CDC braces for back-to-school flu spike, addresses vaccine worries

Lisa Schnirring Staff Writer


Jul 17 2009 (CIDRAP News) – Novel flu activity is still going strong but dropped for the third week in a row, the US Centers for Disease Control and Prevention (CDC) said today during a media briefing that also sought to calm fears about vaccine availability.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said the CDC will probably follow the World Health Organization's (WHO's) lead and phase out weekly reports of lab-confirmed cases, which grossly underestimate the true disease burden and divert resources from other pandemic response activities. She said over the next several weeks the agency will start adding new data and other enhancements to its weekly flu report to provide a more detailed profile of the nation's activity.

The CDC's update today, however, reports that the country's number of lab-confirmed cases has reached 40,617, of which 263 were fatal.

In its flu surveillance report for the week ending Jun 11, the CDC said nine states reported widespread activity: California, Delaware, Georgia, Hawaii, Maine, Maryland, Nebraska, New Jersey, and New York. Twelve states and Puerto Rico reported regional influenza activity.

More than 99% of flu isolates that have been subtyped are the novel H1N1 virus, the CDC reported. One of three cases of oseltamivir-resistant viruses detected worldwide was from a child who got sick in California and traveled to Hong Kong. Enhanced antiviral-resistance testing in California has not revealed any oseltamivir-resistant novel H1N1 viruses, the CDC said.

One pediatric death from the new virus was reported during the past week, in a child from Massachusetts. Of the 90 fatal pediatric flu cases that have been reported to the CDC so far this season, 23 were novel H1N1 infections.

Schuchat said the virus might be persisting through the summer, despite the heat and humidity, because of the US population's low immunity to the novel virus rather than because the virus has mechanisms for coping with the conditions. However, she said the CDC doesn't have the data to flesh out its theory about the summer spread.

The CDC expects flu activity to start rising again in September, ahead of the regular flu season, which would coincide with kids congregating in greater numbers as school resumes, she said. The CDC and its partners are in the active stage of planning for a spike in pandemic H1N1 flu activity in early fall, she added.

The CDC's Advisory Committee on Immunization Practices (ACIP) will hold an emergency meeting on Jul 29 to discuss recommendations for which populations should be targeted for novel H1N1 flu vaccination and whether tiering the vaccine prioritization would be appropriate, Schuchat told reporters.

Two federal officials who are involved in high-level vaccine decisions were on hand at the press conference to address recent questions that have cropped up about disappointingly low novel flu vaccine yield and potential international squabbles over vaccine supplies. The officials were Jesse Goodman, MD, the Food and Drug Administration's acting chief scientist and deputy commissioner for scientific and medical programs, and Bruce Gellin, MD, director of the National Vaccine Program, Department of Health and Human Services.

Gellin said federal officials have stockpiled antigen and adjuvant and that National Institutes of Health investigators, as well as researchers at vaccine companies, are starting to test both adjuvanted and nonadjuvanted versions of the novel flu vaccine. Stockpiling the bulk ingredients gives US officials greater flexibility in pulling together a safe and effective vaccine for its citizens, he said.

Schuchat said the CDC has heard concerns about vaccine manufacturers in foreign countries diverting vaccine orders to their own populations. "From our own planning, this is not one of our current concerns," she said. "We haven't received any information that makes us question the supply of what's been promised."

As for poor antigen yields that some manufacturers are reporting for the new virus, Schuchat said the CDC is not surprised and has already incorporated such yields into its planning and vaccine production expectations. "It's within the range of our planning assumptions, but of course there could always be some surprises," she said.

EU - Working document on surveillance and control measures for the pandemic (H1N1) 2009 influenza virus in pigs

17/jul/2009
The purpose of this document is to provide provisional guidance to the Member States on the appropriate measures to implement under different epidemiological scenarios promoting a harmonised approach for dealing with the situation as regards:

a) surveillance/monitoring for the influenza pandemic (H1N1) 2009 virus in the pig
Populations,

b) the possible measures to be put in place if the pandemic (H1N1) 2009 enters EU pig farm(s).

read the full text

Libya: Khalifa warns of rapid spread of swine flu in the region

Jul-18-2009

Warned the Minister of Health Mohammed Jawad Khalifa, the rapid spread of swine flu in the region, noting that the number of people are now compounded by the registration of local situations, in addition to Cases imported from the United States, Australia, Canada, raises questions Many on the possibilities ahead.
Khalifa said in an interview with a "world" news, the individual actions of no avail in such cases, emphasizing the need to take collective action to ensure its success
He called attention to the emergency meeting of Arab Ministers of Health will be held next week To discuss measures to be taken to prevent the spread of swine flu at the threshold of the pilgrimage season.

Vietnam: Additional Information on the 17 newly confirmed

Excerpt
Seven more H1N1 cases detected in Vietnam

Saturday, July 18, 2009

The six new cases in the south and one in the north took the country’s tally to 345 cases.

The Ministry of Health also reported an increase in infections recently among people entering Vietnam on road, apart from those arriving on flights.

The Center for Preventive Health in Dong Nai Province on Friday reported 17 locals of Viet Kieu Hamlet in Xuan Loc District had tested positive to influenza A (H1N1) and were being treated under quarantine at the HCMC Hospital for Tropical Diseases and the Xuan Loc General Hospital.

The patients include 49-year-old Vu Duc Yen, an overseas Vietnamese from the US, his wife Chu Thi Sen and his son Vu Minh Tuan. Fourteen other patients were identified to have had direct contact with Yen’s family.

Yen’s family had arrived at the Tan Son Nhat International Airport on July 10 and two of their children had been quarantined as they had high temperatures. Subsequent tests found the two had contracted the H1N1 virus.

Doctors of Xuan Loc General Hospital said they had quarantined seven others at Viet Kieu Hamlet for flu tests, after they recorded high body temperatures. Twenty others were also encouraged to quarantine themselves at home to avoid the possible spread of the flu, which is also known as swine flu.

-snip-

Vietnam: A village with 17 people infected with influenza A/H1N1

18/07/2009 0:51

Through 17.7 pm, Medical Center for Dong Nai has said 17 people in Viet Kieu Hamlet, Xuan Hiep (H. Xuan Loc) infected with influenza A/H1N1, are isolation treatment, monitoring at the Hospital tropical diseases and HCMC Hospital H. Xuan Loc (Dong Nai).

The patient had contact with family Yen Vu Germany (49 years old, from overseas Vietnamese in the U.S.). He is married and Yen Chu Thi Sen and the Vu Tuan Minh, Vu Minh Tuan Vu Thanh Tuyen entry to 10.7 days in the last border gate of Tan Son Nhat. At the border gate, and he Minh Tuyen have detected body temperature should be high isolation and test results positive for influenza A/H1N1.

14.7 days, the couple Mr. Yen to relatives as Vu Van Pen (zone 3, Viet Kieu village). Then, the contact with his family Yen signs are high fever should automatically take the test. Results, the 17/20 test positive for influenza A/H1N1, including his spouse and child Tuan Yen. At Hospital Xuan Loc in isolation and sampling of 7 people in Viet Kieu Village signs are high fever to take the test. In addition, while nearly 20 other cases in this village isolation at home to track.

According to the Center and disease control in Europe, to 17.7, the world has recorded 128,273 cases positive for influenza A/H1N1 in 137 countries / territories, including 679 fatal cases.

Vietnam: 1 village in Dong Nai province with 20 people infected with H1N1 influenza

18/07/2009

According to information from the Health Center for Dong Nai province, to the 18 / 7, Dong Nai province has added 20 cases positive for influenza A/H1N1, the total patients with influenza to 36 people.

Especially, Viet Kieu Hamlet, Xuan Hiep commune (Xuan Loc) has been to 20 cases, including 3 children father overseas Vietnamese from the U.S. on 8 / 7 on flight KE 861, 17 people are left people in the village are exposed to the father 3 children say on overseas Vietnamese.

Now, these cases are treated in isolation hospital Tropical Diseases in Ho Chi Minh City, Vietnamese Dong Children's Hospital 1 in Ho Chi Minh City and Hospital Xuan Loc (Dong Nai).

According to Health Center for Dong Nai province, is first spread influenza A/H1N1 largest since the first season and up to now.

Health sector Dong Nai held fold area, processing environment and close monitoring of disease. At 9 in the form of contact is near isolation in the community and waiting for test results from the Pasteur Institute of Ho Chi Minh City.

Relatives in the area but this 3 overseas Vietnamese live each supervised by the epidemic prevention measures, closely monitoring the health status of people who have been exposed to early detection of cases suspected to infected measures for timely processing. /.

Legal immunity set for swine flu vaccine makers

By MIKE STOBBE AP Medical Writer

Posted: 07/17/2009 09:04:05 AM PDT

Updated: 07/17/2009 05:16:01 PM PDT

ATLANTA—The last time the government embarked on a major vaccine campaign against a new swine flu, thousands filed claims contending they suffered side effects from the shots. This time, the government has already taken steps to head that off.

Vaccine makers and federal officials will be immune from lawsuits that result from any new swine flu vaccine, under a document signed by Secretary of Health and Human Services Kathleen Sebelius, government health officials said Friday.

Since the 1980s, the government has protected vaccine makers against lawsuits over the use of childhood vaccines. Instead, a federal court handles claims and decides who will be paid from a special fund.

The document signed by Sebelius last month grants immunity to those making a swine flu vaccine, under the provisions of a 2006 law for public health emergencies. It allows for a compensation fund, if needed.

The government takes such steps to encourage drug companies to make vaccines, and it's worked. Federal officials have contracted with five manufacturers to make a swine flu vaccine. First identified in April, swine flu has so far caused about 263 deaths, according to numbers released by the Centers for Disease Control and Prevention on Friday.

The CDC said more than 40,000 Americans have had confirmed or probable cases, but those are people who sought health care. It's likely that more than 1 million Americans have been sickened by the flu, many with mild cases.

The virus hits younger people harder that seasonal flu, but so far hasn't been much more deadly than the strains seen every fall and winter. But health officials believe the virus could mutate to a more dangerous form, or at least contribute to a potentially heavier flu season than usual.

"We do expect there to be an increase in influenza this fall," with a bump in cases perhaps beginning earlier than normal, said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

On Friday, the Food and Drug Administration approved the regular winter flu vaccine, a final step before shipments to clinics and other vaccination sites could begin.

The last time the government faced a new swine flu virus was in 1976. Cases of swine flu in soldiers at Fort Dix, N.J., including one death, made health officials worried they might be facing a deadly pandemic like the one that killed millions around the world in 1918 and 1919.

Federal officials vaccinated 40 million Americans during a national campaign. A pandemic never materialized, but thousands who got the shots filed injury claims, saying they suffered a paralyzing condition called Guillain-Barre Syndrome or other side effects.

"The government paid out quite a bit of money," said Stephen Sugarman, a law professor who specializes in product liability at the University of California at Berkeley.

Vaccines aren't as profitable as other drugs for manufacturers, and without protection against lawsuits "they're saying, 'Do we need this?'" Sugarman said.

The move to protect makers of a swine flu didn't go over well with Paul Pennock, a prominent New York plaintiffs attorney on medical liability cases. The government will likely call on millions of Americans to get the vaccinations to prevent the disease from spreading, he noted.

"If you're going to ask people to do this for the common good, then let's make sure for the common good that these people will be taken care of if something goes wrong," Pennock said.

California: 24 More Fatalities Reported Last Week

24 More Deaths, 707 New Cases of A/H1N1 Flu Reported in California

According to the latest figures released by the California Department of Public Health (CDPH) on Thursday, the state's A/H1N1 flu death toll has reached 55, while the number of confirmed and probable cases rose to 3,168.

The department reported that 24 more fatalities have been reported last week. This figure represents a 77-percent increase from the previous record of 31. Likewise, 707 new cases have been detected, representing a 29-percent rise from the previous total of 2,461 released last week by the Centers for Disease Control and Prevention (CDC).

Ever since the flu outbreak began, the state of California has been among the leaders with the most number of fatalities and confirmed cases. The latest CDPH report shows that Los Angeles, San Diego, Orange, and Long Beach counties have been the four hardest-hit areas, with Orange County and San Diego each having 8 deaths, while Los Angeles and Long Beach each has 7 A/H1N1 related fatalities.

Oregon: 13 people hospitalized for flu symptoms

7/17 4:40 pm

Springfield (KMTR) - 13 people are hospitalized for flu symptoms at Sacred Heart Medical Center at RiverBend in Springfield.

So far, only one of the 13 patients has tested positive for swine flu, otherwise known as the H1N1 virus. Test results are pending on the others. The patients range in age from 14 months to 62 years of age. Five of them are in the intensive care unit being treated for pneumonia.

One local health official says it's unusual to see a cluster of flu cases like this during the month of July. Betsy Meredith from Lane County Public Health has some advice for patients with flu-like symptoms. "They should stay home for seven days after the onset of symptoms or 24 hours after the fever has dropped, whichever is longer."

If you do feel symptoms coming on, health officials urge you to call your doctor. Do not go to the hospital.

hat-tip thebes

Fight for swine flu vaccine could get ugly

The Associated Press
By MARIA CHENG
7/16/09

LONDON — An ugly scramble is brewing over the swine flu vaccine — and when it becomes available, Britain, the United States and other nations could find that the contracts they signed with pharmaceutical companies are easily broken.

Experts warn that during a global epidemic, which the world is in now, governments may be under tremendous pressure to protect their own citizens first before allowing companies to ship doses of vaccine out of the country.

That does not bode well for many countries, including the United States, which makes only 20 percent of the flu vaccines it uses, or Britain, where all of its flu vaccines are produced abroad.

"This isn't rocket science," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "If there is severe disease, countries will want to hang onto the vaccine for their own citizens."

Experts say politicians would not be able to withstand the pressure.

"The consequences of shipping vaccine to another country when your own people don't have it would be devastating," added David Fedson, a retired vaccine industry executive.

About 70 percent of the world's flu vaccines are made in Europe, and only a handful of countries are self-sufficient in vaccines. The U.S. has limited flu vaccine facilities, and because factories can't be built overnight, there is no quick fix to boost vaccine supplies.

Last week, the World Health Organization reported nearly 95,000 cases of swine flu including 429 deaths worldwide. If swine flu turns deadlier in the winter, the main flu season in the Northern Hemisphere, countries will likely be clamoring for any available vaccines.

"Pandemic vaccine will be a valuable and scarce resource, like oil or food during a famine," said David Fidler, a professor of law at Indiana University who has consulted for WHO. "We've seen how countries behave in those situations, and it's not encouraging."

Britain claims it will start vaccinating people in August, Italy says it will begin by the end of the year, and many other countries have similar strategies. Those mass vaccination plans could be derailed by problems making the vaccine and by other countries' refusal to ship it abroad.

If the virus remains mild, this could all be moot. Experts estimate swine flu to be about as dangerous as seasonal flu, and there usually isn't a high demand for those vaccines. Still, regular flu kills up to 500,000 people a year.

In past pandemics, or global epidemics, vaccines were never exported before the country that produced them got enough for its own population first.

Unlike the last two pandemics in 1957 and 1968, however, many more countries this time around have struck deals with companies which they say guarantees them first access to vaccine. Yet in a global health emergency, those contracts may ultimately be meaningless.

Countries with flu vaccine plants might decide to seize all vaccines and ban their export, thus breaking the pharmaceutical contracts promising other countries vaccine supplies. These private contracts are not binding international law between two countries, according to Fidler.

He said most vaccine contracts include a clause allowing them to be broken under extraordinary circumstances, such as a health emergency. That would leave the countries who had brokered such deals not only without vaccine, but without legal recourse.

"There's nothing in international law that helps you resolve this, it's just a political nightmare happening in the midst of an epidemiological nightmare," Fidler said.

Britain has ordered 60 million doses, enough to cover its entire population. But those doses are being manufactured by GlaxoSmithKline PLC and Baxter International Inc., whose production plants are in Germany, Austria and the Czech Republic. Neither Britain's department of health or the vaccine manufacturers would comment on delivery plans.

Osterholm said about 80 percent of the United States' pandemic vaccine supply will be coming from abroad and he is very concerned about when it might arrive. Timing could be everything to avoid a vaccine spat.

"It's easy to move vaccine around if the disease is relatively mild. But if it is more severe, countries may not be willing to let it go," he said.

So far, swine flu remains a relatively mild disease, and most people don't need medical treatment to get better. But experts fear the virus could mutate into a more dangerous form. And during the flu season, when the virus spreads more easily, more people will probably fall sick and die.

Public health officials are aware that so-called "vaccine wars" might break out if the swine flu outbreak worsens, but are loathe to even discuss the topic.

The European Centre for Disease Prevention and Control, an agency of the European Union, said it had no mandate to advise countries in such circumstances. WHO said it was not aware of any countries planning to block the shipment of vaccines and said they would work to ensure all countries get enough doses to protect their health workers.

Questions also remain about when a swine flu vaccine will even be available, as WHO reported this week that a fully licensed vaccine might not be ready until the end of the year.

With little or no safety data about a swine flu vaccine, governments that are planning to roll out mass campaigns are taking a gamble, since any rare side effects won't show up until millions of people start getting the shots.

Experts say government promises about when vaccines will arrive should be taken with a huge grain of salt.

"Many pieces of the puzzle are missing," Osterholm said. "Anyone who pretends to have a well-defined schedule of vaccine delivery is obviously very poorly informed."
hat-tip St Michael

Increase in the number of swine flu infections to the Palestinian territories ‮ ‬ 80 ‮ ‬ case of

The state of New South Wales and Australian record ‮ ‬ 5 ‮ ‬ cases and new deaths from the deadly virus
flu virus in the West Bank The Ministry of Health confirmed that the Palestinian scored recorded in the cities of Ramallah, after the Central Bank the necessary medical examinations, ‮ ‬ scored pointed out that the new, took up the number of cases that have been discovered to Bank ‮ ‬ 80 ‮ ‬ ‮ ‬ case of the majority Tmathloa recovering ‮. ‬ thus become casualties that have been detected Bank ‮ ‬ 49 ‮ ‬ ‭ ‬ Ramallah Central Bank and 12 Bank town of Bethlehem and Nablus 17 ‭ ‬ and 2 ‮ ‬ Bank town of Tulkarm ‮. ‬ registered health authorities in the state of New South Wales, Australia, ‮ ‬ 5 new cases and deaths of avian influenza virus pigs, ‮ ‬ including a boy aged ‮ ‬ ‮ ‬ 9 ‮ ‬ ‭ ‬ years ‮. ‬ and the Australian Broadcasting Corporation radio reported that the death of these five the number of deaths caused by the deadly virus in the state to ‮ ‬ 10 ‭ ‬ people ‮. ‬وبلغ‮ ‬.‬ ‬ ‮ ‬ The total number of deaths in Australia due to the new flu case of ‮ ‬ 29

Strict measures to prevent the entry of ‮ »‬ plague ‮« ‬'s

‬Mustafa wrote ‮: ‬ Dr Rahman Shahin ‮ ‬ Spokesman of the Ministry of Health continued strict procedures to protect the Egyptian border to prevent the entry of plague disease ‮‬ "The measures include epidemiological investigation ‮ ‬ ‮ ‬ sampling of nationals coming from the area in which ‮ ‬ cases appeared on the plague, after ‮ ‬ ‮ ‬ 250 ‮ ‬ ‮ ‬ kilometers from the Egyptian-Libyan border ‮. ‬ as well as procedures for safe disposal of garbage in the province ‮ ‬ ‮ ‬ Mersa Matrouh, Shaheen stressed continued cooperation with the mission of the World Health Organization for the application of preventive measures for the coming ‮ ‬ ‮ ‬ Egyptian territory through the port ‮ »‬ SALLUM ‮« ‬ He said that the Libyan authorities had control of ‮ ‬ plague bacterium, showing new cases of the disease have ‮.

S. Korea confirms 31 more flu cases

S. Korea confirms 31 more flu cases

18 July 2009 04:52 FOCUS News Agency

Seoul. South Korea's health authorities said Saturday that they have confirmed 31 more cases of influenza A, raising the number of flu inflections here to 727, Yonhap reports. The new patients, including an elementary school student and a staff member with an international choir competition, tested positive for the H1N1 virus after showing flu-like symptoms, the Ministry for Health, Welfare and Family Affairs said in an emailed statement.The student was believed to have contracted the disease through contact with other recently confirmed patients in school. The staff member worked for a choir event that recently canceled part of its schedule due to the spread of the virus among foreign participants, the ministry said.As of Saturday morning, a total of 142 people remain in isolation for treatment, with the other confirmed patients having been discharged from hospitals as they showed no further flu symptoms. South Korea has been relatively insulated from the global pandemic, which has claimed hundreds of lives since the disease was first identified in April. No deaths have been reported here but concerns are growing that the disease may become more widespread as the number of reported infections is rising fast. In a precautionary move, the government earlier said it has set aside 174.8 billion won (USD 134.4 million) to secure enough vaccine to inoculate around 27 percent of the nation's population against the flu virus. The vaccine will be available beginning in November, ahead of the winter flu season, it added.

Pandemic (H1N1) 2009 (04): MBDS region-Asia

17-JUL-2009
Subject	PRO/MBDS> Pandemic (H1N1) 2009 (04): MBDS region

In this update:[1] Cambodia: 14 confirmed cases
[2] China (mainland): 1444 confirmed cases
[3] Laos: 31 confirmed cases
[4] Myanmar: 4 confirmed cases
[5] Thailand: 4500 confirmed cases, 26 confirmed deaths
[6] Viet Nam: 338 confirmed cases

******
[1] Cambodia: 14 confirmed cases
Date: Fri 17 Jul 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-07/17/content_11725475.htm>


American family confirmed influenza A /H1N1 in Cambodia
-------------------------------------------------------
A 4-member American family (a man and 3 women) were confirmed
positive test[s] for A (H1N1) flu in Cambodia, a Cambodian health
official said on Friday [17 Jul 2009].

"The family traveled from the US to Cambodia in [7 Jul 2009] and
[their tests were confirmed positive] by our doctors on Thursday [16
Jul 2009]," said Ly Sovan, deputy director of communicable disease
control of the Health Ministry, adding that "they are being treated
at the main hospital in Phnom Penh and so far they are getting better."
Ly Sovan said that up to now, Cambodia has had 14 cases of A (H1N1)
virus infection and the latest cases are the 4 members of American family.

[Editor: Fang Yang]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of Cambodia, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/cambodia_pol_97.jpg>.
For the interactive HealthMap/ProMED-mail map with links to other
recent PRO/MBDS and ProMED-mail postings in Cambodia and neighboring
countries, see <http://healthmap.org/r/00ul>. - Mod.YMA]

******
[2] China (mainland): 1444 confirmed cases
Date: Wed 15 Jul 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-07/15/content_11714137.htm>


Chinese mainland A (H1N1) flu cases surpass 1400
------------------------------------------------
The Chinese mainland confirmed 90 new cases of the A (H1N1) influenza
from 6 p.m. Monday [13 Jul 2009] to 6 p.m. Wednesday [15 Jul 2009],
putting the total at 1444, the Ministry of Health said.

Among the newly confirmed, 57 were "imported cases." The other 33
were infected in the Chinese mainland, the ministry said.

Northeast China's Heilongjiang Province reported its 1st imported
case Wednesday [15 Jul 2009], said the ministry.

Among the patients, 1197 have been cured and discharged from hospitals.

No fatal or critical cases of the influenza have been reported on the
Chinese mainland so far, but a patient in Hangzhou of Zhejiang
Province reportedly died of electrocution caused by leakage of
electricity from the electrical circuits in her ward lavatory on [1 Jul 2009].

[Editor: Li]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of China with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>.
For the interactive HealthMap/ProMED-mail map of China with links to
other ProMED-mail and PRO/MBDS postings in China and surrounding
areas, see <http://healthmap.org/r/008e>. - Mod.YMA]

******[3] Laos: 31 confirmed cases
Date: Fri 17 Jul 2009
Source: Vientiane Times [edited]
<http://www.vientianetimes.org.la/FreeContent/Free_Private.htm>


Private school closes to control the spread of H1N1 virus
---------------------------------------------------------
A private school in Vientiane's Sisattanak district [will close] for
more than a week as a way to control the spread of the new influenza
A (H1N1)virus.

The school closure was made after 2 more children at the school were
identified with the virus, bringing the total number of detection
cases at the school to 5.

Both students previously found with the virus have since transmitted
it to one family member respectively.
These cases bring the total number in Laos to 31, 21 of which are in
the capital.

The school, which boasts 800 students, should be re-opened on [27 Jul
2009]. The class that included the 1st child to be found with the
virus has already been suspended for a week.

This coming Saturday [18 Jul 2009], health and education officials
will meet with parents whose children are studying at the private
school. Parents will be urged to monitor their children's health at
home and report to officials about the situation.

The World Health Organisation says it is important to ensure children
stay at home and avoid areas with a high-risk of virus transmission.

Most agreed that the school must be washed or cleaned during its closure.

The Head of National Emerging Infectious Disease Coordination Office
Head, Dr Bounlay Phommasack, said the school closure aimed to respond
to the virus outbreaks in a timely fashion, rather than waiting for
more cases to close the school. However, the government has no plans
to close all schools in Vientiane or the provinces. Any closures
would take place based on an area-by-area assessment. This would
ensure that the public was not unduly alarmed. Instead, it would urge
greater cooperation with parents. It would close only those schools
that were believed to hold a greater risk of the virus spreading.

Some officials said clear information through the media was important
to avoid unsubstantiated rumours that could cause misunderstanding in
the public.

Government officials also had plans to meet with parents whose
children were studying at private schools to give them information
about H1N1. Private schools were chosen as it was often those
families that had the financial capability to take children to travel
abroad, putting them at greater risk.

Dr Bounlay said there was no restriction on travel, but parents
should have correct information in mind to protect themselves from the virus.
Yesterday [16 Jul 2009], authorities from Vientiane in Laos and
Nongkhai province in Thailand met and agreed to cooperate on
surveillance and responses to the virus along their shared border.
Officials from both sides would launch a project to create capacity
for officials as well as link their information to jointly respond to
the virus.

The new project will be supported by Mekong Basin Disease
Surveillance, aiming to stop the virus from spreading to rural
communities in Laos and Thailand.

Dr Bounlay handed over the project responsibility to Vientiane Health
Department Dr Inlavanh Keobounphanh on behalf of the government.

The health department is working in cooperation with Thai authorities.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of Laos with provinces, see
<http://www.un.org/Depts/Cartographic/map/profile/laos.pdf>. For the
interactive HealthMap/ProMED-mail map of Laos with links to other
recent ProMED-mail and PRO/MBDS reports on events in Laos and
surrounding areas, see <http://healthmap.org/r/00uc>. - Mod.YMA]

******
[4] Myanmar: 4 confirmed cases
Date: Fri 17 Jul 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-07/17/content_11723102.htm>


Influenza A (H1N1) cases rise to 4 in Myanmar
---------------------------------------------
The influenza A (H1N1) cases have risen to 4 in Myanmar as a
22-year-old woman has been confirmed with the infection in the
country, the official newspaper New Light of Myanmar reported Friday
[17 Jul 2009].
The woman arrived back in Yangon from Thailand last weekend [11-12
Jul 2008] by a Thai Airways flight and was admitted to hospital after
falling ill.

The patient's 4 family members are under quarantine and monitoring,
the report said.

The woman was on the same flight of the 3rd patient, a 51-year-old man.

Myanmar reported its 1st case of flu A (H1N1) on [27 Jun 2009], which
involved a 13-year-old girl who came back from Singapore. The girl
has recovered and been discharged from hospital and the 2nd patient
will be discharged from hospital soon, according to the report.

So far, the authorities have given medical check up to over 2 million
people at airports, ports, and border check points and examined those
suspicious of having contracted the disease since the outbreak in
Mexico on [28 Apr 2009], the report said.
Of the over 15 000 people with symptoms of fever and suspected flu,
6184 have been free from surveillance after 10 days' period of
monitoring and a total of 8825 people remain under surveillance.

The authorities continue to take preventive measures against the
possible spread of the global human flu pandemic, advising all
private clinics in the country to report or transfer all
flu-suspected patients, who returned from abroad, to local state-run
hospitals or health departments for increased surveillance.

[Editor: Li Xianzhi ]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of Myanmar, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/burma_pol_96.jpg>.
For the interactive HealthMap/ProMED-mail map of Myanmar with links
to other recent ProMED-mail and PRO/MBDS postings in Myanmar and
surrounding areas, see <http://healthmap.org/r/008a>. - Mod.YMA]

******
[5] Thailand: 4500 confirmed cases, 26 confirmed deaths
Date: Fri 17 Jul 2009
Source: Bangkok Post [edited]
<http://www.bangkokpost.com/news/health/149271/sanan-flu-unstoppable>

Deputy Prime Minister Sanan Kachornprasart, chairman of the national
committee for prevention of the spread of A (H1N1)flu, admitted on
Friday [17 Jul 2009] the government is not able to limit the spread
of the deadly virus.

"Control is impossible. It is a matter for every individual to
protect him or herself. Politicians are not to blame because we have
done the best we can," he said.

Maj-Gen Sanan said the best way out was for all people to take care
of themselves. It was not an issue of a failure of government policy.

There have so far been 4500 confirmed cases of influenza A (H1N1)in
Thailand with 26 deaths.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of Thailand showing the geographic regions, see
<http://thailandforvisitors.com/general/regions.html>. For the
interactive HealthMap/ProMED-mail map with links to other ProMED-mail
and PRO/MBDS postings in Thailand and neighboring countries, see
<http://healthmap.org/r/00cC>. - Mod.YMA]

******
[6] Viet Nam: 338 confirmed cases
Date: Fri 17 Jul 2009
Source: VietNamNet Bridge [edited]
<http://english.vietnamnet.vn/Health/2009/07/858681/>


Another 18 test positive for A (H1N1); 14 in one hamlet
-------------------------------------------------------
The Ministry of Health yesterday [16 Jul 2009], reported 18 new A
(H1N1) flu cases, 14 of which were in Xuan Hiep commune, Xuan Hoa
district, Dong Nai province.

All 14 patients had contact with an A (H1N1) flu patient that entered
Viet Nam from a high-watch area.
One of the cases is a student, who participated in the college
entrance exams in HCM [Ho Chi Minh] City, and had close contact with
someone who returned from a trip abroad. The 19-year old man was the
1st student found to be infected with the A (H1N1) virus in the
university and college entrance examinations this year [2009].

"Currently, the student is in isolation and being treated in the
hospital. All students and 2 proctors, who had direct contact with
the case in the examination room, were monitored," said director of
the Preventive Medicine and Environment Department at the Ministry of
Health Nguyen Huy Nga.

Nga warned about the increasing number of A (H1N1) flu patients who
might be travelling by on the roadways and returning from areas with
cases. "Especially as students and pupils return after the summer
break would be good chance for the pandemic to spread in schools and
to the community," added Nga.

As of yesterday [16 Jul 2009], the ministry confirmed a total 338
positive cases of the superflu, but no fatalities. Out of all the
cases, 279 had been discharged from the hospitals, and 59 patients
were still in isolation and receiving treatment.
As of [15 Jul 2009], the European Centre for Disease prevention
Control (ECDC) reported total 125 993 positive A (H1N1) flu cases, of
which there were 667 fatal cases in 135 countries and territories worldwide.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[According to the data presently available, nearly 4900 cases and 26
deaths of influenza A (H1N1) infection have been confirmed in the
MBDS region and the deaths were reported from Thailand.

The World Health Organization (WHO) announced on 16 Jul 2009 that it
would no longer issue regular reports of confirmed global case totals
due to questionable usefulness of reporting case counts and the
burden it puts on countries experiencing widespread transmission. The
WHO had issued 58 reports on influenza A (H1N1) infection since the
start of the outbreak; the latest one was on 6 Jul 2009 (see
<http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jul1609cases-br.html>).
A 42-year-old Philippines man died of suspected influenza A (H1N1)
infection in Hong Kong SAR on 10 Jul 2009. Laboratory tests and a
post-mortem examination would be conducted in order to find out the
cause of the death (see
<http://www.news.gov.hk/en/category/healthandcommunity/090716/html/090716en05002.htm>).
In addition, the 3rd critical case of influenza A (H1N1) infection
has been detected in a 39-year-old man in Hong Kong SAR, and the
total number of confirmed cases is 1640 as of 17 Jul 2009, (see
<http://www.news.gov.hk/en/category/healthandcommunity/090717/html/090717en05011.htm>).


For maps of Viet Nam with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/vietnam_admin01.jpg>
and <http://www.angelfire.com/co/hongnam/vnmap.html>. The interactive
HealthMap/ProMED-mail map with direct links to other outbreaks in
Viet Nam and surrounding countries reported on ProMED-mail and
PRO/MBDS can be accessed at <http://healthmap.org/r/008c>. - Mod.YMA]

Egypt’s H1N1 cases rise to 112

By Yasmine Saleh / Daily News Egypt
First Published: July 17, 2009

CAIRO: Number of confirmed positive cases of H1N1 flu in Egypt increased to 112 after the Ministry of Health announced four new cases late Thursday.

According to the Ministry’s Official Media Spokesperson, Abdel Rahman Shahin, among the 112 cases, 93 have totally recovered, and the remaining 19 are in good condition receiving proper treatment in Egyptian hospitals.

The new cases are of a 20-year-old British female employer who came to Sharm Al-Sheikh with her husband on July 15; two Egyptian sisters, six and nine years old, who both came to Cairo from Saudi Arabia on July 15; and the fourth case was that of a 54-year-old British female who came with her family from England to Luxor on July 15, according to Shahin.

Shahin said that the Ministry of health has also examined some 38 other suspected cases of H1N1 along with 17 suspected cases of bird flu on Thursday which all came out negative.

On the other hand, the World Health Organization (WHO) announced that H1N1 is “spreading widely in an unprecedented way.”

“At this point, further spread of the pandemic, within affected countries and to new countries, is considered inevitable,” stated the WHO’s statement released on Thursday.

WHO further added that due to the wide and quick spread of the disease among enormous countries, it became impossible for the organization to keep track and update the number of infected cases worldwide.

“However, as part of continued efforts to document the global spread of the H1N1 pandemic, regular updates will be provided describing the situation in the newly affected countries. WHO will continue to request that these countries report the first confirmed cases and, as far as feasible, provide weekly aggregated case numbers and descriptive epidemiology of the early cases,” WHO said.

“As for countries already experiencing community-wide transmission, they are no longer to submit regular reports of individual laboratory-confirmed cases to WHO,” the statement added.

According to the British Times and The Guardian newspapers, the British government announced that the number of deaths from H1N1 flu could increase to 65,000 this year, according to a scientific research results.

In Britain, the number of H1N1 deaths increased to 29 from 17 last Monday, while the number of infected cases reached 652, 53 of which are in critical condition and have been placed in intensive care units.

British medical authorities have also reported that some 55,000 patients have experienced flu like symptoms in Britain last week.

Two Russians prove A/H1N1 flu positive after Cypriot vacation

17.07.2009, 20.23

MOSCOW, July 17 (Itar-Tass) -- Two young women were hospitalized in Ramenskoye near Moscow with A/H1N1 flu after a Cypriot vacation, a source at the Russian Emergency Situations Ministry told Itar-Tass on Friday. “A female resident of Ramenskoye was hospitalized on July 15 with the preliminary A/H1N1 flu diagnosis. She had visited Cyprus together with her father, mother, sister and friend,” the ministry said. “The girl and her friend were both diagnosed as A/H1N1 positive. They are staying at the Ramenskoye infectious disease hospital,” the ministry said. Russian Chief Public Health Official Gennady Onishchenko said on Thursday that a man contracted the new flu virus in Thailand. In all, Russia has seven A/H1N1 flu cases. All of them contracted the virus abroad, including the United States, Cyprus, Thailand and Spain. The first batch of the A/H1N1 flu vaccine Russia is developing will be sent to the Far Eastern Federal District, Onishchenko said at a meeting of the Council of the Presidential Representative to the Far Eastern Federal District in Khabarovsk in early July. He said it was planned to deliver 1.1 million doses of adult vaccine and 400,000 doses of vaccine for children. “We have two major tasks: we must prepare regions for possible outbreaks of the virus and to keep off the virus from the national territory,” he said. The Far East and other Russian regions have drafted flu action plans. The plans are most detailed in the Primorye and Khabarovsk territories and the Amur region. Plans of Yakutia and the Chukotka autonomous district contain serious shortcomings, the officer said. Onishchenko said that the ‘bird’ flu hazard was also serious. China registered 38 ‘bird’ flu cases this year, and 25 of them were lethal. The situation will be most dangerous if the ‘bird’ and ‘swine’ flu viruses combine. That may happen in Southeast Asia. The Far East is an area visited by migrant birds, which enhances the contamination risk, he said.

20 cases of influenza A among Spanish soldiers deployed in Afghanistan

Actualizado el 17/7/2009 - 20:47h Updated 17/7/2009 - 20:47 h

. The Ministry of Health and Consumer Affairs this afternoon confirmed the existence of 20 positive cases of influenza A/N1H1 between the Spanish soldiers deployed in the Advanced Support Base in Herat, in western Afghanistan.

During a ceremony this morning in Santander, Chief of Staff of Defense (Milreps) Air general José Julio Rodríguez Fernández, said that some cases were detected positive for influenza A in Herat, although he stressed that all troops are " under control "and that are activated and applied to all protocols against the H1N1 virus.

At present, the Advanced Support Base in Herat remain isolated 54 Spanish soldiers deployed in this country within the framework of the International Force Security Assistance in Afghanistan (ISAF). Most of the detainees belong to the military contingent based in the Command of the Canary Islands.

Spain maintains a contingent in Afghanistan more than a thousand military personnel in the International Force Security Assistance (ISAF) under NATO command and under the resolutions of the Security Council of UN. The bulk of the troops concentrated in the Advanced Support Base in Herat and in the Provincial Reconstruction Team in Badghis, based in the capital of this western province, Qala-i-Now.

The deployment is completed by both teams and Operating Instructions Link (OMLT) based at Camp Stone in Herat, and responsible for the formation of battalions of the Afghan National Army (ANA). The detachment of the Spanish Armed Forces consists of 778 soldiers, reinforced over the next three months by a battalion to provide security during the celebration of the Afghan parliamentary elections next August 20. The Spanish contingent will increase in autumn with the deployment of a detachment of control and security in the Kabul International Airport and two new OMLT españa.

Navy lab in Norfolk gets equipment for swine flu test

Study: New flu inefficient in attacking people

Excerpt:

It's currently flu season in the Southern Hemisphere, and viral spread in Argentina has prompted schools there to give students an early vacation. But swine flu hasn't abated in the Northern Hemisphere, unusual since influenza usually retreats from summer's high heat and humidity. Confirmed U.S. cases have reached nearly 34,000 — a fraction of the infected are tested — and deaths rose 34 percent in the past week to hit 170, the CDC said Thursday. England's health minister said Thursday that his country faces a projected 100,000 new swine flu cases a day by the end of August.

Also Thursday, Health and Human Services Secretary Kathleen Sebelius said the U.S. will provide 420,000 treatment courses of the anti-viral medicine Tamiflu to the Pan-American Health Organization to help fight the flu in Latin America and the Caribbean. "All of us have a responsibility to help support one another in the face of this challenge," Sebelius said at a meeting of health ministers in Mexico.

Sasisekharan's paper, meanwhile, warned that the H1N1 strain might just need a single change or mutation to make it resistant to Tamiflu.

The researchers also noted that the new virus is more active in the gastrointestinal tract than seasonal flu, leading to intestinal distress and vomiting in about 40 percent of those infected.

The research was funded by the Singapore-MIT Alliance for Research and Technology and the National Institutes of General Medical Sciences.

Persistent Influenza

July 17, 2009

Excerpt:

An influenza genome is generally very unstable and highly susceptible to rapid mutation and recombination within its genetic composition. The current swine flu is decoded as of A(H1N1) subtype whereas the previous Avian flu belonged to A(H5N1) subtype. Pigs can potentially be mixing container where all flu types may swap genes amongst themselves, owing to its vulnerability to all the types of flu that can affect mankind.

As said before, there s a high probability that this mutual reassortment of genes of different influenza viruses in a single host may lead to production of a new strain that spreads easily. The aforesaid genetic reassortment will occur when different strains of influenza virus affect a single cell. According to calculations, such a new strain requires practically many years of continuous reassortments to emerge. For example, the new strains of swine origin flu virus [(H1N1)(S-OIV)] has emerged over years by continuous reshuffling of 8 gene segments contributed by three different strains stated as human flu, North American Avian flu and the Classic Swine flu.

Education 101: Swine flu for school year 2009-2010

July 17, 11:31 AM

On July 9, the Obama administration warned Americans to be ready for an aggressive return of the Swine Flu virus in the fall.

Swine Flu, also known as influenza A (H1N1), originated in Mexico. Although the original warning at the announcement of this flu last April were mere travel warnings, the Center for Disease Control (CDC) is now ready to call this virus a pandemic. http://www.examiner.com/examiner/x-5067-Education-in-the-News-Examiner~y2009m4d27-Los-Angeles-schools-prepare-for-Swine-Flu

Furthermore, on June 11, 2009, a pandemic was declared by an international health agency, the World Health Organization (WHO), for the H1N1 Swine Flu. http://www.who.int/en/ A pandemic is defined as "a sudden outbreak that becomes very widespread and affects a whole region, a continent, or the world." http://www.medterms.com/script/main/art.asp?articlekey=4751

The CDC has issued a warning for all schools, from preschool to colleges and universities, suggesting guidelines for schools to consider in the event that an outbreak is suspected. http://www.cdc.gov/

As a means in which to quarantine and prevent spread of this infectious disease, the CDC recommends all education facilities to close "as an option to lessen the risk of infection" and to prevent the spread to other community members if there is a suspected outbreak of this flu.

The CDC also asks teachers and staff to pay close attention to the signs of the flu and have those children removed from the school population and sent home. Meanwhile teachers and staff should also stay home when ill and make a lesson plan to show students "good cough and hand hygiene etiquette." Schools should also "sanitize frequently-touched surfaces, (such as desks, doorknobs, computer keyboards, toys) routinely."

According to health care professionals, early detection is the key in battling the spread of any disease. Anyone with symptoms should go to their physician for a nose swab to determine the strain of flu. Physicians are already required to report confirmed cases to the LA County Health Services, however, a proactive approach of notification can make a big difference in a community.

THIS FALL A NEW OUTBREAK OF THE SWINE FLU IS ANTICIPATED AND COULD BE RESISTANT TO ANTI-VIRAL DRUGS.

According to the CDC and WHO, there will be more cases, more hospitalizations and more deaths associated with this pandemic in the United States over the summer and into the fall and winter. This fall's new season of the Swine Flu H1N1 virus, in conjunction with the regular seasonal influenza viruses, pose the potential to cause significant illness expecting hospitalizations and deaths during the U.S. influenza season.

Symptoms: The Swine Flu H1N1 symptoms to watch for include including fever, cough, sore throat, body aches, headache, chills and fatigue as well as nausea, vomiting and/or diarrhea.

The new flu shot: The CDC has isolated the new H1N1 virus, and there are reports that the Illinois based pharmaceutical company, Baxter, is working tirelessly to finalize and test the new vaccine for the fall. However, Baxter admits that it cannot keep up with the demand and they have ceased taking any new orders for the vaccine. If tests prove the vaccines to be safe and effective, flu shots will be available starting in October.

School starts in September for most of our children and the flu shots will not be ready until October. Therefore, there will be about one month of children in close quarters who are unprotected from the flu. Here are the steps that you can take and teach your children to prevent contracting or spreading the flu:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.

Certain countries are at the beginning of their flu season such as Australia, Chile and Argentina. The alarm bells went off when three initial cases of the flu in those countries were resistant to the anti-viral drug Tamiflu.

Health officials in the United States fear that there exists a Tamiflu-resistant strain of the virus currently spreading silently in the United States. http://www.nytimes.com/2009/07/10/health/10flu.html?bl&ex=1247284800&en=7d10bb085fb2733a&ei=5087%0A

On June 12, a case involving a teenage girl who flew to Hong Kong from San Francisco revealed a serious case of the Swine Flu. What makes this case notable and alarming is that authorities in Hong Kong proved "that it had a mutation, known as H274Y on the neuraminidase gene, making it resistant to Tamiflu, a neuraminidase inhibitor." The suggestion of this mutation points to a strong probability that this girl contracted the "already resistant virus from someone else, presumably in Northern California."

Soon to be announced by the United States health officials, is a new promotion to ready its citizens for a pandemic and Tamiflu resistant flu for this season. In the works, is a US contest partnered with Youtube awarding prizes for community members sharing how their workplace, school or community is preparing for a possible flu outbreak. Some contingency plan suggestions are homeschooling preparation or for offices, a work from home readiness program.

Swine Flu: Why You Should Still Be Worried

Friday, July 17, 2009

Friday, July 17, 2009
By Marrecca Fiore

• Print
• ShareThis

Swine flu is spreading faster than ever — so much so that the World Health Organization has decided to stop tracking cases.

In the U.S., the H1N1 virus has sickened tens of thousands and closed summer camps at a time when there should be little or no flu activity.

Even as the WHO and the U.S. Centers for Disease Control and Prevention continue to raise awareness of this potentially deadly disease, which appears to be killing both sick and healthy individuals, the topic has virtually disappeared from the headlines.

“Complacency is a major concern,” said Dr. Anne Schuchat, director for National Center for Immunization and Respiratory Diseases at the CDC.

“This virus is a new one, and on top of that, we really still don’t know how it’s going to behave,” Schuchat said during a media conference call Friday. “There are special efforts that have been undertaken by health agencies, but individuals also need to be ready, to be thinking ahead and have steps in place should a family member get sick or a workplace close down or a situation arise that requires working from home.”

Over the next six to 12 weeks, there are several concerns that national health officials are preparing for:

1. Figuring out how the virus will react and spread once students return to schools, especially inner city schools, which typically struggle with overcrowding issues.

2. Overseeing the completion of a vaccine and getting it to the individuals who need it most.

3. Determining how the virus will behave as it spreads and mutates.

Schools

School districts across the U.S. struggle every fall with outbreaks of typically non-flu respiratory viruses, which are easily spread through germs on surfaces and doorknobs, as well as passed from student to student through sneezing, coughing, and sharing drinks and food.

Seasonal influenza usually begins to spread through schools in the late fall and early winter, but this probably will not be the case with swine flu, which behaves differently than seasonal influenza – by oddly thriving in warm and humid conditions.

“This year we’re seeing the H1N1 virus circulating through summer camps and military units, so I’m expecting we may see an increase in cases once school starts, but we don’t definitely know that,” Schuchat said. “We are concerned that there will be challenges in the fall. It is the kind of thing we want to be ready for and not surprised by.”

Schuchat said national and state health officials are working closely together on updating their guidance for schools and similar institutions with regard to swine flu outbreaks.

“We still believe that the best place for kids is in schools, where they can be nourished receiving a healthy breakfast and lunch and learning,” she said. “But we also believe the best place for a sick kid is at home being cared for. So we’re working on putting strong plans in place on communication and preparedness on the local and state levels.”

Click here to read the CDC’s advice for parents for educating and protecting children from swine flu.

Vaccine

Companies such as Baxter, GlaxoSmithKline and Novartis are working to ready a swine flu vaccine for October. Earlier this week, concerns were raised that the U.S. may not receive all the vaccine it needs because it only manufactures about 20 percent of its own supply. The other 80 percent is produced in foreign countries, which will also need ample supplies of the vaccine.

But Schuchat downplayed those concerns, saying the U.S. has contracts in place with manufacturers around the world that guarantee it will receive adequate vaccine.

But, will the vaccine be effective?

In a typical year, the seasonal flu vaccine is about 70 to 90 percent effective, depending on how closely the vaccine matches the strains circulating and on the population the vaccine is used in. In other words, a vaccine is not going to be as effective in a person with a compromised immune system or someone who is considered at high risk for the virus.

Scientists typically spend months researching the strains of seasonal flu virus that are circulating the globe in order to pick out the three strains that it puts into the annual vaccine.

Because swine flu is new and mutating – for example, in Argentina the virus appears to have mutated to where it can now easily spread from humans to pigs – scientists have their work cut out for them when it comes to determining what strains of the H1N1 swine flu virus to include in the vaccine.

“Unfortunately, right now, we do not know how effective it will be in different populations,” Schuchat said. “We will be looking back at how well it worked, taking into account whether it worked as well as expected, better than expected or worse than expected. Unfortunately, that’s something we’re not able to do until after the fact.”

Virus Behavior

World and U.S. health officials have already determined that swine flu behaves differently than seasonal flu in a number of ways. First, it’s able to spread in hot and humid weather, which is not usually the case for the seasonal flu virus.

Second, the infection appears to be more severe in young people and less severe in the elderly than the typical seasonal flu. Schuchat said in some countries, elderly people, usually at high-risk for influenza, appear to be immune to swine flu – possibly because of the similarities between swine flu and the 1918 flu pandemic, which some of the world’s elderly survived and may be resistant to.

“We are particularly concerned about pregnant women; we’re seeing fatalities and life-threatening illnesses that have occurred in pregnant women in the Southern Hemisphere,” Schuchat said. “We are expecting pregnant women to get a recommendation to get the H1N1 vaccine to reduce the risk of complications from influenza. We know many pregnant women don’t like to take any drugs, but this is one instance where you need to be much more concerned about your health than the baby’s health.”

“We’re in a very active stage of preparing for the [coming months],” she continued. “We’re working with the private sector. We want individuals and families to be preparing. Influenza in general is unpredictable, and we don’t know what to expect in the weeks and months ahead.”

2009 H1N1 Influenza A: Clinical Details, Antiviral Resistance, and Other Mutations

Clinicians Biosecurity Network
University of Pittsburg Medical Center

By Amesh A. Adalja, MD, July 17, 2009

As more clinical and scientific facts are learned about illness caused by the novel 2009 H1N1 influenza virus, clinical policy will become more firmly rooted in scientific data, and optimal management strategies will emerge. To that end, several scientific papers have been published recently that shed light on both the spectrum of illness caused by this virus and its ability to evade antiviral drugs.

Clinical Characteristics of Severe Cases

Two recent papers in The New England Journal of Medicine detail the clinical characteristics of severe cases. One, from the National Institutes of Health’s Fogarty International Center, confirms that deaths in Mexico from severe pneumonia during the beginning stages of the outbreak did represent a shift in demographics from previous influenza seasons. In prior epidemics, patients aged 5 to 59 years accounted for 17% of deaths; in contrast, 87% of the 2009 deaths in Mexico occurred in patients in that age group. Similar shifts were seen in the age distribution of severe pneumonia cases.1

The other NEJM paper2 recounts the clinical course of 18 hospitalized patients in Mexico. All suffered from pneumonia and influenza. Eight of the 18 patients had pre-existing medical conditions, while 3 had received seasonal flu vaccine. Those 3 did not require mechanical ventilation. Several other important details emerged from the study:

* The median time from symptom onset to hospital admission was 6 days, with a range of 4 to 25 days.
* All patients presented with fever, cough, and dyspnea.
* Twelve of 18 patients were treated with antibiotics.

Common laboratory abnormalities among these patients included elevated lactate dehydrogenase, creatine kinase, and lymphopenia. No co-pathogens (bacterial or viral) were identified within 24 hours of admission.

Statistically significant differences were found between those who survived (11) and those who died (7); specifically, among patients who died, the following features were more common:

* development of renal failure;
* lower arterial blood pH;
* higher Apache II score;
* higher SOFA score; and
* lower Pa02:FiO2 ratio.

Oseltamivir therapy was not initiated in any patient prior to hospitalization; however, 14 of 18 received it during hospitalization. Antibacterial therapy was administered to the majority of patients. Mechanical ventilation was initiated in 10 patients within 24 hours of hospitalization, while 2 others required it later in their hospital stay. Ventilator-associated pneumonia occurred in 4 patients. Before infection control measures were instituted, influenza-like illness developed in 22 healthcare workers who cared for the first 3 of these patients.2

Antiviral Resistance Has Emerged

Prior to the outbreak of 2009 H1N1, most isolates of the seasonal variety of H1N1 influenza A harbored a resistance mutation (H274Y) that renders oseltamivir ineffective; now this mutation has appeared in several 2009 H1N1 virus isolates. To date, 3 resistant cases have been identified in Asia and Europe among patients with uncomplicated influenza: 2 of the patients were being treated with oseltamivir, the third was a patient who had neither taken oseltamivir nor been exposed to anyone who had, suggesting acquisition of a resistant strain circulating in the community. All isolates retained susceptibility to zanamivir, a neuraminidase inhibitor. The CDC has not altered antiviral guidelines due to the current rarity of this phenomenon.3

Shanghai Mutation Renders Virus More Fit for Human Replication

Another important mutation that has been identified in some isolates from Shanghai is the E627K mutation in the PB2 gene. This mutation renders the virus more fit to replicate at 33°C, the temperature of the human nose during winter months. The PB2 gene of the 2009 H1N1 virus is derived from an avian source and, accordingly, contains a genetic sequence optimizing replication at 41°C, the normal temperature of avian species.4,5

2009 H1N1: The Future

As the 2009 H1N1 influenza A virus continues to spread, tracking the clinical and virologic attributes of this virus will be important as policy is developed to prepare for the possibility of a severe influenza season around the globe. Of the developments to date, antiviral resistance poses a major challenge given the extensive reliance on oseltamivir. Fortunately, inhaled zanamivir remains an option, albeit a limited one. Two possibilities in the pipeline include the investigational agent peramivir and an intravenous formulation of zanamivir. The emergence of the E627K mutation and its potential for worldwide progression could foster more efficient spread of the virus, increasing the proportion of persons expected to become ill, and stretching an already over-burdened healthcare system.

References

1. Chowell G, Bertozzi SM, Colchero MA, et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 2009; Jun 29. [Epub ahead of print]. http://content.nejm.org/cgi/content/full/NEJMoa0904023. Accessed July 10, 2009.
2. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009; Jun 29. [Epub ahead of print]. http://content.nejm.org/cgi/content/full/NEJMoa0904252. Accessed July 10, 2009.
3. CDC. Three reports of oseltamivir resistant novel influenza A (H1N1) viruses. July 9, 2009. http://www.cdc.gov/h1n1flu/
HAN/070909.htm. Accessed July 10, 2009.
4. MacKenzie D. “Swine flu sweeps the southern hemisphere.” New Scientist. July 9, 2009. http://www.newscientist.com/article/
mg20327164.000-swine-flu-sweeps-the-southern-hemisphere.html. Accessed July 10, 2009.
5. Recombinomics. E627K acquisition in swine H1N1 raises pandemic concerns. June 18, 2009. http://www.recombinomics.com/News/06...ine_E627K.html. Accessed July 10, 2009.

hat-tip St. Michael

UK: Schools could stay closed after summer break if swine flu cases surge

July 18, 2009

Schools could be forced to stay closed after the summer break if the swine flu pandemic worsens, it was announced yesterday as officials confirmed details of the latest people with the virus to die.

A woman who died after giving birth on Monday in Whipps Cross hospital, East London, was infected with swine flu, a hospital spokesman said.

Ruptara Miah, 39, was paraplegic after a car crash 15 years ago. She was from Bangladesh and had six other children, a family spokesman said.

Other deaths reported in the past few days include those of a baby under the age of six months who died at the Royal Free Hospital on July 8, and a man aged 70 who died at the Royal London Hospital on July 14.

Investigations are continuing into the sudden death on Tuesday of a boy aged 7 from Rochester, in Kent, although health officials said that the cause appeared to be “a range of complications which were not related to swine flu”.

The total number of deaths linked with swine flu stands at 29 in the UK. Ten people have died in the capital, and NHS London is investigating a further three to see if they were linked with the virus. About 55,000 people reported flu symptoms last week, while the number of patients in hospital with the virus doubled to 652, of whom 53 are in intensive care.

Figures issued by Sir Liam Donaldson, the Chief Medical Officer for England, suggest that the under-14 age group is being hit hardest, with a further surge in cases possible as early as late August or September.

The Department for Children, Schools and Families said yesterday that while it expected schools and nurseries to open as usual in the autumn, it “cannot be certain what the situation will be”.

About 1,000 schools had recorded cases of swine flu, the department said in its guidance to teachers, though most had managed to stay open. At the start of the outbreak, affected schools closed in an attempt to contain the virus but Britain abandoned such steps as the number of cases became too high.

The department said that it was monitoring the situation daily. Schools would be told in the last week of August what to do at the start of term.

Its statement said: “We expect that schools and early years and childcare settings will reopen as usual, but at this time we cannot be certain what the situation will be then; we will need to monitor developments over the summer, and take decisions based on the best advice available shortly before the start of term.”

The planning document issued to the NHS by the Chief Medical Officer suggests that the NHS should plan services around a worst-case scenario of 65,000 swine flu deaths this year. It suggests that if the present growth in cases is sustained there could be a peak in the flu pandemic in early September, with up to 30 per cent of the population experiencing symptoms.

But it is possible it could begin to slow down over this month and next, before a resurgence in the autumn, when schools reopen.

Sir Liam said there was now “exceptional influenza activity” across most of the country apart from Yorkshire and the Humber.

First commercial pig farm worker in Britain contracts swine flu

July 18, 2009
The first case of a pig farm worker contracting the swine flu virus was reported this week. The stockman from the South West worked on a commercial pig farm.

Other staff and pigs on the farm are free of the H1N1 virus but veterinary experts are working with the pig industry to agree a code of practice should pig herds become infected with the flu strain.

There is no threat to human health if people eat pork, bacon and ham from a pig that has recovered from swine flu provided that the meat is cooked properly.

Any pig contracting flu is to be quarantined and it cannot be slaughtered for the food chain unless the animal has been free of flu symptoms for seven days. Veterinary checks will also take place at the abattoir where any sick animals will be rejected.

There are no plans to cull pigs with swine flu, but it is known that flu strains can easily pass between pigs and human beings as well as from pig to pig.

CDC fears more new flu to come back in fall

Fri Jul 17, 2009 12:39pm EDT

WASHINGTON (Reuters) - The new H1N1 swine flu virus is still circulating and likely will cause more disease in the autumn, especially when schoolchildren return from the summer break, a U.S. Centers for Disease Control and Prevention official said on Friday.

The virus, which has been declared a pandemic, is causing severe disease and deaths in older children and younger adults in the southern hemisphere, just as it has been in the United States, the CDC's Dr. Anne Schuchat said.

"We are concerned that there will be challenges in the fall," Schuchat told reporters in a telephone briefing.