Flu in Pregnancy May Increase Child’s Bi-Polar Risk 4x

Pregnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood, in a study funded by the National Institutes of Health. The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

“Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University and New York State Psychiatric Institute, a grantee of the NIH’s National Institute of Mental Health (NIMH). “In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.” [Read more…]

Flu Prevention for Children and Teens – Report

Although children and teenagers rarely die from flu–related causes, many of the deaths could have been prevented if the children had been vaccinated against the flu, according to a report by the Centers for Disease Control and Prevention.

The study reports 115 influenza–associated deaths of people younger than 18, from September 2010 through August 2011 and highlights the importance of both annual vaccination and rapid antiviral treatment.

“It′s vital that children get vaccinated,” said Dr. Lyn Finelli, chief of the CDC′s Surveillance and Outbreak Response Team. “We know the flu vaccine isn′t 100 percent effective, especially not in children with high risk medical conditions. That′s why it′s essential that these two medical tools be fully utilized. Vaccinate first; then use influenza antiviral drugs as a second line of defense against the flu. Right now we aren′t fully using the medical tools at our disposal to prevent flu illnesses and deaths in children.”

The study in CDC′s Morbidity and Mortality Weekly Report provides details on the deaths. Since 2004, states have been required to report influenza-associated deaths in children and teenagers, giving the CDC a chance to look closely at factors that can increase risk.

Among the most notable findings was the infrequent use of the most important influenza prevention measure – vaccination. Despite a recommendation for vaccination of all children 6 months of age and older having been in place since 2008, only 23 percent of the 74 children older than six months with a known vaccination history had received their flu vaccine last season.

While many people believe that healthy children can withstand a bout of flu, this is not always the case. About half of the children who died last season were previously healthy and did not have a medical condition that would put them at risk for flu complications. However, the report underscores the fact that young age in itself is a risk factor. The report identified that 46 percent of the children who died were younger than 5 years and 29 percent were younger than 2 years.

The other half of the children who died did have a medical condition that predisposed them to being at greater risk of flu complications. Of 57 children with a medical condition, 54 percent had a neurological disorder, 30 percent had pulmonary disease, 25 percent had a chromosome or genetic disorder and 19 percent had congenital heart disease or other cardiac disease.

The report also identified issues with the use of antiviral drugs, which provide effective treatment for influenza. Of the 94 children who died in a hospital or emergency department, only 50 percent were prescribed antiviral drugs. Since the 2009 H1N1 pandemic especially, CDC has recommended immediate treatment with influenza antiviral medications in severely ill patients with suspected flu.

Another report in the Sept. 16 MMWR provides a summary of influenza activity from mid–May to the beginning of September. “If trends in that report continue,” Finelli says, “we should have a vaccine that will offer good protection against the viruses we expect will circulate this season.”

This season′s influenza vaccine protects against three influenza viruses, the 2009 influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. These are the same three flu virus strains that were circulating in 2010–2011 – just the eighth time since 1969 this phenomenon has occurred. Moreover, it is important to note that vaccine immunity wanes over time so CDC is recommending that everyone get vaccinated this season, even if they got vaccinated last season, in order to be optimally protected.

Source: CDC

Study Models H1N1 Flu Spread

As the United States prepares for the upcoming flu season, a group of researchers continues to model how H1N1 may spread.

The work is part of an effort  called the Models of Infectious Disease Agent Study (MIDAS), to develop computational models for conducting virtual experiments of how emerging pathogens could spread with and without interventions. The study, supported by the National Institutes of Health, involves more than 50 scientists with expertise in epidemiology, infectious diseases, computational biology, statistics, social sciences, physics, computer sciences and informatics.

As soon as the first cases of H1N1 infections were reported in April 2009, MIDAS researchers began gathering data on viral spread and affected populations. This information enabled them to model the potential outcomes of different interventions, including vaccination, treatment with antiviral medications and school closures. The work built upon earlier models the MIDAS scientists developed in response to concerns about a different potentially pandemic influenza strain H5N1 or avian flu.

“Computational modeling can be a powerful tool for understanding how a disease outbreak is unfolding and predicting the implications of specific public health measures,” said Jeremy M. Berg, Ph.D., director of the National Institute of General Medical Sciences, which supports MIDAS. “During the H1N1 pandemic, MIDAS scientists applied their models to see what they could do to help in a real situation.”

Because the H1N1 flu strain is still circulating, a MIDAS group based at the University of Washington in Seattle is now studying the impact the virus could have this fall and winter. Its model, which represents the world population, includes information about immunity — how many people are protected by vaccination or prior infection—and the other circulating flu strains. Using the model, the scientists may be able to predict how H1N1 evolves and the possible role of the H3N2 strain, which historically has been the dominant seasonal flu virus. The results also may help forecast the potential effectiveness of the new flu vaccine that includes both the H1N1 and H3N2 viral strains.

Estimating Severity

To predict the likely severity of H1N1 in the fall and winter months following the initial outbreaks, the MIDAS group led by Marc Lipsitch, D.Phil., of the Harvard School of Public Health in Boston analyzed patient care data from Milwaukee and New York City. The researchers estimated that about 1 in 70 symptomatic people were admitted to the hospital, 1 in 400 required intensive care and 1 in 2,000 died. They predicted H1N1 to be no more and possibly even less severe than the typical seasonal flu strain. The work, which factored in local differences in flu detection and reporting, also showed that it’s possible to make predictions about severity using data from the early stages of an outbreak.

Vaccinating Children

Ira Longini, Ph.D., at the University of Washington and his MIDAS colleagues developed a simulation model to evaluate the effectiveness of different strategies to vaccinate school-aged children, who are known to play a key role in transmitting the flu virus. They modeled a range of scenarios that varied the type of vaccine, the percentage of children vaccinated and the infectiousness of the virus. For each situation, the modeling results indicated that vaccinating this age group substantially reduced overall disease spread and prevented up to 100 million additional cases in the general population. These effects, however, were less strong when the virus was more contagious or when fewer children were vaccinated. Based on these results, Longini’s group concluded that vaccine distribution strategies should depend on a number of factors, including vaccine availability and viral transmission rates.

Cost-Benefit of Employee Vaccination Programs

In one of the first analyses of the economic value of work-sponsored seasonal and pandemic flu vaccine programs, the MIDAS group led by Donald Burke, M.D., at the University of Pittsburgh developed a model that estimated the employer cost to be less than $35 per vaccinated employee with a potential savings of $15 to $1,494 per employee, depending on the infectiousness of the virus.

Interventions and Local Demographics

To determine if a vaccination strategy would likely have the same effect in different locations, a team led by MIDAS investigator Stephen Eubank, Ph.D., of the Virginia Bioinformatics Institute at Virginia Tech in Blacksburg developed models representing the demographics of Miami, Seattle and each county in Washington. The models indicated that while vaccinating school-aged children was the best strategy in each place, the optimal timing and overall effectiveness of the approach varied due to specific characteristics of the local population, such as age, income, household size and social network patterns. These differences, Eubank concluded, suggest that vaccination and probably other intervention strategies should take local demographics into account.

Antiviral Medications

Lipsitch’s collaborators Joseph Wu, Ph.D., and Steven Riley, D.Phil., at the University of Hong Kong used mathematical modeling to predict the likelihood that the H1N1 strain would develop resistance to the widespread use of antiviral medications taken to lessen flu symptoms. Their work showed that giving a secondary antiviral flu drug either prior to or in combination with a primary antiviral could mitigate the emergence of resistant strains in addition to slowing the spread of infection. The results, the researchers concluded, point to the value of stockpiling more than one type of antiviral drug.

School Closures

A public health measure under consideration was closing schools, which previous MIDAS pandemic flu models identified as a potentially effective intervention. According to Burke’s model of Allegheny County, Penn., closing individual schools after they identified cases may work as well as closing entire school systems. When strictly maintained for at least 8 weeks, both types of school closure could delay the epidemic peak by up to 1 week, allowing additional time to develop and implement other interventions. However, the model also indicated that school closures lasting less than 2 weeks could actually facilitate flu spread by returning susceptible students to school in the middle of an outbreak.

“Models like the ones MIDAS has developed help us understand not only trends in disease spread, but also how different factors can influence those trends,” said Irene A. Eckstrand, Ph.D., who directs the MIDAS program. “MIDAS research is leading to new tools and approaches that can aid in making public health decisions at a range of levels, from local to national.”

Source: National Institutes of Health (NIH), September 21, 2010

World Health Organization Declares End to H1N1 Influenza Pandemic

The World Health Organization (WHO) International Health Regulations (IHR) Emergency Committee and the WHO Director-General, Dr. Margaret Chan, today declared an end to the 2009 H1N1 influenza pandemic. This declaration was based on strong indications that influenza, worldwide, is transitioning toward seasonal patterns of transmission.

In the majority of countries, out-of-season 2009 H1N1 outbreaks are no longer being observed, and the intensity of 2009 H1N1 influenza virus transmission is lower than that reported during 2009 and early 2010. Members of the Emergency Committee further noted that the 2009 H1N1 viruses will likely continue to circulate for some years to come, taking on the behavior of a seasonal influenza virus.

This does not mean that the H1N1 virus has disappeared. Rather, it means current influenza outbreaks including those primarily caused by the 2009 H1N1 virus, show an intensity similar to that seen during seasonal epidemics. Pandemics, like the viruses that cause them, are unpredictable. WHO noted that continued vigilance is extremely important, and it is likely that the virus will continue to cause serious disease in younger age groups and pregnant women, at least in the immediate post-pandemic period.

The WHO Director-General ended the Public Health Emergency of International Concern in accordance with the International Health Regulations (2005).

Implications for United States
This is a formal WHO declaration regarding the end of the pandemic at the global level. The U.S. Public Health Emergency determination for 2009 H1N1 Influenza expired on June 23, 2010.

The only impact on the United States resulting from the WHO declaration will be a cessation in weekly reporting under the International Health Regulations (IHR) to the Pan American Health Organization and the World Health Organization. CDC has reported weekly to IHR since early in the pandemic.

There are no changes for the United States in terms of CDC’s recommendations for the upcoming influenza season and the United States is already proceeding with the understanding that the 2009 H1N1 virus is now part of seasonal influenza virus circulation.

Protecting Yourself and Others from Influenza
CDC recommends a three-step approach to fighting flu: vaccination, everyday preventive actions and the correct use of antiviral drugs if your doctor recommends them. The first and most important step in protecting against the flu is to get a flu vaccine each season.

The U.S. 2010-2011 influenza vaccine will protect against an H3N2 virus, an influenza B virus, and the 2009 H1N1 influenza virus that caused the first global pandemic in more than 40 years and resulted in substantial illness, hospitalizations and deaths. In the United States, the CDC’s Advisory Committee on Immunization Practices recently recommended that everyone 6 months of age and older be vaccinated against influenza each season. Pregnant women, young children, and anyone with underlying health conditions like asthma, diabetes and neuromuscular diseases are at especially high risk for influenza-related complications and, therefore, should be vaccinated as soon as vaccine becomes available. Vaccine manufacturers are predicting an ample supply of influenza vaccine for the upcoming 2010-2011 U.S. influenza season.

Source: CDC, August 10, 2010

Pandemic Flu Can Be Controlled Pending Availability of a Vaccine

Prompt use of social-distancing measures, antiviral treatment and prophylaxis could control an outbreak of pandemic influenza in the United States, pending the availability of a vaccine, according to a recently-published study.

Three teams of researchers in the U.S, and England, in close collaboration with Government officials, studied various intervention combinations to guide national pandemic planning. The three research teams and an informatics group that participated are part of the Models of Infectious Disease Agent Study (MIDAS) Network, an effort funded by the National Institute of General Medical Sciences, or NIGMS.

"The federal government wanted three separate infectious-disease-modeling groups working on the same problem just to make sure the results were robust, since this data would be used to inform national pandemic planning," said the study’s co-author, Ira M. Longini Jr., Ph.D. "We got the highest level of input."

The researchers concentrated on assessing the effectiveness of a blend of antiviral and social-distancing interventions (like closing schools) in preventing a flu pandemic, since a vaccine was unavailable at the time. Other studies had shown that a vaccine would be very helpful in slowing a pandemic.

"The good news was that all three of the disease-modeling groups involved in the study found that an outbreak of pandemic flu similar to the pandemic of 1918 could be mitigated if these measures were implemented quickly," said M. Elizabeth Halloran, M.D., D.Sc., the study’s lead author.

To conduct the study, the researchers used three separate but similar computer models to calculate the spread of influenza within a population similar to that of Chicago, with approximately 8.6 million people. Members of this virtual community interacted the way people normally do: within households, schools and workplaces, and the community at large. All three models were set up to have attack-rate patterns similar to those of past U.S. flu pandemics.

Predicting the spread of an infectious disease such pandemic influenza requires much more than simply connecting dots on a map. Instead, Halloran and colleagues rely on a tool called stochastic modeling to take into account real-world unpredictability, as well as many factors about the disease and the affected population. In constructing these models, the researchers begin with assumptions about how people interact and how the virus spreads. They also introduce and evaluate the effectiveness of various intervention strategies.

These were the findings published in the online Early Edition of PNAS, a publication of the Proceedings of the National Academy of Sciences of the United States of America. M. Elizabeth Halloran, M.D., D.Sc., was the lead author, Ira M. Longini Jr., Ph.D., was the co-author. Both are researchers at Fred Hutchinson Cancer Research Center and professors of biostatistics at the University of Washington, and use mathematical and statistical methods to study the natural course of infectious diseases. Prior to publication, Longini presented the findings at the White House and at the Institute of Medicine.

Industry Standards Needed for Children’s Flu Vaccine, Says Report

Evaluating and establishing industry standards for flu vaccines for hospitalized children could help prevent additional hospitalizations and complications from influenza, according to a study published in a recent issue of Pediatrics.

A research team led by Danielle M. Zerr, MD, MPH, medical director of infection control at Seattle Children’s Hospital and associate professor of Pediatrics at the University of Washington School of Medicine (UWSOM), monitored the number of times children with influenza had been hospitalized, and summarized their findings in an article entitled "Hospital-Based Influenza Vaccination of Children: An Opportunity to Prevent Subsequent Hospitalization."

It was found that 23% of the children admitted to hospital with influenza had a previous hospitalization during the most recent flu season. This suggests that providing in-hospital vaccinations when the children were at highest risk for influenza could reduce the rates of childrens’ influenza during the flu season.

Approximately 14,000 children were hospitalized with influenza—and 170,000 were hospitalized with influenza or a respiratory illness—during a 5-year period (2001–2006) when discharge data provided by the Pediatric Health Information System (PHIS) database was analyzed. The data was checked to see how many children had a previous hospitalization during the most recent flu season.

Researchers found approximately 16% of those hospitalized with influenza and 23% of those hospitalized with influenza and another underlying condition had previous hospital admissions during the vaccination season.

"This information will help pediatricians recognize hospitalization as an important opportunity to vaccinate the highest-risk children, and may hopefully prompt the development of hospital-based flu vaccine programs," said Zerr.

The study looked at five years of hospital discharge data from the Pediatric Health Information System (PHIS) database from 2001 through 2006 to determine how many children hospitalized with influenza or respiratory illness had a previous hospitalization during the most recent flu-vaccine season. PHIS is an administrative database developed by the Child Health Corporation of America (CHCA), used by 42 free-standing pediatric hospitals. Subjects included newborns through age 18. A previous hospitalization during flu vaccination season was considered if it occurred in the two weeks to six months prior to the influenza admission and between September 1 and March 1. Approximately 14,000 cases of children hospitalized with influenza and 170,000 hospitalized with influenza or a respiratory illness were reviewed.

Source: Pediatrics, February, 2008

Teaching Kids Hand Washing Habits to Avoid Flu

A new study, presented at the American Public Health Association’s Annual Meeting & Exposition in Washington, D.C. shows that with a little effort, kids can be taught to make hand-washing a lifetime habit.
A sample of 492 children in grades 1 through 6 was coached by a teacher, with role-playing and education on hand hygiene and a visual demonstration of its effectiveness. The coaching resulted in a lasting increase in the frequency of hand hygiene among elementary school-aged children.
The researchers suggest that with parent volunteers and the limited funds available, the school nurse could train the volunteers to teach a hand hygiene method, using germ-simulating lotion. The teachers could then prompt students to wash their hands before lunch, setting the example by washing their own hands.
"With flu season right around the corner, now is a great time to be having a conversation about what schools can do to encourage kids to develop the habit of washing their hands," said Michelle Snow, RN, MSPH, SHR, lead researcher on the study. "Our research shows that for a very low cost and just a little bit of effort, we can have an impact on a behavior that is important for our children’s health, not just now, but throughoutmtheir lives."
Source: American Public Health Association (APHA)

Flu Shot Decreases Elderly Death Risk by Half Says Study

A recent study published in The New England Journal of Medicine indicates that seniors over 65 who get the flu vaccine cut their risk of influenza death in half, and that vaccination lowers hospitalization rates by 27 percent.

Approximately 36,000 deaths and 200,000 hospitalizations are attributed to the flu each year in the United States.

The study, lead by Dr. Kristin Nichol, from the Minneapolis VA Medical Center, was conducted on approximately 300,000 unvaccinated and 415,000 vaccinated seniors over the age of 65 from three different HMO’s over 10 years.

Interestingly, this study contradicts one that was released just last week that indicated results of flu vaccine effectiveness were exagerated. Dr. Nichol’s study attempted to address some of the discrepancies.


Source: The New England Journal of Medicine, October 4,


Tamiflu May Lead to Dangerous Behavior

Japan’s health ministry has issued a warning to physicians in Japan that the bird-flu drug Tamiflu should not be prescribed to teenagers after some teens exhibited dangerous behavior after taking the drug.

The ministry reported delerium, hallucinations, and other potentially dangerous psychiatric behavior among some Japanese teens. Two Japanese youth fell from their apartment rooftops while taking the drug.

The drug’s manufacturer, Roche Holdings, indicated that they have seen no study linking the drug with the behavior in these Japanese teens.

Source: AP