Swine flu roundup - June 19, 2009
All Nature’s swine flu coverage is collected on our news special page. These regular updates on The Great Beyond round up the latest from other news sources around the globe.
The 2009 pandemic flu continues to spread in many parts of the United States and elsewhere in the Northern hemisphere. Some had figured it might go away, as the normal flu season has ended, and not return until the autumn when seasonal flu activity typically picks up. In hard hit places such as New York almost a tenth of the population are showing influenza like symptoms.
In the Southern Hemisphere, where the flu season is getting underway, South Africa yesterday reported its first case, following recent cases in Egypt and Morocco. Africa has not reported anything like the same extent of spread asother parts of the South (such as Australia and countries in South America) - but that is likely down to lack of surveillance.
Clinical researchers have been slow to respond to the 2009 flu pandemic, lament researchers writing in today's Lancet. "Public health officials, virologists, epidemiologists, and policy makers have done well in responding to a rapidly emerging and complex problem. By contrast, the clinical research community's response has been delayed and modest, " writes Jeremy Farrar, a researcher in Ho Chi Minh City, Vietnam and colleagues from Vietnam, the US and Mexico.
They deplore the "lack of information" on the pathogenesis and clinical aspects of those with severe illness, and argue that trials and other clinical research are urgently needed to better understand the disease, and learn of necessary tweaks to treatment regimes. What research is being done isn't being published fast enough, add Farrar et al., contrasting this with the speedy publication by researchers in other disciplines who have published in fast-tracked journal articles, or shared on public wikis – eg here – in advance of formal publication. Clinical researchers need to "catch up," they conclude, "To do otherwise would be unethical."
Staying with the clinical aspects, reporter Helen Branswell from The Canadian Press has an excellent article out today, describing how patients being admitted to intensive care units are showing unusually severe respiratory disease. The numbers of them are also surprising doctors. "In a typical flu season, the Winnipeg hospitals where Dr. Anand Kumar works might see one, maybe two life-threatening cases of viral pneumonia caused by influenza. So seeing 10, 15 and more flu patients in those same hospitals' intensive care beds in June is still a shock", suggests Kumar... "You don't see rows and rows of patients on ventilators because they have respiratory failure, a viral pneumonia kind of thing. It's unusual."
Healthworkers not taking precautions
Some healthcare staff themselves seem to be getting infected at work because they are failing to take basic precautions such as wearing a mask when in contact with ill patients, says a study in the latest issue of the CDC Morbidity and Mortality Weekly Report. And a German researcher who developed pandemic flu in Singapore after returning from the US has also been subject to some vitriol for allegedly failing to take precautions to not spread it further, according to media reports, claims that the researcher denies.
Vaccine offers for poor countries
Many countries in the South are low-income countries where the toll of the pandemic risks being highest. In response to a call by the World Health Organization (WHO) for vaccine makers to set aside 10% of pandemic vaccine for low-income countries. Pharma company Sanofi-aventis said Wednesday that it "intends" to donate 100 millions doses to WHO to distribute, and also sell vaccine cheaper in developing countries
How much vaccine the company will be able to make won't be known until clinical trials show much antigen is needed per dose, and until decisions are taken about the use or not of adjuvants to make vaccine go further, however. It also remains unclear when the company would make any donated vaccine available, given its existing contracts with several rich countries. Novartis has been reported to not wish to go down the donation road, preferring cheaper pricing of vaccine for low-income countries.
Nonsensical numbers
The World Health Organization's last formal update on 17 June of lab confirmed cases reported by member states stood at around 40,000 lab confirmed cases and 167 deaths. With a pandemic underway, and extensive spread in the population in many countries such case numbers are now fairly meaningless though, as lab confirmed case numbers are but the tip of the iceberg . The US has around 18,000 lab confirmed cases, for example, but CDC expects the real figure is in the hundreds of thousands; CDC has stopped counting cases, and switched to population surveillance of influenza-like illness and other measures. At this early stage in the pandemic, estimates of the case fatality rates are also subject to many caveats – see here, and here for why this is.
Comments
Declan, that is a SUPERB roundup.
But why on earth is the page illustrated with a photo of pigs?
I strongly support the short-hand use of the term "swine flu," which is losing out to "H1N1", according to Google News search counts. (And leading to some hilarious articles which talk about seasonal flu versus H1N1...).
"Pandemic swine flu" might be even better, to differentiate it from other swine flu issues that might end up in the news, such as actual swine flu in swine.
But it is an important communication goal to help people understand that the swine flu currently in the news is (at present) "not about pigs."
There are thousands of media sources illustrating their articles about the pandemic with pig pix. Nature shouldn't join that herd.
Posted by: Jody Lanard M.D. | June 20, 2009 03:58 PM
If we could get geographical jurisdictions, (countries, states, provinces, etc.) to count hospitalized confirmed cases, we would have a much better idea the extent of serious infection. Almost everyone is counting these cases, but when milder cases are added to the total count, the numbers become relatively meaningless.
We need someone to assemble the hospitalized case data in one location. Then we could make more useful comparisons from one area to another. I wish the CDC would do this for the U.S.
Posted by: Adrienne LeBailly, MD | June 23, 2009 09:01 PM
I cannot understand why it has taken so long for a vaccine to be developed. Perhaps there is a money reason!
Posted by: michael | July 22, 2009 01:04 PM