Influenza A(H1N1)v infection - Update 27 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 27 June 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 70 new cases were reported in EU and EFTA countries;
• 1673 new cases were reported from non-EU and EFTA countries;
• The total of fatal cases worldwide is 312;
• 6 new fatal cases have been reported by the Canada (2), Argentina (3), and Australia (1) since yesterday.
  

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 27 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

The number of EU and EFTA countries reporting cases is 29 out of 31. In the past 24 hours, 70 new cases were confirmed in 9 EU and EFTA countries (Table1).

The cumulative number of cases in the EU and EFTA countries is now 6092, including one death.

Outside of the EU and EFTA countries, a total of 63 747 cases, including 311 deaths, have been reported, representing an increase of 1673 from yesterday (Table 2). There were only 6 new deaths, considerrably less than the 48 new deaths that were reported yesterday worldwide; however, yesterday’s increase was predominantly due to the weekly batch reporting by the USA (40).


Recent developments in the UK

Reports in the Media of Changing Policy on Delaying to Mitigation in the UK

A medical correspondent of the BBC this week reported on a press conference given by the Chief Medical Officer and the UK Health Minister on June 25th. This announced the start of a change of policy at least for the parts of the country that are most affected.

The change is moving from attempting to delay spread of the virus in to one of protecting people at higher risk of experiencing severe disease if they are affected. The statement with a link to a video clip of the Minister and CMO is available on the website of the correspondent scrolling down to the part dated June 25th ECDC has considerable guidance on this topic in two formats a longer evidence based document and a shorter health education version for policy makers. As usual ECDC does not make recommendations but puts the arguments for and against. This was also the topic of an ECDC Web Cast this week.


Package of Clinical Guidance for the Pandemic

ECDC neither produces clinical guidance nor endorses specific national guidance. However it does draw to the attention of Member States evidence-based quidance produced by national and international authorities. The United Kingdom has recently produced a package of guidance which it refers to as the Swine Flu Clinical Package

The swine flu clinical package is a set of tools for use in a pandemic situation by frontline healthcare professionals designed to be used during the phase of a pandemic when there is increased demand for clinical care; i.e. they are not intended to be followed immediately. They are also tailored to the way the health services are structured in the UK and so they will not necessarily suit other European Countries. The tools are designed to support and empower those in primary care, emergency health services and hospitals and are designed to assist these health care professionals to assess patients, authorise treatment, refer those with severe illness or complications, and guide treatment of patients in hospital. There is a companion document about managing surges of patients


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 27 June 2009, 17:00 hours (CEST) in the EU and EFTA countries

[Country - Confirmed cases in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

1. Austria ... - 12 - ...
2. Belgium 3 - 40 - ...
3. Bulgaria ... - 7 - ...
4. Cyprus 6 - 20 - ...
5. Czech Republic ... - 9 - ...
6. Denmark 2 - 43 - ...
7. Estonia 1 - 13 - ...
8. Finland ... - 27 - ...
9. France 48 - 239 - ...
10. Germany ... - 366 - ...
11. Greece 3 - 73 - ...
12. Hungary ... - 8 - ...
13. Iceland ... - 4 - ...
14. Ireland 4 - 33 - ...
15. Italy ... - 102 - ...
16. Latvia ... - 1
17. Lithuania ... - 1
18. Luxembourg ... - 3 - ...
19. Netherlands ... - 118 - ...
20. Norway ... - 24 - ...
21. Poland ... - 13 - ...
22. Portugal ... - 9 - ...
23. Romania ... - 23 - ...
24. Slovakia ... - 9 - ...
25. Slovenia 1 - 4 - ...
26. Spain ... - 541 - ...
27. Sweden 2 - 67 - ...
28. Switzerland ... - 33 - ...
29. United Kingdom ... - 4250 - 1

• Total 70 - 6092 - 1

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 26 June 17:00 hours and 27 June 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 27 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h(a) - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Montenegro ... - 1 - ...
2. Serbia ... - 2
3. Russian Federation ... - 3 - ...
4. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 2 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 43 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 7 - ...
6. Israel ... - 375 - ...
7. Jordan ... - 15 - ...
8. Kuwait ... - 26 - ...
9. Lebanon ... - 25 - ...
10. Morocco ... - 9 - ...
11. Occupied Palestinian Territory ... - 9 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia ... - 48 - ...
15. Tunisia ... - 2
16. Turkey ... - 26 - ...
17. United Arab Emirates ... - 7 - ...
18. Yemen ... - 6 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 2
3. Ivory Coast ... - 2
4. South Africa ... - 1 - ...

• NORTH AMERICA

1. Canada 1043 - 7775 - 21
2. Mexico ... - 8617 - 116
3. **USA ... - 27717 - 127

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2
2. Bahamas ... - 4
3. Barbados ... - 10 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 1 - ...
6. Cayman Islands 2 - 9 - ...
7. Costa Rica ... - 222 - 1
8. Cuba 12 - 46 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 226 - ...
12. Guatemala 8 - 262 - 2
13. Honduras ... - 119 - 1
14. Jamaica ... - 19 - ...
15. ***Martinique ... - 2 - ...
16. ****Netherlands Antilles ... - 4 - ...
17. Nicaragua 12 - 277 - ...
18. Panama 45 - 403 - ...
19. Suriname ... - 11 - ...
20. Trinidad-Tobago ... - 25 - ...

• SOUTH AMERICA

1. Argentina 99 - 1587 - 26
2. Bolivia 12 - 59 - ...
3. Brazil 123 - 522 - ...
4. Chile ... - 5186 - 7
5. Colombia ... - 73 - 2
6. Ecuador ... - 125 - ...
7. Paraguay ... - 79 - ...
8. Peru ... - 360 - ...
9. Uruguay ... - 195 - ...
10. Venezuela ... - 153 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 7 - ...
2. China ... - 570 - ...
3. Hong Kong SAR ... - 506 - ...
4. India 7 - 80 - ...
5. Japan 1 - 1049 - ...
6. Korea (South) ... - 142 - ...
7. Macao ... - 13 - ...
8. Sri Lanka 1 - 8 - ...
9. Taiwan ... - 61 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 11 - ...
2. Cambodia ... - 5
3. Indonesia ... - 2
4. Laos PDR ... - 3
5. Malaysia ... - 68 - ...
6. Philippines 134 - 861 - 1
7. Singapore 50 - 365 - ...
8. Thailand 69 - 1054 - ...
9. Vietnam ... - 63 - ...

• AUSTRALIA AND PACIFIC

1. *****Australia ... - 3519 - 5
2. Fiji ... - 2
3. ***French Polynesia 1 - 2 - ...
4. New Zealand 54 - 507 - ...
5. Papua New Guinea ... - 1 - ...
6. Samoa ... - 1 - ...
7. Vanuatu ... - 2

• TOTAL 1673 - 63747 - 311

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (a) Cases reported between 26 June 17:00 hours and 27 June 17:00 hours
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico.
• (***) The cases in Martinique and French Polynesia were reported by France
• (****) Three of the cases are reported to occur in a cruise ship in Curacao.
• (*****) One Australian case reported from a cruise ship.

(...)

-
-----

Blogged with the Flock Browser

Argentina. Video: las distintas caras de la gripe A (H1N1)

Blogged with the Flock Browser

Argentina. Pulmones que se "incendian" en horas - lanacion.com

Pulmones que se "incendian" en horas - Hay pacientes de una gravedad "inusitada"

Sábado 27 de junio de 2009

"Estamos viendo la internación de pacientes jóvenes, de entre 15 y 50 años, con neumonías, algunas que evolucionan rápidamente hacia una gravedad que para muchos es inusitada, en la que el pulmón se «incendia» en cuestión de horas", comentó el doctor Jorge San Juan, jefe del Departamento de Terapia Intensiva del hospital Muñiz.

Eso ha llevado a que los pacientes de estas características comiencen a ser tratados en forma cada vez más agresiva. Como informó ayer LA NACION, los médicos recibieron del Ministerio de Salud la directiva de tomar, de ahora en más, a todos los casos de influenza como potenciales de gripe A (H1N1), con la recomendación de realizar radiografías de tórax a los pacientes con síntomas de fiebre y fatiga e internar rápidamente a todos los que padezcan neumonía.

"Hoy, que ya se conoce que el virus está circulando masivamente, la actitud que se tiene con los pacientes depende de la evaluación clínica que hace el médico, para que no se transforme en un caso grave. Ya no es necesario hacer el diagnóstico de laboratorio [que confirma la infección por el nuevo virus] para comenzar el tratamiento", dijo la doctora Vilma Savy, jefa del Servicio de Virus Respiratorios del instituto Malbrán.

La preocupación por cómo ataca esta gripe a algunas personas jóvenes fue confirmada a LA NACION por un médico forense que, en las últimas horas, realizó dos autopsias en dos personas fallecidas por gripe A.

"Los cuerpos tenían las vísceras, las meninges y el cerebro inflamados, un factor poco común en los que mueren por gripe. Además, los pulmones estaban en muy mal estado, con unas manchas que no hemos podido identificar. Las enviamos a realizar estudios de anatomía patológica", dijo el forense que pidió no dar a conocer su nombre hasta tanto las autoridades sanitarias tomaran nota de lo hallado.

Los cambios en las estrategias de atención de los pacientes que llegan con cuadros avanzados de gripe apuntan a ser más agresivos: tratar, y después ver qué pasa; quemar etapas. "Esta forma de atención del paciente grave cambiará la evolución y evitará más muertes y neumonías -afirmó el doctor San Juan, coordinador del Comité de Emergencia Epidemiológica del Ministerio de Salud porteño.

Para una neumonia grave, explicó San Juan, hoy los pacientes no sólo reciben antibióticos en forma empírica sino también antivirales y no se demora la posibilidad de recurrir a la asistencia respiratoria mecánica. "Si bien generalmente se esperan 24 horas para ver cómo evoluciona, sugerimos no hacerlo y, si se descompensa rápidamente, llegar a la intubacion", precisó San Juan.

La provincia de Buenos Aires contará, a partir de la semana próxima, con tests de diagnóstico rápido que permitirá discriminar, en sólo 15 minutos por medio de hisopados, si la persona es portadora de gripe A. De todos modos, la confirmación final la dará el instituto Malbrán. El nuevo test servirá para comenzar antes el tratamiento, informaron las autoridades sanitarias bonaerenses.
-

Pulmones que se "incendian" en horas - lanacion.com

Blogged with the Flock Browser

Espana. Sanidad confirma dos casos "graves" por nueva gripe en Madrid y Tarragona · ELPAÍS.com

Sanidad confirma dos casos "graves" por nueva gripe en Madrid y Tarragona

Se trata de una joven de 19 años y de un hombre de 32 años que sufrían afecciones respiratorias antes de contagiarse con el virus AH1N1 y que han desarrollado neumonía

ELPAÍS.com - Madrid - 27/06/2009

La ministra de Sanidad y Política Social, Trinidad Jiménez, ha confirmado que existen dos casos "graves" de gripe AH1N1 en Cataluña y Madrid, según informa la agencia Efe.

Se trata de una mujer de 19 años, que está embarazada y padece asma, que ha sido ingresada en el Hospital Gregorio Marañón de Madrid y de un hombre de 32 años ingresado en Hospital Joan XXIII de Tarragona.

El hombre fue ingresado el pasado sábado por gripe A en el Hospital Joan XXIII de Tarragona y actualmente se encuentra en estado "grave" en la unidad de cuidados intensivos, debido a una complicación de una afección respiratoria que padecía previamente.

El director del Servicio Regional del Camp de Tarragona de la Agencia de Protección de la Salud Pública de Cataluña, Joan Guix, ha explicado, en declaraciones recogidas por la agencia Efe, que el paciente se encuentra "estable dentro de la gravedad", después de que su situación se fuera agravando paulatinamente durante los últimos cinco días.

El joven ingresó el día 20 de junio en el hospital Joan XXIII de Tarragona por contagio del virus H1N1 y mostraba dificultades respiratorias y tos, síntomas de un cuadro agudo de infección respiratoria. El empeoramiento de su situación obligó a que el lunes 22 fuera trasladado a la unidad de curas intermedias, y al día siguiente, a la unidad de cuidados intensivos, afectado de una neumonía bilateral. Su estado se fue agravando paulatinamente hasta hoy, y según Guix "se encuentra estable respecto a ayer, dentro de la gravedad", algo que también ha confirmado un portavoz del centro hospitalario.

La paciente madrileña, embarazada de 28 semanas, ha desarrollado una neumonía, por lo que ha sido preciso su ingreso con respiración asistida, según han informado fuentes de la Consejería de Sanidad de la Comunidad de Madrid. Las mismas fuentes han señalado que el Hospital Gregorio Marañón está en permanente contacto con el Joan XXXIII de Tarragona. La ministra de Sanidad ha destacado la "vigilancia intensiva epidemiológica" que se está llevando a cabo en toda la red de hospitales y ha indicado que está en "permanente contacto" con los consejeros de Sanidad de Madrid y Cataluña.

Un caso en Vizcaya
Las autoridades sanitarias vascas detectaron ayer un caso de nueva gripe en un campamento de verano en la comarca vizcaína de Urdaibai. El afectado es un monitor madrileño de 29 años que ya ha abandonado el hospital de Galdakao, donde estaba ingresado, y ha regresado a su casa.

El joven ejercía como profesor de música en dichas colonias veraniegas, en las que participan cuarenta menores de 6 a 16 años de varias comunidades autónomas. El Departamento de Sanidad vasco ha afirmado que ninguno de los menores ha resultado contagiado y que los padres de todos ellos han decidido que continúen en el campamento, informa Unai Larrea.
-

Sanidad confirma dos casos "graves" por nueva gripe en Madrid y Tarragona · ELPAÍS.com

Blogged with the Flock Browser

Myanmar reports first case of H1N1 flu (AlertNet, edited)

Myanmar reports first case of H1N1 flu

27 Jun 2009 13:35:47 GMT
Source: Reuters
YANGON, June 27 (Reuters)

Myanmar has confirmed its first case of H1N1 influenza after a schoolgirl returning from Singapore tested positive for the virus, state radio reported on Saturday.

The 13-year-old was sent to a hospital in Yangon on Friday after showing flu symptoms while at school.

Tests carried out on Saturday showed she had been infected with H1N1, Myanmar Radio said.

Laos and Cambodia reported their first cases on Wednesday and Thursday respectively.

Neighbouring Thailand, which has detected more than 1,200 cases since May 12, reported its first two deaths on Saturday.

(Reporting by Aung Hla Tun; Writing by Martin Petty)
-

Reuters AlertNet - Myanmar reports first case of H1N1 flu

Blogged with the Flock Browser

Australia. National tally of confirmed cases of H1N1 Influenza 09 - As at 5 pm 27 June 2009 (Dept. of Health, edited)

Australian Government - Department of Health and Ageing

National tally of confirmed cases of H1N1 Influenza 09 - As at 5 pm 27 June 2009

[Original Document: LINK. EDITED.]


The information contained in this situation report uses the most accurate currently available data.

Given the rapidly changing nature of the incident, recipients should be aware of the potential for later confirmation or clarification.


Current Australian confirmed cases of, and deaths associated with, H1N1 Influenza 09 (1800 AEST on 27 June 2009)

[Jurisdiction - Confirmed Cases - Deaths]

• Australian Capital Territory 131 - 0
• New South Wales 751 - 0
• Northern Territory 139 - 0
• Queensland 552 - 0
• South Australia 262 - 1
• Tasmania 71 - 0
• Victoria 1560 - 3
• Western Australia 211 - 1

• Total 3677 - 5

-
------

Blogged with the Flock Browser

India. Update on Influenza a [H1N1] as on 27th June 2009 19:38 IST (PIB Press Release, edited)

Update on Influenza a [H1N1] as on 27th June 2009 19:38 IST

World Health Organization has reported 59814 laboratory confirmed cases of influenza A/H1N1 infection from 112 countries as on 26th June 2009. There have been 263 deaths. No further update is available.

Health screening of passengers coming from affected countries is continuing in 22 International airports.

54,113 passengers have been screened on 26.6.2009 of which 37,296 passengers were from affected countries.

224 doctors and 112 paramedics are manning 77 counters at these airports.

A cumulative total of 2,482,286 passengers have been screened.

The nine new cases are reported from Bangalore (4), Delhi (4) and Punjab (1).

A family of four who travelled from Newark, USA ( 38 year old Male, 32 yr Female, 9 year old female and 2 year old Male ) transiting Germany reached Bangalore on 26.06.09 by Lufthansa Flight LH 403/ 753 were quarantined at the Bangalore airport and shifted to the identified health facility. All of them have tested positive.

The four cases reported from Delhi include a nine year old child who travelled from Seattle USA transiting Seoul and reaching Delhi by Asiana Airlines on 25.06.09 was quarantined at the Delhi airport and shifted to the identified health facility.

The remaining three cases ( 40/F, 13/F and 9/M) have all travelled from USA reaching Delhi on 23.06.09 and reported to identified health facility on 26.06.09.

The case from Gurdaspur, Punjab is an indigenous case, a contact of positive case reported earlier on 23.06.09.

The indigenous positive case [66 year old female] at Delhi, covered in earlier reports, is stable.

645 persons have been tested so far of which 89 are positive for Influenza A H1N1 [Swine].

187 out of the 645 persons have been identified through entry screening, twenty seven through contact tracing and the rest were self reported.

Of the 89 cases, 59 have been discharged. Rest of them remain admitted to the identified health facility.

The situation is being monitored.

DS/MT
-

PIB Press Release

Blogged with the Flock Browser

Hong Kong: New hospital and clinic arrangements for human swine flu patients (6/27/09)

The following is issued on behalf of the Hospital Authority:

The Hospital Authority (HA) will implement the new service arrangements for managing patients who are suspected or confirmed with human swine influenza in both public hospitals and Designated Flu Clinics (DFCs) from next Monday (June 29), in view of the Government's announcement of a revision of the mitigation strategy for the human swine flu pandemic.

A spokesman for HA today (June 27) said that the admission and discharge criteria for patients confirmed human swine influenza would be based on their clinical conditions.

Confirmed patients with mild symptoms would not be required for admission and would be provided with symptomatic treatment.

''The new arrangements will enable our hospitals to reserve adequate isolation facilities and manpower resources for the severe cases, as we are now having more confirmed cases each day.''

On the service of Designated Flu Clinics, it will continue to attend to patients with fever and influenza-like-illness (ILI).

However, its priority would be given to pregnant women, those aged two or below, and high risk groups; which include those suffering from chronic diseases or having immuno-compromised states.

Tamiflu would only be given to ILI patients with chronic diseases or in immuno-compromised states.

''In addition to treating ILI patients, the DFCs will also notify patients if their test result was confirmed to be positive. Confirmed cases with mild symptoms will attend the DFCs for reassessment. Patients with severe conditions will be referred to hospital for admission,'' the spokesman added.

Regarding the services of the eight DFCs and the confirmed human swine influenza patients admitted to public hospitals, the HA spokesman provided the following updates today (June 27):

The Designated Flu Clinics today (as at 5pm) provide treatment to a total of 252 patients.

The HA spokesman reminded the public that the eight DFCs have ceased the provision of general outpatient services.

Patients with other illnesses are advised to seek medical treatment at other general outpatient clinics in the district or private practitioners.

Chronic patients who have been pre-scheduled for follow up at the eight DFCs should proceed to their corresponding clinics with drug refill service according to their date of original appointment and bring along the appointment slip and Identity Card.

As at 2.30pm today, there were 33 newly confirmed cases of human swine influenza in the past 24 hours.

This brings to 629 the total number of confirmed human swine influenza cases in Hong Kong.

Among them, a total of 506 confirmed cases have been discharged from public hospitals upon recovery, the remaining cases in hospitals have been stable (none required intensive care and there were no fatal cases).

View Original Article

Blogged with the Flock Browser

Hong Kong: Thirty-three new cases of human swine influenza (6/27/09)

A spokesman for the Department of Health said there had been 33 newly confirmed cases of human swine influenza (Influenza A H1N1) in the 24 hours to 2.30pm today (June 27).

This brings to 629 the total number of human swine influenza cases in Hong Kong.

The new cases involve 22 males and 11 females, aged between 2 and 52.
-

View Original Article

Blogged with the Flock Browser

Hong Kong: DH advises a secondary school to start summer break (6/27/09)

A spokesman for the Department of Health (DH) today (June 27) advised Carmel Secondary School in Ho Man Tin to start summer break tomorrow to stop the possible spread of human swine influenza (Influenza A H1N1) in the school.

The advice was made following the confirmation of a human swine influenza case in the school.

The case involved a 13-year-old girl, a Form One student of the school. The girl had onset of symptoms on June 23 and last attended school on June 25. The student is in stable condition. Investigations into the case are ongoing.

The spokesman called on parents to pay attention to the health condition of their children, and to remind them to observe good personal and environmental hygiene.
-

View Original Article

Blogged with the Flock Browser

Research Articles Abstracts - June 27, 2009 Issue

Research Articles Abstracts

June 27, 2009 Issue


Contents:

1. Generation and evaluation of an H9N1 influenza vaccine derived by reverse genetics that allows utilization of a DIVA strategy for control of H9N2 avian influenza.
2. Detection of human rhinovirus C in children with acute lower respiratory tract infections in South Korea.
3. UK urges more flexibility in criteria for flu pandemic alerts.
4. The problem with flu vaccines.
5. Governments must be pulled up for failings over flu.
6. Number of confirmed A/H1N1 flu cases doubles over one weekend.
7. Mexico City returns to normality, but cases of A/H1N1 reach almost 2000 in US.
8. Global aid agencies boost support to poorer nations to fight flu threat.
9. Detection of novel (swine origin) H1N1 influenza A virus by quantitative real-time RT-PCR.
10. Emergence of European avian-like H1N1 Swine Influenza A Viruses in China.
11. Molecular characterization of human rhinovirus field strains isolated during surveillance of enteroviruses.
12. A Novel Genotype H9N2 Influenza Virus Possessing Human H5N1 Internal Genomes Has Been Circulating in Poultry in Eastern China Since 1998.
13. Characterization of the H5N1 Highly Pathogenic Avian Influenza Virus derived from Wild Pikas in China.
14. Mixed Infection and the Genesis of Influenza Diversity.
15. Palmitoylation of the influenza A virus M2 protein is not required for virus replication in vitro but contributes to virus virulence.
16. T Cell Tolerance for Variability in a Class I HLA Presented Influenza A Virus Epitope.
17. Swine-origin influenza virus in young age groups.
18. Diagnosis of swine-lineage influenza A (H1N1) virus infection.
19. Diagnosis of swine-lineage influenza A (H1N1) virus infection.
20. Patient-oriented pandemic influenza research.
21. Pandemic.
22. Novel influenza A (H1N1) virus infections among health-care personnel - United States, April-May 2009.
23. Fast rise of broadly cross-reactive antibodies after boosting long-lived human memory B cells primed by an MF59 adjuvanted prepandemic vaccine.
24. Vaxfectin((R)), a cationic lipid-based adjuvant for protein-based influenza vaccines.
25. Evaluation of two live attenuated cold-adapted H5N1 influenza virus vaccines in healthy adults.
26. Monoclonal antibody based ELISA tests to detect antibodies against neuraminidase subtypes 1, 2 and 3 of avian influenza viruses in avian sera.
27. Infection of mice with a human influenza A/H3N2 virus induces protective immunity against lethal infection with influenza A/H5N1 virus.
28. Mutations in the nonstructural protein 3A confer resistance to the novel enterovirus replication inhibitor TTP-8307.

See original abstract following the link at the end of the post. EDITED.
-
------

1: Arch Virol. 2009 Jun 19. [Epub ahead of print]

Generation and evaluation of an H9N1 influenza vaccine derived by reverse genetics that allows utilization of a DIVA strategy for control of H9N2 avian influenza.

Wu R, Chen Q, Zheng L, Chen J, Sui Z, Guan Y, Chen Z. - State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, 430071, Wuhan, Hubei, China, wurui1977@126.com.


H9N2 avian influenza viruses have circulated widely in domestic poultry around the world, and their outbreaks have resulted in heavy morbidity and mortality. In addition, H9N2 avian influenza viruses were transmitted directly from birds to humans in Hong Kong and mainland China during 1998 and 2003, which prompted the public health authorities to seek protective strategies to control H9N2 influenza viruses. In this study, we attempted to develop a DIVA (differentiating infected and vaccinated animals) strategy for H9N2 avian influenza viruses. This strategy does not interfere with serological monitoring and allows effective control of H9N2 avian influenza. We generated a reassortant H9N1 influenza vaccine strain by reverse genetics and employed an enzyme-linked immunosorbent assay (ELISA) with a truncated N1 antigen expressed in E. coli to differentiate between vaccinated and naturally infected animals. Immunization of BALB/c mice with the inactivated reassortant H9N1 vaccine conferred protection against lethal challenge with H9N2 viruses. Meanwhile, the ELISA can be used to distinguish between vaccination and natural infection quickly and easily. Therefore, this study has opened up a new avenue for the control of H9N2 avian influenza.

PMID: 19543688 [PubMed - as supplied by publisher]
-
------
-

2: Arch Virol. 2009;154(6):987-91. Epub 2009 May 5.

Detection of human rhinovirus C in children with acute lower respiratory tract infections in South Korea.

Han TH, Chung JY, Hwang ES, Koo JW. Department of Diagnostic Laboratory Medicine, Sanggyepaik Hospital, College of Medicine, Inje University, 761-1 Nowon-Gu, Seoul, Korea.


Recently, HRV-C was identified as a new species of HRV, but its spectrum of clinical disease is still not clear. The purpose of this study was to investigate the molecular epidemiology of HRVs in children with acute lower respiratory tract infections (LRTIs). A total of 54 HRV-positive samples that were negative for other respiratory viruses were sequenced. HRV-A was detected in 33, HRV-B in 4, and HRV-C in 17 of these samples. All HRV-C-positive patients showed favorable clinical outcomes. We confirmed the presence of HRV-C in children with LRTIs, but its association with clinical severity is not clear.

PMID: 19415451 [PubMed - indexed for MEDLINE]
-
------
-

3: BMJ. 2009 May 21;338:b2067. doi: 10.1136/bmj.b2067.

UK urges more flexibility in criteria for flu pandemic alerts.

O'Dowd A.

PMID: 19460801 [PubMed - indexed for MEDLINE]
-
-------
-

4: BMJ. 2009 May 21;338:b2065. doi: 10.1136/bmj.b2065.

The problem with flu vaccines.

Jack A. Financial Times, London. Andrew.Jack@ft.com

PMID: 19460800 [PubMed - indexed for MEDLINE]
-
------
-

5: BMJ. 2009 May 15;338:b2019. doi: 10.1136/bmj.b2019.

Governments must be pulled up for failings over flu.

Jack A. Financial Times, London. Andrew.Jack@ft.com

PMID: 19447826 [PubMed - indexed for MEDLINE]
-
------
-

6: BMJ. 2009 May 12;338:b1962. doi: 10.1136/bmj.b1962.

Number of confirmed A/H1N1 flu cases doubles over one weekend.

O'Dowd A.

PMID: 19435762 [PubMed - indexed for MEDLINE]
-
------
-

7: BMJ. 2009 May 11;338:b1950. doi: 10.1136/bmj.b1950.

Mexico City returns to normality, but cases of A/H1N1 reach almost 2000 in US.

Charatan F.

PMID: 19433500 [PubMed - indexed for MEDLINE]
-
------
-

8: BMJ. 2009 May 6;338:b1856. doi: 10.1136/bmj.b1856.

Global aid agencies boost support to poorer nations to fight flu threat.

Zarocostas J.

PMID: 19420044 [PubMed - indexed for MEDLINE]
-
------
-

9: J Clin Microbiol. 2009 Jun 24. [Epub ahead of print]

Detection of novel (swine origin) H1N1 influenza A virus by quantitative real-time RT-PCR.

Wang R, Sheng ZM, Taubenberger JK. Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.


A novel H1N1 subtype influenza A virus, derived by reassortant between two known circulating swine influenza strains, has now been declared a human pandemic influenza A virus (8). ...

PMID: 19553589 [PubMed - as supplied by publisher]
-
------
-

10: J Clin Microbiol. 2009 Jun 24. [Epub ahead of print]

Emergence of European avian-like H1N1 Swine Influenza A Viruses in China.

Liu J, Bi Y, Qin K, Fu G, Yang J, Peng J, Ma G, Liu Q, Pu J, Tian F. Laboratory of Infectious Diseases, College of Veterinary Medicine, China Agricultural University, Beijing 100193, PR China; Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China; The Shandong Animal Disease Control Center, Jinan 250022, Shandong province, PR China.


During the swine influenza surveillance from 2007 to 2008, ten H1N1 viruses were isolated and analyzed for their antigenic and phylogenetic properties. Our study revealed the emergence of avian origin European swine H1N1 influenza virus in China, which highlights the necessity of swine influenza surveillance for the potential pandemic preparedness.

PMID: 19553585 [PubMed - as supplied by publisher]
-
------
-

11: J Gen Virol. 2009 Jun;90(Pt 6):1371-81. Epub 2009 Mar 4.

Molecular characterization of human rhinovirus field strains isolated during surveillance of enteroviruses.

Blomqvist S, Savolainen-Kopra C, Paananen A, Hovi T, Roivainen M. National Institute for Health and Welfare (THL)dagger, PO Box 30, FI-00271 Helsinki, Finland. soile.blomqvist@thl.fi


Human rhinoviruses (HRVs), which are the most frequent causative agents of acute upper respiratory tract infections, are abundant worldwide. We have identified HRV strains in environmental specimens collected in Finland, Latvia and Slovakia during the surveillance of polio- and other enteroviruses. These acid-sensitive HRV strains were isolated under conditions optimized for growth of most of the enteroviruses, i.e. in stationary human rhabdomyosarcoma cells incubated at 36 degrees C. Phylogenetic analysis of the sequences derived from the partial 5' non-coding region and the capsid region coding for proteins VP4/VP2 and VP1 showed that the HRV field strains clustered together with prototype strains of the HRV minor receptor group. Partial sequences of the 3D polymerase coding region generally followed this pattern, with the exception of a set of three HRV field strains that formed a subcluster not close to any of the established HRV-A types, suggesting that recombination may have occurred during evolution of these HRV strains. Phylogenetic analysis of the VP4/VP2 capsid protein coding region showed that the 'environmental' HRV field strains were practically identical to HRV strains recently sequenced by others in Australia, the United States and Japan. Analysis of amino acids corresponding to the intercellular adhesion molecule-1 receptor footprint in major receptor group HRVs and also in the low-density lipoprotein receptor footprint of minor receptor group HRVs showed conservation of the 'minor receptor group-like' amino acids, indicating that the field strains may have maintained their minor receptor group specificity.

PMID: 19264616 [PubMed - indexed for MEDLINE]
-
------
-

12: J Virol. 2009 Jun 24. [Epub ahead of print]

A Novel Genotype H9N2 Influenza Virus Possessing Human H5N1 Internal Genomes Has Been Circulating in Poultry in Eastern China Since 1998.

Zhang P, Tang Y, Liu X, Liu W, Zhang X, Liu H, Peng D, Gao S, Wu Y, Zhang L, Lu S, Liu X. Animal Infectious Disease Laboratory, College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China; National Drug Screening Laboratory, New Drug Screening Center, China Pharmaceutical University, Nanjing, 210009, China; China-US Vaccine Research Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China; and Laboratory of Nucleic Acid Vaccines, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, 01605, USA.


Many novel reassortant influenza viruses of H9N2 genotype have emerged in aquatic birds in Southern China since their initial isolation in this region in 1994. However, the genesis and evolution of H9N2 viruses in poultry in Eastern China have not been investigated systematically. In the current study, H9N2 influenza viruses isolated from poultry in Eastern China during the past ten years were characterized genetically and antigenically. Phylogenetic analysis revealed that these H9N2 viruses have undergone extensive reassortment to generate multiple novel genotypes, including four genotypes (J, F, K, and L) that have never been recognized before. The major H9N2 influenza viruses represented by A/Chiken/Beijing/1/1994 (Ck/BJ/1/94)-like viruses circulating in poultry in Eastern China before 1998 have been gradually replaced by A/Chicken/Shanghai/F/1998 (Ck/SH/F/98)-like viruses, which have different genotype from viruses isolated in Southern China. The similarity of the internal genes of these H9N2 viruses to those of the H5N1 influenza viruses isolated from 2001 onwards suggests that the Ck/SH/F/98-like virus may have been the donor of internal genes of human and poultry H5N1 influenza viruses circulating in Eurasia. Experimental studies showed that some of these H9N2 viruses could be efficiently transmitted by the respiratory track in chicken flocks. Our study provides new insight into the genesis and evolution of H9N2 influenza viruses and supports the notion that some of these viruses may have been the donors of internal genes found in H5N1 viruses.

PMID: 19553328 [PubMed - as supplied by publisher]
-
------
-

13: J Virol. 2009 Jun 24. [Epub ahead of print]

Characterization of the H5N1 Highly Pathogenic Avian Influenza Virus derived from Wild Pikas in China.

Zhou J, Sun W, Wang J, Guo J, Yin W, Wu N, Li L, Yan Y, Liao M, Huang Y, Luo K, Jiang X, Chen H. Key Laboratory of Animal Epidemic Etiology and Immunological Prevention of Ministry of Agriculture, Zhejiang University, Hangzhou 310029, People's Republic of China; State Key Laboratory of Infectious Diseases for Diagnosis and Treatment, The First Affiliated Hospital of Medical School, Zhejiang University, Hangzhou 310003, People's Republic of China; State Conservation Center for Gene Resources of Endangered Wildlife, Zhejiang University, Hangzhou 310058, People's Republic of China; National Avian Influenza Reference Laboratory, Haerbin Veterinary Research Institute, China Academy of Agricultural Sciences, Haerbin 150001, People's Republic of China; Key Laboratory of Animal disease control and Prevention of Ministry of Agriculture, South China Agricultural University,Guangzhou 510642, People's Republic of China; Institute of Animal Husbandry and Veterinary Medicine, Fujian Academy of Agricultural Sciences, Fujian Fuzhou 350013, People's Republic of China.


The highly pathogenic H5N1 avian influenza virus emerged from China in 1996 and has spread across Eurasia and Africa, with a continuous stream of new cases of human infection appearing since the first large-scale outbreak in migratory birds at Qinghai Lake. The role of wild birds, which are the natural reservoirs for the virus, in the epidemiology of the H5N1 virus has raised great public health concern, but their role in the spread of the virus within the natural ecosystem of free-ranging terrestrial wild mammals remains unclear. In this study, we investigated H5N1 infection in wild pikas in an attempt to trace the circulation of the virus. Sero-epidemiological surveys confirmed a natural infection of H5N1 in wild pikas in their native environment. The hemagglutination gene of the H5N1 virus isolated from pikas reveals two distinct evolutionary clades, a Mixed/Vietnam H5N1 virus sublineage (MV-like pika virus) and a wild bird QH-like H5N1 virus sublineage (QH-like pika virus). The amino acid residue (glutamic acid) at position 627 in the PB2 gene of the MV-like and QH-like pika viruses were different from each other; the MV-like pika virus was the same as that of the goose H5N1 virus (A/GS/Gd/1/96). Further, we discovered that in contrast to the MV-like pika virus, which is nonpathogenic to mice, the QH-like pika virus is highly pathogenic. To mimic virus infection of pikas, we intranasally inoculated rabbits, a species closely related to pikas, with the pika-origin H5N1 virus. Our findings first demonstrate that the wild pikas are a mammalian host exposed to subtype avian influenza virus in the natural ecosystem and also imply a possibility of the potential transmission of highly pathogenic avian influenza virus from wild mammals into domestic mammalian hosts and humans.

PMID: 19553321 [PubMed - as supplied by publisher]
-
------
-

14: J Virol. 2009 Jun 24. [Epub ahead of print]

Mixed Infection and the Genesis of Influenza Diversity.

Ghedin E, Fitch A, Boyne A, Griesemer S, Depasse J, Bera J, Zhang X, Halpin RA, Smit M, Jennings L, St George K, Holmes EC, Spiro DJ. University of Pittsburgh School of Medicine, Departments of Medicine and Computational Biology, Pittsburgh, PA 15261, USA; J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD 20850, USA; Wadsworth Center, NYSDH, Albany, New York, 12201, USA; Canterbury Health Laboratories, Christchurch, New Zealand; The Pennsylvania State University, University Park, PA 16802, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.


The emergence of viral infections with potentially devastating consequences for human health is highly dependent on their underlying evolutionary dynamics. One likely scenario for an avian influenza virus, such as A/H5N1, to evolve human-to-human transmission is through the acquisition of genetic material from the A/H1N1 or A/H3N2 subtypes already circulating in human populations. This would require that viruses of both subtypes co-infect the same cells, generating a mixed infection, and then reassort. Determining the nature and frequency of mixed infection in influenza virus is therefore central to understanding the emergence of pandemic, antigenic and drug resistant strains. To better understand the potential for such events, we explored patterns of intra-host genetic diversity in recently circulating strains of human influenza virus. By analyzing multiple viral genome sequences sampled from individual influenza patients we reveal a high level of mixed infection, including diverse lineages of the same influenza subtype, drug resistant and sensitive strains, those that are likely to differ in antigenicity, and even viruses of different influenza types (A and B). These results reveal individuals can harbor influenza viruses that differ in major phenotypic properties, including those that are antigenically distinct and those that differ in their sensitivity to antiviral agents.

PMID: 19553313 [PubMed - as supplied by publisher]
-
------
-

15: J Virol. 2009 Jun 24. [Epub ahead of print]

Palmitoylation of the influenza A virus M2 protein is not required for virus replication in vitro but contributes to virus virulence.

Grantham ML, Wu WH, Lalime EN, Lorenzo ME, Klein SL, Pekosz A. W. Harry Feinstone Department of Molecular Microbiology and Immunology, Department of Biochemistry and Molecular Biology, Johns Hopkins University, Bloomberg School of Public Health, 615 North Wolfe St, Suite 5132, Baltimore, MD, USA, 21205; Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 21204.


The influenza A virus M2 protein has important roles during virus entry and in the assembly of infectious virus particles. The cytoplasmic tail of the protein can be palmitoylated at a cysteine residue, but this residue is not conserved in a number of human influenza A virus isolates. Recombinant viruses encoding M2 proteins with a serine substituted for the cysteine at position 50 were generated in the A/WSN/33 (H1N1) and A/Udorn/72 (H3N2) genetic backgrounds. The recombinant viruses were not attenuated for replication in MDCK cells, CaLu3 cells, or in primary differentiated murine trachea epithelial cell cultures, indicating there was no significant contribution of M2 palmitoylation to virus replication in vitro. The A/WSN/33 M2C50S virus displayed a slightly reduced virulence after infection of mice, suggesting there may be novel functions for M2 palmitoylation during in vivo infection.

PMID: 19553312 [PubMed - as supplied by publisher]
-
------
-

16: J Virol. 2009 Jun 24. [Epub ahead of print]

T Cell Tolerance for Variability in a Class I HLA Presented Influenza A Virus Epitope.

Wahl A, McCoy W, Schafer F, Bardet W, Buchli R, Fremont DH, Hildebrand WH. Department of Microbiology and Immunology, 975 NE 10 Street, Oklahoma City, Oklahoma, 73104 USA; Department of Pathology and Immunology, Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110 USA; and Pure Protein L.L.C., 800 Research Parkway, Suite 340, Oklahoma City, OK 73104 USA.


To escape immune recognition, viruses acquire amino acid substitutions in class I Human Leukocyte Antigen (HLA) presented CTL epitopes. Such viral escape mutations may (i) prevent peptide processing, (ii) diminish class I HLA binding, or (iii) alter T cell recognition. Because the hypervariable influenza A virus nucleoprotein (NP)418-426 epitope is consistently bound by class I HLA and presented to cytotoxic T-lymphocytes (CTL), we assessed the impact that intra-epitope sequence variability has upon T cell recognition. CTL elicited by intranasal influenza infection were tested for their cross-recognition of 20 natural NP418-426 epitope variants. Six of the variant epitopes, of both H1N1 and H3N2 origin, were cross-recognized by CTL while the remaining NP418-426 epitope variants escaped targeting. A pattern emerged whereby variability at P5 reduced T cell recognition, changes at P4 or P6 enabled CTL escape, and a mutation at P8 enhanced T cell recognition. These data demonstrate that substitutions at P4 and/or P6 facilitate influenza escape from T cell recognition and provide a model for the number, nature, and location of viral mutations that influence T cell cross-recognition.

PMID: 19553306 [PubMed - as supplied by publisher]
-
------
-

17: Lancet. 2009 Jun 20;373(9681):2108-9.

Swine-origin influenza virus in young age groups.

Mermel LA. PMID: 19541030

[PubMed - in process]
-
------
-

18: Lancet. 2009 Jun 20;373(9681):2107.

Comment on: Lancet. 2009 May 9;373(9675):1578.

Diagnosis of swine-lineage influenza A (H1N1) virus infection.

Zuckerman M, Carman B.

PMID: 19541028 [PubMed - in process]
-
------
-

19: Lancet. 2009 Jun 20;373(9681):2107.

Comment on: Lancet. 2009 May 9;373(9675):1578.

Diagnosis of swine-lineage influenza A (H1N1) virus infection.

McCracken J.

PMID: 19541026 [PubMed - in process]
-
------
-

20: Lancet. 2009 Jun 20;373(9681):2085-6.

Patient-oriented pandemic influenza research.

Tran TH, Ruiz-Palacios GM, Hayden FG, Farrar J. The Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam.

PMID: 19541022 [PubMed - in process]
-
------
-

21: Lancet. 2009 Jun 6;373(9679):1939.

Pandemic.

Honigsbaum M. Wellcome Trust Centre for History of Medicine at UCL, USA.

PMID: 19501732 [PubMed - indexed for MEDLINE]
-
------
-

22: MMWR Morb Mortal Wkly Rep. 2009 Jun 19;58(23):641-5.

Novel influenza A (H1N1) virus infections among health-care personnel - United States, April-May 2009.

Centers for Disease Control and Prevention (CDC).


Soon after identification of novel influenza A (H1N1) virus infections in the United States in mid-April 2009, CDC provided interim recommendations to reduce the risk for transmission in health-care settings. These included recommendations on use of personal protective equipment (PPE), management of health-care personnel (HCP) after unprotected exposures, and instruction of ill HCP not to report to work. To better understand the risk for acquiring infection with the virus among HCP and the impact of infection-control recommendations, CDC solicited reports of infected HCP from state health departments. As of May 13, CDC had received 48 reports of confirmed or probable infections with novel influenza A (H1N1) virus; of these, 26 reports included detailed case reports with information regarding risk factors that might have led to infection. Of the 26 cases, 13 (50%) HCP were deemed to have acquired infection in a health-care setting, including one instance of probable HCP to HCP transmission and 12 instances of probable or possible patient to HCP transmission. Eleven HCP had probable or possible acquisition in the community, and two had no reported exposures in either health-care or community settings. Among 11 HCP with probable or possible patient to HCP acquisition and available information on PPE use, only three reported always using either a surgical mask or an N95 respirator. These findings suggest that transmission of novel influenza A (H1N1) virus to HCP is occurring in both health-care and community settings and that additional messages aimed at reinforcing current infection-control recommendations are needed.

PMID: 19543199 [PubMed - indexed for MEDLINE]
-
------
-

23: Proc Natl Acad Sci U S A. 2009 May 12;106(19):7962-7. Epub 2009 Apr 27.

Fast rise of broadly cross-reactive antibodies after boosting long-lived human memory B cells primed by an MF59 adjuvanted prepandemic vaccine.

Galli G, Hancock K, Hoschler K, DeVos J, Praus M, Bardelli M, Malzone C, Castellino F, Gentile C, McNally T, Del Giudice G, Banzhoff A, Brauer V, Montomoli E, Zambon M, Katz J, Nicholson K, Stephenson I. Translational Medicine, Novartis Vaccines, Siena, Italy 53100.


Proactive priming before the next pandemic could induce immune memory responses to novel influenza antigens. In an open-label study, we analyzed B cell memory and antibody responses of 54 adults who received 2 7.5-microg doses of MF59-adjuvanted A/Vietnam/1194/2004 clade 1 (H5N1) vaccine. Twenty-four subjects had been previously primed with MF59-adjuvanted or plain clade 0-like A/duck/Singapore/1997 (H5N3) vaccine during 1999-2001. The prevaccination frequency of circulating memory B cells reactive to A/Vietnam/1194/2004 was low in both primed and unprimed individuals. However, at day 21 after boosting, MF59-adjuvanted primed subjects displayed a higher frequency of H5N1-specific memory B cells than plain-primed or unprimed subjects. The immune memory was rapidly mobilized by a single vaccine administration and resulted in high titers of neutralizing antibodies to antigenically diverse clade 0, 1, and 2 H5N1 viruses already at day 7. In general, postvaccination antibody titers were significantly higher in primed subjects than in unprimed subjects. Subjects primed with MF59-adjuvanted vaccine responded significantly better than those primed with plain vaccine, most notably in early induction and duration of cross-reacting antibody responses. After 6 months, high titers of cross-reactive antibody remained detectable among MF59-primed subjects. We conclude that distant priming with clade 0-like H5N3 induces a pool of cross-reactive memory B cells that can be boosted rapidly years afterward by a mismatched MF59-adjuvanted vaccine to generate high titers of cross-reactive neutralizing antibodies rapidly. These results suggest that pre-pandemic vaccination strategies should be considered.

PMID: 19416838 [PubMed - indexed for MEDLINE]
PMCID: PMC2674105
-
------
-

24: Vaccine. 2009 Jun 21. [Epub ahead of print]

Vaxfectin((R)), a cationic lipid-based adjuvant for protein-based influenza vaccines.

Hartikka J, Bozoukova V, Yang CK, Ye M, Rusalov D, Shlapobersky M, Vilalta A, Wei Q, Rolland A, Smith LR. Vical Incorporated, 10390 Pacific Center Court, San Diego, CA 92121-4340, USA.


Mice were immunized either with unadjuvanted seasonal trivalent influenza vaccine (TIV) or TIV formulated with Vaxfectin((R)), a cationic lipid-based adjuvant. Increasing doses of Vaxfectin((R)) resulted in increased hemagglutination-inhibition or anti-TIV ELISA titers, with up to a 200-fold increase obtained with 900mug of Vaxfectin((R)). A >/=10-fold dose-sparing effect was demonstrated with Vaxfectin((R)) formulations. Vaxfectin((R)) preferentially increased IgG2 titers compared to IgG1 titers, resulting in a balanced IgG isotype distribution. Lower doses of Vaxfectin((R)) (30mug) did not enhance antibody responses, but increased the number of IFN-gamma secreting T-cells by up to 18-fold. The data demonstrate that Vaxfectin((R)) enhances Th1 responses with protein-based seasonal influenza vaccine, and suggest that cellular or humoral immune responses may be preferentially induced by modifying the Vaxfectin((R)):antigen ratio in the vaccine formulation.

PMID: 19552895 [PubMed - as supplied by publisher]
-
------
-

25: Vaccine. 2009 Jun 18. [Epub ahead of print]

Evaluation of two live attenuated cold-adapted H5N1 influenza virus vaccines in healthy adults.

Karron RA, Talaat K, Luke C, Callahan K, Thumar B, Dilorenzo S, McAuliffe J, Schappell E, Suguitan A, Mills K, Chen G, Lamirande E, Coelingh K, Jin H, Murphy BR, Kemble G, Subbarao K. Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.


BACKGROUND:
Development of live attenuated influenza vaccines (LAIV) against avian viruses with pandemic potential is an important public health strategy.

METHODS AND FINDINGS:
We performed open-label trials to evaluate the safety, infectivity, and immunogenicity of H5N1 VN 2004 AA ca and H5N1 HK 2003 AA ca. Each of these vaccines contains a modified H5 hemagglutinin and unmodified N1 neuraminidase from the respective wild-type (wt) parent virus and the six internal protein gene segments of the A/Ann Arbor/6/60 cold-adapted (ca) master donor virus. The H5N1 VN 2004 AA ca vaccine virus was evaluated at dosages of 10(6.7) TCID(50) and 10(7.5) TCID(50), and the H5N1 HK 2003 AA ca vaccine was evaluated at a dosage of 10(7.5) TCID(50). Two doses were administered intranasally to healthy adults in isolation at 4-8 week intervals. Vaccine safety was assessed through daily examinations and infectivity was assessed by viral culture and by realtime reverse transcription-polymerase chain reaction testing of nasal wash (NW) specimens. Immunogenicity was assessed by measuring hemagglutination-inhibition (HI) antibodies, neutralizing antibodies, and IgG or IgA antibodies to recombinant (r)H5 VN 2004 hemagglutinin (HA) in serum or NW. Fifty-nine participants were enrolled: 21 received 10(6.7) TCID(50) and 21 received 10(7.5) TCID(50) of H5N1 VN 2004 AA ca and 17 received H5N1 HK 2003 AA ca. Shedding of vaccine virus was minimal, as were HI and neutralizing antibody responses. Fifty-two percent of recipients of 10(7.5) TCID(50) of H5N1 VN 2004 AA ca developed a serum IgA response to rH5 VN 2004 HA.

CONCLUSIONS:
The live attenuated H5N1 VN 2004 and HK 2003 AA ca vaccines bearing avian H5 HA antigens were very restricted in replication and were more attenuated than seasonal LAIV bearing human H1, H3 or B HA antigens. The H5N1 AA ca LAIV elicited serum ELISA antibody but not HI or neutralizing antibody responses in healthy adults.

(ClinicalTrials.gov Identifiers: NCT00347672 and NCT00488046).
PMID: 19540952 [PubMed - as supplied by publisher]
-
------
-

26: Vaccine. 2009 Jun 17. [Epub ahead of print]

Monoclonal antibody based ELISA tests to detect antibodies against neuraminidase subtypes 1, 2 and 3 of avian influenza viruses in avian sera.

Moreno A, Brocchi E, Lelli D, Gamba D, Tranquillo M, Cordioli P. Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Via Bianchi, 9, 25124 Brescia, Italy.


The objective of this study was the development and the evaluation of competitive ELISA assays based on monoclonal antibodies for the detection of antibodies specific for neuraminidase type 1 (N1), 2 (N2) and 3 (N3) in avian sera. A total of 1450 sera from different avian species (854 negative, 185 positive to N1, 136 positive to N2, 219 positive to N3 and 56 positive to other N subtypes sera) were analysed in parallel by the three ELISAs. ROC analyses were performed to enable the selection of best cut-off values and estimation of diagnostic specificity and sensitivity. In addition, the correlation between the new developed ELISAs and the neuraminidase inhibition test was evaluated on a limited number of sera. The validation process of the three ELISAs proved excellent diagnostic performances, with very high specificity and sensitivity, ranging from 99.4 to 99.8% and from 97.6 to 100%, respectively in the three assays. The discriminating potential between antibodies elicited against homologous and heterologous N validates the test for use in "DIVA" assays, to distinguish between vaccinated and infected birds.

PMID: 19540274 [PubMed - as supplied by publishe
-
-----
-

27: Vaccine. 2009 Jun 15. [Epub ahead of print]

Infection of mice with a human influenza A/H3N2 virus induces protective immunity against lethal infection with influenza A/H5N1 virus.

Kreijtz JH, Bodewes R, van den Brand JM, de Mutsert G, Baas C, van Amerongen G, Fouchier RA, Osterhaus AD, Rimmelzwaan GF. Department of Virology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.


The transmission of highly pathogenic avian influenza (HPAI) A viruses of the H5N1 subtype from poultry to man and the high case fatality rate fuels the fear for a pandemic outbreak caused by these viruses. However, prior infections with seasonal influenza A/H1N1 and A/H3N2 viruses induce heterosubtypic immunity that could afford a certain degree of protection against infection with the HPAI A/H5N1 viruses, which are distantly related to the human influenza A viruses. To assess the protective efficacy of such heterosubtypic immunity mice were infected with human influenza virus A/Hong Kong/2/68 (H3N2) 4 weeks prior to a lethal infection with HPAI virus A/Indonesia/5/05 (H5N1). Prior infection with influenza virus A/Hong Kong/2/68 reduced clinical signs, body weight loss, mortality and virus replication in the lungs as compared to naive mice infected with HPAI virus A/Indonesia/5/05. Priming by infection with respiratory syncytial virus, a non-related virus did not have a beneficial effect on the outcome of A/H5N1 infections, indicating that adaptive immune responses were responsible for the protective effect. In mice primed by infection with influenza A/H3N2 virus cytotoxic T lymphocytes (CTL) specific for NP(366-374) epitope ASNENMDAM and PA(224-232) SCLENFRAYV were observed. A small proportion of these CTL was cross-reactive with the peptide variant derived from the influenza A/H5N1 virus (ASNENMEVM and SSLENFRAYV respectively) and upon challenge infection with the influenza A/H5N1 virus cross-reactive CTL were selectively expanded. These CTL, in addition to those directed to conserved epitopes, shared by the influenza A/H3N2 and A/H5N1 viruses, most likely contributed to accelerated clearance of the influenza A/H5N1 virus infection. Although also other arms of the adaptive immune response may contribute to heterosubtypic immunity, the induction of virus-specific CTL may be an attractive target for development of broad protective vaccines. Furthermore the existence of pre-existing heterosubtypic immunity may dampen the impact a future influenza pandemic may have.

PMID: 19538996 [PubMed - as supplied by publisher]
-
------
-

28: Antimicrob Agents Chemother. 2009 May;53(5):1850-7. Epub 2009 Feb 23.

Mutations in the nonstructural protein 3A confer resistance to the novel enterovirus replication inhibitor TTP-8307.

De Palma AM, Thibaut HJ, van der Linden L, Lanke K, Heggermont W, Ireland S, Andrews R, Arimilli M, Al-Tel TH, De Clercq E, van Kuppeveld F, Neyts J. Rega Institute for Medical Research, Minderbroedersstraat 10, B-3000 Leuven, Belgium.


A novel compound, TTP-8307, was identified as a potent inhibitor of the replication of several rhino- and enteroviruses. TTP-8307 inhibits viral RNA synthesis in a dose-dependent manner, without affecting polyprotein synthesis and/or processing. Drug-resistant variants of coxsackievirus B3 were all shown to carry at least one amino acid mutation in the nonstructural protein 3A. In particular, three mutations located in a nonstructured region preceding the hydrophobic domain (V45A, I54F, and H57Y) appeared to contribute to the drug-resistant phenotype. This region has previously been identified as a hot sport for mutations that resulted in resistance to enviroxime, the sole 3A-targeting enterovirus inhibitor reported thus far. This was corroborated by the fact that TTP-8307 and enviroxime proved cross-resistant. It is hypothesized that TTP-8307 and enviroxime disrupt proper interactions of 3A(B) with other viral or cellular proteins that are required for efficient replication.

PMID: 19237651 [PubMed - indexed for MEDLINE]
PMCID: PMC2681499 [Available on 2009/11/01]
-
------

28 selected items - PubMed Results

Blogged with the Flock Browser

Argentina. Gripe A: reportan 3 nuevas muertes y admiten "complicaciones imprevistas"

Gripe A: reportan 3 nuevas muertes y admiten "complicaciones imprevistas"

23:07 - Lo reconoció el ministro de Salud bonaerense, Claudio Zin, en referencia a los contagios en embarazadas y el colapso de los servicios hospitalarios. A su vez, anunció que ya son 26 los fallecidos y 1.587 los casos positivos en el país.

El Ministerio de Salud reportó hoy 3 nuevas muertes a causa de la gripe A, por lo que se elevó a 26 el número de fallecidos por la pandemia en el país.

Además, precisó que la mayor cantidad de casos siguen estando en la provincia de Buenos Aires, con el 48 por ciento del total, seguido por la Capital Federal, que tiene el 47 por ciento.

A su vez, admitió que los servicios hospitalarios permanecen saturados y piden declarar la emergencia sanitaria. En tanto, el ministro de Salud bonaerense, Claudio Zin, reconoció que hay complicaciones que no estaban previstas, sobre todo en mujeres embarazadas, por la expansión de la enfermedad, cuyo virus "tiene una transmisibilidad realmente única", aseguró.

Uno de los decesos confirmados es una mujer de 40 años que fue internada hace cuatro días por un cuadro grave de neumonía en el Hospital Interzonal General de Agudos (HIGA) "Oscar Alende", de Mar del Plata.

Por su parte, la ministra de Salud de la Nación, Graciela Ocaña, y el viceministro Carlos Soratti, confirmaron las tres nuevas muertes por gripe A, al ofrecer el parte diario por la enfermedad, cuya rueda de prensa se demoró más de tres horas.

En el parte oficial diario, el Ministerio de Salud confirmó que "en el día de la fecha, el Instituto Malbrán informó de 99 nuevos casos positivos", mientras que "44 muestras resultaron negativas".

"De los informados como positivos en la fecha, tres casos corresponden a pacientes fallecidos, sumando un total de 26 debido a Influenza A", precisa el parte diario. Según el mismo, hasta ahora hay 1587 casos positivos y 1.724 negativos, al tiempo que 967 casos están en proceso de análisis para determinar si efectivamente son pacientes afectados por la nueva gripe.

También se precisó que la mayor cantidad de casos sigue estando en la provincia de Buenos Aires, con el 48 por ciento del total, seguido de cerca por la Capital Federal, que tiene el 47 por ciento. Sólo está registrado y oficializado en el interior del país el primer caso mortal de Mar del Plata, y los de Misiones, que se revelaron el miércoles último, aunque se mantiene el alerta por una eventual "nacionalización" de la epidemia, debido al aumento en el nivel de contagios en casi todos los distritos, según la información oficial.

En tanto, también se indicó que hoy se entregaron respiradores microprocesados y monitores para 25 camas de la unidad de terapia intensiva del Hospital de Trauma de Malvinas Argentinas; al tiempo que también "se entregaron 30 oxímetros de pulso, barbijos, guantes de examinación y alcohol gel para el primer nivel de atención".

"En el marco de las acciones implementadas por el SENASA, se realizaron actividades conjuntas para la evaluación epidemiológica" de los contagios humano-animal, en respuesta a la detección de virus A H1N1 humano en ganado porcino de un establecimiento de producción de la provincia de Buenos Aires", se aclaró.
-

Gripe A: reportan 3 nuevas muertes y admiten "complicaciones imprevistas"

Blogged with the Flock Browser

Australia. More swine flu deaths 'a certainty' - ABC News (Australian Broadcasting Corporation)

More swine flu deaths 'a certainty'

By Jennifer Macey for AM
AM | abc.net.au/am

An infectious disease expert says the swine flu vaccine will be available too late to help many of the people who are going to contract the virus.

Four people have died so far and in New South Wales, two children are in intensive care because of the virus.

One of the children has no pre-existing medical conditions.

Professor of Infectious Diseases and Epidemiology at the University of New South Wales, Raina Macintyre, told AM it is certain more people will die from swine flu in Australia.

"We expect that it will peak towards the end of July or early August," she said.

"That's when we'll really be at the height of the epidemic, and we would expect something of the same range or higher, but in the same ball park of a bad flu season.

"It could be anywhere from 10 to 30 per cent of the Australian population over the whole winter. Every year from seasonal flu there are about 2,500 deaths from flu and pneumonia."

She says swine flu deaths are expected to be higher because people have not built up immunity to the virus.

"Any influenza, even seasonal influenza, has a higher rate of complications and death in people with pre-existing conditions because they're just more vulnerable to infections like influenza," she said.

"So, it's not unexpected really that the first deaths that we're seeing are in people who are immuno-compromised or have chronic diseases."

Professor Macintyre says the vaccine for the flu expected to be available by the end of July will not be soon enough.

"No, it's not ideal. Normally with seasonal flu we vaccinate people in February or March, and the flu season starts in June and beyond," she said.

"So, really, in the ideal world you would vaccinate several months before the outbreak starts.

"In this case, we'll be vaccinating at the peak of the outbreak, so half of the people who are going to be get infected will already be infected and won't be able to benefit from the vaccine.

"But, it's still worth doing, because there's still all the other half of the people who have not been infected that could receive protection from the vaccine."
-

More swine flu deaths 'a certainty' - ABC News (Australian Broadcasting Corporation)

Blogged with the Flock Browser

Chile reports four new deaths due to A/H1N1 flu (Xinhua, edited)

Chile reports four new deaths due to A/H1N1 flu

www.chinaview.cn 2009-06-27 09:44:43
SANTIAGO, June 26 (Xinhua)

The Chilean authorities confirmed on Friday four new deaths due to A/H1N1 flu, raising the death toll in the country to 12.

The authorities said that two patients were from Nuble province, one from Valdivia and one from Osorio.

The victims from Nuble, southern Chile, were a 48-year-old female patient and a 47-year-old male, said the authorities.

The female patient was treated with anti-viral drug Oseltamivir from June 15, but she was taken to the hospital due to complications on June 19.

The male patient did not seek medical consultation on time. When he went to the health center, he was hospitalized and received treatment.

Nuble's health official Ivan Paul Espinoza said that most of the cases showed light symptoms.

The other death was a male patient of 41 years old from Valdivia, 800 km south to Santiago, the capital of Chile. The seven-year-old girl in Osorio is the first one who did not have symptoms and the first child who died in the country.
-

Chile reports four new deaths due to A/H1N1 flu_English_Xinhua

Blogged with the Flock Browser

More than 500 Influenza A/H1N1 confirmed cases reported in New Zealand (Xinhua, edited)

More than 500 Influenza A/H1N1 confirmed cases reported in New Zealand

www.chinaview.cn 2009-06-27 13:58:00
WELLINGTON, June 27 (Xinhua)

The number of influenza A/H1N1 confirmed cases in New Zealand rose to 507 on Saturday, up 54 from 453 on Friday.

The Ministry of Health said on Saturday that there were also 49 probable cases and the number of current active cases reported in the past seven days was 268.

The region housing the largest number of influenza A/H1N1 patients is Wellington, with 173 cases, followed by Auckland, 140, then Canterbury who has 128 people with the virus.
-

More than 500 Influenza A/H1N1 confirmed cases reported in New Zealand_English_Xinhua

Blogged with the Flock Browser

Thailand confirms first 2 H1N1 flu deaths (AlertNet, edite)

Thailand confirms first 2 H1N1 flu deaths

27 Jun 2009 05:42:59 GMT
Source: Reuters
BANGKOK, June 27 (Reuters)

Two people have died from the H1N1 influenza virus in Thailand, the Public Health Ministry said on Saturday, the first deaths since the virus was detected in the country six weeks ago.

A 42-year-old Thai man died early Saturday and a 40-year-old local woman succumbed to the virus in a private hospital on June 20, the Public Health Ministry said.

The ministry said it was only informed of the woman's death late on Friday. Thailand has so far reported more than 1,200 cases of the new flu.

(Reporting by Papitchaya Boonngok; Writing by Martin Petty; Editing by Sugita Katyal)
-

Reuters AlertNet - Thailand confirms first 2 H1N1 flu deaths

Blogged with the Flock Browser

Canada. Surveillance - H1N1 Flu Virus (Human Swine Flu) - Public Health Agency of Canada

Surveillance - H1N1 Flu Virus

Cases of H1N1 Flu Virus in Canada


The Public Health Agency of Canada (PHAC) is committed to sharing information about H1N1 flu virus cases with Canadians.

Confirmed cases are posted Monday, Wednesday and Friday at 16:00 EDT.


Laboratory-Confirmed Cases of H1N1 Flu Virus June 26, 2009, 15h00 EDT

As of June 26, 2009, a total of 7,775 laboratory-confirmed cases of H1N1 flu virus have been reported in all provinces and territories in Canada (see Table 1 below).

To date, 460 hospitalizations and 21 deaths have been reported among laboratory-confirmed cases.


[Table 1: Summary of laboratory-confirmed cases of H1N1 flu virus reported to the Public Health Agency of Canada, by the provinces and territories as of June 26, 2009 at 15:00 EDT]

[Province / Territory - NEW laboratory-confirmed cases(1) reported as of June 26, 2009 - New deaths reported as of June 26, 2009 - TOTAL laboratory-confirmed cases (including today’s cases) - Total deaths(2)]

• British Columbia 21 - 0 / 264 - 0
• Alberta 188 - 0 / 793 - 1
• Saskatchewan 59 - 0 / 685 - 0
• Manitoba(3) 82 - 0 / 599 - 2
• Ontario(4) 496 - 0 / 3161 - 7
• Quebec(5) 174 - 2 / 1834 -11
• New Brunswick 5 - 0 / 9 - 0
• Nova Scotia 13 - 0 / 130 - 0
• Prince Edward Island 0 - 0 / 3 - 0
• Newfoundland 4 - 0 / 31 - 0
• Yukon 0 - 0 / 1 - 0
• Northwest Territories 1 - 0 / 7 - 0
• Nunavut NR - NR / 258 - 0

• Total 1043 - 2 / 7775 - 21

• NR : No report
• (1) Note: P/Ts may choose to announce cases that have been confirmed after 15:00 EDT. These cases will be reflected in the next epidemiological update.
• (2) Number of deaths is included in the number of cases.
• (3) Manitoba’s announcement of one new death has not been received by PHAC.
• (4) Ontario is now reporting on a weekly basis (today’s number reflect the situation since Monday, the last report to PHAC).
• (5) Quebec searches systematically for influenza H1N1 among all ILI hospitalized patients which may explain high numbers. Also, information from Quebec is as of June 25, 2009.

(...)
-

Surveillance - H1N1 Flu Virus (Human Swine Flu) - Public Health Agency of Canada

Blogged with the Flock Browser

Australia. National tally of confirmed cases of H1N1 Influenza 09 - As at 6 am, 27 June 2009 (Dept. of Health, edited)

Australian Government - Department of Health and Ageing

National tally of confirmed cases of H1N1 Influenza 09 - As at 6 am, 27 June 2009

[Original Document: LINK. EDITED.]


The information contained in this situation report uses the most accurate currently available data.

Given the rapidly changing nature of the incident, recipients should be aware of the potential for later confirmation or clarification.


Current Australian confirmed cases of, and deaths associated with, H1N1 Influenza 09 (0600 AEST on 27 June 2009)

[Jurisdiction - Confirmed Cases - Deaths]

• Tasmania 71 - 0
• Northern Territory 125 - 0
• Australian Capital Territory 131 - 0
• Western Australia 190 - 0
• South Australia 262 - 1
• Queensland 527 - 0
• New South Wales 653 - 0
• Victoria 1560 - 3

• Total 3519 - 4

-
-----

Blogged with the Flock Browser

USA. Swine flu shot campaign could involve 600M doses - Yahoo! Finance

Swine flu shot campaign could involve 600M doses

Swine flu shot campaign could involve 600M doses; officials wonder how to administer them all

* By Mike Stobbe, AP Medical Writer
* On Friday June 26, 2009, 3:50 pm EDT
ATLANTA (AP)

A potential fall swine flu immunization campaign may involve an unprecedented 600 million doses of vaccine, though officials said Friday they haven't figured out how to administer so many shots or accurately track side effects if a seasonal vaccine is given simultaneously.

The swine flu campaign could far eclipse the roughly 115 million doses of seasonal flu vaccine distributed each year, officials said at a national vaccine advisory committee meeting.

No final decision has been made about whether a swine flu vaccination campaign will take place or whether all Americans would get immunizations. Health officials said that a swine flu vaccination campaign could be only a few months away, and that as many as 60 million doses could be ready by September. The timing depends on how fast a vaccine can be produced and tested, however.

However, health officials are clearly getting ready for a massive vaccination effort, and worry that illnesses could continue or even accelerate in the fall or winter. Preparation discussions dominated a three-day meeting in Atlanta of the Advisory Committee on Immunization Practices, a panel that guides U.S. vaccination policy.

The virus already has caused at least 27,000 illnesses and 127 deaths in this country. Twelve states are seeing widespread cases, and about 6,000 cases were reported in the past week -- more than in any other week since swine flu first appeared in late April.

Those are just reported cases. More than a million U.S. infections probably have occurred, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

"This new infectious disease is not going away," said Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

A new, small CDC study found the virus can cause more serious disease than seasonal flu in ferrets, which have a similar respiratory system to humans. But it does not seem to spread as easily, at least through the droplets that infected ferrets sneeze or cough into the air, said Dr. Nancy Cox, a CDC flu scientist.

However, officials are still worried about the seasonal flu, which causes an estimated 200,000 hospitalizations and 36,000 deaths each year.

Five flu vaccine manufacturers are producing 120 million doses for the 2009-2010 flu season, with a third of that available by Sept. 1 and most of the rest shipped by Nov. 1, CDC officials said. Federal officials are working to ensure a swine flu campaign doesn't force the manufacturers to scale back production of the seasonal vaccine.

The swine flu campaign could be a huge undertaking, involving as many as 600 million doses. Although about 300 million people live in the U.S., health officials anticipate children and perhaps adults under age 50 may need two doses each.

However, the logistics of such a campaign are still being worked out. The CDC relies on one company to distribute 80 million publicly financed vaccine doses for children. That company, McKesson Specialty, still has not said whether it could handle distributing as many as 600 million doses of swine flu vaccines to clinics and doctors around the country, said Dr. Jeanne Santoli, who oversees vaccine purchase and distribution for the CDC.

Officials said they'll probably need to recruit physicians who don't usually give flu shots because local health departments have cut more than 10,000 jobs. Tracking side effects could also be tricky.

Problems don't always show up in early studies. And if the vaccine is given at the same time as the seasonal flu shots, it could be difficult to figure out which vaccine is causing problems.

That happened in 1976, when officials vaccinated 40 million Americans in anticipation of a new strain of swine flu. But the pandemic never materialized, and at least 500 people who got the shots came down with a paralyzing condition called Guillain-Barre Syndrome. It's still unknown what caused the condition.

Some health officials said they'd rather start a swine flu vaccine campaign a few months after the seasonal shots to simplify side-effect monitoring. But they may not have a choice, said Cox, the CDC flu scientist.

Swine flu and seasonal flu have been circulating together, with new data from Australia -- which is experiencing its annual flu season -- indicating that flu cases there are 60 percent swine and 40 percent seasonal.

"There are too many complexities" to say what will be done in the fall, Cox said. "We'll have to wait and see."
-

Swine flu shot campaign could involve 600M doses - Yahoo! Finance

Blogged with the Flock Browser