ScienceInsider

by Dennis Normile

While the world's flu fighters have concentrated on countering the H1N1 swine flu pandemic, avian influenza H5N1 has quietly continued to take its toll on both poultry and humans. Last year, 17 countries, stretching from Côte d'Ivoire and Germany to China and Japan, reported outbreaks of H5N1 in domestic poultry and wild birds; and the World Health Organization, which still says H5N1 poses a pandemic threat, recorded 72 human cases, 32 of them fatal.

The brunt of the outbreak, entering its eighth year, is still in China and the developing countries of Southeast Asia. Indonesia alone accounted for 19 of the 32 H5N1 deaths; Vietnam, for 5 and China, for 4. But there are glimmers of progress.

by Martin Enserink

The chief flu scientist at the World Health Organization (WHO) today defended his agency against criticism that the H1N1 swine flu pandemic was "fake," that its threat to human health was hyped, and that WHO's policies were influenced by vaccine manufacturers who benefited from the pandemic virus. The idea that H1N1 outbreak is not a pandemic is "scientifically wrong and historically inaccurate," WHO's Keiji Fukuda told reporters during a press conference.

With H1N1 apparently on the decline, and the damage much less severe than once feared, many countries are canceling part of their vaccine orders while others are trying to resell unused stocks. As a result, national governments and WHO have come under scrutiny for the way they handled the pandemic.

WHO's chief accuser of late is Wolfgang Wodarg (pictured above left), a German physician and former member of the German Parliament for the Social Democratic Party, who has called the pandemic a "fake"—because the virus isn't very different from existing strains—and who has suggested that big pharma coaxed WHO into declaring a pandemic so that it could produce and sell vaccine. "WHO in cooperation with some big pharmaceutical companies and their re-defined pandemics and lowered the alarm-threshold," Wodarg says in a statement on his Web site.

by Martin Enserink

AMSTERDAM—The Netherlands is selling the bulk of its H1N1 pandemic vaccine supply. Some 19 million doses of the 34 million doses that the government has ordered from manufacturers Novartis and GlaxoSmithKline are now for sale, Health Minister Ab Klink wrote yesterday in a letter to Parliament. Some 2 million of them will be available in December, the remainder in the first months of 2010. Malta and Macedonia have been reported to be among the potential buyers.

The Netherlands is one of the few countries that decided early on in the pandemic to order two doses of vaccine for each of its citizens. But like most countries, it ended up only vaccinating certain groups, such as pregnant women, people with medical conditions that put them at greater risk, health care workers, the elderly, and children aged between 6 months and 4 years. Even if the sale goes through, the Netherlands will still keep a strategic stockpile of 2.2 million vaccines.

by Jon Cohen

As public health officials have stressed since the swine flu pandemic surfaced last April, influenza is unpredictable. But one thing is predictable: pandemic influenza viruses come in waves that typically peak about 6 to 7 weeks after they begin to climb. New data from the United States and the United Kingdom hint that the second wave of the swine flu pandemic may have peaked in these countries.

According to a situation update released by the U.S. Centers for Disease Control and Prevention today, widespread disease last week dropped from 48 states to 46. That may not seem like much, but visits to the doctor for influenza-like illness also declined for the second week in a row after 4 weeks of “sharp” increases. CDC divides the country into 10 regions, and this drop in doctor visits was seen in all but one of them.

by Jon Cohen and Martin Enserink

First the bad news: Revised estimates from the U.S. Centers for Disease Control and Prevention suggest that the novel H1N1 virus has spread much further in the country and taken a far greater toll than earlier analyses suggested.

Now here’s some more bad news: CDC says manufacturers delivered far less pandemic vaccine this week than predicted.

According to new CDC estimates released today, about 22 million Americans have been infected with the virus, 98,000 have been hospitalized, and 3900 have died. Those data account for cases since the pandemic surfaced in April and run through 17 October. Until now, CDC has been reporting only H1N1 cases and deaths confirmed by lab tests. (As of 31 October, the cumulative numbers were 26,917 hospitalizations and 1265 deaths.) But confirmed cases are believed to be only a small portion of the true influenza burden. Many people never seek medical attention, and even if they do, they are not usually tested for the novel H1N1 virus. Some patients even die in hospitals from complications of an infection without making it into the statistics

by Jon Cohen

Concern appears to be rising at the U.S. Centers for Disease Control and Prevention about people in lower risk groups cutting in line to receive the limited supplies of H1N1 vaccine. A letter sent today from CDC Director Thomas Frieden to state and local health officers urges that the 35.6 million doses of the vaccine now available first go to people at the highest risk of developing severe disease from the pandemic virus. Although the letter does not detail any specific problems, it pointedly says, “vaccine distribution decisions that appear to direct vaccine to people outside the identified priority groups have the potential to undermine the credibility of the program.”

by Jon Cohen

With reporting by Martin Enserink.

Although the world’s attention is focused on the novel H1N1 virus causing the swine flu pandemic, H3N2, a seasonal strain of influenza, has popped up in many East Asian countries—and some variants in circulation may outfox the seasonal vaccine in use. “We have seen that H3N2 viruses have been in fairly broad circulation in some of the countries there,” Keiji Fukuda, special adviser on pandemic to the director-general of the World Health Organization, said at a press conference today.

The H3N2 strain is one of three in the seasonal influenza vaccines. But if the H3N2 strain in circulation differs substantially from the one used to make the vaccine, the vaccine may offer less protection, and more people will get sick than usual. “For the current H3N2, we don't have such studies, so I can't tell you right now the degree the current seasonal vaccine will protect against the H3N2 virus,” Fukuda says.

by Martin Enserink

It's a promise: 10% of the 250 million doses of H1N1 vaccine purchased by the United States will be donated to help poor countries. But when is still unclear. At a press conference today, Thomas Frieden, head of the U.S. Centers for Disease Control and Prevention, declined to answer questions about the timing of the gift. "That has to be determined as the production schedule will become more clear in the weeks to come."

WHO expects to send some 200 million doses of vaccines donated by countries and governments to the developing world. Timing is key, because the vaccine will do the most good if it's used before a wave of infection peaks. As WHO's Marie-Paule Kieny just told ScienceInsider, the United States has promised the first part of its share of 25 million doses by early December.

But AFP suggested last week that the United States will not donate any vaccine until it has taken care of the 159 million people in its priority groups.

by Martin Enserink

As the H1N1 swine flu pandemic marches on, western countries have begun vaccinating their most vulnerable populations against the virus. But many countries in the developing world lack the resources to buy the vaccine. With charitable donations from manufacturers and rich countries, the World Health Organization is trying to get cash-strapped countries at least some vaccine. Marie-Paule Kieny, head of WHO's Initiative for Vaccine Research, gave ScienceInsider an update on how this complex operation is moving along. Questions and answers have been edited for brevity and clarity.

Q: At a press conference last week, you said that WHO's plan to distribute vaccine to the developing world is now moving into its operational phase, and that WHO Director-General Margaret Chan has approved a list of 95 countries eligible for vaccine donations. Can we get a list of those countries?

M.-P.K.: No, because some of those countries may decide not to get the vaccine. So far, only about 40 countries have sent us a letter of intent saying they want us to send vaccine. Before we can make the names of the eligible countries public, we must know that they are willing to accept the conditions.

Q: What are those conditions?

M.-P.K.: They have to sign an agreement that they hold the vaccine manufacturers harmless in case of adverse events. WHO cannot bear that responsibility, so we're passing it on to the governments. It's the same as for most developed countries; they had to agree to this as well.

Q: Are the developing countries reluctant to accept that liability?

by Jon Cohen

U.S. policymakers erred on the side of caution in September when they recommended that children under 10 need two doses of the swine flu vaccine to develop a strong enough immune response to protect them from the disease. Now there’s strong evidence that they made the right call. New data also show for the first time that pregnant women need only a single shot.

At a press conference today, Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases (NIAID), revealed the new data about these two groups, which are at high risk of developing severe disease from the novel H1N1 virus. As he explained, the trials tested the inactivated vaccine made in 389 children under 10 and in 50 pregnant women.

NIAID on 21 September reported preliminary data from the children’s study, which analyzed immune responses 8 to 10 days after participants received the vaccine and suggested the younger age brackets would need two doses. The new data confirm the preliminary findings.