Japan digs in its heels in expectation of virulent flu epidemic this winter

Parents beware! Flu investigators in Japan say outbreaks of flu viruses are spread out from elementary schools.

Outbreak of a highly virulent strain of flu virus is possible this winter

Unlike past influenza epidemics that were “attenuated virulent”, this new influenza has the possibility of being “highly-virulent,” derived from the highly-pathogenic bird flu virus; thus this year’s strain calls for strong caution. When infected by a highly-virulent strain of a new influenza virus, you may experience complications such as respiratory failure or multiple organ failure that may result in death. Thus, it is important to take precautions to prevent infection and the transmitting of influenza to others.

The Japanese Ministry of Health, Labor and Welfare envisages that the emergence of a new strain of influenza could lead to infections in 13 to 25 million people and and ultimately could lead to 170,000 to 640,000 deaths in Japan. The Japanese government is worried enough to be the first country in the world to vaccinate six thousand frontline health workers against the bird flu, to prepare birdflu suits for them, to conduct an international mock flu pandemic drill, and to have stockpiled 20 million doses of the vaccine … even though none of the 245 deaths from bird flu have occurred within Japan.

In addition, 3,500 chickens at a farm in Miyazaki prefecture were however confirmed to have been killed by the H5N1 bird flu virus in early January this year…followed by other chicken farm outbreaks in Ibaragi prefecture. 

Currently, as media and public hysteria goes … the fears are that the last line-of-defense-drugs like Tamiflu are no longer working. Last year, 30% of influenza viruses in Tottori, Japan were resistant to Tamiflu and 20% of those in Europe were resistant to Tamiflu (see yomiuri shimbun article posted below).

Hopes are now pinned upon really cutting edge research …researchers in Japan have designed a new vaccine that has been effective in animal tests against multiple strains of influenza, including varieties of the dread bird flu. Using a peptide derived from influenza virus that carries an antigen on the surface that triggers an immune response, the researchers observed that the vaccine worked on the inside of cells, rather than the surface. That differs greatly from current vaccines in use that target the surface of cells. Those surfaces change as the virus mutates, making the vaccines ineffective to the emerging strains of influenza.

Japan’s geographic proximity to many of the avian influenza outbreaks in recent years puts the country at high risk for future outbreaks and for being a possible pandemic intersection. Given how the majority of Japanese are workaholics and don’t take a day off work even when they catch colds or the flu, you can see how quickly the flu can get transmitted from person to person. 

One of the quirks with the school system, unlike other countries, is that you don’t have to have a letter from the doctor’s to stay away from school … but you DO have to have a letter from the doctor’s stating that your child has recovered from the flu, if you want your kid back in school. And that letter will cost 500 yen, plus consultation charges. As a result, most parents learn not to inform the schools that their kids had the flu, usually using the generic excuses “kaze”(common cold), “guwai warui” (not feeling well) or tsukareteimasu (tiredness/lethargy) to avoid the hassle and added costs. This of course also means parents tend to let kids back to schools once their fevers subside and while they are still infectious, leaving their kids to spread the virus to other kids.

In any event, do go out and get that flu jab if you haven’t yet. Last year, I tried too late for my family, and the clinics ran out of the vaccine which had to be ordered in advance. A check this week with my GP and the local pediatricians showed that there were plenty of vaccines available and that you could get one on the spot by just filling in the forms. Also, if your kids are prescribed Tamiflu, then make sure your kids are under constant supervision since hallucinogenic effects can and have resulted in deaths before (see Bird flu drug probe after 18 teenage deaths in Japan).

DO take common cold and flu precautions:

Gargling・washing hands・coughing etiquette・wearing masks!
・Encourage washing hands and gargling after going out. Make it a daily habit!
・Ensure that people with symptoms such as fever, coughing, and sneezing wear a mask.
・Wear a mask when in contact with people with such symptoms.
・Immediately wash hands after covering coughs and sneezes and after blowing your nose.
・Avoid trips to regions where new influenza viruses are prevalent and going to crowded / downtown areas.

In Japan, many nurseries/preschools/elementary schools close certain of their classes for three days if half of the kids in the class are ill with the flu; universities close the schools if a pandemic class 4A alert has been announced (see chart below).

6 phases of the pandemic influenza alert
 The World Health Organization (WHO) uses a series of six phases of pandemic alert in their global influenza preparedness plan. These phases of “pandemic alert” categorize the conditions and progress of transmission. Currently, the highly-pathogenic bird flu (H5N1) virus has not mutated into a new influenza, putting it at Phase 3. However, this situation could easily move to Phase 4 at any time.



Fears rise over flu strains resistant to oral drug Tamiflu
The Yomiuri Shimbun http://www.yomiuri.co.jp/dy/features/science/20081023TDY03101.htm

More than 30 percent of influenza viruses confirmed last winter in Tottori Prefecture were resistant to the major oral drug Tamiflu, according to the National Institute of Infectious Diseases (NIID).

The NIID, based in Shinjuku Ward, Tokyo, says there is a possibility the resistant virus will spread nationwide this winter, adding that authorities must stay on the lookout for a possible spread of such viruses.

The NIID conducted an emergency investigation into the drug-resistant virus last winter after it spread in Europe and other areas of the world. The institution collected 1,544 strains of influenza A virus subtype H1N1 from local offices nationwide and studied whether they were tolerant to Tamiflu.

Forty-four of 1,544 virus strains, or 2.8 percent, showed resistance to the drug. The ratio was extremely high in Tottori Prefecture, with 22 out of 68 virus strains, or 32 percent, resistant to Tamiflu. The ratio was 1.2 percent in Shimane Prefecture, and 7.5 percent in Hyogo Prefecture. Both prefectures neighbor Tottori Prefecture.

Flu viruses resistant to Tamiflu have spread worldwide since November last year, especially in Europe. More than 20 percent of the influenza viruses detected in European countries were resistant to the drug, on average. The ratio was 67 percent in Norway. Almost all the H1N1 viruses in South Africa have become Tamiflu-resistant, the NIID said.

According to the NIID, the resistant virus in Tottori Prefecture was mainly spread from primary school students. It is likely that the resistant viruses prevailing in Europe and the United States spread in the prefecture simultaneously, the NIID said.

If the resistant virus has spread to other prefectures, taking Tamiflu may not protect against the disease.

Takato Odagiri, head of the NIID’s Influenza Viruses Laboratory, said: “At a national level, the ratio of influenza virus resistant to Tamiflu is still low. However, we need to carefully watch how the situation develops.”

The investigation results will be announced at a conference of the Japanese Society for Virology held on Sunday.

(Oct. 23, 2008)


Related articles:

Flu season looks set to get off to early start (Dec.3) Yomiuri Shimbun

Avian flu: Preparing for a Pandemic Nov 12 2008

Japanese R&D team targets next gen flu jabs Japan seeks new form of flu vaccine (Mar 10, 2008)

Japan seeks new form of vaccine (Mar 10, 2008) A group of Japanese researchers has developed a substance that could potentially help make flu vaccines effective for multiple strains of the disease, including strains of the bird flu virus. The group found that when a peptide derived from the influenza virus is induced into mice, it could act against cells infected by multiple strains of influenza, including bird flu. Part of the research was reported in the Journal of Immunology in 2006, and the group presented its findings last month at Japan’s National Cancer Center.

Japan, China and S. Korea plan flu outbreak drill (June 29, 2008)

Coping with new strains of flu Sunday, May 11, 2008

Taking Pandemic Flu Vaccine to Japan, Maybe (October 7, 2008)

Miyazaki bird flu confirmed as the killer H5N1 (Jan 17, 2008); Bird flu casualties mourned; Bird flu in Japan; Japan has third bird flu outbreak

Bird flu suits to be worn by hospital staff (Sep 4 2008)

Drug-resistant flu detected: Japanese strains appear transmissible (Apr 7 2007) article link

Japan and the Pre-pandemic

Bird flu ‘could take 143 m’ lives: Worst case economic cost $4.4 trillion

Epidemic hits early: Docs find flu drug dearth hard to swallow (Tuesday, Feb. 4, 2003)

Bird flu drug probe after 18 teenage deaths in Japan; New tests on bird flu drug after teenagers’ deaths 

Deadly bird flu virus mutation discovered “Japanese and Vietnamese scientists identify (link:http://www.japantimes.co.jp/)
a mutation of an H5N1 avian flu virus that can grow in the human upper respiratory tracts” (Oct 6, 2007)

Highly pathogenic avian influenza virus (H5N1) isolated from whooper swans, Japan (2008)

Japan confirms H5N1 bird flu strain in swans (Nov 3, 2008)

China, Japan and the Republic of Korea (ROK) on Sunday adopted an action plan to jointly combat possible pandemic influenza outbreaks Xinhua (2008-11-02)  The avian strain named H5N1 has posed the greatest risk of a new flu pandemic since it first killed humans in Asia in the 1990s.

What the H5N1 virus looks like

About Bird Flu site

Global impact of bird flu

Kyoto pro creates bird flu antibodies from ostrich egg

Riken Beyond the Genome: Influenza and the Sugar Chain

Singapore develops hand-held bird flu detector

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