Vulnerable To Vibrio

Credit Florida DOH

 

 

# 8758

 

While it is not always appreciated by tourists (and even some locals) here in Florida - once you step out of the tightly controlled environs of our mega-amusement parks - some of our best attractions can carry with them some unexpected hazards.

 

Parts of Florida remain as wild, and potentially dangerous, as it was a hundred years ago.

 

Hence admonitions not to feed, taunt, or otherwise engage our sizable population of alligators, warnings to beachgoers to shuffle your feet while wading to ward off horseshoe crabs, and caveats about ours being the lightning capital of the United States (4 lightning related deaths already in 2014).

 

Not all of our local hazards are as vicious as alligators, or as vivid as lightning bolts.  Some are microscopic, and can hide in  the warm waters of the Gulf coast and in contaminated seafood. 

 

Such is a bacteria called Vibrio Vulnificus.  

 

Ingestion of Vibrio vulnificus can cause gastrointestinal symptoms, but for healthy people, rarely causes serious illness.  The State of Florida warns, however: Vibrio vulnificus infections can be a serious concern for people who have weakened immune systems, particularly those with chronic liver disease

 

The most common route of infection is by eating raw or undercooked shellfish (oysters, mainly). Which is why I’ll take my oysters deep fried or steamed, thank you.

 

It is also possible to contract this infection from swimming, or wading, in contaminated waters.  From the CDC’s Vibrio Vulnificus website:

 

V. vulnificus can cause an infection of the skin when open wounds are exposed to warm seawater; these infections may lead to skin breakdown and ulceration. Persons who are immunocompromised are at higher risk for invasion of the organism into the bloodstream and potentially fatal complications.

 

These skin infections can prove quite nasty, and the press often refers to it as a `flesh eating bacteria’.   Antibiotics and extensive debridement of necrotic tissue are the standard treatments, and in some instances amputation is required.

 

It should be noted that millions of people swim in the Gulf and Atlantic waters off Florida every year, and only a small handful are affected. Frankly, you have a far better chance of drowning than acquiring this bacterial infection.

 

Nevertheless . . . . a handful of people do each year.

 

In order to remind the public of the dangers and to reduce the incidence of infection, yesterday Florida’s Department of Health released the following announcement:

 

FOR IMMEDIATE RELEASE          Contact: DOH Communications June 17, 2014            (850) 245-4111

HEALTH OFFICIALS ENCOURAGE AWARENESS OF POTENTIAL BACTERIA IN COASTAL WATERS

TALLAHASSEE – The Florida Department of Health urges Floridians with certain health conditions to avoid eating raw oysters and exposing open wounds to seawater and estuarine water, which may harbor bacteria called Vibrio vulnificus. Occurring naturally in the warm coastal waters, particularly during the summer months, Vibrio vulnificus has the potential to cause serious illness.

Persons who have wounds, cuts or scratches and wade in estuarine areas or seawater where the bacteria might be present can become ill. Symptoms of Vibrio vulnificus in wound infections typically include swelling, pain and redness at the wound site.

Other symptoms of Vibrio vulnificus infection include; nausea, vomiting, abdominal pain, diarrhea, fever, chills, and the formation of blistering skin lesions. Individuals experiencing these symptoms should contact a physician immediately for diagnosis and treatment.

Individuals with liver disease, including Hepatitis C and cirrhosis, are most at risk for developing serious illness from Vibrio vulnificus obtained from eating raw oysters. Others who should avoid consuming raw shellfish are those with hemochromatosis (iron overload), diabetes, cancer, stomach disorders or any illness or treatment that weakens the immune system. Thoroughly cooking oysters, either by frying, stewing, or roasting eliminates harmful bacteria and viruses in the meat. Consuming raw oysters that have undergone a post-harvest treatment process to eliminate the bacteria can also reduce the risk of illness.

A total of 41 cases of Vibrio vulnificus were reported during 2013 and to date this year there have been six cases, four due to the infection of an open wound and two from consuming raw shellfish.  For more information, please view this

Vibrio vulnificus fact sheet:  

 

 

Despite the dangers, and considering we have 80 million yearly visitors, and 20 million residents, surprisingly few run afoul of our natural hazards.  For that, public education and awareness is probably the biggest mitigating factor, something actively pursued by both the Florida Department of Health and Florida’s Division of Emergency Management.

For some of my earlier posts on Vibrio, you may wish to revisit:

Vibrio Vulnificus: Rare, But Sometimes Deadly

Flood Dangers Run Deep

Florida DOH: Orlando MERS Case Released From Hospital

Photo Credit NIAID

 

 

# 8639

 

Good news from the Orange County and Florida Department of Health concerning our recently imported MERS case.  He has been been given a clean bill of health and has been released from the hospital.  

 

While all known close contacts have tested negative for the MERS virus, we shall be very interested in hearing about any serological test results in the weeks to come.

 

 

 

UPDATE: May 19, 2014 MERS-CoV Update

FOR IMMEDIATE RELEASE Contact: DOH-Orange Communications

May 19, 2014 407-858-1429 or 407-858-1418

Orlando Health- Katie Dagenais

407-242-0305

Florida Department of Health and Orlando Health

PROVIDE UPDATE ON MErs-CoV IN FLORIDA

~Patient discharged from the hospital~

Tallahassee – The first patient in Florida with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection has been discharged from the hospital in Orange County. The patient has now tested negative for MERS-CoV and has recovered from the virus. All health care workers and household contacts who had contact with the patient were tested for MERS-CoV and all of those results have come back negative. There is no broad risk of MERS-CoV infection for the general public, and no threat to those traveling to the Orlando area.

The Florida Department of Health continues to work closely with Dr. P. Phillips Hospital and the Centers for Disease Control and Prevention (CDC) to ensure appropriate follow up, and to protect the health of all residents and visitors in Florida. Surveillance, contact investigation and testing continue, following standard public health protocols.

The information line for the public at the Florida Department of Health in Orange County is 407-858-1490. Information from the CDC for the public is available by calling 800-232-4636.

For more information, please visit DOH’s Online Newsroom- http://newsroom.doh.state.fl.us/2014/05/12/mers-cov-2/ or view the following resources:

• Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Fact Sheet (DOH): MERS-CoV – Fact Sheet

• Frequently Asked MERS Questions and Answers (DOH): MERS-CoV – FAQ

• Middle East Respiratory Syndrome information (DOH): http://www.floridahealth.gov/diseases-and-conditions/mers/index.html

• Middle East Respiratory Syndrome (CDC): http://www.cdc.gov/coronavirus/mers/index.html

• World Health Organization (WHO):

http://www.who.int/csr/disease/coronavirus_infections/en/

 

Florida DOH Press Release On MERS Case

Coronavirus – Credit CDC PHIL

# 8611

 

In a follow up to the CDC’s press conference on the second imported MERS case to the United States, Florida’s Department of Health   (h/t Pathfinder on FluTrackers), has released the following statement:

 

 

FOR IMMEDIATE RELEASE Contact: DOH Communications
May 12, 2014 (850) 245-4111

HEALTH OFFICIALS CONFIRM FIRST MERS-CoV CASE IN FLORIDA

Florida Department of Health working with CDC and Hospital Officials

• Questions from the Central Florida media will be addressed this afternoon by health officials and hospital representatives at the office of the Florida Department of Health in Orange County located at 6101 Lake Ellenor Drive, Orlando.
• The information line for the public at the Florida Department of Health in Orange County is 407-858-1490.
• Information from the CDC for the public is available by calling 800-232-4636.

Tallahassee – The Florida Department of Health today confirmed the first Florida case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in a patient at an Orlando hospital.

“The Florida Department of Health is working closely with hospital officials and the Centers for Disease Control and Prevention (CDC) to ensure appropriate care of the patient and protect the health of all residents and visitors in Florida,” said Dr. John Armstrong, State Surgeon General and Secretary of Health. “There is no broad risk to the health of the general public.”

“The Florida Department of Health in Orange County is taking all necessary steps to protect and inform the public,” said Dr. Kevin Sherin, Director for the Florida Department of Health in Orange County. “Our office has set up an information line to address any questions and we will continue to work closely with the hospital to ensure the safety of our community.”

“The patient is in good condition and is improving,” said Antonio Crespo, MD, Infectious Disease Specialist and Chief Quality Officer for Dr. P. Phillips Hospital. “We are taking every precaution, but believe the risk of transmission from this patient is very low since his symptoms were mild and he was not coughing when he arrived at the hospital.”

The patient is visiting the United States from Saudi Arabia. The patient first flew to London and then through Boston and Atlanta, arriving in Orlando on May 1. The patient was hospitalized on May 9 and was placed in isolation once MERS-CoV was suspected. Efforts are underway to make contact with any individuals who had close contact with the patient during travel or in the Orlando area. The patient remains in stable condition and is receiving appropriate care.

MERS-CoV infection is a viral respiratory illness that was first reported in Saudi Arabia in 2012. MERS-CoV transmission has occurred in hospital settings, but there is no evidence of sustained spread in communities. How the virus emerged is unknown. There is no available vaccine or specific treatment for the virus.

Symptoms of MERS-CoV are similar to those of the flu and include

• Congestion
• Cough
• Fever over 100.4
• Shortness of breath
• Pneumonia
• Body aches
• Diarrhea

MERS-CoV is a reminder of the precautions that everyone can take to protect themselves, their
families, and their communities from any communicable diseases:

• Wash your hands often with soap and water. If soap and water are not available, use an
  alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth. Germs spread this way.
• Stay at home when you are sick, and avoiding close contact with sick people.
  

For more information, please visit the following websites:

• Middle East Respiratory Syndrome: http://www.cdc.gov/coronavirus/mers/index.html
• About Coronavirus: http://www.cdc.gov/coronavirus/about/indes.html
• Frequently Asked MERS Questions and Answers: http://www.cdc.gov/coronavirus/mers/faq.html
  

The Department works to protect, promote and improve the health of all people in Florida
through integrated state, county and community efforts.

Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida

Department of Health please visit www.floridahealth.gov .

Florida Prepares For Chikungunya

One of two highly competent vectors in the Americas

# 8606

 

While MERS and Avian Flu may eventually prove a more dangerous viral foe, for the Caribbean, Florida, and potentially other parts of North America a trio of exotic mosquito borne viruses pose a more immediate threat; West Nile, Dengue, and the new kid on the block . . . the Chikungunya Virus (CHKV).

 

West Nile arrived in New York City 15 years ago, and and very quickly began to spread across the nation.  Today it has been reported in all 48 contiguous states.

From the USGS Factsheet on West Nile Virus

 

The headline last spring from the CDC was DVBID: 2012 Record Number Of West Nile Fatalities, where at least 243 deaths were recorded out of more than 5,000 infections. Given that most people experience only mild symptoms, and only the most serious are ever reported,  the actual number of WNV infections was certainly in the tens of thousands.

Dengue, while a more recent arrival and claiming fewer victims in the United States, showed up in 2009 (see MMWR: Dengue Fever In Key West) after an absence of roughly 60 years, and over the past five years has been sporadically seen in Florida (see Florida: Dengue Forces Suspension Of Blood Donations In Two Counties), Texas, and last November we even saw a case of Locally Acquired Dengue In New York City.

 

In 2009 the Natural Resources Defense Council (NRDC) released a report outlining the risks that Dengue could re-establish itself in North America, that included this map showing the areas of the United States that are vulnerable to the introduction of Dengue.

Northern climes are far less likely to see dengue take hold than say, Florida or Southern Texas. Still, in the 18th and 19th century, both Malaria and Yellow Fever were endemic up and down the mid-Atlantic coast.

 

While Dengue and WNV will both be watched carefully during the upcoming mosquito season, the sudden arrival of Chikungunya into the Caribbean last fall (see CDC Update On Chikungunya In The Caribbean) has added a new threat to the mix. 

 

Last month in Study: Chikungunya’s Growing Threat To The Americas, we looked at predictions that CHKV might be coming to a mosquito near you, an eventuality anticipated by the CDC/PAHO three years ago in their 161-page guide on preparing for the arrival of Chikungunya to the Americas (see Preparedness and Response for Chikungunya Virus Introduction in the Americas).

 

According to the ECDC, Chikungunya – which while rarely fatal, can cause prolonged fever and polyarthralgias (joint pain) - has now spread to more than a dozen Caribbean nations, and has caused more than 30,000 probable and confirmed infections (cite) over the past  6 months.

 

As you might expect, given its climate, its position as the gateway to the Caribbean, and that it receives millions of tourists every year -  Florida is considered a likely first US battleground against any CHKV invasion.  As part of their preparations for this unwelcome arrival, the Florida Department of Health recently held an Interagency Webinar on the CHKV threat.

 Florida’s DOH Chikungunya Website contains some excellent resource materials from that webinar, including:

 

 

April 1st Interagency Webinar Presentations

Florida Surveillance and Response CHIK  (1.1 MB PDF)

Mosquito Control Measures CHIK (2.0 MB PDF)

Epidemiology and Medical Importance CHIK (PDF)

For a recording of the April 1st training please contact Epi.Training@flhealth.gov and list "CHIK Training" in subject line.

 

Although we’ve seen sporadic cases of viremic CHKV infected travelers to the United States in the past (see 2011 CID Journal report Chikungunya Fever in the United States: A Fifteen Year Review of Cases), those numbers have been small (109 between 1995- 2009), and so far (unlike dengue and WNV), we haven’t seen any evidence of local transmission.

 

Imported CHKV in Florida – FL DOH

 

But with CHKV now in the Americas, the number of CHKV infected travelers to the United States will certainly increase,  and any who are viremic (producing large quantities virus in their blood) while visiting regions where suitable mosquito vectors are present, could potentially introduce the virus to the local mosquito population.

 

Which is precisely what happened in Northern Italy in 2007, when a single infected traveler returning from India provided a blood meal to a local mosquito that set off a chain of infection that eventually affected 300 people (see It's A Smaller World After All).

One of the best reviews of CHKV that I’ve seen can be found in the slide presentation - Epidemiology and Medical Importance CHIK (PDF) – a few excerpts which you will find below:

 

 

Chikungunya, like Dengue, WNV and other mosquito borne illnesses are largely preventable.

 

While the overall risk of contracting a mosquito-borne illness anywhere in the United States remains very small, with no vaccines available, and scattered cases of Dengue, West Nile Virus, EEE, SLEV, and now the specter of Chikungunya arriving in the near future - Florida’s Health departments urge people to always follow the `5 D’s’:

 

Good advice in Florida this during this spring and summer, and anyplace else mosquitoes can be found.

Arkansas: Naegleria fowleri Shuts Water Park

Photo  Credit Florida DOH

 

# 7519

 

While extraordinarily rare, each summer we usually hear about one or more cases of infection with Naegleria fowleri,  dubbed the `brain eating amoeba’ by the media.

 

Yesterday the Arkansas Department of Health (ADH) confirmed earlier local media reports of a case of PAM (primary amebic meningoencephalitis) due to this parasite in a 12 year-old girl who recently swam in the Willow Springs water park in Little Rock.

 

First stop, the ADH announcements (2), after which I’ll have more:

 

Friday, Jul 26, 2013

ADH Confirms Case of Parasitic Meningitis

Little Rock -- The Arkansas Department of Health (ADH) has confirmed a case of a rare form of parasitic meningitis. A case of primary amebic meningoencephalitis (PAM) -- a very rare form of meningitis caused by an ameba associated with warm rivers, lakes and streams -- was confirmed with the assistance of the Centers for Disease Control and Prevention.

 

Based on our ongoing investigation, the most likely source of infection is the Willow Springs Water Park. There was another case of PAM possibly connected with Willow Springs in 2010. Based on the occurrence of two cases of this rare infection in association with the same body of water and the unique features of the park, the ADH has asked the owner of Willow Springs to voluntarily close the water park to ensure the health and safety of the public.

 

The organism that causes PAM is known as Naegleria fowleri. It is commonly found in warm freshwater and soil all over the world and can cause a rare but severe brain infection that is usually fatal. Naegleria cannot be passed from person-to-person. The organism typically infects people by entering the body through the nose as they are swimming and diving. Individuals cannot be infected with Naegleria by swimming in properly cleaned, maintained and disinfected swimming pools.

 

While infection with Naegleria can occur anywhere, it usually occurs in the warm southern U.S. From 2003-2012, there have only been 31 reported infections in the U.S. This case is only the sixth case in Arkansas in 40 years.

(Continue . . . )

 

Friday, Jul 26, 2013

ADH Offers Further Guidance on Naegleria

Little Rock -- The Arkansas Department of Health (ADH) would like to remind the public that infection from naegleria fowleri, or parasitic meningitis, is very rare. If you swam at Willow Springs Water Park more than 8 days ago, you are NOT at risk for the infection. Even if you swam at Willow Springs in the past week, your risk of infection is exceedingly low.

 

“If you do not have symptoms, there is no test or preventive antibiotic or treatment needed,” said Dirk Haselow, MD, State Epidemiologist at ADH.

 

Persons with infection will develop symptoms such as fever, vomiting, stiff neck, headache, light sensitivity, irritability, sleepiness, confusion, or mental status changes within 7 days. If you develop two or more of these symptoms, please contact your doctor.

The Arkansas Department of Health (ADH) has confirmed a rare case of primary amebic meningoencephalitis (PAM) caused by an ameba associated with warm rivers, lakes and streams. The organism that causes PAM is known as Naegleria fowleri. It is commonly found in warm freshwater and soil all over the world and can cause a rare but severe brain infection that is usually fatal.

 

Naegleria cannot be passed from person-to-person. The organism typically infects people by entering the body through the nose as they are swimming and diving. Individuals cannot be infected with Naegleria by swimming in properly cleaned, maintained and disinfected swimming pools.
For more information visit: LINK

 

 

 

Local media describes this girl’s condition as `stable’, and that she in a medically induced coma. Historically, the prognosis with this type of infection has been very poor, with only 1 patient out of 128 diagnosed in the United States surviving (cite) over the past 50 years.

 

Although the primary route of infection is from swimming in shallow, warm, (usually stagnant) fresh-water lakes and streams, in 2011 we saw a couple of cases in Louisiana related to the use of Neti Pots for nasal irrigation (see FDA Advice On Safe Use Of Neti Pots).

Photo Credit FDA

 

Daily nasal irrigation is also practiced by many in the Muslim community, and that has led to dozens of deaths in recent years in Karachi, Pakistan where tap water standards are suspect. The most recent report I can find comes from late June:

 

Another man dies due to naegleria fowleri

 

KARACHI: The deadly waterborne infection, which is caused by an amoeba Naegleria fowleri claimed another life in the city on Saturday. With this case, the death toll, caused by this fatal infection, is now three since January 2013.

 

Last year, we saw Pakistan: Naegleria Fowleri Blamed For 10 Deaths, while in 2011, the CDC’s EID journal carried the following dispatch on a much bigger outbreak:

 

Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan

Sadia Shakoor, Mohammad Asim Beg, Syed Faisal Mahmood , Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali, Govinda S. Visvesvara, and Afia Zafar

Abstract

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

 

 

Since millions of people swim in waters where this amoeba naturally occur (or practice nasal irrigation) and only a small handful of infections result, the odds of acquiring this infection are exceedingly low.  

 

Still, as this infection is almost always fatal, is largely avoidable, and often involves kids - the state of Florida - which has had its share of cases over the years, takes the threat seriously.

 

 

The following short video comes from from the Volusia County Health Department.

 

The Florida Department of Health offers some common sense safety advice on how to avoid this parasite.

 

Photo Credit – Florida DOH

For more information on the Naegleria parasite, you can visit the CDC’s Naegleria webpage.

UK CMO: Antimicrobial Resistance Poses `Catastrophic Threat’

PDF Link

 

# 6997

 

The growing threat of antibiotic resistance has made a great many headlines over the years, but real progress in halting its spread has been disappointing. 

 

New superbugs, virtually unheard of a decade ago (see MMWR Vital Signs: Carbapenem-Resistant Enterobacteriaceae (CRE) and NDM-1: A Matter Of Import) continue to emerge, and further erode our dwindling antibiotic arsenal.

 

Today, England’s Chief Medical Officer (CMO) Dame Sally Davies released a a comprehensive overview of the dangers posed by growing antibiotic resistance, and issued a stark warning. 

 

The following 3 minute video introduces this new report.

 

This from the UK’s Department of Health.

 

Antimicrobial resistance poses ‘catastrophic threat’, says Chief Medical Officer

March 11, 2013

Global action is needed to tackle the catastrophic threat of antimicrobial resistance, which in 20 years could see any one of us dying following minor surgery, England’s Chief Medical Officer Professor Dame Sally Davies said today.

 

The stark warning comes as the second volume of the Chief Medical Officer’s annual report is published, providing a comprehensive overview of the threat of antimicrobial resistance and infectious diseases.

 

Calling for politicians to treat the threat as seriously as MRSA, the report highlights a “discovery void” with few new antibiotics developed in the past two decades. It highlights that, while a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed leaving our armoury nearly empty as diseases evolve and become resistant to existing drugs.

 

In addition to encouraging development of new drugs, the report highlights that looking after the current arsenal of antibiotics is equally important. This means using better hygiene measures to prevent infections, prescribing fewer antibiotics and making sure they are only prescribed when needed.

 

The Chief Medical Officer also states that more action is needed to tackle the next generation of healthcare associated infections, including new strains of pneumonia-causing klebsiella, that will be harder to treat.

 

Some 17 recommendations are made as part of the report, including:

• A call for antimicrobial resistance to be put on the national risk register and taken seriously by politicians at an international level, including the G8 and World Health Organization;
• Better surveillance data across the NHS and world wide to monitor the developing situation;
• More work carried out between the healthcare and pharmaceutical industries to preserve existing drugs and encourage the development of new antibiotics to fill the “discovery void” of the last 20 years; and
• Building on the success of the NHS in cutting MRSA rates, which have fallen by 80 per cent since a peak in cases in 2003 through better hygiene measures, which should be used when treating the next generation of healthcare associated infections such as new strains of harder-to-treat klebsiella.

(Continue . . .)

 

Dame Sally Davies remarks are not dissimilar from those made nearly a year ago by World Health Organization Director General Margaret Chan, who painted a bleak picture of the future of antibiotic availability in her keynote address to the Conference on Combating Antimicrobial Resistance in Copenhagen, Denmark.

 

The D-G’s entire remarks may be viewed on the WHO’s website at Antimicrobial resistance in the European Union and the world, but I’ve excerpted a few choice statements below, after which you’ll find a link to the World Health Organization’s latest publication on antibiotic resistance.

 

Excerpts from D-G Chan’s March 14th, 2012 speech.

 

Antimicrobial resistance is on the rise in Europe, and elsewhere in the world. We are losing our first-line antimicrobials. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.

<SNIP>

If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry, especially for gram-negative bacteria. The cupboard is nearly bare.

<SNIP>

A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.

The evolving threat of antimicrobial resistance - Options for action

Authors:
World Health Organization

 

And for a far more complete discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA. Maryn’s SUPERBUG Blog, continues to provide the best day-to-day coverage of these issues.

BBC: The Pandemic Flu Warning You Haven’t Seen . . . Yet

 

 

# 5605

 

 

 

Finding the right content, and tone, to deliver in a TV or radio PSA (public service announcement) during a global crisis like a pandemic has been the subject of much debate over the past few years.

 

Crisis communicators want the public to take a threat seriously, but they don’t want to push too hard, for fear alienating a portion of the public who may choose to tune out an overly ominous warning.

 

During the comparatively mild pandemic of 2009, PSAs were  fairly low-key. Designed to inform, but not inflame the public. 

 

In the UK, the fairly innocuous CATCH IT. BIN IT. KILL IT. was selected as being the appropriate response to a comparatively mild threat.

 

In the United States, the HHS even solicited PSA submissions from the public, resulting in many clever submissions and with the winner of the competition being Dr. John Clarke and his H1N1 Rap.

 

You can view the top 10 entries in my blog Vote For Your Favorite PSA.

 

In 2008, a year before the pandemic, I wrote about a PSA (see Reaching For the 2x4) produced by the The Ohio Department of Health that critics called ominous' and `chilling' while the Ohio Department of Health called them `edgy'.

 

 

Its one thing to run a `scary’ campaign before a crisis arises, quite another when a threat is imminent.

 

So the following year, when the H1N1 pandemic began and it was apparent it wasn’t going to be the killer flu that had been feared, the `big guns’ were left holstered.

 

But public health agencies – in their ongoing preparations for a serious pandemic – continue to work on finding the `right’ message. 

 

The BBC today has convinced (via a Freedom of Information Request) the UK’s DOH to release one of their proposed PSAs – created in 2006 when H5N1 bird flu was on everyone’s radar – that was intended for use during a severe pandemic sometime in the future.

 

You can read the BBC article, and view the video at:

 

Pandemic flu advert revealed by Department of Health

 

This particular PSA eschews the kind of stark imagery shown in the Ohio video above – and uses dominos as a metaphor for an illness sweeping inexorably across the globe.

 

Still, it manages to convey a menacing tone. 

 

Finding the `right message’ before, during, and after a crisis is a constant struggle. What resonates with one segment of the public may very well turn off another.

 

The pandemic threat from H5N1, and other novel viruses, has not gone away. While pandemics often occur decades apart, there are no guarantees that another won’t begin this year or next.

 

So public health agencies will continue to work to fine-tune their messages, looking for the right combination of imagery and advice that will prompt the desired response from the public without arousing unwanted alarm or antipathy.

UK: DOH Urges Doctors To Reassure Pregnant Women About Vaccine

 

 

# 3979

 

Experience over the summer has shown that pregnant women are 6 times more likely to end up in the hospital with complications from the H1N1 flu than the average person.  

 

Couple that with a steady barrage of news stories questioning the safety of the pandemic vaccine, and many women – and even some doctors – are in a quandary as to what to do.

 

Today the BMJ has a news report on the UK’s DOH (Department of Health) urging doctors to reassure their pregnant patients over the safety of the H1N1 vaccine, and the need to get vaccinated.

 

 

Published 9 November 2009, doi:10.1136/bmj.b4642
 

Reassure pregnant women over swine flu vaccine, health officials urge

Jacqui Wise
London

 
England’s Department of Health has urged GPs to reassure pregnant women who are worried about being vaccinated against swine flu.

 

In a letter to GPs and practice nurses David Salisbury, director of immunisation, says, "It is critical that clinicians are well placed to offer appropriate reassurance to pregnant women, their families, and friends. We recognise that a few recent media stories have caused anxiety and apprehension in some pregnant women about receiving the swine flu vaccine."

 

Dr Salisbury states, "There is good and increasing evidence that pregnant women are at higher risk of the serious consequences of swine flu. This evidence suggests that pregnant women are more likely to develop serious complications from swine flu, and the World Health Organization has stated that 7-10% of all hospitalised patients with swine flu are pregnant women in their second or third trimester."

 

The department has developed a question and answer sheet to support GPs in their consultations with pregnant women who may be anxious about the new vaccine(www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_107824).

 

The Joint Committee on Vaccination and Immunisation advises that Pandemrix should be given to pregnant women as it gives adequate levels of antibodies after a single dose, rather than Celvapan, which requires a two dose schedule given three weeks apart. Both vaccines are licensed at any stage of pregnancy.

 
(Continue . . . )