Disaster/Pandemic preparedness - page 16
I was looking the the other Disaster/Pandemic thread that Florida1 started. She mentioned that after the hurricanes, that they had problems getting basic supplies and food stores were often closed... Read More
Nov 2, '07Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741THE PANDEMIC VACCINE PUZZLE
Part 6: Looking to novel vaccine technologies
Maryn McKenna Contributing Writer
"Editor's note: This is the sixth in a seven-part series investigating the prospects for development of vaccines to head off the threat of an influenza pandemic posed by the H5N1 avian influenza virus. The series puts promising advances in vaccine technology in perspective by illuminating the formidable barriers to producing large amounts of an effective and widely usable vaccine in a short time. Part 5 looked at the idea of vaccinating people before a pandemic with a best-guess vaccine and following up later with a vaccine matched to the emergent pandemic strain."
Quote from http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov0107panvax6.html
Frustration with the slow pace of pandemic-vaccine achievement has spurred second looks at both old and new technologies, such as using whole influenza viruses instead of fragments or growing flu viruses in cultures of mammalian cells instead of in eggs.
Such approaches may yield cross-protection against various H5N1 strains, shorten the production timeline, or increase the amount of vaccine that can be produced.
Live-attenuated vaccine has been...struggling for market share since it was introduced in 2003 by MedImmune
Because they contain live virus, live-attenuated vaccines provoke multiple types of immunity.
In studies they have been shown to protect against both the strains from which vaccine candidates were derived and against drifted (slightly mutated) strains as well--characteristics that make them highly appealing to pandemic planners ...
They also grow in eggs at a much higher volume than inactivated vaccines...
But their live-virus content is responsible for the vaccines' greatest potential danger: the possibility that they might lead to reassortment between the vaccine virus and circulating flu strains.
Intradermal vaccination appears to provoke acceptable levels of immunity while using only 20% to 30% of the standard intramuscular dose--but the injection technique is more challenging and may not be feasible for mass vaccination programs that might use less-trained volunteers...
...academics from the University of Hong Kong recommended...giving lower-than-planned doses of vaccine during a pandemic, arguing that vaccinating more people with a reduced dose could create a mass effect large enough to slow down spread of the disease..."We must . . . consider whether anyone is ready for the potential consequences of deploying a suboptimal vaccine in an uncertain attempt to maximize our herd protection, with a possible reduction in the extent of protection of individuals"...
Moving flu vaccine production from eggs to cell culture would...free manufacturers from the necessity of procuring enough eggs up to a year in advance.
By dispensing with eggs, it would eliminate the need for putting a pandemic virus through reverse genetics, shaving 4 to 6 weeks off vaccine production.
And because the vaccine virus is grown in giant industrial fermenters, it could offer a vast increase in production capacity--but only if manufacturers or governments make significant capital investments or manufacturers quickly convert the 2.5 million liters of cell-culture capacity ... in use around the world for other pharmaceutical products
... isolating the flu virus's hemagglutinin gene and using recombinant technology to express the hemagglutinin in insect cells grown in bioreactors... can halve the standard production timeline while delivering higher yields...
...a universal vaccine.... "The optimal long-term solution to pandemic vaccination is the development of a new influenza vaccine against an antigen that is present in all influenza subtypes and does not change,"... So far, however, vaccines based on conserved regions of the virus such as the M2 protein have shown only the ability to reduce disease, not to prevent infection...
Nov 3, '07Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741THE PANDEMIC VACCINE PUZZLE
Part 7: Time for a vaccine 'Manhattan Project'?
Maryn McKenna Contributing Writer
"Editor's note: This is the last in a seven-part series investigating the prospects for development of vaccines to head off the threat of an influenza pandemic posed by the H5N1 avian influenza virus. The series puts promising advances in vaccine technology in perspective by illuminating the formidable barriers to producing large amounts of an effective and widely usable vaccine in a short time. Part 6 explored the potential of novel vaccine technologies such as using whole flu viruses or growing vaccines in cell cultures instead of in eggs."
Quote from //www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov0207panvax7.html
"If we are serious about a pandemic, we should assume it is going to be imminent and we should be prepared as if it is imminent--not 10, 15 years down the road, but imminent," said David Fedson, MD, a retired vaccine industry executive who has published analyses of pandemic vaccine planning ...
Former Senate Majority Leader William H. Frist (R-Tenn.) called in August 2005 for a "Manhattan Project for the 21st century"... In the same month, Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, recommended the creation of "an international project to develop the ability to produce a vaccine for the entire global population within several months of the start of a pandemic [that would be] a top priority of the Group of Seven industrialized nations plus Russia (the G-8)"...
...Trust for America's Health recommended in October 2006 that governments create a "multinational pandemic vaccine research and development master program" ...recommending an appropriation of $2.8 billion in such a project's first year (see Bibliography: IDSA 2007).
"An effort on the scale of the Apollo space project is required," the IDSA said.
It requires active coordination among all the federal health agencies along with cooperation from congressional funders, plus parallel efforts in other countries.... it is a global public health problem that requires better management"...
...it is urgent that such an effort be established soon, because there is no way of predicting accurately when a pandemic might arrive. If it arrives soon rather than later, the lack of vaccine in most of the world will create a divide between haves and have-nots that could corrupt international relations long after the pandemic ends.
The long standoff with the Indonesian government over sharing of H5N1 isolates has provided a foretaste of the disruption such resentment could cause. The health ministry of Indonesia--the country that has experienced the most human cases and deaths from H5N1 flu--stopped sending isolates to World Health Organization (WHO) collaborating laboratories in late 2006. Those laboratories both analyze the isolates to track the evolution of seasonal and novel flu strains and use them to develop pandemic vaccine candidates; Indonesia's decision to stop contributing was apparently triggered by the realization that it could never afford to purchase vaccines made from isolates it provided.
"At this point, when a pandemic happens, vaccines are going to provide some benefit to a very limited number of people," Osterholm said. "But they are also going to create a major diversion of activity and energy when the decisions have to be made about who gets what limited vaccine exists. I worry that their negative impact will outweigh their positive impact: They will cause a crisis of leadership around the world" (see Bibliography: Osterholm 2007).
Nov 5, '07Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741readymoms respond
this is worth reading. these people really are heroes.
Quote from readymoms.orghttp://afludiary.blogspot.com/2007/1...apha-expo.html
we are parents concerned about the potential impact of the next pandemic on children, families, and communities.
we are especially concerned about the following:
1. if a 1918-like pandemic happens today, communities will suffer 20 years of normal child deaths (aged 1-19) in the space of one season.
2. the current h5n1 avian influenza virus is causing human infections with an overall case fatality rate (cfr) of 60%.
3. this cfr rises to 75% for those aged 10-19.
4. h5n1 has to become 30 times (not 30%) weaker to match the 2% cfr of the 1918 pandemic.
5. a who working group report in 2006 tells us that "the present high lethality could be maintained during a pandemic" caused by h5n1.
we believe parents have a right to be given this information, and be supported to make the decisions that are best for their family.
we believe that failure to assist families to make informed choices will result in severe social disharmony as bereaved parents take their wrath against officials who have failed them.
we believe it is possible to protect our families with adequate implementation of the social distancing measures as specifically recommended by the cdc, especially early and proactive school closure.
we believe these same measures will also make it safe for essential workers to go to work.
we understand that implementation of these measures will require communities to make some tough choices between the cost to the economy and saving lives.
we believe that such choices cannot and should not be made for families and communities, only by them.
we fully agree with the following sentiments expressed by this participant at the cdc community mitigation stakeholders' meeting (atlanta, december 2006).
"the question of how much this will cost is the wrong question. the correct question is what is the price we are willing to pay? i would sacrifice everything i own to save one of my kids - everthing. and i would consider it the best bargain of my life.Last edit by indigo girl on Nov 6, '07
Nov 7, '07Updated: Citizen's Guide To Pandemic Preparedness
Quote from afludiary.blogspot.com/2007/11/updated-citizen-guide-to-pandemic.html
With a forward by David Heymann, Deputy Director-General
World Health Organization, and input from Dr. Grattan Woodson on the home treatment of Influenza, this guide is an excellent introduction to pandemic preparedness.
This download is being hosted by the Flu Wiki. The guide itself is a product of the Mid-Peninsula (San Francisco Bay area) Citizens Preparedness CommitteeQuote from http://www.newfluwiki2.com/upload/InSTEDD%20Influenza%20Manual%20v1-5.pdf
The Impact of a Pandemic
* Communities will be affected simultaneously.
* At least 30% of the overall population will
* Absenteeism is expected to be upwards of 50%.
* A pandemic is likely to last for 12 to 18 months.
* Communities could be affected by several waves
lasting 6 to 8 weeks each.
* Vaccines and antiviral drugs for pandemic
influenza will be in short supply, may be of limited
effectiveness, and are not likely to be available to
* Most of the ill will seek medical care.
* All healthcare systems will be overwhelmed.
* Health facilities are unlikely to be available to
most, and may be inadvisable to enter owing to
increased chances of exposure to the virus.
* People and communities will likely be on their
own without the help of mutual aid from other
communities, hospitals, or other public services.
* Those who take steps to prepare ahead of time
will be much more resilient as pandemic influenza
Nov 8, '07Utah Pandemic Flu Commercial
I am having a hard time believing that they are showing this. A year ago,
nothing and now they are finally trying to get thru to people with PSAs
Apparently the intensity of the message is making some people uncomfortable but it does serve the purpose
of getting the public attention, at any rate further PSAs are planned that are more geared to educating
people to prepare themselves:
http://www.flutrackers.com/forum/sho...99&postcount=1Last edit by indigo girl on Nov 9, '07
Nov 9, '07Occupation: IM/Critical Care/Cardiology Specialty: compassion ; Joined: Sep '03; Posts: 1,555; Likes: 656Wow, someone is finally taking the lead, let's hope it catches on state to state. Thanks Indigo Girl.
Nov 10, '07Local Wal-Marts Promote Pandemic Awareness
We need to see more of this with local businesses working with hospitals and and
health departments helping the public to prepare in the most basic way by
putting away food and essentials that families will need.
Quote from http://www.southbendtribune.com/apps/pbcs.dll/article?AID=/20071110/News01/711100438/1052/News01
The Granger resident's mom, Laurie Farris, was the one who entered a contest at the Mishawaka Wal-Mart store to win a pandemic flu kit. She called her daughter to pick up the winnings because she was out of town at the time.
The St. Joseph County Health Department along with other community groups developed the idea of giving away pandemic flu supplies to raise awareness about a possible epidemic.
All St. Joseph County-area Wal-Marts participated in the contest.
The conclusion of the local pandemic flu event came on the heels of a new national study revealing how little prepared children are when it comes to the virus.
The recently released report by the American Academy of Pediatrics and Trust for America's Health showed that children and teens account for nearly 46 percent of all bird flu deaths.
"How to treat and care for the nation's 73.06 million children and adolescents during an influenza pandemic is a significant concern," the report reads.
Nov 11, '07How Much Tamiflu Is Enough?
Avian Flu Diary takes on the Tamiflu dosage controversy with very clear
commentary on why this is such a problem:
Quote from /afludiary.blogspot.com/2007/11/how-much-tamiflu-is-enough.html
Today's story out of the UK indicates that their Pandemic Influenza Scientific Advisory Group is urging the government to triple their stockpile of Tamiflu (oseltamavir).
They believe that coverage for 75% of their population is essential if they are to "exert reasonable control over the scale and severity of the national outbreak"Quote from http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/11/nflu111.xml
The latest research by the Pandemic Influenza Scientific Advisory Group claims that the number of antiviral doses held by the Government must be tripled if a flu pandemic is to be effectively controlled.
The current stockpile of 14.6 million courses of the antiviral drug Tamiflu covers 25 per cent of the population.
... the scientists recommend boosting the stockpile to cover more than 75 per cent of the population.
Nov 12, '07Occupation: IM/Critical Care/Cardiology Specialty: compassion ; Joined: Sep '03; Posts: 1,555; Likes: 656Did I miss something? I thought Tamiflu was ineffective in survival for the H5N1 strain. If so why the discussion on stockpiling or increasing the dosage amount?
Nov 12, '07Quote from sharona97If I understand your two part question correctly:Did I miss something? I thought Tamiflu was ineffective in survival for the H5N1 strain. If so why the discussion on stockpiling or increasing the dosage amount?
No, it is usually very effective, and very much so. Lots
and lots ofTamiflu being used in Indonesia now. It is so effective, that
it is possible that by giving Tamiflu quickly enough, it will cause a negative
test result despite the victim being symptomatic and having family
members having died with the same symptoms.
Now, I did say that it is usually effective, but there have been
resistant cases in Northern Egypt, and these people all died. This is
truly the great fear, that the more the drug is used, the greater the
chance of drug resistance. Eventually, this will happen, and that will
be a terrible thing because it is all we have, for the most part, and it
is what is being stockpiled nationally by many countries.
The discussion about dosage amount has to do with the most effective dose
being higher than was initially thought to be appropriate. Research says we
have to give more Tamiflu, and the problem is that this then decreases the
stockpiles and limits the number of effective
(according to the latest research) doses that can be given. Using more
Tamiflu means fewer people will get it because we do not have enough.
The article sited in the post to which you were referring is talking about
the UK's national stockpile. The US has even less of the drug stockpiled.
Nov 15, '07Another Truth Bites the Dust
This information is important:
Quote from afludiary.blogspot.com/2007/11/another-truth-bites-dust.htmlThis is useful information for now if treating for seasonal flu in elderly
Antivirals don't work if administered more than 48 hours after infection sets in.
At least, that's the prevailing `wisdom'.
Now comes a study that suggests that older patients in particular
might benefit from antiviral therapy for influenza, even after the first
patients, BUT if we are talking pandemic, older patients are not likely
to be at the top of the list for a scarce and precious commodity like Tamiflu.
Quote from http://lfpress.ca/newsstand/Today/2007/11/14/4654219-sun.html
The studies used to win regulatory approval for the newer flu drugs
showed they were of little benefit after 48 hours. But those studies were
done in otherwise healthy adults whose immune systems would have
kicked in to halt the replication of the virus by that point, setting them
on the road to recovery.
But this work suggests older people and people whose immune systems
can't easily combat the flu virus can benefit from treatment past the 48-hour
"It's clear from this experience now that there seems to be benefit
even with later treatment," Dr. Frederick Hayden, an antiviral expert
with the World Health Organization's global influenza program, said from
Hayden said the study will "add to the body of evidence . . . that
hospitalized patients warrant therapy if there's evidence for ongoing
Nov 20, '07A Day of Cautionary Statements
Dr. Margaret Chan, Director-General of the World Health Organization
continues to warn of the possibility of a birdflu pandemic while
Doctor Narendra Singh, the Pandemic Preparedness and Training Specialist of the Secretariat of the Pacific Community gives the same warning.
Quote from http://www.un.org/apps/news/story.asp?NewsID=24733&Cr=influenza&Cr1=
"Vulnerability is universal,"
"A pandemic will, by its very nature, reach every corner of the earth, and it will do so within a matter of months."
Dr. Chan emphasized that this shared vulnerability calls for shared responsibility, and collective action to fulfil that responsibility. "In terms of the risk of disease, we really are all in the same boat," she said.
That is why the international community has an obligation to use the advance warning it has been given to prepare for a possible influenza pandemic...
Nov 20, '07Pandemic Mitigation:
Always remember, we are not helpless. We can prepare ourselves and
Two good commentaries with excellent graphics from SophiaZoe's blog.: