Global's H1N1 Update - 03/30/10

The next update will be on Thursday, April 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 March 21, 2010

International News

WHO plans an external review

With an internal review already underway, the United Nations’ World Health Organization (WHO) will also call on a group of about 30 outside experts to review its response to the H1N1 pandemic outbreak. Dr. Keiji Fukuda, the WHO's top flu official said that the assessment will “address many of the questions which are being raised now." Among the issues expected to come before the group will be the appropriateness of the term “pandemic” for what turned out be a relatively mild disease, the role a disease’s severity plays in the WHO’s assessment of an outbreak, and its movement through the phases of its pandemic alert scale. The expert group of will hold a number of meetings over the next year starting on April 12, and present its findings to the WHO’s Director General. CBC News

H1N1 activity resurgence in tropical-zone Americas

According to the World Health Organization, H1N1 virus transmissions in Central and South America may be on the rise. Guatemala, Nicaragua, El Salvador, Panama, and parts of Brazil have reported increasing pandemic flu detections over the past few weeks. Mexico is seeing more influenza-like illnesses and severe acute respiratory infections, but it's not clear if pandemic flu is the cause. WHO Pandemic H1N1 Weekly Update

Global's H1N1 Update - 03/25/10

The next update will be on Tuesday, March 30th, 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 14th, 2010

International News

China censors vaccine handling story

The International Federation of Journalists has learned that the investigative report we mentioned in Tuesday’s post has been removed by the Chinese authorities even though health officials have pledged to investigate the vaccine issue. The Chinese State Council Information Office ordered the story deleted from the China Economic Times, and the Central Propaganda Department ordered all media outlets to use only information provided by the state-owned Xinhua News Agency. Two weeks earlier, Chinese Premier Wen Jiaobo had committed to improving his country’s press freedom status and recognized of the role of independent media as government transparency watchdogs. International Federation of Journalists

Louisiana opens new H1N1 clinics

Texas, Arkansas, Louisiana, and a number of other southern states in the US have reported an increase in reported influenza-like illnesses. In response, the Louisiana Department of Health and Hospitals is opening free, walk-in H1N1 vaccination clinics. The State Health Officer warned that another pandemic wave could come and urged residents to get immunized. Since the outbreak, the pandemic has hospitalized 697 Louisianians, and there have been 52 confirmed H1N1‑related deaths. Louisiana Dept. of Health and Hospitals’ Press Release

The LA Times offers a look back at H1N1 and lessons learned

We don’t usually link to opinion pieces here at the blog, but The Clevelend Plain Dealer reprinted an article that appeared in the LA Times, and it seemed particularly even-handed and sharp-eyed both in its tone and insights. Among other things, it discusses the new light in which we ought to view the term pandemic, and the grain of salt we ought to take when confronted with shrill cries about dangerous vaccines and conspiracy theories. The LA Times

New research could keep 2009 H1N1 out of the seasonal flu cycle

The American Department of Health and Human Services has discovered a similarity between 2009 H1N1 and the pandemic strain from 1918 that explains why the virus is so successful at infecting younger populations instead of old. According to their study, the key lies in a sugar cap, or rather the lack of one, on the virus’ protein shell. Every H1N1 strain since the 1940’s has had such a cap, but it was and is absent from the 1918 and 2009 pandemic strains, which allowed them to side-step the body’s immune system. Researchers zeroed in on their conclusion when they found that mice vaccinated against the 2009 strain were immune when exposed to 1918 one. The discovery could help scientists anticipate virus mutations and update vaccines more effectively. US Dept. of Health and Human Services

Global's H1N1 Update - 03/23/10

The next update will be on Thursday, March 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 March 14th, 2010

International News

Heath exposé triggers Chinese investigation

Investigative reporter Wang Weqin has produced an article for the China Economic Times that has sparked controversy over whether or not authorities knowingly administered ineffective vaccines to children. According to the story, the vaccines’ cold-chain was broken because processing labels would not stick to the vials when they were chilled. “I saw boxes and boxes of vaccines piled up high like a hill in a hot room without air-conditioning,” said one official who spoke out. China’s health authorities have said they will investigate the allegations, reminding reporters that they had already done so in 2008 and found no real problems. New York Times

US study calls for more rigorous analysis of non-pharmaceutical interventions

Do face masks, cough etiquette, and school closings help to fight the spread of disease? Perhaps, but, according to an article released in the American Journal of Infection Control, there hasn’t been enough hard scientific study to definitively say so. The report said the 11 studies they reviewed had several limitations including insufficient statistical power due to small sample size. The journal contributors say the question requires more rigorous laboratory- and community-based studies, and improved data collection. University of Minnesota CIDRAP

Global's H1N1 Update - 03/18/10

The next update will be on Tuesday, March 23rd, 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 7, 2010

National News

The Canadian government has announced it is planning to overhaul its vaccine supply system. GlaxoSmithKilne, the only company with a flu vaccine plant in Canada, is the government’s sole flu vaccine supplier. The single-source system came about when officials worried that a pandemic outbreak would prompt countries to close their borders, blocking potential vaccine shipments. GlaxoSmithKine ran into production delays last year with its H1N1 vaccine, and its ten-year contract expires next year. In a notice to the drug industry, health officials said they wanted to consider “a second pandemic supply contract,” and look into “additional suppliers for seasonal influenza vaccine, as necessary.” The Globe and Mail

One month after the Vancouver Olympics, three months after the H1N1 pandemic peak in Canada, and four months after the Auditor General accused Ottawa of being unprepared to respond to emergencies, the federal government has adopted its Federal Emergency Response Plan. The plan outlines emergency management roles and responsibilities of federal institutions in case of man-made or natural disasters, including floods, forest fires, terrorist attacks and pandemics. Public Safety Minister Vic Toews said a plan has always been in place, but now it’s been formalized. Auditor General Sheila Fraser says that was not so and that in November the plan was still incomplete though the ministry was created in 2003. CBC News

Vaccine News

In an update to a related story, Fraunhofer USA’s Center for Molecular Biotechnology has been awarded a $4.4 million research grant. The funding will allow the non-profit research organization to begin clinical trials for its plant-based flu vaccines. The American Defense Advanced Research Projects Agency (DARPA) is backing the project to enable a more rapid response to military and civilian disease threats. Fraunhofer USA’s Press Release

Global's H1N1 Update - 03/16/10

The next update will be on Tuesday, March 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 March 7, 2010

News from Global Consulting and Global Medical Services

The Situation is Changing and so is the Blog

When we started this blog in 2009, we wanted to help people educate themselves about pandemic influenza. As the journal approaches its first birthday (coming in April), the writing staff has looked back over a lot of stories covered this past year: from the first Canadian outbreaks in B.C. and Nova Scotia, through the public response and media coverage, to the controversy of a fast-tracked vaccine and the receding of the pandemic tide. We’ve also taken a look ahead to try and catch a glimpse of what the future of H1N1 may hold.

Flu season is approaching in the southern hemisphere, as people there brace against the risk of a second pandemic wave. But this year they have a vaccine to break the wave if it comes. Outbreaks threaten in Eastern Europe, Sub-Saharan Africa and elsewhere as H1N1 continues to circulate, but not as aggressively as we saw in October. The pandemic seems to be winding down. The virus may integrate into the regular flu cycle and become another feature of the seasonal influenza landscape. For now, the risk has diminished.

At Global Consulting, we believe that some element of risk is inherent in life. This is nothing to live in fear of. At the personal level, life is risky. On a larger scale, societal risk is unavoidable. When we can rise to these challenges – if we are prepared – they make us better able to care for ourselves and those around us. They can be opportunities for each of us to more fully realise our potential.

Global Consulting has guarded against many more threats than H1N1. We want to take this opportunity to widen the blog’s focus and offer you a more complete picture of what we do. We’d like to invite you along to explore the latest developments around the world and some of the projects we’re working on in the fields of medical education, emergency medical care and emergency preparedness. And of course, we’ll continue to keep an eye on H1N1 resurgence as we examine some of the indirect repercussions of the pandemic.

Stay tuned.

National News

Canadians trust their doctors, and have high expectations

At crunch-time, Canadians trust their public health officials to make tough decisions according to a poll conducted by the University of Toronto Joint Centre for Bioethics. The poll processed telephone responses from almost 560 random participants across the country. Other findings included strong support for the obligation of health care workers to accept facing elevated risks during a pandemic, and for Canada’s provision of assistance to poorer countries even if the assistance reduces resources for Canadians. BioMed Central

International News

CDC reports H1N1 moves slowly except through children

A new study from the American Centers for Disease Control and Prevention has released a study that finds the H1N1 virus spreads more slowly than the seasonal flu, and that this particular influenza strain disproportionately affects children who go on to further transmit the virus. This last finding is in line with another study we reported on earlier. The full report will be published in the April edition of the Journal of Emerging Infectious Diseases. BusinessWeek

Influenza B may be beginning to displace H1N1

Some East Asian and African nations are reporting increased Influenza B activity to the point where the virus is crowding out the pandemic H1N1 strain. Surveillance information from the World Health Organization reports that Influenza B circulation is moving westward through Russia and Sweden. Both countries say that the virus is now co-circulating with H1N1. Influenza B viruses in general cause less severe disease than influenza A, such as H1N1, and are associated illnesses in younger people. University of Minnesota CIDRAP

Global's H1N1 Update - 03/11/10

The next update will be on Tuesday, March 16th, 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 February 28, 2010

International News

Focus of H1N1 infection may shift in the coming months

A recent epidemiological and statistical analysis of influenza pandemics has suggested that the demographic of people at risk of infection by H1N1 will soon change. According to the study, school-aged children are subjects of the highest infection rates early in the pandemic, but historically the focus of the disease shifts to adults in subsequent waves. As stated by one of the study’s researchers, “These results have significant implications for the allocation of public health resources for H1N1/09 and future influenza pandemics.” PLoS One Science Journal

College flu activity stays steady

The American College Health Association (ACHA) has reported that colleges in the United States saw a very slight decrease in flu-like illnesses last week, but the attack rate stayed about the same as the previous 2 weeks, about 3 to 4 cases per 10,000 students. So far the patterns don't signal a third pandemic flu wave, even on a regional level. Two more hospitalizations were reported, and the vaccination level stayed the same, at about 8%. ACHA

ECDC sees another pandemic wave as unlikely

The European Centre for Disease Prevention and Control (ECDC) has announced that European countries won't likely experience another wave of pandemic H1N1 influenza cases this spring and summer, though the virus will probably continue to circulate and be the region's dominant strain for the next flu season. The agency made the predictions in an 18-page risk-assessment report designed to help countries adjust their vaccine and flu-response strategies over the coming months. However, the ECDC warned that the outlook could change if there are “significant unrecognized uninfected populations” or if the pandemic virus changes to become more transmissible. CIDRAP

Vaccine News

University of Hamilton finds a potential bottleneck for H1N1 proliferation

A study released in the Journal of the American Medical Association has found that the best way to protect a population from infectious diseases is to immunize the group’s healthy children first. Scientists found that the resulting “herd immunity” offered a substantial amount of protection. “If you look at the people who would be at high risk, the level of protection in them was almost the same as if they had gotten a vaccine directly themselves.” said Dr. Mark Loeb, who led the research team. Healthy children over five years of age are generally among last on the priority list for vaccinations because when they do get sick they don’t usually get seriously ill. CanWest News Service

Researchers investigate lingering benefits of previous pandemic vaccines

According to a study in Influenza and Other Respiratory Viruses, infection with a 1976 strain of H1N1 virus completely protected against the current pandemic virus suggesting modern day benefits for those who received the 1976 swine flu vaccine. Mice infected with either 2009 or 1940 seasonal H1N1 viruses showed partial protection. This may explain why older people seem to have been more resistant to the 2009 H1N1 virus. Wiley InterScience

India set to launch vaccine campaign

India's health ministry has said that the country will begin vaccinating its priority groups against the pandemic H1N1 virus next week. Doctors and paramedics will be among the first to receive the vaccine. India has purchased 1.5 million doses from Sanofi and had asked the company to conduct a pandemic vaccine trial in India, which it has completed and sent to the ministry. Indian companies are also working on pandemic H1N1 vaccines. Deccan Herald

Global's H1N1 Update - 03/09/10

The next update will be on Thursday, March 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 February 28, 2010

International News

WHO Reports Pandemic Tide Continues to Recede

Around the globe, the World Health Organization has reported that H1N1 activity is continuing its general decline. Although there has been increased activity in Thailand, Myanmar, Russia, and Armenia, overall the activity in those areas is still quite low. Respiratory tract infections and respiratory disease activity is up in Brazil, Peru, Pakistan, and Afghanistan, but officials are unsure whether or not there is a causal relationship between this and H1N1. The organization is monitoring the southern hemisphere winter and its coming flu season before making a final determination on whether or not the pandemic peak has past. World Health Organization

Top US Health Care Officials Discuss Lessons Learned

As part of a collective debriefing, American public health officials held a conference on lessons from the influenza pandemic. The biggest ones revolved around vaccines: the delays their production and skepticism over their safety. “For this pandemic we had about the longest warning we might ever have for a potential bio-threat, and yet we all lament how long it took for vaccine to be made.” said Dr. Nicole Lurie from the US Health and Human Services Department. Dr. Lurie also went on to say, “We can't ever be in a situation again where we have a countermeasure that half the public won't accept.”

Vaccine News

CDC Reveals Safety Record for H1N1 Vaccines

The American Centers for Disease Control and Prevention has said in a situation update that, five months after its launch, the H1N1 vaccine has demonstrated the same safety record as seasonal flu vaccines. Out of an estimated 70 million administered vaccine doses in the US, there have been 636 cases of “serious” vaccine side-effects. Serious side effects were defined as any condition that was life-threatening or resulted in death, major disability, abnormal conditions at birth, hospitalization, or extension of an existing hospitalization. American health officials have been tracking flu vaccines for safety since 1976. University of Minnesota CIDRAP

Global's H1N1 Update - 03/04/10

The next update will be on Tuesday, March 9th, 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 February 21, 2010

International News

Brazil gears up to shut out H1N1

The Brazilian Health Ministry has announced its plan to begin a massive operation in early March to vaccinate 90 million of its citizens against H1N1 infection. “This will be the largest campaign in the world,” said the Brazilian Health Minister. In 2009, H1N1 infected 39,679 Brazilians. The death tolled climbed to 1,705. China Daily

H1N1 could develop drug resistance

If pandemic H1N1 evolves along similar lines as seasonal flu strains, it will likely develop the same resistance to oseltamivir (Tamiflu) that is widespread in seasonal influenza. The mixing of pandemic and seasonal strains (reassortment) in areas where they co-circulate could speed the evolution of resistance, say researchers at Ohio State University in a study in the International Journal of Health Geographics: “Reassortment and, more likely, point mutation have the potential to create a strain of pandemic H1N1 against which we have a reduced number of treatment options.” International Journal of Health Geographics

Vaccine News

US parents fear vaccine side-effects despite research evidence

More and more studies are coming out that discredit the link between autism and vaccination. The British medical journal The Lancet recently retracted a paper it published when they found that the study was flawed and its researchers were facing disciplinary sanctions for conducting the study unethically. Despite this, the American Pediatrics journal found in a recent poll that one-in-four American parents still harbour concerns about the safety of vaccines. CTV News

Global's H1N1 Update - 03/02/10

The next update will be on Thursday, March 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 February 21, 2010

International News

Pneumonia is worse when mixed with H1N1

Researchers at the University of Chicago have discovered that the pandemic H1N1 flu virus has the intrinsic ability to cause more severe pneumonia than seasonal H1N1 flu. This ability is a measure of a flu virus's pandemic potential. They found pandemic H1N1 caused a pneumonia in certain patients that was intermediate in severity between seasonal H1N1 and the highly pathogenic H5N1. University of Chicago Journal of Infectious Diseases

H1N1 Evolution

Scientists at the University of Hong Kong have isolated the first reported genetic reassortment of the H1N1 virus. The reassortment is a hybrid of the original swine flu and the human pandemic H1N1 virus. Reassortments occur when a single host is infected by more than one strain of virus, and the mixed virus particles assemble themselves into something new. The Chinese Department of Agriculture released a statement saying that the new virus does not pose a public health risk or food-safety issue. University of Minnesota CIDRAP

H1N1 Adds Risk to Pregnancy

An Australian study has found that pregnant women can be particularly vulnerable to H1N1 especially if the mothers are asthmatic, diabetic, or obese. However, effects of H1N1 on the fetus are less well understood. Doctors recommend flu shots for pregnant women, but many women are reluctant to receive immunizations or take drugs during pregnancy. The researchers note there is evidence that doctors' lack of awareness may be “a major contributor, with good acceptance by mothers when the risks and benefits are explained.” Reuters