The swine flu discussion thread....for scientific discussion only.

DrIndy

SomeDose wrote: »

Funnily enough, there's little no difference in cost for the typical bd x 5 days flu regimen...but I salute your cynicism nevertheless!

On a side note, we're starting to see a few isolated cases of raised INRs in warfarinised patients treated with Tamiflu...which in theory wouldn't be expected as it's metabolised outwith the CYP system. Agree on your point regarding the coming months, it'll be a crucial period for pharmacovigilance in many different patient groups.

Can these INR alterations also be due to the patient not eating the normal diet for them due to illness and subsequently altering the normal intake of vitamin K which also will affect their INR?

tallaght01

I don't know the exact answer to your question, Indy. Though there should be lots of data available on patients who took tamiflu prophylactically, where illness shouldn't cloud the issue. they will have been given a lower dose, though.

I wanted to ask what people are doing about pregnant women. About 70% of all call I get from GPs are now either:

A) I have a pregnant woman here who's asymptomatic, but has been in contact with a case. Can I give her tamiflu?

I have a pregnant woman here with suspect swine, can I give her tamiflu?

We've obviously not gotten the message out properly. Was wondering of there's any confusion in Ireland about it?

tallaght01

posts above deleted, as they were dealing with the poster's own medical concerns. Sorry.

DrIndy

Bump - we need to keep this on the front page.

DARK-KNIGHT

<SNIP>

sorry ray, we cant deal with personal medical queries on this forum

Traumadoc

Are pregnant staff being redeployed from "frontline areas"?
Say the receptionist at a GP practice.

tallaght01

They have been within the public service in Oz. But GP surgeries obviously can do what they like. Plus there may not be anything else for them to do in a small practice.

Red Sleeping Beauty

DrIndy wrote: »

Can these INR alterations also be due to the patient not eating the normal diet for them due to illness and subsequently altering the normal intake of vitamin K which also will affect their INR?

SomeDose wrote: »

Funnily enough, there's little no difference in cost for the typical bd x 5 days flu regimen...but I salute your cynicism nevertheless!

On a side note, we're starting to see a few isolated cases of raised INRs in warfarinised patients treated with Tamiflu...which in theory wouldn't be expected as it's metabolised outwith the CYP system. Agree on your point regarding the coming months, it'll be a crucial period for pharmacovigilance in many different patient groups.

If Tamiflu is an anti-biotic then a raised INR result won't be anything unusual. Anti-biotics will usually raise INR results regardless of diet. Altering diet isn't as affective for controlling INR whilst on other meds as altering the Warfarin dose.

nesf

Alan Rouge wrote: »

If Tamiflu is an anti-biotic then a raised INR result won't be anything unusual. Anti-biotics will usually raise INR results regardless of diet. Altering diet isn't as affective for controlling INR whilst on other meds as altering the Warfarin dose.

It's not an antibiotic, it's an anti-viral.

DrIndy

bump

keeping it on the front page

sam34

have moved two posts to general swine flu discussion thread as they are more suited there

tallaght01

I read a case series of kids today who'd all developed transient neurology as an effect of swine flu infection itself. They didn't have tamiflu, and it persisted independently of their pyrexia, so it doesn't seem to be a delerium.

I'll post the reference tomorrow when I'm back in work.

sam34

tallaght01 wrote: »

I read a case series of kids today who'd all developed transient neurology as an effect of swine flu infection itself. They didn't have tamiflu, and it persisted independently of their pyrexia, so it doesn't seem to be a delerium.

I'll post the reference tomorrow when I'm back in work.

i know in the very elderly (and even the not-so-very-elderly) features of delerium can persist for days and even weeks after the cause has apparently resolved.

it's a fight i have on an almost daily basis with medical and surgical reg's :rolleyes:
"no, this 70 year old with no past psychiatric history hasnt just suddenly developed schizophrenia, they're just mildly confused and agitated because of the hyponatraemia/whatever"

anyway, tallaght, i wonder if teh very young are just as susceptible to more prolonged deleriums that a general adult population?
just a thought.

tallaght01

Well, kids usually just get a transient delerium. Anyway, only one of them had hallucinations. The other 3 had seizures and gait disturbance, so not really classical of delerium.

It's actually available online:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a2.htm

SomeDose

DrIndy wrote: »

Can these INR alterations also be due to the patient not eating the normal diet for them due to illness and subsequently altering the normal intake of vitamin K which also will affect their INR?

Just heard of another couple of A+E admissions in the last few days, both with raised INRs after recently finishing courses of tamiflu. I think the diet angle can probably be ruled out here, although I've no more background info on these particular cases at the moment so it's still a bit of a mystery...

CapedCrusader

tallaght01 wrote: »

I don't know the exact answer to your question, Indy. Though there should be lots of data available on patients who took tamiflu prophylactically, where illness shouldn't cloud the issue. they will have been given a lower dose, though.

I wanted to ask what people are doing about pregnant women. About 70% of all call I get from GPs are now either:

A) I have a pregnant woman here who's asymptomatic, but has been in contact with a case. Can I give her tamiflu?

I have a pregnant woman here with suspect swine, can I give her tamiflu?

We've obviously not gotten the message out properly. Was wondering of there's any confusion in Ireland about it?

What is the message you are referring to? Information being given to the public in Ireland says that anti-viral medication should be issued to pregnant women who have been in contact with a case. Is this consistent with the position in Oz?

sam34

womoma i moved your post to the general discussion thread, its more suited there.

tallaght01

CapedCrusader wrote: »

What is the message you are referring to? Information being given to the public in Ireland says that anti-viral medication should be issued to pregnant women who have been in contact with a case. Is this consistent with the position in Oz?

I don't think pregnant woman who've been in contact with a case are getting tamiflu. That wouldn't be consistent with most guidelines, where we would give tamiflu only to pregnant women who develop symptoms. May be different in Ireland, though.

The NEJM published a paper last week, describing the age distribution for serious swine flu related pneumonia (primary viral pneumonia is the common cause of swine flu death). They report that 87% of deaths and 71% of severe pneumonia cased by HSI are seen in people aged 5-59. With seasonal flu, it's usually 17% of deaths and 32% of severe pneumonia.

It's all very strange. The likely cause is that the elderly have been exposed to this bug before. But I've not seen any serological studies to show that.

If that's true, it would mean that this virus is HIGHLY pathogenic (if you think about the fact that it's currently roughly as pathogenic as the seasonal flu even though it doesn't affect the people who get hit by flu hardest). Imagine if it mutates, so the elderly are no longer protected. That could mean the young AND the old are affected, which would be seriously bad news.

Paper is:

http://content.nejm.org/cgi/content/abstract/361/7/674

It's a decent abstract, so people without journal access should be able to read the important bits.

tallaght01

Science 325, 484 (2009);
Taronna R. Maines, et al.
2009 A(H1N1) Influenza Viruses in Ferrets and Mice
Transmission and Pathogenesis of Swine-Origin

The above paper says that, when they inoculated animals with H1N1 from respiratory droplets, it wasn't particularly effective in terms of respiratory droplet transmission, when compared with seasonal flu.

This begs the question......how is it so transmissable? Are we shedding more virus when infected with swine flu, compared to seasonal flu? Is the animal model at fault?

The evidence is that the effective reproduction rate for H1N1 is between 1.4 and 2 (so, 1.4 to 2 people infected by every person who catches it. This has quite a lot of significance for mathematical modelling of pandemics). The number for seasonal flu seems to be about 1.3.

tallaght01

New paper out in the online NEJM (not in paper version yet as far as I know) showing good immune response after one H1N1 vaccine, with minimal side effects.

This is the oz one (15micrograms of unadjuncted antigen, versus 7.5micrograms of adjuncted antigen in Ireland, as far as I know).

But looks good for our vaccine rollout plan here in Oz. Just waiting for the kiddy data in the next few weeks.

http://content.nejm.org/cgi/content/full/NEJMoa0907413

nesf

tallaght01 wrote: »

New paper out in the online NEJM (not in paper version yet as far as I know) showing good immune response after one H1N1 vaccine, with minimal side effects.

This is the oz one (15micrograms of unadjuncted antigen, versus 7.5micrograms of adjuncted antigen in Ireland, as far as I know).

But looks good for our vaccine rollout plan here in Oz. Just waiting for the kiddy data in the next few weeks.

http://content.nejm.org/cgi/content/full/NEJMoa0907413

Can you infer anything about the likely effectiveness of an adjuncted antigen from unadjuncted results? (general question)

tallaght01

No, but you can say that an antigen load from the seasonal virus is pretty much as immunogenic as the equivalent from swine flu.

It basically shows that when you substitute the H1N1 antigen in place of the seasonal flu antigen into the vaccine, it works as well. But you'd need a trial to be certain.

nesf

Single Vaccine Dose, Even One from 1976, Could Protect against the H1N1 Swine Flu (Scientific American article)

samson09

Can someone please tell me that this is a load of nonsense and that it simply can't happen?

Irish government plans mandatory "swine flu" jab or jail

The Irish government plans to introduce compulsory "swine flu" vaccinations and is preparing to jail people if they refuse the jab.

The Irish Daily Sunday Star reports that the Irish health department is planning to activate provisions in the 1947 Health Act to enforce mandatory "swine flu" vaccinations.

Baxter, a company currently under investigation by the Austrian police for deliberately contaminating 72 kilos of vaccine material with the live bird flu virus in February, is to supply Ireland with the "swine flu" vaccines.

http://theflucase.com/index.php?option=com_content&view=article&id=598%3Airish-government-plans-mandatory-qswine-fluq-jab-or-jail&catid=41%3Ahighlighted-news&Itemid=105&lang=en

DrIndy

samson09 wrote: »

Can someone please tell me that this is a load of nonsense and that it simply can't happen?

Irish government plans mandatory "swine flu" jab or jail

The Irish government plans to introduce compulsory "swine flu" vaccinations and is preparing to jail people if they refuse the jab.

The Irish Daily Sunday Star reports that the Irish health department is planning to activate provisions in the 1947 Health Act to enforce mandatory "swine flu" vaccinations.

Baxter, a company currently under investigation by the Austrian police for deliberately contaminating 72 kilos of vaccine material with the live bird flu virus in February, is to supply Ireland with the "swine flu" vaccines.

http://theflucase.com/index.php?option=com_content&view=article&id=598%3Airish-government-plans-mandatory-qswine-fluq-jab-or-jail&catid=41%3Ahighlighted-news&Itemid=105&lang=en

Ah Samson09 - you just can't stay away!

Quote the source of this information from the HSE and this post can remain. A tabloid article on a blog is not a source.

If not, you will be permanently banned from this forum.

Turtwig

samson09 wrote: »

Can someone please tell me that this is a load of nonsense and that it simply can't happen? ...

It is a load nonsense, because it won't happen:P
Though a part of me thinks it would be the most effective way to utilise the vaccine...just not you know fair

samson09

DrIndy wrote: »

Ah Samson09 - you just can't stay away!

Quote the source of this information from the HSE and this post can remain. A tabloid article on a blog is not a source.

If not, you will be permanently banned from this forum.

From the article that appeared in Sunday's paper, word for word:

"A HSE spokeswoman said "The position is that the Department is satisfied that the provisions in the 1947 Health Act for the control and management of infectious diseases gives it sufficient powers to deal with a pandemic outbreak". The Act also states that anyone who willfully obstructs the execution of a regulation-such as compulsory vaccination-shall be liable for conviction in court".

I don't think any journalist, whether working for a respectable paper like The Irish Times, or a not so respectable tabloid paper such as The Daily Sunday Star, would incorrectly quote someone from the HSE on such a serious matter.

I will be contacting the HSE on the matter myself later. In the mean time, could you not just give your own opinion on the piece? Is that too much to ask?

DrIndy

Samson09 - please stop posting conspiracy stuff in this forum.

Last Warning.

The_Conductor

samson09 wrote: »

I don't think any journalist, whether working for a respectable paper like The Irish Times, or a not so respectable tabloid paper such as The Daily Sunday Star, would incorrectly quote someone from the HSE on such a serious matter.

I'd suggest that if you really have such faith in journalists- that your faith is sadly misplaced. Journalists will twist and spin things out of all recognition to sell a story- it doesn't mean they are lying- simply that the quotes they use may be totally out of context, and far beyond what the person they are attributed to, ever intended.

Dr Galen

samson09 wrote: »

From the article that appeared in Sunday's paper, word for word:

"A HSE spokeswoman said "The position is that the Department is satisfied that the provisions in the 1947 Health Act for the control and management of infectious diseases gives it sufficient powers to deal with a pandemic outbreak". The Act also states that anyone who willfully obstructs the execution of a regulation-such as compulsory vaccination-shall be liable for conviction in court".

I don't think any journalist, whether working for a respectable paper like The Irish Times, or a not so respectable tabloid paper such as The Daily Sunday Star, would incorrectly quote someone from the HSE on such a serious matter.

I will be contacting the HSE on the matter myself later. In the mean time, could you not just give your own opinion on the piece? Is that too much to ask?

From my reading the bit in bold above appears to be what the HSE spokesperson said. The next bit, which is outside of the quotation marks appears to be an addon by the journalist.

So that looks like the HSE person said that they think that the Health Act gives them sufficient powers to deal with all eventualities, and then the journo added in the next bit, which is nothing more than a statement of fact, in that the act does allow for prosecution when someone is deliberately disobeying a Public health order, like for example, mandatory vaccination.