Case count update from WHO

As of June 29th, WHO is reporting 70,893 cases and 311 deaths. It looks like the latest countries to find their first cases are Nepal, Monaco, and Lithuania.

http://www.who.int/csr/don/2009_06_29/en/index.html

While we're still reporting on WHO cases counts, it's important to keep in mind that these will be severe underestimates. CDC is estimating that there are probably one million Americans infected with swine flu (but have not been tested)

http://www.nytimes.com/2009/06/27/health/27flu.html

1st case of H1N1 resistance to tamiflu found in Denmark

From Reuters: "Scientists have established the first case of the new H1N1 influenza strain showing resistance to Tamiflu, the main antiviral flu drug, Danish officials and the manufacturer said on Monday.

"While receiving the drug, the patient appeared to develop resistance to it," David Reddy, Roche Holding AG's (ROG.VX) pandemic taskforce leader, told reporters on a conference call on a case observed in Denmark. "This is the first report we have of it in H1N1."

Common seasonal flu can resist Tamiflu and Reddy said a case of resistance in H1N1 -- also know as swine flu -- was not unexpected. Roche had been working on strategies to counter such a development."

http://www.reuters.com/article/swineFlu/idUSLT265113?feedType=RSS&feedName=swineFlu&virtualBrandChannel=10521

CDC updates guidace on antivirals (slightly)

From CIDRAP:

"Jun 25, 2009 (CIDRAP News) – The US Centers for Disease Control and Prevention (CDC) today at the Advisory Committee on Immunization Practices meeting in Atlanta issued updated guidelines for treatment of influenza, including novel H1N1, suggesting basing antiviral selection on laboratory test results when possible.

The new guidance appears to be aimed at preventing the inadvertent prescription of oseltamivir (Tamiflu) for seasonal H1N1 infections, which have shown extensive resistance to oseltamivir in the United States and other parts of the world. The update was provided by CDC spokesman Tom Skinner.

According to the CDC update, only patients who test positive for influenza A/H3N2, pandemic H1N1, or B should receive oseltamivir. Zanamivir (Relenza) is preferred for patients who test positive for seasonal H1N1 influenza.

If a laboratory test is not performed or the test is negative but clinical suspicion remains, the preferred treatment is zanamivir or a combination of oseltamivir and rimantadine, which is an older drug of the adamantine class of antivirals. If testing indicates influenza A or unspecified influenza, the preferred treatment is also zanamivir or a combination of oseltamivir and rimantadine.

As with its earlier recommendation for novel H1N1 treatment, the CDC emphasized in today's updated guidance that treatment should be started as soon as possible after illness onset.

The CDC added a few more specifics to the list of people for whom antiviral treatment should be considered to include those who are hospitalized with influenza, have influenza with viral or bacterial pneumonia, or have influenza with a higher risk for complications, regardless or illness severity."

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jun2509tamiflu-brjw.html

Is "Mild" the right word for H1N1?

There's really no such thing as a "mild" pandemic. Even with a virus that causes mostly mild illness, roughly 30% of the world's population will become ill with the virus. That means increased deaths, even if the case fatality rates are low, and increased burden on health systems. That's most likely why WHO has characterized the pandemic as "moderate"

Yet we keep seeing the word mild pop up a lot and Helen Branswell, an imminently respected influenza reporter wrote about some of the inherent problems with using the word mild.

"Officialdom's mantra about swine flu - "it is overwhelmingly mild" - might seem incongruous if we knew the number of children, teens and young adults in ICU beds right now alive only because a breathing machine has taken over for their ravaged lungs.

The heavy reliance on the word "mild " could be creating a false impression of what is actually going on and what the world may face in coming months, some experts worry."

....

"When we're told that swine flu is mild, we don't think, 'It will infect a half to a third of the world population and kill a few million people, mostly young people, before it's over,"' says Sandman. "We think, 'It's like having a bad cold."'

Well, swine flu isn't over. And it's not like a bad cold sweeping the globe.

But officials and experts are having a hard time striking the balance in messages to the public, unclear what they are dealing with now and what it might become.

"I think the problem is we don't know how to paint this picture properly," says Dr. Allison McGeer, a flu expert at Toronto's Mount Sinai Hospital.

"Because it's perfectly true that most cases are mild. But it doesn't mean that you shouldn't worry about it."

Regular flu, as anyone who has had it know, is no walk in the park.

And with this new flu, a small subset of people gets very, very sick. Their lungs are overwhelmed by an aggressive viral pneumonia one doctor described as looking like a "white out" on an X-ray. A number of hospitals are struggling to keep these people alive.

Generally much younger than the typical hospitalized flu patient, many of these people have been on ventilators for weeks. And every day, officials in some part of the globe announce that a 15-year-old boy, a 24-year-old woman or an otherwise healthy pregnant woman in her third trimester has lost the battle.

"When you look at those things then you begin to say 'Well, is it really accurate, is it really fair to say that this is a mild phenomenon?"' says Dr. Keiji Fukuda, the World Health Organization's top flu expert.

Fukuda and his team have been warning for some time that the unusual age pattern of severe cases, the odd out-of-season spread and the fact that the virus is killing some previously healthy young adults makes the term moderate a more appropriate severity assessment.

That pattern, seen in previous pandemics, makes flu watchers sit up and take notice. "What it really leads you to conclude is that boy, we'd better watch this pretty carefully," Fukuda says.

There still isn't a good estimate of the percentage of total swine flu cases that becomes gravely ill, or the percentage that succumbs to the virus's onslaught. Currently the numbers may seem small; 25 deaths in Canada, 127 in the U.S., 263 worldwide. (Swine flu has already beat bird flu in terms of death tolls.)

But as a human pathogen this virus is still a baby, despite its rapid global spread. No one knows what it is going to be when it grows up.

Catch the whole article here at:

http://chealth.canoe.ca/channel_health_news_details.asp?news_id=28382& news_channel_id=145&channel_id=145

Reports from Southern Hemisphere

CDC indicates today that there are reports of co-circulation of pandemic H1N1, seasonal H3N2, and some seasonal H1N1 viruses in the southern hemisphere at this time.

Additionally, CDC indicates reports of increasing outbreaks of pandemic H1N1 in certain countries in the southern hemisphere.


Source: CDC Joint Information Center

CDC Estimates at Least 1 Million Cases of Pandemic H1N1 in the US, to Date

"At the June 25, 2009 Advisory Committee on Immunization Practice Meeting, CDC estimated that there have been at least 1 million cases of pandemic H1N1 in the United States to date. This estimate is derived from population-based surveys in areas with focal outbreaks of pandemic H1N1 that have reported the incidence of influenza-like-illness to be approximately 6%.

On June 10, 2009, the New York City Health Department released preliminary findings from a household survey suggesting that 6.9% of New Yorkers may have experienced flu-like illness between May 1 and May 20, 2009.

Several other local population-based surveys produced similar estimates of ILI incidence/pandemic H1N1 incidence.

Given the occurrence of pandemic H1N1 outbreaks in cities with large populations and the results of these surveys, CDC estimates that there have been at least 1 million cases of pandemic H1N1 in the United States."

Source: CDC Joint Information Center

WHO Update

As of Friday, 26 June, WHO is reporting 59,814 laboratory-confirmed cases of influenza A(H1N1), including 263 associated deaths in 112 countries/territories/areas. Since Wednesday (WHO is providing reports on Mondays, Wednesdays, and Fridays), 4 new countries/territories/areas are reporting laboratory confirmed cases of influenza A(H1N1). The following list includes the number of lab-confirmed cases and associated deaths, by country/territory/area for these 4 countries/territories/areas:

Reporting site (Cases, Deaths)
- Indonesia (2,0)
- Iran (1,0)
- Serbia (2,0)
- UK: Guernsey, Crown Dependency (1,0)

It is difficult to interpret this information, as it may be a sign of enhanced surveillance and/or improved reporting rather than a true indication of increasing distribution and spread of the virus.

While we think it is important to provide a situation update as well as an update on the distribution and spread of reported disease in countries/territories/areas reporting to WHO, we would like to emphasize that certainly not all cases are detected and/or appropriately reported. Therefore, the figures presented in these updates likely are a substantial underestimate of the actual amount of disease and the numbers of affected countries/territories/areas.

Source site: http://www.who.int/csr/don/2009_06_26/en/index.html