Satisfied Anopheles mosquito after a blood feed. CDC

The path to a viable malaria vaccine is a step closer with the publication of interim results of a vaccine trial conducted in 11 sites in sub-Saharan Africa. The vaccine trial, known as RTS,S, recruited over 15,000 infants, and comprised a broad collaboration between academics, industry and government partners under the guidance of the PATH Malaria Vaccine Initiative. The trial found the majority of its funding from the Bill and Melinda Gates Foundation; Bill Gates, co-chair of the Foundation, commented that “A vaccine is the simplest, most cost-effective way to save lives. These results demonstrate the power of working with partners to create a malaria vaccine that has the potential to protect millions of children from this devastating disease”.

These results refer to reductions in malaria risk for 6,000 children aged 5 to 17 months in the 12 months after vaccination. After 3 vaccinations, the trial showed 56% reductions in risk of clinical malaria and 47% reductions for severe disease. Malaria risk reductions were additional to the protection from use of bed nets, and while impressive, it is clear that even by halving the risk of malaria, this vaccine alone will not control the disease. Other interventions will continue to be necessary if, and when, this malaria vaccine is licensed for use. Andrew Witty, CEO of GlaxoSmithKline (GSK), who produced the vaccine, added that “the addition of a malaria vaccine to existing control interventions such as bed nets and insecticide spraying could potentially help prevent millions of cases of this debilitating disease”.

Malaria is a disease which has continued to challenge the health of vulnerable children mostly in sub-Saharan Africa and news that RTS,S steps closer to becoming a licensed vaccine is welcome. The cost of this potentially viable malaria vaccine has been considered as an integral part of vaccine development. GSK emphasizes its commitment to ensure that a licensed RTS,S malaria vaccine will reach poor and vulnerable individuals, with assurance from Witty that “GSK remains committed to further research into malaria and most importantly, to ensuring that this vaccine will reach those who need it”.

Over recent years, there has been increased emphasis on addressing malaria as an important public health challenge. Tsiri Agbenyega, a principal investigator of the trial and Chair of the Clinical Trials Partnership Committee, said that “Renewed interest in malaria by the international community, and scientific evidence such as that we are reporting today, should bring new hope that malaria can be controlled.”

The infection, caused by a parasite transmitted from the bite of an infected mosquito, continues to kill an estimated 781,000 people, and cause 255 million illnesses, each year. However, year on year, reductions in the burden of disease have been reported. With continued successful control and new tools to prevent malaria, the RTS,S vaccine results bolster hopes that the disease could, within decades, be eradicated.

The post Vaccine Halves the Risk of Malaria appeared first on The Faster Times.

Congo River passing Kinshasa

River flows which are nutrient rich and powerful can lead to cholera outbreaks according to a new study published in the American Journal of Tropical Medicine and Hygiene. The researchers found that increased river discharges, often occurring simultaneously with increased temperatures in coastal water, led first to transient increases in phytoplankton blooms which were in turn associated with cholera outbreaks.

“Finding an association between sea surface temperatures and cholera outbreaks should not lead us to conclude that with global warming cholera will definitely go up” commented lead author Shafiqul Islam of Tufts University. “If river flows are more turbulent, if droughts are more severe, if flood is more severe, cholera is more severe”. The positive relationship between phytoplankton blooms and river discharges could make predicting the effects of global warming on the spread of cholera even more complex according to the research team. The study underscores a “complex ecology associated with cholera” said Peter J. Hotez President of ASTMH. “But cholera may not have direct linkage with rising sea surface temperatures”.

The impact of these new findings on tackling the ongoing cholera outbreaks in Haiti and the Democratic Republic – which have caused illness in more than 400,000 people combined – will be limited. Describing the relevance of this study to the situation in Haiti and DRC, Hotez commented “cholera seems to be gaining a foothold in more places than it used to be. We used to see shorter outbreaks, but in Africa, and now in Haiti, we’re seeing nationwide epidemics lasting months or more than a year. We obviously need to be taking a different approach”.

Advocates like Partners in Health have continued to call for a different approach to cholera in Haiti particularly since the 2010 earthquake. In Haiti cholera is thought to have killed nearly 5,000 people since the epidemic began in October 2010. A global reflection on the environmental epidemiology of cholera may inform future early warning disease systems, but it remains clear that the extended cholera outbreaks in Haiti and DRC reflect the fragility of these nations, rather than turbulent river flows and phytoplankton blooms.

Haiti has faced renewed cholera outbreaks since the 2011 rainy season in spring – and disease transmission has been most closely associated with poor sanitation. Of Partners in Health’s work in Haiti, Paul Farmer, UN Deputy Special Envoy to Haiti, reflected “we’re working as hard as we can, we’re saving a lot of lives, but we can’t replace public water systems”. The lack of functional sanitation infrastructure, and the lack of policy and engagement with this issue, lies at the core of a cholera problem. Well-established methods of disease prevention and treatment for cholera have existed for decades, even centuries in the case of the former.

Pumphandle bringing cholera deaths to 19th century London

Rather than river flows, robust evidence suggests the Haiti cholera outbreak emerged from South Asia brought to the country by UN peacekeepers after the devastating quake. Cholera outbreaks along the River Congo in DRC have intensified in recent weeks and a 7% case fatality rate has been reported, according to WHO. Fears remain that the disease could spread to Kinshasa. While the river flows may play a role in spreading the bacteria along the River Congo, the fear that these river flows meet large populations with inadequate safe water is the source of greatest concern. Elevated coastal water temperatures may have contributed to the spread of these cholera epidemics, but it is the woeful sanitation systems which have held a tight grip to cholera’s hand in Haiti and DRC.

“Virtually nobody who drinks clean water gets cholera” added Farmer. In fragile states like Haiti and DRC, a treatable cholera infection is encouraged to blossom into a public health crisis, reflecting the most extreme chronic and systemic failures of nations to place value on the health of their people. Treating the acute symptoms of cholera alone cannot resolve the chronic and intractable problems of poverty, policy and political will.

The post Cholera: Rivers Run Deep appeared first on The Faster Times.

Punjab Province, Pakistan (Schneider, UN)

As hundreds of thousands continue to be driven from their homes and livelihoods by floods in cities, towns and villages of Pakistan, further heavy rainfall and flooding is predicted for the coming weeks. 160,000 square kilometres of land, or one fifth of the country, is under water. An area larger than twice the size of Ireland has been ravaged by the floods, millions have been left without shelter, food and medical assistance. According to the Pakistani government, an estimated 17 million people have been affected, and the risk of acquiring disease for those displaced is at elevated levels. As of August 23rd, Pakistani government estimates indicated that 1,542 deaths and 2,327 injuries had occurred as a result of the floods. Life-threatening disease outbreaks now face survivors already weakened by displacement and lack of food, in what UN secretary general, Ban Ki-Moon, referred to as “a disaster of unimaginable proportions.”

The end of July marked the beginning of the Pakistan floods and in the aftermath of the deluge, flood-water has carried diarrhoeal, respiratory and skin diseases. Transmission of water borne diseases is enabled by a lack of clean drinking water and by poor sanitation and hygiene. Water borne diseases have been confirmed to be on the rise. As of August 18th, there had been an estimated 204,040 cases of acute diarrhoeal disease, 204,647 acute respiratory disease cases and 263,356 cases of acute skin diseases. Annually, water-borne diarrhoeal diseases still cause premature deaths globally for an estimated 2.2 million people, mostly children; organisms responsible for these diseases vary from bacterial to protozoal to viral.

Cholera, with its rapid disease onset and 5% fatality rates, is one of the most feared water borne diseases in situations of natural disaster. The disease is caused by infection with the Vibrio cholera bacterium, after consuming contaminated water or food; person to person transmission is unlikely to occur. After infection, disease symptoms can be mild or even non-existent, but in severe cases the characteristic watery diarrhoea and dehydration can lead to death within hours. In industrialised countries, cholera is no longer an endemic disease, but the bacteria are endemic in many developing countries, including Pakistan. Cholera cases were documented recently in Zimbabwe in 2009; here the cause was not natural disaster, but man made, resulting in nearly 4,500 deaths. While outbreaks of this deadly wasting water-borne disease have been rumoured, they have not been confirmed in the wake of the Pakistan floods. Cases of acute watery diarrhoea are being treated with cholera treatment protocols, including intravenous fluids and oral re-hydration salts, for individuals suffering severe diarrhoeal diseases.

This disaster situation is complicated not only by the uncharacteristically heavy seasonal monsoon rains, the vast area in need of aid and the lack of the immediate, sufficient international aid, but also by fears of political insurgency. Fears that aid supplies could be hijacked by extremist elements have been expressed. While the tardy international response has also roused fears that this international aid vacuum could be exploited by the same extremist elements. Concerns remain that a poor international response to this natural disaster may mean that the Pakistan floods also wash away progress made in the Afghan war. This natural disaster has become as politicised as any could, highlighting the critical connections that exist between international aid and international security. The poorest survivors remain caught in the middle of this debate, and aid remains essential.

Secretary-General visits displaced (Schneider, UN)

Ban Ki-Moon described that “almost 20 million people need shelter, food and emergency care. That is more than the entire population hit by the Indian Ocean tsunami, the Kashmir earthquake, Cyclone Nargis and the earthquake in Haiti – combined.” The scale of this natural disaster is vast in land mass and numbers affected by loss of homes, land and livelihood, but these factors did not immediately demand the necessary urgent response from the international community. It is clear that the Pakistan death toll does not compare to the natural disasters which have ravaged countries of late. Around 230,000 deaths occurred as a result of the 2004 Indian Ocean tsunami, there were over 73,000 deaths after the 2005 Kashmir earthquake in Pakistan, Cyclone Nargis in 2008 is thought to have caused 140,000 deaths and over 210,000 deaths occurred after the 2010 earthquake in Haiti. Death tolls as a direct result of the relentless Pakistan floods do seem remarkably low in comparison. However, while the mortality rates are much lower than recent natural disasters, it is crucial to appreciate that vast regions and vast numbers of people have been devastated by these floods in what Ban Ki-Moon referred to as Pakistan’s “slow motion Tsunami.”

In other parts of the world, dramatic seasonal weather is also causing devastation. China is suffering from floods and mudslides, which have displaced tens of thousands and killed more than 1,500 people, while bringing devastation to homes and livelihoods. After un-seasonally heavy rains destroyed crops, livestock and livelihoods in West Africa last year, they re-visited countries of the eastern Sahel region this year. Niger was hardest hit; causing more than 1,000 deaths and making 100,000 people homeless. In the aftermath of these disasters, as in Pakistan, water-borne diseases carry risks of further mortality after the immediate ravages of the storms have faded.

“These unprecedented floods require unprecedented assistance” urged the UN Secretary-General, the following his visit to flood-affected zones in Pakistan. According to the UN, 8 million people are in need of life saving humanitarian assistance, and 4.6 million are homeless. With the unremitting floods and particularly in the absence of sufficient aid, the immediate future predicts further misery, especially for the poorest of survivors. Pledges are still being calculated for the $460 million requested in international assistance by the UN, but are thought to beyond the halfway mark according to UN spokesperson Farhan Haq. This cash is not yet delivered, and in order to meet the multitude of varied challenges of disaster, Pakistan still needs sustained “waves of global support.”

The post 10,000 Villages: Pakistan Floods & Water-borne Disease Spread appeared first on The Faster Times.

Punjab Province, Pakistan (Schneider, UN)

As hundreds of thousands continue to be driven from their homes and livelihoods by floods in cities, towns and villages of Pakistan, further heavy rainfall and flooding is predicted for the coming weeks. 160,000 square kilometres of land, or one fifth of the country, is under water. An area larger than twice the size of Ireland has been ravaged by the floods, millions have been left without shelter, food and medical assistance. According to the Pakistani government, an estimated 17 million people have been affected, and the risk of acquiring disease for those displaced is at elevated levels. As of August 23rd, Pakistani government estimates indicated that 1,542 deaths and 2,327 injuries had occurred as a result of the floods. Life-threatening disease outbreaks now face survivors already weakened by displacement and lack of food, in what UN secretary general, Ban Ki-Moon, referred to as “a disaster of unimaginable proportions.”

The end of July marked the beginning of the Pakistan floods and in the aftermath of the deluge, flood-water has carried diarrhoeal, respiratory and skin diseases. Transmission of water borne diseases is enabled by a lack of clean drinking water and by poor sanitation and hygiene. Water borne diseases have been confirmed to be on the rise. As of August 18th, there had been an estimated 204,040 cases of acute diarrhoeal disease, 204,647 acute respiratory disease cases and 263,356 cases of acute skin diseases. Annually, water-borne diarrhoeal diseases still cause premature deaths globally for an estimated 2.2 million people, mostly children; organisms responsible for these diseases vary from bacterial to protozoal to viral.

Cholera, with its rapid disease onset and 5% fatality rates, is one of the most feared water borne diseases in situations of natural disaster. The disease is caused by infection with the Vibrio cholera bacterium, after consuming contaminated water or food; person to person transmission is unlikely to occur. After infection, disease symptoms can be mild or even non-existent, but in severe cases the characteristic watery diarrhoea and dehydration can lead to death within hours. In industrialised countries, cholera is no longer an endemic disease, but the bacteria are endemic in many developing countries, including Pakistan. Cholera cases were documented recently in Zimbabwe in 2009; here the cause was not natural disaster, but man made, resulting in nearly 4,500 deaths. While outbreaks of this deadly wasting water-borne disease have been rumoured, they have not been confirmed in the wake of the Pakistan floods. Cases of acute watery diarrhoea are being treated with cholera treatment protocols, including intravenous fluids and oral re-hydration salts, for individuals suffering severe diarrhoeal diseases.

This disaster situation is complicated not only by the uncharacteristically heavy seasonal monsoon rains, the vast area in need of aid and the lack of the immediate, sufficient international aid, but also by fears of political insurgency. Fears that aid supplies could be hijacked by extremist elements have been expressed. While the tardy international response has also roused fears that this international aid vacuum could be exploited by the same extremist elements. Concerns remain that a poor international response to this natural disaster may mean that the Pakistan floods also wash away progress made in the Afghan war. This natural disaster has become as politicised as any could, highlighting the critical connections that exist between international aid and international security. The poorest survivors remain caught in the middle of this debate, and aid remains essential.

Secretary-General visits displaced (Schneider, UN)

Ban Ki-Moon described that “almost 20 million people need shelter, food and emergency care. That is more than the entire population hit by the Indian Ocean tsunami, the Kashmir earthquake, Cyclone Nargis and the earthquake in Haiti – combined.” The scale of this natural disaster is vast in land mass and numbers affected by loss of homes, land and livelihood, but these factors did not immediately demand the necessary urgent response from the international community. It is clear that the Pakistan death toll does not compare to the natural disasters which have ravaged countries of late. Around 230,000 deaths occurred as a result of the 2004 Indian Ocean tsunami, there were over 73,000 deaths after the 2005 Kashmir earthquake in Pakistan, Cyclone Nargis in 2008 is thought to have caused 140,000 deaths and over 210,000 deaths occurred after the 2010 earthquake in Haiti. Death tolls as a direct result of the relentless Pakistan floods do seem remarkably low in comparison. However, while the mortality rates are much lower than recent natural disasters, it is crucial to appreciate that vast regions and vast numbers of people have been devastated by these floods in what Ban Ki-Moon referred to as Pakistan’s “slow motion Tsunami.”

In other parts of the world, dramatic seasonal weather is also causing devastation. China is suffering from floods and mudslides, which have displaced tens of thousands and killed more than 1,500 people, while bringing devastation to homes and livelihoods. After un-seasonally heavy rains destroyed crops, livestock and livelihoods in West Africa last year, they re-visited countries of the eastern Sahel region this year. Niger was hardest hit; causing more than 1,000 deaths and making 100,000 people homeless. In the aftermath of these disasters, as in Pakistan, water-borne diseases carry risks of further mortality after the immediate ravages of the storms have faded.

“These unprecedented floods require unprecedented assistance” urged the UN Secretary-General, the following his visit to flood-affected zones in Pakistan. According to the UN, 8 million people are in need of life saving humanitarian assistance, and 4.6 million are homeless. With the unremitting floods and particularly in the absence of sufficient aid, the immediate future predicts further misery, especially for the poorest of survivors. Pledges are still being calculated for the $460 million requested in international assistance by the UN, but are thought to beyond the halfway mark according to UN spokesperson Farhan Haq. This cash is not yet delivered, and in order to meet the multitude of varied challenges of disaster, Pakistan still needs sustained “waves of global support.”

The post 10,000 Villages: Pakistan Floods & Water-borne Disease Spread appeared first on The Faster Times.

Maybe an unexpected highlight, but I’m impressed at these findings… A recent study proved that application of azithromycin (Zithromax) to treat trachoma saved sight in Ethiopia and saved lives too. Chlamydia trachomatis is the leading cause of preventable blindness. Left untreated, chronic and repeated trachoma infections in children can lead to irreversible adult blindness; there are an estimated 8 million irreversible visual impairments attributed to trachoma. Surgery, Antibiotics, Facial cleanliness and Environmental improvement (SAFE) can all play a role in reducing the risk of disease, as well as treating and resolving infections.

The study published in September was conducted in Ethiopia, where 119 of every 1000 children die before 5 years of age. After azithromycin treatment for trachoma, the overall mortality rate among children who had taken the drug was half that of those who had not. One of the study leaders, Dr Tom Lietman, from the University of California at San Fransico, commented that “For years, people in trachoma-affected communities have reported that the antibiotic helped address other health problems”.

This study validates those reports, particularly so in the wider context that azithromycin is used to effectively treat many other infections. Diarrhoeal diseases and malaria are common causes of death for children under 5 in sub-Saharan Africa, causing an estimated combined 2.5 million childhood deaths annually. In the study setting, it’s likely that broad use of azithromycin may have treated a host of the neglected diarrhoeal and respiratory diseases as well as malaria, resulting in a significant reduction in childhood mortality.

These important findings are impressive, offering great potential to scale up the antibiotic treatment element of the SAFE programme and save many young lives. But wide-scale application of non-specific drug treatment should be taken with real prudence; such approaches must be integrated with other interventions and considerate of scientific understanding about the development of drug resistance. The rise of drug resistant organisms is no fiction; malaria, tuberculosis, HIV and staphylococcal infections, amongst others, certainly prove the need to proceed with caution!

Number 2, An Effective Malaria Vaccine Coming Soon?

In 2009, phase 3 human clinical trials began with the most promising malaria vaccine to date. The vaccine known as RTS,S/AS02 (aka RTS,S or Mosquirix) can be used safely, generating specific immunity to malaria and most importantly seeming to provide significant reductions in severe malaria (49%) and clinical disease (35%) in African children. The RTS,S vaccine was developed by Glaxo SmithKline (GSK) in the mid 1980s with support from the Walter Reed Medical Centre; since 1991 the vaccine effort has been a public-private partnership between GSK and the PATH Malaria Vaccine Initiative. Designed primarily for use in Africa and first tested on humans in the early 1990s, this is the most promising malaria vaccine to date.

The start of the largest ever malaria vaccine trials was announced this year; seven African countries, including 11 medical research institutes, will participate. The vaccine will be administered to up to 16,000 infants and children younger than 17 months in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania. Results of this trial are expected in 2012. With the already encouraging results shown so far, the first malaria vaccine may be available for wide-scale use by 2015.

Number 1, Swine Flu Fever Takes Over The World & Everything!

H1N1 virus

Swine flu happened to the whole world in a big way in 2009, overshadowing all other public health/infectious disease news. By mid 2009, WHO had declared H1N1 (swine flu) a global pandemic, and some measure of panic, or perhaps I should say elevated concern, set in for a good while. There were masks in public places, and (hopefully!) much practice of good hand-washing hygiene. The H1N1 virus spreads rapidly (just like seasonal influenza), and is a new virus which causes a highly infectious disease. While thousands of deaths have occured, H1N1 is not highly pathogenic, and has not caused the feared high rates of illness and death.

1976 H1N1 vaccination

Vaccines have proven highly controversial and aroused much suspicion regarding safety and efficacy. There is no reliable evidence to show that current vaccines are either unsafe or ineffective; rather there is increasing peer reviewed evidence to the contrary 1 2. However, in the US, nasal and pediatric syringe-filled H1N1 vaccines have recently been recalled due to dosage concerns.

Most countries have stopped recording the numbers of new infections, and millions are thought to have been infected with the H1N1 virus without serious symptoms. The number of deaths continues to rise; to date at least 12,220 deaths have been attributed to H1N1 globally.

Swine flu will undoubtedly continue to inspire research, debate and discussion in this new decade, as will other pressing infectious diseases and public health happenings. So stay tuned for more global pandemics news in 2010.

To Good Health and a Happy New Year!

1. Greenberg ME, Lai MH, Hartel GF, Wichems CH, Gittleson C, Bennet J, Dawson G, Hu W, Leggio C, Washington D, Basser RL. Response to a monovalent 2009 influenza A (H1N1) vaccine. N Engl J Med 2009; 361 (25) 2405-13 http://nejm.highwire.org/cgi/reprint/NEJMoa0907413.pdf

2. Nolan T, McVernon J, Skeljo M, Richmond P, Wadia U, Lambert S, Nissen M, Marshall H, Booy R, Heron L, Hartel G, Lai M, Basser R, Gittleson C, Greenberg M. Immunogenicity of a Monovalent 2009 Influenza A(H1N1) Vaccine in Infants and Children: A Randomized Trial. Jama 2009; http://jama.ama-assn.org/cgi/reprint/2009.1911v1

The post Top 2009 Global Pandemic Happenings: Part 2 appeared first on The Faster Times.

The global rise of H1N1 continues. Currently over 526,000 infections and around 6700 deaths have been confirmed. The Americas account for 72% of all deaths with around 4800 reported deaths. In contrast, while 166,750 cases are confirmed in the Western Pacific region, there are lower mortality rates here than in the Americas; 613 deaths are confirmed in this region 1.

Severe symptoms of pandemic H1N1 2009 can result in hospitalisation and death. Virulence factors could associate pandemic H1N1 infections with more severe disease; H1N1 virulence factors have not been reported. Epidemiological data continues to indicate that pregnant women, young children under 5 years of age and individuals with chronic underlying conditions, (including respiratory problems, obesity and diabetes) are at significantly greater risk of severe disease symptoms than the wider population.

Specific H1N1 (swine flu) vaccines are being administered, but apprehensions about pandemic H1N1 disease severity and vaccination are re-iterated around the world. Concerns abound regarding whether pandemic H1N1 disease risk is great enough to warrant vaccination. Unease about vaccine safety and effectiveness is also frequently expressed.

The World Health Organisation (WHO) estimates that 80 million doses of H1N1 vaccine have been distributed, and an estimated 65 million cumulative doses administered. H1N1 immunization campaigns are in progress in 40 countries and regions. Dr Marie-Paule Kieny, Director for the Initiative for Vaccine Research at WHO commented that H1N1 vaccines ‘include different products, inactivated (virus) with or without adjuvant as well as live attenuated vaccines.’ To date there has been ‘no significant difference in the safety profile between different types of vaccines‘.

One adverse event is reported for every 10,000 H1N1 vaccine doses administered. From these adverse event reports, 5 out of 100 are considered serious. Less than a dozen cases of Guillain-Barre syndrome, (which was associated with H1N1 vaccinations in 1976) have occurred in association with 2009 H1N1 vaccines. Guillain-Barre syndrome disease was transient and all patients recovered. No deaths have been associated with H1N1 vaccines. While there have been around 30 reports of death after H1N1 vaccine delivery, none have been directly associated with these vaccines.

The goal of vaccination is to increase individual and population-level specific disease immunity, reduce illness and mortality rates, and slow the spread of specific disease. Timing of vaccination is crucial in determining vaccine effectiveness. Studies have shown that H1N1 vaccines can generate specific immunity and indicate that responses will be effective against H1N1 2 3.

With the scale of infection, it remains important that all antiviral treatment follow medical advice in order to reduce the development and spread of H1N1 anti-viral drug resistance. Dr Nikko Shindo, a Medical Officer in WHO’s Global Influential Programme recommends prompt antiviral treatment when flu symptoms occur, particularly for individuals in at-risk groups. Medical practitioners are also encouraged to prescribe anti-viral medication to individuals not among at-risk groups when persistent or rapidly worsening symptoms occur. Such symptoms include vomiting, diarrhoea, difficult breathing and high fever lasting more than 3 days.

Whether or not you choose to get vaccinated, you can implement other H1N1 disease reduction measures. Those predicted to be at greater risk of severe disease are encouraged to be immunized, but if all at-risk individuals rushed out to get the vaccine in the coming days and weeks, most would have a very long wait.

1. WHO. Pandemic (H1N1) 2009 – update 75. 2009;

http://www.who.int/csr/don/2009_11_20a/en/index.html

2. Greenberg ME, Lai MH, Hartel GF, Wichems CH, Gittleson C, Bennet J, Dawson G, Hu W, Leggio C, Washington D, Basser RL. Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine — Preliminary Report. N Engl J Med 2009;

http://content.nejm.org/cgi/reprint/NEJMoa0907413.pdf?resourcetype=HWCIT

3. Clark TW, Pareek M, Hoschler K, Dillon H, Nicholson KG, Groth N, Stephenson I. Trial of Influenza A (H1N1) 2009 Monovalent MF59-Adjuvanted Vaccine — Preliminary Report. N Engl J Med 2009;

http://nejm.highwire.org/cgi/reprint/NEJMoa0907650.pdf

The post Around the World with H1N1 (Swine Flu); Mortality & Vaccine Update appeared first on The Faster Times.

The global rise of H1N1 continues. Currently over 526,000 infections and around 6700 deaths have been confirmed. The Americas account for 72% of all deaths with around 4800 reported deaths. In contrast, while 166,750 cases are confirmed in the Western Pacific region, there are lower mortality rates here than in the Americas; 613 deaths are confirmed in this region 1.

Severe symptoms of pandemic H1N1 2009 can result in hospitalisation and death. Virulence factors could associate pandemic H1N1 infections with more severe disease; H1N1 virulence factors have not been reported. Epidemiological data continues to indicate that pregnant women, young children under 5 years of age and individuals with chronic underlying conditions, (including respiratory problems, obesity and diabetes) are at significantly greater risk of severe disease symptoms than the wider population.

Specific H1N1 (swine flu) vaccines are being administered, but apprehensions about pandemic H1N1 disease severity and vaccination are re-iterated around the world. Concerns abound regarding whether pandemic H1N1 disease risk is great enough to warrant vaccination. Unease about vaccine safety and effectiveness is also frequently expressed.

The World Health Organisation (WHO) estimates that 80 million doses of H1N1 vaccine have been distributed, and an estimated 65 million cumulative doses administered. H1N1 immunization campaigns are in progress in 40 countries and regions. Dr Marie-Paule Kieny, Director for the Initiative for Vaccine Research at WHO commented that H1N1 vaccines ‘include different products, inactivated (virus) with or without adjuvant as well as live attenuated vaccines.’ To date there has been ‘no significant difference in the safety profile between different types of vaccines‘.

One adverse event is reported for every 10,000 H1N1 vaccine doses administered. From these adverse event reports, 5 out of 100 are considered serious. Less than a dozen cases of Guillain-Barre syndrome, (which was associated with H1N1 vaccinations in 1976) have occurred in association with 2009 H1N1 vaccines. Guillain-Barre syndrome disease was transient and all patients recovered. No deaths have been associated with H1N1 vaccines. While there have been around 30 reports of death after H1N1 vaccine delivery, none have been directly associated with these vaccines.

The goal of vaccination is to increase individual and population-level specific disease immunity, reduce illness and mortality rates, and slow the spread of specific disease. Timing of vaccination is crucial in determining vaccine effectiveness. Studies have shown that H1N1 vaccines can generate specific immunity and indicate that responses will be effective against H1N1 2 3.

With the scale of infection, it remains important that all antiviral treatment follow medical advice in order to reduce the development and spread of H1N1 anti-viral drug resistance. Dr Nikko Shindo, a Medical Officer in WHO’s Global Influential Programme recommends prompt antiviral treatment when flu symptoms occur, particularly for individuals in at-risk groups. Medical practitioners are also encouraged to prescribe anti-viral medication to individuals not among at-risk groups when persistent or rapidly worsening symptoms occur. Such symptoms include vomiting, diarrhoea, difficult breathing and high fever lasting more than 3 days.

Whether or not you choose to get vaccinated, you can implement other H1N1 disease reduction measures. Those predicted to be at greater risk of severe disease are encouraged to be immunized, but if all at-risk individuals rushed out to get the vaccine in the coming days and weeks, most would have a very long wait.

1. WHO. Pandemic (H1N1) 2009 – update 75. 2009;

http://www.who.int/csr/don/2009_11_20a/en/index.html

2. Greenberg ME, Lai MH, Hartel GF, Wichems CH, Gittleson C, Bennet J, Dawson G, Hu W, Leggio C, Washington D, Basser RL. Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine — Preliminary Report. N Engl J Med 2009;

http://content.nejm.org/cgi/reprint/NEJMoa0907413.pdf?resourcetype=HWCIT

3. Clark TW, Pareek M, Hoschler K, Dillon H, Nicholson KG, Groth N, Stephenson I. Trial of Influenza A (H1N1) 2009 Monovalent MF59-Adjuvanted Vaccine — Preliminary Report. N Engl J Med 2009;

http://nejm.highwire.org/cgi/reprint/NEJMoa0907650.pdf

The post Around the World with H1N1 (Swine Flu); Mortality & Vaccine Update appeared first on The Faster Times.