INFLUENZA >>  NOVEL H1N1 INFLUENZA (SWINE FLU) >>

News Scan

Nov 20

Flu shows signs of peak in some regions Signs of a peak in pandemic flu activity continue in several Northern Hemisphere locations, though transmission is still intensifying in Canada and northern and southern Europe, the World Health Organization (WHO) reported today. Sharp increases were noted in Kazakhstan and Israel; Colombia and Peru also reported increases. More than 99% of subtyped influenza A viruses in Europe are the pandemic strain, and a decreasing number of seasonal viruses are being detected in China and Southeast Asia. [Nov 20 WHO pandemic update]

APHA asks Obama to support CDC's N-95 stance In a letter yesterday, the American Public Health Association (APHA) asked President Obama to resist efforts to change current CDC guidance on respiratory protection for healthcare workers caring for H1N1 patients, which emphasizes face-fitting N-95 respirators over surgical masks. The APHA said it "supports not only the current guidance," but the process by which the guidance was derived. This stance fits respiratory-protection language in a 2006 APHA policy statement on pandemic preparedness. [Nov 19 APHA letter]

Study spotlights asthma risk in kids A study published in CMAJ (Canadian Medical Association Journal) found that asthma "appears to be a significant risk factor for severe disease" in children with H1N1 flu, according to the authors. In comparing 58 children hospitalized for H1N1 with 200 children admitted with seasonal flu, the authors found little difference in flu severity between the groups. But 22% of children admitted with H1N1 had asthma, compared with 6% of those admitted with seasonal flu. [Nov 19 CMAJ study abstract]

Seasonal, H1N1 strains circulating in Oklahoma Oklahoma has had its first seasonal flu-related death of the season, showing that the seasonal and pandemic strains are both circulating in the state, according to a report today by The Oklahoman newspaper. State epidemiologist Dr. Kristy Bradley said five more pandemic flu deaths were reported in the state in the past week, but flu activity is slowing, with fewer flu-related hospitalizations and doctor visits. [Nov 20 Oklahoman report]

Glaxo recalls vaccine lot over allergic reactions GlaxoSmithKline has withdrawn a 170,000-dose lot of H1N1 vaccine distributed in Canada because of an unusual number of allergic reactions, CTV News reported today. Health officials reported six anaphylactic reactions to doses from the lot, versus an expected rate of only one or two, the story said. The company asked provinces to set aside the doses so it can test them. Manitoba's chief medical officer of health said the reactions were brief and all the patients recovered. [Nov 20 CTV report]

China responds to underreporting claim After one of China's top flu researchers, Zhong Nanshan, said the country might be underreporting its pandemic flu deaths, the Chinese health ministry said today that anyone concealing H1N1 fatalities would be severely punished, Reuters reported. Earlier this month the ministry adopted a new policy that deaths in patients with confirmed H1N1 would be attributed to the virus, even if they had other conditions. Zhong had said some facilities weren't testing for H1N1 in severe pneumonia cases. [Nov 20 Reuters story]

EU regulators OK single vaccine dose for most In a reversal of earlier advice, Europe's drug regulatory agency said today that a single dose of the approved adjuvanted H1N1 vaccines may be sufficient in most adults and older children. In October the agency had affirmed an earlier two-dose recommendation. But today regulators said a single dose can be used in adults between ages 18 and 60, and also in children from age 9 (for Focetria) or 10 (for Pandemrix). They said a single dose of Pandemrix is also sufficient for elderly people. [Nov 20 European Medicines Agency release]

Nov 19

First college flu deaths reported, but cases drop The American College Health Association (ACHA) today reported the first two deaths from flu-like illness in college students, but said new cases last week decreased 27% from the previous week. All but five states reported decreases. The report for the week ending Nov 13 said 21.3 new cases of flu-like illness per 10,000 students were reported. There were 12 hospitalizations among the 6,373 new infections. More schools reported access to vaccine, but in very small amounts. [ACHA report for week ending Nov 13]

Effectiveness of Chinese control measures debated H1N1 cases in China have risen sharply, despite aggressive quarantine measures, Dr. Michael O'Leary, the World Health Organization's top official in China, told the Associated Press. He said the 70,000 cases and 53 deaths cited by the government are only "minimum numbers." But China's health minister said the control measures helped buy time to develop a vaccine, which is now being given to 1.5 million people a day in an effort to cover 90 million--7% of the population--by the end of the year. [Nov 19 AP report]

Analysis reveals two genetic clusters of H1N1 viruses German researchers report in Eurosurveillance that a genetic analysis of 300 pandemic H1N1 viruses isolated earlier this year shows that "two closely related but distinct clusters" circulated in most countries simultaneously. Differences were found in the genes for the two surface proteins and four internal proteins. None of the differences involved parts of the genome responsible for known biological functions, and the importance of the findings remains to be determined, the report said. [Nov 19 Eurosurveillance report]

CDC campaigns for flu precautions for travelers The Centers for Disease Control and Prevention (CDC) today launched what it called its largest-ever public awareness campaign about avoiding illness while traveling, with a focus on H1N1. The agency will urge people to stay home if they are sick, get vaccinated against seasonal flu and against H1N1 if they are in a target group, and to use hygiene measures. The campaign will continue through the holidays and involve a wide range of media, with themes such as "Prevention can be travel-sized." [CDC travel health campaign page]

California reports two prisoners died of flu California officials reported two recent flu deaths in prisoners, one who died Nov 13 in a facility in the southern part of the state and one who died 4 days later in a central California prison, the AP reported yesterday. Preliminary tests confirmed influenza A, and federal officials have said circulating flu strains have been the pandemic virus. Final results are pending. Outbreaks have been reported at prisons, but few deaths have been reported. [Nov 18 AP story]

Spike in cases prompts Hungary to declare epidemic Hungarian officials declared a flu epidemic yesterday after illness reports rose more than 30% in a week, putting cases above the country's epidemic threshold, Agence France-Presse (AFP) reported yesterday. The number of flu hospitalizations rose to 172. Hungary launched a pandemic vaccine campaign in October using its own vaccine, which is based on a mock-up produced for the H5N1 virus. Children younger than 18 and people in high-risk jobs receive it for free. [Nov 18 AFP article]

Thai official says second wave starting The second round of the H1N1 epidemic has begun in Thailand, Public Health Minister Witthaya Kaewparadai said today, according to the Bangkok Post. He said 30% of 200 students tested in the northeastern province of Nakhon Ratchasima were infected. An estimated 8.4 million Thais were infected in the first wave of the outbreak, and the death toll reached 185 yesterday. Kaewparadai said the government bought 2 million doses of vaccine from France and is considering buying 800,000 more. [Nov 19 Bangkok Post report]

Nov 18

British patients skeptical about H1N1 vaccine Less than half of British patients who have been offered the pandemic vaccine accepted it, Reuters reported today. The findings were based on a poll of 107 family doctors conducted by Pulse magazine. Reasons included fear of side effects and views that the virus is mild. The doctors reported even less acceptance among pregnant women, a high-risk group. The UK government said it's too early to speculate on vaccine uptake rates. [Nov 18 Reuters story]

Canada reports few serious reactions to vaccine With 6.6 million doses of H1N1 vaccine given so far, Canada has seen only 36 serious adverse reactions, according to Dr. David Butler-Jones, the country's chief public health officer. He said one person died of an anaphylactic reaction, but it was not yet certain if the vaccine caused it, CTV News reported. Serious events have also included fevers and convulsions. Butler-Jones said 20% of Canada's 31 million people have been vaccinated, which he called the highest proportion of any country. [Nov 17 CTV News report]

Global Tamiflu-resistant cases detailed In a review of the global cases of oseltamivir (Tamiflu)-resistant H1N1 reported thus far, the European Centre for Disease Prevention and Control (ECDC) said the patients have been geographically dispersed and not linked and the viruses were all susceptible to the other common antiviral, zanamivir (Relenza). Of the 32 cases detailed, two factors may have played a role: reduced immunity and preventive antiviral therapy (prophylaxis). Three cases had no known history of exposure to oseltamivir. [Nov 18 ECDC review]

Santa groups air pandemic flu concerns Santa workers and volunteers are seeking ways to prevent novel H1N1 infection during the holiday season, the Associated Press (AP) reported. One trade group urged its members to use hand sanitizer and take vitamins and the public to keep sick children home. The president of another group asked state lawmaker to consider prioritizing Santa for H1N1 vaccine, given that many are exposed to sick children and are obese, which has been identified as a high-risk condition. [Nov 17 AP story]

Shortening sermons to fight flu Saudi Arabia's Ministry of Islamic Affairs has told Muslim preachers to keep their sermons short because of concern that the H1N1 virus may spread in crowded mosques, Deutsche Presse-Argentur (DPA) reported today. The ministry also instructed imams to use sermons to dispel rumors about how the virus spreads and to urge the faithful to observe good hygiene to prevent infection. [Nov 18 DPA report]

Nov 17

WHO says no virus mutation in Ukraine The World Health Organization (WHO) said today that preliminary tests reveal no significant changes in pandemic H1N1 viruses taken from patients in Ukraine. The WHO said that genetic sequencing done in Britain and the US on 34 samples shows that the virus is similar to the one used to make novel H1N1 vaccine, reconfirming the vaccine's efficacy. [Nov 17 WHO statement]

Novartis vaccine may protect with half the dose Novartis announced today that US clinical data suggest that half of the company's currently approved unadjuvanted pandemic H1N1 vaccine dose was protective in adults. The trials involve about 4,000 people. The company said it was discussing with US regulators whether reducing the antigen could stretch the vaccine supply. Novartis also said a trial of its MF59-adjuvanted pandemic vaccine showed a single dose was protective in children ages 3 to 8 and adults. [Nov 17 Novartis press release]

Study: H1N1 doesn't readily infect poultry US Department of Agriculture researchers report that the pandemic H1N1 virus does not easily infect poultry or spread among them. The researchers inoculated chickens, turkeys, ducks, and quail with the virus, they wrote in Emerging Infectious Diseases. Most of the birds showed no sign of infection; some quail were infected but did not pass the virus to other quail. The authors note that two turkey flocks in Chile were infected earlier this year, but those may have been isolated events. [Nov 16 letter in Emerg Infect Dis]

Spain, Greece start vaccinating Health officials in Spain and Greece said both countries launched their pandemic H1N1 vaccine programs yesterday, Agence France-Presse (AFP) reported. Spain bought 37 million doses and is giving first priority to high-risk groups, including pregnant women and health workers. Greece has 700,000 initial doses and is targeting health workers and others in high-risk jobs. Next week's priority group will include pregnant women and people with underlying conditions. [Nov 16 AFP story]

FDA grants emergency use for 2 rapid H1N1 tests The US Food and Drug Administration (FDA) recently authorized emergency use of two rapid tests for detecting novel H1N1 flu: ELITech's Molecular Diagnostics 2009-H1N1 Influenza A Virus Real-Time RT-PCR and Roche's RealTime Ready Influenza A/H1N1 Detection Set. The tests are designed for respiratory specimens, such as nasal swabs, taken from symptomatic patients. The FDA previously approved six other pandemic flu tests for emergency use. [FDA notices of approval]

Canada's public health offerings nicked by H1N1 efforts Diverse public health programs in Canada, such as support groups and food inspections, are being postponed or suspended as officials redirect staff to H1N1 vaccination efforts, a plan that has been in the works for months, according to a Toronto Globe and Mail story. Health authorities in several provinces have postponed non-flu vaccination programs and travel clinics, while others have limited the impact on public health programs by employing student or retired nurses. [Nov 16 Globe and Mail story]

China, WHO plan Beijing flu research center The WHO and China have agreed to open an influenza research center in Beijing to identify and share knowledge about new strains, officials announced today. Approval to open the center was given last week, when Chinese health officials met with WHO assistant director-general Keiji Fukuda. If the laboratory is designated a WHO collaborating center as planned, it would join a group of such labs in Atlanta, London, Tokyo, and Melbourne. [Nov 17 Bloomberg News report]

Nov 16

Study profiles Aussie hospital cases Australian researchers who studied hospitalized H1N1 flu patients in seven Melbourne hospitals from May to mid July report that 30 of 112 patients (27%) required intensive care and 3 died. Patients who had multifocal changes on chest x-rays were hospitalized longer and were more likely to need intensive care, according to the Medical Journal of Australia. Twenty-four patients had no known risk factors. Fifteen patients--a quarter of the women--were pregnant or in the postpartum period. [Nov 16 Med J Aust report]

Disparity between H1N1 and seasonal flu deaths explored A Canadian Press report probed the wide difference between the numbers of H1N1 flu deaths reported so far and the estimated toll from seasonal flu. Canada, with 4,000 to 8,000 flu-related deaths yearly, has 161 confirmed H1N1 deaths. Experts note that those numbers count different things, because only a small fraction of all seasonal flu-related deaths are directly attributed to flu. In most cases, flu contributes to death from such direct causes as bacterial pneumonia or heart attack. [Nov 15 Canadian Press story]

Public buy-in crucial in H1N1 response Mistrust in government and economic fears are two factors that would make it difficult to maintain social distancing during a pandemic, according to findings published today in the American Journal of Bioethics. The study was based on the results of focus groups in four Michigan cities. The authors said more intense efforts are needed to engage the public in pandemic planning. [Am J Bioeth study abstract]

WHO notes pandemic-related TB challenges Because many H1N1-related deaths have involved people with chronic respiratory conditions, the World Health Organization (WHO) recently issued a statement to alert tuberculosis (TB) program managers to possible "challenges and synergies" in the effort to control the two diseases. The statement stresses the importance of maintaining TB treatment during a pandemic and notes that lab services developed for TB control can be useful for pandemic H1N1 diagnostics and surveillance. [Nov 12 WHO statement]

Delays faulted in Ukraine's severe cases Factors such as delays in seeking medical care and getting antiviral medication to outbreak areas contributed to a sudden spike in severe flu-related pneumonia cases in the Ukraine, the New York Times reported. The late-October surge in flu-like illnesses prompted a WHO probe, which found the patterns in line with other countries. Doctors blame the news media and politicians for spreading misinformation, while others say a weak healthcare system played a role. [Nov 13 New York Times story]

Switzerland, France OK H1N1 vaccines Novartis announced that Swiss regulators approved its adjuvanted cell-culture pandemic H1N1 vaccine, which was previously licensed by Germany. In clinical trials a single dose containing 3.75 mcg of antigen and 0.125 mcg of MF59 adjuvant provoked a strong immune response. The vaccine is cleared for use in people ages 3 years and older. Also, Sanofi said French regulators approved its unadjuvanted H1N1 vaccine. [Nov 13 Novartis press release]

Pandemic flu detected in North Korea In what may be the first pandemic H1N1 virus detection in North Korea, a man from South Korea got sick with the flu while working across the border at an industrial complex, the Korea Times reported today. The man was diagnosed in South Korea, where the country's unification ministry announced the case today. South Korea reported the case to North Korea and advised it to check all North Korean workers at the industrial complex. [Nov 16 Korea Times story]

Nov 13

Most flu-stricken health workers not infected at work Most healthcare workers who have contracted H1N1 influenza were exposed to the flu in their households and community, not in their healthcare institutions, according to testimony Friday before the National Biodefense Science Board (NBSB). The board, chartered by the Department of Health and Human Services, was meeting to discuss mental health, healthcare strain and vaccine supply in the H1N1 pandemic, including how much personal protective equipment health workers require. [Nov 13 NBSB agenda]

WHO unveils pandemic guide for mass gatherings The World Health Organization (WHO) today issued an interim guide for mass gatherings during a pandemic. Among risk-assessment points, it urges planners to pay close attention to local virus circulation, length of the event, age of participants, and healthcare capacity. To reduce transmission, advising sick people to stay away from the event is a key task, along with isolating ill people, avoiding travel when sick, and reducing crowding in areas such as dining halls, the WHO said. [WHO guidance]

Canada OKs one vaccine dose for 3- to 9-year-olds The Public Health Agency of Canada said yesterday that one dose of adjuvanted H1N1 vaccine is sufficient for healthy children ages 3 through 9 years. The agency called for two doses 21 days apart for children from 6 months through 2 years old and for those 3 through 9 years who have chronic health problems. The recommendations are based on clinical trial findings from Europe. In October, WHO experts suggested one dose is enough for children under 10, but US health officials recommend two doses. [Nov 12 Canadian announcement]

Hispanics in Texas hit hard by H1N1 An analysis by Texas health officials finds that the state's Hispanics are being hit disproportionately hard by H1N1 flu, the Houston Chronicle reported. Hispanics make up 37% of the population but accounted for 52% of the 95 H1N1-rlelated deaths through Oct 17. Several risk factors for severe H1N1 disease, including pregnancy, diabetes, and possibly obesity, are more common among Hispanics, said Dr. Joseph McCormick of the University of Texas School of Public Health in Brownsville. [Nov 13 Houston Chronicle report]

France reports GBS in vaccinated health worker France's health ministry said yesterday that a young female healthcare worker was diagnosed with mild Guillain-Barre syndrome (GBS) 6 days after she received a pandemic flu vaccine, Deutsche Presse-Argentur (DPA) reported today. Hers is one of very few cases that have been reported in H1N1 vaccine recipients. The DPA report said 1,700 GBS cases are reported in France each year and that an October poll showed 17% of French respondents planned to get vaccinated against the pandemic virus. [Nov 13 DPA story]

Nov 12

Lancet study: Seasonal flu shot may protect against H1N1 Contrary to most other reports, a study of H1N1 flu cases in Mexico, published in The Lancet, suggests that seasonal flu vaccine may have had a protective effect. Researchers examined data on 69,479 patients who sought treatment for flu-like illness. H1N1 was confirmed in 11% of cases; 56% of those were in people between 10 and 39 years old. Risk of infection was 35% lower in those who had received seasonal flu vaccine (odds ratio, 0.65; 95% confidence interval, 0.55 to 0.77). [Lancet report summary]

CDC study finds no protective effect of seasonal flu shot A study by the Centers for Disease Control and Prevention (CDC) found no evidence that seasonal flu vaccine was protective against the H1N1 virus. The CDC compared the vaccination coverage among 356 H1N1 case-patients in eight states with the estimated population coverage in those states. Overall vaccine effectiveness was found to be minus-10% but varied widely by age-group. The results, combined with others, suggest that seasonal flu vaccine neither raises nor lowers the risk of H1N1 infection. [Nov 13 MMWR article]

Researchers detail lung damage in fatal cases Autopsies of 15 Mexican patients who died of suspected novel H1N1 infections found the virus in 5 of them, of which 4 were young adults, doctors reported in a New England Journal of Medicine letter. Lung tissue was heavier than normal and solid. Four had upper-airway hallmarks seen in seasonal flu cases, but all five had pulmonary damage and interstitial lesions typically seen with H5N1 infections. Two patients showed evidence of other organ involvement seen in lethal H5N1 cases. [Nov 12 N Engl J Med letter]

Philadelphia hospital reports unusual rhinovirus outbreak Tests at Children's Hospital in Philadelphia found that rhinovirus infections, unusually severe with lower-respiratory symptoms, have been responsible for nearly half of flulike illnesses diagnosed at the institution this fall, the Philadelphia Inquirer reported today. The hospital routinely tests for both and saw rhinovirus activity rise before and after the flu season started. Researchers from the CDC are investigating the findings. [Nov 12 Philadelphia Inquirer story]

Colleges see small rise in flu-like illnesses For the week ending Nov 6, US colleges reported 29 new cases of flulike illness per 10,000 students, a 1% increase from the previous week, the American College Health Association (ACHA) reported today. There were 15 hospitalizations among the 8,951 new flulike illnesses. The ACHA said no deaths have been reported so far and that though the illness pattern seems to be mild so far, it hopes H1N1 vaccine becomes more widely available to blunt the pandemic's impact on students. [ACHA report for week ending Nov 6]

FDA approves use of CSL's H1N1 vaccine in children The US Food and Drug Administration (FDA) has approved the use of CSL Biotherapies' 2009 H1N1 flu vaccine in children aged 6 months through 17 years, the company announced yesterday. The injectable vaccine was approved for adults in September. The formulation for children is available in thimerosal-free, single-dose syringes, the company said. [FDA information about CSL vaccine approval]

Officials say China's aggressive flu-control measures helped Chinese and foreign health officials say the aggressive?and widely protested?quarantine measures China has used to fight the H1N1 virus may have helped slow the disease, according to the New York Times. Although cases have mounted recently, China has not yet had a major epidemic. The director of the World Health Organization's Beijing office said China's control measures have worked "very well." The US Embassy said 2,046 Americans had been quarantined in China through October. [Nov 11 New York Times report]

Vaccine shortages reported in Canada, UK H1N1 vaccine clinics in Ottawa, the Canadian capital, are scheduled to close tomorrow because of a vaccine shortage, CBC News reported yesterday. The city health department said almost 190,000 people, or 22% of the population, would be vaccinated by tonight. Meanwhile, some large medical practices in the United Kingdom were running out of vaccine, as they received the same initial 500-dose allotment as small practices, according to the Pulse, a magazine for British general practitioners. [Nov 11 CBC News report]

Nov 11

FDA approves Glaxo's H1N1 vaccine GlaxoSmithKline (GSK) said yesterday it received US Food and Drug Administration (FDA) approval of its pandemic H1N1 influenza vaccine. The government has ordered 7.6 million doses of the unadjuvanted vaccine, and plans call for shipping all the doses in December, the company said. The vaccine will be produced in multidose vials at the GSK plant in Quebec. The other four companies providing H1N1 vaccine to the US government received their FDA approvals in September. [Nov 11 GSK news release]

FDA head advocates for pandemic vaccine FDA Commissioner Margaret Hamburg, MD, sent a letter to physicians yesterday thanking them for their patience in dealing with pandemic vaccine delays and highlighting the important role they play in preventing serious illnesses and deaths from novel H1N1 flu. The letter describes how the vaccine is made and how officials are monitoring safety. Though most physicians support vaccination, some say they hesitate to get vaccinated themselves or recommend it to patients. [Nov 10 FDA press release]

Father of sick boy develops oseltamivir-resistant H1N1 Canadian doctors today described a case of oseltamivir-resistant pandemic H1N1 flu in a father who underwent prophylaxis then developed flu symptoms after his son was diagnosed with a confirmed infection. In a letter in today's issue of the New England Journal of Medicine, the doctors wrote that their findings support limits for once-a-day postexposure prophylaxis and suggest that patients who develop flu symptoms during prophylaxis immediately start taking the twice-daily treatment dose. [Nov 11 N Engl J Med letter]

Online tool helps locate flu shots A collaboration among Google, the American Lung Association, and the US Department of Health and Human Services has produced a searchable interactive map that displays government and private offices where seasonal and H1N1 vaccines are available, including location and contact details. The tool currently covers chain pharmacies in 50 states and health agencies in 20 states, with more data being added. [Google FluShot]

Canada's plan to vaccinate Afghan detainees draws fire Canada's military said it would vaccinate Afghan detainees against H1N1 on a case-by-case basis, but none of the suspected Taliban members had yet been vaccinated, the Toronto Star reported today. The plan drew objections from Canada's health minister and from Prime Minister Stephen Harper. Meanwhile, the Miami Herald said the US government shipped 300 vaccine doses to the Navy base at Guantanamo for high-risk personnel such as healthcare workers, but not for prisoners. [Nov 11 Toronto Star report]

Pandemic deaths doubling weekly in Europe Deaths caused by the novel H1N1 flu have doubled in the European Union (EU) in 3 of the past 4 weeks, Bloomberg News reported today. Drawing on data from the European Centre for Disease Prevention and Control, the news agency said the number of deaths per week rose over the past month from 12 to 24 to 49 to 43 and then to 84, with a total of 414 in the EU and European Free Trade Association. [Nov 11 Bloomberg News story]

CDC urges pneumococcal vaccine for risk groups The US Center for Disease Control and Prevention (CDC) yesterday sent a letter to healthcare providers warning that pneumococcal infections have been seen in some fatal pandemic H1N1 cases and reminding them to offer the pneumonia vaccine to those who are currently recommended to receive them. It urged special emphasis on vaccinating those under age 65 who have high-risk conditions, because coverage rates are especially low and they may be more likely to develop secondary bacterial infections. [Nov 10 CDC letter]

GBS reported in boy who received H1N1 vaccine A 14-year-old Virginia boy developed symptoms of Guillain-Barre syndrome (GBS) within 18 hours of getting a pandemic vaccine, MSNBC reported today. His mother had taken him to the health department to receive the seasonal shot, where they also offered the H1N1 vaccine. It's not clear if the boy received both. The CDC said five GBS cases have been reported so far, not including the boy's. It said the rate is less than expected; 80 to 120 cases are reported in the general population each week. [Nov 11 MSNBC story]

Nov 10

Vaccine maker donates 50 million doses Pharmaceuticals manufacturer GlaxoSmithKline will donate 50 million doses of H1N1 vaccine to the World Health Organization (WHO) for distribution to countries that cannot afford to buy it, the WHO said today. The agency said that 95 countries are eligible to receive the vaccine and it hopes to procure enough vaccine to cover 10% of their populations. [Nov 10 WHO statement]

Flu worries reduce blood donations Blood-donation centers across the United States are reporting unusually low levels of donations thanks to H1N1 flu, according to the Wall Street Journal. Some school and corporate blood drives have been canceled because of absenteeism, while in other areas regular donors are ill. In addition, donated blood must be discarded under federal rules if donors come down with flu symptoms shortly after donation. [Nov 10 Wall Street Journal story]

More Americans blame drug makers for flu-shot shortage Slightly more Americans hold vaccine manufacturers responsible for shortages of flu vaccine, compared with the percentage who blame the government, USA Today reported. A telephone poll of 1,500 adults conducted last weekend found that 62% of respondents place blame on drug companies versus 58% who blame government policies. Among respondents, 17% tried and failed to get a flu shot, while 19% did not try because they believed no vaccine was available. [Nov 9 USA Today story]

Ukraine cases top 1 million Ukraine's deputy health minister said the nation's epidemic of flu and other acute respiratory illnesses has now affected more than a million people, Agence France-Presse (AFP) reported today. Vasyl Lazoryshynets said the death toll from the epidemic had risen to 174. Nearly 53,000 Ukrainians have been hospitalized, he said, but the number in intensive care has fallen by nearly a quarter to about 330. Sixty-seven confirmed H1N1 cases have been reported, 14 of them fatal, he said. [Nov 10 AFP report]

H1N1 reported in 29 African countries Twenty-nine countries in Africa have reported confirmed pandemic H1N1 flu cases so far, totaling 14,868 illnesses, with 103 deaths, the WHO Regional Office for Africa reported. The vast majority of the confirmed cases were reported by South Africa, with 12,619 cases, the agency said. The numbers show an increase from the 14,109 cases and 76 deaths previously reported through Nov 1. The number of confirmed cases greatly underestimates actual cases. [WHO African region report]

UAE pilgrims must be immunized before hajj A newspaper in the United Arab Emirates (UAE) has reported that everyone going on the annual Muslim pilgrimage (hajj) to Mecca must be vaccinated against H1N1 flu before leaving, AFP reported today. Pilgrims can be vaccinated at four centers in Dubai and 30 elsewhere in the country. The hajj will take place in the last week of November. [Nov 10 AFP report]

Flu spread spurs China to boost vaccine efforts China is stepping up its H1N1 vaccination drive after cases increased by about 5,000 and the death toll rose from 16 to 30 over the past 3 days, AFP reported today. The health ministry numbered confirmed cases at 59,478 and said 240 people were in critical condition. Calling the increase in cases "alarming," health ministry spokesman Mao Qunan said the government has ordered increased vaccine production and immunizations. As of yesterday, 8.7 million Chinese had been vaccinated. [Nov 10 AFP report]

Nov 9

Studies to test steroids, statins for H1N1 Researchers in Canada, the United States, and France are planning studies to find out if corticosteroids or cholesterol-lowering statins could help the sickest H1N1 flu patients, the Canadian Press reported. Networks of intensive care specialists are setting up randomized controlled trials, said Dr. John Marshall, chair of the Canadian Critical Care Trials Group. Interest in using statins in flu patients has been spurred by the writings of retired American virologist Dr. David Fedson. [Nov 8 Canadian Press story]

GSK reports good results with co-administered vaccines Older adults who were given GlaxoSmithKline's pandemic H1N1 and seasonal flu shots at the same time generated a good immune response to both vaccines, GSK reported today. The company said 168 people over age 60 received one injection in each arm, and 89% showed an immune response to an adjuvanted formulation of Pandemrix, the novel H1N1 vaccine. Immune responses to the three strains in the seasonal flu shot were seen in 69% (seasonal H1N1), 79% (H3N2), and 100% (type B) of volunteers. [Nov 9 GSK press release]

Flu-like cases in Ukraine near 1 million Ukraine has had 936,804 cases of flu-like illness and 144 deaths since pandemic H1N1 emerged there in mid October, KyivPost, the online version of a Ukrainian English-language newspaper, reported. The number of cases exceeds the epidemic threshold in 16 of the country's 27 regions. A World Health Organization (WHO) team continued its investigation of the outbreak over the weekend, the WHO said. [Nov 8 KyivPost report]

Russia gives first vaccine doses to utility workers Russia launched the first stage of its pandemic H1N1 vaccine campaign today, giving its first doses to workers in utilities such as water, electricity, and communications, Itar-Tass reported. The health ministry said the next priority group will be medical workers and those in medical schools, followed by those who have underlying medical conditions, pregnant women, and children. The country has approved four vaccines and has so far purchased 43 million doses. [Nov 9 Itar-Tass story]

Belgium, Austria, France vaccinate high-risk groups Belgium on Nov 7 started vaccinating high-risk groups against the pandemic H1N1 virus, Agence France-Presse (AFP) reported. The country has sent 1 million doses to doctors' offices in an effort to reach the vulnerable groups. Meanwhile, Austria and France today started vaccinating high-risk groups with initial supplies, amounting to 1.6 million doses in Austria and 6 million in France, according to media reports. All three countries had already started immunizing healthcare workers. [Nov 7 AFP story]

Bulgaria closes schools, enacts social distancing Bulgaria's health ministry on Nov 6 declared a flu epidemic, which triggered a 1-week school closure and other social distancing measures, AFP reported. The country also suspended hospital visits and prescheduled surgeries. Though the ministry didn't close theaters or other public venues, it urged citizens to avoid crowds. Flu epidemics had already been declared in 16 of the country's 28 regions, including the capital, Sofia. [Nov 6 AFP story]

WHO counters homeopathic vaccine advice in pregnancy A WHO official criticized the Swiss Society of Homeopathic Physicians for advising pregnant women to avoid getting vaccinated against H1N1, the Associated Press (AP) reported Nov 7. Marie-Paule Kieny, director of the WHO's Initiative for Vaccine Research, said the advice could put pregnant women and their babies at risk for severe consequences. The WHO's vaccine advisory group has said the two adjuvanted vaccines licensed in Switzerland are safe for use in pregnant women. [Nov 7 AP story]

Pandemic guide for HR professionals released A guide for human resource (HR) managers looking for ways to quickly plan for and respond to the H1N1 pandemic has been issued by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, and the Society for Human Resource Management. The free 42-page guide was prepared with support from the Centers for Disease Control and Prevention. It includes lessons learned by HR professionals whose response skills were tested in the early days of the pandemic. [Pandemic toolkit]

Nov 6

WHO: Global flu transmission persists In its weekly update today, the World Health Organization (WHO) said intense, persistent H1N1 flu transmission continues in North America with an unusually early flu season under way across Europe and central and western Asia. Countries in northern and eastern Europe, as well as eastern Russia, are seeing increasing activity. Mongolia, China, and Japan are reporting surges in cases. Seasonal H3N2 viruses are waning, though some have been detected recently in sub-Saharan Africa. [Nov 6 WHO pandemic update]

HHS orders IV antiviral drugs The US Department of Health and Human Services (HHS) announced yesterday that it has awarded contracts for up to 120,000 treatment courses of intravenous (IV) antiviral drugs to help treat hospitalized novel H1N1 patients. HHS ordered 10,000 courses each of IV oseltamivir, zanamivir, and peramivir, totaling $31.5 million, with possible additional orders of up to 30,000 additional courses for each drug over 2 years. [Nov 5 HHS statement]

Poland takes anti-vaccine stand Poland will not buy H1N1 vaccine that has not been properly tested or from manufacturers that won't take responsibility for side effects, Prime Minister Donald Tusk said today. Tusk said that vaccine producers were pressuring governments to buy but without taking responsibility for possible negative effects, according to the Associated Press (AP). He said expectations are to spend hundreds of millions of dollars on vaccine "while no one wants to guarantee that it has no side effects." [Nov 6 AP article]

All Beijing to get H1N1 vaccine Beijing health officials said today that they would extend H1N1 vaccine from high-risk citizens to all the city's 16 million residents as the H1N1 death toll in the country rises, according to Xinhua, China's news agency. The city will offer free vaccine to all people older than 3 years. A public health official said Beijing now has 3.63 million doses but will receive more. [Nov 6 Xinhua story]

H1N1 found in 160 Chinese piglets More than 100 piglets on a farm in Chinese Taipei have tested positive for pandemic H1N1 flu, according to a report filed with the World Organization for Animal Health (OIE). Of 3,346 piglets on the farm in T'ai-Tung County, 160 started showing clinical signs such as coughing and diarrhea on Oct 19, and tests revealed H1N1 flu. The sick pigs have recovered, and swine farms within a 3-km radius are being monitored. [Nov 5 OIE report]

WHO: H1N1 in animals needs monitoring Pandemic H1N1 virus infections in pigs, turkeys, and other animals underscores the need for close monitoring but have not changed pandemic dynamics, the WHO said yesterday. Limited evidence suggests the pig illnesses followed human transmission to pigs, and as human infections increase, the WHO said it expects to receive more reports of animal H1N1 infections. A novel H3N2 virus found recently in Danish minks did not spread to humans but signals a need for increased vigilance. [Nov 5 WHO statement]

Nov 5

CDC urges states to focus vaccine on risk groups CDC Director Tom Frieden, MD, sent a letter today to states commending them for their efforts to distribute pandemic vaccine when demand exceeds supply but emphasizing that the scarce supplies should first go to priority groups. He warned that giving early doses to those outside high-risk groups could undermine public health credibility. A spokesman said the CDC doesn't see confusion over allocation as widespread, but it wanted to underscore the importance of vaccinating vulnerable groups. [Nov 5 CDC letter]

Flu-like illnesses on US campuses up 2% The American College Health Association (ACHA) says its member schools had 28.6 new cases of flu-like illness per 10,000 students last week, a 2% increase from the week before. New cases at the 274 schools totaled 9,128. Forty-three percent of the colleges (117 of 274) had H1N1 vaccine on hand, but only about 1% of the students have been vaccinated so far, the association said. [ACHA report for week ending Oct 30]

Virus found in Hong Kong pork samples Two pork samples from a Hong Kong slaughterhouse have tested positive for the pandemic H1N1 virus, Hong Kong's Food and Health Bureau reported today. Experts believe the virus spread to the pigs from humans. The risk of humans contracting the virus has not risen, officials said. Yesterday the World Organization for Animal Health (OIE) said recent detections of the virus in animals are not surprising and animals do not seem to be spreading the virus among humans. [Nov 5 Hong Kong press release]

Poll: 52% of Americans likely to get H1N1 vaccine Fifty-two percent of respondents in a national McClatchy-Ipsos poll said they are likely to get the H1N1 vaccine, while 47% said they are unlikely to get it, according to a McClatchy Newspapers report. In other findings, 63% of respondents said they were concerned about the virus, and 65% said they thought the Obama administration had done everything it could to provide the vaccine in time. The poll involved 1,077 people and had a sampling error margin of 3%. [Nov 3 McClatchy report]

Germany approves cell-based pandemic vaccine German drug regulators have approved Novartis's cell-culture pandemic H1N1 vaccine, becoming the first country to clear a cell-based version, the company announced today. The vaccine, made in Marburg, Germany, contains 3.75 micrograms of antigen and an MF95 adjuvant. It is approved for those 6 months old and older. Studies found a single dose provoked a good immune response with no unexpected safety or tolerability concerns. Novartis is building a second cell-culture plant in the United States. [Nov 5 Novartis press release]

CDC issues guidance for swine farm workers The CDC yesterday issued interim guidance on pandemic flu prevention for swine farm workers. It warns that people and pigs can transmit the virus to each other and explains how to recognize flu signs in pigs. The guidance reviews hand hygiene and reminds workers that pig immunizations might not protect the animals from all circulating flu strains. The CDC urges that workers exposed to potentially sick pigs be required to wear protective equipment. [Nov 4 CDC interim guidance]

Defense department receives first vaccine doses The US Department of Defense (DOD) has started receiving its pandemic H1N1 vaccine and will start vaccinating in the coming weeks. Though vaccination with seasonal and pandemic vaccine is mandatory for service members, the DOD expects initial shipments to be limited. Officials said they will vaccinate high-risk groups while also maintaining mission readiness. Deployed troops, basic training locations, service academies, and healthcare workers will also receive the first of the DOD's doses. [Nov 4 DOD press release]

Nov 4

Norway OKs OTC antiviral sales To ease response to the H1N1 pandemic, Norway is allowing over-the-counter sales of oseltamivir (Tamiflu) and zanamivir (Relenza), the Associated Press (AP) reported. The new policy starts tomorrow and is in effect until the middle of 2010. Norway has ordered 9.4 million doses of vaccine, but the manufacturer has reportedly not produced enough to meet demand. [Nov 3 AP story]

EU asked to help with Ukraine outbreak Poland's prime minister called on the European Union to help respond to the flu threat in the Ukraine, and another official warned that the virus could spread rapidly in eastern Europe, Reuters reported yesterday. The Ukrainian health ministry said today that 86 people have died of respiratory illnesses, five of them from the pandemic virus, the National News Agency of Ukraine reported today. A global team is in the country to help assess the outbreak, which has hit western regions hardest. [Nov 3 Reuters story]

Flu hits remote Amazon tribe Pandemic flu has struck an isolated Amazon Indian tribe over the past 2 weeks, killing 7 and sickening about 1,000 people, Reuters reported today. The outbreak in the Yanomami tribe, who live in an isolated area at the Venezuela-Brazil border, was described in a statement from Survival International, an indigenous people's rights group. The group's director said the situation requires immediate response from the two governments. Venezuela has reportedly sent a medical team. [Nov 4 Reuters story]

US officials say terror suspects not set to get vaccine White House officials yesterday denied reports that terrorism detainees at Cuba's Guantanamo Bay prison would soon receive the pandemic H1N1 vaccine, the AP reported. An earlier report from a jail official that said detainees and guards would soon get the vaccine provoked an outcry that terror suspects would get their doses before most Americans. However, White House spokesman Robert Gibbs said no vaccine is at the facility, and none is on its way. [Nov 3 AP story]

Pain relievers may blunt vaccine response Taking pain relievers such as ibuprofen or aspirin to reduce the pain of flu injections appears to blunt immune response, researchers from the University of Rochester Medical Center (URMC) reported recently at a conference. They found the association across a range of vaccine and pain relievers. They say that cyclooxygenase 2 inhibitors block optimal production of B lymphocytes, which make antibodies. Czech researchers recently found that acetaminophen weakened infants' response to vaccines. [Nov 3 URMC press release]

Iowa cat tests positive for pandemic flu A 13-year-old Iowa house cat was recently diagnosed as having novel H1N1 after two of its three owners were sick, the Iowa Department of Public Health (IDPH) reported today. Iowa's public health veterinarian Dr Ann Garvey said the cat and its owners have recovered and that people should remember to protect family pets from illnesses. The American Veterinary Medical Association said it is the first pandemic virus isolation in a cat, and it doesn't appear the cat spread the virus. [Nov 4 IDPH press release]

Canada exports excess vaccine antigen Canada's chief public health officer, Dr David Butler-Jones, said yesterday that the country's Glaxo plant has exported excess bulk pandemic H1N1 vaccine antigen, the CTV and the Canadian Press reported today. Sources did not say how much antigen had been produced. Butler-Jones said domestic fill-and-finish operations have not yet been able to package all the already-produced antigen for the Canadian market. He said the export would not slow vaccine delivery to Canadians. [Nov 4 CTV story]

Nov 3

Vaccine production reaches 31.8 million doses Total H1N1 vaccine availability today reached 31.8 million doses, said US Centers for Disease Control and Prevention (CDC) Director Dr. Thomas Frieden at a briefing, up 1.8 million doses from yesterday. "We are therefore on track to hit the 10 million increase that we had been hoping for" this week, though the total is far from satisfactory, he said. He declined to predict when the US will give vaccine doses to developing countries, saying it will depend on clarification of production. [CDC H1N1 information]

Uptake of seasonal flu vaccine may set record This year's uptake of seasonal flu vaccine is "unprecedented" and may set a record, said CDC Director Dr. Thomas Frieden at today's H1N1 news briefing. The CDC expects that 114 million doses will be distributed by the end of the year, but the demand may be greater still, he said. He also said there are signs of a higher vaccination rate than usual among healthcare workers, who usually have only about a 40% immunization rate. [CDC H1N1 information]

Virginia takes steps to keep voters healthy Election officials in Virginia, whose citizens vote for governor today, among other offices, are taking steps to avoid transmitting H1N1 influenza. According to the Associated Press (AP), voters will have hand sanitizer available at the polls and possibly cotton swabs or disposable coffee stirrers so they can avoid contact with touch-screen machines. Some sites also have backup election workers on standby. [Nov 3 AP story]

Indiana pigs get pandemic flu The US Department of Agriculture (USDA) yesterday reported that four samples from Indiana pigs tested positive for pandemic H1N1 influenza. The samples were collected on Oct 22. Indiana's state veterinarian said in a statement yesterday that the animals have recovered and are being monitored. He said workers who had contact with the animals had been sick with flulike symptoms before some of the pigs became ill. [Nov 2 USDA report]

GSK vaccine gets Saudi approval The Saudi Food and Drug Authority approved GlaxoSmithKline's H1N1 vaccine yesterday, according to Reuters, as the kingdom readied for more than 2 million pilgrims at this month's Islamic hajj. The vaccine is distributed under the Pandemrix brand. [Nov 3 Reuters story]

South African panel favors novel H1N1 in seasonal vaccine South Africa's National Institute of Communicable Diseases has recommended that South Africa include the pandemic H1N1 virus in its seasonal flu vaccine for next year, according to News24, a South African online news service. Barry Schoub, director of the institute, said it would be up to the nation's health department whether to follow the advice. Reports did not clarify whether the pandemic virus would replace the seasonal H1N1 strain in the vaccine or be added to it. [Nov 2 News24 report]

FDA issues guidance on diagnostic tests The US Food and Drug Administration (FDA) published guidance yesterday to help manufacturers develop diagnostic tests for the novel H1N1 influenza virus. Manufacturers of tests can submit a request to the FDA for an Emergency Use Authorization (EUA). If granted, the EUA will allow the test to be used during the H1N1 pandemic. No H1N1 test is currently approved or cleared by the FDA. [Nov 2 FDA news release]

Nov 2

Canadian advisors push seasonal vaccine Canada's vaccine advisory group yesterday recommended against delaying seasonal flu shots, a move that many provinces made after an unpublished study suggested the vaccine might raise the risk of contracting pandemic flu, the Canadian Press reported. The panel concluded that even if the finding is valid, the risk of skipping the seasonal shot outweighs the risk seen in the studies. The group also endorsed giving both seasonal and H1N1 shots at the same time. [Nov 1 Canadian Press story]

Canada's H1N1 vaccine production lags GlaxoSmithKline is expected to ship far fewer doses of H1N1 vaccine to Canadian provinces this week than was expected, prompting provinces to postpone the rollout of the vaccine for at least 2 weeks, the Toronto Globe and Mail reported. The company was expected to ship 436,000 doses this week, instead of the roughly 2 million previously anticipated, because it had to interrupt production to make an unadjuvanted version of the vaccine for pregnant women, the story said. [Oct 30 Globe and Mail report]

Saudi Arabia to vaccinate hajj participants Saudi Arabian health officials said the country will immunize healthcare workers, hajj workers, and domestic pilgrims who will attend the hajj against the pandemic H1N1 virus, Agence France-Presse (AFP) reported today. Vaccination won't be mandatory. About 1 million residents typically attend the hajj, which peaks near the end of November this year. The country recently received the first 11 million doses of its pandemic vaccine order. [Nov 2 AFP story]

Turkey launches vaccination campaign Turkey today launched its pandemic vaccination campaign with healthcare workers receiving the first doses, Today's Zaman, an English-language newspaper based in Istanbul, reported. The country received its first 500,000 doses last week. The next groups slated to be immunized are the morbidly obese, pregnant women, children younger than 2, those with chronic lung or heart conditions, and people older than age 65. [Nov 2 Today's Zaman report]

Afghanistan closes all schools The Afghan government yesterday ordered the closure of all schools for 3 weeks in the wake of the country's first death from H1N1 flu, AFP reported. Education Minister Farouq Wardak said the closure was ordered "to safeguard the health of all Afghans." An engineer from Kabul was the flu's first victim in Afghanistan. [Nov 1 AFP report]

Oct 30

NY declaration expands vaccinator pool New York governor David A. Paterson yesterday declared a state emergency to permit more health workers to give H1N1 flu vaccinations. Normally only physicians, nurses, and nurse practitioners can do so; the declaration will enable physician assistants, dentists, some dental hygienists, and emergency personnel to participate, the state said in a news release. The action--requested by local governments--also authorizes school-based health centers to vaccinate adults and children. [Oct 29 New York state release]

Do seasonal flu shots open kids more to pandemic flu? Dutch scientists suggest that vaccinating children against seasonal flu may make them more vulnerable to pandemic flu strains, according to a Canadian Press report. In a journal article, the scientists wrote that shielding children from the need to generate immunity to actual seasonal viruses might leave them more vulnerable to pandemic strains. But other experts, while not necessarily agreeing, say it's better to protect children from an annual threat than one they may face every few decades. [Oct 29 Canadian Press report]

WHO: flu rates up in Europe, parts of Asia Though pandemic activity continues to intensify in North America, several European countries are reporting high rates of flu-like illness and pandemic virus detections, including Iceland, Ireland, the United Kingdom, Belgium, and the Netherlands, the World Health Organization (WHO) reported today. Many other countries in Europe and western and central Asia are reporting early flu transmission. Flu activity is up sharply in Japan. At least 5,712 deaths have been reported, up 713 from last week. [Oct 30 WHO pandemic update]

Swiss officials restrict GSK vaccine in some Swiss regulators today restricted the use of an adjuvanted pandemic H1N1 vaccine made by GlaxoSmithKline in pregnant women, children, and people older than 60, Agence France-Presse (AFP) reported. The agency held back its authorization for the groups because it has little data on the vaccine's use in children and no data for pregnant women. It endorsed one of two pandemic vaccines made by Novartis and is still examining the company's cell-based pandemic vaccine. [Oct 30 AFP story]

Oct 29

Flu activity rebounds at many colleges Flu activity at US colleges has increased significantly, showing spikes even in some areas such as the southeast that have reported decreases over the past few weeks, the American College Health Association (ACHA) said yesterday. The Midwest, mid Atlantic, and northeast regions also showed unexpected rebounds. The report for the week ending Oct 23 said the rate of flu-like illnesses on member campuses was 28 per 10,000 students, up 34% from the week before. [Oct 28 ACHA surveillance report]

Feds address spot liquid Tamiflu shortages In response spot shortages of the pediatric liquid suspension version of Tamiflu, an official from the US Centers for Disease Control and Prevention (CDC) said today at a media briefing that on Oct 1, 300,000 bottles from the national stockpile were shipped to states. The CDC said more pharmacy chains are compounding the medication and that parents can mix crushed pediatric capsules with a spoonful of, for example, chocolate syrup. [CDC info on mixing Tamiflu capsules, liquid]

Novartis: US vaccine order is on track Novartis said today it is on track to produce 90 million units of bulk pandemic vaccine antigen to the US market, enough for 60 million doses. It expects multidose and prefilled vial deliveries to reach 25 to 30 million by the end of November. The company has shipped 7.5 million doses. Novartis said early vaccine yield was low, but a new seed strain it began using in mid September is getting a 63% yield. The CDC said today that total US H1N1 vaccine received is now at 24.8 million doses. [Oct 29 Novartis media release]

Lack of parental OK slows NYC school vaccinations Fewer than half of New York City parents with children in elementary school have signed consent forms for their children to receive H1N1 vaccine at school, the New York Times reported. Health officials had no citywide figure but said between 5% and 50% of parents have given permission. Possible reasons for parents' reluctance may include vaccine safety concerns and the assumption that some children had the virus in the spring and are now immune. [Oct 29 New York Times story]

US student absenteeism, school closings climb The number of students home sick with the flu and the number of school closings have been climbing steadily, the Associated Press (AP) reported. By the end of last week, the number of closed schools reported by the US Department of Education reached 351, affecting 125,000 students. Officials suspected that many closing have not been reported. One especially hard-hit school was St. Charles East High in suburban Chicago, where 800 of 2,200 students were absent. [Oct 28 AP story]

Some Canadian docs slow to join vaccination effort Family physicians in parts of Canada have been slow to sign up to give H1N1 vaccinations, citing various obstacles, the Canadian Press reported. In Ontario, some doctors have been deterred by a requirement that they order vaccine in 500-dose lots, while others objected to a demand that they provide a weekly record of every dose delivered. Some provinces are not asking family doctors to help launch the vaccination drive and instead are focusing on mass immunization clinics. [Oct 28 Canadian Press report]

Uncertain timing clouds UK vaccine campaign General practitioners in Britain have said it could take weeks for them to receive H1N1 vaccine supplies, leaving those in priority groups uncertain about when they can be vaccinated, the Daily Express reported. Healthcare workers and hospital patients received their doses last week, and it was expected that vaccination of other priority groups would begin this week. But many doctors have not yet received their doses and don't know just when they will come. [Oct 29 Daily Express report]

China sees tough flu fight ahead Chinese government sources said flu activity is spiking in many parts of the country and clusters of illnesses are occurring in schools, Agence France-Presse (AFP) reported today. China's state council said the country's challenge is grim. The assessment was prompted by the death of a student at a university in Beijing where other students were ill. The fatality is China's fourth from the pandemic H1N1 virus. [Oct 29 AFP story]

Oct 28

WHO experts tackle H1N1 vaccine questions The World Health Organization's (WHO's) immunization experts today discussed issues related to the H1N1 vaccine, according to its agenda. The Strategic Advisory Group of Experts (SAGE) was asked if epidemiologic or vaccine-availability issues would alter SAGE's recommendations, how many doses per person are needed, if seasonal and pandemic doses can be co-administered, and if obesity is a risk factor. A WHO spokesman said results of the meeting may be available tomorrow. [Oct 27-29 WHO SAGE agenda]

Vaccine production reaches 23.2 million doses The cumulative total of H1N1 vaccine doses available reached 23.2 million today, up about 800,000 from yesterday's 22.4 million, Health and Human Services (HHS) Secretary Kathleen Sebelius said at a press conference today. She said about 9 million doses were added to the total in the past week. All 50 states have ordered supplies of vaccine, she reported. [Oct 28 HHS press conference recording]

Lack of prioritization cited for LA vaccine shortage In the early stages of Los Angeles County's free H1N1 vaccination clinics, overwhelmed staff members vaccinated many people who were not in the vaccination priority groups, the Los Angeles Times reported today. As of yesterday, the county had only enough doses to last through Nov 4 instead of the planned Nov 8, said Dr. Jonathan Fielding, public health director. He said officials didn't want to turn away people who had traveled and stood in line to get vaccinated. [Oct 28 Los Angeles Times report]

Former FDA official says policy has slowed vaccine Overly cautious policy decisions by the US government are partly to blame for shortages of the pandemic H1N1 vaccine, according to a former Food and Drug Administration official who wrote an editorial for the Wall Street Journal. Scott Gottlieb, MD, said the use of adjuvants could have stretched supplies. He said a focus on single-dose vials has slowed vaccine delivery, as has reliance on outdated egg-based production. [Oct 27 Wall Street Journal article]

Oman launches H1N1 vaccine campaign Health authorities in Oman said yesterday that they have started the country's pandemic H1N1 vaccine campaign after receiving the first 100,000 doses of its 2.6 million dose order, Agence France-Presse (AFP) reported. For now, priority groups include older people, pregnant women, health workers, and Mecca pilgrims. The vaccine is free for all citizens. To address concerns about vaccine safety, media outlets showed senior officials receiving flu shots. [Oct 27 AFP story]

Iceland finds pandemic virus in pigs Veterinary officials in Iceland confirmed the pandemic H1N1 virus in a pig herd after 10 of the animals started showing symptoms such as poor appetite, fever, and coughing, according to a report yesterday to the World Organization for Animal Health (OIE). Investigators are exploring the possibility that humans spread the virus to the pigs; two workers had flulike symptoms before the pigs got sick. The 4,500-pig farm is under quarantine. [Oct 27 OIE report]

Gender-based vaccine doses suggested to boost supply Two commentators writing in the New York Times say that using lower doses of flu vaccine in women could improve the vaccine supply without sacrificing protection. Sarah L. Klein, a Johns Hopkins immunologist, and Phyllis Greenbrier, president of the Society for Women's Health Research, point to studies in which women had a significantly stronger immune response to flu vaccines than men did. They say that besides stretching the supply, the step would reduce side effects for women. [Oct 28 New York Times commentary]

Sen Collins asks HHS to explain vaccine delays Sen. Susan Collins (R-Maine) wrote a letter to HHS Secretary Kathleen Sebelius yesterday asking why there are fewer pandemic H1N1 vaccine doses than officials originally projected. Her letter appeared on the Web site of the Maine Public Broadcasting Network. Collins said shortages are alarming because not all high-risk groups can be vaccinated and the vaccine could arrive too late to prevent infections in many Americans. She asked the HHS to share its latest projections. [Oct 27 letter from Collins to Sebelius]

Oct 27

NYC to start school-based vaccines New York City's health commissioner said today that the city is proceeding with plans to vaccinate schoolchildren against H1N1 flu, according to the New York Times. Dr. Thomas Farley said, "We have 40,000 doses set aside for the first wave of schools, which we feel should be adequate." Free vaccinations will start tomorrow at 125 small public elementary schools. Last week the city had about 300,000 of the 380,000 doses of H1N1 vaccine it had ordered. [Oct 27 New York Times story]

Canada buys unadjuvanted vaccine To provide pregnant women earlier access to pandemic H1N1 vaccine, Canada's health minister announced yesterday the purchase of 200,000 doses of an unadjuvanted product from CSL Ltd in Australia, the Canadian Press reported today. Officials are particularly concerned about women in remote communities. The bulk of Canada's H1N1 vaccine is adjuvanted, and its unadjuvanted version awaits approval. Pregnant women are among those at greatest risk for flu complications. [Oct 27 Canadian Press story]

New HHS flu ads pair Elmo, governors To raise awareness about flu prevention in children, a high-risk group, the US Department of Health and Human Services (HHS) yesterday launched 13 new radio public service announcements. The messages feature Elmo from Sesame Street with 13 of the nation's governors. They urge children to sneeze into the bend of their arm and wash their hands frequently, and they guide parents to have a care plan if schools are closed or children are sick. [Oct 26 HHS press release]

Calls crash Minnesota clinic's vaccine line A Minnesota clinic that publicized that it had 17,000 doses of pandemic H1N1 vaccine to administer closed its flu shot phone line yesterday after 120,000 calls in 4 hours swamped the system, the Minneapolis Star Tribune reported. A message on the Park Nicollet Clinic Web site says patients in four high-risk groups are targeted to receive the doses: pregnant women, children ages 6 months through 4 years, children ages 5 years to 18 years with underlying conditions, and first responders. [Oct 27 Star Tribune story]

First H1N1 death in Turkey prompts no-kiss advice After Turkey reported its first death from the H1N1 flu, newspapers said the country's health minister urged people not to kiss or shake hands for the next 5 months, Reuters reported today. Schools in Ankara, the capital, were ordered closed for a week after the death of a 29-year-old patient was reported over the weekend. [Oct 27 Reuters report]

EU official says up to 30% may get H1N1 European Commissioner for Health Androulla Vassiliou warned yesterday that up to 30% of Europeans could catch the H1N1 virus, according to an Agence France-Presse (AFP) report. Vassiliou told the German newspaper Die Welt that the pandemic would probably cause "a significant number" of deaths. She also said the virus could become more aggressive in coming months and the pandemic could hurt Europe's economic recovery. She advocated the immediate closure of schools where H1N1 cases occur. [Oct 26 AFP report]

Germany vaccinates health workers amid controversy Germany began vaccinating health workers and chronically people against H1N1 yesterday amid a continuing controversy over the two vaccines being used, the Associated Press reported. Most Germans will receive a GlaxoSmithKline vaccine, Pandemrix, which contains an adjuvant, while soldiers and high-ranking government employees will get Baxter's Celvapan, a cell-based vaccine with no adjuvant. The plan has sparked concern about the safety of Pandemrix and complaints about a two-class health system. [Oct 26 AP story]

Oct 26

Missouri suspends thimerosal ban for vaccine The director of Missouri's health department has suspended a legal restriction so that children under age 3 and pregnant women can receive pandemic H1N1 vaccine containing thimerosal. Margaret Donnelly determined that a shortage of preservative-free vaccine was preventing these groups from being immunized, the health department said. As permitted by law, she temporarily set aside a statute that bars the groups from receiving vaccines containing thimerosal. [Oct 22 Missouri Department of Health release]

Chinese public's interest in H1N1 vaccine plunges A poll finds that only 30% of Chinese would like to get the H1N1 flu vaccine, far below the 76% who said they wanted it in a poll 2 months ago, according to a report in the British newspaper The Independent. Citing safety concerns, 54% said they did not plan to be vaccinated, according to the poll by China Daily and the Web site sohu.com. The government plans to inoculate 5% of the population, about 65 million people, the story said. So far 300,000 people have been vaccinated. [Oct 26 Independent report]

AMA launches flu tools for patients, physicians The American Medical Association (AMA) recently launched a flu assessment Web portal to help patients gauge their symptoms and to help physicians monitor their patients and manage case flow. Based on guidelines from the US Centers for Disease Control and Prevention (CDC), the symptom assessment function advises patients when they should seek care for themselves or their loved ones. The site also offers assessments relating to vaccines for pregnant women and postvaccination symptoms. [Oct 22 AMA press release]

El Salvador notes flu, dengue fever co-infections Health officials in El Salvador are reporting four cases of patients infected with influenza A H1N1 and dengue fever, according to an Oct 24 translated media report published yesterday on the ProMed e-mail listserv. Though it's not clear if the virus is pandemic H1N1, ProMed moderators suspect it is, because virus activity is increasing in El Salvador, unlike other Central American sites. Though the cases did not appear to be fatal, there was little other information about the clinical course. [Oct 25 ProMed post]

Health groups issue letter on H1N1 and pregnancy In an urgent effort to press the importance of seasonal and pandemic H1N1 vaccination for pregnant women, four major medical groups--the AMA, the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists, and the CDC--sent a joint "dear colleague" letter to healthcare professional nationwide. The letter points out the increased number of flu deaths in pregnant women and advises providers to counsel and vaccinate this group. [Oct 22 AAFP press release]

GAO finds gaps in Internet pandemic planning The US Department of Homeland Security has not developed a plan to address Internet congestion during a severe pandemic and has not looked into the possibility of asking the public to reduce nonessential use in such a setting, the US Government Accountability Office (GAO) said today in an investigative report. The study, requested by Congress, also found that most securities firms had addressed pandemic planning, but not all had addressed staffing issues or telework alternatives. [Oct 26 GAO report]

Oct 23

WHO: Pandemic expands in Northern Hemisphere Pandemic flu is spreading in the Northern Hemisphere, particularly in the United States and British Columbia, Canada, the World Health Organization reported today. In Europe, medical visits for flu-like illnesses rose above baseline with high rates of virus detections, possibly signaling an early start to the flu season. The proportion of Asian cases attributed to seasonal H3N2 flu declined, with only East Asia reporting significant numbers. The global H1N1 death total is at least 4,999. [Oct 23 WHO pandemic update]

New York suspends mandatory vaccination for healthcare workers New York state yesterday suspended its new flu vaccination requirement for healthcare workers in order to free up scarce supplies of the vaccine for high-risk groups. Gov. David Paterson said the Centers for Disease Control and Prevention has signaled that the state would receive only 23% of its expected pandemic vaccine by the end of the month. He said slow delivery of seasonal vaccine was also a factor. Some healthcare workers opposed the order and had filed suit to reverse it. [Oct 22 New York governor's office press release]

EU regulators stick with 2-dose pandemic vaccine schedule Europe's drug regulatory agency today announced that it would stick to its initial recommendation that the three pandemic H1N1 vaccines it approved be given in two doses, despite data from two companies that suggests one-dose efficacy. The agency said the data on the GlaxoSmithKline and Novartis vaccines, both adjuvanted, were too limited to warrant recommending a single-dose schedule, but added that one dose may be sufficient in adults. The third vaccine is a cell-based product made by Baxter. [Oct 23 European Medicines Agency press release]

MedImmune reports clinical findings on intranasal pandemic vaccine MedImmune yesterday reported long-awaited clinical trial findings on the immunogenicity of its nasal-mist pandemic H1N1 flu vaccine. US officials approved the live attenuated vaccine on Sep 15 without the immunogenicity results. In a press release the company said trials in children and adults showed that the safety and immunogenicity profiles of the pandemic vaccine are similar to those of its seasonal vaccine. The firm said further data are being collected after a second dose of the vaccine. [Oct 22 MedImmune press release]

Oct 22

Poll shows growing flu concern, uncertainty about vaccine Americans are more concerned about pandemic H1N1 flu than they were a couple of months ago, with about 52% saying they are greatly or somewhat worried, according to the latest Washington Post-ABC poll. The number is up 13 percentage points from August. However, only about a third say they'll get the vaccine, though half said they'll have their kids vaccinated. Those saying they'll pass on the vaccine listed side-effect worries and perceived lack of testing as influencing their decision. [Oct 15-18 Washington Post-ABC News Poll]

Single dose of Chinese H1N1 vaccine found effective In a clinical trial, a single 15-microgram dose of a nonadjuvanted H1N1 vaccine recently licensed in China was found to induce a probably protective immune response in volunteers between the ages of 12 and 60, according to an report published yesterday by the New England Journal of Medicine. Lesser immune responses were seen with a single dose in younger and older people. The vaccine is made by Hualan Biological Bacterin Co. [Oct 21 NEJM report]

Doctors report rhabdomyolysis in pandemic flu patient Australian physicians have documented a rare complication in a patient with pandemic H1N1 flu, myositis, and rhabdomyolysis. They reported their findings in an early online edition of the Pediatric Infectious Disease Journal. According to a news report today about the study, the 16-year-old boy experienced intense muscle pain and nearly black urine 3 days after his flu symptoms began in June when the first wave of the pandemic hit Australia. He recovered after 8 days in the hospital. [Oct 16 PIDJabstract]

Canada's pandemic vaccine campaign will have an unadjuvanted option Canada has purchased 1.8 million doses of unadjuvanted pandemic H1N1 vaccine to use in the youngest children as well as pregnant women and others who might want an alternative to the adjuvanted version, the Canadian Press reported yesterday. Canada's adjuvanted vaccine was approved Oct 16. Officials predict the unadjuvanted vaccine will be cleared in early November, but they don't want people to wait for it even though experts say it may produce a more robust response in children under age 3. [Oct 21 Canadian Press story]

Tamiflu treatment spawned resistance in Taiwan H1N1 case Taiwan reported this week that the H1N1 virus became resistant to oseltamivir (Tamiflu) after a patient was treated with the drug. Oseltamivir-sensitive H1N1 was isolated from a 20-year-old man before treatment, the Taiwan Centers for Disease Control said. Three days later, after treatment began, an isolate from the man showed the resistance mutation. The man recovered, and there was no evidence that the virus spread. His case marked Taiwan's first report of H1N1 resistance to the agent. [Oct 20 Taiwan CDC report]

Flu control measures seem to reduce other diseases in Bolivia Health officials in Bolivia say a massive campaign to promote handwashing to prevent H1N1 flu seems to have reduced the spread of other common diseases, according to a Time magazine report. Dr. Rene Lenis, Bolivia's director of epidemiology, reported a 10% to 15% drop in incidence of acute diarrheal diseases in all age-groups this year compared with last year. Public health agencies began promoting handwashing when the virus emerged in April. [Oct 22 Timereport]

Egyptian capital cuts class sizes to curb flu spread Egypt's health and education ministries have ordered schools in Cairo to halve class sizes to slow the spread of the pandemic virus, IRIN News, a United Nations publication, reported today. Children will attend school on 3 alternate days instead of 6 double-shift days, a variation on a long-standing system to reduce crowding. The World Health Organization has said school closures can be disruptive and has recommended that schools take other preventive measures, such as easing crowding. [Oct 22 IRIN story]

Oct 21

China showing signs of second pandemic flu wave China appears to be entering its second wave of the novel H1N1 pandemic, said an epidemiologist at the country's Center for Disease Control and Prevention who was quoted yesterday in China Daily. Cases are increasing rapidly, and the virus is spreading to small and medium-sized cities. China has had 26,300 known cases but just two deaths, the story said. The World Health Organization reported last week that the seasonal H3N2 flu virus was co-circulating in China with the pandemic H1N1 strain. [Oct 20 China Daily story]

Flu cases increase on US campuses Flu-like illnesses on college campuses rose modestly last week, with schools in the mid Atlantic region reporting increases, while those in the Midwest, Rocky Mountains, and Southwest still cited robust activity, the American College Health Association (ACHA) said today. The report for the week ending Oct 16 says infections may have already peaked in the Southeast and Northeast. The incidence of flu-like illnesses on member campuses was 20.9 per 10,000 students, 9% higher than a week earlier. [Oct 21 ACHA weekly surveillance report]

H1N1 vaccinations begin in Britain Britain today became the latest European country to roll out nationwide shots against H1N1 flu, beginning vaccination of front-line health care workers and high-risk hospital patients. High-risk patients in the community will begin receiving shots Oct 26, Reuters reported. Other European Union countries have already begun campaigns, including France, Italy and Sweden, with Germany expected to begin Oct. 26. [Oct 21 Reuters report]

German vaccine roll-out sparks protest A press outcry and political objections are following news that Germany's H1N1 vaccination campaign plans to use two different formulas: Baxter's cell culture-based Celvapan for politicians and essential workers and GlaxoSmithKline's egg-based, adjuvanted Pandemrix for the general public. To defuse the protest, Chancellor Angela Merkel has agreed to receive the GSK vaccine from her private doctor, Agence France Press reported. The story said Celvapan has fewer side effects than Pandemrix. [Oct 21 AFP report]

H1N1 found in Japanese swine herd Pooled samples from 10 pigs on a 1,000-head swine farm near Osaka, Japan, were positive for H1N1 flu during routine surveillance, according to the World Organization for Animal Health (OIE). None of the pigs died or showed signs of illness. The farm, which raises pigs from birth to slaughter age, is under limited movement control. The finding marks the first identification of H1N1 flu in swine in Japan. [Oct 21 OIE report]

Argentinean report cites high rate of lung disease in H1N1 cases An unexpectedly high rate of lower respiratory disease (8%, 166 of 2,135 patients) was found in adults with flu-like illness who were treated at a tertiary hospital in Buenos Aires, Argentina, during the H1N1 outbreak in June and July, says a report in Emerging Infectious Diseases. Although other pathogens were not ruled out, the authors say the finding suggests that "a unique pattern of virulence, pulmonary tropism, or both" may characterize 2009 H1N1 cases. [Emerging Infectious Diseases letter report]

Oct 20

Flu-related visitor restrictions at hospitals raise questions A number of hospitals around the country have limited visits from children and adults to curb the spread of pandemic flu to patients, though there is little scientific evidence that the measure works, the Associated Press reported yesterday. Some experts say the measures are needed because children are known to spread the virus easily, but others say having visitors benefits patients and that requiring short-term visitors to wear a mask and wash their hands might prevent flu transmission. [Oct 19 AP story]

Study: Some H1N1 patients still shed virus a day after fever ends Researchers who studied an H1N1 outbreak at the US Air Force Academy reported today that 19% (11 of 58) of patients were still shedding the virus after they had been symptom-free for at least 24 hours. Also, 7 of 24 samples taken 7 days after illness onset contained viable virus, according to the report published online by the American Journal of Preventive Medicine. The authors cautioned that virus shedding does not necessarily mean the virus can spread. [American Journal of Preventive Medicine study]

Pandemic virus found in Ontario turkeys, Oregon ferret Ontario officials said today that the pandemic H1N1 virus has been found in turkeys at a breeding farm in the province. The results were confirmed by the Canadian Food Inspection Agency on Oct 16. The farmer had noticed a drop in egg production. Officials said there is no risk of foodborne transmission and that an infected worker may have passed the virus to the birds. Meanwhile, officials in Oregon confirmed pandemic flu in a ferret whose owner had recently been sick with the virus. [Oct 20 Ontario Ministry of Agriculture, Food, and Rural Affairs press release]

OSHA to issue standards for H1N1-related healthcare inspections The US Department of Labor's Occupational Safety and Health Administration (OSHA) announced on Oct 14 that it would soon issue a compliance directive to help its inspectors conduct uniform investigations in high-risk pandemic H1N1 flu settings, such as healthcare facilities. The directive will be designed to ensure that healthcare employers follow controls recommended by the Centers for Disease Control and Prevention and adhere to OSHA respiratory protection standards. [Oct 14 OSHA press release]

Women planning pregnancy are advised to get H1N1 vaccine In a joint statement, the American Society for Reproductive Medicine and the Centers for Disease Control and Prevention advised fertility clinics to urge women who are planning pregnancy to be vaccinated against both seasonal flu and 2009 H1N1 flu. Women who are planning a pregnancy may need to wait a few weeks for the H1N1 vaccine to become available, the groups said. They noted that pregnant women are at risk for serious or even fatal complications of flu. [Statement from ASRM and CDC]

Novavax launches trial of virus-like-particle H1N1 vaccine Novavax, a US-based company, announced today the launch of clinical trials in Mexico to test the safety and efficacy of its virus-like particle pandemic H1N1 vaccine. Amivex, a company that will distribute the cell-based vaccine in Mexico in 2010 pending approval, is supporting the trial. If initial findings in 1,000 volunteers are favorable, the second stage of the trial will be conducted in 3,000 adults starting in January. [Oct 20 Novavax statement]

Two Iraqi provinces close schools to prevent H1N1 Officials in two of Iraq's provinces have announced the country's first school closures to slow the spread of the pandemic H1N1 virus, Agence France-Presse reported today. A 5-day closure in Wassit province starts tomorrow and affects 980 schools, and a 10-day closure in Dhi Qur province starts Oct 22 and applies to 1,477 schools. Both provinces are in southern Iraq. Colleges in the areas will remain open. [Oct 20 AFP story]

FDA, FTC warn firm to stop selling fake H1N1-related products The US Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) said they issued a joint warning letter to a Web site marketing supplements falsely said to help prevent the spread of the H1N1 flu virus. The Oct 15 letter, the first to be issued jointly by the agencies, warned the site owners they would face legal action if they didn't stop the deceptive marketing. The FDA said it has warned more than 75 Web sites to stop selling fraudulent H1N1-related products since May. [Oct 19 FDA announcement of warning letter]

Oct 19

CDC urges early antiviral use for some suspected flu patients The Centers for Disease Control and Prevention (CDC) today urged clinicians to start flu patients on antivirals early, without waiting for test results, particularly if they are hospitalized or have underlying conditions. In an e-mail alert the CDC said that though most people recover without treatment, clinical judgment should guide antiviral use, recommended for anyone who has lower respiratory symptoms or worsening symptoms. A negative rapid test does not exclude flu, the agency said. [CDC health advisory network]

Minnesota plans flu hot line to screen patients, prescribe antivirals Concerned that H1N1 and seasonal flu will overwhelm providers this winter, the Minnesota Department of Health plans to launch a statewide hot line to triage people and prescribe medicine over the phone, the Minneapolis Star Tribune reported today. Officials said the service will offer quick access to antiviral drugs for people at risk and also help people who lack health insurance. The service will be financed with $5 million in federal emergency funds. The launch date has not been set. [Oct 19 Star Tribune story]

Japan launches pandemic vaccine campaign Japan started administering its first pandemic H1N1 doses today, starting with healthcare workers, Agence France-Presse (AFP) reported. So far Japan has a limited supply of a domestically produced vaccine, enough for 1.18 million people. The health ministry said in early November that the vaccination priority will shift to pregnant women and those with underlying medical conditions and that by late December the campaign will include babies and small children. [Oct 19 AFP story]

Canada edges closer to pandemic vaccine approval, launch Canada may approve its pandemic H1N1 vaccine as early as this week, which could set the stage for immunizations against the virus to begin later this month, the Toronto Globe and Mail reported yesterday. An unnamed source said about 1 million doses have already been delivered to provinces and territories. Canada has ordered 50 million doses of an adjuvanted vaccine made domestically by GlaxoSmithKline. [Oct 18 Globe and Mail story]

CDC offers guidance for vaccinating children in primary care clinics The CDC has released a planning guide for vaccinating children against H1N1 in primary care settings. The guidance, published Oct 16, includes checklists that cover items such as staffing needs, billing and reimbursement, storage capacity, and safety monitoring, along with links to additional resources. Other CDC guidance documents released on Oct 16 cover influenza triage and antiviral treatment for children and updated general recommendations on antiviral use. [CDC planning guide for vaccinating children in primary care settings]

Eight more swine herds in Norway infected with H1N1 Eight more swine herds in one county in Norway have been found infected with the H1N1 virus, the pork industry Web site PigProgress.net reported on Oct 16. Because of concern about farmers spreading the virus to pigs, Agriculture Minister Lars Peder Brekk has asked that pig farmers get priority for H1N1 vaccination, the report said. Norway's first outbreak in pigs was reported in Nord Trondelag county a week ago. [Oct 16 PigProgress.net report]

Clinic for the homeless aims to open overnight H1N1 ward A clinic for homeless people in Salt Lake City is raising money to open an overnight ward for patients with H1N1 flu, the Salt Lake Tribune reported today. To keep flu patients out of crowded homeless shelters, the clinic currently puts flu patients in motel rooms and brings them meals and medication, but clinic officials said that strategy is not cost-effective. The Salt Lake Public Health Department has pledged $20,000 for the effort. Officials hope to open the ward by Thanksgiving. [Oct 19 Salt Lake Tribune story]

Oct 16

USDA says pigs in Minnesota may have had H1N1 The US Department of Agriculture said today it is testing to confirm suspected novel H1N1 flu in three pigs that were sampled at the Minnesota State Fair in August. Positive results would mark the first detection of the virus in pigs in the United States. The pigs, which appeared healthy, were tested in a research project by the University of Minnesota and University of Iowa. Some children who stayed in a dorm at the fair contracted H1N1, but no link has been made to the pigs, the USDA said. [Oct 16 USDA statement]

WHO: H3N2 responsible for half of flu in China Nearly half of all flu viruses in China are the seasonal H3N2 strain, which appeared before the pandemic virus and is cocirculating with it, the World Health Organization said today. Pandemic flu activity is well above baseline rates in the United States and is increasing in parts of Canada and Mexico, and cases are rising in Western Europe, northern Asia, and some Caribbean countries. At least 4,735 deaths have been reported. Temperate areas of the Southern Hemisphere now have few cases. [Oct 16 WHO pandemic update]

Judge suspends New York's flu-shot requirement for health workers A New York judge today temporarily blocked a state requirement that all healthcare workers who have direct patient contact receive H1N1 and seasonal flu vaccines, the New York Times reported. Thomas J. McNamara, an acting justice of the New York State Supreme Court, set a hearing on the case for Oct 30. McNamara consolidated three suits filed by Albany nurses and state employees' and teachers' unions. Another suit, filed by a nurse from Poughkeepsie, is still proceeding separately. [Oct 16 New York Times report]

Group in New York sues to stop nationwide vaccination program A group of New York medical workers sued yesterday to try to block the nationwide H1N1 vaccination program, arguing that the vaccines have not been adequately tested, Agence France-Presse (AFP) reported yesterday. The suit was filed in a federal court in Washington, DC. Attorney Jim Turner said the suit was brought by a group of doctors, nurses, and other medical personnel. [Oct 15 AFP report]

FDA: Be wary of H1N1 remedies sold online The US Food and Drug Administration warned yesterday that there's a good potential for fraud when buying products sold online as preventives or remedies for H1N1 influenza. The agency recently bought several products sold online as oseltamivir (Tamiflu). One of them turned out to contain only talc and acetaminophen; several others contained various levels of Tamiflu but were not approved for use in the United States. The agency urged consumers to buy only approved products from US pharmacies. [Oct 15 FDA press release]

Quebec poll finds 25% of workers would go to work with flu A poll of workers in Quebec found that 25% would go to work if they were sick with pandemic H1N1 flu, the Canadian Press reported today. About 45% of the respondents said their employer had not formed a plan to address flu outbreaks, and 53% reported they had not changed their personal hygiene habits. The phone survey of 1,000 adults, conducted between Sep 17 and 27, was done by a human resources association in Quebec. [Oct 16 Canadian Press story]

CDC offers answers on vaccine allocation and distribution The Centers for Disease Control and Prevention (CDC) has posted a new question-and-answer report on H1N1 vaccine allocation and distribution. It notes that the number of sites to which vaccine can be shipped has been increased to 150,000 nationwide, from the original 90,000, with each state being allocated a quota of sites. The CDC also posted new materials yesterday about several other H1N1 topics, including issues for inflammatory arthritis patients and infection control guidance. [CDC Q & A about vaccine allocation and distribution]

Oct 15

Flu up slightly on US campuses The American College Health Association (ACHA) reports that the incidence of flu-like illnesses on member campuses last week was 19.2 per 10,000 students, an increase of about 2% from the 18.9 per 10,000 the week before. The report listed 5,959 new cases at 238 schools. By region, the most new cases were reported in the middle Atlantic states and the Southeast. [Oct 15 ACHA surveillance report]

Hospital uses triage tents for flood of patients Memorial Hospital in Bakersfield, Calif., has set up tents in its doctors' parking lot to triage and treat a flood of patients seeking treatment for cough and fever, the Bakersfield Californian reported yesterday. A hospital spokeswoman said between 210 and 230 patients have been coming to the emergency room daily, breaking the record of 207 set in May. She said the tents keep sick people away from other patients and relieve crowding in the emergency room. [Oct 14 Bakersfield Californian story]

Ill county workers who stay on job could be fired Pima County officials in Tucson, Ariz., have decided that county employees who refuse to go home when they have flu-like symptoms can be disciplined or even fired, the Arizona Daily Star reported. Under the new policy, any worker with a fever of 100.4?F or higher and one other symptom is required to stay home until the fever has been gone for at least a day. The county dropped a previous rule that employees who miss 3 days in a row had to bring in a doctor's note. [Oct 14 Arizona Daily Star report]

Massachusetts prioritizes high-risk prisoners for vaccine Health officials in Massachusetts have added prisoners with underlying conditions as a priority group to receive the pandemic H1N1 vaccine, the Associated Press (AP) reported today. A spokeswoman said that vaccine doses will go to correctional facilities the second week of November. Though inmates with high-risk conditions and facility healthcare workers will be immunized then, the general prison population won't receive them until after the general public is offered the vaccine. [Oct 15 AP story]

Kentucky district targets college students for vaccine College students in western Kentucky will receive the area's first doses of pandemic H1N1 vaccine, the AP reported today. The seven-county Green River District Health Department, based in Frankfort, told the local press that the vaccine will be available next week and that college students are at the top of the list because they have had high hospitalization rates from the flu and live in close-contact dormitory settings. [Oct 15 AP article]

China plans vaccine for hajj pilgrims China will administer pandemic H1N1 vaccine to 12,700 Muslims who will travel to the annual hajj pilgrimage in Saudi Arabia, Agence France-Presse (AFP) reported today. Pilgrims will also receive free medication, disposable masks, and advice on flu prevention, Xinhua, China's state news agency, reported. The hajj is held around the end of November and draws about 3 million worshippers. [Oct 15 AFP story]

Oct 14

Novel H1N1 turns up on Australian pig farm Veterinary officials in Queensland, Australia, have detected the pandemic H1N1 virus at a pig farm near Toowoomba, the Australian Associated Press (AAP) reported today. The animals have been quarantined, and biosecurity authorities are working with the farm's owners to establish measures to control the virus. The latest outbreak is Queensland's second; in August the virus struck a farm near Dalby. [Oct 14 AAP article]

Mexico seals pandemic vaccine deal Mexico's health secretary, Jose Angel Cordova, said yesterday that the government has agreed to obtain 10 million more doses of pandemic H1N1 vaccine from two unnamed European companies, the Canadian Press reported. He said the agreement will raise the country's pandemic vaccine supply to 30 million doses. [Oct 13 Canadian Press story]

Researchers ID pulmonary embolism risk Patients with severe pandemic H1N1 infections may be at greater risk for developing pulmonary emboli, according to an American Journal of Roentgenology (AJR) study. Researchers compared imaging studies performed on two groups, those in the intensive care unit and those who weren't severely ill. Of 14 ICU patients who underwent computed tomography (CT), they saw pulmonary emboli in 5. The authors said though most x-rays are normal, CT can help identify complication risks. [Oct 14 AJR study]

Imaging may help detect severe H1N1 cases Imaging studies may help identify severe novel H1N1 flu cases more quickly, researchers from the National Institutes of Health reported today in AJR. They detail the case of a patient who tested negative for the virus on a rapid antigen test, while imaging revealed a severe infection. Radiography showed peripheral lung opacities, and CT showed round-glass opacities. The researchers said that early CT may help detect severe infections, and CT may also help in monitoring treatment. [Oct 14 AJR report]

Canadian hospital screens all pregnant patients A British Columbia hospital is screening all pregnant women for the pandemic H1N1 virus when they arrive at the facility in an effort to keep sick women separated from flu-free ones, the Vancouver Sun reported. Pregnant women are one of the groups at highest risk for serious complications. Screening consists of three questions, and women who have flu symptoms are to be isolated in negative-pressure rooms where staff and visitors will be required to wear masks and gowns. [Oct 12 Vancouver Sun story]

Kids under 10 need two Sanofi vaccine doses Reporting the first data in children younger than 10 years old, Sanofi Pasteur announced today that this age-group will need two doses of its injectable pandemic H1N1 influenza vaccine, while older kids will require only one shot, consistent with seasonal flu vaccine. In the ongoing clinical trial, after one shot, 50% of kids under 3 had an adequate immune response, compared with 76% of those 3 to 9. No serious side effects were reported. [Oct 14 Sanofi press release]

Psoriasis medications may pose H1N1 risk Those who have psoriasis or psoriatic arthritis and are taking immunosuppressive drugs should get both seasonal and pandemic flu shots as soon as possible, according to the National Psoriasis Foundation. The foundation recommends that patients get vaccinated early, but not with the nasal-spray vaccine, which contains live, weakened virus. It also advocates general flu-avoiding hygienic steps. [Oct 13 News-Medical.net report]

Oct 13

NIAID launches vaccine trials in HIV-infected groups The National Institute of Allergy and Infectious Diseases (NIAID) recently announced the launch of H1N1 vaccine trials in HIV-infected pregnant women and HIV-infected children and young adults. The trials are important because HIV infection and pregnancy increase the risk of a poor immune response to vaccines and because these groups have an increased risk of severe H1N1 illness, the NIAID said. Plans call for enrolling 130 pregnant women and 140 people aged 4 to 24 years in the two studies. [Oct 9 NIAID announcement]

NBA prepares defense against pandemic flu The National Basketball Association (NBA) has deployed several measures to respond to the pandemic flu threat, including hiring an infectious disease expert advisor, the Orlando Sentinel reported today. The NBA has contingency plans for when games are canceled or when many players get sick. Players are urged to report illnesses immediately so team doctors can prescribe antiviral medication, and teams have installed hand sanitizer dispensers throughout their facilities. [Oct 13 Orlando Sentinel story]

EU works out vaccine-sharing proposals European Union health ministers met yesterday to discuss how to make sure all member states have the tools to manage a surge of pandemic flu cases, EUobserver.com reported today. Some countries, such as Bulgaria and Malta, have few resources in their stockpiles. The officials asked the European Commission to develop a vaccine-sharing mechanism and draft a stance on sharing vaccine with needy countries outside the EU. [Oct 13 EUobserver.com story]

H1N1 spreads from farmer to pig in Norway A pig on a farm in Norway apparently caught the pandemic H1N1 virus from the farmer, according to a report that Norwegian veterinary authorities filed with the World Organization for Animal Health (OIE) yesterday. The farmer tested positive for the virus Oct 7, and the pig tested positive 3 days later, the report said. No other pigs in the herd of 850 were reported ill. [Oct 12 OIE report]

Emergency docs concerned about pandemic impact Nearly 90% of emergency physicians who responded to a poll by the American College of Emergency Physicians (ACEP) voiced concern about their ability to take care of extra patients generated by the H1N1 pandemic, the ACEP reported. ACEP President Dr. Angela Gardner said emergency departments need more resources to help them prepare for the pandemic and other health crises. The online poll was sent to 20,464 emergency physicians, 1,043 of whom responded. [Oct 13 ACEP news release]

Oct 12

WHO sees November vaccine delivery to poor nations An official from the World Health Organization said today that the group hopes to start shipping 60 million H1N1 vaccine doses to poor countries in November, the Associated Press (AP) reported. Marie-Paule Kieny said the first doses of the donated vaccine from drug companies and other countries will go to doctors and nurses and maybe high-risk patients in about 100 nations. She added that more donations are needed. [Oct 12 AP story]

Flu illnesses drop slightly at US colleges The number of flu-like illnesses at the nation's colleges decreased 6% from last week's report, the American College Health Association (ACHA) said in its surveillance for the week ending Oct 2. The report listed 6,326 new influenza-like illness cases at 250 schools. Nine hospitalizations were reported. The highest levels of flu activity were seen in the mid Atlantic region, as well as in New Hampshire, Rhode Island, Montana, Wyoming, Oregon, and Alaska. [Oct 8 ACHA surveillance report]

NY nurse sues over mandatory flu shots A registered nurse in Dutchess County, New York, not far from New York City, has sued to prevent New York State from requiring heathcare workers to take the H1N1 flu vaccine. Newsday reports that attorneys for nurse Suzanne Field filed for a temporary restraining order last week on behalf of New York State's 60,000 healthcare workers and expect to appear in court Wednesday. New York is the only state to require the vaccine, though individual healthcare organizations do as well. [Oct 9 Newsday report]

Pregnant women are Cuba's first H1N1 deaths The Cuban government says that 2,100 pregnant women on the island have been treated for symptoms of H1N1 flu, 110 are seriously ill, and 3 have died, according to a report by state-sponsored media that was carried by the AP. While the first wave of illness was among tourists, Cuban residents are now contracting the flu, with 621 cases confirmed, including 177 children, the deputy health minister said. [Oct 10 AP report]

Sweden starts vaccinating health workers Sweden began vaccinating health workers in the southern part of the country today, with clinics slated to begin immunizing people as soon as they receive the vaccine, Swedish-based TT News Agency reported today. Authorities noted a lot of interest in the vaccine a month ago when a few fatalities were reported, but the demand for the vaccine has leveled since. Sweden becomes the fourth country to launch novel H1N1 vaccination, after China, Australia, and the United States. [Oct 12 TT News story]

UK fears its health workers will shun vaccine The United Kingdom's Department of Health has ordered regional chiefs of the National Health Service (NHS) to make sure doctors and nurses take the H1N1 vaccine amid fears that uptake will be only 10% to 20%, The Guardian reports. NHS executives say healthcare staff will shun the vaccine because the disease appears mild, but fear high absenteeism if unvaccinated staff contract the flu. [Oct 11 Guardian article]

Oct 9

Pandemic flu still on rise in Northern Hemisphere The spread of pandemic influenza and rates of flu-like illness continue to climb in many regions of the Northern Hemisphere, according to today's World Health Organization (WHO) weekly update. Early flu transmission continues to increase in many European and Asian countries, while the Southern Hemisphere continues to see a substantial decline. The WHO reports little change with the virus, which has caused at least 4,525 global deaths, up more than 400 from the week before. [WHO H1N1 update 69]

Lack of case counts blunts assessment of flu impact The fact that US and other countries' officials have stopped keeping close track of novel H1N1 cases and deaths means the government doesn't have a clear grasp of how hard the pandemic is affecting various groups, said flu expert Andrew Pekosz of Johns Hopkins University, according to the Associated Press (AP). H1N1 appears to be more dangerous for children, young adults, pregnant women, and the obese, but just how dangerous is hard to discern because of this lack of comprehensive data. [Oct 9 AP story]

UK H1N1 cases fewer than feared Britain reported about 18,000 new pandemic H1N1 cases last week, up from 14,000 the previous week and 9,000 the week before that, according to the Nursing Times. However, flu spread is nowhere near the doubling that some had predicted. Sir Liam Donaldson, the UK's chief medical officer, said, "We may be able to get the vaccine out there before our flu season really gets under way." [Oct 9 Nursing Times article]

Vaccine for public to trickle in to Minnesota H1N1 flu shots for the general public are scheduled to arrive in Minnesota next week, but not enough to meet demand, according to the Minneapolis Star Tribune.The state health department will distribute the 30,000 doses and the following week's supply randomly to clinics that care for the state's sickest children. An official said shipments should grow to 100,000 to 150,000 doses by late October, but the slow supply may mean many high-risk patients might not get vaccine till mid November. [Oct 9 Star Tribune report]

Hospital gives workers two choices: shot or mask An Arkansas hospital has devised an alternative to mandating pandemic vaccine for its employees: It gives them a choice between vaccine and wearing a mask. And nearly all 3,200 St. Vincent Health System workers opted for the vaccine; only six chose the mask. A spokesperson said the hospital devised the policy to protect both the public's and its employees' health. [Oct 7 AP story]

Most Canadians unconcerned about H1N1 Only a third of Canadians plan to get vaccinated against novel H1N1 flu, and few seem concerned about the pandemic, a recent poll indicated. The Canadian Press Harris-Decima poll, conducted Oct 1 to 5, found that 36% of respondents were either very concerned or somewhat concerned about the virus, while nearly two thirds were not very or not at all concerned. In the same poll in late August, 45% had planned to get an H1N1 flu shot. [Oct 8 Canadian Press report]

Oct 8

Spring wave may have given NYC some protection New York City and a few other cities that had big H1N1 outbreaks in the spring are seeing little activity now, leading to suggestions that the spring wave spawned a significant level of population immunity, the New York Times reported today. City health officials believe that perhaps 20% to 40% of the population were exposed to the virus in the spring and gained immunity. But city officials and other experts agreed it would be unwise to assume that New Yorkers don't need the H1N1 vaccine. [Oct 8 New York Times story]

Lack of paid sick leave could spread flu A lack of paid sick leave could force working parents either to report to work sick with flu or to send their children to school sick, at the risk of sacrificing either income or their jobs, ABC News reports. Up to 54 million Americans, many of them self-employed or employees of small businesses, have little or no paid sick leave, an issue that advocates hope to bring before Congress. [Oct 7 ABC News report]

Third of parents may say no to kids' vaccine Concerned over the new H1N1 vaccine, or unconcerned about the seriousness of the disease, 38% of parents say they are unlikely to permit their children to be vaccinated during school programs planned by many states, according to an Associated Press (AP)-GfK poll. Federal health officials vouched for the vaccine's safety, urging widespread inoculation. Among concerns are the newness of the vaccine and potential side-effects. [Oct 7 AP story]

New Web resources for individuals, families The federal government's www.flu.gov Web site has two new features, the Department of Health and Human Services (HHS) announced yesterday. A self-evaluation section for adults offers a click-through assessment aimed at determining whether flu is or is not present, followed by guidance on self-care, preventing transmission, and warning signs of serious disease. "Flu Myths and Facts" provides accurate refutations of common misconceptions about vaccinations and the disease itself. [Oct 7 HHS news release]

CDC unveils system to gather data on flu-like illness The CDC today announced the launch of a system to gather data about influenza-like illness (ILI) from syndromic surveillance systems run by health departments in cooperation with hospital emergency departments. The system, called Distribute, enhances existing flu surveillance by providing more details on geographic- and age-specific trends. The system involves a partnership of the CDC with the International Society for Disease Surveillance and the Public Health Informatics Institute. [CDC announcement in Oct 9 MMWR]

Canadian H1N1 vaccination to lag US by weeks Canada's national campaign to vaccinate residents against the H1N1 flu is likely to begin in early November because attempts to move up the shots' delivery have not been successful, according to the Canadian Press. The US campaign uses multiple suppliers and began with a roll-out of aerosol vaccine; Canada uses only one manufacturer, and aerosol vaccine is not approved for sale there. [Oct 6 Canadian Press report]

Michigan man recounts 7-week H1N1 battle A Michigan man who barely survived a battle with the H1N1 virus is expressing support for the vaccination campaign, according to ABC News. Jim Shrode, 53, was in excellent health before he fell ill with the virus in May. He was hospitalized for 7 weeks, required mechanical ventilation, and lost 37 pounds. "People need to know that the risks of the vaccine are minimal compared to the risks if you get ill with it," he said. [Oct 8 ABC News report]

Oct 7

Study: Seasonal vaccine may help fight H1N1 Contrary to most other evidence, a study from Mexico suggests that seasonal flu vaccine may offer some protection against the novel H1N1 virus. Researchers compared the vaccination status of 60 H1N1 case-patients and 180 control patients at a specialty hospital. The H1N1 patients were less likely to have had a seasonal flu shot. But the authors say the study is limited by its small size, retrospective design, and the high prevalence of vaccination and chronic conditions in the control group. [Oct 6 British Medical Journal study]

Microsoft offers online flu self-assessment Microsoft launched a new Web site today, H1N1 Swine Flu Response Center, to help patients assess flu-like symptoms and decide their next step. The self-assessment is licensed from experts at Emory University. Dr Arthur Kellermann, professor of emergency medicine at Emory, said in a Microsoft release that the tool "can encourage those who are severely ill or at risk for serious illness to contact their doctor, and reassure everyone else that it is safe and prudent to recover at home." [Oct 7 Microsoft news release]

EU approves Baxter's cell-based vaccine The European Commission today approved Baxter International's pandemic H1N1 vaccine, Celvapan, for use in the European Union, the company announced. It is the first cell culture-based H1N1 vaccine as well as the first non-adjuvanted product to win European approval. The EU authorization calls for using two doses of the vaccine in adults and children; the company is awaiting trial results to determine if one dose will be sufficient in adults. [Oct 7 Baxter news release]

Novartis ships seasonal, H1N1 vaccines to US Vaccine manufacturer Novartis said yesterday it has completed shipments of its seasonal flu vaccine, Fluvirin, to the United States after delivering 27 million doses. The Swiss company originally had said it planned to supply about 30 million doses to the US market. Yesterday the firm also said it started shipping swine flu vaccine on Sept. 27, 2 weeks after the formulation received approval from the US Food and Drug Administration. [Oct 6 Novartis press release]

Oct 6

US, Canada, Mexico discuss flu coordination Officials of the US, Mexican, and Canadian governments met in Mexico City Monday to map out cross-border communication and immigrations issues raised by the continuing spread of H1N1 flu, according to the Department of Homeland Security (DHS). The United States was represented by officials from DHS, the Departments of State and Agriculture, the Transportation Security Administration, and Customs and Border Protection. [Oct 5 DHS press release]

Cuba asks international help getting vaccine The Cuban government has asked the World Health Organization (WHO) and the Pan American Health Organization to help the country acquire H1N1 vaccine, saying the formula is too expensive for it to afford on its own. The island nation has officially recorded 468 cases of H1N1 flu but no deaths since the pandemic began. [Oct 5 Agence France-Presse report]

Tunisia prohibits hajj pilgrimages Though some Muslim countries have taken measures to limit the number of people making the hajj pilgrimage to curb the spread of pandemic flu, Tunisia today became the first to bar its citizens from making the trip, Reuters reported today. The country's religious affairs ministry said a vaccine would not arrive in time to vaccinate pilgrims for November travel. About 10,000 Tunisians typically make the trip every year. [Oct 6 Reuters story]

China reports first pandemic flu death China's health ministry has confirmed the nation's first pandemic H1N1 death today, an 18-year-old woman from Tibet's capital, Lhasa. The ministry said it has confirmed 21,453 cases of pandemic flu and that 78.7% of the patients have fully recovered. On Sep 21 China became the first nation to start vaccinating its people against the novel H1N1 virus. [Oct 6 Associated Press story]

Study shows regional variance in pandemic response In the first several days after the WHO declared pandemic level 5 on Apr 29, Malaysians showed greater concern than their European counterparts but also more preparedness steps, according to a study released today. Forty-two percent of Malaysians and only 5% of Europeans said they were "very concerned" about the outbreak. Malaysians also ranked higher in reduced public transport use (48% to 22%), flight cancellations (56 % to 17%), and intent to buy protective equipment (41% to 15%). [BMC Infect Dis study abstract]

Oct 5

UN officials call for more donated vaccine Though some vaccine companies and affluent nations have already donated supplies of pandemic flu vaccine to developing nations, more is needed, officials from the World Health Organization (WHO) and the United Nations said yesterday, according to a Reuters report. Julie Hall, an infectious disease expert at the WHO, said more readiness is needed in developing countries, especially if a different pattern is seen when big outbreaks hit poorer countries. [Oct 4 Reuters report]

NYC's schools hold pandemic vaccine drill New York City health and education department will hold vaccination clinics at five of the city's schools next week to prepare for school based pandemic H1N1 vaccine clinics. Parents will start receive consent forms to sign if they want their children to receive the vaccine. The city said it will begin an 8-week school-based vaccination effort in late October at the elementary schools. In November and December vaccine clinics will be held at middle schools and high schools on weekends. [Oct 3 NYC Department of Health news release]

Researchers derive formula for closing schools For optimal social distancing in a flu outbreak, schools should consider closing when they reach 5% absenteeism on a single day, 4% on 2 consecutive days or 3% on each of 3 days, researchers in Boston and Niigata, Japan, say in an Emerging Infectious Diseases (EID) article. The group based its recommendation on absentee data gathered over four flu seasons from one 54-school district in Japan. [EID article]

WHO will not act on unpublished Canadian data A teleconference convened Friday by the WHO to assess the validity of unpublished data linking seasonal flu vaccine and development of H1N1 flu did not find the association persuasive, according to the Canadian Press. The data by Canadian researchers, contained in an article that is in press at an unnamed medical journal but apparently has circulated widely, has led to almost universal scaling back of seasonal flu shot campaigns in Canada. [Oct 4 Canadian Press report]

CDC issues treatment algorithm for flu-like illness The Centers for Disease Control and Prevention (CDC) and Emory University School of Medicine have developed a treatment algorithm to guide healthcare professionals and their surrogates on when and how quickly to steer adult flu patients to care. The algorithm, on the CDC's flu Web site, progressively assesses patients by age, vital signs, symptoms of severe disease, presence of underlying conditions, and membership in a high-risk group. [CDC/Emory treatment algorithm]

Oct 2

Pandemic flu widespread in 27 states The US Centers for Disease Control and Prevention (CDC) said today that 27 states reported geographically widespread influenza activity for the week that ended Sep 26, up 1 state from the previous week. In addition, 11 children died from pandemic H1N1 flu, compared with 3 the week before. There have been 60 confirmed pediatric deaths from the virus since the outbreak began. [Oct 2 CDC update]

Flu cases drop at US colleges The number of flu-like illnesses at colleges dropped 19% from the previous week, according to a report for the week ending Sep 25 from the American College Health Association (ACHA). The report showed 6,527 new cases at 248 schools. Though the report doesn't include flu subtype, federal authorities have said about 99% of circulating strains are pandemic H1N1. Colleges in New England and some western states reported increases, but other parts of the country saw cases decline. [Oct 1 ACHA surveillance report]

WHO: Flu continues climb in Northern Hemisphere Pandemic H1N1 flu is widespread in the Northern Hemisphere, particularly in the United States and northern and northwestern Mexico, the World Health Organization (WHO) said today. Activity is starting to increase in Europe and parts of Asia but is slowing in most of South America and Australia. So far the WHO has recorded more than 4,100 deaths, an increase of at least 130 from the previous week. About 85% of reported specimens were the pandemic strain. [WHO pandemic update 68]

Poll finds limited interest in vaccine, growing H1N1 worry Another poll has found lukewarm interest in getting the pandemic H1N1 vaccine. A Harvard survey found that 40% of adults were certain they'd get the shot and 51% were sure they'd get their kids vaccinated, slightly higher than in a recent Consumer Reports poll. The Harvard survey, conducted in mid September, indicated demand would surge if the virus caused local sickness and death. Seventy-six percent said they were concerned about more outbreaks, up from 59% in the summer. [Oct 2 Harvard School of Public Health press release]

Taiwanese flu case reports reveal viral pneumonia A review of the medical records from the first 100 severe H1N1 cases in Taiwan, initially posted to an international listserv, reveals that complex illness tends to strike children and young adults who are obese or have other underlying conditions, including pregnancy. Twenty-three of the 100 patients required mechanical ventilation, 9 went on extra-corporeal membrane oxygenation (ECMO), and 9 died. In contrast to US data, 89 of the 100 had primary viral pneumonia. [Oct 1 ProMED-mail report]

Researchers name severe flu syndrome: FLAARDS Australian and New Zealand researchers have dubbed the direst manifestation of H1N1 flu "FLAARDS," for "flu A-associated acute respiratory disease syndrome," according to Bloomberg News. In a medical journal editorial, intensive-care specialists Drs. Steven Webb and Ian Seppelt describe inflamed, flooded lungs requiring mechanical ventilation or ECMO, sometimes leading to multi-organ failure and death. Bacterial pneumonias and underlying chronic conditions also play a role, they said. [Sep 29 Bloomberg News report]

European agency endorses Baxter's cell-based vaccine The European Medicines Agency (EMEA) today recommended approval of Baxter's cell culture-based H1N1 vaccine, Celvapan, for use in the European Union. The move follows similar verdicts last week on H1N1 vaccines from Novartis and GlaxoSmithKline. EMEA recommendations are usually adopted by the European Commission. Baxter said Celvapan is the first cell-based, non-adjuvanted H1N1 vaccine to get the EMEA's endorsement. The EMEA is recommending two doses of the vaccine for both adults and children. [Oct 2 EMEA press release]

Oct 1

Poll: Americans iffy on pandemic flu shot Americans are uncertain about getting the pandemic H1N1 vaccine, according to a poll conducted in early September by the Consumer Reports Health Ratings Center. Only 34% said they would definitely get the vaccine when it's available, while 21% said they would decline. Forty-three percent said they will wait and see what happens with flu developments. The nation survey of 1,502 adults found that 35% will have their children vaccinated, 50% are unsure, and 14% will not. [Consumer Reports poll results]

US Army records H1N1 death An apparently healthy 23-year-old soldier may be the US military's first fatality from the novel strain. Spec. Christopher Hogg of Deltona, Fla., serving at Fort Jackson, S.C., died of flu-related pneumonia Sep 10, 10 days after falling ill. The fort's commanding general told media that autopsy data confirmed Spec. Hogg had no underlying conditions that would have made him vulnerable. More than 50 soldiers at the 10,000-member base, the Army's largest training center, currently have flu. [Oct 1 The State (Columbia, S.C.) article]

Flu sidelines 1 in 14 on US Navy ship An outbreak of H1N1 flu aboard the USS Boxer, a Navy amphibious assault ship holding more than 2,200 sailors and Marines, put 166 personnel into isolation for an average of 3.6 days each, according to military medical surveillance. Epidemiologists described the illness, which struck 7.3% of personnel, as mild and brief, with cough, aches, sore throat and fevers less than 102 degrees. The month-long outbreak began after the ship completed a 5-day "liberty port" in Phuket, Thailand. [Sep Medical Surveillance Monthly Report]

Sanofi warns of delay in seasonal flu shots A spokeswoman from Sanofi said today that the company is behind on its shipments of seasonal flu vaccine because of pressure to quickly produce the pandemic flu vaccine, the Associated Press (AP) reported today. Sanofi said it has shipped more than half of the 50.5 million doses ordered by US providers, who may face delays into November. Some clinics have had to turn patients away, despite advice to get seasonal flu shots early to make way for the pandemic H1N1 shot. [Oct 1 AP story]

Navy awards $1.25 million for DNA flu vaccine San Diego biotech company Vical Inc. said Thursday it has received $1.25 million from the US Navy to support a phase 1 human clinical trial of its DNA-based vaccine against H1N1 flu. The company received earlier grants from the National Institute of Allergy and Infectious Diseases for the technology, which has shown early positive results using strains of H5N1 avian flu. [Oct 1 AP story]

Sanofi study confirms H1N1 vaccine 1-dose efficacy Sanofi today announced the results of additional trials that confirm the company's pandemic H1N1 vaccine is effective with just one dose, similar to initial findings from a National Institutes of Health study. Results of the latest trial of 849 adults show that a single 15-microgram dose is protective after 21 days, even in seniors. US regulators approved Sanofi's vaccine on Sep 15. [Oct 1 Sanofi press release]

Sep 30

3 H1N1 vaccine makers ship first doses Three H1N1 vaccine manufacturers have begun shipping vaccine doses, according to CNN. Sanofi Pasteur said it shipped its first batch yesterday, several days ahead of schedule. More shipments will follow, according to a company spokesperson, with a total of 75.3 million doses expected by year's end. MedImmune sent its first batch of 5 million doses to distribution centers last Tuesday, and Novartis began shipments on Sunday. [Sep 29 CNN report]

Researchers find mutation in novel H1N1 Virologists in the Netherlands have detected a pandemic H1N1 virus mutation that has been linked to enhanced replication and possible virulence changes. In a Sep 28 ProMed e-mail list post, they said they found the mutation in the basic polymerase 2 protein in samples from two patients who had links to an island in northern Holland. Both patients recovered. In a Canadian Press report yesterday, experts said it's not clear how clinically significant the mutation is, but it bears watching. [Sep 28 ProMed mail post]

CDC updates advice on flu testing The CDC yesterday released updated recommendations on diagnostic testing for flu during the coming season. The agency recommends considering testing for hospital patients with suspected flu; those for whom a flu diagnosis will affect decisions about care, infection control, or management of contacts; and those who died of suspected flu. The advisory includes information about rapid testing and issues related to antiviral treatment. [Updated CDC recommendations]

Australia begins vaccination campaign Australia began nationwide vaccinations against H1N1 influenza today, administering the first shots in what is intended to be a 21-million-dose campaign. The initial allotment of 5.5 million doses from Australian manufacturer CSL Ltd. will be given to pregnant women, healthcare workers, and the chronically ill. Authorities are concerned the vaccine will face low uptake because the flu season is waning after 35,000 confirmed cases and 178 deaths. [Sep 30 Sky News article]

Military flu shots to provide data Active-duty members of the US armed forces will begin receiving 1.4 million doses of H1N1 flu vaccine in the next 10 days, part of a 2.7-million-dose vaccine purchase by the Pentagon. The shots, which are mandatory, will go first to troops preparing to deploy, followed by troops on hold for domestic disasters. Planners hope the early shot campaign will provide needed data on efficacy and side effects. [Sep 29 Associated Press report]

Nationwide school closure would prove costly Closing all US schools for 4 weeks to curb the spread of pandemic flu would cost between $10 billion and $47 billion in lost workforce productivity and temporarily shrink the pool of healthcare workers by 6% to 19%, according to a report today from economists at the Brookings Institution. The group estimated that about 14% of households with kids would have a sick worker during the pandemic. Federal guidance discourages school closure but allows local officials to make their own determinations. [Sep 30 Brookings report abstract]

Biggest business flu concern is vaccine When it comes to pandemic flu, US businesses are most concerned about the availability of a vaccine for employees, according to a survey released today by the Business Roundtable. The organization also found that "nearly 90%" of businesses surveyed have activated or updated their preparedness plans since novel H1N1 flu first appeared. About 35% of respondents said they need more information about the severity of pandemic H1N1 flu compared with seasonal flu. [Sep 30 CNBC story]

Irish pigs infected with novel H1N1 Forty pigs have contracted pandemic H1N1 flu, apparently from an infected worker, on a swine farm in County Cork, Ireland, according to a report filed yesterday with the World Organization for Animal Health (OIE). The worker tended pigs on the farm Sep 15 through 18 while sick, and on Sep 22 was confirmed to have novel H1N1. Forty of the farm's 650 sows began showing clinical flu symptoms Sep 25 and are being monitored. The farm, near Kilworth, also contains 2,400 young pigs. [Sep 29 OIE report]

Sep 29

CDC addresses liquid Tamiflu supply, dosing concerns The US Centers for Disease Control and Prevention (CDC) yesterday posted a notice about possible shortages of the pediatric liquid suspension oseltamivir (Tamiflu) as more states report widespread activity. The CDC said pharmacists may need to compound Tamiflu capsules into a liquid syrup to help fill the demand. Also, the CDC warned that the units on the liquid dosing dispenser have led to some confusion, and doctors and pharmacists need to ensure that their dosing instructions match. [Sep 25 CDC Health Alert Network notice]

IOM issues report on standards of care for disasters The Institute of Medicine (IOM) has released a report titled "Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations." As the name indicates, the 150-page report is designed to help public health officials and other healthcare personnel devise standards of care for use in disaster situations in which resources are scarce. The report uses two scenarios to illustrate the principles it presents: a gradual-onset flu pandemic and an earthquake. [IOM page with linked table of contents and general information]

Report offers lessons from school closures in 1918 pandemic Researchers who combed the records of 43 cities that closed schools during the 1918 flu pandemic found that closures worked best when there were clear lines of authority between agencies and good communication between school officials and the public, according to a report in Health Affairs. Usually, school closures were linked to community-wide steps such as quarantine, isolation, and public-meeting bans. The authors say that preparedness and dialogue are the key to smooth implementation. [Health Affairs article]

Flu threat prompts suspension of school attendance incentive School officials in Bismarck, N.D., have suspended an attendance incentive at the city's two public high schools to encourage students to stay home if they are sick, the Associated Press reported yesterday. The pandemic H1N1 virus is hitting schools in most states, though North Dakota is reporting localized flu activity, according to the latest national surveillance report. The incentive allows students to skip most final exams if they have no more than two excused absences and two tardies. [Sep 28 AP story]

Ho Chi Minh City reports success with field hospital for H1N1 patients Ho Chi Minh City's health department said an H1N1 field hospital that was set up in August has proved "immensely effective," according to the Vietnamese newspaper Thanh Nien. The 11-room hospital has treated 200 patients, some in critical condition. The health department is seeking permission to set up similar field hospitals in other parts of the city to relieve hospital overcrowding. Meanwhile, Vietnam's official H1N1 case count has reached 8,065, with 14 deaths, the story said. [Sep 29 Thanh Nien report]

Hungary approves H1N1 vaccine Hungary's drug regulatory agency has approved the country's pandemic H1N1 vaccine, Dow Jones Newswires reported yesterday. Officials cleared the vaccine after clinical trials showed promising efficacy and safety results. The vaccine is made by Omninvest Kft, Hungary's only vaccine manufacturer. Based on the company's H5N1 avian flu vaccine, the pandemic H1N1 shot will be available within 2 weeks. The Hungarian government has ordered 4 million doses. [Sep 28 Dow Jones Newswires story]

Sep 28

Zambian district bans social gatherings Health authorities in Zambia's Luanshya district have banned weddings and other social gatherings to curb the spread of the pandemic H1N1 virus, according to a Sep 26 Times of Zambia report that was picked up by Xinhua, China's state news agency. Over the past 4 days the district has reported more than 630 suspected pandemic flu cases. Flu cases are reportedly on the rise elsewhere in Zambia, as well. [Sep 26 Xinhua story]

British Columbia pares back seasonal flu efforts British Columbia said today it would delay promoting seasonal flu shots until early in 2010, except for those in high-risk groups such as older people, the Vancouver Sun reported. Quebec, Alberta, Saskatchewan, Ontario, and Nova Scotia announced similar steps in the past few days. The moves follow reports of an unpublished Canadian study that suggests seasonal flu vaccination may double the risk of pandemic H1N1 infection, a finding not confirmed by WHO and CDC data. [Sep 28 Vancouver Sun story]

High antiviral dosage may have saved H1N1 patients Doubling the dosage of oseltamivir (Tamiflu) in patients with severe H1N1 flu cases has helped Prince of Wales Hospital in Hong Kong avoid any deaths from the disease so far, according to the Hong Kong newspaper The Standard. The hospital has treated at least 60 severely ill patients without loss of life, said Dr. David Hui Sui-cheong, a respiratory disease specialist. The hospital has focused on early treatment along with doubling the dose. [Sep 28 Standard report]

Pandemic chokes flow of pilgrims to Mecca Worries about the H1N1 pandemic have kept many Muslims from traveling to Mecca for the minor pilgrimage called umra, which can be done any time of year, according to the Herald, a Scottish newspaper. The drop in visitors has hurt business for shops, hotels, and tour operators in Mecca, with hotel occupancy rates in the last 10 days of Ramadan down by more than a third from last year. Saudi Arabia had urged the elderly and people with chronic diseases to postpone trips. [Sep 28 Herald story]

Sep 25

WHO: Flu activity up in Northern Hemisphere In a global pandemic flu update today the World Health Organization (WHO) said flu activity is increasing in temperate parts of the Northern Hemisphere such as the US and parts of the UK. Activity in tropical regions varies. It is increasing in some parts of Peru and Mexico but decreasing in temperate parts of the Southern Hemisphere such as South Africa. So far the WHO has logged 3,971 deaths. [WHO pandemic update 67]

Europe approves two pandemic vaccines Europe's drug regulatory agency today approved two pandemic H1N1 vaccines, one made by GlaxoSmithKline and the other by Novartis. The two vaccines were developed through a "mock up" process that moved forward during preparation for the H5N1 avian influenza virus. Both vaccines contain adjuvants, with Novartis's having been in use since 1997. The agency is recommending a two-dose schedule but said it expects further data that may confirm one-dose efficacy. [Sep 25 European Medicines Agency release]

Mexico unveils measures against next wave Mexico's health minister announced measures yesterday to address renewed novel H1N1 outbreaks in the country, Xinhua, China's state news agency, reported. Public hospitals will delay nonessential surgeries and reserve 12% of their beds for flu patients. The new measures also establish special areas in hospitals to isolate patients who have the virus. Officials expect 8,000 to 10,000 hospitalizations over the coming flu season. [Sep 24 Xinhua story]

Survey finds tepid interest in kids' H1N1 vaccine Researchers from the University of Michigan reported yesterday that only 40% of 1,679 parents indicate they will get their children vaccinated against pandemic flu. However, 54% said they would have their kids receive the seasonal flu vaccine. Among racial groups, support for the vaccine was highest in Hispanics. Of those who answered no or were unsure, half said they worried about side effects. [Sep 24 University of Michigan press release]

Sep 24

Forecast for early-October vaccine deliveries doubles Between 6 million and 7 million doses of H1N1 flu vaccine will arrive the first week of October, about double the previous estimate of 3.4 million doses, according to an Associated Press (AP) report today quoting Health and Human Services (HHS) Secretary Kathleen Sebelius. Most of the doses will be the nasal-spray vaccine, Sebelius said. Previous reports said the initial 3.4 million doses would all be the nasal-spray vaccine, which is approved only for healthy people aged 2 to 49 years. [Sep 24 AP story]

Toronto group pens pandemic-ethics reports The University of Toronto Centre for Bioethics has nine articles covering ethical issues likely to arise in the second wave of the H1N1 flu pandemic. Topics include the duty of healthcare workers to work during a pandemic, limits on individual freedom, government responsibilities in vaccination programs, allocation of limited medical resources; and rich countries' obligation to share resources with poor countries. The authors drew on academic and public opinion research. [Sep 23 EurekAlert press release]

HHS offers pandemic guidance for community, faith groups HHS today released "H1N1 Flu: A Guide for Community and Faith-Based Organizations." The guide describes how the leaders of organizations can help fight the pandemic by communicating health information effectively, supporting vaccination efforts, linking vulnerable and hard-to-reach populations to information and resources, and adjusting organizational activities to help people stay healthy. [Sep 24 HHS guide]

AHRQ offers guide to mass medical care The HHS Agency for Healthcare Research and Quality (AHRQ) today released a guide titled "Mass Medical Care with Scarce Resources: The Essentials," which is an abbreviated version of a 2007 AHRQ publication. Topics covered are community-wide planning, ethical and legal considerations, prehospital, acute, and palliative care, and alternative care sites during public health emergencies. A special section on influenza pandemic preparedness is included. [Hyperlinked table of contents and pdf document]

CDC launches mobile texting tool A 3-month pilot text-messaging service has been launched by the Centers for Disease Control and Prevention (CDC) to deliver important CDC information on H1N1 flu and other topics directly to users' mobile phones. A subscription is required, but there is no cost. The CDC anticipates delivery of about three messages a week, and it is possible to opt out at any time. Feedback is sought during the pilot period. [CDC Web page with instructions]

US campus flu cases rise 15% Flu-like illnesses at the nation's colleges rose by 15% from the previous week, according to a surveillance report for the week ending Sep 18 from the American College Health Association (ACHA). The report was based on 7,696 cases at 243 schools. It doesn't specify flu subtype, but federal officials have said 98% of all circulating strains are pandemic H1N1. The number of new infections was highest in New England and some western states, and the pace seemed to slow in some southern states. [Sep 24 ACHA surveillance report]

Trial confirms CDC wariness about rapid flu tests A field trial at two schools at the start of the novel H1N1 outbreak showed that the rapid influenza A and B test worked well for confirming the new virus, but not for ruling it out, according to the latest issue of Morbidity and Mortality Weekly Report. The researchers compared the rapid test with real-time reverse transcription-polymerase chain reaction assay. The findings confirm recent CDC advice to be cautious about using negative rapid test results to guide treatment. [Sep 25 MMWR report]

Sep 23

US orders 29 million more doses of H1N1 spray vaccine The US government has ordered another 29 million doses of nasal-spray pandemic H1N1 flu vaccine from MedImmune, the company announced this week. The government had previously ordered about 13 million doses. The government has now ordered a total of about 251 million doses of H1N1 vaccine from five firms. MedImmune said it has already made enough vaccine to fill its orders, and the Food and Drug Administration has released 3.4 million doses, which are expected to reach providers in early October. [Sep 21 MedImmune news release]

Quebec may delay or cancel seasonal flu shots Quebec may delay or shelve its seasonal flu vaccination campaign and concentrate on vaccinating people against pandemic H1N1 instead, CBC News reported today. For now, seasonal flu shots are "on hold," said Karine White, a spokeswoman for the provincial health ministry. She said officials are considering delaying seasonal flu shots until after the pandemic vaccine is delivered, narrowing the effort to focus on those at highest risk, such as seniors, or even canceling the drive altogether. [Sep 23 CBC News story]

Scientist: Russia underreporting pandemic flu cases One of Russia's leading virologists claims that the country is underestimating its number of pandemic H1N1 cases, the Wall Street Journal reported today. Dr Dmitry Lvov made the claims in a state TV interview on Sep 21 and said Russia had also confirmed its first novel flu death. The country's health ministry has disputed both of Lvov's claims. [Sep 23 Wall Street Journal article]

Review suggests non-drug measures can curb flu A meta-analysis of nonpharmaceutical interventions such as hand washing, masks, gloves, and gowns shows they can curb the spread of flu and should be pursued more vigorously, the British Medical Journal (BMJ) reported yesterday. The review included 58 papers, which varied in quality. N-95 respirators were generally superior to surgical masks, but the N-95s caused skin irritation. The authors said more studies are needed to gauge the efficacy of individual interventions. [Sep 22 BMJ report]

Meta-analysis supports link between flu and heart attack A meta-analysis of 39 studies supports the idea that influenza (including flu-like illness) increases the risk of myocardial infarction, according to a report by British researchers in Lancet Infectious Diseases. Many observational studies showed consistent links between flu and acute myocardial infarction. One small randomized trial showed that flu vaccination reduced the risk of cardiac death in people with cardiovascular disease, but another randomized trial was inconclusive. [Lancet Infectious Diseases article summary]

Sep 22

BioCryst nets federal funding to further peramivir development BioCryst said it has received $77.2 million from the US government to continue late-stage development of its intravenous antiviral medication peramivir, Reuters reported yesterday. The company said it has also received a request for proposal to supply the government with between 1,000 and 40,000 courses of the experimental drug, which, if an emergency use authorization is granted, could be used to treat critically ill flu patients. [Sep 21 Reuters story]

Hospital sets up tents to handle flu surge Authorities at Dell Children's Medical Center in Austin, Tex., set up tents outside its emergency department to start triaging some patients with less severe flu-like illnesses today, the Austin Statesman reported. The hospital has seen a steady increase in flu patients, and daily numbers over some of the past few days have exceeded 300. The hospital made the decision on Sep 20 to open the tents after 343 patients swamped the hospital. [Sep 22 Austin Statesman story]

Survey finds businesses see flu risk but have planning gaps A survey of 400 companies by the British law firm DLA Piper revealed that about half of them believe they are at high or very high risk for disruptions caused by the next wave of pandemic flu, the Financial Times reported yesterday. About 80% said they were reviewing their continuity plans, but only slightly more than half had communicated the strategies to employees, customers, or suppliers. About 75% said they had no plans to modify employee policies. [Sep 21 Financial Times story]

New York doctor wins H1N1 video message contest Dr. John Clarke of Baldwin, N.Y., won the Department of Health and Human Services (HHS) 2009 H1N1 public service announcement contest, HHS said today. More than 50,000 YouTube viewers voted for Clarke's video. He will receive a $2,500, and the video will be broadcast on national television. "I want to congratulate Dr. Clarke, the 'hip hop doc,' for producing his creative and engaging video. His work will reach millions of Americans this flu season," said HHS Secretary Kathleen Sebelius. [Sep 22 HHS press release]

Sep 21

Poll: Many workers feel pressure to work when ill More than 80% of workers feel pressure to come to work when sick, and 69% have received little direction from employers on pandemic H1N1, according to a survey released today. The poll of 1,028 employees by Mansfield Communications found that 84% of workers believe the recession creates more pressure to show up for work, even when they're feeling sick. Mansfield's Rob Ireland said that employers need to communicate clearly about extended sick-leave policies and how to minimize disease spread. [Sep 21 Reuters story]

US orders 27.3 million more doses of Sanofi vaccine The US Department of Health and Human Services (HHS) has ordered another 27.3 million 15-microgram doses of pandemic H1N1 vaccine from Sanofi Pasteur, bringing the total government order of Sanofi vaccine to 75.3 million doses, the company announced today. HHS had previously ordered a total of about 195 million doses from five companies. Sanofi's H1N1 vaccine and versions made by Novartis, CSL Ltd., and MedImmune were licensed by the Food and Drug Administration last week. [Sep 21 Sanofi press release]

Sanofi projects mid October for US vaccine delivery An official from Sanofi said today that the company would begin delivering pandemic H1N1 flu vaccine to the United States by mid October, the Associated Press (AP) reported. Chris Viehbacher, head of the France-based company, said Sanofi would be able to produce at least 800 million doses of pandemic flu vaccine per year. [Sep 21 AP story]

WHO's Chan says severe cases could overwhelm ICUs Margaret Chan, director general of the World Health Organization (WHO), told a WHO Western Pacific regional meeting today that the overall clinical picture of the pandemic H1N1 virus is reassuring, but health officials are increasingly concerned about a small group of patients who rapidly become severely ill. Though numbers have been small, they could burden intensive care units as infections spread. She said the second wave of the pandemic appears to be beginning. [Sep 21 Margaret Chan speech]

China begins immunizing students China today became the first country to start administering the pandemic H1N1 vaccine, Agence France-Presse (AFP) reported. Medical workers are vaccinating students who will take part in National Day celebrations. Health workers, border inspectors, and transportation workers will also be among the first to receive vaccine, followed by the military, police, children and their teachers, and those with chronic conditions. [Sep 21 AFP story]

Canadian experts applaud deliberate vaccine process Some of Canada's infectious disease experts are applauding the country's decision to put its pandemic vaccine through the full approval process, rather than speeding it through with an emergency use authorization, the Canadian Press reported. One expert said the vaccine uses an adjuvant that hasn't been used before, and a more thorough and deliberate review could avoid future problems and build public trust in the new vaccine. [Sep 20 Canadian Press story]

Health departments' job losses accelerate Budget cuts forced public health departments to cut 8,000 positions between January and June, according to a new survey from the National Association of County and City Health Officials (NACCHO). The trends reflects a big increase in the continuing erosion of the health department workforce, which lost more jobs in the first 6 months of 2009 than all of 2008. The news comes as departments prepare to launch two immunization campaigns, one for seasonal flu and the other for the pandemic H1N1. [Sep 21 NACCHO press release]

Sep 18

WHO praises pandemic vaccine donations The World Health Organization (WHO) today applauded the donation of the United States and eight other developed countries of pandemic H1N1 vaccine to poorer nations. The donation announcement yesterday shows a commitment to fairness, the WHO said in a statement. Given that demand will exceed the global supply of vaccine, the WHO noted that the country donations, plus those previously announced by some manufacturers, will ensure vaccine for nations that lack resources for their own stockpiles. [Sep 18 WHO statement]

WHO lowers pandemic vaccine estimate The WHO has scaled back its projection of how much pandemic H1N1 vaccine that will be produced globally, spokesman Gregory Hartl told the media today, according to the Associated Press (AP). Output will be "substantially less" than the WHO's previous forecast of 94 million doses a week and 4.9 billion doses in the next year, Hartl said. Estimates are lower because some companies are still making seasonal vaccine, and some have experienced production problems. [Sep 18 AP story]

Piglets in Northern Ireland test positive for H1N1 Some piglets in Northern Ireland have tested positive for the novel H1N1 virus, the jurisdiction's Department of Agriculture and Rural Affairs announced yesterday. A BBC News report said the finding is the first such case in Europe. "Given that this virus is currently circulating in humans this finding is not unexpected," the department said in a news release. Officials did not list the location of the affected farm. [Sep 17 Northern Ireland Department of Agriculture statement]

Australia approves CSL's H1N1 vaccine The Australian government has approved a pandemic H1N1 vaccine made by CSL Ltd. for use in adults, the Australian Associated Press (AAP) reported today. The government has bought 21 million doses, which Health Minister Nicola Roxon said will be enough for all adults, and doses are expected to be available starting Sep 30. The government is awaiting clinical trial results before approving the vaccine for use in children. The virus has killed 172 people in Australia. [Sep 18 AAP story]

Minnesota says to keep ill preschoolers home longer The Minnesota Department of Health (MDH) says that children up to age 5 who have flu should be kept home from day care and school for 7 days after they get sick or 24 hours after symptoms resolve, a more cautious approach than the federal one, the Star Tribune reported. The CDC recommended in August that children be kept home until they are fever-free for 24 hours without the help of medication. Minnesota, which now has widespread flu activity, still uses that advice for older children. [Sep 17 Star Tribune story]

Sep 17

Flu cases up 21% on campuses In its surveillance of flu-like illnesses for the week ending Sep 11, the American College Health Association (ACHA) reported 6,432 cases at 253 schools, a 21% increase from the previous week. Though the report doesn't include flu subtype, federal officials have said 98% of circulating flu viruses are the pandemic strain. Cases slowed in the southeast but increased elsewhere, particularly in Mid Atlantic and Midwestern states. [Sep 16 ACHA surveillance report]

US, others donate pandemic vaccine The Obama administration today announced that the nation will donate 10% of its pandemic vaccine supply as supplies become available to help stop the global spread of the virus. The news follows reports that most people may need only one dose of the vaccine, which will greatly boost the nation's stockpile. Australia, Brazil, France, Italy, New Zealand, Norway, Switzerland, and the United Kingdom have also joined the donation program, which will go through the World Health Organization. [Sep 17 White House press release]

Similar H1N1 strain may explain 1-dose effectiveness The unexpectedly robust response to just one dose of pandemic H1N1 vaccine in research subjects might suggest that the vaccine boosts preexisting immunity to a similar strain that has circulated since 1977, New Scientist reported today. Experts say other factors could also play a role, such as a slight priming effect from seasonal flu vaccination or a priming effect on the cell-mediated immune system from previous seasonal flu infections. [Sep 17 New Scientist story]

Canada sets pandemic vaccine priorities The Public Health Agency of Canada (PHAC) yesterday announced priority groups to receive the country's first pandemic H1N1 vaccine doses. They include those under age 65 with underlying health conditions, pregnant women, children ages 6 months to younger than 5 years, people in remote or isolated communities, frontline healthcare workers, and household contacts of high-risk groups. The government is urging provinces to use the guidance based on local conditions. [Sep 16 PHAC press release]

UK sees signs of 2nd pandemic wave British health officials said today that surveillance data show a slight increase in pandemic H1N1 cases, which might herald the start of a second wave of infections, the London Telegraph reported. Suspected outbreaks have been reported at six schools, though there are no closure plans. Scottish officials also reported a rise in novel flu cases. [Sep 17 London Telegraph story]

Lab clue led researchers to immune therapy A Melbourne scientist who recently presented a study on the use of immunoglobulin in severely ill H1N1 patients said a colleague first considered the therapy when evaluating the lab work of a rapidly declining hospitalized patient, the Canadian Press reported. Doctors noticed the patient had low IgG2 antibody levels after ordering tests on all H1N1 patients in the intensive care unit. They said IgG2 deficiency might explain why some patients become severely ill. [Sep 16 Canadian Press story]

Sep 16

H1N1 said to kill at same rate as seasonal flu The H1N1 flu death rate is lower than previously estimated and comparable to what is seen in a moderate flu season, a Harvard University expert said at a meeting in Washington, DC. Dr. Mark Lipsitch estimated the case-fatality rate is between .007% and .045%, Reuters reported. That would qualify as a category 1 pandemic (the lowest level) on the US government's pandemic severity index. Lipsitch based his estimate on global reports of flu-like illness, hospitalizations, and deaths. [Sep 16 Reuters report]

Saudi Arabia dismisses hajj flu risk Health officials in Saudi Arabia yesterday downplayed the risk of pandemic H1N1 flu transmission at the upcoming hajj pilgrimage in Mecca, Agence France-Presse (AFP) reported today. They said they are reassured because no flu deaths have been linked to the smaller Umrah pilgrimage, which began Aug 22 with the month-long Islam Ramadan observance. Other countries, such as Egypt, have considered barring pilgrim travel, and others have advised that high-risk groups not make the trip. [Sep 16 AFP story]

Experts say hand washing science shaky for flu Some infectious disease experts are questioning the science behind hand washing as a measure to curb the spread of the pandemic H1N1 virus, Newsweek reported. Though hand washing can prevent the spread of cold and other respiratory viruses, there is no evidence that it helps stop influenza, said Arthur Reingold, an epidemiologist at the University of California Berkeley. He says that flu transmits through airborne routes and that hand washing could provide a false sense of security. [Sep 15 Newsweek story]

Microsoft offers Web tools for teachers, sick students Microsoft today launched a Web portal with free tools to help teachers and students manage class assignments during novel H1N1 outbreaks. The Microsoft Office Live Workspace H1N1 flu site enables teachers to post assignments, share handouts, and conduct group projects. The tools are accessible with any Internet connection and don't require Microsoft Office on the students' computers. A Microsoft official said the tools could help schools handle flu-related disruptions. [Sep 16 Microsoft press release]

WHO director: Pandemic may devastate poor nations In a speech yesterday in Copenhagen, World Health Organization director-general Margaret Chan said the H1N1 pandemic is causing "manageable disruptions" in affluent countries but will likely have a "devastating impact" on developing countries that have few health resources. She predicted the pandemic will be a "watershed event" that will test the world on fairness issues. On the same day the European Commission urged members to share vaccine with developing nations. [Sep 15 Margaret Chan speech]

China licenses third novel flu vaccine China has licensed its third pandemic H1N1 vaccine, made by the government-affiliated Shanghai Institute of Biological Sciences, the United Kingdom Press Association reported today. The state-run paper Shanghai Daily reported that the institute has plans to produce 3 million doses by Oct 1 and up to 10 million by the end of the year. Sinovac and Hualan Biological Engineering produce the other two approved vaccines. China hopes to vaccinate 5% of its population by the end of 2009. [Sep 16 Press Association story]

Glaxo awaits US approval for H1N1 vaccine A spokeswoman from GlaxoSmithKline, the only one of five producers that didn't received Food and Drug Administration approval for its pandemic H1N1vaccine yesterday, said the company earlier this month submitted a request for approval for its nonadjuvanted vaccine, Bloomberg News reported. She said the company initially concentrated on developing a vaccine with an adjuvant, but US health officials have favored a nonadjuvanted vaccine approach to speed and simplify the approval process. [Sep 15 Bloomberg News story]

Sep 15

Study finds no protection from surgical masks Surgical masks don't protect healthcare workers, but N95 respirators do, according to a 5-week trial at 24 Chinese hospitals. Results of the trial, headed by researchers from Australia, were presented today at the Interscience Conference on Antimicrobial Agents and Chemotherapy. The study involved 1,936 healthcare workers and also showed that fit-testing did not appear to boost N95 efficacy. A federal group recently said that workers caring for H1N1 patients should use fit-tested N95s. [Sep 15 Bloomberg News story]

Business travel group advises curbing handshakes The Association of Corporate Travel Executives (ACTE) yesterday urged its members to temporarily suspend business handshakes until the threat of the pandemic H1N1 virus subsides. The group said business travelers might be less willing to soil their business suits covering coughs and sneezes with their sleeves and cuffs and that eliminating the handshake could reduce person-to-person spread. The group also recommends that business travelers carry hand sanitizer and get vaccinated. [Sep 14 ACTE press release]

CDC issues new vaccine safety resources Yesterday the US Centers for Disease Control and Prevention (CDC) issued documents addressing pandemic H1N1 vaccine safety, Guillain-Barre syndrome (GBS), thimerosal, and general immunization issues. The CDC notes that each year 1 to 2 people per 100,000 develop GBS, whether or not they are vaccinated. Though research has found no evidence that thimerosal preservative is unsafe, two versions of the vaccine won't need to contain it: single-use and inhaled units. [CDC Q&A on Guillain-Barre syndrome]

Tamiflu-resistant H1N1 said to be less transmissible The same genetic mutation that makes the pandemic H1N1 virus resistant to oseltamivir (Tamiflu) also reduces its ability to spread to others, said David Mercer, acting head of the communicable disease unit in the World Health Organization's European regional office, as reported by Bloomberg News today. He noted that 23 oseltamivir-resistant H1N1 cases have been identified. Public health officials are concerned that overuse of the drug may lead to widespread resistance. [Sep 15 Bloomberg News report]

Restaurant carves out flu-control niche A restaurant in a Spanish suburb of Madrid has specialized in preventing pandemic H1N1 flu and other infectious diseases by adopting measures such as taking employee temperatures at the start of each shift, washing menus after each use, and placing tables farther apart, the Associated Press (AP) reported. The eatery is designed so that customers don't need to touch doorknobs, faucets, or light switches. [Sep 14 AP story]

Sep 14

Glaxo study supports single dose for adjuvanted pan flu vaccine GlaxoSmithKline today announced that the first results from clinical trials of its adjuvanted pandemic H1N1 vaccine show a strong immune response from one dose, 3 weeks after immunization. The study involved 130 German adults, aged 18 to 60. The antigen content was 5.25 micrograms. Glaxo, the fourth company to report evidence of one-dose efficacy, said it is conducting 15 more studies in healthy adults, elderly people, and children, including infants. [Sep 14 Glaxo press release]

Sebelius predicts early October arrival of first vaccine doses The nation's first doses of the pandemic H1N1 vaccine could be available the first week of October, about a week earlier than expected, US Health Secretary Kathleen Sebelius said yesterday, the Associated Press (AP) reported. Appearing on ABC's "This Week" news show, she said the first doses are earmarked for healthcare workers and high-priority groups. She predicted ample supplies will be available by mid October and said vaccine will be sent to states as soon as it is produced. [Sep 13 AP story]

G-7 nations vow to help developing nations with pandemic response Members of the Group of Seven (G-7) leading economies plus Mexico at a Sep 11 meeting to discuss pandemic flu measures in Brussels agreed to prioritize pregnant women, healthcare workers, and people with underlying conditions for H1N1 vaccination, the AP reported. The seven nations?Canada, Japan, Germany, France, Britain, Italy, and the US?also agreed to share data, coordinate vaccine actions, and help poorer nations fight the virus. [Sep 11 AP story]

ICU study: Half of flu patients were previously healthy A review of the first 32 patients with severe pandemic H1N1 infections treated in Spain's intensive care units found that only half had preexisting medical conditions, though about a third were obese. Most required mechanical ventilation. About 90% of patients had viral pneumonia with severe lung damage, while only one had secondary bacterial pneumonia. [Sep 11 Critical Care study]

GISAID re-launches flu database A widely used database for influenza gene sequences is available again at the Global Initiative on Sharing Avian Influenza Data (GISAID) Web portal, according to a press release today. In July GISAID's database administrator, the Swiss Institute of Bioinformatics, removed access after a legal conflict. The Max Planck Institute and A3 Systems developed the new version with the world science community. WHO researchers are using it to select strains for the southern hemisphere's 2010 flu vaccine. [GISAID EpiFlu database platform]

Feds launch novel H1N1 guidance for small businesses Federal officials today released guidance to help small businesses prepare for the next surge of pandemic H1N1 illnesses. Homeland Security Secretary Janet Napolitano emphasized that the most important element is to have a written plan, and the guidance lists steps for doing that. The resource also includes tips for keeping employees healthy, such as encouraging sick workers to stay home, providing for telework, and supplying resources for personal hygiene. [Federal pandemic flu guidance for small businesses]

Sep 11

H1N1 activity rises in parts of Asia, Europe, US Novel flu activity is declining in the Southern Hemisphere and in parts of Central America and the Caribbean but increasing in tropical areas of Asia and the Americas and in some parts of the United States and Eastern Europe, the World Health Organization reported today. Oseltamivir-resistant strains have been identified in 21 patients, 12 linked to postexposure prophylaxis and 4 linked to treatment. At least 3,205 deaths have been reported. The WHO also issued school closure guidance today. [WHO pandemic H1N1 update 65]

Baxter behind on UK pandemic vaccine order British officials recently said one of the companies it ordered pandemic H1N1 vaccine from, US-based Baxter, is behind on delivering doses, the Financial Times reported. The government placed about one-third of its order with Baxter for its cell-based product. Baxter had promised 400,000 doses by the end of August, but has delivered only about half that amount. Britain ordered the rest of its vaccine supply from GlaxoSmithKline, which is reportedly on schedule. [Sep 9 Financial Times story]

Inhaled H1N1 vaccine may ship within days An official from MedImmune, which is making an inhaled vaccine against pandemic H1N1 influenza, said the company would begin shipping orders to the US government by the end of September, Reuters reported yesterday. The company official, Raburn Mallory, said MedImmune said there are no "red flags" in the safety data submitted to the Food and Drug Administration and that 5 million doses will likely be delivered by the end of the month, about 2 weeks ahead of other pandemic vaccine makers. [Sep 10 Reuters story]

Egypt delays school start to curb flu A state-run paper in Egypt carried an announcement from the country's prime minister today that the start of school and universities will be delayed to slow the spread of the pandemic H1N1 virus, the Canadian Press (CP) reported. The school year will begin Oct 3, a week later than planned, to allow those returning from Mecca Ramadan pilgrimages to show illness signs. [Sep 11 CP story]

Poll: Pandemic vaccine interest highest in seniors A new Associated Press-Gallup poll shows seniors are the group most interested in getting the pandemic H1N1 vaccine, and more people in the 18- to 29-year-old age- group are now saying they'll get the shot, the AP reported today. Younger people are bearing the greatest pandemic flu burden, so they are at the front of the line to receive the vaccine. During a normal flu season, seniors are at the front of the line for vaccine because they are among the hardest hit groups. [Sep 11 AP story]

Efforts to extend shelf life of oseltamivir urged British scientists writing in Emerging Infectious Diseases call for a systematic effort to extend the shelf life of oseltamivir (Tamiflu), as it is one of just two drugs active against the H1N1 virus and is scarce globally. Oseltamivir's chemical profile suggests it should be feasible to extend its shelf life to more than 20 years, the writers say. In May, they note, European authorities said new batches of the drug would have a shelf life of 7 years instead of the previous 5 years. [EID article posted Sep 10]

Study shows little cross-protection from seasonal flu vaccines A New England Journal of Medicine study of children and adults published yesterday showed that receiving recent seasonal flu vaccines produced little or no immune response to this year's novel H1N1 in any age-group. However, 34% of adults older than 60 had cross-reactive antibodies to novel H1N1. Also, vaccination with the 1976 swine flu vaccine substantially boosted cross-reactive antibodies to novel H1N1 in adults. [NEJM study posted Sep 10]

Study: Novel H1N1 can infect deep-lung cells Pandemic H1N1 flu can infect cells deeper in the lungs than seasonal flu can, according to a study in Nature Biotechnology. Influenza viruses infect cells by attaching to molecules on the outside of the cell, called receptors. Seasonal flu viruses attach to receptors found on cells in the nose, throat, and upper airway tract, but this study shows that pandemic H1N1 flu can also attach to a receptor found on cells deep inside the lungs, which can cause a more severe infection. [Sep 10 study summary from Medical Research Council]

Sep 10

CDC says H1N1 virus has claimed 47 children's lives Forty-seven children died of confirmed 2009 H1N1 flu between Apr 26 and Aug 29, the CDC reported in an MMWR early release today, up from 43 such deaths the CDC reported in a weekly update last week. Today's report, an overview of flu activity from April through August, notes that cases declined in July and early August but picked up in the Southeast in the last 2 weeks of August, reaching levels usually seen during winter peaks. This may signal an early start to the 2009-10 flu season. [Sep 10 MMWR early release]

Resistant H1N1 strain found in summer camp cabin mates A report in the Sep 11 MMWR describes the first known instance of oseltamivir-resistant H1N1 infection in patients with epidemiologic links. The virus was found in two girls who shared a cabin at summer camp and had received prophylactic doses. Respiratory specimens revealed two mutations, including I223V, which had not been seen before. Elsewhere, two other resistant cases were noted in media reports today, one in Hong Kong and the other in Israel. [Sep 11 MMWR report]

Colleges report big increase in flu-like illness cases The American College Health Association, in its surveillance report for the week ended Sep 4, reported 4,974 flu-like illness cases at 236 participating schools, a 105% increase from the week before. The report doesn't list the flu subtype, but federal officials have said the pandemic virus makes up 97% of circulating strains. Schools in the South had the most cases, but Washington and Kansas also reported big increases. About 96% of the new cases occurred in the 17- to 24-year-old age-group. [Sep 8 American College Health Association surveillance report]

EU official says early H1N1 vaccine trial results promising The head of the European Union's drug regulatory agency said early clinical trial results for pandemic H1N1 vaccines in Europe look promising, Reuters reported today. "The immune response to all these vaccines is very promising, whatever type of vaccine it is, whether it is adjuvanted or non-adjuvanted," said Thomas Lonngren, executive director of the European Medicines Agency. He said the first vaccines could be licensed by the EU in early October if all goes well. [Sep 10 Reuters report]

NIAID launches trial of pandemic vaccine in pregnant women Federal officials yesterday announced the start of the first clinical trial of a pandemic H1N1 vaccine in pregnant women, who face an increased risk of complications from the virus. The trial is to enroll up to 120 women in the second or third trimester of pregnancy, the National Institute of Allergy and Infectious Diseases (NIAID) said. The women will receive two doses, 21 days apart, of a Sanofi Pasteur vaccine. NIAID Director Anthony Fauci said interest in the trial has been "extraordinary." [Sep 9 NIAID news release]

Flu absences shutter special-needs school Officials at an Atlanta public high school for students with severe cognitive disabilities suspended classes yesterday after about half of its 50 students were out sick, 15 of them with confirmed flu-like symptoms, the Atlanta Journal-Constitution reported. Five of the school's teachers were also sick. One student was hospitalized. Officials will sanitize the building before classes resume Sep 14. [Sep 9 Atlanta Journal-Constitution story]

Sep 9

Harvard survey finds business preparedness gaps Only one third of businesses responding to a national survey said they could sustain operations if half their employees were absent for 2 weeks because of pandemic H1N1 flu, researchers from the Harvard School of Public Health reported today. Though 74% offer sick leave, only 35% of businesses allow paid leave for taking care of sick family members. The report's lead author advised businesses to start making continuity and disease-prevention plans now. [Sep 9 Harvard School of Public Health press release]

Alabama reports rising school absence rates Alabama's school absence rates have doubled over the past few weeks, though officials aren't able to determine how much of the rise is related to novel flu, the Associated Press (AP) reported. Dr Don Williamson, the state's health officer, said emergency departments are reporting that 20% of patients have flu-like illnesses. He attributes the rise in pandemic flu cases to schools resuming and said the virus has been detected at most of Alabama's colleges. [Sep 8 AP story]

WHO urges Southeast Asian countries to prepare A World Health Organization (WHO) official speaking to health ministers from 11 Southeast Asian nations today urged the region to prepare for another wave of pandemic flu cases as the northern hemisphere moves closer to its winter season, Agence France-Presse (AFP) reported. The WHO told the group meeting in Kathmandu that although the virus has yet to take a big toll in Asia, hospitals should prepare for a surge of severe cases. [Sep 9 AFP story]

Egypt orders 5 million vaccine doses Egypt's health ministry said in a Saudi News Agency report that the country has ordered 5 million doses of the pandemic H1N1 vaccine and expects to receive the first delivery in October, Dow Jones news reported yesterday. The story did not say what company was under contract to produce vaccine for Egypt. According to a Sep 5 update from the WHO's eastern Mediterranean office, Egypt has confirmed 727 novel H1N1 cases, including 1 death. [Sep 8 Dow Jones story]

Sep 8

China reports flu rise, predicts vaccine shortage China's health minister Chen Zhu today called the country's pandemic flu situation "grim," due to a surge in cases and clusters in the wake of schools resuming, Agence France-Presse (AFP) reported. Chen cited worries over a national holiday next month, which will prompt gatherings and travel, and the limited ability of China's flu vaccine company to supply enough pandemic H1N1 vaccine to meet demand. China has confirmed 5,592 cases, but has reported no deaths. [Sep 8 AFP story]

Pandemic puts damper on French cheek kiss To help curb the spread of the pandemic H1N1 virus, French health officials, as well as some companies and schools, are advising people to avoid greeting other with "la bise," the country's traditional cheek-to-cheek kiss, the Associated Press (AP) reported yesterday. The health ministry's phone hotline recommends avoiding close contact, such as shaking hands or kissing. [Sep 7 AP story]

Report says job questions among top pandemic-related legal issues Questions related to employment are among the most significant legal issues raised by an influenza pandemic, the Congressional Research Service (CRS) said in a recent report on pandemic-related legal issues. Compliance with public health measures such as isolation and quarantine are likely to suffer if workers fear pay cuts or firing, the report says. It says workers may have some protection under the Family and Medical Leave Act. [Full text of CRS report]

Singapore finds pandemic H1N1 virus in Indonesian pigs Singapore's Agri-Food and Veterinary Authority has detected the pandemic H1N1 virus in pigs imported from Indonesia, according to a recent report by Channel NewsAsia. While saying that pork sold in Singapore is safe to eat, the agency vowed to step up its inspections of pork products and to work with Indonesian authorities to identify and isolate affected pig houses on farms. [Sep 3 Channel NewsAsia report]

New York nurses group advocates N95 respirators In an open letter, the New York State Nurses Association (NYSNA) called on the state health department to recommend the use of fit-tested N95 respirators to protect nurses who care for pandemic H1N1 flu patients. The Sep 4 letter said the state's current guidelines, which call for the use of surgical masks, are not adequate. A health department spokeswoman defended the current guidelines and said nurses would be protected by mandatory vaccinations, the New York Daily News reported. [Sep 4 NYSNA open letter]

Production delay slows vaccine delivery to Holland The Dutch health ministry said today a delivery of 18 million doses of pandemic H1N1 vaccine from Novartis slated for the end of October will be late, Dow Jones news reported today. Novartis attributed the delay to "disappointing production result." The country, now expecting 6 to 10 million doses from the company by the end of next month, expects 2 million more from GlaxoSmithKline. Novartis said it hopes to boost yield by using a new seed strain it received from the World Health Organization. [Sep 8 Dow Jones story]

Flu fatal for Ecuador's security chief Ecuador's presidential security chief, John Merino, died on Sep 6 from a pandemic H1N1 infection, AFP reported today. He was first diagnosed with the novel flu strain on Aug 10. The virus has struck a host of other South American government officials over the past few weeks, including the presidents of Costa Rica and Colombia. [Sep 7 AFP story]

Sep 4

Britain scales back flu death projection The British government scaled back its projection of how many novel H1N1 deaths could occur, The Times of London reported today. In July it predicted 65,000 fatalities in a worst-case-scenario, but now the National Health Service (NHS) says fatalities could range between 3,000 and 19,000. Officials lowered the estimate because symptoms of the virus are mild for most patients. The NHS's chief medical officer said case numbers have not risen in Scotland, where school resumed 3 weeks ago. [Sep 4 Times story]

Tiered epidemic plans could improve response Responses to the novel H1N1 virus outbreak might be seen as alarmist, because many pandemic plans accounted for only a worst-case scenario, Peter Doshi, a doctoral student at Massachusetts Institute of Technology wrote in the British Medical Journal yesterday. Calibrated responses based on four types of risk assessments that take into account disease distribution and severity could build public trust and engage the public's attention to warning messages, he wrote. [Sep 3 British Medical Journal press release]

Uninsured New Jersey residents to get free pandemic flu vaccine In announcing new measures to curb the fall wave of pandemic flu, New Jersey officials said yesterday that the state will provide free novel H1N1 vaccine to the 1.3 million uninsured people. The free vaccines will be offered though public health clinics located in all New Jersey counties. Other response measures include a public education campaign, working with school districts to keep schools open, and partnering with districts to establish a voluntary vaccination program. [Sep 3 New Jersey governor's office press release]

Lung tissue in some fatal cases resembles H5N1 infection Pathologic investigation of lung tissue from patients who have died of pandemic H1N1 infections resembles that in those dying from H5N1 avian influenza, a scientist who has studied about 70 fatal cases told the Canadian Press. Dr Sherif Zaki, a pathologist at the US Centers for Disease Control and Prevention said the level of lung damage makes it difficult to oxygenate patients. About a third of the patients had bacterial coinfections, and about 90% had underlying conditions such as obesity. [Sep 3 Canadian Press story]

Doctors reverse severe infection with experimental IV antiviral A 22-year-old woman with pandemic H1N1 infection and chemotherapy-induced immune compromise recovered from a severe infection after treatment with an experimental intravenous version of zanamivir, her doctors reported today in The Lancet. She had not responded to oseltamivir or nebulized zanamivir alongside antibiotics, hydrocortisone, and mechanical ventilation. Her doctors combined IV zanamivir with corticosteroids, which is controversial but is used in some respiratory distress cases. [Sep 4 Lancet report]

WHO: flu activity increasing in many tropical regions In its weekly pandemic update today, the World Health Organization (WHO) said flu activity is widespread and increasing in many tropical regions of South and Southeast Asia as well as South America. Though flu activity is past its seasonal peak in some parts of the southern hemisphere, parts of Australia and South America are seeing sustained circulation. Japan is experiencing an early start to its flu season. The global number of deaths is at least 2,837, mostly from WHO's Americas-region count [WHO pandemic update 64]

Sep 3

Novartis H1N1 vaccine may be effective after 1 dose After a pilot trial of its cell-based pandemic flu vaccine, Novartis reported today that 80% of volunteers had a potentially protective immune response after only one shot. The trial, using 100 healthy adults, showed 90% of subjects had protective immunity after two doses of the vaccine, to be called Celtura. The vaccine was administered with an immune-boosting adjuvant and was well tolerated, according to Novartis. Cell-based vaccines can be produced faster than traditional vaccines. [Sep 3 Novartis press release]

China approves 1-dose H1N1 vaccine China has granted approval for the country's first domestic pandemic flu vaccine, which its maker Sinovac says is effective after only one dose, according to Agence France-Press (AFP). "The Sinovac H1N1 vaccine is officially approved," said the head of China's State Food and Drug Administration's registration department, adding that trials showed the vaccine to be "very safe." [Sep 2 AFP story]

Tracking system tallies 1,640 campus flu cases A tracking system set up by the American College Health Association Students has logged 1,640 cases on college campuses from Aug 22 to 28, with the highest rates in the Southeast and Northwest, according to the New York Times. The system uses reports from campus health services at 165 universities nationwide but does not delineate between pandemic and seasonal flu cases. [Sep 3 New York Times item]

Obama adds $2.7 billion for antivirals, vaccine President Barack Obama's administration will spend an additional $2.7 billion for antiviral drugs and vaccines to fight pandemic influenza, according to Reuters. This is in addition to $1.8 billion the administration earmarked in July. Obama said the added funds would go toward buying vaccines and antiviral drugs as well as a vaccination campaign. The money has already been appropriated by Congress. [Sep 2 Reuters report]

US orders $52 million in flu supplies The US government has ordered $52 million in flu products from the UK firm Becton Dickinson and Co, according to a Reuters story today. The order includes syringes, needles, sharps collectors, and alcohol swabs through March of next year. [Sep 3 Reuters story]

Sep 2

New York City to offer kids free pandemic flu shots New York City's school district said yesterday it will offer free novel H1N1 flu vaccine to all its students, according to the Associated Press (AP). Hundreds of US school districts will provide vaccinations in schools as the vaccine becomes available, projected to occur next month. Brenda Greene, director of school health programs for the National School Boards Association, said New York, with its more than 1 million schoolchildren, could be "a great role model." [Sep 1 AP story]

Other large US cities detail their plans In addition to New York's immunization plan, other large US cities are announcing steps, according to Bloomberg News. Los Angeles will administer vaccine at its fairgrounds, Boston is allowing city employees to leave work for 2 hours for vaccine, and Chicago's schools for the first time plan to track real-time attendance to pinpoint trends. Los Angeles and Boston are also setting up swine flu centers to administer vaccinations. [Sep 1 Bloomberg report]

Egyptian H5N1-H1N1 coinfection report debunked A story out of Egypt about a man infected with both the novel H1N1 virus and the deadly H5N1 avian flu is not accurate, according to an official with the Centers for Disease Control and Prevention (CDC). The story by an Egyptian newspaper was picked up yesterday by the widely read electronic surveillance system ProMED mail. However, Nancy Cox, head of the CDC's influenza division, told the blog ScienceInsider, "Our reliable sources indicate that this report is incorrect." [Sep 2 ScienceInsider blog entry]

China nears decision on one-dose vaccine China is close to approving domestic novel flu vaccines that manufacturers claim can protect people with just a single dose instead of the two doses that most officials believe will be necessary, according to the AP today. China's vaccines could boost global health efforts if the one-dose administration proves effective. China's State Food and Drug Administration said at least two pandemic vaccines are near approval and another four are under review. [Sep 2 AP report]

WHO expert: Mutations no obstacle for H1N1 vaccine Novel H1N1 vaccines should offer effective protection even if the pandemic flu virus mutates as it spreads, a World Health Organization (WHO) official said today, according to Reuters. Marie-Paule Kieny, director of the WHO vaccine research program, said, "Based on the extensive knowledge available on seasonal vaccines and the results obtained through evaluation of H5N1 avian influenza vaccines, there is no doubt that it will be possible to make effective H1N1 pandemic vaccines." [Sep 2 Reuters article]

Novel flu may cause deaths in heart patients Physicians have raised concerns that pandemic flu may hit heart patients hard, according to the AP. Thus, some specialists at a European cardiology meeting said that such patients should receive vaccine priority. Although most heart patients are 60 or older and therefore may have some immunity to novel H1N1, "It's almost a given that any influenza exposure is going to cause more mortality in heart patients," said Alfred Bove, president of the American College of Cardiology. [Sep 2 AP story]

iPhone app may help track flu near you A new iPhone application, created by researchers at Children's Hospital Boston, is said to enable users to track and report outbreaks of infectious diseases, such as H1N1 pandemic flu, in real time. The application, "Outbreaks Near Me," employs the online resource HealthMap, which collects, filters, and maps information about emerging infectious diseases and pinpoints outbreaks near the user. [Sep 1 Children's Hospital Boston press release]

Sep 1

Neurologists to help with vaccine safety surveillance The American Academy of Neurology has joined with the CDC to ask neurologists to report any potential new cases of Guillain-Barre syndrome (GBS) after the pandemic H1N1 vaccine campaign begins. The organizations are asking neurologists to report through the federal Vaccine Adverse Event Reporting System. The groups don't anticipate that the vaccine will pose a GBS risk, but they are acting with caution because some GBS cases were linked to the 1976 swine flu vaccine. [Aug 31 American Academy of Neurology press release]

Canadian expert urges using non-adjuvanted vaccine Dr. Paul Hebert, editor of the Canadian Medical Association Journal, said in an editorial that approving an adjuvanted version of Canada's H1N1 vaccine will cause delays and urged using a non-adjuvanted version to begin vaccinating high-risk groups, according to the Toronto Star. But a spokeswoman for the Public Health Agency of Canada said the government has a "highly flexible regulatory plan" and will not need extra time to approve the adjuvanted vaccine, the story said. [Sep 1 Toronto Star story]

Openness was Mexico's most effective tactic against H1N1 Mexican health officials who are examining what worked and what didn't in fighting the first wave of H1N1 flu say that rapid notification of the public about the virus was the most effective step, though it cost the economy billions of tourist dollars, the Associated Press (AP) reported today. Rapid diagnosis, treatment, and quarantine, along with hand-washing, also were helpful. Ineffective steps included travel bans, school closures, and widespread use of surgical masks, the story said. [Sep 1 AP report]

Mexico City offers travelers free insurance To boost travel business in the wake of the novel H1N1 epidemic, Mexico City last month began offering free insurance to anyone who registers to stay at one of the city's hotels, the Toronto Star reported today. The coverage, provided by Spain-based Mapfre, covers medical problems, trip cancellations, and document losses. It costs the hotels $30 per visitor. Enrollment is automatic when travelers book a Mexico City hotel room. [Sep 1 Toronto Star story]

Walgreens' seasonal flu vaccine program includes some free doses The Walgreens drugstore chain announced yesterday that it will begin offering the seasonal flu vaccine today in its stores. Walgreens also announced a $1 million program to provide free flu vaccine to uninsured adults, who will receive vouchers to use at wellness tour bus locations in nine cities. The Centers for Disease Control and Prevention has called for early seasonal flu vaccine campaigns to make way for novel H1N1 vaccination efforts, expected to start in mid October. [Aug 31 Walgreens press release]

Federal agencies launch 'Sesame Street' PSAs Three federal agencies, including the Department of Health and Human Services (HHS), have teamed with Sesame Workshop, the educational group linked to television's "Sesame Street," to launch a new series of public service announcements to teach families and children how to prevent pandemic H1N1 flu. The four videos, available on the Flu.gov Web site, address hand-washing and proper coughing and sneezing techniques. The groups produced a similar series at the start of the spring flu outbreak. [Sep 1 HHS press release]

Aug 31

H1N1 cases may strain ICUs this winter Experience to date suggests that the novel H1N1 flu may put a heavy burden on intensive care units (ICUs) in coming months, said critical care specialists quoted in a Canadian Press report today. ICUs in some of the hospitals hit hardest by virus nearly ran out of specialized equipment and skilled staff. The Public Health Agency of Canada has scheduled a meeting this week in Winnipeg to discuss the problem. [Aug 31 Canadian Press story]

Mexico predicts 1 million cases in next flu wave Mexico's government projects that 1 million of its citizens will become ill this winter with the novel H1N1 virus, the Latin American Herald Tribune reported today. The country's health secretary, Jose Angel Cordova, said on Aug 28 that the number of cases is stable for now, with about 80 to 100 infections reported each day. He said the government is working on emergency plans on school closures, social distancing measures, and hospital preparations. [Aug 31 Latin American Herald Tribune story]

WHO chief: H1N1 spreads at 'unbelievable' speed Dr. Margaret Chan, head of the World Health Organization, told France's Le Monde newspaper that the novel H1N1 virus "spreads at an unbelievable, almost unheard-of speed," according to an Aug 29 Agence France-Presse (AFP) story. She said the virus can travel as far in 6 weeks as other viruses travel in 6 months and estimated that up to 30% of people in densely populated countries are at risk for infection. Chan also noted that about 40% of deaths are in previously healthy young adults. [Aug 29 AFP story]

Colombia's president ill with pandemic flu Colombian President Alvaro Uribe became ill with flulike symptoms on Aug 28 while addressing South American leaders at a summit in Argentina and was diagnosed yesterday as having the pandemic H1N1 virus, The Guardian reported today. He has continued working in partial isolation via phone and internet. So far no illnesses have been reported in other leaders or in Uribe's travel group. [Aug 31 Guardian story]

HHS opens public vote for flu-prevention video The US Department of Health and Human Services (HHS) has invited the public to help pick the best video in its Flu Prevention Public Service Announcement (PSA) Contest. The top 10 videos, chosen from among 240 entries, have been posted on YouTube, and the public is invited to view the 30-second spots and vote their choice. The winner will receive $2,500 and see the video broadcast on national television. [Aug 31 HHS news release with link to PSAs]

Kuwait postpones kindergarten start Kuwait's education ministry said yesterday that the country will delay opening kindergartens for 2 months to curb the spread of the novel H1N1 virus, AFP reported today. The measure will also apply to nurseries and schools that serve students with special needs. Other schools will reopen at the usual time, the last week of September. [Aug 31 AFP story]

CVS stores to offer seasonal flu vaccine The CVS pharmacy chain today announced that seasonal flu vaccine will be available starting tomorrow at 500 of its stores, according to a company press release. Vaccine will be available to adults and children over 18 months without an appointment. The chain said it will host about 9,000 flu clinic events starting Sep 15. With novel H1N1 vaccine expected to reach providers in October, the US CDC has said that people should receive the seasonal vaccine as soon as it's available. [Aug 31 CVS/Caremark press release]

Aug 28

Poll suggests rising flu concern in US public A new USA Today/Gallup poll suggests Americans are becoming more concerned about getting sick with the pandemic flu virus, USA Today reported yesterday. Of 1,007 adults who were polled, 1 in 3 believe they or a family member will get sick with the virus, up from 1 in 5 in May. Compared with the earlier poll, slightly more accept the government's risk assessment, and 55%, up from 46%, now say they will get the vaccine. The poll's margin of error is 4 percentage points. [Aug 27 USA Today story]

Expert warns about next year's pandemic flu wave The fall wave of pandemic H1N1 flu in the northern hemisphere will likely resemble the spring spread of the virus, but a more deadly outbreak could strike next year because of natural selection pressure, virologist John Oxford told Agence France-Presse (AFP) yesterday. Once the virus infects a third of the population, it will find fewer susceptible individuals, which may give mutant viruses a selective advantage, he said. He urged governments not to let down their guard after the next wave. [Aug 27 AFP story]

Manitoba finds novel flu virus on pig farms Manitoba's chief veterinary officer recently announced that the novel H1N1 virus has been detected on various pig farms in the province, according to a post today on ProMED-mail, the Internet-based reporting system of the International Society for Infectious Diseases. No deaths were reported, but the animals showed mild flu-like symptoms. Movement of the pigs was limited to curb transmission, and veterinarians have been asked to help identify and report further outbreaks. [Aug 28 ProMED-mail post]

Britain, France get first H1N1 vaccine shipments Britain and France have received their first novel flu vaccine shipments, but they await regulatory approval and likely won't be administered to patients until October, AFP reported today. British officials said they received 100,000 doses of a vaccine made by US-based Baxter, but French officials didn't specify the number of doses they received or the manufacturer. [Aug 28 AFP story]

Several factors tipped US decision for 2 separate flu vaccines In response to reader questions about why US officials didn't combine the novel flu vaccine with the seasonal flu vaccine, Columbia University virologist Vincent Rancaniello, who authors a virology blog, posed the question to the Centers for Disease Control and Prevention. The agency responded that factors weighing against inclusion were lack of clinical trials for tetravalent vaccines, different high-risk populations for seasonal and pandemic flu, production timing, and ease of safety tracking. [Aug 26 Virology Blog post]

Aug 27

Judge rejects bid to ban use of some H1N1 vaccines in pregnant women A federal judge yesterday rejected an advocacy group's request to bar the government from using thimerosal-containing H1N1 flu vaccines in pregnant women, the Associated Press reported. The group argued that thimerosal could harm fetuses. But a judge in Washington said the group couldn't prove that pregnant women would get shots containing thimerosal. Most flu vaccines contain it, but the CDC has said it plans to supply enough thimersoal-free H1N1 vaccine for pregnant women and young children. [Aug 26 AP story]

Chicago H1N1 study shows children far more susceptible than older adults A study of the first 3 months of the H1N1 flu epidemic in Chicago shows that children aged 5 to 14 were 14 times more susceptible to the virus than adults aged 60 and older, according to Morbidity and Mortality Weekly Report (MMWR). Chicago had 1,557 confirmed cases during the 3 months, and the attack rate for children was 147 per 100,000 population. The hospitalization rate was highest for children 0 to 4 years old (25 per 100,000), followed by those aged 5 to 14 (11 per 100,000). [Aug 29 MMWR article]

New Zealand's medical visit rate for flu-like illness tripled this year Flu surveillance in New Zealand from early May to early August showed that the peak in weekly visits to general practitioners for flu-like illness was the highest since 1997 and three times as high as in 2008, according to MMWR. Surveillance also showed that as the season progressed, the number of 2009 H1N1 isolates rapidly exceeded the number of seasonal flu isolates, with the new strain making up 80% of all weekly isolates by early July. [Aug 29 MMWR article]

Brazil reports world's highest H1N1 flu death toll at 557 Brazil has displaced the United States as the country with the most 2009 H1N1 flu deaths, at 557, Agence France-Presse reported yesterday. The latest official death toll for the United States was 522 as reported by the CDC last week. Brazil's health ministry said the country's H1N1 epidemic appears to be declining. The ministry has allocated $1 billion to buy 73 million doses of H1N1 vaccine, along with oseltamivir, hospital equipment, and diagnostic tests. [Aug 26 AFP story]

Federal workers may be allowed to use sick leave to care for ailing relatives Under a new proposal, federal employees could use accumulated sick leave to care for family members sick with H1N1 flu or other infectious diseases, the Washington Post reported. The proposal, published yesterday, would allow workers to use up to 13 days of sick leave to care for a relative before getting a doctor's determination that the relative had an infectious disease. With the doctor's determination, the employee could use up to 12 weeks of sick leave a year. [Aug 27 Washington Post story]

Liability, insurance coverage threaten Australia's vaccine program Australia's pandemic H1N1 vaccine campaign is in peril because the government has refused to indemnify physicians who administer the vaccine and insurance companies seem unwilling to pay doctors to deliver the vaccines, the Sydney Morning Herald reported today. Insurance companies have also raised concerns about multidose vial safety and a lack of vaccine safety data. The country's vaccine campaign is slated to start in mid September, with enough vaccine to cover half of the population. [Aug 27 Sydney Morning Herald story]

Defense Department secures its own vaccine supply The US Department of Defense has purchased a 2.7-million-dose supply of novel H1N1 vaccine for active military members through the federal government and will launch immunization campaigns in October, starting with high-risk groups and those who live in close quarters at sea, Government Executive reported yesterday. All service members are slated to receive the vaccine, though their dependents will receive theirs though civilian channels. [Aug 26 Government Executive story]

South Korea rolls out strict school flu measures South Korea's education ministry yesterday announced strict measures to curb the spread of the pandemic H1N1 virus, including checking all students' temperatures each day, sterilizing classrooms daily, and refraining from group activities, Agence France-Presse reported today. So far 46 schools have closed or delayed the start of fall classes. The government expects to place school children on its vaccine priority list. [Aug 27 AFP story]

Aug 26

CDC reports 2 more antiviral-resistant H1N1 cases Two more oseltamivir (Tamiflu)-resistant cases of novel H1N1 flu have been identified in the United States, bringing the US total to four, Dr. Scott Epperson of the CDC reported today during a teleconference sponsored by the National Influenza Vaccine Summit. "These two new cases as well as the first two reported 2 weeks ago were associated with treatment or prophylaxis with Tamiflu," Epperson said. The two latest cases were included in the CDC's weekly surveillance update issued Aug 21. [CDC's most recent weekly flu surveillance report]

Pandemic H1N1 picks up pace at schools, colleges Officials at Carnegie Mellon University in Pittsburgh have confirmed novel H1N1 in 24 students, many of whom are being treated in isolation units, the Pittsburgh Post-Gazette reported today. Penn State has also confirmed several cases. Meanwhile, schools near Lee County, Alabama, including the cities of Opelika and Auburn, are reporting hundreds of students sick with flu-like illnesses, and dozens of illnesses have been reported in Los Alamos, NM, schools, according to other reports. [Aug 26 Pittsburgh Post-Gazette story]

Novel flu suspected in another Australian pig herd Another pig herd in Australia has been quarantined because of a suspected novel H1N1 flu outbreak, the Australian Associated Press (AAP) reported. Veterinarians took samples from the pigs after several in a shed of 450 showed flu-like symptoms. The farm is located west of Brisbane in Queensland. Initial results were positive for influenza A, and further tests are under way to confirm the pandemic H1N1 virus. An outbreak was reported in Victoria last week and New South Wales in July. [Aug 25 AAP story]

Australia's H1N1 epidemic still going strong Australia's H1N1 flu epidemic has not yet passed its peak, Health Minister Nicola Roxon said today, according to the AAP. Roxon said there have been signs of a decline in cases in some areas, but cases are still increasing in others. The country has had 138 deaths from the virus, and about 80% of people tested for flu-like illness have had it. Australia currently has 440 people hospitalized with the illness, including 100 in intensive care units, the story said. [Aug 26 AAP story]

Angola reports first novel flu cases Angola's health ministry yesterday reported the country's first four pandemic H1N1 cases, Angola Press reported. The patients include two Brazilians and two Angolans from the same family, both of whom traveled internationally. All of the patients are in isolation and are reportedly in stable condition. [Aug 25 Angola Press story]

EU puts chronically ill, pregnant women, health workers first for vaccine The European Union's (EU's) health authorities yesterday recommended that people ages 6 months and older who have chronic health conditions, pregnant women, and healthcare workers be first in line for novel H1N1 flu vaccine. The EU statement said it will be up to member states to develop their own vaccination strategies. Unlike the US priority group list, the EU list does not include the general population of children aged 6 months through 4 years. [Aug 25 EU statement]

FDA issues emergency authorization for H1N1 test in military The US Food and Drug Administration (FDA) yesterday issued an emergency use authorization (EUA) for a novel H1N1 flu diagnostic test in US troops overseas. The Centers for Disease Control and Prevention developed the test, called the CDC swH1N1 Influenza Real-Time RT-PCR. FDA Commissioner Margaret A. Hamburg said the test will permit faster diagnosis of H1N1 in troops so that treatment can start sooner. [Aug 25 FDA statement]

Aug 25

Full H1N1 immunity may not come till Thanksgiving Health and Human Services Secretary Kathleen Sebelius said yesterday it will probably be Thanksgiving before many Americans are fully immunized against the novel H1N1 flu virus, the Associated Press (AP) reported. Sebelius, speaking to reporters in Atlanta, said immunization will probably require two doses 3 weeks apart, and full immunity won't develop until a week or two after the second dose. The first doses are expected to become available in mid-October. [Aug 25 AP report]

As demand drops, UK closes 2 pandemic flu call centers Because of declining demand, Britain's National Pandemic Flu Service will close two of its telephone call centers this week, the Guardian newspaper reported. The story said infection rates have dropped and calls to the help lines have fallen since late July. The centers prescribe antiviral drugs over the phone to people with flu-like illnesses, a practice that has stirred controversy. More than 500,000 packs of oseltamivir were prescribed in the first 2 weeks after the centers opened. [Aug 25 Guardian story]

Smokers may be susceptible to severe H1N1 illness A Hong Kong health official said smokers may be prone to suffering life-threatening complications from novel H1N1 flu, Bloomberg News reported yesterday. At a medical meeting, Thomas Tsang of Hong Kong's Centre for Health Protection said 12 of 27 patients who suffered pneumonia and other serous complications were current or former smokers, and some had no other known risk factors. About 1 in 200 people in Hong Kong who tested positive for H1N1 experienced severe disease, the story said. [Aug 24 Bloomberg News story]

Asia predicted to fall far short on H1N1 vaccine Asian countries will far markedly short of novel H1N1 vaccine this fall, a spokesman for the World Health Organization (WHO) said, according to a Reuters story today. Australia and China are scheduled to start vaccine production in September, but their vaccine is unlikely to benefit the rest of the region. "There is going to be massive underproduction of vaccines as compared to the needs and demand," said Manila-based WHO spokesman Peter Cordingley. [Aug 25 Reuters article]

Sweden targets entire population for vaccine Sweden has set aside $142 million to pay for the vaccination of its entire population against pandemic flu, an official said yesterday, according to an Agence France-Press (AFP) story today. The country has signed an agreement with British vaccine maker GlaxoSmithKline for 18 million vaccine doses enough to cover its population of about 9.3 million with two doses each. Sweden's vaccination program will be voluntary. [Aug 25 AFP story]

All Maryland hospitals e-linked for flu tracking Maryland officials announced Monday that all of the state's hospitals will be linked via computer to better track pandemic influenza this fall and winter, according to a Baltimore Sun report. Maryland is the first state to enroll all its hospitals in the surveillance program, which also can be used to combat bioterror. Forty-six hospitals will share data on patients admitted, diagnoses, and treatments. In addition, state drugstores will log sales of flu and cold medications. [Aug 25 Baltimore Sun report]

Aug 24

WHO urges vaccine support for poor nations The World Health Organization's (WHO's) flu chief urged wealthy nations and drug makers to donate more novel H1N1 vaccines to the world's poorest countries, according to an Aug 22 Associated Press (AP) story. Dr. Keiji Fukuda said, "It is clear that the poorest countries in general are just the most vulnerable to any number of diseases." Two drug companies have already agreed to donate 150 million doses to developing countries, while a third is looking at reduced pricing. [Aug 22 AP article]

HHS tallies US ventilator capacity The US Department of Health and Human Services (HHS) has enlisted the help of the American Association for Respiratory Care to gauge the supply of mechanical ventilators in the nation's hospitals, according to the respiratory therapy journal RT. The HHS requested the inventory, due Sep 10, to help assess how to boost ventilator capacity in advance of an expected fall wave of pandemic H1N1 flu. The report will be confidential and will not be used to relocate machines. [Aug 21 RT story]

PLoS launches preliminary flu research findings site Public Library of Science, a nonprofit, open-access scientific publisher, recently introduced a new portal for rapidly disseminating preliminary influenza-related research findings. Articles on the Web site, called PLoS Currents: Influenza, are screened by a board of moderators but are not thoroughly peer reviewed. The site currently contains 10 articles, including one on pandemic H1N1 virulence and another on the outbreak and intensive care capacity. [PLoS Currents: Influenza Web site]

South Korea delays school openings over flu Because of the rapid spread of H1N1 flu, some South Korean schools are delaying their semester start, scheduled for yesterday, to slow the spread of the virus, the Korea Herald reported. The schools include 3 middle schools, 12 high schools, and 1 international school that reported a total of 38 confirmed H1N1 infections. The number of South Korean cases reached 3,113 yesterday with 188 new cases in that day alone. [Aug 25 Korea Herald story]

Kyrgyzstan reports first novel flu cases Public health officials in Kyrgyzstan today confirmed the country's first novel H1N1 cases, a 24-year-old man and his wife who had traveled to Dubai in mid August, Trend News Agency reported. The two were admitted to an infectious disease hospital on Aug 18 with flu symptoms. Lab tests in Moscow confirmed the diagnosis. [Aug 24 Trend News Agency story]

CSL launching H1N1 vaccine trials CSL Biotherapies, one of five companies making novel H1N1 vaccine for the US government, today announced the launch of clinical trials of the vaccine in adults and children. Plans call for enrolling 1,300 adults and 450 children (aged 3 months to 9 years) in the trials. The subjects will receive two doses 3 weeks apart; three different doses will be tested in the adult trial and two doses in the children's. The children's vaccine will be in a thimerosal-free formulation. [Aug 24 CSL news release]

Aug 21

Chile finds novel flu virus in turkeys Chile's agriculture ministry yesterday reported an outbreak of novel H1N1 flu at two turkey farms west of Santiago, the first such report in birds, Reuters reported. The farms were quarantined on Aug 13 after a change in egg production prompted testing. So far officials have found no further spread. Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a press conference today that the finding was interesting but not surprising or worrisome. [Aug 21 Reuters story]

WHO official predicts 'explosion' of H1N1 cases this fall A World Health Organization (WHO) official speaking in Beijing today said he expects to see an "explosion in case numbers" this fall when novel H1N1 virus activity picks up again in the northern hemisphere, the Associated Press reported. Shin Young-soo, the WHO's Western Pacific director, said cases in many countries could double every 3 to 4 days. But a US CDC official said that while vigilance is needed, fall outbreaks might resemble only a bad flu season. [Aug 21 AP story]

US death toll from H1N1 virus rises to 522 The Centers for Disease Control and Prevention (CDC) recorded 7,963 hospitalizations and 522 deaths attributed to novel H1N1 flu as of the end of last week, up from 7,511 hospital cases and 477 deaths a week earlier, Dr. Jay Butler of the CDC reported at a news conference today. Butler said the overall level of flu activity was low, but two states, Alaska and Maine, still had widespread activity. Those two states plus Hawaii and South Carolina had widespread activity a week earlier. [CDC flu surveillance page]

WHO says cases declining in temperate parts of southern hemisphere H1N1 flu cases in temperate areas of the southern hemisphere are declining, except South Africa, the WHO reported in a revised situation update today. But cases are increasing in tropical parts of Asia that are entering their monsoon season, such as India. The WHO expects the new strain to dominate the early part of the northern hemisphere's flu season. Twelve oseltamivir-resistant cases have been reported. The global H1N1 death toll has reached 1,799, with 177 countries confirming cases. [Aug 21 WHO revised situation update]

Flu fatality study finds half of patients had underlying conditions A review by French researchers of 574 novel flu deaths reported globally through mid July found that about half involved people with underlying conditions, most notably pregnancy and obesity. Reporting in the latest issue of Eurosurveillance, they said more research is needed to explore if other conditions contribute to higher death rates in obese patients. Though older people seem to have some immunity, the group found that elderly patients who had novel flu infections were more likely to die. [Aug 20 Eurosurveillance study]

Study says flu vaccination should target kids and their parents A modeling study to assess flu vaccine allocation strategies found that immunizing school children and adults their parents' age, 30 to 39, might be optimal, researchers reported in Science Express yesterday. Their rationale is that school children are responsible for most flu transmission and that their parents spread the virus to the wider community. The authors wrote that CDC recommendations for seasonal and novel flu vaccination don't fully address those transmission factors. [Aug 20 Science Express abstract]

Another large insurer vows to cover H1N1 vaccine administration Minneapolis-based UnitedHealth Group (UNH), one of the largest US health insurance companies, announced yesterday it would cover administration of the novel H1N1 vaccine for all its members, even if their benefit plans do not usually cover immunizations. Earlier this month, a trade association of health insurance companies told the CDC that insurers would generally cover administration of the vaccine for their members. [Aug 20 UHC announcement]

Aug 20

Australian doctors question country's vaccination plans Australia's major infectious disease society is questioning the safety of the country's novel H1N1 vaccination plans, the Australian Broadcasting Corp. reported today. In a letter to the government, the Australasian Society for Infectious Diseases cited a risk of cross-contamination when using multidose vials and said the flu epidemic has subsided, so the campaign needn't be rushed. A spokeswoman for vaccine maker CSL countered that the single-dose approach would be slower and more expensive. [Aug 20 Australian Broadcasting Corp. News story]

Novel H1N1 deaths in Latin America exceed 1,300 Deaths from H1N1 flu in Latin America, the world's hardest-hit region, have reached 1,303, more than 70% of the global total of 1,799 listed by the World Health Organization, Agence France-Presse reported yesterday. Argentina has had 404 deaths, the second-highest toll after the United States' 477, and Brazil has 368, the story said. Trailing Brazil are Mexico, with 164 deaths; Chile, 105; and Peru, 62. [Aug 19 AFP report]

Americans not worried about H1N1 but will get vaccine More than 60% of Americans say they are not worried about the novel H1N1 flu, but 55% plan to get the H1N1 vaccine for themselves or someone in their household, according to a Washington Post-ABC News Poll. The poll indicates that about one in eight Americans is very worried that the pandemic will affect his or her family, while twice as many are not at all worried, the Post reported. Nearly 75% were confident that the government will be able to cope effectively with the epidemic. [Aug 19 Washington Post story]

Canada expects November vaccination launch, adequate supply Canadian officials hope to license the country's novel flu vaccine and begin immunizing people in November, the Canadian Press reported yesterday. Canada's vaccine supplier, GlaxoSmithKline, will ship about 10 to 15 million doses and will be able to quickly replenish supplies as healthcare workers administer the vaccine to patients. Officials project that GSK's antigen production will outpace its fill-and-finish capacity, but said finishing the vaccine elsewhere would cause delays. [Aug 19 Canadian Press story]

Zimbabwe, Belarus report first novel flu cases Zimbabwe's health ministry today announced the confirmation of the country's first novel H1N1 cases, in five private-school children who got sick in early August, Agence France-Presse reported. Doctors at Zimbabwe's state hospitals are on strike over wage and allowance issues, but the health minister said the medical system is coping. Meanwhile, Belarus confirmed its first novel flu case yesterday, in a Chinese man who had recently returned from visiting China, the Interfax news agency reported. [Aug 20 AFP story]

Many British firms have had H1N1-related absences In a survey of 429 small and medium-size British companies, 72% said they had weathered staff absenteeism because of the H1N1 flu and 38% expected that their sales would suffer, Reuters reported yesterday. The survey by the law firm Eversheds also found that one in five businesses said they expected to have to close or partially close premises, and 87% said they had introduced new sanitation measures to combat the virus. [Aug 19 Reuters report]

Aug 19

New York state requires health workers to get flu immunizations The New York State Department of Health has adopted an emergency rule requiring healthcare workers who have direct contact with patients to be vaccinated against seasonal and novel H1N1 influenza, the New York Times reported yesterday. The rule affects hospitals, home health agencies, and hospices but not nursing homes. The state's largest healthcare union protested the rule, saying the policy could become punitive for workers who shun vaccination for religious or cultural reasons. [Aug 18 New York Times story]

NIAID to launch trials of H1N1 vaccine in children Following approval from a safety monitoring panel, the National Institute of Allergy and Infectious Diseases said it would launch two trials of novel H1N1 vaccines in children. Plans for the trials were announced in July. The safety committee reviewed data from two adult trials that started Aug 7 and found no problems that would preclude the tests in children. One trial will test two different doses of an H1N1 vaccine, and the other will involve giving an H1N1 vaccine with seasonal flu vaccine. [Aug 18 NIAID announcement]

H1N1 vaccine orders in northern hemisphere top 1 billion doses A World Health Organization (WHO) official said yesterday that northern hemisphere countries have ordered more than 1 billion doses of H1N1 vaccines, Agence France-Presse reported. The WHO's Melinda Henry said a few countries, such as Greece, Canada, and Israel, have ordered enough doses to cover their whole populations, while others, including the United States, have ordered less. [Aug 18 AFP story]

Australian government expects first H1N1 vaccine doses next week The Australian government expects to receive its first 2 million doses of H1N1 vaccine by the end of next week, the Adelaide Advertiser reported today. Pregnant women, health workers, and chronically ill people will be first in line for the vaccine. It is expected that immunizations could begin Sep 7, pending approval from national health authorities. They are awaiting safety data from the vaccine manufacturer, CSL, which is also making vaccine for the US government. [Adelaide Advertiser report]

British agency says Tamiflu plus warfarin may increase stroke risk Britain's Medicine and Healthcare Products Regulatory Agency (MHRA) is concerned that oseltamivir (Tamiflu) may interact with the anticoagulant warfarin to increase the risk of uncontrolled bleeding and stroke, according to a report by the Daily Mail newspaper. The agency has advised health professionals to be alert for such cases. The story said the MHRA has received reports of 12 suspected adverse reactions to oseltamivir that involved interactions with warfarin. [Aug 19 Daily Mail report]

Australian survives near-fatal H1N1 case with help of IV zanamivir A 20-year-old Australian who has asthma survived a nearly fatal case of H1N1 flu after he was treated with an experimental intravenous form of zanamivir (Relenza), the Adelaide Advertiser reported today. The man's lungs had filled with mucus and his stomach had shut down, ruling out treatment with oral oseltamivir, the report said. So his doctors decided to try IV zanamivir, which had to be flown in from the United States. The drug is normally taken with an inhaler. [Aug 19 Adelaide Advertiser report]

Aug 18

Canadian experts call for 'health czar' to lead flu fight Canada should have a "health czar" to lead a mass immunization campaign against the novel flu virus and streamline the deployment of equipment and staff needed to manage the epidemic, Dr Paul Hebert, editor-in-chief of the Canadian Medical Association Journal, and his team wrote in an editorial yesterday. They said governments need laws that give leaders the power to rapidly respond to complex pandemic issues. He called for a summit to plot out the next public health response actions. [Aug 17 CMAJ editorial]

Dutch officials set flu vaccine priorities Health authorities in the Netherlands said today they will administer novel flu vaccine starting in October to about 5 million to 6 million people who are at high risk for flu complications, Agence France-Presse reported. Priority groups include those with certain medical conditions, women with underlying conditions who are more than 4 months pregnant, and those older than 60. Officials said they aren't planning to vaccinate the whole population but have ordered vaccine for 16.5 million people. [Aug 18 AFP story]

Chinese firm claims good results in clinical trial of H1N1 vaccine The Chinese company Sinovac Biotech said a single dose of its novel H1N1 vaccine generated an immune response and appeared safe in its first clinical trial, Bloomberg News reported today. The firm asserted that the product met "international criteria for vaccines" and caused no severe side effects in 1,614 volunteers. The company said the results were the first reported for any H1N1 vaccine clinical trial. No details were released on the immune responses to different doses. [Aug 18 Bloomberg story]

Mozambique confirms first novel flu case Mozambique's health ministry today confirmed the country's first novel flu case, in a 46-year-old woman who had recently traveled to South Africa, AFP reported. She is recovering at home. Meanwhile, a disease expert in South Africa said poverty, diseases such as HIV, and overburdened health systems make African countries vulnerable to the novel flu virus, according to another AFP report today. Ed Rybicki, a virologist, said the virus could spread undetected because of poor disease surveillance. [Aug 18 AFP story]

Minorities account for oversize share of Boston's flu hospitalizations A disproportionate number of patients hospitalized with novel H1N1 flu in the Boston area have been African American or Hispanic, the city's public health officials have found, according to the Boston Globe. They speculate that urban crowding, high levels of chronic health conditions, and other issues related to poverty are contributing factors. Of 71 flu patients hospitalized, 49% were African American and 28% were Hispanic, rates double the groups' shares of the city population. [Aug 18 Boston Globe story]

Crucell gets NIAID contract for monoclonal antibody work The Dutch pharmaceutical company Crucell announced today that it received a $40.7 million contract from the National Institute of Allergy and Infectious Diseases to continue developing monoclonal antibodies for the treatment of seasonal and pandemic flu. It contains an option for $28.4 million in additional funding. Crucell said the antibodies are active against seasonal H1N1 viruses, including antiviral-resistant strains, plus H5N1 and pandemic H1N1. [Aug 18 Crucell press release]

Aug 17

Oseltamivir resistance seen in two immunosuppressed H1N1 patients Oseltamivir (Tamiflu) resistance developed in two immunosuppressed patients in Seattle who were treated with the drug for novel H1N1 flu, the CDC reported recently. Both patients, a teenage boy and a woman in her 40s, were receiving immunosuppressive therapy for leukemia, and both had prolonged viral shedding. The cases were not epidemiologically linked. The CDC said clinicians caring for such patients should be aware of the potential for antiviral resistance and prolonged viral shedding. [Aug 14 MMWR Dispatch]

UK expert panel urged against prescribing Tamiflu by phone In launching its system to diagnose H1N1 flu and prescribe oseltamivir by phone, the British government rejected an advisory committee's advice that the practice might engender growing resistance to the drug, according to the Guardian newspaper. A member of the committee said officials judged that the public would not tolerate being told that the national stockpile could not be used, the story said. The advisory panel said the drug should be reserved for people in high-risk group. [Aug 16 Guardian report]

British health officials ask neurologists to track GBS cases England's Health Protection Agency has sent a letter to neurologists asking them to be alert for any increase in Guillain-Barre syndrome (GBS) cases after the public starts receiving the novel H1N1 vaccine, the London Daily Mail reported on Aug 15. The letter, obtained by the newspaper, warns of GBS cases that occurred in the wake of the 1976 US swine flu vaccine campaign. Britain's neurologist association told its members in July that it would launch a 9-month GBS survey on Aug 1. [Aug 15 Daily Mail story]

Democratic Republic of Congo reports first pandemic flu case The Democratic Republic of Congo reported its first novel flu case, in a South African mining official employed by a US firm in Katanga province, Agence France-Presse (AFP) reported today. The man, who is recovering, had recently returned from a vacation in South Africa, and so far none of his family contacts have had flu-like symptoms. [Aug 17 AFP story]

China rolls out tough school flu-prevention measures China's state media said yesterday that the country's education and health ministries have ordered strong measures to curb the spread of the novel flu virus when schools reopen, AFP reported yesterday. Schools in flu-stricken areas can postpone the start of the school year and have been advised not to hold large gatherings and to reduce class sizes. Students are being asked to stay home for 7 days if they have close contact with a sick person and, if they are sick, to stay home until recovered. [Aug 16 AFP story]

Egyptian pilgrims protest travel ban About 300 people staged a protest at Cairo's airport yesterday to oppose an Egyptian government restriction that bars them from traveling to Mecca on pilgrimage, the Associated Press reported. Airport security dispersed the crowd. The travel ban is intended to slow the spread of the pandemic H1N1 virus. The new restriction took effect yesterday. Only travelers between ages 25 and 65, a group thought to be at lower risk for flu, are allowed to make the trip to Mecca. [Aug 16 AP story]

Quebec districts to keep pregnant teachers home this fall Two school districts in Quebec will keep pregnant teachers at home this fall to reduce their risk of severe complications if they get sick with pandemic H1N1 flu, the Canadian Press reported on Aug 15. An official from the Toronto district school board said keeping pregnant teachers home is an idea worthy of consideration, but quantifying the risks is difficult. Pregnant women are listed as a priority group for novel flu vaccines by the United States and the United Kingdom. [Aug 15 Canadian Press story]

Aug 14

CDC reports 41 more US flu deaths The number of novel H1N1 deaths in the United States has risen to 477, up from 436 last week, the US Centers for Disease Control and Prevention said today in its weekly update. Hospitalizations rose to 7,511, up from 6,506. Dan Jernigan, MD, MPH, with the CDC's Influenza Division, said during a teleconference today that flu continues to decline, with widespread activity reported in four states. Officials are looking into reports of increased flu activity in Florida and North Carolina. [Aug 14 CDC novel flu situation update]

Hong Kong reports second Tamiflu-resistant case Health officials in Hong Kong today announced the detection of a second case of novel flu resistant to oseltamivir (Tamiflu). They found the virus in a 40-year-old woman who is a resident of a home for disabled people. She was prescribed the drug prophylactically after other residents of the home became ill. She developed flu-like symptoms about a week later. The Tamiflu-resistant strain wasn't found in any other of the 20 novel flu cases at the home. [Aug 14 Hong Kong Centre for Health Protection news release]

Researchers suggest osteoporosis drugs may have antiviral benefits Researchers from Hong Kong have found that two osteoporosis drugs, pamidronate and zoledronate, might have potential as treatment for influenza, including the novel H1N1 and the H5N1 viruses, Reuters reported today. They found that the two drugs triggered yd-T cells that killed flu-infected human cells. The next steps are to test the drugs in animals and conduct clinical trials in humans. The findings were released by the University of Hong Kong, Xinhua reported today. [Aug 14 Reuters story]

Massachusetts deputizes more healthcare workers to give vaccine The Massachusetts Public Health Council on Aug 12 voted to enable such healthcare professionals as dentists, pharmacists, and paramedics to administer the novel flu vaccine in this fall's vaccination campaigns, the Boston Globe reported yesterday. The move would open the possibility of volunteering to about 12,000 additional workers. The regulators also directed hospitals and clinics to provide vaccine to all their workers, although the workers will not be forced to receive the vaccine. [Aug 13 Boston Globe story]

UK releases vaccine priority plan Government officials in the United Kingdom released details of the country's pandemic H1N1 vaccination priority plan today, which places pregnant women, healthcare workers, and people aged 6 months to 65 years with underlying chronic medical conditions first in line to get the vaccine, reported the Guardian, a British newspaper. The plan also prioritizes people who live in households that include individuals with certain underlying conditions, such as cancer or immune system compromise. [Aug 14 Guardian story]

Aug 13

Canada develops business preparedness tools Canada's health minister Leona Aglukkaq yesterday urged businesses to prepare for another novel flu surge, Agence France-Presse (AFP) reported. She said small- and medium-size firms lag behind larger corporations that have more resource for continuity planning. To help smaller companies prepare, the country's public health agency has contracted with two groups to develop tools to assist with such tasks as flu-related communications and staffing issues. [Aug 12 AFP story]

EU issues school and travel pandemic recommendations The European Union (EU) today issued two pandemic H1N1 policy statements, one on school closures and one on travel. The EU's health security committee said it doesn't see a need for mass preemptive school closures, but said that local closures when large numbers of staff and students are infected may help delay virus transmission. The travel advisory urges sick people to stay home but does not support restriction of individual travelers or movement of people across borders. [Aug 13 EU school closure and travel statements]

WHO: pandemic H1N1 reported in 170 global sites In an update on the novel flu pandemic yesterday, the World Health Organization (WHO) said the virus has now been confirmed in 170 countries and territories. Newly confirming first cases are Timor-Leste, Pakistan, Kirabati, Maldives, French Guiana, Falkland Islands, and Wallis and Futuna. Global deaths, as of Aug 6, rose to 1,462. Flu activity is waning in many southern hemisphere countries and is picking up in tropical regions. [Aug 12 WHO situation update 61]

India urges restraint in media flu coverage India's broadcast ministry has asked media organizations to avoid creating panic over the pandemic H1N1 virus that is quickly spreading in the country, Indo Asian News Service (IANS) reported today. The ministry, however, said it supports efforts to raise flu awareness. In other developments, Delhi province officials have ordered private hospitals with 200 or more beds to help diagnose and treat flu patients as a means of reducing burden on government facilities. [Aug 13 IANS story]

China, Singapore report Tamiflu-resistant H1N1 The WHO said yesterday that China and Singapore have found osteltamivir (Tamiflu)-resistant novel H1N1 viruses, according to a report from the Canadian Press. The story also said the WHO has informal information on a small, unspecified number of other oseltamivir-resistant viruses. The WHO has received formal notification of seven oseltamivir-resistant cases from Japan, Canada, Denmark, Hong Kong, and now Singapore. China has yet to file a formal report on its case. [Aug 12 Canadian Press report]

Seven novel flu cases found in Peruvian tribe Seven members of the native Amazonian Matsigenka tribe tested positive for pandemic H1N1 and have recovered, Peruvian health officials said yesterday, according to Reuters. But because the tribe lives near a reserve set aside for tribes that have limited contact with modern society, human rights groups fear the virus could spread to the more isolated native people who lack immunity to the disease. [Aug 12 Reuters story]

Aug 12

Officials close schools in Bombay Government officials in India's Maharashtra state have ordered all schools and colleges in Bombay to close for a week to slow the spread of novel flu, Agence France-Presse (AFP) reported today. The state has the country's highest number of confirmed pandemic H1N1 cases and has reported four deaths over the past 10 days. India's cable news channels are reportedly devoting hours to novel flu coverage, but the health minister told reporters this week other diseases are more serious and costly. [Aug 12 AFP story]

Costa Rica's president has novel flu Costa Rica's president, Oscar Arias, said in a statement yesterday that he was sick with the pandemic H1N1 flu, AFP reported today. He is the first world leader known to have been sickened by the virus. His brother said the 67-year-old president has asthma and had flulike symptoms for days. Tests yesterday confirmed that he had the novel flu virus. Arias is in home isolation but has not delegated power. [Aug 12 AFP story]

France prepares TV lessons for school shutdowns France's education minister said officials have prepared lessons that can be broadcast on state television and radio if novel flu outbreaks spark flu closures after classes resume this fall, the Associated Press (AP) reported today. Schools in France resume in late August and September. The minister said the country's national distance learning agency developed the lessons. He said school-closure decisions will be made on a case-by-case basis. [Aug 12 AP story]

Researchers question predictive value of past pandemic waves Health officials are being prudent to plan for a more severe second pandemic wave, but a historical review of previous pandemics offers confusing clues about patterns with no evidence that virus mutations led to increased transmissibility, two federal researchers wrote today in a commentary appearing in the Journal of the American Medical Association (JAMA). The authors are Dr David Morens and Dr Jeffrey Taubenberger from the National Institute of Allergy and Infectious Diseases. [Aug 12 JAMA commentary extract]

Aug 11

Flu picks up in Asia with monsoon season Novel H1N1 influenza is spreading in India, Thailand, and Vietnam with the onset of Asia's monsoon season, the World Health Organization (WHO) said today, according to Reuters. The regular flu season has started in those countries, and both H1N1 and seasonal flu are being detected, said WHO spokeswoman Aphaluck Bhatiasevi. But the spread of pandemic H1N1 appears to have peaked in parts of the southern hemisphere, including Argentina, Chile, Australia, and New Zealand. [Aug 11 Reuters article]

Disease expert notes fever-free flu cases In his clinical observation of novel flu cases in the United States and South America, Richard P. Wenzel, MD, former president of the Infectious Diseases Society of America, has noted that some patients are afebrile, even some with serious infections, and lack of fever might underestimate case totals, the New York Times reported yesterday. He said diarrhea seen in a portion of patients suggests a need for stool testing to assess transmission and the role of better hand hygiene. [Aug 10 New York Times article]

School nurse shortage could slow ID of sick kids School nurses are expected to be at the frontlines of detecting and fighting novel flu when schools resume this fall, but the ratio of nurses to students in many states falls well below the levels suggested by the US Centers for Disease Control and Prevention (CDC), USA Today reported yesterday. The CDC recommends a workload of 1 nurse per 750 students, but the newspaper's analysis of census data puts the national average at 1 per 971 students. [Aug 10 USA Today story]

IOM holds meeting on protective equipment for novel flu The Institutes of Medicine's (IOM's) Board on Health Sciences Policy is convening a meeting today through Aug 13 on pandemic influenza and personal protective equipment (PPE) for healthcare workers. Today's agenda includes a call to the committee, with panel discussions starting tomorrow. Topics include the science and clinical experience with novel H1N1, infection control guidelines, risk assessment in health workers, and data on the effectiveness of PPE. [IOM meeting home page]

Aug 10

Review finds little benefit from antiviral use in children An analysis of studies of the effects of oseltamivir and zanamivir for seasonal flu treatment and prophylaxis in children aged 12 and younger showed a small benefit, according to a study in today's British Medical Journal. The authors, who looked at seven studies, found that the drugs provided a small benefit by shortening illness duration and reducing household transmission, but they had little effect on asthma or antibiotic use. Vomiting was reported in children who took oseltamivir. [Aug 10 BMJ abstract]

Pakistan confirms first novel flu case Pakistan's health ministry today reported the country's first novel H1N1 case, according to Xinhua, China's state news agency. The patient is 1 of 25 people with suspected cases undergoing treatment. No other details were available. The health minister revealed the case in a speech to Pakistan's parliament. [Aug 10 Xinhua story]

Iraq sees flu threat from US troops As the US military reported yesterday that 51 American soldiers in Iraq have novel H1N1 flu and 71 others may have the illness, Iraqi health officials expressed concern that the US troops could spread the disease, the New York Times reported yesterday. Members of the Iraqi parliament said Iraqi soldiers serving alongside US troops could spread the virus into Iraq. A health official claimed US soldiers aren't screened for the virus and that their 2-week visits home pose disease risks. [Aug 9 New York Times story]

Canada promotes 'flu buddy' preparedness Health officials in Canada are urging citizens to find "flu buddies" to help care for them during the novel H1N1 pandemic, Canwest News Service reported on Aug 7. The Public Health Agency of Canada is urging people to check in on people who live alone or are vulnerable and help care for them or seek medical care if they are sick. The measure may help take some pressure off the health system and is among the general preparedness tactics that the agency will promote in the fall. [Aug 7 Canwest News Service story]

Trials of long-acting antiviral show promise The Australian drug company Biota today reported positive phase 3 study results from Asian countries of its new antiviral medication laninamivir, a long-acting neuraminidase inhibitor. In adults, a single inhaled dose of the new drug was as effective as oseltamivir taken twice a day for 5 days. Similar trials in children showed the drug was safe and effective. Preclinical studies suggested that the new antiviral is effective against seasonal H5N1 and pandemic H1N1 viruses. [Aug 10 Biota press release]

Aug 7

Canada orders 50.4 million doses of H1N1 vaccine The Canadian government announced plans yesterday to buy 50.4 million doses of novel H1N1 flu vaccine, enough for all Canadians who "want and need" to be immunized. Officials said immunizations will begin by November. Canada has a longstanding contract with GlaxoSmithKline to maintain vaccine production capacity in Canada to meet the country's pandemic vaccine needs. The federal government will cover 60% of the vaccine cost, with provinces and territories paying the rest. [Aug 6 Canadian government news release]

US death toll from novel H1N1 reaches 436 The US death toll due to novel H1N1 flu has risen to 436, up from 353 a week ago, the CDC said in today's weekly flu surveillance report. The agency said flu activity continued its decline last week but still remained above normal for this time of year. Four states and Puerto Rico reported widespread flu activity, the same number as the week before. More than 98% of all subtyped flu viruses were the novel H1N1. The CDC said 6,506 hospitalizations related to the virus have been reported. [CDC flu surveillance report for Jul 26 to Aug 1]

Prospect of three flu shots raises questions People in groups targeted for both seasonal flu and H1N1 flu immunizations will likely need three separate vaccine doses this fall, according to the Associated Press. Experts believe that two doses will be necessary for the new H1N1 virus. Because giving seasonal and H1N1 vaccinations at the same time would complicate safety monitoring, government experts prefer the idea of giving the three shots in three separate visits. But that's expecting a lot from the public, said one vaccine expert. [Aug 6 AP story]

Sanofi files for H1N1 vaccine license, launches clinical trial Sanofi Pasteur announced today that it has launched a clinical trial of its novel H1N1 influenza vaccine and applied to the US Food and Drug Administration for licensure of the vaccine. The company is testing the vaccine, including a version that contains an adjuvant, for immunogenicity and safety in about 2,000 volunteers. In line with recent FDA recommendations, the company has asked the FDA to evaluate the vaccine the same way it reviews seasonal flu vaccine strain changes. [Aug 7 Sanofi news release]

Hanoi closes all schools in bid to stop pandemic Hanoi today closed all of its schools until further notice in an effort to contain the novel H1N1 outbreak, according to an Agence France-Presse report. The city's education department said three schools have had cases among their students. Schools just began opening this week, though the new school year doesn't begin until Aug 17, the story said. Vietnam has had 1,043 H1N1 cases since May, but only one death, which occurred Aug 3 and involved a 29-year-old woman in Khanh Hoa province. [Aug 7 AFP story]

H1N1 enters Ghana Ghana's Deputy Health Minister, Benjamin Kumbour, said yesterday that the country had recorded its first two cases of novel H1N1 flu, according to Independent Online, a South African news service. One case is in a 19-year-old woman from Accra, the capital, who may have been infected by a relative who had visited Britain. The other case involves a woman from the Western Region. Kumbour said Ghana, in collaboration with the World Health Organization, has procured drugs for H1N1 treatment. [Aug 6 Independent Online article]

Healthcare retirees may be called up in UK pandemic efforts Some of the UK's National Health Service (NHS) trusts (organizations that provide services on behalf of the NHS) have begun contacting retired doctors, nurses, and other staff to see if they are willing to help if the H1N1 pandemic worsens. Depending on the trust involved, retirees up to 3 years out have been approached, according to Nursing Times, a British weekly. Some trusts are not enlisting retirees but are cross-training staff and may stop elective services and transfer staff as needed. [Aug 7 Nursing Times online article]

US, Mexican, Canadian leaders to discuss H1N1 President Barack Obama, Mexican President Felipe Calderon, and Canadian Prime Minister Stephen Harper will include the flu pandemic on their agenda when they meet Sunday and Monday in Guadalajara, Mexico. The leaders will confer about vaccine development for the H1N1 flu wave expected this fall and discuss mitigation measures, according to a Reuters story. A joint statement from the three leaders will be issued after the summit. [Aug 6 Reuters article]

Aug 6

British lab finds better-yielding seed strain of H1N1 Britain's National Institute for Biological Standards and Control (NIBSC) has produced a seed strain of novel H1N1 virus that grows much better than strains currently used, the Canadian Press reported yesterday. John Wood of the NIBSC said the strain grows about as well as typical seasonal flu seed strains, but the results must be confirmed by manufacturers. Vaccine makers welcomed the news. Yields from the seed strains now in use have been 50% below those with seasonal flu vaccines or worse. [Aug 5 Canadian Press story]

Argentina flu deaths double in latest count The number of novel H1N1 flu deaths in Argentina has risen to 337, according to the health ministry's latest report, suggesting that Argentina could soon pass United States as the country with the most fatalities, The Guardian, a British newspaper, reported yesterday. The number was more than double the deaths reported in the ministry's last report 2 weeks ago. Though Argentina has more fatalities than any South American country, officials believe novel flu cases have peaked. [Aug 5 Guardian story]

Iran bars pilgrims from attending the Hajj To slow the spread of the pandemic H1N1 virus, Iran's health ministry has banned the country's citizens from attending the annual Hajj pilgrimage in December in Saudi Arabia, the Associated Press (AP) reported today. The health minister said through state media that the event draws 3 million pilgrims from all over the world, presenting a heightened risk of flu transmission. Iran has confirmed 145 cases so far, but no fatalities. [Aug 6 AP story]

California nurses protest inadequate safety equipment California nurses protested outside the University of California-San Francisco (UCSF) medical center yesterday to demand better equipment to protect them against the pandemic virus, according to an Aug 4 press release from the California Nurses Association. An ABC News report yesterday showed the nurses protesting in scrubs and masks. Nurses also protested the alleged firing of a UCSF nurse for complaining about inadequate safety gear. The California Hospital Association has denied the claims. [Aug 4 California Nurses Association statement]

Baxter finishes first batches of cell-based pandemic H1N1 vaccine Baxter International Inc. yesterday announced completion of the first commercial batches of its cell-based pandemic H1N1 vaccine, called Celvapan A/H1N1. The company said the vaccine was developed and produced within 12 weeks of receiving the H1N1 virus strain. In making the vaccine, Baxter applied the same processes used in gaining earlier European licensure of a mock-up pandemic vaccine, officials said. Clinical trials are scheduled to start this month. [Aug 5 Baxter news release]

CDC reports low sensitivity for rapid flu tests The CDC reported today that it assessed several rapid influenza diagnostic tests and found they had low sensitivity, ranging from 40% to 69%. Sensitivity declined substantially when the clinical samples had lower levels of virus, the agency said in Morbidity and Mortality Weekly Report. Thus a positive result can guide treatment, but a negative result does not exclude a novel H1N1 infection. The agency evaluated the tests using 65 samples known to contain novel H1N1 or seasonal viruses. [Aug 7 MMWR article]

Large insurer to cover novel H1N1 vaccine WellPoint, the nation's largest health insurance company in terms of membership, says it will cover administration of the novel H1N1 vaccine as it becomes publicly available, according to a story today from IFAwebnews. WellPoint operates as Anthem Blue Cross in Virginia and as Empire Blue Cross in New York. Members whose plans already provide coverage for vaccines will qualify for the added coverage. [Aug 6 IFAwebnews article]

Aug 5

India flu death spurs crowds, tussles at hospital India's announcement of its first novel flu death 2 days ago sparked panic at a hospital in the town where the 14-year-old girl died, the Associated Press (AP) reported today. Hundreds of people gathered outside a hospital in Pune hoping to be tested for the virus. Several fights broke out while people were waiting in long lines. Local authorities are testing all students who attended the girl's school, the Press Trust of India reported. [Aug 5 AP story]

Novartis novel flu vaccine trials under way Novartis has launched human trials of its novel H1N1 vaccine, according to a company spokesman quoted in an AP story today. The company, like other vaccine makers, is seeing antigen yields that are only 30% to 50% of seasonal flu vaccine, but is still working with the original seed strains. The spokesman said Novartis is testing an unadjuvanted vaccine for the US market and an adjuvanted version for use in Europe and expects to begin shipping in the last quarter of 2009. [Aug 5 AP story]

North Carolina strives to protect pigs at fairs North Carolina's agriculture department yesterday said fairgoers will be asked to wash their hands at hand washing stations to protect pigs from the novel H1N1 flu virus. The department is advising people to avoid fairs or at least avoid animal exhibits if they have flulike symptoms. Veterinary officials have recommended that fair managers add 6-foot-high barriers around swine exhibits to separate animals from people [Aug 4 North Carolina Department of Agriculture press release]

Flu strikes summer camps in 40 states The pandemic H1N1 virus has been detected at 80 summer camps in 40 states so far this summer, according to Anne Schuchat, MD, an official from the US Centers for Disease Control and Prevention (CDC). She made the comment yesterday during a webcast during which federal officials shared updates on novel flu and the status of planning efforts. Health officials have said they expect flu activity to rise when school starts again, and students in some parts of the country are already returning. [Readout of Aug 4 federal flu webcast]

Aug 4

Federal officials weigh narrowing school closure advice Federal officials are considering plans to recommend fewer school closures, according to anonymous sources cited in a Washington Post story today. Early in the novel H1N1 flu outbreak, officials recommended closures when student illnesses were confirmed, but later recommended closing only when large numbers were ill. The new guidance might recommend closure only under "extenuating circumstances," such as schools that have large numbers of children with chronic medical conditions [Aug 4 Washington Post story]

Some call for more use of pneumococcal vaccine in H1N1 battle Some infectious disease experts say the pneumococcal vaccine Pneumovax should be used more widely as a way to prevent serious cases of novel H1N1 flu, the Los Angeles Times reported today. Preliminary CDC data indicate that about 30% of H1N1-related pneumonia cases are caused by Streptococcus pneumoniae, which is targeted by Pneumovax. At least 70 million Americans are in groups advised to receive the vaccine, but coverage among non-elderly groups is fairly low. [Aug 4 LA Times story]

China cancels camps in flu-stricken areas China's health ministry is canceling summer camps in areas where novel H1N1 outbreaks are occurring, China Daily reported, according to an Agence France-Presse (AFP) story today. The action follows reports of more than 120 illnesses in students and adults at summer camps in Beijing and in Guangzhou in southern China. The ministry statement said camps elsewhere in the country should be held "only when necessary." [Aug 4 AFP story]

Russian official warns against travel to UK Russia's chief health officer, Gennadi Onischenko, urged Russians not to travel to Wales for a World Cup soccer match on Sep 9 because of Britain's novel H1N1 flu epidemic, according to the British newspaper the Times. Onischenko blamed Britain for most of Russia's H1N1 cases and called travel there "absolutely inappropriate." He suggested that Britain is covering up virus spread. The story said Wales is the least affected part of the country, with 89 confirmed cases and no deaths. [Aug 4 Times report]

Aug 3

Argentina's novel flu pace slows Argentina's pandemic H1N1 cases have peaked, and so far the death rate from the disease seems to be less than for seasonal flu, said public health experts quoted in a Jul 31 Associated Press (AP) report. However, one official said the disease has had its greatest impact on young people. With more than a month left of the country's flu season, scientists report that viruses isolated in Argentina are nearly identical to those circulating in North America. [Jul 31 AP story]

UK sees spurt in reports of reactions to oseltamivir Britain has seen a spurt in reported negative side effects from oseltamivir (Tamiflu) use since the National Pandemic Flu Service was launched Jul 23, the Daily Mail newspaper reported today. The service allows people to get the drug over the phone without seeing a doctor. The story said 293 reports have come in since early April, of which 143 were in the past week. The reported effects include vomiting, diarrhea, and psychiatric and nervous system problems. [Aug 3 Daily Mail report]

Solomon Islands reports first novel H1N1 case The country of the Solomon Islands has reported its first case of novel H1N1 flu, in a member of a multinational assistance team that arrived in the islands from Brisbane, Australia, Jul 30, according to an Australian Broadcasting Corp. (ABC) report. The patient and 12 other team members who traveled with him to Honiara, the capital, are in quarantine. Authorities are urging passengers who were on Pacific Blue flight DJ-169 to contact them. [Aug 3 ABC News report]

CDC issues call-center resource The US Centers for Disease Control and Prevention (CDC) on Jul 30 issued a tool to help communities develop and manage call centers as a way of relieving pressure on 911 systems and healthcare systems during the H1N1 flu pandemic. The guidance, developed for the CDC by a Department of Energy facility, acknowledges that each community's needs and capabilities vary. Communities are urged to identify key partners and build on systems that are already in place. [CDC call center guidance]

Feds launch school-closure monitoring system The CDC and the US Department of Education have set up a system for monitoring school dismissals related to the novel H1N1 pandemic. The CDC has posted a page for the system on its Web site. School districts have the option of filling out and submitting the report online or printing out a form that can be submitted by e-mail or fax. [CDC/DOE school dismissal monitoring portal]

Jul 31

CDC says H1N1 hospitalizations total 5,514 The US Centers for Disease Control and Prevention (CDC) today said it is aware of a total of 5,514 H1N1 flu hospitalizations and 353 deaths from 47 states and territories. The agency said last week it would no longer list national H1N1 case counts. Meanwhile, the CDC's flu surveillance report for last week says that novel H1N1 activity continued to drop for the fifth consecutive week, with only four states and Puerto Rico reporting widespread activity, down from seven states the week before. [CDC novel flu hospitalization and death count]

UK surveys find side effects in children given preventive oseltamivir Two survey studies in the Jul 30 issue of Eurosurveillance report side effects in British schoolchildren who received prophylactic oseltamivir treatment. In an online survey of three London schools, 53% of the children reported side effects, including gastrointestinal (40%) and mild neuropsychiatric (18%) problems. In the other study, 51% of students from one school reported symptoms such as feeling sick, headache, or stomachache. Compliance was higher in the single-school study. [Jul 30 issue of Eurosurveillance]

Two nurses die of novel flu infections A 51-year-old California nurse who worked on a cancer unit at a hospital in Carmichael died of a novel H1N1 flu infection, the Sacramento Bee reported today. A hospital spokesman said authorities don't know if she was exposed to the virus at the hospital or elsewhere. Her death certificate said she also had pneumonia and was infected with methicillin-resistant Staphylococcus aureus. Meanwhile, a pediatric nurse in New Zealand recently died of a novel H1N1 infection, local media reported. [Jul 31 Sacramento Bee story]

Wal-Mart may help feds with vaccine campaign Wal-Mart officials met with US health officials on Jul 29 to discuss what role the retail chain might play in helping to distribute the pandemic H1N1 vaccine this fall, Reuters reported yesterday. Dr. John Agwunobi, the company's president of health and wellness, in an address at the annual meeting of the National Association of County and City Health Officials yesterday, said options might include giving flu shots in stores and helping federal officials with logistic and supply-chain issues. [Jul 30 Reuters story]

Switzerland to be among first to get Glaxo pandemic vaccine shipments A GlaxoSmithKline spokesman said Switzerland will be one of 10 countries to receive the "first wave" of the company's pandemic H1N1 vaccine, though he did not name the other nine countries, Bloomberg News reported today. He said first-wave-countries will get their supplies in September or October and that countries in the second wave will receive theirs "a bit later." The spokesman said Switzerland signed an agreement with Glaxo in 2006 to receive priority delivery of pandemic vaccine. [Jul 31 Bloomberg News story]

Jul 30

Canadian officials hold off on flu vaccine priority list Canadian health officials said yesterday that they would wait until at least September to finalize pandemic H1N1 vaccine priorities, Canwest News Service reported today. Dr David Butler-Jones, chief public health officer, said authorities still have time to assess developments, such as the southern hemisphere's evolving flu season. Yesterday US officials recommended five priority groups to receive the vaccine, with pregnant women topping the list. [Jul 30 Canwest News Service story]

Novel flu strain found in second Canadian pig herd Quebec's agriculture ministry announced that it detected the novel H1N1 virus in a pig herd, the second such finding in Canada, the Alberta Farmer news Web site reported on Jul 28. Clinical signs were detected in late June, the herd has recovered, and no other farms were affected, the ministry said. Authorities suspect a human source for the outbreak, though no illnesses in the farm family, workers, or visitors have been reported. [Jul 28 Alberta Farmer story]

H1N1 cases in Britain may be leveling off Britain's Health Protection Agency estimated today that the country had about 110,000 new cases of H1N1 flu last week, as compared with about 100,000 the week before. But the agency said overall indications are that the number of cases is "no longer rising rapidly, and may have plateaued." Cases appear to have decreased in 5- to 14-year-olds but were still rising in other age-groups, officials said. [UK weekly pandemic flu update]

Pandemic flu strikes Air Force unit Four pandemic H1N1 illnesses have been confirmed in airmen at the US Air Force's Hurlbut Field, a special operations command based in northwestern Florida, the Associated Press reported today. A spokeswoman for the unit said 59 more airmen were suspected of having the virus, but will not be tested. [Jul 30 AP story]

Moldova, Azerbaijan report first pandemic flu cases Moldova's health ministry reported the country's first pandemic H1N1 case, in a 24-year-old woman who had recently taken a 2-week trip in Europe, the Associated Press reported today. In other developments, Azerbaijan reported its first two novel flu cases, in a 14-year-old boy and a woman. Both were returning from European countries and were screened and identified at the airport as they returned home, Reuters reported today. [Jul 30 AP story]

CDC issues guidance on use of rapid flu tests The Centers for Disease Control and Prevention (CDC) yesterday issued interim guidance for detecting novel H1N1 influenza with rapid tests. The agency advises labs that use rapid tests to add to result reports a statement describing the tests' limitations to help physicians make treatment decisions. The note would emphasize that rapid tests do not distinguish influenza A subtypes, including the novel one, and that if a test is negative for A and B, clinical presentation should guide diagnosis. [Jul 29 CDC rapid testing guidance]

Jul 29

Military may assist with US H1N1 response US military personnel may work alongside civilian authorities during any significant outbreaks of the H1N1 influenza virus this fall, according a CNN report. Unnamed Department of Defense officials said the proposal is awaiting approval by Secretary Robert Gates. Personnel from all branches of the military may be involved, and it has not been determined whether the troops would be pulled from active duty or from the National Guard and/or reserves. [Jul 29 CNN article]

UK advises nurseries to remove soft toys Britain's Department of Children, Schools and Families has come under fire for issuing recommendations that nurseries and "childminders" remove communal soft toys from care settings to help contain the spread of H1N1 flu, saying the toys cannot be cleaned adequately. The agency also recommend that crayons and pencils not be shared and large assemblies be suspended. Defenders of the guidance say it is sensible but should be administered sensitively so as not to upset children. [Jul 29 The Times article]

Latin America has lion's share of H1N1 deaths Although novel H1N1 flu strain is spreading worldwide, Latin America, currently in its winter season, is being disproportionately hit right now, according to WA Today.com, an Australian news service. Of the 816 deaths the World Health Organization has so far confirmed, two thirds have occurred in Latin America, the report said. [Jul 29 WAtoday article]

Japan finds two more Tamiflu-resistant H1N1 cases Japan has detected two more cases of Tamiflu-resistant pandemic H1N1 flu, Alexander Klimov, PhD, of the CDC's flu surveillance branch, revealed at the CDC's vaccine advisory committee today. He also said that Chinese officials revealed during a World Health Organization conference call that they may have one more antiviral-resistant case. Klimov said all cases so far have been linked to Tamiflu prophylaxis or treatment, except for one involving an American girl who was diagnosed in Hong Kong. [Jul 29 ACIP meeting agenda]

Canada to use adjuvanted H1N1 vaccine Canadian health officials anticipate using an adjuvant to address the possible need to stretch supplies of an H1N1 influenza vaccine this fall, according to a Canadian Press story. Neither Canada nor the United States have licensed flu vaccines with adjuvants before. Health Canada has worked with GlaxoSmithKline on safety studies of the AS03 adjuvant for H5N1 vaccine and is urging the company to do a small trial with an H1N1 vaccine. US officials have been more circumspect on the subject. [Jul 29 Canadian Press story]

Jul 28

Pregnant women bear disproportionate share of flu deaths About 6% of pandemic H1N1 deaths in the United States have occurred in pregnant women, though they make up just 1% of the population, the Associated Press reported today. The numbers are based on 266 detailed death reports that the Centers for Disease Control and Prevention (CDC) has received. Fifteen deaths occurred in pregnant women. The CDC's vaccine advisory committee meets tomorrow and is expected to list pregnant women among the high-priority groups to receive the pandemic H1N1 vaccine. [Jul 28 AP story]

Poll shows parents likely to seek H1N1 flu shots for kids An Associated Press-GfK Roper poll suggests that about 63% of American parents are likely to allow their children to receive the pandemic H1N1 vaccine, but only 51% of adults would probably receive the immunization themselves. Only 43% said they were concerned that they or a family member might contract the new flu virus. The telephone poll, conducted in mid July and released yesterday, included 1,006 adults, of whom 296 were parents. [AP-GfK flu poll report]

Chinese officials say their policy of quarantining foreigners is working Chinese authorities assert that their aggressive quarantine policy to prevent foreign visitors from spreading H1N1 flu has worked well, according to a New York Times report. Officials say China has had few cases and proudly note that no deaths have been reported. But the newspaper tells the story of an American woman who said her surgery for appendicitis was delayed because of the quarantine policy. More than 1,800 Americans have been quarantined in China since the start of the pandemic. [Jul 28 New York Times story]

El Salvador extends school vacation to battle pandemic El Salvador announced it will extend a scheduled school vacation to 2 weeks to fight the spread of the H1N1 flu, the Associated Press reported yesterday. School vacations that began yesterday and last from 2 days to a week, depending on the region, will be extended until Aug 10. The action will affect nearly 2 million students. The country has had 545 confirmed cases of H1N1 flu, including seven fatal ones, the story said. [Jul 27 AP story]

Canadian cities group says national pandemic plan is lacking The head of the Federation of Canadian Cities has charged that Canada has no national plan for protecting critical frontline workers such as police, firefighters, and transit workers, the Toronto Globe and Mail reported. In an open letter to federal Health Minister Leona Aglukkaq, Basil Stewart said Canada's pandemic plan does not say who will have priority access to vaccines and antivirals. A spokesman for Aglukkaq said ongoing epidemiologic studies will guide vaccine allocation. [Jul 28 Globe and Mail report]

WHO to probe antiviral use patterns A World Health Organization (WHO) spokeswoman said today that the agency will host a technical teleconference soon to discuss antiviral use during the H1N1 pandemic and the risks of antiviral resistance, Agence France-Presse reported. Countries vary in their use of oseltamivir (Tamiflu). Some use it widely for prevention and treatment of mild cases, while others are reserving it for infections in high-risk groups and for severe cases. So far, five antiviral-resistant cases have been identified. [Jul 28 AFP story]

Jul 27

Europe plans to streamline H1N1 flu vaccine approval Europe's drug regulators are fast-tracking the approval process for novel H1N1 vaccines, which could mean they would be used before much human testing is done, the Associated Press reported yesterday. Though flu vaccines in the EU usually get thorough testing, authorities plan to evaluate H1N1 vaccines largely based on previous data for H5N1 avian flu vaccines, since both types have the same basic ingredients, the AP said. Regular safety monitoring will be required as the vaccines are used. [Jul 26 AP story]

H1N1 flu cases surge in Mexico's Chiapas state The number of novel H1H1 cases in the Mexican state of Chiapas is soaring, with up to 130 new infections reported each day, Agence France-Presse reported today. However, Mexican health officials say the virus is under control in the rest of the country. Located in the country's southeast, Chiapas has a poor indigenous population, tourist sites, and heavy traffic from Central American immigrants. The state has the country's highest case count and has reported 8 of the last 10 deaths. [Jul 27 AFP story]

Canada to test idea that vitamin D boosts flu protection To see if high vitamin D levels help protect against novel H1N1 flu, the Public Health Agency of Canada is launching a trial to compare blood levels of the vitamin in those with mild and severe cases, the Toronto-based Globe and Mail reported today. Scientists speculate that the winter spike in flu infections is related to lower vitamin D levels associated with reduced exposure to sunlight. Higher vitamin D levels in mildly infected people might suggest a low-cost flu prevention measure. [Jul 27 Globe and Mail story]

South American nations ask WTO to ease flu drug patent rules A trade bloc of seven South American nations on Jul 24 demanded exemptions from paying patent fees for vaccines and drugs against the pandemic H1N1 virus, Agence France-Presse reported. They urged the application of a World Trade Organization intellectual property provision to relax patent rules to protect public health. Argentine President Cristina Kirchner said that though suspending patents could save millions of lives, she wasn't suggesting that the vaccines should be produced for free. [Jul 24 AFP story]

Jul 24

Britain's H1N1 cases soared last week The United Kingdom's Health Protection Agency (HPA) estimated yesterday that the nation had 100,000 new cases of H1N1 flu in the past week, up from 55,000 the week before. The estimate is based on medical-visit rates for flu-like illness. Children up to age 14 were the age-group most affected, with people older than 65 showing much lower rates, the HPA said. Most cases continued to be mild. [HPA pandemic flu update]

UK flu line hits glitch on first day The Web component of Britain's national flu line, which launched yesterday alongside a telephone service, crashed yesterday after receiving about 9.3 million hits per hour, the London Telegraph reported today. The system was reportedly back online a short time later. The system is designed to relieve pressure on doctors' offices by diagnosing novel flu cases over the phone and issuing patients code numbers that allow them to obtain oseltamivir (Tamiflu). [Jul 24 Telegraph story]

Canada clears Tamiflu use for infants Canada's health ministry yesterday approved an interim order authorizing the use of oseltamivir (Tamiflu) in children younger than 1 year, despite limited safety data, Canwest News Service reported yesterday. As in the United States, the drug previously had been approved only for use in patients older than 1. The Public Health Agency of Canada requested the action because infants seem to be at higher risk for novel H1N1 flu complications. [Jul 23 Canwest News Service story]

FDA issues emergency authorization for H1N1 diagnostic test The Food and Drug Administration (FDA) today issued an emergency use authorization (EUA) for another unlicensed diagnostic test for novel H1N1 flu. The test, made by Focus Diagnostics of Cypress, Calif., is the third H1N1 test to receive an EUA. The EUA allows the company to distribute the test to labs certified under the Clinical Laboratory Improvement Amendments to run highly complex tests. The test amplifies viral genetic material from nose or throat swabs or nasal discharges. [Jul 24 FDA news release]

Kazakhstan reports first H1N1 cases Kazakhstan yesterday reported its first three novel H1N1 cases, involving three students who were diagnosed after returning from London, according to a Reuters report based on an Interfax news service story. [Jul 23 Reuters report]

Baby girl had Mexico's first known novel flu case Mexico's first known H1N1 flu case was in a 6-month-old baby girl from San Luis Potosi in the northern part of the country, Agence France-Presse (AFP) reported today. Previously the country's first patient was thought to be a 5-year-old boy who lived near a pig farm in eastern Mexico or a woman from Oaxaca in the southeast. The baby girl first showed symptoms in late February, a Mexican lab official told AFP. [Jul 24 AFP story]

Canadian employers see high H1N1-related absenteeism Canadian employers are reporting "huge increases" in absenteeism tied to concerns about the H1N1 virus, according to Karen Seward of Shepell-fgi, a Canadian firm that provides health and productivity services to businesses. Seward said her company is getting many questions from employers about handling absences, according to a story in the Hamilton, Ont., Spectator. She said employers and public health officials are giving conflicting advice about when sick workers should see a doctor. [Jul 23 Spectator story]

Jul 23

Neurologic complications arise in children with H1N1 The US CDC reported today on four children who had neurologic complications of novel H1N1 flu. The four, aged 7 to 17, were hospitalized with flu-like illness and seizures or altered mental status, according to Morbidity and Mortality Weekly Report. All recovered fully. The complications were less severe than those described in two recent reports of cases related to seasonal flu. The CDC advises clinicians to be alert for such cases and use appropriate tests and antiviral treatment. [Jul 24 MMWR article]

Muslim countries bar high-risk groups from hajj Health ministers from Middle Eastern countries who met yesterday to discuss pandemic flu risks decided to ban children, the elderly, and those with chronic health conditions from attending the hajj pilgrimage in Saudi Arabia in late November, the Associated Press (AP) reported. The ban applies to children under 12 and adults over 65. Some Muslim clerics have opposed pilgrimage travel bans and have said flu risks are exaggerated. [Jul 23 AP story]

Britain launches flu phone line Britain launched its national influenza phone hotline today, staffed by more than 1,500 people, the London Telegraph reported. The system is designed to relieve pressure on England's National Health Service. Patients experiencing novel H1N1 flu symptoms can call in to have their illness diagnosed and receive a code number that allows them to obtain oseltamivir (Tamiflu). Patients from high-risk groups will be referred to doctors. [Jul 23 Telegraph story]

British businesses lag on preparedness Absenteeism in British workplaces is three times normal for this time of year, a consultant group told the British government this week, leading to fears that businesses will struggle when the H1N1 influenza pandemic peaks, the Financial Times reported today. Many companies have instituted hygiene steps, but an expert said most haven't planned for absences, such as making telecommuting plans, boosting customer self-service systems, and identifying key workers. [Jul 23 Financial Times story]

Southern hemisphere sees H3N2 seasonal flu variant Laboratory experts in the southern hemisphere are reporting the circulation of a drifted strain of the seasonal H3N2 flu virus, raising the threat of a vaccine mismatch for the northern hemisphere's upcoming flu season, the Canadian Press reported today. Officials, overwhelmed by handling a deluge of pandemic H1N1 samples, aren't sure how common the variant is. It was first identified in March by researchers in British Columbia. [Jul 23 Canadian Press story]

Jul 22

Australia, China launch novel H1N1 vaccine trials Two Australian pharmaceutical companies said they began human trials this week of their pandemic H1N1 vaccines, the Associated Press (AP) reported today. CSL, based in Melbourne, said it hoped that results will allow release of the government-contracted vaccine in October, and Vaxine said it hoped to have results in 6 to 8 weeks. Meanwhile, two Chinese companies said they launched clinical trials of novel H1N1 vaccines, Xinhua reported today. They are Hualan Biological Engineering and Sinovac. [Jul 22 AP story]

Glaxo issues vaccine update, triples Relenza production In an update on its pandemic activities, GlaxoSmithKline (GSK) said in a press release today that it is talking with regulatory agencies about testing its pandemic H1N1 vaccine, which consists of antigen and its AS03 adjuvant, to be combined before administration. The firm said its first orders will be delivered to countries in September, but the delivery pace will depend on production yield. GSK also said it tripled production of its antiviral drug, zanamivir (Relenza). [Jul 22 GSK press release]

Sanofi set to launch human vaccine trials An official from Sanofi Pasteur today said the company would begin human trials of its pandemic H1N1 vaccine in early August and expects to have a vaccine ready by November or December, Bloomberg News reported today. The clinical trials, which could last about 2? months, will take place in the United States, France, and one other European country. The company said it doesn't know yet how much antigen will be needed for each dose. [Jul 22 Bloomberg News story]

Canadian inspectors got sick after exposure to infected pigs The Canadian Food Inspection Agency said yesterday that two of its employees contracted the novel H1N1 virus during their investigation earlier this spring of an Alberta pig herd that had the virus, the Calgary Herald reported yesterday. The employees reportedly removed their protective masks, contrary to recommended procedures, in the hog barn after their equipment fogged up. They got sick within days of their exposure to the virus in the barn. [Jul 21 Calgary Herald story]

Canada, Japan find new oseltamivir-resistant cases Canada reported its first and Japan its second case of oseltamivir (Tamiflu)-resistant pandemic H1N1 flu, the Canadian Press reported today. The Canadian patient is a 60-year-old Quebec man who was treated with the drug, and public health officials said it appears to be an isolated incident. The Japanese patient is from Yamaguchi and received the drug as postexposure prophylaxis. The patient's virus was sensitive to zanamivir, and officials said there was no sign of additional spread. [Jul 22 Canadian Press story]

Hungary reports first pandemic H1N1 death Hungary today reported its first novel H1N1 death, in a 41-year-old man who had underlying heart and lung problems, Reuters reported. The country has so far confirmed 37 cases, and two patients are hospitalized with mild illnesses. [Jul 22 Reuters story]

Jul 21

US Coast Guard Academy has 37 H1N1 cases Thirty-seven confirmed cases of H1N1 flu have been reported at the US Coast Guard Academy in New London, Conn., according to the Connecticut newspaper The Day. The outbreak includes 31 incoming freshmen, or "swabs," more than 10% of the class. Also among the sick are two clinic staff members and four cadets who were training the freshmen. The academy is awaiting test results for 13 more patients. An official said it was not known how the virus was introduced to the campus. [Jul 21 The Day report]

WHO says H1N1 death toll tops 700 A World Health Organization (WHO) official told reporters the H1N1 virus has killed more than 700 people, well above the 429 deaths listed in the WHO's last official update on Jul 6, Reuters reported today. The official, Alphaluck Bhatiasevi, said confirmed cases have reached 125,000, far above the 94,000 mentioned in the Jul 6 update. The WHO last week stopped reporting global case counts, because case testing is expensive and confirmed cases are only a small fraction of total cases. [Jul 21 Reuters report]

Namibia reports first H1N1 cases Namibia has reported its first two cases of novel H1N1 infection, both in young people who traveled abroad, a Jul 20 Agence France-Presse (AFP) report said. One case was in a 13-year-old boy who went on a rugby trip to South Africa with 20 other students; the other involved a "young student" who was treated at a hospital after returning from Europe, the story said. Two neighboring countries, South Africa and Botswana, had their first cases in June and last week, respectively. [Jul 20 AFP report]

FDA advisory committee to discuss H1N1 vaccines Jul 23 The Food and Drug Administration's (FDA's) vaccine advisory committee will meet Jul 23 to discuss clinical trials of vaccines for the H1N1 virus and related FDA regulatory activities. The meeting of the Vaccines and Related Biological Products Advisory Committee (VRBPAC) will be held in Gaithersburg, Md. [VRBPAC meeting announcement]

ACIP sets special meeting Jul 29 on H1N1 issues A special meeting of the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) will be held Jul 29 in Atlanta to discuss novel H1N1 flu issues, the CDC announced yesterday. The group will discuss epidemiology, vaccine development and formulations, and communications, and will hear a report from the FDA's Vaccines and Related Biological Products Advisory Committee, which meets Jul 23 (see above item). [CDC ACIP announcement]

Malicious software poses as H1N1 update from CDC A piece of malicious computer software that's disguised as H1N1 information from the Centers for Disease Control and Prevention (CDC) is circulating, according to the Internet security firm F-Secure. The file, called Novel H1N1 Flu Situation Update.exe, has an icon that makes it look like a Microsoft Word document. When opened, the file creates several new files that contain "backdoor functionality" and a key logger, or program that records keystrokes. [Jul 21 F-Secure report]

Jul 20

NIAID to study simultaneous seasonal-flu, pandemic vaccination The head of the US National Institute of Allergy and Infectious Diseases (NIAID) said the agency will approve a study of whether vaccines for the pandemic H1N1 virus and seasonal flu can be given at the same time, the Canadian Press reported today. Meanwhile, Canada has plans to test whether people who have egg allergies can be given flu vaccines produced in eggs, a step now considered too risky. The studies are among a number planned in preparation for a likely H1N1 vaccination drive this fall. [Jul 20 Canadian Press story]

Advice to pregnant women sows confusion in UK Messages from two health groups in Britain yesterday caused confusion about the dangers posed by the novel H1N1virus to women who are pregnant or may become pregnant, according to a TimesOnline report. The Royal College of Midwives said pregnant women should not use public transport, while the National Childbirth Trust suggested that women delay pregnancy until the pandemic ends. Government health officials described the groups' advice as extreme and said their advice to women had not changed. [Jul 20 TimesOnline report]

ECDC assesses pandemic risks In a risk assessment published today, the European Centre for Disease Prevention and Control (ECDC) said to expect 20% to 30% of the population to be affected during the next wave of pandemic H1N1, with the attack rate highest in children and young adults. Though it admits uncertainty, the ECDC says a "reasonable" assumption is a hospitalization rate of 1% to 2%. It also estimates a case-fatality rate of 0.1% to 0.2% and says, "this pandemic can severely stress healthcare systems." [Jul 20 ECDC report]

Security guards to protect Tamiflu depots in Britain Security guards will be used to protect oseltamivir (Tamiflu) supplies when more than 100 distribution centers are set up in the United Kingdom this week, according to a report by Metro, a free British newspaper. The location of the centers will be kept secret until they are set to open. Richard Hampton of the National Health Service said there is concern about theft and the safety of workers at the centers. Plans call for giving the drug to patients who describe symptoms over the phone. [Jul 20 Metro story]

Canada sees decline in flu-like illness Canada saw a decrease in people with flu-like symptoms last week, suggesting that community transmission of the H1N1 virus is decreasing, Canwest News Service reported today. Most cases have been mild, but there were still "pockets of more severe disease" in some communities, Health Minister Leona Aglukkaq said at a Jul 17 press conference, according to the story. [Jul 20 Canwest story]

Egypt reports its first H1N1 fatality Egypt reported its first death from the novel H1N1 virus, involving a young woman who fell ill while on a Muslim pilgrimage to Saudi Arabia, Reuters reported yesterday. The woman, who had a heart condition due to rheumatic fever, was hospitalized after she returned to Egypt and died Jul 18, the health ministry said. Other reports listed the woman's age as 25. Egypt has had confirmed 130 H1N1 cases, including 10 new ones reported yesterday, the state news agency said. [Jul 19 Reuters report]

Air carriers list restrictions on suspected H1N1 patients Two British air carriers, British Airways and Virgin Atlantic, announced they would increase restrictions on passengers with suspected H1N1 infections, according to an Agence France-Presse (AFP) report. If a customer looks sick, the airport staff can call in a medical team for advice, the story said. If the medical team is concerned, the customer will be asked to produce a "fit-to-fly" certificate from a doctor or hospital. [Jul 20 AFP story]

Jul 17

Australian ob-gyn group urges pregnant women to wear masks The Royal Australian and New Zealand College of Obstetricians and Gynaecologists urged pregnant women to wear masks in public and "wash themselves scrupulously" after coming into contact with others, the Australian newspaper The Age reported today. Ted Weaver, president of the group, said pregnant women should work at home if possible. "If it's not essential to go out, stay home," he said. The story said six pregnant women were fighting for their lives in intensive care units in Sydney. [Jul 17 The Age report]

Baxter stops taking H1N1 vaccine orders The vaccine maker Baxter International said it has orders for 80 million doses of H1N1 flu vaccine and can take no more, according to a Reuters report published yesterday. The Illinois-based company has orders from five countries, including Britain, Ireland, and New Zealand, said spokesman Chris Bona. Though the company is taking no more orders, it has agreed to reserve some doses for the World Health Organization, Bona said. The firm does not have an order from the United States. [Jul 16 Reuters story]

Germany to offer vaccine to 22.5 million people Germany plans to provide H1N1 flu vaccine to 22.5 million people, including healthcare workers, police, and people with chronic ailments, according to a Bloomberg News story citing a report in the newspaper Die Welt. The target groups make up slightly less than a quarter of Germany's population, the story said. The nation's compulsory health insurance program will pay for the immunizations and notify those eligible for the vaccine. [Jul 17 Bloomberg News story]

Canada says it can meet its own vaccine needs When vaccination against the novel H1N1 virus begins, Canada will be able to fill all of its vaccine needs within its borders, the Canadian Press reported yesterday. In 2001, Canada signed a contract with a vaccine maker that is now owned by GlaxoSmithKline that requires the company to be able to make pandemic vaccine for Canadians whenever needed. The contract was prompted by an incident during the 1976 swine flu outbreak, when Canada never got the vaccine it ordered from the United States. [Jul 16 Canadian Press story]

Sudan reports first novel flu cases Sudan's health ministry yesterday reported the country's first pandemic H1N1 influenza cases, Reuters reported. The patients are two Sudanese men who arrived on a flight from Britain on Jul 13. They are reportedly recovering from their illnesses. [Jul 16 Reuters story]

Jul 16

Britain prepares to launch phone service to supply antivirals Following a surge of flu-like illnesses, a British system that will allow people to report symptoms by phone and obtain antiviral drugs will be launched very soon, The Times reported today. Data from general practitioners indicated that the rate of people reporting flu-like illnesses rose to 73 per 100,000 last week, from 50 per 100,000 the week before, the newspaper said. Using the phone service, people will get reference numbers that friends can use to collect antivirals for them. [Jul 16 Times report]

South American health ministers meet to coordinate pandemic response Health ministers from six South American countries met yesterday in Buenos Aires, Argentina, to coordinate responses to the H1N1 pandemic, according to a report from TerraDaily, a business and technology news Web site. Besides Argentina, the meeting included Bolivia, Brazil, Chile, Paraguay, and Uruguay. Ministers said the countries need to share medicine and supplies, and they voiced concern about access to vaccines. Argentina has had 137 deaths, second highest toll after the United States. [TerraDaily report]

Vaccine contracts might prove worthless in severe pandemic, experts say Experts warn that if the H1N1 flu pandemic turns severe, countries that have vaccine factories might seize vaccine supplies, rendering contracts that promise doses to other countries meaningless, the Associated Press reports. Many vaccine contracts that countries have signed involve doses made outside their borders. In a severe pandemic, countries with vaccine plants might decide to seize all doses and ban their export, said David Fidler, a law professor at Indiana University, and other experts. [Jul 16 AP story]

Haiti reports its first pandemic H1N1 cases Haiti has confirmed its first three novel H1N1 flu cases, according to a Xinhua report published yesterday. Two cases are in Chilean soldiers serving in the United Nations Stabilization Mission for Haiti, and the third involves a 23-year-old Haitian who has not been outside the country. The two soldiers entered Haiti early this month. All three patients were in stable condition. Samples from 61 people are being tested in foreign laboratories, Health Minister Alex Larsen said. [Jul 15 Xinhua report]

National Biodefense Science Board to hold teleconference The National Biodefense Science Board will host a public teleconference tomorrow to allow the public to participate and comment in a session on findings from an H1N1 countermeasures and decision-making forum held last month by the board's pandemic influenza working group. Members of the public are invited to call in to listen to and comment on the board's deliberations. Call-in information is listed on the board's Web site (see link). [NBSB teleconference information]

NIAID seeking H1N1 patients for study The National Institute of Allergy and Infectious Diseases (NIAID) said today that it is seeking patients with pandemic H1N1 influenza to participate in a study of how the disease affects those with chronic illnesses and impaired immune systems. The study is taking place at the NIH Clinical Center in Bethesda, Md. Findings will be used to develop new prevention and treatment strategies against the new flu strain. [NIAID flu study information]

Jul 15

American Lung Association recommends closing affiliated summer camps The American Lung Association (ALA) has asked about 50 summer camps with which it is affiliated to close, after four children who attended one of the camps were diagnosed with H1N1 flu, the Associated Press (AP) reported yesterday. An ALA spokeswoman said she wasn't sure how many ALA camps would follow the advice. Patients who have asthma and other chronic conditions are at greater risk for flu complications. In June the Muscular Dystrophy Association canceled its camps for similar reasons. [Jul 14 AP story]

California nurses detail complaint about masks The California Nurses Association yesterday detailed the complaints of nurses at a Vallejo hospital about inadequate respiratory protection to care for patients with novel flu. They said the hospital had too few N95 masks, and the masks were not properly fitted. Also, they said they were asked to reuse masks repeatedly and to wear surgical masks over the N95s. A hospital official told the Associated Press that only one employee had confirmed H1N1 flu and that the masks could be safely reused. [Jul 14 California Nurses Association press release]

Australia and Chile each exceed 10,000 H1N1 cases Australia and Chile have both counted more than 10,000 H1N1 flu cases, according to reports today from Agence France-Presse (AFP) and Reuters. In Australia, which has had 22 deaths, patients' average age is 19, and authorities are worried about a growing number of serious cases in young, otherwise healthy people, according to AFP. Chile has had 33 deaths, and its case count is the highest in South America, according to Reuters. [Jul 15 AFP report]

Tonga reports first H1N1 cases The South Pacific archipelago of Tonga has reported its first two cases of novel H1N1 flu, according to a report today from Radio Australia News. Blood tests conducted in Australia confirmed the illness in two women, one a resident and the other a visitor from Brisbane, Australia, the report said. [Radio Australia report]

Jul 14

Novel flu hits dozens at Air Force Academy The US Air Force Academy in Colorado Springs has confirmed that 67 incoming cadets have tested positive for pandemic H1N1 influenza and that a total of 121 incoming freshmen with flulike symptoms are being quarantined in a separate dorm, the Associated Press (AP) reported yesterday. The students are among about 1,300 who recently reported to the academy for their first weeks of military training. [Jul 13 AP story]

Nurses file complaint against hospital over protective gear Nurses at a hospital in Vallejo, Ca., filed a complaint today with the state's Division of Occupational Safety and Health alleging that their facility hasn't supplied them with adequate masks for caring for patients with pandemic H1N1 influenza, the AP reported. Ten nurses reportedly got sick after treating three patients with novel flu infections. [Jul 14 AP story]

Oregon beefs up pig biosecurity at fairs Oregon's Department of Agriculture is asking fairgoers this year to help protect pigs from the pandemic H1N1 virus. In two instances, in Canada and Argentina, pig herds apparently contracted the virus from infected workers. Officials are asking people to keep at least 6 feet away from pigs and are recommending that fairs keep an adequate number of hand washing stations stocked with disinfectant nearby. They ask people with flu symptoms to stay away from pigs for at least 7 days. [Oregon Department of Agriculture press release]

Pandemic forces postponement of surgeries in Chile Five thousand surgeries were postponed in Chile last week to free up hospital beds for patients with H1N1 flu, according to the Santiago Times. The story said the number of delayed procedures could rise to 20,000 over the next few weeks as the country continues to battle the pandemic. As of the last World Health Organization update on Jul 6, Chile had 7,376 H1N1 cases and 14 deaths. [Santiago Times story]

Bangkok to close schools for 5 days to fight H1N1 Officials in Bangkok said they will close 435 city schools for 5 days to fight the flu pandemic, Reuters reported today. The schools will be thoroughly cleaned during the interval. Also, Thailand's cabinet decided today to order 2 million doses of an H1N1 vaccine, with delivery expected by December, the story said. It said Thailand has had 4,057 H1N1 cases with 24 deaths. [Jul 14 Reuters story]

HHS to spend $884 million for H1N1 vaccine ingredients The US government will commit $884 million to buy additional pandemic H1N1 vaccine antigen and adjuvants, Health and Human Services (HHS) Secretary Kathleen Sebelius announced yesterday. The products will be additional orders under existing contracts with Sanofi Pasteur, MedImmune, GlaxoSmithKline, and Novartis, an HHS news release said. The announcement is an apparent follow-up to Sebelius's comment on CNN 2 days ago that the agency would spend another billion dollars on H1N1 vaccines. [Jul 13 HHS announcement]

Inovio reports preclinical findings for DNA vaccine Inovio, a biotechnology company based in San Diego, yesterday announced promising results in a preclinical trial of its DNA vaccine against pandemic H1N1 influenza. All pigs immunized with a two-dose regimen showed an antibody response, the company reported. The firm said it is conducting other animal studies to determine if the seasonal and pandemic H1N1 vaccines it is developing provide cross-protection against other circulating influenza strains. [Jul 13 Inovio press release]

Jul 13

US to spend another $1 billion on H1N1 vaccines The United States will order another $1 billion worth of pandemic H1N1 influenza vaccine, Health and Human Services (HHS) Secretary Kathleen Sebelius said yesterday, according to Reuters. "There'll be another $1 billion worth of orders placed to get the bulk ingredients for an H1N1 vaccination," Sebelius told CNN, without naming the suppliers. Sebelius had announced on May 22 that HHS would spend about $1 billion to buy vaccine antigen and adjuvant and fund clinical studies. [Jul 12 Reuters story]

Lurie OK'd as new HHS preparedness head HHS Secretary Kathleen Sebelius announced today that the US Senate unanimously confirmed Nicole Lurie, MD, MSPH, as assistant secretary for preparedness and response. Lurie most recently worked for the Rand Corporation and with federal officials and state and local health departments on pandemic preparedness and other public health issues. Sebelius said in today's release that Lurie's "knowledge and expertise will be essential" as the country coordinates its national response to the H1N1 virus. [Jul 13 HHS news release]

Botswana confirms first novel flu case Botswana's health ministry on Jul 10 confirmed the country's first novel flu case, Mmegi, a Botswana newspaper, reported today. Confirmatory tests were conducted in South Africa. The patient, who is one of three people with suspected cases, has been isolated at a clinic, and the ministry is tracing his contacts. The health minister said oseltamivir (Tamiflu) will be available to those in high-risk groups and those who have respiratory infections. [Jul 13 Mmegi story]

CSL set to launch human trial of H1N1 vaccine Australia-based flu vaccine maker CSL Ltd said today that it expects to launch a human trial of its novel H1N1 vaccine Jul 22, Bloomberg News reported. In a Jun 29 press release, CSL said it would undertake the trial with a research group in Adelaide and was seeking healthy adults aged 18 to 64 to enroll in the study to compare two injections of a standard dose, administered 3 weeks apart, with a higher dosage. The Australian government has ordered enough vaccine to immunize 10 million people. [Jul 13 Bloomberg News story]

Jul 10

US warns that China may quarantine children traveling alone The US State Department yesterday said parents planning to send unaccompanied children to China should consider postponing such trips until China changes its quarantine policies or the H1N1 flu pandemic subsides. The agency said some unaccompanied minors, including some under 10 years old, have been quarantined on arrival in China. It is nearly impossible to predict which travelers might be quarantined, and the US continues to receive reports of poor quarantine conditions, officials said. [State Department warning]

H1N1 case count in US tops 37,000 The US tally of pandemic H1N1 flu cases has risen to 37,246, with 211 deaths, the CDC reported today. The numbers are up by 3,344 cases and 41 deaths since the last CDC report on Jul 2. Wisconsin led the list with 6,031 cases and 4 deaths, followed by Texas (4,463 and 21), Illinois (3,259 and 14), New York (2,582 and 52), and California (2,461 and 31). [Current CDC numbers]

US flu activity down, but still above normal US influenza activity decreased last week but stayed above normal for this time of year, the CDC said in its weekly flu surveillance report today. More than 97% of the influenza A viruses that were subtyped were the novel H1N1. Nine states still reported widespread flu activity, while 10 states and Puerto Rico reported regional activity. Five novel H1N1-related pediatric deaths were reported. The proportion of medical outpatient visits due to flu-like illness was below the national baseline. [CDC flu report for Jun 28 to Jul 4]

Pigs vulnerable to novel H1N1 flu Piglets experimentally infected with the novel H1N1 flu develop symptoms and measurable immune responses, excrete virus, and can infect other pigs (but not chickens), researchers from Germany's Friedrich Loeffler Institute report today in the Journal of General Virology. The findings echo USDA Agricultural Research Service data. The authors voice concern that the virus will become endemic in farmed pigs and ask whether human access to them should be controlled. [J Gen Virol full text]

HHS details preparedness grants for states The Department of Health and Human Services (HHS) today announced state-by-state details of the $350 million it will grant states and territories to prepare for H1N1 pandemic and seasonal flu. State public health departments will receive $260 million, and hospitals $90 million. States receiving the most funds were (in millions): California ($22.7), Texas ($20.1), Florida ($15.5), Pennsylvania ($10.6), Ohio ($9.8), New York ($9.5), Michigan ($8.6), Illinois ($8.6), and Georgia ($8.0). [Jul 10 HHS press release]

Jul 9

HHS to fund $350 million for state preparedness The Department of Health and Human Services (HHS) plans to rapidly distribute $350 million that Congress recently provided for pandemic efforts by states, HHS Secretary Kathleen Sebelius said today. Speaking at a federal "flu summit," Sebelius said HHS will announce the funding tomorrow. She said $260 million will go to state health departments for general and vaccine efforts and $90 million will go to hospitals for surge capacity. "We hope to push the money out the door by July 31," she said. [HHS pandemic flu Web site]

Thailand, Argentina launch community mitigation measures Thailand's government has ordered more than 1,000 schools to close for 15 days starting Jul 13 and has asked Internet cafes, popular with youth, to close during the time to curb the spread of pandemic flu, the Australian Broadcasting Corporation reported today. Elsewhere, Argentina will close financial markets and banks tomorrow to slow the spread of the virus, Reuters reported yesterday. It encouraged private businesses to do the same. Today is a national holiday in Argentina. [Jul 9 ABC story]

Tanzania, Zimbabwe confirm first novel flu cases Tanzania's health ministry today confirmed the country's first novel H1N1 case, a British student who arrived in the country about a week ago and told immigration officials he felt sick, the Associated Press (AP) reported. Also, Zimbabwe's state media today reported the country's first two cases, an Asian man who had recently arrived from London and a squash player hospitalized in South Africa, the Kenya-based Daily Nation reported. It's unclear where the player was infected. [Jul 9 AP story]

New Zealand: flu season eclipses 12-year high An official with New Zealand's influenza center said today that flu activity has reached a 12-year high point and predicted the season hasn't peaked yet, Bloomberg News reported. A flu surveillance report released today for the week ending Jul 5 notes that novel H1N1 makes up 80% of circulating flu strains in New Zealand, an increase from the 48% reported in the previous week's report. [Jul 9 Bloomberg News story]

Japan quarantines American university student group Japanese health officials quarantined 20 American university students Jul 3 after two of their Japanese instructors were diagnosed as having novel flu, the AP reported yesterday. Authorities are monitoring the students' health, but so far none have shown any flu symptoms. The students are from California colleges, and the quarantine is scheduled to end tomorrow. [Jul 8 AP story]

CDC updates home care guidance The Centers for Disease Control and Prevention (CDC) yesterday updated its guidance on caring for people who are sick with novel H1N1 flu at home. The revision incorporates interim guidance on facemask and respirator use that the CDC updated in late May. The updated home care guidance suggests that all caregivers, not just those in high-risk groups, who must have close contact with a sick person try to use a facemask or N-95 disposable respirator. The update also lists where to buy the items. [Jul 8 CDC home care guidance]

Jul 8

CDC releases pandemic H1N1 vaccine guidance 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]

Novel strain may dominate Australia's flu season 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]

Tamiflu-resistant strain found in US traveler 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 lawmakers pass emergency measures 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]

Live feeds from tomorrow's White House flu summit 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]

Jul 7

Jamaica reports first pandemic flu death 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 officials cancel religious festival to curb flu spread 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]

Military flu data boosts global influenza surveillance 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]

CDC issues flu advisory for OB settings 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]

Jul 6

Global novel flu total passes 94,000 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]

Hong Kong finds antiviral-resistant novel flu strain 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]

UN director: $1 billion needed to help poor nations fight flu 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]

Study: Credible flu info linked to behavior changes 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]

Traveler is Syria's first novel H1N1 case 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]

Three countries report first pandemic flu deaths 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]

Jul 2

US cases rise to almost 34,000 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]

Malta, Uganda report first novel flu cases 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, China report first pandemic flu deaths 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. [