今秋のブタインフルエンザ逆襲に警告/新型インフルエンザ オバマ政権

 オバマ政府はこの秋にブタインフルエンザの猛烈な逆襲に対して準備するようにと木曜日にアメリカ人に対して警告を発し、10月からワクチン接種を開始し、州や病院に対して資金援助を行うと発表した。
 8月に試験が始まる予定のワクチンの安全性と効果が証明されれば10月から接種開始となる。しかしその時点では1,000万人分にすぎず、誰から優先して接種するかを決める必要がある。学童、医療従事者、妊婦、喘息などのリスクのある疾患を持つ人が優先されるだろう。
 5月のピーク時に米国で726の学校が閉鎖されたが、決定は地域により行われたが、どういう基準で選んだかを説明するのが大変である。
 学校や職場は数週間出席率が低下する可能性があることを準備しておく必要がある。
 セベリウス保健福祉長官は、連邦政府としてはワクチン準備に州や市に2億6000万ドル、患者急増の準備に病院へ9000万ドルを提供するとした。議会はすでに最高75億ドルまでのワクチン対策費を承認している
 6月12日に10代女性から見つかったウイルスはノイラミニダーゼ遺伝子上の抵抗性遺伝子変異H274Yがあり、タミフル未使用にもかかわらず変異をもっていた。しかし、この変異が広範囲に見つかっているわけではない。
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新型用ワクチン、2000万人分を輸入へ
http://www.yomiuri.co.jp/science/news/20090710-OYT1T01052.htm
 舛添厚生労働相は10日、新型インフルエンザ(豚インフルエンザ)用ワクチンについて、海外企業から最大約2000万人分を購入する方針を明らかにした。
 年度末までに最大5300万人程度がワクチン接種を希望すると予測し、国内生産で足りない分を輸入で穴埋めする意向だ。
 大阪府庁で関西10知事・市長との意見交換会後、記者会見で明らかにした。
 国内4企業では計3000万人分の製造能力しかないため、舛添厚労相は「海外諸国とのワクチンの確保競争になる」との認識を示した。輸入に必要な財源の確保などについて、今月中に方向性を決めるという。
 海外製品は、有効成分の容量などが国内製品と異なるため、輸入には本来、臨床試験が必要で、数年かかる。緊急時の特例として、1961年にカナダと旧ソ連から輸入したポリオワクチンなどの例がある。
(2009年7月10日23時09分 読売新聞)
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Obama Warns of Return of Swine Flu in the Fall
http://www.nytimes.com/2009/07/10/health/10flu.html

By DONALD G. McNEIL Jr.
Published: July 9, 2009

BETHESDA, Md. ― The Obama administration warned Americans on Thursday to be ready for an aggressive return of the swine flu virus in the fall, announcing plans to begin vaccinations in October and offering states and hospitals money to help them prepare.
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Times Topics: Swine Flu (AH1N1 Virus)

“The potential for a significant outbreak in the fall is looming,” President Obama said by telephone link from Italy to the White House’s H1N1 Influenza Preparedness Summit, held at the National Institutes of Health.

With good planning, “we may end up averting a crisis,” Mr. Obama said. “That’s our fervent hope.”

The summit meeting was jointly led by the secretary of health and human services, Kathleen Sebelius; the secretary of homeland security, Janet Napolitano; and the secretary of education, Arne Duncan. It gathered health and school officials from across the country and took questions by video link from the governors of several states, most of whom wanted to know who would pay for preparations like the vaccination drive.

Vaccinations will begin in October only if tests scheduled to begin in August prove that the vaccine is safe and effective. Even then, officials expect only tens of millions of doses to be ready, so they will have to decide who is vaccinated first. The most likely candidates, Ms. Sebelius said, are school children, health care workers, pregnant women and people with asthma or other conditions that make the flu riskier.

While health officials were careful to warn that there was no evidence that the flu had mutated into a more dangerous form, they noted that it seriously disrupted some cities, including New York, in the late spring and could do worse as the fall flu season begins.

“This flu is not over,” said Dr. Thomas R. Frieden, the new head of the Centers for Disease Control and Prevention, describing its continuing spread in more than 50 summer camps, the large numbers of cases seen in Chile, Argentina and Australia, which are now at the beginning of their flu season, and the initial detections of three cases resistant to the drug Tamiflu.

At the flu’s peak in May, Mr. Duncan noted, 726 schools were closed across the United States. Decisions on closing schools will be made locally, he said.

Officials from New York and Texas described the difficulties they had in deciding which schools to shut down and how hard it was to explain why they picked those they did.

Both schools and businesses need to prepare for the possibility of several weeks of high absenteeism, Ms. Napolitano said. She also reminded governors that not only the obvious services, like hospitals and schools, would be affected.

“As a former governor, I can say: make sure your payroll continues,” she said. “Whoever processes your checks, make sure they have a backup.”

Ms. Sebelius outlined actions the federal government was taking. It will offer $260 million in “preparedness grants” to states and cities for the vaccination drive and $90 million to hospitals preparing for surges of cases. (Congress has already appropriated $1 billion for vaccine ingredients and up to $7.5 billion more for testing, buying and distributing vaccine if health officials decide it is safe and effective.)

The Health and Human Services Department is also remaking its Web site, www.flu.gov, to be the central repository of information for everyone, including parents, school officials and doctors. And it will hold a contest, asking Americans to film their own public-service announcements about flu.

“This is a YouTube challenge to everyone,” Ms. Sebelius said. “The best will be aired nationwide.”

Health officials said that they were aware of fears that a Tamiflu-resistant strain of the virus was already spreading silently in the United States, but that they had not seen evidence that it was a threat.

The worry stems from a single case found in a teenage girl who flew to Hong Kong from San Francisco on June 12. According to Hong Kong media reports, she was found to have a fever during a routine airport screening and was hospitalized as a precaution and tested.

The girl was never dangerously ill, was not treated with Tamiflu and recovered. But the sequence of her virus, released last week by the authorities in Hong Kong showed that it had a mutation, known as H274Y on the neuraminidase gene, making it resistant to Tamiflu, a neuraminidase inhibitor.

The fact that the girl had a resistant strain without being treated suggests that she caught an already resistant virus from someone else, presumably in Northern California, said Henry L. Niman, who runs a Web site tracking flu mutations (recombinomics.com).

The Centers for Disease Control and Prevention has intensified its monitoring in Northern California, and no other samples with Tamiflu-resistant virus have been found.

Therefore, Dr. Frieden said, “it does not appear to be widespread.”

Different strains of virus “compete” with one other each year, and the drug-resistant strains do not always win. But a Tamiflu-resistant strain of seasonal H1N1 flu utterly crushed its rivals during the last American flu season, rising to 99 percent of sequenced samples.

Also, Tamiflu-resistant strains can sometimes be successfully treated with Relenza, another neuraminidase inhibitor, with older drugs like rimantadine, or even with larger Tamiflu doses.

Cadets Tested for Swine Flu

COLORADO SPRINGS (AP) ― The Air Force Academy says 84 cadets with flu-like symptoms have been isolated and are being tested for swine flu. A spokeswoman, Capt. Corinna Jones, told The Gazette here on Thursday that most of the cadets were members of the entering freshman class who began training June 25. Captain Jones said the cadets began coughing and showing other upper respiratory symptoms over the past two days. She said that tests had been sent to a laboratory in San Antonio, and that results were expected within 24 hours.

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