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02 November, 2009

Update Re: "Unidentified Outbreak in Western Ukraine"

I promised yesterday when this first hit my radar that I would try to stay on top of it as it unfolds, but I have to admit the information coming out of Ukraine has a really high noise-to-signal ratio, and therefore it is difficult to know what to report and what to ignore. For now, I'm going to try to stay away from the obvious tinfoil hat conspiracy stuff, but if it continues to pile-up I may start passing it along as well. Don't worry, however, if I do, I'll be sure to mark it accordingly; that way, you can skip it if it isn't your thing.

Okay. Here we go:

From the WHO website...

"Pandemic (H1N1) 2009, Ukraine

On 28 October 2009, the Ministry of Health of the Ukraine informed WHO, through its Country Office in Ukraine, about an unusually high level of activity of acute respiratory illness in the western part of the country, associated with an increased number of hospital admissions and fatalities.

On 30 October 2009, the Ministry of Health of the Ukraine announced the confirmation of pandemic (H1N1) 2009 virus infection by RT-PCR in eleven out of 30 samples obtained from patients presenting with acute respiratory illness in two of the most affected regions. Tests were performed in two laboratories in Kyiv, including the National Influenza Centre. Confirmatory tests will be performed at one of the WHO Collaborating Centres for Influenza.

The situation is quickly changing with increasingly high levels of acute respiratory illness (ARI)/Influenza-like-illness (ILI) activity being observed in Ternopil, Lviv, Ivano-Frankivsk, and Chernivtsi regions. The higher levels of transmission in these regions corresponds to an increased number of hospital admissions and fatalities associated with severe manifestations of acute respiratory illness.

As of 30 October 2009, over 2,300 individuals have been admitted to hospital, including over 1,100 children. One hundred and thirty one (131) cases have required intensive care, including 32 children. As of 31 October 2009, a total of 38 fatalities associated with severe manifestations of ARI have been registered. Preliminary epidemiological data analysis indicates that severe cases and deaths primarily occur among previously healthy young adults aged 20 – 50 years. Fatal and severe cases are reported to have sought medical attention 5 to 7 days after onset of symptoms.

International experience of the (H1N1) 2009 pandemic to date, especially from the Southern Hemisphere, has shown that poor clinical outcomes are associated with delays in seeking health care and limited access to supportive care. In addition, this virus has also shown its ability to cause rapidly progressive overwhelming lung disease which is very difficult to treat.

Public health measures recommended by the Ministry of Health of the Ukraine across the entire country include: social distancing (school closures and cancellation of mass gatherings); enhancement of surveillance activities; increased respiratory hygiene; and continuation of the vaccination campaign against seasonal influenza targeting at risk groups.

The Government of the Ukraine has activated coordination mechanisms to respond to the rapidly evolving situation, including the harmonization of response plans across all administrative levels.

In response to the request from the Minister of Health of the Ukraine, WHO is deploying a multi-disciplinary team of experts to assist national authorities in mitigating the impact of the pandemic. The team comprises of the following expertise: health emergencies coordination, case management, epidemiology, laboratory diagnostics, logistics, and media/risk communications.

As per WHO's communication in May 2009, there is no rationale for travel restrictions because such measures will not prevent the spread of the disease.

Travelers can protect themselves and others by following simple recommendations aimed at preventing the spread of infection such as attention to respiratory hygiene. Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases and not only the pandemic (H1N1) 2009 virus."

Note: Bold emphasis above is mine.

So, there is an official report, but there is also quite a lot of internet chatter bouncing around as well. Obviously, this stuff needs to be taken with a grain of salt, since the internet is usually awash with some of the craziest conspiracy theories, et cetera. To my mind, however, it is still important to absorb the information for whatever shreds of truth it may hold before discarding the junk. Oh, and believe me, even as I expose you to the following, be aware that I'm still insulating you from some of the heaviest tinfoil conspiracy stuff as promised.

The blogosphere is all-a-flutter with reports out of Ukraine that claim deaths are being vastly under-reported. They are saying that many fatalities where the patient was over 50 years old are being classified as 'heart attacks' instead of flu.

If you took the time to listen to the interview with Dr. Niman that I provided the link to yesterday, you heard him say that he believes it is H1N1 swine flu and that Ukrainian officials are likely just unwilling to make a definitive statement until they get the test results back; likely within 2 weeks.


Niman's latest:

"H1N1 Doctor Deaths In Ukraine Raise Concerns
Recombinomics Commentary 22:22
November 1, 2009

Four doctors died of flu in Ukraine's Ternopol and Lvov regions, Health Minister Vasily Knyazevich said at the Sunday meeting of the operative headquarters for the prevention and treatment of A/H1N1 flu.

The above comments describe the death of four health care workers (HCWs) at two sites in western Ukraine. The government website shows a total of 53 deaths (see map), which is quite low if four HCWs have already died. HCW are trained in methods to minimize infections from parents, and they are likely to get prompt medical attention, yet four have already died. These numbers add to the confusion in Ukraine.

Initial reports denied the outbreak was due to H1N1 even though there was virtually no seasonal flu circulating in Europe (or North America). The explosion in cases of acute respiratory illness (ARI), in view of the exploding H1N1 pandemic throughout the northern hemisphere, would signal involvement in the cases in Ukraine
... continued here.


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