Wednesday, September 30, 2009

Early Treatment of H1N1 With Antivirals and Antiviral Resistance

The CDC has updated its Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season.

One of the key issues highlighted once again by the CDC includes the importance of early treatment following the onset of symptoms. According to the report, “When a decision is made to use antiviral treatment for influenza, treatment should be initiated as soon as possible without waiting for influenza test results. Antiviral treatment is most effective when administered as early as possible in the course of illness.”

WHO has also issued a brief, stressing the importance of early treatment with the antiviral drugs, oseltamivir or zanamivir, especially for patients who are at increased risk of developing complications, such as pregnant women and children, as well as those who present with severe illness.

Many health professionals however are worried by the manifestation of oseltamivir resistant viruses. Systematic surveillance conducted by the Global Influenza Surveillance Network, supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to oseltamivir. To date, 28 resistant viruses have been detected and characterized worldwide. However, cases of oseltamivir-resistant viruses continue to be sporadic and infrequent, with no evidence that oseltamivir-resistant pandemic H1N1 viruses are circulating within communities or worldwide. Except for immunocompromised patients, those infected with an oseltamivir-resistant pandemic H1N1 virus have experienced typical uncomplicated influenza symptoms. No evidence suggests that oseltamivir-resistant viruses are causing a different or more severe form of illness.

As use of antiviral drugs continues to grow, further reports of drug-resistant viruses are certain to occur. WHO and its network of collaborating laboratories are closely monitoring the situation and will issue information and advice on a regular basis as indicated.

View the WHO brief at;
and the CDC Interim Recommendations at

Swine Flu Deaths Linked to Secondary Infections

The U.S. Centers for Disease Control and Prevention reported on Wednesday that many H1N1 pandemic influenza deaths have been linked with secondary bacterial infections, most commonly, Streptococcus pneumoniae, which can be prevented with a vaccine. The CDC has reported that in a study of 77 patients who died of the new pandemic H1N1 virus, results showed that 29 percent of them also had bacterial co-infections.

The report noted that in previous pandemics -- in 1968, 1957 and 1918 -- many of the patients who died were also infected with S. pneumoniae, Haemophilus influenzae, Staphylococcus aureus and group A Streptococcus, which causes rheumatic fever and "strep throat".

CDC epidemiologist Dr. Matthew Moore suggests that people seeking H1N1 flu vaccinations, should also ask about getting a pneumococcal vaccine if they have not received it.

View the Reuters article on the report at

Friday, September 25, 2009

WHO H1N1 Situation Update

The lastest WHO briefing note addresses the following issues:

  • Latest distribution and spread trends
  • Oseltamivir resistant viruses
  • Recommended composition for 2010 influenza season vaccines

View the situation update at

Wednesday, September 23, 2009

Preliminary Results for Pandemic H1N1 Vaccine Trials in Children

Since mid-August, the National Institute of Allergy and Infectious Disease (NIAID), has sponsored a trial testing a 2009 H1N1 influenza vaccine in children provided by the drug manufacturer Sanofi Pasteur in Swiftwater, Pennsylvania.

Preliminary analysis of blood samples from a small group of trial participants shows that a single 15-microgram dose of a non-adjuvanted 2009 H1N1 influenza vaccine – the same dose that is in the seasonal flu vaccine – generates an immune response that is expected to be protective against 2009 H1N1 influenza virus in the majority of 10 to 17 year olds, eight to 10 days following vaccination. These results are similar to those recently reported in clinical trials of healthy adults. Younger children under the age of 10 however, generally had a less robust early response to the vaccine.

The trial is assessing the safety and immune responses to one and two doses of either 15 micrograms or 30 micrograms of vaccine. Data from the trial is being compared for three age groups: children 6 months to 35 months old; 3 to 9 years old; and 10 to 17 years old.

The preliminary results are based on blood samples taken 8 to 10 days after the first vaccination. Results were most impressive among children in the 10 to 17 age group; of 25 volunteers who received one 15-microgram dose of vaccine, 76% showed a high immune response. The immune responses in children nine years old and younger were not as strong. Among 25 volunteers aged 3 to 9 years old, a strong immune response was seen in 36% of those given 15 micrograms of vaccine, while in the youngest group of 20 children between 6 months to 35 months old, a single 15-microgram dose of vaccine produced a strong immune response in only 25% of recipients.

Study investigators are also collecting blood samples from the volunteers approximately three weeks after both the first and second injections. It is anticipated that the immune response to the 2009 H1N1 influenza vaccine will be similar to that of seasonal influenza vaccination and will continue to rise for several weeks following vaccination, says NIAID Director Dr. Anthony S. Fauci MD.

The news that a single-dose H1N1 vaccine may be extremely effective, as opposed to a two-dose regimen, could have significant implications for leaders in countries that will have surplus vaccines, and for low-income countries that may have difficulty meeting the demands for the vaccine. According to a Reuters report, some European states have begun exploring how they will divvy up excess stocks of the vaccine. "The European Union's executive arm said it would encourage 'a common approach to cross-border sharing and voluntary sale within the EU,'" the news service writes, adding, "Some countries have already included a provision in contracts with manufacturers stating that unused vaccines can be sold to other countries".

To view the NIAID press release in its entirety, please visit

Friday, September 18, 2009

H1N1 Vaccine Donations to WHO for Low-Income Countries

The World Health Organization Director-General Dr. Margaret Chan reported today that the United States plans to donate 10 percent of its supply of pandemic H1N1 influenza vaccine to the organization for use in low-income countries. The US has on order 195 million doses of the swine flu vaccine, which is due to start arriving early next month. The White House has not yet released any details about the program, such as timetables and total amounts of vaccine to be donated.

The United Kingdom and France have also committed to donating 10 percent of their supply to help fight the pandemic. Other countries making donations include Australia, Brazil, Italy, New Zealand, Norway and Switzerland.

Global production, by about 25 pharmaceutical companies in all, is projected to be 2 billion to 4 billion doses over a year. However, the number of people who could be protected is uncertain since the first tests of the pandemic vaccine showed that adults will need only one shot, not two as some experts predicted. Children, however, are likely to need two.

WHO however, has warned that production of swine flu vaccines will fall "substantially" short of the amount needed to protect the global population. "Current supplies of pandemic vaccine are inadequate for a world population in which virtually everyone is susceptible to infection by a new and readily contagious virus," Dr. Margaret Chan said in a statement.

Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people, WHO spokesman Gregory Hartl said output next year will be "substantially less" than the 4.9 billion doses annual production forecast. This information comes as some 25 pharmaceutical laboratories working on vaccines have indicated that weekly production is lower than 94 million doses, he said, due to poorer than expected yields from the so-called "seed virus" strains developed by WHO-approved laboratories. In May, WHO forecasted a weekly output of 94.3 million doses, assuming full scale vaccine production.

Dr. Chan did say that the donations from the aforementioned countries, as well as doses pledged by some manufacturers, will help to alleviate issues in the imbalance of the supply and demand for the vaccine. The WHO has not yet said how it will distribute the vaccine.

View the entire article on the United States’ plans to donate at

Tuesday, September 15, 2009

Novel influenza A (H1N1) is contagious longer than originally thought

Marilynn Marchione of the Associated Press reported last night on a series of studies which find the pandemic influenza A (H1N1) virus has a longer infectious period (meaning people may be contagious longer) than originally thought, longer than seasonal influenza viruses.

One study conducted by the Institute of Public Health in Quebec, Canada found that among 43 patients with lab confirmed novel H1N1 infections and dozens of family members who submitted nose and throat swabs, 19-75% still harbored the virus in their noses 8 days after symptom onset (the time when their first symptoms began). Similarly, Dr. Guillermo Ruiz-Palacios of the National Institutes of Medical Science and Nutrition reported that infected people shed the virus for more than a week after they became symptomatic. A study out of Tan Tock Seng Hospital in Singapore illustrated that 80% of 70 study patients harbored the virus 5 days after symptom onset, 40% harbored the virus 7 days after symptom onset, and some harbored the virus as long as 16 days after symptom onset. Factors such as length of time from symptom onset to initiation of treatment with Tamiflu and underlying medical conditions, including obesity, may influence the length of time a person harbors the virus.

While this new information may have implications for public health recommendations, there is still some uncertainty about how long the infectious period may last because even though people harbor the virus in their noses, they still may not shed enough virus to infect others. An important take home message from the results of these studies - wash your hands and practice good hygiene (cover your coughs/sneezes).

The entire Associated Press article can be viewed at:

Sunday, September 13, 2009

Unanticipated effectiveness of single dose of pan flu vaccine may bode well for developing countries

According to an article recently released by, results from pandemic influenza vaccine trails coming out of Australia and the United States found the receipt of a single, unadjuvanted pandemic influenza vaccine to be effective (conferring protective antibody response). Australian-based manufacturing company CLS Ltd. reported that more than 95% of study patients had protective levels of antibodies 3 weeks after vaccination, while a U.S. study found a single vaccination to be effective within 8-10 days. No serious side effects were reported, though trails are too small to detect rare conditions. According to U.S. officials, potential adverse vaccine reactions will be closely monitored once vaccination campaigns begin.

An effective single dose of pan flu vaccine has implications for developing countries, as these findings may double anticipated stockpiles of vaccine and render more vaccine available in developing countries.

CSL Ltd. said it plans to donate its vaccine to developing nations in Asia and the South Pacific. The company is also discussing a pilot program with the World Health Organization, for which an initial donation of 100,000 vaccine doses would be made. Nancy Cox, director of the influenza division at the U.S. Centers for Disease Control and Prevention, said the U.S. is in “very active discussions” about donating some of its supply to countries in need.

View the entire Bloomberg article at:

Saturday, September 12, 2009

WHO provides advice on measures that can be taken in school settings in light of the current influenza pandemic (H1N1)

WHO has issued advice on measures that can be undertaken in schools to reduce the impact of the H1N1 influenza pandemic. Recommendations draw on recent experiences in several countries as well as studies of the health, economic, and social consequences of school closures. These studies were undertaken by members of a WHO informal network for mathematical modeling of the pandemic.

Experience to date has demonstrated the role of schools in amplifying transmission of the pandemic virus, both within schools and into the wider community. While outbreaks in schools are clearly an important dimension of the current pandemic, no single measure can stop or limit transmission in schools, which provide multiple opportunities for spread of the virus.

WHO recommends the use of a range of measures that can be adapted to the local epidemiological situation, available resources, and the social role played by many schools. National and local authorities are in the best position to make decisions about these measures and how they should be adapted and implemented.

WHO continues to recommend that students, teachers, and other staff who feel unwell should stay home. Plans should be in place, and space made available, to isolate students and staff who become ill while at school.

Schools should promote hand hygiene and respiratory etiquette and be stocked with appropriate supplies. Proper cleaning and ventilation and measures to reduce crowding are also advised.

Detailed information on school closures, class suspensions, and economic and social costs of such interventions can be viewed at:

Thursday, September 3, 2009

Some great information, videos and flyers from IFRC at

Check out the video

Our world. Your move.

Tuesday, September 1, 2009

H1N1 Virus May Have Biological Advantage Over Seasonal Influenza Viruses

A recent study in ferrets had some interesting learnings for the novel H1N1 virus and seasonal flu viruses,

"Preliminary findings in ferrets suggest that the novel 2009 H1N1 influenza virus may outcompete human seasonal influenza viruses, researchers say. Tests in animals showed that levels of the 2009 H1N1 virus rose more quickly than levels of the seasonal virus strains, and the new virus caused more severe disease. In line with previous findings by other research groups, the University of Maryland researchers also observed that the novel H1N1 virus was transmitted more easily from infected to uninfected ferrets than either of the two seasonal influenza viruses.

The researchers found no evidence that the 2009 H1N1 virus combined with either of two seasonal flu viruses to form new, so-called reassortant viruses. These findings suggest that while 2009 H1N1 virus probably will predominate in the coming flu season, there may not be biological pressure for the new virus to re-combine with other circulating viruses, the researchers say."

Convergence of diseases in Papua New Guinea?

Preliminary reports out of Papua New Guinea suggest that 47 people have died and 2,000 have become ill from what seems to possibly be simultaneous outbreaks of influnenza like illness and dysentery. When don't know whether of not this is novel H1N1, but it's an important reminder that influenza outbreaks can really have substantial impact on areas with already fragile health systems.

"TWIN outbreaks of a mystery flu and dysentery in a remote region of Papua New Guinea have killed 47 people and infected another 2,000 villagers, a senior medical official said on Monday.

And a separate eruption of cholera in the Pacific island nation has killed seven adults and sickened 73 other people, provincial health adviser Theo Likei told AFP.

Twenty-seven villagers in the Menyamya district of Morobe province, on the northeast coast, have died from an as-yet unidentified influenza since August 3, while a further 20 were felled by dysentery.

'Roughly 2,000 people are sick in about 12 villages and we suspect influenza and dysentery are the cause,' Mr Likei told AFP.

'So far there have been about 47 deaths, about 90 per cent of them in the village of Akwanda,' where 95 per cent of the reported flu and dysentery infections were reported."