Strange Stories Coming Out of Brazil

oramar · Aug 16, 2009

Anyone deciding not to get vaccine because they fear Guillian-Barr should read this first then decide yes or no to the vaccine.

indigo girl · Aug 19, 2009

What's Going on in Brazil?

http://news.xinhuanet.com/english/2009-08/19/content_11909815.htm

While this article is about H1N1 in Latin America, what caught my eye is the percentage of people in Brazil that have died without any prior health problems. That would be 37.5%. Why is that? 12.5% were pregnant women.

Overall the swine flu seems to have hit them harder than other countries. Out of the 5765 confirmed cases, 3087 were severe which included 238 pregnant women?

Of course, there were probably many more undiagnosed cases just like everywhere else,

but it makes me wonder how many pregnant women in our country had severe cases of flu that we will never hear about in any public health report or in the media. The CDC has those numbers , though.

The number of deaths from the disease in Brazil reached 384, with 13 new victims in three states, the Brazilian health authorities reported on Tuesday.
About 50 percent of the victims had some risk factors, such as pregnancy, chronic diseases, high blood pressure and debilitated immune system, and a total of 12.5 percent were pregnant women, the authorities said.
Meanwhile, the authorities confirmed 5,767 cases of infections, with 3,087 severe ones including 283 pregnant women.

misswoosie · Aug 19, 2009

Anyone deciding not to get vaccine because they fear Guillian-Barr should read this first then decide yes or no to the vaccine.

It is a risk benefit analysis we need.I need to know the risk of dying from swine flu, the risks of the vaccine (which I doubt there is enogh data on) and the risk of dying or bring severely disabled from GB or any other side effect.

As the vaccine is only know being given to humans there will not be enough safety or efficacy data available before they introduce mass vaccination programmmes.

I wonder how these death rates compare to the usual flu death rates- need to be mortality rates not just numbers of deaths.700 deaths in the US is a drop in the ocean.We also need to know the demographics of these people who are dying ie

Pregnant

Immunosupressed

Elderly with multiple chronic illnesses and polypharmacy.

Children.

I wonder how many of the people that died received Tamiflu?

8 May 2009: MHRA authorises temporary distribution of unlicensed medicine

In accordance with Article 5(2) of Directive 2001/83/EC on the Community Code relating to Medicinal Products for Human Use, in response to the confirmed spread of influenza virus the Secretary of State for Health has temporarily authorised the distribution of unlicensed oseltamivir powder and an unlicensed oral liquid formulation of oseltamivir for administration to infants under 1 year of age in the prevention or treatment of influenza. The Medicines for Human Use (Marketing Authorisations etc) Regulations 1994 and the Medicines for Human Use (Manufacturing, Wholesale Dealing and Miscellaneous Amendments) Regulations 2005 have been amended.

Follow this link to the UK MHRA (Medicines and healthcare products regulatory agency) ie the agency that review clinical trial data and grant drug licenses.

http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON054506&RevisionSelectionMethod=Latest

They say that side effects and "clinically significant drug interactions" are quite rare.

I saw this today-suspected interaction with warfarin (coumadin).They say it may be the virus that is affecting the INR.

http://living.aol.co.uk/health/warning-over-tamiflu-stroke-risk/article/20090819035826527394?icid=main|main|dl1|link4|http%3A%2F%2Fliving.aol.co.uk%2Fhealth%2Fwarning-over-tamiflu-stroke-risk%2Farticle%2F20090819035826527394

Also interesting to look at the curret=nt clinical trials for the vaccine

http://clinicaltrials.gov/ct2/results?term=H1N1

Seems they are all phase 2 studies-so they are measuring safety and efficacy rtaher than just efficacy-so little safety data available yet

Some are adult studies some paeds.

None of the trials are due to finish before Spring next year

The exclusion criteria are fairly similar (if not completely the same) in all the studies

Some that are particularly interesting are

1.Pregnancy

2.Certain psychiatric illnesses of medications

3.Immunosuppresion including steroid inhalers

4.History of GB.

So if these groups of people are excluded from the studies,even if they did an interim safety analysis,there will not be any data available for these groups of people.

oramar · Aug 19, 2009

It is a risk benefit analysis we need.I need to know the risk of dying from swine flu, the risks of the vaccine (which I doubt there is enogh data on) and the risk of dying or bring severely disabled from GB or any other side effect.
As the vaccine is only know being given to humans there will not be enough safety or efficacy data available before they introduce mass vaccination programmmes.
I wonder how these death rates compare to the usual flu death rates- need to be mortality rates not just numbers of deaths.700 deaths in the US is a drop in the ocean.We also need to know the demographics of these people who are dying ie
Pregnant
Immunosupressed
Elderly with multiple chronic illnesses and polypharmacy.
Children.
I wonder how many of the people that died received Tamiflu?
8 May 2009: MHRA authorises temporary distribution of unlicensed medicine
In accordance with Article 5(2) of Directive 2001/83/EC on the Community Code relating to Medicinal Products for Human Use, in response to the confirmed spread of influenza virus the Secretary of State for Health has temporarily authorised the distribution of unlicensed oseltamivir powder and an unlicensed oral liquid formulation of oseltamivir for administration to infants under 1 year of age in the prevention or treatment of influenza. The Medicines for Human Use (Marketing Authorisations etc) Regulations 1994 and the Medicines for Human Use (Manufacturing, Wholesale Dealing and Miscellaneous Amendments) Regulations 2005 have been amended.
Follow this link to the UK MHRA (Medicines and healthcare products regulatory agency) ie the agency that review clinical trial data and grant drug licenses.
http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON054506&RevisionSelectionMethod=Latest
They say that side effects and "clinically significant drug interactions" are quite rare.
I saw this today-suspected interaction with warfarin (coumadin).They say it may be the virus that is affecting the INR.
http://living.aol.co.uk/health/warning-over-tamiflu-stroke-risk/article/20090819035826527394?icid=main|main|dl1|link4|http%3A%2F%2Fliving.aol.co.uk%2Fhealth%2Fwarning-over-tamiflu-stroke-risk%2Farticle%2F20090819035826527394
Also interesting to look at the curret=nt clinical trials for the vaccine
http://clinicaltrials.gov/ct2/results?term=H1N1
Seems they are all phase 2 studies-so they are measuring safety and efficacy rtaher than just efficacy-so little safety data available yet
Some are adult studies some paeds.
None of the trials are due to finish before Spring next year
The exclusion criteria are fairly similar (if not completely the same) in all the studies
Some that are particularly interesting are
1.Pregnancy
2.Certain psychiatric illnesses of medications
3.Immunosuppresion including steroid inhalers
4.History of GB.
So if these groups of people are excluded from the studies,even if they did an interim safety analysis,there will not be any data available for these groups of people.

It is true that the data that would make it possible for you to make a really educated decision will not be ready till long after that flu has swept thru and done what ever it is going to do. You will have to decide based on incomplete stats. It is up to you and everyone else to read what ever is avaliable and decide. If you decide yes or no it is fine with me. I hear some talk of forced vaccination for HCW, I am totally against that.

indigo girl · Aug 22, 2009

brazil: "at least" 488 deaths

http://crofsblogs.typepad.com/h5n1/2009/08/brazil-at-least-488-deaths.html

via folha online, more bad news: estados confirmam mais 81 mortes por gripe suína e total chega a 488 no país.states confirm 81 more swine flu deaths and the national total reaches 488. excerpt, with my translation:
as secretarias de saúde de são paulo, paraná, rio e rio grande do sul confirmaram nesta sexta-feira, ao todo, mais 81 mortes em decorrência da gripe suína --a gripe a (h1n1). somente em são paulo, o total de óbitos saltou de 134 --conforme balanço do último dia 11-- para 179 nesta sexta-feira. com as confirmações, o número de mortes no país sobe para, ao menos, 488.
this friday the health secretariats of são paulo, paraná, rio and rio grande do sul confirmed 81 more swine flu deaths. in são paulo, the death total jumped from 134 on august 11 to 179 today. with these reports, the number of deaths in the country has risen to at least 488.
i'm getting a little upset about this. a large country (183,000,000 people) is suffering a serious public-health crisis, and the rest of the world is studiously ignoring it.
the world health organization isn't suggesting, tactfully or otherwise, that we might want to pay attention to brazil's experience before we repeat it. the major english-language news sources like the new york times and the guardian say little or nothing about brazil.
as for the rest of latin america, our apathy is even worse. the english-language media of north america and europe should be ashamed of themselves.

tencat · Aug 22, 2009

Brazil and the rest of Latin America have a high proportion of very poor people with limited access to quality health care. Living conditions coupled with limited access to quality health care facilities probably has a lot to do with their higher death rate from this flu. Not that we don't have to worry about it, I think we do. But I don't think that what's happening in Brazil is representative of what will happen here. It's possibly more helpful to the US and Canada to look at what's happening in Australia and New Zealand during this flu season to somewhat gauge what might happen during ours.

oramar · Aug 22, 2009

Brazil and the rest of Latin America have a high proportion of very poor people with limited access to quality health care. Living conditions coupled with limited access to quality health care facilities probably has a lot to do with their higher death rate from this flu. Not that we don't have to worry about it, I think we do. But I don't think that what's happening in Brazil is representative of what will happen here. It's possibly more helpful to the US and Canada to look at what's happening in Australia and New Zealand during this flu season to somewhat gauge what might happen during ours.

I wonder what is going on in Australia and New Zealand at the moment? Haven't heard anything out of there in a while. Last time I heard they were having a pretty good outbreak. There was that post by Indigo on the 19th that said Australia was getting ready for mass vacination but it said nothing about state of flu outbreak.

indigo girl · Sep 1, 2009

http://crofsblogs.typepad.com/h5n1/2009/08/brazil-paraná-state-extends-removal-of-pregnant-civil-servants.html

Brazil: Paraná state extends removal of pregnant civil servants
Via Folha Online: Paraná prorroga afastamento de servidoras grávidas por causa da gripe suína. [Paraná extends distancing of pregnant civil servants because of swine flu]
To summarize the story: Civil servants who are pregnant will be kept from public contact until September 14. The state of Paraná has had 4,931 H1N1 cases, including 285 pregnant women. One hundred and ninety-five persons have died in the state, including 20 pregnant women.

indigo girl · Sep 1, 2009

http://crofsblogs.typepad.com/h5n1/2009/09/brazil-more-numbers-confusion.html

Brazil has the highest number of swine flu related deaths in the world thus far.

Brazil: More numbers confusion
Via Xinhua: Brazil reports highest death toll of A/H1N1 flu in world. Excerpt:
Brazil's A/H1N1 flu death toll reached 584 on Wednesday, making it the highest in the world, according to the health authorities.
Brazil's Health Ministry said the fatality rate of the virus in the country was only the seventh highest in the world despite the high death toll.
The ministry also said the number of confirmed A/H1N1 flu cases, which stood at 5,206, decreased in the past two weeks, indicating that the incidence of the disease may be falling in the country.
Evidently the federal and state health authorities still can't harmonize their statistics. Folha Online offers two swine-flu maps today, with different numbers: 557 for the federal estimate, 576 for the states' estimates. Before the Brazilian media stopped talking about numbers, the total seems to have been about 600 or a bit higher. Your guess is as good as mine.

indigo girl · Sep 9, 2009

Brazil: 719 Deaths

http://crofsblogs.typepad.com/h5n1/2009/09/brazil-719-deaths.html

Earlier today I estimated 722 H1N1 deaths in Brazil. But a story in Folha Online--Número de mortos pela gripe suína chega a 121 no Rio Grande do Sul--says the new total, according to state-supplied data, is 719. The federal tally up to August 29 is 657. Some of these deaths may have occurred days or even weeks ago, and had to await testing to be confirmed as caused by H1N1.

oramar · Sep 9, 2009

I think it is giving a preview of what it is going to do in third world countries. Just think what it will do in countries with much higher pregnancy rates and no medical care for mothers.