Influenza treatment
revere | April 1, 2008If you were infected with seasonal influenza virus, how long before you start having symptoms (the incubation period)? How about how long before you start shedding virus so that you can infect others (the latent period)? When are you most infectious? Expert opinion. based on experience and the scientific literature, says that the incubation period is about 2 days but you might start shedding virus after only a day, i.e., before you get any symptoms. You are most infectious on day 2 of your illness. But will everyone who is infected really "come down with" the flu? We know that a good…
revere | March 25, 2008We've covered the Indonesian refusal to cooperate with international influenza surveillance system to a fare thee well (see posts posts here, here, here, here, here, here, here, here, here, here, here, here, here and links therein), so this is just an update with some additional observations how Indonesia's deplorable behavior isn't that different than the US's deplorable behavior in the Middle East. First, Indonesia. When last we checked in Indonesia had sent off half a dozen flu specimens from the period after the end of January 2007 when it started its boycott. The hope was that the…
revere | March 23, 2008My children are no longer young. In fact they are old enough to have children of their own and when my daughter asked me if I thought her then 6 month old should get a flu shot I didn't hesitate: Absolutely, I said. And he did. Two of them, the required number. That was just before the flu season, which he has so far weathered just fine. Sadly that's not true for all children. The two most vulnerable groups for dying from influenza are children under 5 and the elderly (me). I got flu shots, too, although the evidence it will help me is not as good as the evidence my little grandson will be…
revere | March 11, 2008I'm an advocate of using computer models to help us think about what might or could happen during various pandemic flu scenarios, but it is a technique with drawbacks. For one, it can suggest that some things might be possible that are either very difficult to do or aren't feasible. This happened in 2005 when some models were published in Science and Nature that suggested a pandemic could be nipped in the bud before it started. Most people thought that what was required was unrealistic but it put WHO in a bind. They had to marshal their resources to show they were willing to try or go down…
revere | March 7, 2008There are a lot of open questions about the influenza antiviral drug oseltamivir ("Tamiflu"), among them whether it works at all for bird flu (highly pathogenic influenza A/H5N1), and if it does, whether resistance will develop making it ineffective. But all the questions have a common assumption: that the patient is actually taking Tamiflu. How would you know if you were or not? Because the bottle says so? Not necessarily. In December 2005 U.S. Customs and Border Protection (CBP) Officers seized 51 shipments they said were counterfeit Tamiflu pills at their air mail facility in San Francisco…
revere | March 4, 2008Press releases are the way a lot of scientific information is released today. Straight to the public, no peer review. This has advantages and disadvantages. The advantages are speed and directness. No filtering through reviewers, journal editors, colleagues. And of course that's the disadvantage, too, especially when the news comes from an interested party as it usually does in a press release. This is part of the interpretation of data these days. All that being said, the maker of Tamiflu, Hoffman - La Roche, has released data they have gathered from physicians treating cases of H5N1 in…
revere | February 17, 2008When my colleagues announced early afternoon on Friday he was headed home because he was sick, I knew the flu had finally arrived on my doorstep. It was already here, of course. The emergency rooms are jammed, clinics have long waits and hospital admissions for flu are up -- way up. The flu situation was the page one column eight story in Saturday's Boston Globe:
The flu virus is rampaging across New England, spawning waves of coughs and fevers, causing patients to flood doctors' offices, and raising questions about the effectiveness of flu shots given to tens of millions of Americans.
During…
revere | February 8, 2008We've discussed this already, but now CIDRAP News also has a story (which they got from AP) that this year's flu vaccine is not perfectly matched to the all the circulating viruses (of course we had it first, but hey, who's keeping track?). The data that are used to prepare vaccines for the next flu season come from predictions based on what is seen during the current season as determined by a global surveillance network (the same network at issue in the refusal of Indonesia to share H5N1 isolates, although this mismatch has nothing to do with the Indonesian situation). The circulating…
revere | January 30, 2008OK, they're not cities, they are states. Or cities in states. Whatever. But when it comes to flu shots they are quite different. First benighted Mississippi:
The Mississippi State Department of Health (MSDH) reports 27 laboratory-confirmed influenza cases in counties throughout Mississippi. The presence of influenza was documented by the MSDH Laboratory in the past few weeks.
"We are now in the peak season of influenza, which will last for the next couple of months," said State Health Officer Dr. Ed Thompson. "If you haven't gotten your flu shot, it's time to get it now. It's still not too…
revere | January 29, 2008Since the antiviral agent oseltamivir (Tamiflu) has been touted as the global savior should a bird flu pandemic materialize the idea has been haunted by the specter of Tamiflu resistance. What if H5N1 becomes resistant to the drug? Is all lost? Now it is being reported in the media that the European Centre for Disease Control and Prevention has found that the predominant circulating seasonal flu virus in Europe this year, H1N1, is showing an unexpectedly high rate of Tamiflu resistance (19/148 isolates tested). This is much more than what has been seen in the past and was from patients not…
revere | January 27, 2008There's no vaccine for the influenza subtype, H5N1, of most concern as the agent of the next pandemic but evidence exists that there is some cross-reactivity with existing seasonal vaccines (it's not clear how much if any, but it might not take much) or that previous vaccination with seasonal vaccine produces a much quicker response to an H5N1 vaccine. Moreover there remains a substantial toll in morbidity and mortality from the seasonal influenza which the current vaccines are designed for. So strategies to encourage key populations to get the existing flu vaccine are of interest to public…
revere | January 10, 2008Whenever confirmed human cases of bird flu appear in an area there usually follows heightened sensitivity to new cases of severe pneumonia. Are they bird flu too? Severe pneumonia is pretty common, so you can't automatically assume that "if it quacks like a duck and walks like a duck it must be a duck." It turns out there are a lot of birds that look like ducks that aren't ducks, at least when it comes to influenza-like illnesses. On the other hand, "testing negative" with PCR, which on its own is a pretty sensitive and specific test is also not foolproof. "On its own" means under the best…
revere | January 7, 2008Hospitals are dangerous places, but sometimes you have to be there. If you are a child in the developing world sick with pneumonia, the World Health Organization (WHO) thinks that's one of the times. Pneumonia is the big killer of children globally, so WHO guidelines call for children with severe pneumonia to be treated with intravenous antibiotics in the hospital. Now a landmark clinical trial from a team at the Boston University School of Public Health and published this week in The Lancet (January 4 issue), says these seriously ill children will do just as well at home on antibiotic syrup…