Influenza Virus Mashup

Via BBC News, a long article: WHO faces questions over swine flu policy. Excerpt:

The WHO has struggled to offer clear answers on the question of its definition of a pandemic, partly because of its policy of keeping the identity and the deliberations of its pandemic emergency advisory committee secret. The only known member of the committee is its chairman, Australian flu specialist John MacKenzie. 

WHO spokesman Gregory Hartl said names of those on the sitting committee had not been made public because of the potential “for bringing undue pressure on them when they are making decisions which have societal and economic impacts”. 

The lack of transparency in its decision making process, together with the WHO’s advice to countries to begin widespread vaccination against swine flu, has led some observers to suspect undue influence from the pharmaceutical industry. 

Looking at the balance sheets of the pharmaceutical companies it is clear that many did make a healthy profit out of swine flu. Vaccine producer Novartis, for example, posted an 8% jump in profit in 2009. The company’s annual report cites swine flu vaccine sales as a major reason for the increase - though such a profit is, of course, not proof of any undue influence by the firm. 

These medical products have cost national health budgets billions. France, for example, spent over 600m euros ($739m, £515m) on 94 million doses of vaccine, most of which have not been used. 

“Who benefited from what happened?” asked British Labour Member of Parliament Paul Flynn. “Really the only people to benefit were the pharmaceutical companies. I’m not saying I’m drawing any firm conclusions, but there are legitimate questions here.”

(Thu, 20 May 2010 11:51:00 +0000)

# 4583

Yesterday the NEJM published a review of 20 public opinion polls taken during the pandemic outbreak of 2009.   

PERSPECTIVE

The Public’s Response to the 2009 H1N1 Influenza Pandemic
G.K. SteelFisher and Others

While I was otherwise occupied, John Solomon wrote about it in New Report Says Most Americans Approve Of Govt. Flu Pandemic Handling, But Many Say They (& Their Kids) Might Not Get H1N1 Vaccine In Future   and Crof covered it in US: The public’s response to H1N1.

Robert Roos, News Editor for CIDRAP, has a comprehensive review of the findings in:

Polls traced declining interest in H1N1 vaccine

Robert Roos News Editor

May 19, 2010 (CIDRAP News) – If the trajectory of public opinion during the H1N1 influenza pandemic is any guide, safety worries and doubts about the severity of the disease threat may cause a good share of the public to shun vaccination the next time a pandemic emerges, according to a review of 10 months’ worth of polls.

 

Surveys taken before the H1N1 vaccine became available showed that about half of the population planned to be vaccinated, but that fraction shrank considerably by the time the vaccine became readily available in December, says the report published online today by the New England Journal of Medicine. The main reasons for not wanting the vaccine were safety worries and a belief that it wasn’t needed.

 

(Continue . . . )

Given that excellent coverage of this story has already appeared, I’ll spare you a lengthy rehash.  

Suffice to say that by the end of the fall wave of H1N1, interest in the pandemic vaccine (and it’s uptake) had fallen, with many people either unconvinced of its necessity or still concerned over its safety.

The concern here is that the impressions left by the experience of 2009 may mean that a lot of people may not be quick to accept a pandemic vaccine in the future.

It is the same sort of reaction we see in Florida, and along the Gulf and Atlantic Coastline, after every hurricane season.

People who emerged unscathed, or who may have ridden out a weaker storm, come away believing that they’ve seen a hurricane . . . and they weren’t particularly impressed.

People who evacuated upon the order (or advice) of local officials, only to return and find their house intact, are less likely to evacuate in the future. 

But of course, all hurricanes aren’t created equal.   And basing your future expectations on the last storm can be a fatal error.

The same holds true for pandemics.   

As epidemiologists like to say, “If you’ve seen one pandemic . . . you’ve seen one pandemic.”

Although there were some missteps along the way (particularly in the overpromising of vaccine supplies in October and November) the HHS and the vaccine manufacturers pulled off a considerable coup by delivering a safe and effective vaccine a month sooner than originally anticipated.

Despite the ominous warnings of the anti-vaccine contingent, we have not seen any spike in Guillain-Barre syndrome, or any other serious vaccine related side effects.

 

The pandemic shot has proven to have roughly the same safety profile as the seasonal flu shot, which is excellent.

Unfortunately, the unfounded message that the `vaccine is deadlier than the virus’ continues to persist – particularly online – and that raises doubts in many people’s minds.  

While everyone is happy that the pandemic of 2009 proved less deadly than first feared, the public complacency that this has engendered may prove to be a substantial obstacle the next time we face an emerging public health threat.

Via Cuban News Agency: National Vaccination Campaign against A H1N1 Flu Virus Nearing Completion. Excerpt:

Cuban Deputy Health Minister Luis Estruch described an ongoing nationwide vaccination campaign against the A H1N1 influenza virus whose second and final phase is about to conclude as transcendental.  

Estruch told reporters that the vaccine, donated by the World Health Organization (WHO), has been administered to 1,265,807 people included in highly vulnerable groups such as pregnant women and those within the term of up to 42 days after labor. 

The official said that 500 facilities were used as vaccination centers and more than 100,000 professional nurses played a decisive role in the preparation and organization of all services and resources. He also praised their work in a recently concluded national anti-polio vaccination campaign that protected over half a million Cuban children. 

Dr. Miguel Angel Galindo, an advisor of the national vaccination program who won the 1999 Pan American Health Organization (PAHO) Award for Immunization, noted that Cuba leads the region in these vaccination efforts and added that 29 countries of the Americas have implemented vaccination programs among vulnerable groups.

Via the New England Journal of Medicine, a very informative report on The Public’s Response to the 2009 H1N1 Influenza Pandemic. Excerpt:

The public expressed two particular concerns about the government’s response. First, some people were displeased with the vaccine shortage, and while the shortage existed, a majority of respondents (54%) said the federal government was doing a poor or very poor job of providing the country with adequate vaccine supplies (Gallup). 

Second, the public was divided about public health officials’ efforts to make sure the H1N1 vaccine was safe early in the distribution process, even though two thirds (63%) of the public said in January that “public health officials had done the right amount to make sure the H1N1 flu vaccine is safe” (HSPH, January 2009). 

For example, in November, adults were nearly evenly divided on whether medical testing of the H1N1 influenza vaccine had moved too quickly to ensure that it was safe: 45% said it was done as quickly as possible while still making sure the vaccine was safe, whereas 40% said it was done too quickly so that people could not be sure it was safe (Fox, November 2009). 

Our review of these data suggests that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine because they may believe that the illness does not pose a serious health threat, because they (especially parents) may be concerned about the safety of the available vaccine, or both. More work may need to be done to understand the basis of these beliefs and to address them in the case of a serious influenza outbreak. 

Polls during the 2009 H1N1 pandemic also suggest that public health communication efforts related to other personal influenza-prevention behaviors were effective in reaching a large swath of the public. 

Building on these efforts, as well as developing a vaccine strategy, may be useful during response planning and during an outbreak.

(Wed, 19 May 2010 20:17:00 +0000)

# 4582

Potential for severe weather today (May 19th, 2010) as forecast by the Storms Prediction Center in Norman, Oklahoma.

Later today most of Oklahoma, and parts of northern Texas will be  under high threat of severe weather . . . which could include flash floods, strong winds, severe hail, and tornadoes.  A larger area of the Mid-West will be under a medium threat.

According to the latest bulletin, the biggest window of danger will run from about 2pm Central time until midnight, although severe weather could occur into tomorrow morning.

 

 

Which means that everyone in these areas should already have an emergency plan in place, have a battery-operated weather radio, and be prepared to seek shelter immediately should conditions threaten.

Many people have family and friends in this region, and are no doubt interested in ways to follow the latest developments via the internet.  Others may simply have an interest, or fascination, with severe weather. 

In either event, I thought I’d share some of the resources I use when tracking severe storms across `tornado alley’.

The first stop should always be NOAA’s  Storms Prediction Center, where multi-day outlooks of severe weather are constantly being updated.

A clickable U.S. map that will link you to the regional NOAA weather forecast offices can be found here, or by clicking the graphic below.

Although not a substitute for having your own emergency weather radio, you can listen to NOAA weather radio alerts online, coming from most areas of the country.

When a tornado warning has been issued, I will sometimes check to see if local TV stations in the threat area are broadcasting live on the Internet. Cities with a long history of severe storms often break into regular programming for with non-stop coverage. 

A Google Search will often provide you with several local TV stations that may be streaming video.   KFOR.COM in Oklahoma City usually goes live once tornado warnings are issued.  Other stations you might try in the OKC area are KOCO.COM  and KWTV.COM.

If streaming video is a bit too much for your internet connection, you might prefer to listen in to one of the hundreds of police/fire/EMS scanner feeds that are available online. 

RadioReference is just one of several online portals for scanner feeds, but is the one I tend to use.  Simply click on the maps to select the state, then county, that you wish to monitor.

But if your internet connection can handle it, you might find the live streaming video (and sometimes audio) from storm chasers in the field to be of interest.  Once again there are several options here. 

One of the biggest is Severe Studios, which often has more than a half dozen chasers streaming video simultaneously.

You may also wish to check out Storm Chaser TV, and often you’ll find Hurricane City’s live feed available on their site, or on USTREAM.

Of course, if you are in the path of the storm, you need to get off the Internet and down into your cellar or safe room.  Hopefully today’s threat will turn out to be less serious than the forecast indicates.

When Hurricane season arrives, I’ll have some hurricane-centric links for you as well.

Via The Pnom Penh Post: Kingdom to deliver 1.5m swine flu shots. Excerpt:

The Ministry of Health plans to distribute 1.5 million doses of A(H1N1) influenza vaccine to 20 provinces at the end of this month, a health official said Tuesday. 

San Chan Seoun, director of the programme overseeing the distribution of the vaccines, said the World Health Organisation (WHO) delivered the Kingdom’s second round of vaccines last week. An initial round arrived in March. 

“At the end of this month, health officials will give the vaccines to healthcare providers, [to be administered to] pregnant women, infants between 6 months and 2 years and people with serious lung disease,” he said, and noted that those groups were considered to face the highest risk of contracting the virus, also known as swine flu. 

Some 300,000 doses have already been distributed to high-risk groups in Phnom Penh, Kandal, Kampong Cham and Kampong Chhnang, he said.

(Wed, 19 May 2010 11:46:00 +0000)

# 4579

The April, 2010 issue of Annals, Academy of Medicine, Singapore (AAMS) is devoted to Pandemic Influenzas, with more than a dozen editorials, research articles, cases series, and commentaries on the subject. 

ANNALS is open access, and so you can download and review each of these articles in their entirety.   They are for private use only, of course, and subject to copyright rules and certain restrictions.

This looks like an excellent resource, and as I get time to review some of these articles, I imagine I’ll find some fodder for a few blogs in the coming weeks.

The emergence of novel H1N1 will no doubt end up being the most studied public health event to date, and the next few years should bring a great deal more knowledge and understanding of the workings of a pandemic.

Editorial
The Influenza A (H1N1) 2009 Pandemic in Singapore
Li Yang Hsu, Derrick MK Heng, Yee Sin Leo

 

Original Articles
Pandemic (H1N1) 2009: Clinical and Laboratory Findings of the First Fifty Cases in Singapore
Monica Chan, Mark I Chen, Angela Chow, Caroline PS Lee, Adriana SH Tan, David Chien Lye, Yee Sin Leo

Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009
Jeffery L Cutter, Li Wei Ang, Florence YL Lai, Hariharan Subramony, Stefan Ma, Lyn James

An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009
Hariharan Subramony, Florence YL Lai, Li Wei Ang, Jeffery L Cutter, Poh Lian Lim, Lyn James

Tracking the Emergence of Pandemic Influenza A/H1N1/2009 and its Interaction with Seasonal Influenza Viruses in Singapore
Julian WT Tang, Chun Kiat Lee, Hong Kai Lee, Tze Ping Loh, Lily Chiu, Paul A Tambyah, Evelyn SC Koay

Obstetric Outcomes of Influenza A H1N1 (2009) Infection in Pregnancy – Experience of a Singapore Tertiary Hospital
May Li Lim, Wai Yee Lim, Nancy WS Tee, Siok Hong Lim, Jing Jye Chee

Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club
Pei Pei Chan, Hariharan Subramony, Florence YL Lai, Wee Siong Tien, Boon Hian Tan, Suhana Solhan, Hwi Kwang Han, Bok Huay Foong, Lyn James, Peng Lim Ooi

Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures
Wu Meng Tan, Nidhi Loomba Chlebicka, Ban Hock Tan

Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns
Koh Cheng Thoon, Chia Yin Chong

 

Review Article
Influenza A (H1N1-2009) Pandemic in Singapore – Public Health Control Measures Implemented and Lessons Learnt
Joanne Tay, Yeuk Fan Ng, Jeffery Cutter, Lyn James

 

Short Communication
International Health Regulations: Lessons from the Influenza Pandemic in Singapore
Chew Ling Low, Pei Pei Chan, Jeffery L Cutter, Bok Huay Foong, Lyn James, Peng Lim Ooi

 

Case Series
Severe Infection with H1N1 Requiring Intensive Care – Lessons for Preparedness Programmes
Jaime MF Chien, Ban Hock Tan, Kok Soong Yang, Thuan Tong Tan, Chian Yong Low, Asok Kurup, Hoe Nam Leong, Jenny GH Low, Mei Ling Kang, Maciej Piotr Chlebicki, Yin Ling Koh

 

Commentaries
2009 Pandemic Influenza H1N1: Paediatric Perspectives
Hao Yuan Lee, Chang Teng Wu, Tzou Yien Lin, Cheng Hsun Chiu

Surveys of Knowledge, Attitudes and Practices on the Influenza A (H1N1) Pandemic
Li Yang Hsu

 

Letters to the Editor
Streptococcus pneumoniae Bacteraemia in a Young Man with Pandemic Influenza A (H1N1) 2009
Florante S Isais, Frederico Dimatactac, Ryan Llorin, Angela Chow, Yee Sin Leo

Use of Healthcare Worker Sickness Absenteeism Surveillance as a Potential Early Warning System for Influenza Epidemics in Acute Care Hospitals
Sapna Sadarangani, Mark IC Chen, Angela LP Chow, Arul Earnest, Mar Kyaw Win, Brenda SP Ang

 

Afterword
Jeffery L Cutter

(Wed, 19 May 2010 10:45:00 +0000)

# 4578

Sharp-eyed visitors to this blog have no doubt already noticed the new National Preparedness Month 2010 logo on my sidebar. 

Although this is only May, and NPM 2010 happens in September, the Ad Council in concert with Ready.gov, FEMA, and Citizen Corps are kicking off their awareness campaign and looking for coalition members.

As you might expect, Avian Flu Diary has already signed up.  And you can too.

I’ll let Ready.gov explain the process. Click on the image below to go to the sign up page.

Once you sign up you’ll have access to the NPM toolkit, which includes PowerPoint presentations, brochures, posters, web badges and logos, videos, and a calendar where you can post planned activities online.

It’s free, and easy.  

And by taking part in NPM 2010 you’ll be helping to create a culture of preparedness in your workplace, your community and in your circle of friends and family.

Something that could save lives during an emergency.

For more potentially life saving preparedness information, go to:

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

And a few of my (many) preparedness essays include:

An Appropriate Level Of Preparedness

Inside My Bug Out Bag

Red Cross Unveils `Do More Than Cross Your Fingers’ Campaign

The Gift Of Preparedness

You can search this blog for more preparedness information by clicking this link.

I missed this yesterday when WHO published Margaret Chan’s speech to the 63rd World Health Assembly: Time to get back on track to meet the Millennium Development Goals. Excerpt:

Good news for public health usually arises from factors like political commitment, sufficient resources, strong interventions and implementation capacity, equitable delivery, and alignment with national priorities and capacities. Sometimes, though, we are just plain lucky. 

This has been the case with the H1N1 influenza pandemic. The virus did not mutate to a more lethal form. Cases of resistance to oseltamivir remained few and isolated. The vaccine closely matched circulating viruses and showed an excellent safety record. 

Emergency wards and intensive care units were often strained, but few health systems were overwhelmed and the effects were usually short-lived. Schools closed, but borders remained open, and disruptions to travel and trade were far less severe than feared. 

Had things gone wrong in any of these areas, we would have a very different agenda before us today. 

This has been the most closely watched and carefully scrutinized pandemic in history. It is normal that every decision and action, especially on the part of WHO, will likewise be closely scrutinized and critically assessed. We welcome this process. 

The pandemic has also been the first major test of the functioning of the revised International Health Regulations, which entered into force in 2007. 

During the January session of the Executive Board, I proposed that a previously scheduled review of the functioning of the Regulations could also be used to assess the international response to the influenza pandemic. The Board agreed to this proposal. A report of the Review Committee’s first meeting is before you. 

When I opened that meeting, I stressed the need for a frank and critical assessment of performance, including WHO’s performance, in a process that is independent, credible, and transparent. We want to know what worked well. We want to know what went wrong and, ideally, why. We want to know what can be done better and, ideally, how. 

We are seeking lessons, about how the International Health Regulations have functioned, about how WHO and the international community responded to the pandemic, that can aid the management of future public health emergencies of international concern. And I can assure you: there will be more. 

The report of the Review Committee’s first meeting summarizes issues and questions repeatedly raised and likely to guide the review. The Committee further agreed to look into criticisms that have been levelled at WHO for its management of the pandemic. As I said, we welcome this review.

Via PLoS Medicine, a fascinating report: Early Pandemic Influenza (2009 H1N1) in Ho Chi Minh City, Vietnam: A Clinical Virological and Epidemiological Analysis. An excerpt from the Editors’ Summary:

These findings, although limited by missing data, suggest that the strict containment measures introduced early in the 2009 H1N1 pandemic in Ho Chi Minh City may have reduced the circulation of infected people in the community. 

This reduction in circulation might have delayed the onset of community transmission, suggest the researchers, but because the study was observational, this possibility cannot be proven. 

However, importantly, these findings show that the containment measures were unable to prevent the eventual establishment of pandemic influenza in Vietnam, presumably because many imported cases were not detected by airport screening. 

Finally, these findings suggest that in Vietnam, as in other countries, 2009 H1N1 causes a mild disease and that this disease responds quickly to treatment with oseltamivir whenever treatment is started in relation to the onset of illness.

By the way, the April 2010 issue of PLoS Medicine has several articles on H1N1; swine flu is going to be one of the most exhaustively studied outbreaks in history.