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".

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.

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.

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.”

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).