<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_414"
                     title="H1N1 Vaccination Still a Good Idea, CDC Says"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18325?impressionId=1265805515591"
                     
      &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_302"
                     title="WHO Calls H1N1 Response Imperfect"
                     score="0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18165?impressionId=1265805515591"
                     
      &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="-0.004"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/17990?impressionId=1265805515591"
                     
      &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_2145"
                     title="WHO: Drug Resistance Expected in H1N1 Pandemic"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/14994?impressionId=1265805515591"
                     
      TORONTO, July 7 -- The discovery of three cases of the pandemic H1N1 influenza that are resistant to a key antiviral drug is not surprising, experts say.
              &lt;p&gt; 
              &lt;p&gt;What is worrying some is that one of the cases of resistance to oseltamivir (Tamiflu) occurred in a woman in Hong Kong who had not been treated with the drug.
              &lt;p&gt; 
              &lt;p&gt;In the other two cases -- one each in Denmark and Japan -- the patients had been given the drug as a preventive measure, according to Keiji Fukuda, MD, of the World Health Organization.
              &lt;p&gt; 
              &lt;p&gt;Dr. Fukuda said the agency is monitoring the situation closely but no other cases have yet turned up and there&apos;s no evidence that a resistant strain is beginning to circulate.
              &lt;p&gt; 
              &lt;p&gt;&quot;Right now this looks like spontaneous mutation in these patients,&quot; Dr. Fukuda told a press conference today. He said all three patients had the same mutation and all three had &quot;uncomplicated&quot; disease from which they made full recoveries.
              &lt;p&gt; 
              &lt;p&gt;He added there&apos;s also no evidence of a resistant strain in any of the contacts of the three patients.
              &lt;p&gt; 
              &lt;p&gt;The CDC said that nearly all of the tested strains of seasonal H1N1 flu this season were resistant to oseltamivir, although there was less resistance among circulating strains of H3N2 influenza A or influenza B. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/13803&quot; target=&quot;blank&quot;&gt;Mild Flu Season Winds Down&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;But until these cases emerged, there had been no sign of oseltamivir resistance in the pandemic H1N1 flu. Dr. Fukuda said there is still no evidence that a resistant strain is being transmitted. 
              &lt;p&gt; 
              &lt;p&gt;That said, &quot;the emergence of drug-resistant viruses is not unexpected,&quot; according to David Topham, PhD, of the University of Rochester in Rochester, N.Y., &quot;especially in light of the increased use of influenza antivirals in the context of this recent pandemic.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Topham cautioned, &quot;overuse of the antivirals will almost certainly hasten the emergence of resistant strains, which will leave us fewer options for treating those who truly are in need.&quot;
              &lt;p&gt; 
              &lt;p&gt;And many physicians are using oseltamivir in a way calculated to generate resistance, according to Len Horovitz, MD, of Lenox Hill Hospital in New York City.
              &lt;p&gt; 
              &lt;p&gt;&quot;It is my observation that all too many physicians (mostly pediatricians) are treating mild cases,&quot; he said, and are also using the drug as a preventive measure in household contacts of patients.
              &lt;p&gt; 
              &lt;p&gt;&quot;It is not surprising that resistance is being seen,&quot; Dr. Horovitz said, adding it is &quot;certainly a concern if there is a second wave of a more virulent mutated strain (this fall).&quot;
              &lt;p&gt; 
              &lt;p&gt;Resistance to oseltamivir is more frequent in people treated with the drug, according to Daniel Hinthorn, MD, of the University of Kansas Hospital and Medical Center in Kansas City, Kan.
              &lt;p&gt; 
              &lt;p&gt;If it shows up in a person who hasn&apos;t been exposed to the drug, it could be that it was transmitted from a person who had been given oseltamivir, he said.
              &lt;p&gt; 
              &lt;p&gt;The virus might also have undergone a genetic change to become resistant -- the &quot;spontaneous mutation&quot; Dr. Fukuda mentioned.
              &lt;p&gt; 
              &lt;p&gt;Or the virus might have recombined with other strains -- something that influenza viruses do frequently -- and derived resistance that way, Dr. Hinthorn said.
              &lt;p&gt; 
              &lt;p&gt;That&apos;s not very likely right now, he said, since the pandemic virus is just about the only strain in circulation.
              &lt;p&gt; 
              &lt;p&gt;&quot;This is certainly potentially important,&quot; he said, but &quot;only time will tell if this is a rare or a common event.&quot;
              &lt;p&gt; 
              &lt;p&gt;Oseltamivir is a member of the class of neuraminidase inhibitors -- neuraminidase in the &quot;N&quot; in H1N1 -- and is widely used because it is an oral drug.
              &lt;p&gt; 
              &lt;p&gt;The other approved member of the class is zanamivir (Relenza), which is inhaled, making it difficult to use for people with respiratory conditions. It is also not approved for children.
              &lt;p&gt; 
              &lt;p&gt;If oseltamivir resistance becomes widespread in the pandemic flu, it could create difficult treatment choices for physicians, according to Jeffrey Boscamp, MD, of Hackensack University Medical Center in Hackensack, N.J.
              &lt;p&gt; 
              &lt;p&gt;&quot;We struggled during the seasonal flu outbreak this past winter with the emergence of Tamiflu resistant flu A and had to come up with some difficult antiviral combinations, particularly for children who couldn&apos;t take Relenza,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;&quot;It is highly likely that we will see Tamiflu resistance here (in the pandemic strain) and it will limit our treatment options,&quot; he said. &quot;It will be a very big problem if we see this novel virus becoming more virulent than it currently is.&quot;
              &lt;p&gt; 
              &lt;p&gt;Predicting what influenza will do is a &quot;dangerous game,&quot; according to Marc Lipsitch, DPhil, of Harvard School of Public Health.
              &lt;p&gt; 
              &lt;p&gt;Even if it turns out that a resistant strain has been transmitted from one person to another, &quot;it could be an unlucky, one-off event, and we need to watch and see how much more it spreads,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;And even if that&apos;s not so, it will take a while for resistance to become widespread, Dr. Lipsitch said.
              &lt;p&gt; 
              &lt;p&gt;&quot;The use of oseltamivir will continue to have benefits for quite a while, because there are so many more drug-sensitive cases out there than drug-resistant ones,&quot; he said, &quot;and we would expect it to be months at least -- maybe more -- before a resistant strain became a majority of cases.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;But predictions are hazardous and careful surveillance is critical,&quot; he added.
            &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/2009/5/14/14212.jpg&quot;&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4017"
                     title="Drug-Resistant H1N1 Cluster Seen in Vietnam"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/17426?impressionId=1265805515591"
                     
      &lt;p&gt;Researchers in Vietnam have reported a cluster of seven cases of pandemic H1N1 flu that were resistant to the antiviral drug oseltamivir (Tamiflu).&lt;/p&gt;
&lt;p&gt;The resistance appears to have originated in one patient and was transmitted to six others during a 42-hour train journey, according to Peter Horby, M.B., B.S., of the Oxford University Clinical Research Unit in Hanoi, and colleagues.&lt;/p&gt;
&lt;p&gt;None of the patients was taking or had taken the drug before they came down with the flu, Horby and colleagues wrote in a letter published online in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;This shows that resistant 2009 H1N1 viruses are transmissible and can replicate and cause illness in healthy people in the absence of selective drug pressure,&quot; Horby and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The resistance was blamed on a known resistance mutation, the so-called H275Y substitution in the virus&apos;s neuraminidase enzyme, the researchers said.&lt;/p&gt;
&lt;p&gt;The mutation has been responsible for all cases of oseltamivir resistance seen in pandemic flu cases so far, but in most cases it has occurred in the wake of treatment with the drug. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/14994&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/14994&quot; target=&quot;_blank&quot;&gt;WHO: Drug Resistance Expected in H1N1 Pandemic&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The current cluster arose in July, when 10 students socialized in the same railway car, Horby and colleagues reported. They had not known each other previously, had not had contact with anyone with suspected influenza in the week before the trip, had no symptoms during the journey, and had not been taking oseltamivir, the researchers found.&lt;/p&gt;
&lt;p&gt;Nonetheless, four of the students came down with a fever within 12 hours of arrival and two more developed fever within 48 hours. A traveler in a different rail car was also identified with the flu.&lt;/p&gt;
&lt;p&gt;Reverse-transcriptase polymerase chain reaction testing of nasal swabs from all seven was positive for the H1N1 pandemic flu.&lt;/p&gt;
&lt;p&gt;The H275Y substitution was also found in diagnostic specimens taken before any of the patients had started oseltamivir, the investigators reported.&lt;/p&gt;
&lt;p&gt;All seven were treated with oseltamivir at 75 milligrams daily and all recovered, the researchers said. No more cases were uncovered despite an extensive public health investigation.&lt;/p&gt;
&lt;p&gt;On the other hand, not all contacts could be traced, the researchers said, &quot;so ongoing transmission cannot be ruled out.&quot;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>
