Global's Daily Influenza A (H1N1) Update - May 22, 2009

Please note that the Influenza A (H1N1) Daily Update will be posted by 1200 hrs PST over the weekend (May 23-24) and posted by 0830 HRS PST throughout the week (May 25-29).

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST May 22st)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #36.

Local/National News

• On May 21th, the Public Health Agency of Canada (PHAC) and the British Columbia Centre for Disease Control (BCCDC) announced that there were no new confirmed cases of influenza A (H1N1) in the country. PHAC also noted that they will only be updating case totals on Monday, Wednesday, and Friday.

International News

• Dr. Margaret Chan, head of the World Health Organization (WHO), said she would not hesitate to declare a pandemic if the novel H1N1 flu virus starts spreading globally. However, she signaled that she may stray from the WHO's formal definition of a phase 6 pandemic alert by considering the severity of the disease and whether it is spreading in both the northern and southern hemispheres. Pandemic phase 6 is officially defined as community-level spread of a novel virus in more than one global region. Reuters
  

• Two high school girls who live in the Tokyo area were found to have contracted the novel H1N1 flu yesterday, two days after they returned from a trip to New York City, according to the Japan Times. Their cases are the first in the Tokyo area, the newspaper reported. Japan has over 250 confirmed cases, most of them in the Osaka and Hyogo prefectures, and thousands of schools have been closed. Japan Times


• Mexico City lowered its swine flu alert level from yellow to green on Thursday, and Mayor Marcelo Ebrard said "we can relax" now that there have been no new infections for a week. Ebrard also said the change means the risk of contagion is low, the situation is under control, and the images of countless people wearing blue surgical masks in cars, sidewalks, restaurants and theaters are now behind the city. Associated Press

Vaccine News

• Despite recent news report to the contrary, the U.S. Centers for Disease Control and Prevention (CDC) has assured health experts and policy makers that efforts to make a vaccine against the the H1N1 virus have not met unexpected delays. Confusion about the vaccine timeline stemmed from a report released this week from the WHO. The group concluded that manufacturers would not be able to begin “large-scale production” of a vaccine against the virus until mid-July. While the report did not describe this issue as a delay, but many media accounts did. Science Insider

Today’s Key Question

How has the outbreak of influenza A (H1N1) progressed in Mexico?

Mexico’s Ministry of Health regularly posts informative, detailed graphs of the country’s outbreak that have received little prime-time exposure. This graph taken from a May 21st report provides a great overview of the evaluation of the outbreak. It is interesting to note that there are 34 cases prior to “patient zero” from La Gloria, Veracruz.

Global's Daily Influenza A (H1N1) Update - May 21, 2009

GMS INFLUENZA A (H1N1) Daily Update as of May 21, 2009(0830 HRS PST)

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST May 21st)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #35.

Local/National News

• On May 20th, the Public Health Agency of Canada (PHAC) announced that 223 new cases of Influenza A (H1N1) had been confirmed in the country (PHAC had not released any revised case totals since May 15th). Ontario still has the most cases in Canada (284), followed by British Columbia (114), Quebec (106), Alberta (86), Nova Scotia (68), Saskatchewan (49), Manitoba (6), PEI (3), New Brunswick (2), and the Yukon (1). Canada’s total case count is now at 719 with 16 hospitalizations and one death.

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

• 43 in Fraser Health


• 3 in Interior Health


• 22 in Northern Health


• 31 in Vancouver Coastal Health


• 15 in Vancouver Island Health

International News

• A recent survey found that more than half (55%) of global companies belonging to the Conference Board had activated pandemic response plans because of the H1N1 epidemic. The survey covered 121 members of the Conference Board, a global nonprofit association of businesses. Almost all the companies said they were making special efforts to provide pandemic information to employees, and 81% said they have encouraged workers who feel sick to stay home. Medical News Today


• New York City health officials said a 16-month-old boy who died May 18 of suspected H1N1 flu tested negative for the virus. Meanwhile, City Health Commissioner Thomas Frieden recommended closing three more schools as of today because of high rates of flu-like illness, bringing the number of closed schools in the city to 21. AP report

• At yesterday’s U.S. Centers for Disease Control (CDC) press conference, Dr. Dan Jernigan announced the following information about the US case load:




• 78%, of the viruses that have been collected through the surveillance systems in the United States are the novel H1N1 influenza.


• There are 247 individuals that have been hospitalized and over 70% of those hospitalized patients have had underlying chronic medical conditions, including pregnancy.


• Asthma and heart disease are the most common underlying chronic medical conditions.

Vaccine News

• If US officials decide to launch an H1N1 immunization campaign later this year, seasonal flu vaccination efforts may start earlier than usual. Dr. Dan Jernigan said the CDC estimates that an H1N1 vaccine will become available sometime in the fall. "If possible, we do want to have earlier rollout of seasonal vaccine simply for that reason, to make it easier for an additional vaccine if that is the ultimate policy". CDC briefing transcript

Latest Guidance from the WHO, U.S. CDC, PHAC, and BCCDC

• Yesterday, the CDC released translated versions (Arabic, French, Russian and Simplified Chinese) of several guidance documents for the general public. CDC

Today’s Key Question

Is influenza A (H1N1) directing attention away from more important diseases?

According to some, due to fears that Influenza A (H1N1) may evolve into the next pandemic, many other diseases are being neglected at this year’s World Health Assembly. Discussions regarding Chagas disease, cancer and diabetes, hepatitis, were either dropped or postponed, to the outrage of many health officials. Moreover, according to Dr. Sam Zaramba, Uganda’s chief medical officer, “If all the emphasis that has been put on swine flu had been put on malaria and TB, we would have made a bigger impact on health.”

However, a World Health Organization (WHO) spokesperson, Thomas Abraham asserted that certain issues had to be dropped or deferred when the member nations decided to shorten the meeting as their ministers were needed at home to help prepare against a possible pandemic. “H1N1 influenza is not taking up the major portion of discussions…and just because a topic is not discussed here does not mean WHO programs are going to stop,” said Abraham.

Since April, influenza A (H1N1) has contributed to the deaths of 80 people while infecting more than 10,000.

Associated Press

Global's Daily Influenza A (H1N1) Update - May 20, 2009

GMS INFLUENZA A (H1N1) Daily Update as of May 20, 2009(830 HRS PST)

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST May 20th)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #34.

Local/National News

• On May 19th, the Public Health Agency of Canada (PHAC) did not announce that any new cases of Influenza A (H1N1) had been confirmed in the country.


• The British Columbia Centre for Disease Control (BCCDC) continues to report the following confirmed cases across the province:




• 38 in Fraser Health


• 2 in Interior Health


• 20 in Northern Health


• 27 in Vancouver Coastal Health


• 13 on Vancouver Island Health

International News

• The U.S. Centers for Disease Control and Prevention (CDC) reported on Tuesday that an early look at trends in patients who have been hospitalized with novel influenza A (H1N1) infections showed that all but one of a group of 30 patients presented with fever and that about two thirds of them had an underlying medical condition. The CDC's review, based on California patients who were hospitalized from April 20 through May 17, highlighted that the majority of patients recovered without problems after short hospitalizations, though some had severe illness with prolonged complications and remain hospitalized. CIDRAP


• The influenza A (H1N1) outbreak has switched from one initially linked to schools or travelers to one with true community-wide spread in much of the United States, said the CDC’s, Dr. Anne Schuchat. Twenty-two states are reporting widespread or regional flu activity, particularly in the Southwest and Midwest. Associated Press


• The U.S. strategic inventory of pandemic supplies contains only 39 million surgical masks, far short of the 27 billion federal officials say would be needed in a serious influenza pandemic,Time reported on May 19th. The nation's supply of respirators is also well below the estimated requirement of 3 billion . Moreover, most of the masks are now made in Mexico or China, leaving many officials to wonder if the few U.S.-based companies could make-up the difference during a serious outbreak.Time


• Japanese officials have closed more than 4,400 schools in two prefectures that have reported dozens of novel H1N1 cases, which is up from about 2,000 closures reported on Monday. The affected areas are Osaka and Hyogo, in the central part of Honshu, which is Japan's main island. The country now has nearly 200 confirmed cases, and experts said the virus has probably already spread to Tokyo, the world's most populated urban area. In a related development, Japaneses officials also said the country will begin to phase out airport quarantine checks. Agence France-Presse and Associated Press

Vaccine News

• On Tuesday, the World Health Organization (WHO) said drug manufacturers won't be able to start making a vaccine for the H1N1 influenza virus until mid-July at the earliest. The virus isn't growing very fast in laboratories, making it difficult for scientists to get a key vaccine ingredient. Associated Press


• WHO officials also urged drug manufacturers to reserve some of their influenza A (H1N1) vaccine for poor countries. WHO argued for companies to donate at least 10 per cent of their production or offer reduced prices to poor countries that could otherwise be left without vaccines if there is a sudden surge in demand. The only major drug maker that publicly agreed to the WHO request was Britain's GlaxoSmithKline PLC, which said it would donate 50 million doses in a pandemic and offer more doses that the WHO could buy at a discount for poor countries. Associated Press

Latest Guidance from the WHO, U.S. CDC, PHAC, and BCCDC

• Yesterday, WHO’s Strategic Advisory Group of Experts on Influenza A (H1N1) Vaccines released their recommendations, namely that:




• It is premature to recommend the immediate start of commercial‐scale production of influenza A (H1N1) vaccine.


• The WHO Secretariat, in close coordination with its Collaborating Cent res and the Essential Regulatory Laboratories of the WHO Global Influenza Surveillance Network, should recommend which vaccine viruses ought to be used for vaccine development as soon as possible.

Today’s Key Question

How do influenza vaccines work?

When a healthy person becomes infected with a particular flu virus for the first time, that person’s immune system takes several days to identify the infecting virus and attack it. Special immune system proteins known as antibodies recognize and then attach to the virus. Additionally, T cells further this process by encouraging the production of antibodies, and also destroying cells infected with the virus to rid the body of it.

Upon repeat infection with a particular virus, the immune system “remembers” the virus and produces a stronger and more efficient attack, eradicating the virus in the early stages of infection. Therefore, the symptoms of this subsequent infection are less severe, if present at all, and the virus is less likely to be transmitted to others. Vaccines work by this very same principle. A vaccine generally contains a “killed” or weakened form of the virus which, when introduced into the body, mimics the presence of the real virus. The immune system is then primed and ready for rapid action if or when the virus were to infect that individual. Nature

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

GMS INFLUENZA A (H1N1) Daily Update as of May 19, 2009 (830 HRS PST)

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST May 19th)

Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #33.

Local/National News

• On May 18th, the Public Health Agency of Canada (PHAC) announced that no new cases of Influenza A (H1N1) had been confirmed in the country.


• PHAC no longer recommends Canadians postpone elective or non-essential travel to Mexico. Travellers who go to Mexico should follow recommendations outlined by PHAC and continue to consult the PHAC web site to remain informed regarding the Influenza A (H1N1) virus and travel-related recommendations.

International News

• At the opening of the World Health Assembly in Geneva, several countries urged WHO Director-General Margaret Chan to revise the pandemic alert system, as it reflects geographic spread but not the severity of disease. Chan said the alert level will remain at phase 5, despite Japan reporting over a hundred cases—up from four a few days earlier. She also stated that, “The virus has given us a grace period” but cautioned against complacency. “No one can say whether this is just the calm before the storm.” Science Insider


• At yesterday’s U.S. CDC press briefing, Anne Schuchat of the science and public health program said some unusual patterns are emerging with the novel H1N1 virus in young people. Officials have already noted that the new virus has disproportionately affected younger people, she said. However, she specified that hospitalizations are primarily occurring in those between the ages of 5 to 24 years old. Schuchat asserted that the number of school closures this late in the season in diverse parts of the country is also unusual. CIDRAP

Today’s Key Question

Is there a better way to warn of a pandemic?

American researchers say monitoring human behaviour, such as people buying flu-related medications or Google searches, may be a way to warn of pandemic.

Barrett Caldwell, a Purdue University associate professor of industrial engineering, said the conventional monitoring approach requires public health officials to know when certain events leading to pandemic begin. "The problem with this requirement is that by the time you know an event has happened, it's often too late to do much about it," said Caldwell.

Caldwell and Sandra K. Garrett, an assistant professor of industrial engineering at Clemson University, have proposed this new approach to warn the public of an impending pandemic. "If you can recognize the triggers (the signals suggesting an event is likely to occur), you can start responding to it, gathering resources, and preparing and mobilizing people," said Garrett. UPI

Global's Daily Influenza A (H1N1) Update - May 18th, 2009

Please note that GMS Influenza A (H1N1) Daily Updates will be posted before 1200 hrs PST over the May long weekend (May 16-18).

The WHO Pandemic Alert remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as confirmed by the WHO by 1130 hrs PST, May 18th)

Local/National News

• The Public Health Agency of Canada (PHAC) noted on May 17th that there were no new H1N1 cases confirmed in Canada over the long weekend. Ontario still has the most cases in the country (187), followed by British Columbia (100), Alberta (67), Nova Scotia (66), Quebec (47), Saskatchewan (19), Manitoba (4), PEI (3), New Brunswick (2), and the Yukon (1). Canada’s total case count remains at 496. PHAC
• The British Columbia Centre for Disease Control (BCCDC) continues to report the following confirmed cases across the province: 20 in Northern Health; 2 in Interior Health; 13 on Vancouver Island Health; 27 in Vancouver Coastal Health; and, 38 in Fraser Health.

International News

• China, Britain, Japan, and other countries urged the World Health Organization (WHO) on Monday to be very cautious about declaring the arrival of a pandemic, fearing that a premature announcement could cause worldwide panic and confusion. As the agency opened its annual meeting, WHO Director-General Dr. Margaret Chan said she had listened carefully to the concerns of member states and would follow their instructions. Health experts from dozens of countries also urged WHO to change its standards for declaring a pandemic, saying it should take into account whether the virus was causing severe or mild illness, not just how quickly it was spreading. "We need to give (the WHO) team more flexibility as to whether we move to phase 6," said British Health Secretary Alan Johnson. Associated Press
• A high school assistant principal has become the first New York City death linked to the outbreak of influenza A (H1N1). He had been sick for nearly a week before his school was closed on Thursday (please note that additional cases confirmed by the U.S. Centers for Disease Control and Prevention [CDC], in addition to this fatality, have not yet been confirmed by the WHO, hence the discrepancy between this story's totals and the case count table above). Associated Press
• A wave of new confirmations sent the number of swine flu cases in Japan soaring to 135, health officials say, prompting the government to order the closure of nearly 2,000 schools and the cancelation of community events (please note that 10 of these cases in Japan have yet to be confirmed by the WHO, hence the discrepancy between this story's totals and the case count table above). Associated Press
• Chile confirmed its first two cases of H1N1 in two women who arrived from the Dominican Republic over the long weekend. The women, ages 25 and 32, are hospitalized and in good condition, Health Minister Alvaro Erazo said (please note that only one of Chile's cases have been confirmed by the WHO, hence the discrepancy between this story's totals and the case count table above). Associated Press
• President Barack Obama's appointment of New York City Health Commissioner Thomas Frieden to lead the U.S. CDC drew enthusiastic applause late last week from public health organizations and disease experts. Frieden, a tuberculosis expert, is credited with achievements as varied as helping improve tuberculosis control in India, driving trans-fats out of New York City restaurants, and reducing smoking in that city. Dr. Richard Besser, who has served as acting CDC director since early in the Obama administration, will continue in his regular role as head of the CDC's Coordinating Office for Terrorism Preparedness and Emergency Response, the White House announced. Frieden will assume the CDC post in early June. CIDRAP

Today's Key Question

What does the vaccine manufacturing process look like and how long could it take for an H1N1 vaccine to be developed?

The following diagram provides a succinct overview of the key agencies and activities required for the vaccine manufacturing process, along with general timelines over a 12-month period. Nature

Global's Daily Influenza A (H1N1) Update - May 17th, 2009

Please note that GMS Influenza A (H1N1) Daily Updates will be posted before 1200 hrs PST over the May long weekend (May 16-18).

The WHO Pandemic Alert remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 1100 hrs PST, May 17th)

Local/National News

• The Public Health Agency of Canada (PHAC) announced on May 16th that there were no new H1N1 cases confirmed in Canada. Ontario still has the most cases in the country (187), followed by British Columbia (100), Alberta (67), Nova Scotia (66), Quebec (47), Saskatchewan (19), Manitoba (4), PEI (3), New Brunswick (2), and the Yukon (1). Canada’s total case count remains at 496. PHAC
• The British Columbia Centre for Disease Control (BCCDC) continues to report the following confirmed cases across the province: 20 in Northern Health; 2 in Interior Health; 13 on Vancouver Island Health; 27 in Vancouver Coastal Health; and, 38 in Fraser Health.

International News

• Japan said Sunday that its confirmed cases rose to 74, from just five cases one day earlier. Japan earlier confirmed its first case of swine flu caught within the country, showing that efforts to block flu at its borders had failed. Associated Press
• Turkey's health officials said the virus was detected in a man and his mother who had traveled to Istanbul from the U.S. Associated Press
• Additional countries--Malaysia and Peru--reported their first novel H1N1 cases, the Voice of America reported on Friday. Malaysia's health ministry reported a case in a student returning from the United States. According to other media reports, the Peruvian patient is a woman who got sick after returning from New York. Voice of America News

Today’s Key Question

What is the genetic lineage of the novel influenza A (H1N1) strain?

The current swine flu virus bears the same two identifying markers (H1 and N1) as the 1918 Spanish influenza virus, but it is still genetically unique. This picture depicts its genetic lineage and breaks the science down:

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

Please note that GMS Influenza A (H1N1) Daily Updates will be posted before 1200 hrs PST over the May long weekend (May 16-18).

The WHO Pandemic Alert remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 1200 hrs PST, May 16th)

Local/National News

• On May 15th, the Public Health Agency of Canada announced that 47 additional cases of Influenza A (H1N1) had been confirmed. Ontario still has the most cases in Canada (187), followed by British Columbia (100), Alberta (67), Nova Scotia (66), Quebec (47), Saskatchewan (19), Manitoba (4), PEI (3), New Brunswick (2), and the Yukon (1). Canada’s total case count is now at 496. PHAC


• The British Columbia Centre for Disease Control (BCCDC) is now reporting the following confirmed cases across the province:
  o 20 in Northern Health
  o 2 in Interior Health
  o 13 on Vancouver Island Health
  o 27 in Vancouver Coastal Health
  o 38 in Fraser Health

International News

• President Barack Obama named New York City’s health commissioner, Thomas R. Frieden, as the new director of the U.S. CDC—a post that has been vacant since the departure of former director, Julie Gerberding, in January. Science Insider


• On Friday, May 15th, health officials in Texas confirmed the state's third swine flu-related death. Dr. William Burgin Jr. of the Corpus Christi-Nueces County Health District said a 33-year-old man died May 5th or 6th after becoming sick a few days earlier. He said the man had pre-existing medical conditions, including heart problems. CBC


• Three public schools in Queens, New York, were closed and disinfected on Friday after the re-emergence of the H1N1 virus, which the city’s chief health official said appeared to be intensifying in larger clusters. An assistant principal remained hospitalized in critical condition with the most serious case since the virus turned up more than three weeks ago. New York Times

Vaccine News

• GlaxoSmithKline plans to begin production of a swine flu vaccine, pre-empting a recommendation by the World Health Organization (WHO), after four European countries placed orders for the shots. The United Kingdom, France, Belgium, and Finland have agreed to buy approximately 158 million shots from London-based GSK and Baxter International Inc. of Deerfield, Illinois, according to statements today from Glaxo and the U.K. government. Bloomberg

Latest Guidance from the WHO, U.S. CDC, PHAC, and BCCDC

• The U. S. CDC’s Travel Health Warning recommending against non-essential travel to Mexico, in effect since April 27, 2009, has now been downgraded to a Travel Health Precaution for Mexico. This based on evidence that:
  o The Mexican outbreak is slowing down;
  o The United States and other countries are now seeing increasing numbers of cases not associated with travel to Mexico; and,
  o The risk of severe disease from novel H1N1 virus infection now appears to be less than originally thought.
  The U.S. CDC continues to recommend that travelers visiting Mexico take steps to protect themselves from getting novel H1N1 flu. CDC

Today’s Key Question

Should public health officials continue to allow large public gatherings as H1N1 spreads further around the world?

The U.S. CDC has provided the following recommendations for large public gatherings (defined as an assembly or grouping of many people in one place where crowding is likely to occur, including indoor and outdoor gatherings):

• Masks and respirators are not recommended (for non-healthcare settings where frequent exposures to persons with novel influenza A H1N1 are unlikely).


• Persons with influenza-like-illness (ILI) should be advised to stay home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved (whichever is longer).


• Persons who are at high risk of complications from novel influenza A H1N1 infection (e.g., persons with certain chronic medical conditions, children less than 5 years, persons 65 or older, and pregnant women) should consider their risk of exposure to novel influenza if they attend public gatherings in communities where novel influenza A virus is circulating. In communities with several reported cases of novel influenza A H1N1 virus infection, persons who are at risk of complications from influenza should consider staying away from such gatherings.


• All persons should be reminded to use appropriate respiratory and hand hygiene precautions.


• Additional measures for consideration include:
  o At such events, planners should make hand washing facilities with soap and running water (or hand sanitizing stations) widely available.
  o Provide on-site medical assessment and care for persons with ILI.
  o Provide alternative options and venues for participation (e.g., remote Web-based viewing sites) and simultaneously reduce crowding. CIDRAP