Archive for the ‘H1N1 (Swine) Flu’ Category

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The H1N1 Line-up: Pregnant Women and Children First?

Friday, July 31st, 2009 by

flushotThough U.S. officials hope to have enough of the H1N1 vaccine to distribute it to 120 million people, the Advisory Council on Immunization practices has recommended prioritizing vaccinations based on the scenario of having only 42 million doses available by October.

At the top of this priority list are the following groups: pregnant women, children and healthcare workers.  Surprisingly, last in line for the vaccine are those over the age of 65. Though they are normally considered high-risk, the breakout of H1N1 among this group has been comparatively lower than in other groups. The CDC suggests that this may be because this group was exposed to early strains of H1N1 many years ago.

Some EU countries including Britain, Greece, France and Sweden, are anxious to get a vaccine tested and approved in a shorter timeframe and plan to deploy it as soon as it is approved– within weeks in some countries.  Though many wonder if the risks and benefits have been properly weighed, European officials clearly think the rush is worth it.  If you are planning a trip to Europe in the next couple of months, we will help you keep an eye on any vaccination requirements for international travelers.

What does all this mean?  H1N1 continues to keep us wondering what will happen next. And if countries are reacting differently to the threat it presents, at least it is being given proper consideration. 

Be sure you check out the recommended priorities from the Advisory Council and find out where you fall on the list. Will you get the vaccine or will you choose to take your chances with H1N1?

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Preparing for H1N1 and the Upcoming Flu Season

Thursday, July 9th, 2009 by

In conjunction with the White House, Kathleen Sebelius, Secretary of Health and Human Services, Janet Napolitano, Secretary of Homeland Security and Arne Duncan, Secretary of Education, are holding an H1N1 Influenza Preparedness Summit today.  The meeting will focus on plans to monitor the spread of 2009-H1N1 and to initiate plans for a vaccination program (assuming a safe vaccine is produced).

To view today’s live airing of the summit or for more information on preparing for and managing the effects of H1N1, visit Flu.gov.

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Overreacting to H1N1: WHO and China Try to Banish Ghosts

Tuesday, June 30th, 2009 by

chinah1n1With the benefit of a few weeks of perspective on the H1N1 outbreak, it’s possible to conclude that the some of the initial response qualifies as overreaction. Let’s start with the World Health Organization’s declaration of a pandemic. Observers such as Michael Fumento have argued that the WHO adopted a “pandemic” definition that is skewed toward human transmission of animal viruses even if the transmission rate and virulence are modest compared to seasonal human flu viruses. Fumento suggests that the WHO declared a swine flu pandemic in part to justify the expenses incurred at the WHO’s behest over the past five years to ready the world for an avian flu outbreak that is still  confined to people living in close proximity to infected barnyard fowl. We may be readier than ever, but is the WHO risking its credibility in an attempt to justify our readiness?

Similarly, China, haunted by its slow and clumsy handling of the SARS outbreak a few years back, is now using a heavy hand with international visitors suspected of carrying H1N1. The U.S. State Department has issued a travel alert citing China’s quarantine measures as posing unwarranted risks. Even slightly elevated body temperatures (as measured by remote sensing devices) have resulted in airline passengers being placed in quarantine under conditions where suitable drinking water, food and sanitation are wanting. Children have reportedly been separated from parents and communication has broken down between members of families’ travel parties. This “get tough” approach appears to be clearly out of proportion to the risks posed by H1N1 and can be traced to a desire to banish the ghost of SARS past.

As the H1N1 story continues to unfold, we hope that major players like the WHO and China find a more proportional response. Overreacting can compromise the credibility of worldwide efforts to keep us safe and produce unnecessary risks as well. Look for future posts that strive to put travel health risks into perspective.

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H1N1 News: WHO Declares Pandemic, Sets No Travel Restrictions

Thursday, June 11th, 2009 by

swineflupicThe World Health Organization has declared the H1N1 outbreak a pandemic but has characterized it as “moderate in severity” and has not recommended any international travel restrictions.  At a press conference this morning, WHO officials noted that the most severe cases are in adults aged 30 to 50 and said their greatest concern is “we don’t know how this virus will behave under conditions typical in the developing world.” In fact, they anticipate a “bleaker picture as the virus spreads to areas with limited resources, poor healthcare and high prevalence of underlying medical problems.”

This declaration sets in motion a coordinated worldwide effort to manage the spread of the virus and to treat those infected.  Details are sketchy but WHO officials say anti-viral drugs have already been sent to “many countries.”  As for a vaccine, the WHO reports that the first doses will be available in September but in very small amounts.  The WHO will be watching the progress of the pandemic in the coming weeks and will make recommendations on which populations (and countries) should be at the head of the line to receive vaccine supplies.

The Healthy Travel Blog will be tracking events as they unfold and highlighting the angles of most concern to international travelers.  Please stay tuned.

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Japan Scans International Flights for H1N1

Friday, June 5th, 2009 by

h1n1planescanJapan is taking the threat of H1N1 very seriously, as evidenced by the new process arriving international flights must undergo.  I experienced this first hand when I went to Japan a few weeks ago to attend my niece’s wedding.  

As I prepared myself for the flight from the U.S. to Japan, H1N1 was not something that I was thinking about.  However, the Japanese officials were focused on it and were hoping to prevent the virus from invading Japan by stopping it at the airport.  For this reason all incoming flights were rescheduled in order to arrive 30 minutes earlier than planned so that health examiners would have time to scan every arriving passenger for signs of the flu.

Once our flight landed in Tokyo, we were told to remain in our seats.  Then seven health examiners awkwardly stepped onto the plane.  Each one was dressed in a plastic suit and was wearing a protective cap, goggles, a mask and gloves (they looked like spacemen).  They walked up and down the aisles with a body temperature scanning device stopping to analyze each passenger by aiming the device at them to check for elevated temperatures indicating a fever.

If anyone had shown signs of a fever, EVERYONE on the flight would have been quarantined in a local hospital for one week.  I was stressed for the entire thirty minutes these men spent scanning the passengers, worried that I was going to miss the wedding!  Fortunately, no one had a fever, and we were allowed to exit the plane. Three days later the health officials called me to see if I had a fever, which I did not (but I did have a great time at the wedding!). 

The Japanese actively work to contain potential outbreaks, but I have heard from family members in Japan that the officials are now loosening up on the inspection process.  

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H1N1 (Swine Flu Virus) Vaccine – What are we waiting for?

Wednesday, May 20th, 2009 by

vaccineThe H1N1 virus is no longer front page news, and the World Health Organization (WHO) has not classified the current outbreak as a pandemic despite 40 countries collectively reporting over 10,000 cases, including 79 deaths. Most epidemiologists agree that widespread transmission of H1N1 is inevitable, and that a more virulent strain may emerge in the fall.  This sobering prediction and the 5 to 6 month lead time to produce a vaccine, beg the question: “Why hasn’t development started?”

There are multiple reasons. For one, the conventional flu may pose more of a global threat than this new strain. According to a recent Los Angeles Times article, mass production of a new H1N1 vaccine could sharply curtail the amount of seasonal flu vaccine available because the new vaccine would be made instead. The WHO, in consultation with manufacturers, is responsible for making this decision. It’s a difficult call because seasonal flu kills 250,000 to 500,000 people each year worldwide (36,000 in the U.S.). So going full steam ahead on a novel H1N1 vaccine presumes the swine flu virus would have an even higher mortality rate.

Another consideration is timing the selection of the H1N1 strain used in development. Because the genetic composition of new flu strains is constantly evolving, premature selection of a strain could render a new vaccine ineffective.  Of course, waiting too long might not allow enough time to manufacture a vaccine to prevent a pandemic.

Compounding this dilemma, one of the key variables in producing a new vaccine is how well the virus can be grown in culture.  According to the WHO, disappointing lab results to date indicate that vaccine manufacturers will not be ready to produce a swine flu vaccine until mid-July at the earliest. If this assessment proves true, a vaccine will not be ready until January, 2010–three months into the flu season.

Finally, mass distribution of the vaccine will not take place until it is clear that the evolving H1N1 virus results in significant morbidity and/or mortality this autumn. Once the vaccine begins to be administered, world health officials will vigilantly watch for any incidence of Guillain Barre syndrome, a complication that affected hundreds of recipients following the mass administration of another swine flu vaccine in 1976. The WHO and CDC want to make sure we don’t once again hatch a cure that is worse than the disease.

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H1N1 Flu: What We’ve Learned So Far

Tuesday, May 5th, 2009 by

h1n1strain

As the evidence mounts that the H1N1 virus is beginning to stall out at as a “near pandemic” (currently WHO Level 5), what have we learned so far? First, although intense media coverage has sparked the sales of face masks and engendered a great deal of anxiety, CDC and WHO officials and the federal government have managed the outbreak with steady hands and cool heads (VP Biden excepted), resisting calls for borders to be closed; Containment is not feasible in a world so tightly knit by trade and travel patterns. As a prime example of how interdependent we have become, the New York Times noted that the base ingredient for the antiviral drug Tamiflu, shikimic acid, is manufactured mainly in China. Sealing our borders could leave us defenseless against H1N1.

Second, geneticists, who are sequencing H1N1 and posting the results on the Internet are beginning to conclude that the virus in its current form spreads barely well enough to keep itself going.  The transmissibility appears to be no speedier than ordinary flu which kills 36,000 annually in the U.S. and an estimated 250,000 – 500,000 worldwide.

Third, the story is not over. H1N1 may yet adapt to people in a dangerous way, which means that next winter we may be in for an unpleasant surprise. The virus, which so far has resulted mostly in mild illness, may have a much more devastating effect next flu season, which runs each year from November until March.  The good news is that scientists should have ample time to create a vaccine for this new H1N1 strain before next October, as vaccines typically take 3-4 months to develop.  It is likely that the WHO will recommend inoculation concurrent with the annual flu vaccination.

While we watch and wait, we should recognize that the term “pandemic” only describes how widely an infectious agent is distributed, not how severely it affects the population.  Unless we see a dramatic change in the next few days, it looks as though the current H1N1 virus will be manageable, at least for the next few months, as it takes up residence in the realm of human antagonists.

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For Swine Flu Root Causes and Risks, Dig Into Environment

Friday, May 1st, 2009 by

watermexico2Amid all the news and speculation, it’s natural to wonder how Influenza A H1N1 got off to such a galloping start in Mexico. Reports are coming in about cultural resistance to seeking medical care,  which no doubt is a contributing factor.  But I was struck by a report filed by Jason Beaubien of NPR  potentially linking the flu outbreak to the scarcity of clean water in many parts of Mexico. If maintaining basic hygiene is compromised by chronic water shortages, it seems the environment becomes ripe for infectious diseases to blossom.

Taking a global view of this issue makes it very clear why pandemics are expected to emanate from Africa and Asia –countries like China and India are among the most “water-stresssed” in the world. And Mexico appears to be on a par with them. Until a workable plan for redistributing water to needy populations is adopted, water-stressed destinations will be increasingly problematic for economic development and tourism.  The Healthy Travel Blog will keep digging into underlying environmental issues that world travelers need to understand to keep their travels safe and healthy.

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Before You Say “Pandemic”, Consider the Source

Wednesday, April 29th, 2009 by
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World Health Organization

As quickly as swine flu is popping up around the globe, “news” about swine flu is being consumed at an even faster pace.  If you ever played Whisper Down the Lane, you know that information often changes as it passes from person to person. With the advent of social networks such as Twitter, basic facts can morph into panicky fiction as quickly as a text message is transmitted.

It is at times like these that we need to carefully search out credible sources of information. Let’s take a moment to look at two authoritative sources of international health news and the arbiters of the term “pandemic”: the United Nations World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC).

In an effort to provide meaningful and consistent characterization of flu outbreaks, both the WHO and the CDC have formulated rating systems.  The WHO rates the severity of an outbreak of a new contagion using a six-phase system ranging from no-risk (Level 1) to pandemic (Level 6):

1.       No animal virus has caused human infection

2.       An animal influenza virus has caused at least one human to become ill

3.       An animal influenza virus has caused sporadic cases or small clusters of people to become ill, but there is no sustained human to human transmission (current level of avian or “bird’ flu worldwide)

4.       Verified human-to-human transmission of enough volume to cause community level  outbreaks (such as the swine flu outbreak at the school in Queens, New York)

5.       Human-to-human spread into at least two countries in close proximity without a known host travelling from one country to another (Tourists who return home from Mexico and become ill do not meet this test)

6.      Community level outbreaks on at least two continents (Pandemic)

Don’t even try to “tweet” this important information on Twitter.

Once a pandemic has been declared by the WHO, the CDC uses a “Pandemic  Severity Index” to rate flu outbreaks based on the number of anticipated deaths.  Category 1 outbreaks have an expected death toll limited to less than 90,000, while category 5 puts the number at almost 2 million.  The CDC developed this system in response to the Avian Flu threat in 2007 in order to standardize the level  response taken by  public health agencies around the U.S. and the world. 

Word is just in that the WHO has raised its pandemic alert to Level 5. Let’s keep the WHO criteria firmly in mind as the contagion spreads. There are 36,000 deaths in the U.S. each year from flu complications, and we have a long way to go to reach Category 2.

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More News from the Swine Flu Epicenter

Wednesday, April 29th, 2009 by

tamifluThe CDC has recommended Tamiflu® and Relenza® for treatment of the swine influenza virus . As is often the case in any type of outbreak, there are numerous conflicting reports arising concerning the availability of the necessary medications.

One of our physician advisors, who is based at a Mexico City hospital, has provided us with the latest information on the treatment available for swine flu.

For those already infected, both Tamiflu and Relenza are available in the main hospitals and are believed to be effective for treating swine flu. Tamiflu is not available commercially but has been stockpiled by the government in adequate supplies and is being dispensed with a physician’s prescription under government supervision at large hospitals. We have learned that Tamiflu is starting to appear in pharmacies in Mexico City.  Relenza has been commercially available in Mexico but demand may exceed supply.   We will provide updated information as it becomes available. 

There have also been reports that thousands of people are flooding the hospitals in Mexico City and are being turned away by police. Our physician advisor reports this is NOT TRUE. The main hospitals in the city are accepting anyone who needs treatment. In fact, they are encouraging people to come to the hospital for proper medical care, ideally within the first 24 hours of recognizing symptoms of swine flu.

We will stay in contact with our physician advisor in Mexico and will post any newsworthy updates.

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