All Nature’s pandemic 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 European Medicines Agency has recommended the approval of two H1N1 vaccines. Both Novartis and GlaxoSmithKline should shortly see European Union-wide marketing authorisations from European Commission for their products.

The agency follows hot on the heals of the US FDA, which recently approved four vaccines, from CSL, MedImmune, Novartis, and Sanofi Pasteur.

Officials in the US also confirmed this week that the number of vaccine doses likely to be available will be twice as high as previously believed. Between six and seven million doses will be available, rather than 3.4 million (AP).

Now the job is to get people to come and get jabbed, says Health and Human Services Secretary Kathleen Sebelius.

“Taking the risk and getting sick is probably not a wise roll of the dice,” she says (Reuters). “People can die, and the people who are going to be ill and die are much more likely to be children and young adults.”

Meanwhile, the White House has announced that ‘The H1N1 Rap’ by John Clarke, Medical Director for the Long Island Railroad, was the winning entry in its video contest. Enjoy.

EU Health Commissioner, Androulla Vassiliou. yesterday released a 12-page “”https://ec.europa.eu/health/ph_threats/com/Influenza/docs/com481_2009_en.pdf">EU strategy on Pandemic (H1N1) 2009," as well as five Commission working documents – on vaccine development, vaccination strategies, joint procurement, communication with the public and media, and support for third countries.

It’s difficult to see much new in the package, however. The Commission press release says that “A joint procurement mechanism is proposed to support the Member States that are still in the process of ordering vaccines.” This echoed a proposal the incoming Swedish presidency of the EU made in July.

That seemed a bit odd. With incoming surveillance data signaling an uptick in the spread of pandemic flu in European countries, which could herald the imminent onset of the peak phase in the pandemic, it seems a bit late in the day to start discussing ordering vaccine at the EU level, in particular given that it’s been obvious since early May that a pandemic was underway.

The text of the policy itself agrees, however, and notes that “Given the stage of development of the pandemic, and the advance purchase orders already concluded by several member states, it is not considered reasonable or efficient at this stage to launch a joint procurement procedure at EU level between interested member states for vaccine procurement.” Instead, it argues for considering launching “a bundle of national calls for tender by the interested Member States to be carried out simultaneously or as a whole.”

I’ve checked with the media people at the Commission’s health directorate. It seems there was some confusion in the wording of the press release – finally there will be no joint procurement scheme. The Commission will basically try to “help different countries to help themselves,” says a spokesperson. Many European countries have already ordered vaccine to cover large proportions of their populations, and so the scale of the problem the Commission is seeking to address is not clear either. “It is a problem,” in some countries, according to the spokesperson, but couldn’t say more, or in which countries, as the Commission apparently doesn’t have “a table of who has ordered what.” “Member states aren’t obliged to inform us.”

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In the latest salvo in a legal row between the Global Initiative on Sharing Avian Influenza Data (GISAID) – an international group created by leading flu researchers in August 2006 to promote data sharing – and the Swiss Institute of Bioinformatics (SIB) in Geneva, GISAID today launched its own version of the Epiflu database.

GISAID announced a contract with the SIB in December 2006 to build the first EpiFlu database, an international database which opened last year, and which scientists have since used to help monitor the spread and evolution of influenza viruses and to select the strains used to makes flu vaccines. In July, however, SIB made EpiFlu unavailable via the GISAID website, and available only to users redirected to a SIB website (Nature).

At the time, SIB and GISAID officials declined to discuss the details because of the ongoing legal dispute. But, in short, the SIB alleged that GISAID has breached its contract by failing to pay its bills on time, and that, under Swiss law, a default on payment renders a contract null and void, giving the SIB the rights to the database it built. GISAID claimed that SIB had “misappropriated” the database.

That Epiflu database remains accessible to users on the SIB site, but today GISAID launched its own independent version on the EpiFluDB tab on its own website. The new database was built by the the computational biology department of the Max Planck Institute for Informatics near Saarbrücken in Germany, and a3systems GmbH.

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

With flu season looming, crunch-time is rapidly approaching for Northern hemisphere countries’ pandemic planning. It seems likely that the pandemic H1N1 virus will be the predominant strain seen in the upcoming flu season, as data from the Southern hemisphere show that it is out-competing and displacing seasonal strains. The big question mark is when the flu season will start – although some vaccine is already beginning to flow, substantial amounts sufficient to vaccinate large parts of the population won’t become available until October/November onwards.

The pandemic H1N1 virus has continued to circulate out-of-season throughout the summer, and with schools reopening and colder weather on the way, one possibility is that peak flu season may occur as soon as this month, rather than in the more typical mid-winter window. If it does come earlier, countries will be faced with tackling the pandemic with one hand tied behind their backs, as little vaccine would be available.

The challenges of handling the pandemic should not be underestimated. I have an article in this week’s Nature surveying researchers from a selection of countries worldwide, describing the scientific and public-health challenges they face in battling the H1N1 virus – see Pandemic flu: from the front lines . A recurring theme is that even if the severity of the virus remains moderate, public health systems and particularly intensive care units, risk being overwhelmed.

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All Nature’s pandemic 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.

New guidelines put out by the World Health Organization last week declared that healthy people who contract H1N1 do not need antiviral drugs. This stance appears to put the WHO at odds with the current policies of a number of countries.

“Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment,” says the WHO. “Healthy patients with uncomplicated illness need not be treated with antivirals.”

Patients who present with severe illness or who get rapidly worse should be given oseltamivir (Tamiflu), as should children under five, according to the new guidelines.

Many country’s policies appear to differ from the WHO. The US Centers for Disease Control’s website currently states, “CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.”

A spokesperson for the UK government – which currently makes Tamiflu available to all those suspected of having H1N1 – insisted its policy was in line with the WHO. “We have consistently said that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them,” they told the Daily Telegraph.

Earlier this month a paper suggesting that it might not be necessary to give Tamiflu to children also picked up a lot of coverage (see: Swine flu: Tamiflu for children? – August 11, 2009).

Last week the CDC produced its recommendations on who should receive vaccination against H1N1 when a vaccine does become available.

Amidst all of this, a sizable percentage of informed people seem to not want either drugs or vaccination, even if they do qualify. In the UK two new straw polls of doctors working in primary health care found that only around half would accept a vaccine shot.

Image: word cloud generated from WHO recommendations with Wordle

All Nature’s pandemic 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.

It looks as if the US may face a problem with swine flu vaccine this fall: 45 million doses will be available by mid November, which is not even half of the 120 million doses predicted previously.

The main ingredient of the vaccine is grown in chicken eggs and manufacturers are only getting 30% as much per egg as they do for seasonal flu vaccines. In addition, the final stages of production involve transferring vaccines into individual syringes, and the “finish-and-fill” facilities where this step takes place are limited in number.

But this is not a shortage, just a delay, Bill Hall, the spokesperson for the Health and Human Services cunningly noted (AP).

Adding to potential problems, those supplies might only cover half as many people, if it proves necessary to administer two shots per person.

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Posted for Mico Tatalovic

We’ve previously praised the Swiss government for their frankly bizarre swine flu awareness video. But the Erasmus University Medical Center in Rotterdam has come up with a worthy rival for the award of best H1N1 public campaign, with their game The Great Flu.

In the game, people have the task of containing an unknown flu virus that is spreading throughout the world. Early warning systems, face masks and anti-viral drugs are all available to players, as well as options to close public places such as schools and airports and quarantine people.

“The game is based on the need to increase public awareness to the threat posed by a pandemic and the measures in place to contain it,” said Albert Osterhaus, of Erasmus Medical Centre (BBC). “In no way is it intended to be a substitute for any advice given by the medical authorities. Its purpose is simply to create another avenue of information.”

Osterhaus’s game is the best of a small field, with its main rivals being the Wellcome Trust and Channel 4’s online game Sneeze and the cooperative board games Pandemic, and Pandemic 2: on the Brink.