A bit of good news

More information was released today that supports the earlier hints of AH1N1-2009 not being an entirely novel virus for all of us.

Study Explains Immunity to H1N1 in Older People

[Excerpted]

By Julie Steenhuysen

Reuters

Older people who have been infected with or vaccinated against seasonal flu may have a type of immunity produced by cells that protects them from the swine flu virus, U.S. researchers said on Wednesday.

They said the pandemic H1N1 virus has parts found in earlier flu strains, and some people past age 60, who may have been exposed to similar viruses in their youth, may have some latent immune cells that protect them.

“These findings indicate that human populations may have some level of existing immunity to the pandemic H1N1 influenza and may explain why the 2009 H1N1-related symptoms have been generally mild,” said Carol Cardona of the University of California Davis School of Veterinary Medicine. Her study appears in the journal Emerging Infectious Diseases.

Cardona said cell-based immunity may be serving to weaken the effects of swine flu.

“The meaning clinically is you are going to get sick but it may not be as severe if you had no immunity whatsoever,” Cardona said in a telephone interview.

There may be quite a few people who have had an infection of the genetically related seasonal A/H1N1. I have very little doubt that I have, but I do not know for a fact, and it can be quite murky when we attempt to guess.  Since 1978 there have been two strains of seasonal influenza A virus circulating, A/H1N1 and A/H3N2.

Each “flu season” one strain will represent the majority of infections, referred to as “the predominate strain”.  And, now that we have A/H1N1-2009 we have actually had three strains of influenza A virus circulating, however, the predominate strain quickly became our pandemic virus – A/H1N1-2009, which now officially accounts for roughly 90% of cases typed.  Only a small number of infections are typed so the exact percentage is not known, but extrapolating the ones that are tested we arrive at the 90% of the infections being from our pandemic strain.

The important take away from all of that is even if you had a case of “the flu” last year and think you might be one of the lucky ones who is walking around with a fresh load of these antibodies, you may have had a case of H3N2 and not the seasonal H1N1.  Unless infections were tested and typed there is just no way of knowing beyond a guess.

If one wishes to arrive at a slightly informed guess: look up the predominate strain circulating during the time you remember being ill with a case of “the flu”.  Chances are, the predominate strain is what you had.  Of course, that brings up the question of whether or not you actually had a case of “the flu” in reality, or one of the other hundred odd pathogens that people often confuse with influenza.

We can guess – or we can err on the side of caution and get our pandemic vaccine.  I’m going to play it safe even though I’m fairly certain I had seasonal H1N1 back in the late 70′s.  For me, it’s just not worth being sick, possibly quite sick, when something so simple as a vaccine will protect me.

The Emerging Infectious Diseases paper can be found here: Ahead of Print PDF.

At “my day job” we have been offered the opportunity to receive our vaccines, seasonal and pandemic [if one can take the FluMist pandemic vaccine], I am pleased to be able to report the uptake rate has been impressive.  I assume part of the success has been because our corporate HR department sent around a wonderfully informative memo explaining issues and concerns.  Of course, I would like to think that a small part of the uptake numbers has been because I have answered a few questions here and there.  However, it may only be coincidental that we’ve had our first cases strike within family and an employee.  Whatever the threat is, it “feels” close by — that can be quite motivating, far more so than some “hypothetical – in the future – potential of becoming sick.”

Regardless of the reason[s], I am pleased and proud of the demonstration of my coworkers taking personal responsibility for their health.  I could make a strong argument that those of us who are stepping up and getting our vaccines are also doing something concrete to help protect the “health” of our “community” – our fellow coworkers – the ones who do not have the foresight to protect themselves and the ones who cannot take the FluMist vaccine and are waiting for their turn at the injectable version.  That wait will be several months long for some, months during which the virus will be actively circulating.

Posted in H1N1 General, Science, Swine flu, Vaccines | Comments Off

Rush Limbaugh-’Pig Flu’-and vaccines

One of the Truly Great Things about America is our Constitutionally Guaranteed Right to Free Speech.  Well, such as we still have after political correctness and hate speech sensitivities that is. This very blog is a celebration and testament to my comfort and certainty in my constitutionally guaranteed right to free speech.  I can hop on the internet and post pretty much whatever I choose to post and many readers, in the United States and elsewhere around the globe, can hop on the internet at their end and read my words.  Of course, there are some countries where freedom to speak and freedom to read are not guaranteed – and in some cases are energetically and jealously guarded against “too much of the wrong thing.”

Because of America’s Grand Tradition, we have all manner of people spouting off about all manner of things, and yes, I am included in that category.  The “consumers” of the products of America’s Grand Tradition are not always well served, and on occasion even harmed, by “consuming” the “product” of some other person’s free speech.  Someone who listens is invested with the presumption of reason to independently ferret out the helpful, the benign, and the harmful when such “ferreting” is prudent — such as in matters of health and physical safety.

With Global Warming, believing one side’s “experts” over the other side’s “experts” has no ramifications to one’s health or life [despite what one side likes to say occasionally].  As in: we have only ‘X’ years to fix the issue or we’re all going to fry under the parching  sun, our cities will drown, and our crops will fail, causing death and destruction on a “Biblical Scale” [my phrase].

Although the issue of Global Warming may chafe and bruise my sense of logic and reason, what I choose to believe and disbelieve will have no effect on whether I, or a minor child in my care and custody, will become ill, possibly severely – possibly even fatally so.  The same cannot be said for what I believe about the efficacy and safety of the pandemic A/H1N1-2009 vaccine.

Since I tend to lean rather heavily on “the science”, even if I wind up investing that science with a great deal of “personal emotion”, I do restrict that investment to scientifically credible issues.  In other words: an emotional plea is just not enough for me, it has to be backed by science – credible science.

There is little doubt that the issue of pandemic influenza vaccination is driven by a great deal of emotion, on both sides of the issue, but “the science” speaks for itself… assuming one actually bothers to look at the science — even the dumbed-down layperson’s “science” on the issue.

The A/H1N1-2009 vaccine is no different than the seasonal influenza vaccine we have been manufacturing for decades.  It is made precisely the same way.

The only material difference is the new HA and NA [the two genes that code for influenza's two outer proteins].  These two genes are swapped in our seasonal vaccine with a certain cyclical regularity, anytime the virus changes enough that the [then] current vaccine is no longer a “good match” to the strain [then] circulating.  We’ve had enough of these swaps in recent years that it should not be difficult to remember the news about “pooly matched” vaccines.

The American A/H1N1-2009 vaccine does not contain an adjuvant.  Period.  The British and Canadian versions will contain an adjuvant, but the US vaccine DOES NOT.

The veracity of the Thimerasol controversy aside: The single dose vaccine for children under six years of age does not contain the preservative, nor does the inhaled vaccine known as FluMist.  FluMist can be given to children two and older.  The single dose Thimerasol-free vaccine is also being made available to pregnant women.  So, if one happens to believe the debunked Thimerasol/Autism link: Please know and understand there are Thimerasol free options available for your children.

Those three very simple – basic – FACTS are easily – and understandably – documented with a simple search of the internet or trip to the local library.  Knowing how easy the FACTS are found, FACTS backed up BY SCIENCE and not just “he said” or “she said” or even the very authoritative sounding “Doctor so-and-so said…” I was stunned to find out about – and view – a recent tirade by Rush Limbaugh [video below].

Say what you will about Rush Limbaugh, he is usually much more thorough about checking his facts.

Mr. Limbaugh has fallen victim to the same “infectious disease” as many on the vaccine issue: letting emotions decide a scientifically based medical issue.

Mr. Limbaugh states his doctors have never suggested he receive an influenza vaccine previously, and there is good reason for such: he has always been outside the recommended age brackets, traditionally those over 65, and recently, those under 5, and very recently those under 18 as well.  As you can see, Mr. Limbaugh never met the age criteria when the criteria were operative, so he never warranted a doctor’s recommendation to get a seasonal influenza vaccine.

Healthy adults under age 65 have not been viewed as needing a vaccine because with seasonal influenza healthy adults are not usually at risk of severe illness and/or death.  That doesn’t mean the occasion severe/fatal outcome didn’t happen, but when it did it was a truly freak happenstance of some really bad luck.

With A/H1N1-2009 the only folk who seem to be getting any sort of “influenza free pass” are the folk older than 65, the very same folks who are at greater risk from traditional seasonal influenza.

That may seem “weird”, or counter intuitive at first, but with pandemic influenza no one has existing immunity.  Since A/H1N1-2009 is a “genetic cousin” [so to speak] of the influenza virus A/H1N1 circulating prior to 1957 [when H2N2 replaced it] and after 1978 [when a version was accidentally reintroduced into the human population] some of us are presumed to have at least some pre-existing immunity, those over 65 seem to have drawn the lucky straw on this one and appear to have the most pre-existing immunity.

Those who have never had an infection of seasonal A/H1N1, and there are a goodly many who have not, will not “enjoy” any of the benefits of that pre-existing immunity – at whatever level it may [or may not] exist in reality for each of us as individuals.

There is a blood test that can be done to determine if someone has ever had an infection of A/H1N1, and at what level circulating antibodies specific to A/H1N1 exist.  That takes laboratory analysis, a technician’s time, and a lot more money than a vaccine would cost, to say nothing of not being covered by any health care plan one might have.

Or, one can do as Mr. Limbaugh seems to have decided to do: Not be vaccinated and risk being infected.

Mr. Limbaugh is probably almost 100% safe in his gamble – almost a “sure bet” if you will.  His age is right to be at little risk, though somewhat more than those over 65, still, not very high.  He’s also quite well off financially so if he does suffer a severe infection and lands in the hospital he can afford all those medical bills.  And, if he is really – really – unlucky and ends up one of the statistically rare fatalities for his age bracket and general health then he won’t be around to care – or even know – that he was dead wrong.

Mr. Limbaugh is making the decision for himself.  He’s a grown adult in possession of all his mental faculties, even if some would question the veracity of that statement, he is.  As such, his decision is of no concern to me.

What is of concern to me is that he allowed the propagation of falsehoods on his show for what may have only been a political point.  That is the only explanation I can assume given how easily the FACTS – “the science” if you will – could have been ascertained.  FACTS that are EASILY ascertained by just about ANYONE, let alone someone with the staff and resources Mr. Limbaugh has at his disposal.

For the record: I haven’t listened to Rush Limbaugh since “Bush Senior” was our president.  I do not dislike Mr. Limbaugh in any form or fashion, but neither am I a “fan”.  I know him to be a man of intelligence and sharp whit, even if occasionally “flawed” – in the same respect that I myself am flawed [imperfect] – and you are – and you are – and all are.

I am not writing this to score any sort of “point” at Mr. Limbaugh’s expense, whatever he believes and chooses to do is his business [there are no minor children in his "decision tree"], but the same cannot be said for those that tune into his show and heard his emotionally and politically driven tirade propagating and reinforcing the lies and disinformation campaign of the anti-vaccine lobby.

And so I raise my tiny voice to the Godfather of Talk Radio: “Check your Freakin’ Facts man! ‘Cos that is so NOT like you — to get it sssoooooo WRONG!

Posted in H1N1 General, Swine flu, Vaccines | 4 Comments

Countering misinformation and its effects

I turned 50 years old this year, I am demographically located at the tail end of the Boomer generation.  One of the many things I have enjoyed because I was born in the second half of the 20th century is that infectious diseases have not played a large role in my life. They played an even smaller role in my son’s, and I’m confident – and excited – that the threat to life and health from infectious disease will be even smaller in the life of my two year old granddaughter.

I may die tomorrow in a car accident or some freak random act of violence, but I know I will not die next week from smallpox, a threat my parents faced for the first thirty years of their lives.

Philly.com has a wonderful piece this morning by Rachel Sobel [a medical professional of unclear type].

Scrubbing In: It’s swine flu we should fear, not the vaccine that saves us [Excerpts]

Rachel Sobel

[snip] I’m talking about what’s become a culture of fear around getting the shots. More than a third of parents don’t want their kids vaccinated for swine flu, according to a recent Associated Press-GfK poll. Many fear that vaccines do more harm than good. This comes up a lot with the scientifically discredited link between vaccines and autism-related developmental disorders. There’s also the conventional wisdom that a flu shot can “make you sick.”

The vaccine-autism controversy has mostly run its course. Celebrities such as playmate Jenny McCarthy and actress Amanda Peet argued about whether to vaccinate kids. Peet called McCarthy and the other vaccine-phobic parents “parasites” for relying on the immunity of others to hold off measles, small pox, polio, and other now-rare diseases.

I am not that rabid, but the science at least is clear. “If you decide not to vaccinate your child, you put your child at risk. Your child could catch a disease that is dangerous or deadly,” says the American Academy of Pediatrics.

It has been a long time since the hospital wards were filled with kids on iron-lung machines suffering from polio. And it’s been almost a century since a worldwide flu killed more than 20 million people. That’s probably why some people have not been getting the message about the importance of vaccines.

Last year, the Centers for Disease Control and Prevention counted 131 cases of measles in the first half of the year, more than double what it had been for the preceding year. More than 90 percent of those cases were in unvaccinated children or those with unknown vaccination status. And half of those did not get vaccines because of “philosophical or religious beliefs.”

[snip] Sometimes concerns about vaccines are just plain irrational, even among doctors. Last year one of our residents, who is a particularly astute clinician, opted not to get the flu shot. He boasted that he had never gotten the flu shot and had never gotten sick. Why would he get it now?

We all joked about his overconfidence. Then the next week he got really sick and had to miss work, though he claims it wasn’t the flu. I asked him whether he will get the seasonal flu shot this year. “Probably.” And the H1N1 vaccine? “Potentially,” he said. “We’ll see.”

Vaccines are modern miracles. The last naturally occurring case of small pox was in 1977 in Somalia. Polio is still out there, with several public health groups working toward eradication.

Some time ago I came to believe that having so many people unaware of what it really means to live with the threat of deadly infectious diseases as part of the very fabric of day-to-day life leaves them bereft of a “healthy respect” for that threat – pardon the clumsy pun.  It has been over thirty years since our last influenza pandemic, and that one was also mild.

Additionally, a portion of our population has “never had the flu”, real influenza, the kind that puts you abed for several days wishing you would just ahead and die already.  These people have no conception of what “a case of the flu” feels like – if they did I don’t think they would be quite so cavalier about becoming infected.  I’ve had “the flu”.  I had a pretty nasty bout of influenza in 1978.  I have all the respect one could have for “the flu” because of that infection.

The Wall Street Journal offers us this today:

Swine Flu Is Severe for Some, Studies Show

[Excerpts]

A girl receives the H1N1 nasal mist vaccine at Wake County Human Services in Raleigh, N.C., on Friday.

Only a small portion of those who develop swine flu become severely ill. As of Aug. 22, 278 people had been admitted to ICUs in Canada, about 3.9% of total reported cases for that period, according to the Canadian study.

Swine flu is mild for most people, but some become so gravely ill that they require sophisticated techniques, equipment, and aggressive treatment in intensive-care units to survive, according to three new studies.

“This is the most severely ill that we’ve ever seen people,” said Anand Kumar, lead author of one of the studies and ICU attending physician for the Winnipeg Regional Health Authority in Canada. “There’s almost two diseases. Patients are either mildly ill or critically ill and require aggressive ICU care. There isn’t that much of a middle ground.”

Some of the patients Dr. Kumar and his colleagues saw were so sick they had to be saved with a technology similar to one used for patients undergoing heart bypass.

The studies of critically ill patients in Canada, Mexico, Australia and New Zealand, published online Monday in the Journal of the American Medical Association, suggest that intensive-care units could be stretched as a second wave of H1N1 swine flu builds in Northern Hemisphere countries such as the U.S.

American public-health and hospital officials have expressed concern that the country’s intensive-care facilities may not be up to accommodating the swell of patients they could potentially end up with in large-scale outbreaks.

[snip] In Canada, Australia and New Zealand, doctors turned to an advanced technology similar to one used for cardiovascular surgery when prolonged mechanical ventilation and other therapies proved not to be enough for some H1N1 patients. “Extracorporeal membrane oxygenation,” or ECMO, acts as a lung machine, circulating a patient’s blood through a system that adds oxygen. The severely ill patients’ lungs were so filled with fluid they couldn’t get oxygen to their blood.

[snip] Only a small portion of those who develop swine flu become severely ill. As of Aug. 22, 278 people had been admitted to ICUs in Canada, about 3.9% of total reported cases for that period, according to the Canadian study.

How does one communicate risk when many do not have an existing frame of reference within which to “internalize” that risk?  There’s an entire specialty devoted to the psychology of it: Risk Communications. I’m not expert in it, I’m not even good at it most of the time, but I’ve been doing this long enough to have been continually frustrated by the difficulty of the task.

An excerpt from the New York Times today is yet another attempt to debunk the misinformation campaign of the anit-vaccine lobby.  Please follow the link for the entire offering,

Nothing to Fear but the Flu Itself

By PAUL A. OFFIT

Philadelphia

[excerpts]

PUBLIC health officials are now battling not only a fast-spreading influenza virus but also unfounded fears about the vaccine that can prevent it.

Since April, more than a million Americans have caught H1N1 flu, more than 10,000 have been hospitalized, and about 1,000 have died, including 76 children. And it’s only the beginning of October. Yet, in a new survey, 41 percent of adults said they will not get vaccinated.

The good news is that for the first time in more than 50 years we’ve made a vaccine against a pandemic strain of influenza before the onset of winter, when lower temperatures and humidity allow the virus to spread more easily. Distributing this vaccine to those who need it most — pregnant women, health care workers, children older than six months and people with compromised immunity — will be difficult enough. But the task is made harder by the various myths, spread on TV talk shows and Web sites, suggesting that Americans have more to fear from the vaccine than from the deadly disease it prevents. Here are some of those myths, and why they’re wrong….

[snip]

New myths will inevitably arise as some of the millions of people who are inoculated against H1N1 flu suffer unrelated illnesses. Health officials will keep a close eye out for any real problems. One can only hope that the American public will understand that subsequence isn’t necessarily consequence, and not be scared away from a vaccine that can save lives.

Paul A. Offit, the chief of the infectious diseases division of the Children’s Hospital of Philadelphia, is the author of “Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure.”

I left out Dr. Offit’s debunking because this post is already too long and those who have a genuine interest in seeking the truth will follow the link to read the entire piece. Those who are not interested in learning the truth would not benefit even if I copied Dr. Offit’s OpEd in its entirety.

It is extremely difficult to dissuade people from what they believe, even when what they believe is wrong. We are “emotionally invested” in those things we believe. For the most part, what we believe has a limited impact on our lives, and an even smaller likely impact on those around us. If we are parents of minor children what we believe about influenza in general, pandemic influenza while one is occurring, and vaccines [generally and the pandemic vaccine] has impact on our children.

I would also posit that when it comes to pandemic influenza and its protective vaccine it has an impact on our wallets, or at least some wallets. Importantly to me: My wallet is one of those wallets impacted.

The health insurance premiums I pay and my husband pays [separately insured with two different health insurance companies] are based on what “plan costs” were the previous year. The more plan participants use their health insurance the greater our premiums. The higher the cost of those services the greater the overall plan expenses are.

The company I work for has a statistically probable likelihood of having several plan participants [whether primary or dependent] suffering an H1N1-2009 infection severe enough to require in hospital intensive care. Even one of these cases [above and beyond the plan's normal experiences with intensive care incidents] will affect my health care premium when we renew our policies next fall. If the plan suffers ten infections requiring ICU care my premium will be severely impacted. That’s real money out of my wallet.

Those on publicly funded healthcare plans, Medicare and Medicade, impact the tax dollars the federal government helps itself to out of my pay check. That’s real money out of my wallet.

Those who receive no cost [to them] health care at the local public hospital because they have no health insurance impact my local taxes, my state taxes, and my federal taxes. That’s real money out of my wallet.
So, in the end, what people believe about the threat of pandemic influenza, the statistical likely severe cases, small though the percentage is, and all those who are going to refuse to be protected by the pandemic vaccine does impact me — personally– because it impacts my wallet.

Some people have no choice, or no choice right now.  I can’t yet receive the H1N1-2009 vaccine because I’m pretty far back in the line of who gets it when.  If I become severely ill and require ICU care the impact I have on my health care plan’s costs will be at no fault of mine, up until the time I am allowed to receive my vaccine.  Once I am able to receive and choose not to be vaccinated, then I am willfully telling all of my fellow plan participants that I don’t give a spit about how my actions impact their wallets.

Posted in During a Pandemic, H1N1 General, Swine flu, Vaccines | Tagged , , | 2 Comments