WHO - Clinical management of human infection with new influenza A (H1N1) virus: revised guidance

WHO released revised guidance for clinical management of persons infected with 2009 H1N1. The 15-page document provides information on an array of topics; including guidance for clinical management in resource-poor settings, and examples of clinical triage algorithms for ILI and pneumonia.

The document provides information/guidance on the following:

• Risk factors for severe disease


• Case descriptions (uncomplicated influenza, complicated influenza, signs and symptoms of progressive disease)


• Infection control


• Diagnosis


• General treatment considerations


• Antiviral therapy


• Care of severely ill patients (initial evaluation, antiviral therapy, supportive care, adjunctive pharmacologic therapy, secondary bacterial pneumonia)


• Resource poor settings


• Examples of clinical triage algorithms for ILI and pneumonia

The guide can be viewed in its entirety at: http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html

CIDRAP releases pandemic preparedness guide for human resource managers

University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) released a pandemic preparedness guide entitled Doing Business During an Influenza Pandemic: HR Policies, Protocols, Templates, Tools, and Tips. CIDRAP provides an overview of the guide below. Additional CIDRAP news and resources can be found on their website.

"A guide for human resource (HR) managers looking for ways to quickly plan for and respond to the H1N1 pandemic has been issued by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, and the Society for Human Resource Management. The free 42-page guide was prepared with support from the Centers for Disease Control and Prevention. It includes lessons learned by HR professionals whose response skills were tested in the early days of the pandemic."

The guide is available free of charge at: http://www.cidrap.umn.edu/cidrap/files/33/cidrap-shrm-hr-pandemic-toolkit.pdf

WHO - Agreement for donation of pandemic H1N1 vaccine signed

WHO Statement 10 November 2009 - GlaxoSmithKline (GSK) is to donate 50 million doses of pandemic H1N1 vaccine to the World Health Organization (WHO) under an agreement signed at WHO headquarters in Geneva by the WHO Director-General, Dr. Margaret Chan, and the Chief Executive Officer of GlaxoSmithKline, Mr. Andrew Witty.

"We welcome this very generous donation by GlaxoSmithKline, which will go to protect the health of the world's poorest people. This is a real gesture of global solidarity towards those who would not be otherwise able to have access to the vaccine," said Dr. Margaret Chan. "WHO will now work to see that these vaccines are distributed to those who need them."

GSK expects to prepare the first shipments of vaccine to the WHO by the end of November. The WHO has a list of 95 developing countries that are eligible to receive donated vaccines, and aims to secure enough vaccines to cover 10 percent of the population of these countries.

http://www.who.int/mediacentre/news/statements/2009/pandemic_vaccine_agreement_20091110/en/index.html

2009 H1N1 in pet and farmed animals - No cause for alarm

In light of recent evidence that suggests 2009 H1N1 is transmissible from infected humans to pets (e.g., cats, ferret) and farmed animals (e.g., pigs, turkeys), health experts have released some updated guidance:

CDC has updated its H1N1 Flu & You Q&A webpage to include questions and answers about 2009 H1N1 transmission from ill humans to their pets, including information on preventive measures. Information can be viewed at the bottom of the H1N1 Flu & You webpage (scroll down or click on the hyperlink on the right-hand side of the screen): http://www.cdc.gov/h1n1flu/qa.htm#f

Since the new H1N1 pandemic virus emerged, a small number of infections in swine herds have been reported. Limited evidence suggests that these infections occurred following direct transmission of the virus from infected humans to swine. As we mentioned in last week's Pandemic Influenza Update #11, WHO has characterized these infections as isolated events, which have not yet had any significant impacts on the dynamics of the 2009 H1N1 pandemic among humans. As human infections become more widespread, we can expect more frequent reports of transmission of the virus from humans to animals with greater frequency.

When influenza infections are detected in farmed animals, WHO recommends monitoring of farm workers for signs of respiratory illness, and testing for H1N1 infection should such signs appear. FAO and OIE recommend that animals that are showing signs of illness be examined and properly managed, and allowed to fully recover before being transported or marketed.

"This situation reinforces the need for close monitoring and close collaboration between public health and veterinary authorities."

For more information on WHO guidance on this topic, and results from testing by laboratories in the WHO influenza surveillance network, visit: http://www.who.int/csr/disease/swineflu/notes/briefing_20091105/en/index.html

A new perspective on preventing an epidemic: How H1N1 compares to SARS and Nipah virus

Crofsblog, H5N1, provided a referral to a blog submission originally authored by Dr. Aaron Bernstein on Thrive, a blog supported by Children's Hospital Boston.

The blog submission provides perspective on the way some people in southeast Asia may view 2009 H1N1 - in the context of other emerging infectious diseases such as SARS and Nipah virus, diseases with relatively high mortality rates.

More importantly, however, Dr. Bernstein takes this opportunity to call for prevention of epidemics such as H1N1 from a much broader level, by highlighting the linkage between ecological changes and global health, as he touches on factors affecting intermediate hosts (e.g., expansion of pig farming, changing dietary diversity) and viral reservoirs (e.g., deforestation).

Dr. Bernstein admits, "This comparison is by no means made to belittle H1N1 and its ill effects."

Dr. Bernstein's entire blog submission is worth a read and can be viewed at: http://childrenshospitalblog.org/a-new-perspective-on-preventing-an-epidemic-how-h1n1-compares-to-sars-and-the-nipah-virus/

No bar on Haj over 2009 H1N1 fears

Mohammed Rasooldeen of the Arab News reports that the Kingdom of Saudi Arabia will not bar anyone considered at high risk for developing complications from H1N1 from performing Haj. Minister of Health, Dr. Abdullah Al-Rabeeah, says it is up to individual countries to enforce recommendations that people in high risk groups forgo this year's pilgrimage.

'“Saudi Arabia does not ban anyone because the Haj is a religious event,” Al-Rabeeah told reporters. “Saudi Arabia has put in place strong recommendations that we hope individual countries will abide by.”

Al-Rabeeah made the comments at the launch of a national swine flu vaccine campaign in which he rolled up his sleeve and took the first shot. He then administered the vaccine to one of his twin daughters, Hana, 8. Her sister Haifa did not get the vaccine because she contracted swine flu recently.'

View the entire story from its original source at: http://www.arabnews.com/?page=1&section=0&article=128181&d=8&m=11&y=2009

Pandemic H1N1 in the Ukraine

According to the Ministry of Health of Ukraine, the country has now recorded more than 250 000 cases of influenza-like illness, with 235 patients requiring intensive care. As of 2 November, 70 deaths from acute respiratory illness have been reported.

Regions in western Ukraine continue to show the highest rates of acute respiratory illness/influenza-like illness. The level of activity in the Kyiv area is also increasing rapidly.
Laboratory testing in Ukraine has confirmed pandemic H1N1 influenza virus in samples taken from patients in two of the most affected regions. As the pandemic virus has rapidly become the dominant influenza strain worldwide, it can be assumed that most cases of influenza in Ukraine are caused by the H1N1 virus.

As elsewhere, WHO strongly recommends early treatment with the antiviral drugs, oseltamivir or zanamivir, for patients who meet treatment criteria, even in the absence of a positive laboratory test confirming H1N1 infection.

At the request of the government, a multi-disciplinary team of nine experts has been deployed by WHO and arrived in Kyiv yesterday evening. Discussions with the Minister of Health were held this morning to brief the team.

Team members will now begin field investigations to characterize the clinical and epidemiological features of the outbreak. Work will initially begin in Lviv region, where reported numbers of cases showing severe manifestations of acute respiratory illness have been especially high. Two virologists on the team have started working at the National Influenza Centre and the laboratories of the Central Sanitary and Epidemiological Station in Kyiv to provide diagnostic support.

Many questions remain to be answered. The outbreak in Ukraine may be indicative of how the virus can behave in the northern hemisphere during the winter season, particularly in health care settings typically found in Eastern Europe.

Given the potential significance of this outbreak as an early warning signal, WHO commends the government of Ukraine for its transparent reporting and open sharing of samples.
WHO continues to recommend no closing of borders and no restrictions on international travel, including to Ukraine. Experience shows that such measures will not stop further spread of the virus.

http://www.who.int/csr/don/2009_11_03/en/index.html