|Posted by Jacob Hillier on July 24, 2009 at 2:03 PM||comments (0)|
Health/Health Promotion and Protection
July 24, 2009,1:30 PM
Cases of H1N1 (human swine influenza) continue to be reported in Nova Scotia. The province's first death associated with the virus wasconfirmed by Capital District Health Authority today, July 24. The female patient was in her fifties with underlying health conditions.
"I would like to express my deepest sympathy to family and friends at such a difficult time," said Dr. Robert Strang, chief public health officer."As sad as this news is, it's important to remember that H1N1 and other flu-like viruses are very serious illnesses."
Cases of H1N1 involving severe illnesses and deaths are being reported in other provinces and outside Canada.
"Each year thousands of Canadians die from the flu, and unfortunately we expected to see deaths associated with the H1N1 virus in Nova Scotia,"said Dr. Strang.
The health care and public health systems continue to anticipate new cases, and are prepared to respond appropriately.
"TheDepartment of Health continues to work closely with our health system partners to respond and provide the best care possible to patients as this situation evolves," said Dr. Ken Buchholz, senior physician advisor, Department of Health.
"As a system, we are continuing to be vigilant and are preparing for more severe cases. Unfortunately,this sad event is a reminder of the severity of H1N1 and flu-like illnesses."
While the number of severe cases of H1N1 is increasing, the majority of H1N1 cases are still behaving like a typical flu-like illness.
The total number of cases reported in Nova Scotia since the outbreak started is now 456. Ten people have been hospitalized since April 26.
People are reminded that the best way to stay healthy is to take preventative action. That means washing hands thoroughly and often, using an arm to cover coughs and sneezes,and frequently cleaning and disinfecting common surfaces and items such as doorknobs and counters.
If people have influenza-like symptoms they should stay home and minimize contact with family members as much as possible. If symptoms worsen, they should visit their physician or a walk-in clinic.
It is important for Nova Scotians to understand that it is safe to go to work, participate in community activities and to socialize, if they do not have influenza-like symptoms.
|Posted by Jacob Hillier on July 24, 2009 at 12:43 PM||comments (0)|
Pandemic (H1N1) 2009 briefing note 4
Preliminary information important for understanding the evolving situation
24 JULY 2009 | GENEVA --
The number of human cases of pandemic (H1N1) 2009 is still increasing substantially in many countries, even in countries that have already been affected for sometime.
Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources. It remains a top priority to determine which groups of people are at highest risk of serious disease so steps to best to protect them can be taken.
In addition to surveillance information, WHO is relying on the results of special research and clinical studies and other data provided by countries directly through frequent expert teleconferences on clinical, virological and epidemiological aspects of the pandemic,to gain a global overview of the evolving situation.
Average age of cases increasing
In most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.
As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly. This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community. Some of the pandemic disease patterns differ from seasonal influenza, where fatal disease occurs most often in the elderly (>65 years old).
However,the full picture of the pandemic's epidemiology is not yet fully clear because in many countries, seasonal influenza viruses and pandemic(H1N1) 2009 viruses are both circulating and the pandemic remains relatively early in its development.
Although the risk factors for serious pandemic disease are not know definitively, risk factors such as existing cardiovascular disease, respiratory disease,diabetes and cancer currently are considered risk factors for serious pandemic (H1N1) 2009 disease. Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with an augmented risk of severe pandemic disease in several countries.
A recent report suggests obesity may be anotherrisk factor for severe disease. Similarly, there is accumulating evidence suggesting pregnant women are at higher risk for more severe disease. A few preliminary reports also suggest increased risk of severe disease may be elevated in some minority populations, but the potential contributions of cultural, economic and social risk factorsare not clear.
The development of new candidate vaccine viruses by the WHO network is continuing to improve yields (currently 25% to 50 % of the normal yields for seasonal influenza for some manufacturers). WHO will be ableto revise its estimate of pandemic vaccine supply once it has the new yield information. Other important information will also be provided by results of ongoing and soon-to be-initiated vaccine clinical trials.These trials will give a better idea of the number of doses required for a person to be immunized, as well as of the quantity on active principle (antigen) needed in each vaccine dose.
Manufacturers are expected to have vaccines for use around September. A number of companies are working on the pandemic vaccine production and have different timelines.
|Posted by Jacob Hillier on July 19, 2009 at 6:31 PM||comments (0)|
Canada releases new H1N1 outbreak guidelines for closed facilities
(OTTAWA) – Minister of Health Leona Aglukkaq, and Canada’s Chief Public Health Officer, Dr. David Butler-Jones, today announced that new guidelines on outbreaks of H1N1 in closed facilities have been posted and distributed to stakeholders today. Closed facilities include long term care facilities and correctional facilities for young adults. The Public Health Agency of Canada has also released updated guidelines on clinical care in primary care facilities such as hospitals and clinics.
“This is part of our ongoing commitment to provide leadership on how the outbreak is managed in Canada,” said Minister Aglukkaq. “We will continue to review and update our infection control guidance documents on a number of topics on an ongoing basis and post the revised documents on our website as we learn more about the virus and how it spreads.”
“Throughout the outbreak, we have been updating our clinical care, infection control and public health measure guidelines,” said Dr. Butler-Jones. “We continue to provide this information to ensure that our partners are informed with the information they need to manage this outbreak.”
Minister Aglukkaq also announced that the Public Health Agency of Canada, in concert with provinces and territories, is ramping up the monitoring and surveillance of severe illnesses and measuring the community spread of H1N1, rather than individual cases.
“The goal of surveillance is to assess the impact of the H1N1 flu virus on our communities so that we can adapt our planned responses to the situation at hand,” said Minister Aglukkaq. “Counting cases no longer serves our purposes. What we want to gain a better understanding of how and why the virus is behaving the way it does, and to be prepared for any changes in the virus or the illness it causes.”
As of today, Canada will no longer be releasing individual confirmed cases of H1N1 flu virus three times weekly. Instead, the existing FluWatch surveillance program will be enhanced in order to give a more robust analysis of the national picture in Canada.
FluWatch will provide a weekly analysis that captures the extent and severity of the outbreak, including unusual activity such as increased severity and increased hospitalizations, and will identify any patterns or trends in community spread of the virus early on.
In addition to FluWatch, the Public Health Agency of Canada will provide twice-weekly national updates on H1N1-associated deaths and will report regularly on any unusual outbreaks or clusters of illness. FluWatch also includes reports on antiviral resistance.
FluWatch will include updates from additional Canadian surveillance systems, like the Canadian Nosocomial Infection Surveillance Program, which tracks outbreaks of hospital-acquired infections, and the Immunization Program Monitoring ACTIVE (IMPACT) which collects data on children who are hospitalized with vaccine-preventable disease. These existing networks are being enhanced to meet the ongoing surveillance demands for the H1N1 flu virus.
For more information on the Canadians response to the H1N1 flu virus, please visit www.fightflu.ca. For more information on FluWatch, please see the attached backgrounder.
Public Health Agency of Canada
Phone: (613) 941-8189
|Posted by Jacob Hillier on July 16, 2009 at 1:53 PM||comments (0)|
Pandemic (H1N1) 2009 briefing note 3
Changes in reporting requirements for pandemic (H1N1) 2009 virus infection
16 JULY 2009 | GENEVA
As the 2009 pandemic evolves,the data needed for risk assessment, both within affected countries andat the global level, are also changing.
At this point, further spread of the pandemic, within affected countries and to new countries, is considered inevitable.
This assumption is fully backed by experience. The 2009influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six monthsto spread as widely as the new H1N1 virus has spread in less than six weeks.
The increasing number of cases in many countries with sustained community transmission is making it extremely difficult, ifnot impossible, for countries to try and confirm them through laboratory testing. Moreover, the counting of individual cases is now no longer essential in such countries for monitoring either the levelor nature of the risk posed by the pandemic virus or to guide implementation of the most appropriate response measures.
Monitoring still needed This pandemic has been characterized, to date, by the mildness of symptoms in the overwhelming majority of patients, who usually recover,even without medical treatment, within a week of the onset of symptoms.However, there is still an ongoing need in all countries to closely monitor unusual events, such as clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection, clusters of respiratory illness requiring hospitalization, or unexplained or unusual clinical patterns associated with serious or fatal cases.
Other potential signals of change in the currently prevailing pattern include unexpected, unusual or notable changes in patterns of transmission.Signals to be vigilant for include spikes in rates of absenteeism from schools or workplaces, or a more severe disease pattern, as suggested by, for example, a surge in emergency department visits.
In general, indications that health services are having difficulty coping with cases mean that such systems are under stress but they may also be a signal of increasing cases or a more severe clinical picture.
A strategy that concentrates on the detection, laboratory confirmation and investigation of all cases, including those with mild illness, is extremely resource-intensive. In some countries, this strategy is absorbing most national laboratory and response capacity, leaving little capacity for the monitoring and investigation of severe cases and other exceptional events.
Regular updates on newly affected countries For all of these reasons, WHO will no longer issue the global tables showing the numbers of confirmed cases for all countries. However, as part of continued efforts to document the global spread of the H1N1pandemic, regular updates will be provided describing the situation in the newly affected countries. WHO will continue to request that thesecountries report the first confirmed cases and, as far as feasible,provide weekly aggregated case numbers and descriptive epidemiology ofthe early cases.
For countries already experiencing community-wide transmission, the focus of surveillance activities will shift to reporting against the established indicators for the monitoring of seasonal influenza activity. Those countries are no longer required to submit regular reports of individual laboratory-confirmed cases and deaths to WHO.
Monitoring the virological characteristics of the pandemic virus will be important throughout the pandemic and some countries have well-established laboratory-based surveillance systems in place already for seasonal influenza virus monitoring. Even in countries with limited laboratory capacity, WHO recommends that the initial virological assessment is followed by the testing of at least 10 samples per weekin order to confirm that disease activity is due to the pandemic virus and to monitor changes in the virus that may be important for casemanagement and vaccine development.
Updated WHO guidelines for global surveillance reflect in greater detail these recommended changes, in line with reporting requirements set out in the International Health Regulations.
|Posted by Jacob Hillier on July 16, 2009 at 8:23 AM||comments (2)|
Government of Canada Releases Guidelines for Health Professionals on Caring for Pregnant Women with the H1N1 Flu Virus (OTTAWA)–
Health Minister Leona Aglukkaq and Chief Public Health Officer Dr.David Butler-Jones today released guidelines for health professionalson caring for pregnant women with H1N1 flu virus.
"Thankfully the majority of H1N1 illness in Canada is mild, but we areseeing that some people, including pregnant women, are more susceptibleto serious illness and complications," said Minister Aglukkaq. "To help protect mothers and their babies, experts at the Public Health Agencyof Canada have worked with their provincial and territorial partners todevelop clinical care guidelines that will help health care professionals treat pregnant women more effectively."
The H1N1 flu virus has now been reported in every province and territory inCanada and appears to be spreading similarly to seasonal flu. While pregnant women are at no greater risk of becoming infected with H1N1virus, preliminary research shows that they are more likely to suffer severe illness and complications if they catch the virus.
In addition to the guidelines for health care professionals, the PublicHealth Agency of Canada (PHAC) has also developed a factsheet for expectant mothers. This factsheet offers advice on how to prevent infection, and when to seek medical care. This factsheet will be available online and distributed through community and health organizations used by pregnant women.
"We understand that pregnant women might be nervous about how H1N1 flu virus might affect their health and the health of their babies," said Dr. Butler-Jones,"That’s why we want to help inform them of the precautions they should take to help maintain their health, like practising basic infection control, avoiding large crowds, and seeking medical attention if they begin to exhibit symptoms."
Canada has a National Antiviral Stockpile which includes 55 million doses of both oseltamivir (Tamiflu) and zanamivir (Relenza). Both drugs are effective in treating H1N1 virus, and both are safe for pregnant women. Recent scientific evidence suggests Tamiflu may be more effective. The Government of Canada also maintains the National Emergency Stockpile System, which provides a surge capacity of medical equipment and supplies to support provinces and territories during public health crises. PHAC iscurrently negotiating the purchase of 370 additional ventilators and has secured the purchase of 1.9 million N-95 masks to bolster the existing stockpile and to increase the Government of Canada’s capacity to support provinces and territories.
PHAC is also focusing on how to prevent complications from the flu by learning more about how and why the virus rapidly escalates to severe illness in some individuals. PHAC’s National Microbiology Laboratory (NML) is involved in organizing and coordinating a national study of severe cases of H1N1flu virus. The NML will partner with intensive care units across the country to try and answer the important questions of how and why severe illness affects some patients with H1N1 flu virus. Samples are already being collected for the study. Results will be published in medicaljournals when research is completed.
Office of the Minister of Health
Public Health Agency of Canada
|Posted by Jacob Hillier on July 16, 2009 at 8:14 AM||comments (0)|
As of July 15, 2009 at 17:00 hrs Atlantic Time
Nova Scotia has 48 new cases reported since July 13th. This brings the total cases in Nova Scotia to 330 cases, with 8 hospitilizations and no deaths reported.
In Canada there have been 301 new cases reported since July 13th with 110 new hospitilizations and 6 new reported deaths. This brings the Canadian total to 10,156 confirmed cases with 1,115 hospitilizations and 45 deaths since the begining of the outbreak.
|Posted by Jacob Hillier on July 16, 2009 at 7:57 AM||comments (0)|
Pandemic (H1N1) 2009 briefing note 2
WHO recommendations on pandemic (H1N1) 2009 vaccines
13 JULY 2009 | GENEVA --
On 7 July 2009, the StrategicAdvisory Group of Experts (SAGE) on Immunization held an extraordinarymeeting in Geneva to discuss issues and make recommendations related tovaccine for the pandemic (H1N1) 2009.
SAGE reviewed the current pandemic situation, the current status of seasonal vaccine production and potential A(H1N1) vaccine production capacity, and considered potential options for vaccine use.
The experts identified three different objectives that countries could adopt as part of their pandemic vaccination strategy:
protect the integrity of the health-care system and the country's critical infrastructure;
reduce morbidity and mortality;
andreduce transmission of the pandemic virus within communities.
Countries could use a variety of vaccine deployment strategies to reach these objectives but any strategy should reflectthe country’s epidemiological situation, resources and ability to access vaccine, to implement vaccination campaigns in the targeted groups, and to use other non-vaccine mitigation measures.
Although the severity of the pandemic is currently considered to be moderate with most patients experiencing uncomplicated, self-limited illness, some groups such as pregnant women and persons with asthma andother chronic conditions such as morbid obesity appear to be at increased risk for severe disease and death from infection.
Since the spread of the pandemic virus is considered unstoppable,vaccine will be needed in all countries. SAGE emphasized the importance of striving to achieve equity among countries to access vaccines developed in response to the pandemic (H1N1) 2009
The following recommendations were provided to the WHO Director-General:
All countries should immunize their health-care workers as a first priority to protect the essential health infrastructure. As vaccines available initially will not be sufficient, a step-wise approach to vaccinate particular groups may be considered.SAGE suggested the following groups for consideration, noting that countries need to determine their order of priority based on country-specific conditions: pregnant women; those aged above 6 monthswith one of several chronic medical conditions; healthy young adults of15 to 49 years of age; healthy children; healthy adults of 50 to 64years of age; and healthy adults of 65 years of age and above.
Since new technologies are involved in the production of some pandemic vaccines, which have not yet been extensively evaluated for their safety in certain population groups, it is very important to implement post-marketing surveillance of the highest possible quality. In addition, rapid sharing of the results of immunogenicity and post-marketing safety and effectiveness studies among the internationalcommunity will be essential for allowing countries to make necessary adjustments to their vaccination policies.
In view of the anticipated limited vaccine availability at global level and the potential need to protect against "drifted" strains of virus, SAGErecommended that promoting production and use of vaccines such as those that are formulated with oil-in-water adjuvants and live attenuated influenza vaccines was important.
As most of theproduction of the seasonal vaccine for the 2009-2010 influenza seasonin the northern hemisphere is almost complete and is therefore unlikely to affect production of pandemic vaccine, SAGE did not consider that there was a need to recommend a "switch" from seasonal to pandemic vaccine production.
WHO Director-General Dr Margaret Chan endorsed the above recommendations on 11 July 2009, recognizing that they were well adapted to the current pandemic situation. She also noted that the recommendations will need to be changed if and when new evidence become available.
SAGE was established by the WHO Director-General in 1999as the principal advisory group to WHO for vaccines and immunization.It comprises 15 members who serve in their personal capacity and represent a broad range of disciplines from around the world in the fields such as epidemiology, public health, vaccinology, paediatrics,internal medicine, infectious diseases, immunology, drug regulation, programme management, immunization delivery, and health-care administration.
Additional participants in the SAGE meeting included members of the ad hoc policy advisory working group on influenza A(H1N1) vaccine, chairs of the regional technical advisory groups and external experts. Observers included industry representatives and regulators who did not take part in the recommendation process in order to avoid conflicts of interest.
|Posted by Jacob Hillier on July 16, 2009 at 7:54 AM||comments (0)|
Pandemic (H1N1) 2009 briefing note 1
Viruses resistant to oseltamivir (Tamiflu) identified
8 JULY 2009 | GENEVA
WHO has been informed by healthauthorities in Denmark, Japan and the Special Administrative Region ofHong Kong, China of the appearance of H1N1 viruses which are resistantto the antiviral drug oseltamivir (known as Tamiflu) based onlaboratory testing.
These viruses were found in three patients who did not have severe disease and all have recovered.Investigations have not found the resistant virus in the close contactsof these three people. The viruses, while resistant to oseltamivir,remain sensitive to zanamivir.
Close to 1000 pandemic H1N1viruses have been evaluated by the laboratories in the Global InfluenzaSurveillance Network for antiviral drug resistance. All other viruseshave been shown sensitive to both oseltamivir and zanamivir. WHO andits partners will continue to conduct ongoing monitoring of influenzaviruses for antiviral drug resistance.
Therefore, based oncurrent information, these instances of drug resistance appear torepresent sporadic cases of resistance. At this time, there is no evidence to indicate the development of widespread antiviral resistance among pandemic H1N1 viruses. Based on this risk assessment, there are no changes in WHO's clinical treatment guidance. Antiviral drugs remaina key component of the public health response when used as recommended.
|Posted by Jacob Hillier on June 12, 2009 at 7:51 AM||comments (0)|
Influenza A(H1N1) - update 48
12 June 2009 -- As of 07:00 GMT, 12 June 2009, 74countries have officially reported 29,669 cases of influenza A(H1N1)infection, including 145 deaths.
|Posted by Jacob Hillier on June 12, 2009 at 7:50 AM||comments (0)|
Influenza A(H1N1) - update 47
11 June 2009 -- As of 14:00 GMT, 11 June 2009, 74countries have officially reported 28,774 cases of influenza A(H1N1)infection, including 144 deaths.