Flu Preview – Summer 2010

It seems that over the past several months, influenza has disappeared. However, that is only an illusion. There has been noticeable activity in the southeast US. Novel H1N1 virus has been circulating along with H3N2 and influenza type B viruses. Influenza season is underway in the southern hemisphere. There are some important facts to keep in mind as we approach the new influenza season in our area.

1. Get your seasonal influenza vaccine this year. While CDC has not endorsed mandatory influenza vaccination for healthcare workers, it is one preventative action you can take to protect yourself from developing influenza.

2. The influenza vaccine this year contains 3 viruses: H1N1, H3N3, and Type B. Since the viruses mutate frequently, immunization every year is required to maintain immunity to the currently circulating viruses. Last year’s vaccine will not be close enough to the circulating strains to be fully protective.

3. CDC now recommends surgical face masks can be used for routine patient care, not the N95 respirators that were in short supply during last year’s influenza season. All of the professional infection prevention professional organizations have been making this recommendation all along.

4. The H1N1 vaccine used specifically to prevent the pandemic flu has proven to be very safe. A study looking at the risk for developing Guillain Barre syndrome following vaccination with H1N1 vaccine is comparable to that seen with seasonal influenza vaccines (about 0.8 cases per million vaccinations). In contrast, there were 10 cases per million seen in the 1976 swine flu vaccine program.

5. About 40 million doses of H1N1 vaccine from the last flu season expired and have been discarded. That is 25% of the 162 million doses purchased. this illustrates the difficulty in accurately predicting how much vaccine will be required to immunized those willing to take the vaccine. There are 32 million doses that will expire next year and are available for use if H1N1 appears earlier than this years seasonal vaccine.

I will be providing updates and summarizes concerning influenza activity and how we might be affected as citizens living on the Cape and for healthcare workers at Cape Cod Hospital and Falmouth Hospital.

As always, I am available to discuss this and other infectious disease topics and to answer questions.

Alan Sugar

2009 H1N1 Influenza

It has been several months since my last entry. H1N1 seems to have disappeared from view. However, it is not gone. There has been an increase in cases in the southeast US, particularly in Georgia. Is this a harbinger of things to come? Will the virus now spread to the rest of the country or beyond our borders? No one really knows and this situation bears close watch.

Now is the time to make sure that you and your families have been immunized against 2009 H1N1 influenza. There is no better way to protect yourself and there is fair warning here that the virus has not disappeared.

I will continue with these updates as the situation warrants. I am also glad to answer your questions as part of this blog.

Alan Sugar, M.D.

The Pandemic Recedes

While the supply of H1N1 vaccine continues to be distributed and people continue to be immunized with it, the number of cases of H1N1 influenza has declined to very low levels. What will happen next is not clear and the more people who receive the H1N1 vaccine, the better off we all will be.

As a result of the decrease in new cases of H1N1 influenza, we at Cape Cod Healthcare have stopped restricting those less than 18 years of age from visiting the hospital. This is a welcome development, since not only were visitors kept from entering the hospital, those students interested in volunteering or experiencing what a life in medicine means were also kept from those activities.

We should remain aware that the virus may return in its present form or in a modified, mutated, form. This could mean a new wave of many sick people and the severity of such illness is impossible to predict at this time.

Happy New Year.

Alan Sugar

Vaccine, Seasonal Flu, and Other Items

The news media continues to be reporting on issues surrounding H1N1 influenza. Several days ago, a batch of vaccine destined for children was recalled because of decreased in potency in specific lots of the vaccine manufactured by Sanofi Pasteur. However, this does not mean that the vaccine is not going to work and the chances are extremely good that when the second injection is given to the children, most, if not all, will have protective levels of antibodies. So there is no reason for panic about this.

There also is a new prediction that the usual seasonal flu will not be circulating this year as a result of the continued activity of H1N1 influenza and the very high levels of people actually getting immunized against seasonal and H1N1 influenza. It is hard to accurately predict what will happen, but this happens to make sense.

Over the past 6 weeks, the numbers of new H1N1 infections has continued it weekly decrease. That is good news as I, and others, have pointed out. Deliveries of H1N1 vaccine continue and there seems to be more acceptance of the vaccine, with many people arranging for their families and themselves to receive the vaccine.

CDC reported last week that H1N1 infected 50 million people in the U.S. and killed an estimated 10,000 through Nov. 14 from the start of the pandemic in April. About 90 percent of swine flu deaths were among people younger than 65. With seasonal flu, the effects are reversed, with more than 90 percent of annual deaths among those ages 65 or older. Officials at the World Health Organization (WHO) said that it is too early to make the call that the pandemic is over, especially since there are areas still experiencing high attack rates.

Stay tuned; we are not finished with H1N1 just yet.

The Pandemic Continues

Some interesting developments on the H1N1 influenza front.

The total number of new cases continues to decline. However, there have been some ominous developments.

First, a report from Viet Nam describes 7 people who were on a train and who developed H1N1 influenza infection. What is interesting here is that 6 were students on 1 train and there was another individual in another car on the same train. These 7 people had Tamiflu resistant H1N1 viruses. All 7 got sick with the flu and all recovered. To date, there have been about 100 Tamiflu resistant strains identified.

Second, In China, 8 people have been infected with H1N1 influenza virus that has mutated from the wild type. All of these strains have been susceptible to Tamiflu and the vaccine is expected to be effective against these strains. There are not many details yet about this report and it appears that the 8 cases were scattered throughout China and not part of an outbreak.

The important point with these reports is that the virus is a dynamic, living organism and that even though new cases of infection  are decreasing, the virus is doing what it does best, changing  its features based on mutations as it reproduces. We have to continue to respect what this virus is capable of and continue to use good respiratory hygiene and vaccinate those people who are at highest risk of serious infection. Fortunately, we have a good supply of H1N1 vaccine available, with more coming.

I don’t think we have heard the last of  2009 H1N1 influenza.

Update

For the fourth week in a row, the number of cases of novel H1N1 influenza has continued to decrease. This is good news as we await additional batches of H1N1 vaccine. However, we are still seeing people in the ICU with serious respiratory illness due to influenza and serious illness in the community continue to be reported.

 

Here is a link about antiviral medications that you might find interesting.

http://www.cdc.gov/h1n1flu/antivirals/quickfacts.htm

 

Influenza Update

Reports in the national media indicate that there appears to be a decrease in the number of newly diagnosed cases of novel H1N1 influenza. While this is good news, the virus has been and is so unpredictable, that we do not know whether this decrease will be sustained or whether there will be another increase. The good news is that if cases continue to decrease, even if another wave of new cases should appear, it will give the vaccine companies time to distribute more H1N1 vaccine.

From the local perspective, there have been at least 4 cases of type B influenza identified. This means that the only known circulating viruses on the Cape are novel H1N1 and Type B influenza. Seasonal Type A influenza has yet to appear on the Cape and in Massachusetts.

Welcome to the new venue

It turns out that the old blog address did not have notification features. This new website, however, will allow you to get email notifications when I post new content.

I hope this works for everyone.

Update on the Status of the Pandemic

CDC has released the latest figures relating to the activity of influenza in the United States. The important points are:

• About 1/3 of specimens tested by various surveillance laboratories were positive for influenza
• All of the subtyped influenza A viruses were 2009 H1N1 influenza (swine flu) [That means there has not yet been circulating “seasonal” influenza A detected by these laboratories.]
• The proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold for the sixth consecutive week.
• Thirty-five influenza-associated pediatric deaths were reported. Twenty-six of these deaths were associated with 2009 influenza A (H1N1) virus infection, eight were associated with an influenza A virus for which the subtype was undetermined, and one was associated with an influenza B virus infection.
• The proportion of outpatient visits for influenza-like illness (ILI) was 6.7% which is above the national baseline of 2.3%. All 10 regions reported ILI above region-specific baseline levels.
• Forty-six states reported geographically widespread influenza activity.

Even though there was continued brisk influenza activity,there was a slight decrease in the number of reported cases. It is hard to know what this means. It could indicate that we have reached the peak and the numbers of cases will continue to fall. Alternatively, the numbers could increase again, indicating that we have not seen the peak of the pandemic yet. Even if the number of cases continue to fall, there could be a second peak in the offing and we should not become complacent. We need to keep using good cough etiquette, hand washing, and get immunized when the vaccines become available.

I have continued to hear worries expressed about the thimerosal preservative in the multi-dose vials of vaccine. This concern is not supported by scientific data, whereas the real risk of getting very sick, and perhaps dying, is unquestioned if anyone is infected with H1N1 influenza virus. Therefore, if multi-dose vaccine is the only one available, have your children get it. It makes much more sense than holding on to thoroughly debunked notions that thimerosal is causing any issues in children’s health. Likewise, it is not an issue for adults either. Get the vaccine in whatever form is available.

 

Vaccine redux

The influenza vaccine shortage continues to rile the public and health care providers. As with any limited resource, there is a parallel economy ready to provide the product for the right price. In addition, declarations of need based on social status or personally created risk stratification schemes are increasingly more commonly encountered. I have to say that some of the worst human behaviors are being displayed as the pandemic continues and the press reports on every negative aspect of the infection. It is time for us all to assess what is going on, and what is not.

The pandemic continues to involve all segments of the population and the press continues to report on individual deaths even though for seasonal flu, none of this reporting goes on. An estimated 36,000 Americans die each year from seasonal flu. That is about 100 deaths per day! I have yet to see a headline in a newspaper reporting on that striking statistic.

To all of this, all I can say is that collectively, the people around the world (although the issues seem to arise more as the standard of living increases) need to focus on the total picture and what we can do to protect ourselves and our loved ones, without resorting to anger, frustration, and simply put, selfish behavior. Such antics will not increase the supply of vaccine or any other resource. This is the first real test of modern medicine and the public health infrastructure in dealing with this sort of mass infection. Earlier epidemics and pandemics have occurred as many of the pieces of the response plan were yet to be written and exercised. The pieces are in place now and we are seeing a remarkably coordinated response. That is not to say that there are not mistakes being made. There clearly are things that can be done better, and should have been done better, but everyone, from the top officials in the government on down, are learning and improving systems of communication and action plans.

Vaccine distribution continues to be sporadic and intermittent. As it becomes available, it is being administered without undue delay. Those in the designated risk groups are being offered the vaccine first and then those groups further down on the risk group list are offered the vaccine. The process seems to be moving ahead smoothly.

With respect to treatment of exposures – not everyone needs antiviral prophylaxis. I will be reviewing indications for antiviral prophylaxis and treatment in the coming days. The numbers of questions I have been fielding are increasing daily and I hope to incorporate the teaching points from these questions into future communications.