Influenza treatment
revere | January 25, 2009From a colleague who knows I am interested in prophylactics for flu:
Miss Beatrice, the church organist, was in her eighties and had never been married. She was admired for her sweetness and kindness to all.
One afternoon the pastor came to call on her and she showed him into her quaint sitting room.
She invited him to have a seat while she prepared tea. As he sat facing her old Hammond organ, the young minister noticed a cut-glass bowl sitting on top of it. The bowl was filled with water, and in the water floated, of all things, a condom! When she returned with tea and scones, they began…
revere | January 12, 2009DemFromCt's excellent post at DailyKos alerted us to the fact that this year's vaccine appears to have a mismatched influenza B component. Each year vaccine makers try to anticipate the strains that will be circulating 6 months hence, based on surveillance data. They have been fairly good with their guesses but things seem to be getting more complicated in recent years and mismatched strains are becoming more common, that is, the vaccines don't protect as well or at all against the strains that are actually circulating. There are three strains in the yearly "flu shot," two influenza A strains…
revere | January 11, 2009We've been blogging about flu for over four years. It's not a rare topic these days. But when we started we only found two other bloggers with an interest in the subject. One was the late (and much missed) Melanie Mattson at Just a Bump in the Beltway blog. The other was DailyKos frontpager DemFromCT. Dem is still on the front page at dKos and still on top of flu. He is one of the blogosphere's pre-eminent flu experts, being not only an accomplished blogger but a medical professional whose specialty is pulmonology. He sees flu up close, in the lungs of his patients. So whenever Dem writes…
revere | November 28, 2008In 1988 a 32 year old woman, 36 weeks pregnant, checked into a community hospital in Wisconsin. She'd had flu-like symptoms with a moderately high (spiking to 102 degrees F.) fever for the previous week. Three days before admission she started a cough that brought up sputum and a day before started to get short of breath. On x-ray both lungs showed a consolidated pneumonia in the lower lobes and she was started on broad spectrum antibiotics, transferred to a tertiary care hospital and started on assisted ventilation. Labor was induced and she delived a healthy baby, just over 6 lbs. Four days…
revere | November 14, 2008The idea of stopping flu "at the border" has received almost uniformly bad reviews from public health experts. Once human to human transmission starts we won't be able to stop it by closing our borders, although we likely will cause the usual unintended consequences, like preventing vital personnel and supplies from getting to where we need them. At least if we do it in the usual ham handed way this administration is famous for. We learn via CIDRAP News that federal officials are still willing to give a "risk-based border strategy" (RBBS) a go, at least in the form of an exercise. Now, at…
revere | November 13, 2008If there's an influenza pandemic in the near future all bets are off when it comes to unplanned for consequences. Well, maybe not all bets. Right now the only oral antiviral likely to have any effectiveness in a pandemic is oseltamivir (Tamiflu), although how effective and how long it would retain any effectiveness is in question. But there's a lot of it out there and it will be taken in high volume and, either in its capsule form [oseltamivir ethylester-phosphate (OE-P)] or its active form [oseltamivir carboxylate (OC)], excreted into the sewer system in massive quantities (discussed here…
revere | October 20, 2008Flu season is upon us and with it the perennial question, should I get a flu shot. In 2006 the Advisory Committee on Immunization Practices (ACIP) extended its 2004 recommendation that children 6 months to 23 months be vaccinated (2 doses) to now include children 6 months to 59 months (<5 yyears old). I'm in a targeted group to get vaccinated (over 65 years) and my three grandchildren are in the targeted group for children (one will slide into the window during flu season). What do we know about the usefulness of getting vaccinated? It's been studied, but unfortunately the results are…
revere | October 12, 2008I am still trying to retrieve my lower jaw from the floor, where it fell after reading this:
When Indonesia's health minister stopped sending bird flu viruses to a research laboratory in the U.S. for fear Washington could use them to make biological weapons, Defense Secretary Robert Gates laughed and called it "the nuttiest thing" he'd ever heard.
Yet deep inside an 86-page supplement to United States export regulations is a single sentence that bars U.S. exports of vaccines for avian bird flu and dozens of other viruses to five countries designated "state sponsors of terrorism."
The reason:…
revere | October 9, 2008Every parent's or grandparent's nightmare is to have their darling little one suddenly carried off by illness. Flu isn't on the radar screen of most parents but in recent years the public health community is taking notice. The first alarm occurred in the bad flu season of 2003 - 2004 when a retrospective tally showed over 150 pediatric deaths associated with flu. That was more than half again as much as we thought were occurring, although data was not very good. So a new pediatric surveillance system was put in place. One of the things it is showing is that methicillin resistant…
revere | August 19, 2008News reports that nonagenarians had robust antibodies against the 1918 flu strain were intriguing on several levels but I wasn't sure how many doors were still open to these being antibodies that developed in the years after 1918. After all, the 1918 subtype was H1N1 which circulated freely until the 1950s when it was displaced by the next pandemic strain, H2N2. H2N2 in turn was pushed aside by H3N2 in 1968. Then H1N1 returned in 1977 (some say it escaped from a Russian laboratory) and since then H3N2 and H1N1 have been co-circulating. Some years are predominantly H1N1, some predominantly…
revere | August 6, 2008A curious paper on the 1918 flu pandemic appeared this month in CDC's journal, Emerging Infectious Diseases. It seemed provocative, at least on the surface. It claimed that the conventional wisdom underlying pandemic flu preparations was wrong. It's not the flu virus we should be defending ourselves against but the common bugs of the upper respiratory tract that take advantage of new fertile ground to grow in after the flu virus invades:
Medical and scientific experts now agree that bacteria, not influenza viruses, were the greatest cause of death during the 1918 flu pandemic.
Government…
revere | August 3, 2008We have numerous examples of basic science that becomes unexpectedly useful and other examples of how veterinary science is useful to human health. Once you begin to understand how the world works it gives you tools that can be extended. The first stick used to knock a banana off a tree proved useful for lots of other things as well -- for example, whacking another monkey trying to poach on your personal banana patch (the Second Amendment of the Monkey Constitution gives all primates the Right to carry a club). So it's not such a big surprise that work on bird flu to save humans might have…
revere | August 2, 2008A new article in the British scientific journal, The Lancet, suggests that seasonal influenza vaccines may not be effective in preventing community acquired pneumonia in people 65 years old and older. This is the group specially targeted by CDC for vaccination each year and, not coincidentally, an age group that includes me. So I have both a scientific and personal interest in the subject. This isn't new news. We've previously discussed the evidence that shows seasonal vaccines are less effective in the elderly a number of times (see here and here) over the last few years, but the proposition…
revere | June 30, 2008We started blogging on public health at the beginning of the 2004 - 2005 flu season, although we didn't concentrate on flu immediately. We intended to use the public health problem of influenza, a disease that contributes to the death of almost 40,000 US citizens a year, as a lens through which to look at public health. The interest in bird flu and pandemic flu followed naturally. The intervening years saw seasonal influenza outbreaks that were milder than previous years, but this resourceful virus made a comeback in the flu season just concluded. CDC has just summarized the 2007 - 2008 flu…
revere | April 24, 2008In the previous two posts (here and here) we laid out some new results that dissect what might be happening at the molecular level when a patient infected with SARS or bird flu descends into Acute Respiratory Distress Syndrome (ARDS) from Acute Lung Injury (ALI) in a just published paper in the journal Cell (Imai et al., "Identification of Oxidative Stress and Toll-like Receptor 4 Signaling as a Key Pathway of Acute Lung Injury", Cell, Vol 133, 235-249, 18 April 2008). We have already discussed their experiments showing that TLR4, a receptor that is part of the innate immune system, was…
revere | April 23, 2008In our previous post we set the stage for discussing the results of a significant new paper by Imai et al. and colleagues on the mechanism of lung damage from diverse pathogens, including SARS, bird flu H5N1, 1918 H1N1 flu, inhalational anthrax and Monkeypox. If this work is verified it is a major step forward in our understanding of how the devastating consequences of Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI) come about and may well provide clues about how to treat what is still an essentially untreatable and catastrophic medical condition.
There are two main…
revere | April 22, 2008The cells of your body don't just sit there, unmindful of what is going on around them. They have to respond to things, even cooperate with other cells to get things done for the common good. Humans do the same thing. We've developed a system of signaling to each other using an intricate vocal system, a complex grammar, ears, eyes and smell detecting systems. It's a very complicated package with a lot of moving parts. It's not so surprising, then, that cells also have complex signaling systems with a lot of parts that they use to respond to their environment. Just as we sometimes make a…
revere | April 20, 2008The National Post recently had an interesting article on "disease mongering," an article I largely agreed with. The major point was that fostering a fear of "germs," promoting the idea that following medical advice, especially advice involving "taking your pills," and the very definition of who is diseased and who is not has a suspiciously commercial aspect.
Consider the marketing of hand sanitizers, a subject of interest to the flu obsessed:
The slogan of Purell -- a hand sanitizer manufactured by Pfizer -- is "Imagine a Touchable World." It's hard to miss the implication that the world in…
revere | April 9, 2008If you pay attention to the latest news about bird flu I will not be telling you anything new that there is a detailed description in The Lancet (a British medical journal) of a case in China of probable person to person transmission of bird flu. You can get details from the incomparable reporting of Helen Branswell (Canadian Press), James Macintyre (The Independent), Deborah MacKenzie (New Scientist) or your favorite wire service. You don't need this blog for the facts, although we also try to provide you with some of those, too. What we try to do is always add some value. Usually it's just…
revere | April 7, 2008To everything there is a season, including flu. We are now emerging from the other end of one of the more difficult flu seasons in recent years, although by no means out of the ordinary for the genre. Last time we commented, almost every state was experiencing widespread flu activity by the end of March only seven states reported widespread activity according to CDC:
States that were still reporting widespread flu the week of Mar 22 through 29 were Connecticut, Iowa, Maine, New York, North Carolina, Pennsylvania, and Vermont. Regional flu activity was reported in 27 states and local activity…