Maryland / Regional
Schools gear up
for swine flu shots
(The Associated Press)
Md. plan for swine flu vaccine depends on manufacturers
(Daily Record)
Age-Old Problem, Perpetually Absent Solution: Fitting Special
Education to Students' Needs
(Washington Post)
Va
expands call center for swine flu questions
(USA Today)
Berkeley
Co. schools preparing for swine flu
(Hagerstown Herald-Mail)
National /
International
Swine flu: How-to tips for school flu vaccinations
(Associated Press)
Hunting ultimate
weapon against flu
(Baltimore Sun)
Public health care U-turn
(Baltimore Sun)
Genes
Tied to Gap in Treatment of Hepatitis C
(New York Times)
Patterns: Do
Real Men Go to the Doctor?
(New York Times)
Opinion
A moral obligation?Should the
U.S. produce enough H1N1 flu vaccine to help
developing
countries?
(Baltimore Sun Commentary)
The Scourge of
Tuberculosis
(Washington Post Letter to the Editor)
Maryland / Regional
Schools gear up
for swine flu shots
By Libby Quaid and Lauran Neergaard
The Associated Press
Monday, August 17, 2009
WASHINGTON -- Hundreds of schools are heeding the government's
call to set up flu-shot clinics this fall, preparing for what
could be the most widespread school vaccinations since the days
of polio.
An Associated Press review of swine flu planning suggests there
are nearly 3 million students in districts where officials want
to offer the vaccine once federal health officials begin
shipping it in mid-October.
Many more may get involved: The National Schools Boards
Association told the AP three-quarters of the districts in a
recent survey agreed to allow vaccinations in school buildings.
In South Carolina, "there will be a massive attempt to use
schools as vaccination centers," said state Superintendent Jim
Rex. He plans at least one vaccination clinic in each of the
state's 85 school districts.
South Dakota started offering free children's vaccination
against regular winter flu in 2007, and this year it plans to
offer both kinds in many schools, said state Health Secretary
Doneen Hollingsworth.
Now come the difficult details: figuring out all the logistics
in giving squirmy youngsters a shot in the arm or a squirt in
the nose.
That's in addition to measures being taken to keep the swine flu
virus from spreading inside schools and to keep sick kids at
home.
Already, Lee County, Miss., schools have reported a few cases of
swine flu the first week of school, and a Loui siana high school
football team reported 20 players sick or recovering from it.
To make sure students wash their hands, Minneapolis schools have
outfitted every restroom with tamperproof soap dispensers, so
students don't horse around with soap. And the district has a
no-excuses policy to keep them filled.
"It sounds so simple, but it works," district emergency
management director Craig Vana said.
Bismarck, N.D., is insisting that parents keep feverish children
home. "We're going to have to be a little firmer on that this
year than in the past," superintendent Paul Johnson said.
It can be hard to tell if a child has a bad cold or flu - and
swine flu and regular flu share the same symptoms. For many
schools, a 100-degree temperature automatically means sending a
child home.
The goal is to keep schools open; federal officials said last
week schools should close only as a last resort. The emergence
of the never-before-seen flu strain last spring prompted more
than 700 schools to temporarily close, giving students an
unexpected vacation as parents scrambled to find child care.
Some big states, like California, Ohio and Massachusetts, are
focusing on those steps and not on vaccinations, because they
don't know how much vaccine the federal government will send or
when it will arrive. Boston has decided against in-school
vaccinations because an attempt at regular winter flu
inoculations at a middle school last year flopped, and Dallas
officials also have decided against school shots.
But hundreds of districts are preparing for vaccinations. At
least 700 health and school officials joined an online seminar
last week by the National Association of County & City Health
Officials on how to run school flu vaccinations.
The government is awaiting results of vaccine studies that began
last week before making a final decision on whether and how to
offer swine-flu inoculations. If vaccinations go forward,
children are to be among the first in line. They could get
vaccine at a variety of places, but federal officials want
schools to play a starring role.
"The vaccine over time will be available to every child,"
Education Secretary Arne Duncan said in an interview with the
AP. "And I personally think the best place for them to have
access would be at their local school or at a school in their
neighborhood."
An AP-GfK poll last month found parents like that convenience:
Nearly two-thirds said they were likely to give permission if
their child's school offered vaccinations.
The school setting is attractive for many reasons, said Dr. Anne
Schuchat of the Centers for Disease Control and Prevention.
Swine flu seems to strike the young most often, and it's
particularly easy to spread from child to child. Moreover,
school-age children "don't see doctors very often," Schuchat
told the AP, after they've accumulated the list of vaccinations
required for school entry.
She added that it should be relatively easy for schools to offer
flu-shot clinics because the federal government would be buying
swine flu vaccine and sending it free to states.
"You won't have to screen for insurance. That's been a big
challenge in school-associated regular flu-shot clinics,"
Schuchat said. "That slows down the process."
There is plenty of experience with vaccinating school kids for
regular flu, and there is plenty of evidence it works.
For the fourth year running, Knox County, Tenn., vaccinated
30,000 children for free in schools and daycare centers last
year. The county often closed schools because of winter flu
outbreaks in the past, but it hasn't since vaccinations began.
And in the last flu pandemic, in 1968, Tecumseh, Mich.,
vaccinated 85 percent of its school-age children, resulting in
two-thirds less illness there than in a neighboring community.
There is an important difference with this year's swine-flu
inoculations: Health officials think two separate doses, about
three weeks apart, will be needed. Studies are under way now to
confirm that. If so, it means any school that offers the first
shot must set up for each recipient to get the second dose.
Different school districts handle vaccinations differently. Some
will offer only vaccine against the regular winter flu - also
important, as both types are expected to hit this year. In
Florida's Pinellas County, which includes St. Petersburg, the
health department won an economic stimulus grant to vaccinate
every student at all 78 elementary schools against seasonal flu,
said Rita Becchetti, supervisor of school health services.
That could be confusing for parents trying to remember which
vaccine their child is getting.
Chicago, on the other hand, probably will have swine-flu shot
clinics at select high schools, not elementary schools, saying
it simply doesn't have the workers to send teams to more than
600 schools.
Berkeley County, W.Va., is considering drive-thru vaccinations
at its three high schools, said district official George
Michael.
In New York City, swine flu exploded in the spring at Saint
Francis Preparatory School, which sent home 102 sick kids in one
day. Today, City Health Commissioner Dr. Thomas Farley's first
choice is for kids to get vaccinated by their own family
doctors, but he's looking into clinics at schools or other
locations.
"There's an awful lot of children who need to be vaccinated,"
Farley said.
Once the decision is made to offer flu shots at school, there
are still issues to be worked out.
Not only must a parent sign a permission form, but someone needs
to make sure it's filled out correctly and matches up with the
kid. And there is staffing: Health professionals will need to
administer shots and also check kids for reaction to the
vaccine.
Schools will also need to decide whether parents should be
present, said Brenda Greene, director of school health programs
for the National School Boards Association.
"Are you going to do it at a time when the parents can be
present, if they want?" Greene said. "I've heard the kids are
more panicky when their parents are around than when they're
not."
Knox County, Tenn., has always used FluMist, the nasal spray flu
vaccine, to eliminate that concern, and will again this year in
school vaccinations against regular flu. But most of the swine
flu vaccine supply will be in shot form, and program director
Jennifer Johnson hasn't decided whether to offer that in
schools, too. She said one possibility is to inoculate kids at
elementary schools after-hours, so parents could hold scared
youngsters and then be vaccinated themselves.
The nasal spray is popular. Last year, FluMist maker MedImmune
said it sent about 450,000 doses of the nasal spray vaccine to
140 school vaccination programs. The company expects FluMist
vaccinations against regular winter flu to nearly double in
schools this year.
Duncan, the education secretary, understands the more immediate
issue for many schools is the start of the new school year. Once
kids are back in class, "you want to get parents focused on the
vaccine," he said.
In St. Paul, Minn., vaccinations are on the back burner until
school gets under way after Labor Day, said Ann Hoxie, assistant
director of student health and wellness.
"It's not going to be the first thing on everybody's mind.
Reading and writing remain at the top of the list," Hoxie said.
-----
Contributing to this story from the states were Associated Press
writers Seanna Adcox, Christine Armario, Donna Blankinship,
Terry Chea, Sandra Chereb, Bob Christie, Beth DeFalco, Melinda
Deslatte, P.J. Dickerscheid, Jennifer Dobner, Elizabeth Dunbar,
Benjamin Greene, Samantha Gross, Amy Beth Hanson, Carla K.
Johnson, Dirk Lammers, Sarah Larimer, Matthew Leingang, Jay
Lindsay, Deanna Martin, William McCall, Phyllis Mensing, Shaya
Mohajer, Jean Ortiz, Dinesh Ramde, Monica Rhor, Barbara
Rodriguez, Zinie Chen Sampson, Jamie Stengle, Nafeesa Syeed,
Emily Wagster Pettus and Chris Williams.
© 2009 The Associated Press.
Md. plan for swine flu vaccine depends on manufacturers
Associated Press
Daily Record
Monday, August 17, 2009
Millions of Marylanders would be immunized against swine flu for
free or for a nominal fee under a plan being developed by state
health officials, whose goal is to provide the vaccine to every
resident who wants it.
The vaccination plan is unprecedented in scope but depends on a
robust supply of the vaccine, which is expected to be ready by
mid-October at the earliest.
When it becomes available, Maryland will begin distributing the
vaccine to doctors, pharmacists, local health departments and
other partners.
The first shots will be given to those deemed most vulnerable by
the Centers for Disease Control and Prevention — pregnant women,
health care workers, children and people under 65 with chronic
health problems, said Frances Phillips, Maryland's deputy
secretary for public health.
Those priority groups account for more than 2.5 million of the
state's 5.6 million residents, Phillips said.
"That's to be followed up very quickly thereafter with
vaccinating the remaining 3 million Marylanders," Phillips said.
"It's a massive, unprecedented vaccination campaign."
Some people who receive shots will likely have to pay an
administration fee of between $10 and $20, but no one will be
denied a shot because they are unable to pay, Phillips said.
Vaccination against swine flu remains voluntary, as does
vaccination against seasonal influenza.
State officials and other experts said it's too early to guess
how many people will get shots this year because the severity of
the virus and the amount of available vaccine are difficult to
predict.
The state does not keep track of how many people receive flu
shots each year because the vaccines are typically administered
privately, officials said.
Nationwide, about 34 percent of U.S. residents were vaccinated
against seasonal flu during the 2008-09 season, according to the
CDC, despite its recommendations that 83 percent of the
population be immunized.
"There's going to be a lot of unknowns about that vaccine in
terms of the uptake," said Dr. John Bartlett, a professor at the
Johns Hopkins School of Medicine. "If it turns out to be a
serious flu with some deaths, I think people are going to want
to get it and really bite and scratch to have it available."
Under that scenario, Bartlett is doubtful that the available
domestic supply of the vaccine will allow Maryland to fulfill
its goal of making it available to everyone.
Bartlett also noted that the flu season will be well under way
before anyone becomes immunized. Vaccination against swine flu
is likely to require two doses, three weeks apart, with immunity
taking effect three weeks after the second dose, he said.
"The vaccine is going to be late," Bartlett said. "They can't
make it any faster."
Another open question: how the state will pay for all those flu
shots. The Department of Health and Mental Hygiene has received
nearly $7 million in federal grants for swine flu preparation
and will get more once it begins implementing its plans.
"The public sector can't do this alone. We can't vaccinate all
Marylanders perhaps two times. We're relying on partners,"
Phillips said, including private insurance and Medicare. "We're
hopeful we get the resources we need."
Part of the state's plan is to make the vaccine available at
schools, preferably in the form of a nasal spray, Phillips said.
But it's unclear whether there will be enough doses of
nasal-spray vaccine to immunize Maryland's 1 million school-age
children.
The state is also trying to project what would happen if
hospitals became inundated with swine flu patients. It is common
during flu season for patients to be sent to hospitals other
than the ones closest to their homes, but if swine flu hits
hard, some patients may be hospitalized much farther away,
Phillips said.
To prevent emergency rooms from being overrun, the state is
planning a communication and education campaign about how to
treat mild flu symptoms. Information will be available on Web
sites, and the state may also set up call centers, Phillips
said.
The World Health Organization has estimated that up to 2 billion
people could be sickened during the swine flu pandemic, which is
already known to be responsible for more than 1,400 deaths,
including six in Maryland.
Copyright 2009 Daily Record.
Age-Old Problem, Perpetually Absent Solution: Fitting Special
Education to Students' Needs
By Jay Mathews
Washington Post
Monday, August 17, 2009
Miguel Landeros is a lanky, well-spoken 12-year-old about to
begin seventh grade in Stafford County. He is severely learning
disabled, with reading, writing and math skill levels at least
two years below his peers, and needs special teaching, according
to a licensed clinical psychologist at the Kennedy Krieger
Institute in Baltimore and other specialists.
Last February, Stafford officials refused to accept that
evaluation and left him in regular classes. He performed poorly,
failing all core subjects. Recently, they promised to give him
more specialized services, but not the ones the experts who
examined him say he needs.
I admit that education writers in general, and I in particular,
write very little about learning disabilities and the many
failures of federally mandated public school programs to help
students who have them. I often say the cases are so complicated
I have difficulty translating them into everyday language, and
even then readers struggle to understand.
But that is not the whole truth. I also avoid special education
stories because they all seem the same, one tale after another
of frustrated parents and ill-equipped educators trying but
failing to find common ground, calling in lawyers while the
children sit in class, bored and confused.
That is not a good reason for ignoring what is probably the most
aggravating part of our public school system, at least for the
millions of parents who have to deal with it. Many prefer to
fight these battles in private. But occasionally, someone like
Kelli Castellino, Miguel's mother, shames me by e-mailing a
thick file of her correspondence and asking me to tell the
story. I will give it a try, without much hope anything will
come of it.
Castellino says Miguel attended first through fifth grades at
two Howard County elementary schools, Bryant Woods and Phelps
Luck. He struggled to learn to read, she says, but the schools
did not test him for learning disabilities until she made a
formal request in fifth grade. She was told he did not qualify
for an Individualized Education Plan, which under one federal
law would require special teaching to address his disabilities.
He received the lesser option, called a 504 plan, which under
another federal law guarantees him special accommodations in a
regular classroom setting, such as more time to complete tests.
Castellino, like other parents of children with learning
disabilities, had fallen into a jabberwocky world of legal,
educational and psychological jargon that makes money for
lawyers but leaves parents with headaches and empty bank
accounts. Different evaluators might have different views of a
child's needs. The laws are vague, although a recent U.S.
Supreme Court decision gave parents more sway in such cases.
School district evaluators -- good people placed in impossible
situations -- might choose the option that costs the least money
in hopes that will be enough. They know their budgets may not
support much else.
When Castellino moved to Stafford last year and enrolled Miguel
at Shirley C. Heim Middle School, she told school administrators
that she thought Howard County had overlooked severe problems (a
Howard spokeswoman said "not every child with a disability
qualifies for an IEP") and asked that Miguel be tested again.
School officials told her that because the Howard tests had been
so recent, they wanted to wait and see.
In November, Castellino had Kennedy Krieger evaluate Miguel.
That report identified these disabilities, with numbers
referring to entries in the Diagnostic and Statistical Manual of
Mental Disorders: "Reading Disorder (315.00); Mathematics
Disorder (315.1) and Disorder of Written Expression, 315.2
(Specific Learning Disability); Attention Deficit Hyperactivity
Disorder-Combined Type, by history, (Other Health Impaired)."
Still, the school kept Miguel in regular classes the rest of the
school year. Stafford agreed recently to offer him special
services, but in a class with mentally disabled or emotionally
disturbed children, not the placement his private evaluators
recommended.
Castellino, an office manager, says her insurance has covered
the nearly $10,000 spent on neuropsychological, speech and
language, occupational therapy, hearing, vision and assistive
technology tests by seven different evaluators, including the
$2,000 Kennedy Krieger bill. But she anticipates tapping her own
funds for future legal and private school expenses. "I am
selling my car and will be riding my bike to work, selling
anything I can in my house to come up with the money to place my
child" where he should be, she says.
I asked Stafford for a response. A spokeswoman said the school
system provides "an outstanding education for all of our
special-needs students," but she would not comment on any
individual student "even if the parent signs a waiver of privacy
rights."
Why do you suppose that is? Castellino is following the usual
course, making plans to seek a court order for a better
placement in a private school. The school district has lawyers,
too. They do not want their spokeswoman to say anything that
might weaken their case.
Here we go again. Is there an alternative, some innovative way
to help kids like Miguel? Special education vouchers? Charter
schools for the learning disabled? The old way is rutted, bumpy
and slow. It is not taking us very far. We need something new.
Copyright 2009 Washington Post.
Va
expands call center for swine flu questions
Associated Press
USA Today
Monday, August 17, 2009
RICHMOND, Va. (AP) - People who have questions about swine flu
can get answers from the Virginia Department of Health by
calling a toll-free number.
Gov. Timothy M. Kaine said Monday that the department is
expanding its call center to handle questions about swine flu.
The toll-free number is 1-877-275-8343.
Calls will be answered during state business hours. When
necessary, Kaine says the hours will be adjusted to accommodate
the volume of calls.
Questions about swine flu also can be submitted by e-mail to the
health department through its Web site, www.vdh.virginia.gov.
Copyright 2009 The Associated Press. All rights reserved.
Berkeley
Co. schools preparing for swine flu
Associated Press
Hagerstown Herald-Mail
Monday, August 17, 2009
Berkeley County Schools’ director of pupil services sees some
potentially frightening parallels between swine flu and the
pandemic flu of 1918 that wiped out a third of the world’s
population.
The 1918 influenza first appeared in the spring, followed by
much more fatal waves in the fall and winter. It was deadly not
only to the susceptible very young and old, but also to young
adults. And it almost simultaneously infected humans and swine.
Regardless of whether George Michael’s fears bear out, he says
he’s not taking any chances with the state’s second-largest
school district.
“I just want to make sure we’re prepared,” he said.
With the first day of school just days away, Berkeley County and
the other 54 public school systems across West Virginia are
gearing up for what could be a bad flu season.
Since the World Health Organization signaled in June that a
pandemic was under way, more than 1 million Americans, including
333 in West Virginia, have been infected. Health officials fear
the virus could worsen this fall and winter, when people spend
more time cooped up together indoors.
The West Virginia Department of Education and the Bureau for
Public Health, with guidance from the Centers for Disease
Control and Prevention, have prepared preliminary protocols for
schools, said Melanie Purkey, executive director of the West
Virginia Department of Education Office of Healthy Schools.
Final guidelines will be provided later this week as districts
continue working with local health departments to tailor plans
to meet their individual needs and available resources.
“We hope to be out in front of this thing so we’re not
responding to outbreaks,” said Jeff Neccuzi, director of West
Virginia Department of Health’s Division of Immunization.
All schools are being encouraged to emphasize the importance of
washing hands, sanitizing common areas, covering noses and
mouths when sneezing and coughing, and making hand sanitizer
available to students and staff members alike.
Parents are being encouraged to keep children with fevers of
100.5 or higher at home, and schools are being told to have
isolation areas where feverish children can wait for their
parents.
In the Eastern Panhandle, Michael said Berkeley County teachers
are already know what symptoms to watch for. Nurses have basic
supplies of masks and thermometer sheaths, custodians have masks
and buckets ready for scrubbing and bus drivers have
disinfectant sprays.
Principals may even conduct mass inoculations in the same
assembly line fashion used for school photos, if needed.
Health officials expect enough vaccines to become available to
supply all schools. Neccuzi said vaccines will be distributed
across the state, beginning in mid-October with the highest risk
groups and continuing weekly through February.
The federal government is providing vaccines free to everyone,
though people with private health insurance may be asked to pay
an administration fee of no more than $20, he said.
“The logistics aren’t worked out yet” on who will administer the
vaccines, where and to whom, Neccuzi said.
Michael said principals will be making many of those decisions
after students return to class.
“It’s their building and the principal knows that building much
better than we do,” he said.
Berkeley plans to offer vaccines to all students as well as
infants, pregnant women and older people with chronic health
problems. School officials may inoculate students in school
gymnasiums, but are also considering drive-through inoculations
at the county’s three high schools.
In Logan County, which has nearly 7,000 students, Director of
Student Services Bea Orr said she is awaiting direction from the
schools superintendent before meeting with the county’s six
school nurses to finish its preparedness plan.
Although the CDC is discouraging schools from closings, Berkeley
County is preparing letters in English and Spanish that would
alert parents of all its 18,000 students in case officials
decide to close schools.
Michael said educators are prepared to use the Internet,
Webinars, text messaging and other technology to allow for
at-home learning.
For children who don’t have Internet access at home, Purkey said
officials are exploring whether public broadcasting might be
used.
Copyright 2009 Hagerstown Herald-Mail.
National / International
Swine flu: How-to tips for school flu vaccinations
By Lauran Neergaard
Associated Press
Monday, August 17, 2009
WASHINGTON (AP) - Giving injections to thousands of children _
even something as easy and safe as influenza vaccine _ is
complicated.
But there are resources to help schools plan flu-vaccine
clinics.
"It's not just going from desk to desk and giving a little polio
vaccine on a sugar cube," warned Dr. William Schaffner of
Vanderbilt University, a vaccine specialist who advises the
federal government.
Early planning is key, added Robert Pestronk of the National
Association of County & City Health Officials.
His group offers sample letters to parents explaining the
vaccination process and also case studies of different ways
school systems have successfully performed flu vaccinations. The
group even provides a checklist to help officials be sure
they've remembered every detail.
Health professionals have to administer flu vaccine, and
typically local health departments do the job.
First decision: which to offer, vaccination against regular
winter flu, swine flu or both?
Health officials believe that swine flu inoculation will require
two shots, three weeks or so apart, whereas vaccination against
regular winter flu requires a separate jab.
Regardless, no kid can be vaccinated in school unless a parent
or guardian properly fills out a permission slip that includes
questions about the child's health history.
For example, people with severe egg allergies aren't supposed to
get flu vaccine, and certain conditions require that people
receive the flu shot instead of the nasal-spray version.
Have someone check the consent forms ahead of vaccination day
because many parents miss questions or forget to sign them,
warned Jennifer Johnson of the Knox County, Tenn., Health
Department, which has offered in-school FluMist vaccination for
four years.
Flu vaccine side effects are generally mild, such as a sore arm
or some fever.
But Schaffner warns that weird things can happen, too _ like the
fact that adolescent girls sometimes faint when they get a shot.
Health officials recommend observing children for 15 minutes
after vaccination.
Copyright 2009 The Associated Press. All rights reserved.
Hunting ultimate
weapon against flu
Universal vaccine still eludes researchers
By Stephanie Desmon
Baltimore Sun
Monday, August 17, 2009
The ever-changing flu virus is slippery, mutating so rapidly
that vaccines designed to protect against it shield for a single
season, if that long.
But what if a flu shot could be a one-time proposition, maybe a
rite of childhood like so many other vaccines? In a year like
this with pandemic influenza racing across the globe, officials
have been left scrambling to develop a vaccine to guard against
this new H1N1 virus, all the while preparing for the complicated
annual ritual of giving seasonal flu shots to millions. Fearing
such a pandemic, researchers for years have been working to
create what is known as a universal flu vaccine, a single
inoculation that would defend against severe infection from any
type of flu - seasonal or otherwise.
So far, while there has been some progress, no one has
succeeded. At least not in humans.
"We cannot protect against pandemics. We cannot make vaccine
fast enough" when a new strain appears, said Dr. Hildegund C.J.
Ertl, who heads the vaccine center at the Wistar Institute in
Philadelphia. "If you have a universal vaccine, you stop
worrying about pandemics. A lot of people are trying."
For several reasons, it could be a decade before a vaccine like
this hits the market. Researchers still haven't determined
whether the approach will work. Meanwhile, any vaccine would
need to be championed by a manufacturer, and it could be
difficult to find a company willing to take a risk when the
vaccines currently on the market do a decent job most of the
time.
"We're still pretty far away from any sort of [universal]
vaccine," said Dr. Wilbur Chen, a vaccinologist at the
University of Maryland's Center for Vaccine Development, where
an experimental swine flu shot is being tested now. "We still
haven't been able to find the right candidate."
Still, Chen said, developing one would answer many of the
limitations of seasonal shots, which must be given again and
again: "It would be great if it was like other vaccines where
you could give one vaccine or a booster shot every so often and
not have to do it every year. ... It's the panacea for what
we're doing right now."
While researchers are attacking the universal flu vaccine
problem from many directions, the goal is the same: to find a
part of this ever-changing virus that doesn't change and take
aim at that.
Some researchers are focused on something called the M2 ion
channel, which makes up less than 1 percent of the surface of
the virus, said Dr. Robert Belshe, who is studying universal flu
vaccines as director of St. Louis University's vaccine center.
There are just a few copies of this on the surface of the virus,
but Belshe said it plays an important regulatory role for the
whole virus.
"The virus doesn't function without this ion channel," he said.
"If you make antibodies to the ion channel, do the antibodies
alter that ion channel and basically plug it up? Does it prevent
the disease? Does it slow down the disease?"
In his studies with mice and ferrets, such a vaccine prevents
death in the animals, even when they are exposed to lethal doses
of flu virus.
"The mice are getting influenza, but they're not getting as sick
as they would if they hadn't gotten the vaccine," he said.
A small clinical trial Belshe worked on, designed to determine
safety but not effectiveness, proved successful. But what is
needed is a large clinical trial, he said, to truly test the
promising, though unproven, concept. So far, no such trial is in
the works, he said.
Even then, he said, he believes this approach likely will not
keep people from getting sick. It would just prevent many of the
deaths associated with a severe flu season.
Several leading researchers said that at this point they
envision a universal flu vaccine as a supplement to current
vaccination, not a replacement for the yearly immunizations.
Such a vaccine would be most useful in years like this, when a
new pandemic strain appears and begins circulating widely. Such
vaccines would also be of use in years when the strains of the
flu that end up circulating don't match the strains included in
that year's vaccine.
Mismatches are not uncommon. Two years ago, two of the three
strains included in the seasonal vaccine had mutated by the time
the vaccine was administered, leaving people far less protected
from that year's flu bugs. The seasonal flu kills 36,000
Americans a year and sends hundreds of thousands to the
hospital.
A universal flu vaccine, on its own, would be cheaper and easier
to administer since it wouldn't have to be given every year.
Developing countries can't afford annual vaccination programs.
In India, Ertl said, there are no flu vaccines given. They are
too costly. Many people in the United States go unvaccinated
because it can be a hassle to keep up with the shots each year.
About 100 million Americans a year get seasonal flu shots - less
than 40 percent of those for whom the shots are recommended.
Meanwhile, long lead times in producing a new vaccine and
limited vaccine production capacity in the world mean responding
to a new virus can be much slower than the spread of infection.
And a universal flu vaccine, advocates say, would be of great
help when an unforeseen new virus emerges, like this year's
swine flu. Prior to the outbreak in April, most flu vaccine
research was focused at the H5N1 avian flu which many believed
would be the next pandemic.
"As a pandemic develops, there can be difficulty producing
vaccines," said Dr. Suzanne Epstein, associate director of
research at the Food and Drug Administration and a vaccine
researcher for nearly two decades. Universal vaccines "would be
on the shelf, prepared - not prepared in a rush or a frenzy at
the time of an event.
"The protection is broad. You don't have to worry that the
mutation of the virus is continuing and it won't be a match."
Epstein said she sees a universal flu vaccine as "a
complementary form of vaccination and preparedness."
"This is not based on a prediction," she said. "You don't have
to be able to predict what will happen."
Belshe said that, alternatively, people could be vaccinated
ahead of time and receive boosters, ideally, every decade or so.
"If we had a universal flu vaccine, we could vaccinate everyone
in advance," he said.
Epstein said that, right now, a lot depends on nonscientific
aspects of vaccine production - money for clinical trials,
market forces. She wonders if those companies who make flu
vaccine now will be willing to take a risk on a universal
vaccine.
"Short-term, people want to make something they already know
works," she said.
But, she added, "I feel there's a public health issue that is
not yet satisfactorily met."
Copyright © 2009, The Baltimore Sun.
Public health care U-turn
White House signals readiness to drop government-run insurance
idea
Associated Press
Baltimore Sun
Monday, August 17, 2009
WASHINGTON - Bowing to Republican pressure and an uneasy public,
President Barack Obama's administration signaled Sunday it is
ready to abandon the idea of giving Americans the option of
government-run insurance as part of a new health care system.
Facing mounting opposition to the overhaul, administration
officials left open the chance for a compromise with Republicans
that would include health insurance cooperatives instead of a
government-run plan. Such a concession probably would enrage
Obama's liberal supporters but could deliver a much-needed
victory on a top domestic priority opposed by GOP lawmakers.
Officials from both political parties reached across the aisle
in an effort to find compromises on proposals they left behind
when they returned to their districts for an August recess.
Obama had wanted the government to run a health insurance
organization to help cover the nation's almost 50 million
uninsured, but didn't include it as one of his core principles
of reform.
Health and Human Services Secretary Kathleen Sebelius said that
government alternative to private health insurance is "not the
essential element" of the administration's health care overhaul.
The White House would be open to co-ops, she said, a sign that
Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned
nonprofit cooperatives would sell insurance in competition with
private industry, not unlike the way electric and agriculture
co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the
government, the co-ops would operate under a national structure
with state affiliates, but independently of the government. They
would be required to maintain the type of financial reserves
that private companies are required to keep in case of
unexpectedly high claims.
"I think there will be a competitor to private insurers,"
Sebelius said. "That's really the essential part, is you don't
turn over the whole new marketplace to private insurance
companies and trust them to do the right thing."
Obama's spokesman refused to say a public option was a
make-or-break choice.
"What I am saying is the bottom line for this for the president
is, what we have to have is choice and competition in the
insurance market," White House press secretary Robert Gibbs said
Sunday.
A day before, Obama appeared to hedge his bets.
"All I'm saying is, though, that the public option, whether we
have it or we don't have it, is not the entirety of health care
reform," Obama said at a town hall meeting in Grand Junction,
Colo. "This is just one sliver of it, one aspect of it."
It's hardly the same rhetoric Obama employed during a constant,
personal campaign for legislation.
"I am pleased by the progress we're making on health care reform
and still believe, as I've said before, that one of the best
ways to bring down costs, provide more choices and assure
quality is a public option that will force the insurance
companies to compete and keep them honest," Obama said in July.
Lawmakers have discussed the co-op model for months although the
Democratic leadership and the White House have said they prefer
a government-run option.
Conrad, chairman of the Senate Budget Committee, called the
argument for a government-run public plan little more than a
"wasted effort." He added there are enough votes in the Senate
for a cooperative plan.
"It's not government-run and government-controlled," he said.
"It's membership-run and membership-controlled. But it does
provide a nonprofit competitor for the for-profit insurance
companies, and that's why it has appeal on both sides."
Sen. Richard Shelby, R-Ala., said Obama's team is making a
political calculation and embracing the co-op alternative as "a
step away from the government takeover of the health care
system" that the GOP has pummeled.
"I don't know if it will do everything people want, but we ought
to look at it. I think it's a far cry from the original
proposals," he said.
Republicans say a public option would have unfair advantages
that would drive private insurers out of business. Critics say
co-ops would not be genuine public options for health insurance.
Rep. Eddie Bernice Johnson, D- Texas, said it would be difficult
to pass any legislation through the Democratic-controlled
Congress without the promised public plan.
"We'll have the same number of people uninsured," she said. "If
the insurance companies wanted to insure these people now,
they'd be insured."
Rep. Tom Price, R-Ga., said the Democrats' option would force
individuals from their private plans to a government-run plan as
some employers may choose not to provide health insurance.
"Tens of millions of individuals would be moved from their
personal, private insurance to the government-run program. We
simply don't think that's acceptable," he said.
A shift to a cooperative plan would certainly give some cover to
fiscally conservative Blue Dog Democrats who are hardly cheering
for the government-run plan.
Copyright © 2009, The Baltimore Sun.
Genes
Tied to Gap in Treatment of Hepatitis C
By Nicholas Wade
New York Times
Monday, August 17, 2009
The standard treatment for infection with the hepatitis C virus
is a grueling 48-week course of the antiviral drugs interferon
and ribavirin that gives some patients flulike symptoms and
severe depression. The treatment varies in its effectiveness,
being much more successful in Americans of European descent than
in African-Americans.
A Duke University team has now uncovered the principal reason
for the disparity between the races. It lies not in differing
compliance to the treatment or access to health care, as some
have assumed, but in genetics.
Using a genetic test called a genome-wide association study, the
Duke team, led by David B. Goldstein and John McHutchison, found
that the coding at a single site on the DNA, out of the three
billion sites in the human genome, made all the difference in
people’s response to the treatment.
The site is close to the gene for a special kind of interferon,
known as interferon-lambda-3, and may help control the gene’s
activity. Some people have the DNA unit T at this site, and
others have C. Since a person inherits two copies of the genome,
one from each parent, individuals may have T’s on both copies,
C’s on both, or one T and one C.
People with the CC version, or allele, respond much better to
the standard hepatitis treatment than do those with the TT
allele. The C versions are more common in Europeans than in
Africans, and this explains half of the difference in the
response between the two races, the Duke team said in a report
released Sunday on the Web site of the journal Nature.
The C versions are even more common among East Asians, about 75
percent of whom respond well to the standard treatment, compared
with 55 percent of European-Americans and 25 percent of
African-Americans.
People with the CC versions may produce more interferons, which
are virus-fighting substances produced by cells, than those with
TT, though the exact mechanism has yet to be worked out.
Dr. Goldstein, a population geneticist, said the different
frequencies of the T and C versions were the result of natural
selection, which is particularly effective in the case of
disease resistance.
“We have clearly had very strong selection in the human
population for resistance to different infectious agents, which
have been of different importance in different parts of the
world,” he said.
Presumably in the past some virus struck with particular
severity in East Asia but was less potent in Europe and even
milder in Africa. Dr. Goldstein said this virus might not have
been the hepatitis C virus, which is spread by blood-to-blood
contact, as when needles are shared, a practice common only in
modern times. But he said he did not know what other virus might
have been responsible.
He and Dr. McHutchison, a clinician, said a genetic test based
on the finding would be of great interest to patients and
physicians as a component of the decision on whether to undergo
the standard treatment.
The study was financed by Schering-Plough, which owns the
intellectual property rights on any diagnostic test developed
from the discovery. Robert Consalvo, a spokesman for the
company, said that the finding was an important first step but
that he did not know of immediate plans to develop a diagnostic
test. “Schering-Plough is not a diagnostic company,” Mr.
Consalvo said.
Dr. McHutchison said a test would not be used to deny anyone
treatment, but rather to determine a patient’s best options.
People who have a lower chance of benefiting from the grueling
treatment because they have the TT allele might decide to wait
until better drugs become available, especially if their liver
damage is not severe. On the other hand, African-Americans with
the CC allele might be more confident in accepting the
treatment, Dr. McHutchison said.
In the United States, hepatitis C infects about three million
people and causes 10,000 deaths a year, according to the Centers
for Disease Control and Prevention.
Copyright 2009 New York Times.
Patterns: Do
Real Men Go to the Doctor?
By Roni Caryn Rabin
New York Times
Monday, August 17, 2009
Real men don’t ask for directions, and now researchers are
saying the reluctance to ask for help may not just mean they get
lost. It may also take a toll on their health.
Men who strongly endorsed old-school notions of masculinity —
believing the ideal man is the strong, silent type who doesn’t
complain about pain — were only half as likely as other men to
seek preventive health care services, like an annual physical or
a flu shot, the study found.
Even men with a high level of education, a factor that is
strongly associated with better health and usually a predictor
of longer life, were less likely to seek out preventive health
care if they strongly adhered to the ideal of the macho man,
said Kristen W. Springer, the study’s primary investigator and
an assistant professor of sociology at Rutgers, The State
University of New Jersey.
“It’s ironic that the belief in the John Wayne, Sylvester
Stallone archetype of masculinity — and the idea that real men
don’t get sick and don’t need to see the doctor, and that real
men aren’t vulnerable — is actually causing men to get sick,”
Dr. Springer said. “These stereotypes and ideas are actually a
reason why men do get sick.”
Interestingly, the men who held strong beliefs in old-fashioned
masculinity but who worked in blue-collar, stereotypically male
jobs — like truck drivers or construction workers — were more
likely to seek preventive care. One reason may be because the
possibility of not being able to work was a greater threat to
their masculinity than seeking help, she said.
The study may help explain why there is still a gender longevity
gap, with women outliving men by about five years on average,
Dr. Springer said. She added that the real surprise was that the
health benefits usually associated with higher education were
completely undermined by strongly held macho ideals.
The findings, from a large longitudinal study of about 1,000
middle-aged men who graduated from Wisconsin high schools in
1957, were presented at a meeting of the American Sociological
Association in San Francisco.
The men’s masculinity beliefs were assessed by their answers to
a series of questions, including whether they believed men
should be the main breadwinners in the family, show pain or
display confidence even when they did not feel it, and whether
husbands should have the final say in purchases for the home.
The analysis is believed to be the first population-based study
of men’s masculinity beliefs and preventive health behaviors.
Copyright 2009 New York Times.
Opinion
A moral obligation?Should the U.S. produce enough H1N1 flu
vaccine to help developing countries?
By Ruth A. Karron and Ruth R. Faden
Baltimore Sun Commentary
Monday, August 17, 2009
As the nation prepares for the return of the H1N1 influenza
pandemic, public health officials are faced with difficult
choices. While some doses of the vaccine for what is known as
"swine flu" will be ready by October, the entire supply will not
be available for several more months.
Recently, two landmark meetings have been convened to discuss
plans for the evaluation and use of vaccines against H1N1. On
July 23rd, the Vaccine and Related Biological Products Advisory
Committee (VRBPAC) of the FDA met to discuss ongoing vaccine
trials and pathways for licensure or emergency use authorization
of a variety of vaccines. On July 29th, the Advisory Committee
on Immunization Practices (ACIP) of the Centers for Disease
Control met to determine who should receive vaccine first.
A single number has dominated these discussions: 600 million.
That's the number of doses that would allow every American to be
immunized twice (since this is a new virus, it is possible that
everyone will need two doses of vaccine to achieve protection).
Debate and discussion have centered over the fastest and safest
way to get to this number: whether, for example, some
inactivated (killed) vaccines used in the U.S. could contain
dose-sparing additives called adjuvants that might be used to
stretch the supply of inactivated vaccine to get to 600 million
more quickly, or how to best package a live attenuated vaccine,
normally dispensed by nasal spray if, as appears likely, there
will be more doses of this vaccine available than spray devices
to administer them.
But is 600 million the right number? That the United States
should aim to produce enough vaccine to protect all Americans is
not at issue. What is not being addressed, however, is whether
we ought to aim to do more. Nowhere in these discussions has the
prospect of upping the ante been raised. Should we use available
technologies to provide not only enough vaccine for the U.S. but
also to allow for excess capacity to assist other countries who
have no capacity to procure or produce the vaccine on their own?
The ultimate severity of the H1N1 2009 pandemic cannot be
predicted. However, we do know that context matters and that
loss of life is likely to be greatest in resource-poor settings.
Careful research established that in the 1918 pandemic the death
rate in poor countries was as much as thirty-fold higher than
the death rate in wealthy countries; it is predicted that up to
96 percent of deaths from a new pandemic may occur in developing
countries. When Margaret Chan, the director-general of World
Heatlh Organization, declared an influenza pandemic on June 11,
she made special mention of the likely increased burden in these
countries: "Although the pandemic appears to have moderate
severity in comparatively well-off countries, it is prudent to
anticipate a bleaker picture as the virus spreads to areas with
limited resources, poor health care and a high prevalence of
underlying medical problems."
The H1N1 2009 influenza pandemic will be with us for months and
possibly years to come. Multiple populations will be affected,
and some are at special risk, including pregnant women, young
children and those with underlying medical conditions.
Vaccination will be our most effective medical countermeasure,
and using a number of different types of vaccines: live and
killed, with and without adjuvant, would allow us to immunize
the U.S. population most efficiently.
But do our obligations to minimize the burden of death and
disease from H1N1 end there? If we use the available stocks of
vaccine and adjuvant wisely, we may also be able to reach beyond
our borders and afford some protection to the world's most
vulnerable populations. Global needs, as well as our own, should
inform our decisions as we plan the nation's H1N1 vaccine
strategy.
Ruth Karron is the Director of the Center for Immunization
Research and the Johns Hopkins Vaccine Initiative at the Johns
Hopkins Bloomberg School of Public Health. Ruth Faden is the
Director of the Johns Hopkins Berman Institute of Bioethics.
Their e-mail addresses are rkarron@jhsph.edu and
rfaden@jhsph.edu.
Copyright © 2009, The Baltimore Sun.
The Scourge of
Tuberculosis
Washington Post Letter to the Editor
Monday, August 17, 2009
Regarding the Aug. 11 Metro article "Child's TB Complicates
Adoption by Va. Family":
Harper Yue Ye's story highlights a disease that devastates many
families, especially in developing countries. Annually, about
9.3 million people become sick with tuberculosis (TB), and 1.8
million die from the disease, the majority in Asia and Africa.
In China alone, 1.3 million people became ill with TB in 2007.
Recent studies show that we cannot eliminate TB without a better
vaccine, better drugs and better diagnostics. The current
vaccine against TB, Bacille Calmette-Guérin (BCG), is one of the
most widely used in the world and is routinely administered to
children in China and other countries. But it is not very
effective. It helps protect young children against severe forms
of TB, but it is unreliable against pulmonary TB, the most
common form.
There is hope. Scientists around the world are searching for
better TB vaccines, the goal being to eliminate TB from the
planet by 2050. With several candidates undergoing clinical
trials for safety and efficacy, more effective vaccines may be
available by 2016 to prevent suffering like that of Harper and
her parents, as well as countless other children and families.
JERALD C. SADOFF
President and Chief Executive
Aeras Global TB Vaccine Foundation
Rockville
Copyright 2009 Washington Post.
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