Pandemic (H1N1) 2009 briefing note 2

WHO recommendations on pandemic (H1N1) 2009 vaccines
13 JULY 2009 | GENEVA -- On 7 July 2009, the Strategic Advisory Group of Experts (SAGE) on Immunization held an extraordinary meeting in Geneva to discuss issues and make recommendations related to vaccine for the pandemic (H1N1) 2009.

SAGE reviewed the current pandemic situation, the current status of seasonal vaccine production and potential A(H1N1) vaccine production capacity, and considered potential options for vaccine use.

The experts identified three different objectives that countries could adopt as part of their pandemic vaccination strategy:

* protect the integrity of the health-care system and the country's critical infrastructure;
* reduce morbidity and mortality; and
* reduce transmission of the pandemic virus within communities.

Countries could use a variety of vaccine deployment strategies to reach these objectives but any strategy should reflect the country’s epidemiological situation, resources and ability to access vaccine, to implement vaccination campaigns in the targeted groups, and to use other non-vaccine mitigation measures.

Although the severity of the pandemic is currently considered to be moderate with most patients experiencing uncomplicated, self-limited illness, some groups such as pregnant women and persons with asthma and other chronic conditions such as morbid obesity appear to be at increased risk for severe disease and death from infection.

Since the spread of the pandemic virus is considered unstoppable, vaccine will be needed in all countries. SAGE emphasized the importance of striving to achieve equity among countries to access vaccines developed in response to the pandemic (H1N1) 2009

The following recommendations were provided to the WHO Director-General:

* All countries should immunize their health-care workers as a first priority to protect the essential health infrastructure. As vaccines available initially will not be sufficient, a step-wise approach to vaccinate particular groups may be considered. SAGE suggested the following groups for consideration, noting that countries need to determine their order of priority based on country-specific conditions: pregnant women; those aged above 6 months with one of several chronic medical conditions; healthy young adults of 15 to 49 years of age; healthy children; healthy adults of 50 to 64 years of age; and healthy adults of 65 years of age and above.
* Since new technologies are involved in the production of some pandemic vaccines, which have not yet been extensively evaluated for their safety in certain population groups, it is very important to implement post-marketing surveillance of the highest possible quality. In addition, rapid sharing of the results of immunogenicity and post-marketing safety and effectiveness studies among the international community will be essential for allowing countries to make necessary adjustments to their vaccination policies.
* In view of the anticipated limited vaccine availability at global level and the potential need to protect against "drifted" strains of virus, SAGE recommended that promoting production and use of vaccines such as those that are formulated with oil-in-water adjuvants and live attenuated influenza vaccines was important.
* As most of the production of the seasonal vaccine for the 2009-2010 influenza season in the northern hemisphere is almost complete and is therefore unlikely to affect production of pandemic vaccine, SAGE did not consider that there was a need to recommend a "switch" from seasonal to pandemic vaccine production.

WHO Director-General Dr Margaret Chan endorsed the above recommendations on 11 July 2009, recognizing that they were well adapted to the current pandemic situation. She also noted that the recommendations will need to be changed if and when new evidence become available.

SAGE was established by the WHO Director-General in 1999 as the principal advisory group to WHO for vaccines and immunization. It comprises 15 members who serve in their personal capacity and represent a broad range of disciplines from around the world in the fields such as epidemiology, public health, vaccinology, paediatrics, internal medicine, infectious diseases, immunology, drug regulation, programme management, immunization delivery, and health-care administration.

Additional participants in the SAGE meeting included members of the ad hoc policy advisory working group on influenza A(H1N1) vaccine, chairs of the regional technical advisory groups and external experts. Observers included industry representatives and regulators who did not take part in the recommendation process in order to avoid conflicts of interest.

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Pandemic (H1N1) 2009 - update 58

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005)
6 July 2009 09:00 GMT
The breakdown of the number of laboratory-confirmed cases is given in the following table and map.
Map of the spread of pandemic (H1N1) 2009: number of laboratory confirmed cases and deaths [png 190kb]

Country, territory and area Cumulative total Newly confirmed since the last reporting period
Cases Deaths Cases Deaths
Algeria 5 0 0 0
Antigua and Barbuda 2 0 0 0
Argentina 2485 60 898 34
Australia 5298 10 730 1
Austria 19 0 4 0
Bahamas 7 0 1 0
Bahrain 15 0 0 0
Bangladesh 18 0 6 0
Barbados 12 0 0 0
Belgium 54 0 5 0
Bermuda, UKOT 1 0 0 0
Bolivia 416 0 133 0
Bosnia and Hezegovina 1 0 0 0
Brazil 737 1 0 0
British Virg Islands,UKOT 2 0 0 0
Brunei Darussalam 124 0 39 0
Bulgaria 10 0 0 0
Cambodia 7 0 0 0
Canada 7983 25 0 0
Cap Verde 3 0 0 0
Cayman Islands, UKOT 14 0 0 0
Chile 7376 14 0 0
China 2040 0 226 0
Colombia 118 2 17 0
Cook Island 1 0 1 0
Costa Rica 277 3 50 1
Cote d'Ivoire 2 0 0 0
Croatia 1 0 1 0
Cuba 85 0 12 0
Cyprus 109 0 39 0
Czech Republic 15 0 0 0
Denmark 66 0 3 0
Dominica 1 0 0 0
Dominican Republic 108 2 0 0
Ecuador 204 0 41 0
Egypt 78 0 11 0
El Salvador 319 0 66 0
Estonia 13 0 0 0
Ethiopia 3 0 0 0
Fiji 2 0 0 0
Finland 47 0 4 0
France 310 0 10 0
French Polynesia, FOC 4 0 2 0
Guadaloupe, FOC 2 0 2 0
Martinique, FOC 3 0 1 0
New Caledonia, FOC 12 0 6 0
Saint Martin, FOC 1 0 1 0
Germany 505 0 35 0
Greece 151 0 42 0
Guatemala 286 2 32 0
Guyana 2 0 2 0
Honduras 123 1 0 0
Hungary 11 0 0 0
Iceland 4 0 0 0
India 129 0 25 0
Indonesia 20 0 12 0
Iran, Islamic Republic 1 0 0 0
Iraq 12 0 1 0
Ireland 74 0 23 0
Israel 681 0 104 0
Italy 146 0 16 0
Jamaica 32 0 0 0
Japan 1790 0 344 0
Jordan 23 0 1 0
Kenya 15 0 3 0
Korea, Republic of 202 0 0 0
Kuwait 35 0 0 0
Laos 5 0 2 0
Latvia 1 0 0 0
Lebanon 49 0 2 0
Libya 1 0 1 0
Lithuania 3 0 0 0
Luxembourg 6 0 2 0
Macedonia 2 0 2 0
Malaysia 112 0 0 0
Malta 24 0 22 0
Mauritius 1 0 0 0
Mexico 10262 119 0 0
Montenegro 10 0 1 0
Morocco 17 0 0 0
Myanmar 1 0 0 0
Nepal 5 0 0 0
Netherlands 135 0 1 0
Netherlands, Aruba 5 0 0 0
Nether Antilles, Curaçao 8 0 0 0
Nether Anti,Sint Maarten 7 0 0 0
New Zealand 1059 3 147 3
Nicaragua 321 0 13 0
Norway 41 0 0 0
Oman 4 0 1 0
Palau 1 0 0 0
Panama 417 0 0 0
Papua New Guinea 1 0 0 0
Paraguay 106 1 3 1
Peru 916 0 378 0
Philippines 1709 1 0 0
Poland 25 0 6 0
Portugal 42 0 15 0
Qatar 23 0 13 0
Romania 41 0 5 0
Russia 3 0 0 0
Saint Lucia 1 0 0 0
Samoa 1 0 0 0
Saudi Arabia 114 0 25 0
Serbia 15 0 0 0
Singapore 1055 0 177 0
Slovakia 18 0 0 0
Slovenia 14 0 9 0
South Africa 18 0 6 0
Spain 776 1 16 0
Sri Lanka 19 0 2 0
Suriname 11 0 0 0
Sweden 84 0 10 0
Switzerland 76 0 4 0
Syria 1 0 1 0
Thailand 2076 7 662 4
Trinidad and Tobago 65 0 12 0
Tunisia 5 0 2 0
Turkey 40 0 0 0
Uganda 1 0 0 0
Ukraine 1 0 0 0
United Arab Emirates 8 0 0 0
United Kingdom 7447 3 0 0
Guernsey, Crown Dependen 5 0 0 0
Isle of Man, Crown Depen 1 0 0 0
Jersey, Crown Dependency 11 0 0 0
United States of America 33902 170 0 0
Puerto Rico 18 0 18 0
Virgin Islands 1 0 1 0
Uruguay 195 4 0 3
Vanuatu 2 0 0 0
Venezuela 206 0 2 0
Viet Nam 181 0 50 0
West Bank andGaza Strip 60 0 30 0
Yemen 8 0 1 0
Grand Total 94512 429 4591 47
Chinese Taipei has reported 61 confirmed cases of pandemic (H1N1) 2009 with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.
Cumulative and new figures are subject to revision

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Pandemic (H1N1) 2009 - update 57

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005)
3 July 2009 09:00 GMT
The breakdown of the number of laboratory-confirmed cases is given in the following table and map.
Map of the spread of pandemic (H1N1) 2009: number of laboratory confirmed cases and deaths [png 190kb]

Country, territory and area Cumulative total Newly confirmed since the last reporting period
Cases Deaths Cases Deaths
Algeria 5 0 3 0
Antigua and Barbuda 2 0 0 0
Argentina 1587 26 0 0
Australia 4568 9 478 2
Austria 15 0 0 0
Bahamas 6 0 0 0
Bahrain 15 0 0 0
Bangladesh 12 0 11 0
Barbados 12 0 2 0
Belgium 49 0 2 0
Bermuda, UKOT 1 0 0 0
Bolivia 283 0 78 0
Bosnia and Hezegovina 1 0 1 0
Brazil 737 1 57 0
British Virgin Islands,UKOT 2 0 1 0
Brunei Darussalam 85 0 56 0
Bulgaria 10 0 0 0
Cambodia 7 0 1 0
Canada 7983 25 0 0
Cap Verde 3 0 0 0
Cayman Islands, UKOT 14 0 1 0
Chile 7376 14 1165 2
China 1814 0 296 0
Colombia 101 2 8 0
Costa Rica* 227 2 -52 0
Cote d'Ivoire 2 0 0 0
Cuba 73 0 27 0
Cyprus 70 0 22 0
Czech Republic 15 0 6 0
Denmark 63 0 8 0
Dominica 1 0 0 0
Dominican Republic 108 2 0 0
Ecuador 163 0 0 0
Egypt 67 0 0 0
El Salvador 253 0 27 0
Estonia 13 0 0 0
Ethiopia 3 0 1 0
Fiji 2 0 0 0
Finland 43 0 17 0
France 300 0 23 0
French Polynesia,FOC 2 0 0 0
Martinique, FOC 2 0 0 0
France, New Caledonia,FOC 6 0 0 0
Germany 470 0 53 0
Greece 109 0 17 0
Guatemala 254 2 0 0
Honduras 123 1 5 0
Hungary 11 0 1 0
Iceland 4 0 0 0
India 104 0 0 0
Indonesia 8 0 0 0
Iran 1 0 0 0
Iraq 11 0 0 0
Ireland 51 0 10 0
Israel 577 0 71 0
Italy 130 0 7 0
Jamaica 32 0 0 0
Japan 1446 0 180 0
Jordan 22 0 2 0
Kenya 12 0 11 0
Korea, Republic of 202 0 0 0
Kuwait 35 0 1 0
Laos 3 0 0 0
Latvia 1 0 0 0
Lebanon 47 0 8 0
Lithuania 3 0 2 0
Luxembourg 4 0 0 0
Malaysia 112 0 0 0
Malta 2 0 2 0
Mauritius* 1 0 -6 0
Mexico 10262 119 1582 3
Montenegro 9 0 5 0
Morocco 17 0 0 0
Myanmar 1 0 0 0
Nepal 5 0 2 0
Netherlands 134 0 6 0
Netherlands, Aruba 5 0 5 0
Netherlands Antilles, Curaçao 8 0 1 0
Netherlands Antilles, Sint Maarten 7 0 0 0
New Zealand 912 0 201 0
Nicaragua 308 0 15 0
Norway 41 0 9 0
Oman 3 0 0 0
Palau 1 0 1 0
Panama 417 0 0 0
Papua New Guinea 1 0 0 0
Paraguay 103 0 7 0
Peru 538 0 0 0
Philippines 1709 1 848 0
Poland 19 0 4 0
Portugal 27 0 10 0
Qatar 10 0 0 0
Romania 36 0 8 0
Russia 3 0 0 0
Saint Lucia 1 0 0 0
Samoa 1 0 0 0
Saudi Arabia 89 0 8 0
Serbia 15 0 3 0
Singapore 878 0 177 0
Slovakia 18 0 5 0
Slovenia 5 0 1 0
South Africa 12 0 11 0
Spain 760 1 43 0
Sri Lanka 17 0 2 0
Suriname 11 0 0 0
Sweden 74 0 5 0
Switzerland 72 0 16 0
Thailand 1414 3 0 0
Trinidad and Tobago 53 0 0 0
Tunisia 3 0 0 0
Turkey 40 0 8 0
Uganda 1 0 1 0
Ukraine 1 0 0 0
United Arab Emirates 8 0 0 0
United Kingdom 7447 3 909 0
Guernsey, Crown Dependency 5 0 0 0
Isle of Man, Crown Dependency 1 0 0 0
Jersey, Crown Dependency 11 0 3 0
United States of America 33902 170 6185 43
Uruguay 195 1 0 0
Vanuatu 2 0 0 0
Venezuela 204 0 11 0
Viet Nam 131 0 8 0
West Bank and Gaza Strip 30 0 17 0
Yemen 7 0 0 0
Grand Total 89921 382 12720 50
Chinese Taipei has reported 61 confirmed cases of pandemic (H1N1) 2009 with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.
Cumulative and new figures are subject to revision
http://www.who.int
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Pandemic (H1N1) 2009 - update 56

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005)
1 July 2009 09:00 GMT
The breakdown of the number of laboratory-confirmed cases is given in the following table and map.
Map of the spread of pandemic (H1N1) 2009: number of laboratory confirmed cases and deaths [png 172kb]

Country, territory and area Cumulative total Newly confirmed since the last reporting period
Cases Deaths Cases Deaths
Algeria 2 0 0 0
Antigua and Barbuda 2 0 0 0
Argentina 1587 26 99 3
Australia 4090 7 52 0
Austria 15 0 3 0
Bahamas 6 0 2 0
Bahrain 15 0 0 0
Bangladesh 1 0 0 0
Barbados 10 0 0 0
Belgium 47 0 4 0
Bermuda, UKOT 1 0 0 0
Bolivia 205 0 79 0
Brazil 680 1 228 1
British Virgin Islands, UKOT 1 0 0 0
Brunei Darussalam 29 0 0 0
Bulgaria 10 0 3 0
Cambodia 6 0 0 0
Canada 7983 25 208 4
Cap Verde 3 0 0 0
Cayman Islands, UKOT 13 0 4 0
Chile 6211 12 1025 5
China 1518 0 76 0
Colombia 93 2 5 0
Costa Rica 279 2 24 1
Cote d'Ivoire 2 0 0 0
Cuba 46 0 12 0
Cyprus 48 0 23 0
Czech Republic 9 0 0 0
Denmark 55 0 11 0
Dominica 1 0 0 0
Dominican Republic 108 2 0 0
Ecuador 163 0 38 0
Egypt 67 0 17 0
El Salvador 226 0 0 0
Estonia 13 0 0 0
Ethiopia 2 0 0 0
Fiji 2 0 0 0
Finland 26 0 0 0
France 277 0 42 0
French Polynesia, FOC 2 0 0 0
Martinique, FOC 2 0 0 0
France, New Caledonia, FOC 6 0 6 0
Germany 417 0 51 0
Greece 92 0 6 0
Guatemala 254 2 0 0
Honduras 118 1 0 0
Hungary 10 0 2 0
Iceland 4 0 0 0
India 104 0 40 0
Indonesia 8 0 0 0
Iran 1 0 0 0
Iraq 11 0 1 0
Ireland 41 0 2 0
Israel 506 0 37 0
Italy 123 0 11 0
Jamaica 32 0 11 0
Japan 1266 0 54 0
Jordan 20 0 2 0
Kenya 1 0 1 0
Korea, Republic of 202 0 0 0
Kuwait 34 0 4 0
Laos 3 0 0 0
Latvia 1 0 0 0
Lebanon 39 0 14 0
Lithuania 1 0 0 0
Luxembourg 4 0 0 0
Malaysia 112 0 0 0
Mauritius 7 0 7 0
Mexico 8680 116 401 0
Montenegro 4 0 3 0
Morocco 17 0 6 0
Myanmar 1 0 1 0
Nepal 3 0 0 0
Netherlands 128 0 10 0
Netherlands Antilles, Curaçao 7 0 4 0
Netherlands Antilles, Sint Maarten 7 0 6 0
New Zealand 711 0 124 0
Nicaragua 293 0 16 0
Norway 32 0 1 0
Oman 3 0 0 0
Panama 417 0 14 0
Papua New Guinea 1 0 0 0
Paraguay 96 0 11 0
Peru 538 0 178 0
Philippines 861 1 0 0
Poland 15 0 1 0
Portugal 17 0 6 0
Qatar 10 0 0 0
Romania 28 0 4 0
Russia 3 0 0 0
Saint Lucia 1 0 1 0
Samoa 1 0 0 0
Saudi Arabia 81 0 12 0
Serbia 12 0 7 0
Singapore 701 0 102 0
Slovakia 13 0 4 0
Slovenia 4 0 0 0
South Africa 1 0 0 0
Spain 717 1 176 1
Sri Lanka 15 0 6 0
Suriname 11 0 0 0
Sweden 69 0 2 0
Switzerland 56 0 7 0
Thailand 1414 3 640 3
Trinidad and Tobago 53 0 0 0
Tunisia 3 0 1 0
Turkey 32 0 5 0
Ukraine 1 0 0 0
United Arab Emirates 8 0 0 0
United Kingdom 6538 3 2288 2
Guernsey, Crown Dependency 5 0 4 0
Isle of Man, Crown Dependency 1 0 0 0
Jersey, Crown Dependency 8 0 0 0
United States of America 27717 127 0 0
Uruguay 195 1 0 1
Vanuatu 2 0 0 0
Venezuela 193 0 21 0
Viet Nam 123 0 39 0
West Bank and Gaza Strip 13 0 4 0
Yemen 7 0 1 0
Grand Total 77201 332 6308 21
Chinese Taipei has reported 61 confirmed cases of pandemic (H1N1) 2009 with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.
Cumulative and new figures are subject to revision
http://www.who.int
Read Full Article...>>>