Wednesday, November 17, 2004

Do you have the flu, or something else?

Many people complain they're down with the 'flu' without really knowing whether it's influenza or not. While browsing my new Google ad sense banner (see left lower gutter) , I found a link to QuickVue, a test for influenza which I never knew existed (or had forgotten existed). It uses a nasal swab (and obtaining a sample is therefore less noxious than getting a Rapidstrep test) and takes about ten minutes to give a result. I have no information on cost.

Thursday, November 11, 2004

Flu Vaccine Shortage A Blessing In Disguise?

The flu vaccine shortage of 2004 has focused national (if not world) attention on how we produce influenza vaccines, which companies produce them, and how vulnerable our present system is to interuptions. We haven't seen a major flu pandemic like those of 1918 or 1957 or 1968 yet. It's quite possible that changes to the system that result from the current shortage will make us more prepared for the next pandemic, whenever it comes. We may be seeing the early stages of it in Thailand and Vietnam in the form of bird flu....

Weathering the Influenza Vaccine Crisis

NEJM: Weathering the Influenza Vaccine Crisis

""Influenza vaccine is especially vulnerable to interruptions in supply, because of the unique features of influenza-vaccine production. Unlike any other vaccine, influenza vaccine must be reformulated to keep pace with antigenic changes in the hemagglutinin and neuraminidase proteins of influenzaviruses — essentially necessitating the manufacture of a brand new product from scratch every year. The process is a long one, beginning with the identification of new antigenic variants in the autumn of the previous year and the selection of the strains for inclusion in the vaccine, and proceeding to the generation of appropriate reference reagents, the production and purification of the vaccine antigens, and packaging and distribution, all within a period of six to eight months.""

Thursday, November 4, 2004

Changing Shot Technique May Extend Flu Vaccine (Los Angeles Times)

Changing Shot Technique May Extend Flu Vaccine (Los Angeles Times):

""Los Angeles Times - Supplies of the influenza vaccine could be expanded by up to five times by changing how the shot is given — administering a small dose under the skin rather than a larger dose into muscle, two teams of researchers reported Wednesday.""

[Via Yahoo! News: Top Stories]

Sunday, October 31, 2004

WHO Calls Summit to Address Flu Pandemic

WHO Calls Summit to Address Flu Pandemic:

""The World Health Organization has called an unprecedented summit meeting next week of flu vaccine makers and nations to expand plans for dealing with the growing threat of a flu pandemic.Sixteen vaccine companies and health officials from the United States and other large countries already have agreed to attend the summit in Geneva, Switzerland, on Nov. 11, said Klaus Stohr, influenza chief of the United Nations' health agency.With increasing signs that bird flu is becoming established in Asia and several worrisome human cases that can't be linked directly to exposure to infected poultry, it's only a matter of time until such a virus adapts itself to spread more easily from person to person and cause a severe worldwide outbreak, he said.""

[Via My Way News]

Monday, October 25, 2004

CDC: What Everyone Should Know About Flu and the Flu Vaccine

CDC: What Everyone Should Know About Flu and the Flu Vaccine

New Interim Guidelines Address Use of Antiviral Medications for Influenza

Influenza Antiviral Medications: 2004-05 Interim Chemoprophylaxis and Treatment Guidelines

""Influenza antiviral medications are an important adjunct to influenza vaccine in the prevention and treatment of influenza. In the setting of the current vaccine shortage, CDC has developed interim recommendations on the use of antiviral medications for the 2004-05 influenza season. These interim recommendations are provided, in conjunction with previously issued recommendations on use of vaccine, to reduce the impact of influenza on persons at high risk for developing severe complications secondary to infection.""

[Via Medscape Headlines]

How To Reduce The Risk Of Catching The Flu

From the JCAHO:

New National Campaign Offers Americans Three Easy Steps To Prevent Infections

The Joint Commission urges Americans to do three easy things to limit the spread of respiratory infections in health care settings and communities.

  • Clean your hands – Rub hands vigorously with soap and warm water for at least 15 seconds after using the bathroom, taking out the trash, changing a diaper, or before handling food. Use of alcohol-based hand sanitizers is an acceptable alternative. Americans should also not hesitate to ask their doctors, nurses, dentists or other caregivers whether they have cleaned their hands before rendering care. It is also important that your hands be clean when caring for a sick friend or family member at home.
  • Cover your mouth and nose – To stop the spread of infectious diseases through sneezes and coughs, cover your mouth and nose with a tissue, your hands, or the crook of your elbow. Then, remember to wash your hands.
  • Avoid close contact – A fever or symptoms of a contagious illness are clear signs to you or your child to stay at home and away from other people, either at work or at school. If you are sick and go to work or school, you place others at risk for getting sick as well.

Sunday, October 17, 2004

Coping Strategy For Lack Of Flu Vaccinations

In discussing the issue of influenza vaccinations with your doctor, you should be aware that there are ways to treat the flu once you get it. One drug is called Tamiflu (oseltamivir phosphate). Relenza (Zanamivir) is another. Tamiflu comes in capsule and oral suspension form whereas Relenza is inhaled via 'diskhaler'. These drugs interfere with the ability of Influenza A and B to aggregate and be released from cells. Both are 'designer drugs' in that their molecular structures were created in the lab specifically for their anti-neuraminidase activity:

""What is Tamiflu used for?

Tamiflu is for treating adults, adolescents, and pediatric patients 1year of age and older with the flu whose flu symptoms started within the last day or two. Tamiflu is also used to reduce the chance of getting the flu in people age 13 and older who have a higher chance of getting the flu because they spend time with someone who has the flu. Tamiflu can also reduce the chance of getting the flu if there is a flu outbreak in the community." "


Though clearly not a substitute for flu shots, their lack of availability makes having a 'Plan B' necessary. If history is any guide, Tamiflu and Relenza will become commodity drugs just like ciprofloxacin was after the Anthrax scare.

Rush Limbaugh Is Playing The Blame Game

Michelle Malkin has a quick note on the flu vaccine shortage, and points to a Rush Limbaugh piece: Clintons Ruined Vaccine Industry. Rush basically argues that it's all Hillary's fault because of her role in the Government Vaccine Buying Program. This is a classic case of hindsight bias; the tendency of people with outcome knowledge to exaggerate the extent to which they would have predicted the event beforehand. Yes, I'm sticking up for Hillary here. It IS a powerful example of why the approach taken by the vaccine buying program is flawed. What we should be doing is asking ourselves whether we need to make changes vis-a-vis our other vaccine programs.

The October 14, 2004 Wall Street Journal editorial 'Infectious Politics' (reproduced here) has some disturbing statistics:

  • Hib1 3
  • Influenza 2
  • Hepatitis A 2
  • Hepatitis B 2
  • DTaP2 2
  • Measles, mumps, rubella 1
  • Tetanus 1
  • Tetanus-diphtheria 1
  • Polio 1
  • Chickenpox 1
  • Pneumococcal conjugate (children) 1
  • Pneumococcal polysaccharide (adults) 1
  • Meningococcal 1

and asks the question:

" "Whether or not Chiron disclosed enough about its manufacturing woes is an issue of financial regulation. The main question for public health ought to be how did we arrive at a place where closing a single plant can endanger so many people?" "

Let's stop playing the blame game and figure out how to improve our vaccine production system. To again quote the WSJ piece:

" "There's no shortage of ideas for how to promote greater vaccine production, with many of the best ideas coming from the few manufacturers that remain. Now would be a good time to hear them out. As deadly as the flu is, consider the dangers of such infectious diseases as measles or whooping cough. Those are the next outbreaks to worry about if Washington keeps blaming everyone but itself for the vaccine crisis." "

Lancet: Summary of Flu Vaccine Woes

The Lancet: Vaccine preparedness, or not:

The problem

" "So, what went wrong at Chiron's production plant in Liverpool, UK? On Aug 26, according to Chiron, Serratia marcescens was found in a "small number of lots". The company informed health agencies in the UK and USA, and planned to delay release of the vaccine until early October while it tried to resolve the contamination issue. S marcescens is an important human pathogen because of the growing number of cases of infection by this organism, its virulence, and its increasing resistance to antibiotics. MHRA visited the Liverpool site, and Chiron thought it could address the concerns of the inspectors. The problem, says MHRA, is that the contaminated lots cannot be separated from the whole batch." "

The lesson:

" "There is a lesson here, about vaccine supply. It is not sensible to restrict manufacturing licences, in the case of influenza vaccine and especially in the USA, to two suppliers. At a blow, half this year's stocks were impounded. The risk (of faulty batches) should be spread across several manufacturers." "

Saturday, October 16, 2004

Vaccines: The Long Run

Vaccines: The Long Run:

" "Yesterday I discussed some of the reasons for the current shortage. Today, I will discuss an important paper by Michael Kremer and Christopher Snyder. Kremer and Snyder argue that for the same cost and effectiveness drugs are more profitable to produce than vaccines. As a result, private incentives bias the market against vaccines." "

[Via Marginal Revolution]

Friday, October 15, 2004

Yahoo! News - No Chance of Chiron Vaccine, U.S. Says

Yahoo! News - No Chance of Chiron Vaccine, U.S. Says:

" "None of Chiron Corp.'s flu vaccine made at a British plant is safe, which means the U.S. flu vaccine supply will be half of what was expected, U.S. health officials said on Friday." "

Serratia contamination.

Yahoo! News - Fines, Jail Used to Enforce Flu Shot Rules

Yahoo! News - Fines, Jail Used to Enforce Flu Shot Rules:

" "As the vaccine shortage hits home and long lines queue around the supermarket, a handful of states and the nation's capital are threatening doctors and nurses with fines or even jail if they give flu shots to healthy, low-risk people.

Health care violators in Michigan face a misdemeanor punishable by up to six months in jail and a $200 fine if convicted, the health director said.

At least four other states %u2014 Massachusetts, New Mexico, Oregon and Wisconsin %u2014 and Washington, D.C., have issued similar orders with varying penalties." "

Thursday, October 14, 2004

Vaccines: The Short Run

From a new weblog I discovered today:

Vaccines: The Short Run:

""President Bush was correct when he said that liability risk is one factor in the recurrent shortage of vaccines...
Liability is not the only issue, however. Costly FDA regulations and requirements, for example to remove thimerosal from vaccines despite no evidence of safety problems, have pushed firms out of the industry.

A further problem is that the federal government is the major purchaser of vaccines, although not the flu vaccine, and it uses its monopsony powers and the law to require companies to sell at low prices. Firms have left the industry because they are squeezed on one end by regulation and on the other by low prices and, for vaccines like the flu vaccine not covered by VICP, potential liability. Note that even if the prices are high enough to earn the company a modest profit the point is that they are not high enough to make it worthwhile to make a surplus of vaccine that can be sold in the event of a contamination problem, as has happened this year. If the firms can't price high during a shortage then there is no incentive to plan for a shortage.""

[Via Marginal Revolution]

Tuesday, October 12, 2004

CDC Posts Interim Guidelines for Influenza Vaccination

CDC Posts Interim Guidelines for Influenza Vaccination

[Via Medscape Headlines]

U.S. Health Officials Release National Flu Pandemic Plan

U.S. Health Officials Release National Flu Pandemic Plan:

""The Dept of Health and Human Services recently released its plan to respond to and prepare for an influenza pandemic, detailing domestic actions as well as its role in the global health community.
The Nation's Health""

[Via Medscape Headlines]

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