swine flu
revere | October 26, 2009CDC is again warning parents not to send your children to a swine flu party. The idea is to provide them with immunity, like used to be done with chickenpox parties. It's pretty hard to believe this is a live issue and CDC admits it doesn't have evidence that any have actually occurred. When it came up in the spring, during the first wave of H1N1, we and all other flu experts said it was a very bad idea, but at least one could understand the reasoning then. Since there was no vaccine and the worry was that swine flu might come back in the fall in altered and worse form during flu season, it…
revere | October 24, 2009I keep getting asked about the Atlantic Magazine article, Does the Vaccine Matter? by Shannon Brownlee and Jeanne Lenzer, two reporters whose particular bias is that we as a nation are "over treated." As a generalization that's probably true, and finding examples isn't hard. Unfortunately by taking as their main example flu vaccine during a pandemic, they have not only picked the wrong example but created more confusion at a time when there's already too much.
Here's the gist:
Vaccination is central to the government’s plan for preventing deaths from swine flu. The CDC has recommended that…
revere | October 23, 2009While we don't yet know with certainty the relative contributions of the three most likely modes of transmission for influenza (large droplets, small aerosols of viral laden material that remain suspended in the air for hours or days, inanimate objects like door knobs or desk tops), it is certain that if you are in the path of a cough or sneeze or even vigorous talking from someone actively shedding flu virus you are at risk. When it comes to delivering big time viral loads, nothing quite beats a vigorous cough or sneeze.
Take a look:
Of course it may not be so easy to "just stay home." The…
revere | October 22, 2009A reader (h/t MVD) sent me this link to a "CBS News Exclusive," Study Of State Results Finds H1N1 Not As Prevalent As Feared. As far as I can see the main aim was to raise CBS News's profile and gain readership. That's what news organizations do. We hope they do it by good journalism. I think this is an example where the reporters just didn't have enough knowledge of what they were reporting and put the wrong spin on it.
The central claim is that CDC stopped testing for swine flu hastily and without advance notice to the states:
If you've been diagnosed "probable" or "presumed" 2009 H1N1 or…
revere | October 21, 2009We've gotten the question here fairly frequently: If antivirals (Tamiflu, Relenza) for swine flu work best when given early but shouldn't be given to people who aren't really that sick, how do you balance waiting for them to get sick and have the drugs not work well with giving it when you don't need to? There is no absolutely right answer to this difficult question. Early in the pandemic antivirals were being given prophylactically to stop spread, then they were being given only when a diagnosis of swine flu was confirmed. Then only to the sickest patients. We're all on a learning curve. The…
revere | October 20, 2009When swine flu appeared, the pork producers were keen to say there was no connection or relationship between pigs and swine flu (even though the virus's genetic segments were all of swine origin). They didn't want anyone to call it swine flu, giving rise to the celebrated naming controversy. But then we started seeing pigs infected with human pandemic swine flu, both in the lab and in pig herds. It's likely the pigs got it from us, although which direction things went in isn't completely clear. But originally the virus made the jump from pigs to humans, probably sometime in late 2008 or…
revere | October 19, 2009Monday morning, start of week three of the official flu season (which began October 4). CDC's scientific spokeswoman on the flu, Dr. Anne Schuchat has said we are seeing "unprecedented" flu activity for this time of year, including an unusual toll in the pediatric age group. What does "unprecedented" mean? It's not very specific on what precedents are included, but if we confine ourselves to the three years before this one, we can get a good idea of just how unusual this flu season is. This week CDC unveiled a new graphic for their Emerging Infections Program (EIP) (I liked the old one better…
revere | October 18, 2009We've been traveling again (and offline), so we'll limit this to a few comments to put recent news into the context of things we talked about here recently (an excellent up-to-date status report can be found by DemFromCT at DailyKos). A good article by Rob Stein of the Washington Post highlighted some of the increasing anxiety of clinicians as flu season ramps up with pandemic swine flu in the northern hemisphere. Stein's article is quite long, but I have snipped a few things from it:
Although why a minority of patients become so sick remains a mystery, new research indicates that H1N1 is…
revere | October 17, 2009The vaccine problem as seen from a different angle:
The Daily Show With Jon Stewart
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Political Humor
Ron Paul Interview
revere | October 16, 2009Via Crof's blog (invaluable, as always) I learned of the decision of Massachusetts state health officials to vaccinate state prisoners before the rest of the population:
Prison officials warn that inmates could quickly spread the flu if not inoculated -- particularly those in high-risk groups such as AIDS patients.
Middlesex Sheriff James DiPaola told the Boston Herald that prisons were the perfect flu "breeding ground."
DiPaola dealt with riots in a Cambridge jail when rumors of swine flu spread there. (AP)
State legislators are already complaining that there are other, more vulnerable…
revere | October 15, 2009I've been asked a number of times why I am bothering to get both flu vaccines this year (the seasonal flu trivalent vaccine and the swine flu vaccine when it is my turn). I am in the older age group (last in line for swine flu vaccine) and it is my group that is hit the least hard from the swine flu virus. But there are a lot of us and we're still being hit. I don't know if I will be one of the unlucky few in my age group who draws the short straw or not, and I'd rather get vaccinated with an acceptably safe vaccine than take a chance in winding up having a machine breathe for me or not…
ddobbs | October 14, 2009"The Brite Nightgown," from Donald Fagen's First And Only Solo Tour (2006) -
Dana Blankenhorn, who brings a distinctive mix of skepticism, intelligence, and gruff impatience to his flu coverage, digests some unsettling stats from the JAMA articles. Some of his highlights:
* Health care workers get little protection from fancy masks. Workers given ordinary medical masks had a nearly 1 in 4 chance of getting the disease. The same for those given fancy N95 fitted masks. Many medical workers have been resisting getting the shot.
* Hospitals must be prepared for extraordinary burdens in the…
revere | October 13, 2009The online publication of three papers and a commentary yesterday in the Journal of the American Medical Association (JAMA; free access, links at bottom of post) provides some further data on what demand for critical care resources might be from the current swine flu pandemic. One paper reports on the Mexican experience, where mortality seemed unusually high but where access to services may have made the outcome worse. The papers from Canada are perhaps most pertinent to what might be experienced in the US and Europe. It appears that in terms of demand for ICU beds, the first wave from last…
revere | October 12, 2009I agree with one thing that Paul JJ Payack, president and chief word analyst of The Global Language Monitor says:
“At this point it is becoming increasingly difficult to engage in any form of public dialogue without offending someone’s sensitivities, whether right, left or center.” (Paul Payack, Global Language Monitor site)
Well, not complete agreement. I'm not offended by what he says. I just think it's dumb.
Although I had never heard of Mr. Payack's site, apparently he has taken it upon himself to compile, for the last six years, a list of what he deems the ten most politically incorrect…
revere | October 11, 2009If you are hesitating to be vaccinated for swine flu this year, perhaps this post will help you make up your mind. If it does, I hope it pushes you to get vaccinated, but whatever persuasion we attempt here will only be from a recital of what we know of the epidemiology of this pandemic. Because it is the different epidemiology that is the main feature, not the clinical characteristics or the virulence of the virus. So far this looks pretty much like a standard influenza A virus -- except for the epidemiology. Since I'm an epidemiologist, you might expect me to think this is important, and I…
revere | October 10, 2009When swine flu poked its head above water in the northern hemisphere in April our "normal" flu season was just ending. A surge of swine flu cases during a time when influenza was not usually seen was bewildering and confusing, not to mention alarming. We didn't know what to expect nor were we sure if it would peter out over the summer, as flu usually seems to (we may learn differently in the future as we start to do surveillance over that period) and then come roaring back or just disappear. While it didn't peter out very much, the big question was going to happen when the northern…
revere | October 8, 2009A Catholic hospital system in Arkansas seems to have come up with an innovative solution to encouraging health care workers be vaccinated while allowing them the autonomy to make their own decision. When we last brought up this question one of our commenters said he'd like to see a button on health care workers that said, "I'm not vaccinated." St. Vincent hospital system seems to have figured out a way to do this while still protecting both the worker and the patient. The idea is surprisingly simple:
Given the choice between face masks or the seasonal flu vaccine, nearly all 3,200 employees…
revere | October 7, 2009This is the internet. Like the newspaper, you shouldn't automatically believe everything you read on it, and when it comes to some of the more outlandish stuff, most people don't. But there are a lot of sites that appear quite legitimate, and maybe for some of the material on them they are fine, but sometimes mixed in is some real dangerous stuff. One genre we know is influential and a major source of information is what is sometimes called a "Mommy Blog," blogs or websites that cater to the insatiable hunger for reliable information of newly pregnant women or new moms. We wouldn't have…
ddobbs | October 5, 2009I've wondered many times, including out loud in Slate, why it's not common in the U.S. to give flu vaccinations at schools, so they could efficiently be given to the population (children) whose inoculation most effectively prevents epidemics or pandemics, as well as to anyone else who wanted one. Same place, procedure, and personnel every year. It would simply and speed things immensely, and save scads of money?
This story in the Times has me asking the question anew. Instead of a single date (or a few dates) in which people can line up and get their shots in an orderly, efficient process,…
ddobbs | October 5, 2009Never know what'll top the charts. Top post was a post I put up in January, "Pfizer takes $2.3 billion offl-label marketing fine." That post reported the news (via FiercePharma) that Pfizer had tucked away in its financial disclosure forms a $2.3 billion charge to end the federal investigation into allegations of off-label promotions of its Cox-2 painkillers, including Bextra. (Lot of money ... but it didn't quite wipe out the company's 2008 net income.) The company had set aside the money as part of a deal it was negotiating Justiice. Finalizing the deal, however, took until September. At…