Friday, May 22, 2009

Making a vaccine, and would you want to get it?

CDC has been talking about the steps they are taking that would make it possible to manufacture an effective vaccine for H1N1 flu. They just released some research yesterday that makes them pretty sure that the seasonal flu vaccine won't help at all for this novel (new) H1N1 virus.

It's quite a process to develop vaccine, not to mention the FDA approval process, called clinical trials, that would be necessary to get it into the arms of people.

First, they have to isolate the virus. The good news about is that this particular H1N1 flu virus (and there are many other H1N1s) has remained pretty stable over this last month, so it's not like they are chasing something that is changing every time they look at it.

Then, they have to try to grow the virus to see if it will replicate so they can make anything out of it. If so, this "candidate" virus is shared with manufacturers.

The production people do testing to see if they will be able to make enough vaccine and what dose will generate the immune response that they want. They can add stuff to the vaccine to improve the immune response -- stuff called adjuvants -- which might help reduce how much antigen is needed to get the desired immune response.

OK, so if you are following so far, they are saying it looks promising for a vaccine and the feds have dedicated $1 billion (!) to the clinical studies needed to get it approved and the commercial production.

All this is to be ready if this virus reemerges with some fury in the future, maybe even this fall. Pretty interesting.

So, what do you think? Do you get a seasonal flu shot? If this flu comes back with a vengeance, would you want to be vaccinated?

Wednesday, May 13, 2009

Is H1N1 still a threat?

This from Jackie Zheleznyak, Colorado's pandemic flu planner:

Every day a plethora of articles are released about every aspect of H1N1. This morning a CIDRAP article caught my eye, entitled “WHO: H1N1 flu more contagious than seasonal virus”.

The reason this cause my eye is because for the past 2+weeks most non-governmental organizations and various federal agencies have been telling us that H1N1 isn’t as ‘bad’ as once thought. H1N1 in the U.S. appears to have lost some of its severity. I have seen the reported U.S. cases, I have seen the news that the death rate in the U.S. is low, and while people are still getting sick, sometimes very sick, they just seem to have the flu.

So why do I need to care that this H1N1 virus may be more contagious than a seasonal flu? Why do I need to pay attention to the WHO talking about the severity of this virus?

I am not a clinician or an epidemiologist. I am a planner. Being a planner I analyze everything about twice as much as actually needed. This is why this particular article on H1N1 being more contagious, and WHO’s statement on how to assess severity is causing my mind to spin today. The question remains ‘Why do I need to be paying this much attention to something that hasn’t even been placed on the Pandemic Severity Index and hasn’t cause an increase in the HHS Pandemic Alert Periods?’

In an article titled, "Assessing the severity of an influenza pandemic," released on May 11, 2009, by the WHO, it states: “H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15%. Current estimate of the secondary attack rate of H1N1 range from 22% to 33%.” \

Reading this statement, the question for me becomes ‘why do I care if its really just like the seasonal flu?’

As a planner, I care because if a virus is truly more than twice as contagious as previously thought, I will have that many more people becoming ill, and I will have that many more people using assets from our public health and medical system. As a planner, I need to be able to support the ‘boots on the ground’ in their extraordinary efforts to respond to their new challenge, and this is why I care.

Nevertheless, I struggle with the abrupt changes from U.S. Health and Human Services in its response to this H1N1 flu virus by making a decision not to follow the pandemic alert levels (which they created their own planning around, and encouraged us to also plan around). I struggle with the fact scientists and the WHO have not yet determined a way to grade this virus’ severity. Both of these facts leave me with a place for doubt to grow. I wonder if I, who am very familiar with the topic of influenza, have doubts, then what is the average Coloradan thinking about all of the variety of information out there? This is the other reason I care.

I want to be able to cast away the misconceptions and doubts surrounding H1N1. My colleagues and I strive to provide accurate and appropriate information to Colorado. While some may think that we never provide enough information, others may have already tuned us out.

Public Health is paying so much attention to H1N1 to be able to provide you, Colorado, with the answers you are looking for to the best of our ability. Some days we will have more answers than others, and some days we will not have any answers, only more questions. We pay attention to H1N1 to keep Colorado informed.

I keep reminding myself that science is full of unknowns and that’s what makes it science. We can only work with what we know, and what we know today is that this seems to be a new virus. We know that washing your hands helps prevent H1N1. And we know that staying home when you’re sick not only is good for you, but everyone in your community.

So, the question never was ‘why do I care about H1N1?’ The question has always been ‘why do we care about H1N1?” Surprisingly the answer is very simple: we care because public health is not just something I do for a living; public health is something that we all do, even if it's just by washing your hands.

Tuesday, May 12, 2009

Do Everybody a Favor: Take a Sick Day

Great little opinion piece from the New York Times:

Friday, May 8, 2009

Swine flu parties(!)??

What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is to become infected with what for many people has been a mild disease, in the hope of having natural immunity to the novel H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend "swine flu parties" as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. They should stay home from work or school for 7 days after the onset of illness or until at least 24 hours after symptoms have resolved, whichever is longer.

More on the role of social media in crises

What an interesting blog-posting here:

We are really trying to keep up, but it is challenging.

Thursday, May 7, 2009

Antiviral Stockpile Deployed Quickly in Time of Need

Federal antiviral medication and medical protective supplies from the Strategic National Stockpile were distributed throughout Colorado during the ongoing H1N1 virus outbreak. This is the first time the stockpile was requested and deployed during a declared emergency in Colorado.

The supplies help local public health agencies throughout Colorado ensure that the people who need medication will be able to receive it. The medication primarily is intended for those who are hospitalized or seriously ill.

Swift Transportation Company quickly and successfully worked through the day and night last week to distribute the medication and medical supplies to 13 locations throughout the state. The company is one of many partners that have signed agreements with the Colorado Department of Public Health and Environment’s Emergency Preparedness and Response Division to assist in emergencies or other crisis.

The Emergency Preparedness and Response Division always is looking for community partners to provide volunteers, warehouse space or a variety of necessary services. Interested parties should contact Patrick Barnett at the Colorado Department of Public Health and Environment, 303-692-2648, for information on becoming involved with public health emergency preparedness activities in Colorado.

Wednesday, May 6, 2009

Are we ready?

From Chris Lindley, Colorado's director of public health preparedness and response:

When people ask if we are ready or prepared the answer should be “we are better prepared than we were yesterday.” The last two weeks have reinforced this statement. The rapid coordinated response by local, state and federal public health officials clearly demonstrated that we are better prepared as a nation than we would have been just a few years ago. The investment in public health infrastructure post 9/11 clearly has paid off, and it has paid off big. Systems and processes have been developed and tested to coordinate a national response to any emerging disease or crisis. While there were certainly mishaps, overall we all had the same message, and resources to share that message with health care providers, partners and the general public real-time.

While it appears that this first wave of the H1N1 virus is mild and will likely die down within the U.S. this summer, we all need to remember history. The 1918 pandemic followed a similar path, with a mild presentation in the spring and summer followed by a explosion in the fall and winter, killing an estimated 100 million people worldwide.

Hopefully history will not repeat itself here. However, hope is not part of the preparedness equation. What is needed now is a personal, neighborhood, community, state and national effort to further prepare the country for a severe flu season next year. The challenge is making this a priority for all, at all levels, as we struggle to maintain current responsibilities in a fiscal crisis. Unfortunately we will need to prioritize and something that also needs to be done will be put off until a later date. This is the challenge we face in public health -- an aging workforce, plus limited local, state and federal investment with the responsibility to protect the population. Hopefully the events of the past two weeks will remind elected officials what public health is, and its value.

Tuesday, May 5, 2009

Thank an epidemiologist today...

Especially Nancy Cox from CDC, who home burned to the ground while she was trying to find out what was happening with an emerging virus from Mexico.

Expect a surge of confirmed cases nationwide...

CDC reminded us today that the numbers of confirmed cases of H1N1 Influenza A will climb dramatically over the next few days as the backlog of samples at the CDC lab is reduced and as states start doing their own testing.

No cause for alarm - still the same messages: wash your hands! cover your cough! stay home if you are sick!

Also: new school guidance from CDC today.

Sunday, May 3, 2009

Additional two cases of H1N1 confirmed in Colorado

The state health department announced that two cases of influenza were confirmed to be H1N1.

The first is a male in his 20s from Jefferson County.

The other is a middle-school aged male from Jefferson County who had recently traveled to an affected area in the U.S. The student's school, Excel Academy, is a Jefferson County charter school with 450 students. The superintendent of schools in Jefferson County told reporters today that the school will be closed this week as a precaution.

Saturday, May 2, 2009

Maybe it's time to question CDC's guidance...

More from Chris Lindley, Colorado's director of public health emergency preparedness and response:

We can no longer say that this new H1NI influenza strain appears to be mild like the 1957 and 1968 pandemics, which were both similar to seasonal influenza.

At the national level, politicians and the CDC are recommending containment strategies for a new much more deadly influenza strain, along the lines of the 1918 pandemic strain. All of pubic health can either fall in line like sheep, or stand up and issue their own guidance, only suggesting containment strategies we would employ during any seasonal influenza epidemic. If things changed and we saw more severe illness, we could immediately use more aggressive containment strategies. Now is not the time to play the Ace.

1.) The current mixed message will ultimately hurt the creditability of public health at all levels. It is either one or the other. We cannot say it is mild ("relax, everything will be ok"), but you need to act as if this is the 1918 pandemic otherwise you might risk your and our families' lives. If, as we are told at the national level. it is presenting as a new but mild influenza strain, as it appears to be in Colorado, we should apply containment strategies at a similar level. Doing otherwise will later be considered an abuse of our powers, and credibility will be lost. After 7 years of preparedness funding, this would be a poor demonstration of measured improvement. If the epidemiology and surveillance later presents a different picture, we can always increase containment measures.

2.) CDC has just thrown a grenade to the local and state public health and school districts with the release of its updated "School (K-12) and Childcare Facilities Closure Guidance." The latest recommendations encourage the closure of all schools (K-12) and childcare facilities (as well as all feeder schools and childcare facilities in the network or a geographic area) for 14 days, for those schools/facilities with one or more laboratory-confirmed or non-subtypable influenza A cases among students, faculty or staff. To put this simply, as long as there is a confirmed or probable case “in the same area” in a school-aged kid, all surrounding schools (K-12) and childcare facilities are encouraged to close as well, even if they have no cases according to CDC guidance. Come Monday, schools and childcare facilities that don’t meet some aspect of this description might be few and far between.

3.) We now also have a critical shortage of N-95 masks across the country. Being into this less than one week it is clear that everyone, including the medical community, has responded to the media pandemic with the utmost of caution. In many ways that is good; however, it is time now to be honest about how this disease is presenting itself and how measures can and should be in line with what we are seeing. Again, if this is a mild influenza strain like seasonal influenza, our guidance to healthcare providers and the general public around the use of PPE should be just as it is with seasonal flu.

Let's not pull the trigger too soon.

Friday, May 1, 2009

H1N1 Flu in Perspective

This is important:

H1N1 Flu Information for Spanish speakers, in easy-to-read format!

Thank you, Rachel, for getting these brochures together so quickly.


My advice: use legal size paper and look for the tiny marks to show where to fold them.

We also have a poster on this page - we think that can be printed on either 8.5x11 or 11x17 paper, but I had no luck on 8.5 x 11. Maybe it depends on your printer.

Hurray, Rachel!

WOW - good work!

Lots of public health folks were really busy last night -- and even overnight.

Colorado has moved 167,000 courses of antiviral medications to sites all over the state. You should thank your local public health department!