H1N1 Vaccine

[muck]

Muck, no offense, but if it is only one isolated case among thousands and thousands of cases, isnt that the exception rather than the rule? Isnt there always some small risk with any vaccination?

 

I am not advocating the H1N1 shot, as I will probably not take it, along with my family. I am just questioning the rate of complications associated with the shot.

 

PS- Go to youtube and pull up swine flu shot clips. They are all from fundamentalist religious groups that say the gubmnet is secretly injecting "tracking devices" and that getting the shot will be "mandatory" as it is part of the anti-Christ's plan to take over the world . . .

 

Apparently I didn't put my disclaimer in big enough font.

 

I have no idea if this is bogus, but I couldn't find anything to refute it ... but others did ... which is why I posted it in the first place.

 

PS - older kids may get the shots (only if my wife and I do), but younger kids will not ... probably an irrational fear, but real young kids + vaccines makes me think about autism ... which is another thing that may be bunk, but for my own (possibly) illogical reasons, my youngest kids don't get vaccines unless they are nearly mandatory.

[bpwallace49]

Apparently I didn't put my disclaimer in big enough font.

 

I wasnt saying that it wasnt true muck, so your disclaimer doesnt apply. In my post I stated that EVERY vaccine and a lot of medication have "side effects" that effect a very small percentage of the people that take them. I am not taking the position that it is a hoax, just the point that most vaccinations can and do have negative effects on a very small percentage of the populace.

 

My question was that IF IT IS TRUE, isnt that they extremely small exception rather than the rule? Kinda like the commercials for drugs that list everything that "could" happen, but it is very unlikely that it will?

 

That being said, even if there is a minute possibility that this could occur, then potential receipients should be informed.

[Chargerz]

I know this pregnant lady, she doesn't want to get the shot. Should she avoid it?

No.

 

Seasonal flu shots are recommended for all pregnant patients due to the increased frequency and severity of seasonal flu in pregnancy.

[mitpdub]

My 7yr old got the regular flu shot + H1N1 nasal mist both from his ped. Dr. We have a 5.5mo old that will get hers hopefully in a few weeks if its available.

 

My wife is a critical care RN, and works in a top 10 US hospital she will be getting her shots when available as well. She has incredible resistances for herself and rarely comes down with anything, but we just can't take a chance with spreading it to our little ones, or the kids at school when we volunteer. H1N1 seems to really hit the little ones hard so its just our personal choice.

[Azazello1313]

the wife talked to her dad yesterday (a doc in a clinic) and he recommended we hold off at least a little while on getting the vaccine for us and the little girl (just shy of 2 years). I don't think he said if he was getting one right away or not.

 

so, just to add a little bit to this....he said there was a very, very similar (identical?) strain in 1976 and they came out with mass vaccinations....the flu itself killed one person, the vaccines killed dozens more. he advised waiting a few weeks after the vaccine becomes widely available to make sure there aren't widespread complications, and to possibly consider getting it after that.

[Seahawk37]

The vaccine is a scam for drug companies to make money. Watching too much government run media will scare you into getting the vaccine.

[wiegie]

so, just to add a little bit to this....he said there was a very, very similar (identical?) strain in 1976 and they came out with mass vaccinations....the flu itself killed one person, the vaccines killed dozens more. he advised waiting a few weeks after the vaccine becomes widely available to make sure there aren't widespread complications, and to possibly consider getting it after that.

again a counter-factual: we have no idea how many people would have died from the flu if there had not been those mass vaccinations

[wiegie]

October 12, 2009

NY Times

Op-Ed Contributor

Nothing to Fear but the Flu Itself

By PAUL A. OFFIT

Philadelphia

 

PUBLIC health officials are now battling not only a fast-spreading influenza virus but also unfounded fears about the vaccine that can prevent it.

 

Since April, more than a million Americans have caught H1N1 flu, more than 10,000 have been hospitalized, and about 1,000 have died, including 76 children. And it’s only the beginning of October. Yet, in a new survey, 41 percent of adults said they will not get vaccinated.

 

The good news is that for the first time in more than 50 years we’ve made a vaccine against a pandemic strain of influenza before the onset of winter, when lower temperatures and humidity allow the virus to spread more easily. Distributing this vaccine to those who need it most — pregnant women, health care workers, children older than six months and people with compromised immunity — will be difficult enough. But the task is made harder by the various myths, spread on TV talk shows and Web sites, suggesting that Americans have more to fear from the vaccine than from the deadly disease it prevents. Here are some of those myths, and why they’re wrong:

 

SWINE FLU VACCINE IS UNSAFE The H1N1 virus revealed itself too late for it to be included in this year’s seasonal flu vaccine. But the H1N1-specific vaccine was manufactured in the same way as the regular vaccine: The shot form is made by growing the virus in hen’s eggs, purifying it and then treating it with a chemical that inactivates it. This technology has been used to make influenza vaccines for 60 years, and it has an excellent safety record. The nasal spray form is made by adapting the virus to temperatures below those typically found in the body. This allows it to reproduce in the relatively cool lining of the nose, but not in the lungs where it could cause harm. This technology has been used safely for more than 30 years. FluMist, a seasonal flu vaccine used since 2003, is made the same way.

 

THE VACCINE IS UNTESTED The H1N1 vaccine has already been given to thousands of volunteers to determine whether it could protect them from the virus and to make sure that it caused no adverse reactions. Only then did the Food and Drug Administration license it.

 

THE VACCINE CONTAINS A DANGEROUS ADJUVANT Some vaccines, like the hepatitis B and human papillomavirus vaccines, have substances called adjuvants, which are added to enhance the immune response, so that smaller quantities of vaccine can be given. Some people fear that the H1N1 vaccine contains, in particular, squalene, an adjuvant that, while included in other vaccines in Europe and Canada, has never been used in routine vaccines in the United States. But the H1N1 vaccine available in the United States has no adjuvant of any kind.

 

THE VACCINE HAS A DANGEROUS PRESERVATIVE Thimerosal, a preservative containing ethyl mercury that has been in vaccines since the 1930s, is used to prevent inadvertent bacterial and fungal contamination of multi-dose vials. H1N1 vaccine distributed in multi-dose vials will contain about 25 micrograms of ethyl mercury per dose. The issue of thimerosal received public attention in 1999 when the American Academy of Pediatrics and the United States Public Health Service took the precautionary step of asking that thimerosal be removed from single-dose vials of all vaccines. This was done in such a precipitous and frightening manner that it gave rise to the notion that thimerosal had led to autism or mercury poisoning. It hadn’t.

 

In fact, subsequent studies found that infants could safely receive eight times as much mercury as is contained in the H1N1 vaccine. But the public’s perception of thimerosal was damaged. This year, enough thimerosal-free vaccine is available to inoculate children under age 6, but that does not mean doses with thimerosal are unsafe.

 

New myths will inevitably arise as some of the millions of people who are inoculated against H1N1 flu suffer unrelated illnesses. Health officials will keep a close eye out for any real problems. One can only hope that the American public will understand that subsequence isn’t necessarily consequence, and not be scared away from a vaccine that can save lives.

 

Paul A. Offit, the chief of the infectious diseases division of the Children’s Hospital of Philadelphia, is the author of “Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure.”

[Brentastic]

I'm really freaked out right now about this flu shot. Myself, I never get them because I like my body to do what it's supposed to do. However, the 2 age groups most susceptible to complications with this vaccine and this flu are pregnant women and children under 5 - well, my wife is pregnant and my son is 14 months.

 

This thread seems to be split down the middle on what's the best approach. I think I might wait a few weeks after the vaccine comes out and see if there are any complications. But, it might be too late then, too. Damn, I hate right now.

[Brentastic]

Weige - I'm not so sure about that article, especially the last part referring to Thimerosal. My mom works for a prominent hospital in Illinois and she works with many top-notch doctors. Last week she attended a conference with leading doctors and there are several doctors who are still advising people to NOT get vaccines that contain Thimerosal - they are still seeing evidence that it MAY lead to autism and other problems. Basically, the evidence is not conclusive either way, better to side with caution in that instance.

[Azazello1313]

again a counter-factual: we have no idea how many people would have died from the flu if there had not been those mass vaccinations

 

well something like 24% of the population was vaccinated. certainly not enough to thwart a mass pandemic by itself. it would appear an effective quarantine was responsible for containing the disease rather than the government's big vaccination push.

 

On February 5, 1976, in the United States an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that the cause of death was a new strain of swine flu. The strain, a variant of H1N1, is known as A/New Jersey/1976 (H1N1). It was detected only from January 19 to February 9 and did not spread beyond Fort Dix.[26]

 

This new strain appeared to be closely related to the strain involved in the 1918 flu pandemic. Moreover, the ensuing increased surveillance uncovered another strain in circulation in the U.S.: A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March.[26] Alarmed public-health officials decided action must be taken to head off another major pandemic, and urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.[27]

 

The vaccination program was plagued by delays and public relations problems.[28] On October 1, 1976, immunizations began and three senior citizens died soon after receiving their injections. This resulted in a media outcry that linked these deaths to the immunizations, despite the lack of any proof that the vaccine was the cause. According to science writer Patrick Di Justo, however, by the time the truth was known—that the deaths were not proven to be related to the vaccine—it was too late. "The government had long feared mass panic about swine flu—now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.[29]

 

There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of modern influenza vaccines, with an incidence of about one case per million vaccinations.[30] As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, 48,161,019 Americans, or just over 22% of the population, had been immunized by the time the National Influenza Immunization Program (NIIP) was effectively halted on December 16, 1976.[31] [32]

 

Overall, there were 1098 cases of Guillain-Barré Syndrome (GBS) recorded nationwide by CDC surveillance, 532 of which were linked to the NIIP vaccination, resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine.

 

granted that's only 1 in 90,000 people who got sick from the vaccination and 1 in 2 million who died from it. I'm not sure how exactly that compares to your chances of 1) catching the disease and 2) dying from it (and you would also have to factor in the fact that the vaccine is thought to be only 80% effective). probably favorably for people who are highly exposed (schoolkids, doctors, etc), but I don't exactly see it as a slam dunk decision for everyone at this point.

[McBoog]

All I know is that one of the guys that works for me got it. He is a healthy guy and this flu put him on his A$$. The first throat swab was negative, but after four nights of 103 plus, he went back and the swab was positive.

 

His wife started the symptoms, but the Tamiflu she was given seemed to minimize the "damage" even though it did knock her for a loop as well.

 

As sick as they are, I can see why this bug kills people with other medical issues.

 

If it can stop me from getting as sick as he did, I am getting the vaccine, all things considered.

 

The one benefit he did report was that all of the coughing has given him a nice six pack of abs

[Big Score 1]

My Uncle Paul, down in Macon GA, has been a Pharmacist since the 1960's. He tells me the vaccine is as safe as any other & to ignore the scare rumors. He said he doesn't even know how they got started, but they're bunk.

 

My wife works as a Pharmacy Technician doing compounding for a private pharmacy here in Atlanta GA. Both the Pharmacist owner / operators, Chuck & Gary, echoed what my Uncle Paul told me. Get the vaccine, it's safe & anyone or anything telling you otherwise, is doing so through ignorance.

[BeeR]

From what I gather the odds of getting this are smaller than the odds of serious effects (eg GBS) from the vaccine, but can't say.

 

Plus I haven't gotten the flu shot in years and also haven't gotten the flu in years and also hate needles so screw it.

[CaP'N GRuNGe]

From what I gather the odds of getting this are smaller than the odds of serious effects (eg GBS) from the vaccine, but can't say.

 

Plus I haven't gotten the flu shot in years and also haven't gotten the flu in years and also hate needles so screw it.

 

I've seen headlines that estimate anywhere from 1/3 to 1/2 of the country could come down with it. Seems high to me, but what do I know.

 

I wish someone would come out with a vaccine for the common cold. Stupid stuffed up sinuses.

[CaP'N GRuNGe]

http://www.washingtonpost.com/wp-dyn/conte...9082401733.html

 

Old article from August. Not sure if estimates have changed.

[Skippy]

I don't know how accurate those estimates of Grunge's are but I can tell you that in Western PA this flu is keeping MANY children out of school already. One local HS football team had 10 of its starters out last Friday night in their biggest game of the year when they were fighting for WPIAL playoff berths.

[Seattle LawDawg]

I'm still torn on this. Normally, I wouldn't worry about it, but with a 3 week old in the house, I'm more nervous about bringing it home. I have a co-worker in Texas whose 18 month old is currently in the hospital with the swine flu. Haven't gotten a lot of information, but what little we've heard isn't good.

[rocknrobn26]

No.

 

Seasonal flu shots are recommended for all pregnant patients due to the increased frequency and severity of seasonal flu in pregnancy.

 

Doc,

We need your knowledge here! Please???!!!!

 

 

The vaccine is a scam for drug companies to make money. Watching too much government run media will scare you into getting the vaccine.

 

Can't agree w/ that. Please remove your head from Rush's ass.

[Big John]

Can't agree w/ that. Please remove your head from Rush's ass.

He is libertarian/anarchist.

[cliaz]

Here are some articles from the International Association of Emergency Managers discuss groups on Linkedin. Always review all material before making a decision. I know some people who adamantly refuse flu shots each year and equally dismiss the H1N1. That's fine, if they did the research and are not just blindly refusing it. I am refusing to get it for now. But I am basing my decision on my own research [i am volunteering to assist EMs on both coast with their regions Fluview updates so I have access to a ton of raw data].

 

Always [and I cannot stress this enough] always take what your doctors and pedestrians to heart and make an informative decision. If you choose not to get it, that's is all cool-in-the-gang but don't refuse it blindly. I am seeing some crazy stats and wild reports that are all over the map and it's hard to find the baseline of actual truth at the moment.

 

 

H1N1 (Swine Flu): Shortage of Vaccine, Death Toll Rises, H1N1 Widespread

October 17, 2009 · 1 Comment

 

On Friday, CDC predicted a shortfall in the supply of the H1N1 vaccine, as the numbers of cases, hospitalizations and deaths grow to levels unprecedented for this time of year. The H1N1 virus is now widespread in 41 states, and flulike illnesses account for 6.1 percent of all doctor visits. “That’s high for any time, particularly for October,” said Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the CDC.

 

A chilling number was released…43 children have died from H1N1 since Aug. 30 — about the same number that usually die in an entire flu season. “These are very sobering statistics,” Dr. Schuchat said in a news briefing, “and unfortunately they are likely to increase.”

 

The age breakdown looked like this:

 

* 19 of the 43 who died were teenagers

* 16 were ages 5 to 11 years old

* The rest were under 5.

 

Those who are hospitalized are often very, very sick. Between 15 – 20 percent of the patients who were hospitalized with the flu landed in an intensive care unit, a rate comparable with that for seasonal flu. There is one light of good news, although the disease continues to spread, its severity is not increasing…there is just lots and lots of sick people.

 

Projections of the supply of H1N1 vaccine have widely varied. During the summer, health officials said 120 million doses would be ready in October. They later dropped the estimate to 40 million doses by the end of the month. Now, Dr. Schuchat said, they expect only 28 million to 30 million doses, adding that the exact numbers were impossible to predict and could change daily. She said vaccine manufacturers were reporting that production was behind schedule. “Vaccine production for influenza is pretty complex,” she said in explaining the delay, “and the complex process this year is taking a bit longer than we had hoped. The yield of antigen is lower than they had hoped for.” The antigen is the part of a virus included in vaccine to stimulate the body’s protective response. It is crucial; a vaccine will not work without it.

 

Dr. Schuchat also said that once batches of vaccine were prepared, they had to be tested for potency and purity. “We are not cutting any corners,” she said. “It’s important to us that this process be done carefully and safely.” She acknowledged that some people were having trouble obtaining vaccinations, saying, “I’m sorry it’s a difficult time in terms of looking for vaccine.” As of Wednesday, Dr. Schuchat said, 11.4 million doses of the H1N1 vaccine were available, with more being shipped. She predicted that by early November, there would be widespread vaccine availability and information on where people should go for it.

 

Dr. Schuchat acknowledged that some people had fears about the H1N1 vaccine, but she emphasized that it was safe and urged pregnant women to be vaccinated because they were especially prone to severe complications and had accounted for a disproportionate number of deaths. Studies of the swine flu vaccine are being conducted in pregnant women. But, Dr. Schuchat said, “if I were pregnant, I would not wait for the results of those trials; the risk in pregnant women has been very striking.”

 

On the seasonal flu, Dr. Schuchat said 82 million doses of vaccine had been distributed, out of an expected total of 114 million. But the vaccine has been running low in some areas. Dr. Schuchat urged the public to “keep looking” and emphasized that there was time because seasonal flu did not usually take hold until December. Virtually all cases now are the H1N1 swine flu, she said.

 

--------------------------------------------------------------------------------------------------------------------------------------------------------------

 

 

H1N1(Swine Flu): Emergency Warning Signs for Children, When to Seek Help; FDA Warns About Online Flu Drugs

 

EMERGENCY FLU WARNING SIGNS FOR CHILDREN

 

As flu continues to spread across the US, we continue to hear of children seriously ill and dying. Yes, the disease is mild and deaths are rare but are occurring. Many do have preexisting conditions however 40% are healthy vibrant young people. There are crazy sites about conspiracies and inflammatory comments about the vaccine. It is scary and confusing for parents. Who are you to believe?!? What should you do?

 

I found myself brought to tears as I read an AP story about a year 5 year old boy, whose name was Max who had just started kindergarten when he developed sniffles and a fever. His mother figured it was only a cold. Three days later, the Antioch, Tenn., boy was dead, apparently from swine flu. Heart breaking is the only thing I can say. Doctors are urging parents to watch for warning signs that the flu has become life-threatening.

 

Parents must seek immediate help if emergency warning signs develop. In children, these include:

 

* Fast or troubled breathing.

* Bluish skin color.

* Lack of thirst.

* Failure to wake up easily or interact.

* Irritability so that the child does not want to be held.

* Improvement of symptoms, then a return to fever and worse cough.

* Fever with a rash.

 

Every parent is asking themselves the question, “How can they protect their kids from H1N1 until the vaccine is widely available?” H1N1 has probably infected hundreds of thousands of youngsters nationwide, but deaths among children are rare. Health officials are keeping track of children’s flu deaths, but they say it’s impossible to count all flu cases. So they don’t know exactly what percentage of children’s infections are fatal.

 

Many experts say the H1N1 virus does not appear to be more dangerous than other flu strains, but kids have been catching it more easily than seasonal flu. Last week alone, there were 19 new reports of children who died, according to the federal Centers for Disease Control and Prevention. And the 76 swine flu fatalities since April compare with 68 pediatric deaths from seasonal flu since September 2008.

 

Parents should also seek medical help if flu symptoms develop in children most vulnerable to flu complications: those younger than 5 or with high-risk conditions, including asthma and other lung problems; cerebral palsy, epilepsy and other neurological diseases; heart, kidney or liver problems; and diabetes.

 

Kids should get vaccinations for both ordinary flu and swine flu when the vaccine is available, and stay home from school if they are sick. Parents should stress hand-washing and covering coughs. Mild cases should be treated at home with rest and plenty of fluids, but parents should call their doctor if more serious symptoms develop.

 

-----------------------------------------------------------------------------------------------------------------------------------------

 

 

H1N1 (Swine Flu): OK To Give Seasonal & H1N1 Vaccines At Same Time; Youth Remains At High Risk

October 15, 2009 · Leave a Comment

 

STUDY CONFIRMS TWO IMPORTANT ISSUES REGARDING H1N1 VACCINE

 

A new US study released this week confirms two important issues: confirm

 

* Only one dose of H1N1 vaccine will be needed to protect adults and seniors. The study showed that adults and seniors who received a second dose of the pandemic vaccine didn’t get much additional benefit from the second shot

* Giving seasonal and pandemic flu shots at the same time should be fine

Fauci also revealed preliminary data from another study looking at whether it was safe to give both seasonal and pandemic flu shots at the same. Both protect against different types of H1N1 virus – it is thought that the vaccine against one would not protect against the other. There were theoretical concerns that giving two flu vaccines at once might interfere with the immune system’s ability to generate a good response to all the viruses covered in the shots. What is in the two shots?

 

* The seasonal flu shot is a trivalent vaccine: protecting against three families of viruses – seasonal H1N1 and H3N2, both influenza A viruses and an influenza B virus.

* The pandemic flu shot is a monovalent vaccine: protecting only against the pandemic novel (A)H1N1.

There have been no unusual side effects seen in the people who received the two vaccines together. “We’re seeing pain, redness and perhaps some swelling that we see very frequently with injectable vaccines.” New trials are now beginning studying the safety and effectiveness of the vaccine in people with asthma. Other studies will look at safety and dosing requirements in two groups of people living with HIV – pregnant women, and children and adolescents

 

-----------------------------------------------------------------------------------------------------------------------------------------------

 

H1N1 DEATHS AMONG YOUTHS RISE AS PANDEMIC SPREADS

 

CDC has been reporting that the number of children who have died from swine flu has jumped sharply as the virus continues to spread widely around the United States, striking youngsters, teenagers, young adults and pregnant women unusually often. This has had as you might expect, an unnerving impact on parents and families. On one hand the disease remains mild, and yet when it strikes it can deal a deadly blow.

 

“These pediatric deaths seem to be increasing substantially,” said Anne Schuchat MD (Rear Admiral), who heads the federal Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. While most of the children who have died have had other health problems that made them particularly vulnerable, such as asthma, muscular dystrophy and cerebral palsy, 20 to 30 percent were otherwise healthy, Schuchat said. Between 46 and 88 children died from the seasonal flu in each of the past four years, so the fact that so many have already succumbed is disturbing, Schuchat said.

 

Since the pandemic began (April 2009), at least 3,873 Americans have died from complications associated with the flu, primarily the H1N1 virus, including at least 28 pregnant women.

 

-----------------------------------------------------------------------------------------------------------------------------------------------------

 

H1N1 (Swine Flu): Preparing for the Sickest of the Sick – Three Studies of ICU Treatment of Critically Ill H1N1 Patients

October 13, 2009 · Leave a Comment

 

In the latest issue of the Journal of the American Medical Association (JAMA) there were three reports on the treatment of critically ill H1N1 patients. This is an important body of work and will assist clinicians in intensive care units (ICUs) this fall that have been treating patients largely without empirical data about the nature and severity of disease. I think you will find it pretty interesting too!

 

The Mexican and Canadian study noted striking similarities in their findings:

 

* The Mexican researchers conducted an observational study of 58 patients admitted to 6 ICUs in Mexico City with H1N1-related disease during the initial outbreak in spring 2009.

* The Canadian colleagues conducted a similar study of 168 critically ill patients in 38 Canadian ICUs - 29 people died, including 21 women and four children. Most died quickly.

* Patients tended to be relatively healthy adolescents and young adults who developed a brief illness followed by rapidly progressive respiratory failure.

* Shock and multisystem organ failure were common.

* Patients experienced low levels of oxygen in their arterial blood (Hypoxemia ) which was prolonged and severe, requiring on average 12 days of mechanical ventilation and frequent use of significant rescue therapies.

* In Canada, the average patient was 32.3 years old, but 50 patients were children.

* The influenza outbreak lasted about 3 months in both countries, but the peak lasted just a few weeks, during which time hospitals struggled to accommodate the increased patient load, with 4 Mexican patients dying while awaiting ICU beds.

* Notably, the Mexican study group incurred a mortality rate twice as high as that in Canada. In both cases there were no documented cases of hospital transmission.

 

The Australia and New Zealand is based on data from all centers providing extracorporeal membrane oxygenation (ECMO) for H1N1-related disease in Australia and New Zealand during the 2009 Southern hemisphere winter.

 

* The cases were typically young adults with little underlying diseases who developed severe hypoxemia and multisystem organ failure.

* The median duration of ECMO support was 10 days, and the case-fatality rate was 21%.

How then might hospitals within a given region respond to the unique needs of the sickest patients with H1N1?

 

* One possibility is regionalization of care for patients with advanced respiratory failure. This would allow a few centers to accumulate experience managing the sickest patients, while preserving the resources at outlying hospitals for other patients. Strengths of this approach are the possibility for improved outcomes due to accumulated experience and the potential for streamlined conduct of clinical trials of promising treatments.

* A second possibility is the development of telemedicine consultation for clinicians at outlying hospitals who may benefit from expert clinical advice for such tenuous patients. Demonstration projects are ongoing for telemedicine during a public health emergency.

* A third possibility is for hospitals to make temporary staffing changes to ensure the continuous presence of clinicians competent to handle these cases. This approach lacks some of the potential benefits of regionalization and may be infeasible because of foreseeable workforce shortages during a severe influenza outbreak.

 

The large proportion of critically ill patients with H1N1 who survived is an important reminder that the medical response to a respiratory pandemic is very different today than it was for the 1918 influenza pandemic. The widespread availability of antibiotics, antiviral agents, vasopressors, and mechanical ventilation makes it possible to save many patients who would not have survived in 1918. With this potential comes an obligation for hospitals and public health systems to collaboratively develop strategies to ensure that, if there is a resurgence of 2009 influenza A(H1N1), the benefits of intensive care medicine can be offered to the maximum number of patients. Although guidelines and recommendations exist for augmenting hospital surge capacity, their implementation in individual hospitals is far from complete.

 

The investigators from both Mexico and Canada noted that the health care systems struggled to meet the demands created by the increased patient volume, a sobering observation given that the absolute number of excess ICU admissions was modest.

 

The authors concluded that hospitals must develop explicit policies to equitably determine who will and will not receive life support should absolute scarcity occur. This triage or rationing will be difficult but as in Katrina there may be no other choice. Any deaths from 2009 influenza A(H1N1) will be regrettable, but those that result from insufficient planning and inadequate preparation will be especially tragic.

 

--------------------------------------------------------------------------------------------------------------------------------------------------

 

H1N1 (Swine Flu): Areas Hit Hard by Flu in Spring See Little Now – Herd Immunity?

 

New York and a few other cities that were filled with H1N1 in the spring are detecting very little evidence of a second wave this fall – its appears to be quiet on the home front in those towns! There is widespread flu in 37 states in the US – which is very unusual for this time of year, but public health officials say there appears to be a pattern developing that areas that had big outbreaks in the spring, like New York, Boston and Philadelphia are seeing less swine flu now.

 

Although it is too early to be sure, they said, the high level of what is often called “herd immunity” may mean that the second wave of swine flu infection ends up being far less extensive than expected.

 

This “herd immunity” theory has gained enough credence that Dr. Thomas A. Farley, New York City’s health commissioner, put it forward at a conference on the national preparations for H1N1 last Friday in New York, organized by HHS and CDC.

 

“We’re not seeing illness in the city right now,” Dr. Farley said at one session. “We’re seeing essentially no disease transmitted in the city. We had 750,000 to one million sick people last spring. We were the hardest-hit city then. So we have a lot of immune people right now.” Officials say the conflicting data show the delicate balance public health officials are walking with swine flu. So far it has turned out to be less deadly than it seemed when a pattern of deaths was reported in Mexico last spring.

 

At the same time, officials fear that it could take a turn for the worse, and they want to maintain a high level of alertness without crying wolf too many times. Dr. Martin S. Cetron, a flu expert at the disease control agency and the co-author of a 2007 study of how the 1918 flu hit 43 American cities, called the idea that flu is not big now because it was big in the spring “an interesting hypothesis, with biological plausibility,” but said that only the rest of the winter would tell. “To say, Oh, all of us in New York are immune, we won’t have any more disease and we don’t need to take vaccine, is a dangerous conclusion to draw,” Dr. Cetron said.

 

Comparing flu to other highly infectious diseases, like measles, it is generally accepted that 90 percent to 95 percent of the population has to be immunized to prevent a measles outbreak. For flu, a virus that is constantly changing year to year, it is less clear what the herd immunity has to be to prevent a further outbreak, but it may be as little as half, and New York may be very close to that.

 

Attendance in the New York City’s public school system, with just over a million students, was 91 percent Wednesday. Last spring, when the virus was rampant, nearly 60 schools were closed and about 18 percent of students were absent.

 

In Boston, where an estimated 11 percent of adolescents got swine flu in the spring, public schools and college health services have reported very little flu activity this fall, Dr. Anita Barry, director of the infectious disease bureau of the Boston Public Health Commission, said Wednesday.

 

Some states, including Georgia, Indiana and North Carolina, had “false waves” of swine flu in the spring, Mr. Olson said, which seemed to have been caused by the “worried well” flocking to hospitals. Georgia in particular took off when schools reopened in August. In the last week of September, there were 81 hospitalizations and eight deaths from H1N1 in the state, according to the Georgia Department of Community Health, compared with 44 hospitalizations and one death in the three-months from late April through late July.

 

As of Monday, seven pregnant women were on respirators in Arkansas hospitals, officials said.

 

-------------------------------------------------------------------------------------------------------------------------------------------------

 

H1N1 (Swine Flu): Families Can Reduce Risk of Transmission in the Home

 

Nothing like sharing your “bugs” amongst your friends and family right? Not really! The home is always prime territory for sharing disease. But the resurgence of H1N1 (swine flu) should make you reexamine just how viruses spread, as well as what you can do about it. The H1N1 flu virus, like the seasonal influenza virus and like most other cold viruses, travels by three major routes:

 

1. Close-contact respiratory droplets

2. The surface of inanimate objects

3. Hand-to-face transfer.

 

Close-contact respiratory droplets

 

I am sure you have seen one of those high-speed photographs of a person coughing or sneezing, emitting a spray of moisture resembling the Milky Way. GROSS! A percentage of those droplets remain in the air long enough to find their way to the nasal passages of anyone within three to six feet of the sneezer. The percentage varies with temperature and humidity: Peter Palese of the Mount Sinai School of Medicine in New York says that close-contact studies using guinea pigs — which are susceptible to infection from human flu viruses — found that the flu virus was transmitted almost 100 percent of the time in situations where the temperature was below 41 degrees and the relative humidity was below 50 percent. Sounds like winter no?

 

Check out the very cool video called “Catch It, Bin It, Kill It,” on our website… It shows a young man who sneezes into a chrome elevator..quite visual. ;-)

 

Mitigation Strategy? – Cough and Hand Hygiene

 

That’s a good reason to always sneeze and cough into our tissues, elbows or shoulders. That way you catch the droplets AND don’t contaminate your hands. And of course, hand washing remains our main line of defense (with soap and water or hand sanitizer).

 

The surface of inanimate objects

 

Those nasty droplets can also land on shared surfaces such as a desks, kitchen counters, dining table, phones or computer keyboard. How long the virus remains infectious depends on several circumstances however viruses can last up to 24 hours on hard surfaces.

 

Mitigation Strategy? - Surface Cleaning

 

It is all pretty much common sense. Wipe down surfaces with a solution of bleach and water (one part bleach to one part water), a disinfectant wipe or with an alcohol swab. Clean a commonly used family phone or keyboard with a disinfectant wipe before using. Don’t use drinking glasses or cutlery that someone else has used. Wipe down high touch surfaces in the home like door knobs, refrigerator handles, drawer pulls or stove handles.

 

Hand to face transfer – Self Contamination – touching your hands to your face

 

One of the most common ways to spread viral infections is touching the eyes, nose and mouth with your contaminated hands. Most of us frequently touch our faces: We put things in our mouths, rub our eyes or noses, lick a finger to turn a page, adjust our glasses. Our hands are key to transmission of viruses and bacteria.;

 

Mitigation Strategy? Stop touching your face! Right Now!!! I mean it!

 

What can we do about it? First of all, keep your hands really, really clean ideally with frequent hand washing with plain old soap and water. If you can’t wash your hands then use sanitizer. I know it sounds so simple and how could it possibly work – but there is strong evidence that it does: In one Detroit study, schoolchildren who washed their hands four times a day had 21 percent fewer sick days due to respiratory illness than did students in general, and 57 percent fewer days lost due to upset stomachs.

 

Someone Sick at Home? Take Special Precautions

 

Use a common surgical or dust mask, they are slightly less protective, but offer some clinical benefit. In a 2009 study involving sick schoolchildren in Australia, the use of soft masks reduced the risk of acquiring infection by 60 to 80 percent. Given that the soft mask does not screen all the viral droplets, some of the protection from the masks may be from preventing hand-to-face contact.

 

Isolation – Family Social Distancing

 

“Social distancing” is something you can do at home to minimize spread. What does that mean? Simply put, place some distance (ideally 3 – 6 feet) between you and the sick person. Don’t bring your sick kids into bed with you. Hold off on hugs. Don’t share drinks. If the sick folks normally sleep in a bed with another person, separate them to avoid unnecessary contamination.

 

Taking precautions reduces, but does not eliminate, the chance of infection. These simple tools might make the difference between everyone betting the flu in your house or not…it is worth a try!

 

If BigJohn could set it up - maybe we should pin a topic here and I can update it with the latest H1N1 information we get in for the fluview. It's up to you all if you want a daily update or not. Just a thought.

[Big John]

Here are some articles from the International Association of Emergency Managers discuss groups on Linkedin. Always review all material before making a decision. I know some people who adamantly refuse flu shots each year and equally dismiss the H1N1. That's fine, if they did the research and are not just blindly refusing it. I am refusing to get it for now. But I am basing my decision on my own research [i am volunteering to assist EMs on both coast with their regions Fluview updates so I have access to a ton of raw data].

 

Always [and I cannot stress this enough] always take what your doctors and pedestrians to heart and make an informative decision. If you choose not to get it, that's is all cool-in-the-gang but don't refuse it blindly. I am seeing some crazy stats and wild reports that are all over the map and it's hard to find the baseline of actual truth at the moment.

 

 

 

 

If BigJohn could set it up - maybe we should pin a topic here and I can update it with the latest H1N1 information we get in for the fluview. It's up to you all if you want a daily update or not. Just a thought.

Not sure what walkers have to do with that.

 

And you need to talk with DMD if you want to pin a thread in here.

[cliaz]

Not sure what walkers have to do with that.

 

And you need to talk with DMD if you want to pin a thread in here.

 

 

[CaP'N GRuNGe]

Thanks for the info.

[dmarc117]

Doc,

We need your knowledge here! Please???!!!!

 

 

 

 

Can't agree w/ that. Please remove your head from Rush's ass.

 

 

he may need a different vaccine if his head is there