Possible Swine Flu Mutations

Norway and Britain may have some troubling news regarding the Swine Flu.

A National Emergency of the Swine flu may be improving, at least for now.

Obviously, the Swine flu is far from over. A peak may be seen in America and in Western Europe. The wave of infections seems to be increasing in Eastern Europe and Asia.

Over 6,700 deaths worldwide have been recorded as a direct result of the Swine Flu.

Though, it has been argued, cases may increase in January and several peaks could be seen in the typical single flu season whether human flu or H1N1.

There are “early signs of a peak in disease activity in some areas of the northern hemisphere,” the WHO said in a statement.

Drug-Resistant Swine Flu

The real concern or next phase of concern may be moving to a possible drug resistance by the swine flu virus in certain countries.  The spread of this strain may be occurring in Great Britain.

Importantly, this does not mean a resistance to the vaccine!!

5 individuals in Wales were found to be resistant to the antiviral drug “Tami-flu” from companies Roche AG and Gilead Sciences Inc

These patients did have success with a different antiviral from other companies GlaxoSmithKline and Biota Inc’s “Relenza”.

Each of these patients also had serious immune problems that may have given the strain an opportunity to develop resistance.

Another outbreak is being investigated in Norway where a strain of H1N1 may have mutated causing symptoms that were worse than expected and rather severe.

Recently the Norwegian Institute of Public Health reported that the virus may be able to go deeper into the respiratory system as a result, the symptoms were more serious.

The virus mutation was found on autopsy of two individuals that had died from the Swine flu.

Norway has seen a larger number of deaths per population when compared to other European countries.

Swine Flu Available Vaccines

World production continues to move forward when it comes to the  H1N1 vaccinations.   But truthfully, the world population and the number of vaccines available is quite large.  It is unlikely that a bridge will be able to connect the two sides any time soon.

The United States and several other countries are far behind where they would like to be.  Some countries report a shortage in the vaccine production.   Currently 44 million doses have been shipped so far.    This is only 30% of the anticipated amount.

Plateau

Several countries including the Untied States and Western Europe have experienced a decrease in number of new cases of the Swine flu within the past few weeks.

The question is whether this is a shift or a plateau.  Eastern European countries and Asia have seen an increase in cases.

The next few weeks will be telling for the projection of Swine Flu cases in the New year.

Swine Flu Update

Vaccine Production for the Swine Flu is less than adequate then expected and desired by the public.

According to the CDC, over 1,000 deaths have been attributed to the Swine flu with 100 of those being children.

20,000 hospitalizations are attributed as well. Almost all states have serious flu activity. All but 3 or 4 are largely affected.

Worldwide almost 5,000 deaths have been reported but this may be only a small amount of related deaths.

A  recently signed document by President Barack Obama in attempts to allow certain changes in medical standards with regards to Swine Flu vaccine production.

It is unknown if this will decrease standards of production or the testing with regards to the Swine Flu.   Swine flu is definitely “heating up”.

President Obama believes that this is a critical point in treatment for the Swine Flu. Restrictions of  Medicaid and medicare may also be relaxed as well.

A big question regarding this recent change is the relation between the number of current vaccinations available and a possible emergency status of the Swine Flu. Recent discussions with the White House insists that it is not related to the obvious decrease in expected vaccines available.

The fight against the Swine Flu is just beginning and although we are currently behind our own expectations.

Wasting Money with Medical Malpractice

Imagine driving down the road, a small animal jumps out in front of your vehicle – you slam on the breaks and narrowly miss the animal. You determine that you would have easily missed the animal except your breaks are screeching and they couldn’t slow the car down effectively.

You take your vehicle to the nearest repair shop for a break check and replacement breaks. After an hour, the man behind the counter, comes and informs you that it will take an additional 3 hours to finish the diagnostic process. They will need to check the engine, the alignment, the transmission, the fuel system, and the oil pressure. They must check these out before starting repairs.

You believe that it is only the breaks involved – but they argue that for your safety, [and their protection] they must do an entire system check to make sure you are safe on the road.

This is somewhat similar to the medical field and the diagnosis process of defensive medicine!!

A few changes between the medical scenario is that, the man behind the counter, isn’t necessarily the medical provider; it is society, lawyers, and insurance companies. While with the vehicle repair shop the owner is “the man behind the counter” and he is the one that pressures you into additional diagnostic tests.

A Medical Visit to the Emergency Room

When a patient arrives at the emergency room – the medical staff is designed and determined to improve the status of the patient. Often tests are required such as X-ray for a broken foot or blood work, EKG, and much more for a heart attack.

Some diagnosis are very difficult and may require a great number of exams, tests, and procedures. Where as others are relatively straight forward.

But external pressure, especially because of unwarranted medical malpractice lawsuits, may push a provider to order tests that are unnecessary or unhelpful in the search for a medical problem and subsequent solution.

A recent analysis by Congress indicated that over $41 billion dollars over the next ten years could be saved if malpractice lawsuit awards and rulings became somewhat more reasonable. This would require tort reform

Typically the taxpayer or hospital is responsible for the changes in budget and over-expenditures whether through increased prices, payments, insurance costs, change in medicaid, and/or taxes.

“Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services,” CBO Director Douglas Elmendorf wrote lawmakers.

Medical Malpractice

Is when a medical provider deviates from the standard of care. A standard is set for the medical staff and a change from that standard may, but not always, be considered for a lawsuit

The party reporting malpractice must establish 4 aspects of tort law. A duty was owed, a duty was breached, injury occurred, and damages were sustained. Without all 4 aspects – a lawsuit should not be held for trial.

True malpractice that occurs is not being considered as a waste of money. The term malpractice is being enlarged to include situations that malpractice does not involve. The excess amount of settlements and damages are currently believed to be too much. The relative increasing ease it is to file for malpractice when the 4 aspects of tort law are not being met is driving medical practice to “defensive medicine“. And hurts both medical staff and society.

Defensive Medicine

Some doctors feel obligated to order a MRI costing $1,500 for a patient with back pain that a simple $250 back X-ray would be sufficient because they must cover themselves to prevent an eventual lawsuit for missing a cancerous tumor.

Therefore, defensive medicine covers not only the specific complaint but attempts to cover everything under a “what if” policy and practice. A cancer patient could have symptoms of fever and chills, but so could the flu, tooth infection, stomach pains, and many others. A good medical judgment is essential – a need for a test should warrant a test. Fear of a potential lawsuit should not guide medical practice.

Shotgun medicine covers many things – but the cost has been considered as quite expensive.

The Patient concern

How often has an incidental tumor or other finding been observed because of an X-ray of the neck also showed a portion of the lungs or lab work for one concern brought to light another problem.

Patient advocates argue that patient diagnosis will suffer if too large of a cut back is put into place.

Many argue that several malpractice suits are not frivolous and that real harm has been suffered by some patients due to medical malpractice.

Limits on awards may improve medical cost but not always medical outcome.

What if your medical bills and social life were affected because of medical malpractice – yet because of limits to malpractice lawsuits you were unable to pay your bills and return to a functional living. Who would then cover your costs???

The White House

Obama has placed arguments on both sides. He does agree to limiting the overall use of “defensive medicine”. He is also on the side of patient advocates attempting to collect the appropriate compensation to problem.

Obama is currently looking into alternatives to filing a lawsuit or litigation.

Also a pilot plan was discussed last month that may initiate a tort reform. Limiting medical lawsuits has always been close to the heart of many Republicans.

$25 million dollars could be placed to initiate this program.

Conclusion

Although medicine is often more complicated then automobiles, many of us want a solution to the problem when we go to the emergency room

If a car part has a problem we want it fixed. If we have a medical concern – it is beneficial to have it fixed rather than several expensive tests to find a “possible” problem

A better control model for frivolous lawsuits needs to be put into place.

Medical Malpractice occurs and has scary and expensive consequences. No free ride or protection should be in place when a medical provider deliberately causes a problem. When something does go wrong, then appropriate compensation should be put into place.

Lets hope politics doesn’t get in the way of patient care, again!

Why wash your hands? It might not prevent the Swine Flu!!

Great advice often comes from our mothers, but it appears the the adage of the importance of washing hands isn’t all encompassing and will be little to no benefit in preventing the Swine Flu .

Typically passing soap over your hands and scrubbing can be quite effective in the prevention of passing microbes from person to person.

When it comes to the swine flu, contributing factors to the passage of infection such as restroom use, touching a door knob, covering your mouth when coughing, passing money and others can not be compensated by washing hands alone.

Recent Studies point to the passage of Swine flu through breathing and inhaling the microscopic
particles that are already in the air.

When someone sneezes, droplets are released into the air and they become aerosols that are breathed into the lungs by surrounding individuals.

Therefore, it is noted that the influenza virus is not passed from contaminated hands.

The CDC continues to recommend washing of hands for prevention of infection and overall this is a very good piece of advise.

Companies such as Steris Hand Sanitizers have seen jumps in their sales of almost 15 percent and that increase could triple over the next several months if a new increase or outbreak is seen throughout the U.S.

Overall, although the Swine Flu pandemic might not be prevented from washing your hands, there are many other bacterial and viral infections that may be prevented.

The Swine flu pandemic should not change your habit of washing your hands!!!

Post first seen at InterActive Blog

Swine Flu – Heating Up or Exploding??

The Swine Flu discussion is beginning to heat up again today in Beijing with the World Health Organization indicating that they fear an “explosion” of Swine flu cases in the next few months.

This rhetoric appears to be nothing new from the hundreds of stories regarding Swine flu over the past few weeks to months. The projected timeline includes a modest increase in Swine flu cases over the next few weeks, then a sharp increase – a doubling of cases each day for several weeks and then a peak of cases in the colder months later this year and into early next year.

The current belief is that the Swine flu influenza virus is a rather resistant virus. This is backed up by the fact that the seasonal flu influenza virus typically disappears during the warm months. The Swine flu has diminished in the Northern Hemisphere but is has not disappeared. A better understanding to the pandemic outcome because of this resistance will be seen in the upcoming months.

The symposium held today wanted to address the prognosis and the current situation of the H1N1 influenza or more commonly referred to as the Swine flu.

They reported that over 1,800 deaths can be attributed to the Swine flu and that it is currently classified as a pandemic.

In the United States currently 520+ deaths are Swine flu related/caused

They believe that up to 30% of the entire world population will be exposed or infected by the Swine flu over the next few years.

While others attest that the Swine flu may be no more serious than the annual flu season that is experienced year in and year out.

Worldwide – between 200,000 and 500,000 deaths are attributed every season to the seasonal flu.

The Pacific director of the Western branch of WHO is Shin Young-Soo and he indicated a concern for developing countries. Shin indicates “…it is in developing countries that the accelerated spread of swine flu poses the greatest threat as it places under-equipped and underfunded health systems under severe strain.”

Others believe the most challenging aspect will be the significant demand for vaccine and the high emergency room numbers in both the developed and undeveloped countries. It is believed that many will be overburdened due to fear and potential outbreak.

Swine Flu Vaccine

Many are concerned over the current projected release of the Swine flu vaccine. It is anticipated to begin between the months of September and December.

Most of the vaccine rations will be given to more economically sound countries.

There is a report of two drug makers that have pledge to donate 150 million doses of the vaccine to poorer countries by the later part of the year. It is unknown the price tag on the vaccines donated.

Vaccine Timeline

Currently it is believed that the Swine flu vaccine will be available at the end of the year – or sometime sooner.

Clinical trials Clinical trials began and the results should be known by mid to late September.

Some believe that 50 million doses will be available by late October and over 200 million doses ready by December. This projection is less than half of the original expectation and has taken some by surprise. Initially it was anticipated that some 120 million doses would be ready by October.

Currently no serious side effects have been seen in the initial batch of clinical trials

Initially Adults were tested and just within the last few days – children began testing as early as 6 months of age.

More controversially pregnant women will begin testing sometime next month.

Distribution of the vaccine will be closely discussed and monitored. Currently the U.S. Centers for Disease Control and Prevention is creating a plan for distribution.

Adjuvants will also be tested more fully over the next few months.

Additional modifications to timeline and expectations will be seen over the next few weeks and months.

Swine Flu Vaccine Awarded First Contract

Immunization for the swine flu is big money.. Just ask Protein Science, a biopharmaceutical company who was apparently awarded 35 million dollars for bringing out the first 100,000 doses of the Swine flu vaccine.

But are state health sites or the government ready to open a neighborhood clinics to start giving out a swine flu shot today. Of course not, they are at least a few months from that point. The current doses in circulation have not yet been tested and are only in the development stages. Clinical trials await in the extremely near future.

The U.S. Department of Health and Human Services announced last week the contract with Protein Sciences. The contract includes this year and may include an additional 5 years. The total contract may be worth 147 million dollars.

Caterpillar cells were infected by Protein Science with a virus that had been enhanced with a specific gene called a “hemagluttinin“. This gene is often found on the surface of the influenza virus. This new technology is comparatively different than the traditional mode of vaccine development.

Protein Science’s ability to make this vaccine quicker results from insect use, rather than the traditional route of a “seed strain“. Seed strains are typically done by creating a Hybrid virus. In the case of the Swine flu, the hybrid contains the H1 and N1 aspects of the influenza virus. The incubator is chicken eggs. Typically the process is highly involved with seven rounds of engineering the virus into an egg for harvesting.

Creation of a vaccine for H1n1 – Swine flu will not fall only on Protein Science. Another company Sanofi-Pasteurwhich has received a seed strain and has also begun development. Sanofi is the largest producer of the flu vaccine currently. Several other companies continue in the development of H1N1 vaccine that will enter into the testing stages. The race is not over yet.

Qld uni from Australia has reported its initial 1,000 doses that will only be used for research with the expectation that a working drug may be ready by the end of the year.

Are we moving too fast??

It is expected that the clinical stage may test the vaccine with to shots with 2 or 3 or even 4 week cycle. This will allow a subject to be monitored and their immune system enough time to develop immunity. It will be necessary to determine the human safety involved, the immunological response of antibodies, and the side effects of the vaccine. Even at the 4 weeks we may be pushing too hard.

But what would happen if the pandemic suddenly becomes worse. Would a company or government be inclined to speed up the process. Maybe wait only 1 week or less. It could reasonably take weeks to months to adequately test the vaccine in a manner relatively safe.

Several major questions:

1.)    Who should be the first to get the vaccine? [hospital workers or extremely sick patients]

2.)   Which states first?

3.)   Do we base it on population size or ratio of Swine flu cases??

4.)   Should we plan on vaccinating all 300 million Americans

5.)   What is the groundwork plan in states and counties?

6.)   Which countries should be included?

7.)   Cost?

8.)   What’s the effectiveness of the vaccine?

9.)   Should adjuvants be used?

10.)   Will there be another wave of swine flu?

Adjuvants

Are immune potentiators or immunomodulators that are added to vaccines with the hope to improve the immune response. It has been argued that these products can improve, enhance, accelerate, and even prolong the response of the vaccine.

The severity and amount of the vaccine may force many pharmaceutical companies to adding an adjuvant to the vaccine. This would allow the vaccine to be shared with several other countries.

Examples of adjuvants include: salts, oils, lipids, microbial derivatives, human immunomodulators (cytokines), gold particles and others.

Adjuvants have been seen to act along with the vaccine to allow and improve the desired effect.

Ajuvants may be used in the Swine flu. GlaxoSmithKline Inc. which has received Canada’s pandemic vaccine contract has indicated that they will strongly consider using an adjuvant in their vaccines. In addition to the action of the vaccine it may also speed up the time it takes for the company to produce enough vaccine for the entire county.

However – some argue that once the process has begun the adjuvants may become essential – but the time for the initial production of the vaccine might double or more.

Bankruptcy a possibility??

In concerning news regarding Protein Sciences – just a day prior to receiving the contract – Creditors for Protein Sciences Corporation filed a petition to force them into bankruptcy and liquidation. This calls into concern the stability of the company that has been given the company who has been awarded the contract for production of the Swine flu vaccine.

It does appear that the government has done several internal audits into the company and it was determine that Protein Sciences are financially stable enough to continue in the development of the vaccine.

Originally seen at: Swine Flu Vaccine Awarded First Contract

Several additional stories:

http://www.proteinsciences.com/aboutus/aboutus_news.htm

http://www.abc.net.au/news/stories/2009/06/29/2611426.htm

http://www.tehrantimes.com/index_View.asp?code=197637

http://www.nytimes.com/2009/06/24/business/24vaccine.html

http://www.theglobeandmail.com/life/tall-hurdles-in-race-for-a-swine-flu-vaccine/article1197368

What is the Swine flu and why is it such a concern??

What is the Swine flu and why is it such a concern??

-   The Swine flu is a type of  Influenza
-   Influenza is a type of virus from a class of viruses called Orthomyxoviruses
-   There are 5 main types of this virus and the swine influenza is a subtype of one of the 5.
-   Influenza A is the major player in many flu symptoms and epidemics each year
-   As history speaks this type of virus can be very dangerous
-   Caution should be prudent but at this time not enough is known for a panic

Why is it called the Swine Virus?

-   Some virus affect only animals and some affect both animals and humans
-   This specific virus has some Swine DNA and can affect both pigs and humans
-   It can be referred to as Swine-Origin Influenza A (H1N1)
-   Recently name was changed by CDC to Influenza A H1N1

Has the Swine Flu ever been seen before?

-   Unfortunately yes
-   The Spanish Flu of 1918 saw the death of over 50 million people due to a Swine influenza
-   It was somewhat different in subtype then the current virus of 2009
-   Influenza C can also be found in swine but is not at risk during this outbreak
-   It is typically rather rare

What makes this virus different?

-   It is made up of several strains
-   H1N1 – is made up of two seperate swine influenza virus, one avian influenza virus and humun influenza virus

Are there other influenza type virus?

Yes:
1.)  Swine Influenza
2.)  Avian [Bird] Influenza
3.)  Horse Influenza
4.)  Dog Influenza

What can we do?

Prevention is the key

-   Wash hands
-   Limit touching face and eyes
-   Limit contact with those who are sick
-   Don’t overreact

References include:

CDC:   http://www.cdc.gov
Wikipedia:   http://en.wikipedia.org/wiki/Human_flu

Originally seen at http://www.iahealth.net/swine-flu