ITALY H1N1 UPDATE: 1800 CONFIRMED CASES, NO DEATHS

UNCLAS SECTION 01 OF 02 ROME 001004 SENSITIVE SIPDIS EUR/WE FOR HARTMANN EUR/PGI FOR OSTFIELD AND PARKER-BURNS OES/IHB FOR BOGGESS STATE PASS TO AID/GH/HIDN USDA PASS TO APHIS HHS PASS TO CDC HHS FOR OGHA E.O. 12958: N/A TAGS: TBIO KFLU ECON PREL SOCI CASC EAGR IT SUBJECT: ITALY H1N1 UPDATE: 1800 CONFIRMED CASES, NO DEATHS ROME 00001004 001.2 OF 002 ¶1. (SBU) SUMMARY: The number of confirmed A(H1N1) infections in Italy reached the total of 1800 as of August 26. So far, only a few hospital admissions and no deaths are reported. However, a 24-year-old man is currently in an intensive care unit; his case strengthened calls for a nation-wide delay in the return to school, but the GOI has said school closures will be considered on a school-by-school basis. Budget constraints may be limiting the GOI's purchases of antiviral medication. The GOI is planning to vaccinate 40 percent of the population. END SUMMARY. ¶2. (U) According to an August 26 Labor, Social Policies and Health Ministry press release, the total number of confirmed A(H1N1) infections in Italy is now 1800, with no deaths reported. On August 30, the press reported the first severe case in Italy: a 24-year-old man, without a history of international travel, was admitted to an intensive care unit suffering from pulmonary distress. His clinical condition is still severe but doctors have stated that "he is improving." A Labor/Health Ministry graph dated August 11 shows that 50 percent of cases have been among the 10-to-19-year-old population. According to the Ministry, "a very limited" number of confirmed infections in Italy have resulted from domestic transmission; the majority were caused by international travel (mainly in the U.K., U.S. and Spain). ¶3. (U) According to press reports, the Italian Pediatricians' Federation has called for the opening of schools to be postponed, but Education, Universities and Research Minister Gelmini has stated that schools will open as planned. Italian health authorities also have stated that this would be an overreaction at this time; they will examine the possibility of school closings case-by-case over the course of the fall. Health authorities have stressed instead the importance of an effective medical surveillance network, to identify and treat cases as soon as possible. ¶4. (U) On July 22, the Labor/Health Ministry distributed a circular letter to health care providers providing new instructions on antiviral therapy, following World Health Organization (WHO) guidelines. The Ministry called for "a rational use of antivirals", in order to save drugs for an "unexpected outbreak of a more severe pandemic." According to the circular, antivirals should be administered only when the clinical presentation is severe or progressive, or to "the at-risk" population (e.g. infants and children under five years of age, the elderly (over 65 years of age),pregnant women, patients with chronic co-morbid conditions such as cardiovascular, respiratory or liver disease, diabetes, and those with immunosuppression related to malignancy, HIV infection or other diseases). ¶5. (U) On July 24, the Labor/Health Ministry distributed a circular letter providing new instructions for prevention and surveillance of A(H1N1) cases. Due to the rapid increase of cases, the lab virus confirmation for suspected cases is no longer compulsory, the circular states. Instead, it should be reserved for severe hospitalized cases and in case of domestic transmission (e.g. with no history of international travel or of contact with confirmed cases). Currently the diagnosis is just based on clinical symptoms, not on lab tests. ¶6. (SBU) NOTE: During a conversation with a representative from the pharmaceutical company which produces Tamiflu, the U.S. Consulate in Milan was told that the Italian Labor/Health Ministry did not buy enough drug stocks, due to budget constraints. According to this source, Italy does not have enough Tamiflu (Oseltamivir) to even cover 20 percent of the population. Post does not have information about the amount of Relenza (Zanamivir),the other antiviral drug recommended for use in treating severe A(H1N1),that the Italian Government may have purchased. (While cases of resistance to Tamiflu have been documented in other countries, no cases of resistance to Relenza have yet been reported.) According to the GOI's 2005 pandemic influenza plan, the national government is responsible for buying antivirals for 10 percent of the population, and the regional health authorities are responsible for buying antivirals to cover another 10 percent of the population. Purchases may increase to cover a total of 30 percent of the population if that proves necessary. END NOTE. ROME 00001004 002.2 OF 002 ¶7. (U) Italian health authorities plan to vaccinate 40 percent of the population against A(H1N1) flu this year, according to a press statement released on August 26. The vaccinations will take place in two tranches. The first, "likely" to begin in mid-November, will include 8.5 million doses and will be aimed at at-risk groups and medical and other critical service providers (e.g. police and telecommunications workers). The second, to include 16 million doses, will begin "during the first months of 2010" and will be aimed at children and young adults 2-27 years of age. The vaccine will be voluntary and not be available in pharmacies, but will be distributed free of charge by family doctors and in public health institutions. NOTE: In 2005 the GOI purchased from drug companies, for about 5.5 million euros, pre-emption rights to obtain at least 35 million doses of anti-pandemic-influenza vaccine. Under the provisions of the contracts, which were signed after the outbreak of the H5N1 (Avian) flu in 2005, the vaccines will be available within three months following the WHO declaration of a pandemic. The pre-emption rights are good for five years, and thus will expire in about September 2010. END NOTE. THORNE