Influenza treatment
revere | July 8, 2009A risk factor for swine flu complications is pregnancy. Yet one of the few venues specifically for healthy people in modern health care facilities is for pregnant and postpartum women, the in and out patient portions of the obstetrics department. And what of the newborn whose mother gets the flu? Infants are also at greater risk from influenza complications.
This is a tough problem. CDC has just issued some interim guidance regarding swine flu and obstetrics settings. The guidance is "interim" because CDC is quite frank that there is a great deal we don't know about the probabilities and…
revere | July 6, 2009Flu virus is opportunistic. It takes advantage of any weakness. Seasonal flu picks on the very old and the very young, but pandemic flu has found us old folks tough and the younger amongst us quite tasty. No natural resistance seems to be a flavor enhancer. And pre-existing medical conditions? Quite delectable. So how full is the menu in the prime age range? CDC has just released one of their Quickstat summaries based on household interviews with a sample of the civilian, noninstitutionalized, adult U.S. population. The question the sample was asked was whether a doctor or other health…
revere | July 1, 2009For reasons not revealed to anyone I know, WHO is saying the Tamiflu resistance in a Danish swine flu isolate is "isolated case." Could be, but I'd sure like to know why they think so, other than they don't have any other examples. Meanwhile WHO and CDC continue to advise prompt use of Tamiflu (oral oseltamivir) for treatment of swine flu in high risk patients. Which brings up the question of side effects.
The most common Tamiflu side effect is nausea and vomiting. When my daughter was seen at the local hospital ER for swine flu symptoms and a positive rapid test for influenza A at a time…
revere | June 30, 2009Currently the only antiviral drugs effective against the swine flu (novel H1N1) virus are the two neuriminidase inhibitors, oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza). Relenza is in active form at the outset and cannot be absorbed orally. It must be inhaled, leading to asthmatic reactions in some, ineffective dosage in those with breathing difficulties, and no drug at sites beyond the respiratory tract. Despite these drawbacks, it has so far produced little or no viral resistance. Tamiflu is absorbed orally and converted by the liver into the active form, so it gets…
revere | June 20, 2009Two elite flu reporters, Helen Branswell (Canadian Press) and Declan Butler (Nature), both noted yesterday the dearth of clinic information on the serious and fatal swine flu cases. First Butler:
Clinical researchers have been slow to respond to the 2009 flu pandemic, lament researchers writing in today's Lancet. "Public health officials, virologists, epidemiologists, and policy makers have done well in responding to a rapidly emerging and complex problem. By contrast, the clinical research community's response has been delayed and modest, " writes Jeremy Farrar, a researcher in Ho Chi Minh…
revere | June 14, 2009Swine flu is a depressing and worrying topic, but into each depressing and worrying topic a little sun must shine. Or an opportunity glimpsed. Or something like that:
The World Health Organization declared a swine flu pandemic Thursday, raising its pandemic warning from phase 5 to 6, making swine flu the first global flu epidemic in 41 years. Now that H1N1 "Swine Flu" has been elevated to pandemic status, with reports of outbreaks in Asia, the Middle East and Europe, San Francisco, USA-based Cannabis Science Inc. (OTCBB: CBIS) CEO Steven Kubby urges public health officials around the world to…
revere | June 11, 2009In William Osler's day (turn of the 20th century), pneumonia was called "the old man's friend," because it took the elderly away quietly and with relatively little fuss. It was most often caused by the pneumococcal organism, now called Streptococcus pneumoniae. When penicillin came on the scene in the mid 20th century, there was at last a treatment for pneumonia with this organism, but soon resistant strains developed. S. pneumoniae is a frequent resident of the human respiratory tract and usually causes no problems. But if it gets into the wrong place it can also cause sepsis, otitis media…
revere | June 10, 2009Listening to yesterday's press briefing with WHO's Dr. Keiji Fukuda (audio file here), several things seemed clear to me. The first is that everyone, WHO included, thinks a pandemic is well underway. Second, WHO's efforts to explain why they are not making it "official" by going to phase 6 are becoming increasingly awkward and the explanations manifestly tortured. Essentially what Fukuda said was that WHO was waiting for its member nations to signal they knew it was a pandemic and then WHO would say it was a pandemic. It was reminiscent of the cries of one of the principals of the…
revere | June 7, 2009There is no reason why a flu blogger-epidemiologist-physician's family should be immune to flu in the community. And it appears my family is not. My daughter has had a cough for the last few days and Friday night was suddenly seized by nausea, vomiting and fever. Her HMO's urgent care directed her to the Emergency Room of the local hospital where a rapid flu test was positive. While waiting to be seen at the ER, her 10 month old, who had a croupy cough, also started vomiting and was warm to the touch. His (slightly) older brother (2 years) was also coughing. Her husband has a cough, too, and…
revere | June 5, 2009In New York City, an illness termed "mild" for many has killed 7 and put 300 in the hospital. A preliminary analysis of about half of those hospitalized, most (82%) were said to have some underlying medical condition. That's common with flu, but it's also a reminder that one of five were otherwise healthy, and unusually for flu, most of them relatively young (mostly under 65). Similarly, the deaths also had underlying medical conditions but were relatively young (median age 43). The two most recent deaths were in the mid 40s.
So not being old is one risk factor. What does "underlying medical…
revere | June 1, 2009Since I talk a lot about flu in my real life as well as on the blog, I get questions from moms and care givers who wonder when they should start to get worried about a sick child or relative. It's context dependent, of course. The same symptoms that would be shrugged off at any other time take on a different meaning during a flu outbreak, especially when everyone seems uncertain about what is happening or what might happen. There's nothing irrational about this. Infection with influenza virus is always potentially serious and when the young and healthy are in the cross-hairs even more so.…
revere | May 27, 2009Yesterday New York reported two more swine flu deaths (a 41-year-old woman from Queens and a 34-year-old man from Brooklyn). CDC and just about everyone else who knows anything about influenza have been telling people to expect this. The influenza virus kills people all the time. We don't know exactly how many but we know that many people die of various immediate and underlying causes that wouldn't have died at that time if they hadn't become infected with the influenza virus in the period prior to their demise. Influenza is like heart disease or diabetes or cigarette smoking: a major cause…
revere | May 23, 2009Queens, a borough of the city of New York, seems to be a hotspot for swine flu and a New York Times reporter on the city beat, Anemona Hartocollis, has been writing very astute and perceptive pieces from there. Yesterday she had one on the problem posed by the "worried well" who are flooding Emergency Rooms in quest of reassurance. Articles about worried parents who bring relatively well kids to the Emergency Room (ER) are not uncommon. They usually include interviews with harassed and overburdened emergency room doctors and nurses dismayed at the unnecessary demand and its consequences for…
revere | May 22, 2009There is as yet no vaccine for the novel H1N1 (swine flu) pandemic strain of influenza now causing widespread illness in North America and what appears to be the start of growing outbreaks in Japan and parts of Europe (but check out this excellent piece over at ScienceInsider). WHO says most developing nations are not able to track influenza, so what is happening in Africa and parts of Asia is not known with any confidence. While the clinical illness from this virus doesn't seem very different than seasonal flu, the fact that most of the world's population has no immunity to it means there is…
revere | May 20, 2009A kind reader directed my attention late yesterday to an article on the Boston Globe's web site about three schools closing in Boston because of absenteeism from flu-like illnesses. I was struck by a comment made by a freshman at Boston Latin that seemed to get it exactly right:
The closing surprised freshman Wilhelmina Moen, who noted it was nice that authorities were concerned about the student's health.
"I'm not that worried," said Moen, who lives in Brighton. "It's the same thing as the other kind of flu. That flu kills too." (Stephen Smith, Andrew Ryan, Elizabeth Cooneym Boston.com)
So…
revere | May 18, 2009Five more schools in the New York City borough of Queens have closed because of suspected swine flu cases. Eleven schools have now been closed there and hundreds of students are down with a flu-like illness. Parents are understandably concerned, the more so because not many days ago Mayor Bloomberg and the city's health commissioner (just named by Obama as the next director of CDC) were reassuring city residents this was pretty much lie seasonal flu.
We thought that was something that might come back to bite them, and now it has:
The city’s schools seem to have become both a sentinel and an…
revere | May 17, 2009At Friday's press briefing on the swine flu outbreak, Canadian Press's Helen Branswell twice asked whether CDC's weekly flu surveillance data showing the uptick in swine flu but also an unexpected prevalence in seasonal influenza was an artifact of increased testing or something new and unusual. CDC's Dan Jernigan was not especially clear, but seemed to acknowledge there was a lot of seasonal flu around:
The CDC said part of the increase is certainly due to the fact that much more influenza testing is going on these days, because of concerns about swine flu. But the agency said it seems that…
revere | May 14, 2009A reader (hat tip River) sent me a link to a New York Times piece quoting a physician who recently saw swine flu cases in Mexico City. He called attention to what seemed like an anomalous clinical presentation of many cases. Besides a higher proportion of gastrointestinal symptoms (nausea, vomiting, diarrhea), Virginia Commonwealth infectious disease specialist Dr. Richard P. Wenzel was surprised that many cases, even severely ill ones, did not have fever:
Many people suffering from swine influenza, even those who are severely ill, do not have fever, an odd feature of the new virus that…
revere | May 13, 2009Flu can be a nasty illness, nasty enough to kill you. Pregnant women are at more risk than others because their physiology is altered. They are carrying a foreign body (the fetus) so their immune response is not the same, and their cardiovascular and respiratory physiology are also different. CDC is reporting about 20 swine flu cases in pregnant women, and late yesterday they gave a more detailed description of three cases, one of which ended fatally:
Patient A. On April 15, a woman aged 33 years at 35 weeks' gestation with a 1-day history of myalgias, dry cough, and low-grade fever was…
revere | May 11, 2009Yesterday DemFromCT had another in his continuing series at DailyKos on Flu and You (Part VIII). He extended an earlier post (part II) on a critical piece of public health infrastructure, laboratory surveillance. One of the graphics is this chart of influenza positive tests reported to the CDC by the WHO/NREVSS collaborating laboratories:
What you see in this chart is a weekly record of what seasonal influenza types and subtypes are circulating in the community (influenza A/H1N1, A/H3N2, B; swine flu makes a late appearance, far right). Flu seasons differ on dominant subtypes, whether they…