Announcement

**Giuseppe** · September 23, 2008, 02:26 AM

Re: WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

World Health Organization: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season (Excerpts)

Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season (Excerpts)

(...)

Influenza A(H5N1)
From 1 February to 19 September 2008, 36 human cases of influenza A(H5N1) were confirmed in Bangladesh, China, Egypt, Indonesia and Vietnam. Many of these cases were associated with outbreaks of highly pathogenic avian influenza A(H5N1) in poultry. Since December 2003, a total of 387 human cases have been confirmed from 15 countries. So far, there has been no evidence of sustained human-to-human transmission. The WHO influenza pandemic preparedness level remains unchanged at Phase 3.

(...)

Influenza A(H1N1) viruses
In haemagglutinin-inhibition (HI) tests with post infection ferret sera, the majority of influenza A(H1N1) viruses were closely related to the northern hemisphere 2008-2009 vaccine strain A/Brisbane/59/2007. Phylogenetically the haemagglutinin of recent viruses belonged to one of two distinct clades represented by A/Brisbane/59/2007 and A/Hong Kong/2652/2006, with most belonging to the A/Brisbane/59/2007 clade. These two clades were antigenically indistinguishable.
Influenza A(H3N2) viruses
In HI tests with postinfection ferret sera, the majority of recent influenza A(H3N2) viruses were antigenically similar to the vaccine viruses A/Brisbane/10/2007 and A/Uruguay/716/2007 and phylogenetically belonged to the A/Brisbane/10/2007 clade.
Influenza B viruses
Influenza B viruses of both the B/Yamagata/16/88 and the B/Victoria/2/87 lineages continued to circulate. The B/Yamagata/16/88 lineage has remained predominant in the world, although recently B/Victoria/2/87 lineage viruses have been increasing in some countries, areas or territories, for example in Australia, China, China Hong Kong SAR and New Zealand.

In HI tests with post-infection ferret sera the majority of viruses of the B/Yamagata/16/88 lineage were closely related to B/Florida/4/2006 and B/Brisbane/3/2007, the vaccine strains for the northern hemisphere, 2008-2009. The haemagglutinin genes of the B/Yamagata/16/88 lineage viruses fell into three different clades (represented by B/Florida/4/2006, B/Brisbane/3/2007 and B/Bangladesh/3333/2007); these three clades were antigenically homogeneus except for a small clade represented by B/Syndey/12/2008. Viruses from this clade circulated in Australia and New Zealand but were antigenically indistinguishable from other B/Victoria/2/87 lineage viruses.

Resistance to influenza antiviral drugs

Neuraminidase inhibitors
Resistance of A(H1N1) viruses to the neuraminidase inhibitor oseltamivir, due to the H275Y mutation (numbered according to N1 sequence), increased in many countries in different regions of the world. The proportion varied from 0% to 100% in individual countries. Phylogenetically the majority of oseltamivir resistant viruses fell into the A/Brisbane/59/2007 clade. Only a few of the A/Hong Kong/2652/2006 clade viruses were resistant to oseltamivir. Resistant viruses from both clades retained sensitivity to zanamivir. (...) No oseltamivir resistant A(H3N2) or B viruses were detected.
M2 inhibitor
The proportion of influenza A(H3N2) viruses resistant to amantadine and rimantadine remained very high. The proportion of resistant influenza A(H1N1) viruses was variable from country to country; A/Brisbane/59/2007 clade viruses were sensitive whereas A/Hong Kong/2652/2006 clade viruses were resistant. Resistance in both subtypes wall still predominantly associated with a serine to asparagine change in residue 31 of the M2 ion channel protein.

A few viruses (of the A/Hong Kong/2652/2006 clade) were resistant to both oseltamivir and M2 inhibitors but retained sensitivity to zanamivir.
(...)

Original PDF texts at: http://www.who.int/csr/disease/influ...mmendation.pdf

**Giuseppe** · September 24, 2008, 02:19 AM

Re: WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

CIDRAP >> WHO keeps same strains for 2009 southern hemisphere flu vaccine

WHO keeps same strains for 2009 southern hemisphere flu vaccine

Lisa Schnirring * Staff Writer

Sep 23, 2008 (CIDRAP News) ?

The World Health Organization (WHO) has recommended that influenza vaccines for the southern hemisphere's 2009 flu season be based on the same three viral strains as this year's vaccines.

The recommendation also mirrors the WHO's recommendation for the northern hemisphere's 2008-09 flu season, which is unusual, according to a comment by moderator on ProMED-mail, the online reporting system of the International Society for Infectious Diseases.

Each September the WHO analyzes the circulating flu strains before selecting the ones to include in the southern hemisphere's vaccine for the next flu season, which typically runs from May through October.

The WHO does the same for the northern hemisphere each February.

The 6-month interval between the strain recommendation and the start of the next flu season gives manufacturers time to grow the viruses in chicken eggs and formulate them into trivalent (three-strain) vaccines.

The WHO's flu vaccine recommendations for the southern hemisphere for next season include:
* For the A/H1N1 component, a strain similar to A/Brisbane/59/2007
* For the A/H3N2 component, a strain similar to A/Brisbane/10/2007
* For the B component, a strain similar to B/Florida/4/2006

The WHO said influenza activity this year in the southern hemisphere has been mild.

In Africa, H1N1 viruses caused most outbreaks, but in South America, H1N1 and B viruses cocirculated and were responsible for outbreaks.

Countries in the Oceania region reported outbreaks from H3N2 and B viruses.

As reported previously, H1N1 viruses have shown increased resistance to the antiviral drug oseltamivir (Tamiflu) in a growing number of countries, the WHO said.

Most were in the Brisbane/59/2007 clade, but a few A/Hong Kong/2652/2006 clade viruses showed resistance, as well.

The percentage of resistant viruses ranged from 0% to 100% among different countries.

Both clades showed sensitivity to zanamivir.

The WHO said it did not detect any oseltamivir-resistant H3N2 or B viruses.

The findings strengthen a trend that that was first observed last January in Norway and later in many other countries.

Public health officials are concerned about increased resistance to oseltamivir, because many countries have stockpiled the drug for use in case the H5N1 avian influenza virus evolves into a human pandemic strain.

The proportion of H3N2 viruses that showed resistance to the M2 inhibitors amantadine and rimantadine, two older antiviral drugs, remained very high, the WHO reported.

However, the proportion of H1N1 viruses resistant to the older drugs varied from country to country. In general, Brisbane/59/2007 clade viruses were sensitive to M2 inhibitors, while those from the A/Hong Kong/2652/2006 clade showed resistance.

In 2006, after the dominant circulating flu strains in the United States showed unexpectedly high rates of resistance to M2 inhibitors, the Centers for Disease Control and Prevention advised clinicians to stop prescribing them and instead use the newer antivirals, oseltamivir and zanamivir, which are both neuraminidase inhibitors.
--

<cite cite="http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/sep2308southern-br.html">CIDRAP >> WHO keeps same strains for 2009 southern hemisphere flu vaccine</cite>

**HenryN** · September 24, 2008, 02:42 AM

Re: WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

Originally posted by ironorehopper View Post

World Health Organization: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season (Excerpts)

Resistance to influenza antiviral drugs

Neuraminidase inhibitors
Resistance of A(H1N1) viruses to the neuraminidase inhibitor oseltamivir, due to the H275Y mutation (numbered according to N1 sequence), increased in many countries in different regions of the world. The proportion varied from 0% to 100% in individual countries. Phylogenetically the majority of oseltamivir resistant viruses fell into the A/Brisbane/59/2007 clade. Only a few of the A/Hong Kong/2652/2006 clade viruses were resistant to oseltamivir. Resistant viruses from both clades retained sensitivity to zanamivir. (...) No oseltamivir resistant A(H3N2) or B viruses were detected.
Original PDF texts at: http://www.who.int/csr/disease/influ...mmendation.pdf

The above comments ignore the zanamivir resistance in isolates in the Brisbane/59 clade that are sensitive to oseltamivir.

**HenryN** · September 24, 2008, 10:08 AM

Re: WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

<TABLE cellSpacing=5 cellPadding=4 width="100%" align=left border=0><TBODY><TR><TD vAlign=top>WHO keeps same strains for 2009 southern hemisphere flu vaccine

By Lisa Schnirring
CIDRAP Staff Writer
Sep 23, 2008 (CIDRAP News) ? The World Health Organization (WHO) has recommended that influenza vaccines for the southern hemisphere's 2009 flu season be based on the same three viral strains as this year's vaccines.
The recommendation also mirrors the WHO's recommendation for the northern hemisphere's 2008-09 flu season, which is unusual, according to a comment by moderator on ProMED-mail, the online reporting system of the International Society for Infectious Diseases.
Each September the WHO analyzes the circulating flu strains before selecting the ones to include in the southern hemisphere's vaccine for the next flu season, which typically runs from May through October. The WHO does the same for the northern hemisphere each February. The 6-month interval between the strain recommendation and the start of the next flu season gives manufacturers time to grow the viruses in chicken eggs and formulate them into trivalent (three-strain) vaccines.
The WHO's flu vaccine recommendations for the southern hemisphere for next season include:

<LI class=body>For the A/H1N1 component, a strain similar to A/Brisbane/59/2007 <LI class=body>For the A/H3N2 component, a strain similar to A/Brisbane/10/2007
For the B component, a strain similar to B/Florida/4/2006

The WHO said influenza activity this year in the southern hemisphere has been mild. In Africa, H1N1 viruses caused most outbreaks, but in South America, H1N1 and B viruses cocirculated and were responsible for outbreaks. Countries in the Oceana region reported outbreaks from H3N2 and B viruses.
As reported previously, H1N1 viruses have shown increased resistance to the antiviral drug oseltamivir (Tamiflu) in a growing number of countries, the WHO said. Most were in the Brisbane/59/2007 clade, but a few A/Hong Kong/2652/2006 clade viruses showed resistance, as well. The percentage of resistant viruses ranged from 0% to 100% among different countries. Both clades showed sensitivity to zanamivir. The WHO said it did not detect any oseltamivir-resistant H3N2 or B viruses.
The findings strengthen a trend that that was first observed last January in Norway and later in many other countries. Public health officials are concerned about increased resistance to oseltamivir, because many countries have stockpiled the drug for use in case the H5N1 avian influenza virus evolves into a human pandemic strain.
The proportion of H3N2 viruses that showed resistance to the M2 inhibitors amantadine and rimantadine, two older antiviral drugs, remained very high, the WHO reported. However, the proportion of H1N1 viruses resistant to the older drugs varied from country to country. In general, Brisbane/59/2007 clade viruses were sensitive to M2 inhibitors, while those from the A/Hong Kong/2652/2006 clade showed resistance.
In 2006, after the dominant circulating flu strains in the United States showed unexpectedly high rates of resistance to M2 inhibitors, the Centers for Disease Control and Prevention advised clinicians to stop prescribing them and instead use the newer antivirals, oseltamivir and zanamivir, which are both neuraminidase inhibitors.
See also

Sep 22 WHO statement on 2009 southern hemisphere influenza vaccine
WHO report on recommended composition of 2009 southern hemisphere flu vaccine
Aug 25 CIDRAP News story "H1N1 viruses growing more resistant to Tamiflu"
ProMed-mail report (Sep 22)
Provided by the Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota. ? 2002-2008 Regents of the University of Minnesota.

http://id-center.apic.org/apic/influenza/general/news/sep2308southern-br.html

</TD><TD vAlign=top align=middle>
Sponsored through an educational grant from BD

</TD></TR></TBODY></TABLE>

**HenryN** · September 24, 2008, 10:10 AM

Re: WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

INFLUENZA VACCINE 2009 (02): SOUTHERN HEMISPHERE
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 23 Sep 2008
From: Jody Lanard
<jody@psandman.com>

Southern hemisphere flu vaccines: 5 of 11 were same as prior northern
hemishere vaccine
---------------------------------------------------------------------------------------
In yesterday's ProMED-mail post titled 'Influenza vaccine 2009: S.
hemisphere,' archive number 20080922.2988, the Moderator commented
that: "In summary, perhaps unusually, the composition of the
influenza vaccines for use in the northern and southern hemispheres
in 2009 are identical.

On the contrary it is actually not so unusual. Since 1999, when the
World Health Organisation (WHO) began making recommendations for a
Southern Hemisphere vaccine, the Southern Hemisphere vaccine was the
same as the previous Northern Hemisphere season's vaccine in 5 out of
the 11 years:

1999
2002
2003
2007
2009

The Southern Hemisphere vaccine differed from the previous Northern
Hemisphere season's vaccine by:

0 component: 5 times (1999, 2002, 2003, 2007, 2009)
1 component: 4 times (2001, 2004, 2005, 2006)
2 components: 2 times (2000, 2008)
3 components: 0 times

The Northern Hemisphere vaccine differed from the previous Southern
Hemisphere season's vaccine by:

0 component: 5 times (1999-2000, 2000-2001,2001-2002, 2003-2004, 2008-2009)
1 component: 5 times (2002-2003, 2004-2005,2005-2006, 2006-2007, 2007-2008)
2 components: 0 times
3 components: 0 times

--
Jody Lanard M.D.
The Peter Sandman Risk Communication Website
<http://www.psandman.com>.
<jody@psandman.com>
59 Ridgeview Road
Princeton, NJ 08540 USA

[My comment in the previous post was a guestimate and ProMED-mail is
indebted to Jody Lanard for providing this detailed record of vaccine
composition during the past 11 years. Dr. Lanard has compiled a
comprehensive chart of every season's recommended flu vaccine
components, detailing the changes from the previous season and/or
year. I recommend interested readers to request this informative
chart directly from Dr. Lanard.

It is noteworthy that overall there has been little diverge between
the vaccines recommended for use in the northern and southern
hemispheres, reflecting only a slow drift in the antigenic properties
of the seasonal influenza viruses affecting the human populations of
the northern and southern hemispheres. - Mod.CP]

[see also:
Influenza vaccine 2009: S. hemisphere 20080922.2988
Influenza vaccine 2008/2009 - N. hemisphere 20080805.2404
Influenza virus, vaccine response: RFI 20080209.0528
Influenza, pediatric mortality: CDC notice 20080202.0426
Influenza virus, 2007/2008 vaccine mismatch 20080209.0529
2007
----
Influenza update - USA & worldwide 20070928.3217
Influenza: update & vaccine composition 20070810.2607
2006
----
Influenza vaccine 2006/2007 - N hemisphere 20060303.0676]
..............................cp/ejp/mpp

Announcement

WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

WHO: Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season

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