Influenza Virus Mashup

(Sat, 31 Oct 2009 12:20:00 +0000)

# 3918

As the United States struggles with its slower than anticipated roll out of the pandemic vaccine, so do officials in Canada, where news of additional delays became public yesterday.

Crof at Crofsblog has done a terrific job following this story over the past couple of days, with entries such as Must-read of the day  and Canada: BC downplaying H1N1 vaccine shortage.

As I pointed out in Murphy’s Laws And Vaccine Production last July, and in A Vaccine Reality Check back in May, there are a lot of things that can go wrong during vaccine manufacturing.

 

 

From Healthzone.ca  we get details on the announced shortfall of vaccine in Canada due to production problems at the GSK plant in Ste-Foy, Quebec.

Vaccine glitch delays H1N1 flu shots

October 31, 2009

Theresa Boyle

Joanna Smith

What has been touted as the largest vaccination campaign in Canada’s history hit a major hurdle Friday when health officials announced a production glitch had resulted in a significant shortfall in vaccine supply.

 

Instead of beginning mass immunizations next week, Ontario public health units are being forced to ration limited inventories, delaying plans to vaccinate healthy people so that those at risk of complications from the H1N1 virus and health-care workers can get their shots first.

 

And beginning Saturday, as the number of clinics in Toronto increases to four, Toronto public health officials will beef up screening efforts and turn away from clinics anyone deemed not high priority for the flu shot.

 

While healthy individuals had been invited to start getting their shots at some clinics starting Monday, it’s now uncertain when there will be enough vaccine for them.

 

“We have added staff who will be walking along the line and screening to ensure that the people that will get the vaccine will only be in the priority groups,” warned Toronto’s associate medical officer of health, Dr. Barbara Yaffe.

 

The head of the Public Health Agency of Canada, Dr. David Butler-Jones, said Friday only about 625,000 doses of the H1N1 vaccine are expected to reach flu clinics across the country in next week, compared to the 2 million doses that have been shipped in each of the past three weeks.

 

Ontario, which had been expecting to receive 1 million doses of vaccine next week, will instead receive only 170,000 doses of the regular version of the vaccine that contains an adjuvant – a chemical additive that stretches supply and boosts immunity – and 86,800 doses of the adjuvant-free version for pregnant women.

 

(Continue . . . )

(Sat, 31 Oct 2009 06:49:43 -0500)

Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We’ll get to it in a moment, but first a little background.

Read the rest of this post… | Read the comments on this post…

(Sat, 31 Oct 2009 03:27:12 GMT)          

 

Reminder: Please do not post whole articles, just snippets and links. Thanks!!

China

?  A/H1N1 flu virus spreading quickly(Link)

?  Death toll from A/H1N1 flu reaches 6 on Chinese mainland (Link)

Russia

?  Swine Flu Claims First Five Victims(Link)

Ukraine

?  Ukraine Orders Mobile Military Hospitals for H1N1 Caseload (Link)

?  WHO Team to Investigate Ukraine H1N1 Outbreaks (Link)

United States

?  PA: Allegheny County Sees 2nd H1N1 Flu Death; More Vaccine Expected (Link)

?  PA: H1N1 Flu Seen More In Pittsburgh Area Than Any othe State Region  (Link)

? VA: Accomack County hit hard by flu virus (Link)

?  H (Link)

Commentary, General

?  Opinion on the US fed pandemic response
from DemCT(Link)

?  WHO experts favor single-dose H1N1 vaccine regimen  (Link)

?  Canada: (opinion) We will dodge this bullet, but … (Link)

?  H (Link)

News for October 30, 2009 is here.

US Influenza-Like Illness Reports
Week ending Oct. 24, 2009

Influenza-Like Illness Reports for England & Wales

Week ending Oct 25, 2009




Thanks to all of the newshounds! Special thanks to the newshound volunteers who translate international stories - thanks for keeping us all informed!

Other useful links:

CDC A(H1N1) Site

WHO A(H1N1) Site

WHO H5N1 human case totals, last updated September 24, 2009
Charts and Graphs on H5N1 from WHO
Google Flu Trends (U.S.)
CDC Weekly Influenza Summary
Map of seasonal influenza in the U.S.
CIDPC (Canada) Weekly FluWatch
European CDC Influenza News
UK RCGP Weekly Data on Communicable and Respiratory Diseases
Flu Wiki Main Page

A jaw-dropping report from the Globe and Mail: Ottawa got last-minute warning of shortfall in H1N1 vaccine. Excerpt:

Canada’s vaccine manufacturer did not inform federal health officials until Thursday that the number of H1N1 doses available to Canadians next week would shrink by much more than half – prompting provinces to suspend the rollout of the vaccine to the general public for at least a couple of weeks. 

GlaxoSmithKline is forecast to ship 436,000 doses to provinces and territories, far less than the roughly two million anticipated, because it had to interrupt production at its Ste-Foy, Que., plant to make a version of the vaccine for pregnant women. 

The last-minute admission of a shortfall is the latest and largest blow in a week marked by anxiety, confusion and mounting frustration. Problems with vaccine supply and underestimation in pandemic planning now threaten to undermine Canada’s largest-ever inoculation campaign. 

What’s gone wrong? 

It’s a story of slower-than-expected vaccine production, a resurgent virus targeting the young, and a once-skeptical public suddenly rushing to get the shot. 

As flu clinics prepared to open this week, rising anti-vaccination sentiment persuaded health officials that uptake would be low, prompting them to step up their campaign to persuade Canadians to be immunized. 

What they didn’t count on was the far more compelling effect of real-world events – the deaths of two seemingly healthy young Canadians. Panicked, parents hurried children of all ages to flu-shot clinics; healthy adults went too, ignoring the carefully planned protocol that the most vulnerable should come first. 

And now this: the shortage that David Butler-Jones, Canada’s Chief Public Health Officer, said the government only learned the extent of late Thursday.

Thursday? As in, yesterday? When I saw Butler-Jones and Health Minister Aglukkaq here in Vancouver a couple of weeks ago, they were sticking to “early November” as the roll-out date for the vaccine. They’d said the same thing in an earlier press conference from Iqaluit.

Both were so resistant to reporters’ questions about an earlier vaccination start that I thought something sounded wrong. Then, without much explanation, the vaccinations started a week early after all.

In fairness, Dr. Butler-Jones is an old pro. He may simply have known from experience that pharmaceutical companies can’t always be trusted to deliver the goods. Early November was a reasonable launch date, so he stuck to it. 

But two kids’ deaths, and resulting political pressure, forced the Canadian government to launch early, and GSK didn’t have the vaccine in adequate quantities.

Professional soldiers remind each other that the battle plan is what disappears in the first moment of contact with the enemy. Evidently the same is true of pandemic plans.

Still, you would think that public-health professionals would know how much can go terribly wrong in any disease outbreak. What was their Plan B? And if they didn’t have a Plan B, what’s their excuse?

Via the New York Times: U.S. Releases Its Stockpile of Tamiflu for Children. Excerpt, with my bolding:

Swine flu is sickening so many children across the country, some of them fatally, that federal health officials decided Friday to release the last of the national stockpile of children’s Tamiflu. 

Even though the winter flu season has yet to begin, flu has now killed 114 children and teenagers in the United States since April, said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. 

Since the C.D.C. began tracking children’s flu deaths five years ago, the highest toll was 88, in the winter of 2007-8; many more children died in the pandemics of 1918, 1957 and 1968, but there are no accurate counts. 

Dr. Frieden’s figures were for deaths confirmed by laboratories. On Thursday, the C.D.C. estimated that in the swine flu’s spring wave there were 2.7 deaths for each confirmed one, so the actual number of children’s deaths may be closer to 300. 

On Oct. 1, anticipating shortages of liquid Tamiflu for children, the government released 300,000 doses from the national stockpile. On Friday, it released the last 234,000 doses. 

It has ordered more from Roche, its Swiss manufacturer, but that is not expected to arrive before January, Dr. Frieden said. 

In the meantime, federal officials are encouraging pharmacies to empty powder from adult capsules and dilute it with syrup into children’s doses. Some large pharmacy chains are already doing so. Presumably, the same could be done with the 37 million adult doses still in the stockpile.

Via Xinhua: Death toll from A/H1N1 flu reaches 6 on Chinese mainland. Excerpt:

Two more people on the Chinese mainland died of A/H1N1 influenza in the 48 hours ending at 3 p.m. Friday, bringing the total to six, said the Ministry of Health in a statement on its website Friday night.     

The ministry was not immediately available for more information on the two death cases.     

According to the ministry, the mainland reported 2,972 confirmed cases of the A/H1N1 influenza in the 48 hours, bringing the total number to 44,981.

Via MIGnews.com.ua: Shock! Pestilence expected in Ukraine? 20 people died of influenza already (updated at 05:03 pm). The English isn’t flawless, but the anxiety comes through very well. Excerpt:

Flu epidemic in the Ternopil Region, which appeared a week ago, mowed down nearly 10,000 of residents. Moreover - unknown virus has already killed seven people. 

Two residents of the regional center and five villagers (among them was a woman who recently gave birth to a child) died from pneumonia caused by catarrhal infection. Another four people have been in the grace condition in hospitals of Ternopil. 

As the head of public health city department Vasyl Blykhar reported, all victims of infection were young people who previously had no problems with health. Supposedly they sought help too late, on the sixth or seven day. Quarantine is declared in the region, schools are closed. 

They say infection is coming to the neighboring areas of Western Ukraine. In the Lviv Region a few districts are preparing for quarantine, particularly, Drohobych and Boryslav districts. 

As a resident of Ternopil Olexandra Melys toldh, a lot of people wearing flu masks have appeared in the city. Ternopil residents are buying garlic, onion and vodka for prophylaxis. There are queues for pills and drops from a cold, there is lack of the most popular drugs, “- says a pensioner Lyudmila. - They say that in fact 16 people have already died”. 

Local residents fear swine flu mows down them. Doctors reassure: laboratory studies at the local level do not confirm that it is swine flu. 

“We will be able to confirm the type of influenza in 1,5 week, when research results will be received from London”, - says Bohdan Onyskiv, the head of the regional health administration department. 

One reason for large-scale disease might be sudden cold snap, when a week ago Halychyna was covered with snow and frost. 

According to another version, wage earners, who brought the virus from abroad, are guilty of it. 

The doctors do not rule out that the death of residents occurred precisely because of influenza. But only virology examination may confirm information about it. It will be made in Kyiv within 7-14 days. 

But the head of the Verkhovna Rada Committee on Health protection Tatiana Bakhteyeva said that the Ukrainian examination is not a guarantee: “Our labs have a weak foundation for such research and nobody can guarantee the results will be correct.”

(Fri, 30 Oct 2009 23:36:00 +0000)

# 3917

Note: This story is updated 10/31/09 at

Ukraine: A Rush To Buy Flu Supplies

Given the number of press reports of flu-related illnesses and deaths coming out of the Ukraine in the past 72 hours, it is not terribly surprising that the World Health Organization has been asked to send a team in to investigate.

You’ll find earlier reports on the Ukrainian situation at:

Ukraine Update: H1N1 Quarantine

Reports Out Of The Ukraine

This report from The Canadian Press.   A Hat tip to RWilmer on FluTrackers for posting this story.

 

WHO says it’s sending team to Ukraine to probe reports of serious H1N1 activity

 

(CP)

GENEVA — The World Health Organization is sending a team of experts to Ukraine to look into reports of severe H1N1 disease there, a spokesperson for the global health agency said Friday.

 

Gregory Hartl said the team was being pulled together by the WHO’s Global Outbreak Alert and Response Network, which goes by the acronym GOARN.

 

The team will travel early next week to the eastern European country, which has closed schools and banned public meetings in response to a spike in cases of acute respiratory illness believed to be H1N1.

 

(Continue . . . )

(Fri, 30 Oct 2009 22:39:00 +0000)

# 3916

The CDC has posted FluView for week 42, ending October 24th, 2009. The level of activity we are seeing is roughly what we might expect during the height of the flu season, not during  mid-to-late October.

I’ve excerpted some of the data and graphs below, but follow the link to read it in its entirety.

 

Synopsis:

During week 42 (October 18-24, 2009), influenza activity increased in the U.S.

• 8,268 (42.1%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• All subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Twenty-two influenza-associated pediatric deaths were reported. Nineteen of these deaths were associated with 2009 influenza A (H1N1) virus infection and three were associated with an influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was above the national baseline. All 10 regions reported ILI above region-specific baseline levels.
• Forty-eight states reported geographically widespread influenza activity, Guam and two states reported regional influenza activity, the District of Columbia and Puerto Rico reported local influenza activity, and the U.S. Virgin Islands did not report.

 

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C., report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.

 

 

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 42, 7.1% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.6% for week 42. Including week 42, P&I mortality has been above threshold for four consecutive weeks.

 

 

Influenza-Associated Pediatric Mortality

Twenty-two influenza-associated pediatric deaths were reported to CDC during week 42 (Arizona [3], Florida, Georgia, Guam, Montana, Ohio, South Dakota, Tennessee [2], Texas [9], Washington, and Wisconsin). Nineteen of these deaths were associated with 2009 influenza A (H1N1) virus infection and three were associated with an influenza A virus for which the subtype is undetermined.

 

These deaths occurred between August 23 and October 24, 2009. One death reported during week 42 occurred during the 2008-09 season. Since August 30, 2009, CDC has received 74 reports of influenza-associated pediatric deaths that occurred during the current influenza season (nine deaths in children less than 2 years old, nine deaths in children 2-4 years old, 27 deaths in children 5-11 years old, and 29 deaths in individuals 12-17 years old).

 

Sixty-five of the 74 deaths were due to 2009 influenza A (H1N1) virus infections, and the remaining nine were associated with influenza A virus for which the subtype is undetermined. A total of 114 deaths in children associated with 2009 H1N1 virus have been reported to CDC.