Schuchat said she thinks the unusually high rate of transmission during the heat and humidity of summer, which normally sharply reduce transmission, may be because many Americans have no resistance to the virus from prior exposure. But there are "no data" to suggest why transmission is continuing, she said.
As of Friday, the CDC reported more than 40,000 laboratory-confirmed cases of the virus (commonly known as swine flu), 4,800 hospitalizations and 263 deaths. Experts believe more than a million Americans have been infected, however. Schuchat said the CDC would probably stop reporting cases soon because most people who are infected don’t get tested.
The World Health Organization, which has reported nearly 100,000 confirmed cases worldwide, said Thursday that it would stop counting cases because that required too much unnecessary work by health authorities. The agency had said a week earlier that it recommends local agencies no longer test for the virus unless they have not previously had cases or there is an unusual outbreak.

The WHO said earlier this week that healthcare workers should be the first to be immunized with a pandemic influenza vaccine, both because they are at highest risk due to their exposure to patients and because infected workers could spread the virus to hospitalized patients and others at high risk. Beyond that, the agency said, individual countries should set their own priorities for other groups, vaccinating schoolchildren if their goal is to limit transmission or vaccinating high-risk groups if their goal is to limit illness and deaths.
Schuchat said the CDC’s vaccine advisory committee will meet next week to set this country’s priorities. The Obama administration, however, has already said that it will make the vaccine available to schoolchildren at no charge, budgeting as much as $7.5 billion for the effort beyond the $2 billion already committed for vaccine ingredients.
Dr. Jesse Goodman, acting deputy commissioner of the Food and Drug Administration, said at the same news conference that an H1N1 vaccine will not be available until well after school has begun. Companies and the National Institutes of Health are still planning clinical trials for the pandemic vaccine, and it will be at least two months into such trials before any data are available, he said.
There have also been fears that a vaccine might not be available. The handful of companies that produce influenza vaccineshave been inundated with orders, and some, such as Baxter International Inc., have said they are unable to accept any further orders.
Because the vast majority of vaccine production is done overseas, some experts have speculated that a shortage will lead the countries where it is produced to limit exports so that their own populations will have full access.
Schuchat, however, said health authorities are not worried about such a possibility. "We are not concerned about meeting expectations for the vaccine. We haven’t gotten any information that makes us question the supply."

Swine flu is spreading even in summer

Google knows that you might do something like that, and it also knows which U.S. state you’re in. Now, it’s putting that information together in a tool that Google says could detect flu outbreaks faster than traditional systems currently in use.

Google’s new public health initiative, Google Flu Trends, looks at the relative popularity of a slew of flu-related search terms to determine where in the U.S. flu outbreaks may be occurring.

“What’s exciting about Flu Trends is that it lets anybody — epidemiologists, health officials, moms with sick children — learn about the current flu activity level in their own state based on data that’s coming in this week,” said Jeremy Ginsberg, the lead engineer who developed the site.

The tool, which launched Tuesday, operates on the idea that there’s likely to be a flu outbreak in states where flu-related search terms are currently popular.

The Centers for Disease Control and Prevention collaborated with Google on the project, helping validate and refine the model, and has provided flu tracking data over a five-year period, said Dr. Joseph Bresee, chief of the epidemiology and prevention branch in the CDC’s influenza division.

Although it doesn’t replace the need for real viral surveillance data, Flu Trends is a good model, and the CDC looks forward to testing it this flu season, Bresee said.

“We really are excited about the future of using different technologies, including technology like this, in trying to figure out if there’s better ways to do surveillance for outbreaks of influenza or any other diseases in the United States,” he said. “In theory at least, this idea can be used for any disease and any health problem.”

Researchers found a tight correlation between the relative popularity of flu-related search terms and CDC’s surveillance data, Ginsberg said.

In the 2007-08 flu season, Google accurately estimated current flu levels one to two weeks faster than published CDC reports in each of the nine U.S. surveillance regions, Google said in a statement.

Traditionally, influenza surveillance has involved physicians’ reports of patients with flu-like symptoms, lab reports of influenza from nasal and throat swabs, and death certificates.

Only that kind of analysis will detect the spread of influenza strains not covered by the flu vaccine, information that search engine information does not reflect, experts say.

But there has been concern that influenza surveillance systems in place are not fast enough, and the new tool could be useful for the basic purpose of quickly detecting outbreaks, said Dr. Randall Stafford, associate professor of medicine at Stanford University’s Prevention Research Center, who was not involved in the project.

“Sacrificing accuracy may not necessarily carry a big penalty if you’re able to predict increasing flu incidence as well as the other systems, and do it more rapidly,” he said.

Still, there are limitations, Bresee said. The tool may miss cases of influenza spreading among elderly people, because they are less likely to use the Internet than younger people, Stafford said. He also noted that many people who search for flu-related terms have viral infections that are not actually influenza.

Google has also taken into account that people sometimes look for flu-related terms in response to certain news headlines and do not actually have the flu, Ginsberg said. The tool looks for terms that, for example, reflect searches by a person who has chest congestion or wants to buy a thermometer, he said.

Flu Trends may also help doctors make diagnoses, Ginsberg said.

“I would be very hesitant to diagnose influenza at this point in the year, but if the tool tells me influenza in California is really increasing dramatically, I might be more likely or willing to diagnose,” Stafford said.

Influenza is responsible for more than 500,000 deaths worldwide each year, according to the World Health Organization.

Flu Trends cannot be used to identify individual users, the company statement said. The search engine relies on aggregated counts, made anonymous, of how often certain search terms occur each week. But every computer connected to the Internet has its own internet protocol address, or IP address, which reveals its location to Google.

Software engineers and public health experts at Google.org, the company’s philanthropic arm, collaborated on the project, Ginsberg said. The search engine giant turned 10 years old this year.

The overall flu activity in the U.S. is low, although a few states — such as Hawaii, Arkansas, Mississippi, Kentucky, Delaware and Maine — have “moderate” activity, according to Google’s map, based on data current through Monday.

“There’s no question that testing for virus in blood is the only way to get the most information, but having this sort of information earlier does make sense,” Stafford said.

Science and Tech Blog

The update—in Bahasa, the language of Indonesia—appeared on the health ministry’s Web site, Bloomberg News reported. So far, the government has not posted an English version of the update on the main ministry site or that of the country’s avian flu committee.

As recounted by Bloomberg, Indonesia’s description of the two cases generally agreed with earlier media accounts. The health ministry said one of the two men was a 20-year-old who died on July 31, according to Bloomberg. A media report in early August had described him as a 19-year-old from Tangerang, a suburb of Jakarta, who died in late July.

The health ministry said the other man was a 38-year-old truck driver from Banten province who got sick on Jul 4 and was hospitalized in Tangerang 5 days later. The ministry said he died on Jul 10, Bloomberg reported. Media reports in July had described him as a 38-year-old from Belendung, west of Jakarta, who died on Jul 10.

Tests on samples from poultry in the man’s neighborhood were pending, the ministry statement said.

The health ministry also said that laboratory tests by its research center and the Eijkman Institute on samples from five provinces showed no evidence of human-to-human transmission of avian flu, Bloomberg reported.

On Jun 5, Health Minister Siti Fadilah Supari said the government would announce human H5N1 cases at longer intervals, perhaps as long as 6 months, instead of as they are confirmed. Some health officials have said Indonesia’s delay in reporting cases could hamper global efforts to monitor the risk of a flu pandemic.

Indonesia’s announcement of the two recent deaths, combined with the previous media accounts, puts the country’s H5N1 count at 137 cases and 112 deaths. However, the World Health Organization’s global case count does not yet reflect the two deaths and stands at 135 cases and 110 deaths.

Health authorities have been monitoring the H5N1 strain of avian influenza for more than a decade for any sign that it is becoming as contagious as seasonal flu. While millions of birds have been infected, fewer than 400 people are reported to have contracted the illness, including 36 this year.

“The threat of a pandemic, of a virus jumping from animals into humans, is still there, but the biggest threat that we have now is `flu fatigue’,” Dr. Julie Hall, deputy regional adviser on communicable disease surveillance and response with the WHO’s Western Pacific region, told reporters in Sydney today.

Misconceptions that the pandemic threat is “a storm in a teacup” may sap investment in surveillance for bird flu as well as other infectious diseases, particularly in parts of Asia, where systems are “very weak,” Hall said. Donor governments and organizations such as the World Bank have pledged more than $2 billion the past three years to help poorer nations stem bird flu’s spread and prepare for any pandemic it spawns.

“These systems are useful for many different things — from naturally occurring diseases through to manmade and bioterrorism threats,” Hall said in a telephone interview. “It should be seen as a long-term investment for multiple purposes that one day will most definitely be needed.”

More money to fund global preparedness programs will be sought next month, when Egypt hosts an international ministerial conference on avian and pandemic influenza.

Growing Threat

The world is closer to another influenza pandemic than at any time since 1968, when the last of the previous century’s three pandemics occurred, according to the Geneva-based WHO. The H5N1 virus has spread to more than 60 countries and caused at least 6,500 poultry outbreaks since 2003.

“There has been a lot of hype about pandemic influenza and a fair amount of investment into strengthening surveillance and response systems, but I believe now this new disease called flu fatigue is setting in,” Hall told a meeting hosted by the Australian Science Media Centre.

“We haven’t seen a pandemic, but the H5 virus and all the other influenza viruses are still out there,” she said. “Nipah virus is there causing problems and changing. Dengue is on the rise.”

Population density, increasing poultry production, natural disasters and global warming may spur the emergence of undiscovered diseases in Asia as more people move or are displaced and have closer contact with animals, she said.

An outbreak of nipah virus in Malaysian pigs in 1998 that killed 105 people is one of the most significant epidemics to have occurred anywhere in the world during the past 15 years, according to the Centers for Disease Control and Prevention.

The influenza virus-like particle, or VLP, vaccine is directed against the H5N1 A/Indonesia/05/2005 avian influenza strain.

VLPs are recombinant structures mimicking the size and shape of the virus but lack genetic material and are therefore incapable of replication. However, they are able to induce an immune response. And in clinical trials it produced strong neutralizing antibody responses.

“These data are exciting because they demonstrate that recombinant VLPs are a valid and potent vaccine approach against influenza,” said Rahul Singhvi, president and chief executive of Novavax.

The Rockville, Maryland-based company believes that its VLP vaccine candidate can meet an unmet need in pandemic influenza preparedness, as health authorities around the world are gearing up to check the menace of pandemic influenza.

The company’s manufacturing approach makes it possible to produce and distribute a vaccine matched to a pandemic strain in time to interrupt and/or halt a pandemic. The vaccine can be manufactured within 10 to 12 weeks of identification of a pandemic strain, as the manufacturing process involves recombinant technology and does not require a live influenza virus. The process is quicker and takes about 50% of the time required to manufacture egg-based vaccines.

Novavax has collaborated with GE Healthcare, a unit of General Electric Company to develop manufacturing processes using disposable systems as its manufacturing approach.

No serious adverse events have been reported and an independent external data and safety monitoring board has fully supported continuation of the study including expansion to the 90-mcg dose.

Additionally, Novavax disclosed that the results from this trial are encouraging and that it will go ahead with the development of a vaccine candidate against seasonal human influenza strains.

Dr. Virginia Ross, the director of infection control, says 15 patients in the haematology and bone marrow unit have been infected and two have died. But she says it’s not yet clear if the virus caused their deaths. In healthy people, the virus causes common cold symptoms but patients in the affected unit already have compromised immune systems.

Officials are restricting visitors to the unit while they investigate the illnesses.

The investigation began in mid-July when the first case was identified.