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."