Second peak, maybe

Today Il Giornale di Sicilia, a newspaper of Palermo, wrote that the swine flu epidemic might hit again Italy, and that a further peak might occur in the next months. Apparently, the newspaper was quoting CDC Director Thomas Frieden. Meanwhile, the Bmj, a scientific journal, published an article on December 7th, with the title “Fall in swine flu cases may not signal an end of the epidemic, warns Professor Donaldson”, in which it was explained why experts are cautious about the end of the pandemic in Europe. It said also that UK health authorities are uneasy because “the continuing deaths from swine flu and the high rate of hospitalisations despite low levels of the disease in the community”. The death toll has reached 270 in the United Kingdom and there are still 1000 people in hospital. According to the last report of the Italian Ministry of Health, updated on December 24th , in Italy the deaths are 188. Campania accounts for 25% of the fatal cases (47 deaths). But Campania accounts for only 10% of the Italian population.

Swine flu, no coverage

Many Italian news media don't cover the swine flu any more. Yesterday the Ansa press agency reported about the 10th death in Veneto, a man 56 years old, already ill by cancer, who died near Verona after 20 days in a hospital. And this is the only bit of news about the swine flu.

Situation Update: Week 51

Yesterday the Italian Institute of Health updated its weekly report about the swine flu in the country. The swine flu incidence (as the number of new cases in a week out 1,000 people) is abating and now it has dropped to an incidence of 1.79‰ (or 0.179%). The incidence is moderately high only in the island of Sardinia, where it is still 7.68‰.

All the regions are past the peak. Meanwhile, there have been some differences in the regional peaks of the swine flu. In Basilicata, Campania, Emilia-Romagna, Lazio, Marche, Abruzzo, Molise, Sardinia the maximum incidence has been more than 1.5%, everywhere else less than that. In Abruzzo e Marche the peak has been 3-4%, but maybe the data is wrong.

Swine flu update: Week 50

Yesterday the Ministry of Health said that the swine flu has killed 163 people. In Campania the regional authority has recorded 45 deaths, in Puglia 25, in Lombardia e Calabria 12 each. In the South of Italy the fatal cases are 90, more than half of the national cases. Maybe there's a different kind of recording or updating the data, but it's really strange such a large number.
Until now the Ministry has recorded 811 hospitalized cases, which required respiratory aids in 439 cases. All the cases are 3,794,000. All over Italy the pandemic has already peaked, the total incidence is 0,22%. Only in Sardinia, where the incidence is above 1%, there's still some flu activity. The update has received almost no  coverage by the newspapers.

WHO: 'Too early' to say pandemic over

Today the only piece of news about the swine flu is the WHO press conference in Geneva. Italian news media have covereved the talk of Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza. "Now we are about 8 months into the pandemic and one of the common questions coming to us is, that is the pandemic over, is it time to call it, and really the answer is, that it is still too early to make such a call." said Fukuda. In Italy the flu outbreak has already peaked, thus people expect the WHO to say that pandemic has ended.
Newspapers covered also the reason, according to Dr. Fukuda,to not call the pandemic over. The WHO expert said that the flu activity is still high in parts of Europe such as France and Switzerland, in the Czech Republic, and in parts of central Asia such as Kazakhstan and Kyrgyzstan, and in Russia. So it's to early.
Instead there was nothing about the second reason given by Dr Fukuda. "It is clear in some parts of the world, such as North America and in some parts of Europe, we have seen that the pandemic activity for now, has clearly peaked and is on the way down." said Fukuda "But the peaking has occurred extraordinarily early for influenza and we still have several months for winter to go and one of the big questions which is still before us is whether we expect to see yet another wave of activity occur or perhaps at late winter or in the early spring months".

Swine flu lesson

"And if the virus were only a cold?" wrote La Repubblica some days ago. The article by Angelo Aquaro explains that the mortality of the swine flu has been by far inferior to the expected (0.018%, less than the seasonal flu), there's been a decrease of the hospitalized cases in the United States and Europe (except France) in the days of the expected peak, many controversies on the vaccines (in Italy only the 14% of the health care workers have been immunized), and on the role of the Big Pharma and on WHO. Italy has bought 24 millions of doses of Novartis vaccine for 184,8 million of euros.
"If until now the things have gone better than what was expected, the merit is not surely of the vaccination campaign that has involved a low number of people" is reported to have said in the article Mauro Moroni, Director of Infectious Disease Department of Sacco Hospital, in Milan. "The culprits of the flop, says De Martino, "are also who refused to get the shot themselves, and I speak about my medical colleagues, and the citizens".
And at the end there's the conclution of Giovanni Rezza, Director of Infectious Disease Department of Istituto superiore di sanità in Rome. "The truth is that from this crisis we have learned two lessons. First, that the opposite extremisms, alarmism and denyingser, are counter-productive. The second one is that we must learn to produce the vaccine more quickly in order to prevent situations more serious."

Newly appointed minister

Today Professor Ferrucio Fazio has been appointed to the newly created role of Minister of Health. He has received strong  support by his party's MPs, but also by  medical associations and business unions. In the last months he managed to prepare for the pandemic of swine flu, and many people owe that to him.
Things are going quite well,  especially in North Italy. In the southern regions, in Campania, Puglia and Calabria there's the highest death toll.
Total deaths 149
Abruzzo 3
Basilicata 1
Calabria 16
Campania 32
Emilia Romagna 10
Lazio 14
Liguria 4
Lombardia 9
Marche 1
Molise 3
Piemonte 8
Puglia 19
Sicilia 11
Toscana 4
Umbria 5
Veneto 8
P.A. Bolzano 1

An Italian vaccine

Italy have done well against the swine flu, and the country is ready to research a new universal vaccine against all the flu viruses. Yesterday the Deputy Minister of Health Ferruccio Fazio talked about the pandemic in Italy. Fazio said also that one of the goals of the Istituto Superiore della Sanità is the universal vaccine, active against all the influenza viruses. The target of the research will be the hemagglutinin, "the primary protein responsible for binding to receptor sites on the cell membrane, allowing the virion to enter the cell" (some weeks ago New Scientist published an article about this issue). Professor Fazio said also that Italy has spent for the vaccine campaign less money than other European countries, obtaining better results. However, it's too soon to draw conclusions: the number of cases is decreasing, and so the number of deaths, but the pandemic hasn't stopped yet, said Professor Fazio. In order to end  it it's important to continue the vaccination plan, he said. In Italy there's an high incidence only in Sardinia right now.

The Imaginary pandemic

"The Imaginary Virus. Swine flu milder than the seasonal one and almost nobody got the vaccine shot": this was the headline of Il Foglio newspaper on December 3. "As expected, the 'A' is a second class flu" wrote il Giornale after a week. In these days there are a few of editorials about the swine flu. The outbreak has already peaked, the emergency rooms are no longer crowded by scared people, there are fewer new flu cases. With "only" 146 deaths in total, the swine flu is judged a false alarm by some newspapers. So, the news media have started blaming WHO, flu experts, and a large part of journalists for what happened. Il Corriere della Sera shows a different point of view. It wrote on December 13: "Health care, a communication crisis", blaming  on health authorities and on the lack of good communication for the false alarm.

High flu cases in Sardinia: Week 49

Sardinia has been the last region in Italy to record an high incidence of the swine flu. But in the past week the number of cases recorded in the island has decreased to 2.033%. The total incidence in Italy has dropped to 0.373%. According to InfluNet, the H1N1 virus has spread more than the other seasonal flu viruses, apart from the 2004/05 virus. Meanwhile, the Deputy Health Ministr Ferruccio Fazio is going to be promoted to Minister of Health. Mr Silvio Berlusconi, who has never said anything about the pandemic, is likely to be happy about  how Professor Fazio managed the pandemic.

More swine flu deaths in the souths

What happens in South Italy? Yesterday the Ministry of Health updated the swine flu report. The number of deaths has risen to 137. A total of 67 people have died in the regions of South Italy: Abruzzo, Basilicata, Calabria, Campania, Molise, and Puglia. The virus has killed 30 people in Campania, 18 in Puglia, and 13 in Calabria. So, the 55% of swine flu deaths has occurred in the south, where live only the 25% of the Italians. According to the Ministry, the national update depends on the speed of the regional updates, so maybe there's a difference in the regional reporting. Or maybe something really happened in South Italy. By the way, the Italian news media are still covering the issue, even though there are fewer articles.

Flu outbreak in pig farm

Some days ago there has been an outbreak of swine flu in a pig farm in Italy. The animals have been infected at the end of November by the H1N1 virus at a farm in Nerviano, near Milano, Lombardia. According to the report of the Italian Ministry of Health (through OIE), "the breeding sows were sick with lack of appetite, weakness and fever. All sows recovered fully in few days". There were 375 infected pigs out of 1250. There hasn't been any death and no control measures will be applied.
Untill now the Italian newspapers and televisions haven't covered this story, while reporting about a cat infected in France and two dogs in China, and also a pig in Germany. The German health Ministry has asked the ill farmers to stay away from the animals. In Italy there is no news about control measures.

Drop of swine flu cases: week 48

The swine flu cases are decreasing in Italy. The national incidence has fallen to 0.664%. Only in two regions, in Sardinia and in Friuli Venezia Giulia, the pandemic is still at its peak. Meanwhile, the deaths have stopped to 114 (in Campania region 28), and to 410 the cases who needed respiratory aid. The government's ad is still aired on the State television to invite people to get the vaccine. Until now 611,425 people got the shot.

Flu toll above 100

The swine flu has came to its maximum in Italy, but the deaths are still increasing. The Ministry of Health has said that the deaths are 101 (27 in the Campania region). It said also that 494,915 people has been vaccinated, out of 5,030,851 available doses. More than 131,000 health care workers have been vaccinated, more or less 13%. Italian mass media have covered about a two years old  child who died in Lecce, Puglia region. Apparently, the child was healthy, before becoming infected.

A mutated virus found in Italy

The swine flu has hit the headlines again. Many mass media reported about the mutated virus that was found in one patient out of 100 tested in Italy. According to the Ministry, there was also a case of antiviral resistance to oseltamivir among 160 tested patients. Actually, Italian media haven't reported about antiviral drugs at all, and still now they don't seem interested in this issue. The Italian health authorities keep suggesting that people get the swine flu vaccine, besides the seasonal one. Quite interestingly, the Italian Deputy Health Minister Ferruccio Fazio has said that the vaccination campaign could include also people over 65 years in the risk group, as it has been asked by WHO. In Italy elderly people have been excluded from the vaccine campaign, even though they are asthmatic, obese or affected by other risky desease.

The swine flu not an health problem

This year the swine flu is one of the main issues discussed at the SIMG meeting, in Florence, from November 26 to 28. "The swine flu has never been an health problem for Italy, just a challenge for the health care system" has said  Claudio Cricelli, President of the Societa' Italiana di Medicina Generale (SIMG). So it's official: too much fuss over nothing. Anyway, the vaccination campaign is still on. The deaths have risen to 91, mostly young people. The incidence of the flu has decreased in Lombardia, Tuscany and Campania, while still high in other regions,as Sicily and Sardinia.

Swine flu past its peak: Week 47

The swine flu in Italy  is past its peak. According to the Iss, the incidence has decreased to 1.138%. The Marche incidence data is still the highest in the country, but it's considered not significant of the real situation in the region. So, there have been some troubles collecting datas. Abruzzo, Emilia-Romagna, Sardinia and Basilicata have also high incidence, while Campania and Lombardia are likely past the peak.

Flu peaked in Italy, maybe

As the death toll soars to 85, the swine flu is still in the news. Today the Italian Deputy Health Minister Ferruccio Fazio has said that the vaccine is still effective, even though the virus has mutated. According to Fazio, it's likely that the flu pandemic has already peaked in Italy, infecting only some milions of people. Nevertheless, it's crucial that people in the high risk group get the vaccine, said Fazio. Gianni Rezza, Director of Infectious Desease Department of Istituto superiore di sanità, has confirmed that people need to stay alert and get vaccinated (if at-risk). According to the Ministry, more than 300,000 people have got the vaccine, out of almost 4 milions of doses available.

Topo Gigio, again

Two or three weeks ago the Ministry of Health has launched a new television advertising campaign. The main character is Topo Gigio, the puppet that already featured the first ad against the swine flu. This time Topo Gigio gives a piece of advice about vaccination. It explains who should get the swine flu shot, and who the seasonal one. The result is a bit confusing. Maybe the subject is too complicated to explain all in an ad.

A mutated flu virus in Norway

At least 68 flu-related deaths have been recorded by Italian Health Ministry, a high number in this time of year. Campania's health authority has reported 25 fatal cases, and it's the hardest hit region. The hospitalized cases have climbed to 489, while 241 people needed intensive care. Italian newspapers report today about a mutated version of the influenza virus, found in three patients in Norway, and this seems the most interesting thing of today. The Italian Deputy Health Minister, Professor  Ferruccio Fazio, is still inviting all the people at risk to get the vaccine shot. Today the newspapers cover also a story about a diet agains the flu. Black grapes, bananas, oranges and cauliflower can protect you, claims Fabio Firenzuoli, President of National Association of Phytotherapist Doctors. Also peppers work, if they are in different colours.

Swine flu at its peak: Week 46

Maybe the swine flu in Italy has reached its peak. Today InfluNet, the Italian surveillance network, has released updated datas for week 46, from November 9 to November 15. The incidence is 1.253%, a bit more than last week (1.227%). In the island of Sardinia  there's still one of the lowest incidences of flu cases (0.69%). The highest rate is again in Marche region (4.197%), followed by Abruzzo (3.492%), and Emilia-Romagna (1.917%), all in central Italy.

Media: Poland refuses the flu vaccine

Today the main piece of news is about Poland that is "calm and unvaccinated." Italian online media are really interested in this story:

Despite a serious outbreak of swine flu in neighboring Ukraine, the Polish government played it cool last week. Polish Health Minister Ewa Kopacz announced that she was not planning to stock up on swine-flu vaccine until it had been properly tested.
"The A/H1N1 vaccine is being produced by three companies, none of which has been able to assess its long-term effects. Their testing lasted a relatively short amount of time. It is not known whether [the vaccine] is safe for children and pregnant women," the health minister explained at a press conference last week.

The safety of the flu vaccine, in Italy the Focetria by Novartis, is still strongly debated. The daily government's report have updated the death toll to 62.

Swine flu, at-risk groups in Italy

The New England Journal of Medicine has just published two papers about swine flu in USa, Australia and New Zealand. They discuss if specific groups of people were more involved and more likely to be hospitalized. The results say that people "with underlying medical conditions", were young, of minoritu groups have an increased risk.
There isn't any study in Italy yet, but according to the Minister of Health many deaths have occured in the Campania region. Actually, 23 out of 58 fatal cases of swine flu occured there. There's no explanation of this, maybe it's bad luck. Again, according to the official datas, almost all the people who died, 55 out of 58, were in the at-risk group. Nothing is said about foreign people. After a rough estimate of Ansa datas, it seems that 10% of all the deaths occured among them, a figure that fits in with the % of foreign population in Italy (6,5%).

Topo Gigio against the swine flu

A month ago the Minister of Health launched an advertising campaign about the swine flu. The television ad features the room of "Topo Gigio", a beloved character of very old children series. Topo Gigio explains what to do against the flu:
1. wash your hands well and often with water and soap.
2. cover your nose and mouth with tissues when you cough and sneeze, then throw the tissue away
3. if you have forgotten to wash your hands, don't touch your eyes, nose and mouth: flu virus spreads in this way
4. remember to open the window to air the house
5. if you got, a cold, difficulties in breathing, cough, headache, stay home and call the doctor.
The television ad ends with the catchline "Swine flu is a common flu. These five rules helps fighting it". The ad has received mixed reactions. Many people felt offended by the use of a children puppet.

Campania hit by swine flu

According to the Ministry of Health, the fatal cases of swine flu are 53. Fifty people were in the risk group.Very few people have been vaccinated, only 150,000 people out of 3,000,000 avalaible doses. The websites of many newspapers aren't covering the pandemic in the front page any more, apart from ilmattino.it, newspaper of Campania region, where occured 23 deaths. Meanwhile, the flu articles are in the top 20 news of GoogleNews.
The press release of the government has also announced that 40 million of antiviral drugs doses are avaiable, but this issue is not currently debated.

Vaccine safety debated

In Italy people are arguing about the safety of the vaccination against the swine flu. This is the biggest debate, not the efficiency of the heath care system or the supply of antiviral drugs. Today the Italian news websites cover the unconfirmed death of a man in Germany after the vaccination. The Deputy Health Ministry Ferruccio Fazio keep reassuring that the vaccine is safe. He also announced that his sons will get the vaccine shot very soon.
Professor Franco Cuccurullo, Presidente of Consiglio Superiore di Sanità, has replied to the doubts risen by the consumer organization Codacons over the adjuvant used in the Focetria vaccine, containing squalene. Anyway, Codacons is collecting evidence of possible cases of adverse effects. The confirmed deaths of the pandemic have risen to 44.

Doubts about vaccine safety

The Italian consumers organization Codacons has asked the Ministry of Health to prove the safety of the flu vaccine, the Focetria vaccine made by Novartis. Codacons doubts that  a producer can make and test a flu vaccine in four months. Another point is the use of the MF59C.1 adjuvant, containing squalene. In Italy Codacons is a well known union, but in such a scientific matter it's a bit confused (and confusing).
The European Medicines Agency (Emea) has already explained the procedure of the ‘mock-up’ vaccines: in the first step Emea has evaluated a flu vaccine containing a different strain, the H5N1, and when the WHO declared the pandemic, the vaccine producer has replaced the strain in the mock-up vaccine with the pandemic H1N1 strain.
The second issue is more complex. "Clinical trials with MF59C.1 adjuvanted H5N1 vaccine have shown that the vaccine is adequately immunogenic in children older than 6 months up to 17 years with an acceptable safety profile." wrote Emea about the safety of the adjuvant system in children. So, it's ok for children.

More murky is the evidence of safety in pregnant women. Emea wrote:

"The non-clinical program included studies where the MF59C.1 adjuvant was given alone, or in combination with non-influenza antigens. This included specifically designed studies with administration before pregnancy, at the time of mating, as well as later during pregnancy in rabbits. It was shown that the doses of MF59C.1 applied did not induce reproductive toxicity for the dam or the foetuses. Experience with these adjuvants in pregnant women is very limited. In the pregnancy clinical database of Novartis, a limited number of pregnancies occurred in females of childbearing potential exposed to at least one dose of a MF59C.1 adjuvanted vaccine (either influenza vaccine or not). No occurrence of congenital abnormalities was reported, but the experience is too limited to draw conclusions."

So, it looks like Codacons could be right about the vaccine safety in pregnant women. The adjuvant has been tested in rabbits, not women . On the other hand, one should consider the risk of becoming infected while pregnant. So, it's up to every woman to choose. But the Italian Focetria leaflet doesn't help. Strange enough, the Italian leaflet ("Tell your doctor if you may be pregnant, plan to become pregnant. You should discuss with your doctor whether you should receive Focetria) is less clear from the English Focetria leaflet ("Tell your doctor if you are pregnant, think you may be pregnant, plan to become pregnant. You should discuss with your doctor whether you should receive Focetria).

Swine flu at full speed: Week 45

The A(H1N1) virus is spreading in Italy at top speed. The InfluNet, the Italian surveillance network, has released the report updated to week 45 (November 2-8). The incidence has risen to 1.227% of population. In the island of Sardinia  there's the lowest incidence of flu cases (0.148%). The highest rate is in Marche region (2.86%), followed by Emilia Romagna (1,8), Lazio (1,7), Abruzzo (1,6), and Campania (1,6). Quite unusual, the incidence of the pandemic is very high in children above 5 and below 14 years. This week has been 4.165%. The Ministry of Health has released the flu daily report: 42 confirmed deaths, 294 severely ill patients in hospitals, 149,000 vaccinated people. According to Corriere della Sera, yesterday Lombardia region has sent to all the local hospitals a letter to explain how to report correctly the swine flu cases.

Slow vaccine campaign

Yesterday the Italian Association of General Doctors (FIMMG) has asked its associated to help the vaccination campaign. FIMMH also invited its members to be vaccinated.

“We invite every member to be active in order to facilitate the vaccination of the people in risk group and to get yourself vaccinated against the swine flu” wrote the national secretary of the FIMMG, Giacomo Milillo, in a letter sent to the 27,000 doctors enrolled to the Federation. “The start of the campaign, scheduled on November 15, it is not still at top speed and in many local health unit (Asl) there are some difficulties to begin the campaign. In some regions it has been decided to entrust the vaccination to the general doctors, in others this task has been assigned to local centers. It is not important who will give the vaccine against the swine flu, but the realization of a adequate vaccination cover. Therefore, it is fundamental that the message to the population is clearest and the most similar as possible. It is not a corrected and responsible professional behavior – wrote Milillo - to diffuse doubts on the emergency of the vaccine and perplexities that are not based on reliable sources of reference and rather contribute to create a climate of confusion that could put to risk the vulnerable groups of the population. Our vaccination is necessary to contribute to the protection of the population, in particular of the chronic ill ones who we assist. The advantage that the vaccination have for people at risk (chronic ill, women to the second and third trimester of pregnancy) is infinitely larger then possible theoretical risks. The doubts on the emergency of the vaccine are groundless and pretext: the adjuvant contained has been given to million persons in the past (more than 40 million) and has only recorded three or four cases of serious reactions. The contained mercury amount in the vaccine dose vaccinates is comparable to the amount we eat in one or two tuna cans.”

In Italy many doctors refuse the vaccine. According to La gazzetta del Mezzogiorno, newspaper of Bari city, in the Puglia Region only 7% of health care workers has been vaccinated.

Swine flu not so harmless

According to the Italian Minister of Health the fatal cases of the swine flu are 34 (0.0043%), people in intensive care 108 (0.013%). There are no official data about the age of the victims, but Ansa press agency reports that a large part of the fatal cases are young (maybe 90%). In the past days the Deputy Health Minister Ferruccio Fazio kept repeating that seasonal flu causes each year 8,000 victims, so the death rate of the swine flu is much less of the one of the seasonal flu. But is this correct? Really the swine flu is so mild? The Italian National Institute of Statistics (ISTAT) has published data about the causes of death in 2006. The flu killed 298 people (22 in people under age 65), and all the pneumonia 6,749.
Actually, the swine flu is going to change the mortality pattern, especially for young people.

The vaccination campaign starts everywhere

Two fatal cases of swine flu have been confirmed today, in Umbria and in Campania. The death toll is now 34. The Deputy Health Minister Ferruccio Fazio has asked newspapers "to not rise useless alarms", while insisting that people in the risk group should get the vaccines, which "are safe and are used around the world." There are large differences in the vaccine distribution to population in Italy. Some regions, for example Sardinia, will start tomorrow the first phase of the vaccination campaign, while other regions have already proceeded at step two. However the outbreak has already caused 700,000 flu cases.

Poll: Swine flu worries Italians

People are worried about the swine flu and its complications. They don't trust health authorities and don't believe the vaccine is safe. According to a poll of La Repubblica, 57% of people are very or quite worried about the new virus. The majority, 54%, expect to become ill. A lot of people, 60%, will consult the family doctor in case of fever, while a quarter (25%) will rush to the hospital and 15% will stay home without asking anyone. A large 60% are very or quite worried about complications, 31% a little worried, 7% not worried. About what to do in case of catching the swine flu, only 10% feel to be well informed, 26% quite informed, 32% a bit, 31% don't have any instructions. A staggering 56% are against vaccination, 33% are positive, and 11% don't know what to do. The majority (51%) think that the vaccine is not safe, not tested and can be dangerous, 27% think it's safe. 41% think the government is telling the truth, while 42% no.
There are at least three problems about communication during the swine flu pandemic. First, it looks like communication involved the general public and not only the high risk group. Even worse, it  must have been confusing. So, a lot of people (60%) feel unnecessary anxiety about severe complications. Secondly, many people (63%) are insure about what to do, and this is another failure of the communication process. Last, the flu vaccine is quite unpopular, even though each year in Italt the seasonal vaccination campaign takes place.
The poll is up-to-date, because people have been asked on November 3.

Vatican Radio: Too much alarm

Maybe there aren't new tidings, maybe the pandemic has become boring, but today the flu issue hasn't been the first one in the newscasts. The death toll is still rising, up to 25 fatal cases in yesterday's official report. Vatican Radio has blamed on media for what happened in Italy. “There has been too much alarm for the flu. And this is good only for pharmaceutical firms that produce the vaccine” said the radio channel One-Five Live. “Look at the alarmed way used by media to tell the story of people killed by AH1N1, without mentioning that almost all were patients affected by other illness” it said “scared people asked to be protected and governments, under pressure, buy great bulk of vaccine”. Actually, the newspapers have been reporting obsessively that the victims were all in the high risk group. And the vaccination campaign is targeting, after the health care workers, this group of people. Unfortunately, it looks like the vaccination was too late for some of them. The speaker of the radio seems to think that these deaths were't caused by the flu virus, but by other causes. The two doctors try to explain that this virus can be dangerous for people at risk and that the vaccine is really useful.

Situation Update: Week 44

The flu virus is now spreading fast in Italy. The Italian Health Ministry has released data about week 44 from October 26 to November 1 (updated to 5 pm). The flu incidence has risen to 8.96‰ and it's already higher than the peaks in the seasonal epidemies from 2005/06 to 2008/09. In Campania the regional incidence is 14.66‰, in Lombardia it is 13.48‰, more than 11.5‰ also in Emilia-Romagna, Marche and Lazio. Almost all the cases are caused by A(H1N1) virus (98.8%).
The fatal cases are 21 (9 in Campania, 3 in Emilia-Romagna, 4 in Lombardia, 2 in Lazio, 1 in Sicily, Tuscany and Umbria each). Vaccinated people are 41,000.

New strain, old problem

It's becoming clear that many troubles caused by the pandemic in Italy are actually old problems of the national primary care service. For example, many local doctors don't know what to do, as Corriere della Sera has reported. They haven't been informed very well, but this lack of communication and technical updates from health authorities is often true for other illness.
Another problem is that it's difficult to ask advice to local doctors, even by phone call. So people rush to the emergency room (again Corriere della Sera). But this is a common occurrence in Italy, where it's hard to get a home visit by doctors.
And there's so much difference in flu vaccine campaign in the country, because each regional government has a different approach with a wide range of efficiency. If the strain of the flu virus is  new, the problems look old.

What the minister is asking

Another fatal case of swine flu occurred in Italy. A 37 years old musician died in Salerno, a city south of Naples. Italian newspapers keep track of the death toll, now 18, even though yesterday the Deputy Minister of Health Ferruccio Fazio asked the media to suspend it. Professor Fazio explained that this flu is milder then the seasonal one and that there is no need to worry. However, the Minister from now on will issue a daily update of the pandemic. So, maybe Professor Fazio himself doesn't think the uproar is going to be abated very soon. Actually, he pleaded everyone not to rush to the emergency room, but to consult first the family's doctor.

Vaccination program on time?

Can the vaccination program against swine flu be on time? According to a recent study, it can be expected “an autumn/winter wave in the Northern hemisphere strikingly earlier than expected”. In Italy the peak time of the pandemic will occur from 17 October to 23 November. “The analysis shows the potential for an early epidemic peak occurring in October/November in the Northern hemisphere, likely before large-scale vaccination campaigns could be carried out” write the authors. The simulations refer to a worst-case scenario, with no antiviral drugs used.
This is quite worrying. “The vaccine has been expected for the beginning of November” has said pharmacologist Silvio Garattini, interviewed by Agi press agency. “The trouble is that the pandemic has reached Italy earlier than expected, and if it carries on like, that the vaccine could be useless, because protection develops after 15 days from the shot”. According to the expert, it's necessary that all the Italians in the high risk groups get the shot by the middle of November, but this goal is "almost impossible".
This is a grim forecast, but for once it looks like based on sound science.

Death toll rises in Naples

Other two fatal cases of swine flu occurred in Naples, Corriere del Mezzogiorno reports. A 42 years old, overweight woman died today at Cotugno Hospital, while a 72 years old woman, with respiratory disease died yesterday at Cardarelli Hospital. So the death toll in Naples has risen to 8. Italian newspapers are reporting all the deaths caused by the H1N1 virus, and maybe this can be alarming for the general public. The Deputy Minister of Health Ferruccio Fazio keeps assuring that all the people who died were already ill, and that healthy people should not worry. Another big issue is the vaccine campaign: in the past days Professor Fazio has blamed on local authorities for the delays in the vaccine distribution, while praising the producer, Novartis, for having sent the first batch of two million doses in advance of a fortnight.

Quite surprisingly, nobody talks about antiviral drugs. Maybe this is good luck for the Ministry. According to a study, "the antivirals stockpiled in Italy are sufficient to treat only 7 million individuals, corresponding to the 12% of the population." 

Swine flu, first child's death in Italy

Today Italian media report about a child  who died in Naples on Friday after has been infected by A(H1N1) influenza virus. The child, a 11-years old girl, was cardiopathic. According to Il Mattino newspaper, it's the first child victim of the pandemic.
Anxiety is now spreading fast among population in Naples, while a lot of people in the high-risk list can't still get the shot of the vaccine. Censis, a public opinion research institute, has released a study about the pandemic. It says that more than 61 per cent of Italians aren't worried by the pandemic (but in South Italy only 51%). People were asked at the beginning of last August, so maybe someone have changed idea about the flu.

24 million doses of vaccine

The vaccination campaign against H1N1 virus has started. In some places it's just at the beginning, while in others it has already moved on the second stage. In Liguria the newspaper Il Secolo XIX explains that next Monday in Genoa doctors and other health workers will be vaccinated. Lombardia region is already at phase two of the process, so they will call pregnant women and people under 65 affected by chronic diseases.

Emilia-Romagna region is still completing stage one. Tuscany is operating at the second stage, while carrying out stage one, as Asca press agency reports. Abruzzo region doesn't seem to have received the vaccine against the pandemic flu.

In South Italy Puglia will start the campaign on Monday, first health personnel and pregnant women. The island of Sardinia too has to begin stage one

So, the campaign is on, but it has been carried on speedily in some regions and sluggishly in other parts of the country.

According to Agi press agency, the Minister has distributed one million doses of the pandemic vaccine. To vaccinate the health workers and other essential workers it expect to use 8 millions doses. At the end of the campaign it will distributed 24 million doses.

A network of health care centers

Today Ferruccio Fazio, Health Deputy Minister, has announced that it has been created a network to tackle the severe cases of the flu. The government and the Regional governments have located 14 centers to give treatment to these patients because not all the Regions have the specialized units (Agi press agency).
According to Ansa press agency Professor Fazio also explained that the case-fatality rate for A/H1N1 influenza has been 0,03‰, less than seasonal influenza rate (2‰).

A diverse vaccine campaign

In Italy there're many differences in vaccine distribution at local level. Regional governments organize the health care services, so they are free to choose their organization. Adnkronos press agency has collected information about the vaccine campaign, about who will give the vaccine shot to people. Mb stands for “medico di base”, the family doctor. Asl is the local health center. Some Regions have decided that the vaccine will be available in Asl, some have asked doctors, some both, and some haven't still decided.

A new web site

Today the Italian Ministry of Labour and Health has launched a web site, www.fermailvirus.it. The service is aimed at the general public, mainly at parents. There's a special section for pregnant women and other paregraphs for small children. Instead, there's no mention of another group at risk, people with chronic lung disease (I wonder why). And no information for doctors and nurses (they have other sources). The campaing is quite new for Italy: on the web site there's a lot of stuff about recognizing symptoms, things to do, suggestions etc. It's good, but I prefer the CDC web site, because there are more information and it doesn't speak to me as I were a child.

Week 43

According to the Iss data, the incidence in the 43th week of the year is 3,88 ‰ among all the people who got visited by doctors, and 13,02‰ among the 5-14 years old. The Iss released on October 28th also the local data, updated. In Campania (Naples and other cities) there is the highest incidence, but also in Lombardia (Milan) and Tuscany there are a lot of cases. Yesterday the Deputy Minister of Health Ferruccio Fazio said that in Europe only Spain has such an hign number of cases.
Piemonte 6,61 ‰
Val d'Aosta -
Pr. Aut. Bolzano 1,67
pPr. Aut. Trento 0,92
Veneto 0,88
Emilia-Romagna 3,06
Marche 4,86
Lazio 4,32
Molise -
Campania 12,37
Basilicata 1,33
Sardegna 0,55
Abruzzo 0,00
Calabria 1,08
Friuli vV.G: 0,93
Liguria 4,42
Lombardia 5,85
Puglia 1,75
Sicilia 2,13
Toscana 5,90
Umbria 2,64

More cases all over Italy

The H1N1 virus is spreading in Italy and it's more difficult to keep track of what is going on. Three fatal cases in North Italy: an old woman afflicted by pneumonia in Milan, a young man afflicted by TB in Ferrara, another woman in Rimini. A woman died in Rome and three men in Naples, a 64 years old doctor, a 50 years old afflicted by obesity, a 73 years old doctor already afflicted by pulmonary disease. All the news from Corriere della Sera newspaper. So, now the deaths caused by the virus are 12. On Monday the Lombardia health system will start the second part of the vaccine campaign, for pregnant women and young (under 17 years) people with chronic disease. In other parts of Italy the campaign is still focused on health care workers. This evening the flu news were on tv, on channel Rai 1 (link, in Italian). Health authorities continue to repeat that this flu is a mild one, and that it affects only ill people.
It seems to me that there's a lot of pressure to stop people panicking, and not such an effort to protect people with illness. Maybe I just find irritating, when someone infected by the virus dies, the comment: “the patient was already ill.”

Flu death in Naples

More details about the patient who died yesterday in Naples after being infected by H1N1 flu virus. He was a doctor, affected by anaemia, obesity and cardiac disease. On Monday he was admitted at Cotugno Hospital because of pneumonia. According the local newspaper Il Mattino, he didn't got vaccination because the regional health units have run out of the doses, primarily used for health care workers. The Italian Deputy Minister of Health Ferruccio Fazio said in an interview that the pandemic has started off and that in some part of Italy,, especially in South Italy, the vaccination campaign is late.
Personally, I don't understand who is late, the vaccine manufacturer, the national health structure or the local one.

WHO: Confusion on flu vaccines

Today at the Spallanzani Hospital in Rome there was a meeting, the WHO Global Forum on Mass Gatherings. According to Adnkronos press agency, Hande Harmanci, of the WHO Global Influenza Programme, has said that there's a lot of confusion about the flu vaccine. "There is a lot of confusion in the world on the pandemic vaccines" said Dr. Harmanci "for this reason one should remember that they aren't new: the seasonal influenza vaccines have been on the market for 60 years, and what is new in this case is only the subtype in the vaccine, only one, instead of the usual three in the seasonal vaccines." According to Dr Harmanci licensed pandemic vaccines are safe and a single dose is sufficient to confer protective immunity. The Italian Deputy Minister of Health, Ferruccio Fazio, has said at the same meeting that in Italy there's been only one case of side effects, a woman who developed a local reactions at the injection site. In Italy the safety of the swine flu vaccine hasn't been disputed, but there's a lot of confusion about H1N1 influenza. Today the Cotugno Hospital of Naples said that a 56 years old, suffering of chronic diseases, infected with the virus, died (report of Corriere della Sera). It's the fifth death in Italy because of the swine flu. I think that it seems a lot because nobody remember all the seasonal flu victims (and cases of side effects of vaccines).