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

samson09

smccarrick wrote: »

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.

I'm sure they do it all the time.

I'm just looking for people's opinions. What if this story was 100% correct? Would you agree with jailing people for refusing a vaccination?

tallaght01

If we have an ebola outbreak, there is legislation like this in place.

This is a thread for scientific discussion. So, if there are credible sources (and they had better be VERY credible samson09) then feel free to post them on the general swine flu chat thread, but not on this one.

BUt, like Indy has said, any more links to your quack conspiracy blogs, and the ban will be permanent.

BUt you are very welcome to post official sources. BUt not in this thread.

samson09

Mystik Monkey wrote: »

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.

Thats what I originally thought. Then I read this-

http://www.irishstatutebook.ie/1947/en/act/pub/0028/sec0031.html#zza28y1947s31

What do you make of it? Looks like they can give you up to 6 months for refusing vaccination.

samson09

tallaght01 wrote: »

If we have an ebola outbreak, there is legislation like this in place.

This is a thread for scientific discussion. So, if there are credible sources (and they had better be VERY credible samson09) then feel free to post them on the general swine flu chat thread, but not on this one.

BUt, like Indy has said, any more links to your quack conspiracy blogs, and the ban will be permanent.

BUt you are very welcome to post official sources. BUt not in this thread.

Sorry for posting in the wrong thread, perhaps you could move the posts to the general swine flu thread. The link is to a story in an Irish paper that quotes a spokeswoman from the HSE. If the main papers or the HSE didnt announce it, that's not my fault. I don't think they'd be shouting it from the rooftops anyway to be honest.

I'm going to try and contact the HSE and other relevant agencies to try and see what the story is. I was only looking for people's opinions on the story and whether they thought jailing someone for refusing a vaccination is acceptable.

DrIndy

The 1947 act relates to the control of the spread of TB and as such is not only outdated but irrelevant today (TB physicians and ID specialists in ireland are lobbying for a far wider law to control the spread of TB including mandatory hospitalisations until disease free). One hundred pound fines and ten pounds per day as well as 6 month imprisonments are outdated.

Facts Samson09 or be banned - I am very serious!

This is the scientific thread too you are posting in!

Dr Galen

samson09 wrote: »

Thats what I originally thought. Then I read this-

http://www.irishstatutebook.ie/1947/en/act/pub/0028/sec0031.html#zza28y1947s31

What do you make of it? Looks like they can give you up to 6 months for refusing vaccination.

when

a) the Mods decide if they want this discussion to continue
and
b) the Mods decide where they want said discussion to continue

i'll get back to you

samson09

DrIndy wrote: »

The 1947 act relates to the control of the spread of TB and as such is not only outdated but irrelevant today (TB physicians and ID specialists in ireland are lobbying for a far wider law to control the spread of TB including mandatory hospitalisations until disease free). One hundred pound fines and ten pounds per day as well as 6 month imprisonments are outdated.

Facts Samson09 or be banned - I am very serious!

This is the scientific thread too you are posting in!

Thank you, that's all I was looking for

tallaght01

DrIndy wrote: »

The 1947 act relates to the control of the spread of TB and as such is not only outdated but irrelevant today (TB physicians and ID specialists in ireland are lobbying for a far wider law to control the spread of TB including mandatory hospitalisations until disease free). One hundred pound fines and ten pounds per day as well as 6 month imprisonments are outdated.

Facts Samson09 or be banned - I am very serious!

This is the scientific thread too you are posting in!

I fully endorse the above. If sampson09 posts on this topic again without giving a direct link to good evidence that there is a plan in Ireland for mandatory swine flu vaccination (as opposed to there being existing legislation if it was needed) then there will be an immediate permanent ban.

tallaght01

The Ozzie authorities have just approved the swine flu vaccine here. Well, they've approved it for adults. They're still waiting on us to get the kids data in to them. But that should be happening soon.

http://www.news.com.au/story/0,27574,26091199-29277,00.html

A SWINE flu vaccine has been approved by the Therapeutic Goods Administration, Health Minister Nicola Roxon has confirmed.
The vaccine, developed by pharmaceutical firm CSL, will be available later in September.

Ms Roxon said there was enough vaccination available for all adults.

"I encourage people to now take the opportunity to protect themselves and their families against the pandemic flu by getting vaccinated," she said.

Ms Roxon said while the virus has been mild for most people, it has had severe effects on more than 100 children.

She said the flu has been associated with thousands of hospitalisations and 172 deaths in Australia.

The vaccine will first be available only to adults, with the TGA awaiting further data from clinical trials before determining whether it is safe for children.

Worldwide there have been 3500 deaths associated with the virus.

Deliveries of the vaccine to immunisation providers will begin from next week.

SomeDose

Bumpity-bump. After the summer lull, our hospital is starting the ball rolling on measures to cope with the expected spike in cases once flu season sets in. We had a meeting with some of the ITU team to discuss experiences of cases to date and also the implications of an inevitable increase in ITU admissions (estimated 200-300% increase), which raised some interesting points.

In terms of drug use, Tamiflu is being used at 150mg bd (double the standard licensed dose) which I think agrees with practice in ITUs in the US and Australia. However, there seems to be an abnormally high incidence of delerium (~80% of our cases), and sedation and weaning is proving to be a major problem in these cases (physical restraints were necessary in some instances). Aside from the usual risk of delerium in ITU patients, there have been well-documented case reports of neurological and psychiatric effects in patients treated with Tamiflu during the avian flu outbreak. So it could be due to the higher doses being used, but it would be interesting to see if there's similar experiences in other units. Another point raised was the possibility of getting Tamiflu blood levels measured, purely because of a lack of solid data for dosing in renal failure. This isn't currently available in any hospital so we're looking at the possibility of sending them out to toxicology or university labs.

For ventilated patients, the nebulised Zanamivir formulation on ITU is a no-no due to the likelihood of spreading drug and viral aerosols into the air. This normally isn't an issue because Tamiflu can be put down a feeding tube, but for any patients in ileus or with rubbish gut function the choice of treatment is severely limited. IV Zanamivir is currently our only option here, and can only be obtained on a named-patient basis directly from GSK themselves (I'm really looking forward to getting that request when on-call! ). Interesting times...

tallaght01

SomeDose wrote: »

Bumpity-bump. After the summer lull, our hospital is starting the ball rolling on measures to cope with the expected spike in cases once flu season sets in. We had a meeting with some of the ITU team to discuss experiences of cases to date and also the implications of an inevitable increase in ITU admissions (estimated 200-300% increase), which raised some interesting points.

In terms of drug use, Tamiflu is being used at 150mg bd (double the standard licensed dose) which I think agrees with practice in ITUs in the US and Australia. However, there seems to be an abnormally high incidence of delerium (~80% of our cases), and sedation and weaning is proving to be a major problem in these cases (physical restraints were necessary in some instances). Aside from the usual risk of delerium in ITU patients, there have been well-documented case reports of neurological and psychiatric effects in patients treated with Tamiflu during the avian flu outbreak. So it could be due to the higher doses being used, but it would be interesting to see if there's similar experiences in other units. Another point raised was the possibility of getting Tamiflu blood levels measured, purely because of a lack of solid data for dosing in renal failure. This isn't currently available in any hospital so we're looking at the possibility of sending them out to toxicology or university labs.

For ventilated patients, the nebulised Zanamivir formulation on ITU is a no-no due to the likelihood of spreading drug and viral aerosols into the air. This normally isn't an issue because Tamiflu can be put down a feeding tube, but for any patients in ileus or with rubbish gut function the choice of treatment is severely limited. IV Zanamivir is currently our only option here, and can only be obtained on a named-patient basis directly from GSK themselves (I'm really looking forward to getting that request when on-call! ). Interesting times...

Interesting post.

We've only been using 75mg here in Oz, as that's what our expert advisory group have recommended. Maybe that's why we're not seeing the neuro sequeliae. I've posted this before on this thread, but it might be useful now.

http://www.ncbi.nlm.nih.gov/sites/en...0e3410%5BPG%5D

It's some interesting pharmacokinetic data on high dose oselatmivir (150mg bd).

With relation to weaning off ventilators, that has been a continuous problem over here. Average ventilated time has been 2 to 3 weeks, which is very long for someone with pneumonitis. Ventilation has been difficult, with very high pressures needed, and a lot of playing with rates.

There was a paper published in the Lancet this month describing the successful treatment of a patient with IV zanamivir. I'll dig out the reference later. Though NG oseltamivir probably has some degree of bioavalibility in ileus patients. The clinical picture here suggests it has some use in those patients. Would be great to have something parenteral, though.

You might escape the real chaos if they get the vaccine rolled out before winter. But, as an NHS cynic, I wouldn't hold my breath.

SomeDose

tallaght01 wrote: »

Interesting post.

We've only been using 75mg here in Oz, as that's what our expert advisory group have recommended. Maybe that's why we're not seeing the neuro sequeliae. I've posted this before on this thread, but it might be useful now.

http://www.ncbi.nlm.nih.gov/sites/en...0e3410%5BPG%5D

It's some interesting pharmacokinetic data on high dose oselatmivir (150mg bd).

So are you guys using 75mg bd as a ceiling dose in critical care and then reducing dose/frequency or switching to Relenza according to renal function? We're starting at 150mg bd but then I guess it becomes a moot point since a lot of the seriously ill patients are ending up on a filter and the dose is reduced anyway. That paper you linked to is interesting, although I note that all the patients were being enterally fed so I'm assuming they had some degree of gut function. That's the thing really, the current data is just so scanty that we're basically working off educated guesses. The IV product could at least give us some guaranteed availability. I saw that recent Lancet article but my Athens access is a bit dodgy right now so I can't get the full text...would be great if you could post it up. Incidentally, I believe that Vietnamese hospital where the bioavailability study was carried out is currently the only institution in the world (could be wrong) doing oseltamivir levels.

Ditto your point re: diffiiculty ventilating and weaning. The intensivists are having to use a lot of neuromuscular blockade, and average time on the vent is around 2 weeks or so.

Also, in the last day or two the MA for Tamiflu has now been updated and is recommending 6mo-1yr babies get 3mg/kg bd as opposed to 2mg/kg previously. Based on recent post-marketing data from the Far East I think. Has this been passed on to the aussie Tamiflu licence?

El_Dangeroso

Just found this:

http://www.nutraingredients-usa.com/Health-condition-categories/Immune-system/Canada-examines-vitamin-D-for-swine-flu-protection

So we may have further correlative data soon.

I can understand the need to be prudent when it comes to new medication that may have serious side effects but this is easy, cheap and with little to no side effects. Vitamin D was used extensively as a medication prior to antibiotics, so it's not like the immune boosting effects of it are the least bit controversial.

Worse comes to worse you improve someone's innate immune system. It's worth mentioning this is only an adjuvant therapy and not to replace any other treatment.

tallaght01

Temple_Grandin wrote: »

Just found this:

http://www.nutraingredients-usa.com/Health-condition-categories/Immune-system/Canada-examines-vitamin-D-for-swine-flu-protection

So we may have further correlative data soon.

I can understand the need to be prudent when it comes to new medication that may have serious side effects but this is easy, cheap and with little to no side effects. Vitamin D was used extensively as a medication prior to antibiotics, so it's not like the immune boosting effects of it are the least bit controversial.

Worse comes to worse you improve someone's innate immune system. It's worth mentioning this is only an adjuvant therapy and not to replace any other treatment.

Ok, so you're talking to fellow scientists here. Describe the data, the study design, the stats, and what makes this paper a good piece of evidence.

El_Dangeroso

tallaght01 wrote: »

Ok, so you're talking to fellow scientists here. Describe the data, the study design, the stats, and what makes this paper a good piece of evidence.

Which paper? The study hasn't been completed yet.. I will however report back with the lit review, should be complete in around three weeks, still waiting to hear back from some researchers that I have asked nicely (read begged) for full text of their articles and I still have lots more papers to read. Will take what you have said on board, it's exciting though when you see something that can have immediate benefit that's so easy to implement. If half of the extrapolations are right then it will be very exciting indeed.

tallaght01

The chief medical officer from the department of health and children was on the radio the other day saying the case fatality rate for swine flu had been revised in the northern hemisphere and was ow 0.6%.

Compare that to the previous 0.1% and that's a worry.

Anyone else got anything from the HSE about this?

MrCreosote

tallaght01 wrote: »

The chief medical officer from the department of health and children was on the radio the other day saying the case fatality rate for swine flu had been revised in the northern hemisphere and was ow 0.6%.

Compare that to the previous 0.1% and that's a worry.

Anyone else got anything from the HSE about this?

On the Times today though he estimated 100,000 already had it in Ireland with 10 deaths so far.

Got my vaccine today. Thiomersal leaching into my brain as we speak. Sweet sweet mercury!

nesf

sharmini wrote: »

Heres my concern.....we are being told that gp attendences are up.....yet gps are not routinely swabbing to confirm cases of swine flu

I was swabbed and so were my wife and son three weeks ago. All three of us had confirmed swine flu.

The other side is that these swabbings have shown that the dominant strain of flu this year is swine flu (every year some sub strain of flu is the dominant one). So any flu presented to a GP has a high chance of being swine flu.

Turtwig

sharmini wrote: »

Havent we got the right to information on thiomersal and its effects?

Yep you do, autism isn't one of them though.

nesf

Flu vaccine: a shortage that didn't have to be?: http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=flu-vaccine-a-shortage-that-didnt-h-2009-10-29&sc=CAT_SP_20091102 (Sci Am Observations article)

MrCreosote

sharmini wrote: »

Heres my concern.....we are being told that gp attendences are up.....yet gps are not routinely swabbing to confirm cases of swine flu......tamiflu being dispensed on a to be sure, to be sure basis.......had one case (ok only one so far) where doctor parent insisted on gp swabbing to confirm diagnosis on his child......swab was negative......

Havent we got the right to information on thiomersal and its effects?

Routine swabbing is pointless-it will make no difference to an individual's treatment and will take up huge resources. Getting a swab result in 2 or 3 days won't alter what a GP is going to have to do right now.

Which is usually going to be- you might have swine flu, go home, take paracetamol and take it easy.
Just like for regular flu.

sam34

sharmini wrote: »

two reports of patients, at different surgeries, some 20miles apart, being told not to come to the surgery.....prescription for tamiflu left for collection?

If we are relying on gps surgeries for numbers of ACTUAL swine flu, I fear that we will never know it!

in a previous post tallaght01 explained how they measure teh numbers:

The way they measure the numbers is by "sentinel surveillance". This means about 60 GP surgeries in Ireland report the number of "influenza like illnesses" that present to them every week.

We know, from analysing lab samples, that most influenza are swine influenza at the moment.

So, say those 60 surgeries have 1 million people on their books between them (they don't, but for for ease of numbers) then you can make certain estimates. You'd look at the 1 million people, and multiply that by 4. Then you'd add a bit more in, to account for people who don't show up with flu, but stay at home. Then you adjust the figures some more, to take into account the fact that the demographic presenting to the GP surgeries don;t reflect the normal population (more older people go to the GP etc, more babies, more women).

It's modelled like this around the world. It works reasonably well, but the figures given by the HSE will never be properly exact.

tallaght01

We've gotten a slight resurgence over the last few weeks. Just small increases. But we don't normally see an increase at this time of year in the southern hemisphere. Doubt it's a second wave. But it's something to keep an eye on.

locum-motion

sharmini wrote: »

Loco-motion kindly explained to me ...

Actually, it was Tallaght01 and Sam34, not me.
Thanks for giving me unearned credit, though!

Dr Galen

@Sharmini

You've posted exactly the same post on both the General and Scientific Swine flu threads.
Thats not really in keeping with the accepted norms for internet discussion forums, such as here on boards.ie.

I've deleted one, and left this post here, as although, not scientific as such, your posting is relating to the clinical practice around Swine Flu etc.

You've also posted the same post on the Parenting forum, the Mods there can deal with this as they see fit.

Thanks

MM

locum-motion

Just bumping this back to the front page.

Dr Galen

From RTE.ie

Swine flu deaths increasing across Europe
Monday, 23 November 2009 15:43
The number of H1N1 swine flu deaths in Europe has doubled almost every two weeks since the middle of October, the European Centre for Disease Control and Prevention said today.

169 people died of the virus in the past week and 670 deaths have been reported in Europe from H1N1 flu since monitoring began in April, the Stockholm-based disease surveillance experts said.


'The number of deaths. . . has shown a steady increase - almost doubling every fortnight over the last six weeks,' the Centre said in its daily update.

Advertisement'While the most deaths have to date been in western Europe there are increasing numbers of deaths being reported from central and eastern Europe.'


Vaccination programmes against H1N1 have started in many European countries in recent weeks to try to halt the spread of the virus, which is commonly known as swine flu and was declared a pandemic by the World Health Organisation (WHO) in June.


But immunisation plans are facing mixed levels of uptake and opposition from anti-vaccine lobbyists, according to the European Society of Clinical Microbiology and Infectious Diseases. It said such opposition was putting public health and lives at risk.

The WHO said last week that governments across the world have administered more than 65 million H1N1 vaccine doses. Common side effects of the shots include swelling, redness or pain at the injection site, and sometimes fever or headache but the WHO ruled out any death links to the shots.

Flu levels are reported as being 'unusually high for this time of year' across Europe, with H1N1 accounting for 99% of cases.

all the more reason it appears for the vaccination program to be rolled out to the full population asap. Must have a look into comparative figures between H1N1 mortality and normal flu

Ricky91t

I don't know have you heard about the new mutated H1N1 virus found in Norway and now France..

For people who have got the vaccine are they vaccinated against this mutated form of H1N1?

According to Breaking news: "more prone to infect deeper in the airways and thus cause more severe illness"

So surely this is why the .1% has been increased to .6%?