Friday, September 25, 2009

Letter Warns About Tricky Dosing With Liquid Tamiflu for Kids

THURSDAY, Sept. 24 (HealthDay News) -- Doctors warn that parents across the country could give the wrong dose of Tamiflu to their children as treatment for the H1N1 swine flu because the dosing instructions don't always coincide with the measurement markings on the syringe that comes with the liquid medication.

The warning letter, penned by scientists from Northwestern University Feinberg School of Medicine in Chicago, Emory University in Atlanta and Weill Cornell School of Medicine in New York City and published online Wednesday in the New England Journal of Medicine, also urges doctors and pharmacists to be on the lookout for this potential dosing mismatch and to help parents figure out exactly how much Tamiflu to give their child.

The authors cite a case that they say is probably happening all over the United States: The parents of a 6-year-old girl diagnosed with the H1N1 virus received a prescription for Tamiflu Oral Suspension that told them to give her three-fourths of a teaspoon of the medicine two times a day. However, the dosing syringe inside the box was marked in milligrams. The confused parents, both of whom are health professionals, had to figure out how to convert the measurement, something most parents would find too daunting to do.

"It's an egregious error that there is a conflict in the prescription labeling instructions and the dosage device that comes in the exact same box. It's incredibly confusing to parents," letter co-author Michael Wolf, an associate professor of medicine and learning sciences at Northwestern University Feinberg School of Medicine, said in a news release from the university. "Tamiflu is one of the main courses of treatment right now for H1N1, and it is being widely used among children, even infants."

The letter's authors recommend that all pharmacies and physicians be instructed to ensure that the prescription label instructions for use are in the same dosing units as those on the measurement device.

"Parents being prescribed Tamiflu for their children need to make sure they understand exactly how to take it at the time they pick it up at the pharmacy," lead letter author Dr. Ruth Parker, a professor of medicine at Emory, said in the release.

Wolf warned that an overdose could be toxic, and an underdose could be ineffective.

And even more complex calculations might be necessary now that the U.S. Food and Drug Administration has approved Tamiflu for off-label use among children under the age of 1, because the syringe doesn't include small enough measuring increments for these youngest patients.

"We need to have a better system for ensuring there are standardized directions for administering drugs to children," letter co-author Dr. Alastair Wood, a professor of medicine and pharmacology at the Weill Cornell School of Medicine in New York City, said in the news release. "We need to move to a system where all doses are given in the same units, preferably milliliters."

Meanwhile, a report released Thursday supports recent U.S. Centers for Disease Control and Prevention recommendations not to use negative rapid test results for management of patients that may be infected with the pandemic swine flu virus.

Researchers in Connecticut assessed the performance of the rapid influenza diagnostic test (RIDT) used during outbreaks of pandemic influenza A (H1N1) at two schools in Greenwich in May 2009. Of the 63 people tested at Greenwich Hospital, infection was confirmed in 49 patients.

The results of the RIDT were compared with the reverse transcription--polymerase chain reaction assay. A low sensitivity of 47 percent was found for the rapid test. This poor performance couldn't be explained by the clinical features of the patients or by the timing of the specimen collection, said Dr. James R. Sabetta, of the Greenwich Department of Health and the Connecticut Department of Public Health, and colleagues.

While a positive rapid test for influenza is helpful, a negative test doesn't rule out pandemic swine flu, the researchers said.

The report appears in the Sept. 25 issue of the Morbidity and Mortality Weekly Report, published by the CDC.

More information

The CDC has more about H1N1 flu.

Thursday, September 24, 2009

Medline Abstract: Strategies for mitigating an influenza pandemic with pre-pandemic H5N1 vaccines

Medline Abstract

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Strategies for mitigating an influenza pandemic with pre-pandemic H5N1 vaccines.
George Milne, Joel Kelso, and Heath Kelly
J R Soc Interface, September 15, 2009; .
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School of Computer Science and Software Engineering, The University of Western Australia, , Perth, Western Australia, Australia.

The recent worldwide spread of the swine-origin H1N1 2009 influenza outbreak has resulted in its designation as a pandemic by the World Health Organization. While it appears to result in mild symptoms, concern still exists that a more severe influenza pandemic with a high case fatality ratio might arise by reassortment or mutation of the currently circulating avian influenza (H5N1) virus. Given that recently developed candidate pre-pandemic H5N1 vaccines have shown potential for cross-strain protection, we investigated alternative vaccination strategies that exploit such vaccines using an agent-based simulation model of an actual community of approximately 30 000 people in a developed country. Assuming that a two-dose vaccination regimen would be required, we examined three vaccination strategies: pre-emptive, with vaccination applied prior to emergence of human-transmissible H5N1 influenza; reactive, where vaccination was initiated immediately after the first cases in the community were diagnosed; and a 'split' strategy where the first dose was administered pre-emptively during the pre-pandemic phase, with the second dose administered reactively. We showed that by effectively moving the delay between first and second doses into the pre-pandemic period, the split vaccination strategy achieved a substantially better attack rate reduction than the reactive strategy. Our results for an influenza strain with a reproduction number of 1.5 suggest reactive vaccination strategies that may be applicable to the current H1N1 2009 pandemic.

PMID: 19755499

Medline Abstract: [Pandemic and prepandemic H5N1 influenza vaccines: a 2009 update.]

Medline Abstract

[Pandemic and prepandemic H5N1 influenza vaccines: a 2009 update.]
P Loulergue and O Launay
Med Sci (Paris), August 1, 2009; 25(8-9): 719-26.
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Université Paris Descartes, faculté de médecine ; INSERM CIC BT505 ; Assistance publique- Hôpitaux de Paris, CIC de vaccinologie Cochin Pasteur, pôle de médecine, groupe hospitalier Cochin-Saint Vincent de Paul, 27, rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France.

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Since 2003, hundreds of infections with H5N1 avian influenza virus have been reported in humans with a mortality rate of ca. 60 %, which makes us fear a pandemic influenza in a population without pre-existing immunity. Currently, the inter-human transmission is limited to persons in close contact with poultry. In anticipation of this pandemic threat, a global plan was established in which immunization represents a major issue. However, the development of a vaccine is related to many specific problems as the manipulation of strains or evaluation of immunogenicity. In addition, production delays after identification of the pandemic virus are incompressible and the pandemic is likely to develop before a vaccine is available. Specific approaches have been developed to produce prepandemic vaccines that can induce cross-immunity, partially effective on the pandemic strain. In 2009, several prepandemic and pandemic vaccines have obtained their licensure authorization and strategies are being developed in case of pandemic influenza.

Egypt announces discovery of 87 bird flu infection for a child of the Lake County

Save Bratabaodv comment Posted 9/24/2009 3:10:00 AM

Cairo - Editor مصراوى - Dr. Abdel Rahman Shahin, spokesman of the Ministry of Health, the discovery of human cases of No. 87 from bird flu, a girl named Hend Hamdy Abdel-Maksoud, the old year and two months, and living friend Abu Editorial Department Lake County.

Shaheen said - in a statement issued by the Ministry of Health on Wednesday evening - that the girl went to Damanhur Fever Hospital on Wednesday, with high temperature after exposure to dead birds suspected of being infected with bird flu.

He pointed out that once suspected of being infected with AIDS have been given Tamiflu, and that their illness is stable.

Source: Middle East News Agency,
hat-tip Rwilmer

Tuesday, September 22, 2009

WHO worries about swine flu deaths with no underlying illness

46 mins ago

The World Health Organization said Tuesday it was worried that up to a quarter of the fatal swine flu cases in the Western Pacific were patients with no underlying medical condition.

By September 19, an estimated 25 percent of the 352 death cases reported in the region had no prior medical problems, the WHO announced at its Western Pacific annual conference in Hong Kong.

"That worries us very much. We are looking into it," Takeshi Kasai, the organisation's regional adviser on communicable disease surveillance and response, told the media on the sidelines of the conference.

In other regions the proportion of swine flu fatalities with no underlying medical condition ranged from 20 to 50 percent, he said.

Kasai said one of the more plausible hypotheses virologists had come up with was that the virus replicated more rapidly in those patients.

He said that the WHO was also concerned that young adults were dying of swine flu, while small children and elderly people tend to be the main groups that succumb to seasonal influenza.

The West Pacific region covers 37 countries and extends from China and Mongolia to Australia, New Zealand and French Polynesia.
hat-tip Pathfinder

Monday, September 21, 2009

US agency finds fault with flu preparedness

* Study says more needs to be done to prepare for pandemic

* New HHS data does not include H1N1 preparations

WASHINGTON, Sept 21 (Reuters) - U.S. states and local communities may be ill-prepared to respond to a flu pandemic and could face manpower and logistical problems as they try to distribute vaccines and drugs, a federal watchdog said on Monday.

The U.S. Department of Health and Human Services' inspector general found that some states and municipalities have failed to take basic steps from recruiting crucial personnel to tracking available hospital beds and medical equipment.

The agency also found that preparedness plans often did not say where the staff needed to distribute vaccines and other drugs would come from, and failed to identify the individuals and organizations who would be responsible for specific tasks.

The data, collected last year from 10 municipalities and five states, provides a snapshot of flu preparedness as of August 2008.

It does not reflect preparations for the H1N1 swine flu pandemic that have been undertaken since the federal government allocated more than $1.4 billion in funding for state and local governments.

But it does reflect several years of reports showing the U.S. public health system and hospitals in general are barely prepared to cope with the daily onslaught of disease and accidents, let alone a serious pandemic.

"Although the selected states and localities are making progress ... more needs to be done to improve states' and localities' ability to respond to a pandemic," government investigators concluded.

The inspector general recommended that HHS and the U.S. Centers for Disease Control and Prevention work more closely to address weaknesses.

Federal health officials are racing to try to stay ahead of the swine flu virus, which is now active in all 50 U.S. states and was declared a pandemic in June. They expect the first roll-out of vaccines early next month.

The virus is causing moderate disease, with a death rate similar to that seen in seasonal flu, which kills between 250,000 and 500,000 people globally and about 36,000 in the United States each year. But H1N1 may infect far more people than seasonal flu because so few people have immunity.

One problem the HHS inspector general did not examine involves job cuts among public health workers due to budget restraints caused by economic weakness.

The National Association of County and City Health Officials, which represents 2,800 local health departments and is known as NACCHO, said about 8,000 staff positions were cut by city, county and other local health departments between January and June. That follows the loss of about 7,000 jobs in 2008.

Another 3,000 health employees had their hours cut while 9,000 more were placed on mandatory furloughs, the group said.

"These data demonstrate that the economic strains on local and state government budgets are reducing public health resources at a time when a stable public health system is greatly needed," NACCHO executive director Robert Pestronk said in a statement.

(Reporting by David Morgan; Editing by Maggie Fox and Bill Trott)

Young children need 2 doses of H1N1 vaccine: U.S.

WASHINGTON (Reuters) – Younger children will need two doses of the vaccine against the new pandemic of H1N1 influenza, U.S. officials said on Monday.

They said tests of Sanofi-Pasteur's swine flu vaccine showed that children respond to it just as they do with seasonal flu vaccines, with children over 10 needing just a single dose.

Dr. Anthony Fauci, director of the U.S. Institute of Allergy and Infectious Diseases, said young children will likely need to have their doses 21 days apart, but he said they could receive seasonal flu shots and H1N1 shots on the same day -- something that could ease the logistics of vaccinating children multiple times.

"Immunologically this is acting like seasonal flu and we are very pleased with that," Fauci told reporters in a telephone briefing. "The response in younger children is less robust but that is not unexpected."

The children up to age 17 all mounted an immune response that should protect them from H1N1 within 8 to 10 days, Fauci said.

The U.S. Centers for Disease Control and Prevention said 46 U.S. children have died from swine flu.

(Reporting by Maggie Fox, Editing by Sandra Maler)

hat-tip Treyfish