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Data gaps could give distorted picture of swine flu: study

WHO chief tells Britain swine flu vaccine still months away
World Health Organisation chief Margaret Chan cast doubt Wednesday on the British government's plans to start vaccinating from next month those most at risk of contracting swine flu. Chan told the Guardian newspaper that a vaccine would not be available for several months, despite statements from health officials here that the first stocks would start arriving in August. "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," WHO director general Chan said in an interview with the newspaper. "Clinical trial data will not be available for another two to three months," she said. Health Secretary Andy Burnham has said the first batches were set to arrive in Britain in August, and will be eventually be available to everyone. Seventeen people have died after contracting swine flu in Britain, while nearly 10,000 have been confirmed with the virus. A post-mortem examination has established that one of the latest victims, a doctor from Bedfordshire in eastern England, died of causes other than swine flu, officials said Tuesday. Tests were still being carried out on a six-year-old girl who also died, as health officials urged the public to remain calm. Chief medical officer for England Liam Donaldson told the BBC Tuesday that a third of the population may catch swine flu this winter, and the virus could be here for up to five years. "The virus will not just be here for one winter -- previous pandemics have been around three, four five years," he said. The World Health Organisation said all countries were going to need vaccines against the virus because the swine flu pandemic was now unstoppable. With the global death toll from A(H1N1) now reaching at least 429, WHO director of vaccine research Marie-Paul Kieny said Monday that a vaccine should be available as early as September.
by Staff Writers
Paris (AFP) July 15, 2009
Sketchy or distorted data could cause misleading early judgements about the threat posed by swine flu, experts writing in the British Medical Journal (BMJ) said on Tuesday.

According to the UN's World Health Organisation (WHO), 94,512 cases of A(H1N1) influenza have been reported, causing 429 deaths.

These suggest a case fatality ratio -- the proportion of deaths in the number of people known to have fallen sick -- of around 0.5 percent, which is in the upper range for run-of-the-mill seasonal flu.

Imperial College London epidemiologists caution against "simple interpretations of these crude figures" to those grasping for a yardstick of the virus's severity.

While not saying that the novel flu is any less -- or any more -- virulent than thought, the researchers point to "biases" in data collection.

It could be some time before the world gets a more accurate fix on the viral threat, they say.

One problem they note is the data trawl does not include people who catch the virus but who do not fall sick, or those who feel only a little under the weather and so do not bother to consult a doctor.

As a result, many more people may have been infected by the virus than is known, which brings its lethality index down.

Another curiosity is a large discrepancy in fatalities reported between countries. Mexico has the highest death ratio, with 119 out of 10,292 cases, which is more than twice the average reported in Canada, the United States and Europe.

One theorised explanation for this is that a nastier form of the virus could be circulating in Mexico, say the researchers.

But another could be that Mexican doctor are simply focussing on the severest cases, which means that the true number of infections is higher.

If so, swine flu's case fatality ratio could be much lower than thought and comparable to ordinary flu.

On the other hand, there is likely to be a rise in the number of fatal heart attacks and strokes that are linked to influenza, and these may go largely unreported, says the paper.

Looking at future surveillance of the pandemic, the authors plead with health authorities to speed up reporting data.

One area of worry is the time gap between the onset of flu infection and knowledge of the outcome.

In other words, a watchdog is notified at first that someone has fallen sick with the disease but only later will it be told whether the patient has died or survived.

The delay can have important repercussions for managing the pandemic.

One worry is that the present strain of swine flu will mutate, picking up genes from ordinary viruses that could make it more virulent as well as contagious.

Yet the added virulence factor will only show up when data reveal that the case fatality ratio has suddenly ratcheted higher. That key piece of evidence could be masked if there is a long delay in reporting patients' outcome.

"Given the expectation that antigenic drift or viral reassortment with co-circulating seasonal influenzas may well change the severity of the new influenza virus over the coming months, it is especially important that these biases are minimised," the paper warns.

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Countries plan for mass vaccinations against swine flu
Rome (AFP) July 14, 2009
The "unstoppable" swine flu pandemic Tuesday raised fears of millions of cases by next year and countries talked about mass vaccinations, while South America sought a united front to combat the disease. Italy predicted it may have dealt with between three and four million cases of swine flu by March 2010, the country's deputy health minister Ferruccio Fazio said Tuesday. He added that by ... read more







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