Public health preparedness
revere | November 24, 2007Yesterday was the fourth and final day of the important Geneva summit on sharing flu virus isolates. Like premature news of Mark Twain's death, the Reuters report the meeting had failed was exaggerated. On the contrary, the summit appeared to have moved things forward. We have the latest, below. You can find previous happenings and background here, here, here and here.
Status mid-day, Day 4 (3:26 pm Geneva time, November 23), as reported by Ed Hammond:
Some Things That Happened in the Night Session of Day 3 and Morning Session of Day 4
These sessions were the final negotiations before…
revere | November 23, 2007The critical summit on sharing influenza viruses entered its third day (previous coverage here and links therein). The big media outlets covered the opening but not since. Fortunately, you can read about developments here (Day 2, here). Ed Hammond is there and is keeping us abreast of developments.
A participant's view at the start of Day 3 (5:30 am, Thursday, Geneva time):
Halfway Through and No New Ideas from the US and EU
To be sure, Indonesia has not been the most effective leader for its cause. Its multiple failures at this meeting (if not previous ones) to put forward clear language…
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, 2007It's OK for storm victims to live in them, but don't let your employees enter them: FEMA. Who else?
The Federal Emergency Management Agency is barring employees from entering thousands of stored travel trailers over concerns about hazardous fumes, while more than 48,000 other trailers continue to be used by hurricane victims in Louisiana and Mississippi.
FEMA is advising employees not to enter any of the roughly 70,000 trailers in storage areas across the country, but the directive does not apply to other trailers still in use, agency spokeswoman Mary Margaret Walker said Thursday. (AP; hat…
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 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 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 | November 2, 2007Immigrants traditionally get blamed for a country's ills and historically they have been feared for their ability to bring disease as well. The recent cases of the traveling lawyer (and here, passim)and the Mexican businessman with TB raised concerns that tuberculosis would be brought to the US or other low TB incidence countries by immigrants or travelers from countries where TB was prevalent. Now a new study from Norway suggests this doesn't happen:
Immigrants from countries with high rates of tuberculosis who move to countries of low TB incidence do not pose a public health threat to…
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 30, 2007Bioterrorism defense dollars seem to be devoted mainly to procurement. This follows President Bush's prescription for how all Americans could defeat the terrorists after September 11: go shopping. Practicing what they preach, the federal government has gone on another buying spree for something we don't need: anthrax vaccine:
The federal government has awarded a $400 million contract to Emergent BioSolutions for another 18.75 million doses of anthrax vaccine, with a bonus to be paid if the company wins approval for extending the vaccine's shelf life.
The 3-year contract for BioThrax vaccine,…
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 21, 2007We've talked here fairly often (see, for example, here) that the way and how far influenza virus spreads isn't understood or known precisely. That seems to be a big surprise, not only to the public but to many in the public health community who should know better. That's why I was pleased to see that this dirty little secret is finding its way into the public press (hat tip from one of our many readers in Oz, RobT):
It was a simple question: how far could a virus spluttered out of someone's mouth travel?
When Professor Lidia Morawska went looking for an answer, she was staggered to find…
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 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…