Living With A Pandemic

 

 

# 2434

 

 

 

 

 

We are told, almost on a daily basis, that another pandemic is `inevitable'.  That it could come this year, next year, or perhaps five years from now.

 

Pandemics come, on average, every 30 to 40 years.  Humanity has seen at least 10 pandemics, along with many lesser pseudopandemics, over the past 300 years. 

 

 

It is, quite frankly, just a matter of time before the next one hits.

 

 

And when it hits, we are going to have to find ways to live and work in a pandemic environment.

 

 

An idea that many people hold is that if a pandemic comes, they will simply lock themselves in their homes until it is over.   While this might sound like an attractive strategy, for most people it is an unrealistic goal.

 

 

Pandemics are not short-term events.   They have been known to go on for months, sometimes for years.   

 

 

Few people would be able, financially, to remain sequestered in their homes for months on end.  Fewer still could stockpile enough supplies to tide them over for that length of time. 

 

 

 

The presumption is that a pandemic would come in waves, possibly several of them over a period of a year or two, with each lasting weeks or even months in every community.  

 

 

Schools could be closed for up to 12 weeks at a time.   

 

 

Some businesses, particularly those that involve public gatherings of people, could find themselves temporarily shuttered by order of the public health department.

 

 

Many businesses that remain open may find employee absenteeism seriously compromising their operations. 

 

 

Some people will be sick, others will be taking care of sick loved ones, while others may simply be afraid to come to work out of fear of exposure to the virus.

 

 

While nobody knows just how bad this absenteeism will be, estimates of up to 40% have been mentioned by pandemic planners.  

 

 

That could be low, or it could be high.   We won't know until the next pandemic is over.

 

 

Absenteeism could, of course, lead to supply chain problems.   Remove 40% of a company's employees, even for a short period of time, and production or deliveries of goods is likely to suffer.

 

 

Businesses that depend on goods and services provided by other businesses could find their own operations jeopardized.  The fear is that a cascade effect could be felt throughout the entire global supply chain, and that serious shortages of food and medicines could occur. 

 

 

There could even be interruptions in the power and water supplies, due to absenteeism and fuel delivery problems.

 

 

 

Lest you think the above is simply the ravings of a mad blogger, the HHS on their pandemicflu.gov site warns that:

 

Social Disruption May Be Widespread

• Plan for the possibility that usual services may be disrupted. These could include services provided by hospitals and other health care facilities, banks, stores, restaurants, government offices, and post offices.

 Being Able to Work May Be Difficult or Impossible

• Find out if you can work from home.
• Ask your employer about how business will continue during a pandemic.

Schools May Be Closed for an Extended Period of Time

• Help schools plan for pandemic influenza. Talk to the school nurse or the health center. Talk to your teachers, administrators, and parent-teacher organizations.
• Plan home learning activities and exercises. Have materials, such as books, on hand. Also plan recreational activities that your children can do at home.

Transportation Services May Be Disrupted

• Think about how you can rely less on public transportation during a pandemic. For example, store food and other essential supplies so you can make fewer trips to the store.
• Prepare backup plans for taking care of loved ones who are far away.

Be Prepared

Stock a supply of water and food. During a pandemic you may not be able to get to a store. Even if you can get to a store, it may be out of supplies. Public waterworks services may also be interrupted. Stocking supplies can be useful in other types of emergencies, such as power outages and disasters. Store foods that:

• are nonperishable (will keep for a long time) and don't require refrigeration
• are easy to prepare in case you are unable to cook
• require little or no water, so you can conserve water for drinking

 

 

 

 

 

Much , of course, will depend on the ultimate CFR (case fatality ratio) of the next pandemic, and its attack rate. 

 

A mild pandemic would not be expected to produce such calamitous effects.

 

 

The attack rate is the percentage of people that become sick from the virus.   In 1918, that was limited to only 30%.  

 

In other words, 70% of the world's population, while exposed, never fell ill.

 

The factors that may have led to 70% of the population not coming down with the Spanish Flu are not well understood, nor are they guaranteed to be repeated in the next pandemic. 

 

The CFR, or percent of those who are sickened that die, varied widely in 1918.  Here in the United States, and in many parts of Europe, roughly 1 in 50 died.  

 

In some nations, like India, the number was probably closer to 1 in 10.  And among some aboriginal tribes in New Zealand, the number was 1 in 3.

 

We've seen milder pandemics, of course.  1957 and 1968 were far less deadly.   But 1918 isn't necessarily the worst-possible-case, either.  

 

And as we saw in 1918, the first wave was mild, only to be followed a few months later by a far more lethal second wave.   Things can change quickly in a pandemic.  

 

 

As you can see, a pandemic is a complex, changing, living thing.  

 

 

And we'd better be focusing on how we will meet and adapt to one, if we expect to get through it. 

 

 

 

 

 

I.  The first step is individual preparedness.  

 

Not to hunker down for 3 months, or six, or perhaps a year or longer.  But to take the burden off of relief agencies who will have their hands full trying to help people who were unable to prepare for themselves.

 

As the HHS pandemic site warns:  Even if you can get to a store, it may be out of supplies.

 

 

Being prepared, with a reasonable stockpile of food, water, medicines, and essential items means you can pick and choose when you go out to try to resupply.    

 

If a pandemic is raging in your community, you probably don't want to have to stand in line for hours with hundreds of potentially contagious people, waiting to buy food or medicine.  

 

Having anywhere from 2 weeks to 3 months worth of supplies already in your pantry gives you a lot of options.   The same principal applies to things like prescription medications, water, and other essential supplies.

 

One of the best resources on the web for learning how to prepare for a pandemic, or any other disaster, is  GetPandemicReady.Org.

 

 

Secretary of Health and Human Services Michael Leavitt put it this way earlier this week:

 

 

`We need to continue to use every opportunity to talk about individual preparedness.  Yes the government needs to play a role, at the state, federal and local level . . . but people have a responsibility and it is the aggregate of their actions that will ultimately determine whether we are prepared or not. " - Michael Leavitt  Oct 29th, 2008

 

 

By being prepared, we not only remove a burden from society to help us during a crisis, we free ourselves up to help our friends, our families, and our neighbors.  

 

 

And ultimately, that is what it is going to take to get through a pandemic.  Neighbor helping neighbor.  Friend helping friend.  

 

Communities working together. 

 

 

 

 

 

II.   We need to be prepared to care for ourselves, or our loved ones, at home during a pandemic. 

 

 

The odds that you, or a loved one, will receive treatment at a hospital during a pandemic are probably less than 1 in 20.  

 

Most pandemic plans anticipate that only 5% of those stricken will receive hospital care.    While they talk of admitting only the `sickest of the sick', the truth is, a great many very sick individuals could find themselves turned away from hospitals. 

 

Hospital staffs will likely see high attrition rates due to their constant exposure to the a pandemic virus.   Absentee rates of 40% or more are expected.  

 

The ability of hospitals to care for patients will be dramatically reduced.

 

And it won't just be people with pandemic influenza who will be impacted.   Anyone with medical needs is likely to find the system's ability to deliver timely and effective treatment will be compromised.

 

That means heart attacks, strokes, trauma victims, women in labor, dialysis patients, and a whole range of other patients may find serious challenges in getting care during a pandemic.

 

 

The AMA now recommends that people maintain a `Personal medication supply in times of disaster'.    

 

This new policy supports allowing all patients with chronic medical conditions to maintain an emergency reserve of prescription medications. It also encourages patients to carry a list of current medications and the prescribing physician's contact information with them to ensure continuity of care in the event of a disaster or other emergency.

 

The HHS also recommends you have basic medications and supplies to treat flu victims, such as:

 

 

• Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
• Soap and water, or alcohol-based (60-95%) hand wash
• Medicines for fever, such as acetaminophen or ibuprofen
• Thermometer
• Anti-diarrheal medication
• Vitamins
• Fluids with electrolytes
• Cleansing agent/soap

 

 

Another good resource is Dr. Grattan Woodson's free booklet, available on his website.  Knowing how to deal with pandemic (or even seasonal) influenza in advance, and having the supplies you will need, can be life-saving.

 

Good Home Treatment of Influenza

 

 

The value of taking a first aid, or even an EMT course, cannot be overstated. 

 

And of course, every home should have a well stocked first aid kit!

 

 

 

 

 

 

III.   Businesses and their Employees need to plan on how they can continue to function during a pandemic. 

 

 

We are all interconnected in more ways today than ever before.   Even small businesses that might think of themselves as less than essential, can be important cogs in the functioning of the economy.   

 

While some businesses will undoubtedly have to shut down, or alter their modes of operation,  it is imperative that we keep as much of the economy functioning as possible during a pandemic.  

 

And no, this isn't about profits. 

 

This is about sustainability.

 

The guy who sits behind the counter at the auto parts store might not think of himself as `essential', but if he (or she) isn't on the job then a critical replacement set of brake linings might not be available for an ambulance or a police car.

 

If the corner gas station is closed, the delivery driver can't get fuel.  And if the delivery driver can't get fuel, pharmacies, clinics, and hospitals won't get resupplied.  

 

 

The clerk who processes orders for delivery is every bit as important as the driver who delivers them.   The same can be said for the IT specialist who works in accounts payable, or payroll, or inventory for a corporation.  Take away those functions, and the business grinds to a halt.

 

 

Millions of people who do vital yet unglamorous jobs keep the economy running. 

 

 

And because of that the power stays on, potable water flows through city water systems, ambulances respond, the Internet stays up, and pharmacies are able to dispense medicines.

 

 

Take out enough of these cogs, and the economic machine fails.  

 

And the true costs of that would be measured in lives, not dollars.

 

 

 

Businesses need to be preparing now for the next pandemic, and they need to do so as if their survival depends on it.  For it surely does.

 

 

Few companies could withstand weeks or months of closure. 

 

 

The key is to make workplaces safer during a pandemic, so businesses can continue to operate.    

 

 

No, you can't make any business 100% safe during an infectious disease outbreak, but there are things you can do to reduce the chances of infection. 

 

 

And it not only will protect employees and customers, it may keep you out of court as well.

 

There is an expectation by employees that their employers will provide them a safe workplace.   This covenant, in many countries, is enforced by both civil and criminal law.

 

In fact, here in the United States, OSHA (Occupational Safety & Health Administration) created the following statement of worker's rights nearly 40 years ago.

 

WORKER RIGHTS UNDER THE OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970

---

YOU HAVE THE RIGHT TO A SAFE WORKPLACE. OSHA REQUIRES EMPLOYERS TO PROVIDE A WORKPLACE THAT IS FREE OF SERIOUS RECOGNIZED HAZARDS AND IN COMPLIANCE WITH OSHA STANDARDS.

 

 

Employers take note.   If you haven't spoken to an attorney about your responsibilities and liabilities during a pandemic, it might be prudent to do so.

 

 

To help employers know how to prepare, the Federal government has prepared a number of documents to help employers prepare their workplaces for a pandemic.   These include:

 

 

• Guidance on Preparing Workplaces for an Influenza Pandemic  (PDF - 313 KB) (Occupational Safety and Health Administration)

• Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers (PDF - 405 KB) (Occupational Safety and Health Administration)

• Proposed Guidance on Stockpiling of Respirators and Facemasks in Occupational Settings (Occupational Safety and Health Administration)
• Federal Register Notice on Proposed Guidance on Stockpiling of Respirators and Facemasks in Occupational Settings

 

 

 

Employers may need to work out ways to institute social distancing, work from home solutions, and even provide prophylactic antivirals to high risk employees. 

 

 

The number of potential solutions is only exceeded by the number of likely problems.

 

 

A severe pandemic, when it comes, will present challenges beyond anything that we have ever faced as a society.  We won't have the luxury of hiding away, and waiting for it to pass.

 

As daunting as it may seem, a pandemic is survivable.  

 

Some businesses -the ones that are prepared - may even find ways to thrive in a pandemic.  

 

The choices we make now, before a pandemic strikes, will determine how well we do during a crisis. 

 

But we must make these choices now.  

 

Because once a pandemic has started, our ability and the time we have to prepare, will be severely limited. 

CIDRAP News: Benefits Of Flu Vaccination Debated

 

 

# 2433

 

 

 

Maryn McKenna, writing for CIDRAP News, yesterday brought us an absolutely fascinating look at some of the conflicting studies on influenza vaccines  that were presented at this year's (ICAAC-IDSA) meeting in Washington, D.C.

 

The `science' behind whether or not these vaccines are protective of the elderly, or would substantially reduce the level of illness in society if given to most children, isn't always in agreement.

 

Despite our faith in modern medicine, in reality we are continually learning - and adjusting our ideas - based on this newly gained knowledge.   

 

What we know, or what we think we know, changes over time.

 

While there are, admittedly, gaps in our knowledge - particularly when it comes to the efficacy of vaccinating the elderly against influenza - for most people the yearly flu shot remains their best defense against influenza. 

 

And the evidence is mounting that the Prevnar PCV-7 pneumonia shots for infants and toddlers, along with the PPV-23 pneumonia shot for at-risk adults, can significantly lower mortality and morbidity due to bacterial pneumonia.

 

 

Maryn's article offers us a fascinating look at some of the conflicting studies that were presented this week.

 

I'll only post the opening paragraphs.  Follow the link to read the entire article.   Like everything that Maryn writes, this one is worth reading in its entirety.

 

 

 

 

Benefits of flu vaccination hotly debated

Maryn McKenna Contributing Writer

 

Oct 30, 2008 – WASHINGTON (CIDRAP News) – The benefits conferred by influenza vaccination—to recipients and to their close contacts—were hotly disputed at an international medical meeting this week.

 

Presenters at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy and the 46th annual meeting of the Infectious Diseases Society of America (ICAAC-IDSA) presented abundant but often contradictory evidence regarding flu vaccine's direct and indirect protective abilities.

 

The question whether flu vaccine protects recipients both from developing flu and from serious complications of flu, as well as whether its administration protects contacts of recipients, has been an active research topic over the past year.

 

A study published earlier this month in the New England Journal of Medicine (and placed online in September) found that giving the flu shot to pregnant women lowered both their risk of flu and also the risk for their newborns, who were too young to be vaccinated themselves. Reports in the American Journal of Respiratory and Critical Care Medicine in September and the Lancet in August contended that flu vaccine's ability to protect the elderly from death and from pneumonia has been overstated, and several papers have pointed out that, while vaccination in the elderly has increased, the mortality rate has not declined.

 

Flu vaccine came in for additional critical examination during ICAAC-IDSA, which drew 15,000 people to Washington, DC, and concluded Oct 28.

 

(Continue reading . . .)

FDA Advisory Panel Discussing Merits Of Individual Home Drug Stockpiles

 

 

# 2432

 

 

It is a sticky question, whether to promote the idea of home stockpiling of Tamiflu or antibiotics for use during a pandemic. 

 

Personally, as a responsible adult, and one with a modicum of medical training, I love the idea.  Enough, in fact, that with the assistance of my family physician, I've obtained a small quantity of such medications.

 

But there are legitimate concerns that such individual stockpiles might be misused.  That people may take the meds improperly, or use them for a non-pandemic illness, rather than seeing their doctor.

 

It is an imperfect solution.

 

 

But then, when you are dealing with a pandemic, all solutions are going to be imperfect.  

 

We need to get used to that concept.

 

 

In St. Louis,  the CDC in conjunction with the Missouri Health Department, conducted a test where med kits containing CIPRO were distributed to thousands of selected households, and then at a later date, they were asked to return the medkits.

 

Participants belonged to three cohorts;1) clients and some employees of a community health clinic; 2) corporations; and 3) first responders.

 

The results (from the CBN Report):

 

 

• 97% (3,946 out of 4,076) of all study respondents returned the MedKits upon completion of the study, and 99% of the returned MedKits were intact (i.e. no pills missing).

 

• 130 (3%) of households did not return the MedKits; 125 of these could not find their MedKits, and 5 refused to return them. Only 4 households, all in the clinic cohort, reported having used their MedKits.

 

• 94% or more in each cohort indicated they would like to have a MedKit in their home.

 

• Approximately 85% indicated they would be willing to pay for a MedKit, for a price, on average, of about $23 per person

 

 

 

While the participants of this study may not be representative of the population at large, this study does show that responsible home stockpiling of medications is  possible.

 

 

And given the logistics of dispensing life saving medications during a public health disaster, such as a bioterrorism attack or a pandemic, having pre-positioned medkits in homes around the nation would solve a lot of problems.

 

 

A panel is currently discussing these issues, and will forward their advice to the FDA, who would have to approve of any Medkit before it could be dispensed.

 

 

 

 

U.S. questions home drug stockpiles for flu pandemic

 

Updated Thu. Oct. 30 2008 8:16 AM ET

The Associated Press

BETHESDA, Md. -- Should people be allowed or even urged to buy and store in their homes flu drugs for use in an influenza pandemic? The U.S. government, which has been grappling with how to distribute antiviral drugs in the anticipated chaos of a pandemic, believes the idea bears exploring.

 

But discussions Wednesday of a panel of experts convened to advise the U.S. Food and Drug Administration on the idea showed just how many sticky issues are enmeshed in the proposal to allow pharmaceutical companies to sell "flu medkits."

 

Concerns were raised about whether people could be trusted to store and use the drugs appropriately and whether misuse might fuel the development of resistance to the few influenza drugs on the market. Some experts worried whether parents would be able to gauge the amount of drug their children would need and mix a solution - by breaking open capsules - based on the child's weight.

 

Still others echoed the concerns raised by representatives of physician and pharmacist groups who argued against taking the responsibility for deciding when a person needs a prescription drug out of the hands of medical professionals.

 

But some members of the panel favoured the notion, reminding colleagues that personal stockpiling of the drugs oseltamivir (Tamiflu) and zanamivir (Relenza) is already taking place.

 

"It's going on already. What we need to do is to figure out a way to do it intelligently," said Dr. John Bradley, director of the division of infectious diseases at the Children's Hospital and Health Center in San Diego, Calif.

 

The meeting was not asked to give the U.S. Department of Health and Human Services (HHS), which is spearheading the idea, a "proceed" or "abandon" type of recommendation.

 

Instead, they were charged with discussing and in some cases voting on a series of questions aimed at fleshing out what kinds of studies the FDA - which would have to approve the marketing of medkits - would need before it could consider the products.

 

(Continue . . . )

Bird Flu Concerns In Thailand

 

# 2431

 

Sukhothai Province

 

 

 

After a rocky start in 2004-2005, Thailand is one of the countries that has done pretty well  detecting and containing the H5N1 virus in their nation.

 

We occasionally hear of sporadic outbreaks in Thai poultry, but there hasn't been a confirmed human case in Thailand in more than 2 years.   

 

Today, via TOC (Thailand Outlook TV), we get a report (hat tip Dutchy on Flutrackers) that after a suspicious die-off of poultry in a small village, the H5N1 virus has been detected. 

 

Culling in the village has, reportedly, been completed and the bird owners are to receive compensation for their losses.

 

 

 

 

 

 

 

Bird Flu Scare Emerges in Sukhothai

UPDATE : 30 October 2008

Thailand might be in the grip of a fatal bird-flu scare again, after the H5N1 virus was found in chicken carcasses in northern Sukhothai Province.

Livestock officials in Sukhothai Province reported the discovery of the H5N1 virus in domestic chickens raised by Mee Puengwang, a resident of Nong Wong Kwian Village in Swankalok District.

 

Assistant Village Chief Jamnien Puengwang said that 29 families in the village raised a total of nearly 1,000 chickens before a number of them began to die of suspicious causes.

 

She said there were no reports of the deaths of these fowls as some villagers were worried that their fighting birds might be slaughtered due to bird-flu fears.

 

After officials declared the discovery, all chickens in Sawankalok District were destroyed and their owners are to receive 32 baht per kilogramme for the killed birds.

 

Sukhothai Governor Yothin Samutkheeree has urged all related agencies to keep a close eye on the probable viral spread, especially in the areas where H5N1 was once found.

Locals have been asked to report any suspicious deaths of birds immediately.

 

During the months of August and September, bird-flu virus was reportedly spreading in Sawankalok District before it was recently detected again in a nearby district.

Personal Preparedness Stressed At Today's HHS Webcast

 

# 2430

 

 

During today's HHS PlanFirst webcast Secretary Leavitt stressed, repeatedly, the need for personal preparedness as he and a panel consisting of Dr. William Raub (Science Advisor to Secretary Leavitt), Dr. Michael Osterholm (Director of CIDRAP), and Health and Science editor Maggie Fox of Reuters discussed the nation's pandemic preparedness.

 

 

 

The broadcast began with a speech by Secretary Leavitt, where he discussed the increased scope of responsibility for the HHS since the 9/11 terrorist attacks, with a newfound emphasis on emergency response. 

 

One of the most worrisome events that the HHS is planning for is a pandemic, and while the odds of one starting in any given year may be low, another pandemic Leavitt assured, is inevitable.

 

Calling the 1918 pandemic `mindboggling', he reminded the audience that in New York City alone, some 21,000 children became orphans due to the Spanish Flu.   

 

Talking about a future pandemic, Leavitt warned, "The world is overdue, and regrettably we're still somewhat under prepared."

 

Among the advances made over the past 3 years Secretary Leavitt listed the fact that there are now six companies in various stages of preparing to manufacture vaccines here in the United States.  

 

He noted that investments made by the Federal government in cell-based vaccine technology, along with grants to improve conventional manufacturing capacity, would allow us to produce domestically enough vaccine by 2011 to vaccinate all Americans within six months of a pandemic outbreak.

 

We now have 26 million doses of pre-pandemic vaccine on hand for first responders, and we have 50 million (10 pill) courses of antivirals in the Federal Stockpile, and the States have purchased another 22 million courses.

 

Leavitt reiterated his well known mantra:

 

"Any community that fails to prepare with the expectation that somehow the federal government will come to their rescue at the last moment will be tragically disappointed."

 

Secretary Leavitt listed advances made towards developing rapid tests for detecting the H5N1 virus, along with other influenza strains.   He went on to say that the HHS had assisted more than 40 nations in their pandemic planning, as well.

 

Leavitt  listed four pandemic planning priorities he would like to pass on to his successor.

 

• First, that the next HHS Secretary will need to make sure that  $600 million in vaccine contracts let this year for the construction of cell-based vaccine plants are fulfilled, and the plants are actually built.

 

• As a second priority, next Secretary should `defend strongly, the virus sample sharing network'  and not allow temporary opportunism to allow nations to hold the system hostage.  

 

• The third priority is to concentrate on countermeasure distribution.  He warned that while the Strategic Stockpile could deliver supplies within 12 hours to nearly any area of the nation, not all states are capable of distributing them.  

 

• And the fourth priority is to continually remind states, businesses, and families about their responsibility to be prepared.   This is, he said, a `never-ending task'.

 

 

He warned that public health is a state and local responsibility, and that states legislatures are failing to adequately fund local public health programs.   

 

 

Leavitt said he hoped to release a state-by-state evaluation before he leaves his post early next year, showing which states are adequately meeting their funding obligations.

 

He then stressed:

 

"For the world to be prepared, every nation, every city, every business, every school, every hospital, every clinic, every church, and every household needs a plan.  We need to exercise them and we need to practice them."

 

 

 

Secretary Leavitt then joined the panel of Dr. Raub, Dr. Osterholm, and Maggie Fox where they took questions via email, and discussed them.

 

 

 

Dr. Raub stressed the theme of `shared responsibility'.  Federal governments, state governments, local governments, not-for profit organizations, and businesses large and small must all work together to prepare for a pandemic.

 

Dr. Michael Osterholm was asked about his statement (see I've Hit The Wall):

 

"I've finally come to the conclusion that, as a nation, we don't have and can't find either the political will or private-sector commitment needed to address our pandemic preparedness challenges of today. To make matters worse, other national governments and their private-sector enterprises are not making meaningful progress in preparing for the next influenza pandemic, either. In the US, we have a national pandemic influenza plan, but it doesn't even begin to address the disastrous implications of a collapsing global just-in-time economy."  Michael Osterholm - Sept 11th, 2008

 

Osterholm gave the example of a recent study that showed that of 19 essential drugs used in this country, that 95% were manufactured offshore, and in a pandemic would likely become in short supply or become unavailable.  

 

He cautioned that the number of people who could die from these sorts of collateral effects might exceed those who succumbed to the virus.

 

 

Email questions started off with "What can private citizens do to encourage local officials to discuss pandemic issues?"

 

Secretary Leavitt immediately stated he encourages people to do their own preparedness;  that people should be prepared for any disaster.

 

He recommended that citizens let their local, state, and national representatives know that they should make preparedness a high priority.

 

Dr. Raub and Dr. Osterholm both echoed the need for local investment in pandemic preparedness.  

 

When asked what would be the impact if private business failed to prepare for a pandemic, Dr. Osterholm stated he believed many already had failed.  That while they have held meetings and discussions, they have not taken it to the `next level'.  

 

What happens when their suppliers are unable to funnel supplies to them?   What happens if local utilities are down?

 

 

Osterholm stated that `We need to challenge the private sector much more", to step up and take responsibility for pandemic planning.   He stated that he was worried that the current financial crisis was causing some companies to take `pandemic planning off the table'.

 

A question directed to Maggie Fox asked, "What social responsibility does the media have in covering a mass public health disaster?"

 

Fox replied that, "the responsibility of the media is to report the news, but that these interests coincide in something like a pandemic because there are local news stations and newspapers who are informing their neighborhoods." 

 

Fox then asked the panel what can we do, besides talking a lot, to get people to prepare for a pandemic.

 

Dr. Osterholm admitted it is hard to describe a pandemic. 

 

That he could talk about why coal supplies might be jeopardized during a pandemic, which means electricity might be jeopardized -  but most people would think it was far-fetched.  

 

Still, he insists, the supply chain is razor thin, and a failure of the grid would be a huge public health issue.

 

Secretary Leavitt then stated we needed to `continue to focus on individual preparedness - that there are constant manifestations of the need for it - every time there is a serious storm that affects peoples lives, it is personal preparedness that ultimately spells the difference'.

 

Secretary Leavitt went on to say:

 

`We need to continue to use every opportunity to talk about individual preparedness.  Yes the government needs to play a role, at the state, federal and local level . . . but people have a responsibility and it is the aggregate of their actions that will ultimately determine whether we are prepared or not. "

 

During the 75 minute long presentation the panel addressed such diverse questions as `What measures has the HHS taken to coordinate its current pandemic plans with US embassies to extend protection to U.S. citizens abroad?"  and  (from Maggie Fox) "What happens if we are successful in stopping the H5N1 virus?  How do we keep people willing to stay prepared for the next threat?"

 

 

The last question to the panel was what should families do to plan today?

 

While acknowledging the financial difficulties that families are having in this economy, the need to prepare is real.   Even if you can't afford to stockpile food right now, you can at least be making a family plan, advised Dr. Osterholm.  

 

Dr. Osterholm also stressed that citizens need to voice their concerns over the importance of pandemic (and all-hazards) preparations to their local, state, and national elected officials.

 

Secretary Leavitt finished by saying "There is no replacement for individual preparedness.  Having a small stockpile of food is a very good idea . . .for reasons other than pandemic.  Having a little water, having a stockpile of medicines, that could last you an extra week or two if you can't go out of your home . . is a very good idea.  

 

This is not just about pandemics, this is wise  management and risk management for any family . . . and every family should do it to the extent they find  possible.  . ."

 

 

 

This latest video presentation will be archive on the HHS Website in 5 to 7 days.

 

 

If you've missed any of the earlier editions of the PlanFirst webcast, they are archived as well.

 

Previous PlanFirst Webcasts

Individual Preparedness (September 25, 2008) - 57 minutes

• Admiral Joxel Garcia, HHS
• Dr. Richard Benjamin, American Red Cross
• Harlan Dolgin, PandemicPrep.org
• Tim Woerther, PandemicPrep.org

Home Health Care Agencies Planning (July 8, 2008) - 57 minutes

• Alexis Silver, Home Care Association of New York State
• Geraldine A. Coyle, U.S. Department of Veterans Affairs
• James G. Hodge, Jr., Johns Hopkins Bloomberg School of Public Health

Workplace Preparation (June 4 2008) - 46 minutes

• Andrew Levinson, Department of Labor

New Federal guidance for State Pandemic Planning Assessments (April 30, 2008) - 65 minutes

• Dr. Francisco Averhoff, CDC
• Ms. Dana Carr, Department of Education
• Ms. Barbara Bingham, Department of Labor

New Federal guidance for State Pandemic Planning Assessments (April 2, 2008) - 76 minutes

• Dr. Dan Jernigan, CDC
• Colonel Dan Bochicchio, National Guard
• Ms. Joan Harris,  Department of Transportation
• Captain Ann Knebel, HHS

New Federal guidance for State Pandemic Planning Assessments (March 13, 2008) 68 minutes

• Dr. William F. Raub, HHS
• Ms. Barbara Bingham, Department of Labor
• Dr. Christa-Marie Singleton, CDC
• Paul Strang, Department of Homeland Security 
• Chris Logan, National Governors Association

PCV7 Pneumococcal Vaccine Would Save Lives In A Pandemic

 

 

# 2429

 

 

Evidence is mounting that the main cause of death from the Spanish Flu of 1918 was probably secondary bacterial pneumonia.   While we have antibiotics to combat those types of infections today, an even better solution is to prevent as many of those types of infections as we can in the first place.

 

 

To that end scientists have developed a number of pneumococcal vaccines, for adults and for children.   While they can't prevent all types of bacterial infections, they can prevent a good many of them. 

 

 

Globally, pneumococcal pneumonia claims the lives of between 700,000 and 1,000,000 children (under 5 years) each year.  

 

Since starting the universal vaccination of children with the PCV7 (7 valent vaccine) in the United States, studies have shown a 77% decrease in invasive pneumococcal disease among children under the age of 5, and a 39% decrease in hospital admissions for pneumonia among children under the age of 2.

 

 

A recent CDC MMWR Report (Oct 2008) entitled, Progress in Introduction of Pneumococcal Conjugate Vaccine --- Worldwide, 2000--2008 stated:

 

This report indicates that, although progress is being made to introduce PCV globally, only 26 of 193 (14%) WHO member states have introduced PCV7 into their national immunization programs for all children or have PCV in widespread use, and these countries are primarily high-income countries with relatively few childhood deaths attributable to pneumococcal disease

 

 

Today we get another report that uses a predictive model that shows that vaccinating infants and toddlers with the PCV7 vaccine, not only save lives (and money) during regular flu seasons, it would really pay off in a pandemic.

 

 

Unfortunately, many of the nations who would benefit most from incorporating universal vaccination with the PCV7 have yet to do so.

 

 

 

Pneumococcal vaccine could prevent numerous deaths, save costs during a flu pandemic, model predicts

 

A new predictive model shows that vaccinating infants with 7 valent pneumococcal conjugate vaccine (PCV7)--the current recommendation--not only saves lives and money during a normal flu season by preventing related bacterial infections; it also would prevent more than 357,000 deaths during an influenza pandemic, while saving $7 billion in costs.

 

Keith P. Klugman, PhD, professor of global health at Emory University's Rollins School of Public Health, will present results of the research using the predictive model at the joint ICAAC/IDSA meeting in Washington, DC, Oct. 25-28. (Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Disease Society of America.

 

Bacterial infections, particularly pneumococcal disease, can follow a viral illness such as flu and cause secondary infections that worsen flu symptoms and increase influenza-related risk. Bacterial infections may have been the cause of nearly half of the deaths of young soldiers during the 1918 flu pandemic.

 

"We've known for years that bacterial infections can develop after influenza," says Klugman. "Unlike the 1918 flu pandemic, which preceded the antibiotic era, we now have vaccines that can prevent these types of pneumococcal infections. This model shows what a dramatically different outcome we could expect with standard PCV vaccination."

 

Klugman and colleagues at Harvard University, i3 Innovus in Medford, Ma. and Wyeth Research constructed a model to estimate the public health and economic impact of current pneumococcal vaccination practices in the context of an influenza pandemic.

 

Since 2000 the Centers for Disease Control and Prevention (CDC) Immunization Practices Advisory Committee (ACIP) has been recommending PCV vaccinations for infants and children.

 

The new predictive model was used to compare the results of no PCV vaccination to the current routine vaccination of infants less than two years old. The researchers assessed the effect of vaccination policies under both normal and pandemic influenza conditions. They included both direct vaccination effects in vaccinated individuals and indirect vaccination effects (called herd immunity) in the unvaccinated. For manifestations of pneumococcal disease, they included invasive pneumococcal disease (meningitis or bacteremia), all-cause pneumonia and all-cause acute otitis media (ear infections). The model's estimates were based on the 1918 pandemic.

 

The new model predicted that current pneumococcal vaccination practices reduce costs in a typical flu season by $1.4 billion and would reduce costs by $7 billion in a pandemic. In a pandemic, they would prevent 1.24 million cases of pneumonia and 357,000 pneumococcal-related deaths.

 

"Our research shows that routine pneumococcal vaccination is a proactive approach that can greatly reduce the effects of a future flu pandemic," says Klugman. Countries that have not yet implemented a pneumococcal vaccination program may want to consider this as part of their pandemic flu preparedness."

 

###

The research was funded by Wyeth Research.

Dr. Klugman is a paid consultant for Wyeth Pharmaceuticals.

HHS Webcast Today

 

# 2428

 

 

 

 

The next in the  series of HHS Webcasts on pandemic preparedness is scheduled for later on today (October 29th), at 1 pm ET. 

 

 

It will feature HHS Secretary Michael Leavitt, and his guests will include HHS science advisor Dr. Bill Raub, Dr. Mike Osterholm director of CIDRAP, and Maggie Fox, Health and Science editor for Reuters. 

 

 

You may email in questions prior to, and during the broadcast. 

 

 

Here is the HHS announcement:

 

October Webcast

On October 29, 2008, at 1:00 pm ET, we will have a special edition of PlanFirst, featuring HHS Secretary Mike Leavitt and special guests Dr. Bill Raub, Science Advisor to Secretary Leavitt; Dr. Mike Osterholm, Director of the Center for Infectious Disease Research and Policy, University of Minnesota; and Maggie Fox, Reuters.

 

Secretary Leavitt will provide formal remarks regarding the Nation’s pandemic planning effort. He will then join a roundtable discussion with our special guests to discuss the Nation’s level of pandemic preparedness and related issues.

 

As always, our guests, including Secretary Leavitt, will take questions from our viewing audience.

 

 

No registration is required. Email your questions for the Webcast panelists before and/or during the program to hhsstudio@hhs.gov. Please include your first name, state and town.

 

The pandemic influenza PlanFirst Webcasts are brought to you by the U.S. Department of Health and Human Services.

 

 

You may also watch any of the previous HHS webcasts (there are 6 in the archive).

Individual Preparedness Webcast (September 25)

Home Health Care Agencies Planning Webcast (July 8)

Workplace Preparation Webcast (June 4)

State Planning Process Webcasts

• April 30
• April 2
• March 13

Resources for State Planning Process

• Federal Guidance (PDF - 1.5 MB)
• Resource Documents (PDF - 190.38 KB)
• State & Local Planning

USGS: Genetic Evidence Of The Movement Of Avian Influenza Viruses From Asia To North America

 

 

 

NOTE: I'll be out of town today (10/28), so there will be no updates of AFD  until tonight at the earliest. - MPC

 

 

 

 

# 2427

 

 

A male Northern Pintail duck in Japan.

Photo courtesy of the USGS

 

 

 

The debate over the role of migratory birds in the spread of avian influenza has been a contentious one.   

 

Wildlife enthusiasts tend to cast the blame for the spread of the virus largely on illicit poultry trade and bird smuggling, while the poultry industry often blames migratory birds for bringing the infection to their flocks.

 

 

Today we get a study from the USGS, in collaboration with the U.S. Fish and Wildlife Service in Alaska and the University of Tokyo, that strongly suggests that migratory birds may play a larger role in intercontinental spread of avian influenza viruses than previously thought.

 

 

This from the USGS.

 

 

 

Genetics Provide Evidence for the Movement of Avian Influenza Viruses from Asia to North America via Migratory Birds

Released: 10/27/2008 11:49:09 AM

Contact Information:
U.S. Department of the Interior, U.S. Geological Survey
Office of Communication

 

Wild migratory birds may be more important carriers of avian influenza viruses from continent to continent than previously thought, according to new scientific research that has important implications for highly pathogenic avian influenza virus surveillance in North America.

 

As part of a multi-pronged research effort to understand the role of migratory birds in the transfer of avian influenza viruses between Asia and North America, scientists with the U.S. Geological Survey (USGS), in collaboration with the U.S. Fish and Wildlife Service in Alaska and the University of Tokyo, have found genetic evidence for the movement of Asian forms of avian influenza to Alaska by northern pintail ducks.

 

In an article published this week in Molecular Ecology, USGS scientists observed that nearly half of the low pathogenic avian influenza viruses found in wild northern pintail ducks in Alaska contained at least one (of eight) gene segments that were more closely related to Asian than to North American strains of avian influenza.  

 

It was a highly pathogenic form of the H5N1 avian influenza virus that spread across Asia to Europe and Africa over the past decade, causing the deaths of 245 people and raising concerns of a possible human pandemic.  The role of migratory birds in moving the highly pathogenic virus to other geographic areas has been a subject of debate among scientists.  Disagreement has focused on how likely it is for H5N1 to disperse among continents via wild birds.

 

"Although some previous research has led to speculation that intercontinental transfer of avian influenza viruses from Asia to North America via wild birds is rare, this study challenges that," said Chris Franson, a research wildlife biologist with the USGS National Wildlife Health Center and co-author of the study.  Franson added that most of the previous studies examined bird species that are not transcontinental migrants or were from mid-latitude locales in North America, regions far removed from sources of Asian strains of avian influenza.

 

(Continue . . .)

 

 

 

A hat tip to Ironorehopper on Flutrackers for posting this link.

Study: Statins Linked To Increased Pneumonia Survival Rates

 

# 2426

 

 

The idea of using cholesterol lowering drugs, called statins, to combat pandemic flu has been around for some time.  

 

 

Dr. David Fedson was probably the first to champion the idea. In his paper on the subject, published in July of 2006, Dr. Fedson wrote:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

 

David S. Fedson^a

The next influenza pandemic may be imminent. Because antiviral agents and vaccines will be unavailable to people in most countries, we need to determine whether other agents could offer clinical benefits. Influenza is associated with an increase in acute cardiovascular diseases, and influenza viruses induce proinflammatory cytokines.

 

Statins are cardioprotective and have anti-inflammatory and immunomodulatory effects, and they thus might benefit patients with influenza.

 

 

 

Earlier this year Australian researchers announced preliminary results from their studies on Fibrates, another class of cholesterol lowering drugs, for use in reducing the inflammatory response from influenza.

 

 

 

Today, Reuters is reporting on a new study out of Denmark that followed nearly 30,000 pneumonia patients, and discovered that the survival rate among those taking statins was significantly higher than those not taking the drug.

 

 

 

Statins may cut pneumonia death, blood clot risks

 

27 Oct 2008 20:00:13 GMT

Source: Reuters

By Will Dunham

WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

 

Statins, the world's top-selling drugs, cut heart attack and stroke risk, and research has suggested other benefits including possibly protecting against Alzheimer's disease.

 

Some studies have linked statin use with decreased risk of severe sepsis -- infection of the bloodstream -- or death associated with infections, but there had been conflicting findings on pneumonia, according to Dr. Reimar Thomsen of Aarhus University and Aalborg Hospital in Denmark.

 

Thomsen led a new study tracking 29,900 patients treated for pneumonia in Denmark that found that those who were taking statins before hospitalization had a 31 percent lower risk of dying from pneumonia than those who were not.

 

(Continue . . .)

 

 

In this study, patients were already on statins when they developed pneumonia.   How this would translate to use during a pandemic, where the drug presumably wouldn't be administered until someone showed signs of illness, is unknown.

 

It does, however, fit in with the general idea advanced by Dr. Fedson that statins might improve patient survivability during a pandemic. 

 

Another small, but intriguing, piece of the puzzle.

CIDRAP: Roundup Of Flu Related ICACC Presentations

 

 

# 2425

 

 

Maryn McKenna, writing this time for CIDRAP News, has a roundup of flu related news coming out of the 48th ICACC (Interscience Conference on Antimicrobial Agents and Chemotherapy) meeting going on in Washington, D.C.  through tomorrow.

 

 

The main thrust of her report addresses a presentation on the increasing number of antiviral resistant influenza cases being detected in the United States, and around the world.   Maryn also reports on several other presentations, including:

 

 

• Protecting newborns from flu
• High-dose flu shots for elderly
• Testing nondrug flu defenses
• C difficile peak follows flu peak

 

 

I've only printed the opening paragraphs to Maryn's article, you'll definitely want follow the link to read Maryn's comprehensive report in its entirety.

 

 

 

 

Drug-resistant flu viruses cause growing concern

 

Maryn McKenna Contributing Writer

Oct 27, 2008 – WASHINGTON, DC (CIDRAP News) – Health officials worldwide are becoming increasingly concerned about influenza viruses' resistance to antiviral drugs, which can shut down a flu infection or mitigate symptoms. Flu antivirals are vital for reducing severe illness and death in average flu seasons and could be essential bulwarks against an influenza pandemic if one began.

 

There are currently only four antiviral drugs for flu, grouped into two classes, the adamantanes (amantadine and rimantadine) and the neuraminidase inhibitors (oseltamivir, or Tamiflu, and zanamivir, or Relenza). Flu scientists have known since 2005 that seasonal flu viruses have become widely resistant to the adamantanes, with at least 90% of H3N2 strains and at least 15% of H1N1 strains impervious to the drugs. That leaves only oseltamivir and the less widely used zanamivir as treatment options and has made oseltamivir the most commonly used influenza antiviral in the world.

 

But speaking at a major infectious-disease meeting here Sunday, Dr. Nila Dharan of the Centers for Disease Control and Prevention (CDC) disclosed that 12.6% (142 of 1,124) of H1N1 isolates sent to the CDC from around the United States during the 2007-08 season were resistant to oseltamivir, versus less than 1% before 2007.

 

And in a troubling addition, the CDC found that none of the patients who gave the isolates had taken oseltamivir, casting doubt on the widely held belief that oseltamivir resistance, when it occurs, is not transmissible. 1. (Dharan NJ, Gubareva L, Klimov A, et al. Oseltamivir-resistant influenza A [H1N1] in the United States, 2007-2008 [Abstract V-918])

 

(Continue reading . . . )

 

 

 

 

Maryn also has another update on blog, Superbug, about an outbreak of Zyvox-resistant staph in Madrid.

Study: NPI's Can Help Prevent Spread Of Flu-Like Illnesses

 

# 2424

 

 

 

There are some things in public health we assume to be true pretty much on faith, because they seem reasonable, even when there isn't a lot of good science to back it up.

 

One of those things is the effectiveness of various types of NPI's, or Non-Pharmaceutical Interventions.  Things like using facemasks and alcohol  hand sanitizing gel. 

 

We believe them to be at least somewhat protective against influenza-like illnesses, but we really don't know how protective. 

 

Sure, we can show in a laboratory setting that alcohol gel kills germs when applied to the hands, or that facemasks can block large droplet particles, but it is a bit of a leap to assume that using these interventions will reduce your chance of catching the flu. 

 

In a pandemic, with a vaccine unlikely to be available during the first wave for the vast majority of people, we will have to depend on NPI's such as these to protect ourselves in public, or when caring for a sick loved one.  

 

It would be nice to know how well they actually work. 

 

To that end the University of Michigan is looking for answers.  They have been running a study called M-Flu since the 2006-2007 flu season.   Here is a short video outlining the study.

 

 

 

The University of Michigan's MFlu page, outlining the study, is here.

 

Today, we are getting the preliminary results from the first year's study, and they are encouraging.  

 

According to Allison Aiello, co-principal investigator and assistant professor of epidemiology at the U-M SPH (School of Public Health),

 

"The first-year results (2006-2007) indicate that mask use and alcohol-based hand sanitizer help reduce influenza- like illness rates, ranging from 10 to 50 percent over the study period."

 

 

Aiello cautioned that the 2006-2007 flu season was a mild one, and that these early results must be interpreted cautiously. 

 

 

Here is the University of Michigan's Press release.

 

 

 

 

Oct. 27, 2008

Masks, hand washing, prevent spread of flu-like symptoms by up to 50 percent

 

Listen to podcast

 

ANN ARBOR, Mich.—Wearing masks and using alcohol-based hand sanitizers may prevent the spread of flu symptoms by as much as 50 percent, a landmark new study suggests.

 

In a first-of-its-kind look at the efficacy of non-pharmaceutical interventions in controlling the spread of the flu virus in a community setting, researchers at the University of Michigan School of Public Health studied more than 1,000 student subjects from seven U-M residence halls during last year's flu season.

 

 

"The first-year results (2006-2007) indicate that mask use and alcohol-based hand sanitizer help reduce influenza- like illness rates, ranging from 10 to 50 percent over the study period," said Allison Aiello, co-principal investigator and assistant professor of epidemiology at the U-M SPH. Dr. Arnold Monto, professor of epidemiology, is also a principal investigator of the study.

 

Aiello stressed the first year of the two-year project, called M-Flu, was a very mild flu season and only a few cases were positive for flu, so results should be interpreted cautiously. Ongoing studies will test for other viruses that may be responsible for the influenza-like illness symptoms observed, she said.

 

"Nevertheless, these initial results are encouraging since masks and hand hygiene may be effective for preventing a range of respiratory illnesses," Aiello said.

 

The findings, "Mask Use Reduces Seasonal Influenza-like Illness In The Community Setting," was presented Sunday at The Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America annual meeting in Washington, D.C.

 

At the start of flu season in the last two years, participants were randomly assigned to six weeks of wearing a standard medical procedure mask alone, mask use and hand sanitizer use, or a control group with no intervention. Researchers followed students for incidence of influenza like illness symptoms, defined as cough with at least one other characteristic symptom such as fever, chills or body aches, Monto said.

 

From the third week on, both the mask only and mask/hand sanitizer interventions showed a significant or nearly significant reduction in the rate of influenza-like illness symptoms in comparison to the control group. The observed reduction in rate of flu-like symptoms remained even after adjusting for gender, race/ethnicity, hand washing practices, sleep quality, and flu vaccination.

 

(Continue . . . )

Reminder: HHS Webcast On Wednesday

 

# 2423

 

 

 

The next in the  series of HHS Webcasts on pandemic preparedness is scheduled for this Wednesday (October 29th), at 1 pm ET. 

 

This next webcast promises to be something special. 

 

It will feature HHS Secretary Michael Leavitt, and his guests will include HHS science advisor Dr. Bill Raub, Dr. Mike Osterholm director of CIDRAP, and Maggie Fox, Health and Science editor for Reuters. 

 

You may email in questions prior to, and during the broadcast. 

 

Here is the HHS announcement:

 

October Webcast

 

On October 29, 2008, at 1:00 pm ET, we will have a special edition of PlanFirst, featuring HHS Secretary Mike Leavitt and special guests Dr. Bill Raub, Science Advisor to Secretary Leavitt; Dr. Mike Osterholm, Director of the Center for Infectious Disease Research and Policy, University of Minnesota; and Maggie Fox, Reuters.

 

Secretary Leavitt will provide formal remarks regarding the Nation’s pandemic planning effort. He will then join a roundtable discussion with our special guests to discuss the Nation’s level of pandemic preparedness and related issues.

 

As always, our guests, including Secretary Leavitt, will take questions from our viewing audience.

 

 

No registration is required. Email your questions for the Webcast panelists before and/or during the program to hhsstudio@hhs.gov. Please include your first name, state and town.

 

The pandemic influenza PlanFirst Webcasts are brought to you by the U.S. Department of Health and Human Services.

 

You may also watch any of the previous HHS webcasts (there are 6 in the archive).

 

Individual Preparedness Webcast (September 25)

Home Health Care Agencies Planning Webcast (July 8)

Workplace Preparation Webcast (June 4)

State Planning Process Webcasts

• April 30
• April 2
• March 13

Resources for State Planning Process

• Federal Guidance (PDF - 1.5 MB)
• Resource Documents (PDF - 190.38 KB)
• State & Local Planning

West Africa Bird Flu Risks Remain

 

# 2422

 

 

 

 

`Porous borders', `Grinding poverty',  `Years of civil war' and a `Creaking Infrastructure' are  all listed as impediments to the surveillance and eradication of the bird flu virus in this analysis  by Alastair Sharp on Reuters this morning.

 

 

Nations such as Nigeria, Benin, Ghana, Burkina Faso, Cameroon, and Togo have all reported outbreaks in the past.  

 

And while only one person has been reported to have died from the virus in that region, the truth is, testing for the virus is almost never done when someone dies.  

 

In the one case we know about, a family member insisted on a private autopsy (and paid for it), and that is how the cause of death was discovered.

 

Part of the monies pledged to the fight against bird flu have gone for compensation to poultry farm owners who notify their governments quickly when their flocks show signs of bird flu.  

 

Without compensation, many farmers would simply try to sell the birds quickly, to avoid a loss.   Bird owners are only compensated for birds that die (or are culled) after notification.

 

 

 

 

More from Reuters. 

 

 

 

 

 

W. Africa bird flu risks remain, despite early action

 

Mon Oct 27, 2008 7:42am EDTBy

 

Alastair Sharp - Analysis

SHARM EL SHEIKH, Egypt (Reuters) - West Africa, viewed as a potentially vulnerable bird flu hot spot, has moved quickly to reduce the risk of a widespread outbreak, but porous borders remain an obstacle to wiping out the virus.

 

Creaking infrastructure and grinding poverty that affects large swathes of the population also complicate efforts to contain the deadly H5N1 bird flu virus, which has killed 245 people since 2003 in Asia, Africa and Europe.

 

West African governments have found it hard to control the movement of people and animals across borders -- necessary to contain the virus -- in a region where some countries are only now recovering from years of civil strife, officials say.

 

"The borders are porous and there are unapproved routes that people use without being seen. It is difficult," said Anna Nyamekye, Ghana's deputy minister for agriculture.

 

The bird flu virus, having earlier hit Asia, appeared to arrive in West Africa in 2006 and has been detected in a string of countries there including Nigeria, Benin, Cameroon and Ghana.

 

(Continue . . .)

Maryn McKenna Blogging From the ICAAC Meeting

 

# 2421

 

 

Maryn McKenna, whose writes (among other things) a blog on MRSA called Superbug, is reporting from the ICAAC Meeting underway this weekend. 

 

She has already filed two reports today, and I would expect more updates today or tomorrow.

 

 

Breaking MRSA news from the ICAAC meeting 1

There are 15,000+ people at the 48th Interscience Conference on Antimicrobial Agents and Chemistry (known as ICAAC - yes, "Ick-ack") and 46th Infectious Diseases Society of America Annual Meeting, and at least half of them seem interested in MRSA. At the keynote address last night, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, referred to MRSA as a "global pandemic."

 

(Continue)

 

ST 398 in New York City - via the Dominican Republic?

Here's a piece of MRSA news from the ICAAC meeting (see the post just below) that is intriguing enough to deserve its own post.

US and Caribbean researchers have found preliminary evidence of the staph strain ST 398, the animal-origin strain that has caused human illness in the Netherlands and has recently been found in Ontario and Iowa, in Manhattan. How it may have arrived: Via the Dominican Republic.

(Continue)

 

 

 

 

Maryn is the author of Beating Back The Devil, the story of the disease detectives at the CDC, and is a frequent contributor to CIDRAP.   She wrote the award winning 7-part series called The Pandemic Vaccine Puzzle  last year.  

 

Maryn is now working on her next book, SUPERBUG: The Rise of Drug-Resistant Staph and the Danger of a World Without Antibiotics, coming in 2009 from Free Press. 

 

Her blog, Superbug, serves as a virtual whiteboard for her research on this project.

 

Highly recommended.

Vaccines: Sometimes You Just Need A Bigger Hammer

 

 

# 2420

 

 

 

Over the past couple of years a number of studies have shown that the elderly develop a significantly lower immune response to seasonal vaccinations than do those who are younger.    

 

I've blogged on a number of these studies, including:

 

Another Study: Flu Vaccines Do Not Reduce Mortality Rates In The Elderly

Study: Flu Vaccines And The Elderly

Flu Shots For The Elderly May Have Limited Benefits

 

 

Of the 36,000 flu-related deaths each year in this country, 90% occur in those over 65.    Unfortunately, this is the exact cohort that seems to derive the least benefit from the standard flu shot.

 

 

Sanofi-Pasteur, the vaccines division of Sanofi-Aventis Group, funded a study conducted at 30 centers around the United States where several thousand people over the age of 65 were given a flu vaccine with 4 times the antigen of a standard shot.  

 

Instead of 15ug of antigen per strain, these shots contained 60ug. 

 

The results of this study were delivered today by lead researcher  Dr. Ann Falsey, associate professor of medicine at the University of Rochester School of Medicine and Dentistry, to a joint meeting of the American Society for Microbiology and Infectious Diseases Society of America.

 

 

Those who received the stronger shot developed a significantly stronger immune response than those who received the standard dose. 

 

 

Sanofi-Pastuer hopes to  license the higher-dose vaccine for use in older patients here in the United States.

 

In the meantime, health officials continue to recommend that those over 65 get a flu shot each year.  

 

While it appears true that the elderly mount a less robust response to the standard shot, it is still believed to provide some protection. 

 

 

Here is the Sanofi-Pasteur press release (excerpted and reparagraphed for easier reading).   Follow the link to read the entire article.

 

 

 

 

High-dose influenza vaccine shows increased immune response among adults 65 years of age and older

 

 

Washington, DC, October 26, 2008 - Sanofi Pasteur, the vaccines division of sanofi-aventis Group, announced today that an investigational high-dose influenza vaccine demonstrated increased immune responses among adults 65 years of age and older compared with the standard influenza vaccine. The candidate high-dose intramuscular formulation of the influenza vaccine is being developed by sanofi pasteur.

 

The results were reported today at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC)/Infectious Diseases Society of America (IDSA) 46th annual meeting.

 

According to the U.S. Centers for Disease Control and Prevention (CDC), the currently available inactivated influenza vaccine offers public health benefits in reducing influenza-related morbidity and mortality in older adults.

 

Study authors explain, however, that as people age, the immune system tends to weaken. Older adults become not only more susceptible to infections, but also less responsive to vaccination. When infected with the influenza virus, they are less able to mount an immune response to neutralize the attack.

 

"Development of an influenza vaccine that will provide an improved immune response in older adults is important because this population has the highest rates of complications from influenza including hospitalization and death," said Ann R. Falsey, MD Associate Professor of Medicine, University of Rochester School of Medicine, Rochester, NY; Infectious Diseases Unit, Rochester General Hospital.

 

<snip>

 

In the randomized double-blind study conducted at 30 centers throughout the United States, 2,575 people received the high-dose influenza vaccine and 1,262 received the standard influenza vaccine.

 

The standard influenza vaccine contained 15µg of hemagglutinin (HA) of each of three influenza strains, and the high-dose vaccine contained four times as much, 60µg HA per strain. Both vaccines contained two influenza type A strains (H1N1 and H3N2) and one influenza type B strain.

 

After 28 days, investigators assessed serum hemagglutination inhibition (HAI) titers in study participants, a standard measurement of the immune response to influenza vaccination. HAI titers are thought by researchers to correlate with increased protection against illness after exposure to influenza.

 

Statistically significant higher HAI titers against all three influenza virus strains were reported in those who received the high-dose vaccine compared with those who received the standard vaccine.