Japan: Tamiflu shortages for kids give birth to doses with ice cream

Sunday 29th November, 05:08 AM JST

TOKYO —

Doctors and pharmacists are racking their brains to work out creative formulas to cope with shortages of Tamiflu influenza treatment for small children who have been principally hit by the raging H1N1 flu epidemic, with some coming up with doses of adult formula mixed with ice cream.

Tamiflu is administered typically in sweetened dry syrup for small children and in capsules for adults, which are deemed too bitter for small children.

For this flu season, Chugai Pharmaceutical Co, the sole manufacturer and marketer of Tamiflu in Japan, has planned to produce enough of the antiviral drug for 12 million people, around three times more than last season. It includes the dry syrup formula for around 3.6 million, which Chugai started making in September.

According to the Ministry of Health, Labor and Welfare, about 80% of flu patients in Japan are underage children chiefly comprising students in primary and lower secondary schools.

In that age bracket, patients have been increasing particularly among those aged 7 or younger, resulting in demand for the Tamiflu dry syrup far outstripping projected supply.

A Chugai spokesman said, ‘‘Since the beginning of November, we haven’t been able to catch up in supply. We’re producing at full capacity and aren’t in a position to boost supply any further.’‘

Against this backdrop, the health ministry issued information to clinics and hospitals in early November, telling them they ‘‘may re-administer Tamiflu removed from capsules for pediatric formulas and quantities in the event there are no other alternatives.’‘

Because of its bitter taste, doctors and pharmacists are suggesting doses mixed with ice cream or yogurt, for instance.

Kazutaka Hosoda, a doctor at Navitas Clinic in Tachikawa on the outskirts of Tokyo, points to potential problems with re-administering the adult version for children, saying, ‘‘Redoing preparations takes time and some children may not be able to consume the treatment because it may be too bitter.’‘

If a child stops taking the drug because of such problems, there may be a risk that the flu virus develops resistance to it, he added.

Hosoda said there are effective drugs other than Tamiflu and he prescribes Chinese medicines.

Vietnam: Crackdown ordered on disease transmission

November 27, 2009

They health ministry has warned of an increase in transmitted diseases and ordered health agencies in 31 cities and provinces in the north experiencing weather changes to step up preventive measures.

These agencies should also focus on medicines in schools, the dangers of smoking, child injuries and the difference in the quality of healthcare services between the regions, Minister of Health Nguyen Quoc Trieu told a conference on preventive medicine in Hanoi on Tuesday.

He also instructed concerned agencies to enforce the supervision and management of epidemics in an effort to curb the spread of transmitted diseases.

Despite huge investments in preventive medicine, the transmission of diseases has not received due attention, he said, adding that preventive medicines cost up to 30 percent of the annual budget that the State allocates to the health sector.

According to a report released recently by the Health Ministry, there has been a re-emergence of several transmitted diseases, including HIV/AIDS, A/H5N1 and A/H1 N1 flu, due to weather changes and environmental pollution.

The ministry also warned that 27 percent of all diseases are transmitted by viruses, seriously impacting the nation’s socioeconomic development.

H1N1 virus mutation spreads

Nov 28, 2009

PARIS - SWINE flu virus mutations are spreading in Europe, French health officials said on Friday as the World Health Organisation reported a leap in deaths from the disease by more than 1,000 in a week.

Two patients who were infected by a mutation that was also recently detected in Norway have died in France, the government's Health Surveillance Institute (InVS) said in a statement.

'This mutation could increase the ability of the virus to affect the respiratory tracts and, in particular, the lung tissue,' said the statement.

'For one of these patients, this mutation was accompanied by another mutation known to confer resistance to oseltamivir,' it added, referring to the main drug being used to treat swine flu, under the brand name Tamiflu.

The case was the first drug-resistant strain found in France among the 1,200 strains experts have analysed here, the InVS said, adding that 'the effectiveness of vaccines currently available is not being questioned.'

The two patients were not related and had been hospitalised in two different cities in France, it said.

The WHO said on Friday the death toll had reached at least 7,826 worldwide since the A(H1N1) flu virus was first uncovered in April. The number of deaths reported to the UN health agency showed the biggest rise in the Americas, where 5,360 deaths have now been recorded compared to 4,806 a week ago. -- AFP

CDC warns about rise in serious pneumococcal disease

Lisa Schnirring Staff Writer

Nov 25, 2009 (CIDRAP News) – In a worrisome but not unexpected pandemic-related development, the US Centers for Disease Control and Prevention (CDC) said today that it is seeing a spike in serious pneumococcal disease, particularly in younger patients.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, told reporters at a press briefing that the CDC is seeing an increasing number of invasive pneumococcal disease cases around the country, but the numbers were particularly high in Denver at a time when pandemic H1N1 activity was peaking in the area.

Over the past 5 years the Denver area averaged 20 pneumococcal disease cases in October, but this year the area recorded 58, and most were in adults between the ages of 20 and 59, many of whom had underlying medical conditions.

Health officials expect to see more pneumococcal disease when seasonal flu circulates, but the infections typically strike people who are older than 65. In past pandemics secondary bacterial pneumonia infections, particularly those involving Streptococcus pneumoniae, frequently contributed to illnesses and deaths.

Reminder for pneumococcal vaccine
Schuchat said the rise in pneumococcal disease is a stark reminder for high-risk groups to get the pneumococcal vaccine.

The CDC recommends the vaccine for several high-risk groups, but uptake is low. Only about 25% of adults in high-risk groups who are younger than age 65 have received the vaccine. The CDC's vaccine advisory group recently added people with asthma and smokers to the list of those who should receive the pneumococcal vaccine.

About 75% of Colorado's invasive pneumococcal disease cases were caused by serotypes that are included in the pneumococcal polysaccharide vaccine, consistent with what the CDC sees during nonpandemic years. About two thirds of the patients had at least one indication to receive the vaccine but had not been vaccinated.

Of the 10 patients with confirmed pandemic H1N1 infections, 7 had high-risk conditions, but only 1 had received the vaccine. Others were tested for the virus, but the timing of the testing made it difficult to document influenza. Other patients reported that they had flu-like symptoms before they got sick with pneumococcal infections.

The CDC said it is working with state and local officials to collect more information on pneumococcal disease cases. Colorado is one of 10 states that takes part in its Active Bacterial Core (ABC) surveillance system for pneumoccocal and other bacterial diseases.

Over the past several months, CDC officials have urged healthcare workers to make sure high-risk groups receive the pneumococcal vaccine as the country faces a long flu season that could include waves of pandemic and seasonal influenza. On Nov 10 Schuchat sent a letter to providers urging them to make sure patients with indications receive the vaccine.

Increase not surprising
Andrew Pavia, MD, chief of pediatric infectious diseases at the University of Utah, told CIDRAP News that an increase in bacterial pneumonia, though worrisome, is expected during any influenza epidemic or pandemic. He noted that several studies have described how the infections parallel viral infections, particularly seasonal flu.

Physicians are particularly wary of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia infections this flu season, because they are more severe and deadly than pneumococcal pneumonia infections.

However, Pavia cautioned that it is too early in the season to see big increases in pneumonia cases. "Remember that it is hard to document bacterial pneumonia, and surveillance systems are not well designed to detect it," he said. "I suspect that the relative lack of reports of bacterial pneumonia in the spring may have been artifacts."

He pointed out that, for example, ABC sites didn't experience major waves of pandemic H1N1 illnesses in the spring and that the ABC surveillance sites do not include four of the hardest-hit US cities: New York City, Salt Lake City, Seattle, and Chicago.

Aaron DeVries, MD, a medical epidemiologist with the Minnesota Department of Health, said Minnesota has not seen a larger-than-expected number of bacterial pneumonia cases. Minnesota is one of the states that takes part in the CDC's ABC surveillance system. "We've always been concerned about bacterial coinfections with influenza, but it's not occurring to the degree that we were all concerned about."

He said pneumococcal vaccination can provide powerful benefits, adding that vaccinating infants has reduced illnesses in not only those who are vaccinated but also in those who didn't receive the vaccine.

Because the indications for adults have broadened in the past few years, he said, many people may not be aware that they should receive the vaccine.

DeVries said that although most healthcare providers know which groups are at highest risk and should receive the pneumococcal vaccine, such as patients who have had splenectomies, even they could benefit from more education about the latest recommendations from the CDC's vaccine advisory group.
-snip-
hat-tip: Roehl_JC

China expert warns of pandemic flu mutation

Yesterday, we heard this:

The Manila-based WHO Western Pacific Office said the presence of the H5N1 virus in poultry placed those in direct contact with the birds at risk of getting infected with the disease. It added that it was also closely monitoring the risk of the H5N1 virus combining with the H1N1 swine-flu virus to produce a new and deadlier strain.
"We don't know if this is possible, but we are certainly aware of the risk," said ShinYoung-Soo, WHO regional director for the Western Pacific. "We are on alert for this development."

Today, we hear this....this is something I have been looking for since the Pandemic broke. A new strain...H5N1/H1N1....now we hear two articles in two days from two different sources. This is the time of year of the H5N1 to kick in.


Wed Nov 25, 2009 12:08pm EST

By Stefanie McIntyre

HONG KONG (Reuters) - China must be alert to any mutation or changes in the behavior of the H1N1 swine flu virus because the far deadlier H5N1 bird flu virus is endemic in the country, a leading Chinese disease expert said.

Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases in China's southern Guangdong province, said the presence of both viruses in China meant they could mix and become a monstrous hybrid -- a bug packed with strong killing power that can transmit efficiently among people.

"China, as you know, is different from other countries. Inside China, H5N1 has been existing for some time, so if there is really a reassortment between H1N1 and H5N1, it will be a disaster," Zhong said in an interview with Reuters Television.

"This is something we need to monitor, the change, the mutation of the virus. This is why reporting of the death rate must be really transparent."

The World Health Organization warned on Tuesday that H5N1 had erupted in poultry in Egypt, Indonesia, Thailand and Vietnam, posing once again a threat to humans.

"First, it places those in direct contact with birds -- usually rural folk and farm workers -- at risk of catching the often-fatal disease. Second, the virus could undergo a process of "reassortment" with another influenza virus and produce a completely new strain," it said.

"The most obvious risk is of H5N1 combining with the pandemic ... (H1N1) virus, producing a flu virus that is as deadly as the former and as contagious as the latter."

Zhong told the Chinese media last week that China may have had more H1N1 flu deaths than it has reported, with some local governments possibly concealing suspect cases.

The doctor is known for his candor and work in fighting Severe Acute Respiratory Syndrome in 2003, when nationwide panic and international alarm erupted after it emerged that officials hid or underplayed the spreading epidemic.

Cover-ups by local governments in 2003 during the SARS epidemic led to the sackings of several officials. More than 300 people died in that outbreak.

China, the world's most populous country, has reported around 70,000 cases of H1N1 and 53 death from the virus.

While some regions simply lack the technology to test for H1N1, other areas have been treating deaths as cases of ordinary pneumonia without a question, Zhong said.

"Some local healthcare authorities are reluctant, unwilling to test patients with severe pneumonia because there's some latent rule which says the more H1N1 deaths, the less effective the control and prevention work in your area," Zhong said.

Zhong said China's health minister Chen Zhu rang him up last week and agreed with his views. A notice then appeared on the ministry's website threatening severe punishment for officials caught concealing deaths from H1N1 swine flu.

WHO reported more than 526,060 laboratory confirmed cases of H1N1 worldwide on November 15, with at least 6,770 deaths. However, it has stressed for months now that the figures were only the tip of the iceberg.

It urged countries to place more resources on mitigating the disease rather then on costly prevention measures or testing everyone. All WHO and the U.S. CDC will say is that "millions" have been infected.

(Writing by Tan Ee Lyn; Editing by Bill Tarrant)

Wales Update on person to person spread of swine flu resistant to Tamiflu

From my previous Post entitled: Commonground Summary: Tamiflu Resistant Comparisons of Wales & NC .....[http://tinyurl.com/ya3smsx]

Wales
- 5 people confirmed with Tamiflu resistance
- In hospital at time of becoming infected
- All were severely ill at time of infection
- In same ward of hospital housing patients with severe illnesses
- 2 have recovered and discharged
- 1 in critical care
- 2 still being treated
- 4 others infected (“with same genetic mutation” Health Protection Agency)
- 1 of these were helped with Tamiflu
- 3 others it is not clear.
- Same ward as the 5 confirmed Tamiflu resistance

25 November 2009

One additional patient has tested positive for swine flu resistant to Tamiflu at a Cardiff hospital unit.

The patient – who was linked with the previous group of five people found to be resistant to Tamiflu last week – was tested as part of the routine screening arrangements introduced at the University Hospital of Wales.

Test results are still awaited on one other direct contact of the six patients with swine flu resistant to Tamiflu. All other patients on the unit have now tested negative for the virus.

Three of the patients remain in hospital, with one in critical care and the others being treated in isolation on the unit.

Dr Roland Salmon, Director of the NPHS Communicable Disease Surveillance Centre, said:
“It was not unexpected that more patients exposed to the original cases would test positive for this strain of swine flu as we now know that it has passed from person to person within the unit.

“The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.

“For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness. Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”

Chief Medical Officer for Wales, Dr Tony Jewell, said: “We know that people with suppressed immune systems are more susceptible to the swine flu virus, which is why they are a priority group under the first phase of the vaccination programme in Wales which is progressing well.

China: Detected H1N1 mutations 'not dangerous'

November 25, 2009


Chinese health authorities detected mutations of the H1N1 virus on the Chinese mainland in June and July, but so far, the mutations are not creating any danger in terms of the number and severity of cases, health experts said.

Health officials did not make an announcement to the public earlier because the mutations carried too little public health significance.

China is among seven countries, including Brazil, Japan and Mexico, that have reported isolated cases involving this mutation, according to the World Health Organization (WHO).

Experts say the mutated virus is not circulating widely and has not been resistant to antiviral treatments like Tamiflu.

"The mutated viruses in the nation do not seem to be more virulent or infectious than the regular H1N1 one, and have caused no deaths here," said Feng Zijian, director of the emergency response department of the Chinese Centers for Disease Prevention and Control.

He declined to reveal more.

Vivian Tan, press officer of the WHO Beijing Office, said the organization had been informed by the Chinese government of the mutations earlier and that there were three such cases.

WHO's public health recommendations remain unchanged for now, as no evidence so far suggests these mutations are leading to an unusual increase in the number of H1N1 flu infections or a greater number of severe or fatal cases, the press officer said.
-snip-

Meanwhile, Hong Kong's Department of Health announced on Monday that it had found a mutation in an H1N1 flu virus sample.

Department officials said that they had carried out an examination of the the genetic sequence of the H1N1 flu viruses in their monitoring systems.

Out of the 123 sequences studied, one sample showed a mutation.

The virus was taken from a 1-year-old boy who developed flu-like symptoms July 22.

The patient was admitted to Prince of Wales Hospital July 25 and discharged three days later. He has fully recovered.

Mutations are frequently encountered in influenza viruses, according to WHO.

Source: China Daily

WHO gathers data on H1N1 mutations

Tuesday, November 24, 2009



The World Health Organization is looking for more information on reports of a drug-resistant strain of swine flu in Britain and a batch of H1N1 vaccine that was put on hold in Canada following allergic reactions.

The UN health agency is also checking whether a mutation in the H1N1 strain reported by the Norwegian Institute of Public Health last Friday causes more serious illness by allowing the virus to go deeper into the respiratory system.

The agency is gathering information from Canadian officials about a batch of 172,000 doses of H1N1 vaccine that may have caused more allergic reactions than normal.

"An unusual number of severe allergies to the vaccine have been detected in Canada," WHO spokesman Thomas Abraham told Agence France-Presse on Tuesday.

Vaccine maker GlaxoSmithKline asked provinces last week to stop administering Aprepanrix vaccine from the affected lot, linked to at least six severe reactions. The company has not said how many doses had been used. Those who suffered reactions have recovered.

Abraham also said that the reported Norwegian mutation "is a major issue we are looking at."

"If the mutation in fact is associated with severe cases then we really need to know about it," he told Reuters in Geneva. "This might be a signal. We need to investigate," he added.

"As of now there is no evidence of a particular association with severe cases."

A similar mutation has been reported in Brazil, China, Japan, Mexico, Ukraine and the United States, WHO said.

Also last Friday, Britain's Health Protection Agency said five cases at a hospital in Wales were known to be resistant to antiviral drug Tamiflu, also known as oseltamivir.

Pork "safe to eat" despite infection

2009-11-23 08:30:25

BEIJING, Nov. 23 -- Health experts have assured consumers that Chinese pork is still safe despite reports of pigs being infected with the deadly A/H1N1 flu.

Swine at a slaughterhouse in Heilongjiang province tested positive for the virus last Thursday, the Ministry of Agriculture revealed over the weekend.

Four positive samples were discovered at the abattoir in Shuangcheng by a local flu laboratory, China News Service quoted a ministry statement as saying.

Officials suggested the cause of infection could have been the animals' close contact with humans during transportation.

Gene sequence analysis showed the virus suffered by the pigs is a 99-percent match with the human H1N1 strain. No mutation was found, the government statement said.

It is the first such infection in China, although there have already been reports in 13 other countries and regions, Beijing Times reported yesterday.

However, experts with the World Health Organization (WHO) insisted well-prepared pork is still safe to eat because the virus cannot survive temperatures of 70 C and above.

China consumed more than 46 million tons of pork last year, around half of the world's total.

Since the outbreak of H1N1 in April, prevention and monitoring of swine has been a priority for the government. The virus was originally known as "swine flu" before it was renamed to dispel any links with pigs.

The information office of the Ministry of Agriculture was unable to comment yesterday, but in a statement last week officials said authorities across China had checked about 87 million pigs, but no influenza virus had been detected.

Meanwhile, four patients in North Carolina in the United States tested positive over the weekend for a new H1N1 strain that is resistant to oseltamivir, or Tamiflu, AP reported.

Tamiflu is one of two flu medicines being used in the fight against H1N1 and health officials have been watching for signs of the virus mutating, making the drugs ineffective.

More than 50 resistant cases have been reported since April, including 21 in the U.S.. Almost all in the U.S. were isolated, officials with the U.S. Centers for Disease Control and Prevention said.

London-based BBC reported five Tamiflu-resistant cases in Wales last week.

The Norwegian Institute of Public Health also said it had detected mutations in three positive samples. The viruses were isolated from the country's first two fatal cases and one other patient.

Norwegian scientists have analyzed samples from more than 70 patients, but only in three have mutations been detected. This suggests the mutation is not widespread, say scientists.

Laboratories in Brazil, Japan, Mexico, Ukraine and the U.S. have all detected similar mutations, with the earliest being in April.

Although information is incomplete, the mutations were detected in fatal, as well as mild cases. Experts said the significance of the finding is unclear.

As of Friday, the virus had killed 6,770 people worldwide since April, with 520 deaths in the past week, according to figures released by the WHO yesterday.

(Source: China Daily)

H1N1 flu virus mutation detected in HK

www.chinaview.cn 2009-11-24 07:33:52

HONG KONG, Nov. 23 (Xinhua) -- Hong Kong's Department of Health announced Monday that it had found the same mutation in a H1N1 flu virus sample as the one detected in Norway recently.

The department said that it had examined the genetic sequence of H1N1 flu viruses in its monitoring system. Out of the 123 sequences studied, one sample showed the same mutation as the Norway strain.

The virus was taken from a year-old boy who developed flu-like symptoms July 22. He was admitted to Prince of Wales Hospital July25 and discharged three days later. He has recovered.

Mutations are frequently encountered in influenza viruses. According to the World Health Organization, the same mutation of the virus has been found on the Chinese mainland and in other countries, including Brazil, Japan, Mexico, Ukraine and the United States.

The virus with this mutation remained sensitive to antiviral drugs, Tamiflu and Relenza. No evidence suggests these mutations are leading to an unusual increase in the number of H1N1 flu infections or a greater number of severe or fatal cases.

hat-tip Avian Flu Diary [http://afludiary.blogspot.com/]

TIMOR-LESTE: Bird flu worries as awareness remains low

23 Nov 2009 08:43:38 GMT

Source: IRIN

Reuters and AlertNet are not responsible for the content of this article or for any external internet sites. The views expressed are the author's alone.

DILI, 23 November 2009 (IRIN) - Ask Afonso de Jesus what he knows about avian influenza (H5N1) and the answer is worrying. "What's that?" the 27-year-old chicken vendor asked, holding a bird he hopes to sell on the open market in Dili, the Timorese capital. "I don't know what bird flu is. My chickens are absolutely fine."

Awareness of the deadly virus remains low, say health specialists in Asia's newest but poorest nation. "This is our biggest challenge. This is where we need work," Milena Maria Lay dos Santos, head of the communicable disease control department in the Ministry of Health, told IRIN.

The problem is particularly pronounced in rural areas, Dos Santos said, where most of the country's 1.1 million inhabitants live. More than 50 percent of the population had a general knowledge about what bird flu is, but most had only limited knowledge as to how it was actually spread, she reckoned."Getting the message out is difficult. Many of these people are illiterate and have little to no access to television or radio." "Communities are aware of the disease, but less so on how the virus is contracted," Megan Counahan, an epidemiologist with the World Health Organization (WHO) in Dili, agreed.

No cases yet
There has yet to be a single reported case of H5N1 in the country – either in birds or humans – but the risk remains. Afonso de Jesus hails from southwestern Covalima District along the border with Indonesia, where at least 115 people have died of the disease – the highest number in the world. Despite a government ban on Indonesian poultry products along the country's 228km border, chicken smuggling between west and east Timor continues. "This is a very porous area and difficult to control," Abebe Wolde, team leader of the avian influenza programme for the UN Food and Agriculture Organization (FAO), told IRIN. "This is why awareness campaigns are so important."

Yet poor communications and difficult terrain make reporting difficult, and most farmers have no access to veterinary services. Moreover, the country does not have a comprehensive nationwide animal surveillance system in place, a major weakness in dealing with a possible outbreak. Should a large number of chickens die suddenly, farmers will often blame Newcastle disease, a highly contagious and fatal viral disease affecting domestic poultry and wild birds, which is endemic in the area, when the real cause could be H5N1.

Progress
But despite the challenges, including limited resources, the Timorese government is making inroads. Efforts over the past year to address the threat of swine flu (H1N1 2009) have given bird flu preparedness a boost. "Preparedness levels are much better now because of H1N1," Dos Santos conceded. "People better understand the risk factors, not just of H1N1, but H5N1 as well now." The government now employs a district public health officer in all 13 districts with a mandate for preparedness and response, including raising awareness.Moreover, each district now has a rapid response team that can be dispatched when needed should a suspected human case occur, while at the same time efforts to boost community awareness are also in place. With the Ministry of Agriculture, FAO is working to explain key prevention methods through mass media campaigns, as well as drama presentations to villages in high risk areas, with some 24 villages reached since September. The UN agency has established a pilot programme for animal surveillance in three districts this year, including Dili, Covalima, and the eastern district of Lautem, with the hope of replicating it nationwide."This will allow us to detect at the village level a number of animal diseases early on, not just H5N1," the FAO's Wolde said.

According to WHO, human testing of the virus can be undertaken in Australia, isolation and treatment facilities are available in Dili, and the country now has a healthy stockpile of Tamiflu, the drug used globally to treat avian flu in humans. "We're much better prepared now," said Counahan of the WHO, citing efforts by the Ministry of Health. "However, we're still not where we need to be in terms of awareness."

At least 442 human cases of bird flu have been reported worldwide, including some 262 deaths, mostly in neighbouring Indonesia, the world health body reports.

FACTBOX-Measures to fight H1N1 swine flu in Europe

Nov 24 (Reuters) - Here are some details about measures taken to fight the H1N1 swine flu, a mixture of swine, bird and human viruses and which has killed more than 7,860 people globally, according to the latest European Centre for Disease prevention and Control (ECDC) tallies. The World Health Organisation (WHO) declared an H1N1 pandemic on June 11, indicating the first influenza pandemic since 1968 was underway.

* LATEST MEASURES BY GOVERNMENTS:
FRANCE - Almost 240 schools around the country have had to close in an effort to contain particularly virulent outbreaks. -- A recent jump in cases has given a much needed boost to a national vaccination campaign, with queues forming at centres over the weekend as word spread of an increase in deaths. -- When the centres initially opened earlier this month, the French media, said they were largely deserted, with medical staffing having to throw away large numbers of unused vaccinations.

NETHERLANDS - The Netherlands started vaccinating children against the H1N1 on Monday. Some 830,000 children aged from six months up to and including four-year-olds will be vaccinated. -- Babies up to six months old will not be vaccinated because the vaccine has not been tested on babies. About 200,000 members of families with babies younger than six months will be vaccinated instead. -- At 237 different locations across the Netherlands, parents can visit centres of municipal health organisation GGD to have the vaccinations, with most vaccinations taking place this week. A second round of shots will occur in mid-December. -- The vaccination of children comes after the Netherlands started vaccinating risk groups against the virus on Nov. 9.

POLAND - Poland's Health Ministry decided last week to release its Tamiflu stock on to pharmacies. -- Health Minister Ewa Kopacz has said not enough tests have been conducted to make sure flu vaccinations are safe for people and said she was demanding more guarantees from pharmaceutical firms before any possible purchase. -- Several schools have been temporarily closed across the country, but there has been no central recommendation to do so.

-snip-

Outbreak of low path AI in Germany

24 Nov 2009

The ag authorities of Germany reported an outbreak of low pathogenic avian influenza (H5) in birds on a farm in Grosswechsungen, Thuringen.

Twentyfive of 2420 birds died. The serotype is yet unknown.

Measure: stamping out. Vaccination is prohibited for poultry and is only allowed for zoo birds.

WHO warns of bird flu resurgence

First Published :24 Nov 2009 04:53:07 PM IST

MANILA: The World Health Organisation (WHO) warned Tuesday of a possible resurgence of bird flu amid new cases of the disease in poultry in Egypt, Indonesia, Thailand and Vietnam.

The Manila-based WHO Western Pacific Office said the presence of the H5N1 virus in poultry placed those in direct contact with the birds at risk of getting infected with the disease. It added that it was also closely monitoring the risk of the H5N1 virus combining with the H1N1 swine-flu virus to produce a new and deadlier strain. "We don't know if this is possible, but we are certainly aware of the risk," said ShinYoung-Soo, WHO regional director for the Western Pacific. "We are on alert for this development."

The WHO noted that the H1N1 virus that killed more than 6,000 people around the world since April was a new strain that resulted from "reassortment" or combination of the avian, swine and human strains of flu in pigs in Mexico.

Urging countries to remain on alert against bird flu, Shin stressed that influenza viruses were unpredictable. "In areas where the H1N1 is endemic, we and our partners and national governments are working to build surveillance systems to identify changes in the behaviour of the virus," he said. "We are also focusing on early-response capacity to reduce the potential threats to human health," Shin added.

Since 2003, outbreaks of H5N1 have been reported in poultry flocks in 60 countries in Asia, Europe and North Africa, leading to the culling of millions of birds.

H1N1 Spreading Eastward, WHO Says

Monday, November 23, 2009

The H1N1 (swine flu) virus appears to be spreading eastward across Europe and Asia, after appearing to have leveled off in the U.S. and some western European countries, the WHO said Friday, Reuters reports. "Typically seasonal influenza always starts west and moves eastwards," said Anthony Mounts, of the WHO. "It seems to be following that pattern except it is coming very early this year." In central and South America, the number of flu cases continues to decline, with the exception of Peru and Colombia, WHO said, according to Reuters (Nebehay, 11/20).

The number of new H1N1 cases in the U.S. appears to have slowed, U.S. health officials said Friday, Agence France-Presse reports. "We are beginning to see some decline in influenza activity around the country, but there is still a lot of influenza everywhere," said Anne Schuchat, of the CDC (11/20).

"The number of states reporting widespread activity of the H1N1 virus dropped to 43 from 46 in the past week, and activity fell in all 10 regions of the country, according to the federal Centers for Disease Control and Prevention," the Washington Post reports in a second story (Stein, 11/21).

"It is so early in the year to have this much disease," Schuchat said at a news conference, the Wall Street Journal reports. "We don't know if these declines will persist, what the slope will be, whether we'll have a long decline or it will start to go up again" (McKay, 11/23). The New York Times reports on additional signs the H1N1 virus has peaked in the U.S., including declines in the number of H1N1 diagnostic tests since October and totals of college students infected with the virus (McNeil, 11/20).

AsiaNews.it reports on the rising number of H1N1 cases in Sri Lanka, leading to the closure of all schools in the Central Province of the country on November 23 (11/20).

Washington Post Looks At H1N1 In Eastern Europe

The Washington Post examines how countries in Eastern Europe are responding to the uptick in the number of H1N1 cases. "As the pandemic H1N1 influenza surges with the onset of winter, the nations of Eastern Europe and the former Soviet Union appear particularly vulnerable to the deadly virus. Burdened with weak health-care systems, relatively inexperienced news media outlets and shaky governments that have little public trust, the region also seems ripe for panic and political strife over the flu," the newspaper writes. "The potential for trouble is already on display in Ukraine, where 1.5 million of its 46 million people have had diagnoses of flu and respiratory illnesses since the start of the outbreak and 356 have died, according to the government" – the WHO suspects many of theses cases were caused by the H1N1 virus.

The article examines how politics have weighed into the government's response to the H1N1 outbreak and details "one of the weakest health-care systems in Europe" (Pan, 11/21).

Health Authorities Examine Reports Of Mutated H1N1

Samples of the H1N1 virus obtained by two patients who had died from the disease in Norway contained a mutated form of the virus, the WHO said Friday, Agence France-Presse reports. Health authorities also detected the mutated form of the virus in a third Norwegian patient with severe symptoms of the flu. "However, [the WHO] stressed that the mutation did not appear to cause a more contagious or more dangerous form of A(H1N1) influenza and that some similar cases observed elsewhere had been mild," the news service writes (11/21).

Additionally, "[f]ive patients at a hospital in Wales contracted swine flu that resisted treatment with Roche Holding AG’s Tamiflu, and three more infections are being analyzed, the U.K. Health Protection Agency said [Friday]," Bloomberg reports. The article adds details about the patients and comments from health experts on virus mutations (Cortez/Stigset, 11/20).

Also on Friday, U.S. health experts reported they were investigating what appeared to be Tamiflu-resistant H1N1 among four patients at Duke University, USA Today reports. "Doctors say investigations of the … hospital outbreaks are underway, but the preliminary genetic evidence suggests that the virus spread among patients at the hospitals," according to the newspaper. "If Tamiflu-resistant virus spreads widely, swine flu will become tougher to treat and may cost more lives, says Duke's Daniel Sexton, who is leading the hospital's investigation," the newspaper writes (Sternberg, 11/20).

Saudi Health Officials Announce First Deaths From H1N1 During Hajj

"Saudi health officials announced the first deaths from swine flu of this year's annual pilgrimage to Mecca, as four pilgrims succumbed to the disease soon after arriving in Saudi Arabia, the Associated Press reports (11/22). "An Indian man, a Moroccan woman and a Sudanese man -- all aged 75 -- died from A(H1N1), as had a 17-year-old girl from Nigeria, Saudi health ministry spokesman Khaled al-Marghlani said," Agence France-Presse reports. All patients are reported to have had preexisting conditions (11/21).

H1N1 Deaths Rise in Europe; Toll Below Seasonal Flu (Update4)

Nov. 23 (Bloomberg) -- Swine flu deaths have doubled almost every two weeks since mid October in Europe, with 169 occurring in the past week, the European Center for Disease Control and Prevention said.

Across the region, 670 people infected with the new H1N1 influenza strain have died, the Stockholm-based ECDC said today in a report on its Web site. Cases are being reported in all European Union and European Free Trade Association countries.

“While the most deaths have to date been in Western Europe, there are increasing numbers of deaths being reported from Central and Eastern Europe,” the ECDC said in its daily report.

Europe’s toll accounts for a tenth of the fatal cases reported globally by the World Health Organization last week and so far is a fraction of the 40,000 to 220,000 deaths that the ECDC estimates are caused by seasonal flu in the region each year. Unlike the usual winter strains that predominantly kill the frail elderly, swine flu is targeting younger people who rarely succumb to influenza.

No accurate data are available to compare the number of hospitalizations and deaths caused by swine flu and the number that occur due to seasonal influenza, said John Paget, an epidemiologist at the Netherlands Institute for Health Services Research in Utrecht who monitors flu patterns for the WHO’s euroflu.org.

Thousands Hospitalized

The pandemic strain, which causes little more than a sore throat, fever and a cough in the majority of cases, has hospitalized more than 4,400 people in Europe to date, according to the ECDC.

H1N1 accounts for more than 99 percent of flu samples tested in Europe, indicating the pandemic virus has supplanted seasonal strains in the region, Paget said in a telephone interview last week. More than 19,000 specimens were positive for H1N1 in Europe during the week ended Nov. 15.

“Normally in flu a season we would have a maximum of 3,000,” he said. “We have never seen so many positive specimens reported per week since 1996, when we started collecting data.”

The U.K. has 180 H1N1 patients in intensive care units, France has 81, the Netherlands 38, Norway 24 and Ireland 20, ECDC said.

Italy, Norway and Sweden reported a “very high intensity” of influenza-like illness or acute respiratory illness in the past week, the ECDC said. Intensity was “high” in Bulgaria, Denmark, Germany, Iceland, Ireland, Lithuania, Luxembourg, Poland and Portugal. The remainder reported predominantly “medium” intensity, it said.

The peak of infections has probably occurred in some countries such as Belgium and Ireland, Paget said. In Belgium’s worst week, flu cases reached the fifth highest in a decade, while Ireland’s peak was the highest in about 10 years, he said.

“We are not seeing spectacularly high ILI rates if you look at historical data,” Paget said.

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

Last Updated: November 23, 2009 10:06 EST

Canada: Doctors issue caution in using antivirals for H1N1 Experts fear overuse may make the drugs useless long term

By Sharon Kirkey, Canwest News Service
November 23, 2009

As public health officials urge more rapid use of antivirals for H1N1, some experts worry the drugs could become over-prescribed for what is a relatively mild illness in most people.

More than one million antiviral doses have been drawn from the federal stockpile in recent months, and the number of prescriptions filled by Canadian retail drugstores for Tamiflu and Relenza, the frontline drugs being used in the pandemic, nearly doubled between September and October.

As of Oct. 30, 151,688 prescriptions had been dispensed by retail pharmacists nationwide so far this year -- an increase of 73,291 prescriptions over September, according to prescription-drug-tracking firm IMS Health Canada.

Nationally, the number of visits to doctors for flu-like symptoms are at levels not seen in 12 years.

The World Health Organization is recommending that people in at-risk groups, including pregnant women, children under two and those with underlying conditions such as asthma, be treated with antivirals as soon as possible when they have flu symptoms, and that people without risk factors should also be treated if their symptoms worsen or persist.

WHO says healthy people experiencing mild illness don't need antivirals. But the WHO warns the virus can cause severe pneumonia even in healthy young people.

"The window of opportunity is very narrow to reverse the progression of the disease," Dr. Nikki Shindo, a medical officer in WHO's Global Influenza Programme, said in a recent briefing.

"The medicine needs to be administered before the virus destroys the lungs." WHO is urging doctors not to wait for lab-confirmation before deciding to treat. Tamiflu, or oseltamivir, needs to be given within the first 48 hours of infection to be optimally effective.

"It's a bit of catch-22, when the best impact of the oseltamivir is if you give it early. And yet we're not suggesting that the huge majority of people get oseltamivir," said Dr. Brian Ward, an infectious-disease physician and associate director of The Research Institute at McGill University Health Centre.

"Most of the people who have true influenza should not be prescribed oseltamivir," Ward said.

The drugs can cause nausea and vomiting, and widespread use could lead to H1N1 developing resistance to the only effective antivirals available.

"Really, the cutoff is clinical symptoms out of proportion for what you would expect for routine influenza," Ward said.

He had H1N1 in the summer, "and I very specifically did not take oseltamivir. I didn't want to spread a resistant bug to my children and family. And I had flu. I didn't have unexpected symptoms.

"We should be reserving the oseltamivir for people who are presenting with unusual symptoms." For most people, that would be unexpectedly or surprisingly severe respiratory distress, he said.

"In a very young child, it would be rapid onset of very high fever with respiratory distress . . . or an older child who does OK for a day or two -- so muscle aches, headaches, a little bit of cough -- who suddenly starts having difficulty breathing." In addition, for children with asthma, the threshold for starting Tamiflu "is way, way lower" than it would be for an otherwise healthy child, Ward said.

According to Health Canada, Tamiflu has been shown to reduce the symptoms of illness by, on average, 1.3 days, or 30 hours. An average course of flu lasts approximately five to seven days.

"For the normal flu, they generally cut between a half a day and a day off of the length of symptoms," said Dr. Joel Lexchin, a professor in York University's School of Health Policy and Management.

"If we prescribe them for people with relatively mild flu, and the virus develops resistance, then they wouldn't be of very much use for people with severe cases of H1N1."