H5N1

Sweden: Royals must wait in line for flu vaccine

Via The Local: Royals must wait in line for flu vaccine. Excerpt:

Daniel Westling, fiancé of Crown Princess Victoria, has received the swine flu vaccine after being placed in a high-risk group following a kidney transplant earlier this year. The rest of the Swedish Royal Family, however, has to wait patiently for the jab. 

King Carl Gustaf and Queen Silvia have previously revealed their intention to be vaccinated against the A(H1H1) virus, according to an article in the Expressen newspaper. Yet, despite their privileged position, the couple are not jumping the queue and must wait their turn. 

”The National Board of Health and Welfare has recommended the vaccine,” Nina Eldh, head of information at the Royal Court, told Expressen. ”They will have it when it is available,” she added. 

The Royal Court also confirmed that Daniel Westling had his first swine flu vaccine around a week ago. Following a kidney transplant earlier this year he was placed in a high-risk group of patients. 

It is likely that the rest of the Royal Family will have the vaccine within the next week.

US: Death of a teacher

Via the Salt Lake Tribune, an account of the death of Diane Pugmire: H1N1 claims respected Weber State teacher. Excerpt:

Pugmire's death is a poignant twist in the swine-flu story because of its effect on Weber State's academic community. Earlier this month, Pugmire had been named Educator of the Year by the Utah Association of Supervision and Curriculum Development, sharing the honor with Weber math instructor Dixie Blackinton. 

The award recognized the pair for their success in showing educators and student teachers how to teach math. Pugmire worked most closely with elementary-level teachers. 

"Diane was an amazingly passionate teacher. She was committed to helping students understand math on a one-on-one basis," Ostlie said. "She helped them understand the math they are being asked to teach and provide would-be teachers with the tools to help their students understand math." 

On Monday, Pugmire started to feel sick, her family said, but she went to school and taught class anyway. "All she felt was like she had some night sweats," Hincks said. "She just kind of felt like she had a cold." 

Late that night, however, her husband Daniel Pugmire called 911. "She was crying out for help and was in a lot of pain and she couldn't breathe very well," Hincks said. 

Pugmire was taken by ambulance to Ogden Regional, where she was put in a medically induced coma and placed on ventilators. "She felt OK about it. She said she wasn't scared," Hincks said. 

Before going under, she had her husband call Blackinton at 2:30 a.m. Tuesday to ask her to cover Pugmire's classes while she was out of commission. 

After 31 hours, however, Pugmire stopped breathing. Staff performed CPR, but were unable to revive her. The ICU nurses, Hincks said, commented that they had never seen someone get so sick so fast. 

Unlike most people who die from complications of H1N1, Pugmire had no underlying medical conditions. She was fit, often going for runs before work, and didn't drink or smoke.

Ukraine: 48 dead of swine flu?

Via the Kyiv Post: President: 48 die of swine flu in Ukraine. Excerpt:

The Interfax news agency quotes Ukrainian President Viktor Yushchenko as saying that 48 people have died of swine flu in the ex-Soviet nation.

Ukraine closed schools and banned cinema showings and concerts Friday in a bid to stop the epidemic, which Yushchenko says sickened 150,000 people. 

The outbreak began in the western Ternopol region, health officials said. Ukrainian media reported severe shortages of anti-flu medication and masks in pharmacies.

Must-read of the day

A jaw-dropping report from the Globe and Mail: Ottawa got last-minute warning of shortfall in H1N1 vaccine. Excerpt:

Canada's vaccine manufacturer did not inform federal health officials until Thursday that the number of H1N1 doses available to Canadians next week would shrink by much more than half – prompting provinces to suspend the rollout of the vaccine to the general public for at least a couple of weeks. 

GlaxoSmithKline is forecast to ship 436,000 doses to provinces and territories, far less than the roughly two million anticipated, because it had to interrupt production at its Ste-Foy, Que., plant to make a version of the vaccine for pregnant women. 

The last-minute admission of a shortfall is the latest and largest blow in a week marked by anxiety, confusion and mounting frustration. Problems with vaccine supply and underestimation in pandemic planning now threaten to undermine Canada's largest-ever inoculation campaign. 

What's gone wrong? 

It's a story of slower-than-expected vaccine production, a resurgent virus targeting the young, and a once-skeptical public suddenly rushing to get the shot. 

As flu clinics prepared to open this week, rising anti-vaccination sentiment persuaded health officials that uptake would be low, prompting them to step up their campaign to persuade Canadians to be immunized. 

What they didn't count on was the far more compelling effect of real-world events – the deaths of two seemingly healthy young Canadians. Panicked, parents hurried children of all ages to flu-shot clinics; healthy adults went too, ignoring the carefully planned protocol that the most vulnerable should come first. 

And now this: the shortage that David Butler-Jones, Canada's Chief Public Health Officer, said the government only learned the extent of late Thursday.

Thursday? As in, yesterday? When I saw Butler-Jones and Health Minister Aglukkaq here in Vancouver a couple of weeks ago, they were sticking to "early November" as the roll-out date for the vaccine. They'd said the same thing in an earlier press conference from Iqaluit.

Both were so resistant to reporters' questions about an earlier vaccination start that I thought something sounded wrong. Then, without much explanation, the vaccinations started a week early after all.

In fairness, Dr. Butler-Jones is an old pro. He may simply have known from experience that pharmaceutical companies can't always be trusted to deliver the goods. Early November was a reasonable launch date, so he stuck to it. 

But two kids' deaths, and resulting political pressure, forced the Canadian government to launch early, and GSK didn't have the vaccine in adequate quantities.

Professional soldiers remind each other that the battle plan is what disappears in the first moment of contact with the enemy. Evidently the same is true of pandemic plans.

Still, you would think that public-health professionals would know how much can go terribly wrong in any disease outbreak. What was their Plan B? And if they didn't have a Plan B, what's their excuse?

US: 114 dead children, or 300?

Via the New York Times: U.S. Releases Its Stockpile of Tamiflu for Children. Excerpt, with my bolding:

Swine flu is sickening so many children across the country, some of them fatally, that federal health officials decided Friday to release the last of the national stockpile of children’s Tamiflu. 

Even though the winter flu season has yet to begin, flu has now killed 114 children and teenagers in the United States since April, said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. 

Since the C.D.C. began tracking children’s flu deaths five years ago, the highest toll was 88, in the winter of 2007-8; many more children died in the pandemics of 1918, 1957 and 1968, but there are no accurate counts. 

Dr. Frieden’s figures were for deaths confirmed by laboratories. On Thursday, the C.D.C. estimated that in the swine flu’s spring wave there were 2.7 deaths for each confirmed one, so the actual number of children’s deaths may be closer to 300. 

On Oct. 1, anticipating shortages of liquid Tamiflu for children, the government released 300,000 doses from the national stockpile. On Friday, it released the last 234,000 doses. 

It has ordered more from Roche, its Swiss manufacturer, but that is not expected to arrive before January, Dr. Frieden said. 

In the meantime, federal officials are encouraging pharmacies to empty powder from adult capsules and dilute it with syrup into children’s doses. Some large pharmacy chains are already doing so. Presumably, the same could be done with the 37 million adult doses still in the stockpile.

China: 6 deaths

Via Xinhua: Death toll from A/H1N1 flu reaches 6 on Chinese mainland. Excerpt:

Two more people on the Chinese mainland died of A/H1N1 influenza in the 48 hours ending at 3 p.m. Friday, bringing the total to six, said the Ministry of Health in a statement on its website Friday night.     

The ministry was not immediately available for more information on the two death cases.     

According to the ministry, the mainland reported 2,972 confirmed cases of the A/H1N1 influenza in the 48 hours, bringing the total number to 44,981.

Ukraine is getting worried

Via MIGnews.com.ua: Shock! Pestilence expected in Ukraine? 20 people died of influenza already (updated at 05:03 pm). The English isn't flawless, but the anxiety comes through very well. Excerpt:

Flu epidemic in the Ternopil Region, which appeared a week ago, mowed down nearly 10,000 of residents. Moreover - unknown virus has already killed seven people. 

Two residents of the regional center and five villagers (among them was a woman who recently gave birth to a child) died from pneumonia caused by catarrhal infection. Another four people have been in the grace condition in hospitals of Ternopil. 

As the head of public health city department Vasyl Blykhar reported, all victims of infection were young people who previously had no problems with health. Supposedly they sought help too late, on the sixth or seven day. Quarantine is declared in the region, schools are closed. 

They say infection is coming to the neighboring areas of Western Ukraine. In the Lviv Region a few districts are preparing for quarantine, particularly, Drohobych and Boryslav districts. 

As a resident of Ternopil Olexandra Melys toldh, a lot of people wearing flu masks have appeared in the city. Ternopil residents are buying garlic, onion and vodka for prophylaxis. There are queues for pills and drops from a cold, there is lack of the most popular drugs, "- says a pensioner Lyudmila. - They say that in fact 16 people have already died”. 

Local residents fear swine flu mows down them. Doctors reassure: laboratory studies at the local level do not confirm that it is swine flu. 

"We will be able to confirm the type of influenza in 1,5 week, when research results will be received from London", - says Bohdan Onyskiv, the head of the regional health administration department. 

One reason for large-scale disease might be sudden cold snap, when a week ago Halychyna was covered with snow and frost. 

According to another version, wage earners, who brought the virus from abroad, are guilty of it. 

The doctors do not rule out that the death of residents occurred precisely because of influenza. But only virology examination may confirm information about it. It will be made in Kyiv within 7-14 days. 

But the head of the Verkhovna Rada Committee on Health protection Tatiana Bakhteyeva said that the Ukrainian examination is not a guarantee: "Our labs have a weak foundation for such research and nobody can guarantee the results will be correct."

US: 19 child deaths from H1N1 in last week

Via WebMD.com: Child H1N1 Swine Flu Deaths Rising. Excerpt:

Last week's 19 new child deaths is the biggest single-week jump since the H1N1 swine flu pandemic began. 

The child death toll in the U.S. pandemic now stands at 114 and is certain to rise, CDC Director Thomas Frieden, MD, MPH, said today at a news conference. 

Frieden announced that the remaining 234,000 courses of Tamiflu liquid have been released from the national stockpile and will be distributed to states according to population. 

Earlier this month, the CDC released 300,000 courses of the pediatric formulation of the potent flu-fighting drug. 

Liquid Tamiflu is in short supply in many areas hard hit by the flu. However, child-size Tamiflu capsules remain available in most areas. In addition, several large-chain pharmacies are having their pharmacists mix up new batches of liquid Tamiflu from adult-size capsules of the flu drug. 

"Please don't try this at home," Frieden warned parents. However, if parents receive Tamiflu specifically prescribed for children, and the child can't swallow the capsule, it's OK for parents to open the capsule and mix it with syrup or something the child can swallow. 

This does not apply to adult-size capsules, which can only be remixed for children by a pharmacist.

Germany: Three deaths on Friday

Thanks to the German readers who let me know about this story. Via Spiegel Online: Pandemie in Deutschland: Drei Schweinegrippe-Tote an einem Tag. [Pandemic in Germany: Three swine flu deaths in one day] Excerpt, with my very unreliable translation:

Seit Freitag gibt es in Deutschland sechs Todeopfer des H1N1-Erregers. Allein drei von ihnen starben an diesem Freitag. Die drei jüngsten Opfer erlagen im Universitätsklinikum Bonn, im Augsburger Zentralklinikum und in einer Kinderklinik im saarländischen Neunkirchen den Folgen ihrer schweren Erkrankung. Es handelt sich um eine Frau mittleren Alters, einen Jugendlichen und ein Kind.

As of Friday Germany's swine flu death total reached six. Three deaths occurred this Friday: one in the Bonn University Clinic, one in the Augsburg Central Clinic, and one in a children's clinic in Neunkirchen. They included a middle-aged woman, a young person, and a child.

What the CDC map won't tell you

Thanks to the readers who sent the link to this ABC News story--an interesting analysis of the CDC's "flu activity" map: Swine Flu: What the CDC Map Won't Tell You. Excerpt:

According to the CDC's map of flu activity, 46 states are currently reporting widespread H1N1 flu cases. Since almost all states have by now reported outbreaks, this map, which only a month ago was dappled with the different colors of flu levels, is now almost uniformly brown. 

The CDC notes on its site that the map only shows geographical trends and "does not measure the severity of influenza activity." 

But with the CDC reporting little variance between states, let alone within each state, it is easy to conclude that the amount of swine flu activity is the same across the country. 

A check of 60 hospitals by ABC News suggests a very different picture. The collection of reports from these hospitals, though not a scientific sample, suggested that not only does the extent and severity of the illness vary from region to region, but in some cases it varies even among hospitals in the same state. 

In order to get a better idea of how flu activity varies across the nation, we asked hospitals to rate their level of flu activity in their emergency department and report the number of H1N1 patients in their intensive care unit (ICU) -- a sign that at least some cases were severe enough to warrant extraordinary treatment measures. 

At least 10 out of the 60 hospitals reported heavy activity of H1N1 in their emergency departments, but nearly twice as many said flu levels were "moderate" and the largest proportion, 21 hospitals, said that the situation was "light" in their ER and reported few, if any, patients in the ICU due to swine flu-related problems. 

There is no doubt that there are areas where flu activity is high. The Midwest remained the heaviest area of activity, and other "heavy" hospitals were spread out across the country.