If you're going over the river and through the wood to Grandma's house today, the Centers for Disease Control and Prevention wants you and her to stay flu-free.
So the public health agency is asking travelers to brush up on what's fast becoming a swine-flu prevention mantra. It goes kind of like this:
Don't be a hero: stay home if you're feeling sick.
Wash your hands--a lot!
Put a lid on the coughs and sneezes with a Kleenex or your sleeve, pal.
Get vaccinated against seasonal flu and swine flu (if you're at high-risk) before the trip. A little late to do that today, but Christmas isn't far off. So get the shot (or spray) and give yourself the gift of immunity.
Recently released guidelines suggesting less frequent screening for breast and cervical cancer caused quite a commotion over the last week, prompting some critics to warn of government rationing. Compared with those reports, a guidance proposing an ethical "framework" for rationing scarce ventilators in the event of a severe influenza pandemic arrived yesterday in relative silence.
Short supplies of ventilators could force tough decisions, if swine flu gets ugly. (Michael Krinke/iStockphoto.com)
We predicted a move like this back in September. ProPublica, a nonprofit investigative newsroom, obtained a copy of the guidance and posted it Monday, hours before a public Centers for Disease Control and Prevention teleconference on the document. The CDC advisers who drafted the guidance voted to approve it during the call, but said it wouldn't apply to the current swine flu pandemic unless it becomes significantly more severe, ProPublica reports.
The guidance -- for use only when demand for life-saving ventilators far exceeds supply -- says the equipment "will need to be allocated according to different guidelines than during usual clinical care." Rather than using ventilators to treat the sickest patients, the CDC advisers suggest using criteria such as the likelihood that a patient will survive, the number of years the patient is expected to live, and age.
Two small clusters of drug resistance don't a public health crisis make. But experts worry they could signal the development of a Tamiflu-resistant pandemic virus with the ability to spread from person to person -- at least under certain circumstances.
Health officials are investigating two unrelated clusters of hospital patients -- four patients in North Carolina, five in Wales who've been infected with swine flu viruses resistant to the mainstay antiviral drug Tamiflu.
All of the involved patients reportedly had weakened immune systems. That may have enabled the pandemic virus to replicate in their systems more freely. If these immuno-compromised patients had been given Tamiflu, that combination of factors may have led the virus to develop a point mutation conferring resistance against the drug.
Should Santa Claus be allowed to cut the line for swine flu vaccine?
David Oelerich rents Santa suits in New Hampshire. Santas this year want more than just a suit, they want a swine flu vaccine. ( Jim Cole/AP)
Santa America, a group of 200 santas who visit sick children year-round, say they should. "Santa" Ernest Berger, president of Santa America, wants his cheery colleagues considered for the vaccine in the same way as schoolteachers and other caregivers are.
He tells NPR's Melissa Block on Thursday's All Things Considered that Santas should be considered seriously for the vaccine because of their close contact with large groups of children.
The first two deaths from the swine flu virus on college campuses were reported this week by an organization tracking the virus at schools around the country.
Click on image to see full-size chart. (AHCA)
But the week that ended Nov. 13 also showed a drop in the number of cases of H1N1 swine flu virus reported to the American College Health Association, from 29 cases per 10,000 students to 21.3. Still, the two deaths reported to the organization were the first since they began tracking the virus.
"Though pandemic flu remains generally mild among college students, these two deaths are harsh reminders of the rare but tragic consequences of influenza," Dr. James Turner, president of the ACHA, said.
The swine flu vaccine remains scarce, but is slowly becoming a little less difficult to find.
California counties are trying everything when it comes to distributing the H1N1 vaccine, here a woman gets a shot in a drive-thru H1N1 vaccination clinic in San Pablo. (Justin Sullivan/Getty)
Some people are getting the vaccine at doctors' offices, some at college health centers, and some at public flu clinics. You're best bet will depend on where you live.
As KQED's Sarah Varney reports on Tuesday's All Things Considered, in some parts of California the best source for H1N1 vaccine might be a shopping mall, while in others only a doctor's office will do. Each state orders vaccine from the CDC to be delivered to "distribution sites," such as hospitals, clinics, and doctors' offices. Who receives it and how they distribute it varies.
There was a time, not long ago, when squirting gelatinous goo into your hands after every cough and before every meal would have seemed absurd. No more. Thanks to the flu pandemic, hand sanitizer has made its way into nearly every home, office, and school.
What's in your bottle, Anne Schuchat? (Alex Wong/Getty Images)
The germ-killing ingredient in most of the stuff is alcohol. Any product that is more than 60 percent alcohol quickly punches holes in the membranes of most harmful bacteria and viruses (including H1N1) and quickly "kills them dead," as the insecticide ads say, without damaging the skin. But what about the versions sold as "alcohol-free?" Do they work?
"Depends on what's in them," says Allison Aiello, an epidemiologist at the University of Michigan who has studied hand hygiene.
When the H1N1 pandemic first hit the U.S. last spring, college campuses drew particular scrutiny because of their close quarters teeming with young people, who are more vulnerable to the virus.
Click on image to see full-size chart and data on swine flu cases on campuses. (ACHA)
The concern returned this fall as students headed back to campus just as the virus resumed its march. After a flurry of swine flu reports in September, cases eased a little in October.
How are things these days? Kitty Boyer of Auburn, Alabama, asks:
What's happening on college campuses with swine flu? My daughter's college is swamped. Is that true elsewhere?
We turned to the Web site of the American College Health Association, which has been tracking reported cases of H1N1 on campuses around the country and found they're hitting new highs.
There's been a big jump in the number of people who've died from the new H1N1 swine flu.
Last week the pediatric death count between late April and mid-October stood at 129. This week it's 540 deaths, the Centers for Disease Control and Prevention estimates.
But the flu hasn't gotten more deadly, NPR's Joanne Silberner tells us, it's that the government's estimates have been tweaked.
What changed? Well, the new estimate was derived from same data sources--tallies by select doctors and hospitals. But the CDC is now factoring in deaths that may not be explicitly identified as due to swine flu. Sometimes a a flu test isn't done, or it's wrong, or the death is attributed to a different infection that came after the flu.
Mandatory paid sick-leave might have gotten thrown out of the House health overhaul bill, but Congressional Democrats haven't given up yet. They still have a chance to get legislation passed -- by tying it to swine flu.
Democratic Sen. Chris Dodd announced he would introduce "emergency" sick-leave legislation in the Senate. (Chip Somodevilla/Getty Images)
Sen. Chris Dodd (D-CN) said Tuesday he intended to introduce emergency sick-leave legislation tied to the new H1N1 virus outbreak.
It's similar to a bill introduced in the House last week by Democratic Rep. George Miller of California. The House bill would apply to businesses with 15 or more employees, and guarantee five paid sick days for workers ordered to stay home due to a contagious illness like swine flu. But where this bill significantly differs from other recent proposals is that it comes with an expiration date: two years from the day it's signed into law.
All around our neighborhood, people are coughing. So we weren't too surprised when a blog reader, who asked not to be identified, wrote in with a question about the hacking:
Any H1N1 virus there? (iStockphoto.com)
Is a 'cough' always present with the swine flu, or is it possible for that symptom not to be present and still have H1N1?
Most of the time a cough does go along with the swine flu, Dr. Douglas Kamerow, a family physician and former Assistant Surgeon General, says. The symptoms for swine flu are generally the same as classic influenza, which means a cough is very common.
A little more vaccine help is on the way for swine flu.
Information on flu shots at a California vaccine clinic. (Justin Sullivan/Getty Images)
The Food and Drug Administration just approved a shot against the new H1N1 virus from GlaxoSmithKline. As a result there are now four companies able to provide swine flu shots in the US. The fifth provider is AstraZeneca's MedImmune unit, whose vaccine is a nasal spray.
None of the vaccines for America, including Glaxo's, contain an adjuvant, or immune-system booster. Those chemicals have never been used in an approved flu vaccine in this country, though they are OK in Europe.
Racial minorities have their own stories to tell about the new H1N1 pandemic.
Antonio Magallanes moved to the US 40 years ago to work in the fields and as a landscaper. He says he worked whether he had the flu or not. (Kelley Weiss/Capital Public Radio News)
Kelley Weiss, a reporter with member station Capital Public Radio, reports on Tuesday's All Things Considered from Sacramento, Calif., on the hurdles posed for some Latino communities by a lack of health insurance and jobs that don't offer paid sick leave.
Antonio Magallanes, a 65-year-old retiree who used to be a landscaper, told Weiss, that he had to keep working no matter how sick he felt in order to feed his nine children. "I used to just make up some kind of tea or something and go to work," Magallanes told Weiss.
Hey, doc, Food and Drug Administration Commissioner Dr. Margaret Hamburg wants to thank you for all your hard work dealing with the swine flu. Oh, and by the way, if your patients have questions about the new H1N1 vaccine, she's got some answers.
A man gets an H1N1 shot at drive-thru clinic in San Pablo, Calif. (Justin Sullivan/Getty Images)
We've been getting quite a few of those queries ourselves, such as, is the vaccine effective?
We can give you the high points. She acknowledges that some patients may wonder how everyone can be so confident a vaccine developed in only six months is OK.
If swine flu strikes and you start running a high temperature, should you treat the symptom with aspirin, Tylenol or other medicines to reduce fever?
Julie Heiligenthal, left, a health aide in Burlington, Wis., takes Ann Erickson's temperature late last month. (Paul Sloth/AP)
Our latest question stems from comments from Dale Moss who emailed, "The body's main defense against any viral illness is a strong fever, but the medical profession appears to be suffering mass amnesia on this point."
Moss contends that aspirin used to treat fever during the Spanish flu pandemic of 1918-19 caused many cases of flu "to morph into a raging pneumonia," and that the medicine actually killed many people.
Many readers and listeners have raised questions about how effective the H1N1 vaccine is. This one comes from Jennifer Meegan, who is wondering whether she should bother getting vaccinated. She explains:
The fact is ... the efficacy of flu vaccines is under scrutiny by many legitimate doctors and scientists. I don't necessarily subscribe to the idea that the vaccine(s) itself is toxic, etc, etc. But there is a growing case to be made as to whether or not flu vaccines do any good at all.
Meegan specifically mentions a provocative article in this month's Atlantic magazine.
The cover asks "Does the vaccine really work?" The article itself offers the answer "not really," and suggests more tests need to be done.
But there are a lot of problems with that article. We'll deal with two here: One is that it generalizes from the seasonal flu vaccine to the new one. The other is that it ignores a slew of data.
Harvard pollster Bob Blendon says his latest numbers on swine flu sentiment should shake up the priorities for the federal government's campaign to get most Americans vaccinated against the new H1N1 before it's too late.
Vaccine believers want the shot. So where is it? (Rogelio V. Solis/AP)
Instead of convincing skeptics to get the vaccine, Blendon says, "the real focus has become how do you get the vaccine to people who had already decided they want it but haven't been able to get it."
The new poll, conducted last weekend, is the first to show what people actually do about flu vaccination, rather than what they think they'll do. It shows strong enthusiasm among parents to get their kids vaccinated.
With supplies of swine flu vaccine tight and demand surging, some health officials are catching flack for another Wall Street bailout.
Goldman Sachs headquarters got a few hundred doses of swine flu vaccine. (Chris Hondros/Getty Images)
Centers for Disease Control and Prevention Director Dr.Thomas Frieden sent a not-so-friendly letter yesterday to state and local health officials reminding them to make sure that scarce swine flu vaccine goes to priority groups, such as kids and health-care workers.
How come? The Wall Street Journal reports trouble in the Big Apple, where Frieden was health commissioner until decamping for Atlanta in June. Some New York employers, including Goldman Sachs and Citigroup, got doses of the swine flu vaccines to give to their workers.
We've got another swine flu question. This one comes in an email to the blog from Wendy Pierce of Bozeman, Montana:
I am one of the unfortunate people that had Guillain-Barre, not associated with the swine flu. I have heard that I should not get vaccinated, is that true?
This is a tricky subject. Guillain-Barre syndrome is a rare and mysterious neurological condition that can cause partial paralysis and, on rare occasions, death.
There were several hundred cases of Guillain-Barre following the vaccination of millions of people for swine flu back in 1976, but doctors are still arguing about whether those cases were caused by the vaccine.
Seven months into the flu pandemic of 2009, North America leads the world in cases, the WHO says.
North America: hotbed for swine flu. (iStockphoto.com)
Unlike elsewhere, the new H1N1 never exited stage left after its debut appearance in late April. In fact, it's making more noise than ever. Mexico has experienced more cases of pandemic flu since September than it did over the first four months of the pandemic this spring.
It's too soon to know if the flu pandemic has peaked, or is near its peak, in the United States or any other region, the World Health Organization's H1N1 honcho Dr. Kenji Fukuda said today in a briefing with the media. And we might not know until after the fact.
Lots of people get sniffles, sore throats, fever and other respiratory miseries this time of year. In a normal year, only about one person in four actually has laboratory-confirmed flu when samplings of nasal swabs from sick Americans are tested.
Ah-choo! Is it the flu? (iStockphoto.com)
This year is different. The World Health Organization says more than 40 percent of Americans with "influenza-like illness" are testing positive for flu (and it's nearly always the new H1N1 flu). In some countries as many as 70 percent of nasal swabs turn up flu-positive.
That's pretty interesting, considering that at this point in the season last year, only 2.2 percent of the swabs tested postive.
So if you have respiratory symptoms this year, there's a better-than-usual chance it's the flu.
Here we go with some more swine flu questions and answers. In an email to the blog, Renee Boulis, of Wyomissing, Pa., asks about the nasal spray form of vaccine against the new H1N1 virus.
Three-year-old Abby Hilterbran receives a nasal vaccination in Piqua, Ohio, on Monday. (Mike Ullery/AP)
How effective is the protection for children under 8, ask Boulis, who often babysits two young grandchildren? Is it possible for them to transmit the virus to others while they are waiting for the second spritz?
Let's take your first question first.
The short answer on effectiveness in children is that a single dose is not as effective as people would like. Two doses get the job done.
The National Institute of Allergy and Infectious Diseases just released the results of a study on children under the age of 10. This study used the injectable vaccine, but scientists say the results hold for the nasal spray as well.
After the first shot, researchers looked for signs in the kids' blood that they'd be able to fight off infection. Only 25 percent of children between the ages of 6 and 35 months had a strong enough response three weeks after the first dose, and only 55 percent of those 3 to 9 years old were protected.
After the second dose, though, all the 6 to 35 month olds and 94 percent of the 3 to 9 year olds were protected. That's why the U.S. government is sticking to its recommendation that kids get two doses. The World Health Organization is opting for just one.
We have received so many intriguing listener and reader questions about the swine flu over the last few weeks that we're going to do our best to tackle one a day until the pandemic subsides or we've exhausted your curiosity.
(2009 H1N1 virus/C. S. Goldsmith and A. Balish, CDC)
To kick things off, we have a question from Nancy DeWeese, who asks:
I and my daughters (then 4 and 8) were laid low -- really low -- for several days in 1976 with the flu. We hear now it was probably the 'swine flu' of the day. Any connection between that virus and today's H1N1? Any protection for us as a result?
The short answer, Ms. DeWeese, is that you and your daughters did not have swine flu back in 1976.
Several months into the effort, government health officials are still trying to figure out how to address public concerns about the safety of the H1N1 vaccine. It seems a difficult task, even when there is good news, like today's report that the vaccine shows great promise in protecting pregnant women, even at low doses.
Even though no unexpected health problems have emerged from those who have received the vaccine, HHS announced a new arm to its vaccine safety surveillance system -- that old chestnut known as appointing a panel of outside experts.
The panel will review all the human data the government has, including use of the vaccine in the military, within the Indian Health Service, and other places. The panel review comes in addition to beefed-up ongoing projects to analyze reports of problems, and data already being gathered from various HMOs.
With Halloween behind us, Daylight Saving Time over and the leaves practically jumping off the trees, it's really starting to feel like... flu season.
Fourth-grade teachers Meg Freund and Judy Fratto get creative for Halloween in Washington, D.C. (Jessica Goldstein/NPR)
Fall schmall. The swine flu is hitting early and hard. The CDC says there have been more hospitalizations of people younger than 65 for flu in the last two months than in most entire flu seasons.
The march of the 2009 H1N1 virus across the country is on our mind. And we're not the only ones. On Monday's Morning Edition, NPR's Richard Knox and Joanne Silberner answered listeners' questions and an online piece tackled even more.
Even kids can get by with a single dose of swine flu vaccine, says the World Health Organization. But the U.S. is not so sure just yet.
WHO previously recommended two shots for kids younger than 10. But the new one-shot deal contradicts current U.S. policy, which calls for two shots (or nasal spritzes) in this age group.
After a two-day meeting in Geneva, WHO officials acknowledge data are sparse on whether a single dose protects younger kids against the new H1N1 virus. But vaccine shortages have forced them to reconsider.
"The priority is to give...one dose rather than vaccinate half the number of children with two doses," says Dr. Marie-Paule Kieny, director of WHO's Initiative for Vaccine Research.
You may not have noticed, but we've been having an H1N1 epidemic without America's Top Doctor.
Will Benjamin use the bully pulpit on swine flu? (Charles Dharapak/AP
)
That may change soon. The Senate has confirmed the appointment of Dr. Regina Benjamin as Surgeon General. Medically speaking, 53 year old Benjamin has a lot of street cred. She's a family doctor who founded the Bayou La Batre Rural Health Clinic in Louisiana. She became nationally known for getting it back up and running after Hurricane Katrina.
The SG famously doesn't have any kind of budget. All it has is what former Surgeon General Everett Koop firmly established as a "a bully pulpit" -- a chance to jawbone people about public health.
Catholics in Boston and many surrounding areas won't be sharing wine during Communion anymore -- at least until threats of swine flu ease a bit.
Not so fast! That communal chalice is a hotbed for germs. (iStockphoto.com)
The Roman Catholic Archdiocese of Boston issued a recommendation to churches yesterday to suspend the sipping of wine from a shared cup during Communion. They also suggest avoiding the traditional hugging or kissing of those in neighboring pews when passing the peace.
Changes to religious rituals have been rumored since the first outbreak of the H1N1 virus. NPR investigated the reaction of several individual places of worship back in September, but yesterday's formal movements by the Catholic Church seem to be some of the strongest strides towards containing the virus in public places. And the recommendations are straight out of the government's playbook.
With all the questions floating around about swine flu cases and vaccine shortages, we wondered what the Centers for Disease Control and Prevention might tell us at a briefing today.
(CDC)
Turns out, nothing new really. That's because not all that much has changed on the swine flu front. The vaccine is being made by the same companies, the same way, in the same factories as the seasonal flu vaccine that's been used safely for years. And it's still true that the new H1N1 virus has established itself throughout the country, which most of us had sort of figured out just by talking with the neighbors.
So we reflected instead on some of the question we keep getting from NPR listeners and readers of this blog.
As a good, caring parent, I decided I should provide my 12-year-old son with the H1N1 vaccine. The District of Columbia Department of Health was kind enough to set up free flu clinics in each of the eight wards that make up this city.
If you look closely, you will not see Joe Palca and his son in this line for a H1N1 vaccine clinic. (Rick Roach/AP/The Reporter)
So last Saturday morning, I dragged myself and my surprisingly agreeable child out of bed at 7:30 so we could go to the clinic in my ward at Wilson Senior High School. I figured if we get there by 8 a.m. when it opened there wouldn't be much of a line. Who gets up at 7:30 on Saturday morning to get a vaccination?
The first hint I had miscalculated were the cars parked a quarter mile from the school entrance. My fears were confirmed when I saw two traffic wardens directing the flow of cars to side streets away from the school.
After the jump: Will Joe Palca's son get his vaccine?
What was supposed to be vaccination time has become finger-pointing time.
Good luck finding some of this. ( Mark Boster/Getty Images)
Day by day, we're learning more about why supplies of a vaccine against swine flu, expected to be a centerpiece of public health, are coming up short. But explanations are small consolation for people who took the vaccination message to heart and have been unable to get immunized against the new H1N1 virus.
As NPR's Richard Knox reports on Monday's Morning Edition, the makers of vaccine didn't realize just how badly production was going until very recently, when they got test kits they needed to assess the potency of the vaccine being churned out--it's been low.
If all the good advice about coughing and sneezing into your sleeve to prevent the spread of flu hasn't sunk in, please take a look at this gripping video from NPR's Robert Krulwich and medical animator David Bolinsky.
Now, you can see how the flu virus--any flu virus--propelled by one man's sneeze--any man's sneeze--infects another poor guy, hijacking a cell to make a whole bunch more virus which could infect you.
The new H1N1 virus is doing a lot of this lately. The Centers of Disease Control and Prevention said Friday that since April, when swine flu first hit, the multiplying bug has caused more than 1,000 deaths and put more than 20,000 people in the hospital. Here's how that gets rolling.
Bonus protection: Flu spreads through handshakes, too, so we offer some alternative greetings that might help curb the pandemic. Personally, we hope the Snap and Flick catches on.
The Centers for Disease Control is just as unhappy as the rest of us about the tight supply of swine flu vaccine, we heard today.
Nurses in Indianapolis prepare the swine flu vaccine for another overwhelmed clinic.(Darron Cummings/AP)
In an afternoon briefing today, CDC Director Dr. Thomas Frieden talked about the problems, saying the means of vaccine production aren't exactly modern and are definitely not suited to responding to this pandemic.
In short, manufacturers are having more trouble growing the virus for the vaccine than they originally expected. But, Frieden said, the method is the "tried and true" way that seasonal vaccines are produced, so at least we know it's safe.
In a sign of just how tight the supply of swine flu vaccine is, New York officials said yesterday they are backing down on mandatory vaccination of health-care workers.
People line up for swine flu vaccine in Indianapolis on Thursday. (Darron Cummings/AP)
A controversial state regulation, already blocked temporarily by a New York judge's ruling, has been made moot by the fact that there isn't enough vaccine to get the job done anyway. Now New York will concentrate on vaccinating pregnant women and children, the New York Timesreports. Less than one-quarter of the vaccine expected in New York by the end of October is now on track to arrive.
Same story out west in California, where flu cases are surging and vaccine is scarce. The state is supposed to get 20 million doses of swine flu vaccine this season. So far just 1.7 million doses have made it, the Los Angeles Timesreports, and seasonal flu vaccine is also hard to come by. "It has been an abomination," Marcy Zwelling, a Los Alamitos doctor, told the paper.
We've all done it: Sent our kids to school when their noses are still a little bit runny, or gone to work ourselves with a low-grade fever. "It's just a little cold," we tell ourselves. "We'll get over it."
We know we should stay home, but last-minute childcare arrangements and the pileup of work awaiting us if we dare break routine for a day or more seem more daunting than just soldiering on into work or school, armed with decongestant and a box of tissues.
Should I stay home or should I blow at school?
(iStockphoto.com)
But now we're in the H1N1 world, and the risks of soldiering on seem higher. What if our family has been exposed to the new virus but nobody's sick yet? What if we think we're healthy and we're still shedding the virus and able to infect others?
Or even worse, what if we don't have paid sick leave and have to go to work sick because we need to pay the rent?
We want to hear from you for future stories. Have you faced this dilemma and what did you do? Email us your story at:
shots@npr.org.
If your office is anything like ours, more folks and their families are out of commission with the swine flu.
People wait to be vaccinated against swine flu in Rockville, Maryland. (Saul Loeb/Getty Images)
Most places in the country now have widespread cases of the new H1N1 virus, the Centers for Disease Control and Prevention's latest map shows.
We took the threat of swine flu seriously from the start, but now we're fretting just a little bit more as vaccine supplies remain tight, new research indicates people can spread the virus a little longer than first thought and kids keep getting hit especially hard by the bug.
Press conferences at the Centers for Disease Control and Prevention usually go like this. First, to get onto the CDC's massive campus in Atlanta, stop your car at the security gate. Very serious inspectors then circle about, looking underneath your car with a camera, checking the trunk, and peaking under the hood.
This can occasionally pay off for the reporter. While I was holding up the hood (otherwise it tends to fall on people's heads) before my first CDC press conference, I noticed my radiator fluid level was low. Thanks, CDC!
Once you get into the Tom Harkin Global Communications Center (thanks, Sen. Harkin!), and convince even more serious inspectors to let you in, you walk down a nice, airy hallway to a room with a podium, a lovely midnight-blue backdrop, and black-out shades pulled down so the camera people will be happy.
Today, the room was illuminated by something other than good TV lighting. Travis Stork was there.
Dr. Travis Stork, right, makes a guest appearance on the CBS show Three Rivers. (CBS via Getty Images)
Travis Stork?
OK, you may know him. I didn't. He's on TV. But my TV hasn't worked since stations switched off their analog signals.
Everybody who works in a hospital should wash his hands frequently. But some hands are more important than others.
A few dirty hands can mess up a whole hosptial. (iStockphoto.com)
One careless health-care worker who has fleeting contact with a lot of patients can undermine everybody else's conscientious handwashing, a group of French researchers has found using a mathematical model to simulate infections in a hospital ICU.
An infection "superspreader" can be a radiologist, a physical therapist, or a specialist who consults on many wards. The key thing is that superspreaders are "peripatetic," roaming a wide territory. Other hospital workers who are more rooted to a particular unit don't do as much damage when they forget to wash their hands between patients.
The feds have told a company associated with alternative health guru Dr. Andrew Weil that it has crossed the line by selling an unapproved product for warding off the swine flu.
The FDA questions the evidence behind the herbal remedy astragalus as a cure-all for H1N1. (Wikimedia Commons)
In a stern warning letter, the Food and Drug Administration and Federal Trade Commission told Weil Lifestyle LLC to stop marketing a dietary supplement called "Immune Support Formula" as a product that could "diagnose, mitigate, prevent, treat or cure the H1N1 Flu Virus in people."
The regulators pointed to a bunch of health claims on the Web they say are unsupported. Take a look, they said, at a page on the site Dr.Weil.com titled, "The Swine Flu- H1N1," and subtitled, "Swine Flu and You." The original page appears to have been taken down, but you can see an screengrab of the pagehere.
Our email and calls to Weil Lifestyle LLC for comment weren't returned immediately.
What bugged the regulators? For starters, the following advice attributed to Dr. Weil:
"[D]uring the flu season, I suggest taking a daily antioxidant, multivitamin-mineral supplement, as well as astragalus, a well-known immune-boosting herb that can help ward off colds and flu. You might also consider. .. the Weil Immune Support Formula[,] which contains both astragalus and immune-supportive polypore mushrooms ...."
If you're worried about swine flu, resist the temptation to stock up on dubious medicines being hawked online.
The Food and Drug Administration ordered a bunch of stuff on the Web recently that was supposed to fight or prevent the flu and doesn't recommend you do the same.
One package from India that should have contained the flu-fighter Tamiflu, or oseltamivir, instead had some plain, white tablets that turned out to be a mixture of talc and acetaminophen. The Web site where the meds were offered "disappeared" shortly after the FDA placed its order, the agency said.
Other shipments included products that contained some oseltamivir but they weren't approved for sale in the US.
The FDA has come up with a neat little widget (check it out on the right) to help people separate the impostors from the real deals when it comes to H1N1 products.
So when the swine flu hits, should the doctors and nurses at your local hospital make do with regular old surgical masks to keep the new H1N1 virus at bay or go with a beefier and more costly respirator?
N-95 masks, like this one being demonstrated at an Oakland, Calif., clinic in April, are hot commodities. (Justin Sullivan/Getty Images)
The question has sparked heated debate between health-care workers and infection control specialists. The dispute centers on N-95 respirators.
They look a lot like ordinary surgical masks but they're thicker, they fit tighter and they filter out at least 95 percent of all viruses. The fancier masks also cost more. And they're in increasingly short supply.
Front-line health care workers and their unions want personnel to be fitted with N-95s. Now the Centers for Disease Control and Prevention has sided with them. The public health gurus just posted new advice on the best ways to protect health care workers against the new H1N1 flu virus and recommends the N-95, or equivalents, for people workig closely with "patients with suspected or confirmed 2009 H1N1 influenza."
We've heard plenty of civilians questioning whether to get vaccinated against swine flu. The Centers for Disease Control and Prevention says the answer is pretty much, "Yes, you should." For those on the fence, new data show otherwise healthy people account for almost half the cases of swine flu that land people in the hospital.
One of these vaccine syringes has your name on it. ( Scott Olson/Getty Images)
So it's all the more mystifying to learn that large numbers of health workers--who have a high risk of catching the new H1N1 virus and passing it on to the vulnerable--are balking. These health pros are precisely the people who should know the score on vaccines, right?
Evidently not. After 40 years of talk, New York health authorities are now making vaccination against seasonal and swine flu mandatory for health workers, NPR's Richard Knox reports. Decades of a soft-selling never got even 40 percent of workers in New York to get flu shots.
Good health is no guarantee swine flu won't put you in the hospital.
Swine flu can knock out just about anyone. ( Michael Krinke/iStockphoto.com)
Nearly half of adults hospitalized with swine flu didn't have asthma or any other chronic health problem, the Centers and Disease Control and Prevention has found after looking at 1,900 cases of confirmed swine flu in grown-ups and children.
The new H1N1 "virus can be serious, even in healthy people with no underlying conditions," the CDC's Dr. Anne Schuchat said in a briefing. "Some totally healthy people suffer this very rapid deterioration."
We figured this would be a good time to listen in on the weekly briefing by the Centers for Disease Control and Prevention on the latest news on the H1N1 pandemic. We've got some jazzy hold music now but should be rolling shortly.
Today, we're supposed to hear from:
Dr. Anne Schuchat, Director, National Center for Immunization and Respiratory Diseases, CDC
Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, NIH; and,
Dr. Jesse Goodman, Acting Chief Scientist and Deputy Commissioner, FDA.
Update: The CDC posted a transcript of the briefing here.
Mandatory flu vaccination for health-care workers looks like an idea whose time has come.
Vaccines are giving the drug business a shot in the arm. (Thierry Zoccolan/Getty Images)
Local health authorities and major hospital groups are giving up on more than a quarter-century of cajoling health workers to get vaccinated voluntarily. Increasingly they're saying: get vaccinated, wear a mask during flu season, or find another job.
So far New York State is the only state that's requiring hospital and clinic workers to get flu shots (or nasal squirts). But Hospital Corporation of America, the nation's leading hospital chain, mandates flu shots for its 120,000 workers. So do Barnes Jewish Hospital in St. Louis, MedStar Health in Baltimore/Washington, and now the UC Davis Health System does too.
Some require only seasonal flu vaccination, others are mandating vaccine against the new H1N1 virus when that's available.
Wondering if you have swine flu and should head to the doctor or emergency room?
This flu quiz won't hurt a bit. (Microsoft)
A few weeks ago we wrote about work on a series of questions and answers to help you puzzle out whether or not you've come down with the new H1N1 virus and need immediate help. Now the self-service quiz is ready for prime time.
Microsoft is offering it up here. So are the feds on the flu Web site here. And other sites may host it soon, too.
So you got the message and want to get flu vaccine for your family. That might be easier said than done--especially for the regular old seasonal flu.
Finding a shot against seasonal flu may be a challenge right now. (iStockphoto.com)
Shortages of seasonal flu vaccine and a preponderance of the new H1N1 virus are leading to the cancellation of some vaccination drives for run-of-the-mill influenza, as we just found out in our own backyard.
The health department in Montgomery County, Maryland, told parents that it's halting school-wide seasonal flu vaccination until further notice.
How come? For starters, 99 percent of the flu in Maryland right now is H1N1. There's also not enough of the FluMist nasal-spray vaccine for seasonal flu to go around. Finally, the H1N1 vaccine is coming sooner than expected, so the county wants to focus on that threat.
When it comes to swine flu, many people wonder if the vaccines hurried into production are safe? We only learned of the H1N1 virus early this year and now the US is bent on immunizing almost everyone in the country.
Don't worry and roll up your sleeve, WHO says. (iStockphoto.com)
This vaccine seems to have been rushed to market. Although this has been FDA approved, the FDA has a great track record of approving drugs only to have them pulled from the market due to complications. How can we be sure this vaccine will not have some major side effects as the 70's vaccine did. And do you feel that the fact that the Secretary of Health and Human Services has granted the manufacturer immunity from potential legal proceedings is any cause for alarm to Not get this vaccination?
We're all tempted, but it's generally risky to take medications that have passed the expiration date listed on the package. It's common sense.
To toss or not to toss? (iStockphoto.com)
But when it comes to swine flu, the federal government, worried about the availability of treatments, has other ideas.
HHS Secretary Kathleen Sebelius last week gave states access to 300,000 doses of liquid Tamiflu from the government's strategic storehouse, for use in children. Some of the drugs are as much as three years past their expriation date. A government official says the Food and Drug Administration has tested the expired lots and they're fine.
Swine flu is back, and the first vaccines against the H1N1 virus will soon be on their way.
What do you want to know about swine flu? (CDC)
But how's the flu pandemic shaping up as fall returns to the Northern Hemisphere? What's the difference between the sprayed and injected vaccines? Who should get immunized first and who can wait?
We'll tackle questions like those in an online chat at noon eastern time on Monday, Oct. 5. Bookmark this post and come back here then with the questions you want answered.
NPR's swine flu czar Richard Knox will be on hand after a morning segment on Morning Edition that will feature a few questions and answers.
We'll be joined by Dr. Richard Wenzel, professor and chair of internal medicine at the Medical College of Virginia, Virginia Commonwealth University, in Richmond.
We admit from the start that we're torturing the numerical metaphor by comparing "Beverly Hills, 90210," a trashy TV pleasure of ours from yesteryear, with "90470" a new billing code for swine flu immunization and counseling.
Do you want counseling with the shot? (iStockphoto.com)
But the neurons linking those two ideas in our blog-addled brain were the first ones to fire when we read the American Medical Association's announcement of billing codes for swine flu vaccination. So move over "90210," here comes H1N1.
In case you didn't know, the AMA, among other things, is the keeper of the codes that docs use to document their work and get paid for it.
Among those most eagerly awaiting the swine flu vaccine due soon are college kids. And for good reason. The virus hits young people hard and is spread easily in close quarters like dorm rooms, stadium bleachers and frat parties.
(iStockphoto.com)
But after a quick start on many campuses, swine flu took a bit of a breather last week. The latest numbers of flu-like illnesses on campus shows a slowing pace of infection.
Last week, Sept. 19-25, only 6,527 new cases of "influenza-like illness" were reported across the country, according to the American College Health Association, which has been tracking flu since the year began. The latest figures boil down to 20.1 cases per 10,000 students--19 percent lower than the previous week's rate. And only 11 of those students had to be hospitalized.
Get ready to roll up your sleeve for another shot. The Centers for Disease Control and Prevention, already on guard against the flu, is expected to urge millions of Americans to get vaccinated against yet another dangerous lung infection.
Streptococcus pneumoniae heightens health risks for people who catch swine flu. (Janice Carr/CDC)
A new CDC analysis shows that many people who died this spring of swine flu also had bacterial pneumonia, most often caused by Strep pneumoniae, or pneumococcus.
Such dual infections were often seen in 20th-century flu pandemics. But they hadn't been documented in the early swine flu cases until now. "They are clearly occurring," says Dr. Matthew Moore of the CDC, who briefed doctors on the new danger Monday morning.
The first batches of swine flu vaccine -- between six million and seven million doses -- should start trickling into U.S. clinics within a couple of weeks federal health officials said Friday. More vaccine will soon follow, said Dr. Thomas Friedman, head of the Centers for Disease Control and Prevention.
But Friedman cautions that getting the stuff distributed to the right people is, at least initially, "going to be a little bumpy."
The first swine flu doses shipped will be the nasal version, not injections. (istockphoto.com)
Recent tests suggest the vaccine is a good match to the pandemic strain of flu that's already circulating in all 50 states.
And though children under ten are still likely to need a double dose, there's good evidence that a single dose of vaccine should be "quite protective for everybody age 10 and above," Frieden said.
That's the good news.
But actually getting the 250 million doses of the vaccine that the U.S. has purchased from five different manufacturers into the arms and noses of everybody who needs protection still presents "enormous logistical challenges," Frieden said.
We just got back from the office flu vaccination, with a smiley-face sticker on our shirt, a bandage on our left arm and just a hint of soreness. As soon as the vaccine for swine flu is ready, we plan to be in line for those shots (or spray) too--for us and the kids.
How many parents will have their children vaccinated against H1N1? (iStockphoto.com)
But we may be in the minority, according to results of a national survey just out from the University of Michigan. Only 40 percent of parents surveyed in August said they intend to have their children immunized against H1N1. Thirty-one percent weren't sure and 29 percent said they weren't going to do it.
The findings fly in the face of recommendations from the Centers for Disease Control and Prevention that all children older than six months be a top priority for vaccination.
If swine flu takes a turn toward the truly terrible, hospitals will be swamped and there won't be enough ventilators to help the very sick breathe.
Short supplies of ventilators could force tough decisions, if swine flu gets ugly. (Michael Krinke/iStockphoto.com)
Right now, a doomsday scenario doesn't seem likely. The second wave of H1N1 looks a lot like the usual seasonal flu and not a reprise of the Spanish Flu, the 1918 pandemic that killed 50 million or more.
Still, public health officials are preparing for the worst and that means coming up with plans for who would get a ventilator and who wouldn't. Rationing of ventilators could pit the families of people with serious non-flu illnesses against those of acutely ill flu patients.
ProPublica's Sheri Fink writes about controversial guidelines in the works that could, for instance, allow hospitals to withhold ventilators from people with chronic, irreversible illnesses, such as cancer, so that flu patients would get breathing help instead.
When it takes two health professionals 30 minutes and a bunch of algebra to puzzle out the proper dose of the flu drug Tamiflu to give their sick six-year-old, how's the average parent supposed to make sense of medication labels?
Kara Jacobson, a health literacy researcher at Emory University in Atlanta -- and mom of the sick kid in question -- would sure like to know.
Don't use a kitchen spoon to measure medicine. (iStockphoto.com)
Jacobson says she was "sick as a dog and flat on my back," with swine flu two weeks ago when her two daughters came down with flu symptoms. Their pediatrician prescribed liquid Tamiflu for the six-year-old.
Add Dr. Sanjay Gupta to the growing list of celebs like Marilyn Manson, Harry Potter's movie sidekick, and a couple of worldleaders who have reportedly fallen ill from the new H1N1 flu.
Dr. Gupta, pre-H1N1 days (Diane Bondareff/AP Photo)
As an added bonus, Gupta gives a nice summation on his blog of the symptoms and attempts to reassure us that generally, it feels just like the "regular" flu.
Gupta, CNN's chief medical correspondent and one-time presidential pick for Surgeon General, has been reporting from Afghanistan, where he apparently caught the virus. He writes this morning that "it started as a cough. It wasn't the kind of cough where something is temporarily stuck in your throat."
John Clarke, the rapping medical director for the Long Island Rail Road, is the winner in the government's contest to find a catchy public service announcement about swine flu prevention.
The guy has got the moves and the rhymes, and we're with New York magazine, which called him a "genius" for rhyming "hand sanitizer" and "I advise ya."
Check out his handiwork, the "H1N1 Rap":
Clarke, a fellow of the American Academy of Family Physicians, said he's been writing and producing medical rap since 1997. He dubs the genre "health hop."
The Centers for Disease Control and Prevention says the first doses of swine flu vaccine should get into Americans in a couple of weeks -- but through their noses, not their arms.
The first batches of swine flu vaccine won't hurt a bit. (iStockphoto.com)
Around 3.4 million doses of a swine flu version of the spray vaccine known as FluMist will be shipped the first week of October. Each state will get a share according to its population size.
The nasal spray vaccine won the race because it contains a live, though chemically crippled, form of the pandemic H1N1 virus. Producing the live-virus vaccine was faster than killed-virus preparation used in shots.
There's been a setback on the swine flu front. The crash program to make vaccine against the pandemic strain will produce "substantially less" than the 4.9 billion doses that had been expected by the World Health Organization.
Swine flu vaccine supply will be tighter than expected. (Thierry Zoccolan/Getty Images)
Even after results from recent clinical tests showed one dose of vaccine should be enough to protect most people, the supply of vaccine will be "inadequate" to shield the world's population from swine flu, a WHO spokesman said today.
The bottom line: weekly production of swine flu will be less than 94 million doses, Reuters reports.
Let's take a break for one moment from the breathless coverage of the health care overhaul on Capitol Hill to consider something else listeners are concerned about, especially the pregnant ones: Whether to get vaccinated against the swine flu.
What to consider when pregnant. (istochphoto.com)
FDA recently approved four new swine flu vaccines, and a fifth is in the works.
But there has been some confusion about what the estimated 3 to 4 million women who are pregnant should do.
Health Correspondent Richard Knox, who has been closely following developments on the new H1N1 virus and vaccine development, weighs in on this issue:
Swine flu is serious stuff. But Johns Hopkins University figures a little humor might make it easier for students and staff to take to heart messages about prevention and proper care.
Barnyard denizen or college kid with the flu? ( USDA)
So some folks in the public affairs office of the Baltimore-based university compiled a tongue-in-cheek lexicon to help educate people on campus about H1N1.
For starters, students sick with swine flu shall now be known as "pigs," making freshmen "piglets" and those who comply with orders to stay in the dorm "pigs in blankets."
Alcohol-based sanitizer is "hog tide," and henceforth "Boar War" will designate a college's all-out push against swine flu.
The Food and Drug Administration just approved the vaccine against the H1N1 virus that causes swine flu.
Vaccine against the H1N1 virus is a step closer. (CDC)
FDA just put out the details on the approval (see the full text after the jump), which applies to vaccine from four different manufacturers.
The FDA affirms, as expected, that a single dose for adults should be sufficient to raise a strong immune response in eight to 10 days. A recommendation on the dose for children, whose immune systems may need more priming, should be ready in the "near future," the FDA said, after some clinical test results come in.
Health and Human Services Secretary Kathleen Sebelius told Congress the approval news in testimony a little while ago, according to the Associated Press.
She expects the first shots to be distributed in early October, with most of the vaccine arriving starting on the 15th. Eventually there will be enough vaccine for all Americans who want it, according to Sebelius, but some people, including children and pregnant women, will be among those to be vaccinated first.
In the race between vaccine and virus, the virus is still ahead. But the jockey on the vaccine horse -- Health and Human Services Secretary Kathleen Sebelius -- is using her whip.
Who benefits from limited early-October supply of H1N1 vaccine? (Tim Sloan/Getty Images)
After weeks of saying no swine flu vaccine would be ready until mid-October, Sebelius is now sounding confident that the first doses will be going into some Americans' arms in the first week of October.
But is that early enough to do much good?
Depends on when this second wave of swine flu crests. ( Or the H1N1 flu of 2009, as the government prefers to call it.)
Health authorities say a mutated form of the H1N1 flu virus resistant to Tamiflu, a drug used to treat and sometimes to prevent its spread, may have passed between the cabin mates. It's also possible they caught it from a third person.
The first results from tests of swine flu vaccines in humans are in, and it looks like a single shot will be enough to protect people from the H1N1 virus.
A single shot should keep H1N1 at bay. (CDC)
Officials had worried two doses of vaccine might be required. But, as an editorial accompanying the online publication of two studies in the New England Journal of Medicine says, the data support beginning with a one-shot plan.
The results mean scarce supplies of vaccine can go farther and immunization can be done more quickly than if a two-shot regimen were required. For more, listen to this report from NPR's Joanne Silberner.
Day-care centers and nursery schools double as germ factories, so folks who work there and the kids they watch after need to get ready for the wave of swine flu that's probably on the way.
Elmo watches HHS Secretary Sebelius and a friend wash their hands. (Robert Giroux / Getty Images)
In a briefing on CDC advice for child-care facilities, Health and Human Services Secretary Kathleen Sebelius said the government leans toward keeping them open "knowing that they're safe and secure places for kids." An exception would be if there are too many caregivers out sick to adequately supervise the children, she said.
Elmo is on the swine flu case and soon you won't be able to escape him.
The Sesame Street Muppet and his human pal Gordon, played by Roscoe Orman, star in some public service announcements to help kids and adults alike deal with the flu.
Elmo is always lots of fun. And Gordon, as his show bio says, "gives good advice." So what do they have to say about stopping the flu bug? Cough into the bend of your arm and be diligent about washing your hands.
You'll probably see these ads a gazillion times in the next few months. But if you can't wait, check out one of them below.
As the new school year begins and efforts to slow the spread of H1N1 are ramping up, CDC is trying to make the messages fun but effective. It just named the top ten finalists in its public contest for the best flu prevention PSA. There are some pretty creative entries.
Don't want to wash your hands? Try going to the bathroom in a hazmat suit like this guy.
Another entry suggests touching your mouth without washing your hands is akin to giving a cat a good scratch with a toothbrush that has just cleaned an ATM keypad and a car door handle. This to the strains of a Bach concerto, no less.
Hey, Alvaro Uribe, next time you feel the flu bug coming on, you might consider Skype instead of rubbing your infected shoulders with those of other world leaders.
Colombia's Uribe talks to the press in Argentina. (Daniel Garcia/Getty Images)
Colombian President Uribe started feeling sick on Friday just as a summit of South American presidents was getting rolling in Argentina, the Associated Press reported. "During a public event on Saturday, he was sneezing and had a fever and aching muscle," says the Guardian.
On Sunday, after he got home, the 57-year-old was a confirmed swine flu case. Colombia's foreign ministry is calling leaders in other countries who came into contact with Uribe. At the meeting he defended his country's increasingly close military ties with the US.
Seems like Americans are waking up to swine flu's likely return. Sort of.
Ready for H1N1? (CDC)
A third of people think swine flu will infect them or family members, compared with just one in five who felt that way in May, says a USA Today/Gallup poll conducted Wednesday.
Most people--55 percent--now say they'll get immunized once a vaccine is available, up 9 percent from a few months ago.
Still, the public perceptions are at odds with government projections of the risks--as many as half of Americans could come down with swine flu this fall and winter. Some 1.8 million may need hospital care.
It's the first week of school at Texas Christian University in Fort Worth, and more than three dozen students have come down with flu-like symptoms. Ten people were found to have swine flu and got treated with Tamiflu, the university said the other day.
Classes go on at the 8,700-student institution. "So far, flu cases are mild and most students are recovering within two to four days of illness onset," TCU said on a swine flu page recently added to its Web site.
Federal health officials are unsettled. They're losing sleep over what swine flu might do this fall. But most Americans wonder what all the fuss is about.
This little bug has federal officials worried. (CDC)
What keeps Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, up at night? "Are we prepared if we have to surge up our ventilator capacity," he answered during a meeting with journalists at the CDC headquarters in Atlanta Monday.
Some of President Obama's top science advisers told him this month that half (or more) of the nation's mechanical ventilators may be needed by young flu victims. As many as 1.8 million Americans may be hospitalized because of the H1N1 virus. Some 300,000 patients may need intensive care, putting a strain on a limited hospital resource.
But ordinary Americans aren't staying up nights worrying about the pandemic.
With August waning and an expected resurgence of swine flu on the horizon, health officials from developing countries are meeting in Beijing today. They're deeply worried about the next phase of the flu pandemic, judging from an Associated Press report.
How often will this happen for swine flu?(iStockphoto.com)
The WHO's director for the Western Pacific region, Dr. Shin Young-soo, told the Beijing meeting that soon many countries will see cases of swine flu double every three to four days for several months. "At a certain point, there will seem to be an explosion in case numbers," Shin says.
The most urgent problem is the paucity of swine flu vaccine for developing countries, says Dr. Keiji Fukuda, the World Health Organization's flu chief. The WHO convened the Beijing meeting.
There's one thing no one can accuse the government of doing: neglecting swine flu.
Stay out of my cubicle. (CDC)
Last week the administration issued guidelines for how schools should deal with the likely imminent return of the H1N1 virus. Now the feds have released guidelines for businesses. Coming soon: advice for colleges and universities.
One of the tips for employers is to ease up on sick-leave rules. Employees shouldn't feel that taking sick days will cost them their jobs.
Life would be so much easier if you could get a shot as a youngster that would protect you against flu for decades.
Let's just do this once.
(iStockphoto.com)
The wily flu bugs change so fast, though, that traditional vaccines need to be tailor-made for each flu season. Even then, they often miss the mark.
The Baltimore Sun's Stephanie Desmon writes researchers are making progress on a universal flu vaccine that would work against all sorts of flu viruses, though a version suitable for humans still seems a long way off.
The swine flu virus doesn't much care who you are.
Oscar Arias, at a meeting last month, before the swine flu. (Mayela Lopez/Getty Images)
President of Costa Rica? Sorry, gotcha. Oscar Arias, the 68-year-old head of state, was just diagnosed with the illness. Arias is also an asthmatic, which puts him at higher risk for H1N1 infection.
"Apart from the fever and a sore throat, I feel well and in good shape to carry out my work by telecommuting," the 68-year-old said in a widely reported statement.
Will shots against this virus work? Only tests will tell. ( CDC)
Vaccine makers have begun squeezing out the first drops of the new H1N1 flu vaccine and rushing them to several sites around the world for tests of safety and effectiveness in people.
On Monday's All Things Considered, NPR's Joanne Silberner reports from Baltimore on how everything went on their first day -- why 400 people in the city have volunteered to get the experimental injections this week, and what sort of side effects they can expect. She'll be back on Tuesday's Morning Edition with an update on how the pandemic flu spent its summer vacation, and what to expect next month.
Meanwhile, ATC's Melissa Block talks tonight with Dr. David Fleming, the Director of Public Health for Seattle's King County. Dr. Fleming is charged with getting whatever vaccine is delivered to Seattle in mid-October or so into the arms of nearly a million of his county's 1.8 million residents as quickly as possible.
Just because swine flu crashes a classroom or two doesn't mean the principal should send everyone home.
Swine flu won't spring you from that test. ( CDC)
But to prevent the flu's spread, the Centers for Disease Control and Prevention says adults and kids should stay home for a least a day after their fevers have gone away.
That's some of the advice just released by the CDC for schools and health officials on what to do when swine flu strikes again -- and everyone expects that will happen this fall.
The full set of recommendations, in the works for several months, is fairly tame and reflects the current thinking that so far swine flu doesn't look much worse than seasonal flu.
Several companies have started human tests of experimental swine flu vaccine, and the first results may be in as soon at the first half of September.
If the data are good, they could be used to win quick licensing approvals from governments around the world. The first doses of vaccine might be ready to roll later that month, with more to come in October.
The World Health Organization's Marie-Paule Kieny, director of vaccine research, told reporters today the studies will help determine the proper dose for a vaccine. The central question: one dose, or two?
Run-of-the-mill seasonal flu vaccination typically takes a single shot. Vaccination against avian flu takes two, Kieny said. The lower the dose, the farther a limited supply of vaccine could stretch.
Here's a way to make $2,500: Use your creativity and fight the flu at the same time.
How? Enter your own 15-, 30-, or 60-second public service announcement in a contest sponsored by the Department of Health and Human Services.
Right now, HHS is working on lining up celebrity judges. (We hear Paula Abdul may be available.) Closing date to submit videos is August 17.
Be clever. Everyone who watches TV at odd enough hours to catch public service announcements will be watching the winning video.
The contest is part of the government's efforts to educate people about the flu. "We're very concerned about people having accurate information," a senior government official said at a background briefing yesterday.
It may be back to school for swine flu this fall. The Washington Postreports that the Obama administration is rethinking guidelines for handling swine flu at schools.
See you in September ( CDC )
The Post, citing people involved in the work, said the feds may recommend that schools remain open except when there are "extenuating circumstances." Those particulars might include a school that has lots of kids with existing health problems or many ill teachers, though an official told the paper the discussions continue and no final decision has been made.
Of course, the final call at each school will be made locally. But if the feds scale back advice on when to close, schools may stay open longer even in the face of an expected resurgence of swine flu this fall.
Besser, the public face plastered across televisions nationwide when the new H1N1 swine flu broke out this spring, will become senior health and medical editor in September.
His calm, poised TV appearances gave journos great pause, since public health officials are generally not known for their clarity of message or their telegenics. Besser has been with the Public Health Service since 1991, but not surprisingly, has television reporting experience going way back.
When the Obama Administration chose New York City Health Commissioner Thomas Frieden to head the agency in May, we figured Besser might be looking for a new gig.
Here he is on CNN in April when the flu first became big news in the U.S.
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.)
Growing the new H1N1 virus in eggs is proving tough for vaccine makers /istockphotos.com
Even with the best-case scenarios, it was a very tall order -- make enough of a new swine flu vaccine to blunt the edge of a pandemic in time for flu season this fall.
Forget best-case. The World Health Organization says the virus that's being injected into eggs to create the pandemic vaccine is not growing well at all. Compared to seasonal flu viruses, it's growing only 25 to 50 percent as fast.
Scientists don't understand why. It seems a crucial surface protein on the new H1N1 virus, called hemagglutinin, is not very stable.
The bad news, announced at a press briefing today, has thrown vaccine researchers around the planet back to square one. They've scurried to isolate new samples of the virus from infected people and are working at top speed to hybridize those fresh strains with a standard flu virus that they know grows well in chicken eggs.
If they're lucky, they could have a new "seed strain" in hand later this month.
Not a moment to lose: Human tests with the pandemic vaccine are scheduled to begin in August. If those go well, manufacturers could still start cranking out the stuff by October.
(read past the jump to hear of hurdles that still loom)
Swine-flu parties are still a bad idea /istockphotos.com
Some bad party themes (Everybody Trade Pants!) just won't go away.
The BBC says that some people in the United Kingdom are now deliberately exposing themselves to friends who have the new H1N1 flu. We first heard about "swine flu parties" in the U.S. in May, and apparently the notion is still making the rounds. The goal of these soirees: Try to catch the flu in its current, relatively mild form, effectively vaccinating yourself.
Don't do it. In the early days of the outbreak, officials from the CDC specifically warned against this practice. There was no telling then -- and there's no telling now -- if or when the virus will mutate into a form that's more frequently deadly. (And remember that some otherwise healthy children and adults are dying right now from the current "mild" version).
Plus, even if you get away with few symptoms you may inadvertently spread the nasty party favor to pregnant women or others with damaged immune systems who are especially vulnerable to flu complications.
One has to wonder what's on the menu at a swine flu party, besides a neighbor's germs.
WHO's Margaret Chan: The Pandemic Decider has decided /Laurent Gillieron/AP/Keystone
Even the most labored decision has a tipping point--a moment when the mountain of evidence suddenly shifts in the same direction. NPR's Richard Knox was on a conference call with WHO's chief Margaret Chan this morning when she announced that (finally!) she'd decided to declare the H1N1's spread around the world worthy of the designation "pandemic."
So, how did she decide? Knox says,
She ducked questions about what new evidence has emerged in the past few days to precipitate a declaration of something that many public health experts have said is obvious. The tipping point is widely thought to be the spread of flu in southern Australia, where more than 1,200 cases of the new flu have been counted in a matter of days.
Or, Knox says, maybe it was new spurt of cases in the United Kingdom, or the way the pandemic virus is rapidly crowding out other strains in Chile, which is just now entering it's winter flu season.
OK, it's official. The world has entered the first pandemic of the 21st century -- the latest in 41 years.
The World Health Organization has informed its member-states that today it's declaring a Phase 6 pandemic alert. That means a new flu virus is spreading widely in two or more regions of the world.
WHO Director-general Margaret Chan gave the news to Geneva-based ambassadors shortly after she met with her so-called emergency committee of about 20 flu experts. Chan has sole authority to declare a pandemic, but she has taken great care --- and incurred unnecesary delays, some say --- to get consensus that, in fact, a pandemic has begun.
Chan is scheduled to hold a press conference around noon today, eastern time, to make the official announcement.
She's expected to call the pandemic of 2009 "moderate." But most expect that she'll warn its impact on vulnerable populations can be severe. And she may caution the new H1N1 strain of flu could get nastier as it circulates through millions of people over the next few months.
What does the formal declaration mean?
Probably it'll goose vaccine manufacturers...and assure them of a market. Beyond that, it may not alter much. Paradoxically, WHO officials hope some countries will ratchet down severe measures aimed at keeping the new virus beyond their borders.
" With a pandemic declaration," one official says, "we're saying the virus is widespread and virtually unstoppable."
Good morning. Lots of health news to dissect today.
New FDA Commissioner Peggy Hamburg says she wants to take on tobacco, and it looks like she's going to get her wish.
NPR's Joanne Silberner reports that after a decade-long effort, the power to regulate cigarette content and advertising is about to fall into the agency's hands. They'll get a whole lot of new money to do it, too.
NPR's Richard Knox warns that the WHO is FINALLY about to declare its equivalent of DefCon FIve on the new H1N1 flu virus, stay tuned for details on what that really means.
Egypt, the country that slaughtered its entire pig population in April to ward off swine flu, now has a handful of confirmed H1N1 flu cases.
Gulf News reports that a Cairo doctor is on a campaign to stop the region's traditional kiss-kiss-kiss greetings in favor of dry versions, like handshakes.
Too much skin for some flu-scared high schools /istockphoto.com
Grads at two high schools in Bloomington, MN will sit side by side at commencement ceremonies this week to hear speeches, toss mortarboards, and walk away with diplomas. But forget the photo-op handshake afterward from the principal or anybody else.
With two confirmed cases of swine flu in the district, school officials are taking a new approach to commencement, the district's Rick Kaufman told the Minneapolis Star Tribune: "We're just going to do sort of a head nod and a verbal 'congratulations' to students."
Most StarTrib readers weren't impressed. One scoffed in comments to the online story:
Just what kids these days need, less interaction. Are we going to "Tweet" them a congrats or Txt them "OMG Gr8 job!" Toughen up...
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.
House calls on flu live today from NYC's Dr.Susan Kansagra /NYC Health Department
Come on, 'fess up: Even if you feel swamped by all the media coverage of the H1N1 flu, don't you wish you could sit down with a doctor and ask a few nagging questions of your own? Here's your chance.
The New York City health department this morning deployed one its docs, internist Susan Kansagra, M.D., to take your questions and answer as many as possible today and tomorrow in their blog. The service is aimed at New Yorkers, but health department says everybody's welcome. So log on already, and let us know what you learn.
Up close and personal with the new H1N1 virus. CDC
Margaret Chan, the World Health Organization's director-general, has decided not to declare that the world has entered the first flu pandemic of this century.
But she's leaving open the question -- for now -- of changing the definition of a pandemic.
Chan declared on April 29 that a flu pandemic is "imminent." But she's been under increasing pressure from WHO's member-states to hold off declaring that a pandemic has arrived, based on the WHO's own definition.
Chan now says there's no doubt swine flu will continue to spread -- within the 42 countries already affected and beyond.
By saying that, Chan essentially acknowledges what many have been saying: This genie is out of the bottle.
Worried parents are flocking to New York hospitals to have their kids checked for swine flu, clogging ERs around the city.
Take, for instance, Schneider Children's Hospital in Queens, where more than 200 patients a day--four times the usual number--have been checked in the ER since last Saturday, the New York Timesreports. It's a quintessential New York story featuring a "polyglot of unease, Orthodox Jews in sheitels and skullcaps, Muslim women in headscarves, Asian people, black people and white people," the Times writes.
The swine flu continues to spread, with confirmed cases worldwide now hitting 10,243. Deaths attributed to the infection stand at 80.
North America remains the hotbed for H1N1, according to the World Health Organization's latest stats. Case reports are highest in the U.S., where 346 newly identified cases bring the count to 5,469. One new death attributed to the viral infection put the total at 6. The statistics were unchanged in Mexico, where the case count is 3,648 cases and death total is 72. Canada comes in with 496 confirmed cases and 1 death.
Forty-one countries now have been hit by swine flu. After the U.S., Japan reported the biggest jump in cases--51--bringing the country's total to 210 so far, according to the WHO update. The increases there have come despite Japanese efforts to stop the virus at the borders.
NPR Health Editor Joe Neel diagrams how the new H1N1 virus might reassort into something more dangerous. April Fulton/NPR
More than half the flu viruses infecting people across the nation are the new swine flu strain, and that has health officials fretting.
The latest worry is that the new H1N1 virus will pick up resistance to the only two drugs effective against it -- oseltamivir (Tamiflu) and zanamavir (Relenza) -- by mixing it up with the wrong crowd, i.e. viruses that are already resistant.
It would work like this:
One of the older seasonal flu viruses that's still around, also in the H1N1 family, is already resistant to these antiviral drugs. If somebody got simultaneously infected with one of the older viruses and the new swine flu, the viruses could exchange genes within that person's cells.
This is called reassortment. Flu viruses are good at it, because their genes are segmented into neat mix-and-match packets.
The resulting "reassortant" virus could be drug-resistant, says Dr. Anne Schuchat of the Centers for Disease Control and Prevention.
"This is a really important issue," she said at Tuesday's CDC swine flu media briefing. " If those two strains reassorted and we got a new strain that was a combination of the two, we would hate to see this novel strain become resistant through that mechanism."
That would leave doctors with no effective drug against the novel strain. All those Tamiflu stockpiles would be worthless.
The longer both these H1N1 flu viruses are circulating throughout the country, the greater that chance favors the emergence of such a resistant virus. It can happen quickly. Flu experts were surprised at how fast the old, seasonal H1N1 acquired resistance to the mainstay antiviral drugs.
So far, young people have been the most likely victims of swine flu, but that could change, says Rear Admiral Anne Schuchat, the interim deputy director of the Centers for Disease Control and Prevention's Science and Public Health Program.
As she tells All Things Considered's Melissa Block, children and young people are much more social and that helps promote the flu, which spreads mainly through coughs and sneezes. But as the flu enters adult social networks, it could take off and spread like the regular seasonal flu does.
Schuchat says that the new H1N1 flu virus is "at least as virulent as the regular seasonal flu," but it's still not known whether it could be more lethal. CDC estimates there are about 100,000 cases of swine flu in the U.S. right now.
Whether we're in for an unusual "summer flu" season isn't clear. It could stop spreading soon, or it might persist for weeks in North America, she says.
The CDC will be watching to see if this H1N1 strain takes on new characteristics as it moves into the Southern Hemipshere and through more human populations in the coming months. That will determine whether the world will face a deadly pandemic on the order of 1968, 1957 or even the great 1918 pandemic. The jury's still out on what'll happen.
For more of Block's interview with Rear Adm. Schuchat, listen to today's ATC on your local NPR station. (Find it here.)
And a shout out to Mark Memmott of NPR's newest news blog, "The Two-Way" for his help on this.
Kids between classes at a New York school.
