WHO: Influenza A(H1N1) – update 51; Confirmed Human Cases of Avian Influenza A/(H5N1)

The WHO continues to issue regular updates on both A/(H1N1) and A/(H5N1) posted on the WHO main page, as well as other advisories linked from that page. Here are the current updates:

– Influenza A(H1N1) – update 51
19 June 2009 — As of 07:00 GMT, 12 June 2009, WHO notes 44,287 officially reported cases of influenza A(H1N1) infection, including 180 deaths.
http://www.who.int/csr/don/2009_06_19/en/index.html

WHO has included an interactive “timeline of all cases” (requires Flash player) at:
http://gamapserver.who.int/h1n1/atlas.html?select=ZZZ&filter=filter4,confirmed

– Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO
2 June 2009  [No update since 2 June 2009]
The published tabular chart reports 433 confirmed cases and 262 deaths.
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_06_02/en/index.html

Novel Influenza A (H1N1) Virus Infections Among HCWs: U.S., April–May 2009

The MMWR Weekly: June 19, 2009 / 58(23);641-645 includes:

Novel Influenza A (H1N1) Virus Infections Among Health-Care Personnel — United States, April–May 2009

“Soon after identification of novel influenza A (H1N1) virus infections in the United States in mid-April 2009, CDC provided interim recommendations to reduce the risk for transmission in health-care settings. These included recommendations on use of personal protective equipment (PPE), management of health-care personnel (HCP) after unprotected exposures, and instruction of ill HCP not to report to work (1). To better understand the risk for acquiring infection with the virus among HCP and the impact of infection-control recommendations, CDC solicited reports of infected HCP from state health departments. As of May 13, CDC had received 48 reports of confirmed or probable infections with novel influenza A (H1N1) virus* (2); of these, 26 reports included detailed case reports with information regarding risk factors that might have led to infection. Of the 26 cases, 13 (50%) HCP were deemed to have acquired infection in a health-care setting, including one instance of probable HCP to HCP transmission and 12 instances of probable or possible patient to HCP transmission. Eleven HCP had probable or possible acquisition in the community, and two had no reported exposures in either health-care or community settings. Among 11 HCP with probable or possible patient to HCP acquisition and available information on PPE use, only three reported always using either a surgical mask or an N95 respirator. These findings suggest that transmission of novel influenza A (H1N1) virus to HCP is occurring in both health-care and community settings and that additional messages aimed at reinforcing current infection-control recommendations are needed.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5823a2.htm

Influenza Vaccines for Elderly Individuals

Journal of Infectious Diseases
15 July 2009   Volume 200, Number 2
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
Influenza Vaccines for Elderly Individuals—An Evolving Story
Gregory A. Poland and Mark J. Mulligan
[No abstract published]

MAJOR ARTICLE
Randomized, Double-Blind Controlled Phase 3 Trial Comparing the Immunogenicity of High-Dose and Standard-Dose Influenza Vaccine in Adults 65 Years of Age and Older
Ann R. Falsey,1,2; John J. Treanor,2; Nadia Tornieporth,3; Jose Capellan,5 and Geoffrey J. Gorse4
1Department of Medicine, Rochester General Hospital and 2University of Rochester School of Medicine, Rochester, New York; 3sanofi pasteur, Swiftwater, Pennsylvania; 4Saint Louis Department of Veterans Affairs Medical Center and Saint Louis University, Saint Louis, Missouri; 5sanofi pasteur, Toronto, Canada

Background.Influenza‐associated morbidity and mortality has not decreased in the last decade, despite increased receipt of vaccine. To improve the immunogenicity of influenza vaccine, a high‐dose (HD) trivalent, inactivated influenza vaccine was developed.

Methods.A multicenter, randomized, double‐blind controlled study was conducted to compare HD vaccine (which contains 60 μg of hemagglutinin per strain) with the licensed standard‐dose (SD) vaccine (which contains 15 μg of hemagglutinin per strain) in adults 65 years of age.

Results.HD vaccine was administered to 2575 subjects, and SD vaccine was administered to 1262 subjects. There was a statistically significant increase in the rates of seroconversion and mean hemagglutination inhibition titers at day 28 after vaccination among those who received HD vaccine, compared with those who received SD vaccine. Mean postvaccination titers for individuals who received HD vaccine were 116 for H1N1, 609 for H3N2, and 69 for B strain; for those who received SD vaccine, mean postvaccination titers were as 67 for H1N1, 333 for H3N2, and 52 for B strain. The HD vaccine met superiority criteria for both A strains, and the responses for B strain met noninferiority criteria. Seroprotection rates were also higher for those who received HD vaccine than for those who received SD vaccine vaccine, for all strains. Local reactions were more frequent in individuals who received HD vaccine, but the reactions were mild to moderate.

Conclusions.There was a statistically significant increase in the level of antibody response induced by HD influenza vaccine, compared with that induced by SD vaccine, without an attendant increase in the rate or severity of clinically relevant adverse reactions. These results suggest that the high‐dose vaccine may provide improved protective benefits for older adults.

Trial registration.ClinicalTrials.gov identifier: NCT00391053.

Who runs global health?

The Lancet
Jun 20, 2009  Volume 373  Number 9681  Pages 2083 – 2170
http://www.thelancet.com/journals/lancet/issue/current

Editorials
Who runs global health?
The Lancet

The past two decades have seen dramatic shifts in power among those who share responsibility for leading global health. In 1990, development assistance for health—a crude, but still valid measure of influence—was dominated by the UN system (WHO, UNICEF, and UNFPA) and bilateral development agencies in donor countries. Today, while donor nations have maintained their relative importance, the UN system has been severely diluted. This marginalisation, combined with serious anxieties about the unanticipated adverse effects of new entrants into global health, should signal concern about the current and future stewardship of health policies and services for the least advantaged peoples of the world.

Access to health care for undocumented migrants in Italy

The Lancet
Jun 20, 2009  Volume 373  Number 9681  Pages 2083 – 2170
http://www.thelancet.com/journals/lancet/issue/current

Access to health care for undocumented migrants in Italy
R Ravinetto, C Lodesani, U D’Alessandro, L De Filippi, A Pontiroli

In Italy, since 1998, undocumented migrants have had the right to receive health care under national law, without being reported to immigration authorities. This aspect of the legislation is in line with Article 32 of the Italian Constitution, which states that health is a fundamental right of the individual (not only of the citizen) and statutes free health care for the poor.

Financing of global health: tracking development assistance for health from 1990 to 2007

The Lancet
Jun 20, 2009  Volume 373  Number 9681  Pages 2083 – 2170
http://www.thelancet.com/journals/lancet/issue/current

Financing of global health: tracking development assistance for health from 1990 to 2007

Nirmala Ravishankar, Paul Gubbins, Rebecca J Cooley, Katherine Leach-Kemon, Catherine M Michaud, Dean T Jamison, Christopher JL Murray

This study documents the substantial rise of resources for global health in recent years. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and GAVI having a central role in mobilising and channelling global health funds.