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News Scan

Mar 10

College flu activity stays steady The nation's colleges saw a very slight decrease in flu-like illnesses last week, but the attack rate stayed about the same as the previous 2 weeks, about 3 to 4 cases per 10,000 students, the American College Health Association (ACHA) reported today. So far the patterns don't signal a third pandemic flu wave, even on a regional level. Two more hospitalizations were reported, and the vaccination level stayed the same, at about 8%. [Mar 10 ACHA surveillance report]

India set to launch vaccine campaign India's health ministry said the country will begin vaccinating its priority groups against the pandemic H1N1 virus next week, Indo-Asian News Service (IANS) reported today. Doctors and paramedics will be among the first to receive the vaccine. India has purchased 1.5 million doses from Sanofi and had asked the company to conduct a pandemic vaccine trial in India, which it has completed and sent to the ministry. Indian companies are also working on pandemic H1N1 vaccines. [Mar 10 IANS story]

Study: 1976 vaccine may protect against novel H1N1 A mouse study found that earlier infection with a 1976 classical swine H1N1 virus completely protected against the current pandemic virus, suggesting modern day benefits for those who received the 1976 swine flu vaccine, according to a study in Influenza and Other Respiratory Viruses. Mice infected with either 2009 or 1940 seasonal H1N1 viruses showed partial protection, which might partly explain why older people seem to have some protection against the pandemic virus. [Mar 8 study abstract]

Mar 9

Turkey seeks to return some vaccine doses Turkey is negotiating with vaccine companies to return some of its unused doses of H1N1 flu vaccine, the Anatolia News Agency reported today. Health Minister Recep Akdag said the government had ordered 43 million doses of vaccine but actually purchased 17 million. Officials are talking with manufacturers about giving "a significant part" of that amount back, but will keep 2 to 3 million doses for emergencies, he said. Akdag said in January that more than 600 people in Turkey had died of H1N1. [Mar 9 Anatolia News Agency report]

Rwanda reports increase in flu cases Pandemic flu cases in Rwanda are starting to increase again after dropping in early February, The New Times in Kigali reported today. A health ministry official said an increase was noted in Burera district of Northern province, with six confirmed cases in the past week. He said seasonal flu cases are also being reported and that a stockpile of oseltamivir (Tamiflu) is available. He added that the flu uptick calls for more vigilance but said there is no cause for alarm. [Mar 9 New Times story]

Mar 8

Dutch officials seek to return surplus vaccine The Dutch health ministry has signaled that it is in talks with GlaxoSmithKline to possibly return a large portion of its surplus H1N1 flu vaccine, Reuters reported. The ministry had ordered 34 million doses at a time when experts thought each person would need two doses. Of that total, 11 million doses have been administered, and the government is holding 2.2 million as an emergency reserve. [Mar 6 Reuters story]

ACHA, CDC caution spring break travelers In an effort to prevent a repeat of last year's post spring break flu spread, the American College Health Association (ACHA) and the US Centers for Disease Control and Prevention (CDC) advised students with travel plans to get the pandemic H1N1 vaccine and take other measures to protect themselves. The two groups warned in a Mar 5 letter that the virus is still circulating in the United States and abroad and that some colleges have recently reported increases in flu activity. [Mar 5 ACHA and CDC letter]

UK health records helped vaccination program Britain's system of electronic health records made it easier for medical providers to notify people targeted for H1N1 vaccination than was the case for US providers, said CDC Director Thomas Frieden at a recent conference. While Americans mostly decided on their own if and when to get vaccinated, British providers used the electronic records to identify people with high-risk conditions and invited them to come in for vaccination, he said. [Mar 5 Reuters report]

Spain to give vaccine to Latin America Spain plans to donate 4 million doses of H1N1 vaccine to the countries of Latin America, the Pan American Health Organization (PAHO) announced recently. Trinidad Jimenez, Spain's minister of health, announced the donation at a Mar 4 meeting with Dr. Socorro Gross, assistant director of PAHO. [Mar 4 PAHO announcement]

Mar 5

WHO says H1N1 continues decline in most areas The pandemic H1N1 virus continues to circulate in temperate zones of the Northern Hemisphere but is at low levels and continuing to decline in most areas, the World Health Organization (WHO) said in its weekly update today. The most active areas include Thailand, Myanmar, Russia, Bulgaria, Armenia, and Moldova. Activity is very low in North America, but Mexico and Peru have seen a slight increase in respiratory disease. Several countries in western Sub-Saharan Africa are reporting H1N1 cases. [Mar 5 WHO weekly update]

US flu indicators still below baseline For the sixth week in a row the nation's pandemic flu activity was steady last week, with doctor's visits for flu-like illnesses below baseline and pneumonia and flu deaths up a bit but below the epidemic threshold, the US CDC reported today. One pediatric flu death was reported, in an influenza B case from last season. No states reported widespread activity, but Alabama, Georgia, Mississippi, and South Carolina had regional activity. Testing found only two seasonal flu viruses. [Mar 5 CDC weekly flu update]

Penn State flu cases renew vaccine push The health service at Penn State University has seen several confirmed H1N1 cases over the past few weeks, offering a reminder that the virus is still circulating and that people still need to be vaccinated, the university announced yesterday. The cases were detected at the school's University Park campus. A school newspaper, the Daily Collegian, reported today that pandemic flu was recently confirmed in seven students, the first ones since the new semester began in January. [Mar 4 Penn State press release]

Mar 4

Study: One H1N1 clade pushed out others A genetic study of pandemic H1N1 viruses by Italian researchers today suggests that several H1N1 clades circulated early in the epidemic but that one clade (clade 7) replaced the others and has predominated through most of the pandemic. The authors concluded, however, that it's not clear whether the shift to a single-clade pattern had a clinical impact or gave the virus a transmissibility advantage. The report appears in Public Library of Science (PLoS) Currents. [Mar 4 PLoS Currents study]

Hong Kong reports flu uptick The Hong Kong Centre for Health Protection (CHP) today reported a slight increase in cases of influenza-like illness (ILI). ILI cases increased from 42.8 to 55.1 per 1,000 office visits over the preceding week. The CHP also reported 23 institutional outbreaks, compared with 3 in each of the previous 2 weeks. And the number of respiratory samples that tested positive for flu rose to 85 from 44 the week before. About a fourth of the isolates were pandemic H1N1, and more than 60% were influenza B. [Mar 4 CHP report]

UK eyes H1N1 vaccine for southbound travelers British vaccine advisors are considering advising those traveling to the Southern Hemisphere during its upcoming flu season to receive the pandemic H1N1 vaccine in addition to the seasonal version, Healthcare Republic, a UK-based publication, reported today. The Southern Hemisphere's flu season typically runs from May through October. The Department of Health said it is exploring ways to implement the flu vaccine advice. [Mar 4 Healthcare Republic story]

VA study reports effective flu biosurveillance In a study today, the Department of Veterans Affairs reported that it effectively used an electronic biosurveillance system for tracking and monitoring influenza trends. The system, called Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), effectively tracked trends for seasonal flu as well as the rise in cases at the start of the H1N1 pandemic. The authors said it could serve as an important alerting tool. [Mar 4 PLoS One report]

Mar 3

College indicators show no sustained flu wave Flu-like illness activity at US colleges decreased slightly last week, and although disease incidence was higher than it was between mid December and mid February, the American College Health Association (ACHA) sees no evidence of a third pandemic wave. The attack rate for the week ending Feb 26 was 3.3 cases per 10,000 students, down 20% from the previous week. Southeast and Gulf Coast schools showed slight increases in disease activity, with levels still lower than November's. [Mar 3 ACHA surveillance report]

South Carolina campus sees uptick in cases The University of South Carolina in Aiken saw an increase in suspected H1N1 flu cases in February, according to The State newspaper in Columbia, S.C. After seeing few flu-like illnesses in January, the campus had 27 cases in February, said Cindy Gelinas, director of the student health center. Four sick students were tested in late February, and all had the virus. State epidemiologist Dr. Jerry Gibson said another wave of cases is likely if the pandemic follows historical precedents. [Mar 3 State report]

Pandemic waning in China China's health ministry said the country's H1N1 pandemic has passed its peak, according to Xinhua. The proportion of H1N1 among all flu cases dropped from 36.6% in January to 11.1% in February. The ministry reported that 793 Chinese have died of the illness, including 18 in February. Officials estimated that 30% of the population has immunity to the virus and said a major new wave of cases is unlikely in the near term, but added that localized outbreaks in crowded settings remain possible. [Mar 3 Xinhua report]

India signs deal for pandemic vaccine India's government has signed an agreement with Panacea Biotec, a pharmaceutical company based in New Delhi, to produce pandemic H1N1 vaccine, the company reported today. Panacea has a manufacturing facility in Punjab that can produce 45 million doses a year. Panacea projects that its vaccine, a split-virus, egg-based product, will be available by April for emergency use. India has also signed vaccine agreements with two other companies. [Mar 3 Panacea Biotec press release]

Mar 2

Brazil prepares H1N1 shot campaign The government of Brazil said Monday that it will launch "the largest campaign in the world" to vaccinate its citizens before the Southern Hemisphere flu season. Xinhua reported that the effort aims to give shots to 90 million Brazilians in a tiered campaign: health workers and indigenous citizens first, followed by pregnant women, young children, chronic-disease sufferers and young adults, and then the rest of the population. [Mar 2 Xinhua story]

Earthquake aftermath halts vaccination in Chile Widespread building damage and continuing power-supply interruptions have forced authorities to suspend H1N1 and routine vaccination campaigns in Chile following the Feb 27 8.8-magnitude quake there. New deliveries of H1N1 vaccine from outside the country have been postponed for at least a week, while authorities fear existing vaccine stocks have been ruined by electricity failures that interrupt the cold-chain keeping vaccines potent. [Mar 1 Pan American Health Org update]

Ireland records almost 1,000 reactions to H1N1 vaccine An analysis of complaints to the Irish Medicines Board (IMB) reveals that there have been almost 1,000 reports of adverse reactions to the H1N1 vaccine, the Irish Times reported today. Most of the reactions were injection-site swelling, gastrointestinal problems, and flu-like symptoms. In its most recent update, the IMB said it has no mechanism for separating true adverse reactions from coincidental events. [Mar 2 Irish Times story]

H1N1 could develop drug-resistance patterns of seasonal flu If pandemic H1N1 follows the same evolutionary pathway as seasonal H1N1 strains, it will likely develop the resistance to oseltamivir (Tamiflu) that has become widespread in seasonal strains, Ohio State University researchers predict in the International Journal of Health Geographics. Reassortment between pandemic and seasonal strains in areas where they co-circulate, such as China, could speed the evolution of resistance, and antiviral use must be judicious, they say. [Feb 24 Int J Health Geogr article]

Mar 1

Alabama officials cite continuing H1N1 Pandemic H1N1 flu hasn't ebbed as much as anticipated in Alabama, according to public health officials there. Although frequency was higher in the fall than it is currently, cases are still occurring across the state, and there were three deaths in February, a pattern unlike previous flu epidemics. The state ran a large school immunization program earlier in the winter, but school absences in the state remain higher than the typical 5%. [Mar 1 Tuscaloosa News story]

LA County notes uneven vaccine distribution Pubic health data show that the H1N1 influenza vaccine was distributed unevenly across Los Angeles County, with the north and south sides getting disproportionately less, according to an LA Times story today. The reason for the disparity primarily lies in the lower number of healthcare providers in those areas, which translates into fewer requests for vaccine, county health officials said. They admitted that some of the efforts to ensure equal access to vaccine failed. [Mar 1 LA Times story]

Pneumonia worse with H1N1 vs seasonal flu Pandemic H1N1 flu virus has the intrinsic ability to cause more severe pneumonia than seasonal H1N1 flu, concludes a study in the Journal of Infectious Diseases. This ability is a key measure of a flu virus's pandemic potential. The researchers inoculated ferrets intratracheally--to model influenza pneumonia in humans--with pandemic H1N1, seasonal H1N1, or highly pathogenic H5N1 virus. Pandemic H1N1 caused pneumonia intermediate in severity between the other viruses. [Feb 26 JID study abstract]

How H1N1 transmits in households An April 2009 outbreak of pandemic H1N1 flu in a New York City high school, reported in the Journal of Infectious Diseases, had an 11.3% attack rate of flu-like illness among household contacts. Protective factors were older age, antiviral prophylaxis, and having a family discussion of flu. Risk factors in parents included caring for the index patient and, in siblings, watching TV with the patient. Half the secondary illnesses occurred within 3 days of the index patient's illness onset. [Feb 25 JID study abstract]

Study: 40% of kids with H1N1 otherwise healthy Canada's IMPACT monitoring program has reported that, in the first wave of the pandemic (May-August 2009), 324 cases involving hospitalization occurred in the country's children. Of 235 for whom case details were available, 69% were older than 2, with a median age of 4.8; 40% were previously healthy; 50% received antivirals; and two died. The data show the disease course and risk groups affected to be similar to those for seasonal flu but use of antivirals to be higher. [Feb 26 Vaccine article]

Feb 26

US flu activity steady for fifth week Pandemic flu stayed at the same level for the fifth consecutive week last week, with no states reporting widespread activity and only three--Alabama, Georgia, and South Carolina--reporting regional activity, the Centers for Disease Control and Prevention (CDC) said today. Outpatient visits for flu-like illness were below the national baseline, and deaths from pneumonia and flu were below the epidemic threshold. Influenza B circulated at low levels. Three pediatric flu deaths were reported. [Feb 26 CDC weekly flu update]

Global flu activity wanes, but hot spots persist Though overall pandemic activity waned across the globe, some active areas were seen in parts of south and southeast Asia and in a few areas of eastern and southeastern Europe, the World Health Organization (WHO) said today. Brunei Darussalam reported intensifying flu activity, and overall respiratory disease increased in some countries because of influenza B and respiratory syncytial virus activity. Low levels of influenza B and seasonal H3N2 flu circulated in parts of Africa and Asia. [Feb 26 WHO update]

Death toll in Japan called amazingly small Japan's National Institute of Infectious Diseases has estimated that 20 million people in Japan, mostly children, were infected with H1N1, according to an editorial in the Asahi Shimbun. But fewer than 200 people in Japan have died of the illness, "an amazingly low toll," the newspaper said. It said early diagnosis and treatment apparently helped limit deaths. But it said the health ministry was slow to prepare for the H1N1 vaccination campaign and used a flawed communication strategy. [Feb 25 Asahi Shimbun editorial]

California sees low miscarriage rate with vaccine Fifteen California women who were vaccinated against H1N1 while pregnant had miscarriages or stillbirths, a figure far below the expected rate of miscarriage for all pregnant women, California health officials told TV station KCRA 3 in Sacramento. Officials said the miscarriage rate for all pregnancies is about 15%, but the miscarriage rate among vaccinated women is only a fraction of 1%. Officials said no link between the vaccine and the pregnancy outcomes has been found. [Feb 24 KCRA3 report]

Early flu treatment key for cystic fibrosis patients In the first study describing the course of pandemic H1N1 infection in patients with cystic fibrosis, researchers from an Australian cystic fibrosis center for adults reported that most patients had a mild illness and were managed with antiviral treatment as outpatients. More severe disease was seen in those who presented for treatment late. The findings appear in BMC Pulmonary Medicine. [Feb 25 BMC Pulm Med abstract]

Feb 25

Hospitalizations strongly linked to chronic conditions Among patients hospitalized for pandemic H1N1, 85% of adults and 65% of children had one or more underlying medical conditions, according to the latest data from the US Centers for Disease Control and Prevention (CDC). The types of underlying conditions associated with H1N1 hospitalizations haven't changed much, with asthma as the most common condition in adults, followed by diabetes and cardiovascular disease. In children, asthma and neurodevelopmental conditions topped the list. [Feb 24 CDC Q and A]

Study: Early Tamiflu treatment shortens H1N1 shedding In a study designed to track the response of pandemic flu to oseltamivir, researchers from Singapore followed a series of 70 hospitalized patients early in the outbreak with daily polymerase chain reaction tests. They reported their findings yesterday in Clinical Infectious Diseases. They found prolonged viral shedding in healthy young adults despite treatment, but those who received the drug within the first 3 days of illness had a shorter shedding duration. [Feb 24 Clin Infect Dis abstract]

Bulgaria to start vaccinating risk groups Bulgaria is set to launch its pandemic H1N1 vaccine campaign on Mar 1, targeting 80,000 doses to priority groups, including babies older than 6 months with certain medical conditions, pregnant women, and healthcare workers, Sofia News Agency reported. The start of the program comes about 3 months after flu activity subsided in Bulgaria. The health ministry is asking doctors to recommend the vaccine to patients at high risk for flu complications. [Feb 24 Sofia News Agency story]

U of Colorado urges vaccination before spring break The student health service at the University of Colorado's Boulder campus is encouraging students to receive their pandemic H1N1 vaccine before traveling for spring break, the Colorado Daily student newspaper reported. The school is hosting a series of free vaccine clinics for students, staff, and faculty over the next week. To lure more students, health officials are offering a drawing for one of two iPod Nanos. [Feb 24 Colorado Daily story]

Feb 24

WHO gains scientists' support for H1N1 response Some have accused the World Health Organization (WHO) of hyping novel H1N1 flu, but scientists defended the agency in an Agence France-Presse (AFP) story today. They pointed out that the WHO acted appropriately, given the uncertain nature of the virus. One expert explained, "This virus is not dead yet. It is on a trajectory, and we don't know where it is going to end up," adding that H1N1 is still mutating. Another pointed out that in the last pandemic, 70% of deaths occurred in a third wave. [Feb 24 AFP article]

Almost 30% of Americans now vaccinated At today's meeting of the Advisory Committee for Immunization Practices (ACIP), Dr. James Singleton of the Centers for Disease Control and Prevention (CDC) said that, as of Feb 13, about 86 million Americans had received the pandemic vaccine, or about 29% of the population. Total vaccine doses administered had reached an estimated 97 million, or about 78% of the doses shipped. [Feb 24-25 ACIP agenda]

Defense Department invests in tobacco-based vaccine A Texas-based consortium today announced funding for vaccine technology using tobacco plants instead of chicken eggs to produce H1N1 flu vaccine, according to a news release. The consortium, which comprises G-Con, LLC, and Texas A&M, designed Project GreenVax to eventually produce 100 million doses per month. According to a Wall Street Journal article today, the Defense Advanced Research Projects Agency is providing $40 million of the $61 million cost to produce 10 million initial doses. [Feb 24 Texas A&M release]

Czechs open vaccine to general public This week Czech Republic officials opened up the country's estimated 700,000 doses of novel H1N1 vaccine to the general public free of charge. Although vaccine uptake has been low in that country, officials hope the announcement will spur vaccination, especially in children. The vaccine will be available in vaccination centers, not in doctors' offices. [Feb 23 Czech Radio report]

Feb 23

CDC will reduce H1N1 vaccine stockpiles Over the next 2 months, the Centers for Disease Control and Prevention (CDC) plans to reduce by half the amount of H1N1 vaccine it has pre-positioned in distribution depots around the country managed by McKesson Corp. The CDC has maintained 30 million doses at the sites. The agency said the main strategy will be not replacing 3 million doses that have been recalled, along with 15.3 million doses that are reaching their expiration dates between March and June. [Feb 22 CDC bulletin]

Hong Kong probes possible flu-shot reactions Hong Kong's Centre for Health Protection is studying illnesses in several residents that arose after they received the H1N1 influenza vaccine, the region's government said Tuesday. The cases include a 34-year-old man who experienced double vision, a 28-year-old pregnant woman whose fetus died, and paralysis in a 75-year-old woman and an 80-year-old man. The government was careful to say there are cases of paralysis and stillbirth in the territory every year. [Feb 23 Hong Kong Information Services bulletin]

WHO to decide whether to stand down pandemic alert The pandemic emergency committee of the World Health Organization (WHO) will announce Wednesday whether it plans to step down from its 9-month-old phase 6 pandemic alert. The committee was scheduled to reconsider the pandemic declaration in a confidential teleconference that was to be held today. By WHO protocol, any public announcement will be delayed until director-general Dr. Margaret Chan informs the 193 member states of the decision. [Feb 23 Agence France-Presse story]

Possibility of H1N1 third wave depends on many factors Scientists on the alert for a possible third wave of H1N1 flu are evaluating the influence of many factors that could affect the virus's resurgence, the Washington Post reported today. They include how much of the population--particularly schoolchildren--is already immune, whether uninfected people are gathering in close quarters, and how much the virus is affected by winter temperatures and humidity. Even without a third wave, a variant of pandemic H1N1 is likely to circulate for years. [Feb 23 Washington Post story]

Study: Seasonal vaccines would not have slowed H1N1 A ferret study suggests seasonal flu vaccines would not have contained novel H1N1, which emerged at the end of the 2008-09 flu season, but veterinary vaccines might have limited spread in pigs. A Canadian team administered two 2008-09 seasonal formulas, a veterinary vaccine and a newly developed H1N1 vaccine to ferrets, then infected the animals with a virulent strain of novel H1N1. The swine and H1N1 vaccines were at least partially protective, but the H1N1 would have required a second dose. [Feb 19 Journal of Infectious Diseases abstract]

Feb 22

Blacks overrepresented in Virginia flu deaths About 30% of the 36 people who have died of H1N1 flu in Virginia were African-American, though African-Americans make up only 20% of the state population, Virginia Health Commissioner Karen Remley told the Richmond Times-Dispatch. She said Centers for Disease Control and Prevention (CDC) officials have speculated that higher rates of diabetes and asthma may help explain the increased rate of severe H1N1 cases in African-Americans. [Feb 20 Times-Dispatch story]

South Korea opens vaccine to all Pandemic H1N1 flu vaccine is now available to everyone in South Korea, including foreigners, not just to high-risk groups, the Ministry of Health, Welfare and Family Affairs announced today, according to Arirang News. The ministry urged vaccinations, saying that about 500 daily H1N1 cases are being reported, although the number has been on the decline. [Feb 22 Arirang News story]

No flu yet reported at Olympics So far pandemic flu--as well as seasonal flu--has been held not only off the podium but entirely away from the Vancouver Olympic Games, according to the Canadian Press. Last week the British Columbia provincial laboratory didn't find a single influenza virus in samples it tested. "Boy, so far we are lucky," said Dr. Jack Taunton, chief medical officer for the Olympics. February often brings the peak of flu season. [Feb 20 Canadian Press article]

Lab study shows 3-antiviral combo effective Researchers found that a combination of the antiviral drugs amantadine, ribavirin, and oseltamivir was effective against drug-resistant seasonal and novel H1N1 influenza. In testing in canine kidney cells, the authors found "that the triple combination was highly synergistic against drug-resistant viruses, and the synergy of the triple combination was significantly greater than the synergy of any double combination." [Feb 22 PLoS One study]

ACIP to set vaccine guidelines for next season The CDC's Advisory Committee for Immunization Practices (ACIP) will meet Feb 24 and 25 to discuss which groups should get flu shots for next season, along with other immunization issues. Among other things, the committee will consider whether to recommend that older people receive a high-dose flu vaccine that was recently licensed by the Food and Drug Administration, according to the meeting agenda. The 2010-11 flu vaccine is expected to include the pandemic H1N1 virus. [Feb 24-25 ACIP agenda]

Feb 19

Colleges see slight dip in flu cases Reports of flu-like illnesses at college campuses for the week ending Feb 12 dropped by 7%, a decrease that the American College Health Association (ACHA) says doesn't reflect a significant change, consistent with the bigger national pattern. The attack rate at the nation's colleges was 2.7 cases per 10,000 students. No new hospitalizations or deaths were reported. The group said 85% of campuses have pandemic vaccine, but student uptake remains low, at about 8%. [Feb 19 ACHA surveillance report]

Influenza B activity up in China, Hong Kong The World Health Organization (WHO) said today though pandemic activity hasn't changed much, influenza B now accounts for 82% of flu virus detections in China and nearly 35% in Hong Kong. Several countries in West Africa are reporting increasing pandemic flu cases, but the WHO said the uptick doesn't yet appear to reflect widespread transmission. Some countries, such as Thailand and Jamaica, are reporting increases in respiratory diseases, though the WHO said some may be other diseases. [Feb 19 WHO update]

EU authority approves Sanofi pandemic vaccine Sanofi today announced that Europe's drug regulatory agency has approved its adjuvanted pandemic H1N1 vaccine. The approval clears the vaccine for use in people age 6 months and older. Sanofi's vaccine contains its AF03 adjuvant. Clinical trials showed a single 3.8-mcg dose of the vaccine was safe and effective in all age-groups. The vaccine is manufactured in Sanofi's Val de Reuil, France, facility and is the fifth novel H1N1 vaccine that European regulators have cleared. [Feb 19 Sanofi press release]

Czech Republic cancels 30% of vaccine order Because of low demand, the Czech Republic is reducing its H1N1 vaccine order with GlaxoSmithKline from 1 million doses to 700,000, its health minister told the Associated Press (AP) today. Health Minister Dana Juraskova said only about 64,000 citizens have decided to get vaccinated. [Feb 19 AP story]

Feb 18

Report details outbreak on Navy ship An article today in Morbidity and Mortality Weekly Report (MMWR) describes an outbreak of confirmed novel H1N1 that started aboard a Peruvian Navy ship last June and affected 78 of 355 crew members after the ship had docked in San Francisco. No serious complications or deaths occurred, and lower-ranking crew had a higher incidence. Six patients with preexisting conditions received antivirals. A surveillance program implemented before the ship departed from Peru permitted early detection. [Feb 19 MMWR report]

Study: Tamiflu works well in very ill patients A study determined that oseltamivir (Tamiflu) was well absorbed in critically ill intensive-care patients with suspected or confirmed pandemic H1N1 flu. The study, of 41 patients who needed ventilator support, appeared in the Canadian Medical Association Journal (CMAJ). A standard dosage of 75 mg twice daily achieved bloodstream levels of the drug that were comparable to those in other patients and were far in excess of concentrations required to be effective against the virus. [Feb 16 CMAJ study]

Planner's ordeal highlights toll on kids A pandemic preparedness expert's ordeal with novel H1N1 flu in her own kids highlights the pandemic's toll on children, according to USA Today. Her daughters' conditions--one has autism and epilepsy and one has asthma--increased treatment difficulty. And her expertise intensified her worry. "I knew what was happening medically. I've read the autopsy reports. Seeing those was scary," she says. The girl with asthma, who is 13, may take months to recover. The other girl, 10, has recovered. [Feb 17 USA Today story]

Feb 17

H1N1 vaccine lifts CSL profits Australian vaccine manufacturer CSL Ltd. posted higher-than-expected profits for the second half of 2009, largely due to sales of H1N1 vaccine, Bloomberg News reported. The company's net income was $617.4 million in Australian dollars, above analyst estimates that averaged $530 million. In the 6-month period, CSL earned $160 million just on H1N1 vaccine. Cancellations of some orders did not affect today's numbers, the company said. [Feb 17 Bloomberg story]

South Africa schedules flu-shot campaign The government of South Africa will launch a national flu-vaccination campaign Mar 15, to ensure maximum immunity before the start of the 2010 FIFA World Cup in June. The South African Press Association (SAPA) reported that the country will use a total of 4.8 million doses in two rounds beginning March 15 and May 3. Both rounds will be aimed primarily at front-line healthcare personnel and high-risk groups, including children and pregnant women. [Feb 17 SAPA story]

Maine offers vaccine at sports tournament Capitalizing on the crowds expected to attend a statewide basketball tournament, Maine's public health department will offer both H1N1 and seasonal flu shots this week. The state's Center for Disease Control and Prevention said it will stage daytime and evening clinics at the basketball tournament of the Maine Principals' Association, which includes all public and some private high schools in the state. [Feb 16 Associated Press story]

Chile buys H1N1 vaccine for southern flu season The health ministry of Chile announced it has purchased 2 million doses of H1N1 flu vaccine in anticipation of the start of the Southern Hemisphere's flu season, adding to 500,000 the government already has on hand. The Latin American Herald Tribune reported the shots will be used for healthcare workers, chronic-illness patients, pregnant women, and children younger than 2. Those over 60 will not be eligible for government shot campaigns but can obtain the shots through private providers. [Feb 17 Latin American Herald Tribune story]

Feb 16

College flu data show uptick Data collected by the American College Health Association (ACHA) between Jan 30 and Feb 5 show an uptick in new cases of influenza-like illness. Out of 182 colleges and universities sampled by the association, 58% reported new cases, compared with 55% the previous week, for a national attack rate of 2.9 cases per 10,000 students, 12% higher than a week earlier. There have been more than 90,000 cases among more than 2 million students, the association said. About 11% of students were immunized. [Feb 16 ACHA surveillance summary]

Hospitals reporting little seasonal flu Although pandemic H1N1 flu is now mainly quiet, seasonal flu has not taken off, either, according to a story today in the San Francisco Chronicle. Seasonal flu typically peaks about this time of year, but doctors and healthcare centers are reporting levels of flu well below normal, possibly because of widespread novel H1N1 earlier. One doctor who commented on this unusual flu season said, "It certainly isn't out of the question that seasonal flu could still show up." [Feb 16 Chronicle article]

Mobile, social media help track H1N1 flu More than 100 iPhone applications related to H1N1 flu have been launched since the pandemic began, the Associated Press (AP) reported. The apps encourage two-way communication among civilians and between health authorities and the public and may permanently have changed methods of communication in crises. Outbreaks Near Me, an app linked to the Web-based disease alert service HealthMap, has been downloaded more than 100,000 times. [Feb 15 AP story]

South Dakota reports good vaccine coverage Almost half of South Dakotans have either received the H1N1 flu vaccine or had pandemic flu, which might be enough to prevent further spread, state officials told the AP yesterday. State epidemiologist Lon Kightlinger says the virus has "flat-lined" in the state, though he warned it could yet return. The officials continue to urge people to get vaccinated. [Feb 15 AP story]

South Korea shares hand sanitizer with North South Korea will donate 200,000 liters of hand sanitizer, worth $866,000, to North Korea in an unusual cross-border humanitarian mission, the Korea Herald reported today. The action comes two months after South Korea donated $15 million worth of flu antivirals to North Korea, the first time in two years the closed northern nation allowed such a humanitarian exchange. [Feb 16 Korea Herald story]

Feb 15

H1N1 rapid tests most sensitive in young children A prospective study of the accuracy of rapid diagnostic tests for H1N1 influenza has found that the test returns more accurate results for children and teenagers than it previously has for adults. The study among 820 children treated at Toronto's Hospital for Sick Children found that the test was sensitive to H1N1 flu for 62% of the children tested and was most sensitive in children who were younger than 5 or whose symptoms had begun less than 2 days earlier. [Feb 15 Pediatrics early-release article]

Production delay stalls vaccine delivery to Nepal Deliveries of donated pandemic H1N1 vaccine for Nepal have been delayed by about a month because of production problems at the company that pledged the vaccine, a World Health Organization (WHO) official told the Himalayan Times. He projected that Nepal would receive vaccine by the first week of March. The health ministry has prioritized healthcare workers and their dependents, pregnant women, people with underlying medical conditions, young children, and seniors to receive the vaccine. [Feb 13 Himalayan Times story]

Polish government feuds over flu shots Disputes within the government of Poland over its health ministry's refusal to purchase H1N1 flu vaccine have broken into the open with a threat by the government's ombudsman to sue the health minister, BBC News reported. The ministry declined to buy the shots because of fears of side effects; the ombudsman, who caught the flu himself, contends that decision put the country's citizens at risk. Poland has recorded 172 swine flu deaths. [Feb 12 BBC News story]

Virologist decries India's lack of H1N1 data An Indian virologist says it is "shameful" that no epidemiologic analysis of India's H1N1 epidemic has been published. Writing in Current Science, Shahid Jameel of the International Centre for Genetic Engineering and Biotechnology in New Delhi said it is not known why India's H1N1 mortality rate is three to four times the global average. He said more information is needed for targeting of a vaccine that India expects to deploy this summer. The country has had 1,152 deaths, he said. [Current Science commentary]

Feb 12

Canada compares impacts of H1N1 and seasonal flu The Canadian Institute for Health Information says that 8,507 Canadians were hospitalized with H1N1 flu from April 2009 through January, compared with 2,614 hospitalized for seasonal flu in 2007-08, the Toronto Globe and Mail reported. The median age of hospitalized H1N1 patients was 28 and the median for fatalities was 53; the corresponding ages for seasonal flu patients were 71 and 83. One in six H1N1 hospital patients needed intensive care, versus 1 in 7 seasonal flu hospital patients. [Globe and Mail report]

WHO says influenza B rising in China Though Senegal is the third West African country in the last month to confirm pandemic flu, it's too soon to say if widespread transmission is starting in the region, the World Health Organization (WHO) said today. Flu activity is declining or sporadic in most parts of the world, with other respiratory illnesses increasing in Eastern Europe and Guatemala. Pandemic H1N1 is the dominant flu strain, but seasonal influenza B viruses accounted for 72% of all flu viruses analyzed last week in China. [Feb 12 WHO update]

CDC reports on pandemic's impact on Hispanics The US Centers for Disease Control and Prevention (CDC) has posted an online question-and-answer report on H1N1 and seasonal flu in Hispanic communities. The report notes that H1N1 vaccination rates have been lower in Hispanics than in non-Hispanic whites. It reports on the impact of the pandemic on Hispanics, describes barriers to H1N1 and seasonal flu vaccination, and outlines possible strategies for improving health and vaccine uptake among Hispanics. [CDC information on H1N1 and Hispanics]

Health officials try luck with casino vaccine clinics In an effort to offer the pandemic flu vaccine where people congregate, health officials in Carson City, Nev., are immunizing people at area casinos, the Carson Valley Record-Courier reported. A casino clinic on Feb 6 immunized 174 people, and other similar events are scheduled. Health department spokeswoman Pam Graber said earlier in the outbreak people were more likely to come to vaccination locations, but now that the holidays have passed it's easier to bring the shots to the people. [Feb 12 Record-Courier story]

Singapore lowers pandemic alert level Singapore's health ministry today announced that it was lowering its pandemic H1N1 flu alert from yellow to green, Channel NewsAsia reported. The country raised the alert to yellow and then orange in late April but moved back to yellow in May. Doctor's visits for respiratory infection have been below baseline since August. The ministry vowed to continue monitoring the disease but said dialing back the level will make it easier for people to visit hospitals and nursing homes. [Feb 12 Channel NewsAsia report]

Feb 11

Pandemic virus may have interfered with RSV Writing in Eurosurveillance, French researchers report that respiratory syncytial virus (RSV) circulation in France in late 2009 was reduced and delayed compared with a year earlier, and that this might be explained in part by H1N1 flu. "The influenza pandemic wave of 2009 seems to have partially overcome the RSV epidemic," they write. Viral interference and/or increased hygiene measures in response to H1N1 might have affected RSV activity, they suggest. [Feb 11 Eurosurveillance report]

School outbreaks reported in Minnesota While flu activity in Minnesota remained low last week, two schools reported flu-like illness outbreaks, the Minnesota Department of Health (MDH) reported yesterday. Also, a story in the Minneapolis Star Tribune noted that seasonal flu viruses have been almost absent this winter and said experts are increasingly confident that pandemic H1N1 will be the only virus around for the rest of the winter. The experts also said the pandemic virus is likely to continue to predominate next fall. [Feb 10 MDH weekly flu report]

T-shirts, sign-twirlers used to promote vaccination The Mississippi Department of Health is providing free "Fast Lane" H1N1 flu vaccination clinics throughout the state today and tomorrow, with vaccinees getting free T-shirts. Meanwhile, Riverside County officials in California have posted dancing sign-twirlers at H1N1 vaccination clinics to lure passersby, the Riverside Press-Enterprise reported. And health workers in Morrow County, Ore., offered H1N1 shots at a highway rest stop near Boardman yesterday, the Oregonian reported. [Feb 11 Mississippi news release]

Feb 10

CDC releases pandemic guide for primary care The Centers for Disease Control and Prevention (CDC) released a planning template for primary care medical practices that may have to cope with increased numbers of patient visits and calls during an influenza pandemic. The template's guidelines for maintaining communication, planning for surges of patients, and keeping offices functioning were based on recommendations from healthcare and public health workers brought together by the CDC in August. [Feb 10 CDC document]

Queensland schedules high school vaccinations The government of Queensland will administer free H1N1 flu vaccinations in high schools throughout the Australian state, offering the shot to students and also to their families, the Australian Broadcasting Corp. (ABC) reported Wednesday. The clinics are in anticipation of Australia's winter flu season and in acknowledgement of "disappointingly low" vaccine acceptance by 13% of the state's population. [Feb 10 ABC News report]

Study shows low flu complications in pregnant women Pregnant women treated at a major hospital center in Singapore experienced a low rate of serious illness from H1N1 flu, with 9 of 211 developing pregnancy complications and 2 developing pneumonia. None died. The authors of a medical journal article say the group is the largest cohort of pregnant women with H1N1 yet studied. The authors say early diagnosis and treatment was essential: The women's median time between developing symptoms and seeking help and being put on antivirals was 2 days. [Feb 10 BJOG press release]

Qatar latest state to cancel vaccine order The government of Qatar intends to turn back 40% of the 1.5 million doses of H1N1 vaccine it ordered because it considers the shots no longer needed, the online publication TradeArabia reported. It quoted representatives of the Supreme Council of Health saying that 1.5 million doses were ordered and 500,000 delivered, but only 40,000 people have been vaccinated, including 21,000 children. The council hopes to cancel orders for 620,000 of the remaining 1 million doses. [Feb 10 TradeArabia.com report]

Feb 9

Senegal reports cases after religious festival The health minister of Senegal confirmed that the country has experienced 14 cases of pandemic H1N1 flu after a religious festival, according to an Africa News story today. The first cases were detected in the religious city of Touba and in nearby Diourbel, in central Senegal. Hundreds of thousands of members of the Mouride Muslim Brotherhood gathered in these cities last week to commemorate a religious event. The health minister said the country has the resources to deal with pandemic flu. [Feb 9 Africa News story]

Israel cancels remaining vaccine order Because only a tenth of Israel's population has been vaccinated against pandemic flu, the country has canceled orders for its remaining H1N1 vaccine after receiving 4.6 million doses, according to a Jerusalem Post story today. The original order was for 7.3 million doses, but only 700,000 doses have been used. [Feb 9 Jerusalem Post article]

Controversy forces delay of Romanian vaccinations Romanian authorities have delayed the launch of their H1N1 vaccination campaign by at least a month amid concern about the procedures used in testing the vaccine in children, according to WAZ.EUobserver.com, which reports on relations between the European Union and countries in southeastern Europe. The controversy started when a Romanian newspaper reported that parents were being paid to allow their children to receive the vaccine, which has not been approved by the European Medicines Agency. [Feb 9 WAZ.EUobserver.com report]

NBA team removed water fountains to fight flu The Cleveland Cavaliers basketball team removed all the water fountains from its arena in November to fight pandemic flu and other diseases, the Associated Press reported. Team spokesman Tad Carper said the decision was based on information from qualified sources, which he did not name. Matt Carroll, director of Cleveland's health department, said he was not aware of any evidence that water fountains help spread H1N1. Thirsty fans can get free cups of water at concession stands, said Carper. [Feb 8 AP report]

Feb 8

California data show H1N1 vaccine safe Statistics gathered by the California Department of Public Health show only three deaths among 13 million state residents who received H1N1 flu vaccine, USA Today reported. One person had preexisting flu and bacterial infections and one was a cardiac patient whose death was caused by cardiovascular disease. The cause of the third person's death is still being evaluated, state officials told the paper. [Feb 8 USA Today story]

Parents still worry about vaccine safety Parental concern about pandemic vaccine safety, despite the vaccine's good record, is still an obstacle to immunization, according to a survey released today by the University of Michigan. While about half (55%) of parents worried about their children getting the flu, more (65%) worried about vaccine safety. Pandemic H1N1 has been more deadly for children than seasonal flu, but pollsters said parents may not fully grasp potential illness severity. The January poll included 1,612 parents. [Feb 8 University of Michigan vaccine poll]

Algeria seeks sharp cut in H1N1 vaccine order The government of Algeria hopes to cancel three fourths of its order for 20 million doses of H1N1 vaccine, Agence France-Presse reported. The chief pandemic-flu official in the country's health ministry said Algeria has received 2.5 million doses already but has faced low acceptance of the vaccine, especially among healthcare workers. Algeria has seen 808 confirmed cases and 54 deaths. [Feb 7 AFP report]

Australian officials urge vaccination for children The government of New South Wales says now is the ideal time for young children to be vaccinated against H1N1 flu, as the date for their return to day care or school approaches, the Australian Associated Press reported. Health officials expect Australia's second wave of H1N1 in the next few months, and this time, unlike in the first wave, there is vaccine available. Kerry Chant, chief health officer for New South Wales, said H1N1 is likely to be the dominant flu strain in Australia this year. [Feb 8 AAP story]

Respiratory disease increasing in Haitian camps Respiratory disease is increasing in Haiti's refugee camps, though there has been no formal evaluation or lab confirmation of H1N1 flu, according to a report from the Global Health Cluster, a coalition of humanitarian groups working with the World Health Organization. The report, carried by ProMED-mail, says no vaccination efforts have been launched. With rains expected in March, the potential for flu outbreaks in the camps is moderate, the report states. [Feb 7 ProMED-mail report]

Feb 5

WHO: Most regions show declining H1N1 activity Although pandemic flu activity continues to decline or remain low in most of the Northern Hemisphere, some areas of the world are experiencing active but declining transmission, particularly North Africa and some areas of Eastern Europe and East Asia, the World Health Organization said today (WHO) today. Global H1N1 deaths have risen by several hundred from a week ago, to at least 15,174. China continues to report relatively high levels of influenza B. [Feb 5 WHO update]

Europe notes high H1N1 death rate in kids Pandemic flu raised the death rate in European children last year but not adults, according to a study in Eurosurveillance. Children aged 5 to 14 years in eight countries had a 28% higher death rate than expected, in contrast to mortality in all age-groups, which was lower than in a typical year from seasonal flu. The higher death rate in children amounts to about 77 additional deaths in that age-group. The researchers called their estimates "conservative." [Feb 4 Eurosurveill report]

Northern Vietnam reports outbreak An outbreak of H1N1 has affected the northern Vietnamese province of Bac Kan, health officials said in a VietNamNet story today. Eighteen people recently contracted pandemic flu, said health official Dr. Nguyen Huy Nga. The patients have shown typical symptoms, he said, including fever, cough, sore throat, and muscle pain. [Feb 5 VietNamNet story]

H1N1 patient experienced quadriplegia A letter in Emerging Infectious Diseases outlines the case of a Thai patient with pandemic flu who developed acute respiratory distress followed by severe neurologic problems, including quadriplegia. Physicians ruled out Guillian-Barre syndrome, and the patient later regained muscle strength. Last May four Dallas children experienced pandemic-H1N1?related neurologic symptoms. [Feb 4 Emerg Infect Dis letter]

Feb 4

Study: Rhinovirus may have stalled H1N1 Rhinovirus may have edged out pandemic flu in France this fall, delaying the start of the fall pandemic wave compared with other European countries, according to a study in Clinical Microbiology and Infection. Researchers analyzed novel H1N1 and rhinovirus samples from a pediatric hospital from weeks 36 to 48 of the flu season and found an inverse relationship between rhinovirus and pandemic flu detections. They wrote that rhinovirus infections may interfere with flu transmission. [Jan 28 Clin Microbiol Infect study]

Artificial insemination may spread flu in turkeys The pandemic H1N1 virus can infect turkeys when sick workers artificially inseminate the birds, leading to a drop in egg production, according to a study in Virology Journal. Researchers have been unable to reproduce infections in turkeys through standard routes, but the new report details how the virus transmits during intrauterine inoculation. The finding suggests that protective measures during artificial insemination may help poultry farms prevent disease outbreaks. [Feb 3 Virol J study]

Hungary shutters H1N1 vaccine clinics Hungary's health minister announced yesterday the closure of pandemic H1N1 vaccination centers, Xinhua reported. The country said it will reopen them if public demand rises, and the vaccine will still be available elsewhere. The centers delivered about 92,000 doses, and the total number of vaccinated Hungarians so far is 3 million, about a third of the population. The health minister said doctor's visits for flulike illnesses had increased slightly compared with the past 2 weeks. [Feb 3 Xinhua story]

Gorillas get pandemic flu vaccine Six Western Lowland gorillas at Boston's Franklin Park Zoo received the human H1N1 vaccine yesterday, the Boston Globe reported. The zoo usually immunizes the gorillas against seasonal flu each fall, but they will receive those doses next week. Area hospitals donated the vaccine. The zoo's director of veterinary services said gorillas are susceptible to human diseases and are often protected with human vaccines. [Feb 4 Boston Globe story]

Feb 3

Flu activity up slightly at some US colleges Flu activity was up a bit at colleges last week, though the levels haven't changed significantly over the past 6 weeks, consistent with the decreasing national trend, the American College Health Association (ACHA) said today in its latest update. The attack rate was 2.6 per 10,000 students, about 15% higher than the previous week. No new deaths or hospitalizations were reported. Overall vaccine uptake remained at 9%, but rates were as high as 40% in some states. [ACHA report for the week ending Jan 29]

New Zealand begins H1N1 vaccination New Zealand, which saw some of the earliest deaths from H1N1 influenza during its 2009 winter flu season, has received its first doses of H1N1 vaccine and is scheduling a national shot campaign. The first recipients of the 1 million doses will be health workers, pregnant women, young children, and the chronically ill. The Southern Hemisphere country is concerned that the virus may return from the Northern Hemisphere and trigger an earlier than usual flu season. [Feb 3 ONE News report]

Immunoglobulin deficiency may predict flu outcome Australian researchers say they have identified an immune-system protein that may play a key role in determining the severity of H1N1 flu infection. Among patients hospitalized with H1N1 flu, there was a correlation between severity of symptoms and deficiency in immunoglobulin G2, which supports early response to infection. The authors say that may explain the seriousness of H1N1 flu in pregnant women, because pregnancy mutes immune responses, and may point to a predictive test or treatment. [Feb 1 Clinical Infectious Diseases abstract]

Czech Republic health chief contracts flu Michael Vit, chief health officer of the Czech Republic, told media in that country that he is home sick with a flu infection that is presumed to be H1N1 influenza, according to Reuters. Vit oversaw flu vaccinations for key members of the government but missed his own because of an overseas trip, the news service said. Vit?s ministry led recently abandoned plans for mandatory vaccination of the Czech armed forces. [Feb 2 Reuters report]

CDC warns about flu at Vancouver Olympics With the 2010 Olympic Winter Games set to begin in Vancouver, the US Centers for Disease Control and Prevention has issued a set of travel tips it calls "Stop, wash and go." The agency recommends that attendees receive H1N1 flu vaccine before leaving, delay their departures if they feel unwell, cover coughs and sneezes, and wash their hands frequently. It also suggests taking a travel health kit containing hand sanitizer, tissues, and pain and fever medications. [Feb 2 CDC travel advice]

Feb 2

Poor nations not receiving vaccine Though many nations have surplus H1N1 vaccine, much of it is not getting to developing nations, according to a New York Times story. So far, only two countries, Azerbaijan and Mongolia, have received vaccine. Afghanistan is slated to be next. About a month ago, the World Health Organization said it hoped to have shipped vaccine to 14 countries by now, of 95 nations that need it. Some of these countries are still experiencing significant pandemic cases and deaths. [Feb 1 New York Times article]

Summer camp containment efforts worked A program of hand hygiene, surface cleaning, and targeted antiviral treatment contained H1N1 flu at a boys' summer camp in July 2009, says a new journal article. The program was launched after 12 boys attending the third camp session contracted flu. During the fourth 2-week session, only 3 of 171 campers tested positive for flu, an attack rate of 1.8%, far lower than cited at other summer camps. However, 57% of staff and 31% of campers who took an antiviral reported side effects. [Feb 1 Arch Pediatr Adolesc Med report]

Study: H1N1 can affect conjunctiva Researchers in Hong Kong have found evidence that, although the pandemic H1N1 flu virus and seasonal flu viruses cause several comparable responses in the body, pandemic H1N1 has the distinct ability to replicate in the conjunctiva. The findings, published in the American Journal of Pathology, suggest subtle differences in H1N1's receptor-binding profile in human hosts and demonstrate an additional route of infection. [Jan 28 Am J Pathol abstract]

Ontario probing illness in 17 vaccinees Ontario's health ministry is investigating 17 serious illnesses that occurred after people received H1N1 flu vaccine, the Toronto Sun reported today. There were four cases of Guillain-Barre syndrome (GBS) and 13 anaphylactic reactions. Two GBS cases were in adults who received the vaccine from the same physician's office in Markham, Ont., the report said. GlaxoSmithKline recalled 170,000 doses of vaccine in Canada in November because allergic reactions were more common than expected. [Feb 2 Toronto Sun report]

UK to end pandemic hotline Feb 11 Because of waning flu activity, Britain's hotline for pandemic flu diagnosis and antiviral prescriptions will be shut down on Feb 11, Chief Medical Officer Sir Liam Donaldson announced in a letter to physicians. Donaldson said the service eased pressure on primary care physicians at the height of the pandemic, but flu-like illnesses and confirmed H1N1 cases now are less than half what they were before the service was launched. The service can be restored in 7 days if needed, he said. [Donaldson letter]

Feb 1

Household cleaners effective against H1N1 A PLoS One study today showed that common household cleaners like 1% bleach, 10% malt vinegar, and an all-purpose cleaner rapidly and completely inactivated a strain of seasonal H1N1 influenza. Also, antiviral and antibacterial wipes reduced virus infectivity. The authors conclude that, for pandemic H1N1, "The public does not need to source specialized cleaning products, but can rapidly disinfect potentially contaminated surfaces with agents readily available in most homes." [Feb 1 PLoS One study]

Some more likely to heed pandemic messages People most likely to take protective measures during a pandemic are more likely to be older, female, well-educated, and non-white, according to a review in the British Journal of Health Psychology. In examining 26 papers that varied by quality, researchers found that those responding to messages were likely to believe they were susceptible, that the disease was severe, and that measures were effective. Increased anxiety and trust in authorities were also linked to adoption. [Feb Br J Health Psychol report]

Study cites good vaccine uptake in homeless In a PLoS Currents study, French researchers reported being able to vaccinate almost half of the occupants of a homeless shelter against pandemic flu. After giving 3 days' notice of the vaccine effort, health personnel administered H1N1 flu shots to 117 of the shelter's 249 residents (47%). That compares with vaccine uptake of 6% in the country's general population and 37% in its healthcare workers. Also, 96% of the homeless people vaccinated knew of the shot's benefits. [PLoS Currents study]

Taiwan takes vaccine to airports, homes To boost pandemic vaccination rates, health officials in Taiwan have unveiled two new tactics, immunization at airports and in homes, the Hong Kong Standard reported today. Four airports will offer the vaccines to citizens entering Taiwan. Home-based vaccinations are available to groups of at least 10 people in communities, companies, or institutions who make a reservation with the local health department. Vaccine safety concerns have slowed vaccine uptake, though 24% have received it. [Feb 1 Standard story]

Jan 29

H1N1 still active in some global regions Although pandemic flu has declined in most of the Northern Hemisphere, transmission remains active in some regions of North Africa, eastern and southeastern Europe, and South and East Asia, the World Health Organization (WHO) reported today. Global H1N1 deaths now total at least 14,711. Novel H1N1 remains dominant in most nations, according to a separate WHO update, but in China 49% of flu isolates are the seasonal B strain. Other countries are detecting some seasonal flu, too. [Jan 29 WHO weekly update]

US flu activity stayed low last week H1N1 flu activity stayed at about the same low level last week as the week before, the Centers for Disease Control and Prevention (CDC) said today. No states had widespread cases; five had regional activity. Five flu-related deaths in children were reported. The share of medical visits ascribed to flu-like illness was 1.7%, below the national baseline of 2.3%, but the fraction of deaths due to flu and pneumonia remained above the epidemic threshold. All but two tested viruses were novel H1N1. [Jan 29 CDC weekly flu update]

Flu down, vaccine availability up at colleges Flu activity at US colleges declined again after leveling off the previous week, the American College Health Association (ACHA) reported. The attack rate was 2.3 per 10,000 students. Though the number of vaccinated students was around 9%, the ACHA reports some encouraging signs. Some institutions are reporting vaccine uptake rates exceeding 25% to 30%. Vaccine availability has improved, with 86% of campuses reporting that they have it. [ACHA report for week ending Jan 22]

Vaccine from 1918, 1976 strains may fend off novel H1N1 In an experiment to learn more about pre-existing immunity, researchers found that mice vaccinated with 1918-like and classical (from 1976) swine flu vaccines had complete protection against pandemic H1N1, according to a study in PLoS Pathogens. In contrast, vaccines based on more recent seasonal H1N1 strains afforded only partial protection. The authors say their findings underscore the importance of having people under age 35 receive the pandemic vaccine. [Jan 29 PLoS Pathog article]

China denies vaccine-miscarriage link China's government denied a link between H1N1 vaccine and miscarriages after an official said "several" miscarriages occurred among 10,000 pregnant women who had been immunized, Agence France-Presse (AFP) reported today. The official added the miscarriages were coincidental and that most were seen in women in their first trimester. He emphasized that global experience so far shows the vaccine is safe and effective in pregnant women, who are at high risk for flu complications. [Jan 29 AFP story]

Jan 28

Pandemic hasn't spared nursing homes Though older people appear to have some immunity to the pandemic virus, the US Centers for Disease Control and Prevention learned of several outbreaks at nursing homes, detailing three in Morbidity and Mortality Weekly Report (MMWR). They occurred during the fall before the vaccine was widely available, and infections in healthcare workers were documented at two of the facilities. Infection control steps and antiviral prophylaxis seemed to slow flu spread. [Jan 29 MMWR report]

New Mexico lists hospitalization, death rates The New Mexico Department of Health says the state's H1N1 hospitalization rate is highest in children under 5 and the death rate is highest in people aged 50 to 64. The overall H1N1 hospitalization rate is 50.3 per 100,000, but the rate for children under 5 is 135.5, twice the national estimate. The overall state death rate is 2.6 per 100,000, but the rate is 5.3 for 50- to 64-year-olds and 3.1 for those 65 and older. Children under 5 and adults 25 to 49 had a death rate of 2 per 100,000. [Jan 27 New Mexico statement]

Some on antiviral therapy still test positive In a study by French researchers in Emerging Infectious Diseases, of 16 H1N1-flu-confirmed patients treated with the antiviral drug oseltamivir (Tamiflu), only 9 (56%) tested negative for H1N1 flu within 3 day of treatment, while 3 (19%) still tested positive more than 5 days after treatment. The authors conclude, "These data raise questions about potential virus transmission during antiviral treatment and the possible resistance of pandemic (H1N1) 2009 to oseltamivir." [Feb Emerg Infect Dis study]

Canada to give 5 million vaccine doses to WHO Canada announced today it will give 5 million doses of H1N1 vaccine and $6 million to the World Health Organization to combat the pandemic in developing countries. The doses amount to 10% of Canada's total vaccine order, a donation in line with those from other developed countries, the government said. Health Minister Leona Aglukkaq said Canada can donate vaccine because it has met its own immediate needs. [Jan 28 Public Health Agency of Canada release]

Hong Kong hangs on to its vaccine Hong Kong has no plans to sell or donate its remaining doses of H1N1 vaccine, Secretary for Food and Health Dr York Chow said today, according to the country's news.gov.hk site. Noting that Hong Kong's stockpiled vaccines will expire in October, Chow encouraged people in five high-risk groups to get vaccinated. [Jan 28 news.gov.hk story]

Shoppers bag free flu shots Aiming to put flu vaccine in the paths of shoppers, the Children's Hospitals and Clinics of Minnesota teamed up with Kohl's stores today to offer free pandemic and seasonal flu vaccines to adults and children outside two Twin Cities malls. A grant from Kohl's is covering the administration cost. Federal officials have urged providers to make it easy for people to get vaccinated. [Jan 28 Children's Hospitals statement]

Jan 27

Two Memphis-area kids die of H1N1 Two Memphis, Tenn.-area children died in the past week of H1N1 flu, according to local officials. The Memphis and Shelby County Health Department (MSCHD) today confirmed that a 12-year-old child died from H1N1 infection, and last week a teen from nearby DeSoto County, Mississippi, died of the disease, according to a news release today. The 12-year-old's death is the seventh confirmed H1N1 death in Shelby County. Officials are reminding people to get vaccinated. [Jan 27 MSCHD release]

South Africa aims to vaccinate 3 million South Africa hopes to vaccinate 3 million people against pandemic flu by winter, the South African Press Association (SAPA) reported today. The country's health minister said South Africa has 1.3 million doses and is seeking funding for more. Priority groups will include pregnant women, healthcare workers, some people at border stations, and young people who are at high risk for complications. [Jan 27 SAPA story]

Serbia, Japan look to cut vaccine orders Serbia's health ministry said it is cancelling further orders of pandemic vaccine from Novartis, Balkan Insight news reported today. The country had originally ordered 3 million doses and has administered 160,000 doses of the 857,500 it had already received. Serbia said it needs 300,000 doses in reserve in case of another flu wave. Meanwhile, Japan signaled that it may cancel some of the 99 million doses of vaccine it ordered from Glaxo and Novartis, Kyodo News reported. [Jan 27 Balkan Insight story]

Southeast Asian officials confer on vaccine, antivirals Health officials from the Association of Southeast Asian Nations (ASEAN) plus three countries gathered today in Singapore to open a 3-day meeting on antiviral drugs and pandemic flu vaccines. The conference, supported by the Australian Agency for International Development, will update members on drug and vaccine supplies, provide a forum for discussing issues such as access and technology transfer, and discuss how the nations can share resources, according to an ASEAN statement. [Jan 27 ASEAN statement]

Czech president opposes mandatory military vaccination The president of the Czech Republic, Vaclav Klaus, said he opposes mandatory H1N1 flu vaccinations for the country's military forces, the Associated Press reported today. Klaus said he considers the order from the Czech chief of general staff to "highly controversial, if not unacceptable" because of possible risks of vaccination. In a statement, Defense Minister Martin Bartak said the number of soldiers in the program would be reduced but gave no details. [Jan 27 AP story]

Serbian pigs test positive for H1N1 Pandemic H1N1 flu has been detected on a swine farm near Varvarin, Serbia, according to a report today filed with the World Organization for Animal Health (OIE). Twenty of more than 10,000 pigs on a commercial breeding farm tested positive during routine inspection. Affected animals showed respiratory symptoms, but none have died. The source of the infection is unknown. [Jan 27 OIE report]

Jan 26

Bahamas receive first H1N1 vaccines After months of delay, the Bahamas has received its first shipment of H1N1 influenza vaccines?just as cases of the pandemic virus trend down in much of the world. The Nassau Guardian reported that the 30,000-dose shipment, purchased through the Pan American Health Organization, arrived Jan 20, 2 months late. The Bahamas has recorded 41 cases of novel H1N1 since the pandemic began. [Jan 26 Nassau Guardian story]

Bay area commuters offered flu shots Passengers on the East Bay routes of the Bay Area Rapid Transit (BART), the commuter-train line linking San Francisco and Oakland, Calif., will be offered H1N1 vaccinations during this afternoon's commute. The shots, offered in the Oakland BART station, are a collaboration between BART and the Alameda County Health Department, which believes it is the first such offering in the United States. [Jan 26 San Francisco Chronicle story]

Novartis profits rise as it issues warning to nations Swiss pharmaceutical company Novartis today announced an 8% increase in profits from 2008 to 2009, driven largely by sales of H1N1 vaccine, Agence France-Presse (AFP) reported. But during the announcement in Basel, outgoing CEO Daniel Vasella warned that the company could retaliate against governments now trying to cancel flu-shot contracts. Countries reneging on payment for vaccines that have already been delivered will not receive a priority response during the next pandemic, he said. [Jan 26 AFP report on profits]

High rate of H1N1 complications in pregnancy Australian researchers report that, of 43 pregnant women admitted to hospitals with H1N1 flu infection between May and July 2009 in the state of Victoria, Australia, 8 were admitted to intensive care and 1 died. In addition, 2 of the pregnancies were miscarried and 1 child died after birth. Half of the women had no underlying conditions, and three-fourths were given antiviral treatment; one-third of those receiving antivirals began them within 2 days of the start of symptoms. [Jan 25 Clinical Infectious Diseases abstract]

Jan 25

Kentucky shuts down its H1N1 hotline After receiving about 10,000 calls since it began in October, Kentucky's hotline for questions on pandemic and seasonal influenza has been shut down as demand has waned, the Associated Press (AP) reported. Public health officials say the hotline can be reactivated if needed, but in the meantime those seeking flu-related answers can go to the state's Health Alerts Web site (http://healthalerts.ky.gov).

Hong Kong finds H1N1 vaccine safe for fetuses Despite receiving reports of four recent spontaneous abortions in vaccinated women, Hong Kong has seen no increase in fetal death among women receiving the H1N1 vaccine, according to a press release today from Hong Kong's Centre for Health Protection (CHP). The normal rate of fetal mortality in Hong Kong is 0.3% to 0.5% of total deliveries, compared with a rate so far of 0.2% in pregnant women receiving the vaccine. [Jan 25 CHP release]

Physicians' views on H1N1 vary by country A seven-country survey by the market research firm Synovate found wide differences in physicians' views about the H1N1 pandemic. Only 20% of Chinese doctors agreed that pregnant women should be vaccinated, versus 90% of US doctors. Overall, 51% of the doctors said they had been vaccinated, with a range from 21% in Spain to 76% in Taiwan. Sixty-two percent believed that the vaccine is effective, while 27% were uncertain. The survey focused on Synovate's proprietary physician panel. [Jan 22 Synovate news release]

Tampa health agencies vaccinating homeless people Public health agencies in and around Tampa, Fla., are working with homeless outreach organizations to vaccinate homeless people against H1N1 flu, according to the St. Petersburg (Fla.) Times. With the virus still circulating, the Centers for Disease Control and Prevention has urged communities across the nation to focus attention on the homeless, the story said. [Jan 25 St. Petersburg Times report]

Jan 22

WHO: Pandemic flu activity holds steady Global flu patterns are about the same as last week, with the most intense activity in North Africa, South Asia, and parts of Eastern Europe, the World Health Organization (WHO) reported today. Novel H1N1 still dominates, but a few countries have detected sporadic seasonal flu cases, especially China, where influenza B cases are increasing. Most of the seasonal H3N2 viruses belong to the Perth-like viruses, included in the Southern Hemisphere's seasonal vaccine, not the Northern Hemisphere's. [Jan 22 WHO update]

Colleges have vaccine, but few students immunized The American College Health Association (ACHA) said yesterday that flu activity on college campuses hasn't changed since its last report for the week ending Dec 18. The attack rate stayed at 2.7 cases per 10,000 students. Though vaccine availability has improved dramatically, with 97% of campuses having supplies, the percentage of vaccinated students is rising very slowly. So far only about 9% of students have been vaccinated, up from 8% in the last report. [ACHA report for week ending Jan 15]

Severe H1N1 illness linked to ethnicity, slow treatment In Manitoba, the Canadian province with the highest burden of severe H1N1 illness, patients who required intensive care unit admission and advanced life support for pandemic flu shared several characteristics, according to a new paper in the Canadian Medical Association Journal (CMAJ). They were more likely to have taken longer to receive antiviral treatment or to have underlying conditions, or to be members of First Nations groups. [Jan 21 CMAJ article abstract]

Ireland to offer workplace vaccination Healthy adults in Ireland will be offered the H1N1 vaccine at their workplaces starting in mid February, the Irish Independent reported today. The nation's Health Service Executive (HSE) will provide the vaccine to employers that have occupational health programs. Workers who can't get the vaccine at work will be offered it at HSE-run clinics, said Pat Doorley, HSE head of population health. He said more than 800,000 people, about 18% of Ireland's population, have been vaccinated so far. [Jan 22 Irish Independent report]

UK health chief urges H1N1 shots The second wave of H1N1 influenza in England is "virtually concluding," Sir Liam Donaldson, Chief Medical Officer, said yesterday, but he warned that anyone who has not been vaccinated will be vulnerable when the virus returns in a future season. Anyone who is eligible for the vaccine but has not taken it should "get the jab and protect themselves," he said in a Department of Health bulletin. [Jan 21 Department of Health bulletin]

Jan 21

Pediatric flu deaths triple past 3 season average In an overview of flu activity during the 2009-10 flu season that started Aug 30, the US Centers for Disease Control and Prevention (CDC) said pediatric deaths from the pandemic virus are three times higher than the average for the past three seasons. Flu activity peaked on Oct 24, much earlier than the February peaks of the most recent flu seasons. The CDC pointed out that multiple waves were seen during the three most recent pandemics, emphasizing the importance of vaccination. [Jan 22 MMWR article]

WHO to write response to 'false pandemic' charges In response to a request from India's health secretary, the World Health Organization (WHO) will write formal letters to all countries to clarify the facts about the H1N1 pandemic, to counter charges that the threat was exaggerated, the Indian government said in a statement yesterday. In requesting the WHO action, the Indian official said the reports of a "false pandemic" were hurting public health measures taken by governments. India also asked for more details about vaccine contracts. [Jan 20 Indian government statement]

Massachusetts flu effort targets minority groups Hoping to ease racial disparities in pandemic flu illness, Massachusetts officials said they will target $1 million of its federal funding toward community groups that can help promote vaccination in these groups. The state's public health officials have reported that the disease has taken a heavier illness, hospitalization, and death toll on black, Hispanic, and Asian groups. [Jan 15 Mass. health department release]

Nigeria cites progress in securing vaccine Following the first deaths and illnesses from pandemic H1N1 flu, Nigeria's health ministry said yesterday that it is in advanced talks with theWHO to receive the vaccine, AllAfrica news reported today. The ministry said Nigeria wasn't previously on the WHO's priority list because it had not detected any illnesses but now said the country could receive vaccine doses by February. Nigeria has confirmed two H1N1 deaths and eight illnesses. [Jan 21 AllAfrica news story]

Jan 20

No flu vaccine in Nigeria after first H1N1 death Nigerian health authorities disclosed today that the country has no H1N1 vaccine with which to launch a flu-shot campaign, 2 weeks after recording its first death from the pandemic virus. The newspaper This Day reported that screening of the 38-year-old woman's close contacts revealed 8 infected people, out of 46, who were placed on antiviral treatment. The government is ramping up public education about infection risks. [Jan 20 This Day story]

Japan OKs its first imported H1N1 vaccines Today Japan approved domestic use of H1N1 flu vaccines made by GlaxoSmithKline (GSK) and Novartis, paving the way for their use within a month. Japan has finalized deals for enough GSK vaccine for 7.4 million healthy adults and Novartis vaccine for 2.5 million. The approval marks Japan's first agreement to accept imported vaccine. GSK earlier contracted to supply the country with 74 million doses of H1N1 vaccine. [Jan 20 Kyodo News International article]

Mexico City offers vaccine for subway riders Health officials in Mexico City this week began offering H1N1 vaccine at 26 of the city's busiest subway stations, the Associated Press (AP) reported. On Jan 18 about 10,200 of Mexico City's 300,000 vaccine doses were distributed at the subway stops. City officials said they will extend the immunization effort to markets by the end of the week. Mexico City was at the center of the novel H1N1 outbreak in the spring. The country hopes to vaccinate 24 million people by March. [Jan 19 AP story]

Chinese expert seeks support for sickest flu patients China's government should help seriously ill pandemic flu patients cover the cost of lengthy treatment, Dr Zhong Nanshan, one of the country's top respiratory disease specialists, said at a Jan 18 ceremony marking the hospital discharge of a teenage girl, China Daily reported today. He said a financial safety net would help reduce fear and barriers to treatment. Zhong first spoke out on the issue in December after a toddler was found dead after his parents took him out of the hospital. [Jan 20 China Daily story]

Concern raised over vaccine and autoimmune disease Switzerland's medical regulatory agency, Swissmedic, recommends that people who have serious autoimmune diseases not receive Novartis's H1N1 vaccine because it has not been tested in such patients, Reuters reported today. The agency said it could not exclude the risk that the vaccine antigen or adjuvant could exacerbate disease. [Jan 20 Reuters report]

Jan 19

GSK vaccine sales lower than predicted Flu-vaccine manufacturer GlaxoSmithKline (GSK) could end up earning only 75% of what it once forecast from H1N1 vaccines, as governments renegotiate their contracts to two thirds of what they ordered last year, the Financial Times reported. Similar results are expected for other flu-shot manufacturers. In a separate statement, GSK acknowledged that countries are changing their orders but said it is "too early to say" what final dose totals and earnings for H1N1 vaccine will be. [Jan 17 Financial Times report]

FDA chief stresses safety of H1N1 vaccine Margaret Hamburg, MD, commissioner of the US Food and Drug Administration (FDA) recently sent a letter to healthcare professionals reassuring them about the safety of the pandemic H1N1 vaccine, based on the latest findings. She said no substantial differences between the pandemic and seasonal flu vaccine have been seen and that 94% of adverse events have been nonserious conditions such as injection-site soreness. [Jan 14 FDA letter]

Greece, Norway scale back vaccine orders Greece and Norway have both cut back on pandemic vaccine deliveries, Agence France-Presse (AFP) reported. The Greek health ministry said it would pay for only the 3.6 million doses it has already received and wants companies to refund advances made for future shipments. Meanwhile, Norway's health ministry said it reached an agreement with GSK to trim its order by 30%. It has received about 4.3 million doses so far and has vaccinated about 60% of its population. [Jan 18 AFP story]

Experts review Australia's pandemic response Two respiratory medicine experts from Australia, in a recent issue of Respirology, critiqued their country's H1N1 pandemic response. One said officials could have done more to slow the spread of the virus, such as isolating infected cruise ship passengers and canceling youth sports events, as well as better coordinating response across government levels. The other author praised officials for funding research efforts, but said the next possible wave may reveal more about response. [Jan Respirology report]

Massachusetts minorities hit harder than whites Massachusetts is the latest jurisdiction to find higher rates of flu illness and death in its non-white residents, the Boston Globe reported in its blog White Coat Notes. Asians were hospitalized 1.5 times as often as whites and were 4 times as likely to die from flu; Hispanics were hospitalized 3 times as often and were 6 times as likely to die; and blacks were hospitalized more than 4 times as often, and had death rates more than 3 times higher than whites. [Jan 15 Boston Globe blog post]

County tests emergency response with H1N1 shots Lexington County, S.C., used a newly arrived allotment of H1N1 vaccine to stage a 1-day test of its emergency medical response, The State newspaper reported. The county used a sports field to set up portable hospital tents purchased with homeland security funds, called in health professionals and community volunteers to work the site, and funneled 600 vaccine recipients through at several minutes each. [Jan 17 The State story]

Los Angeles airport makes vaccine available The Los Angeles international airport recently began offering flu shots, including the pandemic vaccine, in most of its terminals. A spokewoman said the airport's goal is to help curb flu spread and put the shots within convenient reach of travelers. Vaccination stations are staffed by nurses from FluEase, a company that specializes in immunization services for organizations. The shots cost $30, and vaccination will continue throughout flu season. [Jan 11 LAX press release]

Jan 15

WHO: Influenza B up in China Though the pandemic H1N1 virus is still the dominant flu strain, China has found influenza B in 12.6% of specimens, the World Health Organization (WHO) reported today. Some countries are sporadically detecting seasonal H1N1 and H3N2 viruses. Regions reporting the most intense pandemic flu activity are North Africa, South Asia, and east and southeastern Europe. The most affected North African countries are Morocco, Algeria, and Egypt. Flu activity also increased in western India. [Jan 15 WHO update]

Kids overdue for booster vaccine dose A review of data from 10 states shows up to 80% of children under age 10 who were immunized against pandemic flu are overdue for their second dose, USA Today reported. Officials have said children ages 6 months to 10 years need a second dose to be fully protected. States said they worry that declining flu activity may dampen the public's interest in the vaccine. Experts have said a booster is still effective, even when given later than the suggested 4 weeks after the first dose. [Jan 14 USA Today story]

California minority groups hit hard California Hispanics, African-Americans, and Native Americans have been hospitalized and died from pandemic H1N1 flu at higher rates than whites, according to an LA Times report today. Death and hospitalization rates for the state's Hispanics have been about twice as high as whites', compared with a 50% higher death rate and a tripled hospitalization rate in blacks. Native Americans' rates were also higher than whites', while Asians had a higher hospitalization rate but lower death rate. [Jan 15 LA Times article]

Belgium, Italy cut vaccine orders Belgium has cut back its pandemic vaccine order with Glaxo by a third because of falling demand, Reuters reported today. The country's health ministry said the cut would save the government about $47.6 million. Meanwhile, Italy cancelled 24 million doses it had ordered from Sanofi, Bloomberg News reported today. The Italian media has reported that only 900,000 people were immunized against pandemic flu. Italy had also bought 24 million doses from Novartis. [Jan 15 Reuters story]

Australia braces for possible back-to-school wave The Australian Medical Association (AMA) has said it is likely swine flu will strike the country again, possibly as a second wave after school resumes in a couple weeks and as people return from overseas holiday travel, according to The Australian. AMA vice-president Steven Hambleton said, "We're expecting to reimport the virus and to see people getting sick again." Officials are encouraging vaccination. [Jan 16 Australian report]

HHS unveils flu-fighter Facebook app Department of Health and Human Services (HHS) Secretary Kathleen Sebelius yesterday announced a new Facebook application called, "I'm a Flu Fighter" that allows users to tell their friends they received the flu vaccine and urge others to do the same. "Social media has been an important tool to communicate with young people and all Americans about the importance of getting the H1N1 flu vaccine," Sebelius said in a press release. [Jan 14 HHS release]

Jan 14

CDC warns about vaccine-related fraud Questions and answers about fraud and abuse related to H1N1 vaccine were posted online yesterday by the Centers for Disease Control and Prevention (CDC). The information is designed to help state and local immunization programs report abuses, such as charging for the vaccine (which is provided free by the federal government, though providers can charge for administering it) or selling the vaccine or ancillary supplies provided by the government. [CDC question-and-answer bulletin]

China urges Lunar New Year precautions To limit the spread of H1N1 during the upcoming Lunar New Year celebrations, China's health ministry is urging people at risk for H1N1 complications to get vaccinated and avoid using public transportation during the holidays, Agence France-Presse (AFP) reported today. The ministry specifically mentioned pregnant women, children, the elderly, obese people, and those with chronic diseases. The travel period lasts from Jan 30 to Mar 10, with Lunar New Year's Day on Feb 14. [Jan 14 AFP story]

Permanent H1N1 lung damage reported Some H1N1 patients in Finland suffered permanent lung damage from their infections, according to a Finnish Broadcasting Corp. (YLE) report. The patients had viral pneumonia, which caused their lungs to fill with fluid and left them with fibrosis after they recovered. At Kuopio University Hospital, all patients who were in the pulmonary ward for H1N1 will be brought back for further testing. The story did not specify how many patients suffered permanent damage. [Jan 14 YLE report]

Drive-through clinics proposed for triage A drive-through clinic for patient triage may be a useful method to reduce emergency-room crowding and disease spread during a flu pandemic, according to Stanford University physicians. The researchers set up a simulated drive-through clinic in a parking ramp and used charts from real patients who had flu-like illness to create patient scenarios. Participating physicians accurately identified patients who were admitted and discharged. The median length of stay was 26 minutes. [Annals of Emergency Medicine report]

Jan 13

Japan clears IV antiviral peramivir Japan has approved peramivir, an intravenous neuraminidase inhibitor, for the treatment of adults with influenza, Shionogi announced today. Shionogi has licensed the drug from US-based BioCryst. Japan is the first country to approve peramivir, though in October the US Food and Drug Administration (FDA) granted it an emergency use authorization. Shionogi said it finished a clinical trial of the drug in children and intends to file an application for pediatric use within the next fiscal year. [Jan 13 Shionogi press release]

Germany, Serbia scale back vaccine orders GlaxoSmithKline yesterday confirmed that the German government is trimming its H1N1 vaccine order by 30%, the Associated Press (AP) reported. Other governments are reducing their vaccine orders because they have surpluses owing to falling public demand and findings that one dose, rather than two, is enough to protect most people against the virus. In a related development, Serbia said yesterday it would stop importing vaccine and reassess its needs in February, BalkanInsight news reported. [Jan 12 AP story]

Georgia to get donated vaccine from WHO Public health officials in Georgia said the World Health Organization (WHO) will provide the country with 400,000 pandemic vaccine doses to immunize high-risk groups, Trend News, a central Asian news agency, reported. Groups slated to receive the first doses include pregnant women, healthcare workers, and those with weakened immunity and chronic conditions. Pandemic flu activity is starting to decline in Georgia, but officials are warning that another wave of illnesses could occur. [Jan 12 Trend News story]

UK leader defends government's H1N1 response British Health Secretary Andy Burnham defended the government's response to the H1N1 pandemic from Labour Party charges that leaders wasted money and distorted the health system's priorities over an exaggerated threat, the Press Association reported. Burnham said he would "make no apology" for taking necessary steps to protect the public. He cited the WHO's pandemic declaration and said the "exceptional spike in flu cases" in Britain last summer triggered strong public concern. [Jan 12 Press Association report]

China orders more H1N1 vaccine China has ordered more pandemic H1N1 vaccine from Sinovac Biotech Ltd., the company announced today. The order is for 8.57 million doses and brings the total bought by the government from Sinovac to 20.05 million doses, of which 10.23 million have been delivered. The order calls for the company to deliver 2.33 million doses by Mar 15 and to stockpile the rest in its own warehouse, officials said. [Jan 13 Sinovac press release]

Mexico has fewer than half of its doses Mexico, site of the world's first pandemic H1N1 cases, has received fewer than half of the 30 million doses of vaccine it ordered in 2009, Health Secretary Jose Angel Cordova said yesterday, according to the AP. He said Mexico has struggled to get the vaccine because it has to import it. So far the country has obtained 12 million doses, including a loan of 5 million from Canada. Cordova said the government hopes to vaccinate 24 million people by March. [Jan 12 AP report]

Many Poles think no-vaccine policy was right Many people in Poland think their government's decision not to buy H1N1 vaccine has been vindicated by events, as the pandemic has peaked in much of Europe and several countries that stockpiled vaccine have many doses left over, according to an AP report from Warsaw. Doctors in Poland are deeply divided on the matter, with some arguing that people should have the right to be vaccinated if they want to. [Jan 13 AP story]

Jan 12

WHO to field questions on pandemic response In response to some European officials who have questioned its response to the flu pandemic, the World Health Organization (WHO) said today it will order an independent review, but probably not until after the pandemic is over, Agence France-Presse (AFP) reported. A WHO spokeswoman said its executive board will address questions on the topic at its Jan 18 meeting. Some members of the Council of Europe have charged that vaccine companies pressured the WHO and have called for an investigation. [Jan 12 AFP story]

Hospitals get mixed grades on H1N1 response In a survey of the Society for Healthcare Epidemiology of America, 60% of the 323 respondents said their hospitals were well prepared for the H1N1 pandemic, but 51% said other infection-prevention activities were neglected during the crisis, according to a report in Clinical Infectious Diseases. About 31% of respondents reported shortages of antiviral drugs, and 30% said personal stockpiling of antivirals occurred at their hospitals. Most endorsed mandatory flu shots for health workers. [Jan 11 Clin Infect Dis abstract]

Mandatory flu shots for health workers deemed success Mandatory flu vaccination of staff has been successful at BJC HealthCare, a St. Louis health group with 26,000 workers, according to a Clinical Infectious Diseases study. After the requirement was set in 2008, 98.4% of workers were vaccinated. Medical exemptions were granted to 1.2% of workers and religious exemptions to 0.3%. Only eight workers were not vaccinated and not exempted. Fewer employees sought medical or religious exemptions than had declined the vaccine the year before. [Jan 11 Clin Infect Dis abstract]

A third of UK health workers now vaccinated Only about a third of frontline National Health Service workers in England have received H1N1 vaccine, according to a report in the Nursing Times newsletter. As of December, 343,000 of about 1 million staff members had been vaccinated, the Department of Health reported. A department spokeswoman said the number of healthcare workers who received the pandemic vaccine is about twice the number who have received the seasonal vaccine. [Jan 12 Nursing Times report]

VaxInnate licenses recombinant H1N1 vaccine to Indian firm VaxInnate Corp. of Cranbury, N.J., announced today that it has licensed its recombinant H1N1 vaccine to Biological E. Limited, an Indian company, and will help the firm test and market the vaccine in India. Clinical development of the vaccine there will start early this year, and it could become available for emergency use after completion of clinical trials. Biological E. will be able to make the vaccine?produced in a bacterial expression system--in its existing facilities, officials said. [Jan 12 VaxInnate press release]

New HHS PSAs urge vaccination for minorities The US Department of Health and Human Services (HHS) held two press briefings today to launch new public service announcement (PSA) campaigns to urge African-Americans, American Indians, and Alaska natives to be vaccinated against H1N1. HHS Secretary Kathleen Sebelius and Surgeon General Regina Benjamin conducted the briefings along with other officials. The briefings were part of National Influenza Vaccination Week activities. [HHS flu.gov page with access to PSAs]

FDA offers guidance on drug production in emergencies In an effort to maintain the nation's supply of drugs and other medical products in the event of a pandemic or other emergency, the US Food and Drug Administration (FDA) recently issued draft guidance to help pharmaceutical companies plan for high absenteeism rates. It focuses on "medically necessary products" such as antivirals and details what the FDA could do to help protect the supply. The guidance is also aimed at companies that make the raw materials and components used in the products. [Jan 2010 FDA draft guidance]

Jan 11

Groups encourage H1N1 vaccination Thirty-seven US health groups today posted an open letter to Americans urging them to get an H1N1 vaccine. The letter, signed by leaders of the AMA, Red Cross, APIC, ASTHO, IDSA, and other physician, nurse, hospital, and other healthcare groups, says, "The H1N1 flu vaccine is safe, effective, and the best way to protect yourself and your family from the H1N1 flu." [Jan 11 letter on CDC site]

Feds kick off flu vaccination week National Influenza Vaccination Week launched yesterday with US Health and Human Services (HHS) director Kathleen Sebelius visiting a Baptist church in Washington, DC, in an effort to rally faith communities behind immunization efforts. The event is designed to raise awareness of flu complications and promote post-holiday vaccination. Officials are highlighting different risk groups each day of the week, with today's messages aimed at healthcare workers and the general public. [Jan 8 HHS press release]

Ohio sees low vaccine uptake in risk groups Pandemic flu vaccine uptake in Ohio's high-risk groups has been low, according to a report in the Cleveland Plain Dealer. Only 20% of those at high risk for flu complications had been vaccinated through the end of the December, according to data from public records. For example, fewer than 2 in 10 of the state's pregnant women had gotten their dose. As of Dec 30 the state had distributed 4 million doses and administered 1 million. [Jan 10 Plain Dealer report]

Aid group says flu spreading in North Korea H1N1 flu is continuing to spread in Pyongyang, North Korea, prompting the closure of day care centers and kindergartens, an aid group called Good Friends reported on the UN-sponsored ReliefWeb site. Quoting an unnamed official, the report said some children have died and severe winter weather has worsened the situation. The group also said flu medications sent from South Korea have been used mainly in Pyongyang, with little reaching the provinces, where the virus is also spreading. [Jan 9 Good Friends report]

European group to air H1N1 vaccine controversy Later this month the Council of Europe will debate charges raised by one of its health officials that vaccine makers manipulated governments to buy stockpiles of pandemic vaccine, the London-based Guardian reported today. Weak demand for the vaccine amid waning flu activity and the need for just one dose have left many countries with surpluses. However, some experts warn another wave of infections could sweep the globe, with more months remaining in the Northern Hemisphere's flu season. [Jan 11 Guardian story]

Azerbaijan receives donated vaccine Azerbaijan has received its first shipment of donated pandemic vaccine, the World Health Organization (WHO) said in a press release. It will receive a total of 860,000 doses. The inactivated adjuvanted vaccine made by Glaxo will go to healthcare workers, pregnant women, people with chronic lung conditions, and children ages 14 to 17. Meanwhile, the WHO sent Nepal five sets of intensive care equipment to help treat severely ill H1N1 patients, Himalayan News Service reported yesterday. [Jan 8 WHO press release]

Jan 8

Mongolia is first country to get donated vaccine Mongolia yesterday became the first developing country to receive donated doses of H1N1 vaccine from the World Health Organization (WHO), the Voice of America reported. The first 35 countries on the list to receive vaccine should all get supplies within the next month, WHO spokeswoman Nyka Alexander told VOA. Azerbaijan and Afghanistan are expected to receive doses within days. The WHO has received pledges for 190 million doses from 14 countries. [Jan 7 VOA report]

Minority groups hit hard by H1N1 African-American, Hispanic, and American Indian residents of Wisconsin were hospitalized for H1N1 flu at much higher rates than whites, the Milwaukee Journal Sentinel reported. Data from Milwaukee and the state show hospitalization rates for whites of 11 to 14 per 100,000, compared with 28 to 38 per 100,000 for blacks, 30 to 32 per 100,000 for Hispanics, and 35 per 100,000 for American Indians. [Jan 7 Milwaukee Journal Sentinel story]

UK considering unloading surplus vaccine The British government is looking at ways to "offload" millions of doses of H1N1 vaccine because a third wave of cases is deemed unlikely, the BBC News reported today. Options include selling the surplus doses or giving them to poor countries, but a stockpile will be kept. The government bought 60 million doses from GlaxoSmithKline and 30 million from Baxter. So far, 23.9 million doses of GSK vaccine and 5 million doses of Baxter vaccine have been delivered. [Jan 8 BBC News report]

China offers free flu shots for holiday China's Ministry of Health said today that the government will fund free H1N1 flu vaccinations for all children in the country who are less than 3 years old. The central government made the move in anticipation of Lunar New Year celebrations, when millions of people travel to visit relatives. China has vaccinated 51.4 million residents so far. [Jan 8 Agence France-Presse story]

Hockey team invites fans to take a shot The Missouri Mavericks, a minor league hockey team in Independence, Mo., are offering a special incentive for fans to attend their game tomorrow: free H1N1 flu shots. The team plans to set up a vaccination table for their game with the Arizona Sundogs, the Associated Press reported. Anyone wanting the immunization must be older than 18 or be accompanied by a parent or guardian. [Jan 8 AP report]

Jan 7

College flu activity down, vaccination up Mirroring the national pattern, flu activity at colleges continues to decline, according to the American College Health Association (ACHA). It said new cases were down 21% from the week before. One new death was reported. The attack rate was 2.7 cases per 10,000 students. The percentage of students who have been vaccinated rose slightly to 8%, with some states reaching 20% with vaccine availability improving. [ACHA report for week ending Dec 18]

NYC's early flu cases helped steer treatment A review of New York City's first hospitalized pandemic flu patients, used early in the outbreak to guide local and federal response, revealed that people with asthma or the obese were more likely to have severe illness, according to the latest Morbidity and Mortality Weekly Report. Findings that early antiviral treatment led to shorter hospital stays influenced recommendations that patients at risk for flu complications receive early osteltamivir (Tamiflu) treatment. [Jan 8 MMWR report]

Kids' cases show false-negatives, coinfections In a review of the first 13 pediatric patients hospitalized for pandemic flu at Johns Hopkins, researchers found that all but one had an underlying medical condition, especially asthma, and that respiratory effects from the disease varied widely. Their report, published in Pediatric Critical Care Medicine, also notes that rapid tests were negative in 8 of 13 children and that about a fourth developed bacterial coinfections. Half needed ventilators, but none died. [Dec 31 Ped Crit Care Med abstract]

Turkey to cancel some vaccine orders Turkey plans to scale back its purchase of 43 million doses of H1N1 vaccine, joining other countries taking similar steps, Today's Zaman newspaper reported today. The ministry said pandemic flu activity has been declining since late November. So far half of the 8 million doses Turkey has received have been administered. The ministry said one in five people have been infected with the virus, especially adults under 50, children, and pregnant women. [Jan 7 Today's Zaman story]

H1N1 in California turkeys, Illinois pig California officials announced that the pandemic H1N1 virus has been detected in a turkey breeding flock in the central part of the state, the American Veterinary Medical Association (AVMA) reported. The only sign of illness was a drop in egg production. Meanwhile, the US Department of Agriculture reported that its National Veterinary Services Laboratories have confirmed the virus in swine herd samples from Illinois that were collected Dec 16. [Jan 6 AVMA report]

Jan 6

WHO says demand for donated vaccine may drop Developing countries in line to receive donated H1N1 vaccine from the World Health Organization (WHO) may not want as much as the agency has been aiming to provide, the Canadian Press reported today. The WHO hoped to provide enough for 10% of the population of countries that wanted the vaccine, but the agency's Dr. Marie-Paule Kieny said that with the pandemic waning, governments are "considering whether and how much vaccine they want to deploy." [Jan 6 Canadian Press report]

Vaccine surplus issues surface in Australia, Ireland Australia has used only about a quarter of the pandemic vaccine doses it ordered, raising questions about a surplus, The Australian newspaper reported today. Though summer flu activity is low in Australia, Health Minister Nicola Roxon and the Australian Medical Association have issued new calls for the public to be vaccinated. Meanwhile, Irish news media reported today that Ireland canceled an order for 3.7 million doses of vaccine from Baxter. [Jan 7 The Australian story]

Canada to lend 5 million vaccine doses to Mexico Canada will lend 5 million doses of H1N1 vaccine to Mexico "to help bridge that country's immediate pandemic vaccine requirements," Canadian Health Minister Leona Aglukkaq said in a press release today. Mexico will repay the doses by Mar 31. The release said Mexico has ordered vaccine from several producers, but most of it will not be available until the end of this month. Canada has enough vaccine on hand to meet its needs and make the loan, officials said. [Jan 6 Public Health Agency of Canada statement]

Indian doctors request more ventilators for hard-hit city The Indian Medical Association (IMA) has asked the government for 50 ventilators to help hospitals in Ludhiana, the largest city in Punjab state, cope with a surge of pandemic flu patients, the Times of India reported yesterday. Punjab is in northern India. The IMA said only 160 ventilators are currently available and there aren't enough beds and isolation rooms to handle the influx of patients. They warned that lack of proper health facilities could raise the flu death toll. [Jan 5 Times of India story]

Rhode Island reports hospital outbreak of H1N1 Seven patients in a state hospital in Rhode Island recently contracted H1N1 flu but have since recovered, according to a report in the Providence (R.I.) Journal. The patients were in the Zambarano Unit of the Eleanor Slater Hospital, located in Burrillville. The outbreak was reported Dec 28, and the state's health department declared it resolved Jan 4. Staff members and other patients on the two floors where the outbreak occurred were treated with oseltamivir. [Jan 6 Providence Journal report]

Los Angeles cab drivers offered free vaccine The nine franchised taxi companies in Los Angeles are offering free H1N1 vaccination to their 3,700 drivers this week, according to an Associated Press report. Norton Medical Industries, a company that tests employees for drugs and alcohol, will administer the shots, the report said. With an increased supply, Los Angeles County recently made the vaccine available to everyone. [Jan 5 AP report]

Jan 5

Leaders line up for flu shots More high-profile leaders are getting their pandemic flu vaccine, including Margaret Chan, the director-general of the World Health Organization, who got her shot on Dec 30, Reuters reported. Meanwhile, state lawmakers from Indiana had a chance to get vaccinated today at a clinic held as the legislative session reconvened, the Associated Press reported. The state's health commissioner said she hoped the lawmakers would set a good example for constituents by getting their shots. [Jan 5 Reuters story]

Researchers create insect-cell H1N1 vaccine In an effort to develop new strategies to more quickly produce pandemic vaccine, Austrian researchers have used an insect cell technique to create a recombinant virus-like particle H1N1 vaccine for use in mouse studies. Their report appeared in Biotechnology Journal. They wrote that the process took 10 weeks. US researchers have already developed a similar system for making seasonal flu vaccine. [Dec 29 Biotechnol J abstract]

National flu vaccine week takes shape Last month federal officials delayed National Influenza Vaccination Week to coincide with more plentiful pandemic vaccine, and they recently announced themes for each day of the week, which starts Jan 10. On Jan 11, efforts will focus on the general public and healthcare workers. The following 2 days will target those at high risk for flu complications, followed by children, pregnant women, and infant caregivers. Jan 14 messages will aim for young adults, and the next day will feature seniors. [Jan 2 HHS news release]

IOM issues report on impacts of pandemic The Institute of Medicine (IOM) recently published a report on the US and international impacts of the H1N1 pandemic, based on a workshop that was held in mid September and involved a committee of about 25 experts. The report outlines the course of the pandemic to that point and describes the scientific and public health responses to it. The body of the report runs about 75 pages, but numerous appendices and related materials swell its total length to several hundred pages. [IOM report title page]

Jan 4

China logs end-of-year flu increase All but 6 of China's 659 deaths from H1N1 flu were recorded in the last 2 months of 2009, raising the possibility that the disease is on the upswing, Agence France-Presse (AFP) reported today. And China Daily said fears are growing of uncontained spread of flu in China's vast interior, with government efforts focusing on getting equipment and resources to rural provinces in advance of the mass exodus to the countryside to celebrate Lunar New Year next month. [Jan 4 AFP article]

France to sell 89 million vaccine doses The French government is offering a vast amount of unused H1N1 flu vaccine for sale to other countries and may have found buyers in the Middle East, AFP reported. Of the 94 million doses bought to inoculate each resident two times, only about 5 million were used. Qatar and Egypt, and also Mexico and Ukraine, may be buyers, France's health ministry said. The country has experienced 198 deaths from the flu. [Jan 5 AFP story]

Thailand admits, learns from H1N1 errors Thailand's health ministry says its actions during the H1N1 pandemic confused people and brought mistrust of the organization, according to The Nation. Among its errors were unclear early messages about the virulence of H1N1, delays in reporting the first death, use of ineffective thermal scanners at airports, mistakenly encouraging people to be tested if they had symptoms, failure to warn high-risk groups of the danger, and misdiagnosis. [Jan 2 The Nation article]

Two Chinese deaths not due to vaccine Two unidentified people who died after being inoculated against H1N1 influenza did not die of vaccine reactions, the Chinese Ministry of Health said today in a report carried by Xinhua. Almost 50 million people have been vaccinated with a vaccine made in China, and about 1 per million has experienced a reaction, but these two deaths were not due to adverse events, the ministry said. [Jan 4 China Daily report]

Rapid H1N1 diagnostic test gets EUA Cepheid's Xpert Flu A Panel, which can identify pandemic H1N1 influenza in less than an hour, was given Emergency Use Authorization (EUA) status by the US Food and Drug Administration today. The test runs on the company's GeneXpert System, and the EUA will allow its use in laboratories certified to perform "moderate complexity" testing, which includes hospital labs. The EUA is expected to expire Apr 26. [Jan 4 Cepheid press release]

Dec 31

CDC: Flu indicators for Christmas week were mixed Only four US states had widespread flu activity last week, down from seven the week before, the Centers for Disease Control and Prevention (CDC) said today. However, outpatient medical visits for flu-like illness, which were at the national baseline the previous week, edged back above that level, reaching 3.2%. Also, deaths due to pneumonia and flu climbed back above the epidemic threshold. There were four flu-related deaths in children, down from nine the previous week. [CDC FluView report]

China advises delaying pregnancy till pandemic over Women in China are being advised by the country's health ministry to wait to become pregnant until the risk of pandemic H1N1 influenza lessens, according to a Xinhua article today. Women are encouraged to avoid others with flu symptoms, stay away from crowds, keep offices and apartments well ventilated, and wear masks when outside. Nearly 14% of H1N1 deaths in mainland China have been in pregnant women. The country provides free vaccination for all pregnant women and new mothers. [Dec 31 Xinhua article]

Japan to study whether H1N1 vaccine is risky for chronically ill Japan's ministry of health announced Wednesday that it will begin an epidemiologic study next spring to evaluate whether pandemic H1N1 flu vaccination can increase the risk of death in people with serious chronic diseases, says a Kyodo News story. Of people in Japan vaccinated with domestically produced H1N1 vaccine, 104 have died, about 80% of whom were 70 years of age or older and had chronic diseases. Almost 1,900 cases of vaccination side effects have been reported. [Dec 30 Japan Times article]

Bowl games will feature HHS message urging vaccination Viewers of four college football bowl games over the New Year's holiday will see an ad encouraging Americans, especially young people, to be vaccinated against H1N1 flu, the Department of Health and Human Services (HHS) announced today. The HHS spot will run during the Outback Bowl, Gator Bowl, Valero Alamo Bowl, and GMAC Bowl telecasts. The ad is aimed at young people because they have been hit hard by the virus, the HHS statement said. [Dec 31 HHS press release]

Dec 30

Report details New York high school outbreak A report released today by the New England Journal of Medicine (NEJM) dissects one of the earliest and largest school outbreaks of H1N1 flu, at a high school in the New York City borough of Queens in April. There were 124 confirmed cases--none of them severe--in students and staff, and more than 800 students and employees reported a flu-like illness. The authors estimated the median incubation period at 1.4 days and the reproductive number (additional cases generated by each case) at 3.3. [Dec 31 NEJM report]

One Novartis pediatric vaccine dose may suffice With the help of an adjuvant, a Novartis H1N1 vaccine at half the standard dose may protect children 3 to 17 years, according to a NEJM letter today. The findings, from Costa Rican and Novartis researchers, showed protection after 22 days among 9- to 17-year-olds after one 15-microgram (mcg) dose or a 7.5-mcg dose with an adjuvant. But among 3- to 8-year-olds, only the adjuvanted 7.5-mcg dose provided an adequate immune response. Adjuvanted flu vaccines are not approved for US use. [Dec 30 NEJM letter]

China launches broad epidemiologic investigation China will launch a two-pronged nationwide investigation of H1N1 influenza to improve case counts and understanding of the disease's communicability, Xinhua News reported. One arm will survey 54,000 people in 12 provinces, cities, and regions in three time periods in 2010, while the other will involve one-time collection of blood samples from 12,400 people in 31 provinces and additional political units. [Dec 30 Xinhua News report]

Eastern Europe, southern Asia are flu hot spots Central and Eastern Europe are currently the hottest spots for pandemic flu activity, but activity is also intense in northern India, Nepal, and Sri Lanka, the World Health Organization (WHO) said in its weekly H1N1 update today. Flu activity seems to be waning in most of the rest of the Northern Hemisphere, but limited data indicate "high-intensity transmission" in Algeria, Tunisia, and Egypt. More than 208 countries and territories have reported confirmed H1N1 cases, with 12,220 deaths. [WHO H1N1 weekly update]

New RT-PCR tests yield promising results A study in the Journal of Molecular Diagnostics found that new rapid RT-PCR tests accurately detected influenza A and B and respiratory syncytial virus (RSV) in nasopharyngeal specimens. Semiautomated and fully automated versions of the RT-PCR assay were able to detect human H3N2 and H1N1, including novel H1N1, and could distinguish flu A of all subtypes from flu B and RSV. Both versions showed greater overall and flu-A-specific sensitivities than the FDA-approved ProFlu+ test. [Jan J Mol Diagn study]

Aid group: North Korea issues flu alert A humanitarian agency said North Korea recently issued a nationwide alert about its apparently worsening outbreak of pandemic flu, according to the Washington Post. The Seoul-based Buddhist aid group Good Friends said that North Korean officials declared that novel H1N1 patients should be given priority. The group said the statement was of a type issued only twice before, for war-related casualties in the 1950s and in 2002. South Korea has shipped 500,000 doses of antivirals to the North. [Dec 31 Washington Post article]

Dec 29

School closings don't keep kids home A study in Emerging Infectious Diseases today found that, while almost half (47%) of Australian parents surveyed supported school closures, the step decreased parents' work time while doing little to keep kids home. The study of 233 children affected by school closings found that 45% of parents of asymptomatic children took at least 1 day off work. And 74% of kids reported at least one activity away from home during the closure, averaging almost four such outings per student. [Dec 29 Emerg Infect Dis study]

No leukocytosis may be key flu indicator A study in PLoS One of 100 cases each of confirmed novel H1N1 flu, seasonal flu, and non-flu acute respiratory illness found very similar clinical profiles between pandemic and seasonal flu. The authors found that the sensitivity and specificity of WHO and CDC influenza-like illness (ILI) clinical criteria were modest in predicting flu. However, the combination of WHO ILI criteria with the absence of leukocytosis (a high white blood cell count) greatly improved diagnostic accuracy. [Dec 29 PLoS One study]

Chile reports 3 H1N1 reinfections In a letter in Emerging Infectious Diseases, Chilean physicians describe pandemic flu reinfection in three patients, ages 14, 38, and 62 years. Both initial and repeat infections were confirmed via polymerase chain reaction (PCR) test, considered very reliable. The authors attributed the reinfections, which occurred 2 to 3 weeks after recovery from the initial illness, to incomplete immunity after the first infection and said one or two may resulted from exposure in the hospital. [Letter in Jan Emerg Infect Dis]

Vical says DNA flu vaccine formulated quickly The pharmaceutical company Vical formulated an adjuvanted DNA-based vaccine against H1N1 influenza more rapidly than any of the companies relying on chicken eggs or cell-culture techniques, and demonstrated its immunogenicity in mice and rabbits, according to an article inl Gene Therapy and Regulation. Vical, based in San Diego, has a $1.25 million contract with the US Navy for a phase 1 trial of a DNA-based vaccine against H1N1 flu. [Gene Ther Regul study abstract]

South Korea reports 16th finding of H1N1 in pigs South Korea today reported another case of pandemic H1N1 infection in pigs, raising the number of such cases in the country since mid December to 16, according to a Xinhua report. The latest finding was on a farm in Jeungup, Jeolla province. Authorities suspect the pigs caught the virus from people. The agriculture ministry plans to take quarantine measures and to vaccinate hog-industry and health workers in an effort to stop the outbreaks. [Dec 29 Xinhua report]

Dec 28

CDC sees further drop in flu-related doctors' visits, deaths Pandemic flu activity continued its decline the week of Dec 13 to 19, with only seven states reporting widespread cases, down from 11 the week before, the US Centers for Disease Control and Prevention (CDC) reported on Dec 24. Flu and pneumonia mortality dipped below the epidemic threshold for the first time in several weeks, and outpatient visits for flulike illness dropped to the national baseline. Nine pediatric flu deaths were reported, the same as the previous week. [Latest CDC Flu View update]

H1N1 declining in most of Europe, ECDC says Flu H1N1 virus activity is still declining in Europe, except in the southeast, the European Centre for Disease Prevention and Control (ECDC) reported today. Deaths are increasing in Central and Eastern Europe. The report for the week ending Dec 20 also comments on the D222G/D222N virus mutations, which have been seen in some severe cases. The ECDC said the mutations also have been found in mild cases and that they represent a natural variation likely to have little impact on public health. [Dec 28 ECDC report]

Dec 23

WHO: Flu activity still up in some areas Pandemic activity seems to have peaked in most of the Northern Hemisphere, except for areas that were affected later, such as Eastern Europe and parts of Asia, the World Health Organization (WHO) reported today. Increases are being reported from South Asian countries such as India, Nepal, and Sri Lanka. Elsewhere, Barbados and Ecuador are noting spikes in respiratory illnesses. In Europe, the pandemic virus is predominant, but low levels of the three seasonal subtypes are circulating. [Dec 23 WHO update]

Study: Kids' death rate 10 times that of seasonal flu A retrospective study of children in Argentina showed twice the rate of hospitalization and 10 times the rate of death compared with seasonal flu, a New England Journal of Medicine study published today found. Of the 251 patients, 47 (19%) required intensive care, 42 (17%) were placed on ventilators, and 13 (5%) died. Of those who died, all but one were under 9 years old, and six were under 1. [Dec 23 N Engl J Med study]

H1N1 has multitude of competitors Samples from patients with respiratory disease sent to a lab company show that H1N1 is far from the only virus circulating in the United States this flu season and that other flu-like viruses are more common than usual. ViraCor Laboratories of Kansas City, Mo., reports that only 6% of specimens they tested were positive for influenza A. The most common virus found was rhinovirus, with metapneumovirus, respiratory syncytial virus, parainfluenza virus, and adenovirus also figuring in. [Dec 22 Reuters article]

Report finds TV most potent flu communicator An August survey of two North Carolina counties found that most people (85%) received their H1N1 information from television, followed by newspapers (52%) according to the Dec 25 issue of Morbidity and Mortality Weekly Report (MMWR). The authors urge officials to focus more messages on TV. About 64% of adults said they would get the H1N1 vaccine, with 65% intending to get it for their kids. Safety concerns and low chance of infection were top reasons for not intending to get it. [Dec 25 MMWR report]

School closings can cause adults to lose pay A phone survey that gauged the impact of a 2008 flu school closure on two Kentucky school districts found that an adult missed work in about a third of the families, with a worker losing pay in 15%, according to a report in the Dec 25 issue of MMWR. The school closed for administrative reasons, but most parents thought it was to stem the outbreak. Findings suggest districts should provide rationale for school closings and recommend how to reduce flu spread while kids are home. [Dec 25 MMWR report]

Seasonal flu vaccine may boost H1N1 vaccine effect Receiving a prior seasonal flu shot may boost the effectiveness of the H1N1 vaccine, according to a study today in Science Translational Medicine. In the study, groups of ferrets who received seasonal flu vaccine a month before H1N1 vaccination showed stronger antibody responses when exposed to the virus than ferrets vaccinated for H1N1 alone--and those responses were greatest when the ferrets received seasonal vaccine with an adjuvant, an immune-boosting substance. [Dec 23 Science Transl Med study]

South Korea finds H1N1 at 15 pig farms South Korean veterinary officials today said they isolated the pandemic H1N1 virus at 15 pig farms during surveillance conducted since May. Their report to the World Organization for Animal Health (OIE) said the source of the virus wasn't known. The outbreaks were detected in December, mostly in the south. Response included movement restriction and farm disinfection. So far 241 of about 24,000 pigs tested positive. [Dec 23 OIE report]

Dec 22

Most parents able to get vaccine for their kids A new poll by the Harvard School of Public Health found that three quarters of parents who sought H1N1 vaccine for their children got it, according to a Harvard press release. The poll, conducted Dec 16 and 17, showed that 6 in 10 parents have gotten or expect to get their children vaccinated. The share of respondents concerned that they or a family member would get the flu was 40%, down from a high of 52% in September. Fifty-five percent of adults said they didn't intend to get the vaccine. [Dec 22 Harvard news release]

WHO: Deaths don't tell whole story of severity The World Health Organization (WHO) today addressed the difficulty of assessing the severity of the H1N1 pandemic by comparing H1N1 fatality counts with seasonal flu counts. In a briefing note, the agency said that such comparisons can be misleading because death tolls from seasonal flu are estimates, whereas death numbers for the pandemic usually represent confirmed fatal cases. Such comparisons can also mislead because H1N1 has a greater impact on young people than seasonal flu does. [Dec 22 WHO briefing note]

Potential pandemic legacy: Easier future flu seasons The vast, rapid spread of the H1N1 flu virus could produce unexpected benefits if it displaces current seasonal flu strains, the Canadian Press reported. If the novel H1N1, an influenza A strain, replaced either or both of the current seasonal A strains, H3N2 and an older H1N1, that could lead to lesser mortality, less resistance to antiviral drugs, fewer nursing-home outbreaks, and vaccines with fewer components. [Dec 21 Canadian Press story]

Study probes low H1N1 mortality in Japan Despite widespread transmission of H1N1 flu, Japan had only 85 confirmed deaths as of Dec 1, according to researchers writing in PLoS Currents. They report that most cases and hospitalizations have occurred in children aged 5 to 14 years, who are very susceptible to infection but have a very low case-fatality rate. The fatality rate is higher in small children and older adults. Aggressive school closures may have reduced transmission to the latter two age-groups, the authors suggest. [PLoS Currents report]

WHO clears Novartis vaccines for developing world The WHO has prequalified all three H1N1 vaccines made by Novartis to be supplied to United Nations agencies for use in the developing world, the company announced yesterday. The vaccines are Celtura and Focetria, both of which contain the MF59 adjuvant, and a nonadjuvanted vaccine based on the Fluvirin seasonal vaccine. The WHO previously prequalified an adjuvanted H1N1 vaccine made by GlaxoSmithKline. [Dec 21 Novartis press release]

South Korea mulls more aid for North Korea In the wake of recent shipments of antiviral medication to North Korea, the government of South Korea is considering sending more assistance, Agence France-Presse (AFP) reported yesterday. A South Korean official said aid may be channeled through agencies such as the United Nation's Children's Fund, Yonhap news agency reported. On Dec 18, South Korea shipped 500,000 antiviral treatment courses to North Korea, the first direct aid in about 2 years. [Dec 21 AFP story]

Dec 21

Survey shows firms' steps to cope with H1N1 In a survey of 1,000 global firms, Mercer, an international human resources company, found that most companies have contingency plans and about two-thirds have communicated them to employees. Many have taken basic steps such as educating workers on flu prevention. Also, most companies aren't modifying sick leave policies, while some are relaxing policies for those at risk for complications, implementing paid time off donation programs, and adding sick days. [Mercer employer H1N1 survey]

New flu drug called promising An antiviral drug called T-705 may be more potent and safer for treating H5N1 avian influenza than existing antivirals, according to a report being published in the Proceedings of the National Academy of Sciences. When tested in mice, the compound worked better than oseltamivir, senior author Yoshihiro Kawaoka said in a University of Wisconsin news release. The drug has also been found effective against pandemic H1N1, and it is about to enter phase 3 clinical trials in Japan. [University of Wisconsin release]

Study: H1N1 immunizations cost effective Canadian researchers found Ontario's pandemic H1N1 vaccination campaign likely to be highly cost effective, consistent with seasonal flu vaccination, according to a report in Public Library of Science (PLoS) Currents. The $118 million campaign, reaching 30% of the population, could reduce cases by 50%, prevent 35 deaths, and cut treatment cost by half they said. They concluded that the program provides good value during times of scarce resources. [Dec 18 PLoS Currents report]

News editors: Pandemic fifth-biggest 2009 story US news editors and directors polled by the Associated Press (AP) picked the H1N1 pandemic as fifth on a list of 2009's top 10 stories. Today's story says, "Swine flu struck tens of millions of people worldwide, worrying governments as supplies of vaccine failed to meet demand." The stories that were ranked ahead of the flu, in descending order, were the economy, President Obama's inauguration, healthcare reform efforts, and the auto industry's troubles. [Dec 21 AP report]

Dec 18

WHO finds no change in pandemic severity pattern An early look at winter pandemic flu fatalities in the Southern and Northern Hemispheres suggests severity has not changed, the World Health Organization (WHO) said today. The virus is peaking or declining in many parts of Europe, except for the north, southeast, and parts of the Russian Federation. Activity is also rising in western and central Asia, as well as northern parts of India, Nepal, Sri Lanka, and the Maldives. Pandemic and seasonal strains are cocirculating in West Africa. [Dec 18 WHO update]

Some countries eye returning surplus pandemic vaccine Swiss officials said today they plan to donate or sell 4.5 million surplus doses of pandemic vaccine, because uptake among the public has been low, Reuters reported. Germany and Spain have also said they want to return excess vaccine to manufacturers. Meanwhile, the Greek media reported today that government officials hope to cancel an order for 8 million vaccine doses. Immunization began in Greece a month ago, but the health ministry said citizens are skeptical and uptake has been low. [Dec 18 Reuters story]

CDC spells out precautions for immunosuppressed patients The US Centers for Disease Control and Prevention (CDC) on Dec 16 outlined special considerations for severely immunosuppressed patients in its updated H1N1 guidance. It said cancer chemotherapy patients, for example, are at increased risk of complications, and those with acute respiratory symptoms should receive empiric treatment, even when no fever is present. Infection control measures should be taken before test results are known to avoid spread of any resistant strains that may develop. [Dec 16 CDC updated pandemic guidance for severely immunosuppressed patients]

Flu triggers cancellation of St. Louis Rams practice The St. Louis Rams of the National Football League canceled their practice yesterday because several players were sick with suspected H1N1 flu, the Associated Press reported. Coach Steve Spagnuolo said five or six players had flu-like illness and that others had reported symptoms the last few weeks. He called the cancellation "more of a precaution than anything" and said he expected the team would return to practice today. [Dec 17 AP story]

Clinton appoints pandemic flu ambassador Secretary of State Hillary Rodham Clinton announced yesterday the appointment of Dr Keri-Ann Jones as the US special representative on avian and pandemic influenza. She will lead US involvement in the pandemic flu arena and guide the department's response and preparedness. She was formerly the State Department's assistant secretary for oceans and international environmental and scientific affairs where she worked in international research and emerging infectious disease issues. [Dec 17 US State Department press release]

Dec 17

Modelers list H1N1 research needs to help form policy A World Health Organization working group of mathematical modelers has presented a list of research needs to help inform policy choices related to the H1N1 pandemic. Leading the list of data needs are serologic surveys to assess what proportion of the population remains susceptible to the virus, says the group's article in PLoS Currents. The group also calls for monitoring the time course of the incidence of severe cases to help assess the effects of steps such as school closures. [PLoS Currents report]

India suspects placental transmission of flu A finding of H1N1 flu infection in a newborn, tested immediately after delivery because her mother was ill, has led Indian health authorities to suspect placental transmission of the flu virus, according to The Hindu newspaper. Placental transmission of influenza is thought to be rare but has been recorded with the H5N1 avian flu virus. [Dec 17 The Hindu report]

Thailand, China report novel H1N1 in pigs, dogs Two countries recently confirmed novel H1N1 viruses in animals: Thailand in pigs and China in pigs and two dogs, according to reports filed with the World Organization for Animal Health (OIE). All cases were detected during enhanced surveillance. The Thai outbreak involved piglets at a farm in Saraburi province. In China the virus was detected in pigs at a slaughterhouse in Heilongjiang province and in dogs at an animal hospital in Beijing. [Dec 17 OIE report from China]

Scientists identify natural flu-fighting proteins Writing in Cell, Boston researchers report the discovery of a family of natural antiviral proteins that help protect human cells from influenza, dengue, and West Nile viruses. In human and mouse cells, the proteins, called interferon-inducible transmembrane (IFITM) proteins, prevented most virus particles from infecting cells or slowed their invasion. The proteins were active against the pandemic H1N1 virus and other flu strains, according to a Harvard Medical School press release. [Cell report]

Dec 16

Colleges report less flu, tad more vaccination After a slight increase in flu activity after students returned from Thanksgiving break, the number of cases dropped again on college campuses, reflecting a decline seen across the nation, the American College Health Association (ACHA) said today. In its report for the week ending Dec 11, the group said new cases were down 35% from the week before. The attack rate was 3.4 cases per 10,000 students. The percentage of students who have received the pandemic vaccine rose from 5% to 7%. [ACHA report for week ending Dec 11]

Walgreens offers H1N1 vaccine in 27 states Walgreens today said the pandemic vaccine is available at many of its pharmacies in 27 states, expanding to all 50 by year's end. The chain is now offering the vaccine to anyone who wants it. Walk-in vaccination is available when an immunizing pharmacist is on duty. Customers can also get the shot during flu clinics and at select in-store clinics. The company advises calling ahead to check availability. The $18 cost may be covered by insurance plans. [Dec 16 Walgreen's press release]

China sees big rise in flu deaths China's health ministry said today that flu deaths have risen by a third over the past few days to 442, Agence France-Presse (AFP) reported. This announcement comes just a few days after health officials warned that flu activity could rise during the upcoming Lunar New Year holiday, when millions of people travel and return home. Last week the health ministry said it would step up vaccination efforts to add to the 34 million in China that have already been vaccinated. [Dec 16 AFP story]

Commentators say it's time for US to share vaccine With the H1N1 vaccine supply growing rapidly, the United States and other rich countries should now donate 10% of their supply to the poorest countries, write three professors from Johns Hopkins. In a San Francisco Chronicle commentary, they note that the US and eight other countries previously pledged to give away 10% of their supply. They also say the World Health Organization (WHO) should set up a public system for reporting contributions to the global H1N1 vaccine supply. [Dec 16 San Francisco Chronicle commentary]

Dec 15

GAO raises questions on pandemic plan implementation A report by the US Government Accountability Office (GAO) raises questions about progress in carrying out the Homeland Security Council's (HSC's) "Implementation Plan for the National Strategy for Pandemic Influenza." The HSC said in 2008 that most of 324 action items were complete. The GAO looked at 60 of the action items, 49 of which were listed as complete, and found that in many cases the performance measures the government used did not fully fit with the activities the items involved. [GAO report released Dec 14]

FDA authorizes emergency use of portable flu PCR The Food and Drug Administration (FDA) has issued an emergency use authorization (EUA) to the company DxNA for a rapid test for H1N1 influenza performed in a portable PCR device called GeneSTAT. The test-device combination speeds up flu detection by allowing small hospitals and other clinical sites to perform strain-specific testing themselves, rather than sending samples out to reference labs. [Dec 9 FDA EUA letter]

Surveillance, research needed on flu in Africa Lack of surveillance has led to the perception that Africa has a low prevalence of influenza, but sporadic reports show that flu circulates there undetected, according to researchers from the Netherlands and Germany writing in Public Library of Science (PLoS) Medicine. The authors say improved surveillance and research into vaccine efficacy in rural tropical conditions are critical to reducing illness and death from endemic and pandemic flu in African countries. [Dec 15 PLoS Med article]

Serbia closes schools to slow flu spread Serbia's education ministry announced the country will close schools for the holiday break early, starting Dec 18, to slow the spread of pandemic flu, Balkan Insight news reported today. Details were first reported by Tanjug news agency. Classes will resume Jan 11. The measure was suggested by a working group monitoring flu developments in Serbia, where the vaccination campaign will begin Dec 17. [Dec 15 Balkan Insight story]

Town offers zoo visits to prompt vaccination To boost vaccine uptake in young people, the public health department in Norfolk, Va, is teaming up with the Virginia Zoo to offer free admission for those who come to the zoo tomorrow to receive their H1N1 shot. The campaign targets young people ages 6 months to 24 years and daycare providers. The groups are offering free parking and a tour of the zoo for all participants, along with a train ride for the first 500 children. [Dec 15 Norfolk Dept of Public Health release]

Dec 14

Army works to vaccinate trainees before holidays The US Army is working to finish vaccinating thousands of trainees against H1N1 flu before they head home on holiday leave, the Associated Press (AP) reported. More than 40,000 soldiers in basic and advanced training around the country will go on leave over the next 2 weeks, officials said. The Department of Defense (DoD) bought about 2.7 million doses of vaccine and is trying to finish administering them by the end of the year, a DoD spokesman said. [Dec 12 AP story]

Low vaccine uptake in Alabama schools Alabama's state health officer said only 20% to 25% of kindergarten through third-grade students in Alabama schools received the H1N1 vaccine when it was available the first week in December, the Huntsville Times reported. The vaccine was offered to children aged 9 and under. Dr. Donald Williamson said many children apparently had received the vaccine from their pediatricians, and the decline in H1N1 cases probably also contributed to low demand. [Dec 11 Huntsville Times story]

Chicago area takes vaccine to holiday shoppers Public health workers in Cook County, Ill., brought their pandemic vaccine campaign to holiday shoppers at a mall Dec 12 in an effort to make it easier for people to be immunized. The health department said in a media statement that it would release details over the coming days about more mall-based clinics. For Saturday's clinic, workers focused on designated priority groups, issuing 400 tickets for designated times between 10 am and 3 pm. [Cook County Department of Health release]

USDA conditionally licenses vaccine for pigs Pfizer Animal Health of Lincoln, Neb., was granted a conditional license for an H1N1 flu vaccine for use in pigs, the US Department of Agriculture (USDA) announced Dec 11. It is the first H1N1 flu vaccine license issued by the USDA and is valid for a year. Under USDA regulations, a product shown to be pure and safe and deemed likely to be effective may be licensed while data on efficacy and potency are still being gathered. The vaccine can be used only by veterinarians. [Dec 11 USDA press release]

PBS to air pandemic documentary Public Broadcasting Service (PBS) will air an hour-long documentary titled "Anatomy of a Pandemic" tonight, though the date may differ in some areas. The program, narrated by Ray Suarez of PBS's "NewsHour," will cover what scientists know about the new virus and past pandemics, vaccine development, issues relating to vaccine safety, and how governments are addressing the pandemic. The network will also host an online ask-the-expert forum tomorrow. [PBS pandemic documentary Web site]

Dec 11

Only 14 US states now have widespread flu US flu activity dropped further last week, as only 14 states had widespread cases, down from 25 states the week before, the Centers for Disease Control and Prevention (CDC) said today. Sixteen flu-related pediatric deaths were reported, 13 of which were from confirmed H1N1. The number of confirmed H1N1 hospitalizations dropped from the week before, but confirmed deaths increased slightly. The share of outpatient medical visits attributed to flu was 2.7%, down from 3.7% the week before. [Latest CDC Flu View update]

WHO says pandemic has peaked in much of Europe The current pandemic wave has passed its peak in western, northern, and eastern Europe as well as in temperate parts of North America, the World Health Organization (WHO) said today. As of Dec 6, flu activity continued to increase in parts of central and southeastern Europe and southern and eastern Asia. Transmission also remained active in much of western and central Asia, and limited data indicated the virus was present in most regions of Africa as well. [Dec 11 WHO update]

UK reports death rate similar to US's Pandemic H1N1 flu has killed fairly low numbers in the United Kingdom, British officials determined in a study published yesterday, but public health officials should stay vigilant and vaccination campaigns continue, according to a Reuters report. The comprehensive analysis of data through Nov 8 revealed 26 H1N1 deaths in every 100,000 cases--a case-fatality rate (CFR) of 0.026%. Yesterday the CDC released figures indicating a US CFR of 0.021%. [Dec 10 Reuters report]

Aggressive steps may have worked for Japan Aggressive pandemic control steps such as hygiene measures, social etiquette, and quick testing and antiviral prescribing have helped Japan curb H1N1 better than other nations, according to a Bloomberg News story today that cites a Nov 13 WHO report. The report found a Japanese rate of 2 deaths per 100,000 H1N1 cases, considerably lower than other countries' published rates. Japanese doctors are advised to administer antivirals to anyone suspected of having flu, even if a rapid test is negative. [Dec 11 Bloomberg News article]

China's outbreak may not peak for months Cases of novel H1N1 may not peak in China for several months, its health ministry said today, according to the Associated Press (AP). The ministry said that hundreds of millions of people returning home for the traditional Chinese New Year in late January and February may exacerbate the outbreak. The country has confirmed more than 100,000 cases but only 326 deaths. China's peak flu season, which could last till March, will be critical for flu control and prevention, a spokesperson said. [Dec 11 AP story]

NIAID to test vaccine in HIV-positive volunteers The National Institute of Allergy and Infectious Diseases (NIAID) is recruiting HIV-positive volunteers to test whether they need a larger-than-standard dose of H1N1 vaccine. People who have suppressed immunity are among the priority groups for H1N1 vaccination because of their risk of flu complications, but their HIV infection may dampen their response to the vaccine, the NIAID said yesterday. The trial volunteers will receive two doses of either 15 or 30 micrograms of antigen [Dec 10 NIAID press release]

Dec 10

Flu response frays state, local public health Responding to the H1N1 pandemic has stretched some already financially strapped public health departments to the point of pulling back in other areas such as testing for other infectious diseases and doing restaurant inspections, the Wall Street Journal reported today. For example, public health nurses in Maine have had to limit home visits only to major health threats. Both the House and Senate health reform bills contain new funds to strengthen public health infrastructure. [Dec 10 Wall Street Journal report]

Return from break prompts flu rise at colleges After weeks of decline, flu activity increased at US colleges last week, and the American College Health Association (ACHA) attributes the uptick to students returning to campus after Thanksgiving break, the group said in an update yesterday. New cases were up 27% from the week before. The attack rate for the week ending Dec 4 was 5.2 cases per 10,000 students. No new deaths were reported. The percentage of students who have received the pandemic vaccine is still only 5%. [ACHA report for week ending Dec 4]

Review finds high death rates in native groups Native Americans and Alaska Natives are four times more likely to die of pandemic H1N1 than any other group, officials reported today in Morbidity and Mortality Weekly Report (MMWR). The review of flu deaths in 12 states could not explain why the flu strikes those groups harder, but the authors said reasons might include higher rates of chronic illnesses and socioeconomic conditions. [Dec 11 MMWR report]

North Korea to accept flu drugs from South A South Korean cabinet minister said today that North Korea has agreed to accept aid in the form of oseltamivir to fight an H1N1 outbreak, the Associated Press (AP) reported. North Korean state media reported yesterday that the country had nine H1N1 cases. A spokesman for the South Korean minister said Seoul would send enough oseltamivir to treat 500,000 people. South Korea's oseltamivir offer was its first offer of humanitarian aid since President Lee Myung-bak took office in early 2008. [Dec 10 AP story]

China reports clinical features of early cases A report on the clinical features of 426 early H1N1 cases in China was published yesterday in the New England Journal of Medicine. The patients, about a third of whom were identified at ports of entry, were isolated in 61 hospitals. Most had a mild illness, and about 60% received early oseltamivir treatment. Their mean age was 23, and the median incubation period was 2 days, with a range of 1 to7 days. The median period of viral shedding, as indicated by lab testing, was 6 days. [Dec 9 N Engl J Med report]

Israel to send vaccine to Gaza Strip Israeli authorities today promised to send 30,000 to 40,000 doses of H1N1 vaccine to the Gaza Strip, where six people have died of the virus in the past 5 days, Agence France-Presse (AFP) reported. The doses were supplied by the World Health Organization, said Col. Moshe Levy, head of the Israeli liaison office for Gaza. Israel previously provided 10,000 doses to the Palestinian territory. [Dec 10 AFP story]

Early Mexican surveillance found two infected pigs Veterinary officials in Mexico today said that they detected the pandemic virus in two pigs at a farm in Queretaro state in late April after the virus was first confirmed in humans, according to a report from the World Organization for Animal Health (OIE). The farm had 360 pigs at the time. The infections were found during enhanced surveillance at pig farms throughout Mexico. Regular testing at the affected and surrounding farms has found no other cases. [Dec 10 OIE report]

Cheetah at California preserve had H1N1 The owner of a wildlife preserve near Santa Barbara said a pandemic H1N1 infection was detected recently in an 8-year-old cheetah after the animal was coughing and showing other flu symptoms, the Press Democrat reported. She believes the animal contracted the virus from a sick animal handler, not from the public. The cat has recovered. The case appears to be the first in an exotic animal and appears to be the one mentioned in a Nov 30 US Department of Agriculture report. [Dec 9 Press Democrat report]

Dec 9

North Korea confirms flu outbreak North Korea's government for the first time has acknowledged having a pandemic H1N1 outbreak, the Associated Press (AP) reported today. The state news agency said nine cases had been confirmed along the border with China and in Pyongyang, the capital. The brief report did not mention any deaths but said a quarantine system was in place and medical treatment was under way. A World Health Organization (WHO) office in the capital said today that no deaths have been recorded. [Dec 9 AP story]

Vietnam reports cluster of seven resistant infections Physicians from Vietnam, writing in the New England Journal of Medicine, today reported a cluster of seven cases of oseltamivir-resistant H1N1 infections. Six cases occurred in a group of 10 students who traveled together on a train, and the seventh case involved a traveler in another carriage. The students were well during the trip and were not taking the drug, but fell ill afterward. All recovered. The resistance mutation was found in specimens taken before any oseltamivir treatment. [Dec 9 N Engl J Med report]

UK report says few hotline diagnoses were pandemic flu A report from the United Kingdom's Health Protection Agency (HPA) estimated that only one in five people who were diagnosed with H1N1 through the country's pandemic flu hotline actually had the virus, the London-based Daily Express said today. The HPA based its estimate on swab samples from people who had used the hotline. A taxpayer group said the flu line wasted antivirals and hurt the economy by causing people to stay home unnecessarily. [Dec 9 Daily Express story]

WHO finds no vaccine link in three Chinese deaths The WHO office in China said three of four deaths of patients from the mainland who received the pandemic vaccine were not related to the immunization, the Hong Kong Daily Standard reported today. The WHO said the fourth case is still under investigation. A WHO spokeswoman said the findings show that the vaccine surveillance system is working. Hong Kong plans to start its vaccine campaign for high-risk groups on Dec 21, using a different vaccine from the one used on the mainland. [Dec 9 Daily Standard report]

Researchers say H1N1 used new strategy to cross into humans Researchers at the University of California, Berkeley, say the 2009 H1N1 virus used a new strategy to jump to humans. Previous flu strains that crossed from birds into people (the H1N1 virus came from pigs but contains bird and human elements) had a specific mutation in the polymerase gene that allowed the protein to operate in human cells, says a university news release. H1N1 lacks that mutation, but it has a second mutation that seems to stop human cells from blocking polymerase activity. [Proc Natl Acad Sci report]

CDC updates antiviral recommendations The US Centers for Disease Control and Prevention (CDC) released an update of its recommendations for the use of antiviral drugs to prevent and treat flu. The new version includes updates on the use of intravenous peramivir under an emergency use authorization, oseltamivir (Tamiflu) dosing for children under 1 year old, treatment and prophylaxis considerations for people who have received pandemic or seasonal flu vaccine, and other topics. [CDC's updated recommendations]

Dec 8

South Korea may aid North Korea's flu fight Today South Korean President Lee Myung-bak offered to send H1N1 vaccine to North Korea amid reports that the novel flu has killed dozens and is spreading fast in that nation, according to the Associated Press (AP). The Seoul-based aid group Good Friends reported that pandemic H1N1 has killed about 40 people in Sinuiju, near China, and 7 in the capital, Pyongyang. North Korea has yet to confirm any H1N1 outbreak. South Korea is studying ways to send the vaccine without conditions. [Dec 8 AP report]

Vaccine inequality may pose security threat Shortages of H1N1 vaccine in developing nations may pose a global security risk if the pandemic worsens, David Heymann, a former World Health Organization (WHO) official, told Bloomberg News. "Globally I think we're not probably as prepared as we need to be in more equitable access to vaccines," Heymann said, adding that high mortality could lead to "extreme destabilization of global security." About 200 million vaccine doses have been donated to the WHO for use in 95 poorer nations. [Dec 8 Bloomberg News article]

Wary Europeans slow to get vaccinated Concerns over vaccine safety and low death rates from pandemic H1N1 flu apparently are keeping European vaccination rates low, according to Bloomberg. Several nations have vaccination rates under 10%, compared with 20% in Europe in a typical flu season. Scandinavia, however, is reporting rates from 19% to 33%. Public concerns that the H1N1 vaccine may cause adverse effects have kept some Europeans from being vaccinated, which means Europe may have more doses to donate to other nations. [Dec 8 Bloomberg News article]

Germany has excess vaccine to sell Germany's health minister said yesterday that states have asked the federal government to sell 2.2 million doses of H1N1 vaccine to other nations, according to an Agence France-Press (AFP) story. Another possibility would be to donate the vaccine, which is available because of low demand. The country has ordered 20 million doses to arrive by the end of December and 50 million by the end of March. So far about 4 million Germans, or 5% of the population, have received the vaccine. [Dec 7 AFP story]

Dec 7

Autopsies show damage to entire airway In patients who died from novel H1N1 flu, the virus damaged cells throughout the respiratory tract, much as in the 1918 and 1957 pandemics, according to a study released today by researchers from the National Institutes of Health (NIH) and the office of New York's medical examiner. Of the 34 fatal cases studied, evidence of secondary bacterial infection was seen in more than half. Also, 62% of deaths were among those 25 to 49 years old, 91% had underlying conditions, and 72% were obese. [Dec 7 NIH release]

Deaths, hospital cases high in Illinois minorities Illinois health officials said the pandemic H1N1 death rate for African-Americans and Hispanics in the state is twice the rate for whites, and the hospitalization rate for the two minority groups is three times as high, the Chicago Sun-Times reported. Dr. Craig Conover of the Illinois Department of Public Health said the reason for the disparities is not clear, but possibilities include more chronic health problems, lower vaccination rates, and less access to healthcare. [Dec 5 Chicago Sun-Times story]

Promising Practices adds tools for H1N1 response A peer-reviewed Web database of pandemic preparedness practices, established by CIDRAP in 2007, today launched a set of public health practices specific to pandemic H1N1 response. For example, it includes tools for managing vaccine clinics and delivering flu information to hard-to-reach groups. It is seeking additional promising practice submissions related to the pandemic. The Association of State and Territorial Health Officials sponsors the project. [CIDRAP Promising Practices Web site]

CDC updates home care guidance The US Centers for Disease Control and Prevention (CDC) updated its home care guidance for people who have pandemic flu. It dropped the previous recommendation that caregivers in close contact with a sick person use a face mask or N-95 disposable respirator. Instead, the CDC recommends that sick people use a face mask if they leave their designated sick room to go to the bathroom or the doctor. If a mask isn't available, the CDC recommends using a tissue to cover coughs and sneezes. [CDC updated guidance]

Cases in UK drop sharply Pandemic H1N1 cases in the United Kingdom dropped sharply last week, but Sir Liam Donaldson, the nation's chief medical officer, warned that cases could rise again after Christmas, according to a news story today in the British Medical Journal. Cases dropped to 22,000 in the week ending Dec 3, from 46,000 the previous week. A high rate of hospital cases continues among children under age 5. There have been 270 confirmed H1N1 deaths, and 1,000 people remain hospitalized. [Dec 7 BMJ story]

HHS launches flu vaccination ads The US Department of Health and Human Services (HHS) and the Advertising Council today launched a new public service advertising campaign to encourage pregnant women, children, young adults, and other priority groups to get the pandemic H1N1 vaccine. The campaign features five television ads, three radio spots, and online and outdoor ads created pro bono by the agency Merckley + Partners, according to HHS. [Dec 7 HHS press release]

Complications threaten kids who have sickle cell Children with sickle cell disease are more likely to develop serious complication from pandemic H1N1 influenza than for seasonal flu, researchers from Johns Hopkins reported today at the American Society of Hematology meeting in New Orleans. Their review of 118 children with sickle cell who were treated for flu since Sep 1993 found that those who had the pandemic strain were more likely, for example, to develop acute chest syndrome and require a ventilator and blood transfusion. [Dec 7 Johns Hopkins press release]

French deaths spark vaccine demand Media reports of pandemic flu deaths in France have led to a recent surge in demand for the vaccine, the Wall Street Journal reported today. The country began immunizing groups at high risk for complications on Nov 12, but interest in the vaccine had been lukewarm. However, now the country's army is helping manage crowds at vaccine clinics. France has vaccinated 2 million people and hopes to reach 30 million by February. It bought 94 million doses. [Dec 7 Wall Street Journal story]

Dec 4

WHO: Flu increasing in some regions In its global pandemic update, the World Health Organization (WHO) said today that flu activity has peaked in the United States, Canada, and some parts of Europe, but is increasing in central Europe, Russia, and some parts of western and central Asia. Respiratory illness activity is also intensifying in southern parts of China and Japan, as well as northwestern parts of India, Nepal, Sri Lanka, and Cambodia. In Africa the pandemic virus is cocirculating with the seasonal H3N2 strain. [Dec 4 WHO pandemic update]

Official says many Californians now immune California's state epidemiologist has estimated that 11 million people, or close to 30% of the state's population, have acquired immunity to the H1N1 virus through infection or vaccination, according to a report by the Riverside (Calif.) Press Enterprise. Dr. Gil Chavez estimated that about 3 million Californians have had the flu already. The story said close to 800 people in California were hospitalized because of H1N1 in the past week, and 12 died. [Dec 3 Press Enterprise story]

Education secretary urges college students to get vaccinated In recent comments to college journalists, Arne Duncan, US Department of Education secretary, urged students to get their pandemic H1N1 vaccine before going home for or during Christmas break, CNN reported today. He also urged college instructors to be flexible with students who are out sick with the flu. Yesterday the American College Health Association said preholiday vaccination could help prevent flu spread and protect students in the event of a third wave. [Dec 4 CNN story]

Study finds low reproductive number for H1N1 Using lab-confirmed cases in the first 2 months of the H1N1 pandemic in Ontario, researchers estimated the basic reproductive number for the illness at a relatively low 1.31, according to the Canadian Medical Association Journal. The authors say public concern about the pandemic may have changed public behavior and medical practices, thereby lowering the observed number. The risk of hospital admission was estimated at 4.5% and the case-fatality rate at 0.3%. [CMAJ article]

Report explores early pneumonia cluster in Mexico A review of severe pneumonia cases in San Luis Potosi, Mexico, a high-profile locale early in the pandemic H1N1 outbreak, reveals many cases occurred in young adults, particularly those who were obese. The findings, published in Emerging Infectious Diseases, also reveal that bacterial coinfections played a minor role in the 50 hospitalized pneumonia cases in April and May. Flu was confirmed in 15 patients, novel H1N1 in 10. [Dec 4 Emerg Infect Dis report]

Kenya, Togo to get Africa's first stockpile vaccine A WHO official said Kenya and Togo will be the first African countries to receive donations of pandemic H1N1 vaccine, Capital News, based in Nairobi, reported today. He said the first shipments, expected in January, will target high-risk groups such as healthcare workers. The countries will receive enough to vaccinate about 10% of their populations by March. [Dec 4 Capital News story]

Flu outbreaks hit China's army China's defense ministry said it has totaled 51 large pandemic H1N1 outbreaks among army soldiers, China Daily reported today. The report didn't list the number of cases. A health official with the Chinese Army said outbreaks involving hundreds of soldiers are difficult to manage. On Dec 2 the Army held a flu drill in Beijing. [Dec 4 China Daily story]

Dec 3

Johns Hopkins finds resistant strain in 2 patients Officials at Johns Hopkins Hospital in Baltimore said two cancer patients recently had oseltamivir-resistant pandemic flu, the Baltimore Sun reported. One was hospitalized after a fever and the other hospitalized but did not improve after treatment. Officials said the cases were isolated and had not spread. The Washington Post reported that two Virginia residents are being treated for the resistant strain. Experts have said such cases in immunocompromised patients are expected. [Dec 3 Baltimore Sun story]

Flu outbreak detected in North Korea An aid group working in North Korea said the country has detected a pandemic flu outbreak in Sinuiju, a northern city on the Chinese border, Agence France-Presse (AFP) reported today. Cases in children are increasing, and North Korean authorities have taken emergency countermeasures, the group said. The antiviral drug oseltamivir (Tamiflu) is scarce in the country. The government has not officially acknowledged any flu cases. [Dec 3 AFP story]

EU releases vaccine safety report The European Union's drug regulatory agency today issued its first report on the safety of novel H1N1 vaccines. The data come from a system that collects and evaluates suspected adverse reactions. So far the agency has detected no unexpected serious safety issues. It is assessing new clinical data showing a greater incidence of fever in children age 6 to 35 months who have received their second Pandemrix dose. It said reports are increasing as more vaccine doses are administered. [Dec 3 European Medicines Agency press release]

Pandemic virus found in British pig herd England's Department for Environment Food and Rural Affairs (DEFRA) reported that a pig herd in Norfolk is infected with the pandemic H1N1 virus, the sixth such finding in British pigs. The virus was found during routine surveillance. Genetic sequencing found that the virus is nearly identical to the strain circulating in humans. [Dec 2 DEFRA press release]

Shanghai seeks blood for serum treatment In an effort to add a serum treatment option for patients with pandemic H1N1 infections, Shanghai authorities are asking people who have been vaccinated to donate blood, Shanghai Daily reported today. The first donations are expected to come from 34 healthcare workers who have already been inoculated. Serum treatment is in the health ministry's recommendations for managing pandemic flu patients. [Dec 3 Shanghai Daily story]

Societies issue organ transplant flu guidance American and Canadian organ transplant societies issued guidance for surgeons and other healthcare professionals on managing pandemic H1N1 issues in recipients and donors. The guidance, which appears in the American Journal of Transplantation, addresses each stage of the transplant process. For example, it suggests donors and recipients receive at least one vaccine dose and that donors with flu receive antiviral treatment for 5 to 10 days. [Dec 2 Am J Transplant report]

Dec 2

College flu cases declined over holiday break Flu activity at US colleges showed another steep decline last week, though the Thanksgiving break may account for some of the decrease, the American College Health Association (ACHA) reported today. New cases were down 69% from the previous week. One more death was reported, raising the total to three. The attack rate for the week ending Nov 27 was 4.1 cases per 10,000 students. So far 84% of institutions reporting had received pandemic vaccine, but only 5% of students have been vaccinated. [ACHA report for week ending Nov 27]

CDC warns about vaccine e-mail scam The US Centers for Disease Control and Prevention (CDC) yesterday warned about an e-mail scam that claims people age 18 and older need to create a personal profile as part of a purported "state vaccination program." The CDC said clicking on the e-mail link could install a harmful computer virus and advised users to avoid unsolicited links and use caution when sharing personal information. [Dec 1 CDC statement]

More liquid Tamiflu for kids on its way Roche said today it has begun shipping more supplies of liquid Tamiflu (oseltamivir) for children to help ease shortages related to the flu pandemic. The company said shipments would continue into 2010 but didn't list quantities. "Pharmacy stock of the oral suspension will continue to be spotty until we are able to get all the shipments out to meet the current orders," Roche spokeswoman Tara Cooper told CIDRAP News. She voiced confidence the firm would be able to meet demand during the winter. [Roche USA press releases]

New Mexico reports higher flu deaths in American Indians New Mexico is reporting a disproportionate number of pandemic flu deaths in American Indians, the Associated Press (AP) reported today. State epidemiologist Mike Landen said the group makes up 10% of the state's population but accounts for 20% of its flu deaths. He said reasons might include higher diabetes and poverty rates and lack of access to medical care. Of 40 deaths, 8 were in American Indians. Five were adults who had underlying conditions. [Dec 2 AP story]

Polish official seeks probe of vaccine policy Poland's top civil-rights official has asked prosecutors to investigate the Polish government for refusing to import pandemic flu vaccine, the Canadian Press reported. The official, Janusz Kochanowski, said refusal to order vaccine is endangering public health. Prime Minister Donald Tusk's administration has said it won't import vaccine unless producers take responsibility for any side effects. [Dec 1 Canadian Press story]

Good results reported for VLP H1N1 vaccine Novavax Inc. today reported good initial results in the first stage of a phase 2 trial of its virus-like-particle (VLP) vaccine for pandemic H1N1 flu. One thousand healthy adults received two doses of 5, 15, or 45 micrograms. A review of findings in 500 participants 14 days after the first dose showed that the vaccine was well tolerated and that antibody responses to the two higher doses met the criteria of regulatory agencies. Novavax plans to pursue registration of the vaccine in Mexico. [Dec 2 Novavax press release]

Japan: Abnormal behavior in young patients Japan's health ministry says that 151 flu patients under age 18 showed abnormal behavior, such as "acting violently or uttering gibberish," between late September and early November, Kyodo News reported today. Most of the patients were believed to have the pandemic virus; 62 were receiving oseltamivir or zanamivir, but some were not on an antiviral. Reports from Japan in recent years have suggested that the use of neuraminidase inhibitors may lead to unusual behavior in children and adolescents. [Dec 2 Kyodo News report]

Dec 1

Sebelius orders review of countermeasure policies In the wake of the delays in H1N1 vaccine production, Health and Human Services (HHS) Secretary Kathleen Sebelius is ordering a major review of policies for developing defenses against public health threats. In a speech prepared for an American Medical Association meeting, Sebelius said she wants a review of HHS's "entire public health countermeasures enterprise, to be completed in the first quarter of next year" and led by Dr. Nicole Lurie, HHS assistant secretary for preparedness. [Sebelius's Dec 1 speech]

WHO clears Glaxo H1N1 vaccine for developing countries GlaxoSmithKline announced today that the World Health Organization (WHO) has prequalified its adjuvanted pandemic H1N1 vaccine made in Canada, a key step that will allow it to be distributed to developing countries. Prequalification signifies that the vaccine meets quality and safety standards. Glaxo's pandemic vaccine is the first to get the WHO endorsement. In November Glaxo promised to donate 50 million doses to the WHO. [Dec 1 Glaxo press release]

CDC issues flu guidance for airliners In interim guidelines for managing influenza-like illness on airliners, the Centers for Disease Control and Prevention (CDC) says airline crews should keep sick passengers at least 6 feet away from others if possible and should ask them to wear a face mask if it can be tolerated. Crew members should wear gloves when tending to sick passengers or touching potentially contaminated surfaces, but routine use of face masks and N-95 respirators is not recommended. [Nov 30 CDC guidance]

Pandemic virus found in turkeys, pigs, cats Veterinary authorities in Virginia detected the pandemic H1N1 virus at a turkey farm after egg production dropped in one of the barns, according to a report from the World Organization for Animal Health (OIE). The source of the virus is thought to be a sick worker. Also, officials from Finland reported an outbreak at a pig farm where workers had recently been ill. And yesterday the US Department of Agriculture reported virus confirmation in two cats and a cheetah. [Nov 30 OIE report]

Australia's seasonal vaccine delayed by H1N1 Production of pandemic H1N1 vaccine may delay the arrival of Australia's seasonal flu vaccine by about 3 weeks, a spokeswoman from CSL Ltd, which makes most of the vaccine for the Australian market, told Bloomberg News. The company expects the seasonal flu vaccine, which will contain the pandemic strain, to arrive in April instead of March. CSL is one of the companies making pandemic vaccine for the United States and is the only vaccine producer in the Southern Hemisphere. [Dec 1 Bloomberg News story]

Nov 30

CDC estimates case-fatality rate at .018% The estimated case-fatality rate (CFR) for pandemic H1N1 flu so far is .018%?about 100-fold lower than the 2% CRF in the pandemic of 1918-19, Dr. Martin Cetron of the Centers for Disease Control and Prevention (CDC) said today. Cetron, director of the CDC Division of Global Migration and Quarantine, gave the estimate in a webcast, presented by Public Health Reports, on lessons of the 1918 pandemic. [Public Health Reports webcast information]

Flu closed 1,897 schools this fall US schools that have closed at some point this fall because of the flu pandemic number 1,897, out of about 132,000 schools nationwide, Dr. Martin Cetron of the CDC reported during today's webcast on the lessons of the 1918 flu pandemic. About 616,000 students were affected, he said. Closures so far this fall peaked at about 500 schools, well below the peak of 980 schools in the spring wave of the pandemic. Student-days missed were roughly twice as high in the spring as in the fall. [Public Health Reports webcast information]

WHO addresses mutation, antiviral resistance issues The World Health Organization (WHO) is awaiting more details on clusters of oseltamivir-resistant pandemic H1N1 cases in the United States and Wales, but doesn't think they signal a major shift in the virus, Keiji Fukuda, MD, pandemic adviser to the director-general, said at a Nov 26 briefing. He pointed out that the clusters involved severely immunocompromised patients. He added that it's not clear if recently reported mutations are linked to more severe disease. [Nov 26 WHO media briefing transcript]

Canada weighs vaccine surplus options Canada may have as many as 30 million doses of pandemic vaccine left after meeting domestic demand, and officials are discussing what to do with the surplus, the Canadian Press reported. Canada ordered enough to immunize 75% of its population with two doses if needed, but studies showed that one dose was enough. Experts predicted Canada may retain some for its own needs and donate the rest to developing countries or return it to the manufacturer to help fill other orders sooner. [Nov 27 Canadian Press story]

Alaska finds ethnic differences in patients A review by state officials of people hospitalized with pandemic flu in Anchorage, Alaska, between Sep 1 and Oct 21 found that rates were highest in Alaska Natives and American Indians, followed by Asians and Pacific Islanders, the Anchorage Daily News reported. Most hospitalized patients had underlying conditions. The state epidemiologist said past studies have shown Alaska Natives have the highest rates of respiratory illnesses. [Nov 28 Anchorage Daily News story]

Few flu deaths, illnesses reported during hajj Five people died of H1N1 flu during the annual hajj pilgrimage to Mecca, and 68 others were sickened, a tiny fraction of the 2.5 million who made the trip, the government of Saudi Arabia said yesterday. Experts are concerned that flu cases may develop among returning pilgrims, because only 10% of the visitors were vaccinated against H1N1. [Nov 29 Associated Press report]

China, Indonesia record H1N1 in animals Two samples taken from sick dogs have tested positive for H1N1 flu, China's Ministry of Agriculture reported Nov 28, based on test results from China Agricultural University. Simultaneously, the World Organization for Animal Health (OIE) confirmed that a pig herd discovered ill in August on Bulan Island, Indonesia, harbored H1N1, showing positive in 33 out of 180 samples. [Nov 28 Xinhua report]

Nov 25

College flu cases continue to drop Influenza activity at US colleges continued to significantly decline last week, with all but seven states reporting decreases, the American College Health Association (ACHA) reported today. New cases dropped 37% from the previous week. The report for the week ending Nov 20 said the attack rate was 13.4 cases per 10,000 students, but with no deaths. The ACHA said pandemic vaccine uptake is low, with only 4% vaccinated just before the Thanksgiving break. [ACHA report for week ending Nov 20]

CDC advisors pressed on ventilator allocation A conference call among advisors to the Centers for Disease Control and Prevention (CDC), held to discuss rationing of ventilators in a severe pandemic, turned contentious Monday, according to the Web site Politico. One member of the public who asked questions during the call said the strategy was "Hitlerian" and called for buying as many ventilators as would be necessary to treat potentially millions of patients, regardless of the cost. An adviser called that approach unrealistic. [Nov 23 Politico report]

China, Hong Kong report virus mutation A Chinese official said today that the country this summer detected the pandemic H1N1 virus mutation seen in Norway and other countries, China Daily reported. Feng Zijian, with the Chinese Centers for Disease Prevention and Control, said the mutated virus didn't seem to be more virulent and wasn't linked to any deaths. On Nov 23 Hong Kong officials said they detected the mutation in July in a toddler who has recovered, Xinhua reported. [Nov 25 China Daily story]

First H1N1 wave hit 1 in 6 UK children Serology studies by the United Kingdom's Health Protection Agency (HPA) reveal that about 15% of children in England became infected with H1N1 flu during the pandemic's first wave in spring and summer. That proportion rose in certain areas of the country, with 25% of children under 15 infected in London and the West Midlands, and 21% of those age 15 to 24. About one third of children tested in a boarding school who showed no symptoms had actually been infected, the agency said. [Nov 24 HPA overview]

Another Wales patient has resistant strain An additional patient has tested positive for H1N1 resistant to oseltamivir (Tamiflu) at a Wales hospital, according to the National Public Health Service for Wales (NPHS). The patient, tested as part of routine screening, was linked with the other five patients whose resistant cases were uncovered last week. Test results are pending on one other direct contact of the six patients. An NPHS official said the new case "was not unexpected." [Nov 25 NPHS report]

Officials still probing recalled vaccine lot In the investigation of a batch of GlaxoSmithKline H1N1 vaccine in Canada that has been linked to more allergic reactions than expected, a company spokeswoman said no clues have yet emerged, the Canadian Press (CP) reported. Six cases of anaphylaxis may be linked to a lot containing 172,000 doses shipped to five provinces. Japan, which expects Glaxo vaccine in December, said it will send experts to assess a possible link, Agence France-Presse reported today. [Nov 24 CP story]

CDC posts guidance for emergency shelters The H1N1 pandemic imposes additional requirements on creating emergency shelters for natural disasters, the CDC said in new guidance. Managers must consider adequate ventilation as well as enough space to create separate intake and isolation areas for those who are ill, and also educate staff and ask them to be vaccinated. Shelter workers who are ill should stay home, the CDC said. [Nov 24 CDC guidance]

Chinese expert warns of possible H1N1-H5N1 mix Chinese respiratory disease expert Zhong Nanshan said the country must be alert to any H1N1 mutation, because the far deadlier H5N1 avian flu is endemic in China, according to a Reuters report today. "China . . . is different from other countries," he said. "Inside China, H5N1 has been existing for some time, so if there is really a reassortment between H1N1 and H5N1, it will be a disaster." [Nov 25 Reuters report]

Nov 24

Study revisits issue of lab origin for H1N1 After examining publicly available genetic sequences, virologist Adrian Gibbs and colleagues suggest in a study in Virology Journal today that the pandemic H1N1 virus may have been the product of a lab. In May the World Health Organization (WHO) examined Gibbs's assertions and said natural means were more likely. Gibbs told Bloomberg News today that, while genes from different flu strains may have mixed naturally to form novel H1N1, human involvement is "by far the simplest explanation." [Nov 24 Virol J study]

Registry tracks ECMO use in flu patients A voluntary registry based in the United States shows that 107 patients who were critically ill with pandemic H1N1 flu have been treated with extracorporeal membrane oxygenation (ECMO), the Associated Press (AP) reported. Research at the University of Michigan on the registry is under way to assess the best candidates for the treatment. ECMO allows blood to bypass damaged lungs to allow healing. [Nov 23 AP story]

CDC confirms doctor had repeat H1N1 The Centers for Disease Control and Prevention (CDC) confirmed that a West Virginia pediatrician contracted novel H1N1 flu twice, in August and in October, according to the Charleston Daily Mail. Local labs had confirmed that Dr Debra Parsons had pandemic flu both times she was sick. Now more exacting tests from the CDC on both samples have confirmed the results. A state health official called this occurrence "very, very, very rare." [Nov 24 Daily Mail report]

Japan reports flu-related brain swelling Japan has identified 132 influenza patients who have developed encephalopathy, or brain swelling caused by an immune overreaction, according to Japan's Yomiuri Shimbun newspaper. This is triple the expected annual number. Patients ranged in age from 1 to 67, but most were under 15, with 7-year-olds most commonly affected. Three patients died. A senior health official said that flu patients who have slow responses or say "strange things" should see a doctor immediately. [Nov 24 Yomiuri Shimbun article]

Mexico receives first vaccine doses Mexico's health ministry announced yesterday that it had received its first 865,000 doses of pandemic H1N1 vaccine, Agencia EFE, a Spanish news service, reported. The country's health secretary, Jose Angel Cordova, said officials will review the vaccine and administer the first doses this week to pregnant women and health workers. He said Mexico expects 30 million doses from Sanofi and GlaxoSmithKline by February 2010. Doses will go to states based on population. [Nov 24 EFE report]

Ukraine to receive vaccine from WHO The WHO said it would provide 5 million H1N1 vaccine doses to the Ukraine, the news service Interfax-Ukraine reported. The news came during a meeting between WHO officials and the country's president, the president's press service reported. Authorities from the WHO have been in the Ukraine to investigate a dramatic increase in respiratory illnesses, including severe cases and deaths. However, initial reports found no significant pandemic virus changes. [Nov 24 Interfax-Ukraine story]

Nov 23

ECDC: Norway mutation may affect receptor binding The mutation recently found in H1N1 isolates from three patients in Norway may influence receptor binding specificity and therefore the virus's ability to infect tissues deep in the respiratory tract, the European Centre for Disease Prevention and Control (ECDC) said in its daily update today. But the binding preferences and the effects of the mutation on the virus's biological properties have not yet been determined. The mutated virus remains sensitive to the two leading antiviral drugs. [Nov 23 ECDC update]

Pandemic death toll rising in Europe The weekly number of deaths due to the pandemic virus in Europe has nearly doubled every 2 weeks over the past 6 weeks and reached 169 last week, with a cumulative total of 670, the ECDC reported in its pandemic update today. Most of the deaths have occurred in Western Europe, but fatalities are increasing in central and Eastern Europe. "Very high intensity" flu activity was reported in Italy, Norway, and Sweden, with high intensity in nine other countries, the agency said. [Nov 23 ECDC update]

Three more countries start H1N1 vaccination The Czech Republic began its pandemic H1N1 vaccine campaign today, with the first doses slated for the military, top state officials, and people with underlying conditions, Reuters reported. Cyprus also started the first phase of its campaign targeting healthcare workers, pregnant women, and those with chronic medical conditions, the Associated Press (AP) reported. And Dutch children between 6 months and 4 years old received their first doses, according to the Canadian Press. [Nov 23 Reuters story]

Authors say high-risk adults need better access to vaccine Two Harvard researchers write that adults with medical conditions other than pregnancy deserve better access to H1N1 vaccine. High-risk adults were left off the list of top-priority groups to be targeted in a vaccine shortage, but some have a higher risk of death than pregnant women and a far higher risk than healthy children under age 4, the authors write in PLoS Currents. Even as vaccine supplies improve, high-risk adults will face competition from healthy people younger than 24. [Nov 20 PLoS Currents article]

State workers among Hawaii's priority group Hawaii has included about 7,000 of 50,000 state workers among the priority group to receive the pandemic H1N1 vaccine, the AP reported. A spokesman for the state's civil defense department said the strategy is to ensure that state government doesn't shut down because of high absence rates. Key employees from all three branches of government were vaccinated, including those from tax, health, and transportation departments. [Nov 21 AP story]

First flu deaths reported in hajj pilgrims Saudi Arabia's health ministry announced the first four pandemic H1N1 flu deaths in hajj pilgrims, Agence France-Presse (AFP) reported. Three of the patients were age 75, hailing from Morocco, Sudan, and India. The fourth was a 17-year-old girl from Nigeria. The health ministry said all four had underlying conditions, including cancer and respiratory illness. Sixteen other flu infections were detected in hajj pilgrims, four of whom are hospitalized in critical condition. [Nov 21 AFP story]

Nov 20

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

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

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

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

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

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

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

Nov 19

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

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

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

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

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

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

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

Nov 18

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

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

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

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

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

Nov 17

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

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

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

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

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

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

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

Nov 16

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

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

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

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

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

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

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

Nov 13

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

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

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

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

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

Nov 12

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

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

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

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

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

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

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

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

Nov 11

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

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

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

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

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

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

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

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

Nov 10

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

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

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

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

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

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

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

Nov 9

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

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

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

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

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

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

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

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

Nov 6

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

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

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

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

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

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

Nov 5

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

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

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

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

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

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

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

Nov 4

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

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

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

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

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

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

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

Nov 3

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

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

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

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

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

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

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

Nov 2

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

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

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

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

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

Oct 30

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

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

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

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

Oct 29

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

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

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

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

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

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

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

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

Oct 28

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

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

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

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

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

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

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

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

Oct 27

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

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

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

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

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

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

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

Oct 26

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

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

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

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

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

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

Oct 23

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

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

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

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

Oct 22

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

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

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

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

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

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

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

Oct 21

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

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

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

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

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

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

Oct 20

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

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

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

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

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

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

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

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

Oct 19

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

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

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

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

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

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

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

Oct 16

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

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

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

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

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

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

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

Oct 15

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

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

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

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

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

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

Oct 14

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

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

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

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

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

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

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

Oct 13

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

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

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

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

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

Oct 12

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

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

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

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

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

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

Oct 9

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

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

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

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

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

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

Oct 8

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

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

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

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

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

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

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

Oct 7

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

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

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

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

Oct 6

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

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

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

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

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

Oct 5

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

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

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

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

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

Oct 2

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

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

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

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

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

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

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

Oct 1

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

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

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

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

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

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

Sep 30

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

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

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

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

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

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

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

Irish pigs infected with novel H1N1 Forty pigs have contracted pandemic H1N1 flu, apparently from an infect