Tag Archives: Centers for Disease Control

Influenza Toys with the Human Race

The current U.S. influenza seasonal epidemic, the mildest in years, is in its death throes, based on infection trends over the past several weeks, including the most recent data released on May 11 by the Centers for Disease Control and Prevention.

During the week that ended on May 5, 13.7% of U.S. respiratory surveillance specimens tested positive for influenza, continuing the clear downhill slope of U.S, flu cases since this season’s U.S. epidemic peaked at 30% positive during the week of March 11-17. The CDC hasn’t yet declared the current, 2011-2012 flu-season’s epidemic, which started in late February, officially over—it can’t until the influenza-positive rate falls back below 10%–but the epidemic curve’s steep downward track (see graphic) is as well defined as the far side of L’Alpe d’Huez.

graphic courtesy of the CDC

With the current influenza epidemic nearly ended, the season’s numbers paint a decidedly benign picture. So far, 22 children have died from influenza; if that figure continues to grow as it has so far it will top out as the lowest since the CDC began collecting these data in 2004.

Other markers of how mild the 2011-2012 season has been include the number of U.S. patients hospitalized for influenza, which sits below past seasons, and the proportion of deaths attributable to pneumonia or influenza has hovered below the epidemic threshold for that measure all season.

During a winter and spring where the influenza world focused on mammalian-transmissible H5N1 flu, strains dubbed by some the “doomsday” virus, having such a mild seasonal flu season tossed at us can’t help but be seen as some ironic, natural-world prank. On a purely rationale basis, year-to-year variations in seasonal flu have nothing whatsoever to do with the looming danger from H5N1 flu, but with this infectious-disease juxtaposition I can’t help but imagine that somewhere, off in the distance, I hear a quiet, cosmic chortle.

—Mitchel Zoler (on Twitter @mitchelzoler)


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The Value of Sleep

Sleep is big business. People need it. They want it. They’ll spend money to get it. And, according to the bulk of presentations at the 25th annual joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society in Minneapolis (SLEEP 2011) last week, the demand for it continues to far outpace the supply. Given these conditions, it’s not surprising that Americans spend nearly $24 billion on sleep-related goods and services annually, and the market for insomnia drugs is predicted to grow by nearly 80%, to approximately $3.9 billion, in 2012, according to market research conducted by Marketdata Enterprises.

Image via Flickr user deansouglass by Creative Commons License.

Evidence of the anything-but-restful sleep market was plentiful in the SLEEP 2011 exhibit hall, with booth after booth of vendors showcasing everything from pharmaceuticals and nutraceuticals to earplugs, continuous positive airway pressure devices, breathing masks, light therapy boxes, aromatherapy sprays, premium mattresses, and customized pillows. There was also row upon row of posters highlighting the latest research on the multiple and varied sleep-related problems that are keeping the vendors in business.

During a walk through the exhibit hall, however, it didn’t take long for the ironic reality of the sleep conundrum to set in. Americans are spending billions of dollars on sleep-related goods and services and researchers are spending billions of dollars seeking insight into the global sleep deficit that, according to the meeting’s scientific program presentations, is leaving children, adolescents, and adults overtired, anxious, depressed, and suboptimally functional and is putting them at risk for a range of adverse health outcomes, including cardiovascular disease, asthma, diabetes, stroke, and obesity. Yet we, as a society, don’t value sleep.

For example, in March of this year, the Centers for Disease Control and Prevention reported that nearly one third of the country’s adults get less than the minimum recommended 7 hours of sleep per night, and it’s not because they’re not tired: nearly 40% of the survey population reported unintentionally falling asleep during the day and nearly 5% reported nodding off while driving in the preceding 30 days.

Notwithstanding suboptimal sleep quality or quantity resulting from chronic sleep disorders, such as insomnia, obstructive sleep apnea, restless leg syndrome, bruxism, narcolepsy, and sleepwalking, the country’s pervasive sleepiness is often a symptom of what has become a “24-hour society,” in which there’s not enough time in a day to do everything we want to do, according to Dr. Michel Cramer Bornemann, co-director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis. Not only have we become accustomed to trading sleep for work, he said in a session on sleep forensics, “we wear sleep deprivation as a badge of honor, as if lack of sleep is synonymous with hard work or achievement, when really it can impede both.”

Sleep is a biological imperative, Dr. Bornemann stressed. When it’s not valued as such,  “everybody pays.”

— Diana Mahoney (on Twitter @DMPM1)

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Filed under Cardiovascular Medicine, Clinical Psychiatry News, Drug And Device Safety, Endocrinology, Diabetes, and Metabolism, Family Medicine, Geriatric Medicine, IMNG, Internal Medicine, Neurology and Neurological Surgery, Otolaryngology, Primary care, Psychiatry, Pulmonary Diseases and Sleep Medicine

H1N1 Pandemic Slip Sliding Away?

U.S. public health officials haven’t given up on the influenza H1N1 pandemic, but it seems like the American public has. 

Has the specter of H1N1 faded like last October's goblins?/image courtesy of Flickr user chrisstreeter

The irony is that just as the H1N1 vaccine became widely available in December, rates of pandemic flu infection dropped to vanishingly low levels and concurrently concern about H1N1 largely dropped off the national radar.

The recent downturn in H1N1 infections helped further blunt any fear. Slow-to-build vaccine supplies undercut the vaccination push. The bottleneck made widespread vaccination impossible during the hyped-up early days of the pandemic’s current wave. The result: the momentum to get much of the American public vaccinated fizzled out. The only thing that could reinvigorate the vaccination campaign now would be a third wave of infection later this winter or in the spring — certainly a possibility, but hardly a given. 

The U.S. H1N1 vaccine supply stream remained at a disappointingly moderate level in December.  During the 5 weeks from late November through the last day of 2009, an additional 48 million doses shipped, bringing the total since the vaccine began appearing in early October to a hair under 100 million doses through the end of last year, half the total ordered and paid for by the Department of Health and Human Services. 

 What this meant was that until mid-December, access to the vaccine was officially limited to high risk groups. According to a report last Friday in the New York Times by Douglas G. McNeil Jr., 60 million Americans had received the H1N1 vaccine through the end of 2009. Just when vaccine availability began to open up, the pandemic wave ebbed away. During the week ending Dec 26, the Centers for Disease Control and Prevention reported that its surveillance labs identified 83 isolates as H1N1 (with another 76 isolates influenza type A, with subtyping not done). That compared with more than 9,500 H1N1 isolates identified (with another 2,100 type A isolates not subtyped) during the current wave’s peak, the week of Oct. 18-24. Four states were reporting widespread flu at the end of December, down from a peak of about 40 states in late October. 

Here’s a personal story that typifies the missed opportunities and misinformation that have hampered the H1N1 public health campaign. I’m not a member of a high-risk group, and so waited till mid-December to call my physician’s office about getting the vaccine, only to hear that they would not carry the vaccine at all, not now or at any time in the future. I was amazed, as this practice routinely administers flu vaccine each fall. I asked why, and the practice’s nurse told me: Their patients are almost entirely middle-aged or elderly, and hence faced little or no risk from H1N1. That was their conclusion, despite the fact that so far this flu season essentially the only virus in U.S. circulation has been H1N1, and despite the fact that infection by H1N1 is still a nasty experience even for older adults. During the current U.S. flu season starting last September, U.S. surveillance labs identified about 60,000 H1N1 isolates compared with fewer than 300 isolates of other flu A types or B type.

Unless the H1N1 pandemic resurges, the U.S. legacy will be a vaccine that wasn’t available for most people until the infection threat died down, and  a triaging of initially-limited vaccine supplies to high-risk groups that got mistaken by even well-informed people to mean that high-risk people were the only ones at risk. 

–Mitchel Zoler (on Twitter @mitchelzoler) 

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Filed under Family Medicine, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Practice Trends, Primary care

H1N1 Vaccine: The Slow Supply Slogs On

It had been a month since I wrote about the H1N1 influenza vaccine supply, and I was curious what had happened during November. The numbers aren’t pretty.

According to a Dec. 4 Webpost by the Centers for Disease Control and Prevention, as of Dec. 3, a total of 63.3 million H1N1 doses had shipped to U.S. providers. Shipments began Oct. 5, so this total represented the output of the first 8.5 weeks of H1N1 vaccine availability. That works out to an average of about 7.5 million doses shipped per week.

To put the numbers in perspective, the U.S. government paid for  production of roughly 200 million doses for administration to Americans this season. As recently as Sept. 18, CDC officials predicted that by October, 20 million new doses would reach providers weekly, a timetable that suggested all 200 million doses would be available by the end of this year. Sure looks now like that’s not going to happen.

Officials running the H1N1 vaccine program began warning in late October that the supply stream wasn’t moving nearly as fast as initially predicted because the vaccine seed strains turned out to have unexpectedly low yields. A little analysis of how the supply has dribbled out so far provides  probably the best guidance on what the near future may hold for when all 200 million doses will reach the U.S. public. 

Here is the vaccine picture in a little more detail. The numbers come from the almost daily tally that the CDC updates (at least give the agency credit for transparency). I focused on the number of doses shipped, rather than the number allocated, as this seems like the most relevant statistic. Here is a week by week tally of how many doses shipped, and the running cumulative total:

Week     Ending Date     Doses Shipped                          Cumulative Total

1                  Oct 12                3.9 million                                  3.9 million

2                  Oct 19                4.9 million                                  8.8 million

3                  Oct 26                4.9 million                                 13.7 million

4                  Nov 2                 8.1 million                                 21.8 million

5                   Nov 9                9.7 million                                31.5 million

6                  Nov 16               9.2 million                                40.7 million

7                  Nov 23              8.9 million                                 49.6 million

8                   Nov 30            7.4 million                                 57.0 million

**8.5           Dec 3                6.3 million**                             63.3 million

Unless a sudden breakthrough in the supply stream occurs, these numbers show some revealing trends. The 3 days since Nov. 30 (what I highlighted with stars to stress that it wasn’t a full week) were the best showing yet, so maybe the process is speeding up. The pace for those 3 days works out to about 15 million doses/week. Even at that rate the last of the 200 million doses won’t reach providers till late January.

But another valid interpretation is that the spurt during the first days of December was catch up from the slow week ending Nov. 30, which included Thanksgiving. If you discount that as an outlier, past performance suggests that the best supply rate we can expect in the coming weeks is about 10 million doses/week. In that case the 200 million dose goal gets met sometime in March.

I think it would be safe to call that timetable disappointing, especially compared with earlier expectations from the CDC and the U.S. Department of Health and Human Services. 

—Mitchel Zoler (on Twitter @mitchelzoler)

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