WHO: H1N1 Weekly update: 20 November 2009

The WHO continues to issue weekly “updates” and briefing notes as below:
Pandemic (H1N1) 2009 – update 75
Weekly update
20 November 2009 –

As of 15 November 2009, worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6770 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual 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.

Situation update:

The situation remains similar since the last update. In temperate regions* of the northern hemisphere, the early arriving winter influenza season continues to intensify across parts of North America and much of Europe. However, there are early signs of a peak in disease activity in some areas of the northern hemisphere.

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

WHO briefing note 16: Safety of pandemic vaccines

Pandemic (H1N1) 2009 briefing note 16
Safety of pandemic vaccines

To date, WHO has received vaccination information from 16 of around 40 countries conducting national H1N1 pandemic vaccine campaigns. Based on information in these 16 countries, WHO estimates that around 80 million doses of pandemic vaccine have been distributed and around 65 million people have been vaccinated. National immunization campaigns began in Australia and the People’s Republic of China in late September.

Vaccination campaigns currently under way to protect populations from pandemic influenza are among the largest in the history of several countries, and numbers are growing daily. Given this scale of vaccine administration, at least some rare adverse reactions, not detectable during even large clinical trials, could occur, underscoring the need for rigorous monitoring of safety. Results to date are encouraging.

Common side effects
As anticipated, side effects commonly reported include swelling, redness, or pain at the injection site, which usually resolves spontaneously a short time after vaccination.

Fever, headache, fatigue, and muscle aches, occurring shortly after vaccine administration, have also been reported, though with less frequency. These symptoms also resolve spontaneously, usually within 48 hours. In addition, a variety of allergic reactions has been observed. The frequency of these reactions is well within the expected range.

Guillain-Barre syndrome
To date, fewer than ten suspected cases of Guillain-Barre syndrome have been reported in people who have received vaccine. These numbers are in line with normal background rates of this illness, as reported in a recent study. Nonetheless, all such cases are being investigated to determine whether these are randomly occurring events or if they might be associated with vaccination.

WHO has received no reports of fatal outcomes among suspected or confirmed cases of Guillain-Barre syndrome detected since vaccination campaigns began. All cases have recovered. WHO recommends continued active monitoring for Guillain-Barre syndrome.

Investigations of deaths
A small number of deaths have occurred in people who have been vaccinated. All such deaths, reported to WHO, have been promptly investigated. Although some investigations are ongoing, results of completed investigations reported to WHO have ruled out a direct link to pandemic vaccine as the cause of death.

In China, for example, where more than 11 million doses of pandemic vaccine have been administered, health authorities have informed WHO of 15 cases of severe side effects and two deaths that occurred following vaccination. Thorough investigation of these deaths, including a review of autopsy results, determined that underlying medical conditions were the cause of death, and not the vaccine.

Safety profile of different vaccines
Campaigns are using nonadjuvanted inactivated vaccines, adjuvanted inactivated vaccines, and live attenuated vaccines. No differences in the safety profile of severe adverse events among different vaccines have been detected to date.

Although intense monitoring of vaccine safety continues, all data compiled to date indicate that pandemic vaccines match the excellent safety profile of seasonal influenza vaccines, which have been used for more than 60 years. http://www.who.int/csr/disease/swineflu/notes/briefing_20091119/en/index.html

WHO Briefing Note 17: H1N1 virus mutation detected in Norway

Pandemic (H1N1) 2009 briefing note 17
Public health significance of virus mutation detected in Norway

The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness.

Norwegian scientists have analysed samples from more than 70 patients with clinical illness and no further instances of this mutation have been detected. This finding suggests that the mutation is not widespread in the country. The virus with this mutation remains sensitive to the antiviral drugs, oseltamivir and zanamivir, and studies show that currently available pandemic vaccines confer protection.

Worldwide, laboratory monitoring of influenza viruses has detected a similar mutation in viruses from several other countries, with the earliest detection occurring in April. In addition to Norway, the mutation has been observed in Brazil, China, Japan, Mexico, Ukraine, and the US.

Although information on all these cases is incomplete, several viruses showing the same mutation were detected in fatal cases, and the mutation has also been detected in some mild cases. Worldwide, viruses from numerous fatal cases have not shown the mutation. The public health significance of this finding is thus unclear.

The mutations appear to occur sporadically and spontaneously. To date, no links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread.

The significance of the mutation is being assessed by scientists in the WHO network of influenza laboratories. Changes in viruses at the genetic level need to be constantly monitored. However, the significance of these changes is difficult to assess. Many mutations do not alter any important features of the virus or the illness it causes. For this reason, WHO also uses clinical and epidemiological data when making risk assessments.

Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases.

Laboratories in the WHO Global Influenza Surveillance Network closely monitor influenza viruses worldwide and will remain vigilant for any further changes in the virus that may have public health significance.


GAVI announces its impact on the vaccine market is bringing down prices

GAVI announced that its impact on the vaccine market is bringing down prices. The announcement was made “just before the GAVI Partners’ Forum, which unites some 400 participants from all over the world including ministers of health, donors, civil society and industry representatives, researchers and development experts.”  GAVI CEO Julian Lob-Levyt said, “This is the ‘GAVI effect’ at work: encouraging and pooling growing demand from countries, attracting new manufacturers and increasing competition to drive down prices. The price drop has come later than we had hoped and it needs to fall further. But this is a clear indication that our market-shaping efforts work.”

The majority of vaccines financed through GAVI is purchased by Alliance member UNICEF. GAVI said that a recent tender for pentavalent vaccine “has shown a significant price drop with the weighted average price for 2010 falling below US$3.00, a decrease of almost 50 cents per dose on the 2009 price. This will create approximately US$55 million in savings in 2010 and enable GAVI to finance the immunisation of 6.3 million more children.  UNICEF Deputy Executive Director Saad Houry commented, “This price drop is no accident, but rather the result of a strategy to leverage the purchasing power of hundreds of millions of people. Clearly, industry understands and responds to a market, regardless of whether that market is in poor or rich countries. The Alliance’s model is beginning to work, and we are optimistic that the trend will continue, as competition and demand increase over time.”

GAVI said its business model is “based on the expectation that rising demand for immunisation in developing countries induces more companies to produce vaccines, thus creating competition and driving prices down. Through the new data, success becomes evident. Whereas in 2001, there was only one company producing the pentavalent vaccine, now there are four. Two are Indian companies, whose products came on the market in 2008. Today, 50% of the vaccines funded by GAVI are from developing country manufacturers.”

At the Hanoi meeting, GAVI Board Chair Mary Robinson noted that progress in immunisation coverage and price decline must be tempered by the fact that more than 20 million children in the world today continue to go without basic life-saving vaccines.

“Our Alliance is not providing charity but rather securing a basic human right, which is the right to equal access to basic standards of health. It is time to recognise that the availability of life-saving vaccines for children worldwide, regardless of where they live, is not a luxury but a fundamental right.”


GAVI Alliance Board appoints Dr Jaime Sepulved as new Vice-Chair

The GAVI Alliance Board appointed Dr Jaime Sepulveda, Director of the Integrated Health Solutions Development programme at the Bill & Melinda Gates Foundation, as its new Vice-Chair. GAVI said that Dr. Sepulveda will replace Dennis Aitken of the World Health Organization who has retired, and that Daisy Mafubelu, Assistant Director-General for Family and Community Health, will become WHO’s representative on the board. The Bill & Melinda Gates Foundation will be represented by its alternate member. The announcement said that Dr Sepulveda served for more than 20 years in a variety of senior health posts in the Mexican government. From 2003 to 2006, he was director of the National Institutes of Health of Mexico. He also served as Director-General of Mexico’s National Institute of Public Health and dean of the National School of Public Health. In addition to his research credentials, Sepulveda is an experienced implementer of effective health programmes. As Mexico’s Director-General of epidemiology and later Vice-Minister of Health, Sepulveda designed Mexico’s Universal Vaccination Programme, which eliminated polio, measles, and diphtheria by more than doubling childhood immunisation coverage in two years. He also designed a national health surveillance system and founded Mexico’s National AIDS Council. Dr Sepulveda holds a medical degree from National Autonomous University of Mexico and three advanced degrees from the Harvard School of Public Health. He was a recent member of the Board of Overseers of Harvard University and is a member of the Institute of Medicine of the U.S. National Academy of Sciences.


MMWR: Mumps Outbreak – New York, New Jersey, Quebec, 2009

The MMWR Weekly (November 20, 2009 / 58(45);1270-1274) includes:

Mumps Outbreak — New York, New Jersey, Quebec, 2009
Mumps is a vaccine-preventable viral infection characterized by fever and inflammation of the salivary glands and whose complications include orchitis, deafness, and meningo-encephalitis (1). In August 2009, CDC was notified of the onset of an outbreak of mumps in a summer camp in Sullivan County, New York. The outbreak has spread and gradually increased in size and is now the largest U.S. mumps outbreak since 2006, when the United States experienced a resurgence of mumps with 6,584 reported cases (2). On August 18, public health departments in Sullivan County, New York state, and CDC began an investigation into the mumps outbreak, later joined by departments in New York City and other locales. As of October 30, a total of 179 confirmed or probable cases had been identified from multiple locations in New York and New Jersey (Figure), and an additional 15 cases had been reported from Canada. The outbreak primarily has affected members of a tradition-observant religious community; median age of the patients is 14 years, and 83% are male. Three persons have been hospitalized. Although little transmission has occurred outside the Jewish community, mumps can spread rapidly in congregate settings such as colleges and schools; therefore, public health officials and clinicians should heighten surveillance for mumps and ensure that children and adults are appropriately vaccinated.

Mumps cases in the United States have been classified according to the 2008 case definition of the Council of State and Territorial Epidemiologists,* and cases in Canada have been classified in accordance with Case Definitions for Diseases Under National Surveillance.† Patients in the United States are considered to have age-appropriate vaccinations for mumps if they are aged 1–6 years and have received 1 dose of a mumps-containing vaccine, aged 7–18 years and have received 2 doses of vaccine, or aged 19–52 years and have received 1 dose of vaccine (3,4). Patients aged 7–18 years who have received 1 dose are considered to have received a partially age-appropriate vaccination.

More at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5845a5.htm