Wednesday, January 09, 2008

January 8 Flu Update

5% of poultry in Vietnam has bird flu infection. If accurate, this gives us an excellent stake in the ground in terms of where we stand.

Kebbi, Nigeria, has a local bird flu publicity committee.

Haiti has banned bird imports from the Dominican Republic because H5N2 is present there. I mention this only to show the kinds of things we could easily see during a pandemic, and how--in fact--illogical it could be, since it is highly likely that H5N2 is all over that island.

CIDRAP has an interesting study---live operators make a difference in reporting urgent disease matters to health departments.

There is going to be a session on influenza pandemic at the JP Morgan Healthcare conference, going on now.

Bird flu and the immunocompromised.....


At 6:17 PM, Blogger Wulfgang said...


Your first article about an estimated 5% of the poultry in Vietnam being infected with the H5N1 virus, does not seem on the surface to be significant, but I believe this vaccination “gap” is worthy of concern. Especially since the 5% appears to be pervasive throughout the entire geographical area of the country. A gap this sizable seems to indicate an undesirable condition, such as one of the following: the virus has perhaps mutated to such an extent to render the administered vaccine ineffective; or, in fact several different sub-strains of the virus are in circulation; or, defective poultry vaccination procedures. Would we view an estimated 5% infection rate in humans as “successful” ? Doubtful.

Regarding your CIDRAP study which arrives at the conclusion that “live operators are key to disease hotline success”, I believe there are also more important facets of this situation that are worth mentioning. For example, process improvement of “hotline systems”, will only effective if accountability is injected into the flow of information. Humans in the reporting system are essential, but I would think that they also need to concentrate on establishing and responding to state and federal guidelines, lines of authorities and responsibilities, reporting criteria, recognized benchmarks of “success”, as well as incentives and penalties. The key to any successful improvement is to identify the appropriate expectations and outcomes, along with communication and leadership.

Your article on the “immunocompromised human dilemma” that we would face during a pandemic is more than a “challenge” in my mind, it could well be one of the hidden catastrophe’s that very few people, other than physicians, have even given any thought to. This also raises other moral and ethical issues and questions along these same lines: who should have priority and access to antivirals and vaccines during an influenza pandemic, or for that matter, during any outbreak of a highly pathogenic and communicable disease ? For example, along with the high number of immunocompromised, there are also: age considerations (old, assisted living versus young infants), social problems cases (incarcerated criminals, mentally ill, drug addicted, homeless), and even economic and political considerations (the impoverished in need versus the wealthy).

If the truth were told, I suspect there is a wide disparity in the priorities and plans for these types of individuals across all 50 states. In addition, if the medical priorities are not resolved before hand, then it only guarantees additional pressures and unreasonable demands on our entire health care system in the US during a time of national medical emergency.

The only solution in my mind is to make the necessary investment in antivirals and vaccines, so they are available to everyone. However, we know that is not going to happen in the near future, due to a variety of reasons. It is estimated that there are over 100M weapons in the hands of people in the US at the current time…in fact, when you add this to the summative equation of the immunocompromised and ill-defined medical priorities, this could result in a very volatile situation that might result in much more dangerous situation than the virus itself.



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