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This is a great article in today's Globe from health reporter Stephen Smith. Please give it a look.
This is a great article in today's Globe from health reporter Stephen Smith. Please give it a look.
Harvard's public health pollster, Bob Blendon, released his latest survey a few days ago. The results confirm what is pretty obvious, that two-thirds of parents are frustrated about their search for an H1N1 vaccine for themselves or their kids. The good news for public health officials is that 91% say that they will try again to get the vaccine as more becomes available. Hopefully the search will start to get a bit easier in the weeks ahead. The Massachusetts Department of Public Health (DPH) reports that about 660,000 doses of H1N1 vaccine has now been shipped to the state. While that represents only a small percentage of what was expected by now, it's about double the amount that we had just a couple of weeks ago.
There's a chance that a large portion of the vaccine will arrive after the peak of the current wave of illness (although based on the latest information from Mass. DPH we haven't reached the peak yet). However, even if much of it did arrive after the peak, it would still be worth getting vaccinated. It's a long flu season and we're just beginning ours here in New England. There could also be a third wave of illness after the first of the year -- during what is normally our peak flu period.
At at press briefing today, Dr. Anthony Fauchi, the Director of NIH, reported on the latest data from clinical trials for the H1N1 vaccine. The good news is that the latest data confirm that pregnant women have a very good immune response after only one (injectable) dose of 2009 H1N1 vaccine. This confirms the guidelines for vaccination for this high risk group -- 28 pregnant women have died of complications from H1N1 flu since the virus first started spreading in the U.S. last April. Dr. Fauchi also confirmed clinical trial data that demostrate that childeren 6 months to 9 years of age will still need two shots to achieve a robust an immune response.
There are still no major safety "red flags" with regard to serious adverse events from people who've been vaccinated. The side effects that have been reported are minor, e.g., pain and swelling at the injection site. Officials also said that they believe the gap between vaccine supply and demand will narrow in the coming weeks as more vaccine is shipped to the states.
Here's the video of today's briefing:
Good morning and happy Monday. In case you missed it yesterday, there was an excellent segment on the H1N1 vaccine production process on 60 Minutes last night. I have embedded video of the segment below. Also yesterday on Face the Nation, White House advisor David Axelrod said that "in very short order" vaccine supply would meet up with demand.
Finally, there is a good piece in today's Washington Post about what it is like to be on the receiving end of all of the frustrationsurrounding the public's hunt for H1N1 vaccine. The Post recounts the challenges faced by staff and clinicians at a busy pediatric practice in No. Virginia.
In his weekly update on H1N1 flu activity, CDC Director Tom Frieden said that the nation is seeing "more virus, more vaccine and more treatment." While some areas, like the Southeastern part of the United States, are seeing a drop in flu-like illnesses places like Massachusetts are seeing an increase in cases.
Surveillance data released today by the Massachusetts Department of Public Health shows that the level influenza-like illness in our state has quickly reached levels normally seen at the peak of flu season in February -- the highest level of flu activity we've seen this early in years. It appears from the data that the Eastern MA communities that form a ring around the city of Boston are the areas experiencing the largest increases right now. The flu situation can vary by area of the state as we saw in the spring outbreak when Suffolk and Middlesex Counties were harder hit than other areas of the state.
You can find DPH's weekly flu surveillance report here: Download DPH Flu Rept-10-29. I noted the areas on two charts which represent the latest data points -- one tracking outpatient office visits flu-like visits and the other tracking ER visits.
In response to a question from Stephen Smith of the Boston Globe, Dr. Frieden said that the intense communication effort around H1N1 flu may be a contributing factor in more people seeking care for an illness that they might not have sought care for in past flu seasons. That, in turn can contribute to the increased numbers reflected in the surveillance data. However, he also noted that elsewhere in the country that rates of hospitalizations were on the rise and that such data are less sensitive to external influences like a large amount of media coverage. So, it seems to be a mix; more illness in the community certainly, but also more people aware of the current H1N1 flu situation and accessing care which they might not have in past years.
One bit of good news is that the amount of vaccine shipped to the state increased pretty significantly according to CDC figures. It looks as though the number of shipped doses jumped to about 404,000 from 269,000 the previous week. Still short of where we want to be, but hopefully increased shipments will be a continuing trend.
With all the talk about vaccine, it seems that some of the basic messages around prevention have been lost. Here are the simple ways we can all help reduce the spread of flu in our communities:
Good morning. Antiviral medications prescribed to fight the flu are in the news today. Much of the coverage was prompted by the announcement yesterday by the CDC about reports of spot shortages of the liquid from of Oseltamivir (Tamiflu), the formulation that is most often prescribed for children. It has been known for some time that quantities of the liquid form of the drug were in limited supply -- there was a similar shortage around the country in during the spring wave of H1N1. The liquid form of the drug is more expensive and time consuming to produce so, according the the Washington Post, the manufacturer, Roche Pharmaceuticals, and federal government officials decided early on to focus production on the capsule form of the drug to maximize the quantities that could be produced. The CDC has developed guidance for parents on how to open the capsule and mix the medicine with liquid if their child cannot swallow a capsule.
Antivirals can be an important tool to help treat people who are severely ill with the flu, and the CDC's recommendations are that only those people who are very sick, hospitalized or at risk of serious complications from the flu (folks with chronic health conditions and pregnant women) should be given the drug. The federal guidance does not call for wide-scale prescribing of the drug to prevent the flu, or for personal stockpiling. The fear is that if the drug is overused, used incorrectly or prescribed inappropriately that the flu can become resistant to the drug's effect -- something that can happen very quickly -- making the medicine useless in efforts to treat people with the flu. That fear is not unfounded; there are whole categories of antiviral medications that used to be "front-line drugs" to fight the flu that are no longer used because resistance has rendered them ineffective against the illness.
It is against that backdrop that Boston Globe health reporter Liz Kowalczyk has a report in today's paper about a prestigious law firm that that has arranged for it's employees to receive a prescriptions for Tamiflu even before they are sick. While the company was likely well-meaning, this is a troublesome precedent that could -- if adopted on a wide-scale -- negatively impact public health.
As suggested in the title of this post, antiviral medication's are not "magic pills" that can cure the flu. While they can reduce the severity of symptoms, and the duration of illness by 1 or 2 days, they are not without their side effects, and to be most effective should be taken within 48 hours of onset of symptoms. Given that most people don't seek care early in the course of flu illness, the latter can often be a problem with respect to accessing the medication during that window of high-effectiveness.
If you or someone you care for falls into one of the "high risk" categories for flu, call your doctor or health care provider and develop a plan for how you will be quickly evaluated for possible treatment with antivirals should you develop flu-like illness. Most people will not need antiviral treatment to get well, but for high risk patients it is important to get evaluated and treated quickly.
The CDC will be updating the national flu situation today at 1:30 p.m., and we also expect Mass. DPH to issue its weekly report on the flu in Massachusetts today as well. Yesterday CDC released a report which estimated that that between 1.8 and 5.7 million people were sickened with H1N1 flu during last spring's wave of the illness.
Posted by Tom Lyons
The Digital Pitch
BENEATH ALL of the anger and frustration surrounding the current flu vaccine supply problem is a simple fact - as we gear up to fight a new flu strain in our first pandemic winter in 40 years, we employ a really old technology to make flu vaccines. The nation needs to find a better option.
Good morning. Here's an op/ed in today's Boston Globe that I wrote regarding the way we make flu vaccines Download BosGlobeOpEd. Our ability to make vaccine more quickly has been a real limiting factor thus far in achieving our vaccination goals during this pandemic. Not only has that been frustrating for those seeking the vaccine, it's been frustrating -- and maddening -- for public health professionals and health care providers who've been working so hard to protect people since the virus was first discovered in the U.S. last April. We've made some progress in new vaccine technology, but we need to continue that commitment after this pandemic passes.
We were lucky to go 40 years between pandemics -- we may not be so lucky next time.
Thank you to the Globe for running this.
Posted by Tom Lyons
The Digital Pitch
Okay, maybe not so much. But, when I put my kid on the bus yesterday for school for the first time after a week of being out of with flu-like illness, I certainly felt like that father in the old Staples commercial.
After a few bad days early on, it was generally a mild course illness for her -- happy about that. In fact, toward the end of week it really became more of a pain due to the disruption it was causing in the normal schedule of life at home. In addition to being out of school, she couldn't play with her friends or cousins for a week -- which seems like an eternity for a kid. Trying to keep her a safe distance from her younger brother was a challenge in our small house. And, obviously, it caused my wife and I to have to juggle things in order to be home with her. We're lucky because I can do work from home -- an option that not a lot of people have.
Come last Sunday, she had met the requirements of the exclusion guidance, which is that she be without fever for at least 24 hours without the use of fever reducing medication. We decided to keep her out for one more day after that just to be safe, and then it was back to her life -- she's doing great.
Now for your viewing pleasure...
the paper's page one story on the Archdiocese of Boston's plan to change elements of its liturgy to prevent spread of the flu. Some are questioning this move as an overreaction, but I think it's a common sense prevention move -- especially given the delay in vaccine production. To our south, the New York Times has a story regarding the difficulty in distributing vaccine to those people who are on the high priority list. Local and state health officials and health care providers are usually the folks who enforce the CDC's recommendation for which people should get the much sought after shot -- an uncomfortable position to be in when there is a shortage of vaccine. And, the Washington Post has an interesting story this morning on a GAO report that says an increase in telecommuting and keeping kids home from school because of the pandemic could seriously bog down the Internet. (*Gasp*!)
Yesterday, CDC director Tom Frieden made news at his media update when he said that there would be a "perceived and real" increase in vaccine availability in the next week or two. You can see Dr. Frieden's press conference in its entirety by clicking here.
Have a good day and stay dry.
Dr. Anthony S. Fauci was talking with fellow federal officials in September, a month before swine flu vaccinations were to begin, when it became clear they had a bigger problem than they feared with supplies.
Oh my. This kind of story is really unfortunate to see right now. There's so much finger pointing going on in this article that it's hard to keep it straight. Feds are blaming feds; feds are blaming state and local officials, and the media; feds are blaming vaccine makers, and vaccine manufacturers are blaming the feds. Here's hoping that the "production problems" get resolved quickly and vaccine supplies begin to increase, so that everyone can get back to the much more important work of responding to this pandemic.
This story again points out the antiquated method by which we produce vaccines. We need to come up with better technology.
Below is a segment from a podcast in 2008 that I did while I was with the Massachusetts Department of Public Health. It's clip of Dr. Al DeMaria, the State Epidemiologist explaining how a flu vaccine is made. If you have a couple of minutes it's worth a listen.