WHO: Pandemic (H1N1) 2009 – update 88: 19 February 2010

The WHO continues to issue weekly “updates” and briefing notes on the H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 – update 88
Weekly update
19 February 2010

As of 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.

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 information.

Situation update:
The situation is largely unchanged since the previous update. In the temperate zone of the northern hemisphere, active but declining pandemic influenza transmission persists in limited areas of eastern and southern Europe, South Asia, and in East Asia. Several countries in West Africa reported increases in the number of cases but there is as yet insufficient evidence to conclude that widespread community transmission is occurring. An increasing trend in respiratory diseases activity was reported in Thailand and Jamaica, however the cause of the respiratory disease is uncertain at this point.

More at: http://www.who.int/csr/don/2010_02_19/en/index.html

Recommended viruses for influenza vaccines: 2010-2011 season/ northern hemisphere

The WHO released “Recommended viruses for influenza vaccines for use in the 2010-2011 northern hemisphere influenza season, February 2010.” WHO noted that it “convenes technical meetings1 in February and September each year to recommend viruses for inclusion in influenza vaccines for the northern and southern hemispheres, respectively. This recommendation relates to the influenza vaccines for the forthcoming influenza season in the northern hemisphere (2010 – 2011). A recommendation will be made in September 2010 relating to vaccines that will be used for the influenza season in the southern hemisphere (2011). For countries in equatorial regions epidemiological considerations will influence which recommendation (February or September) individual national and regional authorities consider more appropriate.”

“…Based on the analyses it is expected that A(H1N1) pandemic 2009, A(H3N2) and B viruses will co-circulate in the northern hemisphere 2010-2011 with the likelihood that the pandemic A(H1N1) 2009 viruses will predominate. Based on recent epidemiological evidence it is anticipated that seasonal A(H1N1) viruses are unlikely to circulate at significant levels during the 2010-2011 northern hemisphere season; hence it has not been recommended for inclusion in the 2010-2011 vaccine. A B/Victoria/2/87 lineage virus, the predominant lineage of type B viruses circulating since September 2009, has been recommended.

“It is recommended that the following viruses be used for influenza vaccines in the 2010- 2011 influenza season (northern hemisphere):

– an A/California/7/2009 (H1N1)-like virus;

– an A/Perth/16/2009 (H3N2)-like virus;#

– a B/Brisbane/60/2008-like virus.

# A/Wisconsin/15/2009 is an A/Perth/16/2009 (H3N2)-like virus and is a 2010 southern hemisphere vaccine virus…


GAVI’s Advance Market Commitment: Letters

The Lancet
Volume 375, Issue 9715, Page 638, 20 February 2010

GAVI’s Advance Market Commitment
Donald W Light

The World Report on GAVI’s Advance Market Commitment (AMC; Dec 5, p 1879)1 contains irreconcilable claims by GAVI and reveals the inability of the AMC approach to make new vaccines available to low-income countries on a sustainable basis.

GAVI’s Advance Market Commitment
Nina Schwalbe, Ibrahim El-Ziq

In response to Ann Usher’s World Report,1 it is necessary to clarify how the pilot Advance Market Commitment (AMC) works. The pilot AMC aims to stimulate the manufacture of an adequate supply of affordable pneumococcal vaccines for developing countries. The price of the vaccine is capped at US$3·50 per dose, paid by the GAVI Alliance and countries. Six donors will pay an additional contribution per dose to participating manufacturers in the early years of each contract to offset costs of expanding production.

HPV vaccination: waiting for evidence of effectiveness

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138


HPV vaccination: waiting for evidence of effectiveness
Eric J Suba, Stephen S Raab, on behalf of the Viet/American Cervical Cancer Prevention Project

As noted by Gary Clifford (Dec 12, p 1948),1 the greatest source of uncertainty about the potential effectiveness of human papillomavirus (HPV) vaccines remains the duration of the immune response. However, even if the most optimistic scenario of HPV vaccine effectiveness is realised, the introduction of HPV vaccines to populations not yet fully covered by screening services may compete with limited budgets for the build-out of screening services and thereby decelerate global reductions in deaths from cervical cancer by creating populations of women who will not be protected by either screening or vaccination.

Biological, clinical, and ethical advances of placebo effects

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138

Biological, clinical, and ethical advances of placebo effects
Damien G Finniss, Ted J Kaptchuk, Franklin Miller, Fabrizio Benedetti

For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings. There is also evidence that placebo effects can exist in clinical practice, even if no placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical use of placebo mechanisms that are inherent in routine clinical care, and encourage the use of treatments that stimulate placebo effects.

Lancet publishes retraction of Wakefield et al; Offit commentary

Lancet published a retraction of Wakefield AJ, Murch SH, Anthony A, et al. “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” Lancet 1998; 351: 637–41:

“Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation.2 In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”
The Editors of The Lancet
Hodgson H. A statement by The Royal Free and University College Medical School and The Royal Free Hampstead NHS Trust. Lancet 2004; 363: 824.

The Philadelphia Inquirer carries an article by Dr. Paul A. Offit which comments on the retraction and the impact of the original Lancet article.  The MMR vaccine scare: How bad science resulted in suffering and death is available at: http://www.philly.com/inquirer/currents/84326297.html. Dr. Offit is chief of the division of infectious diseases at the Children’s Hospital of Philadelphia and provides oversight for the Center for Vaccine Ethics and Policy, which publishes this weekly update.