Archive for the ‘United States’ Category
Science News – CDC Anticipates H1N1 Pandemic
The most at-risk segment of the population — pregnant women, those with chronic diseases, healthcare and emergency medical workers, and children — will be the first recipients, the Centers for Disease Control indicated.
Public health experts say people might be asked to stay away from crowded areas for up to four months to keep spread of H1N1 to a minimum. Dr. Bruce Lee, a University of Pittsburgh infectious diseases expert, said such “social distancing” measures can help to lessen the epidemic.
“Pay very close attention to what the CDC and what other public health officials are saying and take it seriously,” he said.
Some federal government estimates indicate up to 40 percent of the population could get swine flu in the next two years.
Federal panel issues H1N1 vaccine guidelines
CNN Senior Medical Producer
ATLANTA, Georgia (CNN) — A federal advisory committee issued sweeping guidelines Wednesday for a vaccination campaign against the pandemic swine flu strain, identifying more than half the U.S. population as targets for the first round of vaccinations.
The advisory panel’s guidelines don’t trigger the start of vaccinations but are usually accepted by the government.
The priority groups include pregnant women; health care and emergency services personnel; children, adolescents and young adults up to age 24; household and caregiver contacts of children younger than six months; and healthy adults with certain medical conditions.
The guidelines were approved in a near-unanimous vote by the 15-member Advisory Committee on Immunization Practices. One person dissented on whether to include people ages 19 to 24 among those targeted.
The vote does not trigger a decision to vaccinate against the disease, also called H1N1, but the federal government typically follows the committee’s recommendations.
The recommendations could prove especially important if the pandemic strain, which emerged this spring, spreads widely before sufficient quantities of vaccine can be produced to protect everyone. The recommendations are intended to ensure that members of the most vulnerable groups get priority.
Earlier Wednesday, federal officials said they are on track to initiate a mass vaccination campaign by October, although many details remain to be worked out. Clinical trials to assess vaccine safety and efficacy are just getting under way at a handful of centers across the country.
Dr. William Schaffner, a flu researcher at Vanderbilt University, which is running one of the clinical trials, played down safety concerns that have been raised because safety data are limited.
“There is no alternative” to approving the new vaccine based on the limited data, he said. Fortunately, he added, “the novel H1N1 vaccine is created exactly the same way our seasonal vaccine is created, year in and year out.”
Dr. Wellington Sun of the Food and Drug Administration said data from those trials would probably be available in September.
However, Dr. Robin Robinson, director of the Biomedical Advanced Research and Development Authority at the Department of Health and Human Services, said that that even if federal regulators determine that the vaccine is safe and effective, it would take an additional four to six weeks before it could be packaged and available to the public.
About half of Americans — 159 million — fall into one of the five main target groups, including 102 million people aged 6 to 18.
Robinson had predicted earlier that 120 million vaccine doses would most likely be available within a month after the campaign starts.
Dr. Anthony Fiore of the Centers for Disease Control and Prevention, who led the group’s deliberations, said it made sense to target such a large group because it appears that vaccine supplies will be sufficient.
Part of that estimate is based on experience with seasonal flu vaccine; Fiore said that, typically, only 20 percent to 50 percent of people in targeted groups seek out seasonal flu vaccine.
Even if two doses of the swine flu vaccine are required to confer protection — something that will be determined in clinical trials — suppliers would probably be able to ramp up production quickly enough to meet demand, Fiore said.
But the advisory committee approved a backup plan in case supplies are more limited. In such a case, the priority groups would be pregnant women, health care and emergency services workers with direct patient contact, household contacts of children younger than 6 months, children age 6 months to 4 years and children younger than 19 with chronic medical conditions — a total of 42 million people.
The panel also recommended that, once sufficient supplies exist to meet the needs of all targeted groups, the vaccine should be offered to healthy adults ages 25 to 64. Once those needs are met, vaccinations would be recommended for people older than 65.
The targeted groups differ starkly from the recommendations for seasonal flu vaccine campaigns, which include people 65 and older in the highest-risk group.
The difference is based largely on data showing vastly higher infection rates among younger people; the rate of laboratory-confirmed cases in Americans 65 and older is just 0.06 per 100,000, compared with 2.6 per 100,000 for the group with the highest infection rates, children 5 to 11.
Studies have found that many older Americans carry at least some antibody protection against the new virus, probably because it is similar to flu viruses that circulated widely in the 1920s through the early 1950s.
Some of the most alarming complications have been seen in pregnant women. A paper published Wednesday in the journal Lancet reported that pregnant women infected with H1N1 are more likely to be hospitalized and even die. Of the 45 H1N1 deaths reported to the CDC between April 15 and June 16, six (13 percent) were among pregnant women.
Obesity has not been determined to be a risk factor, Fiore said.
The H1N1 flu vaccination campaign would run concurrent with the usual seasonal flu campaign, which the committee recommended get under way as soon as possible.
Vanderbilt’s Schaffner said patients should get the seasonal vaccine before distribution centers are swamped with demand for the pandemic vaccine.
But he also warned that the new vaccine might be of limited use. “The virus and the vaccine are in a race; the virus may win,” he said.
If the pandemic strain starts spreading fast between now and October, he said, hospitals and medical personnel will be pushed to the limit.
“It’s like thinking about a hurricane. You batten down the hatches. You do everything you can. But when the hurricane arrives, damage will occur. This one is going to be a doozy.”
New Push in H1N1 Flu Fight Set for Start of School
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July 18, 2009
U.S. health officials are preparing intensively to combat an anticipated wave of outbreaks of the new H1N1 flu when children return to school and the pace of cases picks up.
Zuma PressKenya Bell, left, stands with daughter, Nyeree, who along with several others came down with the flu at an American Lung Association camp in California.
Anne Schuchat, chief of immunization and respiratory diseases at the U.S. Centers for Disease Control and Prevention, said Friday that the agency expects an increase in cases before the normal start of the flu season in mid-autumn, because children are likely to spread it to one another once they go back to school. Infectious diseases normally spread readily among children, and this virus has hit children and young adults harder than the elderly, who normally suffer the heaviest toll from flu.
“We’ve seen it in camps and military units,” Dr. Schuchat said. “I’m expecting when school reopens and kids are all back together, in some communities at least we may see an increase.”
The number of confirmed U.S. infections is now 40,617, with 263 deaths, the CDC said Friday. But the agency believes that more than one million people have been infected and weren’t tested for the virus or didn’t visit a doctor. The disease has become so widespread that the agency will probably suspend tallying individual case counts within the next few weeks and focus instead on tracking clusters, severe cases, deaths and other unusual events — a more traditional approach to tracking diseases, Dr. Schuchat said.
![[flu]](http://s.wsj.net/public/resources/images/OB-EB991_WFLUAc_NS_20090717222557.gif)
The CDC would be following the WHO, which said on Thursday that it is abandoning individual case counts.
Most of those who have the new flu get only mildly ill for a few days and don’t need treatment. But officials are concerned about the virus because it is new and could easily mutate and become more virulent as it spreads through the population. Argentina declared a nationwide animal-health emergency Friday after finding the virus possibly jumped from humans to two pig herds, a development that flu experts say could potentially spur mutations. The country’s death toll from the virus stands at 137.
Global officials are also concerned because the new H1N1 virus has caused severe illness in some children and young people. Some recently published studies suggest it can cause more severe illness than seasonal flu. Deaths from flu are normally rare among children and young adults, who account for the bulk of the U.S. deaths from the pandemic strain. Nor is it clear why the virus is striking pregnant women, as well as people with asthma, diabetes and other conditions hard.
To combat the virus, federal officials are preparing to mount a massive immunization campaign, and are also urging communities, businesses and individuals to make contingency plans for possible school closures, multiple employee absences for illness, surges of patients in hospitals and other effects of potentially widespread outbreaks.
Clinical trials are expected to begin later this month to test whether a vaccine developed to combat the virus is safe and effective, and the CDC is working with state and local public-health authorities to figure out how to get as many as 600 million doses, or two for every U.S. resident, into people’s arms. Results of the trials aren’t expected until early October, but officials say they expect to have the first 100 million doses of vaccine ready by mid-October.
The WHO and some vaccine manufacturers reported this week that the vaccine was proving difficult to manufacture because the viruses used to make the shots are yielding only 25% to 50% of the active ingredient they normally get for flu vaccines.
But Dr. Schuchat said that wasn’t affecting the U.S. government’s plans. “We haven’t heard news that has changed our expectations for vaccine availability in the fall,” she said. “Based on what has been described to us so far, it’s within the range of our planning assumptions, but that doesn’t mean we won’t have more surprises.”
Obese Suffer Most from Swine Flu
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July 11, 2009
The swine flu, like Brett Favre, is a subject that just won’t go away. Despite the fact that we all wish we didn’t have to hear about it, it still makes news. The latest bit is that researchers believe there is a link between the disease and obesity.
While anyone (obese or not) can still get the swine flu, there is some question as to how well a patient can recover from the disease if they are obese.
Apparently “health officials in the U.S. and Europe said, after a report showed a “striking†prevalence of obesity among patients hospitalized in Michigan.†The report indicated that when the obese were hit with swine flu, they became “severely ill†even if they didn’t have any other health problems.
 Image: sxc.hu
Survey: Americans Expect Widespread Swine Flu
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By MIKE STOBBE (AP) – July 16, 2009Â
ATLANTA — A new survey finds about three out of five Americans believe there will be widespread swine flu cases this fall or winter, but most are not worried it will make them sick.
The results of the survey were released Thursday by the Harvard School of Public Health.
About 60 percent of people surveyed say they are not worried they will get sick from swine flu, a finding that echoes what was found in a similar survey in May. The telephone survey of more than 1,800 U.S. adults was done in late June.
Swine flu was identified a few months ago. Doctors are still investigating this flu strain and how it is different from seasonal flu.
Copyright © 2009 The Associated Press
How Fast Could a Swine Flu Vaccine Be Produced?
A doctor at the Centers for Disease Control examines specimens of the 1918 pandemic influenza virus, part of an effort to develop new vaccines and treatments for future pandemic influenza viruses
With the first reported death from the 2009 H1N1 flu, or swine flu, in the U.S., the Federal Government and flu-vaccine manufacturers are preparing for the possibility that a new vaccine will be necessary to control the outbreak. Should the call for vaccine production come from health officials, both traditional and newer, faster vaccine-making methods could be employed.
Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention (CDC), said the agency has begun cultivating the seed stock of virus needed for a swine flu vaccine. (The current seasonal flu vaccine would not be effective against the swine flu.) “We’re moving forward aggressively so that if a decision is made that we need to rev up production to make that vaccine, we would be ready to do so,” he said.
But even if the CDC’s seed stock of virus were to be released to vaccine makers today, it would take the companies anywhere from four to six months before the first inoculation could be ready for public use. That’s because flu-vaccine production — whether for swine or seasonal flu — is time-consuming and laborious, requiring vaccine makers to grow millions of copies of the flu virus in chicken eggs, then purify those bugs into a ready-to-inject formula safe for patients. “We are moving things around to accommodate this and getting our raw materials ready and having our scientists ready. We are on alert, waiting on the CDC. We’re in daily contact with them,” says Donna Cary, spokeswoman for Sanofi Pasteur, which currently makes 50 million doses of the seasonal flu vaccine used in the U.S. each year.
But if and when the CDC gives the go-ahead, companies such as Sanofi will have to do an about-face, scrapping their current vaccine projects to switch to swine flu. Sanofi and other vaccine makers received the seed stock for the upcoming flu season last January and are now in the midst of culturing and purifying that virus for this fall’s flu season.
History teaches us, however, that it won’t be easy. The last time the U.S. recommended nationwide vaccination against a suspected swine flu was in 1976, with less than successful results, to say the least. Under orders from President Gerald Ford, a vaccine was rushed into production and administered to 45 million Americans, at a cost of $135 million. But within weeks, people started developing Guillain-Barré syndrome, a paralyzing immune-system disorder that can result from the vaccine. Some experts estimated the risk of Guillain-Barré as being seven times higher in those who were immunized vs. those who were not. After the immunization program was terminated nine months after it began, government officials paid $90 million in damages to patients who were injured by the vaccine. The widely feared swine flu epidemic never emerged.
Much has changed since then. Genetic advances have given researchers entirely new ways of developing vaccines. For example, instead of using the entire virus or bacterium to activate the human immune system, new strategies rely on genetic snippets from infectious bugs, which can trigger immunity without the risk of infection.
At the biotech company Novavax, researchers are testing the use of virus-like particles (VLP), instead of the virus itself, to stimulate a flu immune response. Using this method, a vaccine for the 2009 H1N1 virus could be in production in 10 to 12 weeks, rather than the usual four to six months. “We have made vaccines against multiple flu strains and tested them in humans and gotten relevant and robust immune responses, which checks off the major boxes that the technology works against flu,” says Rahul Singhvi, president and CEO of Novavax.
Novavax’s strategy involves isolating three proteins from the virus that flag the human immune system, which then churns out neutralizing antibodies against the proteins. These antibodies are robust enough to fight off the actual virus should an immunized person become infected. This is the same way the recently developed vaccine against human papilloma virus, Gardasil, works. “It provides the look and feel of the flu virus but does not have the genetic materials to cause disease,” Singhvi says.
A VLP vaccine may also prove easier to develop since all it requires is an accurate genetic sequence of three critical virus genes. That could especially help with swine flu, since researchers found back in the 1970s that the virus doesn’t grow well in chicken eggs; that could slash the yield and slow production of a potential new vaccine. “As long as we get the genetic sequence of some viral proteins, it doesn’t matter where the virus came from — human, swine or bird,” says Singhvi. So far, Novavax’s shot is still in the testing phase, but its VLP-based vaccines against seasonal and bird flu are providing good results. The company stands ready to try its strategy against swine flu if needed. “The CDC is aware of what we are doing, and we have offered to help both the Department of Health and Human Services and the CDC,” says Singhvi.
Other companies are taking an entirely novel approach and hoping to pick off influenza viruses in the nasal passages before they get deeper into the body and infect other cells. At NanoBio Corporation, a biotech company in Michigan, scientists are perfecting a topical nasal spray that would destroy any single-celled particles, like viruses, bacteria or fungi, on contact, while leaving our multicelled tissues intact. (Blood cells would be fair game for the destructive emulsion, however, so the solution could not be injected into the body.) In animal studies, says Dr. James Baker, the company’s chairman of the board, the spray protected 90% of mice from a lethal dose of influenza. The company is also testing a combination of the traditional flu vaccine with the emulsion, which, says Baker, provides a 50-times-greater immune response than the vaccine alone, even if using only one-sixth the usual vaccine dose. This technique is still too experimental to be helpful against the current swine flu outbreak, however.
So far, 10 states have confirmed cases of swine flu, including a death in Texas, but all 50 have already requested their portion of the Strategic National Stockpile (SNS) of antiviral medications, according to the CDC. (The SNS, maintained jointly by the Department of Homeland Security and the Department of Health and Human Services, is the nation’s emergency medicine chest, containing critical drugs and medical equipment to be used in a public-health emergency.) Although the stockpiled antiviral drugs can treat existing cases of flu, a vaccine is the only way to protect people who are uninfected and halt further spread of the virus.
The CDC, the only agency that possesses the virus needed to make a vaccine, says it is still “looking very intently” at a swine flu vaccine, but it has not yet given the green light to scale up production. In the event that it does, either in response to the current outbreak or down the road when the next pig-to-people flu causes massive illness, they may have better ways than they did in ’76 to battle the bug.
CDC – Weekly Influenza Activity Estimates
Novel H1N1 Flu Situation Update
July 10, 2009, 11:00 AM ET>
Map: Weekly Influenza Activity Estimates Reported by State and Territorial Epidemiologists
(Activity levels indicate geographic spread of both seasonal and novel influenza A [H1N1] viruses)
(Posted July 10, 2009, 4:30 PM ET, for Week Ending July 4, 2009)
For Weekly Influenza Updates for your State
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WHO News – H1N1 Pandemic Update
 
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Transcript of virtual press conference with:
 Dr Keiji Fukuda, Assistant Director-General ad Interim for Health Security and Environment,
World Health Organization
7 July 2009
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Welcome to the WHO virtual press conference for July 7 2009.
 Dr Keiji Fukuda:Â
 Good afternoon everybody. What I would like to do is to start off with the usual situation update and then talk a little bit about surveillance recommendations and also talk a little bit about some of the oseltamavir-resistant viruses that we have seen in the past few weeks.
In terms of the current situation with the influenza H1N1 pandemic, we are now seeing that 137 countries, territories, and areas are reporting laboratory-confirmed cases to WHO. This includes 120 countries in that group. We have also received over 98 000 reports of laboratory-confirmed cases and over 440 deaths among those cases. As we go into this pandemic, it is important to point out that the situation continues to evolve quite rapidly.
We are definitely in a period in which the situation is changing both globally as well as within many different countries.
Now in the next few days, WHO will be issuing some updated surveillance recommendations for countries and I just wanted to talk about these and explain the reason for it. Because the situation is evolving globally, we are now at a place in which changing some of the surveillance approaches probably makes a lot of sense for many countries. For countries which are having cases, we will be recommending that they begin to move away from trying to laboratory test all individual cases and really move towards larger national indicators of disease, for example following influenza-like illnesses, following pneumonia cases and so on. The reason for this is that because the numbers of cases have increased in so many countries, it is very hard to keep up and we now need to move to these kinds of indicators, to keep following along with the trend in the pandemic to see how activity is going, whether it is going up or down. It also will make it easier for countries in many ways because it will ease the burden on the laboratories and make testing much less of a chore than it has been for many of the countries.
Now in countries that do not have cases, however, we will be continuing to recommend that people who are suspected to have pandemic influenza be tested so that the presence of this virus can be confirmed in countries. And in addition, in all countries we will continue to stress that if you have unusual cases, so perhaps unusually severe cases, or perhaps unusual clusters of cases, or perhaps patients who are developing symptoms which have not been reported before, that these kinds of cases continue to be tested, to confirm that it is due to pandemic influenza. And then, that the cases in the clusters be investigated so we understand whether there are changes going on in the epidemiology and in the clinical picture of the illness. We will be putting up the updated guidance within the next few days and hopefully this will help with the monitoring globally for this pandemic.
A second issue that I wanted to talk about is that in the last two weeks or so, we have now heard about three oseltamivir-resistant viruses which have been isolated from persons in Denmark, in Japan and in Hong Kong. The isolation of these cases has raised some questions about what are the implications of this, and right now these examples of oseltamivir-resistance remain sporadic cases – we do not see any evidence of widespread movement of oseltamivir-resistant viruses. And so far, we have not heard of any additional viruses, including among close contacts of these persons.
There are a couple of important points to emphasize about these current oseltamivirresistant viruses. In the first place, it is not unexpected that we will see some viruses that are resistant to this drug. This normally happens when you treat any infection with any drug.
The important point here is that we are continually monitoring the situation to make sure that we are not seeing the start of any large-spread movement of such viruses. Again, I want to emphasize at this point we do not see this: we are just seeing sporadic cases but we will be monitoring the situation very closely. These viruses are also sensitive to the other neuraminidase inhibitor drug called zanamavir and then, these resistant viruses are also due to mutations – they do not represent any kind of mixture with the current seasonal influenza viruses so right now it looks like that these are spontaneous mutations in these patients.
Probably the single most important point about the oseltamivir-resistant cases is that, at this point, we are not recommending any clinical changes to the approach of treating patients and that is the most important point for physicians and countries to know.
The last thing I will mention is that – many of you know – that we are in the middle of an important meeting called SAGE, which is going on in Geneva. I left this meeting today – it continues on – and we will be discussing this meeting more in depth over the next few days, but will not be going into it in any detail today. So, with that, let me turn it over for any questions.
Martin Ensureck: I have a question about the naming of the virus. I read yesterday in a posting on ProMed that the World Health Organization, along with FAO and OIE, have chosen, once again, a new name and I wonder if you can explain to me when that decision was taken, by whom and why exactly this name, because already I have talked to some people who say it is not exactly a catchy name, it won’t catch on the way that you would hope if you want to end the confusion about what the pandemic and the virus should be called?
Dr Fukuda: As you know, since the emergence of the pandemic, the name of the virus has been a difficult issue for many reasons. In the past, we have seen how the naming of viruses by location can stigmatize those locations and we have also seen in this and in other episodes where associating the virus with one animal species or another, can really cause both anxiety and then fears about food and in this particular instance, about pork.
So, in recognition of those issues, what WHO, FAO and OIE did, actually some weeks ago, was to get together several of the experts who work in these organizations and with many of the laboratory experts who work with these organizations, and then we had a meeting – a virtual meeting – in which these issues were discussed and one of the things that we wanted to do was make sure that any naming of the virus was scientifically accurate but also would avoid any kind of adverse reactions to the name or to minimize those as much as possible.
Based on those discussions, what the experts decided – calling this a pandemic H1N1/09 virus – was a good way to distinguish it from the current seasonal H1N1 viruses and to do so, in a way which was scientifically sound, but also would avoid some of the stigma associated with other options.
Rebecca Smith, The Daily Telegraph: In the UK we have already moved from containment to mitigation and have stopped laboratory testing of all cases and moved to clinical diagnosis, but when that happened last week, we had some projections from officials and ministers that we could be seeing 100 000 cases per day in the UK by as early as next month. Now that is based on current trends of a doubling of the number of cases every week, but that would suggest that the pandemic would be over and done with probably by Christmas. Can you explain a little bit about how the pattern of disease is expected to continue once you move from containment to mitigation.
Dr Fukuda: Probably the most important concept to understand here is that depending  where you are in the world – for example in the Southern Hemisphere where they are in the winter months and entering into their regular influenza season – they may see a pattern which is different from what is being seen in the Northern Hemisphere in countries like the UK, North America and so on. Now in the UK, as in many of the North American countries – Canada, Mexico and the United States – there has been quite widespread activity, or a lot of activity of this pandemic influenza virus, and right now it is at a typical point of the year where the activity should be pretty low, but the activity is quite high because it is a pandemic situation for these countries, and I think that it is likely that infections will continue in these countries.
However, I think it is a little bit hard to predict what the pattern will be for the remainder of the summer. It is possible that the UK and other countries in the Northern Hemisphere could continue to see fairly high levels of activity, but it is also quite possible that the levels of activity could go down because it is in the summer months. And then, again, it is a guess about what will happen in the fall and winter time, although it is more likely that activity will again pick up in the fall and winter time in the Northern Hemisphere countries. The same general perspective holds for the Southern Hemisphere countries where we can expect to see increased activity during the winter months but they may also see unusually high activity in the summer months. We are not positive about how any of this will develop over the next several months and so this is why keeping up with the surveillance is so important so we can monitor it closely.
Maria Cheng Associated Press: I have a couple of questions about the Tamiflu-[oseltamivir]-resistant viruses that have been picked up. I wondered if you might be any more concerned about the case that was detected in Hong Kong since that was apparently in a patient who had not been treated with oseltamivir, suggesting that maybe that the virus once it developed resistance might be … to spread and if you have any particular concerns about the potential reassorting with seasonal H1N1 which has shown a Tamiflu- [oseltamivir]-resistance.
Dr Fukuda: I think for that it is hard to know whether the virus isolated from the person in Hong Kong has any more implications than the viruses isolated from the two other people who were taking prophylactic doses of oseltamivir. If we look at the virus which was isolated from the person in Hong Kong, it has the same mutation as the resistant viruses isolated from the person in Japan and in Denmark. Again, it is not clear whether that mutation occurred spontaneously in the person who is infected in Hong Kong or whether they got that virus from somebody else who may have been taking oseltamivir. At this point, there is a great deal of attention to looking at the viruses coming out of the west coast area in which the person from Hong Kong was residing, but so far there are no other detections of resistant viruses in that area and in all three of the countries so far we have no evidence at all of any other resistant viruses. I think at this point it is not clear whether there is any differences in the implications of these three viruses.
In terms of the question about reassortment, I think that reassortment among influenza viruses is always a possibility and therefore always of concern. Again, I think that the bottom line here is that the major thing that we can do is to continue to monitor these viruses, continue to characterize them, look at their genetic composition and see if there is any evidence of reassortment with any of the other viruses, but again, so far, we do not see any such evidence.
Marion Falco, CNN Atlanta: My question may be a little basic but if you are not, and so  forgive me for that, if you are not requiring testing in the countries that already have well established numbers of cases, then how are you distinguishing between seasonal flu and this particular flu. I mean how are you going to separate the numbers?
Dr Fukuda: It is not that we are recommending not doing any testing at all. In fact when the guidance comes out, what it will suggest is what countries are to do is tailor down their testing so that they are not trying to test everybody but certainly keeping up testing of some people for exactly the kinds of reasons that you bring up. When people get sick with an influenza-like illness it will be important for us to know whether is it caused by the pandemic virus or whether is caused by seasonal viruses. What we are indicating is that if you ratchet down the level of testing we will still be able to figure that out and so we do not need to test everybody for that, but we will continue to recommend some level of testing – at a lower level of people who continue to get sick.
Mika Ruitch, CDF: I have a question about the vaccine, you have not really mentioned anything. I understand that the meeting in Geneva is still going on about that but we have gone a really huge discussion here in Germany about it and I was wondering whether there is anything you can recommend to countries, whether to order or not already the vaccines.
Dr Fukuda: This is the SAGE meeting which is going on today and again, the meeting is actually still going on, so I think it is premature to make any reports on that meeting because it has not concluded . The meeting itself will end in recommendations which will go to the Director-General of WHO to look at, so if you can wait for a few days then we will be hearing more about the outcomes and recommendations of that meeting.
Tom Mo, Los Angeles Times: Can you give us a thumbnail description of what is going on in the Southern Hemisphere now?
Dr Fukuda: In the Southern Hemisphere we have seen activity occurring in a number of countries and similar to what we saw in the Northern Hemisphere, it varies a little bit from country to country. For example, a few weeks ago, Australia was reporting pandemic activity occurring quite heavily in some parts of Australia – in the Victoria area – whereas it was at lower levels in other parts of Australia for a while, then began picking up. In South America, there are viruses which have been isolated from most of the countries there, however much of the heaviest activity has occurred in Chile first and then more recently in Argentina. Again we are seeing a kind of mixed picture of activity in the Southern Hemisphere.
In Africa, if we go back a few weeks ago we would have said that there had been no viruses isolated from that continent but as of today 12 countries in the intervening period have reported detecting the virus. So, it is clearly spreading pretty quickly through the Southern Hemisphere; depending on the country you are seeing relatively lower levels of activity and then relatively higher levels of activity in some countries. Overall, I would still point out that for the Southern Hemisphere it is pretty early in their season so we still have a number of weeks to go through for that part of the world.
Tala Dolachi, Talk Radio Network News: You mentioned earlier that WHO is concerned about the surveillance systems and in particular looking at those national indicators. Of all the countries affected, are there any particular countries that WHO is focusing on now in terms of their inability to keep up to par with the national indicators?
Dr Fukuda: No, there is no particular country that we are looking at, and what we do focus on however is that if there are countries that are requesting help from WHO or from other Member States in terms of assistance to strengthen their surveillance, then we certainly give as much attention to those countries as possible. This has really paid off.
If we go back to the couple of years period before this pandemic occurred, for example there is a lot of discussions with the number of states in Africa and there has been actually a great deal of preparedness work which has gone on in that continent, and I can say that the number of laboratories which have the capacity to test for these viruses has really increased significantly in Africa. As of today, we have two new National Influenza Centres in Africa – one in Cameroon and one in Côte d’Ivoire – and so, although surveillance is definitely not optimal everywhere in the world, I would say that surveillance is definitely much better than it was three or four years ago. We will continue to try to build that capacity everywhere in the world where the countries are requesting help.
Aileen Gobay, CBC Montreal: I am sorry – the line was very bad and when you talked about the new name of the virus I did not catch it so can you repeat this information for me please?
Dr Fukuda: We are calling it the pandemic H1N1/09 virus. This refers to the fact that it is a pandemic influenza virus. If you look at the scientific subtype, it is an H1N1 virus, and the 09 refers to the current time period. Hopefully this will help to distinguish this virus from the seasonal H1N1 viruses.
Gabriella Sotomayor, Mexican Press Agency: How severe are the cases who receive the Tamiflu [oseltamavir]? And of all the cases in Argentina, in general terms, are those cases more severe like in the beginning in Mexico or is it moderate?
Dr Fukuda: I believe all three people have now recovered completely: They have uncomplicated illness. In terms of your second question, it is a little bit difficult for me to answer that so precisely. We know that in Argentina, for example, that most of the cases, as everywhere, have been uncomplicated influenza cases that is to say have not required special medical attention, or special medical care. However it is also true that in the last few weeks, there have been a number of serious cases hospitalizations and some deaths reported. I am sorry but I do not have exact numbers on my fingertips right now. It is a mixed picture similar to many other countries, I cannot tell you whether it is specifically like Mexico was at the beginning of the pandemic.
John Zeracostas: I wonder if you could give us a little bit of a bird’s eye view on the three-day modelling experts meeting here in Geneva on how they project the spread of this pandemic in the short and medium term?
Dr Fukuda: The purpose of that meeting which was held last week, was to further building up a WHO network in which modellers from around the world could work together on some of these pandemic problems, and other infectious disease problems. The meeting brought together over 20 different experts from most of the continents around the world, and what they discussed was some of the preliminary findings of some of the projects that they have been working on, some better ways in which modelling groups around the world could work together – could operationally be linked more closely together – and those were the primary areas of focus of that meeting. I’m sorry I cannot report on any specific project from that meeting, I was not there in attendance.
Lisa S________, The Telegraph News: I wanted to get back to you about the Southern Hemisphere situation, thanks for the snapshot on that. I wanted to see if you also are able to tell how the seasonal flu is doing there, how the pandemic flu is competing against it, what trends you are seeing, if you are able to tell at this point in the flu season, I know you said it was early, but just wondering what you are seeing so far?
Dr Fukuda: The countries are seeing a mixed picture depending on the country. For example, in Chile, it was just reported that over 99% of their influenza viruses are the new pandemic H1N1 virus. By contrast, in Australia, they see more of a mixed picture, where they are seeing both the pandemic H1N1 virus but they are also seeing a seasonal H3N2 virus that circulates there. Then, if we go down to South Africa, right now the seasonal influenza viruses are much more predominant than the pandemic influenza viruses. In the Southern Hemisphere, it is fair to say that there is a mixed picture. In another month or so, we will have again a much clearer picture about how the pandemic virus is spreading in the Southern Hemisphere and whether it is beginning to crowd out the seasonal influenza viruses in many countries or in just some countries.
In terms of the current situation with the influenza H1N1 pandemic, we are now seeing that 137 countries, territories, and areas are reporting laboratory-confirmed cases to WHO. This includes 120 countries in that group. We have also received over 98 000 reports of laboratory-confirmed cases and over 440 deaths among those cases. As we go into this pandemic, it is important to point out that the situation continues to evolve quite rapidly.
We are definitely in a period in which the situation is changing both globally as well as within many different countries.
Now in the next few days, WHO will be issuing some updated surveillance recommendations for countries and I just wanted to talk about these and explain the reason for it. Because the situation is evolving globally, we are now at a place in which changing some of the surveillance approaches probably makes a lot of sense for many countries. For countries which are having cases, we will be recommending that they begin to move away from trying to laboratory test all individual cases and really move towards larger national indicators of disease, for example following influenza-like illnesses, following pneumonia cases and so on. The reason for this is that because the numbers of cases have increased in so many countries, it is very hard to keep up and we now need to move to these kinds of indicators, to keep following along with the trend in the pandemic to see how activity is going, whether it is going up or down. It also will make it easier for countries in many ways because it will ease the burden on the laboratories and make testing much less of a chore than it has been for many of the countries.
Now in countries that do not have cases, however, we will be continuing to recommend that people who are suspected to have pandemic influenza be tested so that the presence of this virus can be confirmed in countries. And in addition, in all countries we will continue to stress that if you have unusual cases, so perhaps unusually severe cases, or perhaps unusual clusters of cases, or perhaps patients who are developing symptoms which have not been reported before, that these kinds of cases continue to be tested, to confirm that it is due to pandemic influenza. And then, that the cases in the clusters be investigated so we understand whether there are changes going on in the epidemiology and in the clinical picture of the illness. We will be putting up the updated guidance within the next few days and hopefully this will help with the monitoring globally for this pandemic.
A second issue that I wanted to talk about is that in the last two weeks or so, we have now heard about three oseltamivir-resistant viruses which have been isolated from persons in Denmark, in Japan and in Hong Kong. The isolation of these cases has raised some questions about what are the implications of this, and right now these examples of oseltamivir-resistance remain sporadic cases – we do not see any evidence of widespread movement of oseltamivir-resistant viruses. And so far, we have not heard of any additional viruses, including among close contacts of these persons.
There are a couple of important points to emphasize about these current oseltamivirresistant viruses. In the first place, it is not unexpected that we will see some viruses that are resistant to this drug. This normally happens when you treat any infection with any drug.
The important point here is that we are continually monitoring the situation to make sure that we are not seeing the start of any large-spread movement of such viruses. Again, I want to emphasize at this point we do not see this: we are just seeing sporadic cases but we willbe monitoring the situation very closely. These viruses are also sensitive to the other neuraminidase inhibitor drug called zanamavir and then, these resistant viruses are also due to mutations – they do not represent any kind of mixture with the current seasonal influenza viruses so right now it looks like that these are spontaneous mutations in these patients.
Probably the single most important point about the oseltamivir-resistant cases is that, at this point, we are not recommending any clinical changes to the approach of treating patients and that is the most important point for physicians and countries to know.
The last thing I will mention is that – many of you know – that we are in the middle of an important meeting called SAGE, which is going on in Geneva. I left this meeting today – it continues on – and we will be discussing this meeting more in depth over the next few days, but will not be going into it in any detail today. So, with that, let me turn it over for any questions.
Good afternoon everybody. What I would like to do is to start off with Martin Ensureck:
posting on ProMed that the World Health Organization, along with FAO and OIE, have chosen, once again, a new name and I wonder if you can explain to me when that decision was taken, by whom and why exactly this name, because already I have talked to some people who say it is not exactly a catchy name, it won’t catch on the way that you would hope if you want to end the confusion about what the pandemic and the virus should be called?
I have a question about the naming of the virus. I read yesterday in a Dr Fukuda:
been a difficult issue for many reasons. In the past, we have seen how the naming of viruses by location can stigmatize those locations and we have also seen in this and in other episodes where associating the virus with one animal species or another, can really cause both anxiety and then fears about food and in this particular instance, about pork.
So, in recognition of those issues, what WHO, FAO and OIE did, actually some weeks ago, was to get together several of the experts who work in these organizations and with many of the laboratory experts who work with these organizations, and then we had a meeting – a virtual meeting – in which these issues were discussed and one of the things that we wanted to do was make sure that any naming of the virus was scientifically accurate but also would avoid any kind of adverse reactions to the name or to minimize those as much as possible.
Based on those discussions, what the experts decided – calling this a pandemic H1N1/09 virus – was a good way to distinguish it from the current seasonal H1N1 viruses and to do so, in a way which was scientifically sound, but also would avoid some of the stigma associated with other options.
As you know, since the emergence of the pandemic, the name of the virus has Rebecca Smith, containment to mitigation and have stopped laboratory testing of all cases and moved to clinical diagnosis, but when that happened last week, we had some projections from officials and ministers that we could be seeing 100 000 cases per day in the UK by as early as next month. Now that is based on current trends of a doubling of the number of cases every week, but that would suggest that the pandemic would be over and done with probably by Christmas. Can you explain a little bit about how the pattern of disease is expected to continue once you move from containment to mitigation.
The Daily Telegraph: In the UK we have already moved from Dr Fukuda where you are in the world – for example in the Southern Hemisphere where they are in the winter months and entering into their regular influenza season – they may see a pattern which is different from what is being seen in the Northern Hemisphere in countries like the UK, North America and so on. Now in the UK, as in many of the North American countries – Canada, Mexico and the United States – there has been quite widespread activity, or a lot of activity of this pandemic influenza virus, and right now it is at a typical point of the year where the activity should be pretty low, but the activity is quite high because it is a pandemic situation for these countries, and I think that it is likely that infections will continue in these countries.
However, I think it is a little bit hard to predict what the pattern will be for the remainder of the summer. It is possible that the UK and other countries in the Northern Hemisphere could continue to see fairly high levels of activity, but it is also quite possible that the levels of activity could go down because it is in the summer months. And then, again, it is a guess about what will happen in the fall and winter time, although it is more likely that activity will again pick up in the fall and winter time in the Northern Hemisphere countries. The same general perspective holds for the Southern Hemisphere countries where we can expect to see increased activity during the winter months but they may also see unusually high activity in the summer months. We are not positive about how any of this will develop over the next several months and so this is why keeping up with the surveillance is so important so we can monitor it closely.
 : Probably the most important concept to understand here is that depending Maria Cheng Associated Press [oseltamivir]-resistant viruses that have been picked up. I wondered if you might be any more concerned about the case that was detected in Hong Kong since that was apparently in a patient who had not been treated with oseltamivir, suggesting that maybe that the virus once it developed resistance might be … to spread and if you have any particular concerns about the potential reassorting with seasonal H1N1 which has shown a Tamiflu-[oseltamivir]-resistance.: I have a couple of questions about the Tamiflu-Dr Fukuda Hong Kong has any more implications than the viruses isolated from the two other people who were taking prophylactic doses of oseltamivir. If we look at the virus which was isolated from the person in Hong Kong, it has the same mutation as the resistant viruses isolated from the person in Japan and in Denmark. Again, it is not clear whether that  mutation occurred spontaneously in the person who is infected in Hong Kong or whether they got that virus from somebody else who may have been taking oseltamivir. At this point, there is a great deal of attention to looking at the viruses coming out of the west coast area on which the person from Hong Kong was residing, but so far there are no other detections of resistant viruses in that area and in all three of the countries so far we have no evidence at all of any other resistant viruses. I think at this point it is not clear whether there is any differences in the implications of these three viruses.
In terms of the question about reassortment, I think that reassortment among influenza viruses is always a possibility and therefore always of concern. Again, I think that the bottom line here is that the major thing that we can do is to continue to monitor these viruses, continue to characterize them, look at their genetic composition and see if there is any evidence of reassortment with any of the other viruses, but again, so far, we do not see any such evidence.
: I think for that it is hard to know whether the virus isolated from the person in Marion Falco, CNN Atlanta forgive me for that, if you are not requiring testing in the countries that already have well established numbers of cases, then how are you distinguishing between seasonal flu and this particular flu. I mean how are you going to separate the numbers?
: My question may be a little basic but if you are not, and so Dr Fukuda
the guidance comes out, what it will suggest is what countries are to do is tailor down their testing so that they are not trying to test everybody but certainly keeping up testing of some people for exactly the kinds of reasons that you bring up. When people get sick with an influenza-like illness it will be important for us to know whether is it caused by the pandemic virus or whether is caused by seasonal viruses. What we are indicating is that if you ratchet down the level of testing we will still be able to figure that out and so we do not need to test everybody for that, but we will continue to recommend some level of testing – at a lower level of people who continue to get sick.
 : It is not that we are recommending not doing any testing at all. In fact when Mika Ruitch, CDF anything. I understand that the meeting in Geneva is still going on about that but we have gone a really huge discussion here in Germany about it and I was wondering whether there is anything you can recommend to countries, whether to order or not already the vaccines.: I have a question about the vaccine, you have not really mentioned Dr Fukuda actually still going on, so I think it is premature to make any reports on that meeting because it has not concluded . The meeting itself will end in recommendations which will go to the Director-General of WHO to look at, so if you can wait for a few days then we will be hearing more about the outcomes and recommendations of that meeting.: This is the SAGE meeting which is going on today and again, the meeting is Tom Mo, in the Southern Hemisphere now? Los Angeles Times: Can you give us a thumbnail description of what is going on Dr Fukuda countries and similar to what we saw in the Northern Hemisphere, it varies a little bit from country to country. For example, a few weeks ago, Australia was reporting pandemic activity occurring quite heavily in some parts of Australia – in the Victoria area – whereas it was at lower levels in other parts of Australia for a while, then began picking up. In South America, there are viruses which have been isolated from most of the countries there, however much of the heaviest activity has occurred in Chile first and then more recently in Argentina. Again we are seeing a kind of mixed picture of activity in the Southern Hemisphere.
In Africa, if we go back a few weeks ago we would have said that there had been no viruses isolated from that continent but as of today 12 countries in the intervening period have reported detecting the virus. So, it is clearly spreading pretty quickly through the Southern Hemisphere; depending on the country you are seeing relatively lower levels of activity and then relatively higher levels of activity in some countries. Overall, I would still point out that for the Southern Hemisphere it is pretty early in their season so we still have a number of weeks to go through for that part of the world.
 : In the Southern Hemisphere we have seen activity occurring in a number of Tala Dolachi,about the surveillance systems and in particular looking at those national indicators. Of all the countries affected, are there any particular countries that WHO is focusing on now in  terms of their inability to keep up to par with the national indicators?Talk Radio Network News: You mentioned earlier that WHO is concerned Dr Fukuda on however is that if there are countries that are requesting help from WHO or from other Member States in terms of assistance to strengthen their surveillance, then we certainly giveas much attention to those countries as possible. This has really paid off.
 If we go back to the couple of years period before this pandemic occurred, for example there is a lot of discussions with the number of states in Africa and there has been actually a great deal of preparedness work which has gone on in that continent, and I can say that the number of laboratories which have the capacity to test for these viruses has really eased ignificantly in Africa. As of today, we have two new National Influenza Centres in Africa – one in Cameroon and one in Côte d’Ivoire – and so, although surveillance is definitely not optimal everywhere in the world, I would say that surveillance is definitely much better than it was three or four years ago. We will continue to try to build that capacity everywhere in the world where the countries are requesting help.
 : No, there is no particular country that we are looking at, and what we do focus
 Aileen Gobay, CBC Montreal:
about the new name of the virus I did not catch it so can you repeat this information for me please?
I am sorry – the line was very bad and when you talked
 Dr Fukuda
a pandemic influenza virus. If you look at the scientific subtype, it is an H1N1 virus, andthe 09 refers to the current time period. Hopefully this will help to distinguish this virus from the seasonal H1N1 viruses.
 We are calling it the pandemic H1N1/09 virus. This refers to the fact that it is Gabriella Sotomayor, Mexican Press Agency:
Tamiflu [oseltamavir]? And of all the cases in Argentina, in general terms, are those cases more severe like in the beginning in Mexico or is it moderate?
How severe are the cases who receive theÂ
Dr Fukuda:
uncomplicated illness. In terms of your second question, it is a little bit difficult for me to answer that so precisely. We know that in Argentina, for example, that most of the cases, as everywhere, have been uncomplicated influenza cases that is to say have not required special medical attention, or special medical care. However it is also true that in the last few weeks, there have been a number of serious cases hospitalizations and some deaths reported.
I am sorry but I do not have exact numbers on my fingertips right now. It is a mixed picture similar to many other countries, I cannot tell you whether it is specifically like Mexico was at the beginning of the pandemic.
I believe all three people have now recovered completely:
