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