Sunday, April 26, 2009

WHO is going to stop the Swine Flu?

I got the following alert from a coworker. After reading this, I can say that I’m much more frightened at the prospect of what the CDC and the WHO are going to force us to do than the actual SIV itself. We’ve heard all this before. We were all going die if we didn’t take “proactive measures” against SARS, the bird flu, etc. But now that we have a usurper in the White House, these big government thugs may be even more emboldened force vaccinations on us than before. Yes, there will come a time when there is a real plague that comes upon the earth and wipes out a large portion of the world’s population (Matthew 24:7). But these fornication-promoting thugs won’t be able to do a thing about it, if they even try to stop it.

Dear IDSA Members,

I am writing to review the swine influenza situation and to apprise you of the Society’s response to the clinical and public health concerns that it has raised. I also want to provide you with ready access to credible resources. We plan to provide you with periodic updates by email on matters of particular importance.

As of April 25, 2009, the Centers for Disease Control and Prevention (CDC) has confirmed the presence of a novel swine influenza virus in 11 cases of influenza-like illness in the United States, occurring in southern California, Texas, and Kansas. (See Friday's MMWR, Update: Swine Influenza A (H1N1) Infections --- California and Texas, April 2009 and Saturday's HAN alert). Additional cases are being investigated in California, Kansas, New York City, and in Canada. The CDC website is being updated several times a day. There have been no fatalities in the United States and only one patient has been hospitalized.

In Mexico more than 800 cases of a respiratory illness in 3 clusters, including 61 deaths, have been noted since mid-March, according to the World Health Organization (WHO). It is not yet clear whether all these respiratory illnesses in Mexico are the same but at least some, including one fatal case, are due to this swine influenza virus. Seven viral isolates from Mexico have been identified as swine flu at CDC and another 18 have been confirmed as swine flu by Canadian laboratories. The ongoing epidemiologic investigation points to person-to-person transmission of this novel virus. Many important details such as the epidemic curve in Mexico, transmissibility, range of clinical manifestations, complications, and response to treatment remain under intense investigation.

This novel swine influenza virus is an influenza A:H1N1 that is a triple recombinant including gene segments of human, swine, and avian origin. Laboratory studies indicate susceptibility to neuraminidase inhibitors (oseltamivir, zanamivir) but resistance to the adamantanes (amantadine, rimantidine). It is not known whether the sensitivity of rapid tests for human influenza A:H1N1 will be equivalent for swine influenza A:H1N1. Because the current cases are dispersed over a fairly wide geographic area, containment is not a feasible option, and attention is focusing on other tools to slow the spread of infection.

Presently, the state and some large city public health laboratories can rule out swine influenza A:H1 but they cannot positively identify it. RT-PCR can be used to detect influenza A or B, and subtype influenza A as H1, H3 or H5. Nontypable influenza A isolates are to be sent to CDC for subtyping and further characterization. CDC is prioritizing its testing queue to test those specimens that are most informative to the epidemiologic investigation and it is actively working on making diagnostic reagents for swine influenza available to state public health laboratories.

CDC has set up a new swine flu website at and is updating it regularly as new information becomes available. Currently, interim guidance, generated with input from many IDSA members, is available on:

Public health experts are very concerned about the pandemic potential of this swine influenza virus, and there is ongoing discussion of whether to raise the WHO pandemic influenza level to phase 4. As emphasized Saturday by CDC, it is important to realize that efforts that we can make today do not depend on whether the alert level is raised. However, national and local pandemic preparedness actions including increasing preparations for community mitigation measures will accelerate if the level is raised. (Community mitigation guidance is available on the website.)

States are implementing guidelines for diagnostic testing and it is important for you to learn the details of the target population for testing, specimen collection, and handling and transport for your state or city. At this time of year, local influenza activity is quite varied and states will vary in their local recommendations on testing. IDSA members can be essential in ensuring that influenza testing is performed on patients hospitalized with acute respiratory illness, and that clinical microbiology laboratories are able to provide specimens confirmed as influenza A to public health laboratories if requested. You should review your hospital’s pandemic plan and urge appropriate partners within the hospital (infection control, ED, laboratory, pharmacy, employee health office, administration, etc.) to do the same.

The situation is a potentially serious one and IDSA urges you to reflect on those steps you can take personally and professionally to be better prepared during this evolving situation. Please think proactively about finding the right balance of concern and preparedness. IDSA members are likely to be seen as resources for their colleagues, institutions and communities. We will provide you with up-to-date information to help in this role.

IDSA is committed to working together with other clinical and public health partners, particularly CDC, WHO and PAHO, state and regional ID societies, in support of our mutual goal of appropriate action at this time of uncertainty. We will continue to provide periodic updates and welcome suggestions for what IDSA members and the Society can do in this evolving situation.

Sincerely yours,
Anne Gershon,

Marguerite A. Neill, MD
Rapid Communications Task Force

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