swine flu
revere | October 5, 2009In an earlier post I said I opposed mandatory vaccination for adults (but not for children), the one exception being for health care workers because they come in contact with people at high risk. My view then was that if you work in a health care institution and won't get vaccinated against flu, then you shouldn't come to work. Now I am re-evaluating my position as a result of some cogent and pragmatic comments from lawyer-bioethicist George Annas, professor of health law, bioethics and human rights at Boston University School of Public Health, and author of "The Rights of Patients." I know…
revere | October 4, 2009This is about a paper published Friday. The post is long because the paper provides practical advice on a problem of importance, the issue of school closures. The advice is based on data and could be implemented at the level of a school district or even a single school without requiring a lot of money or effort. It's not cost free, but could probably be done with existing personnel and resources. The fact that it would be grounded in empirical evidence makes a decision to keep a school open or to close it much easier to defend. It would not be arbitrary or a guess. Improvements in the…
revere | October 3, 2009As Mrs. R. remarked, it's American ingenuity at work. Or something. She was referring to the winner of the 2009 Public Health IgNobel Award. For those of you who don't know about the IgNobel Prizes given each year in a variety of categories for scientific or engineering achievements (as documented in scientific journal articles or patent applications) that "make people laugh, and then make them think." There is a well-attended public ceremony each year at Harvard's Sanders Theater and the 2009 version was two nights ago. There are lots of winners each year, often for achievements from some…
ddobbs | October 1, 2009You have to move fast these days to keep up with the flu. Or outrun it.
A quick roundup from the last 24:
From the invaluable H5N1:
Mexico: 4,000 H1N1 cases in 7 days
Spain: 31,322 cases and 6 deaths in one week
US: 15 states could run out of hospital beds
Scotland sees it Worst week yet for swine flu, with new cases running at 2,000 a day
Toronto catches the wave.
Meanwhile, Helen Branswell reports that Dutch researchers find mutation linked to greater virulence in swine flu virus -- but so far it doesn't appear to be the big upgrade in nasty we've been fearing. Effect Measure gives…
revere | October 1, 2009A couple of days ago Dr. Marion Koopmans, chief of virology in the infectious diseases laboratory of the National Institute of Public Health, The Netherlands, notified the infectious disease community through the website/email list ProMed that two of their swine flu isolates showed a particular genetic change in one of the virus's eight genetic segments. Even though this virus has been described as relatively stable genetically, individual viruses, even within the same patient, often have small differences in the thousands of letters that make up their genetic code. Influenza A virus is a…
revere | September 30, 2009For the first time in medical history we may be seeing an influenza pandemic unfold in real time, but that doesn't mean we know what we are seeing. There remains some uncertainty about virulence, both in terms of how often it kills and how it kills when it does kill. You'd think both would be easy to determine, but those who have been following along know the problem of how often infection with this virus kills is made almost impossible by not knowing how many people it is infecting. But what about the question of how it kills? There are mainly three scenarios of interest: primary viral…
revere | September 29, 2009Hand gel sanitizers are making an appearance all over our medical center. There's one right next to the elevator on the ground floor of the building where my office is and don't have to touch a thing. Just put your hand under it and it dispenses a cool alcohol-based gel that sanitizers my hands and dries very quickly. Alcohol does that. And other things:
Alcohol hand gel meant to combat swine flu has been banned from a prison after inmates started eating it and became embroiled in a drunken brawl.
Inmates have been drinking the liquid soap placed on their wing after realising it contained…
revere | September 28, 2009A good story by the AP's Lauran Neergaard yesterday highlighted the need for better public health surveillance and the efforts being made to improve it so as to keep track of possible rare side effects from the swine flu vaccine. This is an issue we've talked about a lot here, most recently in the context of not being able to fully test any vaccine for rare adverse outcomes prior to deployment. There's more involved than that, but first here's Neergaard's lede:
The U.S. government is starting an unprecedented system to track possible side effects as mass swine flu vaccinations begin next…
revere | September 27, 2009We don't do vaccines so much here, so I missed it last Sunday (Sept. 20) when it was posted over at JustTheVax, but there's an excellent summary of this year's swine flu vaccine offerings by Science Mom. It's hard to keep track of all this stuff so this is really valuable, and I know many readers here are interested. Thanks to Science Mom.
revere | September 27, 2009Flu season has started in earnest, even though it's not "officially" flu season until week 40 (first week in October this year). How do we know it's flu season if we don't test everyone and can't count flu? We use a surveillance system. The flu surveillance system has lots of moving parts and five or six components (or as many as nine, depending on how you count). None of them tell us exactly what we want and putting the different pieces together can sometimes be like the blind men and the elephant. But the system does work better than you'd think and it's undergoing modifications and…
revere | September 26, 2009I'm afraid I have to complain about crappy journalism again. AlterNet is an online newsmagazine I quite like. We've been linked by them numerous times and know their influence. Sometimes, though, some very smart writers write some very dumb things, even if they do it in a smart way. Alas, Joshua Holland has done it today on the front page of Alternet.org with a supremely wrongheaded story about why you don't have to be scared shitless about swine flu. We agree with that bottom line, but how he got there is the problem (that and the fact that he doesn't understand much about influenza).
Let's…
revere | September 25, 2009There's hopeful news about the possibility of an effective HIV/AIDS vaccine and a weird story from Canada about "preliminary results" saying that you are more at risk from swine flu if you get the seasonal flu vaccine. With flu, anything is possible, but that is more than a little counterintuitive and strikes me as unlikely. Nowhere else has reported a similar experience. Since we don't know the methods or the data or the limitations or much of anything else that could allow us to consider how much to weigh this as evidence I won't say any more about it.
While we do write about vaccines here…
ddobbs | September 22, 2009
Eric Michael Johnson contemplates the hearts, minds, teeth, and claws of bonobos and other primates.
Tara Smith explains why she'll be getting her kids their (seasonal) flu vaccines. Revere does likewise
Daniel Menaker, former honcho at Random House, defends the midlist. (Where was he when my book was getting so much push?)
Just in case you missed it, lack of insurance is killing 45,000 people a year (Times) in the U.S. This doesn't include preventable deaths among the underinsured (like yours truly, who is sitting on some surgery that he'd rather put behind him). You can download the…
ddobbs | September 22, 2009
The swine flu triage tent at Dell's Children's Medical Center, in Austin, Texasphoto: Ralph Barerra, Austin American-Statesman
I can't keep up with the flu news. (If you want to, best single bet -- the wide net -- is Avian Flu Diary.) But as the World Health Organisation meets in Hong-Kong to discuss, among other things, swine flu, here are a couple that make good follow-ups to my Slate piece on how adjuvants gobble up vaccine antigen supply:
WHO pushes for worldwide swine flu vaccinations (hoping to vaccinate 3 billion) -- despite that overall supply will fall short .
The U.S. (and some…
revere | September 22, 2009There are multiple trials of swine flu vaccine in different countries and involving different subpopulations. Recent news strongly suggests that -- surprisingly -- a single dose of viral antigen (i.e., one injection) may be sufficient to raise antibody against swine flu to protective levels. There are a lot of uncertainties here, but the data have been fairly consistent. But that's for adults (over 18 years old). Since children are also had high risk, there is much apprehension whether a single dose will also work for children. Now we're getting some of the first results and the news is good…
revere | September 18, 2009Most people are either indifferent to swine flu or fearful, but the makers of Purell hand sanitizer and Chlorox are happy. It's been a boon to the business of sanitizing everything in sight as a way to ward off swine flu. Here's a story about Chlorox (bleach):
The company has secured additional suppliers and will increase production if needed, says Benno Dorer, senior vice president- general manager of Clorox’s cleaning division. Some retailers have already asked for more bleach, he said in a Sept. 4 telephone interview, declining to name specific companies.
An outbreak of the flu may add 2…
ddobbs | September 17, 2009
My latest piece for Slate examines the unsettling consequences of the United States' choice of swine flu vaccines.
The good news about these vaccines is that, to judge by the first vaccine trial results, published last week, they appear to work fast, safely â and at about a half to a quarter of the doses that the CDC expected. This means we effectively have about two to four times as many vaccines as we had figured we would. Since we ordered 195 million doses, we could vaccinate damn near the whole country.
If the fast-tracking efforts continue to work and the flu peaks closer to Christmas…
revere | September 17, 2009I just got my seasonal flu shot. It was free and my medical center is encouraging everyone to get one. I wouldn't be telling the truth if I said I didn't feel it at all, but in all honesty, I hardly felt it. They must be using smaller needles these days. Anyway, given that most circulating flu virus is pandemic swine flu H1N1, for which a vaccine is not yet available (coming soon to a clinic near you, we're told), you might wonder why I -- or anyone --would bother. I'll do my best to explain my reasoning, but I'll grant at the outset I may have missed some good reasons or have reasons that…
revere | September 16, 2009There is no way to keep up with all the flu news, so we pick and choose, usually based on some kind of point we want to make. That's both the good and the bad of this blog: the news comes with a point of view. But so does most news, and we try to make ours both explicit and scientifically as accurate as we can with the information at hand. Today is a typical example. Bloomberg is reporting that any swine flu virus resistant to oseltamivir (trade name Tamiflu), the only antiviral pill effective at all for the infection, transmits less well than swine flu that's sensitive to Tamiflu. The source…
revere | September 13, 2009At the beginning of September CDC initiated a new system for monitoring influenza activity. We reported last week that the old system ended on August 30 and that we were now into the new flu season. We even titled the post, "End of Flu Season." To paraphrase Mark Twain, the reports of the death of the 2008 - 2009 season may have been exaggerated. Well, not really, but the advent of the new system caused some confusion, at least for us, and we think we should clear it up.
There are several interconnected issues here. One is that the way trends in influenza will be monitored has been changed…