Medical Rationing A Must For Severe Pandemic

September 1, 2009 by mimmson  
Filed under Flu Pandemic - Top News Stories

The closer an influenza patient is to death during a severe pandemic where medical resources would be scarce, the more likely they’ll be excluded from admission to an intensive care unit. That’s the recommendation from a task force studying ethical dilemmas during pandemics.

Months before the world was introduced to the swine flu, the S.C. Department of Health and Environmental Control commissioned a task force to take a look at the state’s preparedness plan for a severe influenza pandemic.

“We found (we) had more work to do, DHEC does, particularly in dealing with scarcity of medical resources in a pandemic,” said Dr. Phil Schneider, an emeritus bioethics professor at CCU and co-chair of the SC Pandemic Influenza Ethics Task Force.

“There’s no point in putting treatment into a patient who will not benefit from it. Tough thing to say, but that’s what we’re going to be faced with in a full-fledged pandemic,” Schneider said.

A key component of battling influenza is ventilators. As of June, there were 1,284 ventilators in hospitals across the state, according to the task force.

How those would be rationed during a severe pandemic where tens of thousands could possibly benefit from a ventilator is an “ethical” choice, and one where the task force is weighing in.

“The doctors will have to decide who the sickest people are and who are the people who have the best chance to survive,” Schneider said.

To determine who will receive critical care, specifically ventilators, the task force recommends hospitals implement the Sequential Organ Failure Assessment (SOFA) System, which rates a patient’s mortality risk.

Through a series of testing, the patient will be given a score between 0-24. The higher the score, generally higher than 11, the closer one is to death and less likely they’ll receive critical care, Schneider said.

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Swine Flu Vaccine Trial Seeks Volunteers

September 1, 2009 by mimmson  
Filed under Flu Pandemic - Top News Stories

Researchers at Stanford University School of Medicine are looking for healthy adults to test a new swine flu vaccine mixed with an ingredient that could boost people’s immune response.

Adding such a chemical adjuvant to the vaccine could help stretch limited supplies by making a single dose more potent, researchers believe. That’s important in the United States, where public health officials are expecting about 45 million doses of vaccine by mid-October – far fewer than the 120 million doses that had been expected.

“An adjuvant potentially allows us to use less vaccine, so we can spread the vaccine supply among a larger number of people,” said Dr. Corry Dekker, lead investigator of the Stanford study and medical director of the Stanford-Lucile Packard Children’s Hospital Vaccine Program.

Adjuvants have been used for years in flu vaccines in Europe and in several childhood vaccines in the United States. But they’ve never been added to the seasonal flu vaccine in the United States.

That’s partly because they’ve never been needed, vaccine experts said. The United States almost always has plenty of seasonal flu vaccine to give everyone who wants it, and the vaccine has been fairly effective with most people.

“People have not felt pressed to develop better vaccines,” said David Lewis, a Stanford infectious disease expert who is not involved with Dekker’s study. “But that’s not to say you couldn’t do better by adding an adjuvant.”

Because most people have no immunity to the swine flu – a form of influenza Type A, subtype H1N1 – researchers have assumed they would need two vaccine doses to gain immunity. An adjuvant might mean people only need one dose, or that they can get smaller dosages.

It’s not clear how adjuvants help boost the immune response to a vaccine. Scientists think adjuvants may stimulate different parts of the immune system and make them more responsive to the antigen in a vaccine.

The Stanford clinical trial, which is sponsored by the National Institutes for Health, is the first to test the swine flu vaccine in the Bay Area.

Stanford will be recruiting participants for the trial during the next two weeks. Researchers hope to begin screening participants the week after Labor Day and start immunizing people the week of Sept. 14.

About 130 people will be enrolled in the study. Participants will receive two doses of vaccine, spaced three weeks apart. They will be divided into groups based on age, the size of the vaccine dose and whether or not they get a vaccine with the adjuvant. It’s a double-blind study, so neither participants nor researchers will know how much vaccine subjects receive or whether they are given an adjuvant.

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Green Bay School Districts Prep For Swine Flu

September 1, 2009 by mimmson  
Filed under Flu Pandemic - National News

Students heading back to class Tuesday will be greeted with a continued emphasis on hygiene as school districts look to prevent or limit the instances of swine flu. Meanwhile, schools and health departments continue to prepare for a possible pandemic of the H1N1 virus, creating and bolstering contingency plans in case large numbers of students or teachers fall ill.

They can’t, however, prepare for a host of unknowns, including when and how a vaccine will be available and administered or the timing and severity of a possible pandemic.

The Green Bay School District has a 50-plus page pandemic plan designed to prepare officials as much as possible.

“I feel good about the things I can control,” said Barbara Dorff, director of student services for the Green Bay School District. “The things I don’t feel good about are the fact that they don’t have vaccine ready yet, and they’re not really sure when it should be ready. … We just don’t have all the answers yet.”

Other questions include how much vaccine will be available and how and where it will be distributed, said Judy Friederichs, director of the Brown County Health Department.

via School districts prep for swine flu pandemic | | Green Bay Press-Gazette.

Europe Braces for Swine Flu’s Potential

September 1, 2009 by mimmson  
Filed under Flu Pandemic - Top News Stories

As children across Europe go back to class and staff return from vacation, governments are keeping a watchful eye on the H1N1 virus and are preparing for possible vaccinations, home schooling and the prospect of widespread absenteeism.

For now, governments have resisted closing schools preemptively, judging that the virus has not yet reached the scale where such a move would be beneficial. But they have been circulating contingency plans for schools and companies — an approach broadly supported by health experts.

Simon Cauchemez, an epidemiologist at Imperial College London, said that evidence from the spread of the virus in past months in the southern hemisphere, where it has been winter and where he said the disease had been mild in most cases, showed that there was no reason to shut schools ahead of time.

“I think the view is that we don’t want this kind of intervention unless your health system really cannot cope,” he said, referring to school closures.

Localities should wait and see whether health care systems in specific areas were able to handle the volume of swine flu cases, he said. If the volume of cases began rising to unmanageable levels, only then might it be sound policy to shut schools, he said.

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Toronto – Bird Flu Fears Puts Couple In Isolation

March 19, 2008 by mimmson  
Filed under Flu Pandemic - World News

Fears a couple that just returned from Bangladesh could have avian flu are inaccurate, according to a Toronto hospital.

The elderly couple was admitted to Toronto East General Hospital Tuesday night after complaining of flu-like symptoms and apparently isolated.

However speculation that they could be suffering from a human form of the H5N1 virus is unfounded, the hospital said in a statement released Wednesday.

“Toronto East General Hospital (TEGH) is concerned about inaccurate media speculation and reporting regarding human cases of avian flu. TEGH has no reason to speculate that any patients in the hospital have avian flu,” the statement read.

“Furthermore, media reports are indicating that the individuals suspected to have avian flu had recently traveled to Bangladesh. It is important to clarify that, according to the World Health Network, there have been no reported human cases of H5N1 avian flu in Bangladesh.”

Officials did say they were dealing with an increased number of patients with seasonal flu-like symptoms.

They’re still waiting for test results to confirm what the couple is ailing from, but they insist bird flu is not a possibility.

The H5N1 virus spreads quickly and has a mortality rate as high as 70 per cent..

Health experts fear avian flu is the most likely source for the next pandemic.

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Indonesia: Rampant Bird Flu Raises Pandemic Risks

March 19, 2008 by mimmson  
Filed under Flu Pandemic - Top News Stories

Efforts to contain bird flu are failing in Indonesia, increasing the possibility that the virus may mutate into a deadlier form, the leading U.N. veterinary health body warned.

The H5N1 bird flu virus is entrenched in 31 of the countrys 33 provinces and will cause more human deaths, the U.N. Food and Agriculture Organization said in a statement released late Tuesday.

“I am deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic,” FAO Chief Veterinary Officer Joseph Domenech said.

Indonesia “has not succeeded in containing the spread of avian influenza,” Domenech said, adding that there must be “major human and financial resources, stronger political commitment and strengthened coordination.”

The H5N1 virus has killed at least 236 people in a dozen countries worldwide since it began ravaging poultry stocks across Asia in 2003. It has been found in birds in more than 60 countries, but Indonesia has recorded 105 deaths, almost half the global tally, according to the World Health Organization.

U.S. Flu Epidemic Rises

February 24, 2008 by mimmson  
Filed under Flu Pandemic - National News

The USA’s flu epidemic continued to grow last week, with cases mounting in every state and a dozen new deaths among children, the government’s leading flu expert said Friday.

Altogether 22 children have died of flu so far, with widespread flu activity reported in 49 states, up from 44 last week, says Nancy Cox, director of the Centers for Disease Control and Prevention influenza division. Only Florida is reporting regional flu activity for the week ending Feb. 16th, according to the CDC.

“Influenza activity has continued to increase, but not quite as dramatically as over the previous two weeks,” she said in her weekly flu update. “We’re within the normal parameters of what we’d expect for an influenza season.”


Some Vietnamese Suspectedly Infected With Bird Flu

February 24, 2008 by mimmson  
Filed under Flu Pandemic - Top News Stories

Vietnam’s Preventive Medicine and Environment Department has said some people hospitalized recently are suspected of having contracted bird flu, local newspaper Youth reported on Friday.

Specimens from the people, including a seven-year-old child from northern Hai Duong province, are being tested for bird flu virus strain H5N1. The child is under treatment at the National Hospital of Pediatrics in capital Hanoi.

To date, Vietnam has confirmed a total of 104 human cases of bird flu infections, including 50 fatalities, since the disease started to hit the country in December 2003.

In mid-February, two local people, a 27-year-old man from northern Ninh Binh province and a 41-year-old man from northern Hai Duong province, died from bird flu. On Jan. 18, a 32-year-old ethnic man from northern Tuyen Quang province died from the disease.

Last December, after detecting no human cases of bird flu infections for nearly four months, the Health Ministry confirmed that a four-year-old boy from northern Son La province died on Dec.16, 2007 from bird flu.


Bird Flu Alert For Human Infections Raised In India

February 24, 2008 by mimmson  
Filed under Flu Pandemic - Top News Stories

A week after lifting the ban on the sale of poultry products, the state government on Monday suddenly issued an alert on the spread of bird flu among human beings.

The health department has asked health officials to keep a watch on possible human contraction of the H5N1 virus. “We will have to be alert to prevent any such cases for the next three months,” an official said after attending a high-level meeting to assess the threat.

Health officials are extremely worried that cullers and civilians who helped out in the culling may have escaped the rigorous quarantine process. The condition of culling team members needs to be monitored very closely, doctors from all flu-hit districts suggested.

“All health officials have been instructed that if anyone comes to government healthcare centres with fever running for more than five days after having come in contact with a dead chicken, he/she should be put through all pathological tests for avian flu,” said Basab Mukherjee, a KMC executive health officer in charge of the Integrated Disease Surveillance Programme (IDSP) project in the city.

Mukherjee said the civic authorities would remain in close contact with all government hospitals and KMC health clinics for the next three months, as instructed by the state health department.

Though an alert has been sounded, the menu for the high level meeting, among other items, was egg curry. “Perhaps, it was an attempt to bring back confidence among doctors in the post flu period,” said an official who attended the meeting.


India Influenza Outbreak Portends Pandemic

January 30, 2008 by mimmson  
Filed under Flu Pandemic - Top News Stories

An epidemic of avian influenza in West Bengal, India has the Indian “government in panic mode”, according to the Times of India Web site.

And with good reason: 15 million of West Bengal’s 80 million people are crammed into its capital city, Kolkata (Calcutta), which is a petri dish of poverty, pollution, political intransigence and hopeless public health. It is the city where Mother Teresa founded the Missionaries of Charity order.

If the infection reaches Kolkata’s poultry markets, there is a much greater risk of animal-to-human transmission than there has been in Indonesia or Vietnam, where infections of H5N1 influenza have already crossed species from animals to humans.

There have been many more human infections of highly-pathogenic influenza in Indonesia (120 cases, 98 deaths) and Vietnam (102 cases, 48 deaths) than in India. There were three outbreaks of avian influenza in India in 2006, but there have been no human deaths there, yet.

But Kolkata is a whole other miasma of misery. The population density of Kolkata is 24,000 people per square kilometer (62,000 per square mile), the second highest in the world. In comparison, the population density of Ho Chi Minh City, Vietnam’s largest city, is only 3,000 per square kilometer (8,000 per square mile), a fraction of Kolkata’s. Even the density of Jakarta, Indonesia, at 12,500 people per square kilometer (33,000 per square mile), is just half that of Kolkata.

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