Global's H1N1 Update - 06/24/10

The H1N1 Blog closes shop (and re-opens down the street)

This marks our last post here at the H1N1 (Swine Flu) Update blog. While our blogspot home here has served us well, and we are a little melancholy to say goodbye to it, the feeling is eclipsed by our excitement at posting to our new WordPress digs.

This will be more than just a domain-name change. Over the last 12 years, the staff here has provided thousands of lay-rescuers and healthcare professionals with life-saving, cardiac support training and equipment. We’ve mounted preparations and responses to everything from floods and wildfires to plane crashes and suspected terrorist attacks. In the new blog, we will more completely explore the issues and events that surround everything that happens here at Global Medical Services and Global Consulting – including pandemic H1N1 planning and response.

Rather than just distil useful and relevant news and updates from the media noise for you, we plan on explaining why we think these things merit your attention. We’ll take a look at how people are responding to current incidents, and talk about how we can all do better next time. And we can always do better. The entire staff is looking forward journeying down the road ahead.

We hope you are too.

Read further updates at http://theglobalguard.wordpress.com/

International News

H1N1 appears less contagious than past pandemics

A pair of studies release by Cambridge University suggests the H1N1 virus does not transmit well via secondary infection. One study examined boys who fell ill with the pandemic flu at summer camp in Florida. Among the 212 boys at the camp, the virus’ successful attack rate was 23%. Once they got home the infected boys had contact with 87 more people, but the attack rate fell to 3.5%. Researchers suspect the reason for the drop is the return home after peak infectiousness had passed the advance warning households received when the sick campers returned. The second study found that 13% of 511 students at a Hong Kong secondary school contracted H1N1, but only 5.9% of the people in the infected students’ households got sick. These findings support a December 2009 study published in the New England Journal of Medicine that further noted secondary infection rates for the 1957 and 1968 pandemics were as high as 40%. University of Minnesota CIDRAP

Two members step down from the WHO’s pandemic review panel

To answer critics of the World Health Organization, the UN agency convened an independent panel of experts last month to begin reviewing and discussing the WHO’s pandemic response. The identities of the panels members has been kept secret to insulate them from outside influence, but two of the panel’s experts resigned this week. John MacKenzie and Dr. Tony Evans were involved in planning the WHO’s pandemic response and felt serving on the review committee could become a conflict of interest. Chair of the panel Dr. Harvey Fineberg said, "They each concluded it would be better to avoid the position as reviewer of their own earlier actions." The WHO Director General Margaret Chan has promised to make the names of the remaining committee members public once the review is complete and the pandemic is over. CBC News

Global's H1N1 Update - 06/22/10

The next update will be on Tuesday, June 24th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 13, 2010

International News

H1N1 reassortment in pigs could become a significant threat

Back in February, Chinese researchers recorded the first instance of H1N1 encountering another virus within a host, intermixing and then emerging as something new; this process is known as reassortment. While novel, Chinese officials stated that the new virus strain did not present a public health risk, and to-date the hybrid has not been found in humans. After months of study, these scientists have found that the new strain is too distinctive to cross-react with antibodies triggered by pandemic H1N1 or its vaccines. They also found that pandemic H1N1 reassorts easily with other viruses, noting during their study that H5N1 and H9N2 –both dangerous pandemic candidates– were also found in the pigs. This process could generate other flu viruses with the ability to be much more virulent than existing strains.

As a result, the study calls for much higher levels of surveillance for swine populations, something that, ironically, has dropped since the pandemic outbreak. Pig and poultry farmers have learned that finding viruses in their livestock can produce costly results. However, the report says phylogenetic studies suggest that the pandemics of 1918, 1957, and 1968 all evolved in another mammalian host for years before surfacing in humans. The inference is that the relatively mild 2009 outbreak could only be the prelude to a much longer pandemic. CTV News

Fake, mail-order Tamiflu uncovered

The American Food and Drug Administration has issued a warning against a product available online as “Generic Tamiflu”. There is no such thing. The FDA purchased a package of the drug for testing, and found that it contained no oseltamivir, the active ingredient in Tamiflu. Instead what they discovered were capsules containing cloxacillin; an antibiotic similar to penicillin. Those with allergies to penicillin are at risk of similar, potentially life-threatening reactions when taking cloxacillin. While the website where the FDA purchased its “Generic Tamiflu” is no longer operating, the agency warns that the fraudulent drug is likely to crop up on other sites claiming to be online drug stores. United States FDA

Global's H1N1 Update - 06/17/10

The next update will be on Tuesday, June 22nd, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

Indian H1N1 outbreak claims 16 lives in one month

With onset of monsoon season in Southeast Asia, influenza is considered a common monsoon-related malady. In southwest India, the state of Kerala is suffering from a large resurgence in H1N1 infections. Of the 16 deaths due to H1N1 the agrarian state has reported since May 15th, 9 were pregnant women. India’s National Centre for Disease Control has sent its Joint Director with an epidemiologist and a virologist as a three-doctor swift response team to the state capital, Thiruvananthapuram, to investigate and combat the outbreak. In addition, the Indian parliament has approved shipments to Kerala of 600 000 Oseltamivir tablets, 20 000 bottles of pediatric syrup and 31 000 doses of vaccine. Monsoon season is expected to last another two to three months. Infocera

Vietnam wants to lower its pandemic alert level

Not content to wait for the World Health Organization’s review in July, Vietnam’s Deputy Minister of Health Trinh Quan Huan has suggested lowering his country’s H1N1 alert level. According to Huan, his ministry had “heard” that senior WHO officials had been lobbied by pharmaceutical companies to influence the official pandemic declaration. “This is a big issue,” he said. The Vietnam Health Ministry spent approximately $52.5 million on pandemic prevention measures last year. Thanh Nien News

New Zealand vaccinates record numbers of citizens

The New Zealand government says over a million of its citizens were vaccinated against the flu this year; the highest number of people ever to respond to its public immunization program. New Zealand Health Minister Tony Ryall congratulated health officials, doctors and nurses on their “great job” and urged those who qualify for free vaccinations “to take up this offer while vaccine stocks last”. New Zealand’s last census estimates the country’s population at 4.3 million. TV3 News

Global's H1N1 Update - 06/15/10

The next update will be on Thursday, June 17th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

The WHO, CIDRAP and others continue to respond to BMJ allegations

Defenders of the World Health Organization’s pandemic recommendations continue to surface in the face of criticism from the British Medical Journal, now the BMJ. Earlier this month the BMJ suggested the UN body had come under the influence of drug industry corruption and that the H1N1 guidelines provided by three of its flu experts were suspect. David Ozonoff, an epidemiologist at the Boston University School of Public Health, called the report a "smear" that insinuates the serious charge that they would have given different advice if they hadn’t had relationships with drug companies. The BMJ authors Deborah Cohen and Philip Carter responded, "We think this is the researcher's reading into it, not necessarily ours."

Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, called the article “irresponsible and reckless” saying, “There was nothing in those guidelines that was not based on the best science available. To suggest that the three scientists were able to direct and control the final recommendations [of the 22-member panel] is naive, and stated without a single shred of evidence.”

Epidemiologist Marc Lipsitch at the Harvard School of Public Health compared the situation with the Deepwater Horizon oil spill in the Gulf of Mexico: “It is ironic, as we watch […] the catastrophic results of ‘best-case scenario planning’ […], to have the WHO coming under criticism for planning for, and raising awareness of, the possibility of a severe pandemic. […] They should be commended for it.”

Director General of the WHO Margaret Chan sent an open letter to the BMJ in response to the article. In it, she allowed that transparency and stricter rules of engagement with industry were issues the agency was working to improve on, but “at no time, not for one second, did commercial interests enter my decision-making.”

According to the Journal article, “pharmaceutical companies, […] put pressure on WHO to declare a pandemic. It was the declaring of the pandemic that triggered the [vaccine purchasing] contracts.” However, many countries including the United Kingdom, France, Finland, Canada, the Netherlands, Switzerland, and the United States had already activated their contracts and placed large orders for H1N1 vaccine weeks before the WHO declared the pandemic on June 11, 2009. Therefore, the Emergency Committee could not have influenced these in any way. "You are absolutely right," conceded the authors of the BMJ article when challenged with this timeline. Nature News

Pandemic, one year later

The H1N1 pandemic is officially a year old as of last Friday. On June 11, 2009, the World Health Organization’s Director General declared the H1N1 outbreak was a phase-six pandemic. The avian (H5N1) flu virus had led the public to associate the term “pandemic” with high death rates, so the WHO hesitated making the declaration over concerns it would cause undue alarm. The announcement came about seven weeks after the virus surfaced. A year later, labs officially confirm H1N1 has claimed 18,156 lives though the actual count, which won’t be known for years, is expected to be many times higher. While H1N1 activity has tapered off in most parts of the world, the WHO maintains a phase six alert. World Health Organization

Global's H1N1 Update - 06/10/10

The next update will be on Tuesday, June 15th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 23, 2010

National News

Canada's response to the H1N1 pandemic was one of confusion, says a white paper being presented Tuesday at the World Conference on Disaster Management in Toronto. Serious gaps in the country's pandemic planning and unrealistic management guidelines were exposed, it says. Dr. Allan Holmes, who moderated the roundtable discussion on which the report was based, said a single pan-Canadian approach to planning is needed, along with a severity index to put future outbreaks in context. Vancouver Sun

International News

British virologist John Oxford stated at a recent Dublin conference that "It's too early to do a postmortem" on the pandemic H1N1 flu virus. He predicted it will cause trouble again in the coming winter. People need to be aware of how to limit its spread, and decisions need to be based on science, he said. As for vaccine, he stated, "It's no time to be complacent and say we wasted our money on vaccines, because we haven't. This is a virus that will be in the community for a long time." Irish Times

Global's H1N1 Update - 06/08/10

The next update will be on Thursday, June 10th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 30, 2010

International News

WHO keeps pandemic alert status at phase six

After reviewing the state of pandemic activity, and an extended meeting of the Emergency Committee last week, the World Health Organization decided to maintain its pandemic alert level at phase six. While the Emergency Committee unanimously agreed that it had subsided significantly all over the world, H1N1 proliferation still has not dropped below the threshold defined by their phase six alert and it is expected to continue. The Emergency Committee’s next meeting is scheduled for July when they will review disease activity again and consider downgrading the alert status. World Health Organization

CIDRAP disputes BMJ story's allegations of WHO improprieties

The University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) as come to the defence of the World Health Organization after a story in the British Medical Journal alleged conflicts of interest had compromised the UN agency’s recommendation process. According to the Journal story, three scientists who had written key guidance reports for the WHO did so under the influence of competing interests in the pharmaceutical industry. The story goes on to imply that the WHO tried to cover up the interaction by not disclosing it with the report. Dr. Michael Osterholm, the director of CIDRAP, weighed in on the story declaring he had ties to neither the WHO nor the pharmaceutical industry, “I have no horse in this race except the truth.” He went on to acknowledge that it is common for public health specialists to gain their expertise working in the private sector. The pool of influenza experts is relatively small and, “for the WHO to not call on these [three scientists] would have been a serious subject matter expert mistake. Having said that, all of the appropriate recusals and identification of conflicts of interest were made. And in the imperfect world we live in today, that's as good as it gets.” With regards to the article, he warned, “Today it's very easy to do science witch hunts or character assassination by inference. There's no evidence whatever that any of these individuals acted improperly, nor did WHO.” CTV News

Global's H1N1 Update - 06/03/10

The next update will be on Tuesday, June 8th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 23, 2010

National News

Ontario grades its pandemic response as adequate but improvable

Ontario’s Chief Public Health Officer Dr. Arlene King released a report reviewing that province’s response during the H1N1 pandemic outbreak. While she said Ontario’s handling of the pandemic was fairly comprehensive and effective, she did have criticisms for the manner in which the supply of vaccine was maintained and the lack of coordination in vaccine programs from region to region. “There was never an alignment between H1N1 vaccine supply, demand and our capacity to deliver it,” she said when describing the line ups for vaccine when vaccinations were in short supply and the subsequent fading interest once the supply began to grow.

Much of the uncertainty was compounded by different regions taking varying approaches in their vaccination campaigns and her office’s lack of authority to compel the province's 36 health boards to follow vaccine priority groups recommended by the World Health Organization and set by the federal and provincial governments. "They resulted in, I think, in really frankly shaking some public confidence in terms of how the pandemic was being managed. And I think ultimately those kinds of things result in concerns around public safety as well." Winnipeg Free Press

International News

Public pandemic information didn’t make enough of a case for vaccination

The RAND Corporation has conducted poll that compares public attitudes towards seasonal influenza and the H1N1 pandemic. While people considered H1N1 to be more of a concern than seasonal flu, the vaccine was also seen as less safe. As a result, vaccination up-take compared to that for the seasonal flu was lower. The researchers say people garnered their information from a wide variety of sources, and were told repeatedly how severe a threat the pandemic could be, but received relatively little information about the safety and value of vaccination. Preventative Medicine