All Nature’s pandemic flu coverage is collected on our news special page.

China has confirmed that there have been 659 deaths from H1N1 in the country as of 2 January. In total, 120,940 cases of swine flu have been recorded, says the ministry of health.

“The danger of an explosion of outbreaks in some places exists, and the number of fatalities and serious cases will remain at a rather high level,” warned Liang Wannian, director of the ministry’s emergency response office (AFP).

Liang also warned of problems controlling the spread of H1N1, especially in rural areas. The problem may get worse as Chinese New Year approaches and many people travel around the country.

Last month the World Health Organization said that, as of 27 December 2009, over 200 countries have reported laboratory confirmed cases H1N1 and at least 12,220 deaths have been recorded.

Vietnamese health officials have reported a cluster of drug-resistant H1N1 cases.

In a paper published in the New England Journal of Medicine they report that 10 students travelled together on a 42-hour train journey in July this year and at least six of them later developed tamiflu-resistant swine flu. The paper notes that the students did not know each other before the train ride and had no contact with people suspected of H1N1 infection. Nor had any of them received tamiflu (oseltamivir).

“In this cluster, infection developed in at least 6 of the 10 people who were probably exposed to the index patient; this shows that resistant 2009 H1N1 viruses are transmissible and can replicate and cause illness in healthy people in the absence of selective drug pressure,” write the Vietnam H1N1 Investigation Team. “… The loss of oseltamivir as a treatment option for severe 2009 H1N1 infection could have profound consequences.”

Earlier this month the World Health Organization reported two clusters of patients infected with tamiflu-resistant H1N1, one in Wales and one in North Carolina. However both these incidents involved patients whose immune systems were already weakened and the virus was probably passed between patients in each group.

“This [the Vietnam outbreak] is different and it does raise the levels of concern. But it also I think reinforces the message that we do need to be constantly monitoring for this. And reporting it as quickly as it’s observed,” Charles Penn of the WHO told the Canadian Press.

All the patients in the Vietnamese case eventually recovered.

All Nature’s pandemic flu coverage is collected on our news special page.

All Nature’s pandemic flu coverage is collected on our news special page.

It has been a mixed week for swine flu vaccines.

On Wednesday GSK announced use of one particular batch of its H1N1 jab should be halted after a higher than expected rate of severe allergic reactions related to the vaccine in Canada.

On the other hand, the US Centers for Disease Control and Prevention came out and backed the safety of vaccination. It says 22 million Americans have been vaccinated with 3,200 – mostly minor – side effects being reported.

“The vaccine data so far really suggests this is a safe vaccine,” said the CDC’s Anne Schuchat on Wednesday (AP).

In the UK David Salisbury, director of immunisation at the Department of Health, told family doctors to step up their vaccination efforts (Times). So far only 1 million of 10m distributed doses of vaccine have been used (Financial Times).

“Clearly I would have liked a bigger number, but that is what we have so far. I would like to see an acceleration now,” says Salisbury (BBC).

Some reports have indicated that doctors and pregnant women are wary of vaccination in the UK (Pulse).

Ireland is also pushing people to be vaccinated. “Children under five are a high priority group and . . . we are concerned that we are not getting a sufficient number of them vaccinated,” said Pat Doorley, national director of population health, on Friday (Irish Times).

Posted for David Cyranoski

The Chinese government has sent inspection teams to check on H1N1 reporting after a famed Chinese doctor accused local governments of covering up swine flu cases.

Zhong Nanshan of Guangzhou Institute of Respiratory Diseases in southern China, called into question the official number of deaths from H1N1, telling the Southern Metropolis Daily newspaper that the quoted figure of 53 was too low. “I just don’t believe that there have been 53 H1N1 deaths nationwide,” he said.

Yesterday Ministry of Health spokesman Deng Haihua, said any officials who do not carry out their H1N1 reporting duties or who delay reporting will be “held accountable”. He also said that teams had been sent to inspect pandemic control. In total nine groups have been sent to Hebei, Shanxi, Inner Mongolia, Liaoning, Jilin, Heilongjiang, Zhejiang, Hunan, Gansu, Qinghai, Ningxia, and Xinjiang (official statement).

While many have pointed out that limitations on testing capacity have led to an underreporting, Zhong suggested that some hospitals were intentionally not testing those who died from pneumonia for H1N1.

His words carry weight because he shot to fame during the Sudden Acute Respiratory Syndrome (SARS) outbreak in 2003 for quickly recognizing and reacting to the threat posed by the new virus while government officials around the country tried to cover it up.

All Nature’s pandemic flu coverage is collected on our news special page