On H1N1, Who Should Get It?
As swine flu cases topped 6,600 worldwide, vaccine makers and other experts met Thursday at the World Health Organization in Geneva to discuss the tough decisions that must be made quickly to fight the evolving virus.
Pharmaceutical companies are ready to begin making a swine flu vaccine - but as the virus constantly mutates, questions abound: How much should be produced? How will it be distributed? Who should get it?
The expert group's recommendations will be passed to WHO Director-General Margaret Chan, who is expected to issue advice to vaccine manufacturers and the World Health Assembly next week.
But some feel the main decision has already been made.
"It's a foregone conclusion," said David Fedson, a vaccines expert and former professor of medicine at the University of Virginia. "If we don't invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing."
Most flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake.
Vaccine makers can make limited amounts of both seasonal flu vaccine and pandemic vaccine - though not at the same time - but they cannot make massive quantities of both because that exceeds manufacturing capacity.
Seasonal flu kills up to 500,000 people a year. At the moment, health officials aren't sure how deadly swine flu is, and whether they will need more seasonal flu vaccine or swine flu vaccine. And if the swine flu mutates, scientists aren't sure how effective a vaccine made now from the current strain will remain.
WHO estimates that up to 2 billion doses of swine flu vaccine could be produced every year, though the first batches wouldn't be available for four to six months.
The U.S. Centers for Disease Control and Prevention is currently working on a "seed stock" to make the vaccine, which should be ready in the next couple of weeks. That will be distributed to manufacturers worldwide so they can start producing the vaccine.
Until vaccine manufacturers get the seed stock, they won't know how many doses of vaccine they can make or how long that would take. Sanofi Pasteur, the world's biggest vaccine producer, said Thursday it is waiting for the green light from WHO before it starts making swine flu vaccine.
WHO is also negotiating with vaccine producers like GlaxoSmithKline PLC to save some of their swine flu vaccine for poorer nations. Many rich nations like Britain, Canada, Denmark, France, Switzerland and the United States signed deals with vaccine makers years ago to guarantee them pandemic vaccines as soon as they're available.
As of Thursday, at least 33 countries reported more than 6,600 cases of swine flu worldwide, with 69 deaths. According to WHO's pandemic alert level, the world is at phase 5 - out of a possible 6 - meaning that a global outbreak is "imminent."
"It's a no-brainer," Fedson said of the decision to make swine flu vaccine. "All that's being discussed now is the details of how to make sure you have enough seasonal flu vaccine and the logistics of making the switch to H1N1 vaccine production."
North America has been the hardest-hit continent. The United States has reported 3,352 laboratory-confirmed cases of swine flu, including three deaths. Mexico has 2,656 cases and 64 deaths, while Canada has 389 cases with one death, according to WHO figures.
Mexico confirmed 374 more cases Thursday including four more deaths, but Health Secretary Jose Angel Cordova said the new cases show the virus is appearing less deadly. Mexico's swine flu deaths now represent 2.4 percent of its confirmed cases, he said.
Spain and Britain have the most cases in Europe, at 100 and 78 respectively.
In Central America, Costa Rica has eight cases and one death and Panama has 29 cases
Posted in: Health Topic| Tags: H1N1 Swine Flu Flu H1N1 Flu HealthWarning! H1N1 Could Infect 2 Billion
Up to 2 billion people could be infected by swine flu if the current outbreak turns into a pandemic lasting two years, the World Health Organization said Thursday.
WHO flu chief Keiji Fukuda said the historical record of flu pandemics indicates one-third of the world's population gets infected in such outbreaks. Independent experts agreed that the estimate was possible but pointed out that many would not show any symptoms.
In Mexico, the hardest hit country so far, high schools and universities opened for the first time in two weeks as the government's top health official insisted the epidemic is on the decline. All students were checked for swine flu symptoms and some were sent home.
"If we do move into a pandemic, then our expectation is that we will see a large number of people infected worldwide," Fukuda said. "If you look at past pandemics, it would be a reasonable estimate to say perhaps a third of the world's population would get infected with this virus."
With the current total population of more than 6 billion, that would mean an infection total of 2 billion, he said, but added that the world has changed since pandemics of earlier generations, and experts are unable to predict if the impact will be greater or smaller.
"We don't really know." said Fukuda. "This is a benchmark from the past. Please do not interpret this as a prediction for the future."
Chris Smith, at flu virologist at Cambridge University in England, said the 2 billion estimate was possible.
"That doesn't sound too outlandish to me for the simple reason that this is a very infectious virus," Smith told The Associated Press.
"You're talking about a virus that no one in the population has seen before and therefore everyone is immunologically vulnerable. Therefore it's highly likely that once it starts to spread, people will catch it. And since the majority of the world's population are in contact with one another, you're going to get quite a lot of spread."
John Oxford, professor of virology at St. Bart's and Royal London Hospital, agreed.
"I don't think the 2 billion figure should scare people because it's not as though 2 billion people are going to die. The prediction from WHO is that 2 billion people might catch it. Half of those people won't show any symptoms. Or if they show any symptoms, they will be so mild they will hardly know they've had it."
Fukuda said it also is impossible to say if the current strain of swine flu will become severe or mild, but that even with a mild flu, "from the global perspective there are still very large numbers of people who could develop pneumonia, require respirators, who could die."
A mild outbreak in wealthier countries can be "quite severe in its impact in the developing world," Fukuda said.
People react differently to the flu depending on their general state of health and other factors, he said. Some younger people in the Southern Hemisphere may be more vulnerable because of poor diet, war, HIV infections and other factors.
"We expect this kind of event to unfold over weeks and months," Fukuda said. "Really if you look over a two-year period that is really the period in which you see an increase in the number of illnesses and deaths during a pandemic influenza."
So far the swine flu virus has spread to 26 countries. Brazil and Argentina on Thursday became the second and third countries in South America to announce confirmed cases.
Mexican dance halls, movie theaters and bars were allowed to fully reopen Thursday after a five-day shutdown designed to curb the virus' spread. Businesses must screen for any sick customers, and restaurant employees must wear surgical masks.
Fans can attend professional soccer matches this weekend after all were played in empty stadiums last weekend.
Mexico confirmed two more deaths, for a total of 44, while 1,160 people have been sickened, up 90 from Wednesday. Despite death tolls and confirmed caseloads that rise daily, Health Secretary Jose Angel Cordova insisted the epidemic is waning in Mexico.
WHO raised its global total of laboratory-confirmed cases to 2,099, from 1,893 late Wednesday, and said swine flu also has caused two deaths in the United States.
This swine flu seems to have a long incubation period — five to seven days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. That means the virus can keep being spread by people who won't know to stay home.
Laughing and joking, high school students gathered at the entrance of the National School of Graphic Arts in Mexico City, waiting to fill out forms that asked about their health.
Of 280 students entering the school in the first 20 minutes, two showed symptoms of swine flu, including coughing and nasal congestion, said assistant principal Ana Maria Calvo Vega. Their parents were notified and they won't be readmitted without a statement from a doctor saying they don't have the virus, she said.
Students at a Mexico City vocational high school were welcomed with a hand sanitizer and a surgical mask. Joyful to see each other again, students embraced and kissed — some through masks.
But some worried that the virus could surge back once young people gather in groups again.
"My 17-year-old daughter is afraid. She knows she must go back but doesn't want to," said Silvia Mendez as she walked with her 4-year-old son, Enrique, in San Miguel Topilejo, a town perched in forested mountains near the capital.
Working parents have struggled to provide child care during the shutdown. It forced many to stay home from work, bring their youngsters to their jobs, or leave them at home.
Each school, Mexican officials said, had to be cleaned and inspected this week. Complicating the task: Many schools are primitive buildings with dirt floors and lack proper bathrooms. It was unclear how students attending those schools could adhere to the government's strict sanitary conditions.
The government promised detergent, chlorine, trash bags, anti-bacterial soap or antiseptic gel and face masks to state governments for delivery to public schools. But some local districts apparently didn't get the word.
U.S. health officials are no longer recommending that schools close because of suspected swine flu cases since the virus has turned out to be milder than initially feared. But many U.S. schools have done so anyway, including the school of a Texas teacher who died.
In Asia, top health officials said the region must remain vigilant over the threat of swine flu, stepping up cooperation to produce vaccines and bolstering meager anti-viral stockpiles.
The virus has so far largely spared Asia. Only South Korea and Hong Kong have confirmed cases. On Thursday, China and Hong Kong released dozens of people quarantined over suspected contact with one of the region's few swine flu carriers.
Experience has been the spur to WHO to make sure the world is as prepared as possible for a pandemic, which would be indicated by a rise to phase 6 from the current phase 5 in the agency's alert scale. That would mean general spread of the disease in another region beyond North America, where the outbreak so far has been heaviest.
"I'm not quite sure we know if we're going to phase six or not or when we would do so," Fukuda said. "It's really impossible for anybody to predict right now."
Officials said the agency was likely to shorten its annual meeting of its 193 member states later this month from 10 days to five because of the outbreak, which it was scheduled to discuss.
"That is under consideration," Fukuda said. "Sure it is possible."
Posted in: Flu-Topic| Tags: Swine Flu Health Dog H1N1 Flu H1N1A New Influenza Virus: H1N1 Flu
Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April, 2009. The virus is infecting people and is spreading from person-to-person, sparking a growing outbreak of illness in the United States. An increasing number of cases are being reported internationally as well.
It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus.
It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses. Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks.
Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. The fact that novel H1N1 activity is now detected through seasonal surveillance systems is an indication that there are higher levels of influenza-like illness in the United States than is normal for this time of year. About half of all influenza viruses being detected are novel H1N1 viruses.
Posted in: Flu-Topic| Tags: Flu Swine Flu H1N1 H1N1 Flu