After roughly a month of emergency response to the new H1N1 swine flu virus, US health authorities are taking stock, re-focusing and re- assessing priorities.
This was the main theme of the press briefing that Dr Anne Schuchat, director of the National Center of Immunization and Respiratory Diseases at the US Centers for Disease Control and Prevention (CDC), gave earlier this week.
“I think we’re at a transition point where we’re entering an area of new focus and new priorities,” said Schuchat.
“We really are on a fast track over the next eight to ten weeks to learn as much as we can as this virus heads to the southern hemisphere and to strengthen our planning for this surge of illness that we expect to experience here in the fall,” she added.
The latest World Health Organization Update shows the global count of H1N1 confirmed cases is 48 countries have officially reported 13,398 cases of infection, including 95 deaths. The United States accounts for most of the cases (6,764) and 10 deaths, with Mexico close behind in number of cases (4,541) but by far bearing the brunt of the deaths currently at 83.
Schuchat said there have been more than 300 hospitalizations and the number of deaths may be more than the 10 in the official WHO figures.
She said that the weeks ahead present two challenges for the US (and by implication the rest of the northern hemisphere): understanding how the virus will affect the southern hemisphere as it enters the flu season, and preparing for the fall and the prospect of a normal flu season overlayed with a resurgence of the new H1N1.
As the virus spreads in the southern hemisphere it could change and become more resistant, or more severe or transmissible. There are many countries in the southern hemisphere without a strong healthcare infrastructure and with populations who may be at greater risk of illness.
In preparing for the fall, the US has already announced a 1 billion dollar commitment for vaccine development and pandemic stockpile. Last Friday, Health and Human Services Secretary Kathleen Sebelius told the press that the federal government had asked three drug companies to make enough vaccine for 20 million people, as a first step.
The priority will be to immunize workers in key positions in health care, national security and emergency services, but further orders for hundreds of millions of doses are also expected, said the Washington Post on Saturday.
Schuchat said an immunization campaign takes a lot of planning and this is one of the things the federal authorities will be working on in preparation for the fall, while continuing to:
“Support the state and local areas around the countries for whom this problem has not yet ended.”
However, she added that in the US as a whole the flu-like illness patterns are starting to wane, while there are still “focal areas” with some ongoing and new cases, in many parts of the country the flu illness levels are receding to those that would be expected for this time of year.
Schuchat told reporters that while the authorities expect seasonal flu to return next fall or winter, they are not sure what will happen with the new H1N1 virus.
” It is very possible that this virus will continue to circulate and cause illness again next fall or winter,” said Schuchat.
Whether it will cause more or less illness than it’s causing at the moment, whether it will disappear or come back even stronger than the seasonal flu, that is not possible to predict right now, she said, but stressed it was important to remember that past flu pandemics have sometimes come in waves and the 1918 flu that killed millions worldwide had a mild wave in the spring and very severe second wave in the fall.
In the meantime, the situation in Australia appears to be developing very quickly and is not yet reflected in the WHO figures. Government figures released earlier today show 164 confirmed cases and no deaths; 36 hours earlier the total was 67 cases. Most of the cases are in Victoria (96) and New South Wales (48).
The Japanese authorities reported on Wednesday that the total lab-confirmed cases in the country is now 361, and that schools in the most affected prefectures of Osaka and Hyogo will resume classes on Monday after being closed for a week, said Xinhua news agency.
Japan has also eased restrictions on people travelling to Japan from Mexico and has stopped checking passengers on flights from North America.
The number of confirmed H1N1 swine flu cases on the Chinese mainland rose to 15 earlier today and the virus appears to be spreading to new provinces, and Hong Kong’s count also went up to 15 earlier today following the positive testing of a secondary school student.
In New Zealand the authorities said the number of confirmed cases of H1N1 swine flu remains at nine today and all patients have recovered, reported Xinhua.
In South America confirmed cases are still rising, with Ecuador, Brazil, Peru, Chile, Colombia and Argentina all now affected.
Bahrain and Singapore are new countries to enter the WHO list of lab-confirmed cases, each reporting one case of H1N1 swine flu infection earlier this week.
Sources: CDC, Australian Government Department of Health and Ageing, Xinhua, Washington Post.
Written by: Catharine Paddock, PhD