CDC: Pneumonia and Influenza Hospitalization and Death Tracking Chart

Pneumonia and Influenza Hospitalization and Death Tracking:

This new system was implemented on August 30, 2009, and replaces the weekly report of laboratory confirmed 2009 H1N1-related hospitalizations and deaths that began in April 2009. Jurisdictions can now report to CDC either laboratory confirmed or pneumonia and influenza syndromic-based counts of hospitalizations and deaths resulting from all types or subtypes of influenza, not just those from 2009 H1N1 influenza virus. To allow jurisdictions to implement the new case definition, counts were reset to zero on August 30, 2009. From August 30 – October 24, 2009, 12,466 laboratory-confirmed influenza associated hospitalizations, 530 laboratory-confirmed influenza associated deaths, 25,985 pneumonia and influenza syndrome-based hospitalizations, and 2,916 pneumonia and influenza syndrome-based deaths, were reported to CDC. CDC will continue to use its traditional surveillance systems to track the progress of the 2009-10 influenza season.

Children’s Swine Flu Deaths in U.S. Rise 20% to 114

Oct. 30 (Bloomberg) -- Swine flu has killed 114 children in the U.S. since the outbreak surfaced in April, including 19 reported in the week from Oct. 18 to Oct. 24, the Centers for Disease Control and Prevention said today on its Web site.

The death rate for children rose 20 percent from the 95 children killed by the virus, also known as H1N1 influenza, reported Oct. 23 by the CDC. Swine flu killed 530 people from Aug. 30 to Oct. 24 and accounted for 12,466 hospitalizations, according to the Atlanta-based agency’s Web site. The mortality data come from 28 states.

“We know this is an underestimate,” said CDC Director Thomas Frieden at a press briefing today, noting that 36,000 people typically die from flu in a season. He said he hopes more accurate data will be available soon.

H1N1 flu targets young adults and children in greater numbers than other population groups, CDC says. People ages 6 months to 24 years are among the highest priority groups for getting the swine flu vaccine, according to the agency’s guidelines.

“This is very unsettling news for parents, particularly when coupled with the shortage of the vaccine,” said Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University in New York and a professor of clinical public health and pediatrics at the university’s Mailman School of Public Health. “The situation is much more fluid and uncertain than the government expected and than the public is comfortable with.”

26.6 Million Doses

The U.S. government had 26.6 million doses of swine flu vaccine for delivery as of today, Frieden said. This is 2.4 million to 3.4 million doses short of what the Atlanta-based agency estimated would be available by the end of this month for states to send to local doctors, hospitals and clinics.

States have reported receiving fewer doses of vaccine than they expected. Shortages have generated long lines at public clinics, canceled plans for mass vaccinations and left private physicians questioning when they’ll get a supply for patients.

“We recognize states have real challenges to balance the increasing supply with the large demand,” he said.

Sanofi-Aventis SA has delivered 14.4 million doses to the U.S. as of this week, Wayne Pisano, head of the drugmaker’s vaccine business, said in an interview today. The Paris-based company agreed to sell the U.S. 75 million doses and will deliver the balance by the end of the year, Pisano said.

Novartis AG, the largest U.S. supplier of the H1N1 vaccine, has shipped more than 7.5 million doses and will deliver a further 17 million to 22 million by the end of November, the company said in an e-mailed statement.

President ‘Frustrated’

President Barack Obama is “frustrated” by delays and shortages, White House press secretary Robert Gibbs said today. Obama declared swine flu a national emergency on Oct. 24. The CDC’s Frieden said Obama is “deeply concerned.”

“He’s directly involved, briefed regularly and making sure are doing everything we possibly can,” Frieden said.

The U.S. released an additional 234,000 bottles of liquid Tamiflu, depleting the national stockpile of the antiviral produced by Roche Holding AG, Frieden said. The U.S. had already made available 300,000 bottles on Oct. 1 to the states for use in treating patients infected with the H1N1 virus.

Total pediatric deaths from influenza, including those not confirmed as H1N1, rose to 127 since April 26, the CDC reported on its Web site. The 19 deaths of children from confirmed swine flu in the week that ended Oct. 24 was the largest since the flu first surfaced in April. Overall 2,916 Americans have died from influenza and pneumonia and there have been 25,985 hospitalizations reported to the CDC.

Swine flu may have infected as many as 5.7 million people from April through July in an initial wave of the virus that swept across the U.S., researchers at the CDC and Harvard School of Public Health said yesterday.

To contact the reporter on this story: Pat Wechsler in New York at pwechsler@bloomberg.net

CDC: Weekly H1N1 Update Statistics & Charts

Note: Please take note of the dates of each chart...I have highlighted them.

Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-2009 and Previous Two Seasons
(Posted October 23, 2009, 5:30 PM ET, for Week Ending October 17, 2009)




U.S. Influenza and Pneumonia-Associated Hospitalizations
and Deaths from August 30 to October 24, 2009
Posted October 30, 2009, 11:00 AM ET
Data reported to CDC by October 27, 2009, 12:00 AM ET



U.S. Influenza-associated Pediatric Mortality
Posted October 30, 2009 (Updated each Friday)
Data reported to CDC by October 24, 2009

Young mom's death exposes H1N1 dangers

THE TENNESSEAN • October 30, 2009

The night before Jamie Loveless got sick, she ate at a little pizza place in Madeira Beach, Fla., with her family. She walked along the boardwalk, visited the shops and had some ice cream.

She had been running a low fever off and on all week, but it seemed like nothing to be concerned about.

Still, when she woke up feeling achy on Friday morning, it seemed like skipping the beach to rest would be best.

Saturday afternoon, Jamie Loveless, 27, was admitted to St. Petersburg General Hospital with pneumonia that doctors said probably developed from the H1N1 virus. The illness attacked her lungs and escalated rapidly.

At 2:30 p.m. Thursday, the mother from Middle Tennessee died, leaving behind her husband, Chris, her 9-month-old son, Gavin, and a lot of disbelief.

"This is the most serious thing I have ever seen," said Mary Loveless, Jamie's mother-in-law. "It's unbelievable to me how quickly it went from a minor cough and fever to completely overwhelming her body.

"It affected her liver, it affected her kidneys, it affected her lungs, and in the end it destroyed her heart."

According to the state health department, Tennessee has had 38 H1N1-related deaths: 29 adults and nine children. That doesn't include residents who died outside of the state. By comparison, about 700 Tennesseans die annually from the seasonal flu.

Flu activity is widespread in 46 states, according to the Centers for Disease Control. Because H1N1 — also known as swine flu — is a pandemic virus, it can come in waves, off and on, for up to two years.

It is different from the seasonal flu because it hits hardest in younger populations, particularly in children and pregnant women.

While most of the people who have died have had underlying health complications, about 20 percent of H1N1 deaths are in healthy people, according to the CDC.

Autopsies have shown that in cases involving healthy people, the flu often turned into a bacterial pneumonia that led to death.

Hope was short-lived

Mary Loveless said Jamie was a healthy, happy mother and wife. She ate well, took care of herself, and experienced nothing that would indicate that the H1N1 virus would compromise her health.

Two weekends ago, the Lovelesses traveled home to Indiana to visit family. Mary Loveless thinks that's where Jamie picked up the H1N1 virus. None of the family had been vaccinated because it wasn't available.

"A whole bunch of us got sick," Mary Loveless said. "But we just ran a little fever and then we were OK. Except for Jamie."

Chris and Jamie met in Indiana. Both from Mooresville — a town of just over 10,000 — they were high school sweethearts. They went to college together in Michigan, then moved to Tennessee.

The birth of their son inspired new changes, and the couple bought their first home in Nolensville a month ago.

Experts advise WHO on pandemic vaccine policies and strategies

Pandemic (H1N1) 2009 briefing note 14

30 OCTOBER 2009 | GENEVA -- The Strategic Advisory Group of Experts (SAGE) on Immunization, which advises WHO on policies and strategies for vaccines and immunization, devoted a session of its 27–29 October meeting to pandemic influenza vaccines. The experts reviewed the current epidemiological situation of the pandemic worldwide and considered issues and options from a public health perspective.

Items on the agenda included the status of vaccine availability, results from clinical trials on vaccine immunogenicity, and early results from safety monitoring in countries where administration of the H1N1 pandemic vaccine is currently under way.

The experts also advised WHO on the number of doses of vaccine needed to confer protection, also in different age groups, the co-administration of seasonal and pandemic vaccines, and vaccines for use in pregnant women. Recommendations on the formulation of seasonal influenza vaccines for the southern hemisphere in 2010 were also provided.

Current situation

Globally, teenagers and young adults continue to account for the majority of cases, with rates of hospitalization highest in very young children. Between 1% to 10% of patients with clinical illness require hospitalization. Of hospitalized patients, from 10% to 25% require admission to an intensive care unit, and from 2% to 9% have a fatal outcome.

Overall, from 7% to 10% of all hospitalized patients are pregnant women in their second or third trimester of pregnancy. Pregnant women are ten times more likely to need care in an intensive care unit when compared with the general population.

Based on these and other current findings, the experts made a number of recommendations.

Single dose recommended

The experts noted that a variety of pandemic vaccines, including live attenuated and both adjuvanted and non-adjuvanted inactivated vaccines, have now been licensed for use by regulatory authorities. SAGE recommended the use of a single dose of vaccine in adults and adolescents, beginning at the age of 10 years, provided such use is consistent with indications from regulatory authorities.

Data on immunogenicity in children older than 6 months and younger than 10 years are limited and more studies are needed. Where national authorities have made children a priority for early vaccination, SAGE recommended that priority be given to the administration of one dose of vaccine to as many children as possible. SAGE further stressed the need for studies to determine dosage regimens effective in immunocompromised persons.

Co-administration of vaccines

Clinical trials investigating the co-administration of seasonal and pandemic vaccines are ongoing, but SAGE acknowledged the recommendation, from the US Centers for Disease Control and Prevention, that live attenuated seasonal and live attenuated pandemic vaccines should not be co-administered.

The experts recommended that seasonal and pandemic vaccines can be administered simultaneously, provided both vaccines are inactivated, or one is inactivated and the other is live attenuated. The experts found no evidence that co-administration of vaccines, as recommended, would increase the risk of adverse events.

Vaccine safety

The experts reviewed early results from the monitoring of people who have received pandemic vaccines and found no indication of unusual adverse reactions. Some adverse events following vaccination have been notified, but these are well within the range of those seen with seasonal vaccines, which have an excellent safety profile. Although early results are reassuring, monitoring for adverse events should continue.

Vaccines for pregnant women

Concerning vaccines for pregnant women, SAGE noted that studies in experimental animals using live attenuated vaccines and non-adjuvanted or adjuvanted inactivated vaccines found no evidence of direct or indirect harmful effects on fertility, pregnancy, development of the embryo or fetus, birthing, or post-natal development.

Based on these data and the substantially elevated risk for a severe outcome in pregnant women infected with the pandemic virus, SAGE recommended that any licensed vaccine can be used in pregnant women, provided no specific contraindication has been identified by the regulatory authority.

Vaccines for the southern hemisphere in 2010

SAGE also considered vaccines for use in the southern hemisphere during the 2010 winter season. Two options were assessed: a trivalent vaccine, effective against the H1N1 pandemic virus, the seasonal H3N2 virus, and influenza B viruses, and a bivalent seasonal vaccine, effective against H3N2 and influenza B viruses, which might need to be supplemented with a separate monovalent H1N1 pandemic vaccine.

The experts concluded that both options should remain available for vaccine formulations in the southern hemisphere, subject to national needs.

TGen seeks emergency FDA approval of new swine flu test

H1N1 testing data presented at Infectious Diseases Society of America conference

FLAGSTAFF, Ariz. – Oct. 29, 2009 – The Phoenix-based non-profit Translational Genomics Research Institute (TGen) announced today that, along with a business collaborator, it will submit a request to the U.S. Food and Drug Administration for emergency use of a new test to diagnose the 2009 H1N1 swine flu virus.

Details about TGen's test will be presented Sunday (Nov. 1) at the 47th annual meeting of the Infectious Diseases Society of America (IDSA), being held today through Sunday (Oct. 29-Nov. 1) in Philadelphia.

The new test, developed at TGen's Pathogen Genomics Division (TGen North) in Flagstaff, can not only detect influenza — as some tests do now — but also can quickly inform doctors about what strain of flu it is and whether or not it may be resistant to oseltamivir (sold under the brand name Tamiflu®; Roche), the primary anti-viral drug on the market to treat H1N1.

As with other influenza strains, H1N1 flu can be expected to show signs of resistance to oseltamivir, and new treatments will be needed to respond to this and future pandemics.

"The problem with influenza is that it is becoming resistant to the antiviral drugs that are out there,'' said Dr. Paul Keim, a Professor of Biology at Northern Arizona University and Director of TGen North. "Because it is a virus, it mutates easily and becomes resistant.''

David Engelthaler, Director of Programs and Operations for TGen North, said this would be the only resistance test available that uses a standard molecular technique that rapidly makes exact copies of specific components of H1N1's genetic material.

-snip-
Currently, only the U.S. Centers for Disease Control Prevention (CDC) and a few select labs can look for resistance, using cumbersome and time intensive technology, Engelthaler said.

"This new test would put the power in the hands of the clinician to determine if their drugs will work or not. This is really important moving forward. When this outbreak first started (in April), everything was 100 percent sensitive to Tamiflu. But now, we're starting to see isolated cases of resistance pop up,'' Engelthaler said.

The World Health Organization has identified more than three-dozen instances of resistance to Tamiflu in the H1N1 swine flu virus.

-snip-
"The novelty in our study is the use of increasingly common laboratory tools to rapidly and accurately detect resistance to anti-influenza drugs. Until now, nearly all this work has required highly sophisticated laboratory procedures not readily available to most clinical labs and has really only been used for broad public health surveillance,'' Engelthaler said. "Our testing procedure measures very minute amounts of virus and minute changes to the virus. Not only does it detect when resistance is occurring, but it also detects it at the earliest onset possible."

CDC: Up to 6 million swine flu cases in few months

October 29, 2009 13:10 EDT ATLANTA (AP) -- Health officials think that as many as 5.7 million Americans were infected with swine flu during the first few months of the pandemic.

Scientists at the Centers for Disease Control and Prevention estimate that between 1.8 million and 5.7 million Americans were infected from April through July. The estimate is the CDC's most specific calculation to date. Officials had simply been saying millions have been infected.

The estimate is in an article in a CDC publication called Emerging Infectious Diseases.

http://www.wlos.com/template/inews_wire/wires.national/25d2af5d-www.wlos.com.shtml

22 Pediatric Influenza-associated Deaths For Week Ending 10/24

[Click on Title for Document]

Notifiable Diseases/Deaths in Selected Cities Weekly Information

Table I Summary of provisional cases of selected notifiable diseases, United States, cumulative, week ending October 24, 2009 (42nd Week)

Influenza-associated pediatric mortality§,¶¶




hat-tip Florida1

Swine flu prompts hundreds of schools to close

By DON BABWIN (AP) – 14 hours ago

CHICAGO — Across the country schools are closing by the dozen as officials say they're being hit so hard by swine flu that they feel shutting down for a few days is the only feasible option.

The U.S. Education Department says at least 351 schools were closed last week alone — affecting 126,000 students in 19 states. So far this school year, about 600 total schools have temporarily closed.

The number of closures this year appears on target to surpass the roughly 700 schools closed last spring when the swine flu outbreak first hit. Flu season hasn't peaked yet, and each day more schools are closing.

The superintendent of Connecticut's Middletown Public Schools says a middle school closed for the rest of the week after 120 students stayed home sick Monday.

Thailand: Alert for three types of flu over winter

October 29, 2009

Surveillance was especially needed in 11 provinces which had a history of birdflu outbreaks, Public Health Minister Witthaya Kaewparadai said yesterday.

He spoke after meeting 240 government doctors and chiefs of provincial public health offices across the country.

The 11 provinces are Sukhothai, Tak, Phitsanulok, Kamphaeng Phet, Phichit and Uthai Thani in the North, and Nakhon Sawan, Chai Nat, Sing Buri, Lop Buri and Ayutthaya in the Central.

There have been reports of unusually high poultry deaths in Chiang Rai, Lampang, Tak, Phitsanulok and Si Sa Ket.

Witthaya cited the recent death of a woman who was six months pregnant, saying he has ordered all state hospitals to give special care to any pregnant women with flulike symptoms.

Health officials were warned yesterday to keep a special watch out for a possible combined outbreak of the 2009 influenza and the avian flu over the coming cold season.

Permanent secretary Dr Phaijit Warachit said seasonal flu, the 2009 influenza and the avian flu all had identical symptoms: fever, coughing, runny nose - and all could be cured by Oseltamivir.

Public health volunteers have been ordered to educate villagers about possible outbreaks of both the both the 2009 influenza and birdflu, and report any outbreak of suspicious cases over the next four months till the end of February next year.

State hospitals would have special rooms and facilities to diagnose suspicious cases as well as to provide medications to flu victims.

Farm workers and cattle or pig breeders who are sick were advised to stop working till they felt better, to prevent any crossbreeding of the viruses that cause the 2009 flu and the avian flu.

Underachieving virus, mixed Federal messages contribute to H1N1 swine flu vaccine debacle

Scott McPherson's Blog...click on the title for the full post.

Tuesday, October 27, 2009

In yesterday's blog, I mentioned what I thought were the root causes of the H1N1v vaccine shortage/delay situation.

So as I always try to do, I reached out to an expert to get his opinion and bounce theories off of him. In this case, the expert is one of the top scientists in the field of vaccine research: Dr. Greg Poland of the Mayo Clinic.
-snip-
Anyway, Dr. Poland concurred with my belief that the two major factors that have contributed to the delays are a low-yield, difficult-to-grow virus; plus an "overly optimistic" Federal government spin on the vaccine situation.

While the early stages of this pandemic were managed according to the Bush playbook, authored by then-CDC head Dr. Julie Gerberding and then-HHS Secretary Mike Leavitt, this is now Obama's pandemic to manage. And the setbacks and mixed risk communications are becoming apparent.

The vaccine is no longer "early." In fact, by this time in Florida alone, there should have been some 3.787 million doses of H1N1 vaccine shipped to providers in-state. That is what was promised to the State of Florida back in September. Most of those shots would have gone directly to the "FloridaShots" network of 3,000+ health care providers and counth health departments.

But instead, Florida has only received some 900,000 doses of vaccine, a combination of FluMist and injectable vaccine. This is not even 25% of the doses promised by the Feds.

Likewise, back in September, the Feds had told the states there would be some 63.8 million doses of vaccine available by the end of October. Now, Washington is saying they will be lucky to deliver 28 million doses, or roughly 44% of the originally-promised total.

What, you say? the Feds promised 63.8 million doses? The media are reporting it was only 40 million! Wrong, swine breath. The original early September figure for planning purposes was 63.8 million doses nationwide. The Feds revised that 63.8 million figure downward to 40 million, then downward again to 28 million.

And in order for Washington to even keep that promise, it would have to send Florida 780,000 doses of vaccine within the next three days. Now how likely is that? I am not holding my breath. Nor should you.

Florida, instead of being promised 3.787 million doses of vaccine by the end of October, is now promised 5 million doses by the end of December.
-snip-
So let's recap: We have insufficient vaccine, which is the fault of the virus itself for not growing rapidly enough in labs to produce sufficient amounts of vaccine. Damned underachieving virus! Additionally, the seed stock of virus, even after being turbocharged by the CDC and others, simply did not respond well enough to grow quickly.

The Federal government knew this back in the summer, and that was dutifully reported here at this blogsite and in the blogosphere and sometimes in the mainstream media. Nonetheless, when the vaccine makers said they could deliver vaccine earlier than expected, the Administration chose to trumpet this to the press, which dutifully reported it to the American people (and as I did and others in the blogosphere). Unfortunately, the Administration did not choose to "trust but verify," as a great president once recommended, and now it is trying to distance itself from a problem of its own exacerbation by making claims, as HHS Secretary Sibelius said this week, that there would be "an ample supply" of vaccine.

Really? When?

Is it any wonder that the Obama Administration just declared a national emergency over swine flu? Perhaps they are reading the tea leaves, as I am reading them. Here's what I see.

We are going to have a nasty winter. No, we're going to have a milder winter. That depends on what our old buddy El Nino does. For the mid-Atlantic states south, it means colder and wetter winter. Imagine a line from northern Virginia west to the Texas Panhandle, south to Lubbockand southeast to Key West. Cold, wet and generally crappy winter is forecast within that area. Maybe the rest of the nation, too, if the El Nino is weak, as some are beginning to forecast.

Couple this coming winter's uncertainty with the absolute certainty that vaccine will be in short supply until Christmastime, and you have perfect conditions for a return of H1N1v as soon as temperatures drop to regular winter levels. The sad fact is that we have lost the ability to vaccinate in sufficient numbers in time for the arrival of winter.

Add in the fact that people outside of the target groups are demanding and getting vaccine, means that those who really need it may be forced to stand in line and wait. And wait.

The Administration's declaration opens up the financial pipeline for Federal reimbursement for costs of triage centers set up far away from the hospitals that they might be connected to. That tells me that this Administration thinks things will get much, much worse before they get better; that the prevailing (yet hushed) talk in DC and elsewhere is of a virus that is poised to strike like a rattler once temperatures stay low and the heart of winter sets in.

Now add in the shortage of vaccine, and you have what many of us have predicted for years: A flu pandemic where vaccine was not readily available until well into the second wave of the pandemic.

Why anyone would have not stayed "on message" regarding this vaccine scenario is beyond me. As Karl Malden's Omar Bradley said to George C. Scott's Patton: "Well, I would give myself a little leeway if I were you."

A new question I now have is this: Can we still trust that one shot will provide sufficient protection? After all, the virus is growing slowly and underperforming. There is tremendous pressure to deliver vaccine at any cost. Are we testing to ensure the vaccine is as potent as promised?

Anyone have an answer?

Are We in a National Emergency Hoax?

Kathleen Reardon
Professor, USC Marshall School, and author of The Secret Handshake and Childhood Denied
Posted: October 27, 2009 09:07 PM

This time labels won't cut it. My three children and perhaps yours are smack-dab in the middle of the high-risk group, and we keep watching people on television lined up to get the H1N1 flu shot wondering where those fortunate people live. Where most of us live you know that H1N1 is a national emergency, but there's nothing you can do about it. The vaccine is always coming next week. You know that they don't want to close the schools until so many people are sick that education is nearly impossible. Okay, I guess. But, what they don't know is where you can get your kids, and yourselves, into a line that actually leads to prevention.

Now, if this doesn't remind you of the government's inept Hurricane Katrina response where people desperate for water and help waited, waited and waited, then you must have been born in the last few years.

The head of the CDC, Thomas Frieden, has apologized. He says he "shares" our frustration. Is that what he was doing in August when he downplayed flu fears? And why was the White House not on that problem right away given that its own report contradicted this view?

The apology is disingenuous and doesn't mean beans to parents wondering if their child is going to be one of the unfortunate who, for some as yet unknown reason, has a violent reaction to H1N1. And why are we in the dark? And why is that acceptable?

Have members of Congress gotten H1N1 shots or sprays yet? Have their families? Well, what about yours and mine? If it's a national emergency and an informed hospital health care worker I overhead talking today is right, that most of the flu we're now seeing is H1N1 and the severity of the threat is being understated, then what is going on?

Is this the same government that wants us to believe that we need to send thousands of troops to Afghanistan? If they can't even get flu shots to kids in danger at home, then what makes us think these geniuses know what they're doing there either? Once again are their kids being protected and ours not?

We're in a national emergency and most of us are seeing squat when it comes to a national response.

There is no excuse for this. No apology makes it acceptable. If we don't see action now, then we need new people in government, a new party to run against the two bought and sold ones. As we can see this time, and there will be other times, they don't protect our children until they're good and ready to get around to it. But they don't mind sending them half way around the world to make some generals happy, our president a "wartime" one, and some masters of the universe even more deliriously wealthy. If they want our trust, they can earn it.

Dr. Reardon also blogs at bardscove.

Read more at: http://www.huffingtonpost.com/kathleen-reardon/are-we-in-a-national-emer_b_336266.html

Sen. Collins Writes HHS Sec. Sebelius Demanding To Know Why There Is Vaccine Shortage

Collins Demands Explanation for H1N1 Vaccine Shortage
10/27/2009 12:05 PM ET
Collins has written to U.S. Health and Human Services Secretary Kathleen Sebelius, asking why there are not enough doses of the vaccine.

Maine Senator Susan Collins is demanding to know why there are shortages of the H1N1 vaccine. Collins sent a letter Monday to U.S. Health and Human Services Secretary Kathleen Sebelius, asking her to explain why there are fewer doses of the vaccine than federal officials had originally projected.

Collins, the ranking Republican on the Senate Homeland Security and Governmental Affairs Committee, questioned why some of the vaccines won't arrive until after people have become infected with the virus.

In her letter, Collins said the tight supplies of the H1N1 vaccine is "alarming." She said HHS originally projected 40 million doses of the vaccine by the end of October, and only 28 to 30 million doses have materialized.

"I am troubled that HHS has assured the public since August that the government would have enough vaccine to meet demand," Collins writes in the letter. "It now appears that much of the vaccine could arrive only after many people have already been infected with H1N1."

Collins requested that Sebelius respond to her inquiry by Friday. The full text of the letter is below:

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201

Dear Secretary Sebelius:

As the President acknowledged just a few days ago, the nation is facing an emergency in responding to the H1N1 epidemic. A primary concern for nearly every American at this time is the lack of sufficient vaccine supply even for those at high risk for serious complications, including children, young adults, and pregnant women. The Department of Health and Human Services (HHS) originally projected that it would have at least 40 million doses available by the end of October. More recently, however, HHS downgraded this amount to just 28 to 30 million doses by that time. As I pointed out to you last week at the H1N1 hearing held by the Senate Homeland Security and Governmental Affairs Committee, the lack of sufficient supply is alarming.

I am troubled that HHS has assured the public since August that the government would have enough vaccine to meet demand. It now appears that much of the vaccine could arrive only after many people have already been infected with H1N1. Indeed, an October 15, 2009 Purdue University study predicts that nearly 60 percent of the American population will be infected with H1N1, that a third of them will fall ill, and most disturbingly, that the peak week of infection was this past week. It seems that HHS gave its assurance of sufficient supply in August without adequate information to make such a commitment. In addition, HHS should have noted that an adequate supply also depended on whether one or two doses were needed for the vaccine to be effective something that was not known until September.

Before our Committee, you stated that delays in production were due to problems in the manufacturing process that have now been corrected. To ensure that actions are taken to address fully the delays in providing the vaccine to the public, I ask that you respond to the following questions by October 30th:

• What is HHS's revised schedule for distributing the full 250 million doses of H1N1 vaccine?
  
• When does HHS expect that there will be enough vaccine to meet the needs of all those who are in the priority groups?
  
• What is the estimate of the number of doses of H1N1 vaccine required to vaccinate those in the high-risk groups?
  
• How will HHS ensure that the currently limited supply reaches those groups in an expedited manner?
  
• What actions is HHS taking to recover ground lost due to the prior production delays?
  

There are longer-term issues as well that affect our response capability.Most experts agree that a significant limiting factor in the production of any type of flu vaccine is our dependence on egg-based production rather than cell-based technology to produce the vaccine more quickly. How soon does HHS anticipate that the United States government can shift to cell-based technology for the production of flu vaccine? What effort is HHS making to ensure that this shift in production occurs rapidly and safely?

Of the five manufacturers of the H1N1 vaccine, only one is based in the United States, while the other four are foreign. In the case of a pandemic,a foreign vaccine producer will likely be compelled to prioritize the bulk of their production for their own country's consumption. What investment or policy changes should the United States undertake to ensure that the U.S. can manufacture a sufficient percentage of flu vaccine domestically?

Should you have any questions about this letter, please contact me directly or have your staff contact Asha Mathew on my Committee staff at (202) 224-8432. I look forward to your prompt response.

Sincerely,

Susan M. Collins
Ranking Member

H1N1 is mutating, turning deadlier

Sumitra Deb Roy / DNA

Wednesday, October 28, 2009 2:39 IST

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Mumbai: A preliminary study conducted by the state government into the deaths caused by the H1N1 influenza virus has revealed that the pathogen is now affecting patients more virulently and is producing newer reactions in the body. The study has also thrown up a perplexing fact--two-thirds of those suspected to have died of swine flu did not have the virus, despite showing all clinical symptoms.

Pathologists at the state-run Sassoon General Hospital in Pune took tissue samples from the bodies of the deceased to study the effect of the virus that attacks the respiratory tract. "Our doctors have concluded that the virus has undergone some genomic changes," said Dr Arun Jamkar, dean, BJ Medical College, Pune. A key discovery is that the virus, which was initially causing a bacterial infection, is now causing a more potent viral infection.

"The viral is now leading to a condition called hyalinisation of alvelar membrane, or thickening of the lung wall by deposition of proteins. Due to this, oxygen supply is severely affected, and even ventilators have been of little help," said Dr Pravin Shingare, joint director, Directorate of Medical Education and Research (DMER).

The state experts have found that the deaths between August 3 and 25 were largely due to formation of pus on the membrane lining the lungs. "During that period, deaths were caused mostly due to a secondary bacterial infection," said a professor who was involved in the study. But the deaths caused thereafter were the result of deposition of proteins on the membrane. "The deposition is more severe in the case of recent deaths. It leads to the thickening of the membrane, and therefore oxygen cannot not pass into the body at all," the professor said.

This finding has led experts to conclude that the virus has indeed undergone some changes and its anti-antigenicity is changing. But, the National Institute of Virology (NIV) in Pune has a different opinion. Director of NIV, Dr AC Mishra, said that his team is yet to record any change in the behaviour of the virus. "We still cannot say conclusively that the virus has mutated," he added.

Jamkar said that another interesting finding of the state experts has been that two-thirds of the influenza H1N1 patients who died actually tested negative for the virus. "As many as 36 suspected cases who died were later found negative for the virus," he said.

Close the schools!

By Ron Carrico

Tuesday, October 27, 2009

In the interest of the lives of our children it is now time to close the schools. We are seeing frightening stories of the infection and unfortunately we are also seeing stories that the immunizations are lagging behind. Far behind.

From the Center For Disease Control: "During the week of October 11-17, 2009, influenza activity continued to increase in the United States ... Flu activity is now widespread in 46 states. Nationwide, visits to doctors for influenza-like-illness are increasing steeply and are now higher than what is seen at the peak of many regular flu seasons. In addition, flu-related hospitalizations and deaths continue to go up nation-wide and are above what is expected for this time of year."

This is an understated way to say things are not looking good very early in the flu season, which officially started Oct. 4. The problem is, we are not adequately prepared for the pandemic that is upon us.

From what I have read and seen on television, this flu is far more aggressive than past influenzas. And from my rough calculations of the number of deaths per infection, it seems we will at least double the number of terminal cases nationwide this year from about 30,000 to over 70,000.

Any parent or grandparent knows that colds and viruses spread like wildfire among kids and teachers who are in close contact many hours each day. This H1N1, swine flu virus is virulent and we are learning it can be deadly to young people.

In San Diego it is apparent that this virus is rapidly spreading in the schools and preschools. And unfortunately the amount of virus vaccine is lagging far behind. For the health and safety of our population in general and our children in particular, we should close the schools until we can completely sanitize them. Thereafter, we should not allow teachers or students to return until they have been vaccinated.

As of last weekend there were about 100,000 doses available, most of which have been used by now. But there must be a million or more children in the schools. How much would they lose from their educations if they missed a few days? How much could they lose if they are infected? Well, their lives for one thing. Overall, it is likely that less student/teacher/school days will be lost if we close the schools until we are properly prepared. Any days lost from school can be made up later in the year.

The local school boards making the decision should immediately act to close the schools until the vaccinations have been given to at least half the students, and wait five days or so to become effective. Meanwhile the school staffs should thoroughly clean and disinfect and set up opportunities for outdoor instruction when possible.

When hospitals are purchasing more additional respirators, the World Health Organization tells us this is a pandemic and Washington removes many hospitalization and health treatment requirements, it is time to realize this is an important issue that needs to be addressed immediately.

OK, school board members; do your duty and close the schools right now.

Obama girls vaccinated against swine flu

By Garance Franke-Ruta
Well, that settles that.

Ending speculation about when and whether the Obama girls would receive the scarce swine flu vaccine, the White House on Tuesday revealed that Sasha and Malia were both vaccinated last week, after the vaccine became available to children in the District of Columbia.

As previously reported by The Post, all four members of the Obama family have received the seasonal flu vaccine, but the president and first lady have not yet received a shot to protect against the H1N1 flu virus, or swine flu. Only 16.5 million doses of the H1N1 vaccine have become available so far, a figure well short of public demand, leading to rationing.

"They will wait until the needs of the priority groups identified by the CDC - including young people under the age of 24, pregnant women, and people with underlying conditions - have been met," the first lady's press secretary, Catherine Mccormick-Lelyveld, explained on the White House blog.

"The girls' H1N1 vaccine was administered by a White House physician, who applied for and received the vaccine from the DC Department of Health using the same process as every other vaccination site in the District," she wrote.

The Centers for Disease Control's Advisory Committee on Immunization Practices recommends that all children between 6 months and 18 years be vaccinated against H1N1 "as soon as possible." Those not in the high-priority groups are being asked to wait until more vaccine is available.

Posted at 5:09 PM ET on Oct 27, 2009

Companies struggling to get H1N1 vaccine to U.S.

Tue Oct 27, 2009 3:01pm EDT

By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - GlaxoSmithKline has yet to get U.S. government approval for its swine flu vaccine, the company said on Tuesday, while Novartis said it was still struggling to make vaccines.

A U.S. senator accused the Health and Human Services department of over-promising how many and how quickly H1N1 vaccines could be delivered, as disgruntled people lined up outside clinics across the United States seeking immunization.

The United States has contracted with its five suppliers of seasonal influenza vaccine to also deliver H1N1 vaccine, but has sharply cut initial estimates of how much will be delivered this month and next. HHS says companies are having more trouble than anticipated making the vaccine, which is grown in chicken eggs using 50-year-old technology.

Glaxo, which signed a broad agreement earlier this year with HHS for $250 million of pandemic products including vaccines, says its vaccine has yet to be approved by FDA, although it submitted it in September.

"We are working with the HHS to determine how we can best meet their needs and final shipping dates will not be known until these discussions and the regulatory approval process have been completed," said Glaxo spokeswoman Claire Brough.

Australian vaccine maker CSL said it had a new "seed" strain -- the virus sample sent to companies to make vaccine with -- that grows better in eggs.

"This is helping CSL produce more vaccine antigen more quickly than before," a spokeswoman said. She said a new U.S. facility in Illinois got FDA approval in September and was now packaging vaccines.

Novartis was also struggling.

"Yes the yields are lower than initially expected, with delays to the volume available," said spokesman Eric Althoff, adding that the Swiss group had informed the U.S. government about the lower yields through the whole process.

HHS initially predicted it would have distributed 40 million doses of vaccine by the end of October, but only 16 million have been parceled out.

On Tuesday CDC director Dr. Thomas Frieden said 22.4 million doses were now available to states, which can get them a day after they order them.

"It's quite likely that that too little vaccine is one of the things that's making people more interested in getting vaccinated, frankly," Frieden told reporters.

"We think it will get easier to find vaccine in the weeks that come."

AstraZeneca's MedImmune unit has had no trouble producing nasal spray vaccine, which was the first available to the U.S, market, while Sanofi-Aventis said on Friday it was on track to deliver more than 75 million doses.

Maine Republican Senator Susan Collins asked why the estimates were so far off.

"I am troubled that HHS has assured the public since August that the government would have enough vaccine to meet demand," she said in a letter to Health and Human Services Secretary Kathleen Sebelius, released late on Monday. "It now appears that much of the vaccine could arrive only after many people have already been infected with H1N1," she added.
"It seems that HHS gave its assurance of sufficient supply in August without adequate information to make such a commitment."

An HHS spokesman had no immediate comment.

Three more dead of H1N1 as severe cases soar in B.C.

Published: October 27, 2009 11:00 AM
Updated: October 27, 2009 12:00 PM

The H1N1 flu pandemic has killed three more B.C. residents in the past week, two of them in the Fraser Health region and the third in the B.C. Interior.

The provincial death toll due to swine flu now stands at 12 lab-confirmed cases. All of the victims, except a 26-year-old Mission mother, had underlying medical conditions.

The B.C. Centre for Disease Control also reported 88 new severe cases of swine flu requiring hospitalization in the past week – 43 in Fraser Health, 29 in Vancouver Coastal, 11 in the Interior (where the third death this week occurred), four on Vancouver Island and one in the Northern Health region.

That's a 79 per cent jump in the last week, bringing the total number of severe H1N1 cases up to 199 in B.C. since the new flu virus arrived here last spring.

State of alert in South Korea to tackle the spread of swine flu

27/10/2009 SEOUL, Oct. 27 / us / South Korea raised the alert status and began health and education authorities across the country by taking measures after five people died due to the new flu in one day and the emergence of signs of the disease turning into a generalized epidemic. The news agency / Yonhap / health authorities as saying that the number of schools that have emerged more than two goals middle school students $ 900 and the number of injured Balanfonza new in a single day 400 people. The Government has all the medical establishments as medicine antibiotics known as / TAME Pholo / for all patients who have symptoms of fever and difficulty breathing without being sure of the onset of the new Palanlfonza. And demanded the Ministry of Health and Social Welfare and Family Affairs, staff of hospitals and clinics as antibiotics in a positive way for patients suspected of being infected by the new flu, noting that received prompt treatment is crucial because of the rapid spread of new Alanfonza.

Swine Flu Kills Two In Russia's Baikal Region

October 27, 2009

CHITA, Russia -- Russian chief health inspector Gennady Onishchenko says two people have died of swine flu in the southeastern Baikal region, RFE/RL's Russian Service reports.

The two women had been diagnosed with the H1N1 virus and both also had contracted pneumonia.

One of the women was pregnant and doctors were unable to save her fetus.

There have been 235 cases of swine flu registered in Baikal, which is in Siberia. Last week, authorities in the Baikal region decided to suspend the fall army draft because of the swine flu outbreak.

In Moscow, some 444 people are officially registered as having swine flu, and in Russia a total of 1,340.

Russian Influenza Research Institute Director Oleg Kiselev said last week that the official number of swine flu patients should be multiplied by 10 in order to get the real number.

Obama's emergency step aimed to help implement disaster plans

Lisa Schnirring * Staff Writer

Oct 26, 2009 (CIDRAP News) – In a measure designed to help hospitals respond more quickly to surging numbers of pandemic H1N1 cases, President Barack Obama on Oct 24 signed an emergency declaration that will help facilities establish alternative care sites and protocols for triage and transport.

Pandemic H1N1 flu activity is now widespread in 46 states, according to a recent status update from the US Centers for Disease Control and Prevention (CDC). National indicators point to intensifying pandemic activity that could overwhelm local hospitals and emergency departments.

At least two hospitals that experienced a surge of flu patients have already had to alter their flu triage and treatment by setting up tents adjacent to the emergency departments: Memorial Hospital in Bakersfield, Calif., in mid October and Dell Children's Memorial Hospital in Austin, Tex., in mid September.

The emergency H1N1 declaration fulfils one of two conditions that would be needed for the Department of Health and Human Services (HHS) to grant a waiver of section 1135 of the Social Security Act, which would ease certain restrictions on healthcare facilities in an emergency.

The waiver still requires individual requests from facilities and would only apply to a specific emergency area and period and within 72 hours of when a hospital has instituted its disaster protocol.

In the past, section 1135 waivers have been made for events including Hurricanes Katrina, Ike, and Gustav, Obama's inauguration, and North Dakota flooding.

The waiver affects requirements in several government health programs that provide certain patient protections that also may impair the ability of healthcare institutions to fully implement their disaster medical plans. The government programs include Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), the Emergency Medical Treatment and Active Labor Act (EMTALA), and the Health Insurance Portability and Accountability Act (HIPAA).

In background materials on the HHS's flu.gov Web site, federal officials said the waiver doesn't suspend HIPAA privacy rules. It said, however, that the president's emergency declaration and an HHS secretary waiver could temporarily shield affected hospitals against sanctions for not complying with some provisions such as securing patient approval for the medical team to speak with family or friends involved in their care.

Paula Steib, a spokeswoman with the Association of State and Territorial Health Officials, told CIDRAP News that Obama's signing of the emergency declaration wasn't unexpected.

"It was a continuation of similar actions taken this past spring to ensure all authorities are in place so the federal government and the states have the flexibility to respond to needs should they arise," she said.

"It was not related to any specific events or vaccine supply issues, but an effort to be as prepared as possible."

In late April after the first novel H1N1 illnesses were identified, federal officials declared a public health emergency, which they said was a routine measure that allowed the government to free up resources to respond to the outbreak and deploy antiviral medications from the Strategic National Stockpile to states.

See also:

Leading Physician Groups Urge Pregnant Women to Get Both Flu Vaccines

Pregnant women have high-risk for serious complications from the seasonal flu and H1N1

FOR IMMEDIATE RELEASE
Thursday, October 22, 2009

Contact:
Adam Lee
American Academy of Family Physicians
(800) 274-2237 Ext. 5221
alee@aafp.org

Lisa Lecas
American Medical Association
312-464-5980
Lisa.lecas@ama-assn.org

Office of Communications
American College of Obstetricians and Gynecologists
202-484-3321
communications@acog.org

To help stress the urgent message that pregnant women must get vaccinated against both seasonal influenza and 2009 H1N1 to protect themselves and their unborn baby, the American Medical Association (AMA), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) joined forces today. In a group letter sent to health care professionals nationwide, leaders from the four groups emphasized the increased number of deaths among pregnant women from influenza and provided helpful information for medical professionals.

The letter urges health care professionals to vaccinate their pregnant patients and counsel them on the benefits of the vaccine. Both the seasonal influenza vaccine and the H1N1 vaccine are safe to administer to pregnant women in any trimester and can be given simultaneously. Pregnant women should be given the flu shot, not the nasal spray version of the vaccine.

“Pregnant women carry a heightened risk for serious complications and death from the flu,” said AMA Board of Trustees Member Mary Ann McCaffree, M.D. “We need to counsel our patients so that they understand that the vaccines are safe and that getting vaccinated is the single best way to protect them and their babies from the flu.”

"It is critical that physicians talk with their pregnant patients about all of the immunizations recommended during pregnancy and in the postpartum period," said AAFP President Lori Heim, M.D. "Right now it is even more important for physicians to educate pregnant women to be immunized for both H1N1 and seasonal flu. Pregnant women are four times more likely to be hospitalized from novel H1N1 influenza, but that risk can be lessened through vaccination."

“ACOG is taking an active role in encouraging obstetrician-gynecologists to vaccinate their pregnant patients against both the seasonal flu and the H1N1 flu,” said ACOG President Gerald F. Joseph Jr., M.D. “We need to ensure that all pregnant women understand the seriousness to both their health and the health of the fetus if they become ill with the flu.”

To view the joint letter visit: web address. For more information on pregnancy and vaccination against the flu, visit: www.cdc.gov/h1n1flu/pregnancy.

INFLUENZA PANDEMIC (H1N1) 2009 (76): EL SALVADOR, DENGUE CO-INFECTION

Date: Sat 24 Oct 2009
Source: La Prensa Grafica [trans. Mod.MPP, edited]



In the eastern zone of the country, there have been reports of
patients with simultaneous infection [co-infection] of influenza A
(H1N1) and classical dengue fever, confirmed by the Vice Minister of
Health, Eduardo Espinoza. In total, there have been 4 such cases of
co-infection in the country nationwide.

Of these, 2 are from the eastern zone, and the other 2 are minors who
were treated at the Benjamin Bloom Children's Hospital months ago,
said the health official.

A day earlier, the head of the Health Surveillance Unit, Julio
Armero, said he feared that in Upire, Nueva Esparta (La Union), where
a 4th outbreak of the virus had been reported to the Department,
there was a cross of influenza A (H1N1) and dengue, which could lead
to a major outbreak.

The Vice Minister of Health, Violeta Menjivar, does not believe that
there will be an intersection of the disease at the national level,
because preventive sanitary measures have been implemented and
reinforced, and there is a focus on identifying and finding
preventive processes.

Communication with Honduras has been established in order to
implement joint sanitary policies and avoid a major outbreak related
to the flow of people, she said.

"In La Union, there are combined [infections with] (H1N1) and dengue,
so we have concentrated efforts of monitoring, education, prevention
and elimination of [mosquito] breeding sites," said the deputy minister.

Also, the Ministry of Health closed the case of the 9-month-old
infant that had died in Guajiniquil, and he was suspected of having
had H1N1. The mother took the infant from the [health center] before
specimens were obtained, and, in addition, there was no autopsy. But
the death was most probably due to H1N1 because 3 of the sisters of
the child had H1N1, and one of them was also co-infected with dengue virus.

Up to the present, El Salvador has reported 6 deaths from dengue
hemorrhagic fever and 22 from H1N1 infection.

[Byline: Loida Avelar Martinez]

Genes May Determine Susceptibility To H5N1 Avian Influenza A Virus Infection

ScienceDaily (Oct. 26, 2009) — A new study found genetic variations in mice affect their susceptibility to and severity of H5N1 avian influenza A virus infection suggesting that humans who contract the virus may be genetically predisposed.

The researchers from St. Jude Children's Research Hospital, VA Medical Center and MidSouth Center for Biodefense and Security, and the University of Tennessee Health Science Center, Memphis, Tennessee report their findings in the October 2009 issue of the Journal of Virology.

Over the last 10 years, highly pathogenic H5N1 avian influenza A has spread from Southeast Asia into Europe and Africa killing millions of chickens and ducks along the way. It has also infected tigers, cats, dogs and humans often resulting in death. Despite the countless cases reported in birds, the number of human cases remains few and of those few more than 90% occurred in genetically related family members indicating a possible genetic correlation.

In the study researchers conducted genome-wide linkage analysis to identify chromosomes that contribute to varying susceptibility to H5N1 in two inbred strains of mice challenged with a lethal dose of a highly pathogenic H5N1 virus. Results revealed five quantitative trait loci for influenza virus resistance located on multiple chromosomes also associated with H5N1 resistance. Additionally, a number of candidate susceptibility genes were identified, one of which affected virus titers 7 days following infection.

"An important and novel finding of this study is that H5N1-induced pathology is greatly affected by genetic polymorphisms in the genome of the infected host," say the researchers. "We have also found that, at least in mice, H5N1 pathogenesis is a complex genetic trait with multiple genes affecting disease outcome."

http://www.sciencedaily.com/releases/2009/10/091025200248.htm

Severe Swine Flu Patients Eligible for BioCryst Drug, FDA Says

By Jason Gale

Oct. 26 (Bloomberg) -- Hospitals in the U.S., where hundreds of swine flu patients are being admitted daily, may use BioCryst Pharmaceutical Inc.’s antiviral drug peramivir in some cases under a Food and Drug Administration emergency ruling.

The FDA authorized on Oct. 23 the use of an intravenous version of the medicine, which is in final-stage testing in the U.S., to treat confirmed or suspected swine flu in children and adults who may not benefit from conventional treatments or where an infusion is likely to be more beneficial.

The decision will spur wider use of BioCryst’s unapproved drug and give physicians an alternative to Roche Holding AG’s Tamiflu tablet and GlaxoSmithKline Plc’s inhaled medicine Relenza. Since Aug. 30, more than 8,200 people have been hospitalized for influenza in the U.S., according to government estimates. In severe cases, patients are too ill to swallow a pill or inhale powder, doctors said.

“The fact that peramivir can be given intravenously is a definite advantage, particularly for patients in intensive care,” said Dominic Dwyer, professor of immunology and infectious diseases at the University of Sydney, in a telephone interview today.

Production of about 130,000 courses of intravenous peramivir is under way in anticipation of government orders and more can be made if required, the company said in an Oct. 23 statement. A course comprises 600 milligrams given in a once- daily infusion for five days.

The company, based in Birmingham, Alabama, said it has donated about 1,200 courses of peramivir to the Department of Health and Human Services and is prepared to deliver more.

BioCryst Shares

BioCryst shares have surged more than fivefold to $9.66 since the new H1N1 influenza strain was reported in Mexico and the U.S. in late April and reached a three-year high of $12.80 on Aug. 26.

BioCryst’s partner, Osaka-based Shionogi & Co., which is preparing to file for regulatory approval in Japan this year, climbed 70 yen, or 3.4 percent, to 2,105 yen on the Tokyo stock exchange today. The shares have risen 23 percent since April 23.

The pandemic virus drove a 15-fold increase in intensive care admissions for viral lung inflammation in Australia and New Zealand during the Southern Hemisphere’s winter flu season. At the peak, swine flu patients filled 8.9 percent to 19 percent of all intensive-care hospital beds in each state of Australia and New Zealand, according to an Oct. 8 study in the Journal of the American Medical Association.

“In our experience with flu last winter, something that you could give intravenously would be useful,” Dwyer said.

Neuraminidase Inhibitor

Like Tamiflu and Relenza, peramivir works by blocking a protein on the surface of influenza particles called neuraminidase, which allows the virus to escape from infected cells to other cells in the body.

As part of the conditions of the FDA’s so-called Emergency Use Authorization, health-care providers must report adverse events and all medication errors associated with peramivir to the regulator within seven days.

“It’s reasonable to make this drug available during outbreaks and to expect clinicians to fill out adverse drug reports for investigational agents,” said Steven M. Opal, professor of medicine at Brown Medical School and chief of infectious diseases at Memorial Hospital in Pawtucket, Rhode Island. “We do this all the time in clinical trials.”

To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net.

Last Updated: October 26, 2009 05:19 EDT

Oregon: Josephine County declares swine flu emergency

Associated Press - October 23, 2009 6:25 PM ET

GRANTS PASS, Ore. (AP) - Josephine County has declared a state of emergency over the swine flu.

The declaration Friday by county commissioners in Grants Pass cited two people dead, 21 in the hospital, and many more sick with the H1N1 virus.

County health director Belle Shepherd says the declaration will allow the county to get faster results on state lab tests and extra medical personnel if the local hospital gets overwhelmed.

Shepherd says Josephine County has 1 of the highest rates of hospitalization of swine flu cases in the state, and that hospitals in Grants Pass and Medford are near capacity - a condition known as code yellow.

Commissioners in neighboring Jackson County, where Medford is located, will consider making the same declaration at their meeting Wednesday.
hat-tip Treyfish