Global Tamiflu-resistant H1N1 cases reach 225

From CIDRAP News -- February 5, 2010

The World Health Organization (WHO) reported today that 225 cases of H1N1 flu with resistance to oseltamivir (Tamiflu) have been found worldwide, and resistant viruses have spread from person to person in several clusters but have not spilled into the community.

Many of the resistant cases involved people with severely weakened immunity, reinforcing the importance of monitoring for the problem in such patients, the WHO said in today's issue of its Weekly Epidemiological Record.

The 225 cases come from 20 countries and include 65 cases in the Americas, 77 in Europe, 1 in Africa, and 82 in the Western Pacific region, the agency said. All the isolates had the H275Y mutation that confers resistance to oseltamivir but not to the other neuraminidase inhibitor in general use, zanamivir (Relenza).

Of 142 cases for which data were available, 56 (40%) were in severely immunocompromised patients, and 54 (38%) were linked to treatment of flu. Another 16 cases (11%) were associated with preventive treatment, and 16 others did not involve any known antiviral use.

The WHO reviewed reports of three clusters of resistant cases, one each in the United States, the United Kingdom, and Vietnam. They involved:

• Four severely immunocompromised patients in the same ward at Duke University Hospital in Durham, N.C., in October and November; in three cases, resistance was found before the drug was used
• Eight patients with hematological malignancies at the University Hospital of Wales in Cardiff, Wales, in November, at least four of whom contracted the resistant virus from someone else
• Seven healthy young adults in Vietnam who traveled together by train last July and were believed to have caught the virus from an unidentified index case; the cluster apparently did not lead to any further cases

The WHO said the number of resistant cases remains low despite the large scale of the pandemic, the wide use of oseltamivir, and extensive monitoring.

"Although there is no evidence of general community circulation of such resistant viruses, there is clear evidence of limited person-to-person transmission in several epidemiological settings," the agency said. It added that active surveillance for resistant cases should continue and all cases should be investigated and reported to health authorities.

Source:

CIDRAP http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/feb0510resist-jw.html

WHO http://www.who.int/wer/2010/wer8506.pdf

2009 H1N1 Outbreak in Northern Vietnam

On February 4th, Vietnamese health officials reported an outbreak of 2009 H1N1 in the northern province of Bac Kan.

Eighteen people have recently contracted the A/H1N1 virus in the province’s Na Ri District, said Dr. Nguyen Huy Nga of the Preventive Health and Environment Department. The patients have shown typical symptoms of the virus including fever, cough, sore throat, and muscle pain, he added.

Dr. Nga made the announcement at a meeting of the National Steering Board for Human Flu Prevention on February 3 in Hanoi.

Earlier on January 27, the Ministry of Health reported that several Bac Kan students at a secondary school in Dong Xa Commune had contracted the illness.

Dr. Nga said the epidemic is complicated and that the health ministry has therefore ordered medical clinics to strengthen monitoring of A/H1N1 cases, quarantine patients immediately, and ensure prompt treatment of those affected to stop the virus from spreading. Hospitals have also been asked to step up monitoring of avian flu, acute diarrhea and dengue fever.

Provinces with border crossings must control the flow of visitors from affected regions and detect swine flu cases quickly.

Source: http://www.english.vietnamnet.vn/Health/201002/Fresh-swine-flu-outbreak-hits-Bac-Kan-893274/

Neurologic Manifestations of Pandemic (H1N1) 2009 Virus Infection

A recently published article in the scientific journal Emerging Infectious Diseases highlighted a case study of a 34 year old male in Thailand who developed neurologic manifestations - namely, progressive quadriplegia - after contracting 2009 H1N1.

Similar to the effects of other viruses, pandemic (H1N1) 2009 virus may cause neurologic complications. Associated neurologic symptoms were first reported from Dallas, Texas, USA: 4 children experienced unexplained seizures or had an alteration of consciousness level that was associated with this virus.


Source: CDC EID http://www.cdc.gov/eid/content/16/3/pdfs/09-1699.pdf

Avian Influenza in Humans: Lessons from Egypt

From Eurosurveillance -- January 28, 2010

Highly pathogenic avian influenza A(H5N1) has ravaged the Egyptian poultry population. Ninety human cases, including 27 fatalities have been recorded by 30 December, 2009. However, epidemiological information on the infection in humans in Egypt is scarce. We analyzed the first three years of highly pathogenic avian influenza A(H5N1) in Egypt between 20 March 2006 and 31 August 2009 and found that more cases occurred in females than males, especially in 2006 and 2007.

Women in the age group 20-39 years had the greatest tendency to be infected. It took an average of one day and 18 hours to seek medical assistance in patients who recovered and of six days in fatal cases. Children sought treatment much earlier than adults. On average, patients died 11 days after the onset of symptoms. Exposure to infected poultry remained the most important risk factor.

The overall case fatality in this study was 32% (27/85). This percentage may appear small when compared with statistics from other places, for example 82% in Indonesia (115/141), 68% in Thailand (17/25), 66% in China (25/38) and 50% in Vietnam (56/111). Nevertheless, with the exceptional surge in number of cases (especially in children) arising in Egypt in 2009 and the recent recurrence of human cases of avian influenza A(H5N1) in China and Vietnam despite an intensive control program in the poultry populations, the pandemic potential of this virus is still very evident.

Public health guidelines in Egypt will need to be tailored to meet the local situation, taking into consideration the agricultural practices and the people’s perceptions. It will also be necessary to conduct more studies on human H5N1 influenza infection in Africa to evaluate the situation of asymptomatic carriers and unreported cases.

CDC Guidance: A Coordinated Approach to Communicating Pediatric-related Information on Pandemic Influenza at the Community Level

The U.S. Centers for Disease Control and Prevention (CDC) has released guidance on communicating pediatric-related information on pandemic influenza at the community level. Below are some excerpts from the document.

Effective communication is a key component of emergency response planning. It can help direct the medical community and the general public to take appropriate action to contain a disease outbreak, limit exposure, and reduce morbidity and mortality. On the other hand, ineffective communication can lead to confusion in both the general public and the emergency response community. It can interfere with the response to an incident. It can lead to public distrust and skepticism, and, once that has happened, it is difficult to regain that trust.

The purpose of this document is to provide a suggested approach, based on input from pediatric stakeholders, to communicating pediatric-related information on pandemic influenza at the community level in a step-by-step manner. This is a suggested approach to coordinating communication and disseminating information; it can be adapted or modified to suit most communities as they see fit. The goal is to give community planners "talking points" for discussions on a coordinated approach to communication in their community.

The target audience for this document is community planners who would oversee communication with the medical community and the general public during an influenza pandemic.

During an influenza pandemic, a lack of a coordinated approach to communication between the medical community and the general public can result in confusion and actions that interfere with the medical response to the outbreak. To address this issue, pediatric stakeholders, including members of national associations (medical, health, and school related), pediatric primary care providers, and hospitals, met to develop a suggested approach to coordinating the communication of pediatric-related information during the 2009 H1N1 influenza pandemic.

Source: http://www.cdc.gov/h1n1flu/guidance/pediatrics_tool.htm

ASEAN Meeting on Promoting Access to Antiviral Drugs and Pandemic Influenza Vaccines

From The Information Centre on Emerging Infectious Diseases in the ASEAN Plus Three Countries -- 27 January 2010

The ASEAN Secretariat, in collaboration with the Ministry of Health of Singapore, is convening the ASEAN Meeting on Promoting Access to Antiviral Drugs and Pandemic Influenza Vaccines on 27 to 29 January 2010 in Singapore.

The Meeting is supported by the ASEAN Plus Three Emerging Infectious Diseases (EID) Programme which is funded by the Australian Agency for International Development (AusAID). It aims to:

• provide an update on status of supply and availability of pandemic influenza vaccine and antiviral drugs at the global, regional (ASEAN) and national levels;
• share information among ASEAN Member States on the approaches, strategies and issues related to production, distribution, access and transfer of technology of pandemic influenza vaccine and antiviral agents within the region;
• discuss on how to share resources among the Member States, as follow-up to the Joint Statement of the ASEAN Plus Three Health Ministers Special Meeting on Influenza A (H1N1) held on 8 May 2009 in Bangkok, Thailand; and
• provide recommendations on ways to promote increased availability of and access to pandemic influenza vaccines and antiviral agents within the region.

The Meeting is attended by Focal Points of the Senior Officials Meeting on Health Development (SOMHD), ASEAN Expert Group on Communicable Diseases (AEGCD), officers from Food and Drug Regulatory bodies of the ASEAN Member States, manufacturers of influenza vaccines and antiviral agents and local manufacturers or sub-licensees of antiviral agents of selected countries.

Source: http://www.aseanplus3-eid.info/newsread.php?nid=1415&gid=8

Serbia and Japan to Cancel Further Vaccine Imports

Serbia and Japan are the latest countries to join the list of nations canceling further purchases of H1N1 vaccine.

Serbian Health Minister Tomica Milosavljevic announced Wednesday that “Serbia paid for 857,500 doses. Out of that amount, 160,000 were administered to citizens”. He added that the country needs to have 300,000 doses in its permanent reserves in case the epidemiological situation deteriorates.

Serbia has registered 690 swine flu cases so far and has experienced 79 fatalities from the virus. On Tuesday, Novartis warned countries not to cancel their orders for the vaccine, stressing that priority in a future epidemic would be given to those states which honored their contract obligations.

Meanwhile, according to Kyodo News, the government of Japan is considering canceling some of its H1N1 flu vaccine purchase contracts with foreign pharmaceutical companies amid the prospect of a surplus in vaccines against the new flu virus, health minister Akira Nagatsuma said Monday.

Source:
http://home.kyodo.co.jp/modules/fstStory/index.php?storyid=482214
http://www.balkaninsight.com/en/main/news/25273