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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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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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.

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.

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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.

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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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Bird Flu – Bangledesh Considers Red Alert

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

The government has been carrying out allout efforts to resist the bird flu throughout the country.

A number of steps have already been taken to face the probable menace. Sources said monitoring cell has been opened at the office of the Deputy Commissioner in each district.

Special task force has been formed. BDR patrol in the border areas has been geared up, importation of all kinds of poultry through India and Myanmmar borders has been prohibited, propaganda to create awareness among the people is being made and the masses are being urged not to be panicked.

Besides, the government is mulling to declare red alert as a drastic measure to face this catastrophe if necessary. According to the official figure the country has 1.50 lakh poultry farms and a panic of bird flu has been spread all over, although, infection of bird flu in hundred farms has so far been informed.

About 3.50 lakh cocks in 134 farms have already been killed and as a result the poultry farmers who invested a huge amount are being frustrated. If it is not controlled now, it would be spread all over the country in an epidemic form.

And at the same time it would not only cause a huge economic loss but also thousands of people involved in this industry would be jobless. Ministry of Livestock sources said the price of cock, duck and pigeon has been reduced in the market.

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Bird flu: India Asks For All Possible Help

January 27, 2008 by mimmson  
Filed under Flu Pandemic - Top News Stories

The Indian state of West Bengal, battling the country’s worst outbreak of deadly bird flu, appealed on Saturday to the federal government to send “all possible help to defeat” the virus.

The call by state animal resources minister Anisur Rahaman came as authorities struggled to stop the disease spreading beyond the 12 out of 19 state districts already affected.

“We have to control the disease immediately as the deadly H5N1 virus has been spreading fast,” Rahaman said, adding “avian flu is knocking on the doors of Kolkata,” the eastern state’s congested capital of 13.5 million people.

“I’m urging the federal government to send all possible help to defeat the virus before it affects the humans,” he told AFP.

New Delhi has already sent some medical teams and other assistance to the state.

Three days of heavy rains have held up efforts to slaughter poultry, turning some rural dirt roads into muddy rivers and making it impossible for health teams to reach chicken farms in the poverty-ridden state.

Rahaman said he was deeply concerned by reports some villagers in rural areas were eating slaughtered chickens.

“We don’t understand why people do not understand the dangers of the disease despite repeated warnings,” he said, adding children were still playing with chickens.

Humans typically catch the disease by coming into direct contact with infected poultry, but experts fear the H5N1 strain may mutate into a form easily transmissible between people.

Panic about bird flu has gripped Kolkata after news spread that the disease had reached the outskirts of the city on Friday.

Few shops were selling poultry on Saturday in the city.

“Not a single customer has come to my shop since the morning,” said Malati Mondal, a store owner.

The government has raised the number of chickens to be slaughtered to 2.5 million from 2.2 million, Rahaman said, adding 1.3 million had been killed so far.

Workers at entry points to Kolkata were disinfecting vehicles entering the city.

India has not had any human cases of bird flu. But Rahaman said he feared the disease would spread to humans with hundreds of people reporting flu symptoms.

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Pandemic Bird Flu Warnings Not In The News But It’s Still A Threat

January 23, 2008 by mimmson  
Filed under Flu Pandemic - Top News Stories

Last year, for the first time since avian flu emerged as a global threat, the number of human cases was down from the year before. As the illness receded, the scary headlines with their warnings of a pandemic that could kill 150 million people all but vanished.

But avian flu has not gone away. Nor has it become less lethal or less widespread in birds. Experts argue that preparations against it have to continue, even if the virus’s failure to mutate into a pandemic strain has given the world more breathing room.

There were 86 confirmed human cases last year compared with 115 in 2006, according to the World Health Organization, and 59 deaths compared with 79. Experts assume that the real numbers are several times larger, because many cases are missed, but that is still a far cry from a pandemic.

Dr. David Nabarro, the senior United Nations coordinator for human and avian flu, recently conceded that he worried somewhat less than he did three years ago. “Not because I think the threat has changed,” he quickly added, but because the response to it has gotten so much better.”

The world is clearly more prepared. Vaccines have been developed. Stockpiles of Tamiflu and masks have grown. Many countries, cities, companies and schools have written pandemic plans. The European Center for Disease Prevention and Control, created in Stockholm in 2005, just estimated that the European Union needed “another two to three years of hard work and investment” to be ready for a pandemic, but that is improving because previous estimates were for five years.

In the worst-hit countries — all poor — laboratories have become faster at flu tests. Government veterinarians now move more quickly to cull chickens. Hospitals have wards for suspect patients, and epidemiologists trace contacts and treat all with Tamiflu — a tactic meant to encircle and snuff outbreaks before the virus can adapt itself to humans.

Bernard Vallat, director general of the World Organization for Animal Health, recently called the virus “extremely stable” and, thus, less likely to mutate into a pandemic form. Many prominent virologists would vehemently disagree. But others who argued three years ago that H5N1 would not “go pandemic” are feeling a bit smug.

Avian Flu – H5N1 Pandemic – Bird Flu – New York Times

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