GENEVA (AP) — Global production of swine flu vaccines will be "substantially less" than the previous maximum forecast of 94 million doses a week, the World Health Organization said Friday.
The number of doses produced in a year will therefore fall short of the 4.9 billion doses the global health body previously hoped could be available for the pandemic, WHO spokesman Gregory Hartl told reporters in Geneva.
Production will be lower because some manufacturers are still turning out vaccines for seasonal flu — an illness that can be serious in sick and elderly people, Hartl said.
Production problems also have reduced the weekly output of pandemic vaccine, he said.
The United States, France, Britain and six other countries announced Thursday that they will share part of their vaccine supply with poorer countries.
WHO welcomed the move Friday, saying it "demonstrates the commitment of these countries to fairness in sharing of scare resources."
"Current supplies of pandemic vaccine are inadequate for a world population in which virtually everyone is susceptible to infection by a new and readily contagious virus," it said.
WHO says that in theory all the world's 6.3 billion people should receive at least one dose of vaccine against the pandemic strain of H1N1 — also known as swine flu — to ensure comprehensive protection against the disease, which has so far killed some 3,500 people.
Friday, September 18, 2009
CDC Unveils Distribution Plan for H1N1 Influenza Vaccine
By David Brown
Washington Post Staff WriterFriday, September 18, 2009; 6:05 PM
Pandemic H1N1 influenza vaccine will be distributed on a three-day turnaround time from four regional warehouses around the country next month. The vaccine deliveries, expected to equal 20 million doses a week by the end of October, will be distributed among 90,000 immunization "providers," including health departments, hospitals, clinics, doctors' offices and pharmacies.
Those were among the details unveiled Friday by the Centers for Disease Control and Prevention as part of the federal government's increasingly complex response to the pandemic of H1N1 influenza, also known as "swine flu."
"This is a huge logistical process. There's not [going to be] a sudden appearance of vaccine in 90,000 refrigerators around the country," said Jay Butler, an epidemiologist heads CDC's task force on the pandemic vaccine.
About 3.4 million doses of nasal-spray flu vaccine -- which can be used only by people age 2 to 49 -- are expected to be available the first week of October. The injectable vaccine, which will form the vast bulk of the 195 million doses the government has ordered, won't be available until later that month when many experts believe the flu outbreak will be in full-swing.
All the pandemic vaccine will be bought by the federal government. It will be divided among states and territories on the basis of population. Providers, including private companies such as pharmacies, will get it for free. They won't be permitted to charge consumers or health insurers for it, but they can charge an "administration fee" for giving the shots or sprays. In some settings, such as public health clinics, people will get the shots for free.
Earlier this summer, the committee of experts advising the federal government on vaccine policy drew up a list of who should be at the front of the line for flu vaccine. They include, among others, children and teenagers, pregnant women, and people with chronic illnesses who are at higher risk of serious or fatal infection.
As the vaccine arrives at the four distribution centers -- their location for the moment is secret -- CDC will tell each state what its allocation will be. States will put in orders based on the need in their jurisdictions and the number of doses that hospitals, clinics and other providers say they can use in the immediate future.
Vaccine will then be sent directly to providers; CDC expects to have 90,000 names and addresses on file. Orders will be filled in three business days and the vaccine shipped overnight, Butler told reporters in a teleconference Friday.
Government planners expect demand for vaccine will outstrip supply in the first weeks after it becomes available. During that time, states will have to decide which hospitals, clinics and offices are most apt to reach the priority populations and thus should get vaccine first.
The CDC won't police those decisions and expects that very quickly there will be enough vaccine to fill essentially all that states will order.
"If we were looking at a long-term shortage, we would be much more involved in this process in terms of how to allocate vaccine," Butler said.
In a related matter, a World Health Organization spokesman said that donations of vaccine to WHO from wealthy countries (including the United States) for use in the developing world will begin in early November and continue for six to eight months.
The Obama administration on Thursday said it will give 10 percent of the U.S. supply to WHO. At least eight other countries will do the same, with 10 percent "a rough estimate" of the fraction to be given, WHO spokesman Gregory Hartl said.
First U.S. H1N1 vaccines will be nasal spray: CDC
Fri Sep 18, 2009 2:52pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - The first U.S. roll-out of vaccines against the new swine flu virus will be 3.4 million doses of MedImmune's nose spray, the Centers for Disease Control and Prevention said on Friday.
The CDC's Dr Jay Butler said the vaccines would be distributed the first week of October.
"Initially we anticipate that 3.4 million doses of vaccine will be available," Butler told a telephone briefing.
"We anticipate being able to start receiving orders for the vaccine by early October," Butler added. The U.S. government is providing the H1N1 vaccine for free to about 90,000 distributors, including doctor's offices, retail chains and state health departments.
"We estimate that the amount of vaccine that will be available will increase through October," Butler said, adding that eventually delivery would rise to about 20 million doses a week.
The United States has ordered 195 million doses of H1N1 swine flu vaccine from five companies -- MedImmune, a unit of AstraZeneca, Sanofi-Aventis, Australia's CSL, GlaxoSmithKline and Novartis.
It has recommended that about 160 million people, roughly half the population, get vaccinated first -- pregnant women, healthcare workers, children and people with chronic conditions such as diabetes or asthma who are most at risk of getting very ill from flu.
There is no enforcement of this, however, and it will be up to the people giving the vaccine to decide who goes first.
MedImmune's vaccine is not approved for people with asthma, people over age 50 or very young children, mostly because it has not yet been tested widely in these groups. State health officials say that might affect who gets the first doses.
Some of the other vaccines contain thimerosal, a preservative that scientists say is safe but which worries some people, and the state of Washington, for instance, says infants and pregnant women may not be given thimerosal-containing vaccines, another factor that could affect distribution.
MODERATE DISEASE
The CDC officials said they are racing to try to stay ahead of the virus, which is now active in all 50 states. It spread around the world to cause a pandemic within a few weeks in April and May.
"The flow of vaccine the first week or so may be slower than we like," Butler said.
So far, the virus is causing moderate disease, with a death rate similar to that seen in seasonal flu. Every year, seasonal influenza kills between 250,000 and 500,000 people globally and around 36,000 in the United States.
But H1N1 may infect far more people than seasonal flu does, because so few people have any immunity to it. It also causes symptoms in a far younger age group than does seasonal flu, which is worse among the elderly.
"We expect that if the H1N1 (virus) remains the predominate strain, that more younger people might be affected than we have seen in the past," the CDC's Dr Daniel Jernigan said.
"There is some increase in the rate of hospitalization for younger children and for adults, but it is not up at the levels that we would see for seasonal flu."
He said it was very unusual to have so much flu spreading this time of year in the United States. It is usually more common in the United States from January to March.
"It's about twice as much, at least for what we would expect this time of year," Jernigan told the briefing.
"If you talk to doctors they will tell you, 'boy I am seeing a lot of flu for this time of year,'" he added.
(Editing by Eric Beech)
hat-tip GennieF
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - The first U.S. roll-out of vaccines against the new swine flu virus will be 3.4 million doses of MedImmune's nose spray, the Centers for Disease Control and Prevention said on Friday.
The CDC's Dr Jay Butler said the vaccines would be distributed the first week of October.
"Initially we anticipate that 3.4 million doses of vaccine will be available," Butler told a telephone briefing.
"We anticipate being able to start receiving orders for the vaccine by early October," Butler added. The U.S. government is providing the H1N1 vaccine for free to about 90,000 distributors, including doctor's offices, retail chains and state health departments.
"We estimate that the amount of vaccine that will be available will increase through October," Butler said, adding that eventually delivery would rise to about 20 million doses a week.
The United States has ordered 195 million doses of H1N1 swine flu vaccine from five companies -- MedImmune, a unit of AstraZeneca, Sanofi-Aventis, Australia's CSL, GlaxoSmithKline and Novartis.
It has recommended that about 160 million people, roughly half the population, get vaccinated first -- pregnant women, healthcare workers, children and people with chronic conditions such as diabetes or asthma who are most at risk of getting very ill from flu.
There is no enforcement of this, however, and it will be up to the people giving the vaccine to decide who goes first.
MedImmune's vaccine is not approved for people with asthma, people over age 50 or very young children, mostly because it has not yet been tested widely in these groups. State health officials say that might affect who gets the first doses.
Some of the other vaccines contain thimerosal, a preservative that scientists say is safe but which worries some people, and the state of Washington, for instance, says infants and pregnant women may not be given thimerosal-containing vaccines, another factor that could affect distribution.
MODERATE DISEASE
The CDC officials said they are racing to try to stay ahead of the virus, which is now active in all 50 states. It spread around the world to cause a pandemic within a few weeks in April and May.
"The flow of vaccine the first week or so may be slower than we like," Butler said.
So far, the virus is causing moderate disease, with a death rate similar to that seen in seasonal flu. Every year, seasonal influenza kills between 250,000 and 500,000 people globally and around 36,000 in the United States.
But H1N1 may infect far more people than seasonal flu does, because so few people have any immunity to it. It also causes symptoms in a far younger age group than does seasonal flu, which is worse among the elderly.
"We expect that if the H1N1 (virus) remains the predominate strain, that more younger people might be affected than we have seen in the past," the CDC's Dr Daniel Jernigan said.
"There is some increase in the rate of hospitalization for younger children and for adults, but it is not up at the levels that we would see for seasonal flu."
He said it was very unusual to have so much flu spreading this time of year in the United States. It is usually more common in the United States from January to March.
"It's about twice as much, at least for what we would expect this time of year," Jernigan told the briefing.
"If you talk to doctors they will tell you, 'boy I am seeing a lot of flu for this time of year,'" he added.
(Editing by Eric Beech)
hat-tip GennieF
WHO: Pandemic (H1N1) 2009 - update 66
Weekly update
In the temperate regions* of the northern hemisphere, influenza activity remains widely variable. In North America, the United States is reporting increases in influenza-like-illness activity above the seasonal baseline, most notably in the southern, southeastern, and parts of the northeastern United States.
In Canada, influenza activity remains low. In Europe and Central Asia influenza activity remains low overall, except in France, which is reporting increases in influenza-like-illness activity (for week 37) above the seasonal epidemic threshold. Geographically localized influenza activity is being reported in several countries (Austria, Georgia, Ireland, Luxembourg, Norway, Portugal, the Czech Republic, Cyprus, and Israel). In Japan, influenza activity remains stably increased above the seasonal epidemic threshold with the most notable increases being reported on the southern island of Okinawa.
In the tropical regions of the Americas and Asia, influenza transmission remains active. Geographically regional to widespread influenza activity continues to be reported throughout much of South and Southeast Asia, with increasing trends in respiratory diseases being reported in India and Bangladesh. Geographically regional to widespread influenza activity continues to be reported for the tropical regions of Central and South America without a consistent pattern in the trend of respiratory diseases (continued increases are being reported in Bolivia and Venezuela).
In the temperate regions* of the southern hemisphere, influenza activity continues to decrease or has returned to the seasonal baseline in most countries. In Australia, later affected areas are also now reporting declining levels of influenza-like-illness. In South Africa, influenza activity appears to have recently passed over the second peak (the first peak was due to seasonal influenza A (H3N2) and second peak was due to pandemic (H1N1) 2009).
WHO Collaborating Centres and other laboratories continue to report sporadic isolates of oseltamivir resistant influenza virus. Twenty six such virus isolates have now been described from around the world, all of which carry the same H275Y mutation that confers resistance to the antiviral oseltamivir but not to the antiviral zanamivir. Of these, 12 have been associated with post-exposure prophylaxis, five with long term oseltamivir treatment in patients with immunosuppression. Worldwide, over 10,000 clinical samples and isolates of the pandemic (H1N1) 2009 virus have been tested and found to be sensitive to oseltamivir. WHO will continue to monitor the situation closely in collaboration with its partners.
Pandemic (H1N1) influenza virus continues to be the predominant circulating influenza virus, both in the northern and southern hemisphere. See below for detailed laboratory surveillance update.
*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.
-snip-
Thursday, September 17, 2009
Egypt Confirmed H5N1 Cases
Listed by Age, Location, Onset Date and # confirmed by Min. of Health
- 34 yo Tanta, [Gharbia Gov.] April 21 #68
- 5 yo Tama [Sohag Gov.] May 7 #69
- 4.5 yo Kafr Saqr [Ash Sharqiyah Gov.] May 10 #70
- 4 yo Hashim, Mahalla [Gharbia Gov.] May 12 #71
- 4 yo Ghamr [Dakahlia Gov.] May 9 #72
- 4 yo Sherbin Dakahliy [Dakahlia Gov] May 18 #73
- 3 yo Sohag [Sohag Gov] May 17 #74
- 4 yo Hehia, [Ash Sharqiyah Gov.] May 24 #75
- 4 yo Abo Hammad (Ash Sharqiyah] May 23 #76
- 14 mos. Dekerness [Dakahlia Gov.] May 25 #77
- 4 yo El Sheikh [Ash Shaykh Gov.] May 30 #78
- 1.5 yo Albesartp [Damietta Gov.] June 1 #79
- 4 yo Maniya [Dakahlia Gov] June 5 #80
- 1 yo Kulain [Ash Shaykh Gov.] June 16 #81
- No Age Sidi Ghazi [Ash Shaykh Gov.] July 24 #82
- 1.6 yo Shebin [Menoufia Gov.] July 28 #83
- 2 yo Berket al-Saba [Menoufia Gov.] August 23 #84
- 14 yo Damietta [Damietta Gov.] August 21 #85
- No Age Halouasy Echmoun [Menoufia Gov.] Posted 9/13 #86
- 13yo Ascot Manor Montazah [Alexandria Gov.] September 3 #87
- 14 mos. Tahrer District [Beheira Gov.] September 23 #88
Egypt: "Health" announced on the incidence of 86 bird flu
Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health, the discovery of human cases of No. 86 from bird flu, a child named Solomon Solomon Radi, aged 13 years of estate management Ascot Park in Alexandria.
Shaheen said that the onset of symptoms in the patient was on 13 of the month, and went into a hospital issued the globe, which is suffering from a fever and sore throat after being exposed to birds suspected of being infected with bird flu, noting that once suspected to have bird flu been given Tamiflu, and his condition is stable.
وقال شاهين إن بداية ظهور الأعراض على المصاب كانت يوم 13 من الشهر الجارى ، دخل على إثرها مستشفى صدر المعمورة، وهو يعانى من ارتفاع فى درجة الحرارة والتهاب بالحلق عقب تعرضه لطيور نافقة يشتبه فى إصابتها بمرض أنفلونزا الطيور، لافتا إلى أنه فور الاشتباه فى إصابته بالمرض تم إعطاؤه عقار التاميفلو وحالته المرضية مستقرة.
Shaheen said that the onset of symptoms in the patient was on 13 of the month, and went into a hospital issued the globe, which is suffering from a fever and sore throat after being exposed to birds suspected of being infected with bird flu, noting that once suspected to have bird flu been given Tamiflu, and his condition is stable.
Flu experts gear up for pandemic of vaccine worry
September 16, 2009
By Maggie Fox, Health and Science Editor
WASHINGTON, Sept 16 (Reuters) - One million heart attacks, 700,000 strokes and 900,000 miscarriages -- U.S. public health officials want Americans to know these will happen every single year with or without a swine flu vaccine campaign.
Yet this year, they know a significant number will be blamed on the H1N1 vaccine, which will roll out within weeks, and they are struggling to be ready.
They expect an avalanche of so-called adverse event reports, which are reports of death, illness or other health trauma that occur within two weeks after receiving treatment -- in this case, the swine flu vaccine.
"We are going to be overwhelmed with potential events," said Mike Osterholm, a public health expert at the University of Minnesota.
"Anything that happens to anybody in the period of seven to 14 days after vaccination will be reported."
And not just to U.S. officials. The World Health Organization is trying to reassure a global audience that vaccines being made by 25 different companies, with various formulations, are all safe.
"If we have a safety signal in one country it could stop vaccination efforts in others," WHO's top flu expert Dr Keiji Fukuda told a meeting of infectious disease specialists organized by the U.S. Institute of Medicine this week.
Flu experts themselves have little doubt the vaccine being made against H1N1 is safe. It is made using precisely the same technology as the annual seasonal flu vaccine, which is given to hundreds of millions of people every year.
But because H1N1 is new, vaccine makers have been testing it to learn what the right dose is.
SPIRIT OF '76
Memories linger of the 1976 swine flu debacle, when 43 million Americans were vaccinated against a virus that never spread, and newspapers filled with reports of a rare and crippling neurological disease called Guillain-Barre syndrome.
Guillain-Barre was never definitively linked with the vaccine, but many Americans have viewed immunizations with suspicion ever since.
"We have anticipated that there will be a need for enhanced surveillance for Guillain-Barre as well as other adverse events," Dr Nancy Cox of the U.S. Centers for Disease Control and Prevention told the meeting.
And there will be more to contend with than critical newspaper and television reports. The Internet did not exist in 1976. Nor did blogs, Facebook, Twitter or dozens of other ways for people to communicate globally and instantly.
"Information is the most globalized product of all," Fukuda said. "The ability of blog sites to influence countries' decision-makers and so on -- coming to grips with how we deal with this is going to be a priority."
To address this, CDC and the U.S. Food and Drug Administration are gearing up for one of the biggest surveillance efforts ever. "We know how absolutely essential clear, transparent communications are to the public in order to have a successful vaccination campaign," Cox said.
CDC's weapons of choice -- Facebook, Twitter, Internet RSS feeds, humorous "viral" videos posted on YouTube, iPhone apps such as the CDC News Reader. Children's Hospital Boston has an an app (short for application) called Outbreaks Near Me that allows people to track the pandemic locally.
(Editing by Eric Beech)
Wednesday, September 16, 2009
CDC: Swine flu causing deadly lung infections like avian virus; vaccine OK'd
Autopsies show that he H1N1 swine flu virus is causing deep, fatal lung infections rarely seen in seasonal flu but common with the deadly avian strain, experts reported today.
Reuters tells us that "this virus is different from seasonal influenza, even if it has not yet caused more deaths."
Tests on about 100 Americans who have died from swine flu virus found that they had infections deep in their lungs, which caused acute respiratory distress syndrome. Often fatal, it fills the air sacs with fluid, starves the blood of oxygen and leaves patients gasping for breath. Basically, patients suffocate or drown.
Unlike seasonal flu, the H1N1 virus frequently causes severe problems in younger adults and children.
"This is almost exactly what we see with avian flu. This looks like avian flu on steroids," Dr. Sherif Zaki of the U.S. Centers for Disease Control and Prevention told flu experts meeting in Washington.
Other findings:
• 90% of those killed by the virus had an underlying condition that made them susceptible to serious diseases.
• The median age was 38. One victim was 2 months old who died a day after becoming ill.
• 46% were obese; 27% had heart disease; 22% had asthma, and many had fatty liver disease.
Separately, several new studies suggest that people infected with the swine flu virus are contagious longer — up to a week — than those suffering seasonal flu.
So far, the World Health Organization has confirmed 3,205 deaths globally from swine flu. Experts say, however, that all estimates are grossly understated because so few patients are ever tested for the H1N1 virus.
Worldwide, seasonal flu kills about 250,000 to 500,000 people a year.
Also today, the Food and Drug Administration approved the new swine flu vaccine, clearing the way for vaccinations to begin next month.
Health and Human Services Secretary Kathleen Sebelius announced the approval during a congressional hearing. She said the bulk of the vaccine, which is being produced by four firms, will start arriving Oct. 15 and should be available at 90,000 sites nationwide.
Read the FDA's news release.
hat-tip Treyfish
Reuters tells us that "this virus is different from seasonal influenza, even if it has not yet caused more deaths."
Tests on about 100 Americans who have died from swine flu virus found that they had infections deep in their lungs, which caused acute respiratory distress syndrome. Often fatal, it fills the air sacs with fluid, starves the blood of oxygen and leaves patients gasping for breath. Basically, patients suffocate or drown.
Unlike seasonal flu, the H1N1 virus frequently causes severe problems in younger adults and children.
"This is almost exactly what we see with avian flu. This looks like avian flu on steroids," Dr. Sherif Zaki of the U.S. Centers for Disease Control and Prevention told flu experts meeting in Washington.
Other findings:
• 90% of those killed by the virus had an underlying condition that made them susceptible to serious diseases.
• The median age was 38. One victim was 2 months old who died a day after becoming ill.
• 46% were obese; 27% had heart disease; 22% had asthma, and many had fatty liver disease.
Separately, several new studies suggest that people infected with the swine flu virus are contagious longer — up to a week — than those suffering seasonal flu.
So far, the World Health Organization has confirmed 3,205 deaths globally from swine flu. Experts say, however, that all estimates are grossly understated because so few patients are ever tested for the H1N1 virus.
Worldwide, seasonal flu kills about 250,000 to 500,000 people a year.
Also today, the Food and Drug Administration approved the new swine flu vaccine, clearing the way for vaccinations to begin next month.
Health and Human Services Secretary Kathleen Sebelius announced the approval during a congressional hearing. She said the bulk of the vaccine, which is being produced by four firms, will start arriving Oct. 15 and should be available at 90,000 sites nationwide.
Read the FDA's news release.
hat-tip Treyfish
Swine flu deaths show this flu is different: experts
Tue Sep 15, 2009 3:17pm
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Autopsies on people who have died from the new pandemic H1N1 flu show this virus is different from seasonal influenza, even if it has not yet caused more deaths, experts told a meeting on Tuesday.
Americans who died from swine flu had infections deep in their lungs, Dr. Sherif Zaki of the U.S. Centers for Disease Control and Prevention told a meeting of flu experts, including damage to the alveoli -- the structures in the lung that deliver oxygen to the blood.
This in turn caused what is known as acute respiratory distress syndrome -- an often fatal development that leaves patients gasping for breath.
The World Health Organization has confirmed 3,205 deaths globally from swine flu but experts agree all estimates of the extent of the pandemic are grossly understated because so few patients are ever actually tested.
Seasonal flu kills, too -- about 250,000 to 500,000 cases a year globally, according to the WHO. But not in the same way as swine flu, which unlike seasonal flu frequently causes severe disease in young adults and children.
"It is very rarely you see what we call diffuse alveolar damage in fatal seasonal influenza," Zaki told a meeting sponsored by the U.S. Institute of Medicine, which advises government on health matters.
Seasonal flu causes bronchitis and other upper respiratory disease. But Zaki, the chief infectious disease pathologist at CDC, said the new virus had burrowed into the lungs of the 90 or so people he examined after they died, and they had huge amounts of the virus in their blood.
"This is almost exactly what we see with avian flu," Zaki said. "This looks like avian flu on steroids."
EXPERIMENTAL DRUGS
Dr. Yoshi Kawaoka of the University of Wisconsin said tests in monkeys showed the virus lives and replicates 1,000-fold better in the lungs than does seasonal flu.
He said the No. 1 drug of choice against H1N1 -- Roche AG's and Gilead Sciences Inc's Tamiflu -- lowered the so-called viral load of virus in the lungs just enough to help the body fight back.
Experimental flu drugs lower it even more, notably Daiichi Sankyo Co Ltd's CS 8958 and another drug called T-705 or favipiravir, made by Fujifilm Holdings Corp unit Toyama Chemical Co, Kawaoka said.
Zaki said 90 percent of the fatalities he looked at had some condition that would predispose them to serious disease. They had a median age of 38 and one victim was a two-month-old infant who died within a day of getting sick.
Nearly half -- 46 percent -- were obese, many had fatty liver disease, 27 percent had heart disease and 22 percent had asthma, he said.
Dr. Guillermo Ruiz-Palacios of Mexico's National Institute of Medical Sciences and Nutrition said many Mexican patients with severe disease were also obese. In addition, patients came in late for treatment and many were infected with a second common virus, called parainfluenza virus.
Fewer than a third of the U.S. deaths, 29 percent, had a so-called secondary bacterial infection, usually Streptococcus pneumoniae, Zaki said.
Ruiz-Palacios also said the new virus can be found in the urine and feces of patients, something that may affect how it spreads.
(Editing by Cynthia Osterman)
hat-tip Pathfinder
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Autopsies on people who have died from the new pandemic H1N1 flu show this virus is different from seasonal influenza, even if it has not yet caused more deaths, experts told a meeting on Tuesday.
Americans who died from swine flu had infections deep in their lungs, Dr. Sherif Zaki of the U.S. Centers for Disease Control and Prevention told a meeting of flu experts, including damage to the alveoli -- the structures in the lung that deliver oxygen to the blood.
This in turn caused what is known as acute respiratory distress syndrome -- an often fatal development that leaves patients gasping for breath.
The World Health Organization has confirmed 3,205 deaths globally from swine flu but experts agree all estimates of the extent of the pandemic are grossly understated because so few patients are ever actually tested.
Seasonal flu kills, too -- about 250,000 to 500,000 cases a year globally, according to the WHO. But not in the same way as swine flu, which unlike seasonal flu frequently causes severe disease in young adults and children.
"It is very rarely you see what we call diffuse alveolar damage in fatal seasonal influenza," Zaki told a meeting sponsored by the U.S. Institute of Medicine, which advises government on health matters.
Seasonal flu causes bronchitis and other upper respiratory disease. But Zaki, the chief infectious disease pathologist at CDC, said the new virus had burrowed into the lungs of the 90 or so people he examined after they died, and they had huge amounts of the virus in their blood.
"This is almost exactly what we see with avian flu," Zaki said. "This looks like avian flu on steroids."
EXPERIMENTAL DRUGS
Dr. Yoshi Kawaoka of the University of Wisconsin said tests in monkeys showed the virus lives and replicates 1,000-fold better in the lungs than does seasonal flu.
He said the No. 1 drug of choice against H1N1 -- Roche AG's and Gilead Sciences Inc's Tamiflu -- lowered the so-called viral load of virus in the lungs just enough to help the body fight back.
Experimental flu drugs lower it even more, notably Daiichi Sankyo Co Ltd's CS 8958 and another drug called T-705 or favipiravir, made by Fujifilm Holdings Corp unit Toyama Chemical Co, Kawaoka said.
Zaki said 90 percent of the fatalities he looked at had some condition that would predispose them to serious disease. They had a median age of 38 and one victim was a two-month-old infant who died within a day of getting sick.
Nearly half -- 46 percent -- were obese, many had fatty liver disease, 27 percent had heart disease and 22 percent had asthma, he said.
Dr. Guillermo Ruiz-Palacios of Mexico's National Institute of Medical Sciences and Nutrition said many Mexican patients with severe disease were also obese. In addition, patients came in late for treatment and many were infected with a second common virus, called parainfluenza virus.
Fewer than a third of the U.S. deaths, 29 percent, had a so-called secondary bacterial infection, usually Streptococcus pneumoniae, Zaki said.
Ruiz-Palacios also said the new virus can be found in the urine and feces of patients, something that may affect how it spreads.
(Editing by Cynthia Osterman)
hat-tip Pathfinder
Tuesday, September 15, 2009
Swine Flu That Resists Tamiflu Is Harder to Spread, WHO Says
By Michelle Fay Cortez
Sept. 15
(Bloomberg) -- Swine flu that can resist treatment with Roche Holding AG’s Tamiflu is also harder to spread to other people, according to World Health Organization officials.
Almost two dozen people have developed swine flu infections that don’t respond to Tamiflu, a mainstay of therapy for the outbreak that began in April. The genetic mutation that helps the virus evade the drug also thwarts its transmission, so the infection isn’t passed on to other patients, said David Mercer, acting head of the communicable diseases unit of the WHO’s European region.
“It’s a very specific genetic mutation that causes resistance and reduces the transmissibility of the virus, so it’s not infectious,” Mercer said in an interview in Copenhagen, where the WHO’s European governing body met this week.
The findings may reassure public health officials worried that overuse of Tamiflu would render impotent one of the key weapons against the pandemic virus. Some countries, including the U.K., took an aggressive approach to controlling the outbreak when it first arrived at the end of April, giving Tamiflu to people who had come into contact with pandemic flu patients to slow the spread of the disease.
For patients with seasonal influenza that doesn’t respond to Tamiflu, the only treatment option is GlaxoSmithKline Plc’s inhaled drug Relenza. Reducing therapies for the pandemic outbreak, caused by a novel combination of avian, swine and human influenza, could be disastrous if the virus, formally known as H1N1, turns more deadly, Mercer said. Flu patients who are otherwise healthy and without serious complications shouldn’t get Tamiflu, he said.
Viruses Change
“Healthy patients with uncomplicated illness don’t need antivirals,” Mercer said. “Viruses do change and evolution is unpredictable. Seasonal influenza is almost entirely resistant. Overuse of Tamiflu could result in the same thing” for swine flu, he said.
The WHO has been too firm on its advice to not treat patients with uncomplicated infections, said Liam Donaldson, England’s chief medical officer. About 40 percent of deaths occur among previously healthy people, and treatment is most effective when given early, before it’s clear whether the infection is complicated, he said.
“Some people will die” if left untreated, Donaldson said. “To regard them as inevitable statistical occurrences doesn’t go down well. We have these antivirals and we know they can have an impact.”
52,000 Cases
There have been more than 52,000 confirmed cases across 48 countries in Europe, including at least 140 deaths, Mercer said. Almost 90 percent of the deaths occurred in the U.K., Spain and Israel, he said.
There have been 23 cases of resistance developing to Tamiflu, Mercer said. Twelve of them were healthy people who had encountered swine flu patients, and were given Tamiflu in an effort to prevent the infection from taking hold, he said. Four or five others were healthy patients who had mild infections.
“The good news is that the resistant strains haven’t been transmissible to others,” Mercer said. “It’s not infecting anyone else.”
To contact the reporter on this story: Michelle Fay Cortez in London at mcortez@bloomberg.net
Last Updated: September 15, 2009 11:00 EDT
hat-tip Treyfish
Sept. 15
(Bloomberg) -- Swine flu that can resist treatment with Roche Holding AG’s Tamiflu is also harder to spread to other people, according to World Health Organization officials.
Almost two dozen people have developed swine flu infections that don’t respond to Tamiflu, a mainstay of therapy for the outbreak that began in April. The genetic mutation that helps the virus evade the drug also thwarts its transmission, so the infection isn’t passed on to other patients, said David Mercer, acting head of the communicable diseases unit of the WHO’s European region.
“It’s a very specific genetic mutation that causes resistance and reduces the transmissibility of the virus, so it’s not infectious,” Mercer said in an interview in Copenhagen, where the WHO’s European governing body met this week.
The findings may reassure public health officials worried that overuse of Tamiflu would render impotent one of the key weapons against the pandemic virus. Some countries, including the U.K., took an aggressive approach to controlling the outbreak when it first arrived at the end of April, giving Tamiflu to people who had come into contact with pandemic flu patients to slow the spread of the disease.
For patients with seasonal influenza that doesn’t respond to Tamiflu, the only treatment option is GlaxoSmithKline Plc’s inhaled drug Relenza. Reducing therapies for the pandemic outbreak, caused by a novel combination of avian, swine and human influenza, could be disastrous if the virus, formally known as H1N1, turns more deadly, Mercer said. Flu patients who are otherwise healthy and without serious complications shouldn’t get Tamiflu, he said.
Viruses Change
“Healthy patients with uncomplicated illness don’t need antivirals,” Mercer said. “Viruses do change and evolution is unpredictable. Seasonal influenza is almost entirely resistant. Overuse of Tamiflu could result in the same thing” for swine flu, he said.
The WHO has been too firm on its advice to not treat patients with uncomplicated infections, said Liam Donaldson, England’s chief medical officer. About 40 percent of deaths occur among previously healthy people, and treatment is most effective when given early, before it’s clear whether the infection is complicated, he said.
“Some people will die” if left untreated, Donaldson said. “To regard them as inevitable statistical occurrences doesn’t go down well. We have these antivirals and we know they can have an impact.”
52,000 Cases
There have been more than 52,000 confirmed cases across 48 countries in Europe, including at least 140 deaths, Mercer said. Almost 90 percent of the deaths occurred in the U.K., Spain and Israel, he said.
There have been 23 cases of resistance developing to Tamiflu, Mercer said. Twelve of them were healthy people who had encountered swine flu patients, and were given Tamiflu in an effort to prevent the infection from taking hold, he said. Four or five others were healthy patients who had mild infections.
“The good news is that the resistant strains haven’t been transmissible to others,” Mercer said. “It’s not infecting anyone else.”
To contact the reporter on this story: Michelle Fay Cortez in London at mcortez@bloomberg.net
Last Updated: September 15, 2009 11:00 EDT
hat-tip Treyfish
Monday, September 14, 2009
Studies: Swine flu spreads long after fever stops
Graphic shows a timeline of how doctors believe the swine flu progresses during its contagious phase (J. Bell - AP)
| |
By MARILYNN MARCHIONE
The Associated PressMonday, September 14, 2009; 6:30 PM
SAN FRANCISCO -- When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away.
The federal Centers for Disease Control and Prevention has been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer - especially at home where the risk of spreading the germ is highest.
Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said.
"This study shows you're not contagious for a day or two. You're probably contagious for about a week," said Gaston De Serres, a scientist at the Institute of Public Health in Quebec.
He presented one of the studies Monday at an American Society for Microbiology conference. It is the first big meeting of infectious disease experts since last spring's emergence of swine flu, which now accounts for nearly all of the flu cases in the United States. More than 1 million Americans have been infected and nearly 600 have died from it, the CDC estimates.
It is unclear whether the new research will lead the CDC to rethink its advice on how long people with swine flu should hole up. Long breaks from school and work do not seem worth it for a virus that now seems to cause mostly mild illness, said the CDC's flu chief, Nancy Cox. Swine flu is spreading so widely now that confining the sick does less good, she said.
"We tried to have our guidance balance out all of these factors," she said. "It's just virtually impossible not to have virus introduced into settings such as schools and universities."
Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug.
"It's probably realistic that this virus sheds much longer than seasonal flu," said Dr. Jonathan McCullers, an infectious diseases specialist at St. Jude Children's Research Hospital in Memphis, Tenn.
Three reports suggest this is so. De Serres and other researchers in Canada took nose and throat swabs from 43 patients with lab-confirmed flu and dozens of other sick family members.
On the eighth day after symptoms first appeared, 19 to 75 percent showed signs of virus remaining in their noses, depending on the type of test used.
"This proportion appears to be very big, and it is," but it's not clear how much virus is needed to actually spread flu, so the lower number is more reliable, he said.
-snip- [click on title for full article]
Cautious optimism regarding recent tests of swine flu vaccine
From Scott McPherson's Web Presence
Posted on Friday, September 11, 2009 at 03:24PM by Registered CommenterScott McPherson in Politics and government, influenza and infectious diseases | Comments1 Comment
The newspapers are positively aglow with the recent studies which seem to indicate the H1N1/2009, (aka swine flu) vaccine can confer immunity with one shot, and after only ten days. And justifiably so! For the news is good.
Previously, scientists and researchers postulated that it would take two jabs, spaced three weeks apart, in order to deliver enough attenuated inert virus to confer immunity to swine flu.
So this study, on the surface, is decidedly good news. The ramifications of this are nothing short of spectacular. First, it means the entire seed virus-to-vaccine chain performed surprisingly well and was also surprisingly nimble. As you recall, initial seed virus stock was very slow to grow, and the CDC and WHO had to whip up a faster-growing batch of seed virus stock to send to vaccine manufacturers.
Second, there had to be enough eggs, and those eggs had to be free of cross-contamination. So as Earl Butz, late of this earth and the Ford Administration famously said, the roosters of America did their duty.
It also means very little virus "drifted" during manufacturing, and it speaks volumes about the research and quality control that the vaccine industry has undertaken since the debacle of 2004-05's flu season. For more information and a superb primer on vaccine manufacture, read the book "A Warning Shot: Influenza and the 2004 Flu Vaccine,"by Timothy Brookes and the staff at Johns Hopkins.
The US government ordered 195 million doses of the new H1N1/2009 monovalent vaccine. The calculus performed was that most Americans would need two jabs, as I said earlier. Now if these initial test results hold firm, it means we will now have double the available vaccine than we thought we had a month ago.
The projected available vaccine doses equals 62% of the American population. I dare say that if we were to vaccinate everyone in the high-risk groups, plus virtually all school-age children under 25, we stand a very good chance of reaching the Holy Grail of Herd Immunity. Herd Immunity is when enough people are vaccinated against a virus, that virus can no longer gain a beachhead in a community. It fails to achieve the critical mass necessary to sustain human-to-human transmission. Herd Immunity means the virus cannot infect enough hosts in a chain, and the chain breaks. Think a viral chain mail/email scheme that breaks due to unwilling participants.
Same thing: The virus' chain of transmission is broken when enough people are vaccinated, predominantly the young. It is the young -- schoolchildren and college students -- who pass this virus (and all flus) on to their family members and then on to the community at large. You break that chain, you break the pandemic.
So the Quest for Herd Immunity against a pandemic virus is within the reach of Americans. It decidedly does not mean the same for persons within developing nations, however. And I would not be the least bit surprised if persons such as Supari of Indonesia and others begin clamoring for vaccines, since everyone thought it would take two jabs anyway. It might be appropriate for the favored nations to siphon off some of their vaccine to the WHO for use in developing nations.
Even if we were to siphon off some vaccine, the goal of herd immunity against H1N1/2009 could be within reach. Let us hope that the final test reports confirm the initial speculation. We could use some good news now!
Posted on Friday, September 11, 2009 at 03:24PM by Registered CommenterScott McPherson in Politics and government, influenza and infectious diseases | Comments1 Comment
The newspapers are positively aglow with the recent studies which seem to indicate the H1N1/2009, (aka swine flu) vaccine can confer immunity with one shot, and after only ten days. And justifiably so! For the news is good.
Previously, scientists and researchers postulated that it would take two jabs, spaced three weeks apart, in order to deliver enough attenuated inert virus to confer immunity to swine flu.
So this study, on the surface, is decidedly good news. The ramifications of this are nothing short of spectacular. First, it means the entire seed virus-to-vaccine chain performed surprisingly well and was also surprisingly nimble. As you recall, initial seed virus stock was very slow to grow, and the CDC and WHO had to whip up a faster-growing batch of seed virus stock to send to vaccine manufacturers.
Second, there had to be enough eggs, and those eggs had to be free of cross-contamination. So as Earl Butz, late of this earth and the Ford Administration famously said, the roosters of America did their duty.
It also means very little virus "drifted" during manufacturing, and it speaks volumes about the research and quality control that the vaccine industry has undertaken since the debacle of 2004-05's flu season. For more information and a superb primer on vaccine manufacture, read the book "A Warning Shot: Influenza and the 2004 Flu Vaccine,"by Timothy Brookes and the staff at Johns Hopkins.
The US government ordered 195 million doses of the new H1N1/2009 monovalent vaccine. The calculus performed was that most Americans would need two jabs, as I said earlier. Now if these initial test results hold firm, it means we will now have double the available vaccine than we thought we had a month ago.
The projected available vaccine doses equals 62% of the American population. I dare say that if we were to vaccinate everyone in the high-risk groups, plus virtually all school-age children under 25, we stand a very good chance of reaching the Holy Grail of Herd Immunity. Herd Immunity is when enough people are vaccinated against a virus, that virus can no longer gain a beachhead in a community. It fails to achieve the critical mass necessary to sustain human-to-human transmission. Herd Immunity means the virus cannot infect enough hosts in a chain, and the chain breaks. Think a viral chain mail/email scheme that breaks due to unwilling participants.
Same thing: The virus' chain of transmission is broken when enough people are vaccinated, predominantly the young. It is the young -- schoolchildren and college students -- who pass this virus (and all flus) on to their family members and then on to the community at large. You break that chain, you break the pandemic.
So the Quest for Herd Immunity against a pandemic virus is within the reach of Americans. It decidedly does not mean the same for persons within developing nations, however. And I would not be the least bit surprised if persons such as Supari of Indonesia and others begin clamoring for vaccines, since everyone thought it would take two jabs anyway. It might be appropriate for the favored nations to siphon off some of their vaccine to the WHO for use in developing nations.
Even if we were to siphon off some vaccine, the goal of herd immunity against H1N1/2009 could be within reach. Let us hope that the final test reports confirm the initial speculation. We could use some good news now!
CIDRAP Summit represents last chance to get H1N1-ready
Computerworld Blogs
September 10, 2009 - 9:35 A.M.
September 10, 2009 - 9:35 A.M.
Contrary to what you might think from the press, I do not believe the second wave of swine flu/H1N1(2009) is here yet. Sure, we are seeing another spike in cases, and new deaths, but it is too early to tell if this is the end of the first wave or the beginning of the second wave.
One thing is for sure: A second wave is coming, and it threatens to wash over the United States like a tsunami. It will make the spring and summer look mild in comparison. It does not have to mutate to do this; all it has to do is do its stuff.
And still, businesses, corporations and governments are not fully prepared to deal with the multitude of issues that this pandemic will present. You can never be too well-briefed, or over-briefed on this emerging phenomenon, and opportunities are very rare to attend conferences aimed at getting business, industry and government ready.
So the upcoming CIDRAP Summit is fortuitously-timed. CIDRAP stands for the Center for Infectious Disease Research and Policy at the University of Minnesota. Its director is the world-famous Dr. Michael Osterholm. Dr. Osterholm advises everyone from the White House to Oprah on infectious disease, and Dr. Mike is also an expert on bioterrorism.
The upcoming summit is titled "Keeping the World Working During the H1N1 Pandemic -- protecting employee health, critical operations and customer relations." Its focus is on those final steps that corporations, businesses and governments need to take to ensure they do not implode when the second and third waves of H1N1 traverse the globe.
The Summit is September 22 and 23, 2009, in Minneapolis.
I need to disclose that I am both a friend of Dr. Osterholm and a presenter at the Summit. I am presenting (twice) on the topic of final IT preps for the pandemic. As you know, I have been pounding this message of IT pandemic preparation since 2006, on my own site, www.scottmcpherson.net. I have been preaching on this since 2008 here at Computerworld. I have been doing this because I do not wish to see any IT failures associated with this pandemic. I also have a rather uncanny ability to predict what future events will be causing IT professionals grief, which I hope to somehow parlay into picking six winning numbers someday.
But I digress. Please go up onto the Summit's Website and try to attend this event. Or try and send people to this conference. Think "Last Chance for Gas" just before you drive through the desert.
This conference truly is the Last Chance for Preps before Wave 2 hits.
Sunday, September 13, 2009
Egypt: Proved positive case of bird flu Ashmoon
Sunday, September 13th, 2009 - 14:20
Directorate of Veterinary Medicine has received a notice of certified Menoufia positive case of bird flu infected suspicions of a person called HA Abdullah, a village resident Halouasy Echmoun city, which has been taken a blood sample to be sent to laboratories in Cairo, the ministry statement to be positive or not.
صرح الدكتور أحمد فؤاد مدير عام الطب البيطرى أنه ثبت إيجابية الحالة وتم على الفور التعامل مع الحالة وإعطاؤها العلاج المناسب وإعدام جميع الطيور الموجودة بمنزله وعمل كردون صحى على المنطقة المحيطة به وإعدامها ومتابعة جميع أفراد عائلته لمدة 10 أيام.
Dr. Ahmed Fouad, General Manager of Veterinary Medicine have proved positive case was immediately deal with the situation and given appropriate treatment and culling all birds in his home and the work of cordon sanitaire surrounding area, and execution and follow-up of all members of his family for 10 days.
Directorate of Veterinary Medicine has received a notice of certified Menoufia positive case of bird flu infected suspicions of a person called HA Abdullah, a village resident Halouasy Echmoun city, which has been taken a blood sample to be sent to laboratories in Cairo, the ministry statement to be positive or not.
صرح الدكتور أحمد فؤاد مدير عام الطب البيطرى أنه ثبت إيجابية الحالة وتم على الفور التعامل مع الحالة وإعطاؤها العلاج المناسب وإعدام جميع الطيور الموجودة بمنزله وعمل كردون صحى على المنطقة المحيطة به وإعدامها ومتابعة جميع أفراد عائلته لمدة 10 أيام.
Dr. Ahmed Fouad, General Manager of Veterinary Medicine have proved positive case was immediately deal with the situation and given appropriate treatment and culling all birds in his home and the work of cordon sanitaire surrounding area, and execution and follow-up of all members of his family for 10 days.
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