Oct 16, 2009 (CIDRAP News) – The susceptibility of some young, healthy people to severe illness with pandemic H1N1 influenza marks a striking difference from the pattern of disease seen in seasonal flu epidemics, the World Health Organization (WHO) said today.The factors that increase the risk of severe illness in previously healthy people remain unknown, the WHO said in reporting on the results of a 3-day conference on the features of severe H1N1 cases. The meeting involved about 100 clinicians, virologists, and other experts at the Pan American Health Organization headquarters in Washington, DC.The ability of the virus to make young, healthy people dangerously sick has been noted for months, but the WHO put new emphasis on the phenomenon today. At the same time, the agency said pregnant women, children younger than 2 years, and people with chronic lung disease face the greatest risk of severe illness.In a statement, the WHO said the experts confirmed that the vast majority of patients around the world experience an uncomplicated flu-like illness and recover within a week, even without treatment.Patients hard to treat But concern now focuses on “small subsets of patients who rapidly develop very severe progressive pneumonia,” the agency said. “In these patients, severe pneumonia is often associated with failure of other organs, or marked worsening of underlying asthma or chronic obstructive airway disease.”These patients are hard to treat, which suggests that emergency rooms and intensive care units will bear the heaviest burden during the pandemic, the statement said. That conclusion matched the message from several medical journal reports published in the past week on hospitalized H1N1 cases.Primary viral pneumonia is the most common finding in severe cases and often causes death, the WHO said. However, bacterial infections have been found in about 30% of fatal cases—more common than previously recognized.Data from animal studies also show the virus’s ability to cause severe pneumonia. “This virus really likes the lower respiratory tract,” said the WHO’s Dr.Nikki Shindo at a press teleconference today. “That means this virus is likely to cause viral pneumonia.”Physicians who have managed severe cases “agreed that the clinical picture in severe cases is strikingly different from the disease pattern seen during epidemics of seasonal influenza,” the WHO statement said. “While people with certain underlying medical conditions, including pregnancy, are known to be at increased risk, many severe cases occur in previously healthy young people. In these patients, predisposing factors that increase the risk of severe illness are not presently understood, though research is under way.”In a separate pandemic update today, the WHO noted that about a third of intensive care unit patients with H1N1 in Australia and New Zealand had no predisposing conditions. Likewise, Canadian and Mexican researchers who recently reported on severe cases were “impressed” by the number that occurred in previously healthy people, the agency said.The latest US figures suggest that an even higher proportion of patients hit hardest by the virus were previously healthy. The Centers for Disease Control and Prevention reported this week that 45% of about 1,400 adult H1N1 patients who were hospitalized had no preexisting health problems.In severe cases, patients usually begin deteriorating about 3 to 5 days after their first symptoms, the WHO statement said. Many of them then slip into respiratory failure, requiring admission to an ICU and ventilatory support. Some patients don’t respond well to conventional ventilatory support, making treatment even harder.Known at-risk groupsOf groups with conditions that raise the risk of severe illness, conference participants agreed that three lead the list: pregnant women, especially in the third trimester; children under the age of 2 years, and people with chronic lung disease, including asthma, the WHO reported.Disadvantaged populations, such as minority groups and indigenous people, also are disproportionately subject to severe disease, the WHO said. The reasons are not clear, but possibilities include lack of access to care and an increased prevalence of conditions like asthma and diabetes.The statement also noted that obesity—especially morbid obesity—has been present in many of the severe H1N1 cases, but its role remains poorly understood.More support for antiviralsOn the brighter side, the meeting pointed up a growing body of evidence that prompt treatment with the antiviral drugs oseltamivir and zanamivir is helpful, the WHO said.”We have increased evidence that timely antiviral treatment really helps to decrease the severe disease,” said Shindo at the press conference.Where the virus is circulating, clinicians should base antiviral treatment decisions on epidemiologic and clinical findings and not wait for lab test results, she said. “The message for clinicians is, don’t miss this opportunity for early treatment.”Shindo said the WHO has shipped antivirals from its stockpile to 72 countries so far.See also: Oct 16 WHO report on clinical consultationhttp://www.who.int/csr/disease/swineflu/notes/h1n1_clinical_features_20091016/en/index.htmlOct 16 WHO weekly update on pandemichttp://www.who.int/csr/don/2009_10_16/en/index.htmlAug 28 WHO briefing note on lessons from recent outbreakshttp://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html
DES MOINES — The Iowa Attorney General’s Office is appealing the district court ruling that threw out Iowa’s Ag Protection Fraud Law, the so-called “ag gag” law.Drew Mogler, public policy director for the Iowa Pork Producers Association, says his organization thinks the state has an excellent argument to protect farmers from imposters and intruders from animal rights groups. “When we look at some of the pressures our industry is facing with foreign animal diseases in other countries,” Mogler says, “I think we’re all aware of the issue of African swine fever moving around lots of countries in Asia, biosecurity and protecting biosecurity in this state is definitely in the state’s interest.”Mogler says the state’s livestock producers need to be shielded from activists’ attacks, including the use of undercover videos on farms and ranches. “This law is designed to protect farmers from folks who are really driving an agenda to end meat production and meat consumption in this state and in this country,” Mogler says. “Farmers deserve that protection because they’re caring for their animals each and every day.”Mogler says if the court of appeals rules in favor of the state, then the ag-gag law will be reinstated. “If this appeal gets overturned in the Eighth Circuit, then the Ag Protection Fraud Law is back on the books here in the state of Iowa,” he says, “and producers will have protection under that statute.”Mogler says those who challenged the Iowa law originally claimed it was a violation of free speech rights, but he says that wasn’t the intention of the law, as it aimed to protect ag operations.