Two more oseltamivir (Tamiflu)-resistant cases of novel H1N1 flu have been identified in the United States, bringing the US total to four, Dr. Scott Epperson of the CDC reported today during a teleconference sponsored by the National Influenza Vaccine Summit. "These two new cases as well as the first two reported 2 weeks ago were associated with treatment or prophylaxis with Tamiflu," Epperson said. The two latest cases were included in the CDC's weekly surveillance update issued Aug 21. [CDC's most recent weekly flu surveillance report]

Officials at Carnegie Mellon University in Pittsburgh have confirmed novel H1N1 in 24 students, many of whom are being treated in isolation units, the Pittsburgh Post-Gazette reported today. Penn State has also confirmed several cases. Meanwhile, schools near Lee County, Alabama, including the cities of Opelika and Auburn, are reporting hundreds of students sick with flu-like illnesses, and dozens of illnesses have been reported in Los Alamos, NM, schools, according to other reports. [Aug 26 Pittsburgh Post-Gazette story]

Another pig herd in Australia has been quarantined because of a suspected novel H1N1 flu outbreak, the Australian Associated Press (AAP) reported. Veterinarians took samples from the pigs after several in a shed of 450 showed flu-like symptoms. The farm is located west of Brisbane in Queensland. Initial results were positive for influenza A, and further tests are under way to confirm the pandemic H1N1 virus. An outbreak was reported in Victoria last week and New South Wales in July. [Aug 25 AAP story]

Australia's H1N1 flu epidemic has not yet passed its peak, Health Minister Nicola Roxon said today, according to the AAP. Roxon said there have been signs of a decline in cases in some areas, but cases are still increasing in others. The country has had 138 deaths from the virus, and about 80% of people tested for flu-like illness have had it. Australia currently has 440 people hospitalized with the illness, including 100 in intensive care units, the story said. [Aug 26 AAP story]

Angola's health ministry yesterday reported the country's first four pandemic H1N1 cases, Angola Press reported. The patients include two Brazilians and two Angolans from the same family, both of whom traveled internationally. All of the patients are in isolation and are reportedly in stable condition. [Aug 25 Angola Press story]

The European Union's (EU's) health authorities yesterday recommended that people ages 6 months and older who have chronic health conditions, pregnant women, and healthcare workers be first in line for novel H1N1 flu vaccine. The EU statement said it will be up to member states to develop their own vaccination strategies. Unlike the US priority group list, the EU list does not include the general population of children aged 6 months through 4 years. [Aug 25 EU statement]

The US Food and Drug Administration (FDA) yesterday issued an emergency use authorization (EUA) for a novel H1N1 flu diagnostic test in US troops overseas. The Centers for Disease Control and Prevention developed the test, called the CDC swH1N1 Influenza Real-Time RT-PCR. FDA Commissioner Margaret A. Hamburg said the test will permit faster diagnosis of H1N1 in troops so that treatment can start sooner. [Aug 25 FDA statement]

Health and Human Services Secretary Kathleen Sebelius said yesterday it will probably be Thanksgiving before many Americans are fully immunized against the novel H1N1 flu virus, the Associated Press (AP) reported. Sebelius, speaking to reporters in Atlanta, said immunization will probably require two doses 3 weeks apart, and full immunity won't develop until a week or two after the second dose. The first doses are expected to become available in mid-October. [Aug 25 AP report]

Because of declining demand, Britain's National Pandemic Flu Service will close two of its telephone call centers this week, the Guardian newspaper reported. The story said infection rates have dropped and calls to the help lines have fallen since late July. The centers prescribe antiviral drugs over the phone to people with flu-like illnesses, a practice that has stirred controversy. More than 500,000 packs of oseltamivir were prescribed in the first 2 weeks after the centers opened. [Aug 25 Guardian story]

A Hong Kong health official said smokers may be prone to suffering life-threatening complications from novel H1N1 flu, Bloomberg News reported yesterday. At a medical meeting, Thomas Tsang of Hong Kong's Centre for Health Protection said 12 of 27 patients who suffered pneumonia and other serous complications were current or former smokers, and some had no other known risk factors. About 1 in 200 people in Hong Kong who tested positive for H1N1 experienced severe disease, the story said. [Aug 24 Bloomberg News story]

Asian countries will far markedly short of novel H1N1 vaccine this fall, a spokesman for the World Health Organization (WHO) said, according to a Reuters story today. Australia and China are scheduled to start vaccine production in September, but their vaccine is unlikely to benefit the rest of the region. "There is going to be massive underproduction of vaccines as compared to the needs and demand," said Manila-based WHO spokesman Peter Cordingley. [Aug 25 Reuters article]

Sweden has set aside $142 million to pay for the vaccination of its entire population against pandemic flu, an official said yesterday, according to an Agence France-Press (AFP) story today. The country has signed an agreement with British vaccine maker GlaxoSmithKline for 18 million vaccine doses enough to cover its population of about 9.3 million with two doses each. Sweden's vaccination program will be voluntary. [Aug 25 AFP story]

Maryland officials announced Monday that all of the state's hospitals will be linked via computer to better track pandemic influenza this fall and winter, according to a Baltimore Sun report. Maryland is the first state to enroll all its hospitals in the surveillance program, which also can be used to combat bioterror. Forty-six hospitals will share data on patients admitted, diagnoses, and treatments. In addition, state drugstores will log sales of flu and cold medications. [Aug 25 Baltimore Sun report]

The World Health Organization's (WHO's) flu chief urged wealthy nations and drug makers to donate more novel H1N1 vaccines to the world's poorest countries, according to an Aug 22 Associated Press (AP) story. Dr. Keiji Fukuda said, "It is clear that the poorest countries in general are just the most vulnerable to any number of diseases." Two drug companies have already agreed to donate 150 million doses to developing countries, while a third is looking at reduced pricing. [Aug 22 AP article]

The US Department of Health and Human Services (HHS) has enlisted the help of the American Association for Respiratory Care to gauge the supply of mechanical ventilators in the nation's hospitals, according to the respiratory therapy journal RT. The HHS requested the inventory, due Sep 10, to help assess how to boost ventilator capacity in advance of an expected fall wave of pandemic H1N1 flu. The report will be confidential and will not be used to relocate machines. [Aug 21 RT story]

Public Library of Science, a nonprofit, open-access scientific publisher, recently introduced a new portal for rapidly disseminating preliminary influenza-related research findings. Articles on the Web site, called PLoS Currents: Influenza, are screened by a board of moderators but are not thoroughly peer reviewed. The site currently contains 10 articles, including one on pandemic H1N1 virulence and another on the outbreak and intensive care capacity. [PLoS Currents: Influenza Web site]

Because of the rapid spread of H1N1 flu, some South Korean schools are delaying their semester start, scheduled for yesterday, to slow the spread of the virus, the Korea Herald reported. The schools include 3 middle schools, 12 high schools, and 1 international school that reported a total of 38 confirmed H1N1 infections. The number of South Korean cases reached 3,113 yesterday with 188 new cases in that day alone. [Aug 25 Korea Herald story]

Public health officials in Kyrgyzstan today confirmed the country's first novel H1N1 cases, a 24-year-old man and his wife who had traveled to Dubai in mid August, Trend News Agency reported. The two were admitted to an infectious disease hospital on Aug 18 with flu symptoms. Lab tests in Moscow confirmed the diagnosis. [Aug 24 Trend News Agency story]

CSL Biotherapies, one of five companies making novel H1N1 vaccine for the US government, today announced the launch of clinical trials of the vaccine in adults and children. Plans call for enrolling 1,300 adults and 450 children (aged 3 months to 9 years) in the trials. The subjects will receive two doses 3 weeks apart; three different doses will be tested in the adult trial and two doses in the children's. The children's vaccine will be in a thimerosal-free formulation. [Aug 24 CSL news release]

Chile's agriculture ministry yesterday reported an outbreak of novel H1N1 flu at two turkey farms west of Santiago, the first such report in birds, Reuters reported. The farms were quarantined on Aug 13 after a change in egg production prompted testing. So far officials have found no further spread. Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a press conference today that the finding was interesting but not surprising or worrisome. [Aug 21 Reuters story]

A World Health Organization (WHO) official speaking in Beijing today said he expects to see an "explosion in case numbers" this fall when novel H1N1 virus activity picks up again in the northern hemisphere, the Associated Press reported. Shin Young-soo, the WHO's Western Pacific director, said cases in many countries could double every 3 to 4 days. But a US CDC official said that while vigilance is needed, fall outbreaks might resemble only a bad flu season. [Aug 21 AP story]

The Centers for Disease Control and Prevention (CDC) recorded 7,963 hospitalizations and 522 deaths attributed to novel H1N1 flu as of the end of last week, up from 7,511 hospital cases and 477 deaths a week earlier, Dr. Jay Butler of the CDC reported at a news conference today. Butler said the overall level of flu activity was low, but two states, Alaska and Maine, still had widespread activity. Those two states plus Hawaii and South Carolina had widespread activity a week earlier. [CDC flu surveillance page]

H1N1 flu cases in temperate areas of the southern hemisphere are declining, except South Africa, the WHO reported in a revised situation update today. But cases are increasing in tropical parts of Asia that are entering their monsoon season, such as India. The WHO expects the new strain to dominate the early part of the northern hemisphere's flu season. Twelve oseltamivir-resistant cases have been reported. The global H1N1 death toll has reached 1,799, with 177 countries confirming cases. [Aug 21 WHO revised situation update]

A review by French researchers of 574 novel flu deaths reported globally through mid July found that about half involved people with underlying conditions, most notably pregnancy and obesity. Reporting in the latest issue of Eurosurveillance, they said more research is needed to explore if other conditions contribute to higher death rates in obese patients. Though older people seem to have some immunity, the group found that elderly patients who had novel flu infections were more likely to die. [Aug 20 Eurosurveillance study]

A modeling study to assess flu vaccine allocation strategies found that immunizing school children and adults their parents' age, 30 to 39, might be optimal, researchers reported in Science Express yesterday. Their rationale is that school children are responsible for most flu transmission and that their parents spread the virus to the wider community. The authors wrote that CDC recommendations for seasonal and novel flu vaccination don't fully address those transmission factors. [Aug 20 Science Express abstract]

Minneapolis-based UnitedHealth Group (UNH), one of the largest US health insurance companies, announced yesterday it would cover administration of the novel H1N1 vaccine for all its members, even if their benefit plans do not usually cover immunizations. Earlier this month, a trade association of health insurance companies told the CDC that insurers would generally cover administration of the vaccine for their members. [Aug 20 UHC announcement]

Australia's major infectious disease society is questioning the safety of the country's novel H1N1 vaccination plans, the Australian Broadcasting Corp. reported today. In a letter to the government, the Australasian Society for Infectious Diseases cited a risk of cross-contamination when using multidose vials and said the flu epidemic has subsided, so the campaign needn't be rushed. A spokeswoman for vaccine maker CSL countered that the single-dose approach would be slower and more expensive. [Aug 20 Australian Broadcasting Corp. News story]

Deaths from H1N1 flu in Latin America, the world's hardest-hit region, have reached 1,303, more than 70% of the global total of 1,799 listed by the World Health Organization, Agence France-Presse reported yesterday. Argentina has had 404 deaths, the second-highest toll after the United States' 477, and Brazil has 368, the story said. Trailing Brazil are Mexico, with 164 deaths; Chile, 105; and Peru, 62. [Aug 19 AFP report]

More than 60% of Americans say they are not worried about the novel H1N1 flu, but 55% plan to get the H1N1 vaccine for themselves or someone in their household, according to a Washington Post-ABC News Poll. The poll indicates that about one in eight Americans is very worried that the pandemic will affect his or her family, while twice as many are not at all worried, the Post reported. Nearly 75% were confident that the government will be able to cope effectively with the epidemic. [Aug 19 Washington Post story]

Canadian officials hope to license the country's novel flu vaccine and begin immunizing people in November, the Canadian Press reported yesterday. Canada's vaccine supplier, GlaxoSmithKline, will ship about 10 to 15 million doses and will be able to quickly replenish supplies as healthcare workers administer the vaccine to patients. Officials project that GSK's antigen production will outpace its fill-and-finish capacity, but said finishing the vaccine elsewhere would cause delays. [Aug 19 Canadian Press story]

Zimbabwe's health ministry today announced the confirmation of the country's first novel H1N1 cases, in five private-school children who got sick in early August, Agence France-Presse reported. Doctors at Zimbabwe's state hospitals are on strike over wage and allowance issues, but the health minister said the medical system is coping. Meanwhile, Belarus confirmed its first novel flu case yesterday, in a Chinese man who had recently returned from visiting China, the Interfax news agency reported. [Aug 20 AFP story]

In a survey of 429 small and medium-size British companies, 72% said they had weathered staff absenteeism because of the H1N1 flu and 38% expected that their sales would suffer, Reuters reported yesterday. The survey by the law firm Eversheds also found that one in five businesses said they expected to have to close or partially close premises, and 87% said they had introduced new sanitation measures to combat the virus. [Aug 19 Reuters report]

The New York State Department of Health has adopted an emergency rule requiring healthcare workers who have direct contact with patients to be vaccinated against seasonal and novel H1N1 influenza, the New York Times reported yesterday. The rule affects hospitals, home health agencies, and hospices but not nursing homes. The state's largest healthcare union protested the rule, saying the policy could become punitive for workers who shun vaccination for religious or cultural reasons. [Aug 18 New York Times story]

Following approval from a safety monitoring panel, the National Institute of Allergy and Infectious Diseases said it would launch two trials of novel H1N1 vaccines in children. Plans for the trials were announced in July. The safety committee reviewed data from two adult trials that started Aug 7 and found no problems that would preclude the tests in children. One trial will test two different doses of an H1N1 vaccine, and the other will involve giving an H1N1 vaccine with seasonal flu vaccine. [Aug 18 NIAID announcement]

A World Health Organization (WHO) official said yesterday that northern hemisphere countries have ordered more than 1 billion doses of H1N1 vaccines, Agence France-Presse reported. The WHO's Melinda Henry said a few countries, such as Greece, Canada, and Israel, have ordered enough doses to cover their whole populations, while others, including the United States, have ordered less. [Aug 18 AFP story]

The Australian government expects to receive its first 2 million doses of H1N1 vaccine by the end of next week, the Adelaide Advertiser reported today. Pregnant women, health workers, and chronically ill people will be first in line for the vaccine. It is expected that immunizations could begin Sep 7, pending approval from national health authorities. They are awaiting safety data from the vaccine manufacturer, CSL, which is also making vaccine for the US government. [Adelaide Advertiser report]

Britain's Medicine and Healthcare Products Regulatory Agency (MHRA) is concerned that oseltamivir (Tamiflu) may interact with the anticoagulant warfarin to increase the risk of uncontrolled bleeding and stroke, according to a report by the Daily Mail newspaper. The agency has advised health professionals to be alert for such cases. The story said the MHRA has received reports of 12 suspected adverse reactions to oseltamivir that involved interactions with warfarin. [Aug 19 Daily Mail report]

A 20-year-old Australian who has asthma survived a nearly fatal case of H1N1 flu after he was treated with an experimental intravenous form of zanamivir (Relenza), the Adelaide Advertiser reported today. The man's lungs had filled with mucus and his stomach had shut down, ruling out treatment with oral oseltamivir, the report said. So his doctors decided to try IV zanamivir, which had to be flown in from the United States. The drug is normally taken with an inhaler. [Aug 19 Adelaide Advertiser report]

Canada should have a "health czar" to lead a mass immunization campaign against the novel flu virus and streamline the deployment of equipment and staff needed to manage the epidemic, Dr Paul Hebert, editor-in-chief of the Canadian Medical Association Journal, and his team wrote in an editorial yesterday. They said governments need laws that give leaders the power to rapidly respond to complex pandemic issues. He called for a summit to plot out the next public health response actions. [Aug 17 CMAJ editorial]

Health authorities in the Netherlands said today they will administer novel flu vaccine starting in October to about 5 million to 6 million people who are at high risk for flu complications, Agence France-Presse reported. Priority groups include those with certain medical conditions, women with underlying conditions who are more than 4 months pregnant, and those older than 60. Officials said they aren't planning to vaccinate the whole population but have ordered vaccine for 16.5 million people. [Aug 18 AFP story]

The Chinese company Sinovac Biotech said a single dose of its novel H1N1 vaccine generated an immune response and appeared safe in its first clinical trial, Bloomberg News reported today. The firm asserted that the product met "international criteria for vaccines" and caused no severe side effects in 1,614 volunteers. The company said the results were the first reported for any H1N1 vaccine clinical trial. No details were released on the immune responses to different doses. [Aug 18 Bloomberg story]

Mozambique's health ministry today confirmed the country's first novel flu case, in a 46-year-old woman who had recently traveled to South Africa, AFP reported. She is recovering at home. Meanwhile, a disease expert in South Africa said poverty, diseases such as HIV, and overburdened health systems make African countries vulnerable to the novel flu virus, according to another AFP report today. Ed Rybicki, a virologist, said the virus could spread undetected because of poor disease surveillance. [Aug 18 AFP story]

A disproportionate number of patients hospitalized with novel H1N1 flu in the Boston area have been African American or Hispanic, the city's public health officials have found, according to the Boston Globe. They speculate that urban crowding, high levels of chronic health conditions, and other issues related to poverty are contributing factors. Of 71 flu patients hospitalized, 49% were African American and 28% were Hispanic, rates double the groups' shares of the city population. [Aug 18 Boston Globe story]

The Dutch pharmaceutical company Crucell announced today that it received a $40.7 million contract from the National Institute of Allergy and Infectious Diseases to continue developing monoclonal antibodies for the treatment of seasonal and pandemic flu. It contains an option for $28.4 million in additional funding. Crucell said the antibodies are active against seasonal H1N1 viruses, including antiviral-resistant strains, plus H5N1 and pandemic H1N1. [Aug 18 Crucell press release]

Oseltamivir (Tamiflu) resistance developed in two immunosuppressed patients in Seattle who were treated with the drug for novel H1N1 flu, the CDC reported recently. Both patients, a teenage boy and a woman in her 40s, were receiving immunosuppressive therapy for leukemia, and both had prolonged viral shedding. The cases were not epidemiologically linked. The CDC said clinicians caring for such patients should be aware of the potential for antiviral resistance and prolonged viral shedding. [Aug 14 MMWR Dispatch]

In launching its system to diagnose H1N1 flu and prescribe oseltamivir by phone, the British government rejected an advisory committee's advice that the practice might engender growing resistance to the drug, according to the Guardian newspaper. A member of the committee said officials judged that the public would not tolerate being told that the national stockpile could not be used, the story said. The advisory panel said the drug should be reserved for people in high-risk group. [Aug 16 Guardian report]

England's Health Protection Agency has sent a letter to neurologists asking them to be alert for any increase in Guillain-Barre syndrome (GBS) cases after the public starts receiving the novel H1N1 vaccine, the London Daily Mail reported on Aug 15. The letter, obtained by the newspaper, warns of GBS cases that occurred in the wake of the 1976 US swine flu vaccine campaign. Britain's neurologist association told its members in July that it would launch a 9-month GBS survey on Aug 1. [Aug 15 Daily Mail story]

The Democratic Republic of Congo reported its first novel flu case, in a South African mining official employed by a US firm in Katanga province, Agence France-Presse (AFP) reported today. The man, who is recovering, had recently returned from a vacation in South Africa, and so far none of his family contacts have had flu-like symptoms. [Aug 17 AFP story]

China's state media said yesterday that the country's education and health ministries have ordered strong measures to curb the spread of the novel flu virus when schools reopen, AFP reported yesterday. Schools in flu-stricken areas can postpone the start of the school year and have been advised not to hold large gatherings and to reduce class sizes. Students are being asked to stay home for 7 days if they have close contact with a sick person and, if they are sick, to stay home until recovered. [Aug 16 AFP story]

About 300 people staged a protest at Cairo's airport yesterday to oppose an Egyptian government restriction that bars them from traveling to Mecca on pilgrimage, the Associated Press reported. Airport security dispersed the crowd. The travel ban is intended to slow the spread of the pandemic H1N1 virus. The new restriction took effect yesterday. Only travelers between ages 25 and 65, a group thought to be at lower risk for flu, are allowed to make the trip to Mecca. [Aug 16 AP story]

Two school districts in Quebec will keep pregnant teachers at home this fall to reduce their risk of severe complications if they get sick with pandemic H1N1 flu, the Canadian Press reported on Aug 15. An official from the Toronto district school board said keeping pregnant teachers home is an idea worthy of consideration, but quantifying the risks is difficult. Pregnant women are listed as a priority group for novel flu vaccines by the United States and the United Kingdom. [Aug 15 Canadian Press story]

The number of novel H1N1 deaths in the United States has risen to 477, up from 436 last week, the US Centers for Disease Control and Prevention said today in its weekly update. Hospitalizations rose to 7,511, up from 6,506. Dan Jernigan, MD, MPH, with the CDC's Influenza Division, said during a teleconference today that flu continues to decline, with widespread activity reported in four states. Officials are looking into reports of increased flu activity in Florida and North Carolina. [Aug 14 CDC novel flu situation update]

Health officials in Hong Kong today announced the detection of a second case of novel flu resistant to oseltamivir (Tamiflu). They found the virus in a 40-year-old woman who is a resident of a home for disabled people. She was prescribed the drug prophylactically after other residents of the home became ill. She developed flu-like symptoms about a week later. The Tamiflu-resistant strain wasn't found in any other of the 20 novel flu cases at the home. [Aug 14 Hong Kong Centre for Health Protection news release]

Researchers from Hong Kong have found that two osteoporosis drugs, pamidronate and zoledronate, might have potential as treatment for influenza, including the novel H1N1 and the H5N1 viruses, Reuters reported today. They found that the two drugs triggered yd-T cells that killed flu-infected human cells. The next steps are to test the drugs in animals and conduct clinical trials in humans. The findings were released by the University of Hong Kong, Xinhua reported today. [Aug 14 Reuters story]

The Massachusetts Public Health Council on Aug 12 voted to enable such healthcare professionals as dentists, pharmacists, and paramedics to administer the novel flu vaccine in this fall's vaccination campaigns, the Boston Globe reported yesterday. The move would open the possibility of volunteering to about 12,000 additional workers. The regulators also directed hospitals and clinics to provide vaccine to all their workers, although the workers will not be forced to receive the vaccine. [Aug 13 Boston Globe story]

Government officials in the United Kingdom released details of the country's pandemic H1N1 vaccination priority plan today, which places pregnant women, healthcare workers, and people aged 6 months to 65 years with underlying chronic medical conditions first in line to get the vaccine, reported the Guardian, a British newspaper. The plan also prioritizes people who live in households that include individuals with certain underlying conditions, such as cancer or immune system compromise. [Aug 14 Guardian story]

Canada's health minister Leona Aglukkaq yesterday urged businesses to prepare for another novel flu surge, Agence France-Presse (AFP) reported. She said small- and medium-size firms lag behind larger corporations that have more resource for continuity planning. To help smaller companies prepare, the country's public health agency has contracted with two groups to develop tools to assist with such tasks as flu-related communications and staffing issues. [Aug 12 AFP story]

The European Union (EU) today issued two pandemic H1N1 policy statements, one on school closures and one on travel. The EU's health security committee said it doesn't see a need for mass preemptive school closures, but said that local closures when large numbers of staff and students are infected may help delay virus transmission. The travel advisory urges sick people to stay home but does not support restriction of individual travelers or movement of people across borders. [Aug 13 EU school closure and travel statements]

In an update on the novel flu pandemic yesterday, the World Health Organization (WHO) said the virus has now been confirmed in 170 countries and territories. Newly confirming first cases are Timor-Leste, Pakistan, Kirabati, Maldives, French Guiana, Falkland Islands, and Wallis and Futuna. Global deaths, as of Aug 6, rose to 1,462. Flu activity is waning in many southern hemisphere countries and is picking up in tropical regions. [Aug 12 WHO situation update 61]

India's broadcast ministry has asked media organizations to avoid creating panic over the pandemic H1N1 virus that is quickly spreading in the country, Indo Asian News Service (IANS) reported today. The ministry, however, said it supports efforts to raise flu awareness. In other developments, Delhi province officials have ordered private hospitals with 200 or more beds to help diagnose and treat flu patients as a means of reducing burden on government facilities. [Aug 13 IANS story]

The WHO said yesterday that China and Singapore have found osteltamivir (Tamiflu)-resistant novel H1N1 viruses, according to a report from the Canadian Press. The story also said the WHO has informal information on a small, unspecified number of other oseltamivir-resistant viruses. The WHO has received formal notification of seven oseltamivir-resistant cases from Japan, Canada, Denmark, Hong Kong, and now Singapore. China has yet to file a formal report on its case. [Aug 12 Canadian Press report]

Seven members of the native Amazonian Matsigenka tribe tested positive for pandemic H1N1 and have recovered, Peruvian health officials said yesterday, according to Reuters. But because the tribe lives near a reserve set aside for tribes that have limited contact with modern society, human rights groups fear the virus could spread to the more isolated native people who lack immunity to the disease. [Aug 12 Reuters story]

Government officials in India's Maharashtra state have ordered all schools and colleges in Bombay to close for a week to slow the spread of novel flu, Agence France-Presse (AFP) reported today. The state has the country's highest number of confirmed pandemic H1N1 cases and has reported four deaths over the past 10 days. India's cable news channels are reportedly devoting hours to novel flu coverage, but the health minister told reporters this week other diseases are more serious and costly. [Aug 12 AFP story]

Costa Rica's president, Oscar Arias, said in a statement yesterday that he was sick with the pandemic H1N1 flu, AFP reported today. He is the first world leader known to have been sickened by the virus. His brother said the 67-year-old president has asthma and had flulike symptoms for days. Tests yesterday confirmed that he had the novel flu virus. Arias is in home isolation but has not delegated power. [Aug 12 AFP story]

France's education minister said officials have prepared lessons that can be broadcast on state television and radio if novel flu outbreaks spark flu closures after classes resume this fall, the Associated Press (AP) reported today. Schools in France resume in late August and September. The minister said the country's national distance learning agency developed the lessons. He said school-closure decisions will be made on a case-by-case basis. [Aug 12 AP story]

Health officials are being prudent to plan for a more severe second pandemic wave, but a historical review of previous pandemics offers confusing clues about patterns with no evidence that virus mutations led to increased transmissibility, two federal researchers wrote today in a commentary appearing in the Journal of the American Medical Association (JAMA). The authors are Dr David Morens and Dr Jeffrey Taubenberger from the National Institute of Allergy and Infectious Diseases. [Aug 12 JAMA commentary extract]