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WHO urges swift treatment for riskiest flu cases

Swine flu: Youngest likeliest to be infected, study confirms
Paris (AFP) Nov 11, 2009 - New data from Mexico, the epicentre of the swine flu pandemic, has confirmed that young people are most at risk of catching the A(H1N1) virus but elderly patients are most at risk of dying from it.

The study bolsters the belief that the pathogen is not as virulent as first feared but also stresses the need for caution, as a mutation into a more lethal form cannot be ruled out.

Epidemiologists led by Victor Borja-Aburto of the Mexican Institute for Social Security looked at data for 63,479 people who had been treated for flu-like symptoms in public clinics from the start of the scare in April until the end of July.

Of the 6,945 cases confirmed by tests as H1N1, 56 percent occurred among people between 10 and 39 years, an age group with a high risk of contact through social interaction.

There were far fewer cases among older patients, which suggests that people in this age group were exposed in the past to a cousin to swine flu and may have gained some immunity, the author say.

But when analysed for mortality, a "J-shaped curve" revealed a preponderance of deaths among the elderly.

Among patients aged between 60 and 69, the death rate was 5.7 percent, compared with only 0.9 percent among patients aged between 20 and 29 years.

The study adds to several previous analyses which suggest vaccination against seasonal flu provides a partial shield.

It also strengthens warnings that people with chronic underlying disease are especially vulnerable. Individuals in this category increased their risk of death sixfold.

As of November, 1, more than 199 countries had reported lab-confirmed cases of swine flu, according to a toll published by the World Health Organisation (WHO) last Friday. There have been more than 482,300 notified cases and at least 6,071 deaths.

But the real number of swine flu infections is likely to be very much higher as many countries have stopped counting individual cases, says the WHO.

In addition, the count does not include people who have only mild symptoms -- or no symptoms at all -- and thus do not bother seeing a doctor.

The mortality rate from swine flu has been variously estimated at between 0.2 and 1.23 percent, according to the country or region or social group that is analysed.

At its lower range, this estimate is akin to the death toll from ordinary, so-called seasonal flu, of around 0.1 percent.

But even the highest figure is still only half of that for the 1918 Spanish flu, where the mortality rate is estimated to have been at least 2.5 percent. Tens of millions of people were killed in that event.

"Some researchers believe, with the information available up to now, that the present H1N1 influenza virus will not cause a pandemic on the scale of those during the 20th century," said the new study, published online on Thursday by The Lancet.

"This pandemic might not be the one we expected; however, the virus is evolving and the threat continues."

by Staff Writers
Geneva (AFP) Nov 12, 2009
The World Health Organisation on Thursday called on doctors to use antiviral drugs swiftly on the most vulnerable swine flu patients, to prevent severe cases and avoid swamping hospitals.

WHO clinical expert Niki Shindo said the agency would issue new guidelines targeting three key groups in countries where the A(H1N1) virus is spreading, to avoid severe cases that could kill within a week.

However, Shindo emphasised that the "vast majority" of pandemic swine flu cases were mild and victims recovered within days without the need for treatment or hospitalisation.

"Firstly, people in at-risk groups need to be treated with antivirals as soon as possible when they have flu symptoms, this includes pregnant women, children under two years old, and people with underlying conditions," she said.

The other two groups were people with rapidly worsening symptoms, such as breathing difficulties and high fever for more than three days, while those found with pneumonia should be treated immediately with antivirals and antibiotics.

"I want to stress that people who are not from the at-risk groups... need not take antivirals," Shindo told journalists during a conference call.

"We are not recommending taking antivirals if otherwise healthy people are experiencing only mild illness, or as a preventive measure."

When asked in recent months about the preventive administration of antivirals in some European nations, WHO officials had largely left it up to countries to decide.

The UN health agency refined its guidance after in-depth studies of swine flu cases and clinical treatment found that early administration of drugs like Tamiflu in some instances could avoid potentially fatal severe cases.

"The virus is quite stable, the disease pattern did not change either," Shindo said.

"The reason we are updating now is that we can confidently say now that early antiviral treatment can make a difference in terms of preventing severe illness and death."

Shindo noted that Ukraine, Afghanistan and Mongolia had reported hospitals and clinics being "overwhelmed" by pandemic flu cases.

However, in Ukraine, the proportion of severe cases was less than those found in the southern hemisphere, and people appeared to have been admitted to hospitals there with "milder symptoms than needed" for intensive care, she added.

In Mongolia, pregnant women were "over-represented" amongst hospitalised flu cases, Shindo said, without giving details.

The WHO recently added Ukraine, Afghanistan, Belarus and Azerbaijan to the list of poorer countries receiving deliveries from the agency's aid stockpile of antiviral drugs.

The global death toll from flu pandemic passed the 6,000 mark last week according to the UN health agency.

The A(H1N1) virus has swept around the world since it was first identified in Mexico and the UNited States in April 2008, spreading into at least 199 countries.

The pandemic is currently surging in the northern hemisphere with the onset of colder weather.

earlier related report
Swine flu has killed nearly 4,000 in US: estimates
Washington (AFP) Nov 12, 2009 - Swine flu is thought to have killed nearly 4,000 people in the United States, including more than 500 children, health officials said after a new counting method yielded an estimate six times higher than the last.

The new system is based on more precise figures provided by 10 states, the Centers for Disease Control and Prevention (CDC) said. The previous estimated death toll from H1N1 was 672.

While still imprecise, the new numbers provide "a bigger picture of what has been going on in the first six months of the pandemic," Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, told a press conference.

She said previous estimates were based on "laboratory confirmed cases of hospitalization and death, potentially giving an incomplete picture of the story of this pandemic."

According to the new estimates, the total deaths since the swine flu virus first appeared in April total about 3,900, the CDC said, noting that figures were rounded to the nearest 10. The CDC also posted the new set of figures on its website.

The new swine-flu death toll for children under 18 years of age is 540, four times higher than the previous estimate.

Still considered the tip of the iceberg compared to the real, full extent of the swine-flu pandemic, the new estimates are based on more precise data provided by hospitals in 10 states, Schuchat said.

Those figures were extrapolated to the national level, she added.

The CDC cautioned that methodology was "not a predictive tool and cannot be used to forecast the number of cases, hospitalizations and deaths that will occur going forward over the course of the pandemic because they are based on actual surveillance data."

Schuchat said the estimated range of all H1N1 fatalities in the United States from April to mid-October was 2,500-6,100, with the mid-level range at 3,900.

Broken down by age group, the range was 300-800 deaths for children up to 17 years of age (mid-level range 540); 1,900-4,600 for ages 18-64 (2,920), and 300-700 for people above 65 years of age (440).

In all, 22 million Americans were infected by the swine flu virus during the period studied, with 98,000 hospitalized, according to the new CDC estimates.

Schuchat also said that 41.6 million doses of the H1N1 vaccine were made available Thursday for distribution around the country.

While the volume of vaccine deliveries shows the progress made in production facilities, it remains far below initial estimates and expectations, she added.

US health authorities have recently acknowledged greater shortfalls than anticipated in the vaccine supply, as long queues form outside authorized clinics and health centers in the inoculation drive.

Education Secretary Arne Duncan stressed Thursday that schools will soon begin offering the vaccine to students.

"Schools have done an extraordinary job of staying open and keeping sick students home," Duncan told CNN.

"Many are opening their doors so students can receive the vaccine within the school building."

Meanwhile, the global death toll from the pandemic passed the 6,000 mark last week according to the World Health Organization.

The H1N1 virus has swept around the world since it was first identified in Mexico and the United States in April, spreading into at least 199 countries.

The pandemic is currently surging in the northern hemisphere with the onset of colder weather.

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Nine hajj flu cases so far: Saudi health minister
Riyadh (AFP) Nov 11, 2009
Nine people out of more than half a million who have arrived for the annual hajj pilgrimage have been diagnosed with swine flu, Saudi Health Minister Dr Abdullah al-Rabeeah said on Wednesday. "The situation from the point of health, we are very happy. Out of the 600,000 arriving so far, we have only seen nine suspected cases of A(H1N1), and only two of those are in the hospital," Rabeeah ... read more

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