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.