Influenza Virus Mashup

(Fri, 30 Jul 2010 10:47:00 +0000)

# 4769

In April of this year, dozens of reports of febrile reactions (sometimes with convulsions) associated with Australia’s seasonal flu vaccine were reported in young kids. 

An investigation was launched, and a temporary moratorium declared on vaccinating kids under the age of five.

 

Australia Investigating Adverse Vaccine Reactions

Australian Vaccine Investigation Widens

 

Over time, it became apparent that while the exact reasons for these febrile reactions remained elusive, that the problem was associated only with CSL’s Fluvax, and not with any other manufacturer’s vaccines.

Today, the Sydney Morning Herald is reporting that the ban on vaccinating under-fives in Australia has been lifted since these levels of side effects have not been observed in children receiving competing  brands Influvac or Vaxigrip.

Ban on flu vaccine for young kids lifted

July 30, 2010 - 4:09PM

Certainly good news, not only for kids in Australia, but for our own seasonal flu vaccination campaign which is due to kick off in September. 

This year’s trivalent flu vaccine will contain antigens for the pandemic A/California/7/2009 (H1N1)-like virus, the newly emerging A/Perth/16/2009 (H3N2)-like virus, and B/Brisbane/60/2008-like Influenza B virus.

Although minor adverse affects (usually a mild fever, or localized swelling at the site of injection) are sometimes seen with flu shots, the vaccine itself has proven to be remarkably safe, and most years very effective.

 

Serious side effects are extremely rare.

Given the burden of mortality and morbidity that influenza places upon society, the CDC has been moving towards recommending nearly universal voluntary vaccination for those over 6 months of age in recent years.

This year, that will be the goal of the vaccination campaign. Lisa Schnirring at CIDRAP brings us the details.

CDC launches universal flu vaccination recommendation

Lisa Schnirring Staff Writer

Jul 29, 2010 (CIDRAP News) – The US Centers for Disease Control and Prevention (CDC) today endorsed its vaccine advisory group’s recommendation for universal influenza immunization, as public health groups prepare to shift gears from pushing the pandemic H1N1 vaccine to drawing the public’s attention to the new seasonal flu vaccine advice.

 

The CDC issued a comprehensive update on seasonal flu vaccination, which includes the new universal recommendation, in an early online edition of Morbidity and Mortality Weekly Report (MMWR). In February the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended seasonal flu immunizations for nearly everyone except babies younger than 6 months old.

(Continue . . . )

Jul 29 MMWR report

PKIDSs Online Web site

Via The Times of India: ‘2nd wave of swine flu has arrived’. Excerpt:

The second wave of the pandemic H1N1 influenza has struck and its infection rate is likely to be higher than the first wave, according to the National Institute of Virology (NIV). 

The wave is currently strong in Mumbai, Pune and Bangalore, an NIV official said, adding that there’s no need to panic as anti-H1N1 vaccines are available in the market. 

“We are in it now. The second wave of the virus arrived in mid-July and will continue until September. We need to be prepared for whatever surprises this nasty new virus delivers,” NIV director A C Mishra told TOI.

Via CIDRAP, a report by Lisa Schnirring: CDC launches universal flu vaccination recommendation. Excerpt:

The US Centers for Disease Control and Prevention (CDC) today endorsed its vaccine advisory group’s recommendation for universal influenza immunization, as public health groups prepare to shift gears from pushing the pandemic H1N1 vaccine to drawing the public’s attention to the new seasonal flu vaccine advice. 

The CDC issued a comprehensive update on seasonal flu vaccination, which includes the new universal recommendation, in an early online edition of Morbidity and Mortality Weekly Report (MMWR). In February the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended seasonal flu immunizations for nearly everyone except babies younger than 6 months old. 

Based on literature reports on the vaccine’s safety and its ability to prevent disease, the CDC has been expanding its recommendation, and by 2009 its seasonal flu vaccination recommendation covered 85% of the population. 

The CDC’s latest expansion includes all healthy, nonpregnant adults aged 18 to 49. The CDC said expanding the recommendation to that group helps address two problems: Flu complications can occur, even in healthy people, and many adults with underlying conditions such as diabetes and asthma don’t consider themselves at increased risk.

Via The Mercury in Tasmania: Mum-to-be critical in RHH with swine flu. Excerpt:

A pregnant woman with swine flu was in a critical condition in the Royal Hobart Hospital last night. 

Public health director Roscoe Taylor said the patient, an overseas visitor, was being treated in intensive care. 

The H1N1 strain, or human swine flu, was confirmed last night by laboratory tests. It was Tasmania’s fifth case so far this year, of which three cases were overseas travellers who developed their illness after arrival, Dr Taylor said. 

“This case is a reminder of the need for clinicians to be alert in their assessment of travellers reporting illness after arriving in Tasmania, so any signs of swine flu can be identified early and people at higher risk of serious illness [such as pregnant women] treated with antivirals,” Dr Taylor said. 

“It’s also a reminder of the importance of being vaccinated against H1N1. As we saw last year, H1N1 can be very serious, even for ordinarily healthy people, and our first line of defence is vaccination.”

(Thu, 29 Jul 2010 16:33:00 +0000)

# 4768

The ongoing post-mortem on this past year’s influenza season continues with today’s release in the CDC’s MMWR of a summary of influenza activity in the United States.

I’ll just post the opening paragraph, and a few selected bullet points from the text. They indicate, as many experts have previously stated, that this past pandemic flu season wasn’t quite as benign as some might have you believe.

Follow the link to read it the report in its entirety.

 

Update: Influenza Activity — United States, 2009–10 Season

Weekly

July 30, 2010 / 59(29);901-908

During the 2009–10 influenza season, the second wave of influenza activity from 2009 pandemic influenza A (H1N1) occurred in the United States; few seasonal influenza viruses were detected. Influenza activity* peaked in late-October and was associated with higher pediatric mortality and higher rates of hospitalizations in children and young adults than in previous seasons.

 

The proportion of visits to health-care providers for influenza-like illness (ILI), as reported in the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), was among the highest since ILI surveillance began in 1997 in its current form. This report summarizes influenza activity in the United States during the 2009–10 influenza season (August 30, 2009–June 12, 2010).

(Continue . . .)

A few selected highlights include . . .

• 740,000 influenza specimens were tested for influenza, and the number of laboratory-confirmed positives was approximately four times the average of the previous four seasons

• three cases, identified in Kansas, Iowa, and Minnesota, were isolated cases of human infections with contemporary North American swine-lineage influenza A (H3N2) viruses currently circulating in swine herds

• ILI activity next exceeded baseline beginning the week ending August 23, 2009, and continued to be elevated above baseline through January 2, 2010, for a total of 19 consecutive weeks

• August 30, 2009, through June 12, 2010, the peak proportion of outpatient visits to healthcare providers for ILI was among the highest seen since the system began in its current form in 1997 and was approximately equal to that seen during the 2003–04 influenza season

• During the 2009–10 influenza season, the percentage of deaths attributed to pneumonia and influenza (P&I) exceeded the epidemic threshold†† for 13 consecutive weeks, from October 3 to December 26, 2009, and from January 16 to January 30, 2010 (Figure 4). 

• From August 30, 2009, to June 12, 2010, the 2009–10 influenza season, a total of 279 laboratory-confirmed, influenza-associated pediatric deaths were reported, nearly four times the average reported in the previous five influenza seasons

Via Infobae.com: Por la gripe A, Bolivia declara el alerta nacional.[Bolivia declares national alert over H1N1] Excerpt, with my translation:

Desde la cartera sanitaria confirmaron el alerta nacional epidemiológica ayer, informó el sitio web local La Prensa.

A national epidemiological alert has been confirmed, according to the local website La Prensa.

El jefe nacional de Epidemiología, René Lennis, señaló que esta medida de excepción “no significa ningún estado de gravedad, sino que todos los servicios y personal de salud deben estar atentos a las personas con los síntomas de la influenza H1N1 como fiebre, dolor de garganta y otros”. 

The national chief of epidemiology, René Lennis, said that this exceptional measure “does not mean a state of gravity, but that all health services and personnel should be attentive to persons with symptoms of H1N1 such as fever and sore throat.”

Hasta el momento se confirmaron 34 casos y hay más de 1.000 sospechosos. Los pacientes infectados corresponden a los departamentos de La Paz (24), Santa Cruz (6), Cochabamba (2) y Trinidad (2).

So far 34 cases have been confirmed and over a thousand cases are suspected. Infected patients are in the departments of La Paz (24), Santa Cruz (6), Cochabamba (2) and Trinidad (2).

Via the Hong Kong government website: Seasonal flu activity on the rise. Excerpt:

The Centre for Health Protection warns of increasing influenza activity, detecting 125 flu infections for the week ending July 24, compared to 98 the previous week.
  

Flu virus isolates in last two weeks were mainly human swine flu (40%). Seasonal influenza A-H3N2 and seasonal influenza B occupied 30% each.
  

The consultation rates for flu-like illness at sentinel private doctors for the week ending July 24 was 51.5 per 1,000 consultations, rising from 40.1 in the preceding week.

WHO has published Avian influenza - situation in Egypt - update 35.

The Ministry of Health of Egypt has announced a new human case of A(H5N1) avian influenza infection. 

The case is a 20 year-old female from Shobra Elkhima district, Qliubia Governorate. She was admitted to hospital on 21 July, placed on a ventilator, and received oseltamivir treatment. She died on 27 July. 

Investigations into the source of infection indicated that the case had exposure to sick and dead poultry. 

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN). 

Of the 110 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 35 have been fatal.

(Thu, 29 Jul 2010 12:29:00 +0000)

# 4767

With the fall flu vaccination campaign slated to begin less than 2 months from now, the ACCV (Advisory Commission on Childhood Vaccines) will hold a teleconference this afternoon to review the CDC’s draft statements for the upcoming flu season.

Interested parties may listen in, or make a public comment at the end of the meeting. 

This notice appears on the right hand news column of the HRSA Vaccine Compensation Website.

Interim Influenza Vaccine Information Statements Special Meeting

Thursday July 29, 1 to 2 pm ET

The Advisory Commission on Childhood Vaccines will review the CDC’s draft statements slated for distribution during the 2010-2011 flu season. The conference call meeting is open to the public. Persons who wish to make oral statements may announce their intent at the time of the public comment period.

To join, phone 1-888-606-5950.
Leader’s Name: Dr. Geoffrey Evans
Password: ACCV

Meeting Agenda (PDF - 10 KB)

Federal Register (PDF - 57 KB)

Inactivated Influenza Vaccine: What You Need to Know 2010 – 2011 (PDF - 33 KB)

Live, Intranasal Influenza Vaccine: What You Need to Know 2010 – 2011 (PDF - 36 KB)

VICP Authorizing Legislation (PDF - 497 KB) (January 13, 2010)

Review of Adverse Effects of Vaccines Committee Membership Comment on provisional appointments by April 9

(Thu, 29 Jul 2010 11:32:00 +0000)

# 4766

Having performed CPR in excess of 500 times over the years, and since I was an American Heart Association and an American Red Cross CPR instructor in my distant past, I’ve watched the adoption of a `compression only’ method of CPR for laypeople over the past couple of years with considerable interest.

Admittedly, the removal of rescue breathing from the protocol seemed a bit counterintuitive to me.   Airway management and proper ventilation were a huge part of my EMT and Paramedic training.

But I understand the reluctance of bystanders to do mouth-to-mouth – particularly on strangers (which is why I  own two Ambu-bags - one for each of my first aid kits).

Despite my initial skepticism, the NEJM has published the results of a comparative study of CPR outcomes with, and without, rescue breathing that support the notion of doing compression-only CPR. 

At least among those who have little or no CPR training. 

This study was conducted in Sweden, and researchers found that the 30-day survival rate was 8.7% in the compression-only group and 7.0% in the group receiving standard CPR.

Excerpts from the abstract follow.

CPR with Chest Compression Alone or with Rescue Breathing

Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H. and Mickey S. Eisenberg, M.D., Ph.D.

N Engl J Med 2010; 363:423-433July 29, 2010

Background

The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

Methods

We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.

 

<BIG SNIP>

 

Conclusions

Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing.

 

(Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)

Doing 1-man CPR, even for a trained responder, can be difficult and quickly exhausting.  For a layperson, changing from compressions to rescue breaths and back again to compressions  can be awkward and ultimately inefficient.

The end result is often poor ventilation and poor circulation. 

Rescue breathing and trying to maintain a proper airway complicates CPR considerably, but emergency dispatchers can coach untrained bystanders to do chest compressions relatively easily. 

By concentrating on chest compressions alone, the layperson can keep a little oxygenated blood flowing to the brain while waiting for medics to arrive. 

 

This can help stave off brain death, which is the primary goal of bystander CPR.

I would urge everyone to take a CPR course, and follow up with refresher courses every few years.  Contact your local Red Cross Chapter or the American Heart Association  for training options.

You should be warned, however, that the `miraculous saves’ shown on many dramatic TV shows - where the CPR success rate is usually over 50% – aren’t very realistic.  

CPR can, and does, save lives. 

But the rate of success is usually 10%-15%, even under the best of circumstances.  For a sobering, but realistic appraisal of CPR’s effectiveness you might wish to read:

CPR: Less Effective Than You Might Think