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News Scan

Aug 9, 2010

WHO may soon declare pandemic's end The World Health Organization (WHO) may sound the global "all clear" for pandemic H1N1 shortly, says Director-General Dr. Margaret Chan. In a Canadian Press interview, Chan said the decision could be made soon after a WHO meeting that is likely to occur this week. H1N1 has lost its dominance, now behaving more like seasonal flu viruses, and the population has gained some immunity. Any delay in the decision would likely be due to continuing cases in a few areas, such as New Zealand and India. [Aug 8 Canadian press article]

Cases, deaths continue in India The H1N1 pandemic may be abating in much of the world, but India reports 942 new cases in the past week (Aug 2-8), with 83 deaths. An article in the Times of India says two patients in the city of Pune died from pandemic H1N1 Aug 6, bringing the number of H1N1 deaths there to 99 since April. The state health department reported that 29 people are in critical condition and on ventilator support in city hospitals; 38 people tested positive for the infection Aug 6. [Indian government's case count]

Aug 6, 2010

Biochemical trick helps H1N1 virus spread in humans A new study has identified an amino acid in pandemic H1N1 that allows its efficient replication in mammals. The acid, at position 591 of polymerase subunit PB2 (ie, PB2-591), apparently compensates for the virus's lack of the amino acid PB2-627K, thought to be critical for avian flu virus adaptation to mammals. The authors say this finding, plus another regarding an alteration in surface shape of the H1N1 PB2 protein, helps explain the spread of the virus in humans. [Aug PLoS Pathog article]

WHO reports little change in flu levels The World Health Organization (WHO) reports that the global pandemic H1N1 situation remained largely unchanged in the week that ended Aug 1, with transmission still most active in parts of South Asia and limited areas of tropical South and Central America. India continues to have the most notable activity, although the intensity and severity did not appear to exceed levels during the first 2009 wave. Southern Hemisphere areas with H1N1 flu activity include Chile, New Zealand, and Australia. [Aug 6 WHO update]

H1N1 activity up in New Zealand Influenza-like illnesses (ILIs) in New Zealand, now in its winter season, are showing a significant uptick, according to a news release from the country's ministry of health. Reports of ILIs are at their highest level for the year so far but remain well below the level at this time last year, just after the peak of the 2009 wave. Pandemic H1N1 is the predominant strain circulating, and some areas that were not affected severely last year are seeing higher rates of hospitalization. [Aug 5 news release]

Aug 5, 2010

Pandemic H1N1 and H5N1 genetically similar A group of Japanese and US researchers has found that the 2009 pandemic H1N1 influenza virus and a contemporary H5N1 avian flu virus have a high degree of genetic compatibility. The study involved co-infecting susceptible (MDCK) cultured cells with both viruses. Their findings, they say, show that reassortment between the two viruses is likely in the event of co-infection in a susceptible host (likely swine) and could create a pandemic H5N1 virus. [Aug 4 J Virol abstract]

Study: Importance of HA and NA in pandemic vaccine Inclusion of the neuraminidase (NA) surface glycoprotein in pandemic H1N1 influenza vaccine is likely to reduce the hemagglutinin (HA) dose required and to broaden protective immunity. Dutch researchers evaluated the efficacy of soluble, multimeric forms of 2009 H1N1 HA and NA as vaccines in ferrets. NA dramatically reduced virus replication, and HA markedly decreased clinical effects of infection; optimal protection was achieved by co-administration of both. [Aug 4 J Virol abstract]

Pandemic H1N1 was dominant flu virus in Southern Hemisphere Researchers analyzing World Health Organization Southern Hemisphere data collected during the winter of 2009 found that the pandemic H1N1 strain almost totally displaced seasonal H1N1 in the first phase of the pandemic. Also, the rates of seasonal H3N2 influenza declined from typical levels but to a lesser extent. The authors recommend that seasonal vaccines for the coming winter include representative pandemic H1N1 and seasonal H3N2 viruses but not previously circulating seasonal H1N1. [August 5 Eurosurveillance article]

Large rise in antibodies to pandemic H1N1 in Norwegians A study from Norway found that the prevalence of antibodies to pandemic H1N1 rose from 3.2% to 44.9% from August 2009 to January 2010. Young people aged 10 to 19 had the highest prevalence, at 65.3%. Population-representative serum samples were collected before the pandemic, during the early phase, and after a nationwide vaccination program. The authors state that the high immunity to pandemic H1N1 may be enough to forestall an epidemic of the virus in Norway in the coming flu season. [August 5 Eurosurveillance article]

Aug 4, 2010

New Zealand region sees high H1N1 school absenteeism The frequency of pandemic H1N1 flu is rising in New Zealand's Wairarapa region, according to The Dominion Post today, with five schools reporting 20% to 50% of students affected. All told, more than 400 children are out sick. A Wellington health official said the outbreak is particularly severe and spreading rapidly, according to a TVNZ report. Radio New Zealand today reported that the country has had more than 380 confirmed H1N1 cases and 183 hospitalizations in the past 2 weeks. [Aug 4 Dominion Post story]

Study shows many similarities with seasonal flu Researchers compared lab-confirmed pandemic influenza (871 cases) with seasonal flu (288) in Western Australia last year and found hospitalization rates slightly higher with pandemic H1N1 but many similarities between the strains. Patients in both cohorts reported a median of 6 of 11 flu symptoms, and less than half the patients in both groups had more than one underlying condition. However, those with pandemic flu were more likely to have diabetes. [Aug 3 Emerg Infect Dis study]

Hong Kong residents said no to mitigation Researchers surveyed 13,000 Hong Kong residents at various times between April and November 2009 and noted that respondents reported low anxiety throughout that period of the pandemic. Greater anxiety was associated with poorer hygiene but greater social distancing. Over time, knowledge on modes of transmission and efforts to control transmission failed to improve and social distancing declined. The authors conclude that community mitigation played little role in mitigating the impact of H1N1. [Aug 2 J Infect Dis abstract]

Aug 2, 2010

H1N1 cases rise in New Zealand, Australia Some New Zealand emergency departments struggled to keep up last week as pandemic H1N1 flu cases increased, according to the New Zealand Herald. Almost 1,900 people sought medical care for flu-like symptoms last week, with Auckland's hospitals running near capacity. Officially, 59 hospitalized H1N1 cases were confirmed for the week. Australia is also reporting a rise in cases, with several requiring intensive care, according to other media reports. [Jul 31 New Zealand Herald story]

New York highlights flexible surveillance Using enhanced surveillance methods, New York City's health department identified 996 likely H1N1 patients (929 confirmed, 27 probable) who needed hospitalization by Jul 7, 2009. Its methods, which included hospital-based surveillance and enhanced passive reporting, found that about 50% of patients lived in high-poverty areas and about as many were kids. The approach helped the city target its response and "demonstrates the need for flexibility in surveillance approaches." [Jul 30 Emerg Infect Dis study]

Two patients may have been re-infected Israeli officials report two cases of possible lab-confirmed re-infection with pandemic H1N1. The first patient, a 26-year-old man with Noonan syndrome, developed pandemic flu in August 2009 and was discharged without antivirals or supportive treatment. His disease redeveloped last November. The second patient, a 13-year-old boy with advanced cerebral palsy, was treated for 5 days with oseltamivir (Tamiflu) in July 2009 and improved. He tested positive for recurrent novel H1N1 in December. [Jul 30 Emerg Infect Dis letter]

Jul 30, 2010

Study shows lower fitness, transmission in drug-resistant H1N1 Researchers studied closely matched isolates of pandemic H1N1 in ferrets and found the oseltamivir (Tamiflu)-resistant strain to not transmit efficiently via droplets but to transmit well via direct contact. The oseltamivir-sensitive strain transmitted well via both routes. Although both strains caused a similar disease course, they found signs of lower viral fitness in the resistant strain. The authors said drug-resistant strains must continue to be closely monitored. [Jul 29 PLoS Pathog study]

Australians show resistance to some prevention efforts An Australian study comparing attitudes during the pandemic with those 2 years prior showed increased hand washing but a drop in willingness to comply with certain prevention efforts. About 47% reported increased hand washing, and 28% reported increased covering of coughs and sneezes. The percent willing to be quarantined stayed about the same, but willingness to avoid public events and social gatherings for a month and to wear a mask in public dropped over the 2 years. [Aug Emerg Infect Dis study]

H1N1 hit Down syndrome patients hard Mexican researchers compared more than 200,000 cases of flu-like severe acute respiratory illness during the pandemic with 60 patients with Down syndrome who reported the same flu-like symptoms in the same period. They found that those with Down syndrome were 16 times more likely to be hospitalized, eight times more likely to require intubation, and 335 times more likely to die from the disease. They recommend vaccination and early antiviral treatment in this group. [Aug Emerg Infect Dis study]

Jul 29, 2010

Expert: Pandemic definition should exclude severity Though many are calling for the World Health Organization (WHO) to incorporate severity into its pandemic alert phases, a renowned virologist is saying no. Malik Peiris of the University of Hong Kong said there was no doubt novel H1N1 was a pandemic, well before the WHO declaration. "We really don't have good assessments of severity," he told The Hindu. "So it would completely paralyze international public health policy, I think, if severity is linked to the definition of a pandemic." [Jul 29 The Hindu story]

Study shows rates of antibodies to H1N1 varied by country A seroprevalence study of 7,962 people aged 1 to 60 years found that, from August to October 2009, people had these rates of antibodies to pandemic flu: Costa Rica (26.4%), the United States (22.5%), Switzerland (16.9%), Germany (12.6%), Belgium (10.1%), and Japan (5.9%). The authors write, "The low proportion of seropositive children in Europe and Japan suggests that little local viral transmission had occurred." They say the data show that public health steps in late 2009 were justified. [Jul 29 Eurosurveillance study]

City's 5-phase vaccine effort helped reach thousands Today in Morbidity and Mortality Weekly Report, officials from Skokie, Ill.'s health department detail how they administered 40,000 doses using a five-phase H1N1 vaccination campaign. Highlights included school and day care clinics that reached a large number of staff and caregivers as well as children, targeting emergency medical services personnel, shifting unused vaccine from the school clinics to medical clinics, employing mass-vaccination clinics, and reaching out to the homebound. [Jul 30 MMWR report]

Jul 28, 2010

Beijing study: Obesity, pregnancy not tied to serious H1N1 A study of 475 severe, 73 critical, and 69 fatal pandemic H1N1 cases in Beijing last year showed that heart disease, diabetes, and allergies increased the risk of serious disease, while obesity and pregnancy did not. Also, those aged 6 to 17 years had a lower risk of serious illness. The city had a case-fatality rate of 0.6%, and serious cases made up 5.7% of all H1N1 cases. About half the patients had no underlying condition (58% of severe, 53% of critical, and 41% of fatal cases). [Jul 27 J Infect abstract]

Antivirals protected against secondary infection Japanese public health staff visited 124 homes of people infected with pandemic flu last year, educating household contacts about flu-avoidance steps and providing 88% of contacts with antiviral drugs (postexposure prophylaxis, or PEP). The secondary attack rate (SAR) in the households visited was 0.6% in contacts given PEP (2 of 331, including an antiviral-resistant case), compared with 26.1% in those with no PEP (12 of 46). The researchers estimated the protective efficacy of PEP to be 98%. [Jul 27 J Infect abstract]

Pandemic led to better hand hygiene South Korean researchers who surveyed 942 college students last December found that 30% said they had increased their frequency of hand washing over the previous year. Female students, students who perceived hand washing to be effective, and those who perceived H1N1 illness to be more severe were more likely to wash hands frequently. The authors say their results suggest that public education campaigns are effective at changing behavior [Jul 28 BMC Infect Dis abstract]

Jul 27, 2010

India reports 38 new H1N1 deaths India reported 548 pandemic flu cases and 38 deaths for the week ending Jul 25, up significantly from 332 cases and 21 deaths the week before, according to the country's Press Information Bureau (PIB) today. The southern states of Maharashtra (19), Kerala (8), and Andhra Pradesh (5) reported the most deaths. All of the newly infected patients contracted the disease within the country. [Jul 27 PIB release]

Gambia begins vaccination campaign Gambia's Ministry of Health and Social Welfare announced yesterday that it has started its vaccination campaign against pandemic H1N1 flu in collaboration with the World Health Organization, according to the Daily Observer today. The program will last all week and aims to reach 170,000 people, with priority given to health workers, pregnant women, children, and those with underlying disease. [Jul 27 Daily Observer story]

Jul 26, 2010

CDC outlines steps for expired vaccine The US Centers for Disease Control and Prevention (CDC) released a question-and-answer document explaining what providers should do with expired H1N1 vaccine. Because the federal government issued the vaccine, the process to return it differs from that for both seasonal flu vaccine and the Vaccine for Children program. The recovery program applies to unopened vaccine that expired Jun 30 (from CSL, Novartis, and MedImmune) but not to Sanofi's multidose vials, which expire in 2011. [Jul 23 CDC Q&A]

H1N1 hit organ-transplant patients hard Of 237 cases of pandemic flu in those receiving organ transplants in 26 US, Canadian, and Dutch centers, 167 (71%) were hospitalized because of their infection. Of 230 patients for whom data were available, 73 (32%) had pneumonia, 37 (16%) were admitted to intensive care, and 10 (4%) died. The authors conclude, "Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic" and that early antiviral therapy provided clinical benefit. [August Lancet Infect Dis abstract]

Diabetes raises risk of H1N1 hospitalizations, ICU Having diabetes triples a person's risk of being hospitalized for pandemic H1N1, according to a new study. Of 162 patients with lab-confirmed novel H1N1, 22 (14%) had diabetes (9 with type 1 and 13 with type 2). This was three times the 7.1 cases expected, based on population demographics. Also, the diabetic H1N1 patients had quadruple the risk of requiring intensive care compared with other H1N1 patients. The authors conclude that their results corroborate other findings in those with diabetes. [July Diabetes Care abstract]

Tamiflu-resistant strain still virulent In a study on mice and ferrets, researchers found that the oseltamivir (Tamiflu)-resistant pandemic flu strain was just as virulent as the oseltamivir-susceptible strain. The two strains differed only by a single change (H274Y mutation) in the neuraminidase protein. The authors state that "the H274Y pH1N1 mutant strain has the potential to disseminate in the population and to eventually replace the susceptible strain," a phenomenon that has already occurred in seasonal flu. [Jul 22 PLoS Pathog study]

Jul 23, 2010

Tropics remain most active areas for H1N1 Pockets of West Africa, Central America, the Caribbean, and South and Southeast Asia continue to have the most active pandemic flu activity, while overall global flu activity remains low, the World Health Organization (WHO) said in its weekly update today. Australia and New Zealand have seen recent increases in respiratory disease, mostly pandemic flu. Influenza B and H3N2 are dominating South Africa's flu season. The areas with highest H1N1 activity in Asia are India, Cambodia, and Singapore. [Jul 23 WHO update]

Surveys provided quick assessment of H1N1 in NYC Two telephone surveys in May and June 2009 enabled New York City health officials to quickly assess the prevalence and severity of pandemic flu, according to a study published in PLoS One. The polls indicated that the prevalence of flu-like illness in a 50-day period was 15.8%, and estimated case-fatality rates for H1N1 ranged from 0.054 to 0.086 per 1,000. The surveys indicated that the risk of severe illness was similar to that with seasonal flu, which influenced the city's pandemic response. [Jul 21 PLoS One report]

Jul 22, 2010

Asian nations call for pandemic phase change Health ministers from the Association of Southeast Asian Nations (ASEAN) today during a retreat in Singapore called on the World Health Organization (WHO) to review its current pandemic alert level, Xinhua, China's state news agency, reported. They said flu activity has reached the post-pandemic phase and that future assessments should account for severity or virulence. The request comes a day after the WHO announced it was waiting on clearer signals from the Southern Hemisphere and other areas.

Google tool tracked well with European flu surveillance Google Flu Trend (GFT) monitoring during the H1N1 pandemic in Europe correlated well with peaks in sentinel physician network surveillance in several countries, according to a report today. The authors suggested that GFT could be a useful adjunct to other systems because it provides a more rapid estimate that is most relevant in countries with large numbers of Internet users that perform regular Web searches. An earlier comparison of GFT and US flu data showed similar results. [Jul 22 Eurosurveillance report]

Swine, avian N1 strains found sensitive to Tamiflu Researchers studying influenza viruses of the N1 neuraminidase subtype (eg, H1N1, H5N1) in birds and pigs found resistance to the common antiviral drug oseltamivir (Tamiflu) to be low. For example, of 91 isolates collected from ducks, shorebirds, and gulls, 7 (7.7%) had reduced susceptibility to the drug but were susceptible to related antivirals zanamivir (Relenza) and peramivir. N1 strains from swine, birds, and humans formed the novel H1N1 flu that caused the current pandemic. [Jul 21 J Virol abstract]

Jul 20, 2010

WHO committee may meet to decide to end pandemic The Emergency Committee of the World Health Organization (WHO) may meet next week to review infection data from the Southern Hemisphere and recommend that the agency announce an end to the pandemic, sources "familiar with the matter" told Bloomberg News. WHO spokesman Gregory Hartl said that Director-General Margaret Chan will decide on whether to declare a post-pandemic phase guided by how the virus behaves, adding that the agency hasn't set a date for an announcement. [Jul 20 Bloomberg News story]

UK media reports aided public calm, prevention steps UK public service ads and media coverage of the H1N1 pandemic helped alleviate public concern and improved protection measures like using hand sanitizer, according to a new study. Telephone surveys of more than 38,000 people between May 2009 and January 2010 found the levels of those who were very or fairly worried varied between 10% and 33%, with those exposed to media messages less likely to worry. Among protection steps, 33% reporting carrying tissues with them and 10% bought sanitizer. [Jul 20 Medical News Today release]

Tamiflu helped blunt household transmission A study exploring the use of oseltamivir (Tamiflu) in preventing household transmission of pandemic H1N1 flu found that early treatment reduced the odds of secondary infection by 42%s. In the study of 362 Milwaukee households, 135 had information about oseltamivir use, 25 of which reported early use of the drug. The authors concluded that the findings may have implications for future pandemic flu control efforts. [Jul 20 BMC Infect Dis abstract]

Jul 19, 2010

Study says Ontario's vaccine campaign worth it Even though it began late in the pandemic, Ontario's H1N1 vaccination efforts may have saved 50 lives, averted 1 million cases, and was well worth the cost, according to a new study. Using data on hospitalizations and deaths before the start of the campaign, Ontario health officials used a computer model to predict what would have happened without the vaccine. They estimated the vaccine prevented 420 hospitalizations, 28,000 emergency-department trips, and 100,000 visits to physicians' offices.

Pandemic kills 21 more in India India reported 332 pandemic flu cases and 21 deaths this past week, up a bit from 330 cases and 17 deaths the week before, according to the Press Trust of India (PTI) today. The southern states of Kerala and Maharashtra reported the most deaths, 8 and 11, respectively. Only 1 of the 332 patients contracted the disease outside India. [Jul 19 PTI article]

India mandates vaccine for health workers With pandemic flu on the increase in the country and more than 60% of its vaccine still unused, India's health secretary has made flu vaccination of healthcare workers mandatory. Union Health and Family Welfare Secretary K. Sujatha Rao asked the state to make the vaccination "mandatory for all health workers without fail." Stressing urgency, she said, "The life of this vaccine is not very long and needs to be utilised well before its expiry date." [Jul 16 Deccan Herald story]

Experts criticize Egypt's pandemic response Egyptian health experts are questioning their government's pandemic response, according to a report from the UN's Integrated Regional Information Networks (IRIN). They point to the nation's culling of all swine early on, which affected many people's livelihoods, as well as its cutting class sizes in half and being unable to vaccinate many people. "Egypt is probably the only country in the world that acted in such an insane way towards the virus," said Saed Aun, a former health ministry adviser. [Jul 19 IRIN report]

Jul 16, 2010

Global cases continue at low levels In its weekly update, the WHO reported today that global pandemic flu activity remains low, with the most active areas in parts of South Asia, West Africa, and Central America. Flu activity remains low in the temperate Southern Hemisphere during the first half of winter except in South Africa, which has had increased detections of primarily seasonal flu (type B and A/H3N2). Pandemic flu activity in Asia remains low to sporadic, except in parts of India, Malaysia, and Singapore. [Jul 16 WHO update]

Pathology study finds alveolar damage, bacterial co-infection A pathology study of 100 fatal H1N1 cases from last spring found the most prominent damage to tissue was diffuse alveolar lung damage, particularly to alveolar lining cells. Also, more than 25% of patients had bacterial co-infections. Viral pneumonia and localization of viral antigen to damaged alveoli were also prominent. The authors conclude, "Underlying medical conditions and bacterial co-infections contributed to the fatal outcome of this infection."

One fifth of Pittsburgh patients had H1N1 antibodies Researchers studied blood samples from Pittsburgh-area hospitals and clinics for 846 patients, roughly 100 samples for each decade of age (eg, 0 to 9) and found that seroprevalence for pandemic H1N1 flu averaged 21%. However, seroprevalence varied by age-group, with those age 10 to 19 years having the highest (45%), and patients age 70 to 79 the lowest (5%). This compares with a baseline seroprevalence of 6% among 18- to 24-year-olds for seasonal H1N1 influenza in 2008. [Jul 14 PLos ONE study]

Jul 15, 2010

School closure caused missed work in 22% of households A study that looked at a week-long closing of a Pennsylvania elementary school because of H1N1 last May found that in 22% of households at least one parent had to miss work, often for multiple days. The overall economic impact, however, was not major. But of those who missed work, about 40% missed 5 days of work. Although home was the primary location that students spent their time off, more than two thirds reported visiting other locations like stores or restaurants. [Jul 14 HealthDay News report]

Study finds seasonal vaccine did not give H1N1 protection Australian researchers found that the seasonal flu vaccine did not protect against pandemic H1N1 flu. Their study found that 15% of both seasonal flu-vaccinated people and their unvaccinated counterparts developed H1N1 flu in the week after a household member did. The authors list some caveats, including that the outcome sought was clinical flu-like illness and not lab-confirmed novel H1N1 (though a high percentage of those tested had pandemic flu) and that vaccination history was not verified. [Jul 15 Euro Surveill study]

Study: Kids shed H1N1 virus longer Children under age 13 shed pandemic H1N1 viruses longer than do adolescents and adults, found a Taiwan study. The researchers, who studied 602 confirmed cases, found that the median duration of viral shedding for all ages was 9 days, longer than in other studies. But it was 11 days for children younger than 13, and 7 for the rest of the population. They also found that patients with pneumonia had significantly higher viral loads than those with upper respiratory tract infections or bronchitis. [Jul 14 MedPage Today article]

Report faults France's vaccine distribution A parliamentary review has concluded that France's H1N1 vaccination efforts were a "failure," with millions of doses discarded or cancelled, according to a Connexion story. Less than 8.5% of the population was vaccinated. The parliament's report found that excluding local general practitioners from distribution efforts contributed to the low uptake, and that a number of doctors who helped with vaccinations have yet to be paid. It did not fault officials for taking the virus seriously. [Jul 15 Connexion story]

Saudi pilgrims won't need H1N1 vaccination Saudi Arabia this year has waived the requirement that Hajj and Umrah pilgrims traveling to the country be vaccinated against pandemic H1N1 flu, according to the Press Trust of India (PTI) today. Last year the country's health ministry had recommended the vaccine for all pilgrims. The Hajj pilgrimage takes place in November, while Muslims can make an Umrah pilgrimage any time of year. [Jul 15 PTI story]

Jul 14, 2010

WHO delays decision on pandemic phase The expert committee advising the World Health Organization (WHO) on whether to lower the pandemic alert level from phase 6 might not meet till August, according to an Agence France-Presse (AFP) story today. It had originally planned to meet in mid July. WHO Director-General Margaret Chan said the committee will wait to see what happens in the Southern Hemisphere, which usually sees its peak influenza activity in August. "I expect the committee to meet at the end of July or in August," she said. [Jul 14 AFP report]

Northern Hemisphere nations saw substantial hospitalizations Studies on the H1N1 pandemic in the Northern Hemisphere showed considerably high hospitalization, intensive care (ICU), and death rates, according to a meta-analysis in the European Journal of Clinical Microbiology & Infectious Diseases (EJCMID). Among evaluated cases in 35 studies, researchers found hospitalization rates as high as 93.8%, ICU admission as high as 36.4%, and fatality rates as great as 38.5%. They also found "substantial percentages" of the elderly among the severely ill. [Jul 13 EJCMID abstract]

Jul 13, 2010

Mumbai seeing widespread flu Pandemic flu in Mumbai, India, this year has reached 150 cases and is no longer localized, prompting officials to alter their strategy. In last year's wave they could identify pockets of flu and focus efforts, but now they say the virus is "in the air," and they'll shift to informing the public on how best to prevent the disease. "We are getting swine flu patients from everywhere in the city," an official said. "We have to maintain vigilance all over." The city's slums have been hardest hit. [Jul 13 Express India story]

Most UK H1N1 fatalities had no underlying illness UK researchers found that 55% of 631 hospitalized H1N1 patients and 59% of fatal cases were otherwise healthy. Racial minorities and pregnant women were overrepresented. Thirteen percent of patients were admitted to a "high dependency" or intensive care unit, and 5% died. Of 349 patients who had chest x-rays, 29% had evidence of pneumonia, which was associated with a severe outcome. Other risk factors for severity were obesity, certain pulmonary conditions, and raised C-reactive protein levels. [July Thorax study]

Maryland invites input on pandemic response Maryland's health department is seeking people willing to take part in focus groups to provide feedback on the state's pandemic response, including why only 25% of citizens received the H1N1 vaccine, as well as their opinions on the pandemic in general. Officials would like to hear from those who did and did not get the vaccine and will finalize focus groups of 8 to 10 people by Jul 30. The department has hired facilitators who have experience conducting H1N1 focus groups. [Jul 12 WBALTV report]

Double-lung transplant gives patient H1N1 A 53-year-old Edmonton man who received a double-lung transplant last fall appears to be the first reported patient to have developed pandemic H1N1 flu from infected donor lungs, according to the Toronto-based Financial Post. The infection presented a major challenge to the treating physicians because of the immune-suppressing drugs that transplant patients receive. The patient, however, recovered fully.

Jul 12, 2010

India confirms 330 cases last week For the week ending Jul 11, India confirmed 330 pandemic H1N1 flu cases, including 17 deaths, the country's Press Information Bureau (PIB) reported today. All of the cases are indigenous. The fatal cases occurred in three southern states that have been among the hardest hit: Kerala (8), Maharashtra (8), and Andhra Pradesh (1). [Jul 12 PIB chart]

Mauritius records its first H1N1 death of year Mauritius, a small island nation east of Madagascar, has recorded its first pandemic H1N1 death of the year, according to China's Xinhua news service. A 51-year-old government official died Jul 10 after having lab-confirmed pandemic flu for about 15 days. The country has seen "several suspected cases of A/H1N1 virus" in both private and public medical centers. [Jul 12 Xinhua story]

Jul 8, 2010

WHO official rates global pandemic response Public health officials generally responded well to H1N1 pandemic flu but can improve in several areas, according to the WHO's European regional director, Zsuzsanna Jakab. She said officials "contained" the pandemic through "intensive activity" but need to improve in three areas: flexibility to scale activity to pandemic severity, integrated communication, and better WHO coordination of antiviral and vaccine efforts. She also said the WHO may declare a post-pandemic phase this month. [Jul 8 EurActiv interview]

Study finds antivirals help reduce transmission A recent study found that households using antiviral drugs for pandemic flu lowered overall transmission rates even though levels of adult-to-child transmission remained relatively high. Dutch researchers studied 47 households early in the pandemic whose index case (the first sick member) and all household contacts took oseltamivir within 24 hours after detection of the index case. Though they found a low secondary attack rate (0.075), the attack rate from an adult to a child under 12 was 0.35. [Jul 7 PLoS ONE study]

Flu continues to rise in New Zealand Flu activity in New Zealand continues to increase but is at the level usually seen this time of year and is still below baseline, the country's Ministry of Health (MOH) reported today. Weekly general practice visits for flu-like illness were 27.5 patients per 100,000 population; baseline is 50. Of 17 viruses typed, 13 were pandemic H1N1, 3 influenza A not subtyped (likely pandemic H1N1), and 1 influenza B. The country has had 4 H1N1 patients treated in intensive care this year and 1 death. [Jul 8 New Zealand MOH report]

Jul 6, 2010

India reports 16 more H1N1 deaths India reported 16 pandemic-related deaths among 370 cases in the past week, according to the Hindustan Times today. The state of Kerala had 10 deaths, Maharashtra 4, and Andhra Pradesh 2. Also today, the country has started retailing its first domestically produced nasal-spray pandemic vaccine, Nasovac, made by Serum Institute and approved for those 4 years old and older. A domestically produced injectable vaccine was made available last month. [Jul 6 Hindustan Times story]

Only 12% of UK hotline antiviral users had H1N1 Almost 90% of the more than 1 million UK citizens who obtained antiviral drugs using Britain's pandemic flu hotline or Web site did not have novel H1N1 flu, according to BBC News. Of 16,560 people who used the service and were tested, only 1,932 (12%) had H1N1. The country's Patients Association has raised issues about the system, and the country's independent review of its pandemic response last week called for a complete review of the service. [Jul 4 BBC News report]

Health-provider reminder aids vaccination Only one third of US adults for whom seasonal flu vaccine is recommended knew they were in the target group, and this figure dropped to 30% for the pandemic H1N1 vaccine, according to a recent study. However, interaction with a healthcare provider raised those rates. For seasonal flu vaccine, the figure rose to 39% for those who had a recent provider visit and to 59% for those who received a fact sheet clarifying their status. For the H1N1 vaccine, the numbers rose to 32% and 56%, respectively. [Jul 2 Am J Infect Control abstract]

Jul 2, 2010

Flu activity up slightly in some parts of world Global pandemic and seasonal flu activity remains low, but South Africa, New Zealand, and Australia have all noted recent slight increases in respiratory disease, according to the WHO today. South Africa logged its first H1N1 case of 2010, but most flu viruses there are seasonal H3N2. Low levels of H1N1 continue in parts of the tropics, particularly in South and Southeast Asia, the Caribbean, and West Africa. Low levels of type B flu persist in parts of Asia, Africa, and Central America. [Jul 2 WHO update]

Canada wrestles with expiring-antiviral issues Faced with about 9 million expiring doses of the antiviral drug Tamiflu worth $18 million, Canadian officials are exploring the options, according to the Toronto-based Globe and Mail. Public health leaders are faced with three options: destroy the expired doses, reprocess them (to replace the expired ingredients) to prolong shelf life, or make do with remaining stockpiles that won't expire soon. A federal official said a decision on the antiviral stockpiling should come this fall.

Study proposes Tamiflu dosing for preemies Before its emergency use authorization expired Jun 23, oseltamivir (Tamiflu) was at times prescribed to treat children under 1 year old. Researchers used their experience with 32 premature newborns exposed to the pandemic virus to establish a dosing protocol for the drug. Their results indicate that a twice-daily dose of 1.0 mg/kg in premature neonates produced drug exposures similar to that in older children receiving twice-daily doses of 3.0 mg/kg. [Jul 1 J Infect Dis abstract]

Jul 1, 2010

US may destroy 43% of H1N1 vaccine About 40 million doses of H1N1 vaccine worth $260 million have expired and will be destroyed, and 30 million more will expire later and may also be tossed, according to an Associated Press (AP) story. This would amount to more than 43% of all US vaccine made. "Although there were many doses of vaccine that went unused, it was much more appropriate to have been prepared for the worst-case scenario than to have had too few doses," said Bill Hall of the Department of Health and Human Services.

New Zealand sees rise in flu activity New Zealand is seeing gradually increasing flu activity to a level typically seen at this time of year, its Ministry of Health (MOH) reported today in its weekly update. Although the country is still below the baseline influenza level for flu season, it is experiencing pandemic H1N1 flu in communities and offering free vaccine to all those in at-risk groups. Of the influenza viruses typed, most are pandemic H1N1, with some seasonal H3N2. [Jul 1 New Zealand MOH update]

Study highlights first cases in Britain A study today in Epidemiology and Infection detailed 392 of the first UK pandemic H1N1 cases, including 14 patients who were hospitalized, 3 on mechanical ventilation. Patients were young (median age 15 years) and symptoms were similar to seasonal flu, except that 27% had diarrhea. Also, 11% had an underlying condition, similar to the general population, and 92% received antiviral drugs. The study found that the antivirals shortened the course of illness from 9 to 5 days. [Jul 1 Epidemiol Infect abstract]

Study tracks pandemic H1N1 adaptation in mammals To explore how novel viruses adapt to mammals, a team from Russia and St Jude's Children's Research Hospital in Memphis performed a series of genetic experiments on mice with pandemic H1N1 viruses, which isn't lethal to the animals. They published their findings in the Journal of Virology. They found that changes in receptor specificity and interaction of viral polymerase components with host cell factors are the major modulators of virulence that shaped early evolution of novel H1N1. [Jun 30 J Virol abstract]

Jun 30, 2010

Business planners withstand global response complaints In the wake of criticisms, mainly from European politicians, that global health officials overreacted to the H1N1 pandemic, Continuity Central conducted an online poll of its business continuity readership. Of 99 respondents, 26% said their pandemic planning efforts have been ridiculed and 52% said they had not. Also, 23% said their organizations now have less respect for preparedness efforts, while 71% reported no drop in respect. Some said their plans are on hold or have been shelved. [Jun 30 Continuity Central report]

Outbreak reported in Australia's Northwest Territories At least 29 pandemic H1N1 cases have been reported in recent days in Nhulunbuy, a town in Australia's Northwest Territories (NT). The NT Centre for Disease Control confirmed the cases and urged high-risk groups to get vaccinated, according to an NT News story. Prior to this outbreak, only 2 cases had been reported in the territory. [Jun 30 NT News story]

Another state in India reports H1N1 cases Tamil Nadu, a state in southern India, has reported pandemic flu cases. "In Tamil Nadu, 21 persons who were affected by H1N1 were admitted and getting treatment in various hospitals," state Health Minister M. R. K. Panneerselvam said, adding that the state was screening travelers at its borders and had adequate antivirals, according to the Press Trust of India (PTI). The neighboring states of Kerala, Karnataka, and Andhra Pradesh have been among the hardest hit.

Adjuvanted vaccine shows promise in young kids Spanish researchers conducting a trial of GlaxoSmithKline's adjuvanted pandemic H1N1 vaccine in children ages 6 to 35 months found that one dose was highly immunogenic and safe, according to a study in Vaccine. The trial included 157 children who received two standard doses or a higher-dose formulation 21 days apart. The first doses in both groups produced similar robust responses that exceeded European regulatory criteria. Reactions were more common after the second dose. [Jun 29 Vaccine study]

Mexico ends pandemic alert Mexico lifted its alert for pandemic H1N1 flu yesterday, officially ending the health emergency that began 14 months ago in that country, the Associated Press (AP) reported. Secretary of Health Jose Angel Cordova said only 10% of influenza cases in May were pandemic flu, down from 90% in October. Mexico has officially logged 72,546 H1N1 cases and 1,289 deaths, the last in May. [Jun 29 AP article]

Jun 29, 2010

WHO meeting on H1N1 response convenes tomorrow The special committee assigned to review the World Health Organization's pandemic response will convene its second face-to-face meeting tomorrow. Plenary sessions tomorrow and the morning of Jul 1 will include updates from the review committee, input from states' representatives, and interviews with stakeholders. The committee will also hold private sessions and may develop recommendations. A wrap-up plenary session Jul 2 will focus on discussing and adopting the meeting report. [Most recent committee update]

Study shows cross-protective immunity between 2009, 1918 viruses A study shows that immune-inducing compounds (peptides) derived from the current pandemic H1N1 influenza virus are more representative of 1918 pandemic flu than more recent seasonal flu strains. Researchers studied 12 peptide variants that emerged since 1918 and found no pre-existing immunity at the cellular level to the 2009 virus. However, infection with pandemic 2009 flu elicited a response specific to the 2009 and 1918 variants. They said the findings hold potential in vaccine development. [Jun 28 Proc Natl Acad Sci abstract]

Jun 25, 2010

Pharma group rates pandemic response The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) released a review of the world's pandemic response. It said that the years that public health, regulatory agencies, and vaccine producers invested in pandemic preparedness were a strong point. Other achievements were global cooperation and vaccine monitoring. Areas it said need improvement were upgrading vaccine-production technology, establishing advance supply agreements, and enhancing regulatory processes.

Study: 10% of H1N1 infections produce low immunity Blood samples from 881 H1N1 patients showed that the immune system in 90% of patients produced a sufficient antibody response to ward off the disease (a seroprotective titer of 1:40), according to a new study. This means 10% had an incomplete immune response to the disease, making them susceptible to re-infection. Having pneumonia and sputum production increased the chance of a robust immune response, while having no fever lowered it. The authors say the 10% may benefit from vaccination. [Jun 24 Clin Infect Dis abstract]

Jun 24, 2010

India reports mutation linked to different symptoms Health officials in India are reporting a "slight" mutation in the pandemic H1N1 virus that is leading to more sore throat and backache and fewer high fevers, according to the Hindustan Times. One health officer said the antiviral oseltamivir (Tamiflu) and vaccination are still "very effective" against the virus. Dr Om Srivastav, who is on a state government H1N1 advisory committee, said, "There is a small change in the virus. But this is not surprising. We expect it to change further." [Jun 24 Hindustan Times story]

Antiviral resistance found in immunocompromised A report published yesterday in Emerging Infectious Diseases studied 32 H1N1 patients whose immune systems were compromised -- 17 undergoing stem-cell transplant and 15 with cancer. Ten (31%) were admitted to intensive care (9 of whom were stem-cell patients), and 7 (22%) died. The H275Y neuraminidase mutation, which confers oseltamivir resistance, developed in 4 of 7 patients who tested positive for H1N1 after more than 4 days receiving oseltamivir. Three of these 4 were critically ill. [Jul Emerg Infect Dis study]

Chinese surveillance finds swine-avian flu reassortment Surveillance in Chinese pigs from 2006 to 2009 found novel reassortment between swine and avian flu viruses. Among 3,546 samples taken from pork-producing provinces, researchers found 29 strains of influenza A (19 H1N1, 1 H1N2, 9 H3N2). Genetic analysis showed that all H1N2 and H3N2 strains were double- or triple-reassortant viruses, which contain avian H5N1 fragments. The authors say the findings "raise concern about generation of novel viruses in pigs, which could have pandemic potential." [Jul Emerg Infect Dis dispatch]

Rapid test often negative in severe illness Thai researchers examining 20 confirmed and 3 suspected H1N1 patients found that those with the most severe illness were least likely to have a positive rapid diagnostic test (RDT). They could not explain the finding by differences in time to access medical care, performance of RDT, or antiviral therapy. They say their finding confirms CDC guidance, which recommends empiric treatment even when RDT is negative and recommends collecting lower respiratory tract specimens for PCR testing. [Jul Emerg Infect Dis letter]

Jun 23, 2010

Nature editors take pandemic conspiracy theorists to task Saying, "The council should think twice," the editors of Nature today advised the Council of Europe's parliamentary assembly against voting this week to express alarm over the World Health Organization's (WHO's) pandemic response. The journal said it has "heard many objections to the conclusions of the report on which the resolution is based." The editorial lauded transparency but said it would have been unwise to exclude from the H1N1 response all experts with ties to drug firms. [Jun 24 Nature editorial]

Most businesses took steps to protect workers Most US employees say their companies took steps to protect them from illness during the H1N1 pandemic, such as providing hand-hygiene solutions (81%), encouraging ill employees to stay home (80%), providing information on stopping flu spread (77%), and promoting vaccination (60%). About 42% said employers created backup plans to cover workload, and the same percent reported expanded leave policies. The poll by the Harvard School of Public Health (HSPH) was conducted Apr 21 to May 13. [Jun 22 HSPH poll results]

CT findings may help diagnose severe H1N1 Researchers found that high-resolution CT (HRCT) findings can help diagnose severe cases of pandemic flu. Of 106 H1N1 patients, 29 (27%) had multifocal asymmetric ground-glass opacities alone on plain CT, but the finding was much more common in those who required mechanical ventilation compared with those who didn't (63% vs 20%). On HRCT, the ground-glass opacities had a distinctive distribution that could aid early diagnosis of severe infection. [Jun 20 Eur J Radiol abstract]

PCR method detects pandemic-origin viruses in pigs In a study in Clinical Chemistry, researchers found that a method using polymerase chain reaction (PCR) can detect reintroductions of the pandemic H1N1 virus in pigs. Their test detected all 10 viruses of pandemic H1N1 origin among 48 swine influenza strains isolated from an ongoing surveillance program. The authors concluded, "These assays might be useful screening tools for identifying viral reassortants derived from pandemic H1N1/2009 or its precursors." [Jun 21 Clin Chem abstract]

Jun 22, 2010

WHO plans to review containment measures Measures to contain pandemic H1N1 flu failed to work last year and may need to be revised for future pandemics, a World Health Organization (WHO) official said, according to a Healthcare Republic news story. Dr. Sylvie Briand, head of the WHO's global influenza program questioned whether it is possible to contain influenza at its source and said, "Rapid containment was not feasible this time," adding that "at least we must slow transmission." [Jun 22 Healthcare Republic article]

India reports increased H1N1 activity Monsoon rains have increased pandemic H1N1 flu activity in India, with 13 deaths and 233 flu cases reported in the past week, according to the Indo-Asian News Service (IANS). Kerala has been hit the hardest, with 9 deaths last week and 14 the week before, but the situation is becoming "grave" in Maharashtra, Karnataka, and Andhra Pradesh states. "We are prepared to handle the threat with adequate doses of Tamiflu and vaccines available," a health ministry official said. [Jun 22 IANS story]

Latin American nations experience some flu An update from the Pan American Health Organization (PAHO) reported widespread influenza activity in Jamaica, while Cuba, Bolivia, Colombia, Peru, Venezuela, Brazil, and Chile reported regional flu activity. Bolivia reported a trend of increased acute respiratory disease for the first time, while Colombia reported 2 consecutive weeks and Venezuela 3 consecutive weeks of increased acute respiratory disease.

FDA approves CDC H1N1 test The US Food and Drug Administration (FDA) today approved a test developed by the Centers for Disease Control and Prevention (CDC) to diagnose pandemic flu, according to a CDC news release. The test, called the "CDC Influenza 2009 A (H1N1)pdm Real-Time RT-PCR Panel (IVD)," can provide results within 4 hours and has 96% sensitivity and specificity. It replaces one that was developed at the start of the pandemic in April 2009. [Jun 22 CDC news release]

Jun 21, 2010

Indian state reopens H1N1 isolation wards Citing the reemergence of pandemic flu and other viral diseases with the rainy season, Hyderabad, India, health officials announced they would reopen H1N1 isolation wards in all 28 hospitals in the state, according to The Hindu. Health Secretary P. V. Ramesh said the government was on top of the situation and urged people to seek medical attention for persistent or severe flu symptoms. [Jun 21 The Hindu report]

Hong Kong nurses show low desire for vaccine A survey conducted before the fall wave of pandemic flu found that only 13% of Hong Kong nurses planned to get the H1N1 vaccine, with another 41% undecided and 45% rejecting the idea. By comparison, 38% said they would get the seasonal flu vaccine. The survey of 812 nurses, conducted last July and August, found the nature of the nurses' practice and their frequency of patient contact did not play a role in their decision. Two thirds of nurses reported frequent direct patient contact. [Jun 20 Am J Infect Control abstract]

Jun 18, 2010

Global activity remains stable Global H1N1 activity remains mostly unchanged, according to today's World Health Organization (WHO) weekly update. Pandemic flu transmission remains low worldwide, with limited circulation in parts of Central America (Costa Rica), the Caribbean (Cuba), and South and Southeast Asia (Malaysia, Singapore, and, to a much lesser extent, India, Bangladesh, and Bhutan). Recently re-emerged seasonal H3N2 continues to circulate in East Africa, with type B in parts of Asia, Africa, and South America. [Jun 18 WHO update]

Average age at H1N1-related death in US was 40 The average age of those in the United States who died of pandemic flu last spring and fall was 40, with the median age, or midpoint, at 43, according to statistics from the Centers for Disease Control and Prevention (CDC). In the fall, the average age of those who died was 41, and the median age was 45. Data from the spring reflected all confirmed H1N1 deaths, while data from the fall were from a random sampling. [Jun 17 CDC document]

Study shows varied attack rate in Scotland A serum study shows that the age-adjusted percentages of people having antibodies to pandemic flu in four Scottish cities varied from 28% in Glasgow to 43% in Aberdeen. These rates roughly reflect the hospitalization rates in those cities, which ranged from 23% to 41%. In Inverness, younger adults were more likely to be H1N1-positive than were older people. The authors say the findings show that "older people are no longer more likely to have antibodies against the virus than younger adults." [Jun 17 Eurosurveillance study]

Jun 17, 2010

Chest x-ray may underestimate infections To gauge the relationship between symptoms and signs of disease on radiographic tests, researchers reviewed records of 157 hospitalized patients who had confirmed pandemic H1N1 infections. Researchers report in the British Journal of Radiology that chest x-ray abnormalities were found in only 33% of cases and were linked to breathing difficulties. The test was less sensitive than computed tomography among immunocompromised patients. [Jun 15 BJR abstract]

Autopsy study finds unique traits of H1N1 flu An autopsy study of H1N1 patients found peripheral pulmonary vascular thrombosis occurred in 5 of the 8 fatal cases, compared with 3 of 8 controls, according to an American Journal of Clinical Pathology report. Researchers also found cytophagocytosis in all of the flu-related cases. They found that the two features distinguished H1N1 cases from other flu types and that hemophagocytic syndrome should be suspected in severe H1N1 patients. [July Am J Clin Pathol abstract]

Jun 16, 2010

London reviews its pandemic flu response A report today from the London Assembly gave high marks to the local pandemic response, but listed several areas for improvement. The report, based on several meetings of health officials, said the pandemic plan should have considered a range of severity scenarios and that antiviral distribution points weren't evenly dispersed. Requests for data from multiple agencies sometimes overburdened local officials, and more efforts were needed to reach vulnerable groups and improve immunization rates. [Jun 16 London Assembly pandemic report]

India's health ministry to probe increase in cases A team from India's health ministry will assess a rise in pandemic flu illnesses and deaths in Kerala state that occurred over the past month after a monsoon hit the area, Indo-Asian News Service reported yesterday. Since May 15, 201 cases and 16 deaths have been reported, of which 9 were pregnant women. An official said extra antiviral medication and vaccines are being deployed to the area. Four flu deaths were also recently reported from two other Indian states, Maharashtra and Karnataka. [Jun 15 IANS story]

Jun 15, 2010

Contrasting vaccine supplies in Malta, Kuala Lumpur Only 92,043 doses of pandemic H1N1 vaccine were dispensed in Malta, and the government has 239,620 remaining. No decision has been made on what to do with the leftovers. It is estimated that the country spent 2.5 to 3 million euros on the stockpile. The situation is reversed in Kuala Lumpur, Malaysia, according to bernama.com, the country's national news agency. Only about 31,000 doses remain of the 400,000 purchased. [Jun 15 Times of Malta article]

Record numbers vaccinated in New Zealand The health minister of New Zealand says more than 1 million in the country have received flu vaccinations this year, setting a record, according to the New Zealand Press Association (NZPA). Last year 960,000 people were vaccinated. This year's flu shot includes the H1N1 pandemic strain. Cases of flu-like illness have increased in New Zealand over the past 2 weeks, with 18 pandemic H1N1 cases so far this year, and health officials are continuing to promote vaccination. [Jun 15 NZPA report]

Jun 14, 2010

Vietnam considers lowering H1N1 alert level The deputy minister of health in Vietnam has suggested lowering the alert level for pandemic H1N1 flu there, given that Vietnam has had no reports of the disease for more than 2 months. The World Health Organization (WHO) has not suggested this move, but the minister said the the health ministry had "heard" that the WHO had blown the pandemic out of proportion at the urging of pharmaceutical companies, an accusation the WHO strongly refutes. [Jun 11 Thanh Nien article]

Australian girl's autopsy shows no vaccine link Autopsy results show no evidence linking the April death of a 2-year-old Brisbane girl to the trivalent seasonal flu vaccine she had received a day earlier. But no clear cause of death was found, leaving some observers unconvinced. Because of increased adverse reactions, the seasonal vaccine is on hold for Australian children under 5. (Note: An earlier version of this item wrongly indicated the girl had received monovalent pandemic H1N1 vaccine. H1N1 is included in the trivalent vaccine.) [ABCNews story]

Jun 11, 2010

Seroconversion with oseltamivir prophylaxis Postexposure prophylaxis an effective way to mitigate pandemic flu outbreaks, says a study published today. The authors tested 237 military members in Singapore during and after oseltamivir prophylaxis. Infection occurred in 27 (11.4%), including 11 index cases and 16 people with a four-fold or more rise in antibody titers during treatment; 8 of these had symptoms and 8 did not. The authors say asymptomatic infections that occur during prophylaxis may confer protection against future infection. [Jun 10 BMC Infect Dis report]

Pandemic officially a year old Today marks the passage of a year since the World Health Organization (WHO) declared a pandemic of H1N1 influenza. WHO Director Margaret Chan declared phase 6 on Jun 11, 2009, about 7 weeks after the virus had surfaced. The WHO hesitated to take the step because of concern that it would cause undue alarm, given that H5N1 avian flu had led the public to associate "pandemic" with high death rates. Although H1N1 activity is now low in most of the world, the WHO has maintained the phase 6 alert. [Jun 11, 2009, pandemic declaration]

Limited global pandemic cases continue This week's flu surveillance report from the WHO indicates active but declining H1N1 flu transmission in limited tropical areas--specifically Singapore, Malaysia, Bangladesh, and Cuba. As the Southern Hemisphere enters its winter season, early H1N1 activity has been noted in Chile and Uruguay, plus increasing but low levels of seasonal H3N2 and influenza B over South America and H3N2 in East Africa. [Jun 11 WHO update]

Jun 10, 2010

Much of Hong Kong vaccine to be tossed Only 200,000 of the 3 million H1N1 vaccine doses available in Hong Kong were administered, and the expiration date on the 2.8 million unused doses is approaching. The doses destined for the trash in October cost about $28.2 million US. Hong Kong offered the vaccine free to health professionals, pregnant women, babies, the elderly, and patients at risk, but safety concerns in the population after several complications in recipients reduced demand. [Jun 10 Economic Times article]

Greece data profile two waves of H1N1 Data gathered in Greece from May 18, 2009, through Feb 28, 2010, showed two waves of pandemic H1N1, a milder one in July-August and a stronger one that peaked Nov 23 to 29. A total of 18,075 lab-confirmed cases were reported, including 294 admissions to intensive care and 140 deaths. Of patients who died, 115 (82.1%) had at least one underlying medical condition, the most common being obesity, diabetes, and cardiovascular disease; 89 (63.5%) were under 60 years of age, with 8 (5.7%) under 19. [Jun 11 Morbidity and Mortality Weekly Report article]

Jun 8, 2010

Expert warns against H1N1 complacency British virologist John Oxford stated at a recent Dublin conference that "It's too early to do a postmortem" on the pandemic H1N1 flu virus. He predicted it will cause trouble again in the coming winter. People need to be aware of how to limit its spread, and decisions need to be based on science, he said. As for vaccine, he stated, "It's no time to be complacent and say we wasted our money on vaccines, because we haven't. This is a virus that will be in the community for a long time." [Jun 8 Irish Times story]

Pandemic exposed gaps in Canada's planning Canada's response to the H1N1 pandemic was one of confusion, says a white paper being presented today at the World Conference on Disaster Management in Toronto. Serious gaps in the country's pandemic planning and unrealistic management guidelines were exposed, it says. Dr. Allan Holmes, who moderated the roundtable discussion on which the report was based, said a single pan-Canadian approach to planning is needed, along with a severity index to put future outbreaks in context.

Jun 7, 2010

Pandemic review committee to look at new reports Dr Harvey Fineberg, chairman of the World Health Organization's (WHO's) pandemic review committee, said the group would consider new reports published by the British Medical Journal and the Council of Europe that are critical of the WHO's H1N1 response, Agence France-Presse reported today. He said the committee's second meeting will be Jun 30 to Jul 2 in Geneva. The two reports, dismissed by some experts, say conflicts of interest may have swayed WHO decisions on vaccines and antivirals. [Jun 7 AFP story]

German study compares summer, fall waves of cases A study of case-based surveillance in Germany suggests that school holidays and containment efforts may have led to differences in summer and fall 2009 pandemic flu waves, according to a report today in BMC Infectious Diseases. Increased fall spread didn't change risk groups or severity, but the affected age-groups trended younger and the number of people with underlying medical conditions increased slightly. The authors said a case-based approach can help guide public health measures. [Jun 7 BMC Infect Dis abstract]

Jun 4, 2010

Global H1N1 activity continues decline The World Health Organization (WHO) today reported "active but declining" pandemic H1N1 transmission in parts of the Caribbean and Southeast Asia, with much of the rest of the world remaining quiet. The WHO also said the Southern Hemisphere is showing no evidence of the onset of the winter flu season but mentioned limited, localized pandemic flu activity in Chile. It also specified low but significant levels of predominantly seasonal H3N2 flu in several countries of East Africa. [Jun 4 WHO update]

New Zealand infection rates surprise officials An estimated 18% of the population of New Zealand were infected by pandemic H1N1 from November 2009 through March 2010, including 1 in 3 children aged 5 to 19 years and 1 in 4 preschoolers. Results of the study, commissioned by the country's ministry of health, showed far higher rates than expected. About 45.2% of infected individuals had no symptoms. Age was found to be the most important risk factor. The current prevalence of H1N1 immunity in the New Zealand population is estimated at 29%. [Jun 4 New Zealand ministry of health release]

One fifth of European vaccine used Only about a fifth of the more than 179 million doses of H1N1 vaccine distributed in Western Europe have been used, the European Medicines Agency (EMA) said in a report. Three major drug companies accounted for the doses, with GlaxoSmithKline accounting for 131.7 million doses, Novartis with 36 million, and Baxter with 11.7 million. Safety concerns and milder-than-expected illness decreased demand for vaccine in some European countries, the report said.

Diagnostic kit effective for novel H1N1 A monoclonal antibody kit to detect the 2009 pandemic H1N1 virus by indirect immunofluoresce assay showed 100% agreement with the real-time polymerase chain reaction panel used by the Centers for Disease Control and Prevention. The kit, made by Diagnostic Hybrids, does not detect any of 14 seasonal H1N1 or H3N2 influenza prototype virus strains nor is it reactive with seven other respiratory viruses. [Jun 2 J Clin Microbiol abstract]

Jun 2, 2010

Group notes 6 challenges for next pandemic An international committee released six public health policy challenges that it anticipates will continue for the next 12 to 18 months and will help shape and improve preparation for the next pandemic: measuring age-specific immunity to infection, accurately quantifying severity, improving treatment outcomes for severe cases, quantifying the effectiveness of interventions, capturing the full impact of the pandemic on mortality, and rapidly identifying and responding to antigenic variants. [Jun 1 PloS Med commentary]

H1N1 in skunks suggests wildlife transmission In perhaps the first documented pandemic H1N1 infection in wild animals, researchers from British Columbia confirmed the virus in two skunks found dead at a mink farm, they reported in Emerging Infectious Diseases. Some minks had respiratory symptoms, but no testing was done. Farm workers did not report flu-like illness but could have had asymptomatic infections. Researchers said skunks could play a role in interspecies transmission and should be included in wildlife flu surveillance. [June Emerg Infect Dis letter]

Test for H1N1, H5N1 could aid early diagnosis Researchers from Beijing developed a real-time polymerase chain reaction assay that can simultaneously detect pandemic H1N1 flu and H5N1 avian flu. In a Virology Journal report today, they said early symptoms for both influenzas are similar, and a test to detect both could be useful for diagnosis and surveillance. In tests on 236 clinical specimens, they found the duplex test was as sensitive as each single-target test, and was even more sensitive for H5N1. [Jun 2 Virol J study]

Ontario notes pluses, minuses of H1N1 response Ontario's chief medical officer reported today that the province responded well to pandemic flu but could benefit from better coordination to ensure services to all. Successes included getting vaccine to all who wanted it, reaching isolated villages, and collaboration between levels of government. Areas for improvement include better information on vaccine from the federal government, greater preparedness for mass immunization, and an ability to electronically track vaccine shipments and uptake. [Jun 2 Ontario Ministry of Health release]

Melbourne attack rate lower than expected Researchers who tested blood samples from 706 Melbourne residents from August to October found that 16% had antibodies to pandemic H1N1 flu. Assuming an estimated 6% prevalence rate of antibodies existing before the pandemic, they estimated a pandemic flu attack rate of 10% in adults. The authors concluded, "This community attack rate is lower than anticipated," and said the results underscore the importance of vaccination. [Jun 1 Aust NZ J Public Health abstract]

Jun 1, 2010

WHO to make pandemic-phase announcement An emergency committee of experts set up to advise the World Health Organization (WHO) on its pandemic alert status met by teleconference for the eighth time today and is expected to release a statement tomorrow on whether to hold or lower the current status. At the last meeting on Feb 23 the group declined to move to a post-peak phase, because some countries were reporting new pandemic activity and some Southern Hemisphere countries were just entering their winter months. [WHO pandemic H1N1 page]

Vaccine information didn't make a case for safety A Rand Corp survey comparing vaccine uptake and attitudes about seasonal compared with pandemic flu vaccines revealed that though adults perceived pandemic flu to be more severe, they were less likely be vaccinated against it than seasonal flu, according to a study in Preventive Medicine. The 3,917 respondents relied on widely varied information sources. Researchers said pandemic flu communications didn't appear to reassure adults about the safety and value of the vaccine. [May 25 Prev Med survey]

CDC suspends flu reports till fall The US Centers for Disease Control and Prevention (CDC) said it is resuming its October-through-May schedule of publishing weekly flu surveillance reports, though surveillance activities will continue. Unusually high levels of flu activity last spring prompted the CDC to keep issuing weekly reports throughout summer and early fall. The CDC's final report for 2009-2010 showed continued low levels for all flu indicators. [CDC H1N1 flu update]

China study details H1N1 deaths A retrospective chart review of patients in Shenyang, China, hospitalized with 2009 H1N1 influenza in November and December showed that many were apparently healthy, nonelderly adults. Of the 68 patients, 30 (44%) were admitted to the ICU and 10 (14.7%) died. Median age was 41 years; only one patient was over 65. At least one underlying medical condition was present in 23 (34%), and obesity and lymphopenia not resolving with 5 days of treatment were associated with a poor outcome. [BMC Infect Dis article]

May 28, 2010

Global, US H1N1 transmission very low The World Health Organization (WHO) again reported only low global pandemic flu activity, with the most active areas in the Caribbean and Southeast Asia, which are experiencing "low-level circulation," notably in Cuba, Singapore, Malaysia, and Bangladesh. Except for localized areas in Chile, the temperate Southern Hemisphere is showing little evidence of H1N1 activity. Seasonal influenza strains continue to be detected at low levels globally. The CDC also reported very low US rates today. [May 28 WHO update]

Adjuvanted split-virion vaccine performs well in kids In a study of the two vaccines used in Britain during the pandemic, the split-virion version with an immune-boosting adjuvant produced a stronger immune response in children than did the whole-virion vaccine. The study, of 937 UK children 6 months to 12 years old, compared an adjuvanted, egg-based split-virion H1N1 vaccine with an unadjuvanted, cell-based whole-virion version. While the split-virion vaccine induced a stronger immune response, it also produced more adverse reactions. [May 27 BMJ abstract]

Taiwan school vaccine campaign led to mass hysteria Public officials in Taiwan yesterday described 23 clusters of mass psychogenic illness after pandemic flu vaccination in school children, who started receiving the vaccine at schools last November. After the first cluster, officials looked for others. Ten involved 15 or more children, median age was 13, and 68% were girls. Researchers said intense media coverage and suspicion about the vaccine contributed to the events, which show a need for surveillance and communication strategies. [May 27 Eurosurveillance study]

Study finds H1N1, seasonal flu differ subtly Researchers who compared patterns between patients with seasonal and pandemic flu at two Philadelphia hospitals found few clinical differences between the two groups, though pandemic flu patients tended to have more lower respiratory symptoms. They found that pregnancy was the only risk condition that was more common in the pandemic group, and those with pandemic flu were younger, with a median age of 29, compared with 59. [May 25 Infect Control Hosp Epidemiol study]

May 24, 2010

Study shows sepsis, fetal distress with H1N1 in pregnancy Among 18 pregnant women hospitalized with pandemic flu, 9 had gastrointestinal symptoms, 13 met sepsis criteria, 4 experienced fetal distress, 1 had a miscarriage, and 1 2-day-old baby died from sepsis. Among the mostly minority women, 5 had asthma, 2 had sickle cell disease, 1 had diabetes, and 1 was HIV-positive. All patients received oseltamivir (Tamiflu), which, the authors write, may have improved outcomes. All were released from the hospital with good outcomes. [May 24 Arch Intern Med abstract]

Symptoms differ between H1N1, seasonal flu A study of hospital patients in Singapore in the first 3 months of the pandemic showed that H1N1 patients were younger but had fewer symptoms, on average, than those with seasonal flu. Of 547 patients with novel H1N1 flu, 42% were age 6 to 18, 35% were 19 to 35, and just 6% were 51 or older. In 193 patients who had seasonal flu, the respective numbers were 16%, 21%, and 23%. Fever was more common in those with seasonal flu, but cough, sore throat, and muscle aches were more common with H1N1. [May 24 Arch Intern Med abstract]

H1N1 shedding, transmission akin to seasonal flu A study of pandemic flu virus shedding and transmission in German households found that most patients stopped shedding virus by 5 days, consistent with other studies, and that the secondary attack rate for contacts was 26%, somewhat higher than other studies. Investigators also found that nasal wash was the most sensitive specimen type. They concluded that the findings are similar to seasonal influenza patterns. [Jun 1 Am J Epidemiol abstract]

FDA clears H1N1 diagnostic test The US Food and Drug Administration (FDA) said today it has approved the first diagnostic test for pandemic H1N1 flu through its normal regulatory pathway. The newly approved Simplexa influenza A H1N1 test was previously available through an emergency use authorization. The approval will allow clinicians to continue using the test even after the public health emergency expires, the FDA said in a statement. The test is made by Focus Diagnostics, of Cypress, Calif. [May 24 FDA statement]

Brazil extends vaccine campaign Brazil's Health Ministry last week announced plans to extend its H1N1 vaccination campaign by almost 2 weeks, to Jun 2, according to China's news agency Xinhua. Since March, the country has vaccinated more than 61 million people, about 70% of the campaign's goal The ministry also decided to broaden vaccination to include children 2 to 5 years old, which will require almost 11 million additional doses. [May 21 Xinhua story]

May 21, 2010

Global H1N1 rate stays at low levels The World Health Organization (WHO) reported today that global pandemic flu activity remains largely unchanged, with the most active areas of transmission in parts of the Caribbean and Southeast Asia. Activity in temperate regions remains low to sporadic. Central Africa has been seen increased transmission of seasonal influenza type B, which is accounting for 85% of all its flu isolates. Type B flu continues at low levels in parts of Asia, Europe, and Central America. [May 21 WHO update]

Flu-like illness remains quiet in US Influenza activity in the United States continues to taper, the CDC reported today, with the proportion of deaths attributed to pneumonia and influenza remaining below the epidemic threshold for the week ending May 15. The proportion of outpatient visits for flu-like illness was 0.8%, down from 1.1% the week before. Of the four influenza A viruses subtyped by the CDC, all were novel H1N1. One state had local flu activity, and 19 states and Puerto Rico reported sporadic activity. [May 21 CDC update]

H1N1 can spread among air passengers Sitting near H1N1-infected airline passengers may slightly raise infection risk, according to a new study. Scientists interviewed 97 of 102 passengers who shared the rear section of a Boeing 747-400 with 24 students and teachers during a long international flight from New Zealand. Nine members of the school group were determined to have pandemic flu during the flight, and 2 of the 57 passengers seated within two rows of those 9 became infected after the flight, implying a 3.5% risk of infection.

H1N1 screening, travel limits were common at borders Surveys of actions taken at borders early in the pandemic showed that entry screening and travel restrictions were common early on, but steps changed as the outbreak evolved, according to a WHO study today. Data were collected from 56 national public health officials (29% of WHO member states), as well as from 32 airports, 25 airlines, and 46 ports. Among the findings: 91% of nations gave travelers H1N1 info, 46% at first limited travel to outbreak areas, and 61% conducted entry screening. [May 21 Wkly Epidemiol Rec (see p. 186)]

Study finds little antiviral hoarding Researchers found no evidence of antiviral hoarding in the United States during the H1N1 pandemic, according to a new survey by Prime Therapeutics. Researchers for Prime and one of its Blue Cross Blue Shield clients compared the use of antiviral flu drugs in 11 states during the pandemic with use during past seasonal flu outbreaks. They found regional variations in antiviral use but comparable pandemic-flu and seasonal-flu use overall and little indication of hoarding. [May 20 Prime Therapeutics news release]

May 20, 2010

Underlying risk factors common in UK deaths A study published today found that 77% of Brits who died of pandemic flu last year had underlying risk factors such as low immunity or respiratory disease. The study, which assessed data on 440 deaths, found fatalities were most common in young adults (median age 53, and 85% were under 65). The case-fatality rate was 0.9% in those 65 and older and 0.04% for those under 64. The authors state that the results point to the need for early, targeted intervention for pandemic flu. [May 20 Eurosurveillance study]

Study: Seasonal flu vaccine offers some H1N1 protection In a study of 1,205 military personnel who contracted pandemic H1N1 in 2009, researchers found that those who had received seasonal flu vaccine the year before had a 45% level of vaccine effectiveness (VE) against the novel virus. Those who had been vaccinated against seasonal flu as early as 2004 had 41% VE. The study also showed VE of 62% against severe disease, compared with 41% against milder outcomes. Shots appeared to grant a higher VE (44%) compared with the nasal-spray vaccine (24%). [May 19 PLoS One study]

Severe H1N1 may warrant serum testing Australian researchers determined that up to a third of severe cases of pandemic H1N1 may not be properly detected without serologic testing. The authors collected acute and convalescent blood specimens from 33 patients with severe H1N1 admitted to intensive care units. With hemagglutination inhibition of novel H1N1, 29 paired serum samples showed significant increases in specific antibody titers. Of these 29, only 18 had pandemic H1N1 RNA detected by routine nucleic acid testing. [May 19 Clin Infect Dis abstract]

Cambodia announces second vaccine round Cambodia's ministry of health announced plans to administer 1.5 million doses of pandemic H1N1 vaccine by the end of this month, according to the Phnom Penh Post. The new vaccine arrived recently from the World Health Organization. In March the country received 300,000 doses, which have been administered to high-risk groups. [May 19 Phnom Penh Post story]

May 19, 2010

H1N1 review seeks confidential correspondence The 29-member expert panel convened to conduct an independent review of the World Health Organization's (WHO's) pandemic response has asked to review confidential correspondence between the agency and vaccine manufacturers. Dr. Harvey Fineberg, chair of the committee and president of the Institute of Medicine, said reviewing all records is necessary to address claims that pharmaceutical companies benefited inappropriately from contracts for vaccines and antivirals that went unused.

Early flu spread linked to dance club One of the earliest outbreaks of H1N1 pandemic flu in Singapore arose from close contact in the crowded confines of a dance club, researchers from that nation's Ministry of Health report. The outbreak's source was a 20-year-old woman who developed flu symptoms on Jun 16, 2009, after visiting Malaysia, and went to a giant dance club the next evening with 20 friends. The total toll was 48, including 3 of the friends, other club patrons and employees, and family members. [Ann Acad Med Singapore report]

Spanish health workers decline vaccine A survey of healthcare workers at a major Madrid hospital, taken during the H1N1 pandemic and published in Vaccine, shows that only 16.5% accepted the pandemic vaccine, though 49.7% received the seasonal vaccine that same year. The goal set by the WHO is 60%. The most common reasons for refusal of the pandemic vaccine were doubts about its efficacy, fear of adverse reactions, and lack of concern over contracting the pandemic virus. [May 14 Vaccine abstract]

Severe H1N1 infection linked to loss of key immune cell An analysis of three severe cases of H1N1 flu in the United Kingdom--two young adults who survived and a pregnant patient who died--shows that all three experienced loss of a particular class of blood cell. Researchers from several British institutions write that the unexpected sharp drop in NK cells, peripheral-blood lymphocytes that are a key component of the innate immune system, may provide a clue to the body's inability to control viral reproduction in severe cases of pandemic H1N1 flu. [May 18 PLoS One article]

May 18, 2010

CDC updates summer camp flu guidance The Centers for Disease Control and Prevention (CDC) yesterday updated its flu guidance for the summer camp season. Based on sporadic activity, officials expect to see less flu at summer camps this year, though the CDC says vaccination, especially for high-risk people, is the best way to prevent camp-related outbreaks. Antivirals are recommended only for high-risk patients who have been exposed to flu, and the CDC said camps should maintain hand hygiene and other cleaning measures. [May 17 CDC recommendations]

Australia sees uptick in flu-like illness Australia's most recent surveillance data show that community levels of influenza-like illness have increased, but that few of the cases are due to influenza. Instead, respiratory syncytial virus was the most common lab confirmation for the week ending May 7. Of the 557 confirmed flu cases this year, 12% have been pandemic H1N1, 75% unspecified type A influenza (most likely pandemic H1N1), 1% A/H3N2, and 10% type B. Sentinel sites reported two recent hospitalizations, both due to type B flu.

ACIP vaccine-priority guidelines reinforced Using a computer simulation model, researchers from the University of Pittsburgh, in conjunction with the Department of Health and Human Services, determined that allocating limited pandemic vaccine first to at-risk patients proved effective. The study, which looked at vaccination distribution in the greater Washington, DC, area, compared a policy of vaccinating children (high transmitters) first, versus the at-risk-first policy of the Advisory Committee on Immunization Practices (ACIP). [May 16 Vaccine study]

Study shows tell-tale heart findings A review of 28 pandemic H1N1 patients hospitalized for at least 24 hours showed that an elevated heart rate and certain echocardiographic findings may indicate novel H1N1 infection. Compared with controls, the H1N1 patients showed higher left ventricular end-systolic dimension as well as decreased early diastolic velocity and increased late diastolic velocity, which means they also had a significantly decreased early diastolic/late diastolic velocity ratio, among other findings. [May 17 J Infect abstract]

Study finds cross-reactivity between H1N1, swine strains Whether through vaccination or infection, pigs show cross-reactivity between pandemic H1N1 and various strains of swine-specific influenza strains, according to a letter in Emerging Infectious Diseases. Researchers inoculated swine with a pandemic H1N1 vaccine, as well as antigen from four different H1N1 strains of influenza found in swine (from 1976, 1980, 1992, and 2003). They also infected the animals with the 2003 strain. Blood draws showed cross-reactivity to all subtypes. [May 17 Emerg Infect Dis report]

May 17, 2010

DFA inaccurate for very ill H1N1 patients Direct immunofluorescence assay (DFA) for detecting pandemic H1N1 flu is unreliable in intensive care unit patients, according to a study presented today at the American Thoracic Society (ATS) conference in New Orleans. "Our findings suggest that in patients with severe H1N1 influenza, in whom rapid and precise diagnosis would be most important, DFA unfortunately does not perform well," said lead author Chanu Rhee, MD, who added that the test is reliable in noncritical patients. [May 17 ATS press release]

Clinical flu symptoms help guide triage A triage system that scored emergency room patients for influenza-like illness (ILI) complemented clinical judgment in deciding antiviral treatment, according to a new study. Patients in a Guadalajara, Mexico, hospital last year received scores for various ILI signs, symptoms, or lab results (eg, "2" for cough, fever, fatigue, difficulty breathing, or underlying condition). An ILI score of 7 or greater indicated a possible need for antiviral drugs, and 16 or higher for hospitalization. [May 14 PLoS ONE study]

China vaccinates 100 million The Chinese pandemic H1N1 vaccination campaign has reached more than 100 million people, China's health minister said, according to the Indo-Asian News Service (IANS). Health minister Chen Zhu said, "We have achieved progress in the fight against A(H1N1) influenza." In addition, "China has more than 20 million doses of A(H1N1) vaccine in store, and pharmaceutical manufacturers are always ready for production," Chen said. [May 14 IANS report]

South Korea offers free vaccine to World Cup fans South Korea will offer free H1N1 vaccine to tourists traveling to South Africa for the 2010 World Cup soccer tournament, which begins next month, according to China's Xinhua news service. Those interested in the shots should visit state-run clinics throughout the country, the Korea Centers for Disease Control and Prevention said. The first World Cup match is set for Jun 11. [May 13 Xinhua story]

May 13, 2010

India approves pandemic vaccine The pharmaceutical company Zydus Cadila announced today it has gained approval from the drug controller general of India to become the first India-based firm to market a pandemic H1N1 vaccine in the country. The vaccine, VaxiFlu-S, will be marketed by Vaxxicare, part of a division of the company that focuses on preventives.

Study finds side effects with mass antiviral 'blanket' Last June when pandemic H1N1 struck 17% of students and staff at a UK elementary school, 92% of students and 91% of staff received the antiviral drug oseltamivir (Tamiflu) for treatment and prevention. Of those, 41% (113/273) of students and 47% (25/53) of staff reported adverse effects. Overall, 14% of students and 20% of staff did not complete the course of oseltamivir, primarily due to adverse effects. The authors say potential benefits of mass treatment must outweigh possible side effects. [May 13 Eurosurveillance study]

Netherlands cancels third of its GSK vaccine order GlaxoSmithKline (GSK) has agreed to cut 33% of its order of H1N1 vaccine from the Netherlands, saving the country 21 million euros, Reuters reported. The Dutch government said in March it wanted to sell 21 million unused vaccine doses back to drug firms. The original Dutch order was 34 million doses, 11 million of which were administered and 257,000 sold to other countries. GSK cut its Dutch order from 9 million to 6 million doses. A second supplier, Novartis, has not reduced its order. [May 12 Reuters article]

Virus-like-particle vaccine shows promise A recombinant pandemic H1N1 virus-like-particle flu vaccine made by Rockville, Md.-based Novavax protected ferrets against the disease in a study published in Vaccine. The vaccine induced a good antibody response in the animals and inhibited viral replication in the upper and lower respiratory tract. A single 15-microgram dose resulted in complete clearance of the virus from the lungs. Ferrets are known to be good animal models for flu in humans. [May 12 Vaccine abstract]

May 12, 2010

Pandemic vaccine sales totaled $3.4 billion Though some had predicted higher amounts, drug companies in 2009 sold almost $3.4 billion worth of H1N1 vaccine, according to a Kalorama Information report. Breakdown by company, in millions of US dollars and percent of market share was: GSK (1,190, 35), Novartis (950, 28), Sanofi (620, 18), Astra Zeneca (365, 11), CSL (160, 5), Baxter (50, 1.5), and other (50, 1.5). The report details the challenges of producing a new vaccine and says the methods used will serve as a model for future vaccines. [May 10 Kalorama news release]

Hong Kong to lower flu alert level Hong Kong officials announced yesterday that they will lower their flu response level from "emergency" to "alert" on May 24, pending any signals indicating otherwise that might arise from the World Health Organization's World Health Assembly next week. Officials said their decision is based on flu activity that has been declining since late September and has remained low, even during the area's winter flu season. It also said it has detected no change in clinical severity.

California promotes vaccine ahead of summer travel California's health department has renewed its push for pandemic flu vaccination, advising the public that flu outbreaks in the Southern Hemisphere over the summer months combined with summer travel spread globally, the Los Angeles Daily News reported. Officials said they hope to use up some of the state's 4 million-dose vaccine surplus before some of it expires in June. [May 11 Daily News story]

Flu outbreak temporarily curbed blood donations Confirmation of the first pandemic flu cases in a community reduced blood donations 21%, with whole-blood donations dropping by 1,329 units, Japanese researchers reported in Transfusion. They examined blood donation patterns 4 weeks before and 4 weeks after novel H1N1 was detected in Kobe. Bloodmobile donations saw the most dramatic drop, 39%. Within 1 week, however, donations returned to normal, propelled by e-mails requests and new bloodmobile drives. [May 3 Transfusion abstract]

Clinical definition, immunofluorescence not sensitive Clinical and microbiological examination of 444 Australian children who were seen for flu-like symptoms at the start of the country's pandemic outbreak showed that 119 had the pandemic virus, with direct immunofluorescence identifying only 69. The findings appear in Pediatric Infectious Disease Journal. Clinical symptoms didn't vary much between kids that had the pandemic virus and those with other illnesses, except younger children with flu were more likely to have headaches and myalgia.

May 11, 2010

WHO to reassess pandemic status The Emergency Committee of the World Health Organization (WHO) will wait for winter in the Southern Hemisphere before again reviewing the status of the H1N1 pandemic, Reuters reported today. The 15-member expert committee will likely meet later this month or early next, after the WHO's governing World Health Assembly next week. The panel may maintain the status quo, declare a transitional "post-peak" phase, or declare that the pandemic is over. [May 11 Reuters story]

EU Parliament members call for H1N1 investigation More than 200 deputies of the European Parliament have signed a proposal calling for a special committee to look into the European Union's (EU's) response to the H1N1 pandemic, including an evaluation of the EU's dependence on the WHO. According to theparliament.com, signers claim that steps taken undermined EU credibility, the amount spent on vaccines was unwarranted, and officials should have changed course early on. The assembly's Conference of Presidents will vote on the matter tomorrow. [May 5 theparliament.com article]

Vermont asks for input on its H1N1 response The Vermont Department of Health is asking Vermonters, including those who helped respond to the pandemic, what they think of the state's response to novel H1N1 flu, according to an Associated Press (AP) article. The state, which saw a third of its population receive the H1N1 vaccine, is offering two survey versions on its Web site: www.HealthVermont.gov. Health Commissioner Dr. Wendy Davis said the surveys will be used to strengthen the state's planning and future response.

New Zealand administers 900,000 vaccine doses New Zealanders this year have received more than 900,000 doses of seasonal flu vaccine, covering more than 20% of the population, the government said today. Health Minister Tony Ryall said, "Including protection against the pandemic swine flu in the seasonal vaccine has driven this unprecedented demand." Last year a record 960,000 doses were distributed in 30 weeks. Ryall estimated New Zealand would reach that mark in 11 weeks. [May 11 New Zealand government release]

Tonga to get enough vaccine for all The WHO announced today that the Pacific Island nation of Tonga will receive 90,000 doses of donated H1N1 vaccine on top of the 10,000 doses it received in March, which will provide enough to cover its entire population. Funds will be provided to help administer the doses, and ancillary items, such as syringes, will also be shipped. [May 11 press release]

May 10, 2010

Drills highlight gaps in H1N1 procedures During the first weeks of the H1N1 pandemic last spring, drills to simulate resuscitation of pediatric patients showed that many healthcare workers failed to don proper protective equipment, according to Johns Hopkins research presented at the Pediatric Academic Societies annual meeting last week. Of 84 participants in simulations involving H1N1 and a cardiopulmonary event, only 51 used protective eyewear, 73 used gowns, and 68 used an N-95 or air-purifying respirator. [May 10 JHU Gazette story]

Ireland reports 1,600 vaccine reactions More than 1,600 adverse reactions to the pandemic H1N1 vaccine were reported to the Irish Medicines Board, according to the Dublin-based Sunday Tribune. Two deaths were also reported, in people who had underlying conditions, but a link to the vaccine has not been proven. Fifteen people reported an "anaphylactic"-type reaction. Less serious reactions included injection-site problems, stomach upset, flu-like symptoms, dizziness, fainting, and limb weakness. [May 9 Sunday Tribune story]

India region has almost 1% H1N1 case-fatality rate A study of pandemic H1N1 flu lab investigations, hospital admissions, outpatient data, and mortality figures in the Pune metropolitan region of India showed a case-fatality rate (CFR) of almost 1%. The researchers found that confirmed H1N1 patients had a significantly higher risk of hospitalization than seasonal flu patients did. Of 93 flu deaths, 84 were from novel H1N1 and 9 from seasonal flu. Pandemic CFR was 0.86%, significantly higher than that of other countries. [May 7 PLoS Med abstract]

Flu still fairly quiet in Australia Australia so far this year has confirmed 492 cases of influenza, of which 13% have been subtyped as pandemic H1N1; another 73% were influenza A but not subtyped. Less than 1% were A/H3N2, and 11% were type B, according to the country's Department of Health and Ageing (DHA). Two H1N1 patients were hospitalized. "Levels of influenza-like illness (ILI) in the community remain relatively low and reporting from laboratories indicates that little of this ILI is due to influenza," the DHA said.

May 7, 2010

WHO reports sporadic global H1N1 activity The most active areas of pandemic H1N1 flu are parts of West Africa, the Caribbean, and Southeast Asia, the World Health Organization (WHO) said today. In the Americas, limited data suggest transmission in Guatemala, Cuba, and Peru, with Chile reporting evidence of low-level community H1N1 circulation, including some severe cases. Activity remains sporadic in other Southern Hemisphere regions. Seasonal type B flu was detected sporadically across Asia, Africa, Europe, and the Americas. [May 7 WHO update]

US flu activity remains low Influenza activity across the United States continues to decline, the CDC reported today, with the proportion of deaths attributed to pneumonia and influenza below the epidemic threshold. The proportion of outpatient visits for flu-like illness was 0.7%, below the national baseline of 2.3%. Of the eight influenza A viruses subtyped, all were novel H1N1. One pediatric H1N1 death was reported. Four states had local flu activity, and 30 states or territories reported sporadic activity. [May 7 CDC update]

Australian state running low on seasonal vaccine Supplies of seasonal influenza vaccine, which contains the pandemic strain, are running low in Australia's second most populous state, Victoria, according to the Melbourne-based Herald Sun. Australia's CSL, which makes most of the country's flu vaccine, rushed new doses to wholesalers to help meet demand, which has remained high even after the country banned use of the vaccine in those under 5 years old after some had adverse events. CSL warned that more shortages may loom. [May 8 Herald Sun article]

Study shows ethnic variations in vaccine acceptance A survey that explored ethnic differences among 1,025 Malaysians showed a high willingness to accept the pandemic vaccine, especially when vaccine safety and religious accommodations were ensured. About 70% of those surveyed late last year indicated a willingness to be vaccinated. For the Muslim Malay people surveyed, a halal vaccine (acceptable to Islam) was the main factor in deciding to get vaccinated, whereas vaccine safety was the main factor for Chinese and Indian participants. [May 6 Vaccine study]

May 6, 2010

Pandemic may force UK primary-care cuts The cost borne by primary care practices in England to combat pandemic H1N1 flu may lead to cuts in services, The Guardian reported today. A survey of 107 primary care practices found that each practice paid an average of $512,000 (US) to fight novel H1N1. This may lead one in six of the practices to cut other services, and some have already made cuts. A British Medical Association official said the government should foot the pandemic bill rather than individual practices. [May 6 Guardian article]

New Zealand sees increase in flu-like illness As New Zealand heads into its traditional flu season, its Ministry of Health (MOH) said today that surveillance data from physicians' offices and the national Healthline hotline show a continued increase in those reporting influenza-like illness. Though numbers are still below baseline, they are higher than at this time last year. The MOH, which advised people to get vaccinated and to be treated at the first signs of symptoms, said the increase could signal higher pandemic flu activity. [May 6 New Zealand MOH release]

Swap-meet clinics bring vaccine to Hispanics California has devised a unique way to reach Hispanics, who have been hit particularly hard by pandemic flu. Public health officials are setting up clinics at popular weekend swap meets such as the Kern County Fairgrounds meet in Bakersfield. Nurses with the Kern County Public Health Department administer free H1N1 vaccine amid the food booths and discount merchandise. One nurse said, "We're using up a lot more vaccines than we would've if we had them just coming in to our clinics." [May 4 National Public Radio story]

May 5, 2010

Activity on US campuses falls further H1N1 activity at colleges continues to drop, the American College Health Association (ACHA) said today. A total of 162 new cases of flu-like illness (but no hospitalizations or deaths) were reported for the week ending Apr 30, down from 192 the week before. The H1N1 attack rate was 0.8 cases per 10,000 students, down from 0.9 the week before. It has been below 5 cases per 10,000 students for almost 5 months. Among 170 campuses monitored, 28% reported cases, down from 34%. [May 5 ACHA report]

Web surveillance allowed early H1N1 tracking Web-based syndromic surveillance of the 2009 H1N1 pandemic allowed earlier detection of regional outbreaks and permitted tracking of disease spread around the world, according to a report today. The HealthMap system, which collected data primarily from Internet news sources, showed confirmed or suspected outbreaks in 32 countries by Apr 28, 2009, with early spread being fastest in the Americas and Europe. The data also showed that wealthier nations had shorter delays in confirming cases. [May 6 N Engl J Med report]

May 4, 2010

US has 71 million vaccine doses left The US has 71 million doses of H1N1 vaccine remaining, according to the Department of Health and Human Services (HHS). States should keep offering doses until the seasonal flu vaccine, which will contain the pandemic strain, is available this fall, HHS spokesman Bill Hall said. Sen. Chuck Grassley, R-Iowa, has asked HHS Secretary Kathleen Sebelius how much vaccine is left and when it will expire. Hall said the remaining doses "have varying expiration dates, some as long as early 2011." [May 3 Reuters report]

H1N1 hospitalized older kids, those with underlying conditions Children hospitalized with pandemic H1N1 in 2009 were older and more likely to have underlying conditions than children hospitalized with seasonal flu in past years, according to a study presented today at the Pediatric Academic Societies (PAS) annual meeting. From surveillance data from 10 states, researchers found the median age of hospitalized children to be 5 years for pandemic flu and 1 year for seasonal flu, and H1N1 patients were more likely to have underlying medical conditions.

Czechs used only one-seventh of vaccine Czechs used only about 100,000 doses of H1N1 vaccine of the 700,000 doses ordered, according to the Czech News Agency. Only about 66,000 people in the country of more than 10 million were vaccinated. Health officials confirmed 102 deaths in the country and estimated that 100,000 people were infected.

May 3, 2010

Australian study finds waste with multidose vaccine vials To gauge Australian doctors' use of pandemic flu vaccine in multidose vials, not routinely used in that country, researchers polled general practices in Sydney and found that about 42% of vaccine was wasted in the first month of the campaign. Less waste occurred with 10-dose vials than with 20-dose vials. There was no difference between solo and group practices. The group concluded that the vials are inefficient for general practice use and that greater use of 10-dose vials could reduce waste. [May 3 Med J Aust letter]

H1N1 infected 20% of Nicaraguan kids Researchers who studied flu in a cohort of 4,391 Nicaraguan children found that 20.1% of the group had pandemic flu in 2009, compared with seasonal flu attack rates of 11.9% in 2007, when influenza A dominated, and 24.2% in 2008, when types A and B were both common. Children who had pandemic flu were more likely to have sore throat, lower respiratory symptoms, and gastrointestinal problems, including nausea and loss of appetite. [Clin Infect Dis abstract]

Apr 30, 2010

WHO: No changes in pandemic stats worldwide The World Health Organization (WHO) said today that activity of the 2009 H1N1 pandemic virus continues to decline worldwide, with some circulation still occurring in West and Central Africa and South and Southeast Asia. Influenza B continues to circulate at detectable levels in China, Mongolia, Korea, Ghana, and Cameroon, and seasonal A/H3N2 flu has been found in Southeast Asia. In the Americas, Cuba and Peru have reported increases in unidentified respiratory disease. [Apr 30 WHO pandemic H1N1 weekly update]

CDC: Flu subsides across US Visits to doctors for flu-like illness, hospitalizations for lab-confirmed flu, and the proportion of deaths attributable to pneumonia and influenza all continue to decline in the United States or have leveled off, the Centers for Disease Control and Prevention (CDC) said today. No flu-related deaths among children were reported in the past week. No states are experiencing widespread or regional flu, and only two have enough reports of illness to qualify as having "local" flu activity. [Apr 30 CDC FluView weekly report]

Australia: No contamination in flu vaccine Australian health authorities said today they have found no abnormalities in their current flu vaccine, despite the apparent spike in fever and convulsions among young children recently vaccinated against flu. Tests by manufacturers, a government body, and independent experts have found no contamination. Authorities said the cases may be a statistical artifact of many more shots being given than in past years; Western Australia, where the cases have occurred, has administered 2 million doses. [Apr 30 Western Australia Today report]

Researchers profile kidney injury in severe flu infections In a report on acute kidney injury (AKI) in severe pandemic H1N1 infections, researchers at a hospital in Australia said that 8 of 13 patients admitted to the intensive care unit had AKI. Three patients met kidney-failure criteria and received renal replacement therapy. The findings were reported in the Apr 20 issue of Contributions to Nephrology. Mortality in the AKI patients was about 25%. Histology from one of the patients showed typical acute tubular necrosis. [Apr Contrib Nephrol report]

Apr 28, 2010

Flu activity at colleges tails off further The American College Health Association (ACHA) said today that influenza-like illness (ILI) at colleges is down from the already low levels reported the week before. A total of 192 new ILI cases were reported for the week ending Apr 23, which is 3% of the number reported during the pandemic's peak. There were no hospitalizations or deaths. The nationwide attack rate was just 0.9 cases per 10,000 students, down from 1.1 the week before. Among 182 campuses, 34% reported cases, down from 38%. [Apr 28 ACHA surveillance report]

Australia widens probe into flu-vaccine events Australia's Therapeutic Goods Administration has widened its probe into CSL's seasonal flu vaccine, which includes the pandemic strain, after children receiving the shot had fevers and convulsions, according to Bloomberg News. The agency asked all states and territories to examine all reports of fever in children under 5 for evidence of any pattern. Also, New Zealand reported today that five children experienced convulsions after flu vaccinations, according to news reports in that country. [Apr 28 Bloomberg article]

Standard case definition might not fit mild H1N1 Researchers found that the commonly used CDC case definition may not work for detecting mild pandemic H1N1 flu. They reviewed medical records of 44 patients with lab-confirmed H1N1 who were hospitalized in early summer 2009 and found that many of them had no fever. They found cough to be a more sensitive H1N1 indicator. The authors conclude that "the standard case definition for 2009 H1N1 influenza has low sensitivity for mild influenza infection." [Apr 26 Am J Infect Control abstract]

Apr 26, 2010

Australia's number of suspected vaccine reactions grows The number of children in West Australia who had convulsions or fever and vomiting after receiving a seasonal flu vaccine that covers the pandemic strain has grown to 251, the Australian Broadcasting Corporation (ABC) reported today. Officials say the immunizations likely came from multiple batches. Queensland is also investigating the possibility of adverse reactions in children, and police in Brisbane are probing the death of a recently vaccinated 2-year-old, according to other ABC reports. [Apr 26 ABC story]

HHS vaccine advisors to probe GBS-vaccine findings The vaccine advisory group of the US Department of Health and Human Services voted unanimously to explore recent findings that may suggest a Guillain-Barre syndrome link to the pandemic vaccine, the Washington Post reported. A member of the National Vaccine Advisory Committee said the possible link would likely disappear with further analysis and that no other safety monitoring systems detected such a link. The initial GBS findings were presented at a neurology meeting in mid April. [Apr 24 Washington Post story]

Cuba reports rise in flu infections Cuba's number of pandemic H1N1 infections continues to grow for the fifth week in a row, with 93 new cases reported to the country's national flu lab, Cuban News Agency (ACN) reported. The rising infections prompted a warning from national health authorities for the public to follow hygiene measures and seek medical care at the first sign of flu-like symptoms. Cuba recently launched its pandemic vaccination campaign, and health workers have so far immunized 981,130 people from high-risk groups.

Philippines launches vaccine campaign The Philippines launched its pandemic vaccine campaign today, with the top priority of immunizing about 420,000 of the country's healthcare workers, Deutsche Presse-Agentur (DPA) reported. The next priority is 2.5 million pregnant women, health officials said, adding that the disease threat remains, especially in advance of the country's rainy season in July. So far the country has seen no recent evidence of community transmission. [Apr 26 DPA article]

Apr 23, 2010

Worldwide H1N1 activity remains low Pandemic H1N1 remains at low levels in temperate regions of the world, according to the World Health Organization (WHO) today, with the most active areas in parts of west and central Africa, Southeast Asia, and Central America. Seasonal influenza B has become the predominant circulating flu virus across East Asia, central Africa, and northern and eastern Europe. Seasonal H3N2 is still being detected in south Asia, Indonesia, and several countries of west Africa, and eastern Europe. [Apr 23 WHO update]

Most key US flu indicators decline In its weekly update, the CDC reports that most key US flu indicators declined slightly from the previous week and overall flu activity is low. Doctor visits and hospitalizations for H1N1 are at low levels, and no pediatric deaths were reported for the week ending Apr 17. The proportion of deaths for pneumonia and influenza was up slightly, but not higher than expected. For the first time since the week ending Dec 13, 2008, no states are reporting widespread or regional flu activity. [Apr 23 CDC report]

H1N1 can lead to respiratory failure in pregnant women A report in Obstetrics & Gynecology describes three H1N1-infected pregnant women, two of whom had no underlying conditions, who experienced acute respiratory failure but delivered healthy babies--twins for one woman and triplets for another. None of the patients tested positive for pandemic flu initially, but early oseltamivir was administered because of their clinical presentation. All required respiratory support and were discharged in good condition 12 to 77 days after hospitalization. [May Obstet Gynecol report]

H1N1 far deadlier than seasonal flu in pregnancy Another Obstetrics & Gynecology study determined that novel H1N1 causes far more deaths than seasonal flu in pregnant women. Researchers found that, between 1998 and 2005, 78 pregnant women died from influenza or pneumonia, according to CDC data, and 40 of these deaths occurred during flu season, for a rate of 5 flu-related deaths per year. This compares with 28 lab-confirmed H1N1 deaths in pregnant women for the first 4 months of the pandemic alone. [May Obstet Gynecol study]

Apr 22, 2010

Alabama reporting 1 H1N1 death per week One fourth of Alabama's 52 pandemic flu deaths have occurred this year, health officials report, and over the past several weeks the death toll has risen. The Montgomery Advertiser reports today that, after recording five H1N1 deaths in January and February, the state has already seen eight in March and April. "It looked like it [death rate] had peaked and was reaching the lower end of the bell curve," said Dr. Jim McVay of the Alabama Department of Public Health. "Then it increased."

Study highlights bacterial complications in kids Researchers studying children hospitalized with parapneumonic empyema from 2004 to 2009 compared rates of the condition before and during the H1N1 pandemic and found an increase in pneumonia complicated by empyema during the pandemic. The study, published in the Pediatric Infectious Disease Journal, found infection with Streptococcus pneumoniae and S pyogenes associated with H1N1 flu. The authors call for better understanding of bacterial complications of pandemic flu.

British Columbia tries to recoup loss of expired vaccine British Columbia hopes to get back at least some of the $20 million it paid for 2.5 million doses of adjuvanted H1N1 vaccine that is becoming ineffective long before its expiration date, CBC News reported. The vaccine was supposed to last 18 months but had only a 6-month shelf life. Provincial health minister Ida Chong said officials are seeing what they can do "to find out if there is any kind of recovery." The province, which had a 40% vaccination rate, has some unadjuvanted vaccine available. [Apr 21 CBC News report]

Apr 21, 2010

Campus flu activity remains low For the week that ended Apr 16, the American College Health Association (ACHA) today reported continued low levels of influenza-like illness (ILI) at colleges, with only a slight increase in cases. The ACHA reported 229 new ILI cases and no hospitalizations or deaths. Thirty-eight percent of 177 colleges reported new cases, compared with 36% the previous week. The attack rate was 1.1 cases/10,000 students, 10% higher than the previous week, with no evidence of a third pandemic wave. [Apr 21 ACHA surveillance report]

Bangladesh sees H1N1 cases surge After a quiet start to the year, Bangladesh is reporting rapid spread of pandemic flu this month and has placed health officials across the country on alert, according to the Philippine newspaper Balita. "The virus sustained at a lower level in Bangladesh during January-March period, but it showed rising trend since the beginning of this month," a health official said, adding that April through September is typically the busiest season for flu. He did not specify case numbers. [Apr 20 Balita story]

Qatar ponders swapping H1N1 vaccine Faced with surplus pandemic vaccine, Qatar's Supreme Council of Health (SCH) plans to negotiate with vaccine manufacturers for other vaccines in exchange for unused doses. The country had planned to receive up to 200,000 doses of H1N1 vaccine a month throughout the winter. "We are considering the possibilities of exchanging the orders which have not been delivered with other vaccines that are being used in the country," an SCH official said, without specifying the vaccines being sought. [Apr 21 Gulf Times story]

Nigeria still unable to get vaccine Nigeria has yet to receive any H1N1 pandemic vaccine and is concerned that cases may grow as nearby Ghana is reporting an outbreak, according to a Nigerian Bulletin story. Nigeria has confirmed 11 cases and 2 pandemic deaths. The story quoted unnamed experts as saying global demand for the vaccine has outpaced supply, making it difficult for developing countries to obtain doses.

Apr 20, 2010

Sebelius cites H1N1 success stories Health and Human Services (HHS) Secretary Kathleen Sebelius yesterday thanked those "on the front lines" fighting H1N1 flu and highlighted successes. Among them: investing in preparedness, declaring a public health emergency quickly, mobilizing health workers for vaccination, relaying prevention messages, reaching out to other nations, ensuring vaccine safety, defining vaccine priority groups, and employing creative distribution. She said HHS needs to better engage minorities and physicians. [Sebelius's Apr 19 speech]

Volcanic ash smothers New Zealand's vaccinations New Zealand's Ministry of Health has halted clinic and workplace influenza vaccinations because of supply issues related to the volcanic ash cloud over Europe, according to Radio New Zealand. Although demand for seasonal influenza vaccine, which includes the pandemic strain, has been "unprecedented" for this time of year, the ash cloud has disrupted vaccine shipments from Paris. An immunization manager said the country has 80,000 vaccine doses in stock. [Apr 20 Radio New Zealand report]

Alberta seeks reimbursement for unused vaccine Alberta, Canada, is recalling more than 650,000 unused doses of H1N1 vaccine and seeking a refund from its maker, GlaxoSmithKline (GSK), according to the Ontario-based National Post. Health Canada has reduced the expiration date for adjuvanted vaccine only from 18 to 6 months, which has left the province with $2.2 million worth of about-to-expire vaccine. An Alberta official said there will be discussions with federal officials, regulators, and GSK about reimbursement.

Most Australians willing to take vaccine during pandemic An Australian survey found that most participants would accept pandemic H1N1 vaccine, though their perceived risk for the disease was low. Vaccine became available there Sep 30, 2009; 627 people were surveyed from Sep 5 to Oct 3: 53% perceived their risk of H1N1 as very low to low; 55% were willing to accept vaccine. Other findings: 25% thought H1N1 would affect their health very seriously or extremely, and 49% had made one or more behavior changes (eg, avoiding crowds, frequent hand washing). [Apr 19 BMC Infect Dis abstract]

French show low acceptance of H1N1 vaccine A survey of over 2,000 people conducted in France 1 week before the country's November H1N1 peak found the H1N1 vaccine as acceptable by only 17% of respondents. Acceptance was highest among pregnant women, people with chronic diseases, and those who had been formally advised to get vaccine. Of those refusing vaccination, 71% noted safety concerns. H1N1 was perceived as a severe disease by 36%. France began a mass vaccination campaign last July, but it did not involve primary care physicians. [Apr 16 PLoS ONE study]

Apr 19, 2010

South Africa feels vaccine pinch Just weeks before it hosts the World Cup, South Africa is reporting a shortage of H1N1 vaccine, West Cape News reported today. Doctors and pharmacies have run out of the vaccine, imported from Australia, and say no more is available. The country received 1.3 million doses, which are being used for "front line" port-of-entry workers and certain HIV patients. A further 3.5 million doses donated by the World Health Organization (WHO) will be used on pregnant women and others at high risk. [Apr 19 West Cape News story]

Chile reports low vaccine uptake Health officials in Chile are concerned that only 600,000 of a hoped-for 4 million people have received the H1N1 vaccine in a country that saw 300,000 cases and 1,800 hospitalizations last year, The Santiago Times reported. And this year a Feb 27 earthquake destroyed 5,000 hospital beds in the central region. One university faculty member explained that getting the shot early is essential to prevent overloading of hospitals, because immunity takes about 2 weeks to build. [Apr 18 Santiago Times report]

Australian seasonal flu vaccine delayed Australia's efforts to get the seasonal influenza vaccine to as many high-risk people as possible have been met with low availability of doses, at least in part because H1N1 vaccine production has taken precedence, according to Australia's The Morning Bulletin. Health officials are advising patients to get free H1N1 vaccine now, and then a separate seasonal flu shot as soon as it becomes available, which may be in the coming weeks. [Apr 19 Morning Bulletin article]

Apr 16, 2010

WHO: H1N1 activity low in most countries Circulation of the 2009 H1N1 pandemic virus persists only in tropical zones of the Americas, Africa, and Southeast Asia, the World Health Organization (WHO) reported today. B strains of seasonal flu are circulating in East Asia, along with sporadic seasonal A/H3N2 flu in Asia, Eastern Europe, and Eastern Africa; the most recent H3N2 reports were in Indonesia and Tanzania. A few seasonal H1N1 viruses, not the pandemic strain, were recorded last week in the Russian Federation and Northern China. [Apr 16 WHO update]

CDC: US H1N1 activity still declining Visits to doctors, lab-confirmed hospitalizations, and the proportion of deaths attributed to pneumonia and influenza all declined in the United States last week, the Centers for Disease Control and Prevention (CDC) reported today. However, 3 pediatric deaths were reported in the last week. One report was from a previous season, but 2 were from the current flu season, of which one was due to the 2009 H1N1 strain and the other to an influenza A strain that was not typed further. [Apr 16 CDC update]

Structural analysis confirms 1918, 2009 pandemic links Structural analysis of the hemagglutinin of the 2009 H1N1 pandemic flu virus, and comparison of the structure with the recovered 1918 pandemic flu virus, reveals a shared epitope in both viruses, US researchers report today in Science. That antigenic similarity may explain repeated observations over the past year that those old enough to have been exposed to descendants of the 1918 virus possess some degree of protection against the 2009 strain. [Apr 16 Science abstract]

H1N1 virus found to damage heart A previously healthy 11-year-old girl died of heart failure, caused by compression of the heart by fluid in its outer sac, that appears to have been caused by H1N1 flu infection. Italian researchers report in the Journal of Clinical Microbiology that H1N1 viral sequences were found in the girl's heart tissue and pericardial fluid, suggesting direct damage by the flu virus. They warn that myopericarditis may be an underappreciated result of H1N1 infection. [Apr 14 J Clin Microbiol abstract]

Malaysia orders school monitoring for H1N1 Malaysia's Education Ministry has directed school principals in the country to monitor student bodies for influenza-like illness and to immediately isolate any students who may be suffering from novel H1N1 flu. Eleven new clusters of illness have been reported by the Health Ministry. The Education Ministry wishes to preserve school closures as a last resort, The Star of Malaysia reported today. [Apr 16 Star article]

Apr 15, 2010

Study: Primary care reports accurately show flu spread Researchers in Singapore established a network of primary care clinics that submitted daily forms about their cases of influenza-like illness (ILI), defined as acute respiratory illness with a fever of 100 degrees F or more. They started tracking in June 2009 and determined that primary-care ILI reports accurately showed the progress of the H1N1 pandemic, including its peak. They conclude that such a simple tool may be particularly useful for tracking flu waves in developing countries. [Apr 14 PLoS ONE study]

Severe H1N1 cases may put kidneys at risk Patients severely ill with pandemic H1N1 infections can have kidney injury or failure, though usually the conditions are reversible, Canadian researchers reported yesterday at a National Kidney Foundation (NKF) meeting in Orlando. In a study of critically ill patients from seven Manitoba hospitals, two-thirds had the conditions, and those with kidney failure were 11 times more likely to die. They said the findings are a reminder to avoid dehydration and substances that could hurt kidneys. [Apr 14 NKF press release]

Technique could streamline testing for flu exposure Mexican researchers have developed a virus-free ELISA method to detect exposure to the pandemic H1N1 virus, according to a Public Library of Science ONE (PLoS ONE) study. The immunoassay is based on a recombinant fraction of hemagglutinin of the virus expressed in Escherichia coli. They write that the technique could better help determine a population's disease burden, especially when lab supplies are limited, and help gauge virus exposure when vaccine supplies are scarce. [Apr 14 PLoS ONE study]

Apr 14, 2010

Official: Online activities hampered flu messaging In comments to a panel reviewing the World Health Organization's (WHO's) pandemic response, Keiji Fukuda, MD, special influenza adviser to the director-general, said that the Internet and social networking sites complicated the WHO's flu messages, Agence France-Presse (AFP) reported today. He said online tools sped the flow of flu news, but they also fueled speculation and misinformation that disrupted vaccination efforts. Communications is one of five core topics the review will cover. [Apr 14 AFP story]

College flu activity drops to lowest level since summer Flu activity at US colleges dropped to its lowest level since August, when surveillance began, the American College Health Association (ACHA) said today. The increases seen in southeastern states in February and March are also easing. The attack rate last week was 1 case per 10,000 students, a decrease of 38% from the previous week. No hospitalizations or deaths were reported, and the ACHA saw no evidence of sustained transmission. Vaccine uptake held at 8%, where it has been for several weeks. [Apr 14 ACHA surveillance report]

Namibia reports first pandemic flu case A laboratory in Namibia recent confirmed the country's first pandemic H1N1 case, a patient who had traveled with a group to Thailand, the Namibian reported. The illness is also suspected in a second patient who was with the group. Namibia's health minister expressed disappointment that the finding was first reported in the media before the case was reported to health officials. The country expects to launch its vaccine campaign in May with 220,000 doses from the WHO. [Apr 12 Namibian story]

CDC publishes pediatric flu guide for hospitals The US Centers for Disease Control and Prevention (CDC) recently released a guide to coordinating pediatric care during a flu pandemic. The guide is based on a stakeholders meeting held in September. The book covers topics such as liaisons between hospitals, surge capacity assessment, alternate staffing, and triage, targeting both children's and general hospitals. [CDC workbook]

Apr 12, 2010

Experts urge world not to forget other flu threats Infectious disease experts meeting at an international conference in Vienna warned against complacency in fighting influenza and other illnesses, Agence France-Presse (AFP) reported. Dr Albert Osterhaus, a Dutch virologist, said he worried that complacency due to the mild nature of the pandemic virus could hamper efforts to control the more lethal H5N1 avian influenza. Experts warned governments to expect stronger seasonal flu outbreaks in the wake of the pandemic.

New Zealand's ethnic groups hit hardest A review of adults treated at a hospital in New Zealand's Wellington region last summer during the country's pandemic flu wave suggests that Pacific Islanders and native Maori had higher admission rates than expected for their population size, researchers reported in the New Zealand Medical Journal. Reasons for the higher rates are unclear but could include greater household size, higher numbers of younger people, or greater susceptibility. [Apr 9 N Z Med J study]

Researchers track developing oseltamivir resistance Australia researchers, reporting in Antiviral Research, used rolling circle amplification to show rapid emergence of oseltamivir-resistant pandemic flu in treated patients. From a group of 96 samples, 3 of 25 patients who had received oseltamivir had the H275Y mutation. Two were adults whose samples became resistant after 9 days of treatment, and the child's virus showed the mutation during treatment. Rapid detection in severe infections is crucial, they noted. [Apr 10 Antiviral Res study]

Pandemic virus dominates in H3N2 co-infections In a September flu outbreak at a Beijing college, researchers detected both the pandemic and H3N2 viruses, but found that patterns were similar for patients with different viral infections. The group, reporting in Clinical Infectious Diseases, found no differences in sequences and that all viruses were sensitive to oseltamivir but resistant to adamantane. Because the pandemic virus took precedence, they predicted that circulation of competing seasonal strains seems less likely. [Apr 9 Clin Infect Dis abstract]

Apr 9, 2010

Potency decline shrinks expiration date for Canada's vaccine Canada has shortened the expiration date on its adjuvanted H1N1 vaccine from 18 to 6 months, due to nonsafety-related declines in H1N1 antigen in some lots. Subsequent testing of the GlaxoSmithKline vaccine detected the potency issue, which has also been found in some US vaccine lots. Health officials assured the public that vaccines already administered provide sufficient protection. Relabeling guidance, expected soon, won't affect the unadjuvanted vaccine that Glaxo produced for Canada. [Apr 9 Health Canada statement]

CDC sees little change in low H1N1 levels The incidence of H1N1 flu has sunk to low levels in most of the United States, the Centers for Disease Control and Prevention (CDC) said in its weekly update. The three southeastern states about which the CDC raised the alarm a week ago--Alabama, Georgia, and South Carolina--continue to report regional flu activity. However, visits to doctors, lab-confirmed hospitalizations, and the proportion of deaths attributed to pneumonia and influenza all declined. The update covers Mar 28 through Apr 3. [Apr 9 CDC update]

Tamiflu resistance appears in immunocompromised patients The first cluster of oseltamivir-resistant H1N1 flu in 10 patients in Scotland appeared in a small group who were immunocompromised and persistently shed flu virus, leading to a longer-than-normal course of antivirals. The distinctive resistance mutation was limited to that group out of 1,608 who were hospitalized and did not spread beyond them. The researchers recommend that patients likely to develop resistance be monitored and they and their household contacts vaccinated when possible. [Apr 8 Euro Surveill article]

No adverse effects to flu antivirals in pregnancy Researchers from the University of Texas Southwest Medical Center report that neither oseltamivir nor amantadine/rimantadine caused any adverse events in pregnant women treated at the medical center during the H1N1 flu pandemic. The 104 women given amantadine or rimantadine and the 135 women given oseltamivir had the same rates of preterm birth, premature rupture of membranes, gestational diabetes, and preeclampsia as the 82,097 women who did not receive antivirals. [April Obstet Gynecol abstract]

Rare, severe cases of H1N1 and strep co-infection Of 8,075 patients hospitalized for H1N1 pandemic flu in California in 2009, 10 suffered severe effects from co-infection with invasive group A Streptococcus (S pyogenes). Eight needed mechanical ventilation, and 7 died. Three belonged to one family. S pneumococcus and Staphylococcus aureus have been reported with pandemic and seasonal flu, but group A strep is rare. Physicians should watch for flu complications and be sure to draw blood first and then administer antibiotics quickly. [Apr 8 Clin Infect Dis abstract]

Apr 8, 2010

Some Southeastern colleges see flu activity Though flu-like illnesses remained at very low levels at colleges, with an attack rate of 1.6 cases/10,000 students, the level was 14% higher than previous weeks, the American College Health Association (ACHA) reported today. Disease incidence has remained below 5/10,000 students for 17 weeks. Low-level regional activity occurred in some Southeast states, consistent with trends in the general population. ACHA reported no signs of sustained transmission on college campuses. [Apr 8 ACHA surveillance report]

School outbreaks prompt warning in Ghana Health groups in Ghana, along with its health ministry, issued a warning of a heightened pandemic flu threat in the wake of several school closures in several regions of the country, GhanaWeb reported today. A statement from the groups said children are among the most vulnerable groups, and they advised the public to minimize crowding at social events targeted to children. It also reviewed hygiene measures for preventing flu spread. [Apr 8 GhanaWeb story]

Malaysia also reports school outbreaks School outbreaks of influenza-like illnesses, some of which has been confirmed as pandemic H1N1, have spurred Malaysia's health ministry to asked state officials to boost flu education and prevention activities, particularly in schools and public areas, The Star, a Malaysia-based newspaper, reported today. The country's health minister said illness clusters have been detected at seven schools and that students from six other schools have received outpatient treatment. [Apr 8 Star story]

Study: H1N1 name game hinders lit searches A study found that inconsistent naming of the novel H1N1 virus last spring impeded retrieval of relevant scientific articles in PubMed, an oft-used US National Library of Medicine database. Researchers developed a PubMed search algorithm covering different names of the pandemic virus and simulated results from the first 10 weeks of the pandemic. When they excluded one term from the string, such as "H1N1" or "swine," they found that the search missed from 14% to 21% of relevant articles. [Apr 7 PLoS Med study]

Lung study finds variation in virus replication An ex vivo study comparing flu virus replication in human lung tissue suggests that pandemic H1N1 replication varied among samples but overall replicated more efficiently than seasonal H1N1 but less efficiently than H5N1 avian influenza, Chinese researchers reported in the Journal of Infectious Diseases. They wrote that it's not clear if replication variations in the H1N1 virus relate to clinical outcomes. [Apr 6 J Infect Dis abstract]

Israel to hold on to excess vaccine Israel's health ministry told The Jerusalem Post that it plans to keep 3 million doses of unused pandemic flu vaccine in storage for a potential resurgence of cases in the fall or winter. The ministry had initially ordered 7 million vaccine doses, but later canceled 2.5 million of them. Fewer than a million Israelis have been vaccinated. [Apr 8 Jerusalem Post story]

Apr 6, 2010

UK cuts GSK vaccine order by a third The UK Department of Health (DH) announced today that it has reached an agreement with GlaxoSmithKline (GSK) to cut its H1N1 vaccine order by about a third, according to a news release. The UK order with GSK has been capped at 34.8 million doses of Pandemrix vaccine, including those already received, and there will be no cancellation fee. Some unused vaccine will be kept in reserve for a potential third wave of cases, while 3.8 million doses will be donated to African nations.

Study: No H1N1 immunity in older Singaporeans Researchers in Singapore performed serologic tests on 50 healthy volunteers, most of whom were born before 1958 and therefore potentially carrying H1N1 antibodies. However, none of the recruits, whose median age was 60, had immunity to pandemic H1N1 flu, which differs from findings in western populations. The authors say the results may reflect demographic differences, a very low seasonal-flu-vaccine rate in Singapore, or less exposure of Southeast Asians to swine-origin viruses from the West. [Apr 5 Emerg Infect Dis letter]

Florida reports 4 H1N1 deaths Four Floridians have died from H1N1 flu infections in the past week, bringing the state's total to 24 deaths, the Florida-based Naples News reported. The four deaths occurred in Sarasota, Miami-Dade, Volusia, and Indian River counties and were primarily among middle-aged people with underlying conditions such as respiratory or neurologic disease, a county health spokeswoman said. She said more than 90 people in the state have been hospitalized this year because of pandemic flu. [Apr 5 Naples News article]

Apr 5, 2010

Editorial maps out Australia's flu lessons In an editorial exploring the lessons Australia learned during the H1N1 pandemic, Dr Peter Collignon, director of infectious diseases at Canberra Hospital, wrote that the outbreak stretched the health system even though disease severity was mild to moderate. In the Apr 5 Medical Journal of Australia, he said quicker assessment of virulence and clearer messages about oseltamivir (Tamiflu) use to focus on high-risk groups could have eased the pandemic response. [Apr 5 Med J Aust editorial]

New Zealand reports vaccine shortage Higher-than-expected demand for the flu vaccine in advance of New Zealand's flu season, in which the pandemic virus is expected to dominate, is leading to vaccine shortages, The Medical News Web site reported today. The health ministry said about 20,000 to 30,000 vaccine doses have been administered daily. In late December Sanofi, New Zealand's main vaccine provider, announced a delay in vaccine delivery, which prompted the ministry to order about 450,000 doses from other companies. [Apr 5 The Medical News story]

Study: School profile may influence flu spread An analysis in the International Journal of Infectious Diseases of schools that had H1N1 flu cases last spring suggests that public schools with younger, more affluent students may have been sentinels and played a role in flu spread. Using a news database, the authors matched 32 schools reporting cases with controls in the same counties. Compared with controls, schools with H1N1 cases had fewer low-income students and had younger student populations. [Apr 2 Int J Infect Dis abstract]

Some afebrile patients shed viable H1N1 virus Researchers who studied H1N1 in 47 Quebec City households determined that between 8% and 13% of patients were still shedding viable virus 8 days into their illness, but none were still shedding on day 11. Among 47 patients who tested positive by PCR within the first 7 days of illness, 22 of 35 afebrile patients tested positive by viral culture. The authors write that self-isolation only until fever abates seems inadequate to limit spread and that self-isolation for 1 week may be more effective. [Apr 2 Emerg Infect Dis report]

Apr 2, 2010

CDC: Southeast sees rising flu hospitalization Flu activity last week stayed steady, although increases in flu-related hospitalization occurred in the Southeast, an area that has seen sustained local and regional flu activity over the past several weeks, the Centers for Disease Control and Prevention (CDC) said today. Doctor's visits for flu-like illnesses were below the national baseline, but deaths from pneumonia and flu increased slightly above the epidemic threshold. One pandemic H1N1 pediatric death was reported. [Apr 2 CDC weekly flu update]

Taiwan cites good vaccine safety In a letter published today in The Lancet, officials from the Taiwan Centers for Disease Control reported a good safety profile for the H1N1 pandemic vaccine. Researchers had projected that they would see about 27 cases of Guillain-Barre syndrome (GBS) after 6 weeks of vaccination. However, with more than 4 months' of data, the country has confirmed only four GBS cases in vaccinees. [Letter in Apr 3 Lancet]

Study ID's array of PCR tests to detect flu A German research team reports good results for a bundled PCR assay in quickly and accurately detecting influenza B and key influenza A strains: seasonal H1N1 and H3N2, avian H5N1, as well as pandemic H1N1. Reporting in Public Library of Sciences (PLoS) ONE, the authors state that the nine-assay bundle enables "a fast and precise determination of virus type and subtype in respiratory specimens." These assays have been used successfully at the German national reference lab since 2007. [Apr 1 PLoS ONE study]

IV zanamivir for patients in respiratory distress German physicians writing in Clinical Infectious Diseases detail two cases of critically ill H1N1 patients on ventilators who had pneumonitis and acute respiratory distress, were treated with intravenous zanamivir (Relenza), and had good outcomes. The patients, a 39-year-old man with no underlying conditions and a 49-year-old man with type 2 diabetes, received the drug 5 and 8 days, respectively, after hospitalization and were taken off the ventilator after 6 and 9 days, respectively. [Mar 31 Clin Infect Dis abstract]

Mar 31, 2010

Regional flu spread seen at some Southern campuses Flulike illness on college campuses stayed at low levels for the 16th consecutive week, though some regional activity continued in the Southeastern area, consistent with what federal officials are reporting, the American College Health Association (ACHA) said today. Significant, short increases were seen in mid February to early March, especially in the Carolinas and Georgia. The attack rate was 1.4 cases/10,000 students, down slightly from the previous week. [Mar 31 ACHA surveillance report]

Study: Emergency personnel most H1N1-susceptible Emergency department workers have had the highest H1N1 infection rate among hospital staff, according to a new study, followed by those in pediatrics, ambulatory care, and anesthesiology. Data from five hospitals showed 123 confirmed cases, with an infection rate of 29% in adult emergency departments. As a group physicians and medical personnel had the highest rate (6.7%), followed by security/transportation (3.9%), housekeeping/food service (2.7%), and nurses/clinical technicians (2.2%). [Disaster Med Public Health Prep abstract]

Maine lawmakers kill sick-leave bill A scaled-back bill in Maine addressing sick-leave issues died in the state house of representatives Mar 29, the Associated Press (AP) reported yesterday. As pandemic flu peaked last fall, Senate President Elizabeth Mitchell, D-Vassalboro, had proposed a law that would have required Maine employers to offer paid sick leave as a measure to slow flu transmission in the workplace. Later she scaled back the proposal to prevent employers from firing workers who take paid or unpaid sick days.

Study suggests CBC pattern may be flu marker Lymphopenia with or without monocytosis in the complete blood count may be a marker for the pandemic H1N1 virus and may be useful when demand for virus testing exceeds capacity, Greek researchers reported in Public Library of Science Currents (PLoS Currents). They found the pattern in data from patients treated in a private clinic emergency department during the fall flu wave. They said though lymphopenia has been seen in seasonal and pandemic flu, the monocytosis observation is new. [Mar 30 PLoS Currents study]

Bulgaria's health minister steps down over Tamiflu flap Bulgaria's health minister resigned yesterday after federal prosecutors charged him with wasting public funds by overpaying for oseltamivir (Tamiflu), Agence France-Presse (AFP) reported today. Bojidar Nanev allegedly paid $4.4 million to Roche for the drug that it could have bought from British health services for $2.7 million, according to the charges. Nanev has denied the charges, and Roche said its contract complies with Bulgaria's public tender requirements, Sofia News Agency reported. [Mar 31 AFP story]

Mar 30, 2010

CDC to travelers: Get vaccinated For those who will be journeying on spring break, to the World Cup, or elsewhere, the Centers for Disease Control and Prevention (CDC) released guidance today advising travelers to get the H1N1 flu vaccine 2 weeks before they leave. Though the document specifically mentions H1N1 risk during the Southern Hemisphere's flu season, the CDC recommends the vaccine for all travelers not yet immunized. [Mar 30 CDC document]

Study says entry screening may have worked Countries that began screening incoming travelers after the World Health Organization issued its pandemic alert last year may have delayed local transmission 7 to 12 days, according to a study today in BMC Infectious Diseases. The authors conclude that entry screening at airports, ports, and border crossings "may lead to short-term delays in local transmission of a novel strain of influenza virus." They added that resources need to be balanced against expected benefits. [Mar 30 BMC Infect Dis abstract]

Irish leave two thirds of H1N1 vaccine unused Almost two thirds of the $17 million worth of H1N1 vaccine that Ireland ordered has gone unused, with only 25% of the population getting vaccinated, the Irish Times reported today. The nation's health service was discussing options for the surplus with vaccine maker GlaxoSmithKline (GSK). Some of the 3 million doses bought by Ireland will remain stockpiled against the risk of a subsequent pandemic wave. [Mar 30 Irish Times story]

Republic of Georgia receives its first vaccine The Republic of Georgia is due to receive its first shipment of H1N1 vaccine, according to Eurasianet. About 100,000 doses of GSK vaccine are expected to arrive in the country by the end of March. A Georgian health official said the country has not been hit as hard as its neighbors, thanks to early detection, disease containment, and treatment of cases. It has logged fewer than 1,300 H1N1 cases [Mar 29 Eurasianet report]

Mar 29, 2010

Cuba to launch pandemic vaccination Cuba will launch the first phase of its pandemic flu vaccine campaign on Apr 1, targeting priority groups such as pregnant women, healthcare workers, teachers, and people who have contact with foreign travelers, the Associated Press (AP) reported, citing Cuba's communist newspaper. The country previously signaled it was hesitant because of cost and efficacy issues, but Cuba has now received vaccine from the World Health Organization. Officials hope to protect 1.1 million people. [Mar 26 AP story]

Possible spread of resistant H1N1 reported Oseltamivir-resistant H1N1 flu probably spread between two children living in adjacent rooms in an institution for disabled children, Israeli physicians reported in Emerging Infectious Diseases. A 13-year-old boy became ill in late July and was found to have the resistant strain. His neighbor, a 10-year-old girl, got sick about 2 weeks later and had the resistant strain from early in her illness. The resistant virus did not appear to spread to any other children in the facility. [Emerg Infect Dis report]

China drought threatens key Tamiflu ingredient A severe drought in four of China's southwestern provinces is threatening production of star anise, a major source of shikimic acid, a key ingredient of oseltamivir (Tamiflu), Xinhua reported. A forestry expert said Roche, the maker of Tamiflu, gets two thirds of its star anise from China. A Roche official said it's not clear if the drought will affect Tamiflu production and that the company could substitute another ingredient for star anise. [Mar 26 Xinhua story]

Jordan reallocates flu-vaccine money With no new cases of pandemic flu in Jordan since December, part of the money that Jordan had planned to spend on flu vaccine will be used to buy drugs for other conditions, the Jordan Times reported today. The health ministry had planned to buy 2.25 million doses of vaccine from Novartis for 9 million Jordanian dinar. Now, 4 million dinar of that sum will be used to buy Novartis drugs for various conditions. Jordan has had 3,049 confirmed H1N1 cases and 16 deaths. [Mar 29 Jordan Times story]

Mar 26, 2010

WHO: Flu activity up in Central, South America Pandemic activity may be increasing across Central America and in some parts of South America, the World Health Organization (WHO) said today. Guatemala, Nicaragua, El Salvador, Panama, and parts of Brazil have reported increasing pandemic flu detections. Mexico is seeing more respiratory illnesses, though it's not clear if flu is the cause. Flu activity hasn't peaked in West Africa, though it is subsiding in Thailand. European countries are increasingly reporting influenza B. [Mar 26 WHO weekly update]

Review calls nondrug steps effective against flu After assessing 11 CDC-funded studies on the effect of non-pharmaceutical interventions (NPIs) on pandemic flu, a committee has determined that "evidence exists of the effectiveness of NPIs, including face masks, hand hygiene, cough etiquette, reduced crowding, and school closures, in reducing the spread of influenza." The group, however, identified 16 research gaps, including the role of transmission modalities, implication of viral load, clinical definitions, and barriers to implementing NPIs. [Mar 26 Emerg Infect Dis report]

China eases flu ban on US pork China lifted its flu-related ban on US pork, a move welcomed by American pork producers, the Associated Press (AP) reported today. Several countries restricted US pork imports last spring when the pandemic H1N1 virus emerged in Mexico and the United States, but China was the last country to end its ban. Industry experts said shipments to China could resume within 2 weeks. [Mar 26 AP story]

Japan cancels part of vaccine order Japan's Ministry of Health, Labor and Welfare announced today that it has reached agreement with GlaxoSmithKline to cancel a third of its H1N1 vaccine order, or 24 million surplus doses. It is also working to cancel part of a 25-million-dose vaccine order from Novartis, according to Kyodo News. Of the 99 million doses Japan had ordered from the two companies, about 50 million have been shipped

Mar 25, 2010

Georgia reports rise in flu hospitalizations Georgia health officials said that flu hospitalizations are at their highest level since last September, with 70 to 80 reported in each of the past 2 weeks, the Associated Press (AP) reported today. Dr Susan Lance, state epidemiologist, is advising clinicians to continue immunizing adults and children and consider pandemic H1N1 infections in those who present with flu-like symptoms, according to a posting on the Georgia Division of Public Health Web site. [Mar 25 AP story]

Study highlights pregnancy risk factor A case series of New York City pregnant women who needed intensive care unit (ICU) treatment of pandemic flu infections in 2009 found that only 2 of 17, one of whom was postpartum, had underlying conditions other than pregnancy. The study, published today in Morbidity and Mortality Weekly Report (MMWR), also revealed that, although all received oseltamivir (Tamiflu), only one woman received it within 2 days of symptom onset, a time frame linked to better outcomes. Two of the women died. [Mar 26 MMWR report]

UK begins post-pandemic review Britain's Department of Health (DH) today announced an independent review of the UK response to the H1N1 influenza pandemic. Deirdre Hine, a former Welsh chief medical officer, will chair the review and forward recommendations to health ministers before the summer parliamentary recess. "This review is being conducted as part of the normal procedure following a major emergency event," today's DH release stated. "The findings will be used to inform future planning for pandemics." [Mar 25 DH news release]

Novavax reports cell-based vaccine effective Novavax Inc., of Rockville, Md., announced that its H1N1 virus-like particle (VLP) vaccine produced good immune response and safety profiles in 1,000 volunteers, replicating results of a study on 500 volunteers reported in December. The vaccine provided protective immunity in two doses of either 5, 15, or 45 micrograms. The next step is a 3,500-person study. Novavax said its VLP vaccine can be grown in weeks instead of the months it takes to make a traditional egg-based vaccine. [Mar 24 Novavax release]

Masks and N-95s performed equally in study An observational study in the April 1 issue of Clinical Infectious Diseases of health workers at a Singapore hospital suggests that surgical masks were as effective as N-95 respirators against pandemic H1N1 infections. For one month last summer workers wore N-95s in emergency and isolation areas, and the following month they wore surgical masks. Few workers got sick, and all transmission occurred outside the hospital. The CDC recommends N-95s for health workers caring for H1N1 patients. [Clin Infect Dis study]

Mar 24, 2010

Flu on US campuses stays level Flu-like illness activity held at low levels on US college campuses last week, though regional activity continued in the Southeast, which was consistent with what federal officials observed, the American College Health Association (ACHA) said today. The attack rate was 1.5 cases/10,000 students, up just 0.2 cases/10,000 students from the previous week. The ACHA said it still sees no sign of a third wave and that it's unclear if flu activity will rise when students return from spring break. [Mar 24 ACHA surveillance report]

Aboriginal ethnicity cited as risk factor in Canadian kids A comparison of children treated in nine Canadian pediatric intensive care units (ICUs) with all kids hospitalized in Canada with flu during the first pandemic wave revealed that those with underlying conditions and from aboriginal groups were more likely to have severe illness. The report, published by Pediatric Critical Care Medicine, said ICU patients typically had severe respiratory failure and prolonged mechanical ventilation, but mortality rates didn't exceed those for seasonal flu.

Cambodia receives vaccine from WHO Cambodia's health ministry has received 300,000 doses of H1N1 vaccine from the World Health Organization (WHO), and a vaccination campaign may begin immediately, the Phnom Penh Post reported today, quoting Dr. Nima Asgari of the WHO. The doses received so far are intended for at-risk populations in four provinces, and more doses are on the way for other provinces, Asgari said. A Mar 18 report by the health ministry said Cambodia has had 566 H1N1 cases with 6 deaths.

Mar 23, 2010

Australia logs its first serious case of year Australia's Influenza Complications Alert Network (FluCAN) picked up the nation's first pandemic H1N1 case this year requiring hospitalization, a woman of childbearing age with an underlying illness, according to an Australian Associated Press (AAP) story today. The woman, described as of "child-bearing years but not pregnant," was the first case since Dec 11 reported by 13 major hospitals that are part of FluCAN. An official used the occasion to remind Australians to get a flu shot. [Mar 23 AAP story]

Louisiana flu clinics target rise in flu activity Reports from clinics and hospitals of rising flu-like illnesses over the past few weeks prompted Louisiana health officials to launch walk-in pandemic H1N1 flu vaccine clinics throughout the state this week. Louisiana's state health officer warned in a press release that another wave of infections could occur and urged residents to get vaccinated. The department also noted that other southern states, including the border states of Arkansas and Texas, were seeing rises in flu activity. [Mar 22 Louisiana health department release]

France to reimburse vaccine makers $65 million France will pay three H1N1 vaccine manufacturers a 16% reimbursement fee of $65 million for doses it cancelled, Reuters reported today, citing the newspaper Le Figaro. The government will pay Novartis, GlaxoSmithKline, and Sanofi Pasteur for cancelling 50 million vaccine doses. A French health ministry spokesperson declined to comment on the article, which did not name a source for the information. When France ordered its vaccine, it assumed two doses would be needed instead of one. [Mar 23 Reuters report]

Scientists show 3D view of H1N1 binding Researchers from the Center for Disease Control and Prevention's (CDC's) influenza division have used x-ray crystallography, which allows a 3D view of structure and function, to analyze changes in the hemagglutinin of the pandemic H1N1 virus. Reporting in Public Library of Science (PLoS) Currents, they said the protein's receptor binding shows a strict preference for human-type receptors and noted that their research technique can help develop better interventions. [Mar 22 PLoS Currents study]

X-ray findings may predict serious flu outcomes Findings on chest radiographs may help predict outcome in patients with pandemic H1N1 infections, but normal findings can't exclude serious outcomes, researchers reported in Radiology. They based their findings on x-ray reviews of 179 patients who were hospitalized from May through September. Thirty-nine patients (40%) had abnormal findings. Extensive involvement of both lungs and bilateral peripheral opacities were linked to adverse outcomes. [Apr Radiology abstract]

Mar 22, 2010

WHO: Central America, Caribbean see flu upticks Limited data point to increasing pandemic flu activity in parts of Central America and the Caribbean, according to the latest weekly update from the World Health Organization (WHO). Other hot spots are parts of Southeast Asia and West Africa, including Thailand, Bangladesh, and Ghana. Though flu levels are declining in most of the Northern Hemisphere, influenza B is increasing in some European countries and is dominant in several Asian countries, Iran, Mongolia, and the Russian Federation. [Mar 19 WHO weekly update]

WHO has sent vaccine to 17 developing countries The World Health Organization (WHO) has delivered about 4 million doses of H1N1 flu vaccine to 17 developing countries so far, the Voice of America reported on Mar 20. WHO spokesman Gregory Hartl said doses will be shipped to another 25 countries in Africa, Central America, and Eastern Europe in coming weeks. Doses have been requested by 95 countries, but each must have a deployment plan before it can receive a supply. On Mar 18 Togo became the first African country to receive the vaccine. [Mar 20 Voice of America report]

Risk of severe H1N1 highest in late pregnancy A study of pregnant women treated in intensive care units for pandemic flu in Australia and New Zealand last summer suggests that the risk of critical illness was greater during later pregnancy, when it was about 13 times higher than in nonpregnant young women, according to a British Medical Journal (BMJ) report. Indigenous women and those with chronic conditions such as asthma were at greater risk than other pregnant women. Most of the 64 women in the study needed mechanical ventilation. [Mar 18 BMJ study]

Massachusetts claims highest flu vaccination rates The Massachusetts Department of Public Health says the state had the nation's highest rates of vaccination against both H1N1 and seasonal flu, the Boston Globe reported yesterday. The immunization rates in Massachusetts were 36% for H1N1 and 57% for seasonal flu, versus 21% and 37% nationwide. Public Health Commissioner John Auerbach credited government agencies working with local health departments, school systems, doctors, and hospitals. The report was based on US CDC data. [Mar 21 Boston Globe report]

Mar 18, 2010

Many lower-risk people got first H1N1 shots An investigation by the Associated Press using government documents tendered under the Freedom of Information Act reveals that, though the first wave of H1N1 shots were designated for high-risk groups, many were diverted to lower-risk healthy adults in firms, refineries, jails, and other sites. There is no complete record of where or to whom the vaccine was administered, the wire service said.

Hong Kong records seasonal, H1N1 flu rise Hong Kong's Centre for Health Protection is detecting rising numbers of flu cases during its traditional flu-season peak, with half the isolates turning out to be H1N1 pandemic flu. The remainder of isolates are influenza B, not other seasonal influenza A strains. The centre said Thursday that it recorded 268 new flu cases last week, compared with 177 the week before, and added that visits to doctors for flu-like illnesses are rising.

Japanese researchers: Blood may transmit H1N1 In a letter to the journal Emerging Infectious Diseases, the blood service of the Japanese Red Cross Society has expressed concern that blood transfusion may transmit pandemic H1N1 flu. Forty out of 96 people who gave blood last fall were diagnosed with H1N1 within 2 days of donation. Testing of retained segments did not reveal H1N1 nucleic acids; the researchers say flu viremia may be too brief to be detectable. [Mar 17 EID letter]

Texas: Thousands of flu shots may be thrown out The Tarrant County, Texas, heath department, which serves Fort Worth, is rushing to administer its remaining 20,000 H1N1 flu vaccine doses before they expire. KSDK-TV reported that the department was administering 300 shots per day during the winter but that demand has dropped by 80%. [Mar 17 KSDK-TV report]

Scientists call for "one health" flu analysis Two specialists in zoonotic diseases, one of them a founder of the Global Initiative on Sharing Avian Influenza Data (GISAID), have called for a new approach to flu surveillance and analysis that would pay equal attention to nonhuman species. Ilaria Capua and Giovanni Cattoli say in a letter to Emerging Infectious Diseases that analyzing the flu gene pool as one cross-species entity will improve early detection of new strains such as pandemic H1N1 flu. [Mar 17 EID letter]

Mar 17, 2010

Flu activity on US campuses drops Influenza-like illness (ILI) at US colleges dropped by more than half from the previous week, to an attack rate of 1.3 cases/10,000 students, in today's surveillance report from the American College Health Association (ACHA). Nationally, the reported disease incidence has remained below 5 cases/10,000 students for 3 months. "At this point we continue to see no definitive evidence of a third wave of ILI disease, even on a regional basis," said Dr. James C. Turner, president of the ACHA.

Review: Better studies needed on nondrug measures A review of 11 studies on the effectiveness of nonpharmaceutical interventions (NPIs) in containing flu found that "the data provide some evidence that face masks, hand hygiene, cough etiquette, reduced crowding, and school closures are effective in reducing the spread of influenza." The studies, however, had several limitations, including insufficient statistical power due to small sample size. The authors call for rigorous laboratory- and community-based studies to improve data collection. [Mar 15 Am J Infect Control abstract]

H1N1 vaccine could go unused in Australia Australians are opting for newly available, broader seasonal flu vaccine rather than the monovalent H1N1 flu vaccine offered free of charge by the government. About 21 million doses of the latter were purchased; about 7 million have been distributed, and 2.1 million have been committed to developing countries. The vaccine has a shelf life of 12 months, raising concern that many doses will go to waste. H1N1 flu has hospitalized close to 5,000 Australians, with at least 190 deaths so far. [May 17 The Age article]

Study: Fatal H1N1 involves diffuse lung damage Pathology findings in two patients who died after novel H1N1 infection showed diffuse alveolar damage, results the study's authors called similar to findings for seasonal flu. The first patient, a 36-year-old man, died 15 days after symptom onset and had alveolar damage with extensive alveolar bleeding. The second patient, a 46-year-old woman with alcoholism, was found unresponsive and died 4 days after admission. She had acute bronchopneumonia and diffuse alveolar damage. [Mar Am J Clin Pathol study abstract]

Rwanda reports H1N1 contained Most cases of flu now being reported in Rwanda are of the seasonal variety, including type B, which is common in the rainy season, according to health officials there. The number of H1N1 cases is decreasing significantly, and samples are no longer being sent routinely for laboratory diagnosis. Preventive measures, such as hand washing and covering coughs, continue to be encouraged. Rwanda saw its first case of H1N1 last October, and total cases number nearly 400, with no reported deaths. [Mar 16 The New Times article]

Mar 16, 2010

Kentucky seeks to prevent flu absences from hurting school aid Kentucky's Senate unanimously approved a measure yesterday to protect schools from funding cuts due to student absenteeism during the flu pandemic, the Huntington, W.V., Herald-Dispatch reported. The bill would allow schools to choose their highest attendance averages from the last 3 years to help determine state aid allocations. Some districts that had high absence rates were in danger of losing some state funding. The measure now goes to House lawmakers. [Mar 15 Herald-Dispatch story]

Firm gets DARPA funds for plant-based vaccine Fraunhofer USA's Center for Molecular Biotechnology announced today that it received a $4.4 million award from the Defense Advanced Research Projects Agency (DARPA) to develop a pandemic H1N1 vaccine using its plant-based recombinant technology. The award, Fraunhofer's third from DARPA, allows the vaccine to enter phase 1 trials. The technology is designed to enable a more rapid response to military and civilian disease threats. Fraunhofer opened a new production facility in late 2009. [Mar 16 Fraunhofer press release]

Canada ponders multiple pandemic vaccine suppliers Canadian officials yesterday said they plan to move to a multiple-source supplier for pandemic vaccines. For the past 10 years the nation has relied on only GlaxoSmithKline (GSK), which has a plant in Canada, for pandemic vaccine, as well as much of its seasonal vaccine. During the H1N1 pandemic, GSK's Quebec plant experienced production delays. According to yesterday's notice, officials are considering "a second pandemic supply contract, if feasible and of demonstrated value to Canada."

College survey finds little concern last year over H1N1 A recent study found that students and staff at a major Australian university were largely not worried about pandemic flu. Of 2,882 respondents to an online survey conducted Jun 29 through Sep 30, 2009, 64% reported little concern and 76% had not made pandemic-related lifestyle changes. Only 10% had gotten a flu shot (students, 7%; staff, 16%). Also, 19% said they would stay home if sick with flu-like symptoms, but the number jumped to 58% (67% in students) if they were facing a deadline. [BMC Public Health study abstract]

Mar 12, 2010

US pandemic flu levels still remain low For the seventh straight week, US pandemic flu activity held steady at low levels, the Centers for Disease Control and Prevention (CDC) reported today. All 174 specimens that tested positive for flu were of the pandemic strain, and the proportion of outpatient visits for influenza-like illness (ILI) was below the national baseline. Three of 10 regions reported ILI at or above baseline. No states reported widespread influenza activity, but five states reported regional activity. [Mar 12 CDC weekly flu update]

Canadians express opinions on pandemic planning A survey of 500 Canadians on ethical issues in pandemic planning found that a majority saw (1) saving lives as the primary goal, (2) an obligation for healthcare workers to work during a pandemic and for government to provide disability and death benefits for them, and (3) stockpiling adequate antivirals and vaccinations for all Canadians as a government responsibility. Also, over 70% thought their country should assist poorer countries in a pandemic, even if it reduced domestic resources.

Students main H1N1 disseminators in Hong Kong A study of the first 3 months of pandemic H1N1 flu's spread in Hong Kong using routinely collected surveillance data showed that the disease diffused relatively slowly from six initial foci, suggesting close person-to-person rather than airborne spread, and that students were the major disseminators of infection. All cases from May through July 2009 were included in the study. Cases were georeferenced and the data analyzed by SatScan to characterize space-time clustering. [PloS Currents article]

Mar 11, 2010

Household transmission lower for H1N1 A study of household transmission of the novel H1N1 virus in San Antonio, Tex., during the first pandemic wave found that children were most affected and were more likely to transmit the virus to other children at rates that were generally lower than seasonal flu. The median time to illness onset between contacts was 4 days. The Emerging Infectious Diseases study found secondary attack rates of 4% for confirmed novel H1N1, compared with rates ranging from 13% to 30% for seasonal flu. [Mar 11 Emerg Infect Dis study]

Brain death reported in H1N1 patient Doctors writing in Clinical Infectious Diseases report the case of a 7-year-old girl infected with pandemic H1N1 flu who developed encephalopathy that led to brain death. She had had fever and malaise for 1 day but no upper respiratory symptoms. Her condition then deteriorated, and on admission to intensive care she had signs of severe neurologic compromise. Brain death was confirmed within 3 days, in the first such instance documented in the pandemic, according to the authors. [Mar 10 Clin Infect Dis abstract]

Study cites obesity as risk factor for severe H1N1 To identify risk factors, French researchers compared the frequency of preexisting health conditions in patients who had severe H1N1 flu with their frequency in the general French population. Writing in PLoS Currents, an online journal that screens content but does not use full peer review, they report that pregnancy, obesity, heart failure, and diabetes were risk factors for admission to an intensive care unit. But only obesity, heart failure, and diabetes were risk factors for death. [PLoS Currents report]

Arab states cooperate to fight pandemic flu Ministers of health from Arab nations are meeting to discuss various health topics, including their response to pandemic H1N1 flu, Kuwait News Agency (KUNA) reported today. Kuwaiti Minister of Health Dr. Hilal Musaed Al-Sayer said there is full coordination among members of the Gulf Cooperation Council (GCC), especially in the seasons of pilgrimage and lesser pilgrimage, on fighting the pandemic, as well as on exchanging data and statistics related to the infections and deaths. [Mar 11 KUNA article]

Mar 10, 2010

College flu activity stays steady The nation's colleges saw a very slight decrease in flu-like illnesses last week, but the attack rate stayed about the same as the previous 2 weeks, about 3 to 4 cases per 10,000 students, the American College Health Association (ACHA) reported today. So far the patterns don't signal a third pandemic flu wave, even on a regional level. Two more hospitalizations were reported, and the vaccination level stayed the same, at about 8%. [Mar 10 ACHA surveillance report]

India set to launch vaccine campaign India's health ministry said the country will begin vaccinating its priority groups against the pandemic H1N1 virus next week, Indo-Asian News Service (IANS) reported today. Doctors and paramedics will be among the first to receive the vaccine. India has purchased 1.5 million doses from Sanofi and had asked the company to conduct a pandemic vaccine trial in India, which it has completed and sent to the ministry. Indian companies are also working on pandemic H1N1 vaccines. [Mar 10 IANS story]

Study: 1976 vaccine may protect against novel H1N1 A mouse study found that earlier infection with a 1976 classical swine H1N1 virus completely protected against the current pandemic virus, suggesting modern day benefits for those who received the 1976 swine flu vaccine, according to a study in Influenza and Other Respiratory Viruses. Mice infected with either 2009 or 1940 seasonal H1N1 viruses showed partial protection, which might partly explain why older people seem to have some protection against the pandemic virus. [Mar 8 study abstract]

Mar 9, 2010

Turkey seeks to return some vaccine doses Turkey is negotiating with vaccine companies to return some of its unused doses of H1N1 flu vaccine, the Anatolia News Agency reported today. Health Minister Recep Akdag said the government had ordered 43 million doses of vaccine but actually purchased 17 million. Officials are talking with manufacturers about giving "a significant part" of that amount back, but will keep 2 to 3 million doses for emergencies, he said. Akdag said in January that more than 600 people in Turkey had died of H1N1.

Rwanda reports increase in flu cases Pandemic flu cases in Rwanda are starting to increase again after dropping in early February, The New Times in Kigali reported today. A health ministry official said an increase was noted in Burera district of Northern province, with six confirmed cases in the past week. He said seasonal flu cases are also being reported and that a stockpile of oseltamivir (Tamiflu) is available. He added that the flu uptick calls for more vigilance but said there is no cause for alarm. [Mar 9 New Times story]

Mar 8, 2010

Dutch officials seek to return surplus vaccine The Dutch health ministry has signaled that it is in talks with GlaxoSmithKline to possibly return a large portion of its surplus H1N1 flu vaccine, Reuters reported. The ministry had ordered 34 million doses at a time when experts thought each person would need two doses. Of that total, 11 million doses have been administered, and the government is holding 2.2 million as an emergency reserve. [Mar 6 Reuters story]

ACHA, CDC caution spring break travelers In an effort to prevent a repeat of last year's post spring break flu spread, the American College Health Association (ACHA) and the US Centers for Disease Control and Prevention (CDC) advised students with travel plans to get the pandemic H1N1 vaccine and take other measures to protect themselves. The two groups warned in a Mar 5 letter that the virus is still circulating in the United States and abroad and that some colleges have recently reported increases in flu activity. [Mar 5 ACHA and CDC letter]

UK health records helped vaccination program Britain's system of electronic health records made it easier for medical providers to notify people targeted for H1N1 vaccination than was the case for US providers, said CDC Director Thomas Frieden at a recent conference. While Americans mostly decided on their own if and when to get vaccinated, British providers used the electronic records to identify people with high-risk conditions and invited them to come in for vaccination, he said. [Mar 5 Reuters report]

Spain to give vaccine to Latin America Spain plans to donate 4 million doses of H1N1 vaccine to the countries of Latin America, the Pan American Health Organization (PAHO) announced recently. Trinidad Jimenez, Spain's minister of health, announced the donation at a Mar 4 meeting with Dr. Socorro Gross, assistant director of PAHO. [Mar 4 PAHO announcement]

Mar 5, 2010

WHO says H1N1 continues decline in most areas The pandemic H1N1 virus continues to circulate in temperate zones of the Northern Hemisphere but is at low levels and continuing to decline in most areas, the World Health Organization (WHO) said in its weekly update today. The most active areas include Thailand, Myanmar, Russia, Bulgaria, Armenia, and Moldova. Activity is very low in North America, but Mexico and Peru have seen a slight increase in respiratory disease. Several countries in western Sub-Saharan Africa are reporting H1N1 cases. [Mar 5 WHO weekly update]

US flu indicators still below baseline For the sixth week in a row the nation's pandemic flu activity was steady last week, with doctor's visits for flu-like illnesses below baseline and pneumonia and flu deaths up a bit but below the epidemic threshold, the US CDC reported today. One pediatric flu death was reported, in an influenza B case from last season. No states reported widespread activity, but Alabama, Georgia, Mississippi, and South Carolina had regional activity. Testing found only two seasonal flu viruses. [Mar 5 CDC weekly flu update]

Penn State flu cases renew vaccine push The health service at Penn State University has seen several confirmed H1N1 cases over the past few weeks, offering a reminder that the virus is still circulating and that people still need to be vaccinated, the university announced yesterday. The cases were detected at the school's University Park campus. A school newspaper, the Daily Collegian, reported today that pandemic flu was recently confirmed in seven students, the first ones since the new semester began in January. [Mar 4 Penn State press release]

Mar 4, 2010

Study: One H1N1 clade pushed out others A genetic study of pandemic H1N1 viruses by Italian researchers today suggests that several H1N1 clades circulated early in the epidemic but that one clade (clade 7) replaced the others and has predominated through most of the pandemic. The authors concluded, however, that it's not clear whether the shift to a single-clade pattern had a clinical impact or gave the virus a transmissibility advantage. The report appears in Public Library of Science (PLoS) Currents. [Mar 4 PLoS Currents study]

Hong Kong reports flu uptick The Hong Kong Centre for Health Protection (CHP) today reported a slight increase in cases of influenza-like illness (ILI). ILI cases increased from 42.8 to 55.1 per 1,000 office visits over the preceding week. The CHP also reported 23 institutional outbreaks, compared with 3 in each of the previous 2 weeks. And the number of respiratory samples that tested positive for flu rose to 85 from 44 the week before. About a fourth of the isolates were pandemic H1N1, and more than 60% were influenza B. [Mar 4 CHP report]

UK eyes H1N1 vaccine for southbound travelers British vaccine advisors are considering advising those traveling to the Southern Hemisphere during its upcoming flu season to receive the pandemic H1N1 vaccine in addition to the seasonal version, Healthcare Republic, a UK-based publication, reported today. The Southern Hemisphere's flu season typically runs from May through October. The Department of Health said it is exploring ways to implement the flu vaccine advice. [Mar 4 Healthcare Republic story]

VA study reports effective flu biosurveillance In a study today, the Department of Veterans Affairs reported that it effectively used an electronic biosurveillance system for tracking and monitoring influenza trends. The system, called Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), effectively tracked trends for seasonal flu as well as the rise in cases at the start of the H1N1 pandemic. The authors said it could serve as an important alerting tool. [Mar 4 PLoS One abstract]

Mar 3, 2010

College indicators show no sustained flu wave Flu-like illness activity at US colleges decreased slightly last week, and although disease incidence was higher than it was between mid December and mid February, the American College Health Association (ACHA) sees no evidence of a third pandemic wave. The attack rate for the week ending Feb 26 was 3.3 cases per 10,000 students, down 20% from the previous week. Southeast and Gulf Coast schools showed slight increases in disease activity, with levels still lower than November's. [Mar 3 ACHA surveillance report]

South Carolina campus sees uptick in cases The University of South Carolina in Aiken saw an increase in suspected H1N1 flu cases in February, according to The State newspaper in Columbia, S.C. After seeing few flu-like illnesses in January, the campus had 27 cases in February, said Cindy Gelinas, director of the student health center. Four sick students were tested in late February, and all had the virus. State epidemiologist Dr. Jerry Gibson said another wave of cases is likely if the pandemic follows historical precedents. [Mar 3 State report]

Pandemic waning in China China's health ministry said the country's H1N1 pandemic has passed its peak, according to Xinhua. The proportion of H1N1 among all flu cases dropped from 36.6% in January to 11.1% in February. The ministry reported that 793 Chinese have died of the illness, including 18 in February. Officials estimated that 30% of the population has immunity to the virus and said a major new wave of cases is unlikely in the near term, but added that localized outbreaks in crowded settings remain possible.

India signs deal for pandemic vaccine India's government has signed an agreement with Panacea Biotec, a pharmaceutical company based in New Delhi, to produce pandemic H1N1 vaccine, the company reported today. Panacea has a manufacturing facility in Punjab that can produce 45 million doses a year. Panacea projects that its vaccine, a split-virus, egg-based product, will be available by April for emergency use. India has also signed vaccine agreements with two other companies. [Mar 3 Panacea Biotec press release]

Mar 2, 2010

Brazil prepares H1N1 shot campaign The government of Brazil said Monday that it will launch "the largest campaign in the world" to vaccinate its citizens before the Southern Hemisphere flu season. Xinhua reported that the effort aims to give shots to 90 million Brazilians in a tiered campaign: health workers and indigenous citizens first, followed by pregnant women, young children, chronic-disease sufferers and young adults, and then the rest of the population.

Earthquake aftermath halts vaccination in Chile Widespread building damage and continuing power-supply interruptions have forced authorities to suspend H1N1 and routine vaccination campaigns in Chile following the Feb 27 8.8-magnitude quake there. New deliveries of H1N1 vaccine from outside the country have been postponed for at least a week, while authorities fear existing vaccine stocks have been ruined by electricity failures that interrupt the cold-chain keeping vaccines potent. [Mar 1 Pan American Health Org update]

Ireland records almost 1,000 reactions to H1N1 vaccine An analysis of complaints to the Irish Medicines Board (IMB) reveals that there have been almost 1,000 reports of adverse reactions to the H1N1 vaccine, the Irish Times reported today. Most of the reactions were injection-site swelling, gastrointestinal problems, and flu-like symptoms. In its most recent update, the IMB said it has no mechanism for separating true adverse reactions from coincidental events.

H1N1 could develop drug-resistance patterns of seasonal flu If pandemic H1N1 follows the same evolutionary pathway as seasonal H1N1 strains, it will likely develop the resistance to oseltamivir (Tamiflu) that has become widespread in seasonal strains, Ohio State University researchers predict in the International Journal of Health Geographics. Reassortment between pandemic and seasonal strains in areas where they co-circulate, such as China, could speed the evolution of resistance, and antiviral use must be judicious, they say. [Feb 24 Int J Health Geogr article]

Mar 1, 2010

Alabama officials cite continuing H1N1 Pandemic H1N1 flu hasn't ebbed as much as anticipated in Alabama, according to public health officials there. Although frequency was higher in the fall than it is currently, cases are still occurring across the state, and there were three deaths in February, a pattern unlike previous flu epidemics. The state ran a large school immunization program earlier in the winter, but school absences in the state remain higher than the typical 5%. [Mar 1 Tuscaloosa News story]

LA County notes uneven vaccine distribution Pubic health data show that the H1N1 influenza vaccine was distributed unevenly across Los Angeles County, with the north and south sides getting disproportionately less, according to an LA Times story today. The reason for the disparity primarily lies in the lower number of healthcare providers in those areas, which translates into fewer requests for vaccine, county health officials said. They admitted that some of the efforts to ensure equal access to vaccine failed. [Mar 1 LA Times story]

Pneumonia worse with H1N1 vs seasonal flu Pandemic H1N1 flu virus has the intrinsic ability to cause more severe pneumonia than seasonal H1N1 flu, concludes a study in the Journal of Infectious Diseases. This ability is a key measure of a flu virus's pandemic potential. The researchers inoculated ferrets intratracheally--to model influenza pneumonia in humans--with pandemic H1N1, seasonal H1N1, or highly pathogenic H5N1 virus. Pandemic H1N1 caused pneumonia intermediate in severity between the other viruses. [Feb 26 JID study abstract]

How H1N1 transmits in households An April 2009 outbreak of pandemic H1N1 flu in a New York City high school, reported in the Journal of Infectious Diseases, had an 11.3% attack rate of flu-like illness among household contacts. Protective factors were older age, antiviral prophylaxis, and having a family discussion of flu. Risk factors in parents included caring for the index patient and, in siblings, watching TV with the patient. Half the secondary illnesses occurred within 3 days of the index patient's illness onset. [Feb 25 JID study abstract]

Study: 40% of kids with H1N1 otherwise healthy Canada's IMPACT monitoring program has reported that, in the first wave of the pandemic (May-August 2009), 324 cases involving hospitalization occurred in the country's children. Of 235 for whom case details were available, 69% were older than 2, with a median age of 4.8; 40% were previously healthy; 50% received antivirals; and two died. The data show the disease course and risk groups affected to be similar to those for seasonal flu but use of antivirals to be higher. [Feb 26 Vaccine article]

Feb 26, 2010

US flu activity steady for fifth week Pandemic flu stayed at the same level for the fifth consecutive week last week, with no states reporting widespread activity and only three--Alabama, Georgia, and South Carolina--reporting regional activity, the Centers for Disease Control and Prevention (CDC) said today. Outpatient visits for flu-like illness were below the national baseline, and deaths from pneumonia and flu were below the epidemic threshold. Influenza B circulated at low levels. Three pediatric flu deaths were reported. [Feb 26 CDC weekly flu update]

Global flu activity wanes, but hot spots persist Though overall pandemic activity waned across the globe, some active areas were seen in parts of south and southeast Asia and in a few areas of eastern and southeastern Europe, the World Health Organization (WHO) said today. Brunei Darussalam reported intensifying flu activity, and overall respiratory disease increased in some countries because of influenza B and respiratory syncytial virus activity. Low levels of influenza B and seasonal H3N2 flu circulated in parts of Africa and Asia. [Feb 26 WHO update]

Death toll in Japan called amazingly small Japan's National Institute of Infectious Diseases has estimated that 20 million people in Japan, mostly children, were infected with H1N1, according to an editorial in the Asahi Shimbun. But fewer than 200 people in Japan have died of the illness, "an amazingly low toll," the newspaper said. It said early diagnosis and treatment apparently helped limit deaths. But it said the health ministry was slow to prepare for the H1N1 vaccination campaign and used a flawed communication strategy. [Feb 25 Asahi Shimbun editorial]

California sees low miscarriage rate with vaccine Fifteen California women who were vaccinated against H1N1 while pregnant had miscarriages or stillbirths, a figure far below the expected rate of miscarriage for all pregnant women, California health officials told TV station KCRA 3 in Sacramento. Officials said the miscarriage rate for all pregnancies is about 15%, but the miscarriage rate among vaccinated women is only a fraction of 1%. Officials said no link between the vaccine and the pregnancy outcomes has been found. [Feb 24 KCRA3 report]

Early flu treatment key for cystic fibrosis patients In the first study describing the course of pandemic H1N1 infection in patients with cystic fibrosis, researchers from an Australian cystic fibrosis center for adults reported that most patients had a mild illness and were managed with antiviral treatment as outpatients. More severe disease was seen in those who presented for treatment late. The findings appear in BMC Pulmonary Medicine. [Feb 25 BMC Pulm Med abstract]

Feb 25, 2010

Hospitalizations strongly linked to chronic conditions Among patients hospitalized for pandemic H1N1, 85% of adults and 65% of children had one or more underlying medical conditions, according to the latest data from the US Centers for Disease Control and Prevention (CDC). The types of underlying conditions associated with H1N1 hospitalizations haven't changed much, with asthma as the most common condition in adults, followed by diabetes and cardiovascular disease. In children, asthma and neurodevelopmental conditions topped the list. [Feb 24 CDC Q and A]

Study: Early Tamiflu treatment shortens H1N1 shedding In a study designed to track the response of pandemic flu to oseltamivir, researchers from Singapore followed a series of 70 hospitalized patients early in the outbreak with daily polymerase chain reaction tests. They reported their findings yesterday in Clinical Infectious Diseases. They found prolonged viral shedding in healthy young adults despite treatment, but those who received the drug within the first 3 days of illness had a shorter shedding duration. [Feb 24 Clin Infect Dis abstract]

Bulgaria to start vaccinating risk groups Bulgaria is set to launch its pandemic H1N1 vaccine campaign on Mar 1, targeting 80,000 doses to priority groups, including babies older than 6 months with certain medical conditions, pregnant women, and healthcare workers, Sofia News Agency reported. The start of the program comes about 3 months after flu activity subsided in Bulgaria. The health ministry is asking doctors to recommend the vaccine to patients at high risk for flu complications. [Feb 24 Sofia News Agency story]

U of Colorado urges vaccination before spring break The student health service at the University of Colorado's Boulder campus is encouraging students to receive their pandemic H1N1 vaccine before traveling for spring break, the Colorado Daily student newspaper reported. The school is hosting a series of free vaccine clinics for students, staff, and faculty over the next week. To lure more students, health officials are offering a drawing for one of two iPod Nanos.

Feb 24, 2010

WHO gains scientists' support for H1N1 response Some have accused the World Health Organization (WHO) of hyping novel H1N1 flu, but scientists defended the agency in an Agence France-Presse (AFP) story today. They pointed out that the WHO acted appropriately, given the uncertain nature of the virus. One expert explained, "This virus is not dead yet. It is on a trajectory, and we don't know where it is going to end up," adding that H1N1 is still mutating. Another pointed out that in the last pandemic, 70% of deaths occurred in a third wave. [Feb 24 AFP article]

Almost 30% of Americans now vaccinated At today's meeting of the Advisory Committee for Immunization Practices (ACIP), Dr. James Singleton of the Centers for Disease Control and Prevention (CDC) said that, as of Feb 13, about 86 million Americans had received the pandemic vaccine, or about 29% of the population. Total vaccine doses administered had reached an estimated 97 million, or about 78% of the doses shipped.

Defense Department invests in tobacco-based vaccine A Texas-based consortium today announced funding for vaccine technology using tobacco plants instead of chicken eggs to produce H1N1 flu vaccine, according to a news release. The consortium, which comprises G-Con, LLC, and Texas A&M, designed Project GreenVax to eventually produce 100 million doses per month. According to a Wall Street Journal article today, the Defense Advanced Research Projects Agency is providing $40 million of the $61 million cost to produce 10 million initial doses. [Feb 24 Texas A&M release]

Czechs open vaccine to general public This week Czech Republic officials opened up the country's estimated 700,000 doses of novel H1N1 vaccine to the general public free of charge. Although vaccine uptake has been low in that country, officials hope the announcement will spur vaccination, especially in children. The vaccine will be available in vaccination centers, not in doctors' offices. [Feb 23 Czech Radio report]

Feb 23, 2010

CDC will reduce H1N1 vaccine stockpiles Over the next 2 months, the Centers for Disease Control and Prevention (CDC) plans to reduce by half the amount of H1N1 vaccine it has pre-positioned in distribution depots around the country managed by McKesson Corp. The CDC has maintained 30 million doses at the sites. The agency said the main strategy will be not replacing 3 million doses that have been recalled, along with 15.3 million doses that are reaching their expiration dates between March and June. [Feb 22 CDC bulletin]

Hong Kong probes possible flu-shot reactions Hong Kong's Centre for Health Protection is studying illnesses in several residents that arose after they received the H1N1 influenza vaccine, the region's government said Tuesday. The cases include a 34-year-old man who experienced double vision, a 28-year-old pregnant woman whose fetus died, and paralysis in a 75-year-old woman and an 80-year-old man. The government was careful to say there are cases of paralysis and stillbirth in the territory every year.

WHO to decide whether to stand down pandemic alert The pandemic emergency committee of the World Health Organization (WHO) will announce Wednesday whether it plans to step down from its 9-month-old phase 6 pandemic alert. The committee was scheduled to reconsider the pandemic declaration in a confidential teleconference that was to be held today. By WHO protocol, any public announcement will be delayed until director-general Dr. Margaret Chan informs the 193 member states of the decision. [Feb 23 Agence France-Presse story]

Possibility of H1N1 third wave depends on many factors Scientists on the alert for a possible third wave of H1N1 flu are evaluating the influence of many factors that could affect the virus's resurgence, the Washington Post reported today. They include how much of the population--particularly schoolchildren--is already immune, whether uninfected people are gathering in close quarters, and how much the virus is affected by winter temperatures and humidity. Even without a third wave, a variant of pandemic H1N1 is likely to circulate for years. [Feb 23 Washington Post story]

Study: Seasonal vaccines would not have slowed H1N1 A ferret study suggests seasonal flu vaccines would not have contained novel H1N1, which emerged at the end of the 2008-09 flu season, but veterinary vaccines might have limited spread in pigs. A Canadian team administered two 2008-09 seasonal formulas, a veterinary vaccine and a newly developed H1N1 vaccine to ferrets, then infected the animals with a virulent strain of novel H1N1. The swine and H1N1 vaccines were at least partially protective, but the H1N1 would have required a second dose. [Feb 19 Journal of Infectious Diseases abstract]

Feb 22, 2010

Blacks overrepresented in Virginia flu deaths About 30% of the 36 people who have died of H1N1 flu in Virginia were African-American, though African-Americans make up only 20% of the state population, Virginia Health Commissioner Karen Remley told the Richmond Times-Dispatch. She said Centers for Disease Control and Prevention (CDC) officials have speculated that higher rates of diabetes and asthma may help explain the increased rate of severe H1N1 cases in African-Americans. [Feb 20 Times-Dispatch story]

South Korea opens vaccine to all Pandemic H1N1 flu vaccine is now available to everyone in South Korea, including foreigners, not just to high-risk groups, the Ministry of Health, Welfare and Family Affairs announced today, according to Arirang News. The ministry urged vaccinations, saying that about 500 daily H1N1 cases are being reported, although the number has been on the decline. [Feb 22 Arirang News story]

No flu yet reported at Olympics So far pandemic flu--as well as seasonal flu--has been held not only off the podium but entirely away from the Vancouver Olympic Games, according to the Canadian Press. Last week the British Columbia provincial laboratory didn't find a single influenza virus in samples it tested. "Boy, so far we are lucky," said Dr. Jack Taunton, chief medical officer for the Olympics. February often brings the peak of flu season.

Lab study shows 3-antiviral combo effective Researchers found that a combination of the antiviral drugs amantadine, ribavirin, and oseltamivir was effective against drug-resistant seasonal and novel H1N1 influenza. In testing in canine kidney cells, the authors found "that the triple combination was highly synergistic against drug-resistant viruses, and the synergy of the triple combination was significantly greater than the synergy of any double combination." [Feb 22 PLoS One study]

ACIP to set vaccine guidelines for next season The CDC's Advisory Committee for Immunization Practices (ACIP) will meet Feb 24 and 25 to discuss which groups should get flu shots for next season, along with other immunization issues. Among other things, the committee will consider whether to recommend that older people receive a high-dose flu vaccine that was recently licensed by the Food and Drug Administration, according to the meeting agenda. The 2010-11 flu vaccine is expected to include the pandemic H1N1 virus.

Feb 19, 2010

Colleges see slight dip in flu cases Reports of flu-like illnesses at college campuses for the week ending Feb 12 dropped by 7%, a decrease that the American College Health Association (ACHA) says doesn't reflect a significant change, consistent with the bigger national pattern. The attack rate at the nation's colleges was 2.7 cases per 10,000 students. No new hospitalizations or deaths were reported. The group said 85% of campuses have pandemic vaccine, but student uptake remains low, at about 8%. [Feb 19 ACHA surveillance report]

Influenza B activity up in China, Hong Kong The World Health Organization (WHO) said today though pandemic activity hasn't changed much, influenza B now accounts for 82% of flu virus detections in China and nearly 35% in Hong Kong. Several countries in West Africa are reporting increasing pandemic flu cases, but the WHO said the uptick doesn't yet appear to reflect widespread transmission. Some countries, such as Thailand and Jamaica, are reporting increases in respiratory diseases, though the WHO said some may be other diseases. [Feb 19 WHO update]

EU authority approves Sanofi pandemic vaccine Sanofi today announced that Europe's drug regulatory agency has approved its adjuvanted pandemic H1N1 vaccine. The approval clears the vaccine for use in people age 6 months and older. Sanofi's vaccine contains its AF03 adjuvant. Clinical trials showed a single 3.8-mcg dose of the vaccine was safe and effective in all age-groups. The vaccine is manufactured in Sanofi's Val de Reuil, France, facility and is the fifth novel H1N1 vaccine that European regulators have cleared.

Czech Republic cancels 30% of vaccine order Because of low demand, the Czech Republic is reducing its H1N1 vaccine order with GlaxoSmithKline from 1 million doses to 700,000, its health minister told the Associated Press (AP) today. Health Minister Dana Juraskova said only about 64,000 citizens have decided to get vaccinated. [Feb 19 AP story]

Feb 18, 2010

Report details outbreak on Navy ship An article today in Morbidity and Mortality Weekly Report (MMWR) describes an outbreak of confirmed novel H1N1 that started aboard a Peruvian Navy ship last June and affected 78 of 355 crew members after the ship had docked in San Francisco. No serious complications or deaths occurred, and lower-ranking crew had a higher incidence. Six patients with preexisting conditions received antivirals. A surveillance program implemented before the ship departed from Peru permitted early detection. [Feb 19 MMWR report]

Study: Tamiflu works well in very ill patients A study determined that oseltamivir (Tamiflu) was well absorbed in critically ill intensive-care patients with suspected or confirmed pandemic H1N1 flu. The study, of 41 patients who needed ventilator support, appeared in the Canadian Medical Association Journal (CMAJ). A standard dosage of 75 mg twice daily achieved bloodstream levels of the drug that were comparable to those in other patients and were far in excess of concentrations required to be effective against the virus. [Feb 16 CMAJ study]

Planner's ordeal highlights toll on kids A pandemic preparedness expert's ordeal with novel H1N1 flu in her own kids highlights the pandemic's toll on children, according to USA Today. Her daughters' conditions--one has autism and epilepsy and one has asthma--increased treatment difficulty. And her expertise intensified her worry. "I knew what was happening medically. I've read the autopsy reports. Seeing those was scary," she says. The girl with asthma, who is 13, may take months to recover. The other girl, 10, has recovered. [Feb 17 USA Today story]

Feb 17, 2010

H1N1 vaccine lifts CSL profits Australian vaccine manufacturer CSL Ltd. posted higher-than-expected profits for the second half of 2009, largely due to sales of H1N1 vaccine, Bloomberg News reported. The company's net income was $617.4 million in Australian dollars, above analyst estimates that averaged $530 million. In the 6-month period, CSL earned $160 million just on H1N1 vaccine. Cancellations of some orders did not affect today's numbers, the company said.

South Africa schedules flu-shot campaign The government of South Africa will launch a national flu-vaccination campaign Mar 15, to ensure maximum immunity before the start of the 2010 FIFA World Cup in June. The South African Press Association (SAPA) reported that the country will use a total of 4.8 million doses in two rounds beginning March 15 and May 3. Both rounds will be aimed primarily at front-line healthcare personnel and high-risk groups, including children and pregnant women.

Maine offers vaccine at sports tournament Capitalizing on the crowds expected to attend a statewide basketball tournament, Maine's public health department will offer both H1N1 and seasonal flu shots this week. The state's Center for Disease Control and Prevention said it will stage daytime and evening clinics at the basketball tournament of the Maine Principals' Association, which includes all public and some private high schools in the state.

Chile buys H1N1 vaccine for southern flu season The health ministry of Chile announced it has purchased 2 million doses of H1N1 flu vaccine in anticipation of the start of the Southern Hemisphere's flu season, adding to 500,000 the government already has on hand. The Latin American Herald Tribune reported the shots will be used for healthcare workers, chronic-illness patients, pregnant women, and children younger than 2. Those over 60 will not be eligible for government shot campaigns but can obtain the shots through private providers. [Feb 17 Latin American Herald Tribune story]

Feb 16, 2010

College flu data show uptick Data collected by the American College Health Association (ACHA) between Jan 30 and Feb 5 show an uptick in new cases of influenza-like illness. Out of 182 colleges and universities sampled by the association, 58% reported new cases, compared with 55% the previous week, for a national attack rate of 2.9 cases per 10,000 students, 12% higher than a week earlier. There have been more than 90,000 cases among more than 2 million students, the association said. About 11% of students were immunized. [Feb 16 ACHA surveillance summary]

Hospitals reporting little seasonal flu Although pandemic H1N1 flu is now mainly quiet, seasonal flu has not taken off, either, according to a story today in the San Francisco Chronicle. Seasonal flu typically peaks about this time of year, but doctors and healthcare centers are reporting levels of flu well below normal, possibly because of widespread novel H1N1 earlier. One doctor who commented on this unusual flu season said, "It certainly isn't out of the question that seasonal flu could still show up." [Feb 16 Chronicle article]

Mobile, social media help track H1N1 flu More than 100 iPhone applications related to H1N1 flu have been launched since the pandemic began, the Associated Press (AP) reported. The apps encourage two-way communication among civilians and between health authorities and the public and may permanently have changed methods of communication in crises. Outbreaks Near Me, an app linked to the Web-based disease alert service HealthMap, has been downloaded more than 100,000 times.

South Dakota reports good vaccine coverage Almost half of South Dakotans have either received the H1N1 flu vaccine or had pandemic flu, which might be enough to prevent further spread, state officials told the AP yesterday. State epidemiologist Lon Kightlinger says the virus has "flat-lined" in the state, though he warned it could yet return. The officials continue to urge people to get vaccinated. [Feb 15 AP story]

South Korea shares hand sanitizer with North South Korea will donate 200,000 liters of hand sanitizer, worth $866,000, to North Korea in an unusual cross-border humanitarian mission, the Korea Herald reported today. The action comes two months after South Korea donated $15 million worth of flu antivirals to North Korea, the first time in two years the closed northern nation allowed such a humanitarian exchange. [Feb 16 Korea Herald story]

Feb 15, 2010

H1N1 rapid tests most sensitive in young children A prospective study of the accuracy of rapid diagnostic tests for H1N1 influenza has found that the test returns more accurate results for children and teenagers than it previously has for adults. The study among 820 children treated at Toronto's Hospital for Sick Children found that the test was sensitive to H1N1 flu for 62% of the children tested and was most sensitive in children who were younger than 5 or whose symptoms had begun less than 2 days earlier. [Feb 15 Pediatrics early-release article]

Production delay stalls vaccine delivery to Nepal Deliveries of donated pandemic H1N1 vaccine for Nepal have been delayed by about a month because of production problems at the company that pledged the vaccine, a World Health Organization (WHO) official told the Himalayan Times. He projected that Nepal would receive vaccine by the first week of March. The health ministry has prioritized healthcare workers and their dependents, pregnant women, people with underlying medical conditions, young children, and seniors to receive the vaccine.

Polish government feuds over flu shots Disputes within the government of Poland over its health ministry's refusal to purchase H1N1 flu vaccine have broken into the open with a threat by the government's ombudsman to sue the health minister, BBC News reported. The ministry declined to buy the shots because of fears of side effects; the ombudsman, who caught the flu himself, contends that decision put the country's citizens at risk. Poland has recorded 172 swine flu deaths. [Feb 12 BBC News story]

Virologist decries India's lack of H1N1 data An Indian virologist says it is "shameful" that no epidemiologic analysis of India's H1N1 epidemic has been published. Writing in Current Science, Shahid Jameel of the International Centre for Genetic Engineering and Biotechnology in New Delhi said it is not known why India's H1N1 mortality rate is three to four times the global average. He said more information is needed for targeting of a vaccine that India expects to deploy this summer. The country has had 1,152 deaths, he said.

Feb 12, 2010

Canada compares impacts of H1N1 and seasonal flu The Canadian Institute for Health Information says that 8,507 Canadians were hospitalized with H1N1 flu from April 2009 through January, compared with 2,614 hospitalized for seasonal flu in 2007-08, the Toronto Globe and Mail reported. The median age of hospitalized H1N1 patients was 28 and the median for fatalities was 53; the corresponding ages for seasonal flu patients were 71 and 83. One in six H1N1 hospital patients needed intensive care, versus 1 in 7 seasonal flu hospital patients. [Globe and Mail report]

WHO says influenza B rising in China Though Senegal is the third West African country in the last month to confirm pandemic flu, it's too soon to say if widespread transmission is starting in the region, the World Health Organization (WHO) said today. Flu activity is declining or sporadic in most parts of the world, with other respiratory illnesses increasing in Eastern Europe and Guatemala. Pandemic H1N1 is the dominant flu strain, but seasonal influenza B viruses accounted for 72% of all flu viruses analyzed last week in China. [Feb 12 WHO update]

CDC reports on pandemic's impact on Hispanics The US Centers for Disease Control and Prevention (CDC) has posted an online question-and-answer report on H1N1 and seasonal flu in Hispanic communities. The report notes that H1N1 vaccination rates have been lower in Hispanics than in non-Hispanic whites. It reports on the impact of the pandemic on Hispanics, describes barriers to H1N1 and seasonal flu vaccination, and outlines possible strategies for improving health and vaccine uptake among Hispanics. [CDC information on H1N1 and Hispanics]

Health officials try luck with casino vaccine clinics In an effort to offer the pandemic flu vaccine where people congregate, health officials in Carson City, Nev., are immunizing people at area casinos, the Carson Valley Record-Courier reported. A casino clinic on Feb 6 immunized 174 people, and other similar events are scheduled. Health department spokeswoman Pam Graber said earlier in the outbreak people were more likely to come to vaccination locations, but now that the holidays have passed it's easier to bring the shots to the people. [Feb 12 Record-Courier story]

Singapore lowers pandemic alert level Singapore's health ministry today announced that it was lowering its pandemic H1N1 flu alert from yellow to green, Channel NewsAsia reported. The country raised the alert to yellow and then orange in late April but moved back to yellow in May. Doctor's visits for respiratory infection have been below baseline since August. The ministry vowed to continue monitoring the disease but said dialing back the level will make it easier for people to visit hospitals and nursing homes. [Feb 12 Channel NewsAsia report]

Feb 11, 2010

Pandemic virus may have interfered with RSV Writing in Eurosurveillance, French researchers report that respiratory syncytial virus (RSV) circulation in France in late 2009 was reduced and delayed compared with a year earlier, and that this might be explained in part by H1N1 flu. "The influenza pandemic wave of 2009 seems to have partially overcome the RSV epidemic," they write. Viral interference and/or increased hygiene measures in response to H1N1 might have affected RSV activity, they suggest. [Feb 11 Eurosurveillance report]

School outbreaks reported in Minnesota While flu activity in Minnesota remained low last week, two schools reported flu-like illness outbreaks, the Minnesota Department of Health (MDH) reported yesterday. Also, a story in the Minneapolis Star Tribune noted that seasonal flu viruses have been almost absent this winter and said experts are increasingly confident that pandemic H1N1 will be the only virus around for the rest of the winter. The experts also said the pandemic virus is likely to continue to predominate next fall. [Feb 10 MDH weekly flu report]

T-shirts, sign-twirlers used to promote vaccination The Mississippi Department of Health is providing free "Fast Lane" H1N1 flu vaccination clinics throughout the state today and tomorrow, with vaccinees getting free T-shirts. Meanwhile, Riverside County officials in California have posted dancing sign-twirlers at H1N1 vaccination clinics to lure passersby, the Riverside Press-Enterprise reported. And health workers in Morrow County, Ore., offered H1N1 shots at a highway rest stop near Boardman yesterday, the Oregonian reported. [Feb 11 Mississippi news release]

Feb 10, 2010

CDC releases pandemic guide for primary care The Centers for Disease Control and Prevention (CDC) released a planning template for primary care medical practices that may have to cope with increased numbers of patient visits and calls during an influenza pandemic. The template's guidelines for maintaining communication, planning for surges of patients, and keeping offices functioning were based on recommendations from healthcare and public health workers brought together by the CDC in August. [Feb 10 CDC document]

Queensland schedules high school vaccinations The government of Queensland will administer free H1N1 flu vaccinations in high schools throughout the Australian state, offering the shot to students and also to their families, the Australian Broadcasting Corp. (ABC) reported Wednesday. The clinics are in anticipation of Australia's winter flu season and in acknowledgement of "disappointingly low" vaccine acceptance by 13% of the state's population. [Feb 10 ABC News report]

Study shows low flu complications in pregnant women Pregnant women treated at a major hospital center in Singapore experienced a low rate of serious illness from H1N1 flu, with 9 of 211 developing pregnancy complications and 2 developing pneumonia. None died. The authors of a medical journal article say the group is the largest cohort of pregnant women with H1N1 yet studied. The authors say early diagnosis and treatment was essential: The women's median time between developing symptoms and seeking help and being put on antivirals was 2 days. [Feb 10 BJOG press release]

Qatar latest state to cancel vaccine order The government of Qatar intends to turn back 40% of the 1.5 million doses of H1N1 vaccine it ordered because it considers the shots no longer needed, the online publication TradeArabia reported. It quoted representatives of the Supreme Council of Health saying that 1.5 million doses were ordered and 500,000 delivered, but only 40,000 people have been vaccinated, including 21,000 children. The council hopes to cancel orders for 620,000 of the remaining 1 million doses. [Feb 10 TradeArabia.com report]

Feb 9, 2010

Senegal reports cases after religious festival The health minister of Senegal confirmed that the country has experienced 14 cases of pandemic H1N1 flu after a religious festival, according to an Africa News story today. The first cases were detected in the religious city of Touba and in nearby Diourbel, in central Senegal. Hundreds of thousands of members of the Mouride Muslim Brotherhood gathered in these cities last week to commemorate a religious event. The health minister said the country has the resources to deal with pandemic flu. [Feb 9 Africa News story]

Israel cancels remaining vaccine order Because only a tenth of Israel's population has been vaccinated against pandemic flu, the country has canceled orders for its remaining H1N1 vaccine after receiving 4.6 million doses, according to a Jerusalem Post story today. The original order was for 7.3 million doses, but only 700,000 doses have been used. [Feb 9 Jerusalem Post article]

Controversy forces delay of Romanian vaccinations Romanian authorities have delayed the launch of their H1N1 vaccination campaign by at least a month amid concern about the procedures used in testing the vaccine in children, according to WAZ.EUobserver.com, which reports on relations between the European Union and countries in southeastern Europe. The controversy started when a Romanian newspaper reported that parents were being paid to allow their children to receive the vaccine, which has not been approved by the European Medicines Agency.

NBA team removed water fountains to fight flu The Cleveland Cavaliers basketball team removed all the water fountains from its arena in November to fight pandemic flu and other diseases, the Associated Press reported. Team spokesman Tad Carper said the decision was based on information from qualified sources, which he did not name. Matt Carroll, director of Cleveland's health department, said he was not aware of any evidence that water fountains help spread H1N1. Thirsty fans can get free cups of water at concession stands, said Carper. [Feb 8 AP report]

Feb 8, 2010

California data show H1N1 vaccine safe Statistics gathered by the California Department of Public Health show only three deaths among 13 million state residents who received H1N1 flu vaccine, USA Today reported. One person had preexisting flu and bacterial infections and one was a cardiac patient whose death was caused by cardiovascular disease. The cause of the third person's death is still being evaluated, state officials told the paper. [Feb 8 USA Today story]

Parents still worry about vaccine safety Parental concern about pandemic vaccine safety, despite the vaccine's good record, is still an obstacle to immunization, according to a survey released today by the University of Michigan. While about half (55%) of parents worried about their children getting the flu, more (65%) worried about vaccine safety. Pandemic H1N1 has been more deadly for children than seasonal flu, but pollsters said parents may not fully grasp potential illness severity. The January poll included 1,612 parents. [Feb 8 University of Michigan vaccine poll]

Algeria seeks sharp cut in H1N1 vaccine order The government of Algeria hopes to cancel three fourths of its order for 20 million doses of H1N1 vaccine, Agence France-Presse reported. The chief pandemic-flu official in the country's health ministry said Algeria has received 2.5 million doses already but has faced low acceptance of the vaccine, especially among healthcare workers. Algeria has seen 808 confirmed cases and 54 deaths.

Australian officials urge vaccination for children The government of New South Wales says now is the ideal time for young children to be vaccinated against H1N1 flu, as the date for their return to day care or school approaches, the Australian Associated Press reported. Health officials expect Australia's second wave of H1N1 in the next few months, and this time, unlike in the first wave, there is vaccine available. Kerry Chant, chief health officer for New South Wales, said H1N1 is likely to be the dominant flu strain in Australia this year. [Feb 8 AAP story]

Respiratory disease increasing in Haitian camps Respiratory disease is increasing in Haiti's refugee camps, though there has been no formal evaluation or lab confirmation of H1N1 flu, according to a report from the Global Health Cluster, a coalition of humanitarian groups working with the World Health Organization. The report, carried by ProMED-mail, says no vaccination efforts have been launched. With rains expected in March, the potential for flu outbreaks in the camps is moderate, the report states.

Feb 5, 2010

WHO: Most regions show declining H1N1 activity Although pandemic flu activity continues to decline or remain low in most of the Northern Hemisphere, some areas of the world are experiencing active but declining transmission, particularly North Africa and some areas of Eastern Europe and East Asia, the World Health Organization said today (WHO) today. Global H1N1 deaths have risen by several hundred from a week ago, to at least 15,174. China continues to report relatively high levels of influenza B. [Feb 5 WHO update]

Europe notes high H1N1 death rate in kids Pandemic flu raised the death rate in European children last year but not adults, according to a study in Eurosurveillance. Children aged 5 to 14 years in eight countries had a 28% higher death rate than expected, in contrast to mortality in all age-groups, which was lower than in a typical year from seasonal flu. The higher death rate in children amounts to about 77 additional deaths in that age-group. The researchers called their estimates "conservative." [Feb 4 Eurosurveill report]

Northern Vietnam reports outbreak An outbreak of H1N1 has affected the northern Vietnamese province of Bac Kan, health officials said in a VietNamNet story today. Eighteen people recently contracted pandemic flu, said health official Dr. Nguyen Huy Nga. The patients have shown typical symptoms, he said, including fever, cough, sore throat, and muscle pain.

H1N1 patient experienced quadriplegia A letter in Emerging Infectious Diseases outlines the case of a Thai patient with pandemic flu who developed acute respiratory distress followed by severe neurologic problems, including quadriplegia. Physicians ruled out Guillian-Barre syndrome, and the patient later regained muscle strength. Last May four Dallas children experienced pandemic-H1N1-related neurologic symptoms. [Feb 4 Emerg Infect Dis letter]

Feb 4, 2010

Study: Rhinovirus may have stalled H1N1 Rhinovirus may have edged out pandemic flu in France this fall, delaying the start of the fall pandemic wave compared with other European countries, according to a study in Clinical Microbiology and Infection. Researchers analyzed novel H1N1 and rhinovirus samples from a pediatric hospital from weeks 36 to 48 of the flu season and found an inverse relationship between rhinovirus and pandemic flu detections. They wrote that rhinovirus infections may interfere with flu transmission. [Jan 28 Clin Microbiol Infect study]

Artificial insemination may spread flu in turkeys The pandemic H1N1 virus can infect turkeys when sick workers artificially inseminate the birds, leading to a drop in egg production, according to a study in Virology Journal. Researchers have been unable to reproduce infections in turkeys through standard routes, but the new report details how the virus transmits during intrauterine inoculation. The finding suggests that protective measures during artificial insemination may help poultry farms prevent disease outbreaks. [Feb 3 Virol J study]

Hungary shutters H1N1 vaccine clinics Hungary's health minister announced yesterday the closure of pandemic H1N1 vaccination centers, Xinhua reported. The country said it will reopen them if public demand rises, and the vaccine will still be available elsewhere. The centers delivered about 92,000 doses, and the total number of vaccinated Hungarians so far is 3 million, about a third of the population. The health minister said doctor's visits for flulike illnesses had increased slightly compared with the past 2 weeks. [Feb 3 Xinhua story]

Gorillas get pandemic flu vaccine Six Western Lowland gorillas at Boston's Franklin Park Zoo received the human H1N1 vaccine yesterday, the Boston Globe reported. The zoo usually immunizes the gorillas against seasonal flu each fall, but they will receive those doses next week. Area hospitals donated the vaccine. The zoo's director of veterinary services said gorillas are susceptible to human diseases and are often protected with human vaccines. [Feb 4 Boston Globe story]

Feb 3, 2010

Flu activity up slightly at some US colleges Flu activity was up a bit at colleges last week, though the levels haven't changed significantly over the past 6 weeks, consistent with the decreasing national trend, the American College Health Association (ACHA) said today in its latest update. The attack rate was 2.6 per 10,000 students, about 15% higher than the previous week. No new deaths or hospitalizations were reported. Overall vaccine uptake remained at 9%, but rates were as high as 40% in some states. [ACHA report for the week ending Jan 29]

New Zealand begins H1N1 vaccination New Zealand, which saw some of the earliest deaths from H1N1 influenza during its 2009 winter flu season, has received its first doses of H1N1 vaccine and is scheduling a national shot campaign. The first recipients of the 1 million doses will be health workers, pregnant women, young children, and the chronically ill. The Southern Hemisphere country is concerned that the virus may return from the Northern Hemisphere and trigger an earlier than usual flu season. [Feb 3 ONE News report]

Immunoglobulin deficiency may predict flu outcome Australian researchers say they have identified an immune-system protein that may play a key role in determining the severity of H1N1 flu infection. Among patients hospitalized with H1N1 flu, there was a correlation between severity of symptoms and deficiency in immunoglobulin G2, which supports early response to infection. The authors say that may explain the seriousness of H1N1 flu in pregnant women, because pregnancy mutes immune responses, and may point to a predictive test or treatment. [Feb 1 Clinical Infectious Diseases abstract]

Czech Republic health chief contracts flu Michael Vit, chief health officer of the Czech Republic, told media in that country that he is home sick with a flu infection that is presumed to be H1N1 influenza, according to Reuters. Vit oversaw flu vaccinations for key members of the government but missed his own because of an overseas trip, the news service said. Vit's ministry led recently abandoned plans for mandatory vaccination of the Czech armed forces.

CDC warns about flu at Vancouver Olympics With the 2010 Olympic Winter Games set to begin in Vancouver, the US Centers for Disease Control and Prevention has issued a set of travel tips it calls "Stop, wash and go." The agency recommends that attendees receive H1N1 flu vaccine before leaving, delay their departures if they feel unwell, cover coughs and sneezes, and wash their hands frequently. It also suggests taking a travel health kit containing hand sanitizer, tissues, and pain and fever medications. [Feb 2 CDC travel advice]

Feb 2, 2010

Poor nations not receiving vaccine Though many nations have surplus H1N1 vaccine, much of it is not getting to developing nations, according to a New York Times story. So far, only two countries, Azerbaijan and Mongolia, have received vaccine. Afghanistan is slated to be next. About a month ago, the World Health Organization said it hoped to have shipped vaccine to 14 countries by now, of 95 nations that need it. Some of these countries are still experiencing significant pandemic cases and deaths. [Feb 1 New York Times article]

Summer camp containment efforts worked A program of hand hygiene, surface cleaning, and targeted antiviral treatment contained H1N1 flu at a boys' summer camp in July 2009, says a new journal article. The program was launched after 12 boys attending the third camp session contracted flu. During the fourth 2-week session, only 3 of 171 campers tested positive for flu, an attack rate of 1.8%, far lower than cited at other summer camps. However, 57% of staff and 31% of campers who took an antiviral reported side effects. [Feb 1 Arch Pediatr Adolesc Med report]

Study: H1N1 can affect conjunctiva Researchers in Hong Kong have found evidence that, although the pandemic H1N1 flu virus and seasonal flu viruses cause several comparable responses in the body, pandemic H1N1 has the distinct ability to replicate in the conjunctiva. The findings, published in the American Journal of Pathology, suggest subtle differences in H1N1's receptor-binding profile in human hosts and demonstrate an additional route of infection.

Ontario probing illness in 17 vaccinees Ontario's health ministry is investigating 17 serious illnesses that occurred after people received H1N1 flu vaccine, the Toronto Sun reported today. There were four cases of Guillain-Barre syndrome (GBS) and 13 anaphylactic reactions. Two GBS cases were in adults who received the vaccine from the same physician's office in Markham, Ont., the report said. GlaxoSmithKline recalled 170,000 doses of vaccine in Canada in November because allergic reactions were more common than expected. [Feb 2 Toronto Sun report]

UK to end pandemic hotline Feb 11 Because of waning flu activity, Britain's hotline for pandemic flu diagnosis and antiviral prescriptions will be shut down on Feb 11, Chief Medical Officer Sir Liam Donaldson announced in a letter to physicians. Donaldson said the service eased pressure on primary care physicians at the height of the pandemic, but flu-like illnesses and confirmed H1N1 cases now are less than half what they were before the service was launched. The service can be restored in 7 days if needed, he said. [Donaldson letter]

Feb 1, 2010

Household cleaners effective against H1N1 A PLoS One study today showed that common household cleaners like 1% bleach, 10% malt vinegar, and an all-purpose cleaner rapidly and completely inactivated a strain of seasonal H1N1 influenza. Also, antiviral and antibacterial wipes reduced virus infectivity. The authors conclude that, for pandemic H1N1, "The public does not need to source specialized cleaning products, but can rapidly disinfect potentially contaminated surfaces with agents readily available in most homes." [Feb 1 PLoS One study]

Some more likely to heed pandemic messages People most likely to take protective measures during a pandemic are more likely to be older, female, well-educated, and non-white, according to a review in the British Journal of Health Psychology. In examining 26 papers that varied by quality, researchers found that those responding to messages were likely to believe they were susceptible, that the disease was severe, and that measures were effective. Increased anxiety and trust in authorities were also linked to adoption.

Study cites good vaccine uptake in homeless In a PLoS Currents study, French researchers reported being able to vaccinate almost half of the occupants of a homeless shelter against pandemic flu. After giving 3 days' notice of the vaccine effort, health personnel administered H1N1 flu shots to 117 of the shelter's 249 residents (47%). That compares with vaccine uptake of 6% in the country's general population and 37% in its healthcare workers. Also, 96% of the homeless people vaccinated knew of the shot's benefits. [PLoS Currents study]

Taiwan takes vaccine to airports, homes To boost pandemic vaccination rates, health officials in Taiwan have unveiled two new tactics, immunization at airports and in homes, the Hong Kong Standard reported today. Four airports will offer the vaccines to citizens entering Taiwan. Home-based vaccinations are available to groups of at least 10 people in communities, companies, or institutions who make a reservation with the local health department. Vaccine safety concerns have slowed vaccine uptake, though 24% have received it. [Feb 1 Standard story]

Jan 29, 2010

H1N1 still active in some global regions Although pandemic flu has declined in most of the Northern Hemisphere, transmission remains active in some regions of North Africa, eastern and southeastern Europe, and South and East Asia, the World Health Organization (WHO) reported today. Global H1N1 deaths now total at least 14,711. Novel H1N1 remains dominant in most nations, according to a separate WHO update, but in China 49% of flu isolates are the seasonal B strain. Other countries are detecting some seasonal flu, too. [Jan 29 WHO weekly update]

US flu activity stayed low last week H1N1 flu activity stayed at about the same low level last week as the week before, the Centers for Disease Control and Prevention (CDC) said today. No states had widespread cases; five had regional activity. Five flu-related deaths in children were reported. The share of medical visits ascribed to flu-like illness was 1.7%, below the national baseline of 2.3%, but the fraction of deaths due to flu and pneumonia remained above the epidemic threshold. All but two tested viruses were novel H1N1. [Jan 29 CDC weekly flu update]

Flu down, vaccine availability up at colleges Flu activity at US colleges declined again after leveling off the previous week, the American College Health Association (ACHA) reported. The attack rate was 2.3 per 10,000 students. Though the number of vaccinated students was around 9%, the ACHA reports some encouraging signs. Some institutions are reporting vaccine uptake rates exceeding 25% to 30%. Vaccine availability has improved, with 86% of campuses reporting that they have it. [ACHA report for week ending Jan 22]

Vaccine from 1918, 1976 strains may fend off novel H1N1 In an experiment to learn more about pre-existing immunity, researchers found that mice vaccinated with 1918-like and classical (from 1976) swine flu vaccines had complete protection against pandemic H1N1, according to a study in PLoS Pathogens. In contrast, vaccines based on more recent seasonal H1N1 strains afforded only partial protection. The authors say their findings underscore the importance of having people under age 35 receive the pandemic vaccine. [Jan 29 PLoS Pathog article]

China denies vaccine-miscarriage link China's government denied a link between H1N1 vaccine and miscarriages after an official said "several" miscarriages occurred among 10,000 pregnant women who had been immunized, Agence France-Presse (AFP) reported today. The official added the miscarriages were coincidental and that most were seen in women in their first trimester. He emphasized that global experience so far shows the vaccine is safe and effective in pregnant women, who are at high risk for flu complications. [Jan 29 AFP story]

Jan 28, 2010

Pandemic hasn't spared nursing homes Though older people appear to have some immunity to the pandemic virus, the US Centers for Disease Control and Prevention learned of several outbreaks at nursing homes, detailing three in Morbidity and Mortality Weekly Report (MMWR). They occurred during the fall before the vaccine was widely available, and infections in healthcare workers were documented at two of the facilities. Infection control steps and antiviral prophylaxis seemed to slow flu spread. [Jan 29 MMWR report]

New Mexico lists hospitalization, death rates The New Mexico Department of Health says the state's H1N1 hospitalization rate is highest in children under 5 and the death rate is highest in people aged 50 to 64. The overall H1N1 hospitalization rate is 50.3 per 100,000, but the rate for children under 5 is 135.5, twice the national estimate. The overall state death rate is 2.6 per 100,000, but the rate is 5.3 for 50- to 64-year-olds and 3.1 for those 65 and older. Children under 5 and adults 25 to 49 had a death rate of 2 per 100,000.

Some on antiviral therapy still test positive In a study by French researchers in Emerging Infectious Diseases, of 16 H1N1-flu-confirmed patients treated with the antiviral drug oseltamivir (Tamiflu), only 9 (56%) tested negative for H1N1 flu within 3 day of treatment, while 3 (19%) still tested positive more than 5 days after treatment. The authors conclude, "These data raise questions about potential virus transmission during antiviral treatment and the possible resistance of pandemic (H1N1) 2009 to oseltamivir." [Feb Emerg Infect Dis study]

Canada to give 5 million vaccine doses to WHO Canada announced today it will give 5 million doses of H1N1 vaccine and $6 million to the World Health Organization to combat the pandemic in developing countries. The doses amount to 10% of Canada's total vaccine order, a donation in line with those from other developed countries, the government said. Health Minister Leona Aglukkaq said Canada can donate vaccine because it has met its own immediate needs. [Jan 28 Public Health Agency of Canada release]

Hong Kong hangs on to its vaccine Hong Kong has no plans to sell or donate its remaining doses of H1N1 vaccine, Secretary for Food and Health Dr York Chow said today, according to the country's news.gov.hk site. Noting that Hong Kong's stockpiled vaccines will expire in October, Chow encouraged people in five high-risk groups to get vaccinated.

Shoppers bag free flu shots Aiming to put flu vaccine in the paths of shoppers, the Children's Hospitals and Clinics of Minnesota teamed up with Kohl's stores today to offer free pandemic and seasonal flu vaccines to adults and children outside two Twin Cities malls. A grant from Kohl's is covering the administration cost. Federal officials have urged providers to make it easy for people to get vaccinated.

Jan 27, 2010

Two Memphis-area kids die of H1N1 Two Memphis, Tenn.-area children died in the past week of H1N1 flu, according to local officials. The Memphis and Shelby County Health Department (MSCHD) today confirmed that a 12-year-old child died from H1N1 infection, and last week a teen from nearby DeSoto County, Mississippi, died of the disease, according to a news release today. The 12-year-old's death is the seventh confirmed H1N1 death in Shelby County. Officials are reminding people to get vaccinated.

South Africa aims to vaccinate 3 million South Africa hopes to vaccinate 3 million people against pandemic flu by winter, the South African Press Association (SAPA) reported today. The country's health minister said South Africa has 1.3 million doses and is seeking funding for more. Priority groups will include pregnant women, healthcare workers, some people at border stations, and young people who are at high risk for complications.

Serbia, Japan look to cut vaccine orders Serbia's health ministry said it is cancelling further orders of pandemic vaccine from Novartis, Balkan Insight news reported today. The country had originally ordered 3 million doses and has administered 160,000 doses of the 857,500 it had already received. Serbia said it needs 300,000 doses in reserve in case of another flu wave. Meanwhile, Japan signaled that it may cancel some of the 99 million doses of vaccine it ordered from Glaxo and Novartis, Kyodo News reported.

Southeast Asian officials confer on vaccine, antivirals Health officials from the Association of Southeast Asian Nations (ASEAN) plus three countries gathered today in Singapore to open a 3-day meeting on antiviral drugs and pandemic flu vaccines. The conference, supported by the Australian Agency for International Development, will update members on drug and vaccine supplies, provide a forum for discussing issues such as access and technology transfer, and discuss how the nations can share resources, according to an ASEAN statement. [Jan 27 ASEAN statement]

Czech president opposes mandatory military vaccination The president of the Czech Republic, Vaclav Klaus, said he opposes mandatory H1N1 flu vaccinations for the country's military forces, the Associated Press reported today. Klaus said he considers the order from the Czech chief of general staff to "highly controversial, if not unacceptable" because of possible risks of vaccination. In a statement, Defense Minister Martin Bartak said the number of soldiers in the program would be reduced but gave no details. [Jan 27 AP story]

Serbian pigs test positive for H1N1 Pandemic H1N1 flu has been detected on a swine farm near Varvarin, Serbia, according to a report today filed with the World Organization for Animal Health (OIE). Twenty of more than 10,000 pigs on a commercial breeding farm tested positive during routine inspection. Affected animals showed respiratory symptoms, but none have died. The source of the infection is unknown. [Jan 27 OIE report]

Jan 26, 2010

Bahamas receive first H1N1 vaccines After months of delay, the Bahamas has received its first shipment of H1N1 influenza vaccines--just as cases of the pandemic virus trend down in much of the world. The Nassau Guardian reported that the 30,000-dose shipment, purchased through the Pan American Health Organization, arrived Jan 20, 2 months late. The Bahamas has recorded 41 cases of novel H1N1 since the pandemic began.

Bay area commuters offered flu shots Passengers on the East Bay routes of the Bay Area Rapid Transit (BART), the commuter-train line linking San Francisco and Oakland, Calif., will be offered H1N1 vaccinations during this afternoon's commute. The shots, offered in the Oakland BART station, are a collaboration between BART and the Alameda County Health Department, which believes it is the first such offering in the United States. [Jan 26 San Francisco Chronicle story]

Novartis profits rise as it issues warning to nations Swiss pharmaceutical company Novartis today announced an 8% increase in profits from 2008 to 2009, driven largely by sales of H1N1 vaccine, Agence France-Presse (AFP) reported. But during the announcement in Basel, outgoing CEO Daniel Vasella warned that the company could retaliate against governments now trying to cancel flu-shot contracts. Countries reneging on payment for vaccines that have already been delivered will not receive a priority response during the next pandemic, he said. [Jan 26 AFP report on profits]

High rate of H1N1 complications in pregnancy Australian researchers report that, of 43 pregnant women admitted to hospitals with H1N1 flu infection between May and July 2009 in the state of Victoria, Australia, 8 were admitted to intensive care and 1 died. In addition, 2 of the pregnancies were miscarried and 1 child died after birth. Half of the women had no underlying conditions, and three-fourths were given antiviral treatment; one-third of those receiving antivirals began them within 2 days of the start of symptoms. [Jan 25 Clinical Infectious Diseases abstract]

Jan 25, 2010

Kentucky shuts down its H1N1 hotline After receiving about 10,000 calls since it began in October, Kentucky's hotline for questions on pandemic and seasonal influenza has been shut down as demand has waned, the Associated Press (AP) reported. Public health officials say the hotline can be reactivated if needed, but in the meantime those seeking flu-related answers can go to the state's Health Alerts Web site (http://healthalerts.ky.gov).

Hong Kong finds H1N1 vaccine safe for fetuses Despite receiving reports of four recent spontaneous abortions in vaccinated women, Hong Kong has seen no increase in fetal death among women receiving the H1N1 vaccine, according to a press release today from Hong Kong's Centre for Health Protection (CHP). The normal rate of fetal mortality in Hong Kong is 0.3% to 0.5% of total deliveries, compared with a rate so far of 0.2% in pregnant women receiving the vaccine.

Physicians' views on H1N1 vary by country A seven-country survey by the market research firm Synovate found wide differences in physicians' views about the H1N1 pandemic. Only 20% of Chinese doctors agreed that pregnant women should be vaccinated, versus 90% of US doctors. Overall, 51% of the doctors said they had been vaccinated, with a range from 21% in Spain to 76% in Taiwan. Sixty-two percent believed that the vaccine is effective, while 27% were uncertain. The survey focused on Synovate's proprietary physician panel. [Jan 22 Synovate news release]

Tampa health agencies vaccinating homeless people Public health agencies in and around Tampa, Fla., are working with homeless outreach organizations to vaccinate homeless people against H1N1 flu, according to the St. Petersburg (Fla.) Times. With the virus still circulating, the Centers for Disease Control and Prevention has urged communities across the nation to focus attention on the homeless, the story said. [Jan 25 St. Petersburg Times report]

Jan 22, 2010

WHO: Pandemic flu activity holds steady Global flu patterns are about the same as last week, with the most intense activity in North Africa, South Asia, and parts of Eastern Europe, the World Health Organization (WHO) reported today. Novel H1N1 still dominates, but a few countries have detected sporadic seasonal flu cases, especially China, where influenza B cases are increasing. Most of the seasonal H3N2 viruses belong to the Perth-like viruses, included in the Southern Hemisphere's seasonal vaccine, not the Northern Hemisphere's. [Jan 22 WHO update]

Colleges have vaccine, but few students immunized The American College Health Association (ACHA) said yesterday that flu activity on college campuses hasn't changed since its last report for the week ending Dec 18. The attack rate stayed at 2.7 cases per 10,000 students. Though vaccine availability has improved dramatically, with 97% of campuses having supplies, the percentage of vaccinated students is rising very slowly. So far only about 9% of students have been vaccinated, up from 8% in the last report. [ACHA report for week ending Jan 15]

Severe H1N1 illness linked to ethnicity, slow treatment In Manitoba, the Canadian province with the highest burden of severe H1N1 illness, patients who required intensive care unit admission and advanced life support for pandemic flu shared several characteristics, according to a new paper in the Canadian Medical Association Journal (CMAJ). They were more likely to have taken longer to receive antiviral treatment or to have underlying conditions, or to be members of First Nations groups. [Jan 21 CMAJ article abstract]

Ireland to offer workplace vaccination Healthy adults in Ireland will be offered the H1N1 vaccine at their workplaces starting in mid February, the Irish Independent reported today. The nation's Health Service Executive (HSE) will provide the vaccine to employers that have occupational health programs. Workers who can't get the vaccine at work will be offered it at HSE-run clinics, said Pat Doorley, HSE head of population health. He said more than 800,000 people, about 18% of Ireland's population, have been vaccinated so far. [Jan 22 Irish Independent report]

UK health chief urges H1N1 shots The second wave of H1N1 influenza in England is "virtually concluding," Sir Liam Donaldson, Chief Medical Officer, said yesterday, but he warned that anyone who has not been vaccinated will be vulnerable when the virus returns in a future season. Anyone who is eligible for the vaccine but has not taken it should "get the jab and protect themselves," he said in a Department of Health bulletin.

Jan 21, 2010

Pediatric flu deaths triple past 3 season average In an overview of flu activity during the 2009-10 flu season that started Aug 30, the US Centers for Disease Control and Prevention (CDC) said pediatric deaths from the pandemic virus are three times higher than the average for the past three seasons. Flu activity peaked on Oct 24, much earlier than the February peaks of the most recent flu seasons. The CDC pointed out that multiple waves were seen during the three most recent pandemics, emphasizing the importance of vaccination. [Jan 22 MMWR article]

WHO to write response to 'false pandemic' charges In response to a request from India's health secretary, the World Health Organization (WHO) will write formal letters to all countries to clarify the facts about the H1N1 pandemic, to counter charges that the threat was exaggerated, the Indian government said in a statement yesterday. In requesting the WHO action, the Indian official said the reports of a "false pandemic" were hurting public health measures taken by governments. India also asked for more details about vaccine contracts. [Jan 20 Indian government statement]

Massachusetts flu effort targets minority groups Hoping to ease racial disparities in pandemic flu illness, Massachusetts officials said they will target $1 million of its federal funding toward community groups that can help promote vaccination in these groups. The state's public health officials have reported that the disease has taken a heavier illness, hospitalization, and death toll on black, Hispanic, and Asian groups.

Nigeria cites progress in securing vaccine Following the first deaths and illnesses from pandemic H1N1 flu, Nigeria's health ministry said yesterday that it is in advanced talks with theWHO to receive the vaccine, AllAfrica news reported today. The ministry said Nigeria wasn't previously on the WHO's priority list because it had not detected any illnesses but now said the country could receive vaccine doses by February. Nigeria has confirmed two H1N1 deaths and eight illnesses. [Jan 21 AllAfrica news story]

Jan 20, 2010

No flu vaccine in Nigeria after first H1N1 death Nigerian health authorities disclosed today that the country has no H1N1 vaccine with which to launch a flu-shot campaign, 2 weeks after recording its first death from the pandemic virus. The newspaper This Day reported that screening of the 38-year-old woman's close contacts revealed 8 infected people, out of 46, who were placed on antiviral treatment. The government is ramping up public education about infection risks. [Jan 20 This Day story]

Japan OKs its first imported H1N1 vaccines Today Japan approved domestic use of H1N1 flu vaccines made by GlaxoSmithKline (GSK) and Novartis, paving the way for their use within a month. Japan has finalized deals for enough GSK vaccine for 7.4 million healthy adults and Novartis vaccine for 2.5 million. The approval marks Japan's first agreement to accept imported vaccine. GSK earlier contracted to supply the country with 74 million doses of H1N1 vaccine. [Jan 20 Kyodo News International article]

Mexico City offers vaccine for subway riders Health officials in Mexico City this week began offering H1N1 vaccine at 26 of the city's busiest subway stations, the Associated Press (AP) reported. On Jan 18 about 10,200 of Mexico City's 300,000 vaccine doses were distributed at the subway stops. City officials said they will extend the immunization effort to markets by the end of the week. Mexico City was at the center of the novel H1N1 outbreak in the spring. The country hopes to vaccinate 24 million people by March.

Chinese expert seeks support for sickest flu patients China's government should help seriously ill pandemic flu patients cover the cost of lengthy treatment, Dr Zhong Nanshan, one of the country's top respiratory disease specialists, said at a Jan 18 ceremony marking the hospital discharge of a teenage girl, China Daily reported today. He said a financial safety net would help reduce fear and barriers to treatment. Zhong first spoke out on the issue in December after a toddler was found dead after his parents took him out of the hospital.

Concern raised over vaccine and autoimmune disease Switzerland's medical regulatory agency, Swissmedic, recommends that people who have serious autoimmune diseases not receive Novartis's H1N1 vaccine because it has not been tested in such patients, Reuters reported today. The agency said it could not exclude the risk that the vaccine antigen or adjuvant could exacerbate disease. [Jan 20 Reuters report]

Jan 19, 2010

GSK vaccine sales lower than predicted Flu-vaccine manufacturer GlaxoSmithKline (GSK) could end up earning only 75% of what it once forecast from H1N1 vaccines, as governments renegotiate their contracts to two thirds of what they ordered last year, the Financial Times reported. Similar results are expected for other flu-shot manufacturers. In a separate statement, GSK acknowledged that countries are changing their orders but said it is "too early to say" what final dose totals and earnings for H1N1 vaccine will be.

FDA chief stresses safety of H1N1 vaccine Margaret Hamburg, MD, commissioner of the US Food and Drug Administration (FDA) recently sent a letter to healthcare professionals reassuring them about the safety of the pandemic H1N1 vaccine, based on the latest findings. She said no substantial differences between the pandemic and seasonal flu vaccine have been seen and that 94% of adverse events have been nonserious conditions such as injection-site soreness. [Jan 14 FDA letter]

Greece, Norway scale back vaccine orders Greece and Norway have both cut back on pandemic vaccine deliveries, Agence France-Presse (AFP) reported. The Greek health ministry said it would pay for only the 3.6 million doses it has already received and wants companies to refund advances made for future shipments. Meanwhile, Norway's health ministry said it reached an agreement with GSK to trim its order by 30%. It has received about 4.3 million doses so far and has vaccinated about 60% of its population.

Experts review Australia's pandemic response Two respiratory medicine experts from Australia, in a recent issue of Respirology, critiqued their country's H1N1 pandemic response. One said officials could have done more to slow the spread of the virus, such as isolating infected cruise ship passengers and canceling youth sports events, as well as better coordinating response across government levels. The other author praised officials for funding research efforts, but said the next possible wave may reveal more about response. [Jan Respirology report]

Massachusetts minorities hit harder than whites Massachusetts is the latest jurisdiction to find higher rates of flu illness and death in its non-white residents, the Boston Globe reported in its blog White Coat Notes. Asians were hospitalized 1.5 times as often as whites and were 4 times as likely to die from flu; Hispanics were hospitalized 3 times as often and were 6 times as likely to die; and blacks were hospitalized more than 4 times as often, and had death rates more than 3 times higher than whites. [Jan 15 Boston Globe blog post]

County tests emergency response with H1N1 shots Lexington County, S.C., used a newly arrived allotment of H1N1 vaccine to stage a 1-day test of its emergency medical response, The State newspaper reported. The county used a sports field to set up portable hospital tents purchased with homeland security funds, called in health professionals and community volunteers to work the site, and funneled 600 vaccine recipients through at several minutes each. [Jan 17 The State story]

Los Angeles airport makes vaccine available The Los Angeles international airport recently began offering flu shots, including the pandemic vaccine, in most of its terminals. A spokewoman said the airport's goal is to help curb flu spread and put the shots within convenient reach of travelers. Vaccination stations are staffed by nurses from FluEase, a company that specializes in immunization services for organizations. The shots cost $30, and vaccination will continue throughout flu season. [Jan 11 LAX press release]

Jan 15, 2010

WHO: Influenza B up in China Though the pandemic H1N1 virus is still the dominant flu strain, China has found influenza B in 12.6% of specimens, the World Health Organization (WHO) reported today. Some countries are sporadically detecting seasonal H1N1 and H3N2 viruses. Regions reporting the most intense pandemic flu activity are North Africa, South Asia, and east and southeastern Europe. The most affected North African countries are Morocco, Algeria, and Egypt. Flu activity also increased in western India. [Jan 15 WHO update]

Kids overdue for booster vaccine dose A review of data from 10 states shows up to 80% of children under age 10 who were immunized against pandemic flu are overdue for their second dose, USA Today reported. Officials have said children ages 6 months to 10 years need a second dose to be fully protected. States said they worry that declining flu activity may dampen the public's interest in the vaccine. Experts have said a booster is still effective, even when given later than the suggested 4 weeks after the first dose. [Jan 14 USA Today story]

California minority groups hit hard California Hispanics, African-Americans, and Native Americans have been hospitalized and died from pandemic H1N1 flu at higher rates than whites, according to an LA Times report today. Death and hospitalization rates for the state's Hispanics have been about twice as high as whites', compared with a 50% higher death rate and a tripled hospitalization rate in blacks. Native Americans' rates were also higher than whites', while Asians had a higher hospitalization rate but lower death rate. [Jan 15 LA Times article]

Belgium, Italy cut vaccine orders Belgium has cut back its pandemic vaccine order with Glaxo by a third because of falling demand, Reuters reported today. The country's health ministry said the cut would save the government about $47.6 million. Meanwhile, Italy cancelled 24 million doses it had ordered from Sanofi, Bloomberg News reported today. The Italian media has reported that only 900,000 people were immunized against pandemic flu. Italy had also bought 24 million doses from Novartis. [Jan 15 Reuters story]

Australia braces for possible back-to-school wave The Australian Medical Association (AMA) has said it is likely swine flu will strike the country again, possibly as a second wave after school resumes in a couple weeks and as people return from overseas holiday travel, according to The Australian. AMA vice-president Steven Hambleton said, "We're expecting to reimport the virus and to see people getting sick again." Officials are encouraging vaccination. [Jan 16 Australian report]

HHS unveils flu-fighter Facebook app Department of Health and Human Services (HHS) Secretary Kathleen Sebelius yesterday announced a new Facebook application called, "I'm a Flu Fighter" that allows users to tell their friends they received the flu vaccine and urge others to do the same. "Social media has been an important tool to communicate with young people and all Americans about the importance of getting the H1N1 flu vaccine," Sebelius said in a press release. [Jan 14 HHS release]

Jan 14, 2010

CDC warns about vaccine-related fraud Questions and answers about fraud and abuse related to H1N1 vaccine were posted online yesterday by the Centers for Disease Control and Prevention (CDC). The information is designed to help state and local immunization programs report abuses, such as charging for the vaccine (which is provided free by the federal government, though providers can charge for administering it) or selling the vaccine or ancillary supplies provided by the government. [CDC question-and-answer bulletin]

China urges Lunar New Year precautions To limit the spread of H1N1 during the upcoming Lunar New Year celebrations, China's health ministry is urging people at risk for H1N1 complications to get vaccinated and avoid using public transportation during the holidays, Agence France-Presse (AFP) reported today. The ministry specifically mentioned pregnant women, children, the elderly, obese people, and those with chronic diseases. The travel period lasts from Jan 30 to Mar 10, with Lunar New Year's Day on Feb 14. [Jan 14 AFP story]

Permanent H1N1 lung damage reported Some H1N1 patients in Finland suffered permanent lung damage from their infections, according to a Finnish Broadcasting Corp. (YLE) report. The patients had viral pneumonia, which caused their lungs to fill with fluid and left them with fibrosis after they recovered. At Kuopio University Hospital, all patients who were in the pulmonary ward for H1N1 will be brought back for further testing. The story did not specify how many patients suffered permanent damage. [Jan 14 YLE report]

Drive-through clinics proposed for triage A drive-through clinic for patient triage may be a useful method to reduce emergency-room crowding and disease spread during a flu pandemic, according to Stanford University physicians. The researchers set up a simulated drive-through clinic in a parking ramp and used charts from real patients who had flu-like illness to create patient scenarios. Participating physicians accurately identified patients who were admitted and discharged. The median length of stay was 26 minutes. [Annals of Emergency Medicine report]

Jan 13, 2010

Japan clears IV antiviral peramivir Japan has approved peramivir, an intravenous neuraminidase inhibitor, for the treatment of adults with influenza, Shionogi announced today. Shionogi has licensed the drug from US-based BioCryst. Japan is the first country to approve peramivir, though in October the US Food and Drug Administration (FDA) granted it an emergency use authorization. Shionogi said it finished a clinical trial of the drug in children and intends to file an application for pediatric use within the next fiscal year. [Jan 13 Shionogi press release]

Germany, Serbia scale back vaccine orders GlaxoSmithKline yesterday confirmed that the German government is trimming its H1N1 vaccine order by 30%, the Associated Press (AP) reported. Other governments are reducing their vaccine orders because they have surpluses owing to falling public demand and findings that one dose, rather than two, is enough to protect most people against the virus. In a related development, Serbia said yesterday it would stop importing vaccine and reassess its needs in February, BalkanInsight news reported.

Georgia to get donated vaccine from WHO Public health officials in Georgia said the World Health Organization (WHO) will provide the country with 400,000 pandemic vaccine doses to immunize high-risk groups, Trend News, a central Asian news agency, reported. Groups slated to receive the first doses include pregnant women, healthcare workers, and those with weakened immunity and chronic conditions. Pandemic flu activity is starting to decline in Georgia, but officials are warning that another wave of illnesses could occur. [Jan 12 Trend News story]

UK leader defends government's H1N1 response British Health Secretary Andy Burnham defended the government's response to the H1N1 pandemic from Labour Party charges that leaders wasted money and distorted the health system's priorities over an exaggerated threat, the Press Association reported. Burnham said he would "make no apology" for taking necessary steps to protect the public. He cited the WHO's pandemic declaration and said the "exceptional spike in flu cases" in Britain last summer triggered strong public concern.

China orders more H1N1 vaccine China has ordered more pandemic H1N1 vaccine from Sinovac Biotech Ltd., the company announced today. The order is for 8.57 million doses and brings the total bought by the government from Sinovac to 20.05 million doses, of which 10.23 million have been delivered. The order calls for the company to deliver 2.33 million doses by Mar 15 and to stockpile the rest in its own warehouse, officials said. [Jan 13 Sinovac press release]

Mexico has fewer than half of its doses Mexico, site of the world's first pandemic H1N1 cases, has received fewer than half of the 30 million doses of vaccine it ordered in 2009, Health Secretary Jose Angel Cordova said yesterday, according to the AP. He said Mexico has struggled to get the vaccine because it has to import it. So far the country has obtained 12 million doses, including a loan of 5 million from Canada. Cordova said the government hopes to vaccinate 24 million people by March.

Many Poles think no-vaccine policy was right Many people in Poland think their government's decision not to buy H1N1 vaccine has been vindicated by events, as the pandemic has peaked in much of Europe and several countries that stockpiled vaccine have many doses left over, according to an AP report from Warsaw. Doctors in Poland are deeply divided on the matter, with some arguing that people should have the right to be vaccinated if they want to.

Jan 12, 2010

WHO to field questions on pandemic response In response to some European officials who have questioned its response to the flu pandemic, the World Health Organization (WHO) said today it will order an independent review, but probably not until after the pandemic is over, Agence France-Presse (AFP) reported. A WHO spokeswoman said its executive board will address questions on the topic at its Jan 18 meeting. Some members of the Council of Europe have charged that vaccine companies pressured the WHO and have called for an investigation. [Jan 12 AFP story]

Hospitals get mixed grades on H1N1 response In a survey of the Society for Healthcare Epidemiology of America, 60% of the 323 respondents said their hospitals were well prepared for the H1N1 pandemic, but 51% said other infection-prevention activities were neglected during the crisis, according to a report in Clinical Infectious Diseases. About 31% of respondents reported shortages of antiviral drugs, and 30% said personal stockpiling of antivirals occurred at their hospitals. Most endorsed mandatory flu shots for health workers. [Jan 11 Clin Infect Dis abstract]

Mandatory flu shots for health workers deemed success Mandatory flu vaccination of staff has been successful at BJC HealthCare, a St. Louis health group with 26,000 workers, according to a Clinical Infectious Diseases study. After the requirement was set in 2008, 98.4% of workers were vaccinated. Medical exemptions were granted to 1.2% of workers and religious exemptions to 0.3%. Only eight workers were not vaccinated and not exempted. Fewer employees sought medical or religious exemptions than had declined the vaccine the year before. [Jan 11 Clin Infect Dis abstract]

A third of UK health workers now vaccinated Only about a third of frontline National Health Service workers in England have received H1N1 vaccine, according to a report in the Nursing Times newsletter. As of December, 343,000 of about 1 million staff members had been vaccinated, the Department of Health reported. A department spokeswoman said the number of healthcare workers who received the pandemic vaccine is about twice the number who have received the seasonal vaccine. [Jan 12 Nursing Times report]

VaxInnate licenses recombinant H1N1 vaccine to Indian firm VaxInnate Corp. of Cranbury, N.J., announced today that it has licensed its recombinant H1N1 vaccine to Biological E. Limited, an Indian company, and will help the firm test and market the vaccine in India. Clinical development of the vaccine there will start early this year, and it could become available for emergency use after completion of clinical trials. Biological E. will be able to make the vaccine--produced in a bacterial expression system--in its existing facilities, officials said. [Jan 12 VaxInnate press release]

New HHS PSAs urge vaccination for minorities The US Department of Health and Human Services (HHS) held two press briefings today to launch new public service announcement (PSA) campaigns to urge African-Americans, American Indians, and Alaska natives to be vaccinated against H1N1. HHS Secretary Kathleen Sebelius and Surgeon General Regina Benjamin conducted the briefings along with other officials. The briefings were part of National Influenza Vaccination Week activities. [HHS flu.gov page with access to PSAs]

FDA offers guidance on drug production in emergencies In an effort to maintain the nation's supply of drugs and other medical products in the event of a pandemic or other emergency, the US Food and Drug Administration (FDA) recently issued draft guidance to help pharmaceutical companies plan for high absenteeism rates. It focuses on "medically necessary products" such as antivirals and details what the FDA could do to help protect the supply. The guidance is also aimed at companies that make the raw materials and components used in the products. [Jan 2010 FDA draft guidance]

Jan 11, 2010

Groups encourage H1N1 vaccination Thirty-seven US health groups today posted an open letter to Americans urging them to get an H1N1 vaccine. The letter, signed by leaders of the AMA, Red Cross, APIC, ASTHO, IDSA, and other physician, nurse, hospital, and other healthcare groups, says, "The H1N1 flu vaccine is safe, effective, and the best way to protect yourself and your family from the H1N1 flu." [Jan 11 letter on CDC site]

Feds kick off flu vaccination week National Influenza Vaccination Week launched yesterday with US Health and Human Services (HHS) director Kathleen Sebelius visiting a Baptist church in Washington, DC, in an effort to rally faith communities behind immunization efforts. The event is designed to raise awareness of flu complications and promote post-holiday vaccination. Officials are highlighting different risk groups each day of the week, with today's messages aimed at healthcare workers and the general public. [Jan 8 HHS press release]

Ohio sees low vaccine uptake in risk groups Pandemic flu vaccine uptake in Ohio's high-risk groups has been low, according to a report in the Cleveland Plain Dealer. Only 20% of those at high risk for flu complications had been vaccinated through the end of the December, according to data from public records. For example, fewer than 2 in 10 of the state's pregnant women had gotten their dose. As of Dec 30 the state had distributed 4 million doses and administered 1 million. [Jan 10 Plain Dealer report]

Aid group says flu spreading in North Korea H1N1 flu is continuing to spread in Pyongyang, North Korea, prompting the closure of day care centers and kindergartens, an aid group called Good Friends reported on the UN-sponsored ReliefWeb site. Quoting an unnamed official, the report said some children have died and severe winter weather has worsened the situation. The group also said flu medications sent from South Korea have been used mainly in Pyongyang, with little reaching the provinces, where the virus is also spreading.

European group to air H1N1 vaccine controversy Later this month the Council of Europe will debate charges raised by one of its health officials that vaccine makers manipulated governments to buy stockpiles of pandemic vaccine, the London-based Guardian reported today. Weak demand for the vaccine amid waning flu activity and the need for just one dose have left many countries with surpluses. However, some experts warn another wave of infections could sweep the globe, with more months remaining in the Northern Hemisphere's flu season. [Jan 11 Guardian story]

Azerbaijan receives donated vaccine Azerbaijan has received its first shipment of donated pandemic vaccine, the World Health Organization (WHO) said in a press release. It will receive a total of 860,000 doses. The inactivated adjuvanted vaccine made by Glaxo will go to healthcare workers, pregnant women, people with chronic lung conditions, and children ages 14 to 17. Meanwhile, the WHO sent Nepal five sets of intensive care equipment to help treat severely ill H1N1 patients, Himalayan News Service reported yesterday.

Jan 8, 2010

Mongolia is first country to get donated vaccine Mongolia yesterday became the first developing country to receive donated doses of H1N1 vaccine from the World Health Organization (WHO), the Voice of America reported. The first 35 countries on the list to receive vaccine should all get supplies within the next month, WHO spokeswoman Nyka Alexander told VOA. Azerbaijan and Afghanistan are expected to receive doses within days. The WHO has received pledges for 190 million doses from 14 countries. [Jan 7 VOA report]

Minority groups hit hard by H1N1 African-American, Hispanic, and American Indian residents of Wisconsin were hospitalized for H1N1 flu at much higher rates than whites, the Milwaukee Journal Sentinel reported. Data from Milwaukee and the state show hospitalization rates for whites of 11 to 14 per 100,000, compared with 28 to 38 per 100,000 for blacks, 30 to 32 per 100,000 for Hispanics, and 35 per 100,000 for American Indians. [Jan 7 Milwaukee Journal Sentinel story]

UK considering unloading surplus vaccine The British government is looking at ways to "offload" millions of doses of H1N1 vaccine because a third wave of cases is deemed unlikely, the BBC News reported today. Options include selling the surplus doses or giving them to poor countries, but a stockpile will be kept. The government bought 60 million doses from GlaxoSmithKline and 30 million from Baxter. So far, 23.9 million doses of GSK vaccine and 5 million doses of Baxter vaccine have been delivered. [Jan 8 BBC News report]

China offers free flu shots for holiday China's Ministry of Health said today that the government will fund free H1N1 flu vaccinations for all children in the country who are less than 3 years old. The central government made the move in anticipation of Lunar New Year celebrations, when millions of people travel to visit relatives. China has vaccinated 51.4 million residents so far. [Jan 8 Agence France-Presse story]

Hockey team invites fans to take a shot The Missouri Mavericks, a minor league hockey team in Independence, Mo., are offering a special incentive for fans to attend their game tomorrow: free H1N1 flu shots. The team plans to set up a vaccination table for their game with the Arizona Sundogs, the Associated Press reported. Anyone wanting the immunization must be older than 18 or be accompanied by a parent or guardian.

Jan 7, 2010

College flu activity down, vaccination up Mirroring the national pattern, flu activity at colleges continues to decline, according to the American College Health Association (ACHA). It said new cases were down 21% from the week before. One new death was reported. The attack rate was 2.7 cases per 10,000 students. The percentage of students who have been vaccinated rose slightly to 8%, with some states reaching 20% with vaccine availability improving. [ACHA report for week ending Dec 18]

NYC's early flu cases helped steer treatment A review of New York City's first hospitalized pandemic flu patients, used early in the outbreak to guide local and federal response, revealed that people with asthma or the obese were more likely to have severe illness, according to the latest Morbidity and Mortality Weekly Report. Findings that early antiviral treatment led to shorter hospital stays influenced recommendations that patients at risk for flu complications receive early osteltamivir (Tamiflu) treatment. [Jan 8 MMWR report]

Kids' cases show false-negatives, coinfections In a review of the first 13 pediatric patients hospitalized for pandemic flu at Johns Hopkins, researchers found that all but one had an underlying medical condition, especially asthma, and that respiratory effects from the disease varied widely. Their report, published in Pediatric Critical Care Medicine, also notes that rapid tests were negative in 8 of 13 children and that about a fourth developed bacterial coinfections. Half needed ventilators, but none died. [Dec 31 Ped Crit Care Med abstract]

Turkey to cancel some vaccine orders Turkey plans to scale back its purchase of 43 million doses of H1N1 vaccine, joining other countries taking similar steps, Today's Zaman newspaper reported today. The ministry said pandemic flu activity has been declining since late November. So far half of the 8 million doses Turkey has received have been administered. The ministry said one in five people have been infected with the virus, especially adults under 50, children, and pregnant women.

H1N1 in California turkeys, Illinois pig California officials announced that the pandemic H1N1 virus has been detected in a turkey breeding flock in the central part of the state, the American Veterinary Medical Association (AVMA) reported. The only sign of illness was a drop in egg production. Meanwhile, the US Department of Agriculture reported that its National Veterinary Services Laboratories have confirmed the virus in swine herd samples from Illinois that were collected Dec 16. [Jan 6 AVMA report]

Jan 6, 2010

WHO says demand for donated vaccine may drop Developing countries in line to receive donated H1N1 vaccine from the World Health Organization (WHO) may not want as much as the agency has been aiming to provide, the Canadian Press reported today. The WHO hoped to provide enough for 10% of the population of countries that wanted the vaccine, but the agency's Dr. Marie-Paule Kieny said that with the pandemic waning, governments are "considering whether and how much vaccine they want to deploy."

Vaccine surplus issues surface in Australia, Ireland Australia has used only about a quarter of the pandemic vaccine doses it ordered, raising questions about a surplus, The Australian newspaper reported today. Though summer flu activity is low in Australia, Health Minister Nicola Roxon and the Australian Medical Association have issued new calls for the public to be vaccinated. Meanwhile, Irish news media reported today that Ireland canceled an order for 3.7 million doses of vaccine from Baxter. [Jan 7 The Australian story]

Canada to lend 5 million vaccine doses to Mexico Canada will lend 5 million doses of H1N1 vaccine to Mexico "to help bridge that country's immediate pandemic vaccine requirements," Canadian Health Minister Leona Aglukkaq said in a press release today. Mexico will repay the doses by Mar 31. The release said Mexico has ordered vaccine from several producers, but most of it will not be available until the end of this month. Canada has enough vaccine on hand to meet its needs and make the loan, officials said. [Jan 6 Public Health Agency of Canada statement]

Indian doctors request more ventilators for hard-hit city The Indian Medical Association (IMA) has asked the government for 50 ventilators to help hospitals in Ludhiana, the largest city in Punjab state, cope with a surge of pandemic flu patients, the Times of India reported yesterday. Punjab is in northern India. The IMA said only 160 ventilators are currently available and there aren't enough beds and isolation rooms to handle the influx of patients. They warned that lack of proper health facilities could raise the flu death toll. [Jan 5 Times of India story]

Rhode Island reports hospital outbreak of H1N1 Seven patients in a state hospital in Rhode Island recently contracted H1N1 flu but have since recovered, according to a report in the Providence (R.I.) Journal. The patients were in the Zambarano Unit of the Eleanor Slater Hospital, located in Burrillville. The outbreak was reported Dec 28, and the state's health department declared it resolved Jan 4. Staff members and other patients on the two floors where the outbreak occurred were treated with oseltamivir. [Jan 6 Providence Journal report]

Los Angeles cab drivers offered free vaccine The nine franchised taxi companies in Los Angeles are offering free H1N1 vaccination to their 3,700 drivers this week, according to an Associated Press report. Norton Medical Industries, a company that tests employees for drugs and alcohol, will administer the shots, the report said. With an increased supply, Los Angeles County recently made the vaccine available to everyone.

Jan 5, 2010

Leaders line up for flu shots More high-profile leaders are getting their pandemic flu vaccine, including Margaret Chan, the director-general of the World Health Organization, who got her shot on Dec 30, Reuters reported. Meanwhile, state lawmakers from Indiana had a chance to get vaccinated today at a clinic held as the legislative session reconvened, the Associated Press reported. The state's health commissioner said she hoped the lawmakers would set a good example for constituents by getting their shots. [Jan 5 Reuters story]

Researchers create insect-cell H1N1 vaccine In an effort to develop new strategies to more quickly produce pandemic vaccine, Austrian researchers have used an insect cell technique to create a recombinant virus-like particle H1N1 vaccine for use in mouse studies. Their report appeared in Biotechnology Journal. They wrote that the process took 10 weeks. US researchers have already developed a similar system for making seasonal flu vaccine. [Dec 29 Biotechnol J abstract]

National flu vaccine week takes shape Last month federal officials delayed National Influenza Vaccination Week to coincide with more plentiful pandemic vaccine, and they recently announced themes for each day of the week, which starts Jan 10. On Jan 11, efforts will focus on the general public and healthcare workers. The following 2 days will target those at high risk for flu complications, followed by children, pregnant women, and infant caregivers. Jan 14 messages will aim for young adults, and the next day will feature seniors. [Jan 2 HHS news release]

IOM issues report on impacts of pandemic The Institute of Medicine (IOM) recently published a report on the US and international impacts of the H1N1 pandemic, based on a workshop that was held in mid September and involved a committee of about 25 experts. The report outlines the course of the pandemic to that point and describes the scientific and public health responses to it. The body of the report runs about 75 pages, but numerous appendices and related materials swell its total length to several hundred pages. [IOM report title page]

Jan 4, 2010

China logs end-of-year flu increase All but 6 of China's 659 deaths from H1N1 flu were recorded in the last 2 months of 2009, raising the possibility that the disease is on the upswing, Agence France-Presse (AFP) reported today. And China Daily said fears are growing of uncontained spread of flu in China's vast interior, with government efforts focusing on getting equipment and resources to rural provinces in advance of the mass exodus to the countryside to celebrate Lunar New Year next month.

France to sell 89 million vaccine doses The French government is offering a vast amount of unused H1N1 flu vaccine for sale to other countries and may have found buyers in the Middle East, AFP reported. Of the 94 million doses bought to inoculate each resident two times, only about 5 million were used. Qatar and Egypt, and also Mexico and Ukraine, may be buyers, France's health ministry said. The country has experienced 198 deaths from the flu. [Jan 5 AFP story]

Thailand admits, learns from H1N1 errors Thailand's health ministry says its actions during the H1N1 pandemic confused people and brought mistrust of the organization, according to The Nation. Among its errors were unclear early messages about the virulence of H1N1, delays in reporting the first death, use of ineffective thermal scanners at airports, mistakenly encouraging people to be tested if they had symptoms, failure to warn high-risk groups of the danger, and misdiagnosis. [Jan 2 The Nation article]

Two Chinese deaths not due to vaccine Two unidentified people who died after being inoculated against H1N1 influenza did not die of vaccine reactions, the Chinese Ministry of Health said today in a report carried by Xinhua. Almost 50 million people have been vaccinated with a vaccine made in China, and about 1 per million has experienced a reaction, but these two deaths were not due to adverse events, the ministry said. [Jan 4 China Daily report]

Rapid H1N1 diagnostic test gets EUA Cepheid's Xpert Flu A Panel, which can identify pandemic H1N1 influenza in less than an hour, was given Emergency Use Authorization (EUA) status by the US Food and Drug Administration today. The test runs on the company's GeneXpert System, and the EUA will allow its use in laboratories certified to perform "moderate complexity" testing, which includes hospital labs. The EUA is expected to expire Apr 26. [Jan 4 Cepheid press release]