Swine Flu News - H1N1 Pig Influenza

The live attenuated swine flu vaccine intended for millions of children has dangerous side effects and is genetically unstable, risking generation of new pandemic strains should mass vaccinations go ahead.
Prof. Joe Cummins and Dr. Mae-Wan Ho

This report has been submitted to Sir Liam Donaldson, UK Chief Medical Officer, and to the US Food and Drug Administration Please circulate widely, with all the hyperlinks included, to your elected representatives, wherever you are

The swine flu vaccines being prepared for release to combat the current pandemic will be fast tracked without the usual clinical trials to ensure their safety. Five different companies were contracted to produce vaccines worldwide - Baxter International, GlaxoSmithKline, Novartis. Sanofi-Aventis and AstraZeneca - using a range of technologies from traditional chicken egg production to cell culture [1] ( Fast-tracked Swine Flu Vaccine under Fire , SiS 43).

Most of the vaccines will not contain live virus and will be delivered by injection. However AstraZeneca will produce a genetically engineered live attenuated vaccine through its global biologics unit, MedImmune, using cell culture or eggs [2]. The MedImmune vaccine will be used primarily for children, to be delivered as a nasal spray. The nasal spray vaccine against pandemic H1N1 influenza has been fast tracked for global distribution [3].

The live-attenuated vaccine appears more effective than the inactivated virus vaccine, but it resulted in significantly higher rates of severe adverse events. Furthermore, there is evidence that the live vaccine is highly genetically unstable in warm body cells and that has not been thoroughly evaluated in the children vaccinated .

LEADING infectious disease experts have called on the Federal Government to abandon its mass swine-flu vaccination plan because of fears the vaccine is a contamination risk that could spread blood-borne diseases.

Health Minister Nicola Roxon yesterday announced that the Government would start deploying its first batch of swine-flu vaccine in coming weeks, with an aim to vaccinate as many people as possible to prevent further spread of the virus.

But in a letter sent to Commonwealth Chief Medical Officer Jim Bishop, the Australasian Society for Infectious Diseases expresses deep concern about CSL’s use of multi-dose vials for the vaccine and urged the Government to abandon its plan until it had single-dose vials.

The letter, written by the Society’s president, Associate Professor Tom Gottlieb, says multi-dose vials – bottles containing many doses of the vaccine – had been shown on many occasions to transmit infectious diseases, ”resulting in considerable morbidity and mortality”.

To prevent contamination, clinicians must follow stringent infection-control guidelines and use new syringes and needles for every vaccination.

”Many members are concerned that there is a risk of adverse outcomes if a mass vaccination campaign was conducted using multi-dose vials,” the letter says. It adds that it would be difficult to guarantee proper procedures were followed in hospitals, ”let alone clinics and general-practice units in the community, where there may be a lesser safeguarding of the necessary safe infection-control practices”.

Children report a range of side-effects, but the official advice is that Tamiflu is safe

More than half of children taking the swine flu drug Tamiflu experience side-effects such as nausea and nightmares, research suggests.

An estimated 150,000 people with flu symptoms were prescribed the drug through a new hotline and website last week, according to figures revealed yesterday.

Studies of children attending three schools in London and one in the South West showed that 51-53 per cent had one or more side-effects from the medication, which is offered to everyone in England with swine flu symptoms.

The research by the Health Protection Agency emerged as Sir Liam Donaldson, the Chief Medical Officer for England, said that swine flu infections “may have reached a plateau”.

Releasing the latest figures, Sir Liam said that an estimated 110,000 new cases of the H1N1 virus were diagnosed by doctors in the week to Sunday. That did not include those using the new National Pandemic Flu Service for England to obtain antiviral drugs without seeing their GP.

Sir Liam said that the deaths of 27 people in England were confirmed to have been linked to swine flu, compared with 26 last week. As of Wednesday morning 793 people were in hospital in England with the virus, and 81 were in intensive care.

Yesterday Natasha Newman, 16, of Highgate, North London, was seriously ill in hospital in Athens after contracting swine flu while on holiday on the island of Cephalonia. Her parents, Julian Newman and Nikki Boughton, were at her bedside at the Agia Sofia children’s hospital, said a spokeswoman for Mr Newman’s business, J. Newman Textiles. “This is a very distressing and worrying time,” she said.

An apparently healthy six-year-old girl from west London has died of swine flu. She is the first child in Britain without underlying health problems to be killed by the virus.

Chloe Buckley, who lived in West Drayton, died at St Mary's Hospital in Paddington a day after her doctor is reported to have wrongly diagnosed her illness as tonsillitis.

It is alleged that Chloe was taken to her GP with a sore throat on Wednesday but was sent home without being prescribed antiviral flu drug Tamiflu. Her condition deteriorated overnight and her parents Michael, 40, and Jacinta, 37, rushed Chloe to Hillingdon Hospital in Uxbridge on Thursday morning.

She was transferred for emergency treatment to St Mary's but died a few hours later. She was due to celebrate her seventh birthday on Friday.

Sara Benn, headteacher of St Catherine's RC primary school where Chloe was a pupil, said today: "It is impossible to put into words the sorrow that the whole school feels in such tragic circumstances.

"Chloe was a bright and tenacious student with a keen interest in sports and will be missed by her fellow pupils and teachers at the school. Our thoughts are with the parents and family at this time. We are working with the council and health authority to support parents and pupils dealing with this devastating news."

Provisional tests revealed Chloe had contracted swine flu and a post-mortem examination being carried out today is expected to confirm the cause of death.

Chloe is only the second person in Britain to have died of the illness despite not suffering any other health issues. Her death will spark widespread fears that the virus is increasingly potent. A mother with a child at the same school said today: "Chloe was fit and healthy and in school on Monday and Tuesday. By Wednesday she had developed a very sore throat and her mother took her to the doctor.

WASHINGTON  — The U.S. military wants to establish regional teams of military personel to assist civilian authorities in the event of a significant outbreak of the H1N1 virus — the swine flu — this fall, according to Defense Department officials.

The proposal is awaiting final approval from Defense Secretary Robert Gates.

The officials would not be identified because the proposal from the U.S. Northern Command’s Gen. Victor Renuart has not been approved by the secretary.

• Saint Louis University has received more than 500 responses since Wednesday
• Thousands of Americans being recruited for trials in dozen of sites across nation
• Patients will be asked to keep progress while they are monitored for two months
• Doctor says virus could sicken one in five people this fall and peak in October

Days after the U.S. government announced upcoming trials for an H1N1 flu vaccine, Saint Louis University has been inundated with phone calls and e-mails from people volunteering for the study.

The university's Center for Vaccine Development has received more than 500 responses from potential volunteers since Wednesday, when the National Institutes of Health (NIH) announced human trials for a swine flu vaccine would begin in early August.

"This response has been exceptionally strong," Nancy Solomon, a spokeswoman for the university's medical center, told CNN Radio. "We haven't had that strong of a response to our call for volunteers since we conducted our small pox vaccine research after September 11."

Thousands of Americans are currently being recruited for swine flu vaccine testing at several research centers across the country, including Saint Louis University's Center for Vaccine Development.

"The federal government comes to us when they need a quick response to test the safety and efficacy of vaccines," Solomon said.

Other trial sites include the University of Maryland Medical Center in Baltimore; Baylor College of Medicine in Houston, Texas; Cincinnati Children's Hospital Medical Center; Emory University in Atlanta, Georgia; Group Health Cooperative in Seattle, Washington; The University of Iowa in Iowa City; and Vanderbilt University in Nashville, Tennessee.

Instead of picketing, public health staff should be preparing for 2nd wave of swine flu

Toronto will see more deaths from the global H1N1 pandemic because of the civic workers' strike, warns the head of infection control at Mount Sinai Hospital.

"The bottom line is more people will die," microbiologist Dr. Allison McGeer, a respected authority on pandemic planning who has consulted for all three levels of government on the issue, said yesterday.

On the picket line are as many as 1,800 unionized employees from the Toronto Public Health Unit, which is supposed to be playing a critical role in the battle against the H1N1 influenza virus, particularly in planning for the second wave, which is feared to hit North America in September with a vengeance.

"We are already in trouble. Now we've got 26 days of work that hasn't been done," McGeer said.

Instead of being on the picket line, public health nurses, doctors, epidemiologists and other health unit staff should be providing pandemic management advice to school boards, long-term care facilities, jails, the Toronto Police Service, Toronto Fire Services and other essential services, she said.

They should be tracking the spread and severity of the virus, following up on cases where people have tested positive, and making plans for the establishment of vaccination clinics and flu assessment centres.

They should be organizing ways to help the homeless, shelter residents and people who don't have family doctors. And they should be ensuring that plans are in place to quickly communicate updated pandemic response instructions to the general public and to health-care providers.

"We are expecting them to have spent the summer doing this. ... They are the experts in pandemic planning," McGeer said.

A senior adviser to the Government has moved to calm concerns over the swine flu vaccine after questions were raised about whether it will have been sufficiently tested before it is used.

Professor Sir Gordon Duff, co-chairman of the Scientific Advisory Group for Emergencies, said the benefits far outweighed any potential risks.

The first deliveries of the vaccine are expected in August. But a spokesman for the European Medicines Agency told The Independent newspaper: "What the manufacturers will be submitting will not have any clinical trial data."

He added: "We expect the interim adult data from September and the first paediatric data from October onwards."

The Department of Health said the vaccine would be safe and warned that any suggestion otherwise would create unnecessary panic.

Sir Gordon, who is also chairman of the Scientific Pandemic Influenza Advisory Committee, told the Press Association: "We are content that benefits far outweigh the risks."

He said the companies preparing the vaccine had been working on "core" vaccines which had been tested on 6,000 people.

"In a pandemic, you can't predict what the virus is going to be, so to make a vaccine you use a similar virus. These core vaccines have been tested on 5,000-6,000 people already, with no serious adverse effects.

"It is inconceivable that in the UK we would consider a vaccine without giving a full scientific appraisal of its benefits and theoretical risks. That is just what these risks are - theoretical."

The four children are being treated in a Beijing hospital and are all said to be in a stable condition. The youngsters had just started a visit to the country to learn about Chinese culture and language when they were found to be suffering from the disease.

Three of the four children, aged 14 to 15, were found to have high temperatures when they arrived in Beijing earlier in the week. They were taken straight from the airport to a hospital where it was confirmed they had swine flu. A fourth classmate fell ill later in the week.

The group of 52 children and teachers, which is being quarantined at a four star Beijing hotel, is made up of mostly 14-year-olds from schools across England on a visit organised by the Confucius Institute, which promotes Chinese language and culture.

Their parents have been told that the quarantine should last a week. The students were part of a 1,000-strong group of visitors to China from across the world learning about the country’s language and culture.

More than 500 Britons were understood to be on the trip organised by the Specialist Schools and Academies Trust, the Department for Children, Schools and Families, the British Council and Chinese organisation Hanban.

Among the children kept in quarantine was 15-year-old Lucy van Amerongen, a pupil at Cheltenham Ladies College who last year published a guide to teenage slang for parents.

"In a move that caught many public health experts by surprise, the WHO quietly announced Thursday that it would stop tracking swine flu cases and deaths around the world," the New York Times reports. According to the newspaper, the announcement "perplexed some experts, and even baffled a WHO spokesman, Gregory Hartl," who "earlier in the day … had confirmed Argentina, with 137 swine flu deaths since June, had surpassed Mexico, where the epidemic began in February, as the country with second largest number of swine flu deaths." While the last WHO updated indicated nearly 95,000 people worldwide had been infected with H1N1, "[m]any epidemiologists have pointed out that, in reality, millions of people have had swine flu, usually in a mild form, so the numbers of laboratory-confirmed cases were actually meaningless" while tests "overwhelmed national laboratories," according to the New York Times (McNeil, 7/16).

The WHO has asked countries who have yet to confirm cases of H1N1 (swine flu) to report their first cases to the organization and advises countries to watch for unexpected clusters of severe or fatal cases of H1N1 or "unexpected, unusual or notable changes in patterns of transmission" (WHO Pandemic (H1N1) 2009 briefing note 3, 7/16).

Obama Releases $1.8B To Prepare U.S. For H1N1

President Obama on Thursday released $1.825 billion for emergency use to enhance the capabilities of the U.S. to prepare for H1N1, Reuters reports. The money - that comes "from $7.65 billion Congress already appropriated to the Department of Health and Human Services for the swine flu pandemic" - "will go to buy vaccine ingredients, to help health officials plan immunization campaigns and to help get the vaccines approved at the U.S. Food and Drug Administration, Obama said in a letter to House of Representatives Speaker Nancy Pelosi," the news service writes (7/16).

Albertans can expect a spike in the reported number of severe swine flu cases and smaller volumes of mild infections as the province shifts its monitoring efforts toward patients who are hospitalized with the virus, health officials said Friday.

As Ottawa announced it will stop releasing data on individual cases, Alberta Health said it has already directed physicians and laboratories in this province to focus on testing serious respiratory illness.

The provincial Health Department said it has learned what it can about the mild cases of H1N1 influenza and, with limited lab resources, it's now emphasizing monitoring of serious infections and events such as "clusters" of cases.

Alberta has had 1,401 confirmed cases of the virus, including 509 in the Calgary area, and three deaths related to H1N1.

"You will start to see lower numbers of confirmed cases and you'll see the hospitalized cases going up strictly because that's where we'll be focusing our attention," said John Tuckwell, a spokesman for Alberta Health.

"What we need to learn about now is the severe cases and how they will differ from seasonal influenza."

The comments follow the Public Health Agency of Canada's announcement it's boosting surveillance of the overall "extent and severity" of the outbreak, including unusual activity like increased hospitalizations, instead of releasing individual confirmed cases of H1N1.

The new influenza virus, which first emerged in Mexico this spring and has since been declared a global pandemic, has infected more than 10,000 Canadians, killing 45.

Reports this week have suggested international efforts to produce a vaccine against H1N1 have hit a snag and large quantities of the shots may not be available at the start of the fall flu season.

On Friday, Health Minister Leona Aglukkaq said Canada remains on track in its development of a vaccine for the virus.

The State Government is urging people to wash their hands as it was revealed a vaccine to fight the deadly swine flu is still several months.

Queensland now has Australia's highest number of swine flu cases with 3468 confirmed cases - climbing by more than 1000 cases since last week.

But the state's chief health officer Dr Jeanette Young said the actual number, when including unreported cases across the state, was thousands higher.

The Government will today launch a $700,00 public hygiene campaign, telling people to wash their hands to stop the spread of the flu.

It will use billboards and posters, plastered in shopping centre toilets, universities, cafes and railway stations.

"The message that we are launching this weekend is that 80 per cent of common infectious diseases are spread by hands," Dr Young said.

She refused to speculate on how many the swine flu toll could rise by, but Federal Health Minister Nicola Roxon said 6000 Australians could be killed by the virus this winter if no preventative action was taken.

The national swine flu death toll stands at 31 people, with 14 in Victoria, 10 in NSW, two each in the Northern Territory and South Australia and one each in Queensland, Tasmania and WA.

There are 35 flu patients in Queensland hospitals, including 13 people in intensive care.

With more than 200 new cases in Queensland each day, 50 extra ventilators would be delivered to hospitals, Dr Young said.

Emergency room doctors have told The Sunday Mail some hospitals were close to activating pandemic plans such as cancelling elective surgery as they struggle to deal with the extra workload at a time when the seasonal flu already puts them under strain.

One doctor said the strain was enormous and only a freeze on elective surgery to free up beds would help the situation.

An outbreak of swine flu – declared as the first global pandemic in four decades by the World Health Organization – has struck locally.

Michael Lester, 31, of 525 Lincoln Ave. in Lake Wales, passed away at 6:17 p.m. Thursday evening, according to family members who confirmed he had been diagnosed with the H1N1 virus several weeks ago. He had been in intensive care at Winter Haven hospital during much of that time, the family and a medical source close to the situation confirmed to The News.

According to a family member, he visited his own physician June 22, and the following day was taken to the emergency room at Winter Haven Hospital as his illness worsened.

He is the 16th person in the state to have died so far due to the swine flu illness. According to the Centers for Disease Control, more than 40,000 cases nationally have been confirmed, and the U.S. death toll as of yesterday was 263.

In a week that has seen the British swine flu death toll reach 29 and it is estimated that 55,000 people have caught the virus, hospitalizing 652 of them, the National Health Service (NHS) has received instructions to plan for the death toll reaching up to 65,000.

On Thursday, the UK's Chief Medical Officer (CMO), Professor Sir Liam Donaldson, who is also the professional head of all medical staff in England, told the NHS to plan for between 19,000 and 65,000 swine flu deaths occuring this winter.

He stressed that the figures are not predictions but "worst case scenarios" to enable health authorities to plan. He explained that there haven't been enough cases to produce proper estimates.

According to a report in the Telegraph yesterday, some GPs are seeing up to 60 cases of suspected swine flu a day, and leading doctors have suggested putting routine operations on hold in order to give priority to swine flu patients.

The Department of Health said in its weekly flu update yesterday that GPs are seeing flu patients at a rate that is "above the threshold level for normal seasonal flu activity and higher than the peak activity in winter 08/09".

The number of deaths to swine flu in the UK has doubled in a week, from 14 to 29. The latest victim was a six-year-old boy from Kent who died on Wednesday.

According to the Department of Health, the swine flu is affecting predominantly the under 5s and 5-14 year olds.

A BBC report said that in the worst hit areas, hospitals are reporting having wards full of children with swine flu.

Half of all children could be infected during the first major pandemic wave, said Sir Liam.

Meanwhile the police authorities in the West Midlands have said that the pandemic poses a greater threat to the country than terrorism.

• Saudi authorities concerned 2009 Hajj season will facilitate swine flu spread
• Annual pilgrimage to Mecca attracted nearly two million visitors in 2008
• Total number of swine flu cases stand at nearly 100,000, according to WHO

Two Hajj pilgrims from Iran have contracted the H1N1 virus, according to reports from the country's official news agency.

Iran's official Fars news agency Wednesday reported that a 57-year-old woman and a 24-year-old man who had recently returned from a pilgrimage tested positive for the H1N1 virus, also known as swine flu. This brings Iran's tally to three cases.

Every year about two million Muslims go on pilgrimage to Mecca -- the holiest place in Islam. As well as the annual Hajj pilgrimage, which all Muslims are required to make at least once if they can afford to, the faithful can also make a lesser pilgrimage to Mecca, known as umra, at any time of the year.

The latest cases highlights concerns that the Muslim pilgrimage will hasten the spread of swine flu.

In June, host country Saudi Arabia held a workshop where health officials recommended that pregnant women, children and elderly people with chronic illness should not attend the pilgrimage this November.

In addition, officials are recommending that visitors to the country receive a seasonal flu vaccine at least two weeks before traveling to the holy places.

Gregory Hartl, Team Leader for WHO's H1N1 Communications told CNN: "We are distributing to all countries the advice that Saudi Arabia itself has put out for Hajj season."

Rates of infection in the Middle East, however, are still relatively low standing at just over 1100 cases, with no reported deaths. And in Saudi Arabia the total number of reported infections currently stands at just 114.

On Monday, the country shut an international school after 20 students were diagnosed with the Influenza A(H1N1) virus.

Doctors are to be allowed to issue "fast-track" death certificates under Government plans to help the health system cope with the workload at the height of the swine flu pandemic.

Sir Liam Donaldson, Chief Medical Officer for England, confirmed the planned move in an interview on BBC's Newsnight.

"We want to try and reduce as much as possible the burden of work on doctors and we're considering all sorts of things which wil help with that," he said. "It's one of a number of things that we hope at the height of the pandemic - which we may see in the autumn and winter - will reduce the burden of paperwork for doctors."

But Sir Liam, the Government's principal advisor on public health issues, disputed a report from researchers at Imperial Collge London suggesting that 0.5 per cent - or one in 200 - of those who are ill enough to seek help for swine flu will go on to die as a result of it.

That projection means that there could be as many as 500 people a day dying of the virus by the end of August, by which time, according to the Health Secretary Andy Burnham, the daily infection rate could have hit 100,000.

"The range that we're working with is lower than the Imperial College predictions," Sir Liam said. "But the point is that nobody can be absolutely sure what level of mortality we'll actually see. It's very early days."

Separately, Sir Liam disputed comments from Dr Margaret Chan, director-general of the World Health Organisation, who cast doubt on minister's claims that the UK would start receiving its first stocks of swine flu vaccine this summer.

Dr Chan told the Guardian that a vaccine could be available as early as August. "But having a vaccine available is not the same as having a vaccine that has been proven safe," she added. "Clinical trial data will not be available for another two or three months."

Tennessee has had its first death from swine flu, state health officials confirmed.

The death was of a male and was earlier this month, it was stated.

To date, there have been 246 confirmed cases of the novel H1N1 virus in Tennessee with the one reported death.

State health officials said, "Tennessee continues its efforts to ensure the health of state residents during the flu pandemic. Late last week, state officials from the Departments of Health, Education and Homeland Security participated in the 2009 Flu Summit organized by the United States government, where federal planning and response efforts were discussed."

BASEL (Switzerland): Swiss pharmaceuticals company Novartis AG said on Friday it has successfully produced a first batch of swine flu vaccine weeks ahead of expectations.

The vaccine was made in cells, rather than grown in eggs as is usually the case with vaccines, the company said.

The announcement comes a day after the World Health Organization declared swine flu, also known as A(H1N1), a pandemic. The move indicates that a global outbreak is under way. WHO says drugmakers will likely have vaccines approved and ready for sale after September.

Novartis said it would use the first batch of vaccine for pre-clinical evaluation and testing. It is also being considered for clinical trials, the company said.

The vaccine was produced at a Novartis plant in Marburg, Germany. Novartis said the facility could potentially produce millions of doses of vaccine a week.

A second plant is being built in Holly Springs, North Carolina, the company said.

Novartis said more than 30 governments have requested vaccine supplies, including the US Department of Health and Human Service, which placed a USD 289 million order in May.

VANCOUVER - Vancouver's Olympic organizers say they won't be at the front of the line if a vaccine against swine flu becomes available before the 2010 Games.

But they are concerned that delays in production of the vaccine could impact the Winter Olympics.

"If it was produced at the same rate as the seasonal flu we would have been fine, but now we have meetings coming up and we'll have our plans completed by the end of August,'' said Dr. Jack Taunton, the chief medical officer for the Olympic organizing committee, known as VANOC.

Vaccine manufacturers have been reporting that they are getting a low yield of vaccine viruses from the existing seed strains.

If the yield cannot be increased, it will slow the rate at which pandemic vaccine is produced, adding to the time it will take to protect populations in countries like Canada that have purchased vaccine.

"We have our own Tamiflu and we're stockpiling that, and we have our own seasonal flu in order,'' said Taunton.

"What we're awaiting now is in terms of getting first, the Canadian supply from the World Health (Organization) . . . . and then how much normally would Vancouver Coastal Health and the Ministry of Health get and out from that, what is our proportion?''

Taunton said VANOC would look into vaccinating all of its 25,000 volunteers as well as its staff, though he added they can't force anyone to take the vaccine, only recommend it.

Athletes are being looked after by their own national Olympic committees, though Taunton said that VANOC was already talking to them about how they might be able to obtain the vaccine.

The World Health Organization said earlier this week that health care workers should be the first to get access to the vaccine and Taunton said organizers had no plans to butt in line.

"We know that there are other priorities,'' he said.

The emergence of the H1N1 virus, or swine flu, in April has highlighted the influenza virus's ability to constantly change. Natural and selective pressures allow the virus to evolve in ways that make it increasingly resistant to anti-viral drugs. The loss of immunity to the virus requires annual reformulation of vaccines to prevent against potentially pandemic strains.

In an effort to address the ongoing H1N1 pandemic and to prepare against future ones, leading influenza experts from around the world will gather at the University of Georgia for the third annual "Immunobiology of Influenza Virus Infection" conference at the University of Georgia Center for Continuing Education Conference Center and Hotel on July 26-28.

The multi-disciplinary conference will provide a forum for virologists, immunologists and vaccine researchers from academia, government and industry to discuss advances in basic and applied influenza research. It is organized by Andrew Park in the Odum School of Ecology, as well as Georgia Research Alliance Scholar Ralph Tripp and Professor S. Mark Tompkins in the College of Veterinary Medicine's department of infectious diseases.

"While the original program for the conference was prepared prior to the H1N1 virus outbreak, many of the speakers have been involved in the response to the outbreak and the format has allowed us to include cutting edge research on the pandemic virus," said Tompkins.

A particular aim of this year's conference is to advance the use of mathematical modeling tools to predict the behavior of influenza virus and its interaction with hosts and the environment, added Tompkins.

The world's top health official said on Wednesday a vaccine to combat the surging swine flu pandemic would not be readily available for months as the number of deaths from the virus spiralled.

The comments by World Health Organization chief Margaret Chan came as Australia and Japan reported a surge in cases of the A(H1N1) virus, and Argentina dramatically upped its death toll from 94 to 137 in just three days.

"There's no vaccine. One should be available soon, in August. But having a vaccine available is not the same as having a vaccine that has proven safe," Chan told Britain's Guardian newspaper.

"Clinical trial data will not be available for another two to three months," she added, contradicting health officials in Britain and elsewhere who said the first stocks would start arriving in August.

WHO director of vaccine research Marie-Paul Kieny, calling the pandemic "unstoppable", had said on Monday that a vaccine would be available as early as September.

Germany said it envisaged having to order some 25 million doses of vaccine to immunise nearly a third of its population.

Australia, the Asia-Pacific region's worst-hit country, has already placed an advance order for 21 million doses -- enough to immunise its entire population.

Australia and Argentina are now in the southern hemispheric winter, and officials fear a major rise in infections when the northern hemisphere enters the colder months and regular influenza becomes rampant.

Italy may have to deal with between three and four million cases of swine flu by March 2010, deputy health minister Ferruccio Fazio said.

He said that by the end of this year some 8.6 million Italians would have been vaccinated against the A(H1N1) virus, with priority given to the most vulnerable and to emergency workers.

AS IF people struggling with obesity did not have enough to worry about, they now face a new health hazard. According to statistics from the US, overweight people appear more likely to die of swine flu.

Most of the people who have died from H1N1 swine flu have had an underlying health problem that weakened their ability to fight off the virus. Among the conditions recognised as increasing the risk from flu are hypertension, diabetes, chronic lung obstruction and coronary disease. Now it may be time to add obesity to the list.

Unpublished figures reported at a recent meeting of the US Centers for Disease Control and Prevention in Atlanta, Georgia, show that of 99 people who died in the early stages of the pandemic in the US, 45 per cent were obese. As only 26 per cent of US adults are obese, this suggests that obesity doubles the risk of getting seriously ill with swine flu (see chart).

The figures surprised most flu researchers. "In 40 years of studying flu, I have never heard anything about obesity," says virologist John Oxford of Barts and The London School of Medicine and Dentistry, University of London. Obesity specialists, however, say it fits with what they have learned in recent years.

The number of confirmed cases of swine flu rose by 40 nationally yesterday, to 2025, but there were no more reports of deaths related to the illness.

At Dunedin Hospital, no patients admitted were known to have the illness, Otago and Southland District Health Boards H1N1 incident controller Leanne Samuel said yesterday.

Late last week, the hospital limited visiting to wards 8C (cancer), 7A (respiratory), the children's ward and the Queen Mary Maternity Centre to arranged visits, asking prospective visitors to report to the patient inquiries desk in the main foyer before proceeding further.

Ms Samuel said there had been a few teething issues around this, but it was expected that once communications were refined more people would comply.

This week, the World Health Organisation's Strategic Advisory Group of Experts (Sage) on immunisation issued guidelines on vaccine use, although at this stage no vaccine is available.

In New Zealand, 300,000 doses of what is expected to be a two-dose vaccine have been ordered in advance, but it is not expected they will be licensed for use before late December, deputy director of public health Dr Fran McGrath said.

Most people with the illness had found it to be mild, but if it became more severe it would be possible for Medsafe to shorten its licensing programme to accommodate that, but at this stage this did not seem likely.

The WHO recommendations were that countries should immunise their health care workers as a first priority and New Zealand's pandemic planning would comply with that.

No decisions had been made about whether the vaccine might be offered to people other than front-line health workers and those in other emergency services.

The effectiveness and safety of the vaccine would need to be known before further decisions on its availability would be made.

Last week’s news that the Novel H1N1 flu virus, formally known as the swine flu, had finally hit Lassen County served as a reminder to residents that the virus is still a concern, if only a moderate one.

After confirming a 57-year-old Lassen County woman is the first in the county to be hospitalized with a confirmed case of Novel H1N1 virus, Lassen County Public Health Nurse Laura Warren said residents should continue to take the same precautions recommended for seasonal flu to avoid coming in contact with the virus.

These precautions include common sense flu-prevention measures like covering your mouth when coughing or sneezing, keeping hand sanitizer at the ready, and frequent hand washing, said Warren.

Plumas, Tehama, Butte and Humboldt counties have also reported confirmed cases of Novel H1N1, which Warren said is normal as the virus circulates the northern part of the state in the same manner as other respiratory viruses.

As of press time, there are 1,658 confirmed cases in California, with only 233 of those cases requiring hospitalization. Twenty-three have died, though all with a previous underlying condition.

According to the Centers for Disease Control and Prevention, experience with the virus, dubbed a “novel” virus because it is a virus that has never previously infected humans, is limited and health officials are currently working to better understand and control the spread. The CDC has developed a simple diagnostic test kit to detect the H1N1 virus and has distributed test kits nationwide. A vaccine is also in the works, though it may not be available for several months, according to the CDC Web site.

The number of people suffering from the symptoms of swine flu has risen by nearly 50 per cent in a week.

The highest rates of reported illness are in children aged five to 14, according to a data sample of GPs’ surgeries.

The report shows that up to 40,000 people visited their doctor last week with flu-like symptoms in England and Wales.

Alarm: Parents leave St Catherine's Catholic School in West Drayton after an emergency meeting following the death of pupil Chloe Buckley

Of five-14-year-olds, 160 of every 100,000 in this age group reported symptoms, followed by 114 per 100,000 of 0 to four-year-olds.

Across all all age groups, the rate of people with symptoms increased to 73.4 cases for every 100,000, compared to 50.3 cases per 100,000 the week before.

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This is a 46 per cent rise, The Times Online reports.

The figures, from the Royal College of GPs (RCGP), are based on a sample of 84 doctors’ surgeries across the country.

Although they do not provide a total of confirmed cases of swine flu, they are used by the Government as an official measure of how the outbreak is spreading.

OKLAHOMA CITY -- Oklahoma's new Commissioner of Health said the state is not prepared for a full-blown swine flu outbreak.

Dr. Terry Cline, who took over as Oklahoma's top health official on June 30, said it's not time to sound the alarm about swine flu.

But Cline said the continued spread of the swine flu virus during summer months when the state generally does not experience influenza cases is troubling.

Cline said it could lead to a very difficult flu season. And, he said, the state needs to be as prepared as possible.

Cline said health professionals are already gearing up for a possible outbreak. He said they should plan to rapidly administer thousands of doses of the swine flu vaccine in case of a pandemic this fall or winter.

The Public Health Ministry has ended daily updates on the type A (H1N1) influenza pandemic, saying it wants to avoid public confusion.

The virus claimed another life yesterday, as a health specialist attributed a recent increase in new infections to better reporting rather than increasing prevalence of H1N1.

Disease Control Department director-general ML Somchai Chakrabandhu said new cases of flu, normally reported daily on the Public Health Ministry's website, http://www.moph.go.th, now will be updated every Wednesday.

"We will give weekly updates instead, to avoid confusion," he said.

The department has also decided to change the process of laboratory testing for A (H1N1).

Tests now will be done for severe cases and sampling cases only.

ML Somchai said lab tests mean nothing at the moment because 80% of people with flu symptoms probably also have the H1N1 virus.

"We have over 5,000 samples pending for tests, and we assume most are infected with A (H1N1).

"Lab staff have been overworked, so we plan to get a lab confirmation test only in severe cases or risk groups, to provide faster treatment," he said.

Deputy Public Health Minister Manit Nopamornbodee promised not to withhold any information.

He said the daily updates were scrapped to avoid confusion among the public.

Some hospitals which are not under the ministry and some private hospitals did not report infections.

"Health officials will check every hospital for information. We will not withhold or hide information about flu casualties," he said.

More than 2,100 people yesterday called the ministry's around-the-clock hotline service to inquire about the pandemic.

Deputy permanent secretary for public health Paichit Varachit said most callers wanted to know about symptoms and treatment.

The ministry expects to receive two million doses of A (H1N1) vaccines from Sanofi Pasteur, a pharmaceutical company, in October.