Joshua Moore was due to partner Goshen at Wincanton in place of his brother Jamie, who is still recovering after fracturing his sternum and back in a fall at Fontwell in August.Gary Moore reports his son to be progressing well – but when asked if Jamie could be fit to ride at Ascot, he added: “That will be the doctor’s decision, not mine or Jamie’s.“He’s doing fantastically well, but you’ve got to respect a very serious injury like that.”- Advertisement – Goshen was one of three not declared for Wincanton’s feature race, along with Ballyandy and Song For Someone – which leaves six contenders including Paul Nicholls’ Solo, who reappears following a disappointing Cheltenham effort back in March.A 10-length winner of the Adonis Juvenile Hurdle on his British bow at Kempton in February, Solo could finish only eighth in the Triumph Hurdle at the Festival.He is the pick of stable jockey Harry Cobden, leaving Bryony Frost to team up with Nicholls’ other runner Diego Du Charmil – who was third on his return at Kempton last month.Master Debonair was an impressive winner of an Ascot Grade Two on his third hurdles outing last term, but Colin Tizzard’s charge has been off the track since disappointing in his Festival prep run in February – with connections deciding to head straight to Aintree, which was subsequently cancelled due to the Covid-19 pandemic.Sceau Royal won this race in 2016 and is back again for Alan King, with victory in the Welsh Champion Hurdle at Ffos Las already in the bag this term.Teqany won twice in September but was a length and a quarter behind Diego Du Charmil when fourth at Kempton, with Neil King’s Brandon Castle completing the line up. Goshen could be rerouted to Ascot later this month after a combination of unsuitable ground and an imperfect scope ruled him out of the Unibet Elite Hurdle at Wincanton.Trainer Gary Moore had earmarked Saturday’s Grade Two as a first outing over obstacles for Goshen since his unlucky unseating of rider Jamie Moore at the final flight when in a commanding lead in the Triumph Hurdle back in March.- Advertisement – Goshen has had two outings on the Flat in recent weeks. But the Wincanton ground – which is described as good, good to soft in places – and a minor health issue means the four-year-old may be seen next in the Coral Hurdle at Ascot on November 21.He said: “The ground wasn’t ideal, and everything with the horse is fine – but his scope wasn’t perfect, so we will get that right now.“It’s nothing serious, and we’ll have a look at the Ascot Hurdle.”- Advertisement – – Advertisement –
Vote counting continued Thursday in the tight presidential race, but odds of a Joe Biden win and a split Congress have increased. If that’s the final outcome, history shows that this type of gridlock in Washington has been quite market-friendly for stocks.The stock market has enjoyed the best returns under a Democratic presidency and a split Congress, according to Sam Stovall, chief investment strategist at CFRA Research, who analyzed data going back to the end of 1944. The S&P 500 has rallied 13.6% on average during a calendar year with such a political makeup, the data showed. Democratic U.S. presidential nominee and former Vice President Joe Biden speaks about the results of the 2020 U.S. presidential election during an appearance with in Wilmington, Delaware, U.S., November 4, 2020.Kevin Lemarque | Reuters – Advertisement – – Advertisement –
– Advertisement – The defendants, including Derek Chauvin, the white officer who pinned Mr. Floyd to the ground for more than nine minutes, had asked the court for a change of venue, arguing that they would not be able to receive a fair trial in Minneapolis because of pretrial publicity and the wide-scale protests against racial injustice Mr. Floyd’s death sparked in Minneapolis and around the country, as well the world. In an important win for the prosecution, a judge in Minneapolis on Thursday ruled that the four officers charged in the killing of George Floyd, a Black man who took some of his last breaths under the knee of a white officer on a Minneapolis street corner in May, will stand trial together.The judge also ruled that the news media can broadcast the trial, scheduled for next spring, an unusual move in Minneapolis, where courts are generally closed to cameras. The judge cited the coronavirus pandemic, which limits the number of people who can be in the courtroom at any time, and the immense national and international interest in the case.- Advertisement – Experts following the case in Minneapolis have said they believe Judge Cahill is determined to keep the case in the Twin Cities, understanding that moving the trial would likely provoke new protests, and fears of a less diverse jury. Such a move would have evoked the history of the Rodney King case in Los Angeles in 1992. The trial against the police officers who beat Mr. King was moved to a largely white suburb, resulting in acquittals on assault charges that led to riots.Judge Cahill also ordered that the jurors would remain anonymous, and said they would be partially sequestered during the trial and ordered to drive each morning to a secure location, from where they would be escorted to the courtroom.Attorney General Keith Ellison of Minnesota, whose office is overseeing the prosecution, said in a statement that he was satisfied with the court’s decision. – Advertisement – The two rookie officers, Thomas Lane and J. Alexander Keung, were the first on the scene the evening of May 25, after a convenience store clerk called the police saying that Mr. Floyd had tried to pass off a counterfeit $20 bill to pay for cigarettes.From the start, Mr. Floyd, 46, was agitated, and resisted being put in the back of a squad car, saying he was claustrophobic. After Mr. Chauvin arrived, Mr. Floyd was placed face down on the street, where he repeatedly said he couldn’t breathe.As bystanders gathered, one of them captured the scene on a cellphone camera; in video that was viewed around the world and provoked weeks of unrest in American cities, Mr. Floyd continued to say he couldn’t breathe and called out for his mother. By the time paramedics arrived, Mr. Floyd went limp, and seemed to stop breathing. He was later declared dead at a hospital. Earl C. Gray, the lawyer for Mr. Lane, and Eric Nelson, the lawyer for Mr. Chauvin, declined to comment on the judge’s rulings. Lawyers for the other two former officers did not immediately respond to requests for comment.All four of the former officers had asked for separate trials, and suggested in court filings that they each place blame for Mr. Floyd’s death onto one another. The prosecution, all along, has asked for one trial, arguing that multiple trials would traumatize Mr. Floyd’s family, eyewitnesses and the larger community, which faced weeks of unrest in the streets after Mr. Floyd’s death.In his ruling ordering one trial, Judge Cahill noted that the defense for all four defendants centers on similar arguments: that the use of force to subdue Mr. Floyd was justified; and that Mr. Floyd’s death was caused by drugs that were found in his system and underlying health conditions.The medical examiner has ruled Mr. Floyd’s death a homicide because of “cardiopulmonary arrest” from Mr. Chauvin’s knee, with other causes considered contributing factors. “Protests demanding justice for George Floyd continue,” the judge, Peter A. Cahill of Hennepin County, wrote in his ruling. “It is expected that, even with some overflow courtrooms, the demand by family members, the public, and the press to attend the joint trial will outstrip the court’s ability to provide meaningful access.”Judge Cahill also said the trial will remain — for now — in the Twin Cities, although he left open the possibility of moving it later if the court is unable to seat a jury untainted by the vast publicity the case has already generated. “The murder of George Floyd occurred in Minneapolis, and it is right that the defendants should be tried in Minneapolis,” he said. “It is also true that they acted in concert with each other, and the evidence against them is similar, so it is right to try them in one trial.”Mr. Chauvin, who had been a 19-year-veteran on the police force, is charged with second-degree murder and second-degree manslaughter, and faces 40 years in prison if convicted.The other officers, including two rookies who had aided Mr. Chauvin in pinning Mr. Floyd to the pavement in front of a convenience store, are charged with aiding and abetting second-degree murder. The former officer Tou Thao, who knelt to the side and kept at bay bystanders who were yelling that Mr. Floyd was having difficulty breathing, is also charged with aiding and abetting second-degree murder. All four former officers, who were fired after the incident, have been released on bail. – Advertisement –
Bale scores the winner as Spurs beat Brighton 2:59 – Advertisement – Wales will be without manager Ryan Giggs for all three matches, after he was arrested on suspicion of assault.His assistant coach, former Watford and Sheffield United defender Robert Page, will instead take charge of the team for the next three games and will be supported by Arsenal coach Albert Stuivenberg. “I think he’s getting better and better and better and today I felt that he could play 90 minutes but it’s not about can or cannot,” Mourinho said after the victory in Bulgaria.“It’s about managing the situation and keeping safe because he’s a player that needs to be safe. “Wales have two matches in the Nations League and I expect him to play but if they care as much about him as we do they have to manage the recovering periods.“They have to manage how many days difference between one match and another, they have to manage the minutes that he plays and they should not let him get into fatigue levels. Jose Mourinho was pleased with the attitude of his team during their 3-1 win over Bulgarian champions Ludogorets – having criticised their approach to week’s loss in Antwerp “He’s a player that’s had enough problems in the past. He’s working so much and we all are working so much and so carefully with him that we don’t want to destroy the work that everybody has been doing for the past couple of months.- Advertisement – Image:Gareth Bale played for 65 minutes for Tottenham against Ludogorets in the Europa League on Thursday 0:32 Jose Mourinho is calling on Wales to take care of Gareth Bale while he is on international duty and not “destroy” the work Tottenham have done with him.Giggs has returned to the Wales squad after missing October’s international games because of a knee injury.- Advertisement – “I think from what I’m reading that it is not (Ryan) Giggs that is responsible for these matches,” added Mourinho. “I’m sorry about it because on the previous fixtures he called me, we spoke about Ben Davies – not Gareth because Gareth was not there – but we spoke about Ben Davies.“We shared opinions about the situation which is probably not going to happen this time and the fact that one of the coaches is an Arsenal coach doesn’t make me very comfortable.“Honestly, it doesn’t make me very comfortable. I think national teams should have coaches that work exclusively for them and not coaches that work for other clubs.” They face the United States in a friendly at the Liberty Stadium on November 12 before crucial Nations League games against the Republic of Ireland on November 15 and Finland on November 18, both at the Cardiff City Stadium.Tottenham have been nurturing Bale back to full fitness after he rejoined the club on loan from Real Madrid in September.He scored the winner against Brighton last Sunday and played over an hour in the 3-1 win over Ludogorets Razgrad in the Europa League on Thursday.- Advertisement –
Mr. Biden’s team had a few more false starts this past week as the counting of votes continued. Early Friday, his campaign was advising that he would give a major prime-time speech by evening, as a crowd began to congregate outside a security barrier. He had planned to make use of the elaborate, flag-studded setup that has remained on display all week. This is someone who does not drink, who does not smoke, who once scolded friends at his own bachelor party for growing too rowdy. People have not historically hustled to spontaneous outdoor dance parties for Joe Biden.They have not clanged spoons against frying pans in celebration for him, formed triumphant honk-parades along Fifth Avenue for him, made Champagne toasts with strangers in his honor through chants and tears.- Advertisement – As the sun set in Wilmington on Friday, teleprompters were ready, “Biden Harris” flashed on big screens, and onlookers convened in an increasingly chilly parking lot nearby, hoping to catch a glimpse of a president-elect. But with Pennsylvania, and the race, still officially uncalled, they would have to wait another day.“I was here Tuesday night, and it was, like, very stressful,” Ms. Casey said. “To wake up in the morning and there still be hope, and the next day and the next day, and being patient — and to be here right now is absolutely incredible.” “BIDEN!” his supporters shouted outside Manhattan’s Washington Square Park on Saturday, the call echoing from apartment windows and taxis and sidewalk restaurant tables. “JOE BIDEN!”Joe Biden. That Joe Biden — institutionalist 70-something, incorrigible square, inexhaustible reciter of Irish poetry.But then, it seems that defeating President Trump can do strange things for a man’s reputation.- Advertisement – During the campaign, Mr. Biden’s team strained to create a mini-cult of personality around him, bragging on his signature accessory (aviators), his signature vice (ice cream), his interest in muscle cars.“Ridin’ With Biden,” went one slogan that kinda-sorta caught on.While most of the impromptu gatherings this weekend came in places unaccustomed to Biden-associated revelry — with rollicking bashes from Los Angeles to Washington to most any city in between, cheering Mr. Biden and his running mate, Kamala Harris — there was at least one ZIP code for which the embrace was more culmination than novelty.On Saturday, hundreds of cars jammed into a parking lot outside an events center in Wilmington, Del., ferrying in Mr. Biden’s friends and fans from the state he represented for 36 years in the Senate for a somewhat socially distanced drive-in rally. They sat on the roofs of their vehicles and played cornhole as they waited. They lugged around oversize American flags and kibitzed in lawn chairs and balanced Champagne flutes on top of their cars. They were proud, they said, of their state’s most famous resident.Carrie Casey, 49, said she had come in part to bask in “the utter excitement of a Delaware almost-native winning the presidency, as well as the first female and woman of color vice president.”She had turned out a few days earlier — the original Election Day, on Tuesday — for what was supposed to have been a victory party. Instead, with the outcome uncertain, Mr. Biden gave only brief remarks about trusting the process. Some of his supporters left deflated and on edge. In his own speech, Mr. Biden was quintessentially himself. After jogging onstage to a chorus of car honks, he began with a nod to the fine people of Delaware (“the people who brought me to the dance!”) and then decided to name a few, shouting out assorted local dignitaries like a city council candidate.He quoted relatives and welcomed Ms. Harris and her husband to the Biden family, “like it or not.”He tried to empathize with Trump voters, noting that he had “lost a couple times myself” in his political day. He acknowledged the present national gravity. He projected humility. He smiled a little.It had been a long campaign — three, actually, for the presidency alone in his lifetime. He looked out on guests who had seen him lose as often as they’d seen him win.This time around, the mood was purely festive — so much so that Maureen Whilby had decided to celebrate her 55th birthday on-site, where the fireworks and confetti blasts might as well have been for her, too. In Mr. Biden’s first hours as president-elect on Saturday, many voters who have appraised him through the decades as a particular kind of capital veteran — prone to perpetual windiness, requests for a “point of personal privilege” in casual conversation and digressions about dead senators — appeared ready to greet him as a sort of conquering hero. Updated Nov. 8, 2020, 9:37 a.m. ET “Winners write history,” said Amanda Litman, a former aide to Hillary Clinton’s 2016 campaign and the executive director of Run for Something, a group encouraging Democrats to seek local office. “I think he definitely gets bonus points for doing what no one thought was possible, even when we hoped it was.”Ms. Litman said she had spent the day walking miles across Brooklyn, sobbing in the street and encountering an intersection dance-a-thon, set to “Shout” by the Isley Brothers, that felt airlifted from a wedding reception.- Advertisement – “Best birthday in the world!” she said, several hours before the sky would light up with the words “Biden” and “president elect.” “Never forget this birthday. Unity. Bring us back together. No division.”Nearby, a cluster of Delawareans stood together wearing T-shirts indicating their past lives as Iowa volunteers for Mr. Biden, a reminder of the dark, icy days he spent in a state that rejected him in his 2008 run and again in 2020.“We were a little nervous at that point,” admitted Patti McKelvey, 53, a Pilates and yoga teacher from Wilmington. “But we were still 100 percent backing Joe.”State Representative Krista Griffith — “I’m Joe Biden’s state representative,” she noted — also made the trek to Iowa. This, she suggested, was more fun.“We all know him,” she said on Saturday. “We just can’t wait for the rest of the country to experience that.”Katie Glueck reported from Wilmington, Del. Mr. Biden, of course, has not generally been Washington’s leading purveyor of cool. That will not necessarily change over the long term. It is likely that gushing Democratic affection would have awaited anyone who managed to beat Mr. Trump.And yet, this is the person who did it.If the last two commanders-in-chief have been phenomenon candidates who became phenomenon presidents, Mr. Biden would appear to be ending the trend, comfortable instead with the identity that helped elect him: the man to rein things in a bit, to lower the collective volume before the neighbors complain. – Advertisement –
Mr. Foster said his organization was looking into Mr. Holland’s connections to the Arkansas Patriots, which he said was a local right-wing militia with ties to the larger Proud Boys network and advocates politically motivated violence.Members of the Arkansas Patriots have been showing up at protests with firearms, Mr. Foster said, adding that many claim to be current or former members of law enforcement and the military. Mr. Holland, he said, had been spotted at such protests recently as part of a militia group. The police chief’s undoing came at breakneck speed.- Advertisement – Mr. Elliott said that Mr. Holland quickly turned in the car, badge, cellphone and other items issued by the city, including a sawed-off shotgun. Mr. Holland carried his own sidearm on duty, which he retained, the mayor said.“As far as the city attorneys are concerned, we’ve done what they asked us to do and they’re going to stand behind us,” Mayor Elliott said. Mr. Holland’s calls for politically motivated violence were only the most recent ones he made on Parler, according to Mr. Foster. On Oct. 17, Mr. Holland called for Democrats to be hanged and said the F.B.I. and C.I.A. were Marxist organizations. Two days later he called for the F.B.I. director, Christopher A. Wray, to be tried for treason.He also encouraged followers to throw water on Democrats while in restaurants and to push them off sidewalks, calling them “traitors” who “have no right to live in this Republic after what they have done.”Aside from the former police chief, Marshall has three other full-time police officers and four part-time officers. “Death to all Marxist Democrats. Take no prisoners leave no survivors!!” Chief Holland added. Updated Nov. 9, 2020, 7:57 p.m. ET – Advertisement – Roughly a day later, after an NBC affiliate in Little Rock reported on his posts, Chief Holland was out of a job. His Parler account, which says he previously worked as a trainer in Iraq and Afghanistan, has since been made private but has not been deleted. After Mr. Holland resigned, Mr. Foster said the Ozark Mountain Proud Boys released a statement on Parler calling for Mr. Foster to be harmed. The Ozark Mountain Proud Boys did not respond to a message asking for comment on whether Mr. Holland was a member of their organization. Quinn Foster, a 26-year-old Arkansan who runs the Ozarks Coalition, an anti-racist watch group, and shared screen shots of Mr. Holland’s Parler posts with The New York Times, said he was alerted to the posts at 7 a.m. on Saturday. An hour later he had taken screen shots of Mr. Holland’s online statements on Parler that were then shared with the mayor’s office in Marshall.By 3:20 p.m. the mayor’s office released a statement saying that Chief Holland had resigned, effective immediately.Email requests for comment were not immediately returned by Mr. Holland on Monday. Efforts to reach Mr. Holland by phone were unsuccessful.- Advertisement – As the results of the presidential election unfolded last week and former Vice President Joseph R. Biden Jr. took the lead in the Electoral College, the police chief of Marshall, Ark., a town of roughly 1,350 people north of Little Rock, shared his feeling of rage online.“Will you and several hundred more go with me to D.C. and fight our way into the Congress and arrest every Democrat who has participated in this coup?” Chief Lang Holland posted Friday on Parler, a right-wing messaging site. “We may have to shoot and kill many of the Communist B.L.M. and ANTIFA Democrat foot soldiers to accomplish this!!!”- Advertisement – Kevin J. Elliott, Marshall’s mayor, said that Mr. Holland was hired as police chief about two years ago and that he was unaware of his political beliefs until Friday night, when he received screen shots of the chief’s posts on Parler from people around the country. On Saturday morning, Mr. Elliott said, he contacted lawyers from the Arkansas Municipal League, who informed him that he was within his rights to fire Mr. Holland.Mr. Elliott summoned Chief Holland to a meeting at the Marshall City Hall at 1 p.m. Saturday and showed him the posts. Mr. Holland declined to answer the mayor’s questions and announced his decision to resign.
The death toll remains at one, but health officials in Maryland and Idaho are still waiting for lab results in two deaths that may be related to the outbreak. It’s not clear why investigators searched the Growers Express facility. A press release on the companys Web site said Growers Express does not process bagged spinach. It packages and markets a variety of fresh vegetables under the Western Express, Farm Day, and Green Giant Express labels, none of which has been connected to the fresh spinach recall. “The small amount of bagged spinach marketed by Growers Express is purchased from outside processors, none of which have been connected to the recent recall,” the company said. The firm said it was cooperating with federal investigators. See also: “We are investigating allegations that certain spinach growers and distributors may not have taken all necessary or appropriate steps to ensure that their spinach was safe before they were placed into interstate commerce,” US Attorney Kevin Ryan told the AP. Oct 5, 2006 (CIDRAP News) A nationwide outbreak of Escherichia coli O157:H7 infections linked to fresh spinach has increased to 192 cases and triggered what was described as a federal raid on two produce processing plants. Last week, the FDA announced laboratory and epidemiologic evidence from multiple states, and the CDC determined that all spinach involved in the outbreak has been linked to Natural Selection Foods, based in San Juan Batista, Calif. The company recalled its products on Sep 15; four other companies recalled products because they had received spinach from Natural Selection Foods. Oct 4 FDA press releasehttp://www.fda.gov/bbs/topics/NEWS/2006/NEW01476.html The 192 cases represent an increase of 5 since Sep 28, according to updates from the Food and Drug Administration (yesterday) and the Centers for Disease Control and Prevention (CDC) (Oct 3). Ninety-eight people (51%) were hospitalized, and 30 cases of hemolytic uremic syndrome (HUS), a serious kidney condition, hae been reported. The outbreak has affected people in 26 states and one Canadian. Samples from eleven bags of spinach have been confirmed to contain the outbreak strain of E coli; all but one were Dole baby spinach, one of the brands distributed by Natural Selection Foods. A sample from Nevada did not list the brand. Oct 4 Natural Selection Foods press releasehttp://www.nsfoods.com/ Federal officials told the AP they didnt think anyone deliberately contaminated any spinach. In its update on the outbreak yesterday, the FDA pointed to a long history of E coli outbreaks involving leafy greens from central California. Though other companies have not been implicated in this particular outbreak, the FDA said it and the state of California expect the industry to develop comprehensive plans to minimize the risk of another outbreak. Implementing the plans will be voluntary, but the FDA and the State of California said they havent ruled out the possibility of future regulatory changes. Natural Selection Foods said in its press release that it had already provided the FDA and the California Department of Health with the documents sought yesterday, but that it was cooperating with the investigation. The company also said tests done at its processing facilities by independent scientists and government investigators have come back negative, suggesting the contamination source is at the farm level. Meanwhile, the outbreak has prompted a criminal investigation by the FBI and FDA. According to an Associated Press (AP) report today, federal agents executed search warrants yesterday at a Natural Selection Foods facility in San Juan Batista and a Growers Express plant in Salinas (Calif.) to determine if the companies violated food safety or environmental laws. The FDA has not cleared any of the processing plants and continues to investigate nine farms in three counties in the greater Salinas Valley growing area.
Jul 25, 2007 (CIDRAP News) – World health experts have been working under a general assumption that a feared reassortment between human and avian influenza viruses—a scenario that could spark a pandemic—might only occur during a short winter interval, but researchers who recently examined virus circulation patterns warn that time frames for coinfection are wider and sometimes unpredictable.Researchers Andrew W. Park, from the Institute of Research for Development in Montpellier, France, and Kathryn Glass, from the Australian National University in Canberra, report their findings in the August issue of The Lancet Infectious Diseases.Though much is known about human influenza patterns in temperate zones such as the United States and Australia, little is known about the seasonality of influenza A infections in tropical and subtropical areas in Asia, where the H5N1 virus is more common, the authors write. Reviewing the timing of influenza A infections, as well as of H5N1 poultry outbreaks and human infections, could reveal useful information for epidemiologists and pandemic planners, they add.H5N1 patternsPark and Glass examined the seasonality of the H5N1 virus using data from the World Organization for Animal Health (OIE) and the World Health Organization (WHO) from 2003 onwards as well as articles from the literature on animal outbreaks and human cases in Hong Kong between 1997 and 2003.They investigated the seasonality of the influenza A virus by searching for published reports of confirmed reports in east and southeast Asia between 1996 and 2005. The researchers also looked for changes in patterns between host range and seasonality by conducting a literature search that covered the period from 1996 to 2006.After comparing the data, they found that human H5N1 cases generally coincide with poultry infections, though human cases sometimes occur before or shortly after poultry outbreaks. A review of H5N1 isolates taken from aquatic and terrestrial poultry in mainland China from July 2000 to January 2004 showed that a greater percentage of birds were positive for the virus during winter months.Similarly, the researchers found that the presence of H5N1 in isolates from birds in live poultry markets in China showed a winter pattern, but a number of outbreaks extended into summer months, suggesting that risks are not confined to winter.Influenza A trendsSurveillance data from the Pacific basin from 1954 to 1988 show a marked variation in human influenza A activity, the authors say. They found that while consistent seasonality of viral activity between December and March occurs in Japan, patterns were not uniform across the rest of the region.”Periods of moderate to high activity typically last longer in tropical and subtropical regions than in temperate regions, and they occur more frequently than once a year,” Park and Glass write. “It is not prudent to assume there is a short period of risk of reassortment.”More influenza surveillance in east and southeast Asia would be useful, especially where H5N1 has been confirmed, they added.Host changesThe existence of new host populations in which the H5N1 virus is endemic raises the pandemic flu risk to humans, especially when there is close contact between people and the infected animals, the researchers point out.Between 2003 and 2005 the H5N1 virus was found in several new host species, they report, including tigers, leopards, pigs, raptors, and domestic cats. But they say the greatest concerns are (1) the frequency with which the virus is found in domestic ducks, because the ducks have close contact with people, and (2) isolation of the virus from pigs in China and Indonesia, because receptors in their respiratory tracts make coinfection with human and avian strains and thus generation of reassortant strains possible.Interventions impact seasonalityThough a review of the H5N1 viral circulation data suggest some seasonal factors, outbreak patterns also appear to be affected by interventions such as culling, the authors report. Migration and movement of birds are also thought to play a role.”Looking to the future, the suggestion that H5N1 virus has become endemic in ducks is of great concern,” the researchers write. Poultry culls have successfully contained the spread of the disease in many instances, but if the virus is endemic in some species, culling might not be practical and animal health officials may need to focus on vaccination and intensive surveillance to contain the virus, they say.Awareness of the seasonal risk of both human disease and viral reassortment can help health officials design control measures to help prevent an emerging pandemic strain, the authors conclude.Park AW, Glass K. Dynamic patterns of avian and human influenza in east and southeast Asia. Lancet Infect Dis 2007 Aug;7(8):543-8 [Abstract]
Aug 29, 2008 (CIDRAP News) – Some healthcare experts have wondered if large mortality reductions among older people who receive seasonal influenza immunizations are real or if the findings are biased by a “healthy-user” effect. But now a study that more rigorously controlled for confounders suggests that the benefits are overstated.The study, by Canadian researchers who evaluated data from patients admitted to six Capital Health hospitals in Alberta, appeared in the Sep 1 issue of the American Journal of Respiratory and Critical Care Medicine.It revealed no statistical difference between in-hospital mortality rates of elderly patients receiving seasonal flu vaccination and of those not vaccinated.It is the latest among a handful of recent studies that have cast doubt on the benefits of flu vaccines for older people and may call for a reexamination of public policy on flu vaccination among the elderly. A study that appeared in the Aug 2 issue of The Lancet suggested that the vaccine’s ability to protect the group from pneumonia was less than expected.Accounting for ‘good behavior’The research group pointed out that most evidence on the benefit of influenza vaccines in older patients is based on observational studies that suggest a 50% mortality rate reduction. However, they said many experts have suspected that such a high benefit is implausible.For example, they wrote that though vaccination rates in the United States’ elderly population have risen from 15% to 65% over the over the past 20 years the increase has not been matched by decreasing hospitalization and mortality rates.”Previous studies were likely measuring a benefit not directly attributable to the vaccine itself, but something specific to the individuals who were vaccinated—a healthy-user benefit or frailty bias,” said Dean T. Eurich, PhD, the study’s first author, in a press release from the American Thoracic Society, which publishes the American Journal of Respiratory and Critical Care Medicine. Eurich is a clinical epidemiologist and assistant professor at the University of Alberta’s School of Public Health.Also, the researchers wrote that other studies have detected similar mortality reductions during the times of year when influenza viruses aren’t circulating, which cast further doubt on the size of the vaccination benefit.Sumit Majumdar, MD, MPH, principal investigator and associate professor of medicine at the University of Alberta, said in the press release, “The healthy-user effect is seen in what doctors often refer to as their “good” patients—patients who are well-informed about their health, who exercise regularly, do not smoke or have quit, drink only in moderation, watch what they eat, come in regularly for health maintenance visits and disease screenings, take their medications exactly as prescribed—and quite religiously get vaccinated each year so as to stay healthy.””Such attributes,” he said, “are almost impossible to capture in large-scale studies using administrative databases.”Majumdar and colleagues hypothesized that if a healthy-user effect was responsible for mortality benefits, then the same benefit would be seen during the “off season,” when the influenza virus wasn’t circulating.The researchers had access to a large database that allowed them a unique opportunity to explore the bias, because it included a number of potential healthy-user indicators such as smoking and functional status.Looking beyond biasesThey analyzed data from 704 patients ages 65 and over who were admitted to the hospital for community-acquired pneumonia during non-flu season intervals from 2000 through 2002. Researchers matched 352 patients who had received their flu vaccines against 352 controls who did not.Twelve percent (81) of the patients died. When the group looked at in-hospital death rates, they found that vaccinated patients were about half as likely to die as those who weren’t vaccinated (28 [8%] versus 53 [15%]), which is consistent with past observational studies. However, when they adjusted for the healthy-user effects, the benefit was much smaller, and at 19% didn’t reach statistical significance.The authors concluded that a difficult-to-detect healthy-user effect is present among vaccinated patients, and that other analyses of vaccine benefit during influenza season probably overestimate the benefit of vaccination. However, they cautioned that their findings might not be generalized to healthier, lower-risk patients in a nonhospital setting.Putting the findings to useThe findings have broad implications for public health, the authors wrote. Patients with chronic diseases, as well as their contacts, should still get their annual flu vaccines, Majumdar said in the press release. “But you also need to take care of yourself. Everyone can reduce their risk by taking simple precautions,” he said, such as hand-washing, avoiding sick people during flu season, taking antiviral medication, and seeking prompt medical care.Inflated mortality reductions noted in previous studies could hamper efforts to develop better vaccines, particularly for use in elderly populations, they wrote. Evidence-based findings, however, may help policymakers to direct their efforts more toward hand-washing and vaccinating children and healthcare workers, they added.And for researchers, the findings might serve as a useful reminder, Majumder said in the press release. “The healthy-user effect is everywhere you don’t want it to be.”Eurich DT, Marrie TJ, Johnstone J, et al. Mortality reduction with influenza vaccine in patients with pneumonia outside ‘flu’ season: pleiotropic benefits or residual confounding? Am J Respir Crit Care Med 2008 Sep 1;178(5):527-33 [Abstract]See also:Aug 29 American Thoracic Society press releaseAug 8 CIDRAP News story “Study: Flu shots may not protect elderly from pneumonia”
Apr 21, 2009 (CIDRAP News) – Two California children who had not had contact with pigs recently recovered from infections with “unique” swine influenza viruses, raising concern about possible human-to-human transmission and putting health authorities on alert, the Centers for Disease Control and Prevention (CDC) reported today.The two cases were in a 10-year-old boy in San Diego County and a 9-year-old girl in neighboring Imperial County, but they are apparently unrelated, the CDC said in an MMWR Dispatch report today.”The viruses from the two cases are closely related genetically, resistant to amantadine and rimantadine [the two older flu antivirals], and contain a unique combination of gene segments that previously has not been reported among swine or human influenza viruses in the United States or elsewhere,” the CDC report says.The lack of any known exposure to pigs in the two cases increases the chance that the children contracted their infections from other people, the CDC said. The agency advised physicians to consider animal influenza virus infections in patients who recently were in the two California counties or had contact with pigs.The CDC says it received reports of 12 human swine flu cases from December 2005 through January 2009, an increase from the previous long-term average of about one case every 1 to 2 years. The “vast majority” of such cases do not lead to human-to-human transmission, but all need to be investigated thoroughly, the agency states.Illnesses began in MarchThe 10-year-old boy fell ill with fever, cough, and vomiting on Mar 30, according to the CDC. He was taken to a clinic, where he received symptomatic treatment, and he recovered in about a week. He had not received flu vaccine this season. The boy and his family said he had had no exposure to pigs.Initial testing at the clinic indicated an influenza A virus but was negative for human subtypes H1N1, H3N2, and H5N1, the report says. A sample was sent to reference laboratories, which were unable to identify the subtype. The CDC received a sample Apr 14 and identified the virus as swine influenza A/H1N1.The boy’s mother had a nonfebrile respiratory illness in the first few days of April, and his 8-year-old brother was sick with a cough and fever on Apr 11, but no respiratory samples were taken during their illnesses.In the other case, the CDC received an influenza specimen on Apr 17 that the Naval Health Research Center in San Diego had sent as a type A virus that couldn’t be subtyped, according to the report. The CDC identified the virus as a swine influenza A/H1N1 isolate the same day.The sample came from the 9-year-old girl, who got sick with a cough and fever (104.3ºF) on Mar 28, the report says. She was treated at an outpatient clinic with antibiotics and an antihistamine, and she recovered uneventfully. The girl reported that she had visited a fair with a pig exhibit about 4 weeks before her illness but that she had not seen the pigs, and she reported no other exposure.The girl’s 13-year-old cousin, who was living with the family, had a flu-like illness 3 days before she got sick, and her 13-year-old brother had similar symptoms on Apr 1, the CDC reports. But neither was tested for flu while they were sick.So far, no epidemiologic link between the two cases has been found, nor have any other cases been identified involving the new strain, the report says. Case and contact investigations by the county and states health agencies are under way.A new combination of genesThe viruses from the two patients are similar, and the majority of their genes, including the hemagglutinin gene, are similar to those of swine flu viruses that have circulated in US pigs since about 1999, the CDC reports. But the genes for the neuraminidase (NA) and matrix (M) proteins are similar to corresponding genes of Eurasian swine flu viruses.”This particular genetic combination of swine influenza virus segments has not been recognized previously among swine or human isolates in the United States, or elsewhere based on analyses of influenza genomic sequences available on GenBank,” the report states.While there is no formal system for monitoring what viruses circulate in US swine, viruses with this combination of genes are not known to be circulating in the country, the report adds.Testing is under way to learn whether the two viruses are susceptible to the neuraminidase inhibitor drugs oseltamivir and zanamivir.The CDC advises that clinicians should consider animal as well as seasonal flu virus infections in patients who live in or who visited San Diego or Imperial County or were in contact with sick people from either county in the week before their illness onset. It also urges clinicians to take a nasopharyngeal swab in such cases and to contact their state or local health department to arrange for testing at a state public health lab.CDC. Swine influenza A (H1N1) infection in two children—Southern California, March-April 2009. MMWR Dispatch 2009 Apr 21;58 [Full text]