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Global’s H1N1 Update

The next update will be on Tuesday, June 22nd, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

Indian H1N1 outbreak claims 16 lives in one month

With onset of monsoon season in Southeast Asia, influenza is considered a common monsoon-related malady. In southwest India, the state of Kerala is suffering from a large resurgence in H1N1 infections. Of the 16 deaths due to H1N1 the agrarian state has reported since May 15th, 9 were pregnant women. India’s National Centre for Disease Control has sent its Joint Director with an epidemiologist and a virologist as a three-doctor swift response team to the state capital, Thiruvananthapuram, to investigate and combat the outbreak. In addition, the Indian parliament has approved shipments to Kerala of 600 000 Oseltamivir tablets, 20 000 bottles of pediatric syrup and 31 000 doses of vaccine. Monsoon season is expected to last another two to three months. Infocera

Vietnam wants to lower its pandemic alert level

Not content to wait for the World Health Organization’s review in July, Vietnam’s Deputy Minister of Health Trinh Quan Huan has suggested lowering his country’s H1N1 alert level. According to Huan, his ministry had “heard” that senior WHO officials had been lobbied by pharmaceutical companies to influence the official pandemic declaration. “This is a big issue,” he said. The Vietnam Health Ministry spent approximately $52.5 million on pandemic prevention measures last year. Thanh Nien News

New Zealand vaccinates record numbers of citizens

The New Zealand government says over a million of its citizens were vaccinated against the flu this year; the highest number of people ever to respond to its public immunization program. New Zealand Health Minister Tony Ryall congratulated health officials, doctors and nurses on their “great job” and urged those who qualify for free vaccinations “to take up this offer while vaccine stocks last”. New Zealand’s last census estimates the country’s population at 4.3 million. TV3 News

The next update will be on Thursday, June 17th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

The WHO, CIDRAP and others continue to respond to BMJ allegations

Defenders of the World Health Organization’s pandemic recommendations continue to surface in the face of criticism from the British Medical Journal, now the BMJ.  Earlier this month the BMJ suggested the UN body had come under the influence of drug industry corruption and that the H1N1 guidelines provided by three of its flu experts were suspect.  David Ozonoff, an epidemiologist at the Boston University School of Public Health, called the report a “smear” that insinuates the serious charge that they would have given different advice if they hadn’t had relationships with drug companies.  The BMJ authors Deborah Cohen and Philip Carter responded, “We think this is the researcher’s reading into it, not necessarily ours.”

Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, called the article “irresponsible and reckless” saying, “There was nothing in those guidelines that was not based on the best science available.  To suggest that the three scientists were able to direct and control the final recommendations [of the 22-member panel] is naive, and stated without a single shred of evidence.”

Epidemiologist Marc Lipsitch at the Harvard School of Public Health compared the situation with the Deepwater Horizon oil spill in the Gulf of Mexico: “It is ironic, as we watch […] the catastrophic results of ‘best-case scenario planning’ […], to have the WHO coming under criticism for planning for, and raising awareness of, the possibility of a severe pandemic. […] They should be commended for it.”

Director General of the WHO Margaret Chan sent an open letter to the BMJ in response to the article. In it, she allowed that transparency and stricter rules of engagement with industry were issues the agency was working to improve on, but “at no time, not for one second, did commercial interests enter my decision-making.”

According to the Journal article, “pharmaceutical companies, […] put pressure on WHO to declare a pandemic. It was the declaring of the pandemic that triggered the [vaccine purchasing] contracts.”  However, many countries including the United Kingdom, France, Finland, Canada, the Netherlands, Switzerland, and the United States had already activated their contracts and placed large orders for H1N1 vaccine weeks before the WHO declared the pandemic on June 11, 2009.  Therefore, the Emergency Committee could not have influenced these in any way.  “You are absolutely right,” conceded the authors of the BMJ article when challenged with this timeline.  Nature News

Pandemic, one year later

The H1N1 pandemic is officially a year old as of last Friday.  On June 11, 2009, the World Health Organization’s Director General declared the H1N1 outbreak was a phase-six pandemic.  The avian (H5N1) flu virus had led the public to associate the term “pandemic” with high death rates, so the WHO hesitated making the declaration over concerns it would cause undue alarm.  The announcement came about seven weeks after the virus surfaced.  A year later, labs officially confirm H1N1 has claimed 18,156 lives though the actual count, which won’t be known for years, is expected to be many times higher.  While H1N1 activity has tapered off in most parts of the world, the WHO maintains a phase six alert.  World Health Organization

The next update will be on Thursday, May 25th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

International News

In the face of criticism, some powerful support steps forward for the WHO

There is no shortage of criticism for the World Health Organization’s (WHO) handling of the H1N1 outbreak.  Chat forums and web logs are rife with accusations of collusion with the pharmaceutical industry.  Almost a third of the European Union’s members of parliament have signed a petition criticizing the WHO’s handling of the influenza pandemic and calling for an investigation.  

This week the World Health Assembly, the decision-making arm of the WHO, convenes to discuss a range of global health issues including the H1N1 pandemic response.  At the first day of the gathering, France, India, and the US gave public statements in support of the WHO’s efforts.  French Health Minister, Roselyne Bachelot went so far as to issue a point-by-point rebuttal of the criticisms saying the UN agency had been “taken to task in an unjust manner,” and that “the vaccine, which was the answer to a real danger, turned into a source of risk in the collective mind.  The effects of this smear campaign are potentially devastating.”  

In her opening address to the assembly, WHO Director-General Margaret Chan said that the news regarding the pandemic is mostly good, and while public health successes are usually owed to political commitment, adequate resources and cooperation, this time we were “just plain lucky.” For India’s part, this seems to either represent a 180° change in their position, or that their earlier criticism was a political gambit.  Agence France-Presse

H1N1 response review committee holds its first press conference

On May 19 the external review committee for the WHO’s pandemic response held a press conference to discuss the findings of their first meeting.  The group’s final report will be a public document and is under no restrictions on scope of their recommendations.  Dr. Harvey Fineberg, chair of the review committee outlined their mandate saying they were looking to into any aspect that bears on lessons for the future saying, “We want to offer recommendations that are keyed to the problems we find. We want to offer recommendations that enable the world, WHO and the nations, to do better the next time, and we are confident there will be a next time.”

The committee plans to measure the WHO’s response in term of 5 issues: preparedness, alert, response, communication and International Health Regulations performance.  To facilitate its investigation, the committee will have access to confidential WHO documents and data.  While the report will be public, Dr. Fineberg said that the group will have no authority to compel confidential documents into the public view.  When asked what types of confidential information the group had, he described it as mostly letters of agreement and contracts with private industry.  World Health Organization

The next update will be on Thursday, May 18th, at 0830 hrs PST.

 The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

 

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

National News

H1N1 claims the life another Canadian

A Quebecois man who recently returned from a trip to Cuba has died after contracting the H1N1 virus. The man passed away in a Montreal hospital after transferring from Shawinigan, near his home. Quebec health authorities say the death does not mark the beginning of a third pandemic wave. “We know now that there are many flu cases in Cuba,” said Dr. Gilles Grenier, a public health director in the Shawinigan region. “The hypothesis is that he got the virus over there, so it’s really an isolated case.” The man, who was in his fifties, suffered from asthma and had not been vaccinated against H1N1. CBC News

 International News

 India approves its first H1N1 vaccine supplier

The Drug Controller General of India has approved pharmaceutical company Zydus Cadilia to market its own H1N1 vaccine. The nod makes Zydus Cadilia the first company in India to domestically to launch an H1N1 vaccine. The Ahmedabad-based company will use Vaxxicare, its preventative medication division, to sell the vaccine under the trade-name VaxiFlu-S. “With the development and launch of vaxiflu-s, Zydus now has proven capabilities in researching, developing, and manufacturing of safe and efficacious vaccines,” said Pankaj Patel, the company’s chairman and managing director. He went on to say that he expects Zydus Calilia to soon produce vaccines for other viral, bacterial and protozoal infections. Hindustan Times

Researchers say the benefits of H1N1 prophylaxis must be quantified against side-effects

A study published in the European science journal Eurosurveillance reports that side-effects are a significant factor in the dispensing of the anti-viral drug oseltamivir as a mass, preventative antiviral blanket. Of the students and staff at a British elementary school given the drug in June 2009 as a prophylactic measure, 42% reported adverse side-effects and 15% did not complete the course of oseltamivir due to adverse effects. The authors of the study call for an assessment of each patient’s likelihood of infection to avoid unnecessary treatment. Eurosurveillance

Global’s H1N1 Update

The next update will be on Tuesday, May 18th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 2, 2010

Looking ahead: beyond H1N1

With the North American H1N1 pandemic looking more and more like it’s over, Global Consulting has partnered with Roche Canada to host a workshop aimed at helping groups and organizations carry their pandemic safeguarding measures beyond H1N1. Many organizations spent a lot of money and worked like yeomen preparing for the pandemic, and a lot of companies have gleaned new insights into their operations through their efforts. There’s no reason to scrap those resources just because the crucible they were forged in has cooled. There will be other infectious threats in the future, to be sure, but the benefits realized here can also be applied in areas well beyond the scope of emergency planning.

A number of speakers are confirmed for the workshop. Dr. Allan Holmes helped a lot of companies and government authorities develop their frontline response to the pandemic. He’s going to share his experiences in guiding the public through the threat. Dr. Graham Dodd, an emergency physician who worked clinically at Royal Inland Hospital during the outbreak, will talk about the impact H1N1 had on our health care system and the kinds of things it, and we, can expect in the future. Also, Gian Di Giambattista, one of Ontario Power Generation’s emergency planning chiefs, will give his perspective working at a utility few of us can do without, and, with three nuclear power plants on line, has little inherent tolerance for operational disruptions. All three men expect to give and come away with valuable insight gathered from each other and the attendees. Global Consulting

International News

WHO will take another look at its pandemic alert status

After the onset of the southern hemispheric winter, the World Health Organization’s Emergency Committee will meet to re-assess the status of the H1N1 pandemic. The 15-member panel will then recommend that the UN body maintain its current alert status, stand down to a “post-peak” level or declare the pandemic over. To date, there have been over 18 000 laboratory-confirmed deaths due to H1N1, but it will be a few years before we know the actual death toll. John Mackenzie, the committee chair and the only member known to the public, said that the casualty rate will prove to be high as the 1957 and 1968 outbreaks, which claimed lives by the millions. Identities of committee members are kept secret to insulate them from influence from drug companies or special interest groups. Reuters

EU Members of Parliament are miffed over their handling of H1N1

Over 200 deputies of the of the 736-member European Union’s Parliament have called for an investigation into the EU’s response to the H1N1 outbreak. Isabelle Durant, a Belgian MEP, described the EU’s management of the pandemic as having “seriously undermined the credibility of, and confidence in our institutions.” The proposal sent to the parliament asserts that the amount spent on vaccines was unwarranted, officials should have changed their response tactics early on, and that the EU relies too heavily on the World Health Organization. The Parliament

The next update will be on Thursday, May 13th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of May 2, 2010

International News

H1N1 may have been a milder pandemic than expected, but in populations affected by the disease, the impact has been profound.

In a meeting with the American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention issued a statement saying that the two pandemic waves of H1N1 in America have claimed the lives of 317 patients under the age of 18.  Compared to the last five years, that amounts to over 3.5 times the pediatric mortality rate for seasonal influenza.  The average age for deaths was 9.4 years, older than the previous averages which were a little over 6 years.  Of the deaths, 65% (205) of the patients were in a high risk category for influenza-related complications due to underlying conditions such as obstructive pulmonary disease, neurological disorders, asthma, and heart disease.  In contrast, only 43% of those who died in the previous two seasons had these conditions.  CDC Flu Activity and Surveillance

Routine pediatric vaccination uptake on the decline in the US

A study released by the U.S. Centers for Disease Control and Prevention shows that more American parents are refusing or significantly delaying vaccinations for their children.  Compared with parents who opted for vaccinations, those who declined were less likely to believe that their children were susceptible to vaccine-preventable diseases, that the diseases were a health concern, or that vaccines are safe and effective.  Children who are not immunized by 19 months of age risk being more vulnerable to vaccine-preventable diseases.  CBC News

Vaccine shortages in Australia

Australia’s supply of seasonal influenza vaccine, which includes protection from pandemic H1N1, is running low. In Victoria, Australia’s second most populous state, pharmacies have started waiting lists for people seeking immunizations.  Because of the unexpected demand, CSL, the company that makes most of the country’s vaccines, rushed a second batch to market but warns that there may be more shortages.  The Herald Sun

The next update will be on Tuesday, May 4th, at 0830 hrs PST.

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths*

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

International News

Australia’s Therapeutic Goods Administration has widened its probe into CSL’s seasonal flu vaccine, which includes the pandemic strain, after children receiving the shot had fevers and convulsions.  The agency asked all states and territories to examine all reports of fever in children under 5 for evidence of any pattern.  Also, New Zealand reported today that five children experienced convulsions after flu vaccinations, according to news reports in that country.  Bloomberg

Researchers found that the commonly used CDC case definition may not work for detecting mild pandemic H1N1 flu. They reviewed medical records of 44 patients with lab-confirmed H1N1 who were hospitalized in early summer 2009 and found that many of them had no fever. They found cough to be a more sensitive H1N1 indicator. The authors conclude that “the standard case definition for 2009 H1N1 influenza has low sensitivity for mild influenza infection.”  American Journal of Infection Control