Influenza Virus Mashup

Influenza Virus Mashup

Archive for June, 2011

[Crof's H5N1] Long-term disaster preparation

Posted by Automator On June - 20 - 2011

Mike Coston at Avian Flu Diary has an excellent post on preparedness: When 72 Hours Isn’t Enough. Read the whole thing; it will indeed be on the final exam. Excerpt:

The standard advice provided by Ready.gov, FEMA, and organizations like the Red Cross, is that every family, individual, and business needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.   

Sure . . .  they’d like you to be prepared for longer . . .  but few enough Americans bother to prepare for even 72 hours.   If most people won’t prepare for 3 days, the thinking is there’s little value in asking them to prepare for a week, or even two.   

Yet time after time we see instances when entire communities are devastated - and services and supplies are disrupted - for periods that far exceed this 3 day scenario.

[Avian Flu Diary] When 72 Hours Isn’t Enough

Posted by Automator On June - 20 - 2011

(Sun, 19 Jun 2011 12:59:00 +0000)

 

 

 

# 5637

 

 

The standard advice provided by Ready.gov, FEMA, and organizations like the Red Cross, is that every family, individual, and business needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

 

Sure . . .  they’d like you to be prepared for longer . . .  but few enough Americans bother to prepare for even 72 hours.

 

If most people won’t prepare for 3 days, the thinking is there’s little value in asking them to prepare for a week, or even two.

 

Yet time after time we see instances when entire communities are devastated - and services and supplies are disrupted - for periods that far exceed this 3 day scenario.

 

I was in New Orleans six weeks after Hurricane Katrina struck to try to retrieve what few belongings we could from my brother’s French Quarter apartment, and the place still looked like a war zone.

 

Water and electrical service was absent in many parts of the city, rotting garbage was piled up on every curbside, a curfew was in effect, and everywhere you looked grocery stores, pharmacies, and doctor’s offices were boarded up.

 

While most of the city was still evacuated, many of those that remained (including emergency workers) were living in third world conditions.

 

Seven weeks later Hurricane Wilma struck south Florida, and although just a category 3 storm, caused serious damage from Naples to Ft. Lauderdale and points south. 

 

Power was out to more than 3 million customers (approximately 6 million people), and it took up to 2 weeks to get these folks back online.

 

Friends of mine living in Miami were literally cooking over an open fire in their front yard for two weeks.

 

image

Wilma Crossing South Florida – NOAA

 

Hurricane Ike in 2008 brought similar misery to the Texas Gulf Coast, all but wiping the town of Gilchrist from the map, and leaving tens of thousands of residents without electricity for weeks.

 

In Japan, 100 days after the combined earthquake and Tsunami, millions of people’s lives are still uprooted, thousands remain in temporary shelters, and the misery factor runs very high.

 

On a smaller scale, the same could be said about the residents of Christchurch, New Zealand who have now experienced three major seismic events in less than a year.

 

To this list we can add the residents of Port-au-Prince, Haiti . . .  Joplin, Missouri . . .  Tuscaloosa, Alabama . . .   just to name a few.

 

In fact, as of 6/17/2011 the United States Federal Government has declared 50 Major disasters in 2011 alone.

 

While we can’t prevent disasters like earthquakes, hurricanes, floods, and tornadoes . . . we can be better prepared to deal with them.

 

Last March I stumbled upon a colorful, easy-to-follow, 100 page `survival guide’ released by Los Angeles County, that covers everything from earthquake and tsunami preparedness, to getting ready for a pandemic.

 

The guide may be downloaded here (6.5 Mbyte PDF).

 

While designed specifically for the nearly 10 million residents of Los Angeles County, this guide would be a valuable asset for anyone interested in preparing for a variety of hazards.

 

image

 

And in Los Angeles, the advice is to have emergency supplies (food, water, etc) to last up to 10 days.

 

While in all likelihood help will begin to arrive within 48 to 72 hours of a major disaster, if you have extra supplies on hand you are in a better position to offer help to a friend, a neighbor, a relative, or your community.

 

And in the wake of a major disaster, you may find there are better things to be doing with your time than queuing up for hours waiting for water and food distributions.

 

Beyond being practical, prepping is ethical.  

 

And it isn’t just me saying that.

 

In October, 2008 I wrote a blog which highlighted the John’s Hopkins Study entitled Ethics and Severe Pandemic Influenza: Maintaining Essential Functions through a Fair and Considered Response.

 

It included the following snippet from the summary provided on  the Johns Hopkins Berman Institute of Bioethics website.

 

. . .  individuals and families who can afford it should do their best to prepare for any disaster. The paper notes, the more initiative the general public exercises in stockpiling several weeks’ worth of food, water, paper goods, batteries medicines, and other needed supplies, the less vulnerable they will be to a break in the supply chain.

 

It is important for leaders to communicate to the middle class and the wealthy that it is their responsibility to prepare for self-sufficiency in order to free up scarce supplies and allow first responders to direct their attention towards those too poor or vulnerable to prepare themselves.

 

 

While this may not have been the main thrust of this paper’s message, it is a powerful component.  One that bloggers such as myself have been trying to promote for several years.

 

As long as our supply chains are intact, grocery store shelves are full and capable of being restocked, and no major shortages exist it is not hoarding, selfish, or unethical to be stockpiling a reasonable amount of emergency supplies for you, your family, and others you might be able to assist during a disaster.

 

So the standard advice to prepare for 3 days is a good start, but if you are capable of doing more, you really should.

 

During a crisis relief agencies will have their hands full trying to help those who were unable to prepare, or who lost their preps due to a disaster.

 

By being prepared in advance, you take some of the burden off these agencies, which will allow them to concentrate their efforts on helping those less able to help themselves.

 

And by being prepared, you are in a better position to help others.

 

And that’s a win-win situation.

 

For you, your family, and your community.

Via Hoy Digital: Sigue alto número de pacientes con diarrea. [Continuing high number of diarrhea patients] Excerpt, with my translation:

El flujo de pacientes con diarrea y sospecha de cólera se mantiene alto en los hospitales de Salud Pública, en algunos centros se observó ayer una mayor organización en la asistencia a enfermos. 

The number of patients with diarrhea and suspected cholera continues high in the Public Health hospitals; in some, reporters yesterday saw a major effort in caring for patients.

Sólo en tres hospitales de Santo Domingo y el Distrito Nacional se registraban a mediado de la tarde 66 personas ingresadas. 

In just three hospitals in Santo Domingo and the National District, 66 persons were admitted by mid-afternoon.

Las quejas son las mismas, pero el flujo de pacientes sube y baja en el transcurso del día y de la noche. 

The symptoms are same, but the flow of patient rises and falls through the day and night.

En tres hospitales de Santo Domingo visitados por periodistas de Hoy se pudo observar una mayor organización en la llegada y salida de los enfermos, lo mismo que en el tratamiento. 

In three Santo Domingo hospitals visited by journalists from Hoy, a major organization could be observed in the arrival and departure of patients, as well as in their treatment.

En el hospital Luis Eduardo Aybar, ubicado en la zona pobre y rodeada de marginalidad del Distrito Nacional, el número de pacientes llegaba a 32, pero también era evidente la organización del servicio sanitario. 

In Luís Eduardo Aybar Hospital, located in the slums and surrounded by the margins of the National District, the number of patients reached 32, but the organization of the health service was also evident.

En el primer piso de un edificio en construcción están los enfermos adultos, mientras en el segundo nivel están los niños. Los más pequeños están más cómodos que los adultos.

On the first floor of a building still under construction, adult patients are housed, while on the second floor are the children. The smallest patients are more comfortable than the adults.

También se observa orden en la unidad diarreica del hospital Francisco Moscoso Puello, un centro ubicado en la zona periférica del Distrito Nacional. 

The same kind of order was seen in the diarrhea unit of Francisco Moscoso Puello Hospital, located on the edge of the National District.

A la entrada y salida del centro han sido colocadas sendas frazadas, a las cuales se les coloca cloro para que quienes entran y salen tengan que limpiar sus zapatos. 

At the entrance and exit of the hospital, blankets soaked with chlorine have been laid, so those who come in and go out must disinfect their shoes.

El mismo nivel de limpieza se observó en el hospital Santo Socorro. Este centro es infantil, pero da servicio a los adultos con la enfermedad diarreica.

The same level of cleanliness was seen in Santo Socorro Hospital. This centre is for children, but also cares for adults with diarrhea.

I’ve been impressed with the quality of cholera coverage in the Dominican media (especially Hoy), even though the outbreak has triggered huge controversies between the government and the healthcare professionals.

Maybe similar coverage is going on in the French- and Creyol-language Haitian media, but I haven’t seen it in HaitiLibre.com or even in the tweets of NGOs. The closest might be the reports in Cuban media about the Cuban doctors’ work in Haiti, but those reports focus on the good-news aspects of the problem. 

Hoy, by contrast, has covered the good and bad news pretty fairly. The Dominicans are speaking for themselves, rather than letting outsiders tell their story.

[Flu Wiki Forum] News Reports for June 19, 2011

Posted by Automator On June - 19 - 2011

(Sun, 19 Jun 2011 02:44:43 GMT)

Reminder: Please do not post whole articles, just snippets and links, and do not post articles from the Las Vegas Review-Journal. Thanks!

India

?  It’s pouring viral ailments (Link)

South Africa

?  Swine Flu Now Hits South Africa (Link)

Commentary

?  Recombinomics: H1N1 Clonal Expansion of H274Y Tamiflu Resistance In Japan (Link)



?  H (Link)

News for June 18, 2011 is here.


Thanks to all of the newshounds!
Special thanks to the newshound volunteers who translate international stories - thanks for keeping us all informed!

Other useful links:

WHO A(H1N1) Site

WHO H5N1 human case totals, last updated June 16, 2011
Charts and Graphs on H5N1 from WHO
Google Flu Trends (U.S.)
CDC Weekly Influenza Summary
Map of seasonal influenza in the U.S.
CIDPC (Canada) Weekly FluWatch
UK RCGP Weekly Data on Communicable and Respiratory Diseases
Flu Wiki Main Page

[Avian Flu Diary] Online Hurricane Resources

Posted by Automator On June - 19 - 2011

(Sat, 18 Jun 2011 12:04:00 +0000)

 

 

 

# 5636

 

Ready.gov reminds us that there are three important steps to preparedness.

 

image

 

 

Luckily the third step – staying informed – gets easier every year as the number of online resources for tracking severe weather improves.

 

Since the 2011 Atlantic Tropical Storm Season has begun, today I’ve a list of some of my favorite online Hurricane resources. Some of these are `official government’ portals of information, while others are run by hurricane and severe weather enthusiasts.

 

While some very good information and analysis can be had through non-official channels on the internet, you should only rely on local emergency management officials, the National Hurricane Center, and the National Weather Service for:

  • forecasts
  • warnings
  • evacuation recommendations.

 

 

The first stop on our list is the National Hurricane Center in Miami, Florida.  These are the real experts, and the only ones you should rely on to track and forecast the storm.

 

image

 

Last year there were some significant changes in how the NHC will advise us on hurricanes.   Some of the (excerpted) highlights include:

Watches and warnings for tropical storms and hurricanes along threatened coastal areas will be issued 12 hours earlier than in previous years.

  • Tropical storm watches will be issued when tropical storm conditions are possible along the coast within 48 hours.
  • Tropical storm warnings will be issued when those conditions are expected within 36 hours. Similar increases in lead-time will apply to hurricane watches and warnings.

 

The Saffir-Simpson Hurricane Wind Scale will become operational.  The scale keeps the same wind speed ranges as  the original Saffir-Simpson Scale for each of the five hurricane categories, but no longer ties specific storm surge and flooding effects to each category.

 

The size of the tropical cyclone forecast cone will be adjusted.

 

The cone represents the probable track of the center of a tropical cyclone, and is formed by enclosing the area swept out by a set of imaginary circles placed along the forecast track (at 12, 24, 36 hours, etc.).  The size of each circle is set so that two-thirds of historical official forecast errors over a 5-year sample fall within the circle.

 

The circle radii defining the cones in 2010 for the Atlantic and eastern North Pacific basins are given in the table below.

 

image

 

 

The second official information source you should have bookmarked is you local Office of Emergency Management.  Here you’ll be able to access local warnings, flood maps and evacuation information.

 

To find it, you can Google or Yahoo search with your county/parish name and the words `Emergency Management’.   Below you’ll find a screenshot of the entry page to my county’s page.

 

image

 

If you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadydotGov.

 

The NOAA’s NWS National Hurricane Center in Miami also has a Facebook page, where you can keep up with the latest tropical developments.

 

image

 

For those who like to look at satellite imagery (and who doesn’t?), you’ll find a treasure trove of continually updated photos and movie loops at NOAA’s Satellite Imagery page.

image

 

 

Beyond the official channels there are resources for those who wish to follow these storm more closely, to participate in online discussions, or who would like independent assessments of storm tracks or movement.

 

These are not substitutes for the National Hurricane Center’s forecasts or your local office of Emergency Management advisories.

 

And while some of these sites have some very talented and knowledgeable amateur meteorologists, until you know the players and their track records, you really don’t know who is worth listening to, and who isn’t.

 

You can learn a lot from the online Hurricane discussion forums, but Caveat Lector when it comes to forecasts and predictions.

 

The first stop on the unofficial tour is Weather Underground’s Tropical weather page.  This is an extremely comprehensive website, and a good source of global weather information. Here you’ll alos find Dr. Jeff Masters (a co-founder of Weather Underground), who writes his well respected WunderBlog.

 

For those who like to `look under the hood’, my hometown (Tampa Bay) Fox TV station has a terrific hurricane page, with access to numerous (animated) hurricane forecast models.

 

For hurricane geeks, this is about as close to weather nirvana as you can get.

 

image

 

 

While there are dozens of other hurricane resource and tracking/discussion sites out there, I’ll just mention a couple I’ve used in the past.

 

First is Hurricane City, which has been around since 1997, and boasts an active discussion board, up-to-date NHC advisories, and frequent live video broadcasts during the hurricane season via their hurricane TV  channel.

 

And then there’s storm chaser Mark Sudduth’s Hurricanetrack.com, which also features live video, often from inside the storm.

 

Both of these sites have free access and paid subscription access levels. I offer these as examples of a genre, but without specific recommendation. Their usefulness to you will depend, quite frankly, upon your level of hurricane geekiness.  They aren’t for everyone.

 

As hurricane season ramps up, you can expect a fair amount of coverage in this blog as well. 

 

When a storm threatens a specific region of the coast, I’ll try to provide local resources that you can monitor including radio, TV, and emergency service scanner feeds.

 

In the meantime, now is the time to get your disaster preparations in order.  Here is some of the information provided by the National Hurricane Center on preparedness.

Be Prepared

“Preventing the loss of life and minimizing the damage to property from hurricanes are responsibilities that are shared by all

.”

Hurricane Season: Are You </p>
<p>Prepared?Throughout this Web site, information has been provided regarding actions that you can take based on specific hurricane hazards. The most important thing that you can do is to be informed and prepared. Disaster prevention includes both being prepared as well as reducing damages (mitigation).

Disaster Prevention should include:

[Crof's H5N1] Indonesia: Suspected H5N1 family cluster

Posted by Automator On June - 18 - 2011

Via Ida’s Bird Flu Information Corner, a translated report from Harian HaluanAgam, West Sumatera ::: A family treated of bird flu suspicion.

A family, E (43 years old) and his children, Adi (14), Gilang Ramadhan (9) and Nuzuli (5.5), from Jorong Koto Panjang Nagari Kapau, Kecamatan Tilatang Kamang, Agam, suspected of contracting bird flu H5N1 after the family’s chickens had suddenly died since Friday last week. 

The family started to feel sick and to have high fever since Monday. A sample of dead chickens was tested positive bird flu infection. 

The family has been referred to Adam Malik hospital in Bukittinggi for medical examination.

If confirmed, this will be the first Indonesian family cluster I can recall since the Ginting family in the spring of 2006.

[Avian Flu Diary] SHEA: Improving HCW Flu Vaccine Uptake

Posted by Automator On June - 18 - 2011

(Fri, 17 Jun 2011 13:29:00 +0000)

 

 

# 5635

 

 

Hospital acquired infections are the bane of modern health care, with MRSA, C. Diff, garden variety staph, various pneumonias, and other infections estimated to cost tens of thousands of lives and add billions of dollars to healthcare costs each year. 

 

And while we tend to think of bacterial infections in this context most of the time, every year there are legitimate concerns over the spread of influenza in healthcare facilities as well.

 

These concerns have sparked repeated calls for mandatory yearly vaccination of HCWs (Health Care Workers) against the flu.

 

A few recent blogs on that contentious subject include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs
AAP: Recommends Mandatory Flu Vaccinations For HCWs
SHEA: Mandatory Vaccination Of Health Care Workers
IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

 

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

In recent years a few large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

However, it is possible to achieve high vaccination rates without mandating vaccination, as the following article published in the current edition of Infection Control and Hospital Epidemiology points out.

 

An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

 

image

 

Although full access to the article is available only to SHEA members (the first page is available to all), the Society for Healthcare Epidemiology in America has published a press release with the details.

 

Society for Healthcare Epidemiology of America

Health system achieves high flu vaccination rates by mandating masking

CHICAGO (June 15, 2011) – Geisinger Health System vaccinated more than 92% of all employees against influenza this season, with a modification of a mandatory program. On average, fewer than half of all healthcare workers receive flu vaccinations.

 

In an article published in July’s Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, Dr. Lisa Esolen demonstrated the effectiveness of Geisinger’s influenza vaccination that helped achieve high rates of vaccine compliance for two consecutive years. This past season, 2010-2011, Geisinger had vaccinated 95% of clinical employees and 92% of all employees by mid-December. Since hospitals continue to release vaccine until the end of March, final vaccination rates were not known at that the time of this publication.

 

“Influenza vaccination rates among hospital employees has received extensive attention in recent years,” said Lisa Esolen, MD, Systems Director, Infection Control Geisinger Health System “Healthcare workers are critical to limiting the spread of influenza since they are exposed to numerous sick patients and can readily spread the infection from patient to patient.”

 

To increase vaccination rates among staff, some hospitals have embraced a mandatory approach – get vaccinated or lose your job. However, Geisinger Health System chose a slightly different approach. The 14,000-employee system decided to allow staff members to opt out of receiving the flu vaccine for ethical or medical reasons, but required that those who did opt out would need to wear a facemask for the entire flu season, extending from November 1 to March 31. All vaccinated employees were known by a campaign sticker placed on their identification badge – no sticker meant the employee needed to wear a mask whenever they were within five or six feet of any other person throughout the entire day.

 

“We’re proud of the success we had and the team building it inspired, encouraging each unit to act as a team to achieve full vaccination.” said Dr. Esolen.

 

 

This idea is one I actually wrote about (and advocated) during the pandemic as being a reasonable compromise to mandatory vaccination (see Public Support For Mandatory HCW Vaccination).

 

Although some HCWs may consider wearing a mask as onerous, they should help reduce in-hospital influenza transmission, while being a considerably less draconian solution than mandating employees either accept the flu vaccine or risk losing their jobs.

 

It’s not a perfect solution (neither are vaccines, btw), but compromises rarely are. 

[Avian Flu Diary] Watching Indonesia Again

Posted by Automator On June - 18 - 2011

(Fri, 17 Jun 2011 11:39:00 +0000)

 

 

# 5634

 

image

 

Thanks go to Ida at the Bird Flu Information Corner – a joint project of Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – for this report from the Indonesian media on a family in West Sumatra suspected of H5N1 infection.

 

 

Agam, West Sumatera ::: A family treated of bird flu suspicion

Posted by Ida on June 17, 2011

Agam – A family, E (43 years old) and his children, Adi (14), Gilang Ramadhan (9) and Nuzuli (5.5), from Jorong Koto Panjang Nagari Kapau, Kecamatan Tilatang Kamang, Agam, suspected of contracting bird flu H5N1 after the family’s chickens had suddenly died since Friday last week. The family started to feel sick and to have high fever since Monday. A sample of dead chickens was tested positive bird flu infection.

 

The family has been referred to Adam Malik hospital in Bukittinggi for medical examination.

 

 

The original media report indicated that 7 chickens kept as family pets began to die about a week ago, and since then the family has experienced recurrent high fevers. 

 

There are a number of other illnesses common to Indonesia that could produce similar symptoms - including seasonal influenza and dengue fever – and so their diagnosis at this time is anything but certain.

 

Until we get laboratory confirmation, these are simply `suspected cases’.

 

Unfortunately, all too often, we never get a follow up on these cases that are reported in the media.

 

 

For several years the Indonesian MOH (Ministry of Health) has been slow to provide details about human cases and has refused to share viral samples with the World Health Organization.

 

Since former Minister of Health Supari was replaced by Dr. Endang Rahayu Sedyaningsih in 2009, we’ve seen some subtle signs of greater transparency. And recently an agreement was reached on the sharing of viral samples (see WHO Announcement On Framework For Virus Sharing). 

 

Hopeful signs.

 

Although we continue to see isolated human infections in Indonesia, Egypt, and around the world - for now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

[Avian Flu Diary] PPEs & Transocular Influenza Transmission

Posted by Automator On June - 18 - 2011

(Thu, 16 Jun 2011 14:19:00 +0000)

 

 

 

 

image

Photo Credit PHIL (Public Health Image Library)

 

 

# 5633

 

Constant readers of this blog are aware that over the past several years we’ve seen many differing studies on the  effectiveness of different types of  PPEs (Personal Protective Equipment) in protecting against influenza.

 

image

 

Ideally, the well-protected HCW (Health Care Worker) working in an infectious environment would be wearing an N95 mask, gloves, gown and eye protection.

 

But during the opening months of the 2009 pandemic, it became glaringly obvious that our world faced a shortage of PPEs, and so strategies were adopted to maximize their use.

 

In some cases nurses were issued only one N95 mask to be used for an entire 8 hour shift, and told to don it only when in direct contact with a potentially infected patient.

 

In other venues, HCWs were issued surgical masks in lieu of N95s, despite the recommendation at the time from the CDC that N95 masks were the preferred level of protection.

 

This, as you might imagine, raised concerns among health care workers and sparked protests across the country.

 

Nurses Protest Lack Of PPE’s
Report: Nurses File Complaint Over Lack Of PPE
California Nurses Association Statement On Lack Of PPE

 

 

Fortunately, the virulence of the novel 2009 H1N1 virus was less than originally feared. Had the pandemic carried a higher mortality and morbidity rate, the lack of PPEs would have become a much bigger issue.

 

 

For decades, the assumption was that only properly fitted N95 masks protected the wearer, and that surgical masks were only worn by HCWs to protect the patient during invasive procedures.

 

image image

N-95 Respirator         Surgical Facemask

 

But over the past two years we’ve seen dueling studies that alternately show surgical masks to be a reasonable protective barrier against respiratory viruses  . . . or pretty much useless.

 

Take your pick.

 

A few highlights of these conflicting reports include:

 

In October of 2009 the NEJM published a perspective article (see NEJM Perspective: Respiratory Protection For HCWs) based on a 2009 IOM evaluation of surgical masks vs. respirators, and came out in favor of the N95.

 

A few days later JAMA (Journal of the American Medical Association) published a study which reported that HCWs using surgical masks experienced `noninferior rates of laboratory-confirmed influenza.

 

In March of 2010, we saw the following study (see Study: Efficacy of Facemasks Vs. Respirators) in Clinical Infectious Diseases, that suggested that surgical masks are just as effective as respirators in protecting HCWs.

 

In guidance, updated as late as March of 2010, the CDC continued to recommend N95 respirators for HCWs who came in close contact with suspected or confirmed influenza patients.

 

But in June of 2010, the CDC proposed new guidance that relaxed those recommendations to using surgical masks for routine care, and reserving N95 masks for aerosol producing procedures (intubation, suctioning, etc).

 

Still, the controversy remains. 

 

Adding to the confusion, we’ve seen recent studies that give more credence to the notion that influenza may be spread in aerosolized form (see Study: Aerosolized Transmission Of Influenza), as opposed to primarily by large droplets. 

 

But the truth is, our knowledge of how influenza spreads, and what barriers work well to protect HCWs, is severely limited.

 

Which is why a few months back the IOM (Institute of Medicine) released, through the National Academies Press, an extensive, 200+ page update on the use of PPEs  that essentially calls for better science on which to base our decisions regarding the right kind of protection for HCWs.

 

While the requisite knowledge won’t come overnight, today we have an ingenious piece of research that appears in the current issue of the IDSA’s  Journal of Infectious Diseases

 

Not only does it compare the efficacy of surgical masks verses N95s, it  gives us important new perspectives on the importance of eye protection against the influenza virus.

 

First the link, then I’ll return with a brief summary of what they found.

 

Transocular Entry of Seasonal Influenza–Attenuated Virus Aerosols and the Efficacy of N95 Respirators, Surgical Masks, and Eye Protection in Humans

Werner E. Bischoff, Tanya Reid, Gregory B. Russell and Timothy R. Peters

 

 

Finding safe and ethical ways to test the effectiveness of PPEs against influenza – when exposing test subjects to a virus could endanger their health – has always been a challenge.

Instead, researchers at Wake Forrest chose to expose 28 volunteers (divided into six groups) for 20 minutes to an aerosolized LAIV (Live Attenuated Influenza Vaccine) in a special air-tight chamber.

The six groups were:

 

  1. No protective equipment
  2. Ocular exposure only
  3. Surgical mask only
  4. Surgical mask plus eye protection
  5. Fit-tested N-95 only
  6. Fit-tested N-95 plus eye protection

 

 

While the study size was small, and the type of virus limited to 2 influenza A strains and 1 influenza B strain (MedImmune’s 2009/10 seasonal Flumist), the study yielded some very interesting results.

 

Researchers detected flu virus in all 4 subjects in Group 1 (unprotected), and in 3 of 4 in Group 2 (Ocular Exposure only).

 

Somewhat surprisingly, nasal washes of subjects with ocular exposure only were positive for flu virus within 30 minutes, suggesting the virus made its way rapidly to the nasopharynx by way of the nasolacrimal duct.

 

Flu virus was detected in all 10 volunteers who wore surgical masks (groups 3 & 4), regardless of eye protection.

 

N95 wearers (group 5) fared somewhat better, with 3 of 5 testing positive for the virus.

 

The best result came from the wearing of eye protection and an N95 (group 6). 

 

Only 1 in 5 subjects wearing that combination of protection showed detectable levels of virus.

 

 

The authors conclude:

 

“The eyes could be an entry route for influenza, allowing viral particles easy and fast access to the upper respiratory tract.

The type of surgical mask tested was inferior to a fit-tested N95 respirator in preventing aerosol delivery; however, none of the tested barrier precautions provided complete protection, including a CDC-recommended fit-tested N95 respirator and the addition of eye protection.”

 

This study – like all laboratory research – is subject to certain limitations. The results, while compelling, aren’t definitive.

 

The size of the study – 28 test subjects –was fairly small, and the substitution of a live influenza virus with an LAIV could have potentially skewed the results.

 

More research will be needed to confirm these findings.

 

Meanwhile, conflicting opinions regarding the efficacy of various types of respiratory PPEs will likely continue while we await further studies.

[Crof's H5N1] Egypt: Five new human H5N1 cases, three deaths

Posted by Automator On June - 18 - 2011

Thanks to Mike Coston at Avian Flu Diary for alerting me to this new report from WHO: Avian influenza - situation in Egypt - update 53. Excerpt:

The Ministry of Health of Egypt has notified WHO of five cases of human infection with avian influenza A (H5N1) virus. 

The first case is a 40 years old female from Aswan District, Aswan Governorate. She developed symptoms on 14 May, and was hospitalized. She completed the course of oseltamivir, recovered and was discharged. 

The second case is a 21 years old pregnant female from Ashmoun District, Menofia Governorate. She developed symptoms on 21 May, was hospitalized and received oseltamivir. She died on 29 May. 

The third case is a 31 years old male from Shobra Elkhima District, Qaliobia Governorate. He developed symptoms on 21 May, was hospitalized and received oseltamivir. He died on 5 June. 

The fourth case is a 32 years old male from Elzawya District, Cairo Governorate. He developed symptoms on 23 May was hospitalized and received oseltamivir. He died on 2 June. 

The fifth case is a 16 years old male from Ashmoon District, Menofia Governorate. He developed symptoms on 21 May was hospitalized and received oseltamivir. He was in a critical condition but he is recovering. 

Investigations into the source of infection indicate that all the cases had exposure to poultry suspected to have avian influenza.