EXPOSING the FDA and the USDA - Broad Casting here the things that they would prefer us NOT to know about our FOOD & DRUGS & Farming.

Thursday, July 30, 2009

Swine Flu Vaccine Priorities

INFLUENZA PANDEMIC (H1N1) 2009 (21): VACCINE PRIORITIES
*******************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


In this update:
(1) Pregnancy
(2) ACIP meeting
[3] Adjuvants

******
[1] Pregnancy
Date: Tue 28 Jul 2009
Source: CIDRAP NEWS, Associated Press report [edited]



Pregnancy likely to be swine flu shot priority
----------------------------------------------
Swine flu [influenza pandemic (H1N1) 2009 virus infection] has been
hitting pregnant women unusually hard, so they are likely to be among
the 1st group advised to get a new swine flu shot this fall. Pregnant
women account for 6 percent of U.S. swine flu deaths since the
pandemic began in April [2009], even though they make up just 1
percent of the U.S. population.

On Wednesday [28 Jul 2009] a federal vaccine advisory panel is
meeting to take up the question of who should be 1st to get swine flu
shots when there aren't enough for everyone. At the top of the list
are health care workers, who would be crucial to society during a bad
pandemic. But pregnant women may be near the top of the list because
they have suffered and died from swine flu at disproportionately high rates.

"Are they more at risk for severe disease? That's the issue," and it
appears they are, said Dr. Denise Jamieson, an epidemiologist with
the U.S. Centers for Disease Control and Prevention (CDC).

Pregnant women's risk from swine flu has been a raging topic in
Europe, following the contentious suggestion this month by British
and Swiss health officials that women should consider delaying
pregnancy if they can. Most health officials call that advice
unwarranted, but have agreed that the health risks are significant.
In a recent report, World Health Organization (WHO) experts found
that pregnant women appear to be "at increased risk for severe
disease, potentially resulting in spontaneous abortion and/or death,
especially during the 2nd and 3rd trimesters of pregnancy." However,
so far, WHO has not recommended that pregnant women get priority vaccinations.

Now doctors are waiting to see what's decided by the Advisory
Committee on Immunization Practices {ACIP, see below], whose guidance
usually is accepted by the CDC and influences doctors and insurance
coverage. For more than a decade, the committee has recommended that
pregnant women get vaccinated for seasonal flu, which is considered a
serious threat even to pregnant women who are young and healthy.
Pregnant women are unusually vulnerable -- especially in the 3rd
trimester -- due to changes in the lungs and immune system that make
it harder for them to shake off respiratory infections, said Dr.
Kevin Ault, an Emory University obstetrician.

CDC data indicate swine flu is at least as dangerous. Of 302 U.S.
deaths attributed to swine flu to date, the CDC has detailed
information on 266 of them. The agency has found that 15 of the 266
were pregnant women -- or about 6 percent. The 1st American with
swine flu to die was a 33-year-old pregnant woman in Texas. She died
5 May 2009 after slipping into a coma and giving birth to a healthy
baby girl, delivered by Cesarean section.

Some infected pregnant women have other health problems. The Texas
woman, for example, also had asthma and the skin condition psoriasis.
But many of the pregnant women who died were considered relatively
healthy, suggesting pregnancy itself is a significant risk, Jamieson said.

"I think the whole concept that this flu only affects pregnant women
with underlying medical conditions is incorrect," Jamieson said.

Experts believe an effective vaccine would benefit not only a
pregnant woman but also her unborn child. Infants, whose immune
systems are weak, should not get a flu shot until they are at least 6
months old. So whatever immunity they have is passed on to them by
their mothers, doctors say. The belief in the protective powers of a
mother's vaccination on their unborn children was demonstrated in a
study of women in Bangladesh published last year [2008] in the New
England Journal of Medicine. It found that flu shots given to
pregnant women reduced flu in infants by 63 percent.

Only about 15 percent of pregnant women get seasonal flu shots,
experts noted, so it's not clear how many will get the new shot. Some
women avoid regular flu shots, worried about possible risks to the
fetus, but studies have not shown any increased dangers from the
shot. Until recently, many obstetricians haven't offered them,
choosing to avoid the expense of buying and storing vaccine and the
hassle of trying to convince reluctant patients, said Dr. William
Schaffner, a Vanderbilt University flu expert. "Obstetricians are
only now getting with the program and are growing comfortable with
administering flu vaccine," he said.

It's not clear that the demand for swine flu shots would be much
greater. Pregnant patients haven't expressed much concern about swine
flu, said the CDC's Jamieson, who is also an obstetrician seeing
inner-city patients at Atlanta's Grady Memorial Hospital. "It hasn't
been a major concern," viewed as a relatively mild illness. They
worry more about economic concerns -- "how to take care of the baby,
how to get food to eat and how to get safe and secure housing," Jamieson said.

So far, swine flu has likely infected more than 1 million Americans,
the CDC believes, with at least 300 deaths. The United States expects
to begin testing swine flu vaccines on some volunteers in August
[2009], and predicts 160 million doses may be ready by October.

[Byline: Mike Stobbe]

--
Communicated by:
ProMED-mail


******
[2] ACIP meeting
Date: Wed 29 Jul 2009
Source: The New York Times [edited]



Swine Flu Vaccine Priorities Outlined
-------------------------------------
Anticipating that not enough swine flu [influenza pandemic (H1N1)
2009 virus] vaccine will be available to immunize every American in
time for the expected surge of cases this fall and winter, health
experts recommended on Wednesday [29 Jul 2009] that certain people
should be vaccinated 1st. The top priority group, 150 million
Americans in all, or about half the population, would include health
care workers and emergency medical responders, because their jobs are critical.

It would also include people with the highest risk of complications
and severe illness from the new H1N1 virus: pregnant women [see
above]; people caring for infants under 6 months; children and young
adults from 6 months to 24 years; and people aged 25 to 64 with
medical problems like asthma, diabetes or heart disease.

The recommendations were issued at a meeting of the Advisory
Committee on Immunization Practices (ACIP), a panel of medical
experts from around the country that advises the Centers for Disease
Control and Prevention. The group has 14 members who voted on the
recommendations, and the disease centers [CDC] usually take their
advice in issuing guidelines for state and local health officials.

But once the panel made its initial recommendation, members struggled
and argued about what to do if there was a severe shortage of the
vaccine and the eligibility requirements had to be drawn even
tighter. The deliberations left some shaking their heads in confusion
and dismay. As the meeting dragged on past its deadline, one member,
looking piqued, left before the final vote.

Ultimately, the group decided that if the shortage was severe,
healthy children over 4 would not be vaccinated, nor would any adults
except pregnant women, health and emergency workers and people caring
for infants. Those cuts would reduce the number of vaccinations
needed in the 1st round to about 40 million.

The last to be eligible for vaccine will be healthy people over 65,
who are least likely to contract swine flu but most likely to suffer
complications when they do become ill. The group recommended that
they not be offered vaccine until all the other groups had received it.

Some argued that any efforts to restrict vaccination, based on fears
of a shortage, inevitably confuse the public, discourage people from
being immunized and result in vaccine going to waste. "Tight
prioritization will result in vaccine being unused," said Dr. William
Schaffner, a nonvoting member of the group and an infectious disease
expert at Vanderbilt University. "When you have vaccine, just give it."

The decisions are being made against a backdrop of uncertainty and in
real time, as the pandemic continues to unfold in this country and
around the world. Health officials expect a surge of new cases when
schools open in the fall, but they cannot be sure.

The vaccine has not yet been tested for either safety or efficacy.
Government officials have projected that 120 million doses of vaccine
will be available by October [2009], but a number of participants at
the conference said they thought that was overly optimistic. "I think
the virus is beating us to the tape, and it will be the virus itself
that will immunize us in the fall," said Dr. Schaffner. He said he
feared a "double-barreled flu season," with many cases of swine flu
in the fall and early winter, and then a seasonal outbreak starting
later and peaking in February as it usually does.

[Byline: Denis Grady]

--
Communicated by:
ProMED-mail


******
[3] Adjuvants
Date Wed 29 Jul 2009
Source: Bloomberg.com [edited]



Swine Flu Shot May Rely on Emergency Use of Additives (Update1)
---------------------------------------------------------------
Swine flu vaccine makers may rely on a U.S. emergency declaration to
use experimental additives made by GlaxoSmithKline Plc and Novartis
AG to boost a limited supply of shots that will be available to fight
the pandemic. The ingredients, known as adjuvants, may be added for
the 1st time to flu shots in the U.S. Health officials today are
meeting to discuss the additives at the U.S. Centers for Disease
Control and Prevention (CDC) in Atlanta, and to recommend who should
receive the limited amount of vaccines drug makers say they will
begin delivering in September or October [2009].

The U.S. Health and Human Services Department (DHHS) declared a
public health emergency over swine flu in April [2009], and the Food
and Drug Administration (FDA) has the power to allow the use of
unapproved medical products during such a crisis. The U.S. has been
slow to approve the use of adjuvants because of safety concerns, and
for fear of giving Americans an excuse to avoid getting the shots,
said John Treanor, a University of Rochester researcher. "The
question is, do you really feel comfortable throwing this new thing
into the mix and do you really need to?" said Treanor, a professor of
medicine, microbiology and immunology at the school in Rochester, New
York. "I myself, if I had to do it, would really wrestle with that decision."

The CDC agreed to pay London-based Glaxo and Novartis, based in
Basel, Switzerland, more than USD 415 million for adjuvants that
could be added to the swine flu vaccines, according to a 13 Jul 2009
statement. Adjuvants may not be necessary if enough shots can be
produced without them, according to Health and Human Services. That
possibility got a boost today from authorities at the CDC, who said
40 million shots of unadjuvanted vaccine may be available in
September [2009], earlier than previously reported, with 80 million
more doses ready in October. A safety concern was raised in 2004 when
researchers at the University of Florida in Gainesville reported that
mice injected with oils used in the adjuvants developed conditions of
the type that occur when the body's immune system produces an
excessive protective reaction. Similar reactions haven't been seen in humans.

MF59, made by Novartis and sold in Europe, has been given to more
than 40 million people, mostly adults, to prevent seasonal flu,
according to the company. Glaxo's adjuvant has proven safe and
effective in clinical trials with 39 000 people, said Lisa Behrens, a
spokeswoman for the company, in an e-mail message. Glaxo will conduct
more studies and continue to monitor safety after the vaccines are in
use, she said. Under the U.S. health emergency, the FDA may authorize
the use of unlicensed vaccines, according to Peper Long, an agency
spokeswoman. The FDA convened an advisory committee 23 Jul 2009 to
consider what trials are necessary for the vaccines' approval.
Advisory committees consist of medical experts who provide guidance
to the agency.

Swine flu's [influenza pandemic (H1N1) 2009 virus infection] full
force may reach the U.S. earlier than the typical flu season,
according to the CDC. Vaccine makers are racing to make shots by
mid-October, when cases are expected to rise in the northern
hemisphere, fueled by cooler temperatures and the return of pupils to
close quarters of classrooms. The World Health Organization, based in
Geneva, has said the H1N1 influenza, as the pandemic flu is known, is
moving with "unprecedented speed." The flu spread farther globally in
less than 6 weeks than previous pandemics have in more than 6 months,
the Geneva-based agency said on its Web site on 17 Jul 2009. Global
health authorities have stopped counting the number of cases and the
CDC says more than 1 million people Americans have been sickened by the virus.

The vaccine makers have found it difficult to cultivate the
quantities of virus needed for vaccine, as the strain yields 50
percent to 75 percent less antigen, the substance that induces
immunity, compared with a typical seasonal flu strain, according to
the WHO. The virus didn't initially grow well in eggs, the principal
medium used by the industry, vaccine makers said. In the last week,
scientists have been able to improve yields in eggs for the 1st time,
which should ease pressure on manufacturers, Robin Robinson, chief of
the Biomedical Advanced Research Development Authority, the U.S.
agency in charge of buying the vaccine, said today [29 Jul 2009]. A
decision on adjuvant use hasn't been made, he said.

The adjuvants are mixes of oil and water that -- by stimulating the
immune system -- offer a way to boost the body's response to antigen.
Adjuvants, whose effectiveness vary by flu strain, may boost the
strength of the antigen as much as 10-fold, as was the case with a
bird flu vaccine approved in Europe, said Treanor, of the University
of Rochester. By adding an adjuvant the same amount of antigen can be
used to treat more people, he said.

"Until GlaxoSmithKline and Novartis can show me it won't harm a rat
or guinea pig, I think it's a bad idea to give it to humans," Vicky
Debold, a registered nurse with a Ph.D. in public health, who is a
member of the FDA's advisory committee for reviewing vaccines, said
27 Jul 2009 in an interview. The U.S. never had to consider the risks
of an adjuvant because regular flu vaccines were deemed to have
"worked so tremendously well," said Lone Simonsen, research director
in the department of global health at George Washington University in
Washington. "We have had a safe experience with the MF59-adjuvanted
vaccine in Italy and Spain for many years now," Simonsen said. "That
experience we can lean on. Those are going to be the best data we
have in time for using adjuvanted vaccines."

CSL Ltd., which has a USD 180 million order to supply bulk H1N1
antigen to the U.S. government, decided against boosting its vaccine
with an adjuvant, preferring to use a formulation more closely
resembling the seasonal flu shot, said Mary Sontrop, general manager
of the Melbourne-based company's biotherapies unit. The U.S. has
contracts with 5 companies to provide flu shots. Novartis, based in
Basel, Switzerland, is responsible for 45 percent of the supply,
while Sanofi will provide 26 percent and CSL will make 19 percent,
said Anthony Fauci, director of the National Institute of Allergy and
Infectious Diseases in Bethesda, Maryland, in an interview last week.
The remaining doses will be made by Glaxo and London-based drug maker
AstraZeneca Plc.

[Byline: Tom Randall and Gary Matsumoto]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[An official statement on these issues from the the Advisory
Committee on Immunization Practices (ACIP) is awaited. - Mod.CP]

[See also:
Influenza pandemic (H1N1) 2009 (20): Peru, 33 percent
asymptomatic 20090730.2668
Influenza pandemic (H1N1) 2009 (19): Viet Nam, H1N1, H5N1 (susp) 20090728.2655
Influenza pandemic (H1N1) 2009 (18): 1st case? 20090725.2631
Influenza pandemic (H1N1) 2009 (17): neurologic complications 20090723.2606
Influenza pandemic (H1N1) 2009 (16): Argentina, sequencing 20090723.2604
Influenza pandemic (H1N1) 2009 (15): Canada (AB) swine workers 20090723.2603
Influenza pandemic (H1N1) 2009 (14): case count 20090722.2599
Influenza pandemic (H1N1) 2009 (13): comments 20090722.2598
Influenza pandemic (H1N1) 2009 (12): antivirals 20090722.2597
Influenza pandemic (H1N1) 2009 (11): vaccine issues 20090722.2595
Influenza pandemic (H1N1) 2009 (10): vaccine 20090720.2577
Influenza pandemic (H1N1) 2009 (09): UK, pig stockman 20090718.2560
Influenza pandemic (H1N1) 2009 (08): pandemic origins 20090718.2559
Influenza pandemic (H1N1) 2009 (07): Argentina, swine, alert 20090718.2557
Influenza pandemic (H1N1) 2009 (06): case reporting 20090717.2553
Influenza pandemic (H1N1) 2009 (05): vaccine 20090716.2540
Influenza pandemic (H1N1) 2009 (04): pandemic origins 20090715.2527
Influenza pandemic (H1N1) 2009 (03): vaccine 20090713.2505
Influenza pandemic (H1N1) 2009 (02): obesity risk factor 20090711.2482
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450]
.....................mpp/cp/ejp/mpp

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Friday, July 24, 2009

More Snags in H1N1 Vaccine Production

Health officals warn of long, hard flu season

SEASONAL INFLUENZA (H3N2) VIRUS - POTENTIAL VACCINE MISMATCH
************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Thu 23 Jul 2009
Source: The Edmonton Sun, The Canadian Press report [edited]



More flu vaccine woes
---------------------
Another storm may be brewing for the coming flu season: A component
of the seasonal flu shot may not be well matched to the circulating
viruses, potentially setting up what's known as a vaccine mismatch.
Some samples of the emerging new strain of H3N2 viruses show a
substantially reduced response to antibodies generated by the
corresponding virus in the seasonal vaccine, raising the possibility
of significantly reduced protection in some cases.

Vaccine mismatches are bad at the best of times. More people get sick
during flu seasons with mismatches. But a seasonal flu vaccine
mismatch coinciding with a flu pandemic? That is no one's idea of a
good time. Dr. Allison McGeer groaned when she heard a new H3N2
variant is circulating in some parts of the Southern Hemisphere.
"It's going to be a long winter. I know that already," said McGeer,
an influenza expert and head of infection control at Toronto's Mount
Sinai Hospital. "It's not going to be pleasant because ... it's going
to be one big long influenza season, from some time in September
until next May."

The new variant has been seen on a number of continents, though it
still remains a minority member of the H3N2 [strains], according to
experts at the World Health Organization (WHO) and the U.S. Centers
for Disease Control and Prevention (CDC) in Atlanta. With the demands
the ongoing pandemic is placing on the WHO's laboratory network,
researchers haven't yet had time to study whether the new variant is
making up a growing percentage of H3N2 viruses, said Dr. Nancy Cox,
director of the CDC's influenza division. If they were, that would
suggest the variant was on its way to becoming the dominant H3N2
virus and a vaccine mismatch would be on the cards.

Further clouding the issue is the fact that labs around the world
haven't been submitting as many H3N2 viruses to the WHO network.
There are simply fewer of them around. "We haven't had that many H3N2
viruses to analyze because we've had such a flood of the novel H1N1
viruses because they're predominating," Cox said. Dr. Wenqing Zhang
of the WHO's global influenza program said many Southern Hemisphere
countries are just coming into their regular flu seasons. The next
month or so will give the world a clearer picture as to whether the
pandemic virus will crowd out the previous influenza A subtypes --
making the composition of the seasonal vaccine less relevant -- or
whether one or both of the seasonal flu A virus [subtypes] will
continue to circulate. And if H3N2 sticks around, the coming weeks
will also offer a sign as to whether this new variant is likely to
complicate the upcoming Northern Hemisphere flu season.

"While seemingly this variant H3 is emerging, we do not know to what
extent it will be circulating," Zhang said by e-mail from Geneva. Cox
said the WHO collaborating labs will be heightening surveillance for
seasonal flu viruses in the lead-up to the WHO's strain selection
meeting for the Southern Hemisphere seasonal vaccine, held in
September [2009]. One place they'll be checking is virus samples from
nursing homes. H3N2 viruses prey on seniors and are behind many of
the frequent flu outbreaks seen in long-term care facilities. For
some reason, nursing home outbreaks are rarely caused by seasonal
H1N1 viruses and so far the influenza pandemic (H1N1) 2009 virus has
largely spared that population too. "If we start to see outbreaks in
those types of settings, this would increase our level of concern,"
Cox said. "We haven't seen that to date."

Because it takes months to make and ship flu vaccine, the viruses
covered by the seasonal flu shot have to be chosen long in advance.
For the Northern Hemisphere vaccine, experts like Cox gather at the
WHO in February [2009] to assess the viruses circulating and make
their best estimates of which will be the major disease sources in
the following winter. For the 2009-2010 winter they chose an H3N2
virus called A/Brisbane/10 first spotted in 2007. But within weeks of
the decision hints emerged that there was a new H3N2 variant, one
sufficiently mutated ("drifted" in the language of flu) that it might
be able to evade the vaccine.

Researchers in the influenza lab at the British Columbia Centre for
Disease Control spotted it in early March [2009] as they were
conducting late-season surveillance looking for just such viral
evolution. In early May [2009], they reported the finding on
ProMed-mail, an electronic bulletin board and mailing list which
monitor infectious diseases outbreaks around the world [Influenza A
(H1N1) - worldwide (11): coincident H3N2 variation 20090505.1679].

Dr. Danuta Skowronski, an influenza expert at the BCCDC, said she is
expecting this new variant to take over as the dominant H3N2 strain.
And since the swine flu virus isn't infecting older adults much, it
could leave a niche for the new H3 variant. "So it's hard to know. We
just have to prepare for that possibility either way," Skowronski
said. "The idea of having a mismatched drift strain circulating the
same year that we also have swine influenza [influenza pandemic
(H1N1) 2009 virus infection] may mean that all segments of the
population are affected by influenza one way or the other, whether
it's the elderly with H3N2 and the young with H1N1."

[Byline: Helen Branswell]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[For an up-to-date detailed account of the prevention and control of
seasonal influenza with vaccines, readers should consult the recently
published "Recommendations of the Advisory Committee on Immunization
Practices (ACIP), 2009." MMWR Early Release Fri 24 July 2009 / 58
(Early Release document);1-52, available at:
.

"This report updates the 2008 recommendations by CDC's Advisory
Committee on Immunization Practices (ACIP) regarding the use of
influenza vaccine for the prevention and control of seasonal
influenza (CDC. Prevention and control of influenza: recommendations
of the Advisory Committee on Immunization Practices [ACIP]. MMWR
2008;57[No. RR-7]). Information on vaccination issues related to the
recently identified novel influenza A H1N1 virus will be published
later in 2009. The 2009 seasonal influenza recommendations include
new and updated information. Highlights of the 2009 recommendations
include 1) a recommendation that annual vaccination be administered
to all children aged 6 months--18 years for the 2009-2010 influenza
season; 2) a recommendation that vaccines containing the 2009-2010
trivalent vaccine virus strains A/Brisbane/59/2007 (H1N1)-like,
A/Brisbane/ 10/2007 (H3N2)-like, and B/Brisbane/60/2008-like antigens
be used; and 3) a notice that recommendations for influenza diagnosis
and antiviral use will be published before the start of the 2009-2010
influenza season. Vaccination efforts should begin as soon as vaccine
is available and continue through the influenza season. Approximately
83 percent of the United States population is specifically
recommended for annual vaccination against seasonal influenza;
however, <40 percent of the U.S. population received the 2008-2009
influenza vaccine.

These recommendations also include a summary of safety data for U.S.
licensed influenza vaccines. These recommendations and other
information are available at CDC's influenza website
(http://www.cdc.gov/flu ); any updates or supplements that might be
required during the 2009-2010 influenza season also can be found at
this website. Vaccination and health-care providers should be alert
to announcements of recommendation updates and should check the CDC
influenza website periodically for additional information."

The 2009 recommendations include 3 principal changes or updates, one
of which is that: The 2009-2010 trivalent vaccine virus strains are
A/ Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and
B/ Brisbane 60/2008-like antigens. - Mod.CP]

[see also:
Influenza A (H1N1) - worldwide (11): coincident H3N2 variation 20090505.1679]
....................cp/ejp/lm
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thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Sunday, July 19, 2009

NO! to Mandatory Vaccines!

Click on title above to see why;

http://www.drcarley.com/

Saturday, July 18, 2009

Pig Farm Worker Gets Swine Flu / UK

INFLUENZA PANDEMIC (H1N1) 2009 (09): UNITED KINGDOM, PIG STOCKMAN
*****************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Sat 18 Jul 2009
Source: The The times newspaper, online [edited]



Commercial pig farm worker in Britain contracts swine flu
---------------------------------------------------------
The 1st case of a pig farm worker contracting the swine flu virus
[i.e., influenza pandemic (H1N1) 2009 virus] was reported this week.
The stockman from the South West worked on a commercial pig farm.
Other staff and pigs on the farm are free of the H1N1 virus.

Veterinary experts are working with the pig industry to agree a code
of practice should pig herds become infected with the flu strain.

There is no threat to human health if people eat pork, bacon and ham
from a pig that has recovered from swine flu, provided that the meat
is cooked properly.

Any pig contracting flu is to be quarantined and cannot be slaughtered
for the food chain unless the animal has been free of flu symptoms for
7 days. Veterinary checks will also take place at the abattoir where
any sick animals will be rejected. There are no plans to cull pigs
with swine flu, but it is known that flu strains can easily pass
between pigs and human beings as well as from pig to pig.

[Byline: Valerie Elliott]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This article reports that a worker at a commercial pig farm has
contracted Influenza pandemic (H1N1) 2009 virus infection. There is no
evidence that the pigs he tended are or were infected with the same
virus and there is no evidence to suggest that he had contracted the
infection from pigs (or other workers on the farm), nor that has
transmitted his infection to the pigs. It is probable that he
contracted infection from another human off-site, in view of the rapid
escalation of cases in the human population in many parts of the UK.

A pig herd in Canada was initially thought to have acquired infection
from a farm worker, but this was later discounted and the origin of
the outbreak remains unexplained. Earlier this month officials of
SENASA [The National Service of Health and Agrifood Quality of
Argentina] said workers at a pig farm in Buenos Aires province were
suspected of having passed the new strain to their animals (see:
Influenza pandemic (H1N1) 2009 (07): Argentina, swine, alert
20090718.2557).

So far the evidence for transmission of infection from workers to
their animals (or vice versa) is no more than circumstantial.
Transmission of influenza pandemic (H1N1) 2009 virus infection from
human to pig, or vice versa, has yet to be established unequivocally
anywhere. - Mod.CP]

[It is somewhat contradictory to say on the one hand there is no
danger from eating meat from a pig sick with pandemic H1N1 2009 virus
if properly cooked, and on the other to mandate a 7-day symptom-free
period before slaughter. I wonder what the regulations are for
slaughtering pigs sick with common-or-garden variety swine H1N1 virus.
- Mod.JW]

[see also:
Influenza pandemic (H1N1) 2009 (07): Argentina, swine, alert 20090718.2557
Influenza pandemic (H1N1) 2009 (04): pandemic origins 20090715.2527
Influenza A (H1N1): animal health (17), Argentina, OIE 20090703.2401
Influenza A (H1N1): animal health (16), Argentina, swine, OIE 20090626.2322
Influenza A (H1N1): animal health (13) swine, Canada, origin, RFI
20090615.2215
Influenza A (H1N1): animal health (12) swine trial inf. 20090605.2088
Influenza A (H1N1): animal health (11) swine trial inf. 20090604.2067
Influenza A (H1N1): animal health (10) swine, Canada, cull 20090514.1813
Influenza A (H1N1): animal health (09), swine, Canada 20090513.1790
Influenza A (H1N1): animal health (08), food safety, FAO/OIE/WHO
20090507.1710
Influenza A (H1N1): animal health (07), swine, Canada, OIE 20090506.1691
Influenza A (H1N1): animal health (06), Canada, OIE 20090505.1683
Influenza A (H1N1): animal health (05), swine, Canada, FAO 20090505.1680]
....................cp/ejp/jw
*##########################################################*
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ProMED-mail makes every effort to verify the reports that
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thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Doctors Face Civil Suits Over Pain Pill Prescriptions

No, this in not about Michael Jackson, though it should be. How long do you think it will be before they arrest some doctor(s) in his case? Hummm. Very interesting, and Time will Tell.
---------------

Dr. Stephen Schneider and Dr Lawrence Simons of Haysville, Kansas, face civil suits over pain pill prescriptions

BY RON SYLVESTER
The Wichita Eagle

Two Haysville doctors facing federal criminal charges over their prescribing of painkillers also share mounting claims of malpractice in civil court.

Stephen Schneider and Lawrence Simons, who worked together at Schneider's clinic in Haysville, were sued this week by the family of a woman who died from an accidental drug overdose.

The Sedgwick County District Court suit claims Patsy Westcoat Fowler got the drugs that killed her from prescriptions written by the two doctors.

It's the sixth malpractice lawsuit filed against them in 2008 and 2009. The Kansas Board of Healing Arts suspended Schneider's medical license and closed the clinic in January 2008.

Simons, meanwhile, is set for trial next month in U.S. District Court in Wichita on 36 criminal charges of trading narcotic prescriptions for favors. None of the criminal charges against Simons accuse him of causing patient deaths.

The lawsuits do.

The latest, filed Tuesday by Fowler's family, claims the doctors continued to give her narcotics despite family members' pleas for them to stop and evidence that Fowler was a drug addict.

Lawyers representing Schneider and Connie White, a physician assistant at the clinic who is also named as a defendant in the lawsuit, declined to talk about the cases. The lawyer representing Simons in the malpractice claims did not return phone calls.

Records filed in previous suits say patients of Simons and Schneider abused drugs given to them by the doctors, causing their own deaths.

"The defense in these cases has been that the patients hid their drug and alcohol addictions from the doctors," said Larry Wall, the lawyer representing Fowler's family.

But the doctors knew about Fowler's addiction, Wall said.

The Wichita Treatment Center sent Schneider a notice in 1999 saying Fowler had been diagnosed with "opiate dependency." Her regimen at the substance abuse treatment center included taking methadone, a pain reliever used in detoxification.

Fowler sought treatment from the Haysville doctors for chronic anxiety and back pain, according to court documents.

"We are quite concerned about cross-addicting medications, as most of our patients have abused multiple substances throughout their lives," said the statement from Niranjan Baxi, medical director for the Wichita Treatment Center.

The center asked Schneider to indicate whether Fowler needed to continue with the medications he was providing. There's no documentation that Schneider responded, Wall said.

Fowler's family said they called Schneider's office on several occasions, beginning in 2000. They said they told the doctor's office that Fowler had been arrested for altering a hospital emergency room prescription, changing it from six to 60 pills of Soma, a brand of muscle relaxant.

Schneider, meanwhile, gave Fowler early refills of Soma, the narcotic Lortab and the anti-anxiety drug Xanax, the lawsuit said.

At one point, Schneider refused to treat Fowler, the lawsuit said, but the doctor accepted her again as a patient when he opened his Haysville clinic in 2002.

Fowler remained a patient of Schneider's, and then Simons', the lawsuit said, until she died in July 2007 at age 49.

Jaime Oeberst, Sedgwick County coroner, ruled that Fowler's accidental death came as a result of "mixed drug intoxication."

Schneider and his wife, Linda, a licensed practical nurse who managed the clinic, are accused of helping to cause 59 patient deaths through drug overdoses. They face criminal charges in 21 of the deaths.

Their lawyers in that case have said they are not responsible for the deaths.

The couple is out on bond while their trial is on hold, awaiting a decision by the 10th Circuit Court of Appeals on whether a Wichita judge can limit prosecutors' evidence.

Reach Ron Sylvester at 316-268-6514 or rsylvester@wichitaeagle.com.


Click on title above for original article and place to comment; http://www.kansas.com/topstories/story/894862.html

Friday, July 17, 2009

Chang Farm Recalls Soy Bean Sprouts

Chang Farm, River Road, Whatley, MA, is issuing a voluntary recall of Soy Bean Sprouts produced by Chang Farms, with the specific sell-by date of July 17, 2009 because of the possible presence of Listeria monocytogenes (L. Monocytogenes) contamination.

Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headaches, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

The affected product is packaged in 10 lb bags (bulk) and 12 oz plastic bags (retail), labeled under the Chang Farm Brand as Soy Sprouts and have a “Sell By” date of July 17, 2009.

The product has been distributed to retail stores and wholesalers throughout MA, CT, NY and NJ.

JULY-15-09: Chang Farm Recalls Soy Bean Sprouts [FDA: SOY BEAN PRODUCTS RECALLED BY CHANG FARM]


Legal Help
If you or a loved one has suffered illness or adverse health effects from consuming this product, please click the link below and your complaint will be sent to a lawyer who may evaluate your claim at no cost or obligation.

Click on title above for legal help and a free evaluation of your possible case


--------------------------------------------------------------------------------


https://www.lawyersandsettlements.com/submit_form.html?label=sprout-recall-listeria-contaminated-soy-bean-sprouts

Wednesday, July 15, 2009

INFLUENZA PANDEMIC (H1N1) 2009 (04): PANDEMIC ORIGINS

*****************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


[1]
Date: Mon 13 Jul 2009
Source: Rehabpub, Reuters Health Stories [edited]



In a review of the genotypes of viruses responsible for the 3 major
influenza pandemics in the 20th century, scientists in China have
found clues indicating that viral precursors probably circulated for
several years in animal and human hosts before the pandemic strains
emerged.

"The evolutionary history of these 3 pandemic viruses remains unclear,
and that lack of understanding hinders the recognition of and
preparedness for future influenza pandemics," senior author Dr. Yi
Guan and associates at The University of Hong Kong write in the 14 Jul
2009 issue of the Proceedings of the National Academy of Sciences [see
part (3) below].

To clarify the mechanisms underlying pandemic emergence, Dr. Guan's
team compared amino acid similarities of all 8 gene segments of all
available viruses associated with the emergence of the A/Brevig
Mission/1/1918 virus (BM/1918), H2N2/1957, and H3N2/1968 pandemic
strains.

"These pandemics were initiated by the introduction and successful
adaptation of a novel hemagglutinin subtype to humans from an animal
source, resulting in antigenic shift," the investigators say.
Estimates for the times of most recent common ancestors to the BM/1918
strain indicate that the they ranged from 1903 for the PB2 gene to
1916 for the HA gene, suggesting that the virus genes were present in
swine or human hosts 2 to 15 years prior to the pandemic. "It is
unlikely," the authors state, "that the BM/1918 virus could have
resulted from adaptation of an entire avian virus introduced directly
into humans shortly before the pandemic. More likely, it was generated
by reassortment between previously circulating swine and human strains
and introduced avian viruses over a period of years." They estimate
that 3 H1N1 variants co-circulated in 1918, BM/1918 and precursors of
seasonal and classic swine H1N1.

Phylogenies showed that the H2N2/1957 resulted from the genetic
reassortment between already circulating human and avian viruses and 3
genes derived from a Eurasian avian source. These genes were
introduced into human populations 2 to 6 years before the pandemic.
Their data point to a similar process for the H3N1 pandemic. Dr.
Guan's team concludes that if future pandemics arise in a similar
manner -- generated through reassortment events in unknown mammalian
hosts and involving multiple avian viruses preceding pandemic
recognition -- appropriate surveillance strategies for detection of
precursor viruses may abort future pandemics.

Furthermore, they believe that high-throughput characterization of all
8 gene segments of human virus isolates will be necessary for early
warning of an incipient pandemic.

--
Communicated by:
ProMED-mail

******
[2]
Date: Tue 14 Jul 2009
Source: Fort Frances times, The Canadian Press [edited]



The precursors of pandemic flu viruses may circulate in humans for
years before picking up all the genetic changes needed to ignite a
pandemic, a new study suggests. The authors argue that the last 3
pandemics -- including the infamous 1918 Spanish flu -- emerged in
this gradual manner. They also say their findings contradict the
notion that the Spanish flu virus jumped directly from birds into
people. Instead, they say, it evolved in a gradual manner over years,
with some of the genes likely coming from the virus responsible for
the pandemic that preceded 1918. That pandemic, which occurred in
1889, is believed to have been caused by an H3 virus.

"It's always been contentious," lead author Gavin Smith said of the
theory that the Spanish flu virus came directly and intact from birds
rather than through a series of gene-swapping events known as
reassortments. "It's never been a consensus view of people in the
research community." However, the researcher who led the effort to
find and sequence the 1918 virus said this new work, done by
calculations drawn from virus family trees -- a process called
phylogenetics -- can only generate hypotheses about how the Spanish
flu virus emerged.

"The fundamental problem in terms of dating the emergence of the 1918
virus with all of these models ... (is) that the crucial data that we
would need to understand the origin of the 1918 flu are influenza
samples from before 1918," said Jeffery Taubenberger, an influenza
researcher at the U.S. National Institutes of Allergy and Infectious
Diseases. "And until such time that those sequences are available, I
think that phylogenetics is not going to be able to answer with
specificity the question about the origin of the 1918 virus."

The new paper, published in the journal Proceedings of the National
Academy of Sciences, is by researchers from the University of Hong
Kong, Shantou University in China, and St. Jude Children's Research
Hospital in Memphis, Tenn. USA [see (3) below]. Smith is an
evolutionary biologist and virologist at the University of Hong Kong.
He was also lead author of a paper published last month [June 2009] in
Nature that estimated the new swine flu virus has been circulating in
people probably since about January of this year [2009]. The current
research used the same techniques as were employed in the Nature
paper. Smith and his colleagues looked at gene sequences for all 8
genes in the flu viruses responsible for the 1918, 1957 and 1968
pandemics, tracing back their lineages through the available banked
sequence data. Smith said the work suggests all 3 of the pandemics of
the 20th century emerged through reassortment, the swapping of genes
that can occur when an animal or a human is infected with 2 different
strains of flu at the same time.

While it is widely accepted that the 1957 and 1968 strains were
reassortant viruses, some contend the 1918 virus was an avian virus
that mutated to the point where it was able to infect people. Smith
and his co-authors also compared the viruses to current seasonal H1N1
viruses and H1N1 viruses known to circulate in pigs and came to a
somewhat startling conclusion. Current seasonal H1N1 viruses and swine
viruses are not the distant offspring of the 1918 virus, they said.
Rather, the gene dating techniques suggest the 1918 H1N1, current
seasonal H1N1s and the H1N1s circulating in pigs all had a common
ancestor, making them more like cousins or distant relatives.

If they are right, that suggests those viruses were all circulating
during the 1918 pandemic, which could explain uneven patterns of
disease seen at the time. "There was variation in the severity of the
pandemic," Smith explained in an interview from Hong Kong. "Some areas
had more severe (disease) and others didn't. So it sort of fits into
that idea. But again it is inference. And unless you've got a lot of
isolates from that period, I think it's always going to be impossible
to say definitely."

Taubenberger remains skeptical, noting that if modern science can't
say where and when the current pandemic virus evolved, it has less
chance of cracking the mysteries of 1918. "Even in this time and age
of extraordinary influenza surveillance and rapid genetic analysis, we
actually don't know with specificity when that reassortment event
(that produced the pandemic virus) occurred, in what species, in what
location geographically. We don't know that ... in something that just
happened right now, in a molecular virology era," he said from
Bethesda, Md. "Since we don't know what happened in 2008 or 2009 in
the emergence of this new H1 (virus), we really don't know what
happened in 1918 where so much data is not available and probably will
never become available."

[Byline: Helen Branswell]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[3]
Date: 13 Jul 2009
Source: Proceedings of the National Academy of Sciences [edited]



Dating the emergence of pandemic influenza viruses. By Gavin J. D.
Smitha, Justin Bahla, Dhanasekaran Vijaykrishnaa, Jinxia Zhanga, Leo
L. M. Poona, Honglin Chena, Robert G. Webstera, J. S. Malik Peirisa,
and Yi Guana. At: State Key Laboratory of Emerging Infectious Diseases
& Department of Microbiology, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Pokfulam, Hong Kong SAR, China; International
Institute of Infection and Immunity, Shantou University, Shantou,
Guangdong 515031, China; Virology Division, Department of Infectious
Diseases, St. Jude Children's Research Hospital, Memphis, TN 38015;
and HKU-Pasteur Research Centre, The University of Hong Kong,
Pokfulam, Hong Kong SAR, China.

Abstract
----------
Pandemic influenza viruses cause significant mortality in humans. In
the 20th century, 3 influenza viruses caused major pandemics: the 1918
H1N1 virus, the 1957 H2N2 virus, and the 1968 H3N2 virus. These
pandemics were initiated by the introduction and successful adaptation
of a novel hemagglutinin subtype to humans from an animal source,
resulting in antigenic shift.

Despite global concern regarding a new pandemic influenza, the
emergence pathway of pandemic strains remains unknown. Here we
estimated the evolutionary history and inferred date of introduction
to humans of each of the genes for all 20th century pandemic influenza
strains.

Our results indicate that genetic components of the 1918 H1N1 pandemic
virus circulated in mammalian hosts, i.e., swine and humans, as early
as 1911 and was not likely to be a recently introduced avian virus.
Phylogenetic relationships suggest that the A/Brevig Mission/1/1918
virus (BM/1918) was generated by reassortment between mammalian
viruses and a previously circulating human strain, either in swine or,
possibly, in humans. Furthermore, seasonal and classic swine H1N1
viruses were not derived directly from BM/1918, but their precursors
co-circulated during the pandemic.

Mean estimates of the time of most recent common ancestor also suggest
that the H2N2 and H3N2 pandemic strains may have been generated
through reassortment events in unknown mammalian hosts and involved
multiple avian viruses preceding pandemic recognition. The possible
generation of pandemic strains through a series of reassortment events
in mammals over a period of years before pandemic recognition suggests
that appropriate surveillance strategies for detection of precursor
viruses may abort future pandemics.

--
Communicated by:
ProMED-mail

[These authors have carried out phylogenetic analyses of all available
influenza virus sequences by an alternate methodology. In the case of
influenza genome sequences, establishing the times of most recent
common ancestor (TMRCA) can provide an estimate of when virus genes
emerged in a given host that allows the time of interspecies
transmission to be inferred. The authors have used this approach to
investigate the possible date of introduction to humans of each of the
genes for all available 20th century pandemic influenza strains. The
mean TMRCA estimates of each gene segment of H1N1 viruses shows that
the components of the 1918 pandemic strain were circulating in
mammalian hosts, i.e., swine and humans, at least 2 to 15 years prior
to the pandemic. The phylogenetic analyses suggest that the 1918 H1N1
pandemic virus most likely was generated by reassortment between
mammalian viruses and a previous human strain and was not a pure avian
virus, likewise that seasonal and classic swine H1N1 viruses were not
derived directly from the 1918 virus but rather their precursors
co-circulated during the pandemic. Furthermore, mean TMRCA estimates
also suggest that the avian-derived genes of the H2N2 and H3N2
pandemic strains may have been introduced to humans on multiple
occasions over a number of years.

These conclusions regarding the origin of the pandemic viruses of the
20th century are somewhat different from the outcome of previous
analyses, and in the absence of isolates from earlier years, are
likely to remain controversial. - Mod.CP]

[see also:
Influenza pandemic (H1N1) 2009 (03): vaccine 20090713.2505
Influenza pandemic (H1N1) 2009 (03): official nomenclature -- to be archived
Influenza pandemic (H1N1) 2009 (02): obesity risk factor 20090711.2482
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
Influenza A (H1N1) - worldwide (86): official nomenclature 20090706.2430]
...........................................................cp/msp/jw
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
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using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
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or archived material.
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No NAIS for Now

National animal ID plan stumbles
PROGRAM ON HOLD: House bill cuts off spending for system
By MARC HELLER
TIMES WASHINGTON CORRESPONDENT
TUESDAY, JULY 14, 2009
ARTICLE OPTIONS
A A A

WASHINGTON — Congress is on the verge of putting on hold a national system to track livestock, telling the Obama administration it will not fund the effort until the U.S. Department of Agriculture does a better job implementing it.

The House passed a spending bill Thursday that cuts off funding for the National Animal Identification System, even as USDA officials take suggestions from farmers and others who will be affected by the program, which is aimed at halting the spread of diseases that can contaminate food.

Lawmakers are grappling with several issues, including whether the voluntary system should be made mandatory and, if it remains voluntary, how to boost participation beyond the 35 percent or so of producers nationwide who take part. A group opposed to the system has sued the USDA, asking a federal court to halt the program's implementation.

The USDA has spent $142 million on the program since 2004.

ADVERTISEMENT

Criticism of the program comes from two directions. On one are lawmakers such as Rep. Rosa DeLauro, D-Conn., who pushed through the funding cut and has pushed for a mandatory system.

On another are groups such as the Empire State Family Farm Alliance, which has said the national system is unnecessary and will cost farmers several times the $3 to $4 per animal that officials have estimated.

The group said the federal system, as well as one being implemented by the New York state Department of Agriculture and Markets, are "among the most intrusive surveillance systems the government has ever created," designed to keep track of every head of any livestock animal, from birth or hatching to death.

That is just the goal the program's advocates embrace. They say a comprehensive system is needed in response to illnesses such as mad cow disease and swine and avian flu, which have sparked alarm in consumers and led to steep declines in sales of beef and pork even though scientists say such fears are exaggerated or misplaced. The system would allow the government to track each animal's movement throughout its life, possibly pinpointing where it contracted an illness within 48 hours.

Some farm groups say they worry that the government would overstep, killing entire herds or all of a farmer's chickens, for instance, if an illness were revealed. Many farmers oppose a mandatory system.

In addition, farm groups say the system will be costly to farmers — especially to small farms that would have to put tags on every animal. The largest farms, called concentrated animal feeding operations, would be exempt from that requirement and would have one NAIS identification number for an entire herd.

But large agribusinesses favor the program, and the American Farm Bureau Federation sparked controversy and confusion in the farm community by supporting a mandatory system – although it has said its support depends on the system being as inexpensive as possible for farmers and on the confidentiality of information farmers share with the government.

Farm Bureaus in Missouri and other states followed the national Farm Bureau’s lead, but New York Farm Bureau has never supported a mandatory system, said a spokesman, Peter Gregg. New York Farm Bureau supports a national system, but on a voluntary basis, he said.

The National Milk Producers Federation, representing dairy farmers' bargaining cooperatives, also supports a mandatory system.

A spokeswoman for the New York Department of Agriculture and Markets, Jessica Chittenden, defended the importance of an animal identification program to protecting food safety but had no information about how a cuttoff of the NAIS would affect New York's own program.

Yet the issue has caused little splash in some key New York congressional offices. A spokeswoman for Sen. Kirsten E. Gillibrand, D-N.Y., said her office has not heard much on the subject, even though the senator serves on the Senate Agriculture Committee, which oversees the USDA. A spokesman for Rep. Scott Murphy, D-Glens Falls, one of just two New Yorkers on the House Agriculture Committee, had no immediate information about his views on the subject, although he voted for the bill that cuts off funding.

In one of the stiffest challenges to the program, the Farm-to-Consumer Legal Defense Fund sued the USDA to block the system and has said the department should focus instead on enforcing existing laws, including inspections of slaughterhouses, and should bar the import of animals from countries with known disease problems.

The USDA recently finished a tour of 14 locations around the country to take suggestions on the program. Officials are still considering those comments, which news reports and industry groups say were largely negative from producers.

"The USDA continues to confuse industry support for efforts to identify and eliminate animal diseases with support for NAIS, despite the fact that some 80 percent of the people who testified during the hearings testified against the department's animal identification program," said the group's acting president, Pete Kennedy.

Whether the department can reach decisions before Congress makes a final decision about funding remains to be seen. In public comments, Agriculture Secretary Tom Vilsack has stressed that Congress is in early stages of setting the budget.

The Senate Appropriations Committee approved $14.6 million for the program, meaning a House-Senate conference committee likely will make the final decision. The Senate could vote on its bill this month but a final spending measure may not come until after the annual August recess.


http://www.watertowndailytimes.com/article/20090714/NEWS02/30714998

BOVINE TUBERCULOSIS - USA (10): (INDIANA) CERVID, BOVINE

********************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: 13 Jul 2009
From: Graham Hickling



Regarding ProMED-mail Archive Number 20090711.2480, the moderator's
comment that "White-tailed deer in the United States (Michigan) have
been classified as maintenance hosts; however, some authors now
believe they may be spillover hosts" is surprising.

This statement originates from the University of Iowa fact sheet cited
in the ProMED post, and it would be of interest to learn who "some
authors" are. The history of the Michigan outbreak is in fact the
reverse, that initially it was believed that deer infections had
resulted from spillover from cattle. In the subsequent decade and a
half it has become clear that there is stable, persistent cycling of
infection in the deer (see for example:
) with no credible evidence to suggest this is being supported by ongoing transmission of infection to the deer from cattle or other wildlife
species.

--
Graham J. Hickling, PhD
Research Associate Professor
Director, The Center for Wildlife Health
Dept. Forestry, Wildlife and Fisheries
274 Ellington Plant Science Bldg.
University of Tennessee
Knoxville TN 37996-4563


[Dr.Hickling is correct that the experience in Michigan does
contradict the statement in the fact sheet from the University of
Iowa. However, it may be true in other states. It will be interesting
to see which way the spillover goes in the state of Indiana.
However, while Dr. Hickling is correct in the Michigan experience,
there are still many people who are willing to vilify the captive
cervid industry without taking the time to examine the wildlife and
the epidemiology of the situation.

We thank Dr. Hickling for his comments. - Mod.TG]

[see also:
Bovine tuberculosis - USA (09): (IN) cervid, bovine 20090711.2480]
....................tg/ejp/jw
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at

************************************************************
Visit ProMED-mail's web site at .
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Monday, July 13, 2009

Swine Flu Vaccine Production Hits a Snag

INFLUENZA PANDEMIC (H1N1) 2009 (03): VACCINE
********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


In this update:
[1] WHO update
[2] Canada Press report

******
[1] WHO update
Date: Mon 13 Jul 2009
Source: World Health Organisation (WHO), Global Alert and Response,
EPR [edited]



Pandemic (H1N1) 2009 briefing note 2: WHO recommendations on pandemic
(H1N1) 2009 vaccines
------------------------------------------
On Tue 7 Jul 2009, the Strategic Advisory Group of Experts (SAGE) on
Immunization held an extraordinary meeting in Geneva to discuss issues
and make recommendations related to vaccine for the pandemic (H1N1)
2009. SAGE reviewed the current pandemic situation, the current status
of seasonal vaccine production and potential A(H1N1) vaccine
production capacity, and considered potential options for vaccine use.

The experts identified 3 different objectives that countries could
adopt as part of their pandemic vaccination strategy:
- protect the integrity of the health-care system and the country's
critical infrastructure;
- reduce morbidity and mortality; and
- reduce transmission of the pandemic virus within communities.

Countries could use a variety of vaccine deployment strategies to
reach these objectives, but any strategy should reflect the country's
epidemiological situation, resources and ability to access vaccine, to
implement vaccination campaigns in the targeted groups, and to use
other non-vaccine mitigation measures.

Although the severity of the pandemic is currently considered to be
moderate, with most patients experiencing uncomplicated, self-limited
illness, some groups such as pregnant women and persons with asthma
and other chronic conditions such as morbid obesity [body mass index
(weight/square of height) = 40 plus. - Mod.JW] appear to be at
increased risk for severe disease and death from infection.

Since the spread of the pandemic virus is considered unstoppable,
vaccine will be needed in all countries. SAGE emphasized the
importance of striving to achieve equity among countries to access
vaccines developed in response to the pandemic (H1N1) 2009.

The following recommendations were provided to the WHO Director-General:

- All countries should immunize their health-care workers as a 1st
priority to protect the essential health infrastructure. As vaccines
available initially will not be sufficient, a step-wise approach to
vaccinate particular groups may be considered. SAGE suggested the
following groups for consideration, noting that countries need to
determine their order of priority based on country-specific
conditions: pregnant women; those aged above 6 months with one of
several chronic medical conditions; healthy young adults of 15 to 49
years of age; healthy children; healthy adults of 50 to 64 years of
age; and healthy adults of 65 years of age and above.

- Since new technologies are involved in the production of some
pandemic vaccines, which have not yet been extensively evaluated for
their safety in certain population groups, it is very important to
implement post-marketing surveillance of the highest possible quality.
In addition, rapid sharing of the results of immunogenicity and
post-marketing safety and effectiveness studies among the
international community will be essential for allowing countries to
make necessary adjustments to their vaccination policies.

- In view of the anticipated limited vaccine availability at global
level and the potential need to protect against "drifted" strains of
virus, SAGE recommended that promoting production and use of vaccines
such as those that are formulated with oil-in-water adjuvants and live
attenuated influenza vaccines is important.

- As most of the production of the seasonal vaccine for the
2009-2010 influenza season in the northern hemisphere is almost
complete and is therefore unlikely to affect production of pandemic
vaccine, SAGE did not consider that there was a need to recommend a
"switch" from seasonal to pandemic vaccine production.


WHO Director-General Dr Margaret Chan endorsed the above
recommendations on 11 Jul 2009, recognizing that they were well
adapted to the current pandemic situation. She also noted that the
recommendations will need to be changed if and when new evidence
becomes available.

SAGE was established by the WHO Director-General in 1999 as the
principal advisory group to WHO for vaccines and immunization. It
comprises 15 members who serve in their personal capacity and
represent a broad range of disciplines from around the world in fields
such as epidemiology, public health, vaccinology, paediatrics,
internal medicine, infectious diseases, immunology, drug regulation,
programme management, immunization delivery, and health-care
administration.

Additional participants in the SAGE meeting included members of the ad
hoc policy advisory working group on influenza A(H1N1) vaccine, chairs
of the regional technical advisory groups and external experts.
Observers included industry representatives and regulators who did not
take part in the recommendation process in order to avoid conflicts of
interest.

--
Communicated by:
ProMED-mail

******
[2] Canada Press report
Date: Sun 12 Jul 2009
Source: The Canadian Press [edited]



Swine flu vaccine production has hit a snag, with manufacturers
reporting a disappointingly low yield when vaccines viruses are grown
in eggs. The World Health Organization [WHO] says so far the yield for
egg-based production is half or less than what manufacturers get when
they make vaccine to protect against seasonal H1N1 viruses. The lion's
share of influenza vaccine is made by companies that grow the viruses
in eggs.

New seed strains are being made in the hopes of increasing the vaccine
yield, a report by the WHO's vaccine chief, Dr. Marie-Paule Kieny,
says. But if the yield cannot be increased, it will slow the rate at
which pandemic vaccine comes out of the production pipeline, adding to
the time it takes to protect populations in countries like Canada that
have purchased vaccine. And countries that haven't pre-ordered
pandemic vaccine would face substantial delays before manufacturers
have product to sell to them.

"There's nothing to suggest it will take longer to make vaccine, if in
fact everything goes as planned. The question is: How much?" says Dr.
Michael Osterholm, director of the Center for Infectious Diseases
Research and Policy at the University of Minnesota. "There is nothing
magical about making this virus. The questions will be: How much?
When? and Where will it be available?"

The yield problem is revealed in presentations WHO staff made to last
week's special meeting of the expert panel that advises the
Geneva-based global health agency on vaccine issues. The body --
called the strategic advisory group of experts on immunization, or
SAGE -- was convened to give WHO counsel on a variety of questions
about pandemic vaccine use. Those include which groups should be given
priority when vaccine becomes available and whether the WHO should
recommend companies use adjuvants, which are boosting compounds that
could help stretch limited supplies.

Kieny, head of the WHO's initiative for vaccine research, was not
available for interview Sunday [12 Jul 2009]. The WHO is expected to
reveal details of the SAGE's deliberations and recommendations on
Monday [13 Jul 2009 [but not included in the preceding WHO press
release - Mod.CP]. But a report to the meeting by Dr. Wenqing Zhang of
the WHO's global influenza program says that vaccine manufacturers who
use so-called wild-type viruses (unmodified viruses like those now
circulating around the globe) are reporting yield rates similar to
what they get when they grow seasonal H1N1 viruses in Vero cells, a
cell culture medium. However, few manufacturers produce flu vaccine
this way.

Most make vaccine in eggs, using a reassortant or hybrid seed strain
designed to improve the chances of a good yield. These seed strains
can be made by a couple of methods, but the end result is a hybrid
with the external genes of the virus that vaccine is to protect
against and the internal genes of a virus with a proven track record
for growing well. Zhang's presentation says that of the various
reassortant vaccine viruses that have been made, the one with the
highest output still only generates about half of the yield seen with
seasonal H1N1 vaccine production.

Kieny's presentation calls the yield "less than optimal" and says
laboratories in the WHO's lab network are generating new sets of
vaccine viruses as quickly as possible. Her presentation illustrates
the impact low yield would have on availability of vaccine. Somewhere
between 850-900 million and 1.8 billion doses of pandemic vaccine are
already spoken for, she reports. The low end of the scale represents
what would be needed by countries with contracts if it is shown that
one shot will be enough to protect a person; the high end represents
what those countries would need if 2 shots per person are required. If
all manufacturers used the lowest possible effective dose, if yields
are on a par with seasonal H1N1 production and if countries only used
one dose per person, manufacturers could fill all their [advance]
purchase orders by mid-November 2009, Kieny's presentation suggests.

That best-case scenario also requires that all manufacturing capacity
remains devoted to pandemic vaccine and no portion shifts back to the
production of seasonal vaccine for next year's [2010] Southern
Hemisphere flu season. If companies don't use low doses and countries
that have pre-purchased vaccine demand 2 shots for all their citizens,
it could be mid-April [2010] before the vaccine manufacturers in
high-income countries have free capacity to devote to making vaccine
for middle and low income countries, Kieny's presentation estimates.
90 per cent of the world's flu vaccine production capacity is in the
high-income countries that use seasonal flu vaccine. A lower yielding
vaccine "would considerably push back the time lines," the
presentation warns. Assuming the yield is half that of seasonal flu
vaccine production, it would be mid-January 2010 before producers
could fill all contracts if they use a single-shot, low-dose regime,
Kieny estimates.

She suggests even with low-dose shots, a low-yield scenario would mean
manufacturers would not be able to fill all their existing contracts
until next June [2010] if the countries opt for 2 shots per person for
all their citizens.

[Byline: Helen Branswell]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[see also:
Influenza pandemic (H1N1) 2009 (03): official nomenclature -- to be archived
Influenza pandemic (H1N1) 2009 (02): obesity risk factor 20090711.2482
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
Influenza A (H1N1) - worldwide (86): official nomenclature 20090706.2430]
....................................................cp/msp/jw
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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Swine Flu Vaccines: To Jab or Not to Jab?

SWINE FLU VACCINES--A PUBLIC SERVICE NOTE

Dear all, This is not the first warning I've received about this subject, thus I feel obliged to post this to all our groups so you will have an opportunity to do some research on this issue.
-------------------------------------------------------------------------------------------------------------------------------
VIDEO: Swine Flu & "60 Minutes"

Come this fall, many governments will have a great deal
of swine flu vaccine stocked and ready to go.

There's big money to be made selling vaccines (just ask major Swine
Flu vaccine shareholder, Donald Rumsfeld) who refuses to talk about his Tamiflu connection;



The government and media fear-mongering is already starting.

On Thursday, July 9, US health officials said the government would
like to institute mass vaccinations of school-aged children
starting in October.

Should this happen, we will be removing our children from school
rather than let them receive this vaccine.

Why? Well just watch the two videos below, from the last time
the government got into the swine flu vaccine business.

The two videos are a 1979 "60 Minutes" story about some
of the people who became seriously ill, permanently paralyzed, or
died due to the vaccine.

Before letting yourself or your loved ones be vaccinated with
this new, untested vaccine, before you let them become
fodder for Big Pharma profits, do some research and
seriously question the need for this -- or any government
vaccine schemes.

The 1976 mass vaccination was stopped, but only after
thousands of people became massively ill.
Nothing has changed between then and now.


Rumsfield Links to Tamiflu;
http://www.dailymail.co.uk/news/article-1176743/Donald-Rumsfelds-controversial-links-drug-company-Tamiflu.html

Mass Flu Vaccination May Target Schools;
http://www.webmd.com/cold-and-flu/news/20090709/swine-flu-vaccination-may-target-schools

Swine Flu on 60 Mins / Click on title above to see vid;
http://www.vegsource.com/articles2/media_swine2.htm

PLEASE ALSO NOTE:

Studies Suggest, Doctors Agree, "Ignore" Swine Flu, DO NOT Vaccinate;
http://exposingfdanusda.blogspot.com/2009/06/study-suggests-doctors-agree-ignore.html

Tamiflu Resistant Swine Flu Reported;
http://exposingfdanusda.blogspot.com/2009/06/tamiflu-resistant-swine-flu-reported.html

Friday, July 10, 2009

Doctors offered cruise to prescribe Sigma

From "Open Your Eyes News"
http://www.openyoureyesnews.com/?p=10062

News Limited - A DRUG company is offering doctors who prescribe its medicines a 10-day Mediterranean cruise in a move that could breach a code of conduct.
And taxpayers will help subsidise the cruise - described as “the perfect mix of education and relaxation” - because doctors are being told they can claim it as a professional development program.
The cruise raises questions about drug company ethics and the Australian Medical Association and the peak pharmaceutical industry group have warned the offer could lead to the perception of a conflict of interest for doctors who take it up.

Click on title above for full article;

http://www.news.com.au/story/0,27574,25750206-421,00.html

Thursday, July 9, 2009

Ex-Monsanto VP hired as FDA adviser

This is exactly the type of "Revolving Door" Special Interest / Croniesm Politics Obomba promiced would not happen in his administration; so much for the promices of politicians, so much for "RealChange".Org

Article;

A former lawyer with Monsanto Co. has been hired as an adviser at the U.S. Food and Drug Administration.

Michael Taylor, who worked as Monsanto’s former vice president for public policy for two years until 2000, will advise Commissioner of Food and Drugs Margaret Hamburg, the FDA said Tuesday.

Taylor also worked as a food safety expert and research professor at George Washington University.

Hamburg said Taylor would work with her office and with the management of the FDA’s Center for Food Safety and Applied Nutrition, Center for Veterinary Medicine, the Office of Regulatory Affairs, Congress and with members of the Obama Administration.

Taylor first worked for the FDA in 1976 as a litigating attorney. He then served as the FDA’s deputy commissioner for policy from 1991 to 1994, overseeing the FDA's policy development and rulemaking, including the implementation of the Nutrition Labeling and Education Act and issuance of new seafood safety rules.

Creve Coeur, Mo.-based Monsanto Co. (NYSE: MON), led by Chairman, President and CEO Hugh Grant, develops insect- and herbicide-resistant crops and other agricultural products. It is one of the largest employers in St. Louis with 4,000 local employees.

http://www.bizjournals.com/stlouis/stories/2009/07/06/daily47.html

Wednesday, July 8, 2009

Europe pays 40% less for drugs than U.S.

By Tracy Staton

Decision Resources came out with a report showing that drug costs in Europe are an average of 40 percent less than in the U.S.--a price differential that shows why reimportation was ever raised in the first place. The study covered 170 of the most popular drugs and found costs to range from a low of 55 percent of the U.S. price in Italy to a high of 70 percent in Germany.

Most of the biggest price differences were on older drugs--such as Eli Lilly's Prozac--that face generic competition; apparently, branded drugmakers tend to cut prices in the face of generic competition in Europe, but hold those prices steady in the U.S. Differentials varied not only by geographic area, but also by therapeutic area, too.

Decision Resources' Neil Grubert cautioned against conclusion-jumping based on these numbers, however. "Many payers will look to compare the prices they pay with prices in other markets," he said in a statement. "The United States is widely assumed to be by far the most expensive pharmaceutical market, but pharmaceutical companies and payers need to be aware of the enormous price variations by therapeutic area and drug type from one country to another."

Still, the bottom line is that prices are higher in the U.S. With everyone's budget hatchet ready for use, drug costs are likely to attract plenty of attention precisely because of statistics like these. Reimportation or no, drugmakers need to be ready to explain why U.S. payers have to pay more. Because payers will definitely be asking.

- read the Decision Resources release

Related Articles:
Drugmakers pledge $80B to health reform
Treximet: Cautionary tale of payer price revolt
MedPAC: Are new drugs worth higher prices?
Bayer pharma chief laments pricing pressures

Read more about: Europe, drug prices


--------------------------------------------------------------------------------

Monday, July 6, 2009

H1N1 Tamiflu Resistant Strain Identified

INFLUENZA A (H1N1) - WORLDWIDE (84): TAMIFLU RESISTANCE, CHINA (HONG
KONG S.A.R.)
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Sat 4 Jul 2009
Source: 660News, All News Radio, The Canadian Press [edited]



All cases of Tamiflu resistance are not created equal. So while the
1st 3 instances of swine flu infection with Tamiflu-resistant viruses
were reported in the past week, it was Number 3, not Number 1 that put
influenza experts on edge. Public health authorities in Hong Kong
announced Friday [3 Jul 2009] they have found a case of Tamiflu
resistance in a woman who hadn't taken the drug. That means she was
infected with swine flu viruses that were already resistant to
Tamiflu, the main weapon in most countries' and companies' pandemic
drug arsenals.

The 2 earlier cases, reported from Denmark and Japan, involved people
who had been taking the medication. While always unwelcome, that type
of resistance is known to occur with seasonal [influenza virus]
strains and may be less of a threat to the long-term viability of this
key flu drug. "It was not at all surprising to see resistance in
patients on treatment, but seeing it in someone who was not treated,
it certainly is more concerning," says Dr. Malik Peiris, a flu expert
at the University of Hong Kong.

There is currently no evidence Tamiflu-resistant viruses are spreading
widely. Still, some experts see the Hong Kong case as a warning that
Tamiflu's role in this pandemic may not be as long-lived as pandemic
planners would like. "I think it's too early to judge," says Dr.
Frederick Hayden, an expert on influenza antivirals who teaches at the
University of Virginia. "But I think that possibility has existed from
the beginning, and it's something that needs to be certainly
considered in making determinations about things like antiviral
stockpiling, management of patients with more serious illness in
hospital and how the available drugs will be used."

Some experts say this early sign of resistance should prompt a rethink
of how often and in which circumstances Tamiflu is used to battle the
novel H1N1 virus. "It ... probably highlights the importance of not
using these antiviral drugs indiscriminately, given that the disease
is relatively mild," says Peiris, whose hospital monitored the woman
who was found to be carrying the resistant virus. "In people who don't
have underlying risk factors, they probably should not be treated with
Tamiflu, basically."

Others suggest countries should limit how often they use the drug to
prevent infection, a regimen known as prophylaxis. In prophylaxis,
people who've been exposed to the virus are given one pill a day for
10 days, compared to the treatment regime of 2 pills a day for 5 days.
Some countries, including Canada, have been reserving prophylaxis for
people at high risk from this flu, such as pregnant women. But others
have taken a different approach, using Tamiflu to try to curb spread
of the virus. For instance, Britain has made the drug widely available
to contacts of confirmed cases, though it announced this past week it
was changing that policy.

The World Health Organization is drafting guidance for countries on
the use of antivirals. While the WHO advises rather than instructs, it
has been stressing that saving these drugs for treatment makes the
most sense, says Dr. Keiji Fukuda, the agency's top flu expert. "In
general we have been pushing the advice that using these drugs for
treatment is definitely the priority use of them," says Fukuda, the
acting assistant director general for health security and environment.
"And I think this is not just from a theoretical resistance
perspective but also from the fact that if you have limited amounts of
antiviral drugs, then you need to make some choices about how you use
them."

From their 1st sighting, the new H1N1 viruses have been resistant to
2 older flu drugs, amantadine and rimantadine. That left the only 2
other influenza drugs, oseltamivir (Tamiflu) and zanamivir (Relenza),
as the sole options for treatment and prophylaxis. There is a risk
inherent in using the drug to prevent illness. If people who are
already infected but aren't yet experiencing symptoms are put on
prophylaxis, there won't be enough drug in their systems to kill all
the viruses they house. Those that survive develop resistance to the
drug. And that, it appears, may be what happened in the resistance
cases in Denmark and Japan. In both instances the women involved had
been given Tamiflu prophylaxis after a contact developed swine flu.

But the Hong Kong case was different. A 16-year-old girl travelling
from San Francisco was stopped in Hong Kong's airport in mid-June
[2009] after setting off a fever detection device. She was taken to
hospital where she tested positive for swine flu. She had not been
taking antivirals and declined to be treated with the drug. She was
kept in isolation until she recovered.

Dr. Jennifer McKimm-Breschkin, an influenza expert from Australia and
a member of the team that developed Relenza, says this case shows
resistant swine flu viruses can spread. It was previously thought flu
viruses that developed resistance to the drug would be crippled in the
process and would not transmit to others. But that belief was
shattered in 2008 when it was discovered Tamiflu-resistant versions of
the seasonal H1N1 viruses were spreading rapidly around the globe.
They have since all but wiped out [replaced] Tamiflu-susceptible
seasonal H1N1 viruses. "This is a patient that hasn't been treated who
has gone from San Francisco to Hong Kong. What that means is that she
has caught a resistant virus in San Francisco," says McKimm-
Breschkin, virology project leader at the Commonwealth Science and
Research Organization -- known as CSIRO -- in Melbourne. "So that
means this virus has been transmitted from somebody who's presumably
been treated. Which means it's been fit enough to transmit -- and that
is of a lot more concern than just resistance in a treated patient."
Experts have worried the seasonal H1N1 viruses might reassort or swap
genes with the swine H1N1. If swine flu picked up the neuraminidase
gene -- the N in a flu virus' name -- from the seasonal H1N1, it would
acquire the resistance its seasonal cousin has developed.

Authorities in Hong Kong have not yet told the WHO whether that is
what has happened in this case. But whether the Hong Kong resistance
case is due to reassortment, or from the fact that some swine flu
viruses have developed resistance on their own, the situation demands
careful monitoring, Fukuda and others say. "The really big question
for any finding of antiviral drug resistance with these viruses is
whether it's an isolated event or whether it's a tip of a larger
phenomenon," he explains. "The bottom line, as is so often the bottom
line with influenza, is that the real answer to the current situation
is monitoring as closely as possible, which in this instance is really
being done, since an extraordinary number of viruses are being
collected and looked at."

[Byline: Helen Branswell]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The identification in Hong Kong (S.A.R.) of a patient arriving from
the USA harboring Tamiflu-resistant A (H1N1) pandemic influenza virus,
who had not previously received Tamiflu treatment, is a disturbing but
not unexpected development in view of the often indiscriminate use of
the antiviral in some countries. It remains to be seen whether this
Tamiflu-resistant virus will be transmitted more or less efficiently
than Tamiflu-sensitive virus. It may be that Tamiflu will become
largely ineffective in the control and treatment of the A (H1N1)
pandemic virus sooner rather than later. Restriction in future use of
Tamiflu should be considered.

Unlike Tamiflu, which is administered orally in tablet form, the
alternate neuraminidase inhibiter Zanamivir (Relenza) is an antiviral
that must be administered twice a day in powder form through a special
inhaler, with treatment continuing for up to 5 days. This may be an
advantage in reducing the indiscriminate use of the drug. Relenza can
be used by people over 12 years of age who are known or suspected to
have influenza A or influenza B virus infection. - Mod.CP]

[see also:
Influenza A (H1N1) - worldwide (83): antiviral resistance 20090705.2417
Influenza A (H1N1) - worldwide (82): transmission 20090704.2402
Influenza A (H1N1) - worldwide (81): epidemic analysis 20090703.2391
Influenza A (H1N1) - worldwide (80): Argentina, human to pig 20090701.2376
Influenza A (H1N1) - worldwide (79): case count 20090701.2372
Influenza A (H1N1) - worldwide (78): Tamiflu resistance, DK 20090630.2359
Influenza A (H1N1) - worldwide (76): comments on 1918 virus (03) 20090625.2309
Influenza A (H1N1) - worldwide (74): susp. origin 20090624.2303
Influenza A (H1N1) - worldwide (73): case count, epidemiology 20090622.2288
Influenza A (H1N1) - worldwide (72): case count, epidemiology 20090619.2261
Influenza A (H1N1) - worldwide (70): risk factors 20090619.2260
Influenza A (H1N1) - worldwide (69): other viral infections 20090618.2254
Influenza A (H1N1) - worldwide (68): southern hemisphere 20090618.2253
Influenza A (H1N1) - worldwide (65): antivirals in pregnancy 20090616.2224
Influenza A (H1N1) - worldwide (64): case count, pandemic 20090616.2221
Influenza A (H1N1) - worldwide (62): Egypt, Lebanon 20090611.2150
Influenza A (H1N1) - worldwide (62): Egypt, Lebanon 20090611.2150
Influenza A (H1N1) - worldwide (60): Egypt (Cairo) 20090608.2117
Influenza A (H1N1) - worldwide (59): Worldwide 20090608.2117
Influenza A (H1N1) - worldwide (58): USA, Africa 20090607.2109
Influenza A (H1N1) - worldwide (57): Brazil, USA 20090605.2090
Influenza A (H1N1) - worldwide (55) 20090603.2056
Influenza A (H1N1) - worldwide (47): China, epidemiology 20090526.1962
Influenza A (H1N1) - worldwide (45) 20090525.1951
Influenza A (H1N1) - worldwide (42) 20090523.1929
Influenza A (H1N1) - worldwide (39) 20090521.1903
Influenza A (H1N1) - worldwide (37) 20090520.1893
Influenza A (H1N1) - worldwide (34) 20090518.1863
Influenza A (H1N1) - worldwide (31) 20090516.1835
Influenza A (H1N1) - worldwide (29) 20090515.1824
Influenza A (H1N1) - worldwide (26) 20090514.1798
Influenza A (H1N1) - worldwide (23) 20090511.1764
Influenza A (H1N1) - worldwide (21) 20090510.1749
Influenza A (H1N1) - worldwide (19) 20090509.1733
Influenza A (H1N1) - worldwide (17) 20090508.1722
Influenza (H1N1) - worldwide (15) 20090507.1709
Influenza A (H1N1) - worldwide (13) 20090506.1695
Influenza A (H1N1) - worldwide (11): coincident H3N2 variation 20090505.1679
Influenza A (H1N1) - worldwide 20090430.1636
Influenza A (H1N1) "swine flu": worldwide (07), update, pandemic 5
20090429.1622
Influenza A (H1N1) "swine flu": Worldwide 20090427.1583
Influenza A (H1N1) virus, human: worldwide 20090426.1577
Influenza A (H1N1) virus, human - New Zealand, susp 20090426.1574
Influenza A (H1N1) virus, human - N America (04) 20090426.1569
Influenza A (H1N1) virus, human - N America 20090425.1552
Acute respiratory disease - Mexico, swine virus susp 20090424.1546
Influenza A (H1N1) virus, swine, human - USA (02): (CA, TX) 20090424.1541
Influenza A (H1N1) virus, swine, human - USA: (CA) 20090422.1516
Influenza A (H1N1) virus, swine, human - Spain 20090220.0715]
...........................................................cp/msp/jw
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using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
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