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http://www.cdc.gov/swineflu/index.htm


In response to an intensifying outbreak in the United States and internationally caused by a new
influenza virus of swine origin, the World Health Organization raised the worldwide pandemic alert
level to Phase 5  on April 29, 2009. A Phase 5 alert is a “strong signal that a pandemic is imminent and
that the time to finalize the organization, communication, and implementation of the planned mitigation
measures is short.”
The United States Government has declared a public health emergency in the United States. CDC’s
response goals are to reduce transmission and illness severity, and provide information to help health
care providers, public health officials and the public address the challenges posed by this emergency.
CDC is issuing and updating interim guidance daily in response to the rapidly evolving situation. CDC’s
Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective
equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond
to the outbreak. The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs
oseltamivir and zanamivir. In addition, the Federal Government and manufacturers have begun the
process of developing a vaccine against this new virus.
The Country of Mexico Closing Down.
Mexico shuts nonessential services amid swine flu ( Hi Ni Virus)
30 April, 2009
(Just 14 days since a new and dangerous virus was discovered in Mexico)

By MARK STEVENSON and ANDREW O. SELSKY, AP

Mexico is telling citizens to stay home, urging businesses to close for five days and suspending
government services as the
World Health Organization warns the swine flu outbreak is on the
brink of becoming a global epidemic
.

In the United States, federal health officials said Thursday the number of confirmed cases had risen to
109. President Barack Obama told Americans the government was "taking the utmost precautions and
preparations" to stop the virus.

Mexican President Felipe Calderon said in a televised address that only essential businesses such
as supermarkets, hospitals and pharmacies should stay open, and only critical government
workers such as police and soldiers would be on duty from Friday through Tuesday. School had
already been canceled nationwide through Tuesday.

The steps are aimed at stopping further spread of the virus, blamed for 168 deaths in Mexico and one in
the United States, even though the WHO has suggested nations should focus on minimizing its effects,
not containing its spread.

"There will be no government activities — those that are not fundamental for citizens — nor any private-
sector activities that are not fundamental to common life," Calderon said Wednesday night in a televised
address.

"There is no safer place to protect yourself against catching swine flu than in your house," he said,
defending the government against criticism that it had been slow to act against signs of a new and
dangerous virus.

In the U.S., both Vice President Joe Biden and the acting head of the Centers for Disease Control and
Prevention said in televised interviews Thursday there would be no practical benefit to closing the U.S.-
Mexican border. Biden said on CBS that it would be a "monumental undertaking" with far-reaching
consequences.

Biden also said on NBC's "Today" show that he is advising his own family to stay off commercial airlines
and even subways because of swine flu. If one person sneezes on a confined aircraft, he said, "it goes all
the way through the aircraft."

Within two hours, Biden's office issued a statement backing off the remarks and suggesting he was
talking about travel to Mexico.

His precautions go beyond official advice from the U.S. government; Obama merely urged people to
wash their hands, cover their coughs and stay home when they feel sick. Calderon gave similar advice.

The WHO on Wednesday raised its alert level to Phase 5, the second-highest, indicating a pandemic may
be imminent, and was talking about moving to Phase 6. The Phase 5 alert — the first ever — activates
added efforts to produce a vaccine.

"It really is all of humanity that is under threat during a pandemic," WHO Director General Margaret
Chan said in Geneva. "We do not have all the answers right now, but we will get them."

Switzerland and the Netherlands became the latest countries to report swine flu infections. In addition to
Mexico and the U.S., Canada, New Zealand, Britain, Germany, Spain, Israel and Austria have confirmed
cases.

The Swiss government said a 19-year-old student with swine flu was mistakenly released from the
hospital and then hastily readmitted. The Dutch said a 3-year-old child who recently returned from
Mexico had contracted swine flu and was being treated and recovering well.

European Union health ministers planned emergency talks in Luxembourg to coordinate national efforts in
preventing the spread of swine flu in Europe.

WHO flu chief Dr. Keiji Fukuda said it was difficult to say whether the outbreak justified declaring a
Phase 6 pandemic.

By definition, he said, a pandemic means "established transmission of this new virus in multiple countries
and multiple regions of the world. So right now we're saying that we see it convincingly in two countries
in one region of the world."

"We think we are in the process of moving toward there, but we still need to see the evidence that we are
there," Fukuda said.

The WHO raised its tally of confirmed swine flu cases around the world to 236 from 148, with most of
the new cases from Mexico. The WHO count lags behind what individual countries report.

The United States confirmed its first swine flu death on Wednesday, a Mexican toddler who visited
Texas with his family and died Monday night in Houston. Thirty-nine Marines were confined to their
base in California after one came down with the virus, a mix of pig, bird and human genes to which
people have limited natural immunity.

The outbreak appeared to be stabilizing in Mexico, the epicenter. New deaths and cases seemed to be
leveling off after an aggressive public health campaign launched when the epidemic was declared April
23. Hospital records suggest the outbreak may have peaked here last week.

Calderon said authorities would use the partial shutdown to consider whether to extend emergency
measures or ease some restrictions. The dates of the shutdown include a weekend and two holidays,
Labor Day and Cinco de Mayo, minimizing the added disruption.

Even before the shutdown went into full effect, a surprised radio reporter exclaimed that traffic was
unusually light Thursday. Businessmen in surgical masks trudged in for their last day of work, passing
beggars who kept their masks on too. Even the capital's legendary smog seemed to be easing.

Obama said his administration has made sure that needed medical supplies are on hand and he praised the
Bush administration for stockpiling 50 million doses of antiviral medications.

"The key now is to just make sure we are maintaining great vigilance, that everybody responds
appropriately when cases do come up. And individual families start taking very sensible precautions that
can make a huge difference," he said.

Ecuador, Cuba and Argentina have all banned travel to or from Mexico, and Peru has banned inbound
flights. The Panama Canal Authority ordered pilots and other employees who board ships passing
through the waterway to use surgical masks and gloves.

The U.S., the European Union and other countries have discouraged nonessential travel to Mexico. Some
countries have urged their citizens to avoid the United States and Canada as well. Health officials said
such bans would do little to stop the virus.

In France, President Nicolas Sarkozy met with Cabinet ministers to discuss swine flu, and the health
minister said France would ask the European Union to suspend flights to Mexico.

Medical detectives have not pinpointed where the outbreak began. Scientists believe that somewhere in
the world, months or even a year ago, a pig virus jumped to a human and mutated, and has been
spreading between humans ever since.

China has gone on a rhetorical offensive to squash any suggestion it's the source of the swine flu after
some Mexican officials were quoted in media reports in the past week saying the virus came from Asia
and the governor of Mexico's Veracruz state was quoted as saying the virus specifically came from
China.

One of the deaths in Mexico directly attributed to swine flu was that of a Bangladeshi immigrant, said
Mexico's chief epidemiologist, Miguel Angel Lezana. He said the unnamed Bangladeshi had lived in
Mexico for six months and was recently visited by a brother who was reportedly ill. Lezana suggested
the brother could have brought the virus from Pakistan or Bangladesh.

By March 9, the first symptoms were showing up in the Mexican state of Veracruz, where pig farming is
a key industry in mountain hamlets and where small clinics provide the only local health care.

The earliest confirmed case was there: a 5-year-old boy who was one of hundreds of people in the town
of La Gloria whose flu symptoms left them struggling to breathe. People from La Gloria kept going to
jobs in Mexico City despite their illnesses, and could have infected people in the capital.

Days later, a door-to-door tax inspector was hospitalized with acute respiratory problems in the
neighboring state of Oaxaca, infecting 16 hospital workers before she became Mexico's first confirmed
death.

Neighbors of the inspector, Maria Adela Gutierrez, said Wednesday that she fell ill after pairing up with a
temporary worker from Veracruz who seemed to have a very bad cold.

Jose Cordova, the Mexican health secretary, said getting proper treatment within 48 hours of falling ill "is
fundamental for getting the best results" and suggested people can survive the virus if it is quickly
diagnosed and treated.

But it was neither caught quickly nor treated properly in the early days in Mexico, which lacked the
capacity to identify the virus, and whose health care system has become the target of widespread anger
and distrust. In case after case, patients have complained of being misdiagnosed, turned away by doctors
and denied access to drugs.

Swine flu has symptoms nearly identical to regular flu — fever, cough and sore throat — and spreads
like regular flu, through tiny particles in the air, when people cough or sneeze. People with flu symptoms
are advised to stay at home, wash their hands and cover their sneezes.
___

AP writers Frank Jordans in Geneva; Tom Raum and Lauran Neergaard in Washington; Olga Rodriguez
in Oaxaca, Mexico; Paul Haven and E. Eduardo Castillo in Mexico City; Mike Stobbe in Atlanta; Mike
Corder in The Hague, Netherlands, and Balz Bruppacher in Bern, Switzerland, contributed to this report.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast,
rewritten or redistributed.

                  ---------------------------------------------

Swine Flu Likely to Return to U.S. Next Winter
WEDNESDAY, May 6 (HealthDay News)

Many experts are predicting that the current outbreak of swine flu, much like the regular seasonal flu,
will subside during the summer months and reappear in the fall.

That return could come with a vengeance, or not.

"We can't actually be certain, but there likely will be a reemergence," said Dr. Len Horovitz, a pulmonary
specialist with Lenox Hill Hospital in New York City. "We're seeing this virus at a time that is usually the
end of the flu season, so you would expect, because the flu virus is hardier in cold weather, that there
will probably be a return."

"If you draw parallels to previous flu pandemics, the pattern has always been a mild epidemic in the early
summer or late spring, then you see a larger epidemic in the winter," said Dr. Luis Z. Ostrosky, an
associate professor of medicine and epidemiology in the division of infectious diseases at the University
of Texas Medical School in Houston. "If this were to follow the pattern of previous outbreaks, we would
see it again in the winter."

Ostrosky was referring to 1918 (Spanish flu pandemic), 1957 (Asian flu) and 1968 (Hong Kong flu).

This pattern of an initial "herald wave" followed by a second wave is common in the flu world.

"Sometimes we will see a little spike of flu towards the end of the season with that turning up next year.
Maybe that's what this is. That would be very typical," said Dr. John Treanor, a professor of medicine
and of microbiology and immunology at the University of Rochester Medical Center. "My guess would
be that if this virus does not end up causing significant disease in the northern hemisphere over the
summer, it will certainly do so in the fall."

So far, some of the most affected nations have been in North America and Europe, but the flu is spread
more easily in the winter, and it's already fall in the Southern hemisphere. Experts fear public health
systems could be overwhelmed if swine flu and regular flu collide in major urban populations, according
to the Associated Press.

"You have this risk of an additional virus that could essentially cause two outbreaks at once," Dr. Jon
Andrus, of the Pan American Health Organization's headquarters in Washington, D.C., told the wire
service.

Two separate flu strains could also mutate into a new strain that is more contagious and dangerous. "We
have a concern there might be some sort of reassortment, and that's something we'll be paying special
attention to," World Health Organization spokesman Dick Thompson told AP.

In North America, the summer should slow down the spread of swine flu; neither viruses nor bacteria
survive well at temperatures above 70 degrees Fahrenheit, explained C. Ed Hsu, an associate professor of
public health informatics at the University of Texas School of Health Information Sciences at Houston
and associate director of health informatics at the Center for Biosecurity and Public Health Preparedness
at the University of Texas School of Public Health.

How and when the flu spreads is dependent on other factors as well: the fitness and efficiency of the
virus itself along with its innate ability to replicate; the susceptibility of the host; and the environment,
which includes not only the weather, but also human behavior (for example, groups of people confined
together inside, making it easier for the virus to jump from person to person).

If a particular virus is especially robust, the weather and other environmental factors may play a lesser
role.

"It may not care what the environment is like, because it doesn't need that assistance, or it may depend
on environmental factors. It could go either way," Treanor said.

And while influenza virus needs a warm human body to replicate, it seems to sustain itself better in
airborne respiratory droplets when it's cold, Horovitz said. Hence, the sneeze heard around the world.

"But, if it does go away, it will come back, he added. "I would be pretty sure of that."

A fall/winter resurgence may or may not be more virulent, said Ostrosky.

"We've been very lucky so far that it's appearing to be mild, at least in the U.S., as far as virulence and
susceptibility to antivirals is concerned," he said. "It could change. That's one of the concerns."

"The severity depends on whether [and how] the genotype of the virus reassorts itself," Horovitz added.
The reassortment may be so minimal as to make no clinical difference, or it could assert itself in entirely
new ways."

But a vaccine will likely be ready by the time a second wave hits, Ostrosky noted, and the world is
prepared in other ways as well.

"We have completely sequenced the genome of the virus, and it shows low virulence at this point. We
know about it. We can prepare," he said. "If nothing else, this has been an extraordinary exercise in
preparation."

More information

The U.S. Centers for Disease Control and Prevention has more on the current outbreak of swine flu. http:
//
www.cdc.gov/h1n1flu/
Antiviral Drugs and Swine Influenza
Antiviral Drugs

Antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza
viruses, including swine influenza viruses. Antiviral drugs can be used to treat swine flu or to prevent
infection with swine flu viruses. These medications must be prescribed by a health care professional.
Influenza antiviral drugs only work against influenza viruses -- they will not help treat or prevent
symptoms caused by infection from other viruses that can cause symptoms similar to the flu.
There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir,
amantadine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans
in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not
work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1)
viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir.
Benefits of Antiviral Drugs
Treatment: If you get sick, antiviral drugs can make your illness milder and make you feel better faster.
They may also prevent serious influenza complications. Influenza antiviral drugs work best when
started soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be
considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk
for influenza-related complications.
Prevention: Influenza antiviral drugs also can be used to prevent influenza when they are given to a
person who is not ill, but who has been or may be near a person with swine influenza. When used to
prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number
of days that they should be used will vary depending on a person’s particular situation.
CDC Recommendation
CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection
with swine influenza viruses.
•        Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A and B
virus infection in people one year of age and older.
•        Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people
7 years and older and to prevent influenza A and B virus infection in people 5 years and older.
Recommendations for using antiviral drugs for treatment or prevention of swine influenza will change
as we learn more about this new virus.
Clinicians should consider treating any person with confirmed or suspected swine influenza with an
antiviral drug. Visit: http://www.cdc.gov/swineflu/recommendations.htm for specific recommendations.

- - - - - -

SWINE FLU - H1N1 Flue
Interim Guidance on Antiviral Recommendations for Patients with Confirmed or
Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts
April 29, 2009 02:45 PM ET
Objective: To provide interim guidance on the use of antiviral agents for treatment and
chemoprophylaxis of swine influenza A (H1N1) virus infection. This includes patients with confirmed,
probable or suspected swine influenza A (H1N1) virus infection and their close contacts.

Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-
OIV)
A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with
laboratory confirmed S-OIV infection at CDC by one or more of the following tests:
1.        real-time RT-PCR
2.        viral culture
A probable case of S-OIV infection is defined as a person with an acute febrile respiratory illness who
is positive for influenza A, but negative for H1 and H3 by influenza RT-PCR
A suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with
onset
•        within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or
•        within 7 days of travel to community either within the United States or internationally where there
are one or more confirmed cases of S-OIV infection, or
•        resides in a community where there are one or more confirmed cases of S-OIV infection.
Infectious period for a confirmed case of swine influenza A (H1N1) virus infection is defined as 1 day
prior to the case’s illness onset to 7 days after onset.
Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of
swine-origin influenza A (H1N1) virus infection during the case’s infectious period.
Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal
congestion, sore throat, cough (with or without fever or feverishness)
High-risk groups: A person who is at high-risk for complications of swine influenza A (H1N1) virus
infection is defined as the same for seasonal influenza (see MMWR: Prevention and Control of
Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008).
Special Considerations for Children
Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be
administered to any confirmed or suspected ill case of swine influenza A (H1N1) virus infection aged
18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic
medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.

Antiviral Resistance
This swine influenza A (H1N1) virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral
medications zanamivir and oseltamivir.  It is resistant to the adamantane antiviral medications,
amantadine and rimantadine.  

Antiviral Treatment
Confirmed, Probable and Suspected Cases of Swine-origin Influenza A (H1N1) Virus Infection
Recommendations for use of antivirals may change as data on antiviral effectiveness, clinical spectrum
of illness, adverse events from antiviral use, and antiviral susceptibility data become available.
Antiviral treatment should be considered for confirmed, probable or suspected cases of swine-origin
influenza A (H1N1) virus infection. Treatment of hospitalized patients and patients at higher risk for
influenza complications should be prioritized.
Only RT-PCR or viral culture can confirm infection with swine-origin influenza A (H1N1) virus. The
test performance of rapid antigen tests and immunofluorescence tests for detection of swine-origin
influenza A (H1N1) virus is unknown. Persons who might have swine-origin influenza A (H1N1) virus
and who test positive for influenza A using one of these tests should have confirmatory RT-PCR or
viral culture testing to confirm the presence of swine-origin influenza A (H1N1) virus.   A negative
rapid antigen or immunofluorescence test cannot be used to rule out swine-origin influenza A (H1N1)
virus infection.
Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset
of symptoms. Evidence for benefits from treatment in studies of seasonal influenza is strongest when
treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal
influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for
patients whose treatment was started more than 48 hours after illness onset. Recommended duration of
treatment is five days. Recommendations for use of antivirals may change as data on antiviral
susceptibilities and effectiveness become available.  Antiviral doses recommended for treatment of
swine-origin influenza A (H1N1) virus infection in adults or children 1 year of age or older are the same
as those recommended for seasonal influenza (Table 1). Oseltamivir use for children < 1 year old was
recently approved by the U.S. Food and Drug Administration (FDA) under an Emergency Use
Authorization (EUA), and dosing for these children is age-based (Table 2).
Note: Areas that continue to have seasonal influenza activity, especially those with circulation of
oseltamivir-resistant human A (H1N1) viruses, might prefer to use either zanamivir or a combination of
oseltamivir and rimantadine or amantadine to provide adequate empiric treatment or chemoprophylaxis
for patients who might have human influenza A (H1N1) infection.

Antiviral Chemoprophylaxis
For antiviral chemoprophylaxis of swine-origin influenza A (H1N1) virus infection, either oseltamivir or
zanamivir are recommended (Table 1). Duration of antiviral chemoprophylaxis post-exposure is 10 days
after the last known exposure to an ill confirmed case of swine-origin influenza A (H1N1) virus
infection. Post exposure prophylaxis should be considered for contact during the infectious period (e.g.,
one day before until 7 days after the case’s onset of illness).  If the contact occurred more than 7 days
earlier, then prophylaxis is not necessary.  For pre-exposure protection, chemoprophylaxis should be
given during the potential exposure period and continued for 10 days after the last known exposure to
an ill confirmed case of swine-origin influenza A (H1N1) virus infection. Oseltamivir can also be used
for chemoprophylaxis under the EUA (Table 3).
Antiviral chemoprophylaxis with either oseltamivir or zanamivir is recommended for the following
individuals:
1.        Household close contacts who are at high-risk for complications of influenza (e.g., persons with
certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and
pregnant women) of a confirmed or probable case.
2.        Health care workers or public health workers who were not using appropriate personal
protective equipment during close contact with an ill confirmed, probable, or suspect case of swine-
origin influenza A (H1N1) virus infection during the case’s infectious period. See guidelines on personal
protective equipment.
Antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:
1.        Household close contacts who are at high-risk for complications of influenza (e.g., persons with
certain chronic medical conditions, persons 65 years or older, children younger than 5 years old, and
pregnant women) of a suspected case.
2.        Children attending school or daycare who are at high-risk for complications of influenza
(children with certain chronic medical conditions) and who had close contact (face-to-face) with a
confirmed, probable, or suspected case.
3.        Health care workers who are at high-risk for complications of influenza (e.g., persons with
certain chronic medical conditions, persons 65 or older, and pregnant women) who are working in an
area of the healthcare facility that contains patients with confirmed swine-origin influenza A (H1N1)
cases, or who is caring for patients with any acute febrile respiratory illness.
4.        Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with
certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and
pregnant women). (Note: A travel warning is currently in effect indicating that nonessential travel to
Mexico should be avoided.
5.        First responders who are at high-risk for complications of influenza (e.g., persons with certain
chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant
women) and who are working in areas with confirmed cases of swine-origin influenza A (H1N1) virus
infection.
Children Under 1 Year of Age

Children under one year of age are at high risk for complications from seasonal human influenza virus
infections. The characteristics of human infections with swine-origin H1N1 viruses are still being studied,
and it is not known whether infants are at higher risk for complications associated with swine-origin
H1N1 infection compared to older children and adults.  Limited safety data on the use of oseltamivir (or
zanamivir) are available from children less than one year of age, and oseltamivir is not licensed for use in
children less than 1 year of age.  Available data come from use of oseltamivir for treatment of seasonal
influenza. These data suggest that severe adverse events are rare, and the Infectious Diseases Society of
America recently noted, with regard to use of oseltamivir in children younger than 1 year old with
seasonal influenza, that "…limited retrospective data on the safety and efficacy of oseltamivir in this
young age group have not demonstrated age-specific drug-attributable toxicities to date." (See IDSA
guidelines for seasonal influenza.)

Because infants typically have high rates of morbidity and mortality from influenza, infants with swine-
origin influenza A (H1N1) infections may benefit from treatment using oseltamivir.
Healthcare providers should be aware of the lack of data on safety and dosing when
considering oseltamivir use in a seriously ill young infant with confirmed swine-origin
H1N1 influenza or who has been exposed to a confirmed swine H1N1 case, and carefully
monitor infants for adverse events when oseltamivir is used. See additional information on
oseltamivir for this age group.

Pregnant Women

Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no
clinical studies have been conducted to assess the safety of these medications for pregnant
women. Because of the unknown effects of influenza antiviral drugs on pregnant women
and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the
potential benefit justifies the potential risk to the embryo or fetus; the manufacturers'
package inserts should be consulted. However, no adverse effects have been reported
among women who received oseltamivir or zanamivir during pregnancy or among infants
born to women who have received oseltamivir or zanamivir. Pregnancy should not be
considered a contraindication to oseltamivir or zanamivir use. Because of its systemic
activity, oseltamivir is preferred for treatment of pregnant women.  The drug of choice for
prophylaxis is less clear.  Zanamivir may be preferable because of its limited systemic
absorption; however, respiratory complications that may be associated with zanamivir
because of its inhaled route of administration need to be considered, especially in women at
risk for respiratory problems.

Adverse Events and Contraindications

For further information about influenza antiviral medications, including contraindications
and adverse effects, please see the following:

Antiviral Agents for Seasonal Influenza: Side Effects and Adverse Reactions
MMWR: Prevention and Control of Influenza: Recommendations of the Advisory
Committee on Immunization Practices (ACIP), 2008
MMWR August 8, 2008 / 57(RR07);1-60
Adverse events from influenza antiviral medications should be reported through the U.S.
FDA Medwatch website
=========================
Information Board on H1N1 Virus
Dr. Synthia Andrews N.D.

Andrews Healing Arts Clinic
Guilford, CT. 06437
USA
www.AndrewsHealingArts.com
NEW ALERT as the pieces predicted by the 2012 Mayan Prophecy come together:
19th September 2009.

Chikungunya virus has spread - now beyond Africa into India and Italy - Much
more serious than the West Nile virus which is also spreading like wildfire.

WASHINGTON — The United States and Europe face a new health threat from a mosquito-borne
disease far more unpleasant than the West Nile virus that swept into North America a decade ago, a U.S.
expert said on Friday.

Chikungunya virus has spread beyond Africa since 2005, causing outbreaks and scores of fatalities in
India and the French island of Reunion. It also has been detected in Italy, where it has begun to spread
locally, as well as France. Full story:
HERE
Highly disturbing allegations - LATEST H1N1 UPDATE

                       LEN HOROWITZ
FILES PANDEMIC CHARGES AGAINST ROCKEFELLER
http://www.theflucase.com/index.php?option=com_content&view=article&id=647%3Alen-horowitz-files-
pandemic-charges-against-rockefeller&catid=1%3Alatest-news&Itemid=64&lang=en

19 September 2009


LOS ANGELES, CA -- Drug-industry investigators have uncovered documents exposing an international
drug ring, operating from New York City, is behind the H1N1 swine flu fright and vaccination
preparations.

Dr. Leonard G. Horowitz and Sherri Kane, an investigative journalist, have released evidence in legal
affidavits that leaders of a private global biotechnology "trust" are behind the pandemic flu, including its
origin and alleged prevention via vaccinations. Their documents, being sent by attorneys to the FBI this
week, evidence industrialists are operating a crime ring within the "Partnership for New York City"
(PNYC), and are behind the pandemic's creation, media persuasions, vaccination preparations, and health
official promotions.

"David Rockefeller's trust, that engages several powerful partners on Wall Street, including media moguls
Ruppert Murdock, Morton Zuckerman, Thomas Glocer, and former Chairman of the Board of Directors
of the Federal Reserve Bank of New York, Jerry Speyer, are implicated in advancing global genocide,"
Dr. Horowitz wrote to FBI directors.

"This 'partnership' controls biotechnology research and development globally. Health commerce
internationally is also controlled virtually entirely by this trust that also exercises near complete control
over mainstream media to promote/propagandize its products and services for the drug cartel's organized
crime. This trust, in essence, makes or breaks medical and natural healing markets, primarily through the
mass media companies and propaganda it wields for social engineering and market building," Dr.
Horowitz wrote.

Among the revelations from the Horowitz-Kane research are those linking Larry Silverstein of Silverstein
Properties, Inc., and the 9-11 terrorist attacks, to the drug cartel's geopolitical, economic, and population
reduction activities. Mr. Silverstein, leaser of the World Trade Center who authorized to have Building-7
"pulled" [detonated] is a chief suspect in the "9-11 truth" investigation. Silverstein is currently landlord
and co-partner in the biotechnology trust founded by David Rockefeller and implicated by these new
discoveries.

Given the unprecedented nature and urgency of these findings, Dr. Horowitz has posted his affidavit for
public review on FLUscam.com, hoping wide spread dissemination will prompt governments worldwide
to cease mass vaccination preparations to avoid becoming accessories.

"The last time I contacted the FBI I warned them about the impending anthrax attacks one week before
the first mailings were announced in the press," Dr. Horowitz recalled. "It took them 6 months to
respond. When they did, they made me a suspect in the mailings. This time I am warning the Justice
Department a month before the deadliest genocide in history. I'm praying they'll take kindly to my appeal
for a PNYC investigation, and Court-ordered injunction, to stop the vaccinations for public protection.
2012 Debate - HEALTH
===========================================
===========================================
H1N1 FLU TRACKER
DISCLAIMER: The views published below, do not necessarily reflect the views of Dr. Synthia and Colin Andrews
Serious situation: If its not H1N1 what is it?
Posted: November 10, 2009.
November 10, 2009
at 9.40 PM US Eastern.

The explosion of cases in Ukraine, and delays in the release of sequences from fatal cases in Ukraine is
a cause for increasing concern.  Recent accelerations of deaths have been widespread across the
northern hemisphere, raising concerns that receptor binding domain changes described above, as well
as a third polymorphism at position 225, D225E, (see list) are gaining traction as the swine H1N1
adapts to human hosts. Full article
HERE.

Thanks to Busty Taylor.
=======================================
Ret Chief medical Officer for Finland condemns the Swine Influenza issues and
explores other related matters. Excerpt from The Researchers series.
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