WHO eyes swine flu transmision rates, new vaccine

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By ELIANE ENGELER and MARI YAMAGUCHI, Associated Press Writers Eliane Engeler And Mari Yamaguchi, Associated Press Writers – 46 mins ago

GENEVA – Health experts are looking very closely at the spread of swine flu among people in Spain, Britain and Japan, a WHO official said Sunday as Japan reported a one-day explosion of over 70 new cases, mostly among teenagers.

The swine flu epidemic is already expected to dominate the World Health Organization's annual meeting, a five-day event that begins Monday in Geneva and involves health officials from the agency's 193 member states.

WHO Director-General Dr. Margaret Chan will reveal experts' recommendations on the production of a swine flu vaccine sometime at the meeting. Pharmaceutical companies are ready to begin making such a vaccine, but many decisions have to be made first — such as how much vaccine should be produced, how it should be distributed and who should get it.

Some experts say there's no question that a swine flu vaccine must be produced but WHO needs to discuss the issue with its members.

As of Sunday, the swine flu virus — which WHO calls the A (H1N1) virus — has sickened at least 8,480 people in 39 countries, killing 75 of them, mostly in Mexico.

Japan's health ministry confirmed dozens of new cases of swine flu in waves of announcements Sunday, prompting the government to shut down schools and cancel public events like Kobe's annual festival. By late Sunday, Japan's tally rose from five confirmed cases to 78 — many of them high school students who had not traveled overseas.

Most of the new cases involved students in the western prefectures of Hyogo and Osaka, and health officials said they were recovering in local hospitals.

Customer service workers at stores, restaurants and train stations in those two regions immediately began wearing masks as a precaution.

Japan had established strict quarantine measures at airports to try to keep the virus from spreading, but decided Saturday to shift its focus instead to containing the domestic outbreak.

WHO spokesman Gregory Hartl said in-country transmission rates were a key factor in whether the global body decides to increase its pandemic alert level. Right now, the world is at phase 5 — out of a possible 6 — meaning that a global outbreak is "imminent."

"We already know about the UK and Spain, that they have a relatively high number of cases compared to other European countries, so by simple virtue of the fact that they have more cases they need to be kept an eye on," Hartl said in an interview with AP Television News.

"There seems to have been activity in the last few days in Japan so we need to watch that too," he said.

Spain and Britain have had the highest numbers of cases in Europe, reporting 103 and 101 cases respectively. Britain announced 14 new cases on Sunday — with 11 of those being transmitted in-country — people who had not traveled to Mexico or the United States but became infected from others who had the virus.

Hartl said he couldn't tell whether the rapid spread of the virus in Japan might trigger a pandemic.

"We don't want to prejudge anything, but certainly this is something we are watching with interest," he said.

If the virus starts to be transmitted from person to person on a large scale in a country outside the Americas, this could trigger a pandemic, WHO experts have said. But it would have to jump among people outside schools, hospitals and other institutions that typically pass on such viruses quickly.

WHO estimates that up to 2 billion doses of swine flu vaccine could be produced yearly, although the first batches wouldn't be available for four to six months.

U.N. Secretary-General Ban Ki-moon will visit WHO on Tuesday and meet with senior representatives there from the vaccine industry, but the U.N. declined to say which companies.

Most flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake.

The U.S. Centers for Disease Control and Prevention is working on a "seed stock" to make the vaccine, which should be ready in a few weeks. Until vaccine manufacturers get the seed stock, they won't know how many doses of vaccine they can make or how long that would take.

WHO is also negotiating with vaccine producers like GlaxoSmithKline PLC and Sanofi Pasteur to save some of their swine flu vaccine for poorer nations. Many rich nations — such as Britain, Canada, Denmark, France, Switzerland and the United States — have already signed deals with vaccine makers to guarantee them pandemic vaccines.

A sense of urgency about preventing a swine flu pandemic helped Taiwan get a first-time observer seat on the World Health Assembly. Taiwanese Health Minister Dr. Yeh Ching-chuan said Taipei was proud to take part in the meeting for the first time in 38 years.

"Taiwan and China are both part of the world community. We should fight this disease together," he told reporters in Geneva.

China and Taiwan split amid civil war in 1949. Beijing normally objects to Taiwan's participation in international organizations but relations have improved substantially over the past year.

WHO's health assembly will run through May 22, five days shorter than initially planned because health ministries are busy fighting the swine flu outbreak.

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Eliane Engeler reported from Geneva and Mari Yamaguchi from Tokyo. AP Television News reporter Martin Benedyk in Geneva, AP Medical writer Maria Cheng in London and reporter Jennifer Quinn in London also contributed to this report.


http://news.yahoo.com/s/ap/20090517/.../med_swine_flu

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GENEVA – The chief of the World Health Organization says she is not raising the world swine flu alert level just yet.

Several countries including Britain, Japan and China had urged the U.N. health agency to change how it decides to raise the alert level.

WHO chief Dr. Margaret Chan says the swine flu epidemic is in "a grace period" with the WHO alert remaining at phase 5 out of a possible six for the last month. She told the WHO annual assembly on Monday that no one can say how long this period will last.

Chan says the danger now is that the swine flu virus could mix with other flu strains and become more dangerous.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

GENEVA (AP) — Britain, Japan, China and other nations urged the World Health Organization on Monday to change the way it decides to declare a pandemic __ saying the agency must consider how deadly the virus is, not just how fast it is spreading.

The debate arose as WHO began its annual meeting, a five-day event attended by hundreds of health experts from the agency's 193 member nations. Swine flu is expected to dominate this year's conference — and WHO must consider whether it should raise its alert level or tell manufacturers to begin making a specific swine flu vaccine.

WHO's current system focuses on how widespread the disease has become without regard to its severity. Some member nations are anxious to avoid having the agency declare a swine flu pandemic, because the ramifications of that scientific decision could be very costly and politically charged.

"We need to give you and your team more flexibility as to whether we move to phase 6," British Health Secretary Alan Johnson said.

Japan also called for changes in WHO's system, which would move to pandemic if the virus starts to be transmitted among people outside schools, hospitals and other institutions where viruses typically pass quickly.

"It's certainly something we will look at very closely," Dr. Keiji Fukuda, WHO's flu chief, said of the proposal.

So far, the United States was noncommittal on the issue. U.S. Health and Human Services Secretary Kathleen Sebelius told The Associated Press she wanted more information on the proposal before taking a position, but that she was impressed how many countries supported it.

Health experts were examining new swine flu cases in Spain, Britain and especially Japan, where more than 130 people, the vast majority of them teenagers, have been infected, prompting the government to close 2,000 schools and cancel public events. A good number of the new cases were transmitted in-country, infecting people who had not traveled overseas recently.

WHO says transmission rates in countries outside the Americas is the key factor in whether the agency should raise its pandemic alert scale to the highest level. Right now it is at phase 5 — out of a possible 6 — meaning a global outbreak is "imminent."

Dr. Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention, told the WHO meeting that the outbreak is "not winding down" in the United States and "widespread transmission" continues. He also said the epidemic also was not over in Mexico.

Speaking a day after New York school assistant principal Mitchell Wiener died of swine flu, Besser said the world needed to maintain its vigilance against the virus.

Dr. Margaret Chan, WHO director-general, said scientists were working to provide as much detail about the disease as possible.

"What we need now most of all is information," Chan said. "We must guard against complacency."

But WHO officials did not appear to welcome the concept of a universal severity measure.

"Severity and the broader impact on society is something that we really can't set globally, because of the unique conditions in every community," WHO spokesman Dick Thompson told the AP. "Severity is going to be different in different countries. And within a country, it will be different in different populations."

As of Monday, the swine flu virus has sickened at least 8,829 people in 40 countries, including 76 deaths. Chile on Sunday became the latest country to confirm a case of swine flu.

A pandemic announcement would likely have severe economic consequences: it could trigger expensive trade and travel restrictions like border closures, airport screenings and quarantines, as countries not yet affected struggle to keep the virus out.

Governments may also fear outbreaks of mass panic, social disruption and increased pressures on their health systems. Under public pressure, extraordinary measures such as large-scale pig slaughters like the recent one in Egypt could be taken, whether or not they are scientifically justified.

In one of their first moves Monday, delegates unanimously elected Sri Lanka's Health Minister Nimal Siripala de Silva to preside over the assembly, a largely ceremonial post.

That vote surprised about 200 protesters demonstrating outside the U.N.'s European headquarters against Sri Lanka's assault on ethnic Tamil rebels.

"We are really shocked about this," said Safeena Mohamed Rawfal, claiming de Silva has cared only for majority Sinhalese and ignored the needs of the Tamils in the country's long civil war.

Sometime during the meeting, Chan is expected to reveal experts' recommendations on whether to produce a swine flu vaccine.

U.N. Secretary-General Ban Ki-moon will visit WHO on Tuesday to meet with senior representatives from the vaccine industry. The U.N. declined to name the companies but major vaccine producers include Sanofi-Aventis, GlaxoSmithKline and Baxter International.

The issue of producing a vaccine is sensitive, particularly for southern hemisphere countries where the annual flu season is about to begin. Seasonal flu can claim as many as 500,000 lives a year globally. But to have enough vaccine to confront a pandemic from a new strain such as swine flu, companies would have to switch from producing vaccine for seasonal flu.

WHO estimates up to 2 billion doses of swine flu vaccine could be produced yearly, though the first batches would not be available for four to six months.

Swine flu cases in Japan rose from four on Friday to over 130 on Monday. Most of the new cases involved high school students in the western prefectures of Hyogo and Osaka who had not traveled overseas.

Spain and Britain have the highest numbers of cases in Europe, reporting 103 and 101 cases, respectively.

Taiwan was taking part in the World Health Assembly as an observer with the approval of Beijing, the first time the island has participated in a U.N. meeting since its seat was given to China in 1971.

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Associated Press Writers Mari Yamaguchi in Tokyo and AP Medical writer Maria Cheng in London contributed to this report.


http://news.yahoo.com/s/ap/20090518/.../med_swine_flu

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By FRANK JORDANS and MARIA CHENG, Associated Press Writers Frank Jordans And Maria Cheng, Associated Press Writers – 1 min ago

GENEVA – Drug manufacturers won't be able to start making a swine flu vaccine until mid-July at the earliest, weeks later than previous predictions, the World Health Organization said Tuesday. It will then take months to produce a new vaccine.

The disclosure that making a swine flu vaccine is proving more difficult than experts first thought came as U.N. Secretary-General Ban Ki-moon and WHO chief Dr. Margaret Chan met Tuesday with representatives from about 30 pharmaceutical companies to discuss the subject.

Health officials from around the world are attending WHO's annual meeting in Geneva this week to discuss the outbreak that has infected 9,830 people in over 40 countries, killing at least 79 of them.

According to vaccine experts convened by WHO, swine flu virus is not growing very fast in laboratories, making it difficult for scientists to get the key ingredient they need for a vaccine, the "seed stock" from the virus, the agency reported.

Previously, WHO officials had estimated that production could start in late May, and would take four to six months.

Experts also found no evidence that regular flu vaccines offer any protection against swine flu.

Vaccine experts estimated under the best conditions, they could produce nearly 5 billion doses of swine flu vaccine over a year after beginning full-scale production.

In that situation, the U.N. might have access to up to 400 million doses for poor countries. The rest of the vaccines would presumably go to wealthy countries who have already signed deals to get the pandemic vaccine as soon as it is available.

Mass producing a pandemic vaccine would be a gamble, as it would take away manufacturing capacity for the seasonal flu vaccine that kills up to 500,000 people each year. Some experts have wondered whether the world really needs a vaccine for an illness that so far appears mild.

Chan said Monday it would be impossible to produce enough vaccine for all 6.8 billion people on the planet — a situation that could set off a global scramble where rich countries outbid poorer nations for the vaccine.

The impact of a pandemic — a global epidemic — is expected to be worse in poor countries, where people with other diseases like AIDS and malaria are more susceptible to swine flu and national health systems are less able to respond.

U.S. Health and Human Services Secretary Kathleen Sebelius said Tuesday that the U.S. felt it had a responsibility to ensure that both antiviral drugs and any new vaccine are also available to poor countries.

To do that, the United States is working to boost its production capacity for seasonal flu vaccines so in the event of an outbreak those factories can switch to the pandemic swine flu strain, she said.

Unlike other countries such as Britain, the United States has so far refrained from reserving its share of any new vaccine.

"At this point we have not placed orders for vaccine," Sebelius told reporters in Geneva. "There is still so much uncertainty about this virus that it is really premature for us to even make a determination of how many people would appropriately be vaccinated, in what order, how many doses would be required, and at what point."

These are the issues Ban and Chan were discussing with vaccine makers, including top producers Novartis, Sanofi-Aventis, GlaxoSmithKline and Baxter International as well as drugmakers from developing countries.

One expert, however, thought 5 billion doses estimate was too optimistic.

"We should go forward with production as quickly as possible, but we should be cautious" about predictions, said David Fedson, a vaccine expert. "We just don't know what the numbers will be until manufacturers start working with the virus."

He also wondered about political issues involving vaccine distribution — saying he was not sure if countries with vaccine plants would be willing to ship pandemic vaccines elsewhere before all of their own citizens were vaccinated.

On Monday, dozens of governments lobbied WHO to tread carefully before next raising its swine flu alert to the highest pandemic level of phase 6. The level currently stands at phase 5 — saying a global outbreak is "imminent."

Britain, Japan, China and others said Monday that declaring a global outbreak could cause unnecessary panic and confusion, especially since the virus has turned out to be less deadly than feared.

The vaccine experts emphasized that WHO's declaration of a pandemic should not automatically force vaccine makers to switch from making regular flu vaccine to pandemic vaccine. In addition, they said even if swine flu vaccine production began, that did not mean that countries should start immunizing large groups of people.

The experts told WHO that it should come up with targeted advice on which groups of people need the vaccine the most and should get it first. They also planned to meet again in several weeks to decide whether large-scale production of swine flu vaccine should begin.

Since the outbreak began last month, 79 people have died from the disease — 72 in Mexico, five in the U.S., one in Canada and one in Costa Rica, WHO says. Another U.S. death — that of a 16-month-old — is being investigated for swine flu.

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Associated Press writer Frank Jordans reported from Geneva and AP Medical Writer Maria Cheng reported from London.

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On the Net:

WHO: http://www.who.int


http://news.yahoo.com/s/ap/20090519/.../med_swine_flu

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WHO to consider severity of 'sneaky' swine flu
By FRANK JORDANS, Associated Press Writer Frank Jordans, Associated Press Writer – 1 hr 16 mins ago

GENEVA – The World Health Organization said Friday it will change the rules for declaring a swine flu pandemic, a virus the agency's chief called "sneaky" because of its ability to spread quickly from person to person and potentially mutate into a deadlier form.

Under political pressure from many of its 193 members to consider factors other than just the spread of the disease before announcing a global epidemic, WHO's flu chief said "course corrections" were being made.

"What we will be looking for is events which signify a really substantial increase in risk of harm to people," Keiji Fukuda told reporters in Geneva.

So far the virus has been mild, sickening 11,168 people and causing 86 deaths, most of them in Mexico, according to WHO.

But experts worry it could evolve into a more deadly strain or overwhelm countries unprepared for a major flu outbreak.

Many countries fear a pandemic declaration would trigger mass panic, and be economically and politically damaging. For developed countries that already have activated their pandemic preparedness plans, a pandemic declaration would change little in their response strategies.

Earlier this week, Britain and other countries urged WHO to reconsider its pandemic definition.

WHO hastily responded to these concerns, as Fukuda said the agency would revise the conditions needed to move from the current phase 5 to the highest level, phase 6, which makes it a pandemic.

"The countries are telling us now that moving from phase 5 to 6 is not so helpful," Fukuda said. He said the alert phases were developed before the outbreak hit, and now need to be adjusted to the reality of the situation.

The virus' lethality could become one of the required criteria before a pandemic is declared, Fukuda said.

Fukuda's comments echoed those of WHO Director-General Margaret Chan, who told governments she would heed their call to caution in declaring a pandemic.

At the same time, Chan warned against complacency.

"This is a subtle, sneaky virus," she said at the close of the weeklong meeting. "It does not announce its presence or arrival in a new country with a sudden explosion of patients seeking medical care or requiring hospitalization."

"We expect it to continue to spread to new countries and continue to spread within countries already affected," Chan said.

Countries taking part in the Geneva meeting agreed Friday to delay efforts to finalize a deal on sharing flu viruses, instead instructing Chan to find a solution by early next year.

Developing countries lobbied hard to ensure they would benefit from any drugs created using their virus samples.

Against that, the United States and the European Union called for samples to be shared without restriction, arguing that this was in the best interest of science and global efforts to combat disease.

Both sides agreed Chan should form a task force to investigate unresolved questions, including whether countries should have to share samples and resulting drugs could be patented. They also want the task force to consider whether doses of any new pandemic flu vaccine should be reserved for developing countries, and to report back to members in January with recommendations.

WHO said confirmed cases of the new virus — termed A/H1N1 — increased by 134 since Thursday.

The U.S. has reported the most laboratory-confirmed cases with 5,764 — an increase of 54 — followed by Mexico with 3,892.

Japan raised its tally by 35 to 294, while in Chile the caseload rose by 19 to 24.

Overall there have been 86 deaths linked to swine flu.

Of those, Mexico have been in 75, nine in the U.S., and one each in Costa Rica and Canada.


http://news.yahoo.com/s/ap/20090522/..._who_swine_flu

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US moving closer to swine flu vaccine
By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer – Fri May 22, 6:15 pm ET

WASHINGTON – Inching closer to a swine flu vaccine, the government is beginning to analyze two candidates for the key ingredient to brew one.

The Centers for Disease Control and Prevention hopes to deliver one or both to vaccine manufacturers by the end of next week so scientists can begin the months-long process of producing shots.

Friday, the government set aside $1 billion for crucial testing of the first pilot doses and stockpiling of key vaccine ingredients — in case world health authorities decide that people indeed need to be vaccinated starting sometime next fall. The stockpile will allow for quick production of shots to protect health workers and other people at high-risk from flu.

Also on Friday, CDC scientists unveiled the most detailed genetic examination yet of the novel virus, finding that the new swine flu may have been circulating undetected in pigs for years.

That report, in the journal Science, still fails to solve the bigger mystery of when and where the virus made the jump to people and what genetic change allowed it to start spreading so rapidly. The virus was first detected last month, and at least 42 countries now have confirmed it in more than 11,000 people. At least 85 people have died from it.

The confirmed cases don't represent anywhere near the full scope of the outbreak: For every reported case of swine flu, there may be 20 people sickened with it, said CDC's Dr. Anne Schuchat — more than 100,000 people in the U.S. There are signs that it is declining in parts of the country, although school-related outbreaks in New York City and elsewhere have led to the closings of about 60 schools affecting 42,000 students, Schuchat said.

The candidate vaccine viruses the CDC has begun analyzing contain a mix of genes from the new swine flu virus itself with components of other viruses that allow them to grow better in the eggs that manufacturers use to produce vaccine. If one or both prove usable, manufacturers could begin producing pilot lots for testing this summer to see if the shots are safe, trigger immune protection and require one dose or two.

Influenza is a master of evolution, a quick-change artist that can rapidly swap genes to create new strains. Birds are the ultimate origin of influenza viruses, said CDC flu chief Nancy Cox, a senior author of the gene paper in Science.

But Type A flu viruses have long circulated in pigs, too, dating to when the infamous 1918 pandemic strain was introduced to swine. All three global flu epidemics of the past century passed on traits to ancestors of this new flu. Among those ancestors was a triple-strain, or "triple reassortant," as scientists call it — part pig, part bird, part human — that first hit U.S. pig farms in 1998. Others are traced to pig viruses in Europe and Asia.

In fact, viruses with genes that most resemble the new swine flu — known scientifically as part of the H1N1 influenza family — were identified 10 years ago. And a human case in Thailand in 2005 was found to share genes from both the North American and Eurasian swine flu lineages, but not in the exact never-before-seen genetic combination that this new flu contains, Cox said.

Pig populations around the world need to be more closely monitored for emerging influenza viruses, the CDC-led team concluded. The researchers have asked veterinarian colleagues around the world to check their freezers for samples from pigs or other animals that might help narrow down how the new flu made the species jump to people. It could have involved yet another intermediate animal host, Cox noted.

On the good side, the 51 virus samples from Mexico and the U.S. that the team analyzed were all very similar, in both their genetic characteristics and the way they interact with immune-system cells. That makes hunting a usable vaccine easier, Cox said.

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On the Net:

Science: http://www.sciencemag.org


http://news.yahoo.com/s/ap/20090522/...ne_flu_origins

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WHO says it may declare swine flu pandemic soon

By FRANK JORDANS, Associated Press Writer Frank Jordans, Associated Press Writer – 37 mins ago

GENEVA – The World Health Organization said Tuesday a spike in swine flu cases in Australia may push it to finally announce the first flu pandemic in 41 years. It also expressed concern about an unusual rise in severe illness from the disease in Canada.

WHO's flu chief Keiji Fukuda said the agency wanted to avoid "adverse effects" if it announces a global outbreak of swine flu. Fukuda said people might panic or that governments might take inappropriate actions if WHO declares a pandemic.

Some flu experts think the world already is in a pandemic and that WHO has caved in to country requests that a declaration be postponed.

"On the surface of it, I think we are in phase 6," or a pandemic, said Margaret Chan, WHO's director-general.

Chan said it was important to verify the reports that the virus is becoming established outside North America before declaring a pandemic. "The decision to make a phase 6 announcement is a heavy responsibility, a responsibility that I will take very seriously, and I need to be convinced that I have indisputable evidence," she said.

Chan said she will hold a conference call with governments Wednesday in order to verify some of the reports she has received before making a formal announcement. "Once I get indisputable evidence, I will make the announcement," she told reporters in Geneva.

WHO said the virus has infected 26,563 people in 73 countries and caused 140 deaths. Most of the cases have been in North America, but Australia also has seen a sharp increase in recent days.

In most of the 73 countries, the new H1N1 virus has triggered only mild illness. But the fact that some of the deaths have occurred in otherwise healthy adults has prompted WHO to classify the outbreak as "moderate" for the time being.

"Approximately half the people who have died from this H1N1 infection have been previously healthy people," Fukuda said, adding that this was "one of the observations which has given us the most concern."

Wealthy countries such as the U.S., Canada and Britain already have large stockpiles of antivirals used to treat swine flu, but many developing countries have no supplies of the drugs and could be more vulnerable to the virus, given their struggle with widespread problems such as AIDS, malnutrition and malaria.

Some pharmaceutical companies are preparing to make a swine flu vaccine, if WHO declares a pandemic.

The number of cases in Australia jumped to more than 1,000 by Monday, with the vast majority reported from the southern state of Victoria.

If the swine flu virus were to be shown to be spreading rapidly from person to person in another world region beyond North America, such as Australia or Europe, that should trigger the conditions for WHO to declare a pandemic, meaning the outbreak has gone global.

"We are getting really very close to knowing that we are in a pandemic situation," Fukuda said.

He also said it was more important that countries take "the right actions" than that they accurately report the extent of their outbreaks.

With 675 reported swine flu cases in Britain, some experts suspect the virus already is entrenched in communities, but that U.K. health authorities are deliberately not testing for the virus and not reporting cases.

In recent weeks, two Greek students caught swine flu in Scotland — who had no history of contact with any confirmed cases, a clear sign the virus is spreading in British communities.

"Our primary concern is not so much the numbers that are being reported," Fukuda said. He said countries simply needed to take appropriate actions to handle their outbreaks.

In his weekly update on the outbreak, Fukuda also addressed reports that an unusually large number of severe cases have occurred among Canada's Inuit population.

"There are reports of infections occurring in Inuit communities with a disproportionate number of serious cases," he said. "These are observations of concern to us."


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