Bird Flu In The News

by DemFromCT

Avian flu (aka bird flu and H5N1) is in the news again. There are sobering reports that bird flu has now spread to Russia and more parts of Indonesia, where 3 members of a family are confirmed to have died raising the possibility of human to human (H2H )  transmission. For a good FAQ on this topic if you are new to it, go here or try Flu Wiki. we are not in the midst of a pandemic, but the possiblility exists that we could be some time in the next few years. Even if it does not happen,  pre-planning is an absolute must.

On the other hand, the CDC is finally finishing its pandemic preparedness plan. Can you spell rationing?

The plan lays out just who will get the vaccine, in descending order of priority:

• Group 1. The highest-priority group includes 9 million healthcare workers involved in direct patient care; 40,000 people who are making the vaccine and antiflu medicines; and some 37 million people who are at greatest risk if they get the flu, namely those over age 64 with a medical illness, younger people with two serious underlying medical conditions, pregnant women, and all household contacts of children under 6 months of age. Also in this top group are key government officials and specialized pandemic flu responders.
• Group 2. In the next tier are healthy seniors; younger people with one risky health condition; young children between 6 to 23 months old (the vaccine is not recommended for infants under 6 months); and workers in critical fields like public safety, utilities, emergency response, transportation, and telecommunication. This group is 68 million strong.
• Group 3. The third priority is 500,000 people, including key government healthcare decision makers and those working in mortuary services.
• Group 4.At the bottom are the remaining 179 million healthy people, 2 to 64 years old, not included in any other category.

Rationing is going to be part of the mix of how we respond, and will be subject to change as more data becomes available. It almost has to be as there's not enough antiflu medicine to go around, and a proper vaccine will likely take 6 months or more to show up in any quantity. Quarantine and shutting down certain services such as schools, entertainment, etc might in certain circumstances be necessary as well.

Given that that's the case, best to discuss it beforehand, early rather than late. There's enough mistrust of this government without a natural disaster making things even worse then they already are. We need our public health officials out in front explaining things as they go along. We need to get used to who they are and what their role is. And they need to be trained in how to communicate risk  to the population honestly and fairly. It's the only way we'll ever begin to be prepared.

Comments

[DemFromCT]

I don't know if it's a good thing or a bad thing, but rationing brings us into the realm of the political.

[emptypockets]

The existing cocktail that we know as the flu vaccine is also effective against avian flu, or it's not clear?

The rationing scheme looks superficially the same as the one used last year during (human) flu season. Is it different?

[DemFromCT]

The existing cocktail that we know as the flu vaccine is also effective against avian flu, or it's not clear?

The existing cocktail does not work at all against avian flu. In fact, part of the reason it's so dangerous is that humans currently alive have never had a flu exposure to H5N1, the bird flu we're talking about. There's 15 different H types and 9 different N types... humans get H1, H2 and H3 and N1,N2 and N3 so human flus are some mix of one of the 3 H and one of the 3 N (i.e., H2N3 or H3N2, etc). Birds get all 15 H and all 9 N. If and when humans get H5, there's no protection either from the current vaccine or previous exposure.

The rationing scheme looks superficially the same as the one used last year during (human) flu season. Is it different?

What, you want originality form government workers? The plan is based on risk assessment, and is the same last year as this. But... bird flu is suspected to attack healthy adolescent and young adults harder because their excellent immune systems over-react (something called cytokine storm). So the plan may have to change if it turns out that who they think is at risk is not who really is at risk.

All of the above is covered here at the Flu Wiki.

[emptypockets]

Thanks. I checked the other links you gave but hadn't delved into the flu wiki pages. They are very informative though a little more up-front indexing would be helpful to the skimming-inclined (for example, on the contents page a list of subsections within "Influenza Primer I," Influenze Primer II"...)

I got confused by US News' reference to "flu vaccine" when they are referring to a new avian flu vaccine not the well-known human flu vaccine that would usually be the subject of a story with that headline.

Apologies if this is already well-covered in flu wiki, but why not put avian & human flu vaccine in a single shot?

While I'm thinking of it, do you know why flu vaccines need to be re-administered every year, unlike most vaccines that last on the order of a decade or two? I know it is partly because each year's shot is customized to that year's anticipated mix of infectious strains, but is that the only reason?

And to bring it back to politics -- your point about needing the public health officials who will be directing us and reassuring us in the event of catastrophe to gain our trust now when things are calm is excellent. But it begs the question, WOULD we trust them if we knew them? It might make them the only government agents we'd (as a country) feel that way about (possible exception for Alan Greenspan).

[DemFromCT]

why not put avian & human flu vaccine in a single shot?

They don't know which avian flu is coming... the one now will have to mutate somewhat to be pandemic, the current one kills the chicken eggs it takes to make the vaccine, etc. Little details, big headaches. There are vaccines in the pipeline, but whether they're the right ones remains to be seen.

The flu virus mutates every year (the H and the N bits). That's the reason the vaccine has to keep up. Until we get a vaccine that covers all flus at once (not yet available), we get stuck every year.

Remember C. Everett Koop? If you don't trust the guy now, fire him and get one you can. Anthony Fauci is pretty visible, and fairly trusted as an example.

[DemFromCT]

btw, emptypockets, you can go to the site map... it doubles as a TOC.

[emptypockets]

I hadn't heard of Anthony Fauci but I'll take your word on him for now. Having another Koop would be fine with me (although to me he lost some credibility when he went dot-com... no offense to present company intended). But the current surgeon general is, from the little I've read of interviews with him, about what you'd expect from Bush.

Quick Google refreshes my memory of how he parrots absolutely false Bush talking points:

On prescription drug prices (from mediamatters): "Surgeon General Richard H. Carmona claimed that high U.S. prescription drug prices fund 'the research and development of drugs.' But large profit margins and marketing budgets indicate that drug companies could reduce prices without cutting into research and development money."

On stem cells (from his alma mater:

[Q]. I imagine most of your colleagues, if not you personally, believe in the utility of stem cell research. The Bush administration doesn’t.

[A]. I think that’s an oversimplification. The present administration’s thought is, “We need more information.” Talk to Elias Zerhouni, the director of National Institutes of Health, for example. He started stem cell research at Johns Hopkins. Even he will tell you we were getting way out in front of the science. And, it’s not just science; there are moral issues, ethical issues, religious issues.

I think all the president has done is say, “OK, use these 80 cell lines that we have available [these turned out not to exist - empty.]. Let’s take a look at where we can go with this, and then have the scientists develop evidence-based medicine [wtf? - empty.] to show me that we’re OK or we’re not OK and we can revisit it.”

And sometimes he is just plain wacky: "U.S. Surgeon General Richard H. Carmona, M.D., sees dentists as equal partners in war on terrorism, he told dental leaders March 27 at a conference on 'Dentistry's Role in Responding to Bioterrorism and Other Catastrophic Events.'"

Toothbombers and weaponized gingivitis peddlers beware.

[DemFromCT]

That's why Fauci, who is at NIH and runs their infectious disease and AIDS section, needs to step forward. Carmona is a political hack and a total waste. Fauci is a working researcher, and very eloquent (and knowledgable). And although I don't care for Dr. Julie (Gerberding) at CDC because of her demonstably poor admin skills, she is a good spokesperson and handles herself well on TV.

That latter characteristic is important, but whoever steps up has to tell the truth, whether it's Secy of HHS or CDC or NIH. See Flu Wiki for a few pertinent communication links.