Laidback Al

In 2013, I noted the initial outbreak of Middle East Respiratory Syndrome (MERS-CoV), a novel coronavirus. At the time it had infected several health care workers. MERS (Middle East Respiratory Syndrome) hospital transmission in several countries Healthcare Workers and Hospital Patients Are at Risk from MERS Members here at allnurses should be aware of the growing number of nosocomial outbreaks that have occurred in more than a dozen health care facilities on the Arabian Peninsula. Today, we know that of the 340+ reported cases, at least 80 of them are health care workers. That means that 1 out of every 5 infected persons is a health care worker who most likely became infected in a hospital caring for a sick patient. And about 40% of all the cases have died. Allnurses members should be take the time to educate themselves about this novel infectious disease.

Why Should I care about MERS? Let me preemptively respond to a question that might be posted in this thread-- "Why should I care about MERS, it's only infected about 140 and people and most of the nosocomial infections are taking place in Saudi Arabia on the other side of the world?" Here is why readers at allnurses should be concerned about MERS. We don't know how extensively MERS is circulating in the general population in Saudi Arabia. Official reports from the Saudi Arabia Ministry of Health are limited and probably do not provide an accurate picture of the MERS outbreak in that country. We do know that in the next several weeks almost 2 million international visitors will travel to Saudi Arabia to participate in the annual Hajj pilgrimage. These visitors will be mingling with more than 1 million local citizens of Saudi Arabia. Additional human-to-human transmission could occur if the disease is circulating in the local Saudi Arabia population. Infected international Hajj travelers could bring the disease back to their home country when they return. The fact is, international travelers to the Middle East have already become infected and brought the coronavirus back to their home countries. Cluster outbreaks from international travelers have occurred in France, Italy, Tunisia, and the United Kingdom earlier this year. So the spread of MERS by Hajj pilgrims around the world is a very real possibility in the coming weeks when these travelers return to their home countries. It is important that healthcare workers all around the world be vigilant and consider MERS as the infectious agent for individuals who developed fever and pneumonia or other respiratory illnesses and have recently traveled to the Middle East or have had contact with sick individuals who have recently traveled to the Middle East.

In June I made an allnurses' post about the hospital transmission of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (link). At that time about 55 cases had been reported from around the world. Now, 4 months later, more than 80 additional cases have been reported, most from Saudi Arabia. MERS-CoV is a novel infectious disease that was first recognized in 2012. The coronavirus is similar to the coronavirus responsible for the SARS outbreak in 2002-2003, which infected more than 8000 people. Although less than 150 people have been infected with MERS-CoV around the world, the frequency has been increasing since March of this year. At least 50 people with MERS-CoV have died and many patients require extensive care in ICUs. While sustained human-to-human transmission has not occurred, human-to-human transmission is prevalent as evidenced by clusters of cases and nosocomial infections among healthcare workers and hospital patients. Although official information is limited, about half of all MERS-CoV cases have occurred in clusters. Many of those clusters of infection occurred in health care facilities. A number of patients were infected during their hospital stay. Importantly, at least 30 healthcare workers, including nurses and possibly doctors, were infected while treating patients in hospitals and other healthcare facilities. The fact that human to human transmission is occurring in healthcare facility settings among both patients and healthcare workers, including nurses, means that special care should be taken by healthcare workers when treating and caring for suspected and confirmed MERS-CoV cases.

from: Clinical Infectious Disease, vol 57, issue 2, pp. 197-204. Lack of Association of Guillain-Barré Syndrome With Vaccinations Roger Baxter, Nandini Bakshi, Bruce Fireman, Edwin Lewis, Paula Ray, Claudia Vellozzi, and Nicola P. Klein Background.  Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy, thought to be an autoimmune process. Although cases of GBS have been reported following a wide range of vaccines, a clear association has only been established with the 1976 H1N1 inactivated influenza vaccine. Methods. We identified hospitalized GBS cases from Kaiser Permanente Northern California (KPNC) from 1995 through 2006. The medical record of each suspected case was neurologist-reviewed according to the Brighton Collaboration GBS case definition; only confirmed cases were included in the analyses, and cases of Miller Fisher syndrome were excluded. Using a case-centered design, we compared the odds of vaccination in the 6 and 10 weeks prior to onset of GBS to the odds of vaccination during the same time intervals in all vaccinated individuals in the entire KPNC population. Results. We confirmed 415 incident cases of GBS (including Brighton levels 1, 2, and 3) during the study period (>30 million person-years). Incidence peaked during the winter months. The odds ratio of influenza vaccination within a 6-week interval prior to GBS, compared with the prior 9 months, was 1.1 (95% confidence interval [CI], .4-3.1). The risk in the 6-week interval compared to the prior 12 months for tetorifice diphtheria combination, 23-valent pneumococcal polysaccharide, and for all vaccines combined was 1.4 (95% CI, .3-4.5), 0.7 (95% CI, .1-2.9), and 1.3 (95% CI, .8-2.3), respectively. Conclusions. In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.

This is now becoming a public relations disaster in Italy for health officials. A second round of testing on at least eight of these individuals produced negative test results. It is worth noting that as many as five of these individuals were HCWs.

At least 10 more people in Florence, Italy, all contacts of the original three cases, are reported as asymptomatic cases of MERS-CoV today. These are apparently not HCWs. More information from official sources is necessary to speculate on the implications of these additional suspected cases in Italy.

Map of Current MERS cases as of June 2, 2013 from novel-infectious-diseases

Time to Watch for MERS in Hospitals around the world The Middle East Respiratory Syndrome (MERS) was first identified among a group of hospital personnel in Jordan in April 2012. (link) It is a severe novel zoonosis with a CFR of more than 50%. As of June 1, 2013, this disease has only infected about 55 people in various countries in the Middle East and Europe. However, human-to-human transmission of the disease has been reported in hospital settings in France and Saudi Arabia. The family clusters of infections in the Italy and the United Kingdom may also partially be a result of nosocomial transmission. In all of these clusters the index cases were infected on the Arabian Peninsula, either because the person recently traveled there or was a resident there. Nurses should be aware of the potential for MERS infection from sick patients who have recently returned from any of the countries located on the Arabian Peninsula. WHO link: http://www.who.int/csr/don/2013_05_31_ncov/en/index.html

If it was bird flu - it wouldn't be a funny story. I hope you understand that the addition vaccination in 2009 was for a novel pH1N1 virus that circulated. It was developed separately from the trivalent seasonal influenza vaccine. Since then pH1N1 had been incorporated in the seasonal vaccine every year. I pretty sure your didn't get bird flu (H5N1). You ought to be concerned about the "new" bird flu in China. In the past two months more than 80 cases have been reported and 16 have died. That means 1 in 5 infected people are dying. So far, the is no sustained transmission between people, but that could change tomorrow. It will take a minimum of seven months to create a vaccine. So you all have time to decide whether or not you would consider taking a H7N9 vaccine.

Today, a 7 -year-old child was confirmed with an H7N9 infection in Beijing. This child was hundreds of miles away from any of the other 40+ cases confirmed so far in China. The source of infection in China seems to be very widespread. So far, human-to-human transmission has not been identified. link: FluTrackers - View Single Post - China - Cumulative number of today confirmed and suspected cases (April 13, 2013): 1 cases / 0 death (Total 44 / 11) - Beijing case confirmed

Novel Influenza Strain H7N9 in China - 38 cases, 10 dead Twelve days ago, no had ever heard about H7N9 infecting humans. Since then 38 cases of H7N9 infection have been reported by Chinese authorities. Ten have died. This is a virulent novel influenza strain. Health care workers should be watching this outbreak carefully. OIE Overview: http://www.oie.int/en/for-the-media/press-releases/detail/article/questions-and-answers-on-influenza-ah7n9/ WHO Update: http://www.who.int/csr/don/2013_04_11/en/index.html

CDC . . . Interim Guidance on Case Definitions to be Used for Novel Influenza A (H7N9) Case Investigations in the United States This document provides interim guidance for state and local health departments conducting investigations of infections with novel influenza A (H7N9) viruses. The following definitions are for the purpose of investigations of confirmed and probable cases, and cases of novel influenza A (H7N9) virus infection under investigation. CDC is requesting notification of all confirmed and probable cases of novel influenza A (H7N9) virus infection within 24 hours of identification. When possible, state health departments are encouraged to investigate all potential cases of novel influenza A (H7N9) virus infection further to determine case status. Case Definitions Confirmed Case: A patient with novel influenza A (H7N9) virus infection that is confirmed by CDC's Influenza Laboratory or a CDC certified public health laboratory using methods agreed upon by CDC and CSTE.1 Probable Case: A patient with illness compatible with influenza for whom laboratory diagnostic testing is positive for influenza A, negative for H1, negative for H1pdm09, and negative for H3 by real-time reverse transcriptase polymerase chain reaction (RT-PCR), and therefore unsubtypeable. Case Under Investigation: A patient with illness compatible with influenza meeting either of the following exposure criteria and for whom laboratory confirmation is not known or pending, or for whom test results do not provide a sufficient level of detail to confirm novel influenza A virus infection. A patient who has had recent contact (within ≤ 10 days of illness onset) with a confirmed or probable case of infection with novel influenza A (H7N9) virus. OR A patient who has had recent travel (within ≤ 10 days of illness onset) to a country where human cases of novel influenza A (H7N9) virus have recently been detected2 or where novel influenza A (H7N9) viruses are known to be circulating in animals. Cases under investigation with severe respiratory illness (including radiographically-confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness) of unknown etiology may be prioritized for diagnostic testing. 1 Confirmation of all novel influenza A (H7N9) viruses will initially be performed by CDC's Influenza Laboratory. Once appropriate diagnostic testing methodology has been identified by CDC, confirmation may be made by public health laboratories following CDC-approved protocols for detection of novel influenza A (H7N9) virus, or by laboratories using an FDA-authorized test specific for detection of novel influenza A (H7N9) virus. 2 Countries that have recently reported novel influenza A (H7N9) human cases include: China. For more information, please see the CDC Avian Influenza A (H7N9) Virus information page. http://www.cdc.gov/flu/avianflu/h7n9-case-definitions.htm

Latest information from World Health Organization Background and summary of human infection with influenza A(H7N9) virus- as of 5 April 2013 In the past few weeks, WHO has received from China reports of human infection with influenza A(H7N9) virus. The influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses, which normally circulate among birds. Human infections with other subgroups of H7 influenza viruses (H7N2, H7N3, and H7N7) have previously been reported in the Netherlands, Italy, Canada, United States of America, Mexico and the United Kingdom. Most of these infections occurred in association with poultry outbreaks. The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands. These recent reports from China are the first cases of human infection with H7N9 viruses. Epidemiology The reported laboratory-confirmed cases have come from several different provinces in eastern China and are not known to be linked. All patients so far have been severely ill, and some have died (for the latest information on cases and outcomes, see Disease Outbreak News. Two family clusters have been reported. Beyond these two clusters, no cases have been reported among contacts or in health care workers associated with confirmed cases. The source of infection and the mode of transmission are currently unknown. No association with outbreaks of disease among animals or clear exposure to animals has been established. Some of the confirmed cases had contact with animals or with environments in which animals were located. The virus has been found in a pigeon in a market in Shanghai. The possibility of animal-to-human transmission is being investigated, as is the possibility of human-to-human transmission. The family cluster raises the possibility of human-to-human transmission, but two of the cases in that cluster have not been laboratory confirmed and there is no other evidence pointing toward sustained transmission among people. Clinical presentation The main clinical feature among most patients is respiratory diseases resulting in severe pneumonia. Symptoms include fever, cough and shortness of breath. Patients have required intensive care and mechanical ventilation. Information is, however, still limited about the full spectrum of disease that this infection might cause. Virology The HA gene is genetically distinct from the HA gene of other H7 viruses. The six internal genes are derived from influenza A(H9N2) viruses circulating in birds in eastern Asia. The NA gene is similar to the NA genes from influenza A(H11N9) viruses detected in birds in previous years. We do not know why cases of influenza A(H7N9) virus infection are being detected now , as we do not know how these persons were infected. Sequence analyses have shown that the genes of the influenza A(H7N9) viruses from the first human cases in China are of avian (bird) origin. However, these genes also show signs of adaption to growth in mammalian species. These adaptations include an ability to bind to mammalian cell receptors, and to grow at temperatures close to the normal body temperature of mammals (which is lower than that of birds). Treatment Laboratory testing conducted in China has shown that the influenza A(H7N9) viruses are sensitive to the anti-influenza drugs known as neuraminidase inhibitors (oseltamivir and zanamivir). When these drugs are given early in the course of illness, they have been found to be effective against seasonal influenza virus and influenza A(H5N1) virus infection. There is no experience yet with the use of these drugs for the treatment of H7N9 infection. Prevention No vaccine for the prevention of influenza A(H7N9) infections is currently available, although viruses have already been isolated and characterized from the initial cases. The first step in development of a vaccine is the selection of candidate viruses that could go into a vaccine. WHO, in collaboration with partners, will continue to characterize available influenza A(H7N9) viruses to identify the best candidate viruses. These candidate vaccine viruses can then be used for the manufacture of vaccine should this become necessary. While the source of infection and the mode of transmission have not yet been determined, it is prudent to follow good hygiene practices to prevent infection. For advice on infection prevention, contact with animals and food preparation, see: http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/. Guidance for infection prevention and control in health care settings is available at http://www.who.int/csr/resources/publications/swineflu/WHO_CDS_EPR_2007_6/en/index.html. Current activities WHO has closely monitored the situation since detection of the first case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. We have also been working with animal health partners to investigate possible circulation in animals. Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks. Actions taken by WHO in coordination with national authorities and technical partners include the following: * Information is being provided to countries under the International Health Regulations (IHR). * Enhanced surveillance for pneumonia cases of unknown origin to ensure early detection and laboratory confirmation of new cases. * Epidemiological investigation, including assessment of suspected cases and contacts of known cases. * Close collaboration with animal health partners, specifically the World Organization for Animal Health (OIE), the Food and Agriculture Office of the United Nations (FAO) and the OIE/FAO Network of Expertise on Animal Influenza (OFFLU), to investigate possible circulation of this virus in animals and to ensure that materials and information, including laboratory test reagents, are shared between animal health and public health laboratories. * Continuous risk assessment of the situation in collaboration with the WHO Global Influenza Surveillance and Response System (GISRS), which is comprised of WHO Collaborating Centres for Reference and Research on Influenza, National Influenza Centres and Essential Regulatory Laboratories (see http://www.who.int/influenza/gisrs_laboratory/en/); in animal health laboratories, coordinated by the WHO-OFFLU collaboration; and with other technical partners. WHO recommendations Based on the current situation and available information, WHO advises the following: * When laboratories testing for influenza viruses detect an influenza A virus by RT-PCR assays using primers for the conserved M genes and then find that tests using currently available H1, H3 and H5 primers are negative, such unsubtypable influenza A viruses should be sent urgently to a WHO Collaborating Centre for further analysis (see http://www.who.int/influenza/gisrs_laboratory/collaborating_centres/en/). * When a laboratory or Member State finds such an unsubtypable influenza A virus, the finding should be reported to WHO through the International Health Regulations national focal point as is required under the IHR. * The same surveillance strategy applies as for human infections with highly pathogenic avian influenza A (H5N1) virus. * Clinicians and laboratory specialists should consider the possibility of human infection with influenza in any person presenting with severe acute respiratory disease. * Clinicians are reminded of standard guidance for infection control and contact tracing around such cases. * Standard guidance should also be applied for vigorously investigating clusters of severe respiratory infections and such infections in health care workers who have been caring for patients with severe acute respiratory disease. * WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied. Summary Any animal influenza virus that develops the ability to infect people can theoretically cause a pandemic. However, whether the influenza A(H7N9) virus could actually cause a pandemic is unknown. Experience has shown that some animal influenza viruses that have been found to occasionally infect people have not gone on to cause a pandemic while others have done so. Surveillance and the investigations now underway will provide some of the information needed to make this determination. WHO continues to work closely with national authorities and technical partners to gain a better understanding of this disease in humans and will continue to provide updated information. WHO will continue to reassess the situation as it evolves. As more information becomes available WHO will revise its guidance and actions accordingly. http://www.who.int/influenza/human_animal_interface/update_20130405/en/index.html

Officially China only reported human H7N9 infections to the world a few days ago. As of today, China has reported 16 cases of human infection of H7N9. Six have died. This is a novel influenza A virus that could become easily transmissible among people. Nurses should be following the media reports on this outbreak just in case.

Today China announced 4 new cases of H7N9 in Jiangsu Province (link), bringing the total confirmed cases of this new influenza virus to 7, with possibly 5-8 more infected individuals in Shanghai. This influenza outbreak deserves watching carefully.

Novel Human Influenza Infections (H7N9) in China This new variant of bird flu has killed two people in the last 30 days. Everyone should be concerned about novel zoonotic diseases. In the past 30 days at least two people died and one other is in a hospital in serious condition in China from an infection from a novel H7N9 influenza virus (link to FluTrackers news thread). There is no evidence of human to human transmission yet, but there is also no vaccine for this influenza virus at this time.

In my youth, I never wore a seat belt, and was never in a car accident. After seat belts were mandated, I was in accident wearing my seat belt. Did the seat belt cause my accident? It's tough to know what to believe.

Ask the parents of the dozens of children who died from flu this year if they are sorry they didn't get their child vaccinated. http://minnesota.publicradio.org/display/web/2013/03/22/health/kids-died-of-flu-most-didnt-get-vaccine

As mariebailey notes GBS does occur in a a small fraction of individuals who receive an influenza vaccination. I am unaware of any studies that have compared and contrasted the health outcome of individuals who have had numerous flu shot in their lifetime with individuals who have only been vaccinated once in their lifetime. I would be interested in seeing the results of such studies.

There is no proof that if you wear a seat belt you won't die in a car accident. . . . I guess you don't wear your seat belt.

I hope you weren't referring to my post. Corporations are not motivated by trying to improve the public good. But that does not mean that flu vaccines are ineffective or dangerous. I am always skeptical of drive-posters spouting anti-vaccer propaganda. I generally recommend people research the facts, not the hearsay, for themselves. First, vaccine manufacturers do not make money off of flu vaccine which is why there is government support. Big pharma makes a lot more money off of patented drugs and vaccines such as ZOSTAVAX or GARDASIL. There are single does vaccines that are available that contain no preservatives at all, no Thimerosal and hence no mercury. While getting the flu vaccine may not stop you from getting the flu, it certainly increases your chances of avoiding infection. Don't believe anonymous posters on internet sites. Read peer-reviewed scientific studies. No matter what you read on the internet, these studies are all not a part of a big pharma-government cover-up and vaccination conspiracy.

fear of lawsuits? It is hard to know. Big corporations and operations don't like dissension in the ranks. They certainly know that, in general, nurses don't want to be forced to be vaccinated. I am pretty sure that hospital and health care facilities don't get a kick back from the vaccine manufacturer for every nurse they vaccinate. But for whatever reason, bottom line perhaps, they are willing to aggravate their employees and make them get vaccinated.

It is easy to ascribe human emotions and motivations to corporations or governments. Despite the supreme court ruling, these headless mutli-tendriled conglomerates are not people--and they do not think, feel, or act on a rational basis like individuals do. The only person that has your own best interest at heart is yourself. While I may not agree about purposeful conspiracy theories, I think everyone needs to educate themselves and make the choices they think are best for themselves.

Instead parroting hearsay about preservative, adjuvants, etc. in influenza vaccines, I urge everyone to educate themselves to make informed decisions. Here are links to the package inserts for all of the approved vaccines for the 2012-2013 season. Package Insert - AFLURIA (PDF - 230KB) Package Insert - Agriflu (PDF - 117KB) Package Insert - FluLaval (PDF - 149KB) Package Insert - Fluvirin (PDF - 235KB) Patient Information Sheet - Fluzone and Fluzone High Dose (PDF - 21KB) Package Insert - Fluzone (PDF - 239KB) Package Insert - Fluzone - High Dose (PDF - 164KB) Package Insert - Fluzone-Intradermal (PDF - 253KB) Package Insert - FluMist (PDF - 536KB)

Esme12 - I understand that it was not your quote but a quote you cited in your post. But selecting a quote from a biased site rather than a direct quote from the article itself may indicate a bias. The statement in the quote you selected - "A PLoS study has documented that, given enough vaccine injections, everyone will develop an autoimmune disorder." - is absolutely not true. The article does NOT document anything about getting too many vaccinations, as I note in my post. Anecdotal evidence and self reporting are not reliable or scientific measures of efficacy or lack of efficacy of influenza vaccinations. We seems to go around and around on these civil rights issues and conspiracy theories. It is not the government that is mandating flu vaccinations, it is employers. And no one is forced to work for an employer. In the USA at least, everyone still has the freedom to quit if they don't like the rules of the employer or risk being fired (see this thread).