In this week’s JAMA, there’s a research letter evaluating two strategies for achieving healthcare worker compliance with influenza vaccination. HCWs (n=480) were randomized to an “opt-in” group or an “opt-out” group. In the opt-in strategy the HCWs received an email with a link to a website where they could schedule their vaccinations. In the opt-out strategy, the HCWs were sent an email with a scheduled appointment for vaccination. Compliance with vaccination was 33% in the opt-in group versus 45% in the opt-out group (P=.008). The authors conclude that automatic scheduling of vaccination may be an effective method for increasing compliance with influenza vaccination. While that may be true, what is striking to me is the abysmal compliance rates in both groups. We are aware of hospitals that are achieving >90% compliance without mandating vaccination, but by actively promoting vaccination and providing incentives.

via Controversies in Hospital Infection Prevention: Opting-in vs. opting out.

The extent of the H1N1 pandemic has been estimated from case counts and deaths but the proportion of exposed populations with inapparent infections has not been described in detail. We analysed haemagglutination-inhibition (HI) antibody titres of pre-vaccination sera from pandemic vaccine trials conducted in six countries on four continents to provide an indication of A/CA/07/2009(H1N1)-like influenza seroprevalence in those populations. Among 7,962 subjects, ranging in age from 12 months to over 60 years, the proportions with HI antibody titres ≥40 to the H1N1pnd virus in the period from August to October 2009 were, by country: Costa Rica 26.4%, United States (US) 22.5%, Switzerland 16.9%, Germany 12.6%, Belgium 10.1%, and Japan 5.9%. Age-specific seropositivity rates in the samples were higher in children and adolescents in Costa Rica and in the US than in Europe and in Japan. The low proportion of seropositive children in Europe and Japan suggests that little local viral transmission had occurred in those regions even as late as September and October 2009, while in the US and Costa Rica, the greater proportion of previously infected children and young adults suggested that a significant number of asymptomatic infections had occurred during the first pandemic wave. Nevertheless, in all locations, the majority of the population remained susceptible to the pandemic virus at the beginning of the influenza season in the northern hemisphere, justifying the implementation of public health interventions.

via A TIME’S MEMORY: Regional and age-specific patterns of pandemic H1N1 influenza virus seroprevalence inferred from vaccine clinical trials, August-October 2009 (Euro Surveill., abstract, edited).

This report updates the 2009 recommendations by CDC’s Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine—recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged ≥6 months for the 2010–11 influenza season; 2) a recommendation that children aged 6 months–8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009–10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010–11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010–11 season; 3) a recommendation that vaccines containing the 2010–11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged ≥65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010–11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC’s influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010–11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010–11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

via Prevention and Control of Influenza with Vaccines.

The emergence of the 2009 pandemic influenza A(H1N1) virus in North America and its subsequent global spread highlights the public health need for early warning of infectious disease outbreaks. Event-based biosurveillance, based on local- and regional-level Internet media reports, is one approach to early warning as well as to situational awareness. This study analyses media reports in Mexico collected by the Argus biosurveillance system between 1 October 2007 and 31 May 2009. Results from Mexico are compared with the United States and Canadian media reports obtained from the HealthMap system. A significant increase in reporting frequency of respiratory disease in Mexico during the 2008–9 influenza season relative to that of 2007–8 was observed (p<0.0001). The timing of events, based on media reports, suggests that respiratory disease was prevalent in parts of Mexico, and was reported as unusual, much earlier than the microbiological identification of the pandemic virus. Such observations suggest that abnormal respiratory disease frequency and severity was occurring in Mexico throughout the winter of 2008–2009, though its connection to the emergence of the 2009 pandemic influenza A(H1N1) virus remains unclear.

via A TIME’S MEMORY: Event-based biosurveillance of respiratory disease in Mexico, 2007–2009: connection to the 2009 influenza A(H1N1) pandemic? (Euro Surveill., abstract, edited).

During the 2009–10 influenza season, the second wave of influenza activity from 2009 pandemic influenza A (H1N1) occurred in the United States; few seasonal influenza viruses were detected. Influenza activity(*) peaked in late-October and was associated with higher pediatric mortality and higher rates of hospitalizations in children and young adults than in previous seasons. The proportion of visits to health-care providers for influenza-like illness (ILI), as reported in the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), was among the highest since ILI surveillance began in 1997 in its current form. This report summarizes influenza activity in the United States during the 2009–10 influenza season (August 30, 2009–June 12, 2010).

via A TIME’S MEMORY: Update: Influenza Activity — United States, 2009–10 Season (MMWR Morb Mortal Wkly Rep., edited).

According to the ministry, the numbers reflect the impact of the vaccination campaign carried out in Brazil in 2010, which immunized 88 million persons against pandemic flu between March 8 and June 2.

Still, it’s astounding to think that Brazil, with a population of over 191,000,000, could vaccinate almost half its people in less than three months.

And it’s even more astounding that our media didn’t even notice.

via H5N1: A Brazilian triumph.

Bangladesh Sunday announced that in the first half of this year the country has detected 298 cases of A/H1N1 flu.

The latest statistics of the country’s Institute of Epidemiology,Disease Control and Research under the Health Ministry released here on Sunday showed 298 cases of A/H1N1 flu were confirmed during January-June period of this year, raising the overall figure to 1,183.

via Bangladesh detects 298 A/H1N1 flu cases in January-June period.

Health authorities in Northland have reported the first ever suspected swine flu death in the region.

They say a 51-year-old man, who died suddenly earlier in July, was found to have the H1N1 virus. His death has been referred to the coroner.

Medical Officer of Health Jonathan Jarman says the man had an underlying health condition.

via Radio New Zealand News : Stories : 2010 : 07 : 28 : First suspected swine flu death in Northland.

Is this, however, an adequate response? As stated by the BMJ report, the 2004 WHO pandemic-preparedness document detailed new rules on managing conflicts of interest and these rules seem not to have been followed in this case. In a interview with the BMJ, Härtl was asked whether or not WHO knew if the three contributing scientist used signed a conflict of interest statement, to which he replied, “I think they did it but I am not 100% sure”. As pointed out by the BMJ, it is very odd that WHO might not have known about possible conflicts of interests.

This lack of transparency is a key shortcoming of the WHO process. As Flynn notes, some WHO advisors have made no secret of consulting work—for example, Karl Nicholson declared his receipt of speaker’s fees from several pharmaceutical companies in a 2003 Lancet seminar on influenza, but as pointed out by the BMJ and the Bureau of Investigative Journalism report he seems not having enclosed a conflict of interest form for the annex he wrote for WHO’s 2004 pandemic-preparedness document. The two above reports have prompted a statement from Chan confirming that the identity of the 16 members of the Emergency Committee formed last year will be revealed as soon as the experts finish their work. Chan added that the lack of disclosure to date is to protect the committee. However, the BMJ report names Arnold Monto, John Wood, and Masato Tashiro as three of the 16 members of the Emergency Committee and identifies potential conflicts of interest for one of them.

via WHO failing in duty of transparency : The Lancet Infectious Diseases.

Via Infobae.com: Por la gripe A, Bolivia declara el alerta nacional.[Bolivia declares national alert over H1N1]

A national epidemiological alert has been confirmed, according to the local website La Prensa.

The national chief of epidemiology, René Lennis, said that this exceptional measure “does not mean a state of gravity, but that all health services and personnel should be attentive to persons with symptoms of H1N1 such as fever and sore throat.”

So far 34 cases have been confirmed and over a thousand cases are suspected. Infected patients are in the departments of La Paz (24), Santa Cruz (6), Cochabamba (2) and Trinidad (2).

via H5N1: Bolivia declares alert over H1N1.