The Centers for Disease Control and Prevention (CDC) issued recommendations today to help state and local health officials decide who should get novel H1N1 vaccine when supplies are initially limited. Target groups include schoolchildren and staff, children in daycare and staff, pregnant women and contacts of newborns, those with medical underling conditions, and health workers. The report also discusses weighing the needs of other nations and military personnel, but it focuses on US civilians. [Jul 8 CDC recommendations]

The novel flu virus seems poised to dominate Australia's flu season, the country's health minister, Nicola Roxon, said today, according to the Adelaide Advertiser. Flu surveillance for the week ending Jun 20 revealed that almost two thirds of the infections were from the pandemic H1N1 virus. Roxon said the new virus will likely replace seasonal flu, rather than circulate alongside it. [Jul 9 Advertiser story]

Federal and state health departments are increasing their testing of novel flu viruses for oseltamivir (Tamiflu) resistance, the Associated Press (AP) reported today. The measures were prompted by a report of a resistant strain isolated from a San Francisco resident who had arrived in Hong Kong in June. The girl had had not taken osteltamivir. The CDC has asked states to send more samples for resistance testing, and California said it has stepped up its testing. [Jul 8 AP story]

Paraguay's government passed emergency legislation yesterday aimed at curbing the spread of pandemic flu, the AP reported today. The law gives the country's president expanded powers to respond to the flu outbreak and allows health officials to use $19.2 million from the treasury to fund programs to boost healthcare capacity. [Jul 8 AP story]

The two plenary sessions of tomorrow's White House pandemic H1N1 flu preparedness summit--a substantial portion of the event--will be broadcast over the Web via flu.gov, according to the Department of Health and Human Services. In addition, David Hale, a biomedical informatics and social media expert, will be providing live Twitter updates during the entire event. His Twitter name is lostonroute66. The day-long event starts at 8:30 a.m. Eastern time. [David Hale's Twitter home page]

Jamaica's health ministry yesterday reported its first novel flu death, a patient who had an underlying medical condition who died at the University Hospital of the West Indies in Kingston, the Jamaica Observer reported. The ministry has asked a medical team to investigate the death. Jamaica reported its first novel flu cases in late May, and on Jun 24 announced the virus was spreading in the community. So far 33 cases have been reported, including the recent fatality. [Jul 7 Observer story]

Chile's health ministry recently cancelled a large religious festival, set to converge on a small town in the southern part of the country, in an effort to slow the spread of pandemic flu, the Santiago Times reported on Jul 3. The dance and music celebration typically brings 200,000 visitors to the town of La Tirana. The event was last cancelled in 1991 during a cholera outbreak. The World Health Organization said yesterday Chile has confirmed 7,376 novel H1N1 cases. [Jul 3 Times report]

A profile of US military flu surveillance efforts, to appear in the September issue of the American Journal of Preventive Medicine, illustrates the importance of global influenza surveillance and quick access to epidemiologic data, the journal said in a press release today. Military surveillance efforts began in the 1970s and have made notable contributions, such as detecting the first novel H1N1 cases in the United States. Military disease surveillance is active in 56 countries. [Jul 7 Am J Prev Med press release]

The Centers for Disease Control and Prevention (CDC) yesterday released interim guidance for preventing and managing novel H1N1 infections in obstetric settings. Severe illnesses in pregnant women and infants have been a feature of the flu pandemic, though experts don't have a firm grasp on the epidemiology and illness spectrum. The new guidance says areas where prenatal care and labor and delivery services are delivered should be separated from areas where the sick are handled. [Jul 6 CDC guidance]

The world's pandemic flu total reached 94,512 cases, 429 of them fatal, the World Health Organization (WHO) reported today. The number is 4,591 more cases and 47 more deaths than the last report on Jul 3. Countries reporting their first cases include Cook Island, Croatia, the French overseas territories Guadaloupe and St Martin, Guyana, Libya, and Macedonia. Countries reporting the highest numbers of new cases are Argentina (898), Australia (730), and Thailand (662). [WHO update 58]

Public health officials in Hong Kong said they have detected their first oseltamivir (Tamiflu)-resistant novel H1N1 strain, which was isolated from a 16-year-old girl after she arrived from San Francisco, the health ministry said in a Jul 3 press release. Similar cases were recently reported in Denmark and Japan. The girl was isolated and treated at a hospital where she refused antiviral treatment. She was released on Jun 18. The sample was sensitive to zanamivir (Relenza). [Jul 3 Hong Kong Department of Health statement]

United Nations Secretary-General Ban Ki Moon today estimated that $1 billion is needed by the end of the year to help developing countries respond to pandemic influenza, the Associated Press (AP) reported. Speaking at a press conference in Geneva after a donor's conference, Moon said funding isn't coming in as expected. Margaret Chan, the WHO's director-general, said donor assistance is needed to help 49 developing countries stockpile antivirals and other drugs. [Jul 6 AP story]

A British survey on the public's perceptions and behavior changes related to the novel flu outbreak revealed that just over a third had followed any advice to reduce their risk, the British Medical Journal reported on Jul 2. The survey of 997 adults showed that changes were associated with beliefs that the outbreak is severe, that good information is available, and that people can control their risk. Belief that outbreak reports are exaggerated was linked to less behavior change. [Jul 2 BMJ report]

Syria's health ministry confirmed the country's first novel flu case, a Syrian woman living in Australia who had flown back for a visit, the AP reported on Jul 4. The woman's family was tested, and all of the passengers on her flight were slated for testing. The woman had flown through Dubai on her way to Syria. [Jul 4 AP story]

Peru, New Zealand, and El Salvador recently reported their first pandemic flu deaths, according to several media reports. Peru's fatalities include a 38-year-old woman and a 4-year-old girl, both of whom had underlying conditions and died last week, the AP reported yesterday. New Zealand reported three deaths: two men, ages 19 and 42, and a young girl. One of the men and the girl had underlying conditions. El Salvador's fatal case was a 9-year-old boy who died in the country's capital. [Jun 5 AP story]

The United States' number of pandemic flu cases climbed to 33,902, with 170 deaths, the US Centers for Disease Control and Prevention (CDC) reported today. The new totals reflect 6,185 more cases and 43 more deaths than last week. In its new surveillance report today for the week ending Jun 27, the CDC said flu activity decreased but is still higher than normal for this time of year. The New York/New Jersey area is still reporting elevated activity, as is the Pacific Northwest. [Current CDC numbers]

Authorities in Malta today confirmed the country's first two pandemic flu cases, two 26-year-old men who had recently traveled with a group to Spain, Deutsche Presse-Agentur reported. Others from the group also have flu symptoms. Before today's confirmation, Malta was the only European Union country that had not reported a novel flu case. Elsewhere, Uganda today reported its first case, a 40-year-old British man who had recently arrived from Kenya, Xinhua, China's state news agency, reported. [Jul 2 DPA article]

Paraguay's health ministry today reported the nation's first novel flu death, a man in his 60s, Agence France-Presse (AFP) reported. No details were available about any preexisting conditions. Meanwhile, China's state media said a woman who was hospitalized with a novel H1N1 infection was found dead yesterday in a hospital bathroom, according to the Associated Press. She was reportedly recovering and her death is under investigation. [Jul 2 AFP story]

The United Kingdom is moving from a novel flu containment strategy to focus more of its resources on more vulnerable patients, AFP reported yesterday. Prime Minister Gordon Brown announced the change yesterday, noting that case numbers spiked by 2,000 over the past week and that a "more flexible and local approach" will be used in hard-hit areas. Media reports say hot spots include London, the West Midlands, and Glasgow. [Jul 1 AFP story]

Some health officials in Argentina are criticizing the government for rejecting calls to postpone the nation's recent election, a move they say could have avoided the virus's spread at crowded polling places and focused the public's attention on pandemic issues, the New York Times reported yesterday. The officials said the health minister who just resigned was among those who recommended postponing the election. Increased flu cases prompted an emergency declaration in Buenos Aires. [Jul 1 New York Times article]

President Obama has called a "flu summit" on Jul 9 to discuss the nation's pandemic flu preparedness plans for the fall, CNN reported yesterday. The meeting will be held at the National Institutes of Health and be led by Department of Homeland Security Secretary Janet Napolitano and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. On Jul 30 Obama met with federal officials who helped manage the 1976 influenza outbreak to discuss lessons learned from their experience. [Jul 1 CNN story]

HHS Secretary Kathleen Sebelius announced today that the country will supply 420,000 treatment courses of oseltamavir (Tamiflu) to the Pan-American Health Organization to fight novel H1N1 flu in Latin America and Caribbean countries. She announced the effort while attending a series of meetings in Cancun, Mexico, for health ministers throughout the Americas. [Jul 2 HHS statement]

Japan's health ministry today confirmed the country's first instance of oseltamivir (Tamiflu) resistance in a novel flu virus, Reuters reported. The patient, from Osaka prefecture, was sick with the new H1N1 virus in mid May and has since recovered. A health ministry spokesman said the patient's sensitivity to the drug has not been tested yet. Danish officials reported the world's first oseltamivir-resistant novel flu case Jun 29 [Jul 2 Reuters article]

The world's number of pandemic flu cases rose to 77,201 today, including 332 deaths, the World Health Organization (WHO) reported. Today's numbers represent 6,308 more cases and 21 more deaths than the last report on Jun 29. Countries included for the first time are the French overseas territory of New Caledonia, Kenya, Mauritius, Myanmar, and Saint Lucia. About a third of the new cases are from the United Kingdom. South American countries and Thailand also reported large increases. [WHO update 56]

Health officials in Argentina's Buenos Aires city and province yesterday, amid quickly rising numbers of pandemic flu cases, declared a health emergency, extending school vacations and giving the mayor the power to suspend sports and other entertainment gatherings, the Associated Press reported today. Public places remain open. Buenos Aires is the fifth province to declare a health emergency. Argentina has South America's highest number of pandemic flu cases, with 1,587, including 26 deaths. [Jul 1 AP story]

Roche, the maker of Tamiflu (oseltamivir), today launched a program to help developing countries buy the drug at a discount for their national stockpiles. The company will produce and store the drug at a significantly reduced price, with the cost spread over the drug's shelf life. Roche will ship the supplies whenever the country requests them. The price will depend on the length of storage time that the country requests. An international health group will likely coordinate the orders. [Jul 1 Roche press release]

Bosnia's health ministry today announced the nation's first pandemic flu case, a 24-year-old woman who recently arrived from a South American country, the AP reported. She is recovering in isolation at the home of relatives. Meanwhile, the US territory of Guam confirmed its first pandemic flu case today, a woman in her 40s who just returned from Texas, KUAM, Guam's broadcast network, reported. [Jul 1 AP story]

NOTE: This item originally cited "San Francisco officials" as a source, but there has been no official confirmation of these cases nor any evidence they are related to each other.
A San Francisco doctor reported five cases of novel H1N1 infections in pregnant women in the city, according to KPIX, a northern California television station, in a story that referred to the cases as a "cluster." All five remain hospitalized, two of them in intensive care, all in their third trimester. [Jun 29 KPIX story]

Health officials in Spain and Uruguay today reported their first novel H1N1 deaths, Agence France-Presse (AFP) reported. The patient who died in Spain was a 20-year-old Moroccan woman who was 7 months pregnant and had asthma. Spain's health ministry said the baby was delivered by Caesarean section and, though premature, appears to be healthy. The Uruguayan was a 60-year-old woman who died of multiple organ failure before tests confirmed novel H1N1. [Jun 30 AFP article]

Indonesia's health minister said yesterday that visitors arriving at the country's airports from nations hit by novel flu will be asked to wear a mask for 3 days, according to a report today from AFP. The masks are a precautionary measure to reduce human-to-human transmission, she said. The masks will be handed out to international visitors as soon as funding for them comes through; however, those who don't wear them will not be penalized. [Jun 30 AFP article]

Argentina's health minister, Graciela Ocana, resigned yesterday, citing differences with the government on the handling of pandemic flu and a previous dengue fever outbreak, the New York Times reported yesterday. Meanwhile, a crisis committee will meet today to discuss raising the response level, according to a local media report, which could close schools and other public places and curb mass gatherings. Argentina has 1,488 confirmed novel flu cases, many of them around Buenos Aires. [Jun 29 New York Times article]

Saudi Arabian health officials who just concluded a 4-day meeting with international health experts to discuss pandemic flu risks related to the hajj today advised that children, pregnant women, elderly people, and those with chronic health conditions avoid the annual pilgrimage, the Associated Press reported. The 4-day hajj starts in late November this year and is expected to attract about 3 million pilgrims. The health ministry said the crowded setting could pose a flu transmission risk. [Jun 30 AP story]

San Diego researchers with close knowledge of the confirmation of the first US novel flu cases reported today in a letter to the New England Journal of Medicine that the sensitivity of rapid tests used during the outbreak was low, the same as for seasonal strains, and varied by subtype. When they compared rapid tests to polymerase chain reaction (PCR) tests, sensitivity for the QuickVue rapid test was 51% for novel H1N1, 63% for seasonal H1N1, and 31% for H3N2. [Jun 29 N Engl J Med letter]

Airline industry data show a high correlation between the start of the H1N1 flu pandemic in various countries and the number of passengers from Mexico that tend to arrive in those countries in March and April, according to Toronto researchers. Of the 20 countries that had the highest passenger volume from Mexico in 2007 and 2008, 16 experienced importations of H1N1 from Mexico in 2009; countries that had more than 1,400 such passengers had a "significantly elevated" risk of flu importation. [Jun 29 N Engl J Med letter]

The latest global number of new pandemic flu cases is 70,893 cases, including 311 deaths, the World Health Organization (WHO) reported today. The new total is an 11,079-case rise from the WHO's last update on Jun 26. The once-weekly update of US cases represents more than half of the new cases. The number of fatalities rose by 48 since the last report. The list includes four countries reporting their first cases: Iraq, Lithuania, Monaco, and Nepal. [WHO update 55]

A Danish patient confirmed as having novel H1N1 influenza exhibited resistance to the antiviral drug oseltamivir (Tamiflu), an official from Roche, the maker of the drug, said today. "While receiving the drug, the patient appeared to develop resistance to it," David Reddy, Roche's pandemic task force leader, said on a conference call, according to Reuters. "This is the first report we have of it in H1N1," he said. [Jun 29 Reuters report]

The pandemic vaccine now being produced will require two shots 3 weeks apart to provide full immunity, which could overwhelm state agencies, officials said at a meeting last week at the Centers for Disease Control and Prevention. And children younger than 9 years old will need four shots, the CDC said, according to a Bloomberg News report. "Public health departments are underfunded and will get fatigued," said flu expert William Schaffner, adding that one shot will give at most 20% protection. [Jun 26 Bloomberg News report]

Kenya's health ministry today announced the country's first novel flu case, a 20-year-old British man visiting as a student, Agence France-Presse (AFP) reported. The man got sick 2 days after arriving in Kenya and is recovering in isolation at a hotel. In other developments, Myanmar's government on Jun 27 reporting the country's first pandemic flu case, a 13-year-old girl who became ill after visiting Singapore with her family, according to Irrawaddy, a Thai-based news service. [Jun 29 AFP article]

Brazil has reported its first swine flu fatality, in an adult woman of unspecified age, according to a story in today's Hindustan Times. Brazil's health ministry said in a statement that the woman, who died Jun 28, was "from the state of Rio Grande do Sul who had spent 1 week in Argentina." The story said officials were investigating another suspected novel flu death in the same state. [Jun 29 Hindustan Times story]

Children with chronic medical conditions have fewer flu-related complications when they receive oseltamivir (Tamiflu) within a day of flu diagnosis, researchers reported today in an early online edition of Pediatrics. The study covered six flu seasons between 2000 and 2006 and was based on a Reuters Thomson database. Compared with those who didn't receive the drug, children who received oseltamivir had fewer complications and hospitalizations 14 and 30 days after flu diagnosis. [Jun 29 Pediatrics abstract]

The global number of novel H1N1 cases climbed to 59,814 cases, including 263 deaths, the World Health Organization (WHO) reported today. The total reflects a 3,947 increase from the last update on Jun 24. Jurisdictions appearing on the list for the first time are Indonesia, Iran, Serbia, and the UK crown dependency of Guernsey. Countries reporting the highest increases since the last report include Chile, the UK, Mexico, Australia, and Canada. [WHO update 54]

The nation's number of novel flu cases rose to 27,717 cases and 127 deaths, the US Centers for Disease Control and Prevention (CDC) reported today. The tally represents 6,268 more cases and 40 more deaths than the last update a week ago. States reporting the highest number of cases include Wisconsin, Illinois, Texas, New York, California, Pennsylvania, and Massachusetts. New York has the most fatalities, 35, followed by California with 16. [Current CDC numbers]

A surveillance expert from the CDC said yesterday at the agency's immunization group meeting in Atlanta that the true number of pandemic H1N1 cases in the United States could be as many as 1 million, the Associated Press (AP) reported today. Lyn Finelli said the projection was based on mathematical modeling and surveys from health officials. She told the Advisory Committee on Immunization Practices (ACIP) that 6% or more of the population from some urban areas could be infected with the virus. [Jun 26 AP story]

Robin Robinson, an official from the US Biomedical Advanced Research and Development Authority (BARDA) who addressed the ACIP group yesterday, projected that as many as 60 million doses of the pandemic H1N1 vaccine could be available by September, the AP reported today. However, others at the meeting said the estimate may be too optimistic. [Jun 26 AP story]

The pandemic H1N1 strain is dominating seasonal flu strains in Victoria, according to a report from the Victoria Infectious Diseases Reference Laboratory (VIDRL) that covered last week. Of 138 influenza A samples tested, 60 were novel H1N1, 3 were H3N2, and 2 were seasonal H1N1. Victoria is the state with the most confirmed novel flu cases, 1,560 of Australia's 3,519. Experts predicted that the new flu strain might push out seasonal strains as the southern hemisphere's flu season progresses. [VIDRL weekly flu surveillance report]

Health officials in England said pandemic flu response in two parts of the country will shift from a containment to a management strategy, the London Daily Mail reported today. The change, which affects London and West Midlands, means that schools will no longer close and that antiviral medication will no longer be given to close contacts of flu patients, only those who have illness symptoms. Also, most illnesses will be diagnosed clinically rather than through lab testing. [Jun 26 Daily Mail story]

Sanofi Pasteur, one of the five companies that are developing a novel H1N1 vaccine for the US market, said it began large-scale production on Jun 23, according to the company's Web site. The company will still need to conduct clinical trials, which it said in an earlier statement could take place as early as August. In late May the company received a $190 million order from the US Department of Health and Human Services to make bulk vaccine and conduct other activities. [Sanofi timeline of novel flu vaccine developments]

Animal health officials from Argentina said yesterday in a report to the World Organization for Animal Health (OIE) that two workers at a pig farm where the animals tested positive for novel H1N1 were sick between Jun 7 and 9, but did not seek medical care or undergo testing. The report said pigs started getting sick on Jun 15. The virus sickened 30% of the 5,586 pigs, but none have died. The facility has its own restocking system, and no pigs have entered from outside the farm since July 2008. [Jun 25 OIE report]