Public health preparedness
revere | July 24, 2008The headline said, "Vaccination plan puts health care workers first," but you had to read the article to find out who goes next: the military. This according to the Guidance on allocating and targeting pandemic influenza vaccine released yesterday by the US Department of Health and Human Services (DHHS). The guidance is premised on the assumption that in the early phases of a pandemic, any vaccine will be in short supply and will need to be rationed. The document gives "strong advice" on how DHHS thinks this rationing should take place, although much is left unexplained. Since the allocation…
revere | July 7, 2008So Roche Pharmaceuticals now has sufficient productive capacity to make their influenza antiviral Tamiflu (oseltamivir) meet demand. More than enough, it appears, since they now have come up with a new scheme to unload some of their inventory before its 3 year shelf life expires and to keep turning over the inventory year after year, whether or not there is a demand in any particular year:
With an endorsement from US health officials, Roche, maker of the antiviral drug oseltamivir (Tamiflu), today unveiled a program to encourage more businesses to stockpile the drug to protect employees in…
revere | June 25, 2008In our earlier discussion of the science behind greenhouse gases we pointed out that all objects radiate electromagnetic radiation, doing so at a peak wavelength dependent upon their surface temperatures. That means two things. One is that things at the usual temperatures in our world are radiating EM radiation at wavelengths characteristic of the far infrared region. The other is that by measuring the intensity of infrared you can also measure the surface temperature of the body without touching it. Commercial devices are touted as highly accurate. Clinicians use them to measure body "core…
revere | June 12, 2008Crof, over at H5N1, has an important piece on Indonesia that is worth thinking about. He observes something that lots of us haven't paid attention to: Indonesia hasn't been notifying the UN agency on animal health, the OIE, about bird flu outbreaks in poultry for almost two years:
Here is the very last post from Indonesia: OIE DAILY UPDATE ON AVIAN INFLUENZA SITUATION IN BIRDS. As you will see, the date is September 26, 2006. Since then, Indonesia has told the world nothing about its poultry panzootic.
Look at this map of B2B H5N1 outbreaks. Indonesia looks as clean as Argentina.
Look at this…
revere | June 6, 2008The Indonesian Health Minister, Siti Fadilah Supari, has figured out how to deal with her country's reputation as being the bird flu capital of the world. She isn't going to announce deaths from the disease as they happen:
A 15-year-old girl died of bird flu last month, becoming Indonesia's 109th victim, but the government decided to keep the news quiet. It is part of a new policy aimed at improving the image of the nation hardest hit by the disease. Health Minister Siti Fadilah Supari said Thursday she will no longer announce deaths immediately after they are confirmed. But she promised to…
revere | June 2, 2008In a typically well informed and thoughtful commentary over at the mega-blog, DailyKos, DemFromCT reminds everyone that just because the media aren't talking about bird flu and pandemics and just because the candidates are arguing about the economy, the war and whose pastor is worse doesn't mean that anything has changed. All the elements that alarmed the public health community as far back as 1997 when the first human cases of H5N1 appeared are still there. In some respects we should be more alarmed because so much of what we thought about flu then we now know isn't the case at all. Learning…
revere | June 1, 2008Republicans are supposed to be the tight fisted fiscal conservatives and Democrats the ones who think that problems can be solved by throwing federal money at it. In reality it is just the opposite, a triumph for Republican image makers but a disaster for the rest of us who have lived through a decade of Republican Congressional and then Bush administration profligacy, with nothing to show for it but a widening gap between the favored plutocrats and everyone else. One sees it everywhere, most spectacularly in the Iraq debacle, which has enriched Bush - Cheny cronies while wreaking violence on…
revere | May 27, 2008IEDs, or Improvised Explosive Devices are killing American soldiers in Iraq. In Massachusetts people are dying from more prosaic things: auto accidents, heart attacks, homicides and suicides. IEDs aren't on Death's Menu in Massachusetts. So naturally the Bush-Chertoff Department of Homeland Security wants to protect Massachusetts citizens against IEDs:
Juliette N. Kayyem, the Massachusetts homeland security adviser, was in her office in early February when an aide brought her startling news. To qualify for its full allotment of federal money, Massachusetts had to come up with a plan to…
revere | May 8, 2008We seem to be doing a lot of vaccination stuff here lately. It's an obvious public health topic, one that's in the news and (in some quarters) considered controversial. I'm a strong proponent of vaccination where it makes sense (which is in most of the instances where it is used) but that doesn't mean I think it is problem free. For a public health scientist the problems are not only interesting but of practical import. Yesterday's post about fainting during vaccinations produced an unexpected comment thread from people who have at one time or another fainted during a vaccination or medical…
revere | April 23, 2008A viral infection with serious public health consequences occurred in Canada on January with little publicity:
Hundreds of computers at the Public Health Agency of Canada fell victim to a "worm," a bit of malicious software that nearly brought operations to a halt.
The trouble began Monday, Jan. 15, 2007, when a few computer users at the agency and at Health Canada reported getting error messages. The worm eventually knocked out 1,308 or 80 per cent of work stations in three cities and took more than a month to eradicate, say newly released documents.
The attack is estimated to have cost the…
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 17, 2008Peter Doshi has a bone to pick with CDC . His particular idée fixe is that CDC is cooking the books on their estimates of excess mortality attributable to influenza and he aims to set the record straight. He's done it before. Doshi is not the kind of critic CDC is used to. He is a graduate student, not an established public health figure. But he's no shrinking violet and is getting in CDC's face again in the latest issue of the American Journal of Public Health. This time Doshi extends his criticism to imply CDC is pandemic fear mongering, perhaps in collusion with Big Pharma. This has been…
revere | April 12, 2008If you want to know the single most important class of public health interventions with respect to infectious diseases in the 20th century it wasn't vaccines but provision of clean water and food supplies. But vaccines may be next. With major waterborne diseases like typhoid and cholera under control, the next big category of infectious diseases was the major childhood ailments: measles, German measles (aka rubella), mumps, chickenpox, polio, diphtheria, whooping cough. Some were just memories by the time I came along (diphtheria, pertussis), one was conquered in my younger years, the others…
revere | April 11, 2008Faith-based disaster relief sounds a bit like a contradiction to me. Why did God send the disaster in the first place? But what do I know. I'm an atheist. I'm also an American, however, and it seems passing strange to me that money raised from Missouri taxpayers should be used to support religious organizations to "transform lives and empower Missourians." That's what Republican Governor Matt Blunt is doing with his faith-based disaster relief initiative, designed "to increase cooperation between state government and faith and community-based groups in providing services to Missouri families…
revere | April 10, 2008First Tamiflu (oseltamivir), now Relenza (zanamivir):
Health officials [in Canada] are investigating whether Relenza - a drug provinces have stockpiled in case of a pandemic flu outbreak - can be linked to fatal reactions or abnormal behaviour in children.
[snip]
The investigation is a response to recently updated safety warnings issued by the U.S. Food and Drug Administration (FDA) or Relenza. In March, pharmaceutical giant GlaxoSmithKline updated Relenza's safety labels after children in Japan were reported to suffer from delirium, hallucinations. Some died after injuring themselves.
A…
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…
revere | April 4, 2008One of the least talked about problems in pandemic preparedness planning is that even if there is flu all around us and the health care system is struggling (and almost certainly failing) to handle the resulting demand of patients, people will still be getting sick from the usual things (heart attacks, strokes, etc.), having accidents, and yes, getting pregnant.
There is pretty good reason to think that getting the flu when pregnant is even worse than getting the flu otherwise. A pregnant woman's immune system reacts differently because of the special circumstance of accommodating the…
revere | April 3, 2008The index case was a 5 year old Miniature Schnauzer with 5 days of nasal discharge and sneezing. The dog recovered but the next case, a 3 year old Cocker Spaniel wasn't so lucky, nor were the 2 Korean hunting dogs (Jindos) or a 3 year old Yorkshire terrier. Then 13 dogs in a shelter started to show signs of nasal discharge, cough and high fever. Antibody studies showed that they had all been suffering from influenza infection, subtype H3N2. These cases happened in the spring and summer of 2007 (NB: this is not flu season). H3N2 is the most common subtype involved in human seasonal influenza.…
revere | April 2, 2008If a worker refused to report for work because it was a demonstrably dangerous workplace they would be within their rights, with a few exceptions. One of the exceptions in some states seems to be health care workers (HCW) who refuse to work during a pandemic. A HCW, like any other worker, might not report for work for a variety of reasons: fear for their own safety, fear for the safety of their families should they bring home an infectious disease like influenza, need to care for their family if one is sick or has not caretaker (say, because the schools are closed). In at least two states,…