Grippe porcine / Swine flu - Nature biting back at industrial animal production?

[Al-khiyal]

Cas de grippe porcine en Arabie Saoudite :
La polémique enfle autour du Hadj

Un premier cas de grippe porcine a été enregistré en Arabie Saoudite.
L'affaire risque d'alimenter la polémique qui enfle entre les religieux au sujet d'un éventuel report du Hadj

Jeudi 4 Juin 2009 -- Un premier cas de grippe A (H1N1) a été confirmé en Arabie Saoudite. Il s'agit d'une infirmière de nationalité philippine qui a été hospitalisée à Ryad. Alors que l'Organisation mondiale de la santé estime que le monde se rapproche d'une « pandémie » de grippe porcine, la nouvelle, annoncée hier par le ministre de la Santé saoudien, Abdullah Al-Rabiah, ne va pas manquer de susciter de vives inquiétudes. C'est qu'on est à la veille du grand rush de la Omra, en période de Ramadhan, qui sera suivie par le grand pèlerinage. Ces dernières années, la Omra en période de Ramadhan a drainé un nombre considérable de pèlerins, qui se rapproche en nombre du rush planétaire du grand pèlerinage. Si le système de prise en charge sanitaire mis en place par les Saoudiens s'est révélé, de l'avis de beaucoup d'experts, assez efficace pour prendre en charge les problèmes de santé courante posés par l'afflux de pèlerins, il n'est pas évident qu'il le sera pour une épidémie. Prendre les dispositions pour détecter les porteurs de virus à leur arrivée en Arabie Saoudite est bien entendu la démarche qui semble la plus rationnelle, mais elle n'est pas nécessairement efficace. Le problème sera beaucoup plus ardu, dès le Ramadhan, avec l'afflux des centaines de milliers de personnes qui viennent effectuer la Omra durant le mois sacré. Et il le sera encore davantage durant le grand pèlerinage avec des hommes et des femmes venus de tous les coins du monde.

La terre sainte, plate-forme de propagation ?

La terre sainte pourrait se retrouver, malgré elle, comme une plate-forme de diffusion du virus à l'ensemble des pays musulmans. L'OMS ne recommande pas des restrictions de voyages qui n'empêcheraient pas le virus de se propager, tout en perturbant le fonctionnement de la communauté mondiale. Il s'agit d'une recommandation pour le flux normal des voyageurs, l'Organisation mondiale estimant qu'il faut chercher à en limiter l'impact en repérant rapidement la maladie et en offrant des soins adéquats aux malades. L'organisation précise que la détection des signes et symptômes de la grippe peut être une « technique de surveillance efficace », elle n'aide pas « à limiter la propagation de la maladie car le virus peut se transmettre d'une personne à une autre avant l'apparition des symptômes ».

Voilà qui donne une idée de l'ampleur du risque qui se pose pour le rassemblement planétaire qui se déroule en terre sainte. Le cas de l'infirmière philippine est déjà exemplaire. À son arrivée à l'aéroport de Ryad, vendredi, après des vacances dans son pays, elle ne présentait aucun symptôme de la maladie. Ils ne sont apparus, indique le ministre saoudien de la Santé, que trois jours plus tard. Par extrapolation, on peut imaginer ce qui est susceptible d'arriver lorsque plus de deux millions de personnes vont se retrouver dans une forte promiscuité sur des espaces restreints autour du Haram mecquois, à Arafat et à Mina.

L'Egypte pourrait mettre les pèlerins en quarantaine

La possibilité d'une transmission du virus avant même l'apparition des symptômes chez la personne atteinte est donc très forte. Sur le site du ministère du Haj saoudien, on rappelle l'obligation pour les pèlerins de certains pays d'être vaccinés contre la fièvre jaune, la méningite à méningocoques et la poliomyélite et une recommandation générale de prendre le vaccin saisonnier contre la grippe. Si ce dernier est utile, il n'est d'aucun secours pour la grippe porcine. L'OMS doute d'ailleurs que « les dépistages d'entrée et de sortie permettront de réduire la propagation de cette maladie », même si elle considère que « les mesures appliquées à l'échelle nationale pour faire face à un risque de santé publique sont du ressort des autorités nationales ».

Pas de quoi rassurer donc sur le fait que la Omra du Ramadhan et le pèlerinage seront sans risque. L'Egypte, qui a enregistré, mardi, son premier cas avec une petite fille de douze ans arrivée des Etats-Unis, s'inquiète ouvertement des risques. Le ministre égyptien de la Santé, Hatem al-Gabali, a mis en garde contre les risques de propagation pour les millions de pèlerins musulmans qui se rendent en Arabie Saoudite. Dans une interview publiée hier par le journal Al-Masri Al-Yom, il estime que le gouvernement ne pouvait interdire aux quelque 600.000 pèlerins égyptiens de se rendre à La Mecque. Par contre, il a évoqué la possibilité que ces pèlerins soient mis en quarantaine à leur retour. « Nous pourrons ouvrir une quarantaine et dire : personne ne retournera chez lui d'Arabie Saoudite... Il y a une grande possibilité» que la grippe A (H1N1), qui a tué 80 personnes et contaminé près de 10.000 personnes dans 39 pays, atteigne l'Egypte pendant la saison du Hajj et de la Omra ».

Faut-il dès lors, au nom du principe de précaution très clairement admis par la charia d'ailleurs, annuler le pèlerinage cette saison ? Le débat est chez les religieux, les « civils » n'osant se prononcer sur une question aussi délicate. Le mufti de la République en Egypte, Cheikh Ali Gomaa, a appelé à un « ijtihad » entre toutes les institutions religieuses reconnues dans le monde islamique pour décider d'un éventuel report de l'accomplissement de la Omra et du pèlerinage cette année en raison de la propagation de la grippe porcine. Cette idée a reçu l'appui du grand mufti de Dubaï, Cheikh Abdelaziz Haddad, qui a recommandé aux fidèles de « reporter les Omras de deux à trois semaines jusqu'à la stabilisation de la situation ». Il a également recommandé un « éclaircissement des rangs » durant les prières collectives et de prier à l'air libre plutôt que dans des endroits fermés. Mais ces appels ont été largement rejetés par de nombreux dignitaires religieux qui estiment qu'aucune raison n'est valable pour retarder ou annuler l'accomplissement d'un pilier de la religion.

Le mufti d'Arabie Saoudite, cheikh Abdelaziz Ben Abdallah Al-Cheikh, a critiqué les discours alarmistes sur la grippe porcine. « Pourquoi ceux qui appellent à reporter le Haj et la Omra ne demandent-ils pas également l'arrêt des voyages vers l'Europe ? ». Il a estimé que certains laboratoires pharmaceutiques pourraient être derrière le tapage organisé autour de la grippe porcine. D'autres religieux estiment qu'il n'y a pas de fatwa à prendre à ce sujet et que les choses doivent relever de l'appréciation des médecins. La polémique ne fait que débuter...

[Al-khiyal]

No swine flu case detected in Algeria

ALGIERS, June 5, 2009 (KUNA) -- Algerian medical authorities have affirmed on Friday that no infection case with the Influenza A subtype virus H1N1 known as swine flu had been reported in the country so far. The crisis management taskforce of the Ministry of Health, Population and Hospital Reform is coordinating directly and transparently with the World Health Organization (WHO) in this regard, according to a statement issued here by the ministry's crisis management office. The statement confirmed that the results of tests conducted on the blood samples of a Canadian national for suspicion of infection with the fatal virus were negative. A Canadian man, identified by the statement as only B.K., 47 years old, working for a Chinese construction company, was admitted to Mohamed Boudiaf Hospital in Relizane, eastern Algeria for suffering from swine flu-like symptoms. The blood samples taken from the man were sent to Pasteur Institute in Algiers but the test results came back negative. After spending two days in medical quarantine and receiving the necessary medication, the man is recovering gradually, the statement added. This is the third suspected infection case in the North African country after the ones pertaining to a Georgian, a fortnight ago, and an Algerian last week.

[Al-khiyal]

WHO 'to declare swine flu pandemic'

June 11, 2009 -- Speculation has grown that world health bosses could declare the swine flu outbreak the first global flu pandemic for more than 40 years.

With the number of UK cases jumping to 750, officials at the World Health Organisation (WHO) are due to meet shortly to discuss the worldwide spread of the disease.

It follows consultations on Wednesday between WHO director-general Margaret Chan and health chiefs around the world about the outbreak's status.

She said on Tuesday she believed the disease may have reached pandemic level, adding: "Once I get indisputable evidence, I will make the announcement."

The last global pandemic was declared in 1968 over an outbreak of Hong Kong flu which killed about one million people.

WHO said the H1N1 swine flu virus has infected 27,737 people in 74 countries and caused 141 deaths. Most of the cases have been in North America, but Europe and Australia have seen a sharp increase in recent days.

WHO's meeting is expected to take place in Geneva, Switzerland.

The organisation currently classes the swine flu outbreak as a level five on the pandemic scale, one short of a full pandemic rating of level six.

The upgrade could prompt countries to take extra measures against the disease, such as imposing travel bans and producing more vaccines.

[Al-khiyal]

WHO 'declares swine flu pandemic'

June 11, 2009 -- The World Health Organization (WHO) has declared a global flu pandemic after holding an emergency meeting, according to reports. It means the swine flu virus is spreading in at least two regions of the world with rising cases being seen in the UK, Australia, Japan and Chile. The move does not necessarily mean the virus is causing more severe illness or more deaths.

The swine flu (H1N1) virus first emerged in Mexico in April. It has since spread to 74 countries. Official reports say there have been 28,000 cases globally and 141 deaths and figures are rising daily. Hong Kong said it was closing all its nurseries and primary schools for two weeks following 12 school cases. It is the first flu pandemic in 40 years - the last in 1968 with Hong Kong flu killed about one million people.

The current pandemic seems to be moderate and causing mild illness in most people. One factor which may have prompted the move to a level six pandemic was that in the southern hemisphere, the virus seems to be crowding out normal seasonal influenza. It is thought the move was not prompted by the situation in any one country but the reports of several pockets of community spread.

The BBC's Imogen Foulkes, in Geneva, says that while the number of cases has made the declaration inevitable, the problem is that the pandemic phase system is designed for a very different type of virus.

WHO spokesman Gregory Hartl said it had been expecting something more like the deadlier bird flu. "It was believed that the next pandemic would be something like H5N1 bird flu, where you were seeing really high death rates, and so there were people who believed we might be in a kind of apocalyptic situation and what we're really seeing now with H1N1 is that in most cases the disease is self-limiting," he told the BBC.

The WHO will have to manage the global anxiety the declaration of a pandemic will generate, our correspondent says.

Pandemic planning

There have been more than 800 cases in the UK with some areas of Scotland being particularly hard hit. The government has been stockpiling antivirals such as Tamiflu and has ordered vaccine, some doses of which could be available by October.

Chief medical officer, Sir Liam Donaldson said the WHO declaration of a pandemic would not significantly change the way the UK was dealing with swine flu at the moment. But he added there could be some minor changes to who received antivirals. "The declaration of a pandemic per se doesn't make a big difference to the to the way we are handling the outbreaks we have. We are going to continue to investigate every case that occurs and treat their contacts with antivirals even though they may not be ill. The difference is that the Health Protection Agency has learnt a lot about approaching this question of antiviral prophylaxis and they are going to be treating the closer contacts of the cases, rather than the more far-flung contacts, because they feel that that is supported by what they know so far about how the disease is transmitting."

He added: "These flu viruses can change their pattern of attack, so when we come into the flu season in the autumn and winter in this country, when we expect a big surge of cases, we need to watch very carefully to see if the character of the virus is changing."

Scottish health secretary Nicola Sturgeon said a move to level six means that countries need to be ready to implement pandemic plans immediately but the UK was already operating at a "heightened state of readiness". But it could affect the speed at which the UK gets pandemic vaccine supplies but that had been factored into pandemic planning.

Flu expert Professor John Oxford, said people should not panic as the outbreak was milder than others seen in the past century. "It is global and fulfilling the requirements of a pandemic but I don't think anyone should worry because nothing drastic has happened between yesterday and today."

[Al-khiyal]

WHO declares flu pandemic

GENEVA, June 11, 2009 (Reuters) -- The World Health Organisation declared the first flu pandemic of the 21st century on Thursday, Sweden's health ministry said.

The health ministry said the United Nations agency was raising its pandemic flu alert to the top phase 6 on a six-point scale, indicating the first influenza pandemic since 1968 is under way.

"Today... the Minister for Elderly Care and Public Health Maria Larsson has called a press conference following a decision by the WHO to raise the pandemic level to six for the influenza A H1N1 virus," the ministry said in a statement.

WHO Director-General Dr Margaret Chan was due to give a news conference on the influenza (A) H1N1 pandemic at 1600 GMT, following a meeting of the WHO's emergency committee of flu experts, and WHO spokesmen declined to comment before that.

The move will trigger heightened health measures in the WHO's 193 member states as authorities brace for the worldwide spread of the virus that has so far caused mainly mild illness.

The move to phase 6 reflects the fact that the disease, widely known as swine flu, was spreading geographically, but not necessarily indicate how virulent it is.

"Phase 6, if we call a phase 6, doesn't mean anything concerning severity, it is concerning geographic spread ... Pandemic means global, but it doesn't have any connotation of severity or mildness," WHO spokesman Gregory Hartl said.

"In fact, what we are seeing with this virus so far is overwhelmingly to date mild disease. So we would think that this event is really a moderate event for the time being, because the numbers are high but the disease is overwhelmingly mild," he told Reuters Television before the committee meeting.

David Heymann, a former top WHO official now chairing Britain's Health Protection Agency, said that countries had tried to contain the virus through measures including school closures during the previous phase 5. This has extended the precious time needed to prepare for a full-blown pandemic.

"During phase 5, the government and people in the U.K. have had the time to prepare for a pandemic - this has hopefully decreased any surprise and concern that might be associated with a WHO announcement of phase 6, if one is made," he told Reuters.

As it spreads in humans, science cannot predict what course the virus will take, the disease it causes and the age groups infected, Heymann said. "The severity of that disease, the effectiveness of antiviral drugs and the stability of the virus must all be watched closely," he added.

A pandemic could cause enormous disruption to business as workers stay home because they are sick or to look after family members and authorities restrict gatherings of large numbers of people or movement of people or goods.

World markets shrugged off the possibility of a pandemic, as investors focussed on possible global economic recovery.

Widespread transmission of the virus in Victoria, Australia, signalling that it is entrenched in another region besides North America, was likely to be the trigger for moving to phase 6.

Five people have been admitted to intensive care in Australia and more than 1,000 cases confirmed following widespread testing in the state.

"We have tested 5,500 people in the last two weeks, that is more people than we test in our whole influenza season," said Victorian state premier John Brumby.

One health source, who declined to be named, said the experts were also expected to recommend finishing production currently under way of seasonal flu vaccine for the northern hemisphere next winter.

"They might say finish seasonal vaccine and say begin pandemic vaccine as soon as it is feasible," he said.

Drugmakers have obtained the new influenza A (H1N1) seed virus in the past two weeks, enabling them to begin the production process by growing the virus in eggs.

Company officials said on Wednesday that they were on track to have a vaccine against the new strain ready for the northern hemisphere autumn.

Seasonal flu each year kills up to half a million people, mainly elderly, and causes severe illness in millions, so a premature switch in vaccine production to cope with the new strain could put many people at risk.

The new strain can be treated by antiviral drugs oseltamivir, the generic name of Roche Holding's Tamiflu tablets, and Relenza, a spray made by GlaxoSmithKline.

The strain, which emerged in April in Mexico and the United States, has spread widely in nations including Australia, Britain, Chile and Japan.

Authorities in Germany have confirmed 30 cases of H1N1 at a school in the industrial Rhineland city of Duesseldorf, the most concentrated outbreak of the virus so far in Europe's biggest economy.

There have been 27,737 infections reported in 74 countries to date, including 141 deaths, according to the WHO's latest tally of laboratory confirmed cases, but the real number of people with the disease is likely to run into at least hundreds of thousands, as mild cases may not have been detected.

A survey by New York City's health department showed that 6.9 percent of the city's population of over 8 million had experienced "flu-like illness" - which could include other diseases - in the first three weeks of May.

"The findings don't tell us exactly how many New Yorkers have had H1N1 influenza," said New York City Health Commissioner Dr Thomas Farley in a statement. "But they suggest it has been widespread, and mild in most affected people."

[Al-khiyal]

Grippe porcine :
Première pandémie à être déclarée au XXIe siècle

Vendredi 12 Juin 2009 -- L’Organisation mondiale de la santé (OMS) a relevé hier son niveau d’alerte sur la grippe porcine au seuil maximal 6, ce qui équivaut à une pandémie. La première du XXIe siècle. Depuis 40 ans, l’OMS n’a jamais déclenché cette alerte. La grippe A (H1N1) a continué à s’étendre à l’échelle mondiale, a déclaré hier la ministre suédoise de la Santé, Maria Larsson. L’OMS attendait depuis plusieurs jours des preuves que le virus, apparu fin mars au Mexique puis aux Etats-Unis, se propageait bien localement dans une région autre que le continent américain. Passer en phase six signifie que la propagation du virus continue, mais ne signifie pas que la gravité de la maladie a augmenté, selon le numéro deux de l’OMS, Keiji Fukuda. Le virus d’origine porcine, aviaire et humaine affecte désormais 27 737 personnes dans 74 pays et fait 141 morts. Et c’est la situation en Australie qui est, semble-t-il, à l’origine de la décision de l’OMS. Keiji Fukuda avait reconnu mardi une transmission locale dans l’Etat de Victoria (sud-est de l’Australie). Cinquième pays le plus touché au monde avec 1 263 cas, l’Australie a fait savoir hier que quatre malades avaient été admis en soins intensifs.

La situation est également préoccupante au Chili : le nombre de malades y a plus que triplé en deux jours, atteignant désormais 1 694 personnes. À Hong Kong, la fermeture des écoles primaires et les crèches a été ordonnée après la contamination de douze élèves par le virus. Et en Allemagne (78 cas répertoriés mercredi), 27 élèves d’une école japonaise de Düsseldorf (ouest) ont contracté la maladie. Depuis dix jours déjà, l’OMS prépare activement le terrain à l’annonce de la pandémie. De fait, la mortalité du virus s’est révélée jusqu’à présent, à peu près équivalente à celle de la grippe saisonnière (0,1%), en dehors du Mexique (0,4%), alors que celle de la grippe aviaire est de 60 %. Mais le virus devrait muter et pourrait se combiner avec une souche plus virulente, ouvrant la voie à des scénarios beaucoup plus pessimistes, craint l’OMS. Malgré tout, l’organisation se veut rassurante, répétant à l’envi que le monde n’a jamais été aussi bien préparé à une pandémie de grippe.

[amalgamate]

Novartis says produces first batch of H1N1 vaccine

BASEL, Switzerland, June 12, 2009 – Swiss pharmaceuticals company Novartis AG said Friday it has successfully produced a first batch of swine flu vaccine weeks ahead of expectations. The vaccine was made in cells, rather than grown in eggs as is usually the case with vaccines, the company said. The announcement comes a day after the World Health Organization declared swine flu, also known as A(H1N1), a pandemic. The move indicates that a global outbreak is under way. WHO says drugmakers will likely have vaccines approved and ready for sale after September. Novartis said it would use the first batch of vaccine for pre-clinical evaluation and testing. It is also being considered for clinical trials, the company said. The vaccine was produced at a Novartis plant in Marburg, Germany. Novartis said the facility could potentially produce millions of doses of vaccine a week. A second plant is being built in Holly Springs, North Carolina, the company said. Novartis said more than 30 governments have requested vaccine supplies, including the U.S. Department of Health and Human Service, which placed a $289 million order in May.