MBayFluWatchMonterey Bay's Pandemic Flu Watch...keeping Monterey Bay communities informed about influenza |
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MBayFluWatchMonterey Bay's Pandemic Flu Watch...keeping Monterey Bay communities informed about influenza |
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The U.S. Food and Drug Administration (FDA) has approved the use of the CSL Limited's (an Australian pharmaceutical company) influenza A(H1N1) and seasonal flu vaccines in children aged six months and older. Previously the vaccine was approved for use only in adults. The approval came after a study involving children demonstrated that CSL Limited's seasonal flu vaccine was safe and efficacious by inducing antibody production against influenza virus. FDA's announcement includes a comment by Commissioner Margaret A. Hamburg stating: "Because children are among those most vulnerable to the 2009 H1N1 virus, having a broader range of children's vaccines available is an important step in responding to the H1N1 outbreak."
According to the FDA, the most common adverse events that affect children having received seasonal and influenza A(H1N1) vaccines are pain, redness, and swelling at the injection site. Rarer side effects are irritability, loss of appetite, and drowsiness. Because CSL's vaccines contain a small amount of egg protein, anyone allergic to eggs or egg products should avoid them. The vaccines will be packaged in pre-filled syringes, each of which contains a single, preservative-free dose. The vaccines will also be available in multi-dose vials that contain thimerosal, which is a mercury derivative preservative. More information about the FDA's approved influenza A(H1N1) vaccines is available at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm181950.htm.
Don Reisinger, the author of a technology column for Cnet, reports that Google has added a new tool to its Maps section that Internet users can use to search for influenza vaccine provider by Zip code or town name. However, Google has not yet received information from 30 states on sites that provide injectable influenza vaccine. Also, depending on the area, Internet users may find clinics listed that actually have run out of influenza vaccine. Google created its flu shot page in collaboration with the CDC, state and local health agencies, U.S. Department for Health and Human Services, Flu.gov, American Lung Association, and Walgreens and CVS pharmacy companies. The tool can be found at: http://www.google.com/flushot.
Health Day News reports that CDC has confirmed the first case in the U.S. of a Tamiflu-resistant A(H1N1) influenza virus passing between two people at a summer camp in North Carolina that had 600 participants. Even though all campers and staff members received Tamiflu to prevent influenza A(H1N1), 65 of them became infected with the virus and thereupon received Tamiflu treatment. Health officials later discovered a mutated version of the virus in two female campers who were sharing a cabin. Since health officials did not discover the mutated influenza A(H1N1) virus in the other 63 sick campers, they believe that it is resistant to Tamiflu.
The article quotes Dr. Natalie Janine Dailey, an epidemic intelligence service officer with the North Carolina Division of Public Health Communicable Disease Branch, as stating: "It is likely that this resistant virus was passed from one camper to the other based on the timing between the illnesses and 2 genetic mutations found in the virus in both campers. This suggests that using oseltamivir to prevent influenza in healthy people may increase the risk of resistance." Therefore, Dailey believes that the influenza A(H1N1) vaccine, instead of antivirals, is a more efficient way of protecting people against the virus, although treatment with antivirals should begin immediately in hospitalized influenza A(H1N1) patients and high risk target populations such as pregnant women, children under the age of two, and people with underlying health conditions.
So far, almost all strains of influenza A(H1N1) virus have responded to both oseltamivir (Tamiflu) and another antiviral called zanamivir (Relenza), while displaying resistance to amantadine, a drug in a different class. As a result, health workers tend to use Tamiflu and Relenza for both the prevention and treatment of influenza A(H1N1).
Steve Sternberg, a writer for USA Today, reports that hospitals throughout America are struggling with the increasing number of influenza A(H1N1) patients who are flooding emergency rooms. Even though only a relatively small number of influenza A(H1N1) patients require intensive care, the few patients who are so ill as to require round-the-clock care for weeks has led to some hospitals cancelling services such as elective surgery.
The article quotes the President's Council of Advisors on Science and Technology as having predicted that if 30 percent of the U.S. population contracts influenza A(H1N1), over 90 million could suffer illness; of these, 1.8 million would be hospitalized and 30,000 or more would die. The Trust for America's Health, a non-profit public-health advocacy group, reported in early October that if the infection rate reaches 35 percent, many states may run out of hospital beds, forcing hospitals to cancel elective procedures. According to Eric Toner of the University of Pittsburgh Center for Biosecurity, at most American hospitals, however, influenza A(H1N1) has had "very little impact on patient care - except in ICUs."
Courtney Hutchison, a writer for ABC News, after having analyzed influenza-related web sites state-by-state reports that some states are doing a better job than others in informing their inhabitants about vaccine availability. She found, for instance, that New Jersey, Wisconsin and Kansas, are providing their inhabitants with vaccine locating tools, lists of local doctors who are willing to provide the vaccine, and phone numbers for hotlines devoted to helping the public locate a influenza A(H1N1) vaccine clinic or a nearby doctor. Conversely, web sites in Alabama and Mississippi relate little information about influenza A(H1N1) vaccine availability, stating only that people should "contact their health provider" or that information is "coming soon." According to Hutchison, it is up to state and local health departments to inform the public when vaccine will be arriving to their area and where those eligible can obtain it. It is essential that states have means of communicating with the public so that when vaccine supply increases in availability more than it currently is, residents will know how and where to obtain it.
Information about influenza A(H1N1) vaccine availability in Monterey County is located at http://www.co.monterey.ca.us/health/HealthOfficer/IZ/fluSeason.asp
In an article, Washington Post reporters Michal D. Shear and Rob Stein discuss reasons for the shortage of influenza A(H1N1) vaccine. In July, Obama administration officials asserted that vaccine manufacturers would produce 80 - 120 million doses by mid-October, but as of October 27 only about 16.5 million doses have become available. The vaccine shortage has caused practical and political problems. On the practical side, local governments have been forced to shift vaccination campaigns and limit access to the vaccine to priority groups. The resulting confusion and frustration at vaccination have led to government officials to pressure vaccine manufacturer executives to explain why their optimistic forecasts about vaccine's availability ended up so far off the mark.
The article quotes Health and Human Services Secretary Kathleen Sebelius as stating that her department has been "relying on the manufacturers to give us their numbers, and as soon as we got numbers we put them out to the public. It does appear now that those numbers were overly rosy." Her deputy Nicole Lurie added that vaccine manufacturers "hit some stumbling blocks, they sometimes thought the fix was around the corner and didn't always feel the need to tell us, and then sometimes it turned out the fix wasn't around the corner." She also refused to make any projections about whether 50 million vaccine doses would become available by November and 150 million by December, as leading health officials have previously promised. Vaccine makers' representatives claim that they have been keeping the government informed about production challenges, including a slower-than-expected growth of vaccine virus in chicken eggs.
The article also quotes David P. Fidler, a professor of health law at Indiana University, as stating that: "Are we going to see this sort of nationwide impact that's also going to be seared in the nation's mind in the way Katrina was? One of the possibilities is that the administration and state governments will lose their credibility, because the response strategies and the promises made about the vaccine, at least in the public's eye, the promises will look again like empty promises."
The American Medical Association (AMA) has launched the nation's first comprehensive web-based patient flu health-assessment program, located at www.amafluhelp.org. This program helps patients and physicians better communicate and improve care coordination. It walks patients through a series of questions to help them determine the severity of their influenza symptoms based upon the latest CDC guidelines. Patients can choose to share their information with their physician, as well as family members. It also provides a set of online tools to help physicians monitor their patients' symptoms, facilitate care and treatment decisions, and efficiently manage their practices' patient flow. Furthermore, the program contains a special section for pregnant women to evaluate their need for an influenza vaccination and for all patients to monitor any post-vaccine related symptoms.
Personal information entered into the program is private, secured through Microsoft HealthVault and it is inaccessible without consent from the user. The AMA has collaborated with a broad-based coalition established under the Flu Information & Care System (FiCS) to promote the new portal, including AllOne Health, BlueCross NEPA, CVS Caremark, EMSC, HealthyCircles, HERAE, Merck, MedImpact, Microsoft, Minute Clinic, Schumacher Group, Staywell/Krames, Team Health, and WorldDoc.
Jacques Von Lunen, a writer for Oregon Live, reports that Oregon has registered its first case of human-animal transmission of the influenza A(H1N1) virus when a pet ferret, whose owner had presented flu-like symptoms, tested positive for influenza A(H1N1). According to the state's public health veterinarian Emilio DeBess, ferrets have been used in labs as an animal model to study how the flu virus affects people, but this may be the first case anywhere of a ferret becoming infected with its owner's flu. DeBess advises pet owners to avoid coughing and sneezing near other people and pets and to wash their hands often. The article also claims that so far no influenza A(H1N1) cases have been recorded in birds, cats, or dogs.
Christopher Doering and Charles Abbott, writers for Reuters, report that a hog has tested positive for the pandemic influenza A(H1N1) virus for the first time. The hog was exhibited at the Minnesota State Fair where four teenagers also became sick with the same virus. The article quotes a U.S. Department of Agriculture's (USDA) announcement "information available at this time would suggest the children were not sickened by contact with the pigs at the fair."
Influenza A(H1N1) is common world-wide in hogs. Until now, the closest to the U.S. where this virus has been detected in hogs was Canada. Since show pigs do not usually come into contact with pigs raised for slaughter in pig factories, spread of A(H1N1) influenza to the pig industry in not necessarily imminent. USDA officials once again emphasized that people cannot become infected with influenza A(H1N1) virus by eating pork products. Despite this fact, however, seven countries, including China, have banned U.S. pork imports.
Sheri Fink, a writer for Sun Sentinel, reports that Florida health officials are drawing up guidelines that include recommendations for barring patients with incurable cancer, end-stage multiple sclerosis, and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases. The guidelines, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, calls for doctors to remove patients with poor prognoses from ventilators and use the released ventilators to treat those who have better chances of surviving. The Florida guidelines also call for intensive care unit patients and those using ventilators to be reassessed after 48 to 72 hours. Those whose chances of survival have significantly worsened would be taken off the machines or discharged from critical care to make way for others who may have a better chance of survival. Patients with significantly worsened survival chances would be given palliative care as needed to keep them comfortable. In case of a significantly worsening situation, Florida's draft guidelines call for hospitals to turn away anyone whose doctor has signed a "Do Not Resuscitate" order, which instructs rescuers not to revive a patient whose heartbeat or breathing stops.
The article quotes professor Ken Goodman, Director of the University of Miami bioethics program and the Florida Bioethics Network, stating that Florida's guidelines need to be balanced with an effort to distribute scarce resources in the least discriminatory way and that methods included in the draft are still imperfect: "Among the ways we can do that is to somehow take the evidence about what we think works and bolt it to the values that I think are uncontroversially shared: Namely, life is good, suffering is bad. It's a very difficult problem to figure out how the world of science can help ensure that our strategies for allocating resources are fair and effective."
As the situation now stands, Florida health officials believe that the number of severely ill flu patients will likely remain at a manageable level provided that its residents become vaccinated, they know when to stay home and when to seek medical care, and the currently circulating flu strain does not mutate into a more virulent form.
Bloomberg reports that Walgreen Co. and CVS Caremark Corp will stop providing seasonal flu vaccines at many of their locations and instead will concentrate on influenza A(H1N1) immunizations. According to Bloomberg, some of Walgreen's clinics have already run out of seasonal influenza vaccine and the company has decided not to restock its seasonal flu vaccine once out of stock. The article states that CVS will halt its seasonal flu clinics on October 22nd. CVS will, however, depending on vaccine availability, continue to offer seasonal flu vaccine at its 500 pharmacies throughout the ongoing flu season. The article also highlights the heightened public awareness of seasonal influenza and the fact that drug manufacturers have to produce influenza A(H1N1) and seasonal influenza vaccine simultaneously as main reasons why manufacturers are falling behind in delivering both vaccines.
The U.S. Department of Health and Human Services' U.S. Food and Drug Administration (FDA) has warned consumers to be careful when purchasing products over the Internet with claims that they can be used to diagnose, prevent, treat, or cure A(H1N1) influenza. FDA issued this warning because it has recently purchased and analyzed several products represented online as Tamiflu (oseltamivir), but which are not and in fact may pose risks to patients. Among the counterfeit products that the FDA analyzed were Indian-made unlabeled tablets containing talc and acetaminophen, but none of which contained Tamiflu's active ingredient oseltamivir. Furthermore, even if these counterfeit products were to contain oseltamivir, their manufacturers would not have FDA approval to be used in the U.S.
FDA has approved Tamiflu (oseltamivir phosphate) and Relenza (zanamivir) for treatment and prophylaxis of A(H1N1) influenza virus when manufactured by ethical pharmaceutical companies. These products have Emergency Use Authorizations that describe specific authorized uses during this public health emergency. More recommendations about how to protect purchasers of medicines online is available at http://www.fda.gov/Drugs/ResourcesForYou/ucm080588.htm
Commissioner of Food and Drugs Margaret A. Hamburg warns that: "Medicines purchased from Web sites operating outside the law put consumers at increased risk due to a higher potential that the products will be counterfeit, impure, contaminated, or have too little or too much of the active ingredient." The FDA urges consumers to only purchase FDA-approved products from licensed pharmacies located in the United States and to contact their health care provider if they have any questions about medical products.
Robert Roos, a writer for CIDRAP, reports on top U.S. health officials' concerns that a significant portion of their current work consists of refuting rumors and myths about the influenza A(H1N1) vaccine. The article quotes Tennessee Health Commissioner Susan Cooper as explaining that: "We've been spending an inordinate amount of time lately saying the vaccine is made just like seasonal flu vaccine. There's this misperception that keeps getting heightened in the media that this vaccine was rushed to market, that corners were cut, that there's some special way this was made that's different from seasonal flu [vaccine], but then you get a talking head saying, 'Well, they're lying to you.' That then complicates the messaging."
Also noted by Roos is that according to recent polls, about 50 percent of parents will allow their children to become vaccinated against influenza A(H1N1) virus and 61 percent of respondents said they would definitely or probably agree to be vaccinated against influenza A(H1N1) if vaccine becomes available to them.
Maggie Fox, a Health and Science editor for Reuters, reports on the largest study yet conducted on influenza A(H1N1) cases in the U.S. The CDC-led study examined detailed data on 1,400 adults and 500 children hospitalized with influenza A(H1N1) in 10 states. Six percent of the observed population groups were pregnant. One of its important findings was that 55 percent of Americans who have died from influenza A(H1N1) had underlying conditions such as asthma, chronic lung disease, chronic heart disease and immunosuppression, or neurological or neuromuscular diseases. The study also found that similarly to seasonal flu, children with sickle cell anemia and other blood diseases are particularly threatened by influenza A(H1N1).
Medical News reported on a National Psoriasis Foundation recommendation urging psoriasis and/or psoriatic arthritis patients who are taking biologic (Amevive, Enbrel, Humira, Remicade, Simponi or Stelara) or non-biologic immunosuppressive medications (cyclosporine-Neoral or methotrexate) to receive both seasonal and influenza A(H1N1) vaccines as soon as possible. According to Medical News, psoriasis patients taking immunosuppressive medication should take care to receive only the inactive version of both seasonal and influenza A(H1N1) vaccines, both of which are available in inactivated and live forms.
The article quotes Mark Lebwohl, Professor and Chairman of Dermatology at the Mount Sinai School of Medicine and Chair of the National Psoriasis Foundation Medical Board: "For most people, flu is an annoying aspect of winter. For people with psoriasis and psoriatic arthritis who are taking immunosuppressive drugs, it can be a much more serious health threat. With the addition of influenza A(H1N1) as a concern this year, we urge everyone on these drugs to take extra precaution." National Psoriasis Foundation also recommends psoriasis patients to discuss the risk and benefits of vaccination with their doctor and follow the immunization information for the general population available on the CDC web site.
Mike Stobbe, a Medical Writer for Associated Press, reports on an announcement made by Andrew Pekosz, a flu expert at Johns Hopkins University, claiming that even though the current monitoring system for influenza A(H1N1) is adequate, public health analysts do not have enough information about the spread of the virus after U.S. and other governments stopped counting confirmed influenza A(H1N1) cases. According to Pekosz, the current monitoring system provides too little information about how influenza A(H1N1) affects different population groups. For instance, it is unclear to what extent children, young adults, pregnant women, and other risk groups are likely to become infected with influenza A(H1N1) virus in comparison to other groups.
Currently, methods for recording influenza A(H1N1) cases vary from state to state. For example, some states report only laboratory-confirmed cases to the Centers for Disease Control and Prevention (CDC), whereas others report illnesses that could be influenza A(H1N1), seasonal flu or other respiratory diseases. The CDC itself utilizes nine methods for monitoring influenza. Some methods focus on people who die from flu-like illness, one tracks deaths in children, another records pneumonia and flu deaths of all ages in 122 cities.
The article highlights state budget shortfalls as one of the reasons that explains why monitoring influenza A(H1N1) cases is less than comprehensive. For example, in 2008 state officials cut 7,000 health department jobs and additional 8,000 during January-June 2009.
Difficulties regarding recording influenza A(H1N1) cases are not unique to the U.S. WHO also stopped recording influenza A(H1N1) cases in July, after deciding that tracking individual influenza A(H1N1) cases was too labor-intensive for countries where the virus was spreading widely. WHO has continued to update influenza A(H1N1) reports, but with the disclaimer that since countries are no longer required to report cases, WHO's statistics about influenza A(H1N1) infection rates are underestimates. Great Britain also releases weekly influenza A(H1N1) updates, but these reports include estimates based on how many people visit their doctors with flu-like illness that may be unconnected to A(H1N1).
Maggie Fox, a health and science editor for Reuters, reports on a study confirming that the younger population has a greater risk of becoming infected with influenza A(H1N1) and that younger people are also more likely to experience symptoms peculiar to that age group. The study investigated 272 hospitalized influenza A(H1N1) patients, of whom 45 percent were younger than 18 years. (The majority of seasonal flu victims are middle-aged or older.) 40 percent of examined patients experienced diarrhea and vomiting, which seasonal flu victims rarely exhibit.
Anemona Hartocollis and Donald G. McNeil Jr., writers for New York Times, report that New York, Boston, Philadelphia, and other areas that experienced large influenza A(H1N1) outbreaks during spring 2009 currently are registering fewer than usual seasonal flu cases for this time of year. New York health officials believe that people who became infected with influenza A(H1N1) in spring have since then developed immunity, and this prevents the virus from spreading. Although it is too early to be sure, as regular flu season usually peaks in January, New York health officials claim that the high level of immunity may lead to a smaller influenza A(H1N1) infection rate than expected during the current flu season. Nevertheless, the city is conducting an extensive influenza A(H1N1) immunization campaign.
Dr. Martin S. Cetron, a flu expert at the CDC and the co-author of a 2007 study describing how the 1918 flu affected 43 American cities, states in the article that it is too early to conclude whether areas that experience high influenza A(H1N1) infection rates in spring will experience low infection rates this winter. Cetron is quoted as stating that "To say, Oh, all of us in New York are immune, we won't have any more disease and we don't need to take vaccine, is a dangerous conclusion to draw."
Microsoft announced that it has established the H1N1 (Swine flu) Response Center, which is an online service that aims to help people learn whether they have the symptoms of H1N1 flu (swine flu) and, if they do, gives guidance about next steps. The service is based on self-assessment questions and guidance that were developed by Emory University experts. By effectively "triaging" potential flu cases online, patients, health care providers, and the public can help limit their exposure to the flu virus as well as wait times for health care services.
If a person decides to see a health provider after taking the assessment, a prepare-for-visit tool allows for compilation of an organized health history for providers. This history combines answers from the self-assessment with health information stored in the user's Microsoft HealthVault account (a personal health application platform designed to put consumers in control of their health information). HealthVault enables individuals to act on their assessment through partners such as TelaDoc, which offers telephone consultations, and American Well, which connects individuals to their health plan physicians for video, chat or telephone consultations.
Microsoft launched the H1N1 Response Center (http://www.h1n1responsecenter.com), in response to concerns that hospitals and physicians' offices may experience an overload of patients seeking determine whether they are infected with influenza A(H1N1). The announcement quotes Angela Gardner, president of the American College of Emergency Physicians as saying that: "If current estimates are correct, many emergency departments across the nation could be overwhelmed by two groups of patients — those who have H1N1 and those who believe they have H1N1. It is going to be essential that we use every tool and service at our disposal to contain this illness, and online H1N1 self-assessment tools, such as the one offered by Microsoft, can be helpful in providing people with ways to determine whether they should seek emergency care."
Harvard School of Public Health (HSPH) reports that according to its recent survey, only 40 percent of adults are "absolutely certain" they will agree to receive the A(H1N1) flu vaccine for themselves, and 51 percent of parents are "absolutely certain" that they will permit their children to receive the vaccine. The main reasons why people do not want to vaccinate themselves against the A(H1N1) include: (1) they are concerned about side effects of the vaccine; (2) they do not think they are at risk of contracting a serious case of the illness; (3) they think they could receive medication to treat A(H1N1) if they do become sick, and (4) they do not trust public health officials to provide correct information about the vaccine's safety. However, an additional finding was that if the A(H1N1) pandemic was to become severe, respondents would be likely to change their minds about being willing to receive the vaccine. In view of these findings, Robert J. Blendon, Professor of Health Policy and Political Analysis at HSPH, recommends that public health officials need to be prepared for a surge in demand for the A(H1N1) vaccine if the A(H1N1) flu was to become more severe than it is now.
David A. Lieb, a writer for Associated Press, reports that Sanofi Pasteur is running behind on its shipping schedule for the seasonal flu vaccine because the company is also simultaneously producing the A(H1N1) influenza vaccine. Sanofi Pasteur, the largest U.S. supplier of seasonal flu vaccine, has so far shipped more than half of the 50.5 million doses of seasonal flu vaccine to U.S. health care providers.
Therefore, some of the company's customers may not get all of their orders before November. As a result, some doctors have been forced to turn away patients who are requesting seasonal flu vaccinations and public health officials have had to cancel scheduled community vaccination clinics. The article quotes Tom Skinner, a spokesman for the Centers for Disease Control and Prevention (CDC), as urging people to be patient and stating that the delay will not cause a big concern because about 70 million of the nation's expected 114 million vaccine doses have already been delivered.
Skinner emphasizes that currently the A(H1N1) flu is the dominant virus, whereas the seasonal flu usually peaks in January or later. Therefore, people should not be concerned about having to receive their flu shot later than planned. Walgreen Co., which has about 16,000 certified immunization providers in more than 7,000 pharmacies nationwide, encourages people who want to get a seasonal flu shot to do it now, even though the company expects its vaccine supplies to run out towards the end of December.
Robert Roos, news editor for the Center for Infectious Research & Policy, reports that the first 600,000 doses of pandemic A(H1N1) vaccine should arrive to 25 states and major cities by October 6th. The article quotes Dr. Anne Schuchat of the CDC, as saying that the vaccine should become available later, in the week that starts on October 5th. According to Schuchat, the live-virus nasal-spray vaccine, which is made by MedImmune, will be the first to reach health providers. Like MedImmune's seasonal vaccine FluMist, the A(H1N1) vaccine is approved for healthy people aged 2 through 49 years, but not for pregnant women or people with chronic conditions that raise their risk for flu complications.
CNBC reports on a recent survey of U.S. businesses performed by the Business Roundtable whose main conclusion was that businesses' primary concern is whether A(H1N1) vaccine will be available to their employees. In addition, 35 percent of survey respondents said they need more information about the severity of A(H1N1) pandemic flu compared to seasonal flu. According to Business Roundtable President John Castellani "The findings are a reminder of how it is incumbent on the business community to work together with the government and other key parties to protect the health and well-being of our employees, fellow citizens, and communities in which we live and work."
Business Roundtable's member companies, which employ 10 million workers, represent one third of the U.S. economy. Currently, it is helping companies communicate A(H1N1) prevention advice to workers, using information from several government agencies, including the CDC, the Department of Health and Human Services, the Small Business Administration, the Department of Homeland Security, and the Occupational Safety and Health Administration.
Terence Chea, a writer for Associated Press, reports that many school districts in the U.S. have few or no nurses to prevent or respond to A(H1N1) outbreaks, leaving students more vulnerable to a virus that spreads easily in classrooms and infects mostly children and young adults. The article refers to a 2008 survey conducted by the National Association of School Nurses that found that only 45 percent of public schools have their own full-time nurse, another 30 percent have a part-time nurse, and a quarter have no nurses. In California, for instance, roughly half of the state's 1,000 school districts do not have any nurses. According to this survey, the average nurse-to-student ratio nationwide was one nurse for every 1,151 students, but in 14 states there was only one nurse for more than 2,000 students.
School districts that have no nurses are depending on teachers, principals, and secretaries with little medical training to identify, isolate, and send sick children home, as well as monitor absences and illnesses for signs of a wider outbreak. The article refers to statements by Brenda Green, director of school health programs for the National School Boards Association, who has urged school districts without nurses to partner with local health agencies, hospitals, and nursing schools to prepare for A(H1N1) flu.
School districts all over the country that have nurses are developing plans to screen and quarantine sick students, teaching students proper classroom hygiene, urging parents to keep ill children at home, organizing vaccination campaigns, and instructing teachers and school staff how to identify sick students.
Melissa Healy, a writer for Los Angeles Times, reports on a poll conducted by the University of Michigan's C.S. Mott Children's Hospital that found that only 40 percent of U.S. parents plan to get their children immunized against the A(H1N1) influenza virus. Among those who said they do not intend to have their children vaccinated, 46 percent indicated they are not worried about their children becoming ill with the A(H1N1) virus and 20 percent said they do not believe that A(H1N1) flu is a serious disease. About half of the parents who said they would vaccinate their children against the A(H1N1) flu expressed concern about possible side effects of the vaccine. The Centers for Disease Control and Prevention has said that though serious complications of seasonal flu appear to spare most children and strike the elderly and very young most heavily, the novel A(H1N1) flu appears to hit children and young adults the hardest.
Reuters reports on a survey conducted by Mansfield Communications Inc. has found that 69 percent of American workers have not had any direction from their employers about the upcoming flu season, including information related to hand washing or sick leave. The survey also found that 84 percent of workers believe the recession creates more pressure for employees to report to work while being sick. Even though 80 percent of the respondents believe they are knowledgeable about precautions that should be taken if the A(H1N1) virus reached their workplaces, about half of them said that they would still engage in public activities such as riding busses, picking up a prescription, and doing grocery shopping, even when they were infected with A(H1N1) and required to stay home from their office due to a company-imposed quarantine.
The article quotes Rob Ireland, a partner at Mansfield Communications Inc., as saying: "Many workers are understandably concerned about how absenteeism due to sickness will impact their job security in the current economic environment. However, sick employees coming into the office during the H1N1 flu season will undermine the health and productivity of the entire workplace. Clearly, there is much to be done to educate America's workforce and help people act appropriately in order to contain the spread of H1N1."
Maggie Fox, the Health and Science Editor for Reuters, reports that Dr. Marc Lipsitch of Harvard University claims the death rate from the pandemic A(H1N1) flu is likely lower than earlier estimates, stating that its mortality rate compares to a moderate year's rate of seasonal influenza. "Barring any changes in the virus, I think we can say we are in a category 1 pandemic. This has not become clear until fairly recently," said Lipsitich.
Normally, seasonal flu's mortality rate is less than 0.1 percent. According to Lipsitich's research, the range of mortality from A(H1N1) is between 0.007 and 0.045 percent. The seasonal flu, however, has a far greater affect on the elderly, who constitute 90 percent of the annual flu deaths. In contrast, A(H1N1) flu preferably attacks younger adults and older children, but their mortality rate is much lower than that of the elderly.
The U.S. Food and Drug Administration (FDA) announced that it has approved four vaccines against A(H1N1) influenza virus. "This vaccine will help protect individuals from serious illness and death from influenza," states Commissioner of Food and Drugs, Margaret A. Hamburg. The vaccines will be distributed nationally after the initial lots become available, which are expected within the next four weeks.
The vaccines induce a robust immune response in most healthy adults eight to 10 days after a single dose, which is about the same as the seasonal influenza vaccine. Ongoing clinical studies will provide additional information about the optimal dose in children. People with severe or life-threatening allergies to chicken eggs, or to any other substance in the vaccine, should not be vaccinated. Potential side effects of the A(H1N1) vaccines are expected to be similar to those of seasonal flu vaccines. For the injected vaccine, the most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation. For the nasal spray vaccine, the most common side effects are runny nose or nasal congestion for all ages, sore throats in adults, and - in children 2 to 6 years old - fever.
The vaccines are made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and Sanofi Pasteur Inc. All four firms manufacture the A(H1N1) vaccines using the same processes, which have a long record of producing safe seasonal influenza vaccines. Vaccines against three seasonal virus strains are already available to consumers and the U.S. government has recommended that Americans should get vaccinated as soon as possible. As far as is known, seasonal flu vaccine does not protect against the A(H1N1) virus.
The Department of Homeland Security (DHS) has published a preparedness guide to assist small businesses in planning for the A(H1N1) flu. "Small business owners should take the time to create a plan, talk with their employees and make sure they are prepared for flu season," Small Business Administration (SBA) Administrator Karen Mills stated in the announcement. The preparedness guide offers small business employers tools and information to help them plan for and respond flexibly to varying levels of severity of an A(H1N1) outbreak—which may lead to increased absenteeism, and, if the outbreak becomes more severe, may include restricted service capabilities and supply chain disruptions.
Additional preparations may be necessary if a more serious outbreak evolves during the fall and winter. Employers are encouraged to put strategies in place now to protect their employees and their businesses in advance of the fall flu season. Included in the preparedness guide are tips on how to write a continuity of operations plan, steps for keeping employees healthy, frequently asked questions about the 2009 A(H1N1) flu, and a list of additional resources that employers can access online. To view the preparedness guide, visit http://www.flu.gov/professional/business/smallbiz.html.
Marilynn Marchione, a medical writer for AP, reports that a new study conducted by the Centers for Disease Control and Prevention (CDC) suggests that the A(H1N1) virus can still spread up to a week after a patient's fever has disappeared. Previously, CDC has been recommending people to stay home from work and school and avoid contact with others until a day after their fever breaks. The agency's advice to stay home for one day after fever breaks does not apply to health care settings. There, confinement for seven days from the start of symptoms — or until they go away, whichever is longer — is still advised. The CDC recommends that persons who have had A(H1N1) flu should cover their mouths when they cough or sneeze and wash their hands frequently once they do return to work and school.
It is unclear whether the new research findings will lead to the CDC rethinking its advice on how long people with A(H1N1) should remain away from public settings when infected. Long breaks from school and work do not seem appropriate for a virus that now seems to cause a mostly mild illness. A(H1N1) flu is spreading so widely now that confining the sick does less good, the article quotes CDC's flu chief Nancy Cox saying. "We tried to have our guidance balance out all of these factors. It's just virtually impossible not to have virus introduced into settings such as schools and universities," she added.
AP quotes Health and Human Services Secretary Kathleen Sebelius as saying that America's first round of A(H1N1) flu shots could begin sooner than expected, with some vaccine available as early as the first week of October. She is confident that the vaccine will be available early enough to beat the peak of the expected flu season this fall. As she has stated before, early doses are intended for health care workers and other high-priority groups.
Sebelius said the vaccine doses will be distributed immediately to designated locations across the country once they are available. "Every state has a plan saying these are the sites to get the vaccine as quickly as possible into people's arms. That's where the distribution will go. So, the first week in October, we expect some of the vaccine to begin to roll, and by mid-October, to have the kind of supplies we were talking about. But we may have some available earlier. And we'll get it out to states as fast as it comes off the production lines," Sebelius explains.
CIDRAP News reports that the desire to complete seasonal flu immunizations before A(H1N1) vaccinations begin has led to a boost in demand for seasonal flu vaccine as vaccinations have begun in many areas. As a result, the demand for seasonal flu vaccine has exceeded the supply. The seasonal flu vaccine supply is, however, likely to improve as the flu season wears on.
The first doses of A(H1N1) vaccine are expected to become available in mid-October. To make way for the H1N1 vaccination campaign, public health officials have been urging people to get their seasonal flu shots early.
"Some [vaccination] providers book more than one product but are not intending to buy both, so some prebooks don't materialize into purchases. So providers should continue to use the supplies they have and then look for opportunities to order additional vaccine as the season goes on. I wish we could say more to people who want to buy vaccine and right now can't buy the vaccine they need," Dr. Jeanne Santoli from the Centers for Disease Control and Prevention (CDC) is quoted regarding the situation.
Santoli said the CDC hasn't heard of "any significant delays that are on the horizon" for seasonal vaccine production. She expects that the vaccine would be ready in August-September. As of her knowledge, no manufacturers are "significantly off" their production schedule.
National Institutes of Health News reports on an announcement made by the National Institute of Allergy and Infectious Diseases (NIAID), in which it reported that a first round of testing A(H1N1) influenza vaccine in pregnant women has begun. Women are considered to be at higher risk of developing severe illness if they become infected with either seasonal influenza virus or 2009 A(H1N1) while pregnant, NIAID Director Anthony S. Fauci said in the article.
Up to 120 women 18 to 39 years of age who are in their second or third trimester (14 to 34 weeks of pregnancy) will be enrolled in this initial trial. The trial is taking place at the following six medical centers: Baylor College of Medicine VTEU (Vaccine and Treatment Evaluation Unit) in Houston; Group Health Cooperative Center for Health Studies VTEU in Seattle; Saint Louis University VTEU; Vanderbilt University VTEU in Nashville; Duke University in Durham, N.C.; and Scott and White Memorial Hospital and Clinic in Temple, TX.
Researchers from the Centers for Disease Control and Prevention reported a month ago that six out of 45 people who died from A(H1N1) between mid-April and mid-June were pregnant women. According to an earlier study, the rate of hospitalization for A(H1N1) infection in pregnant women was approximately four times higher than it was in the general population.
Journal Watch reports that the Centers For Disease Control and Prevention (CDC) has issued guidance to reduce the spread and severity influenza among children in early childhood programs and their providers. The full document, based on an article published in Physician's First Watch, can be accessed at:
http://www.cdc.gov/h1n1flu/childcare/guidance.htm
Some of its recommendations include that children should be immunized against A(H1N1) influenza virus and that those with flu-like illness should stay home until they have been without fever for 24 hours. In addition, it encourages child care providers to check their staff members' and children's health daily. If influenza severity increases, the guidance recommends that children living with ill household members should be allowed to stay home.
On September 1, U.S. president Barack Obama gave an overview about America's economic situation and national preparedness for the upcoming flu season. The following are excerpts from his speech. Its entire text can be accessed at: http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-on-2009-H1N1-National-Preparedness-and-Response/
"Now, we just had a good meeting about our ongoing efforts to prepare this country for the H1N1 flu virus this fall. And I want to thank John Brennan, our CDC Director Tom Frieden, and Secretaries Sebelius, Napolitano, Duncan, and Locke, for all the good work that they've been doing to get us ready today.
"As I said when we saw the first cases of this virus back in the spring, I don't want anybody to be alarmed, but I do want everybody to be prepared. We know that we usually get a second, larger wave of these flu viruses in the fall, and so response plans have been put in place across all levels of government. Our plans and decisions are based on the best scientific information available, and as the situation changes, we will continue to update the public.
"We're also making steady progress on developing a safe and effective A(H1N1) flu vaccine, and we expect a flu shot program will begin soon. This program will be completely voluntary, but it will be strongly recommended.
"For all that we do in the federal government, however, every American has a role to play in responding to this virus. We need state and local governments on the front lines to make antiviral medications and vaccines available, and be ready to take whatever steps are necessary to support the health care system. We need hospitals and health care providers to continue preparing for an increased patient load, and to take steps to protect health care workers. We need families and businesses to ensure that they have plans in place if a family member, a child, or a co-worker contracts the flu and needs to stay home.
"And most importantly we need everyone to get informed about individual risk factors, and we need everyone to take the common-sense steps that we know can make a difference. Stay home if you're sick. Wash your hands frequently. Cover your sneezes with your sleeve, not your hands. And take all the necessary precautions to stay healthy. I know it sounds simple, but it's important and it works. Finally, for people who want to learn more about this virus, please go to www.flu.gov, or talk to your doctor."
Sarah Mahoney, a reporter for Marketing Daily new service, writes that in an effort to promote public health and win new customers, drugstore chains are raising their competitive activities. CVS says it will give $3 million worth of free flu shots to the unemployed, and rival Walgreens will hand out $1 million worth. CVS' 100,000 free shots will be offered onsite at One-Stop Career Center locations, and it will also hand out vouchers that can be used at CVS stores or many of its MinuteClinics. The company stated that seasonal flu shots will be available for all consumers at 500 of its MinuteClinic locations, beginning September 1, and starting September 15, at about 9,000 flu shot clinics in select stores. A spokesperson announced that each shot costs $30, and are covered by most insurance plans. Walgreens says it will offer flu vaccines at more than 7,000 stores, starting September 1, with 16,000 certified immunizers administering the vaccine, including pharmacists, nurse practitioners, and physicians assistants. Shots are offered on both a walk-in and by-appointment basis between 10 a.m. and 4 p.m., and cost $24.99. (Its Take Care Clinics are also offering the FluMist nasal spray alternatives, for $29.99.)
CVS says it decided to offer the free shots after its research found that only 34% of job seekers say they got a flu shot last year, compared with 49% of the overall population. "CVS Caremark wants to ensure cost and access are not barriers to getting a flu shot this year for one of the most vulnerable populations, the unemployed," the Woonsocket, R.I.-based company says in its release, adding that the large-scale immunization program is "part of our broader efforts to help prevent the spread of seasonal flu, which can lead to more serious and costly health problems."
Dorie Turner, a reporter for the Associated Press, writes that colleges across the country are seeing an increased number of students with suspected cases of swine flu as dorms fill up and classes begin for the fall semester. While the increases were expected and colleges say they were ready for the coughing, sneezing and feverish students before move-in day, health experts say hundreds more are likely to get sick as the virus spreads through college campuses. At Georgia Tech in Atlanta, classes are in full swing for the university's 20,000 students, and so is the highly contagious A(H1N1) virus. The university has had 150 suspected cases of the virus in the two weeks since students moved back to campus. At the University of Kansas, nearly 200 students have reported having flu-like symptoms in the last week or so. University of Tennessee administrators are estimating about 100 suspected swine flu cases on campus. The University of Alabama had more than 50 cases of flu reported on the first day of classes last week. At Texas Christian University, 10 students were diagnosed with swine flu on the first day of class Monday.
CDC spokesman Tom Skinner is quoted as stating: "The mere fact you have lots of people in close proximity with each other results in the virus being transmitted from person to person. I don't think we're surprised by the fact influenza is returning to these campuses. What is concerning to us is people becoming complacent about this and not taking the steps we know can protect them." The CDC recommends that students with flu symptoms — fever, cough, sneezing, chills, aches, sometimes diarrhea or vomiting — stay home from class.
Nedra Pickler, a reporter for the Associated Press, writes that a judge on 26 July denied the Coalition for Mercury-Free Drugs' bid to prevent the government from giving pregnant women flu vaccines with a preservative that contains mercury. A government advisory committee recently recommended that pregnant women be among the first people to get swine flu vaccinations when the vaccine becomes available this fall.
A small amount of the mercury-containing preservative thimerosal is present in most influenza vaccines, including swine flu vaccines, although some vaccines are packaged without thimerosal. The Coalition argued that pregnant women should receive only the thimerosal-free version because of a risk that the mercury in the shot could poison a fetus and cause medical problems, including autism. But U.S. District Judge Reggie Walton ruled against the group's request for a preliminary injunction because he said the group could not prove that the pregnant women they represent would get vaccines containing thimerosal. Walton said he would consider further written arguments in the next month about whether the lawsuit can continue.
Thimerosal used to be added to many vaccines, but manufacturers began removing the preservative from all routine child vaccines in 2001 as a precaution. However, numerous large studies have shown no link between thimerosal and autism, or other health problems.
Katherine McIntire Peters, a reporter for the government news service GovernmentExecutive.com, writes that while the Department of Health and Human Services (HHS) plans for the immunizing of millions of Americans against the A(H1N1) flu, Defense officials are working on a parallel track to protect service members and mitigate the flu's effect on military operations. Army Lt. Col. (Dr.) Wayne Hachey, director of preventive medicine and surveillance in the Office of the Assistant Secretary of Defense for Health Affairs is quoted as stating: "We'll be getting vaccine the same time the highest priority groups are receiving their vaccine. That likely will be in October. In the meantime, military officials are working to contain the virus by isolating infected troops and using antiviral drugs whenever A(H1N1) is detected. All the services screen personnel before they deploy overseas and when they arrive at their destination. Earlier this summer, several dozen infected troops en route to Iraq were held in isolation in Kuwait until they were no longer contagious."
During one week in July, more than 100 cases of A(H1N1) flu were reported at the Air Force Academy in Colorado Springs, but by rigorously following public health guidelines, officials quickly contained the virus. Patients were isolated for several days and closely monitored; individuals who had been in contact with them also were watched for signs of infection.
The Department of Defense is purchasing its own supply of vaccine through HHS to meet military operational requirements. It has ordered 2.7 million doses, which it expects will be sufficient to vaccinate 1.35 million people. While all military personnel on active duty or reservists activated for service will be vaccinated, troops and some key civilians determined most vulnerable will receive the vaccine first, including those deployed on missions overseas, recruits in training, sailors and Marines aboard ships that are at sea, and health workers. Military dependents will receive the A(H1N1) vaccine under a separate distribution program managed by HHS through supplies provided to states based on population data. Access to vaccine among military family members living on bases will be the same as it is in civilian communities, with priority given to health care workers and the most vulnerable groups, including pregnant women and children. Defense has been preparing for pandemic influenza for several years now. For the last four years it has maintained significant stockpiles of gowns, gloves, masks, needles and syringes, and has on hand 8 million antiviral treatment courses.
Associated Press Writer Christine Simmons writes that the Food and Drug Administration (FDA) has authorized the emergency use of a swine flu test for U.S. troops overseas, allowing the military to speed up diagnoses and treatment of a virus that could cause widespread infections this fall. The FDA emergency authorization lets the Defense Department distribute the swine flu test to its laboratories that are qualified to perform and interpret test results. The FDA authorized the swine flu diagnostic test for the public in April.
The authorization allows for the use of unapproved medical products or unapproved uses of approved medical products during a public health emergency. The FDA said the test will help to speed up diagnosis of H1N1 infections so that deployed troops can quickly begin treatment. According to a statement by the Joint Program Executive Office for Chemical and Biological Defense, the Defense Department will use the test for combat units in the Middle East and on Navy ships, beginning with deliveries next month.
The President's Council of Advisors on Science and Technology issued its "Report to the President on U.S. Preparations for 2009 H1N1 Influenza." Most attention so far has been on the estimates the Council makes. Thus, a "plausible scenario" for the United States is a large-scale outbreak of swine flu later this year, causing possibly 30,000 to 90,000 deaths, mostly among young children and young adults, and perhaps as many as 300,000 sick enough to require treatment at intensive care units in hospitals. Seasonal flu typically causes 30,000-40,000 annual deaths, mainly among people over 65. According to CIDRAP News, Tom Skinner, a CDC spokesman, told reporters that the report presented a worst-case scenario that was used for planning purposes only. He and other CDC officials reiterated that federal experts agree that the virus is unpredictable and that it's impossible to make a reliable projection. "At the end of the day, we just don't know," he said.
The full report can be accessed at: http://www.whitehouse.gov/assets/documents/PCAST_H1N1_Report.pdf
Rob Stein, a reporter for the Washington Post, writes that U.S. government health officials are about to launch a swine flu vaccination campaign this fall that is unprecedented in its scope, and in its potential for generating complications. The campaign aims to vaccinate at least half the country's population within months. Although more people have been inoculated against diseases such as smallpox and polio over a period of years, the United States has never tried to immunize so many so quickly. But even as scientists rush to test the vaccine to ensure it is safe and effective, the campaign is lagging. Officials say only about a third as much vaccine as they had been expecting by mid-October is likely to arrive by then, when a new wave of infections could be peaking. Among the unknowns: how many shots people will need, what the correct dosage should be, and how to avoid confusing the public with an overlapping effort to combat the regular seasonal flu.
Officials stress that they are proceeding cautiously. A final decision to move forward will not be made until they get the results of clinical trials -- testing to determine safety and dosing -- and assess the virus's threat. But officials are confident the vaccine will pass muster and expect a campaign will be launched as soon as manufacturers deliver the first vials. To prepare, more than 2,800 local health departments have begun recruiting pediatricians, obstetricians, nurses, pharmacists, paramedics and even dentists, along with a small army of volunteers from churches and other groups. They are devising strategies to reach children, teenagers, pregnant women and young and middle-aged adults in inner cities, suburban enclaves and the countryside.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and Department of Education (ED) Secretary Arne Duncan joined with Dr. Beth Bell, Deputy Director, National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), to announce new guidance for Institutions of Higher Education (IHE) to plan for and respond to the upcoming flu season. The guidance crafted by the scientists and doctors at the CDC is designed to help colleges and universities start planning and acting now for the impact that seasonal and 2009 H1N1 influenza could have this fall and winter on their students and faculty members, as well as other university employees. Secretary Duncan is quoted as stating: "We can all work to keep ourselves healthy now by practicing prevention, close monitoring, and using common sense. We know that some students may be affected by H1N1. Our top priority is making sure that they have a way to get well, stay well, and keep learning. With this guidance, we're providing a menu of strategies that institutions can use to keep their facilities open, while doing what they can to reduce exposure of students, faculty, and staff -- particularly those at higher risk for complications -- from the flu." Secretary Sebelius stressed the importance of using innovative communications strategies to reach out to students who are some of the people most at risk for H1N1 flu. She highlighted new social media tools and online toolkits that have been created to help faculty, staff, and students at colleges and universities.
Government officials are especially concerned about the impact of H1N1 on schools because the virus appears to disproportionately affect young people. The CDC's Advisory Committee on Immunization Practices recently found that younger Americans, specifically those ages 6 months to 24 years, are one of the top priority groups when it comes to the new H1N1 vaccine.
HHS has created a special toolkit for administrators and students, as well some badges and widgets that can be used on social media sites such as Facebook and Twitter. The Toolkit is available at: http://www.flu.gov/plan/school/higheredtoolkit.html.
For the complete H1N1 guidance for higher education institutions and the special H1N1 Higher Education, please visit: http://www.flu.gov/plan/school/higheredguidance.html.
Discovery News reports that canine influenza, commonly known as dog flu, is now affecting dogs in at least five states: Colorado, New York, New Jersey, Pennsylvania, and Virginia. During the week of 10 Aug 2009, the infection caused the death of a 15-year-old whippet and sickened 26 dogs at Virginia's Fairfax County Animal Shelter. While the reason for the shelter outbreak remains unknown, it is possible that one or more infected dogs from Philadelphia or Washington, D.C. introduced the illness to Virginia. Edward Dubovi, director of the virology center at Cornell's Animal Health Diagnostic Laboratory, told Discovery News that "Dogs often move in and out of shelter systems over long distances, such as via breed and rescue groups. Boarding kennels and even elite doggie day care centers can also result in cases, since, as for kennel cough spread, the virus is highly contagious and dogs may catch it from one another." Signs in dogs include fever, lethargy, loss of appetite, and a respiratory infection that may last a few weeks. One to five percent of victims die from related hemorrhagic pneumonia.
A scientific team led by Dubovi was the first to determine that the causative virus of canine influenza actually is an A(H3N8) equine flu virus that had jumped from horses to dogs. In addition to spreading from dog to dog, canines can also catch it from humans, who may have come into contact with infected animals. Since dogs are in regular contact with their owners and other people, the illness could potentially spread from dogs to humans in the future. However, the virus has as yet not sickened any people.
Although 30 states have reported cases over the past five years, Dubovi said that outbreaks are "usually sporadic and then die out. For example, we've seen outbreaks in San Diego, Los Angeles, and Pittsburgh, but those all ended."
In July 2009, a vaccine against canine influenza was released. It is administered in two doses, three weeks apart. Dubovi claims that, "in clinical trials, it reduces viral shedding and diminishes signs of the illness." Dubovi would like to see "blanket vaccinations in affected areas, as it would be nice to get this virus out of the dog population."
Anemona Hartocollis, a reporter for the New York Times, writes that "the New York State Health Department is requiring tens of thousands of health care workers across the state to be vaccinated for flu, amid fears that swine flu will return in the fall. The new regulation, quietly adopted as an emergency on Thursday, affects workers at hospitals, in home health care agencies and in hospice care, but, because of a technicality in state law, not in nursing homes. Until now, flu vaccination has been voluntary, and fewer than half of health care workers have been vaccinated in a typical season. The new regulation, which requires vaccination against seasonal flu and the H1N1 virus, would affect workers and volunteers who come into direct contact with patients, including nurses, doctors and aides, and even nonmedical staff members like food service workers if they enter a patient's room.
The regulation raised protest on 18 August from New York's largest health care union, 1199 S.E.I.U. United Healthcare Workers East, whose president, George Gresham, is quoted as stating that the policy was "completely unprecedented" and could become punitive if the religious or cultural beliefs of workers prevented them from being vaccinated. He added, "health care workers on the front lines of providing care deserve the dignity and respect of thoughtful consideration before a regulation like this can just be rushed through and put into effect."
On 19 August, the CDC published on the federal governments principal flu information site, flu.gov, new guidance that recommends actions that non-healthcare employers should take now to decrease the spread of seasonal flu and A(H1N1) flu in the workplace and to help maintain business continuity during the 2009-2010 flu season. The guidance includes additional strategies to use if flu conditions become more severe and some new recommendations regarding when a worker who is ill with influenza ought to return to work. The CDC notes that guidance in this document may change as additional information about the severity of the 2009-2010 influenza season and the impact of 2009 H1N1 influenza become known. It suggests that all citizens check www.flu.gov periodically for updated guidance. The full guidance can be accessed at: http://www.flu.gov/plan/workplaceplanning/guidance.html.
NIH News announced that on August 17, Francis S. Collins became the 16th director of the National Institutes of Health. He was nominated to lead the NIH, the nation's premiere biomedical research agency, by President Barack Obama on July 8, and was unanimously confirmed by the U.S. Senate on August 7. In his July 8 nomination announcement, President Obama stated: "The National Institutes of Health stands as a model when it comes to science and research. My administration is committed to promoting scientific integrity and pioneering scientific research and I am confident that Dr. Francis Collins will lead the NIH to achieve these goals. Dr. Collins is one of the top scientists in the world, and his groundbreaking work has changed the very ways we consider our health and examine disease. As a scientist, physician, and passionate visionary, Dr. Collins will further NIH's ultimate mission to improve human health." Kathleen Sebelius, U.S. Health and Human Services Secretary, added "He is an ideal choice to lead the NIH and I look forward to working closely with him."
Lisa Schnirring, a staff writer, for CIDRAP News, reports that Dr. Robin Robinson, director of the Biological Advanced Research and Development Authority (BARDA) at the U.S. Department of Health and Human Services (HHS), on 14 August said that the latest estimate is that 45 million doses of the A(H1N1) vaccine will be available by mid October, with manufacturers delivering 20 million doses per week after that. This compares to estimates made in July of 120 million doses being available in October, with another 80 million per month in the following months.
Robinson explained that revised, lower estimate is based on several factors expected to slow vaccine delivery from manufacturers. Health officials have already acknowledged that yields of the novel H1N1 antigen are less than for the seasonal flu vaccine. Robinson also said vaccine makers have a limited number of fill-and-finish sites, which are just completing seasonal flu vaccine production. Another factor that has added to the delay in ramping up production of the novel flu vaccine is that one of the companies making seasonal flu vaccine is having problems finishing up production so that it can clear the decks to make novel flu vaccine. This problem has delayed the vaccine timelines by 4 to 6 weeks.
Robinson added that a new seed strain developed to replace the slower-growing strain has shown in laboratory studies that it will produce A(H1N1) antigen yields that are on par with those for the seasonal vaccine, and that federal scientists will be working with manufacturers over the next two weeks to determine whether the improved yields are also seen in commercial production.
Lauran Neergaard reporting for Associated Press writes that CDC officials are concerned about emergency rooms (ERs) being overwhelmed this autumn by both the so-called "worried well" (people who are well but think they have symptoms of illness) and people who are not so sick. Dr. Arthur Kellermann, an ER specialist at Emory University in Atlanta, stated "There's a clear sense that we can't afford a repetition of the spring experience all over the country. You can't drop millions, much less tens of millions of Americans, into that system willy-nilly because they want to play it safe and get checked. The play-it-safe strategy may be to stay home." Kellermann has been instrumental in stimulating government planning for what he calls "an unprecedented partnership to create the tools in time" to prevent ERs from being overwhelmed should the U.S. be faced with a dire flu situation this coming fall and winter.
With flu season rapidly approaching, the plans aren't finished yet, and it's too soon to know how many people could access such programs. "But," states Dr. Anne Schuchat of the CDC, "we are working on triage systems so people will have good information about, 'What will I need to do?'" Exactly how call centers may work or even how many hasn't been finalized, Schuchat cautions. In the meantime, the CDC has given states and hospitals guidelines on how to open their own — using existing phone-banks like poison-control centers plus the agency's latest information on flu risk and treatment — while exploring whether the government can create a more comprehensive system.
Some local jurisdictions are already implementing programs for ER preparedness. For example, Dallas' health department opened a call center to help doctors decide whether and how to treat sneezy patients, to blunt ER visits, and has begun planning an expanded fall program. According to Dallas preparedness chief Dr. Ira Nemeth, "the main message is, most patients probably won't need the ER."
An article titled "Highly pathogenic H5N1 influenza virus can enter the central nervous system and induce neuroinflammation and neurodegeneration" was published on this date in the Proceedings of the National Academy of Sciences of the United States and authored by Haeman Jang, David Boltz, Katharine Sturm-Ramirez, Kennie R. Shepherd, Yun Jiao, Robert Webster, and Richard J. Smeyne. The abstract of the article reads as follows:
One of the greatest influenza pandemic threats at this time is posed by the highly pathogenic H5N1 avian influenza viruses. To date, 61% of the 433 known human cases of H5N1 infection have proved fatal. Animals infected by H5N1 viruses have demonstrated acute neurological signs ranging from mild encephalitis to motor disturbances to coma. However, no studies have examined the longer-term neurologic consequences of H5N1 infection among surviving hosts. Using the C57BL/6J mouse, a mouse strain that can be infected by the A/Vietnam/1203/04 H5N1 virus without adaptation, we show that this virus travels from the peripheral nervous system into the CNS to higher levels of the neuroaxis. In regions infected by H5N1 virus, we observe activation of microglia and alpha-synuclein phosphorylation and aggregation that persists long after resolution of the infection. We also observe a significant loss of dopaminergic neurons in the substantia nigra pars compacta 60 days after infection. Our results suggest that a pandemic H5N1 pathogen, or other neurotropic influenza virus, could initiate CNS disorders of protein aggregation including Parkinson's and Alzheimer's diseases.
The entire article can be accessed at: http://www.pnas.org/content/early/2009/08/07/0900096106.short?rss=1
Robert Roos, news editor at CIDRAP News, writes that the Minnesota McKesson Corporation, based in San Francisco, will be the sole distributor of A(H1N1) vaccines under a contract with the CDC. McKesson currently distributes vaccines under the CDC's Vaccines for Children (VFC) program. The company's press release states "McKesson's role will be to distribute the vaccine to sites designated by state health departments across the country. Each state will designate the providers who will receive and administer the vaccine. The distribution effort will include the centralized distribution of the A(H1N1) vaccine to as many as 90,000 sites across the country, making it the largest public health initiative in the CDC's history."
Jim Blumenstock, chief program officer for public health practice at the Association of State and Territorial Health Officials in Washington, D.C., is quoted as stating "That's different from how seasonal flu vaccines are handled. This is a government-controlled program, so it'll be the state agencies working with local partners and the CDC that will make the determination as to where the public will be able to get vaccine. This is not like your seasonal flu [vaccination] program where healthcare providers decide whether or not they want to do it and then submit private orders."
An explanation released by the CDC states that using a single vaccine distributor will be more efficient than having vaccine manufacturers ship doses directly to customers. One of the key benefits of using a centralized, third-party distributor to support A(H1N1) vaccine distribution is that it allows distribution of doses to a much larger number of provider sites than would be feasible with direct manufacturer distribution. The CDC also repeated previous government predictions that vaccine shipments are likely to begin about mid-October, though a late September start for shipments remains a possibility. It said each person will probably need two doses. The federal government will pay for the vaccine and related supplies, including needles, syringes, and sharps containers.
The CDC also stated that vaccination planners should consider two scenarios for vaccine availability. The first possibility is that about 120 million doses will be released starting in mid-October and continuing over 4 weeks, followed by 80 million doses per month after that. The second scenario envisions about 20 million doses being released starting in late September, followed by 20 million doses a week thereafter.
The Associated Press reports that 2,800 Americans in eight cities are participating in government-led clinical studies of different combinations of two A(H1N1) vaccines made by drug makers Sanofi Pasteur and CSL Limited, as well as a seasonal flu vaccine. Sharon Frey, an infectious diseases expert who is leading a study at Saint Louis University, is quoted as stating that "...scientists have been working late nights and weekends to organize the studies and recruit volunteers. Typically it takes a year to do this. I can tell you we're working at breakneck speed. The data will be turned around quickly for review by the Food and Drug Administration." Dr. Anne Schuchat, who oversees the flu vaccination programs at the Centers for Disease Control and Prevention (CDC), stated that "It's possible the government will begin a public vaccination campaign before all of the work of the trials is complete."
Saint Louis University will test 200 adults and 200 children. The other study sites are Baylor College of Medicine in Texas, Children's Hospital Medical Center in Cincinnati, Emory University, Group Health Cooperative in Seattle, University of Iowa, University of Maryland School of Medicine, and Vanderbilt University. Also under way are separate studies by five flu vaccine manufacturers under contract with the government. The studies are testing the safety and effectiveness of the newly developed vaccines, will help determine dosage, and make clear whether A(H1N1) vaccines can be safely administered with a seasonal flu shot.
The Associated Press reports that a study of duck and geese hunters in Iowa is the first to show that people can contract avian flu from wild birds. Previous cases of people being infected with any form of avian flu involved only domestic poultry, like chickens. The type of avian flu identified in the study is not the H5N1 avian flu, which is the deadly form that emerged in Asia and has led to concerns being voiced about a potential worldwide flu epidemic. Rather, it is the H11N9 avian flu, which has not been associated with human illness.
Dr. James Gill, the University of Iowa researcher who led the study, stated "that one hunter and two state environmental workers tested positive for the H11N9 virus, though none of the three men got sick."
Tom Skinner, a CDC spokesman, stated that the study's findings are noteworthy. Domesticated birds - like chickens - are an established source of bird flu transmission to humans, but this is believed to be the first documented case of a person getting such a virus from a wild bird. Skinner is quoted as stating "This study is evidence that transmission of avian influenza virus from wild birds to humans can occur. However, it's not clear from the paper whether the virus was spread through blood, water or by other methods. But we want to make clear this type of influenza virus should not be confused with H5N1." He also noted that domestic birds are a bigger worry than wild birds when it comes to the deadly bird flu.
The study is published in the August issue of the CDC journal, Emerging Infectious Diseases: http://www.cdc.gov/ncidod/EID/vol12no08/06-0492.htm.
The Associated Press reports that a commercial turkey flock in Meeker County, Minnesota, has been quarantined after routine testing discovered that some of its members were infected with the H7N9 avian influenza virus. The State's Bureau of Animal Health states that the birds appeared healthy and showed no signs of infection and there was no sign of illness among farm workers. The Bureau is following the state's containment plan by quarantining the flock and all other flocks within three miles. They will be repeatedly tested for the virus for six weeks.
Dr. Dale Lauer, the Bureau's assistant director and director of the Minnesota Poultry Testing Laboratory, is quoted as stating that "it's not uncommon to find the bird flu virus in domestic poultry flocks, and Minnesota turkey remains safe. However, if the virus is left unchecked it can change into a form that's lethal to domestic poultry." Minnesota is the nation's top turkey producing state.
Lisa Schnirring, a Staff Writer at CIDRAP News, writes that the CDC has revised its advice for how long those who are sick with the A(H1N1) virus should stay away from other persons. The new exclusion guidance urges people with influenza-like illnesses to stay home at least 24 hours after they are free of a fever (in the absence of fever-reducing medication), defined as 100° F (37.8° C), which in most cases ranges from 3 to 5 days. Earlier recommendations urged people to stay home for 7 days after illness onset or for 24 hours after symptoms resolve, whichever was longer. Besides businesses and schools, the guidance also applies to camps, mass gatherings, and other community settings. However, the new recommendations do not apply to healthcare settings. People working or visiting healthcare facilities should still observe the earlier, longer-period exclusion guidance. CDC also emphasized that more stringent and longer exclusions may be needed for sick people who will return to settings where they have contact with people who have underlying medical conditions, such as camps for children with asthma or daycare centers that children younger than 5 attend. The new advice is expected to reduce the pandemic's absence burden on businesses and schools.
Bob Graham reporting for the IFAwebnews.com writes that WellPoint, the U.S.' largest health insurance company, has announced that it will cover the administration of the A(H1N1) vaccine for members whose benefit plans provide coverage for vaccines. WellPoint also will continue coverage of seasonal flu vaccine administration for those whose health plans offer vaccine coverage. WellPoint's move is likely to force other, smaller health insurers to provide coverage for the vaccine.
WellPoint operates as Anthem Blue Cross in Virginia (outside of Northern Virginia), and as Empire Blue Cross in 10 New York City metropolitan and surrounding counties, as well as in several upstate counties in New York. In addition, WellPoint, an independent licensee of the Blue Cross Blue Shield Association, serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Wisconsin; and through UniCare.
Los Angeles Times reporter Thomas H. Maugh II writes that most of the serious consequences linked to flu viruses are the result of pneumonia, and an underused vaccine called Pneumovax can prevent, or at least limit, such complications in many patients. The vaccine, made by Merck & Co., stimulates the body's ability to defend against the bacteria responsible for many cases of pneumonia and has the potential to prevent an estimated one-third of pneumonia deaths linked to swine flu. However, it is not yet clear what proportion of swine-flu-related pneumonia is caused by Streptococcus pneumoniae and thus could be prevented or ameliorated by immunization. But preliminary results presented to the CDC vaccine committee in June by Dr. Matthew R. Moore, a CDC medical epidemiologist, indicated that about 40% of swine-flu-related pneumonia had an unknown cause -- and that about 30% were caused by S. pneumoniae. This suggests that at least a third of flu-related pneumonia deaths could be prevented by vaccination.
Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University School of Medicine, president-elect of the National Foundation for Infectious Diseases, and member of the CDC's advisory committee on vaccines, is quoted as stating: "We would certainly like to see the vaccine used more extensively."
Dr. Linda Rosenstock, dean of UCLA's School of Public Health, believes that Pneumovax has not been promoted more heavily because the A(H1N1) pandemic has so far been perceived to be milder than seasonal flu. However, if the virus mutates to become more deadly, then the recommendations will become stronger. But she argues that increased efforts should be made to vaccinate more people. "As a public health measure, it makes sense to target the groups we would be most worried about, independent of the pandemic."
The Centers for Disease Control and Prevention (CDC) has published in advisory on "Managing Calls and Call Centers during a Large-Scale Influenza Outbreak: Implementation Tool." It notes that "during a response to a large-scale influenza outbreak such as the current H1N1 outbreak, a community's 9-1-1 and healthcare systems may experience a surge in calls or walk-in visits for care, advice, and information. In fact, call volumes or walk-in visits could reach the point of overwhelming the 9-1-1 and healthcare systems, rendering them unable to respond to other emergencies in an efficient and effective manner. In those instances, community planners should take steps to divert unnecessary calls away from the community 9-1-1 system and non-critically ill patients away from the healthcare system to reserve both for actual emergency situations. This implementation tool provides a step-by-step approach to achieving this objective by focusing on alternative call center resources." The complete advisory can be accessed at: http://www.cdc.gov/h1n1flu/callcenters.htm.
Matthew Biggs reporting for the Reuters news service writes that the Health and Human Services Department's Advisory Committee on Immunization Practices met today at CDC headquarters in Atlanta. It learned that up to 160 million doses of flu vaccine probably will be available for the start of a vaccination campaign planned for mid-October. Each person will likely need two flu vaccine doses, but it is not clear exactly how much vaccine would be available when. After the Committee had finished its deliberations on how available vaccines should be apportioned, it recommended that state and local health officials prepare to vaccinate as many as 160 million people. The United States would need 600 million doses to immunize everyone. Kathy Neuzil, the advisory committee's influenza work group chairwoman, said that "...the committee's main message is that it's half the population has priority to be vaccinated. And it's the younger half of the population, as well as healthcare workers." The Health and Human Services Department almost always follows the advice of the committee.
The committee's recommendations are that pregnant women, people who care for babies, and healthcare workers should be the first protected against the virus, which is a total of approximately 41 million people. Children between the ages of 6 months and four years were also included in that group. The vaccine was not recommended for infants under six months. People at risk of serious complications from catching the flu should be next in priority, including those with asthma, diabetes and heart disease. Then, healthy young adults aged 19 to 24. Committee members stated that young adults should be a priority because they are more likely to become infected and tend to work in places that would accelerate the flu's spread. Surveys show that people over 65 are at lower risk of contracting A(H1N1).
The committee also sought to provide clear guidance to state and local health officials attempting to explain to the public who is a priority for H1N1 flu - as opposed to seasonal flu - vaccination. The CDC's Dr. Anthony Fiore is quoted as stating that "at present, only 20 to 25 percent of people in high-risk groups are vaccinated against seasonal flu, which is in an indication of the size of the task facing doctors and clinics."
The Advisory Committee's recommendations and reasons for making them can be accessed at: http://www.cdc.gov/media/pressrel/2009/r090729b.htm.
CNN news service has learned that the U.S. Northern Command's General Victor Renuart has proposed that the military establish regional teams of military personnel to assist civilian authorities in the event of a significant outbreak of the A(H1N1) virus this fall. The proposal is awaiting final approval from Defense Secretary Robert Gates. The plan calls for military teams to work in conjunction with the Federal Emergency Management Agency. There is no final decision on how the military effort would be manned, but one source said it would likely include personnel from all branches of the military. However, it has yet to be determined how many troops would be needed and whether they would come from the active duty or the National Guard and Reserve forces.
Civilian authorities would lead any relief efforts in the event of a major outbreak. The military, as it would for a natural disaster or other significant emergency situation, could provide support and fulfill any tasks that civilian authorities could not, such as air transport or testing of large numbers of viral samples from infected patients.
Tom Randall and Gary Matsumoto reporting for Bloomberg news service write that H1N1 flu vaccine makers may rely on a U.S. emergency declaration to use experimental additives made by GlaxoSmithKline Plc and Novartis AG to boost a limited supply of shots that will be available to fight the pandemic. The ingredients, known as adjuvants, may be added for the first time to flu shots in the U.S. Health officials today are meeting to discuss the additives at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, and to recommend who should receive the limited amount of vaccines that will begin being delivering in September or October. Under the U.S. health emergency, the FDA may authorize the use of unlicensed vaccines.
John Treanor, a professor of medicine, microbiology and immunology at the University of Rochester, is quoted as stating "that the U.S. government has been slow to approve the use of adjuvants because of safety concerns, and for fear of giving Americans an excuse to avoid getting the shots. The question is, do you really feel comfortable throwing this new thing into the mix and do you really need to? I myself, if I had to do it, would really wrestle with that decision."
The CDC agreed to pay London-based Glaxo and Novartis, based in Basel, Switzerland, more than $415 million for adjuvants that could be added to the swine flu vaccines. MF59, made by Novartis and sold in Europe, has been given to more than 40 million people, mostly adults, to prevent seasonal flu, according to the company. Glaxo's adjuvant has proven safe and effective in clinical trials with 39,000 people, said Lisa Behrens, a spokeswoman for the company, in an e-mail. Glaxo will conduct more studies and continue to monitor safety after the vaccines are in use, she said.
An article in the New York Times written by Anemona Hartocollis describes how New York City is using lessons learned from the first wave of swine flu during spring 2009 to prepare for the expected second wave this autumn. In particular, health officials are making plans to set up screening facilities at hospitals, clinics, and other buildings to separate worried-well people from genuine sick people before they can overwhelm emergency rooms. The reason for this action is that biggest surprise for hospital and city officials last spring was the surge of visits to emergency rooms by the very large number of people who panicked because they thought they were showing symptoms of flu but actually were well. "I think we were a little surprised at how many people were coming to emergency rooms," said the city's new health commissioner, Dr. Thomas A. Farley. "And the emergency rooms handled them — it wasn't a major problem, but it was a problem."
Hartocollis quotes Dr. Don Weiss, a city epidemiologist, as stating that "on May 25, the worst day of the spring outbreak, 2,500 people visited emergency rooms in the city complaining of influenza-like illness, said. The number on the same day in 2008 was 150. From May 15 to June 15, the worst month-long period of the outbreak, 44,678 people complaining of flulike illness visited the city's emergency rooms, compared with 4,267 the year before. Total visits rose to 428,059, from 325,135. But in an indication of the large numbers of what doctors call the 'worried well,' only 40 to 50 people a day were hospitalized during the worst stretch of that month, including on May 25."
City officials are planning for the possibility that they will have to ration or prioritize vaccinations, because it is unlikely that the city will receive enough for everyone, or 8.3 million doses. If both seasonal and swine flu are circulating, people will be advised to take vaccines for both. But many people resist being vaccinated, and there is a chance that the new H1N1 vaccine could require two doses, making the public persuasion more difficult.
Dr. Farley said it was hard to determine whether closing schools had been medically justified. The pressure from parents, teachers and politicians in some neighborhoods, particularly in Queens, was intense. But Dr. Farley said the health department had not responded to political pressure. "I think it made sense at the time," he said of the closings. "We can't say whether it slowed transmission within that school. It might or might not have." The city is considering, in a worst case, measures like canceling big gatherings and staggering work hours, said Dr. Isaac B. Weisfuse, the city's deputy health commissioner for disease control. In consultation with the Metropolitan Transportation Authority, the health department has concluded that shutting down mass transportation would probably cause more headaches, like leaving hospital workers unable to get to work, than it would solve. But Dr. Weisfuse said he expected many people to walk or drive to work if the flu became severe. He said he thought staggered working hours might be a good idea, though he added that he was not sure it would work.
Text of a Letter From the President to the Speaker of the House of Representatives
Dear Madam Speaker:
On June 24, I signed into law the Supplemental Appropriations Act, 2009 (Public Law 111-32). Within the Act, the Congress appropriated $7.65 billion to the Department of Health and Human Services for the 2009-H1N1 influenza outbreak, including a $5.8 billion contingent appropriation for an influenza pandemic. My Administration appreciates the emergency appropriations that the Congress provided and has initiated the development and procurement of 2009-H1N1 vaccines, is expanding the domestic and international surveillance activities, and is preparing for the possibility that a mass immunization campaign may be needed in the fall.
To enhance our Nation's capability to respond to the potential spread of this outbreak, and in accordance with the appropriation, I hereby designate $1.825 billion of the contingent appropriation as emergency funds required to address critical needs related to emerging influenza viruses (specifically, the virus known as 2009-H1N1). These funds will support additional procurement of adjuvant for dose-sparing of vaccine antigen; immunization campaign planning; regulatory activities for H1N1 at the Food and Drug Administration; and funding for the administration of an injury compensation program.
There remains much uncertainty about the outbreak and its potential to return this fall during the northern hemisphere flu season. We continue to watch the evolution of the 2009-H1N1 virus and the worldwide outbreaks and are working diligently to plan and prepare for a national response, should it be necessary.
We will communicate with you further in the future should additional funds be required.
Sincerely,
Barack Obama
The Centers for Disease Control and Prevention (CDC) today published a set of ten activities whose aim is to help medical offices and other outpatient facilities (e.g., outpatient/ambulatory clinics, outpatient surgery centers, urgent care centers, physical therapy/rehabilitation offices or clinics) that provide routine, episodic, and/or chronic healthcare services to manage increased demand for services in the midst of a H1N1 influenza outbreak. The ten activities are as follows:
Detailed explanations of each of the activities can be found on the CDC's H1N1 Flu Page:
http://www.cdc.gov/h1n1flu/10steps.htm.
Reuters news service today quoted U.S. Health and Human Services Secretary Kathleen Sebelius as having said on 12 July that "There'll be another $1 billion worth of orders placed to get the bulk ingredients for an H1N1 vaccination. Congress has agreed with the president that this is the number one priority, keeping Americans safe and secure. We are aggressively working on, first of all, testing the virus strains to get a vaccination ready. It needs to be safe so testing and clinical trials will start this month. We'll know a lot more by the end of the summer and it needs to be effective."
The U.S. Food and Drug Administration has scheduled a July 23 advisory panel meeting to discuss clinical trials of the vaccines against the H1N1 influenza virus and the U.S. Advisory Committee on Immunization Practice wills meet July 29. "FDA is working with the scientists at NIH (National Institutes of Health) to make sure that we have a safe and effective strain and then we're getting ready to make sure that we have a vaccination program," Sebelius said.
Maggie Fox, a Reuters news service reporter, writes that Dr. Lena Napolitano of the University of Michigan Medical Center and colleagues studied the cases of 10 patients admitted to the university's intensive care unit with severe acute respiratory distress syndrome caused by infection with H1N1 and found that "Of the ten patients, nine were obese (body mass index of more than 30), including seven who were extremely obese (BMI more than 40)." All had to be put on ventilators. Further, nine of the ten had multiple organ failure, five had blood clots in the lungs, and six had kidney failure. Three of the ten died, and none of the remainder has fully recovered, the researchers said.
The Michigan study was not designed to see if obesity or anything else poses a special risk factor for flu. Nevertheless, "the high prevalence of obesity in this case series is striking," the CDC's commentary accompanying the report reads. "Whether obesity is an independent risk factor for severe complications of novel influenza A(H1N1) virus infection is unknown. Obesity has not been identified previously as a risk factor for severe complications of seasonal influenza." The fact that nine out of the ten patients were male might also prove significant.
Secretaries Kathleen Sebelius (HHS), Janet Napolitano (DHS), and Arne Duncan (ED), along with Homeland Security Advisor John Brennan, are hosting an all-day H1N1 Flu Preparedness Summit with states to further prepare the nation for the possibility of a more severe outbreak of H1N1 flu in the fall. Federal, state and local officials, emergency managers, educators and others will be discussing lessons learned during the spring and summer H1N1 wave, and discuss best practices and preparedness priorities. On behalf of the three secretaries, Secretary Sebelius made the following statement:
"Fellow Americans,
This spring we were confronted with an outbreak of a troubling flu virus called 2009-H1N1. As the fall flu season approaches, it is critical that we reinvigorate our preparedness efforts across the country in order to mitigate the effects of this virus on our communities.
Today, we are holding an H1N1 Influenza Preparedness Summit in conjunction with the White House to discuss our Nation's preparedness. We are working together to monitor the spread of 2009-H1N1 and to prepare to initiate a voluntary fall vaccination program against the 2009-H1N1 flu virus, assuming we have a safe vaccine and do not see changes in the virus that would render the vaccine ineffective.
But the most critical steps to mitigating the effects of 2009-H1N1 won't take place in Washington - they will take place in your homes, schools and community businesses. Taking precautions for this fall's flu season is a responsibility we all share. Visit Flu.gov to make sure you are ready and learn how you can help promote public awareness.
We are making every effort to have a safe and effective vaccine available for distribution as soon as possible, but our current estimate is that it won't be ready before mid-October. This makes individual prevention even more critical. Wash your hands regularly. Take the necessary precautions to stay healthy and if you do get sick, stay home from work or school.
We are doing everything possible to prepare for the fall flu season and encourage all Americans to do the same - this is a shared responsibility and now is the time to prepare. Please visit www.flu.gov to learn what steps you can take to prepare and do your part to mitigate the effects of H1N1."
The Central New Jersey newspaper The Examiner reports that an outbreak of canine influenza is occurring in the Clarksburg section of Millstone city, NJ. Over the last several weeks, NorthStar VETS, a specialty and emergency trauma hospital located in Millstone, has seen an increasing number of patients being admitted for the treatment of this virus. There have been nine cases in the hospital so far, and because of its contagious nature, more are expected. Canine influenza should be considered a serious disease; infected animals have a 100 percent mortality rate. However, with a rapid and accurate diagnosis, proper treatment can reduce this statistic to a 1-5 percent mortality rate, according to information from the hospital.
Dr. Daniel Stobie, owner of NorthStar VETS, told The Examiner: "It is a new virus. There seems to be a resurgence, with young and older pets being more susceptible." NorthStar VETS is encouraging dog owners to be vigilant and on the lookout for signs such as difficulty breathing, dry coughing, nasal discharge, high fever, severe lethargy or lack of appetite. If any of these signs are displayed, they suggest isolating the dog from other animals and seeking medical treatment immediately. Canine influenza is not contagious to people, cats, or other species, although people can carry the virus in their nasal passages and transmit it to dogs at home.
For brief fact sheets on canine influenza, see the Washington State University College of Veterinary Medicine, Washington Animal Disease Diagnostic Laboratory website and the University of Florida College of Veterinary Medicine website.
Tom Randall, a reporter for the Bloomberg new service, writes that the vaccine being developed to combat a pandemic of swine flu will require multiple shots to provide immunity from the new virus, and the added immunizations may overwhelm U.S. state agencies. Two injections will be required three weeks apart for H1N1 swine flu, and a third will be needed for seasonal flu. Children younger than 9 years old will need four shots, according to the CDC. William Schaffner, an influenza expert at Vanderbilt University School of Medicine in Nashville, Tennessee, said "One shot probably gives you very little immunity, 10 to 20 percent at most."
Randall also quotes Jeanne Santoli, head of the CDC's routine vaccine distribution activities, stating that vaccinations would be slowed if states are responsible for administering shots instead of doctors' offices and pharmacies. The CDC has not yet determined the role state agencies will play in disseminating the vaccine, and it will be working with states to ensure fast distribution, she said. "Probably each state will decide what works best. There may be some states that lean toward the public sites and others that lean more toward the private," Santoli said.
Lisa Schnirring, a staff writer with CIDRAP News, reports that "An official from the US Centers for Disease Control and Prevention (CDC) said today that the nation just saw its largest weekly increase in cases since the beginning of the novel flu outbreak and that the virus has so far been detected at 34 summer camps in 16 states." Anne Schuchat, MD, interim deputy director for the CDC's science and public health program, told reporters, "The key point is that this new infectious disease is not going away." Of the nearly 28,000 cases that have been confirmed in the U.S., more than 6,000 were reported over the past week, according to the weekly update that the CDC issued today. She said influenza activity is widespread in 12 states, something very unusual for summer months, but not so unusual for an influenza pandemic. States reporting widespread activity are Arizona, Connecticut, Delaware, Hawaii, Maine, New Jersey, New York, Pennsylvania, Rhode Island, Utah, and Virginia. Nine others are reporting regional activity.
More than 99% of typed influenza isolates are the novel flu strain, Schuchat said. "So virtually all of the influenza that's circulating and getting a diagnosis is this new strain."
Clinical patterns in patients who are sick with the pandemic flu strain are staying constant, with the highest illness rates in people younger than age 25, she said, adding that the median age of those hospitalized with more severe illnesses is 19. However, the median age of people who are dying from novel H1N1 is somewhat older, 37.
Mike Stobbe, reporter for Associated Press, writes that a potential fall swine flu immunization campaign may involve an unprecedented 600 million doses of vaccine. According to Stobbe, CDC officials have yet to figure out how to administer so many doses or accurately track side effects if a seasonal vaccine is given simultaneously. Were this campaign to take place, it would far eclipse the roughly 115 million doses of seasonal flu vaccine distributed each year. Officials said they probably will need to recruit physicians who do not usually give flu shots because local health departments have cut more than 10,000 jobs. Detecting and tracking side effects under these conditions would be difficult.
No final decision has been made about whether a swine flu vaccination campaign will take place or whether all Americans would get immunizations. Health officials told Stobbe that a swine flu vaccination campaign could be only a few months away, and that as many as 60 million doses could be ready by September. The timing depends on how fast a vaccine can be produced and tested, however.
The U.S. House of Representatives today approved $7.65 billion in new money to respond to the swine flu pandemic. The money will go toward the purchase of vaccine, antiviral drugs, and other medical needs. Congress also stipulated that the funds be available for surveillance and to help assist international efforts. At least $350 million must be spent on "upgrading State and local capacity."
Jeffrey Levi, a health policy specialist who heads the Washington, D.C.-based Trust for America's Health, applauded Congress's action. "This demonstrates a serious commitment on the part of the Administration and the Congress to ramp up our capacity to respond to the H1N1 pandemic," Levi said.
The Associated Press reports that Health and Human Services Secretary Kathleen Sebelius is suggesting that schoolchildren be first in line for swine flu vaccine this fall, and should even be able to get the shot right at school. Sibelius is presenting this scenario to school superintendents around the country, urging them to spend the summer planning what to do if the government decides it needs their buildings for mass vaccinations. "If you think about vaccinating kids, schools are the logical place," Sebelius told the Associated Press today.
Historically, school-based flu clinics have not been common in the U.S. Schools do occasionally team up with local health officials for special flu vaccination clinics. Thus, more than 140 schools around the country scheduled flu vaccination days last fall, with some providing free vaccine. Nevertheless, the turnout of parents with children was disappointing.
Associated Press notes that no decision has been made yet on whether and how to vaccinate millions of Americans against the new flu strain that the World Health Organization last week formally named a phase 6 pandemic, meaning it now is circulating the globe unchecked. But the U.S. government is spending billions of dollars to develop a vaccine in anticipation of it being needed this coming fall.
An article today in the New York Times reports that Federal drug regulators warned consumers to stop using Zicam, a popular homeopathic cold remedy, because it could damage or destroy their sense of smell. The Food and Drug Administration (FDA) has received 130 reports from consumers and doctors of people losing their sense of smell after using one of the Zicam nasal products, which include Zicam Cold Remedy and Zicam Cold Remedy Swabs. The reports date to 1999, when Matrixx Initiatives of Scottsdale, AZ, first introduced the products. In 2006, Matrixx paid $12 million to settle 340 lawsuits from Zicam users who claimed that the product destroyed their sense of smell, a condition known as anosmia. Hundreds more such suits have since been filed.
An article published today on the Boston Globe and written by Stephen Smith states that the swine flu outbreak in the United States exposed gaps in the supply chain that delivers medication, masks, and even testing swabs to hospitals and doctors' offices; shortcomings that could prove vastly more worrisome if a deadlier strain returns in the fall. Smith writes that "across the nation, from sprawling federal agencies to small local health departments, disease trackers are urgently evaluating their response to swine flu, with eyes trained firmly on the autumn months." Further, he quoted James Blumenstock, chief program officer for public health practice at the Association of State and Territorial Health Officials as having averred that "we really didn't have a good handle on how much commercial supplies were out there, who had them, how rapidly were they being drawn down, and how to blend the public and private stockpiles so there would be no disruption of service."
Smith states that some hospitals said shelves usually brimming with surgical masks, used to slow the virus' transmission, turned barren - and suppliers proved unable to replenish supplies in the standard 24-hour timeframe. Hospitals sometimes found themselves in competition with each other for supply reinforcements, and there were instances when departments within the same medical center raced to get their orders in first. Even one of the most low-tech of medical appliances, the basic swab, ran scarce as the state initially asked physicians to collect two nose or throat samples from patients with suspected cases of the disease.
The article ends with a quote from Dr. Jose Montero, New Hampshire's director of public health: "One key assumption is that pandemics will come to us from somewhere else, which basically means we will have time to prepare. Well, this pandemic started in North America. So we were the ones trying to set up a system to assess risk, to assess severity, to assess infectiousness. With flu, you just never know."
An article in Washington Post written by Shailagh Murray states that while "the H1N1 flu outbreak represents a serious public health threat," it may also "offer Democrats a political opportunity." Democrats have added an additional $7.65 billion for flu prevention to a $106 billion emergency war funding bill currently before Congress. House Republicans have opposed the bill "because of an unrelated provision related to the International Monetary Fund, but "if GOP lawmakers follow through with their opposition by voting against the final bill next week, a 'no' vote on flu prevention will appear on the books." A senior Democratic aide "who helped to add funding in the final bill told the Post "if I were a Republican from a marginal district, I would not feel comfortable with that vote." It's happened before. Sen. Susan Collins, R-Maine, was "pummeled by liberal blogs" after she voted to "strip out nearly $900 million in pandemic flu funding from the economic stimulus bill in February," just months before the outbreak of the H1N1 virus.
In view of yesterday's pandemic declaration by the WHO, the US Centers for Disease Control and Prevention (CDC) today urged businesses to review their pandemic plans to make sure they're flexible enough to respond to a moderate or severe pandemic. At a teleconference today for the business community, Lisa Koonin, a senior adviser with the CDC's influenza coordination unit, said that because influenza viruses are so unpredictable and the pandemic may change or become more severe in the fall, now is the time for businesses to revise pandemic plans or begin developing one if they don't already have one. "There will be different pictures all around the world," Koonin said. "We need to be nimble and tailor our response based on that picture."
Employers should review their leave, pay, and benefits policies to determine if any adjustments are needed to allow employees to stay home for 7 to 10 days if they are sick with the novel flu or need to stay home to care for a sick family member, she said. Flexibility with policies will be crucial, Koonin said. For example, employers may not want to require a doctor's note when workers have been home sick, because clinics and emergency departments will likely be swamped, making it difficult for sick people to get notes in a timely manner. She advised the group to address business continuity concerns by identifying essential business functions and critical employees, planning for staffing redundancy for key positions, and assessing supply-chain and critical input issues. Koonin added that it's a good idea for businesses to ask suppliers to provide details about their pandemic plans.
Employees who have risk factors for flu complications, such as asthma, cardiac conditions, or pregnancy, should be advised to seek medical care quickly if they have flu symptoms. Those who don't have risk factors but experience severe symptoms should also seek care.
U.S. Department of Health and Human Services Secretary Kathleen Sebelius and U.S. Department of Homeland Security Secretary Janet Napolitano issued the following statements today in response to the World Health Organization's (WHO) decision to raise the pandemic threat level on the novel H1N1 virus:
"Today's decision by the WHO was expected and doesn't change what we have been doing here in the United States to prepare for and respond to this public health challenge. Once we saw how fast this virus was spreading, we activated our pandemic plans and started doing all the things we needed to do to keep the public as safe and secure as possible. What this declaration does do is remind the world that flu viruses like H1N1 need to be taken seriously. Although we have not seen large numbers of severe cases in this country so far, things could possibly be very different in the fall, especially if things change in the Southern Hemisphere, and we need to start preparing now in order to be ready for a possible H1N1 immunization campaign starting in late September."
--Secretary Sebelius"We responded to the H1N1 outbreak from the outset with the presumption that a pandemic was likely, so this decision comes as no surprise. We acted aggressively to stay ahead of the virus as it spread across the country. Now our challenge is to prepare for a possible return in the fall. The Obama Administration has been working together across the government and will continue to do so over the weeks and months ahead to keep the American people safe. We are reaching out to our partners in state and local government, in school districts and the private sector to urge them to modify and update their pandemic plans. We are working with our scientists to test and prepare a possible vaccine. And we are working with governments around the world to share what we know and learn from what is happening in their countries."
--Secretary Napolitano
The Washington Post reports that the White House asked Congress on 2 June for authority to spend up to $9 billion more for an H1N1 flu vaccine and other preparations against the novel flu strain that first appeared in April. Of the total, the administration asked Congress to provide $2 billion in "contingent" funding. Another $3 billion could come from the Project BioShield Special Reserve Fund, created in 2004 to field countermeasures against nuclear, biological or chemical threats; $3.1 billion from stimulus funds appropriated to spur economic recovery; and $800 million from the Department of Health and Human Services. However, on 7 June, this contingency plan was criticized by leaders of a bipartisan commission on weapons of mass destruction because, they claimed, it would "weaken the nation's preparedness for terrorism." The contingency plan will be considered by Congress in the next few months.
Dr. Thomas Frieden formally assumed the role of Centers for Disease Control and Prevention (CDC) director on June 8. He faces the challenge of helping guide the national response to pandemic influenza, while strengthening the CDC's scientific programs and carving out a sizable role for it in the Obama administration's broader health-care overhaul effort. The new director stated that the CDC will continue to focus intensively on the new H1N1 flu virus as it prepares for the virus's possible return in full force in the fall. The CDC has suffered from having been involved in several controversies in recent years, but has also been credited with a swift and able response to the sudden outbreak of the new flu.
On 4 June, the nonprofit Trust for America's Health published a report that included lessons learned so far in the swine flu outbreak. The Trust's findings included:
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