Pandemic preparedness
revere | November 22, 2007We have an on-the-ground view of the critical influenza virus sharing summit, provided by Ed Hammond in Geneva. I am promoting his comment thread notes from earlier today and a fuller account from late in the evening on Wednesday (Geneva time) sent me by email. It is clear that the atmosphere is tense and not convivial.
First, if you haven't been following the issue here or elsewhere, here's a bit of background from an excellent piece at Intellectual Property Watch (h/t Agitant):
The politically explosive issue of ensuring everyone benefits from vaccines in the event of an influenza pandemic…
revere | November 20, 2007If a rogue H5N1 virus easiy tansmissible between people is to develop, the most plausible spot for it to happen is Indonesia, the world's fourth most populous with a vast reservoir of infected poultry (and who knows what else) and more human cases (113) and more deaths (91) than any other country. But Indonesia still refuses to share its human H5N1 isolates, contending they get nothing tangible from an arrangement which is likely to lead to vaccines they won't be able to afford. Under the current system, which allows intellectual property rights to cover vaccines developed from WHO supplied…
revere | November 13, 2007WalMart isn't my favorite store but they have shown one effective way to increase awareness about preparing for a pandemic or any other catastrophe that would interrupt supply chains and routine services. The store had a "free flu prep kit" lottery where entry involved filling out a survey about how much they knew about fllu preparing for flu. The winner was among 350 entries and she is frank to admit she didn't now anything about pandemic flu. That's changed:
Heather Farris says she didn't know much about a pandemic flu before, but now with enough flu supplies to stock a small van, she plans…
revere | November 11, 2007Time to return to a theme we have sounded on numerous occasions in the past three years. In a recent post we called for a renewed investment in our public health and social service infrastructure as the best strategy. The object is to harden local communities and make them more resilient to all kinds of shocks, not just a pandemic. We should have added, however, that this means local preparation can't be too local: only looking after ourselves and our families. Of course families should prepare, to the best of their ability, and having some reasonable stockpile will stand them in good stead…
revere | November 9, 2007Influenza A/H5N1 (bird flu) bubbles away this year much as in past years and public health professionals continue to wait with bated breath for the other shoe to drop. It could happen this year, next year or not at all. That's the way the world is. Betting on "not at all" isn't considered prudent by most people in public health, despite the fact that it's possible. So given the uncertainty, what is the best strategy?
It is a bit disconcerting to see that the overwhelming preponderance of resources to pandemic preparedness resources are going into influenza-specific counter-measures,…
revere | November 8, 2007Via the Clinician's Biosecurity Network Report we learn of a new study from the Webster St. Jude laboratory in Memphis showing that H5N1 can mutate to oseltamivir (Tamiflu) resistance without any loss in genetic fitness. Tamiflu resistance has been seen but infrequent and there was considerable evidence that the resistant strains were handicapped in some way, thus making them either less virulent or less transmissible. The hope was this was a built-in limitation. Now we know it isn't:
To investigate the fitness (pathogenicity and replication efficiency) of NAI-resistant [neuraminidase…
revere | November 6, 2007When the emergency room gets a huge influx of cases in a disaster it's time for triage, the separation of the those most likely to need and benefit from immediate emergency care from those that can wait or can't be helped. In a mass casualty disaster the assumption is that triage should start outside the doors of the ER, sending only the sickest there. Makes sense. But is it true? A computer simulation done by Cornell Medical School suggests it might not be:
. . . researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have created a computer simulation model of trauma…
revere | November 5, 2007I don't like to be a curmudgeon and I'm pretty tolerant when students write research papers that don't quite make professional grade. Writing papers may look easy -- you just have to report your results, right? -- but it isn't. Nor is designing a study or collecting the data. It takes time and practice to learn this and you make a lot of mistakes. I know from personal experience. It's the job of mentors, advisors and journal editors to educate students, bring them along, show them how to do it.
Apparently none of these guardians of the literature were awake when the paper, "Medical students…
revere | October 25, 2007The "experts" have spoken to WHO and WHO has spoken to us: because of the march of science, there's been a large upswing in the estimates of how much vaccine the world could produce in a pandemic -- if such a vaccine existed and there was a way to deliver it. But if there was one and it could be delivered, then WHO thinks we could produce up to a 4.5 billion doses by 2010 as a result of new manufacturing technologies and techniques to make the produced antigen go farther. A lot of "ifs," to be sure, but without the ability to make the stuff the rest doesn't matter.
At the moment we make a…
revere | October 24, 2007There's a line forming for the pandemic vaccine that doesn't yet exist. Sort of like a new Harry Potter book except it's not first come first served. Like a sinking ship, it's (pregnant) women and children first -- or among the first. The deployed military? Police, I understand. But deployed military? They come ahead of critical infrastructure (power, water, communications) and older children? They come ahead of food and agricultural workers?
"Certain military personnel like deployed forces would get vaccinated before certain other military personnel," HHS science adviser William Raub said in…
revere | October 19, 2007The President vetoes health care for kids, the Congress almost overrides it but not quite, and the American Academy for Pediatrics says the next likely pandemic flu bug, influenza A/H5N1, targets children and is being overlooked as the country whistles past the pandemic graveyard:
"Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among the most at risk," said Dr. John Bradley of the American Academy of Pediatrics, which co-authored the report with the Trust for America's Health.
[snip]
Children have long seemed particularly…
revere | October 18, 2007Almost everyone now seems to think the Iraq debacle was, well, a debacle. Many of us thought invading Iraq was a terrible idea to begin with. Others are silent on that issue (or approved) but think it was carried out poorly. No planning. Failure to plan, however, is a hallmark of the Bush administration. Their intentions are pre-programmed but they never seem to plan for the consequences of those actions. It's not just Iraq. Or Katrina, for that matter. It's also pandemic flu:
When you ask federal officials around the country if they are prepared for a pandemic flu, the answers are unsettling…
revere | October 4, 2007Swedish scientists are warning about Tamiflu in the environment because it passes through sewage treatment plants more or less unchanged. Readers of this blog may remember this coming up before when Andrew Singer and his colleagues in the UK published an article in Environmental Health Perspectives a year ago asking a logical question: what would happen in a pandemic if everyone started taking hoarded and stockpiled Tamiflu at once? Singer gave good reasons to think the active form of Tamiflu, oseltamivir carboxylate, would pass through the wastewater system. The Swedish study apparently…
revere | October 3, 2007The report of another bird flu death from Indonesia wouldn't seem to be "news." In a way, the fact it isn't "news" is news but we'll put that aside for the moment. Another thing about the story that isn't news is that the victim is a young person from the city of Jakarta, not a resident from a poor rural household living cheek by jowl with poultry:
The Health Ministry has confirmed that a West Jakarta shop attendant died of the bird flu Friday, increasing the country's human death toll from the virus to 86.
Ministry spokeswoman Lily Sulistyawati said test results for the latest bird flu…
revere | September 27, 2007It's not nice to get mumps. Mumps is caused by a paramyxovirus. Since the introduction of the measles-mumps-rubella vaccine most people have been spared the unpleasantness of the swollen, inflamed an painful salivary glands, or in older individuals, the systemic complications like orchitis (inflamed testicles) that can sometimes cause sterility in young males. It can also inflame the ovaries or breasts in females. It is contagious through the respiratory route and infected people shed virus three days before they get symptoms until up to nine days after symptoms start. So vaccination is the…
revere | September 24, 2007The National Health Interview Survey (NHIS) is the major source of information about the health of noninstitutionalized Americans -- you and me and our neighbors. Data collection started in 1956 and consists of ongoing data collection and special studies on illness and disability and their trends. Data is done using a questionnaire given to a representative household probability sample of the US population. If you want the gory details you can find them here. A recent report, presented in the CDC Morbidity and Mortality Weekly Reports (MMWR) QuickStats format, gives the estimated percentage…
revere | September 19, 2007The bird flu influenza subtype, H5N1, that has been infecting humans with high mortality is the highly pathogenic (HPAI) version of a virus that also exists in a low pathogenic form (LPAI). The high and low path designations refer to effects on poultry, not humans, but only the HPAI versions have been of public health importance. On the other hand, the HPAI strains have all come from LPAI ones via a variety of genetic mechanisms and LPAI strains are themselves of importance to the poultry industry where they decrease productivity of the flock. For these and other reasons there is a need to…
revere | September 14, 2007&In Europe and North America pets -- what veterinarians call companion animals -- are usually dogs or cats. In other countries (e.g., Korea) dogs are raised for food like livestock. Birds are a sort of cross over creature. Birds as companions are fairly common in Europe and America but they are most often exotic. But even people who raise birds for food frequently develop an attachment to them, and having a chicken or turkey as a pet is far from rare. But chickens get bird flu. It turns out that and dogs can also become infected, although at the moment they are not known to be…
revere | September 11, 2007It's September 11, so time to do a "security" post. Sigh. The current dopiness concerns the lessons we can learned for making das Vaterland safe after the recent Atlanta lawyer TB incident. Since learning the wrong lesson seems to be standard operating procedure for both Republicans and Democrats, not to mention "professional" public health types like the CDC, I'm not surprised to read crap like this:
A congressional investigation into officials' inability to stop a tuberculosis patient from leaving the country found significant security gaps, heightening concern about vulnerability to…
revere | September 5, 2007What seemed pretty obvious at first, that wild birds could be and were long distance carriers of H5N1 is, like the birds themselves, still up in the air. The problem is that existing data on migrating wild birds has failed to show convincing evidence they are infected:
FAO officials last year voiced concerns that bird migration patterns might have spread disease Asia and Europe to Africa. But as elsewhere in the world, very few cases have been found among wild birds in Africa.
The Wildlife Conservation Society Field Veterinary Program Director William Karesh is among those attending the…