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One of the concluding slides in my default pandemic flu Powerpoint presentation is a reminder to get your PPV vaccine.  The PPV vaccine, or Pneumoccal Polysaccharide Vaccine, has been available for many years and helps ward off some 23 types of pneumoccal bacteria.

I mention this because the latest issue of NewScientist magazine has an excellent article about new findings from the 1918 Spanish Flu pandemic.  It is almost a matter of Scripture now that pneumonia was the real killer in 1918-19, and the flu virus paved the way for a rapid and often lethal insertion of pneumoccal bacteria into the lungs of otherwise healthy young adults the world over.

The conclusion drawn from this report, as espoused by one government expert ts to gird for the next influenza pandemic – bird flu or otherwise – and stock up on antibiotics, says John Brundage, a medical microbiologist at the Armed Forces Health Surveillance Center in Silver Spring, Maryland.

Of course, all flu pandemics will be "bird flu," so that is kinda redundant.  But the message is quite clear.

We have spent countless hours talking about magic bullets such as prepandemic vaccines (ask homeless Poles how they feel about that!), H5N1 vaccines that do not survive the inevitable antigenic drift that H5N1 is so notorious for, and quibbling over dosages of antivirals whose distribution in a pandemic will be a massive logistical cluster-you-know-what.

We have certain tools in the shed, arrows in the quiver, that we need to engage today.  And when it comes to PPV, we need to rethink the threshholds for injection.  I got my PPV prior to age 50 because I have a history of pneumonia (there -- a self-inflicted HIPAA violation!).  My nurse practitioner -- who is more pessimistic about bird flu than I! -- also gladly gave me the shot.

In light of college students dying from bacterial meningitis, and in light of the thousands who die from complications from influenza every year, shouldn't we be stressing the need for PPV vaccination at every level possible?  I believe we need to revisit those age threshholds for PPV vaccination with the intent of getting people vaccinated at the youngest age considered medically safe.

Last year, I wrote a blog titled "Influenza is baseball."   Let me continue to work that metaphor.  Influenza preparedness is also baseball.  Defense in depth is what is most important.  You do a whole lot of things well, most of which cost very, very little, and watch the cumulative result for the good.

Mike Coston yesterday posted a blog on the British claim that vaccinating all of Britain's schoolchildren would cut seasonal influenza by 97% in all populations.  Those results are supported by research done here in the American South that support the herd immunity theory.  Yet there are those new "Flat-Earthers" who believe every vaccine is deadly and every jab is a potential death sentence.  Look at the growing numbers of parents who opt out of "mandatory" vaccinations for their school-age children because they fear the Worst Case Scenario more than the most likely one.  By their actions, these new Flat-Earthers are placing all kids at greater and greater risk of disease. 

Again, homeless Poles would disagree with me today, and to them I would admonish and remind that the H5N1 vaccine that killed some of them was experimental and not an everyday, tested, certified and widely available vaccine.  And that they consented to the testing; I do not believe some kind of Polish Tuskeegee Experiment was performed upon them, right?  Someone please correct me if I am wrong.

While I agree in the strongest of terms that research is needed to find the source of autism, I am much more inclined to believe in an environmental or genetic trigger -- or both -- than to think one jab caused that terribly debilitating disorder. 

Those who are repelled by vaccines the same way Dracula is repelled by garlic and wolfbane clearly do not watch nor play baseball.  Otherwise, they would know that you take necessary risks and avoid unnecessary ones.

An unnecessary risk is not getting your PPV vaccine.  Getting that vaccine takes you further down the road of pandemic preparedness -- perhaps much further, courtesy of NewScientist.

As I write this, the Congressional majority's talking heads on CNN are apoplectic over the Bush Administration's decisions a) not to stop putting oil into the Strategic reserve, and b) not to sell oil from the reserve.  As one can imagine, the debate is shaped along mostly partisan lines.

There are worse things than price hikes on gasoline.  What could be worse than $4, or even $5 gasoline?

Try this:  No gasoline at all, for days at a time.  And that is precisely what we will have in a pandemic of any severity:  Little petroleum to go around and flashbacks to the days of 1973 and 1979.  Many of us will never forget those even/odd days when we could or could not buy gas.  After Katrina, I recall sitting in line to buy fuel for an hour, simply because supplies coming into Florida were depleted.  Or maybe it was in 2004 after the Big Four hit Florida.  What specific year is irrelevent; what matters is that I saw something this new century that I had not seen in thirty years, and I was amazed at what I beheld. 

There are many who are openly condemning of this Administration's handling of pandemic preparedness.  This, despite the knowledge that this Administration has done more to combat global infectious disease than any other presidential administration in modern history.  This is the true Bush Legacy:  Real, funded efforts to stop HIV/AIDS in Africa, and concrete moves to prepare America for an eventual flu pandemic without crying WOLF or otherwise appearing to go overboard.  Surely there have been missteps along the way, but let us recall that nothing was happening in Washington on panflu preparedness  -- nothing -- until Bush read The Great Influenza cover-to-cover. 

On the African front, Franklin Graham and Bono can share in the credit for converting Bush into a believer.  Barry himself may take credit for the Bush Administration's turnaround on pandemic flu.  Barry had been meeting with HHS Secretary Mike Leavitt and others in the Cabinet ever since his classic tome hit print.  But Barry, himself a Bush critic, said this to the Los Angeles Times in 2005:

“One lesson is to absolutely take it seriously,” Barry said. “I’m not a great fan of the Bush administration, but I think they are doing that. The Clinton administration I don’t think paid much attention to it as a threat.”  (bold mine)ttp://articles.latimes.com/2005/aug/16/nation/na-bushread16

So the Bush Administration's decision to keep the Strategic Petroleum Reserve in place represents forward-thinking of a kind not expected by his adversaries and, yes, outright enemies.  It means, folks, there are more important things than expensive gas.  The Strategic Petroleum Reserve today holds about a 55-day supply of oil.  That equates to an eight-week reserve.  That we expect pandemics to come in two-to-three-month waves and that the SPR could see America through two months of the first wave of a pandemic is not coincidental.  Those who are running for office, regardless of party and regardless of office, would do well to remember that fact.  Attacking Bush on a lack of panflu preparedness and then attacking Bush for not selling off the SPR is a train wreck and the two cannot be reconciled logically.

A 38-year old male cargo worker from Tangerang, 20+ miles west of Jakarta.  A 19-year-old male factory worker from Tangerang.  The data may not be sufficient to make a distinction, but I have an uneasy feeling about these last two reported human H5N1 deaths from the same province of Indonesia. 

We don't know much yet about either case.  The cargo worker is not "officially" dead of H5N1, although locals familiar with the case swear that tests confirmed the presence of H5N1 bird flu.  And the details are just coming in on the teenage factory worker. 

But so far, there is nothing solid to tie these two deaths to exposure to sickened poultry.  Both had poultry, apparently, but there is no evidence that their poultry was sick; nor was there clear evidence of sick poultry in the neighborhood. 

Previously, we have been conditioned to see Tangerang women die from H5N1 (for reference, look back to my October, 2007 blog entry, New H5N1 death in Tangerang, Indonesia).  These two men, from basically industrial occupations and from the same province, raise some fresh concerns about the Indonesian government's decision to withhold precious information until it is rolled up and placed into summary reports.

It also raises fresh concerns regarding Tangerang, which I think we all regard as the top hot spot for human H5N1 infection in the entire world.  This is also where the US government placed over a million dollars' worth of aid just a few months ago.  Recall that the US ambassador to Indonesia personally handed the aid to the Tangerang government.

Two male deaths that do not immediately track back to poultry, in the same province, within two weeks of each other.  It bears close watching.

I have been a vocal advocate for the mass stockpiling of the antiviral inhalant Relenza, or zanamivir, for some time.  The idea of giving first responders pills to take just doesn't seem to be the right way to go.  The idea is to try and prevent influenza in those first responders, and a 45-day course of a pill a day sounded a little excessive.

Relenza is not as effective as Tamiflu when you have the flu, because it is hard to inhale the medicine deep into the lungs, where, for example, H5N1 likes to go.  But a convenient inhaler in a container that can fit into a utility pocket -- NOW we're talking proactive, easily-administered antiviral dosages!

Yesterday's Bloomberg article regarding the effectiveness of a more potent version of Relenza, manufactured by a Japanese company, should help to promote Relenza as a must-have antiviral in everyone's stockpile -- if your stockpile includes preventing bird flu as well as limiting its symptoms.  I can tell you that my antiviral stockpiling has switched from acquiring any more Tamiflu, to acquiring Relenza.  And, of course, the state antiviral programs under the federal deal with Roche mandate a default 80/20 split between Tamiflu and Relenza.  So for those states who elected to participate in the HHS program, 20% of your stockpile includes Relenza.  Get those dosages out quickly to your first responders whenever the pandemic starts.

Longer-Acting Relenza Fights Flu as Well as Tamiflu (Update1)
By Jason Gale

July 31 (Bloomberg) -- Daiichi Sankyo Co.'s longer-acting version of GlaxoSmithKline Plc's flu drug, Relenza, was as effective as a course of Tamiflu, a patient study found.

The safety and efficacy of a single dose of the inhaled medicine was ``statistically indistinguishable'' from a twice-a- day dose of Roche Holding AG's Tamiflu taken for five days, said Melbourne-based Biota Holdings Ltd., which is developing the drug with Japan's Daiichi Sankyo. The study, involving ``several hundred'' patients with seasonal flu, was the second of three stages of human trials usually needed for regulatory approval.

The companies plan to start final-stage tests in Japan, Taiwan, Hong Kong and South Korea by the Northern Hemisphere winter, Biota said in a statement today. If approved, the medicine could provide a new treatment for flu, a disease causing 250,000 to 500,000 deaths worldwide a year. Previous studies also showed the medicine fights the H5N1 version of bird flu, which world health officials say might set off a lethal pandemic.

``If it's successful, then it would be a very useful drug,'' Scott Power, an equities analyst with ABN Amro Morgans Ltd. in Brisbane, Australia, said today by telephone. He rates Biota's shares ``buy.''

Biota gained 2.5 Australian cents, or 3.6 percent, to 72.5 cents on the Australian Stock Exchange. Power expects the shares to reach A$1.30 within the next 12 months.

Shares of Daiichi Sankyo, Japan's third-largest drugmaker, increased 80 yen, or 2.6 percent, to 3,190 yen on the Tokyo Stock Exchange at 11 a.m. local time.

Governments worldwide are stockpiling anti-flu medicines, including Tamiflu and Relenza, to reduce the severity and spread of disease in the event of a pandemic. A treatment that's taken only once, rather than twice a day for five days, would reduce the amount of medicine needed to be kept on hand, Power said.

Daiichi's experimental medicine, known as CS-8958, is in the same class of antiviral as Tamiflu and Relenza, which works by preventing flu viruses from spreading from infected cells.

http://www.bloomberg.com/apps/news?pid=20601101&sid=aDCmbqrVxu3M&refer=japan

I had no idea how widespread the threat of tick infestation is on Italian transports such as trains and ferries, but this article is downright scary. From Tropical Medical Bureau:

Complaint as Italian ferry cabin infested with ticks

News about: ITALY

Date: Tue, 29 Jul 2008 13:11:05 +0200 (METDST)

ROME, July 29, 2008 (AFP) - An Italian woman is suing a ferry company after waking up in a first-class cabin "covered in ticks from head to toe", newspapers reported Tuesday. Cristina Sassudelli, 41, was making a night crossing at the weekend from the northern city of Genoa to the port of Olbia on the southern Italian island of Sardinia. "At six thirty in the morning I was wakened by the itching on one arm and I realised I was covered with ticks from head to toe," she said, according to accounts in several Italian dailies. "I have always had dogs and I saw immediately that these weren't any kind of insect. There were hundreds of them," she added.

Staff on the ferry, run by a company called La Tirrenia, took her infested clothes and gave her new ones that were far too big, she said. Once they had arrived at Olbia a member of the crew accompanied her to a shop where she was able to buy new clothes. But the company did not reimburse her for her first-class ticket, she said. La Tirrenia told La Stampa newspaper: "This episode happened at a period of heavy traffic and hot, humid conditions. It is the first time, after many years of navigation, that it has happened." It added that the contaminated zone had been sealed off and was being disinfected. Sassudelli said she was taking action against the company to make sure no one else had to go through the same "nightmare." In recent years, there have been several cases of infections from ticks or fleas on Italian transport, particularly on trains.

Source: AGENCE FRANCE-PRESSE Date: 29/7/2008