GMS INFLUENZA A (H1N1) Update as of June 30, 2009
(0830 HRS PST)
The next update will be on Thursday, July 2nd, at 08:30 PST.
The WHO Pandemic Alert level remains at Phase 6
Influenza A (H1N1) Cases and Deaths
- Yesterday, the World Health Organization released its latest case count for novel H1N1 influenza worldwide: 70,083 cases and 311 deaths in over 100 countries, up 11,079 cases and 48 deaths from Friday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since Monday were United States (6268) Canada (1043), Australia (758), the United Kingdom (653) Philippines (416), China (353), Singapore (284) . WHO
Local/National News
- On June 29th, the Public Health Agency of Canada announced that the number of confirmed cases of influenza A (H1N1) since June 22nd has risen to 7983 from 6,732. Of the Canadian cases thus far, 636 required hospitalization and 25 deaths have occurred. PHAC
- Dr. David Butler-Jones, the country's chief public health officer, said given the behaviour of the new H1N1 virus and the risk it poses, there is little chance Canada wouldn't push ahead with a vaccination program in the fall. "At this point I cannot imagine not immunizing, given the nature of this disease, its variability and its risk to people, both in terms of illness but also serious illness and death," Butler-Jones said. AP
International News
- More than 1 million people in the United States may have been infected with the new H1N1 flu, U.S. health officials said on Friday, and infections continue to rise. "The key point is this new infectious disease is not going away," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said. "In the U.S., we're still experiencing a steady increase in the number of reported cases.” Reuters
- H1N1 flu is supplanting seasonal strains in Australia’s Victoria state, suggesting the pandemic virus will be the major cause of influenza this winter. Tests on 138 type-A flu samples collected by a network of doctors confirmed 60 cases of the new A/H1N1 variant and only five of seasonal influenza in the eight weeks ended June 21, according to a report by the Victorian Infectious Diseases Reference Laboratory in Melbourne. This is a typical feature of past pandemic and is also a factor the WHO will consider in determining when vaccine makers should switch to producing only shots against the pandemic virus.
- Health officials in England said pandemic flu response in two parts of the country will shift from a containment to a management strategy. The change, which affects London and West Midlands, means that schools will no longer close and that antiviral medication will no longer be given to close contacts of flu patients, only those who have illness symptoms. Also, most illnesses will be diagnosed clinically rather than through lab testing. Daily Mail
Vaccine News
- Sanofi Pasteur, one of the five companies that are developing a novel H1N1 vaccine for the US market, said it began large-scale production on Jun 23, according to the company's Web site. The company will still need to conduct clinical trials, which it said in an earlier statement could take place as early as August. In late May the company received a $190 million order from the US Department of Health and Human Services to make bulk vaccine and conduct other activities. Sanofi timeline of novel flu vaccine developments
- The vaccine being developed to combat the H1N1 flu pandemic will require multiple shots to provide immunity from the new virus, and the added immunizations may overwhelm U.S. state agencies, according to US health officials. Two injections will be required three weeks apart for H1N1 flu, and a third will be needed for seasonal flu, health officials said at a meeting at the U.S. Centers for Disease Control and Prevention. Children younger than 9 years old will need four shots. Bloomberg
Antiviral News
- Scientists have established the first case of the new H1N1 influenza strain showing resistance to Tamiflu, the main antiviral flu drug, Danish officials and the manufacturer said on Monday. The patient is now well and no further infection with the resistant virus had been detected. "It does not constitute a risk to public health and does not cause changes to the recommendations for the use of oseltamivir (Tamiflu)," Denmark's State Serum institute said in a statement. Reuters
- The US Department of Health and Human Services (HHS) recently provided a shield against damage claims related to the use of the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) in the current H1N1 influenza pandemic. HHS Secretary Kathleen Sebelius signed a notice extending liability protection under the Public Readiness and Emergency Preparedness (PREP) Act. Liability protection is provided to groups and individuals involved in the development, manufacture, testing, distribution, administration, and use of medical countermeasures, according to HHS. CIDRAP
- The US CDC has updated their H1N1 antiviral guidance; only patients who test positive for pandemic H1N1, influenza A/H3N2, or B should receive the antiviral Tamiflu (oseltamivir). If a laboratory test is not performed or the test is negative but clinical suspicion remains, the preferred treatment is zanamivir or a combination of oseltamivir and rimantadine, which is an older drug of the adamantine class of antivirals. If testing indicates influenza A or unspecified influenza, the preferred treatment is also zanamivir or a combination of oseltamivir and rimantadine. The new guidance appears to be aimed at preventing the inadvertent prescription of oseltamivir for seasonal infections, which have shown extensive resistance to oseltamivir in the United States and other parts of the world. CIDRAP
Recommendations and Guidance
- The US CDC has updated their General Business and Workplace Guidance to state that a worker who has been exposed to a person with pandemic influenza may continue to go to work unless he/she becomes ill. This guidance is for employees with minimal contact with the general public and other coworkers.
Today’s Key Question
Will the added immunizations against H1N1 overwhelm health officials?
According to health officials, the vaccine being developed to combat H1N1 flu, will require two injections, three weeks apart. Furthermore, adults will still require a third shot to provide immunity against seasonal flu, while children younger than nine years old will need four shots as they have little immunity to any flu strain, and need two shots for protection against seasonal flu.
H1N1 flu is a new virus and the majority of the population has no natural immunity. Consequently, the initial shot will provide preliminary exposure to the virus, while the second shot will boost antibody levels in the body. It has been noted that those older than fifty are becoming infected with swine flu at far lower rates than younger people, implying that they may have some immunity from prior exposures to a similar virus. Therefore, according to the US CDC, this age group may only require one shot.
The CDC estimates that at least 50 million doses of the vaccine will become available by October 15th, and later in the season, have enough vaccine to immunize everyone against the virus. The shots will likely be administered through vaccine clinics established by state and provincial health organizations. However, according to William Schaffner, an influenza expert at Vanderbilt University School of Medicine in Nashville Tennessee, “Public health departments are under-funded and will get fatigued.” Additionally, Jeanne Santoli, a CDC representative asserted recently that vaccinations would be slowed if states are responsible for administering shots instead of doctors’ offices and pharmacies. Bloomber
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