In a health care system that rewards quantity over quality, rushed clinical encounters with physicians and pharmacists leave too little time to review drug risks and benefits says Jerry Avorn [Communicating Drug Benefits and Risks Effectively: There Must Be a Better Way. Jerry Avorn, MD, and William H. Shrank, MD, MSHS 21 April 2009 | Volume 150 Issue 8 | Pages 563-564]
This is not to mention a problematic mix of overpromotion, undercommunication, and inadequate regulation which has left many patients bewildered and mistrustful of prescriptions.
Avorn makes the case that as lay people and physicians increase their demands for coherent, evidence-based, unbiased drug information, we would all be well served by a comprehensive program to replace our current patchwork of bad communication and excessive promotion with a responsible national system of balanced, evidence-based, and user-friendly drug information.
Neither the package inserts nor the container labels offer as much help as they should says Avorn. Much discussion about drug information for lay people has focused on the package inserts; however, these documents are primarily written for physicians, not patients, and they are rarely inserted in the packages patients actually receive. Another source is the label affixed to the medication bottle. These communicate the name of the pharmacy in large type but vary greatly in their reporting of warnings (3) and instructions (4). When communicating essential safety information, container labels often use a font too small for many patients to read, and they often emphasize information more relevant to the pharmacist than the patient.
This reappraisal should not stop with evaluating patient-directed materials. Physicians need to learn about benefit and safety data through sources that are more useful than the tiny-print overkill that now constitutes these official documents (12–14). But as the work of Schwartz and colleagues points out, more than reformatting will be needed to create educational materials that guide physicians and patients in the right direction.
Using a Drug Facts Box to Communicate Drug Benefits and Harms-Two Randomized Trials Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS; and H. Gilbert Welch, MD, MPH 21 April 2009 | Volume 150 Issue 8 | Pages 516-527
Two randomized, controlled trials were conducted between October 2006 and April 2007 by Lisa M. Schwartz et al. This was a symptom drug box trial using direct-to-consumer ads for a histamine-2 blocker and a proton-pump inhibitor to treat heartburn, and a prevention drug box trial using direct-to-consumer ads for a statin and clopidogrel to prevent cardiovascular events.
In the symptom drug box trial, 70% of the drug box group and 8% of the control group correctly identified the PPI as being "a lot more effective" than the histamine-2 blocker (P < 0.001), and 80% and 38% correctly recognized that the side effects of the 2 drugs were similar (P < 0.001).
When asked what they would do if they had bothersome heartburn and could have either drug for free, 68% of the drug box group and 31% of the control group chose the proton-pump inhibitor, the superior drug (P < 0.001).
In the prevention drug box trial, the drug box improved consumers' knowledge of the benefits and side effects of a statin and clopidogrel. For example, 72% of the drug box group and 9% of the control group correctly quantified the benefit (absolute risk reduction) of the statin (P < 0.001). Most of the control participants overestimated this benefit, and 65% did so by a factor of 10 or more.
A drug facts box improved U.S. consumers' knowledge of prescription drug benefits and side effects. It resulted in better choices between drugs for current symptoms and corrected the overestimation of benefit in the setting of prevention.
Showing posts with label flu drugs. Show all posts
Showing posts with label flu drugs. Show all posts
Friday, May 29, 2009
Tuesday, May 12, 2009
Something Worse Than Swine Flu Is Gaining On Us
Last year, 131 cases of measles were reported nationally, the most since 1996, according to the U.S. Centers for Disease Control and Prevention in contrast to the first seven years of the decade, when only 63 cases were reported.
Experts say measles may be reestablishing itself in US. according the Washington Times (5/6/09, Goff) which reports, "While the uproar continues over a potential swine flu pandemic, there is a quiet controversy brewing about the return of an old disease that had once been nearly eradicated in the United States.”
Many people have the impression it is not a serious disease, but Measles kills three out of 1,000 people who develop it.
We should remember that 50 years ago - more than 100,000 children were hospitalized and 500 died annually. While in the decade before the U.S. measles vaccine program began in 1963, an estimated 3 million to 4 million people in this country were infected annually. Between 400 and 500 people died, 48,000 were hospitalized and another 1,000 developed a chronic disability from measles-related encephalitis, according to the CDC.
This is a brief review of Measles to remind us of what we may be facing if, as stated by a noted pediatrician, "this uptick in measles could be the sign of something bigger."
Many physicians have forgotten or have never experienced how dangerous measles could be.
Measles virus infection can cause a variety of clinical syndromes including:
• Severe measles,
• giant cell pneumonia, and
• measles inclusion body encephalitis in immunocompromised patients.
The incubation period of measles is generally asymptomatic and lasts from 10 to 14 days. The appearance of symptoms typically include fever, malaise, and anorexia, followed by conjunctivitis, coryza, and cough. Patients may develop an exanthem known as Koplik's spots. These hich are 1 to 3 mm whitish, grayish, or bluish elevations with an erythematous base, seen on the buccal mucosa typically opposite the molar teeth. The characteristic skin rash is maculopapular and blanches, beginning on the face and spreading centrifugally to involve the neck, upper trunk, lower trunk and extremities. The lesions may become confluent, especially in areas such as the face where the rash develops first.
This cranial-to-caudal progression of the rash is considered characteristic of measles.
Complications of Measles include
• Pneumonia — Patients with measles can develop secondary bacterial or viral pneumonia. In addition
• Coinfection with other viruses can occur especially with para influenza, and adenovirus, but also with cytomegalovirus, enterovirus, influenza, and respiratory syncytial virus.Measles has also been associated with the subsequent development of bronchiectasis, which can predispose to recurrent respiratory infections
• Acute disseminated encephalomyelitis — (ADEM, also known as post infectious or postvaccination encephalomyelitis); Post infectious encephalomyelitis presents soon after the initial clinical manifestations of measles have resolved. Past experience with measles epidemics identified a 10 to 20 percent mortality associated with ADEM. Furthermore, many survivors have residual neurologic abnormalities including behavior disorders, mental retardation, and epilepsy.
• Tracheobronchitis — Measles virus can involve the upper respiratory tract and cause laryngotracheobronchitis (ie, croup), with its attendant complications.
• Otitis media — When patients with measles develop otitis media, it is usually due to bacterial superinfection caused by the same bacterial pathogens that normally cause this infection.
• Since measles is a disseminated infection, involvement of other organ systems can occur, including corneal ulceration, myocarditis, pericarditis, hepatitis, mesenteric lymphadenitis, diarrhea, and appendicitis.
• Subacute sclerosing panencephalitis whereas subacute sclerosing panencephalitis (SSPE) presents seven to ten years after initial infection. It is a progressively fatal degenerative disease of the central nervous system. Its pathogenesis is not well understood, but persistent infection of the central nervous system with a genetic variant of measles virus may be involved. The typical patient with SSPE is under 20 years of age and develops SSPE seven to ten years after measles infection.
Why Is This Increased Frequency Of Measles Happening Now?
• A study in the United States in 1982 found a progressive fall in the number of cases of SSPE from 0.61 cases per million population in 1970 to 0.06 in 1980. The decline in SSPE cases paralleled the decline of measles cases, but with a lag time of several years.
• The estimated incidence of SSPE was 8.5 cases per one million cases of measles that occurred during 1960-1974.
• However, a follow-up study of cases of biopsy-proven SSPE identified from 1992 to 2003, suggests that the risk of this disease may now be 10-fold higher.
There was a resurgence of measles infection in the United States in 1989 to 1991 due to low overall vaccination rates.
• In 2008, CDC data indicate that "131 cases of measles were reported nationally, the most since 1996," with 63 of those incidences occurring in the "first seven years of the decade."
• The "CDC said that as of 2006, the most recent year numbers are available, 93 percent of American children had received the measles vaccine."
Yet, infectious disease experts say a vaccination rate of 95 percent is necessary to keep highly contagious diseases, such as measles, from becoming re-established in the US.
Moreover, because vaccine rates are much lower in many countries, even developed European countries," people's globe-trotting habits mean that Americans are far from protected.
This led the chief of infectious disease at the Children's Hospital of Philadelphia to opine that the U.S. may be seeing the crest of the vocal anti-vaccine movement, which has gained momentum over the past decade. The movement has been spurred by a feared link between vaccines and autism—which affects one in 150 children in the United States.
In 1998, a study by British researcher Andrew Wakefield looked at 12 children with autism and suggested that the onset of their symptoms was linked to receiving the MMR vaccine. Though it was later discovered that Dr. Wakefield misrepresented some of the data, his findings had a major impact.
As an example of what mis-information can do-Measles vaccination rates in the United Kingdom dropped almost immediately. In 1998, the year Dr. Wakefield's research was published in the Lancet medical journal, there were only 56 measles cases. The current rate of full MMR vaccine coverage for British children is only 77 percent. This resulted in 1,348 cases of measles in the U.K. last year, up 36 percent from 2007.
In the past decade, at least 20 studies have shown no link between the MMR vaccine and autism. And February 2009, a special federal court after a thorough review ruled in three test cases that there was no link between the vaccine and autism.
Despite the above factual evidence that measles vaccine does not cause autism and court rulings corroborating these facts, this growing anti-vaccine movement has not been dissuaded. In California, as in other states there are clusters of unvaccinated children, most of who are from upper-middle-class neighborhoods with supposedly educated parents. They have opted not to protect their children from measles.
“Vaccine refusal,” says the May 7, 2009 NEJM, “ not only increases the individual risk of disease but also increases the risk for the whole community. As a result of substantial gains in reducing vaccine-preventable diseases, the memory of several infectious diseases has faded from the public consciousness and the risk–benefit calculus seems to have shifted in favor of the perceived risks of vaccination in some parents' minds. If the enormous benefits to society from vaccination are to be maintained, increased efforts will be needed to educate the public.
SUMMARY & OPINION
In summary, vaccines are one of the greatest advances in medical history and in just the past 50 years, polio, measles, rubella, mumps, and Haemophilus influenzae type B disease have nearly disappeared in the U.S. Parents, however, are increasingly choosing to refuse vaccination of their children because of the fear of autism caused by vaccination, despite no credible evidence of an association.
• In the early 1980s, all 50 states required immunization.
• Rates of exemptions, however, for required school immunizations began to increase from about 1% in 1991 to 1.5% to 2.5% in 2004 despite the fact that unvaccinated children are significantly more likely to contract measles and pertussis than vaccinated children.
• Unvaccinated children are more likely to be white, live in higher-income households, and have a married mother with a college education.
• The Pediatric Committee on Bioethics advises against discontinuing care for families that refuse vaccines, 40% of pediatricians report that they will no longer provide care to families who refuse all vaccines.
• In view of the shift in perception about the safety of vaccines, we must remind our patients — and ourselves — that immunizations are responsible for saving more lives than virtually any other medical advance.
• Parental doubts about the safety of childhood vaccinations therefore are leading to outbreaks of largely eradicated diseases like measles and whooping cough.
A U.S. measles outbreak last year -- almost exclusively among unvaccinated people -- has sparked concern about places where many parents opt out of having their children vaccinated.
Too many abstainers can put a town at risk. Parents must realize that if children live in a community that has a cluster of refusers, their risk of getting a vaccine-preventable disease goes up, just by virtue of who they play with.
Eradicating a disease requires vaccinating a large percentage of the nearby population to stop infections from spreading -- what's called "herd immunity." Parents must understand that schools with many abstainers have been linked to outbreaks.
As an example in Colorado, schools with an outbreak of whooping cough in the 1990s had an average of 4.3% of students who had opted out of vaccination, compared with 1.5% at schools without an outbreak.
So stay alert for the post-Swine flu pandemics-the used to be common and very dangerous—Measles, Whooping Cough and all the rest of the killer diseases of the pre-vaccination era.
REFERENCES:
Recommended Immunization Schedules
http://www.cispimmunize.org/IZSchedule_Childhood.pdf
http://www.cispimmunize.org/IZSchedule_Adolescent.pdf
http://www.cispimmunize.org/IZSchedule_Catchup.pdf
JW Pediatr Adolesc Med Jan 28 2009
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Saturday, May 2, 2009
FOOD BORNE EPIDEMICS KILL 5,000 AMERICANS EACH YEAR.
The latest Swine flu scare is concentrating the minds of us all to illnesses initiated from animals in our food chain. We remained glued to CNN reporting on deaths from Swine flu. At this writing, only one death has occurred even though more are tragically expected. However, what we must also realize is that the US has regular epidemics of food borne illnesses, which annually kill hundreds of Americans.
Mead PS et al. [Food-related illness and death in the United States. Emerg Infect Dis. 1999 Nov-Dec; 5(6):840-2.] estimates that food borne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths.
Recent reported food-borne illnesses include Cyclosporiasis associated with imported raspberries, hepatitis A associated with green onions, Salmonella serotype Saint Paul infections associated with multiple raw produce items, Shiga toxin-producing Escherichia coli in beef cattle and their products and Salmonella infections associated with peanut butter and peanut butter-containing products.
L. R. Schiller [Food-borne infections in 2009 echoes this. Gastroenterology and Hepatology 6, 197-198 (April 2009) |doi:10.1038/nrgastro.2009.40]
Schiller tells us that the recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, it is increasingly difficult to control outbreaks and minimize their effect on health.
We live in a germy world, says Schiller. We have more bacterial cells in and on our bodies than we do human cells, and every day we are exposed to countless microorganisms: in the air that we breathe, on the surfaces we touch, in the water we drink, and in the food, we eat. Most of the time human mechanisms and barriers against germs work well, but sometimes they are weak or, in some cases, microorganisms evolve counterstrategies, and we become ill.
Despite 21st century improved sanitation, fecal–oral transmission of disease is still prevalent, even in the Western world, and as many as 9,000 Americans die each year from food-borne illnesses. Why? Globalization of food sources has made cases of imported disease more likely. Outbreaks of Cyclospora from imported raspberries, hepatitis A from green onions, salmonellosis from peppers, and Escherichia coli from meat and fruit juice have all been reported in the US.
A global network, which facilitates the spread of food-borne diseases. The centralization of food production has increased the potential for cross-contamination during processing, and broadened the distribution of contaminated products to millions of people.
The outbreak of Salmonella typhimurium associated with peanut butter and products containing it that took place in the US and Canada between September 2008 and January 2009 is a good example of this problem. A reported 529 people from 43 American states and 1 person from Canada were infected, and the contamination may have contributed to eight deaths. Prompt recognition of the outbreak by the Centers for Disease Control's PulseNet surveillance staff and local public-health partners led to identification of the source of the outbreak—a peanut processing plant in Georgia. What can be learned from this experience? About 40,000 laboratory-confirmed. However, only an estimated 3% of salmonella infections are laboratory-confirmed; therefore, about 1.2 million cases probably occur each year. During the 2003–2007 periods, an average of 18 S. typhimurium outbreaks was reported to the US Center for Disease Control each year. Industrialized food production thus can place millions at risk.
What might have been only a local problem with the recent peanut butter infections was magnified as its plant produced peanut butter and other peanut products that were distributed to over 2,000 food companies in the US and 23 other countries. This necessitated over 400 peanut-containing products were recalled because of potential contamination.
Food processing says Schiller must include sufficient safeguards to ensure that contaminants are not introduced during manufacture and that the integrity of systems is checked at critical junctures. If not then we can expect pandemics of food-borne illnesses to worsen. Clean transport and maintenance of a cold chain (when necessary) are essential and proper handling, cooling and preparation of food at stores and restaurants should be mandatory. In the home --clean preparation, avoidance of cross-contamination, thorough cooking, and chilling can all reduce the chance of pathogenic, food-borne bacteria being ingested. A simple step such as using a disposable paper towel on top of a cutting board will decrease the chances of the next food item on that cutting board from being infected too.
“We needn’t have been so surprised by the swine flu, and we must make sure that we are not caught off guard by the epidemics that will certainly follow it,” said
Nathan Wolfe, the director of the Global Viral Forecasting Initiative in an April 30, 2009 NYT OP-ED PIECE “How to Prevent a Pandemic”
He continued-
“Many federal agencies — including the Centers for Disease Control and Prevention, the United States Agency for International Development and the Department of Defense — as well as the World Health Organization are looking for ways to stop pandemics early. Nevertheless, much more work is needed. To establish a worldwide safety net, we would need to devote more resources to expanding disease surveillance in people and in wild and domestic animal populations throughout the world. Our current global public health strategies are reminiscent of cardiology in the 1950s — when doctors focused solely on responding to heart attacks and ignored the whole idea of prevention.”
According to reports “State and federal officials intensifying their response to the swine flu outbreak with President Obama asking Congress for $1.5 billion in supplemental funding.
”Since Obama’s staff director has been quoted as saying something to the effect that “a crisis should be taken advantage of, perhaps this is the time to spend some of this money answering the question of where in the community are various infectious agents being harbored, and also how to curtail the transmission of infectious agents.
Mead PS et al. [Food-related illness and death in the United States. Emerg Infect Dis. 1999 Nov-Dec; 5(6):840-2.] estimates that food borne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths.
Recent reported food-borne illnesses include Cyclosporiasis associated with imported raspberries, hepatitis A associated with green onions, Salmonella serotype Saint Paul infections associated with multiple raw produce items, Shiga toxin-producing Escherichia coli in beef cattle and their products and Salmonella infections associated with peanut butter and peanut butter-containing products.
L. R. Schiller [Food-borne infections in 2009 echoes this. Gastroenterology and Hepatology 6, 197-198 (April 2009) |doi:10.1038/nrgastro.2009.40]
Schiller tells us that the recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, it is increasingly difficult to control outbreaks and minimize their effect on health.
We live in a germy world, says Schiller. We have more bacterial cells in and on our bodies than we do human cells, and every day we are exposed to countless microorganisms: in the air that we breathe, on the surfaces we touch, in the water we drink, and in the food, we eat. Most of the time human mechanisms and barriers against germs work well, but sometimes they are weak or, in some cases, microorganisms evolve counterstrategies, and we become ill.
Despite 21st century improved sanitation, fecal–oral transmission of disease is still prevalent, even in the Western world, and as many as 9,000 Americans die each year from food-borne illnesses. Why? Globalization of food sources has made cases of imported disease more likely. Outbreaks of Cyclospora from imported raspberries, hepatitis A from green onions, salmonellosis from peppers, and Escherichia coli from meat and fruit juice have all been reported in the US.
A global network, which facilitates the spread of food-borne diseases. The centralization of food production has increased the potential for cross-contamination during processing, and broadened the distribution of contaminated products to millions of people.
The outbreak of Salmonella typhimurium associated with peanut butter and products containing it that took place in the US and Canada between September 2008 and January 2009 is a good example of this problem. A reported 529 people from 43 American states and 1 person from Canada were infected, and the contamination may have contributed to eight deaths. Prompt recognition of the outbreak by the Centers for Disease Control's PulseNet surveillance staff and local public-health partners led to identification of the source of the outbreak—a peanut processing plant in Georgia. What can be learned from this experience? About 40,000 laboratory-confirmed. However, only an estimated 3% of salmonella infections are laboratory-confirmed; therefore, about 1.2 million cases probably occur each year. During the 2003–2007 periods, an average of 18 S. typhimurium outbreaks was reported to the US Center for Disease Control each year. Industrialized food production thus can place millions at risk.
What might have been only a local problem with the recent peanut butter infections was magnified as its plant produced peanut butter and other peanut products that were distributed to over 2,000 food companies in the US and 23 other countries. This necessitated over 400 peanut-containing products were recalled because of potential contamination.
Food processing says Schiller must include sufficient safeguards to ensure that contaminants are not introduced during manufacture and that the integrity of systems is checked at critical junctures. If not then we can expect pandemics of food-borne illnesses to worsen. Clean transport and maintenance of a cold chain (when necessary) are essential and proper handling, cooling and preparation of food at stores and restaurants should be mandatory. In the home --clean preparation, avoidance of cross-contamination, thorough cooking, and chilling can all reduce the chance of pathogenic, food-borne bacteria being ingested. A simple step such as using a disposable paper towel on top of a cutting board will decrease the chances of the next food item on that cutting board from being infected too.
“We needn’t have been so surprised by the swine flu, and we must make sure that we are not caught off guard by the epidemics that will certainly follow it,” said
Nathan Wolfe, the director of the Global Viral Forecasting Initiative in an April 30, 2009 NYT OP-ED PIECE “How to Prevent a Pandemic”
He continued-
“Many federal agencies — including the Centers for Disease Control and Prevention, the United States Agency for International Development and the Department of Defense — as well as the World Health Organization are looking for ways to stop pandemics early. Nevertheless, much more work is needed. To establish a worldwide safety net, we would need to devote more resources to expanding disease surveillance in people and in wild and domestic animal populations throughout the world. Our current global public health strategies are reminiscent of cardiology in the 1950s — when doctors focused solely on responding to heart attacks and ignored the whole idea of prevention.”
According to reports “State and federal officials intensifying their response to the swine flu outbreak with President Obama asking Congress for $1.5 billion in supplemental funding.
”Since Obama’s staff director has been quoted as saying something to the effect that “a crisis should be taken advantage of, perhaps this is the time to spend some of this money answering the question of where in the community are various infectious agents being harbored, and also how to curtail the transmission of infectious agents.
Monday, April 27, 2009
How to Confirm Suspected Swine Flu
Swine Flu information resources that are frequently updated:
Google maps has a nice tool for tracking swine flu.
http://maps.google.com/maps/ms?ie=UTF8&hl=en&t=p&msa=0&msid=106484775090296685271.0004681a37b713f6b5950&z=2
There's also HealthMap which tracks all kinds of outbreaks:
http://www.healthmap.org/en
For those of you who follow events on social media sites, CDC has a Twitter feed that contains updates on the Swine Flu:
http://twitter.com/cdcemergency
If you are interested in the view from overseas - European Centre for Disease Prevention and Control
http://ecdc.europa.eu/
Swine Flu Virus-What I Tell My Patients
Many of my patients are calling for more information about about the new Swine Flu. This is what I tell them.
Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. That’s why having taken the human flu vaccine last season may theoretically help you in with this flu-but only a bit because this new strain of influenza virus has been identified as containing a combination of two parts swine, one part avian, and one part human influenza virus genes.
How is this New Virus Transmitted?
The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person. There is no vaccine yet for the new virus.
The 20 confirmed cases in the U.S. young students are all recovering (with only 1 case requiring hospitalization) in contrast to many of the deaths in Mexico which seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu.
Precautions
The usual precautions for patients apply:
• Sneeze and cough into tissues and throw the tissues in the trash.
• Wash your hands or use alcohol-based hand cleaners frequently.
• On greeting people, don’t shake hands or exchange kisses.
Contagious period
People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home.More updated information from the CDC is available at http://www.cdc.gov/swineflu/.
Symptoms
The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, sore muscles, running nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. Also dizziness has been a prominent symptom. A symptom indicating a more severe disease is breathlessness. If this occurs seek medical attention immediately.
Treatment
The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms.
Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. That’s why having taken the human flu vaccine last season may theoretically help you in with this flu-but only a bit because this new strain of influenza virus has been identified as containing a combination of two parts swine, one part avian, and one part human influenza virus genes.
How is this New Virus Transmitted?
The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person. There is no vaccine yet for the new virus.
The 20 confirmed cases in the U.S. young students are all recovering (with only 1 case requiring hospitalization) in contrast to many of the deaths in Mexico which seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu.
Precautions
The usual precautions for patients apply:
• Sneeze and cough into tissues and throw the tissues in the trash.
• Wash your hands or use alcohol-based hand cleaners frequently.
• On greeting people, don’t shake hands or exchange kisses.
Contagious period
People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home.More updated information from the CDC is available at http://www.cdc.gov/swineflu/.
Symptoms
The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, sore muscles, running nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. Also dizziness has been a prominent symptom. A symptom indicating a more severe disease is breathlessness. If this occurs seek medical attention immediately.
Treatment
The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms.
• Swine Flu Update: What to Expect from Doctors & Public Health Professionals
• Swine Flu Update: What to Expect from Doctors & Public Health Professionals from the Centers for Disease Control and Prevention; 1600; Clifton Rd; Atlanta, GA 30333; 800-CDC-INFO; (800-232-4636); TTY: (888) 232-6348
• cdcinfo@cdc.gov
Doctors
Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
State Public Health Laboratories
Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.
Public Health /Animal Health Officials
Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.
Guidance Documents
• Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009
• Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009
• Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus Apr 26, 2009, 11:45 PM ET
• Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 26, 2009
• cdcinfo@cdc.gov
Doctors
Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
State Public Health Laboratories
Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.
Public Health /Animal Health Officials
Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.
Guidance Documents
• Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009
• Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009
• Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus Apr 26, 2009, 11:45 PM ET
• Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 26, 2009
Sunday, April 26, 2009
Swine Flu Public Health Emergency –What To Look For; What To Do.
A public health emergency was declared today in the U.S. as 20 cases of the disease were confirmed in this country. The Centers for Disease Control, in a news conference in Washington stated, “We expect to see more cases of swine flu. Homeland Security Secretary Janet Napolitano, speaking at the same news conference called the emergency declaration a “declaration of emergency preparedness.” However, experts at the WHO will wait until Tuesday before meeting to decide if it should increase its rating of the seriousness of the pandemic potential from the current level three to level four - which would indicate a "significant increase in risk of a pandemic.” Officials said they had confirmed eight cases in New York, seven in California, two in Kansas, two in Texas and one in Ohio, and that the cases looked to be similar to the deadly strain of swine flu that has killed more than 80 people in Mexico and infected 1,300 more. This was amid further reports of potential new cases from New Zealand to Hong Kong to Spain, raising concerns about the potential for a global pandemic. Canada also confirmed six cases of the flu. Swine flu was also likely in 10 New Zealand students.
WHAT TO LOOK FOR:
The symptoms of swine flu are nearly identical to the symptoms of other influenza, including high fever, aches, coughing, and congestion. It appears to spread through human-to-human contact and human contact with live pigs but not by eating pork products.
WHAT TO DO if pandemic is declared by WHO
-Interim Guidance for Swine influenza A (H1N1)
• Wash hands frequently
• stay home
• don't board airplanes, if you feel sick
• Keep sick children out of school.
• Use Facemasks
• Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
• If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask)
• An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods.
• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor.
• Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they do not touch anything else.
• Avoid re-using disposable facemasks and N95 respirators if possible.
• If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
• Ask your doctor whether you are a candidate for Tamiflu or Relenza.
• Do not take any drugs or medications prophylactic ally without your doctor’s permission.
WHAT TO LOOK FOR:
The symptoms of swine flu are nearly identical to the symptoms of other influenza, including high fever, aches, coughing, and congestion. It appears to spread through human-to-human contact and human contact with live pigs but not by eating pork products.
WHAT TO DO if pandemic is declared by WHO
-Interim Guidance for Swine influenza A (H1N1)
• Wash hands frequently
• stay home
• don't board airplanes, if you feel sick
• Keep sick children out of school.
• Use Facemasks
• Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
• If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask)
• An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods.
• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor.
• Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they do not touch anything else.
• Avoid re-using disposable facemasks and N95 respirators if possible.
• If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
• Ask your doctor whether you are a candidate for Tamiflu or Relenza.
• Do not take any drugs or medications prophylactic ally without your doctor’s permission.
Saturday, April 25, 2009
FACTS ABOUT THE NEW SWINE FLU EPIDEMIC
Is Mexico city ground zero for a global epidemic of a new kind of flu — a strange mix of human, pig and bird viruses?
The illnesses breaking out in Mexico currently have epidemiologists at the U.S. Centers for Disease Control and Prevention deeply concerned. The World Health Organization [W.H.O.] says there have been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Doctors have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. The most notorious flu pandemic, thought to have killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults. Scientists have long been concerned that a new killer flu could evolve when different viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Most of Mexico’s dead are young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest. The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs. But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.
FACTS:
• Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.
• Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.
• From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States.
• Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing.
• The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.
• Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to , a W.H.O. spokesman.
• Tests show 20 people in Mexico have died of the new swine flu strain, and that 48 other deaths were probably due to the same strain.
• The caseload of those sickened has grown to 1,004 in Mexico.
• The same virus also sickened at least eight people in Texas and California, though there have been no deaths yet in the U.S.
• If the confirmed deaths are the first signs of a pandemic, then cases are probably incubating around the world by now, says a pandemic flu expert.
• The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention.
• This similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.
This swine flu and regular flu can have similar symptoms — mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea.
UP-TO-DATE ACTIONS ON SWINE FLU
The World Health Organization has convened an emergency expert panel to consider whether to declare the outbreak an international public health emergency — a step that could lead to travel advisories, trade restrictions and border closures.
• The CDC and Canadian health officials were studying samples sent from Mexico, and some governments around Latin America said they would monitor passengers arriving on flights from Mexico.
• No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.
• Actually producing the vaccines could take months.
• The relatively good news is--CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.
• anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain should seek medical attention.
• When a new virus emerges, it can sweep through the population.
• The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.
• Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.
LINKS TO MORE FACTS
General Information about Swine Flu
Questions and answers and guidance for treatment and infection control
Human Swine Flu Investigation Apr 24, 2009
Information about the investigation of human swine flu in California
Swine Influenza: General Information
Swine Flu and You Apr 24, 2009
What is swine flu? Are there human infections with swine flu in the U.S.?
Swine Flu Video Podcast Apr 25, 2009
Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.
Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
How does swine flu spread? Can people catch swine flu from eating pork?
The illnesses breaking out in Mexico currently have epidemiologists at the U.S. Centers for Disease Control and Prevention deeply concerned. The World Health Organization [W.H.O.] says there have been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Doctors have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. The most notorious flu pandemic, thought to have killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults. Scientists have long been concerned that a new killer flu could evolve when different viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Most of Mexico’s dead are young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest. The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs. But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.
FACTS:
• Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.
• Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.
• From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States.
• Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing.
• The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.
• Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to , a W.H.O. spokesman.
• Tests show 20 people in Mexico have died of the new swine flu strain, and that 48 other deaths were probably due to the same strain.
• The caseload of those sickened has grown to 1,004 in Mexico.
• The same virus also sickened at least eight people in Texas and California, though there have been no deaths yet in the U.S.
• If the confirmed deaths are the first signs of a pandemic, then cases are probably incubating around the world by now, says a pandemic flu expert.
• The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention.
• This similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.
This swine flu and regular flu can have similar symptoms — mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea.
UP-TO-DATE ACTIONS ON SWINE FLU
The World Health Organization has convened an emergency expert panel to consider whether to declare the outbreak an international public health emergency — a step that could lead to travel advisories, trade restrictions and border closures.
• The CDC and Canadian health officials were studying samples sent from Mexico, and some governments around Latin America said they would monitor passengers arriving on flights from Mexico.
• No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.
• Actually producing the vaccines could take months.
• The relatively good news is--CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.
• anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain should seek medical attention.
• When a new virus emerges, it can sweep through the population.
• The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.
• Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.
LINKS TO MORE FACTS
General Information about Swine Flu
Questions and answers and guidance for treatment and infection control
Human Swine Flu Investigation Apr 24, 2009
Information about the investigation of human swine flu in California
Swine Influenza: General Information
Swine Flu and You Apr 24, 2009
What is swine flu? Are there human infections with swine flu in the U.S.?
Swine Flu Video Podcast Apr 25, 2009
Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.
Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
How does swine flu spread? Can people catch swine flu from eating pork?
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