WHO: Pandemic (H1N1) 2009 – update 97: 23 April 2010

The WHO continues to issue weekly updates on the H1N1 pandemic updates at http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 97
Weekly update
23 April 2010

As of 18 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17853 deaths…

Situation update:
Summary: Currently the most active areas of transmission of pandemic influenza are in parts of West and Central Africa but transmission is also still occurring in South East Asia, and Central America. Pandemic influenza activity remains low in much of the temperate zone of both the northern and southern hemispheres. Seasonal influenza type B viruses have been increasingly detected over a larger area and are now the predominant circulating influenza viruses across East Asia, Central Africa and Northern and Eastern Europe. Very small numbers of type B viruses have also recently been detected in Central America. Seasonal influenza H3N2 is still being detected in South and Southeast Asia (mainly Indonesia), as well as sporadically in several countries of West Africa, and Eastern Europe.

Full report at: http://www.who.int/csr/don/2010_04_23a/en/index.html

NIH Statement on World Malaria Day

Statement of B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D. National Institute of Allergy and Infectious Diseases National Institutes of Health on World Malaria Day April 25, 2010

“This year, we commemorate World Malaria Day by celebrating recent advances in controlling malaria. At the same time, we acknowledge the urgency in meeting critical milestones if we are to eliminate and eventually eradicate the disease worldwide.

“Although significant strides have been made toward malaria control and the elimination of the disease from many regions, global eradication is a long-term goal that will require a sustained commitment. As we accomplish our goals, disease patterns may change and new problems will inevitably arise. It is important that we adapt to the changing circumstances that result from our successes and commit to a long-term effort.

“Today we enter the second year of the Global Malaria Action Plan, [http://www.rollbackmalaria.org/gmap/] developed by the Roll Back Malaria (RBM) Partnership, a global framework for coordinated action against malaria, [http://www.rollbackmalaria.org/], which set ambitious goals to control, eliminate and eradicate malaria. We continue to support the RBM campaign, Count Malaria Out, which strives to achieve the 2010 target of delivering effective and affordable protection and treatment to all people at risk of malaria and cutting the disease burden in half compared with 2000 levels. This target marks a critical milestone in achieving the Millennium Development Goal [http://www.un.org/millenniumgoals/] set by the United Nations to halt the spread of malaria by 2015…

“…According to the World Health Organization, there were about 243 million cases of clinical malaria and 863,000 deaths in 2008. Most of the deaths occurred among children less than 5 years of age living in sub-Saharan Africa. Reducing the number malaria deaths to 500,000 by the end of this year and to near zero by 2015 will require a concerted effort engaging all stakeholders….

“…global eradication of malaria and even regional elimination may not be possible without the development of a safe, affordable and highly effective malaria vaccine…”


GAVI to pursue common Health System Funding Platform

The GAVI Alliance Board “agreed to pursue the implementation of a common Health System Funding Platform to make better use of new and existing funds for health systems and to leverage additional funding.” This builds on announcements made at the high level Task Force on Innovative Financing and Health, in September 2009, to commit an additional US$900 million for Health Systems Strengthening. This harmonised platform “will help countries access money more simply and spend it more effectively.”

GAVI noted that the performance and results-based platform, which is being developed together with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank with facilitation from the World Health Organization (WHO), “aims to better deliver the Millennium Development Goals (MDGs) by strengthening health systems and removing bottlenecks in the delivery of health services in the world’s poorest countries.”


Ernest Loevinsohn joins Gates Foundation Global Health Program

The Bill & Melinda Gates Foundation announced that Ernest Loevinsohn will join the Foundation’s Global Health Program as Director of Policy and Advocacy. Gates said that Dr. Loevinsohn “will lead the foundation’s efforts to encourage political commitment and effective investment in global health in both donor and developing countries. He will also manage a grant program, oversee work to build evidence to support effective policy making, and help lead the foundation’s work on the Global Fund to Fight AIDS, Tuberculosis, and Malaria.”


PATH updates joint HPV vaccine project in India

PATH provided an update on its joint HPV vaccine project in India. PATH said that over the past few months, a post-licensure observational study involving administration of HPV vaccine in India, conducted as part of PATH’s global HPV Vaccines: Evidence for Impact project, “has been the focus of allegations from various groups. Recently these have been covered in the press, mainly in India. As a precaution, the Government of India has decided to suspend all project HPV vaccination and to conduct an inquiry to respond to voiced concerns.” PATH said that the project is being implemented by the immunization departments of India’s Andhra Pradesh and Gujarat states and “was carried out only after receiving all required approvals in India and the United States. PATH is cooperating fully with the government inquiry to assist in allaying voiced concerns.” To date, 23,500 girls have been fully vaccinated by the Ministries of Health and Family Welfare in Andhra Pradesh and Gujarat utilizing HPV vaccines licensed for sale in India and donated by Merck and GlaxoSmithKline.

Dr. Christopher Elias, president and CEO of PATH, said, “The mission of PATH worldwide, and in India, is to improve the health of people by advancing technologies, strengthening systems, and encouraging healthy behaviors. The HPV Vaccines: Evidence for Impact project was designed to address all three of these areas. The post-licensure observational study is generating data about vaccine coverage, feasibility, acceptability, and implementation costs associated with different HPV vaccine delivery strategies. The project also assesses cervical precancer screening and treatment strategies. It was designed, in cooperation with government agencies, to assist India’s public health system in identifying the most effective and affordable strategies to help prevent cervical cancer, a disease that kills an estimated 143,000 Indian women every year.

“For approval of the post-licensure observational study, PATH and its Indian collaborators worked with two ethical review committees in India and one in the United States to design study protocols and informed consent materials. PATH is confident that these procedural safeguards informed and guided all aspects of study implementation and conduct.”


A(H1N1) Among Pregnant Women in the United States

Vol. 303 No. 15, pp. 1451-1556, April 21, 2010

Original Contributions
Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Alicia M. Siston; Sonja A. Rasmussen; Margaret A. Honein; Alicia M. Fry; Katherine Seib; William M. Callaghan; Janice Louie; Timothy J. Doyle; Molly Crockett; Ruth Lynfield; Zack Moore; Caleb Wiedeman; Madhu Anand; Laura Tabony; Carrie F. Nielsen; Kirsten Waller; Shannon Page; Jeannie M. Thompson; Catherine Avery; Chasisity Brown Springs; Timothy Jones; Jennifer L. Williams; Kim Newsome; Lyn Finelli; Denise J. Jamieson; for the Pandemic H1N1 Influenza in Pregnancy Working Group

Context  Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.

Objective  To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.

Design, Setting, and Patients  Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.

Main Outcome Measures  Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.

Results  We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC’s continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);

Conclusions  Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.