Why Some Will Get Flu Vaccine — and Why Some Won’t

The survey of doctors, conducted in September among 101 pediatricians and 300 primary care physicians, has a margin of error of plus or minus 5.8 percentage points. It was fielded by Sermo Inc.

The adult survey, conducted Aug. 27-30 in 1,010 adult men and women age 18 and older, has a margin of error of plus or minus 3 percentage points. It was fielded by Opinion Research Corporation.

“신종플루 백신 254만명분, 과다공급으로 폐기”

연합뉴스 | 입력 2010.09.07 05:46 | 수정 2010.09.07 08:55 |

신상진 “신종플루로 올해 상반기 71명 사망”

(서울=연합뉴스) 김승욱 기자 = 정부의 과다 공급으로 인해 유통기한이 지나 폐기된 신종플루 백신이 254만명분에 이르는 것으로 나타났다.

국회 보건복지위원회 소속 신상진(한나라당) 의원이 7일 질병관리본부와 건강보험심사평가원으로부터 제출받은 자료에 따르면 지난해 4월 국내에서 신종플루 추정환자가 처음 발생한 이래 지난 6월까지 유통기한을 넘겨 폐기된 백신은 254만751도즈(1도즈는 1명 백신투여량)인 것으로 밝혀졌다. 금액으로는 286억3천700만원에 달한다.

또한 신종플루 백신 예방접종을 받은 사람은 1천277만명이며, 이중 2천598건이 백신 이상 의심증세로 관리당국에 신고됐으나 정부는 88건에 대해서만 보상해준 것으로 확인됐다.

한편 지난 6월까지 국내에서 신종플루로 사망한 사람은 263명이며 이중 71명은 올해 상반기 사망한 것으로 나타났다.

신 의원은 “정부는 신종플루 백신 수요를 가급적 정확히 예측해 국가예산 낭비를 막아야 한다”고 밝힌 뒤 “올가을 신종플루가 재유행할 가능성이 있는 만큼 보건당국의 각별한 주의가 요구된다”고 말했다.

ksw08@yna.co.kr

(끝)

H1N1 in post-pandemic period

The world is no longer in phase 6 of influenza pandemic alert. We are now moving into the post-pandemic period. The new H1N1 virus has largely run its course.

These are the views of members of the Emergency Committee, which was convened earlier today by teleconference.

The Committee based its assessment on the global situation, as well as reports from several countries that are now experiencing influenza. I fully agree with the Committee’s advice.

As we enter the post-pandemic period, this does not mean that the H1N1 virus has gone away. Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come.

In the post-pandemic period, localized outbreaks of different magnitude may show significant levels of H1N1 transmission. This is the situation we are observing right now in New Zealand, and may see elsewhere.

In fact, the actions of health authorities in New Zealand, and also in India, in terms of vigilance, quick detection and treatment, and recommended vaccination, provide a model of how other countries may need to respond in the immediate post-pandemic period.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

During the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

Recently published studies indicate that 20–40% of populations in some areas have been infected by the H1N1 virus and thus have some level of protective immunity. Many countries report good vaccination coverage, especially in high-risk groups, and this coverage further increases community-wide immunity.

Pandemics, like the viruses that cause them, are unpredictable. So is the immediate post-pandemic period. There will be many questions, and we will have clear answers for only some. Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period.

Based on available evidence and experience from past pandemics, it is likely that the virus will continue to cause serious disease in younger age groups, at least in the immediate post-pandemic period. Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish.

In addition, a small proportion of people infected during the pandemic, including young and healthy people, developed a severe form of primary viral pneumonia that is not typically seen during seasonal epidemics and is especially difficult and demanding to treat. It is not known whether this pattern will change during the post-pandemic period, further emphasizing the need for vigilance.

As I said, pandemics are unpredictable and prone to deliver surprises. No two pandemics are ever alike. This pandemic has turned out to be much more fortunate than what we feared a little over a year ago.

This time around, we have been aided by pure good luck. The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile.

Thanks to extensive preparedness and support from the international community, even countries with very weak health systems were able to detect cases and report them promptly.

Had things gone wrong in any of these areas, we would be in a very different situation today.

I will be happy to answer your questions.

New cases of the virus have fallen dramatically in Europe, although it has continued to spread slowly in the southern hemisphere. Following criticism that officials overreacted to the outbreak, the WHO is reviewing its guidelines on what constitutes a pandemic.

This, says Jakab, is likely to result in a more sophisticated system which takes account of the severity of the illness rather than focusing solely on its geographical spread.

“The pandemic continues. However, the emergency committee which advises [WHO Director-General] Margaret Chan will meet at the end of the month to decide whether to scale it back to a post-pandemic phase. We all expect this to happen sooner rather than later, probably by the end of July,” Jakab said.

She defended the WHO’s handling of the pandemic, saying the Organisation – and the EU institutions – had responded well to the crisis. Jakab headed up the European Centre for Disease Prevention and Control during the peak of the outbreak, before taking on her new role at the WHO.

The Council of Europe has held an investigation into the pandemic response and a number of MEPs have called for an official EU probe into the quality of advice given to governments (EurActiv 06/05/10).

More transparency on expert advice

Some EU member states have been left with millions of doses of H1N1 vaccine but Jakab said medicines had to be ordered before the severity of the pandemic was clear (EurActiv 05/01/10).

“It is a difficult issue, because to boost vaccine production in the pharmaceutical industry it was important that some member states made this pre-pandemic purchase agreement to show industry that a market for the vaccines exists. Without this, vaccine production would not have started,” she said.

Jakab also defended the independence of expert advice on which crucial decisions were taken.

The WHO is now reviewing its practice of protecting the anonymity of its scientific experts until they finish their work.

“Now that it has created so many problems, we must reconsider whether it is still the right approach. We have the same policy as the EU on issues of conflict of interest and every expert must declare their interests. These declarations will now be made far more public as part of new procedures put in place,” she said.

The WHO’s new Europe director also revealed that the Organisation will seek to pass on the secretariat of the International Medical Products Anti-Counterfeiting Taskforce (IMPACT).

The initiative, run in cooperation with Interpol, has helped coordinate seizures of falsified medicines. This has been a source of controversy, with NGOs accusing the WHO of taking part in intellectual property enforcement rather than focusing on its public health mandate.

Ministers urged to protect health spending

Jakab addressed health ministers in Brussels this week (6 July) on the current status of the virus and outlined her priorities for her term. These include chronic diseases, smoking, alcohol, obesity and social determinants of health.

She urged governments not to cut back on preventative health initiatives and immunisation programmes as part of austerity measures as the long-term health impact will come at a high cost.

=============================================

[수잔나 제이캅(Zsuzsanna Jakab)  WHO 유럽지역 사무총장 인터뷰 전문 기사]

WHO Europe chief: Flu pandemic was ‘handled well’

출처 : [EURACTIV] Published: 08 July 2010
http://www.euractiv.com/en/health/who-europe-chief-flu-pandemic-was-handled-well-interview-496104

Public health authorities responded well in the face of the H1N1 flu pandemic but must learn to be more flexible and transparent, Zsuzsanna Jakab, WHO regional director for Europe, told EurActiv in an interview.

Zsuzsanna Jakab is regional director for Europe at the World Health Organisation.

She was speaking to Gary Finnegan

To read a shortened version of this interview, please click here.

What are the lessons learnt from the H1N1 flu pandemic?

The pandemic goes on, however, the emergency committee which advises Margaret Chan [WHO director-general] will meet at the end of the month to decide whether to scale it back to a post-pandemic phase. We all expect this to happen sooner rather than later, probably by the end of July.

The first lesson is that we did very well, saving many lives and containing the pandemic through intensive activity. On the other hand, we have three lessons: whilst preparing for a worst-case scenario, we should have an in-built flexibility to scale-back our activities if the pandemic proves milder than expected. We did not have this scenario in the guidelines as they were based on previous ‘tough’ pandemics and not even the best experts expected the pandemic to be as mild as it was.

The other lesson is that we must do much better in the area of communication; we were not good at that. We must also learn from those who worked against us. We need to use social networks better, having coordinated messages.

Coordination is also always something one can improve. Public health measures like vaccination and anti-virals could also be led by the WHO. This is something we can lead on – rather than the EU institutions – because of our broader, open and easy mandate,

At the moment the WHO has a pandemic alert on a scale of six phases. Do you think a more subtle and complicated instrument will come out of its review?

An International Health Regulation Review Committee has been convened by the WHO director-general to review the lessons learned and the guidelines to the pandemic phases, as well as the criteria for determining them. At present the guidelines only take into account the geographical spread of a virus and not its severity.

We expect a full report on this by the end of the year to guide our work and to have a unique opportunity to move on to the next stage of pandemic preparation.

How do you assess the European institutions’ response to the pandemic?

I think they did a good job – I was the ECDC [European Centre for Disease Prevention and Control] director at that time! There was criticism that the ECDC blindly followed the WHO risk assessment, which was not true. ECDC did its own assessment which coincided with that of the WHO. This is why the Commission recommended following the WHO’s guidelines.

I think the ECDC did everything it could. We can all do better, however, such as improving surveillance and involving other specialists and professionals in risk assessments to deal with different scenarios. The conference that took place before the Council meeting highlighted a number of conclusions for improvement.

The ECDC and the Commission enjoy very good cooperation, but risk management issues are strictly national responsibilities and it is very difficult to coordinate 27 member states with very strong views on public health measures.

One of the difficulties was therefore that different countries took different measures. There were different approaches on who to vaccinate, how many vaccines to buy, and who should get anti-virals such as Tamiflu.

All this is known by the general public, but they don’t understand why these differences exist. I believe that the WHO should strengthen its activities where the EU has difficulties with its mandate.

There has been some criticism of the response, mostly from people concerned about the volume of vaccines that some member states bought. Do you think that some of them overreacted, given that others didn’t buy such a high volume of medicines?

It is a difficult issue, because to boost vaccine production in the pharmaceutical industry it was important that some member states made this pre-pandemic purchase agreement to show industry that a market for the vaccines exists. Without this, vaccine production would not have started.

We should learn from this for the future and go towards joint procurement and to have a scaled plan for every country with a number of percentages to buy for the high priority population to be vaccinated and then, if there is a need, expand production.

I suppose those decisions have to be made before it is known how severe the pandemic is. Concerning the alleged conflicts of interest for some of the experts advising the WHO, what is your position on this?

My position is that the reason why this came up is because the Emergency Committee advising on the pandemic phases is composed of experts from all over the world selected by the WHO director-general. It had been deliberately decided that the experts would not be named by the WHO. This is in order to avoid these experts coming under pressure from politicians and the pharmaceutical industry.

We agreed to announce their names only when they have finished their work for the WHO. It is a deliberate decision made after the SARS epidemic, which nonetheless creates a lot of speculation.

Now that it has created so many problems, we must reconsider whether it is still the right approach. We have the same policy as the EU on issues of conflict of interest and every expert must declare their interests. These declarations will now be made far more public as part of new procedures put in place.

You’ve just been to the informal Health Council. What were the main issues being discussed there?

I was talking about two issues: the role of the WHO in stepping up cancer efforts and the leadership role, and the other one is the H1N1 pandemic and what lessons have been learnt from it.

What are your other priorities for your time as WHO regional director for Europe?

My main priority is the NCDs – chronic non-communicable diseases – together with health-determinant lifestyle issues. Within that we must continue to scale-up our work on smoking, as it is the main cause of many cancer deaths and also cardiovascular disease.

We intend to come forward with an alcohol policy and to strengthen our activity in the fields of obesity and physical activity.

Parallel to this we need to continue with the social determinants, the underlying root causes for much ill-health in Europe. For this reason we are doing a European study as the basis for a renewed European health policy I plan to develop in collaboration with member states and have it adopted next year so that it can be a source of inspiration for them.

I also want to reach out to the environment and educational sectors and how to finance social policy. Prevention is also always important!

I presume health inequality will be a big part of this across Europe. What can the WHO do in this regard, apart from ‘inspiring’ action in member states? Do you have powers in this area?

We have a lot. We have a very open mandate and so our hands are not bound by complex competency issues. In this regard it’s easier to be in the WHO than the EU institutions.

Our definition of health is very broad as it doesn’t just cover the absence of disease but also social and mental wellbeing, giving us a mandate on every issue that impacts on health and to reach out to other sectors.

We have a very strong convening power that we should use as much as we can. For example, during the financial crisis many countries are making healthcare sector cuts and the WHO should be leading on this.

My intention is also to bring partnerships together so as not to duplicate the work of the EU and only to work in new areas if the EU doesn’t have a mandate or if we can bring added-value.

Concerning the response to the financial crisis, will you be pushing governments to consider the impacts of cutting social expenditure?

Many governments are having to cut back on health expenditure, which means putting things into a long-term perspective. You should not cut back on health and prevention and immunisation programmes etc. as that would make Europe very vulnerable, but we should make the institutional system more streamlined.

Concerning Europe and health policy, the European Parliament is currently debating counterfeit medicines. Do you have a position on this issue?

Counterfeit medicines was on the agenda of our recent assembly in Geneva. We adopted a resolution on this and the WHO must be involved. I will take it up with the member states in September in our regional committee.

There has been some criticism from Health Action International on the IMPACT initiative of the WHO, saying that the WHO shouldn’t be involved in something that’s about protecting the intellectual property of big companies. What’s your response to that?

We’ve discussed that. I was not very much aware of this before as the Secretariat for this is in Geneva. We had agreed that the WHO be involved in public health aspects of this rather than law enforcement side. Therefore the secretariat is currently within the WHO but the director-general has said she will look at whether someone else can take it over. That’s going ahead.

What can Europe do to reduce global health equalities? Do you think it will continue to grow with the expansion of technologies in health care?

Europe must take leadership on this through humanitarian aid and supporting the Millennium Development Goals. European countries greatly contribute to the WHO budget and thus have a role to say which priorities to invest in.

The EU Global Health initiative is something we fully support as the EU institutions also play a big role in this. I believe that we need a coordinated approach from Europe to address health equalities.

I have an agenda item – Health and Foreign Policy – under the WHO Regional Committee for Europe saying that health is so global and yet so regional these days that many decisions are not made at national level and therefore need to be linked.

WHO Europe represents 53 countries. What are the priorities for the non-EU countries?

The first priority is still the non-communicable diseases and health security. We are seeing this especially now in Tajikistan with the polio outbreak, which is my number one priority. We have been conducting immunisation campaigns there. As a result, there are no new AFP cases.

We do the same in all the central Asian countries where the virus may have been imported and are working with Russia. Now I will also start working with Ukraine where I see a problem with immunisation. There is a gap to be addressed in immunisation there.

Measles and rubella are also a priority but I want to extend the deadline for its elimination from 2010 to 2015 as it is for the whole WHO European region. Also, multi-drug resistant TB is a huge threat. Out of the 27 high-burden countries worldwide, 15 are in Europe, mostly in eastern Europe but including the Baltics. Resistance to antibiotics is also important.

Beyond infectious diseases are the underlying weaknesses in the health system, such as surveillance, public health systems, access and affordability.

What is the current status of the pandemic? Has it continued to decline?

In Europe it has. In the Southern hemisphere you still see a few cases, which is why it is yet to be scaled back to a post-pandemic phase. As autumn and winter will soon come, influenza will return however. This is why the new seasonal flu vaccine will include a H1N1 component. It will be given mainly to the elderly and the chronically ill.

Some say that there is a risk that H1N1 will mutate and come back stronger. Are we guarding against this?

We always have this risk, unfortunately, because influenza viruses are very unstable, so this possibility always exists.

Pandemic (H1N1) 2009 – update 107

Weekly update

출처 : WHO 2 July 2010
http://www.who.int/csr/don/2010_07_02/en/index.html

2 July 2010 — As of 27 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18239 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:

Summary: Worldwide, overall pandemic and seasonal influenza activity remains low. In the temperate regions of the Southern Hemisphere, Chile, and Argentina report low activity and only sporadic detections of both pandemic and seasonal influenza viruses during the early part of winter. South Africa, New Zealand, and Australia have all recently noted slight increases in the rate of respiratory disease. South Africa recently reported their first case of confirmed H1N1; however, the predominant influenza virus there currently is seasonal influenza A(H3N2). The H3N2 virus detected in South Africa is similar to the Perth-like strain, which is currently a component of the trivalent seasonal influenza vaccine. Active transmission of pandemic influenza virus still persists in localized areas of the tropics, particularly in South and Southeast Asia, the Caribbean and West Africa. During the last 2 to 3 weeks, seasonal influenza H3N2 viruses have also been detected at increasing levels in Nicaragua, and low levels or sporadically in Australia, Central America, South Africa and East Africa. Global circulation of seasonal influenza virus type B viruses persists at low levels in parts of East Asia, Central Africa, and Central America.

Regional Details: In most countries of the temperate zone of the southern hemisphere (Chile, Argentina, South Africa, Australia, and New Zealand) pandemic and seasonal influenza viruses have been detected only sporadically in June 2010 and activity is low, indicating a late start of the influenza season compared to 2008. Overall levels of respiratory disease in the population remain low. In Argentina, small numbers of influenza type B viruses were detected during mid June 2010. In both Chile and Argentina, respiratory syncitial virus (RSV) continued to be the predominant circulating respiratory virus resulting in high rates of respiratory illness in children. In South Africa, small and slightly increasing numbers of seasonal H3N2 and type B viruses were detected during mid June 2010. In both Australia and New Zealand, levels of ILI are increasing, but still below recent historical seasonal levels.

In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of southern India, Bangladesh, Singapore, and Malaysia. Rates are decreasing in the latter three countries but in India, the number of laboratory confirmed cases of pandemic influenza has increased since mid June. This activity has been primarily observed in Southern state of Kerala, and includes reports of a number of severe and fatal cases, particularly among pregnant women. In Bangladesh, pandemic and seasonal influenza type B viruses co-circulated at low levels during early June 2010. In Singapore, during the third week of June 2010, the levels of ARI remained below warning levels and the proportion of patients with ILI testing positive for pandemic influenza virus fell from 19% to 15%. In Malaysia, data suggests that overall pandemic influenza activity has declined throughout June 2010 though pandemic virus continues to circulate at low levels. Throughout East Asia, influenza activity remained very low. In China and Japan, levels of ILI remained at or below baseline levels for the summer months. Low and declining levels of influenza type B viruses continued to circulate across China, Hong Kong SAR (China), Chinese Taipei and Republic of Korea.

In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained very low. In Cuba, pandemic influenza virus transmission remains active but has declined substantially since peaking during mid-April to mid-May 2010; no new fatal cases have been reported over the past five reporting weeks. In several countries of the region, there has been recent circulation of seasonal influenza A (H3N2) viruses (Venezuela during May 2010) and B viruses (Bolivia during March and May 2010; El Salvador during late May and early June 2010). Nicaragua notably has seen a sharp increase in the detection of seasonal influenza A (H3N2) and Panama has detected low numbers of the same. In addition, after 20 weeks with no circulating pandemic virus, Panama reported the detection of pandemic influenza (H1N1) 2009 in early June. Many countries in the area also report ongoing co-circulation of other respiratory viruses, most notably RSV.

In sub-Saharan Africa, pandemic and seasonal influenza activity has been observed in several countries. Ghana, in West Africa, continues to have active circulation of pandemic influenza virus several weeks after activity peaked during early April 2010. Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, most notably in Cameroon. As reported in previous updates, small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern Africa; the most recent detections have been reported in Ghana, Kenya, and South Africa during mid June 2010. The persistence of H3N2 in this area over time very likely represents sustained community transmission of the virus.

Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected sporadically or at very low levels during the past month.

*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

**Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 24: 13 JUNE – 19 JUNE 2010)

Qualitative indicators (Week 29 to Week 24: 13 July 2009 – 19 June 2010)

The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

Geographic spread of influenza activity

Trend of respiratory diseases activity compared to the previous week

Intensity of acute respiratory diseases in the population

Impact on health care services

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 20 June 2010

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 106): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 106): none.

*The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related

**No update since 7 March 2010

***No update since 23 May 2010