WHO Likely To Raise H1N1 Influenza Alert to Highest Level
The WHO will likely soon declare H1N1 (swine) influenza to be a pandemic, raising its global flu alert system to the highest level, Reuters reports. In an article published Monday in the Spanish newspaper El Pais, WHO chief Margaret Chan said, "Level 6 does not mean, in any way, that we are facing the end of the world." Rather, the Phase 6 distinction would kick international pandemic response plans into high gear and provide "increased support for developing countries which lack the drugs, diagnostic tests, and medical staff to respond appropriately to the flu that the WHO has said could be especially dangerous for people with HIV/AIDS," Reuters writes.
According to Reuters, the WHO will evaluate whether H1N1 is spreading in Europe and Asia before raising the alert to a Phase 6, a decision that "reflect[s] views about how a virus is spreading and not how severe its effects are," according to Reuters. The WHO last raised the flu alert level to 5, out of a 6-point scale, on April 29, signifying a pandemic was imminent (Reuters, 5/4).
According to the WHO, 20 countries have reported 985 cases of H1N1. Laboratory tests have confirmed 590 cases of infection in Mexico, including 25 deaths, and 226 cases of swine flu in the U.S., including one death. Additionally, "The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (85), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (2), Germany (8), Ireland (1), Israel (3), Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15)" (WHO Swine Influenza A(H1N1) - update 13, 5/4).
With any declaration of a pandemic by the WHO, the body is expected to decide whether vaccine makers should switch from making seasonal flu vaccines to H1N1 flu vaccines, Reuters/Boston Globe reports (Harding/MacInnis, Reuters/Boston Globe, 5/4). Because the production of vaccines takes months the AP/Google.com writes, "WHO is trying to figure out how many doses of seasonal flu vaccine remain worldwide before asking vaccine manufacturers to start pumping out pandemic vaccine instead."
"We are gambling whether or not we will have enough seasonal vaccine, but it will not be an 'either-or' situation," said Marie-Paule Kieny, director of WHO's Initiative for Vaccine Research. The gamble will likely have an immediate impact on people living in the southern hemisphere, where the flu season is just beginning (Cheng, AP/Google.com, 5/2).
The CDC has already started and reported success while working on creating a "seed stock" from the H1N1 flu virus, a critical step in vaccine production, USA Today reports. "If the virus cooperates and grows well, we will soon be able to distribute a candidate vaccine virus to the manufacturers," in roughly three weeks, Nancy Cox, chief of the influenza branch at the National Center for Immunization and Respiratory Diseases. The drug companies will then need 8-10 weeks to create pilot vaccines that will then be tested in clinical trials (Rubin, USA Today, 5/3).
Virus Might Not Be As Deadly As Feared, Second Wave Could Be More Lethal
Acting director of the CDC Richard Besser on Sunday said that the swine flu virus may not be as deadly as initially feared, the Washington Post reports. Bresser said that genetic tests of the swine flu virus have found that it lacks the "virulence factors" of more deadly outbreaks. Additionally, health officials are beginning to believe that the swine flu was more widespread in Mexico than originally believed, "which would make the seemingly high mortality rate there a misperception," the Washington Post writes.
"As we learn more about how widespread this is, it may be that the rates of severe disease in Mexico will end up being not different than what we see here," Besser said (Achenbach, Washington Post, 5/4). Health Secretary José Córdova on Sunday reported a dip in the number of new and serious cases of swine flu and said patients in the region were responding well to antivirals, Bloomberg reports (Randall, Bloomberg, 5/4).
Still, Chan told the Financial Times that the declining swine flu mortality rate in Mexico did not lessen the threat of a pandemic. She said that the virus may return "with a vengeance," in coming months (Jack, Financial Times, 5/3).
Chan also said weather patterns could play a role in how well H1N1 continues to spread, Reuters reports. "We have to be very careful. No one can predict what is going to happen when countries in the south have flu peaks and this new one arrives which it is going to do, without a doubt," Chan said (Harding/MacInnis, Reuters, 5/4).
Canadian health officials on Saturday reported the first known case of swine flu moving from humans to pigs, Bloomberg reports. Bloomberg writes, "Pigs are an ideal breeding ground for new forms of the flu, and further genetic scrambling can result in deadlier forms of the new swine flu, said Nancy Cox, chief of the flu division at the Center for the Immunization and Respiratory Disease at the Atlanta-based CDC." Health officials believe a farm worker from Alberta who recently returned from a trip to Mexico and later became sick may have passed the virus to the pigs. According to the Canadian Food Inspection Agency hundreds of pigs have shown symptoms similar to those found in humans who have the H1N1 virus (Randall, Bloomberg, 5/4).
Though health officials stress that there is no risk of the public contracting the swine flu from pork products, the Globe and Mail writes, "The unusual development creates a whole new series of challenges for public-health officials trying to limit the spread of the new form of flu in humans and swine alike" (Picard, Globe and Mail, 5/3).
WHO Releases 2.4 M Doses of Antivirals to Developing Countries
WHO on Saturday announced it had sent 2.4 million doses of the antiviral Tamiflu to 72 developing countries to help protect them from the spread of H1N1, the AP/Jerusalem Post reports (Olson, AP/Jerusalem Post, 5/2). While affluent countries have enough antivirals to reach at least one-quarter of their populations, "developing countries, like Guatemala, Indonesia and India have enough for only 2% of their people or less," according to the AP/Google.com.
Because Tamiflu is only effective when taken within 48 hours of the first symptoms of the flu virus, even if populations in developing countries have access to the antiviral they may not receive the drugs in time. "Countries without sophisticated labs, and without quick distribution methods, may not be able to use their small stocks [of antivirals] properly," said Elspeth Garman, an Oxford University molecular biophysicist.
In theory, antiviral stockpiles should correspond with the numbers of people who were affected by past influenza pandemics between 30-40% of the population, according to Adrian Sleigh, a professor of epidemiology at Australian National University. "India has medicine for less than 1% of its people, although more is expected within seven days. In Mexico, the epicenter, there are enough antivirals for about 1.3% of the population. Indonesia, the country hardest hit by bird flu in recent years, has tablets for roughly 0.2% of its 235 million people, officials said," the AP/Google.com writes.
"It may be that, tragically, the poor parts of this world are going to miss out on the benefits of modern antivirals," Sleigh said. "We've been talking about that for years. The WHO was developing a global stockpile and had millions of tablets. But how does that compare to the billions required in the developing world?"
Though public health advocates have urged developing countries to donate antivirals to poorer nations, Garman warns that without a supporting pandemic plan to distribute antivirals to individuals affected by H1N1, resources could be wasted (Katz, AP/Google.com, 5/2).
AP/Los Angeles Times Examines Challenges Facing the WHO
The AP/Los Angeles Times on Sunday examined the challenges the WHO has faced while it tries to prevent H1N1 deaths and whether the agency could be more effective if its powers were expanded. According to AP/Los Angeles Times, prevention measures, such as travel bans, raising alert levels etc. can meet "stiff political opposition" because global powers like the U.S. and China are all lobbying for their own national interests behind the scenes. The AP/Los Angeles Times writes, "WHO's mandate is to direct and coordinate U.N. health policy: It makes recommendations and global assessments on issues including HIV/AIDS, malaria, and tuberculosis, and also coordinates responses to health crises like disease outbreaks and humanitarian disasters. But its recommendations are not binding - and countries are free to disregard WHO's advice."
Richard Horton, editor of the journal Lancet, said, the WHO is in an "incredibly difficult position," because its "modus operandi" is to respond to government requests, but in the situation of a possible pandemic, "what governments might want may not align with what WHO thinks is best" (Higgins/Cheng, AP/Los Angeles Times, 5/3).
Regions Worldwide Prepare for Possible Pandemic, Avian Influenza Helps Preparedness in Some Cases
Time magazine on Friday examined how responses to H1N1 in Africa and India differ to the responses in more developed countries. According to Time, in places like India and Africa, "where 'pandemic' is just another part of the daily vocabulary, no one has so much as stifled a sneeze." The WHO has urged governments to prepare, so "politicians have to make like they're doing something," Time reports.
But since many public health systems in Africa are burdened by other diseases such as HIV/AIDS, tuberculosis and malaria "the truth is that a threat of another disease even a pandemic flu tends to elicit shrugs in this sickness-struck continent," according to Time.
Research shows that governments in the developing world could be "forced to make difficult decisions on how to allocate resources in the case of a pandemic, and these decisions should be made public early on to avoid causing social unrest," Time reports. The response in India is stronger compared to other developing countries, according to Time. "We are reaping the benefits of our experience with bird flu," Dheeraj Singh a spokesperson for the National Institute of Communicable Diseases in New Delhi, India said (Perry, Time, 5/1).
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More Reponses in Asia
- The Asia Development Bank (ADB) is prepared to assist countries in the region that might need to prepare for the possible spread of H1N1, Haruhiko Kuroda, the Bank president, said on Saturday, Reuters reports. "At this moment, Asia is not much affected by this new influenza but we must prepare to take necessary action," he said, echoing assertions that Asia's experience with SARS and avian influenza helped to prepare the continent for infectious disease outbreaks (Arak, Reuters, 5/2).
- Indonesia has started screening people are airports and other ports, Health Minister Siti Fadilah Supari said on Monday, Xinhua reports. She added that the 100 hospitals that had been designated to deal with avian flu are preparing to deal with the H1N1 virus (Xinhua, 5/4).
- Bloomberg recently examined Asia's response to the first two confirmed cases of swine flu on the continent. The article describes swine flu control methods in China, Japan, South Korea, Taiwan and other places (Koo/Wan, Bloomberg, 5/2).
Additional African Responses
- IRIN recently examined the response to swine flu in West Africa. The WHO's Africa regional office put together a crisis management team to monitor the spread of swine flu. The article outlines how West African regional organizations and governments are preparing to deal with a potential outbreak (IRIN, 5/1). In East Africa, Uganda has started screening people for swine flu when they enter the country, New Vision/AllAfrica.com reports (Bugembe, New Vision/AllAfrica.com, 4/30).
- Countries in Latin America are better prepared to handle a swine flu outbreak because of the experience with avian influenza five years ago Mirta Roses, director of the PAHO, said on Friday at a special meeting of the Organization of American States in Washington, D.C. AFP/Google.com reports. Roses said countries in the region have "updated their plans against the influenza since 2004, with tested plans, drills and increased training of personnel." According to AFP/Google.com Latin America has part of the world's strategic reserve of anti-viral medicines. Officials are working with each country and with industry to determine specific needs and availability, Roses said (AFP/Google.com, 5/1).