Global Pandemics

Here's an interesting lecture from MIT World by Hidde Ploegh, PhD, Professor of Biology, MIT; Member, Whitehead Institute.

In his role as a biochemist, Hidde Ploegh explains the "essential features of the lifestyle of the flu virus" discussing not only how viruses work to invade our systems and cause the flu, but also adding insights into the political and societal framework in which public health groups and governments deal viral disease.

2009 was about H1N1, health care reform, and health IT

Wow, 2009 is nearly over! This was the year of swine flu (H1N1). We saw it, many of us experienced it, and now we're not sure what H1N1 will look like in 2010. Is it here to stay and cause problems every year? Or, will this virus somehow mutate and become a thing of the past?

2009 was also a year where we saw so much happen in health care reform. The HITECH provisions within the American Recovery and Reinvestment Act (ARRA) of 2009 drove significant changes in the health IT space and we will continue to see major changes in 2010. The buzz around EHR, EMR, PHR, and CPOE has never been stronger (the world of Health IT is all about strange acronyms). Meetings like HIMSS and AHIMA have never been more full of energy.

As we prepare for 2010, I'm sure many of us are wondering what type of impact H1N1 will make this winter. Will we see a second wave of swine flu?

Also, are you prepared for all the health IT changes that will be taking place in your hospital/office/practice in 2010?

It's been an amazing year and it's flown by so quickly. They say that time seems to go faster as you get older. Do you think that's true for you? It sure feels like it for me.

800,000 H1N1 vaccine doses recalled

It's no surprise that we're already seeing a recall of 800,000 H1N1 vaccines. Fortunately, this recall isn't due to any safety concerns. Rather, this recall is occurring because the vaccine doses are not considered "potent" as they should be. According to CNN:

The French manufacturer Sanofi Pasteur is voluntarily recalling about 800,000 doses of vaccine meant for children between the ages of 6 months and 35 months... The CDC emphasized that there is no danger for any child who received this type of vaccine... When asked what parents should do, CDC spokesman Tom Skinner said, "absolutely nothing." He said if children receive this vaccine, they will be fine.

So, if your child got the vaccine, you don't need to do anything. To learn more about this recall, visit the CDC website.

Will we see a second wave of H1N1 this winter?

It may seem like the H1N1 pandemic has spread through your community. My wife had confirmed H1N1 last month. Many schools in our area closed because of the pandemic in November. Yet it's only mid-December and we know that the flu season can easily go beyond February. So, will we see a second wave of H1N1 later this winter? What about the early spring?

Experts are definitely concerned about that possibility and many are evaluating historical data, exploring computer models, and looking at other ways to predict what may happen this winter. The bottom line is that no one really knows what will happen. However, if we see a second wave, what will that look like now that many people have already been exposed and have (theoretically) developed immunity to H1N1. Will the virus mutate to the point that it will cause reinfection in those who have already been vaccinated?

There are still so many unanswered questions about H1N1. We must continue to practice proper hygiene and common sense so that we reduce the spread of viral infections this winter. That's going to be difficult since December is a busy month for stores, malls, etc. How often will you be going to a crowded place filled with potentially sick people?

My pregnant wife had swine flu

Many of you know that we have a newborn at home. (Baby Kim and mom now at home) My wife delivered last week after Thanksgiving and we've been enjoying more sleep deprivation than normal.

What I didn't share was that my wife had confirmed H1N1 a few weeks ago. During her last trimester of pregnancy, she came down with the swine flu. Since she's a family physician, it's not a surprise that she would get sick because of her frequent interactions with sick patients. Now that she's on maternity leave, she has a little break from seeing sick patients in a busy primary care office.

Well, our baby's bilirubin levels came down, so we no longer need to make any additional trips to the hospital this week. Wow, soon baby Kim will be a week old!

Another H1N1 vaccine receives FDA approval

The FDA approved the fifth vaccine for protection against the 2009 H1N1 influenza virus. The vaccine is manufactured by ID Biomedical Corp. of Quebec, Canada, owned by GlaxoSmithKline PLC.

So, here's a list of the current injectable H1N1 vaccines:

• Influenza A (H1N1) 2009 Monovalent Vaccine (CSL Limited)
• Influenza A (H1N1) 2009 Monovalent Vaccine (ID Biomedical Corporation of Quebec)
• Influenza A (H1N1) 2009 Monovalent Vaccine (Novartis Vaccines and Diagnostics Limited)
• Influenza A (H1N1) 2009 Monovalent Vaccine (Sanofi Pasteur, Inc.)

We can't forget the intranasal option for H1N1:

• Influenza A (H1N1) 2009 Monovalent Vaccine (MedImmune LLC)

Have you gotten your H1N1 vaccine?

Pregnancy and H1N1

This flu season is going to be a very difficult one for patients and health care providers. There's a story on CNN about how a pregnant mother and her pregnant daughter are both battling H1N1. Nancy Brizendine, 42, and her daughter Kayla Yost, 22, are both pregnant and had H1N1. It's no surprise since Brizendine works as a medical assistant. Health care professionals are getting exposed every day to the possible risk of swine flu infection. It's a scary reality, but as this virus permeates society and spreads throughout the world, a significant percentage of clinicians will get sick.

The most important point to this story is prevention. We must exercise the highest level of vigilance to protect ourselves and others from infection. If you're not in the habit of routinely washing your hands, get into the habit. If you don't have easy access to soap and water, then get some anti-microbial gel. Healthy people are dying because of H1N1 and we must do our part to protect ourselves and the public.

H1N1 and the uninsured in America

Let's face it: many uninsured patients don't have primary care providers. They are reluctant to seek medical care because they can't afford it, and more importantly - they're afraid of the potential medical bills that may result from a sick visit.

So, what's going to happen to the uninsured as H1N1 spreads across the country? We know it's going to spread because we can't stop it. Global public health agencies have admitted that H1N1 simply can't be stopped.

• We're not going to see any type of public option emerge this fall/winter. There will be no universal health coverage to help patients this winter.
  
• Unemployment is still a significant problem in this country. With unemployment comes uninsured patients and families.
• H1N1 may lead to increased hospitalization. How will individuals handle these hospital bills?

Here's a novel thought: if you're uninsured in the United States, perhaps you may wish to spend this winter in a westernized country that offers free universal health care coverage. That way, if you get sick, you'll have access to free health care. Do you have any relatives living in other countries?

This winter will be a trying period for many individuals and families living in the United States. My hope and prayer is that H1N1 infections will be mild and that they won't cause too many hospitalizations or deaths. If we all do our part to wash our hands and practice good sanitation and hygiene, then I think we'll help prevent the spread of this contagious virus.

AMAFluHelp.org

There's a new resource on the Internet to help patients deal with the flu this season. It's called: AMAFluHelp.org

As you may have guessed, the AMA (American Medical Association) has launched this website to provide educational content regarding the seasonal flu and H1N1. This educational content is available to consumers (or patients) and also to health care professionals.

Upon establishing a free account, you can subscribe to personalized, interactive Health Session Programs that have been authored by the AMA for patients and their families. These programs include:

• Child Assessment: H1N1 flu and children under 18
• Am I high risk for H1N1 and need the vaccine?
• Adult Self Assessment: Do you have H1N1 flu?
• H1N1 Post Vaccine Monitoring
• Pregnancy: Do you need the H1N1 flu vaccine?
• H1N1 Flu: Can I return to school or work?

The website is currently in "beta" stage, but it looks quite promising. The Internet has revolutionized the way that patients and professionals can learn information. It's great to see the AMA providing this resource to the public.

MIT Lecture: Reflections on the Current H1N1 Flu

MIT World has a lecture by John M. Barry about the H1N1 pandemic and it's titled, "Reflections on the Current H1N1 Flu." It's hard to believe that H1N1 has already killed several children and teenagers this fall. the winter hasn't even arrived and it's frightening to imagine what will happen since the H1N1 vaccine is being released so late in the year.

Here's a brief summary of the lecture:

John M. Barry brings unsettling news from the frontlines of H1N1 research: this novel influenza virus is very hard to pin down. In spite of international scientific scrutiny, H1N1 continues to baffle and elude, worrying health officials defending against the pandemic, and challenging some ideas about influenza in general. Says Barry, “A lot of things we thought we knew, the virus demonstrates we knew wrong.”

Barry examines the current pandemic in both historic and scientific context. Most influenza viruses share certain features: They can jump to other species by way of mutation, or by mixing genetic components with another virus that happens to be infecting the same cell at the same time. Influenza pandemics go “as far back in history as we can look,” with 10 occurring in just the last 300 years. Four of the most recent pandemics appear to have rolled out in waves of varying lethality, infecting at peak times some 30% of the human population...

To view the online MIT World lecture, click here.

FDA and FTC issue warning letters regarding fraudulent H1N1 supplements

The FDA and the FTC have issued joint warning letters to a few websites that promote products related to H1N1. The subject is specifically: "Unapproved/Uncleared/Unauthorized Products Related to the H1N1 Flu Virus; and Notice of Potential Illegal Marketing of Products to Prevent, Treat or Cure the H1N1 Virus"

Here are some of the websites that have received these FDA warning letters:

• Weil Lifestyle LLC (http://www.drweil.com)
• http://www.novalisintegra.com
• SKW Ventures (http://skinwearusa.com)
• Viraban (http://www.viraban.com)
• and others
  

Here's a list of the FDA warning letters: http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2009/default.htm

H1N1 (swine flu) vaccination begins

FluMist is appearing around the country and patients are receiving this nasal H1N1 vaccine. According to this story on CNN, every U.S. state has ordered H1N1 vaccines and 2.2 million doses have been ordered (there are only 2.4 million available). So, who's going to end up getting the H1N1 vaccine and who will be left behind?

Since pregnant women are unable to get FluMist, what will they get and when will they get it? What about kids less than 2 or adults over the age of 49?

There are still some unanswered questions regarding H1N1 vaccination but the CDC is making every attempt to educate health care providers and patients about the risks associated with swine flu this fall/winter. Let's hope that the vaccine gets distrubuted effectively so that people are protected this flu season.

Doctors discussing H1N1 vaccination

Doctors on Sermo are so many different views on the new H1N1 (swine flu) vaccine. Primary care providers, emergency medicine physicians, and hospital physicians are most likely to get exposed. If you're a subspecialist, then maybe your patients will stay at home if they have flu-like symptoms.

So, are doctors eager to get the swine flu vaccine? Are they waiting in line? Some are, but others are reluctant and hesitant. Scattered witihin the flurry of posts regarding health care reform, physicians are debating the public health implications of H1N1. Will H1N1 be like any other seasonal flu? You're going to find that some physicians don't get the seasonal flu vaccine for a variety of reasons. Will H1N1 be worse than the seasonal flu? Will we see more fatalities this flu season because of the H1N1 pandemic mixed with seasonal flu? Some people fear the unknown safety of this new flu vaccine. Will the potential risks outweigh its benefits, or will it be the other way around?

I think that every healthcare provider who has any directly patient contact should receive the H1N1 vaccine. So, if you're a radiologist and you're working out of a dark computer lab and you never interact with patients, then maybe you'll have minimal exposure. However, if you're a hospital physician or a primary care provider, then I think you'd be out of your mind to skip the H1N1 flu vaccine.

FDA Public Health Alert: Potential Medication Errors with Tamiflu for Oral Suspension

FDA Public Health Alert: Potential Medication Errors with Tamiflu for Oral Suspension

Prescribers and pharmacists should be alert for potential dosing errors with Tamiflu (oseltamivir) for Oral Suspension. U.S. health care providers usually write prescriptions for liquid medicines in milliliters (mL) or teaspoons, while Tamiflu is dosed in milligrams (mg). The dosing dispenser packaged with Tamiflu has markings only in 30, 45 and 60 mg. The Agency has received reports of errors where dosing instructions for the patient do not match the dosing dispenser.

Health care providers should write doses in mg if the dosing dispenser with the drug is in mg. Pharmacists should ensure that the units of measure on the prescription instructions match the dosing device provided with the drug.

If prescription instructions specify administration using mL, the dosing device accompanying the product should be replaced with a measuring device (e.g., a syringe) calibrated in mL.
Specific Considerations for Tamiflu Dosing for Children over 1 Year of Age:

• Dosing should be prescribed in mg according to information provided in the table below.  Caregivers for children should use the dosing dispenser packaged with the medication, unless otherwise directed by a health care provider.

• If the dosing dispenser packaged with Tamiflu oral suspension is lost or damaged, or if the prescriber wishes to use volume-based dosing, appropriate dosages in mL are also provided in the table. In these cases the prescriber and pharmacist should ensure that a dosing dispenser, such as an oral syringe calibrated in mL, is given to the patient or caregiver with instructions for use. The dosing dispenser packaged with the product should be discarded.

• Prescribers should avoid prescribing Tamiflu oral suspension in teaspoons. This can lead to inaccurate dosing. If a prescription is written in teaspoons, the pharmacist should convert the volume to mL and ensure that an appropriate measuring device, such as an oral syringe calibrated in mL, is provided. The dosing dispenser packaged with the product should be discarded.

To read the entire alert, visit the FDA site here.

Inhalable H1N1 vaccine: are you ready to inhale?

Are you ready for the H1N1 vaccine? The CDC is reporting that over 3 million doses of the inhalable (no needles!) vaccine will be available in early October. Here's a snippet from a recent CNN article:

"3.4 million doses of vaccines will be available," said Dr. Jay Butler, who heads the 2009 H1N1 Vaccine Task Force at the Centers for Disease Control and Prevention.

So, if you hate needles, you can still get vaccinated. However, the inhalable vaccine is not indicated for pregnant women (sorry, you'll need to get the needle version). Someday, we'll see painless needles everywhere. Imagine needles so small that you don't even feel them. They already exist, but they're not commonly used (yet).

As you consider swine flu vaccination, consider a few things:

• You may not need to protect yourself, but you may need to protect others who are vulnerable. If you spend any time around young children, elderly, or immune compromised individuals, then you're a risk to them if you don't get vaccinated.
  
• Young and healthy people have been dying from H1N1. 
• Follow your doctor's advice. I realize that many people don't like the idea of vaccines, but this fall/winter is going to be very different because of the H1N1 pandemic. 

Sanofi Pasteur, Novartis and CSL Limited all have FDA-approved flu shots, and MedImmune makes the inhalable vaccine. GlaxoSmithkline is waiting for FDA approval on its flu shot.

H1N1 (swine flu) and pregnancy

I seem to see pregnant women everywhere. As the flu season approaches, it's important to consider your health this fall/winter because of the H1N1 (swine flu) pandemic. Now that an H1N1 vaccine has been approved by the FDA, it's very important for those who are at "high risk" to get vaccinated first (since we don't even know if we have enough vaccine for everyone else). This includes pregnant women.

The first place to start is the CDC's  website: "2009 H1N1 Influenza Vaccine and Pregnant Women" that can be found here: http://www.cdc.gov/H1N1flu/vaccination/pregnant_qa.htm

That page is arranged in a question/answer format, so it will probably answer most of your questions. The important thing to remember is that swine flu (H1N1) can be fatal, even to healthy people. It's very important to discuss these issues with your healthcare provider and to make an appointment so that you can get the vaccine as soon as possible.

H1N1 spreading in colleges and universities

I'm glad that I'm not a college student this year. According to this CNN report, H1N1 (swine flu) appears to have infected over 2,600 students at Washington State University. Sounds like people should stay at home and take their courses online. Distance learning is now very effective thanks to major advances in communications technologies.

The school is following guidelines from the Centers for Disease Control and Prevention (CDC) and the local health department by "treating all patients with influenza-like symptoms as if they have H1N1."

As H1N1 spreads to more colleges this fall and winter, I wonder how this will impact academic performance. Wouldn't you love to have an excuse for those lousy grades? I was sick during finals. I missed too many classes. I was quarantined.

H1N1 (swine flu) advice for parents now that students are returning to school

Now that many students are back to school, parents are very concerned about swine flu (H1N1). Dr. Sanjay Gupta on CNN offers some practical advice for parents who have concerns about this pandemic. The four points outlined by Dr. Gupta include: keep your sick kids at home, call your pediatrician before taking your child to the doctor, and make sure you know when you must call your doctor.

We know that many students (and parents) are going to get sick this fall/winter with H1N1. Let's hope that parents and teachers don't over-react to this situation but that they use common sense as they deal with swine flu and that they consult their healthcare providers appropriately. Emergency rooms and primary care offices will be extremely busy this fall/winter. What's going to happen as healthcare providers get sick? We're probably going to see some significant shortages of healthcare providers this fall/winter.

Here's my tip for parents:
Have a backup plan so that you can go somewhere else in case your healthcare provider is unavailable. If your pediatrician is a solo practitioner and he/she gets sick, then you'll have to find a different office.

Disturbing reality about swine flu (H1N1)

The disturbing truth about swine flu is that it may kill hundreds of thousands of people in the U.S. this fall/winter. According to a recent story on CNN, the estimated number of deaths is 90,000. That's not an insignificant number when you consider that the seasonal flu kills roughly 40,000 each year. Although several vaccines against H1N1 are currently in development, they probably won't get released to be very helpful. As a result, many patients may choose to refuse the vaccine because they may think that the vaccine won't have any beneficial effect to protect them. The reality is that they should probably still get the vaccine because you never know if you'll get infected early or late in the flu season.

There's no doubt that this fall/winter will be very busy for hospitals, emergency rooms, and primary care offices. Avoid the hospital unless you really need to be there. Wash your hands at every opportunity and carry and use hand sanitizers. Let's see how schools get affected as students get ready to return to the classroom later this month and early next month.

Is your workplace prepared to handle the swine flu pandemic? Read the CNN story here.

Swine flu deaths around the world exceeding 1,100

According to this CNN story, the World Health Organization is reporting that global swine flu deaths are exceeding 1,100. We know that H1N1 is an unstoppable pandemic. This virus has spread in six weeks like how the common flu virus spreads in six months! We're waiting for effective vaccines and I'm sure we'll see them. The question in my mind is: will we have enough vaccines?

So who should get the vaccine?

The priority groups include pregnant women, health care and emergency services personnel, children, adolescents and young adults from six months to 24 years of age, household and caregiver contacts of children younger than six months and healthy adults with certain medical conditions.

Even though there are strong public health campaigns to get people vaccinated, we know that some simply won't receive the vaccine. Either they will refuse it, or they won't have access to medical care. Some won't make it a priority and they won't get the swine flu vaccine in time. Will we have enough anti-viral therapies for all those who don't receive a vaccine?