H1N1 France: From vaccine refusal to panic and riot police in just 7 days

"Please speak into the hygiaphone." photo: Flickr (CC)

There’s nothing like a good dose of reality to get people to change their minds about things. And the H1N1 vaccine debate in France is a textbook example of that.

The extreme cynicism with which the French considered H1N1 vaccination just one week ago has been replaced by panic and exasperation at not being able to get vaccinated. Riot police have been deployed at certain vaccination stations.

Flesh & Stone has already reported that people have been taking the government to court for attempted mass poisoning or, as the charge sheet puts it: “Attempting to administer substances…of a nature which could result in death.” Polls taken as recently as two weeks ago showed that around 80 percent of the population wouldn’t or most probably wouldn’t, get vaccinated against H1N1, and there has been violent public reaction against government attempts to persuade people to get their children vaccinated. Figures suggest that children represent almost 75 percent of those infected.

Sections of the national media have had a lot of fun ridiculing attempts to get people to vaccinate, and one video skit showed a supposedly desperate health minister begging people to be nice to her and take “my” vaccine.

Things have changed extremely quickly. The days of anti-vaccine conspiracy theories have evaporated into thin air in the space of just one week, replaced by crowds of worried people clamouring to be vaccinated and overwhelming vaccination stations and their staff.

This situation has come about because of the sudden and dramatic rise in infection rates and, with it, the sudden and dramatic rise in the number of dead, particularly among the young.

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H1N1 France: From vaccine refusal to panic and riot police in just 7 days

Kottke.org: How the H1N1 vaccine is made (using 1.2Bn eggs in the process!)

The most striking feature of the H1N1 flu vaccine manufacturing process is the 1,200,000,000 chicken eggs required to make the 3 billion doses of vaccine that may be required worldwide. There are entire chicken farms in the US and around the world dedicated to producing eggs for the purpose of incubating influenza viruses for use in vaccines. No wonder it takes six months from start to finish. But we'll get to that in a minute.

The most commonly used process for manufacturing an influenza vaccine was developed in the 1940s -- one of its co-inventors was Jonas Salk, who would go on to develop the polio vaccine -- and has remained basically unchanged since then. The process is coordinated by the World Health Organization and begins with the detection of a new virus (or rather one that differs significantly from those already going around); in this instance, the Pandemic H1N1/09 virus.

Once the pandemic strain has been identified and isolated, it is mixed with a standard laboratory virus through a technique called genetic reassortment, the purpose of which is to create a hybrid virus (also called the 'reference virus strain') with the pandemic strain's surface antigens and the lab strain's core components (which allows the virus to grow really well in chicken eggs). Then the hybrid is tested to make sure that it grows well, is safe, and produces the proper antigen response. This takes about six to nine weeks.

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Kottke.org: How the H1N1 vaccine is made

The Canadian Press: Vaccinations, antiviral supply mean H1N1 no threat to 2010 Olympics

The World Health Organization is sending a representative to monitor for potential disease outbreaks at the 2010 Winter Olympics, but Games officials and health experts say the threat from H1N1 has likely passed.

Most athletes, officials and spectators are expected to be vaccinated against H1N1 by the time the Winter Olympics begin in February.

'If the vaccination rate is high enough, I don't think H1N1 is going to be a risk,' said Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, the agency overseeing health services for the Olympics.

Planning for the possible impact H1N1 could have on the Games has been underway since before the WHO declared an official global pandemic in June.

In April, B.C. health officials made a decision to increase the stockpile of antiviral drugs available in the province because of the Games, according to briefing notes released under Access to Information.

How much it cost was censored in the documents, but B.C.'s provincial health officer said in an interview the original supply was boosted by three million doses, bringing the total amount available to 10 million.

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The Canadian Press: Vaccinations, antiviral supply mean H1N1 no threat to 2010 Olympics

Epinions.com: Do We Really Need Anti-Viral Kleenex?

Kleenex Anti-Viral Tissue is a moisture-activated facial tissue designed to kill common cold and flu viruses from droplets caught in the tissue, thus protecting the hands from contacting the viruses.

Kleenex states these tissues kill 99.9% of these viruses within 15 minutes. These tissues are 3-ply, with the middle layer containing the anti-viral ingredients, and are easily identified as the Anti-Viral brand by the little blue dots all over the layer. They are standard size tissues, measuring 8.4 X 8.2 inches. I've seen them available in the 120-count rectangular box and the 60-count cubed box.

Active anti-viral ingredients include food-grade Citric Acid and Sodium Lauryl Sulfate. Since these ingredients are food-grade, the EPA does not require any warning labels, and the tissues are safe for little ones.

Kleenex also boldly states that these tissues have not been tested against bacteria, fungi, or other viruses. But do we really need them?

Epinions.com: Do We Really Need Anti-Viral Kleenex?

Netherlands to sell surplus flu shots

The Dutch government is going to sell its surplus swine flu vaccine doses to countries who are experiencing acute shortages. Some two million doses will be sold.

They are no longer needed next month for the national vaccination drive.

Another 18 million doses may be sold in the first months of next year. The cabinet says it wants to help countries unable to inoculate all of their risk groups. Health Minister Ab Klink expects no other groups in the Netherlands need to be vaccinated.

The number of people to visit their general practitioner with flu complaints has begun dropping. Eight people, however, died of the A H1N1 virus last week.

All of them had been suffering from other complaints by the time they contracted the flu.

Netherlands to sell surplus flu shots

H1N1 Re-infections Raise Pandemic Concerns

Dr. Debra Parsons, a pediatrician at Kid Care West in Cross Lanes, was met with reactions of doubt from local health officials last month when she said two flu tests had come back positive for H1N1, or swine flu.

Parsons first came down with the virus, complete with all the telltale symptoms, in August.

Her son became ill at the same time with the same symptoms. Figuring they had the same bug, Parsons tested herself to see what it was.

The test came back positive for Influenza A, so the lab at Charleston Area Medical Center sent it to be sub-typed. Parsons was positive for H1N1.

Parsons and her son recovered, but in October they started having the same symptoms, but they became much worse.

They were both tested this time, and the results were the same -- they were positive for Influenza A and then H1N1.

'It was swine flu both times,' Parsons said.

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H1N1 Re-infections Raise Pandemic Concerns

AAP: Two deaths in France from mutated H1N1

Two patients who were infected by a swine flu mutation that was also recently detected in Norway have died in France, health officials say.

'This mutation could increase the ability of the virus to affect the respiratory tracts and, in particular, the lung tissue,' a statement from the French government's Health Surveillance Institute (InVS) said on Friday.
'For one of these patients, this mutation was accompanied by another mutation known to confer resistance to oseltamivir,' it added, referring to the main drug being used to treat swine flu, under the brand name Tamiflu.

The case was the first drug-resistant strain found in France among the 1,200 strains experts have analysed here, the InVS said, adding that 'the effectiveness of vaccines currently available is not being questioned'.
The two patients were not related and had been hospitalised in two different cities in France, it said.

The death toll in mainland France now stood at 76, the InVS statement said.
The World Health Organisation said on Thursday it was investigating reports of mutations in the swine flu virus, after half a dozen countries recorded cases in which the virus was transforming.

AAP: Two deaths in France from mutated H1N1

H1N1 Cases Declining In Hospitals Across US

The swine flu pandemic has taken a turn in the United States. Doctors in several cities are now reporting fewer cases of the H1N1 virus, prompting some to believe the outbreak may have peaked. Still, the virus has killed nearly 7,000 people worldwide since April, and health officials say there could be another outbreak in the U.S.

At its peak, there were so many outbreaks of H1N1 flu, this children's hospital in Texas had to set up tents for its patients. Two months later, the tents are down and so are the number of people who are sick.

'At some points we were seeing as many as 70 percent of patients testing positive for the flu, and now it's down below 10 percent,' Dr. Pat Crocker, Dell Children's Medical Center estimates.

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H1N1 Cases Declining In Hospitals Across US

TheMedGuru: Hajj pilgrims in Mecca and Medina unconcerned about swine flu threat

Millions of devout Muslims are descending on the holy cities of Mecca and Medina for the largest annual pilgrimage in the world despite the underlying fears of the pandemic swine flu affecting the Hajj.

A decrease in the turnout had been anticipated sparked by the global pandemic, but pilgrims have poured from the four corners of the world into Saudi Arabia in preparation for this year's Hajj, which will begin on Wednesday, Nov. 25.

According to official sources, around 500,000 pilgrims offered Friday prayers in Medina, the second holiest city in Islam.

Nevertheless, fears of disease were well founded as already four have fallen prey to the lethal virus - the first among pilgrims. The health ministry stated the deaths were due to underlying health issues and the failure of the victims to take adequate precautions and get vaccinated before embarking on the pilgrimage.

Fortunately the number of infections is less than had been feared by Saudi authorities. Only 20 pilgrims had been detected with the virus. Of these, 12 have been treated and discharged, while four remain critical in hospital.

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TheMedGuru: Hajj pilgrims in Mecca and Medina unconcerned about swine flu threat

Chinaview.com: H1N1 flu virus mutation detected in Hong Kong

Hong Kong's Department of Health announced that it had found the same mutation in a H1N1 flu virus sample as the one detected in Norway recently.

The department said that it had examined the genetic sequence of H1N1 flu viruses in its monitoring system. Out of the 123 sequences studied, one sample showed the same mutation as the Norway strain.

The virus was taken from a year-old boy who developed flu-like symptoms July 22. He was admitted to Prince of Wales Hospital July25 and discharged three days later. He has recovered.

Mutations are frequently encountered in influenza viruses. According to the World Health Organization, the same mutation of the virus has been found on the Chinese mainland and in other countries, including Brazil, Japan, Mexico, Ukraine and the United States.

The virus with this mutation remained sensitive to antiviral drugs, Tamiflu and Relenza. No evidence suggests these mutations are leading to an unusual increase in the number of H1N1 flu infections or a greater number of severe or fatal cases.

Chinaview.com: H1N1 flu virus mutation detected in Hong Kong

WKYC.com: New swine flu strain resistant to Tamiflu

Could there be a new strain of H1N1? That's what health officials are investigating after a few cases seem to be resistant to the treatment drug, Tamiflu.

It was discovered that a few patients at Duke University Medical Centers and a few others overseas in whales were diagnosed with a strain of flu too strong for Tamiflu to treat.

Health officials with the CDC say this doesn't indicate a health emergency. But there is concern over what appears to be mutations of the virus.

'We are unable to say if their deaths were caused by influenza, they are influenza associated but they had medical issues that were compromising their health,' says Megan Davies, a North Carolina State Epidemiologist.

The virus is just as severe, but this new mutation of H1N1 has a different characteristic. It might not be treatable with medications currently available.

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WKYC.com: New swine flu strain resistant to Tamiflu

Reuters: WHO probing drug resistant swine flu

GENEVA (Reuters) - The World Health Organization is looking into reports in Britain and the United States that the H1N1 flu may have developed resistance to Tamiflu in people with severely suppressed immune systems, a spokesman said Tuesday.

Britain's Health Protection Agency (HPA) said five cases have been confirmed in Wales of patients infected with H1N1 resistant to oseltamivir -- the generic name of Roche and Gilead Sciences Inc's antiviral drug Tamiflu.

The patients had serious conditions that suppressed their immune systems, which can give the virus a better than usual opportunity to develop resistance, the HPA said. It said the drug-resistant strain had probably spread person to person.

'We have seen the reports, we need to look into them,' WHO spokesman Thomas Abraham said in Geneva.

The U.S. Centers for Disease Control and Prevention last week also reported four cases of H1N1 resistant to Tamiflu at Duke University Hospital in North Carolina. All were said to be very ill with underlying severely compromised immune systems and multiple other complex medical conditions.

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Reuters: WHO probing drug resistant swine flu

BBC News - Canada's doctors told to stop using swine flu vaccine

GlaxoSmithKline has advised doctors in Canada to stop using a batch of its swine flu vaccine, amid reports of severe side-effects in some patients.

The batch of some 170,000 doses was put on hold because of the reported higher than usual number of patients having anaphylactic reactions.

This may include breathing problems, raised heart rate and skin rashes.
The pharmaceutical company said it was investigating the reports, which could lead to the withdrawal of the batch.

The reports say one in 20,000 people suffered adverse reactions to the batch of GlaxoSmithKline's Pandemrix vaccine. This is five times the expected number.

None of the patients reportedly suffered long-term ill-effects.

BBC News - Canada's doctors told to stop using swine flu vaccine

RT Reports: Mutant drug resistant H1N1 showing up in U.S

Swine flu mutation - Same receptor as 1918 Spanish flu pandemic found in Ukraine virus

According to analysis of genetic testing done by the World Health Organization, the Ukraine flu virus is an H1N1 mutation that is similar to the 1918 Spanish flu epidemic.

The two flu virus outbreaks both have changes in the receptor binding domain D225G, and similar symptoms, which include bleeding in the lungs. Current estimates of the deaths attributed to the Ukraine flu outbreak is as many as 400, and increasing daily.

In 1918, the Spanish flu pandemic killed between 20 million and 40 million people. The pandemic took place during the end of World War I, but ten times as many Americans died from the Spanish Flu as died in the war - nearly 700,000.

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Swine flu mutation - Same receptor as 1918 Spanish flu pandemic found in Ukraine virus

Dutch begin mass vaccinating 830,000 children, a musical variation

The Netherlands has begun vaccinating up to 830,000 children against swine flu in one of the country's largest vaccination programs.
Children between six months and four years old have received invitations to be vaccinated against the H1N1 virus.
The Netherlands has ordered enough vaccine to inoculate the entire country of 16 million people. Pregnant women, the elderly, and people with autoimmune diseases were vaccinated first.
A major center in Amsterdam is expecting 64,000 children Monday, the first day of a three-day campaign.
Children and parents arrived in a constant stream of buggies and bikes, and were greeted with clowns singing songs about how shots don't hurt - though an occasional wail could still be heard.

The NOS Jeugdjournaal (Junior News) reports (in Dutch):


And a funny re-edit of the mass-vaccination, on music

SF Chronicle: Fear spreading faster than swine flu in Ukraine

One night at the height of the panic over what people here call the California flu, as 24-hour news stations tracked a rising death toll and politicians speculated about a mystery lung plague, Ukraine's prime minister rushed to the airport to greet a shipment of Tamiflu as if it were a foreign dignitary. Not to be outdone, the president, a bitter political foe, dispatched a top aide to meet the plane, too.

In neighboring Belarus, the government took an opposite tack, accusing drug companies of fanning hysteria over swine flu to boost profit. In Poland, the health minister is under fire for refusing to stock up on a vaccine, while doctors in Hungary are resisting orders to administer the shot. In Turkmenistan, the authorities have been accused of covering up an epidemic, with infectious-disease wards reportedly full and people being turned away.

As the pandemic H1N1 influenza surges with the onset of winter, the nations of Eastern Europe and the former Soviet Union appear particularly vulnerable to the deadly virus. Burdened with weak health care systems, relatively inexperienced news media and shaky governments that have little public trust, the region also seems ripe for panic and political strife over the flu.

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SF Chronicle: Fear spreading faster than swine flu in Ukraine

And a report at RT Wladiwostok:

Today.AZ: WHO to send extra swine flu medicines to Azerbaijan

The World Health Organization (WHO) has sent to Azerbaijan extra Tamiflu sufficient for treatment of 38,700 people for swine flu, project coordinator of WHO office in Azerbaijan Elkhan Gasimov said.

He said the major A/H1N1 (swine flu) medicines were brought to Azerbaijan at the end of last week.

“WHO did not send medicines only to Azerbaijan. There are other countries in this list, too,” he said.

Elkhan Gasimov said in May WHO sent Tamiflu to Azerbaijan for treatment of 10,000 people.

The first part of the vaccines against the swine flu will be brought to the country late in November – early in December.

Nearly 170,000 doses of vaccines (2 percent of the population) will be brought to Azerbaijan.

Today.AZ: WHO to send extra swine flu medicines to Azerbaijan

USA Today: Drug resistant H1N1 found in USA and UK

Epidemic experts say they are investigating the apparent spread of Tamiflu-resistant swine flu virus among four patients at Duke University Medical Center in Durham, N.C., and five in a hospital in Wales.

These clusters appear to be the first in which a virus resistant to the antiviral Tamiflu, a mainstay of flu treat, has spread from person to person, researchers said Friday.

If Tamiflu-resistant virus spreads widely, swine flu will become tougher to treat and may cost more lives, says Duke's Daniel Sexton, who is leading the hospital's investigation.

Doctors say investigations of the two hospital outbreaks are underway, but the preliminary genetic evidence suggests that the virus spread among patients at the hospitals.

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USA Today: Drug resistant H1N1 found in USA and UK

Next Gen Pharma: Lower dose of H1N1 vaccine may be enough

With flu season hotting up, debate over the use of Influenza A (H1N1) vaccines continues to divide opinion. Now, Swiss-based pharmaceutical giant Novartis has announced that half of the currently-approved US dose actually fulfils immune response criteria for adults and the elderly.

Novatis' announcement is based on new interim data from ongoing clinical trials, and shows how a single 3.75µg dose of MF59-adjuvanted A(H1N1) 2009 vaccine met serologic protection criteria against influenza A(H1N1) in children ages three to eight, adults ages 18 to 64, and the elderly.

As such, the pharmaceutical firm is now in discussions with the US Food and Drug Administration (FDA) and is set to perfrom additional analysis suggested by the agency.

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Next Gen Pharma: Lower dose of H1N1 vaccine may be enough