CDC recommends for families to prepare for Pandemic

Pandemic Flu Planning Checklist for Individuals and Families

Pandemic Flu Planning Checklist for Individuals and Families in PDF format

Pronto pondremos a su disposición esta información en español.

Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®.

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

1. To plan for a pandemic:
• Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
• Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
• Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
• Volunteer with local groups to prepare and assist with emergency response.
• Get involved in your community as it works to prepare for an influenza pandemic.


2. To limit the spread of germs and prevent infection:
• Teach your children to wash hands frequently with soap and water, and model the correct behavior.
• Teach your children to cover coughs and sneezes with tissues, and be sure to model that behavior.
• Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick.


3. Items to have on hand for an extended stay at home:

Examples of food and non-perishables	Examples of medical, health, and emergency supplies
Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups	Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
Protein or fruit bars	Soap and water, or alcohol-based (60-95%) hand wash
Dry cereal or granola	Medicines for fever, such as acetaminophen or ibuprofen
Peanut butter or nuts	Thermometer
Dried fruit	Anti-diarrheal medication
Crackers	Vitamins
Canned juices	Fluids with electrolytes
Bottled water	Cleansing agent/soap
Canned or jarred baby food and formula	Flashlight
Pet food	Batteries
Other non-perishable items	Portable radio
	Manual can opener
	Garbage bags
	Tissues, toilet paper, disposable diapers

Bird flu case in Mongolia

Written by Ulaanbaatar correspondent Friday, 30 June 2006
AVIAN FLU UPDATE, MONGOLIA: RESULTS OF ADDITIONAL CASE OF H5N1,
KHUNT NUUR, SAIKHAN SOUM, NORTHERN MONGOLIA, MAY 4, 2006.


US Embassy, Ulaanbaatar. Mongolia has reported one additional case of H5N1 Avian Influenza, in a wild whooper swan. The swan was found sick at Khunt Nuur, Saikhan Soum, on May 4 in Bulgan, a northern province, during surveillance activities by the Central Veterinary Laboratory. The Ministry of Food and Agriculture did an initial rapid test for H5 and sent a sample to the OIE reference laboratory at Hokkaido University in Tokyo for confirmation of H5N1. This was confirmed on May 29. Active surveillance has been implemented in the western and central parts of Mongolia following the main flyways of migratory birds. A total of 182 samples have been collected from birds belonging to 27 different wild species. The Government of Mongolia (GOM) has quarantined the area and has found no further dead birds. There have been no human cases of avian influenza in Mongolia.

The U.S. Embassy reminds U.S. citizens in Mongolia to review information about H5N1 Avian Influenza A, including suggested precautions, on the U.S. Department of State’s “Avian Flu Fact Sheet,” at http://travel.state.gov/travel/tips/health/health_1181.html The State Department website includes answers to Frequently Asked Questions (FAQ’s), and links to websites of the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). Guidance on how private citizens can prepare for a “stay in place” response to an avian flu pandemic or a variety of other emergencies is available on the websites of the CDC, the American Red Cross (http://www.redcross.org) and the Federal Emergency Management Agency (http://www.fema.gov) and http://pandemicflu.gov/ websites.

China Bird Flu in 2003 story from AP

Chinese Health Ministry investigating whether man died of bird flu in 2003

BEIJING Health experts are checking to see if a man thought to have died of SARS, might really have had bird flu instead.

The World Health Organization says it happened in 2003, two years before any human cases of the disease were reported by mainland China.Officials are testing samples from the man. The case came to light in a letter Chinese scientists published in the June 22nd issue of the New England Journal of Medicine.The case raises questions about China's ability to track emerging diseases and cooperate with the W-H-O.China's failure to release timely information about the SARS emergence in late 2002-early 2003 was criticized by health experts for contributing to the disease's spread.SARS, which has very similar symptoms to bird flu, eventually killed 774 people worldwide.

Ducks and chicks removed from petting zoo

National Zoo moves chickens, ducks over bird flu

WASHINGTON (AP) — The National Zoo has removed the chickens and ducks from its children's petting farm to prevent the possible spread of bird flu from the animals to humans.

None the birds is infected with the avian flu virus, and there have been no bird or human infections reported in North America. Still, the zoo is moving them to its research center in Front Royal, Va., as a precaution, said director John Berry.

"This is the only place in the zoo where children are actively encouraged to pet and touch the animals," Berry said Thursday. "We want to be extra cautious."

The 18 ducks and 27 chickens are part of the Kids' Farm exhibit, a two-acre area that opened in 2004.

None of the other bird exhibits is affected because the birds and visitors don't have close contact, Berry said. He said the zoo was working with the Department of Agriculture on vaccines for its birds, particularly those considered endangered species, to prevent them from becoming infected.

The virus has killed at least 130 people worldwide since it began ravaging Asian poultry stocks in late 2003. Most human cases of bird flu have been traced to contact with sick birds.

Copyright 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

China to Block Blogs and Search Engines

Here is a problem that can effect information getting in and out of China and I see the potential
for bird flu news suppression.

China Cracks Down on Blogs, Search Engines
Jun 30 2:26 AM US/Eastern


BEIJING

China's Internet regulators are stepping up controls on blogs and search engines to block material it considers unlawful or immoral, the government said Friday.

"As more and more illegal and unhealthy information spreads through the blog and search engine, we will take effective measures to put the BBS, blog and search engine under control," said Cai Wu, director of the Information Office of China's Cabinet, quoted by the official Xinhua News Agency.

The government will step up research on monitoring technology and issue "admittance standards" for blogs, the report said, without providing any details.

China encourages Internet use for business and education but tries to block access to obscene or subversive material. It has the world's second-biggest population of Internet users after the United States, with 111 million people online.

China launched a campaign in February to "purify the environment" of the Internet and mobile communications, Xinhua said.

China has 37 million Web logs, or blogs, Xinhua said, citing a study by Beijing's Tsinghua University. It said that number was expected to nearly double this year to 60 million.

The government has launched repeated crackdowns on online material considered pornographic.

Cats, bird flu and disasters from WiredNews

When Fluffy Catches the Bird Flu

As medical research links house pets to SARS and bird flu, public health officials have something new to worry about: the risk that poodles and parakeets will need to be quarantined during an outbreak. The worst-case scenario? A runaway epidemic that can only be stopped by dispatching pets to that big animal shelter in the sky.

During Toronto's SARS outbreak in 2003, cats were ignored because health officials "had bigger things on their minds," said Dr. Scott Weese, a veterinarian and associate professor at the University of Guelph in Ontario. "But we need to think about it. What if someone had SARS in their household and infected their cat, and their cat went outside and infected feral cats? SARS would still be in Toronto, or there would be no cats in Toronto."

Weese and a colleague argue in the June issue of Emerging Infectious Diseases that health officials and veterinarians need to develop quarantine protocols for house pets in case of an epidemic.

Among household pets, cats and birds seem to pose the most danger as potential transmitters of epidemic disease. In Germany, a cat's death from avian flu earlier this year sparked the government to warn people to keep their cats inside and not to sleep with them.

Research does suggest that cats get avian flu from eating infected birds and can spread it to each other, said Dr. Michael Greger, who oversees public health for The Humane Society of the United States.

This is surprising because until now, "no flu virus in recorded history (has) been able to make cats sick," he said. Still, no cat-to-human cases have been reported. Cats and ferrets can also become infected with SARS and spread it to each other.

Dogs seem to be in the clear, at least so far. While they share a wide variety of diseases with humans and can spread some to people, there haven't been any reports of dogs coming down with avian flu, Greger said. Even so, dogs have shown signs of avian flu antibodies, suggesting they were exposed but didn't get visibly sick.

If a pet species was connected to avian flu, "the knee-jerk reaction with this virus is mass culling within (the habitat) of a susceptible species," Greger said. "That's what they do with birds."

But in Thailand, the mandatory killing of valuable fighting cocks led people to flee with their birds and spread the disease, he said. In the United States, if authorities even thought about killing cats, "people would run and stay with their cat at their aunt's house five states away."

In the wake of Hurricane Katrina, public health officials have been paying more attention to pets and people's reluctance to abandon them in times of crisis, said Dr. Clete DiGiovanni, a public health adviser with the Defense Threat Reduction Agency.

"When push comes to shove, a lot of people are not going to abandon their pets and may put their own lives at risk because of that," DiGiovanni said.

Indeed, a Zogby International poll released last October found that 61 percent of pet owners surveyed would refuse to evacuate before a disaster if they couldn't take their animals.

However, DiGiovanni added that he's attended meetings where public health officials have argued that it's "ludicrous" to worry about pets when human lives are at stake. According to him, the officials say something along the lines of, "We'll have a difficult enough time managing people; let's not worry about pets."

There are signs that the North American authorities aren't ready to handle simple human quarantines, let alone those complicated by potentially infectious pets.

During the 2003 SARS outbreak in Toronto, officials had trouble getting food to people who quarantined themselves at home at the request of the government, DiGiovanni said. And some of those who were self-quarantined left their homes to walk their dogs.

"We don't really have well-established quarantine protocols in place," said Dr. David Katz, director of the Yale-Griffin Prevention Research Center at Yale University. "It's a system we've neglected, and you can't fix that in a sprint. We need to be running a marathon."

ScienceNews/Wikipedia has prep for bird flu suggestions

Preparations for a potential influenza pandemic

Main article: Influenza pandemic

"The United States is collaborating closely with eight international organizations, including the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE), and 88 foreign governments to address the situation through planning, greater monitoring, and full transparency in reporting and investigating avian influenza occurrences. The United States and these international partners have led global efforts to encourage countries to heighten surveillance for outbreaks in poultry and significant numbers of deaths in migratory birds and to rapidly introduce containment measures. The U.S. Agency for International Development (USAID) and the U.S. Department of State, the U.S. Department of Health and Human Services (HHS), and Agriculture (USDA) are coordinating future international response measures on behalf of the White House with departments and agencies across the federal government." ^[7]

Together steps are being taken to "minimize the risk of further spread in animal populations", "reduce the risk of human infections", and "further support pandemic planning and preparedness".^[8]

Ongoing detailed mutually coordinated onsite surveillance and analysis of human and animal H5N1 avian flu outbreaks are being conducted and reported by the USGS National Wildlife Health Center, the Centers for Disease Control and Prevention, the World Health Organization, the European Commission, and others.^[9]

KFC in Hanoi

KFC sets up at focal point of avian flu crisis
Vietnamese customers crowd new restaurant
THE ASSOCIATED PRESS

HANOI, Vietnam -- American fast food chain KFC opened its first restaurant in Hanoi this month and said it plans to expand its operations elsewhere in northern Vietnam.

People packed the 120-seat restaurant during lunchtime on the opening day last week, and many had to line up to get their food.

"It's a very good start," said Nguyen Chi Kien, deputy general director of KFC Vietnam. "Hanoi is a huge potential market for KFC."

Kien said the company plans to open three more restaurants in the capital by the end of this year and looks to open several more in other northern cities.

KFC opened its first restaurant in Vietnam in 1997 in Ho Chi Minh City, the southern commercial hub, and now operates 19 restaurants there and one in neighboring Dong Nai province, Kien said.

Hanoi, a city of about 3.5 million people, has domestically owned chain restaurants and coffee shops, but KFC is the first U.S. fast food brand to enter the market.

Louisville, Kentucky-based Yum Brands Inc., is the parent of fast food chains KFC, Taco Bell and Pizza Hut.

The opening of KFC's first restaurant in Hanoi comes as Vietnam continues to battle the H5N1 bird flu virus. The country has suffered the highest number of human deaths in the world, but mass poultry vaccinations coupled with strong political will have slowed the spread of the virus. Vietnam has not reported any outbreaks in poultry since December and no human cases since November.

Kien declined to comment on the impact of bird flu on the company's business, but said all the chickens supplied by Thai CP Vietnam group must meet KFC's standards.



© 2005 Copyright The York Dispatch

News from cattlenetwork.com re: H5N1 in Russia

Hot Topic: Bird Flu Outbreak Intensifies in Russia's Tuva Republic

MOSCOW (Dow Jones)--The Siberian office of the Russian emergencies ministry Tuesday said the outbreak of the H5N1 strain of bird flu in the constituent Tuva Republic was intensifying.

The emergencies ministry first reported June 23 that 169 dead wild birds had been collected from the Ubsu-Nur Lake in the Ovyursky district of the Tuva Republic, and the presence of H5N1 in their blood samples had been confirmed by the Kemerovo veterinary laboratory.

Tuesday's statement said wild bird deaths were continuing, with 371 new deaths reported by Sunday afternoon. A total 1,622 birds have died since the first were found on the lake June 15. The emergencies ministry warned further outbreaks were likely towards the end of July among young wild birds, as their immunity to the disease was weak.

Zoo joins fight against bird flu

Zoo on forefront of avian flu fight Officials develop four-level protocol to combat outbreaks By KATHARINE OTT kott@journalsentinel.com Posted: June 26, 2006 While researchers in Alaska continue to monitor migratory bird flocks for evidence of avian flu, the Milwaukee County Zoo is one of the first zoos in the nation to develop its own response system to the virus. Avian Flu Photo/Jeffrey Phelps Rhinoceros hornbills are among the 80-plus species of birds at the Milwaukee County Zoo considered equally susceptible to avian flu. If the flu enters Wisconsin or neighboring states, all birds would be quarantined. The zoo's protocol for handling avian flu includes several procedures aimed at protecting the animal collection from an emerging disease. The protocol, in practice since April, consists of four response levels depending on the proximity of avian flu to the Milwaukee area. The zoo is operating at Level 1 - or normal - and that won't change unless a highly pathogenic influenza enters North America. Zoo officials acted early because of their experience with the West Nile virus in 2002, when 12 penguins died, said Kim Smith, bird curator and one of the primary authors of the response plan. They learned that after an initial outbreak, there is absolutely no immunity against an emerging disease. "We will take no chances," Smith said. She has been at the forefront of the national effort to prepare zoos for avian flu. She serves as the chairwoman of the Avian Scientific Advisory Group for the American Zoo and Aquarium Association, which advises bird curators on issues of bird management in zoos. Nationwide, zoos will act as surveillance and monitoring tools for avian flu. "Zoos are a perfect sentinel," said Robyn Barbiers, vice president of collections at the Lincoln Park Zoo in Chicago and chairwoman of the Animal Health Committee for the zoo association. "We are here 365 days a year with trained staff and veterinary care. If there is a disease with the potential to affect zoos, we will notice it." Not a worry for humans Authorities at the Milwaukee zoo worked with the Wisconsin Department of Agriculture, Trade and Consumer Protection, the zoo association and local public health officials to develop the procedures, which focus on the health and safety of the bird collection. If avian flu were to develop into a human disease, the federal Centers for Disease Control and Prevention would take over. Zoo Director Charles Wikenhauser said he believes the zoo is well-equipped in the event of an outbreak. The aviary and Animal Health Center, built in 2003, provide holding areas large enough to accommodate the birds, including the penguins, if quarantine is necessary. People should not be worried about visiting the zoo even if avian flu gets closer, said Donald Janssen, associate director of veterinary services at the San Diego Wild Animal Park. People have become sick with the H5N1 virus strain of avian flu , but it is very difficult for humans to become infected. "The virus would need a major change (to easily infect humans), and it has remained the same for roughly the past 10 years," Janssen said. "H5N1 is very bad news for birds, not people." No cases of avian flu have been found in North America. The World Health Organization reports 228 human cases and 130 human deaths from avian flu. Although threats of avian flu prompted the zoo to create a plan, the protocol applies to any emerging disease that could endanger the animals. Smith stressed that zoos in general have biosecurity measures already in place. An important part of the policy is ongoing communication between the zoo and local and federal authorities. "Most importantly," Smith said, "we want to avoid euthanization of the collection over a scare." Managing infection Each of the more than 80 species of birds at the zoo is considered equally susceptible to avian flu and would be treated the same under the plan. If avian flu entered the vicinity, the zoo would work with regulatory officials to possibly quarantine cats and primates. These are the remaining three levels in the protocol: • Level 2 corresponds to an incident of the H5N1 strain in North America and would require cautionary measures, such as posting a sign at the aviary to keep out those people who have visited an outbreak area. Uncooked poultry and raw eggs would be removed from any animal diets. • Level 3 corresponds to an incident of avian flu in neighboring states or Ontario. The aviary and the Family Farm and Animal Encounter buildings would be closed. All birds on the premises would be quarantined. Working with the CDC, the zoo would decide whether to vaccinate employees. • Level 4 corresponds to avian flu entering Wisconsin or northern Illinois. All birds would remain quarantined, and outdoor ponds would be drained. From the June 27, 2006 editions of the Milwaukee Journal Sentinel Have an opinion on this story? Write a letter to the editor or start an online forum. Subscribe today and receive 4 weeks free! Sign up now.

Feds say last resort to close borders to prevent H5N1

Feds: Bird Flu Border Closures Unlikely

By BARRY SCHWEID

The Associated Press
Monday, June 26, 2006; 6:18 PM

WASHINGTON -- Closing U.S. borders would be the last option in combating the spread of bird flu, a senior State Department official said Monday.

It would not be likely to decrease the number of cases, would interrupt essential services and would disrupt lawful border crossings, said Paula J. Dobriansky, undersecretary of state for democracy and global affairs.

"Avian flu is not only a health issue. It has economic, social and security ramifications," Dobriansky said at a seminar at the Nixon Center, a private think tank.

Dobriansky outlined a U.S. government program in which information and other support is provided to 46 countries. Congress has provided $3.8 billion to finance this year's expenses.

The Agriculture Department's inspector general last week reported that the Bush administration lacked a comprehensive plan to test and monitor bird flu in commercial poultry.

Dobriansky declined to reply directly to the report, saying it was not issued by the State Department. However, she said "our efforts have been extremely well-coordinated" and include strong support for the World Health Organization and the U.N. Food Agency.

There have been outbreaks of the disease in 53 countries, leading to the deaths of 130 people, Dobriansky said.

If the disease escalates it could lead to civil unrest and instability, the State Department official said, and she likened the potential impact to the bubonic or Black Plague, which started in China and ravaged Europe in the 14th century.

Most human cases of bird flu have been traced to contact with sick birds. In Vietnam, 42 people have died, and in Indonesia, 39, since the virus began ravaging Asian poultry stocks in late 2003.

Wild birds cause bird flu new research released

First avian flu deaths from wild birds

David Adam and James Meikle, London
June 27, 2006

FOUR people have died after catching bird flu from swans.

The deaths, just revealed by German scientists, happened earlier this year. They were the first confirmed cases of avian flu being passed from wild birds.

The victims, from a village in Azerbaijan, are believed to have caught the lethal H5N1 virus when they plucked dead swans to sell the feathers for pillows. Three other people infected by the swans have survived.

Andreas Gilsdorf, an epidemiologist at the Robert Koch Institute in Berlin, who led the team that made the discovery, said: "As far as we know this is the first transmission from a wild bird, but it was a very intensive contact.

"We know that the virus is carried by swans and we know that you can catch the virus if you have close contact, so it doesn't change anything, it's just the first time it has been reported."

Some ornithologists and conservation experts have tried to play down the role that wild birds could play in spreading the disease. The UN's Convention on Migratory Species organised a "world migratory bird day" in April, which it said came "at a time when migratory birds were being unfairly portrayed as harbingers of death and disease".

Almost all of the 220 other confirmed human cases of bird flu, including 130 deaths, have been linked to infected domestic poultry. A handful are believed to have caught the disease directly from infected humans.

The cluster of cases in the Salyan district of Azerbaijan, 144 kilometres south-east of Baku, was first reported in March. Six of the seven victims, all aged between 10 and 20, were from the same family.

Relatives initially denied any contact — hunting and trading wild birds and their products is illegal — but eventually admitted that the victims had plucked the feathers from dead swans, among a large number that died in February.

GUARDIAN

Catastrophic bird flu and you

Pandemic could overwhelm agencies
The Department of Health Services says local officials would be largely on their own if catastrophes hit multiple cities
By Sarah Arnquist
sarnquist@thetribunenews.com


Imagine multiple hurricane Katrinas hitting several U.S. cities simultaneously and lasting for weeks. Then imagine second and third waves of similar disasters occurring several months later.

In such a scenario, state and federal departments will be overwhelmed and local officials will largely be on their own, said Dr. Howard Backer, chief medical consultant for the California Department of Health Services.

A flu pandemic would be much the same, he told a group gathered Friday in San Luis Obispo at a pandemic influenza community forum.

"Pandemics are a local phenomenon," he said. "The local jurisdictions have the responsibility to carry out services."

Participants at the forum received information on statewide and county preparedness efforts and took part in a roundtable discussion with members of the business community who have begun pandemic influenza planning efforts.

Pandemics occur when a virus mutates into a new form that humans have no immunity from. For that reason, the disease is easily transmitted between people, said Dr. Christian Sandrock, a professor at UC Davis’ medical school and member of the California Preparedness Education Network.

Pandemics naturally occur, but scientists do not know for sure when or if the H5N1 avian flu virus causing alarm in Southeast Asia will mutate and spark a worldwide pandemic, Sandrock said.

"Just like predicting an earthquake, it is very hard to put your finger on when it’s going to happen," he said.

That uncertainty reinforces the need for sufficient preparation, he said. Pandemics are unique disasters because they come in multiple waves and could last for weeks, he said.

Maintaining the community infrastructure during a pandemic outbreak is a top concern, said Dr. Gregory Thomas, San Luis Obispo County’s health officer.

The county is partially prepared now and is developing a more detailed pandemic response plan that will help the county prepare for any natural disaster, Thomas said.

"These are general preparedness steps that help us prepare for earthquakes, fires, floods or any large communicable disease outbreaks," he said.

Backer said a pandemic will disrupt all aspects of society, and businesses and individuals must also prepare.

Business leaders should begin asking how they will continue operating if their workforce is home sick, and parents should have plans to care for their children if schools close. People should get to know their neighbors, who will be their support network in a pandemic flu outbreak, Backer said.

Health experts said individuals can prepare for a pandemic flu outbreak by practicing good hygiene habits, such as frequent hand washing, staying home from work when feeling ill, stockpiling two weeks worth of basic supplies and getting reliable information.

Web sites for more on pandemic flu:

www.slocounty.ca.gov/health: Local site with fact sheets on public health strategies regarding pandemic flu

www.pandemicflu.gov: U.S. government site with updates on pandemic preparedness

www.who.org: World Health Organization site with the latest information on avian flu
Click here to find out more!

Mutation and resistance concerns of Sumatran H5N1

Commentary

Amantadine Resistance in Karo Cluster in Sumatra Indonesia

Recombinomics Commentary
June 25, 2006

The recent meeting on human H5N1 in Indonesia revealed additional detail on the sequences from the Karo cluster and presented several phylogenetic trees representing various genes of the humans isolates.

The H5N1 isolates from the Karo cluster had been described in a prior WHO update. The update had some information on the bird flu sequences of the H5N1 genes from the family members. In the WHO update, the Tamiflu sensitivity of the isolates was noted.

Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).

The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak.

However, the report failed to mention that all isolates were amantadine resistant. Data at the conference indicated that most of the human isolates in Indonesia were resistant. Prior media reports had indicated that human isolates were sensitive.

In addition, information was presented on the father of the 10 year old nephew of the index case. Media reports had indicated a minor mutation had linked the isolates from the father and son. However, in addition to the minor mutation shared by father and son, the father had 8 additional changes in HA, 3 in NA and 2 in M. These changes suggest that the father had been infected with another flu virus, leading to acquisition of a number of polymorphisms by recombination.

The rapid accumulation of polymorphisms, coupled with amantadine resistance, is cause for concern.

Amantadine resistant isolates:

S31N