A panel of experts that advises the US Centers for Disease Control and Prevention (CDC) on vaccine issues, voted this week to recommend that all persons aged 6 months and over receive annual influenza vaccinations.The effect of the CDC’s Advisory Committee on Immunization Practices (ACIP) recommendation is to expand the proportion of people recommended to have flu shots from the current 85 per cent of the population (the higher risk groups) to virtually 100 per cent. Exceptions include babies under 6 months old and people with egg allergies (the vaccine is cultured in eggs) and other unusual conditions.

The panel voted 11 to 0 with one abstention, on Wednesday in Atlanta. According to a report in the Washington Post, when the vote was cast, there was a short round of applause in the public meeting room, reflecting the fact some public health experts and doctors have been pushing for everyone to be included the annual flu shot recommendation for more than 10 years.The CDC usually follows the advice of its advisory panels, so the recommendation is likely to be adopted and then it will be communicated to all doctors and hospital throughout the US. A statement on the CDC website said that the expanded recommendation is to take effect in the 2010 – 2011 flu season and that it seeks to:

“Remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population.”

A CDC flu specialist, Dr. Anthony Fiore, told the Washington Post that:

“Now no one should say ‘Should I or shouldn’t I?’”

The ACIP meeting focused on the value of protecting people aged 19 to 49 (the group not included in the current recommendation). This group was hit hard by the 2009 H1N1 pandemic virus, which experts predict is likely to continue circulating in the next flu season and even after that.Another reason given for moving to universal vaccination, apart from the simple practicality of giving out an all inclusive message, is that many people currently advised to have the flu shot are not aware that they are at higher risk and should have the vaccine.Also, new data gathered during the 2009 H1N1 shows that some people who are currently not covered by a specific recommendation to receive an annual flu shot may also be at higher risk of flu-related complications. These groups include people who are obese, certain racial/ethnic minorities and women who have just had babies.

The panel recognized that more doses will be needed to cover the coming season’s requirement, but based on current projections, the CDC statement said that:

“More licensed types and brands of seasonal influenza vaccines will be available in the 2010-11 influenza season than has ever been available before.”

CDC records from past years show that less than half the number of people recommended for vaccination actually get their flu shot.The CDC stressed that although the annual flu vaccine is a safe and preventive health action that benefits everyone, we must not forget that some groups are still at higher risk of flu complications. These include people aged 65 and over, children under 6 months, pregnant women, and anyone with certain chronic medical conditions.The main focus of a vaccination campaign, even if it is universal, should be to ensure these groups, and the people they come into close contact with, get their annual shots, said the CDC.

Sources: CDC, Washington Post.

Social interaction between neighbours, work colleagues and other communities and social groups makes voluntary vaccination programs for epidemics such as Swine Flu, SARS or Bird Flu a surprisingly effective method of disease control.

New research published today, Thursday 11 February, in New Journal of Physics (co-owned by the Institute of Physics and German Physical Society), shows that contact with others can positively influence individuals to choose voluntary vaccination when considering the pros and cons.

The group of Chinese researchers found that in scale-free networks – social networks with an uneven distribution of connectedness such as neighbourhoods, work places or gyms – the so-called hub nodes, people with multiple social connections, tend to choose to vaccinate themselves as they are at higher risk of infection from others, thus containing the spread of epidemics.

Based on their studies, the researchers have observed that at the beginning of an epidemic, when levels of infection are high, a large number of people will gradually take vaccination. As the effects of the temporary vaccination wear off, a second wave of outbreak will occur, however on a less severe level due to the number of individuals with still effective immunisation.

This is why outbreaks of disease and voluntary vaccination occur periodically, eventually settling down to a stable state. Individuals with a large social network play a crucial role in this cycle as, given information on the spread of the disease is freely available, the majority of them will choose voluntary vaccination.

In order to set up an effective vaccination strategy it is therefore crucial to affect the hub nodes’ willingness to vaccinate, which can potentially be negatively influenced by factors such as the risk of infection, the coverage of disease and the cost of vaccination.

As the researchers write, “Sometimes the high costs of vaccination or misunderstanding the side effect of vaccinations can reduce the enthusiasm for taking vaccination. In this case the external incentives such as subsidy of vaccination cost would be helpful in enhancing the vaccination inclination of the hub nodes.”

Source:
Joseph Winters
Institute of Physics

There could be third wave of H1N1 infection in B.C. but the province’s chief medical health officer thinks the chances of that happening are “diminishing.”While there will be one final report next week, Dr. Perry Kendall and Ida Chong, the Minister for Healthy Living and Sport, gave the media their last comprehensive update Thursday on the influenza pandemic that turned out to be less deadly than expected.Chong thanked everyone in the health sector for fighting the disease.“These are people that rose to the occasion,” said Chong.Kendall, while repeatedly stressing the need for continuing vaccinations, was optimistic about the flu fight being over for now.

“I personally feel the risk of a third wave is diminishing,” said Kendall, who nonetheless hedged his bets.
“Influenza is unpredictable,” he said.

If the disease was to come back, “it would occur a couple of months after the last wave,” said Kendall.
The peak of the second wave came in the last week of October.There are usually 400 to 800 deaths associated with the flu annually in the province, mostly in the elderly.There were just 55 deaths positively linked to H1N1 but the disease differed from typical flu bugs in that it affected younger people.Kendall guessed about 25 per cent of the province was actually infected with H1N1 but the effects were less severe than other strains and there was also a significant distribution of anti-viral drugs to treat the illness.

There have not been any severe H1N1 cases reported since Jan. 19 and since April 2009 the total of severe cases was 1,032.B.C. is prepared if there is another wave of H1N1.The province ordered 4.2 million doses of the vaccine, enough to cover the entire population.An exact total of how many doses were administered was not available but Kendall said approximately 38 to 40 per cent of the province was vaccinated.The rate was below the Canadian average of 45 per cent but much better than many other countries such as Australia (25 per cent), the U.S. (20 per cent), Japan (12 per cent) and the U.K. (seven per cent).
The immunization rate in B.C. was much higher among First Nations, according to Kendall and ranged from 71 per cent to 140 per cent on one reserve where people came from outside the area to receive the vaccine.About 750,000 doses have been loaned to Mexico and will be replaced when that country’s production ramps up.Another 500,000 doses are at the B.C. Centre for Disease Control and another 250,000 are distributed around the province.

Unless there is a greater supply of vaccine for the next pandemic, Kendall said the distribution plan would again target the most at-risk first.But he also believes there needs to be better “queue management.”

“We need to be able to deliver it more efficiently or more conveniently,” he said.

The provincial government set the budget for the entire H1N1 program in B.C. at $80 million. That total includes everything from the vaccine to clinics to paying for doctors to take calls about the flu and has not been exceeded.

It is not too late for those who have not been immunized against the novel H1N1 influenza A virus or seasonal influenza to protect themselves from a potentially serious and possibly fatal illness.

“Flu is very unpredictable,” said Dr. Peter Wenger, an associate professor in the departments of Preventive Medicine & Community Health and Pediatrics at the UMDNJ-New Jersey Medical School. “Though H1N1 activity appears to be waning nationwide and is no longer widespread in New Jersey, we could see another wave as the winter progresses, possibly even into March or April,” he said. “The prudent course is to protect yourself and those around you, and the best way to do that is through vaccination.”

As of mid-November, an estimated 47 million persons in the United States had been infected with the H1N1 virus, resulting in an estimated 213,000 hospitalizations and 9,820 deaths, according to figures just released by the U.S. Centers for Disease Control and Prevention. In contrast with previous influenza seasons, approximately 87% of influenza-related deaths from the H1N1 virus had occurred among persons younger than 65 years of age.

“People might say ‘Oh, the flu season is almost over. Why should I get vaccinated?’ You really should because the flu season, as last year showed, can extend into spring,” Wenger noted.

“Influenza is not a disease to fool around with,” he warned. “Why wouldn’t you want to protect yourself against something like that? Even if you get what’s called ‘mild disease,’ you’d be sick for about a week and be pretty miserable. Why go through it?”

Those still on the fence about getting immunized should not worry about the H1N1 or seasonal flu vaccines’ safety, Wenger said. “We’ve been giving the seasonal flu shot for decades now, and it’s proven to be a very safe and effective vaccine in most who have received it,” Wenger noted. “The H1N1 flu vaccine is processed and produced exactly the same way as the seasonal flu vaccine, and studies have shown that the new vaccine is as safe as the seasonal flu vaccine.”

Wenger encourages everyone, especially younger people those under the age of 50 and anyone with underlying conditions such as asthma, to get vaccinated now.

The University of Medicine and Dentistry of New Jersey (UMDNJ) is the nation’s largest free-standing public health sciences university with nearly 5,700 students attending the state’s three medical schools, its only dental school, a graduate school of biomedical sciences, a school of health related professions, a school of nursing and its only school of public health on five campuses. Annually, there are more than two million patient visits at UMDNJ facilities and faculty practices at campuses in Newark, New Brunswick/Piscataway, Scotch Plains, Camden and Stratford. UMDNJ operates University Hospital, a Level I Trauma Center in Newark, and University Behavioral HealthCare, a statewide mental health and addiction services network.

Source: University of Medicine and Dentistry of New Jersey

There is a surplus of about 5,000 doses of the swine flu vaccine in Nunavut, according to health officials.The leftover doses are in every community across Nunavut, the Health Department says.Officials believe local health centres are still seeing a few people who were unable to get the vaccine during immunization clinics in November.

The department estimates about 60 per cent of Nunavummiut had received the H1N1 shot by the end of the mass vaccination campaign. That figure is expected to be updated sometime in the new year.The current vaccine will remain available until it expires this fall.However, if the H1N1 virus is still present by the fall, health officials say an H1N1 component may be included in the next seasonal flu vaccine.There have been 33 confirmed cases of swine flu since the beginning of October. No new cases were confirmed in the last two weeks.

After doing immunizations at about 100 schools and offering community events geared toward people at greatest risk, the Polk County Health Department says its clinics are open to anyone who isn’t able to get the H1N1 swine flu vaccine from a private provider.Some private groups, doctors, pharmacies and large employers with medical clinics also have the shots. At least one pharmacy chain, Walgreens, is advertising its availability.

‘Anyone who calls us wanting an appointment, regardless of whether they’re in a priority group or not, can get the vaccine,’ said Daniel Jimenez, the department’s public information officer. ‘Now we’re trying to get it out to the general public.’Despite a couple of recalls, in which some H1N1 doses were safe but not as strong as originally thought, state and local public health officials recommend that people interested in getting vaccinated go ahead and do it. But people who got the vaccine from ≠recalled batches don’t need to get re-vaccinated.

The H1N1 flu has been unpredictable, with a couple of peak periods this year, and there’s no way to know for sure whether it will have another surge later in the winter, health officials said. The regular flu season often doesn’t peak in Florida until February.Polk County has had nine deaths related to H1N1 swine flu, although only eight have been recognized officially. One was a 4-year-old girl who was recovering from the flu. She died of other, unrelated medical issues, but the death is recorded among swine flu fatalities.Five women and three men, ages 31 to 71, are Polk’s other swine-flu-related deaths. One of them, a woman who was 43, lived in Polk for a few months before getting the flu, but her death was recorded in the area considered her home.

All the adults who died in Polk County had medical complications putting them at higher-than-average risk, and none had gotten the H1N1 swine flu shot, said Dr. Daniel Haight, director of the Polk Health Department.Health officials say more than a million Floridians have received swine flu vaccinations.Florida Department of Health spokesman Doc Kokol said everyone should make plans to get shots or the nasal spray vaccine.

Priority groups recommended by the federal Centers for Disease Control and Prevention to receive the H1N1 vaccine first include pregnant women, people who live with or take care of infants younger than 6 months old, and health care and emergency medical personnel. Also seen as a priority is anyone between 6 months and 24 years old, and anyone between 25 and 64 years old who has medical conditions that put them at higher risk.

Call 863-519-7510 to make appointments for the vaccine at one of the Polk Health Department’s clinics. The state flu information number is 877-352-3581.

Obama was comfortable getting the swine flu shot, and having his family vaccinated against the H1N1 flu virus, does this mean that getting the H1N1 vaccine is perfectly safe?  President Obama said in an interview with April Ryan of the American Urban Radio Network, “people need to understand that the vaccine is safe,” and in many cases it is.  Tens of thousands of people have gotten the swine flu shot and have only walked away with a sore arm, perhaps an upset stomach, fever, and a headache.  Others have had a severe allergic reaction due to a bad batch.  Many pregnant women have questioned the strange and terrible occurance of losing their baby within hours or a couple days of getting the H1N1 vaccine.  Flu.gov, the government’s flu information site has called the miscarriages nothing but coincidence.

How does anyone know for sure if the swine flu shot is safe, and what exactly are all of the side effects of the H1N1 vaccine?

As much as the medical community and the government firmly stand behind their motto, that everyone should get the swine flu shot, the public may be better served using their own judgement.  The H1N1 vaccine was very recently created, and its side effects and potential risks are untested beyond the people who have taken the swine flu shot so far this year — that is a fact.  For perfectly healthy people, supplements of echinacea and vitamin C to boost the immune system may be a much safer way to prevent the flu.  For people in at-risk gorups, the decision is much more difficult, but there is information out there on what exaclty a vaccine does to the body, and why it may or may not be necessary.

The El Dorado County Health Services Department, Public Health Division is holding upcoming community H1N1 (swine) flu vaccination clinics for the general public. There is no cost to receive the vaccine. The vaccine will be administered subject to availability. The upcoming H1N1 vaccination clinic dates and locations include:

* December 28, 2009 from 1 p.m. to 4 p.m. at the Pollock Pines Community Church, 6361 Pony Express Trail, Pollock Pines, in the Fellowship Hall.

* January 5, 2010 from 3 p.m. to 6 p.m. at the Divide Wellness Center, 6065 Highway 193, Georgetown.

* January 10, 2010 from 12 p.m. to 3 p.m. at the El Dorado Hills Community Services District, 1021 Harvard Way, El Dorado Hills, in the gymnasium.

* January 14, 2010 from 1 p.m. to 3 p.m. at Pioneer Bible Church, 6851 Mount Aukum Road, Somerset.

Additional community H1N1 flu shot clinics will be scheduled as more vaccine becomes available. Dates and locations of those vaccination clinics will be posted to the County’s website and through local media as soon as that information is available.

“Although the vaccination clinics are open to everyone, we encourage those who are at high risk, and who have not yet been vaccinated, to come,” said El Dorado County Health Officer, Dr. Olivia Kasirye. “People who have a family doctor should check with their doctor about getting the H1N1 vaccine in the doctor’s office if they can. Availability of the vaccine has increased over the past few weeks, so more doctor’s offices should have it now.”

The H1N1 flu vaccine is made using the same manufacturing methods as those used to make the seasonal flu vaccine. There are some individuals, such as those people who are severely allergic to eggs and infants under the age of six months, who should not receive the H1N1 vaccine. Individuals who are not sure if they should receive the vaccine should consult with their health care provider. Detailed information about the H1N1 vaccine can be found at www.flu.gov.

Primary symptoms of H1N1 (swine) flu include fever of 100 degrees or higher, with cough. People with flu symptoms should stay home from work or school until their fever has been gone for at least 24 hours. Individuals with severe symptoms, such as difficulty breathing or dehydration from vomiting and/or diarrhea, should seek medical advice. Pregnant women and people with chronic health conditions (such as a respiratory condition, immune disorder, or diabetes) should seek early medical care if they get the flu.

Updated local information on H1N1 (swine) flu can be found at www.edcgov.us/publichealth.

Washington (SmartAboutHealth) – The H1N1 swine flu has dominated headlines for months now, but with the number of cases appearing to shrink, can we stop worrying about the virus?

The H1N1 swine flu has ran rampant all over the world since it was first spotted last April, and has sickened hundreds of thousands of people.On top of making people sick, it has also led to thousands of deaths.The H1N1 swine flu has been most devastating in regards to causing younger people as well as the elderly to become ill.WHat is taking place now though is quite interesting, as recently, the number of H1N1 swine flu cases have appeared to be diminishing in the United States.This is not present, however, in other part so the world, where it has yet to peak.

The World Health Organization (WHO) has made it very clear that they believe the H1N1 swine flu is only going to get worse, but is this the case for the U.S.?
The swine flu vaccines are becoming much more available in regards to the ability of people in the U.S. to receive them.Only time will tell if the H1N1 swine flu is in decline in the U.S., but as of right now it certainly appears so.

MANILA, Philippines—The Department of Health is still waiting for the 1.2 million doses of Influenza A (H1N1) vaccine earlier committed by the World Health Organization.Health Secretary Francisco Duque III and WHO Director General Margaret Chan announced last month that the WHO would turn over a total of nine million doses of H1N1 vaccine to the Philippine government as part of its pledge to give developing countries access to the much-needed medication.

The first delivery of the vaccine consisting of 1.2 million doses is expected before the end of year.

“We’re still waiting, although the commitment of the WHO is before the year ends. Our vaccination
program is already in place, we are ready when the vaccines arrive,” said Dr. Lyndon Lee Suy, DOH program manager on emerging and re-emerging infectious diseases.

The DOH has said it would give priority to about 400,000 frontline health workers because they are at “higher risk of getting the disease than ordinary people due to the larger probability of exposure.”Health workers have to be vaccinated against the novel flu virus since they may unknowingly transmit the infection to their families and other patients with other illnesses.Lee Suy said social workers and members of the military who directly deal with health patients would also be vaccinated.

The vaccination however will be purely voluntary, according to the DOH. The vaccine will also be administered free of charge.As of Nov. 7, DOH records showed that at least 32 people with H1N1 infection have died out of the 5,463 confirmed cases since the monitoring started in May.Lee Suy said top government officials including the President and the Vice President would be given the vaccine.“They are also considered in the frontline too. It’s not a matter [of the personalities]. We think of the position. If they fall ill, the government functions will also be affected,” he said.

PIERRE – More than 2,000 South Dakotans have had laboratory-confirmed cases of H1N1 influenza and an estimated 50 times that many have had H1N1 but not been ill enough to seek medical care, says a state health official. Some 200,000 more have been vaccinated for H1N1 to date, leaving two-thirds of the state’s residents still at risk for H1N1 and its complications as the virus continues to circulate.

“The flu season is far from over in South Dakota. It would not be unusual to see an increase in cases in the next few weeks as people travel and mingle for the holiday season,” said Doneen Hollingsworth, Secretary of Health. “We strongly encourage people to take advantage of the opportunity to be vaccinated now while we have vaccine and activity is lower. The more people we vaccinate now, the less disease we can expect to see as the season progresses.”

The state has now received and shipped out more than 240,000 doses of vaccine to over 400 locations in the state. With projections calling for that supply to continue increasing, the secretary said there is sufficient vaccine to start reaching out to the general population. Earlier supplies were targeted at individuals considered to be at highest risk.

Hollingsworth said public clinics continue to be scheduled at locations across the state, including schools, community centers, fire halls, senior centers and even this week’s Lakota Nation Invitational basketball tournament in Rapid City. A list of public clinics, updated daily, can be found on the department’s web site at http://h1n1.sd.gov under “Vaccination Dates.”

The vaccine is also available from private clinics and physician offices and the department’s own Community Health Services offices at the county level. Beginning December 21, vaccine will also be available at those pharmacies in the state that have chosen to be providers. A list will be available on the vaccination web site.

H1N1 vaccination is completely voluntary. The vaccine is free but some private providers may charge an administration fee. There is no fee charged at the public clinics or at the department’s Community Health offices.

In addition to H1N1 and seasonal flu vaccination, people can help prevent the flu by frequent hand washing, covering coughs and sneezes, and staying home when sick.

Go to http://h1n1.sd.gov and click on “Vaccination Dates” for an updated listing of scheduled clinics.

Scheduled H1N1 Vaccination Clinics

The listing of upcoming public clinics can be found on the web at http://h1n1.sd.gov under “Vaccination Dates.” In addition to these public clinics, the vaccine is also available from private clinics and physician offices and the department’s own Community Health Services offices at the county level. All South Dakotans are now eligible for H1N1 vaccine. Vaccination is voluntary and there is no charge for the vaccine. Private providers may charge an administration fee. There is no fee at the public clinics or at the department’s Community Health offices.

Friday, December 18

· Aberdeen – Avera St. Luke’s Midland Campus, 1400 15th Ave. NW (North U.S. Highway 281; enter through the west – Door 3), 8 a.m. – 1 p.m.

Monday, December 21

· Baltic – Baltic School, 1 Bulldog Avenue, 1 – 7 p.m.

· Roscoe – Roscoe Fire Hall, 208 Mitchell St. – 3 – 6 p.m.

Tuesday, December 22

· Belle Fourche – Butte County Community Health Office, 830 6th Ave., 8 a.m. – 1 p.m.

· Britton – Marshall County Community Health Office, 909 S. Main, 1 – 6 p.m.

Canadian scientists have helped make a discovery that might explain why some people develop severe illness when infected with H1N1 flu and others don’t.The researchers from Toronto’s University Health Network found high levels of a molecule called interleukin 17 in the blood of severely ill H1N1 patients, and low levels in patients with mild forms of the disease.Interleukin 17 is a cytokine, a kind of molecule that helps regulate the body’s white blood cells which fight viral, bacterial and other infections.But interleukin 17 can also go “out of control” in some cases and has been linked with such inflammatory autoimmune diseases as rheumatoid arthritis and asthma.

In the cases of respiratory infections, cytokines plays a part in a potentially fatal immune reaction called a “cytokine storm,” in which the immune system of a healthy person goes haywire and “overreacts” to an infection. The cytokines command a patient’s body to flood the lungs with fluids and mucous, which can eventually block off the airways and “drown” the patient.

Cytokine storms are what are thought to have caused many of the deaths in the SARS outbreak, bird flu, and the 1918 Spanish flu, which killed a disproportionate number of otherwise healthy adults.For this latest study, to be published in the journal Critical Care, the Toronto researchers joined a team from Spain to examine a group of otherwise healthy Spanish patients who became infected with H1N1 during the first wave, in July and August 2009. The group included 20 hospitalized patients, 15 outpatients with mild forms of the illness, and 15 control subjects who weren’t infected.

The researchers focused on 29 cytokines and analyzsed them to find any patterns among the study volunteers.They found that those with severe symptoms from the flu had elevated levels of interleukin 17, while patients with the mild form of the disease had low levels.Dr. David Kelvin, the leader of the Canadian team and the head of the Experimental Therapeutics Division at the Toronto General Hospital Research Institute, says the discovery is the first clue about what could be causing some patients to develop potentially fatal lung inflammation and pneumonia.Kelvin said it is still not known whether high levels of interleukin 17 are always present in patients, or if they are overproduced only in response to the virus. But he told the Globe and Mail that IL-17 levels are likely high in patients who develop other lung infections.

“It’s probably not an isolated example that is specific for H1N1, and it probably spills over to other types of respiratory illness,” he said.

Kelvin said his team believes the discovery could lead to preventive therapies that would target IL-17 in future flu pandemics and other outbreaks, potentially speeding recovery.As well, a test to determine who has high levels of the molecule could be possible in the near future.

“A diagnostic test could let us know early who is at risk for the severe form of this illness quickly,” he said, noting that high levels would indicate a failure of the immune system to eliminate the virus.

He cautioned, though, that the clinical application of this work is still many years away.Researchers are now expanding on the study to look for similar patterns in people living in other countries, such as China.

Dr Brian Dunn, Chairman of the BMA’s Northern Ireland General Practitioner Committee has responded “with disappointment” to yesterday’s comments about the H1N1 vaccination programme that have been made by Mr John Compton, Chief Executive of the Health and Social Care Board.

Dr Brian Dunn, a general practitioner in Larne tonight said,

“GPs are incredibly disappointed at the comments made by Mr Compton, who is Chief Executive of the body that has been asked by DHSSPS to approach GPs to negotiate a local, Northern Ireland, solution to the under fives swine flu vaccination phase.

“Either Mr Compton does not understand the situation or he is deliberately misleading the public. “The breakdown in negotiations regarding this phase of the H1N1 vaccination programme was not over money. It was about the desire of GPs to be able to continue their normal clinical work to look after all patients, in the midst of delivering swine flu vaccinations.

“Northern Ireland GPs do not want more money than what was offered.

“What GP negotiators have consistently asked for is a reduction in the bureaucracy associated with their contract to allow them to cope with this vaccination programme in addition to their ongoing work, without harming patient safety and other aspects of medical care”.

Dr Dunn concluded,

“It is interesting that Mr Compton’s Board is the body tasked now with the delivery of this phase of the vaccination programme. NIGPC presumes by his comments that he has organised an alternative programme that will not be delivered by GPs”.

Source: The British Medical Association

OTTAWA — As cities across the country announce plans to wrap up their mass H1N1 vaccination clinics, federal officials said Wednesday that about one-third of Canadians have so far rolled up their sleeves for the shot, which leaves millions more still vulnerable to infection.Vaccination rates among the provinces and territories are varying from 25 to 66 per cent but Dr. David Butler-Jones, Canada’s chief public health officer, said most jurisdictions are hovering around 30 to 40 per cent coverage.

“We want to immunize as many people as possible, as are willing, because at the end of the day this is a virus which will almost certainly continue to circulate and so if you’re vulnerable and you’ve not been immunized and you haven’t already been ill, then at some point you will become infected with this virus,” Butler-Jones said in a news briefing.

The H1N1 flu pandemic has been waning in recent weeks but it would be “imprudent” to declare that Canada has reached the peak of this second wave of disease and to predict that the activity will continue to decline, said Butler-Jones. In the pandemic that occurred in 1957-58 cases also waned after a spike in the early fall, only to see a resurgence of serious illness in December and January, he said.Butler-Jones answered critics who have called for the H1N1 immunization campaigns to be halted because they say enough Canadians have already been exposed to the virus and developed immunity or received the vaccine.

“Unfortunately there are Canadians who are denying themselves the benefits of vaccination because they believe that we’ve reached a critical mass of population with immunity. I question that logic,” said Butler-Jones.

Cities across the country have begun announcing that the public H1N1 vaccination clinics will be wrapping up in the coming days.Ottawa is closing its clinics after this Saturday and then will operate roving clinics, while Toronto is shutting its doors after Sunday. Halifax wraps its clinics up next Tuesday, and Vancouver will stop offering the shots after Dec. 18.

Butler-Jones was not critical of the decisions to close down mass clinics, saying that in the first few weeks of the campaign, when vaccine supply was limited, it made the most sense to offer it through mass clinics. Now that there is a steady supply — by the end of this week about 24 million doses will have been distributed — it can be offered through other venues, Butler-Jones said, such as doctor’s offices or workplaces.

Canada has ordered 50.4 million doses of the H1N1 vaccine and if uptake doesn’t improve, could potentially have millions of leftover shots.

Discussions with the manufacturer, GlaxoSmithKline, the World Health Organization, and other stakeholders regarding excess vaccine are ongoing and no decisions have been made, said Butler-Jones. He pledged, however, that no vaccine would be wasted.
© Copyright (c) Canwest News Service

H1N1 vaccine is now available to all residents in Maryland and Georgia, state health officials announced. The two states join a growing number of state and local governments expanding the availability of swine flu vaccine beyond the initial priority groups, which include health care workers, children, pregnant women and persons with underlying medical conditions.The trend comes as reported cases of H1N1 continue to decline and manufacturers are able to produce more vaccine — easing a nationwide shortage.Still, questions have surfaced as to whether some major corporations in at least three states received preferential treatment when vaccine was scarce. Public outcry over Wall Street firms receiving doses in October prompted USA TODAY to review vaccine distribution in other states.

According to the newspaper, several hundred doses went to defense contractors and petroleum companies in Texas, as well as a 2,120 dose shipment to the Toyota Family Health Center in San Antonio. USA TODAY also reports Norwegian Cruise Line in Miami used 300 doses to vaccinate medical staff, youth counselors and other shipboard employees and that Walt Disney World got 2,200 doses for its “college-age theme park workers and members of its 100-person medical team.”

“Of the 2.42 million doses in Texas and 2 million in Florida distributed through mid-November, fewer than 1% went to employers,” according to USA TODAY’S analysis. But these big corporations were receiving vaccine at a time thousands of doctors and hospitals had none.

While the federal Centers for Disease Control and Prevention issues recommendations for which groups should receive priority for immunization, state and local governments direct vaccine distribution.The thinking among public health officials is that one size does not fit all. What works to mitigate an epidemic in Montana, may not work in New York — or, for that matter, Florida and Texas. The private sector always plays a role in flu immunization efforts — from the companies that make the vaccine to the drug store clinics that provide shots.

Big employers are a convenient venue for large numbers of people to get vaccinated. One could argue Disney World’s workforce is at elevated risk of acquiring the virus because of its relatively youthful age, and that vaccination not only protects those employees, but the thousands of theme park visitors they come in contact with each day.

It would be less of an issue if this were a typical outbreak of seasonal flu, where vaccine supply generally exceeds limited demand. But with H1N1 vaccine in such short supply back in October and early November, doctors, politicians and, no doubt, readers of this blog will debate whether distributing doses to big business was preferential treatment or practical public health.

Infection with the H1N1 virus, or swine flu, causes more life-threatening complications than seasonal flu in children with sickle cell disease, according to research from Johns Hopkins Children’s Center. The findings, to be presented on Dec. 7 at the annual meeting of the American Society of Hematology, warn parents and caregivers that such children are more likely to need emergency treatment and stays in an intensive-care unit.

The researchers analyzed the records of 118 children with sickle cell disease treated for any kind of flu at Hopkins Children’s between September of 1993 and November of 2009. Of them, 28 were infected with the H1N1 virus, a new strain that emerged for the first time in April of 2009.

While both the seasonal flu and the H1N1 virus caused similar general symptoms like fever, cough and a runny nose in most of the children, sickle cell patients infected with H1N1 were three times more likely to develop acute chest syndrome, a leading cause of death among these patients, marked by inflammation of the lungs, reduced oxygen capacity and shortness of breath. H1N1-infected children were five times more likely to end up in the intensive-care unit, and were overall more likely to end up on a ventilator and more likely to need a blood transfusion than those with seasonal flu.

Another Hopkins Children’s study, released earlier this year, found that children with sickle cell disease are hospitalized with seasonal flu nearly 80 times more often than other children.

The researchers say their findings point to the need to include children with sickle cell disease in the list of those who must be immunized against all flu strains, which already includes children with asthma, diabetes, heart disease and other chronic conditions.

“Children with sickle cell disease are hospitalized about once a year for pain crises and other complications, so we should do everything we can to prevent hospitalization from the flu by using safe and effective vaccines,” says lead investigator John J. Strouse, M.D. Ph.D., a pediatric hematologist at Hopkins Children’s.Named for the unusually sickle-shaped red blood cells caused by a genetic abnormality, sickle cell anemia affects nearly 100,000 Americans. The cells’ abnormal structure reduces their oxygen delivery to vital organs and causes them to get stuck in the blood vessels, leading to severe pain and so-called “sickling crises,” which require hospitalization.

The CDC recommends that all children over 6 months of age get seasonal and H1N1 flu shots, except those who are allergic to eggs or have had a severe reaction to a flu vaccine in the past.

Co-investigators include Martha Amoako, B.S.; Megan Reller, M.D., M.P.H.; and James Casella, M.D. The research was funded by the National Heart Lung and Blood Institute and the Doris Duke Charitable Foundation.

Source:
Ekaterina Pesheva
Johns Hopkins Medical Institutions

The number of severe new cases of H1N1 flu in B.C. dropped sharply over the past week.

Three more people died in the province – two on Vancouver Island and one in the north, according to statistics from the B.C. Centre for Disease Control.Just 32 new patients were hospitalized from swine flu over the past week.

That’s about a third the number of hospitalizations as a week earlier and way down from the peak in early November, when B.C. was recording almost 200 severe cases a week.

ATLANTA – Swine flu infections continue to wane, just as vaccine is becoming plentiful enough that some communities are allowing everyone to get it, not just those in priority groups.Swine flu was widespread in only 25 states last week – mostly in the Northeast and Southwest, officials at the Centers for Disease Control and Prevention said Friday.In late October, 48 states were reporting widespread cases of swine flu. But since then, there’s been a decline across the country, and it appears that a fall wave of swine flu infections has peaked.

Meanwhile, a shortage of swine flu vaccine is easing, with 73 million doses now available, roughly twice as much as there was a month ago. And another 10 million doses are expected in the next week, said Dr. Thomas Frieden, the CDC’s director.Initially, limited supplies caused the CDC to advise state and local health officials to reserve doses for those at highest risk for severe complications from swine flu or those who take care of them. That group includes pregnant women, children and young adults, health-care workers and people with asthma and certain other health problems.

Demand for the vaccine is still high in many places, but enough has become available that some communities are now giving it to people outside the priority groups, Frieden said.”The number of communities that do that will increase in the coming weeks,” he predicted, at a press conference in Atlanta.

At least three states – Alaska, Arkansas and Oklahoma – have begun offering swine flu vaccine to all comers. And some communities have opened vaccinations up, including Broward County, Fla., and Sacramento County, Calif., said Paula Steib, spokeswoman for the Association of State and Territorial Health Officials. Since it was first identified in April, swine flu has sickened an estimated 22 million Americans and killed 4,000. It has proved to be similar to seasonal flu but a bigger threat to children and young adults.

The swine flu pandemic has so far hit in two waves in the United States: First in the spring, then a larger wave that started in the late summer.Flu is hard to predict, and health officials say they are worried of the possibility of a third wave this winter. The CDC said a new round of public service announcements about getting vaccinated are to begin next week.

The World Health Organization (WHO) issued an update on the current statistics of H1N1 swine flu symptoms around the world on November 20th, covering up until the 15th of November.

Viewed across the globe as a whole, the situation is largely unchanged since the last update.  While some areas seem to have peaked or are on the decline, others are still intensifying.  The Americas continue to have the highest case count, but the Western Pacific is quickly catching up in numbers; though that may be skewed as the total number of cases are no longer being reported by some areas in the Americas or in Europe.

H1N1 Swine Flu Symptoms in the Americas

In the US, the spread of the H1N1 virus and cases of H1N1 symptoms remains widespread across the nation, though it seems to have peaked in all areas except the northeast. In Canada, however, influenza transmission and swine flu symptoms continue to intensify without any sign of peaking, and is worst among children ages 5 to 19.Most of Central and South America, including the Caribbean, report declining numbers of new H1N1 symptom cases, with the exception of Peru and Columbia.

H1N1 Symptoms in Europe On the Rise

With the exception of a few Western Europe countries, such as Iceland, Ireland, and Belgium, H1N1 transmission and symptoms remain widespread and are increasing, particularly in northern, eastern, and southeastern Europe.  In a number of countries – including Spain, Portugal, Estonia, Slovenia, Slovakia, Moldova, Bosnia and Herzegovina, Greece, Norway, Finland, Denmark, Belgium, Iceland, and Ireland – over half of all tested samples were positive for influenza, with over 99% of subtyped influenza A viruses being the pandemic 2009 H1N1 virus.

Asia Holding Steady Against Swine Flu Symptoms

Most of the H1N1 statistics out of Asia remain relatively steady.  Mongolia is still seeing intense influenza activity; in Japan, it is elevated but steady, with a slight decline in urban areas; China and Southeast Asia are still seeing some numbers of seasonal influenza instead of the pandemic H1N1 virus, but the proportion is dropping again in favor of the pandemic strain.

OTTAWA — Most of the city’s H1N1 vaccination clinics were out of wristbands entitling residents to swine-flu shots by mid-morning Saturday.

According to Ottawa’s public-health department, the clinics at Constellation Crescent, Barrhaven Crossing mall, Kanata Recreation Complex and Fred Barrett Arena were out of wristbands by 10 a.m.The clinics with some slots still available were Tom Brown Arena on the west side of downtown (200 left) and the city building on Centrum Boulevard in Orléans (also 200 left, as of 9:30 a.m.).

On weekends, the city’s vaccination clinics are open from 9 a.m. to 3 p.m., with wristbands being distributed in advance so people can leave and come back at appointed times.

A list of fixed vaccination sites can be found at www.ottawa.ca/health or by contacting the Ottawa Public Health information line at 613-580-6744.
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