It sounds so simple as to be innocuous, a throwaway line in publichealth warnings about Type A (H1N1) flu. But one of the most powerful weapons against the new virus is summed up in a three-word phrase you first heard from your mother: Wash your hands.
A host of recent studies have highlighted the importance and the scientific underpinning of this most basic hygiene measure. One of the most graphic was done at the University of California,Berkeley, where researchers focused video cameras on 10 college students as they read and typed on their laptops.
The scientists counted the times the students touched their faces, documenting every lip scratch, eye rub and nose pick. On average, the students touched their eyes, noses and lips 47 times during a three-hour period, once every four minutes.
Hand-to-face contact has a surprising impact on health. Germs can enter the body through breaks in the skin or through the membranes of the eyes,mouth and nose.
The eyes appear to be a particularly vulnerable port of entry for viral infections, said Mark Nicas, a professor of environmental health sciences at Berkeley. Using mathematical models,Nicas and colleagues estimated that in homes, schools and dorms, hand-toface contact appears to account for about one-third of the risk of flu infection,according to a report this month in the journal Risk Analysis .
In one study of four residence halls at the University of Colorado, two of the dorms had hand sanitiser dispensers installed in every dorm room, bathroom and dining area, and students were given educational materials about the importance of hand hygiene. The remaining two dorms were used as controls, and researchers simply monitored illness rates.
During the eight-week study period,students in the dorms with ready access to hand sanitisers had a third fewer complaints of coughs, chest congestion and fever. Overall, the risk of getting sick was 20 percent lower in the dorms where hand hygiene was emphasized,and those students missed 43 percent fewer days of school.
Young children benefit, too. In a study of 6,000 elementary school students in California, Delaware, Ohio and Tennessee, students in classrooms with hand sanitisers had 20 percent fewer absences due to illness. Teacher absenteeism in those schools dropped 10 percent.
Better hand hygiene also appears to make a difference in the home, lowering the risk to other family members when one child is sick. Harvard researchers studied nearly 300 families who had children 5 or younger in day care. Half the families were given a supply of hand sanitiser and educational materials; the other half were left to practice their normal hand washing habits.
In homes with hand sanitisers, the risk of catching a gastrointestinal illness from a sick child dropped 60 percent compared with the control families. The two groups did not differ in rates of respiratory illness rates, but families with the highest rates of sanitiser use had a 20 percent lower risk of catching such an illness from a sick child.
Regular soap and water and alcoholbased hand sanitisers are both effective in eliminating the H1N1 virus from the hands. In February, researchers in Australia coated the hands of 20 volunteers with copious amounts of a seasonal H1N1 flu virus.
The concentration of virus was equivalent to the amount that would occur when an infected person used a hand to wipe a runny nose.
When the subjects did not wash their hands, large amounts of live virus remained even after an hour, said the lead author, Dr M. Lindsay Grayson, a professor of medicine at the University of Melbourne. But using soap and water or a sanitiser virtually eliminated the presence of the virus.
Frequent hand washing will not eliminate risk. When an infected person coughs or sneezes, a bystander might be splattered by large droplets or may inhale airborne particles. In a recent Harvard study of hand sanitiser use in schools, hand hygiene practices lowered risk for gastrointestinal illness but not upper respiratory infections.
Still, it is a good idea to wash your hands regularly even if you're not in contact people who are obviously ill. In a troubling finding, a recent study of 404 British commuters found that 28 percent had faecal bacteria on their hands. In one city, 57 percent of the men sampled had contaminated hands,according to the study, which was published this month in the journal Epidemiology and Infection ."We were surprised by the high level of contamination," said Gaby Judah, a researcher at the London School of Hygiene and Tropical Medicine. Judah added that many of the contaminated commuters reported that they had washed their hands that morning. They may have been embarrassed to admit they hadn't washed, or they may have picked up the bacteria on their hands during their commute.
For all those reasons, the Centres for Disease Control and Prevention, with other health organisations around the world, urge frequent hand washing with soap and water or alcohol-based hand sanitisers.(They also repeat some advice you may not have heard from your mother: Cough or sneeze into the crook of your elbow, not your hands.)
And as hospitals put stricter hand hygiene programmes in place, absentee rates during cold and flu season also drop.
"Statistically, you can't determine a causal relationship, but it's very suggestive," said Neil O. Fishman, infectious disease specialist at the University of Pennsylvania.
"Our vaccination rates remained relatively stable, so what else changed? The only thing different was that hand hygiene rates increased."
Wednesday, September 23, 2009
Eid gatherings fuel fears of flu contagion
Muslims across the world celebrated Eid al-Fitr yesterday to mark the end of Ramadan, but authorities urged caution as large social gatherings and returning Mecca pilgrims fuelled fears of swine flu spreading.
In Cairo, where two people have died from the H1N1 flu virus and nearly 900 cases have been reported, preachers suggested that worshippers perform the traditional dawn prayer at home rather than at crowded mosques.
"We ought to cancel Eid prayers ...there should be a national campaign to keep crowded places clean and ensure they are safe for people," Suad Saleh, head of Islamic Jurisprudence at Al-Azhar University told the Englishlanguage Egyptian Gazette .Cairo airport authorities have reinforced swine flu testing measures as the end of Ramadan means the return of thousands of pilgrims from Saudi Arabia.
Fear of the virus spreading in the crowded conditions during the pilgrimage is shared by many other countries who are considering cancelling the annual Hajj pilgrimage this year.
Jordanians have been urged to refrain from kissing each other in a bid to combat the contagious disease.
"People should not kiss at social events and gatherings. Instead, they should just shake hands," the government's fatwa department said in a statement ahead of the Eid holiday.
In Jakarta, thousands of people queued for hours outside the presidential palace to pay their respects to President Susilo Bambang Yudhoyono.
Indonesian officials fearful of the spread of swine flu set up thermal scanners at the open house event, which is part of a tradition whereby people throughout the country ask forgiveness from others for slights and offences.
In the world's largest Muslimmajority country, nearly 30 million people were estimated to have emptied out of cities and towns in a yearly exodus to celebrate the holiday.
The Transport Ministry said 184 people have died in the traffic chaos already.
The start of Eid is traditionally determined by the sighting of the new moon, often dividing rival Islamic countries and sects over the exact date.
In Iraq, Shi'ites loyal to the Grand Ayatollah Ali Husseini al-Sistani, the nation's top Shi'ite cleric, continued fasting yesterday, observing nationally televised and locally delivered messages that the new moon had not yet risen.
However those who follow the Shi'ite cleric Moqtada al-Sadr ended the holy month of Ramadan early yesterday.
Iraq's minority Sunnis ended Ramadan on Saturday.
In neighbouring Iran, politics overshadowed prayer, with supreme leader Ayatollah Ali Khamenei taking aim at Israel, Western powers and the foreign media. In his sermon, Mr Khamenei said a "Zionist cancer" was gnawing into the lives of Islamic nations.
In Afghanistan, President Hamid Karzai extended an olive branch to Taliban militants trying to overthrow his Western-backed government.
"On this auspicious day once again I ask all those Afghan brothers who are unhappy or are in others' hands to stop fighting, destroying their own land and killing their own people," he said at the presidential palace in Kabul."They must come to their houses and live in peace in their own country."
Pakistani families uprooted by conflict with the Taliban face a miserable Eid, with no cash to splash on celebrations and desirous of returning to homes they fear no longer exist.
The UN said about two million Pakistanis were displaced as a result of fighting between the army and Taliban militants.
Meanwhile, residents of restive Indian Kashmir jammed markets in defiance of a rise in militant violence to stock up for Eid.
The festival to celebrate the close of the holy month will be held Monday or Tuesday, depending when the new crescent moon is sighted in the restive Himalayan region where Islamic militants have been fighting against New Delhi's rule for 20 years.
Shopkeepers set up extra kiosks to cater to the mad shopping rush.
Muslim separatists who are leading the movement to break away from India and join Pakistan, or declare an independent state, called on followers to show austerity.
In Cairo, where two people have died from the H1N1 flu virus and nearly 900 cases have been reported, preachers suggested that worshippers perform the traditional dawn prayer at home rather than at crowded mosques.
"We ought to cancel Eid prayers ...there should be a national campaign to keep crowded places clean and ensure they are safe for people," Suad Saleh, head of Islamic Jurisprudence at Al-Azhar University told the Englishlanguage Egyptian Gazette .Cairo airport authorities have reinforced swine flu testing measures as the end of Ramadan means the return of thousands of pilgrims from Saudi Arabia.
Fear of the virus spreading in the crowded conditions during the pilgrimage is shared by many other countries who are considering cancelling the annual Hajj pilgrimage this year.
Jordanians have been urged to refrain from kissing each other in a bid to combat the contagious disease.
"People should not kiss at social events and gatherings. Instead, they should just shake hands," the government's fatwa department said in a statement ahead of the Eid holiday.
In Jakarta, thousands of people queued for hours outside the presidential palace to pay their respects to President Susilo Bambang Yudhoyono.
Indonesian officials fearful of the spread of swine flu set up thermal scanners at the open house event, which is part of a tradition whereby people throughout the country ask forgiveness from others for slights and offences.
In the world's largest Muslimmajority country, nearly 30 million people were estimated to have emptied out of cities and towns in a yearly exodus to celebrate the holiday.
The Transport Ministry said 184 people have died in the traffic chaos already.
The start of Eid is traditionally determined by the sighting of the new moon, often dividing rival Islamic countries and sects over the exact date.
In Iraq, Shi'ites loyal to the Grand Ayatollah Ali Husseini al-Sistani, the nation's top Shi'ite cleric, continued fasting yesterday, observing nationally televised and locally delivered messages that the new moon had not yet risen.
However those who follow the Shi'ite cleric Moqtada al-Sadr ended the holy month of Ramadan early yesterday.
Iraq's minority Sunnis ended Ramadan on Saturday.
In neighbouring Iran, politics overshadowed prayer, with supreme leader Ayatollah Ali Khamenei taking aim at Israel, Western powers and the foreign media. In his sermon, Mr Khamenei said a "Zionist cancer" was gnawing into the lives of Islamic nations.
In Afghanistan, President Hamid Karzai extended an olive branch to Taliban militants trying to overthrow his Western-backed government.
"On this auspicious day once again I ask all those Afghan brothers who are unhappy or are in others' hands to stop fighting, destroying their own land and killing their own people," he said at the presidential palace in Kabul."They must come to their houses and live in peace in their own country."
Pakistani families uprooted by conflict with the Taliban face a miserable Eid, with no cash to splash on celebrations and desirous of returning to homes they fear no longer exist.
The UN said about two million Pakistanis were displaced as a result of fighting between the army and Taliban militants.
Meanwhile, residents of restive Indian Kashmir jammed markets in defiance of a rise in militant violence to stock up for Eid.
The festival to celebrate the close of the holy month will be held Monday or Tuesday, depending when the new crescent moon is sighted in the restive Himalayan region where Islamic militants have been fighting against New Delhi's rule for 20 years.
Shopkeepers set up extra kiosks to cater to the mad shopping rush.
Muslim separatists who are leading the movement to break away from India and join Pakistan, or declare an independent state, called on followers to show austerity.
Poor "have no access" to vaccine
Top of the agenda for the World Health Organisation's (WHO)Western Pacific meeting this week will be how to combat the H1N1 flu pandemic in developing nations.
There are growing fears that poorer countries will not get enough vaccines,despite a pledge last week by the US and eight other nations to make 10% of their flu vaccine supply available to others in need.
"The developing world will have no access to vaccines for the time being.There are some donations but it is not enough," said Lo Wing-lok, a member of Hong Kong's government scientific committee on emerging diseases.
"It is very much a matter of equity and the WHO must look at any way to address this."
Developing countries such as the Philippines are not only unable to produce the vaccine for the H1N1 flu virus but their people are more vulnerable to infection because of poverty, crowded living conditions and lack of healthcare.
While the Americas still have the highest death toll from the virus, cases are expected to increase.
In the Western Pacific there are about a million people living in poor conditions without access to healthcare, making them particularly vulnerable, WHO regional director Shin Young-soo said yesterday, on the eve of the WHO meetings in Hong Kong.
"Hopefully many countries including China and the United States are soon going to vaccinate their own people but that is not the case for many developing countries and it is something we are worried about," he said.
The WHO and the UN are working on raising a billion dollars to help buy vaccines for countries that need help,he added.
Mr Shin said some experts estimate that 20% to 30% of the Western Pacific region will eventually be affected by the virus. So far Australia has the highest H1N1 flu death toll in the region, with about 171 deaths, according to the WHO.
The organisation warned last week that production of vaccines will fall substantially short of the amount needed to protect the global population.
The WHO put the number of deaths worldwide from the virus at 3,486, up 281 from the previous week.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people,a WHO spokesman said output next year will be "substantially less" than the annual 4.9 billion doses production forecast. The US, Australia, Brazil, UK, France,Italy, New Zealand, Norway and Switzerland have said they will make donations to nations without vaccines.
There are growing fears that poorer countries will not get enough vaccines,despite a pledge last week by the US and eight other nations to make 10% of their flu vaccine supply available to others in need.
"The developing world will have no access to vaccines for the time being.There are some donations but it is not enough," said Lo Wing-lok, a member of Hong Kong's government scientific committee on emerging diseases.
"It is very much a matter of equity and the WHO must look at any way to address this."
Developing countries such as the Philippines are not only unable to produce the vaccine for the H1N1 flu virus but their people are more vulnerable to infection because of poverty, crowded living conditions and lack of healthcare.
While the Americas still have the highest death toll from the virus, cases are expected to increase.
In the Western Pacific there are about a million people living in poor conditions without access to healthcare, making them particularly vulnerable, WHO regional director Shin Young-soo said yesterday, on the eve of the WHO meetings in Hong Kong.
"Hopefully many countries including China and the United States are soon going to vaccinate their own people but that is not the case for many developing countries and it is something we are worried about," he said.
The WHO and the UN are working on raising a billion dollars to help buy vaccines for countries that need help,he added.
Mr Shin said some experts estimate that 20% to 30% of the Western Pacific region will eventually be affected by the virus. So far Australia has the highest H1N1 flu death toll in the region, with about 171 deaths, according to the WHO.
The organisation warned last week that production of vaccines will fall substantially short of the amount needed to protect the global population.
The WHO put the number of deaths worldwide from the virus at 3,486, up 281 from the previous week.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people,a WHO spokesman said output next year will be "substantially less" than the annual 4.9 billion doses production forecast. The US, Australia, Brazil, UK, France,Italy, New Zealand, Norway and Switzerland have said they will make donations to nations without vaccines.
Monday, September 21, 2009
Migrant health care a critical issue
In Tak province, caring for migrant workers and their families is straining the provincial hospital toits limits, while in some border provinces many apparently go without needed treatment By Erika Fry
When Mae Sot General Hospital first ran out of space a few years ago,hospital staff pitched tents and dragged out old beds. Since then, the problem hasn't improved - the crowded conditions have become more frequent and new beds have been permanently stationed in the hospital corridors. They are seldom empty.
But beds are hardly the extent of the hospital's resource problems. The hospital has a skeleton staff of five Burmese migrants serving as health workers and translators who assist Thai health personnel, but because of labour regulations they are technically employed as domestic workers. The Ministry of Labour limits migrant workers to low-skill work in the agricultural, manufacturing, fisheries or domestic sectors.
The waiting room is invariably crowded,and hospital personnel are overworked. Last year the hospital ran a 50 million baht deficit.
The reason for this debt is well known,and a subject on the minds of hospital administrators, public health officials, NGO staff and a number of Thai patients who ask their doctors why they must treat patients from Burma - the rising cost of providing health care to Mae Sot's migrant population.
Dr Patjuban Hemhongsa, chief medical officer for Tak province, home to Mae Sot and 30 formal points of entry on the ThaiBurma border, looked exasperated when asked about the issue. He called Tak "a perfect place for so many problems we can't solve refugees, stateless, displaced persons and a continuous flow of illegal migrants. There is no budget or system to care for them".
Dr Supakit Sirilak, director of the Bureau of Policy and Strategy for the Ministry of Public Health (Moph), agrees that migration has increased the burden on Thailand's health services and manpower, and added challenges to the disease surveillance and outbreak control system. He also acknowledges that the burden is one that can't be ignored.
Under his nine-year watch in Tak province,the public health system has initiated a number of programmes to target migrant populations and increase their access to medical services.
These included a migrant health worker and volunteer programme, as well as an ini-tiative targeting malaria."The security of the country is security in the health of the people living in it, no matter if they are Thai or not,"said Dr Supakit.
Indeed, these migrant populations, who tend to live in cramped and unsanitary conditions, are often those most vulnerable to disease outbreaks and severe medical problems. Yet because of their mobility, they are also the most difficult to treat.
Dr Supakit spoke of concerns over outbreaks of cholera and emerging diseases like meningococcal meningitis in the border areas.
Tuberculosis, a disease once thought to have been largely conquered in Thailand,now has a strong and increasingly threatening presence in the form of drug-resistant strains along the border. Handfuls of cases of multidrug resistant and extremely drug-resistant forms of the disease have been detected in recent years.
Tuberculosis is a special concern among migrant populations because of the intensive six-month regimen needed to treat the disease.
Health workers speak of challenges in getting migrant patients to complete treatment - often they will begin to feel better and stop coming while at other times, they simply disappear.
In one case a worker being treated was learned to have been arrested and placed in the Immigration Detention Centre. Because of bureaucratic obstacles, it took the NGO nearly two weeks to get him the drugs he needed.
Yet, while many public health workers and officers at Moph agree with Dr Supakit's sentiments, there remains a disconnect between ideology and financing.
"Moph allocates money according to provincial headcounts, which exclude migrant populations. Hospitals cannot request extra budgets, and the government cannot allocate it. You can't spend money you don't have,"Dr Patjuban said.
The reasons for the rising costs are not as clear-cut as they might seem. While there have long been migrants in the border province - in Mae Sot and surrounding districts the Burmese population is estimated at more than 400,000- there hasn't always been hospital debt.
In 2005 and 2006, Mae Sot General Hospital actually earned enough revenue through the Compulsory Migrant Health Insurance (CMHI)scheme to cover the medical costs of both registered and unregistered migrant patients,said Dr Ronnatrai Ruangweerayut, the hospital's deputy director.
He blames the shortfalls that have arisen since largely on the decreasing number of registered workers, a problem which is as much the making of policy makers as it is of Mae Sot's migrants.
According to statistics from the Ministry of Labour,85% of migrant workers living in Thailand in 2004 were registered and insured.Workers pay an annal fee of 1,900 baht for a health screening and insurance that entitles them to health care similar to that available to Thai citizens.
The registration rate has fallen precipitously ever since - only 30% of migrant workers were registered in 2007- because of the restrictive nature (it had been closed to new workers) of the registration programme. Dr Ronnatrai estimates that only 20% of Mae Sot's migrant population is now registered.This figure is bound to increase, as the government opened registration to new migrants earlier this year.
However, the Thai government's recent promise to permanently close the border suggests a likely continuation in the pattern of decline in terms of registration.
As the number of registered migrants has fallen, so too has revenue from CMHI. Hospitals now have a fraction of the income generated through the insurance programme to care for a growing, or at least equal, number of migrants. Revenue collected from CMHI fell from 800 million baht in 2005 to 500 million baht in 2006. At the same time, fewer migrants are entitled to care and more are likely to face out-of-pocket health expenses they cannot afford.
The amount of health services provided free of charge to Burmese rose from nearly 44 million baht in 2006 to 49 million baht in 2008.
Before the advent of universal healthcare coverage in Thailand in 2001, hospitals used the income generated from out-of-pocket payments to fund care for those who could not afford it. With that income no longer available, hospitals and provinces are on their own. Dr Ronnatrai said his hospital has already burned through its past savings and has appealed, along with the Moph, to the government to allocate an additional budget to provinces with large stateless and migrant populations. Their requests have been denied.PROVINCIAL DIFFERENCES While Tak struggles with swelling health care costs, many provinces - some also with large migrant populations - continue to generate significant income through CMHI. Samut Sakhon and Rayong provinces, hubs for migrants working in the Thai fishing and manufacturing sectors, both generated nearly 10 million baht in revenue in 2006 through the insurance scheme, even after covering the costs of services that uninsured and unregistered workers could not afford.
Dr Supakit says the discrepancies are due to the particularities of each province. Tak has far more unregistered workers than registered ones, while that gap is not as great in Samut Sakhon and Rayong. Uninsured workers in these provinces, where wages are higher,may also be more able to pay out-of-pocket medical costs than those in Tak.
Just as hospital exemption payments for unregistered migrants have increased over the years, so too have out-of-pocket health payments made by migrants. Nationally, hospital exemptions in 2006 cost 170 million baht, while out-of-pocket costs by unregistered migrants totaled 120 million baht. In addition,registered migrants contributed 493 million baht through the CMHI scheme. This data includes only 47 provinces.
Any surplus income earned through the system is used, at the discretion of individual hospitals or provinces, to subsidise the costs of providing care to unregistered migrants and stateless people. In most cases, this income exceeds the costs of exempted payments and theoretically is intended for outreach to migrants in the community.
Though this is the expectation, it's hard to know what becomes of this surplus funding. Reports of populations covered and revenue collected through the CMHI scheme have been incomplete and inadequate, despite the fact that the Moph requests all provinces to report their data to the central office.
In 2007, only nine provinces submitted data - four of these are sites of IOM-Moph migrant health projects - down from 65 in 2004 and 46 and 47 in 2005 and 2006, respectively.
"There is no real enforcement of the penalty for those that don't do it," said Dr Nigoon Jitthai, programme manager of International Organisation of Migration's (IOM) Thailand Health programme, which since 2003 has collaborated with the Moph on a Migrant Health Program.
Meanwhile, figures which have been reported vary widely and attract questions on their own.
"The governance and management of the funds is being questioned by everybody, as it seems that it lacks transparency. Many NGOs have tried to find out how the funds are managed and how exactly the funds are spent,without success. To be honest, no one knows how the surplus is used," said Dr Nigoon.
Dr Supakit agrees that reporting has been a problem, and has for several years been working to establish a Migrant Health Management Information System to better monitor migrant health financing and population data.
The surplus funds in many provinces suggest to Dr Nigoon that the public health services - even those in Mae Sot - to which registered workers are entitled through CMHI,are vastly underused. Data from the Moph show that from 2004-2006, registered migrant workers were half as likely to visit public health centres as other insured patients insured migrant workers averaged less than one visit per year, while Thais under the universal coverage plan seek services an average of 2.5 times per year.
Dr Nigoon says this under-utilisation is due to several factors, including fear of local authorities - even those that are registered tend to feel this way - a lack of awareness of their coverage, long working hours, long journeys to health care facilities, restrictive employers, and perhaps, as a consequence of all of these, the preference to self-medicate.
She says the self-medication is unfortunate as migrants may lose money for inappropriate treatment, health providers may miss health developments within migrant populations,and in cases of infectious diseases, the chronic misuse of antibiotics etc can cause drug resistance.
Available data continues to show that migrants under the CMHI scheme are most likely to seek treatment when health cases are quite severe and require in-patient care.
While Dr Supakit calls CMHI an effective system for those it covers, he acknowledges there are some locations where there may not be adequate translators or cultural help for migrant workers to feel comfortable in accessing it. Those who are not covered by CMHI - stateless persons and illegal migrants - present the complications.
Accordingly, he recommends that policy makers adopt a system that will facilitate migrant workers into insurance schemes."The more they are insured, the better health insurance can survive."
While this year's influx of one million migrants into the registration system should buoy, or further bloat, hospitals' CMHI accounts, the increase will not resolve the disparities and gaps within the funding system.
A handful of NGOs and international organisations like IOM continue to pitch in, in areas where service is most patchy. These efforts are often specifically targetted to provide TB services or HIV/Aids prevention, though others more broadly address the migrant community's health needs. IOM, for example,funds several community health posts and the training and service of migrant health workers.
A health worker in a post in Tak's Thasong Yang district - a young Karen woman whose family has lived in Thailand for more than 40 years, but lacks Thai citizenship - attends the health needs of her village's 884 members,sometimes around-the-clock as her home is next to the health post, providing basic care.
Much relief also comes from Mae Sot's Mae Tao Clinic, an internationally-funded operation that in 2006 had a caseload of 80,000 and expended 55 million baht in health services to Burmese patients. Half of these came from Burma for treatment.
While the Moph and provincial health offices have recently absorbed some programmes once supported by IOM, in a nod for sustainability, much of the external assistance comes with an expiration date, and provides neither a complete nor permanent fix.
Dr Patjuban grapples with how to keep the population of Tak healthy, and his public health services financially solvent."The shortages impact the whole system. We need more human resources, more equipment.It's an insufficient budget."
While Tak province receives assistance for funding migrant health care from a handful of NGOs, the inequalities of the migrant health care system and lack of assistance from the government get to him.
"For education, its not a problem. The resources are allocated," he says, referencing the Education for All programme that, at least theoretically, provides education to Thais and non-Thais."Why more funding for education, but none for health?" he asks.
He sees no light at the end of the tunnel,and having given up on on his own government turns to another."The strain on our system is great. We need Burma to improve."
When Mae Sot General Hospital first ran out of space a few years ago,hospital staff pitched tents and dragged out old beds. Since then, the problem hasn't improved - the crowded conditions have become more frequent and new beds have been permanently stationed in the hospital corridors. They are seldom empty.
But beds are hardly the extent of the hospital's resource problems. The hospital has a skeleton staff of five Burmese migrants serving as health workers and translators who assist Thai health personnel, but because of labour regulations they are technically employed as domestic workers. The Ministry of Labour limits migrant workers to low-skill work in the agricultural, manufacturing, fisheries or domestic sectors.
The waiting room is invariably crowded,and hospital personnel are overworked. Last year the hospital ran a 50 million baht deficit.
The reason for this debt is well known,and a subject on the minds of hospital administrators, public health officials, NGO staff and a number of Thai patients who ask their doctors why they must treat patients from Burma - the rising cost of providing health care to Mae Sot's migrant population.
Dr Patjuban Hemhongsa, chief medical officer for Tak province, home to Mae Sot and 30 formal points of entry on the ThaiBurma border, looked exasperated when asked about the issue. He called Tak "a perfect place for so many problems we can't solve refugees, stateless, displaced persons and a continuous flow of illegal migrants. There is no budget or system to care for them".
Dr Supakit Sirilak, director of the Bureau of Policy and Strategy for the Ministry of Public Health (Moph), agrees that migration has increased the burden on Thailand's health services and manpower, and added challenges to the disease surveillance and outbreak control system. He also acknowledges that the burden is one that can't be ignored.
Under his nine-year watch in Tak province,the public health system has initiated a number of programmes to target migrant populations and increase their access to medical services.
These included a migrant health worker and volunteer programme, as well as an ini-tiative targeting malaria."The security of the country is security in the health of the people living in it, no matter if they are Thai or not,"said Dr Supakit.
Indeed, these migrant populations, who tend to live in cramped and unsanitary conditions, are often those most vulnerable to disease outbreaks and severe medical problems. Yet because of their mobility, they are also the most difficult to treat.
Dr Supakit spoke of concerns over outbreaks of cholera and emerging diseases like meningococcal meningitis in the border areas.
Tuberculosis, a disease once thought to have been largely conquered in Thailand,now has a strong and increasingly threatening presence in the form of drug-resistant strains along the border. Handfuls of cases of multidrug resistant and extremely drug-resistant forms of the disease have been detected in recent years.
Tuberculosis is a special concern among migrant populations because of the intensive six-month regimen needed to treat the disease.
Health workers speak of challenges in getting migrant patients to complete treatment - often they will begin to feel better and stop coming while at other times, they simply disappear.
In one case a worker being treated was learned to have been arrested and placed in the Immigration Detention Centre. Because of bureaucratic obstacles, it took the NGO nearly two weeks to get him the drugs he needed.
Yet, while many public health workers and officers at Moph agree with Dr Supakit's sentiments, there remains a disconnect between ideology and financing.
"Moph allocates money according to provincial headcounts, which exclude migrant populations. Hospitals cannot request extra budgets, and the government cannot allocate it. You can't spend money you don't have,"Dr Patjuban said.
The reasons for the rising costs are not as clear-cut as they might seem. While there have long been migrants in the border province - in Mae Sot and surrounding districts the Burmese population is estimated at more than 400,000- there hasn't always been hospital debt.
In 2005 and 2006, Mae Sot General Hospital actually earned enough revenue through the Compulsory Migrant Health Insurance (CMHI)scheme to cover the medical costs of both registered and unregistered migrant patients,said Dr Ronnatrai Ruangweerayut, the hospital's deputy director.
He blames the shortfalls that have arisen since largely on the decreasing number of registered workers, a problem which is as much the making of policy makers as it is of Mae Sot's migrants.
According to statistics from the Ministry of Labour,85% of migrant workers living in Thailand in 2004 were registered and insured.Workers pay an annal fee of 1,900 baht for a health screening and insurance that entitles them to health care similar to that available to Thai citizens.
The registration rate has fallen precipitously ever since - only 30% of migrant workers were registered in 2007- because of the restrictive nature (it had been closed to new workers) of the registration programme. Dr Ronnatrai estimates that only 20% of Mae Sot's migrant population is now registered.This figure is bound to increase, as the government opened registration to new migrants earlier this year.
However, the Thai government's recent promise to permanently close the border suggests a likely continuation in the pattern of decline in terms of registration.
As the number of registered migrants has fallen, so too has revenue from CMHI. Hospitals now have a fraction of the income generated through the insurance programme to care for a growing, or at least equal, number of migrants. Revenue collected from CMHI fell from 800 million baht in 2005 to 500 million baht in 2006. At the same time, fewer migrants are entitled to care and more are likely to face out-of-pocket health expenses they cannot afford.
The amount of health services provided free of charge to Burmese rose from nearly 44 million baht in 2006 to 49 million baht in 2008.
Before the advent of universal healthcare coverage in Thailand in 2001, hospitals used the income generated from out-of-pocket payments to fund care for those who could not afford it. With that income no longer available, hospitals and provinces are on their own. Dr Ronnatrai said his hospital has already burned through its past savings and has appealed, along with the Moph, to the government to allocate an additional budget to provinces with large stateless and migrant populations. Their requests have been denied.PROVINCIAL DIFFERENCES While Tak struggles with swelling health care costs, many provinces - some also with large migrant populations - continue to generate significant income through CMHI. Samut Sakhon and Rayong provinces, hubs for migrants working in the Thai fishing and manufacturing sectors, both generated nearly 10 million baht in revenue in 2006 through the insurance scheme, even after covering the costs of services that uninsured and unregistered workers could not afford.
Dr Supakit says the discrepancies are due to the particularities of each province. Tak has far more unregistered workers than registered ones, while that gap is not as great in Samut Sakhon and Rayong. Uninsured workers in these provinces, where wages are higher,may also be more able to pay out-of-pocket medical costs than those in Tak.
Just as hospital exemption payments for unregistered migrants have increased over the years, so too have out-of-pocket health payments made by migrants. Nationally, hospital exemptions in 2006 cost 170 million baht, while out-of-pocket costs by unregistered migrants totaled 120 million baht. In addition,registered migrants contributed 493 million baht through the CMHI scheme. This data includes only 47 provinces.
Any surplus income earned through the system is used, at the discretion of individual hospitals or provinces, to subsidise the costs of providing care to unregistered migrants and stateless people. In most cases, this income exceeds the costs of exempted payments and theoretically is intended for outreach to migrants in the community.
Though this is the expectation, it's hard to know what becomes of this surplus funding. Reports of populations covered and revenue collected through the CMHI scheme have been incomplete and inadequate, despite the fact that the Moph requests all provinces to report their data to the central office.
In 2007, only nine provinces submitted data - four of these are sites of IOM-Moph migrant health projects - down from 65 in 2004 and 46 and 47 in 2005 and 2006, respectively.
"There is no real enforcement of the penalty for those that don't do it," said Dr Nigoon Jitthai, programme manager of International Organisation of Migration's (IOM) Thailand Health programme, which since 2003 has collaborated with the Moph on a Migrant Health Program.
Meanwhile, figures which have been reported vary widely and attract questions on their own.
"The governance and management of the funds is being questioned by everybody, as it seems that it lacks transparency. Many NGOs have tried to find out how the funds are managed and how exactly the funds are spent,without success. To be honest, no one knows how the surplus is used," said Dr Nigoon.
Dr Supakit agrees that reporting has been a problem, and has for several years been working to establish a Migrant Health Management Information System to better monitor migrant health financing and population data.
The surplus funds in many provinces suggest to Dr Nigoon that the public health services - even those in Mae Sot - to which registered workers are entitled through CMHI,are vastly underused. Data from the Moph show that from 2004-2006, registered migrant workers were half as likely to visit public health centres as other insured patients insured migrant workers averaged less than one visit per year, while Thais under the universal coverage plan seek services an average of 2.5 times per year.
Dr Nigoon says this under-utilisation is due to several factors, including fear of local authorities - even those that are registered tend to feel this way - a lack of awareness of their coverage, long working hours, long journeys to health care facilities, restrictive employers, and perhaps, as a consequence of all of these, the preference to self-medicate.
She says the self-medication is unfortunate as migrants may lose money for inappropriate treatment, health providers may miss health developments within migrant populations,and in cases of infectious diseases, the chronic misuse of antibiotics etc can cause drug resistance.
Available data continues to show that migrants under the CMHI scheme are most likely to seek treatment when health cases are quite severe and require in-patient care.
While Dr Supakit calls CMHI an effective system for those it covers, he acknowledges there are some locations where there may not be adequate translators or cultural help for migrant workers to feel comfortable in accessing it. Those who are not covered by CMHI - stateless persons and illegal migrants - present the complications.
Accordingly, he recommends that policy makers adopt a system that will facilitate migrant workers into insurance schemes."The more they are insured, the better health insurance can survive."
While this year's influx of one million migrants into the registration system should buoy, or further bloat, hospitals' CMHI accounts, the increase will not resolve the disparities and gaps within the funding system.
A handful of NGOs and international organisations like IOM continue to pitch in, in areas where service is most patchy. These efforts are often specifically targetted to provide TB services or HIV/Aids prevention, though others more broadly address the migrant community's health needs. IOM, for example,funds several community health posts and the training and service of migrant health workers.
A health worker in a post in Tak's Thasong Yang district - a young Karen woman whose family has lived in Thailand for more than 40 years, but lacks Thai citizenship - attends the health needs of her village's 884 members,sometimes around-the-clock as her home is next to the health post, providing basic care.
Much relief also comes from Mae Sot's Mae Tao Clinic, an internationally-funded operation that in 2006 had a caseload of 80,000 and expended 55 million baht in health services to Burmese patients. Half of these came from Burma for treatment.
While the Moph and provincial health offices have recently absorbed some programmes once supported by IOM, in a nod for sustainability, much of the external assistance comes with an expiration date, and provides neither a complete nor permanent fix.
Dr Patjuban grapples with how to keep the population of Tak healthy, and his public health services financially solvent."The shortages impact the whole system. We need more human resources, more equipment.It's an insufficient budget."
While Tak province receives assistance for funding migrant health care from a handful of NGOs, the inequalities of the migrant health care system and lack of assistance from the government get to him.
"For education, its not a problem. The resources are allocated," he says, referencing the Education for All programme that, at least theoretically, provides education to Thais and non-Thais."Why more funding for education, but none for health?" he asks.
He sees no light at the end of the tunnel,and having given up on on his own government turns to another."The strain on our system is great. We need Burma to improve."
MOSQUITO-BORNE AFRICAN VIRUS "A THREAT TO WEST"
The United States and Europe face a new health threat from a mosquito-borne disease far more unpleasant than the West Nile virus that swept into North America a decade ago,a US expert said on Friday.
Chikungunya virus has spread beyond Africa since 2005, causing outbreaks and scores of fatalities in India and the French island of Reunion. It also has been detected in Italy, where it has begun to spread locally, as well as France.
"We're very worried," Dr James Diaz of the Louisiana University Health Sciences Center told a meeting on airlines,airports and disease transmission.
"Unlike West Nile virus, where nine out of 10 people are going to be totally asymptomatic, or may have a mild headache or a stiff neck, if you get Chikungunya you're going to be sick," he said.
"The disease can be fatal. It's a serious disease," Dr Diaz added."There is no vaccine."
Chikungunya infection causes fever,headache, fatigue, nausea, vomiting,muscle pain, rash and joint pain. Symptoms can last a few weeks, though some suffers have reported incapacitating joint pain or arthritis lasting months.
The disease was first discovered in Tanzania in 1952. Its name means "that which bends up" in the Makonde language spoken in northern Mozambique and southeastern Tanzania.
The virus could spread globally now because it can be carried by the Asian tiger mosquito, which is found across the world.
Chikungunya virus has spread beyond Africa since 2005, causing outbreaks and scores of fatalities in India and the French island of Reunion. It also has been detected in Italy, where it has begun to spread locally, as well as France.
"We're very worried," Dr James Diaz of the Louisiana University Health Sciences Center told a meeting on airlines,airports and disease transmission.
"Unlike West Nile virus, where nine out of 10 people are going to be totally asymptomatic, or may have a mild headache or a stiff neck, if you get Chikungunya you're going to be sick," he said.
"The disease can be fatal. It's a serious disease," Dr Diaz added."There is no vaccine."
Chikungunya infection causes fever,headache, fatigue, nausea, vomiting,muscle pain, rash and joint pain. Symptoms can last a few weeks, though some suffers have reported incapacitating joint pain or arthritis lasting months.
The disease was first discovered in Tanzania in 1952. Its name means "that which bends up" in the Makonde language spoken in northern Mozambique and southeastern Tanzania.
The virus could spread globally now because it can be carried by the Asian tiger mosquito, which is found across the world.
FRESH WAVE OF SWINE FLU INFECTS THOUSANDS IN MEXICO
Mexico was hit with 1,341 new swine flu cases since Monday, bringing the total to 26,338 ahead of the usual autumn flu season, health officials said yesterday.
The Health Ministry said one more person died from the A(H1N1) virus between Monday and Thursday, bringing the death toll to 218 in the country where the virus first emerged in April before becoming a pandemic. In late August, Health Minister Jose Angel Cordova estimated nearly one million people could be infected by the virus during the winter, out of a total population of 100 million in Mexico.
The official global flu death toll has reached 3,486, up 281 from a week ago, according to the World Health Organisation (WHO), which has reported 296,471 known cases of infection. That number is seenas far below actual figures as some countries lack systematic analysis.
The UN agency said the Americas region still has the highest death toll, at 2,625. The Asia-Pacific region reported 620 official fatalities, while Europe recorded at least 140 deaths.
In the Middle East, 61 people succumbed to the virus while in Africa, 40 people have died from it.
The WHO on Friday warned that the production of swine flu vaccines will fall "substantially" short of the amount needed to protect the global population.
"Current supplies of pandemic vaccine are inadequate for a world population in which virtually everyone is susceptible to infection by a new and readily contagious virus," WHO director general Margaret Chan said.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people, WHO spokesman Gregory Hartl said output next year will be "sub-stantially less" than the 4.9 billion doeses annual production forecast.
Some 25 pharmaceutical laboratories working on vaccines have indicated that weekly production is lower than 94 million doses, he said.
In May, the WHO had forecast a weekly output of 94.3 million doses if full scale vaccine production was launched.
But pharmaceutical companies have in recent weeks slashed their production expectations due to poorer than expected yields from the so-called "seed virus" strians developed by WHO-approved laboratories.
Amid growing fears that poorer nations will not get enough vaccines, the United States led nine countries which on Thursday pledged to make 10 per cent of their swine flu vaccine supply available to other nations in need.
The UN health agency's chief applauded the move the United States, Australia, Brazil, Britain, France, Italy, New Zealand, Norway and Switzerland.
Mexico Health Minister Jose Angel Cordova estimated nearly 1 million people could be infected.
The Health Ministry said one more person died from the A(H1N1) virus between Monday and Thursday, bringing the death toll to 218 in the country where the virus first emerged in April before becoming a pandemic. In late August, Health Minister Jose Angel Cordova estimated nearly one million people could be infected by the virus during the winter, out of a total population of 100 million in Mexico.
The official global flu death toll has reached 3,486, up 281 from a week ago, according to the World Health Organisation (WHO), which has reported 296,471 known cases of infection. That number is seenas far below actual figures as some countries lack systematic analysis.
The UN agency said the Americas region still has the highest death toll, at 2,625. The Asia-Pacific region reported 620 official fatalities, while Europe recorded at least 140 deaths.
In the Middle East, 61 people succumbed to the virus while in Africa, 40 people have died from it.
The WHO on Friday warned that the production of swine flu vaccines will fall "substantially" short of the amount needed to protect the global population.
"Current supplies of pandemic vaccine are inadequate for a world population in which virtually everyone is susceptible to infection by a new and readily contagious virus," WHO director general Margaret Chan said.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people, WHO spokesman Gregory Hartl said output next year will be "sub-stantially less" than the 4.9 billion doeses annual production forecast.
Some 25 pharmaceutical laboratories working on vaccines have indicated that weekly production is lower than 94 million doses, he said.
In May, the WHO had forecast a weekly output of 94.3 million doses if full scale vaccine production was launched.
But pharmaceutical companies have in recent weeks slashed their production expectations due to poorer than expected yields from the so-called "seed virus" strians developed by WHO-approved laboratories.
Amid growing fears that poorer nations will not get enough vaccines, the United States led nine countries which on Thursday pledged to make 10 per cent of their swine flu vaccine supply available to other nations in need.
The UN health agency's chief applauded the move the United States, Australia, Brazil, Britain, France, Italy, New Zealand, Norway and Switzerland.
Mexico Health Minister Jose Angel Cordova estimated nearly 1 million people could be infected.
Human trials of flu jab delayed again
Human trials of the Thai-made type-A (H1N1) influenza vaccine have been delayed for the second time after the World Health Organisation recommended the Thai team conduct more studies on the trial jab's safety.
Vichai Chokewiwat, the Government Pharmaceutical Organisation (GPO)chairman, said the WHO viewed that Thai scientists were new to the production of live-attenuated vaccine, so the country should take careful steps in producing a vaccine.
The WHO's recommendation came after the Thai team detected an abscess in a rat injected with its trial H1N1 vaccine earlier this month.
Although the WHO experts concluded that the abscess had nothing to do with the trial vaccine, they recommended more studies be done before Thailand goes ahead with human trials.
"So we decided to postpone the vaccine testing on humans for 10 more days. The trials will begin on Oct 5," Dr Vichai said after the meeting of a committee on vaccine trials on humans which he chaired yesterday.
The human testing was originally scheduled for Sept 21, but was later postponed to Sept 24 and then Oct 5.
"Yes, we are worried that Thailand's H1N1 vaccine development project is not going as smoothly as expected, but we have come this far and we won't give up," said Dr Vichai.
In the meantime, the GPO would recruit volunteers for vaccine trials.
The GPO planned to conduct vaccine tests on 24 volunteers, but only seven were on the list as most of the applicants did not meet the testing requirements.
In another development, the subcommittee on immunisation practices,a body that counsels the government on vaccine matters, yesterday proposed a priority list of H1N1 vaccine recipients.
The advisory panel would next week submit the list to the Public Health Ministry for review and then help state and local health departments plan for a vaccination campaign as soon as the previously-ordered 2 million vaccines arrive around December and January.
Under the list, health care workers,pregnant women and those with obesity problems will be among people first in line to receive the vaccine, followed by those with chronic diseases and developmental disabilities, totalling 5 million,who are at the highest risk of complications from the new flu strain.
Somchai Chakrabhandu, Disease Control Department chief, said the recommendation is based on the number of fatalities reported by the Bureau of Epidemiology.
The type-A H1N1 flu has caused over 10,000 hospitalisations and 153 deaths in 56 provinces as of Sept 16. Most of them were among these risk groups,except for the healthcare workers.
Charung Muangchana, director of the national vaccine committee, said an estimated 400,000 healthcare workers are listed to receive the vaccine first because they are on the front lines in providing services at hospitals.
Vichai Chokewiwat, the Government Pharmaceutical Organisation (GPO)chairman, said the WHO viewed that Thai scientists were new to the production of live-attenuated vaccine, so the country should take careful steps in producing a vaccine.
The WHO's recommendation came after the Thai team detected an abscess in a rat injected with its trial H1N1 vaccine earlier this month.
Although the WHO experts concluded that the abscess had nothing to do with the trial vaccine, they recommended more studies be done before Thailand goes ahead with human trials.
"So we decided to postpone the vaccine testing on humans for 10 more days. The trials will begin on Oct 5," Dr Vichai said after the meeting of a committee on vaccine trials on humans which he chaired yesterday.
The human testing was originally scheduled for Sept 21, but was later postponed to Sept 24 and then Oct 5.
"Yes, we are worried that Thailand's H1N1 vaccine development project is not going as smoothly as expected, but we have come this far and we won't give up," said Dr Vichai.
In the meantime, the GPO would recruit volunteers for vaccine trials.
The GPO planned to conduct vaccine tests on 24 volunteers, but only seven were on the list as most of the applicants did not meet the testing requirements.
In another development, the subcommittee on immunisation practices,a body that counsels the government on vaccine matters, yesterday proposed a priority list of H1N1 vaccine recipients.
The advisory panel would next week submit the list to the Public Health Ministry for review and then help state and local health departments plan for a vaccination campaign as soon as the previously-ordered 2 million vaccines arrive around December and January.
Under the list, health care workers,pregnant women and those with obesity problems will be among people first in line to receive the vaccine, followed by those with chronic diseases and developmental disabilities, totalling 5 million,who are at the highest risk of complications from the new flu strain.
Somchai Chakrabhandu, Disease Control Department chief, said the recommendation is based on the number of fatalities reported by the Bureau of Epidemiology.
The type-A H1N1 flu has caused over 10,000 hospitalisations and 153 deaths in 56 provinces as of Sept 16. Most of them were among these risk groups,except for the healthcare workers.
Charung Muangchana, director of the national vaccine committee, said an estimated 400,000 healthcare workers are listed to receive the vaccine first because they are on the front lines in providing services at hospitals.
Friday, September 18, 2009
GPO seeks hygienic eggs to make flu jab
The Government Pharmaceutical Organisation is seeking the help of the Livestock Department to acquire hygienic local hen eggs to produce flu vaccines after limitations were found with imported eggs.
GPO deputy managing director Somchai Srichainak yesterday said the agency could produce up to 1,000 specific pathogen-free (SPF) eggs a day for vaccine development.
He said the GPO and the department were discussing the feasibility of in-creasing the production and supply of SPF eggs."We're seeking ways to find local hygienic egg suppliers to help in the manufacture of vaccines as the time it takes to ship supplies from overseas could affect the eggs and the vaccine production," Mr Somchai said.
SPF eggs are now being imported from Germany and the US.
Mr Somchai said the GPO at first planned to use hygienic eggs from local poultry producers such as CP and Saha Farm to cultivate the virus. But their technologies were not tailored for SPF egg production unlike those from the Livestock Department.
However, imported eggs were still needed for vaccine production as an average of 1,500 SPF eggs were used to manufacture each batch of vaccine.
GPO chairman Vichai Chokewiwat said a committee overseeing human vaccine trials would meet tomorrow to decide if the trials should be delayed.They were scheduled to start on Sept 24.
A report of a lung infection in one of 12 guinea pigs being used in pre-trial tests had raised concerns, although studies had shown the flu vaccine did not cause the problem.
Postponing the human trials would set back the availability of the vaccine which was scheduled for January.
The Public Health Ministry yesterday confirmed 11 new deaths from the typeA (H1N1) flu, bringing the country's death toll since the outbreak began to 153, deputy permanent secretary for health Paijit Varachit said.
H1N1 WATCH Deaths: As of Sept 12,compared to Sept 5 142 153 Sept 5Sept 12 Contact numbers: * Public Health Ministry hotline: 02-590-1994 (24 hours) or 1422 * Health Emergency Response Unit: 02-590-3333 * BMA disease control division: 02-245-8106
GPO deputy managing director Somchai Srichainak yesterday said the agency could produce up to 1,000 specific pathogen-free (SPF) eggs a day for vaccine development.
He said the GPO and the department were discussing the feasibility of in-creasing the production and supply of SPF eggs."We're seeking ways to find local hygienic egg suppliers to help in the manufacture of vaccines as the time it takes to ship supplies from overseas could affect the eggs and the vaccine production," Mr Somchai said.
SPF eggs are now being imported from Germany and the US.
Mr Somchai said the GPO at first planned to use hygienic eggs from local poultry producers such as CP and Saha Farm to cultivate the virus. But their technologies were not tailored for SPF egg production unlike those from the Livestock Department.
However, imported eggs were still needed for vaccine production as an average of 1,500 SPF eggs were used to manufacture each batch of vaccine.
GPO chairman Vichai Chokewiwat said a committee overseeing human vaccine trials would meet tomorrow to decide if the trials should be delayed.They were scheduled to start on Sept 24.
A report of a lung infection in one of 12 guinea pigs being used in pre-trial tests had raised concerns, although studies had shown the flu vaccine did not cause the problem.
Postponing the human trials would set back the availability of the vaccine which was scheduled for January.
The Public Health Ministry yesterday confirmed 11 new deaths from the typeA (H1N1) flu, bringing the country's death toll since the outbreak began to 153, deputy permanent secretary for health Paijit Varachit said.
H1N1 WATCH Deaths: As of Sept 12,compared to Sept 5 142 153 Sept 5Sept 12 Contact numbers: * Public Health Ministry hotline: 02-590-1994 (24 hours) or 1422 * Health Emergency Response Unit: 02-590-3333 * BMA disease control division: 02-245-8106
SICK GUINEA PIG MAY DELAY FLU VACCINE TEST
The Government Pharmaceutical Organisation (GPO) will decide next Wednesday whether to delay the first phase of clinical trials of a vaccine against a new strain of type-A (H1N1) influenza discovered after a test with guinea pigs found one had an infection in its lungs.
Meanwhile, the Public Health Ministry announced yesterday the type-A (H1N1) virus has killed 11 people during the past seven days, bringing total fatalities to 153. Most were suffering underlying diseases.
The GPO had planned to run its first clinical vaccine trial against the flu virus on September 21. However, after finding an infection during an animal trial, GPO decided to put off its human trials for another three days.
GPO board chairperson, Dr Wichai Chokwiwat said the board will meet on Friday to discuss results of the animal trial where one of ten guinea pigs was found to have developed pockmarks in its lung.
"We will have to study all information about the guinea pig tests carefully before we make a decision whether or not to begin testing the vaccine in 24 volunteers from September 24," he said.
"We will postpone the human trials if we find any problems in the first lot of vaccine against new flu virus," he said.
Wichai said he has consulted with experts about the marks in the guinea pig's lungs and been advised they might have been caused by an abnormality in the animal and not by the vaccine.
He said scientists had injected the vaccine into two guinea pigs with the same concentration planned for humans. One of the two guinea pigs developed an infection which might have been caused by a previous lesion.
GPO's deputy director, Somchai Srichainaka said they were negotiating with the Livestock Development Department to produce local specific pathogen free eggs for the production of vaccine.
GPO has faced problems importing these hen's eggs for vaccine development from Germany and the United States.The long distance transportation might be affecting specific eggs and causing the virus incubated in them to grow more slowly. However 3,000 eggs from the US will arrive today.
Somchai said Thailand would save expense in the long term if it could produce local specific free pathogen eggs, reducing costs from Bt180 to Bt120 an egg. GPO has asked the US Food and Drug Administration for help with production of the specific free pathogen.
World Health Organisation (WHO) representative to Thailand, Dr Maureen Birmingham, said WHO is negotiating with two leading vaccine makers,Sanofi Pasteur and GlaxoSmithKline, to contribute vaccine to the WHO for distribution to developing countries. Agreement is expected in the next two weeks.
Meanwhile, the Public Health Ministry announced yesterday the type-A (H1N1) virus has killed 11 people during the past seven days, bringing total fatalities to 153. Most were suffering underlying diseases.
The GPO had planned to run its first clinical vaccine trial against the flu virus on September 21. However, after finding an infection during an animal trial, GPO decided to put off its human trials for another three days.
GPO board chairperson, Dr Wichai Chokwiwat said the board will meet on Friday to discuss results of the animal trial where one of ten guinea pigs was found to have developed pockmarks in its lung.
"We will have to study all information about the guinea pig tests carefully before we make a decision whether or not to begin testing the vaccine in 24 volunteers from September 24," he said.
"We will postpone the human trials if we find any problems in the first lot of vaccine against new flu virus," he said.
Wichai said he has consulted with experts about the marks in the guinea pig's lungs and been advised they might have been caused by an abnormality in the animal and not by the vaccine.
He said scientists had injected the vaccine into two guinea pigs with the same concentration planned for humans. One of the two guinea pigs developed an infection which might have been caused by a previous lesion.
GPO's deputy director, Somchai Srichainaka said they were negotiating with the Livestock Development Department to produce local specific pathogen free eggs for the production of vaccine.
GPO has faced problems importing these hen's eggs for vaccine development from Germany and the United States.The long distance transportation might be affecting specific eggs and causing the virus incubated in them to grow more slowly. However 3,000 eggs from the US will arrive today.
Somchai said Thailand would save expense in the long term if it could produce local specific free pathogen eggs, reducing costs from Bt180 to Bt120 an egg. GPO has asked the US Food and Drug Administration for help with production of the specific free pathogen.
World Health Organisation (WHO) representative to Thailand, Dr Maureen Birmingham, said WHO is negotiating with two leading vaccine makers,Sanofi Pasteur and GlaxoSmithKline, to contribute vaccine to the WHO for distribution to developing countries. Agreement is expected in the next two weeks.
Monday, September 14, 2009
Most infectious malaria strain came from chimps?
The most malignant known form of malaria may have jumped from chimpanzees to humans, according to a new study of one of the most deadly diseases in the world.
Malaria, a mosquito-borne illness, can be caused in humans by one of four strains of the Plasmodium parasite. More than a million people die from malaria each year.P. falciparum is the most virulent of these strains and accounts for nearly 85 percent of all malaria infections.
Three of the four human strains are known to have originally come from Old World monkeys. The exact origins of P. falciparum have been a mystery.Researchers had thought that P. falciparum and P. reichenowi - the malaria strain found in chimpanzees - evolved independently from a common ancestor about 5 to 7 million years ago. But the new study has found that the human strain is actually a mutated form of the chimp strain.
"Current wisdom that P. falciparum has been in humans for millions and millions of years is wrong," said study co-author Nathan Wolfe, director of the Global Viral Forecasting Initiative based in San Francisco, California, and a National Geographic emerging explorer.
"We now know that there was a point in time when this was primarily a disease in chimpanzees that jumped and took hold in humans."
Wolfe and his colleagues analysed tissues samples from 94 live wild and wild-born captive chimpanzees in Cameroon and Cote d'Ivoire. Eight of the animals were found to have malaria.
The team discovered that the human and chimpanzee strains have certain genetic similarities, but that the chimp strain is more genetically diverse. Further analysis placed all 133 variants of P.falciparum found around the world under a single branch of the P. reichenowi family tree.
"This suggests that there has been only one transfer. P. falciparum is the result of a single cross-species transmission event," said Wolfe, whose work appears this week in the Proceedings of the National Academy of Sciences .The scientists aren't sure how the chimp strain mutated to become infectious to humans or when it might have made the jump, although the oldest known human cases of malaria date back thousands of years. The team believes it's possible that, as early humans settled into an agrarian lifestyle in Africa,their likely encroachment into chimpanzee territory provided the parasite with new opportunities.
Biologist Dan Hartl of Harvard University noted that, until now, only one sample of the chimpanzee parasite had ever been studied.
"Researchers had believed that P. falciparum probably originated from parasites in birds," said Hartl, who was not involved in the study."[Wolfe and colleagues'] paper proves that is not true, and that data from those early studies were misleading."
Late last year, a team led by Arnab Pain, a malaria researcher at the Welcome Trust Sanger Institute in Cambridge, UK,announced they had sequenced the genome of P. knowlesi , a monkey malaria parasite that can also infect humans.Pain agrees that Wolfe and his colleagues have conclusively proven that the chimpanzee malaria parasite was transferred only once to humans. But researchers would need to know the entire genetic make-up of the chimp parasite to find out what changes it underwent, he added.
"How much the parasite changed,we don't know the full story yet."
According to study co-author Wolfe,the new work hints that even today similar disease-causing parasites may be ready to make the leap from monkeys and apes to humans.
"Our study suggests that there is a [version of P. reichenowi] out there that is very similar to P. falciparum - it has a tremendous amount of genetic diversity, and is present in animals that are close to humans in a very geographically distributed area," Wolfe said.
That means there's a chance that a new malaria parasite might make its way into people, he said.
The work also highlights how long a disease can last once a parasite has made that leap, Wolfe added.
"What this finding demonstrates is that the kinds of jumps we're having right now - HIV, Sars, etc.- could very well be the beginning of something that lasts for thousands of years."
Malaria, a mosquito-borne illness, can be caused in humans by one of four strains of the Plasmodium parasite. More than a million people die from malaria each year.P. falciparum is the most virulent of these strains and accounts for nearly 85 percent of all malaria infections.
Three of the four human strains are known to have originally come from Old World monkeys. The exact origins of P. falciparum have been a mystery.Researchers had thought that P. falciparum and P. reichenowi - the malaria strain found in chimpanzees - evolved independently from a common ancestor about 5 to 7 million years ago. But the new study has found that the human strain is actually a mutated form of the chimp strain.
"Current wisdom that P. falciparum has been in humans for millions and millions of years is wrong," said study co-author Nathan Wolfe, director of the Global Viral Forecasting Initiative based in San Francisco, California, and a National Geographic emerging explorer.
"We now know that there was a point in time when this was primarily a disease in chimpanzees that jumped and took hold in humans."
Wolfe and his colleagues analysed tissues samples from 94 live wild and wild-born captive chimpanzees in Cameroon and Cote d'Ivoire. Eight of the animals were found to have malaria.
The team discovered that the human and chimpanzee strains have certain genetic similarities, but that the chimp strain is more genetically diverse. Further analysis placed all 133 variants of P.falciparum found around the world under a single branch of the P. reichenowi family tree.
"This suggests that there has been only one transfer. P. falciparum is the result of a single cross-species transmission event," said Wolfe, whose work appears this week in the Proceedings of the National Academy of Sciences .The scientists aren't sure how the chimp strain mutated to become infectious to humans or when it might have made the jump, although the oldest known human cases of malaria date back thousands of years. The team believes it's possible that, as early humans settled into an agrarian lifestyle in Africa,their likely encroachment into chimpanzee territory provided the parasite with new opportunities.
Biologist Dan Hartl of Harvard University noted that, until now, only one sample of the chimpanzee parasite had ever been studied.
"Researchers had believed that P. falciparum probably originated from parasites in birds," said Hartl, who was not involved in the study."[Wolfe and colleagues'] paper proves that is not true, and that data from those early studies were misleading."
Late last year, a team led by Arnab Pain, a malaria researcher at the Welcome Trust Sanger Institute in Cambridge, UK,announced they had sequenced the genome of P. knowlesi , a monkey malaria parasite that can also infect humans.Pain agrees that Wolfe and his colleagues have conclusively proven that the chimpanzee malaria parasite was transferred only once to humans. But researchers would need to know the entire genetic make-up of the chimp parasite to find out what changes it underwent, he added.
"How much the parasite changed,we don't know the full story yet."
According to study co-author Wolfe,the new work hints that even today similar disease-causing parasites may be ready to make the leap from monkeys and apes to humans.
"Our study suggests that there is a [version of P. reichenowi] out there that is very similar to P. falciparum - it has a tremendous amount of genetic diversity, and is present in animals that are close to humans in a very geographically distributed area," Wolfe said.
That means there's a chance that a new malaria parasite might make its way into people, he said.
The work also highlights how long a disease can last once a parasite has made that leap, Wolfe added.
"What this finding demonstrates is that the kinds of jumps we're having right now - HIV, Sars, etc.- could very well be the beginning of something that lasts for thousands of years."
Sunday, September 13, 2009
FLU SHUTS MEXICO SCHOOLS
Officials have closed 1,400 schools in the city of Culiacan in northern Mexico after a suspected rise in swine flu cases.
The education secretary of Sinaloa state, where Culiacan is located, says 19 students have been tested for swine flu after showing symptoms. Officials are still awaiting the results.
Education Secretary Florentino Castro says officials detected 50 students with respiratory problems at 80 schools.
The decision to cancel all primary, secondary and university classes in Culiacan was implemented on Friday. Officials will decide whether to resume instruction September 17.
An outbreak in April prompted a nationwide shutdown of school and nonessential businesses.
The education secretary of Sinaloa state, where Culiacan is located, says 19 students have been tested for swine flu after showing symptoms. Officials are still awaiting the results.
Education Secretary Florentino Castro says officials detected 50 students with respiratory problems at 80 schools.
The decision to cancel all primary, secondary and university classes in Culiacan was implemented on Friday. Officials will decide whether to resume instruction September 17.
An outbreak in April prompted a nationwide shutdown of school and nonessential businesses.
Friday, September 11, 2009
Abscess in rat delays human vaccine tests
H1N1
An abscess found in a rat injected with a Thai-made trial H1N1 vaccine has prompted the Government Pharmaceutical Organisation to delay vaccine testing in humans for three more days.
The GPO has postponed the start of the human trial from Sept 21 to 24, Vichai Chokewiwat, GPO board chairman, said yesterday.
The decision was made after the Thai team detected an abscess in a lung of the vaccinated rat.
Scientists were studying a lung sample from the animal to find out what caused it, Dr Vichai said.
The Russian H1N1 flu vaccine development team found a similar problem when they tested their vaccine, he said.
"Initial tests found the abscess has nothing to do with the trial vaccine. But we must look at it in detail before going ahead with the human trial," he said.
Another problem to emerge was the number of volunteers available for vaccine testing.
Dr Vichai said the GPO planned to conduct vaccine tests on 24 volunteers,but only two people had joined the list as most of the applicants did not meet the testing requirements.
The problems would not affect the vaccine production process, he said.
An abscess found in a rat injected with a Thai-made trial H1N1 vaccine has prompted the Government Pharmaceutical Organisation to delay vaccine testing in humans for three more days.
The GPO has postponed the start of the human trial from Sept 21 to 24, Vichai Chokewiwat, GPO board chairman, said yesterday.
The decision was made after the Thai team detected an abscess in a lung of the vaccinated rat.
Scientists were studying a lung sample from the animal to find out what caused it, Dr Vichai said.
The Russian H1N1 flu vaccine development team found a similar problem when they tested their vaccine, he said.
"Initial tests found the abscess has nothing to do with the trial vaccine. But we must look at it in detail before going ahead with the human trial," he said.
Another problem to emerge was the number of volunteers available for vaccine testing.
Dr Vichai said the GPO planned to conduct vaccine tests on 24 volunteers,but only two people had joined the list as most of the applicants did not meet the testing requirements.
The problems would not affect the vaccine production process, he said.
Wednesday, September 9, 2009
Next wave of H1N1 flu
Mexico is preparing for a second wave of Type A (H1N1) flu, looking at what worked and what didn't last spring when it banned everything from dining out to attending school, in an effort to control the virus.
As the Northern Hemisphere flu season begins,the rest of the world is also studying Mexico's experience, looking for measures to replicate and costly mistakes to avoid.
So what worked? Public awareness; rapid diagnosis,treatment and quarantine; and a near-compulsive outbreak of hand-washing.
What didn't? Travel bans, school closures, overuse of antibiotics and those flimsy paper face masks that tangled hair, slid down necks and hid the beautiful smiles of this gargantuan city.
When H1N1 flu first flared up in Mexico in April,the government erred on the side of caution, closing schools and museums, banning public gatherings,playing soccer games to empty stadiums and telling people not to shake hands or kiss one another on the cheek. This bustling city of 18 million became eerily hollow.
Mexican health officials say they made the right call.
"Since we were the first country affected by the flu,we didn't know the possible magnitude and severity,so we took measures that we now know can be [focused]," said Dr Pablo Kuri, the health secretary's special influenza adviser.
In hindsight, Mexico's most effective action - one now emulated around the world - was immediately telling its own citizens when the new virus was detected.
Not every country has been so candid when facing an epidemic: China was heavily criticised for its slow response to Sars in 2003, while Argentina refused to declare a national public health emergency when H1N1 flu flared there in July.
But Mexico's openness didn't come cheap: economists say the outbreak cost the country billions of dollars, mostly in losses from tourism.
"Mexico shared information early and frequently,"said Dr Jon Andrus at the Pan American Health Organisation's headquarters in Washington."Mexico did this at great cost to its economy, but it was the right thing to do."
At the height of the epidemic in March, you could hardly make it a block in Mexico City without a masked public health worker, maitre d', bus driver or store owner squeezing a dollop of antiseptic gel onto your hands.
Health experts say hand-washing offered the best defence - while the masks probably did little to stop the virus from spreading. Masks are now advised only for health care workers and people who are already infected.
Fear also left behind a cleaner city: crews now regularly scrub underground railways and buses, park benches and offices - something almost unheard of before the epidemic.
"Clearly, millions of Mexicanos wore masks this spring everywhere they went, but H1N1 continued to spread," said Laurie Garrett, a senior fellow at the New York-based Council on Foreign Relations."It now seems clear that the best personal protections are regular hand-washing, avoiding crowded places,and - when it is available - vaccination."
Many Mexicans wait until they suffer full-blown symptoms before going to a doctor, if at all. Often,people self-diagnose and go to a pharmacy to treat themselves since few drugs require a prescription.Since April, however, certain anti-flu drugs are distributed only at hospitals.
Millions of uniformed Mexican children were greeted with a dash of antibacterial gel as they returned to school on Monday. Classes were postponed until mid-September in southern Chiapas state because of an increase in swine flu cases in the past month.Chiapas has had 3,400 swine flu cases to date, the most in the country.
Schools nationwide are checking for possible signs of swine flu among children and teachers and are sending home anyone who seems sick. They also have added new curriculum guidelines to ensure children learn about personal hygiene and basic sanitation.
But this time, schools will be closed only if so many sick children or teachers get sick that education is compromised. Plans are already under way to continue lessons at home.
"We aren't going to panic, but we are being more careful here this year," said Cecilia McGregor, spokeswoman for Colegio Ciudad de Mexico, a 1,100-student private school in Mexico City.
Caretakers at schools are required to wash doorknobs every two hours, she said, and an oncampus doctor was performing checks.
Despite all the precautions, Mexico's health advisers say the most important lesson they have learned about swine flu is that in most cases, it's fairly mild.
Swine flu caused 164 deaths in three months in Mexico, where tobacco-related illnesses kill that number every day.
"So now we can put into context what actually happened," Kuri said.
As the Northern Hemisphere flu season begins,the rest of the world is also studying Mexico's experience, looking for measures to replicate and costly mistakes to avoid.
So what worked? Public awareness; rapid diagnosis,treatment and quarantine; and a near-compulsive outbreak of hand-washing.
What didn't? Travel bans, school closures, overuse of antibiotics and those flimsy paper face masks that tangled hair, slid down necks and hid the beautiful smiles of this gargantuan city.
When H1N1 flu first flared up in Mexico in April,the government erred on the side of caution, closing schools and museums, banning public gatherings,playing soccer games to empty stadiums and telling people not to shake hands or kiss one another on the cheek. This bustling city of 18 million became eerily hollow.
Mexican health officials say they made the right call.
"Since we were the first country affected by the flu,we didn't know the possible magnitude and severity,so we took measures that we now know can be [focused]," said Dr Pablo Kuri, the health secretary's special influenza adviser.
In hindsight, Mexico's most effective action - one now emulated around the world - was immediately telling its own citizens when the new virus was detected.
Not every country has been so candid when facing an epidemic: China was heavily criticised for its slow response to Sars in 2003, while Argentina refused to declare a national public health emergency when H1N1 flu flared there in July.
But Mexico's openness didn't come cheap: economists say the outbreak cost the country billions of dollars, mostly in losses from tourism.
"Mexico shared information early and frequently,"said Dr Jon Andrus at the Pan American Health Organisation's headquarters in Washington."Mexico did this at great cost to its economy, but it was the right thing to do."
At the height of the epidemic in March, you could hardly make it a block in Mexico City without a masked public health worker, maitre d', bus driver or store owner squeezing a dollop of antiseptic gel onto your hands.
Health experts say hand-washing offered the best defence - while the masks probably did little to stop the virus from spreading. Masks are now advised only for health care workers and people who are already infected.
Fear also left behind a cleaner city: crews now regularly scrub underground railways and buses, park benches and offices - something almost unheard of before the epidemic.
"Clearly, millions of Mexicanos wore masks this spring everywhere they went, but H1N1 continued to spread," said Laurie Garrett, a senior fellow at the New York-based Council on Foreign Relations."It now seems clear that the best personal protections are regular hand-washing, avoiding crowded places,and - when it is available - vaccination."
Many Mexicans wait until they suffer full-blown symptoms before going to a doctor, if at all. Often,people self-diagnose and go to a pharmacy to treat themselves since few drugs require a prescription.Since April, however, certain anti-flu drugs are distributed only at hospitals.
Millions of uniformed Mexican children were greeted with a dash of antibacterial gel as they returned to school on Monday. Classes were postponed until mid-September in southern Chiapas state because of an increase in swine flu cases in the past month.Chiapas has had 3,400 swine flu cases to date, the most in the country.
Schools nationwide are checking for possible signs of swine flu among children and teachers and are sending home anyone who seems sick. They also have added new curriculum guidelines to ensure children learn about personal hygiene and basic sanitation.
But this time, schools will be closed only if so many sick children or teachers get sick that education is compromised. Plans are already under way to continue lessons at home.
"We aren't going to panic, but we are being more careful here this year," said Cecilia McGregor, spokeswoman for Colegio Ciudad de Mexico, a 1,100-student private school in Mexico City.
Caretakers at schools are required to wash doorknobs every two hours, she said, and an oncampus doctor was performing checks.
Despite all the precautions, Mexico's health advisers say the most important lesson they have learned about swine flu is that in most cases, it's fairly mild.
Swine flu caused 164 deaths in three months in Mexico, where tobacco-related illnesses kill that number every day.
"So now we can put into context what actually happened," Kuri said.
Tuesday, September 8, 2009
10 things you need to know
Since it first emerged in April, the global swine flu epidemic has sickened more than 1 million in the US and killed about 500.
It has also spread around the world, infecting tens of thousands and killing nearly 2,000.
This summer, the virus has been surprisingly tenacious in the US, refusing to fade away as flu viruses usually do.
And health officials predict a surge of cases this autumn, perhaps very soon as schools reopen.
A White House report from an expert panel suggests that from 30 percent to half the US population could catch H1N1 during the course of this pandemic and that from 30,000 to 90,000 could die.
So how worried should you be and how do you prepare? Here are 10 things you should know to be flusavvy:
1. No cause for panic.
So far, H1N1 isn't much more threatening than regular seasonal flu.
During the few months of this new flu's existence, hospitalisations and deaths from it seem to be lower than the average seen for seasonal flu, and the virus hasn't dramatically mutated. That's what health officials have observed in the Southern Hemisphere where flu season is now winding down.
Still, more people are susceptible to Type A flu and US health officials are worried because it hung in so firmly during the summer - a time of year the flu usually goes away.
2. Virus tougher on some.
H1N1 is more of a threat to certain groups - children under 2, pregnant women, people with health problems such as asthma, diabetes and heart disease. Teens and young adults are also more vulnerable to H1N1.
Ordinary, seasonal flu hits older people the hardest, but not H1N1. Scientists think older people may have some immunity from exposure years earlier to viruses similar to this one.
3. Wash your hands often and long.
Like seasonal flu, H1N1 spreads through the coughs and sneezes of people who are ill.
Emphasize to children that they should wash with soap and water long enough to finish singing the alphabet song,"Now I know my ABC's ..." Also use alcoholbased hand sanitisers.
4. Get the children vaccinated.
These groups should be first in line for H1N1 shots when they become available, especially if vaccine supplies are limited - people 6 months to 24 years old, pregnant women and health care workers.
Also a priority: parents and carers of infants, people with high-risk medical conditions.
5. Get your shots early.
H1N1 shots should be available later this year. If you are in one of the priority groups, try to get your shot as early as possible.
Check with your doctor about where to do this.
6. Immunity takes a while.
Even those first in line for shots won't have immunity for a month or more.
That's because it's likely to take two shots, given three weeks apart, to provide protection. And it takes a week or two after the last shot for the vaccine to take full effect.
The regular seasonal flu shot should be available later in the year. People over 50 are urged to be among the first to get that shot.
7. Vaccines are being tested.
Health officials presume the H1N1 vaccine is safe and effective, but they're testing it to make sure.
The US government has begun studies in eight cities across the country to assess its effectiveness and figure out the best dose.
Vaccine makers are doing their own tests as well.
8. Help! Surrounded by H1N1.
If an outbreak of swine flu hits your area before you're vaccinated, be extra cautious.
Stay away from public gathering places such as shopping complexes, sports events and churches. Try to keep your distance from people in general. Keep washing those hands and keep your hands away from your eyes, nose and mouth.
9. What if you get sick?
If you have other health problems or are pregnant and develop flu-like symptoms, call your doctor right away. You may be prescribed Tamiflu or Relenza.These drugs can reduce the severity of Type A flu if taken right after symptoms start.
If you develop breathing problems (rapid breathing for children), pain in your chest, constant vomiting or a fever that keeps rising, go to an emergency room.
Most people, though, should just stay home and rest. Cough into your elbow or shoulder. Stay home for at least 24 hours after your fever breaks. Fluids and pain relievers like Tylenol or paracetamol can help with achiness and fever. Always check with a doctor before giving children any medicines. Adult cold and flu remedies are not for them.
10. No H1N1 from the barbecue.
You can't catch H1N1 from pork or poultry either (even though it recently turned up in turkeys in Chile). H1N1 flu is not spread by handling meat, whether it's raw or cooked.
It has also spread around the world, infecting tens of thousands and killing nearly 2,000.
This summer, the virus has been surprisingly tenacious in the US, refusing to fade away as flu viruses usually do.
And health officials predict a surge of cases this autumn, perhaps very soon as schools reopen.
A White House report from an expert panel suggests that from 30 percent to half the US population could catch H1N1 during the course of this pandemic and that from 30,000 to 90,000 could die.
So how worried should you be and how do you prepare? Here are 10 things you should know to be flusavvy:
1. No cause for panic.
So far, H1N1 isn't much more threatening than regular seasonal flu.
During the few months of this new flu's existence, hospitalisations and deaths from it seem to be lower than the average seen for seasonal flu, and the virus hasn't dramatically mutated. That's what health officials have observed in the Southern Hemisphere where flu season is now winding down.
Still, more people are susceptible to Type A flu and US health officials are worried because it hung in so firmly during the summer - a time of year the flu usually goes away.
2. Virus tougher on some.
H1N1 is more of a threat to certain groups - children under 2, pregnant women, people with health problems such as asthma, diabetes and heart disease. Teens and young adults are also more vulnerable to H1N1.
Ordinary, seasonal flu hits older people the hardest, but not H1N1. Scientists think older people may have some immunity from exposure years earlier to viruses similar to this one.
3. Wash your hands often and long.
Like seasonal flu, H1N1 spreads through the coughs and sneezes of people who are ill.
Emphasize to children that they should wash with soap and water long enough to finish singing the alphabet song,"Now I know my ABC's ..." Also use alcoholbased hand sanitisers.
4. Get the children vaccinated.
These groups should be first in line for H1N1 shots when they become available, especially if vaccine supplies are limited - people 6 months to 24 years old, pregnant women and health care workers.
Also a priority: parents and carers of infants, people with high-risk medical conditions.
5. Get your shots early.
H1N1 shots should be available later this year. If you are in one of the priority groups, try to get your shot as early as possible.
Check with your doctor about where to do this.
6. Immunity takes a while.
Even those first in line for shots won't have immunity for a month or more.
That's because it's likely to take two shots, given three weeks apart, to provide protection. And it takes a week or two after the last shot for the vaccine to take full effect.
The regular seasonal flu shot should be available later in the year. People over 50 are urged to be among the first to get that shot.
7. Vaccines are being tested.
Health officials presume the H1N1 vaccine is safe and effective, but they're testing it to make sure.
The US government has begun studies in eight cities across the country to assess its effectiveness and figure out the best dose.
Vaccine makers are doing their own tests as well.
8. Help! Surrounded by H1N1.
If an outbreak of swine flu hits your area before you're vaccinated, be extra cautious.
Stay away from public gathering places such as shopping complexes, sports events and churches. Try to keep your distance from people in general. Keep washing those hands and keep your hands away from your eyes, nose and mouth.
9. What if you get sick?
If you have other health problems or are pregnant and develop flu-like symptoms, call your doctor right away. You may be prescribed Tamiflu or Relenza.These drugs can reduce the severity of Type A flu if taken right after symptoms start.
If you develop breathing problems (rapid breathing for children), pain in your chest, constant vomiting or a fever that keeps rising, go to an emergency room.
Most people, though, should just stay home and rest. Cough into your elbow or shoulder. Stay home for at least 24 hours after your fever breaks. Fluids and pain relievers like Tylenol or paracetamol can help with achiness and fever. Always check with a doctor before giving children any medicines. Adult cold and flu remedies are not for them.
10. No H1N1 from the barbecue.
You can't catch H1N1 from pork or poultry either (even though it recently turned up in turkeys in Chile). H1N1 flu is not spread by handling meat, whether it's raw or cooked.
Sunday, September 6, 2009
NEWS ITEMS ON H1N1 FLU "INCOMPLETE"
News reports concerning H1N1 flu offered by most state TV channels lack clarity and tend to cause confusion, a study shows.
Media Monitor, an independent agency sponsored by the Thai Health Promotion Foundation, revealed the study at a seminar on news reporting and the H1N1 flu pandemic at Suan Dusit Rajabhat University, organised by the Thai Journalists Association and the Thai Broadcasting Journalists Association.
The study also looked at evening news programmes on the six free TV channels between July 28 and Aug 17.
The study said news information presented was incomplete. The presentation of news issues involving the causes of deaths related to the virus was unclear and tended to cause confusion.
The study found issues and news content presented by the six channels was similar with an emphasis on the pandemic situation, the preventive measures to control the spread of the virus, the dispensing of anti-viral medicines and the impact the flu pandemic had on the economy and tourism and the closure of tutorial and cram schools.
The study said that overall, reports by the six channels focused on the number of deaths caused by the flu or those suspected of dying from the flu. If it was later proved that any deaths were not linked to the flu, those channels only came up with brief reports on the issue,the study said.
The study also said the language used in news headlines of newspapers was strong and tended to provoke excitement and panic.
The study looked at news content presented by eight newspapers during the first three weeks of the flu pandemic situation from April 28 to May 18.
It also said many terms coined and used by newspapers to describe the virus could be misleading such as "swine flu"or "Mexican flu".
Media Monitor, an independent agency sponsored by the Thai Health Promotion Foundation, revealed the study at a seminar on news reporting and the H1N1 flu pandemic at Suan Dusit Rajabhat University, organised by the Thai Journalists Association and the Thai Broadcasting Journalists Association.
The study also looked at evening news programmes on the six free TV channels between July 28 and Aug 17.
The study said news information presented was incomplete. The presentation of news issues involving the causes of deaths related to the virus was unclear and tended to cause confusion.
The study found issues and news content presented by the six channels was similar with an emphasis on the pandemic situation, the preventive measures to control the spread of the virus, the dispensing of anti-viral medicines and the impact the flu pandemic had on the economy and tourism and the closure of tutorial and cram schools.
The study said that overall, reports by the six channels focused on the number of deaths caused by the flu or those suspected of dying from the flu. If it was later proved that any deaths were not linked to the flu, those channels only came up with brief reports on the issue,the study said.
The study also said the language used in news headlines of newspapers was strong and tended to provoke excitement and panic.
The study looked at news content presented by eight newspapers during the first three weeks of the flu pandemic situation from April 28 to May 18.
It also said many terms coined and used by newspapers to describe the virus could be misleading such as "swine flu"or "Mexican flu".
Friday, September 4, 2009
CHINA APPROVES ONE-DOSE LOCALLY MADE H1N1 VACCINE
Twice as many people can now be vaccinated, says WHO
China yesterday granted approval to its first homegrown producer Sinovac says is effective after only one does, as the country braces for feared winter outbreak.
The decision could boost the global fight against type-A (H1N1) influenza, as most experts had assumed that two doses of vaccine per person would be needed to provide adequate protection.
"The completion of trails for Sinovac's vaccine has shown this vaccine to be very safe," the regulatory agency said in a written statement announcing the decision.
Hans Troedsson, the outgoing WHO representative in China, said ahead of the decision that a one-dose vaccine would be "very important as it means we can vaccinate twice as many people".
Zhang said the SFDA was looking at applications from nine other Chinese companies who are developing vaccines against the virus, with decisions expected by mid-September.
The approval of the Sinovac vaccine came just days after China's health ministry warned of the growing risk of a mass outbreak as hundreds of millions of students went back to school this week with the winter flu season looming.
"With autumn and winter approaching, the risk of a large-scale outbreak is increasing ... and the possibility of the first death is gradually rising," the ministry said earlier.
The ministry said China had confirmed 3,981 cases of swine flu as of Wednesday, but no deaths had been reported.
The World Health Organisation (WHO) says at least 2,185 people have died worldwide after contracting swine flu, now the most prevalent strain of influenza. It has been detected in nearly every country in the world.
The UN health body has warned of a possible vaccine shortage as winter, and the regular flu season, approaches in the northern hemisphere. "We know that supplies will be extremely limited for some months to come," WHO chief Margaret Chan said last month.
Countries in the northern hemisphere have so far ordered more than one billion doses of swine-flu vaccine, according to the WHO.
More than two dozen pharm aceutical companies around the world are racing to test, produce and ship vaccines before the global pandemic enters an expected second wave.
Five of those firms are expected to account for more than 80 per cent of production: Sanofi-Pasteurin France, AstraZeneca and GlaxoSmithKline (GSK) in Britain, Baxter in the United States, and the Swiss group Novartis.
But Sinovac announced after clinical trials in mid-August that its one-dose formula had proven effective, a major advantage as the vaccine would be easier to administer and available to more people.
"We have not found any negative side-effects ... it is safe and reliable," Sinovac president Yin Weidong said in a recent interview at the company's Beijing headquarters.
Swiss pharmaceutical giant Novartis said yesterday that its clinical trial of its vaccine had shown "encouraging" results and suggested that one dose could suffice.
Andrin Oswald, chief executive of Novartis Vaccines and Diagnostics, added that "while two doses seem to provide better protection, one dose of Novartis's Celtura vaccine may be sufficient to protect adults".
The Chinese government plans to vaccinate 65 million people before year end.
Britain and France received their first batches of swine flu vaccine in late August.
China yesterday granted approval to its first homegrown producer Sinovac says is effective after only one does, as the country braces for feared winter outbreak.
The decision could boost the global fight against type-A (H1N1) influenza, as most experts had assumed that two doses of vaccine per person would be needed to provide adequate protection.
"The completion of trails for Sinovac's vaccine has shown this vaccine to be very safe," the regulatory agency said in a written statement announcing the decision.
Hans Troedsson, the outgoing WHO representative in China, said ahead of the decision that a one-dose vaccine would be "very important as it means we can vaccinate twice as many people".
Zhang said the SFDA was looking at applications from nine other Chinese companies who are developing vaccines against the virus, with decisions expected by mid-September.
The approval of the Sinovac vaccine came just days after China's health ministry warned of the growing risk of a mass outbreak as hundreds of millions of students went back to school this week with the winter flu season looming.
"With autumn and winter approaching, the risk of a large-scale outbreak is increasing ... and the possibility of the first death is gradually rising," the ministry said earlier.
The ministry said China had confirmed 3,981 cases of swine flu as of Wednesday, but no deaths had been reported.
The World Health Organisation (WHO) says at least 2,185 people have died worldwide after contracting swine flu, now the most prevalent strain of influenza. It has been detected in nearly every country in the world.
The UN health body has warned of a possible vaccine shortage as winter, and the regular flu season, approaches in the northern hemisphere. "We know that supplies will be extremely limited for some months to come," WHO chief Margaret Chan said last month.
Countries in the northern hemisphere have so far ordered more than one billion doses of swine-flu vaccine, according to the WHO.
More than two dozen pharm aceutical companies around the world are racing to test, produce and ship vaccines before the global pandemic enters an expected second wave.
Five of those firms are expected to account for more than 80 per cent of production: Sanofi-Pasteurin France, AstraZeneca and GlaxoSmithKline (GSK) in Britain, Baxter in the United States, and the Swiss group Novartis.
But Sinovac announced after clinical trials in mid-August that its one-dose formula had proven effective, a major advantage as the vaccine would be easier to administer and available to more people.
"We have not found any negative side-effects ... it is safe and reliable," Sinovac president Yin Weidong said in a recent interview at the company's Beijing headquarters.
Swiss pharmaceutical giant Novartis said yesterday that its clinical trial of its vaccine had shown "encouraging" results and suggested that one dose could suffice.
Andrin Oswald, chief executive of Novartis Vaccines and Diagnostics, added that "while two doses seem to provide better protection, one dose of Novartis's Celtura vaccine may be sufficient to protect adults".
The Chinese government plans to vaccinate 65 million people before year end.
Britain and France received their first batches of swine flu vaccine in late August.
NEW FLU STRATEGY TO SURVEY CROWDS, WATCH FOR MUTATION
The governmetn has announced measures to fight the type-A(H1N1) influenza pandemic, focusing on public surveillance and an investigation on whether the virus could mutate, the Public Health Ministry said yesterday.
The ministry is discussing a control and prevention strategy with a national subcommittee,as the number of flu-infected people increases, particularly in upcountry provinces.
The subcommittee says 80 per cent of the population does not have immunity against type-A(H1N1) flu. It will closely monitor infection rates among students, people who work at entertainment venues, prisons, dormitories, factories and military camps.
In upcountry provinces, the sub-committee will use local administrative organisations ot survey and prevent infection, as they can access treatment faster.
The subcommittee will look for any mutation and cross-breeding of the new influenza virus in pigs and humans,.and for drug-resistant virus strains that could increase the severity of the pandemic.
The Ministry of Public Health, Ministry of Agriculture and Cooperatives, Ministry of Skcience and Technology and the Educational Institute will oversee these measures.
The subcommittee will format measures to boost the tourism industry. to create confidence and reduce tourist panic over the pandemic.
Finally,it will control infections in crowded areas by uring people to use hand wash gel and wear face masks.
Paijit has warned farmers who develop flu-lide symptoms to stay clear of pigs and poultry,to prevent the cross-breeding of a new strain of the type-A(H1N1) virus.
"I believe if we follow these measures we can handle the second pandemic wave, due in the next tow months," he siad.
The ministry is discussing a control and prevention strategy with a national subcommittee,as the number of flu-infected people increases, particularly in upcountry provinces.
The subcommittee says 80 per cent of the population does not have immunity against type-A(H1N1) flu. It will closely monitor infection rates among students, people who work at entertainment venues, prisons, dormitories, factories and military camps.
In upcountry provinces, the sub-committee will use local administrative organisations ot survey and prevent infection, as they can access treatment faster.
The subcommittee will look for any mutation and cross-breeding of the new influenza virus in pigs and humans,.and for drug-resistant virus strains that could increase the severity of the pandemic.
The Ministry of Public Health, Ministry of Agriculture and Cooperatives, Ministry of Skcience and Technology and the Educational Institute will oversee these measures.
The subcommittee will format measures to boost the tourism industry. to create confidence and reduce tourist panic over the pandemic.
Finally,it will control infections in crowded areas by uring people to use hand wash gel and wear face masks.
Paijit has warned farmers who develop flu-lide symptoms to stay clear of pigs and poultry,to prevent the cross-breeding of a new strain of the type-A(H1N1) virus.
"I believe if we follow these measures we can handle the second pandemic wave, due in the next tow months," he siad.
Tuesday, September 1, 2009
Mystery dysentry leaves 47 PNG dead
Twin outbreaks of a mystery flu and dysentery in a remote region of Papua New Guinea have killed 47 people and infected another 2,000 villagers, a health official said yesterday.
And a separate eruption of cholera in the Pacific island has killed seven adults and sickened 73 other people, provincial health adviser Theo Likei said.
Twenty-seven villagers in the Menyamya district of Morobe province, on the northeast coast, have died from an asyet unidentified influenza since Aug 3,while a further 20 died from dysentery.
It was not immediately known whether the flu-like illness was H1N1 flu or another strain. The World Health Organisation (WHO) has taken samples from stricken villages and test results could be available within days.
"We cannot rule out swine [H1N1]flu at the moment but the outbreak is in a remote area, which would be a little surprising if it is H1N1", said WHO representative Eigil Sorensen.
"But the number of sick and fatalities are certainly higher than normal so we take both of these outbreaks seriously."
Papua New Guinea has reported around 10 cases of H1N1 flu but they were traced back and appeared to have been imported into the country.
Local health officials warned the dual outbreak of illness was proving difficult to control as the eruption was in an isolated area eight hours' rough drive from the island's second city of Lae.
"The problem is that once it gets started in remote areas it's very hard to stop and the area is hard to reach, but we are hoping the illness will remain isolated to pockets of the area so we can manage it," Mr Likei said."This is the worst such crisis we have seen here.
"The situation is not that encouraging as of today but we will monitor closely over the next two days or so and hope it comes under control."
A cholera outbreak in the east of the rugged and often inaccessible province is complicating the medical relief effort.
"We are very concerned and hope cholera hasn't established itself as it would be another great burden to an already strained health system," Health Minister Sasa Zibe said.
And a separate eruption of cholera in the Pacific island has killed seven adults and sickened 73 other people, provincial health adviser Theo Likei said.
Twenty-seven villagers in the Menyamya district of Morobe province, on the northeast coast, have died from an asyet unidentified influenza since Aug 3,while a further 20 died from dysentery.
It was not immediately known whether the flu-like illness was H1N1 flu or another strain. The World Health Organisation (WHO) has taken samples from stricken villages and test results could be available within days.
"We cannot rule out swine [H1N1]flu at the moment but the outbreak is in a remote area, which would be a little surprising if it is H1N1", said WHO representative Eigil Sorensen.
"But the number of sick and fatalities are certainly higher than normal so we take both of these outbreaks seriously."
Papua New Guinea has reported around 10 cases of H1N1 flu but they were traced back and appeared to have been imported into the country.
Local health officials warned the dual outbreak of illness was proving difficult to control as the eruption was in an isolated area eight hours' rough drive from the island's second city of Lae.
"The problem is that once it gets started in remote areas it's very hard to stop and the area is hard to reach, but we are hoping the illness will remain isolated to pockets of the area so we can manage it," Mr Likei said."This is the worst such crisis we have seen here.
"The situation is not that encouraging as of today but we will monitor closely over the next two days or so and hope it comes under control."
A cholera outbreak in the east of the rugged and often inaccessible province is complicating the medical relief effort.
"We are very concerned and hope cholera hasn't established itself as it would be another great burden to an already strained health system," Health Minister Sasa Zibe said.
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