Pandemic (H1N1) 2009 – update 109

Weekly update

16 July 2010 — As of 12 July, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18337deaths.

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:

Worldwide, overall pandemic influenza activity remains low. The most active areas of pandemic influenza virus transmission currently are in parts of South Asia, West Africa, and Central America. In the temperate zone of the southern hemisphere, pandemic and seasonal influenza activity has remained low during the first half of the southern hemisphere winter, except in South Africa, where increased detections of primarily seasonal influenza viruses (type B and H3N2) were reported during late June and early July 2010. Seasonal influenza H3N2 viruses continue to circulate at varying levels across parts of the Americas, Africa, and Southeast Asia. Increased seasonal influenza activity continues to be observed in several countries of Central America.

To date, most countries of the temperate zone of the southern hemisphere, with the exception of South Africa, have reported low overall levels of respiratory disease activity and low to sporadic levels of pandemic and seasonal influenza virus circulation during the first half of the southern hemisphere winter season. Pandemic influenza viruses have been detected only sporadically or at low levels in most of these countries. As reported last week, South Africa began observing a sharp increase in the proportion of sentinel respiratory samples testing positive for influenza virus (primarily seasonal influenza B and H3N2) during late June 2010, reaching a peak of ~50% detection rate during the first week of July 2010, and falling to ~40% during the second week of July 2010. In Chile (as of late June 2010) and Argentina (as of early July 2010), the most recent available data show that influenza activity remains sporadic in Argentina and low in Chile (~5% respiratory samples tested positive for influenza, 84% of which were pandemic virus with small numbers of seasonal influenza H3N2 and type B detected as well). In both Chile and Argentina, RSV has been the predominant circulating respiratory virus since mid-April 2010. In Australia, as of the last week of June 2010, overall rates of ILI remained low and below levels observed during the same period in past three winter seasons. Although a small cluster of pandemic influenza cases, including a few hospitalized cases, were recently detected in the Northern Territory of Australia, pandemic and seasonal influenza virus detections remain otherwise sporadic, albeit slightly increased during late June and early July 2010. Similarly, in New Zealand, rates of ILI have remained low and below the seasonal baseline, with only sporadic detections of pandemic and seasonal H3N2 viruses through the first week of July 2010. In both Australia and New Zealand, current levels of ILI are similar to those observed during the same period in 2008, when the influenza season was noted to have arrived and peaked late in winter.

In Asia, overall pandemic influenza activity remains low to sporadic, except in parts of southern and western India, Malaysia, and Singapore. As reported last week, in India, transmission of pandemic influenza virus remains active but stable in the southern state of Kerala. The extent of illness in the community is currently being assessed and monitored by the Government of India. Similar numbers of new cases, including small numbers of fatal cases, have been reported on a weekly basis since transmission first increased during mid-June 2010. Recent, small increases in pandemic influenza virus circulation have also been observed since mid-June 2010 in other southern and western states of India, particularly in the western state of Maharashtra. In Singapore, levels of ARI increased during the first two weeks of July 2010; however, the intensity of pandemic influenza virus transmission has declined during June and July 2010 after peaking in May 2010. The proportion of patients with ILI testing positive for pandemic influenza virus in Singapore remained stable (14-16%) during first two weeks of July 2010. In addition, substantial co-circulation of seasonal influenza H3N2 viruses (with pandemic H1N1 virus) was detected in Singapore throughout May and June 2010. In Malaysia, numbers of new cases of pandemic influenza continued to decline; overall pandemic influenza activity fell substantially in June and early July 2010 after peaking during mid-April to mid-May 2010. Low levels of seasonal influenza type B viruses (and to much lesser extent pandemic influenza virus) continue to circulate across northern and southern China as levels of ILI remain stable and near seasonal levels seen in the same period in recent years. Low levels of pandemic and seasonal influenza (H3N2 and type B) viruses also continued to circulate in Hong Kong SAR (China), Chinese Taipei, and parts of Thailand.

In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained low, except in parts of Central and South America, where there has been recent active co-circulation of pandemic and seasonal influenza H3N2 viruses. The majority of recent active transmission of pandemic influenza virus has been reported in Colombia, Costa Rica, and to a lesser extent in Cuba. In Colombia, although low level circulation of pandemic influenza viruses has persisted throughout the first half 2010, a second period of active transmission began in mid-May 2010, peaked in June 2010, has now largely subsided during the second of week of July 2010. Similarly, in Costa Rica, low level circulation of pandemic virus has persisted throughout 2010, however, there has been a recent resurgence in active transmission (though less intense than the initial 2009 wave) of pandemic influenza virus during June 2010. As reported previously, in Panama, a sharp increase in the circulation influenza A viruses (particularly H3N2, but also small numbers of pandemic H1N1) was reported over the month of June 2010; a high intensity of respiratory diseases and a moderate impact on healthcare services continued to be reported during the second week of July 2010. In Nicaragua, recent active transmission of seasonal influenza H3N2 viruses, which began during late May 2010 and peaked during mid June 2010, appears to have largely subsided during recent weeks. Many countries in the region continue to report ongoing co-circulation of other respiratory viruses, most notably RSV.

In sub-Saharan Africa, the current situation is largely unchanged since the last update. Pandemic and seasonal influenza activity continues to be observed in several countries. Ghana, in West Africa, continued to have a sustained resurgence in circulation of pandemic influenza virus during June 2010, more than several months after the first period of pandemic activity peaked (early April 2010). Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, particularly in Cameroon, where an increase in influenza type B virus circulation was observed during June 2010. Small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern and southern Africa; the most recent detections have been reported in Kenya and South Africa.

Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected only 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 26: 20 JUNE – 3 JULY 2010)

Qualitative indicators (Week 29, 2009 to Week 26, 2010: 13 July 2009 – 3 July 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 11 July 2010

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 108): 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. 108): 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

의학인류학(Medical Anthropology)적인 입장에서 2009 돼지독감(신종플루) 대유행에 대한
다양한 쟁점을 다룬 논문들입니다.

Medical Anthropology

ISSN 0145-9740
Volume 28, Number 3, July 2009

http://www.ingentaconnect.com/content/routledg/gmea/latest

Apology from the BMJ for erroneous flu vaccine profits allegation

출처 : The Pharma Letter Article | 6 July 2010
http://www.thepharmaletter.com/file/96423/apology-from-the-bmj-for-erroneous-flu-vaccine-profits-allegation.html

The British Medical Journal has published a correction and apology for the use of incorrect figures in its expose on whether advisors to the World Health Organization had a conflict of interest in so far as they had financial ties to drugmakers (The Pharma Letter June 7).

Fiona Godlee, editor-in-chief of the BMJ, conceded that she was quoting from the Council of Europe report which itself was quoting a JP Morgan report that estimated total sales (not profit as she stated) for pandemic vaccine and adjuvant, and was $6.9 billion. The industry’s audited accounts for 2009 give sales figures for pandemic vaccine in 2009 in the region of $2.5 billion, according to a posting on the European Federation of Pharmaceutical Industries and Associations (EFPIA) web site.

The JP Morgan figures quoted in a TPL (June 10 issue) story on the issue said that producers of pandemic vaccines had so far “netted” an estimated $7-$10 billion from government orders, so not implying this was profit.

Apparently, Ms Godlee took the numbers not directly from the JP Morgan report, but from the Council of Europe report, which had in turn quoted “incorrectly” from the JP Morgan report, declaring that industry sales figures were profits.

The EFPIA posting says that is worth noting a quote from the author of the Council of Europe report – Member of the European Parliament Paul Flynn (UK, SOC) – on his blog referring to the press conference he gave with the BMJ: “We have never met before but we cooed in harmony and just avoided saying it was the Pharmas that did it.”  This “tells us a great deal about Mr Flynn’s attitude towards the pharmaceutical industry,” the EFPIA commented.

An industry insider told TPL in a personal capacity: “I don’t want to be too critical of BMJ, but [Ms Godlee’s] closeness to Paul Flynn, a severe critic of the industry (and her decision not to check the facts from the primary source) does not reinforce an impression of objectivity on the industry.

2009년 7월 21일자 [슈피겔]지에 실린 전염병학자 톰 제퍼슨의 인터뷰 내용입니다.
그는 신종플루 위험이 과대평가되었으며, 그것은 연구기금, 권력, 영향력 및 과학적 평판과 밀접한 관련이 있다고 밝혔습니다. 그리고 WHO가 대유행 평가 기준을 변경한 것에 대한 문제제기를 하였습니다. 옛 기준에 따르면 신종 바이러스가 빠른 속도로 출현하고, 대중들이 그 바이러스에 대한 면역력을 획득하지 못했으며, 높은 유병룰(morbidity)과 치명률(morbidity)이 나타날 때 대유행 선언을 한다고 되어 있지만… 새로운 기준에는 2개 이상의 지역에서 환자 집락이 발생할 때라고 변경되어 있다는 점을 지적하였습니다.

Interview with Epidemiologist Tom Jefferson

‘A Whole Industry Is Waiting For A Pandemic’

출처 : 슈피겔(SPIEGEL) 07/21/2009
 http://www.spiegel.de/international/world/0,1518,637119,00.html

The world has been gripped with fears of swine flu in recent weeks. In an interview with SPIEGEL, epidemiologist Tom Jefferson speaks about dangerous fear-mongering, misguided, money-driven research and why we should all be washing our hands a lot more often.

ABOUT TOM JEFFERSON

Eligio Paoni

Tom Jefferson, 55, has worked for the Cochrane Collaboration for 15 years. Along with an international team of scientists, he evaluates all published flu- related studies. Before assuming his current position, he was a general practitioner in the British Army. He lives near Rome.

SPIEGEL: Mr. Jefferson, the world is living in fear of swine flu. And some predict that, by next winter, one-third of the world’s population might be infected. Are you personally worried? Are you and your family taking any precautions?

Tom Jefferson: I wash my hands very often — and it’s not all because of swine flu. That’s probably the most effective precaution there is against all respiratory viruses, and the majority of gastrointestinal viruses and germs as well.

SPIEGEL: Do you consider the swine flu to be particularly worrisome?

Jefferson : It’s true that influenza viruses are unpredictable, so it does call for a certain degree of caution. But one of the extraordinary features of this influenza — and the whole influenza saga — is that there are some people who make predictions year after year, and they get worse and worse. None of them so far have come about, and these people are still there making these predictions. For example, what happened with the bird flu, which was supposed to kill us all? Nothing. But that doesn’t stop these people from always making their predictions. Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur.

SPIEGEL: Who do you mean? The World Health Organization (WHO)?

Jefferson: The WHO and public health officials, virologists and the pharmaceutical companies. They’ve built this machine around the impending pandemic. And there’s a lot of money involved, and influence, and careers, and entire institutions! And all it took was one of these influenza viruses to mutate to start the machine grinding.

SPIEGEL: On your Italian homepage, there is a “pandemic countdown” that expires on April 1. Don’t you think the situation calls for just a bit more seriousness?

Jefferson: I’m just using it ironically to expose the false certainty that we are fed. Will one-third of the world’s population get swine flu? Nobody can say for sure right now. For now, at least, I don’t really see any fundamental difference, no difference in the definition between this and a normal flu epidemic. Swine flu could have even stayed unnoticed if it had been caused by some unknown virus rather than an influenza virus.

SPIEGEL: Do you think the WHO declared a pandemic prematurely?

Jefferson: Don’t you think there’s something noteworthy about the fact that the WHO has changed its definition of pandemic? The old definition was a new virus, which went around quickly, for which you didn’t have immunity, and which created a high morbidity and mortality rate. Now the last two have been dropped, and that’s how swine flu has been categorized as a pandemic.

SPIEGEL: But, year after year, 10,000-30,000 people in Germany alone die from influenza. In the Western world, influenza is the most deadly infectious disease there is.

Jefferson: Hold on! These figures are nothing more than estimates. More than anything, you have to distinguish between an influenza-like illness and a genuine flu, the real influenza. Both of them have the same symptoms: a sudden high fever, a sore throat, coughing, rheumatic pain in the back and legs, possible bronchitis and pneumonia. But real flues, real influenzas are only caused by influenza viruses, while there are more than 200 different viruses that cause influenza-like illness. When it comes to figures related to so-called flu deaths, you always get other causes of death caused by other viruses mixed in. Now, in the case of elderly people who die of pneumonia, nobody would do a postmortem to figure out if it was really an influenza virus that killed them. Approximately 7 percent of influenza-like illness cases are caused by influenza viruses. It’s a very small percentage. What I know is that real influenza is systematically overestimated.

SPIEGEL: And what about the 200 other kinds of viruses?

DER SPIEGEL

Flu-related deaths and causes of flu-like illnesses.

Jefferson: They’re not as popular as influenza. Researchers are just not as interested in that. Take rhinovirus, a horse-derived virus. It’s the most commonly isolated agent in common colds. There are a hundred different types of these rhinoviruses. They usually only cause a normal runny nose, but they can be deadly, too. Or so-called RSV, the human respiratory syncytial virus, that is highly dangerous to infants and small children.

SPIEGEL: So why aren’t researchers interested in it?

Jefferson: It’s easy: They can’t make money with it. With rhinoviruses, RSV and the majority of the other viruses, it’s hard to make a lot of money or a career out of it. Against influenza, though, there are vaccines, and there are drugs you can sell. And that’s where the big money from the pharmaceuticals industry is. It makes sure that research on influenza is published in the good journals. And that’s why you have more attention being paid there, and the entire research field becomes interesting for ambitious scientists.

SPIEGEL: But is there any scientific reason to be interested in influenza viruses?

Jefferson: The strict focus on influenza is not only misguided; it’s also dangerous. Do you remember something called SARS? That was a truly dangerous epidemic. It was like a meteor: It came and it went quickly, and it killed a lot of people. SARS took us by surprise because it was caused by a completely unknown coronavirus. Where did it come from? Where did it go? Or is it still here? We still don’t know. There are lots of other strange things like that coming out. Every year, a new agent is identified. For example, there’s something called bocavirus, which can cause bronchitis and pneumonia in small children. And there’s something called metapneumovirus, which studies say is responsible for more than 5 percent of all flu-related illnesses. So, we should keep our eyes open in all directions!

SPIEGEL: But the great pandemic of 1918/1919 was caused by an influenza virus, and it killed up to 50 million people around the world. Or do scientists contest that?

Jefferson : It’s very well possible that it was, but there are many aspects about the 1918/1919 pandemic that still puzzle us. It was only 12 years ago that we learned that the H1N1 virus caused it. But there was also a lot of bacterial activity going on at the time. And it’s particularly unclear why the mortality rate for the flu dropped so dramatically after World War II. Today, you only get a fraction of what was standard before the war. When it comes to the later pandemics, such as the “Asian flu” of 1957 or the “Hong Kong flu” of 1968/69, you can barely detect them as exceptional figures when it comes to death statistics as a whole.

Part 2: Contradictions between Scientific Findings and Practice

SPIEGEL: So why should we even speak of pandemics at all?

Jefferson: That’s something you should ask the World Health Organization!

SPIEGEL: In your opinion, what do you think it takes to make a virus like the swine flu a global threat?

Jefferson: Unfortunately, we can only say that we don’t know. I suspect that the whole issue is much more complex than we are even able to imagine it today. Given all the viruses that produce flu-like symptoms, perhaps Robert Koch’s postulate that one particular pathogen causes one particular disease doesn’t go far enough. Why, for example, do we not get influenza in the summertime? In the end, the pathogen is there all year long! Already in the 19th century, the German chemist and hygienist Max von Pettenkofer had developed a theory about how the pathogen’s contact with the environment can alter the disease. I think that research in this direction would be worthwhile. Perhaps it would allow us to understand the pandemic of 1918/1919 better or to be able to assess the dangers of swine flu.

SPIEGEL: Humans have better defenses today than they did in 1918, and it probably won’t be long before we have a swine flu vaccine. Last week, Germany’s federal government announced that it wanted to buy enough for 30 percent of the population. How much do you think that will protect us?

Jefferson: When it comes to pandemic vaccination, as we say in English, the proof is in the pudding. The proof is in using it. We’ll see. It does generate an antibody response, but will it really guard against the disease?

SPIEGEL: Are you pessimistic about that?

Jefferson: No, I’m just saying I think we’re about to find out (laughter). Let’s have this conversation again in about a year’s time, shall we?

SPIEGEL: For a number of years, as part of the Cochrane Collaboration, you have been systematically evaluating all the studies on immunization against seasonal influenza. How good does it work?

Jefferson: Not particularly good. An influenza vaccine is not working for the majority of influenza-like illnesses because it is only designed to combat influenza viruses. For that reason, the vaccine changes nothing when it comes to the heightened mortality rate during the winter months. And, even in the best of cases, the vaccine only works against influenza viruses to a limited degree. Among other things, there is always the danger that the flu virus in circulation will have changed by the time that the vaccine product is finished with the result that, in the worst case, the vaccine will be totally ineffectual. In the best of cases, the few decent studies that exist show that the vaccine mainly works with healthy young adults. With children and the elderly, it only helps a little, if at all.

SPIEGEL: But aren’t those the exact groups that influenza immunization is recommended for?

Jefferson: Indeed. That’s one of the contradictions between scientific findings and practice, between evidence and policy.

SPIEGEL: So, what’s behind this contradiction?

Jefferson: Of course, that has something to do with the influence of the pharmaceutical industry. But it also has to do with the fact that the importance of influenza is completely overestimated. It has to do with research funds, power, influence and scientific reputations!

SPIEGEL: So, at the moment is it reasonable to keep vaccinating against seasonal influenza?

Jefferson: I can’t see any reason for it, but I’m not a decision maker.

SPIEGEL: And what about Tamiflu and Relenza, two of the anti-flu medications that are being deployed against swine flu? How well do they really work?

Jefferson : If taken at the right time, on average, Tamiflu reduces the duration of a real influenza by one day. One study also found that it diminishes the risk of pneumonia.

SPIEGEL: Could these medications lower mortality rates associated with the flu?

Jefferson : That’s possible, but it has yet to be scientifically proven.

SPIEGEL: And what about side effects?

Jefferson: Tamiflu can cause nausea. And there are things that point toward psychiatric side effects. There are reports coming out of Japan that young people who have taken Tamiflu have had acute psychotic reactions similar to those found in schizophrenics.

SPIEGEL: So, is it sensible to use such medications at all?

Jefferson : When it comes to severe disease, yes. But under no circumstances should Tamiflu be handed out to whole schools, as is currently sometimes being done. With that being the case, it doesn’t surprise me at all that we’re already hearing reports about resistant strains of swine flu.

SPIEGEL: In Germany, the government is supposed to stockpile flu medications for 20 percent of the population. Do you see that as being sensible?

Jefferson: Well, at least there are much cheaper ways to accomplish a lot more. For example, school children should be taught to wash their hands regularly — preferrably after every class! And every airport should install a couple hundred wash basins. Whoever gets off a plane and doesn’t wash their hands should be stopped by the border police. You could tell for example by putting an invisible, neutral dye in the water. And wearing masks can be sensible, as well.

SPIEGEL: Has it really been shown that these measures work?

Jefferson : There are several good studies on this that were done during the SARS epidemic. They are so-called case-control studies that examined individuals that had had close contact with the SARS virus. They compared the characteristics of those who had been infected with the virus through this contact with those of people who had not been infected. These studies resulted in very clear results.

SPIEGEL: You sound pretty impressed.

Jefferson: I am. What’s great about these measures is not only that they are inexpensive, but also that they can help against more than just influenza viruses. This method can fight against the 200 pathogens that bring about flu symptoms as well as against gastrointestinal viruses and completely unknown germs. One study done in Pakistan has shown that hand washing can even save children’s lives. Someone should get a Nobel Prize for that!

SPIEGEL: Mr. Jefferson, we thank you for this interview.

Interview conducted by Johann Grolle and Veronika Hackenbroch.

Pandemic (H1N1) 2009 – update 106

Weekly update

25 June 2010 — As of 20 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18209 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:

Worldwide, overall pandemic and seasonal influenza activity remains low. Active transmission of pandemic influenza virus persists in parts of the tropics, particularly in the Caribbean, West Africa, and South and Southeast Asia. Pandemic and seasonal influenza viruses have been detected only sporadically during the early part of winter in the temperate regions of the southern hemisphere. Global circulation of seasonal influenza virus type B viruses has declined substantially and persists at low levels in parts of East Asia, Central Africa, and Central America. During the past month, seasonal influenza H3N2 viruses have been detected at low levels across parts of East Africa and South America.

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 during the first two weeks of June 2010 and overall levels of respiratory disease in the population remain low. In Chile, during the second week of June, approximately 1% samples tested positive for influenza (the majority were pandemic influenza virus). In Argentina, small numbers of influenza type B viruses were detected during early June 2010. In both Chile and Argentina, respiratory syncitial virus (RSV) continued to be the predominant circulating respiratory virus. In South Africa, very small numbers of seasonal H3N2 and type B viruses were detected since the beginning of June 2010. In both Australia and New Zealand, levels of ILI are below recent historical seasonal levels and there have been only sporadic detections of seasonal or pandemic influenza virus during the first half of June 2010.

In Asia, the most active areas pandemic influenza virus transmission currently are in parts of southern India, Bangladesh, Singapore, and Malaysia. In India, there have been recent reports of increasing pandemic influenza activity in the southern state of Kerala, including reports of small numbers of severe and fatal cases, particularly among pregnant women; the extent of illness in the community is currently being assessed. In Bangladesh, pandemic and seasonal influenza type B viruses continued to co-circulate at low levels during early June 2010. In Thailand, limited data suggests that there continues to be low levels of pandemic and seasonal influenza virus co-circulating in parts of the country. In Singapore, during the third week of June 2010, levels of ARI declined below warning levels and the proportion of patients with ILI testing positive for pandemic influenza virus fell from 28% to 19%. In Malaysia, limited data suggests that overall pandemic influenza activity declined throughout June 2010 as pandemic virus continued to circulate at low levels. Throughout East Asia, overall pandemic and seasonal activity remained very low to sporadic. In China and Japan, levels of ILI remained at or below baseline levels for the summer months. Low and declining levels of seasonal influenza type B viruses continued to circulate across China, Hong Kong SAR (China), and Chinese Taipei.

In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained very low, except in Cuba and Colombia, where low levels of pandemic influenza virus continue to circulate (approximately 8% of respiratory samples tested positive for pandemic influenza in both countries during the early part of June 2010). 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 four reporting weeks. In Colombia, persistent but low level circulation of pandemic influenza virus has increased slightly since late May 2010; however, the overall level of respiratory diseases in the population was reported to be low to moderate during mid June 2010. In several countries of the region, there has been recent circulation of seasonal influenza viruses including type A (Venezuela during May 2010) and B (Bolivia during March and May 2010; El Salvador during late May and early June 2010). Variable ongoing co-circulation of other respiratory viruses, including RSV, continues to be reported across the region.

In sub-Saharan Africa, pandemic and seasonal influenza activity has been limited to several countries. Ghana, in West Africa, continued to have active circulation of pandemic influenza virus long after overall activity peaked during early April 2010; the proportion of respiratory samples testing positive for pandemic influenza virus increased from 16% to 23% during the first two weeks of June 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 the second week of 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.

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).

*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 23: 30 MAY – 12 JUNE 2010)

Qualitative indicators (Week 29 to Week 23: 13 July 2009 – 12 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. 105): 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. 105): 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

WHO의 돼지독감(신종플루) 바이러스 대응을 검토하는 전문가 패널의 대표를 맡고 있는 하비 파인버그 박사가 200명의 패널 조사단 중 29명이 이해관계의 상충에 따라 이 문제를 다룰 것이라는 우려를 밝혔다는 AP통신의 4월 14일자 보도입니다.

하비 파인버그(Harvey Fineberg) 교수 현재 독립적인 비영리 기구인 의학연구소(the Institute of Medicine, http://www.iom.edu/) 소장을 맡고 있습니다. 하버드 의대 학장으로 재직했으며,  미국 국립보건원장을 역임한 바 있습니다. 1976년 미국의 돼지독감 사태에 대해 미 보건복지교육부 보고서 『돼지 독감 사태: 허깨비 전염병에 대한 의사결정과정(The Swine Flu Affair: Decision-Making on a Slippery Disease, U.S. Department of Health, Education, and Welfare)』, (Neustadt, Richard E, Fineberg Harvey V, 1978)의 저자 중의 한 명으로 유명합니다. 

그는 매커릿 찬(Margaret Chan ) WHO 사무총장이 임명하 200명의 조사단 가운데 적어도 10명은 과거나 현재 WHO에 자문을 하였던 적이 있으며, 24명의 위원은 정부에 고용된 적이 있기 때문에 궁극적으로 편향된 성향을 나타낼 수 밖에 없을 것이라는 우려를 밝혔습니다.

런던에 기반을 둔 국제정책네트워크(International Policy Network)라는 단체의 필립 스티븐스(Philip Stevens)도 일반적으로 봤을 때 WHO가 자신의 정책을 재검토하는 위원회에서 결론을 미리 정해놓고 그 결론에 짜맞추는 것 같은 방식으로 일처리를 했던 역사를 가지고 있다는 비파적 견해를 제시했다고 합니다.

결국 이러한 우려들은 ‘WHO의 가짜 신종플루 대유행 스캔들 조사’가 제대로 이루어질 수 없다느 비관적 현실을 반영하는 것이라 생각합니다.

현재 전세계 각국 정부들이 신종플루 위험성을 과대평가하여 지나치게 많은 백신을 주문하여 비축함으로써 사용하지 못한 백신이 너무 많이 남았다는 대중들의 비난이 쇄도하고 있는 상황입니다.

WHO의 권고가 이러한 문제를 초래했는데요, 로슈, GSK,  노바티스 등 다국적 거대 제약회사들의 이윤을 위해 WHO가 가짜 신종플루 대유행 경고를 발령했다는 의혹이 제기되어 조사가 진행되고 있는 상황입니다.

1918년 인플루엔자(속칭 스페인독감)의 대유행으로 5천만명의 사람이 사망한 것에 비해 이번 2009 돼지독감(신종플루) 바이러스에 의한 사망자는 1만8천명에 불과합니다.  해마다 계절성 독감으로 사망하는 사람이 35만명 가량 되었던 사실에 견주어 볼 때, 신종플루는 위험은 지나치게 과장된 것이 틀림없습니다.

WHO는 거대 제약회사와 유착의혹으로 스스로의 권위를 땅에 떨어뜨렸는데요, 결국 이러한 피해는 전세계 가난한 국가의 민중들에게 고스란히 전가될 것입니다.

과연 전세계 어느 누가 가난한 국가들의 질병을 경감시키기 위해 재정적 지원을 요청하는 양치기 소년 WHO의 말을 따르겠습니까?

전문가 조사패널의 보고서는 2010년 5월에 WHO 회원국가들에게 제출될 예정이고, 최종보고서는 내년에 출판될 예정이라고 합니다.

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Chair seeks to tackle bias in WHO swine flu review

WHO의 최고 독감 전문가가 다음 주 목요일 스트라스부르크에서 열릴 예정인 가짜 신종플루 대유행(false pandemic) 스캔들을 조사할 유럽의회 청문회에 참석할 예정이라고 합니다.

청문회에 참석할 WHO 독감전문가팀은 신종플루 대유행에 대한 WHO 사무총장 특별 자문관(WHO Special Adviser on Pandemic Influenza)인 케이지 후쿠다(Keiji Fukuda)를 단장으로 구성되었다고 합니다.

케이지 후쿠다는 기자들에게 “세계가 실제 대유행으로 진행되고 있으며 이를 허위라고 하는 얘기는 잘못이고 무책임한 것”이라고 말하는 등의 언론 플레이를 하고 있습니다.

그는 WHO와 거대 제약회사의 공모설을 부인하며, WHO가 산업계의 영향을 전혀 받지 않았다고 강변했습니다.

그러나 가짜 대유행 스캔들을 별개로 하더라도… WHO는 거대 제약 산업계의 눈치를 보며 항바이러스제(타미플루, 리렌자)에 대한 강제실시를 전혀 권고하지 않았으며, 신종플루 백신을 준비하는데 있어서도 세계 각국 시민들의 건강과 안전보다 거대제약회사들의 이윤을 우선시했다는 비판으로부터 자유롭지 못합니다.

유럽의회의 청문회에서 얼마나 많은 진실이 밝혀질지 기다려봐야 할 것 같습니다.
 
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WHO attend key European hearing on flu pandemic’

출처 : AFP 통신 Fri Jan 22, 1:29 pm ET

GENEVA (AFP) – The World Health Organisation’s leading flu expert will join a Council of Europe hearing next week to scrutinise if they had overreacted to the swine flu pandemic, an official said Friday.

“There will be a WHO delegation going to Strasbourg to this open hearing on Tuesday,” said spokesman Gregory Haertl, adding that it would be led by Keiji Fukuda, WHO Special Adviser on Pandemic Influenza.

The France-based Council of Europe announced on its website Thursday that the hearing entitled “The handling of the H1N1 pandemic: more transparency needed?” would be held in public.

The Health Family and Social affairs commission of the Council’s assembly invited the WHO and pharmaceutical firms after a political storm erupted over the alarm caused by the declaration of a pandemic with A(H1N1) influenza.

Council of Europe parliamentarian Wolfgang Wodarg has accused national and international authorities of declaring a “false pandemic”, claiming pressure from pharmaceutical firms anxious to profit from vaccine and drug sales.

The WHO responded a week ago by announcing a likely independent review of its response to swine flu, but only once the pandemic is over.

Haertl defended the UN health agency’s response after the emergence of the new flu virus with fast spreading illness, and deaths, in the United States and Mexico in April 2008.

“The question is not really whether we had contact with the industry but whether we had any undue influence exerted upon us by commercial interests — and the answer is no,” he told journalists on Friday.

He insisted that the WHO had maintained that the symptoms of the disease were largely mild in a “sober and balanced” assessment of the worldwide spread of swine flu into more than 200 countries.

French Health Minister Roselyne Bachelot on Friday described talks with drug companies to cancel orders for millions of swine flu vaccines as “tough”.

France spent 869 million euros (1.25 billion dollars) on 94 million vaccines for the A(H1N1) virus, but like some other European countries it has witnessed less demand than expected.