CDC
revere | May 18, 2009Five more schools in the New York City borough of Queens have closed because of suspected swine flu cases. Eleven schools have now been closed there and hundreds of students are down with a flu-like illness. Parents are understandably concerned, the more so because not many days ago Mayor Bloomberg and the city's health commissioner (just named by Obama as the next director of CDC) were reassuring city residents this was pretty much lie seasonal flu.
We thought that was something that might come back to bite them, and now it has:
The city’s schools seem to have become both a sentinel and an…
revere | May 16, 2009The other shoe has dropped at CDC. Yesterday Obama named a new CDC Director, New York City Health Commissioner Dr. Thomas R. Frieden, an infectious disease specialist (drug resistant TB) who worked at CDC prior to going to New York in 2002. Frieden has long been rumored to be at the top of Obama's short list, so this wasn't a surprise, but the impressive performance on the swine flu outbreak of Richard Besser as Acting Director suggested to some he might get the job. Besser may be relieved he didn't:
At the C.D.C., [Frieden] will inherit a host of immediate and long-term problems, including a…
revere | May 11, 2009Yesterday DemFromCT had another in his continuing series at DailyKos on Flu and You (Part VIII). He extended an earlier post (part II) on a critical piece of public health infrastructure, laboratory surveillance. One of the graphics is this chart of influenza positive tests reported to the CDC by the WHO/NREVSS collaborating laboratories:
What you see in this chart is a weekly record of what seasonal influenza types and subtypes are circulating in the community (influenza A/H1N1, A/H3N2, B; swine flu makes a late appearance, far right). Flu seasons differ on dominant subtypes, whether they…
revere | May 7, 2009Breathing easier, may be an apt phrase for an almost audible collective sigh of relief. So far, the incipient swine flu pandemic is not extremely nasty. Is this perhaps premature? The world's premier scientific journal, Nature, and many flu scientists, suggest it is:
Complacency, not overreaction, is the greatest danger posed by the flu pandemic. That's a message scientists would do well to help get across.
[snip]
There is ample reason for concern: a new flu virus has emerged to which humans have no immunity, and it is spreading from person to person. That has happened only three times in the…
revere | May 5, 2009As I write this the US has 279 confirmed cases and one death from H1N1/2009 in 36 states. WHO has tallied 1085 1124 cases in 21 countries with 25 deaths. There is a backlog of samples waiting for confirmation, so by the time you read this the counters will probably have rolled upward, especially as state laboratories become facile with the new primers and are able to do their own confirmation. And predicting an increasing case count is about all anyone can say with certainty at this point. What we said once about flu pandemics can be said just as appropriately for the flu virus: "If you've…
revere | May 1, 2009Just a brief note to remind everyone about the case definitions CDC is using for reporting on swine flu (or whatever name we collectively settle on). In order to make sure numbers are comparable from day to day and place to place we have to decide on criteria for knowing we have something to count. Is someone with flu-like symptoms to be counted as a case? Or do we confine it to someone with laboratory proved infection with the virus? Should there be different categories of diagnostic certainty?
For the moment, CDC is using the following definitions for suspected, probable and confirmed cases…
mikethemadbiologist | May 1, 2009For keeping the big picture in mind when it comes to influenza--as the CDC decides to proceed with seasonal influenza vaccine production:
Dr. Marc Lipsitch, a Harvard School of Public Health epidemiologist, said the decision to proceed with seasonal flu vaccine production is evidence "that garden-variety seasonal flu kills on the order of 36,000 people a year, and while we are in a crisis and it might seem to make sense to ignore that, you can't."
..."We want to make sure in the vaccine manufacturing that we were still able to protect the country from seasonal flu and be able to protect from…
mikethemadbiologist | April 30, 2009...Oh my? The CDC is being very smart about this issue. As long time readers of this blog will know, the Mad Biologist is very concerned about the evolution of resistance to antibacterials (antibiotics) and antivirals. One such antiviral is Tamiflu which is used to treat influenza infections.
The CDC has flown in experts on the evolution of antiviral resistance to advise them on when and how Tamiflu should be used, so as to limit the evolution of resistance to Tamiflu.
And the CDC seems to be listening. You might have noticed that there has been very little public discussion of Tamiflu--…
ddobbs | April 28, 2009The excellent blog H5N1 (now covering H1N1 as well, and all over it), points us to the New York Times for an op-ed by John M. Barry, author of the definitive history of the Spanish flu in the US: Where Will the Swine Flu Go Next? Excerpt:
As the swine flu threatens to become the next pandemic, the biggest questions are whether its transmission from human to human will be sustained and, if so, how virulent it might become.
But even if this virus were to peter out soon, there is a strong possibility it would only go underground, quietly continuing to infect some people while becoming…
mikethemadbiologist | April 27, 2009Republican Senator Susan Collins went along with Karl Rove and cut or eliminated funding from the stimulus package for pandemic influenza spending. While Democratic Congressman Obey was able to restore $50 million for infection reporting, all state and local funding was eliminated. Nicely done, 'moderate' Senator Collins (italics mine):
Did Rove, Collins and their compatriots want a pandemic?
Of course not.
They were just playing politics, in the exceptionally narrow and irresponsible manner that characterized the Republican response to the stimulus debate - and that, because of Democratic…
sciencepunk | April 26, 2009
Thanks to Sandy for letting me know about the Center for Disease Control's Twitter Feed, which will keep you up to date with the current swine flu outbreak. Latest news is 20 confirmed cases in the US, with one hospitalisation, and clear human-to-human spread. Over at Effect Measure, Paul Revere has a well-informed running commentary of the emerging virus.
revere | April 25, 2009There may not have been much news at the CDC briefing, but it is coming thick and fast now. The CDC works through state health departments and defers to them on information about what is going on in their localities. Hence all questions about this were deflected at the 1 pm CDC briefing. I think I understand the thinking behind this but it doesn't serve the goal of getting the information out there quickly. CDC needs to be the information clearing house for all the swine flu news going on around the country and they need to do with absolute transparency. Here's what has developed since that…
revere | April 25, 2009CDC has just concluded a press briefing and the big news is there is no big news. In fact there was hardly any small news. The major questions have been identified -- how transmissible, what is the epidemic curve, are there more cases in the US, are there subtle genetic differences in the US and Mexican versions to account for the apparent difference in clinical and epidemiological features, etc. -- but answering them will take longer.
Meanwhile, no new cases have been identified in the US, but CDC in collaboration with state and local health departments and the academic and medical sectors…
revere | April 25, 2009There will be an update from CDC later today and WHO's expert committee established under the new International Health Regulations (IHR) meets via teleconference this morning North American east coast time at 10 am (4 pm Geneva time) to consider whether the swine flu situation merits declaring it “a public health event of international concern.” If they do, WHO Director General Margaret Chan may respond by raising the pandemic threat alert level from the current phase 3 (new virus: no or limited human to human transmission) to phase 4 (new virus, evidence of increased human to human…
revere | April 24, 2009Two recent sources of information, a conference call for clinicians and a just concluded media conference call held by CDC Acting Director Richard Besser.
Clinician call:
An emergency conference call for the Clinician Outreach and Communication Activity (COCA) was announced just hours ago on the Clinicians Terrorism and Emergency Preparedness listserv. It was "live blogged" via the Comments Thread by reader Abigail, MD. Here's the gist (lightly edited), as typed by her in real time (thanks!):
Update on current emergency situation - 8 individuals in US with swine flu, the hospitalized patient…
revere | April 24, 2009Late yesterday we summarized a CDC media briefing about the developing investigation of cases of influenza in California and Texas with a previously unknown flu virus with genetic components from pigs ("swine flu", humans and birds). At the same time reports were surfacing of an especially virulent respiratory disease outbreak in central and southern Mexico that had resulted in 20 deaths and hospitalizations with acute respiratory failure. 137 cases have been reported, including health care workers. When asked yesterday, CDC said they were in close touch with their Mexican counterparts but at…
revere | April 23, 2009This afternoon CDC held a "media availability" on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are "new," with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father - daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial…
revere | April 22, 2009Late yesterday afternoon a Morbidity and Mortality Weekly Report (MMWR) Dispatch appeared on CDC's website that is unique in my experience. MMWR is usually heavily vetted and edited and nothing gets out of there fast. Indeed, in recent years, nothing at all got out of CDC very fast. And yet here is this Dispatch, with text referring to the same day of issue (April 21), reporting on two young patients with febrile respiratory illnesses, one of whose cases CDC only learned about on April 13, 8 days earlier. April 17 CDC determined that the two children, both from the San Diego, California area…
revere | April 15, 2009The Wall Street Journal (WSJ) calls it a "reality check," meaning, in their terms, a check against the mistaken idea that there is more foodborne illness these days. That's one way to look at it. Another is a look that is reality based. The reality is that there is a tremendous health burden from tainted food that is unaddressed, at least going by the same CDC Morbidity and Mortality (MMWR) report the WSJ was citing. MMWR was reporting on 2008 data from FoodNet on the incidence of infection from enteric pathogens commonly transmitted via food:
Despite numerous activities aimed at preventing…
revere | April 1, 2009We have a small dog in our house. She came to us from Mrs. R.'s elderly mother, who had decided that a dog would be a good companion. She lived alone in the city. She also had low vision, and within weeks she had already fallen over the frisky little pup who was constantly under foot. As a public health measure, we took the pooch, although we already had a dog of our own. That was seven years ago and Rosie remains a beloved member of the family. She discovered we were easily trainable, so that part went fine (for her). Now CDC has published a report verifying that the circumstances that…