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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=1265754958129"
                     
      &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=1265754958129"
                     
      &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=1265754958129"
                     
      &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_1420"
                     title="H1N1 (Swine) Flu Could Spread Easily Among Nations"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/14101?impressionId=1265754958129"
                     
      TORONTO, May 7 -- Early data on the H1N1 (swine) flu suggest it has the &quot;potential for efficient, rapid spread among countries,&quot; the CDC said.
              &lt;p&gt; 
              &lt;p&gt;And, although most cases have been uncomplicated and self-limited, there has been a &quot;substantial number of cases of severe disease and death&quot; among previously healthy children and young adults, the agency said in the May 8 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The snapshot of the outbreak -- up to date as of May 6 -- suggests several novel aspects:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;The percentage of patients requiring inpatient treatment seems to be higher than would be expected during a typical flu season, although the agency cautioned that many of the numbers associated with the outbreak are still not firm.
                &lt;li&gt;The age distribution of inpatients -- mostly young adults -- is different from that of seasonal influenza, where children under two, adults over 65, and people with chronic health conditions are the ones who typically need hospital care.
                &lt;li&gt;In Mexico and the U.S., the percentage of patients requiring hospital care has been particularly high among those ages 30 to 44.
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;In Mexico, where nearly 1,000 cases have laboratory confirmation, information is available on the clinical course for 22 inpatients with laboratory-confirmed illness, including seven who died, the agency said.
              &lt;p&gt; 
              &lt;p&gt;Five of the 15 surviving patients and one of the seven patients who died had underlying chronic medical conditions. Additional details on the clinical signs and symptoms of these and other patients are being collected, the CDC said.
              &lt;p&gt; 
              &lt;p&gt;The H1N1 symptoms were by and large similar to typical flu. Among patients with confirmed cases for whom information was available, 98% reported fever, 94% reported cough, 79% reported shortness of breath, 80% reported headache, and 83% reported runny nose.
              &lt;p&gt; 
              &lt;p&gt;There were minor differences in the U.S. where almost 650 confirmed cases have been reported. Among patients with confirmed disease for whom data were available, the CDC said that 90% reported fever, 84% reported cough, 61% reported sore throat, 26% reported diarrhea, and 24% reported vomiting.
              &lt;p&gt; 
              &lt;p&gt;Outside the U.S. and Mexico, the World Health Organization was reporting more than 300 laboratory-confirmed cases, the CDC said, and all but a handful were uncomplicated.
              &lt;p&gt; 
              &lt;p&gt;The vast majority of those patients reported travel to Mexico, the agency said. Of those with a travel history available, the CDC reported, 82% had recently been to Mexico and four reported traveling to the U.S. Among those who had not traveled to Mexico, 52% reported contact with a recent traveler.
              &lt;p&gt; 
              &lt;p&gt;Although there have been cases of second-generation transmission outside the U.S. and Mexico -- a healthcare worker in Germany who had cared for a patient with a confirmed infection came down with the flu -- there&apos;s no evidence of sustained community transmission in other countries, the CDC said.
              &lt;p&gt; 
              &lt;p&gt;As in North America, most cases reported from other countries have been among young adults, with a median age of 27.1 years. 
           
    </recommendedItem>
    <recommendedItem id="20090101_19_3088"
                     title="Bacteria Had Role in Some H1N1 Deaths"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/16220?impressionId=1265754958129"
                     
      &lt;p&gt;Bacterial lung infections were common among 77 people who died because of the 2009 H1N1 flu, a finding similar to past pandemics, the CDC said.&lt;/p&gt;
&lt;p&gt;In a subset of the 600 U.S. deaths associated with the current pandemic, 29% had a bacterial coinfection, the agency said in a early release from the &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The most common pathogen found was &lt;em&gt;Streptococcus pneumoniae&lt;/em&gt;, identified in 10 of the 22 cases of coinfection, the agency said.&lt;/p&gt;
&lt;p&gt;The finding underscores the need for vaccination against pneumococcus, according to CDC epidemiologist Matthew Moore, MD, one of the report&apos;s co-authors.&lt;/p&gt;
&lt;p&gt;&quot;Our influenza season is off to a fast start, and, unfortunately, there will be more cases of bacterial infections in people suffering from influenza,&quot; Moore said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s really important for people, especially those at high risk for the serious complications from influenza, to check with their provider when they get their influenza vaccine about being vaccinated against pneumococcus,&quot; he said.&lt;/p&gt;
&lt;p&gt;In previous pandemics, the agency said, most deaths blamed on the flu have occurred concurrently with a bacterial coinfection, but that had not been shown so far in the current outbreak.&lt;/p&gt;
&lt;p&gt;Indeed, two early reviews of severe cases had shown no bacterial coinfections among 40 H1N1 inpatients, 10 of whom were in intensive care.&lt;/p&gt;
&lt;p&gt;&quot;These reports might have led to a perception that bacterial coinfections are playing a limited role or no role in influenza deaths during the current pandemic,&quot; the CDC said.&lt;/p&gt;
&lt;p&gt;But the CDC said such an absence of evidence might simply reflect the difficulty of identifying pathogens.&lt;/p&gt;
&lt;p&gt;Although the current report established that bacterial coinfection is playing a role, the results don&apos;t give information about the rate of bacterial pneumonia among H1N1 patients, the agency said.&lt;/p&gt;
&lt;p&gt;The cases studied for the report are not a systematic sample and might not be representative of all serious H1N1 cases, the CDC said.&lt;/p&gt;
&lt;p&gt;Along with the 10 cases of pneumococcus infection, analysis found: &lt;ul&gt; &lt;li&gt;Seven cases of &lt;em&gt;Staphylococcus aureus&lt;/em&gt;&lt;/li&gt; &lt;li&gt;Six of &lt;em&gt;Streptococcus pyogenes&lt;/em&gt;&lt;/li&gt; &lt;li&gt;Two of &lt;em&gt;Streptococcus mitis&lt;/em&gt;&lt;/li&gt; &lt;li&gt;And one of &lt;em&gt;Haemophilus influenzae&lt;/em&gt;&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Four cases involved multiple pathogens.&lt;/p&gt;
&lt;p&gt;No information was available on the vaccination status of the 22 patients, but one was younger than five years and was therefore a candidate for the pneumococcal conjugate vaccine (Prevnar).&lt;/p&gt;
&lt;p&gt;Fifteen others had underlying medical conditions that were indications for the 23-valent polysaccharide vaccine (Pneumovax or Pnu-Immune).&lt;/p&gt;

    </recommendedItem>
</recommendedContent>
