Victoria: “… there is not really that much true influenza around yet …”

15 06 2009

Dr Attila Danko posted another great comment on this blog this morning. Dr Danko is a GP in Ballarat (in regional Victoria). This guy is great – he’s seeing Swine Flu up close and interacting with Government agencies and labs – as well as the patients themselves. It’s worth reading his comment in full – I’ve reproduced it here in its entirety:

Another update. After getting my first Influenza A positive result today (almost 1 week after testing!) I rang the lab to find out if this would be further tested for specific typing (ie. novel H1N1) I ended up having a very lovely and informative chat to one of the microbiologists there. She reckons that about 2/3 of all influenza currently circulating in Victoria is actually non-swine seasonal flu. However samples from around the Austin and northern suburbs are now almost all novel H1N1. She also said that much of last years seasonal influenza in Australia was resistant to Tamiflu. She also agreed with my conclusion, based on seeing hundreds of patients with colds, and getting negative results bar one from the dozens I have tested (because they had severe symptoms) that there is not really that much true influenza around yet, swine or otherwise.

There are confusing statements going around, with some recommendations that (more sensibly) we should now only be treating high risk people with Tamiflu. (ie. people with respiratory disease etc). The recommendations on the link I posted to earlier though still stands. (treat everyone who meets the case definition).

By the way, the definition of “mild illness” is a slippery definition. My patient who tested positive had what most people would describe as severe symptoms, practically bedridden with aches and pains and feeling unwell, nauseous, cough, hot sweats and chills. My patient is at no risk of death, so this probably makes it classified as mild. However most lay people would assume “mild” means a bit of a sniffle and cough where you can go about your business. Ordinary influenza has got quite severe symptoms that put you in bed for a week, and if the one I tested is swine, it has these severe symptoms too, but nothing different to the influenza we usually see.

Totally irresponsible reporting from the Age today
http://www.theage.com.au/national/onethird-of-victorians-may-have-flu-20090614-c7eq.html
One third have swine flu?? Bollocks! One of those academics who hasn’t been near a patient in decades, most likely.

I’ve blogged on Dr Danko’s original comment yesterday here, where he talks about seeing a lot of patients with bad colds, but not much flu: and where he wonders if the Victorian Government’s response risks creating a Tamiflu-resistant strain of Swine Flu.

Anyway – it’s just fantastic having someone of Dr Danko’s calibre contributing to this debate.

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8 responses

15 06 2009
Dr Attila Danko

Thanks, Nick

I’ll post this in the right place now.

Well, my second positive test for influenza A this afternoon. Results coming in quicker, only 5 days since the swab. Again a much more severe illness clinically. I’m starting to get more of a feel of this influenza. I feel good that I started both of them on Tamiflu immediately on a stronger than usual suspicion.

15 06 2009
aussieflublogger

Thanks Attila. As I understand it – both the tests you’ve had done so far are positive for Influenza A – but they haven’t yet been sub-typed? That means we don’t know yet whether they are “novel” (ie Swine Flu)? (By the way – I’ve shot you an email to your Yahoo address). Cheers. Nick.

15 06 2009
Dr Attila Danko

Quite right, we do not know if they are novel H1N1, I believe that Victoria is no longer doing sub-type testing as a policy so I am not expecting I will ever know. Which is a pity, we could track the evolution of this pandemic much more accurately if we did.

15 06 2009
aussieflublogger

That’s really frustrating and enough to make a guy start to get a little bit paranoid…

15 06 2009
Victoria’s rushed back in with a vengeance « Swine Flu in Australia

[…] thing to note is that they don’t seem to be testing as much. Dr Danko said in one of his comments today that sub-typing of Influenza A cases may not be being done at all in Victoria now. Not sure […]

16 06 2009
Irene

Hi Nick, found you through crofs. Great stuff. Just FYI – subtyping won’t be done once it appears the majority of flu in an area is the new H1N1. We should be able to watch what is going on through the regular flu surveillance data. For Victoria you can find that here
http://www.vidrl.org.au/surveillance/flu%20reports/flurpt09/flu09.html
“From the swabs received from surveillance GPs to date 34 have been positive for influenza A, of which 13 have been confirmed as H1N1 swine influenza.”
We are watching closely to see whether the new flu pushes out the regular flu strains – seems to have happened in Chile.
And yes – we are concerned about the high degree of seasonal A/H1N1 resistance to Tamiflu – virtually 100%. However those strains that are resistant are so far sensitive to Relenza.
Thanks again for a very useful blog.

16 06 2009
aussieflublogger

Thanks Irene – this is really interesting and I’ll have a look at the link abd think about how to incorporate it.

Warm regards

Nick

19 06 2009
Dr Attila Danko

Fantastic, Irene, I was looking for this data without success until now; it really hasn’t been publicised much; I am being interviewed for Aus Doc so I will point out this site to them and hopefully they will publish it. You sound like a microbiologist or someone in public health; are you?

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