Saturday, December 02, 2006

December 1 Flu Update

In Thailand, officials are considering whether to take the controversial step of vaccinating poultry against the flu.

Canada has issued a warning about Tamiflu, blogged here by Revere. Note MSM screwing up vaccine/anti-viral distinction in headlines, and Revere's own practice on Tamiflu (which matches mine).

The EU has extended its ban on importing birds for 3 additional months.

South Korea says it dealt well with bird flu...but North Korea would be another story.

ProMed on WHO guidelines for diagnosing bird flu. Mod comment says that the guidelines are in response to concerns raised in those NEJM articles on missed cases.

Excellent article on vaccine labs gearing up to fight the bird flu.

The animal husbandry industry lost $2B due to bird flu, according to a report.

CIDRAP on the Canadian triage plan to allocate ventilators.

The inclusion criteria identify patients who may benefit from critical care treatment, focusing on respiratory failure.

Exclusion criteria place patients in three different categories: those who have a poor prognosis despite critical care, those whose care demands resources that can't be provided during a pandemic, and those who have underlying advanced medical conditions such as malignant cancer or end-stage organ failure that complicates their critical influenza status.

The authors write that they struggled with the decision to put an age cutoff in the plan's exclusion criteria. They did not include one in their original protocol draft because they claim age may not strongly predict critical care outcomes. "However, we received strong and consistent feedback from both expert and stakeholder consultations that an age criterion should be included," they wrote. Age above 85 is listed among the exclusion criteria, but the authors suggest that the topic of age cutoff requires more research and community input.

The "minimum qualifications for survival" component attempts to place a limit on the resources used for any one patient. "This is a concept foreign to many medical systems in developed countries but one that has been used in war zones and refugee camps," the authors write. In the triage protocol, patients are reassessed at 48 and 120 hours to identify early those who are improving and those likely to have a poor outcome.

Lame Duck Governor (flu humor) Bob Taft held a pandemic exercise in Ohio.

Stars and Stripes says to be aware, not worried.

Nice story from the Central Michigan student paper--A professor and student are studying water, sediment and feces in migratory pathways for bird flu.

There is now a website that has information on wild bird surveillance.

Officials in North Dakota are conducting bird flu surveillance.

The American Public Health Association has a seasonal flu blog...and in this post they answer the question of whether the flu shot will protect against bird flu.

A UN map on the bird flu.


At 12:01 PM, Blogger Wulfgang said...


Lots of news to chew on today.

The most interesting and optimistic is the San Francisco article about the numerous U.S. drug companies ramping up to rapidly manufacture a pandemic vaccine. I absolutely agree with the viewpoint of Michael Osterholm, "... the government should put the cell culture program on overdrive... we keep assuming we have this unlimited amount of time". Mike,there are other very excellent reasons we need to turn on a 24X7 around-the-clock effort: currently we are dangerously dependent on other countries for our flu vaccines. This is more than a health issue, this is a national security issue. If a pandemic broke out next year, we have no assurance the foreign avian pandemic vaccines will be safeguarded, or even delivered for that matter. They might not even reach the U.S. In an national emergency, we wouldn't even be know where the vaccines would be subcontracted out to (Croatia? Give me a break, please, they have too many Gypsies). Finally there is a quality question - if we rely on foreign sources for a pandemic vaccine, there is no guarantee it will meet standards required for effectiveness. I guess developing a full manufacturing capability to innoculate 300M people within 6 months of an outbreak is great news text spin, but if there is no viable targeted schedule with achievable milestones to meet this objective, then we might as well be whistling Dixie. The years 2009 - 2012 mentioned in the article seem pretty far off to this old blogster. Good article, nice first step, but we ain't even close to where we need to be. Any nation in the world that job-shops its vaccine production capability out to third world countries, should insist that its leaders undergo electro shock therapy on their brains.

Now then, the CIDRAP article on triage plans, the use of severity scoring systems, priortization and categories of patients, and "minimum qualifications for survival". Very interesting and fascinating indeed. But I'm a pretty fundamental person about these things. I wonder what paragraph in the triage guidelines manual the physicians and nurses are going to refer to when the first person pulls out an "equalizer" and insists that little Suzie and auntie Deloris be treated ?

Now that's might be a real bioethical challenge that academia should consider.


At 3:08 PM, Anonymous wayne said...

To me the article in the San Francisco Times was interesting but I did not find it all that optimistic.Companies that produce vaccines are working hard to produce thes drugs but it was also stated in the article that at any time these companies would also have to start from scratch to produce a new vaccine when the virus mutates and according to Michael Osterholm it is mutating often and he says that we caqnnot assume that we have unlimited time.
The posts lately in Recombinetics lately on the clusters forming in Egypt the virus appeare to be changing fairly rapidly into a form which makes it easier to pass between humans.
Then again wulfgang perhaps this is a case where you see the glass half full and I see it half empty.

At 5:28 PM, Blogger Orange said...

The work on cell-based vaccine manufacturing is important....because we might not get a pandemic strain of H5N1, and if we do it might be years. It might not--but it might. And, a vaccine that was less than a perfect match could still provide protection--either full, or partial. In a pandemic, even partial protection would make a big difference as we tried to buy time until a perfectly matched vaccine was available.

This is all to say that these are necessary steps that do not change the fact that as the sun sets on what was a stunning winter day, we remain in big trouble.

At 8:53 PM, Blogger Wulfgang said...


I share both your and Orange’s concerns, perhaps even more so, for many reasons. Basically, it is my personal belief that the H5N1 virus will mutate and cross over and assimilate into one of the prevailing flu strains around the world. I think it will do this sometime in the next 36 months, perhaps sooner, maybe later, but nevertheless, the handwriting is on the wall. It is unstoppable. Try to inoculate all the chickens in the world, it doesn’t matter, the world's a giant mixing bowl of other potential suitable vectors. The critical question in my mind is that if the virus mutates and we have full-up H2H transmission in the near 36 month term, we are hosed. The facts are and remain that we cannot at present rapidly manufacture our own pandemic vaccine. We as a country are supremely vulnerable until this capability matures.

I have the highest regard for Dr. Osterholm and his viewpoints, and do not think he is over reacting at all by his constant warning statements. I do not personally know him, but I work with a few highly professional individuals who do, and they are mainly in agreement with his comments and concerns. The sixty four thousand dollar question in all of our minds is how severe the next pandemic will be, not that it won't happen. Nobody knows, but the Big Guy in the blue sky. In a mild to moderate outbreak, everything is manageable – no major worries, only minor inconveniences. However, anything equal to or greater than the 2.5% 1918/1919 estimated fatality rate and “big trouble” begins to unfold in exponential proportions, rapidly, as the breakdowns, panic and fear occur. I lived through the 50’s and 60’s mild epidemics, and fell quite ill both times. My grandfather also caught the flu during WWI and told me stories about it when I was a little boy. Maybe somebody ought to use my blood as a potential vaccine – it might contain some pretty high octane against H5N1 and all the other nasty flu types. I could be worth a lot money and not even know it.

Finally the bummer… during a pandemic, the first stored avian type flu vaccine (regardless if it’s a matched type) goes to the armed forces, first responders, medical personnel and other essential personnel – this is to say the general public is at the back of the bus, if they even have a chance to get on it.



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