10.31.09
Posted in Uncategorized at 1:00 am by Luis
LONDON (AP) -- Hundreds of people on any given day will die, develop the paralyzing Guillain-Barre syndrome or have spontaneous abortions, and that doesn't necessarily mean that their swine flu vaccination shot was to blame, a new study says.
As millions of people worldwide begin getting the new swine flu shot, public health officials are bracing for rumors about dangerous side effects linked to the vaccine.
To provide context, experts combed hospital databases and population samples in Britain, Canada, Finland, the United States and elsewhere to find daily baseline rates of commonly reported events like Guillain-Barre syndrome, sudden deaths, seizures and abortions. The research was published online Saturday in the British medical journal Lancet.
They found that in Britain, for every 10 million people who might get the swine flu shot, about 22 cases of Guillain-Barre syndrome and 6 unexplained deaths will likely occur within 6 weeks of vaccination - and probably won't be caused by the vaccine.
In the U.S., experts expect that for every 1 million pregnant women who get the swine flu shot, 397 will have a spontaneous abortion within a day.
Only if the rates of these events exceed these baseline numbers should experts suspect the vaccine might be responsible.
"People die every day for lots of reasons, but we tend not to think about that when a mass immunization campaign is happening," said Steven Black of Cincinnati Children's Hospital in Ohio, one of the paper's authors. "We're not saying we don't need to look at vaccine safety, but let's do it judiciously."
Black, like several of the study's authors, received grants from companies that make swine flu vaccine.
Mass immunization campaigns for diseases like measles and yellow fever have frequently been undermined by rumors that the vaccines cause dangerous side effects.
Still, rumors may also mask legitimate vaccine concerns. In Nigeria, fears that the oral polio vaccine causes HIV were unfounded but concern about the vaccine was not entirely unwarranted: it does cause polio in rare instances.
"The greatest danger ahead is that there will be coincidental events between (swine flu) vaccination and adverse health events and people will draw conclusions that are not based on science," said Leonard Marcus of Harvard University's School of Public Health, an expert not linked to the study.
Marcus said health officials must be vigilant in case any unforeseen side effects do pop up.
"When side effects happen to an individual, it's devastating. And it's human nature to want to link it to a recent vaccination," Marcus said. "But it's also possible to be compassionate without leaping to conclusions."
Of the thousands of people so far who have received the swine flu vaccine worldwide, no side effects more serious than a sore arm, fever, or muscle pain have been reported.
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On the Net:
http://www.lancet.com
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
NEW YORK (AP) -- While headlines focused this week on potential long-term risks of head injuries to pro football players, Jarek Dombrowski was just hoping to get through his school days without the headaches coming back.
Jarek, 16, returned to high school in Norwich, Conn., on Monday after a neurologist sent him home for most of last week. He suffered a concussion during football practice, and while the nausea and blurred vision he endured in class the next day had gone away, the headaches continued.
Still banned from football on doctor's orders, he's "not doing too bad," said his mother, Donna Dombrowski. But the headaches have been coming back in the afternoons.
Dombrowski said the recent news reports about retired NFL players blaming mental problems on gridiron head injuries have made her think about Jarek. She isn't sure how concerned to be. And while she enjoys seeing him play, she's torn about whether she wants him to suit up again.
In fact, experts say they know very little about long-term medical risks of concussion for America's football players still in high school.
A congressional hearing in Washington on Wednesday focused on the NFL. A month ago, a preliminary study suggested that retired football players may have a higher than normal rate of Alzheimer's disease or other memory problems, presumably because of head injuries. But at the hearing, Rep. John Conyers, D-Mich., said he'd seek records on head injuries in amateur ranks as well, "because of the effect on the millions of players at the college, high school and youth levels."
Every year, as many as 1 in 10 high school football players has a concussion, estimated Kevin Guskiewicz of the University of North Carolina at Chapel Hill. He is lead author of the National Athletic Trainers' Association position statement on concussion management.
He said nobody has followed such players systematically for a decade or more to see what effect concussions might have.
He sees reason for concern. In 2005, he published a study of retired pro players that found having three or more concussions was associated with a heightened risk of mild cognitive impairment after age 50.
"One would assume a high school player who likewise had three or more during his high school years would potentially be predisposed to some of these same long-term neurodegenerative conditions that NFL players are," he said. But, he stressed, there's no evidence for that.
Mark Lovell, who directs the sports medicine concussion program at the University of Pittsburgh Medical Center, said he has begun to collect data on long-term consequences of high school concussions. He noted that the kind of careful mental testing his center does has not been widely used until fairly recently, so there is no big database yet of people who've been followed a long time since high school.
As it stands now, "we can't look into the future" and tell who is going to develop a long-term problem from one or more concussions, he said.
"I can tell you that I don't think anyone knows exactly what the long-term risk is, and I wish I did.... For a given kid, if we knew that kid was going to be at risk for long-term problems, we could get him or her in a different sport early on," Lovell said.
So what can be done now to reduce the risk of long-term trouble?
Experts say players, coaches and parents must learn to recognize the symptoms of a concussion, and be ready to pull affected players out of competition until a health professional clears them to play again. Players should not return to action until their brains heal, because it's dangerous to get a second concussion when the brain is still recovering from the first one.
"When in doubt, sit them out," Lovell said.
Determining when it's safe to play again is more complicated than just waiting until symptoms disappear, said Dr. Anthony Alessi, who co-chairs the American Academy of Neurology's sports neurology section. He's working to update the academy's 1997 guidelines on how long to keep an athlete out after a concussion.
Alessi, who is chief of neurology at the William W. Backus Hospital in Norwich, Conn., also recommends that every high school should have a certified athletic trainer on the sidelines. Only 42 percent of high schools use the services of one, according to the trainers' association.
And he suggests that coaches limit the number of practices in which players slam into each other at full speed. Teams that have only one full-contact practice a week perform as well as those with four, with much less risk of concussion, Alessi said.
"We can reduce the risk and still keep the level of play up there," he said.
Earlier this month, Alessi told a 16-year-old that his football season at a Norwich high school was over. The boy, M.J. Belmont, had just had his third concussion in two years, this one at a practice.
M.J.'s mother Christine said she hasn't asked Alessi about whether M.J. can play football next season.
"I'm hesitant to have him on the field again," she said. "The mother in me says, `No way,' but I also know how much he loves it, and how do you say no? It's part of who he is ... Part of what makes M.J. a whole person is loving football and being part of the team."
She also has a 13-year-old son who loves playing football, and will start high school next year. And that, she said, is "kind of scary."
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On the Net:
High school sport concussions: http://www.cdc.gov/ncipc/tbi/Coaches(underscore)Tool(underscore)Kit.htm
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
LOS ANGELES (AP) -- It was bound to happen: Some people who aren't at high risk for swine flu complications got the much-in-demand vaccine.
Sometimes they were healthy adults or senior citizens instead of kids, pregnant women and people with health problems.
Before Los Angeles County health officials stepped up screening at their flu clinics, Natalie Thompson sailed through the long line and got the vaccine along with her 8-year-old son, even though she's not in one of the priority groups.
"If I can get it, I'm not gonna say no," said Thompson, 35, of Hollywood Hills.
Another mom, Katy Radparvar, didn't say no either.
"Our doctor doesn't have it yet," said the 41-year-old woman who was vaccinated along with her three children at a public health vaccination site in suburban Encino last week.
Public health officials don't want to be vaccine police. Many don't turn anyone away who wants the vaccine, though some locations are tougher than others.
"For many this is a frustrating process and we really sympathize with those who show up at a clinic and can't get vaccinated," said Los Angeles County public health director Dr. Jonathan Fielding.
Across the country, thousands have waited in line and many have been turned away, as manufacturers have trickled out the slow-to-produce vaccine. Things are improving, and now about 25 million doses are available, the government says.
Aware of scant supplies up front, Santa Barbara County clinics administered their 4,400 shots to pregnant women only. San Diego County is only immunizing those on the priority list, but is taking the word of residents.
Nevada is using the honor system with vaccinations offered on a first-come, first-served basis to those who identify themselves as at-risk for the H1N1 virus.
"We really are hoping people go on the honor system and let us immunize people in the priority groups," Southern Nevada Health District spokeswoman Stephanie Bethel said. "I think, for the most part, it's working."
In Oregon, Portland metro area officials say pregnant women and children are moved to the front of the lines and inoculated before the general public.
"We assertively asked those who were not in the priority group to move to the end of the line, so when we ran out of vaccine, those people who were left were those who were not at risk," said health officer Dr. Gary Oxman. "And people have responded well to it."
The vaccine shortfall prompted Wisconsin state health officials this week to remind local health agencies "to strongly encourage" announcements about the limited vaccine supply and the focus on vaccinating high-risk groups first.
Robert M. Pestronk, executive director of the National Association of County and City Health Officials, said local health departments are doing the best they can under challenging conditions.
"Despite those best efforts, it doesn't surprise me that people who are not in high priority groups are appearing at clinics for vaccination," he said. "It's difficult to restrict vaccine simply to the priority groups."
One of the doctors who helped draw up guidelines for vaccine priority groups also isn't surprised at how things are unfolding.
The government's vaccine advisory panel "did not expect vaccine police to be set up around the country," said Dr. William Schaffner, a flu specialist at Vanderbilt University Medical Center, who is on the panel.
If vaccine demand is low in some locations, it makes sense for non-priority groups to get it instead of wasting the supply.
"I don't consider it a problem," said Schaffner. "I consider it more of a problem if vaccine is left unused."
That's what happened in the 2004-05 flu season when there was a shortage of seasonal flu vaccine. Many older healthy people refused to get the shot so that those who had health problems would have access to vaccine.
"One of the things that was learned was to be careful about turning people away because we might end up with a lot of vaccine at the end of the year," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention But right now, there aren't many vaccine leftovers to be found. Every morning, Anne Jenkins of Shreveport, La., makes a round of calls to ask doctors and health clinics if they have the injectable swine flu vaccine. She is 23 weeks pregnant.
After seeing four elderly women requesting swine flu vaccine - to no avail - at a local military treatment facility she thought to herself, "you're not on the list."
Though local officials tell Jenkins the vaccine won't be available until mid-November, she's ready to compete for her dose when it arrives.
"You feel the animal instinct come out," she said.
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Associated Press Writers Mike Stobbe in Atlanta, William McCall in Portland, Ore., Ken Ritter in Las Vegas and Marilynn Marchione in Milwaukee contributed to this report.
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
LONDON (AP) -- Dutch scientists made a controversial suggestion Friday that children might be better off skipping the seasonal flu vaccine this year - a proposal flatly rejected by other health experts.
Their commentary, based largely on animal studies, was published online Friday in the British medical journal Lancet Infectious Diseases. Yet many top health officials said there was no proof that children are more likely to avoid swine flu by passing on a seasonal flu shot.
"The best shot parents have at protecting their kids is to get them a shot in the arm or up the nose," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "Parents should get whatever vaccine is available and approved."
In the opinion piece, Guus Rimmelzwaan of Erasmus University and his colleagues suggested that health authorities reevaluate the recommendation by countries like the U.S. and Canada to give all healthy children between 6 months and 5 years old a flu shot. The World Health Organization recommends that healthy children under 2 get a flu shot.
The theory is that children infected with seasonal flu acquire a certain kind of immunity that might protect them against new flu outbreaks like swine flu or bird flu.
In the 1957 Asian flu pandemic, the Dutch scientists noted that people infected with seasonal flu were less likely to catch the pandemic virus. They also cited data showing the same trend in mice and ferrets, the latter of which are believed to be a good model for flu in humans.
Other health experts said it would be dangerous to revise flu policies now for results based mainly on animal experiments.
"This is an interesting theory, but it does not reflect what we see in human populations," said Ville Peltola of Turku University Hospital in Finland, who co-authored an accompanying reaction piece in same medical journal.
Peltola said the Dutch scientists' suggestion might also confuse parents.
"Skipping seasonal flu vaccine does not protect from swine flu, but it leaves the child without protection against seasonal flu," he said. Children under 2 are among the highest risk group of developing complications from seasonal flu, which kills up to 500,000 people worldwide every year.
Osterholm said there was no biological reason why a seasonal flu infection might ward off swine flu. If that were the case, countries with low rates of seasonal flu vaccination - such as Mexico - would not have had a big swine flu problem.
"There is no evidence of a reduction in H1N1 in places where the flu vaccine hasn't been used," he said.
WHO said their flu vaccine recommendations remain unchanged.
"Flu vaccine is one of the most important tools we have against influenza," said spokesman Gregory Hartl. "Children are one of the groups most affected by seasonal flu and we recommend they continue to get vaccinated."
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On the Net:
http://www.lancet.com
http://www.who.int
http://www.cdc.gov
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
GENEVA (AP) -- A single dose of swine flu vaccine is enough to immunize adults and children over 10 against the pandemic strain, the World Health Organization said Friday.
The global body's expert group - known as SAGE - said that while more data on children between 6 months and 10 years are needed, countries that have made vaccinating children a priority can also administer them a single dose in order to ensure that as many as possible are immunized quickly.
"The SAGE recommendation (for children under 10) could change as more data come in," said WHO vaccine chief Marie-Paule Kieny.
For the time being, she said, "the priority should be to give them at least one dose of vaccine now, and to cover as many of them as possible."
The expert group, which held a three-day meeting in Geneva this week, said medical regulators should have the final say on which vaccines can be administered as a single shot.
But its recommendation is an important indication for those regulators - particularly in the developing world - that haven't yet decided how many doses should be required.
U.S. regulators have recommend two doses for children under 10.
Europe's drug authority EMEA last week said the swine flu vaccines it has licensed should be given in two doses, at least three weeks apart, to all age groups. EMEA noted that current data were too "limited" to allow the agency to recommend one dose.
Swine flu has killed at least 5,700 people worldwide since the A(H1N1) strain appeared in April, according to WHO's tally.
Governments in the northern hemisphere are under pressure to carry out their vaccination campaigns before the winter flu season starts. The number of doses authorities recommend will play a decisive role in determining how far available vaccine stocks will stretch.
The experts also recommended to WHO that pregnant women use those licensed vaccines deemed safe by regulators. The recommendation is based on the high risk that swine flu poses to pregnant women, as well as on animal tests showing vaccines are safe for mother and child.
Seasonal and pandemic flu vaccines can be given simultaneously, provided at least one uses "inactivated" virus, which isn't contagious anymore, the experts said.
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AP medical writer Maria Cheng in London contributed to this report.
© 2009 The Associated Press.
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