Update on the Transmission Dynamics of the H1N1 pandemic

Researchers from the MRC Centre have contributed to a recent publication in WHO’s weekly epidemiologic record. Follow the link below to this publication describing the transmission dynamics of the pandemic (http://www.who.int/wer/2009/wer8446.pdf).

While you’re at it, check out an earlier publication of the WER by the WHO informal mathematical modelling network for pandemic influenza (lead by researchers at the MRC Centre), which provides a summary of the network’s activities (http://www.who.int/wer/2009/wer8434.pdf).

Contributed by: Dr. Maria Van Kerkhove (MRC Outbreak Centre WHO liaison)

New York Doctor Raps about H1N1 Prevention

Earlier this summer, the US Health and Human Services Secretary, Kathleen Sebelius, challenged Americans to come up with short videos on the subject of good hygiene and prevention of the H1N1 flu virus.

The winner, New York doctor (and amateur rap artist) John Clarke, was presented $2500 and will star in a national ad campaign for H1N1 prevention.

Click here to see Dr. John's video and those of a few runners up.
http://www.flu.gov/psa/contest/2009/index.html

I think 'Bagman' is my favourite.

A New Way to Access the Latest Flu Research - Plug In!

In a new venture, the Public Library of Science (or PLoS) has started a feature called 'PLoS Currents'. A clever play on both the flow of information and it's immediate relevance, 'Currents' allows researchers to post their most recent work on-line thereby stimulating scientific discourse as well as disseminating potentially useful information to both scientists and interested members of the general public.
The 'Currents' are moderated by a panel of experts from the relevant field to ensure the integrity of the work and general decorum in the resulting discussion.
In the first issue of 'PLoS Currents - Influenza', centre researchers led by Dr. Francois Balloux report their findings on the spatiotemporal dynamics evidenced in the early stages of the 2009 A/H1N1 influenza pandemic.

Follow this link to check it out:
http://knol.google.com/k/thibaut-jombart/spatiotemporal-dynamics-in-the-early/11igg07td5uji/1?collectionId=28qm4w0q65e4w.1&position=1#

Imperial College Researchers Weigh In on Swine Flu

Follow the link below to see a great resource for following Imperial College researchers, many from the MRC Outbreak Centre, as they contribute their knowledge of and research on the A(H1N1) pandemic.

http://www3.imperial.ac.uk/media/influenza

Move over swine flu...

...The Zombies are coming!!

Follow the links below to learn how Centre Director, Prof. Neil Ferguson came to comment on the relationship between Infectious Disease modelling and a Zombie attack!!

The Times:

http://timesonline.typepad.com/science/2009/08/when-zombies-attack-science-meets-shaun-of-the-dead.html

BBC Radio 4, Today Programme

http://news.bbc.co.uk/today/hi/today/newsid_8206000/8206612.stm

Let it not be said that we're always serious!

watchful waiting

Apologies for the lack of updates recently. My thinking was that it made little sense to keep reporting increasing case numbers when they may or may not accurately illustrate the true picture of A(H1N1) spread but this caught my eye today and seemed worthy of a mention.

In Argentina there are 60 deaths in 2485 cases (34 deaths and 898 cases reported since friday 3 July) and in Chile there are 14 deaths in 7376 cases.

http://www.who.int/csr/don/2009_07_06/en/index.html

There are lots of reasons why this could be, remember it's winter in the Southern Hemisphere and there will be other respiratory pathogens co-circulating. Also, at this point I am unaware of how the cases are identified and processed.

However, this is something to watch for sure...

WHO Moves to Pandemic Alert Level 6

Following a meeting of the WHO Emergency Committee this morning, the decision was taken to raise the Pandemic Alert level to level 6 for the first time in 41 years.

Director General, Margaret Chan, explained that Influenza A(H1N1) is significantly different from seasonal flu in that it preferentially infects people with a mean age <25 years. Two percent of cases result in severe illness and a progression to pneumonia. These cases tend to be adults between 30-50 years of age. One-third to one-half of cases occur in previously healthy people though, some underlying health conditions do present additional risk (e.g. respiratory diseases, cardiovascular disease, autoimmune disorders, diabetes and obesity).

Dr. Chan said the move to level 6 does not indicate an increase in severity, but rather reflects sustained transmission (not simply due to travel related cases) globally and the need for countries to activate their pandemic plans. She cautioned that we need to be vigilant in tracking the virus in the developing world where differences in surveillance, underlying health conditions and available medical care may mean the virus will take a trajectory different to that we have witnessed thus far. At this time, the WHO is not recommending any travel restrictions or border closures.

A link to Dr. Chan's statement: http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html

With 25 new cases confirmed today, the UK case count now totals 822. England - 502, Scotland - 311, Northern Ireland - 7, Wales - 2

UK Case Count Continues to Climb

My skill with alliterative post titles aside, the A(H1N1) case count is continuing to climb steadily here in the UK. Specifically, there are now 750 confirmed cases with a further 607 possible cases currently under investigation. According to the HPA confirmed case numbers, that is 264 new cases in 5 days (see our post from Friday, 5 June).
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1244617876260?p=1231252394302
5 schools are closed in England and a further 5 are closed in Scotland.
http://news.bbc.co.uk/2/hi/uk_news/8093665.stm

Australian Four-Fold Increase May Tip WHO Pandemic Balance

In the last week, Australia has seen a four-fold increase in cases of A(H1N1) influenza (greater than 1200 confirmed cases). Taken together with the number of cases in North America, the WHO are seriously considering a move to level 6 in their Pandemic Alert system. (http://www.who.int/csr/disease/avian_influenza/phase/en/index.html)
The Southern Hemisphere is currently experiencing it's Autumn/Winter 'flu season' and the Australian cases are largely concentrated in Victoria and Melbourne.
The WHO will hold a conference call with governments tomorrow before deciding whether or not to change the pandemic alert level.
http://news.bbc.co.uk/2/hi/asia-pacific/8092474.stm

Hospitals Missing True Extent of Swine Flu

Speaking at the Cheltenham Science Festival last Friday, Centre Director Neil Ferguson told the audience of his concern that the true extent of Influenza A(H1N1) was being missed due to current surveillance strategies. He suggested that the UK would benefit from a shift to testing young adults hospitalised with respiratory disease. This is currently the surveillance model employed in the US where the outbreak is more advanced.
Read the article in The Times summarising Prof. Ferguson's talk here:
http://www.timesonline.co.uk/tol/life_and_style/health/article6450267.ece
And further commentary on the point of underestimation by Professor Hugh Pennington of Aberdeen University in Scotland:
http://news.bbc.co.uk/1/hi/uk/8087213.stm

A(H1N1) gets a foothold in Scotland

A last minute update from the BBC...
http://news.bbc.co.uk/1/hi/scotland/8086128.stm
Scottish confirmed case number reaches 41, including 2 doctors at the Royal Alexandra Hospital in Paisley.

UK Confirmed A(H1N1) Case Count Nears 500

According the the HPA , the total number of confirmed Influenza A(H1N1) cases in the UK has risen to 486 with 27 new cases recorded today.
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1244188831739?p=1231252394302

The CDC in Atlanta reported a total of 13,217 probable and confirmed cases and 27 deaths in 52 states (including the District of Columbia and Puerto Rico). Puerto Rico is newly mentioned as there is now 1 confirmed case there.
http://www.cdc.gov/h1n1flu/update.htm
These figures are are up sharply from Monday's estimate with 3,164 new probable and confirmed cases and 10 additional deaths.

Globally, the situation looks like this:
http://www.who.int/csr/don/Map_20090605_1000.png
According to the WHO, the cumulative total of global confirmed cases is 21, 940 with 125 deaths.
http://www.who.int/csr/don/2009_06_05/en/index.html

And finally, my mother would like you all to to know that in my hometown of Livingston, New Jersey, USA, there are 6 confirmed cases of A(H1N1). Three are 16 year old males, 1 is a 12 year old female and 1 is a 46 year old male. Thanks Mom!

Centre Researchers Publish Paper in New England Journal of Medicine

In collaboration with Mark Lipsitch (Harvard Unniversity) and Steven Riley (Univ. of Hong Kong) Centre researchers Neil Ferguson (Director), Azra Ghani and Simon Cauchemez were co-authors on a paper published last week (27 May 09) in the New England Journal of Medicine.
http://content.nejm.org/cgi/content/full/NEJMp0904380
The paper focuses on the the early stages of an influenza pandemic and the challege of balancing the need for answers to guide action with the paucity of data available to inform such decisions. The need for and benefits of international cooperation and collaboration are highlighted.
Nice work, guys!

Swine Flu Spreads Amongst Football Fans

Thirteen new cases (11 from the Dunoon area of Scotland) of A(H1N1) were found amongst Scottish Premier League fans who travelled to Dundee on the 24th of May to watch Glasgow Rangers win the league title. A further 19 cases were confirmed in England and Scotland yesterday taking the UK total to 278.
http://news.bbc.co.uk/1/hi/uk/8077784.stm

As of 11am yesterday (EST), the CDC in Atlanta reported 10,053 confirmed and probable cases and 17 deaths in 51 U.S. states (including the district of Columbia).
http://www.cdc.gov/h1n1flu/update.htm

Confirmed A(H1N1) cases in Australia jumped markedly over the weekend, passing the 400 mark. Oz is now ranked fourth behind the US, Canada, and Mexico in the Swine Flu league table!
http://www.google.com/hostednews/afp/article/ALeqM5iJvQQux5LC30ih-2yfWqikG8iKFg

Confirmed cases of A(H1N1) rise to 705 in Asia-Pacific
http://news.xinhuanet.com/english/2009-06/01/content_11471304.htm

Case Count Rises in Britain

Yesterday, 15 new cases of Influenza A(H1N1) were reported in the UK by the HPA bringing the UK total to 244 cases.

http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1243771211786?p=1231252394302

14 of the new cases are in England and 1 is in Wales.
Two children and 1 adult from the West Midlands are among the new cases and were linked to previous outbreaks.
Of the 8 new cases confirmed in the South East, 6 are travel related and 2 are linked to an on-going school outbreak.

Artesunate Resistant Malaria in Cambodia

Malaria parasites in patients from a small village in western Cambodia are responding more slowly than usual to treatment with Artesunate. Indeed, some patients (33-50% in one clinical trial) still have circulating parasites 4-5 days post treatment when clearance normally occurs in 2-3 days.
http://news.bbc.co.uk/1/hi/world/asia-pacific/8072742.stm

Listen here to a report this morning on the BBC radio 4 'Today' programme.
http://news.bbc.co.uk/today/hi/today/newsid_8073000/8073222.stm
Prof Brian Greenwood from the LSHTM provides commentary after the report.

Swine Flu Closes Eton!

In addition to an increase in the number of confirmed cases in the Birmingham school cluster (Handsworth) to 64, Eton College has taken the decision to remain closed for an additional week beyond the half-term break after a student was diagnosed with A(H1N1).
http://news.bbc.co.uk/1/hi/uk/8072679.stm

The UK case total now stands at 203
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1243467936876?p=1231252394302

A(H1N1) is also now spreading in the Philippines with 10 confirmed cases. These cases include a cluster of individuals who attended a wedding in Zambales last weekend.
http://www.philstar.com/Article.aspx?articleId=472370&publicationSubCategoryId=63

Worldwide, there have been 95 deaths and an estimated 13,450 cases.

GOOD NEWS:
The good news is that the development of an A(H1N1) vaccine is moving forward. Researchers at the NIBSC have successfully produced a hybrid virus (cross between a disease causing H1N1 strain and a tested lab strain) that will hopefully produce a protective immune reponse in vaccinees without causing disease. This is a crucial step in the production of a safe and effective vaccine.
http://news.bbc.co.uk/1/hi/health/8071758.stm

Update: 44 Cases in Birmingham Primary School

Influenza A(H1N1) work continues apace here in the Centre with staff working collaboratively at the WHO, CDC and HPA.
The HPA have just reported a cluster of 44 cases in a Birmingham primary school, bringing the current UK case count to 184.

Here are some links to the latest reports:
http://news.bbc.co.uk/1/hi/uk/8068054.stm
http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1240732817665?p=1240732817665
http://www.who.int/csr/don/2009_05_26/en/index.html

Science Paper!

As part of the 'WHO Rapid Pandemic Assessment Collaboration', members of the MRC Outbreak Centre have published a paper entitled, 'Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings'. The paper was published on-line yesterday via Science Express.

http://www.sciencemag.org/cgi/content/abstract/1176062v1

Not surprisingly, there has been a great deal of interest from the Press.
Here are some links:

http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_12-5-2009-11-1-24?newsid=66374

http://news.bbc.co.uk/2/hi/health/8045364.stm

http://www.newscientist.com/article/dn17109-first-analysis-of-swine-flu-spread-supports-pandemic-plan.html

http://www.guardian.co.uk/world/2009/may/12/swine-flu-report-pandemic-predicted

http://news.bbc.co.uk/1/hi/health/8044299.stm

Radio:
http://news.bbc.co.uk/today/hi/default.stm (interview with Prof. Neil Ferguson begins 1hr 13min in)

Crunching Numbers

Morning all!
Here are some numbers for today...

Mexico - 1112 confirmed cases, 42 deaths
US - 642 confirmed cases, 2 deaths, in 41 states,
UK - 32 confirmed cases, 390 under laboratory investigation, 5 schools closed

The US Health and Human Services Secretary, Kathleen Sebelius recommends that schools no longer need to close when a case of swine flu is confirmed in a school. Sick students should be kept at home for 7 days but 'the schools should feel comfortable about opening'

Links to daily updated H1N1 case maps:

http://www.nytimes.com/interactive/2009/04/27/us/20090427-flu-update-graphic.html
http://news.bbc.co.uk/2/hi/americas/8021547.stm

(sources: Secretaria de Salud (Mexico), WHO, CDC and news sites)

MRC Centre at the Forefront:

The last 10 days have seen Centre and DIDE staff and students put in an amazing effort to help collate often sketchy data on the unfolding outbreak, undertaking vital early analyses, and work with key collaborators in the UK and around the world assisting them as they manage their response to the epidemic. I have been incredibly pround to be part of this effort - I can categorically say that no other University research group has had a larger impact on how this epidemic has been and continues to be investigated and managed around the world.

I thought it might therefore be useful to emphasise that (regardless of what the media may report), this pandemic has barely started, that there remain huge uncertainties about its potential impact (in terms of morbidity and mortality) and the time scale this will occur over. We will need to remain closely engaged with public health bodies around the world for weeks and months ahead, quite possibly to the end of the year - and this will include having staff located in Geneva and Atlanta.

A big thank you to everyone for their good nature and forebearance during this period!

Centre Folks in the Media

In the last 10 days, Centre researchers have engaged with the media to help raise public awareness and understanding of the outbreak:

Sky News - Dr. Christophe Fraser and Prof Azra Ghani
BBC TV- Prof. Azra Ghani
BBC Radio 4: Centre Director Neil Ferguson and Prof. Christl Donnelly

The links to these interviews are ephemoral, so not presented here, but I will add links to new press info as and when.

Swine Flu Outbreak

Members of the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, led by Centre Director Professor Neil Ferguson, are closely monitoring the current swine-flu outbreak and recognize the potential for a pandemic situation. At this time there are too many unknowns to make robust predictions about the trajectory of the outbreak and as such, Centre efforts are focused on modeling and planning for a wide range of possible scenarios. We are in consultation with global authorities to assist with the refinement of planning and updates in policy as more evidence becomes available.

Welcome!

Welcome the MRC Outbreak Centre Blog!

Follow our posts for the latest news about outbreaks and epidemics around the world.

A little about us:

It is the mission of the Centre to be an international resource and centre of excellence for research on the epidemiological analysis and modelling of novel infectious disease outbreaks.
SARS and H5N1 avian influenza have highlighted the need of the world to improve its readiness for new epidemics. The centre will build upon a world-leading research group in the Department of Infectious Disease Epidemiology at Imperial College to undertake applied collaborative work with national and international agencies in support of policy planning and response operations against emerging infectious disease threats.
Based at Imperial College London, the Centre also involves staff at the UK Health Protection Agency. Centre researchers are world leaders in epidemic modelling and have extensive experience of advising governments and international agencies on the control of a wide range of diseases, including influenza, SARS, polio, HIV, BSE and foot-and-mouth disease. The centre will build on this experience and provide the infrastructure to establish long-term relationships with public health bodies around the world.