by Deborah Franklin
There's headline news for both sides of the gender gap this morning: Pregnant women are four times more likely to need hospitalization for swine flu and aren't getting anti-virals fast enough, according to the CDC. A CDC group is meeting today to recommend whether women who are pregnant should be among the first in line to get the pandemic vaccine. Meanwhile, the FDA warns that many men taking "nutritional supplements" to build muscle are actually gulping down unregulated amounts of hidden steroids that can severely injure the liver and kidneys.

When a pregnant woman develops flu symptoms, many obstetricians are hesitant to prescribe antiviral drugs out of fear of harming the fetus.

But they're making a big mistake, according to the CDC's Denise Jamieson, who studied the cases of 34 pregnant women who got very sick with swine flu between April and mid-June. Six of the previously healthy women died. In her Lancet study making headlines this morning, Jamieson said the world's 3.3 million pregnant women seem to be extra vulnerable to serious complications when infected with the new H1N1 flu, and should get anti-viral drugs within 48 hours of their first symptoms. She told the AP,

"The message is don't delay appropriate treatment because she's pregnant."

A CDC panel meeting today is expected to recommend that pregnant women get top priority in access to a new swine flu vaccine when it becomes available this fall. But the decision is likely to be controversial among some factions clamoring for vaccine, and others who don't want to be immunized.

(More on flu vaccine priorities and body-building supplements after the jump.)

Continue reading "Morning Rounds: Pregnant Women Need Swine Flu Vaccine And Anti-Virals Fast" >

by Jon Hamilton

Francis Collins was all smiles at a White House ceremony last March when President Obama signed an Executive Order on stem cell research. Ron Edmonds/AP

President Obama has picked a physician and geneticist best known for his work on the Human Genome Project to lead the National Institutes of Health, NPR has learned.

Francis Collins led the government's effort to decode the entire DNA sequence of a person. That project was completed in 2003, ahead of time and under budget.

At the time, Collins was director of the National Human Genome Research Institute at NIH. He left the institute in 2008.

Before coming to the NIH, Collins established himself as a scientist at the University of Michigan. His research team there discovered the genes responsible for cystic fibrosis and Huntington's disease.

Collins describes himself as a devout Christian who sees no conflict between his faith and science.

If confirmed by the Senate, Collins would take over an agency with a budget of more than $30 billion.

Good Morning.

Three medical mysteries that have experts scrambling today sound more like financial headlines than health: They're all about dough, raw deals, and jobs.

First up, raw dough: Microbiologists from the FDA are in Danville, Va. this morning, scouring a Nestle factory for clues. The plant is thought to be the source of the contaminated raw cookie dough (recalled last Friday) that has sickened at least 65 people in 29 states. The big question: How did E.coli 0157 -- an especially nasty intestinal bug usually limited to cattle -- get into the pre-packaged dough?

According to the Washington Post, federal investigators are checking "a broad range of possible factors," including all ingredients, worker health, plant equipment and location. The Post says:

Federal officials are also considering whether the dough might have been intentionally contaminated.

Meanwhile, outraged veterans and radiation oncologists around the country are wondering why it took six years for regulators to discover that at least one surgeon at the Philadelphia VA Medical Center was routinely botching surgeries to treat prostrate cancer, and then covering up his mistakes.

Continue reading "Morning Rounds: Raw Deals and Medical Mysteries" >

by Richard Knox

Kids likely to get swine flu shots before the elderly. /istockphoto.com

It's never been done before but it is the official goal: Vaccinate every American against a new flu virus between next fall and the following spring.

A tall order, and costly. How does $17 billion strike you?

Continue reading "Vaccinating Everybody Will Cost You" >

by Richard Knox

Will we all be lining up for swine shots soon?/Toby Talbot/AP

The big push to make a swine flu vaccine is on.

The Centers for Disease Control and Prevention is starting to ship vials of "seed" viruses to drug companies so they can begin making vaccine against swine flu.

Important decisions loom. Many are technical and complex. How much vaccine needs to be in each dose? Should a booster substance be added to make the vaccine go further? How many people should get vaccinated? Who?

Then there's the really big decision: Should hundreds of millions of people get vaccinated next fall against swine flu?

To make the best decision, policymakers need a good sense of how severe a disease this swine flu is. But that may be almost impossible to know, experts warn.

Continue reading "Swine Flu Forecast: More Uncertainty Ahead" >

by Vaughn Ververs

During a Spanish-language town hall meeting at the White House today, President Obama warned that the swine flu remains a serious concern. "We are seeing that the virus may not have been as virulent as we at first feared," the president said. "But we are not out of the woods yet. We still have to take precautions."

By Frank James

You know what really ticks off Homeland Security Secretary Janet Napolitano? Neither do I.

Chip Somodevilla/Getty Images

But she was clearly unhappy with how some school children and their parents responded to the swine flu-related closures of their schools.

In nearly every media briefing she's had in the past week, she has mentioned that the closing of a school with one or more identified swine-flu cases was no excuse for healthy students with free time on their hands to gather elsewhere, like parks or shopping malls.

She mentioned it again today, saying that federal officials are going to turn up the on the need for students to avoid each other and stay home, especially if the swine flu returns with a vengeance next fall.

Continue reading "Good Luck With Anti-Flu Plan To Keep Teens From Malls" >

by April Fulton

Required cabinet-level reading? Amazon

It's never too early to start second-guessing the government's handling of the swine flu crisis, so let's begin.

On Monday, National Journal's health blog posed the serious question of whether the U.S. is prepared to cope with swine flu or any other potential pandemic, and got six experts to weigh in.

The problem is, where they stand is colored by where they sit.

For example, Kerry Weems, a long-time career employee at HHS who was elevated to Centers for Medicare and Medicaid Services director at the end of President George W. Bush's term, praised career HHS employees for their "calm, clear manner."

Continue reading "A Little Light Swine Flu Reading, Anyone?" >

By Mark Memmott

Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, was the featured speaker at CDC's daily news conference about the flu outbreak. Just click the "play" button in the box below and our updates should flow in automatically:

This community health centers explainer comes from our health blogging partners over at Kaiser Health News.

A masked child walks to a community health center in Wisconsin. Jeffrey Phelps/AP/Milwaukee Journal-Sentinel

 

by Andrew Villegas/KHN

Swine flu -- or the fear of it -- is filling waiting rooms of community health centers, and in many cases, testing is taking place in the parking lot.

Amy Simmons, spokeswoman for the National Association of Community Health Centers, said the threat of the new H1N1 virus has brought a surplus of people into the centers to seek care for what they think may be this illness.

Simmons said six people around the U.S. have been diagnosed and treated for swine flu at a CHC, and more are expected.

What makes CHCs so central in the current outbreak is that they are often the first line of care for the 18 million Americans who are uninsured or do not have enough insurance coverage. Even before swine flu, those numbers were growing due to the economic downturn.

As officials direct people who think they may have swine flu to avoid hospitals if the condition is not life-threatening, many are showing up at the centers.

Continue reading "Swine Flu Fears Fill Community Health Centers" >

By Frank James

You can tell the swine flu crisis is winding down, at least for official Washington, because there's not much federal officials are now saying that we haven't heard before.

Such was the case with Homeland Security Secretary Janet Napolitano's media briefing this afternoon. She said nothing new, save that there are now 286 confirmed cases in the U.S. that have now spread to 36 states with just about all of those cases being mild.

And even that wasn't really new since the Centers for Disease Control had reported that earlier in the day.

There were only six questions from the reporters. One of them was from a reporter who asked Napolitano, who had earlier said that officials were cautiously optimistic that the flu would be mild and limited in its reach, specifically what she was cautiously optimistic about. She essentially repeated herself. It was that kind of press conference. Again, no news.

One measure of how under control the flu outbreak appears to be from the Obama Administration's perspective is that the White House went ahead with a previously scheduled tabletop exercise to game out how its officials would respond to another large Katrina-like storm since the official start of hurricane season is merely weeks away.

Continue reading "Swine Flu Crisis Ebbing (In Washington) " >

By Frank James

Americans are up to their old tricks, hoarding medications to deal with their microbe-driven anxieties.

During the anthrax attacks in 2001, for instance, many people laid in supplies of the antibiotic Cipro in the unlikely chance that they would be exposed to the deadly spores.

Now Americans are evidently hoarding Tamiflu and Relenza, the two antivirals used to treat those who have been exposed to the flu virus or who are in the early stages of the illness itself.

The Associated Press reports:

TRENTON, N.J. (AP) - Americans frightened by swine flu are snapping up two antiviral medicines that treat the disease, whether they have it or not.

New data show more than a quarter-million prescriptions for Tamiflu pills alone were filled at retail U.S pharmacies in the week ending last Friday. That's 34 times higher than the week before and more than double the peak of last winter's flu season.

Continue reading "Swine Flu Leads To Drug Hoarding" >

The HHS ops room has swung into action. Joanne Silberner/NPR

 

by April Fulton

Ever wanted to go behind the scenes in a war room? The federal government has been waiting for the new H1N1 virus, or any other new microbe to appear on the scene, for several years now so that they can use the room set up at HHS. And use it for swine flu, they are.

Tune in to Morning Edition tomorrow as NPR's Joanne Silberner takes us on the inside tour of the Secretary's Operations Center. She tells us what's happening there, including how planners are tracking cases and deciding when and how to send medical tools and supplies around the country.

by April Fulton

None of these pills can cure swine flu istockphoto.com

It was only a matter of time before charlatans and fakers would start selling swine flu "cures" on the Internet.

One such site features a pig's face spotted with graphic tattoos of skulls and ringed with fire and a screaming banner headline promising a "swine-flu cure-all medicine that is only $19.99 per dose or $99.99 for 6 doses!"

But as the Food and Drug Administration and the Federal Trade Commission remind us, there are no cures for swine flu, so don't be fooled.

Here's what Michael Chappell, acting FDA Associate Commissioner for Regulatory Affairs, had to say:

Consumers who purchase products to treat the novel 2009 H1N1 virus that are not approved, cleared or authorized by the FDA for the treatment or prevention of influenza risk their health and the health of their families.

And FTC Chairman Jon Leibowitz adds:

The last thing any consumer needs right now is to be conned by someone selling fraudulent flu remediesThe FTC will act swiftly against companies that resort to deceptive advertising.

For more information about protecting yourself when buying medicine online, go here.

For more information on what CDC recommends about the use of the two drugs currently approved to TREAT the new swine flu, go here.

CLARIFICATION: The swine flu cure website mentioned in this post is a parody. It does not actually sell swine flu cures.

By Frank James

At the end of a cabinet meeting called to discuss the swine flu, President Barack Obama explained to reporters and thus the public why his administration is taking the current swine flu outbreak so seriously.

In short, it's because the new swine flue or H1N1 virus is so relatively new that the U.S. population doesn't have any immunity to it.

An excerpt:

One last point I want to make, because this was actually raised during this meeting. Somebody asked why is this different from other flus. We don't know for certain that this will end up being more severe than other seasonal flus that we have. And it's been noted, I think, before that you have over 36,000 people die on average every year from seasonal flus. You have 200,000 hospitalizations.

It may turn out that H1N1 is -- runs its course like ordinary flus, in which case we will have prepared and we won't need all these preparations.

The reason that people are concerned is -- the scientists are concerned is, this is a new strain.

And so what happens is that Americans and people around the world have not built up immunity, in the same way that they've built up immunity to the seasonal flus that we're accustomed to.

Those seasonal flus may change, mutate slightly from year to year. But they're all roughly in the same band. When you have a new strain, then potentially our immune systems can't deal with it as effectively.

And there are indications that in Mexico at least, what you saw were relatively young, healthy people die from these -- from the H1N1, rather than people whose immune systems are already compromised, older individuals, very small infants and so forth.

So that's why we're taking it seriously. We have not yet seen those same kinds of fatalities here in the United States, among young, healthy people with non-compromised immune systems. But we want to make sure that we're preparing appropriately.

So I just want everybody to be clear that this is why this is a cause for concern but not alarm.

Continue reading "Obama On Swine Flu Concerns: It's A New Strain" >

By Frank James

The Centers for Disease Control and Prevention's latest count of confirmed flu U.S. cases has risen to 109, according to Dr. Richard Besser, the agency's acting director in a briefing occurring right now.

At present, there is only one confirmed death in the U.S., a 23-month old Mexican toddler who died Monday evening during a visit to Texas with his family.

Cases have been confirmed in 11 states, with the newest addition being South Carolina where there are two cases, Besser said. The other states are Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio and Texas.

Besser said the median age of victims is 16, with the ages of affected individuals ranging from 22 months to 81 years old.

As Besser has cautioned in previous briefings, the CDC statistics lag behind the actual numbers. For instance, the CDC is based in Atlanta, Georgia but his latest count didn't include a case just confirmed in that state by its public health officials.

Indeed, Besser acknowledged the case in the question and answer session with reporters following his opening statement but directed reporters to Georgia officials for more information on it.

Continue reading "Swine Flu U.S. Count At 109: CDC " >

By Mark Memmott

The Obama administration is again turning to the Web to get its message out. This time the subject will be the flu outbreak.

According to an e-mail just sent to reporters by the Department of Health and Human Services, newly sworn-in HHS Secretary Kathleen Sebelius, Homeland Security Secretary Janet Napolitano and acting director of the Centers for Disease Control and Prevention, Dr. Rich Besser will be taking part in a webcast today at 1 p.m. ET. Their mission:

"To answer questions and provide information directly to the American people regarding the 2009 H1N1 flu."

HHS says it will be webcast here and here.

The departments are soliciting questions. E-mail them to hhsstudio@hhs.gov.

As NPR's Yuki Noguchi reported today on Morning Edition, the federal government is anxious to use social networking to inform the public about the outbreak.

Using the Web is nothing new for the Obama team, of course. Last month, President Barack Obama held an "online town hall" meeting at the White House.

By Mark Memmott

When he opens his news conference at 8 p.m. ET, President Barack Obama will tell Americans that the federal government is "continuing to closely monitor the emerging cases of the H1N1 flu virus throughout the United States."

And, according to excerpts released this evening by the White House, the president will also say that "this is obviously a very serious situation, and every American should know that their entire government is taking the utmost precautions and preparations."

We expect the members of the White House press corps will have some questions about the outbreak. Once the news conference gets going, we'll use the Cover It Live box below to follow what the president has to say about the situation.

Click the "play" button in the box and our updates should flow in automatically. Along the way, we also may pose some questions. Feel free to cast your ballots.

Update at 9:03 p.m. ET: The news conference is over, but if you hit the "play" button you'll be able to scroll through and see what was said.

By Frank James

Homeland Security Department Secretary Janet Napolitano told reporters this afternoon that 49 people were detained at the U.S.-Mexico border by the Customs and Border Patrol agents for suspicion of carrying swine flu and that all but eight were released after testing came back negative.

"My understanding is no one was detained more than a couple of hours," she told reporters at the briefing.

She also said the infection has now been reported in ten states (that's up from the nine the CDC reported earlier today): Arizona, Texas, California, New York, Indiana, Illinois, Michigan, Nevada, Kansas and Massachusetts.

By Mark Memmott

There is a chance that the ability of the swine flu virus to cause severe infections has diminished in recent days and weeks, Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, just told All Things Considered host Robert Siegel.

That could partly explain why the virus has caused more deaths and stricken more people in Mexico than it has elsewhere, he said.

But, Besser added, "unfortunately I think there will be additional deaths" -- including, possibly, in the U.S.

The interview with Besser is scheduled for today's ATC broadcast. Go here to find your local NPR station.

By Mark Memmott

The official word from the White House on how worried to be at this point:

Reporter: "Is there still a situation of concern, as opposed to alarm?"

White House spokesman Robert Gibbs: "I think so. I mean, I think the way -- I would phrase it the way the president did: It's a very serious situation and one that requires serious precautions. I think that's what he outlined today. I think that continues to be his concern and he continues to ask questions of those that are involved in this to ensure that we're taking every step and precaution that's possible to ensure safety."

(From the official transcript of Gibbs' "gaggle" with reporters aboard Air Force One this morning as the president flew to St. Louis.)

By Richard Knox

It's not only the desire to avoid offending Muslims and Jews that is driving the US government's concerted effort to avoid the term "swine flu" for what is bedeviling us.

The pig farmers are perhaps an equally important constituency.

Here's what US Agriculture Secretary Tom Vilsack said yesterday on CNN: "This isn't swine flu, it's H1N1 virus. That's very important, because markets...are very sensitive. They react to positive news. They also react to negative news. The livelihoods of a lot of people are at stake here."

The problem with calling this "H1N1" is that that's the general moniker of one of the seasonal flu viruses circulating this year (and in other years). This new virus is a different kind of H1N1.

Scientists say there's no question where this virus came from -- it was a pig virus. That's what its genes tell them. "This was originally a new swine influenza virus," Dr. Keiji Fukuda of the World Health Organization said today (4/29). "But it is now behaving more or less like a human influenza virus, with transmission going from person to person."

So what should we call it now? The brand-new Secretary of Health and Human Services, Kathleen Sibelius, is calling it "the 2009 H1N1 flu virus."

Good luck to her in getting that on everybody's lips. My bet is that we'll be calling it "swine flu" for the rest of eternity.

(This item was changed since it was first posted to correct the identity of the federal official questioned by Sen. John McCain.)

By Frank James

Sen. John McCain, among other senators, pressed Adm. Anne Schuchat MD, interim deputy director of the Centers for Disease Control, and Homeland Security Secretary Janet Napolitano today on a recurrent question during the current swine flu crisis: What would cause the U.S. to close the U.S.-Mexico border? Essentially nothing at present would, Schuchat and Napolitano indicated.

Homeland Security Secretary Janet Napolitano testifying on Capitol Hill. Alex Wong/Getty Images

Here's the exchange between the Arizona Republican and Schuchat during a Senate Homeland Security Committee hearing today:

MCCAIN: What conditions would prevail that would say that we need to close the border between the United States and Mexico, if any?

SCHUCHAT: I don't think there are any.

MCCAIN: You don't think there are any. I thank you...

Schuchat was seconded by Homeland Security Secretary Janet Napolitano who indicated in a response to Sen. Susan Collins of Maine that the Obama Administration had effectively ruled out border closings.

NAPOLITANO: But again, the decision to actually close the entire border, which is what has been raised -- and since we have flu in Canada, I would anticipate that the same argument would be made there -- so closing both borders with all of the huge impacts that that would have, in light of the fact that the scientists and the epidemiologists say would have virtually no impact on the amount of disease in our country. When you balance those things, particularly in light, as you say, of the difficulty of knowing whether any individual has the disease, and we make that whole package of decisions, you understand why closing the border is not an adequate answer to this epidemic.

By Frank James

Dr. Richard Besser, acting director at the Centers for Disease Control and Prevention in Atlanta, just provided the CDC's update of the number of U.S. cases of swine flu infected individuals. The CDC count is up to 91 individuals in 10 states, doubling yesterday's five states.

But these statistics must be taken with some caution, which even Besser admits. "These numbers are almost out of date by the time I say them given the activities going on around the country to look for cases and to investigate them," Besser said.

The CDC is apparently only updating its numbers once a day, then publishing them on its website at 11 am ET. Seems glacially slow in the Twitter age but it's apparently good enough for government work.

Here's the CDC breakdown:

NY. 51

Tex. 16

Cal. 14

Mass. 2

Mich. 2

Az. 1

Nev. 1

Ind. 1

Kansas 2

Ohio 1

by April Fulton

*UPDATE* The CDC re-posted the guidance mentioned below shortly after this post. The only change appeared to be adding the new name of the flu, H1N1.

The Centers for Disease Control just issued an interim guidance to help airline crews identify passengers who may have swine influenza and is recommending that any passengers observed with two or more symptoms be sent to a CDC Quarantine Station.

But not five minutes later, pulled the notice off their website. An agency spokeswoman speculated that they were probably making changes to the notice, but provided no more detail.

When the notice was up, it said crews are required to observe and report passengers who are feeling feverish or have a temperature greater than 100 degrees F, a sore throat, a cough, stuffy or runny nose.

"Any passengers observed to have or who report having two or more of these symptoms should be reported immediately to the CDC Quarantine Station of jurisdiction where the plane is expected to land," the advisory says.

CDC has 20 Quarantine Stations around the country near ports of entry and has the legal authority to detain anyone who may have cholera, diphtheria, infectious TB (tuberculosis), plague, smallpox, yellow fever, and viral hemorrhagic fevers, SARS, or new types of flu that may cause a pandemic.

CDC can deny ill persons with these diseases entry to the United States or have them admitted to a hospital or confined to home.

Stay tuned for more details.

By Frank James

How soon can a vaccine be created to protect against swine flu? Perhaps September, according to an expert heard on NPR's All Things Considered and Morning Edition programs this morning and yesterday.

Dr. Bruce Gellin, director of the Health and Human Services Department's National Vaccine Program Office, told ATC host Robert Siegel, that the lab which first identified the new strain of swine flu virus now spreading globally is creating a "reference strain" of the virus, copies of which can then be shipped to vaccine makers in May.

That will allow the vaccine makers to start growing the vaccine in eggs and eventually ramp up to manufacture hundreds of millions of doses, with the vaccine being delivered in September, just in time for healthcare providers to start inoculating people for the next flu season which typically starts in October.

Here's an excerpt of Siegel and Gellin's discussion:

SIEGEL: How far are we from having a vaccine that could inoculate people against the swine flu?

Dr. GELLIN: Well, we've already started the process and it'll take some time. What's going on right now is that when the laboratory that identified this new strain of influenza virus recognized that it was something that hadn't been seen before, they do what they usually do and begin developing it into a -- what's called a reference strain. Essentially one of the seeds that then is used to go on and make a fully manufactured virus. That process is going on now. We expect manufacturers to receive it probably by late May.

Continue reading "Swine Flu Vaccine Possible By September" >

By Mark Memmott

The Commander in Chief has some orders for all Americans -- starting with telling them to keep their hands clean.

At a White House event marking the decision by Pennsylvania Sen. Arlen Specter to leave the Republican Party and join the Democrats, President Barack Obama just used his time at the podium to speak about the flu outbreak.

Along with pledging that the federal government will "do whatever is necessary" to protect the public, Obama reinforced some of the advice that medical professionals have been giving.

"Keep your hands washed," he said. Stay at home if you feel sick. And "keep your children home" if they fall ill with flu-like symptoms (but get them to the doctor if those symptoms become severe).

Update at 8:25 a.m. ET: The president also said that schools where any pupils are suspected to have the flu should "strongly" consider closing. That's exactly what has happened today in Obama's hometown, Chicago, where a North Side elementary school has closed for at least two days because a student may have the disease.

Update at 12:40 p.m. ET. Courtesy of the Associated Press, here's some video of the president from this morning's event:

By Frank James

You don't need to visit an airport to see a copy of the Travelers Alert the U.S. government is distributing at ports of entry. "Flu Shots" saves you the trouble.

Travelers Health Alert Notice 4 26 09

By Mark Memmott

In its first such request since the flu outbreak began, the White House has asked Congress for $1.5 billion to fund efforts to keep the disease from spreading in the U.S..

Spokesman Robert Gibbs told reporters earlier that President Barack Obama has sent a letter requesting the funds.

Among the intended uses for the money: Building drug stockpiles and monitoring suspected cases.

By Mark Memmott

NPR's April Fulton reports that not only is the new administration getting some praise for its response to the flu outbreak -- so are the past actions of the Bush team:

Dr. Richard Besser, the acting head of the Centers for Disease Control and Prevention and a long-time agency leader on emergency preparedness, along with newly confirmed Department of Homeland Security Chief Janet Napolitano, were "pitch perfect" as they explained the state-of-play in recent days, bioterrorism expert Eric Toner of the University of Pittsburgh tells NPR's Julie Rovner on Morning Edition.

"They explained very complicated issues in a very understandable way. They were calm, they were reassuring, but not overly so. They stressed the serious nature of the outbreak, but without scaring people," Toner adds.

But the new administration shouldn't get all the credit.

Anthony Fauci, who has overseen the National Institute of Allergy and Infectious Diseases for the last two decades and change, has told friends and reporters that the Bush administration deserves a lot of credit for getting a federal system in place to deal with a pandemic.