In its weekly update today, the World Health Organization (WHO) said intense, persistent H1N1 flu transmission continues in North America with an unusually early flu season under way across Europe and central and western Asia. Countries in northern and eastern Europe, as well as eastern Russia, are seeing increasing activity. Mongolia, China, and Japan are reporting surges in cases. Seasonal H3N2 viruses are waning, though some have been detected recently in sub-Saharan Africa. [Nov 6 WHO pandemic update]

The US Department of Health and Human Services (HHS) announced yesterday that it has awarded contracts for up to 120,000 treatment courses of intravenous (IV) antiviral drugs to help treat hospitalized novel H1N1 patients. HHS ordered 10,000 courses each of IV oseltamivir, zanamivir, and peramivir, totaling $31.5 million, with possible additional orders of up to 30,000 additional courses for each drug over 2 years. [Nov 5 HHS statement]

Poland will not buy H1N1 vaccine that has not been properly tested or from manufacturers that won't take responsibility for side effects, Prime Minister Donald Tusk said today. Tusk said that vaccine producers were pressuring governments to buy but without taking responsibility for possible negative effects, according to the Associated Press (AP). He said expectations are to spend hundreds of millions of dollars on vaccine "while no one wants to guarantee that it has no side effects." [Nov 6 AP article]

Beijing health officials said today that they would extend H1N1 vaccine from high-risk citizens to all the city's 16 million residents as the H1N1 death toll in the country rises, according to Xinhua, China's news agency. The city will offer free vaccine to all people older than 3 years. A public health official said Beijing now has 3.63 million doses but will receive more. [Nov 6 Xinhua story]

More than 100 piglets on a farm in Chinese Taipei have tested positive for pandemic H1N1 flu, according to a report filed with the World Organization for Animal Health (OIE). Of 3,346 piglets on the farm in T'ai-Tung County, 160 started showing clinical signs such as coughing and diarrhea on Oct 19, and tests revealed H1N1 flu. The sick pigs have recovered, and swine farms within a 3-km radius are being monitored. [Nov 5 OIE report]

Pandemic H1N1 virus infections in pigs, turkeys, and other animals underscores the need for close monitoring but have not changed pandemic dynamics, the WHO said yesterday. Limited evidence suggests the pig illnesses followed human transmission to pigs, and as human infections increase, the WHO said it expects to receive more reports of animal H1N1 infections. A novel H3N2 virus found recently in Danish minks did not spread to humans but signals a need for increased vigilance. [Nov 5 WHO statement]

CDC Director Tom Frieden, MD, sent a letter today to states commending them for their efforts to distribute pandemic vaccine when demand exceeds supply but emphasizing that the scarce supplies should first go to priority groups. He warned that giving early doses to those outside high-risk groups could undermine public health credibility. A spokesman said the CDC doesn't see confusion over allocation as widespread, but it wanted to underscore the importance of vaccinating vulnerable groups. [Nov 5 CDC letter]

The American College Health Association (ACHA) says its member schools had 28.6 new cases of flu-like illness per 10,000 students last week, a 2% increase from the week before. New cases at the 274 schools totaled 9,128. Forty-three percent of the colleges (117 of 274) had H1N1 vaccine on hand, but only about 1% of the students have been vaccinated so far, the association said. [ACHA report for week ending Oct 30]

Two pork samples from a Hong Kong slaughterhouse have tested positive for the pandemic H1N1 virus, Hong Kong's Food and Health Bureau reported today. Experts believe the virus spread to the pigs from humans. The risk of humans contracting the virus has not risen, officials said. Yesterday the World Organization for Animal Health (OIE) said recent detections of the virus in animals are not surprising and animals do not seem to be spreading the virus among humans. [Nov 5 Hong Kong press release]

Fifty-two percent of respondents in a national McClatchy-Ipsos poll said they are likely to get the H1N1 vaccine, while 47% said they are unlikely to get it, according to a McClatchy Newspapers report. In other findings, 63% of respondents said they were concerned about the virus, and 65% said they thought the Obama administration had done everything it could to provide the vaccine in time. The poll involved 1,077 people and had a sampling error margin of 3%. [Nov 3 McClatchy report]

German drug regulators have approved Novartis's cell-culture pandemic H1N1 vaccine, becoming the first country to clear a cell-based version, the company announced today. The vaccine, made in Marburg, Germany, contains 3.75 micrograms of antigen and an MF95 adjuvant. It is approved for those 6 months old and older. Studies found a single dose provoked a good immune response with no unexpected safety or tolerability concerns. Novartis is building a second cell-culture plant in the United States. [Nov 5 Novartis press release]

The CDC yesterday issued interim guidance on pandemic flu prevention for swine farm workers. It warns that people and pigs can transmit the virus to each other and explains how to recognize flu signs in pigs. The guidance reviews hand hygiene and reminds workers that pig immunizations might not protect the animals from all circulating flu strains. The CDC urges that workers exposed to potentially sick pigs be required to wear protective equipment. [Nov 4 CDC interim guidance]

The US Department of Defense (DOD) has started receiving its pandemic H1N1 vaccine and will start vaccinating in the coming weeks. Though vaccination with seasonal and pandemic vaccine is mandatory for service members, the DOD expects initial shipments to be limited. Officials said they will vaccinate high-risk groups while also maintaining mission readiness. Deployed troops, basic training locations, service academies, and healthcare workers will also receive the first of the DOD's doses. [Nov 4 DOD press release]

To ease response to the H1N1 pandemic, Norway is allowing over-the-counter sales of oseltamivir (Tamiflu) and zanamivir (Relenza), the Associated Press (AP) reported. The new policy starts tomorrow and is in effect until the middle of 2010. Norway has ordered 9.4 million doses of vaccine, but the manufacturer has reportedly not produced enough to meet demand. [Nov 3 AP story]

Poland's prime minister called on the European Union to help respond to the flu threat in the Ukraine, and another official warned that the virus could spread rapidly in eastern Europe, Reuters reported yesterday. The Ukrainian health ministry said today that 86 people have died of respiratory illnesses, five of them from the pandemic virus, the National News Agency of Ukraine reported today. A global team is in the country to help assess the outbreak, which has hit western regions hardest. [Nov 3 Reuters story]

Pandemic flu has struck an isolated Amazon Indian tribe over the past 2 weeks, killing 7 and sickening about 1,000 people, Reuters reported today. The outbreak in the Yanomami tribe, who live in an isolated area at the Venezuela-Brazil border, was described in a statement from Survival International, an indigenous people's rights group. The group's director said the situation requires immediate response from the two governments. Venezuela has reportedly sent a medical team. [Nov 4 Reuters story]

White House officials yesterday denied reports that terrorism detainees at Cuba's Guantanamo Bay prison would soon receive the pandemic H1N1 vaccine, the AP reported. An earlier report from a jail official that said detainees and guards would soon get the vaccine provoked an outcry that terror suspects would get their doses before most Americans. However, White House spokesman Robert Gibbs said no vaccine is at the facility, and none is on its way. [Nov 3 AP story]

Taking pain relievers such as ibuprofen or aspirin to reduce the pain of flu injections appears to blunt immune response, researchers from the University of Rochester Medical Center (URMC) reported recently at a conference. They found the association across a range of vaccine and pain relievers. They say that cyclooxygenase 2 inhibitors block optimal production of B lymphocytes, which make antibodies. Czech researchers recently found that acetaminophen weakened infants' response to vaccines. [Nov 3 URMC press release]

A 13-year-old Iowa house cat was recently diagnosed as having novel H1N1 after two of its three owners were sick, the Iowa Department of Public Health (IDPH) reported today. Iowa's public health veterinarian Dr Ann Garvey said the cat and its owners have recovered and that people should remember to protect family pets from illnesses. The American Veterinary Medical Association said it is the first pandemic virus isolation in a cat, and it doesn't appear the cat spread the virus. [Nov 4 IDPH press release]

Canada's chief public health officer, Dr David Butler-Jones, said yesterday that the country's Glaxo plant has exported excess bulk pandemic H1N1 vaccine antigen, the CTV and the Canadian Press reported today. Sources did not say how much antigen had been produced. Butler-Jones said domestic fill-and-finish operations have not yet been able to package all the already-produced antigen for the Canadian market. He said the export would not slow vaccine delivery to Canadians. [Nov 4 CTV story]

Total H1N1 vaccine availability today reached 31.8 million doses, said US Centers for Disease Control and Prevention (CDC) Director Dr. Thomas Frieden at a briefing, up 1.8 million doses from yesterday. "We are therefore on track to hit the 10 million increase that we had been hoping for" this week, though the total is far from satisfactory, he said. He declined to predict when the US will give vaccine doses to developing countries, saying it will depend on clarification of production. [CDC H1N1 information]

This year's uptake of seasonal flu vaccine is "unprecedented" and may set a record, said CDC Director Dr. Thomas Frieden at today's H1N1 news briefing. The CDC expects that 114 million doses will be distributed by the end of the year, but the demand may be greater still, he said. He also said there are signs of a higher vaccination rate than usual among healthcare workers, who usually have only about a 40% immunization rate. [CDC H1N1 information]

Election officials in Virginia, whose citizens vote for governor today, among other offices, are taking steps to avoid transmitting H1N1 influenza. According to the Associated Press (AP), voters will have hand sanitizer available at the polls and possibly cotton swabs or disposable coffee stirrers so they can avoid contact with touch-screen machines. Some sites also have backup election workers on standby. [Nov 3 AP story]

The US Department of Agriculture (USDA) yesterday reported that four samples from Indiana pigs tested positive for pandemic H1N1 influenza. The samples were collected on Oct 22. Indiana's state veterinarian said in a statement yesterday that the animals have recovered and are being monitored. He said workers who had contact with the animals had been sick with flulike symptoms before some of the pigs became ill. [Nov 2 USDA report]

The Saudi Food and Drug Authority approved GlaxoSmithKline's H1N1 vaccine yesterday, according to Reuters, as the kingdom readied for more than 2 million pilgrims at this month's Islamic hajj. The vaccine is distributed under the Pandemrix brand. [Nov 3 Reuters story]

South Africa's National Institute of Communicable Diseases has recommended that South Africa include the pandemic H1N1 virus in its seasonal flu vaccine for next year, according to News24, a South African online news service. Barry Schoub, director of the institute, said it would be up to the nation's health department whether to follow the advice. Reports did not clarify whether the pandemic virus would replace the seasonal H1N1 strain in the vaccine or be added to it. [Nov 2 News24 report]

The US Food and Drug Administration (FDA) published guidance yesterday to help manufacturers develop diagnostic tests for the novel H1N1 influenza virus. Manufacturers of tests can submit a request to the FDA for an Emergency Use Authorization (EUA). If granted, the EUA will allow the test to be used during the H1N1 pandemic. No H1N1 test is currently approved or cleared by the FDA. [Nov 2 FDA news release]

Canada's vaccine advisory group yesterday recommended against delaying seasonal flu shots, a move that many provinces made after an unpublished study suggested the vaccine might raise the risk of contracting pandemic flu, the Canadian Press reported. The panel concluded that even if the finding is valid, the risk of skipping the seasonal shot outweighs the risk seen in the studies. The group also endorsed giving both seasonal and H1N1 shots at the same time. [Nov 1 Canadian Press story]

GlaxoSmithKline is expected to ship far fewer doses of H1N1 vaccine to Canadian provinces this week than was expected, prompting provinces to postpone the rollout of the vaccine for at least 2 weeks, the Toronto Globe and Mail reported. The company was expected to ship 436,000 doses this week, instead of the roughly 2 million previously anticipated, because it had to interrupt production to make an unadjuvanted version of the vaccine for pregnant women, the story said. [Oct 30 Globe and Mail report]

Saudi Arabian health officials said the country will immunize healthcare workers, hajj workers, and domestic pilgrims who will attend the hajj against the pandemic H1N1 virus, Agence France-Presse (AFP) reported today. Vaccination won't be mandatory. About 1 million residents typically attend the hajj, which peaks near the end of November this year. The country recently received the first 11 million doses of its pandemic vaccine order. [Nov 2 AFP story]

Turkey today launched its pandemic vaccination campaign with healthcare workers receiving the first doses, Today's Zaman, an English-language newspaper based in Istanbul, reported. The country received its first 500,000 doses last week. The next groups slated to be immunized are the morbidly obese, pregnant women, children younger than 2, those with chronic lung or heart conditions, and people older than age 65. [Nov 2 Today's Zaman report]

The Afghan government yesterday ordered the closure of all schools for 3 weeks in the wake of the country's first death from H1N1 flu, AFP reported. Education Minister Farouq Wardak said the closure was ordered "to safeguard the health of all Afghans." An engineer from Kabul was the flu's first victim in Afghanistan. [Nov 1 AFP report]

New York governor David A. Paterson yesterday declared a state emergency to permit more health workers to give H1N1 flu vaccinations. Normally only physicians, nurses, and nurse practitioners can do so; the declaration will enable physician assistants, dentists, some dental hygienists, and emergency personnel to participate, the state said in a news release. The action--requested by local governments--also authorizes school-based health centers to vaccinate adults and children. [Oct 29 New York state release]

Dutch scientists suggest that vaccinating children against seasonal flu may make them more vulnerable to pandemic flu strains, according to a Canadian Press report. In a journal article, the scientists wrote that shielding children from the need to generate immunity to actual seasonal viruses might leave them more vulnerable to pandemic strains. But other experts, while not necessarily agreeing, say it's better to protect children from an annual threat than one they may face every few decades. [Oct 29 Canadian Press report]

Though pandemic activity continues to intensify in North America, several European countries are reporting high rates of flu-like illness and pandemic virus detections, including Iceland, Ireland, the United Kingdom, Belgium, and the Netherlands, the World Health Organization (WHO) reported today. Many other countries in Europe and western and central Asia are reporting early flu transmission. Flu activity is up sharply in Japan. At least 5,712 deaths have been reported, up 713 from last week. [Oct 30 WHO pandemic update]

Swiss regulators today restricted the use of an adjuvanted pandemic H1N1 vaccine made by GlaxoSmithKline in pregnant women, children, and people older than 60, Agence France-Presse (AFP) reported. The agency held back its authorization for the groups because it has little data on the vaccine's use in children and no data for pregnant women. It endorsed one of two pandemic vaccines made by Novartis and is still examining the company's cell-based pandemic vaccine. [Oct 30 AFP story]

Flu activity at US colleges has increased significantly, showing spikes even in some areas such as the southeast that have reported decreases over the past few weeks, the American College Health Association (ACHA) said yesterday. The Midwest, mid Atlantic, and northeast regions also showed unexpected rebounds. The report for the week ending Oct 23 said the rate of flu-like illnesses on member campuses was 28 per 10,000 students, up 34% from the week before. [Oct 28 ACHA surveillance report]

In response spot shortages of the pediatric liquid suspension version of Tamiflu, an official from the US Centers for Disease Control and Prevention (CDC) said today at a media briefing that on Oct 1, 300,000 bottles from the national stockpile were shipped to states. The CDC said more pharmacy chains are compounding the medication and that parents can mix crushed pediatric capsules with a spoonful of, for example, chocolate syrup. [CDC info on mixing Tamiflu capsules, liquid]

Novartis said today it is on track to produce 90 million units of bulk pandemic vaccine antigen to the US market, enough for 60 million doses. It expects multidose and prefilled vial deliveries to reach 25 to 30 million by the end of November. The company has shipped 7.5 million doses. Novartis said early vaccine yield was low, but a new seed strain it began using in mid September is getting a 63% yield. The CDC said today that total US H1N1 vaccine received is now at 24.8 million doses. [Oct 29 Novartis media release]

Fewer than half of New York City parents with children in elementary school have signed consent forms for their children to receive H1N1 vaccine at school, the New York Times reported. Health officials had no citywide figure but said between 5% and 50% of parents have given permission. Possible reasons for parents' reluctance may include vaccine safety concerns and the assumption that some children had the virus in the spring and are now immune. [Oct 29 New York Times story]

The number of students home sick with the flu and the number of school closings have been climbing steadily, the Associated Press (AP) reported. By the end of last week, the number of closed schools reported by the US Department of Education reached 351, affecting 125,000 students. Officials suspected that many closing have not been reported. One especially hard-hit school was St. Charles East High in suburban Chicago, where 800 of 2,200 students were absent. [Oct 28 AP story]

Family physicians in parts of Canada have been slow to sign up to give H1N1 vaccinations, citing various obstacles, the Canadian Press reported. In Ontario, some doctors have been deterred by a requirement that they order vaccine in 500-dose lots, while others objected to a demand that they provide a weekly record of every dose delivered. Some provinces are not asking family doctors to help launch the vaccination drive and instead are focusing on mass immunization clinics. [Oct 28 Canadian Press report]

General practitioners in Britain have said it could take weeks for them to receive H1N1 vaccine supplies, leaving those in priority groups uncertain about when they can be vaccinated, the Daily Express reported. Healthcare workers and hospital patients received their doses last week, and it was expected that vaccination of other priority groups would begin this week. But many doctors have not yet received their doses and don't know just when they will come. [Oct 29 Daily Express report]

Chinese government sources said flu activity is spiking in many parts of the country and clusters of illnesses are occurring in schools, Agence France-Presse (AFP) reported today. China's state council said the country's challenge is grim. The assessment was prompted by the death of a student at a university in Beijing where other students were ill. The fatality is China's fourth from the pandemic H1N1 virus. [Oct 29 AFP story]

The World Health Organization's (WHO's) immunization experts today discussed issues related to the H1N1 vaccine, according to its agenda. The Strategic Advisory Group of Experts (SAGE) was asked if epidemiologic or vaccine-availability issues would alter SAGE's recommendations, how many doses per person are needed, if seasonal and pandemic doses can be co-administered, and if obesity is a risk factor. A WHO spokesman said results of the meeting may be available tomorrow. [Oct 27-29 WHO SAGE agenda]

The cumulative total of H1N1 vaccine doses available reached 23.2 million today, up about 800,000 from yesterday's 22.4 million, Health and Human Services (HHS) Secretary Kathleen Sebelius said at a press conference today. She said about 9 million doses were added to the total in the past week. All 50 states have ordered supplies of vaccine, she reported. [Oct 28 HHS press conference recording]

In the early stages of Los Angeles County's free H1N1 vaccination clinics, overwhelmed staff members vaccinated many people who were not in the vaccination priority groups, the Los Angeles Times reported today. As of yesterday, the county had only enough doses to last through Nov 4 instead of the planned Nov 8, said Dr. Jonathan Fielding, public health director. He said officials didn't want to turn away people who had traveled and stood in line to get vaccinated. [Oct 28 Los Angeles Times report]

Overly cautious policy decisions by the US government are partly to blame for shortages of the pandemic H1N1 vaccine, according to a former Food and Drug Administration official who wrote an editorial for the Wall Street Journal. Scott Gottlieb, MD, said the use of adjuvants could have stretched supplies. He said a focus on single-dose vials has slowed vaccine delivery, as has reliance on outdated egg-based production. [Oct 27 Wall Street Journal article]

Health authorities in Oman said yesterday that they have started the country's pandemic H1N1 vaccine campaign after receiving the first 100,000 doses of its 2.6 million dose order, Agence France-Presse (AFP) reported. For now, priority groups include older people, pregnant women, health workers, and Mecca pilgrims. The vaccine is free for all citizens. To address concerns about vaccine safety, media outlets showed senior officials receiving flu shots. [Oct 27 AFP story]

Veterinary officials in Iceland confirmed the pandemic H1N1 virus in a pig herd after 10 of the animals started showing symptoms such as poor appetite, fever, and coughing, according to a report yesterday to the World Organization for Animal Health (OIE). Investigators are exploring the possibility that humans spread the virus to the pigs; two workers had flulike symptoms before the pigs got sick. The 4,500-pig farm is under quarantine. [Oct 27 OIE report]

Two commentators writing in the New York Times say that using lower doses of flu vaccine in women could improve the vaccine supply without sacrificing protection. Sarah L. Klein, a Johns Hopkins immunologist, and Phyllis Greenbrier, president of the Society for Women's Health Research, point to studies in which women had a significantly stronger immune response to flu vaccines than men did. They say that besides stretching the supply, the step would reduce side effects for women. [Oct 28 New York Times commentary]

Sen. Susan Collins (R-Maine) wrote a letter to HHS Secretary Kathleen Sebelius yesterday asking why there are fewer pandemic H1N1 vaccine doses than officials originally projected. Her letter appeared on the Web site of the Maine Public Broadcasting Network. Collins said shortages are alarming because not all high-risk groups can be vaccinated and the vaccine could arrive too late to prevent infections in many Americans. She asked the HHS to share its latest projections. [Oct 27 letter from Collins to Sebelius]

New York City's health commissioner said today that the city is proceeding with plans to vaccinate schoolchildren against H1N1 flu, according to the New York Times. Dr. Thomas Farley said, "We have 40,000 doses set aside for the first wave of schools, which we feel should be adequate." Free vaccinations will start tomorrow at 125 small public elementary schools. Last week the city had about 300,000 of the 380,000 doses of H1N1 vaccine it had ordered. [Oct 27 New York Times story]

To provide pregnant women earlier access to pandemic H1N1 vaccine, Canada's health minister announced yesterday the purchase of 200,000 doses of an unadjuvanted product from CSL Ltd in Australia, the Canadian Press reported today. Officials are particularly concerned about women in remote communities. The bulk of Canada's H1N1 vaccine is adjuvanted, and its unadjuvanted version awaits approval. Pregnant women are among those at greatest risk for flu complications. [Oct 27 Canadian Press story]

To raise awareness about flu prevention in children, a high-risk group, the US Department of Health and Human Services (HHS) yesterday launched 13 new radio public service announcements. The messages feature Elmo from Sesame Street with 13 of the nation's governors. They urge children to sneeze into the bend of their arm and wash their hands frequently, and they guide parents to have a care plan if schools are closed or children are sick. [Oct 26 HHS press release]

A Minnesota clinic that publicized that it had 17,000 doses of pandemic H1N1 vaccine to administer closed its flu shot phone line yesterday after 120,000 calls in 4 hours swamped the system, the Minneapolis Star Tribune reported. A message on the Park Nicollet Clinic Web site says patients in four high-risk groups are targeted to receive the doses: pregnant women, children ages 6 months through 4 years, children ages 5 years to 18 years with underlying conditions, and first responders. [Oct 27 Star Tribune story]

After Turkey reported its first death from the H1N1 flu, newspapers said the country's health minister urged people not to kiss or shake hands for the next 5 months, Reuters reported today. Schools in Ankara, the capital, were ordered closed for a week after the death of a 29-year-old patient was reported over the weekend. [Oct 27 Reuters report]

European Commissioner for Health Androulla Vassiliou warned yesterday that up to 30% of Europeans could catch the H1N1 virus, according to an Agence France-Presse (AFP) report. Vassiliou told the German newspaper Die Welt that the pandemic would probably cause "a significant number" of deaths. She also said the virus could become more aggressive in coming months and the pandemic could hurt Europe's economic recovery. She advocated the immediate closure of schools where H1N1 cases occur. [Oct 26 AFP report]

Germany began vaccinating health workers and chronically people against H1N1 yesterday amid a continuing controversy over the two vaccines being used, the Associated Press reported. Most Germans will receive a GlaxoSmithKline vaccine, Pandemrix, which contains an adjuvant, while soldiers and high-ranking government employees will get Baxter's Celvapan, a cell-based vaccine with no adjuvant. The plan has sparked concern about the safety of Pandemrix and complaints about a two-class health system. [Oct 26 AP story]