FLU-SHOT UPDATE

Our office is expecting a supply of flu shots to be available in early November.  When we have received our supply, we will post a notice here.  So check here before calling the office for appointments.

TAMIFLU POLICY

Our office is keeping close tabs on the situation and as of yet, there is no reason to believe that this will be a problem at any time in the next few months.  Vaccine is being developed which will be available within a year. Once an epidemic starts, it might take months before it gets to the U.S. The government has stockpiled Tamiflu and would be in a position to have it available on short notice. It is possible that the virus will become resistant to Tamiflu. We feel that it is probably not necessary to have Tamiflu on hand given the lead time and the promised availability of the drug. However, we are willing to give 10 Tamiflu as a prescription to those who ask. This would be kept at hand to be used ONLY in the event of an outbreak. It may not be covered by the insurance plans. Ten Tamiflu have a retail cost of about $130. Because of present shortages it is considered ethically irresponsible to hoard the medication and we would discourage prescriptions larger than that size. Please do not take this medication unless the Federal government declares an outbreak. Realize that it is not to be taken by pregnant patients. Realize also that the Tamiflu may expire long before an outbreak occurs.

Dr. Ruden believes that genetically it is unlikely that enough mutations would occur for this to be transmitted to humans and therefore does not feel that any prescription should be given to his patients at this time.

Use this link for the latest info on the Avian Flu:
http://avianflu.typepad.com/

AVIAN FLU FACT SHEET

Introduction

Avian flu, also known as "bird flu", is not a current threat in the United States but is a potential concern due to outbreaks, primarily in Asian countries, during the past few years. The US government recently invested in research to develop vaccines to protect humans against the more virulent strains of avian flu. The Center for Health & Health Care in Schools has developed this fact sheet that summarizes recent developments as well as recommendations from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) for responding to future outbreaks.

Avian flu is an infectious disease caused by viruses that infect birds, and less commonly, pigs. The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the influenza A virus, H5N1 strain, caused severe respiratory disease in 18 humans, and resulted in 6 deaths. The infection of humans happened at the same time and withthe same strain that was infecting Hong Kong's bird population. The investigation sparked by this outbreak of avian flu determined that close contact with live infected poultry was the source of human infection and that the virus had jumped directly from birds to humans. As of October 2004, there have been 44 proven cases of human H5N1 infections. Thirty-two have been fatal. All cases have occurred in Cambodia, China, Indonesia, Laos, Malaysia, Thailand, and Vietnam.

This fact sheet summarizes what is known about avian flu; describes recommendations for health care providers, consumers, and travelers; and includes links to resources about avian flu.

Avian Flu Facts

• All bird species are thought to be susceptible to viral infection, however, domestic poultry flocks are especially vulnerable to infections that can rapidly reach epidemic proportions.
• Only influenza A viruses infect birds and the disease occurs in two forms- "high pathogenicity" and "low pathogenicity". The "highly pathogenic" or contagious form is of great concern because it is extremely contagious in birds and rapidly fatal. Viruses with "low pathogenicity" can, over time, mutate into highly pathogenic viruses.
• There are 15 subtypes of influenza A virus. Influenza A strain H5N1 is of primary concern because it has caused the most severe outbreaks, although strains H9N2 and H7N7 as well as several other strains have also caused illness in humans.

How is avian flu spread among birds?

• Large amounts of the virus can be secreted in bird droppings, which contaminate soil and dust, causing the virus to be easily spread among birds.
• Birds can inhale the virus if it is airborne.
• The virus can also be carried on the feet and bodies of animals, such as rodents, which act as "mechanical vectors" for spreading the disease.

How does avian flu affect humans?

• Avian flu viruses do not usually infect humans, but there have been several instances of human infections and outbreaks of avian flu since 1997.
• Most cases of avian flu in humans are thought to have resulted from human contact with infected poultry or contaminated surfaces.

Can avian flu be transmitted from person-to-person?

• Currently there is no evidence that avian flu is transmitted by human-to-human contact. However, according to the WHO, because influenza viruses have the potential to change and gain the ability to spread between people, monitoring for human infection and person-to-person transmission is important.
• The WHO notes that "The spread of infection in birds increases the opportunities for direct infection of humans. If more humans become infected over time, the likelihood also increases that humans, if concurrently infected with human and avian influenza strains, could serve as a 'mixing vessel' for the emergence of a novel subtype with sufficient human genes to be easily transmitted from person to person."

What are the symptoms of avian flu in humans?

• The reported symptoms of avian flu range from typical flu-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections.
• Pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications have also been reported as symptoms.

How is avian flu diagnosed?

Testing for avian flu (H5N1) is indicated for hospitalized patients with:

• Radiographically confirmed pneumonia, acute respiratory distress syndrome, or other severe respiratory illnesses for which another diagnosis has not been made.
• History of travel within 10 days of symptom onset to a county with documented H5N1 avian flu in poultry and/or humans.

How is avian flu treated?

There are several different influenza antiviral drugs that can be used to treat pneumonia caused by the avian flu. They are amantadine, rimantadine, oseltamivir (*TAMIFLU), and zanamivir.  Of these Tamiflu is the drug of choice.

DOSING of Tamiflu:
Influenza prophylaxis: Oral: 75 mg once daily for at least 7 days; treatment should begin within 2 days of contact with an infected individual. During community outbreaks, dosing is 75 mg once daily. May be used for up to 6 weeks; duration of protection lasts for length of dosing period.  Influenza treatment: Oral: 75 mg twice daily initiated within 2 days of onset of symptoms; duration of treatment: 5 days)

• All four of these drugs have an affect on influenza A viruses, but some of the strains have become resistant to these drugs.
• In 2004, it was found that H5N1 viruses, which had been isolated from poultry and humans in Asia, were resistant to both amantadine and rimantadine. This has led to the ongoing monitoring of avian viruses for resistance of influenza antiviral medications.

Are there any vaccines available for avian flu?

• The National Institutes of Health (NIH) has awarded contracts to Aventis Pasteur Inc. and Chiron Corporation to support the production of a vaccine for avian flu (H5N1).
• As noted previously, a rising concern is that the avian and human flu viruses can exchange genes when a person is simultaneously infected with viruses from both species, which can give rise to a new subtype of the flu virus.
• If a new flu virus emerges, it is possible that few humans would have natural immunity and existing vaccines would not be effective against this new subtype. Therefore, the NIH suggests that preparedness efforts be continued because of the possibility of an avian flu pandemic.

What are some recommendations for avian flu?

Due to the fact that the avian flu can be transmitted from infected poultry to humans, the CDC has issued a series of interim recommendations for the following groups in the U.S.:

Health Care Professionals

• Providers should be alert for any respiratory illness in individuals who may have been in contact with infected poultry.
• Health care providers should pay careful attention to hand hygiene before and after patient contact (gloves, gowns, eye wear), especially if they are treating a suspected case of avian flu.
• If caring for a suspected case of avian flu, provides should place the patient in an isolation room to prevent others from becoming exposed.

• No evidence has been shown that avian flu is spread by eating contaminated poultry or poultry products. Influenza viruses, like many food borne pathogens, are usually destroyed by adequate heat.
• Consumers should cook all poultry and poultry products thoroughly before eating (above 180° F).
• Raw poultry should be handled carefully. Therefore, all utensils and surfaces that come in contact with raw poultry should be cleaned well after preparation.

• Monitor your health for 10 days.
• If an illness develops within 10 days consult your health care provider. It is important to alert your provider that you have recently traveled to an area that has a known avian flu outbreak.

*TAMIFLU:

DOSING: ADULTS
Influenza prophylaxis: Oral: 75 mg once daily for at least 7 days; treatment should begin within 2 days of contact with an infected individual. During community outbreaks, dosing is 75 mg once daily. May be used for up to 6 weeks; duration of protection lasts for length of dosing period

Influenza treatment: Oral: 75 mg twice daily initiated within 2 days of onset of symptoms; duration of treatment: 5 days

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