Early in the 2009 H1N1 influenza pandemic, an editorial in Eurosurveillance noted the importance of observing experience with this novel virus in the southern hemisphere during their usual winter influenza season [1].

This special issue of Eurosurveillance is a timely response to that call. It contains reports from the island of Réunion, South Africa, South America (Brazil, Peru), and Australia (New South Wales and Victoria). It also includes an overview of the effect of the pandemic on indigenous people. This editorial summarises some of the key findings from these papers, reviews features of pandemic H1N1 influenza epidemiology in these countries, and lists some potential lessons for the northern hemisphere (and possible future waves in the southern hemisphere).

 Important findings from the papers in this issue

The effectiveness of pandemic flu vaccination campaigns -- like that now underway for H1N1 -- could be undermined by the public incorrectly associating coincidental and unrelated health events with the vaccines.

This is the conclusion of a paper published online Oct. 31 by the Lancet and authored by an international team of investigators led by Cincinnati Children's Hospital Medical Center.

"Regardless of whether someone gets the vaccine, bad things happen to people every day and generally occur at fairly predictable rates," said Steven Black, M.D., lead author and a physician in the Center for Global Health and Division of Infectious Diseases at Cincinnati Children's. "Identifying real safety concerns with new vaccines means we have to untangle actual safety signals from background medical events, which are those that would happen without vaccination."

A “perplexing” Canadian study linking H1N1 to seasonal flu shots is throwing national influenza plans into disarray and testing public faith in the government agencies responsible for protecting the nation's health.

Distributed for peer review last week, the study confounded infectious-disease experts in suggesting that people vaccinated against seasonal flu are twice as likely to catch swine flu.

The paper is under peer review, and lead researchers Danuta Skowronski of the British Columbia Centre for Disease Control and Gaston De Serres of Laval University must stay mum until it's published.

Met with intense early skepticism both in Canada and abroad, the paper has since convinced several provincial health agencies to announce hasty suspensions of seasonal flu vaccinations, long-held fixtures of public-health planning.

Dietary fish oils, rich in (n-3) PUFA, including eicosapentaenoic acid and docosahexaenoic acid, have been shown to have antiinflammatory properties. Although the antiinflammatory properties of fish oil may be beneficial during a chronic inflammatory illness, the same antiinflammatory properties can suppress the inflammatory responses necessary to combat acute viral infection. Given that (n-3) fatty acid-rich fish oil supplementation is on the rise and with the increasing threat of an influenza pandemic, we tested the effect of fish oil feeding for 2 wk on the immune response to influenza virus infection. Male C57BL/6 mice fed either a menhaden fish oil/corn oil diet (4 g fish oil:1 g corn oil, wt:wt at 5 g/100 g diet) or a control corn oil diet were infected with influenza A/PuertoRico/8/34 and analyzed for lung pathology and immune function. Although fish oil-fed mice had lower lung inflammation compared with controls, fish oil feeding also resulted in a 40% higher mortality rate, a 70% higher lung viral load at d 7 post infection, and a prolonged recovery period following infection.

BACKGROUND: Influenza vaccination is recommended for the elderly in many countries, but immune responses are weaker compared to younger adults. OBJECTIVE: To investigate the impact of daily consumption of a probiotic dairy drink on the immune response to influenza vaccination in an elderly population of healthy volunteers over 70 years of age. DESIGN: Two randomised, multicentre, double-blind, controlled studies were conducted during two vaccination seasons in 2005-2006 (pilot) and 2006-2007 (confirmatory). Eighty-six and 222 elderly volunteers consumed either a fermented dairy drink, containing the probiotic strain Lactobacillus casei DN-114 001 and yoghurt ferments (Actimel, or a non-fermented control dairy product twice daily for a period of 7 weeks (pilot) or 13 weeks (confirmatory). Vaccination occurred after 4 weeks of product consumption. Geometric mean antibody titres (GMT) against the 3 viral strains composing the vaccine (H1N1, H3N2, and B) were measured at several time intervals post-vaccination by haemagglutination inhibition test.

Last night Zero Hedge obtained some interesting documents from the CDC web site. They contain blank 'forced quarantine' orders from Iowa and Florida regarding novel H1N1 -- including quarantine to a 'secure detention center'-- which appear to be recent -- dated April 2009. Some may be aware the NIH and CDC just held an H1N1 conference in DC -- August 19-21 2009 -- that focused on 'mass fatality management'. For many, this should be cause for concern. As is becoming clear, our government is quite corrupt. The idea that this same government is now preparing for forced quarantine and mass vaccination should make anyone who has been following recent events shudder. There is something going on here, but governments have not come clean with the public. Why 'secure detention centers' in the U.S. and 'secure vaccination centers' in France if there is nothing to be concerned about?

Five flavonols (3, 5, and 9-11) were isolated from Rhodiola rosea, and compared with commercially available flavonoids (1, 2, 4, 6-8, and 12-14) to facilitate analysis of their structure-activity relationship (SAR). All compounds (1-14) showed neuraminidase inhibitory activities with IC(50) values ranging from 0.8 to 56.9muM. The in vitro anti-influenza virus activities of flavonoids 1-6, 8-12, and 14 were evaluated using two influenza viral strains, H1N1 (A/PR/8/34) and H9N2 (A/Chicken/Korea/MS96/96), testing their ability to reduce virus-induced cytopathic effect (CPE) in MDCK cells. We found that the activity of these compounds ranged from 30.2 to 99.1muM against H1N1- and 18.5 to 133.6muM against H9N2-induced CPE. Of compounds 1-14, gossypetin (6) exhibited the most potent inhibitory activity, with IC(50) values of 0.8 and 2.6muM on neuraminidases from Clostridium perfringens and recombinant influenza virus A (rvH1N1), respectively.

Few people changed their behaviour in the early stages of the swine flu outbreak, finds a study published on the British Medical Journal website. But the results do support efforts to inform the public about specific actions that can reduce the risks from swine flu and to communicate about the government's plans and resources.

Encouraging the public to undertake specific behaviours related to hygiene has proved useful in containing previous outbreaks of infectious disease, but motivating the public to adopt such behaviours can be difficult.

So researchers at Institute of Psychiatry King's College London and the Health Protection Agency set out to assess whether perceptions of the swine flu outbreak predicted changes in behaviour among members of the public England Scotland and Wales.

They conducted a telephone survey of 997 adults between 8 and 12 May 2009. Participants were asked nine questions about recent behaviours.

Preliminary information important for understanding the evolving situation 24 JULY 2009 | GENEVA -- The number of human cases of pandemic (H1N1) 2009 is still increasing substantially in many countries, even in countries that have already been affected for some time.Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources.

BACKGROUND: Influenza vaccination is recommended for the elderly in many countries, but immune responses are weaker compared to younger adults. OBJECTIVE: To investigate the impact of daily consumption of a probiotic dairy drink on the immune response to influenza vaccination in an elderly population of healthy volunteers over 70 years of age. DESIGN: Two randomised, multicentre, double-blind, controlled studies were conducted during two vaccination seasons in 2005-2006 (pilot) and 2006-2007 (confirmatory). Eighty-six and 222 elderly volunteers consumed a fermented dairy drink, containing the probiotic strain Lactobacillus casei DN-114 001 and yoghurt ferments (Actimel((R))), or a non-fermented control dairy product twice daily for a period of 7 weeks (pilot) or 13 weeks (confirmatory). Vaccination occurred after 4 weeks of product consumption. Geometric mean antibody titres (GMT) against the three viral strains composing the vaccine (H1N1, H3N2, and B) were measured at several time intervals post-vaccination by haemagglutination inhibition test.

Energy restriction (ER) without malnutrition extends lifespan in mice and postpones age-related changes in immunity. However, we have previously shown that aged (22 mo old) ER mice exhibit increased mortality, impaired viral clearance, and reduced natural killer (NK) cell cytotoxicity following influenza infection compared with aged mice that consumed food ad libitum (AL). To determine whether the detrimental effects of ER in response to influenza infection occur independently of advanced age, young adult (6 mo) male C57BL/6 mice consuming an AL or ER diet were infected with influenza A virus (H1N1, PR8). Young adult ER mice exhibited increased mortality (P < 0.05) and weight loss (P < 0.01) in response to infection. ER mice exhibited decreased total (P < 0.001) and NK1.1+ lymphocytes (P < 0.05) in lung and reduced influenza-induced NK cell cytotoxicity in both lung (P < 0.01) and spleen (P < 0.05).

For the purposes of inhibiting ACE and reducing cytokines, the following foods and compounds seem to be the best choices:

• Green tea (ACE inhibitor, reduces cytokines)
• Black tea (ACE inhibitor, reduces cytokines)
• Quercetin (possible ACE inhibitor, reduces cytokines)
• Pomegranate juice (ACE inhibitor)
• Red wine (ACE inhibitor)
• Turmeric (reduces cytokines)
• Black pepper (reduces cytokines)
• Raw crushed garlic (reduces cytokines)
• Red palm oil (reduces cytokines)
• Vitamin E (reduces cytokines)
• Coconut oil (reduces cytokines)

The following foods, while beneficial in many other ways, may not be a good idea in terms of reducing cytokine levels:

• Olive oil (may increase cytokines)
• Fish oil (may increase cytokines)
• Chocolate (ACE inhibitor, increases cytokines)

In addition, it seems that vitamin D3 could be on either list, depending on the dosage. Average blood levels of vitamin D may be worse than very low or high levels.

Pandemic Potential of a Strain of Influenza A(H1N1):Early Findings

"We have found a mechanism that the influenza virus uses to inhibit the body's immune response that emphasizes the vital role of a certain protein in defending against viruses,"," says Jae Jung, Ph.D., professor and chair of the Department of Molecular Microbiology and Immunology at the Keck School of Medicine of USC, and the principal investigator of the study. "Along with our previous studies (Nature 2007 and PNAS 2008), this finding could provide researchers with the information needed to create a new drug to enhance immunity and block influenza virus infection and replication."

Joshua Hamilton, the MBL's Chief Academic and Scientific Officer and a senior scientist in the MBL's Bay Paul Center; graduate student Courtney Kozul of Dartmouth Medical School, where the work was conducted; and their colleagues report their findings in the journal Environmental Health Perspectives.

"When a normal person or mouse is infected with the flu, they immediately develop an immune response," says Hamilton, in which immune cells rush to the lungs and produce chemicals that help fight the infection. However, in mice that had ingested 100 ppb (parts per billion) arsenic in their drinking water for five weeks, the immune response to H1N1 infection was initially feeble, and when a response finally did kick in days later, it was "too robust and too late," Hamilton says. "There was a massive infiltration of immune cells to the lungs and a massive inflammatory response, which led to bleeding and damage in the lung." Morbidity over the course of the infection was significantly higher for the arsenic-exposed animals than the normal animals.