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Swine flu expected next flu season: vaccines encouraged

BY Michael Johnsen

ATLANTA —The novel H1N1 virus is expected to make a big impact in the coming cough-cold-flu season, though just by how much is hard to determine, noted Anne Schuchat, director of the National Center For Immunization and Respiratory Diseases for the Centers for Disease Control and Prevention, during a press conference held late last month.

Based on the course of the novel H1N1 virus in the spring, between 6% and 8% of people in those communities that were affected came down with the novel flu at a time when seasonal flu incidence is relatively zero. “In a longer winter season, attack rates would probably reach higher levels than that,” Schuchat said. “Maybe two or three times as high as that.” During seasonal influenza in the winter, as many as 15% of people develop influenza-like illnesses.

To put this into perspective, if the novel H1N1 virus has a run rate of 24% and is no more or less virulent than the seasonal influenza, that would suggest that more than 70 million Americans could come down with the flu this year, more than 320,000 could be hospitalized and more than 57,000 could even die from flu-like causes.

Worse-case scenario models used as pre-pandemic planning tools have accounted for as many as 40% of Americans to be infected, or to be tasked with caring for an infected relative, this fall, which is expected to cause mass absenteeism across schools and work forces.

However, there are a number of x-factors that make projecting the potential impact from a pandemic flu exceedingly difficult: the virulence of a constantly-mutating strain, whether or not a Tamiflu/Relenza-resistant strain becomes predominant, and the effectiveness of either the seasonal influenza vaccine or a novel H1N1 influenza vaccine.

The CDC also updated its H1N1 vaccination recommendations late last month, identifying five priority groups. These groups, in order, are: pregnant women, household contacts of those children less than 6 months of age (babies under 6 months of age cannot be vaccinated), healthcare professionals and emergency service personnel, children/adults between the ages of 6 months and 24 years old, and nonelderly adults with such underlying medical conditions as asthma, for example.

Should there be a shortage of vaccine supply, prioritizations will be made for: pregnant women, household contacts of those children under the age of 6 months, a subset of healthcare professionals who have direct contact with H1N1 patients, children between the ages of 6 months and 4 years old, and children between the ages of 5 years and 18 years with underlying complications. Those “shortage-contingency” groups number approximately 40 million patients, Schuchat said, the larger priority groups number some 159 million.

“We do think it is likely that two doses [of this vaccine will be necessary], and that’s what we’re planning,” she added. For school children also being inoculated with a seasonal vaccine, that means as many as four shots—two vaccine shots and two boosters. Some of the studies that are being carried out are looking at simultaneous administration of H1N1 and seasonal influenza vaccines versus subsequent administration. “Our assumption is it is very likely that they can be given together,” Schuchat said.

“At this point, 83% of the population is recommended to get an annual flu vaccine, and we recommend it for anyone who wants to reduce their risk of flu,” Schuchat said. “Unfortunately, only about 40% of the U.S. population received the flu vaccine last year, so we’re really recommending an intensifying use of this vaccine because it does protect against illness and complications like hospitalization and severe outcomes.”

Schuchat also stressed that healthcare workers need to get vaccinated, especially this year. “We recommend them strongly to receive the seasonal flu vaccine,” Schuchat said. “And I’m expecting when H1N1 vaccine recommendations come out, it’s very, very likely healthcare workers will be in that group that ought to get vaccines as well.” Presently, the CDC is estimating that enough novel H1N1 vaccine, if approved, may be ready by mid-October to sustain a national vaccination program.

Also muddying the waters of any projection is media coverage and consumer reaction. Extensive media coverage earlier in the season before any significant outbreaks could prompt many Americans to be extra-vigilant in preventing influenza transmission through hand-washing and the use of sanitizers, for example, cutting into the spread of infection.

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Washington, Mo., considers repealing recently passed PSE legislation

BY DSN STAFF

NEW YORK The objective here is closing down clandestine methamphetamine labs. The question is: Who is going to bear the cost? And the answer, ultimately, is the consumer.

It seems that one of the primary reasons behind legislation like this, which is also under consideration by the California state legislature as well as several local municipalities throughout Missouri, is cost shifting.

Indeed, one solution that would prevent the practice of “smurfing,” a practice whereby meth addicts exceed their legal purchase limits in pseudoephedrine products by buying across several nearby pharmacies, is electronic logbooking. By granting access to PSE logbooks to law enforcement in real time, law enforcement officers would not only be made aware of a “smurfer” as they were driving between pharmacies, but would also identify who that smurfer was and where they lived.

Setting up that comprehensive electronic logbooking system requires resources, however. State coffers have traditionally been tapped for that purpose, and at least in the case of California, the Consumer Healthcare Products Association has offered to help defray that cost. In the case of Missouri, more than $500,000 has already been earmarked for the implementation of an electronic logbooking system at the state level.

However,  a not-as-much-talked-about cost is also borne by law enforcement, as pointed out by Franklin County Sgt. Jason Grellner in Missouri. After all, it requires additional resources to actually apprehend and prosecute those criminals, he suggested. And a system that better defines who those criminals may be, by his estimation, could cost the state as much as $350,000 per criminal per year.

Therefore, Grellner argues, it’s a fiscal responsibility to take PSE off the OTC market altogether, and require a prescription for the popular decongestant.

That, in a nutshell, is cost-shifting. Because reverse switching PSE translates into less revenue for retailers (and consequently less taxable revenue, as well) for those consumers who choose to forego PSE-provided relief, and for those who don’t, it’s a greater healthcare cost because now consumers have to schedule an appointment with their primary care practitioner and pay the co-pay for that doctor’s visit on top of the cost of the PSE product.

Regardless of how the consumer ultimately pays for the elimination of meth labs — whether through increased taxes to cover escalating law enforcement budgets or through increased personal healthcare costs — there is another argument to be made here. Switching PSE to prescription-only status may result in fewer meth labs busted, but it’s not going to do anything about those meth addicts still on the street. Necessity is the mother of invention, and for addicts, that simply means sourcing their meth from somewhere else.

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