Tag Archive: Swine Flu

Getting a grip on what the A (H1N1) pandemic is all about is key to devising a proper approach to handle the disease.

Sometimes we get frightened to death and paralysed by stories of a pandemic from diseases overseas and ignore the real danger literally lurking and killing in our very own backyards.

The Influenza A (H1N1), known in some parts of the world as swine flu, has been classified as Phase 6, the highest, in the World Health Organisation classification of pandemics, sparking off a panic of sorts, especially among Asian countries which have had to deal with SARS and avian flu among others.

While one should not underestimate the need to be careful and proactive with the outbreak, there is a need to be very circumspect about what Influenza A (H1N1) – the WHO-given name for this strain of the flu – is.

First, what is a pandemic? According to the WHO, a disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease.

An influenza pandemic may occur when a new influenza virus appears, against which the human population has no immunity.

And what does Phase 6 mean?  Phase 6, the pandemic phase, is characterised by community-level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5, the WHO says. Designation of this phase will indicate that a global pandemic is under way.

Phase 5 is characterised by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent.

The WHO cautions that with the increase in global transport, as well as urbanisation and overcrowded conditions in some areas, epidemics due to a new influenza virus are likely to take hold around the world and become pandemics faster than before.

What this basically establishes is that the latest flu strain is very contagious and is spreading very rapidly throughout the world. That is only to be expected from any new strain of flu and the WHO is only doing its duty when it points this out. But the alert level does not relate to danger.

As the US Centers for Disease Control and Prevention says: “A Phase 6 pandemic declaration is based on the sustained worldwide spread of Influenza A (H1N1), not the severity of illness caused by the virus.”

The rapidity with which the virus is spreading is very evident in Malaysia, too. On May 15, Malaysia reported its first case, a student back home from the US. A month later, it reported the first case of a Malaysian catching the flu from another infected Malaysian.

Two days ago, it reported 38 new cases, the biggest one-day jump in cases, bringing the total to 196. But there has been no death yet. From here on, one has to expect that the cases will jump and we will find records being broken daily. (There were 48 cases yesterday.)

But what one must remember is that this strain of the flu is not as deadly as some of the infections that we have had before, such as SARS or avian flu. Worldwide, some 77,201 cases have been reported with 332 deaths, a fatality rate of 0.43% or less than one in 200 people infected.

That’s less dangerous than most other strains of flu. Some say the common cold may be killing more people than A (H1N1)! The people who are most likely to succumb to the disease are those with pre-existing conditions where their systems have already been weakened.

The question we must ask ourselves is whether we are overreacting given that it is not a severe illness. That in no way implies that we drop our state of alertness and preparedness, but that our response should be commensurate with the severity of the disease.

Take dengue for instance. Up to June 13 this year, there had been 23,056 cases with 57 deaths. Certainly more can be done to curb this backyard killer, which is carried by mosquitoes.

Cool heads must prevail to find appropriate solutions to the Influenza A (H1N1) problem. We need to look at what can be reasonably done.

Some countries, such as Australia and New Zealand, are already taking a different approach and dealing with the disease directly instead of trying to test for all suspected cases, which takes up a lot of resources.

There is no one-size solution that will fit all countries, but it is perhaps high time we try out some other outfits and let our lives return to normalcy. Undue fear about Influenza  A (H1N1) can be rather disruptive for business – and leisure.

GENEVA (Reuters) – The World Health Organization declared an influenza pandemic on Thursday and advised governments to prepare for a long-term battle against an unstoppable new flu virus.

The United Nations agency raised its pandemic flu alert to phase 6 on a six-point scale, indicating the first influenza pandemic since 1968 is under way.

WHO Alert System

WHO Alert System

“With today’s announcement, WHO moves from an emergency to a longer-term response. Based on past experience, this pandemic will be with us for some months, if not years, to come,” WHO Director-General Dr. Margaret Chan said in a letter to staff, a copy of which was obtained by Reuters.

People aged 30-50, pregnant women or people suffering from chronic conditions such as asthma, diabetes or obesity are at highest risk, Chan told a news conference.

The virus has killed 109 people in Mexico, where it was first detected in April before spreading to the rest of the world, prompting the Mexican government to temporarily shut schools and businesses in an effort to slow its spread.

2009-06-12T064820Z_01_NOOTR_RTRMDNP_1_India-402482-11-pic0Countries from Australia to Chile to the United States are reporting that the new swine flu virus is “crowding out” seasonal flu, becoming the predominant influenza strain, she said.

For now the virus was “pretty stable,” but Chan warned that it could still change into a more deadly form, perhaps mixing with the H5N1 bird flu virus circulating widely in poultry.

“So it is incumbent on WHO and all members to stay vigilant and alert for the next year or two or even beyond,” she said.

Mexican health minister Jose Angel Cordova said on Thursday the virus was under control in Mexico but warned there could be a new spike in cases later this year.

There is also a risk the swine flu could mix with its seasonal H1N1 cousin, which has developed resistance to the main antiviral flu drug Tamiflu, made by Roche AG and Gilead Sciences Inc, Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention told a briefing.

The United States has been operating on pandemic status for weeks, with hundreds of thousands of cases and at least 1,000 hospitalizations, Schuchat said.


The virus disproportionately makes younger people sick. Some 57 percent of U.S. cases were among people aged 5 to 24, and 41 percent of those hospitalized were in this younger age group.

The World Health Organisation has declared the influenza A (H1N1) a pandemic, raising the alert level to the highest at Phase Six. This means that the flu has spread from human to human in more than one region in the world.

The World Health Organisation has declared the influenza A (H1N1) a pandemic, raising the alert level to the highest at Phase Six. This means that the flu has spread from human to human in more than one region in the world.

H1N1 is active in all 50 states and there are so many cases now that in some areas, patients with specific flu-like symptoms — a fever above 104 degrees F (40 degrees C), cough or other respiratory symptoms — are presumed to have the new virus.

WHO reiterated its advice to its 193 member countries not to close borders or impose travel restrictions to halt the movement of people, goods and services, a call echoed by U.N. Secretary-General Ban Ki-moon.

“We must guard against rash and discriminatory actions such as travel bans or trade restrictions,” Ban told a news conference at U.N. headquarters.

The move to phase 6 reflects the fact that the disease, widely known as swine flu, is spreading geographically, but does not indicate how virulent it is.

Widespread transmission of the virus in Australia, signaling that it is entrenched in another region besides North America, was one of the key triggers for moving to phase 6.

“We are satisfied that this virus is spreading to a number of countries and it is not stoppable,” Chan said.

“Moving to pandemic phase 6 level does not imply we will see an increase in the number of deaths or very severe cases. Quite on the contrary. Many people are having mild disease, they recover without medicines in some cases and it is good news,” she said.

“Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems,” she added.

Canadian health officials said they were concerned about reports of more severe symptoms in some aboriginal communities, but said it was too soon to say for sure.

“To make conclusions based on a couple of communities that this is somehow a disease that is worse in a particular ethnic group. It’s much too early to make any of those kinds of conclusions or presumptions,” said Dr. David Butler-Jones, Canada’s chief public health officer.


Chan said WHO would start distributing a further donation of 5.65 million courses of Tamiflu from Roche.

WHO recommended drugmakers stay on track to complete production of seasonal influenza vaccine for the Northern Hemisphere’s next winter. Each year, normal flu kills up to 500,000 people and infects millions.

Work on developing an H1N1 vaccine is already under way at leading companies, whose factories will be ready to switch to making a pandemic shot in around two weeks’ time, when normal season flu vaccine production is complete.

Seasonal flu affects mainly the elderly and causes severe illness in millions, so a premature switch in vaccine production to cope with the new strain could put many people at risk.

“So our recommendation is they need to finish the seasonal vaccine and then move over,” Chan said.

Chan said the Geneva-based agency would work with regulatory authorities to help fast-track approval of new pandemic vaccines that are safe and effective so that they can be made available as soon as possible.

In any case, the first doses would only be available in September, she added.

A pandemic could cause enormous disruption to business as workers stay home because they are sick or to look after family members and authorities restrict gatherings of large numbers of people or movement of people or goods.

World markets shrugged off the pandemic, as investors focused on possible global economic recovery.

The strain has spread widely, with 28,774 infections confirmed in 74 countries to date, including 144 deaths, according to WHO’s latest tally of laboratory-confirmed cases. The United States has said tests only turn up a fraction of the true number of cases.

Source: Reuters / The Star Online.

H1N1 Flu Guidance

Guidance for Schools, Colleges and Universities

Guidance for Pregnant and Breastfeeding Women

Guidance for Public Gatherings

Clinician Guidance for Patients

Clinician Guidance for Specific Audiences

Screening & Specimen Collection

Treatment Guidance


Travel & Travel Industry Guidance

Emergency Personnel Guidance

Protection of Migrant Farm Workers

Source: CDC  of USA   http://www.cdc.gov/h1n1flu/guidance/

Questions are grouped by subject.

:: About the disease

:: Levels of pandemic alert

:: Vaccines for the new influenza A(H1N1)

:: Travel

:: The safety of pork

:: What can I do?

:: Are some people more at risk?


Are some people more at risk?

More study is needed to determine if some populations (i.e. younger or older people, or people with other medical conditions) could be affected by the outbreak, of if they are at higher risk for severe illness. WHO recommends that everyone take precautions to prevent the spread of infection.

Are there any special recommendations for pregnant women?

Yes, they are vulnerable. Like everyone, they should take all the necessary precautions.


What are the recommendations for face masks?

If you are not sick you do not have to wear a mask. If you are caring for a sick person you should wear a mask. All home made masks should be cleansed regularly.

If you are sick, stay at home and avoid contact with people.

How can I protect myself and prevent illness?

Practise general preventive measures for influenza to prevent infection:

  • avoid close contact with people who appear unwell and have fever and cough;
  • wash your hands with soap and water thoroughly and often;
  • practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

How do I care for an ill person at home?

  • Separate the ill person from others, keeping the person at least 1 metre in distance from others.
  • Cover your mouth and nose when caring for the ill person. Either commercial or homemade materials are fine, as long as they are disposed of or cleaned properly after use.
  • Wash your hands with soap and water thoroughly after each contact with the ill person.
  • Improve the air flow where the ill person stays. Use doors and windows to take advantage of breezes.
  • Keep the environment clean with readily available household cleaning agents.

If you are living in a country where there are infections follow additional advice from your national and local health authorities.

What should I do if I think I have the illness?

If you feel unwell, have high fever, cough or sore throat:

  • Stay at home and keep away from work, school or crowds.
  • Rest and take plenty of fluids.
  • Cover your mouth and nose with disposable tissues when coughing and sneezing, and dispose of the used tissues properly.
  • Wash your hands with soap and water often and thoroughly, especially after coughing or sneezing.
  • Inform family and friends about your illness and try to avoid contact with other people.

What should I do if I need medical attention?

  • Contact your doctor or healthcare provider before travelling to a health facility, and report your symptoms. Explain why you think you have influenza A(H1N1) (if you have recently travelled to a country where there is an outbreak in humans). Follow the advice given to you.
  • If it is not possible to contact your healthcare provider in advance, communicate your suspicion of infection as soon as you arrive at the facility.
  • Cover your nose and mouth during travel.


Is it safe to eat pork and pork products?

Yes. influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.

Related link

Influenza A(H1N1) and the safety of pork


Is it safe to travel?

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, international travel moves rapidly, with large numbers of individuals visiting various parts the world. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The focus now is on minimizing the impact of the virus through the rapid identification of cases and providing patients with appropriate medical care, rather than on stopping its spread internationally. Furthermore, although identifying the signs and symptoms of influenza in travellers can be an effective monitoring technique, it is not effective in reducing the spread of influenza as the virus can be transmitted from person to person before the onset of symptoms. Scientific research based on mathematical modelling indicates that restricting travel will be of limited or no benefit in stopping the spread of disease.

Historical records of previous influenza pandemics, as well as experience with SARS, have validated this point.

Travellers can protect themselves and others by following simple recommendations related to travel aimed at preventing the spread of infection. Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases and not only Influenza A(H1N1).

Is an effective vaccine already available against the new influenza A(H1N1) virus?

No, but work is already under way to develop such a vaccine. Influenza vaccines generally contain a dead or weakened form of a circulating virus. The vaccine prepares the body’s immune system to defend against a true infection. For the vaccine to protect as well as possible, the virus in it should match the circulating “wild-type” virus relatively closely. Since this H1N1 virus is new, there is no vaccine currently available made with this particular virus. Making a completely new influenza vaccine can take five to six months.

What implications does the declaration of a pandemic have on influenza vaccine production?

Declaration by WHO of phase 6 of pandemic alert does not by itself automatically translate into a request for vaccine manufacturers to immediately stop production of seasonal influenza vaccine and to start production of a pandemic vaccine. Since seasonal influenza can also cause severe disease, WHO will take several important considerations such as the epidemiology and the severity of the disease when deciding when to formally make recommendations on this matter. In the meantime, WHO will continue to interact very closely with regulatory and other agencies and influenza vaccine manufacturers.

How important will influenza A(H1N1) vaccines be for reducing pandemic disease?

Vaccines are one of the most valuable ways to protect people during influenza epidemics and pandemics. Other measures include anti-viral drugs, social distancing and personal hygiene.

Will currently available seasonal vaccine confer protection against influenza A(H1N1)?

The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against influenza A(H1N1).

What is WHO doing to facilitate production of influenza A(H1N1) vaccines?

As soon as the first human cases of new influenza A(H1N1) infection became known to WHO, the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America) took immediate action and began the work to develop candidate vaccine viruses. WHO also initiated consultations with vaccine manufacturers worldwide to facilitate the availability of all necessary material to start production of influenza A(H1N1) vaccine. In parallel, WHO is working with national regulatory authorities to ensure that the new influenza A(H1N1) vaccine will meet all safety criteria and be made available as soon as possible.

Why is WHO not asking vaccine manufacturers to switch production from seasonal vaccine to a influenza A(H1N1) vaccine yet?

WHO has not recommended stopping production of seasonal influenza vaccine because this seasonal influenza causes 3 million to 5 million cases of severe illness each year, and kills from 250 000 to 500 000 people. Continued immunization against seasonal influenza is therefore important. Moreover, stopping seasonal vaccine production immediately would not allow a pandemic vaccine to be made quicker. At this time, WHO is liaising closely with vaccine manufacturers so large-scale vaccine production can start as soon as indicated.

Is it possible that manufacturers produce both seasonal and pandemic vaccines at the same time?

There are several potential options which must be considered based on all available evidence.

What is the process for developing a pandemic vaccine? Has a vaccine strain been identified, and if so by whom?

A vaccine for the Influenza A(H1N1) virus will be produced using licensed influenza vaccine processes in which the vaccine viruses are grown either in eggs or cells. Candidate vaccine strains have been identified and prepared by the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America)1. These strains have now been received by the other WHO Collaborating Centers which have also started preparation of vaccine candidate viruses. Once developed, these strains will be distributed to all interested manufacturers on request. Availability is anticipated by mid-May.

How quickly will influenza A(H1N1) vaccines be available?

The first doses of Influenza A(H1N1) vaccine could be available in five to six months from identification of the pandemic strain. The regulatory approval will be conducted in parallel with the manufacturing process. Regulatory authorities have put into place expedited processes that do not compromise on the quality and safety of the vaccine. Delays in production could result from poor growth of the virus strain used to make the vaccine.

How would manufacturers be selected?

There are currently more than a dozen vaccine manufacturers with licenses to produce influenza vaccines. Upon request, the vaccine strain will be available to each of them, as well as to other qualified vaccine manufacturers who are preparing to make influenza vaccine but do not yet have a licensed influenza vaccine.

What is the global manufacturing capacity for a potential influenza A(H1N1) pandemic vaccine? Is this the same as the global manufacturing capacity for H5N1?

The projections made for the production capacity of an vaccine for H5N1 cannot be automatically assumed to be the capacity to make an H1N1 vaccine. H5N1 and H1N1 viruses are different and the amount of antigen needed to make an effective H1N1 vaccines may be different than for H5N1. Therefore it is not possible to make a precise estimate. However, given these considerations, a conservative estimate of global capacity is at least 1 to 2 billion doses per year.

How is production capacity for influenza vaccines distributed geographically?

More that 90% of the global capacity today is located in Europe and in North America. However, during the past five years, other regions have begun to acquire the technology to produce influenza vaccines. Six manufacturers in developing countries have done so with technical and financial support from WHO.

What will be the storage requirements for influenza A(H1N1) vaccine?

The vaccine should be stored under refrigerated conditions at between 2°C and 8°C.

It has been impossible so far to develop vaccines for major killers such as HIV and malaria. How sure are we that there will not be scientific or other hurdles in developing an effective influenza A(H1N1) vaccine?

Typically, development of influenza vaccines has not posed a problem. Influenza vaccines have been used in humans for many years and are known to be immunogenic and effective. Each year seasonal influenza vaccines with varying composition are produced for the northern and southern hemisphere influenza seasons. Vaccine manufacturers will employ a number of different technologies to develop their vaccines. They will take advantage, notably, of novel approaches that were developed over the past years for H5N1 avian influenza vaccines. One key unknown is yield of vaccine virus production, since some strains grow better than others and the behavior of the new influenza A(H1N1) strain in manufacturers’ systems is not yet known. New recombinant technologies are under development, but have not yet been approved for use.

Will influenza A(H1N1) vaccines be effective in all population groups?

There are no data on this but there also is no reason to expect that they would not, given current information.

Will the influenza A(H1N1) vaccine be safe?

Licensed vaccines are held to a very high standard of safety. All possible precautions will be taken to ensure safety of new influenza A(H1N1) vaccines.

How can a repeat of the 1976 swine flu vaccine complications (Guillain-Barré syndrome) experienced in the United States of America be avoided?

Guillain-Barré syndrome is an acute disorder of the nervous system. It is observed following a variety of infections, including influenza. Studies suggest that regular seasonal influenza vaccines could be associated with an increased risk of Guillain-Barré syndrome on the order of one to two cases per million vaccinated persons. During the 1976 influenza vaccination campaign, this risk increased to around 10 cases per million vaccinated persons which led to the withdrawal of the vaccine.

Pandemic vaccines will be manufactured according to established standards. However, they are new products so there is an inherent risk that they will cause slightly differently reactions in humans. Close monitoring and investigation of all serious adverse events following administration of vaccine is essential. The systems for monitoring safety are an integral part of the strategies for the implementation of the new pandemic influenza vaccines. Quality control for the production of influenza vaccines has improved substantially since the 1970s.

Will it be possible to deliver new influenza A(H1N1) vaccine simultaneously with other vaccines?

Inactivated influenza vaccine can be given at the same time as other injectable vaccines, but the vaccines should be administered at different injection sites.

If the virus causes a mild pandemic in the warmer months and changes into something much more severe in, say, 6 months, will vaccines being developed now be effective?

It is too early to be able to predict changes in the influenza A(H1N1) virus as it continues to circulate in humans or how similar a mutated virus might be to the current virus. Careful surveillance for changes in the influenza A(H1N1) virus is ongoing. This close and constant monitoring will support a quick response should important changes in the virus be detected.

Will there be enough influenza A(H1N1) vaccine for everyone?

The estimated time to make enough vaccine to vaccinate the world’s population against pandemic influenza will not be known until vaccine manufacturers will have been able to determine how much active ingredient (antigen) is needed to make one dose of effective influenza A(H1N1) vaccine.

In the past two years, influenza vaccine production capacity has increased sharply due to expansion of production facilities as well as advances in research, including the discovery and use of adjuvants. Adjuvants are substances added to a vaccine to make it more effective, thus conserving the active ingredient (antigen).

What is WHO’s perspective on fairness and equity for vaccine availability?

The WHO Director-General has called for international solidarity in the response to the current situation. WHO regards the goal of ensuring fair and equitable access by all countries to response measures to be among the highest priorities. WHO is working very closely with partners including the vaccine manufacturing industry on this.

Who is likely to receive priority for vaccination with a future pandemic vaccine?

This decision is made by national authorities. As guidance, WHO will be tracking the evolution of the pandemic in real-time and making its findings public. As information becomes available, it may be possible to better define high-risk groups and to target vaccination for those groups, thus ensuring that limited supplies are used to greatest effect.

Will WHO be conducting mass influenza A(H1N1) vaccination campaigns?

No. National authorities will implement vaccination campaigns according to their national pandemic preparedness plans. WHO is exploring whether the vaccine can be packaged, for example, in multi-dose vials, to facilitate the rapid and efficient vaccination of large numbers of people.

Developing countries are very experienced in administering population-wide vaccination campaigns during public health emergencies caused by infectious diseases, including diseases like epidemic meningitis and yellow fever, as well as for polio eradication and measles control programmes.

How feasible will it be to immunize large numbers of people in developing countries against a pandemic virus?

Developing countries have considerable strategic and practical experience in delivering vaccines in mass campaigns. The main issue is not feasibility, but how to ensure timely access to adequate quantities of vaccine.

What is the estimated global number of doses of seasonal vaccine used annually?

The current annual demand is for less than 500 million doses per year.

Will seasonal influenza vaccine continue to be available?

At this time there is no recommendation to stop production of seasonal influenza vaccine.


1National Institute for Biological Standards and Control (UK), Food and Drug Administration/Center for Biologics Evaluation and Research (USA), New York Medical College (USA), Victorian Infectious Diseases Research Laboratory (Australia)

Levels of pandemic alert

What does pandemic alert phase 5 mean?

According to WHO definitions of phases – the virus has caused sustained community level outbreaks in at least two countries in one WHO region. At phase 5 a pandemic is considered imminent.

What is sustained human to human transmission?

This occurs when three generations are involved – i.e. the virus has passed from person A to person B and then to person C.

What is the difference between a probable case and a confirmed case?

A probable case is one that shows the symptoms of influenza such as cough, fever, headache, chills and fatigue and either tests positive for type A influenza or is considered linked to another probable or confirmed case.

A confirmed case is one which tests positive in a laboratory for the influenza A(H1N1) virus.

At what point does WHO consider a pandemic to have started?

Phase 6, as defined by the WHO pandemic preparedness guidelines. However, during both phase 5 and phase 6, national and local actions to respond to the outbreak shift from preparedness to response at a global level. The goal of recommended actions during these phases is to reduce the impact of the pandemic on society.