John C Kim and International Adoption Video

Thursday, April 30, 2009

Sleep Apnea Linked to Memory Loss - ; early alzheimers ? for osa pts

Wednesday, June 11, 2008; 12:00 AM

WEDNESDAY, June 11 (HealthDay News) -- People with sleep apnea show tissue loss in brain regions that help store memory, a University of California, Los Angeles (UCLA) study shows.

"Our findings demonstrate that impaired breathing during sleep can lead to serious brain injury that disrupts memory and thinking," principal investigator Ronald Harper, a professor of neurobiology at the David Geffen School of Medicine at UCLA, said in a prepared statement.

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Happiness 101 - New York Times; it's the hip thing in colleges, and it's actually useful I think

Happiness 101

Published: January 7, 2007

Correction Appended

One Tuesday last fall I sat in on a positive-psychology class called the Science of Well-Being — essentially a class in how to make yourself happier — at George Mason University in Fairfax, Va. George Mason is a challenge for positive psychologists because it is one of the 15 unhappiest campuses in America, at least per The Princeton Review. Many students are married and already working and commute to school. It’s a place where you go to move your career forward, not to find yourself.

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Face masks aren't a sure bet against swine flu - Lat; still it's a symbol that we're trying to do something, anything

Face masks aren't a sure bet against swine flu

Though sales have increased worldwide, the coverings weren't designed to protect wearers from an airborne virus. Health officials say their value is limited, at best.
By Shari Roan And Rong-Gong Lin II
April 30, 2009
Don't count on those disposable masks to protect you against swine flu.

Residents of Mexico City, as well as travelers to and from Los Angeles, have turned to mouth and nose protection of one type or another in recent days in an attempt to stop errant airborne viruses from entering their respiratory tract.

3M, a major producer of face masks and respirators, said that worldwide sales have increased significantly, and some Los Angeles pharmacies have reported selling out of masks

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Scientists see this flu strain as relatively mild - Los Angeles Times; difficult to extropolate,and mutation potential is the real danger

Scientists see this flu strain as relatively mild

BUt some good news to be eeked out.

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re updated clinician guidelines for kids cdc

Interim Guidance for Clinicians on the Prevention and Treatment of Swine-Origin Influenza Virus Infection in Young Children

April 28, 2009 7:00 PM ET

This document provides interim guidance for clinicians who are caring for young children with confirmed or suspected swine-origin influenza A (H1N1) virus infection.


Young children and swine-origin influenza virus (S-OIV)
Little is currently known about how this new S-OIV circulating in people may affect children. However, we know from seasonal influenza and past pandemics that young children, especially those younger than 5 years of age and children who have high risk medical conditions, are at increased risk of influenza-related complications.

Illnesses caused by influenza virus infection are difficult to distinguish from illnesses caused by other respiratory pathogens based on symptoms alone.  Young children are less likely to have typical influenza symptoms (e.g., fever and cough) and infants may present to medical care with fever and lethargy, and may not have cough or other respiratory symptoms or signs.

Influenza-associated deaths among children, while uncommon, do occur with seasonal influenza with an estimated average of approximately 92 influenza-related pediatric deaths each year in the United States.  Some deaths in children have been associated with co-infection with influenza andStaphylococcus aureus, particularly methicillin resistant S. aureus (MRSA).

Symptoms of severe disease may include:

  • Apnea
  • Tachypnea
  • Dyspnea
  • Cyanosis
  • Dehydration
  • Altered mental status
  • Extreme irritability

Treatment and prevention of swine flu

No vaccine is currently available to prevent S-OIV infection and it is thought unlikely that seasonal influenza vaccine will provide protection against this new virus.  While not a substitute for a vaccine, a number of other interventions may be used to decrease the risk of infection and possible complications from S-OIV infection in children.

Influenza antiviral medications for use in children age 1 year and older

Antiviral treatment with oseltamivir or zanamivir is recommended for children with confirmed or probable S-OIV infection. See for case definitions.  Empiric antiviral treatment is also recommended for children with suspected cases of swine influenza A (H1N1) virus infection, especially those with severe illness. Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset.  Recommended duration of treatment is five days. Recommendations for use of antivirals may change as data on antiviral effectiveness, side effects and antiviral susceptibilities become available.  Antiviral doses recommended for treatment of S-OIV infection in children 1 year of age or older are the same as those recommended for seasonal influenza (Table 1).

Table 1. Recommended doses of zanamivir and oseltamivir antiviral medications for the treatment and prevention of influenza in children 1-18 years-old


Antiviral agent Age group (yrs)
1-6 7-9 10-12 13-18
Zanamivir* Treatment, influenza A and B N/A† 10 mg (2 inhalations) twice daily 10 mg (2 inhalations) twice daily 10 mg (2 inhalations) twice daily
Chemoprophylaxis, influenza A and B Ages 1-4
Ages 5-9
10 mg (2 inhalations) once daily
10 mg (2 inhalations) once daily 10 mg (2 inhalations) once daily
Oseltamivir Treatment†, influenza A and B Dose varies by child's weight§ Dose varies by child's weight§ Dose varies by child's weight§ 75 mg twice daily
Chemoprophylaxis, influenza A and B Dose varies by child's weight¶ Dose varies by child's weight¶ Dose varies by child's weight¶ 75 mg/day
Duration of Treatment Treatment Recommended duration for antiviral treatment is 5 days.
Chemoprophylaxis Recommended duration is 10 days after the last known exposure.

Children Younger than 1 Year of Age

Children less than one year of age are at higher risk for complications associated with seasonal human influenza virus infections compared to older children, and the risk of influenza complications is especially high for children less than 6 months of age. The characteristics of human infections with S-OIV are still being studied, and it is not known whether infants are at higher risk for complications associated with S-OIV infection compared to older children.  However, children less than 1 year old are known to be at increased risk of complications from seasonal influenza infection and during previous pandemics.  Limited safety data on the use of oseltamivir (or zanamivir) is available from children less than one year of age, and oseltamivir is not licensed for use in children less than 1 year old.  Available data comes from use of oseltamivir for treatment of seasonal influenza. However, these data suggest that severe adverse events are rare, and the Infectious Diseases Society of America recently noted that “… limited retrospective data on the safety and efficacy of oseltamivir in this young age group have not demonstrated age-specific drug-attributable toxicities to date.”.

Because infants typically have higher rates of morbidity and mortality from influenza compared to healthy older children, infants with S-OIV infections may benefit from treatment using oseltamivir.  Oseltamivir use for children less than 1 year old was recently approved by the FDA under an Emergency Use Authorization (EUA), and dosing for these children is age-based. (Table 2).

Table 2.  Recommended doses of oseltamivir antiviral medication for the treatment of S-OIV influenza for children less than 1 year of age.

Age Recommended treatment dose for 5 days
<3 months 12 mg twice daily
3-5 months 20mg twice daily
6-11 months 25 mg twice daily

Use of fever-reducing medications in children

Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of swine influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.

Antiviral Chemoprophylaxis

For antiviral chemoprophylaxis of S-OIV infection, either oseltamivir or zanamivir are recommended for children 1 year of age or older (Table 1). Oseltamivir can be used for chemoprophylaxis under the EUA for children less than 1 year-old (Table 3). Under this EUA, chemoprophylaxis is not recommended for infants less than 3 months old unless the situation is judged to be critical. Duration of antiviral chemoprophylaxis post-exposure is 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. For emem Posted via email from wholefamilyjoy's posterous

Wednesday, April 29, 2009

How to Fix Health Care: Four Weeds to Remove - TIME

Doctor's View

How to Fix Health Care: Four Weeds to Remove

By Dr. Scott Haig Thursday, Apr. 30, 2009
Dennis Degnan / Corbis


Scores of agencies police doctors. Thousands of people make their living doing it. They give us yearly tasks that doctors, on pain of ending our careers, absolutely must do: 10-page re-appointment forms, written exams, blood tests, physicals. Every hospital we work in, every HMO we sign up with, does this too. Every year. Every 10 years we have to take our Boards again (Imagine if lawyers had to pass the bar exam again, every decade until they quit.) And there are yearly federal and state licensures and safety exams, fire exams, infection control exams, malpractice insurance exams, queries about crimes we're assumed to have committed and disabilities we must prove we have not developed. (See the top 10 medical breakthroughs of 2008.)

Of course we need to know our doctors are healthy and competent. But the system now is redundant and takes up way too much of our time. Many doctors believe that it's largely for the benefit of the regulators themselves. A unified federal credentialing agency could pull those weeds right out and leave the country with five to ten percent more doctoring at almost no cost.


From where we sit (and doctors think we are the ones who are in the best position to know what malpractice means and when it happens) there is little or no correlation between doing bad stuff and getting sued. We also observe that none of the countries whose medical systems are held up to us as better than ours have any malpractice system at all. And that the cost of defensive medicine is enormous — much higher than published estimates.

We're also much less likely to do charity work when we can lose our houses in the process. This last is a serious problem for the uninsured; most doctors are pretty decent folk who actually like what they have spent their lives learning to do; they really wouldn't mind doing some free work. As a group though, we tend to be quite risk averse. We worry about the downside — it's where we live. Our insurance premiums can be crushing: it's $240,000 a year for a neurosurgeon in New York now. One way or another that's an expense that gets passed down to all. Can our country afford this luxury at this time? Want more medical care for less money? Get the lawyers out of our garden, and find a better way to sanction bad practices without damaging everyone.

The Medical Billing Industry:

It costs the typical doctor about 10%, right off the top, to collect our fees from the HMOs and other insurance companies we have to deal with. This is due to the ultra-complex set of rules and regulations those companies have established to "control costs" (read: to pay us less while their executives take home more) and the billing staffs we have to hire to deal with them. This money does nothing for patients; it's a healthcare expense that produces no healthcare. It could easily be eliminated with simple, intelligent, centralized payment rules. The result would be at least 5% more care for the money.

Computerizing Everything:

It's a complex topic that boils down to this: if we who do the medicine thought more computers would save us money we'd buy them ourselves. In fact, sometimes we do. But the federal mandate to computerize and centrally connect the entire country's medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from their costs to us, electronic records are time consuming — a constant distraction from patient care. They also put doctors on a slippery ethical slope; it's pretty easy to bill more for the same services with a good EMR program. They are a dangerous weed being advertised as fertilizer.

There are others: our byzantine system of Continuing Medical Education, medical advertising, the HMOs themselves and our top-heavy system of hospital administration to name a few. More on these during growing season.

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Containing Flu Is Not Feasible, Specialists Say -; definition of pandemic

Containing Flu Is Not Feasible, Specialists Say

Many countries are still ignoring that advice. The globe is a confusing welter of bans, advisories and alerts on some pork and some people.

On Wednesday, Homeland Security Secretary Janet Napolitano was heavily pressed in Congressional hearings to ignore the advice and close the border with Mexico. She defended her decision not to do so, saying it “would be a very, very heavy cost for what epidemiologists tell us would be marginal benefit.”

President Obama defended it too, telling a reporter that it would be “akin to closing the barn door after the horse is out.”

Experts on the global movement of flu say Dr. Fukuda, Ms. Napolitano and Mr. Obama are right. The world, they say, must bow to the inevitable: closing borders would not only fail to stop the virus, but would also cause economic collapse and possibly add to the death rate.

“But it’s wrong to think we’re throwing up our hands and saying ‘Let ’er rip and let’s hope for the best,’ ” said Dr. Martin S. Cetron, director of global migration and quarantine for the Centers for Disease Control and Prevention in Atlanta. “This has all been in the national pandemic flu plan since 2007.”

Closing borders is dangerous because many goods needed in a pandemic are made abroad, said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, including most masks, gowns and gloves, electrical circuits for ventilators and communications gear, and pharmaceutical drugs and the raw materials to make them. (For example, most suppliers of shikimic acid, the base ingredient in the antiviral drug Tamiflu, are in China.)

“You cut those off and you cripple the health care system,” he said. “Our global just-in-time economy means we are dependent on others.” Much of our food is from overseas. “A Kellogg’s Nutri-Grain bar has ingredients from nine countries in it,” he noted.

The fallback position, experts said, is mitigation, the use of “nonpharmaceutical measures.” They include personal ones like washing hands and wearing a mask, occupational ones like working from home or arranging care for children who are sick or whose schools close, neighborhood-level ones like closing theaters, museums or restaurants, and metropolitan-wide ones like shutting a school system or canceling a major league ballgame.

The three goals, Dr. Cetron said, can be plotted on the graph of new infections called the epidemic curve. “You want to shift the curve to the right, blunt the peaks and squash the area under them,” he said.

Moving right is slowing new transmissions until the arrival of hot summer weather, which is unfriendly to flu, and to buy time — the 16 to 20 weeks it takes to make a new vaccine.

Blunting the peaks of new cases decreases demand on hospitals, so patients do not have to be triaged off ventilators to die because others are waiting.

Ventilators cost $30,000 each, though models as cheap as $100 are stockpiled for pandemics. But patients whose lungs are delicate or mucus-jammed need professional monitoring. And fewer people infected per day slows the multiplier effect. Each one usually infects two or three more.

For the World Health Organization, mitigation is an about-face from the strategy that has contained the H5N1 avian flu, which has caused fewer than 300 deaths. That flu’s first appearance in 1997 was contained by killing every chicken in Hong Kong. Since then, each time a cluster appears, the public health authorities try to cull all the local poultry, vaccinate birds in a large ring around that, and drop the “Tamiflu blanket” on people — dosing everyone in the area.

The 1976 swine flu was also beaten by containment, said Dr. Pascal J. Imperato, dean of the school of public health at the State University of New York Downstate Medical Center, who was the chairman of the New York City Swine Flu Task Force in 1976. The 230 cases were all among soldiers at Fort Dix, N.J., “and they were all just held within that base,” he said. “They had no external contacts. One died, the rest had mild infection.”

Experts feared that flu was a re-emergence of the 1918 strain and that it would come back with a vengeance in the winter. They vaccinated 40 million people, but it never did come back.

In the 1918 Spanish flu, American cities that reacted quickly had fewer deaths than those that acted slowly and used fewer precautions, according to a 2007 study of 43 cities by researchers from the University of Michigan and the Centers for Disease Control. The most common combination was school closings and bans on public gatherings, which in 34 cities lasted for a median of four weeks. All those cities except New York, Chicago, and New Haven closed their schools; the median time was six weeks.

Deaths per 100,000 population ranged from 210 for Grand Rapids, Mich., to 807 for Pittsburgh.

Although some scientists and historians have argued that those measures just delayed deaths that later happened anyway, Dr. Cetron, one of the authors of the 2007 study, denied it.

“There’s no evidence of that,” he said. “Cities that acted early and layered on different interventions did well.”

Many people do not realize how long measures take to work. A child can shed flu virus for 10 days, Dr. Imperato said, an adult for 5.

Some experts are cautiously optimistic. A computer simulation of this outbreak released Wednesday by a team from Northwestern University projected a worst-case scenario, meaning no measures have been taken to combat the spread. It predicted a mere 1,700 cases in the United States four weeks from now.

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How Much Sleep Do You Really Need? - TIME


How Much Sleep Do You Really Need?

By Laura Blue Friday, Jun. 06, 2008
Woman sleeping



TIME talks to Daniel Kripke, of California's Scripps Clinic Sleep Center, about how a night's sleep can prolong

#151;or shorten

#151;your life

Download | Subscribe

Q: How much sleep is ideal?

A: Studies show that people who sleep between 6.5 hr. and 7.5 hr. a night, as they report, live the longest. And people who sleep 8 hr. or more, or less than 6.5 hr., they don't live quite as long. There is just as much risk associated with sleeping too long as with sleeping too short. The big surprise is that long sleep seems to start at 8 hr. Sleeping 8.5 hr. might really be a little worse than sleeping 5 hr.

Morbidity [or sickness] is also "U-shaped" in the sense that both very short sleep and very long sleep are associated with many illnesses—with depression, with obesity—and therefore with heart disease—and so forth. But the [ideal amount of sleep] for different health measures isn't all in the same place. Most of the low points are at 7 or 8 hr., but there are some at 6 hr. and even at 9 hr. I think diabetes is lowest in 7-hr. sleepers [for example]. But these measures aren't as clear as the mortality data.

I think we can speculate [about why people who sleep from 6.5 to 7.5 hr. live longer], but we have to admit that we don't really understand the reasons. We don't really know yet what is cause and what is effect. So we don't know if a short sleeper can live longer by extending their sleep, and we don't know if a long sleeper can live longer by setting the alarm clock a bit earlier. We're hoping to organize tests of those questions.

One of the reasons I like to publicize these facts is that I think we can prevent a lot of insomnia and distress just by telling people that short sleep is O.K. We've all been told you ought to sleep 8 hr., but there was never any evidence. A very common problem we see at sleep clinics is people who spend too long in bed. They think they should sleep 8 or 9 hr., so they spend [that amount of time] in bed, with the result that they have trouble falling asleep and wake up a lot during the night. Oddly enough, a lot of the problem [of insomnia] is lying in bed awake, worrying about it. There have been many controlled studies in the U.S., Great Britain and other parts of Europe that show that an insomnia treatment that involves getting out of bed when you're not sleepy and restricting your time in bed actually helps people to sleep more. They get over their fear of the bed. They get over the worry, and become confident that when they go to bed, they will sleep. So spending less time in bed actually makes sleep better. It is in fact a more powerful and effective long-term treatment for insomnia than sleeping pills.

It obviously depends on person, but in general we don't get enough.

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re Class III at Willowcreek NorthShore.Wrapping UP Magnetic Families,Obstacles to Joy;grumpy kids,parental being over technique,can't give what

Wrapping up Magnetic Families, Whole Family JOY
Obstacles to Joy; 
Focus on Circumstances. How to avoid the Buzz kill flu.
Grumpy kids, Marriage as the second child.
Vicious cycles, virtuous cycles
Parental being over technique,
Let's talk about technique; WIN WIN;
Judo moves,
Pick your battles carefully, but when you have them, ALWAYS WIN.
It's ok to negotiate. 
What you sound like to your children when you are grumpy. 

Can't give what you don't have.Get it and don't settle.
An interview about the importance of touch. 
Eat from the banquet of JOY PRAXIS 
Making an action plan: Rest more, do less. 
Eat what you enjoy, Exercise more. 
Watch less TV, Make LOVE MORE; Gotcha. 
Focus on the now, not the woulda shoulda coulda.
Dream on, 
I say it again Rejoice, and Delight yourself in the Lord and He will Give you the Desires of your heart. 
Embracing a Savior, our Emmanuel. 

John C Kim MD and Thea N Kim, mother of 4 delicious children. 
Remember to invite your friends. 

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the Il recs are a bit dif from the natl cdc recs;they are rec suspec swine flu, stay home, but if kids under 5; should consider tx

April 29, 2009 


State Public Health Director Announces 9 Probable Cases of Swine Flu in Illinois  

Proclamation issued to ensure medicine and
medical supplies are readily available  

SPRINGFIELD, Ill. – Dr. Damon T. Arnold, Illinois Department of Public Health Director, announced there are currently nine probable cases of swine flu in Illinois: five in Cook County (all within the Chicago city limits), one in DuPage County, two in Kane County and one in Lake County. A probable case means the Illinois Department of Public Health (IDPH) has tested a specimen and found that it is positive for influenza A, but it could not be subtyped. The Department has shipped three of the nine probable cases to the Centers for Disease Control and Prevention (CDC) to perform final testing to confirm if the cases are positive for swine flu, and the other six will be shipped later day.

The federal government has declared a health emergency and identified a potential threat to the health and safety of the citizens of Illinois.  A Gubernatorial Proclamation issued by Governor Pat Quinn Tuesday allows for the mobilization of state assets, as the Governor deems necessary, to aid in the distribution of medical supplies and other actions needed to protect public’s health and safety.

“Our goals during this public health emergency are to quickly identify cases of swine flu and reduce the spread and severity of the illness,” said Dr. Arnold. “The Governor’s proclamation is not cause for alarm but simply allows us to be proactive and distribute medicines and medical supplies from the state and federal stockpiles to hospitals and local health departments across the state so they are available when they are needed.”

U.S. Health and Homeland Security officials have released a quarter of the country's Strategic National Stockpile (SNS) to be shipped to every state. Illinois is expecting to receive its shipment sometime this week. The SNS contains large quantities of medicine and medical supplies to protect the American public in the event of a public health emergency, such as the swine flu outbreak. Included in the SNS are antiviral drugs, Tamiflu and Relenza, as well as surgical masks, gloves and gowns.

Illinois has developed plans to receive and distribute SNS medicine and medical supplies to local communities as quickly as possible. Once the SNS reaches Illinois, approximately 200 Illinois National Guard members will repackage the supplies into smaller shipments and Illinois Department of Transportation trucks will distribute those shipments to state facilities in all areas of Illinois outside the City of Chicago. Chicago has its own stockpile and receives its own SNS from the federal government due to the size of population.

Once the smaller shipments reach state facilities across Illinois, they will then be distributed to local health departments and hospitals to be dispensed as needed. The Department will issue guidance on how medicine will be given out when it’s needed.

“The swine flu situation is rapidly evolving and we fully expect to see cases in Illinois.  The Department and its public health partners, including local health departments, hospitals and emergency departments, are on full alert to watch for possible cases.  We are prepared to act swiftly to assure early detection and to respond in the event a case or cases are identified to limit its spread,” said Dr. Arnold.

The Illinois Emergency Management Agency (IEMA) continues to closely monitor the developing situation and is taking steps to ensure response plans can be activated quickly if necessary. In addition to coordinating closely with Dr. Arnold, IEMA Director Andrew Velasquez, III has participated in several situation briefings with the Department of Homeland Security. IEMA alerted state agency liaisons to the State Emergency Operations Center (SEOC) of the developing situation over the weekend, and on Monday afternoon the liaisons met to discuss potential response actions. State emergency management officials are also in contact with local emergency management agencies throughout the state to make them aware of developments and ensure that they are prepared to deal with a potential flu outbreak in Illinois.

Dr. Arnold recommends people who have flu-like symptoms, fever with a cough or sore throat, should stay home for seven days after the onset of illness or at least 24 hours after the symptoms go away, whichever is longer. People with symptoms who wish to seek medical care should contact their health care provider by phone before going to a clinic, physician’s office or hospital. If someone is having difficulty breathing or shortness of breath, or are believed to be severely ill, they should seek immediate medical attention.

Dr. Arnold said the public should follow some common sense precautions to avoid getting sick or, if sick, infecting others:

  • Cover your nose and mouth with a tissue when you cough or sneeze. If you don’t have a tissue, cough or sneeze into your arm.
  • Wash your hands often with soap and water – especially after you cough and sneeze.  You can also use alcohol-based hand cleaners.
  • Avoid touching your eyes, nose or mouth – that’s how germs are spread.
  • If you get sick – stay home from work or school and limit your contact with other people to avoid infecting them. Parents should follow these same recommendations for their children.

The Department will continually update information on swine flu on its Web site at and also the Web site.

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Swine flu for parents by cdc
John C Kim MD
Sent telepathically from imind. A man So cutting edge,he sometimes falls off.

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re what to do when faced with high viral loads, Phil 4 v 6; Enjoy your life, your health, live the day very very well.


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CDC - Swine Influenza (Flu) | Interim Guidance for Clinicians on the Prevention and Treatment of Swine-Origin Influenza Virus Infection in Young Children

Interim Guidance for Clinicians on the Prevention and Treatment of Swine-Origin Influenza Virus Infection in Young Children

Bottom line, is that the paradigm has changed; we never have treated anyone under 1 yr ,basically these guidelines promote use of tamiflu or relenza in children down to 3 months, and preventative or prophylaxis down to that age. Uncharted waters.

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CDC -This is tip of iceberg, unfortunately in my opinion. THis is a very efficient transmitter, and my concern is how it will mutate.

Swine Influenza (Flu)

Swine Flu website last updated April 29, 11:00 AM ET

U.S. Human Cases of Swine Flu Infection
(As of April 29, 2009, 11:00 AM ET)
# of laboratory confirmed cases
New York City
91 cases
1 death
International Human Cases of Swine Flu Infection
See: World Health OrganizationExternal Web Site Policy.

The outbreak of disease in people caused by a new influenza virus of swine origin continues to grow in the United States and internationally. Today, CDC reports additional confirmed human infections, hospitalizations and the nation’s first fatality from this outbreak. The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S. Most people will not have immunity to this new virus and, as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks.

CDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus. Yesterday, CDC issued new interim guidance for clinicians on how to care for children and pregnant women who may be infected with this virus. Young children and pregnant women are two groups of people who are at high risk of serious complications from seasonal influenza. In addition, CDC’s Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak. The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

This is tip of iceberg, unfortunately in my opinion. THis is a very efficient transmitter, and my concern is how it will mutate.

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Swine Flu Vaccine May Be Months Away, Experts Say -

Swine Flu Vaccine May Be Months Away, Experts Say

And beyond the United States and a few other countries that also make vaccines, some experts said it could take years to produce enough swine flu vaccine to satisfy global demand.

Although production is much faster than would have been possible even a few years ago, it still may not be in time to avert death and illness if the virus starts spreading widely and becomes more virulent, some experts said.

In this country, the biggest problem is that despite years of effort, the country is still relying on half-century-old technology to make the flu vaccines.

Federal authorities have spent years and more than a billion dollars trying to shift vaccine production to a faster, more reliable method — one that involves growing the vaccine viruses in vats of cells rather than in hen’s eggs, the old technology. And there are numerous small companies developing totally new approaches that might allow for the production of huge volumes of vaccines in a matter of weeks.

But the cell-based production is not quite ready, and some of the newer techniques are not proven enough to satisfy many experts.

“Those are all great technologies, but it isn’t going to happen in time,” said Dr. Greg Poland, head of the vaccine research program at the Mayo Clinic.

Federal officials have not yet made a decision on whether the swine flu is enough of a threat to warrant vaccine production. But they are taking the initial steps.

A potential problem is that producing swine flu vaccine might interfere with production of the seasonal flu vaccine for next winter.

“We would have to most likely make a compromise,” Andrin Oswald, chief executive of the vaccine division at the drug maker Novartis, said in an interview.

But Robin Robinson, who runs the emergency preparation research program for the federal Department of Health and Human Services, said most manufacturers would have finished producing the bulk of seasonal vaccine by June.

If production of the swine flu vaccine were to start right after that, the first 50 million to 80 million doses would be available by September, Dr. Robinson said.

A full 600 million doses, enough to provide the required two shots for each American, could be finished by January. If immune stimulants called adjuvants were added to the vaccine, that could reduce the dosage needed by each person, allowing enough doses to be ready by late November, he said.

The vaccine industry is in a much stronger position to respond now than it was five years ago, when the United States had only two flu vaccine suppliers and was hit by a severe shortage.

Now there are five suppliers to the domestic market. And the vaccine industry, once a backwater of the pharmaceutical industry, is attracting new investments, lured by government subsidies and higher prices for vaccines.

Still, a study done with the World Health Organization and the International Federation of Pharmaceutical Manufacturers and Associations estimated that it would probably take four years of production to satisfy fully global demand for a vaccine to protect against the bird flu strain that has concerned health authorities for the last few years.

Similar projections might apply to the swine flu vaccine, some experts say.

“The bottom line is there won’t be enough vaccine quickly enough and the vaccine will largely go to the countries that already produce the vaccine,” because countries will restrict exports in a pandemic, said Dr. David Fedson, an independent expert on pandemic preparedness.

The federal government is encouraging manufacturers to set up production in the United States, since all companies but one, Sanofi-Aventis, now import their flu vaccines.

The government also gave $1.3 billion, spread among several manufacturers, to develop ways of producing the vaccine in vats of animal cells rather than in eggs. Cell culture is less vulnerable to contamination and the process could save at least a few weeks.

The results so far have been mixed. Solvay, which was awarded the biggest federal grant, nearly $300 million, decided it was economically too risky to build a flu vaccine plant in the United States. (Most of the grant money had not yet left federal coffers and will not be lost, Dr. Robinson said.) Sanofi-Aventis has also put cell culture production on the back burner, Dr. Robinson said.

But Novartis is building a cell culture flu vaccine factory in Holly Springs, N.C., which might be ready for use in 2010 or 2011. The federal government is providing nearly $500 million in construction costs and guaranteed vaccine purchases.

It will be a very dramatic race

Posted via web from wholefamilyjoy's posterous

Tuesday, April 28, 2009

Monday, April 27, 2009

My predictions for swine flu

Here's what I think will happen with swine flu.  As of this writing, Monday, April 27 there are five states affected with 20 cases. Generally, there is a direct connection between transmission and travel to Mexico. However the swine flu appears to be fairly efficiently transmitted between people. And it is likely to spread fairly rapidly over the next several weeks. The virus has killed between 20 and 100 people in Mexico. Several thousand people had appeared to have been made ill. This is probably a fairly significant underestimation. There is no reason to think that in crossing the border, the virus will be nicer to Americans. But who knows? There will likely be documented cases found in Illinois over the next several weeks. Nationally, there will likely to be a handful of swine flu related deaths. This will intensify national hysteria.
The virus so far appears to be effectively well controlled by the two most common antiviral flu medications, Relenza and Tamiflu. They have some side effects that are generally well tolerated.
The question will come up, whether to treat or not, just to stay home or not. I think around here, people will want to be treated. There may be sporadic reports of Tamiflu or Relenza shortages and will increase anxiety. Whenever there are shortages of anything people sometimes freak out. There probably will be plenty of Tamiflu as we did not use nearly as much as we did last year and the CDC has stockpiled 50 million doses. However, there may be local and transient shortages and that will add to the excitement.
The interesting thing about the Mexican experience is that most of the severe cases and deaths involved healthy young adults. This echoes the 1918 influenza pandemic signature. The most vulnerable populations typically, i.e. the youngest kids and oldest adults appear not to have been severely affected.
Currently, as of this morning the CDC is generally recommending home isolation of cases as most cases appear to be fairly mild. They want us to stay at home for seven days after becoming ill. Or at least 24 hours after symptoms have resolved whichever is longer. 
How information will  be transmitted will be interesting. I predict a twitter storm of swine flu information and it will be useful/hazardous mode of communicating public health information/panic about swine flu. 

Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.