Saturday, July 11, 2009

Kathleen Sebelius will be on CNN’s “State of the Union

Kathleen Sebelius, secretary of Health and Human Services, is on CNN’s “State of the Union” to discuss the H1N1 swine flu virus and its expected resurgence in the fall.

Hattip Aroura

This Sunday's Show

In a live, EXCLUSIVE interview this Sunday, Secretary of Health and Human Services Kathleen Sebelius discusses President Obama's plan for health care reform and the administration's response to the spread of the H1N1 virus.

Update on Dearborn County Indiana Mystery Death

An update on this previously reported story out of Indiana:

Wednesday, July 8, 2009

New Information on Indiana Mysterious Death

Last Update: 6:52 pm

New Information:
The Indiana family struck by a fatal medical mystery is thanking everyone for their prayers and asking them to stay calm. The Mcintosh family says doctors still don't know what killed 19-year-old Matt Mcintosh and has his sister Mindy in critical condition.

Teen is state's 1st H1N1 death
19-year-old from Dearborn County had no underlying health problems
By Shari Rudavsky
Posted: July 11, 2009. Post a Comment RecommendE-mailPrintShare.A

A .A Dearborn County teenager who died Sunday in a Cincinnati hospital is Indiana's first fatality from the H1N1 flu virus, health officials said Friday.
Matthew McIntosh, 19, is the second person to die in Ohio of the virus and the first in the Cincinnati area, Hamilton (Ohio) County Coroner O'Dell Owens said. An autopsy revealed no underlying health problems, he said.

Nationwide, there have been 211 deaths attributed to H1N1, or swine flu, and 37,246 confirmed cases.
Since the start of the outbreak, Indiana has had 273 cases and 36 hospitalizations. The death was the first confirmed case in Dearborn County, in the southeastern part of the state.
Indiana State Department of Health officials declined to confirm McIntosh's identity or provide further details, saying such information could mislead the public into complacency.
"If we focus on one individual, we could give false hope or false security to everyone," said Dr. Judith Monroe, state health commissioner. "We don't feel we have the right to do that."
Instead, Monroe emphasized that people should continue to take precautions against the virus by covering their mouths when they cough, washing their hands and staying home if they are ill.
While the disease has been mild in most cases, people with asthma, other respiratory conditions, heart disease and possibly obesity appear to be at increased risk for more severe illness, she said.
Older people may have immunity. Only 6 percent of those hospitalized are older than 65.
Seasonal influenza, which kills about 36,000 people a year, tends to strike the very old and very young worse than young, healthy adults.
Health officials are gearing up to fight both flu viruses this fall. On Friday, the federal government announced it will make nearly $7.3 million available to Indiana to help the state prepare.
Unlike seasonal flu, the H1N1 virus is spreading despite the warmer weather, Monroe said.
"This is July. It's hot and humid, and we have a circulating influenza virus," she said. "That is unusual."
From the beginning, McIntosh's case was unusual. McIntosh passed out in a barn. Doctors thought something in the barn was to blame.
"Normally a swine flu case would not be a coroner's case," Owens said.
McIntosh's older sister also fell ill around the same time, as did his father and a friend, Owens said. His sister, who has tested negative for the virus, remains in intensive care. Both the friend and the father are recovering.
On Friday, McIntosh's H1N1 swab came back positive, solving the mystery.
hat-tip alert

UK: Swine flu could paralyse country, Whitehall is told

The Observer, Sunday 12 July 2009

Vital sections of society could be paralysed if swine flu reaches epidemic proportions as expected, the government has been warned.

A Whitehall meeting of emergency services and business chiefs has been told that more than a third of Britain's businesses have no response plans at all for dealing with the pandemic, while specific fears have been raised about the ability of the country's broadband network and the London Underground to operate effectively.

The development follows news last week that the first British person with no underlying health problems had died of swine flu. The patient, who died on Friday at a hospital in Essex, was the 15th swine flu-related death in the UK. "This death underlines that, although the virus is proving generally mild in most people, it is more severe in some cases," said the government's chief medical officer, Sir Liam Donaldson.

Doctors have also warned that rates of infection are reaching epidemic levels in London and the West Midlands. Several million people could become ill with either seasonal flu or swine flu by the end of the year. Schools would close and transport and other vital services, such as GP surgeries, would be put under severe strain.

As a result, health officials are considering plans that would allow people with suspected swine flu to take up to two weeks off work without a doctor's note. At present employees are allowed to sign themselves off sick for seven days.

According to data revealed at the Whitehall meeting, 38% of businesses have no response plans for dealing with a pandemic. At the meeting, transport bosses outlined details of how trains, airports and bus services would function. Transport for London officials said staff shortages could produce a reduced tube service but argued this would be sufficient as there would be fewer commuters.

But international business continuity expert Lyndon Bird, who attended the meeting, told the Observer he was "not convinced" by TfL's response. Bird, who is international technical director of the Business Continuity Institute, was also sceptical about the ability of Britain's digital infrastructure to cope with hundreds of thousands of people being forced to work from home.

BT could not give "definitive" assurances that Britain's broadband network would work fully because of the vast numbers of people logging on from home, he said.

UK: Swine flu vaccine to be cleared after five-day trial

July 12, 2009

The path of a popular medicine from the laboratory to the chemist or doctor’s surgery can involve years of clinical trials on a select group of patients.

When the new vaccine for swine flu arrives in Britain, regulators said this weekend, it could be approved for use in just five days.

Regulators at the European Medicines Agency (EMEA) said the fast-tracked procedure has involved clinical trials of a “mock-up” vaccine similar to the one that will be used for the biggest mass vaccination programme in generations. It will be introduced into the general population while regulators continue to carry out simultaneous clinical trials.

The first patients in the queue for the jab - being supplied to the UK by GSK and Baxter Healthcare - may understandably be a little nervous at any possible side effects. A mass vaccination campaign against swine flu in America was halted in the 1970s after some people suffered Guillain-Barré syndrome, a disorder of the nervous system.
Related Links

* Swine flu claims first 'healthy' victim

* Three more die after contracting swine flu

However, regulators said fast-tracking would not be at the expense of patient safety. “The vaccines are authorised with a detailed risk management plan,” the EMEA said. “There is quite a body of evidence regarding safety on the trials of the mock-up, and the actual vaccine could be assessed in five days.”

The UK government has ordered enough vaccine to cover the entire population. GPs are being told to prepare for a nationwide vaccination campaign.

Dr Peter Holden, the British Medical Association’s lead negotiator on swine flu, who has been attending Department of Health meetings on the outbreak, said GPs’ surgeries were prepared for one of the biggest vaccination campaigns in almost 50 years.

He said although swine flu was not causing serious illness in patients, health officials were eager to start a mass vaccination campaign, starting first on priority groups. First, the jabs would reduce the chances of a shortage of hospital beds because of people suffering from swine flu. Second, it would reduce the effect on the economy by ensuring workers were protected from the virus.

“The high-risk groups will be done at GPs’ surgeries. People are still making decisions over this, but we want to get cracking before we get a second wave, which is traditionally far more virulent.”

Holden said it was likely the elderly would be given their seasonal flu jab as well as the swine flu vaccination. The new vaccine is likely to require two doses.

Details of the inoculation plans emerged after the death of a patient, reportedly a middle-aged man, at a hospital in the Basildon area of Essex. The victim had no underlying health problems, but officials say there is no evidence the swine flu virus had mutated into a more dangerous strain.

Holden said it would be the biggest campaign in response to an outbreak since mass vaccination against smallpox in 1962. He said surgeries would be aiming to inoculate about 30 people an hour in a “military-style operation”.

The Department of Health said it had still not finalised which groups would be vaccinated first, but children, frontline health workers, people with underlying illnesses and the elderly are likely to take priority.

The European Commission is also identifying population groups which it believes should get priority. It is keen to ensure that countries such as the UK, which had ordered supplies of the vaccine in advance, do not cause inequities in treatment elsewhere in Europe.

It warned health ministers in a note circulated last month that if the vaccines were more readily available in some countries it could cause “vaccine tourism/shopping in other member states”.

About 15 people have died of swine flu in Britain, but most of those infected get only mild symptoms. According to the latest figures from the Health Protection Agency, the UK has had 9,718 confirmed cases of the disease.
hat-tip kiwibird

Argentina: 100 are already dead by the H1N1 flu in the country

From the previous article. Dr. Chan:

Global barometer

During the summer break, all eyes are on the Southern Hemisphere, where the winter flu season is just getting under way.

Scientists are watching to see if the illness grows more severe. They want to know who is at greatest risk, and whether the virus will become drug-resistant or mutate away from the vaccines that big pharmaceutical companies are scrambling to develop.

The picture so far is “largely reassuring,” Dr. Margaret Chan, the World Health Organization’s secretary general, said at an international health meeting in Mexico last week. “The overwhelming majority of patients experience mild symptoms and make a full recovery within a week.”


* They warn that further raise the number of patients with influenza A in Buenos Aires
* Influenza A: City gives back to a controversy

In Santa Fe today another confirmed fatality and Coast district nearly a third of people killed by the new flu. The district remains the worst affected province

With the confirmation of a new influenza deaths by health authorities of Santa Fe in Argentina there is already a hundred killed by swine flu, the first infection was detected in the country the first week of May.

In this way, the number of people killed in the province of Santa Fe for influenza A is 30, said today the deputy minister of Health, Debora Ferrandini who indicated that all cases are confirmed in laboratory tests.

The rest of the confirmed dead are distributed in the provinces of Misiones and Córdoba, with 3 deaths each, San Juan (2), Neuquén, Santa Cruz, Entre Rios, Formosa, and Black River, with one death in each district. The Federal Capital, in turn, confirmed 13 deaths by the new flu.

Influenza A in Santa Fe
Ferrandini the official said "so far not reached the 8,000 doses of the antibiotic Tamiflu, but remarked that" it is a matter of hours. "

However, as "very small amount insured" and said "this is not related to the logic of the distributive province."

Ferrandini said, in statements to the press, Santa Fe has a stock of Oseltamivir, which agreed to comply with the Federal Health and stated that each province would prefer to administer the dose according to your needs.

hat-tip Shiloh

New Jersey braces for return of swine flu in the fall

Thursday, July 9, 2009

New Jersey is girding for the return of swine flu this fall, with a series of summits to prepare for possible mass vaccinations against a virus that has killed 10 state residents, including three children.

In a summit next week, emergency responders, health officers and school leaders will discuss the possible use of schools as vaccination sites, a protective measure akin to the anti-polio campaigns of half a century ago.

They’ll also share strategies on how to contain the spread of the H1N1 influenza virus among children, who appear to be particularly susceptible.

One certain topic: whether to close schools. Superintendents who cancelled canceled classes in the spring are reexamining those decisions as more is learned about the flu. A likely focus for the fall: keeping schools open, but making sure ill children stay out of school for a full week after symptoms recede.

“Closing school won’t stop the flu,” said Dr. Peter Wenger, a pediatric infectious disease specialist at the University of Medicine and Dentistry of New Jersey. The virus can spread before symptoms appear, and may not be diagnosed for days after a victim recovers and feels fine.

The federal Centers for Disease Control and Prevention calls for a seven-day isolation period, including at least 24 hours after symptoms end. Parents must be responsible for making sure their children adhere to the guideline, said Dr. Wayne Yankus, Ridgewood’s school medical director and chairman of the school-health committee of the state chapter of the American Academy of Pediatrics.

“We rely on parents to use common sense,” he said, such as telling children that they must stay home and miss out on planned practices, dances or trips — the sort of sacrifices that a frustrated Yankus didn’t see this spring.

“People didn’t keep sick kids home,” Yankus said. “A lot of parents don’t care about society. They care about their child and their child’s entitlement.”

Global barometer

During the summer break, all eyes are on the Southern Hemisphere, where the winter flu season is just getting under way.

Scientists are watching to see if the illness grows more severe. They want to know who is at greatest risk, and whether the virus will become drug-resistant or mutate away from the vaccines that big pharmaceutical companies are scrambling to develop.

The picture so far is “largely reassuring,” Dr. Margaret Chan, the World Health Organization’s secretary general, said at an international health meeting in Mexico last week. “The overwhelming majority of patients experience mild symptoms and make a full recovery within a week.”

However, “some deaths are occurring in perfectly healthy young people,” she said. And some patients deteriorate very quickly, developing life-threatening pneumonia that requires mechanical ventilation.

The disease is still spreading in New Jersey, with 833 confirmed cases and 10 deaths as of Wednesday. Three of the dead were children: boys ages 6, 10 and 15, from Ocean, Sussex and Somerset counties, respectively. State health officials have said that all those who died in New Jersey had underlying health conditions.

Come fall, health officials are bracing for the worst, while hoping for the best. Once kids are back in classrooms, it may start to spread earlier than the typical seasonal flu. The federal government will test vaccines next month, and if approved, schoolchildren would likely receive the shots by mid-October, U.S. Health and Human Services Secretary Kathleen Sebelius said Thursday.

“The worst case is if [the virus] comes roaring back more virulent than it was,” said Dr. Susan Walsh, New Jersey’s deputy commissioner of health. “The best case is that it comes back about the same, maybe drops off a bit.”

So far, more than 80 percent of deaths and severe illnesses in the United States have occurred in people with underlying medical conditions — about the same ratio as seasonal flu. Such conditions include pregnancy, being an infant or over age 65, or having a compromised immune system, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Even if unexpected deaths in young people make up a tiny percentage of all cases, that number could be significant: The great flu pandemic of 1918 infected 20 to 40 percent of the world’s population.


Keeping track of ill children is up to local and state health departments, who report every suspected case of swine flu and are in continual communication with local schools. But it’s up to superintendents to decide whether to close schools.

Swine Flu Shots May Be Ready in October

WASHINGTON, July 9, 2009

HHS Secretary Sebelius Says Studies Still Need to Be Done Before Final Decisions on Vaccinations for Kids

  • Play CBS Video Video H1N1: A Looming Threat?

    The U.S. government believes that there will be a vaccine for H1N1 before the fall flu season. Dr. Jennifer Ashton tells Chris Wragge that two vaccines will most likely be available, one for influenza and one for H1N1.

  • Within a few weeks, manufacturers will deliver test doses of a swine flu vaccine for a study to see if they're safe and seem to work. Photo

    Within a few weeks, manufacturers will deliver test doses of a swine flu vaccine for a study to see if they're safe and seem to work. (AP Photo/Elaine Thompson)

  • Interactive Swine Flu's Impact

    The latest numbers, photos and information to keep you safe.

(CBS/AP) The Obama administration says vaccinations against swine flu are likely and probably will begin in mid-October, assuming soon-to-start studies go well.

Health and Human Services Secretary Kathleen Sebelius says no final decision has been made. But she says first in line for shots likely will be school-age children, young adults with conditions such as asthma, pregnant women and health workers.

Studies of the brand-new vaccine are set to start in early August, and the government will make its final decision once results are available. But Sebelius told officials from all 50 states Thursday to figure out now how they would deliver the shots to people who need them.

The announcement was made at the start of the Obama administration's swine flu summit today, which was designed to put states on notice that the disease promises to create a mess this fall. Are you ready?

Swine flu may have faded from the headlines but it's still sickening people here and abroad and is certain to worsen when influenza-friendly fall temperatures arrive. The federal government called together health and education officials from every state to check their preparations for the likely prospect of vaccinations and determine how they'll handle flu-riddled schools.

"I want to be clear: This summit is not about raising alarms or stoking fears. It is about being prepared," Health and Human Services Secretary Kathleen Sebelius said. "We must avoid complacency."

The government estimates that 1 million Americans so far have been infected with the never-before-seen virus known formally by its scientific family name, H1N1.

No longer do many public health experts warn of the new virus' "return" in the fall. Summer's heat and humidity usually chase away influenza, but the swine flu has never left. Children are spreading it in summer camps, and U.S. deaths have reached 170.

It has spread worldwide, and is causing larger problems in parts of the Southern Hemisphere, where it's currently flu season.

In the U.S., even if the virus doesn't mutate to become more dangerous, greater spread is considered inevitable as students return to crowded classrooms and temperatures drop - and regular winter flu makes its own return.

"This fall, it's daunting, all that will be required," said Paul Jarris, executive director of the Association of State and Territorial Health Officials.

At the top of his worry list is finding enough workers for two vaccination campaigns.

The 100 million-plus doses of regular winter flu vaccine are set for the usual October inoculation start. But those shots won't protect against swine flu.

Within a few weeks, manufacturers will deliver test doses of a swine flu vaccine for a study to see if they're safe and seem to work. If so, the Obama administration will quickly decide whether to press forward with a second swine-flu vaccine campaign - and determine who would be first in line.

Looking back at school closings that disrupted the spring, communities also are struggling to determine when such a drastic step - one that has the chain reaction of parents missing work - is necessary.

A key theme to Thursday's summit: Consider now how your family would handle a disruption even bigger than what happened last spring when the outbreak began. To spur those discussions, HHS will host a contest - at - for the best anti-flu video to turn into a national public service announcement.

CBS News medical correspondent Dr. Jennifer Ashton sounded a somewhat optimistic note on "The Early Show". Though the flu isn't going away, she said, people will likely get the vaccine in the fall, and there should be ample doses to go around.

"We don't want people to panic," Ashton said. "We just want to be prepared."

Flu To Return

July 10, 2009
The White House has drawn up a battle plan for taking on the virus when influenza season returns to the northern hemisphere in several weeks' time. -- PHOTO: AP

BETHESDA (Maryland) - US PRESIDENT Barack Obama and top officials urged Americans on Thursday to ramp up preparations against H1N1 flu, warning that the virus could return with a vengeance in the fall and pledging a huge campaign to beat it.

'I think it's clear that although we were fortunate not to see a more serious situation in the spring when we first got news of this outbreak, the potential for a significant outbreak in the fall is looming,' Mr Obama said in remarks piped into a flu preparedness summit here from the G-8 meeting in Italy. 'We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,' he said.

Health Secretary Kathleen Sebelius at the meeting in Bethesda warned that (A)H1N1 flu 'is not gone, it's continuing to spread, it's in more than 100 countries around the world and in every state in this country.' And, she warned, US scientists and health officials who have been monitoring the virus as it works its way through the southern hemisphere, think (A)H1N1 'could worsen in the fall or earlier, when schools start to open.'

The White House has drawn up a battle plan for taking on the virus when influenza season returns to the northern hemisphere in several weeks' time. A key facet of the four-tiered plan is vaccination. 'We know that a safe and effective vaccine is the best means of both preventing the disease in individuals and stopping the community spread of the virus.

'That's why we are researching a vaccine now and have already taken steps to purchase vaccine components,' said Ms Sebelius. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said clinical trials on a first candidate vaccine were expected to begin next month.

Scientists would pay attention in the tests to how quickly the vaccine triggers an immune response, he said, saying the knowledge would be crucial in the event of the disease returning in the fall flu season in a more virulent form and spreading rapidly.

Usually, the immune response from flu vaccines kicks in after around three weeks, he said, but the trials would test the (A)H1N1 vaccine candidates to see if they trigger an effective immune response within one week or a fortnight.

Ms Sebelius told the meeting that 'the current estimate is that some vaccine will be ready for distribution in mid-October.' Mr Fauci said there would probably be tens of millions of doses by then.

That would not be enough for a blanket vaccination campaign, so populations who have been shown to be at the greatest risk from the new strain of swine flu - children, pregnant women and health workers who are dealing with the virus on a daily basis - would likely be vaccinated in a first round of immunisations, the officials said.

A handful of pharmaceutical companies around the world are working to develop a vaccine against (A)H1N1 influenza, which the World Health Organization (WHO) says has infected 100,000 people in 137 countries and territories, and caused 440 deaths around the world. -- AFP

Egypt: Detention of a girl on suspicion of bird flu lake

Saturday, July 11, 2009 - 19:09

Congratulations, Dr. Yusri said Undersecretary of the Ministry of Health the lake, the hospital admitted Damanhour girl detained on suspicion of bird flu after an outbreak of the disease with similar symptoms, the high temperature and pain in bones, severe stress and difficulty in breathing.

حيث قامت المستشفى باحتجاز أميرة مصطفى طه ( 29سنة) مقيمة فى كفر الدوار، بعد أخذ عينة دم منهم لتحليلها بالمعامل المركزية بالقاهرة.

The hospital where the Princess of the detention of Mustafa Taha (29 years) resident of Kafr Al-Dawar, after taking a blood sample for analysis, including central labs in Cairo.

على الفور انتقلت لجنة مكافحة المرض لمنازل المرضى لتطهيرها وتطهير المنازل المجاورة وأخذ عينات من الطيور الموجودة بالمنازل لفحصها وبيان مدى إصابتها.

Immediately moved to the Committee against the disease for patients, clearing houses and clearing houses nearby and took samples of domestic birds to be tested and the extent of her statement.

Egypt: The death of a child suspected of having bird flu in Fayyoum

Saturday, July 11, 2009 - 16:47

Children died in the eight-year-old Fayyoum, following his transfer to hospital suffering from fever, a very high temperature, and doctors suspected of being infected with bird flu.

كان كريم عبد التواب مصطفى حبشى (8 سنوات) من قرية سنهور البحرية قد دخل مستشفى الفيوم العام، وهو يعانى من ارتفاع شديد فى درجة الحرارة، واشتبه الأطباء فى إصابته بمرض أنفلونزا الطيور، فتم تحويله لمستشفى الحميات وأخذت العينات اللازمة منه لإرسالها للمعامل المركزية بوزارة الصحة، وبينما كان يتم التحضير لنقله للقاهرة لفظ الطفل أنفاسه الأخيرة.

Karim Mustafa Abdel Tawab Habashi (8 years) from the village has entered the marine Nohor Fayoum General Hospital, suffering from a very high temperature, and doctors suspected of being infected with bird flu, was transferred to a hospital diets are necessary for the samples sent to labs central Ministry of Health and while they were preparing to transfer him to Egypt, the word the child last breath.

HK-Filipino maid critical with human swine flu

July 11, 2009

A Filipino domestic helper is in critical condition with human swine flu, the Centre for Health Protection announced today.

It was the second serious case of the virus in Hong Kong.

Centre Controller Dr Thomas Tsang said today the maid, 37, needs mechanical ventilation to support her breathing while being treated at the intensive care unit at United Christian Hospital.

Her employers, a couple living in Kwun Tong, also had flu-like symptoms. As the wife is pregnant, she has been admitted to hospital for observation, while the husband was prescribed Tamiflu.

The patient developed a fever a day after arriving in Hong Kong from the Philippines on June 28 and was given medication at a private clinic. She returned for follow-up on July 1 when an X-ray showed her lungs were clear.

Her condition quickly deteriorated, though, and she was admitted to United Christian Hospital's intensive care unit with serious pneumonia symptoms on July 7.

Results of tests taken on July 7 and 8 showed she was negative for Influenza A. But one taken yesterday was positive for Influenza A, while further tests carried out at the centre's lab today confirmed she was infected with human swine flu.

Dr Tsang said they were investigating whether the maid had another hidden disease which could have led to her critical condition.

In the 24 hours up to 2.30pm today, 58 new cases of human swine flu were confirmed, involving 26 males and 32 females, aged between two and 55.

There have been 1,236 human swine flu cases in Hong Kong.

Recombinomics: Tamiflu Resistant Pandemic H1N1 Surveillance Failures in US

Recombinomics Commentary 14:41
July 11, 2009

The recent report of osletamivir resistant pandemic H1N1 in Hong Kong in a traveler (16F) from San Francisco, A/Hong Kong 2369/2009 raised concerns because the traveler had not take osletamivir and her case was mild. She recovered without any antiviral treatment, but the presence of H274Y raised concerns that resistant virus was silently circulating because most mild cases in the United States were no longer tested or reported.

The publication of the sequence increased concerns, because the NA sequence, except for H274Y, exactly matched the sequence from the first case in New Jersey, A/New Jersey/1/2009, a Bergen county women (22F) infected in April. Since the Hong Kong case was in June, the identity between the two sequences indicated that the virus had spread across the United States undetected between April and June, and was only detected when it was exported to Hong Kong, through routine osletamivir resistant testing of pandemic isolates.

The sequence in Hong Kong matched a sequece from Japan, A/Sapporo/1/2009, which was published in Genbank a few days later. Like New Jersey, the Japan sequence did not have H274Y, but it also was detected in a traveler (20M) from the United States (Hawaii), increasing concerns that this sequence was transmitting in the United States undetected.

The next day, two more sequences were released. One was a partial NA sequence from Catalonia, Spain (A/Catalonia/387/2009), which also exactly matched the sequence from New Jersey and Japan, while the other was from Vastra Gotalands , Sweden (A/Stockholm/37/2009), which also matched the above sequences, but had one additional change. The isolate from Sweden was also from a traveler (2M) from the United States. Both isolates were also from patients infected in June, so the Tamiflu flu resistant sequence, or precursor, was detected in Hong Kong, China, Sapporo, Japan, Catalonia, Spain, and Vastra Gotalands, Sweden in the month of June, and at least three of the four isolates were from patients traveling from the United States. However, the only match in isolates from the United States was in a New Jersey patient infected in April.

The export of infections from a country not reporting corresponding infections signals a poor surveillance system. Although the number of sequences from the United States is the highest in the world, the failure to identify the oseltamivir resistant precursor sequences matching those found worldwide in travelers from United States is cause for concern.

After the resistant isolate was announced, assurances were given, citing on the lack of detection of resistance in the United States. This failure however may be due an emphasis on severe cases and lack of testing of mild cases. Moreover, even if precursor sequences are detected, a low abundance version would not be identified in a consensus sequence.

In any event, the failure to identify the precursor since April, when the sequence is detected worldwide in June travelers from the United States, raises serious concerns about surveillance programs which focus efforts on severe cases and largely ignore milder cases.

Media Links

Argentia: Swine Flu - Total Deaths 88

Figure rises to 88 dead in Argentina by swine influenza

06:13 PM, July 10 2009 BUENOS AIRES, 10 Jul 2009 (AFP) - The number of dead swine influenza in Argentina rose to 88 after the confirmation of six new deaths in the capital, said Friday the Minister of Health of that district, Jorge Lemus.

The delegation of foreign medical students criticized the "hospital" Egypt

انتقد وفد كليات الطب الأجنبية، والذى تستضيفه جامعة بنها حاليا، والمكونه من 17 طالباً وطالبة من 14جنسية من 17 كلية طب حول العالم، بناء على اتفاقية التبادل العلمى والطلابى.

Criticized the delegation of foreign medical schools, which is currently hosted by the University of Banha, consisting of 17 students from 14 nationalities from 17 Faculty of Medicine around the world, based on the scientific and student exchanges.

انتقد الوفد إجراءات مكافحة العدوى داخل المستشفيات المصرية، وأكدوا أنه لا يوجد أى اهتمام بمكافحة العدوى داخل المستشفيات، حتى من جانب الأطباء وفرق التمريض، مما ينذر بكارثة فى حال وجود وباء لا قدر الله.

Criticized the infection control procedures within the Egyptian hospital, and stressed that there was no interest in combating the infection in hospitals, even by doctors and nursing teams, which portends a disaster in the event of a pandemic is not as much as God.

جاء انتقاد الطلاب فى حضور الدكتور حسام العطار رئيس الجامعة والدكتور محسن خيرى عميد كلية الطب وعدد كبير من أساتذة الجامعة، ولم ينفِ أحد منهم انتقادات الوفد.

The criticism of the students in the attendance of Dr. Hussam Al-Attar the university president, Dr. Mohsen Khairy Dean of the Faculty of Medicine and a large number of university professors, one of them did not deny the criticism.

كما انتقد الطلاب أيضا ظاهرة التدخين داخل المستشفيات، وخاصة مستشفى الجامعة، وذلك من جانب المرضى والزوار والأطباء وفرق التمريض، وأكدوا أن هذه الظاهرة لا يمكن أن تحدث فى بلادهم لأن من يفعل ذلك يتعرض لعقوبات وغرامات رادعة، كما عبروا عن دهشتهم من تضخم عدد مرضى الكبد الوبائى.

The students also criticized the phenomenon of smoking in hospitals, especially university hospital, by patients, visitors, doctors and nursing teams, and stressed that this phenomenon could not occur in the home do so because it is being subjected to deterrent fines and penalties, and expressed surprise at the rise in liver patients epidemic.

Swine Flu Packs Bigger Jolt for Obese as ‘Striking’ Link Found

By Jason Gale

July 11 (Bloomberg) -- Extremely fat swine flu sufferers may have a tendency to become severely ill, health officials in the U.S. and Europe said, after a report showed a “striking” prevalence of obesity among patients hospitalized in Michigan.

Nine of 10 patients with the pandemic flu strain admitted to an intensive care unit at Ann Arbor from late May to early June, were obese and seven were “extremely obese,” with a body mass index of at least 40, doctors said. Three of the 10 died and seven had no other known health problems.

The study, in the Morbidity and Mortality Weekly Report yesterday, supports a pattern seen by doctors tracking the pandemic in hospital reports from Glasgow to Melbourne and from Santiago to New York. Researchers say the trend is surprising because obesity hasn’t been identified previously as a risk factor for severe complications of seasonal flu.

“Clinicians should be aware that severe illness and fatal outcomes also can occur in patients without known risk factors for complications of seasonal influenza, including persons with extreme obesity,” the Centers for Disease Control and Prevention in Atlanta said in an editorial note accompanying its report.

With the new virus on a collision course with the obesity epidemic, the World Health Organization says it’s gathering statistics to confirm and understand this development.

“Morbid obesity is one of the most common findings turning up in severely ill patients,” said Nikki Shindo, who is leading the investigation of swine flu patients at the WHO in Geneva. “It’s a huge problem.”

Seeking More Answers

So far, the evidence is anecdotal. No global or national data have been reported and the CDC said it’s unknown whether obesity is an independent risk factor. Yesterday, the European Centre for Disease Control and Prevention in Stockholm began including obesity on a list of factors that put patients at risk of dying from the pandemic bug.

Drugmaker Roche Holding AG is combing through studies to determine whether heavier people should get bigger doses of its Tamiflu antiviral. The CDC said yesterday that, until more data are available, a double dose of the Roche pill or a longer course of treatment can be considered for severely ill hospitalized swine flu patients.

The pandemic strain is reported to have killed 429 people worldwide since its discovery in the U.S. and Mexico in April, according to the WHO’s most recent report. The infection, which has spread as far as New Zealand and Norway, causes little more than a fever and cough in most cases. The majority of those who died were pregnant, had asthma, diabetes or other chronic diseases, according to the WHO.

Obesity ‘Stands Out’

“About 75 percent of patients have underlying conditions, and clearly obesity stands out as a statistically significant factor involved in the seriousness of the disease,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. “It was a bit of a surprise to us.”

It’s the first time the prominence of obesity has been widely recognized among severely ill flu sufferers, Fauci said in a July 9 interview. “It’s very likely that if we went back retrospectively and looked at people who did poorly during seasonal flu, what would shake out is that obesity would be one of the risks,” he said.

CDC researchers noted the association among California H1N1 patients in a May 22 report. The agency is investigating whether overweight people need different flu vaccinations. Last year, 26.1 percent of adults in the U.S. were obese, up from 25.6 percent in 2007, the CDC said in a July 8 statement.

Severe Pneumonia

Some patients are showing up at hospitals with viral pneumonia so severe they are suffocating. All 10 of the Michigan patients, ages 21 to 53, suffered acute respiratory distress and weren’t getting enough oxygen even when put on a conventional mechanical ventilator.

The patients, who represent “the most severely ill subset” of H1N1 sufferers, were notable for several reasons, the CDC said. Nine were male, five developed dangerous clots in the lung and major organs became dysfunctional in nine of the patients. The body mass index of nine patients ranged from 34.2 to 58.9, according to the report. People with a BMI of 25 to 29.9 are considered “overweight” and those higher than 30 are “obese.”

“The high prevalence of obesity in this case series is striking,” CDC said.

A 5-foot, 5-inch (1.65 meters) woman is considered overweight at 150 pounds (68 kilograms) and obese at 180 pounds. A 6-foot man is considered overweight at 184 pounds and obese at 221 pounds.

Cause or Complication

Scientists don’t yet know whether extremely overweight people get sicker because of associated conditions like heart disease and asthma, or whether the excess fat itself makes them more vulnerable. Both may be to blame.

Fat cells secrete chemicals that cause chronic, low-level inflammation that can hamper the body’s immune response and narrow the airways, says Tim Armstrong, a doctor working in the WHO’s chronic diseases department in Geneva.

What’s more, excess fatty tissue compresses the chest, and the fatty infiltration of the chest wall causes a decrease in lung function and an increase in the pulmonary blood volume, Armstrong said. “If you are obese, you tend to be less physically active and have an associated shallower breathing pattern. All these compound, leading to breathing difficulties.”

Insulin Resistance

The morbidly obese also are more likely to experience insulin resistance, a condition that makes it harder for doctors to lower the level of sugar in the blood of critically ill patients, said Greet Van den Berghe, head of acute medical sciences at Belgium’s Catholic University of Leuven.

“The question has always been, is it the obesity or the other problems?” said Melinda Beck, professor of nutrition at the University of North Carolina, Chapel Hill. “There haven’t been studies that looked just at weight. In my research, it appears to be the obesity itself.”

In mouse studies, flu killed about half of the rodents made obese by a high-fat diet, compared with a mortality rate of about 4 percent in lean animals, according to Beck’s research. She is studying whether obese humans might need stronger doses of vaccine or a different method of delivery.

People may reduce their risk of developing complications from swine flu -- as well as many other diseases -- by maintaining a healthy weight, quitting smoking, exercising regularly and moderating alcohol intake, said Frederick Hayden, a clinical virologist at the University of Virginia.

Rates Jump

Obesity rates have tripled in the U.S., U.K. and Australia during the past three decades, according to the Organization for Economic Cooperation and Development. The ranks of the overweight are also swelling in the developing world. In China, obesity doubled among women and tripled in men between 1989 and 2000 and it may double again in 20 years, according to research released last year in the journal Health Affairs.

Studies are needed to better understand the immune response of obese people and determine whether excess body weight impairs their ability to fight the infection, said Pamela Fraker, a professor of biochemistry at Michigan State University.

“It’s sort of strange that it’s been neglected with this major population,” Fraker said. “We need to know about this for the further care and protection of the growing number of obese we have and for society in general.”

To contact the reporter on this story: Jason Gale in Singapore at

Last Updated: July 10, 2009 20:28 EDT

Swine flu never a benign flu - Massey scientist

Early assumptions that swine flu would be benign because of reports of low death rates in Canada and the United States may have made people nonchalant about its seriousness, says a Massey scientist.

As at July 10, New Zealand had reported six deaths from swine flu and 1272 confirmed cases. The total number of cases in the community would be considerably higher however, says Professor Mick Roberts, a mathematical biologist at the University’s Institute of Information and Mathematical Sciences at Albany.

Professor Roberts has been researching the spread and virulence of the (A) H1N1 virus, or swine flu, in recent months and says conflicting reports in April about the severity of the virus resulted because of the time delay between the onset of infection and death.

Professor Roberts has just returned from a three-month research stint at Utrecht University in the Netherlands working on a Marsden-funded project with Professor Hans Heesterbeek to develop mathematical models that will help with understanding the evolution and transmission of viruses.

They were focusing on HIV/AIDs and seasonal flu when the swine flu broke out in Mexico. The pair interrupted their research to analyse data on infection and death rates in Mexico, Canada and the United States, in order to assess its virulence.

A paper Professor Roberts co-wrote with Dutch epidemiologists was presented last week to a meeting of the World Health Organisation’s Network for Pandemic Human Influenza. It looked at the case fatality ratio of swine flu – the ratio of deaths from an infectious disease to the number of cases. “We examined data at the beginning of the pandemic for the United States and Canada in April and May, and compared it with data on the number of confirmed cases and deaths in Mexico. The death rate was similar in all three countries,” he says.

However some media reports stated that more than 150 people had died of swine flu in Mexico by the end of April, despite the World Health Organisation issuing a statement saying nine had died. Cases from the same period resulted in two and four reported deaths in the United States and Canada respectively. There are now 25 reported deaths and 7983 confirmed cases of swine flu in Canada, he says.

Professor Roberts says people should not underestimate the seriousness of swine or seasonal flu. Last year 472 people were hospitalised in New Zealand for seasonal flu, and every year about 400 die from flu-related conditions. “A lot of people lump colds and flu together. A cold is a very different virus to the flu,” he says. ”Seasonal flu can be a serious illness.”

Professor Roberts has previously worked with the WHO Pandemic Influenza Research Group, to establish how a new virus could spread through New Zealand. He believes New Zealand health authorities are correctly managing swine flu, which the World Health Organisation last month declared a worldwide pandemic.
hat-tip Sally

Distrust in Argentina by the official figure of deaths from influenza A

* The humanitarian organization accuses the government of manipulating the figures

Ramy Wurgaft | Buenos Aires
Updated 11/07/2009 01:06 hours Saturday

Argentina and start removing the protective mask and returned to attend cinemas and nightclubs, where once again sounded the alarm.

The filial argentina Doctors warned the world on the afternoon of Friday, which may be more of the 240 fatalities caused by Influenza A. The figure showed that the perpetrators of this NGO, is three times higher than that recorded the final report of the Ministry of Health. "If they say the authorities are 100,000 people infected by the H1N1 virus, it is impossible that only 82 deaths. This figure defies the basic concepts of statistics and is equal to saying that the sun revolves around the Earth" said Gonzalo Basile, head of the same organization that assisted the poorest Argentines during the dengue outbreak that the country suffered three months ago.

At that time, Doctors of the World reported that the Government did not take the measures outlined to combat the Aedes aegypti mosquito, transmitter of the virus. Now back to the barricades, blaming the executive branch of the importance of the new epidemic. At a press conference convened at the headquarters of the agency, Basile noted that political considerations, the government headed by Cristina Fernández is played to the flu. "Prior to the elections (from June 28) the issue was not on the agenda and not, nor is adopted preventive measures," said Basile. "Just as of July 29 Argentines, we learned that influenza is a threat to our health," he added.
Official figures' unreliable '

The doctor Javier Montano, another leader of the humanitarian organization, said that official figures were "very reliable" and demanded the implementation of a reform in the health system so that all citizens are treated equally. The doctor was referring to low-income sectors in and around Buenos Aires and the provinces of northern Argentina. "Until today, each municipality is taking measures at their discretion and that as the virus passes from one region to another," said Montano. On the alleged data manipulation by the authorities, the doctor said that "the same thing happened with dengue and that worries us."

A few hours earlier, the Ministry of Health, Juan Manzur, pointed out that "there is a marked decline in cases, especially in metropolitan Buenos Aires, but warned an increase in the number of consultations within the country." From Ezeiza Airport, where he went to receive a shipment of 100 doses of Flu, Manzur told reporters that the Argentina passes mitigation stage of the virus and that people can look to the future with greater optimism.
hat-tip Shiloh

Argentina: Doctors of the World believe that the death toll is much higher


In a strong complaint, the owner of "Doctors of the World", Gonzalo Basile, warned today that it is "impossible" that Argentina has 82 fatal cases of influenza A, and that figure must be at least tripled.

"It would be such a fatality, but so low that it would be nonexistent," he said at a news conference. In this regard in the country noted that "there is a reliable information system and, in this scenario, it is easier to manipulate data."

The owner of the NGO said that "Argentina would be tripling the deaths given by the Ministry of Health, using the case-fatality rates internationally."

In the same vein, Basile noted that "in Argentina in 2008, we had 1,186,997 cases of influenza-like illnesses and 3,200 deaths from seasonal influenza." "There were 203,504 cases of pneumonia and 262,285 cases of bronchiolitis, which resulted in the death of 19,000 people for acute lower respiratory infections," he argued.

He added that "this means that respiratory diseases were serious last year. And a new virus that causes disease and death, the situation had worsened in 2008."

Javier Meritano, a member of the association, said that "one can speak of misinformation" because "the system is not prepared for a minimum overhead." The system of epidemiological surveillance in Argentina does not work, so the figures are not reliable "he said.

Basile, on the other hand, demanded the "repeal of the emergency decree in 2002 that health was not thought to strengthen public health or to meet the collective needs of the population's health. It was a tool to subsidize the private health sector" .

"We ask the national health emergency in which they work all the country's health sector on diseases affecting the population, including dengue fever and respiratory infections," ended.
hat-tip Shiloh

New Zealand is suffering worst flu season in decade

By Jason Gale | Bloomberg News
New Zealand is suffering the worst influenza season in more than a decade, spurred by a surge in cases of swine flu, which is supplanting the winter strains, according to a report by the country's health department.

Doctors reported 183.7 cases of flu-like illness per 100,000 people across the country in the week ended July 5, the Institute of Environmental Science and Research and National Influenza Centre said in a report Thursday. The rate is about double last year's peak.

Cases of flu have climbed as the H1N1 pandemic virus spread across New Zealand. Tests on viruses collected by doctors in the country's flu surveillance network last week showed 80 percent were the new strain, compared with 48 percent the previous week. The usual seasonal strains now account for about 20 percent of flu viruses tested, the report said.

"Flu activity has reached the point of being the highest in 12 years," said Sue Huang, director of the National Influenza Centre, in a telephone interview Thursday. "It keeps going up, and the season hasn't really peaked yet."

Fran McGrath, New Zealand's deputy-director of public health, announced the country's fifth fatality from the pandemic virus Wednesday.

"For most people who get influenza this winter, it will be a mild to moderate illness and they will recover at home without needing medical treatment," McGrath said in a statement on the health ministry's Web site. "People who are at higher risk of more serious illness from influenza are those who have other significant health conditions."

hat-tip Chuck

Friday, July 10, 2009

Zimbabwe Seen Vulnerable To Emergence of H1N1 Flu in Southern Africa

08 July 2009

Shortly after the United Nations Office for the Coordination of Humanitarian Affairs warned that Zimbabwe must prepare for the threat of swine flu, reports emerged in Harare this week of the country's first two cases on the heels of occurrences in South Africa.

Reuters reported that state media said a man of Asian origin recently arrived from London had tested positively for the virus and was quarantined in Harare.

The agency quoted Health Minister Henry Madzorera as saying he could only confirm the case of an 18-year-old squash player who was being treated in South Africa.

In its latest monthly report, OCHA said Zimbabwe has had a respite from its humanitarian emergency as cholera cases have dwindled, but is now at risk from the H1N1 flu.

When the U.N. agency issued the report two cases had just been reported in South Africa. It said South Africa's proximity raises the need for plans to deal with an outbreak.

Responding to the OCHA warning, Health Minister Henry Madzorera said Zimbabwe is on high alert and has plans to deal with any such outbreak, adding that the country has received sophisticated equipment and drugs from the World Health Organization.

But Dr. Douglas Gwatidzo of the Zimbabwe Association of Doctors for Human Rights said he does not believe Zimbabwe is ready to deal with a major outbreak of H1N1 flu, pointing to the need for effective border controls.

Cholera has claimed more than 4,000 lives in the country since August of last year, though the epidemic has subsided significantly from its peak in February.

15 basic cadets test positive for H1N1, dozens report symptoms

AIR FORCE ACADEMY - The Air Force Academy says 15 of their basic or incoming cadets have tested positive for H1N1, also known as swine flu, after nearly 100 started showing upper respiratory symptoms.

"This is a serious matter and we are treating it as such. We understand friends and family are concerned about their loved ones and we will release updates as information becomes available," Lieutenant General Mike Gould said, Air Force Academy superintendent.

All of the 88 basic cadets showing symptoms have been receiving treatment since Monday and have been kept in isolation in the Vandenberg Hall on campus.

The 15 cases were identified at the Air Force School of Aerospace Medicine Epidemiology Lab at Brooks City Base, Texas after lab tests were sent there Thursday.

"We are taking the necessary precautions to educate and safeguard military and civilian personnel, as well as family members," Gould said. "The entire cadet wing and all USAFA personnel have been informed and given instructions of actions to take if flu-like symptoms are exhibited."

USAFA health officials are following Centers for Disease Control guidelines for treatment, testing and prevention and consulting with the CDC, Air Force Surgeon General and El Paso County Public Health Department.

For more information about the H1N1 flu, visit the CDC Web site at

H1N1 Still Spreading in Virginia

Richmond, Va.
Posted: 12:03 AM Jul 10, 2009
Last Updated: 4:39 PM Jul 10, 2009

Virginia's Health Commissioner sent a memo this week to doctors at state agencies that says 95 percent of influenza illness being reported are actually the H1N1 virus.

A newly established Office of H1N1 Response in the state is working with emergency responders to prepare for another outbreak this fall.

Dr. Karen Remley says the virus continues to affect the young disproportionately, with the highest number of cases being reported at at camps and day cares.

Nationwide, more than 37,000 cases of H1N1, or swine flu, have been confirmed. Of those cases, 211 patients have died.

Those numbers rose from 170 deaths and nearly 34,000 confirmed and suspected swine flu cases reported last week

Five new swine flu cases, now 169 in India

New Delhi, July 10 : Five people, including two children, were detected with swine flu Friday, taking the total number of influenza A (H1N1) infections in India to 169, health officials said.

'One thousand and seventy-eight people have been tested so far, of whom 169 were positive for influenza A (H1N1),' a statement issued here said.

'Of the 169 positive cases, 118 have been discharged,' it added.

Health officials said of the five new laboratory-confirmed cases, two were from Delhi, followed by and one each from Bangalore, Mumbai and Pune.

In Delhi, a father-son duo were detected with the virus. The 31-year-old man had travelled from Bangkok and reached Delhi July 2. On July 8, he developed swine-flu like symptoms. The man's eight-year-old son also developed fever. Both tested positive for the flu Friday.

In Bangalore, a five-year old girl who had come from New York with her family tested positive Friday.

According to the World Health Organization (WHO), 94,512 laboratory-confirmed cases of influenza A (H1N1) were reported from 135 countries till July 6. There have been 429 deaths worldwide, mostly in Mexico and the US.

--- IANS

Red Cross Preparing for Possibility of More Severe H1N1 Flu Outbreak

Friday, July 10, 2009 — In April 2009 an outbreak of human cases of H1N1 flu was discovered in North America. By mid-June, the World Health Organization had raised the worldwide pandemic alert level to Phase 6, indicating a global pandemic was underway. More than 70 countries are now reporting cases of human infection.

In the United States, most people who have become ill with H1N1 have recovered without requiring medical treatment. However, according to the CDC, this virus could cause significant illness with associated hospitalizations and deaths in the fall and winter during the U.S. influenza season.

While nobody can be certain of what will happen this fall, the America Red Cross, along with government agencies and partner health organizations, are planning and preparing for the possibility of an increased spread in the H1N1 flu.

This past week, President Obama's cabinet held a H1N1 Flu Preparedness Summit to prepare for the possibility of a more severe outbreak of H1N1 flu. Joe Becker, American Red Cross Senior Vice President of Disaster Services was in attendance, along with government officials, health and emergency preparedness professionals, policy makers, and business leaders.

According to Sharon Stanley, Red Cross Chief Nurse, “It’s important to remember that the Red Cross partners at every level of pandemic planning and response, from the field at the local level, clear up through the White House like the event this week. This gives us the ability as the Red Cross response operation to have a working knowledge in order to take care of our communities in a pandemic environment.”

In addition to coordinating and planning with government and partners, the Red Cross is taking other steps to prepare. They include:

The Red Cross is also ramping up plans to provide specific services. To this end, the Red Cross will tailor it’s response from community to community depending on the needs of that specific area. During a flu pandemic, the Red Cross will:

  • Continue to respond to disasters of all types and sizes.
  • Provide educational materials and logistical support alongside local health partners.
  • Educate the public and disseminate information from the CDC, and state and local public health agencies.
  • Ensure a safe blood supply.

At this time, the American Red Cross continues to monitor the current H1N1 outbreak. The most important action the public can take now to reduce the spread of the H1N1 virus is to practice healthy hygiene habits.

About the American Red Cross:
The American Red Cross shelters, feeds and counsels victims of disasters; provides nearly half of the nation's blood supply; teaches lifesaving skills; and supports military members and their families. The Red Cross is a charitable organization — not a government agency — and depends on volunteers and the generosity of the American public to perform its humanitarian mission. For more information, please visit or join our blog at

Over 300 pigs die in Mizoram, officials rule out H1N1 scare

10 Jul 2009, 1745 hrs IST, PTI
AIZAWL: More than 300 pigs have died reportedly of swine fever in south Mizoram's Lunglei and Saiha districts over the last week, even as health
officials sought to allay fears of people, saying the disease was different from the dreaded H1N1 flu.

At least 177 pigs died in Buknuam and neighbouring villages in Lunglei district, while over 150 died at Laki village in Saiha district along Mizoram-Myanmar border, official sources said in Aizawl on Friday.

Medical officers from Saiha, who visited Laki to conduct a spot verification, said the pigs died due to the prevailing "swine fever and not the dreaded H1N1 swine flu."

District veterinary officer of Lunglei district also confirmed that 177 pigs in the district died due to swine fever that has hit the state since 1980.

Earlier, more than 100 pigs died in Kolasib district of the state.

The import of pigs from neighbouring Myanmar and Bangladesh is still banned.

WHO to give H1N1 jab guidance on Monday at latest

GENEVA (Reuters) – The World Health Organization (WHO) plans to hold a media briefing on Friday or on Monday to issue guidance about the need for a H1N1 influenza jab, a WHO spokeswoman said.

"The recommendations are still in the process of being developed," Fadela Chaib told a news briefing in Geneva, where the United Nations agency is based.

Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, would give a news briefing once the recommendations emerging from the closed-door WHO meeting on Tuesday are approved by WHO Director-General Margaret Chan.

The WHO raised its influenza pandemic alert to the highest level on June 11 in response to the worldwide spread of H1N1, a newly discovered virus strain commonly known as swine flu.

Vaccine makers such as Sanofi-Aventis, Novartis, Baxter, GlaxoSmithKline and Solvay are seeking WHO guidance about whether to ramp up production of jabs for the strain, to keep making seasonal flu vaccines, or to produce a combination.

The discovery of three isolated cases of H1N1 flu in Denmark, Japan and Hong Kong that resisted treatment with the anti-viral drug Tamiflu, made by Roche and Gilead, has raised interest in a jab to prevent infection.

The WHO said earlier this week that Tamiflu-resistant H1N1 flu does not appear to be spreading in a sustained or worrisome way. All patients with the resistant variety have recovered fully, and their viruses were sensitive to treatment with the other anti-viral recommended by the WHO, the inhaled drug Relenza made by Glaxo under license from Biota.

Jiangsu Binhai 20,000 chickens died of bird flu experts denied the relevant

中国养殖网 China Culture Network 2009-7-9 10:23:28 江苏新闻网 Jiangsu News Network 2009-7-9 10:23:28
Jiangsu Yancheng new network of power on July 9 (童盛from the text) from the end of June, Binhai county, Jiangsu Province, south-west outskirts of the two chicken farms raised the phenomenon of large-scale deaths, as of today, the two chicken The number of dead chickens in the market more than 20,000, live chickens left.

Lived to see today's County Economic Development Zone, Binhai Industrial Park District community three groups Zhang Baojun poultry farmers, he can hardly cover up the pain of the face color. He's dead chickens to the scene, standing 50 meters away from where the chicken loop will be able to smell the taste of rotting corpses, the chicken full circle dead chickens lying dead body, dead chickens Jiguan black, extremely thin body feathers falling loose, the mouth still unknown liquid. Zhang Baojun said the other day most of the dead chickens had been buried or burned.

Zhang Baojun told reporters in February and April this year, bought a total of 14,000 chickens, as a result of expansion, and in June 6500 about the purchase, together with the later-born chicks, the two chicken farms scale to reach more than 20,000 only. Day of June 27, in which a small-scale chicken farms death, in accordance with the practice of this is a normal phenomenon, there is no need to arouse attention, nor to use chicken. But did not expect, then days later, doubled the number of dead chickens, the largest number of dead chickens in 1000 appear one day.

It is understood that the coastal counties reflected from the relevant departments to investigate the many times after. The afternoon of July 8, Lin County Coastal Fisheries Service staff provided farmers live and dead chickens autopsy samples, the main lesions observed were: fat Xinguantong edema, pericardial effusion, gastric nipple swelling cecal tonsil hemorrhage; liver there are two of about a half centimeters in diameter, the middle edge of uplift depression necrotic foci of yellow-white. Accordingly, Lin Fisheries Board staff finds that the preliminary cause of death in the Department of suspected chicken Infectious result ruled out the prevalence of viruses and the possibility of large-scale epidemic.

Binhai County, the Environmental Protection Agency Environmental Monitoring staff on farms near the water reservoirs have also been sampling laboratory analysis, water quality test results for: PH value is 7.35, total phosphorus 0.0 to 82 mg / l, with a total coliforms for the 1400 / L, with a total lead to 13 0.0 mg / l, with a total cadmium for four 0:00 mg / l, water quality of surface water environmental quality standard (GB 3838 -- 2002) three types of water standards.

Vietnam-Dak Lak public green ear disease in pigs

Updated at: 8:50 PM, 10/07/2009

(VOV) - Dak Lak People's Committee has just issued Decision express public and reproductive disorders and respiratory in pigs (blue ear disease) in Cu Bao, Buon Ho town, Dak Lak province.
According to this decision, in time have, prohibits the trade, transport pigs and pig products in the targeted area; transport to areas on pigs and pig products
. The transport in the region and out to comply with the instructions of officials on animal health in the area defined by regulation. Livestock owners have the responsibility to comply with the guidelines of the animal in the application of measures to prevention and mandatory; implement sanitation targets in khử same.

Department of Agriculture and Rural Development, the departments concerned and Buon Ho town mobilize human, material resources to organize measures against disease by the law.

For the district, the city no blue ear pig disease should strengthen the prevention and, close monitoring of disease on pigs to actively process and if found.

Animal Health Department, Animal Health Station Buon Ho town to quickly fold with regional outbreaks in Cu Bao, identifying areas and, the reputation of being translated (area monitoring), and buffer areas for epidemic prevention measures achieve efficiency. /.


In this update:
[1] Cambodia: 8 confirmed cases
[2] China: 1151 confirmed cases
[3] Thailand: 2925 confirmed cases, 14 confirmed deaths
[4] Viet Nam: 259 confirmed cases
[5] Viet Nam - patient data

[1] Cambodia: 8 confirmed cases
Date: Thu 9 Jul 2009
Source: Xinhua News Agency [edited]

Cambodia's Health Ministry on Wednesday [8 Jul 2009] confirmed the
country's 8th infection case, a 15-year-old Australian girl. The
ministry said the previous 7 patients have returned home after treatment.

Communicated by:

[For a map of Cambodia, see
For the interactive HealthMap/ProMED-mail map with links to other
recent PRO/MBDS and ProMED-mail postings in Cambodia and neighboring
countries, see <>. - Mod.YMA]

[2] China: 1151 confirmed cases
Date: Wed 8 Jul 2009
Source: Xinhua News Agency [edited]

China relaxes quarantine on A/H1N1 flu close contacts, mild cases
Chinese people in close contact with A/H1N1 flu patients will no
longer be quarantined in specially reserved places, and patients with
mild symptoms may receive treatment at home, the Health Ministry said
Wednesday [8 Jul 2009]. Close contacts could observe home quarantine,
and the range of close contacts was narrowed down, according to a
notice on adjusting A/H1N1 flu prevention and control measures issued
by the ministry Wednesday [8 Jul 2009].

"The adjustment does not give up supervising close contacts. It's
just a different place for quarantine, and they still will be
restricted from going outside and contacting other people
," said
Liang Wannian, deputy director of the ministry's emergency office.

Close contacts now include people who diagnosed, treated, nursed or
visited a patient, people who worked or lived with a patient, and
people who contacted the spit or body fluid of a patient. And on
aircraft, close contacts include 8 passengers surrounding a patient,
the notice said.

According to the notice, mild flu cases may be quarantined and
treated at home, and health departments at provincial level have a
general discretion to decide. Liang said the adjustment is aimed to
ensure timely and effective treatment of severe cases. The notice
also urged all regions to strengthen prevention and control work on
special groups including the old, the sick and the pregnant.

China had confirmed 1151 A/H1N1 flu patients by Tuesday [7 Jul 2009]
and 870 of them had been discharged from hospital, according to the
Ministry of Health
. There have been no deaths directly caused by the
influenza so far.

[Byline: Wang Guanqun, editor]

Communicated by:

[For a map of China with provinces, see
For the interactive HealthMap/ProMED-mail map of China with links to
other ProMED-mail and PRO/MBDS postings in China and surrounding
areas, see <>. - Mod.YMA]

[3] Thailand: 2925 confirmed cases, 14 confirmed deaths
Date: Thu 9 Jul 2009
Source: Bangkok Post [edited]

The cabinet on Thursday [9 Jul 2009] approved the temporary closure
of tutoring schools for 15 days starting Monday [13 Jul 2009] to
limit the spreading of influenza A as the Public Health Ministry
confirmed 3 more deaths from the virus. The move came after the
Public Health Ministry reported that many students have caught the
virus while at tutoring schools. All tutoring schools throughout the
country will be closed from Monday until 28 Jul 2009, the cabinet decided.

The temporary closure was necessary because most tutoring classes
were in air-conditioned rooms, which facilitate the spread of the
virus because the students are in confined spaces, Deputy Education
Minister Chaiwuti Bannawat said.

The cabinet also asked owners of online game shops to cooperate by
closing their business during the same period, because many young
players had also caught the infection.

The Public Health Ministry on Thursday [9 Jul 2009] confirmed 3 more
deaths from influenza A and 211 new infections

The 12th victim was a 52-year-old traffic policeman in Bang Na,
Bangkok, who suffered from kidney failure.
The 13th victim was a
student in the 11th grade at Maha Sarakham University demonstration
school in the northeastern province of Maha Sarakham.

The 14th fatality was a 17-year-old girl who had been treated in
Srinagarind Hospital in Khon Kaen province since 3 Jul 2009. She died
on Tuesday, and her blood test on Thursday afternoon showed that she
was positive for the A(H1N1) flu.

The Maha Sarakham student was believed to have caught the disease
when he went to take an assessment examination for Chulalongkorn
University's faculty of medicine. At least 10 of his friends have
been admitted to hospitals for tests. After his death, the school
announced that it would close on Thursday and Friday.

Total influenza A infections had risen to 2925, the health ministry said.

Tourism and Sports Minister Chumpol Silpa-archa said the flu pandemic
was expected to continue for months and would add to the burden of
the country's suffering tourism sector. He said the flu outbreak
would have a psychological effect on foreign tourists, who were
likely to cancel overseas travel plans.

Communicated by:

[For a map of Thailand showing the geographic regions, see
<>. For the
interactive HealthMap/ProMED-mail map with links to other ProMED-mail
and PRO/MBDS postings in Thailand and neighboring countries, see
<>. - Mod.YMA]

[4] Viet Nam: 259 confirmed cases
Date: Thu 9 Jul 2009
Source: Thanh Nien News [edited]

Patients suspected of having antiviral resistant H1N1 strain
The National Institute of Hygiene and Epidemiology is studying the
genes of H1N1 virus from 2 patients following suspicion about its
resistance to the antiviral drug oseltamivir or Tamilflu. The 2
patients were among the 19 people admitted to the institute so far,
Director Nguyen Van Kinh said Wednesday [8 Jul 2009]. 3 of these
cases were locally transmitted, he added.

The Health Ministry reported Wednesday [8 Jul 2009] 11 new influenza
A (H1N1) patients -- 7 in the south, one in the central and 3 in the
northern region -- raising the country's tally to 259. Of these, 186
patients have been discharged from hospitals after full recovery

The ministry also said they are closely monitoring treatment
resistance. The ministry will allow more hospitals to announce
official test results instead of having to wait for the results of
another test by authorized agencies. This would avoid waste of time
and reduce the government's expenditure on testing, which comes to
about USD 150 per case, the ministry said.

The Department of Health in Thua Thien-Hue Province, said Wednesday
[8 Jul 2009] they had instructed districts to set up facilities to
quarantine those suspected of carrying the virus and treating
confirmed H1N1 patients.

Nguyen Dung, the department director, said the facilities at the
districts would meet all criteria issued by the Health Ministry, and
help ease overload in the provincial level hospitals. This will also
prevent possible spread of the flu while transporting the patients, he added.

The World Health Organization (WHO) Wednesday [8 Jul 2009] said some
137 countries and territories have reported more than 98 000 cases
including more than 440 deaths.

WHO has been informed by health authorities in Denmark, Japan and the
Special Administrative Region of Hong Kong, China of the appearance
of H1N1 viruses which are resistant to Tamiflu based on laboratory testing.

Communicated by:

[5] Viet Nam - patient data
Date: Wed 8 Jul 2009
From: Rogier van Doorn <>

In the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam,
patients with flu symptoms and a positive RT-PCR result for pandemic
Influenza A (H1N1) 2009 virus infection with the CDC assay (specific
A(H1N1)v primers/probe) are hospitalized and treated with oseltamivir
(75mg bd) until RT-PCR results are negative.

We collected clinical data, haematology and biochemistry, and daily
virological data (nose and throat swabs) from the 1st 44 Influenza A
(H1N1)v RT-PCR positive patients in Viet Nam hospitalized between 29
May and 26 June 2009. The average age of the patients was 28.6 years
(3-62), 19 female and 25 male
. 5 patients contracted flu while in
Viet Nam but with a clear epidemiological link to someone with
"imported" H1N1, 39 cases were thought to be directly imported (14
US, 18 Australia, 2 Canada, 2 Thailand, 1 Japan, 1 China, and 1 Singapore).

Fever was present in 91 percent (n - 40), cough in 55 percent (n -
24), runny nose in 20 percent (n - 9), sore throat in 27 percent (n -
12), and diarrhea in 2 percent (n - 1). Average duration of fever on
presentation was 2 days. After 24 hours 75 percent (n - 33) of
patients had a normal temperature. All patients had a mild illness course.

Viral PCRs were positive on day 0 for all patients with an average Ct
value of 30.3. The number of PCR positive patients dropped to 25
after 1 day (average Ct 30.3). On day 2, 21 patients were positive
(average Ct 35.8) and on day 3 and 4, 8 patients were still PCR
positive (average Ct 37.0 and 37.2). No patients were positive on day
5, 6 and 7.

These data suggest that patients treated with oseltamivir have a
favourable clinical and virological response and are not shedding
viral RNA after 5 days of treatment. In comparison, Whitley et al
[Pediatr Infect Dis J 2001 20:127] found 55 percent (n - 51/93)
culture positive patients in oseltamivir treated children with
non-severe influenza on day 4.

There have been a few anecdotal reports from Viet Nam of patients
that remained symptomatic and PCR positive for a prolonged period,
and one patient in our hospital (not included in this report) had a
positive PCR after 18 doses of oseltamivir. Investigations into the
presence of the NA H274Y mutation in [virus isolated from] these
patients are ongoing but have so far been negative.

Tran Tinh Hien
Nguyen Thanh Truong
Nguyen van Vinh Chau
Tran Thuy Ngan
Jeremy Farrar
Rogier van Doorn
Hospital for Tropical Diseases
Ho Chi Minh City
Viet Nam

Rogier van Doorn
Hospital for Tropical Diseases
Wellcome Trust Major Overseas Programme
Oxford University Clinical Research Unit
190 Ben Ham Tu
District 5
Ho Chi Minh City
Viet Nam

[For maps of Viet Nam with provinces,
<> and
<>. The interactive
HealthMap/ProMED-mail map with direct links to other outbreaks in
Viet Nam and surrounding countries reported on ProMED-mail and
PRO/MBDS can be accessed at <>.

The strain of influenza A (H1N1) resistant to Tamiflu was 1st
detected in Denmark, and followed by Japan, United States, Hong Kong
SAR (see prior PRO/MBDS postings listed below) and Viet Nam.

According to the latest figures on confirmed cases of influenza A
(H1N1) infection in neighboring countries of the MBDS region, there
are 18 cases in Bangladesh, 1055 in Hong Kong SAR, 68 in Macau SAR,
61 in Taiwan, 52 in Indonesia, 158 in India, 2033 in Japan, 513 in
Malaysia, 1217 in Singapore, 19 in Sri Lanka, 333 in South Korea, and
1709 cases and one death in Philippines.

Update 58 of laboratory-confirmed cases of the new influenza A (H1N1)
as officially reported to WHO by states parties to the international
health regulations (2005), dated 6 Jul 2009, is available at

The map of the spread of influenza A (H1N1) from WHO, which includes
the number of laboratory confirmed cases and deaths as of GMT 09:00,
6 Jul 2009 is available
at <>. - Mod.YMA]