The View in Pennsylvania Election Results: Democrats are Confident

first_imgAllegheny County, which includes Pittsburgh, expects to report its outstanding mail votes by the end of Wednesday. Other Democratic enclaves, including Philadelphia and its suburban counties, are expected to report in the next one to three days. As of Wednesday morning, more than half of the ballots in Philadelphia had still not been counted.Looming over the counting, however, are multiple lawsuits filed by Republicans at both the county and statewide level, questioning the process by which voters were notified of issues with mail in ballots and allowed to cast provisional ballots. Hearings are scheduled in both Montgomery County and at the state level on Wednesday.At a news conference on Wednesday, Gov. Tom Wolf reiterated that election officials would count every ballot remaining.- Advertisement – PITTSBURGH — As Pennsylvania continued to count an estimated 1.4 million outstanding mail-in ballots on Wednesday, Democrats were confident that the results would skew heavily to Joseph R. Biden Jr. and ultimately deliver him a narrow victory over President Trump, whose legal team was descending on the state to mount challenges in court.Mr. Trump holds a 542,000-vote lead with 78 percent of the estimated total votes reported. Elections offices in the state’s populous, Democratic-leaning cities and suburbs were only partway through tabulating and reporting the bulk of mail ballots.- Advertisement – “Pennsylvania will have a fair election, and that election will be free of outside influences,” Mr. Wolf said. “I will vigorously, and we all will vigorously, defend against any attempt to attack that vote in Pennsylvania.” – Advertisement –center_img “The distance now is 540,000,” he added. “So Biden probably wins the state by roughly 100,000.’’- Advertisement – So far, Mr. Biden has won nearly four in five of the mail votes reported, a reflection of the president’s monthslong disparagement of mail ballots, which led to far fewer Republicans voting by mail than Democrats than Republicans.If the unreported votes follow the same pattern, said Rich Fitzgerald, the Democratic county executive of Allegheny County, “Joe Biden would probably pick up 1,050,000 voters, Donald Trump would pick up 350,000, for a net gain for Joe Biden of about 700,000 votes.’’last_img read more

Cilaos Emery back in action in Clonmel Chase | Racing News

first_imgCilaos Emery fell on his last race over fences at Leopardstown in February, after which connections put him back over the smaller obstacles. Following success in the Red Mills Trial Hurdle at Gowran, Cilaos Emery was supplemented for the Champion Hurdle, finishing fourth to Epatante.“When he fell on his prep run for the Champion Chase, owner Luke McMahon took the decision that the Champion Hurdle looked wide open and chanced that,” said Patrick Mullins, assistant to his father.“I think they got their money back for finishing fourth, but we are keen to go back over fences again.- Advertisement – – Advertisement – Mullins junior said: “He was in great form last season. He won on the last day before lockdown in Clonmel.“I rode him in the Coral Cup where he ran a very good race. We dropped out in a pace which was slow. He finished sixth, but he could have finished closer on a different day.“He’s a high-class horse as well so it would be no surprise if he caused an upset.”Kemboy, who won this race in 2018, was withdrawn at the 48-hour final declaration stage.The three-time Grade One winner could reappear later this month ahead of his main early-season objective, the Savills Chase at Leopardstown over Christmas.“All is well with him. There are a few other races coming up in the next fortnight he could go for, but all is good with him. Willie has a few different races in mind,” said Mullins.“We’ll aim everything at Christmas, but it would be great to get a run in beforehand.”Of the four horses that take on the Mullins pair, Gordon Elliot’s Alpha Des Obeaux and the Joseph O’Brien-trained Mortal are owned by Gigginstown House Stud. Noel Meade’s Snow Falcon and Henry de Bromhead’s Paloma Blue complete the sextet.Elliott’s Shattered Love, wearing the Gigginstown colours, attempts to repeat last year’s victory in the T.A. Morris Memorial Irish EBF Mares Chase.The five runners include Jessica Harrington’s Magic Of Light, runner-up in the 2019 Randox Health Grand National.The Mullins stable is represented by Cabaret Queen, fresh from her last-gasp victory in the Kerry National at Listowel.“She’s been in great form since her win at Listowel,” said Mullins.“Obviously on ratings she needs to improve a little bit again, but it’s a very competitive race. Hopefully she has the advantage of being hard fit on her side. Maybe that will bring things in her favour.” Cilaos Emery tries two and a half miles for the first time as the Willie Mullins-trained gelding makes his seasonal debut in the Clonmel Oil Chase at the County Tipperary course on Thursday.The eight-year-old was fourth on his only previous attempt at the trip in the Hatton’s Grace Hurdle in 2017 behind Apples Jade, but has stuck to around two miles under both since codes since then.- Advertisement – “Ruby (Walsh) felt going up to two and a half miles might help him. He had been a very keen horse in his younger days, but he seems to settle much better now so we’re hoping that two and a half won’t pose any problem.“We’re expecting a big run.”The Closutton yard is also represented by Bachasson in a bid to win the race for a sixth time since 2013.- Advertisement –last_img read more

Harry Winks: England midfielder admits lack of first-team action at Tottenham threatens Euro 2020 chances | Football News

first_imgSouthgate has options across the pitch, with a host of players in most positions in the running come England’s opening game of the finals – a Wembley date with Croatia on June 13.While that could also lead to Winks slipping out of favour, he feels having such quality to call upon can help England achieve their goals as he hopes for another chance to impress Southgate in Wednesday’s Nations League game against Iceland, live on Sky Sports. Asked if he needed to play more minutes at club level to stay in the England picture, Winks replied: “Definitely, my situation at Tottenham is difficult at the moment.“It’s important that I keep fighting and working as hard as I can to stay in the squad and to stay in the team. Harry Winks admits his “difficult” situation at Tottenham may threaten his chances of making the cut for England’s Euro 2020 squad.The 24-year-old midfielder has found himself on the periphery of the Spurs team under Jose Mourinho and has played just 17 minutes of Premier League football since the start of October.- Advertisement – “Every time I get the opportunity for England I love it. It’s a great place to play football here, it’s free and the lads get on really well, it’s a great place to come to.- Advertisement – “We are definitely up there in the sense of the players that we’ve got,” Winks added when asked what level he thought England were at.“The squad and the quality in depth as well is frightening, and the amount of players who can step in and who are constantly trying to give the manager difficult decisions to make.“The good thing about England right now is we’ve got so many good, technical players. There are so many good players performing at such high levels in their clubs as well.“Once we get that gel right and once we start to get a bit of consistency going into the Euros we definitely believe that we are good enough to go all the way.” Harry Winks remonstrates with referee Peter Bankes after Newcastle's penalty Image:Winks has struggled for game time in the Premier League 1:12 Jack Grealish is not resting on his laurels after being praised by England manager Gareth Southgate, saying there are ‘world class’ players who play in his position “I want to be a part of that in the Euros and I want to be in the starting XI in the Euros as well.“But, yes, it’s important that back at Tottenham I get the opportunities there and I stay in the team there as well.” – Advertisement – Despite falling down the pecking order at club level, Winks remains a regular in the England ranks and picked up his ninth cap as he came on at half-time during Sunday’s UEFA Nations League defeat to Belgium.Winks is a favourite of England manager Gareth Southgate and is likely to be in the mix for a place in the squad for next summer’s rescheduled European Championships.But he concedes that things need to change at Tottenham if he is going to challenge for a starring role.- Advertisement – Jack Grealish of England(R) looks on during the national anthems during the international friendly match between England and the Republic of Ireland at Wembley Stadium on November 12, 2020 in London, England. Sporting stadiums around the UK remain under strict restrictions due to the Coronavirus Pandemic as Government social distancing laws prohibit fans inside venues resulting in games being played behind closed doors. (Photo by Mike Egerton - Pool/Getty Images) Kick off 7:45pm Wednesday 18th November 7:00pmlast_img read more

Vietnamese girl’s death adds to avian flu toll

first_imgApr 6, 2005 (CIDRAP News) – A 10-year-old girl is the latest victim of the H5N1 avian influenza virus in Vietnam, news services reported today.Nguyen Hai Yen died Mar 27 in Hanoi’s St. Paul’s Hospital, and tests confirmed her illness on Apr 4, Agence France-Presse (AFP) reported today. Nguyen lived in Hanoi, said a hospital staff doctor who wished to remain unidentified.Her death brings the unofficial case count to 82, with 51 deaths, since the H5N1 virus began spreading through eastern Asia in late 2003.Epidemiologists were also looking into the abrupt death of a doctor who worked at Vietnam-Sweden Hospital in the northern Vietnamese province of Quang Ninh. Ho Dai Nghia, 34, died on Apr 3, 2 days after he began showing signs of acute pneumonia, according to Xinhua, a Chinese news service. He received emergency treatment for SARS (severe acute respiratory syndrome), but the cause of his illness wasn’t clear today. He is being tested for H5N1 flu as well as SARS, news sources reported.Two people with confirmed avian flu and one person with a suspected case have been treated at Vietnam-Sweden Hospital, according to a story published today by Bloomberg News. However, the deputy director of the Quang Ninh health department said the physician was not known to have had contact with any of those three patients, according to the report.Human H5N1 infections are persisting in Vietnam even though poultry outbreaks are diminishing, AFP reported. All but two of the 35 Vietnamese cities and provinces affected by poultry outbreaks in recent months have been free of the disease for more than 3 weeks, according to an agriculture ministry daily report.Elsewhere in Asia, a World Health Organization (WHO) employee in Thailand speculated that the reported outbreak of H7 avian flu among poultry in North Korea could increase the risk of a human flu pandemic.”The fact that two viruses—one with a proven track record of transmitting easily into people and another with a mortality rate of between 50 and 80 percent—are circulating in Asia at the same time is something to keep a very close eye on,” said William L. Aldis, WHO representative in Thailand, as quoted in an AP story.If H7 and H5N1 exchanged genetic material, it could create an “organism with H5 lethality and H7 transmissibility,” he added. Tests on the North Korean avian flu strain are ongoing.H7N7 avian flu is potentially more transmissible among humans than H5N1 is. A recent World Health Organization (WHO) report lists 93 human cases, including one death, as the result of H7 infections. All but four of these were linked with a major avian flu outbreak in the Netherlands in 2003. Most people who fell ill during that outbreak had only conjunctivitis, but one veterinarian died of pneumonia.Follow-up research on the Netherlands outbreak suggested there were high rates of transmission of the virus from chickens to people and secondary transmission from person to person. On the basis of antibody testing, researchers estimated that 1,000 to 2,000 people were infected with H7N7 in the outbreak.last_img read more

HHS using Indonesian strain for second H5N1 flu vaccine

first_imgMar 7, 2006 (CIDRAP News) – A second vaccine against human H5N1 influenza is being developed, US Health and Human Services (HHS) Secretary Mike Leavitt announced yesterday.In a speech at an immunization conference, Leavitt announced that he has authorized the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) to start work on a second vaccine, according to an Associated Press (AP) report published yesterday.The decision is routine, HHS spokesman Bill Hall told CIDRAP News today.”We’ve been following the virus and trying to monitor it. We have determined there is a strain that is distinct enough from the Asian strain that first arose,” Hall said. It was isolated in Indonesia, so it’s named after that country: A/Indonesia/5/2005.”If a third strain were to evolve, which is very likely, we would do the same thing,” he said.The United States has been testing and stockpiling vaccines based on an earlier strain of H5N1, isolated from Vietnam in 2004. Two companies, Sanofi Pasteur and Chiron Corp., have been producing the vaccines under HHS contracts worth a total of more than $200 million. But no one knows how effective those vaccines will be if the virus evolves into a pandemic strain.Work with the Indonesian strain of H5N1 began in October 2005, Ruben Donis, team leader of the molecular genetics group in the CDC’s flu branch, told Bloomberg News yesterday. He said the vaccine is ready for further development by companies now.Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md., told the AP that this second vaccine could give pharmaceutical companies a head start if a viral variant similar to the Indonesian strain were to develop efficient human-to-human transmission.Using a CDC-developed prototype virus will allow companies to decide how best to grow viruses that can be used in the vaccine, Fauci said in the Bloomberg story. Subsequently, animal and human tests would be needed to determine the efficacy of the vaccine. Fauci said the decision to develop a second vaccine “doesn’t necessarily mean we’re going to be stockpiling doses of this vaccine.”Michael T. Osterholm, PhD, MPH, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site, today praised HHS for closely tracking the H5N1 virus. The need to update the antigen composition shouldn’t be a surprise, he said.However, Osterholm expressed hope that eventually vaccine development will be sophisticated enough that instead of constantly updating to accommodate changes, suppliers could produce a vaccine for any H5 virus.In related developments, Sanofi Pasteur and Chiron recently reported progress in fulfilling their government contracts for producing vaccines based on older H5N1 strains. The contracts are for the national emergency stockpile of vaccines and drugs.In February, Sanofi Pasteur reported it had finished making a supply of H5N1 in bulk concentrate form under a $150 million contract with HHS. The agency originally awarded the company a $100 million contract in September 2005, and later added another $50 million for additional vaccine, the company said. The extra vaccine will be used by the US Department of Defense, the company said in a Feb 6 news release.The number of doses provided under the contract remains to be decided in clinical trials designed to determine, among other things, the optimal formulation of the vaccine, company and HHS officials have said.Sanofi recently delivered 15,000 experimental doses of the vaccine to the NIH for use in the clinical trials, the company reported in the same news release. The doses include the adjuvant aluminum hydroxide (alum), intended to stimulate the immune system so it will take less vaccine to generate an effective response. The doses contain varying amounts of antigen (active ingredient) for testing purposes.Chiron Corp. reported on Feb 24 that HHS had agreed to give the company more time to complete production of its H5N1 vaccine. HHS awarded Chiron a $62.5 million contract in October 2005 to produce the vaccine in bulk form.”Chiron is producing the vaccine at its facility in Liverpool, England, and expects to complete approximately 70 percent of the order” before switching over to production of seasonal flu vaccine in March, a company statement said. Chiron plans to switch back to producing the H5N1 vaccine this fall, after production of the seasonal vaccine is finished.last_img read more

FDA joins probe as E coli outbreak widens

first_imgDec 7, 2006 (CIDRAP News) – The US Food and Drug Administration (FDA) announced yesterday it was joining the probe of a growing Escherichia coli O157:H7 outbreak associated with Taco Bell restaurants in the Northeast. The outbreak, which involved Salmonella enterica serotype Newport, occurred over the summer and early fall, sickened 106 people in 19 states and was first reported in late November. Most of the cases occurred on the East Coast. Taco Bell Corp announced yesterday it was removing green onions from all of its 5,800 restaurants after its own preliminary tests indicated E coli O157:H7 in some samples. However, the company has not confirmed the results. “In view of this, FDA is continuing to explore the possibility of other food commodities being the source of the E coli,” the FDA said. The agency, in a press release, said 43 probable cases were linked to the outbreak, in which green onions are a suspected cause. Cases include 20 in New Jersey, 15 in New York, 7 in Pennsylvania, and 1 in Connecticut. Additional cases are suspected in all four states, officials said. Thirty five people have been hospitalized, including three with hemolytic uremic syndrome, a type of kidney failure, which can be fatal, the FDA said. Herndon said the FDA decided not to do a traceback on the smaller outbreak because it lacked a well-defined cluster of cases. “Given the serotype and PFGE [pulsed-field gel electrophoresis] type and time frame and distribution, we are going to assume the tomatoes are from the eastern shore of Virginia,” he said by e-mail. A larger Salmonella outbreak linked to restaurant tomatoes, which occurred in early November, involved S enterica serotype Typhimurium and sickened 183 Americans in 21 states, plus two Canadians. Meanwhile in New York, a Suffolk County laboratory confirmed the outbreak strain in 3 of 4 green onions from a previously unopened package from a Taco Bell restaurant in Deer Park, the Times reported. Suffolk County’s acting health commissioner, David Graham, told the Times that the testing suggests the product was contaminated before it arrived at the restaurant. The FDA advised consumers who are concerned that they may have contracted an E coli infection to seek medical attention. In other food contamination news, FDA spokesperson Michael Herndon told CIDRAP News that the agency would not be conducting a traceback investigation regarding a recent Salmonella outbreak linked to restaurant tomatoes. The Times story said Ready Pac bought the onions from Boskovich Farms, a California producer. A spokesperson for Boskovich told the Times it was working closely with Taco Bell during the investigation.center_img Taco Bell has had problems with contaminated green onions before, the Times report said. In 2000, 23 Florida residents fell ill with hepatitis A after eating green onions in Taco Bell restaurants. Andrew Weisbecker, a Seattle attorney who represented plaintiffs in the Florida outbreak, told the newspaper that similar outbreaks occurred around the same time in Nevada and Kentucky. See also: Dec 6 FDA press release on E coli outbreak Federal and state officials are also investigating a food processor, Ready Pac Produce in Florence, N.Y., that cuts, washes, and sanitizes green onions that are sent to some distributors that service Taco Bell outlets in the Northeast, the Times reported. The New York Times reported today that the number of cases has grown to 99 and that the outbreak involves additional restaurants, a second food distributor, and a food processing plant that supplied green onions to at least one of the two distributors that supplied the implicated Taco Bell restaurants with produce, including green onions. E coli O157:H7, which often causes bloody diarrhea but no fever, was also blamed for an outbreak earlier this fall that was traced to eating fresh spinach. That outbreak sickened 200 people and resulted in 3 deaths. The FDA said it was testing samples of all nonmeat items served at Taco Bell that could carry E coli O157:H7, including cilantro, cheddar cheese, blended cheese, green onions, yellow onions, tomatoes, and lettuce. “At this time, the agency does not have data implicating or ruling out any of these items,” the agency said. Media outlets reported yesterday that state and federal investigators toured a Burlington, N.J., warehouse of Texas-based McLane Co., which supplies 8 of the implicated Taco Bell stores. Today the Times said a distributor in Albany, N.Y., supplies some upstate New York Taco Bells that are linked to the outbreak. Dec 1 CIDRAP News article “Second Salmonella outbreak linked to tomatoes”last_img read more

Study: First flu wave in 1918 was vaccine for some

first_imgOct 2, 2008 (CIDRAP News) – In the influenza pandemic of 1918, those who got sick in the first wave of illness were up to 94% less likely to fall ill when the second and much more severe wave struck, according to a new analysis of historical data.The authors, led by historian John M. Barry, sifted data mostly from US Army camps, along with some from the British navy and British cities, to conclude that infection in the first wave acted like a vaccine, conferring immunity that protected people when the second wave arrived. Barry wrote the 2004 book The Great Influenza, a chronicle of the pandemic.Their analysis “strongly points to cross-protection between outbreaks of respiratory illness during spring and early summer of 1918 and the influenza pandemic wave in the fall of 1918. The cross-protection effect was estimated to range from 35% to 94% for clinical illness and from 56% to 89% for mortality,” says the report, published online by the Journal of Infectious Diseases.The authors say their findings suggest that when novel flu viruses emerge and initially cause a mild wave of illness, public health authorities should think twice before taking aggressive steps to limit exposure, since people infected with the virus might benefit later on if the virus grows more virulent and triggers another wave of cases.Besides Barry, the authors are Cecile Viboud of the Fogarty International Center in Bethesda, Md., and Lone Simonsen of George Washington University in Washington, DC.The pandemic of 1918-19 occurred in three waves: a mild one in the spring or summer of 1918 (depending on location), a much more severe one in the fall, and a less severe one in the winter and spring of 1919, the authors note. The first wave began in March 1918 in the US Army and spread quickly through training camps and on to some civilian communities, and then faded by June. This initial wave came later in Europe, peaking in June and July, the report notes.US Army records show that 11.8% of all personnel at all camps were hospitalized for respiratory illness in the spring wave from March through May, compared with 27.5% during the fall wave, the report says.Multiple tests of hypothesisThe authors used several approaches to test the hypothesis of cross-protection. One was to examine detailed data available from five US Army camps on flu cases and deaths in seasoned troops—defined as those who had been in the Army at least 1 month—and new recruits during the second wave. New recruits were considered less likely to have been exposed in the first wave, because the spring epidemic was much larger in the army than in civilian communities. In fact, in only a few civilian areas was the spring wave large enough to be recognized as an epidemic at the time, the report says.Using these data, the investigators estimated that at two of the camps, Camp Grant and Columbus Barracks, seasoned troops were, respectively, 56% (95% confidence interval [CI], 51% to 61%) and 89% (95% CI, 66% to 97%) less likely to die in the second wave, compared with new recruits. For the other camps, the seasoned troops, as compared with new recruits, had protection against clinical illness estimated at 94% (95% CI, 90% to 97%) for Fort McDowell, 49% for Camp Pike (95% CI, 48% to 51%), and 86% (95% CI, 84% to 87%) for Camp Lee.The investigators acknowledge that some of the seasoned troops could have escaped the spring wave of illness and that some of the new recruits might have been exposed to the flu as civilians. But the resulting bias in their estimates would go against showing a protective effect, resulting in an underestimation rather than an overestimation of the true benefits, they write.The authors also found useful data on two regiments of seasoned troops who were trained at Camp Dodge in the fall of 1918; one regiment had been exposed to the spring wave while stationed in Hawaii, and the other had escaped it while in Alaska. Of those who had been exposed in the spring, 6.6% (198 of an estimated 3,000 troops) contracted flu in the fall. In the regiment that had been in Alaska, 48.5% (1,455 of an estimated 3,000) became sick in the fall. In this case, the protective effect of prior exposure was estimated at 86% (95% confidence interval, 84% to 88%).Data from the British Grand Fleet offered another opportunity for assessing cross-protection. A 1919 report in a medical journal supplied the numbers of sailors, out of the fleet total of 90,000, who were sick during each of the two waves and during both waves. From these numbers, the authors estimated that those who were sick in the spring had 72% protection (95% CI, 68% to 76%) against the fall wave.A British government report on flu cases in 12 civilian communities with a total population of 24,706 provided still another pathway for testing the hypothesis. In this population, 11.6%, or 2,863 people, were hit by the first wave. The authors estimated that these people gained 35% protection (95% CI, 27% to 43%) against the second wave, compared with those who escaped the earlier wave.However, using data from the same report, the investigators concluded that illness during either the first or the second wave did not seem to confer protection against the third wave in the winter.But overall, the authors conclude, illness in the first wave yielded about as much protection against the second wave as modern flu vaccines, which are about 70% to 90% effective in healthy adults. The finding of cross-protection matches the impressions of contemporary US Army epidemiologists, they note.Viral evolution and cross-protectionBarry and colleagues write that the simplest explanation of their findings is that the spring and fall waves of the pandemic were caused by “sequential variants” of the influenza A/H1N1 virus. The spring virus might not have been fully adapted to humans, they say, since it apparently didn’t spread effectively in civilian communities. By fall, it had evolved into a fully human-adapted and more virulent form.But there is at least one other possible explanation: that nearly identical viruses circulated during both waves, but respiratory bacterial pathogens exacerbated the disease in the fall.The authors suggest that their findings may help explain why pandemic mortality rates in the fall of 1918 varied almost fourfold among US cities. Though recent studies suggest that these differences can be largely explained by differences in nonpharmaceutical interventions, “we propose that geographical differences in population immunity acquired during the first wave could have contributed to the observed variation during the second wave,” they write.The investigators see at least two policy implications in their findings. One is that timely surveillance is crucial for learning the transmissibility, virulence, and age-group impact of influenza in the early stages of a pandemic.”Second, if indeed a mild first wave is documented, the benefits of cross-protection during future waves should be considered before implementing public health interventions designed to limit exposure,” they write.Other experts impressedSeveral other infectious disease experts said they were impressed with the study and found it convincing, though one military medical historian saw problems with some details of the data presented.”I think you have to say they make a strong circumstantial case,” said Richard J. Hatchett, MD, of the National Institute of Allergy and Infectious Diseases (NIAID), who has studied the effects of nonpharmaceutical interventions in the 1918 pandemic.”It’s really amazing that we can go back after almost 100 years and get any useful data on an epidemic that occurred in 1918,” said Hatchett, who is an associate director of emergency preparedness in the NIAID’s Division of Allergy, Immunology and Transplantation.He said the evidence of a sizable spring epidemic in cramped Army camps but only a minor one in civilian communities suggests that initially the virus was not well-adapted for human-to-human transmission and that the camps, with their continual influx of new recruits, may have served to incubate and sustain the virus until it became more transmissible and much more lethal.”If this were the case, the fall pandemic would’ve been a direct consequence of the war and social arrangements that allowed this inefficient virus to spread through the population. There’s probably a useful lesson in that experience, if that speculative observation were proved,” he said.”I’m not sure there is any direct application of the results of this paper to current pandemic planning,” Hatchett said. He added, however, “I think their [the authors’] recommendation of not implementing aggressive nonpharmaceutical interventions in a mild pandemic is in line with what the government is currently recommending.” He referred to Centers for Disease Control and Prevention (CDC) guidelines, which link interventions to a pandemic severity index.Dr. Christophe Fraser, an infectious disease epidemiologist at Imperial College London, said Barry and colleagues’ results are in line with his own findings in a study that has not yet been published.”We have analyzed some previously unpublished data from the USA in 1918, and our conclusions are very concordant with Dr. Barry and collaborators’ work, and even go a bit further,” Fraser told CIDRAP News by e-mail.He also commented, “This issue, of whether the population was protected by exposure to a limited spring epidemic of flu, is rather important for the current debate as the fall wave of 1918 is being used as one of the baseline scenarios for pandemic preparedness. If a significant proportion of the population were actually immune, then that means it’s not a good baseline to plan around.”Fraser said Barry and colleagues’ findings—combined with certain other evidence, such as a recent report that Scandinavian countries had a major spring epidemic—suggest that that fall wave of 1918 would have been worse without the protective effective of the earlier epidemic.”This is not as outlandish as it may seem,” he wrote. “Indeed one of the big discoveries from the historical record, now widely replicated, is that the 1918 fall wave virus was not very infectious. It was virulent, even lethal in many cases, but not easy to transmit compared to many other common viruses.”Some discrepancies seenCarol R. Byerly, PhD, a historian at the University of Colorado and author of the 2005 book Fever of War: The Influenza Epidemic in the US Army during World War I, said that some Army physicians at the time had a sense that soldiers who were sickened in the spring of 1918 may have had some immunity when the second wave of flu arrived in the fall. But, while making clear she is not an epidemiologist, she said she saw some flaws in the data.For a few examples, she said:The report says that the Army conducted disease surveillance at 37 of 39 training camps, but the Medical Department provided detailed information on at least 40 camps, all of which did surveillance.The authors say that five Army camps provided detailed data for illnesses and deaths as a function of length of time in service, but she knows of at least eight monographs on the experiences at individual camps.Army medical officers’ definition of “seasoned” recruits varied in different studies, so it is inaccurate to state that the criterion was clearly defined as just 1 month of service. Most studies used 3 or 4 months.Whereas the report says Army documents show that 475,000 men had respiratory illness in 1918, the actual figure War Department records show for all hospitalizations for respiratory illness in 1918 is 756,676.”I am therefore concerned about the construction of a statistical analysis on top of such a poorly defined database,” Byerly said.Reconsidering assumptionsAnother disease expert, Michael T. Osterholm, PhD, MPH, said he found the study “quite convincing,” adding, “I think it adds another piece to our understanding of what happened” in 1918.The results suggest a possible need to rethink some assumptions about pandemics, which by definition involve viruses to which the population has no immunity, said Osterholm, who is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News.”If we have wave 1 and it’s relatively mild, and a number of people are exposed to that virus, that may actually be a very positive thing relative to a second wave in which the disease is much more severe,” he said. “That could mean a lot of infection in a first wave is actually a good thing, with much of the world not having a vaccine.”But he added, “This is all theoretical. . . . As to whether there are any policy decisions we should make on the basis of this, I think at this point it’s just unclear.””I think the point it demonstrates very clearly is that pandemic waves may act very differently, in large part due to the virulence of the virus and the subsequent immunity that may develop,” Osterholm said.Barry JM, Viboud C, Simonsen L. Cross-protection between successive waves of the 1918-1919 influenza pandemic: epidemiological evidence from US Army camps and from Britain. J Infect Dis 2008 Nov 15;198 (early online publication) [Abstract]last_img read more