OTHERWISE HEALTHY PEOPLE DO NOT NEED ANTIVIRALS FOR H1N1, SAYS UN HEALTH AGENCY

Otherwise healthy people infected with the H1N1 virus do not need to be treated with antiviral drugs, the United Nations World Health Organization (WHO) said today as it issued new guidelines in the use of the drugs against the pandemic.

Worldwide, most infected patients continue to display typical influenza symptoms and fully recover within a week without any form of medical treatment.

According to the new guidelines, formed by consensus by a global group of experts, healthy patients with uncomplicated illnesses do not need to take antivirals.

The guidelines emphasize using drugs such as oseltamivir and zanamivir, to which the pandemic virus is susceptible, to prevent severe illness and deaths, reduce the need for hospitalization, and shorten hospital stays.

When properly prescribed, oseltamivir is found to significantly curb the risk of pneumonia, a leading cause of death for both pandemic and seasonal influenza.

WHO recommends treatment with the drug as soon as possible among people who are severely or whose conditions begin to deteriorate. Where oseltamivir is not available, zanamivir can be given.

The virus is currently resistant to a second class of antivirals, known as M2 inhibitors.

Pregnant women are among the groups considered to be at increased risk, and WHO recommends that they receive antiviral treatment as soon as possible after the onset of symptoms.

The agency cautioned that the presence of underlying medical conditions is not a reliable indicator of all or even most cases of severe illness, with some 40 per cent of severe cases now occurring in previously healthy children and adults under the age of 50.

For children, the guidelines call for prompt treatment for children – including those under five years of age – with severe or worsening illnesses, as well as those at risk of more severe or complicated illness.

Otherwise healthy children over five years, WHO said, do not need antiviral treatment unless their conditions persist or worsen.

If someone with confirmed or suspected H1N1 infections shows symptoms including shortness of breath, chest pain and high fever lasting beyond three days, they should seek immediate medical attention.

Among children, warning signs include fast or difficult breathing, lack of alertness, difficulty in waking up and little or no desire to play.

Earlier this week, WHO, the UN Office for the Coordination of Humanitarian Affairs (OCHA), the UN Children's Fund and other groups issued a "Call to Action" to support governments and communities in their bid to minimize the virus' impact.

UN AGENCY URGES VIGILANCE AS A(H1N1) VIRUS CONTINUES TO SPREAD

UN AGENCY URGES VIGILANCE AS A(H1N1) VIRUS CONTINUES TO SPREAD
New York, Jun 3 2009 2:00PM
Although the influenza A(H1N1) infection may not be making news headlines like it did several weeks ago, it is continuing to spread globally and the United Nations health agency is considering raising its pandemic alert level, a spokesperson for the body said today.

"Certainly two or three weeks ago the headlines were all about A(H1N1); now that's not the case so much," Gregory Hartl of the UN World Health Organization (<"http://www.who.int/en/">WHO) said in an interview with UN Radio.

"But the threat of A(H1N1) becoming a pandemic virus is even greater than it was two or three or four weeks ago," he stated, adding that the agency is closely watching how the infection is developing outside of the Americas.

According to WHO, 66 countries have officially reported 19,273 cases of the new flu strain, including 117 deaths, as of today.

The agency's pandemic alert level remains at Phase 5 – on a six-point warning scale – meaning that sustained human-to-human transmission of the virus on a community level is mostly restricted to a single geographic region, in this case North America.

Mr. Hartl said WHO is closely monitoring the situation. "We would say not for anyone to let down their guard because we might be living through a few weeks or months in the Northern Hemisphere of reduced influenza activity because it is the summer.

"I think everyone though would be well advised to be ready and aware of the fact that in the autumn in the Northern Hemisphere – in the autumn anywhere – his virus could reappear very strongly again."

He added that it is possible to see an easier spread of the virus in the Southern Hemisphere, where winter is just beginning.

"We need to watch the behaviour of A(H1N1) very carefully as it encounters other influenza viruses circulating during the winter season in the Southern Hemisphere," WHO Director-General Margaret Chan told the World Health Assembly in Geneva recently.

"The current winter season gives influenza viruses an opportunity to inter-mingle and possibly exchange their genetic material in unpredictable ways," she noted.
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UN HEALTH AGENCY CHIEF PUTS SOUTHERN HEMISPHERE ON ALERT FOR A(H1N1) VIRUS

UN HEALTH AGENCY CHIEF PUTS SOUTHERN HEMISPHERE ON ALERT FOR A(H1N1) VIRUS
New York, May 22 2009 11:00AM
Health authorities around the world need to be vigilant as the influenza A(H1N1) virus meets seasonal flu viruses flowing through the yet unaffected Southern Hemisphere, warned the head of the United Nations World Health Organization (<"http://www.who.int/en/">WHO) today.

"The current winter season gives influenza viruses an opportunity to inter-mingle and possibly exchange their genetic material in unpredictable ways," WHO Director-General Margaret Chan said in her closing remarks to the World Health Assembly in Geneva.

One month after the outbreak of the new flu, WHO expects it to continue spreading to new countries and within nations already affected over the coming weeks.

According to WHO, as of this morning, some 42 countries had officially reported 11,168 cases of the infection, including 86 deaths.

However, Dr. Chan noted that the pandemic alert level remains at Phase 5 – on a six-point warning scale – meaning that sustained human-to-human transmission of the virus on a community level is mostly restricted to a single geographic region, in this case North America.

During the high-level consultation on pandemic influenza, several delegations called on WHO to consider criteria other than geographical spread when evaluating the phases of influenza pandemic alert.

Dr. Chan stressed that up to now, the new virus has largely circulated in the Northern Hemisphere, where epidemics of seasonal influenza should be winding down.

"We need to watch the behaviour of A(H1N1) very carefully as it encounters other influenza viruses circulating during the winter season in the Southern Hemisphere," she said. "The current winter season gives influenza viruses an opportunity to inter-mingle and possibly exchange their genetic material in unpredictable ways."

Although WHO does not predict a dramatic jump of severe or fatal infections, Dr. Chan warned that countries where the virus is already widespread should expect to see more cases of this type of infection.

"But countries, especially in the developing world, where populations are most vulnerable, should prepare to see more than the present small number of severe cases, which are being picked up under the best detection and testing conditions possible."

The week-long Assembly gathered officials from WHO's 193 member countries for an annual review of the agency's activities and to set new priorities for the future. On its agenda this week were implementation of the International Health Regulations; primary health care, including health system strengthening; social determinants of health; and monitoring the achievement of the health-related Millennium Development Goals (MDGs).
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Poor Countries 'Far From Ready' For Flu Pandemic.

"Africa is 'far from being ready' for a pandemic of H1N1 flu, and developing countries in Asia and Latin America will need help accessing life-saving drugs and vaccines, top health officials said on Monday. Addressing the World Health Organization's annual congress... Nigeria's delegate said African countries would face major difficulties responding to an outbreak of H1N1 flu, which has caused mild symptoms in most patients but may be especially threatening to people with HIV/AIDS and other diseases...." [Reuters/Factiva]

Xinhua adds that "...international cooperation must be carried out for a global response to the current A/H1N1 influenza outbreak, Chinese Health Minister Chen Zhu said Monday.... Chen also called for more international support for developing countries' health sector. 'The implementation of the health-related Millennium Development Goals (MDGs) has made important progress, but great challenges sill lie ahead,' he told delegates at the meeting. 'The MDGs are strong commitments made by governments around the world, and the shared responsibility for the whole international community,' he added...." [Xinhua/Factiva]

FT reports that "...vaccine manufacturers will hold talks with public health officials Tuesday to discuss price discounts and unprecedented joint manufacturing arrangements to help limit the effects of the H1N1 swine flu pandemic in poorer countries. In a meeting with WHO Director-General Margaret Chan representatives from GlaxoSmithKline, Sanofi-Aventis, Novartis, Baxter and other vaccine producers will seek clarity on regulation and funding as they debate how best to respond to the virus...." [Financial Times/Factiva]

NEW FLU UNCOVERS PUBLIC HEALTH’S SUCCESSES, CHALLENGES – BAN

NEW FLU UNCOVERS PUBLIC HEALTH'S SUCCESSES, CHALLENGES – BAN
New York, May 19 2009 2:01PM
Global solidarity is crucial to containing the outbreak of influenza A(H1N1), which has also revealed the successes and challenges public health faces, Secretary-General Ban Ki-moon <"http://www.un.org/apps/sg/sgstats.asp?nid=3866">said today.

In addition to highlighting the interconnected nature of the world, the new flu's spread has allowed for a deeper understanding of the need for advance planning for a pandemic, Mr. Ban told the <"http://www.who.int/mediacentre/events/2009/wha62/en/index.html">World Health Assembly under way in Geneva. "We have never been better prepared to respond."

Crucial in fighting the new flu is global solidarity, which he said "must be at the heart of the world's response to this crisis."

This solidarity must be manifested in greater access to drugs and vaccines, the sharing of virus samples and data, and the lifting of "self-defeating" restrictions on travel, the Secretary-General said.

"It means that <"http://www.who.int/en/">WHO [World Health Organization] and other vital bodies have the resources they need when they need them," he added. "It means that we all act in the interests of the poorest and most vulnerable people in the world."

Further, the outbreak has highlighted the importance of transparency and the importance of investing in strong public health systems, which Mr. Ban characterized as "the guardians of good health in normal times and the bedrock of our response to the new outbreaks and emerging diseases."

WHO reported today that 40 countries have officially reported nearly 10,000 cases of influenza A(H1N1), with nearly 80 deaths. WHO's pandemic alert level remains at Phase 5 – on a six-point warning scale – meaning that sustained human-to-human transmission of the virus on a community level is restricted to one of the agency's geographic regions, in this case North America.

In today's address, the Secretary-General also emphasized the importance of ensuring continued investment in public health, even in the face of a recession. Curbing funding on health at times of financial downturns is "not just morally wrong, it is economically foolish," he added.

In spite of the need for increased resources, he pointed out that "we also must do more with what we have now," calling for creative solutions to surmount obstacles, including women's health, an issue he said ties together with global security, prosperity and progress.

Also today, Mr. Ban took part in a meeting, convened by WHO and attended by representatives of some 20 pharmaceutical companies, to ensure that developing countries will have access to vaccines.

At a high-level gathering on influenza A(H1N1) yesterday, WHO Director-General Margaret Chan underscored the importance of obtaining reliable information on the different aspects of the influenza A(H1N1) infection in order to make informed decisions on how to manage the outbreak and prepare for a possible global pandemic.

"We are all under pressure to make urgent and far-reaching decisions in an atmosphere of considerable scientific uncertainty," she said.
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INFLUENZA A(H1N1) CASES NOW REPORTED IN 33 COUNTRIES, SAYS UN HEALTH AGENCY

INFLUENZA A(H1N1) CASES NOW REPORTED IN 33 COUNTRIES, SAYS UN HEALTH AGENCY
New York, May 13 2009 7:00PM
The United Nations World Health Organization (<"http://www.who.int/csr/disease/swineflu/en/index.html">WHO) said today that 33 countries have reported 5,728 laboratory confirmed cases of influenza A(H1N1) infection as of today, with Cuba, Finland and Thailand the latest to join the list.

Mexico has reported 2,059 laboratory confirmed human cases of infection, including 56 deaths, while the United States has reported 3,009 cases, including three deaths.

In addition, Cuba, Finland and Thailand have now been added to the list of countries that have reported laboratory confirmed cases with no deaths.

Dr. Sylvie Briand of WHO's Global Influenza Programme told reporters in Geneva that several things about the virus are already known, including that the virus transmits easily and that most of the cases are mild and don't require treatment.

"However, we know also that there will be severe cases in people with underlying conditions, but also probably in young, healthy adults," she added.

"What we are trying to do at the moment is gather as much information as possible on the virus and to provide this information to countries so that they can assess their level of vulnerability and then put in place interventions that are needed to fight this disease," Dr. Briand stated.
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Interview: Rapid Support Needed to Contain a Possible Pandemic.

In an interview with Kyodo News about Influenza A, World Bank Development Committee Executive Secretary Kiyoshi Kodera said, "... 'There are sufficient amounts of therapeutic medication of Tamiflu worldwide, but they are mostly in developed countries. The World Bank can play an important role to provide rapid support in case of outbreak in developing countries... [In the case of the $200 million fast-disbursing assistance to Mexico,] the Bank promptly made a decision and coordinated with the Government of Mexico. The Bank has accumulated the experiences of the response to SARS and Avian Flu. We would like to provide rapid support tailored to each recipient country....

It is hard to estimate the magnitude of [the impact of Influenza A] on the global economy. I am afraid winter is approaching in the southern hemisphere, home to many developing countries in South America, because they will become prone to outbreak in winter. To recover the global economy, we should stay alert to the spread of the influenza to developing countries.'..." [Kyodo News/Factiva]

UN AGENCY TO ISSUE GUIDANCE FOR INFLUENZA A(H1N1) CAREGIVERS

UN AGENCY TO ISSUE GUIDANCE FOR INFLUENZA A(H1N1) CAREGIVERS
New York, May 12 2009 4:00PM
The United Nations World Health Organization (<"http://www.who.int/csr/disease/swineflu/en/index.html">WHO) said today it will soon publish initial guidance for clinical management of influenza A(H1N1) infection, 5,251 cases of which have now been officially reported by 30 countries.

"This guidance is to help doctors, nurses and persons who will be, and already are, caring for patients with this disease," Dr. Nikki Shindo, Medical Officer in WHO's Global Influenza Programme, told reporters in Geneva.

At the same time, she highlighted the fact that most patients will not require hospitalization or antiviral therapy.

According to the latest figures, Mexico has reported 2,059 laboratory confirmed human cases of infection, including 56 deaths, while the United States has reported 2,600 cases, including three deaths.

Meanwhile, Canada has reported 330 cases, with one death, and Costa Rica has reported eight cases, including one death. Another 26 countries have reported laboratory confirmed cases with no deaths.

Dr. Shindo said her team has been looking closely into the clinical picture of the disease, including symptoms, severity and factors for hospitalization and treatment, since the new flu outbreak began.

It has been working closely with Mexican and US health officials and partners on the ground, and has seen a spectrum of the virus from mild – involving typical flu symptoms – to a very severe form of the disease, which includes pneumonia and sometimes requires mechanical ventilation.

"The most important question from the beginning was why only Mexico was having very severe cases," she stated. "The proportion of severe cases initially seemed to be very high in Mexico but not in the other countries. But as more information became available, the proportion of mild versus severe became very similar between these two countries – United States and Mexico."

Dr. Shindo said that there are mainly two groups that have been affected by very severe illness in these two countries. The first is persons with underlying chronic medical conditions, such as weak immune system, diabetes, cardiovascular disease and asthma. There have also been reports of very severe illness and death in pregnant women.

The second group is previously healthy, very fit young children and adults, and the reason why these cases become very severe is yet unknown, she said, adding that WHO is working with clinicians, especially from Mexico, to find the reason.
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INFLUENZA A(H1N1) CASES NEARLY DOUBLE OVER WEEKEND – UN HEALTH AGENCY

INFLUENZA A(H1N1) CASES NEARLY DOUBLE OVER WEEKEND – UN HEALTH AGENCY
New York, May 11 2009 5:00PM
The United Nations World Health Organization (WHO) said today that the number of laboratory-confirmed cases of the influenza A(H1N1) virus has increased to 4,694 – nearly double the figure reported last Friday – including 53 deaths.

Mexico and the United States top the list of the 30 countries which have reported laboratory-confirmed human cases of the virus so far, according to the latest <"http://www.who.int/csr/disease/swineflu/en/index.html">WHO update. Mexico has reported 1,626 cases with 48 deaths, while the US has reported 2,532 cases, including three deaths.

WHO's pandemic alert level remains at phase 5 – on a six-point warning scale – as it has for the past several days, Dr. Keiji Fukuda, WHO's Acting Assistant Director-General for Health Security and Environment, told a news conference in Geneva.

"Community-level sustained human-to-human transmission has been documented in North America, in Mexico and in the United States most clearly. We do not see clear evidence of sustained community-level transmission going on in other countries yet," he stated.

Dr. Fukuda noted that it is possible that the alert level will go up to phase 6, which would mean that the spread of the virus has become established in another region outside of North America and is spreading at the community level. At the same time, the current situation could stabilize where it is now, or the alert level could even go back down to phase 4 in the future.

The agency said it is mindful of the many travel-related cases that have now been reported from a large number of countries in almost all regions of the world.

WHO is not recommending travel restrictions related to the current outbreak. But individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care, the agency noted on its web site.

"This is still unfolding," noted Dr. Fukuda. "We are still evaluating the clinical features, the epidemiology and the spread, and we will continue to evaluate what is the impact on both people and countries."

He added that much of what is going on now reflects the fact that so much planning and preparedness has gone on for the past few years. "I think it is still a confusing situation. We cannot come to you and say we understand everything which is going on.

"But I do believe that if we had not had all of those preparations, if we had not worked so hard to get information out quickly, if countries had not been thinking about what to do in this kind of situation, in fact we would have had much more confusion and in many ways the severity would have been greater," he stated.

"We will continue to work as hard as we can to make sure that countries are as prepared as possible."
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PAUSE IN DEATHS FROM INFLUENZA A(H1N1), INFECTIONS CLIMB TO 2,500 – UN AGENCY

PAUSE IN DEATHS FROM INFLUENZA A(H1N1), INFECTIONS CLIMB TO 2,500 – UN AGENCY
New York, May 8 2009 4:00PM
Although the number of influenza A(H1N1) infections jumped by over 400 worldwide in the last day with two more countries reporting cases of the virus, there were no new deaths from the disease, the United Nations health agency announced today.

The World Health Organization (<"http://www.who.int/csr/disease/swineflu/en/index.html">WHO) reported that as of 16:00 GMT, Brazil and Poland have been added to the list of countries with verified cases of the new flu strain since yesterday morning, with the total number of laboratory confirmed infections rising to 2,500 in 25 countries.

Despite the increase in the number of cases, WHO Global Influenza Programme Director Sylvie Briand noted that the agency's global pandemic alert remains at phase 5 on its six-point warning scale, which means that sustained human-to-human transmission of the disease on a community level is restricted to one of the agency's geographic regions, in this case North America.

"We have new cases. Most of them are imported cases from travellers, returning travellers or close contact of these people," Ms. Briand told reporters at the daily WHO briefing in Geneva.

Meanwhile, WHO Director-General Margaret Chan told a gathering of Asian health ministers to remain vigilant in monitoring avian flu, H5N1 influenza, in an address to a meeting of the Association of Southeast Asian Nations (ASEAN) in Bangkok today. She noted that the virus is widespread in poultry in parts of the region and the agency does not know how the infection will behave if spread to other regions.

Paying tribute to the region's leaders for monitoring the virus and largely keeping it under control for five years, Ms. Chan stressed that the world is "better prepared for an influenza pandemic than at any time in history."

Ms. Chan noted that avian flu has "conditioned the public to equate an influenza pandemic with very severe disease and high mortality." She explained that such a disease pattern is not inevitable during a pandemic. "On the contrary, it is exceptional."
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INFLUENZA A(H1N1) INFECTIONS TOP 2,000 WITH 44 DEATHS, REPORTS UN AGENCY

INFLUENZA A(H1N1) INFECTIONS TOP 2,000 WITH 44 DEATHS, REPORTS UN AGENCY
New York, May 7 2009 3:00PM
The number of people infected with the influenza A(H1N1) virus has topped 2,000, the United Nations health agency confirmed today, stressing that although symptoms for the vast majority of the cases are mild, there is no room for complacency.

The World Health Organization (<"http://www.who.int/csr/disease/swineflu/en/index.html">WHO) noted that its international pandemic alert remains at phase 5, on a six-level warning scale, as the number of laboratory confirmed cases rises to 2,099 – up by 441 from yesterday – including 44 deaths.

As of 06:00 GMT today, 23 countries reported influenza A(H1N1) infection, with Mexico containing 1,112 cases and 42 deaths, and the United States verifying 642 cases and two deaths.

"We continue to see human-to-human transmission – community level transmission – primarily in North America," said WHO Assistant Director-General Keiji Fukuda at the agency's daily update in Geneva.

"We are not seeing it yet anywhere else," he said, explaining the decision to maintain the pandemic alert level at phase 5.

Mr. Fukuda warned that the situation is still evolving and "we really don't understand how things are going to go in the future."

Important questions remain over the spread of the flu from the northern hemisphere and whether it will become more dangerous over time than it is now. If the outbreak were to hit pandemic proportions, it would be reasonable to estimate a third of the world's population would be infected, warned Mr. Fukuda.

Even when on an individual basis illness for most people is relatively mild, if the numbers of infected are multiplied on a pandemic scale, the number of deaths will increase, he cautioned.

WHO also reiterated that people have not been infected by the influenza A(H1N1) virus through eating processed pork or other food products derived from pigs.
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UN SWINE FLU PANDEMIC ALERT REMAINS AT PHASE 4 AMID RISING INFECTIONS

The international influenza pandemic alert remains at phase four, on a six-level warning scale, the United Nations health agency said today, as the count of swine flu infections continues to rise.

The World Health Organization (WHO) reported that at present there are 79 cases – up from yesterday's tally of 73 – worldwide of the strain of the new H1N1 influenza, otherwise known as swine flu because the strain is thought to have originated from pigs.

The virus has infected 40 people across the United States, 26 in Mexico and 6 in Canada, according to WHO, which also noted that there are verified reports of 2 cases in Spain, 2 in the United Kingdom and 3 in New Zealand.

"There have been seven deaths among this total number of cases, all of which are reported in Mexico," WHO Assistant Director-General Keiji Fukuda told reporters in Geneva.

Mr. Fukuda pointed out that the number of swine flu infections WHO reports are only of laboratory confirmed cases specific to the virus and not the suspected numbers of H1N1 human contaminations presented in the media.

Although WHO has determined that the disease has spread to a number of different countries, it is only in Mexico that swine flu has reached sustained levels of person-to-person infections, which warrants a phase 4 alert.

Mr. Fukuda highlighted that the phase 4 alert recognises the increased risk of a pandemic, but does not mean the virus will necessarily spread to different countries and be transmitted to large numbers of people.

"It is too early to say that pandemic is inevitable but it is a possibility," he said, adding that it is also too early to determine the origins of this new strain of the influenza virus.
He noted there is still no good explanation as to why cases of the infection in Mexico have appeared more severe than in other countries.

Although the evolution of the outbreak into a pandemic is not certain, Mr. Fukuda underscored the importance for countries to prepare themselves for the possibility of the global spread of the disease.

"We are beginning to focus on the anticipated needs of developing countries if the pandemic should develop," he said. "We know from the analysis of past pandemics and we also know from many infectious diseases and health problems that the poor and the developing countries are the ones that really get hit the hardest."

Developing countries also have the least resources to deal with a health emergency, warned Mr. Fukuda, while calling on the international community to help meet the demands a crisis may place on the poor.

WHO is working to facilitate the process needed to develop a vaccine effective against the swine flu virus, which the agency noted could take around 4 to 6 months. In addition, several more months would be needed to produce a suitably large amount of the vaccine.
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