SHEA: Mandatory Vaccination Of Health Care Workers

 

 

 

# 4855

 

 

The vaccination rate among health care workers (HCWs) against seasonal influenza runs abysmally under 50%, and in recent years there have been multiple calls to make yearly vaccination a requirement of employment.

 

For infection control professionals, the advantages are obvious.  Influenza exacts a heavy burden on patients, their families, and co-workers.  Requiring vaccination would undoubtedly save lives, and reduce costs.

 

But for many HCWs, the issues are more about personal rights to decide what they will inject into their bodies. And that has left this hot-potato issue in the wings.

 

Earlier this summer the CDC released their proposed infection control guidelines, where they strongly urged – but did not mandate – flu vaccinations for HCWs.

 

Here is the passage from the proposed guidance:

 

Strategies to improve HCP vaccination rates include providing incentives, providing vaccine at no cost to HCP, improving access (e.g., offering vaccination at work and during work hours), and requiring personnel to sign declination forms to acknowledge that they have been educated about the benefits and risks of vaccination.

 

While some have mandated influenza vaccination for all HCP who do not have a Contraindication, it should be noted that mandatory vaccination of HCP remains a controversial issue.

 

In response to what many felt was a tepid policy, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), wrote an open letter to CDC  director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.

 

You can read the letter off the IDSA website from the link below.  

 

IDSA Letter to CDC Director Tom Frieden on Draft Guidance “Prevention Strategies for Seasonal Influenza in Healthcare Settings”  07/15/2010

 

 

As you can imagine, this is a hot button issue.
 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

• Some hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season.
• APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for two years (see APIC Seeking Mandatory Flu Shot For HCWs)
• In the UK, the Department of Health  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

 

Which brings us to a press release and a positions paper from SHEA (Society for Healthcare Epidemiology of America), – endorsed by the IDSA -  that calls for the mandatory vaccination of all HCWs against seasonal flu each year.

 

First an excerpt from the press release, followed by a link to the position paper.

 

NATION’S LEADING INFECTIOUS DISEASES EXPERTS CALL FOR MANDATORY FLU VACCINE FOR ALL HEALTHCARE PERSONNEL

Vaccination Should Be Requirement for Continued Employment for Healthcare Personnel, Epidemiologists and Infectious Disease Physicians Say

(Arlington, VA)— Influenza vaccination of healthcare personnel is a professional and ethical responsibility and non-compliance with healthcare facility policies regarding vaccination should not be tolerated, according to a position paper released today by the Society for Healthcare Epidemiology of America (SHEA). The paper, published in this month’s Infection Control and Healthcare Epidemiology journal and endorsed by the Infectious Diseases Society of America (IDSA), stresses influenza vaccination of healthcare personnel as a core patient safety practice that should be a condition of both initial and continued employment in healthcare facilities.

 

According to SHEA, their recommendations apply to all healthcare professionals in all healthcare settings, regardless of whether the professional has direct patient contact or whether he or she is directly employed by the facility. The policy also applies to students, volunteers, and contract workers. The only exemptions, say the epidemiologists and infectious disease physicians, should be in cases of medical contraindications.

(Continue . . . )

 

 

SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

An update of an original SHEA statement issued in 2005, this paper states that influenza vaccination is the professional and ethical responsibility of healthcare professionals and that non-compliance with healthcare facility policies regarding vaccination should not be tolerated. It is endorsed by IDSA.

 

SHEA Position Paper

 

 

 

Hospitals are looking at this as both a liability and an economic issue, on top of their concerns for patient welfare.  So this movement has `legs’.

 

Of course, legal challenges still lie ahead, but the momentum is clearly moving in the direction of mandatory vaccinations for Health Care Workers.

“You Do Have A Plan, Right?”

 

# 4854

 

 

Title Quote, a variation of several refreshingly informal and candid tweets from FEMA Director Craig Fugate on Twitter  over the past few days.

Photograph by NOAA.

 

 

 

For some terrific coverage of how FEMA, and other preparedness agencies are using social media to get people informed (and hopefully prepared) for a hurricane I would heartily recommend John Solomon’s In Case of Emergency Blog.

 

For advice on how to prepare for an approaching hurricane – or any other disaster – go to Ready.gov.

 

 

‘Nuff said.

Another Mask Study To Ponder

 

 

# 4853

 

 

Long-time readers of this blog are aware of a number of conflicting studies that have come out in recent years regarding the relative efficacy of surgical masks and N95 respirators in protecting HCWs (Health Care Workers) against airborne infections.

 

 

For decades, the assumption was that only properly fitted N95 masks protected the wearer, and that surgical masks were worn by HCWs to protect the patient during invasive procedures.

N-95 Respirator         Surgical Facemask

 

Last year, during the summer outbreak of pandemic H1N1, many hospitals citing shortages of N95 masks, opted to equip their nurses with surgical masks instead. 

 

This went against the recommended infection control guidelines issued by the CDC at the time, but was supported by several major infectious disease professional organizations.

 

This resulted in numerous protests last fall by nurses and other care givers, as I reported in:

 

CNA/NNOC Plan Protest Over Inadequate H1N1 Protection

 

(Photo from CNA/NNOC Webpage)

 

Since then, we’ve seen several `semi-reassuring’ studies that suggested that surgical masks are acceptable protection.

 

In October the NEJM published a perspective article (see NEJM Perspective: Respiratory Protection For HCWs) based on the recent IOM evaluation of surgical masks vs. respirators, and reiterated the advice:

 

Until more data are available, the committee recommends that clinicians reach for the N95 respirator when confronting patients with influenza-like illnesses, particularly in enclosed spaces.

 

A few days later JAMA (Journal of the American Medical Association) published a study which reported that HCWs using surgical masks experienced `noninferior rates of laboratory-confirmed influenza’.

In March of this year, we saw the following study (see Study: Efficacy of Facemasks Vs. Respirators).

 

 

Study finds surgical masks provided effective protection of health-care workers against H1N1

The effectiveness of ordinary surgical masks as opposed to respirators in protecting health care workers against the 2009 H1N1 influenza virus has been the subject of debate. An observational study published in the April 1, 2010 issue of Clinical Infectious Diseases, available online, suggests that surgical masks are just as effective as respirators in this regard.

 

 

The evidence over the winter, it seemed, was largely supportive of the notion that surgical masks were adequate protection against influenza viruses.

 

So in June of this year, the CDC released revised infection control guidance proposals which relaxed their previous recommendations to the allowing of surgical masks for routine care, and reserving N95 masks for aerosol producing procedures (intubation, suctioning, etc).

 

CDC: Proposed Influenza Infection Control Guidance

 

To complicate matters, however - after these studies suggested that surgical masks are reasonably protective against influenza - we now get a new study that questions whether surgical masks or N95 respirators provide any substantial protection to the wearer at all.

 

No . . .  I don’t make these things up.  I just report on them.

 

The study appears in the September issue of the AJIC (American Journal of Infection Control), and is titled:

 

Quantifying exposure risk: Surgical masks and respirators

Keith T. Diaz, MD, Gerald C. Smaldone, MD, PhD

 

These researchers (using mannequins fitted with a variety of masks, and using radiolabeled wet aerosols) determined that wearing surgical masks and N95 masks without an airtight (Vaseline) seal provided little more protection than wearing no mask at all.

 

They did find that placing a surgical mask on an infected source (patient) could significantly reduce the spread of a virus to the environment.

 

Since only the abstract is freely available, it is helpful that the SurgiStrategies website has posted a summary of these findings.  

 

A hat tip to Tetano on FluTrackers for passing along this link.

 

 

AJIC Releases New Study on Face Masks and H1N1

 

The authors of this review quote the researchers as stating the type of mask (N95 vs Surgical) “does not play a significant role in reducing exposure to the recipient unless a respirator is physically sealed to the face of the source."

 

 

While obviously not the last word on the subject, the issue of just how protective various types of masks are to the wearer has just gotten a bit more murky.

 

Obviously, we will await the next mask efficacy study with considerable interest. In the meantime, I guess I’d better check my supply of Vaseline.

ECDC: Effectiveness Of Chemo-Prophylaxis During The Pandemic

 

 

# 4853

 

 

During the opening months of the pandemic there were widely varying policies and opinions around the world as to how antivirals would be used. 

 

In the UK, fearing that patient loads would overwhelm their medical system, just about anyone who exhibited flu-like symptoms could call a hotline and get a packet of Tamiflu prescribed without testing or seeing a doctor.

 

In the United States, and many other countries, antivirals were used more conservatively, partially out of concerns over fostering antiviral resistance.

 

Now that the pandemic is over, we are getting studies looking at how these varying strategies worked.  

 

Today the ECDC’s web portal has summaries, and a comparison, of two recent journal articles that looked at the therapeutic and prophylactic use of antivirals during the pandemic.

 

Differing effectiveness of the therapeutic and prophylactic use of antivirals and other measures for public health purposes during the 2009 influenza A(H1N1) pandemic

31 Aug 2010

 

 

The two studies in question are:

Lee VJ, Yap J, Cook AR, et al.
Oseltamivir Ring Prophylaxis for Containment of 2009 H1N1 Influenza Outbreaks
New England Journal of Medicine; Volume 362:2166-2174; 10 June 2010; Number 23

and

Health Protection Agency UK The role of the Health Protection Agency in the ‘containment’ phase during the first wave of pandemic influenza in England in 2009
Health Protection Agency, March 2010

 

At first glance, these two studies appear to come up with different conclusions. 

 

In the first study, which I profiled back in June (see CIDRAP On Two NEJM Pandemic H1N1 Studies), ring prophylaxis (or PEP) was shown to slow down or contain an influenza outbreak in a closed or semi-closed setting.

 

The second study, conducted by the UK’s HPA, found that chemo-prophylaxis could be effective in the home, and somewhat effective in schools, but proved less effective when scaled up to a larger community.

 

The ECDC’s comment (slightly reformatted for readabilty) follows:

 

ECDC Comment (19/08/10)

On the surface these two evaluations suggest different outcomes while in reality they are compatible.

 

Both found that if antivirals are used intensively in small defined populations in combination with personal health measures even pandemic influenza can be halted at least for a while. That is consistent with other observations of the effectiveness of oseltamivir against the pandemic strain.(1)

 

However when scaling up to the macro-level such containment is simply impossible as well as being very resource intensive and exhausting.  That is what was suggested by WHO in April and the UK experience was reported to the Swedish Presidency meetings in July 2009 which led to the abandonment of containment policies in Europe.(2,3)

 

It had been pointed out in the UK by their official evaluation that containment was never part of the original plan.(4)

 

Whether or not to use antivirals in a pandemic remains a controversial area. In some EU countries it was policy to offer them to all people when they developed symptoms, in others only to those at higher risk of severe disease and in yet others to confine their use to those ill enough to require hospital treatment.

 

Dilemmas for clinicians were that it is generally agreed that to be effective antivirals had to be given early, hence waiting for someone to become very ill was risky. Equally the policy of giving treatment to only those in the risk group was confronted with the fact that around 30% of those who eventually died from the pandemic infection were outside any risk group.(5) 

 

 

Of course, limiting the spread of the virus isn’t the only measure of the effectiveness of chemoprophylaxis. 

 

The aggressive use of antivirals in some communities may have reduced pandemic morbidity or mortality, but without a uniform surveillance and reporting system (and definition of `flu-related fatality’), it is exceedingly difficult to judge.

 

No doubt, some group of researchers is working on that weighty problem, and in time we may have a better idea of how antiviral use affected these numbers.

 

The pandemic of 2009 will no doubt end up being the most studied pandemic in history (up to now). 

 

Over time we should end up with a better understanding of what mitigation strategies worked best under which circumstances.

 

It is unlikely, however, that we will find a `one-size-fits-all’ solution.

Fitness Of Oseltamivir-Resistant A/H1N1/2009

 

 

 

# 4952

 

 

Last night CIDRAP posted a summary of a PLoS Pathogens study in their nightly newsscan that has the potential, at some point, to become a significant story.

 

A brief excerpt, followed by some comments on my part.

 

Study: Tamiflu-resistant 2009 H1N1 passes fitness tests

Trials to assess the pathogenicity and transmissibility of oseltamivir-resistant 2009 H1N1 viruses in mice and ferrets suggest that the resistant strain is as fit as counterparts that are sensitive to the drug, according to Japanese researchers. The group, which includes Dr Yoshihiro Kawaoka, a virologist from the University of Wisconsin at Madison, reported their findings in PLoS Pathogens . .  .  .

Aug 26 PLoS Pathogens abstract

 

 

The entire study is titled:

 

Characterization of Oseltamivir-Resistant 2009 H1N1 Pandemic Influenza A Viruses

Kiso M, Shinya K, Shimojima M, Takano R, Takahashi K, et al. (2010) Characterization of Oseltamivir-Resistant 2009 H1N1 Pandemic Influenza A Viruses. PLoS Pathog 6(8): e1001079. doi:10.1371/journal.ppat.1001079

 

And as the CIDRAP piece explained, the authors looked a the fitness (ability to replicate, compete, and transmit) of oseltamivir (Tamiflu) resistant novel H1N1 viruses compared to non-resistant strains.

 

For now, the good news is that the 2009 H1N1 virus remains overwhelmingly sensitive to Tamiflu.

 

But of course, the same could have been said about the old seasonal H1N1 virus back in 2006-2007, when 99% of isolates tested showed good sensitivity to oseltamivir.

 

Resistance is generally caused by a mutation, known as H274Y, where a single amino acid substitution (histidine (H) to tyrosine (Y)) occurs at the neuraminidase position 274.

 

Back in 2007, the belief was that the mutation that made the virus resistant to Tamiflu (H274Y), also reduced its biological fitness – suggesting that mutated versions of the viruses were unlikely to spread widely.

 

But those hoped dimmed when, by the end of the 2007-2008 flu season,  nearly 13% of H1N1 isolates tested the United States were resistant to the drug.

 

Jump ahead to December of 2008, and nearly all seasonal H1N1 isolates tested around the world carried the H274Y mutation that conferred Tamiflu resistance.

 

The CDC was forced to issue major new guidance for the use of antivirals for the second time in just three years (see CIDRAP article With H1N1 resistance, CDC changes advice on flu drugs).   

 

The `replacement’ 2009 pandemic virus, that supplanted the largely resistant seasonal strain, was fortunately both relatively mild and sensitive to Tamiflu. 

 

But over the past 16 months, several hundred scattered cases of Tamiflu resistance have been detected, including in a couple of clusters, raising the specter that someday this new strain of H1N1 could become resistant as well.

 

Earlier this summer, part of the mystery of how the old seasonal H1N1 developed resistance and still managed to transmit efficiently was revealed when researchers identified two "pre-adaptive mutations” that helped pave the way for the H274Y strains to spread (see Caltech: How Seasonal Flu Gained Tamiflu Resistance).

 

Today’s study shows that while still limited in the wild, the mutated 2009 H1N1 virus demonstrates biological fitness, and replicates and spreads efficiently in mice and ferrets.

Post mortem exams of ferrets used in this study also show no reduction in pathogenicity of the mutated virus.

 

Leading the authors to state:

 

Our findings highlight the possibility that NA H274Y-possessing oseltamivir-resistant 2009 H1N1 pandemic viruses could supersede oseltamivir-sensitive viruses, as occurred with seasonal H1N1 viruses.

 

Since novel H1N1 is already resistant to the older amantadine-class (M2 ion channel blockers) antivirals, the loss of these newer neuraminidase (NA) inhibitors (oseltamivir and zanamivir) would be a serious blow.

But not as serious as it would have been before a vaccine was available. Today, unlike a year ago, we have the ability to substantially (not 100%, of course) protect against this virus. 

 

And it is almost always better to prevent a disease than to try to treat one.

 

Antibiotics and antivirals are fleeting victories against rapidly evolving pathogens at best, since from the minute they are introduced, nature begin to work on ways to defeat them.

 

Once again, from the study’s text:

 

The widespread administration of oseltamivir, and to a lesser extent zanamivir, will clearly contribute to the emergence of NA inhibitor-resistant viruses that retain optimal replication fitness and transmissibility in humans. 

 

The authors note that in vitro and in vivo experiments on two experimental drugs- CS-8958 and favipiravir – suggest these may be candidates to deal with 2009 H1N1 line of viruses in the future.

 

For some earlier essays on the H274Y mutation, you might wish to check out:

 

NIH: Rapid Development Of Antiviral Resistance In Two Cases

WER Review: Oseltamivir Resistance In Pandemic H1N1

NEJM: Community Cluster Of Tamiflu Resistant H1N1

Indonesia: H5N1 Infected Chickens Sold At Market

 

 

# 4951

 

 

Back in the late 1920s my grandfather kept chickens in the backyard.   Every Sunday morning he’d tell my Dad (who was a young boy at the time) to go out back and grab the sickliest looking bird for their Sunday meal.

 

It was a pragmatic decision back then, given the lack of refrigeration.  And, of course, bird flu wasn’t a concern. 

 

But today, sickly chickens are viewed somewhat more suspiciously, at least in regions where bird flu is endemic. 

 

At least, that’s what we expect to happen.

 

But a story today from ANTARA news tells us that there are exceptions to that practice.  A poultry vendor in East Java, Indonesia who had 60 chickens die suddenly last week, admits he sold the fresh carcasses to a wet market.

 

He claims he thought the birds died of a `normal sickness’, and so he didn’t report it to the authorities.  Later his dead birds were tested and found positive for H5N1 bird flu virus.

 

 

Bird flu-infected chickens sold in E Java

Monday, August 30, 2010 20:44 

Pamekasan, Ewat Java, Aug 30 (ANTARA) - A local chicken seller admitted that he sold 30 of 60 dead chickens to a wet market in Pamekasan district, East Java Province, recently.

 

About 60 chickens of Sofiullah, a resident of Bugih village, East Java, died of bird flu on August 24 but he did not immediately report this to local veterinary authorities.

 

Speaking to newsmen here Sunday, Sofiullah said he did that because he thought that they died of normal sickness. "I had even sold thirty or sixty dead chickens to the market," he said.

(Continue . . . )

 

 

The matter-of-fact reporting of this case, and the focus of the reporter on the stability of poultry prices in the region, suggests that this sort of thing may be more commonplace than we might suspect.

 

Alerting the authorities that your chickens are sick or dying is undoubtedly bad for business, even if some form of compensation is offered. So it isn’t unusual to hear of a certain amount of reluctance on the part of bird owners to cooperate.

 

The good news is, just because infected birds entered the food chain, that doesn’t necessarily mean that anyone will get sick.

 

Given the wide geographic spread of the bird flu virus, it is likely that Infected chickens are sold, prepared, and eaten in countries around the world every day.

 

It is a testament to how difficult it is for people to contract H5N1 that we don’t have more human cases than we do.

 

Still, handling and consuming infected birds is not without risk, and public health officials will no doubt be keeping an eye on local clinics and hospitals in the area in case human cases show up.

Inappropriate Use Of OTC Medicines In Children

 

 

# 4850

 

 

From the International Pharmaceutical Federation’s (FIP) conference in Lisbon, Portugal (Aug 28th-Sept 2nd), an illuminating press release on a paper to be presented today on the widespread parental misuse of over-the-counter (OTC) medicines for children.

 

A research team led by Dr. Rebekah Moles of the University of Sydney, New South Wales, reports that the inappropriate use, and incorrect dosing of OTC meds lead to a large number of accidental drug poisonings each year.

 

Running through a  variety of scenarios, nearly 100 adult caregivers were asked to decide what OTC medicines were appropriate for a child given their symptoms, and asked to measure out an appropriate dose.

 

 

A brief excerpt from the press release outlining the abysmal results follows.  By all means, click the link to read it in its entirety.

 

 

Widespread parental misuse of medicines puts children at risk

(Excerpt)

Common OTC medicines were made available, together with different types of dosing devices, including household spoons. Participants then chose whether or not to give a medicine, at what stage, and at what dose. They were asked to measure the dose for the researchers. Because doses for children are often small, the risk of getting the measurement wrong is greatly increased, the researchers say.

 

"Taking all the scenarios together, 44% of participants would have given an incorrect dose, and only 64% were able to measure accurately the dose they intended to give. We found that 15% of participants would give a medicine without taking their child's temperature, and 55% would give medicine when the temperature was less than 38 degrees", said Dr. Moles. Paracetamol was the preferred treatment, even for coughs and cold, and was used most often – 61% of the time – despite the child having no fever. Only 14% of carers managed the fever scenario correctly.

(Continue . . .)

A Tough Week Ahead For Emergency Planners

 

 

 

# 4849

 

 

As Hurricane Earl ramps up in the eastern Caribbean, forecasters and emergency operations agencies all along the Atlantic seaboard have a difficult week ahead.

 

This morning, the official track from the NHC takes the storm close to, but just off shore from, the eastern coast of the United States as a major hurricane. 

 

Close enough that portions of the coastline are within the cone of forecast uncertainty.

 

 

With the Labor Day weekend ahead, considered to be the last hurrah of the summer for many visitors to the eastern shore, the stakes for getting this forecast right are understandably high.

 

The good news is, the worst of the weather in a tropical system generally remains to the right of the storm, and in this case, should remain off shore.

 

The bad news is, computer models continue to run the storm up the eastern seaboard; close enough to pose a danger, but far enough out that it could easily spare the area entirely.

Making this a difficult forecast indeed.

 

And an unenviable week for emergency planners as well, who must decide at least 48 hours in advance whether to pull the trigger and issue evacuations or other local warnings.

 

A thankless job, particularly if they err on the side of caution, and the storm stays out to sea.

 

Be glad this isn’t your call to make.

 

Although most of the computer models keep Earl offshore, they waver and change with every run (usually twice daily), and a few put the storm uncomfortably close to the coast in 96 to 120 hours.

 

I’m not going to get into `model wars’ (a favorite pastime on the hurricane forums), or in speculating whether this storm affects the U.S. coastline.

 

It is enough to acknowledge that sections of the coast lie within the cone of forecast uncertainty.  Which no doubt will have a lot of planners burning the midnight oil the next couple of nights.

 

 

And on the heels of Earl, we are likely to have Fiona threatening the Leeward Islands by week’s end, although it is too soon to know where she goes after that.

 

Which means that – no matter where you live along the Gulf or Atlantic Coastlines (and inland for hundreds of miles) – you need to be watching developments in the Caribbean and taking steps to prepare should one of these storms head your way.

 

This from FEMA.

 

Hurricane Season 2010

FEMA is urging residents to be prepared for their personal safety and survival in case a hurricane threatens their community. To assist in these efforts, FEMA, along with the National Oceanic and Atmospheric Administration, is helping to raise awareness of steps that can be taken to help protect citizens, their communities and property.

Be Prepared for 2010

• Take Action – Get a Kit
• Weather Radios
• Hurricane Preparedness from Ready.gov (PDF 27KB, TXT 6KB)
• The Disaster Declaration Process (PDF 278KB, TXT 6KB)
• Hurricane Season and Flooding (PDF 278KB, TXT 4KB)
• Inland Flooding (PDF 30KB, TXT 4KB)
• Preparing for Your Pets (PDF 30KB, TXT 7KB)
• Use of Social Media Tools (PDF 106KB, TXT 12KB)

Some Assorted Bird Flu Reports

 

 

 

 

# 4848

 

 

Late summer is generally a quiet time for bird flu reports, as the H5N1 virus tends to spread more easily during cooler weather.

 

Still, Egypt has reported two human infections in August, and a lack of timely reporting out of China and Indonesia doesn’t exactly guarantee that all is quiet in those countries.

 

So - even in these dog days of August - we keep our eyes open for reports that either suggest or confirm bird flu, even if many of these stories appear relatively minor.

 

With that in mind, a small selection of bird flu reports from the past couple of days, gathered by newshounds in Flublogia.

 

Ida at the Bird Flu Information Corner - a joint effort between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has a pair of stories this morning.

 

Meulaboh, Aceh ::: Meulaboh’s chickens test positive bird flu.

Meulaboh – Chickens in Seuneubok village, kecamatan (sub-district) Johan Pahlawan, Meulaboh, West Aceh found to have suddenly died since Friday (27/8).

 

Further investigation by Participatory Disease Surveillance and Response (PDSR), Agriculture of Livestock Service West Aceh confirmed those chickens died of bird flu H5N1.

 

Control measures had been taken by burning and burying dead chickens, also by culling the survivors.

Source: Indonesia local newspaper, Serambi News.

 

A little geography for those unfamiliar with the area.

 

Meulaboh is the capital of the West Aceh Regency, Indonesia and was among the hardest hit areas by the 2004 Indian Ocean earthquake.

 

 

Indonesia ::: Forty percent bird flu victims in Indonesia are children

National Committee of Avian Influenza Control and Influenza Pandemic Preparedness (Komnas FPBI) recorded forty percent of 160 bird flu victims in Indonesia are children.

 

This was stated by Communication Specialist Staff, Arie Rukmantara in Padang, West Sumatera, Sunday (29/8) at a meeting of animal and human bird flu information dissemination for West Sumatera authorities.

 

“Data was taken from 2006 to 2009. Of forty percent cases mostly occurred in Jakarta, Banten and Surabaya,” said Arie.

 

Source: Indonesia TV news, Metro News.

 

Not exactly a surprising result, given that in the relatively brief history of H5N1, the virus has shown a decided predilection for the young. 

 

It isn’t known whether this pronounced shift towards younger victims is due to physiological, societal, or environmental reasons (or perhaps, a combination of factors).

 

 

 

Dutchy, posting on FluTrackers, has the following (somewhat confusing) item from China’s People’s Daily.  

 

While calling this outbreak in the Mongolian Capital `Bird Flu’, it also references `Newcastle’, which is a different type of avian disease entirely. 

 

Machine translations are often difficult to decipher, so we’ll probably need to wait for additional reports to get a better feel for what is going on in Ulan Bator.

 

 

Bird flu outbreak in Mongolian capital of Ulan Bator
on the August 30, 2010
 
People's Network in Ulaanbaatar on August 30 (Xinhua Robert Footman), according to local media reports, the Mongolian capital of Ulan Bator-uul District 13, Area 27, a poultry farm confirmed bird flu. 28, Khan uul District, Area 13, the Government decided the area around the implementation of martial law there is an outbreak, local emergency office set up emergency headquarters, and to disinfect the affected areas, testing and other prevention work.

 

It was reported recently discovered that some of the farm raising chickens died due to unknown reasons, the epidemic prevention departments to conduct blood tests on 50 chickens to determine the chickens infected with avian flu as "Newcastle (Ньюкасл)" caused by the virus. Mongolia Emergency Committee today held a meeting to study the outbreak response.

 

 

Lastly, a small blurb appeared in my RSS feed this morning reporting that in the wake of recent bird flu reports out of Egypt, Bahrain has raised their bird flu alert level.

 

Bahrain on the alert for bird flu

 

Frankly, this is such a generic report, devoid of any real detail, that it could easily be a `phantom’ story from the past.  We get those occasionally, regurgitated from the news archives, and stamped with today’s date.

 

Pending  corroboration, my confidence in the age of this report is fairly low.

 

While bird flu reports have been on the back burner for the past year or so, it is worth remembering that H5N1 remains in Pre-Pandemic Phase III.  

 

 

Outbreaks occur primarily in birds, but sporadic widely scattered human cases are reported as well, particularly in Indonesia and Egypt.   Most (but not all) have been linked to close contact with infected poultry or birds.

 

The virus has yet to adapt well enough to human hosts to transmit effectively between people, although scientists still worry that the virus could mutate into a pandemic strain someday.

Puerto Rico Dengue Week 31: Cases Back On The Ascendant

 

 

 

# 4847

 

 

After a brief downward blip in the number of reported cases of Dengue Fever in Puerto Rico last week (reporting week 30), this week’s surveillance numbers are back on the rise again.

 

 

 

As indicated by the chart above, the number of cases currently being reported are running at rates more than 4 times above the epidemic threshold, and the yearly total is on target to exceed that seen during the big 1998 epidemic.

 

1998 Epidemic – MMWR November 13, 1998 / 47(44);952-6 http://tinyurl.com/3ae6vdd

Roughly 9800 cases of suspected dengue were reported through the end of August, 1998.  This year, the number of suspected cases is roughly 9,700 through early August.

 

The sudden drop in cases detected in 1998 was due to Hurricane Georges interrupting surveillance efforts/ 

 

With heavy rains likely to spread across the island over the next couple of days courtesy of hurricane Earl, the island’s mosquito control efforts could well grow more challenging over the coming weeks.

 

The height of the Dengue season on the island is normally September through November  - which corresponds with the rainy season.

 

You can find the latest weekly Dengue Surveillance Report HERE and will find more information in the recent MMWR report:

 

Notes from the Field: Dengue Epidemic --- Puerto Rico, January--July 2010

Weekly

July 23, 2010 / 59(28);878

For an extensive list of my blogs on Dengue and Mosquito Borne Diseases you can select the DENGUE Quick Search here,  on my sidebar.

Keeping An Eye On The Atlantic

 

 

UPDATED:  0840 EDT 08/29

Earl has been upgraded to a hurricane. 

 

 

# 4846

 

 

Although the Atlantic Hurricane season has been relatively quiet up until now, the tropics have awakened in the past week and we are watching a hurricane (Danielle), an intensifying tropical storm (Earl), and an impressive looking area of suspicion.

 

 

Danielle, which briefly reached CAT 4 strength earlier this week, has weakened and is headed for a cold watery death in the north Atlantic.

Earl is expected to reach hurricane strength later today, and is an immediate threat to Puerto Rico, the Virgin Islands, and parts of the northern Leeward chain of islands.

 

 

Later in the week, Earl may even pose a threat to the U.S. mainland as a major (CAT 3 or greater) hurricane, although it is far too early to tell.

 

Right now, the tropical storm-force wind field forecast shows only about a 20% probability for the mid-Atlantic coastline 5 days out.   These forecasts are subject to change and refinement, so interested parties need to check them every day.

 

Lastly, the area of disturbed weather in the far eastern Atlantic is following roughly the same path as Earl, although it is too early to know if it will pose a threat to the islands.

 

These tracking maps are likely to become very busy over the next 60 days as we traverse the peak of the hurricane season.   You can follow the latest tropical developments on the National Hurricane Center’s website or by following the @FEMA on Twitter.

 

May was National Hurricane Preparedness week, and during that month this blog devoted considerable time to the subject.  A few of my blogs on the subject included:

A Hurricane Reality Check

Hurricanes and Inland Flooding

Why I’ll Be Gone With The Wind

Storm Surge Monday

You Don’t Have To Live On The Coast

 

Everyone should have a preparedness plan, of course.

 

But if you live anywhere within a few hundred miles of the the Atlantic or Gulf Coasts - given the time of year – it makes sense to get those plans in order now.

 

Some essential hurricane resources to get you started include:

 

http://www.fema.gov/hazard/hurricane/index.shtm

 

http://www.ready.gov/america/beinformed/hurricanes.html

Referral: Crof On Pakistan

 

 

 

# 4845

 

Like many of you, I’ve been watching the unfolding disaster in Pakistan with a heavy heart.   Crof has devoted a good portion of his blog space to this tragedy these past few weeks, along with Chen Qi.

 

Last night Crof wrote extensively on why a massive flood in a faraway land should matter to us, and the ways this disaster could influence the future of that region for decades to come.  

 

Highly recommended.

 

Thinking about Pakistan

Concerns Over H3N2 In Vietnam

 

# 4844

 

 

At about the same time that the pandemic H1N1 virus began its rapid spread around the world, reports of an antigenically drifted version of seasonal H3N2 appeared as well (see Who Knew? New Flu).

 

 

This new strain, dubbed A/Perth/16/2009-like H3N2 virus, failed to compete successfully with the emerging pandemic strain, and really hasn’t circulated widely over the past 12 months. 

 

It has, however, continued to show up in scattered surveillance reports from parts of Africa, Asia, and South America.

 

Analysis of this new H3 virus  suggests that exposure to earlier H3N2 viruses – or even taking last year’s seasonal flu vaccine - is unlikely to convey much (if any) immunity to this new strain.

 

And H3N2, unlike the recent H1N1 virus, is no respecter of age, and so it is likely to affect those over 65 as well as younger patients.  

 

The good news is that this year’s seasonal flu vaccine contains antigens against this new strain.

 

Whether this H3N2 virus ends up having a big impact on this year’s flu season is impossible to know right now.

 

But the fact that immunity to this strain in the community is probably very low, and the virus continues to circulate, suggests that it might.

 

The CDC released a HAN (Health Alert Network) Message earlier this month on the recent detection of H3N2 in the United States called Seasonal Influenza A (H3N2) Virus Infections.

 

 

Which brings us to a report out of Hanoi, Vietnam (courtesy of the incredibly hard working  Arkanoid Legent) on the level of H3N2 influenza cases they are currently seeing.

 

This from the Saigon Daily.

 

 

Doctors concerned about likely expansion of H3N2 flu virus in Hanoi

 

Saturday ,Aug 28,2010, Posted at: 17:41(GMT+7)

Medical workers fretted that seasonal H3N2 flu virus continued to be widespread in Hanoi and the disease is likely to erupt into epidemic.

 

Seasonal influenza viruses, H1N1 and H3N2, flow out of overlapping epidemics in Vietnam. Meanwhile H1N1 has been controlled, most influenza infections this season have been attributed to influenza A (H3N2) viruses.

 

According to Dr. Nguyen Hong Ha, deputy director of the National Institute of Infectious and Tropical Diseases, there has been an increase of H3N2 patients. The hospital receives over 130 people suffering from the flu a day, doubling the number of last weeks.

(Continue . . . )

 

 

While reports of H3N2 over the past year have been sporadic, and widely scattered.  A few blogs on these reports from the past couple of months include:

 

Singapore: H1N1 No Longer Dominant Strain

Global Flu Activity Update

Transitions: 3 Global Snapshots Of Flu Activity

Flu: Down, But Not Completely Out

Recent Media Reports On Solar Maximum

 

 

 

# 4843

 

 

Twice over the past few months I’ve written about the concerns that  FEMA and NASA, along with a host of other agencies and governments, have voiced about potential damage a severe solar storm might cause to our high-tech infrastructure.

 

NASA Braces For Solar Disruptions

A Carrington Event

 

While sounding a bit like science-fiction, in truth large and potentially disruptive solar storms do occur on rare occasions – usually at the time of a solar maximum.

 

The next solar maximum is due in 2012-2013, and some scientists have suggested this could be a particularly active cycle. 

 

Some have gone so far as to suggest we could see a flare as big as 1859’s `Carrington Event’ (described here), or the somewhat lesser event of 1921. 

 

Both were strong enough, that were they to happen today, would likely cause serious damage to parts of our electrical infrastructure.

 

NASA, while admitting that a serious solar storm could happen practically anytime, also cautions that the next big one could be many decades away. It is a genuine threat, they say, but the timing is impossible to predict. 

 

In 2009 the National Academy of Sciences produced a 134 page report on the potential damage that another major solar flare could cause in Severe Space Weather Events—Understanding Societal and Economic Impacts.

 

You can read it for free online at the above link. 

 

Last year Space.com produced a spectacular 18 minute video entitled Attack of the Sun, which may be viewed on YouTube.

 

 

Which brings us to some slightly frantic news reports that appeared this week – inspired by an article that appears in Australasian Science by David Reneke called Huge Solar Storms to Impact Earth.

 

Typical is the report from news.com.au that proclaims:

 

Sun storm to hit with 'force of 100m bombs'

 

 

Admittedly, these sorts of disaster headlines sound a bit like a `Scarrington’ event to me, but the point is to draw the reader’s attention to the story, and here I suppose the headline succeeds admirably.

 

The body of the article is a bit more grounded, and provides an entertaining and interesting overview of the concerns being voiced by some astronomers about the upcoming solar max.

 

As you might imagine, this threat has been picked up and greatly amplified by a number of prophesy/ Mayan 2012/ End-of-the-World websites, which tends to dilute it’s legitimacy in many circles.

 

But astronomers know that our sun is a variable star, and it goes through many major, and minor cycles. The best documented of these is the 11-year/22-year sunspot cycle.

 

Roughly every 11 years (it runs anywhere from 9 to 14 years), the sun experiences a magnetic pole shift at the time of solar maximum – a period of high sunspot and solar flare activity.

 

Every 22 years, the cycle completes, and the poles return to their `original’ position.

 

Our sun has, since 2006, been in a solar minimum or quiescent phase.   Very few sunspots and solar flares.

 

The next solar maximum was predicted to occur in 2012, but the sun’s sunspot activity remains low, and so now NASA is looking more towards 2013. 

 

This from science.nasa.gov.

 

As the Sun Awakens, NASA Keeps a Wary Eye on Space Weather

 

June 4, 2010: Earth and space are about to come into contact in a way that's new to human history. To make preparations, authorities in Washington DC are holding a meeting: The Space Weather Enterprise Forum at the National Press Club on June 8th.

 

Many technologies of the 21st century are vulnerable to solar storms. [more]

 

 

Solar flares the size of 1859’s  `Carrington Event’ don’t happen very often, and in order to affect earth, the flare or CME (coronal mass ejection) must be pointed towards our planet (or where the earth will be when it arrives 2-3 days later).

 

Still, in 1989 a geomagnetic storm fried several large power transformers in Quebec, causing a province-wide blackout.

 

And in 2003, a number of satellites were severely damaged by an extremely powerful CME which also caused some power outages in Europe.

 

Over the past couple of decades we’ve become increasingly dependant upon computers, the Internet, cell phones, electronic devices, and of course . . . the electrical grid.

 

Systems that are considered vulnerable to unusually severe geomagnetic storms.

 

While imbued with a certain degree of hyperbole, the media reports this week aren’t without scientific merit, although the immediacy of the threat is far less certain.

 

As I’ve stated before, another `Carrington Event’ may not happen in our lifetime, or it could happen within the next few years.

 

No one knows.

 

Since National Preparedness Month (NPM10)  is just a week away, it is a good time to remind my readers that:

 

If you are well prepared for an earthquake, a hurricane, or a pandemic . . . you are automatically in a better position to weather the disruptions caused any disaster . . . including something as rare as a catastrophic a solar storm.

 

Preparing is easy.  Worrying is hard.

 

Some resources to get you started on the road to `all threats’ preparedness include:

 

   FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

Federal Appeals Court Rejects Vaccine-Autism Link

 

 

 

# 4842

 

Yesterday a Federal Appeals court upheld an earlier vaccine court decision (Cedillo v. Secretary of Health and Human Services) that determined there is little if any evidence to support claims of a vaccine-autism link.

 

 

In the previous ruling (2009) Special Master Denise Vowell wrote that the evidence of any link  "is weak, contradictory and unpersuasive.”

 

In it’s ruling yesterday, the appeals court wrote “we have carefully reviewed the decision of the special master and we find that it is rationally supported by the evidence, well-articulated, and reasonable.”

 

While this won’t end the legal battles for compensation (more test cases are on the docket), this is another in a long series of setbacks for those who maintain a link exists between vaccines and autism.

 

The court’s ruling can be read in its entirety at this link.

 

 

Additional coverage of this story can be found at:

 

Autism-Vaccine Link Rejected by Appeals Court

 

Appeals court rejects autism vaccine link

 

Court finds no link between vaccines, autism

Referral: Katrina Preparedness Advice

 

 

# 4841

 

 

 

On the five year anniversary weekend of Hurricane Katrina’s New Orleans and gulf coast landfall, John Solomon, editor of the In Case of Emergency blog brings us an impressive compendium of hurricane preparedness and evacuation advice collected by the New Orleans Times-Picayune.

On Katrina 5th Anniversary, A Compelling & Useful List Of Preparedness Tips, Lessons Learned From The Hurricane Survivors Themselves

August 28th, 2010 ·

 

Even if you don’t live in `hurricane country’, these tips are food for thought, and could apply to other disaster scenarios.

 

Well worth taking the time to review.

EMA To Review Pandemrix Vaccine

 

 

# 4840

 

 

The EMA (European Medicines Agency) is a London based EU regulatory agency that is responsible for the scientific evaluation of drugs developed by pharmaceutical companies for use in the European Union. 

 

It is roughly the EU equivalent to the United State’s FDA.

 

Today the EMA announced that they will review GSK’s Pandemrix vaccine to see if they can ascertain any causal link between it - and reports of unusual occurrences of narcolepsy – mostly in children, reported in Sweden and Finland  (see Finland Suspends Use of Pandemrix Vaccine) in recent days.

 

For now, no causal link has been established and the number of reported cases of narcolepsy (which afflicts several thousand  Europeans each year) remains small. 

 

Still, the number of cases among recently vaccinated children has been sufficient to raise concerns, and an investigation will be conducted.

 

 

The EMA press release (h/t Ironorehopper on FluTrackers) provides additional details.

 

 

European Medicines Agency starts review of Pandemrix

The European Medicines Agency has launched a review of Pandemrix on the request of the European Commission to investigate whether there is a link between cases of narcolepsy and vaccination with Pandemrix. A limited number of cases was reported, all collected through spontaneous reporting systems, mainly in Sweden and Finland. Pandemrix, an influenza vaccine, has been used since September 2009 for vaccination against H1N1 influenza in at least 30.8 million Europeans.

 

Narcolepsy is a rare sleep disorder that causes a person to fall asleep suddenly and unexpectedly. Its precise cause is unknown, but it is generally considered to be triggered by a combination of genetic and environmental factors, including infections.

 

Although the cases of narcolepsy have been reported in temporal association with the use of Pandemrix, it is at present not known if the vaccine caused the disorder. The Agency’s Committee for Medicinal Products for Human Use (CHMP) will look carefully at all of the available data to determine whether there is evidence for a causal association. As part of this evaluation the Committee will also consider the so-called background rate for narcolepsy, i.e. the number of cases that would normally be expected to be diagnosed.

 

The Committee will be working with experts from across the EU to assess this possible safety concern and any impact on the benefit risk balance of Pandemrix. The Committee will consider at its September 2010 meeting the need for any provisional measures pending completion of the evaluation.

 

The Agency is also liaising with the European Centre for Disease Prevention and Control (ECDC), international regulatory partners and the World Health Organization (WHO).

 

The European Medicines Agency will provide updates as new information becomes available.

Notes:

1. On 24 August 2010, Finland’s National Institute for Health and Welfare recommended that vaccination with Pandemrix be discontinued until the suspected link with narcolepsy is thoroughly evaluated.
2. Pandemrix has been authorised in the European Union since September 2009. The vaccine was extensively used during the 2009 (H1N1) pandemic, with at least 30.8 million Europeans vaccinated.

 

 

 

The Pandemrix vaccine was an adjuvanted monovalent pandemic H1N1 shot, and as such, was not licensed for use in the United States.

UK Study: PCV7 Vaccine Success Story

 

 

# 4739

 

 

 

Given the nearly constant vitriol spewed on the internet by activists railing against the use of vaccines, it is worth giving the other side a bit of the spotlight from time to time.   

 

The PCV7 (pneumococcal conjugate vaccine) was introduced in the United States for children in early 2000, and was designed to help prevent 7 common types of pneumococcal infection found in the United States.

 

This year, the new PCV13 replaces the original PCV7, and adds coverage for 6 more types of pneumococcal bacteria. 

 

The CDC has a factsheet on this new vaccine.

 

While this vaccine doesn’t prevent all types of pneumococcal infections, according to the CDC the introduction of the PCV7 vaccine in the United States has reduced the rate of severe pneumococcal disease by nearly 80% among children under the age of 5.

 

The UK introduced the PCV7 vaccine in 2006, after seeing an unexpected increase in hospitalizations for bacterial pneumonia and empyema (infection and pus in pleural space) among young children.

 

Today we’ve a study showing that between 1997 and 2006 the rates of childhood bacterial pneumonia and
empyema hospital admissions in the UK were steadily increasing, and then began to decrease (by 19% and 22%, respectively) after the inclusion of the PCV7 vaccine into their national immunization program in 2006.

 

While not a panacea for pneumococcal disease, these results do show genuine progress is being made, and the hopes are that the new PCV13 will make further strides in the reduction of morbidity and mortality due to these bacterial infections.

 

The study is titled:

 

Impact of the seven-valent pneumococcal conjugate vaccination (PCV7) programme on childhood hospital admissions for bacterial pneumonia and empyema in England: national time-trends study, 1997 – 2008

Elizabeth Koshy, Joanna Murray, Alex Bottle, Mike Sharland, Sonia Saxena

 

 

You can also read the press release from the Imperial College of London on this study.

 

Vaccine has cut child cases of bacterial pneumonia, says study

The number of children admitted to English hospitals with bacterial pneumonia decreased by a fifth in the 2 years following the introduction of a vaccine to combat the disease

While the PCV7 and PCV13 vaccines are intended for children, I would note that there is an adult 23-valent pneumococcal polysaccharide vaccine (PPSV23) available as well.

 

For several years I’ve urged my readers to talk to their doctors about whether this vaccine is appropriate for them.

 

CDC Issues Pneumococcal Vaccine Recommendations

Seven Steps You Can Take Now To Prepare For A Pandemic

It Doesn't Have To Be Pandemic Flu

 

It isn’t universally recommended by the CDC, but for many people in a variety of risk groups, it can be an important preventative against many causes of secondary bacterial pneumonias.

 

Even if you aren’t sure if you fall into one of the risk groups, you may wish to discuss this option with your family physician. 

Hong Kong Braces For Back-To-School Flu Surge

 

 

 

# 4838

 

 

Although this report is from Hong Kong, the same concerns are likely to emerge in other parts of the northern hemisphere as students return to school for the fall session.

 

Not only do we have the remnants of the 2009 H1N1 pandemic virus still in circulation - we’re seeing reports in some parts of the world of a resurgence of H3N2 – a new strain to which community immunity may be low.

 

Trying to predict how the upcoming flu season will play out usually only serves to underscore the total unpredictability of the virus and our longstanding inability to prognosticate such events.

 

So I’ll not even bother.  

 

What I will say is this year’s trivalent seasonal flu vaccine contains antigens for the former pandemic H1N1 virus, the newly emerging H3N2 Perth virus, along with a B influenza virus. 

 

Which makes it your best bet for reducing your odds of getting the flu this year.   

 

But of course, that only works if you get the shot before you are exposed (keeping in mind it takes a couple of weeks to build immunity).

 

This report from news.gov.hk.

 

 

August 27, 2010

Public Health

Flu outbreaks in new school term expected

Centre for Health Protection Controller Dr Thomas Tsang warns a significant number of flu outbreaks are expected when the new school term begins next week, and the public should also stay vigilant against any possible outbreak of hand, foot and mouth disease later this year.

 

Dr Tsang told the media today Hong Kong is remains in the summer influenza peak season, and the centre has recorded at least 300 isolates of flu virus a week showing the viruses are quite active in the community.

 

He also expects the number of hand, foot and mouth disease cases will rise next month with the peak season starting in October or November.

 

He urged schools, institutions and parents to stay alert and take precautions to prevent outbreak. Schools and institutions should report outbreaks immediately to the centre.

 

Dr Tsang said the pneumococcal vaccination programme for children will start in October at the Department of Health's Maternal & Child Health Centres, using a new vaccine which can prevent the 10 most common types of the disease.

More On the MMWR Influenza Mortality Report

 

UPDATED  with Maryn McKenna’s Post (see bottom)

# 4837

 

 

We’ve a couple of more items of interest revolving around the report issued today by the CDC on influenza-related deaths from seasonal flu (see MMWR: Estimates Of Yearly Seasonal Influenza Deaths).

 

 

First, the CDC has posted a Q&A page on the study, called:

 

Questions & Answers

Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu

 

 

 

And second, Lisa Schnirring of CIDRAP news has an overview of the MMWR report and details from today’s pre-release press conference.

 

CDC's new seasonal flu death estimates reflect disease variability

Lisa Schnirring Staff Writer

Aug 26, 2010 (CIDRAP News) – The US Centers for Disease Control and Prevention (CDC) released new death estimates for seasonal flu today that are designed to move away from a single number and instead take into account the disease's unpredictability and the extra toll inflicted when influenza A H3N2 is the dominant strain.

 

A 2003 CDC estimate of 36,000 flu deaths a year has been used by the media and some researchers as a general benchmark, but some experts have criticized that use of the number, because it is likely to overestimate deaths, given that the estimate is based on flu seasons during the 1990s when H3N2 was the main circulating strain during eight of nine flu seasons.

(Continue. . . )

 

 

The challenge will be in finding ways to portray these revised estimates in the media, since there is no easy `number’ to toss out as has been done so often in the past.

 

Admittedly still a bit rough, but I suppose I’ll try to employ language such as:

 

Most years, influenza-related illness claims tens of thousands of lives in the United States - but that number can vary widely depending on the strain in circulation – along with many other factors.

 

or

 

Over the past 3 decades flu-associated deaths in the United States ranged from a low of about 3,000 to a high of about 49,000 people with the higher numbers seen in years when H3N2 predominated.

 

While these may sound like vague answers, they take into account the extreme variability of influenza, and so they are actually truer depictions of burden of flu-related deaths each year in the United States.

 

They just don’t fit easily into a sound bite.

 

 

UPDATED: 2040hrs EST 8/26

 

Author and journalist Maryn McKenna has weighed in on these new numbers on her Superbug Blog, outlining her concerns over how the media can convey these revised estimates to the public. 

 

As my examples given above prove, it is going to be a bit awkward. But Maryn delves far deeper into the dilemma these numbers present for journalists in:

 

 

New CDC flu numbers: This may not go well