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EPIDEMICS
Jury still out on swine flu handling a year on

H1N1 virus still holds threat: scientists
Paris (AFP) April 21, 2010 - There may be many people who believe that as its first anniversary looms, this is a great moment to consign swine flu to the Book of Great Health Scares. To them, virologists sound a word of caution. Yes, they admit, rather chastened, the novel virus did turn out to be less nasty than many predicted. Possibly hundreds of millions have been infected by the bug, officially known as 2009 H1N1 influenza, since it was officially notified on April 24 last year. But less than 18,000 have been killed by it, according to the UN's official death toll. That places it in roughly the same ballpark of lethality as a routine, or "seasonal," flu virus.

H1N1 thus bears no comparison to fellow pandemic viruses that erupted in the last century. These strains scythed as many as 50 million lives in 1918-19 and one or two million each in 1957-8 and 1968-9. Even so, say these and other experts, H1N1 still has devastating potential and the world must maintain its guard. "In the past, more often than not, the first wave (of a flu pandemic) has been overshadowed by the second and third waves," says John Oxford, a professor at Queen Mary's School of Medicine and Dentistry in London. Lone Simonsen, an epidemiologist at George Washington University, notes that in the 1968-9 pandemic, about 70 percent of the fatalities occurred in the outbreak's second year. The theoretical underpinning of this thinking is Darwinian tradeoff. In its early phase, according to this hypothesis, a new virus finds it easy to survive because billions of people have no, or at best limited, immunity to it. But this pool of easy pickings dwindles, which means the virus has a harder time finding a human host. To survive, it has to devise a new foothold.

That means genetic change: the virus changes shape through mutation or trades some of its transmissibility in exchange for greater lethality by picking up genes from nastier flu viruses. As for mutation, very little variation has been seen in the present pandemic strain of H1N1, says virologist Albert Osterhaus of the Erasmus Medical Centre in Rotterdam. It is likelier to drift genetically, as "seasonal" strains do, rather than leap. That is good news for vaccine campaigners. People who were infected by H1N1 or primed with the anti-H1N1 vaccine are likely to get a lot of carry-over immunity for the 2010-11 flu season. Of greater concern, says Osterhaus, is the risk of a gene mix, or reassortment, with other flu viruses. He points to countries where H1N1 co-circulates with H3N2 strain and the notorious H5N1 strain of bird flu, which carries a case fatality rate of some 60 percent.

Osterhaus also voices worry over another genetic risk: the possibility that H1N1 widens a so far rare resistance to oseltamivir. This drug, also called Tamiflu, is the frontline treatment for flu. It is not a cure, but if taken early enough can reduce viral numbers, thus reducing contagiousness and shortening the length and severity of illness. Overall, the news today is reassuring. But given the uncertainties, watchdogs will need to prepare an arsenal of options when the 2010-2011 flu season returns in the northern hemisphere's autumn, says the European Centre for Disease Prevention and Control (ECDC). Epidemiologists will be keeping a close look at the southern hemisphere's winter, from June-September, to see if there is any data that points to a change in target or lethality by the virus. The 2010-2011 vaccine campaign will have to fine-tune recommendations for shielding groups most at risk and concentrate on "countering anti-vaccine messages and campaigns" that scared many people into refusing the jab, says the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
by Staff Writers
Geneva (AFP) April 20, 2010
Last April's discovery of a previously unknown flu virus in Mexico and the United States sparked fears of a deadly pandemic and set off a chain of unprecedented action by health authorities.

But a year on, questions linger as to whether a decision by the World Health Organization to declare swine flu a pandemic, thereby unleashing the slew of health measures, was over-dramatic or even tainted by commercial interests.

"It's a decision which costs huge amounts of money, which frightened people throughout the world unnecessarily," said Paul Flynn, a British parliamentarian who led a Council of Europe inquiry on the issue.

The WHO's decision resulted "in the disruption the changing of priorities in health services which were concentrating on swine flu instead of concentrating on matters which were far more important to save lives," he charged.

Flynn noted that huge sums were spent on anti-virals and vaccines, which went largely wasted as skeptical populations refused to get vaccinated.

In France, for instance, the purchase of 94 million vaccines cost the state around 600 million euros, but only less than 10 percent of the population went to get vaccinated.

"It's a waste," said French senator Marie-Christine Blandin, who compiled a report on the management of swine flu.

While governments rushed to cancel massive vaccine orders as vaccination campaigns fell flat, critics turned to the big winners in the flu episode -- pharmaceutical firms.

Swiss giants Novartis and Roche, for instance, both reported exceptional results last year thanks to the unexpected boost from vaccine or flu medication orders.

Indeed, critics have raised the question of big pharma's influence on the WHO's treatment of the epidemic.

"Everything that mixes money and health is a problem of credibility for the decisions which are taken," said Didier Tabuteau, a professor at the Institute of Political Studies in Paris.

However, many scientists jumped to the defense of the WHO.

"A lot of the criticism is political. I've not heard criticism from any virologist," said John Oxford, a virologist and professor at Queen Mary's School of Medicine and Dentistry in Britain.

After all, the A(H1N1) virus was a new one and it showed rapid spread since its discovery late April.

According to data compiled from health authorities, it was killing more young, healthy people than other seasonal flu viruses -- which tend to be more lethal for the old and vulnerable.

Based on guidelines drawn up on pandemic, the WHO's committee of experts in June therefore recommended that a pandemic be declared.

The move led to a series of action, with countries rushing to stockpile anti-virals and pharmaceutical companies ordered to develop vaccines.

Although the WHO said when declaring the pandemic that it was a "moderate" one, it had also warned against complacency, noting the virulence of a flu such as the 1918 Spanish flu which killed at least 40 million people.

The intensity of the reaction to the flu may also have unwittingly led the public to develop an impression that the flu was more deadly -- like the lethal Spanish flu or bird flu -- than it turned out to be.

This month, as the WHO launched a probe into the handling of the flu, the UN health agency's flu chief Keiji Fukuda acknowledged with hindsight that a better response would have involved "less confusion."

Critics believe that the swine flu episode may have done more harm to the WHO than good.

"The great danger is that the world will say you cried wolf, you frightened us about things that didn't happen and that the authority of the WHO could be undermined," said Flynn.

"If there is a very dangerous virus in future, no one might take notice of the warning and people could die," he added.

The WHO review panel's final overall report on the handling of the pandemic is due to be ready by this autumn.



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EPIDEMICS
Pandemic not over, WHO flu probe hears
Geneva (AFP) April 14, 2010
Experts who planned the global drive against swine flu on Wednesday warned that the pandemic was not yet over and rejected charges they had been unduly influenced by the drug companies. Their comments came at the end of the first meeting of an external review set up by World Health Organisation to probe the much criticised international response to the new A(H1N1) influenza virus over the pa ... read more







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