Swine flu update : 10 February 2010

The WHO has defended its handling of swine flu — influenza A(H1N1) — after being accused of declaring a pandemic without adequate scientific evidence.

Wolfgang Wodarg, an epidemiologist and chair of the European Council's Health Committee, told the Parliamentary Assembly of the Council of Europe (PACE) in Strasbourg, France, last month (25–29 January) that the WHO was not justified in announcing in June 2009 that A(H1N1) was a pandemic that could kill millions.

He also said that the decision was made only on the basis of a change in the criteria of what defines a pandemic the year before.

"In my view, the WHO undertook an incomprehensible action which cannot be justified by the scientific evidence. The Council of Europe should investigate this to see how the WHO can undertake this kind of dangerous nonsense," he said.

Keiji Fukuda, the WHO's special advisor on pandemic flu, said the organisation responded decisively in accordance with the International Health Regulations.

"The new virus spread with unprecedented speed reaching 120 countries and territories in about eight weeks and has now been reported from virtually all countries," he said.

Fukuda rejected allegations that the WHO created a 'fake' pandemic to make money for industry.

"The flu pandemic policies and responses were not improperly influenced by the pharmaceutical industry. Cooperation with a range of partners, including the private sector, is necessary but numerous safeguards are in place to avoid conflict of interest."

A report on pandemic flu is being prepared for PACE for debate in July or October 2010.

Influenza A(H1N1) can grow in the human eye, scientists from the Queen Mary Hospital in Hong Kong reported in this month's (1 February) American Journal of Pathology.

Their research found that, unlike seasonal flu, A(H1N1) can replicate in the conjunctiva, the transparent surface of the eye. This suggests that the viruses bind to different kinds of cells and that A(H1N1) could be transmitted through the eyes as well as the respiratory system.

If one in twenty people who recovered from A(H1N1) donated their blood plasma, more than two-thirds of patients still suffering from the disease could be treated by transfusion, researchers from the University of Hong Kong have calculated.

Their research, which used mathematical models, was published by the Proceedings of the National Academy of Sciences this month (1 February).

The authors said clinical researchers should test the safety and usefulness of transfusions as a treatment for A(H1N1).

Vietnamese scientists have developed an influenza A(H1N1) test kit that diagnoses the disease within four hours. The kit — developed by the Ho Chi Minh City Pasteur Institute and the Vietnam Institute of Biotechnology — costs half the price of an imported kit, online news site Thanh Nien News reported last month (28 January).

Tamiflu to be sold in retail outlets from today

UPDATE 1-Australia approves roll out of H1N1 flu vaccine

CANBERRA, Sept 18 (Reuters) - Australian health authorities approved a vaccine for H1N1 influenza, which will be rolled out across the country from September, Health Minister Nicola Roxon said on Friday.

"There is going to be sufficient vaccine for everyone," Roxon told reporters in Canberra, adding Australia would be one of the first countries to protect its population from the H1N1 virus.

Australia has ordered 21 million doses of the vaccine from pharmaceutical company CSL Ltd (CSL.AX).

While the country is coming to the end of its regular flu season, chief medical officer Jim Bishop said the virus was unpredictable, and new cases could emerge throughout the summer with a possible second outbreak before the next flu season.

More than 4,600 Australians have been hospitalised and 172 people have died from H1N1 flu.

Roxon said the rollout would be Australia's biggest mass vaccination. The vaccinations will be voluntary, and Roxon said she expected the vaccine rollout to be complete by late December.

The initial vaccinations would target health workers and those most vulnerable to severe effects from the pandemic influenza, including pregnant women, people with chronic health conditions and Aborigines in remote communities.

Roxon said the full cost of the vaccines was confidential, but said it was worth more than A$100 million ($87 million). ($1=A$1.15) (Reporting by James Grubel; Editing by Michael Urquhart)

Swine Flu Update : Department of Health Update on H1N1

The Centers for Disease Control and prevention has reported that the Clinical trials for the H1N1 Swine Flu vaccine for healthy adults are going well with no adverse side effects among those tested.

The Centers for Disease Control and Health and Human Services recently announced that healthy adults will require just one dose of the vaccine.

Florida Flu Information Line 1-877-352-3581

On Monday, August 24th, Florida Department of Health launched a toll-free number to provide public health information and updates on H1N1 Swine flu. The information line is available from 8 a.m. to 8 p.m. EDT, seven days a week. Information is available in English, Spanish and Creole.

*To align our media updates with the Centers for Disease Control and Prevention schedule, we will send a media update each Wednesday noting any significant events that have taken place during the reporting period. Please note that following the lead of the Centers for Disease Control and the World Health Organization, we will no longer be collecting numbers of confirmed H1N1 Swine Flu cases.

Additional laboratory confirmed H1N1 Swine Flu deaths have been verified in the following: An 82-year-old male in Alachua County, a 46-year-old female in Charlotte County, a 44-year-old male in Miami-Dade County, a 52-year-old female in Duval County, a 14-year-old male in Highlands County, a 52-year-old male in Pinellas County, a 46-year-old female in Polk County, a 27-year-old male in Sarasota County, a 52-year-old male in St. Lucie County, and a 53-year-old female in Volusia County. While most cases of H1N1 Swine Flu are mild, there are exceptions. Pre-existing health conditions often play a role in how individuals react to the flu. To-date, there have been 87 laboratory confirmed H1N1 Swine Flu deaths in Florida.

"Our hearts and prayers go out to the family and friends of these individuals, " said Surgeon General Dr. Ana Viamonte Ros. " H1N1 Swine Flu, like seasonal flu, can in some circumstances be very serious, therefore, all of us should continue to adhere to good health practices including, stay home if sick, cover cough and sneeze, and wash hands frequently."

The Department of Health continues its enhanced surveillance and outreach to physicians, hospitals, and other health care professionals. The surveillance system, consisting of sentinel physicians reporting influenza activity, DOH laboratories receiving specimens from physicians and hospitals, and our ability to monitor emergency room cases is fully operational. We have activated our response plan and are ready to respond if needed.

The World Health Organization (WHO) alert level is at Phase 6 "pandemic." The pandemic (WHO level 6) status is based on geographic distribution and not the severity of swine flu. In effect the WHO is saying that swine flu H1N1 is now circulating world-wide.

The State Surgeon General provided these recommendations:

People with respiratory illness should stay home from work or school to avoid spreading infections, including influenza, to others in the community.

§ Avoid close contact with people who are coughing or otherwise appear ill.

§ Avoid touching your eyes, nose and mouth.

§ Wash hands frequently to lessen the spread of respiratory illness.

People experiencing cough, fever and fatigue, possibly along with diarrhea and vomiting, should contact their physician.

If you think you have influenza, please call your health care provider and discuss whether you need to be seen in their office, emergency department or stay home.

First swine flu death in India

India's first death due to H1N1 flu infection, with a 14-year-old girl from Pune succumbing to the deadly influenza virus.

Everything you wanted to know about swine flu

The spread of swine flu is fast emerging as No 1 healthcare emergency not just in the country but the world over. Despite the issue being in the
Swine flu
The spread of swine flu is fast emerging as No 1 healthcare emergency not just in the country but the world over.
media for a long time, there continue to be ignorance and mis-information about the disease and how to handle it. Indian Medical Association, Nagpur Centre, has come up with a information dossier on the subject. We reproduce it here for the benefit of our readers.

What is H1N1 (swine) flu?
H1N1 (referred to as "swine flu" early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have also reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas.

In the beginning it was difficult to predict the effect of this virus on general population. In seasonal flu, there are certain people who are at higher risk of serious flu-related complications. This includes people with 65 years of more age, children below five years, pregnant women, and people of any age with chronic medical conditions.

This virus is contagious but, at this time, it not known how easily the virus spreads between people. The symptoms of H1N1 swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhoea and vomiting associated with H1N1 swine flu. Severe illness (pneumonia and respiratory failure) and even deaths have been reported with H1N1 swine flu infection. Like seasonal flu, H1N1 swine flu may cause a worsening of underlying chronic diseases.

In children, emergency warning signs that need urgent medical attention include:
* Fast breathing or difficulty in breathing
* Bluish or gray skin colour
* Not drinking enough fluids
* Severe or persistent vomiting
* Not waking up or not interacting
* Being so irritable that the child does not want to be held
* Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:
* Difficulty in breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
* Flu-like symptoms improve but then return with fever and worse cough

How do you catch H1N1 (swine) flu?
Spread of H1N1 (swine) flu can occur in two ways:

H1N1 virus appears to be transmitted the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?

Infected people can infect others right from day one even before they themselves develop any symptoms up to seven or more days after becoming sick. That means that one can pass on the infection to someone else before he/she even knows that he/she is sick, as well as while one is sick.

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against H1N1 (swine) flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

* Avoid touching your eyes, nose or mouth. Germs spread this way.

* Try to avoid close contact with sick people.

* If you get sick with influenza, you should stay at home and not go for work or school and limit contact with others to prevent them from getting infecting by you.

* Reduce the time spent in the crowded settings.

* Improve airflow in the living space by opening the windows and proper ventilation.

* Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface.

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches his own eyes, mouth or nose before washing hands.

Are there medicines to treat H1N1 (swine) flu?

Yes, use of oseltamivir (brand name Tamiflu?) or zanamivir (brand name Relenza ?) for the treatment and/or prevention of infection with these H1N1 (swine) influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within two days of symptoms).

Follow the advice of your local public health department regarding school closures, avoiding crowds and other measures to reduce flu transmission. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.

What should I do if I get sick?

If you live in areas where people have been identified with new H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhoea, you should stay home and avoid contact with other people, except to seek medical care. If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

Antiviral drugs may reduce the symptoms and duration of illness, just as they do for seasonal influenza. They also may contribute to preventing severe disease and death. WHO is in touch with public health authorities and clinicians in affected countries and is gathering information about how effective the drugs are.

What about using a mask? What does WHO recommend?

If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and clean your hands thoroughly afterwards.

If you are sick and have to travel or be around others, cover your mouth and nose.

Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

How do I know if I have influenza A (H1N1)?

You will not be able to tell the difference between seasonal flu and influenza A (H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A (H1N1). If they suspect any symptoms they will send your blood sample, throat swab and nasopharyngeal (nose to mouth) for testing to laboratories. Presently this facility is available only at certain specified government laboratories.

Swine flu Q&A: Can we protect ourselves against swine flu?

What is swine flu and where has it come from?

Swine flu is a respiratory infection caused by influenza type A. It usually affects pigs, but can be passed to humans. This is a new strain, probably created when two older swine flu viruses infected the same pig in Mexico. These then swapped genes to create a fresh strain

Do facemasks protect against infection?

Possibly, but the evidence is disputed. An Australian study found they can reduce the chances of infection, but only if worn properly and continuously. The Government has stockpiled 350 million masks for NHS staff, but there are no plans to distribute any to the general population



What are the symptoms?

Symptoms of swine flu are similar to those produced by standard, seasonal flu. These include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people also have diarrhoea and vomiting

How do I know if I should see a doctor?

If you develop the symptoms above, and you live in places where swine flu cases have been confirmed or you recently travelled to Mexico, you should seek medical advice. Patients are being asked not to go into doctors’ surgeries to minimise the risk of spreading the disease to others. Instead, they should stay at home and call their healthcare provider for advice

Is it treatable?

Yes, with the flu drugs Tamiflu or Relenza, but not with two older flu medications

Is there a vaccine?

No. Now the strain has been isolated, it will take three to six months to produce one

How well prepared is the UK?

As well as it can be. The Government has bought 33 million courses of Tamiflu — the frontline antiviral drug — which is enough to cover half the population. Arrangements are also in place to buy a pandemic vaccine as soon as it is available. The World Health Organisation judges Britain and France as the best-prepared nations

Why has swine flu killed people in Mexico while causing only mild cases in the US?

Scientists do not know yet for certain, but the likeliest answer is that we have yet to discover the full extent of either outbreak. The virus has probably been circulating in Mexico for several weeks, but went undetected because it usually causes only mild symptoms — there may well have been hundreds of mild cases for every death that has occurred. The Mexican outbreak may simply be more advanced than the one in the US

Does that mean we can expect to see deaths in the US and elsewhere too?

Possibly. There will probably be more severe cases, but many of those who have died in Mexico were not treated promptly. The medical response will be swifter and more effective in countries like the US and Britain, and that will certainly save lives

How do I protect myself?

Take common sense precautions. Cover coughs and sneezes with a tissue that you throw away. Wash hands frequently. Adults should stay at home if sick, while children should be kept home from school