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Archive for the ‘Medical Education’ Category

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

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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

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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

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Pneumonia is worse when mixed with H1N1

Researchers at the University of Chicago have discovered that the pandemic H1N1 flu virus has the intrinsic ability to cause more severe pneumonia than seasonal H1N1 flu. This ability is a measure of a flu virus’s pandemic potential. They found pandemic H1N1 caused a pneumonia in certain patients that was intermediate in severity between seasonal H1N1 and the highly pathogenic H5N1. University of Chicago Journal of Infectious Diseases

H1N1 Evolution

Scientists at the University of Hong Kong have isolated the first reported genetic reassortment of the H1N1 virus. The reassortment is a hybrid of the original swine flu and the human pandemic H1N1 virus. Reassortments occur when a single host is infected by more than one strain of virus, and the mixed virus particles assemble themselves into something new. The Chinese Department of Agriculture released a statement saying that the new virus does not pose a public health risk or food-safety issue. University of Minnesota CIDRAP

H1N1 Adds Risk to Pregnancy

An Australian study has found that pregnant women can be particularly vulnerable to H1N1 especially if the mothers are asthmatic, diabetic, or obese. However, effects of H1N1 on the fetus are less well understood. Doctors recommend flu shots for pregnant women, but many women are reluctant to receive immunizations or take drugs during pregnancy. The researchers note there is evidence that doctors’ lack of awareness may be “a major contributor, with good acceptance by mothers when the risks and benefits are explained.” Reuters

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