One In Six Public Health Workers Unlikely To Respond In Pandemic Flu Emergency

ScienceDaily (July 24, 2009) — Approximately 1 in 6 public health workers said they would not report to work during a pandemic flu emergency regardless of its severity, according to a survey led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The findings are a significant improvement over a 2005 study conducted by the same research team, in which more than 40 percent of public health employees said they were unlikely to report to work during a pandemic emergency. The new study suggests ways for improving the response of the public health workforce.

“Employee response is a critical component of preparedness planning, yet it is often overlooked. Our study is an attempt to understand the underlying factors that determine an employee’s willingness to respond in an emergency,” said Daniel Barnett, MD, MPH, lead author of the study and assistant professor in the Department of Environmental Health Sciences at the Bloomberg School of Public Health. “Overall, 16 percent of the workers surveyed said they would not report regardless of the severity of the outbreak.”

The online survey was conducted among 1,835 public health workers in Minnesota, Ohio and West Virginia from November 2006 to December 2007. The survey analysis was based on the Extended Parallel Process Model (EPPM), which postulates that willingness to follow instructions in an emergency is based on an individual’s perception of a threat’s validity and belief that the actions taken can be feasibly accomplished and will have a positive impact on the threat.

According to the survey, public health workers who were both “concerned” about the threat posed by a pandemic, and who were “confident” that they could fulfill their response roles and that their roles would have a meaningful impact on the situation, were 31 times more likely to respond to work in an emergency than those who perceived the threat low and had low levels of confidence. Workers whose perception of the threat was “low” but who strongly believed in the efficacy of their job were 18 times more likely to say they would respond compared to those in the “low threat/low efficacy” group.

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U.S. CDC stops swine flu death count at 300

WASHINGTON (Reuters) - More than 300 people have died from the new pandemic swine flu virus, U.S. health officials said on Friday, but they said the virus was so widespread they were ceasing the official count.

The U.S. Centers for Disease Control and Prevention said 43,771 cases of H1N1 influenza had been officially confirmed, with 302 deaths.

A child with a suspected case of the H1N1 influenza virus waits with his mother outside Miguel Couto hospital in Rio de Janeiro July 23, 2009. (REUTERS/Sergio Moraes)

The pandemic spread globally in less than two months and has infected people in 160 countries, killing 800 people, the World Health Organization said. The WHO numbers do not include the latest CDC count.

Health experts say millions have likely been infected worldwide, but doctors can only test a fraction of suspected cases. Flu tests are expensive and unreliable and confirming H1N1 swine flu is difficult.

Health officials are now working with companies to test and make a vaccine against H1N1 to be delivered alongside seasonal influenza vaccines.

World Health Organization - WER, Weekly Epidemiological Record - Original Document

Since the detection in April 2009 of the first 2 cases of human infection with pandemic A (H1N1) 2009 influenza virus in Southern California (USA), >100 000 laboratory-confirmed human cases have been notified to WHO from 124 countries (data as of 15 July 2009).

Several countries at advanced stages of the pandemic have changed their strategies for surveillance testing and are no longer attempting to identify all human cases of pandemic A (H1N1) 2009 influenza virus infection.

For example, as of 10 July 2009, the USA had reported 37 246 cases, 4132 hospitalizations and 211 deaths; however, estimates based on mathematical modelling suggest that >1 million people have been infected. In such countries, surveillance of pandemic disease has shifted to “monitoring” the occurrence of disease among outpatients using syndromic surveillance (of influenza-like illness (ILI)) and other traditional methodologies including laboratory-confirmed hospitalizations and mortality from pneumonia and influenza.

Laboratory-based virological surveillance is ongoing, with prioritization on testing of hospitalized patients.

In many countries, the capacity for laboratory diagnosis has been severely stressed; the number of samples to be processed has been overwhelming. Laboratory diagnostic testing for pandemic A (H1N1) 2009 influenza virus infection should be prioritized for (i) samples from patients with severe disease, atypical presentations or unexplained deaths; (ii) samples from patients in whom determination of antiviral resistance will influence clinical management or is considered clinically important; and (iii) random samples from impatients and outpatients to monitor viral characteristics (e.g. antigenic, genetic and antiviral susceptibility data).

The total number of laboratory-confirmed cases reported to WHO no longer reflects the full magnitude of the pandemic, especially for those countries experiencing widespread pandemic activity; the difference between laboratory-confirmed cases and the true number of cases in the population is expected to increase in the future.

WHO has been closely monitoring the clinical severity of the pandemic since its onset. The clinical spectrum of pandemic A (H1N1) 2009 virus infection is broad, from mild upper respiratory tract illness with or without fever and occasional gastrointestinal symptoms such as vomiting or diarrhoea and exacerbation of underlying conditions, to severe complications such as pneumonia resulting in respiratory failure, acute respiratory distress syndrome (ARDS), multi-organ failure and death.

While the vast majority of cases have resulted in mild, self-limited ILI, the global death toll caused by pandemic A (H1N1) 2009 influenza virus infection was 460 (as of 9 July 2009) in only 3 months since its inception and will soon exceed the total mortality caused by highly pathogenic avian influenza A (H5N1) virus infection since 2003.

This report summarizes the clinical features of hospitalized cases of human infection by the pandemic (H1N1) 2009 influenza virus in Canada, Chile, Mexico and the USA. Information has been collected mainly through teleconferences organized by WHO and supported by national public health authorities as well as data reported by clinicians involved in patient care.


Hospitalizations

In May 2009, WHO reported that 2–6% of confirmed cases had been admitted to hospital.(1) Based on data obtained during recent teleconferences, the rate of hospitalization can be as high as 10% of confirmed cases in some cities. These data, however, should be interpreted carefully because clinical samples from severe or hospitalized cases have been preferentially tested; the burden of mild illness is therefore under-reported and the denominator is likely to be underestimated.

For example, initially, Chile reported that 1.7% of cases had been hospitalized, but is now reporting that 3.8% of confirmed cases are being hospitalized (data as of 6 July 2009) after implementing a change of policy in laboratory testing.

The aforementioned USA estimate gives a figure of approximately 0.3% as an overall hospitalization rate. As of 7 July 2009, New York City had reported 1291 cases, with 909 hospitalizations and 47 deaths. However, of an estimated several hundred thousand cases in New York City , the overall percentage of hospitalizations is <1%.


Characteristics of hospitalized cases

The vast majority of cases of pandemic A (H1N1) 2009 virus infection have experienced clinically mild disease (e.g. influenza-like illness). A small proportion have experienced complications requiring admission to hospital.

Hospitalization occurs in all age groups, but the median age of patients tends to be somewhat older (ranging from 15 to 42 years), as reported from various sites, compared with all cases. People aged >65 years old are still relatively rare among hospitalized patients; however, reported deaths have occurred mostly in patients aged >40 years. In California, the median ages of all cases is 17 years, of hospitalized cases 26 years and of fatal cases 45 years. The male:female ratio in hospitalized cases is approximately 1:1.

Severe disease has been reported in some minority populations, but it is unknown whether this represents a higher incidence of severe disease or reflects cultural, economic and social risk factors.

The main reason for hospitalization remains lower respiratory illness due to primary viral pneumonia, often described as “viral pneumonitis,” reflecting direct viral invasion in lung tissues.

Preliminary pathological findings including diffuse alveolar damage, haemorrhagic interstitial pneumonitis with lymphocyte proliferation and a relative paucity of neutrophils (suggestive of viral
pneumonitis) and ARDS. Secondary bacterial pneumonia has been infrequently documented but has been found in some autopsied cases (in Chicago (USA) and Manitoba (Canada)).

Of 50 fatal cases in California, 7 (14%) had microbiological evidence of a secondary bacterial or fungal infection. Nosocomial infection such as ventilator-associated pneumonia has been identified in critically ill cases with a prolonged hospital course.

Multiple pulmonary emboli have been observed in several very severe cases in patients admitted to intensive care units (ICUs) with refractory ARDS in the USA.(2)

Anecdotal reports from Manitoba indicate that the viral pneumonia progresses rapidly to respiratory failure and ARDS that is unusually refractory to standard oxygenation strategies; they also report that in such patients, nasopharyngeal sampling is substantially inferior to deep tracheal aspirates for confirming the diagnosis of pandemic A (H1N1) 2009 influenza virus infection by realtime reverse transcription polymerase-chain reaction.


Underlying medical conditions

The relative proportion of patients with or without comorbidities differs by reporting sites. Canada as a whole reports that 37% of hospitalized patients have at least 1 co-morbidity; the most frequent underlying medical conditions are chronic lung disease (including asthma), heart disease, kidney disease, immunosuppression and pregnancy.

In the USA, >70% of hospitalized patients and approximately 80% of fatal cases have had underlying conditions considered high risk for complications of seasonal influenza. Severe cases and deaths have been reported in pregnant women from all sites, especially in their third trimesters, with intrauterine fetal demise or spontaneous abortion; in some cases, treating physicians have performed emergency Caesarean section to rescue mother and baby.

A high prevalence of obesity in very severe or fatal cases was initially reported from clinicians in Mexico,(3) and this finding has been anecdotally supported by clinicians from California, Chile and Manitoba. A recent report(2) of 10 ventilated ICU patients from Michigan (USA) in which 9 had a BMI >30 and 7 had a BMI />40 highlights this finding. Of 50 fatal cases in California, 30 (60%) had a BMI >30, of whom 14 (47%) had a BMI >40.

Of the 30 fatal cases with a BMI >30, 11 (37%) did not have known risk factors for complications of seasonal influenza; 3 of the 11 (27%) had other comorbidities, including hypertension (2) and gastroesophageal reflux disease (1).

Further population-based studies, with careful documentation of BMI and comorbidities, are highly desirable in order to learn more about the role of obesity in severe disease from pandemic influenza.


Atypical presentations

Gastrointestinal symptoms, including vomiting and diarrhoea, have been reported in up to 50% of patients with mild to moderate illness not requiring hospitalization. However, gastrointestinal symptoms have been reported less frequently among hospitalized patients.

One 23 month-old baby in New York City (USA) has been reported as sudden infantile death attributed to pandemic A (H1N1) 2009 influenza virus infection. Paediatric cases of infl uenza-associated encephalopathy have been reported in the USA, Chile and other countries.

Additionally, invasive bacterial infections have been also reported in Chilean paediatric patients (including Staphylococcus aureus, Group A Streptococcus and Streptococcus pneumoniae).


Editorial note.

The increasing burden of disease associated with pandemic A (H1N1) 2009 influenza virus infection is severely stressing emergency departments and ICUs in some localities. Clinicians participating in the periodic WHO teleconferences agreed that almost all ICU hospitalizations were primarily a result of ARDS caused by viral pneumonia; secondary bacterial pneumonia has rarely been diagnosed.

However, in some areas with high levels of community-wide pandemic influenza virus activity, characteristics of severe hospitalized cases are changing from previously healthy young people (aged 20–35 years) with primary viral pneumonia to older people with underlying chronic medical conditions (aged >55 years old, at high-risk for seasonal influenza risk complications).

One Manitoba intensivist reported 2 “waves” of patients, the first being young adults without pre-existing co-morbid conditions, with rapidly progressive pneumonitis and high oxygen requirements who were very difficult to ventilate, and a second, older cohort, with pre-existing conditions traditionally linked to progressive disease with seasonal influenza, who generally had a more benign course.

The ICU critical care specialists from the pandemic A (H1N1) 2009 influenza virus “hot spots” report that a considerable proportion of severely ill patients have not received influenza antivirals until very late in the course of their illness.

A frequently reported pattern is for clinicians to start empirical antimicrobial therapy for community-acquired pneumonia, while deferring antiviral therapy until laboratory test results have confirmed H1N1 infection.

Where pandemic A (H1N1) 2009 influenza virus activity has been detected in the community, clinicians should not delay antiviral treatment, especially for patients with pneumonia or progressive
lower respiratory tract symptoms. Empirical antiviral treatment with a neuraminidase inhibitor (oseltamivir or zanamivir) should be initiated as soon as possible upon hospital admission for any suspected case of pandemic influenza.

Health authorities need to inform health-care workers and the general public that although most cases of H1N1 disease are mild and will not require antiviral therapy, medical consultation when
appropriate should not be discouraged and home isolation should not be over-emphasized.

The general public should be made aware of pre-existing conditions as well as danger signs that ought to trigger timely consultation with health-care providers and appropriate antiviral treatment.


Acknowledgement

WHO thanks colleagues from the following institutions in Canada, Chile, Mexico and the USA for their response and contributions.

Public Health Agency of Canada, Manitoba Province; Ministerio de Salud, Chile; United States Centers for Disease Control and Prevention; Chicago Department of Public Health; New York Cit y Department of Health and Mental Hygiene; Northwestern University (Chicago); the Michigan Department of Community Health; the University of Michigan; New York-Presbyterian Hospital; California Department of Health Services; and CONAMED, Mexico.

1 See No. 21, 2009, pp. 185–189.
2 Morbidity and Mortality Weekly Report Dispatch, 2009, 58:1–4 (available at http://www.cdc.gov/mmwr/preview/mmwr...58d0710a1.htm; accessed July 2009).
3 See No. 21, 2009, pp. 185–196 (available at http://www.who.int/wer/2009/wer8421/en/index.html; accessed July 2009).

U.S. Officials Call for FDA to Move on Vaccine Without Data from Clinical Trials

Wall Street Journal
JULY 24, 2009

Swine Flu Prevention Takes on New Urgency
Excerpt
-snip-

Global health officials are scrambling to try to prevent the spread of the H1N1 swine flu virus, with U.S. officials moving Thursday with a recommendation that the Food and Drug Administration approve or license a vaccine.

In the U.S., a federal advisory panel said the FDA should move ahead to approve or license the new H1N1 vaccine without waiting to receive data from clinical trials to test its safety and efficacy. The government and vaccine makers plan to start human studies of the H1N1 vaccine in the U.S. in the coming weeks, but the first-look data from those studies won't be given to the FDA until September.

Each year the FDA approves seasonal vaccines based on strain changes without new human studies. The agency does test the vaccines for potency and also monitors vaccine safety on a continuous basis.

"I think this is an entirely appropriate way of proceeding and in the public health's best interest considering that schools will be opening in a month," said John Modlin, the panel chair and a professor of pediatrics at Dartmouth-Hitchcock Medical Center.

The new H1N1 shots would be for a vaccination campaign that potentially would be targeted first at school-age children, who along with young adults have been hit hard by the new flu strain. A Centers for Disease Control and Prevention vaccine advisory panel will meet next week to make recommendations about such a vaccination campaign.

Anthony Fiore, of the CDC's influenza division, said the agency is anticipating that two doses of an H1N1 vaccine would be needed. That limits the number of people at high risk for flu who would be able to get the shots in the early fall, although health officials are hoping that clinical study data will show that one dose is enough to protect some people. It will take until March to obtain enough doses for the entire U.S. population of just over 300 million people, officials predicted.

Agency sees sharp rise in swine flu in Europe

July 24, 2009, 10:30 GMT

Berlin/Geneva - A European health agency has reported 1,671 new cases of swine flu within one 24-hour period across Europe this week, a sharp rise, as the UN's health agency said Friday the virus was continuing its geographic spread.

The rise, reported by the European Centre for Disease Prevention and Control (ECDC), was monitored in the 24-hour period leading up to 5 pm (1500 GMT) Thursday.

The group had only monitored 552 new cases in the prior 24-hour period,

and 212 in the one before that.

-snip-

Vietnam: A/H1N1 flu continues spreading in schools

To 14 pm this (24 / 7), University RMIT International Vietnam decided temporarily closed from now on 3 / 8 by the school has 3 students and 1 teacher influenza A/H1N1 infection.

University RMIT International Vietnam 4000 on each student to learn, with teachers more than 300 participants in the teaching, of which 5% are foreigners. Do students study and group activities clubs in schools, often in contact with each other so the ability to spread influenza A/H1N1 very high. The school contacted the Medical Center for District 7 conducted germicide spray medicine school campus, the lecture halls, and notify students and parents raise awareness of prevention of influenza A/H1N1. If there are manifestations of fever, cough, runny nose .. than the contact with the hot line phone number: 0837761360 for advice guide treatment in time.

Ho Chi Minh City: a doctor infected with influenza A/H1N1

Ho Chi Minh City has confirmed 1 case of influenza infection AH1N1. The patient is a doctor specializing in treatment of science in the International Clinic Columbia Asia, road Alechxandre de Rhodes.

Maximum 22 / 7, physician symptoms are high fever, cough, sore throat after the doctor in clinic. Pasteur Institute in Ho Chi Minh City conducted sample tests to see positive results for influenza A/H1N1. Patient this isolation is at home. According to the doctor Phan Chu Trinh, Clinic Manager Columbia Asia International, every day Clinic received 50 patients, in which, patients foreigners accounted for more than half. Statistics to present, in Ho Chi Minh City have 4 physicians influenza A/H1N1 infection, including both new cases detected.

Related to prevention of influenza A/H1N1, this morning, Health Department of Ho Chi Minh City is a business donated 100 thermometer with the results measured body temperature in 60 seconds, and 10 thermometer to measure body temperature results after 1 second. No. thermometer will be distributed on line health facilities to timely detect cases of influenza A/H1N1 infection.

3 positive cases of H1N1 in Dak Nong

They are 3 students in high schools Ngo The Times (in Ho Chi Minh City) on summer holiday, in which 1 child in Thuan An (Dak Mil district), 2 children in town To Germany (district Dak RLap) .

The child is being isolation treatment in Ho Chi Minh City. Health sector has Dak Nong spray drug targets in

khử in the same family of students, and organizations monitor strict health status of people who have contact with patients. Besides, Dak Nong and implementation supervision of 22 students in high schools Ngo The Times is on summer holiday in 6 districts Text-ended, Dak Song, Dak Min, Gia Nghia town, Dak and RLap Although Germany; advice for this object should not be exposed to many people.

Department of Health Dak Nong said, since the new outbreak detected in secondary schools Khuyến Nguyen (Ho Chi Minh City), Dak Nong many students attend, but not statistics.

Mr. Ngo Minh Truc, Director of the Department of Health to Dak Nong, because children of school in Ho Chi Minh City a lot, so the risk of outbreaks of H1N1 penetrate local is very high. Difficult to control is the monitoring of the illness when they use means of public transport.

Known to deal with flu A H1N1, the health sector Dak Nong have prepared relatively full of materials, vehicles, medicines and 4000 Vienna tamiflu for distribution units, with the motto translation process in place . Ministry of Health has also equipped for 1 local ambulance professionals, and are issued to vehicles sold in 1 specific for the prevention and the community.

Hai Phong detected 2 cases of influenza A/H1N1 infection

Today (24 / 7), Department of Health Hai Phong city said test results form two products disease father children in the Channel Duong, Le Chan District positive for influenza A/H1N1.

18 / 7, a man from Canada than through Hong Kong to Vietnam at Noi Bai airport. To date 21/7, men are manifestations of high fever, headache, or khan, very throat and hospitalization at 10 hours the same day. Immediate patient isolation and treatment in the infectious ward - Hospital Viet-Tiep. Besides The health product samples of 3 patients who are exposed to the most recent patients. Results showed that two products form the disease first showed that two of the men infected with this flu A/H1N1. Number of sample products remaining patients are awaiting more tests.

Health sector Hai Phong has implemented emergency measures to prevent, control and not to spread on a large scale; conduct epidemiological investigations and health status of patients, families and those who have important; for treatment with medication Tamiflu; spray is being defined area of the patient. /.

DEPUTY PRIME MINISTER NGUYEN THIEN NHAN: Not the owner but not completely brought before flu A/H1N

[I can only hope that the USA does the same. Kudos to Vietnam]

At this meeting, besides the conclusion is very specific on prevention and Deputy Prime Minister also requested need special attention to the propaganda on the media in order to improve our sense of self protect themselves and the community.

Deputy Prime Minister Nguyen Thien Nhan highly appreciated the efforts of the rooms on Health, and confirmed the determination of the Government is limited to the low flu spread in the society. Deputy Prime Minister also advised students need training to avoid activities where common people, especially those areas and risk occurs and to reduce the risk of spreading.

Deputy Prime Minister also highly appreciated by city initiatives. Ho Chi Minh model "the hospital", it should soon summarizing the experience to education sector and health sector can expand. Deputy Prime Minister requires, in the new subject of teaching the first week school year is: "students are ready to prevent and respond to influenza A/H1N1.

Deputy Prime Minister said that the body of students is propaganda with their families and to society is very effective. In the new school year, students should be guaranteed. For Ministry of Education and Training, latest 28 / 7, all materials on prevention flu (epidemic prevention manual) must be taken up by departments of Education to all 41,000 schools in the the country can use. 30 / 7 is limited to the last school to establish the Steering Committee prevention flu A/H1N1, 2 weeks / times to report the results of the Department of Education and Training local.

For Ministry of Health, require reports of 2 cases of influenza infection in the city. Ho Chi Minh City, the withdrawal how prevention and effective lessons to the local reference, not completely bring to society.

In Hanoi, Minister of Health Nguyen Quoc Trieu said the flu A/H1N1 in the school period is the most dangerous. Therefore need for training schools for the students have minimal knowledge about prevention and. Early detection, early isolation and early treatment are certainly not fatal. This is also the combination of both communities, the education sector has the role is particularly important. Minister of Health also recommended should form the isolation form close temporarily by the school period when outbreaks of Bùng local.

For A/H1N1 flu this time, according to Deputy Prime Minister, the implementation of the guideline is not 2, which is not the owner but does not completely take. Deputy Prime Minister believes the Ministry of Health, Ministry of Education and Training and the whole society will continue to actively prevent possible flu pandemic to become not hinder the whole society.

Place of the A/H1N1 influenza outbreaks occur in high schools Ngo The Times (TP. Ho Chi Minh City) as follows: Total number of students is 1,118 children, 36 classes, with 790 inpatient children. Pm Friday (17 / 7) a parent of students to phone the school permission to leave school because of influenza A/H1N1 infected. The school was immediately notify Health Center for District 9 and the Center identified students has been spread from flu outbreak in Dong Nai province when the child is of his. Right after that, on 18 / 7, the school was detected 6 cases of high fever, after 5 tests positive for the influenza A/H1N1 (4 students and 1 teacher). 19 / 7, detected 15 more cases and to present the 54 cases (50 students and 4 teachers). Until this afternoon (23 / 7), the treatment had 40 students and 4 teachers completely healthy, no signs of fever.

Vietnam: Ministry of Education and Training plan against pandemic influenza A/H1N1v

Ministry of Education and
Training
plan against pandemic influenza A/H1N1
08:44, 24/7/2009 (GMT +7)
Previous risk and spread of Bùng A/H1N1 flu is very high, the Ministry of Education and Training (GD-Tel) has issued the Action Plan prevention A/H1N1 flu in 2009 in all education establishments education.

Accordingly, the first 15-8, and will establish the conditions of the Steering Committee on Medical School from Ministry, the Department of GD-Tel local, universities, academies, colleges, secondary professional level. Flu cases spread in the community, the Steering Committee of the provinces, the city decided to close the institution in areas A/H1N1 flu to limit the maximum spread and get set hospital war if necessary. When flu A/H1N1 has temporarily lắng, the institution must quickly restore nề sticky teaching, learning and solutions ensure plan new school year.


Meanwhile, Nguyen Huy Nga, Director Department of Department of Health and Environment (Ministry of Health) said: "There are close to half of infected without manifesting symptoms or clinical. Such conduct can not be supervised.

If the object potential risk infected still exposed to the people around, freedom to travel, the ability to appear chùm of the new disease that may occur. "Families should ask their children often see friends in the class are not sick. In the case of the sick children need isolation at home, reported the Health Department for examination and consultation, to wear page for you and not to give people ", he emphasized Russia.

To actively cope with flu A/H1N1 pm on 23-7, doctor Pham Hung Chien, Director of the Department of Health, said the city will be developed in collaboration with Department of Education and Training and the University of Da Nang plan specific prevention diseases in schools, first as promoting advocacy for teachers and parents improve student alert before the manifestation of influenza A/H1N1.

According to information from the Medical Center for the city, on way to 23-7, the city still has 7 cases positive for influenza A/H1N1, does have a patient is treated at the hospital and Da Nang 1 other patient who is how china cup as the manifestation of infection.

50% of infected influenza A/H1N1 in Vietnam do not have symptoms

July 23, 2009

This is a warning by Dr. Nguyen Huy Nga, Director Department of Department of Health and Environment at the meeting the Steering Committee countries to prevent pandemic flu in the 22-7 pm.

Dr. Nga said, in the country has recorded 32 more cases positive for influenza A/H1N1, raising the total number of infected in Vietnam to 475 people.

For 2 chùm flu A/H1N1 in the South: Currently, chùm flu in Viet Kieu Hamlet, Xuan Hiep, Xuan Hoa, Dong Nai, the cases have stable health and not the spread wider. Also chùm and secondary schools in The Times Ngo, District 9, Ho Chi Minh City, is relatively stable but previously had many children after exposure to cases to be about 8 provinces.

Currently, some provinces such as Khanh Hoa, Ba Ria - Vung Tau, Lam Dong has acknowledged the positive shift as a student at The University of Ngô Thời local summer holiday.

TS Russia emphasized, now about 50% A/H1N1 flu patients in Vietnam there are no clinical symptoms such as cough, fever, sore throat, diarrhea ... this is the greatest risk of disease continue to cause widespread public contract. Therefore, the appearance of more chùm of disease in other localities in the near future, even including the death is unavoidable.

At the meeting, representing the Ministry of Education and Training for Ministry has decided to establish the special flu A/H1N1 and require schools in the country least to date 15-8 Established Steering Committee flu A/H1N1 in schools.

Vietnam: 50% Show No Symptoms

24-07-2009
Deputy Prime Minister chaired a meeting emergency

Risk of cross infection in the very next day.

Maximum rate (23-7), Deputy Prime Minister Nguyen Thien Nhan has chaired the emergency meeting online in the first three Hanoi, Da Nang and Ho Chi Minh City to discuss measures against the disease. He received the flu A/H1N1 has become threat to the entire society, especially the education sector.

Minister of Health Nguyen Quoc Trieu said the country had 499 cases were determined positive for influenza A/H1N1.

Concern is the risk of more children in 2000 students boarding school Khuyến Nguyen may have on the days.

Minister Trieu proposed education sector must be notified danger influenza A/H1N1 in the industry, training measures for prevention, early detection of influenza. Over 23 million HS-SV must be equipped with minimum knowledge to counseling, self-check their health. At each have, within 1-2 weeks in school, they must wear to pages. Each HS-SV if fever must be active to examination. Deputy Prime Minister homogeneous and require the health sector not the money this case.

According to Deputy Prime Minister, the schools turn into the hospital is in reality very important. The schools must have experience report, describing the operation of the hospital and put on website of the Ministry of GD & ĐT other schools to study. The first day of school faculty must establish steering committee on prevention, information, and environment hygiene. At each school must ensure adequate medicines, address basis nearest health. From seven to 10 days of school must report the number. If the school does not ensure these requirements are not for the instructor. But the Deputy Prime Minister, on the faculty of more than 23 thousand HS-SV still happen as usual every year.

- According to Deputy Minister of Health Trinh Quan Huan, in Vietnam, the current detecting patients with flu more difficult by more than 50% have no symptoms and start the patient cross-infection.

School private Ngô Thời The (District 9) has 72 cases positive for influenza A/H1N1. RMIT School (District 7) and Elementary School Kumom (Phu Nhuan District), each school has two students with positive influenza A/H1N1. A student University of Natural Science and HCMC influenza A/H1N1 infection.

Some local authorities have recorded many of the new flu infection as a student of the University Ngo The Times. In Lam Dong has 49 students studying at The University of Ngô Thời his summer holiday. Has two children positive for influenza A/H1N1.

Binh Duong province has three of the positive influenza A/H1N1, a boarding student at this school. In Ba Ria-Vung Tau patients infected with influenza A/H1N1 is Ngô School students The Times. Some provinces such as Khanh Hoa, Dong Nai has also affected the new school from The Times Ngo.

Has 700 to 900 in total students of the University Ngô Thời The returning families in eight provinces in neighboring Vietnam.

In Dong Nai province has been the small chùm of influenza A/H1N1 infection in five to eight people. Chum of the largest in Dong Nai province in the Viet Kieu village (Xuan Loc), up to 22 ca.

Swine flu puts pressure on intensive care units

July 24, 2009
The Ministry of Health is closely monitoring pressure on intensive care units as swine flu rages on unabated.

Deputy director of public health Dr Fran McGrath said some ICUs were at capacity, but coping.

Among units hardest hit is at Christchurch Hospital, where 20 people were in intensive care yesterday, including 15 on ventilators.

Of those, 10 had or were suspected of having swine flu.

Intensive care specialist Geoff Shaw said the unit usually had a 12-patient capacity but extra staff had been brought in.

A cardiac ward had also been cleared to provide extra intensive care beds.

Elective cardiac surgery and other operations requiring a stay in ICU were being postponed to free up beds, he said.

"We are faced with a situation we've never had before. We've got more people requiring ventilators (because of the swine flu) and it's only expected to get worse," Dr Shaw told The Press.

However, the situation varied from region to region, with some hospitals reporting spare intensive care beds.

Some Christchurch patients had been transferred to Dunedin, which had free beds.

In Wellington, which was the first region to feel the pressure from swine flu admissions, there were three patients with flu complications on ventilators in intensive care.

They were in a serious but not critical situation, a spokesman said.

There were still some spare beds.

Wellington regional medical officer of health Stephen Palmer said there could be worse to come, with a spike in infections anticipated as schools returned this week from their mid-winter break.

The northern district health boards were coping, with Auckland last night reporting seven swine flu cases in ICU (22 percent of capacity); Northland two (50 percent); Counties-Manukau five (35 percent); and Waitemata three (43 percent).

Research showed the swine flu virus penetrated deeper into the lungs than seasonal flu, causing greater damage to the respiratory system.

This meant higher numbers of patients, including the young and people without underlying health conditions, were requiring ventilation.

"The extended length of ventilation time required by patients with pandemic influenza (H1N1) 09, which can be up to 14 days, along with the peak winter requirements, indicates that there will be continuing pressure on ICU capacity for the foreseeable future," Dr McGrath said.

The ministry was monitoring the situation and working with district health boards to manage hospital capacity, she said.

Meanwhile, the virus has been found to be more infectious than first thought.

Wellington-based researchers from the University of Otago today reported that in New Zealand a person ill with swine flu will on average infect almost two others.

This is the first published estimate for the "reproduction number" of the pandemic in the southern hemisphere.

To date researchers have used the lower estimate of 1.5 which was published early in the pandemic based on data from Mexico.

hat-tip DazzaMc

Swine flu, more infectious than 1918 flu, study says

11:42AM Friday Jul 24, 2009
By Martin Johnston

Swine flu deaths up to 14 - coroner
Students warned to be vigilant on swine flu

Swine flu is more infectious than both seasonal influenza and the 1918 Spanish flu, a study based on New Zealand epidemic case numbers has found.

And this suggests nearly 79 per cent of an affected population will catch the virus, although not all will become ill.

The researchers, from Otago University at Wellington and Utrecht University in the Netherlands, say in a letter published in today's New Zealand Medical Journal that it was estimated early in the swine flu pandemic that the transmission rate was around 1.5. This means that every two people who are sick with the virus will infect three others.

This was calculated in Mexico, where the virus first emerged.

But Associate Professor Michael Baker, Dr Nick Wilson and Dr Hiroshi Nishiura estimate from New Zealand data that every case is infecting nearly two others - a rate of 1.96.

This is based on official notifications of swine flu between June 2 and 15. This was a period of exponential growth in the New Zealand epidemic. It began with the first case of local transmission, excludes 63 imported cases, and ends before health authorities, because so many people were catching the virus, gave up testing every potential case.

In Japan a transmission rate of between 2 and 2.6 was calculated.

The Medical Journal letter notes that a transmission rate of 1.96 is higher than published estimates for seasonal influenza in temperate-zone countries like New Zealand. It is also "slightly greater than that of Spanish influenza pandemic from 1918-19 in New Zealand", but the death rate from Spanish flu was much higher than in the current swine flu pandemic.

Drs Baker and Wilson have estimated the death rate from swine flu in developed countries could be as low as one death out of 10,000 cases.

The letter says a transmission rate of 1.96 suggests that 78.6 per cent of the population will experience infection by the end of the pandemic, although only two-thirds of those infected are expected to show symptoms.

But public health interventions like promoting good hygiene and social distancing were likely to reduce the proportion infected to below that estimate.

This is the first swine flu transmission rate estimate for the southern hemisphere. The researchers say the reasons it is higher than the Mexican estimate include that the south is now in winter and flu viruses spread more readily between people in wintertime.

The Ministry of Health said yesterday the official death toll from the swine flu pandemic stood at 11. However, chief coroner Judge Neil MacLean said he was investigating the deaths of a further three people who had the virus.

The ministry said the number of confirmed past and current cases - now just a fraction of the likely total number - was 2525.

hat-tip Frenchiegirl

Pandemic (h1n1) 2009 (05): Mbds region-asia

22-JUL-2009
Subject	PRO/MBDS> Pandemic (H1N1) 2009 (05): MBDS region

In this update:
[1] China (mainland): 1537 confirmed cases
{2] Laos: 51 confirmed cases, 1st confirmed death
[3] Thailand: 6776 confirmed cases and 44 confirmed deaths
[4] Viet Nam: 443 confirmed cases******

[1] China (mainland): 1537 confirmed casesDate: Fri 17 Jul 2009Source: Xinhua News Agency [edited]<http://news.xinhuanet.com/english/2009-07/17/content_11726625.htm>Chinese mainland A (H1N1) flu cases top 1500--------------------------------------------------------The Chinese mainland confirmed 93 new cases of the A (H1N1) influenza from 6 p.m. Wednesday [15 Jul 2009] to 6 p.m. Friday [17 Jul 2009], putting the total at 1537, the Ministry of Health said.Among the newly confirmed, 56 were "imported cases." The other 37 were infected in the Chinese mainland, the ministry said. Among the patients, 1263 have been cured and discharged from hospitals.No fatal or critical cases of the influenza have been reported on the Chinese mainland so far, but a patient in Hangzhou of eastern Zhejiang Province reportedly died of electrocution caused by leakage of electricity from the electrical circuits in her ward lavatory on [1 Jul 2009].[Editor: Yan]--Communicated by:PRO/MBDS<promed-mbds@promedmail.org>[For a map of China with provinces, see <http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>. For the interactive HealthMap/ProMED-mail map of China with links to other ProMED-mail and PRO/MBDS postings in China and surrounding areas, see <http://healthmap.org/r/008e>. - Mod.YMA]******

[2] Laos: 51 confirmed cases, 1st confirmed deathDate: Wed 22 Jul 2009Source: Lao News Agency (KPL) [edited]<http://www.kpl.net.la/english/news/edn3.htm>

New type flu claims one life----------------------------The National Emerging Infectious Disease Coordination Office yesterday [21 Jul 2009] confirmed 51 people infected with new type influenza A (H1N1) and that the virus has claimed one life in Borikhamsay province.[Nationwide there are 51 confirmed cases of influenza A (H1N1)], of which 47 cases have recovered and 3 patients are receiving medical treatment at the hospitals.[Of the 51 cases 27 were found in Vientiane Capital, 4 in Vientiane province, one in Luang Prabang province, one in Khammouane province, 9 in Savannakhet province, 7 in Champassak province, one case in Saravane province, and one man who died in Borikhamsay province on 17 Jul 2009].[The 31-year-old flu victim who died had a fever for some days this month (July 2009); he sought treatment in a few clinics in Paksane district. On [14 Jul 2009] he was in critical condition at the provincial hospital and on [17 Jul 2009] he was taken to a hospital in Vientiane Capital where he died the same day. Contributing factors were his weight of 111 kg (245 lb) weight and many underlying diseases.]A team of the National Emerging Infectious Disease Coordination Office went to the victim's house to disinfect it and prevent the spread of the virus.--Communicated by:PRO/MBDS<promed-mbds@promedmail.org>[For a map of Laos with provinces, see <http://www.un.org/Depts/Cartographic/map/profile/laos.pdf>. For the interactive HealthMap/ProMED-mail map of Laos with links to other recent ProMED-mail and PRO/MBDS reports on events in Laos and surrounding areas, see <http://healthmap.org/r/00cX>. - Mod.YMA][Obesity has been identified as a risk factor for more serious disease with the pandemic (H1N1) 2009 virus infection in the United States. Recent articles in the CDC, MMWR have discussed obesity as a risk factor. Nine out of 10 seriously ill patients hospitalized in Michigan were found to be obese (Body Mass Index (BMI) greater than 30), with 7 of them seriously obese (BMI greater than 40). (see Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection --- Michigan, June 2009. MMWR. 10 Jul 2009 / 58(Dispatch);1-4 available at: <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0710a1.htm>.) Severe obesity was described in a newswire reporting the 17th death in Thailand, a woman from Ratchaburi province with a BMI greater than 40 (see prior PRO/MBDS posting Pandemic (H1N1) 2009 (03): MBDS region 20090712.2497). Obesity has also been mentioned as a risk factor for severe disease by WHO (see prior PRO/MBDS posting Influenza A (H1N1) - worldwide (24): case count, pandemic 20090612.2167). - Mod.MPP]******

[3] Thailand: 6776 confirmed cases and 44 confirmed deathsDate: Wed 22 Jul 2009Source: Bangkok Post [edited]<http://www.bangkokpost.com/news/health/149792/flu-toll-rises-to-44-with-6776-infected>

Flu toll rises to 44, with 6776 infected----------------------------------------The swine flu death toll has more than doubled from 20 last week [week of 13 Jul 2009] to 44, while the total number of confirmed A (H1N1) flu cases has rocketed to 6776, the Public Health Ministry reported on Wednesday [22 Jul 2009].Health deputy permanent secretary Paichit Varachit said 6697 patients had recovered. Thirty-five others remained in hospitals and 7 of them were in critical condition.Public Health Minister Witthaya Kaewparadai said he had instructed provincial governors, doctors and nurses nationwide to implement more stringent measures to curb the A (H1N1) flu outbreak."Provincial authorities need to educate people about the disease and ways to protect themselves from being infected so they do not panic," Dr Witthaya said.Government officials and employees of state enterprises with flu-like symptoms can rest at home without having to get medical certificates, and they would not lose their holidays and other benefits, he said."Thailand's ranking in the number of swine flu cases and fatalities has not really risen to 4th place, as other countries have stopped reporting on the flu situation," the minister said.--Communicated by:PRO/MBDS<promed-mbds@promedmail.org>[For a map of Thailand showing the geographic regions, see <http://thailandforvisitors.com/general/regions.html>. For the interactive HealthMap/ProMED-mail map with links to other ProMED-mail and PRO/MBDS postings in Thailand and neighboring countries, see <http://healthmap.org/r/00cC>. - Mod.YMA]******

[4] Viet Nam: 443 confirmed casesDate: Wed 22 Jul 2009Source: VietNamNet Bridge [edited]<http://english.vietnamnet.vn/Health/2009/07/859445/>

Nation at high risk for rapid spread of H1N1 flu------------------------------------------------The Ministry of Health yesterday [21 Jul 2009], warned of the high risk that the A (H1N1) flu could spread, especially during the upcoming winter weather, which would provide favourable conditions for the virus to develop.A flu report to the Prime Minister said the A (H1N1) flu virus had spread quickly into the community. It particularly noted 2 flu clusters that were recently found in Viet Kieu hamlet, Xuan Hiep commune, Xuan Loc district, Dong Nai province and at the Ngo Thoi Nhiem Private High School in District 9, HCM [Ho Chi Minh] City.As of yesterday [21 Jul 2009], 84 of the country's A (H1N1) positive patients were relatives of overseas Vietnamese patients who had returned to Dong Nai from the US."The health sector has found 61 teachers and pupils from the Ngo Thoi Nhiem Private High School in District 9, HCM City, to be positive for the virus. The number of patients will rise high in the coming time," said Director of the Preventive Medicine and Environment under the Ministry of Health (MoH) Nguyen Huy Nga. "Signs have shown that the A (H1N1) flu pandemic has spread into the community," said Nga.Viet Nam has begun to see signs of A (H1N1) flu in the community more than 50 days after the 1st reported case. So far, all patients have been isolated, closely monitored and effectively treated for quick recovery.Health experts have warned that when the A (H1N1) flu spreads widely into the community, Viet Nam will face challenges in its control. An increasing number of patients and even fatalities are unavoidable. In particular, people suffering from chronic diseases, weak immune systems, the elderly, children, pregnant women, and obese people are vulnerable to the flu.At present, the health sector is focusing its activities on closely monitoring patients, isolating suspected cases, and treating positive patients in a timely manner. The health sector has made efforts to prepare sufficient drugs, hospital beds, medical facilities, and isolation areas for a pandemic, according to Nga.The MoH [Ministry of Health] yesterday [21 Jul 2009] confirmed 35 new A (H1N1) flu cases, bring the nation's total to 443 cases and no fatalities since the onset of the threat. Of all cases, 328 have been discharged from hospitals and the rest are stable, resting in isolation and undergoing treatment.--Communicated by:PRO/MBDS<promed-mbds@promedmail.org>

[To date, a total of 45 deaths attributable to influenza pandemic (H1N1) 2009 virus infection have been identified in the MBDS region, which include one death reported in Laos and 44 deaths reported in Thailand.Viet Nam confirmed community-level transmission of influenza pandemic (H1N1) 2009 virus in the country on 21 Jul 2009. This was the 2nd domestic outbreak in Viet Nam and it occurred in a private high school where 41 students and teachers were found to be infected (see <http://english.vietnamnet.vn/Health/2009/07/859257/>).For maps of Viet Nam with provinces, see <http://www.lib.utexas.edu/maps/middle_east_and_asia/vietnam_admin01.jpg> and <http://www.angelfire.com/co/hongnam/vnmap.html>.

The interactive HealthMap/ProMED-mail map with direct links to other outbreaks in Viet Nam and surrounding countries reported on ProMED-mail and PRO/MBDS can be accessed at <http://healthmap.org/r/008c>.Singapore, Egypt, Guam, Panama, and Venezuela have each reported 1st deaths attributable to influenza pandemic (H1N1) 2009 virus infection in their countries (see <http://www.chinaview.cn/health/world.htm>). In addition, in the USA, Georgia, Indiana, Nebraska, Tennessee, and Puerto Rico have recently confirmed their 1st deaths attributable to influenza pandemic (H1N1) 2009 virus infection (see <http://www.china.org.cn/health/swineflu/2009-07/18/content_18159240.htm>). - Mod.YMA]

Swine Flu Seizures in Children Reported in U.S. (Update1)

By Elizabeth Lopatto

July 23 (Bloomberg) -- Swine flu caused seizures in two Texas children and hallucinations, difficulty standing and slowed speech in two others, say U.S. health officials who advised quick treatment with antiviral medicine in such cases.

Two patients, a 7-year-old and a 10-year-old, were described as having seizures, according to the report from the Atlanta-based Centers for Disease Control and Prevention. Children aged 11 and 17 exhibited the other symptoms. The cases, which occurred from May 13 to May 26, were reported today in the CDC’s Morbidity and Mortality Weekly Report.

This is the first evidence of potential seizures or other neurological symptoms from swine flu, also called H1N1, the report said. Seasonal flu can also cause neurological complications such as personality changes, loss of concentration, involuntary eye movements and impairment of cognitive function, according to an editorial accompanying the report.

“This is not to say that neurological side effects are very common or will be common,” said Tim Uyeki, a study author and flu epidemiologist at the CDC, in a telephone interview today. “It’s to alert people to the fact that these complications can occur with H1N1 infections.”

Choosing Treatment

Such warnings may prevent doctors from giving patients the wrong medications for the neurological symptoms, Uyeki said. One kind of neurological illness, encephalitis, has multiple causes, so doctors should be aware that the brain dysfunction may be linked to swine flu to choose proper treatment, he said.

About 5 percent of childhood encephalitis arises from seasonal influenza, the authors wrote. The cases in swine flu patients appear to be less serious than similar cases from seasonal flu, the researchers wrote.

Swine flu, which causes mostly mild illness, has been declared a pandemic by the World Health Organization in June, the first since 1968. This is the fourth time in the last century a new flu virus has swept across the globe.

The pandemic, also called H1N1, has spread across the world faster than any previous influenza outbreak, and its full force may reach the U.S. earlier than the typical flu season, the CDC has said. England and Wales are suffering the worst rates of flu in a decade, even though the typical flu season in that region doesn’t start for several months.

Companies including Novartis AG, Sanofi-Aventis SA and CSL Ltd. are racing to produce a flu vaccine by mid-October, when cases are expected to soar in the Northern Hemisphere, fueled by cooler temperatures and kids returning to the close quarters of classrooms.

To contact the reporter on this story: Elizabeth Lopatto in New York at elopatto@bloomberg.net.

Last Updated: July 23, 2009 15:07 EDT

Deadlier H1N1 in winter

BUENOS AIRES - MOUNTING fatalities in the South American winter launched a new warning yesterday on what to expect from the flu pandemic.'
With the World Health Organisation now putting the global toll at more than 700 - a leap of 40 per cent since the start of the month - scientists fear the onset of winter could see Influenza A (H1N1) mutate to a more deadly form, in a reprise of the Spanish and Asian influenza pandemics of 1918 and 1958.

And while the number of fatalities is growing even in countries still in the summer season, the experience of South America suggests the scientists' fears could be right.

Argentina now accounts for 165 of deaths worldwide and is the world's second worst-affected country, behind the United States with 263 confirmed deaths.

Chile on Tuesday announced that it had 68, up by 28 in four days.

And with every country in the region blaming the onset of the Southern Hemisphere winter, Uruguay has declared 20 deaths, Brazil 15, Peru 12, Paraguay 10, Bolivia five and Venezuela two.

Mexico, where the outbreak started, remains in third place with 128 deaths.

As with other regions, the H1N1 flu fallout is growing too, with concerns about the virus forcing the cancellation of a 227-year-old Roman Catholic pilgrimage in Costa Rica.

Elsewhere, Thailand's death toll has reached 44 - almost doubling in a week - to overtake Australia's as the biggest in the Asia-Pacific region.

Fans arriving for a football match involving English side Liverpool against Thailand in Bangkok yesterday had to pass through thermal scanners at Rajamangala Stadium as a precaution against the flu. -- AFP

Swine Flu Vaccine Delays Won’t Slow October Timetable (Update1)

By Tom Randall and Elizabeth Lopatto

July 23 (Bloomberg) -- Swine flu vaccine delays reported by Novartis AG, Sanofi Aventis SA and Baxter International Inc. shouldn’t postpone availability in October, health officials said. That won’t be soon enough for kids going back to school.

When U.S. agencies laid out their plan for pandemic vaccine production, they anticipated that companies may harvest only half the immunity-triggering antigen grown from a typical seasonal flu strain, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.

CSL Ltd., based in Australia, and Paris-based Sanofi are tapping the institute’s network of eight vaccine-testing research hospitals to study the shot’s safety, effectiveness and proper dosing, Fauci said in a telephone interview. Recommendations based on the studies will apply to vaccines made by five U.S. suppliers, and results should be available in September, Fauci said.

“We’re not going to get all of the vaccine from all of the companies at the same time,” Fauci said. “We need to be prepared for the possibility that when the schools open, there may be an acceleration of cases. That’s why we want to have it as quickly as we can in the fall. We should be on track.”

School Openings

At least 50 million doses of swine flu vaccine will be available in mid-October, and more deliveries will provide enough shots to inoculate everyone in the U.S., according to the Centers for Disease Control and Prevention in Atlanta. The shots won’t be available when children return to schools in August and early September, Arne Duncan, the U.S. education secretary, told reporters today in Washington.

“We got a little bit lucky last year when this didn’t hit until late in the school year,” Duncan said. “We’re not going to be lucky going into this school year. We have to be ready now.”

Also today, the CDC published a report linking swine flu to seizures in two Texas children and hallucinations, difficulty standing and slowed speech in two others.

This is the first evidence of seizures or other neurological symptoms from swine flu, also called H1N1, the CDC’s Morbidity and Mortality Weekly Report said. Seasonal flu can cause brain complications such as personality changes, loss of concentration, involuntary eye movements and impairment of cognitive function, according to an editorial accompanying the report.

Spreading Quickly

The pandemic H1N1 virus has spread across the world faster than any previous influenza outbreak, and its full force may reach the U.S. earlier than the typical flu season, according to the CDC. England and Wales are suffering the worst rates of flu in a decade, even though the usual flu season doesn’t start for several months.

The U.S. has contracts with five companies to provide shots. Novartis, based in Basel, Switzerland, is responsible for 45 percent of the supply, Sanofi will provide 26 percent and CSL Ltd. will make 19 percent, Fauci said. The remaining doses will be made by London-based drugmakers AstraZeneca Plc and GlaxoSmithKline Plc.

Antigens are substances derived from the virus that trigger the body to produce disease-fighting antibodies.

Every American should get a shot for the seasonal flu, which is “ready to go for the upcoming season,” Health and Human Services Secretary Kathleen Sebelius said today at the briefing. People should cough in their sleeves, wash their hands and stay home if they’re sick to prevent the spread of flu, she said.

To contact the reporters on this story: Tom Randall in New York at trandall6@bloomberg.net; Elizabeth Lopatto in New York at elopatto@bloomberg.net

Last Updated: July 23, 2009 15:51 EDT

UK: Public fear mounts as swine flu cases soar

July 24, 2009

Millions of patients overwhelmed a new telephone and online service yesterday to obtain swine flu treatment without seeing a doctor as the number of cases doubled in a week.

The National Pandemic Flu Service, which offers callers or internet users a prescription code for antiviral drugs if they have symptoms, was experiencing “unprecedented demand”, with 9.3million hits every hour.

The website crashed within minutes of going live at 3pm but was later restored. By 5pm it was receiving the equivalent of 2,600 hits per second. The Government said that it was increasing capacity for the site.

It also emerged that: • swine flu has reached epidemic levels in many areas, with under-14s the worst hit. About 100,000 people in England were infected with the H1N1 virus in the week to Sunday compared with 55,000 cases the previous week;

• Vodafone could make millions of pounds from calls to the hotline. It is the only one of the big four mobile phone operators to charge users 20p a minute for calls to the 0800 number;

• the Church of England issued an unprecedented order to suspend “sharing of the chalice” at Communion;

• town hall leaders will meet today to discuss new measures, such as asking lollipop ladies and social workers to collect Tamiflu prescriptions for vulnerable people who contract swine flu.

Doctors have said that Tamiflu, the main antiviral drug being used to treat symptoms, could be overprescribed by staff at the telephone service, who are not medically trained. Gordon Brown said that the service was required to take the burden off frontline health staff. “We know that for people to be treated in the first 24 to 48 hours makes a real difference,” he said.

Applicants to the service are asked to supply their name, address and date of birth before receiving a code to exchange for medication. This code can be given to a “flu friend” who collects the antivirals, using a form of identification from the patient.

Peter Holden, of the British Medical Association, said: “There’s a few people who may seek to get antivirals by telling porkies. What they need to remember is that their identity will be checked and if they get one dose they will not be given another. Tamiflu is not a drug to be given in mild cases: it has side-effects and there’s no point in using it as a prophylactic. People may be thinking of taking it on holiday or selling it on eBay but they need to remember that the NHS stops at the White Cliffs of Dover and it is illegal to sell medicines without a licence.”

Charities have warned that diagnosing flu cases by phone or the internet could miss the symptoms of other serious illness such as meningitis.

Sir Liam Donaldson, the Chief Medical Officer, said that 840 people in England were being treated in hospital after contracting the virus; 63 were in a critical condition. The official death toll stayed at 30. About 25,000 people in Scotland and 3,000 in Wales also contacted their GPs about symptoms in the past week, but only patients in England so far are being invited to apply for drugs by phone or online.

A 26-year-old Scot critically ill with swine flu was transferred to Sweden yesterday for specialised treatment. The woman, who was admitted to hospital in Kilmarnock last week, has been on a ventilator due to an extreme reaction to the H1N1 virus.

Vietnam: More on the 2,000 students in Nguyen Khuyen

[previous story is 2 posts below]

Update 17:29 on 23-07-2009

NDDT - On 23-7, the Health Department of Ho Chi Minh City, a student's high school private school Nguyen Khuyen (Ward 13, Mai Lao Bang, Tan Binh District, Ho Chi Minh City) has the Results positive for influenza A (H1N1).

It is girls LTNL, 12C8 classes, indicated in Gia Lai. 22-7 pm girls this mild fever, medical staff have the samples tested my results 23-7 L with positive influenza A (H1N1).

Immediately thereafter, the Department implemented to establish the hospital and at the center for preventive health Tan Binh district responsibility. Also, organizations khử khuẩn, kill germs entire campus, class rooms, kitchen meals every school day.

In Le, the school principal for schools with private Nguyen has 44 classes with 2,289 students, of which over 400 students belonging to the residence sold, houses Ho Chi Minh City. Center for Health District conducts screening and isolation of 32 students has close contact with patient L. The students left the residence and selling the boarding schools to notify parents to catch on. Students with families should avoid contact with people at the same time bring to the page often because patients are able to in person.

According to doctor Nguyen Van Chau, Director of Health Department of Ho Chi Minh City Department of Health and Department of Education and Training and Ho Chi Minh City conducted close to boarding school to avoid the spread if the infected influenza A (H1N1).

Pm the same day the Department of Health, Department of Education and Training and Health Center for Ho Chi Minh City to check the sanitation of the two seats in high schools Truong Vinh Ky and Nguyen Thai Binh (Tan Binh).

Up to this time, in private schools PTTH Ngô Thời The confirmation has 80 students with positive influenza A (H1N1) and the RMIT University students have 2 get flu A (H1N1).

Vietnam: May close all schools in HCM City

23/07/2009

Previous events flu spread rapidly in schools, this afternoon, the GD & ĐT HCMC emergency steering boarding schools suspend the histology.

Mr. Huynh Cong Minh, Director of the Department require schools and boarding for the students during the summer holiday, to prevent the flu infection cases from outside spread to students, teachers in schools. If the students are boarders at this time, they must quickly pay the children of local to focus on the plan.

Head education sector also proposed all across the city to organize the total sanitation classrooms, boarding area, dining ... safety and hygiene before accepting students.

District office of GD & ĐT city - Mr. Bui Khac Huy said, if the flu spreads in school events trend of the poor may have to close all schools, students in isolation to safe.
The 22 / 7, Department of GD & ĐT HCMC has sent documents to the foreign language, information technology, fostering the cultural city proposed tracking measures to prevent influenza. Specifically, directors of note are the basis of the teachers of the foreign of Vietnam in the house 3 days prior to the center to ensure safety for all students, teachers.

Earlier, on 21 / 7, Vice President of the Permanent People's Committee of Ho Chi Minh City - Nguyen Thanh Tai also requires agencies, in addition to monitoring at border gate, should be monitored at the community. The note his treatment of the disease severity, to prevent death but not to focus on hospitals that refinement distribution for hospital districts. "Focus area for the right school for the city to have 1 million students and faculty about the new school year and over 300,000 more students. Before the school year instruction must survey all schools, conducting hygiene, the same ", the vice president stated.

Besides, he also recommended The attention to the accommodation areas, the export processing - the industrial workers crowded living focus for advocacy, for A/H1N1 flu.

Until this afternoon, was wishy-washy HPAI H1N1 outbreak in the 2 schools in HCMC. Flu at first, high school private Ngo The Times, District 9, the number of students identified positive continuous increase in the days and now is over 70. In the 3 schools with private Nguyen, only yesterday and today, 32 students on fever, 2 of the identified positive. Of them have formed "the hospital", to deal with the ability to spread to the community.

Vietnam: 2000 school student Nguyen Khuyen 'evacuated' for flu

23/07/2009 17:54
(Zing) - high school private Nguyen Khuyen had to temporarily disband the whole of 2000 students boarding because a student infected with influenza A/H1N1.

Hoang Bang not end after detecting the "outbreak" of influenza A/H1N1 schools in HCM City today, many parents of students to "giật you" before the students at the 3, schools private Khuyến Nguyen Tan Binh District (Ward 13, Tan Binh district) infected with influenza.

According Profile Vinh Hien, 11 grade students in private schools Nguyen Khuyen (Tan Binh District, HCMC), the start is known as a "student the female side of the field of influenza A infection / H1N1. Immediately, members of this isolation is complete with all of the remaining students of the school. All of them are careful examination to determine infection with or not.

In the evening 22 / 7, medical staff to each class in school to check. All are required to wear and to keep certain distance in communication. Each grade receive focus in the school yard to listen to instructions on how to identify and influenza A/H1N1 room. "Now, concerns feelings of the four children moved place of fear," said Hien Next. "Since that night, four children still sleep in the school's campus, no one knows what will come to you."

"All students are encouraged to wash their hands after each day's action, though that is, to touch objects or other people before going to sleep. Water also is prepared to súc mouth frequently.

Immediately after the publication of information about the Department of Health and Department of Education - Training HCMC has allowed the school to temporarily disband the whole of 2000 boarding students (of 2,300 students). They are a family of his shuttle, or the school will be organized for transportation to take home.
-snip-