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    <recommendedItem id="20100101_19_414"
                     title="H1N1 Vaccination Still a Good Idea, CDC Says"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18325?impressionId=1265756237634"
                     
      &lt;p&gt;Although pandemic H1N1 influenza activity appears to have leveled off, the CDC remains wary of what the future may hold.&lt;/p&gt;
&lt;p&gt;No states were reporting widespread influenza activity, and only six  --  Alabama, Georgia, Maine, New Jersey, New Mexico, and Virginia  --  were reporting regional activity, Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases, told reporters on a conference call today.&lt;/p&gt;
&lt;p&gt;Influenza-like activity remained below the baseline level for this time of year for the third straight week, Schuchat said.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s fairly similar to what we would normally see at this time of year with seasonal flu,&quot; she said.&lt;/p&gt;
&lt;p&gt;However, she said that the H1N1 virus continues to circulate, causing severe disease and death in some cases.&lt;/p&gt;
&lt;p&gt;Although total activity is down, Schuchat noted that the proportion of deaths attributed to either flu or pneumonia is higher than the epidemic threshold, and has been for the past three weeks. The reasons were unclear, but she said there are no indications that the virus has become more virulent.&lt;/p&gt;
&lt;p&gt;But, she said, &quot;H1N1 vaccination remains a good idea.&quot;&lt;/p&gt;
&lt;p&gt;The most recent results of the CDC&apos;s National H1N1 Flu Survey revealed that about 70 million people, or 23.4% of Americans, have been vaccinated so far. About 76 million doses of the vaccine have been used because of the requirement that children younger than 10 get two.&lt;/p&gt;
&lt;p&gt;About 37% of children up to age 18 have been vaccinated. For those younger than 10, 37% have received their second dose.&lt;/p&gt;
&lt;p&gt;Vaccine supply remains ample, Schuchat said, with about 124 million doses shipped around the country up to this point.&lt;/p&gt;
&lt;p&gt;Citing an &quot;unprecedented&quot; effort to monitor safety, she said there have not been any major safety concerns identified.&lt;/p&gt;
&lt;p&gt;&quot;So if safety was the reason that you were waiting, I think you can be reassured on that front.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_302"
                     title="WHO Calls H1N1 Response Imperfect"
                     score="0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18165?impressionId=1265756237634"
                     
      &lt;p&gt;The World Health Organization says its response to the H1N1 pandemic could have been better, but was not unduly swayed by drug manufacturers.&lt;/p&gt;
&lt;p&gt;&quot;We are under no illusions that this response was the perfect response,&quot; Keiji Fukuda, MD, the agency&apos;s top flu expert, told a hearing being held by the Council of Europe&apos;s health committee.&lt;/p&gt;
&lt;p&gt;But he added, &quot;The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry.&quot;&lt;/p&gt;
&lt;p&gt;The council&apos;s hearing is a response to criticism by some European politicians, as well as elements of the media, that the danger of the H1N1 pandemic was exaggerated, perhaps to allow drug companies to score multimillion-dollar contracts for vaccines and antivirals.&lt;/p&gt;
&lt;p&gt;In North America, many experts defended the response to the outbreak, which WHO last April declared a phase six pandemic  --  the highest level. The phases reflect that an infectious agent is widely spread and causing disease in the community, but they say nothing about the severity of the disease.&lt;/p&gt;
&lt;p&gt;&quot;I do not believe that the record supports the claim that health officials in the U.S. or WHO exaggerated the threat,&quot; said Andy Pavia, MD, of the University of Utah in Salt Lake City.&lt;/p&gt;
&lt;p&gt;Pavia said in an e-mail that health officials had a choice  --  to assume the threat was minor or to react strongly.&lt;/p&gt;
&lt;p&gt;&quot;The choice is obvious,&quot; Pavia said, &quot;and I would not want to be in a position of explaining to the families of victims why we planned for the mildest outcome.&quot;&lt;/p&gt;
&lt;p&gt;For the most part, illness caused by the disease has been mild, although several thousand people have died around the world and many more were sick enough to require intensive care.&lt;/p&gt;
&lt;p&gt;But the relatively low number of deaths has prompted Wolfgang Wodarg, MD, a German member of the council&apos;s Parliamentary Assembly, to dub the outbreak a &quot;false pandemic&quot; and call for this week&apos;s hearing.&lt;/p&gt;
&lt;p&gt;&quot;What we have experienced now is that millions of people have been vaccinated unnecessarily,&quot; Wodarg said. &quot;This is damage done to people, in order to earn money.&quot;&lt;/p&gt;
&lt;p&gt;Fukuda, on the other hand, said today the pandemic &quot;is a scientifically well-documented event.&quot;&lt;/p&gt;
&lt;p&gt;&quot;The labeling of the pandemic as &quot;fake&quot; is to ignore recent history and science,&quot; he said, &quot;and to trivialize the deaths of over 14,000 people and the many additional serious illnesses experienced by others.&quot;&lt;/p&gt;
&lt;p&gt;Utah&apos;s Pavia echoed that sentiment. Ask any front-line doctor if the H1N1 flu was mild, he said, &quot;and prepare to get your head handed to you.&quot;&lt;/p&gt;
&lt;p&gt;One of them was Daniel Hinthorn, MD, of the University of Kansas Medical Center in Kansas City, Kan. &quot;As a physician who saw many patients with this disease, I believe it was very serious in many people,&quot; he wrote in an e-mail. &quot;The threat was not exaggerated, at least to my mind.&quot;&lt;/p&gt;
&lt;p&gt;Even last month, as flu activity in the U.S. declined, he said his hospital treated 11 inpatients for the flu, including six in intensive care, while &quot;lots of others&quot; were being seen in emergency wards and clinics.&lt;/p&gt;
&lt;p&gt;On the other hand, to say the threat was exaggerated &quot;is merely to say the obvious,&quot; argued Philip Alcabes, PhD, of City University of New York City. By the time a vaccine was available, &quot;this outbreak was far less serious than feared,&quot; he said in an e-mail.&lt;/p&gt;
&lt;p&gt;But &quot;reality-based skepticism about swine flu&quot; doesn&apos;t mean that people would refuse immunization  --  not if an outbreak was a real public danger, caused by a &quot;highly transmissible agent, likely to be virulent, highly preventable with reliably effective vaccine.&quot;&lt;/p&gt;
&lt;p&gt;He warned that public health professionals must avoid &quot;falling in love with the most dire forecast and then pushing high-tech precautions against the worst-case scenario.&quot;&lt;/p&gt;
&lt;p&gt;When that happens, &quot;people have to be excused for wondering whether the officials, the media, and the pharmaceutical companies were in cahoots on swine flu,&quot; he said.&lt;/p&gt;
&lt;p&gt;But several experts argued that preparing for a worst-case scenario was the responsible thing to do.&lt;/p&gt;
&lt;p&gt;Sometimes, &quot;mother nature throws us a break,&quot; argued Howard Markel, MD, PhD, of the University of Michigan in Ann Arbor.&lt;/p&gt;
&lt;p&gt;&quot;We responded to a threat without knowing the future,&quot; he said in an e-mail. &quot;A far worse outcome might have occurred if we did not take the threat seriously and H1N1 turned out to be worse than we initially predicted.&quot;&lt;/p&gt;
&lt;p&gt;The public health response should be compared to the use of seat belts or auto insurance, according to Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn.&lt;/p&gt;
&lt;p&gt;Every day, he said in an e-mail, he puts on his seat belt before driving. &quot;I don&apos;t finish each day and say &apos;What a waste, I didn&apos;t have an accident,&apos;&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;It is (and remains) unpredictable as to whether this virus could further mutate or change in a manner such that it could literally turn deadly within weeks,&quot; he said. &quot;If this pandemic had been deadly (and you don&apos;t know until you are into it) and we weren&apos;t prepared, the criticism would have been overwhelming.&quot; Poland said.&lt;/p&gt;
&lt;p&gt;He and others also noted that the flu season isn&apos;t over yet.&lt;/p&gt;
&lt;p&gt;&quot;This argument should be taking place at the end of the flu season in late March, not now,&quot; said Peter Katona, MD, of the University of California Los Angeles. &quot;Flu is unpredictable, and this is the heart of the argument.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_160"
                     title="CDC Says 20% of Americans Got H1N1 Flu Shot"
                     score="-0.004"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/17990?impressionId=1265756237634"
                     
      &lt;p&gt;As 2009 ended, an estimated 55 million Americans had been infected with the H1N1 pandemic flu and roughly one in five Americans had been vaccinated against the disease, the CDC said.&lt;/p&gt;
&lt;p&gt;The immunization data works out to about 61 million people, the agency said in an early release issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The proportion of people vaccinated was higher among those in priority groups, the agency said, including 29.4% of children ages 6 months through 18 years and 38% of pregnant women.&lt;/p&gt;
&lt;p&gt;At the same time, the CDC issued new estimates of the toll taken by the pandemic virus since the outbreak began last April: &lt;ul&gt; &lt;li&gt;About 55 million people had been infected up to Dec. 12, although the estimates ranged from 39 million to as high as 80 million.&lt;/li&gt; &lt;li&gt;About 246,000 needed inpatient care, although the number ranged from 173,000 to 362,000. &lt;/li&gt; &lt;li&gt;And about 11,160 died, with the estimate ranging from 7,880 to 16,460.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The vaccination findings are based on two surveys  --  the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System survey, which took place from Dec. 27 to Jan. 2 and from Dec. 1 to 27, respectively.&lt;/p&gt;
&lt;p&gt;Because vaccine was expected to be in short supply at the beginning, the CDC established initial target groups, including pregnant women, people living with or caring for infants under 6 months, healthcare and emergency medical services personnel, children and young adults, and adults with certain medical conditions.&lt;/p&gt;
&lt;p&gt;The CDC estimated that 27.9% of those people got vaccinated.&lt;/p&gt;
&lt;p&gt;The agency said the vaccine supply is now &quot;ample&quot; and efforts to promote general vaccination should continue.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1294"
                     title="IVW: Pandemic Vaccines May be Too Little, Too Late"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/13943?impressionId=1265756237634"
                     
      CANNES, France, April 28 -- If the swine flu outbreak develops into a pandemic -- and that&apos;s a big if -- the earliest the public would see a vaccine against the disease would be September, a researcher said here at the conference on Influenza Vaccines for the World.
              &lt;br&gt; 
              &lt;br&gt;And that&apos;s if the government asks industry to start production today, said Klaus Stohr, D.V.M., vice president and global head of Novartis Vaccines and Diagnostics and former head of the World Health Organization&apos;s global influenza program.
              &lt;br&gt; 
              &lt;br&gt;&quot;What we have seen the last two or three days is that the current pandemic vaccine system is not ideal not only in terms of timing . . . but also in terms of vaccine production,&quot; he said.
              &lt;br&gt; 
              &lt;br&gt;Any hopes that the version of H1N1 in the current seasonal vaccine would provide protection against the swine flu seemed to be dashed by preliminary data from Novartis-run tests.
              &lt;p&gt; 
              &lt;p&gt;Dr. Stohr said the findings suggested the H1N1 viruses contained in seasonal vaccines all the way back to 1980 are more closely related to each other than any are to the new virus, although he cautioned that more study was needed before concluding that there wouldn&apos;t be cross-protection.
              &lt;p&gt; 
              &lt;p&gt;He said that the outbreak of swine influenza A H1N1 has not changed &quot;the assessment that pandemic vaccines are too little, too late, and that they are not going to be a solution even for countries that have domestic vaccine production.&quot;
              &lt;p&gt; 
              &lt;p&gt;Based on the current state of the swine flu investigation -- ongoing clinical, epidemiological, and virological studies -- it would take about two weeks for vaccine strain preparation, he said.
              &lt;p&gt; 
              &lt;p&gt;Seed virus preparation would take another three or four weeks, putting the start of bulk production at the end of June, Dr. Stohr said.
              &lt;p&gt; 
              &lt;p&gt;Standardizing reagents would not be available for another eight weeks, and quality control would tack on an additional one to two, he said.
              &lt;p&gt; 
              &lt;p&gt;Only then, in early September, would Novartis and other vaccine makers start distributing vaccine, he said.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;Any decisions regarding pandemic vaccine production, he said, are complicated by the fact that nobody knows whether the virus will cause a pandemic, become endemic in humans causing continuous small outbreaks, or fizzle out and disappear.
              &lt;p&gt; 
              &lt;p&gt;If the virus were to &quot;disappear&quot; though, that would not necessarily eliminate the need to prepare for its re-emergence if it remained in an animal reservoir, Dr. Stohr said.
              &lt;p&gt; 
              &lt;p&gt;A possible solution would be development of a tetravalent seasonal flu vaccine, he said.
              &lt;p&gt; 
              &lt;p&gt;Further complicating decision-making is the looming threat of an H5N1 avian flu pandemic.
              &lt;p&gt; 
              &lt;p&gt;&quot;The absolute risk of H5N1 to cause a pandemic has not changed,&quot; he said. &quot;It remains a strain with high pandemic potential.&quot;
              &lt;p&gt; 
              &lt;p&gt;Swine flu, however, has bumped it down to number two on the list, he said.
              &lt;p&gt; 
              &lt;p&gt;The swine flu outbreak serves as &quot;a stark reminder of the unpredictability of the timing and of the speed by which the pandemic situation can change,&quot; he said.
&lt;p&gt;
&lt;p&gt;&lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/&quot; title=&quot;Swine Flu Coverage&quot;&gt;&lt;img src=&quot;/images/swine.jpg&quot; border=&quot;0&quot;&gt;&lt;/a&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1296"
                     title="Swine Flu Numbers Grow Again"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/13942?impressionId=1265756237634"
                     
      TORONTO, April 28 -- The number of U.S. cases of swine flu continues to grow and officials suspect that not all are a result of travel to Mexico. 
              &lt;p&gt; 
              &lt;p&gt;There are now 64 cases of laboratory-confirmed swine flu, CDC acting director Richard Besser, M.D., said in his daily press conference.
              &lt;p&gt; 
              &lt;p&gt;They remain confined to the same five states, he said, but New York now has 45 cases, California 10, and Texas six. Kansas still has two and Ohio one.
              &lt;p&gt; 
              &lt;p&gt;But he added that active investigations at the state and local level are turning up &quot;ongoing respiratory illness that is consistent with swine flu.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Besser added that, although five of the confirmed cases were hospitalized, he still has no reports of any deaths confirmed to be linked to the emerging virus.
              &lt;p&gt; 
              &lt;p&gt;In California, the Los Angeles coroner&apos;s office is reportedly investigating two deaths -- one on Monday and one on April 22 -- but testing for the virus is not complete.
              &lt;p&gt; 
              &lt;p&gt;Although most of the illness reported so far in the U.S. has been mild, Dr. Besser said, &quot;I fully expect we will see deaths.&quot;
              &lt;p&gt; 
              &lt;p&gt;And the number of cases will continue to grow. Indiana is reporting a single confirmed case of the virus -- a young woman who is not seriously ill -- but Dr. Besser said the CDC had not yet been officially informed of that. 
              &lt;p&gt; 
              &lt;p&gt;&quot;Numbers, when it comes to an outbreak like this, will change and through the day, you&apos;ll hear different numbers or newer numbers,&quot; he said. For the sake of consistency, the CDC will be updating its numbers -- reported on its website -- once a day, Dr. Besser said.
              &lt;p&gt; 
              &lt;p&gt;He added that the timing of the outbreak has been relatively fortunate, from the point of view of disease surveillance. 
              &lt;p&gt; 
              &lt;p&gt;&quot;If this outbreak had occurred in January or February, it would have been very difficult to detect,&quot; he said. &quot;There isn&apos;t anything we&apos;ve identified that distinguishes it from the seasonal flu.&quot;
              &lt;p&gt; 
              &lt;p&gt;The major difference is that many patients have a history of travel to Mexico, he said, &quot;but I wouldn&apos;t limit it to that, because it&apos;s really in a minority of cases to date that we&apos;ve been able to identify that travel history.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;That again is information that makes us think this is traveling from person to person,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;To put the current outbreak in context, the seasonal flu causes an average of about 36,000 deaths a year in the U.S., he said. 
              &lt;p&gt; 
              &lt;p&gt;The CDC is still wrestling with the issue of a vaccine against the swine flu, Dr. Besser said. The seed stock for such a vaccine has not yet gone to a manufacturer, because it&apos;s still not clear if it will be needed.
              &lt;p&gt; 
              &lt;p&gt;The agency is looking at whether a swine flu vaccine could be included in the seasonal vaccine, which includes two influenza A strains and one influenza B strain.
              &lt;p&gt; 
              &lt;p&gt;&quot;If it&apos;s possible, that would be great,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;But the production of next year&apos;s vaccine is already under way, and the CDC is reluctant to disturb or delay the process, he said.
              &lt;p&gt; 
              &lt;p&gt;It may also be possible to create a stand-alone vaccine that only targets swine flu, but again there is the risk of competing with the production of the regular vaccine, he said.
              &lt;p&gt;
              &lt;p&gt;And the swine flu outbreak is having some unexpected side effects. In Cleveland, organizers of a free health clinic that was to be held at an area fairgrounds cancelled the event at the request of local health officials. The event organizers said the health department feared the event, which was expected to draw tens of thousands of uninsured Ohioans, could be an incubator for swine flu. Thus far, Ohio has one confirmed case, a nine-year-old Elyria boy who recently vacationed in Mexico.
              &lt;p&gt; 
              &lt;p&gt;In France, at the Influenza Vaccines for the World conference, Klaus Stohr, D.V.M., of Novartis Vaccines, said it would likely take until September for  a targeted vaccine to be available. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/13943&quot; target=&quot;blank&quot;&gt;IVW: Pandemic Vaccines May Be Too Little, Too Late&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;In other developments, California Governor Arnold Schwarzenegger proclaimed a state of emergency similar in its effect to the federal public health emergency declared earlier.
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										&lt;td style=&quot;font-size:9px; line-height:11px;&quot;&gt;&lt;b&gt;Governor Arnold Schwarzenegger Holds Press Conference Regarding State Response to Swine Flu&lt;/b&gt;&lt;br /&gt;&lt;br /&gt;&lt;/td&gt;
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              &lt;p&gt; 
              &lt;p&gt;The governor said there is no need for alarm, but the declaration will cut red tape in the state&apos;s response to the outbreak by coordinating action, waiving some lab certification requirements, and suspending the competitive bidding process for some materials and services. 
&lt;p&gt;
&lt;p&gt;&lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/&quot; title=&quot;Swine Flu Coverage&quot;&gt;&lt;img src=&quot;/images/swine.jpg&quot; border=&quot;0&quot;&gt;&lt;/a&gt;



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