FLU NEWS SCAN: Flu vaccine coverage, vaccine production, kids' flu complications, H5N1 deaths, swine flu diversity

Jun 10, 2011

US flu vaccine coverage reached all-time high in 2010-11
The 2010-11 flu season, the first post-pandemic season in more than 40 years, saw more people in the United States receive flu vaccine than ever before. In Morbidity and Mortality Weekly Report (MMWR) today, the Centers for Disease Control and Prevention (CDC) said that, after a record 163 million doses were distributed, 42.8% of people at least 6 months old were vaccinated, up from the previous high of 41.3% in 2009-10. Although the agency said coverage could still be improved in all age-groups, particularly adults, coverage among Hispanics and African-Americans rose 11 to 12 percentage points. For children of all ethnic groups, coverage was 49.0%, up from 42.3% in 2009-10, whereas for adults it was 40.9%, up slightly from 40.5%. The estimates are based on data collected in 43 states and the District of Columbia by the Behavioral Risk Factor Surveillance System and the National Immunization Survey.
Jun 10 MMWR report

Experts: Egg-based production of flu vaccines won't be replaced soon
Although the past decade has brought a "renaissance" for vaccines, the traditional egg-based method of producing influenza vaccines will not be replaced by new methods very soon, according to a trio of experts writing in The Lancet. In a report on vaccine production and distribution, the experts—two from Sanofi Pasteur and one from Harvard University—write, "In the past decade, expanded markets, realistic pricing, improved advocacy, and wise health priorities have attracted substantial new investment into the industry" and that prospects are good for maintaining the momentum through the next decade. They note that several new methods for producing flu vaccines are in use or under study, including cell-culture systems and the use of recombinant DNA technology to express flu virus proteins in insects, plants, and a fungus. However, none of these new systems "clearly has all the characteristics needed to fundamentally alter manufacturing," the experts say. They predict that the switch to new technologies will gather momentum, but the time needed to finance and license new production systems "will mean that egg-based manufacture of influenza vaccines will be used for some time to come."
Jun 9 Lancet report abstract
The article is one of five early-online Lancet reports focusing on "the new decade of vaccines." An introductory note says the series focuses on advances in vaccine technology but notes that the biggest hurdle to reaping the full benefits of vaccines may relate to parental rejection of safe and effective vaccination for their children.
Jun 9 Lancet introductory note
Lancet page with access to other vaccine article abstracts

Flu-stricken children often hospitalized for nonrespiratory conditions
When children with influenza are hospitalized, the main admission diagnosis is often something other than respiratory signs and symptoms, according to a report from Finnish researchers. In a 16-year retrospective study, they examined the admission diagnoses of 401 children (16 years and younger) who were hospitalized with confirmed flu infections. Only 38% of the children were admitted because of respiratory problems. Sepsis-like illness was the main reason for admission in 52% of infants less than 6 months old and in 7% to 16% of older children. Fifteen percent of children were hospitalized because of acute neurologic conditions, primarily febrile convulsions. Wheezing or exacerbation of asthma was the main reason for admission in 14% of children under age 3. The authors found no differences in admission diagnoses between children with influenza A and B infections. The role of sepsis-like illness in infants under age 6 months—who are too young to be vaccinated—points up the need to find measures to protect them from flu, the researchers say.
Jun 4 Eur J Clin Micro Infect Dis abstract

H5N1 deaths reported in Cambodia, Egypt
Health authorities announced two new H5N1 avian influenza deaths, one in Cambodia and one in Egypt. The case-patient from Cambodia is a 7-year-old girl from Prey Veng province who got sick May 24 and was initially treated by local practitioners, according to a report today from the World Health Organization (WHO). She was admitted to the hospital on May 31, where she died on Jun 7. An investigation into the source of her infection revealed that poultry had died in her village and that she had been exposed to sick poultry. The girl's H5N1 infection is Cambodia's sixth this year, and all have been fatal. Since 2005 the virus has infected 16 and killed 14 people from Cambodia. Elsewhere, the United Nations Food and Agriculture Organization (FAO) reported a fatal H5N1 infection in an Egyptian patient from Cairo governorate, according to a Jun 8 report. Few details were available about the patient, other than where the infection occurred and the May 23 observation date. The source of the information was an FAO field officer. If the WHO confirms the Egyptian case and death, the country's new totals would be 145 cases, including 49 deaths, and the global H5N1 count would rise to 557 cases, 326 of them fatal.
Jun 10 WHO statement
Jun 8 FAO report
Transport of pigs from South to Midwest fertilizes swine flu family tree
The hauling of large numbers of pigs from the US South to the Midwest continually augments the genetic diversity of swine flu viruses in the Midwest, creating opportunities for new hybrid viruses to emerge, according to a report in PLoS Pathogens from a team of US and European researchers. They say little is known about the geographic distribution of swine flu strains, though the 2009 H1N1 pandemic showed the importance of pigs as reservoirs for flu viruses that can infect humans. Using 1,516 hemagglutinin sequences from North American swine flu viruses collected between 2003 and 2010, the authors studied the spatial dissemination of a novel H1 flu virus that spread from humans into swine in two events around 2003. A phylogeographic analysis revealed that the spread of the virus in the swine population followed long-distance swine movements from the South to the Midwest, which imports millions of pigs annually. This suggests that the importation of swine flu viruses from the South chronically adds to the diversity of such viruses in the Midwest. "Overall, the Midwest serves primarily as an ecological sink for swine influenza in the US, with sources of virus genetic diversity instead located in the Southeast (mainly North Carolina) and South-central (mainly Oklahoma) regions," the authors write.
Jun 9 PLoS Pathogens report

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