Global & Disaster Medicine

Archive for the ‘Pandemic’ Category

Trump & Deadly Disease

NY Times

  • “…..President Trump’s budget would cut funding for the National Institutes of Health by 18 percent.
  • It would cut the State Department and the United States Agency for International Development, a key vehicle for preventing and responding to outbreaks before they reach our shores, by 28 percent.
  • And the repeal of the Affordable Care Act would kill the billion-dollar Prevention and Public Health Fund, which provides funding for the Centers for Disease Control and Prevention to fight outbreaks of infectious disease.
  • (While the budget also calls for the creation of an emergency fund to respond to outbreaks, there is no indication that it would offset the other cuts, or where the money would come from.)
  • We are already witnessing an outbreak of influenza in birds — the H7N9 strain, in China — that could be the source for the next human pandemic. Since October, over 500 people have been infected; more than 34 percent have died. Most victims had contact with infected poultry, yet three recent clusters appear to be from person-to-person transmission. Will H7N9 mutate to become easily transmitted between humans? We don’t know. But without sufficient supplies of a vaccine, we are not prepared to stop it…….”

Two US senators and three members of Congress penned a letter this week to Tom Price, the secretary of Health and Human Services (HHS), voicing their concern over President Trump’s proposed cuts to government agencies whose work enables pandemic preparedness.

Letter to Tom Price

Inauguration Day Crowds in Washington, D.C.




US officials charged with preparing the country for influenza pandemics conclude that the stored H7N9 vaccine doesn’t adequately protect against a new branch of this virus family, and a new vaccine is needed.


“…the Biomedical Advanced Research and Development Authority, or BARDA, said the H7N9 vaccine in the [US Strategic National Stockpile (SNS)] would not fend off a new family of these viruses that has emerged in China, known as the eastern or Yangtze River Delta lineage of the viruses….”

  • The H7N9 virus is evolving and has essentially split into two groups that are now different enough that vaccine for one might not protect very well against viruses from the other.
  • The US stockpile currently contains enough vaccines to inoculate about 12 million people against the older lineage of H7N9, the southern or Pearl River Delta viruses.
  • The vaccines in the pandemic flu stockpile are intended to protect first responders in the case one of the highest-risk bird flu viruses triggers a pandemic. BARDA’s policy is to maintain enough vaccine for each of these top threats to be able to vaccinate 20 million people. As each person would need both a primer and a booster dose, that means 40 million doses of vaccine for each viral threat.


Markers of Disease Severity in Patients with Spanish Influenza in the Japanese Armed Forces, 1919–1920

EID Journal

Kudo K, Manabe T, Izumi S, Takasaki J, Fujikura Y, Kawana A, et al. Markers of disease severity in patients with Spanish influenza in the Japanese Armed Forces, 1919–1920. Emerg Infect Dis. 2017 Apr [date cited].

“…..The first and second waves of the Spanish influenza pandemic in Japan affected ≈21 million persons (257,000 deaths) and 2 million persons (127,000 deaths), respectively. ……….

The Study

We analyzed medical charts preserved at the former First Army Hospital in Tokyo, Japan, and other affiliated hospitals. We previously described the clinical features of Spanish influenza among patients who were hospitalized at several study sites (2). Recently, additional records of patients affected by the second wave of disease during 1919–1920 were discovered, and these patients were the subjects of this study.

A total of 470 patients hospitalized during January 1919–January 1920 and diagnosed with Spanish influenza (as “epidemic cold” or “pneumonia due to epidemic cold”) fit the criteria for inclusion in the study. All patients were male soldiers or officers in the military of Japan. We collected data concerning patients’ general background and physical assessments, including lung sounds and fever charts. Among all patients, 8 (2%) died. We divided the patients who survived (n = 462, 98%) into 3 groups on the basis of hospitalization length: <10 days (28%), 11–20 days (34%), and >21 days (36%); we compared variables among the 3 groups. High fever was defined as a body temperature >38°C, and diphasic fever was defined as a body temperature >38°C after the initial fever had decreased to <37.5°C. Data on adventitious lung sounds collected during the hospitalization period were classified (on the basis of international classifications) as continuous, discontinuous, bronchial on the chest wall, and friction rub sounds (3). The study was approved by the Institutional Review Board of the National Center for Global Health and Medicine, Tokyo, Japan.

Of the 8 patients who died, 6 died within 10 days of hospital admission. Median length of hospitalization was 7 days for nonsurvivors and 16 days for survivors. The proportion of patients with audible adventitious lung sounds was significantly higher among those hospitalized for >21 days and among those who did not survive (Table 1( Factors associated with the length of hospitalization in survivors (identified by using a Cox hazard proportional model) included diphasic fever, >6 days of continuing high fever from admission, a maximum respiration rate >26 breaths/min, and adventitious discontinuous lung sounds (Table 2(……”

A new study indicates that the antiviral drug oseltamivir can reduce influenza infections and prevent deaths in a cost-saving manner under most pandemic scenarios.

British Journal of Clinical Pharmacology


Oseltamivir 75 mg relative to no treatment reduced the median number of infected patients, increased ΔQALY by deaths averted, and was cost-saving under all scenarios; 150 mg relative to 75 mg was not cost effective in low transmissibility scenarios but was cost saving in high transmissibility scenarios……”



Coalition for Epidemic Preparedness Innovations raises $500 million

NY Times

“Stung by the lack of vaccines to fight the West African Ebola epidemic, a group of prominent donors announced Wednesday that they had raised almost $500 million for a new partnership to stop epidemics before they spiral out of control.

The partnership, the Coalition for Epidemic Preparedness Innovations, will initially develop and stockpile vaccines against three known viral threats, and also push the development of technology to brew large amounts of vaccine quickly when new threats…arise……Bill Gates, founder of the Bill and Melinda Gates Foundation, one of the largest initial donors…has often predicted that the catastrophe most likely to kill 10 million people in the near future is a pandemic rather than nuclear war, terrorism, famine or natural disaster.

The other donors….include the governments of Japan and Norway, and Britain’s Wellcome Trust. Each is putting up $100 million to $125 million over five years; Germany, India and the European Commission are expected to announce donations soon.

Six major vaccine makers — GlaxoSmithKline, Johnson & Johnson, Merck, Pfizer, Sanofi and Takeda — joined in the coalition as “partners” rather than donors, as did the World Health Organization and Doctors Without Borders……”


GlaxoSmithKline Plc, Johnson & Johnson and Sanofi are among drugmakers backing an effort to develop new vaccines that could be deployed swiftly to contain outbreaks before they spark global emergencies.


Question to out-going CDC chief: “What scares you the most? What keeps you awake at night?”

Washington Post

His answer:

Frieden: The biggest concern is always for an influenza pandemic. Even in a moderate flu year, [influenza] kills tens of thousands of Americans and sends hundreds of thousands to the hospital. That increase in mortality last year may have been driven in significant part by a worse flu season compared to a mild flu season the prior year. So flu, even in an average year, really causes a huge problem. And a pandemic really is the worst-case scenario. If you have something that spreads to a third of the population and can kill a significant proportion of those it affects, you have the makings of a major disaster.


SOFA Score: What it is and How to Use it in Triage


“….Though SOFA was developed for sepsis research and has been validated in additional settings, there is concern that it does not accurately predict mortality when used for patients with isolated respiratory failure as demonstrated during the 2009 H1N1 pandemic. …”

** Commission on a Global Health Risk Framework for the Future (GHRF): Final Report

Neglected Dimension of Global Security

Press Release: “…Infectious disease outbreaks that turn into epidemics or pandemics can kill millions of people and cause trillions of dollars of damage to economic activity, says a new report from the international, independent Commission on a Global Health Risk Framework for the Future. Few other risks pose such a threat to human lives, and few other events can damage the economy so much. The Commission estimated the global expected economic loss from potential pandemics could average more than $60 billion per year. Yet, nations devote a fraction of the resources to preparing, preventing, or responding infectious disease crises as they do to strengthening national security or avoiding financial crises.

The Commission recommended an investment of approximately $4.5 billion per year – which equates to 65 cents per person – to enhance prevention, detection, and preparedness.

**  The biggest component of this investment is to upgrade public health infrastructure and capabilities for low- and middle-income-countries, which is estimated to cost up to $3.4 billion per year.

**  The second biggest component of the $4.5 billion figure is $1 billion per year to fund accelerated research and development in a wide range of medical products.

**  The balance relates to financing the strengthening of the World Health Organization’s (WHO) capabilities and funding WHO and World Bank contingency funds….”



“…Larry Summers, an economist who was US treasury secretary in the Clinton administration, introduced the report today at the New York City briefing and lauded its focus in a blog post today. He put the threat of pandemics over the next century on par with that from global climate change.

Summers said he and his colleagues have calculated what the cost would be for a repeat of the 1918 pandemic, which they will publish soon. They project that global cost for such an event would approach $1 trillion a year…..”



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