World Health Day

Just a quick post for world health day:

Flu Hits 90 Million Children Under 5 Each Year

Global tally also includes 20 million kids with flu who develop potentially deadly pneumonia

FRIDAY, Nov. 11 (HealthDay News) -- Although it can be prevented with a vaccine, roughly 90 million children worlwide who are younger than 5 get the flu each year, resulting in about 1 million hospital admissions, a new study indicates.

Published in the Nov. 11 online edition of The Lancet, the research also revealed that flu-related pneumonia claimed the lives of up to 111,500 children in 2008. According to the report, 99 percent of these deaths occurred in developing countries.

CLICK HERE TO READ REST OF STORY.
Rather depressing, isn't it?

Medical News Today: Flu Vaccine Protects Pregnant Woman's Baby And Does Not Cause Miscarriage

I would suppose that this should go in the "Well, of course" column to rational people grounded in reality, however there has been some legitimately confusing studies that should be addressed.  I for one am glad they they were studied in a rigorous and methodical manner instead of whatever quackery and woo woo the anti-vax pro-disease nutters seem intent on.

Apart from protecting a newborn infant from flu for four months, the flu vaccine does not raise the risk of miscarriage, Kathleen Neuzil, MD, member of the Infectious Disease Society of America's Pandemic Influenza Task Force explained at their 49th Annual Meeting. Various presentations at the meeting are showing that pregnant mothers are getting the message not only about the flu shot's importance, but also its safety.

A newborn whose mother was not vaccinated is particularly vulnerable to flu because he/she is more likely not to be born with protective immunity and cannot be vaccinated for at least six months. A newborn who becomes infected with influenza is at a higher risk of complications, and even death, compared to older humans.

Dr. Neuzil, MD, who is also clinical professor in the School of Medicine at the University of Washington, Seattle, said:

"Pregnant women are understandably concerned about protecting their unborn babies, which makes it all the more important for them to understand that getting a flu shot during pregnancy is an important way to protect the baby, as well as themselves. These new data on the safety and effectiveness of these vaccines is reassuring, and the increasing number of pregnant women receiving the vaccine affirms that women are hearing the message about the vaccine's benefits."

CLICK HERE TO READ REST OF ARTICLE.

Harpocrates Speaks: Speaking of Flu

So yesterday I made a post about a CDC re-evaluation of their flu model.  It seems that Harpocrates Speaks also covered this story.  But as usual, Todd went into a bit more detail, and I wanted to get that info out there (although I find it funny that both he and I keyed on very similar ideas in that post.  Almost as if the anti-vax pro-disease nutters are predictable in their lies).  From his post on this, if you scroll down a bit, he starts:

Speaking of the Flu

While we're on the subject, as temperatures drop, the air becomes drier and people start to congregate indoors more frequently, flu season starts to ramp up. Conditions are becoming ripe for transmission of the virus, and hospitals are places where we really cannot afford to spread the flu. There are a lot of individuals whose immune systems are less able to cope with infection, so even illnesses that might be mild in a healthy individual may become life-threatening. Whether the patients are walk-ins or in for long term care, children, adults or the elderly, it is vital for hospital employees to be vaccinated against the flu.

I'm not just talking about the doctors and nurses, here. I mean everyone that works in the hospital. At the very least, anyone who spends any amount of time in a patient area (waiting room, exam room, elevators, hallways, stairwells, lobbies) should be immunized if they have no medical reasons to the contrary. Hospitals and their employees should take steps to protect the health and well-being of their patients, and that includes taking measures to reduce the risk of infection.

I decided to take a look online to see if I could find any recent reports of vaccine rates among hospital employees and stumbled upon a survey of Maryland Hospital Healthcare Worker Influenza Vaccination (PDF). This was a self-reported, web-based survey of Maryland hospitals looking at total number of employees who received a vaccine, number that exempted out for medical reasons, number that exempted out for religious reasons and number that declined immunization but did not provide a reason, compared to the total number of employees at the hospital. Some hospitals had mandatory immunization policies with consequences for non-compliance (such as loss of privileges or even being fired), some had mandatory policies but no consequences for non-compliance and still others had no vaccination policy.

READ THE REST OF THE POST HERE!
Good charts, graphs, and actual data there as opposed to simple assertions.

CDC Actually Follows Scientific Methods

The CDC has released a correction to one of their reports.  Granted, it is a post hoc release, but the thing about it is that the CDC has actually revised the estimate because they realized their mistake, and they are honest about it.  This is really the greatest strength of science.  To refine things and get better results as information, methods, and knowledge evolves (see what I did there?).  I have never seen an anti-vax pro-disease nutter actually re-evaluate their position, no matter how much data is actually presented to them.

So here is the CDC Press release (emphasis mine):

Notice to Readers: Revised Estimates of the Public Health Impact of 2009 Pandemic Influenza A (H1N1) Vaccination

In the May 20, 2011, report, "Ten Great Public Health Achievements --- United States, 2001--2010," on page 621, preliminary estimates of the impact of public health interventions during the 2009 H1N1 pandemic were presented as follows: "These public health interventions prevented an estimated 5--10 million cases, 30,000 hospitalizations, and 1,500 deaths (1)." These estimates were derived using combined data from two sources: 1) an unpublished CDC model for estimating the impact of the 2009 H1N1 pandemic influenza vaccine on averting cases, hospitalizations, and deaths during the 2009--10 influenza season and 2) a model for estimating the impact of antiviral treatment in averting hospitalizations and deaths during the 2009--10 season (2). As a result of a programming error, the model used to estimate the impact of vaccination did not adequately adjust for the decreasing risk for disease as the pandemic progressed, and thus the impact of vaccination was overestimated.

The corrected estimates for the combined impact from vaccine and antiviral treatment are as follows: 713,000 to 1.5 million cases, 12,300 to 23,000 hospitalizations, and 620 to 1,160 deaths averted. Of these, 713,000 to 1.5 million cases, 3,900 to 10,400 hospitalizations, and 200 to 520 deaths were averted as a result of the vaccination campaign (CDC, unpublished data, 2011), whereas the use of influenza antiviral medications is estimated to have prevented another 8,400 to 12,600 hospitalizations and another 420 to 640 deaths (2).

It is important to note that the error does not involve nor pertain to the effectiveness of the 2009 H1N1 vaccine, nor to estimates of the burden of the 2009 H1N1 pandemic, which resulted in approximately 43 million to 89 million cases, 195,000 to 403,000 hospitalizations, and 8,900 to 18,300 deaths, including 910 to 1,880 deaths among children aged <18 years, during April 2009--April 2010 (3). CDC-supported evaluations have shown that the vaccine was effective in preventing influenza medical visits during the pandemic (4). However, because there was early widespread circulation of the 2009 H1N1 virus, many persons in the United States became ill before vaccine was available.

CDC continues to work on developing and evaluating statistical models for estimating the impact of influenza vaccination in order to develop better programs and ways to monitor the impact of those programs. CDC expects this work might lead to future publications that provide additional impact estimates.

References

1. CDC. Ten great public health achievements---United States, 2001--2010, MMWR 2011;60:619--23.
2. Atkins CY, Patel A, Taylor TH Jr, et al. Estimating effect of antiviral drug use during pandemic (H1N1) 2009 outbreak, United States. Emerg Infect Dis 2011;17:1591--8.
3. Shrestha SS, Swerdlow DL, Borse RH, et al. Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009---April, 2010). Clin Infect Dis 2011;52:S75--82.
4. Griffin MR, Monto AS, Belongia EA, et al. Effectiveness of non-adjuvanted pandemic influenza A vaccines for preventing pandemic influenza acute respiratory illness visits in 4 U.S. communities. PLoS One 2011;6:e23085.

It's refreshing to see that there is a scientific method being adhered to.  If nothing else, that should be a reason for you to actually listen  to the CDC over the dogmatic denialists of the anti-vax pro-disease movement.

The Vaccine Times: Universal Flu Vaccine Another Step Closer, But Still Far

This is exciting news, even though we still have a long way to go.  I suppose that even though this aligns with one of the goals of the anti-vax pro-disease nutters (i.e. fewer vaccines), I bet they will still find a fault in this line of research as well.  One of the hallmarks of their irrational thinking and poor logic is that nothing will ever make them happy.  I think one of the cool things about this research is that our understanding of molecular level evolution led us down this path.  Here we consistently hit on two of the most irrational denialisms on the planet in one post!

On the Apr-Jun 2011 issue of  The Vaccine Times we reported on a new flu shot being tested which could do away with our need for yearly flu shots.  The vaccine candidate, called VAX102 is based on an antibody called F16 which can target a common protein shared by all Influenza A viruses which are the most virulent and the most prone to mutation influenza viruses.

Recently U.S. scientists are reporting the finding of a new antibody which can tackle 30 of the 36 known strains of H1N1 (a virus of the A type) flu virus. The newly discovered antibody, called CH65, can stick to the surface part of the flu virus known as hemagglutinin which mutates every season, forcing the formulation of a new vaccine every year.

CLICK HERE TO READ THE REST OF THE ARTICLE.

Vaccine Times: News Flash

A series of news stories from Vaccine Times.  Make sure to vote for them on the bottom story!

Greek swine flu deaths reach 62 – 14 additional deaths have been recorded in Greece due to swine flu, bringing the total number of fatalities for the country to 62. None of the latest 14 deaths had been vaccinated. Another 223 people with swine flu are in intensive care.

Parents of 4-year-old swine flu survivor call for universal vaccinations – Oliver Scrase-Smith, a 4-year-old British boy suffered a month long ordeal with swine flu, during which time his liver failed and he was given a less than 10% chance of survival, before making an extraordinary recovery. His parents are relieved their child escaped death, but they are angry that vaccinations are not available to everyone:

His father Richard Smith, 34, is calling on the government to give vaccinations to all.
He said: “Anybody who is classed as fit and healthy, like Oliver was, [can't] get a vaccine.

“In my eyes that is wrong. It should be available to everyone, especially children.”

Oliver’s mother Amy Scrase said: “When I think the cause of why my son was in a coma was swine flu and you can have injections to prevent it… it makes me very angry.”

Whooping cough vaccine now required for 7-12 graders in California – In light of the recent whooping cough outbreak in California, which killed 10 infants, beginning 07/01/2011 all 7-12 graders will be required to show proof of vaccination, or they will not be allowed to attend school. This new requirement applies to all public and private schools. For a list of FAQs about this new law, please click here. Oklahoma is also instituting similar requirements for 7th graders starting with the next school year.

New cell-culture vaccine at least as good as egg-produced vaccine in company’s trials - Baxter International is reporting that its trials show its new cell-cultured flu vaccine, Preflucel, was as effective in preventing the disease as the egg-produced flu vaccines. It prevented flu in 78% of patients who were vaccinated, whereas the historic figure for egg-based vaccines is about 73%.

“At 78.5 percent, we certainly would not claim superiority to egg-derived vaccines, but we are at least as protective as vaccines produced by historical manufacturing process involving the use of eggs,” said Dr. Noel Barrett of Baxter’s Bioscience unit in Austria, whose findings were published in Lancet.

The new method of production makes production of flu vaccines quicker and easier, and reduce the time needed to mass produce them by 6-8 weeks. It would improve our abitlity to provide adequate vaccinations especially when a pandemic hits; it would also enable health official to wait a little longer before deciding which strains to include in the vaccine.

The GOOD Vaccine Challenge – Win $5,000 to raise awareness about vaccines. Have a cool idea about raising awareness about live-saving vaccines? Submit your project and you just might win $5,000 and make it happen. Either that, or vote for The Vaccine Times when voting starts.

Vaccine Times: Flu "fatigue"

Flu makes lasting impact on mother and daughter: They’re telling their story to overcome public ‘fatigue’ about flu dangers

On December 16, 2010, in ALL POSTS, Influenza (Seasonal), VACCINE PREVENTABLE SUFFERING, by Leart Shaka

READ THE REST OF THIS STORY AT MLIVE.COM

KALAMAZOO — The Welch family of Comstock Township is spending this Thanksgiving together, and that situation, they agree, is really something to be thankful for.

Last Thanksgiving Day, Amie Welch was sitting at her daughter Cailey’s bedside in Bronson Methodist Hospital’s Pediatric Intensive Care Unit. Welch had just been released from the hospital herself, having spent a month on a ventilator, but Cailey, then 10 years old and admitted just a day after her mother, was far sicker.

It wasn’t some exotic disease that laid both mother and daughter so low. It was the flu.

At times during her six-month hospital stay, Cailey’s survival was in doubt. “Several times, sitting in her room, we were watching them lose her,” Welch said.

Cailey was on a ventilator for months, and the high air pressure needed to keep her alive did serious damage to her lungs, her mother said. “Her lungs will be always be scarred from that,” Welch said.

Cailey, who turned 11 in January, still requires oxygen 12 to 14 hours a day, her mother said, and it’s administered through her nose. “We don’t go anywhere without it,” Welch said.

Cailey also has had “surgery after surgery” to remove tissue that had built up as a result of a tracheotomy she received in the hospital, her mother said. The tissue has to be removed before the tracheostomy stoma can be closed.

Cailey has not been able to return to school at Kalamazoo’s Edison Environmental Science Academy, where she would have been in sixth grade. Instead, she is schooled through a program for homebound students run by the Kalamazoo Regional Educational and Service Agency (KRESA).

Amie Welch, 34, has suffered permanent lung damage, too, although Cailey’s is much worse, she said. “I have a little bit of scar tissue that will always be there,” she said. Its impact is that she becomes winded very easily.

Because of their experiences, the Welches have been working with the American Lung Association to spread the word about the importance of getting flu shots. Amie Welch said she agreed to share their story because “if anything good could come out of what we had to go through, we want that to happen.”

READ THE REST OF THIS STORY AT MLIVE.COM

Vaccine Central: Vaccine Preventable Death – Raymond Plotkin

A lot going on in this story.  I am at least glad that his parents are not anti-vax nutters.  It is sad that there were not enough available vaccines.  It would have done its job of saving this young man's life.  Their whole purpose.

Vaccine Preventable Death – Raymond Plotkin

Age at death - 18 years
Cause of death –H1N1 (Swine Flu)
Vaccination Status – Unvaccinated
What happened – Raymond Plotkin, was a freshman at the University of New Mexico. He was studying to become an engineer. He started class in August 2009 as a freshman interested in Chemical and Nuclear Engineering. He enjoyed his roommates and living in a dorm as part of the Engineering Living Learning Community. In 2009 he had the regular flu shot, but due to shortages of  the vaccine, he wasn’t able to get the H1N1 vaccine.
While Raymond had health issues growing up, he had no problems in the last couple of years, according to family members. Doctors told the family they do not believe underlying health problems contributed to his death
He died on Wednesday evening of  November 11, 2009, four days after being admitted in the hospital. Said Raymond’s mother:

“It was a terrible tragedy. It could have been prevented had there been vaccine,”
“We are strongly recommending that because Raymond couldn’t take his shot last year, that this year everyone, that whether you’re a child, adult, parent, grandparent, we all take one for Raymond,”
People are getting complacent about H1N1. Please remember what happened to Raymond and get both the seasonal flu and H1N1 vaccines as soon as you can.

Raymond’s family has set up a scholarship fund in honor of Raymond’s memory. The first scholarship was awarded to Sean Chavez, a 2010 graduate of Albuquerque High School and computer engineering student at UNM.
For more information about the fund, please contact Susan Georgia, UNM School of Engineering Development Office at 505 – 277-0664; sgeorgia@​unm.​edu.
Contributions can be sent to:
UNM Foundation/Raymond Plotkin Fund
ATTN: Susan Georgia, Development Office
UNM School of Engineering
Centennial Engineering Center
MSCO1 1140
1 University of New Mexico
Albuquerque, New Mexico 87131 – 0001
My deepest condolences to to Raymond’s family. I am very sorry for your loss.
Sources
KVue.com
New Mexico Daily Lobo
The University of New Mexico
Khou.com

 

Why the epidemiology of swine flu matters

From ScienceBlogs:

If 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 do. Epidemiology is the public health science that studies the patterns of illness in populations. One kind of pattern we study is who is getting sick. And it is a change in this pattern that is one of the big differences between a pandemic strain and a seasonal strain.

Pandemic strains have a greater tendency to infect and make sicker much younger victims. In seasonal influenza it is the over 65 age group that contributes most of the serious illness and deaths, but with pandemic strains (not just the current one), lack of immunity in the population makes those under age 65 a bigger target and they sicken and die proportionately more than in a non-pandemic season. And that's exactly what we are seeing this year. The story that made the headlines on Friday was that 19 more pediatric deaths were added to the pediatric death toll in week 39, although not all of these children died in that week. The dates of death for the 19 stretched between July 19 and October 3 because of the way the tally is done. Starting in the 2003 - 2004 flu season deaths from influenza in people below the age of 18 became a nationally notifiable disease, reported to CDC through state epidemiologists. Each state has its own way of ascertaining the number. Some states are more complete and more timely than others, so notifications that come in a particular week can, and do, represent deaths that occurred over varying time periods, as in the instance of the 19 added this week. Still, it is clear that the young population is being hit particularly hard in comparison to the last three years for which we have data. 76 have died from swine flu since it made its first appearance in April, and 29 of those deaths have come since August 30, i.e., 29 in 5 weeks and those 5 weeks are extremely early in the flu season. In fact they occurred before the official administrative flu season even started (week 40).

The pattern of pediatric deaths and its difference from previous years is dramatically shown in this graph from CDC's weekly flu report:

The green bars are pediatric deaths from seasonal flu. You can see that in green bar terms, this flu season, which was not as bad as the previous year, was pretty typical. But this year, unlike previous years, there was a second flu season that started just as the usual one was finishing (the middle hump). We remarked on this back in July. Then there was a lull (we don't know why) and now we are into flu season and we see a third set of bars.

If you aren't in the pediatric population, here are some more patterns that may help convince you that getting vaccinated is a good idea. This comes from the Emerging Infections Program (EIP), another part of the multicomponent CDC flu surveillance system. These are lab confirmed influenza related hospitalizations in 60 counties in 12 metro areas of 10 states (San Francisco CA, Denver CO, New Haven CT, Atlanta GA, Baltimore MD, Minneapolis/St. Paul MN, Albuquerque NM, Las Cruces, NM, Albany NY, Rochester NY, Portland OR, and Nashville TN). It's a passive surveillance system where the data are obtained by record review of lab and hospital admissions databases and infection control logs. Each panel is an age group, with the top being babies and toddlers and the bottom one people over age 65 (you can see the original here if this is too small).

These are cumulative incidence rates. Think of them, at each week (the horizontal axis), as the chance that you will have gotten the flu by that time this year, i.e., if you look at week 37 the height of the curve reflects the probability that by week 37 you would have gotten flu at sometime before that (not necessarily that week). Obviously the curve can only go up, since it is cumulating (adding onto the pile of previously lab diagnosed hospitalized cases that have occurred up to that week). If you wonder how high it "should" go, based on the average of the last three flu seasons (October to April of each year) that level is the dashed horizontal line in each panel (NB: the scales are different for the top and bottom panels, because those are the age groups, the very young and the old, that usually have the highest risks so the curves wouldn't fit if the vertical scales of the other age groups was used). What this means for interpreting the curves is that if this year behaved like the average of the three previous years, the curve would slowly move upward until it reached the dashed line by the end of the flu season in April or May. Obviously this year is very different.

You once again see the altered age pattern, this time very dramatic when comparing the youngest age group with the oldest. For those of us in the over 65 age group, the seasonal has barely begun. We are just inching our way up from typical summer levels. There's a long way to go before we get to where we would usually be by the end of flu season. My age group looks pretty normal for this time of year. But if you look at the other panels you see that several have already exceeded, in the first week of the official flu season, the level of season risk we would have expected by the end of the season. Babies and toddlers are two thirds of the way there already (remember the scale is different for them so the same height is a higher risk than compared to the 2 to 4 year olds). The 2 to 4 year olds are already there and everyone between 5 and 49 years old has already exceeded their year end risk at a time when the season is usually just starting. The 50-44 year old group is already at seasonal average and then there's the over 65 age group, the exception that proves the rule: this is a pandemic strain.

Where and when it will peak we don't know but there's a long, long way until whatever causes flu to be seasonal is ended (usually sometime in April or May). Swine flu could burn itself out before then (but not before taking more children and adults with it); or it could keep going for the whole flu season; or it could co-circulate with the seasonal flu H1N1 and H3N2 strains. The assumption that swine flu will completely crowd out seasonal flu strains is premature and we could have a normal seasonal flu pattern in the over 65 age group appearing later. Or not. We still don't understand flu well enough to predict with any confidence what is going to happen.

The seasonal and swine flu vaccines are not intrinsically different except for the flu strains they contain. We change flu strains every couple of years routinely and these vaccines are made in the same way as we have been making them for many years. The only difference is a strain change, which is routine. This means that we have had extensive experience with the swine flu vaccine already, extending over years and hundreds of millions of delivered doses. It is not untested. Far from it.

The most rational thing to do at this moment, given what we know and don't know, is to get vaccinated with both seasonal flu and swine flu vaccines. That's what I'm going to do. I already got my seasonal flu shot and I'll wait in line for my turn for the swine flu vaccine and get it as soon as I can. You not only protect yourself but you help prevent spread of flu to others.

H1N1 Mortality Rates

A quick study about the virulence of H1N1 is out, and I wanted to share this, as well as a few other thoughts. First, understand the three main ways that the flu can kill you:

Influenza lethality is due to three main causes: First, direct viral origin, leading to viral pneumonia of high severity, with an acute respiratory distress syndrom (ARDS), associated with 30 to 50% lethality in intensive Care Unit (ICU) [1]; Second, bacterial surinfection, due to pneumococal, staphylococal, streptococal, or meningococal pneumonia, usely curable with appropriate antibiotics, provided they are administered early enough; and Third, decompensation of severe underlying conditions, often in elderly people or in vulnerable chronic patients.

What is of concern from the article is this passage:

New Caledonia and Mauritius figures are consistant to a rough estimate of about 1 death from ARDS due to H1N1pdm per 10,000 infections, i.e. a virulence of an order of magnitude of 100 times that observed for seasonal strains.

Now this is very important to understand. This is the ARDS related deaths, not the ones that are attributed to flu that strikes down people in numbers of about 30,000+ in the US each year. We probably will not see 3,000,000+ flu deaths in the US because of these numbers. First of all, as reported, the 30,000+ number is sketchy reporting in the media, and are not all ARDS related. Secondly, we actually do have a vaccine for this strain, and that should help a great deal.

HOWEVER, one of the things that this virus has shown is a greater effect on the young and healthy. Much like the 1918 flu pandemic. So those of you who say, "I never get sick." or "I have a strong immune system." or something along those lines, you may need to be extra careful this flu season. In layman terms, this virus can cause your immune system to go into overdrive, and afflict you with ARDS. Your strong immune system may be your biggest weakness and liability this year. Please take all the prcations that you can. If you feel ill, do not go out in public. Wash your hands often. Cover your nose and mouth when you cough and sneeze. AND GET VACCINATED! If not to save yourself, to save those around you. Who knows, you could end up saving the life of a loved one even.