(0830 HRS PST)
The next update will be on Saturday, June 13, at 11:00 PST
Yesterday, the World Health Organization (WHO) raised its pandemic alert level from Phase 5 to Phase 6 as a result of the ongoing spread of the novel influenza A (H1N1) virus. Phase 6 is the official WHO declaration that a pandemic is underway. It is characterized by human-to-human spread of the virus in at least two countries in one WHO region, as well as community-level outbreaks in at least one other country in a different WHO region. Human-to-human spread of the virus in Mexico, Canada, and the United States, as well as community-level outbreaks in Australia, has led to this declaration.
Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th)
Local/National News
- On June 10th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 8th has risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 138 required hospitalization and four deaths have occurred. PHAC
- Following the phase 6 announcement, the Government of Canada issued a statement to reassure Canadians. According to Minister of Health, Leona Aglukkaq, “Today’s decision by the WHO does not change our approach. Entering phase 6 means we will build on the surveillance and management measures that are already in place under the Canadian Pandemic Influenza Plan.” PHAC
- Amid rising novel flu cases and hospitalizations, Manitoba's regional health authority warned residents to limit hospital visits and asked people with flu-like symptoms to stay away. Two more people were placed on ventilators yesterday, bringing the total to 27. Many are from the province's First Nations communities. The chief of one group said authorities are sanitizing public places and that crowded housing is contributing to the spread of the flu. Globe and Mail
International News
- Today, the WHO released its latest case count for novel H1N1 influenza worldwide: 29,669 cases and 145 deaths in 74 countries, up 1,932 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (532), Mexico (524), Britain (156), Spain (131), Argentina (87), Australia (83), Japan (33), and China (32). WHO
- By the end of trading yesterday, manufacturers of vaccines and antivirals had seen a sizable increase in their respective share prices. Vaccine makers, GlaxoSmithKline and Sanofi Aventis saw their stocks rise 4.07% and 1.28% on the day. Roche the maker of Tamiflu saw a 3.47% increase.
Vaccine News
- The US CDC recently posted interim guidance on use of the 23-valent pneumococcal vaccine during the novel flu outbreak. The vaccine is still recommended for those aged 65 or older and patients aged 2 to 64 who have certain high-risk conditions. The CDC urges that those younger than 65 who have underlying health conditions receive the vaccine, because vaccination rates are low and rates of severe novel H1N1 infections are high. CDC
- Novartis AG expects a vaccine for the H1N1 virus to be available by the autumn after it produced the first batch for testing ahead of schedule. The vaccine will enter clinical trials next month. Reuters
Antiviral News
- Supplies of oseltamivir (Tamiflu) are scarce at some Australian pharmacies, prompting health minister Nicola Roxon to state that many patients with mild illnesses don't need the drug and that government stockpiles are reserved for those at highest risk, such as those with underlying medical conditions. The country's case count has risen to 1,275, with several hospitalizations, including four with reportedly no risk factors in intensive care units. Herald Sun
Today’s Key Question
What were some of the highlights from the World Health Organization’s (WHO) announcement to move to a pandemic alert level of Phase 6?On June 11th, 2009, the WHO raised the level of pandemic alert to phase 6, the highest level on the six-point scale, indicating that a pandemic is currently underway. Margaret Chan, the Director-General of the WHO, made the official announcement. Important highlights and quotes from this announcement are outlined below:
- “Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.”
Although a pandemic has been officially declared, this does not mean that there is any indication that the severity of the virus has intensified. In fact, the WHO’s alert scale, thus far, does not take a virus’ severity into account, only the degree of geographical spread.
- “We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years. Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years. This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.”
From the data presently available, it would appear that, as is the case with previous pandemics, H1N1 affects an inordinately large proportion of younger individuals.
- “Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.”
The 1918 Spanish Flu, the most severe pandemic of the 20th century, also saw pregnant women at increased risk of complications.
- “We do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.”
It is important to note that although the pandemic currently appears to be only moderately severe, the virus may have increased negative impacts as it spreads to countries with inadequate resources, deficient health care systems, and populations with a higher incidence of underlying medical issues. Chan urged countries to be prepared to see more cases, and focus on the appropriate management of patients and concluded by saying, “We are all in this together, and we will all get through this, together.”
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