Pandemic Flu

[InTheBlack]

HiB vaccine is not on the recommended list for adults.

Can someone direct me to a military document outlining why it is administered & what the dosage/schedule is?

AFAIK one dose is used on adults vs a course of 3 pediatric, but I can find no data on whether it is a different amount or just one dose of the pediatric.

HiB is still in short supply, and convincing them to give it to an adult may be difficult.

HiB is often mixed with some other pediatrics; is there anything in the others generally contraindicated for adults?

[temsmedic]

Originally Posted by Snaquebite

Here's an information paper my parent company released today. while not a medical company, they make probably the best respirators and SCBA products around.

[ATTACH]Info Paper[/ATTACH]

Since you work for that company, I'd like to see what your thoughts are on using something like the 3M Half Facepiece respirator. I strongly suspect that any of the standard hospital type masks, within minutes, are so saturated with water that the only way anyone inhales is from around the sides of the mask. The tiny exhalation port on some of the masks is so small, I suspect it isn't much better.


http://solutions.3m.com/wps/portal/3...beF3RH7CD92Ngl

These masks aren't certified for medical use, but if they fit well, I suspect that they are probably better than a saturated mask. They would certainly be more likely to be used. They may also still be found locally.

Also, it is important to remember that you'll need some dorky safety glasses. If the virus containing particle hits the mucous membranes of the eye, you'll be infected also.

[Snaquebite]

I work for the Ballistics side of the house for MSA (Paraclete) so can't offer up much on your question. I did forward it to one of our reps in that department.

[incarcerated]

Originally Posted by temsmedic

Since you work for that company, I'd like to see what your thoughts are on using something like the 3M Half Facepiece respirator. I strongly suspect that any of the standard hospital type masks, within minutes, are so saturated with water that the only way anyone inhales is from around the sides of the mask. The tiny exhalation port on some of the masks is so small, I suspect it isn't much better.


http://solutions.3m.com/wps/portal/3...beF3RH7CD92Ngl

These masks aren't certified for medical use, but if they fit well, I suspect that they are probably better than a saturated mask. They would certainly be more likely to be used. They may also still be found locally.

Also, it is important to remember that you'll need some dorky safety glasses. If the virus containing particle hits the mucous membranes of the eye, you'll be infected also.

temsmedic,
our mfgr training on N95s was that they have a two hour working life in mild environments before saturation. A P100 or half face mask w/ replaceable cartridges will provide a much better fit and seal to the face, while filtering to 99.5%, rather than the N95's 95% filtration performance. The P100s were rated for a six hour working life in a mild environment. IMHO, the N95's chief virtue is that it is cheap. OTOH, an N95 is better than nothing.
Procedure masks (and those things that you see the people in Mexico wearing), of course, are intended for the containment of droplets and particles emitted from an infected wearer, not for filtration.

[albeham]

Local news is carrying that there are 6 cases that are suspected to be swine flu, where ID'ed here in Maryland. All 6 cases the person(s) went to Mexico, or have contact with someone that was in Mexico. All are at home recovering.





Are the daily reported case on the decrease in Mexico?


AL

www.FOXBALTIMORE.COM

[Richard]

They've traced the origins of this to a kid in Mexico - he's doing fine - it'll be interesting to see what they eventually find out.

I'm surprised the Goracle crowd hasn't been on the air claiming it's all due to global warming or some such thing.

Richard's $.02

[Peregrino]

Originally Posted by incarcerated

Procedure masks (and those things that you see the people in Mexico wearing), of course, are intended for the containment of droplets and particles emitted from an infected wearer, not for filtration.

Thanks for reiterating this point - it's something the average "consumer" looking for the cheapest alternative either doesn't know or ignores because it's "just a precaution". I haven't checked lately (already got mine!) but I've found http://www.safetycompany.com/index.php to be a good company to deal with for other "safety" supplies. Personally, I got my last batch of N95 masks from Lowe's; AO Safety is OTC, reliable and the convenience/instant gratification plus not paying S&H made up for the price difference.

[temsmedic]

Originally Posted by InTheBlack

HiB vaccine is not on the recommended list for adults.

Can someone direct me to a military document outlining why it is administered & what the dosage/schedule is?

AFAIK one dose is used on adults vs a course of 3 pediatric, but I can find no data on whether it is a different amount or just one dose of the pediatric.

HiB is still in short supply, and convincing them to give it to an adult may be difficult.

HiB is often mixed with some other pediatrics; is there anything in the others generally contraindicated for adults?

Haemophilus influenzae type b (Hib) is predominantly a disease of children. I don't believe that the Hib vaccine has any place in pandemic preparedness for adults.

A substantial portion of those that died from the 1918-19 pandemic died from bacterial infection, after their lungs were damaged by the virus, and the secondary "immune storm" that is believed to have led to the death of so many young patients. I DO believe that the Pneumococcus vaccine is an important part of pandemic preparedness. I've got a multi-dose vial due to arrive shortly.

http://www.cdc.gov/vaccines/pubs/vis...ds/vis-ppv.pdf

I also would respectfully disagree with the post that implied that the standard influenza vaccine wasn't necessary. The '08-09 influenza vaccine did have a H1N1 component. It doesn't cover the current H1N1, but it could have. I work in an ER, and my immune system is constantly being challenged. I firmly believe that I have far fewer infections/year than I should because my immune system is revved up to a higher level. I strongly support the yearly flu vaccine [30-40k dead/yr from the seasonal influenza].

I found the Vitamin D papers very interesting. I had been ignoring them because they aren't relevant to Emerg Med, but I'll get my sun lamp ready if the big one hits. [we don't see the sun up here in the NW corner of the country]

This was posted on a local sailing board today.. I have not verified the reccomendations..but it is worth sharing.

Quote:
Dr. Marcus Gitterle, M.D.600 N Union Ave
Christus Santa Rosa Hospital - New Braunfels
New Braunfels, TX 78130
Specialties

·Family Practice
·Emergency Medicine


After I returned from a public health meeting yesterday with community leaders and school officials in Comal County and Hays County, Heather suggested I send an update to my patients in the area, because what we are hearing privately from the CDC and Health Department is different from what you are hearing in the media. Some of you know some of this, but I will just list what facts I know.

- The virus is infectious for about 2 days prior to symptom onset

- Virus spreads more than 7 days after symptom onset (possibly as long as 9 days) (this is more unusual than ordinary flu)

- Since it is such a novel (new) virus, there is no "herd immunity," so the "attack rate" is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatic. That is much higher than seasonal flu, which averages 10-15%. The "clinical attack rate" estimation from CDC and WHO may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of this to those outside of the medical fields.

- The virulence (deadliness) of this virus is as bad here as in Mexico, and there are folks on ventilators here in the US, right now. This has not been in the media, but a 23 month old in Houston is fighting for his life, and a pregnant woman just south of San Antonio is fighting for her life. In Mexico, these folks might have died already, but here in the US, folks are getting Tamiflu or Relenza quickly, and we have ready access to ventilators. What this means is that within a couple of weeks, regional hospitals will likely become overwhelmed.

- Some of the kids with positive cases in Comal County have had more than 70 contacts before diagnosis as a minimum figure.

- There are 10-25 times more actual cases (not "possible" cases -- actual), than what is being reported in the media. The way they fudge on reporting this is that it takes 3 days to get the confirmatory nod from the CDC on a given viral culture, but based on epidemiological grounds, we know that there are more than 10 cases for each "confirmed" case right now.

- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.

- They are advising President Obama to declare an emergency sometime in the next 72-96 hours. This may not happen, but if it doesn't, I will be surprised. When this happens, all public gathering will be cancelled for 10 days minimum.

- I suggest all of us avoid public gatherings. Outdoor activities are not as likely to lead to infection. It is contained areas and close contact that are the biggest risk.

- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed for law enforcement and first responders as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.

- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER's south of here are becoming overwhelmed today-- and I mean that -- already. It is coming in waves, but the waves are getting bigger.

- It appears that this flu produces a distinctive "hoarseness" in many victims. The symptoms, in general, match other flu's; namely, sore throat, body aches, headache, cough, and fever. What is not too common in regular flu cycles is vomiting and diarrhea which seems to be associated with this, further dehydrating victims. Some have all these symptoms, while others may have only one or two.

- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.

- Oscillococinum, a homeopathic remedy, has been vindicated as quite effective in a large clinical trial in Europe, with an H1N1 variant. You can buy this at Hill Country Natural Foods, or the Wimberley Pharmacy.


I will try to keep everyone posted if I have any new information. Meanwhile, don't be afraid, stay informed and try to avoid infection. The fewer people infected the easier it will be for our public officials to manage it.
If any of my patients become ill, or suspect infection, call the office, do not come without calling and DO NOT go to the ER. If one member in a family is identified all would be given the Tamiflu or Relenza (that is normal course of action) if there is enough distributed to fill prescriptions. Public health stated that one family member identified or suspected to have contracted the flu it will require the whole family to be ‘quarantined’ in their own home until enough time has passed for the remaining household to have contracted it or be considered infection free ( 7 to 10 days per person). As another suggestion, if any member of the family is on routine medication- fill those prescriptions now. Have plenty fluids, Motrin, soups, etc available and make contingency plans in case your family is affected.

Marc

http://www.who.int/csr/disease/swineflu/en/index.html

[Saoirse]

AM, thanks for sharing this with us. But I think Dr. Gitterle needs to make sure he doesn't sit on the edge of invoking hysteria. Even as I listen to the press, their tone is on the edge of hysteria. However, at this point we only have 109 confirmed cases (out of a population of 304,059,724 - Jul 2008). One confirmed death, the poor lil guy in Texas (a Mexican national visiting our country). I am not saying there aren't more cases; however, that will be up to health officials and the CDC to confirm and release that information. This doctor's posting could have been worded much more carefully. As a health care professional, he has an obligation to the public ...YES...but there are ways to go about it. If I weren't a learned person (who endeavors to stay as informed as possible) I would be freaking out right now. Just my $.02

- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.
Level of influenza pandemic alert raised from phase 4 to 5 --29 April 2009 -- Based on assessment of all available information and following several expert consultations, Dr Margaret Chan, WHO's Director-General raised the current level of influenza pandemic alert from phase 4 to 5. She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities. http://www.who.int/en/



- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed for law enforcement and first responders as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.
I sure would love to know where he is getting his information. Making blanket statements like this can induce an even bigger problem than people getting the flu....mass hysteria is not fun to deal with!

A friend of mine gave me this little tidbit to share and while the numbers are broad (these are estimations) it does help put things in perspective:
http://www.flufacts.com/impact/statistics.aspx
INFLUENZA STATISTICS
The flu isn’t always thought of as a serious or life-threatening illness. Because of the dangers and complications it can have in older people, children, and people with health problems, the perception of flu severity is changing.

In the U.S., an estimated 25–50 million cases of the flu are currently reported each year — leading to 150,000 hospitalizations and 30,000–40,000 deaths yearly. If these figures were to be estimated incorporating the rest of the world, there would be an average of approximately 1 billion cases of flu, around 3–5 million cases of severe illness, and 300,000–500,000 deaths annually.

Flu-related deaths can result from pneumonia and from exacerbations of cardiopulmonary conditions and other chronic diseases. Deaths of older adults account for more than 90% of deaths attributed to pneumonia and influenza.

[BMT]

A member of the security advance team for President Obama's recent trip to Mexico is suspected of having contracted the swine flu, a senior White House official says.

BMT

[albeham]

Has anyone heard of this :


- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.


How sound is this?


AL

[csquare]

AM, thanks for the post, and I'm not killing the messenger.....but i'm calling BS on some of his facts. This "doctor" and I use the term loosely, is sparking hysteria. New Braunfels is 13 miles from my house and currently they have maybe 3 probable cases of swine flu. San Antonio, a top 10 in population, may have 1 probable case.
So this knucklehead saying New Braunfels is past Stage/Phase 6 of the CDC is full of crap! If that was true, the local SA newspaper would have that on the front page and it would be in bold letters. Instead, it talks about how the schools are closed in New Braunfels/ Comal county until 11 May and how kids are going to skateboard parks and still socializing in large groups else where.
1000s of people die every year from regular influenza, we have 1 death of a young Mexiacn national in a Texas hospital. I don't see this type of hysteria with any other flu.

[doctom54]

Originally Posted by albeham

Has anyone heard of this :


- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.


How sound is this?


AL

Here is the latest data on it in "critically ill" patients from www.medscape.com

N-acetyl-cysteine

"N-acetyl-cysteine, a precursor of glutathione, is a sulfhydryl donor that has been used extensively for preventing hepatocellular damage from acetaminophen toxicity. Due to its detoxifying effects, N-acetyl-cysteine has been studied in critically ill patients.[18] Although intracellular levels of glutathione increased with the administration of N-acetyl-cysteine, there was no difference seen in the total antioxidant potential, length of inotropic support, mechanical ventilation, or length of intensive care unit stay. Some study limitations were noted, including the low dose of N-acetyl-cysteine used (much lower of a dose when compared to the dose used in patients with acetaminophen toxicity). The use of N-acetyl-cysteine cannot be recommended at this time."

It is a mucolytic that is also used to treat acetaminophen overdoses.

NOTHING I've seen in the legitimate medical literature has any effect on H1N1 (the politically correct term for swine flu) except the prescription antiviral drugs oseltamivir and zanamivir

[albeham]

doctom54

Thank you..

AL