SAN DIEGO, California- Late in the afternoon of April 16, five days before the public learned about the current outbreak of swine flu, Michele Ginsberg received word of the US Centers for Disease Control and Prevention (CDC) that a 10 year old boy in the County of San Diego had tested positive for the rare infection. "I thought this could be the great, honestly," said Ginsberg, director of the epidemiology of the community of the county Health Agency of Human Services and San Diego. By "big one", meant the arrival Ginsberg as expected of a new strain of flu that humans had not seen before and could completely overwhelm the immune system, immunized.
Ginsberg said the two first cases surfaced that easily could have been missed, but new ongoing research projects in the San Diego area, both connected to the Naval Health research Center (NHRC) here, determined that something unusual was afoot. NHRC has developed sophisticated tests for influenza that can sort if the virus strain a or B, then the specific subtype based on two proteins, hemagglutinin and neuraminidase, on the viral surface. "In the usual context, they would have a quick test and found both were positive for influenza A, and that's as far as it would go, "says Ginsberg. But the new tests could not identify the specific subtype, so the Navy sent the samples to the CDC.
NHRC has received little attention for his crucial role in the discovery of the American epidemic with what is known as H1N1 influenza A virus, so Science Insider requested a detailed explanation of its influenza program and how these cases have come his way.
Answers after the jump.
Q: When did the NHRC to increase its influenza surveillance capabilities?
Our expansion was largely the result of an initiative of the Department of Global Emerging Infectious System (DOD) Defense intensify surveillance for pandemic because of the crisis bird flu (H5N1). NHRC increased febrile respiratory disease surveillance programs among trainees to recruit soldiers and populations to existing ships and expanded in the dependent population in San Diego. Furthermore, in a collaborative effort with the CDC, we have developed monitoring the southern border of California and Mexico, which has been improved this year to deepen surveillance and increase the diagnostic training our Mexican employees through funding from the Department of State's commitment biosafety Program.
Q. How these swine flu cases do end the NHRC?
The first case, a 10-year dependent DOD, was identified in a test to evaluate a new diagnostic virus. April 1st, a patient's specimen sample was tested on the diagnostic platform. The result suggested a flu, but the subtype of the virus negative. Our screening questionnaire considered the low risk patient for infection of bird flu. For the study protocol, a second sample was sent to a third laboratory in Wisconsin. This laboratory and the laboratory of the State, has confirmed influenza A / untyped discovery. The specimen and an isolated virus were then sent to CDC for confirmation. The CDC has determined that the virus was influenza A / swine / H1N1.
The second case, a female of 9 years of Brawley, California, was sampled in the collaborative study with the project monitoring of infectious diseases Border CDC. What was thought to be a routine sample was sent to our laboratory the first week of April. Our initial testing has shown influenza A / typed virus. Other tests on the platform Ibis T5000, which infers the types H and N from several genomic signatures, suggested an A / swine influenza / H1. [Although most tests rely on known DNA sequence or antibodies to identify influenza isolates, the Ibis T5000 has a mass spectrometer and can identify unknown subtypes.] This was just when we received word of CDC on the first case. At that time, we knew we were onto something important. The CDC then confirmed an A / swine influenza A / H1N1.
Q: What was the reaction of researchers NHRC
The elusive nature of influenza viruses keeps us on our toes. Because of the obvious public health concern, we found it prudent to send the sample to the CDC for confirmation.
Q: How many specimens of influenza NHRC process during the flu season and it has increased since the discovery of this swine flu cases
NHRC regularly treats around 5,500 specimens per year, about two-thirds coming during the influenza season from October to February. Normally, late in the flu season, the number of specimens that we treat every week falls. In the 08-09 season, cases began to decline in late January. This decline continued until last week when the number of cases and the sampling effort among our civilian population has increased
Q:.? Have you ever had specimens before you could not type and sent to the CDC
This was the first
Q:.? do do NHRC monitoring only for San Diego County or for a larger area
Our monitoring is quite extensive. NHRC is the Navy's hub for conducting surveillance in population-based recruitment centers involving the Army, Navy, Air Force, Marine Corps and Coast Guard. We also carry the onboard monitoring 20 large Navy ships deck US in the three fleets in the Pacific Basin, deployed among the populations and of course along the border U.S./Mexico. We participate in monitoring during military exercises such as Cobra Gold in Thailand, and also collaborate in monitoring febrile respiratory infection with the Singapore army
Q :. Do you now have the ability to identify this strain of swine flu or even samples must be sent to the CDC?
We hope to have the reagents for swine variant soon. We are currently developing our own reagents. At this point, we can use advanced diagnostics such as the Ibis T5000 to detect swine viruses. That said, it is important to share samples with new CDC for public health. Both institutions benefit from this collaboration.
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