CDC
revere | October 22, 2009A reader (h/t MVD) sent me this link to a "CBS News Exclusive," Study Of State Results Finds H1N1 Not As Prevalent As Feared. As far as I can see the main aim was to raise CBS News's profile and gain readership. That's what news organizations do. We hope they do it by good journalism. I think this is an example where the reporters just didn't have enough knowledge of what they were reporting and put the wrong spin on it.
The central claim is that CDC stopped testing for swine flu hastily and without advance notice to the states:
If you've been diagnosed "probable" or "presumed" 2009 H1N1 or…
revere | October 19, 2009Monday morning, start of week three of the official flu season (which began October 4). CDC's scientific spokeswoman on the flu, Dr. Anne Schuchat has said we are seeing "unprecedented" flu activity for this time of year, including an unusual toll in the pediatric age group. What does "unprecedented" mean? It's not very specific on what precedents are included, but if we confine ourselves to the three years before this one, we can get a good idea of just how unusual this flu season is. This week CDC unveiled a new graphic for their Emerging Infections Program (EIP) (I liked the old one better…
revere | September 28, 2009A good story by the AP's Lauran Neergaard yesterday highlighted the need for better public health surveillance and the efforts being made to improve it so as to keep track of possible rare side effects from the swine flu vaccine. This is an issue we've talked about a lot here, most recently in the context of not being able to fully test any vaccine for rare adverse outcomes prior to deployment. There's more involved than that, but first here's Neergaard's lede:
The U.S. government is starting an unprecedented system to track possible side effects as mass swine flu vaccinations begin next…
revere | September 27, 2009Flu season has started in earnest, even though it's not "officially" flu season until week 40 (first week in October this year). How do we know it's flu season if we don't test everyone and can't count flu? We use a surveillance system. The flu surveillance system has lots of moving parts and five or six components (or as many as nine, depending on how you count). None of them tell us exactly what we want and putting the different pieces together can sometimes be like the blind men and the elephant. But the system does work better than you'd think and it's undergoing modifications and…
revere | September 24, 2009Bats are no doubt fascinating animals. They also carry rabies. And I'll be honest with you. Rabies scares the crap out of me. Most people know that rabies is caused by a virus that is spread through the saliva of an infected animal. Because the virus attacks the nervous system, rabid animals often act aggressively and may bite, thus transmitting the disease. Fortunately vaccination against rabies is available and since the disease has a longish incubation period, there is usually ample time after being bitten by a known or suspected rabid animal to get a series of shots that will protect you…
revere | September 18, 2009Most people are either indifferent to swine flu or fearful, but the makers of Purell hand sanitizer and Chlorox are happy. It's been a boon to the business of sanitizing everything in sight as a way to ward off swine flu. Here's a story about Chlorox (bleach):
The company has secured additional suppliers and will increase production if needed, says Benno Dorer, senior vice president- general manager of Clorox’s cleaning division. Some retailers have already asked for more bleach, he said in a Sept. 4 telephone interview, declining to name specific companies.
An outbreak of the flu may add 2…
revere | September 13, 2009At the beginning of September CDC initiated a new system for monitoring influenza activity. We reported last week that the old system ended on August 30 and that we were now into the new flu season. We even titled the post, "End of Flu Season." To paraphrase Mark Twain, the reports of the death of the 2008 - 2009 season may have been exaggerated. Well, not really, but the advent of the new system caused some confusion, at least for us, and we think we should clear it up.
There are several interconnected issues here. One is that the way trends in influenza will be monitored has been changed…
revere | September 10, 2009Flu season is over. Before you heave a sigh of relief, I'm talking about the (official) 2008 - 2009 flu season, which ended August 30 in week 34 or the calendar year. Welcome to the new flu season, the one called 2009 - 2010. It promises to be, well, "interesting."
Not that the one just concluded wasn't interesting. Indeed before we get done analyzing the data already collected it's likely to be the most informative in flu science history, partly because we have tools we never had before, partly because we have information gathering and handling capacity we never had before. But mostly…
ddobbs | September 2, 2009On the radar of late:
Neuroskeptic ponders reports that antidepressant use in the U.S. has doubled in the last decade. As he notes, perhaps the most troubling thing finding in the study is that
the number of Americans using an antipsychotic as well as an antidepressant increased by a factor of more than 3. This is, frankly, extremely troubling, since antipsychotics are by far the worst psychiatric drugs in terms of side effects. There is evidence that some antipsychotics can be of use in depression as an add-on to antidepressants, but there is better evidence for other alternatives, such as…
revere | August 10, 2009Things have been quiet at CDC but apparently they have been changing. First, Dr. Richard Besser, who acquitted himself ably as Acting Director after January 20 until early June when Obama's new appointment, Dr. Thomas Frieden took over, has decided to leave CDC for television. Yes, television. Many at CDC will be sorry to see him leave. He was "the people's choice" for new Director, as one old CDC hand put it. I had heard that he had once had a TV show in California prior to his CDC days and he's obviously telegenic, articulate and knowledgeable. He will be joining ABC News as its senior…
revere | August 2, 2009Somewhere around mile 500 of the Revere tribe's 1000 mile trek to the beach for an alleged vacation -- long digression that interrupts the clear meaning of the sentence: if I'm on vacation, what am I doing writing about it? That's what Mrs. R. asked, as she headed to the beach, leaving me in air conditioned online splendor in a rented condo that could have been anywhere in the world, as long as it had high speed internet connection -- as I was saying, around mile 500 driving our new-ish car journey, CDC went live on a completely redesigned website for its novel H1N1 (aka swine flu) info. I'…
revere | July 8, 2009A risk factor for swine flu complications is pregnancy. Yet one of the few venues specifically for healthy people in modern health care facilities is for pregnant and postpartum women, the in and out patient portions of the obstetrics department. And what of the newborn whose mother gets the flu? Infants are also at greater risk from influenza complications.
This is a tough problem. CDC has just issued some interim guidance regarding swine flu and obstetrics settings. The guidance is "interim" because CDC is quite frank that there is a great deal we don't know about the probabilities and…
revere | June 23, 2009CDC has another snapshot of what the flu surveillance system is seeing up through week 23 (ending June 13). It shows flu still circulating in many communities at a time when most seasonal flu is normally at a very low level. Indeed of the 2765 specimens tested in CDC's network of 150 laboratories, virtually all of the roughly 40% were influenza A (seasonal influenza B has all but disappeared; the others were not influenza). Not all the flu A viruses were or could be subtyped, but of those that were or could be, 98% were novel H1N1. IN other words, there's lots of flu around, but essentially…
revere | June 19, 2009Swine flu infection of health care workers (or as CDC refers to them, health care personnel or HCP) was of interest early in the pre-pandemic phase for at last two reasons. One was the obvious goal of estimating the risk to front line workers and devising best practices for their protection. Another was the belief, reinforced by the SARS outbreak in 2003, that spread to HCP was an early warning that the virus was easily transmissible from person to person. SARS is a disease where patients are most infectious in the later stages when they are extremely ill, and HCP were among the hardest hit…
revere | June 11, 2009WHO today declared we an influenza pandemic is underway (aka, phase 6), which is not news to anyone. This beast has been barreling long for at least 3 or 4 weeks and the reluctance to call it what it was was related to resistance from some of WHO's member states (the UK, China and Japan have been often fingered as the chief culprits). The apparent lack of cases in Europe didn't fool most experts. The EU was using a testing protocol designed to minimize the case count. It was refreshing not to have the US party to these kinds of shenanigans, but of course we had no opportunity: it started here…
revere | June 11, 2009In William Osler's day (turn of the 20th century), pneumonia was called "the old man's friend," because it took the elderly away quietly and with relatively little fuss. It was most often caused by the pneumococcal organism, now called Streptococcus pneumoniae. When penicillin came on the scene in the mid 20th century, there was at last a treatment for pneumonia with this organism, but soon resistant strains developed. S. pneumoniae is a frequent resident of the human respiratory tract and usually causes no problems. But if it gets into the wrong place it can also cause sepsis, otitis media…
revere | June 1, 2009Since I talk a lot about flu in my real life as well as on the blog, I get questions from moms and care givers who wonder when they should start to get worried about a sick child or relative. It's context dependent, of course. The same symptoms that would be shrugged off at any other time take on a different meaning during a flu outbreak, especially when everyone seems uncertain about what is happening or what might happen. There's nothing irrational about this. Infection with influenza virus is always potentially serious and when the young and healthy are in the cross-hairs even more so.…
revere | May 28, 2009Influenza surveillance in the US has at least five component parts (depending on how you count it is as many as seven). We discussed the virologic surveillance system in another post. CDC has two surveillance sub-systems that look at hospitalized cases with laboratory confirmed influenza, the New Vaccine Surveillance Network (NVSN) and the Emerging Infections Program (EIP). The NVSN is confined to cases in children less than five years old, while the EIP covers all ages. Let's take a look at the most recent EIP data.
EIP doesn't cover the entire country. Instead it collects data from 60…
mikethemadbiologist | May 24, 2009I came across this post decrying the choice of Ralph Frieden as CDC director due to his "bluenose moralizing." Here's part of the argument:
What can't be denied is that Dr. Frieden and Mayor Bloomberg together promoted the myth that bad health is purely a matter of bad behavior.
The myth was an alarming break with the reality of the real causes of poor health, but it played well. There was the ban on smoking in bars, the ban on serving trans fats, the constant hectoring about what we eat and how much of it, and the finger wagging about AIDS "complacency" and our failure to use condoms.…
revere | May 22, 2009There is as yet no vaccine for the novel H1N1 (swine flu) pandemic strain of influenza now causing widespread illness in North America and what appears to be the start of growing outbreaks in Japan and parts of Europe (but check out this excellent piece over at ScienceInsider). WHO says most developing nations are not able to track influenza, so what is happening in Africa and parts of Asia is not known with any confidence. While the clinical illness from this virus doesn't seem very different than seasonal flu, the fact that most of the world's population has no immunity to it means there is…