Pandemic (H1N1) 2009 – update 71: 17 October 2009

The WHO continues to issue weekly “updates” and briefing notes as below:
Pandemic (H1N1) 2009 – update 71
Weekly update

As of 17 October 2009, worldwide there have been more than 414,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and nearly 5000 deaths reported to WHO.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.
New Activity:
Mongolia, Rwanda, and Sao Tome and Principe have reported pandemic influenza cases for the first time this week.
Iceland, Sudan, and Trinidad and Tobago reported their first fatal cases.
Situation update:
In general, influenza activity in the northern hemisphere is much the same as in the last week, though respiratory disease activity continues to spread and increase in intensity. In North America, the U.S.A. is still reporting nationwide rates of Influenza-Like Illness (ILI) well above baseline rates with high rates of pandemic H1N1 2009 virus detections in clinical laboratory specimens (29% of all specimens tested are positive for influenza A and all of those subtyped are pandemic H1N1 2009 virus. Canada reports increases in ILI rates for the fourth straight week but the highest level of activity is in the western province of British Columbia. Mexico still reports active transmission in some areas of the country. Although influenza activity is low in most countries in Europe, in Belgium, Israel, the Netherlands, Norway, and parts of the United Kingdom consultation ILI/ARI rates are above baseline levels. Similarly the number of influenza virus detections relatively high, which may indicate the early start of an influenza season. Rates of respiratory illness in Eastern Europe and Northern Asia are increasing but are not yet at levels normally seen in an influenza season (baseline levels are not defined in many countries of the area). Of note, the proportion of cases in Asia that are related to seasonal influenza A(H3N2) continue to decline globally as the proportion related to pandemic H1N1 2009 virus increases. Currently, only East Asia is reporting any significant numbers of influenza A(H3N2) isolates.
In tropical areas of the world, rates of illness are generally declining, with a few exceptions. Cuba, Colombia, and El Salvador are reporting increases in the tropical region of the Americas. In tropical Asia, of the countries that are reporting this week, all report decreases in respiratory disease activity.
The temperate region of the southern hemisphere has no significant pandemic related activity in the past week.

Weekly update (Virological surveillance data)

New York suspends mandatory HCW influenza immunization

New York Governor David A. Paterson announced that State Health Commissioner Richard F. Daines, M.D., “has suspended the mandatory influenza immunization requirement for New York health care workers so that the limited vaccine supplies can be used for populations most at risk of serious illness and death – especially pregnant women and children and young people between the ages of 6 months and 24 years.” Governor Paterson said, “Over the last week, the Centers for Disease Control and Prevention (CDC) acknowledged that New York would only receive approximately 23 percent of its anticipated vaccine supply by the end of the month. As a result, we need to be as resourceful as we can with the limited supplies of vaccine currently coming into the State and make sure that those who are at the highest risk for complications from the H1N1 flu receive the first vaccine being distributed right now in New York State.”
Commissioner Daines continued, “We had told hospitals that if they had to choose between vaccinating patients or employees to vaccinate patients first. This week, the CDC confirmed that most of the national supply of seasonal flu vaccine has been distributed, and that H1N1 vaccine distribution is far behind projections. New evidence is showing that H1N1 can be especially virulent to pregnant women and young people – so they should get vaccinated first.”

WHO/UNICEF/World Bank: “The State of the World’s Vaccines and Immunization, Third Edition”

The World Health Organization (WHO), UNICEF and the World Bank jointly released “The State of the World’s Vaccines and Immunization, Third Edition” which reports that “more infants are being immunized today than ever before – a record 106 million in 2008,” but that “…life-saving vaccines, now common in wealthy countries, still do not reach an estimated 24 million children who are most at risk and at least an additional US$1 billion per year will be needed to ensure that new and existing vaccines will be delivered to all children in the 72 poorest countries.” Dr Margaret Chan, Director-General, WHO. Commented, “The influenza pandemic draws attention to the promise and dynamism of vaccine development today. Yet it reminds us once again of the obstacles to bringing the benefits of science to people in the poorest nations. We must overcome the divide that separates rich from poor – between those who get life-saving vaccines, and those who don’t.”

The report notes that at least 120 vaccines – a record number – are now available against deadly diseases. In addition, over 80 new products are in late-stage clinical testing, including more than 30 that target diseases for which no vaccine currently exists. At the same time, a significant number of vaccine candidates, including ones targeting diseases such as HIV/AIDS, malaria, tuberculosis and dengue, are moving through the research pipeline.

The report also notes that the global vaccine market has tripled over the last eight years, reaching more than US$17 billion in revenue, and that “rising demand for vaccines via United Nations procuring agencies and a renaissance in vaccine discovery and development have fueled industry’s renewed focus on vaccines.” Significantly, the report notes, “manufacturers in developing countries are now meeting 86 % of the global demand for traditional vaccines, such as those protecting against measles, whooping cough (pertussis), tetanus and diphtheria.”

Report available at:

Gates Foundation announces 76 Grand Challenges Explorations grants

The Bill & Melinda Gates Foundation today announced 76 grants of US$100,000 each “to pursue bold ideas for transforming health in developing countries” as part of its Grand Challenges Explorations program. The grants will support researchers in 16 countries.  Dr. Tachi Yamada, president of the Gates Foundation’s Global Health Program, said, “Some of the biggest stumbling blocks in global health are now being overcome with promising new vaccines and treatments. The Grand Challenges Explorations  will continue to fill the pipeline with possibilities and hopefully produce a breakthrough idea that could save untold numbers of lives.” Grantees from round 3 were selected from almost 3,000 proposals. Gates said “all levels of scientists are represented – from young post-graduate investigators to veteran researchers – as are a wide range of disciplines, such as chemistry, bioengineering, electronics, mechanical engineering, infectious disease, and epidemiology. They are based at universities, research institutes, nonprofit organizations, and private companies around the world.”

Grants involving vaccines and immunology included:

– Cecil Czerkinsky of the International Vaccine Institute in Korea will explore whether vaccines administered under the tongue can produce strong immune responses in distant organs such as the lungs and reproductive tract;

– Margaret Njoroge of Med Biotech Laboratories in Uganda will develop an intranasal vaccine for mothers, designed to induce antibodies against malaria in breast milk and confer immunity on their babies;

– Kate Edwards, at the University of San Diego will study how a brief bout of exercise may enhance the efficiency of pneumococcal vaccine.

Grand Challenges Explorations web site

Lancet Editorial: Vaccines and the world of child health

The Lancet
Oct 24, 2009  Volume 374  Number 9699   Pages 1393 – 1472

Vaccines and the world of child health
The Lancet
For those in developed countries the few vaccinations of our early years are a distant memory. It is easy to take for granted not only the invisible and long-lasting protective veil that vaccinations draw against potentially fatal infectious diseases, but also the public health transformation wrought by vaccines and other interventions in the past century. Our enviable life expectancy and economic success both depend on them.