Health Spectator

The U.S. government’s purchase of H1N1 vaccines cost taxpayers $1.6 billion, according to figures reported recently by the Washington Post. Despite the relatively mild effect of the actual swine flu pandemic, the panic by U.S. health officials resulted in big profits for Big Pharma, with a resulting glut of flu vaccine that is now being given away by public health clinics.

According to the Post, as many as 72 million doses of swine flu vaccine are now considered surplus and may end up being discarded.

Figures from the Centers for Disease Control and Prevention (CDC) indicate that about one in four Americans were vaccinated against H1N1. Among healthcare workers, the H1N1 vaccination figure was slightly higher—about 37 percent—but well below the record 62 percent of healthcare workers vaccinated against seasonal flu during the 2009-2010 season.

Given that 62 percent compliance is the highest ever seen among healthcare workers, it is clear that this group does not believe strongly in the benefits of flu vaccination. Clearly, no one has easier access to vaccination than they. Indeed, the 62 percent figure is no doubt slightly inflated by the forced vaccination of healthcare workers in New York State in 2009. Even so, a 62-percent vaccination rate indicates considerable apathy—if not downright aversion—towards vaccination on the part of healthcare workers, given that the CDC recommends that all healthcare workers be vaccinated against the flu each year.

The 37-percent figure of healthcare workers who took the H1N1 vaccine shows even less belief in the safety and efficacy of that vaccine compared to the seasonal flu vaccine. The irony is that the vaccination rate for children against H1N1 was the same 37 percent, indicating that children in effect ended up being the guinea pigs for the H1N1 flu vaccine.

According to the World Health Organization (WHO), there are typically over 30 million cases of seasonal flu annually in the US. US government figures put the infection rate for the H1N1 virus at approximately 62 million people. Of those, about 12,000 died—far fewer than the 36,000 the CDC says die from seasonal flu each year. (Other CDC figures show that just between January 1 and April 18 of 2009, more than 13,000 people died of complications from seasonal flu, making it a bigger killer for the year than H1N1.)

Approximately 72 million to 81 million people in the U.S. are believed to have been vaccinated against H1N1 as of February 2010.

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.

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.

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

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.

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.

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.

Currently, only two anti-virals are known to be effective against H1N1 pandemic swine flu: Tamiflu (oseltamivir) and Relenza (zanamivir). If not used sparingly, these too could become ineffective, the CDC has warned.

Both drugs can be used to prevent viral infection under the right circumstances, though the protocol currently recommended by the CDC is to use these drugs in this manner only to protect pregnant women, people undergoing chemotherapy, and similar groups who are known to be at higher risk of death from swine flu.

Recently, the doctor at a camp in North Carolina decided to immunize 600 campers by using Tamiflu. The result: two girls caught swine flu anyway, and tests showed that their strain had developed Tamiflu resistance.

Tamiflu is approved by the FDA for “treatment of uncomplicated acute (mild) illness due to influenza infections in patients 1 year and older who have been symptomatic for no more than 2 days.” The drug is also approved for prevention of influenza in patients 1 year of age and older. On August 4, 2009, the FDA commisioner released an Emergency Use Authorization (EUA) for Tamiflu because of the Public Health Emergency that was declared in the wake of the H1N1 (swine flu) epidemic.

That EUA enabled use of Tamiflu to treat and prevent influenza in patients less than 1 year of age. The EUA also allowed for use of Tamiflu at later time points (that is, in patients symptomatic for more than 2 days) and in patients sick enough to require hospitalization (severe illness).

Those seeking more information on the EUA and the current regulations surrounding the use of Tamiflu can find it on the CDC website.

The World Health Organization (WHO) has acknowledged what regular readers of Health Spectator already knew: that the “new” H1N1 swine flu has a tendency to devastate the lungs in at least a significant portion of the people it infects. We reported on July 23 that University of Wisconsin virologist Yoshihiro Kawaoka had found H1N1 produces more severe lung lesions than seasonal flu in non-swine mammals.

The WHO currenlty puts the fraction of patients who need intensive care as a result of direct lung infection as high as 15%. Should the same prove true in the U.S. as the new wave of flu strikes this fall, it could put a strain on medical facilities.

The other distinctive trait of the new flu is its tendency to strike harder against the young. Whereas the elderly are normally most affected by seasonal flu, WHO is reporting that H1N1 infection is 20 times more common in the 5-to-24 age bracket than in those over 65. Some believe that the elderly have some natural resistance to the new flu from having been exposed to similar strains in the past. Others attribute the vulnerability of the otherwise healthy to the disease causing a so-called “cytokine storm,” which is an extreme reaction on the part of the immune system that causes more harm than the virus itself. Those with stronger, healthier immune systems are more likely to be severely affected, the reasoning goes.

Although WHO is also reporting a greater susceptibility to new flu among minorities and indigenous populations in South America, it is not clear whether a similar prevalence will result here in the United States. In other countries, the disparity may be the result of differing social conditions and medical care.

The 1976 swine flu epidemic and consequences