US seeks new review of easier-to-spread bird flu

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WASHINGTON — A scientist who created an easier-to-spread version of the bird flu said his work isn’t as risky as people fear. The U.S. government is asking its biosecurity advisers to reconsider if the research should be made public.

Bird flu only occasionally sickens people, mostly after close contact with infected poultry, but it can be deadly when it does. Scientists have long feared it might mutate to spread more easily and thus spark a pandemic. Researchers in the Netherlands and Wisconsin were studying how that might happen when they created bird flu strains that at least some mammals — ferrets — can spread by coughing or sneezing.

The work triggered international controversy. U.S. health officials urged the details be kept secret so would-be terrorists couldn’t copy the strains, and critics worried that a lab accident might allow deadly viruses to escape.

But contrary to public perceptions, the airborne bird flu didn’t kill the ferrets, Dr. Ron Fouchier of the Netherlands’ Erasmus University told a meeting of U.S. scientists Wednesday. In fact, he said those previously exposed to regular flu were protected from severe disease.

Fouchier said publishing the research would help other scientists monitor the so-called H5N1 bird flu for similar mutations in the wild, and to test vaccines and treatments.

A federal biosecurity panel first sounded the alarm about the research, concerned about the easier mammal-to-mammal spread. The U.S. is asking that panel to conduct another review of the two laboratories’ work, Dr. Anthony Fauci of the National Institutes of Health said Wednesday. He said the board should hear some new data that came to light at a recent closed-door meeting of the World Health Organization, where international flu experts concluded the research eventually should be published.

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CDC and Flu

2011-2012 Influenza Season Week 47 ending November 26, 2011

All data are preliminary and may change as more reports are received.


During week 47 (November 20-26, 2011), influenza activity remained low in the United States.

National and Regional Summary of Select Surveillance Components

HHS Surveillance Regions* Data for current week Data cumulative since October 2, 2011 (Week 40)
Out-patient ILI† % of respiratory specimens positive for flu‡ Number of jurisdictions reporting regional or widespread activity§ A (H3) 2009 A (H1N1) A(Subtyping not performed) B Pediatric Deaths
Nation Normal 1.9% 0 of 54 79 8 104 75 0
Region 1 Normal 0.0% 0 of 6 1 0 0 3 0
Region 2 Normal 0.4% 0 of 4 2 0 2 1 0
Region 3 Normal 0.3% 0 of 6 2 0 3 0 0
Region 4 Normal 3.4% 0 of 8 8 1 74 48 0
Region 5 Normal 1.5% 0 of 6 10 2 1 6 0
Region 6 Normal 0.3% 0 of 5 4 0 2 8 0
Region 7 Normal 0.9% 0 of 4 6 0 3 1 0
Region 8 Normal 2.3% 0 of 6 20 1 11 0 0
Region 9 Normal 0.5% 0 of 5 18 4 4 6 0
Region 10 Normal 0.7% 0 of 4 8 0 4 2 0
*HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA). 
† Elevated means the % of visits for ILI is at or above the national or region-specific baseline 
‡ National data are for current week; regional data are for the most recent three weeks 
§ Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands 

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.
Week 47
No. of specimens tested 2,130
No. of positive specimens (%) 40 (1.9%)
Positive specimens by type/subtype
  Influenza A 33 (82.5%)
             A (2009 H1N1) 1 (3.0%) 
             A (subtyping not performed) 26 (78.8%) 
             A (H3) 6 (18.2%) 
  Influenza B 7 (17.5%)

INFLUENZA Virus Isolated
View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation Microsoft PowerPoint file

Antigenic Characterization:

CDC has antigenically characterized 21 influenza viruses [one 2009 influenza A (H1N1), 16 influenza A (H3N2) viruses, and four influenza B viruses] collected by U.S. laboratories since October 1, 2011.
Influenza A (H1N1) [1]
  • One virus was characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2011-12 influenza vaccine for the Northern Hemisphere.
Influenza A (H3N2) [16]
  • All 16 were characterized as A/Perth/16/2009-like, the influenza A (H3N2) component of the 2011-12 influenza vaccine for the Northern Hemisphere.
Influenza B (B/Victoria/02/87 and B/Yamagata/16/88 lineages) [4]:
  • Victoria Lineage [3]: Three of four B viruses tested belong to the B/Victoria lineage of viruses and were characterized as B/Brisbane/60/2008-like, the recommended influenza B component for the 2011-12 Northern Hemisphere influenza vaccine.
  • Yamagata Lineage [1]: One of four B viruses tested belongs to the B/Yamagata lineage of viruses.
It is too early in the influenza season to determine how well the seasonal vaccine and circulating strains will match.

Antiviral Resistance:

Testing of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) is performed at CDC using a functional assay. Additional 2009 influenza A (H1N1) clinical samples are tested for a single mutation in the neuraminidase of the virus known to confer oseltamivir resistance (H275Y). The data summarized below combine the results of both testing methods. These samples are routinely obtained for surveillance purposes rather than for diagnostic testing of patients suspected to be infected with antiviral resistant virus.
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses (the adamantanes are not effective against influenza B viruses). As a result of the sustained high levels of resistance, data from adamantane resistance testing are not presented in the table below.

Neuraminidase Inhibitor Resistance Testing Results on Samples Collected Since October 1, 2011

Oseltamivir Zanamivir
Virus Samples tested (n) Resistant Viruses, Number (%) Virus Samples tested (n) Resistant Viruses, Number (%)
Influenza A (H3N2) 24 0 (0.0) 24 0 (0.0)
Influenza B 2 0 (0.0) 2 0 (0.0)
Influenza A (2009 H1N1) 5 0 (0.0) 5 0 (0.0)
All viruses tested for the 2011-2012 season since October 1, 2011 have been susceptible to the neuraminidase inhibitor antiviral medications oseltamivir and zanamivir as were the majority of viruses tested last season; however, rare sporadic cases of oseltamivir resistant 2009 influenza A (H1N1) and A (H3N2) viruses have been detected worldwide. Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at greater risk for influenza-related complications. Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at (

Pneumonia and Influenza (P&I) Mortality Surveillance:

During week 47, 6.4% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.1% for week 47.

Pneumonia And Influenza Mortality
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Influenza-Associated Pediatric Mortality:

Two influenza-associated pediatric deaths were reported to CDC during week 47. One death was associated with an influenza A (H3) virus and one was associated with a 2009 H1N1 virus. These deaths occurred during the 2010-11 influenza season and bring the total number of reported pediatric deaths occurring during that season to 120. No influenza-associated pediatric deaths occurring during the 2011-12 season have been reported to CDC.

Influenza-Associated Pediatric Mortality
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Influenza-Associated Hospitalizations:

The Influenza Hospitalization Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza related hospitalizations in children (persons younger than 18 years) and adults. The network covers more than 80 counties in the 10 Emerging Infections Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, and TN) and four additional states (MI, OH, RI and UT). FluSurv-NET estimated hospitalization rates will be updated weekly starting later this season.

Outpatient Illness Surveillance:

Nationwide during week 47, 1.4% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below the national baseline of 2.4%. (ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.)

national levels of ILI and ARI
View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation Microsoft PowerPoint file 

On a regional level, the percentage of outpatient visits for ILI ranged from 0.6% to 2.1% during week 47. All 10 regions reported a proportion of outpatient visits for ILI below their region-specific baseline levels.

ILINet State Activity Indicator Map:

Data collected in ILINet are used to produce a measure of ILI activity* by state. Activity levels are based on the percent of outpatient visits in a state due to ILI and are compared to the average percent of ILI visits that occur during spring and fall weeks with little or no influenza virus circulation. Activity levels range from minimal, which would correspond to ILI activity from outpatient clinics being below the average, to intense, which would correspond to ILI activity from outpatient clinics being much higher than average.
During week 47, the following ILI activity levels were experienced:
  • All 50 states and New York City experienced minimal ILI activity (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming).
  • Data were insufficient to calculate an ILI activity level from the District of Columbia.
Click on map to launch interactive tool
Click on map to launch interactive tool

*This map uses the proportion of outpatient visits to health care providers for influenza-like illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels.
Data collected in ILINet may disproportionately represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state. 
Data displayed in this map are based on data collected in ILINet, whereas the State and Territorial flu activity map are based on reports from state and territorial epidemiologists. The data presented in this map is preliminary and may change as more data is received. 
Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:

The influenza activity reported by state and territorial epidemiologists indicates geographic spread of influenza viruses, but does not measure the intensity of influenza activity.
During week 47, the following influenza activity was reported:
  • Local influenza activity was reported by one state (Massachusetts).
  • Sporadic influenza activity was reported by the District of Columbia, Guam, and 29 states (Alaska, Arkansas, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, New Mexico, New York, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Washington, West Virginia, and Wisconsin).
  • No influenza activity was reported by the U.S. Virgin Islands and 21 states (Alabama, Arizona, Delaware, Georgia, Idaho, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, North Carolina, Oklahoma, Oregon, South Dakota, Tennessee, Vermont, Virginia, and Wyoming).
  • Puerto Rico did not report.

Additional National and International Influenza Surveillance Information

U.S. State and local influenza surveillance: Click on a jurisdiction below to access the latest local influenza information.
Distribute Project: Additional information on the Distribute syndromic surveillance project, developed and piloted by the International Society for Disease Surveillance (ISDS) now working in collaboration with CDC, to enhance and support Emergency Department (ED) surveillance, is available at Web Site Icon
Google Flu Trends: Google Flu Trends uses aggregated Google search data in a model created in collaboration with CDC to estimate influenza activity in the United States. For more information and activity estimates from the U.S. and worldwide, see Web Site Icon
Europe: for the most recent influenza surveillance information from Europe, please see WHO/Europe at Web Site Icon and visit the European Centre for Disease Prevention and Control at External Web Site Icon
Public Health Agency of Canada: The most up-to-date influenza information from Canada is available at Web Site Icon
World Health Organization FluNet: Additional influenza surveillance information from participating WHO member nations is available at External Web Site Icon

Country profiles on noncommunicable disease trends in 193 countries

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WHO maps noncommunicable disease trends in all countries

Country profiles on noncommunicable disease trends in 193 countries

News release
 A new WHO report features information about the noncommunicable diseases (NCDs) situation in 193 countries, as global leaders prepare to meet at the United Nations high-level meeting on noncommunicable diseases in New York, 19-20 September 2011.
“This report indicates where each government needs to focus to prevent and treat the four major killers: cancer, heart disease and stroke, lung disease and diabetes,” says Dr Ala Alwan, Assistant Director-General for Noncommunicable Diseases and Mental Health at WHO.
The report includes details of what proportion of each country’s deaths are due to noncommunicable diseases. Using graphs in a page per country presentation format, the report provides information on prevalence, trends in metabolic risk factors (cholesterol, blood pressure, body mass index and blood sugar) alongside data on the country’s capacity to tackle the diseases.
Noncommunicable diseases are the top cause of death worldwide, killing more than 36 million people in 2008. Cardiovascular diseases were responsible for 48% of these deaths, cancers 21%, chronic respiratory diseases 12%, and diabetes 3%.

“Premature” deaths

In 2008, more than nine million of all deaths attributed to NCDs occurred before the age of 60; 90% of these “premature” deaths occurred in low- and middle-income countries. One of the findings shows that men and women in low-income countries are around three times more likely to die of NCDs before the age of sixty than in high-income countries.
According to these estimates, the proportion of men dying under the age of 60 from NCDs can be as high as 67%. Among women under 60, the highest proportion was 58%.
The lowest rates of mortality from noncommunicable diseases for men under 60 were 8% and for women under 60 it was 6%.

Risk factors

The profiles report on the proportion of people who smoke and are physically inactive. They also indicate trends for four factors that increase people’s risk of developing these diseases, blood pressure, cholesterol, body mass index and blood sugar over the past 30 years.
In the United States of America, for example, 87% of all deaths are due to noncommunicable diseases. 16% of the population smokes and 43% are physically inactive. On average, blood pressure has decreased since 1980; body mass index has increased; and glucose levels have risen.
Overall, the trends indicate that in many high income countries, action to reduce blood pressure and cholesterol is having an impact, but there is a need to do more on body mass index and managing diabetes.

Countries’ capacity to prevent and treat noncommunicable diseases

The profiles show what countries are doing to tackle noncommunicable diseases in terms of institutional capacity, specified funding, and actions to address the four main diseases and their associated risk factors.
The report also highlights what all countries need to do to reduce people’s exposure to risk factors and improve services to prevent and treat noncommunicable diseases.

UN high-level meeting on noncommunicable diseases

The UN meeting will highlight the importance of setting targets for progress. This report provides all countries with a baseline for monitoring epidemiological trends and assessing the progress they are making to address noncommunicable diseases. The WHO plans to issue an updated report in 2013.

For more information, please contact:

Gregory Hartl
Communications Officer
WHO, Geneva
Telephone:             +41 22 791 4458      

Saúde urbana, ambiente e desigualdades

The original advisory opinion was requested by...Image via Wikipedia

AZAMBUJA, M., ACHUTTI, A., REIS, R., SILVA, J., FISHER, P., ROSA, R., BORDIN, R., OLIVEIRA, F., CELESTE, R., SCHNEIDER, A., CAMPANI, D., PICCININI, L., RAMOS, M., SATTLER, M., OLIVEIRA, P., LEWGOY, A.. Saúde urbana, ambiente e desigualdades. Revista Brasileira de Medicina de Família e Comunidade, Local de publicação (editar no plugin de tradução o arquivo da citação ABNT), 6, abr. 2011. Disponível em: <>. Acesso em: 23 Set. 2011..

Saúde urbana, ambiente e desigualdades

Maria Inês Reinert Azambuja, Aloyzio Cechella Achutti, Roberta Alvarenga Reis, Jacqueline Oliveira Silva, Paul Douglas Fisher, Roger dos Santos Rosa, Ronaldo Bordin, Francisco Arsego de Oliveira, Roger Keller Celeste, Aline Petter Schneider, Darci Barnech Campani, Lívia Piccinini, Maurem Ramos, Miguel Aloysio Sattler, Paulo Antonio Barros Oliveira, Alzira Maria Baptista Lewgoy


Os ambientes psicossocial, econômico e físico, nos quais se nasce, cresce, vive e trabalha, afetam a saúde e a longevidade, tanto quanto o fumo, o exercício e a dieta. A atenção individual à saúde não é suficiente para prevenir ou controlar os efeitos das más condições ambientais. Evidências históricas e atuais apontam para o agravamento das condições de saúde das populações mais pobres, acompanhando processos de urbanização rápida. Esperadamente, o envelhecimento populacional num ambiente urbano de desigualdade social deverá agravar a situação de saúde da população mais pobre, resultando em mais sofrimento e em perdas econômicas para o país. Com base nestas justificativas, um grupo de professores da Universidade Federal do Rio Grande do Sul se organizou, via extensão universitária, para contribuir com a discussão e as iniciativas nacionais de intervenção sobre a saúde urbana. Os projetos do grupo abarcam: o debate sobre o impacto potencial de iniciativas privadas e políticas públicas setoriais (de habitação, saneamento, transporte, educação, inovação tecnológica, sustentabilidade ambiental etc.) na saúde urbana; a produção e divulgação de conteúdos sobre determinantes sociais e ambientais da saúde; a produção e disseminação dos indicadores de desigualdade social dos determinantes da saúde; a formação de recursos humanos; e a participação em redes sociais. A apresentação pública deste projeto cumpre o objetivo de contribuir desde já com essa discussão.


Unnatural causes – places matter…. is inequality making us sick? California Newsreel Production 2008. Public Engagement Campaign in Association with the Joint Center for Political and Economic Studies Health Policy Institute. [acesso em 2010 Abr 9]. Disponível em:
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Texto completo: PDF

8th Meeting of WHO Advisory Committee on Safety of Medicinal Products

Via: Drugs (e-mail list )

Dear Colleagues,

Recommendations from the 8th Meeting of WHO Advisory Committee on Safety of Medicinal Products are available.

The WHO Advisory Committee on Safety of Medicinal Products (ACSoMP) was established in 2003 to provide advice to WHO, including its Collaborating Centre for International Drug Monitoring (the UMC), and through it, to the Member States of WHO, on safety issues relating to medicinal products. It guides WHO on general and specific issues related to Pharmacovigilance (PV). The Committee is composed of 12 members drawn from the WHO Expert Advisory Panels for Drug Evaluation and for Drug Policies and Management and, where appropriate, in consultation with other relevant WHO clusters and expert advisory panels. ACSoMP meets once a year to discuss ongoing and new PV topics, with particular focus on issues related to public health programmes.

The eighth ACSoMP meeting was held in WHO Headquarters, Geneva between 31 March and 1 April 2011. The summary of the meeting discussions and recommendations are available on the WHO website at the following link:

Thank you.

With best wishes,

Shanthi Pal
Quality Assurance and Safety: Medicines
Department of Essential Medicines and Pharmaceutical Policies
World Health Organization
Geneva, Switzerland
Tel: + 41 22 791 1318


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H1N1 less lethal than feared: U.K. study

Last Updated: Thursday, December 10, 2009 | 3:34 PM ET Comments285Recommend89

Medical advances such as ventilators and intensive care were not available during previous pandemics. Medical advances such as ventilators and intensive care were not available during previous pandemics. (CBC)The strain of swine flu virus currently circulating around the world is less deadly than previously thought, say British scientists who compared its effect to that of other pandemic viruses.
The 2009 flu pandemic is about 100 times less lethal than the 1918 Spanish flu and nearly 10 times less fatal than the flu pandemics of 1957 and 1968.
Those findings were reported in Thursday’s online issue of British Medical Journal, BMJ.
After analyzing British health department data on all reported swine flu patients who were hospitalized between July and Nov. 8 , the researchers estimated that about 26 of every 100,000 people infected with the H1N1 influenza A virus that causes swine flu died. That is a death rate of 0.026 per cent.
The findings are similar to a U.S. study published on Monday that estimated the death rate in the current swine flu pandemic is 0.048 per cent, or one death per every 2,000 cases.
“The first influenza pandemic of the 21st century is considerably less lethal than was feared in advance,” England’s chief medical officer, Liam Donaldson, and his co-authors from Britain’s Health Protection Agency wrote in the study.
In comparison, the fatality rate for the 1918 Spanish flu pandemic was two to three per cent, compared with around 0.2 per cent for the pandemics in 1957-1958 and 1967-1968. Fatality estimates for previous pandemics were probably less reliable since they were based on statistical methods and death certificates, with few — if any — lab confirmations.
Since the past pandemics, there have been advances in medicine such as ventilators to help patients with breathing problems, as well as better housing, health care and nutrition, Donaldson said.
When the World Health Organization declared swine flu had reached a pandemic stage in June, the agency described it as “moderate,” with most people infected showing mild symptoms and recovering without medical treatment.
A pandemic designation reflects how widely a virus has spread, not the severity of illness.

Findings not a reason for inaction

Donaldson’s study suggested two-thirds of those who died from H1N1 would be eligible for the H1N1 vaccine under the British government’s plan, which prioritizes those at highest risk of developing complications from the flu.
This includes patients sick in hospital, pregnant women, people with asthma or other underlying health problems and health care workers.
“Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction,” the study’s authors concluded. “Our data support the priority vaccination of high-risk groups.”
Some of the deaths, 38 per cent, occurred in people not considered at high risk.
The findings also reinforced calls to prescribe antiviral medications for people at high risk or those showing severe symptoms.
Most of the people who died of swine flu in Britain, 78 per cent, had been prescribed antiviral drugs. But of these, 76 per cent did not received them within the first 48 hours of illness as recommended.

Infection rate higher among native populations

Also on Thursday, U.S. health officials said an estimated 15 per cent of Americans had been infected with the H1N1 virus by mid November.
In its weekly report on death and disease, the U.S. Centers for Disease Control and Prevention (CDC) suggested the death rate among the aboriginal population in the U.S. is about four times higher than that of all other racial and ethnic groups combined.
Similarly, indigenous populations in Australia, Canada and New Zealand have been found to have a three to eight times higher rate of hospitalization and death associated with swine flu.
There is a lot of debate about why the rates are higher among aboriginal populations, but it likely reflects environmental conditions such as nutrition in early childhood, access to health care and the a higher likelihood of un

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