Friday, January 29, 2010

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.


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.


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.


South Africa to Vaccinate 3 Million

The Health Department of South Africa is seeking to immunise at least 3 million people against 2009 H1N1 flu before winter sets in, Health Minister Aaron Motsoaledi said yesterday. South Africa currently has 1.3 million doses of vaccine and because South Africa is classified as both a developed and developing country, it was ineligible to receive the free vaccines distributed to many African countries from WHO.

Motsoaledi added that they could not afford to vaccinate everybody and the Ministry is still seeking funding for additional vaccines. The Ministry aims to vaccinate all pregnant women, health care workers, young people, and some people at points of entry into the country.


Physician Perceptions on 2009 H1N1 Differ by Country

From -- Sunday, January 24, 2010

Global market intelligence firm Synovate has released data from a study examining the physician’s view of the recent Swine Flu pandemic. The survey, which interviewed physicians from the UK, France, Germany, Italy, Spain, USA, China, Taiwan and India about their views of the subject, revealed the following findings:
  • 90% of doctors in the US feel that pregnant women should be given the vaccine compared to just 20% of doctors in China.
  • 82% of UK doctors feel the media has over-dramatized the situation.
  • 58% of European doctors have seen their workload increase as a result of swine flu compared to just 35% in the US.
  • 76% of doctors in Taiwan have been vaccinated.

The subject of swine flu vaccination had the doctors divided. Just over half of those surveyed (51%) have themselves been vaccinated, the highest number of which was in Taiwan (76%) and the lowest in Spain (21%). Whilst 37% overall had not had the vaccine nor intended to have it within the next month, 24% of this group still agreed that those under 21 years of age should receive the vaccination and 32% also agreed that frontline staff should receive it.

Overall, just over half of the respondents agreed or strongly agreed that young people should be vaccinated. Opinion was much stronger in the US with 88% of doctors agreeing, compared to only 44% in Europe.

Commented Jackie Ilacqua, Head of Global Oncology at Synovate: "In the US we very much have a culture of prevention, so it is not surprising that vaccinations are so strongly encouraged. Perhaps more importantly, in this case, this high figure could be attributed to the many false negatives there have been to the H1N1 test and the resulting statistics on the number of patients affected actually being understated"

Fifty-seven percent of respondents agreed that "pregnant women should be vaccinated as soon as practical" Again, the US physicians felt most strongly with 90% of US doctors agreeing with this statement.

In stark contrast, only 20% of doctors in China agreed. Commented Robert Pollard, Director of Synovate Healthcare China: "Culturally, the Chinese are hesitant to use prophylaxis, especially so when their single child is involved. The low agreement with the statement is probably a result of doctors feeling the risks outweigh the possible benefits. We have seen in other studies in which we talk to frontline outpatient doctors in hospitals that very few of them ever consider having a flu shot even when provided free by their hospital"

Sixty-two percent of doctors surveyed agreed that the swine flu vaccine provides effective protection, while 27% were uncertain. The remaining 11% believe that it does NOT provide effective protection.

As with any issue that becomes a national and even international concern, government reaction is heavily scrutinised. Communication, support and infrastructure to deal with the crisis, as well as control and recovery are all components of an epidemic contingency plan which people expect their government to deliver on. The swine flu outbreak is no different. In this instance, when it came to government handling of the situation, opinion was pretty much split equally with 38% of doctors agreeing that their government had handled it well, 33% disagreeing and 28% neither agreeing nor disagreeing.

The Asian markets seemed to be the most satisfied with their governments’ reaction: 54% agreed that it has been well handled. In Europe, it is a rather different story with only 26% agreeing.

There was also a clear contrast between the views of primary care providers and specialists - 40% of primary care providers indicated that they felt their government had not handled the swine flu outbreak well, compared with only 28% of specialists stating the same.

Sixty-one percent of all physicians surveyed felt or felt strongly that the media in their country has over-dramatised the swine flu outbreak. There were notable regional differences in opinion: 75% of respondents in the European markets agreed, 48% in Asia, and 46% in the US.

Commented a doctor in Germany: "In Germany, we now have 80 million experts with 80 million different opinions. This very important topic has become a victim of a lukewarm election campaign played out in the media"

Perhaps the most critical were the UK doctors with a huge proportion (82%) agreeing or strongly agreeing that the British media has over-dramatised the situation.

Commented Steve Lowery, Group Head Healthcare Custom research UK: "This is hardly surprising given the often sensationalist nature of the British tabloid press. When we consider the media hysteria in recent years about both SARS and Bird Flu, perhaps it is little wonder that this time doctors feel that the risks of swine flu have been exaggerated somewhat in some parts of the media"

In China however, there was a rather different story, with a mere 31% of doctors being unsupportive of the level of media publicity in their market. As with opinion on government handling, a significantly larger proportion of primary care physicians felt the media in their market had over-dramatised the situation (72%) than specialists (55%).


WHO Statement to the Council of Europe on Pandemic 2009 H1N1

On January 26th, Dr Keiji Fukuda - Special Adviser on Pandemic Influenza to the Director-
General- released a statement to the Council of Europe on behalf of WHO. Topics addressed included:

a) The role of WHO in improving global and national preparedness through the capacity strengthening of laboratories, epidemiological investigations, clinical care and communications, as well as the building of new capacities such as the International Health Regulations.

b) The current global situation regarding the incidence of 2009 H1N1

c) The importance of the
International Health Regulations and the Emergency Committee in the actions taken with respect to 2009 H1N1

d) Accusations against WHO about conflicts of interest with respect to the pharmaceutical industry.

View the statement at

Friday, January 22, 2010

Nigeria to Receive 2009 H1N1 Vaccine

January 21 2009-- Nigerian Minister of Health, Babatunde Osotimehin, said negotiations between government and the World Health Organization on securing shipments of 2009 H1N1 vaccine had reached advanced stage.

This news comes after the death of a 38-year-old woman in Lagos from the virus and reports that eight others subsequently tested positive. The Minister noted that before now, Nigeria was not considered a high endemic country, hence the decision by WHO to concentrate the vaccine in countries where the disease was more pronounced.

He also said deaths recorded so far were not a result of the absence of a curative drug, but rather as a result of late diagnoses.

The minister, urged Nigerians to adopt precautionary measures, notably frequent hand washing, use of clean water and soap, keeping hands away from the face while sneezing or coughing as the disease gains access to the body through the eyes and nose, seeking medical attention on noticing cough, catarrh and high fever, among others.

He said the curative drug [Tamiflu] was already available throughout the country and stated that the committee set up to tackle the situation, the National Epidemic Preparedness and Response Committee was already on top of the situation even as he maintained that the government would intensify its campaign on precautionary measures.

Meanwhile, the Lagos State Government has expressed its preparedness to control the spread of the disease.


New Zealand: Decline in Hand Sanitizer Use

A recent study published in the European journal, Eurosurveillance, reveals that a follow-up conducted in December 2009 on hand sanitizer use at a New Zealand hospital declined from 18% in August 2009 to 8.2% in December. As expected, with a decrease in flu activity, there has been a reduction in individuals' perceived threat from the pandemic. But with future waves of the pandemic expected to occur, decreased vigilance could have serious implications in the spread and severity of the 2009 H1N1 virus.

According to the authors, the decline in sanitizer use could reflect an underlying seasonal pattern in hygiene behavior by the public. But more likely, the reason is that there was a decline in awareness of the pandemic and associated hygiene behavior over the four-month period between the two studies. This change could have been driven by reduced media reporting of the pandemic and lower public concern about this health threat. Staff and regular hospital visitors may also have become habituated to hygiene messages and to the presence of the sanitizer and associated instructions in the foyer which may also have contributed to reduced use.

Female subjects and children were identified in this study as more conscientious regarding hand hygiene behavior, a result which has been reported in other studies internationally for both sanitizer and soap use. The higher hand sanitizer use by children in this follow-up study was a surprise finding, and the researchers noted that most of the children observed went to the sanitizer first, and then the adults followed them. It is possible that hygiene education in schools during and since the pandemic may have contributed to this difference, and this finding re-enforces the importance of incorporating education in schools as a key prevention strategy in keeping the impact of the pandemic at the lowest possible level.

Source: Eurosurveillance

Thursday, January 21, 2010

H5N1 case in Egypt, bird outbreak in India & Bangladesh, debate in Indonesia

January 19, 2009--From CIDRAP News

Egypt reports human H5N1 case, more bird infections
Egypt has identified its 91st human case of H5N1 avian influenza, according to a Jan 13 report by Strengthening Avian Influenza Detection and Response (SAIDR), an Egypt-based project funded by the US Agency for International Development. The Egyptian health ministry said the case involves a 20-year-old woman from Beni Suef governorate who fell ill Jan 6, was hospitalized, and was reported to be in stable condition on Jan 13. Her family said she had had contact with sick and dead poultry. Meanwhile, Egypt's Ministry of Agriculture and Land Reclamation today reported 17 detections of H5N1 cases in household birds in eight governorates, according to a separate SAIDR report. Officials said the number of findings was a result of the strengthening of passive surveillance in veterinary clinics.

H5N1 hits India's West Bengal state
Animal health officials in India confirmed an H5N1 avian influenza outbreak in backyard birds in three villages in the country's West Bengal state, according to a Jan 15 report from the World Organization for Animal Health (OIE). The outbreak, India's first since October 2009, killed 1,000 of about 80,000 susceptible birds in the three Murshidabad district villages. The remaining birds and those in a 3-kilometer radius around the area were culled to prevent the spread of the virus. The government will compensate owners for the poultry. Veterinary authorities are conducting intensive surveillance in areas within 10 kilometers of the outbreak site. They have also closed poultry markets in the area and have prohibited the sale and transport of birds. Investigators haven't yet determined the source of the virus. West Bengal is in eastern India near its border with Bangladesh.

H5N1 strikes Bangladesh poultry farm
Livestock officials in Bangladesh today reported that the H5N1 avian influenza virus struck a poultry farm in the western part of the country, according to a report from the World Organization for Animal Health (OIE). The outbreak began on Jan 4 and killed 250 poultry; the remaining 932 birds were culled to control the disease. Investigators have not found the source of the outbreak, which is Bangladesh's first since September. Authorities disinfected the farm and have limited poultry transport in the area. Yesterday India reported an H5N1 outbreak in backyard birds in West Bengal state in the eastern part of the country, not far from the border with Bangladesh.

Indonesia's H5N1 status debated as outbreak reported
Health and agriculture officials in Indonesia say fewer H5N1 outbreaks in poultry may have decreased the number of infections in humans, but other experts say the risk has not changed and that the country's poultry surveillance system is weak, the United Nations Integrated Regional Information Networks (IRIN) reported yesterday. Indonesian Health Minister Endang Rahayu Sedyaningsih said there have been no human illnesses since November 2009, and Agus Wiyono, the agriculture ministry's director of animal health, said no major poultry outbreaks have occurred in 3 years. But Dr Chairil Nidom, a microbiologist at Airlangga University in Surabaya, Indonesia, said some poultry outbreaks have probably gone unreported and that the surveillance system is weak. A World Health Organization (WHO) spokesman told IRIN that the group's assessment of Indonesia's risk has not changed. The country leads the world in human H5N1 infections and deaths. The mixed assessments of Indonesia's risk came as veterinary officials in East Java reported that the virus recently struck chickens in a village, which led to the culling of 270 birds, Indonesia's Antara news agency reported today. Rapid-test results on 100 birds were positive, an official from Pamekasan regency's veterinary health office told the news service.


WHO 2009 H1N1 Influenza Situation Update

Dr Keiji Fukuda, Special Adviser to the WHO Director-General on Pandemic Influenza delivered a virtual press conference on January 14, 2010. Dr. Fukuda expressed that the most intense pandemic activity continues to be concentrated in North Africa, Southern Asia and in parts of Eastern and Southeast Europe. Though activity has been declining in other parts of the world, it has not returned to baseline, hence, it is too early to say that the pandemic is over. It is important to also note that over the remainder of the winter and the upcoming spring, it is very likely that we may see a significant recurring wave of transmission. With the situation as it is, the agency considers the pandemic to still be ongoing.

Dr. Fukuda also took the time to dispel rumors that the pandemic was not real, that WHO had changed its definition of the H1N1 as a pandemic, or that the agency over exaggerated the severity of the pandemic. Dr. Fukuda reminded viewers that in the initial briefing given by director-general, Dr. Margaret Chan, she expressed that there was reason to believe that the pandemic would be of "moderate severity", and the agency simply took all the necessary precautions to keep transmission as low as possible. It is impossible to know the exact course that a pandemic will take, and recommendations change as new information about the pandemic is uncovered.

The entire transcript from the briefing is available from the website below.

Source: WHO

CDC Estimates 2009 H1N1 Vaccine Coverage in the U.S. at 20.3%

Many western countries, including the U.S. have reported a surplus of H1N1 vaccines due to low demand. During December 2009 and January 2010, the CDC analyzed results from the National 2009 H1N1 Flu Survey (NHFS) and the Behavioral Risk Factor Surveillance System (BRFSS) survey to estimate 2009 H1N1 vaccination coverage to date for the 2009-2010 influenza season.

The results indicated that, as of January 2, an estimated 20.3% of the U.S. population (61 million persons) had been vaccinated, including 27.9% of persons in the initial target groups. An estimated 29.4% of U.S. children aged 6 months-18 years had been vaccinated.

Vaccination survey shows gaps
The CDC vaccination report also shows that as of Jan 2, 90% of adults under age 65 with chronic medical conditions that increase their risk of flu complications still had not been vaccinated. Over the past several weeks the CDC has emphasized how vulnerable this group is: three-fourths of adults hospitalized with pandemic flu infections had an underlying condition such as asthma, chronic obstructive pulmonary disease (COPD), or diabetes.

Vaccine uptake in healthcare workers, slated to receive the very first doses of the vaccine, was also disappointingly low: Only 22% reported having been vaccinated. The number was even lower than for seasonal flu vaccine, which has historically been below 50%.

The survey also showed worrisome signs of racial disparity, even among healthcare workers.

However, the vaccine survey also had some positive findings. For example, vaccine uptake in pregnant women was 38%, which is higher than typically seen for the seasonal flu vaccine. However, the CDC warned that the confidence interval for the uptake number was large and that a separate system is collecting more data on pregnant women to give officials a better estimate of pandemic vaccine uptake.

Recently some members of the Council of Europe, a 47-nation group that works for European integration, charged that H1N1 has been a "false pandemic"—a threat exaggerated by the WHO and governments under improper influence from vaccine manufacturers. Though WHO and national public health officials, as well as industry groups, have emphatically denied the accusations, it could be a contributing factor to some people's skepticism in seeking out the vaccine.

The CDC expressed that now that an ample supply of vaccine is available, efforts should continue to increase vaccination coverage among persons in the initial target groups and to offer vaccination to the rest of the U.S. population, including those aged ≥65 years.


Thursday, January 14, 2010

Drop in Demand of H1N1 Vaccine for Developing Countries

With H1N1 pandemic influenza activity waning in many countries, developing countries in line to receive donated H1N1 vaccine from the World Health Organization (WHO) may not want as much as the agency has been aiming to provide. WHO hoped to provide enough for 10% of the population of countries that wanted the vaccine, but the agency's Dr. Marie-Paule Kieny said that with the pandemic waning, governments are "considering whether and how much vaccine they want to deploy.

"And it's normal. There is a need for reassessment of what the epidemiology is telling us," Kieny said in an interview from Geneva. "Of course we cannot rule out that there will be another peak. And we don't know exactly what will happen in the Southern Hemisphere when they start (their next winter) also."

"But many countries now have the impression that the peak is over. And so I think then the governments are also themselves considering whether and how much vaccine they want to deploy."

Even with donated vaccine, deployment isn't cheap. Kieny said it's estimated it will cost between US$1 and US$5 a dose. Kieny expressed that now that we are well into winter in the Northern Hemisphere and have seen the trend in several countries, t is the time to reflect and to see how much vaccine will be needed and where, so as not to be wasteful.


Monday, January 11, 2010

Update: WHO 2009 H1N1 Vaccine Deployment

As of December 2009, WHO had received pledges of nearly 190 million doses of vaccine, 75 million syringes and US$70 million for vaccine deployment to developing countries.

WHO and partners are assisting 95 countries to receive and use vaccines, with an immediate focus on a first group of 35 countries. Before countries receive donated vaccines, they complete three steps: 1) make a request to receive donated vaccines, 2) sign an agreement accepting the terms and conditions of support and 3) develop a national pandemic vaccine deployment plan.

Current situation
1. All of the first 35 countries have requested vaccine donations.
2. 23 have signed agreements with WHO.
3. 6 have finalized National Deployment Plans.

WHO has completed 9 training workshops in all regions to help countries produce sound national deployment plans and prepare to receive and manage pandemic influenza H1N1 vaccines.

WHO with partners has placed orders for vaccines for Afghanistan, Azerbaijan, and Mongolia. The agency has also begun to transport ancillary products to several other countries.

There have been reports in the media that the vaccines are making it to these countries only now that the number of cases has dropped. It is important to note that even though at the moment it may seem that flu activity is decreasing, past pandemics have shown that we can reasonably predict that there will be the occurrence of another wave of the virus. The virus still poses a great threat to the public health of individuals, and it is therefore very important that everyone who has access to the vaccine gets vaccinated.

Some ministries of health, including the U.S. and the U.K., are dealing with an oversupply of the vaccine due to low demand in their countries. The Netherlands and Switzerland are also among countries that are negotiating shipping excess vaccine to countries that are still facing shortages.


Tuesday, January 5, 2010

Environmental disruption set to trigger new pandemics, scientists warn

The following article was referenced on the Avian Flu Diary, and is directly relevant to much of CARE's current work and future vision in emerging and re-emerging infectious diseases. Excerpts are presented below, but the entire article is worth reading.

The article goes on to highlight key zoonotic diseases such as HIV(AIDS), hantaviral diseases, H5N1/H1N1 influenzas, rabies, malaria, and West Nile; diseases which have emerged in humans after their respective infectious agents jumped the species barrier from animals to infect and subsequently trigger disease states in humans.

Deadly animal diseases poised to infect humans: Environmental disruption set to trigger new pandemics, scientists warn

By Jeremy Laurance, Health Editor, The Independent

"The world is facing a growing threat from new diseases that are jumping the human-animal species barrier as a result of environmental disruption, global warming and the progressive urbanisation of the planet, scientists have warned.

At least 45 diseases that have passed from animals to humans have been reported to UN agencies in the last two decades, with the number expected to escalate in the coming years.
Dramatic changes to the environment are triggering major alterations to human disease patterns on a scale last seen during the industrial revolution. Montira Pongsiri, an environmental health scientist at the US Environmental Protection Agency in Washington, says that previous transitions in human history have had a devastating impact in terms of the spread of disease.

'We appear to be undergoing a distinct change in global disease ecology. The recent emergence of infectious diseases appears to be driven by globalisation and ecological disruption,' Dr Pongsiri said.

He and eight colleagues examined five emerging and re-emerging diseases – malaria, lyme disease (spread by ticks), Hantavirus (spread by mice and rats), West Nile disease (spread by mosquitoes), and schistosomiasis (spread by freshwater snails). They argue that changes in land use, farming practices and climate lie behind the increasing number of outbreaks.

The best known example of a disease that jumped the animal-human barrier and went on to cause a global pandemic is HIV, the virus that causes Aids. HIV is thought to have crossed from chimpanzees to humans in West Africa in the last century and more than 25 million people worldwide have since died from it. The swine flu pandemic that emerged in Mexico last March also resulted from the mixing of viruses that infected pigs, birds and humans to create a new pandemic strain. Although it turned out to be milder than expected, future flu pandemics are expected in the coming decades that could have higher death rates and infect millions more people.

Dr Pongsiri and colleagues say that the number of people who succumbed to infectious diseases plummeted in the developed world during the industrial revolution, but the rise of manufacturing and pollution levels increased the incidence of chronic diseases including cancer, allergies and birth defects. Now, we are in the grip of another epidemiological transition driven by the destruction of plant and animal habitats, the loss of species and changes that have brought more humans into closer contact with animals than at any stage in human history, they say in the journal Bioscience.

David Murrell, lecturer in ecology at University College London, said: 'Since 1940, over 300 new diseases have been identified, 60 per cent of which crossed to humans from animals and 70 per cent of these came from contact with wildlife. I would expect the emergence of new diseases from contact with animals to continue in this century.'

A key factor has been increasing urbanisation, which has resulted in humans moving into previously untouched areas where they have come into closer contact with animals. At the same time, globalisation has meant newly emerged diseases have transmitted faster and more widely than in the past. 'Before the world became so interconnected, deadly and newly emerged diseases were not capable of spreading widely,' Dr Murrell said. 'Now it is very possible that they will spread across countries and continents within days, thereby sustaining the outbreak.

We don't know what's out there or how it might transmit. It is very difficult to predict. At least our government, with swine flu, is taking these things seriously now. The problem is if we deal with a threat successfully it leads to complacency. But these things are potentially serious. I would rather err on the side of caution.' "

The article can be viewed in its entirety at: