(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.
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