Statistics gathered by the California Department of Public Health show only three deaths among 13 million state residents who received H1N1 flu vaccine, USA Today reported. One person had preexisting flu and bacterial infections and one was a cardiac patient whose death was caused by cardiovascular disease. The cause of the third person's death is still being evaluated, state officials told the paper. [Feb 8 USA Today story]

Parental concern about pandemic vaccine safety, despite the vaccine's good record, is still an obstacle to immunization, according to a survey released today by the University of Michigan. While about half (55%) of parents worried about their children getting the flu, more (65%) worried about vaccine safety. Pandemic H1N1 has been more deadly for children than seasonal flu, but pollsters said parents may not fully grasp potential illness severity. The January poll included 1,612 parents. [Feb 8 University of Michigan vaccine poll]

The government of Algeria hopes to cancel three fourths of its order for 20 million doses of H1N1 vaccine, Agence France-Presse reported. The chief pandemic-flu official in the country's health ministry said Algeria has received 2.5 million doses already but has faced low acceptance of the vaccine, especially among healthcare workers. Algeria has seen 808 confirmed cases and 54 deaths. [Feb 7 AFP report]

The government of New South Wales says now is the ideal time for young children to be vaccinated against H1N1 flu, as the date for their return to day care or school approaches, the Australian Associated Press reported. Health officials expect Australia's second wave of H1N1 in the next few months, and this time, unlike in the first wave, there is vaccine available. Kerry Chant, chief health officer for New South Wales, said H1N1 is likely to be the dominant flu strain in Australia this year. [Feb 8 AAP story]

Respiratory disease is increasing in Haiti's refugee camps, though there has been no formal evaluation or lab confirmation of H1N1 flu, according to a report from the Global Health Cluster, a coalition of humanitarian groups working with the World Health Organization. The report, carried by ProMED-mail, says no vaccination efforts have been launched. With rains expected in March, the potential for flu outbreaks in the camps is moderate, the report states. [Feb 7 ProMED-mail report]

Although pandemic flu activity continues to decline or remain low in most of the Northern Hemisphere, some areas of the world are experiencing active but declining transmission, particularly North Africa and some areas of Eastern Europe and East Asia, the World Health Organization said today (WHO) today. Global H1N1 deaths have risen by several hundred from a week ago, to at least 15,174. China continues to report relatively high levels of influenza B. [Feb 5 WHO update]

Pandemic flu raised the death rate in European children last year but not adults, according to a study in Eurosurveillance. Children aged 5 to 14 years in eight countries had a 28% higher death rate than expected, in contrast to mortality in all age-groups, which was lower than in a typical year from seasonal flu. The higher death rate in children amounts to about 77 additional deaths in that age-group. The researchers called their estimates "conservative." [Feb 4 Eurosurveill report]

An outbreak of H1N1 has affected the northern Vietnamese province of Bac Kan, health officials said in a VietNamNet story today. Eighteen people recently contracted pandemic flu, said health official Dr. Nguyen Huy Nga. The patients have shown typical symptoms, he said, including fever, cough, sore throat, and muscle pain. [Feb 5 VietNamNet story]

A letter in Emerging Infectious Diseases outlines the case of a Thai patient with pandemic flu who developed acute respiratory distress followed by severe neurologic problems, including quadriplegia. Physicians ruled out Guillian-Barre syndrome, and the patient later regained muscle strength. Last May four Dallas children experienced pandemic-H1N1?related neurologic symptoms. [Feb 4 Emerg Infect Dis letter]

Rhinovirus may have edged out pandemic flu in France this fall, delaying the start of the fall pandemic wave compared with other European countries, according to a study in Clinical Microbiology and Infection. Researchers analyzed novel H1N1 and rhinovirus samples from a pediatric hospital from weeks 36 to 48 of the flu season and found an inverse relationship between rhinovirus and pandemic flu detections. They wrote that rhinovirus infections may interfere with flu transmission. [Jan 28 Clin Microbiol Infect study]

The pandemic H1N1 virus can infect turkeys when sick workers artificially inseminate the birds, leading to a drop in egg production, according to a study in Virology Journal. Researchers have been unable to reproduce infections in turkeys through standard routes, but the new report details how the virus transmits during intrauterine inoculation. The finding suggests that protective measures during artificial insemination may help poultry farms prevent disease outbreaks. [Feb 3 Virol J study]

Hungary's health minister announced yesterday the closure of pandemic H1N1 vaccination centers, Xinhua reported. The country said it will reopen them if public demand rises, and the vaccine will still be available elsewhere. The centers delivered about 92,000 doses, and the total number of vaccinated Hungarians so far is 3 million, about a third of the population. The health minister said doctor's visits for flulike illnesses had increased slightly compared with the past 2 weeks. [Feb 3 Xinhua story]

Six Western Lowland gorillas at Boston's Franklin Park Zoo received the human H1N1 vaccine yesterday, the Boston Globe reported. The zoo usually immunizes the gorillas against seasonal flu each fall, but they will receive those doses next week. Area hospitals donated the vaccine. The zoo's director of veterinary services said gorillas are susceptible to human diseases and are often protected with human vaccines. [Feb 4 Boston Globe story]

Flu activity was up a bit at colleges last week, though the levels haven't changed significantly over the past 6 weeks, consistent with the decreasing national trend, the American College Health Association (ACHA) said today in its latest update. The attack rate was 2.6 per 10,000 students, about 15% higher than the previous week. No new deaths or hospitalizations were reported. Overall vaccine uptake remained at 9%, but rates were as high as 40% in some states. [ACHA report for the week ending Jan 29]

New Zealand, which saw some of the earliest deaths from H1N1 influenza during its 2009 winter flu season, has received its first doses of H1N1 vaccine and is scheduling a national shot campaign. The first recipients of the 1 million doses will be health workers, pregnant women, young children, and the chronically ill. The Southern Hemisphere country is concerned that the virus may return from the Northern Hemisphere and trigger an earlier than usual flu season. [Feb 3 ONE News report]

Australian researchers say they have identified an immune-system protein that may play a key role in determining the severity of H1N1 flu infection. Among patients hospitalized with H1N1 flu, there was a correlation between severity of symptoms and deficiency in immunoglobulin G2, which supports early response to infection. The authors say that may explain the seriousness of H1N1 flu in pregnant women, because pregnancy mutes immune responses, and may point to a predictive test or treatment. [Feb 1 Clinical Infectious Diseases abstract]

Michael Vit, chief health officer of the Czech Republic, told media in that country that he is home sick with a flu infection that is presumed to be H1N1 influenza, according to Reuters. Vit oversaw flu vaccinations for key members of the government but missed his own because of an overseas trip, the news service said. Vit?s ministry led recently abandoned plans for mandatory vaccination of the Czech armed forces. [Feb 2 Reuters report]

With the 2010 Olympic Winter Games set to begin in Vancouver, the US Centers for Disease Control and Prevention has issued a set of travel tips it calls "Stop, wash and go." The agency recommends that attendees receive H1N1 flu vaccine before leaving, delay their departures if they feel unwell, cover coughs and sneezes, and wash their hands frequently. It also suggests taking a travel health kit containing hand sanitizer, tissues, and pain and fever medications. [Feb 2 CDC travel advice]

Though many nations have surplus H1N1 vaccine, much of it is not getting to developing nations, according to a New York Times story. So far, only two countries, Azerbaijan and Mongolia, have received vaccine. Afghanistan is slated to be next. About a month ago, the World Health Organization said it hoped to have shipped vaccine to 14 countries by now, of 95 nations that need it. Some of these countries are still experiencing significant pandemic cases and deaths. [Feb 1 New York Times article]

A program of hand hygiene, surface cleaning, and targeted antiviral treatment contained H1N1 flu at a boys' summer camp in July 2009, says a new journal article. The program was launched after 12 boys attending the third camp session contracted flu. During the fourth 2-week session, only 3 of 171 campers tested positive for flu, an attack rate of 1.8%, far lower than cited at other summer camps. However, 57% of staff and 31% of campers who took an antiviral reported side effects. [Feb 1 Arch Pediatr Adolesc Med report]

Researchers in Hong Kong have found evidence that, although the pandemic H1N1 flu virus and seasonal flu viruses cause several comparable responses in the body, pandemic H1N1 has the distinct ability to replicate in the conjunctiva. The findings, published in the American Journal of Pathology, suggest subtle differences in H1N1's receptor-binding profile in human hosts and demonstrate an additional route of infection. [Jan 28 Am J Pathol abstract]

Ontario's health ministry is investigating 17 serious illnesses that occurred after people received H1N1 flu vaccine, the Toronto Sun reported today. There were four cases of Guillain-Barre syndrome (GBS) and 13 anaphylactic reactions. Two GBS cases were in adults who received the vaccine from the same physician's office in Markham, Ont., the report said. GlaxoSmithKline recalled 170,000 doses of vaccine in Canada in November because allergic reactions were more common than expected. [Feb 2 Toronto Sun report]

Because of waning flu activity, Britain's hotline for pandemic flu diagnosis and antiviral prescriptions will be shut down on Feb 11, Chief Medical Officer Sir Liam Donaldson announced in a letter to physicians. Donaldson said the service eased pressure on primary care physicians at the height of the pandemic, but flu-like illnesses and confirmed H1N1 cases now are less than half what they were before the service was launched. The service can be restored in 7 days if needed, he said. [Donaldson letter]

A PLoS One study today showed that common household cleaners like 1% bleach, 10% malt vinegar, and an all-purpose cleaner rapidly and completely inactivated a strain of seasonal H1N1 influenza. Also, antiviral and antibacterial wipes reduced virus infectivity. The authors conclude that, for pandemic H1N1, "The public does not need to source specialized cleaning products, but can rapidly disinfect potentially contaminated surfaces with agents readily available in most homes." [Feb 1 PLoS One study]

People most likely to take protective measures during a pandemic are more likely to be older, female, well-educated, and non-white, according to a review in the British Journal of Health Psychology. In examining 26 papers that varied by quality, researchers found that those responding to messages were likely to believe they were susceptible, that the disease was severe, and that measures were effective. Increased anxiety and trust in authorities were also linked to adoption. [Feb Br J Health Psychol report]

In a PLoS Currents study, French researchers reported being able to vaccinate almost half of the occupants of a homeless shelter against pandemic flu. After giving 3 days' notice of the vaccine effort, health personnel administered H1N1 flu shots to 117 of the shelter's 249 residents (47%). That compares with vaccine uptake of 6% in the country's general population and 37% in its healthcare workers. Also, 96% of the homeless people vaccinated knew of the shot's benefits. [PLoS Currents study]

To boost pandemic vaccination rates, health officials in Taiwan have unveiled two new tactics, immunization at airports and in homes, the Hong Kong Standard reported today. Four airports will offer the vaccines to citizens entering Taiwan. Home-based vaccinations are available to groups of at least 10 people in communities, companies, or institutions who make a reservation with the local health department. Vaccine safety concerns have slowed vaccine uptake, though 24% have received it. [Feb 1 Standard story]

Although pandemic flu has declined in most of the Northern Hemisphere, transmission remains active in some regions of North Africa, eastern and southeastern Europe, and South and East Asia, the World Health Organization (WHO) reported today. Global H1N1 deaths now total at least 14,711. Novel H1N1 remains dominant in most nations, according to a separate WHO update, but in China 49% of flu isolates are the seasonal B strain. Other countries are detecting some seasonal flu, too. [Jan 29 WHO weekly update]

H1N1 flu activity stayed at about the same low level last week as the week before, the Centers for Disease Control and Prevention (CDC) said today. No states had widespread cases; five had regional activity. Five flu-related deaths in children were reported. The share of medical visits ascribed to flu-like illness was 1.7%, below the national baseline of 2.3%, but the fraction of deaths due to flu and pneumonia remained above the epidemic threshold. All but two tested viruses were novel H1N1. [Jan 29 CDC weekly flu update]

Flu activity at US colleges declined again after leveling off the previous week, the American College Health Association (ACHA) reported. The attack rate was 2.3 per 10,000 students. Though the number of vaccinated students was around 9%, the ACHA reports some encouraging signs. Some institutions are reporting vaccine uptake rates exceeding 25% to 30%. Vaccine availability has improved, with 86% of campuses reporting that they have it. [ACHA report for week ending Jan 22]

In an experiment to learn more about pre-existing immunity, researchers found that mice vaccinated with 1918-like and classical (from 1976) swine flu vaccines had complete protection against pandemic H1N1, according to a study in PLoS Pathogens. In contrast, vaccines based on more recent seasonal H1N1 strains afforded only partial protection. The authors say their findings underscore the importance of having people under age 35 receive the pandemic vaccine. [Jan 29 PLoS Pathog article]

China's government denied a link between H1N1 vaccine and miscarriages after an official said "several" miscarriages occurred among 10,000 pregnant women who had been immunized, Agence France-Presse (AFP) reported today. The official added the miscarriages were coincidental and that most were seen in women in their first trimester. He emphasized that global experience so far shows the vaccine is safe and effective in pregnant women, who are at high risk for flu complications. [Jan 29 AFP story]

Though older people appear to have some immunity to the pandemic virus, the US Centers for Disease Control and Prevention learned of several outbreaks at nursing homes, detailing three in Morbidity and Mortality Weekly Report (MMWR). They occurred during the fall before the vaccine was widely available, and infections in healthcare workers were documented at two of the facilities. Infection control steps and antiviral prophylaxis seemed to slow flu spread. [Jan 29 MMWR report]

The New Mexico Department of Health says the state's H1N1 hospitalization rate is highest in children under 5 and the death rate is highest in people aged 50 to 64. The overall H1N1 hospitalization rate is 50.3 per 100,000, but the rate for children under 5 is 135.5, twice the national estimate. The overall state death rate is 2.6 per 100,000, but the rate is 5.3 for 50- to 64-year-olds and 3.1 for those 65 and older. Children under 5 and adults 25 to 49 had a death rate of 2 per 100,000. [Jan 27 New Mexico statement]

In a study by French researchers in Emerging Infectious Diseases, of 16 H1N1-flu-confirmed patients treated with the antiviral drug oseltamivir (Tamiflu), only 9 (56%) tested negative for H1N1 flu within 3 day of treatment, while 3 (19%) still tested positive more than 5 days after treatment. The authors conclude, "These data raise questions about potential virus transmission during antiviral treatment and the possible resistance of pandemic (H1N1) 2009 to oseltamivir." [Feb Emerg Infect Dis study]

Canada announced today it will give 5 million doses of H1N1 vaccine and $6 million to the World Health Organization to combat the pandemic in developing countries. The doses amount to 10% of Canada's total vaccine order, a donation in line with those from other developed countries, the government said. Health Minister Leona Aglukkaq said Canada can donate vaccine because it has met its own immediate needs. [Jan 28 Public Health Agency of Canada release]

Hong Kong has no plans to sell or donate its remaining doses of H1N1 vaccine, Secretary for Food and Health Dr York Chow said today, according to the country's news.gov.hk site. Noting that Hong Kong's stockpiled vaccines will expire in October, Chow encouraged people in five high-risk groups to get vaccinated. [Jan 28 news.gov.hk story]

Aiming to put flu vaccine in the paths of shoppers, the Children's Hospitals and Clinics of Minnesota teamed up with Kohl's stores today to offer free pandemic and seasonal flu vaccines to adults and children outside two Twin Cities malls. A grant from Kohl's is covering the administration cost. Federal officials have urged providers to make it easy for people to get vaccinated. [Jan 28 Children's Hospitals statement]