Published Date: 2013-04-10 16:56:02
http://www.promedmail.org/?p=2400:1000:2512817876171869:::::

AVIAN INFLUENZA HUMAN (39): CHINA (SHANGHAI, JIANGSU, ZHEJIANG) H7N9 UPDATE
***************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:

[1] Origin

[2] Mutation rate

[3] Case count

[4] WHO update



******

[1] Origin

Date: Wed 10 Apr 2013

Source: Xinhua News Agency [edited]

http://news.xinhuanet.com/english/china/2013-04/10/c_132299005.htm

A top Chinese biology lab has ascribed the H7N9 avian influenza to genetic reassortment of wild birds from east Asia and chickens from east China. The researchers found that no genes in H7N9 were traceable to pigs, thus excluding pigs as intermediate hosts for the deadly new strain of bird flu, the Chinese Academy of Sciences’ Key Laboratory of Pathogenic Microbiology and Immunology said on Wednesday [10 Apr 2013]. According to the researchers, the genetic reassortment is likely to have occurred in east China’s Yangtze River Delta areas covering Shanghai, Zhejiang, and Jiangsu [provinces]. They found that a virus carried by wild birds from the Republic of Korea and other east Asian regions mingled with the avian influenza virus carried by ducks and chickens in the Yangtze River Delta during migration. The lab’s research shows the H7 and N9 gene segments in H7N9 [outbreak strain] are similar to those in avian influenza samples collected from wild birds from east Asia, while the other 6 genes are traceable to chickens in China’s Shanghai, Zhejiang, and Jiangsu.

As to why the H7N9 is less harmful to animals than to humans, researchers said it’s because of viral mutation, adding that they had monitored mutation of the N9 genes. Animal experts and scientists have stepped up monitoring of bird migration paths to prevent the H7N9 from spreading, according to the China Wildlife Conservation Association.
The new bird flu has killed 9 of the 33 people infected with H7N9 in the country. Some have speculated that the new virus is related to the dead pigs found floating along Shanghai’s Huangpu River last month [March 2013], though local government has repeatedly underlined that this is not the case. On Wednesday [10 Apr 2013], police in southwest China’s Guizhou Province announced they have detained 3 people for fabricating rumors online that the deadly virus had been detected locally.
[Editor: An]
–

Communicated by:

ProMED-mail

******

[2] Mutation rate

Date: Wed 10 Apr 2013

Source: The South China Morning Post [summ., edited]

http://www.scmp.com/news/china/article/1211077/h7n9-bird-flu-may-mutate-8-times-faster-regular-flu-study-finds
The new bird flu [A/(H7N9) influenza virus] could be mutating up to 8 times faster than an average flu virus around [that is, in] a protein that binds it to humans, a team of research scientists in Shenzhen says. Dr He Jiankui, an associate professor at South University of Science and Technology of China, said yesterday [9 Apr 2013] that the authorities should be alarmed by the results of their research and step up monitoring and control efforts to prevent a possible pandemic.

With genetic codes of [H7N9] viruses obtained from mainland authorities, the team scrutinised the haemagglutinin, a protein that plays a crucial rule in the process of infection. The researchers found dramatic mutation of haemagglutinin [gene] in one of the four flu strains released for study by the central government. 9 of the protein’s 560 amino acids had changed. In a typical flu virus, only one or 2 amino acids could change in such a short period of time, he said. The fast mutation [rate] makes the virus’ evolutionary development very hard to predict. “We don’t know whether it will evolve into something harmless or dangerous,” He said. “Our samples are too limited.
The origin of the virus was puzzling due to its novelty, but his research suggested some clues that differ from the mainland authorities’ theories. His team compared the new virus strain to all other H7N9 viruses identified in Europe and in other Asian countries that were cited by the Ministry of Agriculture as possible origins of the new bird flu, but found them all very different. In fact, the [HA of the] new bird flu was quite similar to [the HA genes] of some familiar domestic viruses such as H9N2, H11N9, and H7N3 found in Zhejiang and Jiangsu.
He said researchers could not rule out the possibility that the new virus was carried into China by wild birds, but it was more likely to be of local origin.
[Byline: Stephen Chen]
–

Communicated by:

ProMED-mail Rapporteur Mary Marshall
******

[3] Case count

Date: Wed 10 Apr 2013

Source: Xinhua News Agency [edited]

http://news.xinhuanet.com/english/china/2013-04/10/c_132298870.htm
Two more human cases of H7N9 bird flu were reported on Wednesday [10 Apr 2013] in Shanghai Municipality, bringing the total number of infected people in the country to 33, health authorities said.

A local [76-year-old retired woman] developed a cough, sore throat and weakness on 1 Apr 2013. On 2 Apr 2013 she developed a high fever and went to the hospital on 5 Apr 2013. Doctors confirmed Tuesday night [9 Apr 2013] that she has H7N9 avian flu, according to a statement issued by the city’s health and family planning committee. The patient is now in stable condition, said the statement. An 81-year-old woman, who is a farmer, went to the hospital with symptoms of diarrhea and fever of unknown origin, and was subsequently diagnosed with acute enteritis and pneumonia. On Tuesday night [9 Apr 2013], the city’s disease prevention and control center confirmed that she has H7N9 bird flu, it said. 9 people who came into contact with the 2 women have so far shown no abnormal symptoms.
Apart from the 2 cases reported in Shanghai, 3 other new cases were also reported in Jiangsu and Zhejiang provinces Wednesday [10 Apr 2013], bringing the country’s total H7N9 infection count to 33 as of 5 pm. Wednesday [10 Apr 2013]. 9 of these individuals have died.
A 4-year-old boy, who had been hospitalized for H7N9 influenza, was discharged from a Shanghai hospital Wednesday [10 Apr 2013] after fully recovering.
[Editor: An]
–

Communicated by:

ProMED-mail

and ProMED-mail Rapporteur Kunhiko Iizuka

******

[4] WHO update

Date: 10 Apr 2013

Source: WHO Global Alert and Response

http://www.who.int/csr/don/2013_04_10/en/index.html
Human infection with influenza A(H7N9) virus in China – update 10 Apr 2013

————————

As of 10 April 2013 (18:00 CET), the National Health and Family Planning Commission notified WHO of an additional 4 laboratory-confirmed cases of human infection with influenza A(H7N9) virus. Of the laboratory-confirmed cases, 2 are from Shanghai and 2 from Zhejiang.

The 1st patient is a 62-year-old man from Shanghai who became ill on [1 Apr 2013], the 2nd patient is a 77 year-old man from Shanghai who became ill on [3 Apr 2013], the 3rd patient is a 51 year-old woman from Zhejiang who became ill on [13 Mar 2013], and the 4th patient is a 79 year-old man from Zhejiang who became ill on [29 Mar 2013].
In addition, 2 patients earlier reported from Jiangsu (83-year-old man) and Anhui (35-year-old woman) have died.
To date, a total of 28 cases have been laboratory confirmed with influenza A(H7N9) virus in China, including 9 deaths, 14 severe cases and 5 mild cases.
More than 600 close contacts of the confirmed cases are being closely monitored. In Jiangsu, investigation is ongoing into a contact of an earlier confirmed case who developed symptoms of illness.
The Chinese government is actively investigating this event and has heightened disease surveillance. Retrospective testing of recently reported cases with severe respiratory infection may uncover additional cases that were previously unrecognized. An inter-government task force has been formally established, with the National Health and Family Planning Commission leading the coordination along with the Ministry of Agriculture and other key ministries. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus.
WHO is in contact with national authorities and is following the event closely. The WHO-coordinated international response is also focusing on work with WHO Collaborating Centres for Reference and Research on Influenza and other partners to ensure that information is available and that materials are developed for diagnosis and treatment and vaccine development. No vaccine is currently available for this subtype of the influenza virus. Preliminary test results provided by the WHO Collaborating Centre in China suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir).
At this time there is no evidence of ongoing human-to-human transmission.
WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.
About this Disease Outbreak News
1. WHO is currently publishing information on laboratory confirmed cases received through the official notification from the Chinese National International Health Regulations (IHR) Focal Point once a day. This formal notification and publication follows verification of the information, and may therefore come after, or not include, some cases reported through public media and other sources.
2. To date, there is limited information to determine whether the reported number of cases represents some or all of the cases actually occurring. As some relatively mild cases of illness have now been reported, it is possible that there are other such cases that have not been identified and reported.
3. If the current pattern of sporadic infections continues, WHO will cease frequent reporting of case numbers, and focus its Disease Outbreak News on new developments or changes in the pattern or presentation of infections.
–

Communicated by:

ProMED-mail Rapporteur Marianne Hopp
[There have been significant advances in determining the origin and genetic characteristics of the A/(H7N9) influenza virus responsible for human disease in eastern China. From genome sequence data it has been deduced that no genes in H7N9 were traceable to pigs, thus excluding pigs as intermediate hosts. Rather the H7 and N9 gene segments in the H7N9 outbreak strain are similar to those in avian influenza samples collected from wild birds from east Asia, while the other 6 genes are traceable to chickens in China's Shanghai, Zhejiang, and Jiangsu provinces. Other research, focussing on the sequence of the HA gene, suggests that the HA gene new bird flu virus could be mutating up to 8 times faster than the HA of an average flu virus. 
Human cases of the H7N9 virus continue to be reported, mainly involving the middle-aged and the elderly. There has still been no confirmed transmission of this virus from person to person.
Currently the number of confirmed human cases is 33, and the number of fatalities is now 9. - Mod.CP]
[The discrepancies between the media reports of numbers of cases and the WHO official report on numbers of cases is explained at the bottom of the WHO update from today (10 Apr 2013).  The WHO numbers reflect those cases that have been laboratory confirmed and are reported through official channels. At present we reflect a difference of 5 cases between the WHO report and the newswire tallies. - Mod.MPP]

See Also

미국 국립과학원회보(PNAS; Proceedings of National Academy of Science) 온라인판 최신호에 실린 스프립스 연구소(The Scripps Research Institute)의 과학자들의 프리온 연구 논문 초록입니다.

연구결과는 프리온은 DNA가 없음에도 불구하고 마치 바이러스처럼 돌연변이(Mutate)를 일으키고,  숙주의 환경에 적응(Adapt)할 수 있다는 것을 보여주고 있습니다.

이러한 연구결과는 2010년 1월 와이스만(Weissmann) 박사팀이 [사이언스]지에 발표했던 “프리온은 다윈의 진화를 할 수 있다”는 연구결과와 일맥상통하며, 비정형 프리온 단백질에 대한 가장 효과적인 치료제는 정상 프리온 단백질이 될 수 있다는 가능성을 열어 두었다고 볼 수 있습니다.

Transfer of a prion strain to different hosts leads to emergence of strain variants

Footnotes

• ¹To whom correspondence should be addressed. E-mail: charlesw@scripps.edu.


• 
  

  Author contributions: C.W. designed research; S.P.M., S.B., J.L., and I.S.-K. performed research; S.P.M., S.B., J.L., I.S.-K., and C.W. analyzed data; and S.P.M. and C.W. wrote the paper.



• 
  

  The authors declare no conflict of interest.



• 
  

  ↵*This Direct Submission article had a prearranged editor.



• 
  

  This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1013014108/-/DCSupplemental.

Reports

2009년 12월 30일자 WHO의 2009 H1N1 인플루엔자 대유행(신종플루) 업데이트 81의 원문입니다.

전세계적으로 최소한 12220명이 2009 H1N1 인플루엔자로 사망했다고 집계하고 있습니다. 

WHO의 마가렛 찬 사무총장은 아직도  2009 H1N1 인플루엔자 대유행 상태라면서 신종 플루 대유행이 끝나가고 있다는 판단은 아직 이르다고
강조하고 있습니다.

마가렛 찬 사무총장은 세계가 신종 돼지독감(돼지 인플루엔자)보다 더 독성이 강하고 치명적인 H5N1 조류독감 바이러스에 유발되는 대유행을 피할 수 있기를 바라고 있다고 밝히고 있습니다.

그러나 WHO가 돼지독감 바이러스의 실제 위험성을 지나치게 과장하여 너무나 성급하게 대유행을 선언함으로써 암묵적으로 로슈나 GSK 같은 다국적 거대제약회사의 경제적 이윤을 극대화시켰으며, 에이즈(HIV), 결핵, 말라리아 등의 긴급하게 대처해야 할 질병들에 투입되었으면 더 좋았을 엄청난 자원(인력, 장비, 의약품 등)을 돼지독감 대유행에 허비했다는 비난으로부터 자유롭기는 힘들 것으로 판단됩니다.

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

Pandemic (H1N1) 2009 – update 81

Weekly update

출처 : WHO, 30 December 2009 
http://www.who.int/csr/don/2009_12_30/en/index.html

As of 27 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12220 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 data.

Situation update:

The most active areas of pandemic influenza transmission currently are in central and eastern Europe. Focal increases in rates of ILI/ARI during recent weeks were reported in at least three eastern European countries, Georgia, Montenegro, and Ukraine. A high intensity of respiratory diseases activity with concurrent circulation of pandemic influenza persists in parts of southern and eastern Europe, particularly in Greece, Poland, Bulgaria, Serbia, Ukraine, and the Urals Region of the Russian Federation. In Western Europe, influenza transmission remains active and widespread, but overall disease activity has peaked. At least 13 of 21 countries (testing more than 20 sentinel samples) reported that 30% or more of sentinel specimens were positive for influenza, down from a peak of over 70%. All were influenza viruses detected in Western Europe were pandemic H1N1 2009, however, very small numbers of seasonal influenza viruses, making up less than 1% of all influenza viruses detected, were reported in Russia. In addition, limited available data indicates that active, high intensity transmission is occurring in Northern African countries along the Mediterranean coast (Algeria, Tunisia, and Egypt).

In Central Asia, limited data suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places. In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong SAR (China). Slight increases in ILI were reported in Mongolia after weeks of declining activity following a large peak of activity over one month ago. In southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka. Seasonal influenza A (H3N2) viruses are still being detected in very small numbers in China making up about 2.5% of the influenza A viruses detected there.

In North America, influenza transmission remains widespread but has declined substantially in all countries. In the US, sentinel outpatient ILI activity has returned to the seasonal baseline, and indicators of severity, including hospitalizations, paediatric mortality, and P&I mortality have declined substantially since peaking during late October. Rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower than those observed during recent influenza seasons.

In the tropical regions of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for focal increases in respiratory disease activity in a few countries.

In the temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza. For more information on virological surveillance and antiviral resistance please see the weekly virology update (Virological surveillance data, below).

Weekly update (Virological surveillance data)

*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)

Qualitative indicators (Week 29 to Week 51: 13 July – 20 December 2009)

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.

Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance
A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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.

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 80): 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. 80): Nepal and Armenia.

Region	Deaths*
WHO Regional Office for Africa (AFRO)	130
WHO Regional Office for the Americas (AMRO)	At least 6670
WHO Regional Office for the Eastern Mediterranean (EMRO)	693
WHO Regional Office for Europe (EURO)	At least 2422
WHO Regional Office for South-East Asia (SEARO)	1056
WHO Regional Office for the Western Pacific (WPRO)	1249
Total*	At least 12220

* 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.

건강한 성인에서 뉴라미니데이즈 억제제의 인플루엔자 치료 및 예방 : 종합 검토 및 메타 분석

[영국의학협회지(BMJ )] 2009년 12월 8일

뉴라미니데이즈 억제제(타미플루, 리렌자 등 인플루엔자 바이러스 치료제의 작용기전)에 대한 4개의 예방적 투여 및 12개의 치료적 투여에 관한 임상시험을 포함하는 20개의 임상시험에 관한 리뷰 및 메타 분석 논문입니다.

연구팀은 뉴라미니데이즈 억제제(타미플루, 리렌자 등)는 인플루엔자유사증상( influenza-like illness) 및 무증상 인플루엔자에 전혀 효과가 없는 것으로 나타났다고 결론을 내렸습니다.

인플루엔자 증상이 나타난 실험실 확정진단 환자에게서 경구용 오셀타미비르(oseltamivir, 타미플루)의 효능은  1일 투여용량 75 mg의 경우  61% ,  150 mg 의 경우 73%로 나타났습니다.

흡입용 자나미비르(zanamivir, 리렌자)의 효능은  1일 투여용량  10 mg 의 경우 62%로 나타났습니다.

항바이러스제 투여시 인플루엔자유사증상(ILE)를 경감시키는 시간은 타미플루(oseltamivir)가 1.20일, 리렌자(zanamivir)가 1.24일 정도인 것으로 나타났습니다. 다시 말해 인플루엔자 감염환자에게 타미플루나 리렌자를 투여할 경우, 약을 전혀 투여하지 않을 때보다 하루 정도 빨리 독감증상이 줄어든다고 볼 수 있습니다.

그리고 연구팀은 타미플루(oseltamivir)의 경우, 하부호흡기(하기도, lower respiratory tract )의 합병증을 줄여주지 못하는 것으로 보인다고 밝혔습니다.

따라서 결론적으로 뉴라미니데이즈 억제제(타미플루, 리렌자 등)는 건강한 성인에서 인플루엔자 증상을 소폭(완만하게) 개선시켜주는 효과가 있는 것으로 나타났습니다. 또한 뉴라미니데이즈 억제제(타미플루, 리렌자 등)는 인플루엔자 실험실 확정진단 후 투여할 경우 효과가 있지만, 인플루엔자유사증상( influenza-like illness) 및 무증상 인플루엔자에는 전혀 효과가 없는 것으로 나타났습니다.

그동안 비판적 전문가들은 건강한 성인들에게 예방적 목적으로 타미플루를 무분별하게 투여하는 것은 효과가 의심스럽고 돌연변이를 통한 내성 바이러스의 출현 등이 우려된다고 주장하며, 고위험군과 중증환자 등에 치료목적으로 제한적으로 투여하는 것이 바람직하다는 의견을 개진해왔습니다.

논문 전문은 첨부파일로 올려 놓았으며, 요약문은 아래와 같습니다.

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

Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis (전문은 첨부파일 참조)

Tom Jefferson, researcher1, Mark Jones, statistician2, Peter Doshi, doctoral student3, Chris Del Mar, dean; coordinating editor of Cochrane Acute Respiratory Infections Group4

1 Acute Respiratory Infections Group, Cochrane Collaboration, Rome, Italy, 2 University of Queensland, School of Population Health, Brisbane, Australia, 3 Program in History, Anthropology, Science, Technology and Society, Massachusetts Institute of Technology, Cambridge, MA, USA, 4 Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

Correspondence to: C Del Mar cdelmar@bond.edu.au

출처 : BMJ 2009;339:b5106, doi: 10.1136/bmj.b5106 (Published 8 December 2009)

Objectives To update a 2005 Cochrane review that assessed the effects of neuraminidase inhibitors in preventing or ameliorating the symptoms of influenza, the transmission of influenza, and complications from influenza in healthy adults, and to estimate the frequency of adverse effects.
Search strategy An updated search of the Cochrane central register of controlled trials (Cochrane Library 2009, issue 2), which contains the Acute Respiratory Infections Group’s specialised register, Medline (1950-Aug 2009), Embase (1980-Aug 2009), and post-marketing pharmacovigilance data and comparative safety cohorts.

Selection criteria Randomised placebo controlled studies of neuraminidase inhibitors in otherwise healthy adults exposed to naturally occurring influenza.

Main outcome measures Duration and incidence of symptoms; incidence of lower respiratory tract infections, or their proxies; and adverse events.

Data extraction Two reviewers applied inclusion criteria, assessed trial quality, and extracted data.

Data analysis Comparisons were structured into prophylaxis, treatment, and adverse events, with further subdivision by outcome and dose.

Results 20 trials were included: four on prophylaxis, 12 on treatment, and four on postexposure prophylaxis. For prophylaxis, neuraminidase inhibitors had no effect against influenza-like illness or asymptomatic influenza. The efficacy of oral oseltamivir against symptomatic laboratory confirmed influenza was 61% (risk ratio 0.39, 95% confidence interval 0.18 to 0.85) at 75 mg daily and 73% (0.27, 0.11 to 0.67) at 150 mg daily. Inhaled zanamivir 10 mg daily was 62% efficacious (0.38, 0.17 to 0.85). Oseltamivir for postexposure prophylaxis had an efficacy of 58% (95% confidence interval 15% to 79%) and 84% (49% to 95%) in two trials of households. Zanamivir performed similarly. The hazard ratios for time to alleviation of influenza-like illness symptoms were in favour of treatment: 1.20 (95% confidence interval 1.06 to 1.35) for oseltamivir and 1.24 (1.13 to 1.36) for zanamivir. Eight unpublished studies on complications were ineligible and therefore excluded. The remaining evidence suggests oseltamivir did not reduce influenza related lower respiratory tract complications (risk ratio 0.55, 95% confidence interval 0.22 to 1.35). From trial evidence, oseltamivir induced nausea (odds ratio 1.79, 95% confidence interval 1.10 to 2.93). Evidence of rarer adverse events from pharmacovigilance was of poor quality or possibly under-reported.

Conclusion Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed.

© Jefferson et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

Swine flu mild for now, but could worsen

By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science Editor –

출처 : 로이터통신 Tue Oct 6, 4:32 pm ET