Tuesday, June 30, 2009

Global's Influenza A (H1N1) Update - June 30, 2009

GMS INFLUENZA A (H1N1) Update as of June 30, 2009
(0830 HRS PST)

The next update will be on Thursday, July 2nd, at 08:30 PST.

The WHO Pandemic Alert level remains at Phase 6



Influenza A (H1N1) Cases and Deaths

  • Yesterday, the World Health Organization released its latest case count for novel H1N1 influenza worldwide: 70,083 cases and 311 deaths in over 100 countries, up 11,079 cases and 48 deaths from Friday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since Monday were United States (6268) Canada (1043), Australia (758), the United Kingdom (653) Philippines (416), China (353), Singapore (284) . WHO



Local/National News



  • On June 29th, the Public Health Agency of Canada announced that the number of confirmed cases of influenza A (H1N1) since June 22nd has risen to 7983 from 6,732. Of the Canadian cases thus far, 636 required hospitalization and 25 deaths have occurred. PHAC


  • Dr. David Butler-Jones, the country's chief public health officer, said given the behaviour of the new H1N1 virus and the risk it poses, there is little chance Canada wouldn't push ahead with a vaccination program in the fall. "At this point I cannot imagine not immunizing, given the nature of this disease, its variability and its risk to people, both in terms of illness but also serious illness and death," Butler-Jones said. AP



International News

  • More than 1 million people in the United States may have been infected with the new H1N1 flu, U.S. health officials said on Friday, and infections continue to rise. "The key point is this new infectious disease is not going away," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said. "In the U.S., we're still experiencing a steady increase in the number of reported cases.” Reuters


  • H1N1 flu is supplanting seasonal strains in Australia’s Victoria state, suggesting the pandemic virus will be the major cause of influenza this winter. Tests on 138 type-A flu samples collected by a network of doctors confirmed 60 cases of the new A/H1N1 variant and only five of seasonal influenza in the eight weeks ended June 21, according to a report by the Victorian Infectious Diseases Reference Laboratory in Melbourne. This is a typical feature of past pandemic and is also a factor the WHO will consider in determining when vaccine makers should switch to producing only shots against the pandemic virus.


  • Health officials in England said pandemic flu response in two parts of the country will shift from a containment to a management strategy. The change, which affects London and West Midlands, means that schools will no longer close and that antiviral medication will no longer be given to close contacts of flu patients, only those who have illness symptoms. Also, most illnesses will be diagnosed clinically rather than through lab testing. Daily Mail

Vaccine News

  • Sanofi Pasteur, one of the five companies that are developing a novel H1N1 vaccine for the US market, said it began large-scale production on Jun 23, according to the company's Web site. The company will still need to conduct clinical trials, which it said in an earlier statement could take place as early as August. In late May the company received a $190 million order from the US Department of Health and Human Services to make bulk vaccine and conduct other activities. Sanofi timeline of novel flu vaccine developments


  • The vaccine being developed to combat the H1N1 flu pandemic will require multiple shots to provide immunity from the new virus, and the added immunizations may overwhelm U.S. state agencies, according to US health officials. Two injections will be required three weeks apart for H1N1 flu, and a third will be needed for seasonal flu, health officials said at a meeting at the U.S. Centers for Disease Control and Prevention. Children younger than 9 years old will need four shots. Bloomberg



Antiviral News



  • Scientists have established the first case of the new H1N1 influenza strain showing resistance to Tamiflu, the main antiviral flu drug, Danish officials and the manufacturer said on Monday. The patient is now well and no further infection with the resistant virus had been detected. "It does not constitute a risk to public health and does not cause changes to the recommendations for the use of oseltamivir (Tamiflu)," Denmark's State Serum institute said in a statement. Reuters


  • The US Department of Health and Human Services (HHS) recently provided a shield against damage claims related to the use of the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) in the current H1N1 influenza pandemic. HHS Secretary Kathleen Sebelius signed a notice extending liability protection under the Public Readiness and Emergency Preparedness (PREP) Act. Liability protection is provided to groups and individuals involved in the development, manufacture, testing, distribution, administration, and use of medical countermeasures, according to HHS. CIDRAP


  • The US CDC has updated their H1N1 antiviral guidance; only patients who test positive for pandemic H1N1, influenza A/H3N2, or B should receive the antiviral Tamiflu (oseltamivir). If a laboratory test is not performed or the test is negative but clinical suspicion remains, the preferred treatment is zanamivir or a combination of oseltamivir and rimantadine, which is an older drug of the adamantine class of antivirals. If testing indicates influenza A or unspecified influenza, the preferred treatment is also zanamivir or a combination of oseltamivir and rimantadine. The new guidance appears to be aimed at preventing the inadvertent prescription of oseltamivir for seasonal infections, which have shown extensive resistance to oseltamivir in the United States and other parts of the world. CIDRAP



Recommendations and Guidance



  • The US CDC has updated their General Business and Workplace Guidance to state that a worker who has been exposed to a person with pandemic influenza may continue to go to work unless he/she becomes ill. This guidance is for employees with minimal contact with the general public and other coworkers.




Today’s Key Question


Will the added immunizations against H1N1 overwhelm health officials?


According to health officials, the vaccine being developed to combat H1N1 flu, will require two injections, three weeks apart. Furthermore, adults will still require a third shot to provide immunity against seasonal flu, while children younger than nine years old will need four shots as they have little immunity to any flu strain, and need two shots for protection against seasonal flu.

H1N1 flu is a new virus and the majority of the population has no natural immunity. Consequently, the initial shot will provide preliminary exposure to the virus, while the second shot will boost antibody levels in the body. It has been noted that those older than fifty are becoming infected with swine flu at far lower rates than younger people, implying that they may have some immunity from prior exposures to a similar virus. Therefore, according to the US CDC, this age group may only require one shot.

The CDC estimates that at least 50 million doses of the vaccine will become available by October 15th, and later in the season, have enough vaccine to immunize everyone against the virus. The shots will likely be administered through vaccine clinics established by state and provincial health organizations. However, according to William Schaffner, an influenza expert at Vanderbilt University School of Medicine in Nashville Tennessee, “Public health departments are under-funded and will get fatigued.” Additionally, Jeanne Santoli, a CDC representative asserted recently that vaccinations would be slowed if states are responsible for administering shots instead of doctors’ offices and pharmacies. Bloomber

Thursday, June 25, 2009

Global's Influenza A (H1N1) Update - June 25, 2009

GMS INFLUENZA A (H1N1) Update as of June 25, 2009

(0830 HRS PST)

The next update will be on Tuesday, June 30th, 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: 55,160 cases and 238 deaths in over 80 countries, up 3,707 cases and 7 deaths from Monday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since Monday were Canada (747), Australia (421), the United Kingdom (399), Mexico (223), Argentina (203), Brazil (203), China (167), and Uruguay (159). WHO

Local/National News


  • On June 24th, the Public Health Agency of Canada announced that the number of confirmed cases of influenza A (H1N1) since June 22nd has risen to 6,732 from 6,457. Of the Canadian cases thus far, 423 required hospitalization and 19 deaths have occurred. PHAC

  • The Assembly of Manitoba Chiefs (AMC) has declared a state of emergency in Manitoba First Nations over the H1N1 pandemic. Grand Chief Ron Evans said the H1N1 influenza virus is spreading rapidly through native communities with supplies taking nearly a month to be delivered. By declaring a state of emergency, First Nations can divert money from other programs to help fight the outbreak. The AMC also wants the provincial and federal governments to ensure plans are in place to protect people when the fall flu season starts. CBC

  • Health Canada delayed the delivery of alcohol-based hand sanitizers to some First Nations communities affected by H1N1 flu because of concerns the alcohol content might be abused. According to Anne-Marie Robinson, assistant deputy minister of Health Canada's First Nations and Inuit Health Branch, First Nations chiefs were involved from the beginning in discussions on pandemic planning and measures such as the use of alcohol-based sanitizers. CBC

  • When speaking to the Canadian Senate earlier this week, Dr. Kim Barker called for an independent task force to study flu outbreaks in First Nations and report back with recommendations for a seamless approach across the country before the fall flu season. CBC

  • A new report on corporate risk and pandemic preparedness touts the benefits of having business plans in place for a global outbreak of flu. The report by Amin Mawani of the Schulich School of Business at Toronto's York University says companies that can prevent absenteeism during a pandemic will be well-positioned to take customers and market share from those that can't. Globe and Mail


International News


  • Over the past few days, several countries have reported their first case of the H1N1 virus, including Antigua and Barbuda, Cape Verde, Cote d'Ivoire, Ethiopia, Indonesia, Cambodia, Montenegro, Latvia, Tunisia Vanuatu, Serbia, and Iraq. Reuters

  • In a recent report on effects of the economic downturn, the World Bank said the severity and impact of the current pandemic seems to resemble the Hong Kong influenza pandemic of 1968-69, which could mean a drop in gross domestic product of 0.7%. The World Bank said developing countries are most vulnerable to pandemic effects because of high population density, weak health care systems, and high prevalence of chronic diseases. Jun 22 World Bank report

  • The H1N1 influenza virus could cost Delta Air Lines $250 million in revenue this year, which the world's largest airline will offset by cutting capacity, its chief executive said on Monday. "The steps we are taking have essentially involved capacity because the flu has decreased demand," said Delta CEO Richard Anderson at the company's annual shareholders’ meeting. Reuters

  • Argentina’s health ministry reported on Tuesday that seven more people in the country have died of novel H1N1 influenza, raising the total to 17, the most in South America. All the deaths occurred in or near Buenos Aires, where a city health official said non-essential surgeries would be postponed to free up hospital beds. Argentina currently has 1,213 novel flu cases, an increase of 203 from the last WHO report. AP


Vaccine News


  • The US government has granted Protein Sciences Corp. (PSC) of Meriden, Conn., a $35 million contract to develop its technique for making influenza vaccines by growing flu virus proteins in insect cells, an approach said to be faster than traditional methods. PSC's approach involves extracting a gene from a flu virus and inserting it into a baculovirus, which infects insects but not people. The recombinant baculoviruses multiply quickly in insect cells, producing many copies of the flu gene, which are then purified and used to make a vaccine. The contract could be extended up to 5 years at a total cost of about $147 million. CIDRAP


Antiviral News


  • A disease-control specialist in Australia's Northern Territory said today that the government's recent decision to restrict oseltamivir (Tamiflu) to "critical case criteria" should be relaxed for aboriginal patients who have suspected pandemic flu symptoms. The expert said that 50% of people in the communities have chronic health conditions and that broader antiviral use could reduce the risk of disease transmission to vulnerable people. ABC



Today’s Key Question

Did arsenic play a role in the severity of H1N1 flu in Mexico?

According to researchers at the Marine Biological Laboratory (MBL) at Dartmouth Medical School, chronic exposure to arsenic compromises the immune response to infection, which may explain why H1N1 flu cases in Mexico have been so severe.


Dr. Joshua Hamilton, MBL’s chief academic and scientific officer, recently asserted, “One thing that did strike us, when we heard about the recent H1N1 outbreak, is Mexico has large areas of very high arsenic in their well water, including the areas where the flu first cropped up.” Dr. Hamilton further stated, “We don’t know that the Mexicans who got the flu were drinking high levels of arsenic, but it’s an intriguing notion that this may have contributed.”


Subsequently, Hamilton’s team of researchers studied the effects of arsenic exposure on respiratory influenza A (H1N1) virus infection in mice. The mice were exposed to arsenic in their drinking water for five weeks and then infected with a sub-lethal dose of the virus. The study found that arsenic was associated with a number of significant changes in response to the virus including an increase in morbidity, including weight loss, and higher levels of the virus in the lungs of the mice. This second finding is particularly interesting as the inability to properly clear virus from the lungs is correlated with an increased risk of unfavorable outcomes in influenza patients.


“These results also suggest that chronic arsenic exposure, particularly in areas of Southeast Asia and Mexico, may be a factor that could enhance the potential impact of a pandemic strain of influenza, should this emerge in the human population,” Dr. Hamilton’s group concluded.


A report of the study was published online in May, in the journal Environmental Health Perspectives.

Tuesday, June 23, 2009

Global's Influenza A (H1N1) Update - June 23, 2009

GMS INFLUENZA A (H1N1) Update as of June 23, 2009 (0830 HRS PST)

The next update will be on Thursday, June 25nd, 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: 52,160 cases and 231 deaths in over 80 countries, up 7,873 cases and 51 deaths from Friday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were the United States (3,594), the United Kingdom (754), Chile (1190), Canada (805), Australia (237), China (220) and Japan (160). WHO


Local/National News


  • On June 22nd, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 19th has risen to 6,457 from 5,710. Of the Canadian cases thus far, 404 required hospitalization and 15 deaths have occurred. PHAC

  • Ontario's Chief Medical Officer of Health said Monday that a six-year-old girl who had the H1N1 flu has died. "I called this news conference today to announce the death of a six-year-old girl from Peel Region with the H1N1 flu virus," Dr. Arlene King said Monday. "The child had not been hospitalized and passed away on June 15. On June 19, laboratory testing confirmed the H1N1 flu virus in this individual."


International News


  • On June 19, the US State Department warned that travelers to China may be quarantined for 7 days if they arrive with a fever or flu-like symptoms. Chinese authorities target travelers with even slightly elevated temperatures if they come from areas with novel H1N1 cases, plus people sitting near them, the statement said. For more information, see Today’s Key Question. State Department

  • The Muscular Dystrophy Association (MDA) has canceled its remaining summer camps after 11 children at camps in two US states got sick with novel H1N1 infections. The MDA said children who attend the camps have weakened respiratory muscles, which puts them in a high-risk flu group. The US CDC consulted on and agreed with the cancellation of the MDA's remaining 47 camps, which were set to host 2,500 children. MDA press release

  • A 49-year-old Filipina with heart and liver ailments has died after contracting the new flu virus, the first such death in Asia, health officials in Manila said on Monday. The woman died at her home on June 19, two days after she first showed symptoms of the new influenza A (H1N1) virus, Philippine Health Secretary Francisco Duque told reporters. Reuters

  • The new strain of H1N1 flu is causing "something different" to happen in the United States this year -- perhaps an extended year-round flu season that disproportionately hits young people, health officials said on Thursday. An unusually cool late spring may also be helping to keep the virus going in the US Northeast. Reuters

  • A Chicago couple decided not to let the H1N1 flu get in the way of their wedding after both testing positive less than 48 hours prior to their wedding. Although the bride’s hairstylist refused to work, and they had to wear surgical masks and gloves, they were able to take their vows in front of family and friends. Chicago Tribune


Vaccine News

  • AVI Biopharma, based in Portland, Ore., recently announced that it has received a contract of up to $5.1 million from the US Department of Defense to develop one or more RNA-based drugs to treat novel H1N1 flu. In addition to identifying potential drug targets, as well as lead and backup drug candidates, the contract supports the production of testing material for animal studies. The company said its RNA-based drugs use proprietary technology that targets messenger and pre-messenger RNA. AVI Biopharma press release


Today’s Key Question

Why has the U.S. issued a travel alert about China’s anti-flu measures?


The US State Department recently issued a travel alert regarding China’s anti-flu measures. China is imposing a seven-day quarantine on passengers arriving with a fever or flu-like symptoms in order to prevent the spread of H1N1 flu. The State Department asserted that although the proportion of travelers arriving in China and being quarantined remains low, the relatively arbitrary nature of the selection process adds to the uncertainty of travel to China.


“The selection process focuses on those sitting in close proximity to another traveler exhibiting fever or flu-like symptoms or on those displaying an elevated temperature if arriving from an area where outbreaks of 2009-H1N1 have occurred. We have reports of passengers arriving from areas where outbreaks have occurred (including the U.S. and Mexico) being placed in precautionary quarantine simply because they registered slightly elevated temperatures," said the State Department.


There have been instances in which parents and children have been separated if a parent or child tested positive for the H1N1 flu virus. This introduces the possibility of Chinese authorities administering medications to minors without first consulting the parents.


Furthermore, the State Department claims to have received reports of unsuitable quarantine conditions, such as a lack of access to suitable drinking water and suitable food, unsanitary conditions, and the inability to communicate beyond the quarantine.


The State Department stressed that all travelers to China are obliged to follow local public health-related measures, and given that there is no compensation for lost travel expenses, has also advised travelers to China to consider buying travel insurance to protect against losses in case they are quarantined. State Department

Friday, June 19, 2009

Global's Influenza A (H1N1) Update - June 19, 2009

GMS INFLUENZA A (H1N1) Update as of June 19, 2009
(0930 HRS PST)

The next update will be on Tuesday, June 22nd, at 08:30 PST.

GMS will be reverting back to providing summaries twice a week as a result of the reduced frequency of updates from health organizations.

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: 44,287 cases and 180 deaths in over 80 countries, up 4,667 cases and 13 deaths from Thursday’s numbers. Countries reporting the greatest increase in laboratory-confirmed cases since the last WHO update were Mexico (1,383), Canada (856), Chile (790), the United Kingdom (291), and Thailand (208). WHO



Local/National News


  • Canada’s case numbers have not been updated since June 17th, when the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 12th has risen to 4,905 from 4,049. Of the Canadian cases thus far, 284 required hospitalization and 12 deaths have occurred. PHAC

  • Leaders from three of Manitoba's First Nations communities met with Canada's health minister yesterday and said their demand for a field hospital in the area was turned down. They said federal officials said that a field hospital could slow novel flu outbreak response efforts. The chiefs said they also raised concerns about the 20 hours it takes to transport severely ill patients to Winnipeg for treatment, but said they believe federal officials heard their issues. CanWest News Service



International News


  • The U.S. Centers for Disease Control and Prevention (CDC) and other experts have rejected a report that a new strain of the novel H1N1 influenza virus has been identified in a Brazilian patient. Earlier, Scientists at Adolfo Lutz Bacteriological Institute in Sao Paolo said they found the new strain in a local patient. However, according to CDC spokesman, Joe Quimby, "It's the same strain; it's not a new strain." CIDRAP

  • In some U.S. areas hit hardest by the novel flu virus, up to 7% of the population may have been infected, a CDC official said at a news briefing yesterday. "In some areas where there's been a lot of transmission, such as New York City, they're finding that maybe around 7% of the community was infected or had influenza-like illness," said Dr. Daniel Jernigan of the CDC's flu division. However,he said thatthe percentage does not apply nationwide. Transcripts of CDC H1N1 briefings

  • Thirty-three infants born prematurely at a North Carolina hospital are receiving precautionary H1N1 flu treatments after possibly being exposed to the virus by a respiratory therapist. Medical Director, Dr. Tim Lane, said the therapist treated a patient who later tested positive for the virus. The therapist worked a shift in the babies' unit several days later. AP

  • Japan's health ministry will close special clinics for people with influenza infections in an effort to prevent people from overwhelming them in the fall if a more severe wave of the novel H1N1 virus strikes. Officials fear overcrowded clinics could delay treatment for those with severe illnesses. Sick patients will be treated at any medical clinic. The ministry also said it would scale back quarantine measures at entry ports to pre-pandemic levels. Asahi Shimbun



Vaccine News

  • Targeting children for vaccination may be the best way of using limited supplies of vaccine to control the current H1N1 flu pandemic, British researchers said on Thursday. Researchers from the University of Warwick said that vaccinating children rather than adults would not only help protect a group at greatest risk of exposure to the virus, but would also offer protection to unvaccinated adults. This so-called "herd immunity" effect would mean significantly less vaccine would be needed. Reuters



Today’s Key Question

What is the timeline for pandemic vaccine development in Canada?



The Government of Canada has already negotiated a long-term contract with Glaxo-Smith-Kline (GSK), a pharmaceutical company, to secure domestic capacity to develop and produce virus-specific vaccines in the event of an influenza pandemic. The Government of Canada’s longstanding contract with GSK requires the company to develop and produce vaccines for every person in Canada in the event of a pandemic, and gives Canada priority access to GSK’s vaccine production over that of any other potential purchaser of vaccines.



However, this does not ensure the immediate availability of a vaccine in the event of a pandemic. In fact, once a particular strain of virus has been identified, it can take around six months for an influenza vaccine to be developed and tested. The following outlines the steps necessary to develop a virus vaccine and the measures Canada has taken to date with regards to the H1N1 flu virus vaccine development process.




Identification of the virus:


Canada’s National Microbiology Laboratory (NML) has developed a test that enables researchers to determine within 24 hours whether a particular sample specimen of influenza being tested is the current H1N1 flu virus.



Development of a Primary Seed:


The primary seed strain is the basic building block for the production of influenza vaccine, and its identification takes approximately four weeks. The World Health Organization (WHO) has developed a seed strain and is presently testing the strain for safety. Meanwhile, the seed strain has been distributed to vaccine manufacturers, including GSK, to use to begin preliminary development of an H1N1 vaccine.



Development and Production:


After the safety testing and preliminary development work is completed, the production process for the H1N1 vaccine will take about 12 weeks. In the meantime, GSK is working through potential production process issues by developing trial vaccines.



Testing:



The H1N1 strain has never before been incorporated into an influenza vaccine and as such, there may be unknown factors which could require changes to the current vaccine manufacturing process. Tests must be conducted to confirm basic information on the vaccine. A small clinical study with humans will also be conducted to ensure that the vaccine is safe and that it produces an immune response - or protects humans – against the strain of H1N1. This process may take an additional 6 weeks.


Review and Authorization:

Health Canada is working to ensure that mechanisms are in place for review and authorization of a safe and effective vaccine for use in Canada within the shortest time frame possible, and that trained staff is available for the timely testing and release of pandemic vaccine lots after it has been authorized for use in Canada. Their review of data would be concurrent with production and will likely take an additional one week.



Based on the above timelines and a best-case scenario, an H1N1 vaccine may be available in November.

Thursday, June 18, 2009

Global's Influenza A (H1N1) Update - June 18, 2009

GMS INFLUENZA A (H1N1) Update as of June 18, 2009 (0830 HRS PST)

The next update will be on Friday, June 19, at 08:30 PST

The WHO Pandemic Alert level remains at Phase 6



Influenza A (H1N1) Cases and Deaths

  • Today, the World Health Organization released its latest case count for novel H1N1 influenza worldwide: 39,620 cases and 167 deaths in over 80 countries, up 3,692 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (1071), Chile (641), Argentina (390), Australia (289), the Thailand (281), the United Kingdom (235), and the Philippines (116), WHO





    *This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48, Monday June 12, 2009.


Local/National News

  • On June 17th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 12th has risen to 4,905 from 4,049. Of the Canadian cases thus far, 284 required hospitalization and 12 deaths have occurred. PHAC



International News

  • The number of novel H1N1 cases in Chile surged to 3,125 today. The number is 1,431 more than the total for Chile reported by the WHO on Jun 15. Chile has reported two deaths from the virus, which seems to be striking children the hardest: 64% of infections are reported in the 5- to 19-year-old age-group. AFP

  • Australian Health Minister Nicola Roxon today raised the country's pandemic response level from "contain" to "protect". The level is a new phase that was created to address the moderate severity of the novel H1N1 pandemic and is in line with the WHO's phase 6 declaration, the government said. The "protect" phase calls for an emphasis on treating people who have severe infections. Roxon said states will phase in the new response level by Jun 26. Australian government statement


  • On Tuesday night, the U.S. House of Representatives approved $7.65 billion in new money to respond to the H1N1 flu pandemic. The money will go toward the purchase of vaccine, antiviral drugs, and other medical needs. Congress also stipulated that the funds be available for surveillance and to help assist international efforts. At least $350 million must be spent on “upgrading State and local capacity.” Science Insider


  • A Spanish cruise ship was turned away from two Caribbean ports Wednesday because of fears of H1N1 flu among crew members, the vessel's owner said. Tour operator Pullmantur said its ship Ocean Dream with 759 passengers and 400 crew members was denied permission to dock in Grenada and Barbados after informing authorities there that crew members had flu symptoms. AP


  • China plans to restrict movement in residential areas and shut down entertainment centres to prevent the H1N1 flu strain from spreading, under worst case contingency plans released by the health ministry on Wednesday. The ministry says stringent quarantine measures on incoming travellers have prevented the disease from spreading among the general population. With 264 cases as of Wednesday, and new cases cropping up around China, the ministry's new plan seeks to address possible outbreaks in residential neighborhoods. Reuters


  • Health officials in New York City reported seven more novel H1N1 deaths, raising the total to 23. The report said all were between the ages of 25 and 64 and that most were hospitalized in late May at the peak of the outbreak. Overall, of the 20 deceased patients whose history was known, 16 had underlying medical conditions that put them at higher risk. New York City Department of Health report

Vaccine News

  • A Sanofi executive announced today at a health conference in Seattle that the company will donate 100 million doses of novel H1N1 influenza vaccine to the WHO to support its efforts to help the world's poorest nations respond to the pandemic. The company said that once vaccine production begins it will set aside 10% of doses to donate to the WHO. Sanofi press release
Today’s Key Question


Should you worry about sending your kids to camp this summer?



The U.S. Centers for Disease Control and Prevention (CDC) recently released guidelines to help day camp and residential camp administrators prevent and respond to novel flu outbreaks. The guidelines were released shortly after one of the first reported outbreaks of influenza A (H1N1) at a camp in Asheville, North Carolina.




The guidelines outline basic measures to be taken, such as educating campers and staff on staying home when sick, covering coughs, and washing hands frequently. Furthermore, the guidelines suggest the following:

  • Establishing relationships with local health departments to assist with response planning, and to becoming familiar with illness reporting requirements
  • Communicating with parents early on how illnesses will be handled
  • Establishing methods to transport sick campers and staff members home from camp


Moreover, the guidelines advise that camps inform campers, staff members, and volunteers ahead of time that they cannot attend if they have experienced an influenza-like-illness within a week before camp or until they have not had any symptoms for 24 hours. Camps are also directed to consider screening incoming campers to determine possible influenza exposure, and to determine if campers are at increased risk of complications resulting from influenza. Camps are also advised to educate, staff and volunteers on how to recognize flu-like symptoms and quickly isolate campers who appear sick.

Wednesday, June 17, 2009

Global's Influenza A (H1N1) Update - June17, 2009

GMS INFLUENZA A (H1N1) Update as of June 17, 2009
(0830 HRS PST)

The next update will be on Thursday, June 18, at 08:30 PST


The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th)

*This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48.



  • On Monday, the World Health Organization released its latest case count for novel H1N1 influenza worldwide: 35,298 cases and 163 deaths in 76 countries, up 5,834 cases and 18 deaths from Friday's numbers (above). Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were the United States (4,638), United Kingdom (404), Australia (221), China (100), Germany (75), and Japan (56). WHO


Local/National News


  • Two people in Manitoba have died after contracting H1N1 flu virus, including a man who had no underlying medical conditions, provincial health officials said Tuesday. Quebec also reported two deaths related to H1N1 flu on Tuesday, bringing the total number of reported deaths in Canada to at least 11. CBC

  • On June 15th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 12th has risen to 4049 from 2978. Ontario has the most cases in Canada (1907), followed by Quebec (971), Saskatchewan (327), Alberta (264), British Columbia (172), Nunavut (164), Manitoba (154), Nova Scotia (81), PEI (3), New Brunswick (2), Northwest Territories (2), Newfoundland (1) and the Yukon (1). PHAC

International News


  • Five countries (Qatar, Yemen, Jordan, Sri Lanka, and Somoa) have reported their first cases of novel H1N1 flu. These countries are not reflected in the WHO case totals above. Reuters

  • On Monday, Dr. Margaret Chan, the head of the World Health Organization warned that the H1N1 flu pandemic will demonstrate "in extremely tragic ways" the consequences of the failure to promote public health and ensure basic care during pregnancy and childbirth in developing countries. She said that developing countries are most vulnerable to the global H1N1 flu epidemic, the financial crisis, food shortages and climate change — and much more must be done to urgently strengthen their health care systems. AP

  • The WHO’s June 11 pandemic declaration did not prompt new worries about novel H1N1 in the United States, according to a Gallup poll conducted just after the announcement. Only 8% of Americans said they worried "yesterday" about getting the novel flu, down from 13% in mid-May and 25% in late April. Gallup said Americans have had 2 months to assess the effects of the disease, which appears to be similar to seasonal flu. Gallup poll

  • Yesterday, an official with the World Organization for Animal Health said It will be difficult to boost surveillance of hogs for the new pandemic strain of H1N1 flu unless farmers are confident they won't be penalized if the disease is found in their barns. Reuters

  • According to a report by the US Government Accountability Office many US agencies are not ready for a pandemic. The report found that many had planned for a pandemic but few agencies had actually tested plans such as telecommuting. Reuters


Vaccine News


  • US schoolchildren may be first in line for H1N1 flu vaccine this fall — and might even be able to get the shot right at school. Health and Human Services Secretary Kathleen Sebelius is taking that possible scenario to school superintendents around the country, urging them to spend the summer planning what to do if the government decides it needs their buildings for mass vaccinations. "If you think about vaccinating kids, schools are the logical place," Sebelius told The Associated Press Tuesday. AP


Today’s Key Question

Is the H1N1 flu hitting First Nations in Manitoba harder?


According to Dr. Joel Kettner, Manitoba’s chief medical officer of health, it appears there is an overrepresentation of aboriginal and First Nations falling ill with the H1N1 flu. According to Kettner, two-thirds of the Manitobans in intensive care units fighting H1N1 flu last week were First Nations people. This is despite the fact that First Nations people only make up between 10 and 15 percent of the province’s population.


The average age of those in this intensive care unit cohort was 35 years old, an unusually young age for anyone to require intensive care for influenza. Moreover, very few people in the intensive care unit are over 55 or are infants; which is also unusual as the elderly and the very young are usually the populations at highest risk from complications due to influenza.


Some might argue that the disproportionately high numbers of Manitoban First Nations falling ill with the virus, may reflect the fact that more aboriginal people have been infected to date. Kettner also stated “It could be that crowded housing conditions and small communities promote faster spread and faster exposure.” However, Kettner does not believe that this accounts for the whole story.


Kettner asserts that his staff are currently using epidemiological analysis to try and make sense of some of the details, in order to discern exactly what is going on. Kettner believes that understanding whether or not First Nations people are more susceptible to swine flu is necessary to understanding the virus.

Tuesday, June 16, 2009

Global's Influenza A (H1N1) Update - June 16, 2009

GMS INFLUENZA A (H1N1) Update as of June 16, 2009

(0830 HRS PST)

The next update will be on Wednesday, June 17, at 08:30 PST
The WHO Pandemic Alert level remains at Phase 6


Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th)

*This case map has been provided by the WHO’s Influenza A (H1N1) - Update #48.

  • On Monday, the World Health Organization released its latest case count for novel H1N1 influenza worldwide: 35,298 cases and 163 deaths in 76 countries, up 5,834 cases and 18 deaths from Friday's numbers (above). Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were the United States (4,638), United Kingdom (404), Australia (221), China (100), Germany (75), and Japan (56). WHO

Local/National News

  • On June 15th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 12th has risen to 4049 from 2978. Ontario has the most cases in Canada (1907), followed by Quebec (971), Saskatchewan (327), Alberta (264), British Columbia (172), Nunavut (164), Manitoba (154), Nova Scotia (81), PEI (3), New Brunswick (2), Northwest Territories (2), Newfoundland (1) and the Yukon (1). Of the Canadian cases thus far, 212 required hospitalization and seven deaths have occurred. PHAC

  • The novel H1N1 virus has been detected in another of Canada's First Nations communities, in Sandy Lake, Ontario. Ten cases have been confirmed in the community so far among 120 people who were treated recently for flu-like symptoms. About 10 people have been airlifted to hospitals, and residents have been asked to avoid large gatherings to control the spread of the virus. CNS

  • Tests have now shown that the carpenter who was suspected to have spread the novel H1N1 virus to pigs in Alberta was never infected. Howard May of Alberta Health and Wellness said that someone else must have passed the virus to the pigs, but authorities may never find out who it was. The carpenter had just returned from Mexico when he did some work at the farm on Apr 14. The infection was confirmed in the pigs in early May. CP report


    • 67 in Fraser Health

    • 5 in Interior Health

    • 30 in Northern Health

    • 50 in Vancouver Coastal Health

    • 20 on Vancouver Island


International News


  • Thailand is reporting a spike in its novel H1N1 cases, as the total grew by 51 today to 201 confirmed infections. Health Secretary Prat Boonyavongvirot said 38 of the new cases are in students and that the number is likely to rise, especially in schools and factories. AP

  • Fears of contracting the H1N1 flu virus have emptied the beaches, restaurants and nightclubs of Mexico's main tourist destinations, hobbling a key industry just as a severe recession is gripping the country. Tourism Minister Rodolfo Elizondo says it could take until December for the flow of foreign tourists to recover, wiping out the key summer season when millions of Americans and Europeans traditionally escape to Mexican beaches. Reuters

  • The US FDA’s campaign against phony H1N1 flu treatments hawked on the internet appears to have been successful. In the six weeks since the campaign began, nearly three-quarters of sites have been pulled down sites or removed illegal claims. Furthermore, "At the beginning, we were seeing as many as 10 new web sites a day" selling fraudulent products, said Alyson Saben, deputy director of FDA's office of enforcement. "Over the last two weeks or so, we're seeing about two new web sites a week." AP

  • Yesterday, the White House circulated a letter addressed to every public school superintendent in the country that outlines ways to cope with the stronger strain of the H1N1 virus that many public health experts predict will hit the U.S. this fall. The letter urges local officials to use the summer break to develop effective policies for hand washing, food service, sending kids home, and other steps, should they become necessary. Washington Post

Today’s Key Question

Are antiviral medications designed to fight influenza safe for pregnant and breastfeeding women?

It is well-known that pregnant women are at a higher-than-normal risk of developing complications from seasonal influenza, and, evidence from past pandemic suggests that pregnant women are disproportionately affected by pandemic influenza strains as well. Furthermore, in their statement last week, the World Health Organization stated that “without question, pregnant women are at increased risk of complications” from the novel H1N1 influenza virus.


Tamiflu (oseltamivir) and Relenza (zanamivir) are two antiviral drugs belonging to a class of medications known as neuraminidase inhibitors and according to available data, and Influenza A (H1N1) is susceptible to both. Yet, there are reports that pregnant women are refusing to take either drug due to fears of harm to the fetus. However, a literature review, published recently in the Canadian Medical Association Journal, suggests that both drugs can be used if an H1N1 infection is suspected.


The authors of the review, from the Motherisk Program at Sick Kids and the Japan Drug Information Institute in Pregnancy, examined the available data on antiviral drug use in pregnant and breastfeeding women. They suggest that Tamiflu is probably the better choice for treatment/prevention of H1N1 flu in pregnant women because there is more safety data on its use in pregnancy. But they say for women who are breastfeeding, either drug could be used because only small amounts are excreted in breast milk. The paper, also asserts that neither drug appears to affect the growth or development of fetuses exposed to them in the womb. The Canadian Press, MedPage Today, and the Edmonton Sun.

Monday, June 15, 2009

Global's Daily Influenza A (H1N1) Update - June 15, 2009

GMS INFLUENZA A (H1N1) Update as of June 15, 2009

(0830 HRS PST)

The next update will be on Tuesday, June 16, at 08:30 PST

The WHO Pandemic Alert level remains at Phase 6


Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 15th)


*This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48.


Local/National News

  • On June 12th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 8th has risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 138 required hospitalization and four deaths have occurred. PHAC

  • A Quebec woman in her 50s has become the sixth person to die after contracting the H1N1 flu in Canada, provincial health officials said Sunday. She reportedly had an underlying medical condition. UPI

International News

  • On Friday, the WHO released its latest case count for novel H1N1 influenza worldwide: 29,669 cases and 145 deaths in 74 countries, up 1,932 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (532), Mexico (524), Britain (156), Spain (131), Argentina (87), Australia (83), Japan (33), and China (32). WHO

  • On Sunday, a woman with H1N1 flu died in Scotland. This is the first known death of a swine flu patient outside of the Americas. Jacqueline Fleming, 38, had been "ill in hospital for a number of weeks," her family said in a statement Monday. According to the Scottish government the woman did have underlying health conditions. CNN

  • The Australian government said Sunday it was ready to raise its H1N1 flu alert as the national tally hit 1,458 cases. Health Minister Nicola Roxon said the whole country would soon move to the "sustain" phase in line with hotspot state Victoria. This phase, Australia's second-highest, gives authorities the power to cancel sports events, close schools and restrict travel, although officials say extreme measures such as closing national borders are unlikely. AFP

Vaccine News


  • Chinese vaccine maker Sinovac Biotech Ltd hopes to put its H1N1 vaccine through its first clinical trial by the end of July, joining other pharmaceutical firms racing to develop and produce vaccines against the new flu virus. Reuters

  • Swiss drugs company Novartis will not give free vaccines against H1N1 flu to poor countries, though it will consider discounts, the Financial Times reported on Sunday. "If you want to make production sustainable, you have to create financial incentives," the FT quoted Novartis Chief Executive Daniel Vasella. Reuters

Latest Guidance from the WHO, the US CDC, PHAC, and the BCCDC


Today’s Key Question

Is Influenza A (H1N1) Likely to Stick Around?

According to Richard Besser, a top official at the Centers for Disease Control and Prevention (CDC), influenza A (H1N1) is not expected to go away any time soon. The CDC has reported a declining number of cases of H1N1; however, health officials expect the disease to re-emerge this fall, possibly in a more severe form.

Besser informed epidemiologists at the annual Council of State and Territorial Epidemiologists Conference that scientists will be watching the Southern Hemisphere closely as they move into their flu season. They hope to find clues as to the how the virus may behave in North America during the next flu season, which will in turn help to form policy decisions regarding social distancing guidelines and vaccination campaigns.

This summer will also be used to study the impact of the hundreds of school closures that resulted from the agency’s initial guidance to shut down schools upon uncovering suspected swine flu cases. Besser stated that it is important to understand what happens when schools close, where the children go, and whether or not the children are more or less likely to spread infection.

Besser added that his biggest concern is complacency, or the sense that a bullet has been dodged. “I don’t think we can let our guard down” he said. Newsday

Sunday, June 14, 2009

Global's Influenza A (H1N1) Update - June 14, 2009

GMS INFLUENZA A (H1N1) Update as of June 14, 2009
(1100 HRS PST)

The next update will be on Monday, June 15, at 08:30 PST
The WHO Pandemic Alert level remains at Phase 6


Influenza A (H1N1) Cases and Deaths by Country (as of 9 AM PST, June 14th)

*This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48. New case information can be found in both the local/national and international news sections.

Local/National News


  • On June 12th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 10th has risen to 3513 from 2978. Ontario still has the most cases in Canada (1781), followed by Quebec (706), Saskatchewan (270), Alberta (240), British Columbia (167), Nunavut (145), Manitoba (119), Nova Scotia (79), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 182 required hospitalization and four deaths have occurred. PHAC


International News



  • Following the pandemic declaration by the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC) urged businesses to review their pandemic plans to make sure they're flexible enough to respond to a moderate or severe pandemic. Lisa Koonin, MN, MPH, a senior adviser with the CDC's influenza coordination unit, said that because influenza viruses are so unpredictable and the pandemic may change or become more severe in the fall, now is the time for businesses to revise pandemic plans or begin developing one if they don't already have one. CIDRAP

  • A private school in San Diego County says 36 of its students are being quarantined in China while being tested for the H1N1 flu virus. Eileen Mullady, head of Pacific Ridge School in Carlsbad, says the ninth graders were at the end of a 13-day educational tour of the country when a few students developed the sniffles. She said Chinese health officials decided on Thursday to place the students, along with seven chaperones, under quarantine in a hotel. Mercury News

Today’s Key Question

Does the World Health Organization (WHO) expect the severity of the Influenza A (H1N1) to change over time?

On June 11th 2009, the WHO announced that the world was officially in the midst of a pandemic. The WHO’s Director General, Margaret Chan, asserted in her statement to the world, that the WHO, thanks to close monitoring, careful investigation, and open reporting, has obtained somewhat of a picture of the virus’ spread and the range of illness it is capable of causing. Because of this, the WHO has reason to believe that this pandemic, at least at present, will be of moderate severity. However, Chan warned that the virus is that which “writes the rules,” and, like other influenza viruses, this virus may, without warning, change these rules.

With this in mind, Chan asked that counties prepare to see cases, or the further spread of cases, in the near future. She also warned those countries in which the virus has appeared to have peaked, to be prepared for a second wave of illness, while countries with only a few reported cases should remain vigilant. In summary, the WHO cannot presently predict whether or not the severity of H1N1 will worsen, however, they acknowledge this possibility and are advocating continued awareness, surveillance and monitoring. WHO

Saturday, June 13, 2009

Global's Daily Influenza A (H1N1) Update - June 13, 2009

GMS INFLUENZA A (H1N1) Update as of June 12, 2009

(0830 HRS PST)

The next update will be on Sunday, June 14, at 11:00 PST

The WHO Pandemic Alert level remains at Phase 6


Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th, 2009)


*This case map has been provided by the WHO’s latest Influenza A (H1N1) – Update #48. New case information can be found in both the local/national and international news sections.


Local/National News

  • On June 12th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 8th has risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 138 required hospitalization and four deaths have occurred. PHAC


  • The rising case totals in first nation communities in Northern Manitoba have led First Nations leaders to heavily criticize federal planning. According to Chief David Harper, “We are in a war with no artillery” and “The federal government says it has a plan in place, but that plan doesn't appear to include this part of the country.” The federal government did release guidelines for first nations pandemic planning two years ago, but there was no money attached according to Kim Barker, public health physician with the Assembly of First Nations. Globe and Mail

International News

  • Friday, the WHO released its latest case count for novel H1N1 influenza worldwide: 29,669 cases and 145 deaths in 74 countries, up 1,932 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (532), Mexico (524), Britain (156), Spain (131), Argentina (87), Australia (83), Japan (33), and China (32). WHO


  • The US Centers for Disease Control and Prevention (CDC) reported yesterday that the nation's count of novel flu cases has grown to 17,855, an increase of 4,638 from its last report on Jun 5. Deaths reported to the CDC over the past week rose by 18 to reach 45. Wisconsin, Texas, and Illinois have the most cases, while New York has reported the most fatalities (13). Current CDC numbers


  • On Thursday, Hong Kong authorities ordered all primary schools in the city to be closed for two weeks after 12 students at a city secondary school were found to have contracted the H1N1 virus. AFP

Vaccine News


  • On Friday, Baxter International Inc said that it is in full-scale production of an A/H1N1 flu pandemic vaccine that could be ready for commercial use next month. A number of national public health authorities have agreements with Baxter that allow them to place orders for a vaccine now that a pandemic has been declared by WHO, Baxter said. Baxter said it would also work with WHO to allocate a portion of the company's commercial vaccine production to address global public health issues deemed most urgent. Reuters

Today’s Key Question

How have national agencies responded to the phase 6 announcement?

In light of the recent World Health Organization (WHO) decision to raise the level of influenza pandemic alert from phase 5 to phase 6, the Government of Canada, in conjunction with the Public Health Agency of Canada (PHAC), has responded with reassurances to Canadians that it will continue to implement the Canadian Pandemic Influenza Plan in close coordination with domestic and international partners in order to address the H1N1 flu virus.


“Since the beginning, Canada has taken decisive action to address the H1N1 flu virus and protect Canadians,” said Minister of Health, Leona Aglukkaq. “The decision by the WHO does not change our approach. Entering phase 6 means we will build on the surveillance and management measures that are already in place under the Canadian Pandemic Influenza Plan.”


PHAC and other federal officials have also said they will continue to advance the following activities as a result of the WHO’s phase 6 pandemic alert level:


  • Ensuring that the National Antiviral Stockpile can be mobilized quickly so Canadians can receive the treatment they need


  • Working with vaccine manufacturer GlaxoSmithKline to advance the process of developing and testing a vaccine in accordance with a pre-established standing contract


  • Managing the National Emergency Stockpile System (NESS) which contains hospital supplies, equipment and other pharmaceuticals (including a stockpile of anti-viral medication)


  • Assessing implementation of community-based strategies aimed at mitigating potential impact on the healthcare system and society as whole


  • Working with national professional organizations and non-government organizations to optimize and monitor essential health-related resources such as: medical supplies, antivirals, vaccines, sanitizers and antibiotics, health care worker availability, hospital occupancy/availability, and use of alternative health facilities

In addition, the Government of Canada has stated that since a proactive approach in addressing the virus has already been taken, the declaration of phase 6 will result in the continuation of several ongoing efforts, including:

  • Monitoring the progress of the H1N1 flu virus and assessing incoming information to inform future actions


  • Continuing to communicate widely with Canadians and ensuring information is easily accessible


  • Providing health care professionals with updated guidelines and advice based on what is known about the disease


  • Utilizing the National Microbiology Laboratory (NML) in Winnipeg to provide laboratory testing to the provinces and territories


  • Sharing information with Canadians via the government website, http://www.fightflu.ca/, the media, and a 1-800 number (1-800-454-8302)

Friday, June 12, 2009

Global's Daily Influenza A (H1N1) Update - June 12, 2009

GMS INFLUENZA A (H1N1) Update as of June 12, 2009

(0830 HRS PST)

The next update will be on Saturday, June 13, at 11:00 PST

The WHO Pandemic Alert level remains at Phase 6

Yesterday, the World Health Organization (WHO) raised its pandemic alert level from Phase 5 to Phase 6 as a result of the ongoing spread of the novel influenza A (H1N1) virus. Phase 6 is the official WHO declaration that a pandemic is underway. It is characterized by human-to-human spread of the virus in at least two countries in one WHO region, as well as community-level outbreaks in at least one other country in a different WHO region. Human-to-human spread of the virus in Mexico, Canada, and the United States, as well as community-level outbreaks in Australia, has led to this declaration.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th)


*This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48.


Local/National News


  • On June 10th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 8th has risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 138 required hospitalization and four deaths have occurred. PHAC

  • Following the phase 6 announcement, the Government of Canada issued a statement to reassure Canadians. According to Minister of Health, Leona Aglukkaq, “Today’s decision by the WHO does not change our approach. Entering phase 6 means we will build on the surveillance and management measures that are already in place under the Canadian Pandemic Influenza Plan.” PHAC

  • Amid rising novel flu cases and hospitalizations, Manitoba's regional health authority warned residents to limit hospital visits and asked people with flu-like symptoms to stay away. Two more people were placed on ventilators yesterday, bringing the total to 27. Many are from the province's First Nations communities. The chief of one group said authorities are sanitizing public places and that crowded housing is contributing to the spread of the flu. Globe and Mail

International News

  • Today, the WHO released its latest case count for novel H1N1 influenza worldwide: 29,669 cases and 145 deaths in 74 countries, up 1,932 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (532), Mexico (524), Britain (156), Spain (131), Argentina (87), Australia (83), Japan (33), and China (32). WHO

  • By the end of trading yesterday, manufacturers of vaccines and antivirals had seen a sizable increase in their respective share prices. Vaccine makers, GlaxoSmithKline and Sanofi Aventis saw their stocks rise 4.07% and 1.28% on the day. Roche the maker of Tamiflu saw a 3.47% increase.

Vaccine News

  • The US CDC recently posted interim guidance on use of the 23-valent pneumococcal vaccine during the novel flu outbreak. The vaccine is still recommended for those aged 65 or older and patients aged 2 to 64 who have certain high-risk conditions. The CDC urges that those younger than 65 who have underlying health conditions receive the vaccine, because vaccination rates are low and rates of severe novel H1N1 infections are high. CDC

  • Novartis AG expects a vaccine for the H1N1 virus to be available by the autumn after it produced the first batch for testing ahead of schedule. The vaccine will enter clinical trials next month. Reuters

Antiviral News


  • Supplies of oseltamivir (Tamiflu) are scarce at some Australian pharmacies, prompting health minister Nicola Roxon to state that many patients with mild illnesses don't need the drug and that government stockpiles are reserved for those at highest risk, such as those with underlying medical conditions. The country's case count has risen to 1,275, with several hospitalizations, including four with reportedly no risk factors in intensive care units. Herald Sun

Today’s Key Question

What were some of the highlights from the World Health Organization’s (WHO) announcement to move to a pandemic alert level of Phase 6?

On June 11th, 2009, the WHO raised the level of pandemic alert to phase 6, the highest level on the six-point scale, indicating that a pandemic is currently underway. Margaret Chan, the Director-General of the WHO, made the official announcement. Important highlights and quotes from this announcement are outlined below:

  • “Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.”

Although a pandemic has been officially declared, this does not mean that there is any indication that the severity of the virus has intensified. In fact, the WHO’s alert scale, thus far, does not take a virus’ severity into account, only the degree of geographical spread.

  • We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years. Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years. This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.”

From the data presently available, it would appear that, as is the case with previous pandemics, H1N1 affects an inordinately large proportion of younger individuals.

  • “Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.”

The 1918 Spanish Flu, the most severe pandemic of the 20th century, also saw pregnant women at increased risk of complications.

  • “We do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.”

It is important to note that although the pandemic currently appears to be only moderately severe, the virus may have increased negative impacts as it spreads to countries with inadequate resources, deficient health care systems, and populations with a higher incidence of underlying medical issues. Chan urged countries to be prepared to see more cases, and focus on the appropriate management of patients and concluded by saying, “We are all in this together, and we will all get through this, together.”

Thursday, June 11, 2009

Global's Influenza A (H1N1) Update - June 11, 2009

GMS INFLUENZA A (H1N1) Update as of June 11, 2009

(0830 HRS PST)

The next update will be on Friday, June 12, at 08:30 PST

The WHO Pandemic Alert level has been raised to Phase 6.


Today, the World Health Organization (WHO) raised its pandemic alert level from Phase 5 to Phase 6 as a result of the ongoing spread of the novel influenza A (H1N1) virus. Phase 6 is the official WHO declaration that a pandemic is underway. It is characterized by human-to-human spread of the virus in at least two countries in one WHO region, as well as community-level outbreaks in at least one other country in a different WHO region. Human-to-human spread of the virus in Mexico, Canada and the United States, as well as community-level outbreaks in Australia and other Asia-Pacific countries have led to this declaration.

What does this mean?

Raising the WHO pandemic alert level to Phase 6 does not mean that the H1N1 virus has become more deadly. In fact, current reports of death and illness, when compared with previous pandemics, indicate that we are experiencing a pandemic of lesser severity. What this does mean is that the virus has been officially recognised as widespread around the world and will most likely continue to spread globally over several more weeks. That said, the H1N1 virus is unpredictable and we can anticipate that as we get closer to our own annual flu season, we will be hearing from authorities to begin increasing our vigilance in North America in response to the possibility that the virus mutates and becomes more severe in a second wave (late 2009, early 2010).

In addition, it is unlikely that the WHO will recommend member states activate strict containment measures, such as border closures or quarantine efforts. Instead, focus ought to be on treatment (e.g., efficient and focused use of antiviral stores), with some community-level mitigation strategies in place for those countries only now seeing a surge in cases.

What should Canadian and American organizations be doing?

As was the case when the WHO raised its pandemic alert level to 4, and then 5, it is expected that media and public interest in this latest development will be substantial. Anxiety and concern may increase as a result of misinformation or poor communication. For your organization, clear and concise communication with employees and stakeholders should be a priority. Beyond communication, organizations may require the activation of their pandemic response measures should the pandemic become more severe in North America.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 11th)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #46 and PHAC.



Local/National News

  • Health Minister Leona Aglukkaq announced recently that Canadian health officials have created a network of 80 scientists from 30 research and public health institutions to speed up influenza research, and test new vaccines against the H1N1 flu. The network, led by Dr. Scott Halperin, director of the Canadian Center for Vaccinology in Halifax, has received C$10.8 million in funding, and links the Canadian Institutes of Health Research and the Public Health Agency of Canada. Reuters

  • Political tensions are flaring over pandemic flu planning for Canada’s First Nations, as a remote Manitoba reserve struggles to deal with a possible outbreak of the H1N1 virus. St. Theresa Point First Nation has confirmed three cases of H1N1and more than 20 residents of the community have been flown to Winnipeg Hospital suffering from flu-like symptoms. Manitoba Health Minister Theresa Oswald is claiming that the Manitoba government has offered Ottawa help with First Nations pandemic planning, but was repeatedly turned down. Federal Health Minister Leona Aglukkaq is denying the claim, stating that she has daily conversations about the H1N1 virus with health ministers across the country, but that Manitoba Health Minister Theresa Oswald never brought up the matter. The Vancouver Sun

  • Dr. Isaac Sobol, Nunavut’s Chief Medical Health Officer, is disputing remarks made recently by Dr. Keiji Fukuda of the World Health Organization (WHO), citing a disproportionate number of serious cases occurring in Inuit communities in Canada. The WHO’s concerns came after Nunavut confirmed 28 new cases of H1N1 influenza Tuesday, more than doubling the total in the territory from 25 to 53. Sobol maintained that the severity of illness in Canada's North is the same as that found in other jurisdictions across Canada. CBC

  • Nova Scotia Health Officials have recently confirmed the province’s first hospitalized case of H1N1. The province's total number of documented cases of the H1N1 influenza A virus is 77. In its statement, the Health Promotion and Protection Department said other cases are mild, and those affected are recovered or recovering. CBC

  • On June 10th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) which had been confirmed in the country since June 8th was had risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases, 121 required hospitalization and four deaths occurred. PHAC

  • The British Columbia Centre for Disease Control (BCCDC) is now reporting the following confirmed cases across the province:


    • 58 in Fraser Health

    • 5 in Interior Health

    • 28 in Northern Health

    • 42 in Vancouver Coastal Health

    • 18 in Vancouver Island Health


International News


  • The recent surge in Influenza A (H1N1) cases in Australia has pushed the World Health Organization (WHO) to declare the first influenza pandemic since 1968. WHO influenza chief Keiji Fukuda said the agency was concerned about the potential harmful effects of moving the alert from its current status of phase 5 to the highest level, phase 6, indicating a full pandemic. Fukuda cited concerns over possible panic among the public or inappropriate steps taken by governments. Dr. Margaret Chan, the WHO’s director general has stated that, in her opinion, the world is in a pandemic. However, she believed it was crucial to verify that H1N1 had become established beyond North America before a pandemic was officially declared. ABC News

  • The number of confirmed H1N1 cases in Australia has reached 1,211, the highest number outside of the Americas. The southeastern state of Victoria continues to be the worst-hit region in Australia with 1,011 confirmed cases. Australia has canceled its Grand Prix, scheduled for later this month in the Victorian capital, Melbourne, due to the risk of H1N1 flu and quarantine procedures. Additionally, several professional rugby league players may have to miss matches this weekend over fears they have contracted the virus. Bloomberg

  • According to his office, Ray Nagin, the mayor of New Orleans, has been released from quarantine in Shanghai following an H1N1 scare. Nagin was detained after a fellow passenger on his flight fell ill with a suspected case of the virus. AFP

  • As of June 10th, 74 countries have officially reported 27,737 cases of influenza A/H1N1 infection, including 141 deaths. WHO

Vaccine News

  • On Tuesday, Hong Kong's government endorsed a plan to immunize 2.5 million people with a novel flu vaccine that it expects to be available no earlier than October. According to the plan, four groups will receive free vaccination: healthcare workers, children between 6 months and 6 years old, those older than age 65, and people who have chronic medical conditions. The government will stockpile enough doses for an additional 500,000 people. Hong Kong Standard

Latest Guidance from the WHO, the US CDC, PHAC, and the BCCDC

The World Health Organization (WHO) has recently released the following guidance documents:

The U.S. CDC has recently released the following materials:

Today’s Key Question

How can Global Consulting help?

Global Consulting will continue to provide analysis regarding the pandemic through our regularly updated blog and free planning resources on our website, as we have been since the onset of the novel H1N1 virus. Additionally, Global has developed a Pandemic Advisory Service to provide timely and effective guidance to help organizations maintain and enhance operations during this global public health emergency.

Our team can also address your needs by:


  • Providing concise updates on the status of the Influenza A (H1N1) virus as it relates to the number of cases, incubation periods, infectivity, and anticipated actions.

  • Presenting a medical and pandemic planning context that can assist in the immediate development of pandemic policies and procedures.

  • Helping you implement comprehensive infection control policies at your workplace.

  • Offering clarification and guidance on the numbers and types of items to be included in personal protective equipment (PPE) stockpiles.

  • Ensuring that your efforts are grounded in pandemic preparedness best practices.