Worst Flu Season in at Least a Decade

Decades Worst Flu Marches on Europe After Virus Hits Ireland
Email | Print | A A A

By Jason Gale

Jan. 15 (Bloomberg) -- Dublins Wexford Street pharmacy cant keep shelves 
stocked with fever remedies and cough drops this week as snuffling 
customers seek relief from Irelands worst flu season in almost a decade.

The virus, which hit Ireland and Portugal a month ago, is on an eastward 
march across Europe, leaving a wake of crowded emergency rooms and absent 
workers. In Ireland, the rate of flu- like illness is the highest since 
2001, and the season is only midway. In Lisbon, Health Minister Ana Jorge 
asked the military last week to provide additional beds for flu patients.

The epidemic is now hitting France, Germany and Scandinavia, according to 
the European Centre for Disease Prevention and Control in Stockholm. 
Laboratories reported a 10- fold jump in flu cases in Sweden since the end 
of 2008 and a government agency says it may be one of the worst seasons of 
this century. It is being driven by a variant of a strain known as H3N2 
that surfaced in Brisbane, Australia in 2007.

Our alarm detection system said that influenza had a grip on the whole 
country by mid-December, said Annika Linde, head of epidemiology at the 
Swedish Institute for Infectious Disease Control in Solna. In the first 
week of 2009, we had an explosion.

At a time when scientists can tailor drugs to match a patients genetic 
profile and people live longer than ever, the flu, first described by 
Hippocrates 2,400 years ago, still has the power to make millions 
bed-bound for a week and kill the very young, the elderly and those 
weakened by chronic disease.

Hong Kong Flu

The H3N2 strain first appeared in 1968 with the Hong Kong flu that killed 
an estimated 1 million people. Four decades later, H3N2 reigns as the 
major and most troublesome influenza in humans, New York Medical College 
researcher Edwin D. Kilbourne wrote in a 2006 study of pandemics.

For many Europeans, it will be their first encounter with the new Brisbane 
variant, so they will have no natural immunity, said Angus Nicoll, ECDC 
influenza coordinator in Stockholm. While those who get a flu shot will be 
protected, Europes typically low inoculation rates will increase the 
amount of illness.

This will be an important season to watch, Nicoll said.

Ross Ardill, a general practitioner in Dublins financial district, said he 
and his five colleagues are treating about 20 flu patients a day, up from 
two or three in a normal season.

More patients are showing up at hospitals with respiratory problems such 
as pneumonia, said Gerard Sheehan, an infectious diseases specialist at 
Dublins Mater Misericordiae University Hospital. The Irish Nurses 
Organisation said there were 435 patients on trolleys in hospital 
emergency departments across the country on Jan. 13, the most in almost 
three years.

Rising Rates

The Health Protection Surveillance Centre in Dublin says the rate of 
influenza-like illness in Ireland climbed to 120.5 cases per 100,000 
people in the second week of the year, from 72.8 per 100,000 at the end of 
December.

Were only seeing the tip of the iceberg, said Ronan Boland, 45, a doctor 
in Cork, Irelands second-largest city, and chairman of the Irish Medical 
Organisations general practitioner group.

In Europe, flu typically starts in Ireland and Portugal and moves 
eastward, according to a 2007 study in the online journal BMC Infectious 
Diseases, which noted population, geographical and climate factors, 
including wind direction, may drive early epidemic activity.

Coughs and Sneezes

The virus travels in the fine spray of the coughs and sneezes of infected 
people. A single sneeze can eject thousands of flu particles. Once inside 
the airways, the virus attacks the cells that line the respiratory tract, 
potentially breaching the airways protective barrier and leading to 
complications such as pneumonia. The body reacts by raising its 
temperature and producing mucus to fight the infection.

The three main flu strains -- H3N2, H1N1 and type-B -- cause 250,000 to 
500,000 deaths a year globally, according to the World Health 
Organization.

The Brisbane H3N2 virus set off the worst epidemic in a decade in 
northeastern Australia in 2007. Nationwide, flu cases were three times the 
average of the previous five years and seven children died, compared with 
a nine-year average of 2.6 deaths.

The virus reached the U.S. late year. There, it contributed to a threefold 
jump in flu-related hospitalization rates among children four years old 
and younger compared with the previous season, according to surveillance 
data of laboratory-confirmed cases by the Centers for Disease Control and 
Prevention in Atlanta.

The symptoms of H3N2 are generally more severe than the symptoms with 
H1N1, David Reddy, head of the influenza task force at Roche Holding AG, 
which makes the best-selling flu medicine Tamiflu, said in a telephone 
interview. Flu-related mortality is typically higher during epidemics in 
which H3N2 is the dominant strain, according to the WHO.

Off the Job

The most significant cost of the disease is lost productivity and 
absenteeism, according to the European Scientific Working Group on 
Influenza, which found flu caused 203 million days of lost productivity, 
$11.6 billion of medical and other direct costs and $25.4 billion of 
indirect costs, such as parents taking time off to care for sick children.

Tamiflu and Relenza, an inhaled powder made by London-based 
GlaxoSmithKline Plc, reduce the severity and duration of symptoms if the 
drugs are taken in the first 48 hours. Dublin doctor Ardill says most of 
his patients seek help too late to benefit from anti-flu medicines.

A lot of people will feel so bad initially that they will spend the first 
three, four, five days in bed, he said.

For patients who make it to the doctors room in time, theres another 
problem: one strain at least has developed resistance to the Roche drug.

Tracking Resistance

Almost all the H1N1 viruses have now developed resistance, according to 
the Centers for Disease Control and Prevention. All flu viruses still can 
be treated with Relenza.

Basel, Switzerland-based Roche will follow 1,200 flu sufferers in seven 
countries during the next three winters to gauge resistance to Tamiflu and 
other drugs, Reddy said.

The important thing is to immunize, immunize, immunize, said the ECDCs 
Nicoll.

A survey of 19 European nations found most countries failed to vaccinate 
at least half those ages 65 or older, especially where the shots werent 
free, researchers said in an October report in Eurosurveillance. In 
comparison, two-thirds of Americans in the same age group were immunized 
in 2007, according to the CDC. The U.S. government recommends 85 percent 
of the population should get a shot each year and covers the cost for 
those 65 and older.

Vaccines

The vaccine requires annual adjustments because the flu virus constantly 
mutates, giving rise to new strains not recognized by the immune system.

Last year, when the H3N2 flu hit the U.S., the vaccines manufactured by 
companies including Glaxo and Sanofi-Aventis SA, based in Paris, didnt 
incorporate the Brisbane variant, so those most at risk werent fully 
protected. The vaccine sold in Europe and the U.S. this year has been 
adjusted for the newcomer.

For such a simplistic virus, its also one of the most complicated, says 
Michael Osterholm, director of the Center for Infectious Disease and 
Policy at the University of Minnesota in Minneapolis. As researchers learn 
more about influenza it is becoming increasingly clear how much we dont 
know.

To contact the reporters on this story: Jason Gale in Singapore at 
j.gale-AlFclGv/[email protected]
Last Updated: January 14, 2009 19:01 EST

http://www.bloomberg.com/apps/news?pid=20601085&sid=a8cTy7tbUjhQ&refer=europe#