Swine Flu Shot in U.S. May Rely on Emergency Use of Additives

July 29 (Bloomberg) -- Swine flu vaccine makers may rely on a U.S. emergency declaration to use experimental additives made by GlaxoSmithKline Plc and Novartis AG to boost a limited supply of shots that will be available to fight the pandemic.

The ingredients, known as adjuvants, may be added for the first time to flu shots in the U.S. Health officials, meeting today at the U.S. Centers for Disease Control and Prevention in Atlanta, plan to discuss use of the additives, and may also recommend who should be first to receive the limited amount of vaccines drugmakers say they will begin delivering in October.

The U.S. Health and Human Services Department declared a public health emergency over swine flu in April, and the Food and Drug Administration has the power to allow the use of unapproved medical products during such a crisis. The U.S. has been slow to approve the use of adjuvants because of safety concerns, and for fear of giving Americans an excuse to avoid getting the shots, said John Treanor, a University of Rochester researcher.

“The question is, do you really feel comfortable throwing this new thing into the mix and do you really need to?” said Treanor, a professor of medicine, microbiology and immunology at the school in Rochester, New York. “I myself, if I had to do it, would really wrestle with that decision.”

The CDC agreed to pay London-based Glaxo and Novartis, based in Basel, Switzerland, more than $415 million for adjuvants that could be added to the swine flu vaccines, according to a July 13 statement.

Mice Studies

A safety concern was raised in 2004 when researchers at the University of Florida in Gainesville reported that mice injected with oils used in the adjuvants developed conditions of the type that occur when the body’s immune system produces an excessive protective reaction. Similar reactions haven’t been seen in humans.

MF59, made by Novartis, has been given to more than 40 million people, mostly adults, to prevent seasonal flu, according to the company. Glaxo’s adjuvant has proven safe and effective in clinical trials with 39,000 people, said Lisa Behrens, a spokeswoman for the company, in an e-mail. Glaxo will conduct more studies and continue to monitor safety after the vaccines are in use, she said.

Under the U.S. health emergency, the FDA may authorize the use of unlicensed vaccines, according to Peper Long, an agency spokeswoman. The FDA convened an advisory committee July 23 to consider what trials are necessary for the vaccines’ approval. Advisory committees consist of medical experts who provide guidance to the agency.

Race to Make Shots

Swine flu’s full force may reach the U.S. earlier than the typical flu season, according to the CDC. Vaccine makers are racing to make shots by mid-October, when cases are expected to rise in the northern hemisphere, fueled by cooler temperatures and the return of pupils to close quarters of classrooms.

The World Health Organization, based in Geneva, has said the H1N1 influenza, as the pandemic flu is known, is moving with “unprecedented speed.” The flu spread farther globally in less than six weeks than previous pandemics have in more than six months, the Geneva-based agency said on its Web site on July 17. Global health authorities have stopped counting the number of cases and the CDC says more than 1 million people Americans have been sickened by the virus.

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

Mixing Oil, Water

The adjuvants are mixes of oil and water that -- by stimulating the immune system -- offer a way to boost the body’s response to antigen. Adjuvants, whose effectiveness vary by flu strain, may boost the strength of the antigen as much as 10- fold, as was the case with a bird flu vaccine approved in Europe, said Treanor, of the University of Rochester. By adding an adjuvant the same amount of antigen can be used to treat more people, he said.

“Until GlaxoSmithKline and Novartis can show me it won’t harm a rat or guinea pig, I think it’s a bad idea to give it to humans,” Vicky Debold, a registered nurse with a Ph.D. in public health, who is a member of the FDA’s advisory committee for reviewing vaccines, said July 27 in an interview.

‘Tremendously Well’

The U.S. never had to consider the risks of an adjuvant because regular flu vaccines were deemed to have “worked so tremendously well,” said Lone Simonsen, research director in the department of global health at George Washington University in Washington.

“We have had a safe experience with the MF59-adjuvanted vaccine in Italy and Spain for many years now,” Simonsen said. “That experience we can lean on. That’s going to be the best data we have in time for using adjuvanted vaccines.”

CSL Ltd., which has a $180 million order to supply bulk H1N1 antigen to the U.S. government, decided against boosting its vaccine with an adjuvant, preferring to use a formulation more closely resembling the seasonal flu shot, said Mary Sontrop general manager of the Melbourne-based company’s biotherapies unit.

The U.S. has contracts with five companies to provide flu shots. Novartis, based in Basel, Switzerland, is responsible for 45 percent of the supply, while Sanofi will provide 26 percent and CSL will make 19 percent, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, in an interview last week.

The remaining doses will be made by Glaxo and London-based drugmaker AstraZeneca Plc.

To contact the reporters on this story: Tom Randall in New York at trandall6@bloomberg.net; Gary Matsumoto in New York at gmatsumoto@bloomberg.net.

Last Updated: July 29, 2009 00:01 EDT

Global trade system raises virus's threat

By Tom Corwin | Staff Writer
Wednesday, July 29, 2009


ATHENS, Ga. --- An international gathering of influenza and immunology experts shared promising research Tuesday on how the immune system reacts to flu and potential new approaches to combating it.
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But one public health expert also issued a dire warning about the coming impact of the novel influenza A H1N1 pandemic and potentially devastating disruptions to worldwide trade.

The University of Georgia played host to the third annual Immunobiology of Influenza Virus Infection conference. The conference shifts annually between UGA and Emory University in Atlanta because the two collaborate in the Influenza Pathogenesis and Immunology Research Center, one of six national Influenza Centers of Excellence funded by the National Institutes of Health and the National Institute of Allergy and Infectious Diseases.

The regional lab allows "real-time" research on the novel virus and its impact on patients, and the conference presents opportunities to build on what is happening now, said Ralph A. Tripp, associate director of the center.

But even groundbreaking work might not be sufficient to combat the problems the flu poses for the U.S., said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy and the Minnesota Center for Excellence in Influenza Research and Surveillance.

A big part of the problem is the globalization of trade and the "just in time" ordering of supplies, where things are shipped as needed to cut down on warehousing. Many items must be shipped from Asia, where widespread flu vaccination is not likely. A significant number of cargo ship crews getting sick could put a serious dent in the supply chain, Dr. Osterholm said.

"Right now, they're on nobody's radar screen," he said.

The same goes for medical supplies and even basic generic drugs such as insulin or albuterol, which often rely on international shipping, Dr. Osterholm said.

"Supply chains are incredibly thin and vulnerable," he said. And though the U.S. has ordered millions of doses of the novel H1N1 vaccine, which officials hope will be ready this year, it might require two shots, which would cut in half the number who get vaccinated, Dr. Osterholm said.

"Even under the best of circumstances, don't count on a lot of people getting vaccinated."

And it is probably too late to correct these things, he said.

There were some glimmers of hope. Testing of antibody responses found that 34 percent of those born before 1950 had a significant response against the new virus, possibly from having a previous flu strain that carried similar antigens. But it is unclear whether that will provide them protection against the new strain, said Jackie Katz, the chief of immunology and pathogenesis in the Influenza Division of the U.S. Centers for Disease Control and Prevention.

And there is some concern that the elderly might think they don't need the flu vaccine this year, Dr. Katz said.

"I think it is an important public health message, especially for that older age group, that they still do need seasonal influenza vaccine," she said.

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.
hat-tip Chuck

Thailand reports 21 more swine flu fatalities

Published:

07.29.09, 12:18 / Israel News

Thailand announced Wednesday it has recorded 21 more swine flu-related deaths over the past week, bringing the total number of fatalities to 65.

"The fatal cases have involved those who have prior medical conditions, those with weak immune system and some who sought treatment late," said the ministry's Deputy Permanent Secretary Paijit Warachit. The number of people infected with swine flu jumped to 8,877 from 6,776, he said. (AP)

Thai baby born infected with swine flu

Published: 4:22PM Tuesday July 28, 2009


Thai health officials said on Tuesday that a baby had been born in Thailand with H1N1 swine flu having contracted the virus while still in the womb.

The baby was born prematurely on Saturday, when doctors decided to deliver it by caesarean section seven months into the pregrancy of a 24-year-old mother who was found to be infected with the flu virus.

"The baby is stable. We are now figuring out how it got infected. This is the only case of infection from mother to unborn baby that we have had," said Dr Suriya Coohahrat, a senior health official in Ratchaburi province, where the woman was first admitted to hospital.

The mother is still very ill in hospital.

Another doctor was quoted in local media as saying three cases of mother-to-child transmission of H1N1 had been reported in the United States.

Thailand had reported 44 deaths from H1N1 and more than 6,700 infections as of July 22, the highest number in Southeast Asia.

The Nation newspaper reported that the Public Health ministry would announce the death toll had risen to 66 at its weekly update on Wednesday.

The World Health Organisation declared an H1N1 influenza pandemic on June 11.

The new virus has killed more than 800 people worldwide since it emerged in April.
hattip Kumerakid

Pregnant Women Hit Hard With Swine Flu, Likely to Be Among First to Get Vaccinated

Tuesday, July 28, 2009

• Swine flu has been hitting pregnant women unusually hard, so they are likely to be among the first group advised to get a new swine flu shot this fall.

Pregnant women account for 6 percent of U.S. swine flu deaths since the pandemic began in April, even though they make up just 1 percent of the U.S. population.

On Wednesday a federal vaccine advisory panel is meeting to take up the question of who should be first to get swine flu shots when there aren't enough for everyone. At the top of the list are health care workers, who would be crucial to society during a bad pandemic.

But pregnant women may be near the top of the list because they have suffered and died from swine flu at disproportionately high rates.

"Are they more at risk for severe disease? That's the issue," and it appears they are, said Dr. Denise Jamieson, an epidemiologist with the U.S. Centers for Disease Control and Prevention.

Pregnant women's risk from swine flu has been a raging topic in Europe, following the contentious suggestion this month by British and Swiss health officials that women should consider delaying pregnancy if they can.

Most health officials call that advice unwarranted, but have agreed that the health risks are significant. In a recent report, World Health Organization experts found that pregnant women appear to be "at increased risk for severe disease, potentially resulting in spontaneous abortion and/or death, especially during the second and third trimesters of pregnancy."

However, so far, WHO has not recommended that pregnant women get priority vaccinations.

Now doctors are waiting to see what's decided by the Advisory Committee on Immunization Practices, whose guidance usually is accepted by the CDC and influences doctors and insurance coverage.

For more than a decade, the committee has recommended that pregnant women get vaccinated for seasonal flu, which is considered a serious threat even to pregnant women who are young and healthy. Pregnant women are unusually vulnerable — especially in the third trimester — due to changes in the lungs and immune system that make it harder for them to shake off respiratory infections, said Dr. Kevin Ault, an Emory University obstetrician.

CDC data indicate swine flu is at least as dangerous. Of 302 U.S. deaths attributed to swine flu to date, the CDC has detailed information on 266 of them. The agency has found that 15 of the 266 were pregnant women — or about 6 percent.

The first American with swine flu to die was a pregnant woman in Texas. Judy Trunnell, 33, died May 5 after slipping into a coma and giving birth to a healthy baby girl, delivered by Cesarean section.

Some infected pregnant women have other health problems. Trunnell, for example, also had asthma and the skin condition psoriasis. But many of the pregnant women who died were considered relatively healthy, suggesting pregnancy itself is a significant risk, Jamieson said.

"I think the whole concept that this flu only affects pregnant women with underlying medical conditions is incorrect," Jamieson said.

Experts believe an effective vaccine would benefit not only a pregnant woman but also her unborn child.

Infants, whose immune systems are weak, should not get a flu shot until they are at least 6 months old. So whatever immunity they have is passed on to them by their mothers, doctors say.

The belief in the protective powers of a mother's vaccination on their unborn children was demonstrated in a study of women in Bangladesh published last year in the New England Journal of Medicine. It found that flu shots given to pregnant women reduced flu in infants by 63 percent.

Only about 15 percent of pregnant women get seasonal flu shots, experts noted, so it's not clear how many will get the new shot.

Some women avoid regular flu shots, worried about possible risks to the fetus, but studies have not shown any increased dangers from the shot.

Until recently, many obstetricians haven't offered them, choosing to avoid the expense of buying and storing vaccine and the hassle of trying to convince reluctant patients, said Dr. William Schaffner, a Vanderbilt University flu expert.

"Obstetricians are only now getting with the program and are growing comfortable with administering flu vaccine," he said.

It's not clear that the demand for swine flu shots would be much greater. Pregnant patients haven't expressed much concern about swine flu, said the CDC's Jamieson, who is also an obstetrician seeing inner-city patients at Atlanta's Grady Memorial Hospital.

"It hasn't been a major concern," viewed as a relatively mild illness. They worry more about economic concerns — "how to take care of the baby, how to get food to eat and how to get safe and secure housing," Jamieson said.

So far, swine flu has likely infected more than 1 million Americans, the CDC believes, with at least 300 deaths.

The United States expects to begin testing swine flu vaccines on some volunteers in August, and predicts 160 million doses may be ready by October.

Japan reports 3rd case of resistant swine flu

TOKYO - Japan has found a third case of Tamiflu-resistant swine flu in a man who had taken the drug to prevent infection, the Tokushima prefectural office said Tuesday.

Just six cases of Tamiflu-resistant swine flu have been reported worldwide.

Six cases of Tamiflu-resistance have been reported worldwideIn a statement, the prefectural health department said the man in his 30s was given Tamiflu after his colleague was infected with the virus this month. The Tamiflu-resistant strain does not appear to have spread beyond the man, who has recovered, the prefectural health department said.

Preventive use of Tamiflu has occasionally given rise to resistant viruses, including those of seasonal flu.

Denmark, Hong Kong and Canada also have reported one case each of Tamiflu-resistant swine flu.

Vietnam: Two cases of severe complication of influenza A/H1N1 infection

[A little more on the 2 patients with complications]
Excerpt:
28/7/2009
Treatment of half a month is not healthy patients

2 more schools in Vietnam have students influenza A/H1N1 infection - Mobilizing 100% hospital participation in TPHCM receiving treatment patients

27-7 days, the doctor Tran Tinh Hien, Deputy Director of Hospital (BV) TPHCM tropical disease, that has 2 more schools in Vietnam have students influenza A/H1N1 infection. Notably, it appears the case of patients with severe complication of influenza A/H1N1 infection.
-snip--

According to doctors Hien, it is worrying appear 2 patients with severe complication of influenza A/H1N1 infection. Both cases (one male, one female) and have indicated to TPHCM BV tropical disease doctor, treatment. Recognition of BV found that for male patients, to hospital after treatment and one day flu, health has returned to normal. However, to date 3, the disease status of patients to this serious, the doctors and taken to detect lung damage was heavy. "It can be affected by the long phrase, but not patients treated early should lead to complication" - Hien doctors predicted. Female cases was 5 months pregnant, due to the weak resistance when infected with influenza should not determine the exact extent of influence for the fetus but the amount will certainly tends not good. At two patients being treated for tracking active.

In addition, it appears the patient must be treated long ... Specifically, a patient (indicated TPHCM) half a month of treatment, but not healthy patients, 2 patients treated abroad to 9th, but test results are still subject patients with positive influenza virus this. According to doctors Hien, a normal flu infected patients treated for 3-4 days results are negative.
-snip-

Vietnam: Patients had serious complication

28/07/2009 09:49
* 2 patients foreigners suspected drug Tamiflu resistance

Influenza virus has increased in power?

Yesterday afternoon 27 / 7, the doctor Tran Tinh Hien - PGDBV TPHCM Tropical Diseases, said, hospitals are treating 80 patients for influenza A/H1N1 infection, including 8 of the foreigners. However, the most anxious to have you here appear in patients with severe complication. It is a male patient who has hospital treatment during the 9 days from now infected and influenza A/H1N1 complication severe pneumonia.

At first patients treated about 3 days then the fever, but after that the fever and accompanied by pneumonia. BV has determined this is the complication of severe A/H1N1 infected by the first BV Tropical Diseases recorded.

In addition, BV Tropical Diseases TPHCM also recorded the suspect drug Tamiflu resistance when 2 foreign patients treated to 9th but still positive for H1N1. Specifically, a patient indicated TPHCM treatment was 14 days but not from making BV Tropical Diseases had to redirect treatment. "Normally a patient treated for 3-4 days for negative results when the treatment time lasts more than 1 week are positive to have found the time to clean the virus slowly," Dr. Tran Tinh Hien confirmed.

Recognition of the NNVN that Ch Tropical Diseases has received treatment for a pregnant woman in first 5 months were influenza A/H1N1. Thai effects are manifestations of cough, fever BV to be tested this month and 4 days for positive results for influenza A/H1N1. There is additive pregnancy active treatment and no assessment of affect pregnancy. Before this poor place, Dr. Tran Tinh Hien salary, up to Vietnam may have died because of influenza A/H1N1.

3 more schools gotten flu

Also in yesterday, a student High School Building (on page Nơ Long, Binh Thanh District) has been officially identified with positive influenza A/H1N1. Initial investigation showed that, before the disease, students have to drink coffee and chat in the Internet service area shore scratch Language Dang Van. Then out of the rain and cold having fever, then the test at the Pham Ngoc Thach BV for the positive results for influenza A/H1N1.

Up to yesterday afternoon, girlfriend of students also have manifestations of high fever and was conducted in isolation, test flu. Am now 27 / 7, the high school construction was red alarm, prohibits all students to school, and implement isolation now 32 students in class with this patient. At the health sector has the 5 students of the high body temperature. BGH by the school, before detection of the disease, the school has 900 students are studying. In addition, parents and brother of the patient is also being conducted in testing.

The same day, Ho Chi Minh City Department of Health has confirmed an additional 1 student private high schools Germany Hong (Tan Binh) influenza A/H1N1 infection. It is the student Tran Thanh Tr., 14 years old. After receiving this information, although not more recognition of influenza A/H1N1 infection, but any school BGH Germany Hong decision temporarily close the school. The Department of Health Daklak province on 27 / 7 also confirm 1 students attending private school in Thai Binh (Tan Binh District, HCMC) positive for HPAI H1N1. Students develop this disease after 2 days of his TPHCM lánh flu but then has the disease. At the Thai Binh has 200 boarding students and is temporarily closed (before the students of this disease) to students free to leave.

Recognition of NNVN that to the 27 / 7 has 8 students, 1 teacher and 1 staff RMIT University Vietnam (Q.7) positive for influenza A/H1N1. This is chùm flu from 22 / 7 the Department of Health TPHCM not timely blockade, but to prevent the school temporarily closed for students free home. Chùm flu at separate high schools private boarding Nguyen Khuyen (Tan Binh) had 10 students have influenza A/H1N1 and secondary schools in The Times Ngo (Q.9) also had 10 more children positive influenza A/H1N1 , raising the total to more than 90 infected children.

Institute of Hygiene epidemiological Central 27 / 7 has been officially confirmed case of death of a patient named T. live in Ky Tien, Ky Anh district, Ha Tinh province non influenza A/H1N1 and influenza A/H5N1.

Anh T. many epidemiological factors, clinical symptoms similar to influenza by influenza A/H1N1 and A/H5N1 tests but official results were negative.

Vietnam: 4 Suspected H5N1, 1 Pos. for H1N1, 3 Neg., which 1 Died

[This excerpt is in the box at the bottom of the article]

"Flu A/H1N1 will carry to Hanoi in the coming time" (28/7/2009)

In 4 patients of influenza A/H5N1 infection in Ha Tinh, one patient was identified with influenza A/H1N1 infection. 3 remaining patients with negative results, in which a person has died.

As VietNamNet has information, Ha Tinh 4 of infection of influenza A/H5N1. 25/7, Health Center for Ha Tinh 4 product samples sent to the disease epidemiology of central test.
On 27 / 7, information from the Department of Health, Ha Tinh province, said Nguyen Thi patients Dao new city. City of Ha Tinh have positive results for influenza A/H1N1.

Patients Nguyen Thi Dao (SN 1962) in his hamlet 3, in Tien Ky, Ky Anh (Ha Tinh) and currently working in Vietnam, about his days playing 21/7.
At Dao patient isolation being treated at the Faculty contagious - Art vie protected Ha Tinh.
As soon as Ha Tinh patients are positive for influenza A/H1N1, the morning of 27 / 7, Nguyen Thien, Deputy Chairman of Ha Tinh People's Committee held an emergency meeting the Steering Committee and to prevent the proposed the preventive areas.

Leaders of Ha Tinh province has directed the investigation to find the vehicle that patients Nguyen Thi Dao from Vietnam went to Ha Tinh to check and monitor the health of people go to the car.

Vietnam: Tamiflu is still the drug treatment of influenza A/H1N1 effective

This is confirmed by a Department Director Department of Management, the Ministry of Health - Mr. Truong Quoc Cuong - in writing the number 875 was issued today, 27 / 7.

According to Department of Pharmacy Management, said the report by the World Health (WHO), the world, only with Denmark, Hong Kong, Japan found the resistance to the drug Tamiflu. Meanwhile, in Vietnam, according to a report by the Institute of infections and tropical Country, it is still no clinical evidence specific for influenza A/H1N1 virus shows drug resistance to Tamiflu.

However, in some cases certain, the treatment with Tamiflu can do a longer immunity and treatment of the virus except for the body.
So far, WHO and the medicines management Europe (EMEA), the management of food and medicines USA (FDA) has not notified a change is the use of Tamiflu (Oseltamivir) in the exposed control therapy for patients with influenza A/H1N1.

Therefore, Department of Management, the Ministry of Health requesting the function, the treatment, the hospital treating influenza A/H1N1 patients need extensive propaganda, dissemination of more effective Results of Tamiflu (Oseltamivir) in treatment of patients with influenza A/H1N1.

Department of Management recommended all information related to this is not propaganda for the people not get the confirmation of state management on health.

In addition, the treatment and people were influenza A/H1N1 must be strictly the instructions of the BS using Tamilu to avoid the situation occurring drug resistance is not necessary.

Vietnam: 60 of influenza A/H1N1 infection in 1 day

(Dân trí) - Mr. Nguyen Huy Nga, Director Department of Department of Health and Environment (Ministry of Health), said, on 27/7/2009, Vietnam has recorded 60 more cases positive for influenza A / H1N1.

This is the number of patients with influenza A/H1N1 best record from Vietnam confirmation of positive influenza A/H1N1 first. Earlier, on 26/7/2009, Vietnam has recorded 45 more cases positive for influenza A/H1N1.

In total 60 of the new record, 52 songs in the South, 4 in the Central and 2 in the Central Highlands. Thus, up to 17h00 on 27/7/2009, Vietnam has recorded 672 positive cases, no deaths.

Number of patients was 375 members, 297 cases are currently being re-isolation, treatment at hospitals, treatment facilities, monitoring community health status is stable, without serious complication.

"In the flu" The Times Ngo Binh Duong carry on
"Until today (27/07) in the province of Binh Duong has detected 3 students of the school Ngo Thoi Nhiem and 4 people have positive results for H1N1," she Luong Le Thi Hong, Director of the center health care for that.

After the outbreak at the school Ngô Thời Bùng TPHCM of the number of students throughout the district in Binh Duong province is 90 children. Get a list of students to this, Medical Center for provinces with official guidance to health departments of district and commune request medical centers associated with the district health centers in the district, town implemented the monitoring advice, guidance and prevention in the community for all students on the same people in the region.


Currently the province has 7 cases positive with H1N1, of which, 3 students of the school Ngo The Times is now being treated in hospital Di An district.

Four cases including 2 of his children and D.TB D.TN at Tan Phuoc Khanh, Tan Uyen (D.TB by his business in the U.S.). After a week of treatment, the two children he was D.TB discharge. NTL children infected by contact with sick brethren at The Times Ngo. And the last is after raising children carrying the disease in Ba Ria - Vung Tau on. The patients being in isolation Hospital in Binh Duong province. So all cases infection above have a common factor that has direct contact with sources of disease.

In addition, there are 7 students University Natural Science with clinical manifestations of the HPAI H1N1 is monitoring, isolation in this hospital.
Dr. Nguyen Duc Minh Hung, Faculty contagious - Hospital Binh Duong, said: "Each day in the hospital receiving hundreds of cases to examine and test HPAI H1N1 ... people in the province is carrying wild Previous events complicated by this disease. "

Influenza A/H1N1 has to Ha Tinh

(VTC News) - A patient positive for influenza A/H1N1 in isolation treatment, a patient exposed to harmful infections A/H1N1 has died although no test results. An emergency meeting was Ha Tinh summoned in this morning.

24 / 7, Vo patients in the Tam Ky Tien, Ky Anh district transferred to General Hospital in Ha Tinh province with symptoms of difficulty breathing, non, headache, pain in the joints and dubious status.

Immediately form's disease patients were taken to the test. While awaiting the results the morning of 26 / 8, the patient has died Tam.

Previously known Tam patients have been exposed to a patient from Ho Chi Minh is Nguyen Thi Dao. Guidance has been confirmed as infected with influenza virus A/H1N1.

Immediately after appearing patients infected influenza virus A/H1N1 in the province, the health sector has focused on treatment for patients, isolation of cases at risk of infection, conducted resolvent coincides khử .

On 27 / 7, under the lead of the People's Committee Vice Chairman Nguyen Thien province, the Steering Committee flu A/H1N1 Ha Tinh, have an emergency meeting. Current difficulties in translation and dập in Ha Tinh is no specific means to transport patients, lack of breathing machines, which lack in body temperature, lack of ultrasound machine working ...

Vietnam: Total Cases SF: 672; Last Count 7/25: 567

Am 27 / 7, take a train from Day HCMC to Hanoi was forced to the station for Hue high fever, which manifests in patients with influenza H1N1. Earlier, also on a different train, 3 cases were detected positive. Building first in Hanoi people are infected with H1N1

Talking to VnExpress.net am 28 / 7, Nguyen Van Truong, Vice-Hanoi railway station for passengers have been detected in the infection of influenza A/H1N1 forced to name the station Le Van Hue cards, native Italy Yen , Nam Dinh, clearly not working or playing in HCMC on. There are still tracking to determine.

Mr. Vice station said this morning, the train station on to Hanoi, Center for Medical, Enterprise car transport and gas Hanoi held spray clean environment both fleet.

According to Deputy gas, even when information is a question of going vessels infected influenza H1N1, corporation Vietnam Railways has directed the gas station that Hanoi established the Steering Committee, construction projects, and the number of active drugs to prevent disease spreading.

However, he was Vice station for the railway sector is not equipped with facilities necessary for the quarantine, so can not control people with signs of infection moving from infected areas in the areas have not. At railway industry are based on the role of the owner of observations, often with eyes to how the glasses have signs of infection.

"Even as cases of H1N1 infection we detected a new light on 27 / 7 station in Hue, also by a report that the Health Center for railway," Mr. Vice-ga straight body.

Le Anh Tuan, Director of the Department of Health Hanoi also said the current health sector monitoring are only forms of transport is a list of addresses and specific (such as airports) is the station, Ben the vessels are difficult to control.

Earlier, on 24 / 7, 3 passengers take the train from HCMC to Hanoi with symptoms of cough, fever, sore throat. Test sample's disease 3 cases were positive for HPAI H1N1 virus.

Presently, Vietnam has recorded 672 positive cases, no deaths.

Xuan Tung

Vietnam: In case of death in Ha Tinh not by influenza A/H1N1 or A/H5N1

Patients have many epidemiological factors, clinical symptoms similar to 2 types of flu, but this official test result negative.

This morning (27 / 7), Nguyen Tran Hien, Director of Institute of hygiene and epidemiology in Central confirmation of the death of a male patient in Ky Tien, Ky Anh district, Ha Tinh province not by influenza A/H1N1 and influenza A/H5N1.

Also in this morning (27 / 7), Institute of Sanitary epidemiological Central for patients infected with influenza A/H1N1 first in Ha Tinh is a woman 47 years old, the hamlet Yen Thinh commune, Ky Tien, Ky district UK. Presently, the Department of Health and Medical Center for Ha Tinh conducted isolation patients to treatment and monitoring, anti-fold region and at the hamlet Yen Thinh, spray chemicals, to restrict influenza A/H1N1 large spread.

Patient is female teacher schools with private Nguyen, Ho Chi Minh City, where outbreak of influenza A/H1N1 in the Tien Ky in 24 / 7. Patients with signs of fever and monitor health at home. 25 / 7, Health Center for Ha Tinh conduct examinations and patient samples sent subject test in about epidemiology Center. Last tested in the epidemiological hygiene Central identify patients with this positive influenza A/H1N1.

Cases patients have died of bowel is you who these women are signs of fever on 22 / 7 and be treated at home to 24 / 7 to be examined, treated at the Faculty Hospital infection Ha Tinh protected status in high fever, severe respiratory failure. Although the emergency treatment of samples and testing for diseases, but too heavy to patients has died in hospital on 26 / 7. In fact, about events and clinical epidemiology of a random match between the male patient deaths and female patients with positive influenza A/H1N1 after returning to the same local time. But test results determined male patient deaths not related to influenza A/H1N1, A/H5N1 flu and not related to patient female teachers High School private Khuyến Nguyen in Ho Chi Minh City. /.

Egypt-Declaration No. 82 of infection with bird flu

Girl from the Kafr El-Sheikh

إعلان الإصابة رقم 82 بأنفلونزا الطيور

الأحد، 26 يوليو 2009 - 21:52

Sunday, July 26, 2009 - 21:52

أكدت وزارة الصحة اليوم، الأحد، إصابة بشرية جديدة بمرض أنفلونزا الطيور لطفلة من محافظة كفر الشيخ ليبلغ إجمالى الإصابات 82 حالة حتى الآن.

The Ministry of Health on Sunday, a new human case of bird flu, a girl from the Kafr El Sheikh is the case of a total of 82 casualties so far.

وأوضح بيان لوزارة الصحة اليوم، الأحد، أن الحالة الجديدة هى للطفلة رانيا أحمد محمد مصطفى من قرية "سيدى غازى" إدارة كفر الشيخ بمحافظة كفر الشيخ.

A statement by the Ministry of Health said on Sunday that the new situation of the girl child is Muhammad Mustafa Ahmed Rania from the village of "Sidi Ghazi," the Department of Kafr El-Sheikh governorate of Kafr el-Sheikh.

وأوضح البيان أن أعراض المرض ظهرت عليها يوم 24 يوليو الحالى وتم إدخالها مستشفى حميات كفر الشيخ يوم 25 يوليو وهى تعانى من ارتفاع فى درجة الحرارة ورشح وكحة عقب تعرضها لطيور منزلية نافقة يشتبه فى إصابتها بمرض أنفلونزا الطيور.

The statement pointed out that the disease developed symptoms on July 24 of this hospital was incorporated in fevers of Kafr el-Sheikh on July 25 with a high temperature, running nose and cough after exposure to dead household birds, suspected of being infected with bird flu.

كما أوضح البيان أنه تم إعطاؤها عقار "التاميفلو" فور الاشتباه فى إصابتها بالمرض وحالتها المرضية مستقرة وتجرى حاليا الاتصالات والإجراءات الخاصة بتحويلها إلى مستشفى منشية البكرى بالقاهرة لاستكمال علاجها.

He also pointed out that the statement was given the drug "Tamiflu" as soon as the suspicion of being infected with the disease and her condition is stable and satisfactory communications are being carried out and procedures for the transfer to the hospital in the capital Cairo for the completion of treatment.

Vaccine for swine flu may be unsafe warns WHO

27.07.09

Plans to fast-track the swine flu vaccine in Britain came under fire from World Health Organisation chiefs today.The Department of Health plans to make the vaccine available at least two months earlier than in America.

More than 132 million doses have been ordered with the first batch due to arrive next month.

However, Dr Keiji Fukuda, the WHO's flu chief, today warned about the potential dangers of the untested vaccine: "There are certain areas where you simply do not try to make any economies. One of the things which cannot be compromised is the safety of vaccines."

The European Medicines Agency, the drug regulatory body for the EU, is accelerating the approval process for the vaccine, allowing firms to bypass large-scale human trials and instead test a vaccine based on bird flu.

Countries including Britain, Greece, France and Sweden plan to start using it as soon as it is cleared.

The Department of Health said it was "extremely irresponsible" to suggest Britain would use an unsafe vaccine. A spokesman said: "Over 40,000 doses of the vaccine which the swine flu vaccines are based on have been given without any safety concerns."

The plan comes amid growing public concern over the outbreak.

A cruise ship packed with 160 British tourists and hit by swine flu was briefly "impounded" by Italian authorities.The Ruby Princess, carrying 3,393 passengers and 1,196 crew, docked in Venice and was surrounded by coastguards yesterday. After a medical examination passengers, except seven confirmed cases of H1N1, were allowed off the boat.

Malaysia confirms 2nd swine flu-related death

7/27/2009, 5:24 a.m. EDT The Associated Press

(AP) — KUALA LUMPUR, Malaysia - Malaysia's health ministry has confirmed the country's second swine flu-related death.

The ministry says the a 46-year-old Malaysian man was working in Belgium but came back for a vacation with his family earlier this month. He died of pneumonia and respiratory failure Sunday after being hospitalized for a week.

The ministry said in a statement Monday that the man tested positive for the H1N1 virus.

Malaysia has reported 1,124 swine flu cases since the outbreak began in this country in May.

Int’l Swine Flu Conference to be held in Washington, DC, August 19-20

Date : 07/27/2009 @ 6:00AM

Int’l Swine Flu Conference to be held in Washington, DC, August 19-20

The International Swine Flu Conference will occur in Washington, DC on August 19-20 to be followed by all day hands-on workshops. New Fields officials announced today. The event will be held at the Hyatt Regency Washington DC on Capitol Hill, August 19-20 and the workshop on the 21st. The ongoing Swine Flu pandemic proved that now more than ever health, education, government, non-profit organizations, and business executives need to discuss and share best practices and lessons learned during this ongoing first pandemic in the age of globalization and prepare for the possibility of a more sever outbreak of H1N1 flu this fall. With delegates from Tribal, local, state, federal and 32 countries already confirmed, the ISFC will provide a platform for public health officials and community stakeholders to come together, to network and exchange preparedness and response efforts. Special emphasis will be placed on identifying the responsibilities of various stakeholders in order to improve global communication coordination and collaboration. “ISFC present a clear, easy-to-remember overview of prevention, preparedness, response and recovery,” said Ahmed Farajallah, vice president, events and conferences, New Fields. “Enough listening. The rest is hands-on experience.” To further prepare for possibility of more sever swine flu outbreak, each day of the conference will offer papers on a wide range of topics including: Preparing Community Strategies Local Partnership and Participation Delivery of Vaccine and Antiviral Medication Emergency Response and Hospital/Healthcare Coordination Prevention Education Efforts and Risk Communication Command, Control and Management Business Community’s Role Over 20 breakout sessions will be offered addressing a wide range of issues, including: Breakout 1. Mass Fatality Management Planning Breakout 2. Business Continuity Planning Breakout 3. Continuity of Operations (COOP) and Continuity of Government Planning Breakout 4. Emergency Management Services Breakout 5. Law Enforcement Agencies Breakout 6. First Responders: Fire Department Breakout 7. First Responders: Public Works Breakout 8. 911 Call Center Services Breakout 9. Hospital and Emergency Medical Services Breakout 10. Workplace-based Planning Breakout 11. Community-Based Planning Breakout 12. School/University Planning Breakout 13. Airlines, Travel, Airport, Quarantine and Border Health Services Breakout 14. Infectious Medical Waste And many more… Registration: The 2-day event is open to all interested governmental agencies, organizations, and businesses from all countries. To register, Call us at 202-536-5000, or download a registration form: www.new-fields.com/isfc/registration.pdf. Complete and fax to 202-280-1239. Those interested in making presentations related to the Swine Flu or pandemic preparedness, please contact our research department by e-mail at Research@new-fields.com. About New Fields: The International Swine Flu Conference is organized by New Fields Exhibitions, Washington, DC, international specialists in public health and emergency planning events and disaster recovery conferences. For expedited registration and other information, contact 202-536-5000. To learn more about latest conference developments please visit: www.New-Fields.com/isfc.

They are backtracking fast, but it is too late. They already said his chickens were dead
..In addition, the inspector in his home and Tam Vo, Medical Center for the province also detected in a series of chicken of the family died, many of the HPAI ...

Vietnam: In case of death in Tien Ky (Ky Anh, Ha Tinh) non-influenza A (H5N1) and influenza A (H1N1)

| 27/07/2009
Am 27 / 7, Dr. Nguyen Tran Hien, Director of Institute of hygiene and epidemiology in Central confirmation of the death of Mr. T. live in Ky Tien, Ky Anh district, Ha Tinh province non influenza A (H1N1) and influenza A (H5N1). Anh T. many epidemiological factors, clinical symptoms similar to the flu A (H5N1) and influenza A (H1N1) but formal testing for negative results.

Am the same day, the sanitation epidemiological Central also identified: Patients infected with influenza A (H1N1) in the first of three Ha Tinh NT D (SN 1962) in the hamlet Yen Thinh commune, Ky Tien, Ky Anh district. Currently, the Department of Health, Health Center for Ha Tinh has isolation patients to treatment and monitoring, anti-fold region and at the hamlet Yen Thinh, spray chemicals, to restrict influenza A (H1N1) spread large.

The 24 / 7, she NTD. teachers in private schools Nguyen Khuyen (where an outbreak is influenza A (H1N1) in Ho Chi Minh City) in his return to Tien Ky. Noon 24 / 7, she Đ. signs are fever and monitor health at home. 25 / 7, Health Center for Ha Tinh conduct examinations and patient samples sent subject test in about epidemiology Center. Last tested in the epidemiological hygiene Central has determined, she Đ. have positive results for influenza A (H1N1).

Cases he also T. (he is her bowel Đ.) signs with fever on 22 / 7 and be treated at home to 24 / 7 to be examined, treated at the Faculty obtained under Hospital in Ha Tinh status high fever, severe respiratory failure. Although the emergency treatment of samples and testing for the disease but the patient should nặng T. has died in hospital on 26 / 7. In fact, about events and clinical epidemiology of a random match between Mr. T. death she Đ. positive for influenza A (H1N1) after returning to the same local time but test results have identified patients T. deaths not related to influenza A (H1N1), influenza A (H5N1) and she NTD. /.

another version of same story..

Chieu now 26-7, doctor Nguyen Luong Tam, Deputy Director of Health Center for Ha Tinh province, said, at 1 hr 15 mins to 26-7 now, patients Vo Cong Tam, SN 1979 (Ha Tinh ) from within your style dac biet ly contaminated Department, General Hospital of Ha Tinh.

Previously, at 8 am now 25-7, his mind was home on emergency status nang have pneumonia, high fever, headache, pain of, joints, or continuous, magnesia, the skin than your heart, sweaty mat, vomiting ...
Through hoi chan, his mind is of the avian influenza virus (A/H5N1 cum), be converted into an emergency room treatment isolation special. So Y te Ha Tinh got the color's disease patients Tam gui khan cap about the epidemiology of the Central de test.

About 10 noon 25-7, when physicians initiate discover and capture the X-ray examination to detect the full distribution of patients based Tam bi mo, lack of oxygen in the tram. Den 1 gio 15 phut sang ngay 26-7 thi benh nhan Vo Cong Tam da tu vong. Den 1 hour 15 minutes to immediately test patients 26-7 Vo Cong Tam da death.

Also the doctors Tam Luong Nguyen, before delivered to hospitalized patients Vo Cong Tam existing contact with Nguyen Thi Dao, SN 1962, is currently teaching High School on private Ngo Thoi Main, District 9, HCMC Ho Chi Minh Tien Ky in (among three Tam Dao and he has relationships relative - PV).
Additionally, through examine your home's Vo Cong Tam, Medical Center for the children detected in the gas bulk of the family died, that's the role of the avian influenza ...

More on the H5N1 death in Vietnam

Days 26-7 pm, doctor Nguyen Luong Tam, Deputy Director of Health Center for Ha Tinh province for 1 hour at 15 minutes the morning of 26-7, the patient Tam Vo, SN 1979 (Ha Tinh ) have died in the isolation room is especially contagious Department, General Hospital of Ha Tinh.

Before that, at 8 am on 25-7, Mr. Tam was the home to the emergency situation is severe pneumonia, high fever, headache, pain in the, match, or continuous, difficulty breathing, body re-purple skin, loss sweaty, vomiting ... Through the leg, and his mind is infected with avian influenza virus (influenza A/H5N1), transferred to emergency room treatment special isolation. Department of Health, Ha Tinh province has taken the form's disease patients sent emergency Tam the level of hygiene epidemiology central to testing.

About 10 noon 25-7, when the doctors conducting examinations and taking the X-ray detection of the entire distribution of patients was grayed Tam, severe lack of oxygen. To 1 hour 15 minutes the morning of the patients 26-7 Vo Cong Tam has died.

Also the doctor Nguyen Luong Tam, before transfer to hospital patients and Tam Vo had contact with Nguyen Thi Dao, SN 1962, is currently teaching at the High School private Ngo The Times, District 9, HCMC Ho Chi Minh Ky in money (between Ms. Tam Dao and his relationship with relatives - PV). In addition, the inspector in his home and Tam Vo, Medical Center for the province also detected in a series of chicken of the family died, many of the HPAI ...

A/H1N1 flu keeps spreading in Vietnam

26/07/2009 22:12:51

A/H1N1 influenza is spreading in Vietnam as the country reported 45 more new cases on July 26, bringing the total number of cases tested positive to the deadly virus to 612, local officials said.

Of the newly-infected cases, several patients are students who contracted the disease in Ho Chi Minh City and then transmitted the deadly virus to others when travelling to the Central Highlands for summer holidays.

The Health Ministry’s Preventive Medicine Department said close to 400 patients have recovered and been discharged from hospitals. The rest are being quarantined and treated and are all in stable health condition.

The department warned of the transmission of A/H1N1 influenza among those who use means of public transport, particularly students as they have not been aware of the danger and the spread of the epidemic.

Southern provinces, such as Khanh Hoa, Ba Ria-Vung Tau, Lam Dong, Binh Duong, Dong Thap, Dong Nai, Binh Phuoc, Tay Ninh, and Long An have detected A/H1N1 cases among students studying in Ho Chi Minh City’s Ngo Thoi Nhiem and Nguyen Khuyen schools who came back home for summer vacation.

In a telegram issued on July 25, Prime Minister Nguyen Tan Dung asked the entire political system to take part in the fight against A/H1N1 flu as the disease showed initial signs of spreading into communities.

The government leader required heads of ministries, ministerial-level agencies, government agencies, and cities and provinces to promptly carry out urgent measures to prevent A/H1N1 flu from spreading.

He asked the media and other means of communication to raise public awareness of flu preventive measures so as to get the entire people involved in combating the disease.

PM Dung asked the Health Minister to lead round-the-clock surveillance over developments of the disease and prepare necessary medicines and medical facilities for treatment.

The PM also ordered the Ministry of Education and Training to provide guidance on flu preventive measures for teachers and students and issue a temporary closure of schools if necessary in order to prevent the disease from spreading vastly.

Since the first A/H1N1 flu case was discovered in Vietnam on May 30, 2009, the disease remained under control with no fatality confirmed./.

Swine flu cases rises to 567

Swine flu cases rises to 567

Students of Nguyen Khuyen High School in District 9, which was quarantined on July 22. Prime Minister Nguyen Tan Dung, ordered the Ministry of Health and relevant departments July 25 to implement urgent measures to prevent the spread of swine flu in the community, as 35 new cases of H1N1 were announced the same day, increasing the country’s total number to 567. The Prime Minister ordered the media to better publicize measures the public can take to prevent swine flu spreading through the community. Of those found to have sine flu, 371 have been discharged from hospital and 196 remain in quarantine for treatment. No deaths have been reported. Some provinces like Khanh Hoa, Ba Ria - Vung Tau, Lam Dong, Binh Duong, Dong Thap, Dong Nai, Binh Phuoc, Tay Ninh, and Long An have reported H1N1 flu cases related to the quarantined Ngo Thoi Nhiem and Nguyen Khuyen high schools. The infections have come from students returning home from the HCM City-based boarding schools for the summer vacation. The ministry recommended students’ parents to closely monitor their children’s health and inform local health officials when they find flu-like symptoms in order to deal with the situation. Tong Quoc Tan, chairman of Binh Phuoc Province’s Thuan Phu Commune municipal committee, said on July 25 that he would close Thuan Phu Market for a week, as two merchants in the market had been found with swine flu.

Government Must Waspadai Virus H5N1-H1N1 Association

Senin, 27 Juli 2009

Head of Laboratory of Influenza Airlangga University (Unair), DR Chaerul Anwar Nidom, the government and people of Indonesia for the cautious emergence of H5N1 virus combined with H1N1.

"India should (the government and the people) do not only focus on the spread of H1N1 virus are due to possible emergence of H5N1 virus coalition with the more dangerous H1N1 again," he said to reporters on the sidelines of the Symposium Pig Flu (H1N1) and Avian Flu (H5N1) , in Mataram, Saturday.

DR Nidom is one of the speakers in the symposium which was held Indonesian Doctor Association (IDI) in cooperation with NTB Askes PT (Persero) Branch Hospital Mataram and Mataram Medika Risa.

He said that, if any combination of the two dangerous viruses that it was difficult to find drugs penawarnya. Researchers at the Laboratory of Influenza Unair this combination of speed estimate influenza virus is located in the area range 1-100 times faster than the speed of transmission of H5N1 or H1N1 virus.

"The combination of the two influenza viruses can occur in the air, can also ulah as scientists or human that is a party that tries mempertemukannya in the laboratory," he said. According to the influenza experts, meeting the second virus is quite dangerous because it allows experts influenza may want certain things for the sake of research. Therefore, he suggested the government involving the State Intelligence Agency (BIN) in each virus in research laboratories anywhere in the territory of Indonesia.

"If the virus is dangerous in the air to meet the desire of non-human, but that need to be monitored ie kesengajaan certain parties to bring together the two viruses in the laboratory and the impact on the people," he said.

Nidom also reveal how to avoid meeting the second virus that is harmful to the mapping efforts (surveillance) system regulation and animal husbandry. "By doing so, attempt to avoid the virus is more vicious from H5N1 and H1N1 that can be done," he said. (Ant)

Of a patient infected with influenza A/H5N1 deaths

---

Chủ Nhật, 26/07/2009
VCT patients in Tien Ky, Ky Anh district (Ha Tinh) is brought to General Hospital in Ha Tinh, 24 / 7, with millions symptoms like influenza A/H5N1 infected have died this morning (26 / 7).

Surveys of patients' T. being taken home

Patients T. be taken to General Hospital in Ha Tinh on 25 / 7 with symptoms of difficulty breathing, high fever, headache, nausea.

The patient was the doctor isolation and proper handling procedures for cases of influenza A/H5N1 infection in infectious ward.


25 / 7, Health Center for Ha Tinh patient samples were sent to the subject and from testing. However, to about 1h 26 / 7, patients T. has died at the General Hospital in Ha Tinh.


Medical Center for Ha Tinh, Khoa contaminated Hospital Ha Tinh collaboration with local health Ky Anh district conducts spray and micro-organism is being used with powder processing environment with a radius of 200m around the patient deaths.


Currently, there are three other people in Ha Tinh also have signs of disease and infection was influenza A/H5N1 Health Center for Ha Tinh disease samples submitted subject test.

Swine flu’s rapid spread

Monday, July 27, 2009

GENEVA: Swine flu has swept the globe since its detection in March, now linked to hundreds of deaths, affecting nearly every country and raising concerns over what dangers await as the new virus develops. The World Health Organization (WHO) declared the first influenza pandemic in four decades in June, and the A(H1N1) virus has, in the words of one WHO official, since become “unstoppable.” More than 800 deaths have been linked to the virus, and though the WHO no longer provides figures on the number of infected people worldwide, swine flu has spread to 160 of the organization’s 193 member states. In addition to the death toll, lives have been disrupted in countless ways, including school closings, changes in church rituals and warnings that vulnerable Muslims should not embark on the pilgrimage to Mecca. In the United Nations, handshakes are now reserved for meetings between ambassadors. The great fear among experts is that the virus could mutate into a more virulent form and leave far more damage in its wake. “There are many questions for which we have no answers,” said WHO spokesman Gregory Hartl. “We don’t know how the virus will change going forward. “In the southern hemisphere, we see that it is spreading well but also in the northern hemisphere. The question is what will the virus do during our winter? We do not know.” The virus was first uncovered in Mexico and combines swine, human and avian influenza. Most deaths have been concentrated in the Americas, with the United States, Argentina and Mexico recording the highest number of fatalities. Amid the winter months of the southern hemisphere, the spread of the virus has gained pace, but even in the north, where summer is in full swing, infections have multiplied. In Britain, Europe’s worst-hit territory, it is estimated that 100,000 people were infected the week before last. Health experts have found so far that the majority of patients are recovering, even without medical treatment, a week after the appearance of the first symptoms. The WHO has asked countries to stop systematic testing of all cases, but it has asked health authorities to report irregular symptoms. “For the moment, we haven’t seen any changes in the behaviour of the virus. What we’re seeing is a geographical expansion,” said Hartl. In the northern hemisphere, new targeted responses to the flu are beginning to be unveiled. Britain launched a swine flu hotline to give those who believe they are infected access to anti-viral drugs without seeing a doctor. France has asked those with flu symptoms to contact their family doctors, who are expected to prescribe flu drugs and masks. It has also placed an advance order for 90-million vaccines, joining other countries like the United States that have ordered stockpiles early. The development of vaccines is ongoing and Novartis has said clinical trials will start as early as this month. While a vaccine should be available in September or October, health authorities in the northern hemisphere fear that it would be too late to cope with the rapid onset of winter. It also remains unclear if one or two injections are necessary to guarantee immunity against the illness, making it difficult to estimate the potential coverage of the production capacity of the vaccine. Even those who have not contracted the virus have seen their lives affected.

Swine flu: deadly waiting game begins

Sunday, July 26, 2009
As the race for a vaccine gathers pace, public health officials attempt to gauge the severity of the H1N1 flu virus, writes Susan Mitchell

In Ireland many of us will not receive the swine flu vaccine until 2010 -months after the flu season has begun.

For some that will simply be too late, but the delay is not for want of trying.

It has been predicted that between 20 and 40 per cent of the Irish population will contract the H1N1 pandemic strain, widely dubbed ‘swine flu’.

According to these figures from the European Centre for Disease Control (ECDC), that means at least one million of us will get the virus.

One in every 300 people reported to have had the virus in the US has died. In Britain, one in every 500 people reported to have been infected has died.

The word ‘reported’ is important here. Many more people have had H1N1 in the US and Britain and dismissed it as a common cold.

Therefore, public health specialists are reluctant to base the potential death toll in Ireland, or elsewhere for that matter, on those statistics.

That said, deaths are inevitable.

‘‘Even if you erred on the side of caution and estimated that one million people got it, and that one in every 1,000 of those people were to die, it is like four jets going down in Dublin airport,” said Professor Sam McConkey, head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland (RCSI).

The vaccine

Right now, the race is on to prepare a pandemic vaccine. That work began in earnest as soon as samples of the virus became available. The virus was grown using tissue culture, grown on living human cells. After that, scientists tried to identify where the virus originated and understand how it was spreading and mutating - a process known as sequencing.

McConkey said that the virus evolved all the time, but that health officials had to select what they believed was an appropriate strain in order to help find a vaccine. That was then used to create a seed vaccine strain which manufacturers have used.

Vaccines are made using fertilised eggs. To begin, scientists painstakingly inject a small amount of virus into each egg. That is grown, replicated and harvested in order to create large amounts of the virus needed to make a vaccine. This relatively crude process has remained broadly unchanged for 40 years.

‘‘It is a laborious and tedious process,” McConkey said.

What is H1N1?

‘‘The H1N1 pandemic strain is effectively a hodgepodge of different viruses,” he said. ‘‘We do not know how it formed.”

McConkey said the term ‘‘swine flu’’ was ‘‘misleading . . . as this is a human pathogen [agent that causes disease].The pigs are not the problem and it is not an agricultural problem,” he said.

Although a five-year-old boy in the small village of La Gloria, Mexico, is said to be ‘‘patient zero’’, with the earliest confirmed case of 2009 H1N1,no one knows exactly how he contracted the virus.

Vaccine makers have already reported problems; the amount of antigen, the active ingredient in a vaccine that is reaped from each batch of eggs, is only about 25 per cent to 50 per cent of the norm for seasonal flu vaccine.

As very few people have immunity to this flu strain, it has been anticipated that people will need two shots. This means that global production capacity would drop further.

The result is that it may be too late to vaccinate people against a first wave: vaccines could be applied only to protect against a second wave that often comes about half a year later.

This problem can be tackled, but not solved, using adjuvants - chemicals added to a vaccine that boost the immune system’s response. The US has never licensed an adjuvated flu vaccine, which could delay approval in America.

Europe does not face the same problem, but if the Obama administration demands pure vaccine from its suppliers, that would affect supply for the rest of the world. As of yet, the Obama administration has not confirmed what it plans to do.

Like all other health authorities, the Health Service Executive (HSE) has yet to receive a definitive time for delivery (see panel) of the vaccine. A HSE spokeswoman said frontline healthcare workers would be the first cohort of the population to receive the vaccine. People who are immuno-compromised and those working in essential services, such as the army and the gardai, will also be prioritised.

The spokeswoman said the HSE would give details of its vaccination plan when it received a time for delivery from manufacturers.

Mass vaccination programme

Running a mass vaccination programme is not without its difficulties. Dr Ronan Boland, chairman of the Irish Medical Organisation’s (IMO) GP Committee, said there were ‘‘enormous challenges in conducting a mass vaccination programme for Ireland and all other countries that have decided to do so’’. Boland said the average GP has between 1,600 and 1,800 patients.

‘‘Patients are going to need two doses one month apart. That means the average GP will have 3,500 vaccines to administer. Over a six month period that would work out at 30 a day,” he said.

‘‘The winter months are the busiest time for any GP. We will also be dealing with the clinical effects of the potential pandemic and significant absenteeism ourselves.”

Boland said the IMO’s GP Committee had indicated it was hugely supportive of the HSE’s efforts to date, but said it was his ‘‘personal view’’ that it would not be possible to deliver a mass vaccination programme solely through the country’s GPs.

‘‘We have asked the HSE to provide us with a concrete plan that is deliverable and to let us know what role they envision for GPs.”

Manufacturers’ fears

The world’s first human trials of the H1N1 vaccine began last week in Australia. Even as a new generation of vaccines is being developed, manufacturers are afraid of litigation for a product that cannot, for practical reasons, receive trials that would ordinarily be more extensive. GlaxoSmithKline has admitted that bringing the drug to market so quickly could affect quality.

‘‘While the vaccine still has to go through clinical trials, there will be a balance between how extensive they are and regulators feeling a need to speed up its availability. We might not have the luxury of time on our hands,” said Stephen Rea, a spokesman for GlaxoSmithKline.

Pharmaceutical companies also fear what they call a form of nationalism, whereby the small number of countries where manufacturing takes place - principally in Europe - might demand that their own populations are vaccinated first before permitting exports.

In a recent interview, World Health Organisation (WHO) director general Margaret Chan expressed huge concern over the fact that ‘‘most of the production capacity has already been booked up by wealthy countries. Again I have to ask the question: do the developing countries have to wait at the end of the queue?”

Another fear, which few have verbalised, is the possibility that H1N1 may mutate and prove resistant to any vaccine that is developed. ‘‘A genetic shift is possible, especially as the virus spreads out. If we were really unlucky that could happen,” said McConkey.

What can the public and business do?

The virus typically spreads from coughs and sneezes or by touching contaminated surfaces and then touching the nose or mouth. Symptoms are similar to those of seasonal flu, and may include fever, sneezes, sore throat, coughs, headache, and muscle or joint pains.

The public is being advised to take everyday actions to stay healthy. They include covering noses and mouths with tissues when you cough or sneeze; washing your hands often with soap and water, especially after you cough or sneeze; using alcohol-based hands cleaners; and avoiding touching your eyes, nose or mouth as that spreads germs. Most important, stay at home if you get sick, to avoid infecting others.

Businesses have been advised to hammer out a business continuity plan that would outline who would do what in order to mitigate high absenteeism rates. The HSE has advised businesses to prepare for absenteeism rates of around 15 per cent.

Among the challenges businesses may face, in addition to high rates of absenteeism, are disruption to supply chains and business travel, infection control among employees, drop in demand for goods and services, as well as strains on insurance and cashflow.

The HSE has advised businesses to prepare by appointing a pandemic coordinator and deputy who will understand the requirements, plan accordingly and communicate with staff in order to help protect staff and reduce the impact on productivity levels.

In the world of flu viruses, there are few rules, but public health officials have to try to gauge the severity and trajectory of theH1N1 flu virus in order to make complicated decisions regarding just how aggressively they should pursue other mitigation strategies, such as the closure of schools and airports.

They are watching the southern hemisphere, which is now going through its flu season, to try to determine whether the H1N1 virus will return in a more virulent second wave.

For now, it is awaiting game.

Isreal-Health Ministry probes possible swine flu deaths

Published:

07.26.09, 20:35 / Israel News

The Health Ministry is investigating whether swine flu caused the death of a 34-year-old man who passed away Saturday in Eilat's Yoseftal Hospital. The man was hospitalized on Friday with complications with pneumonia.

The ministry is also looking into the circumstances of the death of a two-year-old toddler who died over the weekend, possibly also as a result of swine flu. (Meital Yasur

Fears that swine flu can attack unborn

July 26, 2009
From the Sunday Times


The H1N1 flu virus can damage the developing brains of unborn offspring, scientists have found.

They discovered that the virus changes the workings of genes that control fetal brain growth and development. Some of those genes have been implicated in mental disorders.

“Prenatal viral infection led to altered gene expression in the hippocampus, including autism and schizophrenia candidate genes,” said Hossein Fatemi, a neuroscientist at the University of Minnesota medical school, whose research paper details the results.

Fatemi’s research was carried out entirely on mice so the results need to be interpreted cautiously in terms of their implications for humans.

It was, however, prompted by other epidemiological evidence suggesting that children born to women who have suffered flu infections during pregnancy are at increased risk of schizophrenia and possibly autism too.

It reinforces existing advice that pregnant women should do all they can to avoid infection with the virus.

In the study Fatemi, his colleagues at Minnesota, and others at the Johns Hopkins University medical school, infected female mice with human H1N1 virus halfway through their pregnancies, which were then allowed to come to term.

The scientists then examined how the brains of mice born to infected animals had developed, compared with those whose mothers had stayed healthy throughout pregnancy.

They used magnetic resonance imaging to study each animal’s hippocampus. This part of the brain plays a crucial role in memory formation and emotional control and abnormalities are commonly found in people with schizophrenia and autism.

Fatemi said mice exposed to H1N1 as a fetus had a reduction in their hippocampus of up to 14 per cent. He said: “This is consistent with the observed reductions of hippocampus in subjects with schizophrenia and autism.”

The researchers also used DNA assays to find out which genes were over or underactive in the brains of mice that had been infected.

In their report, published in European Neuropsychopharmacology, they list more than a dozen genes whose workings seem to have been changed by the flu virus.

Fatemi said: “A dose of human influenza virus (H1N1) led to altered expression of many brain genes in the hippocampi of the exposed mouse offspring. These changes are in many cases similar to what has been observed in neuropsychiatric disorders, specifically autism and schizophrenia.”

Trevor Robbins, professor of Cognitive Neuroscience at the University of Cambridge, said the hippocampus was a particularly sensitive part of the brain and appeared to be strongly involved in the development of schizophrenia.

“There is a hypothesis that viral infection during pregnancy is linked to the development of mental disorders in offspring.

“Perhaps the best evidence is the influenza epidemic that hit the West Indies in 1958. There was an increase in schizophrenia among people whose mothers were affected during the second trimester. So there is a link between schizophrenia and infection, but with autism it is more controversial.”

Robbins said the new research simply reinforced existing advice. He said: “Pregnant women should do their best to avoid all infections, especially flu.”

http://www.europeanneuropsychopharmacology.com/home

hattip Pixie

Egypt swine flu cases reach 200 mark

Health 7/26/2009 10:13:00 PM

CAIRO, July 26 (KUNA) -- The Egyptian Health Ministry said that swine flu cases discovered in the country have reached 200, after a further 15 victims registered on Sunday. A ministry's statement said that 10 of the 15 confirmed cases were of estranged Egyptian nationals, three of them are arrivals from Saudi Arabia, two from the UK, one from China, one from France and another from the US. The remaining two cases are of a person who was in contact with a sufferer, and the other, of unknown sources. The statement added that 142 cases have so far recovered, with a remaining 57 cases still under treatment and one deceased as a result of A(H1N1) infection. (end) bna.sd KUNA 262213 Jul 09NNNN

H1N1 flu's rapid spread leaves health experts on edge

Posted: 26 July 2009 1112 hrs

GENEVA: The H1N1 flu has swept the globe since its detection in March, now linked to hundreds of deaths, affecting nearly every country and raising concerns over what dangers await as the new virus develops.

The World Health Organisation declared the first influenza pandemic in four decades in June, and the A(H1N1) virus has, in the words of one WHO official, since become "unstoppable."

More than 800 deaths have been linked to the virus, and though the WHO no longer provides figures on the number of infected people worldwide, the H1N1 flu has spread to 160 of the organisation's 193 member states.

In addition to the death toll, lives have been disrupted in countless ways, including school closings, changes in church rituals and warnings that vulnerable Muslims should not embark on the pilgrimage to Mecca.

In the United Nations, handshakes are now reserved for meetings between ambassadors.

The great fear among experts is that the virus could mutate into a more virulent form and leave far more damage in its wake.

“There are many questions for which we have no answers," said WHO spokesman Gregory Hartl. "We don't know how the virus will change going forward.

"In the southern hemisphere, we see that it is spreading well but also in the northern hemisphere. The question is what will the virus do during our winter? We do not know."

The virus was first uncovered in Mexico and combines swine, human and avian influenza. Most deaths have been concentrated in the Americas, with the United States, Argentina and Mexico recording the highest number of fatalities.

Amid the winter months of the southern hemisphere, the spread of the virus has gained pace, but even in the north, where summer is in full swing, infections have multiplied.

In Britain, Europe's worst-hit territory, it is estimated that 100,000 people were infected the week before last.

Health experts have found so far that the majority of patients are recovering, even without medical treatment, a week after the appearance of the first symptoms.

The WHO has asked countries to stop systematic testing of all cases, but it has asked health authorities to report irregular symptoms.

"For the moment, we haven't seen any changes in the behaviour of the virus. What we're seeing is a geographical expansion," said Hartl.

In the northern hemisphere, new targeted responses to the flu are beginning to be unveiled.

Britain launched a H1N1 flu hotline to give those who believe they are infected access to anti-viral drugs without seeing a doctor.

France has asked those with flu symptoms to contact their family doctors, who are expected to prescribe flu drugs and masks. It has also placed an advance order for 90 million vaccines, joining other countries like the United States that have ordered stockpiles early.

The development of vaccines is ongoing and Novartis has said clinical trials will start as early as this month.

While a vaccine should be available in September or October, health authorities in the northern hemisphere fear that it would be too late to cope with the rapid onset of winter.

It also remains unclear if one or two injections are necessary to guarantee immunity against the illness, making it difficult to estimate the potential coverage of the production capacity of the vaccine.

Even those who have not contracted the virus have seen their lives affected.

Several Muslim countries have advised against travel to Mecca, where the virus could spread quickly among the masses of pilgrims.

A British bishop advised his diocese to suspend holy water from churches while Anglicans have been told to stop sipping from the same chalice during communion services.

Some Latin-American countries have even stopped greeting people with a kiss and suspended football matches.

On Saturday, a British city council said it was considering using underground burial chambers, currently a tourist attraction, to store the corpses of H1N1 flu victims if the pandemic worsens.

Medical care, under dire circumstances

Sunday, July 26, 2009

When two or more patients need a ventilator, how do we decide who should receive the only one available? With the H1N1 influenza pandemic surging, we can expect this scenario.


The World Health Organization reports that "in past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks." Will vaccines mitigate the flu's impact?

With at least 50 countries ordering vaccines from GlaxoSmithKline and Novartis, hopes are high for first doses by September. But let us not be overconfident. Novartis has reported H1N1 vaccine production slow-downs because of low antigen yields. This means, according to WHO, that vaccine quantities will be insufficient by fall, and countries will receive half their needs.

University College London biochemical engineer Peter Dunnil predicts global vaccine-making capacities will not cover 10 percent of the world population.

If viral strains become more lethal, rising cases of respiratory distress will exacerbate the need for ventilators, already in short supply.

In 2005, the U.S. Department of Health and Human Services estimated the toll from influenza pandemic using two scenarios. The state Health Department applied these to New York's 19 million-plus population with a 35 percent infection rate over a six-week duration. The moderate scenario reveals a 1,256 ventilator shortfall and 18,650 flu-related deaths. In the severe scenario, a 16,929 ventilator shortfall could lead to 153,301 deaths. Should H1N1 become more virulent, not only vaccines but ventilators will need to be rationed.

The Health Department recognized this when it has asked the New York State Task Force on Life & the Law to establish ethical guidelines for distributing ventilators. The task force's planning document, "Allocation of Ventilators in an Influenza Pandemic," tackles these hard-hitting questions (http://www.health.state.ny.us/diseases/communicable/influenza/pandemic/ventilators/).

During a pandemic, when ventilators are in short supply in acute care settings, who gets them first? The report says priority should go to the "patient with pulmonary failure who has the best chance of survival with ventilatory support, based on objective clinical criteria." This means withdrawing ventilators from patients most likely to die regardless of treatment. However, the group rejects applying an incoming patient's prospective benefit as the barometer to gauge an existing ventilator-dependent patient's prognosis.

The group recommends that physicians who are "triage officers" make this decision, not one's primary physician. The report underscores that rationing depends strictly on medical prognosis -- that is, the likelihood of survival and recovery from ventilator treatment -- and not on age or occupation.

This differs from an earlier report by the Ethics Subcommittee of the Advisory Committee to the Director, Centers for Disease Control and Prevention. According to "Ethical Guidelines in Pandemic Influenza" (http://www.cdc.gov/od/science/phethics/panFlu_Ethic_Guidelines.pdf), "individuals who are essential to the provision of health care, public safety and the functioning of key aspects of society should receive priority in the distribution of vaccine, antivirals, and other scarce resources" (my emphasis).

Should occupation matter? Which aims are more ethically tenable: maximal survival or restoring and sustaining public order and function? How do we measure social worth? Who decides?

Dire circumstances signal the need for altered standards of care. To what degree will the community be engaged in guidelines that will directly impact all of us?

The Health Department guidelines are not yet finalized. You can comment by e-mail to PanFlu@health.state.ny.us.

Public response, discussion, and engagement are crucial.

Michael Brannigan is the Pfaff Endowed Chair in Ethics and Moral Values at The College of Saint Rose. His e-mail address is michael.brannigan@strose.edu.

Swine flu: Mexico gears itself as cases rise in Chiapas

Updated on Sunday, July 26, 2009, 09:38 IST

Mexico City: Much of Mexico has relaxed after swine flu first unleashed a wave of panic here and across the world three months ago, but cases are now soaring in the country's impoverished southeast.

Authorities insist that A(H1N1) is under control, despite a peak in Chiapas, an area with poor indigenous communities, popular tourist sites, and heavy traffic of Central American immigrants heading to the United States.

Scientists have now identified the first known case as a female baby who tested positive on February 24 and survived. The girl from San Luis Potosi state in north Mexico had no known contact with pig farms.

Mexico is well placed to handle a rise in cases expected to coincide with colder temperatures from November, officials say.

"What could have been a disadvantage by being the first is now a strategic advantage, because now we know what to do (and) how to do it," government advisor and doctor Pablo Kuri said.

The government is currently carrying out targeted health campaigns in the worst-affected areas.

Eight of the last 10 deaths bringing Mexico's total to 138 were in Chiapas, which has the country's highest caseload out of some 14,800 reported nationwide.

Bureau Report

Indonesia confirms first swine-flu death

Updated 4 hours 27 minutes ago

Indonesia's Health Ministry has confirmed the country's first death linked to the H1N1 virus, or swine flu, after a 6-year-old girl suffering from severe pneumonia died in Jakarta.

The country says 343 people have been infected with swine flu as of July 24.

A girl was admitted to hospital with fever, coughs and respiratory problems and died on July 22, the Ministry said on its website.

The World Health Organisation has confirmed 800 deaths globally from the H1N1 virus, which has spread to 160 countries, but health experts say that figure does not reflect the true number of people killed by the virus.