Flu Vaccine Plan in U.S. May Shortchange Nations, Lancet Says

By Tom Randall

July 31 (Bloomberg) -- A U.S. plan to rely on swine flu vaccines without ingredients to boost effectiveness would reduce the global supply just when other countries need it most, according to an editorial by the British journal Lancet.

The ingredients, called adjuvants, have never been approved for flu vaccines in the U.S. and are controversial because some studies show they cause immune disorders in mice. The World Health Organization recommended on July 7 that adjuvants be used to pump up the global vaccine supply, and the Lancet criticized the U.S. for plans to rely exclusively on standard formulations.

The U.S. Health and Human Services Department declared a public health emergency over swine flu in April, and the Food and Drug Administration has the power to allow the use of unapproved medical products including adjuvants. The health department agreed to purchase more than $415 million of the vaccine additives, while saying it may not use them if enough shots are available for U.S. residents.

“The USA must support the use of dose-sparing strategies to avoid depletion of an already short vaccine supply,” said the authors of the Lancet’s editorial. “All countries will require the vaccine, but current manufacturing capacity will not be able to meet this demand.”

Spreading Quickly

A pandemic of swine flu, also known as H1N1, has infected more than 1 million people in the U.S. and swept across the globe. Drugmakers are racing to get a vaccine ready for October, when lower temperatures may bolster a wave of outbreaks across the northern hemisphere.

The Lancet, a journal of medical research founded in 1828, was the second-most cited general medical publication in the world in 2007, according to the Institute of Scientific Information’s Journal Citation Reports. The institute evaluates the impact of academic publications based on how many times their articles are cited elsewhere.

Adjuvants are mixes of oil and water that trigger a stronger response in the body to antigen, the substance that induces immunity. Adjuvants, whose effectiveness vary by flu strain, may boost the strength of the antigen as much as 10- fold, as was the case with a bird flu vaccine approved in Europe, said John Treanor, a professor of medicine, microbiology and immunology at the University of Rochester, in an interview.

MF59, an oil-and water adjuvant made by Novartis AG and approved in Europe, has been safely given to more than 40 million people, mostly adults, to prevent seasonal flu, according to the company.

Adjuvant Purchases

The U.S. Centers for Disease Control and Prevention agreed to pay London-based GlaxoSmithKline Plc and Novartis, based in Basel, Switzerland, more than $415 million for adjuvants that could be added to the swine flu vaccines, according to a July 13 statement.

The additives may not be necessary if enough shots can be produced without them, according to the HHS. Authorities at the CDC said July 29 that 40 million shots of unadjuvanted vaccine may be available to the U.S. in September, earlier than previously reported, with 80 million more doses ready in October.

The drugmakers have found it difficult to cultivate the quantities of virus necessary for an H1N1 vaccine. The strain yields 50 percent to 75 percent less antigen, the substance that induces immunity, compared with a typical seasonal flu strain, according to the WHO. The virus didn’t initially grow well in eggs, the principal medium used by the industry, vaccine makers said.

Improving Yields

Scientists have significantly improved yields in eggs recently, which should ease pressure on manufacturers, said Robin Robinson, chief of the Biomedical Advanced Research Development Authority, the U.S. agency in charge of buying the vaccine. A decision on adjuvant use hasn’t been made, he said July 29 during a meeting at the Atlanta-based CDC.

“Already our development efforts have resulted in an improvement of yields,” Donna Cary, a spokeswoman for Paris- based Sanofi-Aventis SA, said yesterday in telephone interview. “Certainly every improvement in yield potentially means more vaccine sooner.”

Yields still appear to be lower than typically seen with seasonal flu, she said.

Glaxo’s adjuvant has proven safe and effective in clinical trials with 39,000 people, said Lisa Behrens, a spokeswoman for the company, in an e-mail. Glaxo will conduct more studies and continue to monitor safety after the vaccines are in use, she said.

To contact the reporter on this story: Tom Randall in New York at Trandall6@bloomberg.net

Last Updated: July 30, 2009 18:30 EDT

Prompt Quarantine Ponpes Patients

Before hundreds of santri the flu, actually have a few weeks ago hundreds of birds belonging to people who die suddenly. Poultry that died near the location of the Pondok Pesantren Babussalam. "According to the news that I received, from 1 July of the property back chicken shack that many die suddenly. There is one citizen who has 30 chickens, all dead," said dr Rosihan Anwar, head of health Pagelaran.

However, after examination conducted by Animal Husbandry and Animal Health Kabupaten Malang some time ago, the number of chickens that died suddenly is not due to bird flu. "Office of the negative farm bird flu," he added.

Before that many fell ill santri flu, on July 12 also have three people infected Banjarejo flu. However, after treatment, they eventually recover. Drugs given to people not tamiflu, flu medicine, but normal.

Therefore, when the treat santri, Dinkes also give regular flu drugs. "To provide tamiflu, we are still awaiting positive or not they have a swine flu or bird flu. For now, we still can not check," he continued.

Dinkes itself is actually distribute tamiflu each 200 tablets to 39 health centers. Also to include health Pagelaran. While in Dinkes own, at this time there are around 5 thousand to 6 thousand stock tamiflu.

Babussalam in addition, there are two cottages on the boarding Singosari who also fell ill flu simultaneously. That is, the Pondok Pesantren Nurul Huda Qur'an and Ponpes Al Ishlahiyah. Attack of flu in the hut before boarding also occur in other areas such as Ponorogo and Jombang.

Therefore, the Head of Malang Regency Dinskes Agus Wahyu Arifin ask the nanny to keep boarding cottages hygiene, health and quality of food. The plan, in the near future Dinkes akan issued circular to all the huts in the boarding wilayahnya.Penjagaan absolute cleanliness in ponpes done, as the spread of infectious diseases in ponpes easier. That's because the community in the ponpes dense enough. "Floors-floor must be cleaned with soap," Agus fate.

He also ask the nurse to ask the boarding cottages all santrinya using masks. In addition to a special mask, according to him, sniffer can also be enabled as closing the mouth. "Dinkes not provide a special mask and indeed there is no budget for the purchase of masks," he said.

In addition, Dinkes also hope that nanny mengarantina wickiup boarding the santrinya the sick. So that the disease can not spread to the wider community outside the hut. Specifically to handle the number of affected santri flu, Dinkes already send samples to the throat mucus Hospital Syaiful Anwar (RSSA).

In Singosari sampelnya have taken five people, while in Pagelaran sampelnya have taken seven people. "What we take is sampelnya santri the worst condition," said Agus.

When RSSA already have tools to test samples of swine flu or bird flu, most likely the result can be known within five days. However, when you do not have any RSSA appliance, the result can be known within a week.

Meanwhile, Hj Darwis, nurse Ponpes Babussalam already mengintsruksikan to clean up the environment santrinya hut. "We fear this swine flu. Dinkes I hope is able to provide masks for santri," harapnya.

Hattip Shiloh

eGYPT-After the injury, diagnosed as avian flu ..

Infection case of swine flu meeting Sunday attended by new

Thursday, July 30, 2009 - 15:40

Swine flu catastrophe threatens Egyptians

The meeting Sunday attended by the Transport Directorate of Health Rasha Abdel Mohsen Ibrahim Abu Taleb (25 years) of the Mahallat Mnov, Center for Tanta, Minshawi General Hospital, after making sure of her disease, swine flu, where she was held since last Monday, a hospital admitted Tanta, was diagnosed as a case infected with bird flu, as it had dead birds in her home.

And Dr. Sharif Hammouda Undersecretary of the Ministry of Health meeting Sunday attended by the sample, the result of central labs, the Ministry of Health was positive, and make sure swine flu and not avian influenza. Were immediately transported to the hospital, admitted to Tanta Minshawi year as swine flu did not know the cause of her disease now.

The Directorate of Health meeting Sunday attended by sampling of the close contacts of the case of the village to see the extent of illness or not, the work of each stock from abroad and from the affected provinces, to determine the cause of the disease, patient injury, have been isolated case and given the drug "Altaymflo" after making sure of her.

IETNAM-Training flu influenza

22:25 30/07/2009

( - Nearly 100 students are permanent staff LHPN Association, Farmers Association, Veterans, Youth Union, veterinary stations, VHTT, staff and clinics of 3 Dong Dien Nam, Dien Ngoc and Electric Hoa (Dien Ban) has involved training activities and behavior change to prevent avian influenza outbreaks by LHPN The provincial organization. Students are equipped with basic knowledge of avian flu, raising awareness and changing behavior of women, people in animal husbandry, slaughter, transport, use of poultry products, Executive rules rooms and toilets. Mobilization of women, people actively participate in implementation of measures to prevent avian influenza, contributing to the restrictions, preventing disease spread, protection of public health.

Brad Blakeman: Swine Flu to Wreak Havoc on Economy

Thursday, July 30, 2009 3:48 PM By: Brad Blakeman Font Size The Government Accountability Office has warned that the U.S. government across the board is not prepared for a national outbreak of swine flu this fall. The GAO set forth a laundry list of deficiencies including: the lack of planning for government staffing; lack of coordination between government agencies; lack of public awareness; insufficient beds and services; the lack of a vaccine; and the list goes on. Many medical experts agree that there is a strong probability that the H1N1 Flu strain will make a strong return this fall. What then is the government doing to prepare the public and private sectors? Not much is the answer. The wild card in the aftermath of a national healthcare challenge is the effect it will have on our already weakened economy. Will government agencies and private sector businesses need to be shut down? Will schools need to be closed? Will mandatory quarantines be ordered? For how long will these and other measures be in effect? The World Bank has stated that a severe flu outbreak could have severe negative results to the global economy. Fear and uncertainty can be more damaging to our economy than the event itself. A poor performance by the Obama administration to manage a national swine flu outbreak will turn out to be their Katrina. Like Katrina, the threat was real. Government knew or should have known there was a high probability that a Category 4 or 5 hurricane was going to strike the U.S. Today, there exists an equally high probability of severe damage to our people and our economy. A hurricane is barreling down on our nation in the form of sickness. The government must have plans in place from Main Street to Wall Street to ensure interruptions to business are kept to a minimum and that commerce continues to flow. There is no excuse for us not to be prepared. Our government must be up to the task to act not only to prevent and treat illness but also to take measures to protect our economy from further and deeper decline due to a national medical epidemic.

NZ-Health worker dies from swine flu

July 30, 2009, 8:20 pm
Swine flu is believed to have claimed the country's first frontline health worker.

Hutt District Health Board (DHB) confirmed yesterday that a 39-year-old woman, who died of the virus in Wellington Hospital, on Monday worked at Hutt Hospital, The Dominion Post reported.

The woman, believed to have been a nurse in a children's ward, is one of 13 confirmed to have died from the virus in New Zealand although the chief coroner is investigating another 20 suspected deaths from the virus.

The woman died from a rare complication on Monday after 11 days in intensive care.

She had suffered a miscarriage within the previous two months, but it was not known whether she had the virus at the time she miscarried.

World lays its swine flu defences

07/30/2009 4:41 PM

PARIS - Governments are stockpiling flu remedies, have ordered tens of millions of vaccines and are drawing up quarantine plans in the hope of halting the swine flu epidemic before it turns truly deadly.

So far the disease's effects have been uneven, hitting some countries more than others, but the World Health Organisation has warned that all 6.8 billion people on the planet are at risk as the pandemic gathers strength.

Here is a selection of the major efforts underway to halt its spread.

UNITED STATES

A neighbour of Mexico, where the A(H1N1) strain of swine flu was first detected, the United States had by mid-July the world's highest number of confirmed cases -- 40,617 -- and 263 people had died.

Behind the confirmed cases, authorities believe the true number of flu carriers to be closer to a million.

Health officials are to hold an emergency meeting on July 29 to draw up an action plan, and orders have been placed for 10 million doses of flu vaccine for distribution by mid-October.

Vaccines, which are now being developed for the new flu strain, will be tested in August. Federal and state governments have stockpiled 61 million doses of Tamiflu and Relenza flu remedies between them.

LATIN AMERICA

Central and South America have born the brunt of the disease's spread, with 500 of the confirmed deaths around the world by mid-July.

The disease was first recorded in Mexico, where 138 people have died, and has spread as far as Argentina, which with 165 dead is second only to the United States in terms of confirmed mortality.

Latin American health ministers have complained that the developed world has pre-ordered much of the expected production of flu remedies, but the states are nevertheless putting in place their own prevention plans.

Several countries have boosted health spending, including Chile, which set aside 30 million dollars for flu remedies. Elsewhere, school holidays have been extended and controls imposed on large-scale public gatherings.

BRITAIN

The worst hit country in Europe has been Britain, perhaps because of its strong Trans-Atlantic ties. More than 100,000 new cases were recorded last week alone, almost twice as many as the week before. 31 victims have died.

London has ordered a total of 132 million doses of flu vaccine, with 60 million (enough for half the population at two doses per head) to be ready by the end of the year.

A dedicated flu telephone line and website has been set up allowing patients to be diagnosed at a distance and issued a coupon to collect flu remedies. Officials are expecting 200,000 calls per day.

SPAIN

Spain is the next worst hit country in Europe, with by 1,806 confirmed cases by Monday and six deaths. No national strategy has yet been drawn up.

The government has ordered 37 million doses of vaccine for its 46 million strong population, with a plan to inoculate 40 percent of the population.

JAPAN

Japan, one of the Asian countries worst hit by swine flu, had reported 4,462 cases by Wednesday, but no one has so far died.

Tokyo has said it could repeat measures taken earlier this year, when it implemented strict airport health controls, including checks aboard landing aircraft. Suspected cases were quarantined in hotels near airports.

Some 4,800 schools and kindergartens were closed for a week.

Japan has Tamiflu and Relenza supplies for 38 million patients or about one third of its population and plans to produce 17 million doses of its own swine flu vaccine this year.

CHINA

The world's most populous nation has yet to see a proportionally large flu outbreak, with only 1,668 confirmed cases, but after the SARS and bird flu scares it is taking the threat seriously.

Hospitals are on a virtual war footing, with many setting up makeshift swine flu reception desks staffed by masked nurses under orders to promptly report any suspected cases to the government and isolate those affected.

China has also imposed seven-day quarantine periods on arriving foreigners who show swine flu symptoms.

Authorities in Hong Kong have reported one death certainly due to the virus in the administrative region, where 2,855 cases have been reported.

AFRICA

Africa has not recorded as many cases of swine flu as other continents, but health experts there warn that the disease could be especially dangerous among populations with high levels of HIV/AIDS.

South Africa has 48 million people, of which nearly six million have HIV, and as of July 17 it had 119 cases of swine flu. Botswana had four and Namibia three.

MIDDLE EAST

Israel reported its first death from swine flu on Monday, as did Saudi Arabia, which is set to welcome vast numbers of Muslim pilgrims in the coming months, raising the risk of the spread of the disease.

Arab health ministers have recommended that children under 12 and people over 65 be banned from the hajj pilgrimage to Saudi Arabia this year to reduce the risk.

One other swine flu death has been reported in the Middle East: a woman in Egypt returning from a pilgrimage to Mecca. It was not clear where she contracted the virus.

CENTRAL AND EASTERN EUROPE

Germany has been relatively lightly affected for a country of its size, with 1,469 cases by July 20 and no deaths. German officials plan to buy enough vaccines to immunise the most vulnerable quarter of their population.

Poland has enough flu remedy on stock but has complained of a lack of European coordination on procuring vaccines, which many countries fear they will miss out on if rich nations corner the world's limited production.

The Czech Republic had at least 63 swine flu cases as of Monday evening.

Swine Flu Hits Panhandle Air Force Operations

4 Hurlburt Field Airmen Test Positive; 59 Suspected Of Having Virus

POSTED: Thursday, July 30, 2009

EITAN ABRAMOVICH/AFP/Getty Images

FORT WALTON BEACH, Fla. -- Swine flu has hit the Air Force's special operations command in northwest Florida.As many as 59 airmen at Hurlburt Field are suspected of having the virus, while another four have tested positive.First Special Operations Wing spokeswoman Amy Oliver said Wednesday they won't be testing the probable cases.Okaloosa County Health Department director Dr. Karen Chapman calls this the first sizable cluster in the area - and it won't be the last.Last week, the Florida Department of Health reported a total of 2,915 confirmed cases of swine flu. Another 22 residents infected with the virus have died.

Behind China's Aggressive Stance on Swine Flu

Wednesday, Jul. 29, 2009


Security guards march through a fenced-off courtyard to enforce a quarantine at the Yanxiang Hotel in Beijing on July 21, 2009

As swine flu continues to infect people around the world, governments are weighing measures like school closures and travel restrictions to dampen its effects. But no country has gone as far as China, where thousands of people who have come into contact with the disease have been quarantined. Beijing says that such aggressive steps will help slow the H1N1 pandemic, which has killed 816 people worldwide since emerging this spring in Mexico. As of July 27 China has reported 1,930 swine-flu cases but no deaths.

Infectious-disease experts say it is impossible to stop swine flu's spread and that extensive hospitalization and quarantine efforts divert important resources. Beijing's quarantine efforts have come under added scrutiny over the past few weeks because several large school groups visiting from the U.S. and Europe have been placed under isolation. One group of American high school students who planned to spend this month visiting China's cultural sites have instead endured two separate stints in quarantine. The 65 students and seven chaperones from St. Mary's School in Medford, Ore., were isolated in a Beijing hotel after arriving in mid-July, when one student tested positive for H1N1. After four nights at the Yanxiang Hotel in northeastern Beijing, a facility reserved for quarantined travelers, they were allowed to resume their trip. (See five burning questions about swine flu.)

But after touring Beijing sites and flying to Henan province, another student tested positive for the flu. That prompted officials from China's Centers for Disease Control and Prevention to quarantine the group once more. As their July 31 departure date approaches, six students with swine flu are in a hospital in the provincial capital of Zhengzhou. The rest of the group is hoping they will be cleared to fly home on Friday. "We came here for a three-week trip," says Scott Dewing, a chaperone and St. Mary's technology director. "When all is said and done, we'll have had at most three days of seeing sites in China." (See 50 essential travel tips.)

Earlier this month, the U.S. State Department issued an alert for citizens planning to travel to China, warning that "the seemingly random nature of the selection process makes it almost impossible to predict when a traveler may be placed into quarantine." The U.S. embassy in Beijing says that 1,800 Americans have been quarantined for suspected swine-flu infections this year, and 200 of those tested positive. "Embassy staff maintain regular contact with Americans who have been isolated in quarantine, and we continue to raise concerns with the Chinese about the conditions in which individuals are being kept," says Susan Stevenson, an embassy spokeswoman. (Read "What Swine Flu? Spain Celebrates Cured Ham.")

Beijing has taken a firm stance on swine flu from the start. When the strain emerged in Mexico this spring, China began detaining visitors from that country. The aggressive measures sparked protest from the Mexican government that its citizens, including some who had not set foot in their homeland for months, were being singled out. As the virus has spread globally, China's quarantine efforts have ramped up. Crews wearing masks and medical suits walk through airplanes upon arrival, testing passengers' temperatures with pistol-grip thermometers. (See pictures of thermal scanners hunting for swine flu.)

The reaction stems in large part from China's painful experience with new infectious diseases over the past few years. In 2002 and 2003, official cover-ups helped SARS spread throughout the country, eventually killing 349 people. Last month Chen Zhu, China's Minister of Health, said the spread of swine flu required an aggressive response. "We are adopting an important containment strategy so that we have more time and space to develop technologies and stock up on preventive materials, including vaccines. It's also part of our contribution to global disease control, and therefore is not an overreaction." St. Mary's chaperone Dewing says he understands the need for aggressive steps to fight the disease. "It's necessary," he says. "If you have people who are H1N1 positive, or possibly positive, you need to be quarantined. That makes sense."

But some medical professionals question the value of such stringent measures. "They are not effective at all in my opinion," says Dr. Lo Wing-lok, a Hong Kong–based infectious-disease expert. "You might be able to pick up certain symptomatic cases at the point of entry, or you might be able to pick up a few person who surrender themselves, but for the majority of cases, you are not able to pick them up either at point of entry or inside the city."

In May, Hong Kong authorities were criticized for sealing off an entire hotel with 300 guests where an infected Mexican traveler — China's first swine-flu case — had stayed. The city's government encouraged people who feared they were infected to visit local hospitals. The result, says Lo, was misuse of resources needed to help actual cases and people suffering from other conditions. "The experience of Hong Kong and most countries is the same," he says. "By picking up these few cases, there isn't any real impact in control of the flu."

U.S. unprepared for second wave of swine flu, report finds

Jul. 29, 2009

WASHINGTON -- The federal government isn't prepared for a potential outbreak of swine flu this fall, a Government Accountability Office report released to Congress concluded Wednesday.

Furthermore, said the GAO, Congress' nonpartisan investigative arm, federal agencies haven't addressed nearly half of the 24 recommendations it made last month.

William Coor, the deputy secretary of health and human services, disputed the findings.

"Given the speed at which the virus has spread we felt our work and coordination has been outstanding," he said. However, Jane Holl Lute, the deputy secretary of homeland security, acknowledged that, "We still have work to do."

The GAO agreed, saying that if a severe outbreak struck:

-Federal, state and local governments would have trouble coordinating with one another.

-The number of beds and medical supplies would be insufficient.

-Plans to protect federal workers aren't adequate.

Health officials worldwide acknowledge that the virus has reached pandemic proportions and could strike more severely in the fall. In the U.S., more than 43,000 people have contracted the virus, and so far, 302 have died.

Rep. Bill Pascrell, D-N.J., called the report "startling" after it was presented to the House Homeland Security Committee Wednesday.

The committee voted unanimously to urge the federal departments to respond to the GAO's recommendations within three months.

"Based on our survey, progress seems to be limited," said Bernice Steinhardt, the GAO's director of strategic issues. The rosy outlook of the agencies could be because they still haven't tested what they'd do in a severe outbreak, she added.

Lute listed the steps that her agency has taken to prepare, including reaching out to Native American tribal governments and drafting a response plan.

Coor also defended his department's actions.

Coor added that HHS and the Federal Emergency Management Agency in the next few weeks will give directions to state and local governments on how to deal with a big outbreak.

Swine flu, or H1N1, emerged in April in the U.S., and by June, the World Health Organization said it had grown to pandemic proportions. The WHO said it has killed at least 816 people worldwide. The Southern Hemisphere is now in its regular flu season, and swine flu there has been particularly deadly.

Coor said a vaccine won't be ready for several more months, after trials are finished. He also said federal and state governments have stockpiled 75 million to 100 million antiviral treatments, a number he called "sufficient."

National Treasury Employees Union President Colleen Kelley told the committee the federal government communicated poorly with federal workers earlier this year.

For example, federal employees were forbidden from wearing face masks to avoid getting the virus unless they were within six feet of a person who seemed likely to have swine flu.

The committee's chairman, Rep. Bennie Thompson, D-Miss., wasn't happy with the report.

"Given this country's recent experience with disasters, it is hard to believe that there are those who underestimate the importance of plans and drills," he said. "Our children are taught in school what to do in a fire drill. They are not taught to wait until a fire starts, yell instructions and hope everyone makes it to the exit."

Mexico alarmed by A/H1N1 flu outbreak in south

2009-07-30 13:02:56

MEXICO CITY, July 29 (Xinhua) -- An outbreak of A/H1N1 flu in southern Mexico states of Yucatan and Chiapas has triggered alarm in local residents who are pressing the government to take more actions against the virus.

During Tuesday's parliament session, deputies asked the government to take immediate actions against the rising number of cases across the nation, which are taking place much earlier than the expected winter flu season.

The number of confirmed cases in Chiapas has reached 2,694, up from 1,510 at the beginning of the month, increasing 78 percent.

The confirmed cases in Yucatan have surged from 860 to 2,088, increasing 242 percent. Eleven deaths were also reported in the two regions during the period.

Responding to widespread public unease, Mexican Health Minister Jose Angel Cordoba Villalobos told media that the outbreak is not out of control, the number of new hospitalizations is declining and those who are seriously ill are recovering.

"All that is happening in the south is that its turn came up," said Malaquias Lopez Cervantes, head of socio-medical research at the National Autonomous University of Mexico. "A chain of transmission had not been established in the south until now," he explained.

"The measures they took were clearly not enough to contain the outbreak," Cervantes said, "However they do seem to be treating the sick much more effectively."

Mexico's much-criticized decentralization policy in the 1990s has also played a part in the spread of the epidemic, he said.

"We have the resources and abilities to manage the epidemic, but coordination between states and municipalities must be improved, to ensure we are not overtaken by events and caught off guard by nasty surprises," he said.

On Tuesday, the Mexican Health Ministry said that the nation now has 16,091 confirmed flu cases, up from 14,861 a week earlier, and that there are now 142 confirmed flu deaths, from 138 a week earlier. Chiapas and Yucatan have replaced Mexico City to be the most infected regions.
hat-tip FrenchieGirl

Rwanda: FAO Warns on Regional Presence of Avian Flue

[They are referring to H5N1; not H1N1]

28 July 2009

Kigali — Two countries in the Eastern African sub-region have reportedly confirmed cases of Avian Influenza, according to reports from Food and Agriculture Organisation (FAO).

Rwanda's country representative of FAO, Elisabeth Balepa revealed that Sudan and Djibouti are part of the eleven African countries currently affected by the disease.

"According to the World Health Organisation (WHO), out of 436 cases reported, 262 cases of HPAI virus have been fatal since the beginning of July this year," she told members of the Eastern Africa Laboratory Network.

Avian flu, commonly known as bird flu, refers to influenza caused by viruses adapted to birds. It is a phrase similar to swine flu, dog flu, horse flu, or human flu. Experts say that Highly Pathogenic Avian Influenza (HPAI) has the greatest concern. Balepa therefore called for possible measures to prevent and control the spread of the virus.

"We should note that the current outbreaks of flu (swine flu) continue to spread to increasing number of countries," she lamented. During the meeting that attracted veterinary officers and laboratory technicians, Agnes Kalibata the Minister of Agriculture said that it is important that regional experts find possible ways of curbing the spread of the virus.

"Disease outbreaks do not recognise political boundaries neither do they require visas to move from one country to another," she said. Kalibata explained that such diseases are a concern and it is important that nations collaborate and exchange information in the spirit of International Health Regulations.

The alert comes barely a year since Rwanda lifted its ban on the importation of poultry and its products from the region. This was after World Organisation for Animal Health (OIE) survey that showed that the region was free from any bird flu threats that killed millions of birds and several human beings in Europe and, in Africa, Nigeria and Egypt.

The lift of the ban paved way for farmers and traders to buy chicks and eggs from any country in the East African region.

According to statistics from Rwanda Animal Resources Development Authority (RARDA), the country has over two million birds.

CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met today to make recommendations for use of vaccine against novel influenza A (H1N1).

The committee met to develop recommendations on who should receive vaccine against novel influenza A (H1N1) when it becomes available, and to determine which groups of the population should be prioritized if the vaccine is initially available in extremely limited quantities.

The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants.

When vaccine is first available, the committee recommended that programs and providers try to vaccinate:

* pregnant women,
* people who live with or care for children younger than 6 months of age,
* health care and emergency services personnel,
* persons between the ages of 6 months through 24 years of age, and
* people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.


The groups listed above total approximately 159 million people in the United States.

The committee does not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable.

There is some possibility that initially the vaccine will be available in limited quantities.

In this setting, the committee recommended that the following groups receive the vaccine before others:

* pregnant women,
* people who live with or care for children younger than 6 months of age,
* health care and emergency services personnel with direct patient contact,
* children 6 months through 4 years of age, and
* children 5 through 18 years of age who have chronic medical conditions.


The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years.

Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.

The committee also stressed that people over the age of 65 receive the seasonal vaccine as soon as it is available. Even if novel H1N1 vaccine is initially only available in limited quantities, supply and availability will continue, so the committee stressed that programs and providers continue to vaccinate unimmunized patients and not keep vaccine in reserve for later administration of the second dose.

The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine. It is intended to be used alongside seasonal flu vaccine to protect people. Seasonal flu and novel H1N1 vaccines may be administered on the same day.

####

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
hat-tip Ironorehopper

Summer camp flu outbreaks presage fall surge: CDC

Wed Jul 29, 2009 8:19pm ED

By Barbara Liston

ORLANDO, Florida (Reuters) - Outbreaks of the H1N1 flu among children attending U.S. summer camps presage a surge in cases this fall as students return to school, an official at the U.S. Centers for Disease Control and Prevention warned on Wednesday.

"This is just a harbinger of what we will see in the fall," Dr. Richard Besser, who led the U.S. response to the virus outbreak last spring, told a meeting of public health officials.

Besser, who was the CDC's acting director for the first half of this year, later told Reuters that the number of outbreaks in summer camps was in the hundreds.

He predicted soaring numbers of H1N1 cases compared to those seen in April when the first U.S. cases were diagnosed in California and urged health officials to plan now for the possibility of crowded hospitals, swamped emergency rooms and overwhelmed clinics.

"The magnitude of the event in the fall will be much greater (than what was experienced last spring)," Besser said.

Besser and local health officials from around the country strategized on how to best respond to the fast-spreading virus during the opening day of the National Association of County and City Health Officials annual conference in Orlando.

Local health officials, who plan and regularly practice their response to hypothetical public emergencies, nonetheless raised concerns about the logistics of sustaining an emergency response to an expanding pandemic and mass vaccination campaign this fall.

A big worry is inadequate staffing and the problem of exhaustion among those on the front lines.

"We all assume we can go home in 48 hours (as in a practice drill) but this may last all winter," said a health official from Portland, Oregon.

Besser advised health officials to consider pausing other activities in their departments to free up staff to help with the H1N1 response.

H1N1 swine flu is now so widespread that the World Health Organization (WHO) has stopped counting individual cases.

So far H1N1 is characterized by mild symptoms in most patients who go on to recover without treatment within a week.

The median age of sufferers has been 14 to 17 years old, although the age is increasing slightly as the number of cases increases, according to the WHO, suggesting the virus is spreading from schools into the wider community.

(Editing by Jane Sutton)
hat-tip Shiloh

Vietnam's A/H1N1 flu cases rise to 763

2009-07-30 12:04:23

HANOI, July 30 (Xinhua) -- Vietnam's Ministry of Health confirmed 60 more cases of A/H1N1 influenza, raising the total number of flu patients in the country to 763, the local newspaper the Young People reported Thursday.

The A/H1N1 virus has been spreading fast in Vietnam nationwide, especially in public buildings including offices, schools, said LyNgoc Kinh, head of the health care management department under the Ministry of Health.

So far, 60 schools in the south of Vietnam have been temporarily closed after many students were found positive to the A/H1N1 virus, said Kinh.

Two large office buildings in Hanoi, the capital city of Vietnam, reported A/H1N1 flu cases, said Kinh.

So far, 389 patients have recovered and been discharged from hospitals. The rest are being quarantined and treated, said the newspaper.

No A/H1N1 related death has been reported in the country since the first case confirmed here.

Health Minister: only half Vietnamese localities have plans to fight A/H1N1 flu

HANOI, July 30 (Xinhua) -- Vietnamese Health Minister Nguyen Quoc Trieu said only 34 out of 63 municipalities and provinces in the country have A/H1N1 prevention plans despite the fast spread of the disease, local newspaper the Vietnam News reported Thursday.

Trieu made the remarks at the weekly meeting of the National Steering Committee for A/H1N1 Prevention in Hanoi on Wednesday, said the newspaper.

In the past week, the disease has spread to many schools and office buildings across the country, said Trieu.

At the meeting, the minister required A/H1N1 flu-hit provinces to set up temporary hospitals where they are most needed such as schools, offices and industrial zones, according to the newspaper.

The Health Ministry planned to buy more Tamiflu and Relenza drugs, said the newspaper. It asked manufacturers and importers to prepare enough medical masks to meet the increasing needs of health staff and the public.

So far, there have been 763 A/H1N1 flu cases reported in the country.

Vietnam: Flu fears hit the larger community

July 30, 2009

More infections have been announced and more students found to have carried the virus from the city to their hometowns.

One employee of PetroVietnam on Le Duan Street in the city s District 1 on Wednesday tested positive for the virus. The employee is said to have contracted the flu after returning home from overseas.

District heath officials have sterilized the fourth and fifth floors of the building where the employee usually works, and also begun monitoring around 30 employees who have had physical contact with the infected person about whom no further details have been released.

PetroVietnam has sent written instructions requiring its offices to have equipment to measure body temperatures and for all employees to be provided with medical face masks.

As the spread of influenza A (H1N1) in the city has reached the community-level, supermarkets such as Big C, Co.opMart and Citimart have asked their employees to visit doctors or take days off when they've got flu symptoms such as fever, cough and a sore throat.

Many employees at office buildings like Diamond Plaza, Sun Wah and Melinh Point in the city's downtown have begun wearing face masks to and at work.

Authorities of Saigon Railway Station have sterilized the station facilities and coaches while ticket agents, guards and motorbike drivers that transport passengers to and from the station have started wearing medical masks.

But they said the success of preventive measures still depends on the cooperation of each passenger since they are not equipped with tools for measuring body temperatures.

"Saigon Railway Station has a very high risk of flu transmission," said director Nguyen Thi Thanh Phuong, adding that the station receives an average of 10,000 passengers every day.

At the Mien Dong Bus Station where buses ferry people between HCMC and destinations in the country's south, central and northern regions, many passengers now put on medical masks to protect themselves from the virus.

The HCMC Health Department said crowded places such as schools, industrial and export processing zones need constant supervision to prevent the spread of the flu.

The Foreign Ministry on Wednesday reported its first officer detected with H1N1 after coming home from overseas. The ministry has had frequently crowded sections at its headquarters sterilized and all employees there wear medical masks.

Also on Wednesday, the Vigracera building in Hanoi had to be sterilized as employee Chen Haowu of a Chinese telecommunications firm tested positive for the flu.

Haowu had traveled to Viettel Telecom headquarters in the capital for work last week and is suspected to have caught the virus there as a Viettel employee tested positive for the H1N1 virus on Sunday.

Five hundred employees of the telcom giant have been given medical masks following the discovery.

The Health Ministry on Wednesday confirmed a further 60 patients of influenza A (H1N1) nationwide, raising the country's tally to 763 of whom 389 have recovered and been discharged from hospitals.

Among the new cases was the first patient in the southern beach city of Vung Tau, a student of the Nguyen Khuyen High School in HCMC who returned home last Saturday. The patient was admitted to the provincial hospital on Monday.

The Nguyen Khuyen School has been closed since last Thursday after several students caught the flu. The school on Tuesday reported 13 infections among students in HCMC.

The Hoang Hoa Tham and Thai Binh High Schools in HCMC on Wednesday temporarily shut down after one student from each school was found with the virus. The schools were holding extended courses for twelfth-graders who will have to attend college entrance exams at the end of their school year.

Dong Nai Province announced Wednesday three more H1N1 cases, including one student of Nguyen Khuyen High School and one of Ngo Thoi Nhiem High School - closed since July 19 as the first school in HCMC infected with H1N1.

The HCMC Pasteur Institute Wednesday sent Dong Nai health authorities a list of more than 50 students of the two schools that have returned home to the southern province for their summer vacation. Yet as of late Wednesday, the province had only managed to contact a little more than half the students, saying the addresses of others were hard to find.

Le Minh Hoang, director of Dong Nai Department of Education and Training, told a provincial meeting Wednesday that Dong Nai was not closing 53 schools due to the influenza A (H1N1) scare as several newspapers had reported earlier this week.

Hoang said most schools are closing as it is summer time, adding that 18 kindergartens in Xuan Loc District were shut down ahead of schedule as a precautionary measure against the flu.

At a meeting of the Health Ministry Wednesday, officials said they had finished composing documents to instruct teachers and students on fighting and preventing H1N1 infections.

Health Minister Nguyen Quoc Trieu said at the meeting that many people in the community were still indifferent about protecting themselves and others from the pandemic.

Trieu requested his subordinates to prepare more medical masks and medicines.

Vietnam: A/H1N1 flu spread rapidly from residential areas

Ổ influenza A/H1N1 in urban areas in Phu My Hung, District 7-TPHCM has infected 21 people. Many people pour buckets to buy Tamiflu drug

> Many ministries lethargy with flu
> Viettel gong against their flu

Department of Health TPHCM that day 28-7, TP detection of 26 additional influenza A/H1N1 infection, raising the total number of people infected in this city to 531. Specifically, influenza A/H1N1 has spread rapidly from residential areas.

According to Health Center for District 7, in urban areas in Phu My Hung on to record 6 influenza A/H1N1 infection, raising the total number of infected influenza patients in this drive to 21 people. According to the Center for Health District 7, Bùng risk of influenza A/H1N1 in the Phu My Hung and the residential area around the enormous because there are many foreigners live, come back daily. At the new center access, isolation requirements at 365 people, while here there are more than 500 people identified as contact with influenza A/H1N1 infection.

Before the influenza A/H1N1 complicated events, particularly increased in residential areas, the same day, District 7 People's Committee held a meeting to discuss the prevention of influenza A/H1N1 with the participation of 60 is the school principal study, the ward leaders. Nguyen Thanh Trieu, Vice Chairman of People's Committee of District 7, for the isolation of 30 hospital beds (BV) District 7 has closed chật for which many people treatment to influenza A/H1N1. District will impress clinics Tan Hung as the isolation of the influenza A/H1N1.

Vietnam: 763 total cases

"Dịch are spread by the number of levels"

(Dân trí) - "People should not bring wild because if detected early, treatment is not timely stars. However, is not because the owners are spread on the number of levels," Minister of Health Nguyen Quoc Trieu identified.

2 more buildings in Hanoi and Ho Chi Minh "sticky" influenza A/H1N1

Up to 17h today (29/7/09), Vietnam has recorded 763 cases positive for influenza A/H1N1, no case of death.

The number of new 29/7 of 60 cases (54 of the South, the North 1, 2 of the Central Highlands and the 3).'s Patients have the hospital is 389, in the remaining health status is stable, without serious complication.
-snip-

Military planning for possible H1N1 outbreak

July 29, 2009 -- Updated 0220 GMT (1020 HKT)

Story Highlights
Military wants to establish regional teams to help civilian authorities respond
Proposal awaiting final approval from Defense Secretary Robert Gates
Military could provide support such as air transport, large-scale testing

From Barbara Starr
CNN Pentagon Correspondent

WASHINGTON (CNN) -- The U.S. military wants to establish regional teams of military personnel to assist civilian authorities in the event of a significant outbreak of the H1N1 virus this fall, according to Defense Department officials.

The proposal is awaiting final approval from Defense Secretary Robert Gates.

The officials would not be identified because the proposal from U.S. Northern Command's Gen. Victor Renuart has not been approved by the secretary.

The plan calls for military task forces to work in conjunction with the Federal Emergency Management Agency. There is no final decision on how the military effort would be manned, but one source said it would likely include personnel from all branches of the military.

It has yet to be determined how many troops would be needed and whether they would come from the active duty or the National Guard and Reserve forces.

Civilian authorities would lead any relief efforts in the event of a major outbreak, the official said. The military, as they would for a natural disaster or other significant emergency situation, could provide support and fulfill any tasks that civilian authorities could not, such as air transport or testing of large numbers of viral samples from infected patients.

As a first step, Gates is being asked to sign a so-called "execution order" that would authorize the military to begin to conduct the detailed planning to execute the proposed plan.

Orders to deploy actual forces would be reviewed later, depending on how much of a health threat the flu poses this fall, the officials said.