Posts Tagged ‘H1N1 (Swine) Flu’

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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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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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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
who4

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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On the Front Lines in Mexico

Tuesday, April 28th, 2009 by

mexico428092After 24 surreal hours on the ground in Mexico, I’m on my way back out of the country. I had arrived in Monterrey yesterday for a conference of Mexican Hospitals, but the conference has been canceled due to the swine flu outbreak.

 

Here are my observations from my quick stay:

 

The mood and behavior of people has changed dramatically from yesterday; when I first arrived, only a few people were wearing masks. Today, well over half the people are wearing masks. If they don’t have masks on, they’re using bandanas and t-shirts over their mouth and nose. I’d estimate that 80 percent of the people in the Monterrey airport were wearing masks. On the street, not as many people are wearing masks. A lot of people aren’t wearing the masks properly, but they seem comforted by the fact that they have them or their bandanas perched on their head or around their neck.

 

The city seems like a set for a disaster movie with everyone wearing masks and avoiding crowds.  It certainly seemed to me that the onslaught of information from reporters all over the globe has put the local citizens on edge.

 

I know there have been some reports that the Mexican government has been a little slow to act in this emergency, but at least one local seemed pleased with the response. My driver from the airport said that the Mexican government has been very open in its communication, and he didn’t think that past administrations would have been as forthright.

 

One of the funniest observations goes into group psychology – during the normally uncomfortable period of lining up and boarding a plane, everyone was even a little more unsettled than usual brought on by the close proximity of strangers all wearing masks.  Of course, once on the plane, despite the quarters being even more confined, everyone seemed to let out a deep breath of relief.  In this case, most of us were probably just happy to be leaving Mexico behind.

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Swine Flu Outbreak: More Answers Needed

Tuesday, April 28th, 2009 by

swineflumexico428Not since the panic of 1976, when a Fort Dix, New Jersey soldier died and four of his fellow recruits became ill, has there been such attention paid to swine flu.  The 1976 “outbreak” triggered a massive effort from the US government to immunize the entire population. The pandemic never materialized despite only 24 per cent of the population receiving the vaccine, and some criticized our government for making much ado about nothing.  Moreover, there were over 500 cases of Guillain Barre Syndrome attributed directly to the vaccination.  Are we currently heading down the same path, or is there good reason to be concerned about an emerging epidemic?

Each year, anywhere from 250,000 to 500,000 people die worldwide as a result of influenza. So what is so different about the swine flu? In 1976, scientists were very concerned because the swine flu isolated from the Fort Dix soldiers closely resembled the flu strain responsible for the pandemic of 1918 that killed countless victims worldwide. Unlike the human influenza A strains that circulate each year, and for which the World Health Organization develops annual vaccines, the swine flu’s primary host is the pig, and is an unknown entity without a “track record” of virulence. As such, epidemiologists do not know what to expect. Generally speaking, new flu viruses are harder for the immune system to defend against, so they can reproduce rapidly and overwhelm the body’s defenses. Ironically, the body can even overreact to a new virus- the so called “cytokine storm”- which may lead to grave illness or death.

The seriousness of the current swine flu from Mexico has yet to be determined.  Several dozen cases have been reported in five states over the past few days, but no one is yet critically ill.  On the other hand, there are already over 140 deaths reported in Mexico from (presumably) the same strain.   History does not help us. In 2007, there was a little publicized outbreak of swine flu in the Philippines that resulted only in mild illness. There were also about a dozen cases of swine flu reported in the United States between 2005 and 2009 – none of them lethal.

A pandemic has three features- the ability to spread rapidly among humans, the ability to cause serious illness in a high percentage of those infected, and novelty in the world of flu viruses.  So far, the Mexican swine flu has proven to only have one of these features- it is a strain not previously identified. We will be watching (and posting) as this story unfolds.

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