Global's H1N1 Update - 12/31/09

The next update will be on Tuesday, January 5th, 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 December 27th, 2009

National News

Influenza awareness on the public’s part has pushed the H1N1 pandemic from the health section of their daily papers to the front page according to a Canadian Press survey. In the poll, 70% of Canadian print and broadcast news editors chose it as their top news story of the year. South of the border, even CNN listed the outbreak as one of their top five health stories. CBC, Winnipeg Free Press

There may be a silver lining – or several – to the H1N1 pandemic. Not just in the event itself, which has been milder than feared, but also in the viral legacy it may leave. Experts say the pandemic H1N1 virus could knock out other viruses and make future vaccines more effective. H1N1 generally hits younger people harder, but children and adults respond better to flu vaccine than do seniors, whose immune systems are breaking down with age. If the burden of influenza shifts down the age spectrum, vaccines could be targeted to people who get more benefit from them. And younger people are less likely to die of flu than seniors, in whom a bout of flu can be the proverbial final straw. The toll influenza takes on the elderly could conceivably ease, at least for awhile. Toronto Star

International News

H1N1 proliferation may have peaked in Canada, the US, England and other northern hemisphere countries, but it would be “premature” to declare the pandemic over says Dr. Margaret Chan, Director General of the UN’s World Health Organization. Not only did she say that the virus must be monitored for at least another year for mutations, last month the WHO warned of new cases of H5N1, the bird flu, in poultry in Egypt, Thailand and Indonesia. CBC

China has started treating severely infected H1N1 patients with blood plasma donated by survivors. Government-run blood collection stations have been harvesting plasma from people who have high levels of swine flu-fighting antibodies in their blood, because they recently recovered from or were vaccinated against the virus. The plasma is being stored in preparation for transfusions for severely or critically ill patients. Because the approach is still being evaluated for safety and effectiveness, the World Health Organization has not recommended it. Boston Herald

Vaccine News

Pharmaceutical company MedImmune has issued a recall of some of its intranasal H1N1 vaccine over concerns that it loses potency as it sits on the shelf. The company advises that the “slight decrease in potency should not affect how the vaccine works,” but healthcare providers should return any unused doses from the recalled lots. New England Journal of Medicine

Global's H1N1 Update - 12/29/09

The next update will be on Thursday, December 31st, 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 December 20th, 2009

National News

A Manitoban under age 18 has become the first patient with H1N1 to show resistance to antiviral drugs, provincial health officials said on Wednesday. The youth, who was only identified as living in Manitoba and having underlying health conditions, was being treated with Tamiflu. "A public health investigation continues, but it appears this is an isolated case with no evidence to date that a resistant strain of H1N1 has been transmitted to others," Manitoba Health said in a statement. The province said antiviral resistance has been previously found with other strains of seasonal flu. CBC

International News

The H1N1 flu pandemic may not be conquered until 2011, the head of the World Health Organization (WHO) said on Tuesday. "I think we must remain prudent and observe the evolution of the pandemic in the course of the next six to 12 months before crying victory,” said WHO Director-General Margaret Chan. "It is too soon to say that we have passed the peak of the (H1N1) flu pandemic on a worldwide scale... Winter is still long.” Reuters

Vaccine News

WHO Director-General Margaret Chan has called for international solidarity to provide equitable access to pandemic influenza vaccine for all countries. Final preparations are underway to distribute donated pandemic influenza vaccines to 95 low- and middle-income countries to help prevent severe disease. On Friday, the WHO reported so far six countries have completed national deployment plans, and another 190 million doses of vaccines, 75 million syringes and US$70 million have been pledged for vaccine deployment. WHO

Global's H1N1 Update - 12/24/09

The next update will be on Tuesday, December 29th, 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 December 20th, 2009

National News

At least 11,516 people around the globe have died from the H1N1 flu virus since the pandemic emerged in April, the World Health Organization (WHO) reported Wednesday. Since its last weekly accounting, reported deaths due to influenza have increased by nearly 1,000. However, the report continued, while the virus remains geographically widespread across Canada and the United States, the overall proliferation of flu-like illnesses has declined substantially and hospitalizations and deaths were dropping. Reuters

International News

According to new research published December 23rd in the online edition of The New England Journal of Medicine, women with suspected or confirmed H1N1 influenza who are pregnant or have delivered within the last 2 weeks should seek prompt and aggressive antiviral treatment and be closely monitored. Researchers concluded that H1N1 influenza can cause severe illness and death in pregnant and postpartum women, and regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment should be considered for this group. The high, cause-specific, maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio. New England Journal of Medicine

Vaccine News

Calgary health officials say that H1N1 vaccine clinics will resume for another six days in the New Year. Three influenza vaccination clinics in Calgary are set to reopen beginning Monday, January 4th. The service will close again on Saturday, January 9th. At that time health officials will determine if there is enough demand to extend the clinics’ hours of operation, said Dr. Judy MacDonald, Deputy Medical Officer of Health in Calgary. Roughly 500,000 people in the Calgary region have been inoculated against the pandemic virus since the mass clinics opened in late October. Calgary Herald

Americans are worried about the safety of the swine flu vaccine and it may not be easy to convince them to get themselves or their children vaccinated, researchers said on Tuesday. According to pollsters, about 60 percent of parents say they plan to get their children vaccinated and 79 percent of adults will try to get the vaccines for themselves, but there is a hard core of resistance that has not been moved by entreaties by the U.S. government. Several studies have shown the H1N1 swine flu vaccine does not cause unusual side effects. Robert Blendon of the Harvard School of Public Health said it is not clear why so many parents are fearful. Reuters

Global's H1N1 Update - 12/22/09

The next update will be on Thursday, December 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 December 13th, 2009

National News

The family of a Calgary H1N1 patient has come forward to say that the father of two has died due to complications related to the virus. The 35-year-old man, whom the family asked not to be identified, had been in and out of hospital with pneumonia for the past three weeks. Health authorities could not immediately confirm the death was related to H1N1. If confirmed, it would bring the number of deaths related to H1N1 to 66 across Alberta. Calgary Herald

A new poll suggests that Canadians think governments at all three levels have done an OK job of handling the H1N1 flu, though many also think the risk was exaggerated. The Canadian Press Harris-Decima survey suggests that as concern is waning among Canadians, they are generally satisfied with how their governments responded to the pandemic. Nearly three-quarters, or 73 per cent, of those who took part in the survey assessed Ottawa's performance as good or fair, and the numbers were similar at the provincial and municipal levels. Winnipeg Free Press

International News

In the temperate zone of the northern hemisphere, transmission of pandemic influenza virus remains active and geographically widespread; however disease activity has peaked or passed its peak in many places, particularly North America. Influenza activity continues to increase in later affected areas of south-eastern and central Europe, and in central and south Asia. In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining. WHO

The government of Switzerland plans to donate or sell some 4.5 million excess doses of the pandemic H1N1 vaccine due to the low uptake of shots. Germany and Spain have also said they want to reduce deliveries of the H1N1 vaccine and potentially return excess supplies to manufacturers, which could hit manufacturers’ profits. Switzerland, whose total population is 7.7 million, ordered 13 million doses of vaccine from GlaxoSmithKline and Novartis. Reuters

The Centers for Disease Control and Prevention (CDC) recently stated that the second wave of the H1N1 influenza pandemic continued to fade, as the number of states with widespread cases dropped to 11 and reported deaths in children also declined. The CDC also reported finding 15 more cases of oseltamivir (Tamiflu)–resistant H1N1 viruses, but it said those instances remain rare. The CDC weekly graph shows a sizable drop in flu-related hospitalizations and deaths last week compared with the week before and a mostly steady decline in both over the past 6 weeks. CIDRAP

Vaccine News

Australian vaccine maker CSL Ltd has announced that its pandemic H1N1 vaccine delivered a strong immune response after just one dose in children as young as 6 months. Global health authorities recommend children get two H1N1 shots for full protection, but the CSL vaccine showed strong response with just one shot. No serious safety concerns were reported with the vaccine. Reuters

Demand for swine flu vaccines below original forecasts is threatening to slow the growth in predicted revenues for four of Europe's leading pharmaceuticals companies. Academic studies in recent weeks have shown that most people require a single dose of vaccine to acquire protection, compared with the two doses originally believed necessary and used in orders by governments including the UK. Separately, public suspicion of the perceived risks of vaccines at a time when the impact of swine flu is far less than previously feared is also discouraging the use of those vaccines already delivered. Financial Times

Afghanistan, Azerbaijan, and Mongolia will be the first three countries to receive donated supplies of pandemic H1N1 vaccine funnelled through the World Health Organization. The WHO aims to vaccinate health care workers initially and other priority groups later in 95 developing countries, with the hope of covering about 10% of the population, or roughly 200 million people. At a news briefing, Dr. Keiji Fukuda, special assistant to the WHO director-general for pandemic flu, said six manufacturers and 12 countries have pledged about 180 million doses of vaccine, and the agency is negotiating with other countries about potential donations. CIDRAP

The next update will be on Tuesday, December 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 December 6th, 2009

National News

Canadian scientists have helped make a discovery that might explain why some people develop severe illness when infected with H1N1 flu and others don't. Researchers from Toronto's University Health Network found high levels of a cytokine molecule called interleukin 17 in the blood of severely ill H1N1 patients, and low levels in patients with mild forms of the disease. In the cases of respiratory infections, cytokines plays a part in a potentially fatal immune reaction called a "cytokine storm," in which the immune system of a healthy person goes haywire and "overreacts" to an infection. CTV

H1N1 has taken the ten more lives in Ontario and eight more in other provinces to boost Canada’s fatalities total from the pandemic virus to 390. In Alberta, an infant with no previous medical history was among two reported dead. Also, a 16-year-old grade-11 Calgary student died on Tuesday after being in a coma since Nov. 2. The additional ten deaths in Ontario comes as a surprise because the province has reported a decline in all other indicators including hospital admissions and visits to doctors for influenza like illness. The 18 new deaths occurred between December 10 and December 15. Vancouverite

International News

China’s H1N1 flu death toll has leapt by more than a third in recent days to 442, just days after the government warned of a holiday-season spike in infections. Of the total deaths, 116 were reported in the week of December 7 to 13. The total number of A(H1N1) influenza cases totalled nearly 108,000. China has pledged to step up a H1N1 flu vaccination programme that has seen more than 34 million people jabbed, warning of heightened risks in the upcoming holiday season, particularly the Lunar New Year in February. Straits Times

In a bid to stop the spread of swine flu virus, Serbia’s Ministry of Education has announced it will suspend classes in schools. Tanjug news agency reports that the country's Minister of Education, Zarko Obradovic, explained that the first day of school will be on 11 January and the first semester will end ten days later, so that the teachers will be able to give final grades for that semester. "According to the information we have received from the working group monitoring the flu, the situation in Serbia is such that it is necessary to suspend school," the agency quoted Obradovic as saying. Balkan Insight

According to researchers from the Netherlands and Germany writing in the Public Library of Science (PLoS) Medicine, a 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. 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. PLoS

The Korean government recently confirmed that pigs have contracted influenza A (H1N1), the first cases of an H1N1 infection among animals in Korea. Authorities said the virus is not as threatening to the animals as to humans and that there is little need to be anxious about cross-infections or a new pandemic. It was decided not to conduct wholesale slaughter of the swine and the government said there is little chance of acquiring the disease by eating pork from infected pigs. Korea Times

Vaccine News

The U.S. has recalled hundreds of thousands of doses of H1N1 swine-flu vaccine intended for young children, saying that testing has found that vaccine may not be potent enough to protect children from the pandemic flu. Canada's vaccine comes from a different manufacturer, a Quebec factory run by GlaxoSmithKline, and is not affected by the recall. The CDC said there's no indication anything in the doses of vaccine is dangerous in itself and described the recall as "non-safety-related." Ottawa Citizen

According to a report published by the New England Journal of Medicine, Novartis's pandemic H1N1 flu vaccine generated stronger immune responses when it was combined with an adjuvant than when used alone, though both formulations yielded good results. The authors published a preliminary report in September showing that the vaccine formulation containing Novartis's proprietary adjuvant, MF59, generated an immune response deemed likely to be protective. The final report, released today, says the nonadjuvanted formulation also elicited a good immune response albeit less intense than the adjuvanted version. CIDRAP

Two of the Calgary’s six H1N1 mass vaccination clinics will close permanently on Wednesday. However, there will still be four other clinics offering both the H1N1 and seasonal influenza vaccine to Calgarians. All Albertans over six months of age are eligible to receive the H1N1 vaccine, and anyone in a high-risk category is also eligible to receive the seasonal influenza vaccine. Edmonton Journal

U.S. government and private health officials have stated that despite a dip in cases, H1N1 influenza has not gone away and could resurge, making continued vaccination critical. Speaking on a webcast for health care providers conducted by the Department of Heath and Human Services (HHS), experts urged health care workers to take the vaccine themselves and to continue to push it out to patients. Federal officials remain concerned that some high-risk populations have not been vaccinated at high-enough rates, including racial and ethnic minorities, pregnant women and young children. CIDRAP

Global's H1N1 Update - 12/15/09

The next update will be on Thursday, December 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 December 6th, 2009

National News

The Public Health Agency of Canada (PHAC) says H1N1 activity in Canada continues to subside, dipping for the third straight week. The agency's weekly update, FluWatch, says widespread activity is limited to two small pockets of the country, in central Saskatchewan and along the south and east coasts of Newfoundland. There were 307 people admitted to hospital with H1N1 flu, 83 admitted to ICUs and 33 who died across the country, in the last two weeks. Canadian Press

Comparing transmission of H1N1 during the current winter season to transmission during the summer season, there appears to be 2-3 times more hospitalized cases and deaths in the United States and approximately 4-5 times more hospitalized cases and deaths in Canada during the winter season. This would indicate that transmission of the virus has been much more widespread and intense during the winter, as predicted, but overall rates of severe illness have not changed compared to southern hemisphere. WHO

Similar to seasonal influenza, persons with certain underlying conditions (compared to those without) were at significantly increased risk of hospitalization and death associated with the H1N1 virus infection. During the current winter season in Canada, 52% of hospitalized cases, 60% of cases requiring intensive care, and 67% of fatal cases, had an underlying chronic medical illness. The most common underlying conditions among fatal cases in Canada were asthma followed by cardiac disease, immunosuppression, and diabetes. WHO

International News

With the exception of France where flu activity continues to increase, flu activity has peaked in much of Western Europe. Increasing activity continues to be observed in central and southeastern Europe, including in Albania, Estonia and Greece. In Western and Central Asia, influenza virus transmission remains active but may have peaked in Afghanistan, Israel, and Oman. In East Asia, influenza activity continues to increase in Japan and has recently begun to increase in Hong Kong. In South Asia, influenza activity has begun to increase in the north-western parts of India and in Sri Lanka. In Central and South America and the Caribbean, overall disease activity has been declining. WHO


U.S. federal health officials have reported that almost 10,000 people had died of H1N1 since April, a significant jump from mortality numbers released last month. Officials also said that 50 million Americans (one sixth of the country), had caught the disease and that 213,000 people had been sick enough to be hospitalized. Dr. Thomas R. Frieden, director of the C.D.C., said about 85 million doses of H1N1 flu vaccine are still available. Some states have so much that they are asking that everyone over six months old get vaccinated, not just high-risk individuals. New York Times

North Korea agreed on December 10th to accept medicine from South Korea to fight an outbreak of H1N1 flu in a development that could improve relations between the nations after a deadly maritime clash. Winnipeg Free Press

South Korea confirmed that pigs infected with H1N1 have been found at domestic farms. Infections were confirmed at five pig farms in Gyeonggi and North Gyeongsang provinces. The ministry has also found infections of the (A) H1N1 virus among pigs imported on November 11 from Canada. Ministry officials, however, say pork is safe to eat as people cannot get flu from eating pork or pork products. A total of 117 people with the virus have died in South Korea. The Straits Times

Respective insurance companies in Malaysia will compensate the next-of-kin of life insurance policy holders who die of the H1N1 virus. Malaysian Deputy Finance Minister Awang Adek Hussein confirmed that insurance companies would not differentiate death due to the H1N1 virus from other causes. Earlier, there were concerns in the country about whether the death resulted by the H1N1 virus would be compensated by insurance companies. China View

China's Health Ministry warned that the H1N1 flu outbreak in the country could peak over the next several months, especially as hundreds of millions of people return home for the traditional Chinese New Year. More than 100,000 people in China have been infected with H1N1 flu, with 326 fatalities as of December 10th. China's peak flu season could last until March. Since September, China has vaccinated more than 30 million people. An average of 1 million people are vaccinated every day, and the ministry aims to increase that to 1.5 million before the Lunar New Year. CTV


Vaccine News

New Brunswick's Department of Health is urging young men to get the H1N1 vaccine as officials are noticing men in their 20s are avoiding getting the H1N1 flu shot. Dr. Paul Van Buynder, deputy chief medical officer of health, said the public H1N1 vaccination clinics are wrapping up this week and the department is concerned young men are avoiding their shots. New Brunswick expects to give its 500,000th H1N1 vaccination shot sometime this week, and that means about two-thirds of the province's population will have been inoculated. CBC

December 12th and 13th was the last chance to get a H1N1 flu shot at a public clinic in Toronto before the holidays. To date, more than 200,000 people in Toronto have received the shot at the clinics. Toronto Public Health has distributed more than one million doses of the vaccine to various health-care providers ranging from family doctors to private clinics. CTV

Vancouver Coastal Health spokesman Gavin Wilson said only 36% of health care staff had received the vaccine. That's compared to 46% of the general population in the Vancouver Coastal Health district. The Vancouver Island Health Authority has recorded even fewer vaccinations. About 31% of employees are known to have been immunized, fewer than the estimated 35% of the population. Dr. Bill Cavers, a Victoria general practitioner who has criticized the immunization campaign, especially its failure to utilize family doctors, said the low uptake of health care workers is likely due to poor organization. B.C. H1N1 flu clinics will cease offering the vaccine December 18th. Kelowna.Com

The U.S. Army plans to inoculate some 40,000 new recruits with the H1N1 flu vaccine before the Christmas holiday leave. Mass inoculations will be conducted in the next two weeks in army bases across the nation before the recruits go home to spend the holiday. The Pentagon is gearing up to prepare enough supply of the H1N1flu vaccine for the roughly 2.7-million-strong U.S. military. China View

Antiviral News

The World Health Organization endorsed findings published in the British Medical Journal that there is no clear evidence the antiviral Tamiflu prevents complications such as pneumonia in otherwise healthy people with seasonal flu. But the WHO continues to recommend that Tamiflu, made by Swiss drugmaker Roche be used immediately in people infected with the separate H1N1 virus who are at high risk of complications or whose symptoms persist for three days or worsen. Governments around the world have stockpiled Tamiflu, known generically as oseltamivir, to fight the flu pandemic. Reuters

Global's H1N1 Update - 12/10/09

The next update will be on Tuesday, December 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 November 29th 2009

National News

The latest figures from the Public Health Agency of Canada show six new deaths reported in the six-day period that ended on December 9th, occurring in British Columbia, Alberta, Quebec, and Newfoundland. By comparison, the agency had reported 28 deaths in the previous period. The national total of laboratory confirmed H1N1 deaths is now 363. Canadian Press

Fatal cases of H1N1 flu result from a devastating form of lung damage virtually identical to the pulmonary devastation caused in the 1918 and 1957 global flu outbreaks. Autopsy studies revealed a consistent pattern of deeply penetrating damage throughout the lungs' lower airways. Dr. Jeffrey Taubenberger, a pioneering flu scientist at NIAID in Maryland, adds that the autopsy cases also revealed evidence of secondary bacterial infections, mostly pneumococcal pneumonia, and methicillin-resistant staphylococcus aureus. Kelowna.com

For a few weeks this spring, the world's attention was focused on a cluster of remote First Nations communities in northern Manitoba. As critically ill residents were airlifted daily to hospital, the reserves appeared to be at the Canadian epicentre of the H1N1 flu outbreak. The WHO has pointed to Canada as an example of how the virus took a harsher toll on people facing poverty. Aboriginal leaders are saying the outbreak should be a wake-up call to people about the squalid living conditions, lack of accessible health care, and poor education on Canadian reserves. Canadian Press

International News

H1N1 flu has struck isolated North Korea, although it was unclear whether there were any fatalities from the virus that has been circling the globe for months. North Korea made its first acknowledgment of an H1N1 outbreak with a short dispatch in state media citing nine confirmed cases in northwestern Sinuiju on the Chinese border and in Pyongyang, the capital. Winnipeg Free Press


The Chinese mainland reported 125 deaths from the A/H1N1 influenza in the week from November 30th to December 6th, nearly 65 percent of the number of deaths for the whole of November. About 13.7% of all the 326 deaths reported so far were pregnant women. Cao Zhixin, a doctor at Beijing Chaoyang Hospital, said the high percentage was because pregnant women were generally unwilling to take medicines or X-ray checks. China View

The number of deaths in mainland France from the H1N1 flu virus jumped in the last week. The toll rose to 68 deaths as of November 22, with 22 new deaths last week. Six of the 68 victims had no underlying health problems. 750,000 people have already been vaccinated but many vaccination centres are now facing long waiting lines. Reuters

Vaccine News

Millions of dollars worth of H1N1 vaccine could go unused in B.C. because demand for the flu shot has declined. The province ordered four million doses of the vaccine from the manufacturer at a cost of $32 million. There was a strong demand when the vaccine first arrived in B.C. in late October. Now, however, with slightly more than half of the doses distributed to clinics, but not all used, there is a real possibility of excess supply as demand drops. 40% of the population and 45% of health workers have been vaccinated. Vancouver Sun

B.C.'s H1N1 vaccine clinics will close on December 18th. Medical Health Officer Dr. Perry Kendall said that people should take advantage of the clinics until then to get immunized against the H1N1 flu. Winnipeg Free Press

According to Alberta Health Services, Calgary’s H1N1 immunization clinics continue to remain steady, with no plans yet to shut them down or cut hours. When at the peak, Calgary clinics were doling out 18,000 to 20,000 H1N1 shots a day, but that number has since dropped to about 5,000 to 6,000. Metro News

When the H1N1 flu vaccine was most scarce, health officials gave thousands of doses to corporate clinics at Walt Disney World, Toyota, defense contractors, oil companies, and cruise lines. There was public outcry last month over Wall Street firms such as Goldman Sachs receiving doses while doctors and hospitals encountered shortages. The data show other companies got the vaccine in October and early November. In some cases, early doses went to people not deemed most at risk by the Centers for Disease Control and Prevention. According to Anne Schuchat, the CDC's immunization director, each state health department must decide how to provide the vaccine to people most at risk, and employers are a legitimate venue. USA TODAY

Flu vaccine shortages in developing nations may destabilize global security should the H1N1 virus become more deadly. According to David Heymann, a former deputy head of the World Health Organization, inequitable access to immunization could inflame international tensions since there aren’t adequate measures in place to ensure less developed countries have access to vaccines. About 200 million doses of H1N1 flu vaccine have been donated to WHO for distribution and the WHO will start immunizing health care workers in developing nations this month. Bloomberg

Fewer Europeans are getting pandemic flu vaccine than typically get seasonal flu shots, as safety concerns and lower-than-expected death rates have damped demand. The U.K., Ireland, Italy, Germany, and France have vaccinated less than 10% of their populations, compared with 20% in Europe in a typical flu season. Public concerns that the vaccines made by GSK, Novartis, and Baxter may cause serious side effects have kept some Europeans on the sidelines since governments began vaccinating residents for free in October. Bloomberg

Germany plans to sell more than two million H1N1 vaccinations abroad due to weak domestic demand. Only about 5% of the public has been vaccinated, according to Health Minister Philip Roesler. He said he was checking with other countries to see if they needed any of the medicines and that Ukraine had already signaled interest. Reuters

Global's H1N1 Update - 12/08/09

The next update will be on Thursday, December 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 November 29th 2009

National News

Within the last 20 days, WorkSafeBC. has investigated four refusals for unsafe work in school districts, including two in Victoria, with each case involving pregnant teachers who didn't want to work because they said it was unsafe due to the potential to contract H1N1 while at work. WorkSafeBC. concluded that the H1N1 risk for employees will likely be lower than the risk in the general community. B.C. Public School Employers' Association has advised school districts that based on the WorkSafeBC. findings, "it will not be deemed to be unsafe for a pregnant teacher to go to work in the classroom where the potential to contract H1N1 exists." Canada.com

Nearly 10 per cent of Manitobans who were on ventilators with a severe H1N1 illness last spring had a history of tuberculosis. Manitoba's chief medical officer Dr. Joel Kettner said there is no clear evidence that suggests there is a higher rate of H1N1 severe illness among people with TB. However, he said many of the risk factors for both diseases overlap, including living in remote northern communities, poverty, and substance abuse. Kettner said there is a possibility people with active TB could have damaged lungs or a weakened immune system that may make them more susceptible to H1N1. Winnipeg Free Press

International News

Influenza activity continues to increase in much of Central Europe in the region between the Baltic and Balkan countries and from Germany to Romania. In Western and Central Asia, disease activity continues to increase in Kazakhstan, Kyrgyzstan, Uzbekistan, Iran, and Iraq. In East Asia, increasing respiratory disease activity has been reported in Southern China and Japan. Influenza activity continues to increase in the north-western parts of India, Nepal, Sri Lanka, and Cambodia. In Africa, pandemic H1N1 2009 virus continues to be isolated from all parts of the continent, and there is evidence of continued co-circulation of pandemic (H1N1) 2009 and seasonal H3N2 viruses. WHO

The number of deaths from the H1N1 flu virus has hit 100 in Japan as a 74-year-old man died after infection. Flu transmission is still active in East Asia and it remains "stably elevated in Japan," but may be decreasing slightly in cities there, according to the World Health Organization. Reuters

Kenya and Togo would be the first African countries to receive the vaccine from WHO. Health workers, medical and nursing students, pregnant women, children who are malnourished, and those with chronic diseases such as diabetes and lung diseases are high risk targets. However, this first consignment of 730,000 doses to Kenya would be enough for two percent of the population while the remaining eight percent would be made available by March. Capital News

The Korea Centers for Disease Control and Prevention has published a report saying that influenza A (H1N1) virus is more threatening to lung disease patients because it is difficult to distinguish flu symptoms from their chronic illnesses. Its analysis of the 117 deaths suspected to be linked to the H1N1 virus showed that of them, cancer patients represented the largest number at 30. Chronic lung disease patients suffering from chronic obstructive pulmonary disease, bronchiectasis, and other ailments came next and diabetes and chronic heart disease patients followed. Korea Times

Vaccine News

The Public Health Agency of Canada says there have been 48 cases of a severe allergic reaction reported in people who have had H1N1 shots. As of the week of Nov. 20, nearly 12.3 million doses of vaccine had been distributed across the country. The rate of anaphylactic reactions is 0.39 per 100,000 doses, which the agency says doesn't exceed the normal rate seen for the administration of vaccines. Winnipeg Free Press

Vaccination clinics across Ontario are closing their doors because fewer people are getting the H1N1 shot and clinic employees need to return to their regular programs. Hamilton's associate medical officer, Christopher Mackie, said the city no longer needs the public clinics because there has been a decline in illness rates. Other large health districts across the country do not plan to shut their vaccination clinics in the immediate future. Halifax, Vancouver, and Winnipeg are all planning to keep their clinics open until mid-December, or depending on need. Globe and Mail

The Strategic Advisory Group of Experts on immunization, that reports to the Director-General of WHO, has reported that H1N1 cases continue to occur mostly in teenagers and young adults, with rates of hospitalization highest in very young children. Mathematical modelling conducted on southern hemisphere data suggests a 20 – 40% infection attack rate. SAGE recommended that public health considerations support the use of a single-dose of vaccine in adults and in adolescents aged greater than 10 years. WHO

With H1N1 poised to enter history as the least deadly of four global flu pandemics, some experts are calling for an end to Canada's mass vaccination program. H1N1's "reproductive number" — the number of people each infected person passes the virus to — was above one when the epidemic began, which led to the explosive initial increase in cases. According to Dr. Fisman, a University of Toronto expert in infectious disease dynamics, the recent drop in cases suggests Canada has hit the critical fraction of the population that needs to be vaccinated to control the pandemic. Despite that view, Chief public health officer David Butler-Jones said that, while 30 per cent of the population is now immune to H1N1, "millions" of people are still at risk of infection. The Gazette

Second half-dose H1N1 immunizations for eligible children will begin December 7th at all the H1N1 immunization sites in Saskatoon. The second half-dose dose is required only for children aged 6 months to less than 3 years and for children over 3 years of age and less than 10 years who have a high risk medical condition. Parents, whose children need an additional dose, should wait at least 21 days after the child's first dose before getting the booster shot. Saskatoon News

The European Medicines Agency warns that data from GlaxoSmithKline PLC showed a higher number of children aged six months to 3 years had a fever after their second dose of GSK’s Pandemrix vaccine. Kids were also more likely to have side effects like muscle pain, drowsiness, and irritability. The European regulator recommends children get two doses of H1N1 flu vaccine though GSK says one dose is enough. GSK’s vaccine contains an adjuvant, a chemical compound to boost the immune response. It is sold across Europe and Canada. Associated Press

Premier Jean Charest is urging Quebecers who haven't yet been inoculated to get their H1N1 flu shot. Charest was vaccinated on December 6th at an inoculation centre in his home riding of Sherbrooke. Public health officials say there are still four million Quebecers who haven't been vaccinated. CBC

Global's H1N1 Update - 12/03/09

The next update will be on Thursday, December 3rd, 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 November 22nd, 2009

National News

Despite evidence that an epidemic peak has been reached by all Canadian provinces and territories, the number of people with flu-like illnesses seeking medical treatment is three times higher than what is normally seen at this time of year. The highest proportion of H1N1 infections is occurring in people under 15 and 40% of deaths are occurring in people age 40 to 65. As well, 40% of those admitted to intensive care, and one-third of those who have died of pandemic H1N1 have not had any pre-existing medical conditions. The Gazette

Chinese officials indicated they would lift the 2009 H1N1-related ban on Canadian pork and pork products from Quebec, Manitoba, and Alberta provinces after shutting it out earlier this year. The announcement comes as Canadian Prime Minister Stephen Harper arrives in Beijing for his first official visit to China. China is an important export market for Canadian pork producers who in 2008 exported 47 million Canadian dollars worth of pork and live swine. Associated Press

International News

Croatia has received its first 140,000 doses of the vaccine against the H1N1 virus and a vaccination program started there on Nov. 27. However, interest in the vaccine among Croatian citizens has been relatively low so far, as many people have said they were not convinced in the safety of the vaccine. Croatia has ordered 1.5 million doses of the vaccine to date. Reuters

The French government has confirmed vaccination centres would stay open seven days a week against six at present to cope with a surge in demand for vaccinations. France has set up some 1,200 centres and after a slow start to their vaccination campaign, doctors have reported a flood of people seeking treatment over the past week, leading to waits of several hours. Student medical interns and army doctors have been called in to help meet the huge demand. Reuters

According to WHO reports, more than 1,000 deaths from the H1N1 virus were officially reported in the past week. More than half of the latest fatalities were reported by health authorities in the Americas region. The winter flu season arrived early in the northern hemisphere this year and continues to be intense across parts of North America and much of Europe. Reuters

South Korea's health authorities will push to vaccinate nearly 40 percent of the country's population against the H1N1 influenza virus as part of a national effort to protect people from the contagious disease. The vaccination will be carried out on a total of 19.5 million people by the end of February. The move comes as demand is growing for vaccination shots amid lingering fears of the influenza which has killed more than 100 people in the country since mid-August. Emirates News Agency

Vaccine News

Six weeks into the H1N1 vaccination effort, provinces and territories have vaccinated 32% of Canadians with the three northern territories reporting 50% rates of immunization. The percentages were calculated based on estimates of doses delivered provided by the provinces and territories and population estimates from Statistics Canada. CTV

With about 360,000 Ottawa residents vaccinated against H1N1 flu, public health officials are turning their attention to fighting the seasonal flu. From December 2nd, some physicians will offer the seasonal flu vaccine, in addition to the H1N1 flu shot, to every resident over six months old. Ottawa’s public health department has received an initial 25,000 doses of the seasonal flu shot. Ottawa Citizen

As British Columbia public health officials announced eight more deaths from H1N1 flu and 93 more hospitalizations in the past week, one individual reportedly died after getting vaccinated and having the H1N1 virus, since the vaccine takes up to two weeks to confer protection. The national rate of adverse events after H1N1 vaccination is 1.8 per 100,000 doses, based on 8.24 million doses across Canada so far. There have been about 175 adverse reactions to the vaccine in B.C. Global BC

Manitoba doctors can now give out the H1N1 flu vaccine. Health Minister Theresa Oswald says the province has enough vaccine to make the shot more widely available. Up until now, the vaccine has only been available at mass immunization clinics. Winnipeg Free Press

Drug giant GlaxoSmithKline says one of its H1N1 vaccines has been certified by the World Health Organization after examining its quality and safety data, making it available for donors to buy for developing countries. The vaccine contains an adjuvant, a chemical compound to boost the immune system. Winnipeg Free Press

Antiviral News

Infectious disease experts worry the H1N1 virus will drive a surge in antibiotic prescribing, potentially leading to more drug-resistant organisms. As Canada enters the normal peak season for flu, doctors are facing a perennial problem: how to distinguish flu from bacterial infections such as meningitis and serious Group A streptococcal infections, which share some of the same symptoms recommended in screening questions for H1N1, including fever, sore throat, headache, muscle aches, vomiting, and diarrhea. Should doctors face what they term "diagnostic uncertainty," doctors will prescribe the antibiotics as well as an antiviral medicine, such as Tamiflu, just in case. Vancouver Sun

The World Health Organization says there is no evidence to date that Tamiflu-resistant viruses spread outside of two clusters of cases among immunocompromised patients in hospitals in Wales and the United States. Early results suggest the resistant viruses do not spread easily to healthy people, especially those following proper infection control procedures. Health care workers treating people with compromised immune systems need to watch for signs of Tamiflu resistance. If resistance emerges, doctors should use another flu drug, Relenza. To date there have been no cases of H1N1 resistance to Relenza reported worldwide. Canadian Press

Global's H1N1 Update - 12/01/09

The next update will be on Thursday, December 3rd, 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 November 22nd, 2009

National News

The World Health Organization is sending a representative to monitor for potential disease outbreaks at the 2010 Winter Olympics in Vancouver, but Games officials and health experts say the threat from H1N1 has likely passed. Most athletes, officials, and spectators are expected to be vaccinated against H1N1 by the time the Winter Olympics begin in February. Associated Press

The Public Health Agency of Canada has said that the current wave of H1N1 activity may have peaked in all provinces and territories. But Dr. Frederick Hayden at the University of Virginia is forecasting increased flu activity after Christmas, because so many people remain susceptible to the virus. Regardless of where the experts come down on the question of a third wave, they say the H1N1 virus will return, which should convince more Canadians of the value of getting vaccinated at this point. Canadian Press

Canada’s top doctor in her first major speech as head of the Canadian Medical Association, Dr. Anne Doig told the Economic Club of Canada in Toronto that both doctors and patients are frustrated that politicians waged a war of words alleging mismanagement of the nation’s response to H1N1. She also bluntly decried the “nasty” politicking that has erupted around the country’s H1N1 response and challenged federal politicians to hold an open, honest discussion about how to fund future health care. Toronto Sun

International News

In temperate regions of the northern hemisphere, the early arriving winter influenza season continues to be intense across parts of North America and much of Europe. Very high activity is being seen in Sweden, Norway, Moldova, and Italy. Impact on health care services is severe in Albania and Moldova. In East Asia, influenza transmission remains active. Influenza activity in India and Nepal and Sri Lanka has increased. In the tropical areas of Central and South America, most countries continue to report declining influenza activity, with the exception of Ecuador and Venezuela. WHO

The Centers for Disease Control and Prevention has reported H1N1 flu infections dropping, but that the number of children who died from the illness has risen. Widespread infections were reported in 32 states as of November 21st, down from 43 states the week before. The CDC also said there were 27 new lab-confirmed H1N1 deaths in children under 18. That's the largest one-week increase since the new virus was identified in April. About 200 pediatric U.S. H1N1 deaths have been reported to CDC so far. Associated Press

Despite fears about the new waves of the H1N1 flu virus spreading by pilgrims travelling to and from Mecca following Hajj, Saudi Health Minister Abdullah Al-Rabeeah said the virus had claimed the lives of only five pilgrims. The Governor of the Mecca region, Prince Khaled Al-Faisal, also confirmed that 73 cases including 5 deaths have tested positive for the virus during this year's Hajj. Only 10 percent of some 2.5 million pilgrims attending this year's Hajj had been vaccinated against the virus. Press TV

China's Ministry of Agriculture has called for intensified monitoring and investigation of H1N1 flu in animals after two samples from sick dogs tested positive for the virus. The China Agricultural University reported two out of 52 samples from sick dogs tested positive for the H1N1 flu virus. The news comes 10 days after four pigs in China's Heilongjiang province were diagnosed with the virus. Countries including the U.S., Canada, and Chile have already reported cases of animals testing positive for the virus. Red Orbit

Vaccine News

The push to get Ontario residents inoculated against H1N1 is turning next to workplaces and college and university students as Ontario hopes to head off a third wave of H1N1. Ontario has launched a $650,000 "Join the Resistance" ad campaign to encourage college and university students to roll up their sleeves for the H1N1 flu shot. Associated Press

The federal government will make a decision in the next couple of weeks about what to do with tens of millions of unused doses of H1N1 vaccine. The admission came after Health Minister Leona Aglukkaq revealed the Public Health Agency of Canada will provide 5.7 million doses of pandemic vaccine to the provinces next week - a shipment which could fulfill the country's H1N1 vaccine needs. Associated Press

Japanese regulators have arrived in Canada to begin investigating reports that GSK’s H1N1 vaccine has been linked to a number of allergic reactions. The Ministry of Health Labour and Welfare, which arrived in the country on November 30th, will examine Health Canada’s response to the problem. The Japanese government has ordered 37 million doses of GlaxoSmithKline’s vaccine as part of its response to the ongoing H1N1 pandemic, with delivery expected to take place next month. In-Pharma

The World Health Organization, which has been stressing the safety and importance of H1N1 shots, had its own staff vaccinated against the pandemic virus. Employees wanting the H1N1 flu jabs were taken from the WHO's Geneva headquarters to a Swiss army barracks as part of Switzerland's national vaccination plan against H1N1. The WHO has repeatedly said the vaccines are safe and should be given first to medical workers and those at highest risk of severe infection, especially children and pregnant women. Reuters

Thousands of B.C. residents now have the option of receiving H1N1 and seasonal flu vaccinations from pharmacists authorized to give injections. More than 300 pharmacists have received official authorization to administer injections from the College of Pharmacists of BC. With about 2,800 community pharmacists practicing in more than 1,000 B.C. community pharmacies, and many pharmacies open evenings and weekends long after physicians' offices and public health units have closed, pharmacists are a logical, additional resource for injections administration. CNW Group

Weekly Feature

Recently, Novartis opened a plant in North Carolina, U.S. which uses the latest cell culture technology to manufacture vaccines. Find out the progress of an international move by pharmaceutical companies away from the egg-based vaccine manufacturing technique to more efficient techniques, which may result in a universal influenza vaccine, in this article in the Wall Street Journal. Wall Street Journal

Global's H1N1 Update - 11/26/09

The next update will be on Thursday, November 26th, 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 November 15th, 2009

National News

Four more Albertans with H1N1 influenza have died, bringing the total number of deaths related to swine flu to 51 in this province. Alberta Health Services said the victims, who were all from the Edmonton area and all had underlying medical conditions. The most recent deaths come as the Alberta Liberals continue to criticize the government for its handling of the H1N1 vaccination program and the high rates of hospitalization and death in the province. Alberta's death rate from H1N1 flu is 11.39 per million people--nearly double the national average of 6.49 per million. Calgary Herald

According to provincial health officer, Dr. Perry Kendall, between 335,000 and 670,000 B.C. residents have been infected with H1N1 flu in the past few months. While there have been only 6,700 lab-confirmed cases, public health experts believe there are 65 to 135 actual cases for every lab-confirmed case. The falling numbers of deaths, emergency room visits, hospitalizations, and doctor visits, as well as lower numbers of H1N1 tests and antiviral medications dispensed, suggests the pandemic may have peaked. Vancouver Sun

International News

Dr. Debra Parsons, an American physician who claimed to have contracted the H1N1 virus twice now has her self-diagnosis confirmed by the Centers for Disease Control in Atlanta. Parsons first came down with the virus in August and then again in October. She was tested both times, and the results were the same – they were positive for influenza A. John Law, spokesman for the West Virginia Division of Health and Human Resources, said the possibility of getting the flu twice was "very, very, very rare." Charleston Daily Mail

The number of confirmed deaths reported by EU and EFTA countries due to the pandemic rose by two thirds in the last week to 169. Routine surveillance reports from primary care indicate that almost all European countries reported intensity above baseline levels. Seventeen countries showed increasing trends. The European Committee on Human Medical Products has strengthened its previous statement that a single injection of the vaccines Focetria and Pandemrix may be sufficient to protect children over age 10 and adults to age sixty. ECDC

The World Health Organization (WHO) warned that the Avian Influenza or A-H5N1 remains a threat to humans, with newly confirmed cases reported in Egypt, Indonesia, Thailand, and Vietnam. In a statement, WHO said the presence of the A-H5N1 in poultries in these countries poses a health risk in two ways. First, those in direct contact with birds are in danger of contracting the virus. Second, the virus can undergo re-assortment with another influenza virus, producing a new strain. Philippine Star

The World Bank Board of Executive Directors has approved a $US491 million loan for influenza virus prevention and control in Mexico. Some of the goals of this project include: improved performance of SINAVE, the national epidemiological surveillance system; vaccination of more than 10 million Mexicans against influenza A/H1N1; 2.15 million antiviral treatments stockpiled in the country’s strategic reserves; and establishing the central epidemiological analysis unit and state epidemiological offices. World Bank

Vaccine News

According to Canadian Health Minister, Leona Aglukkaq, by the end of this week, more than 15 million doses of the H1N1 vaccine will have been distributed to provinces and territories, enough to immunize half the population. So far, one-quarter of Canadians, more than eight million people, have received the H1N1 vaccine. At least three million more doses will be available next week. In most parts of the country, H1N1 shots are available to all, and lineups have dwindled. CBC

Dr. David Butler Jones, head of the Public Health Agency of Canada, has confirmed 24 cases of a type of severe allergic reaction called anaphylaxis in Canadians who have received an H1N1 flu shot, including one person who died after getting vaccinated. It is still not clear whether the vaccine or health problems caused the death. Anaphylaxis is a severe allergic reaction that can cause a person's airways to close up and must be treated quickly with adrenaline. Canadian Press

Quebec will become the latest province to start vaccinating the general population for the H1N1 flu. Health Minister Yves Bolduc says Quebec will begin inoculating the general public by November 25th in several regions of the province after receiving a large shipment of the vaccine. Bolduc says health workers in the rest of the province are expected to get the green light next week to begin vaccinating the general public. Canadian Press

Mass immunization clinics for the H1N1 vaccine in Manitoba are slated to wrap up in two weeks and health officials are urging people to get the shot while they can. Dr. Sande Harlos, the medical officer of health for the Winnipeg Regional Health Authority, said the amount of people who have been immunized represents about 27 per cent of the city's population. She would like to see the number closer to 40 or 50 per cent by the time the campaign is over. In total across the province, about 300,000 people have been vaccinated. CBC

Mexico's health ministry announced that it had received its first 865,000 doses of pandemic H1N1 vaccine. 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 7 million doses by the end of 2009 and 30 million doses by February 2010 from Sanofi and GlaxoSmithKline. Latin America Herald Tribune

Weekly Feature

Find updated guidelines on the H1N1 pandemic vaccine, including recommended recipients, dosages, and routes of administration, from the Public Health Agency of Canada

Global's H1N1 Update - 11/24/09

The next update will be on Thursday, November 26th, 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 November 15th, 2009

Vaccine News

Public health officials in Winnipeg say unusually low numbers of people are attending clinics to be vaccinated against the H1N1 virus. The Winnipeg Regional Health Authority reported that clinics on November 20th attracted 4,400 people, a drop from previous averages of 16,000 people per day. CBC

The H1N1 flu vaccine is now available to every British Columbian after a week of low turnouts at immunization clinics, some of which have operated at as little as 50 per cent capacity. Vancouver Sun

Alberta's H1N1 vaccination clinics opened to the general public on November 23rd for the first time since late October when long lineups and vaccine shortages prompted the province to suspend the program and reopen it for high risk groups only. CBC

Quebec's health minister, Yves Bolduc, is optimistic that the general population of Montreal will be able to get their H1N1 flu shot earlier than December 7th. However, this move will hinge on the number of new doses being shipped in the coming days. Regardless, Bolduc says an announcement should be made in the near term. CJAD

Nova Scotia expanded its H1N1 flu vaccination campaign on November 20th to include the general public. Dr. Robert Strang, Nova Scotia’s medical health officer, said officials felt comfortable in opening up the program because a steady supply of vaccine is expected in the coming weeks. Canadian Press

The Public Health Agency of Canada and vaccine manufacturer GlaxoSmithKline have asked the governments of Manitoba, British Columbia, Alberta, Saskatchewan, Ontario, and Prince Edward Island to stop using a batch of 172,000 doses. Six allergic reactions occurred from the same batch, a higher percentage than usual, according to a spokeswoman for the Public Health Agency. Overall, the number of severe allergic reactions following H1N1 vaccinations is less than 1 per 100,000 doses, the norm for other vaccines. All six people who experienced the allergic reactions have recovered. Reuters

Novartis will officially open the first next-generation flu vaccine plant in the United States this week, but it will be years before it makes its first vaccine. The factory in Holly Hill, North Carolina, will use batches of dog cells to grow influenza vaccine, instead of the chicken eggs widely used now. While the cell method is only slightly faster, it can be scaled up more quickly. Reuters

National News

The Public Health Agency of Canada says that the number of outbreaks at schools and hospitals, the prevalence of flu-related doctor visits, and the number of flu cases for testing across the country has declined, leading to suggestions that the pandemic has peaked. In Ottawa, the number of flu cases fell far enough for local health authorities to close all but one of the city's flu assessment clinics. In Vancouver, a flu clinic at the B.C. Children's hospital also shut down as the number of patients eased. South of the border, fewer Americans are visiting their doctor because of H1N1, according to the Centers for Disease Control. Absentee rates at U.S. schools have returned to normal as well.. CTV

A Vancouver Coastal Health review has found that Richmond Hospital was not at fault in the death of a Richmond, B.C. woman who died of H1N1 after being sent home from the hospital twice. Mae Mah, 51, died of H1N1 on November 1st, hours after being sent home from Richmond Hospital. She had also been to the hospital the day before. Mah had asthma, and had been experiencing breathing problems and fever, but H1N1 was not diagnosed until after her death. Vancouver Sun

International News

In temperate regions of the northern hemisphere, the winter influenza season continues to intensify across parts of North America and much of Europe. However, there are early signs of a peak in disease activity in Western Europe. Further east, Serbia, Norway, Lithuania, Bulgaria and Ukraine reported sharp increases in the rates of flu-like symptoms. In Central and Western Asia, increasing diseases activity and pandemic influenza virus isolations continues to be reported in several countries. In East Asia, influenza transmission remains active. In the tropical areas of Central and South America, most countries continue to report declining influenza activity. With the exception of Sri Lanka, flu activity is declining in tropical South and Southeast Asia. WHO

The Norwegian Institute of Public Health has informed the WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness. Norwegian scientists have analyzed samples from more than 70 patients with clinical illness and no further instances of this mutation have been detected. The virus with this mutation remains sensitive to the antiviral drugs, oseltamivir and zanamivir, and studies show that currently available pandemic vaccines confer protection. WHO

Officials from Japan, China, and South Korea have agreed to share information on food safety and coordinate measures against the outbreak of the H1N1 influenza virus. The Japanese minister of health, labor and welfare, the Chinese health minister and the South Korean minister of health, welfare and family affairs, took part in talks held in Tokyo on November 23rd. Xinhua

Uzbekistan has closed its border with central Asian neighbor Kazakhstan to all but citizens of each nation returning home, as H1N1 spreads in both countries. The World Health Organization reported that Kazakhstan, Uzbekistan, and parts of Afghanistan were reporting higher numbers of flu cases. Reuters

According to the French influenza surveillance system, nearly 2 million French residents have been infected with the H1N1 virus since August. French Health Minister Roselyne Bachelot announced that 200,000 persons thus far have received vaccine injections and urged the vaccination campaign to go "on full acceleration" because of increased virus activity. China View

China's Ministry of Health has ordered all administrative and medical departments to ensure accurate reporting of H1N1 influenza cases, in response to a medical expert from the Chinese Academy of Engineering saying that he did not believe there had been only 53 deaths from the H1N1 virus nationwide. Allegedly, some areas had left dead patients undiagnosed in order to conceal the number of deaths from the flu. The ministry had dispatched nine teams to 12 provinces and autonomous regions to oversee prevention and treatment of the flu, especially treatment of severe cases. China View

Weekly Feature

Find updated guidelines on the H1N1 pandemic vaccine, including recommended recipients, dosages, and routes of administration, from the Public Health Agency of Canada

H1N1 Update - 11/19/09

The next update will be on Tuesday, November 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 November 8th, 2009

Vaccine News

Manitoba Health has announced that on November 18th, the general public will be able to receive the pandemic H1N1 vaccine. Joel Kettner, Manitoba's chief public health officer, said the decision to eliminate the priority list was based on dwindling demand among the priority group and an upward swing in the supply of vaccine arriving weekly. Winnipeg Sun

Ontario Health Minister Deb Matthews has announced that starting November 18th, anyone in Ontario over the age of six months will be able to get vaccinated against the H1N1 virus. CTV

According to Quebec Health Minister Yves Bolduc, by November 22nd, more than 1.3 million Quebecers would have been inoculated against the H1N1 virus. The number of new hospitalizations, still on the rise, is not as worrisome as health authorities initially expected, though some regions, such as Montreal's South Shore, are reportedly being hit harder than others. Ottawa Citizen

Newfoundland and Labrador Health Minister Jerome Kennedy says he is considering making senior citizens the next candidates for vaccination, even if it means overruling the advice of medical experts. Health officials have said people over the age of 65 are considered to have a lower risk of becoming infected with the H1N1 virus than other members of the population. CBC

Alberta’s H1N1 immunization program will expand at the end of this week to include all children under 18, as well as their family and caregivers. And it may expand even further, depending on demand for the vaccine over the weekend. Immunization for seniors will expand shortly to include those 65 years old and above, as well as their spouse or partner of any age. Edmonton Sun

Prince Edward Island will begin vaccinating the general population by November 30th. The PEI Health Department is getting ready to make expected long lines at H1N1 vaccine clinics easier to manage with an arm band system. Charlottetown Guardian

As Canadian health officials assured the public that the pandemic H1N1 vaccine is as safe as the seasonal flu shot, British Columbia Centre for Disease Control said it is probing why B.C. residents are suffering anaphylaxis, an adverse reaction to the vaccine, at a higher rate compared with the previous five seasonal flu vaccination programs. In British Columbia, the rate of adverse reactions is 2.2 per 100,000 doses distributed, compared to 1.2 per 100,000 doses usually. None of the 18 anaphylaxis reactions in B.C. resulted in death. Globe and Mail

Prisoners and staff at Newfoundland's largest prison have been given the H1N1 vaccine to reduce the spread of the virus. The Eastern Health district said the inmate population at Her Majesty's Penitentiary in St. John's was identified as an at-risk group by the Public Health Agency of Canada. Inmates and others in closed correctional facilities are considered at-risk because they live in a confined environment that makes them vulnerable to the spread of a virus. Canadian Press

National News

With more than half of Toronto Public Health's staff deployed to work related to the H1N1 influenza pandemic, some regular programs have been suspended, including sexual health clinics, home visits for new mothers, and some food safety inspections. The impact has been greatest due to nurses being redeployed to work in 10 public vaccination clinics. Health Zone

Teachers in some B.C. public schools have started refusing to work because they contend that the H1N1 illness among students has created an unsafe workplace. By law, employees have a right to refuse work if there is a reasonable cause to believe it poses a health or safety hazard. The teachers' claims of unsafe work prompted an onsite inspection by WorkSafeBC which did not identify a single worksite that was hazardous due to the virus. The B.C. Public School Employers' Association has advised school districts that, based on the WorkSafeBC findings, “it will not be deemed to be unsafe… to go to work in the classroom where the potential to contract H1N1 exists.” Vancouver Sun

International News

51 French schools have been closed due to possible spread of the H1N1 virus or emergence of confirmed cases, according to the French Education Ministry. Since the epidemic broke out in France, the government has granted the regional prefects right to close classes or even schools if three flu cases emerge in the same class during one week or cross infection are possible for different classes sharing same activities. Xinhua

According to a survey of doctors, more than half of Britons being offered vaccination against pandemic H1N1 flu are turning it down because they fear side effects or think the virus is too mild to bother. Many of the 107 family doctors polled by Britain's Pulse magazine said there was widespread resistance from patients, particularly pregnant women, and on average only 46 percent of those offered the vaccination would agree to receive it. Reuters

A new study of pandemic H1N1 cases in Mexico, by Dr. Victor Borja-Aburto of the Mexican Institute for Social Security, and colleagues, found the death rate was above 10% in those aged 70 or older, 5.7% among those aged 60 to 69, 4.5% among those 50 to 59, 2.7% for those 40 to 49, 2% for those 30 to 39 years and 1.6% for infants under the age of one. In terms of catching the disease, those aged 10 to 39 were most affected, comprising 56 per cent of all cases in the study that were confirmed as H1N1 flu. Canadian Press

Another 42 people have died of H1N1 flu in Iran over the past week, raising the Islamic republic's death toll from the illness to 100. Iran has placed restrictions on Muslims planning to travel to Mecca in Saudi Arabia for the annual hajj pilgrimage later this month. Straits Times

Eighteen more people have died in South Korea from the H1N1 virus, raising the country's total death toll from the new flu to 82. An 11-year-old girl and a 42-year-old man died after being diagnosed with the H1N1 virus, both of them not classified as being in the high-risk category and given antiviral medication. Korea Times

Global's H1N1 Update - 11/17/09

The next update will be on Thursday, November 19th, 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 November 8th, 2009

Vaccine News

A number of groups in British Columbia are now eligible for the vaccine, including firefighters, people 65 and older with chronic health conditions, healthy children from five to 18 years old, and health care workers delivering acute care, long-term care, home care, and public health services. Vancouver Sun

Children younger than 10, seniors and anyone with compromised immune systems, who are not eligible for the unadjuvanted vaccine, will not be able to get the H1N1 vaccine in Winnipeg on November 16th as vaccine shipments were delayed. Winnipeg Sun

Alberta will be offering H1N1 flu vaccine to the general public later this week, with a gradual introduction to avoid the hours-long lineups that arose early in the mass immunization campaign. Seniors will be the first group phased into the program. CBC

10 H1N1 vaccination clinics in Toronto, Ontario will now be open seven days a week, starting Monday. Children from six-months of age to 13 years old and those with a chronic health condition, as well as those over the age of 65, are now included in the high-priority group. 680 News

Dr. Robert Strang, the chief public officer of health for Nova Scotia, has announced that pregnant women and people between the ages of 10 and 64 with a chronic illness who are otherwise healthy will now be able to get injected with the unadjuvanted vaccine. Chronicle Herald

Public health authorities in Quebec opened new vaccination centres on November 16th, including a mega-clinic at the Palais des Congrès in Montreal, to keep up with demand for inoculation. The Palais des Congrès clinic has the ability to vaccinate up to 300 people per hour according to Montreal's Public Health Agency. CBC

The Public Health Agency of Canada announced it is changing its recommendation for healthy children aged three to nine, saying they probably do not need a second shot of the vaccine to be protected. The decision is based on promising data, scarcity of vaccines, and is a position advocated by the WHO. The agency said kids aged three to nine with chronic diseases may need a second shot and infants and toddlers aged six to 35 months should get two shots of the vaccine. The agency reserved the right to revisit the decision in the future if newer scientific data point to a need for two doses for these children. Canadian Press

National News

According to experts at the Ottawa Health Institute, comparing seasonal flu fatalities to H1N1 deaths is absolutely statistically unfounded since seasonal flu numbers are estimates and mathematical calculations aimed at capturing all the deaths influenza had a hand in. The H1N1 figures count deaths directly attributed to the pandemic virus. A 2007 study looking at 10 years worth of influenza deaths in Canada reported that deaths directly attributed to seasonal flu made up only eight per cent of all influenza-related deaths in a given year. Canadian Press

Canada's chief public health officer, Dr. Butler-Jones officer has commented that the H1N1 pandemic virus appears no deadlier than regular seasonal influenza and that there could actually be substantially fewer flu deaths than normal this season. Although H1N1 is disproportionately infecting more children and otherwise healthy young adults, according to Dr. Butler-Jones, the mortality rate is no worse than seasonal flu. Canada's national pandemic plan estimated a flu outbreak could cause 15 to 35% of the population to fall clinically sick, and force the hospitalizations of 34,000 to 138,000 people. So far, an estimated seven to eight per cent of the population has been infected in the first and second wave. National Post

Opposition Liberal MPs have asked the federal government to translate information about H1N1 into minority languages, ranging from Chinese to Arabic to Farsi, to allow ethnic Canadians to properly understand the disease. Several local public health units across Canada have ended up having to use their own limited resources to translate information about the virus and vaccine. The opposition also wants the Conservative government to reactivate a 2004 contingency fund brought in by the Liberals to assist public health initiatives in the event of a pandemic. Toronto Sun

B.C.'s Provincial Medical Officer of Health, Dr. Perry Kendall, has commented that B.C. is likely through the second wave of the H1N1 flu outbreak and a third wave is unlikely. Kendall says every region in B.C., except for the north, has seen a decrease in doctor-patient visits. News 1130

International News

In the United States, Europe, and Central Asia, influenza transmission remains geographically widespread and intense. In Europe and Central Asia, overall influenza transmission continues to intensify throughout the continent as pandemic activity spreads eastward. High to very high intensity of respiratory diseases with concurrent circulation of pandemic H1N1 2009 was reported in many countries in the area. WHO

In Western Asia, increasing activity has been observed in several countries like Israel and Afghanistan. In East Asia, very intense and increasing influenza activity continues to be reported in Mongolia with a severe impact on the healthcare system. Most countries in the tropical region of Central and South America continue to report declining influenza activity. With the exception of Nepal and Sri Lanka, overall transmission continues to decline in most parts of South and Southeast Asia. WHO

According to the Robert Koch Institute for infectious diseases, laboratory confirmed cases of H1N1 flu infection in Germany have more than doubled in the past week, to more than 15,000 reported new cases. As of November 14th, 16 people had died from the flu in Germany, with more than 50,000 infected. ABC News

Spain and Greece launched vaccination campaigns against H1N1 on November 16th. Spain's health ministry said the government has bought 37 million doses of the vaccine and will vaccinate pregnant women, health workers and those with serious illnesses. Health authorities in Greece said a total of 700,000 doses would be made available on a voluntary basis to doctors, ambulance staff, and other high-risk employees. AFP

A young woman was diagnosed with Guillain-Barre Syndrome (GBS), possibly linked to the vaccine being used protect the French public against H1N1 flu. GBS is a rare disease that could lead to death if severe pulmonary complications and nervous system problems are present. Every year, about 1,700 cases of the disease are diagnosed in France. Health Minister Roselyne Bachelot said the case diagnosed was light and that the woman was recovering. Earth Times