Countries re-think swine flu vaccine orders

WASHINGTON - The United States said on Monday it had cut in half its order for H1N1 flu vaccine from Australia's CSL Ltd, but said it is not certain how far orders from other suppliers will be trimmed.

While U.S. officials are still calculating how much swine flu vaccine they will need, it is becoming increasingly clear that the United States will not need all 251 million doses it ordered from five companies.

CSL said the U.S. government was halving its order for H1N1 vaccines, partly because the company had diverted some of its early output to the Australian government and would not be able to deliver its full $180 million U.S. contract.

Several other governments have started to cut orders for H1N1 vaccines because the pandemic has not turned out to be as deadly as originally feared and most people need only one dose, not two, to be fully protected.

Original orders for flu vaccine were placed in May, June and July, when it was not known what dose would be needed and it was not clear how severe the pandemic would be.

Different manufacturers have different contracts with governments. Some contain break clauses allowing customers to reduce the size of orders.

Germany's Bild newspaper reported that the German government had agreed to cut its vaccine order with GlaxoSmithKline Plc by one-third.

The newspaper said the agreement would save states about 133 million euros ($193 million). On Friday, Britain said it was in talks with Glaxo about reducing supplies.

Sanofi-Aventis, the largest supplier of flu vaccine to the U.S. market, said it was meeting all its U.S. contracts for sales of swine flu vaccine.

Bill Hall, a spokesman for the U.S. Health and Human Services Department, said U.S. officials were talking with companies about how much to cut orders.

"All the contracts that were put in place were designed to be flexible," Hall said in a telephone interview.

"There is a balancing act to ensuring we have enough vaccine for the population to meet the demand."

The United States has received 136 million doses of H1N1 vaccine from its five suppliers -- CSL, Glaxo, Sanofi, AstraZeneca unit MedImmune and Novartis, and the U.S. Centers for Disease Control and Prevention says more than 60 million people have been vaccinated.

While the pandemic is slowing down in North America, the World Health Organization said on Monday the virus was still active in parts of central, eastern and southeastern Europe, North Africa and South Asia.

Governments are torn between trying to encourage companies to make influenza vaccine and wasting money on doses that are never given. But bulk antigen -- the vaccine before it is put into a syringe -- can be stored and might be used in next year's seasonal vaccine.

The U.S. government was still promoting vaccination, reminding people that influenza is unpredictable and that H1N1 could come back in a third wave.

One potentially large market for the vaccine is children. Children under 10 need two doses of vaccine to be fully protected and some U.S. school districts were planning more vaccination clinics this week to get children a second dose.

Retailers such as Wal-Mart, drug stores and supermarkets were also offering H1N1 vaccine clinics.

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U.S. scales back H1N1 vaccine, cuts CSL order in half

SYDNEY, Jan 11 - The United States has scaled back its supply of H1N1 flu vaccine, cutting its order with Australian firm CSL Ltd in half, the company said on Monday.

The U.S. move follows other nations which have also cut back swine flu vaccines as health authorities around the world grapple with oversupply due to low demand.

The U.S. government has paid for 251 million doses of vaccine from five makers -- GlaxoSmithKline, AstraZeneca, Sanofi-Aventis, Novartis and CSL Ltd.

The United States last Thursday said it had not made a decision on whether to cancel or sell any of its vaccine orders.

Britain last week said it was talks with Glaxo about reducing further supplies of its H1N1 vaccine and might exercise a break clause in its contract with Baxter International.

Governments across Europe are scaling back orders because of limited vaccine uptake and the fact one dose is enough to protect against the virus, rather than two as originally anticipated.

France has said it aims to cancel 50 million of the 94 million doses ordered from Sanofi-Aventis, Glaxo, Novartis and Baxter, while Germany wants to cancel half the 50 million doses ordered from Glaxo.

Last month, Spain said it was looking to return unused vaccine, and the Netherlands and Switzerland plan to ship surplus supplies to countries still facing a shortage.

Sales of H1N1 vaccines have been a windfall for drugmakers since mid-2009 due to government orders.

Glaxo was expected to be the single biggest beneficiary with anticipated sales of $3.5 billion, according to industry analysts.

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Easing H1N1 pandemic may let in new flu viruses

LONDON, Jan 8 - The declining wave of pandemic H1N1 flu is likely to be followed by new, unknown strains of seasonal flu which health authorities must watch carefully to devise protection measures, European flu experts said on Friday.

The European Centre for Disease Prevention and Control (ECDC) warned that flu viruses "never stand still" and said governments should not relax H1N1 flu vaccination programmes, but remain on guard for possible changes in the virus and new strains.

"The historical pattern of human influenzas is that after pandemics, the world experiences a new mix of viruses," the ECDC's flu expert Angus Nicoll wrote in the Eurosurveillance scientific journal.

In a telephone interview, Nicoll said although signs from many parts of Europe and the United States suggest circulation of H1N1 is declining, it is still too early to say the pandemic is over.

He noted that the virus responsible for the last pandemic in 1968-70 became more easily transmitted between its first and second winter, so that there were more cases and deaths in the second winter (1969-70) in at least two European countries. An earlier pandemic in 1957-58 also declined before Christmas 1957, but then came back to cause a rise in flu-related deaths in the new year of 1958.

In the current pandemic, new infections of H1N1 flu have fallen sharply in recent weeks and some governments have been left with an oversupply of vaccines ordered to protect their populations against the virus that emerged last March.

Uptake of the vaccine has been limited in some countries and advice from medical experts that one dose is enough to protect against the virus, rather than the two originally anticipated, means some governments have more than they need.

Latest data from the ECDC, which monitors disease in the European Union, show that H1N1 -- also known as swine flu -- has killed more than 11,600 people around the world, more than 2,000 of them in Europe.

Nicoll said pandemic H1N1 flu had not completely halted other flu viruses in recent months, but had been the predominant strain, meaning that its decline could open the way for a new mix of viruses known as as inter-pandemic or seasonal flus.

He said governments should continue to urge people to get vaccinated against H1N1, since the shots were "the most potent countermeasure" for any human flu.

"The rule with influenza, pandemic and inter-pandemic, is to maintain vigilance and expect the unexpected," he said.

Nicoll also said some H1N1 vaccines, which governments ordered from drugmakers like GlaxoSmithKline , AstraZeneca , Sanofi-Aventis , Novartis and Baxter , among others, may prove useful in warding off any new strains of seasonal flu that emerge in the wake of the pandemic.

"Countries should see through what they planned to do," he said. "And one of the good things about some of the vaccines that European countries are using is that they have adjuvants (or boosters), which it makes it much more likely that they can cope with a virus that changes."

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China says H1N1 flu spreading into the countryside

BEIJING - The H1N1 strain of flu is rapidly spreading into China's vast countryside and there could be a spike in cases around the Lunar New Year period when millions head back to their home towns, the health ministry said.

The world's most populous nation has reported 648 deaths to date from what is often called swine flu, a tiny portion of the estimated 12,220 deaths around the globe, but has launched a massive vaccination campaign.

"Outbreaks in Beijing, Shanghai, other large cities and in schools have seen an obvious decline, but the virus continues to spread into villages and communities," the Health Ministry said in a statement on its website (www.moh.gov.cn).

The government has been especially worried as the country heads into the depths of winter and ahead of the Lunar New Year holiday in February, when millions of people travel back to their home towns -- potentially taking flu with them.

"The risk of catching H1N1 will increase, and the virus prevention situation is still grim," the ministry added.

"It is expected that for the period to come the virus will spread briskly."

China is also concerned that not enough people have been vaccinated against the virus, and that the flu will be hard to control once it reaches the poor and underdeveloped rural hinterland, where most the country's 1.3 billion people live.

The government is rushing to send medical equipment such as respirators to 17 central and western provinces to "increase the overall ability to deal with severe cases," the ministry said.

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WHO chief gets H1N1 flu vaccination

GENEVA, Jan 5 - The head of the World Health Organisation (WHO) has finally been vaccinated against H1N1 flu, a virus expected to infect more people in coming months, the U.N. agency said on Tuesday.

Margaret Chan, WHO director-general, was vaccinated on Dec. 30, a day after admitting at a news conference that she had not got round to it due to travel and other demands.

"She is feeling very well, working and very busy as usual," WHO spokeswoman Fadela Chaib told a news briefing. "The flu will be with us for a few more months."

H1N1, commonly known as swine flu, has spread to 208 countries and territories, according to WHO which declared an influenza pandemic last June. The virus has officially killed at least 12,220 people, but the true death toll is much higher and could take two years to establish, it says.

Chan said last week it would take another six to 12 months for the first pandemic in more than 40 years to run its course.

She called for continued vigilance, noting that pregnant women, young people and those with chronic medical conditions like asthma are at greatest risk.

Azerbaijan and Mongolia are scheduled later this week to become the first developing countries to receive donated H1N1 vaccine doses, Chaib said.

In all, six drug companies and 14 industrialised countries have pledged nearly 190 million doses for use in 95 developing countries, she said.

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H1N1 Deadlier in Children Than Seasonal Flu

BOSTON — H1N1 swine flu can kill children at a much higher rate than seasonal flu, and the elevated risk for pregnant women extends as long as two weeks after they give birth, researchers reported.

The findings show that the H1N1 pandemic, while overall no more deadly than seasonal flu, is capable of hitting vulnerable women and children far harder than regular flu usually does.

"Pediatric 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza than in previous years," Dr. Romina Libster of Hospital Posadas in Buenos Aires and colleagues wrote in the New England Journal of Medicine.

They said hospitalization rates for children with H1N1 were twice those of the 2008 rate for seasonal influenza.

H1N1 flu has killed more than 10,000 people in the United States alone, infected nearly 50 million and put 200,000 into the hospital. Pregnant women and children were known to be at higher risk and had already been given priority for the vaccine.

The results show that prompt treatment is important, Dr. Fernando Pollack of Vanderbilt University in Tennessee said in a telephone interview. Roche AG's Tamiflu and GlaxoSmithKline's Relenza can help ease symptoms if given quickly.

"We cannot chase this disease from behind. Once it gets going, it is very difficult to treat. All our fatal cases had not been treated within 48 hours of the development of symptoms," he said.

"Patients with lung problems or neurologic problems are at serious risk of not only having serious disease, but dying of swine flu," Pollack added. "They should not only be targets for vaccination, but for treatment."

Of 251 children hospitalized with H1N1 at six pediatric centers in Buenos Aires through July, 19 percent ended up in the intensive care unit and most of them required mechanical ventilation.

The death rate was 5 percent. Nearly one third had no pre-existing health problems, and the risk was highest among children less than 1 year old.

In contrast, none of the youngsters hospitalized for seasonal influenza required intensive care.

A second study, involving 94 pregnant women who became ill with H1N1 before Aug. 11 in California, found that those who delayed treatment were four times more likely to end up in the intensive care unit or die compared to those who received antiviral therapy no later than two days after symptoms appeared.

"Although pregnant women frequently presented with mild or moderate symptoms, many had a rapid clinical progression and deterioration," Dr. Janice Louie of the California Department of Public Health and colleagues wrote.

Eight women who were hospitalized for H1N1 flu had given birth less than two weeks earlier, four required intensive care and two died, "highlighting the continued high risk immediately after pregnancy," the researchers said.

That result was surprising, Louie said in a telephone interview. She did not know why women continue to be vulnerable after giving birth.

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WHO says world H1N1 deaths now at least 11,516

GENEVA, December 23 - At least 11,516 people worldwide have died of H1N1 flu pandemic has emerged in April, World Health Organization (WHO) reported Wednesday.

But in its weekly update, which showed an increase in deaths officially recorded at around 1000, since the last report, it said that the disease seems to have reached a peak or a plateau in Western Europe and North America, while the transmission is down in parts of Asia .

In the United States and Canada, is the virus spread geographically, but the general level of flu-like, was significantly decreased illnesses and hospitalizations and deaths are declining, the WHO said.

In Europe, the active transmission of the virus is still widespread throughout the continent, but in most countries, its activity appears to have peaked - although it was rising in the central and eastern parts of the continent.

In an earlier report Tuesday, said the UN agency pandemic is still moderate, but continues to infect and kill people much younger than the traditional seasonal flu.

But although the figures confirmed deaths from H1N1, sometimes called swine flu, WHO officials say comparisons of the number of deaths from the two types of flu is complex and can be misleading. GM Hot News