(If you want to read about any of this information in greater detail, go to the CIDRAP site and click on the link in brackets at the end of each snippet. M.)

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

Oct 16
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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

News Scan



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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...2109senate.html

Sebelius vows supply of H1N1 vaccine will soon improve
Robert Roos News Editor


Oct 21, 2009 (CIDRAP News) – Health and Human Services (HHS) Secretary Kathleen Sebelius promised a Senate committee today that the flow of pandemic H1N1 influenza vaccine doses will greatly improve in November, following its slow start this month.

Speaking to the Senate Committee on Homeland Security and Governmental Affairs, Sebelius blamed production problems for the meager early supplies of vaccine and promised that eventually there will be enough for all Americans who want to be vaccinated.

HHS officials had predicted that 45 million doses would be ready for distribution in mid October, followed by about 20 million more each week after that. But as of yesterday, only 12.8 million doses had become available for ordering, the Centers for Disease Control and Prevention (CDC) said.

Low yields, start-up problems
Sebelius blamed two problems for the low early production numbers: low yields from the eggs used to grow the vaccine virus—which were reported when pharmaceutical companies started production in the summer—and difficulties in starting up new production lines.

"We have some new production lines that have been put in place by the manufacturers; there were glitches in some of these production lines," she told the committee.

"Those two issues have been corrected, so we anticipate that number [of doses] growing exponentially as we move into the season," she added. "By early November we're confident that vaccine will be far more widely available. There'll be enough vaccine so every American who wants to can be vaccinated."

The government has ordered a total of about 250 million doses of H1N1 vaccine from five manufacturers. The expectation is that vaccine deliveries will be completed in December. But the slow start to the vaccine deliveries has complicated planning by state and local health departments and other groups involved in vaccination efforts.

Echoing what a CDC official said yesterday, Sebelius also promised today that the availability of seasonal flu vaccine will improve in coming weeks. Public health agencies had encouraged the public to get their seasonal flu immunizations early, before the rollout of the H1N1 vaccine. But supplies of the seasonal vaccine have run short in some areas.

"We've been assured that production is ramping up," Sebelius told the committee. "Manufacturers are backfilling that, and it'll be much more widely available."

IV antiviral authorization expected
In other comments, Sebelius said HHS will soon issue an emergency use authorization (EUA) for an antiviral drug that can be given intravenously to help critically ill H1N1 patients. The two mainstay antivirals, oseltamivir and zanamivir, are not available in IV formulations.

In her written testimony, Sibelius said, "Physicians treating critically ill patients with H1N1 influenza will soon have access to new antviral drugs supported by HHS/BARDA [the Biomedical Advanced Research and Development Agency] and administered intravenously under a CDC sponsored emergency use authorization."

Under questioning by Sen. Joe Lieberman, committee chairman, she said issuance of an EUA is "imminent" but didn't give a date.

Last week a Food and Drug Administration official said a decision was expected soon on an EUA for IV peramivir, an antiviral that's in the same class as oseltamivir and zanamivir but is not yet licensed.

School closures continuing
Also at today's hearing, Education Secretary Arne Duncan reported that the H1N1 virus has prompted many school closures so far this fall but that the numbers have been below what they were in the spring wave of the pandemic.

So far this fall, 628 schools have closed for at least a day, affecting 219,000 students, Duncan told the committee. As of yesterday, 88 schools were closed, affecting 28,000 students and 1,800 teachers, he said.

By comparison, in the spring, from Apr 27 through Jun 12, more than 1,350 schools in 35 states closed, affecting 824,966 students and 53,217 teachers, Duncan reported. The peak day was May 5, with 980 schools closed.

At the beginning of the H1N1 outbreaks, the CDC recommended that schools close if they had any confirmed or suspected H1N1 cases. But soon afterward, when it became evident that the virus wasn't as virulent as first feared, the agency advised that schools should focus on identifying and isolating sick students and should close only if they had large numbers of cases. Duncan said schools have been heeding the CDC guidance.

He noted that the Education Department, with the CDC and state and local agencies, developed a new school dismissal monitoring system over the summer. The system used earlier didn't work well, he said.

See also:

Senate committee hearing page, with links to testimony:

http://hsgac.senate.gov/public/inde...fe-7610f97708f0

Oct 16 CIDRAP News story "US H1N1 vaccine delayed as cases and deaths rise"

http://www.cidrap.umn.edu/cidrap/co...609vaccine.html

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Roscoe and Miss Priss 

The US has relatively good communication and awareness of SF, relatively good sanitation, numerous doctors, good hospitals and vents, lots of tamiflu, and sadly about 800 deaths. China has 2 deaths. Sounds right to me.

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Roscoe and Miss Priss 

Really the US has closer to 3,000 deaths, but only 800 of those have had SF declared as the lab-confirmed cause of death.

So sure, 2 deaths in China sounds about right.


MomCares

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"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...eflu/index.html

Oct 26
H1N1 Flu Breaking News
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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...eflu/index.html

Oct 28
H1N1 Flu Breaking News
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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...t2909idsa2.html

Statins may help patients with severe seasonal flu
Maryn McKenna Contributing Writer


Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

The research, by the US Centers for Disease Control and Prevention (CDC) and scientists in several states, is part of a slate of new flu reports being presented this weekend at the annual meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia. Also on the agenda: findings that flu vaccination of pregnant women has a protective effect on their babies both before and after birth, and news of what may be the first person-to-person transmission in the United States of H1N1 flu strains resistant to antiviral drugs.

The research presented Thursday examined the effect of the cholesterol-lowering drugs called statins on the clinical course of people who were already taking the drugs and then were hospitalized with lab-confirmed flu infections in the 2007-08 flu season. Those who were already on statins were half as likely to die, Meredith Vandermeer of the Oregon Public Health Division said during a press briefing at the state of the meeting.

The patients were identified via surveillance in 10 states conducted by the CDC’s Emerging Infections Programs; data on their lab results, prescriptions and outcome were drawn from reviews of their medical records. There were 2,800 lab-confirmed cases of flu in the surveillance results, Vandermeer said; 801 of those patients were recorded as taking statins during their hospital stay, presumably because they had been prescribed them before admission. Among the 2,800, 17 people who were on statins died, versus 64 were not on statins. Proportionally, that is 2.1% of those on statins and 3.2% of those not taking the drugs—a risk reduction of approximately half, Vandermeer said.

The connection between statins and flu survival, which has been reported in other research, may be due to the drugs’ ability to damp down the body’s inflammatory response to influenza. But because the study was purely observational, it should not be taken as a recommendation to administer statins during severe flu infection, Vandermeer cautioned: “We encourage further research and randomized controlled trials.”

Vaccine benefits in pregnant women
Protection against flu was also recorded in two separate pieces of research announced Thursday. Researchers from Emory University, the Georgia Division of Public Health and Cincinnati Children’s Hospital Medical Center found that seasonal flu vaccination during pregnancy reduced the chance that a woman would give birth prematurely or to a baby of low birth weight.

That is probably because infections— even mild ones in which the mother does not realize she is ill—reduce the amount of nutrition that flows from mother to fetus, said co-author Dr. Mark Steinhoff of Cincinnati Children’s. But the authors said women are not taking advantage of that protection: There were 6,410 births during the 2-year study, but only 15% of the mothers had been vaccinated during their pregnancies.

In a separate paper, researchers from Yale University School of Medicine found that seasonal flu vaccination during pregnancy appears to protect infants from serious disease during their first 6 months of life, when they cannot receive flu vaccine. In an ongoing, matched case-control study of infants hospitalized for flu or for other reasons, flu vaccine given to the mothers during pregnancy was 85% effective in preventing infants from being hospitalized.

Transmission of resistant H1N1?
The meeting also includes news on H1N1 influenza, though the pandemic is so new that only a few research teams have results. In one report, CDC researchers and North Carolina public health officials describe what may be the first case of person-to-person transmission of Tamiflu-resistant H1N1 flu.

The two resistant cases occurred in June and July in a North Carolina summer camp where 65 campers and staff developed flu and received the drug as treatment, and another 600 were given the drug as a preventative. Two girls who received the drug prophylactically and bunked in the same cabin subsequently fell ill within 3 days of each other.

When the CDC analyzed their respiratory specimens, they were both found to be carrying viruses possessing two mutations that confer resistance to Tamiflu, also known as oseltamivir. Because the girls’ illnesses were so close and they each exhibited both mutations, the CDC assumes that one girl passed the resistant virus to the other, said Dr. Natalie Dailey, a CDC epidemiologist assigned to the North Carolina Department of Health and Human Services.

Finally, researchers from the CDC and the Pennsylvania Department of Health report that children infected with H1N1 flu exhibit the virus on tests and shed it from their respiratory tracts for a median 6 days and up to 13 days after they develop symptoms. That pattern matches what is seen in seasonal flu in children, but is a longer time than is expected in adults, said Dr. Achuyt Bhattarai of the CDC.

Notably, 12 out of 26 children tested during an outbreak in a Pennsylvania elementary school were culture-positive for the presence of flu virus up to 6 days after their fevers resolved. While that does not mean the children were still infectious, the finding deserves further study, Bhattarai said, since current recommendations allow flu victims to return to work or school after 24 hours without fever.

See also:

47th Annual Meeting of the Infectious Diseases Society of America
http://www.idsociety.org

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

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Nov 6
H1N1 Flu Breaking News

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html



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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss 

http://www.cidrap.umn.edu/cidrap/co...scan/index.html

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]

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Roscoe and Miss Priss