HIV: Domestic HIV/AIDS

Domestic HIV/AIDS

Through the Elizabeth Glaser Scientist Award, the International Leadership Award, and other research and training grants, the Foundation maintains its commitment to cutting-edge research with the goal of ultimately eradicating pediatric AIDS. While great strides have been made since the early days of the epidemic, the special needs of children and youth with HIV/AIDS are still too often overlooked. To give them the best possible chance for a healthy future, we must ensure that their specific prevention, care, and treatment needs are appropriately addressed.

The Ryan White CARE Act

The Foundation has long supported prevention, care, and treatment programs aimed at women, children, and families affected by HIV/AIDS. Innovative initiatives like these were included in the groundbreaking Ryan White CARE Act, which was passed in 1990. Since the Act was successfully passed, one of the Foundation's main domestic advocacy goals has been to maintain congressional support for the funding of these programs within the CARE Act.Next to the Medicaid program, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is the largest federal investment in the care and treatment of people living with HIV/AIDS in the United States, providing services to approximately 533,000 low-income, HIV-positive individuals. First enacted in 1990, the CARE Act supports a wide range of community-based services, including primary and home health care, case management, substance abuse treatment, mental health services, and nutritional services.

As part of the creation of the CARE Act, the Foundation successfully advocated for the inclusion of a program to help women and children with HIV/AIDS participate in clinical trials of new therapies. This program would later become part of Title IV of the CARE Act during the reauthorization of the legislation in 1996.

Today, Title IV provides medical care, support services, case management, outreach, and other services to women, children, and families affected by HIV/AIDS. Through its family-centered approach to providing care and treatment, Title IV is saving lives, improving quality of life by keeping people healthier, and saving money by reducing hospitalizations. Title IV projects have also led the way in reducing mother-to-child transmission of HIV from more than 2,000 babies born HIV-positive each year to fewer than 200 per year. In addition, Title IV programs help link women and children to opportunities to participate in cutting-edge HIV/AIDS clinical research.

 

HIV Testing of Pregnant Women and Newborns

Currently, more than 3,700 children and youth in the United States under the age of 13 are living with HIV and AIDS. Of the 40,000 Americans newly infected with HIV every year, half are under 25 years of age. While the discovery of effective drug therapies for preventing mother-to-child transmission of HIV has reduced the number of infected babies born in the United States to less than 200 a year, each infection represents a tragedy that could have been averted.Without medical intervention, an HIV-infected woman has about a one-in-four chance of giving birth to an HIV-infected baby. However, as a direct result of HIV testing and preventative therapies, the risk of HIV transmission from mothers to their infants in the United States has been dramatically reduced to less than two percent. The Foundation strongly believes we must continue to work toward further reductions in mother-to-child transmission of HIV. As recommended by the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM), the Foundation endorses the voluntary, routine, and universal HIV testing of pregnant women as a means of increasing testing rates and further reducing transmission from a mother to her newborn. 
 
Pediatric HIV/AIDS Research
In keeping with Elizabeth Glaser’s legacy, the Foundation advocates for a strong U.S. commitment to domestic pediatric HIV/AIDS research programs, including those funded at the National Institutes of Health (NIH).
From its inception, the Foundation has had a long history of advocating for increased funding for pediatric HIV/AIDS research. In October 1989, the Foundation advocated for and secured $10 million for basic pediatric HIV/AIDS research at the National Institutes of Health (NIH) – marking the first time government funds were ever specified for basic biomedical pediatric HIV/AIDS research. The following year, the FY 1991 Labor-HHS appropriations bill included $20 million for pediatric HIV/AIDS basic research, an increase of $10 million over the previous year. An additional $23.8 million was also appropriated for important pediatric clinical trials.

Building on this legacy of achievement, critical pediatric HIV/AIDS research remains a priority for the Foundation. As we marvel at the progress that has been made in pediatric AIDS, it is important to remember the long battle ahead for the young people infected with HIV. The unique medical and social challenges that these young adults face is highlighted in a June 2005 New York Times article, "Their Unexpected Adolescence."

Many adolescents and young adults are already resistant to existing medications and are waiting for new drugs that can keep the virus in check. These young people are also entering uncharted medical territory with potential problems unknown to even the most experienced AIDS researchers. Additional research is needed into the long-term health implications of drug treatment on these children and young adults, including their psychological and social needs, and appropriately targeted prevention services. In addition, through the use of preventive drug regimens, many children born to HIV-positive mothers were uninfected. As this population of HIV-exposed children grows, more research is needed into the long-term health effects of the exposure of these children to preventive drug regimens

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HIV :Improving Access to AIDS Treatment

As programs to provide care and treatment are being rapidly expanded, many of the 2.2 million HIV-infected children living in resource-poor countries are at serious risk of being left behind. Less than one percent of these children are receiving lifesaving care and treatment. Without it, 50 percent of children born with HIV will die before age two and the majority will die before age five. In 2004 alone, HIV/AIDS was responsible for the deaths of 510,000 children worldwide.

Because children are not just small adults, providing HIV care and treatment presents special challenges. These include the scarcity of programs offering a full continuum of care, from prevention to treatment; the shortage of health care providers trained in diagnosing and treating pediatric HIV/AIDS; limited access to diagnostic equipment suitable for the youngest children; the lack of drug formulations and dosing guidelines tailored to children's needs; the high cost of those drugs that are tested for children, and the lack of a common commitment to specific pediatric treatment targets. The Foundation is committed to helping HIV-infected children live long and healthy lives, and is leading the effort to accelerate the United States' assistance to children living with AIDS around the world.

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HIV: Inclusion of Children in HIV/AIDS Vaccine Trials

HIV: Inclusion of Children in HIV/AIDS Vaccine Trials

History suggests that a vaccine may prove to be the most effective, affordable, long-term approach to stopping the spread of HIV. However, some of the populations hardest hit by the pandemic — infants and youth — are at risk of being left behind in the search for an effective vaccine against the HIV virus. To date, children and youth have been included in only a very small number of HIV vaccine trials.

More than 1,000 children are infected with HIV every day, the vast majority through mother-to-child transmission (MTCT). While effective, low-cost MTCT interventions exist and work to dramatically reduce newborn infection rates, the lack of a vaccine still places infants at risk of contracting HIV through breast-feeding.

Since 1988, the Foundation has provided $10 million to support 41 separate studies related to pediatric vaccine research. In May 2007, the Foundation was awarded a five-year, $9.7 million grant from the Gates Foundation to significantly expand its critical vaccine research. The HIV vaccine program supported by the grant will be the first of its kind to support basic research and clinical trials specific to breast-feeding infants.

As this promising research effort advances, the Foundation is also working to educate Congress and the administration about the importance of vaccine research as a critical preventive strategy in the battle against HIV/AIDS and the need to ensure that the special needs of children are not overlooked in the quest for an effective HIV/AIDS vaccine.

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Prevention of Swine Flu Influenza Virus

Prevention

Prevention of swine

influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.Prevention in swineMethods of preventing the spread of influenza among swine include facility management, herd management, and vaccination (ATCvet code: QI09AA03). Because much of the illness and death associated with swine flu involves secondary infection by other pathogens, control strategies that rely on vaccination may be insufficient.Control of swine influenza by vaccination has become more difficult in recent decades, as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.[74][75] Present vaccination strategies for SIV control and prevention in swine farms typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.[76][77] The United States Department of Agriculture researchers say that while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.[78]Facility management includes using disinfectants and ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and it is readily inactivated by disinfectants.[2] Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus. The virus survives in healthy carrier pigs for up to 3 months and can be recovered from them between outbreaks. Carrier pigs are usually responsible for the introduction of SIV into previously uninfected herds and countries, so new animals should be quarantined.[54] After an outbreak, as immunity in exposed pigs wanes, new outbreaks of the same strain can occur.[2]

Prevention in humans

Prevention of pig to human transmissionSwine can be infected by both avian and human influenza strains of influenza, and therefore are hosts where the antigenic shifts can occur that create new influenza strains.The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs. Although strains of swine influenza are usually not able to infect humans this may occasionally happen, so farmers and veterinarians are encouraged to use a face mask when dealing with infected animals. The use of vaccines on swine to prevent their infection is a major method of limiting swine to human transmission. Risk factors that may contribute to swine-to-human transmission include smoking and not wearing gloves when working with sick animals.[79]Prevention of human to human transmissionInfluenza spreads between humans through coughing or sneezing and people touching something with the virus on it and then touching their own nose or mouth.[80] Swine flu cannot be spread by pork products, since the virus is not transmitted through food.[80] The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days for analysis.[81]Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.[82] Chance of transmission is also reduced by disinfecting household surfaces, which can be done effectively with a diluted chlorine bleach solution.[83]Experts agree that hand-washing can help prevent viral infections, including ordinary influenza and the swine flu virus. Also avoiding touching eyes, nose and mouth with hands prevents flu. [3] Influenza can spread in coughs or sneezes, but an increasing body of evidence shows small droplets containing the virus can linger on tabletops, telephones and other surfaces and be transferred via the fingers to the mouth, nose or eyes. Alcohol-based gel or foam hand sanitizers work well to destroy viruses and bacteria. Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should contact a doctor for advice.Social distancing is another tactic. It means staying away from other people who might be infected and can include avoiding large gatherings, spreading out a little at work, or perhaps staying home and lying low if an infection is spreading in a community. Public health and other responsible authorities have action plans which may request or require social distancing actions depending on the severity of the outbreak.VaccinationVaccines are available for different kinds of swine flu. Although the current trivalent influenza vaccine is unlikely to provide protection against the new 2009 H1N1 strain,[84] vaccines against the new strain are being developed and could be ready as early as November 2009.[85]

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Swine Fle( Swine influenza) :Signs and symptoms

Signs and symptoms

In swine

In pigs influenza infection produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite.[11] In some cases the infection can cause abortion. Although mortality is usually low (around 1-4%),[2] the virus can produce weight loss and poor growth, causing economic loss to farmers.[11] Infected pigs can lose up to 12 pounds of body weight over a 3 to 4 week period.[11]

In humans

Main symptoms of swine flu in humans[68]Direct transmission of a swine flu virus from pigs to humans is occasionally possible (called zoonotic swine flu). In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths.[69] Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy.[69] Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed.[69]In this video, Dr. Joe Bresee, with CDC's Influenza Division, describes the symptoms of swine flu and warning signs to look for that indicate the need for urgent medical attention.See also: See this video with subtitles on YouTube [2]According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting.[70] The 2009 H1N1 virus is not zoonotic swine flu, as it is not transmitted from pigs to humans, but from person to person.Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset."[71] A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).[71]The most common cause of death is respiratory failure. Other causes of death are pneumonia (leading to sepsis)[72], high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea) and electrolyte imbalance. Fatalities are more likely in young children and the elderly.DiagnosisThermal scanning of passengers arriving at Singapore Changi airport. This section requires expansion.Different medical kits are available for diagnosis of swine flu.[73]The two major tests that are being used are the nasopharyngeal (or back of the throat) swab for viral culture, the gold standard, and the indirect evidence test by detection of antibodies to novel H1N1 with PCR studies.

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Classification Of swine flu

Classification Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with influenza A being common in pigs and influenza C being rare.[3] Influenza B has not been reported in pigs. Within influenza A and influenza C, the strains found in pigs and humans are largely distinct, although due to reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries. Influenza C Influenza C viruses infect both humans and pigs, but do not infect birds.[4] Transmission between pigs and humans have occurred in the past.[5] For example, influenza C caused small outbreaks of a mild form of influenza amongst children in Japan[6] and California.[6] Due to its limited host range and the lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.[7] Influenza A Swine influenza is known to be caused by influenza A subtypes H1N1,[8] H1N2,[8] H2N3,[9] H3N1,[10] and H3N2.[8] In pigs, three influenza A virus subtypes (H1N1, H1N2, and H3N2) are the most common strains worldwide.[11] In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.[12] Surveillance Although there is no formal national surveillance system in the United States to determine what viruses are circulating in pigs,[13] there is an informal surveillance network in the United States that is part of a world surveillance network. Veterinary medical pathologist, Tracey McNamara, set up a national disease surveillance system in zoos because the zoos do active disease surveillance and many of the exotic animals housed there have broad susceptibilities. Many species fall below the radar of any federal agencies (including dogs, cats, pet prairie dogs, zoo animals, and urban wildlife), even though they may be important in the early detection of human disease outbreaks.[14] [15]

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Swine Fle( Swine influenza) history

History of Swine Flu Influenza Virus
Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, when pigs became sick at the same time as humans.[16] The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930.[17] For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002, new strains of three different subtypes and five different genotypes emerged as causes of influenza among pigs in North America. In 1997-1998, H3N2 strains emerged. These strains, which include genes derived by reassortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Reassortment between H1N1 and H3N2 produced H1N2. In 1999 in Canada, a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm.[17]
The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic.[18][19] As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza.[19] However, direct transmission from pigs to humans is rare, with only 12 cases in the U.S. since 2005.[20] Nevertheless, the retention of influenza strains in pigs after these strains have disappeared from the human population might make pigs a reservoir where influenza viruses could persist, later emerging to reinfect humans once human immunity to these strains has waned.[21]
Swine flu has been reported numerous times as a zoonosis in humans, usually with limited distribution, rarely with a widespread distribution. Outbreaks in swine are common and cause significant economic losses in industry, primarily by causing stunting and extended time to market. For example, this disease costs the British meat industry about £65 million every year.[22]
1918 pandemic in humans
The 1918 flu pandemic in humans was associated with H1N1 and influenza appearing in pigs;[19] this may reflect a zoonosis either from swine to humans, or from humans to swine. Although it is not certain in which direction the virus was transferred, some evidence suggests that, in this case, pigs caught the disease from humans.[16] For instance, swine influenza was only noted as a new disease of pigs in 1918, after the first large outbreaks of influenza amongst people.[16] Although a recent phylogenetic analysis of more recent strains of influenza in humans, birds, and swine suggests that the 1918 outbreak in humans followed a reassortment event within a mammal,[23] the exact origin of the 1918 strain remains elusive.[24] It is estimated that anywhere from 50 to 100 million people were killed worldwide.[19][25]
1976 U.S. outbreakMain article: 1976 swine flu outbreak

On February 5, 1976, in the United States an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that the cause of death was a new strain of swine flu. The strain, a variant of H1N1, is known as A/New Jersey/1976 (H1N1). It was detected only from January 19 to February 9 and did not spread beyond Fort Dix.[26] President Ford receives swine flu vaccination
This new strain appeared to be closely related to the strain involved in the 1918 flu pandemic. Moreover, the ensuing increased surveillance uncovered another strain in circulation in the U.S.: A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March.[26] Alarmed public-health officials decided action must be taken to head off another major pandemic, and urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.[27]
The vaccination program was plagued by delays and public relations problems.[28] On October 1, 1976, the immunization program began. That same day, three senior citizens died soon after receiving their swine flu shots and there was a media outcry linking the deaths to the immunizations, despite the lack of positive proof. According to science writer Patrick Di Justo, however, by the time the truth was known—that the deaths were not proven to be related to the vaccine—it was too late. "The government had long feared mass panic about swine flu—now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.[29]
There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of modern influenza vaccines, with an incidence of about one case per million vaccinations.[30] As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, 48,161,019 Americans, or just over 22% of the population, had been immunized by the time the National Influenza Immunization Program (NIIP) was effectively halted on December 16, 1976.[31] [32]
Overall, there were 1098 cases of Guillain-Barré Syndrome (GBS) recorded nationwide by CDC surveillance, 532 of which were linked to the NIIP vaccination, resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to GBS, though caution is advised for certain individuals, particularly those with a history of GBS. [33] [34][35] Still, as observed by a participant in the immunization program, the vaccine killed more Americans than the disease did.[36]

1988 zoonosis
In September 1988, a swine flu virus killed one woman and infected others. 32-year old Barbara Ann Wieners was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at a county fair in Walworth County, Wisconsin. Barbara died eight days later, after developing pneumonia.[37] The only pathogen identified was an H1N1 strain of swine influenza virus.[38] Doctors were able to induce labor and deliver a healthy daughter before she died. Her husband recovered from his symptoms.
Influenza-like illness (ILI) was reportedly widespread among the pigs exhibited at the fair. 76% of 25 swine exhibitors aged 9 to 19 tested positive for antibody to SIV, but no serious illnesses were detected among this group. Additional studies suggested between one and three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection. However, there was no community outbreak.[39][40]

1998 US outbreak in swine
In 1998, swine flu was found in pigs in four U.S. states. Within a year, it had spread through pig populations across the United States. Scientists found that this virus had originated in pigs as a recombinant form of flu strains from birds and humans. This outbreak confirmed that pigs can serve as a crucible where novel influenza viruses emerge as a result of the reassortment of genes from different strains.[41][42][43]
2007 Philippine outbreak in swine Please help improve this article by expanding it. Further information might be found on the talk page. (April 2009)
On August 20, 2007 Department of Agriculture officers investigated the outbreak (epizootic) of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, unless there are complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.[44][45]

2009 outbreak in humansMain article: 2009 flu pandemic
The H1N1 viral strain implicated in the 2009 flu pandemic among humans often is called "swine flu" because initial testing showed many of the genes in the virus were similar to influenza viruses normally occurring in North American swine.[46] But further research has shown that the outbreak is due to a new strain of H1N1 not previously reported in pigs.
In late April, Margaret Chan, the World Health Organization's director-general, declared a "public health emergency of international concern" under the rules of the WHO's new International Health Regulations when the first cases of the H1N1 virus were reported in the United States.[47] [48] Following the outbreak, on May 2, 2009, it was reported in pigs at a farm in Alberta, Canada, with a link to the outbreak in Mexico. The pigs are suspected to have caught this new strain of virus from a farm worker who recently returned from Mexico, then showed symptoms of an influenza-like illness.[49] These are probable cases, pending confirmation by laboratory testing.
The new strain was initially described as an apparent reassortment of at least four strains of influenza A virus subtype H1N1, including one strain endemic in humans, one endemic in birds, and two endemic in swine.[46] Subsequent analysis suggested it was a reassortment of just two strains, both found in swine.[50] Although initial reports identified the new strain as swine influenza (i.e., a zoonosis originating in swine), its origin is unknown. Several countries took precautionary measures to reduce the chances for a global pandemic of the disease.[51] The 2009 swine flu has been compared to other similar types of influenza virus in terms of mortality: "in the US it appears that for every 1000 people who get infected, about 40 people need admission to hospital and about one person dies".[52]. There are fears that swine flu will become a major global pandemic in the winter months, with many countries planning major vaccination campaigns. [53]

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Swine Fle( Swine influenza)

Swine influenza

Influenza (flu)2009 flu pandemic (Swine flu)VirusAvian influenzaSwine influenzaFlu Swine influenza (also called swine flu, hog flu, and pig flu) is an infection by any one of several types of swine influenza virus. Swine influenza virus (SIV) is any strain of the influenza family of viruses that is endemic in pigs.[2] As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3.
Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza, often resulting only in the production of antibodies in the blood. If transmission does cause human influenza, it is called zoonotic swine flu. People with regular exposure to pigs are at increased risk of swine flu infection. The meat of an infected animal poses no risk of infection when properly cooked.
During the mid-20th century, identification of influenza subtypes became possible, allowing accurate diagnosis of transmission to humans. Since then, only 50 such transmissions have been confirmed. These strains of swine flu rarely pass from human to human. Symptoms of zoonotic swine flu in humans are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

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Paid to click

Best Paid to Sing up Sites for Bangladesh
There are many paid to singup company in this world but maximum number of company are scam,they don't pay.A rear number of company are good .Now i will show you all these company that's really pay you.

01. Pct buxPtcBux is a unique opportunity for you to earn extra money for FREE! Ptcbux.com will pay you 10 cents for every free Singup.Earnings: 10 cent per SingupPayment: Paid via Alertpay. The minimum payout amount is $1.

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03.Incentria is also a unique opportunity for you to earn extra money for FREE! Incentria will pay you 10 cents for every free Singup.Earnings: 10 cent per singup Payment: Paid via Alertpay. The minimum payout amount is $1.

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Richptc is a unique opportunity for you to earn extra money for FREE! Ptcbux.com will pay you 10 cents for every free Singup.Earnings: 10 cent per SingupPayment: Paid via Alertpay. The minimum payout amount is $1.

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