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]

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]

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]

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]

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]

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]

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'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]

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]

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]

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]

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]

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]

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]

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. [Jul 22 Xinhua story]

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]

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]

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 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]

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]

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. [Jul 19 Postmedia News story]

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]

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]

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]

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]

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." [July Am J Pathol abstract]

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]

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]

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]

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]

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 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]

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]

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]

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]

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'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]

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 Financial Post article]

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, 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]

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]

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 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]