Italy: AIFA Investigating Deaths Among Flu Vaccine Recipients

 

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Flu vaccines have a long and enviable history of safety, and while side effects have been reported, serious reactions are very rare.  But no vaccine, or any other drug or medicine for that matter, is 100% safe or benign. 

 

Complicating matters, drugs and vaccines are often used by the elderly or those with pre-existing medical problems, making it difficult to sort out the cause whenever an untoward medical event occurs. 

 

This weekend, in Italy, officials are trying to determine if two specific lots of Novartis flu vaccine played any role in the recent deaths of a number of (mostly) elderly vaccine recipients.  Right now, there is no proof that the vaccines are at fault, but the use of two lots of the vaccine has been temporarily suspended.  

 

First, a status report from the Italian Pharmaceutical Agency (AIFA), followed by statements by Novartis, and by the European Medicines Agency.

 

Fluad vaccine. The AIFA takes stock of the situation

Twelve reports of deaths after vaccination received to date. 8000 people die each year from the consequences of influenza

29/11/2014

The AIFA informs that after the ban on the use of lots 143 301 and 142 701 vaccine Fluad after reporting three deaths occurred between 7 and 18 November, yesterday were included eight other reports (deaths occurring between 15 and 28 November ) of which the Agency has requested a detailed clinical report that so far has not yet been received for any of them.

In the day today has been registered in the National Network of Pharmacovigilance (RNF) a new death occurred on November 24, and yesterday received a 'e-mails on a death that has yet to be verified. The total number of cases reported through the RNF is therefore 12. A first analysis of these signals allows to draw the following conclusions exclusively preliminary:

• In 8 cases (67%) seen in people aged ≥ 80 years.
• 7 cases are female and 5 male gender.
• In eight cases death occurred in the first 24 hours.
• In eight cases death occurred from cardiovascular causes.
• The reports concern 6 Regions: Sicily (2); Molise (1); Puglia (2); Tuscany (2); Emilia Romagna (2); Lombardy (2); Lazio (1).
• The lots involved have passed from 2 to 6 for a total of 1,357,399 doses.
• The signals are received by the RNF with a time range from immediate (same day of death) to 13 days later.
• If all of the doses of these 6 lots had been administered, the percentage of deaths would rise from 0,001% (1.2 each 100.00) at 0.0009% (0.9 each 100.00) with a dilution of 25% of the signal.
• If it had been given even half the number of deaths would be hundreds of times less than expected in the same non-vaccinated population (about 8,000 deaths per year for flu complications).

The AIFA confirms the correlation time for suspected cardiovascular events in the first 24 hours after administration in patients suffering from over eighty polypathology and polypharmacy. The Fluad however expressly indicated in this population

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This from Novartis:

 

Safety and efficacy of Fluad vaccinations in Italy

November 28, 2014 18:00 CET

Regarding the precautionary suspension of two batches of Fluad® in Italy, Novartis underlines that no causal relationship to the vaccine has been established to date.

Fluad is approved for vaccination of elderly patients (65+) and often prescribed to patients who suffer from pre-existing underlying medical conditions and have a weaker immune system. Serious medical events and deaths are unfortunately quite common in this patient population and hence a coincidental timely association with vaccination is not unusual.

The two suspended batches comprising of 500,000 doses were distributed solely in Italy after having passed all required safety and quality testing, including review by regulatory authorities before release to market.

Worldwide, more than 7 million doses of Fluad have been distributed. No unusual frequency of adverse events has been reported through the extensive pharmacovigilance system.

Fluad is an important vaccine to protect the elderly from influenza. They are at high risk of serious complications from influenza infections. In Europe alone, the death toll is estimated at 40,000 each year. Fluad was licensed in 1997 and has a solid safety history. The vaccine has been tested in clinical trials with 70,000 patients and more than 65 million doses have been distributed to date.

 

And this from the EMA.

 

Investigation into reports of serious adverse events following use of Fluad

EU regulatory authorities following up on suspension of two batches of flu vaccine in Italy

The European Medicines Agency (EMA) is working with the Italian medicines agency (AIFA) and other EU medicines regulatory authorities to investigate the cause of serious adverse events, including deaths, in a small number of elderly patients who had received Fluad flu vaccine. There is so far no evidence to suggest a causal link between the vaccine and the reported adverse events. The suspension is a precautionary measure.

AIFA has suspended the use of two batches of the flu vaccine produced by Novartis. Testing of the batches is underway, as well as a detailed analysis of the case reports from Italy. This includes examining all available information on the affected patients’ age, health condition and medication regime.

The issue will be discussed by EMA’s Pharmacovigilance Risk Assessment Committee (PRAC), a scientific body that brings together Europe’s best experts on the safety of medicines, at their meeting starting on Monday, 1 December 2014.

Member States across the European Union continue with their annual flu vaccination campaigns as influenza can cause severe illness or death especially in the elderly and in people with long-term conditions. The World Health Organisation (WHO) estimates that annual influenza epidemics result in about 3 to 5 million cases of severe illness worldwide, and about 250,000 to 500,000 deaths. Influenza vaccines are the most effective way to prevent the disease and/or the serious complications it can cause.

Fluad is authorised in the EU in a number of EU Member States. For the current vaccination campaign, 4 million doses of Fluad have been distributed in Italy. In the EU, the vaccine has also been distributed for the 2014-15 flu vaccination campaign in Austria, Germany and Spain.

Zhejiang Province Reports H7N9 Case

Credit Wikipedia

 

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On Friday, in H7N9 Case In Guangdong Province, I mentioned there have been local media reports suggesting a couple of other H7N9 cases in China over the past week, but no announcement at the provincial level.

While the government health sites still aren’t carrying any notifications, today we have the next best thing;  China’s official news agency Xinhua is reporting details on a case from Jiaxing city (Zhejiang Province) from earlier in the week.

A quick check finds a recently posted H7N9 safety advisory on the Jiaxing City CDC website, where a tacit admission of a recent case appears.  As H7N9 generally produces no symptoms in poultry, it is often only when a human falls ill and is diagnosed that anyone realizes the virus is circulating in local birds.

This from the Zhejiang Xinhua Channel.

Jiaxing confirmed the first case of human infection with the H7N9 avian winter flu

• Time: 2014-11-30 09:16:32 Sunday

When the Ebola virus has not left the power from people's sight, H7N9 bird flu virus and "comeback" and that it appeared in our midst.

Reporter yesterday learned from the CDC Jiaxing, Jiaxing recently discovered case of human infection cases of H7N9 avian influenza. It is understood that this is the first case of this winter in Jiaxing City, Zhejiang Province, is the first case of human infection of H7N9 cases.

According to reports, the infected person because of roadside stalls to buy live poultry rearing to go home sick infection present, patients have been admitted to a local hospital for treatment, the situation is more critical.

More than 60-year-old aunt in the H7N9 virus trick

Reporters learned that, in patients infected with the H7N9 bird flu virus is a more than 60-year-old aunt, who lives in the urban areas in Jiaxing.

At first, her symptoms are fever, cough, so she will be sent to the family Jiaxing Second Hospital for treatment. However, according to a cold treatment a week later, his condition did not improve, so the hospital contacted the provincial expert testing, test results showed that the H7N9 virus infected aunt.

November 26 morning, the aunt was sent Jiaxing First Hospital of Infectious Diseases, floor, isolation and treatment.

According to relatives, said some time before the onset of the aunt, to Jiaxing Xincheng a roadside farmer's market to buy back two live chickens, chicken rearing in their own homes, it is estimated that chickens are carrying H7N9 avian influenza virus, so it is infected a.

It is understood that the patient is currently in critical condition comparison.

Jiaxing disease control department launched the emergency plan

For this case emerging, Jiaxing disease control department immediately launched the emergency plan, a sample of cases, the source of infection were detected and investigation, to have been in contact with patients who had blood, and make their health follow-up observation. Also strengthen fever clinics and major hospitals pre-triage process, once suspected cases immediately treated in isolation.

Jiaxing Municipal office November 28 is also the official government website message confirming Jiaxing found cases of avian influenza H7N9 virus in case of human infection.

The sources said that this is the first man since the winter, Jiaxing found cases of H7N9 infection, the third case of human H7N9 infection also occurs city level cases.

Jiaxing City CDC also issued a reminder that eating poultry is best cooked cooking, always pay attention to strengthening exercises, enhance immunity, wash their hands, fewer trips to crowded areas, so as to reduce the risk of infection.

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Netherlands: Bird Flu Outbreak In Zoeterwoude

Credit http://www.rijksoverheid.nl/

 

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It’s been more than a week since the last announced bird flu outbreak in the Netherlands (see Netherlands: 2nd Farm At Kamperveen Showing Signs Of Bird Flu), but it appears this respite was short lived, as today the Central Government website announced the culling of 28K chickens for an H5 infection at a farm in Zoeterwoude. 

This farm is about 10 km from Ter Aar which reported an outbreak 10 days ago.

 

My thanks to Gert van der Hoek on FluTrackers for a better translation of the government announcement than my software could manage.   The exact subtype has not been determined, but it is likely to prove a match to the H5N8 virus which has affected 5 other farms in the Netherlands over the past couple of weeks.

 

Bird flu in Zoeterwoude

News item | 30-11-2014

In Zoeterwoude in a chickenfarm with around 28,000 animals bird flu (avian influenza, AI) had been established. This company has no outdoor access. The affected chickens are to be culled today. This is based on European rules. Depopulation is by the Dutch Food and Consumer Product Safety Authority (NVWA).

This infection is an H5 strain of bird flu. It is not yet clear whether it is a low pathogenic or highly pathogenic variant. Further analysis by the CVI should reveal this. It is expected that the results of this analysis are available tomorrow.

Surrounding the company in Zoeterwoude establishes a 10 mile area. Within this area are four other poultry farms. These companies are sampled and tested for avian influenza.

No H5 bird flu found in ducks companies

Meanwhile, the investigation into all ducks companies was completed in the Netherlands. There is no bird flu virus of the H5 type found on these companies.

Central Government

Saudi MOH: 1 MERS Case In Rafha

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While camels are strongly suspected to be the primary zoonotic source of human MERS infection, according to an interview by Dr. Tariq Ahmed Madani last week, only about 3% of human MERS cases actually acquire the virus directly from an animal source. 

 

Limited, and thus far inefficient, human-to-human transmissions – mostly in healthcare settings – are responsible for the rest.

 

While zoonotic transmission represents only a small percentage of the total, these animal exposures are important because they continually reseed the virus back into the community, and provide the virus with additional opportunities to adapt to human hosts. 

 

Hence the repeated warnings (see Back To The Camel `Shed’) regarding unprotected exposure to camels.

 

Today, the Saudi MOH has announced another MERS case – this time with `animal exposure’ listed as a possible route of infection, in Rafha.

Japan: H5N8 Detected In Izumi Crane

H5N8 Branching Out To Europe & Japan

 

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Like the Mission San Juan Capistrano’s annual return of the swallows,  Izumi City on southern tip of Japan is famous for the yearly arrival and overwintering of thousands of rare Hooded, and White-naped cranes.  The International Union for Conservation of Nature (IUCN) lists both species as Vulnerable (one step up from Endangered).

 

Both species spend their summers in Mongolia, Siberia, or Northwestern China - and of the roughly 10,000 hooded swans in the world - 80% overwinter in Izumi.

 

Hooded cranes, and the nature preserve at Izumi, are regarded (and often referred to as) `National Treasures’ in Japan, which is why in 2010-11 we saw a near panic among officials when 5 Hooded Cranes Test Positive For H5N1 in Izumi.  As I discussed in Japan’s Bird Flu Dilemma, there are few options open to officials when a potentially deadly virus strikes a rare, and protected species of birds.

 

The impact that year was limited (many birds can carry the virus without ill effect), and we did not see a major return of H5N1 bird flu during the past few winters. 

Fast forward to 2014, and suddenly Japan, Korea, and Europe are being visited by birds carrying a new – highly pathogenic – H5N8 virus.  This avian influenza subtype emerged as a threat in Korea last January, and last spring caused millions of dollars of damage to their poultry industry. 

 

As I reported on Thursday (see Bird Flu Reports From India, Japan, Korea & Taiwan), Japan has already reported three detections of the H5N8 virus in migratory birds this winter.  Today we learn that the virus has now been detected in a White-naped crane at the nature preserve at Izumi city.

 

Kagoshima in virulent bird flu = Japan's largest crane wintering grounds - Ministry of the Environment

Ministry of the Environment has announced that the 29th was detected highly pathogenic avian influenza virus strong toxic from White-naped of Kagoshima Prefecture Izumi (H5N8 subtype). The city, there is Japan's largest wintering grounds that vines more than 10,000 birds to try, vines and about 245 hectares of land has been designated as special national treasure. The detection of highly pathogenic virus, season four cases first. (2014/11 / 29-17: 46)

While there isn’t a lot of surveillance data available, we’ve already seen the H5N8 virus show up this fall in Korea, China, Japan, Germany, the Netherlands, and the UK – both in domesticated poultry, and in wild or migratory birds.

Compared to other avian flu viruses we’ve followed over the past decade, this one seems to be spreading geographically at a very rapid rate.

The good news, is that so far there have been no documented human infections with H5N8, and so this virus remains primarily a threat to wild birds and poultry operations.

For more on the spread of H5N8, you may wish to revisit:

 

FAO Warns On H5N8’s Spread

Bird Flu Spread: The Flyway Or The Highway?

EID Journal: Subclinical HPAI In Vaccinated Poultry – China

 

H7N9 Case In Guangdong Province

Credit Wikipedia

 

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Although there have been local media reports suggesting a couple of other H7N9 cases in China over the past week, so far only today’s case – announced by Hong Kong’s CHP – that of a 31 year old woman hailing from Guangdong province, has been officially announced.

 

Wed don’t seem to be seeing near the detail (or timeliness) of case reporting in recent months that we grew accustomed to during the first two waves.

 

Notification of confirmed human case of avian influenza A(H7N9) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) has been notified by the Health and Family Planning Commission of Guangdong Province of a confirmed human case of avian influenza A(H7N9) today (November 28) affecting a 31-year-old woman in Dongguan, Guangdong Province.

The patient, who is in critical condition, is currently receiving treatment in a hospital in Guangzhou.  

To date, 444 human cases of avian influenza A(H7N9) have been confirmed on the Mainland in Zhejiang (139 cases), Guangdong (110 cases), Jiangsu (58 cases), Shanghai (41 cases), Hunan (24 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Beijing (five cases), Shandong (five cases), Henan (four cases), Xinjiang Uygur Autonomous Region (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

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Saudi MOH Reports 2 MERS Cases (Sakaka & Taif)

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Two weeks after reporting a pair of cases in Sakaka -  the capital of Al Jawf Province in the north of Saudi Arabia – the MOH is reporting a 3rd infection, that of a 34 y.o. old male. Taif, which has seen the most cases this fall, records another case today as well, this time a 40 y.o. male. 

Both are Ex-pats, and a route of exposure for these cases has not been determined.

A Dog & Cat Flu Review

 

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Until about a decade ago, it was widely (and erroneously) believed that dogs and cats were not generally susceptible to influenza A infections. 

 

That perception began to change in 2004 with two unrelated events; the jump of equine H3N8 influenza from horses to Florida greyhounds, and the infection by avian H5N1 of tigers fed infected chickens in Thailand.

 

While not considered major players (yet) in the spread of human or novel influenza viruses, their role as companion animals make dogs and cats of particular interest to influenza researchers.

 

First a look back at some of the evidence on dogs & cats susceptibility to influenza – then I’ll have a couple of new studies that shed additional light on their ability to contract, and spread, certain subtypes of flu.

 

In 2004, the H3N8 equine influenza – a strain that has been around in horses nearly a half century – was discovered to have jumped, and adapted to dogs, creating a new dog-specific (canine) lineage of H3N8. 

 

Since then, H3N8 has continued to spread among dogs both in North America and around the globe.

While we’ve yet to see any evidence that this equine/canine H3N8 virus can infect humans, there are a number of different H3N8 lineages out there, including the equine, canine, avian, and even a recently discovered Mammalian Adapted H3N8 In Seals.

And a related H3N8 virus is thought to have sparked the 1900 influenza pandemic, giving it a track record in humans, and is considered likely to return someday (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?).

Added to this mix, in 2008 the CDC’s EID Journal carried the following report on a newly emerging canine flu in Korea.

 

Transmission of Avian Influenza Virus (H3N2) to Dogs

Daesub Song, Bokyu Kang, Chulseung Lee, Kwonil Jung, Gunwoo Ha, Dongseok Kang, Seongjun Park, Bongkyun Park, and Jinsik Oh

Abstract

In South Korea, where avian influenza virus subtypes H3N2, H5N1, H6N1, and H9N2 circulate or have been detected, 3 genetically similar canine influenza virus (H3N2) strains of avian origin (A/canine/Korea/01/2007, A/canine/Korea/02/2007, and A/canine/Korea/03/2007) were isolated from dogs exhibiting severe respiratory disease.

 

In late 2012, in China: Avian-Origin Canine H3N2 Prevalence In Farmed Dogs, we saw a study that found more than 12% of farmed dogs tested in Guangdong province carried a strain of canine H3N2 similar to that seen in Korea.

 

During the 2009 H1N1 pandemic we saw reports of dogs infected, and in the middle of the last decade we saw several reports indicating that dogs were susceptible to the H5N1 bird flu virus (see Study: Dogs And H5N1).

Cats, too, were infected during the 2009 H1N1 pandemic (see Companion Animals And Novel H1N1 & EID Journal: Pandemic H1N1 Infection In Cats), and In 2011, it was announced that Korea’s canine H3N2 had jumped to cats (see Korea: Interspecies Transmission of Canine H3N2).

 

Previously we’d seen reports of cats infected with the H5N1 virus after consuming infected birds.  The following comes from a World Health Organization GAR report from 2006.

H5N1 avian influenza in domestic cats

28 February 2006

(EXCERPTS)

Several published studies have demonstrated H5N1 infection in large cats kept in captivity. In December 2003, two tigers and two leopards, fed on fresh chicken carcasses, died unexpectedly at a zoo in Thailand. Subsequent investigation identified H5N1 in tissue samples.

In February 2004, the virus was detected in a clouded leopard that died at a zoo near Bangkok. A white tiger died from infection with the virus at the same zoo in March 2004.

In October 2004, captive tigers fed on fresh chicken carcasses began dying in large numbers at a zoo in Thailand. Altogether 147 tigers out of 441 died of infection or were euthanized. Subsequent investigation determined that at least some tiger-to-tiger transmission of the virus occurred.

In 2006, Dr. C.A. Nidom demonstrated that of 500 cats he tested in and around Jakarta, 20% had antibodies for the bird flu virus. In 2007 the FAO warned that: Avian influenza in cats should be closely monitored, and in 2012 the OIE reported on Cats Infected With H5N1 in Israel, although so far no sustained virus transmission in cats or from cats to humans has been observed.

 

Contrary to the prevailing scientific opinion until the early 2000’s, dogs and cats are obviously both susceptible to a variety of influenza A viruses. All of which proves that you never know what you are apt to find until you actually start looking for it. 

 

Which brings us to a pair of recently published studies.  The first being on the virulence (or lack, thereof) of H5N1 in dogs and cats, and what that might portend as far as transmission is concerned.

 

Arch Virol. 2014 Nov 22. 

Greater virulence of highly pathogenic H5N1 influenza virus in cats than in dogs.

Kim HM¹, Park EH, Yum J, Kim HS, Seo SH.

Author information

Abstract

Highly pathogenic H5N1 influenza virus continues to infect animals and humans. We compared the infectivity and pathogenesis of H5N1 virus in domestic cats and dogs to find out which animal is more susceptible to H5N1 influenza virus. When cats and dogs were infected with the H5N1 virus, cats suffered from severe outcomes including death, whereas dogs did not show any mortality.

Viruses were shed in the nose and rectum of cats and in the nose of dogs. Viruses were detected in brain, lung, kidney, intestine, liver, and serum in the infected cats, but only in the lung in the infected dogs. Genes encoding inflammatory cytokines and chemokines, Toll-like receptors, and apoptotic factors were more highly expressed in the lungs of cats than in those of dogs.

Our results suggest that the intensive monitoring of dogs is necessary to prevent human infection by H5N1 influenza virus, since infected dogs may not show clear clinical signs, in contrast to infected cats.

An interesting result, considering that last spring  Korea Detected H5N8 Antibodies In asymptomatic Farm Dogs.

The second study, which appears in the December issue of the EID Journal, looks at the ability of cats to contract, and spread a contemporary strain of the equine/canine H3N8 virus.

 

Equine Influenza A(H3N8) Virus Infection in Cats

Shuo Su¹, Lifang Wang¹, Xinliang Fu, Shuyi He, Malin Hong, Pei Zhou, Alexander Lai , Gregory Gray, and Shoujun Li

Abstract

Interspecies transmission of equine influenza A(H3N8) virus has resulted in establishment of a canine influenza virus. To determine if something similar could happen with cats, we experimentally infected 14 cats with the equine influenza A(H3N8) virus. All showed clinical signs, shed virus, and transmitted the virus to a contact cohort.

Conclusions

That cats are susceptible to EIV by direct inoculation is not surprising because infection of cats with various influenza A viruses has been reported. Feline respiratory tract epithelial cells contain sialic acid α-2,3-galactose β-1,3-N-acetyl galactosamine (SA α2,3 gal) receptors for avian and equine influenza viruses and SA α2,6 gal receptors for mammalian influenza virus (13).

However, our finding of horizontal transmission of EIV among cats is significant. If transmission occurs outside the laboratory, and if the basic reproduction rate is higher than 1.0, then EIV could potentially establish itself and circulate in this new host species. Why it has not yet happened naturally, as it did for canine influenza virus (H3N8), remains to be determined. Possibilities include lower transmission efficiency, lower probability of horse–cat contact, less virus shedding in a laboratory, or feline behavior (less social contact than dogs).

 

These researchers repeated this experiment with an older strain of the equine H3N8 virus, and while some of the cats seroconverted, they all remained asymptomatic. Illustrating the variance of virulence one often finds between clades or strains of the same influenza A subtype.

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In just over a decade we’ve gone from believing that dogs and cats aren’t really susceptible to flu to viewing them as Potential `Mixing Vessels’ For Influenza. 

 

Last summer, in Canine H3N2 Reassortant With pH1N1 Matrix Gene, we looked at this precise scenario. At roughly the same time the American Society for Microbiology issued this warning:

 

Evolution of Equine Influenza Led to Canine Offshoot Which Could Mix With Human Influenza

WASHINGTON, DC – June 19, 2014 – Equine influenza viruses from the early 2000s can easily infect the respiratory tracts of dogs, while those from the 1960s are only barely able to, according to research published ahead of print in the Journal of Virology. The research also suggests that canine and human influenza viruses can mix, and generate new influenza viruses.

(Continue . . . )

 

Although  it’s true that pigs and birds are considered  far superior biological `flu factories’,  any jump of a novel flu virus to a new species is viewed with concern, because it affords the virus new opportunities to acquire host adaptations – or reassort with other viruses – and thereby increases its chances of becoming a human health threat.

While the future role of dogs and cats in the evolution of influenza is subject to debate, for now, your pet is at far greater risk of catching the flu from you, than you are from it (see Companion Animals & Reverse Zoonosis).

WHO On Ebola In Semen Of Convalescent Men

Credit CDC PHIL

 

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One of the more unusual aspects of an Ebola virus infection is that even after a man has recovered, he can shed the virus in his semen for up the three months.   This is a topic that we’ve looked at in the past, most recently in Lancet: Mackay & Arden On Ebola In Semen Of Convalescent Men, and prior to that in a pair of VDU blogs Ebola virus in semen is the real deal.... &  Ebola: Blood, sweat and tears.

While it has been recommended that men are counseled to use condoms to protect their partners for 3 months post-infection, earlier this month we saw India isolate a man with Ebola-infected semen, more than six weeks after he was pronounced cured (Sept 30th) and released from a Liberian hospital.

 

Today the World Health Organization has published their own review of the evidence, and while they find there is a potential danger of infection, there are no documented cases of of sexual transmission of the ebolavirus. They reiterate the opinion that there is no need to isolate men during this convalescent period. 

 

Ebola virus in semen of men who have recovered from Ebola virus disease

Key messages

26 November 2014

Survivors of Ebola working with WHO, Sierra Leone

• Sexual transmission of Ebola virus disease (EVD) has not been documented
• In four studies that investigated persistence of Ebola virus in seminal fluid from convalescent patients (a total of 43 patients), three men who had recovered from Ebola virus disease were reported to shed live virus in semen 40 days, 61 days and 82 days after onset of symptoms, respectively.
• In two studies, Ebola virus was isolated from semen, but subsequent infections were not identified in household contacts.
• Men who have recovered from Ebola virus disease should be aware that seminal fluid may be infectious for as long as three months after onset of symptoms.
• Because of the potential to transmit the virus sexually during this time, they should maintain good personal hygiene after masturbation, and either abstain from sex (including oral sex) for three months after onset of symptoms, or use condoms if abstinence is not possible.
• WHO does not recommend isolation of male convalescent patients whose blood has been tested negative for EVD.

The Ebola virus is shed in bodily fluids such as blood, vomit, faeces, saliva, urine, tears, and vaginal and seminal fluids. There is evidence that seminal fluids of convalescing men can shed the Ebola virus for at least 82 days after onset of symptoms. Although the scientific evidence is limited, it is clear that semen is a potential source of infection and could therefore cause transmission of the virus through delivery of the infectious virus on a mucosal surface.

1. How long is Ebola virus present in semen?

In a study performed during the Ebola outbreak in Gulu, Uganda, in 2000, the authors tested the semen of a single convalescent patient and were able to isolate Ebola virus up to 40 days after the onset of illness. One study in 1977 (Edmond et al., laboratory infection in England) detected live Ebola virus in semen of one convalescent man 61 days after onset of symptoms. One study in1995 (Rodriguez et al. Ebola outbreak in Kikwit, Democratic Republic of Congo) also detected live Ebola virus in semen in one convalescent man 82 days after disease onset. Therefore, it is possible for Ebola virus to be present in semen for 3 months after disease onset.

2. Is semen that tests positive for Ebola virus infectious?

The evidence is inconclusive. One study (Rowe et al.) that followed four men recovering from Ebola virus disease and their sexual partners found that no sexual partner developed symptoms.

References

• Bausch, D. et al. (2007) Assessment of the risk of Ebola virus transmission from bodily fluids and fomites, The Journal of Infectious Diseases, 196, pp. S142-7.
• Emond, R. et al. (1977) A case of Ebola virus infection, British Medical Journal, 2, pp. 541-544.
• Rodriguez, L. et al. (1999) Persistence and genetic stability of Ebola virus during the outbreak in Kikwit, Democratic Republic of Congo, 1995, The Journal of Infectious Diseases, 179(1), pp. S170-6.
• Rowe, A. et al. (1999) Clinical, Virologic, and Immunologic Follow-up of Convalescent Ebola Hemorrhagic Fever Patients and their Household Contacts, Kikwit, Democratic Republic of the Congo, The Journal of Infectious Diseases, 179(1), pp.S28-35.

Bird Flu Reports From India, Japan, Korea & Taiwan

Credit UK Defra

 

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Between 2004 and 2007 the H5N1 avian flu virus expanded its range, going from basically being a problem for a handful of Southeast Asian countries, to being a problem for much of Europe, Asia, and the Middle East.  We saw huge wild bird die offs in China, Indonesia, and Eastern Europe, along with thousands of poultry infestations and culling operations.  

 

Along the way, several hundred humans were infected as well.

 

In 2008, H5N1’s expansion seemed to halt, and in many places the virus actually receded, leaving behind about a dozen places around the world where the virus remained entrenched.  Among them were Indonesia, Vietnam, Egypt, Cambodia, India,  Pakistan, Bangladesh, and China.

Even in these countries, the number of outbreaks reported – and the number of human infections – dropped markedly, with the peak reached in 2006 (n=115) and steadily dropping since then (2013= 39 cases).   The foci of infections also shifted away from Vietnam and Indonesia towards Egypt and Cambodia.

While never quite going away, it seemed as if the avian flu threat was simply fading away.

 

That is, until a new avian flu virus – H7N9 – appeared abruptly in China in the spring of 2013 sparking two consecutive winter epidemics, and is expected to return again this winter as well.  In quick succession, several more avian flu viruses appeared – including H5N8 in Korea (now spread to Europe & Japan), H5N6 in China and Vietnam, H5N3 in China, and H10N8 in China.

 

Now, instead of one avian flu threat, we have anywhere from three to six to keep track of (H5N1, H7N9, H5N8, H5N6, H5N3, H10N8), and no one should be terribly surprised if several more novel reassortants emerge over the next couple of years. 

Reassortant viruses emerge when two different flu viruses share a common host and swap genetic components. Most reassortant viruses are evolutionary failures, but every once in awhile a more `fit’ virus emerges.

Not only are there more `building blocks’ in play, for flu viruses to swap and play with, the poultry vaccines in use in China and elsewhere are losing their effectiveness, and that may be promoting the creation of new flu strains (see EID Journal: Subclinical HPAI In Vaccinated Poultry – China).

 

In recent weeks we’ve seen more bird flu stories, from more diverse locations, than we have in a number of years.  While this may be a flash in the pan, for now bird flu concerns are once more on the ascendant – albeit, for now, mostly for poultry operations. 

 

With so much going on in India, Korea, Japan, the Netherlands, Germany, the UK, and Egypt – instead of blogging separately about these news stories – I’ve put together a morning round up.

Our first stop: India, where over the past few days we’ve seen reports of massive duck die offs in Kerala, and government plans to cull 200,000 birds.  While initially only identified as an HPAI H5 virus, today multiple media sources are reporting the virus is the H5N1 subtype.

 

Kerala Confirms Bird Flu is Deadly and Highly Contagious Strain

Updated: November 27, 2014 15:56 IST

Kottayam: Kerala has confirmed that the outbreak of bird flu in the state is of the feared H5N1 strain, which is highly contagious and can be fatal to humans.

Government officials said that massive culling of birds is being done to prevent the spread of the disease.

The virus itself killed about 15,000 infected ducks in Kottayam and another 500 in nearby Alappuzha, the first cases of the disease in the country since February this year.

(Continue . . . )

 

Meanwhile, in Korea, there are fresh reports the the H5N8 virus – which emerged there last January and proceeded to devastate the poultry industry -  has been detected again on a poultry farm in the coastal city of Gyeongju in Gyeongsang Province.

 

Bird Flu Spreads in S. Korea

Pyongyang, November 26 (KCNA) -- A bird flu occurred at a chicken farm in Kyongju City, North Kyongsang Province, south Korea on Nov. 24, according to KBS of south Korea.

Hundreds of chickens were culled and buried.

It was also reported that bird flu caused by migratory birds is spreading.

(Continue . . .)

 

In Japan, another report of migratory bird feces testing positive for the H5N8 virus, this time in Tottori.

This season highly pathogenic avian influenza detected in Tottori third example

November 27, 2014

Ministry of the Environment is the 27th, highly pathogenic avian influenza virus from droppings of ducks found in Tottori (H5N8 subtype) was detected, was announced. Domestic wild birds in the highly pathogenic avian influenza has been confirmed Shimane Prefecture Yasugi, season three cases eyes continued to Chiba Prefecture Nagara.

(Continue . . .)

 

And from Taiwan this morning, reports (h/t Ronan Kelly of FluTrackers) of both H7N9 and H7N5 in migratory bird feces samples collected this month from Tainan City, in the southwest of Taiwan.  Further testing will be required to determine the pathogenicity of these subtypes.

 

Four grass wetlands and migratory birds excrement detection of H7N9 subtype avian influenza virus vaccination started around the poultry farms safe and secure

Published date: 2014/11/27 morning 10:55:20| last modification date: 2014/11/27 10:55:20

Four wetland today in this city (103) on November 15, feces sampling inspection in routine monitoring of migratory birds on 25th H7N5 and subtype H7N9 avian influenza viruses isolated, identified highly pathogenic virus does not at present, but homologous strains is a city, pending final confirmation.

Protection of animal epidemic prevention Department said in this city, as a safeguard against four grass migratory birds carrying the virus, around the 25th started 6 games within a 3 km radius of poultry farms quarantine measures, including 1 feeding chickens, health situation is good, same day sampling inspection. Animal Health Department has stepped up poultry farms in and around the public road disinfection and epidemic prevention work, and to strengthen the poultry farm visits and monitoring of the epidemic, and take precautions against the epidemic. According to the sampling frequency of the disposal process 1 times per month on poultry farms within 3 kilometers to strengthen monitoring for 3 months after confirming that the avian influenza virus activity was not detected, you can unlock the wetlands regional monitoring measures.

(Continue . . .)

 

Meanwhile we continue to see scattered media reports of bird flu `alarm’ in Egypt, amid numerous poultry outbreaks and three recent human infections (see Meanwhile, Back In Egypt . . . .), and Europe continues to ratchet up their biosecurity measures against any further introductions of the H5N8 virus (see Defra updated bird flu guidance).

While the public health threat fairly remains low from these viruses, the one constant with influenza viruses is their capacity for change.  So we watch these outbreaks carefully, for any signs that these viruses may be evolving into a greater human health threat.

WHO Ebola Response Roadmap - Situation Report 26 Nov

 

 

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The World Health Organization has released their latest weekly Ebola situation report, and while case counts and death tallies are still believed to be under-counted, they report that the number of new cases appears to be stable or declining in Liberia and Guinea, but may be rising again in Sierra Leone.

The toll on healthcare workers continues to run high, with nearly 600 infected, and 330 deaths.   Follow the link below ro read the full update online, or Download the PDF

 

Ebola response roadmap - Situation report

26 November 2014

summary

A total of 15 935 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 23 November. There have been 5689 reported deaths. Cases and deaths continue to be under-reported in this outbreak. Reported case incidence is stable in Guinea (148 confirmed cases reported in the week to 23 November), stable or declining in Liberia (67 new confirmed cases in the week to 23 November), and may still be rising in Sierra Leone (385 new confirmed cases in the week to 23 November). The total number of cases reported in Sierra Leone since the outbreak began will soon eclipse the number reported from Liberia. The case fatality rate across the three most-affected countries in patients with a recorded definitive outcome is approximately 60%. Three health-care workers were reported infected with EVD in Guinea in the week to 23 November. 

Response activities continue to intensify in line with the UNMEER aim to isolate 70% of EVD cases and safely bury 70% of EVD-related deaths by 1 December. Guinea isolates over 70% of all reported cases of EVD, and has more than 80% of required safe burial teams. Progress on isolation and safe burials has apparently been slower in parts of Liberia and Sierra Leone, although uncertainties in data preclude firm conclusions. At a national level, both countries are apparently unable to isolate 70% of patients, although data on isolation is up to 3 weeks out of date. Every EVD-affected district in the three intense-transmission countries has access to a laboratory for case confirmation within 24 hours of sample collection. All three countries report that more than 80% of registered contacts associated with known cases of EVD are traced, though the low mean number of contacts registered per case suggests that contact tracing is still a challenge in areas of intense transmission.  

<SNIP>

Health-care workers

A total of 592 health-care workers (HCWs) are known to have been infected with EVD up to the end of 23 November, 340 of whom have died (table 5). The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the US (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas).

(Continue . . . )

 

Saudi MOH Reports Another MERS Case In Al-Kharj

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The Saudi MOH is reporting the fifth MERS case from the Al-Kharj region over the past two weeks. While exposure routes have undetermined for many of the other cases, this time nosocomial exposure is listed as a likely source of infection.

 

This is the 22nd MERS case announced thus far by KSA for the month of November, and comes on the heels of 34 cases reported in October, and 12 cases in September.

Thanksgiving Roll Call 2014

@FLA_MEDIC on Twitter

It is hard  for me to believe this makes my ninth Thanksgiving blogging at Avian Flu Diary.  Somehow, even after more than 9,300 blog posts, I still find there are new and interesting things to write about nearly every day. 

In November of 2006 I began what has turned out to be a joyous yearly tradition for me - taking the time to publicly acknowledge and thank many of the friends I've made along the way on this remarkable journey through Flublogia.

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When I began AFD almost 9 years ago, I did so with no expectations that anyone other than myself and maybe some family members would ever read it.  I thought of it as more of an online diary (hence the name) than a public blog, and no one was more surprised than I when it turned out people were actually reading it.

Looking back at the quality of many of my posts in that first year, I have to wonder why they bothered.  

But I suppose if you don’t cringe at least a little when you go back and read your old stuff, you aren’t making any progress as a blogger.  The credit for any progress I may have made, however, more properly belongs to the many people who have – over the years – lent their knowledge, assistance, support and friendship to this humble blogger.

 

Where I’ve done well, I’ve them to thank.  Where I’ve fallen short, I have only myself to fault.

Today, if you will indulge me, I’d like to publicly thank a few of those who have, in one way or another, contributed to the success and longevity of this blog.   In no particular order, my thanks go out to . . .

Revere at Effect Measure, who not only showed Flublogia how a `flu blog’ should be curated (science-based, but written in a way that non-scientists could understand) – but who extended to this fledgling blogger words of encouragement and support long before it was probably due.

 

Four years after he closed up shop, I still go back and re-read the archives, as do many others.  Gone, but far from forgotten, Revere left an indelible mark on flublogia - and hopefully a faint imprint on my ramblings as well. 

 

Readers of this blog no doubt have noticed that I’ve referenced the work of CIDRAP often over the years. The reason is simple: The reporting from CIDRAP News  is always first rate, with most of the heavy lifting done by Editor Robert Roos , and Lisa Schnirring.

 

Dr. Michael Osterholm, Director of CIDRAP, is arguably the best spokesperson on pandemic influenza in the country, and I was delighted to finally get to meet him in 2009. Before devoting his attentions to CIDRAP, Mike served for 24 years (1975-1999) in various roles at the Minnesota Department of Health (MDH), the last 15 as state epidemiologist and chief of the Acute Disease Epidemiology Section.

The gang at CIDRAP have been tremendously supportive over the years, and I hope they know how much it is appreciated.

 

Crof, at Crofsblog, has been on the `flu beat’ longer than anyone else, has a great `nose for news’, and has also been a stout supporter of AFD, and an amazing example of blogging tenacity and endurance. 

 

Blog long and prosper, my friend.

 

Last year I was extraordinarily pleased to help welcome Virologist Dr. Ian Mackay, curator of the Virology Down Under Blog, and associate professor of clinical virology at the University of Queensland to Flublogia.

 

Not only does Ian lend a much appreciated level of scientific expertise to the flu blogging scene, he’s fun to read, and a genuinely nice fellow. If you aren’t already reading his blog, you need to add him to your list.

 

Last year I added a new friend, Dr. John Sinnott, MD FACP FIDSA and Director of the Florida Infectious Disease Institute, and Chairman of Internal Medicine at USF, who has also been extraordinarily kind to this blogger.

 

Among members of the fourth estate, there are some truly remarkable science and health writers and reporters, several of whom I’ve been lucky enough to get to know over the years.

 

Helen Branswell, health reporter for the Canadian Press, has produced some of the finest reportage on the emergence of the H5N1 virus (and now H1N1) as exists anywhere in the world, and she started back when few had heard of the threat.

 

Her writing is clear, concise, and absent of the breathless prose that many lesser journalists rely upon.  Whenever I find a Branswell article, I know in advance it is going to be well worth reading.

 

Likewise, Maggie Fox  with NBC news  is another standout in the world of health reporting. Maggie understands the science, having completed fellowships at the National Institutes of Health on Genomics, at Harvard Medical School on infectious disease, and at the University of Maryland on child and family health policy.

 

Author, and science writer Maryn McKenna lends considerable talent and expertise to Flublogia, particularly on the antimicrobial resistance front.

 

In 2010 her second book, SUPERBUG: The Fatal Menace of MRSA was published to sterling reviews (you can read my review here). Her Superbug Blog continues to be one the best resources on antibiotic resistance issues available online. Maryn is also the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service.

Although the infectious disease blogosphere has contracted a bit in recent years, new additions include the graphic and analysis rich Mens et Manus blog by  Maimuna Majumder, and  Microbiologist Robert Herriman’s Outbreak News Today. 

 

Robert has been kind enough to invite me on his weekly radio show on several occasions, and occasionally syndicates some of my blog posts.

 

Ian York, who now works at the CDC, also pens the  wonderful Mystery Rays blog (although his work schedule has severely limited his blogging). His eclectic meanderings through the world (and history) of infectious diseases are a delight for disease geeks and highly recommended.

 

In 2009, after several years of email correspondence, I finally got to meet the irrepressible (and now zombified!)  Scott McPherson. We were both part of the CIDRAP H1N1 summit in September 2009, and I got to spend two glorious days hanging out with him and Indigo Girl (of the AllNurses forum), forming what we called The Flu Amigos.

 

A fellow Floridian, Scott is the CIO of the Florida House of Representatives, and rubs elbows with State and Federal officials every day.  His insights, often sprinkled with a dash of healthy whimsy, are always a pleasure to read.  I remain hopeful that Scott will resume blogging on a regular basis again in the future.

 

While not necessarily flu-centric, some other bloggers of note that I follow, learn from, and recommend include:

Vincent Racaniello’s always excellent Virology Blog, which devotes a good deal of time to influenza.   His TWiV and TWiP  podcasts are also highly recommended.

Assistant Professor of Epidemiology, Tara Smith’s blog Aetiology and Celeste Monforton and Liz Borkowski of The Pump Handle are highly recommended as well.

And last, but hardly least, there’s Dr. Peter Sandman  who, along with his wife and colleague Dr. Jody Lanard , produce a wealth of invaluable risk management and pandemic communications advice on their Risk Communication Website.   Both have been great friends of this blog, and blogger.

 

And every day outside of the limelight dozens of hardworking flubies scour foreign language news reports, using search engines, text-finding software, and translating programs to bring us the latest tidbits of news from around the world.

 

While there are many who contribute, some of the names that pop up most often on the sites I visit include: Gert van der Hoek , Shiloh, Pathfinder, Emily, Sally, Carol@SC, mojo, bgw in MT, Readymom, Vibrant62, Sharon Sanders, Tetano, Diane Morin, Ronan Kelly . . . .

There are many others, of course.  My sincere apologies to those I failed to name.

 

I’ve written numerous times about the work they do, but if you want to know how they do it, check out Newshounds: They Cover The Pandemic Front. The work they do is remarkable. And I couldn't do much of what I do without them.  Thank you all.

 

The owners and moderators of the flu forums deserve mention, too. 

 

Labors of love, and devourer's of both time and money, flu forums provide a place for laymen and professionals to gather to discuss the various aspects of pandemic planning, and quite often, the science behind influenza and epidemiology. The founders and moderators do a terrific job keeping things on track, and do so without compensation. 

Most of the time, the costs (which can run into the hundreds of dollars each month) are borne by the owners.

 

There are a number of flu forums out there, but the two where I hang my hat are the Flu Wiki and  Flutrackers. Each has their own style and personality, and in many cases, members of one forum belong to several other forums as well.

 

The Flu Wiki, the first of the dedicated flu forums, was founded by DemFromCt, Pogge, and Melanie Matson.  In 2008, we lost Melanie after a long illness.  She was a pioneer, and an activist, and is greatly missed. This year,I’m sad to report, we lost Pogge.

 

FluTrackers, founded by Sharon Sanders (but is run with the aid of dozens of tireless volunteer moderators), boasts nearly 2,000 members and prides themselves on maintaining an impressive library of scientific literature on pandemic influenza and other emerging infectious diseases.

 

Sharon is also a dear friend, fellow Floridian, confidant, and unindicted co-conspirator.  And if it weren’t for Skype, we’d both be impoverished by long-distance phone charges by now.

 

And then there are the flubies, which number in the thousands. Some are active posters on the flu forums, while others take a more passive role.  Many have become activists in their communities.

 

Readymom, whom I've highlighted before in these pages, runs her own website Emergency Home Preparation.

 

Starting in mid-2007, more than a dozen volunteers worked to put together the GetPandemicReady.Org website.   There you will find more than 3 dozen easy-to-follow preparedness guides, written by some pretty familiar names from the Flu Forums.

 

Now is a good time to remind my readers that agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, Médecins Sans Frontières and others are working around the world every day to combat poverty and disease, including pandemic flu.

They could use your support. These NGO’s do a great deal with very little, and even small donations can help make a difference.

 

Often forgotten, I also send out thanks to all who wear the uniform of our country, and who will are often called upon to be on the front lines during any crisis, including a pandemic.

 

This includes our military and national guard troops, both at home and abroad. You guys and gals do a tough, often thankless job, 365 days a year; and are deserving of both our respect and our nation's gratitude.

 

Please know, you have mine.

 

There are hundreds of thousands of doctors, nurses, technicians, EMT's, paramedics, firefighters, and law enforcement officers out there who put it on the line each and every day. I'm proud to have been able to be a part of that universe. And my thanks, and fervent best wishes go out to each of you.

 

And of course, thanks go to the readers of these forums and blogs. There are far more of you out there than you imagine.

 

Those that post on flu forums, or comment on blog sites are just the tip of the iceberg. Ninety percent of our visitors read and absorb the information here, and say nothing. We know you are out there because our web counter software logs every visit.

 

No, I’m not going to `out' anyone. Your secret is safe with me.

 

But even this humble blog gets visits every day from hundreds of corporations, government agencies, financial institutions, and even medical research facilities. Names that you would readily recognize. And that is both extremely gratifying and humbling at the same time.

 

It has been an amazing journey, these past nine years blogging on influenza and emerging infectious diseases, and I've been fortunate enough to meet scores of people, either in person, or via email or chat, from around the world due to this blog.

 

Some of those who deserve particular mention – for reasons they already know – include:

 

To Camille, Sharon & Lance, Cheryl, Scott and Crof, Maryn, Maggie and Helen, MTO & Lisa & Nick & Robert at CIDRAP, Chacal & Family, John Sinnott, Ian Mackay, Jody Lanard & Peter Sandman, Peter C. Hall, Anne, Eric Starbuck, Rolf, Dr. Michael Greger, Jim in Thailand, Anne, Seazar, Paul, Joel, AnnieRn, Caroldn,and Bonnie  (and many more I've no doubt  left out) a special holiday thanks to you and your families.  

 

You guys, whether you know it or not, have extended kindnesses that can never be repaid, but that will never be forgotten.

 

And to my best friend of 46 years, Cliff Travis, who left this mortal coil last August.  You are missed, buddy.  Every day.

 

And to everyone else, a safe, happy, and healthy Holiday.

Thanksgiving Is National Family History Day

Note: This is an updated (including new links) version of my yearly post on National Family History Day.

 

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Every year since 2004 the Surgeon General of the United States has declared Thanksgiving – a day when families traditionally gather together - as National Family History Day.

 

As a former paramedic, I am keenly aware of how important it is for everyone to know their personal and family medical history.  Every day emergency room doctors are faced with patients unable to remember or relay their health history during a medical crisis. And that can delay both diagnosis and treatment.

 

Which is why I keep a medical history form – filled out and frequently updated – in my wallet, and have urged (and have helped) my family members to do the same.

 

The CDC and the HHS have a couple of web pages devoted to collecting your family history, including a web-based tool to help you collect, display, and print out your family’s health history.

Family History: Collect Information for Your Child's Health

Surgeon General's Family Health History Initiative

Using this online tool, in a matter of only a few minutes, you can create a basic family medical history.  But before you can do this, you’ll need to discuss each family member’s medial history. The HHS has some advice on how to prepare for that talk:

Before You Start Your Family Health History

Americans know that family history is important to health. A recent survey found that 96 percent of Americans believe that knowing their family history is important. Yet, the same survey found that only one-third of Americans have ever tried to gather and write down their family's health history.

Here are some tips to help you being to gather information:

• Before You Start (English) (PDF - 557 KB)
• Before You Start (Spanish) (PDF - 214 KB)

I’ve highlighted several other methods of creating histories in the past, some of which you may prefer.  A few excerpts (and links) from these essays. First, I’ll show you how I create and maintain histories for my Dad (who passed away several years ago) and myself.  This was featured in an essay called A History Lesson.

Today I’m going to impart a little secret that will ingratiate yourself with your doctor and not only improve the care you receive, but also reduce the amount of time you spend in the exam room. When you go to your doctor, have a brief written history printed out for him or her.

I’ve created a sample based on the one I used for my Dad (the details have been changed).   It gets updated, and goes with him, for every doctor’s visit.

And his doctors love it.

While every history will be different, there are a few `rules’.

• First, keep it to 1 page.     Even if the patient has an `extensive history’.   If your doctor can’t scan this history, and glean the highlights, in 60 seconds or less . . . it isn’t of much use.
• Second, paint with broad strokes.   Don’t get bogged down in details.  Lab tests and such should already be in your chart.
• Third, always fill in a reason for your visit.   Keep it short, your doctor will probably have 10 to 15 minutes to spend with you.   Have your questions and concerns down in writing before you get there.
• Fourth, list all Meds  (Rx and otherwise) and indicate which ones you need a refill on.   If you have a question about a med, put a `?’ next to it.   And if you have any drug allergies, Highlight them.
• Fifth,  Make two copies!   One for your doctor to keep, and one for you.  As you talk to your doctor, make notes on the bottom (bring a pen) of your copy.  

Once you create the basic template (using any word processor), it becomes a 5 minute job to update and print two copies out for a doctor’s visit.

The history above is great for scheduled doctor’s visits, but you also should have a readily available (preferably carried in your wallet or purse), EMERGENCY Medical History Card.

I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them. Alternatively, there are templates available online.

I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.

And a couple of other items, while not exactly a medical history, may merit discussion in your family as it has recently in mine.

• First, all adults should consider having a Living Will that specifies what types of medical treatment you desire should you become incapacitated.
• You may also wish to consider assigning someone as your Health Care Proxy, who can make decisions regarding your treatment should you be unable to do so for yourself.
• Elderly family members with chronic health problems, or those with terminal illnesses, may even desire a home DNR (Do Not Resuscitate) Order.

Verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

In Florida, the form must be printed on yellow paper. Different states have different requirements.  You should check with your doctor, or the local department of health to determine what the law is in your location.

My father, who’s health declined greatly in his 86th year, requested a DNR in early 2011. That – along with securing home hospice care (see His Bags Are Packed, He’s Ready To Go) – allowed him to die peacefully at home in his own bed. 

Admittedly, not the cheeriest topic of conversation in the world, but for a lot of people, this is an important issue to address.

A few minutes spent this holiday weekend putting together medical histories could spare you and your family a great deal of anguish down the road.