Swine Flu Update: 10/09/2009

Again last week, the number of new cases continued to fall. With around 3,000 new cases reported for last week - compared to 5,000 cases for the week before and a zenith of 130,000 at the start of August – the situation has improved by every known measure or metric, both on a national, and indeed a supranational level. The HPA, continues to warn Britons against complacency in the struggle against the virus. The total number of H1N1-related deaths has now risen to 75 and as of September the 9th, there were 132 patients hospitalized with the virus. HPA figures continue to be questioned for their reliability since the transition to the National Pandemic Flu Service (NPFS) earlier in the month. In delivering his weekly update, the UK’s Chief Medical Officer, Sir. Liam Donaldson, stressed that plans were already being implemented to ensure that the second wave that is likely to hit the UK sometime during the fall will not take the health service by shock. This includes an expansion of the number of hospital beds and training more medical staff in the art of critical care. "We are tantalisingly close to being able to win the battle against the pandemic virus”, he said. “In the past we have had to take whatever it throws at us and chalk up the extra deaths. Tantalising does not mean we can always get there but we are still fighting”, he added. News on the forthcoming H1N1 vaccine has also been positive. Several clinical trials, including several in the U.S. and one in the UK have all produced promising results. First, the trials of Sanofi- Pasteur SA’s and CSL Ltd’s vaccines confirmed that only one dose of the vaccine is needed for effective protection. Trials of Novartis’ H1N1 vaccine, carried out at Leicester University in England, generated a similarly positive outcome. All three vaccines also exceeded expectations on the speed of their immune response, requiring 8-10 days to provide protection from the virus.

“In the temperate region of the southern hemisphere (represented by countries such as Chile, Argentina, Australia, New Zealand, and South Africa), influenza activity continues to decrease or return to baseline. Active transmission persists in tropical regions of the Americas and Asia. Many countries in Central America and the Caribbean continue to report declining activity for the second week in a row. However, countries in the tropical region of South America (represented by countries such as Bolivia, Ecuador, and Venezuela) are reporting increasing levels of respiratory disease. In the tropical regions of Asia, respiratory disease activity remains geographically regional or widespread but the trend is generally increasing as noted in India, Bangladesh, and Cambodia. In the temperate regions of the Northern Hemisphere activity is variable. In the United States, regional increases in influenza activity are being reported, most notably in the south eastern states. Most of Europe is reporting low or moderate respiratory diseases activity, but parts of Eastern Europe are beginning to report increases in activity. WHO Collaborating Centres and other laboratories continue to report sporadic isolates of oseltamivir resistant influenza virus. 21 such virus isolates have now been described from around the world, all of which carry the same H275Y mutation that confers resistance to the antiviral oseltamivir but not to the antiviral zanamivir. Of these, 12 have been associated with post-exposure prophylaxis, four with long term oseltamivir treatment in patients with immunosuppression. Worldwide, over 10,000 isolates of the pandemic (H1N1) 2009 virus have been tested and found to be sensitive to oseltamivir. WHO will continue to monitor the situation closely in collaboration with its partners, but is not changing its guidelines for use of antiviral drugs at this time. Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere. All pandemic H1N1 2009 influenza viruses analysed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus. See below for detailed laboratory surveillance update. Of note, the U.S. Centers for Disease Control and Prevention this week reported on an analysis of 36 fatal pandemic influenza cases in children under the age of 18 years. Sixty-seven percent of the children had one or more high-risk medical conditions, most commonly neurodevelopmental disorders. In addition, ten of 23 children for whom data were available were found to have strong evidence of secondary bacterial co-infections.”
*The information above is a copy of the latest WHO regulations and guidelines for Swine Flu and can be found in more detail at the WHO Website, here.
• There continues to be a downward trend in new swine flu cases. • There are 132 swine flu patients in hospital in England (as of 8am on September 9). • A further five people with swine flu died in England in the last week, bringing the UK total to 75. So far there have been 66 deaths in England, seven deaths in Scotland, one in Wales and one in Northern Ireland. • The majority of cases continue to be mild. There is still no sign that the virus is changing. • Internationally, there have been 3,491 deaths related to swine flu. • Many countries in the southern hemisphere have now passed the peak of their winter flu epidemic. Flu activity in Australia is now returning to normal levels and in total there have been 35,897 confirmed cases and 165 deaths.
*The information above is a copy of the latest NHS key updates for Swine Flu and can be found in more detail at the NHS Swine Flu Website, here.
• WHO Twitter – ‘WHO's official Twitter channel. Who is the directing and coordinating authority within the UN system for public health’. • NHS Swine Flu Overview – ‘This page brings together the latest science and developments on the swine flu pandemic into a single accessible resource for both health professionals and the general public’. • NHS Swine Flu Vaccine – Detailed information on the development of the H1N1 vaccine, along with logistical updates on clinical trials in the U.S. and Australia, efficacy and WHO recommendations. • The Lancet H1N1 Flu Resource Centre – With over 40 journals, Lancet is one of the leading scholarly resources on the topic of Swine Flu – if not any healthcare issue. With free, unlimited access for all, this is one powerful research resource. • Nature – A number of interesting feature articles and blogs pertaining to the topic of Swine Flu. • Fergus on flu – Great Swine Flu blog from the BBC’s Chief Medical Correspondent. • Microsoft Bing Swine Flu Tracker – ‘Map of 2009 Swine Flu H1N1 outbreaks and migration paths reported from news and government agencies. The map lists reported dates and paths of infected persons traveling’. • Facebook Group for H1N1 – With over 3,500 members – and literally hundreds of personal accounts on the current outbreak, this Facebook Group provides an interesting view into the potential future impact of Social Media on healthcare related issues.