Op-Ed: 2009 in Review - Public Information, Awareness, Transparency are Indispensable to H1N1 Fight

by: influenzamonitor

Sun Jan 03, 2010 at 21:24:21 PM EST

As 2009 comes to a close, an estimated 60 million Americans have been vaccinated for H1N1. This represents a remarkable achievement.

Despite waning H1N1 infection rates in the U.S., recent surveys show that half of all Americans desire the vaccine. While HHS handling of the H1N1 pandemic has drawn criticism, overall public awareness has been an underreported success.

In April, when little was known about the H1N1 virus, American public reaction was swift, if irrational. As one news account described it...

Travel to Mexico fell dramatically, pork-belly futures collapsed, and protective masks flew off the shelves. Mexico City virtually shut down

Whether motivated by fear or caution, market signals are indicative of public interest in H1N1. Business journalists reported triple (and double) digit gains in sales of hand sanitizers, cough/cold/allergy medications, analgesics, and spray disinfectants, reversing downward trending in these products due to the recession.

American public perceptions of H1N1 vaccine safety were apparently influenced by memories of the flawed experiences with swine flu vaccine in 1976, and Guillain-Barré syndrome. Medical research notwithstanding, widespread distrust of H1N1 vaccine safety unfortunately persists. When news media were granted inside access to sensitive vaccine plants, subsequent reporting probably has served to reduce public concerns.

CDC and HHS blended traditional and Internet media to provide a regularized flow of information to the public. However, HHS came under sharp criticism when initial vaccine deliveries fell far short of projections. Long queues of American families waiting for scarce vaccines were striking visuals broadcasted around the world. School vaccinations also had controversial optics, but worked well in retrospect.

H1N1 continues to make news. The World Health Organization reports that the virus is circulating at elevated levels in parts of central and southern Asia. Recent H1N1 vaccine product recalls suggest the shelf-life of vaccines bears watching.

We can not forget the 10,000 American lives lost to H1N1. With safe vaccines, transparent mechanisms, and effective public information and awareness campaigns, we will not lose more lives. Best Wishes for the New Year !

Disney workers concerned about H1N1

by: Jamie293

Mon Dec 14, 2009 at 22:20:18 PM EST

See this video: http://www.youtube.com/watch?v...  

H1N1 Is Mutating, And I Don't Like It?

by: Walrus

Tue Dec 01, 2009 at 14:51:42 PM EST

http://www.newfluwiki2.com/dia...

My opening quote asked the rhetorical question whether H1N1 was mutating (which of course it must) and cynically speculated that there appeared to be about a Two week delay between when the authorities knew something was happening, and when they told the public about it.

My speculation was based on a comparison, admittedly with very poor evidence, between the apparently unvarnished news reports of occasional doctors, and the "Official" line from the WHO and/or CDC.

To summarise, the official line Twenty Five days ago (from a Nov 7 post on the original thread by DemfromCT) was:

"Anne Schuchat:Well, influenza viruses change.  That's inevitable.  Mutations with occur.  The key part is will we see something in the near future that makes it change markedly to something more severe than what we are seeing or is there a change that would occur to leave the virus to escape the vaccine?  Both of those changes are possible.  Fortunately, we haven't seen any of those, yet.  We have been testing many of the viruses.  It hasn't changed genetically or the immune characteristics.  The vaccines we are making available are very good matches with the virus. ] It is -- it has been seen with pandemics in the past that over the couple years after a new strain emerges, it starts to change a bit.  It starts to drift and become something that would need a change in vaccine formulation, so that's one of the reasons we make up new vaccines every year for seasonal flu.  Viruses may change from year to year and we may need to modify the vaccine."

Similar pabulum from the WHO, in respect of the Ukraine,  was enough for the revered Reveres of "Effect Measure" to use swear words in their Blog for perhaps the first time.

Since these placid words were uttered about Two weeks ago, we have apparently seen the following events:

1. At least one person reporting "getting the flu twice" which might indicate that the H1N1 virus has mutated in a way that we are no longer immune to it. - Official response: "possible but unlikely,  go back to sleep"

2. The detection of a mutation (D225G?) in several cases that appears to cause severe lung damage. It has been suggested that the 1918 Flu carried this mutation. - Official response: "possible but unlikely,  go back to sleep"

3. More reports of Tamiflu resistant Flu. - Official response: "possible but unlikely,  go back to sleep"

Now those same authorities are suggesting that current H1N1 vaccines might not protect against this mutated H1N1.

And Tamiflu resistant H1N1 might become more prevalent.

And D225G might become more prevalent and might be associated with increased mortality

Being charitable and trying to be measured and in keeping with the august and conservative (in a scientific sense) reputation of this website, the conclusion I draw from this is there seems to be that same Two to Three week lag between when we first hear of something happening and official confirmation.  

I will put that down, assuming for the sake of argument that it's true, to prudent public health professionals preventing public panic. Each time one of these revelations is finally confirmed, the official evaluation seems to  be that the change is unsurprising, of no great importance, and in fact was almost expected anyway.

I think that this appears to be a sensible information management technique, since if I was told in one Twenty four hour period that H1N1 has mutated to a more lethal form that is Tamiflu resistant, and that current vaccines are ineffective, I would be starting to wonder about my Christmas preparations. Instead, since the news was broken to me slowly, in small digestible chunks over a period of weeks, I placidly go on my way, as I suppose I should.

However, that is not my primary concern. I am much more concerned by a rising number of news reports apparently from Health professionals, including one from China on which I commented, discussing the possibility of H5N1 and H1N1 recombining (?) in some way to produce a super flu "slate wiper" with the lethality of H5N1 and the transmissibility and infectiveness of H1N1.

If I make the assumption that my earlier speculation about media management was correct, then this suggests that such a hellish marriage has already been observed somewhere. Should this be true, then I think we can stop worrying about The Global Financial Crisis, Global Warming, and a host of other population related pressures on this planet.

I would welcome your opinions. I apologise for being too lazy to construct an exact timeline showing the relatively consistent gaps between first reports and official denials, followed about Two weeks later by official confirmation.

H1N1(Swine Flu): Could Getting A Cold Prevent You From Getting The Flu?

by: ReginaPhelps

Wed Nov 18, 2009 at 13:46:37 PM EST

Two articles reviewed on PROMED this morning really caught my attention... could catching a "cold" actually help ward off H11N1?  This idea of viral interference is really interesting.    

Are We DONE Here??

by: SusanC

Sat Nov 14, 2009 at 00:02:48 AM EST

H1N1(Swine Flu): Old Family Health Advice for Staying Healthy - Things To Help You Avoid The Flu

by: ReginaPhelps

Mon Nov 09, 2009 at 03:16:19 AM EST

A friend of mine sent me an email asking me if gargling with saltwater could be helpful for overall health and flu prevention.  From my nursing background I remembered of course that is was often recommended for sore throats and "colds" and is very effective...so that sent me on a search...could salt water could be effective as a gargle or a nasal wash to prevent or treat colds or the flu???

Ukraine and Eastern Europe

by: magdelaine

Fri Nov 06, 2009 at 15:45:44 PM EST

In the last 20 days, there have been more than 300 reported deaths in the Ukraine.  At least 90 have been studied as cases of hemorrhagic pneumonia, in which the lungs are destroyed, full of blood, appear back in color, and are completely destroyed. These facts are extremely unusual in the 2009 H1N1 pandemic thus far. Because of this, I feel this phenomenon, which is quickly spreading to nearby countries cannot be explained by the Ukraine health system, by AIDS, by the weather, living conditions, or anything else other than the fact that the virus has changed in a way that makes it more deadly. I believe this has been validated by the sequences released by the WHO to date as well as by the fact that five sequences have yet to be released.

However, I do not have the time to maintain this diary by myself. I find that there is an odd lack of curiosity about what is happening in the Ukriane, and why, here at Fluwiki. So, if as a visitor to Fluwiki you want to follow what this story, I recommend the following resources:

• Recombinomics
• Pandemic Influenza H1N1 2009
• Ukraine Ministry of Health Statistics
• Situation in Ukraine Thread at Rhizalabs (Other threads there are good too.)

In any case, this will all be apparent in the coming weeks. Good luck everyone.

Ukraine Cases and Deaths

Date	Cases	Deaths
11/16/09	1,400,999	315
11/15/09	1,364,939	299
11/14/09	1,347,538	282
11/13/09	1,308,911	265
11/12/09	1,253,558	239
11/11/09	1,192,481	213
11/10/09	1,122,188	189
11/09/09	1,031,597	174
11/08/09	969,247	155
11/07/09	936,804	144
11/06/09	871,037	134
11/05/09	762,835	109
11/04/09	478,456	81
11/03/09	255,516	71
11/02/09	255,504	67
11/01/09	191,431	60

News Resources

• Ukraine Ministry of Health Press Releases * (Translation)
• Radio Ukraine
• News from Belarus, in English

H1N1 (Swine Flu): What Should Be In A Business Pandemic Plan? It Is Built On Four Pillars

by: ReginaPhelps

Fri Nov 06, 2009 at 07:32:44 AM EST

I am what is called an "all-hazards" planner, which means that we write plans that are appropriate for all/most disasters.  Pandemics however are much different and require a different approach.  We have written hundreds of pandemic plans since 2003 and believe that pandemic plans are built upon four basic and distinct pillars:
1. Education and communication.
2. Personal protective equipment (PPE).
3. Facility cleaning.
4. Social distancing.
I recently wrote an article that has just appeared in the Disaster Resource Guide that is now available to download.  Although this article was written for business it is just as applicable for a public sector agency or a not-for-profit.  Take a look at the article and compare our recommendations to your current plan and see how it measures up.

The Pillars of a Business Pandemic Plan

by: ReginaPhelps

Thu Nov 05, 2009 at 15:31:53 PM EST

I recently wrote an article that has just appeared in the Disaster Resource Guide.  I have written hundreds of pandemic plans since 2003 and believe that pandemic plans are built upon four basic and distinct pillars:
1. Education and communication.
2. Personal protective equipment (PPE).
3. Facility cleaning.
4. Social distancing.
Download the article and compare your plan to these points.

H1N1(Swine Flu): WHO Ukraine Update #2; Family Pet Cat Infected with H1N1

by: ReginaPhelps

Thu Nov 05, 2009 at 07:25:22 AM EST

H1N1(Swine Flu):Cases In California Show Hospitalization Can Occur At All Ages, Severe Results

by: ReginaPhelps

Wed Nov 04, 2009 at 14:01:16 PM EST

H1N1(Swine Flu): Ukraine Update; Panic in Iraq Schools

by: ReginaPhelps

Tue Nov 03, 2009 at 14:35:01 PM EST

A total of 38 fatalities associated with severe manifestations of ARI have been registered. Preliminary epidemiological data analysis indicates that severe cases and deaths primarily occur among previously healthy young adults aged 20 - 50 years. Fatal and severe cases are reported to have sought medical attention 5 to 7 days after onset of symptoms.

H1N1(Swine Flu): Disturbing news from Ukraine, Schools Closed, Travel Restricted

by: ReginaPhelps

Mon Nov 02, 2009 at 09:49:10 AM EST

Rather disturbing information starting coming out of the Ukraine on Friday regarding H1N1.  The government has shut schools, banned large public gatherings and imposed travel restrictions for three weeks - some of the most drastic measures taken across the globe to contain H1N1- after confirming that a sudden and swift outbreak has claimed at least 50 lives and placed over 2000 in the hospital. Stories are confusing as to the number of cases, hospitalizations and deaths. News reports range wildly from 11 deaths to 100.  

H1N1(Swine Flu): This Weeks Flu View - Illness Continues to Spread, 22 Child Deaths This Week

by: ReginaPhelps

Sun Nov 01, 2009 at 15:35:15 PM EST

• Of all of the specimens tested by collaborating WHO laboratories and reported to CDC/Influenza Division, all subtyped influenza A viruses were the pandemic strain H1N1 virus.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• 22 influenza-associated pediatric deaths were reported.
o Nineteen of these deaths were associated with the pandemic strain H1N1 and three were associated with an influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was above the national baseline.  
• 48 states reported geographically widespread influenza activity, Guam and two states reported regional influenza activity, the District of Columbia and Puerto Rico reported local influenza activity, and the U.S. Virgin Islands did not report.

H1N1(Swine Flu): Young Kids Shed Virus Longer? And Timing for Antiviral Therapy

by: ReginaPhelps

Sat Oct 31, 2009 at 14:22:05 PM EDT

I belong to the Infectious Diseases Society of America (what a conversation starter that is at a cocktail party?!?!) and find much of their research most interesting.  ;-)  The Society has just released a couple of intriguing research papers at their national meeting in Philadelphia.  I thought they were worth exploring here online.

H1N1(Swine Flu): Trick or Treat? What are you doing about Halloween & H1N1?

by: ReginaPhelps

Thu Oct 29, 2009 at 06:31:33 AM EDT

H1N1(Swine Flu): To Prevent The Flu, What Cleaning Solutions Are Good? EPA Approved Cleaners For H1

by: ReginaPhelps

Wed Oct 28, 2009 at 07:41:01 AM EDT

A question often asked is what should I use to clean surfaces like desk tops, computer keyboards, doorknobs, handrails and other nonporous surfaces.  The EPA has a great guide on their website to help you identify antimicrobial products that are registered by the EPA to disinfect hard, non-porous surfaces that may be contaminated with the 2009-H1N1 flu.

H1N1(Swine Flu): New Online Flu Assessment Tool; UK predicts 1.5 M Cases Per Week at Peak

by: ReginaPhelps

Mon Oct 26, 2009 at 22:14:50 PM EDT

The American Medical Association (AMA) has launched an interactive Web site for the public to evaluate the severity of influenza symptoms of individuals or family members and share that information with their health care providers, who in turn can use the site to monitor their patients' symptoms.  Check it out and share it with your pandemic task force and HR department.

Obama Declares Swine Flu a National Emergency

by: ReginaPhelps

Sat Oct 24, 2009 at 12:27:15 PM EDT

President Barack Obama has declared the H1N1 Flu outbreak a national emergency.

The White House on Saturday said Obama signed a proclamation that would allow medical officials to bypass certain federal requirements. Officials described the move as similar to a declaration ahead of a hurricane making landfall.
Swine flu is more widespread now than it's ever been and has resulted in more than 1,000 U.S. deaths so far.
CDC said almost 100 children have died from H1N1, and 46 states now have widespread flu activity. The White House said Obama signed the declaration on Friday evening.

http://www.nytimes.com/aponlin...

Adjuvants and Cytokines II - The Meaning of 'Reactogenicity'

by: SusanC

Fri Oct 23, 2009 at 20:28:32 PM EDT

"We typically see, for effective adjuvants, increased reactogenicity, an FDA term for feverishness, sore arm at the site, which we typically see with non-adjuvanted vaccines but often see more in the presence of an adjuvant.

"I want to point out it is very unclear whether these ever correlate with more severe adverse events.  You know occasionally they do.  But we have not found, to date -- (unclear) but the flip side is it would be difficult to find, for example, that increased local reactogenicity or feverishness down the road increases the commonality of some of the more severe adverse events that we might be concerned about such as neurologic events.  

"There just aren't those data."

Jesse Goodman, Chief Scientist, FDA, Dec 2008
Workshop on Adjuvants and Adjuvanted Preventive
and Therapeutic Vaccines for Infectious Disease Indications

Part 1 is here http://www.newfluwiki2.com/dia...