Health Spectator

You may remember the case of Andrew Speaker. He went to Italy to be married and returned with a drug-resistant form of tuberculosis that caused a national furor and was reported on this website. The furor arose because Speaker traveled by plane with a highly contagious, hard-to-cure disease. At one point, Speaker was diagnosed by the CDC as having “extensively drug resistant tuberculosis.” That diagnosis was later downgraded to “multi-drug resistant tuberculosis.” Even so, Speaker was faced with a two-year regimen of drugs or surgery. He chose the surgery and recuperated, we are happy to report, without further complications.

While Speaker’s case became an instant sensation, the CDC and other public health officials managed to keep quiet a much more insidious form of the disease that appeared on our shores just a few months later, around September 2007. A 19-year-old student named Oswaldo Juarez came to the U.S. from Peru to study English. When he found himself coughing up blood, he knew something was very wrong.

He was diagnosed as having “extremely drug-resistant tuberculosis”—two cuts above the variety that Speaker had. After three months of futile treatment by a local hospital in Fort Lauderdale, he found himself living at the A.G. Holley State Hospital, the nation’s last tuberculosis sanitarium, located just south of West Palm Beach.

After approximately a two-year regimen not unlike chemotherapy for cancer, Juarez was pronounced cured and allowed to leave the facility. That was in July of this year. After 19 months of treatment at A.G. Holley, Juarez was now 21 and fluent in English.

The Associated Press reports that the Florida taxpayers paid about $500,000 for his treatment, which nonetheless was money well spent, since had he not been treated he most likely would have infected others and might have started an epidemic of virtually incurable tuberculosis had he continued to live in the U.S. or attempted to return home to Peru. According to AP reports, doctors had apparently told him he might only live about a month if he returned to Peru.

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The Taiwan News is reporting that a gynecologist identified only as Dr. Liu plans to sue the Centers for Disease Control in Taiwan over the death of his seven-year-old son in the wake of an H1N1 vaccination the child was given at school on November 19.

The case has been made public by Chang Yao-tsung, an opposition Democratic Progressive Party member of the Taichung City Council, speaking on behalf of the child’s parents.

The report says the child had no previous history of medical problems. Like many cases linked by parents to vaccinations, this one began with almost immediate symptoms. The child began suffering with red blotches on the soles of his feet the day following the vaccination. A private clinic diagnosed the condition as either an allergy or a reaction to the shot. Over the following two weeks, despite treatment with medications, the blotches spread over the child’s entire body. The frantic parents moved him from hospital to hospital, demanding ever more expensive treatments and tests. Some doctors said that the child’s immune system was not functioning properly. Despite all efforts, the child died yesterday, December 21. The official diagnosis was sepsis, commonly known as blood poisoning.

We cite the following directly from the Taiwan News:

A total of almost 4.8 million people had been vaccinated so far, according to CDC statistics.

Including the boy, a total of four deaths were recorded following inoculation, including men aged 82 and 50 respectively who had difficult health histories, and a high school student, reports said.

Five pregnant women were reported with problems ranging from miscarriage to a stillborn infant.

Of… 331 lighter cases, 43 percent were dizzy after being inoculated, 20 percent registered a fever, 18 percent felt ill, 17 percent had a headache and 11 percent vomited, according to CDC data.

The CDC denies that the boy’s sickness and death had anything to do with the H1N1 vaccination.

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If you’ve made it this far, chances are better you won’t be getting the swine flu. The fall wave has peaked, experts seem to agree, and while there will surely be more cases to come, they are on the wane. The Centers for Disease Control and Prevention (CDC) is warning that another (winter) wave may occur in January, possibly prompted by students returning home from college during the Christmas holidays, but thus far, the flu pandemic has been a relative non-event as flu pandemics go.

So far, pandemic H1N1 is still crowding out other influenzas, such as seasonal H1N1 and H3N2. Since September, the CDC has tested 420 patient samples that were positive for influenza, and of those, only eight were not pandemic H1N1. Indeed, only one was seasonal H1N1.

The dominance of pandemic flu has not been good for the youngest age groups, however. During week 46 of 2009 (the last for which CDC figures have been reported) 35 influenza-related pediatric deaths were reported. Twenty-seven of these deaths were associated with pandemic H1N1 infections, seven were due to an undetermined influenza A virus subtype, and one was associated with a seasonal H1N1 infection that occurred in March.

Clearly pandemic H1N1 has been harder on children and teenagers than on older people. The H3N2 virus, on the other hand, tends to kill the elderly. But only three cases of H3N2 were reported out of the 420 patient samples previously mentioned, meaning that the pandemic flu’s tendency to crowd out other strains has spared the older age groups, relatively speaking.

Since April, the H1N1 outbreak has killed about 4,000 Americans, according to CDC estimates, of which at least 230 were children under the age of 18.

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Even the Centers for Disease Control and Prevention (CDC) admits it: H1N1 swine flu is a mild disease for most people, but for those whom it hits hard, it is often fatal.

Approximately a third of those who die from the disease do so because of other complications—generally pneumonia or MRSA (methicillin-resistant Staphylococcus aureus) so that the two primary killers once H1N1 gets involved are S. aureus and S. pneumoniae.¹ In part, this reflects the fact—reported here earlier²—that pandemic H1N1 tends to go deeper into the lungs than seasonal flu. According to Dr. Sherif Zaki, a pathologist at the CDC quoted in the November issue of Nature,³ this particular property of the virus is similar to H5N1 avian flu, a far more virulent form of flu that scientists have feared for years might take on a highly contagious human form.

The good news is that this particular scenario has been slow to develop in nature, and may prove difficult to replicate even in the lab. Researcher Bruno Lina at the Jean Merieux/INSERM biosecurity facility in Lyon, France proposes to try to force recombination of H1N1 and H5N1 in the lab and test the survivability and virulence of any resulting products. Based on some of his previous attempts to reassort H5N1 with seasonal H1N1 and H3N2 and the fact that the two viruses in question are different subtypes, he doesn’t expect to find reassortments that are survivable.

Referring to his previous experiments with reassorting H5N1, Lina told Nature, “After a year we only had three reassortments, and none was fit. They just don’t reassort well.”⁴

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Friday happens to be Malaria Day in the Americas 2009, and while malaria is not much of a problem here in the United States, it does affect our neighbors to the south and is a major problem in Africa. So we thought we’d take the time to acquaint you with the issues.

Malaria kills more than one million people a year, most of them children. (Most of the remaining fatalities are pregnant women.) Somewhere between 350 million and 500 million people are infected with malaria annually, at great economic cost, especially to families, since breadwinners are often unable to work for weeks, even if they eventually recover.

The main efforts being taken to combat malaria involve encouraging the use of bed nets in malaria-infested regions, particularly long-lasting insecticide-treated bed nets, which are the state of the art, and combating antimalarial resistance. So far, resistance to antimalarials —the ineffectiveness of malaria medications due to evolving strains of malaria that are not killed by them—has cost us the use of the cheapest and all but the very best antimalarial medications. Indeed, the World Health Organization (WHO) has mandated that artemisinin, the best of the antimalarials available currently, not be given as a monotherapy. In other words, artemisinin must be adminstered with at least one other antimalarial drug to comply with WHO guidelines.

In the Americas, targets for 2015 include:

• Decreasing annual malaria cases from approximately 1.15 million in the year 2000 to 575,000 by 2010 (50% reduction) and to 287,000 by 2015 (additional 25% reduction)
• Reducing malaria deaths from 348 in the year 2000 to less than 174 (50% reduction) by 2010 and to less than 87 (additional 25% reduction) by 2015

The effectiveness of long-term malaria control is governed by the strength of health systems. Strong health systems can deliver effective, safe, high-quality interventions when and where they are needed and assure access to reliable health information and effective disease surveillance. At the same time, integrating malaria treatment, prevention and surveillance into existing health programs and activities in endemic countries will ensure that funding earmarked for malaria control contributes to the development, expansion and continuous improvement of national health systems.

While the malaria situation in Africa is particularly dire, in the Americas there have been some successes since the turn of the century. Specifically, between 2000 and 2008, we have seen

• a 50.4% reduction of malaria cases in the region
• Approximately a 77% reduction in malaria mortality
• Seven countries have witnessed a greater than 75% reduction in annual malaria cases
• Five countries have shown a reduction in annual malaria cases between 50% and 74%
• Six countries have decreased annual malaria cases by less than 50%

Just in the Americas, the investment needed for malaria control and elimination are $227 million in 2009 and $261 million in 2010.

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What do you suppose is the number one killer among infectious diseases? Ask a number of people, and you will likely get a number of different answers: AIDS, malaria—maybe even this year, swine flu.

But the answer isn’t among the above: It’s pneumonia. Pneumonia claims more than four million lives annually. Just within the U.S., pneumonia claims more lives in a week than swine flu has from its initial outbreak to this date. Worldwide, it kills more children than any other disease—more than AIDS, malaria and measles combined. Children under five account for nearly half the deaths from pneumonia. And guess what is the number one fatal complication to swine flu? Yep. Pneumonia.

Although it primarily kills those under five or over 65, no one is entirely safe from pneumonia. A strong immune system is of course your best defense. In summertime, see that you get enough sunlight to maintain your vitamin D levels. Supplement with vitamin D3 or high-vitamin cod liver oil in winter. And in all seasons, get plenty of vitamin C—three grams or more daily.

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President Obama today declared the swine flu epidemic in this country a national emergency. Forty-six of the 50 states now have widespread flu contagion.

“It’s important to note that this is a proactive measure — not a response to a new development,” an administration official said.

“H1N1 is moving rapidly, as expected. By the time regions or healthcare systems recognize they are becoming overburdened, they need to implement disaster plans quickly,” he said.

The Centers for Disease Control and Prevention (CDC) says that the extent of swine flu contagion in the U.S. is currently on a par with the peak of the seasonal flu season, which normally doesn’t occur until at least late November and sometimes not until early March.

By declaring the national emergency, the administration enables Medicare, Medicaid and other federal health insurance agencies to waive certain requirements. This will smooth the way for doctors, hospitals and clinics to treat patients. As the flu season peaks, health-care providers such as hospitals are expected to be overwhelmed with patients.

The table below shows figures from the CDC giving the breakdown of lab-analyzed specimens for last week. Note that out of nearly 5,000 positive specimens, over 99% were Type A and approximately 70% were swine flu. This latter figure is slightly misleading, however, because almost 30% of the samples determined to be Type A were not subtyped. This means that virtually all positive respiratory specimens that were analyzed last week have turned out to be swine flu if there subtype was checked.

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The things they try to slip past you. We were catching up on our reading in the general press, in particular reading a piece in the New York Times about New York state requiring its health care workers to get both seasonal and swine flu vaccines, which has the unions of the health workers up in arms. And there it was, in the Times:

Immunologists generally agree that real protection against any disease requires vaccination rates over 90 percent. But because rumors always circulate and many people fear needles, voluntary acceptance never gets that high.

Nice try, NYT. “Real protection against any disease requires vaccination rates over 90 percent”? (Italics mine.) Does that mean real protection as opposed to the illusory protection we get from vaccines otherwise?

Obviously our NYT reporters are confusing issues here. They refer, we think, to so-called “herd immunity,” which, the story goes, requires over 90 percent vaccination rates to protect the remaining 10 per cent or fewer who are unvaccinated from being exposed to the disease. In other words, if you don’t get vaccinated and over 90 percent of the total population does, your chance of getting the disease drops to a rate comparable to that for people who did get vaccinated. That’s assuming, of course, that the vaccine really works and people really do derive immunity from it, both increasingly dubious assumptions these days.

That, apparently, is what the New York Times considers “real protection.” But, as the main thrust of the Times story clearly demonstrates, 58% of health care workers across the country disagree with that analysis and choose not to get vaccinated against the flu—H1N1 or otherwise.

Editor’s note: Today through Sunday (October 2-4) is the 4th International Public Conference on Vaccination, held at the Hyatt Regency hotel in Reston, Virginia. For more information, consult the National Vaccine Information Center Website.

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The word’s been out for several weeks now: Newseek has reported that hand-washing won’t help you avoid swine flu. That sounds like the bad news, but it’s really the good news: you’re not likely to get swine flu from touching things that someone who has swine flu has touched.

The most likely way to get swine flu (H1N1) is via particles of moisture suspended in the air and known to scientists as aerosol. That means that a really good way to avoid getting swine flu altogether is to wear a face mask all the time when you’re around other people. It may make you seem weird, but it likely will keep you safe from infection.

Coughs and sneezes from the swine-flu infected are what you have to fear if you’re worried about catching swine flu.

If wearing a face mask doesn’t strike you as a lot of fun but you still want to avoid the pork plague, then we suggest you start downing vitamins D and C: at least 3 grams a day in the case of vitamin C and at least 4,000 IU of D3 a day in the case of vitamin D. Going up to 10,000 IU a day of D won’t hurt you, and you should easily be able to consume 10 grams of C daily without ill effect.

The sign that you’ve taken too much vitamin C? Diarrhea, which also happens to be a symptom of swine flu, but we’re guessing you’ll be able to tell the difference. That’s only likely to happen if you exceed 10 grams of C a day, and it may take nearly twice that—average overdose of vitamin C is around 18 grams for most people.

But it shouldn’t take nearly that much to keep you healthy. And as we said, 10,000 IU of vitamin D3 a day should be more than enough to ward off the flu.

By the way, don’t give up on hand washing. It may not make any difference against swine flu, but for seasonal flu and colds, it likely will. And there are myriad other infections you can get from not washing your hands.

They’re all best avoided.

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In case you haven’t heard, the Commonwealth of Massachusetts has pending legislation mandating that non-health professionals (commonly read as police) can enter homes and force vaccination of children against the will of both the children and their parents if the governor or state health department have declared a state of medical emergency, as would occur in an H1N1 outbreak with resulting compulsory swine flu vaccinations.

The video below features a Fox newscast announcing this statute with analysis provided by Judge Andrew Napolitano, the Fox judicial consultant. That video was recorded after the bill—then Senate Bill 2028—passed the Massachusetts House of Representatives. (The bill had passed the Senate unanimously.)

For those who are opposed to compulsory vaccination, the story is pretty scary. Although adults are not subject to the same compulsory vaccination as children, they are subject to compulsory quarantine. Initially, the bill provided that the compulsory vaccination and quarantine could be performed without a warrant, and transgressors were subject to $1,000 per day in fines and up to 30 days in jail. The bill has since undergone revision as House Resolution 4271 and the warrantless provisions appear to have been removed. The law apparently still does not require that the compulsory vaccinations be given to children by healthcare professionals.

Senate Bill 2028 has become HR 4271

HR 4271 has been passed by the Massachusetts House and has gone back to the Senate, where it is expected to pass. Governor Deval Patrick has already said he will sign it.

Below the Fox newscast (which is now a bit out of date in terms of the provisions of HR 4271) we have posted an older video by way of background. Why post an even older video? Because we thought you might like to see the attitude of the legislator interviewed in this piece and understand the evolution of this particular bill. It gives an answer, we think, to a question we saw posted on another website: “Which is stronger, herd immunity or herd mentality?” (Definitely herd mentality.)

And last, but not least, we’ve posted a video recorded by Barbara Loe Fisher, who is president of the National Vaccine Information Center. This video was recorded in April, but most of the information it provides is not time-sensitive. Fisher discusses the lack of liability and other issues involved in the planned school-based vaccination programs.

Fox news broadcast after Massachusetts bill passes House

Broadcast after Senate Bill 2028 passed Massachusetts Senate

Barbara Loe Fisher, president of National Vaccine Information Center, discusses swine flu vaccination issues

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