Global's Pandemic (H1N1) 2009 Update - July 30, 2009

GMS Pandemic (H1N1) 2009 Update as of July 30th, 2009

(0830 HRS PST)
The next update will be on Tuesday August 4th, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

Local/National News

• The head of the Federation of Canadian Cities has charged that Canada has no national plan for protecting critical frontline workers such as police, firefighters, and transit workers. In an open letter to federal Health Minister Leona Aglukkaq, Basil Stewart said Canada's pandemic plan does not say who will have priority access to vaccines and antivirals. A spokesman for Aglukkaq said ongoing epidemiologic studies will guide vaccine allocation. Globe and Mail


• A majority of Canadians support the way the government has handled the Pandemic H1N1 flu issue, according to a new poll. The Ekos poll, commissioned for the CBC and released Thursday, suggests that 52 per cent of respondents said they support the government's response to the outbreak of the virus, compared to 31 per cent who disapprove. CBC


• According to Nova Scotia’s auditor general, Jacques Lapointe, the province is not as ready as it could or should be. Although Considerable time and effort have gone into preparations, he said, there are several areas that still require work to ensure an effective response. For example, the province does not have an adequate stockpile of medical supplies to protect health-care workers. CBC

International News

• A World Health Organization (WHO) spokeswoman said recently that the agency will host a technical teleconference soon to discuss antiviral use during the H1N1 pandemic and the risks of antiviral resistance. Countries vary in their use of oseltamivir (Tamiflu). Some use it widely for prevention and treatment of mild cases, while others are reserving it for infections in high-risk groups and for severe cases. So far, five antiviral-resistant cases have been identified. AFP


• El Salvador announced it will extend a scheduled school vacation to 2 weeks to fight the spread of the H1N1 flu. School vacations that began recently and last from 2 days to a week, depending on the region, will be extended until Aug 10. The action will affect nearly 2 million students. AP


• Chinese authorities assert that their aggressive quarantine policy to prevent foreign visitors from spreading H1N1 flu has worked well. Officials say China has had few cases and proudly note that no deaths have been reported. But according to the NY Times an American woman who said her surgery for appendicitis was delayed because of the quarantine policy. More than 1,800 Americans have been quarantined in China since the start of the pandemic. New York Times


• About 6% of pandemic H1N1 deaths in the United States have occurred in pregnant women, though they make up just 1% of the population. The numbers are based on 266 detailed death reports that the Centers for Disease Control and Prevention (CDC) has received. Fifteen deaths occurred in pregnant women. The CDC's vaccine advisory committee will meet soon and is expected to list pregnant women among the high-priority groups to receive the pandemic H1N1 vaccine. AP


• The World Health Organization is discussing with South Africa's government how to reduce the risk of H1N1 influenza spreading at next year's soccer World Cup, a spokeswoman for the United Nations agency said Tuesday. The tournament will be played in June and July 2010 -- the height of the seasonal flu period in the southern hemisphere winter. Reuters


• Britain's Department of Children, Schools and Families has come under fire for issuing recommendations that nurseries and "childminders" remove communal soft toys from care settings to help contain the spread of H1N1 flu, saying the toys cannot be cleaned adequately. The agency also recommended that crayons and pencils not be shared and large assemblies be suspended. Defenders of the guidance say it is sensible but should be administered sensitively so as not to upset children. The Times

Vaccine News

• An Associated Press-GfK Roper poll suggests that about 63% of American parents are likely to allow their children to receive the pandemic H1N1 vaccine, but only 51% of adults would probably receive the immunization themselves. Only 43% said they were concerned that they or a family member might contract the new flu virus. The telephone poll, conducted in mid July and released yesterday, included 1,006 adults, of whom 296 were parents. AP-GfK flu poll


• Canadian health officials anticipate using an adjuvant to address the possible need to stretch supplies of an H1N1 influenza vaccine this fall. Neither Canada nor the United States have licensed flu vaccines with adjuvants before. Health Canada has worked with GlaxoSmithKline on safety studies of the AS03 adjuvant for H5N1 vaccine and is urging the company to do a small trial with an H1N1 vaccine. US officials have been more circumspect on the subject. Canadian Press


• The Advisory Committee on Immunization Practices (ACIP), the top US advisory panel on immunizations recommended yesterday that groups totaling up to 159 million people be targeted for vaccination against the pandemic H1N1 influenza virus, but that a narrower population of about 41 million have priority if initial supplies are short. ACIP picked five target groups for initial immunization because of their increased risk of H1N1 infection or complications or their contact with vulnerable people: pregnant women, household contacts of babies under 6 month of age, healthcare and emergency medical services workers, those between 6 months and 24 years of age, people between 25 and 64 years who have chronic medical conditions. CIDRAP

Antiviral News

• Canada's health ministry recently approved an interim order authorizing the use of oseltamivir (Tamiflu) in children younger than 1 year, despite limited safety data. As in the United States, the drug previously had been approved only for use in patients older than 1. The Public Health Agency of Canada requested the action because infants seem to be at higher risk for novel H1N1 flu complications. Canwest News Service


• Japan has detected two more cases of Tamiflu-resistant pandemic H1N1 flu, Alexander Klimov, PhD, of the CDC's flu surveillance branch, revealed at the CDC's vaccine advisory committee yesterday. He also said that Chinese officials revealed during a World Health Organization conference call that they may have one more antiviral-resistant case. Klimov said all cases so far have been linked to Tamiflu prophylaxis or treatment, except for one involving an American girl who was diagnosed in Hong Kong. ACIP meeting

Guidance and Recommendations

• The Government of Canada has released three guidance documents for health care workers and emergency responders to prevent and control infections of H1N1 influenza, Minister of Health Leona Aglukkaq and Canada’s Chief Public Health Officer, Dr. David Butler-Jones, stated. The guidance documents are for workers in acute care facilities, long term facilities, and for emergency response workers including paramedics, ambulance attendants, police officers and firefighters.

Global's Pandemic (H1N1) 2009 Update - July 28, 2009

GMS Pandemic (H1N1) 2009 Update as of July 28th, 2009

(0830 HRS PST)

The next update will be on Thursday July 30th, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

Local/National News

• Canadian health officials are deciding on how much pandemic flu vaccine will be needed in the country this fall. Dr. Arlene King, Ontario's chief medical officer of health, said Monday the order must be placed by the end of the month, and that officials are working on a firm number of how many people will want or need the vaccine. King noted the whole vaccine order will not be ready at the same time, but said officials expect the vaccine to first become available in mid-November. CBC


• Dalhousie university is stepping up its recommendations to fight the flu by encouraging students to keep their distance from one another. The university also advises students to avoid shaking hands, hugging or kissing, hold meetings over the phone, maintain a one-metre distance when meeting in person. CBC

International News

• The United Kingdom's Health Protection Agency (HPA) estimated yesterday that the nation had 100,000 new cases of H1N1 flu in the past week, up from 55,000 the week before. The estimate is based on medical-visit rates for flu-like illness. Children up to age 14 were the age-group most affected, with people older than 65 showing much lower rates, the HPA said. Most cases continued to be mild. HPA pandemic flu update


• Approximately 1 in 6 public health workers said they would not report to work during a pandemic flu emergency regardless of its severity, according to a survey led by researchers at the Johns Hopkins Bloomberg School of Public Health. Newswise


• The global flu pandemic is still in its early stages the World Health Organization's flu chief said Friday. WHO earlier estimated that as many as 2 billion people could become infected over the next two years — nearly one-third of the world population. AP


• Mexico's first known H1N1 flu case was in a 6-month-old baby girl from San Luis Potosi in the northern part of the country. Previously the country's first patient was thought to be a 5-year-old boy who lived near a pig farm in eastern Mexico or a woman from Oaxaca in the southeast. The baby girl first showed symptoms in late February, a Mexican lab official told AFP. AFP


• The Web component of Britain's national flu line, which launched yesterday alongside a telephone service, crashed on Thursday after receiving about 9.3 million hits per hour. The system was reportedly back online a short time later. The system is designed to relieve pressure on doctors' offices by diagnosing novel flu cases over the phone and issuing patients code numbers that allow them to obtain oseltamivir (Tamiflu). Telegraph

Vaccine News

• Europe's drug regulators are fast-tracking the approval process for novel H1N1 vaccines, which could mean they would be used before much human testing is done. Though flu vaccines in the EU usually get thorough testing, authorities plan to evaluate H1N1 vaccines largely based on previous data for H5N1 avian flu vaccines, since both types have the same basic ingredients. Regular safety monitoring will be required as the vaccines are used. AP


• A trade bloc of seven South American nations on Jul 24 demanded exemptions from paying patent fees for vaccines and drugs against the pandemic H1N1 virus. They urged the application of a World Trade Organization intellectual property provision to relax patent rules to protect public health. Argentine President Cristina Kirchner said that though suspending patents could save millions of lives, she wasn't suggesting that the vaccines should be produced for free. AFP

Antiviral News

• Canada's health ministry recently approved an interim order authorizing the use of oseltamivir (Tamiflu) in children younger than 1 year, despite limited safety data. As in the United States, the drug previously had been approved only for use in patients older than 1. The Public Health Agency of Canada requested the action because infants seem to be at higher risk for novel H1N1 flu complications. Canwest News Service

Global's Pandemic (H1N1) 2009 Update - July 23, 2009

GMS Pandemic (H1N1) 2009 Update as of July 23rd , 2009

(0830 HRS PST)

The next update will be on Tuesday July 28th, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

Pandemic (H1N1) 2009 Cases and Deaths

• Citing the questionable usefulness of reporting pandemic H1N1 case counts and the burden it puts on countries experiencing widespread transmission, the World Health Organization (WHO) announced late last week that it will no longer issue regular reports of confirmed global case totals. WHO statement


• A World Health Organization (WHO) official told reporters the H1N1 virus has killed more than 700 people, well above the 429 deaths listed in the WHO's last official update on Jul 6,. The official, Alphaluck Bhatiasevi, said confirmed cases have reached 125,000, far above the 94,000 mentioned in the Jul 6 update. Reuters report

Local/National News

• As of July 21st the total number of deaths associated with the Pandemic H1N1 virus in Canada is now 50. PHAC


• Two Canadian Food Inspection Agency inspectors appear to have contracted Pandemic H1N1 flu while investigating an outbreak of the virus in pigs on an Alberta farm in late April, the agency confirmed Tuesday. The cases appear to be the first reports of people catching the Pandemic H1N1 virus from pigs. The men did not use proper safety techniques while in the barn, apparently removing the N-95 respirators that covered their noses and mouths because they were hot. CP


• B.C. doctors will have to purchase the masks, gowns, gloves and antiviral drugs they need to protect themselves and their patients in their offices during a flu pandemic. B.C.’s provincial health officer, Dr. Perry Kendall, said in a statement published in the B.C. Medical Journal that the province will not follow Ontario’s decision to supply such items, “it is properly the responsibility of the physician to ensure that infection control practices are in place in these offices”. Vancouver Sun


• According to Dr. Patricia Daly, chief medical officer for Vancouver Coastal Health, there are no plans to quarantine or close 2010 Olympic events if there is a severe flu outbreak. “I can tell you right now there is not a lot of evidence they are of any benefit, we have no plans to do any of those things for H1N1. We will not be cancelling any of the Olympic events as a result of the pandemic.” Vancouver Sun

International News

• A special meeting of the US Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) will be held Jul 29 in Atlanta to discuss novel H1N1 flu issues. The group will discuss epidemiology, vaccine development and formulations, and communications, and will hear a report from the FDA's Vaccines and Related Biological Products Advisory Committee. CDC


• Faith groups in Britain are adapting their religious rites in a bid to prevent the spread of the H1N1 virus during worship. Some churches, mosques and temples are encouraging less personal contact between worshippers, and adapting rites such as sharing of vessels or chalices during ceremonial practices across Britain. In addition, those vulnerable to the virus are being discouraged by imams from attending this year's haj Muslim pilgrimage. Reuters

Vaccine News

• Trials of the experimental new H1N1 swine flu vaccine will start at eight university medical centers and clinics next month, starting with vaccines made by Sanofi Aventis and CSL Ltd, U.S. health officials said on Wednesday. The first round of tests will be in adults, but will quickly move to children. Reuters


• Human trials of a vaccine to protect against the pandemic H1N1 flu virus have begun in Australia. Vaxine and CSL have both started injecting volunteers this week, but it will be at least six weeks before the initial results are known. BBC


• Two Chinese pharmaceutical firms kicked off two-month clinical tests on the country's H1N1 influenza vaccines Wednesday. More than 2,000 volunteers have been recruited and during the two-month clinical test, the volunteers would have antibody tests for four times. China View

Antiviral News

• Canada has recorded a case of Tamiflu-resistant swine flu virus, in a Quebec man who had been given the drug to prevent infection. The Quebec man, 60, was given the flu antiviral after his son fell ill with the pandemic virus. It's believed the resistance arose in the man and there is no evidence he transmitted resistant virus to anyone else. "It appears to be an isolated case," said Jirina Vlk, spokesperson for the Public Health Agency of Canada. CP


• Japan revealed Tuesday it had found a second case of Tamiflu resistance, in a person who has no ties to the country's earlier reported case. This case is the fifth globally since the H1N1 virus was discovered in April. CP

Today’s Key Question

How effective are school closures in combating a Pandemic

In a recent review, published in the medical journal the Lancet, researchers evaluated the value and effectiveness of school closures in combating a pandemic.

By reviewing historically data, they found that the effectiveness of school closures depends heavily on the characteristics of a pandemic. For example, it appears that school closures where effective in the 1957 pandemic when much of the virus transmission took place among children. However, they were less effective in the 1968 pandemic when the illness rates were similar among children and adults.

So far in the H1N1 pandemic, a large proportion of cases have been among children and the large numbers of case clusters in schools suggest that school closures will reduce the number of cases.

However, this intervention has a high economic cost. Estimates range from a 1% to 6% decrease in GDP from a 12 week school closure. Moreover, schools also provide a variety of social services such as meal programs to the underprivileged.

The authors conclude that the decision to close schools must be made on the basis of the severity of the pandemic. In addition, it should be considered in combination with a combination of other available interventions, such as antiviral drugs, vaccines, and other non-pharmaceutical interventions. As the H1N1 pandemic could become more severe the current approach of not necessarily recommending school closure might need reappraisal in the autumn.

Global's Pandemic (H1N1) 2009 Update - July 21, 2009

GMS Pandemic (H1N1) 2009 Update as of July 21st, 2009

(0830 HRS PST)

The next update will be on Thursday July 23rd, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

Pandemic (H1N1) 2009 Cases and Deaths

• Citing the questionable usefulness of reporting pandemic H1N1 case counts and the burden it puts on countries experiencing widespread transmission, the World Health Organization (WHO) announced late last week that it will no longer issue regular reports of confirmed global case totals. WHO statement

Local/National News

• Following the lead of the WHO, Canadian Federal public health officials have launched a new way of tracking the spread of the H1N1 virus with a weekly online report designed to spot trends such as a higher number of hospitalizations or other unusual activity. "The goal of surveillance is to assess the impact of the H1N1 flu virus on our communities so that we can adapt our planned responses to the situation at hand," chief public health officer David Butler-Jones said at a news conference. Toronto Star


• Canada saw a decrease in people with flu-like symptoms last week, suggesting that community transmission of the H1N1 virus is decreasing. Most cases have been mild, but there were still "pockets of more severe disease" in some communities, Health Minister Leona Aglukkaq said at a Jul 17 press conference. Canwest


• The median age of Pandemic flu cases among Inuit people is significantly younger than that among other Canadians. The median age of Inuit cases is nine, half the median for First Nations cases (19 years) and non-aboriginal Canadians (18 years), PHAC said Friday in its weekly influenza update, FluWatch. According to PHAC this may be due to the region’s young population demographics. AP


• Canadian companies and organizations are being urged in a new report to consider the swine flu pandemic as a "business continuity crisis" and to put response plans in place now, before the fall flu season arrives. The Conference Board of Canada report released Monday examines the actions some organizations have already taken and provides advice on what should be included in pandemic response plans. Vancouver Sun


• When vaccination against the novel H1N1 virus begins, Canada will be able to fill all of its vaccine needs within its borders. In 2001, Canada signed a contract with a vaccine maker that is now owned by GlaxoSmithKline that requires the company to be able to make pandemic vaccine for Canadians whenever needed. The contract was prompted by an incident during the 1976 swine flu outbreak, when Canada never got the vaccine it ordered from the United States. Canadian Press

International News

• British Airways has told its check-in staff to look out for passengers showing symptoms of the H1N1 virus and to alert doctors who could bar them from boarding a flight, the airline said on Sunday. "If they have any concerns about a passenger when they present for check-in, they have a 24-hour medical number to call and the passenger can then be checked." Virgin Atlantic has also adopted similar measures, according to the Sunday Times newspaper. Reuters


• Messages from two health groups in Britain yesterday caused confusion about the dangers posed by the pandemic H1N1 virus to women who are pregnant or may become pregnant. The Royal College of Midwives said pregnant women should not use public transport, while the National Childbirth Trust suggested that women delay pregnancy until the pandemic ends. Government health officials described the groups' advice as extreme and said their advice to women had not changed. Times Online


• In a risk assessment published yesterday, the European Centre for Disease Prevention and Control (ECDC) said to expect 20% to 30% of the population to be affected during the next wave of pandemic H1N1, with the attack rate highest in children and young adults. Though it admits uncertainty, the ECDC says a "reasonable" assumption is a hospitalization rate of 1% to 2%. It also estimates a case-fatality rate of 0.1% to 0.2% and says, "this pandemic can severely stress healthcare systems." ECDC report

Vaccine News

• An expert panel that advises the US Department of Health and Human Services (HHS) supported the idea of moving quickly on pandemic H1N1 vaccine production with a goal of having "tens of millions of doses" available in September instead of October. Discussing vaccine issues during a public teleconference, the National Biodefense Science Board (NBSB) favored the idea of asking vaccine makers to start the final production steps for their H1N1 vaccines on Aug 15—before the first data from safety and immunogenicity trials will be available. HHS has not yet made a formal decision to go ahead with a vaccination campaign, but HHS Secretary Kathleen Sebelius said the step was likely. CIDRAP


• Experts warn that if the H1N1 flu pandemic turns severe, countries that have vaccine factories might seize vaccine supplies, rendering contracts that promise doses to other countries meaningless. Many vaccine contracts that countries have signed involve doses made outside their borders. In a severe pandemic, countries with vaccine plants might decide to seize all doses and ban their export, said David Fidler, a law professor at Indiana University, and other experts. AP


• The vaccine maker Baxter International said it has orders for 80 million doses of H1N1 flu vaccine and can take no more. The Illinois-based company has orders from five countries, including Britain, Ireland, and New Zealand, said spokesman Chris Bona. Though the company is taking no more orders, it has agreed to reserve some doses for the World Health Organization, Bona said. Reuters


• Germany plans to provide H1N1 flu vaccine to 22.5 million people, including healthcare workers, police, and people with chronic ailments. The target groups make up slightly less than a quarter of Germany's population, the story said. The nation's compulsory health insurance program will pay for the immunizations and notify those eligible for the vaccine. Bloomberg

Antiviral News

• The US HHS wants to increase the proportion of zanamivir (Relenza) in the national stockpile relative to oseltamivir (Tamiflu), in light of a few recent instances of H1N1 resistance to the latter. The current split is 80% oseltamivir and 20% zanamivir; the agency would like to move to 50-50, but that will take time. CIDRAP


• The US HHS is considering issuing an emergency use authorization for peramivir, an antiviral drug that is in phase 3 clinical trials but not yet licensed. "It's under consideration whether we should have some of that drug available for individuals in desperate need," said Dr. Robin Robinson, director of HHS's Biomedical Advanced Research and Development Authority. CIDRAP

Guidance and Recommendations

• New guidelines on outbreaks of H1N1 in closed facilities have been posted by PHAC. Closed facilities include long term care facilities and correctional facilities for young adults. PHAC has also released updated guidelines on clinical care in ambulatory care facilities such as hospitals and clinics.

Today’s Key Question
Why did the World Health Organization (WHO) suspend reporting of H1N1 case counts?

The WHO announced on July 16th that they will no longer issue regular reports of confirmed global case totals of cases of pandemic H1N1. The WHO explained that countries with sustained community transmission are having an extremely difficult time confirming cases through laboratory testing. Furthermore, counting individual cases isn’t essential for monitoring the level or nature of risk posed by the virus or implementing response measures. The WHO will however, provide regular updates on the spread of pandemic flu in newly affected countries.

According to the WHO, detecting and confirming all possible cases is highly resource-intensive. "In some countries, this strategy is absorbing most national laboratory and resource capacity, leaving little capacity for the monitoring and investigation of severe cases and other exceptional events,” said the WHO.

The WHO asserted that in countries where the Pandemic H1N1 virus is already established, the focus of surveillance will shift to existing systems for monitoring seasonal flu. These countries will no longer be required to submit reports of individual case counts and deaths. The WHO has advised countries to continue monitoring for unusual events such as clusters of severe or fatal cases or changes in clinical patterns as this is important. The organization also asked that countries continue to look for changes in patterns which could indicate increasing numbers of severe cases including rising rates of school and worker absenteeism, and surges in emergency department visits.

A spokesperson for the US Centers for Disease Control and Prevention (CDC), said the change in the WHO's case-reporting policy isn't unexpected, because the WHO and CDC have been emphasizing over the past several weeks that the number of lab-confirmed cases is just the tip of the iceberg of the true number of people who are or were sick with the novel H1N1 virus. Moreover, Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, said he fully supports the WHO's policy change. Osterholm believes that the media and other groups have made too much of the case numbers, which grossly underestimate the illness burden.

Furthermore, Peter Sandman, PhD, a New Jersey-based consultant and risk-communication expert, was also supportive of the WHO’s decision. He told reporters that, early on in the H1N1 outbreak, the WHO urged countries to track the number of confirmed cases to help assess community transmission; however, the usefulness of the numbers has declined. According to Sandman, one problem with reporting the case numbers is that it makes the pandemic appear less pervasive than it actually is, as the number of reported cases is likely greatly smaller than the actual number of cases. Furthermore, Sandman argued that an emphasis on the number of confirmed cases, along with the number of deaths makes it appear to the public, and even certain government and health officials, that there is a higher case fatality ratio than there actually is. "The pandemic H1N1 virus could get more deadly at any time," Sandman said. "But if you compare the number of pandemic deaths in the US to the CDC estimates of how many people have already had the disease, it calculates out that the pandemic is less deadly than seasonal flu so far."

Global's Pandemic (H1N1) 2009 Update - July 16, 2009

GMS Pandemic (H1N1) 2009 Update as of July 16th, 2009

(0830 HRS PST)

The next update will be on Tuesday July 21st, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

PLEASE NOTE: The World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE) have decided to use "Pandemic (H1N1) 2009" for the name of the novel influenza virus currently circulating globally.

• On July 6th, the World Health Organization released its latest case count for novel Pandemic (H1N1) 2009 influenza worldwide: 94,512 cases and 429 deaths in over 100 countries, up 4,591 cases and 47 deaths from July 3rd. WHO

Local/National News

• On July 15th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of Pandemic (H1N1) 2009 influenza since July 13th has risen to 10,156 from 9,714. Of the Canadian cases thus far, 1,115 required hospitalization and 45 deaths have occurred. PHAC


• A young child in Metro Vancouver is the first known British Columbian to die from the H1N1 influenza virus. A young Metro Vancouver woman who lived with someone who had the H1N1 virus has also died. She also had an underlying medical condition, and was admitted to hospital last Wednesday. It has not been confirmed that she had the H1N1 virus. CBC


• Dozens of children at three summer camps in Ontario's Muskoka region have been sent home after an outbreak of swine flu, health officials said Wednesday. Dr. Charles Gardner, medical officer of health for the Simcoe-Muskoka District Health Unit said most of the cases are mild and that the children were sent home to make it easier for the camps to manage the remaining children. Health officials aren't recommending parents remove their children from other camps, but they do say children should remain at home if they have flu-like symptoms. CBC


• The Assembly of Manitoba Chiefs unveiled the first stage of its pandemic plan for the approaching flu season late yesterday. The plan includes the creation of kits for people living on Manitoba's remote reserves. Thus far, the plan is to distribute 15,000 medical kits at a cost of about $100 per kit to First Nations' populations located in remote areas of Manitoba (the Manitoba Assembly of Chiefs is actively raising funds). The Assembly is also considering a "comprehensive public education initiative." Further pandemic plans will be released in the future. Digital Journal


• Candidates for national chief in the coming Assembly of First Nations election also urged the federal government Tuesday not to place aboriginals at the bottom of the queue to receive critical H1N1 flu vaccines, or to take their time delivering drugs to reserves. “When a vaccine is created, remote communities should be one of the top priorities in getting the vaccine, because they're obviously more susceptible. It's certainly a fear that it won't happen,” said John Beaucage, the grand council chief for Ontario's Anishinabek Nation. Globe and Mail

International News

• Officials in Bangkok, Thailand said they will close 435 city schools for 5 days to fight the flu pandemic. The schools will be thoroughly cleaned during the interval. Also, Thailand's cabinet decided today to order 2 million doses of an H1N1 vaccine, with delivery expected by December, the story said. Thailand has had 4,057 H1N1 cases with 24 deaths. Reuters


• The American Lung Association (ALA) has asked about 50 summer camps with which it is affiliated to close, after four children who attended one of the camps were diagnosed with H1N1 flu. An ALA spokeswoman said she wasn't sure how many ALA camps would follow the advice. Patients who have asthma and other chronic conditions are at greater risk for flu complications. In June the Muscular Dystrophy Association canceled its camps for similar reasons. AP


• Five thousand surgeries were postponed in Chile last week to free up hospital beds for patients with H1N1 flu. The number of delayed procedures could rise to 20,000 over the next few weeks as the country continues to battle the pandemic. As of the last World Health Organization update on Jul 6, Chile had 7,376 H1N1 cases and 14 deaths. Santiago Times


• Nurses at a hospital in Vallejo, California, filed a complaint today with the state's Division of Occupational Safety and Health alleging that their facility hasn't supplied them with adequate masks for caring for patients with pandemic H1N1 influenza. Ten nurses reportedly got sick after treating three patients with novel flu infections. AP


• Sketchy or distorted data could cause misleading early judgments about the threat posed by swine flu, experts writing in the British Medical Journal (BMJ) said on Tuesday. According to the WHO, 94,512 cases of Pandemic H1N1 have been reported, causing 429 deaths. These suggest a case fatality ratio -- the proportion of deaths in the number of people known to have fallen sick -- of around 0.5 percent, which is in the upper range for a run-of-the-mill seasonal flu. While not saying that the novel flu is any less -- or any more -- virulent than thought, the researchers point to "biases" in data collection. For example, one problem they note is the data trawl does not include people who catch the virus but who do not fall sick, or those who feel only a little under the weather and so do not bother to consult a doctor. AFP

Vaccine News

• Inovio, a biotechnology company based in San Diego, recently announced promising results in a preclinical trial of its DNA vaccine against pandemic H1N1 influenza. All pigs immunized with a two-dose regimen showed an antibody response, the company reported. The firm said it is conducting other animal studies to determine if the seasonal and pandemic H1N1 vaccines it is developing provide cross-protection against other circulating influenza strains. Inovio press release


• The US government will commit $884 million to buy additional pandemic H1N1 vaccine antigen and adjuvants, Health and Human Services (HHS) Secretary Kathleen Sebelius announced on Tuesday. The products will be additional orders under existing contracts with Sanofi Pasteur, MedImmune, GlaxoSmithKline, and Novartis, an HHS news release said. The announcement is an apparent follow-up to Sebelius's comment on CNN 2 days ago that the agency would spend another billion dollars on H1N1 vaccines. HHS announcement


• The medical establishment in Britain is scrambling to roll out a large-scale vaccination program in an effort to protect its population. The state-run health system is deciding whether to hire private contractors to help doctors carry out the massive vaccination job, said Peter Holden, a general practitioner who represents the British Medical Association in pandemic-flu planning with the government. Doctors would rather handle the shots themselves, he said, but as phone calls and office visits related to swine flu have jumped, they are concerned the extra work will overwhelm them unless they suspend some other routine care. Wall Street Journal

Guidance and Recommendations

• The US Centers for Disease Control and Prevention has published pandemic guidance for medical offices and other outpatient facilities. Entitled 10 Steps You Can Take: Actions for H1N1 Influenza Planning and Response for Medical Offices and Outpatient Facilities, it covers steps these facilities should consider in preparation for the fall.

Today’s Key Question

Is H1N1 more serious than seasonal flu?

In a study published recently in Nature, researchers conducted a host of both in vitro and in vivo experiments to characterize the risks of the novel Influenza A (H1N1) virus. Yoshihiro Kawaoka, PhD, a researcher from the University of Wisconsin-Madison who led the study, said recently that the study may help clear up misunderstandings people have about the new virus. "People think this pathogen may be similar to seasonal influenza," he said. "This study shows that is not the case. There is clear evidence the virus is different than seasonal influenza."

The research group evaluated the pathogenicity of H1N1 in four animal models: mice, ferrets, macaques, and pigs. They used pandemic H1N1 viruses obtained this year from patients in California, Wisconsin, the Netherlands, and Japan, as well as a seasonal flu virus from Japan. The scientists found that the pandemic H1N1 virus replicated more efficiently in the lungs and that it exhibits a different pro-inflammatory cytokine response pattern in infected animals. However, they wrote that more study is needed to understand the relevance of the cytokine findings.

The researchers found that the transmission patters for the pandemic H1N1 virus were comparable to that of seasonal influenza strains. They also determined that, the pandemic H1N1 flu virus replicated efficiently in the respiratory organs of pigs, however, pigs infected with pandemic H1N1 were asymptomatic, despite having slightly more apparent bronchitis and bronchiolitis, which may explain why now Pandemic H1N1 flu outbreaks in pigs were detected before the virus surfaced in humans.

The researchers also tested the susceptibility of the flu viruses to various antivirals. In general both pandemic H1N1 and the seasonal flu virus were susceptible to antivirals, however, antiviral resistance was seen against seasonal flu.

Although the results of this study are important, experts acknowledge that there are limitations with animal studies because it is unsure what the results mean for humans. Vincent Racaniello, PhD, professor of microbiology at Columbia University and author of Virology Blog said "We have already had over a million—probably several million—human infections with the new strain, and all agree the symptoms are mild, similar to those of seasonal flu…So it's not clear to me why these results should suddenly make us all fear that the new virus is in fact more virulent than we think."

Adolfo Garcia-Sastre, PhD, a virologist at Mount Sinai School of Medicine in New York City, also noted that, although he believed this study to be comprehensive, “Previous H1N1 immunity in humans may dampen some of the more severe disease seen in animal models, which are naive."

Global's Daily Pandemic (H1N1) 2009 Update - July 14, 2009

GMS Pandemic (H1N1) 2009 Update as of July 14th, 2009

(0830 HRS PST)
The next update will be on Thursday July 16th, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

PLEASE NOTE: The World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE) have decided to use "Pandemic (H1N1) 2009" for the name of the novel influenza virus currently circulating globally.

• On July 6th, the World Health Organization released its latest case count for novel Pandemic (H1N1) 2009 influenza worldwide: 94,512 cases and 429 deaths in over 100 countries, up 4,591 cases and 47 deaths from July 3rd.. WHO

Local/National News

• On July 10th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of Pandemic (H1N1) 2009 influenza since July 8th has risen to 9,714 from 9,429 . Of the Canadian cases thus far, 894 required hospitalization and 39 deaths have occurred. PHAC


• The death of a 25-year-old Calgary mother from the H1N1 virus has left her family reeling and wondering how the otherwise-healthy young woman could have been struck down by the flu so suddenly. Vanessa Bluebell died in hospital early Thursday just days after being admitted, leaving behind four sons ages 1, 3, 4 and 7. National Post

• Health authorities in Canada and the United States are on high alert for Internet scams related to pandemic flu and are cracking down on websites that are selling unauthorized products and making illegal claims about how to prevent and treat the illness. Among the products that have popped up online are:




• A pill that is purported to cure flu infection within hours


• A spray that claimed to leave a layer of ionic silver on the skin that would kill the virus


• Wall-mounted ultraviolet light machines that allegedly prevent the spread and destroy the virus


• An electronic instrument that declared its "photobionic energy" and "deeply penetrating mega-frequency life-force energy waves" would strengthen the immune system and prevent infection Canwest

International News

• An outbreak of pandemic H1N1 flu at California’s San Quentin State Prison led officials to limit the acceptance of new inmates and halt the transfer of prisoners to other correctional facilities. Nearly half the prison’s 5,153 inmates have been placed under quarantine after 47 exhibited flu-like symptoms. LA Times


• US influenza activity decreased in early July but stayed above normal for this time of year, the CDC said in its weekly flu surveillance report today. More than 97% of the influenza A viruses that were subtyped were the Pandemic H1N1 virus. Nine states still reported widespread flu activity, while 10 states and Puerto Rico reported regional activity. Five pandemic H1N1-related pediatric deaths were reported. The proportion of medical outpatient visits due to flu-like illness was below the national baseline. CDC flu report


• The US tally of pandemic H1N1 flu cases has risen to 37,246, with 211 deaths, the CDC reported on Friday. The numbers are up by 3,344 cases and 41 deaths since the last CDC report on Jul 2. Wisconsin led the list with 6,031 cases and 4 deaths, followed by Texas (4,463 and 21), Illinois (3,259 and 14), New York (2,582 and 52), and California (2,461 and 31). CDC

Vaccine News

• H1N1 Pandemic flu vaccine production has hit a snag, with manufacturers reporting a disappointingly low yield when vaccines viruses are grown in eggs. The World Health Organization says so far the yield for egg-based production is half or less what manufacturers get when they make vaccine to protect against seasonal H1N1 viruses. If the yield cannot be increased, it will slow the rate at which pandemic vaccine comes out of the production pipeline, adding to the time it takes to protect populations. AP


• The WHO’s Strategic Advisory Group of Experts (SAGE) recently met and recommended that all countries should immunize their health-care workers as a first priority to protect the essential health infrastructure. Moreover, Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, said that that “The committee recognized that the H1N1 pandemic ... is unstoppable and therefore that all countries need access to vaccine." WHO


• The United States will order another $1 billion worth of pandemic H1N1 influenza vaccine, Health and Human Services (HHS) Secretary Kathleen Sebelius. "There'll be another $1 billion worth of orders placed to get the bulk ingredients for an H1N1 vaccination," Sebelius told CNN, without naming the suppliers. Sebelius had announced on May 22 that HHS would spend about $1 billion to buy vaccine antigen and adjuvant and fund clinical studies. Reuters story


• The US federal government expects to mount an H1N1 vaccination campaign this fall, initially targeting schoolchildren, adults with health problems, pregnant women, and healthcare and emergency workers, a top US official said late last week. “"While we have made no final decisions about its scope, and have 'off ramps' built into our decision making process if the circumstances change, at this point, we expect to initiate a voluntary fall vaccination program against the 2009 H1N1 flu virus," said Health and Human Services (HHS) Secretary Kathleen Sebelius. CIDRAP


• Australia-based flu vaccine maker CSL Ltd said on Monday that it expects to launch a human trial of its novel H1N1 vaccine on July 22nd. In a press release, CSL said it would undertake the trial with a research group in Adelaide and was seeking healthy adults aged 18 to 64 to enroll in the study to compare two injections of a standard dose, administered 3 weeks apart, with a higher dosage. The Australian government has ordered enough vaccine to immunize 10 million people. Bloomberg News

Guidance and Recommendations

• Canadian Health Minister Leona Aglukkaq and Chief Public Health Officer Dr. David Butler-Jones recently released guidelines for health professionals on caring for pregnant women with H1N1 flu virus. "Thankfully the majority of H1N1 illness in Canada is mild, but we are seeing that some people, including pregnant women, are more susceptible to serious illness and complications," said Minister Aglukkaq. "To help protect mothers and their babies, experts at the Public Health Agency of Canada have worked with their provincial and territorial partners to develop clinical care guidelines that will help healthcare professionals treat pregnant women more effectively." PHAC


• The Centers for Disease Control and Prevention (CDC) recently updated its guidance on caring for people who are sick with pandemic H1N1 flu at home. The revision incorporates interim guidance on facemask and respirator use that the CDC updated in late May. The updated home care guidance suggests that all caregivers, not just those in high-risk groups, who must have close contact with a sick person try to use a facemask or N-95 disposable respirator. CDC home care guidance

Today’s Key Question

When does the World Health Organization (WHO) expect the Pandemic H1N1 Flu vaccine to become available?

According to the WHO, it may be several months until a fully-licensed pandemic H1N1 flu vaccine is available to the public.

The pandemic H1N1 flu viruses currently being used to develop a vaccine are only producing about half as much of the required "yield" as do regular flu viruses, and WHO has asked its laboratory network to produce a new set of viruses as soon as possible. According to Marie-Paule Kieny, director of the WHO’s initiative for Vaccine Research, a lower-producing vaccine could significantly delay the timelines for vaccines which would in turn delay many Western countries’ plans to begin public vaccination campaigns in the fall.

Moreover, before countries can start any mass swine flu vaccination campaigns, the vaccines need to be vetted by regulatory authorities for safety issues. That means testing the vaccines in a small number of humans first, which can take weeks or months. "I think it will be a very significant challenge to have vaccines going into peoples' arms in any meaningful number by September," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

There is also still the question of who will get the first doses of vaccine once they become available. According to Kieny, many of those questions remain unanswered at the moment; however, she said the WHO's vaccine advisory group recommended that health care workers receive the first Pandemic H1N1 flu shots since they are on the front lines of the global outbreak. Furthermore, the WHO’s vaccine experts have recommended that countries decide which groups – such as pregnant women, or people with chronic respiratory problems – should get the vaccine first.

In addition, several drugmakers are considering the use of adjuvants, ingredients which can stretch a vaccine's active ingredient, allowing for many more vaccine doses. However, data is limited on the safety of vaccines with adjuvants in populations including children and pregnant women, and in the U.S., there are no licensed flu vaccines that use adjuvants. Associated Press.

Global's Pandemic (H1N1) 2009 Update - July 9, 2009

GMS Pandemic (H1N1) 2009 Update as of July 9th, 2009

(0830 HRS PST)

The next update will be on Tuesday July 14th, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

PLEASE NOTE: The World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE) have decided to use "Pandemic (H1N1) 2009" for the name of the novel influenza virus currently circulating globally.

• On Monday, the World Health Organization released its latest case count for novel Pandemic (H1N1) 2009 influenza worldwide: 94,512 cases and 429 deaths in over 100 countries, up 4,591 cases and 47 deaths from Friday, July 3rd. Countries reporting the greatest increase in laboratory-confirmed cases since Friday were Argentina (898), Australia (730), Thailand (662),) Peru (378), Japan (344) and China (226). WHO

Local/National News

• On July 8th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of Pandemic (H1N1) 2009 influenza since July 3rd has risen to 9,429 from 8,883. Of the Canadian cases thus far, 878 required hospitalization and 37 deaths have occurred. PHAC


• Two farm workers in Saskatchewan have become infected with a new flu virus, health officials said on Tuesday, stressing the strain was not related to Pandemic (H1N1) 2009. The two workers have fully recovered. Reuters


• Health officials have isolated a unit on the third floor of the Alberta Children's Hospital in Calgary because of three Pandemic (H1N1) 2009 flu cases. The hospital has stopped admitting new patients to the unit, which usually treats children with kidney problems, because one staff member and two children are confirmed to have Pandemic (H1N1) 2009 flu. Patients already there have been isolated, and only their parents or close family are being allowed to visit them. CBC


• About 200 infectious disease experts have gathered in Toronto to discuss the Pandemic (H1N1) 2009 flu virus. The meeting is aimed at sharing information from across the country and setting up research collaborations. Canadian Press


• A dancer from one of the troupes taking part in The Halifax International Tattoo has tested positive for the Pandemic (H1N1) 2009 flu. Tattoo marketing manager Thomas Grotrian said organizers were told the case was nothing to worry about, and the final show will go ahead as scheduled. The Chronicle Herald

International News

• In an upcoming study, Dr. Michael Gracey, a medical adviser to Unity of First People of Australia, an aboriginal non-profit organization, suggests that the world's almost 400 million indigenous peoples — including about 1.2 million in Canada — are especially at risk for contracting Pandemic (H1N1) 2009 flu because they often live in remote, impoverished communities with limited access to medical infrastructure. Moreover, according to Gracey, “indigenous people are susceptible to infections because they have low immunity, they're often undernourished, and they often have pre-existing illnesses." Canwest News


• Chile's health ministry recently cancelled a large religious festival, set to converge on a small town in the southern part of the country, in an effort to slow the spread of Pandemic (H1N1) 2009. The dance and music celebration typically brings 200,000 visitors to the town of La Tirana. The World Health Organization said yesterday Chile has confirmed 7,376 Pandemic (H1N1) 2009 cases. Santiago Times


• The WHO said yesterday that it will soon advise most countries to ease the volume of testing for Pandemic (H1N1) 2009 influenza and move toward larger surveillance indicators such as influenza-like illnesses or pneumonia hospitalizations. CIDRAP


• Pandemic flu fears and the global economic crisis are taking their toll on bookings at hotels in the city of Mecca, two months before the start of a minor pilgrimage (Umra) that attracts up to two million Muslim pilgrims. Globe and Mail


• Many local health departments in the United States were slow to alert residents to the public health threat posed by the new Pandemic (H1N1) 2009 influenza virus in April. Researchers at the non-profit, research organization Rand Corp said only a third of 153 local health departments surveyed posted information about the new influenza virus on their websites within the first 24 hours after federal health officials declared a public health emergency. Reuters

Antiviral News

• Over the past week Public health authorities in in Denmark, Japan and Hong Kong have reported a total of three cases of Pandemic (H1N1) 2009 in which the virus was resistant to a key antiviral drug. "Right now this looks like spontaneous mutation in these patients," Dr. Keiji Fukuda of WHO, said at a press conference on Tuesday. He said all three patients had the same mutation and all three had "uncomplicated" disease from which they made full recoveries. WHO

Guidance and Recommendations

• The American College of Emergency Physicians (ACEP) recently released a plan to help emergency departments, first responders, and public health departments manage a surge in pandemic flu cases that many experts predict will happen this fall. The 16-page plan defines critical capabilities and suggests ways to achieve them. CIDRAP


• The Centers for Disease Control and Prevention (CDC) has released interim guidance for preventing and managing novel Pandemic (H1N1) 2009 infections in obstetric settings. Severe illnesses in pregnant women and infants have been a feature of the flu pandemic. The new guidance says areas where prenatal care, labour, and delivery services are delivered should be separated from areas where the sick are handled. CDC


• The Centers for Disease Control and Prevention (CDC) has released Recommendations for State and Local Planning for a 2009 H1N1 Influenza Vaccination Program. The purpose of this document is to describe planning scenarios for state and local governments to target high-priority populations for vaccination in order to reduce the health and societal impact of the pandemic.

Today’s Key Question

What are the recommendations for pregnant women?

The US CDC has been highly active in its recommendations for pregnant women, publishing several guidance documents. The following is a high-level summary of these recommendations:

• Pregnant women with influenza-like symptoms and cough / sore throat, in the absence of a known cause other than influenza, should be treated as thought they have influenza.


• Pregnant women with confirmed / probable / suspected H1N1 illness should take considerations to minimize the potential for exposure when delivering their infants, as infants are assumed to have a higher risk of complications from H1N1. As such they should:
  

• Be given antivirals as soon as possible;


• Be isolated from health pregnant women;


• Don a surgical mask during labor and delivery;


• Be placed in isolation, avoiding contact with her newborn, following delivery; and


• Be encouraged to express milk but the milk will be given to the newborn by a non-ill individual.


• The mother can resume caring for her child when she has been receiving antivirals for 48 hours, her fever has resolved, and she can control coughs and secretions,


• Breastfeeding should be protected and supported at all times because of the protection from respiratory infection that breast milk provides to the infant.

• The newborns of ill mothers should be considered as potentially infected and should be closely monitored for signs and symptoms of the flu. If symptoms of influenza develop, oseltamivir treatment should be considered.


• For pregnant women who have been exposed to, or are close contacts of, clinicians with laboratory-confirmed Pandemic (H1N1) 2009 can consider post-exposure antiviral chemoprophylaxis.

Global's Influenza A (H1N1) Update - July 7, 2009

GMS INFLUENZA A (H1N1) Update as of Ju ly 7th, 2009

(0830 HRS PST)

The next update will be on Thursday July 9th , at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6

• Yesterday, the World Health Organization released its latest case count for novel H1N1 influenza worldwide: 94,512 cases and 429 deaths in over 100 countries, up 4,591 cases and 47 deaths from Friday 's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since Friday were Argentina (898), Australia (730), Thailand (662),) Peru (378), Japan (344) and China (226). WHO

Local/National News

• On July 3rd, the Public Health Agency of Canada announced that the number of confirmed cases of influenza A (H1N1) since June 29th has risen to 8,883 from 7,983. Of the Canadian cases thus far, 663 required hospitalization and 29 deaths have occurred. PHAC

International News

• The United Nations may need more than $1 billion this year to help poor countries fight the global swine flu epidemic, Secretary-General Ban Ki-moon said Monday. Ban said the money is needed to ensure that poor countries get some vaccine doses and antivirals if the global epidemic continues to spread. AP


• The death toll from H1N1 flu in Argentina continued to rise as the President said she would not rule out closing major public venues where the virus could spread more quickly. Dr. Juan Manzur, the new health minister, said Friday that 44 people had died and that the country had 2,800 confirmed flu cases. The numbers reflected a sharp increase compared with a week earlier, when there were 26 deaths and 1,587 cases. H1N1 flu has killed more people in Argentina than in any other country in South America, where the winter flu season is just beginning. The death rate of 1.6 percent is more than three times the world average. New York times


• Some health officials in Argentina are criticizing the government for rejecting calls to postpone the nation's recent election, a move they say could have avoided the virus's spread at crowded polling places and focused the public's attention on pandemic issues. The officials said the health minister who just resigned was among those who recommended postponing the election. Increased flu cases prompted an emergency declaration in Buenos Aires. New York Times


• US President Obama has called a "flu summit" on Jul 9 to discuss the nation's pandemic flu preparedness plans for the fall. The meeting will be held at the National Institutes of Health and be led by Department of Homeland Security Secretary Janet Napolitano and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. CNN


• A British survey on the public's perceptions and behavior changes related to the novel flu outbreak revealed that just over a third had followed any advice to reduce their risk. The survey of 997 adults showed that changes were associated with beliefs that the outbreak is severe, that good information is available, and that people can control their risk. Belief that outbreak reports are exaggerated was linked to less behavior change. BMJ report

Vaccine News

• The government of New Zealand has ordered an initial supply of 300,000 doses of H1N1 flu vaccine from Baxter International Inc., according to a government statement issued Monday. The government said it has agreed in principle to offer swine flu vaccination to frontline health staff and emergency personnel. The 300,000 doses are sufficient for 150,000 workers, the government said. Wall Street Journal

Antiviral News

• Japan has confirmed its first case of a genetic mutation of the new H1N1 flu virus that shows resistance to Tamiflu, a health ministry official said on Thursday. They found the drug-resistant virus in a patient who was given Tamiflu to prevent infection but who developed symptoms anyway. The patient was given Relenza and recovered, and does not appear to have infected anyone else. Reuters


• The U.S. government will donate 420,000 treatment courses of the drug Tamiflu to help treat severe cases of influenza in Latin America and the Caribbean. The donation will go to the Pan American Health Organization (PAHO) to combat the novel H1N1 flu pandemic. Science Insider


• Hong Kong's health department said on Friday it had detected a case of H1N1 flu virus that was resistant to Tamiflu. The virus was isolated from a specimen taken from a 16-year-old girl coming from San Francisco. Reuters

Guidance and Recommendations

• H1N1 influenza is causing mild symptoms that go away without medication in most patients, but care-givers should be alert for warning signs of severe cases, the head of the World Health Organization said on Thursday. According to WHO Director Margaret Chan:




• Pregnant women and people with underlying health problems are at higher risk from complications from the virus and need to be monitored if they fall ill


• Those with normal flu-like symptoms should not seek care in hospitals unless they have certain "warning signs" of severe infection


• Adults with a high fever that lasts for more than three days should seek help, and children who have difficulty waking up, are lethargic or are no longer alert may also need extra care Reuters

Today’s Key Question

Amid warnings about the severity of this fall's flu season, the federal government recently announced that they are ordering 370 ventilators.

So why is Canada ordering more ventilators?

As the pandemic spreads globally, findings from Canadian public health are showing that Canadian victims have been younger and sicker, and have required more ventilators than most other countries.

“It appears that there is a sub-population of relatively young people who very rapidly develop severe illness with this virus. And they are not a large number, but they require very intensive ventilator support with new advanced ventilators,” said Allison McGeer, an expert in infectious disease at Mount Sinai. “We have very few oscillatory ventilators. We generally don't need them very often and usually it's for a very short period of time. So these young people are requiring a disproportionate amount of time on ventilators that we have very small numbers of.” According to Dr. McGeer, this problem has historically been distinctive to pandemics, and particularly to H1N1.

Currently, each Canadian jurisdiction has its own stockpile of ventilators. In addition, the Public Health Agency of Canada (PHAC) owns 130 that are to be distributed to the provinces and territories on an as-needed basis. Recently 15 of these ventilators were sent to Manitoba to deal with the abnormal surge in H1N1 patients requiring ventilation. According to a spokeswoman, PHAC is now seeking to expand this stockpile to 500, and is currently in negotiations to do so. The 370 additional ventilators are expected to cost about $10,000 each for a total cost of $3.7 million.

Despite its pandemic planning, PHAC could not say how many ventilators there are across Canada, how long it would take to make the purchase, and whether it would specifically be looking for oscillating ventilators. But doctors applauded any effort to increase the numbers. An associate professor of medical microbiology and pharmacology at the University of Manitoba, Anand Kumar asserted “I think it would be prudent to review the Manitoba experience and understand where our strengths are and where our weaknesses are. And certainly the issue of ventilator capacity is something that we ought to be paying attention to nationwide…I think it is very appropriate to be concerned about the amount of resources of all sorts, whether you talk about nursing, or certain groups of medications, or ventilators. You want to make sure that sufficient resources are available should this recur in a bigger way.” Furthermore, Dr. Robert Ouellet, the president of the Canadian Medical Association warned of the need for preparation given that H1N1 could be much worse during the fall. “I think that any move to improve the equipment, to improve the human resources, is a good move.” Ouellet stated. Globe & Mail.

Global's Influenza A (H1N1) Update - July 2, 2009

GMS INFLUENZA A (H1N1) Update as of July 2nd, 2009
(0830 HRS PST)

The next update will be on Tuesday July 7th, 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: 77,201 cases and 332 deaths in over 100 countries, up 6,308 cases and 21 deaths from Monday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since Monday were the United Kingdom (2,288), Chile (1025),Thailand (640), and Mexico (401) . 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


• Canada and the United States may go separate ways when deciding whether powerful boosting compounds called adjuvants should be added to swine flu vaccines. Canada will likely use adjuvanted swine flu vaccine, says Dr. David Butler-Jones, head of the Public Health Agency of Canada. However it is not a slam-dunk that regulatory authorities south of the border will clear adjuvanted flu vaccines for a U.S. mass vaccination campaign. AP

International News

• The mayor of Argentina's capital, Buenos Aires, declared a health emergency on Tuesday to help control an outbreak of the deadly H1N1 flu strain that has killed 26 people in the country. Mayor Mauricio Macri urged city residents to stay at home as much as possible, saying the health emergency would remain in place through Friday. Reuters


• Indonesia's health minister said that visitors arriving at the country's airports from nations hit by H1N1 flu will be asked to wear a mask for 3 days. The masks are a precautionary measure to reduce human-to-human transmission, she said. The masks will be handed out to international visitors as soon as funding for them comes through; however, those who don't wear them will not be penalized. AFP


• Saudi Arabian health officials who just concluded a 4-day meeting with international health experts to discuss pandemic flu risks related to the hajj advised that children, pregnant women, elderly people, and those with chronic health conditions avoid the annual pilgrimage. The 4-day hajj starts in late November this year and is expected to attract about 3 million pilgrims. The health ministry said the crowded setting could pose a flu transmission risk. AP


• San Francisco officials reported what they believe may be the first publicized cluster of novel H1N1 infections in pregnant women. All five remain hospitalized, two of them still in intensive care. A doctor who consulted on the cases said all are or were in their third trimester and that some required intubation. Some had underlying conditions. KPIX

Antiviral News

• Swiss drugmaker Roche has launched a program to ease access to its antiviral drug Tamiflu for developing countries, the group said on Wednesday. The program should ensure that Tamiflu is available to many developing nations. Under the program, which will take effect immediately, Roche will produce and store Tamiflu pandemic stockpiles for specified developing countries at a significantly reduced price with the cost spread over a number of years, the group said. Reuters

Guidance and Recommendations

• Following the lead of the US CDC, PHAC has released H1N1 flu guidance for day and residential camps. The document was developed to provide interim guidance to Public Health authorities regarding day camps and residential summer camps for the prevention and management of influenza-like illness (ILI) suspected to be due to H1N1 Flu Virus. It is anticipated that this guidance will be adapted by the Public Health authorities as necessary to address their local situations. PHAC

Today’s Key Question

Once a virus emerges, can we anticipate the evolution of the outbreak using flight patterns?

A study led by a Toronto researcher, and recently published in the New England Journal of Medicine, accurately plotted swine-flu’s course around the world by tracking air travel from Mexico.

The researchers analyzed flight data from March and April of 2008 but stressed that patterns of departures from Mexico in these months varies little from year to year. The data analysis demonstrated that more than 2 million people flew from Mexico to more than 1,000 cities worldwide and that passengers traveled to 164 countries, but four out of five of those went to the United States. That fits with the path of the epidemic a year later. In fact, the researchers assert that more than 90% of the time, they accurately matched air traffic volumes to which countries did and did not suffer swine flu outbreaks as a result of air traffic.

One government health official who praised the work, asserted that this research shows promise in forecasting how a new contagion might unfold. Furthermore, Dr. Martin Cetron of the U.S. Centers for Disease Control and Prevention asked "We share a common interest in this issue: If we map the global airline distribution network, can we anticipate, once a virus emerges, where it is likely to show up next?"

The new swine flu virus was first reported in the United States in mid-April, but the first large outbreak was in Mexico at about the same time. Health officials believe cases of the new virus were circulating in Mexico in March. Scientists have long assumed a relationship between air travel and spread of the virus. But the new research for the first time confirmed the relationship. The Associated Press.