Dr. Marie-Paule Kieny, Director of the World Health Organization (WHO) Initiative for Vaccine Research, explains the WHO’s recommendation that health care workers should get H1N1 vaccine priority. Kieny says it is essential that health care workers do not contract H1N1 in order to maintain a functioning health care system that will be able to survive the pandemic. (0:35)
By Laura Woodhead – Talk Radio News Service
Health care employees should get priority for the H1N1 vaccine, the World Health Organization (WHO) recommended Monday. While there is no official priority ranking for who should get the vaccine first, immunizing health care workers would insure that the health care system would be able to properly combat a possible spread of the virus said Dr. Marie-Paule Kieny, Director of the WHO Initiative for Vaccine Research.
“Health care workers should be immunized in all countries in order to maintain a functioning health care system” she said. “They need to remain in good health condition to care for pandemic influenza sick people.”
While health care employees are the WHO’s main recommendation for priority, there are other vulnerable groups that countries should think about vaccinating first said Kieny. These groups, which include pregnant women and people with chronic illness, have an increased risk of mortality with the H1N1 strain. The obese are also included in the WHO’s list of vulnerable peoples.
“Obesity has been observed as being one of the risk factors for most severe disease with H1N1 influenza.” Kieny said. The Director added that “people with a body mass index over 30 or even more over 40 have a higher chance of having a severe disease.”
Kieny stressed that the WHO’s vulnerable groups are simply recommendations, and should be evaluated on a country by country basis.
“Countries will have to take decisions that are adapted to their own national situation” Kieny said. “There is an identification of options, but no ranking, no priority given to these options.”
The H1N1 vaccine is expected to be fully licensed by the end of the year, Kieny said.
Coffee Brown, MD, University of New Mexico, Talk Radio News
Is this a pandemic? What would that mean?
04:45
Coffee Brown MD, University of New Mexico, Talk Radio News
There are three main differences between a normal flu and a pandemic flu, as described by the Department of Homeland Security: incidence, virulence, and demographics.
Incidence refers to how many of us will get it. In a normal year, about 15 percent of 300 million Americans, or about 45 million people will get infected. In a pandemic, rates rise to 25-50 percent, or 75-150 million cases.
Virulence refers to how many of us will die of the infection. In a normal year, that’s about 0.07 percent, or about 35 thousand out those 45 million. In 1918, mortality was about 2.5 percent, which would be about 7.5 million deaths, given today’s population.
Demographics refers to which of us are at most risk. In a normal year, nearly all deaths occur in people over 65 years old. In 1918 and 1957, mortality was highest among school-aged children and young adults.
This summary, with some calculations, comes from information provided by DHS and presented at GlobalSecurity.Org
Let’s compare the 2009 A-H1N1 Flu. “Atypical flu” may be a handier name. “Swine flu” is passe’.
Incidence: As of 05/02/09: There have been 615 confirmed cases in 15 countries. Attack rates so far are too low and data too incomplete to meaningfully calculate.
Virulence: Mortality in Mexico, the country hardest hit so far, is 16 out of 397 cases: about 4 percent, which works out to four thousand per hundred thousand (a common way of expressing this type of number).
The one U.S. death might properly have been considered a Mexican death, since that child contracted the disease there. If calculated as U.S. data: one death out of 141 cases: about point seven percent. If that fatality is not charged to the U.S. account, the mortality rate outside of Mexico is zero percent as of this writing.
Demographics: Reports say that the Mexican victims were young, but I have not been able to locate details to confirm that. The World Health Organization says that more study would be needed to confirm that younger people are more at risk.
Other: The other elements of this flu that merit precautions are that it is genetically unique, meaning we may have no immunity, and that it is slightly out of season, meaning that it exhibits at least some unpredictable behavior.
We are still at phase 5, so clusters of cases in multiple countries, which would define phase 6, have not yet been confirmed.
Per the WHO, there no travel advisories at this time.
Do masks help? Yes, no, and maybe. Yes: as tiny as viruses are, they could slip right through any screen that we could breathe through, but the virus is carried in droplets of exhaled moisture, and those droplets do stick to the mask. No: But the masks dry, and it’s not clear whether the virus survives and detaches into the inhaled air. Maybe: the real test would be whether people with masks get fewer infections (though such people probably also take more precautions in general), and the Centers for Disease Control and Prevention says that data is not yet available.
Coffee Brown, MD, University of New Mexico, Talk Radio News
A typical flu season kill 37,000 Americans. The swine flu, officially known as “2009 H1N1″, may be responsible for up to 160 deaths in Mexico and one infant death in the U.S.
Of those who have contracted the disease outside of Mexico, the illness has been relatively mild. So, what’s the big deal?
“This is a whole new kind of flu,” said Dr. Anthony Fauci, Director of the National Institute for Allergy and Infectious Diseases. Flu viruses mutate slightly every year, but not like this, Fauci said. Genes from four separate viruses – avian, human, and two kinds of swine flus, have combined into this strain.
Our vaccines and immune systems have “never seen anything like it,” Fauci said. That’s what makes it potentially more dangerous. While this means that we have little or no natural immunity, it does not necessarily mean that this flu must be any more infectious or virulent than the average flu.
So, why is it called “swine flu”? Actually, Sen. Pat Roberts (R-Kan.) really wishes we wouldn’t call it that, as it’s hurting the pork industry. Fauci agrees, “The name that is now being used is ‘the 2009 H1N1 flu.’”
Despite Egypt’s decision to eliminate all swine from the country, people can still eat pork without contracting the swine flu. The American Heart Association may advise moderation, but this flu is entirely unrelated to pigs. Still, the pork industry and health officials are going to have to come up with a catchier name than “2009 H1N1 flu” if they want us to stop calling it “swine flu.”
Epidemic or Pandemic? An epidemic means that more cases are occurring than predicted. With seasonal flu, epidemiologists have so much experience that they can usually predict the number of cases fairly accurately. The number they are seeing right now wouldn’t even be noticeable in the middle of flu season, but this one was winding down for the year. Since this is really a new type of flu, the CDC don’t yet have the experience to predict a “normal” season or number of cases.
A pandemic occurs when a disease covers a large geographic area, such as a continent, or multiple continents, as this one has. The common cold is a type of pandemic, though we usually don’t bother to call it that. Neither word actually refers to the severity of the disease, the likelihood that a sufferer will end up in the hospital or even die.
So what about the rising number of cases? If that makes you nervous, stop watching them, because the numbers will rise steeply with every re-count for the foreseeable future, whether this is a killer flu or of ordinary severity.
On April 29, 2009, the WHO raised the level of alert to “phase 5. “What does that mean? Phase 4 meant human to human transmission, phase 5 means the same thing, but in more than one country, phase 6 will mean clusters of cases, outbreaks, in more than one country. Phases 7 and 8 describe the trailing off of the disease.
So, is it going to get worse, or go away? It may do either. The behavior of flus is variable, and epidemiologists don’t have enough information yet to predict this one’s course. Almost any scenario imaginable could occur.
At a Senate hearing Wednesday, convened on short notice in response to this flu, John McCain (R-Ariz) asked, “Should we close the borders?”
“No,” Richard E Besser, MD, Acting Director, Centers for Disease Control and Prevention, HHS,responded. That was tried during the SARS outbreak, and it appears to have been unsuccessful. Simulations suggest that closing the borders would have little, if any, effect on limiting spread, and it would tie up massive resources that could be put to much better use elsewhere. If we had been one of the later countries to be hit, we might have tried closing the borders to buy a few more weeks to get ready, but even then the gain would be slight, Besser said. The World Health Organization concurs.
That led Sen. Richard Burr (R-N.C.) to ask about resources. Besser told him that stockpiles of antivirals , masks, and respirators are sufficient, because they had been bought when funding was better. Recent cutbacks have cost public health thousands of jobs, lost or threatened, and have made it harder for states to exercise their pandemic control plans.
The Office of the Biomedical Advance Research and Development Authority , which prepares contingency plans and caches supplies, has never had its own funding, but has receives sporadic money from NIH, according to Fauci.
In his 100 day address last night, President Obama re-iterated many of these points, saying “We are continuing to closely monitor the emergency … (This is) obviously a very serious situation,” adding that schools with confirmed or suspected cases should close temporarily.
Obama is requesting $1.5 billion for the further stockpiling of medicines and equipment, and for logistical support. He echoed the CDC and WHO by reminding people, “I’ve asked every American to take the same steps you would take to prevent any other flu: Keep your hands washed; cover your mouth when you cough; stay home from work if you’re sick; and keep your children home from school if they’re sick.”
Readers: Please send questions, tell us what you need to know.
Coffee Brown, MD, University of New Mexico, Talk Radio News
This is a podcast, not a sound-bite. It weighs in at 14:22
The World Health Organization updates the press on the status and handling of swine flu. The call was scheduled for 4 PM EDT. (39:00)
Eric Laroche, Director-General for Health Action in Crisis of the World Health Organization (WHO), spoke at United Nations headquarters in New York today regarding the gradual transformation of the WHO.
According to Mr. Laroche, the WHO “has completely changed [personnel] over the past two or three months.” With the increased threat of climate change, Mr. Laroche spoke of how new priorities will result in an increased presence in countries affected by disaster, and more engagement in piratical and political solutions to disease.
The WHO seems to be looking beyond just climate change. In response to increased proliferation of disease, the Director-General expressed a desire to develop a “new framework” for all disasters, not just climate change.
At the forefront of the WHO’s priorities are concerns about climate change and global food security. The Director-General spoke bluntly about a foreseen increase in diseases like diarrhea, malaria, and asthma, and pledged to work with local governments and Non-Governmental Organizations (NGO) in finding hyper-local solutions. “We have to work with the institutions, for the institutions,” stated Mr. Laroche. In it’s renewed ambition to work with well-informed, on-the-ground actors, Mr. Laroche spoke of working with NGOs to “find the right policy.”
