WHO strikes back at critics — H1N1 pandemic

The World Health Organization has struck back at criticism about the agency’s handling of the H1N1 pandemic, saying claims that the outbreak was a false alarm are scientifically wrong and irresponsible.

“The world is going through a real pandemic. The description of it as a fake is both wrong and irresponsible,” said Dr. Keiji Fukuda, special adviser to the WHO director-general on pandemic influenza.

Fukuda also said dismissing the pandemic as a dud is “somewhat disrespectful” to the people who died or were severely sickened by the virus, as well as to those who have worked long hours on pandemic responses around the world. Those responses, he said, are the most concerted in the history of influenza and have averted infections and deaths.

“We don’t know how much these efforts have helped to mitigate the overall effect of the pandemic, but we firmly believe that these efforts should not be discounted.”

Definition of a pandemic

According to the World Health Organization, a pandemic can start when three conditions have been met:

• emergence of a disease new to a population;
• agents infect humans, causing serious illness; and
• agents spread easily and sustainably among humans.

A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious.

Preventing disease through vaccination — a contrast between developed and developing countries

Nearly 12 million Africans deemed at highest risk from yellow fever will be vaccinated next week against the virus, which can cause explosive epidemics in cities.

Vaccination is the best way to prevent yellow fever, which is hard to diagnose in early stages and for which there is no specific treatment, according to the United Nations agency.  Yellow fever infects 206,000 people a year and kills an estimated 30,000, mainly in tropical parts of Africa and the Americas where it has never been wiped out.

In contrast, a survey of Canadians shows that despite efforts to make vaccines available, nearly half won’t bother to get the H1N1 shot.  Similar results are reported from surveys in the U.S.

Health Canada warns people not to buy unauthorized products to fight H1N1 flu

Federal authorities are warning Canadians not to buy unauthorized products from the Internet or other sources that claim to fight the H1N1 virus.  The Competition Bureau and Health Canada issued a statement Wednesday saying that only three products are authorized for use against the virus: the vaccine from GlaxoSmithKline called Arepanrix, which is available at flu clinics and doctors’ offices, and the antiviral drugs Tamiflu and Relenza.

“Taking unapproved or counterfeit drugs could pose serious risks to health,” the advisory says.  “These products may contain ingredients not listed on the label or dangerous additives, and could cause serious side effects.”

The warning says vaccines should only come from a qualified health care provider, and antivirals should only be purchased with a prescription from a health care practitioner who has examined the patient.

The advisory says there are legitimate Canadian Internet pharmacies, but consumers need to be aware of the risks associated with buying drugs online.

Health Canada says it will monitor the Internet and take action against websites selling unauthorized products for the treatment or prevention of the H1N1 flu virus, or any other health condition.

200,000 doses of the unadjuvanted H1N1 vaccine called Panvax have also been imported from Australia for use in pregnant women.

U.S. and other countries make H1N1 vaccine available internationally through the WHO

The United States joins Australia, Brazil, France, Italy, New Zealand, Norway, Switzerland and Britain in efforts to make the H1N1 vaccine available to less-developed countries.  The White House announced yesterday that they are prepared to make 10 percent of America’s H1N1 vaccine supply available to other countries through the World Health Organization.

The recent news that a single dose of H1N1 vaccine can protect adults against the virus has sparked conversations between the WHO and developed countries about sharing their vaccine stockpiles with developing countries.

The White House said it would make the vaccine available to the WHO on a rolling basis as vaccine supplies become available, to assist countries that might not have direct access to the vaccine.  The vaccine is expected to be available in the coming weeks, earlier than originally anticipated.

Millions of people around the world have been infected with the H1N1 vaccine, thousands have died and the virus continues to spread across international borders.

Treating H1N1 – WHO recommends keeping antivirals for severe cases

In contrast to the H1N1 treatment protocols established by many developed nations, the World Health Organization recently announced that healthy patients who get H1N1 swine flu without suffering complications do not need to be treated with antivirals like Tamiflu.  Antiviral treatments are strongly recommended for pregnant women, patients with underlying medical conditions and children under 5, since they are at increased risk of more severe illness.

The concern with the WHO recommendation, as reported by Reuters, is that judging who will need antivirals is not easy for doctors since the risk of developing severe illness from the new flu strain is not restricted to people who have chronic conditions such as heart disease, diabetes or asthma.  Despite the WHO’s conclusion that underlying medical conditions do not predict a severe infection, the fact that 6 out of 10 patients suffering serious bouts of swine flu do have previous conditions chimes with other medical research.

H1N1 vaccines close to approval says WHO

The World Health Organization recently stated that the first vaccines to combat H1N1 swine flu should be approved and ready for use in some countries from September, according to a recent article by Reuters.

Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, also said vaccine production yields were improving, following a disappointing start that triggered some worries about supplies.

“I don’t want to say too early that the question has been resolved but it really seems that we have found a way to go round this problem,” Kieny told reporters. “We are on track in development.”

First results from clinical trials are expected early next month and these tests will show whether one or two doses are needed to provide immunity — another big swing factor in determining how many people can be vaccinated.

Once initial clinical trial results are in, regulators will be able to approve the vaccines from next month and the first countries are expected to start mass vaccination programmes, Kieny added.

WHO set to declare flu pandemic

The BBC reports that UN health officials are expected to declare the first global flu pandemic in 40 years, after holding emergency talks on the swine flu crisis.

WHO poised to declare first flu pandemic in 40 years

Flu experts expected to recommend move to phase 6

Expected to urge finishing seasonal flu vaccine production

Spread of virus in Australia triggering declaration

The last global flu pandemic came in 1968 over the Hong Kong flu.  That pandemic killed about one million people.  A disease is classed as a pandemic when transmission between humans becomes widespread in at least two regions of the world.

The latest virus emerged in Mexico in April and since then thousands of cases have been confirmed throughout North and South America.

The H1N1 strain has spread to 74 countries but the WHO has so far resisted labelling the outbreak a full-blown pandemic.

WHO chief Margaret Chan talked to officials from eight countries with large flu outbreaks on Wednesday in an attempt to confirm the spread of the disease.

The WHO’s move follows Australia’s confirmation of more than 1,200 cases – a four-fold increase in a week.

Although most sufferers experience normal flu symptoms and make a full recovery, the WHO has confirmed 141 deaths from 27,737 cases.

The BBC’s health correspondent, Jane Dreaper, says classifying the virus as a pandemic does not mean that the virus has suddenly become more deadly.

But it does send a clear signal to health officials and businesses to continue planning for the possibility of large numbers of people catching the virus, she says.

A historical view of flu pandemics: a reason to remain vigilant

Global H1N1 fears are subsiding, but as a recent Wall Street Journal article pointed out this may be premature.  The article illustrates how the number of countries with confirmed H1N1 cases has risen from four on April 27th to 48 as of Wednesday, with the number of individual cases increasing from 73 to 13,398.  However, the central question remains whether or not the virus will make a resurgence in the coming fall flu season, and if it does how virulent will it be.  As you can see from the chart below, the 1918 flu pandemic struck in 3 separate phases, with the most severe occurring in the fall of that year.  Similar to now, in 1918 after the initial outbreak, the world experienced a spring and summer with relatively low fatalities, despite rising infection rates. Nevertheless, by the fall of 1918 this trough culminated with a significant surge in fatality rates, leading to an estimated 500mn deaths.  The 1918 scenario is by no means guaranteed to reoccur; nevertheless, it is certainly a reason to remain vigilant.

A time series of deaths per 1,000 during the 1918 flu pandemic

Interesting to point out is that according to the article 64% of the current H1N1 cases have occurred in the 5-24 age bracket, with only 1% of cases occurring in people older than 65.  This distribution could theoretically be due to existing immunities within that age bracket from exposure to past H1N1 outbreaks.  This pattern again parallels the 1918 pandemic.

Not all is fire and brimstone.  Flu-detection and prevention technology has improved exponentially from 1918.  An article by the NY Times, points out pharmaceutical companies have begun preliminary work on an H1N1 vaccine. The new vaccine could be ready as early as October, after clinical trials this summer.  Nevertheless, given the parallels between now and the 1918 flu pandemic, it is important the public does not become over-complacent.  It is good advice to remain aware of your environment and report any potential infections to the proper authorities for treatment and tracking purposes.

World Health Assembly to be cut short due to swine flu

Earlier this week, the UN announced that the sixty-second World Health Assembly would be cut short due to global concerns about the spread of influenza A (H1N1) – swine flu.  Instead of the previously scheduled 10 day meeting (May 18-27), the WHA will be cut in half and will run from May 18-22, 2009.

Due to the shortened meeting, discussion on many global public health issues has been postponed until the next World Health Assembly in May 2010.

The following is an official UN Statement on the revised WHA agenda:

Due to the evolving situation with regard to influenza A (H1N1), and the stated wish of Member States to minimize the absence of senior public health officials from their national constituencies, a meeting was convened on 7 May attended by, inter alia,  representatives of the Member States. Recognizing that unusual circumstances called for a flexible and pragmatic approach, and without prejudicing the role of the General Committee on the composition of the provisional agenda and on the duration of the Health Assembly, those present agreed in principle to shortening the duration of the World Health Assembly and Executive Board. Through reducing the number of items on the provisional agenda the World Health Assembly would be reduced to five working days (18 to 22 May 2009), and the 125th session of the Executive Board would be convened on the Saturday, for one day, on 23 May 2009.

To that end please find attached a revised provisional agenda which will be submitted to the General Committee on Monday 18 May 2009 for its consideration.

The Provisional agenda (reflecting proposed amendments discussed on 7 May 2009) is included below:

WHO raises global alert for swine flu outbreak

Dr. Margaret Chan, WHO’s Director-General, yesterday raised the current level of influenza pandemic alert from phase 4 to 5, warning that a pandemic is likely imminent.

Listen to the Audio statement by WHO Director-General, Dr Margaret Chan – 29 April 2009 

Swine flu is suspected of killing 160 people in Mexico and making about 2,500 ill.  The United States reported the first swine flu death outside of Mexico, a Mexican toddler who had travelled with his family to Texas.

Total American cases surged to nearly 100, spreading to 11 states.  The WHO has also confirmed cases of swine flu in Canada, Britain, Israel, New Zealand and Spain.  Germany, Austria and Peru became the latest countries to report infections. Germany reported four cases yesterday, Austria and Peru one each.

Dr. Chan stated that all countries should immediately activate their pandemic preparedness plans.  At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

In response to the WHO’s warning, Mexican President Felipe Calderon told his people to stay home for a five-day partial shutdown of the economy.  Mr. Calderon ordered government offices and private businesses not crucial to the economy to stop work to avoid further infections from the new virus.

For more information on swine influenza and the WHO’s role in coordinating a global response, visit the dedicated WHO Epidemic and Pandemic Alert and Response site.