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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_414"
                     title="H1N1 Vaccination Still a Good Idea, CDC Says"
                     score="0.012"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18325?impressionId=1265762138321"
                     
      &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="0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18165?impressionId=1265762138321"
                     
      &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="20090101_19_3486"
                     title="IDSA: N95 vs Surgical Mask Findings Retracted"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/IDSA/tb/16729?impressionId=1265762138321"
                     
      &lt;p&gt;PHILADELPHIA -- In a surprise twist, authors here retracted findings of a study that found N95 respirators were better than surgical masks at preventing flu.&lt;/p&gt;
&lt;p&gt;After a re-analysis prompted by questions from reviewers, the findings were no longer significant, said Holly Seale, PhD, of the University of New South Wales in Sydney, Australia.&lt;/p&gt;
&lt;p&gt;The original study, presented earlier this year, formed the basis of several important policy decisions, including CDC guidance on the use of masks in a health care setting.&lt;/p&gt;
&lt;p&gt;The retraction - near the end of a presentation at the annual meeting of the Infectious Diseases Society of America - prompted a &quot;rush to the microphones&quot; by those involved in flu prevention, one expert said.&lt;/p&gt;
&lt;p&gt;The findings appeared to differ - not only from previous reports  --  but also from the abstract submitted to this meeting, noted Andrew Pavia, MD, of the University of Utah.&lt;/p&gt;
&lt;p&gt;Seale acknowledged those differences and agreed that the original results no longer stand. She was not immediately available for additional comment.&lt;/p&gt;
&lt;p&gt;The lead author of the study - Raina MacIntyre, PhD, also of the University of New South Wales - did not attend the meeting here.&lt;/p&gt;
&lt;p&gt;The retraction took experts here by surprise, although many had been critical of some statistical aspects of the study, according to Neil Fishman, MD, of the University of Pennsylvania.&lt;/p&gt;
&lt;p&gt;&quot;I think there was little bit of shock that there was such a large change (in the results),&quot; he told MedPage Today after the session.&lt;/p&gt;
&lt;p&gt;The study was first presented in San Francisco earlier this year and led to important policy decisions in the U.S. (See &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ICAAC/16006&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ICAAC/16006&quot; target=&quot;_blank&quot;&gt;ICAAC: Surgical Masks Don&apos;t Prevent Infection&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Among other things, it influenced an Institute of Medicine recommendation that health care workers caring for flu patients should use the more expensive N95 respirators. (See &lt;a href=&quot;http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/15518&quot; mce_href=&quot;http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/15518&quot; target=&quot;_blank&quot;&gt;IOM Panel Hears How to Protect Healthcare Workers from H1N1&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;&quot;We now have public policy that&apos;s based on faulty science,&quot; Fishman said.&lt;/p&gt;
&lt;p&gt;The policy has practical implications, he said - the N95 respirators are more costly than simple surgical masks and are in shorter supply. As well, there are costs involved if hospitals try to comply with guidance, he said.&lt;/p&gt;
&lt;p&gt;The original Australian finding was surprise to many experts, Fishman said, because it did not accord with other findings or with clinical experience.&lt;/p&gt;
&lt;p&gt;A Canadian study in the Journal of the American Medical Association in October found no difference between fit-tested N95 masks and surgical masks. (See &lt;a href=&quot;http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/16248&quot; mce_href=&quot;http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/16248&quot; target=&quot;_blank&quot;&gt;Study Shows Surgical Masks Equal Respirators for Healthcare Workers&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The analysis, led by Mark Loeb of McMaster University in Hamilton, Ont., was a true randomized trial among nurses in eight tertiary care hospitals in Canada.&lt;/p&gt;
&lt;p&gt;In contrast, the Australian study, conducted in China, was a cluster randomized trial in which the unit of analysis was the hospital, Fishman said.&lt;/p&gt;
&lt;p&gt;But the Australians were criticized because their control group of nine hospitals was not selected randomly, he said.&lt;/p&gt;
&lt;p&gt;When the data were re-analyzed excluding those hospitals, the differences between N95 respirators and surgical masks were no longer significant, Seale reported.&lt;/p&gt;
&lt;p&gt;&quot;When the P-value was adjusted for clustering and multiple testing,&quot; she reported, there was &quot;no significant difference between N95 respirators and medical masks.&quot;&lt;/p&gt;
&lt;p&gt;Fishman said most clinical experience suggests that flu is spread by large droplets and should be blocked by even a simple barrier such as a surgical mask.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_2059"
                     title="ACIP: Zanamivir Best for All Flu, Including New H1N1"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/ACIP/tb/14896?impressionId=1265762138321"
                     
      ATLANTA, June 29 -- Zanamivir (Relenza), a neuraminidase inhibitor, should be the preferred treatment for patients with influenza-like illness, whether infection is caused by a seasonal virus or the pandemic H1N1 virus, an advisory committee to the CDC said.
              &lt;p&gt; 
              &lt;p&gt;Even if laboratory tests are negative but flu is still suspected, zanamivir should be used when antiviral treatment is considered, the Advisory Committee on Immunization Practices agreed here.
              &lt;p&gt; 
              &lt;p&gt;Oseltamivir (Tamiflu), another neuraminidase inhibitor, could be used in case of a test that&apos;s positive for seasonal influenza A H3N2 or B, or for pandemic influenza A H1N1, although more than 99% of the seasonal H1N1 viruses were resistant to the drug, the committee noted.
              &lt;p&gt; 
              &lt;p&gt;The recommendations were based on testing for antiviral resistance, which found that all strains recently isolated, including the new H1N1, were susceptible to zanamivir.
              &lt;p&gt; 
              &lt;p&gt;Researchers found varying levels of resistance to the adamantanes, rimantadine and amantadine.
              &lt;p&gt; 
              &lt;p&gt;The recommendations, which will be published in an upcoming issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;, stressed that treatment should start as soon as possible for patients needing treatment.
              &lt;p&gt; 
              &lt;p&gt;The advisory panel said antiviral treatment should be considered for patients hospitalized with flu, those with influenza viral pneumonia, those with flu and complicating bacterial pneumonia, and those with flu who are at higher risk for flu-related complications, such as pregnant women and those with comorbidities, regardless of illness severity.
              &lt;p&gt; 
              &lt;p&gt;Anthony Fiore, MD, MPH, of the influenza division of CDC&apos;s National Center for Immunization and Respiratory Diseases, said the recommendations may change depending on how the upcoming flu season develops.
              &lt;p&gt; 
              &lt;p&gt;&quot;It&apos;s very important for clinicians to keep abreast of what the current recommendations are, because there&apos;s a potential for them changing according to epidemiology or to antiviral supply or susceptibility issues,&quot; said Dr. Fiore, who took part in crafting the recommendations.
              &lt;p&gt; 
              &lt;p&gt;Zanamivir is taken by inhalation and is not recommended for those with asthma or other respiratory diseases. It is also not approved for treating influenza in children under 7.
              &lt;p&gt; 
              &lt;p&gt;ACIP also tackled guidance on antiviral chemoprophylaxis, but agreement proved more problematic.
              &lt;p&gt; 
              &lt;p&gt;Some committee members questioned the notion of including detailed guidance in a document issued once a year, because it would become outdated relatively quickly.
              &lt;p&gt; 
              &lt;p&gt;&quot;In the face of the novel H1N1, the chemoprophylaxis recommendations strike me as impractical or obsolete,&quot; said Paul Cieslak, MD, of the Oregon Public Health Division in Portland, and an ACIP member. &quot;They would have us prophylaxing a huge percentage of the American public indefinitely into the future.&quot;
              &lt;p&gt; 
              &lt;p&gt;He said Oregon would not follow the guidelines as written and that more vague wording would be preferable to the proposed guidance.
              &lt;p&gt; 
              &lt;p&gt;But fellow ACIP member Carol Baker, MD, of Baylor College of Medicine in Houston, disagreed.
              &lt;p&gt; 
              &lt;p&gt;&quot;I do think because of all the media attention we do need to have some recommendations, with a strong caveat that these will probably be changing,&quot; she said. &quot;But I think we need to continue to give some guidance right now or we&apos;re not doing our job.&quot;
              &lt;p&gt; 
              &lt;p&gt;Ultimately, the committee included a short section referring clinicians to a Web site that would be updated as needed by the CDC.
              &lt;p&gt; 
              &lt;p&gt;The section would include a list of patients who might be considered for prophylaxis, such as young children or those with congestive heart failure and diabetes, along with instructions to check the Web site for the latest specific recommendations, according to Dr. Fiore.
            
    </recommendedItem>
    <recommendedItem id="20090101_19_2550"
                     title="IOM Panel Hears How to Protect Healthcare Workers from H1N1"
                     score="-0.006"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/15518?impressionId=1265762138321"
                     
      WASHINGTON  --  An Institute of Medicine (IOM) panel heard divergent views on how much gear a healthcare worker should wear to protect against H1N1 (swine flu) virus.
&lt;p&gt;With an expected resurgence of H1N1 this fall, the agency is hearing testimony this week to help it draft final guidelines on personal protective equipment (PPE) standards for healthcare workers, including goggles, surgical masks, N95 respirators, gloves, and gowns.&lt;/p&gt;
&lt;p&gt;Other than preliminary data from a Chinese trial indicating that the N95 respirator offered significantly more protection than standard surgical masks, the testimony was largely anecdotal.&lt;/p&gt;
&lt;p&gt;One emergency room physician asked the panel to scale back the guidelines, arguing that doctors  --  especially in the emergency department  --  don&apos;t have time to don and doff layers of protective gear.&lt;/p&gt;
&lt;p&gt;But a director of a union that represents 2 million healthcare employees said more protection is needed, nothing that the virus might require healthcare workers to take personal protection more seriously than in the past.&lt;/p&gt;
&lt;p&gt;The 14-member ad hoc&lt;em&gt; &lt;/em&gt;committee, chaired by former IOM president Kenneth Shine, MD, (1992 to 2002), will issue a final report on guidelines to the CDC by Sept. 1.&lt;/p&gt;
&lt;p&gt;In April, after the H1N1 outbreak was detected, the agency backed strict protective measures, including recommending that the patient who is exhibiting flu-like symptoms wear a surgical mask, and the healthcare worker wear gloves, a gown, goggles, and an N95 respirator.&lt;/p&gt;
&lt;p&gt;The guidelines were based on a better-safe-than-sorry approach and are being revised in light of new information about how H1N1 is transmitted.&lt;/p&gt;
&lt;p&gt;After Wednesday&apos;s hearing, Dr. Shine told&lt;em&gt; MedPage Today&lt;/em&gt; that many of the presentations were based on anecdotal evidence and opinions, rather than data.&lt;/p&gt;
&lt;p&gt;For instance, Alexander Isakov, MD, MPH, associate director of emergency medicine at Emory University in Atlanta, compared the protection protocols at the two hospitals in which he sees patients.&lt;/p&gt;
&lt;p&gt;Emory University Hospital, a large teaching institution, followed the initial IOM recommendations and took great pains to protect its employees from H1N1 with full equipment (and thus to protect patients from catching the virus from staff). But as the H1N1 threat diminished over time, Isakov recalled, the staff weren&apos;t as compliant about donning PPE for every encounter with a potentially infected patient.&lt;/p&gt;
&lt;p&gt;Isakov said requiring so much protective gear resulted in suspected H1N1 patients having to wait longer to see a doctor while their physicians were seeing other patients for whom they did not have to don so much gear.&lt;/p&gt;
&lt;p&gt;He also sees patients at	Grady Health System, which he described as a a public &quot;safety-net&quot; hospital, which elected to follow less stringent recommendations from the World Health Organization (WHO), which do not call for an N95 respirator.&lt;/p&gt;
&lt;p&gt;A dearth of data on the effectiveness of the N95 will make the IOM&apos;s final decision on their use difficult. To date, there are no published clinical trials comparing the N95&apos;s virus-blocking efficacy with that of plain old surgical masks.&lt;/p&gt;
&lt;p&gt;The N95 designation is an efficiency rating indicating that the mask blocks 95 percent of particles which are 0.3 microns in diameter or larger.&lt;/p&gt;
&lt;p&gt;One researcher disclosed yet-to-be published data comparing surgical masks, fitted N95 respirators, and nonfitted N95 respirators among nearly 2,000 healthcare workers in Beijing.&lt;/p&gt;
&lt;p&gt;The full data will be presented in September at the Interscience Conference on Antimicrobial Chemotherapy in San Francisco, but the researcher&apos;s sneak peak at the findings indicated that surgical masks offered no influenza protection, while the N95 offered 75% protection against lab-confirmed flu. It made no difference whether the N95s were fitted or not.&lt;/p&gt;
&lt;p&gt;That study was conducted in Beijing, where there is a high compliance rate among healthcare workers regarding protective masks, lead researcher Raina MacIntyre, PhD, of the University of New South Wales in Australia, told the panel.&lt;/p&gt;
&lt;p&gt;In the U.S., protective gear compliance rates are low, in part because healthcare workers have no &quot;culture of safety,&quot; said Bill Borwegan, Occupations Health and Safety Director of Service Employees International Union (SEIU).&lt;/p&gt;
&lt;p&gt;The Occupational Health and Safety Act of 1970 (OSHA) requires employers to take feasible steps to reduce the risk inhalation of airborne particles.&lt;/p&gt;
&lt;p&gt;A surgical mask falls short of the standard, but a N95 respirator meets the standard, Borwegan said. He said a surgical mask is about 2.5 times better than no mask, while an N95 is 17.5 times better than no mask.&lt;/p&gt;
&lt;p&gt;The IOM&apos;s final recommendations will likely apply to healthcare workers dealing with any patient who presents with any acute respiratory symptoms.&lt;/p&gt;
&lt;p&gt;Others reminded the panel that healthcare workers exposed to H1N1 go beyond doctors and nurses, and will include nurses&apos; aides, receptionists, food preparation staff, nursing home workers, home healthcare workers, EMTs, and, in some cases, even firefighters and police.&lt;/p&gt;
&lt;p&gt;In July, the WHO said the healthcare workers should be the first to be vaccinated against H1N1 once a vaccine is available, because of their high exposure rates to the virus.&lt;/p&gt;
&lt;p&gt;The H1N1 vaccine is currently being tested at sites around the country and is expected to be available in October. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/15053&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/15053&quot; target=&quot;_blank&quot;&gt;WHO Says Healthcare Workers Are H1N1 Vaccine Priority&lt;/a&gt;)&lt;/p&gt;

    </recommendedItem>
</recommendedContent>
