{ From user diannep, Model How_i_get_sick at Wed, Oct 08, 2008 10:24 AM~~ } Softwareversion 4.1.1 { System Variables with non-default values: } Description Time: Dynamic simulation periods are specified in Time's d~~ efinition. This is usually a list of numbers or labels, typically in ~~ some unit of time (days, weeks, months, etc.). Use the “Dynamic()” f~~ unction in your variables to perform dynamic simulation. Typechecking := 1 Checking := 1 Saveoptions := 2 Savevalues := 0 Model How_i_get_sick Author: casman Date: Tue, Feb 06, 2007 5:59 PM Saveauthor: diannep Savedate: Wed, Oct 08, 2008 10:24 AM Defaultsize: 48,24 Diagstate: 1,1,7,1262,865,17 Diagramcolor: 65535,65535,65535 Fontstyle: Arial, 15 Fileinfo: 0,Model How_i_get_sick,2,2,0,0,C:\Documents and Settings\dia~~ nnep\My Documents\CAMRA\expert model of flu transmission revised Oct0~~ 7.ANA Att__diagramprintsca: 50,1,1,0,1,1,2794,2159,15,0 Variable Infectious_person_wi Title: infectious person with pandemic strain of flu Description: adults are contagious 1 day before falling ill and 3 to 7~~ days after symptoms develop. Children can be contagious longer than ~~ a week. Janse & Gerba 2003 Definition: vulnerable Nodelocation: 768,48,1 Nodesize: 60,40 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Sneezing Title: sneezing coughing~ speaking Definition: Infectious_person_wi Nodelocation: 808,161,1 Nodesize: 48,31 Nodecolor: 65535,65535,65535 Variable Nose_blowing Title: nose blowing Definition: Infectious_person_wi Nodelocation: 1016,192,1 Nodesize: 40,24 Nodecolor: 65535,65535,65535 Variable Mucus_on_hand Title: mucus on hand Definition: cover_mouth+nose_blowing+Mucus_on_tissue Nodelocation: 1016,440,1 Nodesize: 36,28 Nodecolor: 65535,65535,65535 Variable Droplets_in_air Title: droplets in air Description: Droplets from coughs and sneezes travel 3 feet. ~ Introduction of flu by one family member usually results in infection~~ of 2/3 of other family members.~ ~ Janse and Gerba The Germ Freak's Guide to Outwitting Colds and Flu 20~~ 03 Health Communications, Inc.~ ~ Temperature and relative humidity affect droplet size. at high relati~~ ve humidity, droplets grow and fall out. at low temp and RH droplets ~~ are stablized. Influenza virus transmission is dependent on relativ~~ e humidity and temperature Lowen et al 2007 PLoS Pathogens,3(10):e151~~ Definition: sneezing+Animal_fluid+elbow_cough-temperature Nodelocation: 624,304,1 Nodesize: 36,28 Windstate: 2,411,237,476,224 Nodecolor: 65535,65535,65535 Variable Objects Title: droplets hit objects Description: Objects frequently contaminated by sick people:~ light switches, phones, remote control, microwave handle, refrigerato~~ r handle, kitchen counters, sink faucet handles, shared games and toy~~ s, bathroom sink, counter, faucet, doorknob, toilet handle), hand tow~~ els and dishcloths, toothbrushes Jense and Gerba 2003 Definition: sneezing+Animal_fluid Nodelocation: 576,248,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Inhale_droplets Title: people inhale droplets Definition: Droplets_in_air+kissing Nodelocation: 672,408,1 Nodesize: 56,20 Nodecolor: 65535,65535,65535 Variable Cover_mouth Title: people cover mouth with hand Definition: sneezing Nodelocation: 912,312,1 Nodesize: 52,28 Nodecolor: 65535,65535,65535 Variable Hand_to_fomite_trans Title: hand to fomite transfer Description: Objects frequently contaminated by sick people:~ light switches, phones, remote control, microwave handle, refrigerato~~ r handle, kitchen counters, sink faucet handles, shared games and toy~~ s, bathroom sink, counter, faucet, doorknob, toilet handle, tooth pas~~ te, hand towels and dishcloths, toothbrushes Jense and Gerba 2003 Definition: Mucus_on_hand+Stool_on_hand Nodelocation: 520,336,1 Nodesize: 40,36 Windstate: 2,100,145,476,224 Nodecolor: 65535,65535,65535 Variable Mucus_on_tissue Title: mucus on tissue Definition: nose_blowing+sneezing Nodelocation: 952,256,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Transmission Title: transmission Definition: dynamic(0,infectious_dose+Hand_to_mouth_virus+Food_is_cont~~ aminated+Distancing_interrupt-vaccine_failure+mask_wearing+prophylaxi~~ s_failure+Care_givers_infected[time-1]+vertical[time-1]-superstition+~~ fomite_to_mouth) Nodelocation: 496,856,1 Nodesize: 60,24 Windstate: 2,102,90,476,224 Nodecolor: 58982,58982,58982 Variable Spitting Title: spitting Definition: Infectious_person_wi Nodelocation: 320,192,1 Nodesize: 36,20 Nodecolor: 65535,65535,65535 Variable Droplets_caught Title: droplets caught in a mask Description: mask wearing protects others, not the wearer Definition: dynamic(0,sneezing+compliance[time-1]) Nodelocation: 784,296,1 Nodesize: 48,31 Nodecolor: 65535,65535,65535 Variable Hand_disinfection Title: hand disinfection Definition: dynamic(0,Mucus_on_hand-compliance[time-1]-hand_to_hand) Nodelocation: 1024,528,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Virus_inactivated Title: virus inactivated Definition: hand_disinfection Nodelocation: 968,584,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Social_distancing Title: social distancing Description: sick people stay home and avoid household contacts and to~~ uching objects toughed by others, especially children, pregnant women~~ , immunocompromised people. When going to ER, tell reception about ra~~ sh, fever, respiratory symptoms. They may mask you. Janse & Gerba 200~~ 3 Definition: dynamic(0,closures[time-1]+compliance[time-1]) Nodelocation: 1056,736,1 Nodesize: 44,32 Nodecolor: 65535,65535,65535 Variable Fomite_to_hand Title: fomite to hand transfer Description: The common cold virus can survive up t 3 days outside the~~ nasal passages on objects and surfaces. 70% of people who have a col~~ d have infectious germs on their hands. Janse and Gerba 2003 Definition: Fomite_contaminated Nodelocation: 320,512,1 Nodesize: 48,31 Windstate: 2,-365,55,558,905 Nodecolor: 65535,65535,65535 Variable Hand_to_mouth_virus Title: hand to mouth/eye transfer Definition: people_prepare_food+Fomite_to_hand+hand_to_hand Nodelocation: 320,672,1 Nodesize: 52,28 Windstate: 2,481,169,476,224 Nodecolor: 65535,65535,65535 Variable No_transmission Title: transmission interupted Definition: Social_distancing+Droplets_caught+Virus_inactivated+Vaccin~~ ation+prophylaxis+Hand_washing2-herd_immunity+Fomite_disinfection-Les~~ s_than_infectious+infection_control+elbow_cough-glove_wearing Nodelocation: 952,856,1 Nodesize: 52,28 Nodecolor: 58982,58982,58982 Variable People_prepare_food Title: people prepare food Description: Expert opinion based modelling of the risk of human infec~~ tion with H5N1 through the consumption of poultry meat in Germany.~ M Greiner, C Muller-Graf, P Hiller, C Schrader, A Gervelmeyer, L Elle~~ rbroek, and B Appel~ Berl Munch Tierarztl Wochenschr, March 1, 2007; 120(3-4): 98-107. ~~ Abstract ~ ~ Bundesinstitut für Risikobewertung (BfR, Federal Institute for Risk A~~ ssessment), Berlin, Germany. matthias.greiner@bfr.bund.de ~ ~ According to current scientific opinion the risk of human infection w~~ ith H5N1 via preparation and consumption of poultry meat is negligibl~~ e.This opinion has not yet been challenged by a formal risk assessmen~~ t, due to the lack of empirical data. We have developed a scenario pa~~ thway model as a conceptual framework for a formal assessment of the ~~ H5N1 risk to humans through consumption of poultry meat and parameter~~ ise the model using information derived from expert opinions. The aim~~ of this study was to investigate whether the notion of an overall ne~~ gligible risk via the oral infection route is consistent with ad hoc ~~ data and expert opinions on the relevant parameters of the model.The ~~ model is mainly based on expert opinion. A stochastic Monte-Carlo sim~~ ulation was conducted which took into consideration (amongst others) ~~ the exposure and infection of chicken (broiler and layer), turkeys, d~~ ucks and geese, the probabilities of detection prior to slaughter, vi~~ rus survival and contamination during slaughter, as well as during th~~ e cutting and preparation of meat in commercial plants and in private~~ households, respectively. The empirical consumption pattern for poul~~ try meat in Germany was taken into account in the simulation.The resu~~ lts show that the risk for the individual consumer is practically zer~~ o whereas up to 23 cases per year in Germany might occur if the upper~~ (more pessimistic) ranges of the expert opinions apply.The finding o~~ f a low but non-negligible risk to the population is discussed in rel~~ ation to the epidemiological information available from recent outbre~~ aks in South East Asia. Definition: Fomite_to_hand+Infected_poultry Nodelocation: 368,592,1 Nodesize: 36,32 Nodecolor: 65535,65535,65535 Variable Food_is_contaminated Title: uncooked or undercooked food Description: Expert opinion based modelling of the risk of human infec~~ tion with H5N1 through the consumption of poultry meat in Germany.~ M Greiner, C Muller-Graf, P Hiller, C Schrader, A Gervelmeyer, L Elle~~ rbroek, and B Appel~ Berl Munch Tierarztl Wochenschr, March 1, 2007; 120(3-4): 98-107. ~~ Abstract ~ ~ Bundesinstitut für Risikobewertung (BfR, Federal Institute for Risk A~~ ssessment), Berlin, Germany. matthias.greiner@bfr.bund.de ~ ~ According to current scientific opinion the risk of human infection w~~ ith H5N1 via preparation and consumption of poultry meat is negligibl~~ e.This opinion has not yet been challenged by a formal risk assessmen~~ t, due to the lack of empirical data. We have developed a scenario pa~~ thway model as a conceptual framework for a formal assessment of the ~~ H5N1 risk to humans through consumption of poultry meat and parameter~~ ise the model using information derived from expert opinions. The aim~~ of this study was to investigate whether the notion of an overall ne~~ gligible risk via the oral infection route is consistent with ad hoc ~~ data and expert opinions on the relevant parameters of the model.The ~~ model is mainly based on expert opinion. A stochastic Monte-Carlo sim~~ ulation was conducted which took into consideration (amongst others) ~~ the exposure and infection of chicken (broiler and layer), turkeys, d~~ ucks and geese, the probabilities of detection prior to slaughter, vi~~ rus survival and contamination during slaughter, as well as during th~~ e cutting and preparation of meat in commercial plants and in private~~ households, respectively. The empirical consumption pattern for poul~~ try meat in Germany was taken into account in the simulation.The resu~~ lts show that the risk for the individual consumer is practically zer~~ o whereas up to 23 cases per year in Germany might occur if the upper~~ (more pessimistic) ranges of the expert opinions apply.The finding o~~ f a low but non-negligible risk to the population is discussed in rel~~ ation to the epidemiological information available from recent outbre~~ aks in South East Asia.~ ~ the chance of human infection is considered to be low via the oral ro~~ ute, even though carnivores such as cats have become infected as have~~ humans preparing infected poultry. Definition: People_prepare_food+cross_contamination Nodelocation: 440,720,1 Nodesize: 52,28 Windstate: 2,264,101,672,731 Nodecolor: 65535,65535,65535 Variable Viral_decay Title: viral decay~ Definition: fomite_contaminated+Droplets_in_air-temperature-Clo2_inact~~ ivation Nodelocation: 592,464,1 Nodesize: 32,24 Windstate: 2,195,92,476,224 Nodecolor: 65535,65535,65535 Variable Mask_wearing Title: defensive mask wearing Description: to protect self Definition: 1 Nodelocation: 576,784,1 Nodesize: 40,36 Nodecolor: 65535,65535,65535 Variable Stool Title: virus shed in stool Description: J Clin Virol. 2007 Jul;39(3):164-8. Epub 2007 May 29. ~ Influenza A/H5N1 virus infection in humans in Cambodia.~ Buchy P, Mardy S, Vong S, Toyoda T, Aubin JT, Miller M, Touch S, Sova~~ nn L, Dufourcq JB, Richner B, Tu PV, Tien NT, Lim W, Peiris JS, Van d~~ er Werf S.~ Institut Pasteur in Cambodia, 5 Monivong blvd, P.O. Box 983, Phnom Pe~~ nh, Cambodia. pbuchy@pasteur-kh.org~ BACKGROUND: Between January 2005 and April 2006, six patients of infl~~ uenza A/H5N1 virus infection were reported in Cambodia, all with fata~~ l outcome. OBJECTIVES: We describe the virological findings of these ~~ six H5N1 patients in association with clinical and epidemiologic find~~ ings. STUDY DESIGN: Broncho-alveolar lavage, nasopharyngeal, throat a~~ nd rectal swabs and sera were cultured for virus isolation and viral ~~ load quantified in clinical specimens by real-time RT-PCR. We compare~~ d sequences obtained from different body sites within the same patien~~ t to detect viral quasi-species. RESULTS: H5N1 virus strains isolated~~ in Cambodia belong to genotype Z, clade 1 viruses. H5N1 viruses were~~ isolated from serum and rectal swab specimens in two patients. The h~~ aemagglutinin gene sequences of the virus in different body sites did~~ not differ. Amino acid substitutions known to be associated with a c~~ hange in virus binding were not observed. CONCLUSION: The high freque~~ ncy of virus isolation from serum and faecal swabs highlights that H5~~ N1 is likely to be a disseminated infection in humans and this has im~~ plications for antiviral treatment, biosafety in clinical laboratorie~~ s and on risks for nosocomial and human-to-human transmission. There ~~ were no tissue-specific adaptive mutations in the HA gene from viruse~~ s isolated from different organs.~ ~ ~ BMJ 2007;335:693 (6 October), doi:10.1136/bmj.335.7622.693-a ~ ~ The avian flu virus H5N1 tends to target the lungs, causing overwhelm~~ ing and often fatal alveolar damage in infected humans. Researchers u~~ sing sensitive molecular techniques have also found traces of the vir~~ us in other organs, most recently in the brain, intestines, and lymph~~ nodes of two Chinese patients. One of them, a 24 year old woman, was~~ four months pregnant when she died. At autopsy, the researchers foun~~ d evidence of the virus in the baby's lungs, circulation, and liver. ~~ Vertical transmission from the mother is the likeliest explanation, a~~ nd it sets H5N1 apart from common human flu viruses, which are though~~ t to be harmless to the fetus. ~ ~ The presence of H5N1 in the intestine fits well with the diarrhoea th~~ at often accompanies the infection, says a linked comment (p 1106). O~~ thers have already reported viral RNA in faecal samples from infected~~ people, with obvious implications for controlling spread of the . . ~~ . [Full text of this article] Definition: Infectious_person_wi+Infectious_animal Nodelocation: 448,112,1 Nodesize: 48,24 Windstate: 2,103,41,498,693 Nodecolor: 65535,65535,65535 Variable Stool_on_hand Title: stool on hand Definition: stool Nodelocation: 448,200,1 Nodesize: 44,24 Nodecolor: 65535,65535,65535 Variable Prophylaxis Title: prophylaxis Description: Clinical review: Update of avian influenza A infections i~~ n humans~ Christian Sandrock and Terra Kelly Critical Care 2007, 11:209 (doi:10~~ .1186/cc5675) http://ccforum.com/content/11/2/209~ ~ Neuroaminidase inhibitors~ Oseltamivir, Zanamivir:~ Spectrum of activity Oseltamivir: Influenza A and B, Zanamivir: Influ~~ enza A and B~ Administration Oseltamivir: Oral, Zanamivir: Inhalation~ Prophylaxis Oseltamivir: >=13 years; 75 mg daily, Zanamivir: >13 year~~ s; 10 mg daily~ Treatment Oseltamivir: >=1 year; 75 BID x 5 to 10 days, Zanamivir: >=~~ 7 years; 10 mg BID x5 to 10 days~ Select adverse effects Oseltamivir: GI symptoms: N/V, abdominal pain,~~ Zanamivir: Bronchospasm, cough~ Resistance potential Oseltamivir: Drug-resistant strain of H5N1 repor~~ ted, Zanamivir: None yet~ Efficacy Oseltamivir: Estimated efficacy: 30 to 70 percent, Zanamivir~~ : Not well studied~ Generic available Oseltamivir: No, Zanamivir: No~ Data are from [80-82]. BID, twice a day; GI, gastrointestinal; N/V, n~~ ausea and vomiting. Definition: antiviral_drugs Nodelocation: 840,976,1 Nodesize: 52,24 Windstate: 2,227,75,476,224 Nodecolor: 65535,65535,65535 Variable Vaccination Title: vaccination Description: every April the WHO selects 3 strains to be used in the u~~ pcoming flu season vaccine Definition: vaccine_distribution Nodelocation: 264,936,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Infectious_animal Title: infectious animal Description: Transmission of HPAI to humans is thought to occur throug~~ h contact with respiratory secretions, feces, contaminated feathers, ~~ organs, and blood from live or dead infected birds and possibly from ~~ contaminated surfaces. Consumption of properly cooked poultry and egg~~ s is not thought to pose a risk. Definition: zoonotic+control_failure Nodelocation: 224,40,1 Nodesize: 48,28 Windstate: 2,102,90,476,468 Nodecolor: 65535,65535,65535 Variable Animal_fluid Title: virus in animal fluid Definition: infectious_animal Nodelocation: 264,256,1 Nodesize: 48,28 Windstate: 2,117,240,476,224 Nodecolor: 65535,65535,65535 Variable Fomite_contaminated Title: fomite contaminated Definition: Hand_to_fomite_trans+ spitting+objects+elbow_cough Nodelocation: 320,384,1 Nodesize: 56,28 Windstate: 2,246,359,476,224 Nodecolor: 65535,65535,65535 Variable Infected_poultry Title: infected poultry Description: meat can be heavily infeced : "The Korea/03 titers were r~~ ecorded as the mean embryo infectious dose (EID50) and were 10(8.0) E~~ ID50/g in uncooked thigh samples and 10(7.5) EID50/g in uncooked brea~~ st samples. "~ ~ ~ Thermal inactivation of H5N1 high pathogenicity avian influenza virus~~ in naturally infected chicken meat.~ C Thomas and DE Swayne~ J Food Prot, March 1, 2007; 70(3): 674-80.~ ~ Southeast Poultry Research Laboratory, Exotic and Emerging Avian Vira~~ l Disease Research Unit, Agricultural Research Service, U.S. Departme~~ nt of Agriculture, 934 College Station Road, Athens, Gerogia 30605, U~~ SA. ~ ~ ~ Thermal inactivation of the H5N1 high pathogenicity avian influenza (~~ HPAI) virus strain A/chicken/Korea/ES/2003 (Korea/03) was quantitativ~~ ely measured in thigh and breast meat harvested from infected chicken~~ s. The Korea/03 titers were recorded as the mean embryo infectious do~~ se (EID50) and were 10(8.0) EID50/g in uncooked thigh samples and 10(~~ 7.5) EID50/g in uncooked breast samples. ~ ~ Survival curves were constructed for Korea/03 in chicken thigh and br~~ east meat at 1 degrees C intervals for temperatures of 57 to 61 degre~~ es C. Although some curves had a slightly biphasic shape, a linear mo~~ del provided a fair-to-good fit at all temperatures, with R2 values o~~ f 0.85 to 0.93. Stepwise linear regression revealed that meat type di~~ d not contribute significantly to the regression model and generated ~~ a single linear regression equation for z-value calculations and D-va~~ lue predictions for Korea/03 in both meat types. The z-value and the ~~ upper limit of the 95% confidence interval for the z-value were 4.64 ~~ and 5.32 degrees C, respectively. From the lowest temperature to the ~~ highest, the predicted D-values and the upper limits of their 95% pre~~ diction intervals (conservative D-values) for 57 to 61 degrees C were~~ 241.2 and 321.1 s, 146.8 and 195.4 s, 89.3 and 118.9 s, 54.4 and 72.~~ 4 s, and 33.1 and 44.0 s. D-values and conservative D-values predicte~~ d for higher temperatures were 0.28 and 0.50 s for 70 degrees C and 0~~ .041 and 0.073 s for 73.9 degrees C. Calculations with the conservati~~ ve D-values predicted that cooking chicken meat according to current ~~ U.S. Department of Agriculture Food Safety and Inspection Service tim~~ e-temperature guidelines will inactivate Korea/03 in a heavily contam~~ inated meat sample, such as those tested in this study, with a large ~~ margin of safety. Definition: animal_tissue Nodelocation: 192,536,1 Nodesize: 40,24 Windstate: 2,153,8,747,755 Nodecolor: 65535,65535,65535 Variable Hand_washing2 Title: hand washing Description: CDC: When should you wash your hands? ~ http://www.cdc.gov/cleanhands/~ ~ Before preparing or eating food ~ After going to the bathroom ~ After changing diapers or cleaning up a child who has gone to the bat~~ hroom ~ Before and after tending to someone who is sick ~ After blowing your nose, coughing, or sneezing ~ After handling an animal or animal waste ~ After handling garbage ~ Before and after treating a cut or wound ~ ~ ~ Title: Handwashing and risk of respiratory infections: a quantitative~~ systematic review ~ Author(s): Rabie T, Curtis V ~ Source: TROPICAL MEDICINE & INTERNATIONAL HEALTH 11 (3): 258-267 MAR ~~ 2006 ~ Abstract: To determine the effect of handwashing on the risk of respi~~ ratory infection. ~ We searched PubMed, CAB Abstracts, Embase, Web of Science, and the Co~~ chrane library for articles published before June 2004 in all languag~~ es. We had searched reference lists of all primary and review article~~ s. Studies were included in the review if they reported the impact of~~ an intervention to promote hand cleansing on respiratory infections.~~ Studies relating to hospital-acquired infections, long-term care fac~~ ilities, immuno-compromised and elderly people were excluded. We inde~~ pendently evaluated all studies, and inclusion decisions were reached~~ by consensus. From a primary list of 410 articles, eight interventio~~ nal studies met the eligibility criteria.~ ~ All eight eligible studies reported that handwashing lowered risks of~~ respiratory infection, with risk reductions ranging from 6% to 44% [~~ pooled value 24% (95% CI 6-40%)]. Pooling the results of only the sev~~ en homogenous studies gave a relative risk of 1.19 (95% CI 1.12%-1.26~~ %), implying that hand cleansing can cut the risk of respiratory infe~~ ction by 16% (95% CI 11-21%).~ ~ Handwashing is associated with lowered respiratory infection. However~~ , studies were of poor quality, none related to developing countries,~~ and only one to severe disease. Rigorous trials of the impact of han~~ dwashing on acute respiratory tract infection morbidity and mortality~~ are urgently needed, especially in developing countries.~ ~ ~ Am. J. Trop. Med. Hyg., 76(6), 2007, pp. 1166-1173~ A CLUSTER-RANDOMIZED CONTROLLED TRIAL EVALUATING THE EFFECT OF A HAND~~ WASHING-PROMOTION PROGRAM IN CHINESE PRIMARY SCHOOLS~ ANNA BOWEN*, HUILAI MA, JIANMING OU, WARD BILLHIMER, TIMOTHY LONG, ER~~ IC MINTZ, ROBERT M. HOEKSTRA, AND STEPHEN LUBY ~ National Center for Infectious Diseases, Centers for Disease Control ~~ and Prevention, Atlanta, Georgia; China Centers for Disease Control a~~ nd Prevention, Beijing, China; Fujian Provincial Center for Disease C~~ ontrol and Prevention, Fuzhou, China; Procter & Gamble Company, Cinci~~ nnati, Ohio; ICDDR,B Center for Health and Population Research, Dhaka~~ , Bangladesh ~ ~ Intensive handwashing promotion can reduce diarrheal and respiratory ~~ disease incidence. To determine whether less intensive, more scalable~~ interventions can improve health, we evaluated a school-based handwa~~ shing program. We randomized 87 Chinese schools to usual practices: s~~ tandard intervention (handwashing program) or expanded intervention (~~ handwashing program, soap for school sinks, and peer hygiene monitors~~ ). We compared student absence rates, adjusting for cluster design. I~~ n control schools, children experienced a median 2.0 episodes (median~~ 2.6 days) of absence per 100 student-weeks. In standard intervention~~ schools, there were a median 1.2 episodes (P = 0.08) and 1.9 days (P~~ = 0.14) of absence per 100 student-weeks. Children in expanded inter~~ vention schools experienced a median 1.2 episodes (P = 0.03) and 1.2 ~~ days (P = 0.03) of absence per 100 student-weeks. Provision of a larg~~ e-scale handwashing promotion program and soap was associated with si~~ gnificantly reduced absenteeism. Similar programs could improve the h~~ ealth of children worldwide~ ~ Title: How often do you wash your hands? A review of studies of hand-~~ washing practices in the community during and after the SARS outbreak~~ in 2003 ~ Author(s): Fung ICH (Fung, Isaac C. -H.), Cairncross S (Cairncross, S~~ andy) ~ Source: INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 17 (3)~~ : 161-183 JUN 2007 ~ Abstract: We reviewed evidence of hand-washing compliance in communit~~ y settings during the 2003 SARS outbreak. Literature was searched thr~~ ough PubMed, Cochrane Library, Wan Fang database and Google. English ~~ and Chinese papers were reviewed. Studies containing data on hand-was~~ hing, self-reported or directly observed, in community settings were ~~ selected. Case-control studies and studies in healthcare settings wer~~ e excluded. Fourteen studies were reviewed. Self-reported hand-washin~~ g compliance increased in the first phase of the SARS outbreak and ma~~ intained a high level 22 months after the outbreak. The decline of ha~~ nd-washing in Hong Kong after SARS was relatively slow. A significant~~ gender difference in hand-washing compliance (female > male) was fou~~ nd in eight studies. The importance of family support and 'significan~~ t female others' in hand hygiene promotion are noted. The impact of e~~ ducation is uncertain. Perceived susceptibility to and severity of SA~~ RS, and perceived efficacy of hand-washing in preventing SARS, also p~~ redicted self-reported hand-washing compliance. Definition: dynamic(0,People_prepare_food+Stool_on_hand+Mucus_on_hand+~~ Fomite_to_hand+compliance[time-1]+cleanliness-Hand_to_hand) Nodelocation: 448,512,1 Nodesize: 44,28 Windstate: 2,291,-10,505,707 Nodecolor: 65535,65535,65535 Variable Immunosuppressants Title: statins and immunosuppressants Description: Influenza and COPD Mortality Protection as Pleiotropic, D~~ ose-Dependent Effects of Statins.~ FJ Frost, H Petersen, K Tollestrup, and B Skipper~ Chest, April 1, 2007; 131(4): 1006-12. ~ BACKGROUND: Published data on antiinflammatory and immunomodulatory ~~ effects of statins suggest they may reduce mortality risks associated~~ with an unchecked immune response to selected infections, including ~~ influenza and COPD. We assessed whether statin users had reduced mort~~ ality risks from these conditions. METHODS: We conducted a matched co~~ hort study (n = 76,232) and two separate case-control studies (397 in~~ fluenza and 207 COPD deaths) to evaluate whether statin therapy is as~~ sociated with increased or decreased mortality risk and survival time~~ using health-care encounter data for members of health maintenance o~~ rganizations. For the cohort study, baseline illness risks from all c~~ auses prior to initiation of statin therapy were used to statisticall~~ y adjust for the occurrence of outcomes after initiation of treatment~~ . RESULTS: For moderate-dose (>/= 4 mg/d) statin users, this cohort s~~ tudy found statistically significant reduced odds ratios (ORs) of inf~~ luenza/pneumonia death (OR, 0.60; 95% confidence interval [CI], 0.44 ~~ to 0.81) and COPD death (OR, 0.17; 95% CI, 0.07 to 0.42) and similarl~~ y reduced survival hazard ratios. Findings were confirmed with the ca~~ se-control studies. Confounding factors not considered may explain so~~ me of the effects observed. CONCLUSIONS: This study found a dramatica~~ lly reduced risk of COPD death and a significantly reduced risks of i~~ nfluenza death among moderate-dose statin users.~ ***~ ~ ~ A rationale for using steroids in the treatment of severe cases of H5~~ N1 avian influenza. J Med Microbiol. 2007 Jul;56(Pt 7):875-83. ~ Carter MJ.~ Acute hypercytokinaemia represents an imbalance of pro-inflammatory a~~ nd anti-inflammatory cytokines, and is believed to be responsible for~~ the development of acute respiratory distress syndrome and multiple ~~ organ failure in severe cases of avian (H5N1) influenza. Although neu~~ raminidase inhibitors are effective in treating avian influenza, espe~~ cially if given within 48 h of infection, it is harder to prevent the~~ resultant hypercytokinaemia from developing if the patient does not ~~ seek timely medical assistance. Steroids have been used for many deca~~ des in a wide variety of inflammatory conditions in which hypercytoki~~ naemia plays a role, such as sepsis and viral infections, including s~~ evere acquired respiratory syndromes and avian influenza. However, to~~ date, the results have been mixed. Part of the reason for the discre~~ pancies might be the lack of understanding that low doses are require~~ d to prevent mortality in cases of adrenal insufficiency. Adrenal ins~~ ufficiency, as defined in the sepsis/shock literature, is a plasma co~~ rtisol rise of at least 9 mug dl(-1) following a 250 mug dose of adre~~ nocorticotropin hormone (ACTH), or reaching a plasma cortisol concent~~ ration of >25 mug dl(-1) following a 1-2 mug dose of ACTH. In additio~~ n, in the case of hypercytokinaemia induced by potent viruses, such a~~ s H5N1, systemic inflammation-induced, acquired glucocorticoid resist~~ ance is likely to be present. Adrenal insufficiency can be overcome, ~~ however, with prolonged (7-10 or more days) supraphysiological steroi~~ d treatment at a sufficiently high dose to address the excess activat~~ ion of NF-kappaB, but low enough to avoid immune suppression. This is~~ a much lower dose than has been typically used to treat avian influe~~ nza patients. Although steroids cannot be used as a monotherapy in th~~ e treatment of avian influenza, there might be a potential role for t~~ heir use as an adjunct treatment to antiviral therapy if appropriate ~~ dosages can be determined. In this paper, likely mechanisms of adrena~~ l insufficiency are discussed, drawing from a broad background of lit~~ erature sources. Definition: 0 Nodelocation: 168,1088,1 Nodesize: 80,20 Windstate: 2,102,90,486,432 Nodecolor: 65535,65535,65535 Variable Treatment Title: treatment of illness Description: flu surveillance Definition: -Immunosuppressants-antiviral_drugs-vaccination+Supportive~~ _therapies+antibiotics+passive_immuno+diagnostics+insurance Nodelocation: 376,1096,1 Nodesize: 48,24 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Antiviral_drugs Title: antiviral drugs Description: Influenza and COPD Mortality Protection as Pleiotropic, D~~ ose-Dependent Effects of Statins.~ FJ Frost, H Petersen, K Tollestrup, and B Skipper~ Chest, April 1, 2007; 131(4): 1006-12. ~ Health and Environmental Epidemiology Program, Lovelace Respiratory R~~ esearch Institute, 2425 Ridgecrest Dr SE, Albuquerque, NM 87108. ffro~~ st@LRRI.org. ~ ~ BACKGROUND: Published data on antiinflammatory and immunomodulatory e~~ ffects of statins suggest they may reduce mortality risks associated ~~ with an unchecked immune response to selected infections, including i~~ nfluenza and COPD. We assessed whether statin users had reduced morta~~ lity risks from these conditions. METHODS: We conducted a matched coh~~ ort study (n = 76,232) and two separate case-control studies (397 inf~~ luenza and 207 COPD deaths) to evaluate whether statin therapy is ass~~ ociated with increased or decreased mortality risk and survival time ~~ using health-care encounter data for members of health maintenance or~~ ganizations. For the cohort study, baseline illness risks from all ca~~ uses prior to initiation of statin therapy were used to statistically~~ adjust for the occurrence of outcomes after initiation of treatment.~~ RESULTS: For moderate-dose (>/= 4 mg/d) statin users, this cohort st~~ udy found statistically significant reduced odds ratios (ORs) of infl~~ uenza/pneumonia death (OR, 0.60; 95% confidence interval [CI], 0.44 t~~ o 0.81) and COPD death (OR, 0.17; 95% CI, 0.07 to 0.42) and similarly~~ reduced survival hazard ratios. Findings were confirmed with the cas~~ e-control studies. Confounding factors not considered may explain som~~ e of the effects observed. CONCLUSIONS: This study found a dramatical~~ ly reduced risk of COPD death and a significantly reduced risks of in~~ fluenza death among moderate-dose statin users. Definition: drug_distribution Nodelocation: 784,1064,1 Nodesize: 44,24 Windstate: 2,102,90,472,224 Nodecolor: 65535,65535,65535 Variable Recovery Title: recovery Definition: illness*Treatment Nodelocation: 624,1328,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Death Title: death Definition: illness-treatment_failure Nodelocation: 432,1328,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Animal_tissue Title: virus in animal tissue Definition: Infectious_animal Nodelocation: 152,376,1 Nodesize: 44,36 Windstate: 2,318,310,476,224 Nodecolor: 65535,65535,65535 Variable Cross_contamination Title: cross contamination Description: Expert opinion based modelling of the risk of human infec~~ tion with H5N1 through the consumption of poultry meat in Germany.~ M Greiner, C Muller-Graf, P Hiller, C Schrader, A Gervelmeyer, L Elle~~ rbroek, and B Appel~ Berl Munch Tierarztl Wochenschr, March 1, 2007; 120(3-4): 98-107. ~~ Abstract ~ ~ Bundesinstitut für Risikobewertung (BfR, Federal Institute for Risk A~~ ssessment), Berlin, Germany. matthias.greiner@bfr.bund.de ~ ~ According to current scientific opinion the risk of human infection w~~ ith H5N1 via preparation and consumption of poultry meat is negligibl~~ e.This opinion has not yet been challenged by a formal risk assessmen~~ t, due to the lack of empirical data. We have developed a scenario pa~~ thway model as a conceptual framework for a formal assessment of the ~~ H5N1 risk to humans through consumption of poultry meat and parameter~~ ise the model using information derived from expert opinions. The aim~~ of this study was to investigate whether the notion of an overall ne~~ gligible risk via the oral infection route is consistent with ad hoc ~~ data and expert opinions on the relevant parameters of the model.The ~~ model is mainly based on expert opinion. A stochastic Monte-Carlo sim~~ ulation was conducted which took into consideration (amongst others) ~~ the exposure and infection of chicken (broiler and layer), turkeys, d~~ ucks and geese, the probabilities of detection prior to slaughter, vi~~ rus survival and contamination during slaughter, as well as during th~~ e cutting and preparation of meat in commercial plants and in private~~ households, respectively. The empirical consumption pattern for poul~~ try meat in Germany was taken into account in the simulation.The resu~~ lts show that the risk for the individual consumer is practically zer~~ o whereas up to 23 cases per year in Germany might occur if the upper~~ (more pessimistic) ranges of the expert opinions apply.The finding o~~ f a low but non-negligible risk to the population is discussed in rel~~ ation to the epidemiological information available from recent outbre~~ aks in South East Asia. Definition: People_prepare_food Nodelocation: 480,584,1 Nodesize: 56,20 Nodecolor: 65535,65535,65535 Variable Herbs Title: herbs and alternative medicines: Ineffective Description: no documented effect~ echinacea~ green tea~ zinc~ vitamin C, anti-oxidants~ Definition: 0 Nodelocation: 232,1136,1 Nodesize: 84,24 Windstate: 2,221,104,476,224 Nodecolor: 65535,65535,65535 Variable Fomite_disinfection Title: fomite disinfection Description: CDC recommends, after first cleaning the surface, 3/4 cu~~ p of bleach in a gallon of warm water. Let stand 10 minutes before ri~~ nsing.~ ~ In 1918, during the Spanish flu pandemic, Lehn & Fink, Inc. advertise~~ d Lysol disinfectant as an effective countermeasure to the influenza ~~ virus. Newspaper ads provided tips for preventing the spread of the d~~ isease, including washing sick-rooms and everything that came in cont~~ act with patients with Lysol. A small (US50¢) bottle made five gallon~~ s (19 litres) of disinfectant solution, and a smaller (US25¢) bottle ~~ 2 gallons (7.5 litres). The company also advertised the "unrefined" L~~ ysol F. & F. (Farm & Factory) for use in factories and other large bu~~ ildings — a 5-gallon (19 litre) can, when diluted as directed, made 5~~ 0 gallons of disinfecting solution.[5] Lysol (active ing. benzakoniu~~ m chloride) is advertized as killing 99.9% of flu viruses. This is f~~ rom their website:~ The flu virus can live on surfaces for up to 48 hours.2 ~ During the flu season, 59% of surfaces in home can be contaminated wi~~ th the flu virus.2 ~ 22 million school days are lost every year due to the common cold.1 ~ Children have about 6-10 colds a year.1 ~ In families with children in school, the number of colds per child ca~~ n be as high as 12.1 ~ Cold & flu viruses are a leading cause of doctor's visits and childre~~ n missing school.1 ~ In the course of a year, people in the United States suffer 1 billion~~ colds.1 ~ Children are two to three times more likely than adults to get sick w~~ ith the flu, and children frequently spread the virus to others.1 ~ Women, especially those aged 20-30 years, have more colds than men.1 ~~ ~ New research shows your home may be germier than you think. The study~~ and survey come from the Hygiene Council (funded by Reckitt Benckise~~ r, the makers of LYSOL® Brand products). Researchers visited 35 U.S. ~~ homes, swabbing for bacteria in 32 locations in each home. Out of the~~ 32 places in the home, the top spots for bacteria are the toilet bow~~ l, kitchen drain, kitchen sponge or counter-wiping cloth, bathtub, an~~ d kitchen sink. Read more. (Source: WebMD) ~ ~ FACT: During the flu season, 59% of surfaces in your home can be cont~~ aminated with the flu virus. And it can live there for up to 48 hours~~ !* If your family members come in contact with these contaminated sur~~ faces, they can get sick.~ ~ FACT: LYSOL® Disinfectant Spray and LYSOL® Disinfecting Wipes kill th~~ e flu virus** that can make your kids sick. And because there is no k~~ nown cure for colds and flu, your best defense against these nasty vi~~ ruses is prevention and protection.~ ~ FACT: You can help protect your family and help prevent the spread of~~ germs in your home by killing 99.9% of them with LYSOL® Disinfectant~~ Spray and LYSOL® Disinfecting Wipes.~ ~ Sources: ~ 1) US Center for Disease Control and Prevention (CDC). For more infor~~ mation visit http://www.cdc.gov/flu/about/qa/ and http://www.cdc.gov/~~ flu/keyfacts.htm.~ 2) S.A. Boone, “The Occurrence of Influenza A virus on Household and ~~ Day Care Center Fomites”, C.P. Gerba, Journal of Infection, 2004. Definition: dynamic(0,Fomite_contaminated-compliance[time-1]) Nodelocation: 824,608,1 Nodesize: 48,24 Windstate: 2,283,88,476,224 Nodecolor: 65535,65535,65535 Variable Surveillance Title: surveillance Description: http://www.cdc.gov/flu/weekly/~ ~ Definition: 0 Nodelocation: 104,624,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Vaccine_development Title: vaccine development Description: http://www.cdc.gov/flu/weekly/~ ~ Definition: surveillance Nodelocation: 104,696,1 Nodesize: 60,24 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Vaccine_production Title: vaccine production Description: http://www.cdc.gov/flu/weekly/~ ~ Definition: Vaccine_development Nodelocation: 104,760,1 Nodesize: 52,24 Nodecolor: 65535,65535,65535 Variable Vaccine_distribution Title: vaccine distribution Description: http://www.cdc.gov/flu/weekly/~ ~ Definition: Vaccine_production Nodelocation: 144,824,1 Nodesize: 52,24 Nodecolor: 65535,65535,65535 Variable Herd_immunity Title: herd immunity Definition: recovery+vaccination Nodelocation: 952,1032,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Distancing_interrupt Title: social distancing suspended or incomplete Description: measures suspended Definition: social_distancing Nodelocation: 1056,936,1 Nodesize: 48,52 Nodecolor: 65535,65535,65535 Variable Co_infection Title: co-infection Description: ~ Definition: 0 Nodelocation: 352,896,1 Nodesize: 48,16 Nodecolor: 65535,65535,65535 Variable Supportive_therapies Title: supportive therapies Description: keep organ systems from failing~ Definition: 0 Nodelocation: 256,1000,1 Nodesize: 44,20 Nodecolor: 65535,65535,65535 Variable Antibiotics Title: antibiotics Description: ~ Definition: drug_distribution Nodelocation: 712,1160,1 Nodesize: 48,16 Nodecolor: 65535,65535,65535 Variable Equipment_shortage Title: equipment shortage Description: ~ Definition: 0 Nodelocation: 144,1248,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Manpower_shortage Title: manpower shortage Description: ~ Definition: 0 Nodelocation: 168,1304,1 Nodesize: 44,24 Nodecolor: 65535,65535,65535 Variable Drug_shortage Title: drug shortage Definition: 0 Nodelocation: 640,1208,1 Nodesize: 40,28 Nodecolor: 65535,65535,65535 Variable Treatment_failure Title: treatment failure Definition: -equipment_shortage-manpower_shortage-drug_shortage+advanc~~ ed_disease+herbs+treatment-surge+drug_resistance Nodelocation: 280,1208,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Vaccine_shortage Title: vaccine shortage Description: http://www.cdc.gov/flu/weekly/~ ~ Definition: 0 Nodelocation: 136,880,1 Nodesize: 44,24 Nodecolor: 65535,65535,65535 Variable Vaccine_bad Title: vaccine late or poorly matched Definition: 0 Nodelocation: 136,944,1 Nodesize: 48,31 Nodecolor: 65535,65535,65535 Variable Vaccine_failure Title: vaccine failure Definition: vaccine_bad+vaccine_shortage+vaccination Nodelocation: 264,856,1 Nodesize: 44,24 Nodecolor: 65535,65535,65535 Variable Illness Title: illness Description: ~ Definition: co_infection+transmission+stress Nodelocation: 496,944,1 Nodesize: 44,16 Nodecolor: 65535,65535,65535 Variable Advanced_disease Title: advanced disease Description: ~ Definition: 0 Nodelocation: 136,1192,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Kissing Title: kissing~ hugging Definition: Infectious_person_wi Nodelocation: 680,160,1 Nodesize: 40,24 Nodecolor: 65535,65535,65535 Variable Elbow_cough Title: elbow cough Description: mask wearing protects others, not the wearer Definition: sneezing Nodelocation: 856,368,1 Nodesize: 32,24 Nodecolor: 65535,65535,65535 Variable Drug_production Title: antiviral drug production Definition: 0 Nodelocation: 880,1168,1 Nodesize: 60,24 Windstate: 2,352,231,476,224 Nodecolor: 65535,65535,65535 Variable Drug_stockpile Title: Strategic National Stockpile and civilian inventories Definition: drug_production+inventory Nodelocation: 944,1248,1 Nodesize: 84,31 Windstate: 2,211,155,476,224 Nodecolor: 65535,65535,65535 Variable Drug_distribution Title: drug distribution Definition: drug_stockpile Nodelocation: 784,1256,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Prophylaxis_failure Title: prophylaxis failure Definition: drug_shortage-drug_resistance Nodelocation: 640,1112,1 Nodesize: 52,24 Nodecolor: 65535,65535,65535 Variable Surge Title: surge capacity exceeded Description: ~ Definition: 0 Nodelocation: 280,1296,1 Nodesize: 48,31 Nodecolor: 65535,65535,65535 Variable Inventory Title: procurement and inventory decisions Definition: 0 Nodelocation: 1008,1160,1 Nodesize: 60,31 Nodecolor: 65535,65535,65535 Variable Drug_resistance Title: drug resistance Definition: viral_evolution Nodelocation: 384,1168,1 Nodesize: 44,28 Nodecolor: 65535,65535,65535 Variable Care_givers_infected Title: care givers infected Description: ~ Definition: treatment Nodelocation: 368,984,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Infection_control Title: hospital infection control Description: ~ Definition: treatment Nodelocation: 728,952,1 Nodesize: 48,31 Nodecolor: 65535,65535,65535 Decision De2 Title: De1 Definition: 0 Nodelocation: 1072,1336,1 Nodesize: 48,24 Nodeinfo: 1,0,0,0,0,0,0,,0, Variable Passive_immuno Title: passive immunotherapy Description: monoclonal or polyclonal antibodies~ convalescent sera~ Definition: 0 Nodelocation: 144,1008,1 Nodesize: 60,24 Nodecolor: 65535,65535,65535 Variable Viral_evolution Title: viral evolution Definition: dynamic(0,transmission[time-1]) Nodelocation: 656,1032,1 Nodesize: 40,24 Nodecolor: 65535,65535,65535 Variable Diagnostics Title: diagnostics Description: ~ Definition: illness Nodelocation: 424,1040,1 Nodesize: 48,16 Windstate: 2,228,53,381,906 Nodecolor: 65535,65535,65535 Variable Reporting Title: reporting Description: no documented effect~ echinacea~ green tea~ zinc~ vitamin C, anti-oxidants~ Definition: diagnostics Nodelocation: 624,920,1 Nodesize: 44,16 Nodecolor: 65535,65535,65535 Variable Closures Title: closures quarantines~ isolation Description: ~ Definition: public_health Nodelocation: 1056,656,1 Nodesize: 48,36 Nodecolor: 65535,65535,65535 Variable Zoonotic Title: zoonotic Description: ~ Definition: 0 Nodelocation: 304,112,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Control_failure Title: control failure Description: ~ Definition: 0 Nodelocation: 144,112,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Public_health Title: Public Health decision Description: ~ Definition: reporting Nodelocation: 784,840,1 Nodesize: 40,32 Nodecolor: 65535,65535,65535 Variable Public_education Title: public education Description: ~ Definition: public_health Nodelocation: 712,736,1 Nodesize: 40,24 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Compliance Title: compliance Description: ~ Definition: comprehension+ concern+convenience+Presence_of_others+sick~~ _people_known Nodelocation: 656,600,1 Nodesize: 52,16 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Comprehension Title: comprehension Description: ~ Definition: Public_education+advice+Knowledge Nodelocation: 624,696,1 Nodesize: 60,16 Nodecolor: 65535,65535,65535 Variable Vertical Title: vertical transmission Description: BMJ 2007;335:693 (6 October), doi:10.1136/bmj.335.7622.6~~ 93-a ~ NEWS reporting on Lancet 2007;370:1137-45~ ~ Bird fl u can cross the placenta~ in pregnant women~ ~ The avian flu virus H5N1 tends to target the lungs, causing overwhelm~~ ing and often~ fatal alveolar damage in infected humans. Researchers using sensitive~~ molecular techniques~ have also found traces of the virus in other organs, most recently in~~ the brain,~ intestines, and lymph nodes of two Chinese patients. One of them, a 2~~ 4 year old woman,~ was four months pregnant when she died. At autopsy, the researchers f~~ ound evidence of~ the virus in the baby’s lungs, circulation, and liver. Vertical trans~~ mission from the mother~ is the likeliest explanation, and it sets H5N1 apart from common huma~~ n flu viruses, which~ are thought to be harmless to the fetus. The presence of H5N1 in the ~~ intestine fits~ well with the diarrhoea that often accompanies the infection, says a ~~ linked comment (p~ 1106). Others have already reported viral RNA in faecal samples from ~~ infected people,~ with obvious implications for controlling spread of the disease.~ It now seems clear than H5N1 spreads far beyond the lungs in humans a~~ nd may even~ cross the blood-brain barrier. We still don’t know why the infection ~~ is so lethal, but it~ may be something to do with our immune response. The immunologically ~~ naive fetus~ in this report was infected but had no organ damage.~ Lancet 2007;370:1137-45~ Definition: illness Nodelocation: 280,816,1 Nodesize: 76,12 Windstate: 2,102,90,870,778 Nodecolor: 65535,65535,65535 Variable Temperature Title: Temperature & Rel Humidity Description: Influenza virus transmission is dependent on relative hum~~ idity and temperature Lowen et al 2007 PLoS Pathogens,3(10):e151~ In temperate regions influenza epidemics recur with marked~ seasonality: in the northern hemisphere the influenza season spans~ November to March, while in the southern hemisphere epidemics~ last from May until September. Although seasonality is one of the~ most familiar features of influenza, it is also one of the least~ understood. Indoor crowding during cold weather, seasonal~ fluctuations in host immune responses, and environmental factors,~ including relative humidity, temperature, and UV radiation have all~ been suggested to account for this phenomenon, but none of these~ hypotheses has been tested directly. Using the guinea pig model,~ we have evaluated the effects of temperature and relative humidity~ on influenza virus spread. By housing infected and na¹¨ve guinea pigs~~ ~ together in an environmental chamber, we carried out transmission~ experiments under conditions of controlled temperature and~ humidity. We found that low relative humidities of 20%–35% were~ most favorable, while transmission was completely blocked at a high~ relative humidity of 80%. Furthermore, when guinea pigs were kept~ at 5 8C, transmission occurred with greater frequency than at 20 8C,~ while at 30 8C, no transmission was detected. Our data implicate low~ relative humidities produced by indoor heating and cold temperatures~ as features of winter that favor influenza virus spread. Definition: 0 Nodelocation: 544,408,1 Nodesize: 56,24 Windstate: 2,102,90,489,585 Nodecolor: 65535,65535,65535 Variable Clo2_inactivation Title: ClO2 inactivation Description: Influenza virus infection is one of the major causes of h~~ uman morbidity and mortality. Between humans, this virus spreads most~~ ly via aerosols excreted from the respiratory system. Current means o~~ f prevention of influenza virus infection are not entirely satisfacto~~ ry because of their limited efficacy. Safe and effective preventive m~~ easures against pandemic influenza are greatly needed. We demonstrate~~ that infection of mice induced by aerosols of influenza A virus was ~~ prevented by chlorine dioxide (ClO2) gas at an extremely low concentr~~ ation (below the long-term permissible exposure level to humans, name~~ ly 0.1 p.p.m.). Mice in semi-closed cages were exposed to aerosols of~~ influenza A virus (1 LD50) and ClO2 gas (0.03 p.p.m.) simultaneously~~ for 15 min. Three days after exposure, pulmonary virus titre (TCID50~~ ) was 102.6±1.5 in five mice treated with ClO2, whilst it was 106.7±0~~ .2 in five mice that had not been treated (P=0.003). Cumulative morta~~ lity after 16 days was 0/10 mice treated with ClO2 and 7/10 mice that~~ had not been treated (P=0.002). In in vitro experiments, ClO2 denatu~~ red viral envelope proteins (haemagglutinin and neuraminidase) that a~~ re indispensable for infectivity of the virus, and abolished infectiv~~ ity. Taken together, we conclude that ClO2 gas is effective at preven~~ ting aerosol-induced influenza virus infection in mice by denaturing ~~ viral envelope proteins at a concentration well below the permissible~~ exposure level to humans. ClO2 gas could therefore be useful as a pr~~ eventive means against influenza in places of human activity without ~~ necessitating evacuation~ ~ Protective effect of low-concentration chlorine dioxide gas against i~~ nfluenza A virus infection~ Norio Ogata and Takashi Shibata~ J Gen Virol 89 (2008), 60-67 Definition: 0 Nodelocation: 784,456,1 Nodesize: 64,24 Nodecolor: 65535,65535,65535 Variable Less_than_infectious Title: Less than infectious dose~ Definition: inhale_droplets-viral_decay Nodelocation: 824,712,1 Nodesize: 44,32 Nodecolor: 65535,65535,65535 Variable Infectious_dose Title: infectious dose~ Definition: inhale_droplets Nodelocation: 512,656,1 Nodesize: 40,24 Nodecolor: 65535,65535,65535 Variable Glove_wearing Title: glove wearing Description: This could mean wearing gloves in public places OR wearin~~ g chefs plastic gloves while cooking OR wearing rubber gloves while c~~ leaning up. Find out which one they meant.~ ~ people can still infect themselves by touching contaminated gloves af~~ ter they remove them. ~ Definition: fomite_contaminated Nodelocation: 80,536,1 Nodesize: 48,28 Nodeinfo: 1,1,1,1,1,1,0,,0, Windstate: 2,307,130,505,707 Nodecolor: 65535,65535,65535 Variable Superstition Title: superstitious beliefs Description: Worrying about something will make it happen, for example~~ ~ Definition: 0 Nodelocation: 232,760,1 Nodesize: 60,20 Nodecolor: 65535,65535,65535 Variable Stress Title: stress, fatigue, chill Description: Sheldon Cohen may argue stress increases susceptibility t~~ o infection~ ~ physical factors affecting a person's resistance to infection. May or~~ may not actually affect outcome.~ Definition: 0 Nodelocation: 640,848,1 Nodesize: 72,16 Windstate: 2,103,264,476,224 Nodecolor: 65535,65535,65535 Decision De1 Title: De1 Definition: 0 Nodelocation: 848,1376,1 Nodesize: 48,24 Nodeinfo: 1,0,0,0,0,0,0,,0, Variable Advice Title: nonprofessional advice Description: from family or acquataince or CNN~ Definition: 0 Nodelocation: 680,800,1 Nodesize: 60,20 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Vulnerable Title: vulnerable populations Description: children, seniors, HIV-positive~ Definition: 0 Nodelocation: 912,72,1 Nodesize: 48,24 Nodecolor: 65535,65535,65535 Variable Knowledge Title: knowledge Description: knowledge or experience or lack thereof~ Definition: 0 Nodelocation: 736,672,1 Nodesize: 44,12 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Concern Title: concern Description: "if I am concerned about the flu then I might be more lik~~ ely to get a vaccine and wash my hands" Julie Downs~ Definition: 0 Nodelocation: 800,552,1 Nodesize: 40,12 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Fomite_to_mouth Title: fomite to mouth transfer Description: sharing cutlery, glassware, beverage etc are examples of ~~ fomite to mouth transfer Definition: Fomite_contaminated Nodelocation: 216,696,1 Nodesize: 40,32 Windstate: 2,-365,55,558,905 Nodecolor: 65535,65535,65535 Variable Cleanliness Title: personal cleanliness Description: personal hygiene standards Definition: 0 Nodelocation: 384,456,1 Nodesize: 48,20 Nodecolor: 65535,65535,65535 Variable Convenience Title: convenience Description: convenience OR inconvenience~ Definition: 0 Nodelocation: 704,640,1 Nodesize: 52,12 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Presence_of_others Title: presence of others Description: people are more likely to comply if others are around~ Definition: 0 Nodelocation: 624,552,1 Nodesize: 40,20 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Sick_people_known Title: sick people known Description: people are more likely to comply if other people are sick~~ ~ Definition: 0 Nodelocation: 592,648,1 Nodesize: 32,28 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Hand_to_hand Title: hand to hand Description: handshakes etc. Definition: mucus_on_hand Nodelocation: 936,480,1 Nodesize: 36,24 Windstate: 2,102,90,476,224 Nodecolor: 65535,65535,65535 Variable Insurance Title: insurance Description: having health insurance affects treatment seeking choices~~ Definition: 0 Nodelocation: 176,1048,1 Nodesize: 56,12 Windstate: 2,102,90,486,432 Nodecolor: 65535,65535,65535 Close How_i_get_sick