Deadly Bird Flu May Be Five Steps From Pandemic Potential

(Corrects sixth paragraph to show Glaxo vaccine is approved.)

Five genetic tweaks made a deadly strain of bird flu that can infect humans spread more easily, according to a study that the U.S. government had first sought to censor on concerns it could be used by bioterrorists.

The genetic changes made the H5N1 virus airborne among ferrets, the mammals whose response to flu is most like that of humans, researchers from the Netherlands wrote in the journal Science yesterday. The likelihood of those changes occurring naturally is difficult to estimate but there is “no fundamental hurdle to that happening,” said Derek Smith, a University of Cambridge researcher who led a second study.

Scientists have been monitoring for pandemic-inducing changes in H5N1 since the strain was recovered from a farmed goose in China’s southern province of Guangdong in 1996. The virus has since spread across Asia, Europe, the Middle East and parts of Africa, devastating poultry flocks and causing sporadic infections in people, among whom it doesn’t efficiently transmit.

“We now know that we’re living on a fault line,” Smith said on a conference call with reporters. “It’s an active fault line, it really could do something, and now what we need to know is, how likely is that?”

Publication of the paper was delayed after a U.S. biosecurity panel in December asked the scientists to censor some parts of their work to prevent it being used by bioterrorists. Researchers meeting at the World Health Organization in February agreed the full findings should be published to help scientists design vaccines and drugs, and public health officials prepare for a pandemic.

Vaccine Makers

Novartis AG (NOVN), Sanofi (SAN), GlaxoSmithKline Plc (GSK) and CSL Ltd. (CSL) make vaccines against H5N1 avian influenza.

More than 600 people have been infected with H5N1 since 2003, and almost 60 percent have died, according to the Geneva- based WHO. Most had direct contact with infected poultry, prompting scientists to question what it would take for the virus to become easily transmissible between humans.

While influenza viruses mutate constantly in a process called antigenic drift, the flu pandemics of the past century, including the 1918 Spanish flu that killed as many as 50 million people, have all been triggered by so-called antigenic shift, the mixing of human and animal flu viruses to create new pathogens to which people have no preexisting immunity.

Scientists led by Ron Fouchier at Erasmus Medical Center in Rotterdam set out to test whether H5N1 could become more transmissible by antigenic drift alone. The answer: yes.

Infected Ferrets

Fouchier and colleagues examined mutations in viruses responsible for previous flu pandemics, and made three such changes to a strain of H5N1 from Indonesia, the country with the most cases and deaths, which they used to infect a ferret. They later took swabs from its nose and throat and used that to infect another ferret, and so on up to 10 animals, to see how the virus evolved.

Sure enough, it developed the ability to replicate in the animals’ respiratory tract, suggesting the potential for airborne transmission.

The researchers then put the virus to the test by putting the infected animals next to healthy ferrets in neighboring cages. Six out of eight of the healthy ferrets became infected.

In addition to the three genetic changes introduced by the scientists, they identified two other mutations that enabled the virus to spread, the researchers wrote. Those mutations are now the subject of further research.

The five changes have all been observed in nature, but not in the same virus, they wrote. The mutant viruses were susceptible to Roche Holding AG (ROG)’s antiviral drug Tamiflu.

A similar study led by Yoshihiro Kawaoka at the University of Wisconsin at Madison, which was also delayed, was published in the journal Nature in May. That showed how H5N1 could become highly transmissible by mixing with the H1N1 virus that sparked the 2009 swine flu pandemic.

‘Wrong Hands’

The two groups agreed in December to suspend their work for 60 days after the U.S. National Science Advisory Board for Biosecurity asked two journals to censor some details of the work to ensure it wouldn’t “fall into the wrong hands.”

The controversy over the studies triggered a new U.S. government policy for conducting or funding research that could potentially be used for harm, Anthony S. Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases, and Francis S. Collins, the director of the U.S. National Institutes of Health, wrote in an accompanying article.

‘Nefarious Use’

The benefits of the research “far outweigh the risks of the nefarious use of this information,” Fauci said on the conference call. “Being in the free and open literature would make it much more easy to get a lot of the good guys involved than the risk of getting the rare bad guy involved.”

Other pathogens studied by scientists are more transmissible and deadlier than H5N1, Fouchier said.

“Anyone with access to the scientific literature can read about all the dangerous pathogens that are more interesting to terrorize the world with than our particular virus,” he said on the conference call.

A moratorium on the research will remain in place until the conditions under which the work is done are assessed by authorities, Fouchier said.

The research was funded by the National Institutes of Health.

Hospitals get back to normal as they call off swine flu emergency arrangements

Hospitals across Greater Manchester have called off emergency arrangements which saw them cancel thousands of operations to cope with swine flu.

Regional health bosses had asked hospitals to stop carrying out non-urgent surgery so they could double the intensive care capacity – to more than 200 beds.

The emergency arrangements which were brought in to cope after lots of people became seriously ill with complications from swine flu.

Some Greater Manchester hospitals will continue to cancel some operations until the end of this week.

Jane Cummings, chief nurse for the North West said: “The response of clinical teams, from GPs and primary care staff, to those working in hospitals and as part of our ambulance service has been amazing.

“This winter has been particularly tough and teams have been extremely flexible – putting in long hours, working in different areas and even different hospitals – to ensure that people who need emergency treatment get it.

“We plan for increases in activity every winter – but without the support and understanding of NHS staff, it wouldn’t work.”

NHS North West appealed to hospital bosses to cancel all non-urgent, non-life-threatening elective surgery, to make sure that hospitals had enough critical care beds to deal with a spike in the number of people being admitted with complications due to flu at the end of December.

Some cardiac treatment that requires specialist critical care are still on hold as hospitals across the region support the cardiac team at Wythenshawe Hospital, in south Manchester which are running a specialist ECMO service for swine flu patients.

Hospitals are continuing to monitor critical care admissions and will reopen extra beds if necessary.

Ms Cummings added: “I would also like to thank the public for their support and understanding at this difficult time.

“We will do all we can to ensure that those appointments that had to be postponed are re-scheduled as soon as possible.”

Swine flu mum still in coma after giving birth

A NEW mum is fighting for her life with swine flu – after being put in a coma to save her child before the birth.

Leanne Gunnell, 21, suffered brain damage after doctors took the decision to protect her unborn infant, which was then delivered prematurely by caesarean, weighing just 3lb.

The mother, who was six-and-a-half months pregnant, gave birth seven weeks ago but has still not come out of the coma.

Her parents are awaiting further tests and she might never she her child.

The tot is doing well but the mum’s family fear she will not recover and they may have to switch off her life-support.

Simon and Sharon Gunnell, from Robinswood, Gloucester, want to know why their daughter was not offered a swine flu jab despite being pregnant.

Mrs Gunnell, 43, said: “She was a fit and healthy young girl. She was pregnant and she was not offered a swine flu jab – that’s the most annoying thing.”

Her husband, 44, added: “I am not faulting the GP service but something went wrong.” At the end of November, hotel receptionist Leanne complained of being ill for several days with a cold.

Her GP told her she had a virus and she was given antibiotics but not tested for swine flu. A few days later she was rushed to hospital, coughing up blood amid fears of pneumonia.

Doctors at Gloucestershire Royal Hospital discovered her lungs had been so seriously damaged there was little chance of both her and the baby surviving. They said the best chance was to put her in a coma and deliver the baby at 28 weeks.

The baby – named Faith – is doing well but after Leanne deteriorated, her parents were told she had swine flu and brain damage.

NHS Gloucestershire said: “We’re sorry the patient concerned remains very poorly.”

3A GRAN who had an influenza jab just weeks ago has died of swine flu.

Eleanor Carruthers, 68, had the vaccination because she was seriously ill with emphysema and lung cancer but picked up the virus and died in Royal Liverpool Hospital.

Health bosses stressed the jab was still the best option for the vulnerable.

Latest figures show 112 people have died of flu in the UK since September according to the Government.

Of the deaths recorded, 95 have died of swine flu and another five had flu type B. A further 12 deaths have yet to have their flu type confirmed.

The latest figures come a day after Gemma Ameen, the mother of three-year-old victim Lana, urged the Government to reassess its vaccination policy.

“It’s heartless really. It definitely needs looking at again with another review.

“Rather than just taking facts and figures, they need to start thinking about people’s lives.It’s not about whether they thought Lana should have been eligible. Obviously she was because she died from it.

“I think all children should be vaccinated and anyone else who is prepared to pay for it.”

The Department of Health stuck by its decision insisting children who do not have risk factors are in no need to be vaccinated and added that independent expert advice was “absolutely clear”.

The advice had been reviewed recently and the Joint Committee on Vaccination and Immunisation did not change its recommendation, it added.

Recent shortage of the swine flu vaccine has raised alarm across the country as central Government tapped into its leftover stocks of last year’s Pandemrix swine flu vaccine for distribution.

Director of immunisation, Professor David Salisbury, said GPs could now get their hands on Pandemrix:”There really is no reason for anyone to be turned away on the basis that there is no vaccine available or not being sent out.”

Health trusts and GPs have placed orders for 200,500 doses of which 185,000 have already been dispatched.

Pharmacy giant Boots revealed its stores had “very limited” stocks of the winter flu jab, admitting there was currently no hope of replenishing its supplies.

15 more Swine Flu deaths reported in Wales

A FURTHER 15 flu-related deaths have been reported to the Assembly Government in the last week.

It brings the total number of flu deaths in Wales to 27 since October.

Officials said 49 people were in critical care in hospitals across the country, including 23 people aged 16 to 44; 19 aged 45 to 64; and seven over the age of 65.

Aneurin Bevan Health Board, which covers Gwent, said it had 12 patients with flu-like symptoms in critical care, the highest of any health board in Wales, while Betsi Cadwaladwr UHB closely followed with 11 patients in a critical condition.

Abertawe Bro Morgannwg and Cardiff and Vale each have nine patients in critical care; Cwm Taf in the Rhondda has five and Hywel Dda three.

It comes as figures released by Public Health Wales show a slight increase in the number of people contacting their GP with flu-like symptoms.

Last week there were 93 GP consultations for every 100,000 people living in Wales, up from 89.2 for the week ending January 2.

It was a slight increase on the week ending December 26, in which there were 92.1 consultations for every 100,000 people living in Wales.

The figures revealed the highest level of GP consultations was for people aged between 25 and 34, at a rate of 147 consultations per 100,000.

But experts believe the true number of people who have died as a result of flu this winter in Wales will be far higher.

Doctors in Wales this week began using stocks of the 2009 swine flu jab to vaccinate patients. It follows shortages of the seasonal flu vaccine in parts of Wales, including the nation’s largest hospital – the University Hospital of Wales in Cardiff.

Wales’ chief medical officer Dr Tony Jewell defended the decision to stock fewer seasonal flu vaccines for the 2010 flu season.

He said: “Whilst we have been working to make stocks of the vaccine that was developed against swine flu available to be used where supplies of seasonal flu vaccine have run low, we are now well into the flu season.

“People in at-risk groups are at a higher risk of complications from seasonal flu, and the best protection is early vaccination.

“A press and publicity campaign has been running since October and has included television, radio and bus adverts to let people know if they are in an at-risk group, and that the vaccine is available free of charge to those groups from GPs.

“We have also encouraged health boards and GPs to ensure that their patients and front line NHS staff are vaccinated against seasonal flu.”

He added: “Despite the slight increase in the clinical consultation rate for influenza this week compared to the previous week, the rate of consultations for flu-like illness in Wales still remains within the levels of normal seasonal flu activity.

“Most healthy people will recover from flu-like illnesses within five to seven days with plenty of rest and drinking non-alcoholic fluids.”

A spokesman for Hywel Dda LHB said hospitals throughout the area were operating “at a very high capacity” due to the double-impact of higher levels of suspected seasonal and swine flu cases and increased numbers of general admissions.

As of yesterday, 13 patients with flu-like symptoms were being treated at Withybush General Hospital in Haverfordwest; five at Bronglais in Aberystwyth; one in Prince Philip Hospital in Llanelli and another at Glangwili General Hospital in Carmarthen.

Three of the patients were in intensive care.

Ten deaths in East Yorkshire swine flu outbreak

The number of people with swine flu who have died in East Yorkshire so far this winter has risen to 10.

Hull and East Yorkshire Hospitals NHS Trust said nine of the 10 people had other underlying health problems.

One had no previous health issues and swine flu was said to have been a contributory factor in their death.

Five of those who died were men and five were women. No children were among the dead, the trust added. New national figures are to be released later.

The latest number of deaths in England, Wales and Scotland this winter from flu verified by the Health Protection Agency (HPA) was 50, with 45 of these due to swine flu. It can take time for deaths reported by local trusts to be verified and added to the national figures.

Operations cancelledThe East Yorkshire figures are for deaths at Hull Royal Infirmary and Castle Hill Hospital in Cottingham. They do not include hospitals in Goole and Beverley.

More than 200 people have so far been admitted to the hospitals with suspected swine flu since 1 December, with 84 cases confirmed.

The outbreak has meant the trust has been forced to cancel some major operations to keep intensive care beds free.

In December, 168 operations were postponed and up to Tuesday, 50 operations had been postponed in January.

The trust carries out about 7,100 planned operations each month, which includes major surgery.

Call for clarity on swine flu death figures

Island relies on H1N1 vaccine until new flu jabs arrive

It could be weeks before the Isle of Man receives an all-important delivery of seasonal flu vaccination.

In the meantime the government is relying on stocks of the old swine flu vaccine, 3000 doses of this were released last week.

But Health bosses insist there is no vaccine shortage on the island yet.

Dr Parameswaran Kishore from Public Health said: “We might not get new supplies in time so we’re using the swine flu vaccine to fill the gaps.”

Shelf life

Health officials have taken the action in the light of news across the British Isles which indicates that flu deaths figures have risen to more than 50.

Some island pharmacies have now run out of the seasonal flu vaccine.

Dr Kishore added: “There is a mis-match between supply and demand in some areas at the moment. Some places have it, others don’t- but there’s not an island-wide shortage. “The problem is that there may not be anymore vaccine coming for the next few weeks.”

The vaccine, know as Pandemrix, was stockpiled in 2009 but has a shelf life until the end of 2011.

Pregnant women

It only protects against the swine flu strain, just one of three circulating this winter, but as swine flu is the dominant strain in circulation the government has said it is the best option available.

“The vaccine is particularly appropriate for pregnant women since their increased risk of complication is confined to the H1N1 virus and Pandmrix also provides protection for the newborn,” said Dr Kishore.

The remaining doses of the seasonal flu vaccine will continue to be available to the over 65s and other high risk groups.

This kind of scare over vaccine shortages is unheard of, as GPs initially struggled to persuade people to get the jab at all.

Surge in demand

Back in October we were telling people who were in the risk categories to make an appointment to get the vaccine,” continued Dr Kishore.

Cameron admits to swine flu vaccine shortages and says we may see ‘significant outbreaks for years to come’

David Cameron was yesterday forced to deny that spending cuts had made Britain vulnerable to swine flu as he warned that the country faced ‘significant outbreaks’ of flu for years to come.

But the Prime Minister said lessons must be learned from the vaccine shortages that have seen GP surgeries turning away vulnerable people seeking the flu shot in recent days.

His comments came as Labour accused the Coalition of putting pregnant women at risk by failing to promote the flu jab.

The official death toll from the flu outbreak since October has now risen to 50. Most were victims of swine flu, the dominant strain of influenza in circulation.

The latest Department of Health figures show that more people are going to their GPs in England and Wales with winter flu symptoms than at any time since the epidemic of 1999-2000 in which 20,000 died.

This winter’s outbreak is still below epidemic levels and is not as serious as the 2009 summer outbreak, when 500 people died.

However, doctors are concerned because the swine flu strain is hitting the youngest hardest.

In a normal flu season, the elderly suffer most from infection but this winter around 90 per cent of patients being treated are under 65.

Last week the Government announced it was being forced to raid last year’s stocks of the swine flu jab to plug shortages in the vaccination programme.

The old vaccine only protects against one of the three strains in circulation.

Mr Cameron – who revealed that he had not had a jab this year – denied the shortages were caused by spending cuts and insisted that the Government had followed expert advice throughout.

‘Doctors did order something like 14 million doses of vaccine. Because of very heavy usage there are some shortages in some places,’ he told BBC Radio 5 Live. It is very important that we learn the lessons from this.

‘One of the lessons is that it looks likely that, because of the prevalence of swine flu and other strains, we might have quite significant outbreaks in future years and we need to look at the way we order vaccinations and whether more needs to be done.’

He went on: ‘This is nothing to do with cuts. The NHS is not having cuts.’

Out of the 50 people who have died from flu since October, 69 per cent were in an ‘at risk’ group. At risk groups include pregnant women, the elderly and those with weakened immune systems.

Labour yesterday renewed its attack on the Coalition’s handling of the outbreak.

Shadow Health Secretary John Healey questioned why the Government was refusing to publish figures on the number of deaths among pregnant women.

In a letter to Andrew Lansley, the Secretary of State for Health, he said there was ‘no justification’ for not letting the public have information about pregnant women.

He added: ‘This is the first year in which it was decided to classify pregnant women among the at risk groups and offer them the projection of a free flu jab.

‘When did you not ensure more effort was made early to reassure women that the vaccine is safe and important for them to receive?

‘Why did you axe the annual autumn advertising campaign to help inform the public about flu risk and boost take up of the vaccine, including among women who are pregnant?’

Around 600 people die from seasonal flu in a typical year. In an epidemic year the death toll rises to around 13,000.

Last year at least 12 of the victims of swine flu were pregnant women.

Ministers will carry out a review later this year into whether vaccines should be ordered centrally, rather than by GP surgeries.

There is no vaccine shortage in Scotland where supplies are bought in by pharmacies and distributed among practices.

Fears over mutating swine flu virus that could render vaccine useless

A research team has hurriedly been re-formed to investigate whether the swine flu virus has started to mutate in a way that will render the vaccine ineffective.

Senior Government scientists have already discovered slight genetic mutations in the H1N1 virus.

They are checking whether this is causing some people to be more severely affected, although there is no evidence at this stage to suggest the changes would stop the vaccine working or prevent the anti-viral drug Tamiflu from being effective.

So far, 45 people are known to have died from swine flu since October.

The team, based at Imperial College London, are testing the DNA samples of hundreds of swine flu victims.

Professor Peter Openshaw, director of the Centre for Respiratory Infection at Imperial, said: ‘We have paid particular attention to whether the mutations are affecting how well the vaccine works and whether the slight mutations have led to it becoming more severe.’

The study, known as MOSAIC, was set up in 2009 to monitor the virus during the pandemic, but it was swiftly re-assembled last month with the latest outbreak.

Asthma specialist nurse Katy Odeadra, who works in the Chest and Allergy Clinic at St Mary’s Hospital, said: ‘All the talk among doctors and nurses dealing with swine flu cases is of a mutated form of the virus.’

The Health Protection Agency said yesterday: ‘The vaccine still works.’