Global's H1N1 Update - 06/24/10

The H1N1 Blog closes shop (and re-opens down the street)

This marks our last post here at the H1N1 (Swine Flu) Update blog. While our blogspot home here has served us well, and we are a little melancholy to say goodbye to it, the feeling is eclipsed by our excitement at posting to our new WordPress digs.

This will be more than just a domain-name change. Over the last 12 years, the staff here has provided thousands of lay-rescuers and healthcare professionals with life-saving, cardiac support training and equipment. We’ve mounted preparations and responses to everything from floods and wildfires to plane crashes and suspected terrorist attacks. In the new blog, we will more completely explore the issues and events that surround everything that happens here at Global Medical Services and Global Consulting – including pandemic H1N1 planning and response.

Rather than just distil useful and relevant news and updates from the media noise for you, we plan on explaining why we think these things merit your attention. We’ll take a look at how people are responding to current incidents, and talk about how we can all do better next time. And we can always do better. The entire staff is looking forward journeying down the road ahead.

We hope you are too.

Read further updates at http://theglobalguard.wordpress.com/

International News

H1N1 appears less contagious than past pandemics

A pair of studies release by Cambridge University suggests the H1N1 virus does not transmit well via secondary infection. One study examined boys who fell ill with the pandemic flu at summer camp in Florida. Among the 212 boys at the camp, the virus’ successful attack rate was 23%. Once they got home the infected boys had contact with 87 more people, but the attack rate fell to 3.5%. Researchers suspect the reason for the drop is the return home after peak infectiousness had passed the advance warning households received when the sick campers returned. The second study found that 13% of 511 students at a Hong Kong secondary school contracted H1N1, but only 5.9% of the people in the infected students’ households got sick. These findings support a December 2009 study published in the New England Journal of Medicine that further noted secondary infection rates for the 1957 and 1968 pandemics were as high as 40%. University of Minnesota CIDRAP

Two members step down from the WHO’s pandemic review panel

To answer critics of the World Health Organization, the UN agency convened an independent panel of experts last month to begin reviewing and discussing the WHO’s pandemic response. The identities of the panels members has been kept secret to insulate them from outside influence, but two of the panel’s experts resigned this week. John MacKenzie and Dr. Tony Evans were involved in planning the WHO’s pandemic response and felt serving on the review committee could become a conflict of interest. Chair of the panel Dr. Harvey Fineberg said, "They each concluded it would be better to avoid the position as reviewer of their own earlier actions." The WHO Director General Margaret Chan has promised to make the names of the remaining committee members public once the review is complete and the pandemic is over. CBC News

Global's H1N1 Update - 06/22/10

The next update will be on Tuesday, June 24th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 13, 2010

International News

H1N1 reassortment in pigs could become a significant threat

Back in February, Chinese researchers recorded the first instance of H1N1 encountering another virus within a host, intermixing and then emerging as something new; this process is known as reassortment. While novel, Chinese officials stated that the new virus strain did not present a public health risk, and to-date the hybrid has not been found in humans. After months of study, these scientists have found that the new strain is too distinctive to cross-react with antibodies triggered by pandemic H1N1 or its vaccines. They also found that pandemic H1N1 reassorts easily with other viruses, noting during their study that H5N1 and H9N2 –both dangerous pandemic candidates– were also found in the pigs. This process could generate other flu viruses with the ability to be much more virulent than existing strains.

As a result, the study calls for much higher levels of surveillance for swine populations, something that, ironically, has dropped since the pandemic outbreak. Pig and poultry farmers have learned that finding viruses in their livestock can produce costly results. However, the report says phylogenetic studies suggest that the pandemics of 1918, 1957, and 1968 all evolved in another mammalian host for years before surfacing in humans. The inference is that the relatively mild 2009 outbreak could only be the prelude to a much longer pandemic. CTV News

Fake, mail-order Tamiflu uncovered

The American Food and Drug Administration has issued a warning against a product available online as “Generic Tamiflu”. There is no such thing. The FDA purchased a package of the drug for testing, and found that it contained no oseltamivir, the active ingredient in Tamiflu. Instead what they discovered were capsules containing cloxacillin; an antibiotic similar to penicillin. Those with allergies to penicillin are at risk of similar, potentially life-threatening reactions when taking cloxacillin. While the website where the FDA purchased its “Generic Tamiflu” is no longer operating, the agency warns that the fraudulent drug is likely to crop up on other sites claiming to be online drug stores. United States FDA

Global's H1N1 Update - 06/17/10

The next update will be on Tuesday, June 22nd, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

Indian H1N1 outbreak claims 16 lives in one month

With onset of monsoon season in Southeast Asia, influenza is considered a common monsoon-related malady. In southwest India, the state of Kerala is suffering from a large resurgence in H1N1 infections. Of the 16 deaths due to H1N1 the agrarian state has reported since May 15th, 9 were pregnant women. India’s National Centre for Disease Control has sent its Joint Director with an epidemiologist and a virologist as a three-doctor swift response team to the state capital, Thiruvananthapuram, to investigate and combat the outbreak. In addition, the Indian parliament has approved shipments to Kerala of 600 000 Oseltamivir tablets, 20 000 bottles of pediatric syrup and 31 000 doses of vaccine. Monsoon season is expected to last another two to three months. Infocera

Vietnam wants to lower its pandemic alert level

Not content to wait for the World Health Organization’s review in July, Vietnam’s Deputy Minister of Health Trinh Quan Huan has suggested lowering his country’s H1N1 alert level. According to Huan, his ministry had “heard” that senior WHO officials had been lobbied by pharmaceutical companies to influence the official pandemic declaration. “This is a big issue,” he said. The Vietnam Health Ministry spent approximately $52.5 million on pandemic prevention measures last year. Thanh Nien News

New Zealand vaccinates record numbers of citizens

The New Zealand government says over a million of its citizens were vaccinated against the flu this year; the highest number of people ever to respond to its public immunization program. New Zealand Health Minister Tony Ryall congratulated health officials, doctors and nurses on their “great job” and urged those who qualify for free vaccinations “to take up this offer while vaccine stocks last”. New Zealand’s last census estimates the country’s population at 4.3 million. TV3 News

Global's H1N1 Update - 06/15/10

The next update will be on Thursday, June 17th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

The WHO, CIDRAP and others continue to respond to BMJ allegations

Defenders of the World Health Organization’s pandemic recommendations continue to surface in the face of criticism from the British Medical Journal, now the BMJ. Earlier this month the BMJ suggested the UN body had come under the influence of drug industry corruption and that the H1N1 guidelines provided by three of its flu experts were suspect. David Ozonoff, an epidemiologist at the Boston University School of Public Health, called the report a "smear" that insinuates the serious charge that they would have given different advice if they hadn’t had relationships with drug companies. The BMJ authors Deborah Cohen and Philip Carter responded, "We think this is the researcher's reading into it, not necessarily ours."

Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, called the article “irresponsible and reckless” saying, “There was nothing in those guidelines that was not based on the best science available. To suggest that the three scientists were able to direct and control the final recommendations [of the 22-member panel] is naive, and stated without a single shred of evidence.”

Epidemiologist Marc Lipsitch at the Harvard School of Public Health compared the situation with the Deepwater Horizon oil spill in the Gulf of Mexico: “It is ironic, as we watch […] the catastrophic results of ‘best-case scenario planning’ […], to have the WHO coming under criticism for planning for, and raising awareness of, the possibility of a severe pandemic. […] They should be commended for it.”

Director General of the WHO Margaret Chan sent an open letter to the BMJ in response to the article. In it, she allowed that transparency and stricter rules of engagement with industry were issues the agency was working to improve on, but “at no time, not for one second, did commercial interests enter my decision-making.”

According to the Journal article, “pharmaceutical companies, […] put pressure on WHO to declare a pandemic. It was the declaring of the pandemic that triggered the [vaccine purchasing] contracts.” However, many countries including the United Kingdom, France, Finland, Canada, the Netherlands, Switzerland, and the United States had already activated their contracts and placed large orders for H1N1 vaccine weeks before the WHO declared the pandemic on June 11, 2009. Therefore, the Emergency Committee could not have influenced these in any way. "You are absolutely right," conceded the authors of the BMJ article when challenged with this timeline. Nature News

Pandemic, one year later

The H1N1 pandemic is officially a year old as of last Friday. On June 11, 2009, the World Health Organization’s Director General declared the H1N1 outbreak was a phase-six pandemic. The avian (H5N1) flu virus had led the public to associate the term “pandemic” with high death rates, so the WHO hesitated making the declaration over concerns it would cause undue alarm. The announcement came about seven weeks after the virus surfaced. A year later, labs officially confirm H1N1 has claimed 18,156 lives though the actual count, which won’t be known for years, is expected to be many times higher. While H1N1 activity has tapered off in most parts of the world, the WHO maintains a phase six alert. World Health Organization

Global's H1N1 Update - 06/10/10

The next update will be on Tuesday, June 15th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 23, 2010

National News

Canada's response to the H1N1 pandemic was one of confusion, says a white paper being presented Tuesday at the World Conference on Disaster Management in Toronto. Serious gaps in the country's pandemic planning and unrealistic management guidelines were exposed, it says. Dr. Allan Holmes, who moderated the roundtable discussion on which the report was based, said a single pan-Canadian approach to planning is needed, along with a severity index to put future outbreaks in context. Vancouver Sun

International News

British virologist John Oxford stated at a recent Dublin conference that "It's too early to do a postmortem" on the pandemic H1N1 flu virus. He predicted it will cause trouble again in the coming winter. People need to be aware of how to limit its spread, and decisions need to be based on science, he said. As for vaccine, he stated, "It's no time to be complacent and say we wasted our money on vaccines, because we haven't. This is a virus that will be in the community for a long time." Irish Times

Global's H1N1 Update - 06/08/10

The next update will be on Thursday, June 10th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 30, 2010

International News

WHO keeps pandemic alert status at phase six

After reviewing the state of pandemic activity, and an extended meeting of the Emergency Committee last week, the World Health Organization decided to maintain its pandemic alert level at phase six. While the Emergency Committee unanimously agreed that it had subsided significantly all over the world, H1N1 proliferation still has not dropped below the threshold defined by their phase six alert and it is expected to continue. The Emergency Committee’s next meeting is scheduled for July when they will review disease activity again and consider downgrading the alert status. World Health Organization

CIDRAP disputes BMJ story's allegations of WHO improprieties

The University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) as come to the defence of the World Health Organization after a story in the British Medical Journal alleged conflicts of interest had compromised the UN agency’s recommendation process. According to the Journal story, three scientists who had written key guidance reports for the WHO did so under the influence of competing interests in the pharmaceutical industry. The story goes on to imply that the WHO tried to cover up the interaction by not disclosing it with the report. Dr. Michael Osterholm, the director of CIDRAP, weighed in on the story declaring he had ties to neither the WHO nor the pharmaceutical industry, “I have no horse in this race except the truth.” He went on to acknowledge that it is common for public health specialists to gain their expertise working in the private sector. The pool of influenza experts is relatively small and, “for the WHO to not call on these [three scientists] would have been a serious subject matter expert mistake. Having said that, all of the appropriate recusals and identification of conflicts of interest were made. And in the imperfect world we live in today, that's as good as it gets.” With regards to the article, he warned, “Today it's very easy to do science witch hunts or character assassination by inference. There's no evidence whatever that any of these individuals acted improperly, nor did WHO.” CTV News

Global's H1N1 Update - 06/03/10

The next update will be on Tuesday, June 8th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 23, 2010

National News

Ontario grades its pandemic response as adequate but improvable

Ontario’s Chief Public Health Officer Dr. Arlene King released a report reviewing that province’s response during the H1N1 pandemic outbreak. While she said Ontario’s handling of the pandemic was fairly comprehensive and effective, she did have criticisms for the manner in which the supply of vaccine was maintained and the lack of coordination in vaccine programs from region to region. “There was never an alignment between H1N1 vaccine supply, demand and our capacity to deliver it,” she said when describing the line ups for vaccine when vaccinations were in short supply and the subsequent fading interest once the supply began to grow.

Much of the uncertainty was compounded by different regions taking varying approaches in their vaccination campaigns and her office’s lack of authority to compel the province's 36 health boards to follow vaccine priority groups recommended by the World Health Organization and set by the federal and provincial governments. "They resulted in, I think, in really frankly shaking some public confidence in terms of how the pandemic was being managed. And I think ultimately those kinds of things result in concerns around public safety as well." Winnipeg Free Press

International News

Public pandemic information didn’t make enough of a case for vaccination

The RAND Corporation has conducted poll that compares public attitudes towards seasonal influenza and the H1N1 pandemic. While people considered H1N1 to be more of a concern than seasonal flu, the vaccine was also seen as less safe. As a result, vaccination up-take compared to that for the seasonal flu was lower. The researchers say people garnered their information from a wide variety of sources, and were told repeatedly how severe a threat the pandemic could be, but received relatively little information about the safety and value of vaccination. Preventative Medicine

Global's H1N1 Update - 06/01/10

The next update will be on Thursday, June 3rd, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 23, 2010

International News

Taiwanese researchers highlight the need for veracity and calm in a pandemic

Taiwanese Health officials have published a study outlining the importance of strong surveillance and communication strategies as a part of public vaccination campaigns. During the H1N1 outbreak, the Taiwanese government began a nation-wide, in-school vaccination campaign using an inactive vaccine that had no adjuvant. Within two hours of vaccination, 46 children from a 692-student school were sent to hospital with symptoms of dizziness, nausea and weakness.

Physical and laboratory examinations uncovered no organic cause for the symptoms in any of the patients. One student was hospitalized overnight and discharged the next day; the other 45 recovered spontaneously in the emergency department. Doctors concluded it was a case of Mass Psychogenic Illness (MPI) resulting from public hysteria over vaccine safety, but the episodes received intense media coverage, which drove even greater suspicion over the safety of the vaccine. By the end, health officials had documented 22 more clusters of mass psychogenic illness affecting a total of 350 children. Eurosurveillance Journal

WHO expects to review its Pandemic Alert Phases

With the southern hemisphere’s winter solstice this month comes the height of the annual flu season for many countries in that part of the planet. The World Health Organization’s Emergency Committee is expected to meet by teleconference at 12:00(GMT) today to review the spread and proliferation of H1N1 and determine whether or not the pandemic should be declared ongoing, declining, or over. The declaration serves as a signal to the 193 member nations of the UN for the measures they take against the virus with regards to stockpiling and distributing antiviral drugs and vaccines. Currently H1N1 is the most active in the Caribbean, Southeast Asia and parts of Chile. Reuters

Global's H1N1 Update - 05/27/10

The next update will be on Tuesday, June 1st, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 16, 2010

International News

Potential source for universal flu vaccine discovered

The American Society for Microbiology’s journal, mBio, has published a study outlining the construction of a headless version of the flu virus which may be used to create a universal flu vaccine. Currently, annual flu shots use epidemiological research and some guesswork to assemble a cocktail of three vaccines that target a narrow band of virus strains suspected of becoming that year’s dominant bug. Every so often a significant mutation occurs that allows the virus to sidestep existing vaccines and elude the body’s immune system, and a pandemic strain emerges.

The key lies in the hemagglutinin, which is what gives influenza virus strains the ‘H’ in their designations. Hemagglutinin is a protein structure on the virus that it uses to “glue” itself to the cells it infects. Because this attachment is an operation all viruses must be able to perform, portions of the protein are common to all strains, even mutated ones. Researchers at the Mount Sinai School of Medicine in New York isolated these conserved sequences on the protein to create a universal vaccine type. The experimental vaccine has already been used to protect mice from lethal doses of influenza virus.

Annual vaccines represent millions of dollars in income for the pharmaceutical industry. Last year Canada bought over 50 million doses of flu vaccine for its public vaccination program. The US bought over 162 million. Reuters

Doctor who was architect of vaccine-autism link banned from practicing medicine.

After finding him guilty of over 30 charges of professional misconduct and unethical behaviour, the United Kingdom’s General Medical Council has stricken Dr. Andrew Wakefield from the medical registry. In 1998, a research team led by Dr. Wakefield published a study in British medical journal The Lancet that concluded there was link between the administration of measles, mumps and rubella (MMR) vaccines and the onset of autism. The paper set off a 10-year storm of controversy as vaccine rates in England dropped, and measles case numbers rose. The Lancet retracted Wakefield’s study in February

No large scientific study has been able to reproduce these findings, but the General Medical Council (GMC) said their investigation was not concerned with whether or not the study’s findings were right or wrong, but the manner and the circumstances under which the study was conducted. Dr. Surendra Kumar, chair of the hearing committee said that the application of the council’s most severe sanction was the only measure “appropriate to protect patients and is in the wider public interest, including the maintenance of public trust and confidence in the profession, and is proportionate to the serious and wide-ranging findings made against him.”

Among the offences listed at the hearing were the way Dr. Wakefield gathered his blood samples, he paid children £5 each for them at his son’s birthday party; and his nondisclosure of the fact that had been paid £50,000 (about $72,000) by the lawyers of a parents’ group who were suing vaccine makers.

In a BBC interview, Wakefield said he never claimed to prove a link between MMR vaccines and autism, but at an appearance on NBC’s Today show, he claimed the autism link he established was the basis of a smear campaign against him of which the GMC’s ruling was a part. BBC News

Global's H1N1 Update - 05/25/10

The next update will be on Thursday, May 27th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

International News

Brazil's Health Ministry last week announced plans to extend its H1N1 vaccination campaign by almost 2 weeks, to June 2, according to China's news agency Xinhua. Since March, the country has vaccinated more than 61 million people, about 70% of the campaign's goal. The ministry also decided to broaden vaccination to include children 2 to 5 years old, which will require almost 11 million additional doses. Xinhua

A study of hospital patients in Singapore in the first 3 months of the pandemic showed that H1N1 patients were younger but had fewer symptoms, on average, than those with seasonal flu. Of 547 patients with novel H1N1 flu, 42% were age 6 to 18, 35% were 19 to 35, and just 6% were 51 or older. In 193 patients who had seasonal flu, the respective numbers were 16%, 21%, and 23%. Fever was more common in those with seasonal flu, but cough, sore throat, and muscle aches were more common with H1N1. Arch Intern Med

Veterinary officials in South Korea and the Netherlands recently reported low-pathogenic avian influenza outbreaks, South Korea H7N7 and the Netherlands an H7 subtype, according to reports recently submitted to the World Organization for Animal Health (OIE). In South Korea, an H7N2 outbreak struck two duck farms in Cholla Namdo on the southwestern coast. Between the two farms, 53,330 birds were culled to control spread of the disease. Meanwhile, an outbreak in the Netherlands occurred at a poultry farm in Deurne, North Brabant province, located in the southern part of the country. The report said the birds showed no symptoms. Authorities culled 28,000 free-range layer hens to control spread of the virus. CIDRAP

Global's H1N1 Update - 05/20/10

The next update will be on Thursday, May 25th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

International News

In the face of criticism, some powerful support steps forward for the WHO

There is no shortage of criticism for the World Health Organization’s (WHO) handling of the H1N1 outbreak. Chat forums and web logs are rife with accusations of collusion with the pharmaceutical industry. Almost a third of the European Union’s members of parliament have signed a petition criticizing the WHO’s handling of the influenza pandemic and calling for an investigation.

This week the World Health Assembly, the decision-making arm of the WHO, convenes to discuss a range of global health issues including the H1N1 pandemic response. At the first day of the gathering, France, India, and the US gave public statements in support of the WHO’s efforts. French Health Minister, Roselyne Bachelot went so far as to issue a point-by-point rebuttal of the criticisms saying the UN agency had been “taken to task in an unjust manner,” and that “the vaccine, which was the answer to a real danger, turned into a source of risk in the collective mind. The effects of this smear campaign are potentially devastating.”

In her opening address to the assembly, WHO Director-General Margaret Chan said that the news regarding the pandemic is mostly good, and while public health successes are usually owed to political commitment, adequate resources and cooperation, this time we were “just plain lucky.” For India’s part, this seems to either represent a 180° change in their position, or that their earlier criticism was a political gambit. Agence France-Presse

H1N1 response review committee holds its first press conference

On May 19 the external review committee for the WHO’s pandemic response held a press conference to discuss the findings of their first meeting. The group’s final report will be a public document and is under no restrictions on scope of their recommendations. Dr. Harvey Fineberg, chair of the review committee, outlined their mandate saying they were looking to into any aspect that bears on lessons for the future saying, “We want to offer recommendations that are keyed to the problems we find. We want to offer recommendations that enable the world, WHO and the nations, to do better the next time, and we are confident there will be a next time.”

The committee plans to measure the WHO’s response in term of 5 issues: preparedness, alert, response, communication and International Health Regulations performance. To facilitate its investigation, the committee will have access to confidential WHO documents and data. While the report will be public, Dr. Fineberg said that the group will have no authority to compel confidential documents into the public view. When asked what types of confidential information the group had, he described it as mostly letters of agreement and contracts with private industry. World Health Organization

Global's H1N1 Update - 05/18/10

The next update will be on Thursday, May 18th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

National News

H1N1 claims the life another Canadian

A Quebecois man who recently returned from a trip to Cuba has died after contracting the H1N1 virus. The man passed away in a Montreal hospital after transferring from Shawinigan, near his home. Quebec health authorities say the death does not mark the beginning of a third pandemic wave. "We know now that there are many flu cases in Cuba," said Dr. Gilles Grenier, a public health director in the Shawinigan region. "The hypothesis is that he got the virus over there, so it's really an isolated case." The man, who was in his fifties, suffered from asthma and had not been vaccinated against H1N1. CBC News

International News

India approves its first H1N1 vaccine supplier

The Drug Controller General of India has approved pharmaceutical company Zydus Cadilia to market its own H1N1 vaccine. The nod makes Zydus Cadilia the first company in India to domestically launch an H1N1 vaccine. The Ahmedabad-based company will use Vaxxicare, its preventative medication division, to sell the vaccine under the trade-name VaxiFlu-S. “With the development and launch of vaxiflu-s, Zydus now has proven capabilities in researching, developing, and manufacturing of safe and efficacious vaccines,” said Pankaj Patel, the company’s chairman and managing director. He went on to say that he expects Zydus Calilia to soon produce vaccines for other viral, bacterial and protozoal infections. Hindustan Times

Researchers say the benefits of H1N1 prophylaxis must be quantified against side-effects

A study published in the European science journal Eurosurveillance reports that side-effects are a significant factor in the dispensing of the anti-viral drug oseltamivir as a mass, preventative antiviral blanket. Of the students and staff at a British elementary school given the drug in June 2009 as a prophylactic measure, 42% reported adverse side-effects and 15% did not complete the course of oseltamivir due to adverse effects. The authors of the study call for an assessment of each patient’s likelihood of infection to avoid unnecessary treatment. Eurosurveillance

Global's H1N1 Update - 05/13/10

The next update will be on Tuesday, May 18th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 2, 2010

Looking ahead: beyond H1N1

With the North American H1N1 pandemic looking more and more like it’s over, Global Consulting has partnered with Roche Canada to host a workshop aimed at helping groups and organizations carry their pandemic safeguarding measures beyond H1N1. Many organizations spent a lot of money and worked like yeomen preparing for the pandemic, and a lot of companies have gleaned new insights into their operations through their efforts. There’s no reason to scrap those resources just because the crucible they were forged in has cooled. There will be other infectious threats in the future, to be sure, but the benefits realized here can also be applied in areas well beyond the scope of emergency planning.

A number of speakers are confirmed for the workshop. Dr. Allan Holmes helped a lot of companies and government authorities develop their frontline response to the pandemic. He’s going to share his experiences in guiding the public through the threat. Dr. Graham Dodd, an emergency physician who worked clinically at Royal Inland Hospital during the outbreak, will talk about the impact H1N1 had on our health care system and the kinds of things it, and we, can expect in the future. Also, Gian Di Giambattista, one of Ontario Power Generation’s emergency planning chiefs, will give his perspective working at a utility few of us can do without, and, with three nuclear power plants on line, has little inherent tolerance for operational disruptions. All three men expect to give and come away with valuable insight gathered from each other and the attendees. Global Consulting

International News

WHO will take another look at its pandemic alert status

After the onset of the southern hemispheric winter, the World Health Organization’s Emergency Committee will meet to re-assess the status of the H1N1 pandemic. The 15-member panel will then recommend that the UN body maintain its current alert status, stand down to a “post-peak” level or declare the pandemic over. To date, there have been over 18 000 laboratory-confirmed deaths due to H1N1, but it will be a few years before we know the actual death toll. John Mackenzie, the committee chair and the only member known to the public, said that the casualty rate will prove to be high as the 1957 and 1968 outbreaks, which claimed lives by the millions. Identities of committee members are kept secret to insulate them from influence from drug companies or special interest groups. Reuters

EU Members of Parliament are miffed over their handling of H1N1

Over 200 deputies of the of the 736-member European Union’s Parliament have called for an investigation into the EU’s response to the H1N1 outbreak. Isabelle Durant, a Belgian MEP, described the EU’s management of the pandemic as having "seriously undermined the credibility of, and confidence in our institutions." The proposal sent to the parliament asserts that the amount spent on vaccines was unwarranted, officials should have changed their response tactics early on, and that the EU relies too heavily on the World Health Organization. The Parliament

Global's H1N1 Update - 11/05/10

The next update will be on Thursday, May 13th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 2, 2010

International News

H1N1 may have been a milder pandemic than expected, but in populations affected by the disease, the impact has been profound.

In a meeting with the American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention issued a statement saying that the two pandemic waves of H1N1 in America have claimed the lives of 317 patients under the age of 18. Compared to the last five years, that amounts to over 3.5 times the pediatric mortality rate for seasonal influenza. The average age for deaths was 9.4 years, older than the previous averages which were a little over 6 years. Of the deaths, 65% (205) of the patients were in a high risk category for influenza-related complications due to underlying conditions such as obstructive pulmonary disease, neurological disorders, asthma, and heart disease. In contrast, only 43% of those who died in the previous two seasons had these conditions. CDC Flu Activity and Surveillance

Routine pediatric vaccination uptake on the decline in the US

A study released by the U.S. Centers for Disease Control and Prevention shows that more American parents are refusing or significantly delaying vaccinations for their children. Compared with parents who opted for vaccinations, those who declined were less likely to believe that their children were susceptible to vaccine-preventable diseases, that the diseases were a health concern, or that vaccines are safe and effective. Children who are not immunized by 19 months of age risk being more vulnerable to vaccine-preventable diseases. CBC News

Vaccine shortages in Australia

Australia’s supply of seasonal influenza vaccine, which includes protection from pandemic H1N1, is running low. In Victoria, Australia’s second most populous state, pharmacies have started waiting lists for people seeking immunizations. Because of the unexpected demand, CSL, the company that makes most of the country’s vaccines, rushed a second batch to market but warns that there may be more shortages. The Herald Sun

Global's H1N1 Update - 06/05/10

The next update will be on Tuesday, May 11th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 25, 2010

International News

Worried parents overwhelmed many ER’s before the H1N1 pandemic even broke out

A pair of studies presented at the Pediatric Academic Societies’ annual meeting in Vancouver, B.C. have found that before the outbreak of H1N1, fear of the flu was already sending large numbers of patients to hospital emergency departments. Most of the visits were from parents bringing their children.

The report confirms what many doctors had already suspected. “Long before we had flu activity, we had record volumes in our emergency department, most of whom were the worried well or the mildly ill," said Dr. Brian Currie, vice president at Montefiore Medical Center in New York City. "We're talking six to eight times our usually busy ER volume. We have the largest emergency room capacity in New York City and probably the 5th largest in the United States—so if we were getting overwhelmed, you can imagine how smaller hospitals and institutions were feeling.”

Dr. William McDonnell, who led the study, worked clinically during the pandemic and said he felt the study showed, “that media messages about public health issues affect people's behavior. I'd like to see the media and the medical community working together to make sure we inform the public as accurately as possible when risks exist—and also when they do not.” University of Minnesota CIDRAP

Global's H1N1 Update - 05/04/10

The next update will be on Thursday, May 6th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 25, 2010

International News

The University of Minnesota’s Centre for Infectious Disease Research and Policy concluded its comprehensive 3-part series of articles on the H1N1 pandemic and its repercussions. The writings were issued to mark the 1-year anniversary of the pandemic outbreak. Each installment was written by a different staff writer for the university’s journal. Together they examine the inherent uncertainty involved in tackling a global pandemic, the stuttering start to most countries’ vaccination programs, and the scientific and epidemiological dividends to be reaped once the pandemic recedes. For those who would like to read to entire series, parts one and two can be read here and here. CIDRAP

A number of prominent American authorities in health research and policy have offered their assessments on topics ranging from the H1N1 virus to the public response and media coverage of the pandemic. Through these, a view of the virus we had early in the outbreak without the benefit of hindsight or extensive research emerges. When H1N1 spread so quickly and seemed to threaten the youngest and strongest of us so easily, what would happen when infection was widespread? The answer would turn out to be “Not much, as pandemics go,” but there was no way to know this at the time. San Diego Union-Tribune

Global's H1N1 Update - 04/29/10

The next update will be on Tuesday, May 4th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

International News

Australia's Therapeutic Goods Administration has widened its probe into CSL's seasonal flu vaccine, which includes the pandemic strain, after children receiving the shot had fevers and convulsions. The agency asked all states and territories to examine all reports of fever in children under 5 for evidence of any pattern. Also, New Zealand reported today that five children experienced convulsions after flu vaccinations, according to news reports in that country. Bloomberg

Researchers found that the commonly used CDC case definition may not work for detecting mild pandemic H1N1 flu. They reviewed medical records of 44 patients with lab-confirmed H1N1 who were hospitalized in early summer 2009 and found that many of them had no fever. They found cough to be a more sensitive H1N1 indicator. The authors conclude that “the standard case definition for 2009 H1N1 influenza has low sensitivity for mild influenza infection.” American Journal of Infection Control

Global's H1N1 Update - 04/27/10

The next update will be on Thursday, April 29th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

National News

Overall influenza activity has continued to be low for at least 17 consecutive weeks. Only one specimen (out of 1,379) tested positive for pandemic H1N1 2009 in the third week of April. No new H1N1-related hospitalizations and deaths have been reported this week. To date, only 14 hospitalizations and two deaths have occurred across Canada since the beginning of 2010. As of week 14, influenza activity level in the Southern Hemisphere continues to be low in general. Of note, however, in Chile, there was evidence of early localized pandemic influenza virus transmission in advance of the usual start of the southern hemisphere winter influenza season. PHAC FluWatch

International News

Australian Broadcasting Corporation (ABC) has reported that the number of children in West Australia who had convulsions or fever and vomiting after receiving a seasonal flu vaccine that covers the pandemic strain has grown to 251. Officials say the immunizations likely came from multiple batches. Queensland is also investigating the possibility of adverse reactions in children, and police in Brisbane are probing the death of a recently vaccinated 2-year-old, according to other ABC reports. ABC

Global's H1N1 Update - 04/22/10

The next update will be on Thursday, April 27th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

International News

After a quiet start to the year, Bangladesh is reporting rapid spread of pandemic flu this month and has placed health officials across the country on alert. “The virus sustained at a lower level in Bangladesh during January-March period, but it showed rising trend since the beginning of this month,” a health official said, adding that April through September is typically the busiest season for flu. He did not specify case numbers. Balita

Nigeria has yet to receive any H1N1 pandemic vaccine and is concerned that cases may grow as nearby Ghana is reporting an outbreak. Nigeria has confirmed 11 cases and 2 pandemic deaths. The story quoted unnamed experts as saying global demand for the vaccine has outpaced supply, making it difficult for developing countries to obtain doses. Nigeria Bulletin

In the biggest and most detailed look yet at pandemic flu infections in pregnant women, researchers from the US Centers for Disease Control and Prevention (CDC) have reported that early antiviral treatment was linked to fewer intensive care unit (ICU) admissions and that severe illnesses and deaths are more likely to occur during the third trimester. The CDC researchers, along with a Pandemic H1N1 Influenza in Pregnancy Working Group made up of health officials from several U.S. states, based their findings on reports of pregnant women who were sick with pandemic H1N1 infections through August plus more recent reports of women who were admitted to ICUs. The findings appear in the Apr 21 issue of the Journal of the American Medical Association (JAMA). CIDRAP

Global's H1N1 Update - 04/20/10

The next update will be on Tuesday, April 22nd, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by the World Health Organization (WHO), as of April 4, 2010

National News

Canadian researchers have reported that patients who became severely ill with H1N1 swine flu last year often developed kidney failure, which worsened their illness and raised costs. Doctors should be on the lookout for kidney damage in patients who are hospitalized with the virus, they told a meeting of the National Kidney Foundation. “It's concerning that so many people got some form of kidney injury, although it was reversible in the majority of them,” Dr. Manish Sood of the University of Manitoba in Winnipeg said in a statement. Sood's team looked at the cases of 47 critically ill patients with confirmed H1N1 infections who were admitted to one of seven intensive care units in Manitoba. National Post

International News

Just weeks before it hosts the World Cup, South Africa is reporting a shortage of H1N1 vaccine. Doctors and pharmacies have run out of the vaccine, imported from Australia, and say no more is available. The country received 1.3 million doses, which are being used for "front line" port-of-entry workers and certain HIV patients. A further 3.5 million doses donated by the World Health Organization (WHO) will be used on pregnant women and others at high risk. West Cape News

Health officials in Chile are concerned that only 600,000 of a hoped-for 4 million people have received the H1N1 vaccine in a country that saw 300,000 cases and 1,800 hospitalizations last year. And this year a Feb 27 earthquake destroyed 5,000 hospital beds in the central region. One university faculty member explained that getting the shot early is essential to prevent overloading of hospitals, because immunity takes about 2 weeks to build. Santiago Times

Global's H1N1 Update - 04/15/10

The next update will be on Tuesday, April 20th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

National News

The premature expiry of a batch of adjuvanted H1N1 vaccine has prompted the Alberta government to ask manufacturer GlaxoSmithKline for a refund. The vaccines were supposed to last for 18 months, based on scientific evidence at the time; however, Health Canada has announced a new expiry date of only six months, after tests found the vaccine's potency declined after that time period. Alberta has around 650,000 to 700,000 doses of the affected vaccine, worth $2.2 million. CBC

International News

U.S. researchers recently presented a study at the American Academy of Neurology’s annual meeting that showed reports of Guillain-Barré Syndrome associated with H1N1 vaccination in the U.S. were extremely low. For every 10 million H1N1 vaccinations administered in the U.S. last year, officials received about six reports of people developing Guillain-Barré Syndrome, a rare neurological disorder. But memories of problems during a 1976 immunization campaign and public anxiety during last year’s H1N1 pandemic stoked fears that mass inoculation using a new vaccine would result in a rash of serious side effects, health problems and even deaths. Now that the peak of the pandemic has passed and researchers are looking back at the response, signs indicate many of those public fears were exaggerated, or even unfounded. Globe and Mail

The American College Health Association (ACHA) has said that flu activity at U.S. colleges has dropped to its lowest level since August when surveillance began. The increases seen in southeastern states in February and March are also easing. The attack rate last week was 1 case per 10,000 students, a decrease of 38% from the previous week. No hospitalizations or deaths were reported, and the ACHA saw no evidence of sustained transmission. Vaccine uptake held at 8%, where it has been for several weeks. ACHA

A laboratory in Namibia recently confirmed the country's first pandemic H1N1 case, a patient who had traveled with a group to Thailand. The illness is also suspected in a second patient who was with the group. Namibia's health minister expressed disappointment that the finding was first reported in the media before the case was reported to health officials. The country expects to launch its vaccine campaign in May with 220,000 doses from the WHO. Nambian

Global's H1N1 Update - 04/13/10

The next update will be on Thursday, April 15th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*
*Cases reported by The World Health Organization (WHO) are as of April 4, 2010


National News

Adjuvant vaccines set to expire sooner than expected

The Public Health Agency of Canada has moved up the expiry dates for H1N1 vaccines containing adjuvant, effectively shortening their shelf lives. In an e-mail to reporters, the agency said, “In early March 2010, Health Canada, after careful analysis of both GSK [GlaxoSmithKline, the vaccine’s manufacturer] and its own stability data, determined that the 18 month shelf life was no longer appropriate for the product.” Unused vaccines will now have a recommended shelf life of six months. The department has said that the expiry date revision is not safety related, and to date Canadians who have received vaccines using adjuvant have been provided with sufficient immune response against H1N1 infection. CBC News

International News

WHO admits to flaws in its response to H1N1

The World Health Organization (WHO) has conceded shortcomings in its handling of public information during the H1N1 outbreak. Critics have said the organization created a panic in declaring a pandemic and question links with pharmaceutical companies that recorded large profits from producing vaccines. Addressing the first meeting of the external review committee of the WHO’s pandemic response, Dr. Keiji Fukuda, the agency’s top influenza expert said, “We have a great deal of speculation, we have a great deal of criticism […] I think we did not convey the uncertainty [inherent in a pandemic]. That was interpreted by many as a non-transparent process.”

Still, the agency does not regret making the declaration. "We have always been very clear that based on the virologic information, based on the immunologic information, the epidemiologic information, the differences in clinical patterns that we see from seasonal influenza, we have never had a moment's doubt of whether this is a pandemic or not," he said.

Dr. Fukuda went on to describe the confusion around the WHO’s six-phase system for declaring a pandemic as “vexing.” H1N1 was ultimately not as deadly as the widely-feared avian influenza, but the organization’s scale only accounts for the geographic spread of a virus, not its severity. The WHO tried to come up with a standard for measuring the pandemic's severity using death rates, but many countries lack the ability to gather sufficient levels of information or even basic birth and death registries. "Many countries don't have the actual capacity to determine reliably the severity of the virus," said Dr. Martin Cetron one of the experts from the U.S. Centers for Disease Control and Prevention taking part in the review. The Vancouver Sun

Global's H1N1 Update - 04/08/10

The next update will be on Tuesday, April 13th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of March 28, 2010

National News

Even with peer review a controversial H1N1 study may raise more questions than it answers
A series of controversial Canadian studies have been published in the top-flight Public Library of Science Medical Journal causing some who dismissed the research to rethink their skepticism. The studies indicate a person’s chances of contracting pandemic H1N1 double if they first receive a shot for seasonal influenza. Researchers made their findings known in the spring of 2009 prompting a scramble among health authorities as they struggled to revise their vaccination programs, most postponing them altogether until the pandemic vaccine was available.

Outside Canada the effect was not detected, so the findings were dismissed as troubling but unconfirmed. The authors of the report remain proponents of flu shots saying the phenomenon really only relates to a brief period of time when humans were first exposed to the virus. Dr. Ed Belongia, the director of epidemiology at the Marshfield Clinic Research Institute in Marshfield, Wisconsin says that while his centre's findings do not corroborate the Canadian studies, he’s impressed with their level of scrutiny and, “in that sense I can't easily dismiss it.” CBC News


Universal vaccination program saves both money and lives
Unlike most other provinces, Ontario has offered a universal flu vaccination program since 2000. Free flu shots are more commonly offered only to seniors and those who are at higher risk of flu-related complications. A University of Toronto study has found that Ontario’s program routinely saves at least 100 lives and prevents 35 000 more from falling ill each year. Even though it is $20 million more expensive than other plans, the projected cost of administering those escalated cases means the program still saves the Ontario health care system about $7.8 million. CanWest News Service

The next update will be on Thursday, April 8th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*
*Cases reported by The World Health Organization (WHO) are as of March 28, 2010

National News

Federal government wants to analyze the impact of travel on pandemics

The Public Health Agency of Canada is commissioning a study to find out if travel advisories had any effect on when and where people traveled during the H1N1 outbreak and whether or not it resulted in any change in how the diseased was spread. Dr. Mark Lysyshyn at the agency’s Centre for Emergency Preparedness hopes the findings will give insight into the timing of advisories and which airports should be more closely watched. “We may not be able to prevent a pandemic coming to Canada, but we would like the epidemic curve to rise very slowly… it kind of trickles into Canada as opposed to coming in like a waterfall.” The Toronto Star

International News

Australia looks to the future of pandemic response

An editorial has been published in the Medical Journal of Australia that takes a look beyond the H1N1 pandemic and examines some of the lessons to be learned in preparing for future outbreaks. Among other things, the article calls for a review of the use of the term pandemic in consideration of its connotations in the public’s consciousness, and questions the usefulness of antiviral drugs like oseltamivir in slowing the overall spread of the pandemic. Medical Journal of Australia

Global's H1N1 Update - 04/01/10

The next update will be on Tuesday, April 6^th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of March 21, 2010

National News

Nova Scotia pharmacists take on vaccination duties

Health officials in Nova Scotia are preparing an amendment to the province’s Pharmacy Act to allow pharmacists to administer injections in their scope of practice. The move is aimed at relieving some of the workload from Nova Scotia doctors and enabling them to focus on other areas of care. The provincial Health Minister wouldn’t say for certain whether the change would mean user-fees might be charged for the shots. With the support of Doctors Nova Scotia, the Nova Scotia College of Pharmacists has added administering injections to their accreditation curriculum. Currently, pharmacists are training and taking on the new duties on a voluntary basis. Over time, the practice will become the norm. Winnipeg Free Press

International News

Researchers discover avian immunity gene

A research team headquartered at the University of Alberta has isolated a gene that allows ducks’ immune systems to contain the influenza virus without falling ill. Chickens, which lack the gene, can die within 18 hours of infection, but scientists have found a way to transfer the trait from duck to chicken cells and reduce viral replication within chickens by half. The discovery could lead to a breed of H5N1-resistant chickens and suppress the avian flu’s ability spread amongst birds. The Times of India