Monday, March 10, 2008

March 10 Flu Update

CIDRAP outbreaks in India and Vietnam, as reported yesterday.

New reasons to worry for Calcutta.

Very interesting...China is saying it had 12 cases this year.....and calls situation "complicated." Read between the lines alert.

Today's best article. What did we learn for pandemic planning from this year's seasonal flu? Overcrowded ERs, vaccinated people getting sick....CIDRAP reports.

In the meantime, however, clinicians are concerned about the impression that the vaccine mismatch and the resulting flu cases will leave. Several times over the past decade, flu-vaccine problems—manufacturing problems, late vaccine delivery, an early-arriving season—have dented flu-vaccine uptake the following year.

"We will need to really clearly and plainly explain that each year, the experts make their best educated guess . . . and some years are spot-on and some years are a mismatch," said Dr. David Kimberlin, professor of pediatrics at the University of Alabama at Birmingham. "The burden is on the medical community to say that, if we do not have a complete match, you are still getting some protection, and it is better to have partial protection than none."

Some say this flu season has more lessons to teach. In Florida, emergency physician Ramirez—also a disaster-readiness consultant—ticked off the components: a significant flu-virus drift, a vaccine-manufacturing system that could not keep up, seriously ill patients, and an overwhelmed healthcare system.

"These are exactly the things we ought to be prepared for in an influenza pandemic, and we were not prepared," he said. "We ought to consider this flu season as a warning to healthcare and industry. This is a gunshot across our bow.


CIDRAP on another case in Egypt.

Bird flu back in West Bengal---must be smuggling.

Culling commences in West Bengal.

CIDRAP best practices---Kansas has tool to assess at-risk populations.

Japan eyes a mutation-proof flu vaccine.

Op-ED piece asks if Colorado is ready for a pandemic.

A wrong guess on the seasonal flu vaccine?


At 6:40 PM, Blogger Wulfgang said...


Interesting… China is suddenly reporting “12 bird flu cases” so far in 2008, but can only reconcile three documented instances. I guess one has the question the obvious: do they mean outbreaks in poultry cases, or human cases ? And of course, the warning words “more complicated epidemic control situation”, ah, what does that mean ? And, the whopping 5 billion milliliters of vaccine for immunization efforts: for poultry or humans ? (Note to self: if the vaccine is preparation for humans, they know something the rest of us don’t, but that wouldn’t be surprising).

Regarding the CIDRAP article about overcrowded emergency rooms and the ineffectiveness of the current seasonal flu vaccine, I really didn’t see any surprises or show stoppers in the article. Those of us in the really big cities have been watching the mini-crisis unfold for many weeks: emergency rooms over flowing with endless lines of sick people; some hospitals even refusing to admit or see patients and referring them to alternate sources; many people absent from work due to very severe upper respiratory infections; classrooms with as high as 50% absenteeism; and very sick relatives whose entire families have fallen ill with influenza.

In actuality, the influenza epidemic we are experiencing would just be the tip of the iceberg, compared to a full-fledged deadly pandemic. In my mind, the hospital administrators better multiply what they are seeing and experiencing by about a factor of 100-1,000 times, and stop focusing on cost-cutting measures and just-in-time-deliveries, if they want to fathom what a true pandemic would be like. Right now they all have about a few days "tipping point" before supplies run out. Sprinkle in a little thug violence and inner city panic in a few places, and you get the perfect recipe for a potential disaster in every large city in the nation with a population over 100,000.

And the HHS, CDC and FEMA think they are going to head off or curtail an influenza pandemic with a Tamiflu blanket in 48 hours and buy enough time, in order to develop a suitable vaccine in 6-9 months time, and roll it out to the public – dream on – we were no better prepared for 9/11 or Katrina or the Oklahoma City bombing. I hate to be the perpetual pessimist wet-blanket type, but anybody depending on the federal authorities to pass out Tamiflu and supply vaccines in time to make a difference, is going to be very sadly disappointed. The very best preparation any sane person can plan for, is reasonable “self isolation and/or quarantine", for a few weeks or a month or two, minimum (i.e. you limit your exposure to the pathogen).

There is a big lesson learned as result of the current seasonal flu epidemic that everyone should heed: it’s simple, avoid the public, wash and sanitize your hands, and avoid sick people. Those of us that practiced this simple approach didn’t get sick. For those sick and idiotic people who infected others by showing up for work ill, there is no excuse, it’s just plain ignorant and inconsiderate. (I had to send a few of those types home to avoid losing my entire workforce to illness).

The last comment I would like to make is regarding your CIDRAP article about Kansas launching their “online toolkit”, which theoretically identifies “at risk” or “vulnerable” or “special needs” members/segments of a communities, using the latest GIS technology. One thing I noticed: no mention of the most vulnerable group of all, the young people. The online toolkit approach sounds like a great idea on the surface, but without integration of school district and college closures (youngsters and teenagers are the absolute breeding grounds and rocket ship for transmissible diseases), they are going to miss the most vulnerable demographic of all. The H5N1 virus, just like the Great Pandemic of 1918, prefers young people. We will have to shut down our schools as soon as possible to slow the pandemic surge.

In my view, when it comes to either protecting nursing homes, prisons, homeless people, or our youth…the youth will always get my vote. Protect them first, please. They are our future.



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