Swine flu death toll climbs to 66 in Madhya Pradesh

Bhopal, Sep 22 (PTI) With one more person succumbing to swine flu, the death toll due to the disease has risen to 66 in Madhya Pradesh, officials said today. Ramchandra (55) from Ratlam district succumbed to viral disease at the M Y Hospital in Indore on Monday, they said.

Bhopal has recorded 29 deaths since August while Indore (22), Jabalpur (10) Gwalior (3) and Harda (1) after the viral infection resurfaced in the state during monsoon. About 80 people are undergoing treatment for symptoms of HINI and the condition of 15 is stated to be critical.

Five more persons tested positive for the influenza virus yesterday. With this, the number of HINI cases in the state has gone up to 266 so far.

Swine flu cases increase with monsoon

Health Ministry officials are worried as the number of swine flu cases reported from various parts of the country are increasing with the monsoon. A total of 548 fresh cases were reported last week, the highest for the current year.

According to the health ministry, 38 people died of the virus between July 19 and 25.

While the four southern states and Maharashtra continued to be severely hit, West Bengal and Delhi also joined the list of flu cases. Maharashtra reported the highest number, with 230 cases this week, followed by Kerala with 108 cases. Karnataka reported 86 cases while Andhra Pradesh and Delhi reported 34 each, followed by West Bengal with 29 cases. Tamil Nadu reported 11 cases.

As many as 19 deaths were reported from Maharashtra, eight from Kerala, five from Andhra Pradesh, two in Delhi and one in West Bengal. A handful of cases have also been reported from Haryana, Gujarat, Uttar Pradesh and Jammu and Kashmir.

Meanwhile, the health ministry has recommended the use of swine flu vaccines to avoid the threat.

'The moisture due to monsoon is giving a good breeding ground to the virus, precautionary measures such as washing of hands, covering the nose and avoiding crowded places must be followed,' a health ministry official told IANS.

According to the health ministry, 1,692 deaths have been reported due to swine flu since its outbreak in May last year

Online Test Helps You Self-Diagnose H1N1 Flu

Feeling sick? Wondering if it's the H1N1 flu or just a regular old go-away-don't-come-near-me, flu?

Face it, your doctor may not be able to squeeze you right in. But you may be able to figure it out using a Web-based self-assessment tool developed by researchers at Emory University in Atlanta. The tool is now available on several national Web sites, including flu.gov , the Centers for Disease Control and Prevention (CDC), and Microsoft's H1N1 Response Center .

The online test includes questions like, do you have a fever? Have you been short of breath? Do you have a pain or pressure in your chest that you didn't have before? Were you feeling better and now a fever or cough is returning?

The online test includes questions like, do you have a fever? Have you been short of breath? Do you have a pain or pressure in your chest that you didn't have before? Were you feeling better and now a fever or cough is returning?

The H1N1 flu , also widely known as the swine flu, is a fairly new influenza virus that has spread around the world. The CDC reports that it first appeared in the United States this past April. By June 11, the World Health Organization categorized it as a pandemic . Because its extremely contagious, hospitals and health care workers have been bracing for the H1N1 to hit hard this fall.

With concerns about the new flu running high , health care providers expect to get slammed with a mounting wave of people rushing in to find out if they have the H1N1 virus.

The online test, dubbed the Strategy for Off-Site Rapid Triage, is designed to help a lot of people figure out if they need to see their doctor or go to a hospital.

"This Web site is carefully designed to encourage those who are severely ill, and those at increased risk for serious illness, to contact their doctor, while reassuring large numbers of people with a mild illness that it is safe to recover at home," Arthur Kellermann, professor of emergency medicine and an associate dean at the Emory School of Medicine, said in a statement. "Hopefully, providing easy-to-understand information to the public will reduce the number of people who are needlessly exposed to H1N1 influenza in crowded clinic and ER waiting rooms, and allow America's doctors and nurses to focus their attention on those who need us most."

Work instructions if you become ill or exposed

Individuals who pose a risk of infecting others as a result of personal illness with H1N1 Flu (Swine Flu) or who have been exposed through direct caregiving may not enter IBM work environments until the risk ceases.

Please be sure Integrated Health Services receives notification as soon as possible about an illness or exposure concern. Immediate action may be needed to evaluate next steps associated with these issues. If you are unable to notify IHS yourself, please contact your manager to handle in your behalf. To reach an IHS representative, please refer to the local IHS team to whom you would report workplace health concerns. Please see below for specific instructions:

Illness
If you have been diagnosed with H1N1 Flu or have symptoms of this illness including fever and cough, sore throat or body aches you are not permitted to come into any IBM work environment (including customer). This restriction applies for a minimum of seven calendar days following the onset of symptoms or at least 24 hours after symptoms have resolved, whichever is longer.

For all other (non-influenza) illnesses and symptoms, the above requirement does not apply. Contact your manager or Integrated Health Services (for IBM employees) and follow the normal return to work practices.

Exposure
Management of H1N1 Flu exposure situations can vary based on the nature of exposure, country requirements and business considerations. In some circumstances, individual risk assessments may be required. Integrated Health Services should participate in those risk assessments.

Travel from an H1N1 Flu affected community/country:
IBM is not requiring anyone to self quarantine at this time as a result of travel.
NOTE: Self quarantine means restricting entry to IBM work environments for 7 calendar days from the last date of exposure (including offices, meetings, customer locations, etc.)
Some countries may impose a period of self quarantine. In such cases, country regulations apply.
Some customers may require a period of self quarantine. In such cases, a business unit decision along with IHS consultation is appropriate.

Caregiver Exposure
If you are directly caring for someone who is ill with H1N1 flu (such as a small child or incapacitated adult) and have had prolonged periods of close face to face contact such as during feeding or bathing the person, it may be possible for you to transmit the illness to someone else just prior to becoming ill yourself. Because of this, you are restricted from coming into an IBM work environment (including customer) for seven days from the date you stop providing direct care. During this time period, you should conduct daily self screening for illness symptoms and fever.
In all other circumstances, exposed individuals may come into the workplace unless otherwise directed by the local/country health department or customer/client instructions. The exposed individual should conduct self screening for illness symptoms and fever daily for seven days from the last date of exposure.

Self screening
Individuals are asked to perform H1N1 Flu illness self screening following exposure to a confirmed or suspected case.

To conduct self screening, please perform the following steps:

Step One: Check whether you have symptoms of illness including fever and cough, sore throat or body aches.

Step Two: Check your temperature using a standard, good quality thermometer following the manufacturer’s instructions.

Step Three: If you have symptoms as described in Step One or you have a temperature greater than 100.4o F or 38o C, you must not go into the workplace.

You should:

Notify your manager that you are unable to report to work.
Contact an IHS representative; please refer to the local IHS team to whom you would report workplace health concerns.
Contact your health care provider for further health instructions, especially if you are at higher risk for complications.
Refer to the guidance in Work Instructions if You Become Ill or Exposed.

H1N1 Flu Facts from the World Health Organization (WHO)

H1N1 is now the dominant flu strain in most parts of the world. Studies have detected no signs that the virus has mutated to a more virulent or lethal form.
The pandemic will persist in the coming months as the virus continues to move through susceptible populations.
The symptoms of H1N1 flu are similar to the symptoms of seasonal flu and may include fever, cough, headache, body aches, chills, fatigue, sneezing, sore throat and runny nose. A significant number of people who have been infected with this new H1N1 virus also have reported diarrhea and vomiting.
The overwhelming majority of patients continue to experience mild illness.
At higher risk of serious complications from H1N1 flu are people age 65 years and older, children younger than 5 years old, pregnant women, and people of any age with chronic medical conditions (such as asthma, diabetes, heart disease or immunosuppressed).

While this is a new health problem that may cause concern, there are many actions you can take to protect yourself, your family and the workplace.

Most Germans don't want swine flu vaccinations

The German government has ordered 18 million more vaccinations against swine flu. But two-thirds of Germans say they don't want to be immunized.

In the latest step to fight an anticipated breakout of the H1N1 swine flu virus, Germany's 16 state health ministers have announced they plan to order another 18 million vaccination units. That's enough to immunize nine million more people and ensures there is enough stock should demand surge later in the year.

The health ministers have already ordered 50 million swine flu vaccinations for 25 million people, as each person requires two doses of the vaccine. That means there will be enough vaccine to cover 40 percent of the German population.

The latest order is subject to funding being available. The thorny question of who will bear the cost of this – the federal government, the health insurers, the state health departments or local authorities – is being discussed at a special working group meeting in Berlin on Wednesday.

Two-thirds reject swine flu immunization

A new study conducted by the Forsa Institute for DAK, one of Germany's largest health insurers, revealed that a surprising number of Germans do not plan to get immunized.

In the study of 1,001 people aged between 18 and 60 years, 62 percent said they would "definitely not," or "almost definitely not" let themselves be vaccinated this autumn when the first swine flu vaccines become available.

Eighty-two percent of Germans said that swine flu poses a "fairly low" or "very low" danger.

Bavarians, in Germany's south, in particular rejected vaccination. Only nine percent said they would "definitely" go to their doctor to be immunized compared to 14 percent of Germans on average. It's a different picture in eastern Germany, where almost a quarter of those who took part in the study said they were "definitely" going to get immunized.

"If the situation changes in the next few weeks, than we expect the number of people prepared to vaccinate themselves to increase sharply," said Horst Boelle, the director of the claims department at DAK.

Are vaccinations worth the risk?

The German Medical Association is urging the government to reassess its mass vaccinations plan, the largest such scheme in postwar history.

"Many people have already had swine flu and never even noticed that had it," said Frank Ulrich Montgomery, the association's vice president.

Montgomery also questioned whether the risks of vaccinating outweigh those of actually getting swine flu. Swine flu is highly infectious but it produces fairly mild symptoms and no one in Germany has died of it so far.

"The disease could take a turn for the worse, and claim its first fatalities," said Deputy Health Minister Klaus Theo Schroeder.

"I have the impression that we are now able to do that which we need to do in the next few weeks," he added.

The first vaccinations are expected to be available in October and more units will be delivered on a weekly basis. Schroeder said mass vaccinations should be completed by the end of January or early February next year.

Testing of the vaccine is ongoing. In one pilot study, it was shown that a single vaccination was enough to provide protection in 80 percent of all test persons.

What scientists know about swine flu

Preliminary analysis of the swine flu virus suggests it is a fairly mild strain, scientists say.

It is believed that a further mutation would be needed in order for the H1N1 virus to cause the mass deaths that have been estimated by some.

But at this point, it is impossible to predict with any accuracy how the virus will continue to evolve.

UK experts at the National Institute for Medical Research outlined on Friday the work they are due to start on samples of the virus sent from the US.

The research, being done at the World Influenza Centre in Mill Hill, will be vital for working out the structure of the virus, where it came from, how quickly it is capable of spreading and its potential to cause illness.

Structure

Analysis done so far suggests what they are dealing with is a mild virus and nowhere near as dangerous as the H5N1 avian flu strain that has caused scientists so much concern over the past decade.

Influenza A viruses are classified according to two proteins on the outer surface of the virus - hemagglutinin (H) and neuraminidase (N).


The swine flu strain is a H1N1 virus, the same type as seasonal flu which circulates throughout the world every year, and kills roughly 0.1% of those infected or higher in an epidemic year.

Professor Wendy Barclay, chair in influenza virology at Imperial College London says initial indications suggest there is nothing about the genetic make-up of the new virus which is a cause for particular concern.

The key to its potential lies largely in the H1 protein.

"There are two aspects - one is which receptors the virus tends to bind to and what we see is that it is binding to the upper respiratory tract rather than deep in the lungs."

When a flu virus binds to the upper respiratory tract, it tends to cause mild illness but can be easily spread as people cough and sneeze, Professor Barclay explains.

If a virus binds further down in the lungs, it tends to cause much more severe illness, as in the case of the H5N1 avian flu virus which has caused concern in recent years.

"With the H1 gene we also look at the cleavage site," she adds.

"The virus has to be cut into two pieces to be active and it uses an enzyme in the host to do that.

"Most influenza viruses are restricted to the respiratory tract because they use enzymes in the lungs.

"But some, like H5 viruses can evolve to cut into two pieces outside the lungs, so they can replicate outside the respiratory tract."


Analysis

These initial indications are largely guesswork from looking at the genetic sequence of the virus and comparing that to what is known from work on other influenza viruses.

It will take weeks and months of biological analysis to properly get a handle on the potential of the H1N1 virus.

The team at Mill Hill, one of four World Health Organisation's centres for influenza research will be working in close collaboration with the Health Protection Agency who are carrying out testing in the UK, and their findings will also feed into the development of a potential vaccine.


Soon, the Wellcome Trust Sanger Institute in Cambridge will begin the genetic sequencing of the virus and will also be monitoring any mutations or changes in how virulent it is.

However, there is one other reassuring aspect about what is known so far.

That is there seems to be nothing unusual as yet in another protein in the centre of the virus, called NS1, which is linked to the strength of the immune response the virus produces.

In some more pathogenic viruses, it is this NS1 protein which initiates a "cytokine storm", a particularly severe immune reaction that can be fatal in even healthy young people.

Predictions

Scientists have also played down concerns that the milder H1N1 virus, could combine with the more dangerous H5N1 avian flu virus, causing a super virus that has the ability to both spread easily between humans and cause severe illness.

This is unlikely - or at least just as unlikely as it ever was and the H5N1 virus has been around for a decade without combining with normal seasonal flu.

Professor Jonathan Ball, an expert in molecular virology at the University of Nottingham said: "The chance of swine H1N1 combining with H5N1 is as likely as any other strain recombining.

"What this outbreak does highlight is how difficult it is to predict new pandemic strains.

"Many people suspected that H5N1 was the most likely candidate for the next pandemic strain, but now it appears that this was a mistake - but that's not to say H5N1 or another reassortment containing parts of H5N1 may not happen in the future.

"That's the trouble - you can't predict."

Q&A: Swine flu vaccination

The government has unveiled its vaccination programme.

A number of priority groups have been identified and the process should start in October.

What is the current status of the vaccine?



Doses of the vaccine have already been produced. A total of 300,000 doses from the two firms the UK has contracts with are due to be delivered this month.

Human trials are now getting under way and if they go well regulators could approve the jabs by the end of September.

Like seasonal flu vaccines, the jabs can be licensed under a fast-track procedure.

The vaccines have already been tested with a different strain of flu and proven to be safe.

So they just need limited testing with the correct strain to get the green light.

This means the process can take just a month or so, unlike new drugs which can take years to get approval.

How have the priority groups been identified?

The government's official vaccination experts have been studying at the evidence about swine flu for the past few months.

The health service just does not have enough capacity to administer the two shots of the swine flu vaccine needed to give protection to everyone in time for the winter.

So, instead, the government has announced a list of priority groups.

These are mainly people who are most at risk of complications or, in the case of health and social care workers, the people who are most likely to come into contact with the virus.

Many had thought all children would be immunised as they have been getting the infection in the highest numbers.

But the experts decided against such a mass programme as the overwhelming majority of those developing complications were the children with serious health problems.

How does this compare to the seasonal flu programme?
The initial first wave of the vaccination programme is not that different from the average seasonal flu vaccination group.

Only pregnant women and those living with people with immune system problems, such as people with HIV or those receiving chemotherapy treatment, will be getting the swine flu jab without also receiving the seasonal flu one.

The government hopes to be able to combine vaccinations for people who need both.

How will the swine flu vaccine be administered?

The government is still in negotiation with GPs about how the programme will be delivered.

But the vaccine requires people to be given two doses, three weeks apart.

That would mean the first phase of the programme will take until at least early December to complete.

Will everyone be vaccinated?

It is not clear. The government said it will make a decision on this during the winter.

It will eventually have enough vaccine for the whole population, but in most cases it has remained a relatively mild infection.

However, Chief Medical Officer Sir Liam Donaldson has warned that it could still become more deadly and while the death toll remains low, a fifth of cases have involved previously healthy people

Swin Flu Facts Know it now

HOW DO MASK HELP ?





Who is at risk?
Pregnant women, especially those in the third trimester, are at an increased risk of serious complications from the H1N1 A influenza virus, says a new report.


With the H1N1 flu outbreak now elevated to pandemic level, the article in CMAJ (Canadian Medical Association Journal) has reported that oseltamivir (Tamiflu) and zanamivir (Relenza) are relatively safe drugs for use in pregnant and breast-feeding women.

For treatment or prevention during the current pandemic, "oseltamivir appears to be the drug of choice because there are more data on its safety in pregnancy," writes Dr Shinya Ito, Head of the Division of Clinical Pharmacology and Toxicology at SickKids.

Zanamivir can be used, although there is less data available about its safety in pregnant women, the expert added.

Neither drug appears to affect the growth and development of the foetus, although ongoing data collection is important. The groups at high risk of flu-related complications from the novel H1N1 influenza are the same as those for seasonal flu – pregnant women, children under 5 years, the elderly and others such as those with chronic lung conditions.

Only small amounts of oseltamivir and zanamivir are excreted into human milk. If an infant is breastfed by the mother on these drugs and needs treatment, the recommended dose of oseltamivir or zanamivir should be given to the infant.

Is there a vaccine? A new research has suggested that targeting children for vaccination could help control the spread of pandemics such as the current swine flu.


The study suggests that targeting kids is the best way of using limited supplies of the vaccine currently being developed.

Ever since the World Health Organization declared a pandemic global H1N1 swine flu, countries are looking at ways to control the spread of the disease.

These measures include the use of antiviral treatments, such as oseltamivir, social distancing (for example, closing schools and stopping public transport) and quarantining infected individuals.

Pharmaceutical companies have also stepped up production of vaccines effective against this particular strain of the virus.

However, if the spread of the disease increases significantly in the autumn, as some scientists predict, it is unlikely that supplies of the new vaccine will be sufficient to vaccinate entire populations.

Dr Thomas House and Professor Matt Keeling from the University of Warwick have used computer modelling to predict the spread of pandemic influenza and to look at ways of controlling it effectively, particularly where supplies of vaccine are not sufficient for universal coverage.

The researchers showed that the disease is likely to spread fastest in densely populated conurbations, suggesting that these should be priority areas for tackling the spread.

However, they showed that vaccinating entire households at random was an inefficient use of resources; instead, vaccinating key individuals offered sufficient protection to others in their household.

Although a simplification of the complex reality of pandemic flu transmission, the researchers believe their model provides a robust argument for vaccinating children. Our models suggest that the larger the household - which in most cases means the more children living at home - the more likely the infection is to spread," said Keeling.

"This doesn`t mean that everyone in the household needs to be vaccinated, but suggests that vaccination programmes for children might help control a potential pandemic," Keeling added.

The researchers argue that targeting children for vaccination would not only help protect those at greatest risk of exposure to the virus, but would also offer protection to unvaccinated adults.

This so-called "herd immunity" effect would mean that significantly less vaccine would be necessary to help control the spread of the virus than if it were offered to everyone.\\

Swiss pharmaceuticals company Novartis AG has said that it has successfully produced a first batch of swine flu vaccine weeks ahead of expectations.

The vaccine was made in cells, rather than grown in eggs as is usually the case with vaccines, the company said.

The announcement comes a day after the World Health Organization declared swine flu, also known as A(H1N1), a pandemic. The move indicates that a global outbreak is under way. WHO says drugmakers will likely have vaccines approved and ready for sale after September.

Novartis said it would use the first batch of vaccine for pre-clinical evaluation and testing. It is also being considered for clinical trials, the company said.

The vaccine was produced at a Novartis plant in Marburg, Germany. Novartis said the facility could potentially produce millions of doses of vaccine a week.

A second plant is being built in Holly Springs, North Carolina, the company said.

Novartis said more than 30 governments have requested vaccine supplies, including the US Department of Health and Human Service, which placed a USD 289 million order in May.

Save yourself: Fight the spread

The World Health Organization issued the following guidelines on Saturday about ways to prevent and fight flu, especially in poor areas where medical facilities may lack staff, beds and drugs:


Social Distancing

-- "Social distancing, respiratory etiquette, hand hygiene, and household ventilation, are at present the most feasible measures available to reduce or delay disease (morbidity) caused by pandemic influenza."

-- This includes keeping at least an arm`s length distance from other people, minimizing public gatherings, and covering coughs and sneezes.

-- Once pandemic flu becomes widespread in a community, however, the WHO said that "interventions to isolate patients and quarantine contacts would probably be ineffective, not a good use of limited health resources, and socially disruptive."

"Routine mask use in public places should be permitted but is not expected to have an impact on disease prevention."

Mild Cases Treated At Home

-- "During a pandemic, very high numbers of patients presenting to the health-care facility will necessitate home treatment," the WHO said.

-- "In the case of mild illness, patients should be provided with supportive care at home by a designated caregiver and only referred to health care facilities if they deteriorate or develop danger signs."

-- Such danger signs may include: weakness or inability to stand, lethargy, unconsciousness, convulsions, very difficult or obstructed breathing or shortness of breath, inability to drink fluids, high fever.

-- Treatment at home should entail rest, fluids, medication for fever, and good nutrition, with patients kept separate from other people except one designated carer who should wash their hands and household surfaces frequently.

-- It is more important in the home that the patient wears a mask than the caregiver. The mask need not be worn all day and only when close contact with the caregiver is anticipated.

-- If enough masks are available, caregivers should also use them to cover their mouth and nose during close contact.

-- Windows should be kept open to allow good ventilation.

In Health Clinics

-- Medical facilities with limited resources and beds should aggressively triage patients and ensure those with respiratory symptoms are kept separately from other patients.

-- Essential medical services should be continued, while elective medical services should be temporarily suspended.

-- Admission criteria may change depending on bed availability, but should be reserved for severe cases most likely to benefit from treatment.

-- "Health facilities should anticipate a very high demand for treatment," the WHO said. "Based on current estimates, agencies should anticipate that up to 10 percent of those who fall ill may require inpatient treatment."

-- The WHO recommends this order of priority for antiviral drugs: a) treatment of sick health-care and other essential staff, b) treatment of sick individuals from the community, c) post-exposure treatment for essential staff at high risk, d) pre-exposure prophylaxis for critical staff with anticipated high-risk exposure.

Interesting Details

The World Health Organization has confirmed at least some of the cases are a never-before-seen strain of influenza A virus, carrying the designation H1N1.


* Although it`s called swine flu, this new strain is not infecting pigs and has never been seen in pigs. The threat is person to person transmission.

* It is genetically different from the fully human H1N1 seasonal influenza virus that has been circulating globally for the past few years. The new flu virus contains DNA typical to avian, swine and human viruses, including elements from European and Asian swine viruses.

* The World Health Organization is concerned but says it is too soon to change the threat level warning for a pandemic-- a global epidemic of a new and dangerous flu.

* When a new strain of flu starts infecting people, and when it acquires the ability to pass from person to person, it can spark a pandemic. The last pandemic was in 1968 and killed about a million people.

* Seven people in the United States have been diagnosed with the new strain. All have recovered, but the U.S. Centers for Disease Control and Prevention expects more cases.

* Flu viruses mutate constantly, which is why the flu vaccine is changed every year, and they can swap DNA in a process called reassortment. Most animals can get flu, but viruses rarely pass from one species to another.

* From December 2005 through February 2009, 12 cases of human infection with swine influenza were confirmed. All but one person had contact with pigs. There was no evidence of human-to-human transmission in those cases.

* Symptoms of swine flu in people are similar to those of seasonal influenza -- sudden onset of fever, coughing, muscle aches and extreme tiredness. Swine flu appears to cause more diarrhea and vomiting than normal flu.

* Seasonal flu kills between 250,000 and 500,000 people globally in an average year.

In 1976 a new strain of swine flu started infecting people and worried U.S. health officials started widespread vaccination. More than 40 million people were vaccinated. But several cases of Guillain-Barre syndrome, a severe and sometime fatal condition that can be linked to some vaccines, caused the U.S. government to stop the program. The incident led to widespread distrust of vaccines in general.

Impact on drug Industry
For hard-pressed drug makers, more used to attacks than applause, the H1N1 flu crisis is a chance to earn political capital by delivering billions of doses of vaccine across the planet.


Recent investment has put companies in far better shape to meet the challenge compared to five years ago, when a single factory closure in northwest England left the world worryingly short of seasonal flu shots.

This time around big flu vaccine makers like Sanofi-Aventis, GlaxoSmithKline and Novartis look set to book extra sales, although constraints on both capacity and pricing will cap the financial upside.

Until now, the main investor focus has been on stockpiling of antiviral drugs to fight the new strain of H1N1 flu, with Roche and Glaxo -- makers of Tamiflu and Relenza respectively -- the two obvious winners.

But that could be about to change as World Health Organization experts meet on May 14 to consider a switch from seasonal to pandemic vaccine production, with companies under intense pressure to show they are good citizens.

Making a vaccine for the new strain, widely known as swine flu, will mean stopping most production of seasonal shots. But because some companies are now well advanced in making next season`s regular vaccine, there is some room to meet both needs.

Companies are not divulging their production schedules but officials at two manufacturers said they were hopeful they would be finished with much of the production needed for the next northern hemisphere flu season by the time of any switch.

Although the H1N1 flu strain seems mild at present, health officials are worried it might return in a more virulent form in the northern hemisphere winter.

Dealing with such an uncertain threat involves a careful balance by health authorities and companies, since making a new vaccine will take four to six months.

The WHO estimates manufacturers have the capacity to make up to 900 million shots annually against seasonal flu, which kills between 250,000 and 500,000 people a year.

Kieny estimates that translates into pandemic capacity of at least 1-2 billion doses, because a simple pandemic vaccine contains only one ingredient, while the seasonal one has three.

Even so, there will not be enough vaccine for the world`s population of more than 6.5 billion.