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.

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.

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.

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.

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%).

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.

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.

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.

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." 

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.

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

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).