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Megan Coffee

Infectious Diseases Blog


China lifts ban on foreigners with HIV/AIDS

Wednesday April 28, 2010

For the last decade China has maintained a ban on people with HIV/AIDS from entering the country. But the country has revoked the ban after receiving criticism following the barring of an Australian writer who declared he was HIV-positive.

China's regulation formally banned foreigners with "psychiatric illness, leprosy, AIDS, sexually-transmitted diseases, active pulmonary tuberculosis or other infectious diseases." The State Council amended the regulation on Tuesday removing the ban on people who have developed AIDS or are infected with the HIV retrovirus.

The ban still bars foreigners "with serious psychiatric illness, infectious pulmonary tuberculosis or other infectious diseases that may constitute a major threat to public health."

20 Percent of Americans Received H1N1 Swine Flu Vaccine

Monday January 18, 2010

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

After all that uproar when the vaccine wasn't getting here quickly enough and all that persuasion and urging once it was here, the numbers of people vaccinated against H1N1 in the U.S. should be pretty high. The Centers for Disease Control and Prevention has released a report that tells us the estimated number of American citizens who were vaccinated.

At first blink, it sounds huge (and it is, don't get me wrong) when we consider that 61 million Americans have received the H1N1 vaccine since the fall of 2009. However, put another way, that works out to only 20% - 1 out of every 5 Americans have been vaccinated. I dunno, it just doesn't sound that good.

However, there are other ways to look at it that sound more impressive and hopeful:

1) The CDC says that the people at the very highest risk were the most likely to be vaccinated.

2) The estimated number of people who actually caught H1N1 and got sick from it is 50 million, so the public health people are still 10 million in the lead.

You know what? It's not too late. As a matter of fact, now is a great time to get vaccinated if you (or your kids) are in the 80% who have not gotten your vaccine. Unless you were CONFIRMED by a lab to have H1N1, go get your vaccine. Help yourself (in case another wave of H1N1 infections is coming) and help the statistics. It's just a good idea.

Possible Post-H1N1 Pandemic Fallout

Monday January 11, 2010

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

A Reuters article says that the European Center for Disease Control and Prevention (ECDC) is warning that the fact that new cases of H1N1 swine flu are lessening could mean that other flu viruses will start showing up.

Experts say that historically after influenza pandemics, there tend to be new unknown flu viruses that start circulating. They also point out that the pandemic influenza viruses have historically come back after an apparent decline to infect lots more people.

What does this all mean? A couple of things:

  • People should go ahead and get the H1N1 vaccine if they haven't done so yet. It should be easy to find these days and most places have lifted any restriction (such as being age 65 and older), so that anyone can get vaccinated.
  • If your child only got one dose, they should get their second dose.
  • If you haven't gotten your seasonal flu vaccine, get that one, too.
  • Continue to follow all of the common-sense cold and flu season precautions, such as staying home if you are sick, washing your hands often and coughing into your elbow.

H1N1 Swine Flu Herd Immunity?

Saturday January 9, 2010

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

It looks like some regions are becoming immune to widespread outbreaks of H1N1 swine flu, as they have developed immunity from previous waves of exposure.

"Herd immunity" is a term that describes a community being immune to (not able to catch) a certain disease. This immunity can be conferred either from exposure, meaning that people had the disease and recovered, or vaccination. It does NOT mean that no one in the community can get the disease, it just means that there will not be a large outbreak and that individual infection is therefore less likely.

Herd immunity is an interesting concept, as different diseases require different levels of immunity to protect the community, based on the transmissibility of the virus or bacteria. For instance, measles is one of the most infectious, easily transmitted viruses in people. To achieve herd immunity against measles, between 90 and 94% of the population must have been vaccinated. However, for smallpox, the immunity levels were between 80 and 85%, which is one reason that it was possible to eradicate that disease.

Few experts have tackled the idea of herd immunity to a pandemic flu like H1N1, as it was such a rapid wave and there are many unknowns. True herd immunity seems a little less likely than the fact that these types of viruses usually just "peter out" and move along. However, there is evidence that there has been enough exposure in some southern hemisphere countries that there is no longer widespread infection, but isolated cases of H1N1 occurring, even though the virus is still present.

If you are intrigued with the idea of herd immunity and H1N1, see what you can make of this article, which mentions some interesting assumptions and some difficulties in modeling pandemic influenza: Pandemic influenza dynamics and the breakdown of herd immunity

US H1N1 Swine Flu Response in Hindsight

Wednesday January 6, 2010

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

During the H1N1 peak epidemic months of October and November, it seemed like lots of people had lots to complain about in terms of the response to the epidemic. However, listening closely (as I did until I got tired of it), the kvetching kind of came down to a couple of things that weren't really even problems - just poor communication or inconveniences.

For instance, being a mother of young children myself, I know many other mothers of young children. We all wish the vaccine would have been available to our kids sooner. Many of us needed the shot, rather than the mist, which was even later in coming. And, of course, when the vaccines did show up, it often involved hurrying somewhere just to be told that there would be a wait.

Then I heard from my relatives who are older than 65. They wanted the vaccine, too, but were told that they were not in the first priority group (or even the moderate priority group). They were told that they could get the vaccine, but only after everyone who was at higher risk had their chance to get it. They didn't like that. One bit.

However, when we analyze the situation, it turns out we did okay. Government public health officials acted aggressively, but not rashly. They followed logic and data instead of emotion and didn't do things like close down whole school systems. They used a safe vaccine, rather than try something new or add adjuvants, even though the vaccine supply was delayed.

Of course, things could have been better and that is what is the best part of this whole experience: it provided a chance to learn about things in case something worse (deadlier, quicker, more infectious) comes. We also got to observe public behavior around vaccines, which surprised many experts as people screamed for vaccines, complained about delays, then refused to get them.

Of course, none of this is to say H1N1 is a thing of the past. Many experts predict a "3rd wave," based on how other influenza pandemics have behaved. If that is to happen, it is predicted to come in late winter. The suffering and deaths caused by H1N1 are also not insignificant. However, it could have been worse for many, many people and I, for one, am grateful that this "practice epidemic" was taken so seriously.

For further information, read US Reaction to Swine Flu: Apt and Lucky.

Closing Schools to Stop the Flu

Monday January 4, 2010

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Remember in April and May when it seemed like every other school was closing down temporarily to try to stop H1N1 swine flu? I wondered at the time if that was doing any good to slow down the number of students that became infected. Well, a recent study seems to have answered my question...

Researchers at the University of Pittsburg used a computer simulation model to see what the effect of closing schools during an influenza outbreak would be.

The results were surprising:

  • Closing entire school systems did not help slow an epidemic any more than closing individual schools
  • Schools needed to be closed for at least 8 weeks (the length of the worst part of an epidemic) to have an effect on the numbers of students infected. Even when closed 8 weeks, the peak in epidemic numbers were delayed by only one week.
  • When schools were closed for 2 weeks or less, the data showed that this could actually make things worse, as susceptible students could be brought back together at the peak of the epidemic.

Researchers concluded that while school closures alone could not stop (or even put a serious dent in) an influenza epidemic, taking such measures could buy time to do something that is effective - vaccinate susceptible students.


Lee BY, Brown ST, Cooley P et al. Simulating School Closure Strategies to Mitigate an Influenza Epidemic. J Public Health Manag Pract. 2009 Dec 23.

Flu Information in Many Languages

Sunday January 3, 2010

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Do you know someone for whom English is a second language (or doesn't speak English at all)? Then direct their attention to this page from the CDC that presents information about the flu (seasonal and H1N1 swine flu) in Arabic, Chinese, Spanish, French, German, Italian, Korean, Russian, Tagalog and Vietnamese.

There are information sheets that cover topics for specific populations, such as pregnant women and people with certain conditions, such as asthma and diabetes. There are sheets about symptoms and warning signs, as well as information about how to stay healthy at work and about vaccines.

Think about how confused many of us have been at times during this epidemic, even though the news (and the gossip) that we were listening to was in our own language. Now, imagine if you were trying to figure out what was going on in a language that wasn't your native tongue.

Do someone a favor and send them a link to this page so that they can get the plain facts in their own language and make decisions for themselves.

Diabetes and the Flu (Seasonal and H1N1)

Friday December 18, 2009

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

If you have diabetes, you have probably been advised by your physician to get vaccinated for both H1N1 (Swine flu) and the seasonal flu. Ask about it if you haven't already.

If you end up getting the flu (or experiencing flu-like symptoms), you should contact your doctor for next steps. During the course of your illness, you should follow a couple of simple guidelines:

  • Keep taking your medicine, even if you can't eat. Ask your doctor about how to adjust medication levels accordingly.
  • Test your glucose levels every four hours. Write down the results. Any levels lower than 60 mg/dL or sustained at over 300 mg/dL means you need to call your doctor or get to the emergency room.
  • Try to keep eating normally. If you can't, at least try to get some of your normal carbohydrate levels through soft foods and liquids. If you cannot eat or can't keep food down for more than 6 hours, call your doc.
  • Weigh yourself daily to make sure you are not losing weight, which might indicate that your blood glucose is high. If you lose more than five pounds, call your doctor immediately.

The following things should also prompt a call or visit to your doctor immediately: diarrhea, temperature over 101 degrees, trouble breathing, feelings of lethargy or confusion or moderate to large levels of ketones in your urine.

People with diabetes are especially vulnerable to effects of the flu, as well as to complications from pneumonia, which often accompanies the flu. Take care of yourself.

Q. I'm 65 years old. Why can't I get the Swine flu (H1N1) vaccine?

Thursday December 17, 2009

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

A. The good news is that now you probably can.

There were a couple of reasons that people age 65 and older were unable to get the H1N1 vaccine for several months.

The first reason was that there was not enough vaccine to go around for everyone who wanted one and the health departments had to prioritize which people should get it first. They made this decision based on statistics and data as to who was at most risk for serious complications and death from this particular strain of influenza. That is why the first group contained pregnant women and people taking care of infants 6 months of age or younger. The groups then expanded to include children, especially those with certain conditions, as well as young adults with known risk factors.

People over 65 did not seem to be dying from H1N1 flu. Researchers think that maybe this is because older Americans had some sort of immunity that they probably got from exposure to the flu of 1957. (However, seasonal flu is a different story - the seasonal flu historically is the most dangerous to the "over 65" crowd, with the majority of the annual 35,000 deaths in this age group.)

The second reason that people over 65 couldn't get the vaccine is that the nasal mist version came out first and there was a delay in the injectible vaccine. The nasal mist vaccine has only been tested in people ages 2 to 49 years of age - anyone falling outside of that range has to get the shot.

Again, the situation is better in terms of availability of the H1N1 shot, so anyone hankering to get themselves vaccinated should be able to find a vaccine (although it might take a little calling around) in their area.

Swine Flu (H1N1) Vaccine Recall Reassurance

Wednesday December 16, 2009

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Usually the word "recall" means that something has injured or sickened many people, prompting manufacturers to get it all off the shelves.

Fortunately, the recall of 800,000 doses of pediatric swine flu (H1N1) vaccine has absolutely nothing to do with safety. I'll repeat that: The H1N1 vaccine that was recalled is SAFE!

The problem with the vaccine that was recalled by Sanofi-Pasteur was that it somehow lost potency from the time of manufacture and packaging over the following weeks. The potency was only slightly below required levels and the company issued a voluntary recall.

The good news is that there is no recommendation for kids to get vaccinated again if the received the two doses of vaccine that is recommended for all children under the age of 10. This is the case even if both doses came from the recalled lots.

Bottom line: If your child got two doses of H1N1 vaccine, don't do anything. If your child is still missing a dose (or two), get them vaccinated. There is nothing to worry about. Leave the stress over this situation to those dealing with the logistics of such a huge recall.

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