Cook and his clan is laughing all the way to the bank!...

Cook and his clan is laughing all the way to the bank! Shareholders are just spectators. I wonder if there is any breadcrumbs left.


Decade’s Worst Flu Marches on Europe After Virus Hits Ireland


By Jason Gale

Jan. 15 (Bloomberg) -- Dublin’s Wexford Street pharmacy can’t keep shelves stocked with fever remedies and cough drops this week as snuffling customers seek relief from Ireland’s 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 patient’s 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, Europe’s 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 Dublin’s 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 Dublin’s 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.

“We’re only seeing the tip of the iceberg,” said Ronan Boland, 45, a doctor in Cork, Ireland’s second-largest city, and chairman of the Irish Medical Organisation’s 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 airway’s 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 doctor’s room in time, there’s 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 ECDC’s 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 weren’t 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, didn’t incorporate the Brisbane variant, so those most at risk weren’t fully protected. The vaccine sold in Europe and the U.S. this year has been adjusted for the newcomer.

“For such a simplistic virus, it’s 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 don’t know.”

To contact the reporters on this story: Jason Gale in Singapore at [email protected]