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[QUOTE]Originally posted by raybond: [QB] By David Templeton / Pittsburgh Post Gazette Severity of the upcoming influenza season could hinge on our old acquaintance H1N1, the virulent strain that caused 13,000 deaths during the 2009 pandemic and has made an appearance each flu season since then. Many people have developed some immunity to that strain, but if it mutates into a more contagious, deadly strain, another pandemic is possible, health officials say. Rick Zimmerman, a professor in the University of Pittsburgh department of family medicine, said the big question this year is, “Did H1N1 change?” There’s no proof of it yet, “but if it is proven that it has changed — and that’s the pandemic H1N1 virus of 2009 — we might have real concern about a flu outbreak,” he said. “I’m anxious to see what happens.” Health officials and the U.S. Centers for Disease Control and Prevention are recommending people get immunized as soon as vaccines are available and by October at the latest to reduce infection risk. Some drug stores already are advertising they have the vaccine. The CDC recommends the live attenuated nasal spray vaccine for children ages 2 to 8 and the quadrivalent injected vaccine for everyone older. Some health officials, however, are recommending the high-dose trivalent vaccine for people 65 and older, on claims that it’s more effective for that age group, although CDC doesn’t currently recommend it, said Amesh A. Adalja of the UPMC Center for Health Security and member of the public health committee of the Infectious Disease Society. He presented a lecture to doctors last week at UPMC Shadyside on the flu, treatments and trends to doctors. This year the vaccine is identical to last year’s with a focus on H1N1 and a less virulent but ever persistent H3N2 strain, along with the two B-strains of Yamagata and Victoria lineages, but a mutated version of H1N1 is what health officials say they fear most because of the risk of another pandemic, with ultimate concern that the virus returns to the H1N1 strain that caused 675,000 American deaths in 1918. Consider that the national population then barely topped 103 million, which means one of every 153 people died, mostly from secondary pneumonia and other complications, Dr. Adalja said. Flu strains routinely mutate, with some mutations leading to more virulent strains. “Everyone is worried about H1N1 that started in 2009,” said Kelly Stefano Cole, a University of Pittsburgh associate professor of immunology and co-manager of Regional Biocontainment Laboratory in the Pitt Center for Vaccine Research. “As it passes through people, it changes, and that’s the history of the flu. The changes make it more resistant to the vaccine, and it only takes one change for it be recognized as a new strain that can be more transmissible and pathogenic.” Another concern is the avian (bird) strain, H7N9, which first appeared in March 2013 in China. Of 132 cases, 37 people died. Most had chronic health conditions, but it represented a 28 percent death rate. For now, the World Health Organization reports, H7N9 is transmitted mostly from birds to humans who raise and handle chickens or other fowl. Should it develop a better means of transmission, from human to human, a health crisis would emerge. Flu-season predictions rarely are accurate, Dr. Zimmerman said. Clues to what might occur are limited to flu strains now existing in the Southern Hemisphere, where winter and the flu season are winding down, and flu strains in Asia. Health officials south of the equator “are seeing a very severe flu season,” Dr. Adalja said. Last week, he advised physicians to prescribe more readily the antiviral medication, Tamiflu, especially for pregnant women, who have a significantly greater death rate from flu infections. He also said physicians should prescribe Tamiflu even if the patient has had symptoms beyond the cutoff point of 48 hours. “You should give the antiviral medication no matter how long out the patient is, and not just limit it to the first 48 hours,” he said. Dr. Adalja also said a person becomes contagious one day before symptoms appear, which helps explain why the flu is readily transmitted person to person. David Templeton: firstname.lastname@example.org or 412-263-1578. [/QB][/QUOTE]
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