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Online Discussion: Tracking new emerging diseases and the next pandemic; Now tracking the Aussie Flu.

SECONDARY PNEUMONIA FROM SEVERE FLU

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PandemicsHappen View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote PandemicsHappen Quote  Post ReplyReply Direct Link To This Post Posted: December 13 2007 at 3:00pm
In regard to the above Personal Air Purifier - Courtesy of Tom Waites:

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(Don't be a sucker - Prep Up)
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Alyssa View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Alyssa Quote  Post ReplyReply Direct Link To This Post Posted: February 10 2008 at 2:49pm
    How long is a pneumonia vaccination good for?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote PandemicsHappen Quote  Post ReplyReply Direct Link To This Post Posted: February 10 2008 at 4:06pm
AFT Family,

For very good information about
Avian Influenza A (H5N1) Infection
in Humans, see this link to a free
article from the New England Journal of Medicine.

Due to the broad interest in the
article it is also available in the following languages:
Deutsch, Polski, Espanol, Portugues, Brasileiro, Francais, Turkce, Italiano.

Link: http://content.nejm.org/cgi/content/full/353/13/1374#T3


     
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 26 2008 at 12:48pm
Are you ready?  Annie
Vaccines Stand Ready for Flu Season

On this page:

Vaccination is the key component of influenza prevention.

Commonly called "the flu," influenza is a virus-induced, contagious respiratory illness. The Food and Drug Administration (FDA) plays a key role in protecting Americans against seasonal strains of flu.

Assuring the safety of influenza vaccine is one of the agency's top priorities. So is ensuring that there's enough vaccine for everyone who wants it—especially for people who are at risk of complications of influenza.

There are two kinds of influenza vaccines:

  • The flu shot contains inactivated, or killed, influenza viruses.
  • The nasal vaccine is known by the trade name of FluMist. It contains weakened, live viruses, and is sprayed into both nostrils.

Autumn is the best time to get vaccinated, although getting the vaccine in the winter months when flu season often peaks is also recommended.

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Six for This Season

FDA has approved six vaccines for the 2008-2009 flu season. All are for use against influenza disease caused by influenza virus types A and B. They are

  • Afluria, for adults 18 years of age and older
  • Fluarix, for adults 18 years of age and older
  • FluLaval, for adults 18 years of age and older
  • Fluvirin, for people 4 years of age and older
  • Fluzone, for people 6 months of age and older
  • FluMist, for people ages 2 to 49

Manufacturers of the six vaccines project about 146 million doses will be available for this influenza season, according to the U.S. Centers for Disease Control and Prevention (CDC).

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A Challenging Process

"One of the biggest challenges in the fight against influenza is producing new vaccines every year," says Jesse L. Goodman, M.D., M.P.H., Director of FDA's Center for Biologics Evaluation and Research. "There is no other instance where new vaccines must be made every year. The approval of flu vaccines is a part of FDA's mission to promote the health of Americans throughout the year."

Experts from FDA, CDC, the World Health Organization, and other institutions annually study virus samples and disease patterns collected worldwide in an effort to identify strains that may cause the most illness in the upcoming season.

Based on those forecasts and on the recommendations of its Advisory Committee, FDA each February decides on the three strains that manufacturers should include in their vaccines for the U.S. population. Each season's vaccines are modified to reflect the virus strains most likely to be circulating and cause the flu.

In an unusual occurrence, FDA changed all three strains for this year's influenza vaccine. Usually, only one or two strains are updated from year to year.

This year's vaccines include the following strains:

  • an A/Brisbane/59/2007 (H1N1)-like virus
  • an A/Brisbane/10/2007 (H3N2)-like virus
  • a B/Florida/4/2006-like virus

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Health Professionals Need It Too

The approach of flu season also serves to remind health care workers to get vaccinated against influenza. The U.S. Department of Health and Human Services (HHS) recently launched an initiative to help improve vaccination rates among health care personnel.

Influenza vaccination should be considered a part of patient safety. Studies have shown that only about 4 in 10 health care professionals are vaccinated every year. Those that don't get vaccinated can cause influenza outbreaks in health care settings.

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Flu Facts

What are the symptoms? Seasonal influenza—or flu—is a contagious respiratory illness caused by viruses. Symptoms include fever, headache, body aches, chills, extreme exhaustion, and weakness.

How is it spread? Flu is spread through coughing or sneezing. You can also get it by touching objects that are carrying the virus, such as telephones and door knobs, and then touching your mouth or nose. Wash your hands often and teach children to do the same. Most healthy adults may be able to infect others one day before their own symptoms develop and up to five days after becoming sick.

How many people are affected? Each year, according to CDC, an average of 5% to 20% of the U.S. population gets the flu. More than 200,000 people are hospitalized from flu complications. There are about 36,000 flu-related deaths each year.

What are the possible complications? Most people recover from the flu within one to two weeks. But some develop serious complications such as pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions such as congestive heart failure, asthma, or diabetes.

Who is at higher risk for complications? Some individuals—particularly elderly people, young children, and people with chronic medical conditions—are at higher risk for flu-related complications. Vaccination of these groups and of health care personnel is critical.

Can you get the flu from a flu shot? Although some people get a mild fever, body aches, and fatigue for a few days, you can't get the flu from a flu shot. Soreness at the injection site is a common side effect of the flu shot

This article appears on FDA's Consumer Health Information Web page (www.fda.gov/consumer), which features the latest updates on FDA-regulated products. Sign up for free e-mail subscriptions at www.fda.gov/consumer/consumerenews.html.

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For More Information

FDA's Flu Information Web Site
www.fda.gov/oc/opacom/hottopics/flu.html

Information on Approved Influenza Vaccines
www.fda.gov/cber/efoi/approve.htm#flu

FDA Approves 2008-2009 Flu Vaccines
www.fda.gov/bbs/topics/NEWS/2008/NEW01872.html

Health Care Personnel Initiative to Improve Influenza Vaccination Toolkit
www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html

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Updated: September 26, 2008

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Post Options Post Options   Thanks (0) Thanks(0)   Quote GuestRN Quote  Post ReplyReply Direct Link To This Post Posted: October 09 2008 at 5:14am
Where is Jacksdad?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: October 18 2008 at 12:39pm
Good article from CIDRAP.    Clearly the PPV Vaccine could prevent a pandemic and could save a lot of lives.  
 
 

Study: Bacterial pneumonia was main killer in 1918 flu pandemic

Robert Roos * News Editor

Aug 22, 2008 (CIDRAP News) – It was secondary bacterial pneumonia—not the influenza virus by itself—that killed most of the millions who perished in the 1918 flu pandemic, which suggests that current pandemic preparations should include stockpiling of antibiotics and bacterial vaccines, influenza researchers reported this week.

Experts at the National Institute of Allergy and Infectious Diseases (NIAID) examined pieces of lung tissue preserved from 58 victims of the 1918 pandemic and reviewed reports distilled from thousands of autopsies to reach their conclusions, published online by the Journal of Infectious Diseases.

"Histological and bacteriologic evidence suggests that the vast majority of influenza deaths resulted from secondary bacterial pneumonia," says the report by David M. Morens, MD, Jeffery K. Taubenberger, MD, PhD, and NIAID Director Anthony S. Fauci, MD.

Many accounts of the 1918 pandemic have emphasized how quickly patients succumbed to the infection, creating an impression that a large share of the victims died of the virus's direct effects on the lungs or the immune system's intense response to the infection. But the new report suggests that more than 90% actually died of invading bacterial pneumonia after the virus wiped out cells lining the bronchial tubes and lungs.

"In essence, the virus landed the first blow while bacteria delivered the knockout punch," said Fauci in an NIAID news release.

Lung sections and autopsy reviews
The researchers pursued two strategies. First, they examined sections newly cut from blocks of lung tissue preserved from 58 military members who died during the pandemic, representing all known 1918 flu cases in a tissue collection at the Armed Forces Institute of Pathology.

Second, they reviewed 1918-era literature on influenza pathology and bacteriology, gleaning 109 reports providing useful bacteriologic information from 173 series of autopsies. These covered 8,398 autopsies from 15 countries.

Nearly all of the lung tissue examinations yielded "compelling histologic evidence of severe acute bacterial pneumonia, either as the predominant pathology or in conjunction with underlying pathologic features now believed to be associated with influenza virus infection," including damage to the bronchial epithelium, the report says. Bacteria were often present in "massive numbers."

In perusing the contemporary autopsy studies, the authors found 96 reports of lung tissue culture results from 5,266 patients, in which only 4.2% showed no bacterial growth. In 68 "higher quality" autopsy series, representing 3,074 patients, 92.7% of the lung cultures were positive for at least one bacterial species. Cultures of blood samples from another 1,887 victims were positive for bacteria in 70.3% of cases.

At the time of the pandemic, nearly all experts agreed that deaths were almost never caused by the then-unidentified flu virus itself, "but resulted directly from severe secondary pneumonia caused by well-known bacterial 'pneumopathogens' that colonized the upper respiratory tract," the report states. The most common pathogens were pneumococci, streptococci, and staphylococci.

The authors also reviewed evidence from the relatively mild pandemic of 1957-58 and determined that most deaths were due to secondary bacterial pneumonia. In addition, the "few relevant data from the 1968-1969 pandemic" reflect the same pattern, they write.

"We believe that the weight of 90 years of evidence, including the exceptional but largely forgotten work of an earlier generation of pathologists, indicates that the vast majority of pulmonary deaths from pandemic influenza viruses have resulted from poorly understood interactions between the infecting virus and secondary infections due to bacteria that colonize the upper respiratory tract," the report says.

Severity still unexplained
The researchers say their findings leave the extreme severity of the 1918 pandemic unexplained. Because they found evidence of many different types of invading bacteria, it was probably not due to specific virulent bacterial strains. Instead, they speculate that "any influenza virus with an enhanced capacity to spread to and damage bronchial and/or bronchiolar epithelial cells" could pave the way for bacteria in the upper respiratory tract to invade the lungs and cause a severe infection.

The authors suggest that, as in past pandemics, secondary bacterial pneumonia is likely to be the leading killer in the next pandemic—if it is caused by "a human-adapted virus similar to those recognized since 1918." If that's the case, they assert, pandemic preparations must go beyond the development and stockpiling of influenza vaccines and antiviral drugs; efforts should also include the stockpiling of antibiotics and bacterial vaccines to protect against bacterial pneumonia.

However, the investigators also write that if a derivative of the H5N1 avian flu virus causes a future pandemic, lessons from past pandemics may not be "strictly applicable." That virus's pathogenic mechanisms may be atypical because it is poorly adapted to humans and because it causes unusual pathology in animals. On the other hand, they say that if the H5N1 virus fully adapts to humans, the spectrum of resulting disease could revert to something more similar to what was seen in past pandemics.

Study may change thinking
William Schaffner, MD, an influenza expert and chairman of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville, said the new study may change the general understanding of the causes of death in the 1918 pandemic.

"The general notion at least heretofore is that there were two kinds of deadly illnesses, the first caused by the virus all by itself," Schaffner told CIDRAP News. "We know that the influenza virus can cause primary pneumonia, and the time course was so brief from onset to death in many patients that it was thought this was likely due to an extremely virulent influenza virus—an influenza virus on steroids."

But it has also been assumed that bacterial pneumonia often complicated flu cases then, as it does today, and was fatal for many patients in that pre-antibiotic era, he added. "So the general notion was that there were two causes of death. The general sense was that the former, the virus, was more important than the latter. This comes largely from repeated stories about the rapidity with which this carried people off."

But the findings of Morens and colleagues indicate that secondary bacterial pneumonia was the more common cause of death. "The impressive thing is, though this is a tiny, tiny sample of what went on, they showed bacterial pneumonia was extraordinarily common," Schaffner said. "I think they make the point that it was in every one of the autopsy sections they examined. I have to tell you that made me sit up."

He suggested one possible source of inadvertent bias in the study: Because the evidence is derived from autopsies, the subjects included in the study could represent a skewed sample. The victims most likely to be autopsied were those who died in hospitals, and they probably were less sick initially and had a longer course of illness than those who died at home, Schaffner said. Those who died at home were much less likely to be autopsied.

Nevertheless, the study is an important contribution for showing that bacterial pneumonia was common in the 1918 pandemic, Schaffner added. "I'm still not convinced that that bimodal concept [of the causes of death in 1918] is not true," he said. "These fellows have nailed the second part; I'm just not sure they represent the entire population of deaths."

Schaffner observed that the idea of including bacterial pneumonia in pandemic planning has already been under discussion for a while. "But the fact that Tony Fauci lends his name to these discussions gives them impetus because of his central role in the pandemic planning process in Washington," he said.

He said the federal stockpile of drugs and medical supplies for public health emergencies includes some antibiotics, but they are mainly intended for bioterrorism-related diseases, such as ciprofloxacin for anthrax. But some of the antibiotics might be useful for both bioterrorism-linked diseases and pneumonia, he said.

No vaccines to prevent bacterial pneumonia have been included in the federal stockpile, Schaffner said. However, he noted that between 40% and 50% of people aged 65 and older have been vaccinated against pneumococcal disease, as recommended by federal guidelines.

 
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http://www.pandemicflu.gov/vaccine/pneumococcal.html
 

Introduction

Influenza predisposes individuals to bacterial community-acquired pneumonia. During previous pandemics, secondary bacterial pneumonia has been an important cause of morbidity and mortality1-3 with 7-20 percent of persons with influenza infection during 1918-1919 developing secondary bacterial pneumonia, depending on the population and the phase of the pandemic4-6. Attack rates of secondary bacterial pneumonia during the less severe 20th century pandemics are less well-documented but are thought to be lower, perhaps five percent. Among those who acquired secondary bacterial pneumonia during pandemics, 20-36 percent died7.

In virtually all published series, Streptococcus pneumoniae has been the most common etiology of secondary bacterial pneumonia, accounting for 25-75 percent of cases3,6,8-15. Severe pneumococcal pneumonia associated with inter-pandemic influenza has also been described16. The biological basis for the influenza-pneumococcus association is likely related to the neuraminidase activity of individual influenza A virus subtypes17.

A key difference between previous influenza pandemics and the next one is the widespread availability in the United States of two pneumococcal vaccines. An important question is whether these vaccines could be used to prevent secondary pneumococcal pneumonia.

Effectiveness and public health impact of pneumococcal vaccines against pneumococcal pneumonia

A growing body of literature suggests that the 7-valent pneumococcal conjugate vaccine (PCV7) can prevent both invasive and non-invasive pneumococcal pneumonia caused by serotypes included in the vaccine. In clinical trials, 7- and 9-valent pneumococcal conjugate vaccines have been shown to be 20-37 percent effective against radiographically-confirmed pneumonia among young children18-21. In studies using active, population-based surveillance to evaluate the impact of PCV7 in the U.S., rates of all invasive pneumococcal disease (IPD) among children aged less than five years have declined by 75 percent while rates caused by PCV7-serotypes have declined by 98 percent22; approximately 20 percent of all IPD cases in this age group present with pneumonia. Routine use of PCV7 in the U.S. infant immunization program has also been shown to reduce all-cause pneumonia hospitalizations among children less than two years of age by 39 percent23. A South African trial of a 9-valent pneumococcal conjugate vaccine (PCV9) closely related to the 7-valent product showed that PCV9 could prevent secondary pneumococcal pneumonia among children. Children who had received PCV9 experienced 55% fewer hospitalizations for laboratory-confirmed influenza infection than children who had received placebo, suggesting that the vaccine was directly preventing pneumococcal pneumonia as a complication of influenza infection24.

Although direct vaccination of adults with pneumococcal conjugate vaccine has not been studied extensively, considerable evidence suggests a large public health impact of pediatric immunization on IPD among adults. Between 1998 and 2005, rates of IPD caused by PCV7 serotypes among adults declined by 75-85 percent, depending on the age group. In contrast to children where a minority of IPD manifests as pneumonia, approximately 75 percent of IPD cases among adults present as pneumonia, almost always requiring hospitalization25. These indirect effects of PCV7 vaccination of children apparently are not limited to IPD; in one study, routine use of PCV7 in children led to a 26 percent reduction in all-cause pneumonia hospitalizations among adults aged 18-39 years23.  Reductions occurred in other age groups but were not statistically significant.

While evidence for the ability of pneumococcal conjugate vaccines to prevent invasive and non-invasive pneumococcal pneumonia is mounting, evidence for effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) is limited to pneumococcal bacteremia, where published studies estimate the effectiveness to be 44%-81%26,27. The duration of protection of PPV23 may be greater than five years among persons aged less than 65 years but is probably less than five years among people aged greater than 65 years28. Importantly, evidence of effectiveness of PPV23 against pneumonia without bacteremia is lacking despite multiple studies that have looked for such an effect29.

Recommended vaccination schedules

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends a single dose of pneumococcal polysaccharide vaccine for all people 65 years and older and for persons 2 to 64 years of age with certain high-risk conditions (Table 1)30.  A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years. 

For children, four doses of PCV7 are recommended by the ACIP, one each at two, four, six, and 12 to 15 months of age, with catch-up schedules for children who start the series late or who miss doses (Table 1)31. 

Use of the pneumococcal vaccines for influenza pandemic preparedness

The ACIP is currently reviewing existing recommendations for routine use of pneumococcal conjugate and polysaccharide vaccines. At this time, there are no plans to change existing recommendations for PCV7 or PPV23 use specifically in preparation for a possible influenza pandemic.  Instead, emphasis should be placed on increasing vaccination coverage among those for whom the vaccines are already recommended. Administering pneumococcal vaccines during a pandemic may be complicated by personnel shortages due to illness and vaccine shortages due to excessive demand. Therefore, ensuring that all persons with pneumococcal vaccine indications have been vaccinated before a pandemic occurs may be the best way to prevent pneumococcal disease during a pandemic (Table 2)30,31.

Conclusion

To reduce the burden of secondary bacterial pneumonia during the next influenza pandemic, CDC urges healthcare providers and state immunization programs to improve pneumococcal vaccination delivery systems for patients under their care so that national vaccine coverage increases. The ideal time to accelerate vaccination efforts is during the inter-pandemic and pandemic alert phases (phases 1 through 3), when the threat of a pandemic is not imminent. At this time, CDC does not recommend changes to existing recommendations for use or stockpiling of pneumococcal vaccines in anticipation of a pandemic.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: January 13 2009 at 10:41am
Originally posted by GuestRN GuestRN wrote:

Where is Jacksdad?
 
Oops - a few months late, but I'm here. I'm lurking more than posting at the moment, but I'm still around.
"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote FluMom Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2009 at 6:55pm
Just learned something about the pneumonia vaccine if you are under 65 you must get a booster shot 5 years after the first shot to make sure it works.

I just gave my teenager the pneumonia vaccine over Christmas break. I have been ahead of the medical advice. My child got the flu shot 6 years ago when the Dr.s and AMA said NO to that. I demanded it and finally got it then and every year after. NOW, the Dr.s and AMA say that every child should have the flu shot. GEE, DUH!
Always Be Prepared
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Post Options Post Options   Thanks (0) Thanks(0)   Quote timkat Quote  Post ReplyReply Direct Link To This Post Posted: July 19 2010 at 6:53am
< ="-" ="text/; =utf-8">< name="ProgId" ="Word.">< name="Generator" ="Microsoft Word 12">< name="Originator" ="Microsoft Word 12"><>

http://www.trustdownload.com/Antivirus-and-Spyware-Cleaners/Antivirus/Kaspersky-Internet-Security-7.0.html

Use this one to protect your Pc against viruses, spyware and other intruders. I use it too so I can say that is very good.

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