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h1n1

Congratulations to Ottawa Public Health!

Just a quick tip of the cap to everyone involved in the delivery of the H1N1 vaccine at the Jim Durrell Centre yesterday.

Expecting chaos yesterday morning at 7:45 am, I packed drinks, snacks, reading materials, ensured my mp3 and cell was charged, dressed warmly for the inevitable wait outside in the cold and flurries… etc. I was prepared for anything!

Except for an efficiently-run process…

After all of the media accounts I had heard and read in the past few days, I had expected disorder to reign, a long wait and cold feet. But what I got was, chronologically:

7:45 am : a nice greeting at the door, shown to a seat inside (?!!)

8:00 am: told that wristbands would be distributed shortly

8:15:  moved to another waiting where wristbands were distributed by a very enthusiastic and funny gentleman

8:45: given wristbands and, after staff ensured that they were firmly affixed to my wrist, I left the building.

Total time elapsed – 1 frickin’ hour!

So fine, they got the wristband thingy right… surely things wouldn’t be as smooth at the appointed time of 5 pm?

But again, I am happily surprised. We walk into the arena at 4:55, are greeted with a smile, documents checked and all-injected and outta there after the obligatory wait in the designated area by 5:20.

Wow.

This whole business may be a bit wheezy elsewhere, but on this particular day and in this particular place, they sure knew what they were doing!

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H1N1 immunizations – just do it!

There are still a lot of misconceptions out there about the H1N1 vaccine. Confusion about the vaccine in general as well as more specific concerns about the adjuvanted vaccine versus the non-adjuvanted vaccine.

I’m not talking about the Jenny McCarthy lunatic fringe element. The Squid-dude and I have dealt with that in a past posting.

I’m referring to some sane and normal individuals asking some sane and normal questions about the vaccine.  After all, if you are going to put this stuff into your kids’ bodies, or your own, then you should understand a bit about what is in the vial, correct?

So – here are some realities and myths about the vaccine in general and the adjuvanted vaccine more specifically:

1. The H1N1 flu vaccine will give me the flu.

FICTION

This is a common myth that doctors battle every year. And the H1N1 flu is being made the same way that seasonal flu is manufactured. The flu vaccine is created from killed virus, so there is no way to transmit flu from the vaccine.

Flu season coincides with the cold season so people frequently confuse the common cold with the flu. Also, in some cases, people who get a flu shot can still get the flu, but they may get a much less severe form of the illness and, most importantly, they’ll have a decreased risk of flu-related complications — especially pneumonia, heart attack, stroke and death — to which older adults are especially vulnerable.

2. Wearing a mask will protect me from flu.

FICTION

Except in certain health care settings, the Centers for Disease Control and Prevention (CDC) does not recommend wearing a face mask. They have a lot of shortcomings for infection control. They’re only good for a short period of time and as soon as they get moist, they become ineffective. They also do not fit tightly enough around the face to prevent small infected droplets to get through. The best advice is that if you’re sick, stay home. Stay away from sick people and make sure to keep your hands clean and practice good cough etiquette by coughing into your sleeve. Still gross – as discussed by XUP, here.

3. Hand sanitizer is as effective as washing my hands.

FACT

They are an effective way of cleaning your hands of germs. Doctors use them and they’re commonplace in hospitals.

Ashton referenced the CDC, saying, the influenza virus is destroyed by heat. In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses, if used in proper concentration for a sufficient length of time. Wipes or gels with alcohol in them, for example, can be used to clean hands. The gels should be rubbed into hands until they are dry.

4. I am sneezing, have a sore throat and a cough, so I have H1N1 flu.

FICTION

No, you need to also have a fever. Coughing and shortness of breath are common symptoms, but also vomiting, fatigue, muscle soreness and diarrhea.

Ashton cited the CDC saying the symptoms of novel H1N1 flu virus in people are similar to the symptoms of seasonal flu, although vomiting and diarrhea has been reported more commonly with H1N1 flu infection than is typical for seasonal flu.

The CDC studied the hospital records of 268 patients hospitalized with novel H1N1 flu early on during the outbreak. In this early subset of cases with significant clinical data, fever (93 percent) and cough (83 percent) were the two most reported symptoms. This is not surprising since cough and fever were part of the case definition. Other symptoms were shortness of breath (54 percent), fatigue/weakness (40 percent), chills (37 percent) and myalgias, also known as muscle soreness (36 percent).

5. If the rapid flu test comes back negative, that means I don’t have H1N1 flu.

FICTION

The CDC reports that many of the rapid diagnostic tests may miss many cases of the H1N1 flu, Ashton said. The overall sensitivity ranged as low as 40 to 69 percent. So, she said, the first result may not be the most accurate. The CDC recommends that clinicians use their judgment based on the patient, and prescribe Tamiflu if necessary.

Q1. What is the difference between an adjuvanted and non-adjuvanted vaccine?

An adjuvanted vaccine is a vaccine that includes a substance that boosts an individual’s immune system and increases their response to a vaccine. An unadjuvanted vaccine has no “booster” element.

Adjuvanted vaccines are included in common vaccines such as tetanus and Hep B.  The adjuvant in Canada’s H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E.

Q2. When was the last time Canada used an adjuvant in a vaccine?

Adjuvants are not new. They have been used for several decades to boost immune response to vaccines.  Many of the commonly used vaccines in Canada contain an adjuvant.  However, they have not previously been approved for use with influenza vaccines in Canada.

Q3. Are adjuvanted influenza vaccines safe for use?

The adjuvant used by GSK has been tested in approximately 45,000 people around the world and has been evaluated by Health Canada and other regulatory authorities as part of the review of the H5N1 vaccine in the pre-pandemic period.  No significant safety concerns regarding the use of the adjuvanted vaccine were detected.

In June 2009, the WHO held consultations on the safety of adjuvanted influenza vaccines to review and discuss known and theoretical safety concerns and prospective vaccine safety evaluation.  The outcome of the WHO consultation was that no significant safety concerns or barriers to evaluating or using adjuvanted vaccines for the current H1N1 virus were raised.

Clinical studies have been designed to study the risks and benefits of using both adjuvanted and unadjuvanted vaccine against the H1N1 flu virus, and Health Canada and the Public Health Agency of Canada are working closely with other national agencies to implement appropriate post-market monitoring.

Q4. Does an adjuvanted vaccine pose a risk to pregnant women?

All evidence suggests that adjuvanted vaccines are just as safe as unadjuvanted vaccines; however there is no safety data for the use of adjuvanted vaccine in pregnant women.  The WHO’s Strategic Advisory Group of Experts (SAGE) recommended in July that pregnant women should receive non-adjuvanted vaccine where possible, but that an adjuvanted vaccine could be used if necessary.

Q6. Is the Government ordering non-adjuvanted vaccine?  Who will it be recommended for and why?

The Government of Canada plans to purchase a small quantity of non-adjuvanted H1N1 flu vaccine (approx. 1.8 million doses) as part of its total order of 50.4 M doses.

The purchase of a small quantity of non-adjuvanted vaccine is a precautionary measure for pregnant women as no clinical data of the safety of adjuvanted vaccine in this group is available.

In these cases, should a non-adjuvanted vaccine prove to be effective, it may be the preferred option.  The WHO has indicated that it has no special concerns about the safety of adjuvanted H1N1 flu vaccines in general.  The WHO has also strongly recommended that pregnant women be immunized against the H1N1 flu virus, even if no non-adjuvanted vaccine is available.

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Dr. Stevo comes to the rescue!

I wouldn’t be surprised if the Harperites do try to take cedit for saving the lives of Canadians.

(Thanks to Warren Kinsella for this).

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H1N1 colonies – why not?

So I hear that an old busybody in Victoria got her knickers in a twist about being on the same bus as someone who dared to cough in this H1N1-sensitive world. The old busybody makes a fuss about it to the driver and the driver politely (1) asks the coughing lady to leave the bus. The sick one was quite rational about this – I’m not so sure I would have been.

“I get the concern,” said Jenn Chapman, 41, a human resources worker. “There needs to be some precaution, there needs to be some education. But there needs to be way less hype.”

Chapman said on Thursday she was riding a bus and coughing into her sleeve, as directed by public health officials — even though her doctor has assured her she doesn’t have H1N1 swine flu.

An elderly woman sitting some distance away told Chapman she shouldn’t be riding public transit with a cough. The woman then approached the driver and demanded he take action.

The driver, although clearly uncomfortable, asked Chapman if she was close enough to her destination to leave the bus. Since she was only two stops away, she got off to keep the peace.

“What are you going to do? I was brought up to respect my elders,” said Chapman. “She wasn’t rational at that point.” (my note – I respect my elders no more than I respect anyone else – they have to earn it.. it is not something that is automatically endowed upon them! OK. That’s my rant about seniors…)

Clearly an intelligent person, that Ms. Chapman. She realised that she was fighting a losing battle against an irrational bitty.

Which brings me to my point: all of this hype is completely over the top.

In the past two weeks, I have counted 11 people wearing face masks on the bus or at a station. When someone coughs, at least 2 or 3 heads to turn to see if the guilty party was anywhere in close proximity.

It-is-the-FLU, people! So you say: “but this is a different strain of the flu” More deadly than others!”

Not true… this is from a Health Canada site:

Q2. I understand Canada has experienced deaths related to the H1N1 virus. Does this mean the virus has grown in strength?

There is no evidence to suggest that the virus has become stronger.

It is important to realize that different strains of influenza result in about 2,000 to 8,000 Canadian deaths a year. We must take all influenza – not just the current strain – seriously, and take measures to protect ourselves.

So. Use some common sense and stay home when you are sick. Like I am doing today, for example. I’m pretty sure that all I have is a bad cold with my usual bronchial issues… but I don’t want to spread it to my co-workers and they certainly don’t want to hear me coughing and sniffing!

But I don’t have Ebola, Bubonic Plague, Cholera,TB or even Cat Scratch Fever! I’m pretty sure of that!

But we do not need to isolate ourselves or be isolated by others if we have some symptoms that may be similar to those with the flu – any flu! If that is encouraged, then we might as well go the full Monty and set up little communities of Swine flu infected folks. We could call them colonies. Pigger colonies. Flu flats.

Hmm… wasn’t there another disease where those infected where left to themselves on the outskirts of town…

Anyhow – chill folks. This happens every year.

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1. The driver actually was quite nice about this. Wow. Take note, OC Transpo operators!!

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