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June 8th, 2010
11:49 AM ET

Did WHO overstate H1N1 threat?

By Elizabeth Landau
CNN.com Health Writer/Producer

Last week the British Medical Journal published an article accusing the World Health Organization (WHO) of conflicts of interest with regard to H1N1. The authors accused the organization of exaggerating the severity of the virus, and of taking advice from experts with ties to vaccine- and antiviral-producing pharmaceutical companies.

There has been a lack of transparency over conflicts of interests, the article stated, based on research from the British Medical Journal and the Bureau of Investigative Journalism in London, England. It also claimed the WHO also changed the definition of a pandemic, removing the phrase "enormous numbers of deaths and illness" from the criteria.

Dr. Margaret Chan, director of the WHO, said in a statement Tuesday that WHO needs to have stricter rules regarding engaging industry, but that "At no time, not for one second, did commercial interests enter my decision-making." 

Chan said that when she announced the start of the pandemic on June 11, 2009, she highlighted that the number of deaths worldwide was small, and that there would not be an expected jump in the number of severe or fatal infections. "In every assessment of the pandemic, WHO consistently reminded the public that the overwhelming majority of patients experienced mild symptoms and made a rapid and full recovery, even without medical treatment," she said.

She also denies that the WHO changed the criteria for a pandemic because of H1N1. The current plan with its definitions came into being in February 2009, long before H1N1, she said.

Chan wants the WHO's work on H1N1 examined.  She asked for an independent review of how the WHO handled H1N1 in January.

The names of the members of the Emergency Committee that advised WHO on the pandemic will be released when the Committee finishes its work, as the WHO had intended previously, she said.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


April 12th, 2010
10:40 AM ET

Committee begins scrutinizing WHO’s response to H1N1

by Madison Park
CNNhealth.com writer/producer

Health experts convening in Geneva, Switzerland, began its review of the World Health Organization’s response to the 2009 H1N1 flu virus Monday.

The committee will examine the ongoing global response to the pandemic H1N1 and to identify lessons learned about preparedness and response for future pandemics and public health emergencies.  The review committee is made of 29 experts in various aspects of public health, science and infectious diseases.

The WHO has been criticized for its handling of the pandemic with accusations that it exaggerated the flu’s threat after the virus spread globally last April.

“We want a frank and critical assessment,” said Dr. Margaret Chan, WHO’s director general.  “WHO is not defining or restricting the scope of specific issues that may arise. If our member states have questions or concerns, we want to hear these questions and concerns raised.”  Her statement.

The review committee is expected to submit a preliminary report to the World Health Assembly in May.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


February 22nd, 2010
05:44 PM ET

2009 H1N1 flu strain will be in next season flu vaccine

By Miriam Falco
CNN Medical News Managing Editor

The 2009 H1N1 flu virus, which has been circulating since last spring, sickened millions and killed at least 15,000 people worldwide, will be included in the next seasonal flu vaccine when it becomes available in the fall, health experts in the United States decided Monday.

Every February, the Vaccines and Related Biological Products Advisory Committee advises the Food and Drug Administration on which flu strains to include in the next flu shot or spray.

The committee is following the recommendations of the World Health Organization, Dr. Jerry Weir, the FDA's director of the Division of Viral Products, told CNN.

"This is the same process we go through every year," Weir explained. The selection is made early in the year to give flu manufacturers enough time to make enough vaccine by September or October, when health officials recommend people get vaccinated. Pharmaceutical companies need so much lead time because it's takes a long time to grow vaccines in eggs, currently the only licensed method for making flu vaccines.

"The new H1N1 strain didn't exist last February," said Weir, which is why health officials couldn't consider it for the flu vaccine for the current flu season. Once it was determined that this new type of H1N1 flu strain was circulating around the country and the world, flu manufacturers were asked to develop an additional flu vaccine to fight this virus.

The most recent estimates from the Centers for Disease Control and Prevention suggest that between 41 million and 84 million people in the Unites States have been infected with 2009 H1N1 since last April. The CDC also estimates between 183,000 and 378,000 people were hospitalized and between 8,330 and 17,160 people died from this flu since it emerged.

The agency says its estimate vary widely because not everyone who gets sick goes to the doctor, and not everyone who is hospitalized was tested for this flu and because health officials believe hospitalizations and deaths are under-reported.

The following three virus strains will be included in the 2010/2011 seasonal flu shot:

- an "A California viru," which is the pandemic virus H1N1 virus that caused so much illness in the past 10 months;
- an "A Perth virus," which is an H3N2 virus
- a "B Brisbane virus."

Weir says now that the three specific strains have been selected, manufacturers can now begin producing the new batch of seasonal flu vaccine.

For those concerned about getting the flu now, the CDC continues to recommend getting the separate H1N1 vaccine which is now widely available.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


February 18th, 2010
05:21 PM ET

WHO recommends H1N1 be part of next seasonal flu vaccine

By Miriam Falco
CNN Medical News Managing Editor

The World Health Organization is recommending that the H1N1 flu virus that’s currently circulating be included in the next seasonal flu vaccine for the Northern Hemisphere.

The WHO meets twice a year to determine which flu strains are the most dominant and chooses three strains to include in the regular flu vaccine.

Based on recommendations from flu experts from around the world, it was decided at the meeting Thursday in Geneva, Switzerland, that the pandemic H1N1 influenza strain go into the vaccine for the coming fall and winter, according to the Special Adviser on Pandemic Influenza to Dr Keiji Fukuda, director-general of the WHO.

The two other flu strains to be included into the next flu shot or flu
spray are an H3N2 virus and a B-virus. Fukuda said that the fact that the new H1N1 flu strain will be included in the next seasonal flu vaccine does not mean that the H1N1 pandemic is over.

He told reporters in a teleconference that parts of Eastern Europe, parts of Northern and Western Africa and parts of Asia are seeing the highest levels of pandemic H1N1 flu activity.

In a meeting in September, the WHO had already recommended that the seasonal flu vaccine for the Southern Hemisphere contain the H1N1 strain.

Fukuda said so far, "over 200 million people have been vaccinated with
the H1N1 vaccine" and the safety profile of the vaccine has been very good.

While the WHO recommends which strains go into the next flu vaccine, it's up to individual countries to decide whether they want to combine all three recommended strains into one shot, or if they want to have each strain in doled out separately. The pandemic H1N1 strain was not included in this year's flu strain because it emerged in April, about two months after the three seasonal flu strains had been selected for the 2009/2010 flu season.

The Food and Drug Administration's Vaccines and Related Biological
Products Advisory Committee (VRBPAC) is meeting next Monday to decide which flu strains will be included in the next seasonal flu vaccine for the United States.


February 16th, 2010
09:05 AM ET

H1N1 vaccine — I had an allergic reaction

By Ashley WennersHerron
CNN Medical Intern

I am an allergy sufferer — from seasonal sniffles to mushrooms and penicillin. Although I’ve been careful and lucky enough to have to use an adrenaline auto-injector only once, I’m wary of trying new things, whether it’s food or a new vaccine, out of fear of discovering yet another allergy. Despite my hesitation, I felt the protection granted by receiving the H1N1 vaccine outweighed the risk of a possible allergic reaction.

Early this month, I made an appointment with my school’s health center to receive the nasal spray vaccine. When I went in, I bravely tilted my head back, pinched one nostril and then the other for my two shots of vaccine nasal spray. The nurse told me not to blow my nose for 10 minutes and I was free to go.

Nearly 20 minutes later, I felt a familiar tingle in my mouth, similar to the one I get if I eat shellfish. Twenty minutes after that, with my tongue was twice as large as normal, I sounded like Daffy Duck. I had a fever of 102 degrees and a migraine. Yep, I added another allergy to my list — the H1N1 vaccine.

I called a local hospital to see whether I should go to the emergency room. They recommended that I take a Benadryl and come in if I developed respiratory problems. I took the antihistamine tablet and promptly slept away my symptoms. Three hours later, I was a bit groggy, but asymptomatic.

According to the Vaccine Adverse Event Reporting System, which is co-sponsored by the Centers for Disease Control and Prevention and the Food and Drug Administration, 6,528 individuals have reported an adverse reaction after receiving the H1N1 vaccine through injection. There have been 1,962 reactions reported for the live nasal spray vaccine. Both coincidental reactions and those caused directly by the vaccine are reported to the VAERS.

The CDC says that the nasal spray may cause a runny nose, but only in certain individuals is there a stronger reaction. If there is a severe reaction, such as trouble breathing, then the person should be brought to a doctor immediately. I was lucky to have only mild symptoms that did not require medical attention.

Despite my discomfort, I’m glad I received my vaccination. I live in a college dorm, surrounded by the 18- to 24-year-old age group most likely to be affected by this strain of influenza. I use public transportation, I shop in crowded grocery stores and I am constantly interacting with other people. The vaccine not only protects me, but it also aids in preventing transmission of the disease.

For me, a young and healthy individual, the flu would probably be mild, but I would still host the virus. This means I could pass it along to my classmates, my co-workers and to strangers on the subway. Someone with a compromised immune system, or someone with a chronic health problem could have much more severe consequences, such as developing pneumonia or respiratory problems.

I’m doing what I can to prevent people from getting sick; are you?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


Filed under: Allergies • H1N1 Flu • H1N1 Flu Vaccine

February 11th, 2010
04:23 PM ET

H1N1 is not gone – yet

By Miriam Falco
CNN Medical Managing Editor

The World Health Organization announced Thursday that although the number of H1N1 flu cases around the world is declining, the virus has not disappeared yet.

Dr Keiji Fukuda, the special adviser to the WHO's director-general on pandemic influenza, said the number of cases overall is declining, but some regions are still dealing with this flu, noting that the highest levels of activity are in Northern Africa, Eastern Europe and Eastern Asia. He also said the virus has made its way to Western Africa, specifically Senegal, which is reporting 14 cases.

"The virus has not disappeared and is continuing to cause disease and deaths in many parts of the world," Fukuda said. He pointed out that there have been more than 15,000 laboratory-confirmed deaths worldwide so far and that the true toll of this disease won’t be known for another year or two.

So the WHO will not say the pandemic is over, but at the end of this month a committee of scientists will meet to determine whether we've entered into a transitional period, which indicates that the end of this specific flu outbreak is near.

It's interesting to note that while some countries are talking about having too much H1N1 vaccine, 95 countries are still interested in getting the vaccine, according to the WHO.


December 31st, 2009
05:17 PM ET

Pandemic’s moderate numbers ‘best health news of the decade’

By Miriam Falco
CNN Medical Managing Editor

One of the biggest stories of 2009 – the outbreak of the pandemic H1N1 flu – coincided with the biggest story for my family – the birth of my son.

Many of my friends and colleagues asked me whether I missed being part of this huge medical story. At the time I easily said no. I'm a hard-core journalist, but having a baby and being there for him was much more important to me than any news story. That doesn't mean I didn't follow it.

Early on, the World Health Organization announced that the new virus was a new strain of the H1N1 virus, a type of flu virus that was not related to current or previous seasonal flu viruses. On April 23, the CDC said it had identified this new H1N1 strain to be a “swine influenza A, H1N1,” which usually infects only pigs, but in this case was also infecting humans. This is how H1N1 first began to be known as "swine" flu. However, not too long later, researchers determined it was brand new and included DNA from humans, birds and some European pigs, but that it did not originate in a pig.

Before the end of April, we first heard the word pandemic connected to this swine flu. On June 11, the WHO declared that H1N1 had reached the highest pandemic level – phase 6. Even though it had spread to several parts of the world, the virus was still deemed to be "moderate." But the fear was that the virus could change and things could get really bad.

By the time I returned from maternity leave at the end of July, nearly 8,000 people had been confirmed to have H1N1 and over 500 had died from this flu in the United States.

By the end of August, as more and more states reported "widespread" flu activity, a report from the President's Council of Advisors on Science and Technology described a worst-case scenario where the H1N1 flu virus could cause up to 90,000 U.S. deaths, mainly among children and young adults if it resurged in the fall. (Flu activity normally picks up in the fall, but it's estimated that 36,000 die each year from the seasonal flu – 90 percent of whom are 65 and older.)

Although the report was not meant to "predict" what would happen, it did suggest H1N1 could infect between 30 percent and 50 percent of the American population during the fall and winter and lead to as many as 1.8 million U.S. hospital admissions.

As of December 30, more than 120 million doses have been available for Americans. The CDC estimates that at least 60 million people have been vaccinated. Officials also estimate that as many as 67 million Americans had been infected with H1N1 by mid-November – not nearly 30 to 50 percent of the U.S. population as suggested by the president’s advisers. Hospitalizations are estimated at just over 200,000 – fortunately also nowhere near the worst case scenario of 1.8 million as the August report suggested.

Finally the death toll from the H1N1 flu was way below the 90,000 high estimated by the scientific advisers. The CDC estimates that as many as 13,930 people died from H1N1 between April and November 14, 2009. At least 243 of those were children who died since August 30. This number is very high compared with seasonal flu, which usually is a factor in only 80 deaths in children during a flu season.

H1N1 appears to have peaked in the U.S. for now. As of today, the last day of 2009, only four states are reporting widespread H1N1 flu activity. Around the world, many countries are seeing their case numbers decline while others are seeing a resurgence. And as the U.S. has had over 120 million doses of vaccine available already, many developing countries are still waiting for their first doses. Still as the WHO director-general Dr Margaret Chan told reporters this week, "the fact that the long -overdue influenza pandemic is so moderate in its impact, is probably the best health news of the decade."

So as 2009 comes to an end, the H1N1 story will extend into the new year. After listening and participating in countless CDC press briefings over the past several months, I asked CDC Director Dr. Thomas Frieden for his thoughts on this H1N1 pandemic. He says we need three things:

“First, perseverance. It's easy to say it's over, cases are going down, but influenza is unpredictable. We don't know what the future will hold. We have a unique window of opportunity to get vaccinated before the end of this flu season.

Second, we need preparation. Continuing to hone our preparations at every step of the supply chain, and every step of detection and response is important.

And third, we need to continue to invest in science - for better vaccines, and also better understanding of the pattern of influenza in communities and treatment. "


How we found Patient Zero
December 29th, 2009
02:39 AM ET

How we found Patient Zero

It was late April. I remember it being a somewhat quiet news day when I received the call. It was an editor on our international news desk alerting us that about 100 people had gotten very ill in Mexico City with severe flu-like symptoms.

They had no clue what was causing it at the time. The only thing health officials were telling us was that the patients had contracted a highly contagious virus that hadn’t been seen in humans before. The hunt was on: Dr. Sanjay Gupta and I hopped on the next flight out to Mexico City to track down the mystery virus that was getting so many people so sick.

Within 24 hours of arriving, the dense city of about 8 million people had figuratively turned into a ghost town. The mayor was urging people to stay inside; the hospitals were overcrowded; schools, public transportation, and restaurants closed their doors.

At one point, I remember walking down the unusually empty streets of Mexico City in awe. It was an eerie feeling, but also a defining moment for me as a journalist. I realized that people, not just in Mexico City, were scared of this unknown killer virus.

What was it? Would they be infected? What should they do? We didn't know it at the time, but H1N1 influenza was about to become a global epidemic and the world was already looking to us for answers.

A few days into our reporting on the ground, I received a phone call from CNN's senior executive producer for AC 360, David Doss. He had flagged a local health alert from the state of Veracruz, Mexico - there were unconfirmed reports that a little boy in the village of La Gloria was rumored to be “patient zero,” the earliest documented case of swine flu in the world.

Twenty minutes later, our crew was in the car, embarking on a three hour drive into the mountains of Veracruz to find the answer, the source of this outbreak. We had the wireless going on my laptop, phones to both ears, endlessly contacting our sources to confirm this story. We got it: Health officials confirmed to us that five-year-old Edgar Hernandez was in fact patient zero.

The catch? His village was in a very remote location with no phones, no electricity, no address to pop into our car’s navigation system. We knew finding patient zero would be a little like finding a needle in a haystack.

But as diehard journalists, this was the type of assignment we craved! I couldn’t wait to get there and to shuffle through that haystack. I knew in my gut we’d find him.

We walked around the village, visited their clinics, spoke to the locals. We met one man pulling his donkey up the dusty mountain road and asked him if he knew the Hernandez family. Turns out that man was patient zero’s uncle. He quickly walked us to the Hernandez’s home and we met Edgar, known as patient zero. He was no longer sick; he had survived the swine flu virus. He credits “ice cream” for curing him.

Being only 5 years old, Edgar couldn’t possibly realize the significance of being the first patient of what would be declared a global pandemic just two months later. But his mother certainly did. She feared Edgar could possibly be blamed for spreading it (which he did not) and she feared that their family would get sick again. She told us she didn’t understand what this virus was.

But that is why we were there - to find the source of this illness in order to understand it better. At this point, the CDC and the World Health Organization still didn’t know how the virus was spreading. But by discovering the earliest patients of an outbreak like this, health officials could begin to gather clues as to exactly what happened and, more importantly, how to treat and stop it from spreading.

As a journalist, there have been a few defining moments which I’ve felt I had a front row seat to something really big, to a small piece of history. Finding patient zero was one of the moments.

Follow Danielle on Twitter @DanielleCNN for more behind-the-scenes information and exclusive photos from the field.


December 24th, 2009
09:31 AM ET

How can I get rid of a lingering cough after having H1N1 flu?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Scott, Oregon

“After suffering through the H1N1 flu for almost a week, I feel completely healthy, save for a lingering cough. There is not much if any mucous involved, it's just a sensation that makes me constantly want to clear my throat. I am a healthy 33 year old male with no chronic illness; no allergies and I have never smoked.”

Answer:

You are not alone, Scott. Persistent, nagging cough is a common complaint among people who contract the H1N1 virus, even healthy non-smokers like you. Some say that the cough lasts for days – sometimes weeks – after other overt symptoms like fever, nausea, fatigue and congestion go away.

It's sort of like having a house guest who has worn out their welcome.

So why does the cough stick around for so long? The H1N1 virus causes inflammation in the respiratory tract, which includes the back of the throat and bronchial tubes that branch out in the lungs. The virus attacks that lung tissue, causing irritation. So although you are not suffering from the flu any longer, irritation in the mucus membranes lining your respiratory tract is still healing, and that is manifesting as a cough you cannot shake.

Unfortunately, the best thing for you to do is wait it out. Your cough could be a bothersome symptom for another two or three weeks, but it should dissipate as your respiratory tract heals. There are some effective cough medicines out there available over the counter, and even stronger ones in prescription form, but the good news: this is likely to get better on its own.

Incidentally, residual cough is common with most flu, including seasonal strains. As long as you are fever-free and otherwise feel well, there is little chance that your cough is spreading the H1N1 virus. The incubation period for H1N1 – the time during which you are most infectious to others – is between one and seven days.

Of course if several weeks go by and the cough has not subsided, you may decide to visit your doctor.


December 18th, 2009
12:09 PM ET

100 million H1N1 vaccine doses available, flu waning in U.S., officials report

By Miriam Falco
CNN Medical Managing Editor

The Department of Health and Human Resources says as of Friday, December 18, more than 100 million doses of H1N1 flu vaccine will have been made available for states to distribute. This news comes at a time when the so-called swine flu seems to be waning in the United States. It was just a few short weeks ago when the H1N1 flu virus was widespread, in 48 states, and people lined up for hours just to get one of these vaccinations. Now at least four states – Wyoming, Colorado, South Dakota and Nebraska – are reporting "no activity" at all. This may lead many to think that the pandemic is over, that there's nothing to worry about any more. However health officials keep reminding us that flu is unpredictable and we're just now entering the earliest part of what is considered the beginning of a normal flu season.

Yesterday, health officials also announced the latest statistics on how many Americans were affected by H1N1. So far 47 million cases have been reported; nearly 213,000 hospitalizations; nearly 10,000 deaths; and five times more pediatric deaths than in a typical flu season.

Eight months after this global pandemic began, World Health Organization officials say that they are frequently asked whether the pandemic is over or another wave should be expected in late winter or early spring. "The answer is right now is that we simply are not able to answer this question," Dr. Keiji Fukuda, special adviser to the WHO's director-general on pandemic influenza, told reporters Thursday. He also said that even if the H1N1 flu seems to have peaked in North America, other countries such as Switzerland, France, Kazakhstan, Kyrgyzstan and Russia are seeing high activity.

Perhaps more eye-opening was that Fukuda's announcement that six manufacturers and 12 countries had pledged 180 million doses of H1N1 vaccine, which would go to about 95 countries. The WHO had hoped to distribute these vaccines in late November or December, but that has now slid to sometime in the next few weeks. So the U.S. will have been able to distribute more than half of the number of vaccine doses as the WHO hopes to distribute to 95 different countries, most which couldn't afford to buy them themselves.

The question in the U.S. is, with more vaccine becoming more easily available, but flu activity dramatically down compared with just a month or two ago, will people who haven’t been vaccinated yet or gotten sick still get a flu shot or nasal spray?


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About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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