(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
- 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
- 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
- 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
- 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.
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."
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