Saturday, August 22, 2009

Should you get an H1N1 flu shot?

Published: 23/08/2009 at 12:00 AM
Newspaper section: News

More than half a million Thais are thought to have contracted H1N1 flu. The death toll last week passed 111. Many others have had two weeks of mostly uncomfortable, painful quarantine. One other thing: This strain of influenza is striking children more than anyone, and hardly hitting the elderly at all. That is the opposite of most varieties of the flu.

IN THE LAB: Eggs are prepared for viral insertion as part of the process for making seed stock for a vaccine against swine flu.

So. Should you get a shot?

That was a trick question. It doesn't matter if you should get vaccinated, because you can't. Yes, Prime Minister Abhisit Vejjajiva said for weeks there is plenty of vaccine. But he is a politician. Fact: There isn't any vaccine.

There will not be any vaccine for a while. In preparation, the Public Health Ministry set about finding human guinea pigs on which to test the drug. That is a vital, if somewhat routine, part of putting any vaccine on the market.

Worldwide, according to the World Health Organization (WHO), orders have passed one billion doses of vaccine from governments alone. Fear, prudence or a combination of both are feeding a major demand for medicine that is still in the laboratory stage.

Meanwhile, back in the labs at Silpakorn University and elsewhere, medical experts were testing the old theory that you can't make an influenza preventative without breaking a few eggs. And the eggs were not being at all cooperative.

Board chairman Vichai Chokewiwat of the Government Pharmaceutical Organisation (GPO) said scientists were getting a very low amount of vaccine-per-egg. Because of the low-yield (read ''weak'') anti-virus vaccine, there was even a chance that the whole project might have to be restarted. The WHO is sending in some advisers this week to help to make a final decision.

By the end of last week, scientists demonstrated why scientists don't run things. A number of them called on the government to gather all available scientists to work on the solution to the egg problem. ''We need to get ideas from experts in various fields to make mass vaccine production work,'' said International Health Policy Programme researcher Jongkol Lertiendumrong.

This is known in non-scientific terms as ''the IBM solution'', where if 10 scientists cannot solve a problem in four weeks, 40 scientists ought to be able to solve it in one more week. It works in kitchens, too, where too many cooks spoil the broth.

But the GPO wouldn't mind fresh injections of vitamin M (money), Mr Vichai said the WHO should send more money to develop a new plant for vaccine, at a university he did not name.

NYT: 'No Side Effects So Far in Trial of Sw

Published: August 21, 2009

There have been no serious side effects from the first set of injections of the new swine flu vaccine, federal health officials said Friday in predicting that nearly 200 million doses could be produced by year’s end.

Clinical trials in adults began on Aug. 7, and those in children on Wednesday.

“There are no red flags regarding safety,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is overseeing the trials.

Because the only side effects in adults were sore arms, which are typical of any flu shot, trials on children were able to begin, and those in pregnant women are expected to begin early next month, Dr. Fauci said in a telephone news conference with officials from the Food and Drug Administration and the Centers for Disease Control and Prevention.

The vaccine will be tested in about 4,500 people. That is far too few to pick up subtle side effects, but the virus strain in the vaccine is close enough to one strain in seasonal shots so that side effects are expected to be similar.

The trials will help officials decide whether to recommend one dose or two. Even with seasonal flu shots, young children who have never had the flu sometimes need two doses to get a “take” — vaccinologist jargon for a protective immune response.

Unless the virus changes, health officials do not expect to recommend mixing in adjuvants. Adjuvants, usually oil-water emulsions or aluminum salts, boost the immune system but also often heighten unpleasant side effects.

Since it was first detected in April, the pandemic virus has not produced any nasty new surprises during its spread around the world, said Dr. Jay C. Butler, director of the H1N1 Vaccine Task Force at the C.D.C.

Flu activity in the Southern Hemisphere, which soared in June at the beginning of its winter, has begun to wane. In most of the United States, flu activity is “sporadic,” though it is widespread in Alaska and Maine; the reasons for this disparity are unknown, other than for Dr. Butler’s speculation that since swine flu arrived late in Alaska, it may still be peaking.

The virus has not crossbred with other flu viruses or mutated to produce proteins that could make it more lethal. And while some Tamiflu-resistant virus has been found in several countries, it has not become widespread.

Health officials said they were not particularly alarmed by reports Friday that the new flu had been found in turkeys on two large commercial farms in Chile, the first time it had been reported in birds.

“It’s widespread in humans, so who cares if it’s in turkeys?” Dr. Fauci said. “That’s a Department of Agriculture issue.”

Influenza viruses are most commonly found in birds, pigs and humans, though they can infect seals, dogs, horses, ferrets and many other animals.

The flu did not kill the turkeys; it was noticed only because their egg laying fell off and they drank less water. They will be quarantined and allowed to recover, Chilean agriculture officials said.

The H5N1 bird flu, by contrast, is lethal to poultry, and infected flocks are usually culled.

Although the possibility exists that the mild pandemic flu could swap genes with a lethal avian flu in bird hosts and then make the jump back to people, Dr. Fauci pointed out that the dangerous avian flu was circulating in Asia and Egypt, not in South America.

“You could dream up a variety of scenarios,” he said, “but we have enough H1N1 to worry about without worrying about turkeys

In the United States, there have been 522 swine flu deaths confirmed by lab tests, but the real number is undoubtedly higher, Dr. Butler said, because most flu cases are not tested.

Though it has been weeks since the C.D.C. raised its official estimate of swine flu cases, Dr. Butler acknowledged that millions of people had been infected. Children, teenagers and adults under 50 have accounted for about 75 percent of hospitalizations and 60 percent of deaths.

The agency expects cases to surge as soon as students return to school and as colder, drier fall weather sets in. Officials have urged schools to prepare, especially by keeping sick students out and making well students wash their hands frequently and cover coughs and sneezes. Universities have been urged to warn students to be ready to go home or to the house of a relative or friend if they fall ill.

Please Do Not Bring Small Children While Visiting Hospitals

By Zulkiple Ibrahim

KUALA LUMPUR, Aug 21 (Bernama) -- A public hospital here has recently distributed hundreds of flyers reminding visitors not to bring little children while visiting hospital wards particularly in the wake of the latest development of the H1N1 epidemic in the country.

Even without the H1N1 virus, there is a long-standing regulation that bars visitors from bringing their children aged 12 years and below to hospital wards, said a senior nursing officer of the hospital.

"Parents didn't take it seriously if we reminded them not to bring in small children into the hospital wards. I have told mothers carrying babies and toddlers that the children were too small to visit the hospital", she said.

She said some parents heeded the advice but others would simply ignore reminders by nurses and even security guards.

Some even sarcastically retorted " we know lah...' and as they proceeded to enter the wards with their little children.

"It is not safe for little children to visit a hospital. It is not safe for them, and it is not safe for the patients," she added.


Small children and those with chronic and debilitating medical problems are very susceptible to infections.

"When we say chronic diseases, it covers patients that have diabetes, renal failure, asthma and other respiratory problems as well as a host of other diseases", said a Dr K. Regesh, a specialist on respiratory diseases.

He said for these patients and the small children, their immune system is lower than that of healthier persons, hence they are prone to infections, not only to the H1N1 virus but also to other infective diseases.

"At the hospital, there are worse germs there and please do not bring your small children into wards even to say 'hello' to the patients.

"If you cannot visit the hospital without having to bring your children, then don't visit. Maybe you can bring your maid or someone else who can stay with your small children in the waiting room," he said.

For working parents and those who have returned from hospital visits, Dr Regesh has this to say:

"After returning from visiting sick relatives or friends in the hospital, take a shower and change into fresh clothes before cuddling your babies. Do the same when you return from work, take a bath first and put on clean clothes before touching your children".


Recently Deputy Prime Minister Tan Sri Muhyiddin Yassin said that self-control measures by the public are crucial towards stemming the tide of the spread of H1N1 epidemic.

Among these measures are wear a mask if you have fever and are coughing or sneezing to avoid infecting family members, wash your hands regularly more so if you are coughing or sneezing or having a sore throat.

If you are feeling unwell, go to the nearest hospital.

If you are sick, stay within your house and distance yourself from family members.

Avoid public spots and the crowds.


Tourists entering India via Nepal border undergo screeing for swine flu

Malaysia Sun
Saturday 22nd August, 2009

Aligarhwa (Uttar Pradesh), Aug.22 : Following a growing number of HINI virus affected cases, tourists and other visitors travelling between India and Nepal are being screened at the border for a health check up for symptoms of swine flu which has claimed 45 lives in the India.

A lot of people including domestic and international tourists enter India from Nepal on daily basis to visit Buddhist religious sites, most of them are first time visitors.

Everyday at least 500 people along with tourists are being checked at specially set up camps for swine flu symptoms.

A medical camp is being set up at the SSB (Sashastra Seema Bal) check post in Aligarhwa in Siddharthnagar district in Uttar Pradesh. Other camps have been organized in Barahni and Kakrahwa.

Soldiers posted at the border are showing enthusiasm to visit the health check-up camps.

"I came to know that a medical camp is being set up at the border and travellers are being screened for swine flu symptoms. I also came for the check up to ensure about my health condition," Omkar Singh, a Soldier, SSB (Sashastra Seema Bal).

Doctors at the border hospitals are on high alert and taking required precautions to prevent spread of swine flu.

"As our district is near the Nepal border, a lot of foreign tourists come here. We are taking precautions, checking them and we have opened special ward for swine flu patients," said B.R.Ram, Senior Consultant District Hospital Siddharthnagar.

India recorded its first H1N1 case in Hyderabad in May and since then the virus has spread different parts of the country.

The H1N1 virus, commonly known as swine flu, emerged in April in the United States and Mexico, and has spread internationally.

The World Health Organisation (WHO) has termed H1N1 swine flu as 'unstoppable' because many countries are not keeping a track and precise count of the virus cases. By Pawan Kumar

South Korea-

H1N1 Cases Soar to 2,819
  • [2009-08-22, 12:05:47]
The government’s flu task force confirmed 144 new flu cases on Friday, raising the nation’s total number of confirmed cases to two-thousand-819.

Some 800 flu patients are being treated in their homes while seriously ill patients remain hospitalized.

The nation has confirmed at least 100 cases of the new flu each day this week, with more than 200 cases confirmed on Thursday alone. The surging numbers are prompting concerns that a flu pandemic will begin earlier than expected.

Only government-designated hospitals and pharmacists can distribute antiviral drugs to flu patients. The list of authorized medical care providers is available online at the Internet homepages of the Health Ministry and the Korea Centers for Disease Control and Prevention.

Medical costs for flu confirmation are covered by health insurance while antiviral drugs are provided free of charge.

JAPAN-No. of new-flu patients tops epidemic mark / NIID estimates 110,00 infected with A/H1N1

The new A/H1N1 strain of influenza, which has killed three Japanese in the past week, has reached the epidemic stage in the country, the Health, Labor and Welfare Ministry announced Friday, with 110,000 Japanese estimated to have been infected.

The number of influenza patients reported by about 5,000 designated medical institutions across the country during the week of Aug. 10 to last Sunday stood at 7,750, or 1.69 per facility, topping the 1.00 benchmark that is deemed the beginning of an epidemic, the National Institute of Infectious Diseases said in a preliminary report released the same day.

Based on reports from the designated facilities, the institute estimated 110,000 people have been infected with the new flu.

Health, Labor and Welfare Minister Yoichi Masuzoe had issued a de facto "epidemic declaration" on Wednesday as the figure for the previous week of Aug. 3-9 was 0.99. About 60,000 people were estimated to have been infected during that week.

The number of patients, however, has increased by 70 percent since then.

Although the figures include seasonal influenza patients, the ministry believes most of them have been infected with the new H1N1 strain, Masuzoe said.

The per-facility number of flu patients topped 1 in 26 prefectures during the most recent reported period, a jump from six in the previous week.

Two hundred and thirty people had been hospitalized with the new flu between July 28, when the institute began compiling such figures, and Tuesday. By age group, 146, or 63 percent, were aged 5 to 19. Those younger than five totaled 35, while 21 were aged 20 to 39, 10 were aged 40 to 59, and 18 were 60 or older.

Patients under 20 thus accounted for about 80 percent of hospitalized new-flu patients in that period. Ninety-three hospitalized patients, or about 40 percent, had chronic and other illnesses.

People suffering from chronic diseases, pregnant women, babies and young children are thought to be at high risk of developing serious health problems, such as pneumonia and other diseases, after becoming infected with the new influenza virus. The ministry plans to hold briefings for groups of patients and parents of young children next month to provide information to people most susceptible to serious illness.

The ministry also intends to survey medical institutions on such matters as the number of artificial respirators and intensive care units available for critically ill patients.

Outbreaks of influenza rarely occur in summer because flu activity normally wanes due to the hotter weather and higher humidity. However, the new strain of influenza appears to be raging out of control even in summer because most people do not have immunity to the virus yet.

(Aug. 22, 2009)

Japan-Mask sales jump over new-flu fears

Face masks and other hygiene products are flying off the shelves as people anxious about the new-flu epidemic rush to stock up ahead of the main influenza season of autumn through winter. The buying spree, which was triggered by the Health, Labor and Welfare Ministry's declaration Friday that the new flu had reached the epidemic stage, has forced some manufacturers to increase production.

A similar spike in sales was reported in May after the nation's first new-flu case was confirmed.

On Thursday, the day after Health, Labor and Welfare Minister Yoichi Masuzoe announced a de facto "epidemic declaration," retail store chain Ito-Yokado ordered its stores to limit sales of masks to two packets per customer. According to an Ito-Yokado public relations official, sales of masks are five to six times higher than usual years, although they have not skyrocketed quite as much as they did in May.

Zenkoku Masuku Kogyo-kai, a nationwide association of mask manufacturers, has been producing 300 million masks a month--double the pace of usual years--since May to cope with the surge in demand.

In close consultation with the ministry, the association had hoped to use the period through the end of August to stockpile masks ahead of the expected autumn start of the influenza season.

"We never expected that the epidemic would break out in summer," an association spokesman said. "We hope consumers will stay calm and not rush out and buy up masks."

Secom Trust Systems Co., a company that deals with antiflu products for corporate clients, said the influx of orders it received in May were mostly for masks, but that it had seen an uptick in requests for brochures on antiseptic solutions and protective clothing since Masuzoe's announcement Wednesday.

"It seems our customers believe that masks won't be enough to cope with the full-scale epidemic," a Secom Trust Systems official said.

Samore Inc., a company that produces and sells antiseptic solution, has been swamped with five times more orders than usual since Wednesday. In particular, online orders from individuals have been pouring into the company. An official of the Chuo Ward, Tokyo-based company said they had received calls from customers willing to pick up their products from the factory.

The company has extended the factory's operating hours but demand has outstripped production capacity, according to an official.

(Aug. 23, 2009)

Emergency Gharbiya fear bird flu could mutate to the swine flu

Friday, August 21st, 2009 - 20:37
Is still avian and swine out of control

After widespread fears among the people in the western province recently, fear the virus mutating from bird to bird flu, swine, especially as it was diagnosed a number of cases infected with swine influenza as bird flu, by mistake, living in Gharbiya directorates of health state of emergency and high alert to prevent mutation of the virus during the coming period.

These fears have increased after warned WHO Director Margaret Chan, today, Friday, and a permanent shift mutation and invisible to swine flu virus, which represents a mechanism of survival of the world of microbes, emphasizing that we prepare for the second wave or even a third, as we have seen from past epidemics.

In exclusive statements to the seventh day, "said Dr Issam Osman, Director of the Department of Preventive Medicine Department of Health Gharbia, there was no case of mutation of the virus of bird flu the swine flu Gharbiya so far, and after the detention of the Tanta Fever Hospital, 4 cases of suspected bird flu, but samples were the result of their illness positive swine flu.

Were instituted immediately transferred from the Tanta Fever Hospital, where the places of detention cases of bird flu to the hospital Ribbons year, as places of isolation of cases infected with swine flu, to prevent confusion among patients and a mutation of the disease, in this case produces a new virus with new recipes and new features.

"Said Dr Issam Osman, was taken into custody as suspected cases of bird flu, especially since they come from rural areas and emphasized that they come into contact with birds, and inquire Hikhaltoa said theywere not people coming from outside Saudi Arabia, for example, after performing the pilgrimage, were also sent samples to laboratories with the central Ministry of Health in Cairo, which analyzes the samples sent a full analysis of all viruses and not the virus suspected of infection only.

And the seriousness of the mutation of the virus from birds to pigs, confirmed that the mortality rate of avian flu could reach 60% to 66% of the world and 34% in Egypt and the death rate of swine influenza virus and a half percent when the disease mutates into a pandemic, where the rate of death for more 60% even if it may control the disease death rate to 30 or 34%, which may lead to the deaths of more than 22 million people, to the extreme seriousness of the disease, which stems from that a new virus.

The Directorate of Health Gharbiya take intensive measures to prevent such a mutation of the quick discovery of the disease, seizure and immediate removal of any suspected cases, any type of virus, either birds or pigs and also the speed of surveillance for patients and contact them.

The director of the Preventive Medicine Department of Health Gharbia, it is taking samples and swabs from contact with suspects, even though it costs the state huge sums up where the cost per swab, about 400 pounds per capita, but the human effort needed for such analysis, stressing that any the case came from overseas, are taking full data and placed in contact with them and is under constant medical observation for 10 days to prevent the spread of infection.

He stressed that he can not be emphasized that the drug "Tamiflu" can address if the virus mutates, it becomes a new virus do not know the characteristics, but the "Tamiflu" is enough to cure any influenza virus present time.

No H1N1 viruses isolated from CFIA inspectors, can't compare to pig viruses

By Helen Branswell Medical Reporter (CP)

With swine flu viruses now showing they can infect humans, pigs and turkeys, scientists will be looking closely for genetic evidence of whether the viruses change in potentially dangerous ways as they pass from one species to another.

Unfortunately, the first known case where the virus likely passed from people to pigs back to people won't provide any answers.
The head of Canada's National Microbiology Laboratory has revealed his lab couldn't isolate viruses from respiratory specimens collected from two federal employees who became infected while investigating an outbreak of the novel H1N1 virus on an Alberta pig farm.

Though the two Canadian Food Inspection Agency inspectors tested positive for the pandemic flu virus, lab technicians would have to have found live viruses in their specimens to be able to compare them to those of viruses isolated from pigs on the farm and from other humans.

"We weren't able to isolate virus from what we got. So we haven't really sequenced anything," Dr. Frank Plummer said in an interview Friday.

"It's too bad, but I think that's just the way it is."

It's not uncommon that specimens don't yield viruses for study. But in this case it is unfortunate. Scientists would have liked to have seen whether the cycling through different species created changes in the viruses - and what kind of changes.

"It absolutely would have been very interesting," said Plummer, who admitted without live viruses "there's nothing really more to be done."

The pandemic virus was first found in people in mid-April. Late this week officials in Chile announced they had found the virus in turkeys - a species known to be susceptible to influenza viruses.

Though it is largely comprised of swine influenza genes, there is no evidence the virus is spreading in pig populations or that pigs are fuelling the spread among humans. In fact, in the handful of cases where the virus was found in pig herds - in Canada, Argentina and Australia - the presumption has been that people have infected pigs, not the other way around.

The first such case occurred in mid-to-late April in Alberta, on a pig farm near Rocky Mountain House.

It's not known and may never be known who introduced the virus into the pig population, but CFIA believes the source was human. And the agency also believes two of its inspectors who investigated the outbreak and came down shortly thereafter with swine flu picked up the virus in the piggery. The men admitted they took off their protective equipment because they were hot.

As for the viruses isolated from the pigs, the National Centre for Foreign Animal Diseases - the animal counterpart to Plummer's lab - is continuing to study the genetic sequences of those viruses.

But the lab's director, Dr. Soren Alexandersen, said the isolates don't seem to contain any significant changes when compared to the genetic sequences of the viruses circulating in people.

"They are very similar and more than 99 per cent similar," Alexandersen said. "There's nothing that looks specific or interesting at this point."

The lab, which shares a campus with the National Microbiology Laboratory, is also sequencing virus samples taken from a pig herd in Quebec where the novel H1N1 virus was found.
That work isn't yet completed, but Alexandersen said the picture so far is much like the one seen with the Alberta pig isolates.
"Nothing interesting or particular. It's again very, very similar," he said.

Suspected cases of bird flu infection in Fayoum

السبت، 22 أغسطس 2009 - 19:50 Saturday, August 22nd, 2009 - 19:50

Contact with live birds behind the growing incidence of bird flu in Egypt

Held in Fayoum Fever Hospital on suspicion of two cases infected with bird flu, the samples were taken for them and sent to labs central Ministry of Health to make sure they got sick or not.

The purity of Ahmed Metwally Metwally (17 years) from the village Alkaaaby new and Hoda Sayed Afify (30 years) from the village Qlmchap Etsa entered in Fayoum Fever Hospital, and suffered from high temperature and show the symptoms of avian flu, and doctors suspected in their disease , have been detained in hospital and take the necessary samples of them to be sent to labs central Ministry of Health to make sure they got sick or not.

Iran's swine flu cases top 200

22.08.2009 23:14

Iranian officials have reported that the number of positive cases of swine flu, which is still growing rapidly across the globe, has passed 200 in the country, Press TV reported.

The head of the Iranian Health Ministry's Center for Disease Control, Mohammad-Mehdi Gouya, told Mehr news agency that some 42 new cases have been identified last week, bringing the country's tally to 238.

Gouya stressed that no one had died because of the virus in the country.

He added that the majority of the infected cases are from the Iranian capital, Tehran.

The head of the Iranian Health Ministry's Center for Disease Control reported that domestic cases account for some 18 percent of the cases, adding that 52 percent of the cases have recently returned from Hajj pilgrimage.

"Iranian officials are fully prepared for a considerable raise in the number of infected cases expected to take place with the start of the cold season and the opening of schools and universities," Gouya added.

Mahboubeh HajiAbdolbaqi, an infectious disease specialist, had previously claimed that neglecting personal hygiene by infected individuals is the main reason contributing to the rapid spread of the disease in the country.

She, therefore, urged individuals to follow simple preventative measures in order to contain the spread of the virus.

Chile confirmed in swine influenza virus in turkeys

Aug 22, 12:59 EDT

SANTIAGO DE CHILE (AP) - The Institute of Public Health confirmed on Saturday the preliminary study of agricultural organization in the country on the discovery of the virus in turkeys AH1N1 swine flu, which sparked international concern about the spread of the pandemic.

"Preliminary results of genetic analysis showed that the virus found is the same one that has circulated in our country this winter," said health institute in a statement.

He added that "when comparing the samples with the pandemic virus that has circulated AH1N1 Chile has 100% similarity in the gene H (hemagglutinin) and 100% agreement in nucleotides and amino acids.

The agency noted that the report should be complemented with consideration of the entire genome of the virus isolated by the Agriculture and Livestock Service, SAG, which found the disease in turkey breeders at two farms from a private company in La Calera, a town about 100 kilometers northwest of Santiago.

The final report will be available only from fines next week, said the Institute.

The discovery of swine influenza virus in turkeys was detected and preliminarily confirmed by SAG on Wednesday after the turkey meat producer reported a decrease in production of poultry.

The first examinations ruled out bird flu and then Wednesday night confirmed that it was the same virus that has wreaked havoc throughout the world and forced the World Health Organization, WHO, to declare the pandemic.

Evil has affected the middle of this month in the American continent to 105,882 people in 35 countries, with 1579 deaths in 22 countries.

In Chile, swine flu has led to the latest report on Tuesday, 128 deaths and 12,175 cases checked, although the Ministry of Health acknowledged that there are suspicions that the disease has attacked more than 353,000 Chileans reported cases which may have been contaminated. But the same report stated that maintaining the downward trend of the last four weeks.

None of the affected turkeys died.

Health authorities have called for calm with the appearance of the virus in turkeys. In its report on Saturday reiterated that the ISP there is no risk in consumption of turkey meat.

"The risk exists for people following this outbreak is less than that in contact with sick human beings," said Public Health Institute, an agency under the Ministry of Health.

In addition, both the company Soproval as the authorities stated that badly affected the breeding birds and already she was having an emergency on return to productive levels.

Samples taken in turkeys were sent abroad to both the WHO as the center of detection and disease prevention in Atlanta.

China-A(H1N1) epidemic entering its peak season

Sunday, August 23, 2009 0:04 am TWN

The Centers for Disease Control (CDC) yesterday sounded an alert, warning that the A(H1N1) epidemic is moving into the beginning of its peak season, and that the weekly infection rate will soon cross the ten thousand mark, local media reported.

The agency has been plugging community data into a computer simulation to generate virus dispersion and said that the fast increasing number of infections suggest a large-scale epidemic lurking on the horizon, said officials.

CDC Deputy Director General Lin Ding was cited as saying that Taiwan in the past did not see proliferation of seasonal flu strains until late October, with transmission only becoming widespread come November and then topping out after Christmas.

But with the novel A(H1N1) virus thrown into the mix this year, the epidemic will not only be more severe, but widespread eruptions will make a much earlier entrance, likely when schools re-commence in September, Lin said.

Against this backdrop, health officials indicated the need for every hospital and clinic to stock rapid influenza diagnostic tests so as to speed up infection detection, which would help keep rampant transmission at bay.

Lin admittedly said some medical facilities are simply not well-equipped and may be the bottlenecks in the agency's abatement strategy against the epidemic.

There are 11 suppliers of the rapid tests at present and their capabilities collectively should be able to meet local demand, Lin added.

Meanwhile, on the vaccine front, the health official said the 10 million booster shots procured by the Department of Health (DOH) is on track for a October or November delivery.

More 'Circumspect' Strategy

Chen Jian-ren, an academician with the Academia Sinica and the former minister of the Department of Health (DOH), cautioned the government to be more circumspect with the containment of campus outbreaks and to clearly spell out the time frame within which antiviral medication should be taken.

He went on to ask officials to take heed and added that given insufficient epidemic control, the nation could see one-tenth of its population infected with the new strain in six to 12 months.

In response to Chen's statement, Lin backed the current strategy and noted the recent amendment to place the antiviral drug Tamiflu under the National Health Insurance coverage.

As soon as doctors spot symptoms classic to the new flu strain such as continued fever or shortness of breath, the patient may be immediately prescribed Tamiflu, Lin said.

But noting CDC figures, Chen explained that weekly flu-like cases went from 1,000 in early July to 6,000 by late July and then to a staggering 9,000 in the last week, clearly demonstrating the unrelenting spread of the virus in local communities.

Chen predicted the current epidemic will take one of the following courses: Slowly spreading and affecting one-tenth of the population in two to three years' time; or, should containment become ineffective, in six to 12 months.

The latter would also add to the urgency of further bolstering epidemic control and treatment strategies, Chen said.

With students heading back to school in two weeks, coupled with the likelihood of seeing 20,000 to 30,000 weekly infections, the government has yet to hammer out a plan that determines those to be administered vaccines and those to receive antiviral medication.

He urged officials to quickly finalize an effective plan that seizes the golden hour to treat infections and recommended that in group contagions, one confirmed A(H1N1) infection warrant the antiviral treatment of the entire group.

NC: WNC youths show resistance to flu medication

August 22, 2009
Staff Reports

A Buncombe County youth who tested positive last month for swine flu was one of two campers at Camp Blue Star in Henderson County found to be resistant to flu medication.

Both campers became ill with H1N1 last month while receiving Tamiflu following exposure to other ill campers, according to a news release from the Buncombe County Health Center. Both campers have since recovered.

State public health officials said caregivers across the state are being reminded that use of antiviral medications as prevention may be considered for persons with higher risk of complications or for health care workers with an unprotected exposure to influenza.

Overuse of an antiviral drug increases the likelihood for developing resistance to the treatment, according to the news release. Antiviral treatment is recommended for all patients with confirmed, probable or suspected cases of 2009 influenza H1N1 virus infection who are hospitalized or who are at higher risk for influenza complications.

hat-tip Pixie

WHO: Recommended use of antivirals

Pandemic (H1N1) 2009 briefing note 8

Related link:

WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses
20 August 2009

21 AUGUST 2009 | GENEVA -- WHO is today issuing guidelines for the use of antivirals in the management of patients infected with the H1N1 pandemic virus.

The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays.

The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antivirals (the M2 inhibitors).

Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.

On an individual patient basis, initial treatment decisions should be based on clinical assessment and knowledge about the presence of the virus in the community.

In areas where the virus is circulating widely in the community, clinicians seeing patients with influenza-like illness should assume that the pandemic virus is the cause. Treatment decisions should not wait for laboratory confirmation of H1N1 infection.

This recommendation is supported by reports, from all outbreak sites, that the H1N1 virus rapidly becomes the dominant strain.

Treat serious cases immediately

Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalization.

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.

For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.

As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.

At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness.

Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.

Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.

Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals.

Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.

In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.

hat-tip Dutchy

Six more swine flu deaths in India, toll jumps to 54

NEW DELHI: Six more swine flu deaths were reported in India, taking the death toll due to the H1N1 virus to 54, the union health ministry said here

While four deaths were reported from Maharashtra, one each was confirmed in Karnataka and Tamil Nadu.

The country also reported 131 new cases of influenza A (H1N1), taking the total number of infected people across the country to 2,669.

With the four deaths in Maharashtra, the toll in the state has gone up to 31.

In Tamil Nadu, a 45-year-old man died of swine flu, taking the toll in the state to three, an official said.

The victim, identified only as Sekar, died Friday at the Government General Hospital. He had Aug 12 undergone an operation for piles at another government hospital.

"Four days later, he developed breathlessness and was shifted to Government General Hospital and tested positive for swine flu," Director of Medical Education S. Vinayakam said.

Tamiflu tablets were administered to him, but Sekar breathed his last Friday night. Sekar had contracted the flu locally and had not travelled overseas.

The other death was in Karnataka where 12 people have died so far.

Gujarat has confirmed five deaths so far, Delhi two, while in Kerala one person has died.

Of the total 131 confirmed cases reported Saturday, 44 were from Delhi alone.

The worst-hit state of Maharashtra reported 23 cases, with Pune, considered the epicentre of the virus, has 16 fresh cases.

The rest were reported from Karnataka (21), Tamil Nadu (20), West Bengal (5), Kerala (8), Chhattisgarh (1), Goa (3), Haryana (2), Rajasthan (2) and Madhya Pradesh (1).

Of the 131 new cases, six people in Delhi and two in Kerala had travelled to countries that were affected with the flu.

"About 14,187 people have been tested so far of whom 2,669 are positive for Influenza A (H1N1)," a statement issued by the health ministry said here.

According to the World Health Organisation (WHO), about 182,166 laboratory confirmed cases of H1N1 have ben reported till Aug 13. About 1,799 deaths have been reported worldwide, the maximum from Mexico and the US.

Warnings focused viral «pigs» and «birds» and are united with the «season»

Does not object to gather in Ramadan tents ..: Representative of global economic health:

Detection of''economic''Dr. Awad Abu Zeid, WHO representative in Saudi Arabia, that in the event centered swine influenza virus, birds, and are united with the seasonal human influenza may produce a new virus may be fatal, afterthought that the seriousness of the virus or weakness depends on the degree of uniformity between viruses three. He advised Abu Zeid, especially ate breakfast in Ramadan tents to be careful and cautious and follow the instructions and preventive health to avoid the transmission of avian Alkhanaer, and bucking at the same time demanding to stop being Ramadan tents may be provided in custody as a result of the density of human viruses, saying that''The assembly is not in tents, but in the mosque and public places as well as in markets and shopping malls, but all of it is being cautious and adopt preventive measures launched by the World Health Organization and the Ministry of Health Saudi Arabia, from time to time.

WHO warns of second swine flu wave-Video

(01:40) Report

Aug 22 - The World Health Organization chief urges governments to prepare for a likely second wave of H1N1 outbreak.

Basmah Fahim reports

Friday, August 21, 2009

Health Council set for H1N1 awareness campaign

Web posted at: 8/21/2009 7:8:11

DOHA: The Supreme Council for Health is all set for mass awareness campaigns against the H1N1 influenza. The council is planning to launch a new strategy to create awareness, according to a notice from SCH.

To tone down the panic the flu has created, the council will launch campaigns in three stages. The first and the most important part will be involving people coming to Qatar from outside. For this, brochures and pamphlets, in English and Arabic, on H1N1 virus and precautionary measures will be distributed to all arriving in Qatar. Public advisory signs on protecting from the swine flu will be put up at the arrival terminal.

The ministry will also make a short movie to be screened in the aircrafts before landing as a safety message in cooperation with Qatar Airways. The airline company will also be responsible to distribute brochures at all points of entry into Qatar, as per the ministry’s notice.

The second part of the campaign will be for the people in Qatar. The health council will issue guidelines in Al Sharq newspaper and will air awareness clippings on Qatar Radio. Another brochure will be published in three languages Arabic, Hindi and English.

The council in association with Al Jazeera will make a documentary on the disease.

The ministry also has made agreement with various banks to broadcast short movies on H1N1 on monitors inside the banks. As the third part of ministry’s strategy, seminars and lectures organised at schools, mosques and Ramadan tents.

More Flu Virus Vaccines to Be Stockpiled

08-21-2009 18:26

By Kim Rahn
Staff Reporter

Some 170 billion won in supplementary budget will be earmarked to stockpile more vaccines and antiviral agents against the H1N1 flu virus, with the outbreak spreading in a rapid and unpredictable way.

The health authorities confirmed 258 new cases of influenza A, Friday. It was the largest number of cases in a single day, more than double the previous record of 108 recorded only two days ago.

The new confirmation increased the total number of confirmed infections to 2,675, of which 831 are under treatment at home or in hospitals, according to the Ministry for Health, Welfare and Family Affairs.

"Korea is seeing a community-level transmission of the virus. The number of cases is likely to soar when most schools begin for the second semester next week," a ministry official said.

The authorities predict that the disease is likely to prevail in October and November, and that the number of influenza A patients will rise to between 4.5 and 8 million, with about 130,000-230,000 of them hospitalized.

To fight the situation, the government decided to secure vaccines for 13.3 million doses, covering about 27 percent of the nation's population, at a cost of 108 billion won in supplementary budget.

An additional 62 billion won will be spent to secure antiviral agents for 2.5 million doses. South Korea has already secured 5.3 million doses of the agents, such as Tamiflu.

Vaccination will start in November.

For vaccines to be produced by the local pharmaceutical company Green Cross, the authorities will facilitate a prompt process for safety testing and approval, so that the products can be administered starting in November, about two months earlier than the government's original plan.

Schools will be required to strengthen the monitoring of students with fever. Headmasters will be allowed to close schools when a flu case is confirmed at their schools, or force students with influenza A symptoms to take leave.

Suman 30 deaths in Puerto Rico for H1N1 virus

Friday, August 21st, 2009

August 21, 2009, 17:17 San Juan, Aug 21 (Prensa Latina)
The Minister of Health, Lorenzo González, confirmed today that amounts to 30 deaths in Puerto Rico by infection with H1N1 virus.

According to the Minister-third hold the portfolio in the last seven months and expected confirmation by the Senate-confirmed cases generally reach 302 people.

Gonzalez said that is possible within the country there are about two thousand 93 people infected by the disease, although at the moment are unofficial figures.

He said the Department of Health has established jointly with the Education a surveillance system in schools to prevent school attendance of students with flu symptoms.

Only if the identification of a large outbreak of sick people in a school, will assess the possibility of temporarily closing it, he said.

Kenya: Flu Students Put in Isolation

Henry Nyarora and Cosmas Butunyi

21 August 2009

  • Nairobi — The government has imposed a quarantine on the six students of Riakworo Secondary School in Masaba North District who have tested positive for the H1N1 flu.

Neither the students nor members of their families will be allowed to move from their homes for the seven days during which the quarantine will be in force.

"We are not using the police to restrict them within their homes. It is out of a mutual understanding," said Dr Andebe.

He said so far the response had been good and the students and their families were responding well to the measures.

The H1N1 virus has an incubation period of between 14 and 21 days, during which it remains dormant in the body but can cause an infection if conditions become favourable.

Random screening

"Apart from random screening, we are also conducting an advocacy campaign to encourage those who exhibit symptoms of the flu to seek medical attention at recognised health institutions," Dr Andebe said.

The Masaba North district public health officer Thomas Nyang'au said 21 medical officers, in three teams of seven each, are on the ground carrying out investigations.

Taken ill

The six students were part of a school team that returned home from the national music festivals in Mombasa. They are said to have been taken ill on their way back from the fete and taken to Kenyatta National Hospital for examination.

The new developments in Masaba came as four employees of a flower farm in Eldama Ravine became the first suspected cases of the flu in the region.

The four, all women, were ordered to stay off their work stations at the Ravine Roses Flower Company until the Government Chemist releases the results of mucus samples taken from them.

Koibatek District medical health officer, Dr Christopher Kemboi, confirmed the cases.

Japan's H1N1 cases at flu epidemic stage

Saturday, Aug. 22, 2009

Tamiflu stockpile sufficient to deal with virus: expert

Staff writer

On the basis of substantially increased hospitalizations, the H1N1 swine flu outbreak was declared an epidemic by the National Institute of Infectious Diseases on Friday.

News photo
Preventive step: A drugstore in Minato Ward, Tokyo, displays face masks Thursday. Customers are stocking up as the new H1N1 virus claims its first domestic fatalities. SATOKO KAWASAKI PHOTO

According to the NIID, the average number of flu patients per hospital during the week of Aug. 10 to 16 was 1.69. A number of 1.00 or above signals an epidemic.

Most of the flu patients are believed to have the H1N1 strain of type-A flu, the institute said, adding it estimates their number to be about 110,000.

Since early July, swine flu patients have increased in number by 1.7 times each week. Three recently died within the span of five days.

The NIID said the number of patients per hospital exceeded 1.00 in hospitals surveyed by 264 public health centers in 44 prefectures, excluding Hokkaido, Toyama and Kumamoto, indicating the epidemic is increasing in both area and level, it said.

With the first deaths in Japan from the H1N1 virus, there is a renewed sense of anxiety on the streets.

But according to an infectious diseases expert, what may seem a sudden lethal outbreak is only the expected return of the new flu by fall, which the nation has already prepared to deal with by stockpiling the virus-fighting drugs Tamiflu and Relenza.

"This is only the beginning of the first big wave, and it will continue to spread into September and October," said Norio Sugaya, an infectious diseases expert and head of the pediatrics department at Keiyu Hospital in Kanagawa Prefecture.

"It came slightly earlier than expected, but it's hardly a surprise," he added.

From Aug. 15 to Wednesday, the H1N1 strain claimed three lives, in Okinawa, Kobe and Nagoya. All had other previously existing illnesses that are believed to have contributed to their deaths.

The institute said Okinawa averaged 29.60 patients per hospital, followed by Nara Prefecture with 2.96, Shiga Prefecture with 2.48, Fukushima Prefecture with 2.45 and Tokyo with 2.14 per hospital.

Although Okinawa's tropical climate may help the new virus spread regardless of the season, the situation is worse in even warmer climates, Sugaya said. He pointed to Thailand, where the new H1N1 strain has claimed over 100 lives, many during the summer, and thousands more are infected.

"Since it is a new virus and no one is immune to it, even a small amount of it can make you ill," Sugaya said. "And it will be worse in midwinter when the virus will increase in number and live longer."

Globally, there were more than 182,000 confirmed cases of swine flu and nearly 1,800 deaths as of Aug. 13, according to the World Health Organization, which earlier declared an H1N1 pandemic. But the group says that since countries are no longer required to test and report individual cases, the true figures are probably higher.

By mid-August, the U.S. recorded over 7,500 hospitalizations and nearly 480 deaths, according to the government's Centers for Disease Control and Prevention. In England and Scotland, where the new virus has already spread considerably, there are around 25,000 to 30,000 new cases every week, according to the Health Protection Agency, a nondepartmental public body in charge of health matters in the U.K.

In Japan, there have been 230 hospitalizations so far, according to the Ministry of Health, Labor and Welfare. Since the first swine flu-related domestic deaths, the government has begun urging citizens to take preventive measures, including wearing masks, washing hands and gargling, as it had done when the virus first arrived in May.

But Keiyu Hospital's Sugaya said such precautions are largely ineffective.

"The virus is not so mild that you can prevent it just by doing those things," he said. Instead, the government should be looking ahead and publishing estimates of patient numbers and death tolls for the coming months, as in other areas of the world, he said.

"(Government officials have been) slow to react. They say the people have become lax (about swine flu) in recent months, but they have, too."

The Stockholm-based European Center for Disease Prevention and Control has made a risk assessment for Europe, where in most areas, like Japan, the first major H1N1 wave is expected soon. The center estimates 20 percent to 30 percent of the population will be infected, albeit mildly, most frequently among vulnerable groups such as children and those with underlying chronic medical conditions. They say the hospitalization rate will reach 1 percent to 2 percent by winter, and the fatality rate will be around 0.1 percent to 0.2 percent.

If these statistics are applied to Japan, which has a population of 127 million, the country will see more than 25 million confirmed cases and 1.2 million hospitalizations. There could also be as many as 127,000 deaths, which puts the current toll into perspective, Sugaya said.

But the expert said Japan is better equipped than other countries to protect its citizens because it excels in the distribution of antiviral drugs.

"Compared to other countries, Japan has considerably fewer seriously ill patients, and that is because they give out Tamiflu and Relenza," he said.

While in other countries these drugs are not widely used, partly due to the cost, Japan has a stockpile large enough to treat 60 million people, and doctors are quick to administer them to virtually all H1N1 patients, he said.

Tamiflu and Relenza are more reliable methods of treating the new flu than a vaccine, which will not be ready by fall and in too short supply to give to all those at risk, Sugaya said.

On Thursday, the health ministry reduced its previous estimate of the number of people who can be treated with the vaccine by the end of the year from 14 million to 13 million. The treatment will start from mid- to late October, a spokeswoman for the ministry's tuberculosis and infectious diseases division said.

Despite the late and inadequate supply of the vaccine, Sugaya remains confident that Japan will be ready to fight the infections come fall.

"As long as proper measures are taken and Tamiflu or Relenza are administered, Japan is fully equipped to deal with the wave," he said.

Information from Kyodo added

Woman's lungs failing

NAGANO (Kyodo) A woman infected with the H1N1 strain of influenza has fallen seriously ill and been placed on a ventilator, the Nagano Prefectural Government said Thursday, a day after the government declared a full-fledged flu epidemic.

Though the woman, who is in her 30s, has no underlying risk factors, her lungs began to fail after she was confirmed infected with the new flu virus Monday, Nagano officials said, adding that she remains conscious.

A resident of Chikuma, she developed a 39.7-degree fever and other symptoms a week ago and tested positive for influenza A on Aug. 14. She was hospitalized Monday as her condition worsened and taken to another hospital Wednesday after failing to improve, they said.

A facility for the disabled she visited confirmed an outbreak of the flu last week, according to the officials.

In Tokushima Prefecture, 39 participants from two groups at an annual Awaodori dance festival held from Aug. 12 through Sunday have tested positive for influenza A. Three of them were confirmed infected with the new flu, the prefecture said, adding that all are recuperating at home.

The epidemic, which health minister Yoichi Masuzoe declared Wednesday after a report of the third death in Japan since Saturday, also began to affect the ongoing campaigns for the Aug. 30 House of Representatives election.

The ruling Liberal Democratic Party asked all its candidates in a written message Thursday to make antiseptics available at campaign rallies, and to ensure their health and that of their campaigners.

Katsuhito Yokokume, a candidate of the Democratic Party of Japan in the Kanagawa No. 11 constituency, failed to attend a gathering Monday, citing a possible infection.

Bangladesh sounds alert over H1N1

Bangladesh on Thursday alerted its citizens about the spread of H1N1 swine flu as authorities reported 87 cases in the country, with the situation in neighbouring India worsening rapidly, officials said.
‘It is a matter of concern for us as the situation has turned worse in neighbouring India,’ Health Minister Ruhal Haque told reporters after a meeting reviewing the country’s latest H1N1 situation.
He asked the authorities concerned for proper screening of inbound passengers from India, especially through the land border crossings.
Bangladesh has 14 land ports in operation with India.
Earlier, the government enhanced vigilance on airports and sea ports introducing special medical desks to detect swine-flue infection.
Most of the H1N1 cases were detected at Dhaka’s Zia International Airport, officials at the Institute of Epidemiology, Disease Control and Research said.
The government called on the people not to panic over the situation as it has taken adequate measures to deal with it.

H1N1 flu virus hasn't mutated, CDC officials report

The H1N1 flu strain doesn't appear to be mutating as it makes its way through the Southern Hemisphere, the U.S. Centers for Disease Control and Prevention said today in a briefing.

One of the biggest fears has been that the virus, which first appeared in April in the U.S. and Mexico and which people don't have any built-up immunity to, might mutate into an even more dangerous form. Health officials have been keeping a close watch on the Southern Hemisphere, which is in its winter season now, to see what form of the virus is likely to travel north as fall comes to the U.S. and the rest of the Northern Hemisphere.

Flu viruses are unpredictable, so the fact that this one hasn't mutated is "somewhat reassuring" said Jay Butler, director of CDC's H1N1 Vaccine Task Force.

Case numbers in the Southern Hemisphere appear to be dropping, he said.

The U.S. is currently experiencing low levels of influenza, which is rare at this time of the year. Almost all cases are H1N1, Butler says. So far the CDC has laboratory confirmed reports of 7,963 hospitalizations and 522 deaths. Those numbers are very likely a radical underestimate of actual cases, as most people aren't tested, Butler said.

The H1N1 flu, commonly known as swine flu, continues to disproportionately affect young people, which is very different than most influenza strains. Thus far about 75% of hospitalizations and 60% of deaths are in people under 49 years, he reported.

Two states, Alaska and Maine, are currently reporting widespread influenza activity, very unusual for this time of year. Why those are being hit right now isn't known.

"It's one of the mysteries of influenza," Butler says. He did note that Alaska was one of the last states to have laboratory confirmed cases of the H1N1 strain, so it's possible the outbreak there just got a later start.

Flu vaccine production and testing is currently underway. Jesse Goodman, chief scientist and deputy commissioner with the Food and Drug Administration said that they expect to have 45 to 52 million doses of vaccine available by mid-October. They'll then be making more vaccine available weekly, up to about 195 million doses by the end of the year. Five manufacturers are working on producing the vaccine.

Vaccine will be made available to each state according to its population, Goodman said.

Testing of the vaccine to find out how much needs to be given and whether one or two doses is required is well underway in adults, with the first results expected by mid September, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Researchers waited to make sure the vaccine was safe in adults before beginning testing in children, which got started in the past few weeks. Those results should begin coming in by mid-October.

All together over 4,600 people will be enrolled in the trials, Fauci said.

Today in Beijing, World Health Organization Western Pacific director Shin Young-soo said that cases in the Northern Hemisphere will soon begin to increase and most countries may see swine flu cases double every three to four days for several months until peak transmission is reached.

"At a certain point, there will seem to be an explosion in case numbers," Shin told a symposium of health officials and experts."It is certain there will be more cases and more deaths."

Fauci cautioned that while the CDC and FDA are preparing for worse case scenarios, "explosion" might be overstating the problem.

"Sometimes words that are used in an innocent way can cause alarm. I think in a realistic setting we should expect that there clearly is going to be an upsurge of cases when you get into the fall."

Whether or not they get vaccinated, people need to remember the three rules of staying healthy, Butler says.

"We can't stop the tide of flu any more than we can turn a hurricane in its course or stop the earth from shaking in an earthquake," he said. But we can cut down on illness. "Wash your hands, cover your cough and stay home is you're sick."

H1N1 cases in Montgomery

August 21, 2009 10:53 am -
The Free Press


Three cases of H1N1 influenza have been confirmed in workers at a Montgomery food-processing plant.

The cases earlier this month involving employees at Seneca Foods coincides with a higher-than-normal number of local people with flu-like symptoms recently.

Two people from Montgomery were hospitalized with flu-like illness, Le Sueur County Director of Public Health Cindy Shaughnessy said.

She said the cases aren’t surprising because H1N1, or swine flu, continues to circulate in Minnesota, and that most cases continue to produce mild to moderate symptoms.

H1N1 spreads at rapid pace across Alabama

Aug 21, 2009 11:29 AM EDT
Aug 21, 2009 11:29 AM EDT
MONTGOMERY, AL (WBRC) - The H1N1 virus continues to spread at a rapid pace across the state of Alabama.

During a morning news conference, State Health Officer Don Williamson said the number of those infected is growing by the hour.

Out of the last 1000 flu cases they have tested, all but four of them have tested positive for the H1N1 virus.

Williamson said the state will no longer test all flu cases for the swine flu virus and adds that almost all of the people infected with the flu right now are infected with H1N1.

The state is urging students not to go to school if they exhibit fever, muscle aches and cough.

According to Williamson, the state is expected to be getting 600,000 doses of vaccine in October and 300,000 additional doses every two weeks.

Experts revealed this morning that two vaccines will be needed, one in the fall and another in January.

There is a major concern for women who are pregnant, children six months of age to 24 years of age and health care workers. Health care workers are also urged to get the vaccine as soon as it becomes available.

Williamson said if someone comes down with flu like symptoms it should be assumed that it is the H1N1 virus.

Pandemic risk of A/H1N1 flu in China increasing: Health minister 2009-08-21 18:54:07 Print

BEIJING, Aug. 21 (Xinhua) -- The risk of an A/H1N1 flu pandemic in China will increase as the country nears its flu season in the winter and spring, China's Health Minister Chen Zhu said Friday.

"The interweaving between A/H1N1 and seasonal flu could markedly increase the risk of an A/H1N1 flu pandemic," he said at an international symposium held here from Friday to Saturday.

As the total number of infected people increases, drug resistance cases, serious cases of the A/H1N1 flu or even fatalities would be "inevitable," he said.

The minister warned that the flu's impact to social and economic development should not be underestimated.

The Chinese mainland reported 2,861 cases of the A/H1N1 influenza as of Wednesday, the latest figures from the Ministry of Health showed. More than 2,500 of all infected have recovered.

The influenza had so far caused one critical case but no deaths on the mainland, the minister said. And it has not broken out at the community level.

The mainland's first critical case of the A/H1N1 flu involved a17-year-old high school student in the southern province of Guangdong, but the severity of his case was the result of a pre-existing illness.

Chen called on all countries to enhance cooperation in disease prevention, share of information on flu epidemic, and the development of vaccine and new drugs so as to deal with more challenges brought by the A/H1N1 flu.

The International Scientific Symposium on Influenza A/H1N1 Pandemic Response and Preparedness was hosted by China's Ministry of Health with the support of the World Health Organization (WHO) and the Lancet.

The two-day event attracted nearly 1,000 officials and experts from more than 30 countries and regions.