Vaccine news for H1N1 & H5N1

Much of our attention is focused on H1N1 these days, but scientist and vaccine producers have not forgotten H5N1 as a potential pandemic virus. Reuters is reporting on new strains from Egypt being utilized:

"Scientists have used bird flu virus samples from Egypt to develop a new basis for a vaccine against the toxic H5N1 strain that continues to circulate, the World Health Organisation said on Thursday.

Avian influenza kills about half the people it infects, but unlike the quickly circulating H1N1 flu virus has not been shown to pass easily between humans to date.

The WHO said the candidate virus was developed at the U.S. Centres for Disease Control and Prevention in Atlanta "thanks to the ministry of health and population of Egypt, for providing virus specimens,"

"This recombinant vaccine virus is available for distribution," it said in a statement on its website.

"Institutions, companies and others interested in pandemic vaccine development who wish to receive these candidate vaccine viruses should contact either the WHO Global Influenza Programme ... or the Centers for Disease Control and Prevention."

Pharmaceutical companies including Novartis are already working on vaccines against H5N1 bird flu, which has killed or forced the culling of more than 300 million birds since 2003 as it spread to 61 countries in Asia, the Middle East and Africa."

http://uk.reuters.com/article/worldNews/idUKTRE54R2S720090528?rpc=401&&pageNumber=1&virtualBrandChannel=0

Meanwhile, the Sanofi Pasteur Institute, a leading manufacturer of influenza vaccine announced they had recieved the seed virus for H1N1 vaccine production. According to their press release:

"Receipt of the seed virus means that Sanofi Pasteur will begin the development process, called
“passaging”, that will yield a “working seed.” Passaging is the process for acclimating virus to grow in a production environment at optimum yield. The passaging process is expected to take approximately two weeks. Following quality controls, Sanofi Pasteur will be prepared to begin industrial production as soon as directed by public health agencies."

http://198.73.159.214/sanofi-pasteur2/ImageServlet?imageCode=25915&siteCode=SP_CORP

WHO has said they will make decisions about vaccine production this summer.

Daily case count from WHO

As of 06:00 GMT, 29 May 2009, 53 countries have officially reported 15,510 cases of influenza A(H1N1) infection, including 99 deaths. That's an increase of 2,112 cases since yesterday, the majority of new cases being reported in the US, followed my Mexico, Canada & Australia.

Check here for the full list of countries reporting cases:

http://www.who.int/csr/don/2009_05_29/en/index.html

Crisis and Emergency Risk Communication Resources

CDC developed several crisis and emergency risk communication resources. These resources are useful for people, such as our country office focal points, who will be required to develop and disseminate risk communication messages.

Below, we have posted two podcasts on this topic.

Crisis and Emergency Risk Communications: Best Practices
In this podcast, CDC's Dr. Barbara Reynolds discusses best practices in crisis and emergency risk communication. She characterizes the initial phase of the crisis communication lifecycle and describes the five most common mistakes made in emergency communication to the public and how to counter them.

Running time: 7:10
Author: Centers for Disease Control and Prevention, Office of the Director
Series Name: CDC Featured Podcasts

A direct link can be found on CDC’s website at: http://www2a.cdc.gov/podcasts/player.asp?f=11509


Crisis and Emergency Risk Communications: Countering Stigmatization
In this podcast, CDC's Dr. Barbara Reynolds defines stigmatization, describes how stigmatization can occur in a community, and discusses activities that response officials and communication professionals can do to prevent or confront stigmatization.

Running time: 10:29
Author: Centers for Disease Control and Prevention, Office of the Director
Series Name: CDC Featured Podcasts

A direct links can be found on CDC’s website at: http://www2a.cdc.gov/podcasts/player.asp?f=11376

Daily Influenza A(H1N1) Updates

WHO

41 countries have officially reported 11,034 cases of novel influenza A(H1N1) infection, including 85 deaths. The map below, created by WHO, indicates the number of laboratory confirmed cases and deaths reported to WHO.

For more information, visit: http://www.who.int/csr/disease/swineflu/en/index.html

CDC

As of Wednesday, 27 May 2009 (CDC is providing updated case reports on Mondays, Wednesdays, and Fridays), CDC reported 7,927 confirmed and probable cases of novel influenza A(H1N1) in 48 states in the US, including 11 deaths. The map below illustrates geographic spread of the novel influenza A(H1N1) virus in the US.

For more information, visit: http://www.cdc.gov/h1n1flu/

Daily Updates, 11,034 cases in 41 countries

WHO: 41 countries have officially reported 11 034 cases of influenza A(H1N1) infection, including 85 deaths (not including additional US death confirmed by CDC today).
http://www.who.int/csr/don/2009_05_21/en/index.html

CDC: 5764 cases (9 deaths) in 48 states (including DC)
Newly reported death from Utah.
Deaths now in Arizona, Missouri, Texas, Utah, and Washington State.

http://www.cdc.gov/h1n1flu/update.htm

New Web Technology for H1N1 Surveillance?

An excerpt from the NEJM regarding the uses of technology for surveillance, monitoring, and mobilizing global response for outbreaks, such as the current H1N1 epidemics.

"Data about diseases and outbreaks are disseminated not only through online announcements by government agencies but also through informal channels, ranging from press reports to blogs to chat rooms to analyses of Web searches (see Digital Resources for Disease Detection) ... The Internet is also providing new opportunities for connecting experts who identify and report outbreaks. Information technologies such as wikis, social networks, and Web-based portals can facilitate communication and collaboration to accelerate the dissemination of reports of infectious diseases and aid in mobilizing a response ..."

Some scientific societies are leveraging technologies for data exchange, analysis, and visualization:
Distributed Surveillance Taskforce for Real-Time Influenza Burden Tracking and Evaluation (DiSTRIBuTE): a group of state and local health departments that use the Web to share, integrate, and analyze health data across large regions.

GeoSentinel project (CDC & International Society of Travel Medicine): brings together travel and tropical-medicine clinics in an electronic network for surveillance of travel-related illnesses.

Emerging Infections Network (CDC & Infectious Diseases Society of America): a Web-based network of more than 1000 infectious disease specialists that is geared toward finding cases during outbreaks and detecting new or unusual clinical events.

Electronic Health Records, Cell Phones & Texting: Useful for Surveillance?
Broader Web-based networks are also proving useful for surveillance. Social-networking sites for clinicians, patients, and the general public hold potential for harnessing the collective wisdom of the masses for disease detection. Given the continued deployment of personally controlled electronic health records, we expect that patients' contributions to disease surveillance will increase. Eventually, mobile-phone technology, enabled by global positioning systems and coupled with short-message-service messaging (texting) and "microblogging" (with Twitter), might also come into play. For instance, an organization called Innovative Support to Emergencies, Diseases, and Disasters (InSTEDD) has developed open-source technology to permit seamless cross-border communication between mobile devices for early warning and response in resource-constrained settings."

Potential Drawbacks that may limit the realization of their potential for public health practice and clinical decision making.

• Information overload
• false reports
• lack of specificity of signals
• sensitivity to external forces such as media interest
• difficulties with verification and follow-up.

Sample Web-based data sources:
Global Public Health Intelligence Network (GPHIN), www.phac-aspc.gc.ca/media/nr-rp/2004/2004_gphin-rmispbk-eng.php
DiSTRIBuTE, www.syndromic.org/projects/DiSTRIBuTE.htm
GeoSentinel, www.istm.org/geosentinel/main.html
Emerging Infections Network, http://ein.idsociety.org

Full article: http://content.nejm.org/cgi/content/full/360/21/2153

New Cases in Japan, China, South Korea

Japan
WHO reported today that Japan has a total of 210 H1N1 cases, 51 of which were newly confirmed since yesterday. There was also report of the first two cases in Japan's denseley populated capital city, Tokyo. These two cases were high-school aged girls recently returned from New York City. The newly confirmed cases prompted officials to close even more Japanese schools (more below).

China & South Korea
There were also reports of a new quarantined H1N1 case in South Korea, a new case in Beijing (for a total of 2 in the capital city), and one in Taiwan (an Australian cruise ship doctor).

Quarantine & School Closings:
"About 4,500 schools, mostly in the western prefectures of Osaka and Hyogo about 400 km (250 miles) from Tokyo, have closed their doors until the end of the week. The local government in neighbouring Shiga prefecture, which also confirmed its first case on Wednesday, was also urging its schools to follow suit. A university campus in Shiga was also closed, affecting 18,000 students, after one of them was infected with the virus.

A hospital in the port city of Kobe, where a member of staff had been infected, was to ban visits to flu patients, Kyodo news agency said."

Shifts in Preparedness and Response (from H5N1 to H1N1)
"The (Japenese) government is considering drawing up a new plan by Friday to deal with the virus, which is not as deadly as the avian influenza for which existing plans had been created. It is also considering winding down strict health checks at international airports at the end of the week, which had been imposed to try to buy time before an outbreak in Japan."

http://www.who.int/csr/don/2009_05_20/en/index.html
http://www.alertnet.org/thenews/newsdesk/SP441009.htm
http://crofsblogs.typepad.com/h5n1/

Pandemic Alert Phase Change???

**It seems that the sharp increase of Japanese cases reflects the presence of community-level transmission of the A/H1N1 virus. Unless WHO changes their definitions of pandemic phases, this would certainly prompt an uptick in the Pandemic Alert from Phase 5 to Phase 6 (Pandemic). This change has not occurred, however, and there are no reports that WHO has convened the advisory council to discuss such a change. They have been considering development of a pandemic severity scale along with possible revisions of the pandemic phase definitions. More to come**