines pending an investigation. A step that has not been followed by other countries.

 

First, a brief report from Vaccine Daily News on the suspension of these vaccines.

 

 Japan suspends use of two vaccines

by Jeffrey Bigongiari on March 7, 2011

 

Next we get a piece by Matthew Herper in Forbes on this vaccine scare, which includes reassuring comments from Dr. William Schaffner (Chairman of the department of medicine at Vanderbilt University School of Medicine) and Dr. Paul Offit, a vaccine researcher at Children’s Hospital in Philadelphia.

 

Don’t Be Frightened By Japan’s Vaccine Scare

Mar. 7 2011 - 5:35 pm |

 

 

While it is within the realm of possibility that one or both of these vaccines contributed to these child deaths (hence the investigation), the track record of both of these vaccines is very good – making that unlikely.

 

And even if causation is found, the spectacular success of the HiB vaccine in preventing childhood illness and deaths in this country cannot be overstated. 

 

 

There is no such thing, of course, as a completely benign – 100% safe – vaccine.   Side effects – even serious ones – while rare, can occur.

 

All drugs have a risk/reward benefit that must be taken into consideration before taking.  But the evidence is that the Hib and Prevnar vaccines are overwhelmingly safe, and save thousands of lives each year.

 

We’ll obviously await word on the investigation into these deaths with considerable interest, but for now, we’ve no compelling evidence to implicate these vaccines in these fatalities.

»» Read More

Egypt: Two New Bird Flu Cases

 

 

# 5197

 

 

Kudos to newshound Treyfish who just found, and posted on FluTrackers, a news report from Youm7 announcing two new H5N1 cases in Egypt.

 

The first case involves a 25 year-old woman who died on December 29th, from the Qena Governate, and the second regards a 27 year-old man from Ismailia who is in stable condition.

 

Assuming these cases are confirmed by the World Health Organization, and that no new cases from last year emerge, Egypt will have recorded 28 new H5N1 infections in 2010 and 12 new fatalities (42% fatality rate).

 

This represents a decrease in the total number of officially recognized cases (compared to 39 in 2009), but a significant increase in fatalities (there were just 4 in 2009).

 

 

"Health" announces the death of a new case of bird flu in Qena

Saturday, January 1, 2011 - 17:47

 

Dr. Abdel Rahman Shahin

Written by Amira Abdel-Salam

Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health, that the team monitoring the epidemic, Ministry of Health discovered two cases of bird flu, the first old lady (25 years), from Qena Governorate, and died on 29 December last year, the second man from age (27 years), from Ismailia, which is under treatment at a hospital in Ismailia and stable condition.

 

This brings the number of cases to 118 cases and 39 cases the number of deaths since the onset of the disease in 2006 until now.

 

 

Since the beginning of 2009 Sharon Sanders of FluTrackers keeps an excellent listing of human H5N1 cases officially announced by the Egyptian MOH. 

 

You can view the latest version here.

»» Read More

Indonesia: Suspected Bird Flu Fatality

 

# 5013

 

 

Last night, as I was about to retire for the evening, I spotted a pair of very brief reports on the death of an `alleged’ bird flu patient on Monday at M Djamil hospital in West Sumatera.

 

These reports were posted by bgw in MT on the Flu Wiki and Treyfish on Flutrackers.

 

Since details were somewhat scant - I decided to wait until morning to post it - when hopefully more information would become available.

 

Ida at the Bird Flu Information Corner has obliged, with a translation of a report from Antara-Sumbar.

 

While her doctors suspect H5N1 - based on her rapid death, symptoms, and X-rays – confirmatory test results have not been received.

 

I’ve only posted an excerpt from Ida’s translation. Follow the link to read it in it’s entirety.

 

 

Pasaman Barat, West Sumatera ::: A girl possibly die of bird flu

Posted by Ida on October 27, 2010

Pasaman Barat – A 5-year-old girl, Indri Rahmi Wati, resident of Kampung Sungai Janiah, Jorong Sungai Janiah Nagari Talu, Kecamatan Talamu Kabupaten Pasaman Barat (Pasbar) had died in M Djamil hospital, West Sumatera, on Monday (25/10).

 

She was suspected of having bird flu H5N1 infection.

 

Patient had received medical help for four hours at internal medicine isolation unit of M Djamil hospital before the death.

 

Head of Health Service in Pasbar, Yandra Fery confirmed the existence of bird flu suspect patient in Pasbar.

 

Indri, had been admitted to Talu public health center and then transferred to Jambak Pasbar regional hospital. Since her condition was deteriorating, the hospital referred her to M Djamil hospital, where she was immediately treated at internal medicine unit.

(Continue . . . )

 

 

Currently outbreaks of H5N1 occur primarily in birds, although sporadic,widely scattered human cases are reported around the world as well – most commonly in Egypt and Indonesia.

 

Most (but not all) have been linked to close contact with infected poultry or birds. The source of infection in a small number of human cases isn’t known.

 

While the virus has yet to adapt well enough to human hosts to transmit effectively between people, scientists still fear the virus could mutate into a pandemic strain someday.

»» Read More

India: H1N1 Fatalities On The Rise

 

 

#4877

 

 

Although the pandemic was declared over last month, India (and to a lesser extent New Zealand and Australia) continue to report elevated levels of influenza.

 

Given the spotty nature of surveillance, testing and reporting around the world it is likely there are other regional `hotspots’ as well.

 

All of which means that the `official numbers’ we hear from individual countries, and cumulative totals from the World Health Organization are badly undercounted. A fact that the WHO readily admits.

 

So I view media reports announcing the latest tally of H1N1 cases - or fatalities – as being indicators of the latest trend (up, down, stable) in cases more than reliable counts.

 

Which brings us to a report this morning on the NetIndian News Network announcing 128 H1N1 deaths in India in past week: Govt. 

 

The report credits an official statement from the Ministry of Health & Family Welfare, and is for the week ending September 5th. The report also mentions 1257 new H1N1 flu cases around the nation.

 

The latest epidemiological data I can find for India is current only through mid-July of this year, but at that time the number of weekly cases being reported was closer to 300 and the number of deaths each week hovered in the low double digits.

 

 

In June of 2010, India reported fewer than 1,000 H1N1 flu cases, and just 60 fatalities.

 

Which would make 1257 new cases and 128 deaths last week a sizable jump in activity.

 

As the following graphic indicates, most people with ILI’s (Influenza-Like Illnesses) test negative for H1N1, and testing is only being conducted on patients admitted to hospitals.

 

 

Testing and reporting results come mainly from large urban areas since medical care (and influenza testing and surveillance) are spotty in rural areas of India.

 

All of which makes it incredibly difficult to quantify the number of cases – and fatalities – that actually occurred last week in India (or anyplace else for that matter).

 

The best that we can say is that the reported number of cases and deaths in India have increased markedly over the past few weeks.

 

Making India well worth our attention to see how this trend progresses.

»» Read More

MMWR: Estimates Of Yearly Seasonal Influenza Deaths

 

 

# 4836

 

 

One of the downsides to employing averages, rule’s of thumb, and oversimplified but `friendly’ data is that it can skew the public’s perception of what is `normal’ or expected.

 

A prime example is the oft stated statistic that 36,000 Americans die each year from an influenza-related illness. 

 

It’s an easy and convenient `factoid’ that the media can slip into a news report, but it isn’t a completely reliable number.

 

As I’ve mentioned in the past, that number is an estimate . . . not an actual count . . . and it can be a bit misleading because it is an average of estimated deaths that occurred during the 1990s – a number that was calculated as ranging from a low of 17,000 to a high of 52,000.

 

None of this is hidden knowledge, of course.  The CDC has readily stated how they came up with their estimates, and those methods have been the subject of considerable debate.

 

While everyone wants good numbers, there are a number of obstacles in the way of any attempt to accurately estimate flu-related deaths.

 

Including: 

 

• Estimates are extrapolated based on a surveillance subset of the country, not the whole nation
• There are often co-circulating viruses that may influence overall mortality.
• Surveillance, testing, and reporting may change over time
• Different mathematical models can produce differing results
• There are varying opinions as to what constitutes an influenza-related fatality.

 

When combined with the inevitable variations in the severity of influenza seasons (H3 years are usually more severe than H1 years), this makes it impossible to derive a single number that `works’.

 

In an attempt to help us better understand the impact of influenza-related deaths in the United States each year, the CDC has released a new study in today’s MMWR  titled:

 

Estimates of Deaths Associated with Seasonal Influenza --- United States, 1976--2007

Weekly

August 27, 2010 / 59(33);1057-1062

 

There is a lot of data here, as deaths are divided into two broad camps ( 1) pneumonia and influenza causes and 2) respiratory and circulatory causes), and further divided by three age brackets (<19 years, 19--64 years, and ≥65 years)

  

For deaths with underlying pneumonia and influenza causes (the most narrow definition of flu-related fatalities used) the models estimated a yearly average of 6,309 (range: 961 in 1986--87 to 14,715 in 2003--04) influenza-associated deaths.

 

Using a broader criteria (underlying respiratory and circulatory causes including pneumonia and influenza causes)  the models estimated an annual average of 23,607 (range: 3,349 in 1986--87 to 48,614 in 2003--04) influenza-associated deaths.

 

Somewhat less than the old 36,000 number, but explained in the report as that number having been based on estimates derived during the 1990s – when H3N2 was the predominant strain.

 

These new numbers are based on 31 influenza seasons, running 1976-2007.

The short course  from the study is as follows. 

 

What is already known on this topic?

Influenza infections result in substantial medical costs, hospitalizations, lost productivity, and thousands of deaths every year in the United States with the majority of deaths from seasonal influenza occurring among adults aged ≥65 years.

 

What is added by this report?

During 1976--2007, annual estimates of influenza-associated deaths from respiratory and circulatory causes ranged from 3,349 (in 1986--87) to 48,614 (in 2003--04), and the annual rate of influenza-associated death for all ages ranged from 1.4 to 16.7 deaths per 100,000 persons; during seasons when influenza A(H3N2) circulating strains were prominent, 2.7 times more deaths occurred compared with seasons when A(H3N2) was not prominent.

 

What are the implications for public health practice?

A single estimate should not be used to summarize influenza-associated deaths; a range of estimates should be described in the context of circulating virus strains and underlying causes of death among age groups. Annual influenza vaccination (now recommended for all persons aged ≥6 months) is the best way to avoid influenza complications, and prompt treatment with antiviral medications can reduce the risk for severe illness and death among persons at increased risk for influenza or who are hospitalized with influenza.

 

 

Since statistical analysis isn’t my strong suit, I’ll leave it to others to try to analyze these findings and methods.

By just about any calculation, however, influenza is a serious illness that exacts a heavy toll on society.  Which makes getting the yearly flu vaccine a smart move.

 

By all means, follow this link to read the report in its entirety.

»» Read More

Egypt Announces H5N1 Fatality

 

 

# 4835

 

 

The announcement yesterday of the 112th human infection by bird flu in Egypt (see KUNA: Egypt Announces 112th Bird Flu Infection) indicated that the patient – a 33 year-old woman – was in critical condition.

Today, sadly, we learn that she has died.   

 

A hat tip to Twall on FluTrackers for the heads up on this story.

 

Health announces the ninth bird flu death in 2010

Thursday, August 26th, 2010 - 13:23

Written by Amira Abdel-Salam

Ministry of Health announced today, Thursday, for the death of ninth case of bird flu during the year 2010, which is of a woman Qaliubiya old 33 years old.

It is noteworthy that since the issuance of the disease in 2006 cases amounted to 112 cases of infection, while reaching deaths to 36.

»» Read More

Media: Indonesian Bird Flu Fatality

 

 

 

# 4537

 

Indonesian media is reporting the 4 year-old girl who died on Wednesday in the flu isolation unit of Arifin Achmad hospital in Pekan Baru, Indonesia has tested positive for the H5N1 virus.  

 

Meanwhile, three others from the same region remain hospitalized with suspected H5H1 infection.  A 40 year-old mother, her 14-year-old child, and an 8-year-old neighbor. 

 

Their conditions are reported as improving.  

 

 

This machine translation is of an original article from riauterkini.com news.

 

Friday, 30 April 2010 19:40

Positive Joice, Arifin Achmad Hospital Patients Hospitalized third suspect bird flu

 Joice toddlers tested positive Efeline died from bird flu. Sementa currently three residents in the provincial hospital Siak Arifin Achmad for allegedly infected by H5N1 virus.

Riauterkini-Pekanbaru-suspect case of bird flu, Arifin Achmad Hospital has treated this weekend hikes.  After a toddler, child Sidomulyo resident Street, Padang Keluruhan headdress, District Senapelan, named Joice Efeline Pekanbaru City died Wednesday (28/4/10) and ascertained from the virus or the H5N1 strain of avian enfluenza, now there were three patients who origin in Siak Regency should be treated in isolation space suspect bird flu patients.

 

"To Joyce Efeline we can and certainly a positive laboratory result of bird flu," said Chairman of the Bird Flu Prevention Team Arifin Achmad Pekanbaru Hospital Saad Azizman to riauterkini in Pekanbaru, on Friday (30/4/10).

 

While about three patients Siak origin who is now hospitalized in isolation room is a mother named Siti Fatimah (40) and his son, Anggi (14) and neighbor Diva Amandasari (8).

All three residents Apit River, Siak.

All three enter simultaneously at dawn earlier. Initially treated in the emergency room (ER), but because his body temperature reached 38 degrees Celsius, and then referred to were isolated in a special room patients suspect bird flu.

"Now all three conditions began to improve.  His temperature began to decrease and his lung condition is stable, "explained Azizman .***( mad)

»» Read More

Study: Years Of Life Lost Due To 2009 Pandemic

 

 

# 4457

 

 

With the pandemic virus of 2009 (at least temporarily) on the wane in North America and most of Europe, scientists are now trying to quantify its impact. 

 

This is not going to be an easy task, nor shall it be accomplished overnight.  But the first reviews of the data are coming in, and over time a better picture will emerge.

 

One of the big questions is, how shall we calculate the impact?

 

And for that, there is no universally accepted answer.  But one critical measurement would be in years of life lost (YLL).

 

The average (mean) age of a flu-related fatality in a `normal’ flu season here in the United States is about 76 years. Seasonal influenza is primarily seen as a `harvester’ of the aged and infirmed, robbing its victims of the last few months or years of life.

 

Only rarely does it severely impact young adults and children.

When a pandemic strain emerges that pattern can change.  We often see a pronounced age shift, with much younger victims. The pandemic of 2009 followed that pattern, with 85% of its victims under the age of 60. 

 

The mean age of death from the novel H1N1 virus has been calculated to be half that of seasonal flu, or 37.4 years. 

 

 

In terms of years of life lost (YLL), the average pandemic flu death has a many fold greater impact than the average seasonal flu fatality.    

 

This morning, we’ve a preliminary study of these statistics that appears in PLoS Currents Influenza, and an article by Robert Roos at CIDRAP news.  

 

This is a fascinating study, and I heartily recommend that you follow both links to explore further.  It may give you a new perspective on the impact of the pandemic of 2009.

 

 

Preliminary Estimates of Mortality and Years of Life Lost Associated with the 2009 A/H1N1 Pandemic in the US and Comparison with Past Influenza Seasons

By Cecile Viboud, Mark Miller, Don Olson, Michael Osterholm et al (5 authors)

The on-going debate about the health burden of the 2009 influenza pandemic and discussions about the usefulness of vaccine recommendations has been hampered by an absence of directly comparable measures of mortality impact. Here we set out to generate an "apples-to-apples" metric to compare pandemic and epidemic mortality.

 

We estimated the mortality burden of the pandemic in the US using a methodology similar to that used to generate excess mortality burden for inter-pandemic influenza seasons. We also took into account the particularly young age distribution of deaths in the 2009 H1N1 pandemic, using the metric "Years of Life Lost" instead of numbers of deaths. Estimates are based on the timely pneumonia and influenza mortality surveillance data from 122 US cities, and the age distribution of laboratory-confirmed pandemic deaths, which has a mean of 37 years. We estimated that between 7,500 and 44,100 deaths are attributable to the A/H1N1 pandemic virus in the US during May-December 2009, and that between 334,000 and 1,973,000 years of life were lost.

 

The range of years of life lost estimates includes in its lower part the impact of a typical influenza epidemic dominated by the more virulent A/H3N2 subtype, and the impact of the 1968 pandemic in its upper bound. We conclude that the 2009 A/H1N1 pandemic virus had a substantial health burden in the US over the first few months of circulation in terms of years of life lost, justifying the efforts to protect the population with vaccination programs. Analysis of historic records from three other pandemics over the last century suggests that the emerging pandemic virus will continue to circulate and cause excess mortality in unusually young populations for the next few years. Continuing surveillance for indicators of increased mortality is of key importance, as pandemics do not always cause the majority of associated deaths in the first season of circulation.

 

 

(Continue . . . )

 

From CIDRAP, we get this overview.

 

Study: In life-years lost, H1N1 pandemic had sizable impact

Robert Roos News Editor

Mar 23, 2010 (CIDRAP News) – A new study argues that because the H1N1 influenza pandemic cut many young lives short, its real public health impact has been substantially greater than is generally perceived.

 

In the study, a team of government and academic researchers came up with new estimates of deaths in the pandemic. By combining those with data on the age distribution of deaths, they estimated the number of "years of life lost" because of the pandemic. By that measure, its impact was at least as severe as a tough seasonal flu epidemic and possibly greater than the pandemic of 1968-69, they contend.

 

"We conclude that the 2009 A/H1N1 pandemic virus had a substantial health burden in the US over the first few months of circulation in terms of years of life lost, justifying the effort to protect the population with vaccination programs," says the report, published last night by PLoS Currents: Influenza. In the interest of rapid dissemination, the online journal publishes studies that have been screened by experts but have not undergone formal peer review.

 

(Continue. . . )

»» Read More

More Premature Extrapolations

 

 

 

 

# 4310

 

I’ve no doubt that, given time, scientists and researchers will conduct a thorough post mortem on the pandemic of 2009.  

 

Over the next few years they should be able to come up with a reasonable estimate (probably a range) of the number of pandemic related deaths, and should be able to analyze and quantify the effectiveness of various mitigation efforts undertaken around the world.

 

That work is going on right now, of course.  But so is the pandemic.  It will take some time before we get really good answers.

 

So I take articles, like the one below that appears eager to reach a conclusion based on early data, with a sizable grain of salt. 

 

First the report, from the Daily Record, then some additional comments.

 

 

Revealed: Swine flu death rate in Scotland third worst in world..it's even worse than Mexico

Feb 1 2010 By Derek Alexander

 

SCOTLAND'S swine flu death rate is the third worst in the world - beating Mexico where the virus was first discovered.

 

Only Argentina and Latvia have worse death rates.

 

Last night, ministers were being urged to investigate as medical experts blamed Scotland's poor health record for the shocking findings.

 

Stefan Chmelik, of New Medicine Group, said: "There is something of a general health crisis in Scotland.

 

"It stands to reason that if you're fit and healthy then you're more able to fight off disease - and if you're unhealthy then you're potentially more susceptible."

 

In Scotland, the swine flu mortality rate is 13.2 per million people - more than double the 5.76 figure for the rest of the UK.

 

It's also 45 per cent higher than Mexico and three times higher than Poland, where health bosses have refused to administer a vaccine.

 

Argentina tops the poll with 15.37 deaths per million, followed by Latvia with 14.37.

 

(Continue . . . )

 

 

Seemingly a damning indictment of the Scottish Health system, and one that apparently is becoming a bit of a political football.

 

But is it really?

 

I would submit that the evidence at this point is pretty thin.

 

Scotland has recorded 66 deaths that they have attributed to the H1N1 virus. And with a population of just over 5 million, that works out to 13.2 deaths per million.

 

This article compares Scotland’s national death rate to the rates being posted by the small number of countries that are actually counting and reporting swine flu fatalities.

 

Saying Scotland has the 3rd worst numbers in the world is a bit presumptuous when most of the world isn’t even reporting.

 

But even if you refine the declaration to `among countries reporting’, there are still problems with this analysis.

 

First and foremost, there is no standardized definition for what constitutes a `flu-related death’.  

 

Someone who gets the flu, fights it off at home for a week, then is hospitalized with pneumonia isn’t likely to test positive for the virus by the time they hit the ICU. While almost certainly `flu-related’, in most reporting countries, this case wouldn’t be counted.

 

So what may be a flu-related death in one region might not be counted in another.

 

Secondly, surveillance and reporting is patchy at best, even in those countries reporting flu fatalities.

 

The deaths being counted are those with laboratory confirmed H1N1. The WHO, the CDC, and just about every public health agency in the world openly state that those represent just the tip of the iceberg.    

 

The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related. – World Health Organization.

 

Making comparisons with incomplete (and inconsistently gathered) information may make for an interesting news story, but it hardly qualifies as good science.

 

And when you look at the CDC’s estimate of the number of H1N1 deaths in this country you end up with a much higher number for the United States. Anywhere between 26 and  54 deaths per million.

 

Or 2 to 4 times higher than Scotland’s (or any other country’s) published rate.

 

 

 

Which number is right?

Right now, I don’t think you can point to any country’s count, or method of counting, and say they’ve got it right (although I suspect the CDC’s estimate is more realistic).

 

Ask me again in 3 to 5 years.  

 

Does Scotland really have the 3rd highest H1N1 fatality rate in the world?

 

It’s possible, I suppose. 

 

But based on what little we know, I wouldn’t put any money on it.

 

 

For more on how numbers can be used to prove just about anything, you might want to revisit:  

 

Proving Anything With Numbers

Premature Extrapolations

»» Read More

CDC Updates Estimates Of Infections, Hospitalizations, and Deaths From H1N1

 

 

# 4259

 

 

Attempts to count individual deaths from the H1N1 virus in the US ceased during the summer when it was determined that it was no longer possible to keep any kind of accurate tally.

 

 

That was expected since, even during a regular flu season, we don’t count individual flu deaths.  The oft repeated number of 36,000 flu-related deaths annually is an estimate.

 

 

In November the CDC released their estimates of the pandemic’s impact here in the US up until mid-October.  At that time, they estimated 22,000,000 people had been infected and roughly 4,000 had died.

 

In December, the CDC has updated those numbers through November 14th, and they show a significant increase over the previous numbers.  A mid-range estimate of 47 million infections and nearly 10,000 deaths.

 

Today, the CDC once again updates their estimates to carry through to the 12th of December.    Their mid-range estimates are of 55 million infections and 11,160 deaths in the US from H1N1 since April of 2009.

 

 

 

 

CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April – December 12, 2009

January 15, 2010 1:00 PM ET

April – October 17 Estimates
April – November 14 Estimates

On this Page

• Background
• The Numbers
• Table: CDC Cumulative Estimates of 2009 H1N1 Cases and Related Hospitalizations and Deaths from April-December 12, 2009
• Method to Estimate 2009 H1N1 Cases, Hospitalizations and Deaths
• Background Emerging Infections Program
• Seasonal Influenza-Associated Hospitalizations in the United States
• Seasonal Influenza-Associated Deaths
• Under-Counting of Flu-Related Deaths
• Related Links

Background

Estimating the number of individual flu cases in the United States is very challenging because many people with flu don’t seek medical care and only a small number of those that do seek care are tested. More people who are hospitalized or die of flu-related causes are tested and reported, but under-reporting of hospitalizations and deaths occurs as well. For this reason CDC monitors influenza activity levels and trends and virus characteristics through a nationwide surveillance system and uses statistical modeling to estimate the burden of flu illness (including hospitalizations and deaths) in the United States.

When the 2009 H1N1 flu outbreak began in April 2009, CDC began tracking and reporting the number of laboratory-confirmed 2009 H1N1 cases, hospitalizations and deaths as reported by states to CDC. These initial case counts (which were discontinued on July 24, 2009), and subsequent ongoing laboratory-confirmed reports of hospitalizations and deaths, are thought to represent a significant undercount of the actual number of 2009 H1N1 flu cases in the United States. A paper in Emerging Infectious Diseases authored by CDC staff entitled “Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009” reported on a study to estimate the prevalence of 2009 H1N1 based on the number of laboratory-confirmed cases reported to CDC. Correcting for under-ascertainment, the study found that every case of 2009 H1N1 reported from April – July represented an estimated 79 total cases, and every hospitalized case reported may have represented an average of 2.7 total hospitalized people. CDC then began working on a way to estimate, in an ongoing way, the impact of the 2009 H1N1 pandemic on the U.S. in terms of 2009 H1N1 cases, hospitalizations and deaths. CDC developed a method to provide an estimated range of the total number of 2009 H1N1 cases, hospitalizations and deaths in the United States by age group using data on flu associated hospitalizations collected through CDC’s Emerging Infections Program.[e1]

The Numbers

(Print table)

On November 12, 2009 CDC provided the first set of estimates on the numbers of 2009 H1N1 cases and related hospitalizations and deaths in the United States between April and October 17, 2009.

Estimates from April – October 17, 2009:

• CDC estimated that between 14 million and 34 million cases of 2009 H1N1 occurred between April and October 17, 2009. The mid-level in this range was about 22 million people infected with 2009 H1N1.
• CDC estimated that between about 63,000 and 153,000 2009 H1N1-related hospitalizations occurred between April and October 17, 2009. The mid-level in this range was about 98,000 H1N1-related hospitalizations.
• CDC estimated that between about 2,500 and 6,000 2009 H1N1-related deaths occurred between April and October 17, 2009. The mid-level in this range was about 3,900 2009 H1N1-related deaths.

Updated Estimates from April – November 14, 2009

Using the same methodology CDC updated the estimates to include the time period from April through November 14, 2009 on December 10, 2009.

• CDC estimated that between 34 million and 67 million cases of 2009 H1N1 occurred between April and November 14, 2009. The mid-level in this range was about 47 million people infected with 2009 H1N1.
• CDC estimated that between about 154,000 and 303,000 2009 H1N1-related hospitalizations occurred between April and November 14, 2009. The mid-level in this range was about 213,000 H1N1-related hospitalizations.
• CDC estimated that between about 7,070 and 13,930 2009 H1N1-related deaths occurred between April and November 14, 2009. The mid-level in this range was about 9,820 2009 H1N1-related deaths.

Updated Estimates from April – December 12, 2009

Using the same methodology CDC has updated the estimates to include the time period from April through December 12, 2009.

• CDC estimates that between 39 million and 80 million cases of 2009 H1N1 occurred between April and December 12, 2009. The mid-level in this range is about 55 million people infected with 2009 H1N1.
• CDC estimates that between about 173,000 and 362,000 2009 H1N1-related hospitalizations occurred between April and December 12, 2009. The mid-level in this range is about 246,000 H1N1-related hospitalizations.
• CDC estimates that between about 7,880 and 16,460 2009 H1N1-related deaths occurred between April and December 12, 2009. The mid-level in this range is about 11,160 2009 H1N1-related deaths.

Note: Less than 5% of increases in the estimates from one reporting date to the next are the result of delayed reporting in cases, hospitalizations and deaths.

The previous estimates of 2009 H1N1 cases, hospitalizations and deaths through November 14 encompassed the peak of 2009 H1N1 activity in the United States. The latest estimates through December 12 show a modest increase in the total number of 2009 H1N1 cases, hospitalizations and deaths since the 2009 H1N1 virus emerged. The additional four weeks of flu activity data added to the previous estimate correlate with a four week period of decreasing flu activity in the United States.

»» Read More

Indonesia: 19 H5N1 Deaths In 2009

 

 

# 4202

 

 

Via Ida at BFIC (Bird Flu Information Corner)  –a  joint venture between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – we get this translation of the first confirmation of human H5N1 infections and deaths out of Indonesia for 2009.

 

Indonesia has adopted a policy of only rarely providing updates (the last was in January) of the total number of Human infections from bird flu.   

 

According to this report, 19 of 20 known cases died.

 

 

Indonesia ::: H5N1 situation update 2009

December 30, 2009

Since 1 January to 28 December 2009, a total 20 H5N1 cases reported in Indonesia. Of those confirmed cases, 19 have been fatal. First H5N1 case was reported from Bogor on 9 January, and latest was reported from South Jakarta on 23 September 2009.

 

Total cumulative number of H5N1 in Indonesia since 2005 to 2009 is 161 with 134 deaths.

 

This information is broadcasted by Public Communication Center, General Secretary Ministry of Health. Further information is available at: phone 021-52907416-9, fax 52921669, call center 021-30413700, or e-mail puskom.publik@yahoo.co.id, info@puskom.depkes.go.id, kontak@puskom.depkes.go.id.

 

Source: Ministry of Health Republic of Indonesia.

http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=3663

South Jakarta and Bogor, Java, Indonesia

===AvianInfluenzaIndonesia===

 

 

 

The World Health Organization continues to show no cases out of Indonesia for 2009, with its last update on December 21st.  Of course, they can report only what Indonesia reports to them.

 

 

How close this newly admitted number is to reality is unknown. 

 

Despite the news blackout, we’ve seen dozens of unconfirmed reports over the past year of `suspected’ human H5N1 infections in the Indonesian press.

 

A 95% CFR – even in Indonesia – is an astoundingly high number. 

 

One has to assume there are probably other, unreported cases out there, that hopefully would bring down that CFR. 

»» Read More