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    <recommendedItem id="20100101_19_414"
                     title="H1N1 Vaccination Still a Good Idea, CDC Says"
                     score="0.014"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18325?impressionId=1265815262770"
                     
      &lt;p&gt;Although pandemic H1N1 influenza activity appears to have leveled off, the CDC remains wary of what the future may hold.&lt;/p&gt;
&lt;p&gt;No states were reporting widespread influenza activity, and only six  --  Alabama, Georgia, Maine, New Jersey, New Mexico, and Virginia  --  were reporting regional activity, Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases, told reporters on a conference call today.&lt;/p&gt;
&lt;p&gt;Influenza-like activity remained below the baseline level for this time of year for the third straight week, Schuchat said.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s fairly similar to what we would normally see at this time of year with seasonal flu,&quot; she said.&lt;/p&gt;
&lt;p&gt;However, she said that the H1N1 virus continues to circulate, causing severe disease and death in some cases.&lt;/p&gt;
&lt;p&gt;Although total activity is down, Schuchat noted that the proportion of deaths attributed to either flu or pneumonia is higher than the epidemic threshold, and has been for the past three weeks. The reasons were unclear, but she said there are no indications that the virus has become more virulent.&lt;/p&gt;
&lt;p&gt;But, she said, &quot;H1N1 vaccination remains a good idea.&quot;&lt;/p&gt;
&lt;p&gt;The most recent results of the CDC&apos;s National H1N1 Flu Survey revealed that about 70 million people, or 23.4% of Americans, have been vaccinated so far. About 76 million doses of the vaccine have been used because of the requirement that children younger than 10 get two.&lt;/p&gt;
&lt;p&gt;About 37% of children up to age 18 have been vaccinated. For those younger than 10, 37% have received their second dose.&lt;/p&gt;
&lt;p&gt;Vaccine supply remains ample, Schuchat said, with about 124 million doses shipped around the country up to this point.&lt;/p&gt;
&lt;p&gt;Citing an &quot;unprecedented&quot; effort to monitor safety, she said there have not been any major safety concerns identified.&lt;/p&gt;
&lt;p&gt;&quot;So if safety was the reason that you were waiting, I think you can be reassured on that front.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_410"
                     title="Most Adults Are Not Getting Necessary Vaccinations"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/Pneumonia/tb/18317?impressionId=1265815262770"
                     
      &lt;p&gt;Public health experts say they&apos;re concerned about the low number of U.S. adults who receive recommended vaccinations  --  and in particular about seniors who aren&apos;t immunized against pneumonia.&lt;/p&gt;
&lt;p&gt;As of 2008, one-third of people 65 and older had not received the pneumococcal vaccine, according to a report issued by the Trust for America&apos;s Health (TFAH), the Infectious Diseases Society of America (IDSA), and the Robert Wood Johnson Foundation.&lt;/p&gt;
&lt;p&gt;In 36 states, 30% or more of their older residents had not received the vaccine.&lt;/p&gt;
&lt;p&gt;The worst coverage was in the District of Columbia, where 45.6% of seniors had not been vaccinated. Even in the best performing state, Oregon, more than a quarter (26.8%) of older people had not received the one-time shot.&lt;/p&gt;
&lt;p&gt;Among all adults, the investigators also found extremely low rates of immunization against tetanus, diphtheria, and pertussis (2.1%), shingles (&amp;lt;2%), human papillomavirus (10%), and seasonal influenza (36.1%).&lt;/p&gt;
&lt;p&gt;&quot;The vaccination efforts around the 2009 H1N1 outbreak actually showed how well our public health system can react to vaccinate millions of people in a very short amount of time,&quot; L.J. Tan, PhD, director of medicine and public health for the American Medical Association, told reporters in a conference call.&lt;/p&gt;
&lt;p&gt;&quot;But I think our response also clearly demonstrated that we do have a lack of a strategy and a system for vaccinating adults.&quot;&lt;/p&gt;
&lt;p&gt;Added Jeffrey Levi, PhD, executive director of TFAH, &quot;We need a national strategy to make vaccines a regular part of medical care and to educate Americans about the effectiveness and safety of vaccines.&quot;&lt;/p&gt;
&lt;p&gt;Doing so could avoid 40,000 to 50,000 deaths from vaccine-preventable illnesses and save about $10 billion in healthcare costs each year, he said.&lt;/p&gt;
&lt;p&gt;But, according to William Schaffner, MD, chair of IDSA&apos;s immunization working group and a co-author of the report, there are many obstacles to adult vaccination efforts.&lt;/p&gt;
&lt;p&gt;First, unlike children in school, adults lack widespread institutional access to immunizations nor is there a way to require most adults to undergo vaccination.&lt;/p&gt;
&lt;p&gt;In addition, there are limited interactions with the healthcare system because, also unlike in children, care in adults generally revolves around acute care and not well care visits.&lt;/p&gt;
&lt;p&gt;Insurance coverage also plays a major role in low vaccination rates among adults, and not just in the uninsured or underinsured.&lt;/p&gt;
&lt;p&gt;Most insurance plans do not cover routine vaccination, Schaffner said, a situation that would change under pending healthcare reform legislation in Congress. That would require insurers to pay for all vaccinations recommended by the CDC&apos;s Advisory Committee on Immunization Practices.&lt;/p&gt;
&lt;p&gt;Schaffner also cited what he called misunderstandings and misinformation regarding the safety and effectiveness of vaccines, and the limited support for research, development, and production of vaccines as reasons for low immunization rates among adults.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s a shame that we aren&apos;t focusing enough resources on the science to prevent disease and we don&apos;t have a system where we can better protect people by getting them all of the vaccines that are currently available,&quot; he said.&lt;/p&gt;
&lt;p&gt;Tan outlined several recommendations the report makes to increase adult vaccination rates, starting with the creation of a program to provide vaccine coverage to uninsured individuals.&lt;/p&gt;
&lt;p&gt;Also, he said, the CDC and local and state health departments should be given more funding to conduct public education campaigns to increase awareness about the importance of vaccination.&lt;/p&gt;
&lt;p&gt;For their part, physicians should adopt practices to enable them to offer their adult patients vaccines at appropriate visits, like general physicals and cancer screenings, and to make a review of vaccination history a part of standard care.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_302"
                     title="WHO Calls H1N1 Response Imperfect"
                     score="0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18165?impressionId=1265815262770"
                     
      &lt;p&gt;The World Health Organization says its response to the H1N1 pandemic could have been better, but was not unduly swayed by drug manufacturers.&lt;/p&gt;
&lt;p&gt;&quot;We are under no illusions that this response was the perfect response,&quot; Keiji Fukuda, MD, the agency&apos;s top flu expert, told a hearing being held by the Council of Europe&apos;s health committee.&lt;/p&gt;
&lt;p&gt;But he added, &quot;The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry.&quot;&lt;/p&gt;
&lt;p&gt;The council&apos;s hearing is a response to criticism by some European politicians, as well as elements of the media, that the danger of the H1N1 pandemic was exaggerated, perhaps to allow drug companies to score multimillion-dollar contracts for vaccines and antivirals.&lt;/p&gt;
&lt;p&gt;In North America, many experts defended the response to the outbreak, which WHO last April declared a phase six pandemic  --  the highest level. The phases reflect that an infectious agent is widely spread and causing disease in the community, but they say nothing about the severity of the disease.&lt;/p&gt;
&lt;p&gt;&quot;I do not believe that the record supports the claim that health officials in the U.S. or WHO exaggerated the threat,&quot; said Andy Pavia, MD, of the University of Utah in Salt Lake City.&lt;/p&gt;
&lt;p&gt;Pavia said in an e-mail that health officials had a choice  --  to assume the threat was minor or to react strongly.&lt;/p&gt;
&lt;p&gt;&quot;The choice is obvious,&quot; Pavia said, &quot;and I would not want to be in a position of explaining to the families of victims why we planned for the mildest outcome.&quot;&lt;/p&gt;
&lt;p&gt;For the most part, illness caused by the disease has been mild, although several thousand people have died around the world and many more were sick enough to require intensive care.&lt;/p&gt;
&lt;p&gt;But the relatively low number of deaths has prompted Wolfgang Wodarg, MD, a German member of the council&apos;s Parliamentary Assembly, to dub the outbreak a &quot;false pandemic&quot; and call for this week&apos;s hearing.&lt;/p&gt;
&lt;p&gt;&quot;What we have experienced now is that millions of people have been vaccinated unnecessarily,&quot; Wodarg said. &quot;This is damage done to people, in order to earn money.&quot;&lt;/p&gt;
&lt;p&gt;Fukuda, on the other hand, said today the pandemic &quot;is a scientifically well-documented event.&quot;&lt;/p&gt;
&lt;p&gt;&quot;The labeling of the pandemic as &quot;fake&quot; is to ignore recent history and science,&quot; he said, &quot;and to trivialize the deaths of over 14,000 people and the many additional serious illnesses experienced by others.&quot;&lt;/p&gt;
&lt;p&gt;Utah&apos;s Pavia echoed that sentiment. Ask any front-line doctor if the H1N1 flu was mild, he said, &quot;and prepare to get your head handed to you.&quot;&lt;/p&gt;
&lt;p&gt;One of them was Daniel Hinthorn, MD, of the University of Kansas Medical Center in Kansas City, Kan. &quot;As a physician who saw many patients with this disease, I believe it was very serious in many people,&quot; he wrote in an e-mail. &quot;The threat was not exaggerated, at least to my mind.&quot;&lt;/p&gt;
&lt;p&gt;Even last month, as flu activity in the U.S. declined, he said his hospital treated 11 inpatients for the flu, including six in intensive care, while &quot;lots of others&quot; were being seen in emergency wards and clinics.&lt;/p&gt;
&lt;p&gt;On the other hand, to say the threat was exaggerated &quot;is merely to say the obvious,&quot; argued Philip Alcabes, PhD, of City University of New York City. By the time a vaccine was available, &quot;this outbreak was far less serious than feared,&quot; he said in an e-mail.&lt;/p&gt;
&lt;p&gt;But &quot;reality-based skepticism about swine flu&quot; doesn&apos;t mean that people would refuse immunization  --  not if an outbreak was a real public danger, caused by a &quot;highly transmissible agent, likely to be virulent, highly preventable with reliably effective vaccine.&quot;&lt;/p&gt;
&lt;p&gt;He warned that public health professionals must avoid &quot;falling in love with the most dire forecast and then pushing high-tech precautions against the worst-case scenario.&quot;&lt;/p&gt;
&lt;p&gt;When that happens, &quot;people have to be excused for wondering whether the officials, the media, and the pharmaceutical companies were in cahoots on swine flu,&quot; he said.&lt;/p&gt;
&lt;p&gt;But several experts argued that preparing for a worst-case scenario was the responsible thing to do.&lt;/p&gt;
&lt;p&gt;Sometimes, &quot;mother nature throws us a break,&quot; argued Howard Markel, MD, PhD, of the University of Michigan in Ann Arbor.&lt;/p&gt;
&lt;p&gt;&quot;We responded to a threat without knowing the future,&quot; he said in an e-mail. &quot;A far worse outcome might have occurred if we did not take the threat seriously and H1N1 turned out to be worse than we initially predicted.&quot;&lt;/p&gt;
&lt;p&gt;The public health response should be compared to the use of seat belts or auto insurance, according to Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn.&lt;/p&gt;
&lt;p&gt;Every day, he said in an e-mail, he puts on his seat belt before driving. &quot;I don&apos;t finish each day and say &apos;What a waste, I didn&apos;t have an accident,&apos;&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;It is (and remains) unpredictable as to whether this virus could further mutate or change in a manner such that it could literally turn deadly within weeks,&quot; he said. &quot;If this pandemic had been deadly (and you don&apos;t know until you are into it) and we weren&apos;t prepared, the criticism would have been overwhelming.&quot; Poland said.&lt;/p&gt;
&lt;p&gt;He and others also noted that the flu season isn&apos;t over yet.&lt;/p&gt;
&lt;p&gt;&quot;This argument should be taking place at the end of the flu season in late March, not now,&quot; said Peter Katona, MD, of the University of California Los Angeles. &quot;Flu is unpredictable, and this is the heart of the argument.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_160"
                     title="CDC Says 20% of Americans Got H1N1 Flu Shot"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/17990?impressionId=1265815262770"
                     
      &lt;p&gt;As 2009 ended, an estimated 55 million Americans had been infected with the H1N1 pandemic flu and roughly one in five Americans had been vaccinated against the disease, the CDC said.&lt;/p&gt;
&lt;p&gt;The immunization data works out to about 61 million people, the agency said in an early release issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The proportion of people vaccinated was higher among those in priority groups, the agency said, including 29.4% of children ages 6 months through 18 years and 38% of pregnant women.&lt;/p&gt;
&lt;p&gt;At the same time, the CDC issued new estimates of the toll taken by the pandemic virus since the outbreak began last April: &lt;ul&gt; &lt;li&gt;About 55 million people had been infected up to Dec. 12, although the estimates ranged from 39 million to as high as 80 million.&lt;/li&gt; &lt;li&gt;About 246,000 needed inpatient care, although the number ranged from 173,000 to 362,000. &lt;/li&gt; &lt;li&gt;And about 11,160 died, with the estimate ranging from 7,880 to 16,460.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The vaccination findings are based on two surveys  --  the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System survey, which took place from Dec. 27 to Jan. 2 and from Dec. 1 to 27, respectively.&lt;/p&gt;
&lt;p&gt;Because vaccine was expected to be in short supply at the beginning, the CDC established initial target groups, including pregnant women, people living with or caring for infants under 6 months, healthcare and emergency medical services personnel, children and young adults, and adults with certain medical conditions.&lt;/p&gt;
&lt;p&gt;The CDC estimated that 27.9% of those people got vaccinated.&lt;/p&gt;
&lt;p&gt;The agency said the vaccine supply is now &quot;ample&quot; and efforts to promote general vaccination should continue.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_4158"
                     title="Single H1N1 Dose Called Effective for Younger Kids (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/17625?impressionId=1265815262770"
                     
      Health officials&apos; recommendations notwithstanding, a single dose of vaccine may be enough to provide children and infants with immunity against pandemic 2009 H1N1 influenza, according to a randomized trial.&lt;br&gt;
&lt;br&gt;One 15-&amp;#956;g dose of a unadjuvanted, inactivated H1N1 vaccine produced the desired 1:40 or higher antibody levels in 92.5% of healthy kids under 9, while a 30-&amp;#956;g dose reached the same protective threshold in 97.7%, Terry Nolan, MBBS, PhD, of the University of Melbourne, Australia, and colleagues found.&lt;br&gt;
&lt;br&gt;Seroconversion occurred in 86.8% and 94.2% of the children, who were as young as 6 months, the researchers reported online ahead of print in the Jan. 6 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;These findings for a single dose were on par with those seen in adults in prior studies, they said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The CDC recommends two doses for children under 9 and only one for adults, based largely on seasonal vaccine studies, noted editorialists Anthony E. Fiore, MD, MPH, of the CDC&apos;s National Center for Infectious Diseases in Atlanta, and Kathleen M. Neuzil, MD, MPH, of the nonprofit PATH in Seattle.&lt;/p&gt;
&lt;p&gt;Recent studies with H1N1 vaccine by various manufacturers have supported these recommendations so far in adults.&lt;/p&gt;
&lt;p&gt;One &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/17577&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/17577&quot; target=&quot;_blank&quot;&gt;study&lt;/a&gt; showed antibody titers of 1:40 or more achieved by 95% of adults at 15-&amp;#956;g doses and 89.1% with 30-&amp;#956;g doses, while another indicated &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/17566&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/17566&quot; target=&quot;_blank&quot;&gt;seroprotection&lt;/a&gt; in 93% to 100%.&lt;/p&gt;
&lt;p&gt;But for children under 9, the rates were much lower in those recent studies, with seroprotection rates of only 45% to 50% for children 6 to 35 months old, 69% to 75% for those ages 3 to 9, and 77% from ages 9 to 12.&lt;/p&gt;
&lt;p&gt;So the new results were reassuring, but not sufficient to change recommendations, Fiore and Neuzil wrote in their editorial.&lt;/p&gt;
&lt;p&gt;Moreover, none of the H1N1 vaccination studies have had a long enough follow-up to determine effectiveness in preventing illness, only reporting the surrogate of immune response, Fiore added in an interview.&lt;/p&gt;
&lt;p&gt;That data might be expected by the spring, when some experts expect a possible &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/17598&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/17598&quot; target=&quot;_blank&quot;&gt;third wave&lt;/a&gt; of H1N1 influenza, Fiore said.&lt;/p&gt;
&lt;p&gt;In the early days of the vaccination efforts, Nolan&apos;s group started a Phase II study of one company&apos;s vaccine, an inactivated, split-virus 2009 influenza A(H1N1) vaccine from CSL Biotherapies.&lt;/p&gt;
&lt;p&gt;The trial was a randomized, observer-blind, age-stratified assessment of the 15 and 30 &amp;#956;g hemagglutinin antigen doses administered to 370 healthy Australian children ages 6 months to less than 9 years.&lt;/p&gt;
&lt;p&gt;All children got two intramuscular injections of their assigned dose given 21 days apart, with the second dose bringing immunity rates to 100% in both dose groups.&lt;/p&gt;
&lt;p&gt;Unlike in some prior studies, responses didn&apos;t vary much by age.&lt;/p&gt;
&lt;p&gt;Among the youngest children  --  those under 3 years  --  92.1% with the lower dose and 100% with the higher dose had 1:40 or better antibody titers after their first dose. The rates were 92.9% and 96.0% in children ages 3 and older, respectively.&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/21/11074.jpg&quot;&gt;
&lt;p&gt;Intent-to-treat analyses showed similar results.&lt;/p&gt;
&lt;p&gt;Two serious adverse events occurred, one case of a four-day fluctuating fever that started within 24 hours of receiving the first dose and one case of viral gastroenteritis, with onset after the second dose, that wasn&apos;t considered related.&lt;/p&gt;
&lt;p&gt;Two other notable events were a persistent fever that started four days after the initial vaccine dose in one boy and a single febrile convulsion in a boy with pneumonia that set in 20 days after the first vaccine dose.&lt;/p&gt;
&lt;p&gt;Overall, the safety findings indicated &quot;that this unadjuvanted vaccine is well tolerated with a safety profile similar to the seasonal influenza vaccine  --  an expected result given that the pandemic vaccine manufacturing process is identical to that used for seasonal vaccines,&quot; the editorialists noted.&lt;/p&gt;
&lt;p&gt;The researchers noted that while their trial did not include a placebo control group, the effects were almost certain to have been the result of the vaccine rather than infection since none of the children developed H1N1 infection during &quot;rigorous&quot; surveillance.&lt;/p&gt;
&lt;p&gt;Fiore and Neuzil added a few notes of caution to interpretation of the results: &lt;ul&gt; &lt;li&gt;A single 15-&amp;#956;g dose in children under 3 is the equivalent of two 7.5-&amp;#956;g doses as currently licensed for this age group in the U.S.&lt;/li&gt; &lt;li&gt;Antibody titers in children 3 and older were still about 30% lower than seen in adults with the same dose.&lt;/li&gt; &lt;li&gt;More children than expected had a protective level of H1N1 antibody before vaccination (9% to 14% under 3 years and 28% to 33% ages 3 to 9), &quot;raising the possibility of previous subclinical infection&quot; or an unusually sensitive test.&lt;/li&gt; &lt;li&gt;The study excluded children with chronic medical conditions, a population at higher risk of H1N1 complications.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was sponsored by CSL Limited with funding from the Australian government&apos;s Department of Health and Ageing.&lt;/p&gt;&lt;p&gt;Nolan reported being an investigator on vaccine studies sponsored by CSL Limited and other companies; being a member of a CSL Limited vaccine advisory board and receiving honoraria; and receiving travel support to attend scientific meetings to present research findings from CSL Limited, Novartis, and GlaxoSmithKline.&lt;/p&gt;&lt;p&gt;Co-authors reported conflicts of interest with CSL Limited, Novartis, Novartis Vaccines, GlaxoSmithKline, Wyeth, Wyeth Vaccines, Roche, and Sanofi. One reported being a former employee of CSL Limited and having an equity interest in the company; four others reported current employment with CSL Limited and having an equity interest in the company.&lt;/p&gt;&lt;p&gt;Fiore and Neuzil reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
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