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2009 H1N1 Flu: International Situation Update

This report provides an update to the international flu situation using data collected through March 28, 2010, and reported by the World Health Organization (WHO) on April 1. WHO continues to report laboratory-confirmed 2009 H1N1 flu cases and deathsExternal Web Site Icon on its Web page. These laboratory-confirmed cases represent a substantial underestimation of total cases in the world, as most countries focus surveillance and laboratory testing only on people with severe illness.

Currently, 2009 H1N1 influenza activity is highest in the tropical regions of Asia, the Americas and Africa. In the temperate areas of the Northern and Southern Hemisphere, 2009 H1N1 influenza virus continues to circulate at low levels. Although the 2009 H1N1 virus continues to be the predominant influenza virus circulating worldwide, influenza B viruses are predominant in most of East Asia and have been detected at low levels across Southeast and Western Asia, East Africa, and parts of Eastern and Northern Europe. Seasonal influenza A viruses are still being detected in parts of Asia and Australia.


Selected Highlights

* According to WHO, the majority of 2009 H1N1 virus isolates tested worldwide remain sensitive to oseltamivir, an antiviral medicine used to treat flu. Among 2009 H1N1 isolates tested worldwide, 268 have been found to be resistant to oseltamivir – 64 of these isolates were detected in the United States.
* Influenza B remains the predominant flu strain in East Asia, accounting for 66.7% of all influenza viruses reported in the Republic of Korea, 71.6% in the Russian Federation, 84.2% in China, and 100% in Mongolia and Iran. An increase in influenza B activity has also been reported in some European countries.
* Seasonal influenza A activity has been reported recently in some countries in recent weeks, including China, Ghana and Thailand.
* On February 18, 2010, WHO published recommendations for the following viruses to be used for influenza vaccines in the 2010-2011 influenza season of the Northern Hemisphere:

o an A/California/7/2009 (H1N1)-like virus;
o an A/Perth/16/2009 (H3N2)-like virus*;
o a B/Brisbane/60/2008-like virus.

* A/Wisconsin/15/2009 is an A/Perth/16/2009 (H3N2)-like virus and is a 2010 Southern Hemisphere vaccine virus.

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Swine Flu Cases Appear To Have Peaked

The Los Angeles Times:"The current wave of pandemic H1N1 appears to have peaked, with four weeks of declines in several key indicators, the Centers for Disease Control and Prevention said Monday. Despite the decrease, the outbreak is continuing to take a heavy toll of hospitalizations and deaths, especially among children. Widespread activity of H1N1, also called swine flu, was reported in 32 states ... in the week ending Nov. 21, down from 43 states the week before and 48 a month ago. Influenza-like illnesses accounted for 4.3% of all visits to doctors' offices during the week, down from nearly double that proportion in October. That is still well above the normal level, 2.3%, for this time of year, however" (Maugh, 12/1).

The Washington Post: "While officials warned that the number of people getting infected with the H1N1 virus remains high, and cases could surge again, the extended period of falling activity suggests that the intensity of the outbreak has reached a high. ... 'We're far from being out of the woods,' [Thomas Skinner, spokesman for the Centers for Disease Control and Prevention in Atlanta] said. 'There's still a lot of flu out there. And we wouldn't be surprised to see another uptick in activity as we approach the end of December and beginning of January, when kids come back from Christmas break.' But other experts said they thought the wave had peaked" (Stein, 12/1).

USA Today reports: "The steady decline in the USA and elsewhere prompted the World Health Organization to propose Friday that swine flu may have peaked in North America, the Caribbean and parts of Europe, though the 'winter influenza season continues to be intense.' U.S. officials challenged WHO's hopeful assessment, saying it is too soon to declare that swine flu is tapering off. ... As of Monday, 66 million doses of swine flu vaccine were available for states to order, and more were on the way, the CDC's Thomas Skinner says" (Sternberg, 11/30).

Meanwhile, The San Bernardino (Calif.) Sun reports that fewer blacks are receiving the vaccine: "San Bernardino County public health officials this week plan to make a special pitch to get more blacks to roll up their sleeves for the H1N1 vaccine. ... Alonzo Louis Plough, director of emergency preparedness and response at the Los Angeles County Department of Public Health, said last week that his agency had already made attempts at special outreach and participation in the H1N1 campaign, and participation is still lagging. ... Dr. Eric Frykman, health officer for Riverside County, said that he has asked clinic managers to informally start tracking participation by ethnic group" (Steinberg, 11/29).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at

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."

Swine Flu Emergency Should Put IT on Alert

Though the H1N1 flu has been declared a national emergency by President Barack Obama, experts say that many companies remain ill-prepared for its potential consequences, which could include employee absentee rates of 40% or more.

While last month's emergency declaration is targeted mostly at helping health care providers and government agencies bypass regulatory requirements to provide critical care, experts say it should also be a red flag for the IT and business communities.

Organizations probably have not allocated enough resources for virtual private networks nor tested VPNs for the fact that 80% of their staff could be working from home," said Al Berman, executive director of DRI International, a training institute that focuses on helping businesses prepare for emergencies. "We ran some tests with companies, and they ran out of TCP/IP addresses in five minutes."

Berman said that many businesses are probably delaying VPN upgrades because of increasing bandwidth costs. For example, he said, DRI recently met with officials of a large insurance provider and found that it would cost the company $1 million to boost bandwidth enough to support 40% of its staff working from home.

The federal government's Flu.gov Web site, managed by the U.S. Department of Health and Human Services, offers guidance to businesses about what to do in the event of a pandemic. Its suggestions range from making sure sick employees stay home to appointing a pandemic coordinator or team to oversee the preparation and implementation of a disaster plan.

Employers should "send a very strong message to employees to stay home if they're sick. No one is that essential," said Kim Elliott, deputy director of Trust for America's Health, a public health advocacy group. "You don't want employees coming in and infecting others to the point where your business shuts down."

The pandemic coordinator or team should monitor employees to ensure that they follow basic rules of hygiene, such as washing their hands, and make sure that face masks are available, according to the Flu.gov Web site.

Elliott said that the planning process should also include an assessment of how the absence of a large number of employees would affect operations, with recommendations on how to keep things running under such circumstances.

"That may mean cross-training employees in some key business functions," Elliott said, citing IT infrastructure maintenance, bookkeeping and accounting duties, and some customer-facing activities.

Businesses should also develop a plan to communicate with municipal agencies, which determine whether bus routes, schools or even businesses need to be shut down, Berman said.
The national emergency declaration came after a weekly U.S. Centers for Disease Control and Prevention report called FluView noted that 43 states are now reporting widespread influenza activity and that H1N1 has caused 1,000 deaths in the U.S.

elevating its health emergency alert status to Phase 6 -- its highest level. At that time, the number of influenza cases was close to 30,000 worldwide. The WHO now says there are 414,000 confirmed cases of H1N1 and that there have been nearly 5,000 H1N1-related deaths.

iPhone App Tracks Swine Flu

A new, free iPhone app from the creators of HealthMap shows the outbreaks of the H1N1 swine flu in your area and elsewhere. The app, called Outbreaks Near Me, finds your location and shows a map with red pins indicating recent outbreaks.

The app updates every hour using reports from more than 30,000 sources. Users can report updates such as school closings through the app. The app was launched last month and now has been downloaded 81,000 times.

Red pins dot the state of California, with heavy concentrations in Los Angeles and the San Francisco Bay Area. Perhaps one of those red pins includes my friend (and many in his East Bay company) who came down with the swine flu a couple of weeks ago.

There are no warning signs, he says. One day you're happily working in your cubicle, and the next you're fighting a fever, vomiting and worse. He lost eight pounds in only a few days after losing his appetite for food and liquids. Luckily, I hadn't caught up with him in a while.

John Brownstein, an assistant professor at Children's Hospital Boston and one of HealthMap's creators, told the Wall Street Journal that the goal of the free app isn't to spark panic, rather to spread the word. To this end, he says, an app solely running on the iPhone isn't ideal. HealthMap is currently developing an app for Google's Android and, later, for RIM's BlackBerry.

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.

Swine flu vaccine ready, enters Europe

Global pharma major Novartis Friday announced it is ready with a swine flu vaccine and has started first deliveries to governments in Europe, giving hopes to people in many parts of the world.
"Novartis has already started first deliveries of pandemic vaccines under quarantine to governments in Europe, despite the initially low yields with the current production seed strain provided by the World Health Organisation (WHO). A new seed strain could provide higher volumes," the company said in a statement issued in Switzerland.


The company announced that Focetria®, the Novartis Influenza A(H1N1) 2009 monovalent vaccine, Friday received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMEA).


The company has started first deliveries of pandemic vaccines under quarantine to European countries, which means the vaccine is now ready with the governments but only after getting the formal approval the governments can start vaccination.


"The positive opinion clears the way for European Union approval in all 27 member states as well as in Iceland and Norway. Today's announcement marks a significant milestone in bringing a pandemic vaccine to market in Europe," the company added.


"Only three months after the declaration of the pandemic by the WHO, Novartis was able to ship the first batches of our pandemic vaccine under quarantine to governments in Europe pending EU approval," said Andrin Oswald, CEO of Novartis Vaccines and Diagnostics.


This CHMP positive opinion paves the way for EU approval, which will allow governments to begin their vaccination campaigns with the goal of reaching more patients before the rapidly spreading virus reaches them, Oswald added.


The pharma major, however, did not give details of the number of doses it has despatched or the countries which have received the first deliveries.


More than 150 countries have been affected by the new millennium's first pandemic. It has taken hundreds of lives across the globe.


In India, the virus has killed 286 people and infected more than 9,200 people till Sep 25.

Pvt hospitals still not ready for Swine flu

More than a week after Delhi Government's second deadline expired on September 15, private hospitals are yet to open doors to influenza A H1N1 patients.

Delhi reported 2,079 cases - 80 new cases - and 9 deaths till Wednesday evening. While most of the hospitals claimed to be ready and waiting for the state health department's approval, State Health Minister Kiran Walia said they were not.

"Our experts are going on a round of private hospitals virtually every day, and there are minor things that are hampering the approval process like system of ventilation," said Walia. "These hospitals aren't used to the concept of isolation and mostly work in a centralised system.

We may delay it by a few days but absolute compliance is a must. We can't cut corners and risk lives of people," she said.

"Our set-up is ready and we have conveyed this to the health department. Now, we are waiting for their inspection," said B.K. Rao, chairman of Sir Ganga Ram Hospital.

"Our infrastructure is in place, but we are awaiting formal approval from the government," said the Moolchand Medcity spokesperson. Similar reactions were given by Indraprastha Apollo Hospital, which said the hospital was waiting for the second inspection before starting the facility for swine flu patients.

On August 12, Principal Secretary (health) J.P. Singh issued a circular directing "all 200-bed non-government medical institutions/hospitals to set up a 10-bed isolation treatment facility with 15 days". The direction was issued under section 2 of the Epidemic Disease Act, 1897, which empowers the state government to take special measures and prescribe regulations in case of a dangerous epidemic disease.

"The step was taken as a precautionary measure in case the disease takes epidemic shape," said Singh. The hospitals had asked for more time and the state government extended the deadline by 15 days.

But none of the wards were functional

H1N1 vaccine data shows no side effects

Early data on the H1N1 vaccines show the vaccines to be highly effective with no adverse effects. Two peer-reviewed articles now published in the online first addition of new England Journal of medicine, which has the preliminary data of the monovalent H1N1 vaccine, have shown that the vaccines are working in a large number of healthy adults.

The two rivals, Greenberg et al and Clark et al, describe preliminary data on the immunogenicity of the influenza A (H1N1) 2009 monovalent vaccine. This data has been awaited, as governments, public health officials, and other stakeholders respond to the first influenza pandemic in over 40 years.

The study by Greenberg et al. shows that a single dose of nonadjuvanted vaccine containing the usual 15 �g of hemagglutinin (HA) antigen is immunogenic, or creates immunity, in a high proportion of healthy young and middle-aged adults. The study was conducted in Australia during a time when the virus was circulating, and one participant had laboratory-confirmed infection with the 2009 H1N1 virus.

The report evaluates immunogenicity and safety of the vaccine 21 days after the first of two scheduled doses is given. A total of 240 subjects, equally divided into two age groups, less than and over 50 years of age, underwent randomisation to receive either 15 �g or 30 �g of hemagglutinin antigen by intramuscular injection. No deaths or serious adverse events were reported, but mild discomfort like headaches were reported in a few cases.

The study by Clark et al, involving 175 adults between 18 to 50 years of age, to test the monovalent influenza A/California/2009 (H1N1) surface-antigen vaccine, concluded that the vaccine generates antibody responses within 14 days after a single dose is administered. The antibody tier protection was higher in those who had received two doses of the same vaccine.

China's mass swine flu vaccination

China is to become the first country in the world to start a mass swine flu vaccination programme for its population following a big surge in the number of cases.

No one's died yet from the virus in China but the authorities there describe the situation as 'grim'.

The big rise coincides with the start of the school year and the approaching winter.

Quentin Somerville reports.

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."

India's swine flu deaths 101, preventive homeopathy advised

India Tuesday reported one more swine flu death, taking the total toll due to the influenza A (H1N1) virus to 101, health authorities said here.

The latest death was reported from Goa. While two deaths in Karnataka were suspected to be due to the virus, lab reports were still awaited.

Of the 101 deaths, Maharashtra has recorded the highest number of deaths, 55, followed by 27 in Andhra Pradesh.

The union health ministry recommended preventive homeopathy medicine, Arsenicum album 30. The decision to advise people to take the preventive medicine was taken after the Central Council for Research in Homeopathy (CCRH), a state-run research wing, gave the suggestion for curbing the spread of the diseases.

'It has recommended one doze of the medicine daily on empty stomach for three days. The dose should be repeated after one month by following the same schedule in case flu like conditions prevail in the area,' the ministry said in a statement.

Meanwhile, 114 people were tested positive for the influenza A (H1N1) virus Tuesday in the country, taking the total number of cases to 4,101.

Maharashtra continued to top the charts both in terms of deaths and positive cases. On Tuesday, 48 fresh cases were from the state alone. So far, about 1,687 people have been affected due to the virus in the state.

It was followed by Delhi in the number of cases. At least 665 people have been infected with the disease in the capital. On Tuesday, 10 fresh cases were reported in the Indian capital.

Karnataka reported 22 fresh cases, taking the total number of people infected with the virus to 463 - the third highest in the country.

Other fresh cases were reported from West Bengal (18) and Orissa (3). One case each was reported from Haryana, Jammu and Kashmir and Chhattisgarh while Puducherry and Chandigarh reported two swine flu cases each.

Meanwhile, a government study has found that swine flu is killing more young and middle-aged people and those suffering from associated diseases like diabetes and chronic heart ailment.

'We have conducted a study and found that more than 50 percent of those affected by the virus were in the age group of 15-45 years,' R.K. Srivastava, director general of the Directorate General of Health Services, told reporters.

'Deaths were also due to late reporting to identified health facilities and delay in initiation of Tamiflu,' he said.

The report, which was presented to Health Minister Ghulam Nabi Azad during Monday's stock-taking meeting of the ministry, studied the first 82 deaths that occurred till Aug 31.

Among the dead were 43 men and 39 women including three pregnant women.

Srivastava said that of the 82 deaths, 61 were in urban areas and 19 in rural areas.

He said there were five deaths in the age group of 0-5 years and three from 6-15 age group. Thirteen victims were from the age group of 16 to 25 years, while 18 people died in the age group of 26-35 years.

Srivastava said 24 people died in the age group of 36-45, as compared to 18 in the age group of 46-65. Only one person died in the above 65-year category.

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

Deal 'close' over swine flu jabs

Doctors' leaders say they are hopeful that an agreement can soon be reached in negotiations with government over the swine flu vaccination programme.


Ministers unveiled plans on Thursday to vaccinate over 13 million people in the first wave of the UK programme.

But officials were forced to admit GPs had still not signed up to the deal.

The British Medical Association has asked for extra funds to administer the two-shot jab, which some campaigners have dubbed ludicrous.

The government had hoped to have the GPs on board by the time it announced its plan this week.
But negotiations have taken longer than expected. Doctors are paid £7.51 for each seasonal flu vaccine and other jabs, such as travel inoculations.

They are not expecting that amount for what may turn out to be a mass vaccination programme, but have argued in talks that they need extra money to cover staffing and administration costs and the overtime they may need to do.

They have also asked for their bonus payments to be protected if work such as blood pressure checks is affected.

Under the programme put forward, people with health conditions, such as heart disease and diabetes, pregnant women, those with weakened immune systems and frontline health and social care workers will be the first to receive the jab.

This amounts to more than 13 million - about a fifth of the UK population.

It has not been decided whether the rest of the population will then be immunised, although the government has ordered enough vaccine to do so.

There is still time to broker a deal as the vaccination programme will not be started until regulators have approved the vaccine. This is not likely to happen until the end of September at the earliest.

'Ludicrous'
Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said: "Talks with the government remain ongoing and we are hopeful that these discussions will conclude shortly.

"Currently, the health service is working well in response to this enormous challenge and all doctors will continue to work hard on behalf of all their patients."

But Susie Squire, political director at the Taxpayers' Alliance, said: "It is the job of GPs to provide frontline healthcare - and they are well paid by taxpayers for this service.

"To pay them extra to administer swine-flu injections is ludicrous. As doctors they should understand that public health is unpredictable and sometimes there are epidemics or accidents that have to be dealt with, and this can mean unpaid overtime."

A Department of Health spokesman said: "We are now working with BMA and NHS organisations to reach a comprehensive swine flu vaccine implementation plan for this first stage of the programme."

Aishwarya denies swine flu rumour

During a press conference held in Hyderabad on Saturday after the launch of Swiss watchmaker Longines' new collection Conquest Ceramic sports watches at a store in Nagarjuna Hills, India's much-celebrated actress Aishwarya Rai Bachchan has denied all the rumours that she was down with flu for four days. The former Miss World said: My father-in-law Amitabh Bachchan had mentioned on his blog that I was down with flu but many misunderstood it to be swine flu. I am healthy and back to my work. Replying to a question about endorsing international brands, the actress said she was lucky to work with ace film directors, technicians and photographers and gave the credit to them and her family for all the name and fame she has acquired. On her plans to host television shows in the footsteps of superstar Amitabh Bachchan, she said, Many production companies did approach me but my schedule is too full and I had to decline their offers.

Swine flu could kill as many as 30,000 to 90,000 people in US

Washington, August 25 (ANI): In a recently released report, the Obama administration's advisory group on Science and Technology has said that the H1N1 flu virus, dubbed 'Swine flu', could cause as many as 30,000 and 90,000 deaths in the United States and pose a serious health threat.

According to Fox News, deaths would be concentrated among children and young adults, determined the report.

In contrast, the typical seasonal flu kills between 30,000 and 40,000 annually - mainly among people over 65.

The report predicts 1.8 million will be hospitalized during the epidemic, with up to 300,000 patients requiring intensive care units.

These patients could occupy 50-100 percent of all ICU beds in affected regions at the peak of the epidemic and would place "enormous stress" on ICU units.

More needs to be done to speed up the "preparation of flu vaccine for distribution to high-risk individuals," otherwise the vaccine campaign - currently scheduled to begin in mid October - will have potentially missed the peak of the epidemic, according to the report.

The report from the President's Council of Advisors on Science and Technology, PCAST, shows a sober assessment of the dangers of a pandemic, but also serves as a pat on the back for a White House preparing for its first public health crisis.

"Based on the history of influenza pandemics over the past hundred years, PCAST places the current outbreak somewhere between the two extremes that have informed public opinion about influenza," stated the report.

"On the one hand, the 2009-H1N1 virus does not thus far seem to show the virulence associated with the devastating pandemic of 1918-19. On the other hand, the 2009-H1N1 virus is a serious threat to our nation and the world," it added.

This is due to the likelihood that more people will be infected because so few people have immunity to the strain.

As a result, PCAST recommends that the Food and Drug Administration "accelerate a decision about the availability of antiviral drugs for intravenous use."

The current expectation is that the vaccine will be available in mid-October.

According to Harold Varmus, PCAST co-chair and President of Memorial Sloan-Kettering Cancer Center, despite the long 'to-do' list, the Obama administration has thus far done a good job of preparing for a national outbreak.

"The Federal Government's response has been truly impressive and we've all been pleased to see the high level of cooperation among the many departments and agencies that are gearing up for the expected fall resurgence of H1N1 flu," he said.

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.