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The following is from the Article entitled "When the Sniffles Start, Think Before You Buy",  Lesley Alderman, The New York Times, Saturday, January 2, 2010, under "Personal Business", "Patient Money", page B4, also published on-line as follows:

THERE is still no cure for the common cold, but that hasn’t stopped consumers from spending billions of dollars every year on vitamins, medicines and doctor visits. (I admit I do, too, from time to time.)

“There’s a bit of magical thinking at work here,” said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. “In the 21st century, the idea is that we ought to be able to do something about colds and flus.”

So people will pop pills even when there is little or no proof they work. Americans spent about $3.6 billion on over-the-counter cold, cough and throat remedies in 2009, according to projections from Mintel International, a market research firm, about 1.7 percent more than in 2008. In addition, cold and flu sufferers will spend millions of dollars on prescription antibiotics that have no effect on viral infections.

If you’re suffering but also trying to be a smart spender, read on for advice. Some of the best treatments, it turns out, will not cost you much at all.

But before I tell you what not to do, let me remind you of what you should do to build up your immunity so you can avoid getting sick in the first place. For starters, get vaccinated for both H1N1 and the seasonal flu. You can get the H1N1 shot at retail clinics in chains like Safeway and CVS for $10 to $20; the seasonal vaccine is in shorter supply, so call your doctor’s office and ask if any is available.

Also, make sure you get enough rest, stay well hydrated and exercise moderately, all of which can help strengthen your system, said Dr. Schaffner, who is also an infectious disease specialist. Finally, wash your hands frequently and thoroughly.

Now on to a discussion of what you may want to avoid or use in moderation to treat your symptoms.

DOCTOR VISITS Most healthy people do not need to see a doctor for a cold or flu. But if you have a fever for more than three days, a cough that produces sputum, chest pain or difficulty breathing, call your doctor. These may be signs that an infection is developing complications, and your simple cold could turn into something more serious like pneumonia. If you’re not sure whether you need to see a doctor, call and ask to speak to an advice nurse or physician assistant, Dr. Lisa Bernstein, an associate professor in the Department of Medicine at Emory University, suggested. “A nurse can listen to your symptoms and figure out what care you need.”

If you have an underlying condition like lung or heart disease, you are older than 65 or you are pregnant, call your doctor immediately if you have any of these flu symptoms — fever, headache, body aches or a cough. Your doctor may want to prescribe an antiviral medication like Tamiflu or Relenza, which can reduce the duration and severity of flu.

ANTIBIOTICS You probably don’t need them. “Antibiotics have exactly no effect on the common cold,” Dr. Schaffner said. “That’s because viruses, which cause colds and flus, are uninfluenced by antibiotics.” Antibiotics attack only bacteria, and bacteria are rarely involved with respiratory infections.

Not only will the antibiotic be a waste of money, but it may also cause unpleasant side effects like diarrhea, a rash and possibly a yeast infection in women. Even more problematic, overuse of antibiotics leads to drug-resistant superbugs, which are difficult to cure.

Contrary to popular belief, when your nasal discharge is green, it is not a sign that you have a bacterial infection that requires antibiotics. The color of your nasal secretions says nothing about the cause of your malady, Dr. Schaffner said.

If your cold or flu leads to a secondary bacterial infection, a course of antibiotics may then be necessary. Signs that you have such an infection include tenderness around your sinuses, reappearance of symptoms after your cold seemed to be abating and chest pain, said Dr. Shmuel Shoham, an infectious disease specialist at the Washington Hospital Center in the District of Columbia.

COUGH MEDICINES A 2008 review looked at 25 medical studies of over-the-counter cough medications and concluded that there was “no good evidence for or against the effectiveness of O.T.C. medicines in acute cough.” Dr. Shoham partly agreed. “While cough medicines may not work in the majority of the population, they may work in some people,” he said. For that reason, Dr. Shoham does not discourage patients from trying cough medicines if their cough is annoying them or keeping them up at night.

VITAMIN C, ECHINACEA AND ZINC Some studies show a slight benefit from these supplements. But the research is a bit thin, and doctors remain skeptical. “The beneficial effect on the common cold is minor at best for these supplements,” Dr. Shoham said. So, he added, they “are probably not worth your money.”

Taking large doses of vitamin C daily, year round, may reduce the duration of a cold, but it will not keep you from getting one. One well-respected study of echinacea, published in The New England Journal of Medicine, found that the supplement had no effect on the rhinovirus, one of the viruses that cause the common cold. Avoid nasal applications that contain zinc, which may affect your sense of smell.

AIRBORNE Many consumers swear by this remedy, which is a cocktail of 17 vitamins, minerals and herbs — including vitamin C, echinacea and zinc. When the product was introduced, the label claimed that Airborne could fight the common cold. The Federal Trade Commission sued its maker on the grounds of false advertising, and in August 2008, the commission announced that the company had agreed to pay up to $30 million to settle charges that it did not have adequate evidence to support its advertising claims.

The company that makes Airborne changed the wording on the label to read, “helps support your immune system.” Researchers are not persuaded that Airborne does even that.

“The company has not done a proper study to prove the benefits it claims,” David Schardt, a senior nutritionist at the Center for Science in the Public Interest, said. “They certainly could afford the research — the company has made millions of dollars on this remedy.” Dr. Schaffner agreed. “There simply is no good evidence that Airborne boosts your immune system,” he said.

Airborne’s maker said it had no comment.

MULTISYMPTOM MEDICINES Cold medicines with multiple active ingredients like acetaminophen, a decongestant and an antihistamine have not been well studied. The reviews that have been done show they are no better than placebos in shortening the duration of colds, said Dr. Michael Brady, an infectious disease specialist and chairman of the Department of Pediatrics at Nationwide Children’s Hospital in Columbus, Ohio.

These medicines may help with some of your symptoms, but be sure to read the labels carefully. There is a risk when taking these medicines that you may end up taking more active ingredients than you really need.

This is particularly important in young children. The American Academy of Pediatrics strongly recommends that over-the-counter cough and cold medications not be given to infants and children younger than 2 because of the risk of life-threatening side effects.

HOMEOPATHIC REMEDIES A review published in The American Journal of Medicine in 2007 looked at the effectiveness of several alternative therapies, including the popular homeopathic pill Oscillococcinum for treating flu. The researchers concluded that there was simply not enough evidence to say whether any of the therapies studied actually worked.

So, what does work? While few, if any, medicines can shorten the duration of a cold, some can help reduce the onerous symptoms of upper respiratory infections. Nasal sprays shrink swollen blood vessels and relieve stuffy noses, though the relief is temporary and you should not use spray for more than three days.

Acetaminophen and ibuprofen can reduce fevers and body aches. Rinsing your nasal passages with a saline solution or breathing steam can help loosen mucous and increase nasal secretions, which can help to prevent a secondary sinus infection. Humidifiers and hot showers also help. Drinking warm liquids like tea has been shown to reduce a variety of cold and flu symptoms.

And don’t forget chicken soup. The age-old remedy, as you’ve no doubt heard, actually does help to reduce the symptoms of the common cold.

The following quotes are from a letter entitled “Swine influenza”, by Dr. Margaret Chan, Director, the World Health Organization, April 29, 2009, an entire copy of which may be found at the following link:

Swine influenza

Ladies and gentlemen,

Based on assessment of all available information, and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.

Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.

On the positive side, the world is better prepared for an influenza pandemic than at any time in history.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefitting from this investment.

For the first time in history, we can track the evolution of a pandemic in real-time.

I thank countries who are making the results of their investigations publicly available. This helps us understand the disease.

I am impressed by the work being done by affected countries as they deal with the current outbreaks.

I also want to thank the governments of the USA and Canada for their support to WHO, and to Mexico.

Let me remind you. New diseases are, by definition, poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behaviour.

WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels.

The results of these ongoing assessments will be issued as public health advice, and made publicly available.

All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.

I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production.

I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine.

The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this question.

From past experience, we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.

No matter what the situation is, the international community should treat this as a window of opportunity to ramp up preparedness and response.

Above all, this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic.

As I have said, we do not have all the answers right now, but we will get them.

Thank you.

Different Phases were mentioned in the letter entitled “Swine influenza”, by Dr. Margaret Chan, Director, the World Health Organization, April 29, 2009,  which appears below this entry.   The World Health Organization provides a definition of those Phases.  The following are quotes from the article entitled “Current Phase of Alert in the WHO Global Influenza Preparedness Plan”, under the subtitle of “Pandemic preparedness”, which appeared on April 30, 2009, at the following link:

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.

The current WHO phase of pandemic alert is 5.

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

The following quotes are from the CDC Centers for Disease Control and Prevention under the topic of “Swine Flu” that was posted on April 25, 2009 at the following link:

Human Swine Influenza Investigation

April 25, 2009 19:30 EDT

Human cases of swine influenza A (H1N1) virus infection have been identified in the U.S. in San Diego County and Imperial County, California as well as in San Antonio, Texas. Internationally, human cases of swine influenza A (H1N1) virus infection have been identified in Mexico.

Investigations are ongoing to determine the source of the infection and whether additional people have been infected with similar swine influenza viruses.

CDC is working very closely with state and local officials in California, Texas, as well as with health officials in Mexico, Canada and the World Health Organization. On April 24th, CDC deployed 7 epidemiologists to San Diego County, California and Imperial County, California and 1 senior medical officer to Texas to provide guidance and technical support for the ongoing epidemiologic field investigations. CDC has also deployed to Mexico 1 medical officer and 1 senior expert who are part of a global team that is responding to the outbreak of respiratory illnesses in Mexico.

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. There are many things you can to do preventing getting and spreading influenza:

There are everyday actions people can take to stay healthy.

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

  • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
  • If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Residents of California and Texas

CDC has identified human cases of swine influenza A (H1N1) virus infection in people in these areas. CDC is working with local and state health agencies to investigate these cases. We have determined that this virus is contagious and is spreading from human to human. However, at this time, we have not determined how easily the virus spreads between people. As with any infectious disease, we are recommending precautionary measures for people residing in these areas.

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
  • Try to avoid close contact with sick people.
  • If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.

There is no vaccine available at this time, so it is important for people living in these areas to take steps to prevent spreading the virus to others. If people are ill, they should attempt to stay at home and limit contact with others. Healthy residents living in these areas should takeeveryday preventive actions.

People who live in these areas who develop an illness with fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea, should contact their health care provider. Their health care provider will determine whether influenza testing is needed.


Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who:

  1. Live in San Diego County or Imperial County, California or San Antonio, Texas or
  2. Have traveled to San Diego and/or Imperial County, California or San Antonio, Texas or
  3. Have been in contact with ill persons from these areas in the 7 days prior to their illness onset.

If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.

State Public Health Laboratories

Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.

Public Health /Animal Health Officials

Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.

Guidance Documents

Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home
Apr 25, 2009

Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close ContactsApr 25, 2009

Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been DetectedApr 26, 2009

Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory WorkersApr 24, 2009
This guidance is for laboratory workers who may be processing or performing diagnostic testing on clinical specimens from patients with suspected swine influenza A (H1N1) virus infection, or performing viral isolation.

Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare SettingApr 24, 2009

Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A (H1N1) CasesApr 26, 2009
This document provides interim guidance for state and local health departments conducting investigations of human cases of swine influenza A (H1N1) virus.  The following case definitions are for the purpose of investigations of suspected, probable, and confirmed cases of swine influenza A (H1N1) virus infection.

Travel Notices

Outbreak Notice: Swine Influenza in the United States
April 25, 2009 12 p.m. EDT

Travel Health Precaution: Swine Influenza and Severe Cases of Respiratory Illness in Mexico
April 25, 2009 12 p.m. EDT

Press Briefing Transcripts

Media Availability on CDC Investigation of Human Cases of Swine Influenza
April 25, 2009, 1 p.m. EDT

Unedited Transcript of CDC Briefing on Public Health Investigation of Human Cases of Swine Influenza
April 24, 2009 2:30 p.m. EDT

CDC Briefing on Public Health Investigation of Human Cases of Swine Influenza
April 23, 2009 press briefing…

Reports & Publications

CDC Health AdvisoryApril 25, 2009, 3:00 EDT
Investigation and Interim Recommendations: Swine Influenza (H1N1)
Distributed via Health Alert Network

Update: Swine Influenza A (H1N1) Infections—California and Texas, April 2009
Morbidity and Mortality Weekly Report (MMWR) April 24, 2009 / Vol. 58 / Dispatch;1-3

Swine Influenza A (H1N1) Infection in Two Children—Southern California, March-April 2009
Morbidity and Mortality Weekly Report (MMWR) April 21, 2009 / Vol. 58 / Dispatch

Related Links External Web Site Policy.

WHO - Influenza-Like Illness in the United States and Mexico External Web Site Policy.

Past Updates


The following quotes are from the article entitled “Fighting Deadly Flu Outbreak, Mexico Shuts Schools for Millions”, by Marc Lacey and Donald G. McNeill, Jr., The New York Times, April 25, 2009, page A4.

    Mexican officials, scrambling to control aswine fluoutbreak that has killed as many as 61 people and infected possibly hundreds more in recent weeks, closed museums and shuttered schools for millions of students in and around the capital on Friday, and urged people with flu symptoms to stay home from work.

    We're dealing with a new flu virus that constitutes a respiratory epidemic that so far is controllable,”Mexico's health minister, Jose Angel Cordova, told reporters after huddling with PresidentFelipe Calderonand other top officials on Thursday night to come up with an action plan. He said the virus had mutated from pigs and had at some point been transmitted to humans.
    The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said theCenters for Disease Control and Prevention.A similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.
    Most of Mexico's dead were young, healthy adults, and none were over 60 or under 3 years old, theWorld Health Organizationsaid. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest.
    Mexican officials promised a huge immunization campaign in the capital in the coming days, while urging people to avoid large gatherings and to refrain from shaking hands or greeting women with a kiss on the right cheek, as is common in Mexico.
    Mexico City closed museums and other cultural venues, and advised people not to attend movies or public events. Seven million students, from kindergartners to college students, were kept from classes in Mexico City and the neighboring State of Mexico on Friday, in what news organizations called the first citywide closing of schools since a powerful earthquake in 1985.
    Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to Gregory Hartl, a W.H.O. spokesman. Mexican authorities confirmed 16 deaths from swine flu and said 45 others were under investigation, most of them in the Mexico City area. The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.
    “We are worried,” said Dr. Richard Besser, the acting head of the C.D.C. “We don't know if this will lead to the next pandemic, but we will be monitoring it and taking it seriously.”
    Health officials urged anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain to seek medical attention.
    When a new virus emerges, it can sweep through the population, said Dr. Anne Moscona, a flu specialist atCornell University's medical school. The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.
    The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs, Dr. Moscona said.
    But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.
    Despite the alarm in recent years over the H5N1 avian flu, which is still circulating in China, Indonesia, Egypt and elsewhere, some flu experts argued that it would never cause a pandemic, because no H5 strain ever had. All previous pandemics have been caused by H1s, H2s or H3s.
    Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.
    In Canada, hit by the SARS epidemic in 2003, health officials urged those who had recently traveled to Mexico and become ill to seek treatment immediately.


The following quotes are related to the article entitled “Deadly swine-flu strain is in U.S.”, by Mark Stevenson, of the Associated Press, printed in The Seattle Times, April 25, 2009, front page and page A6, that are actually quoted from a version of this article that appears at the following link:

A unique strain of swine flu is the suspected killer of dozens of people in Mexico, where authorities closed schools, museums, libraries and theaters in the capital on Friday to try to contain an outbreak that has spurred concerns of a global flu epidemic.

The worrisome new virus - which combines genetic material from pigs, birds and humans in a way researchers have not seen before - also sickened at least eight people in Texas and California, though there have been no deaths in the U.S.

"e;We are very, very concerned,"e; World Health Organization spokesman Thomas Abraham said. "e;We have what appears to be a novel virus and it has spread from human to human ... It's all hands on deck at the moment."e;

It might already be too late to contain the outbreak, a prominent U.S. pandemic flu expert said late Friday.

Given how quickly flu can spread around the globe, if these are the first signs of a pandemic, then there are probably cases incubating around the world already, said Dr. Michael Osterholm at the University of Minnesota.

Authorities in Mexico urged people to avoid hospitals unless they had a medical emergency, since hospitals are centers of infection. They also said Mexicans should refrain from customary greetings such as shaking hands or kissing cheeks. At Mexico City's international airport, passengers were questioned to try to prevent anyone with flu symptoms from boarding airplanes and spreading the disease.

Epidemiologists are particularly concerned because the only fatalities so far were in young people and adults.

The eight U.S. victims recovered from symptoms that were like those of the regular flu, mostly fever, cough and sore throat, though some also experienced vomiting and diarrhea.

U.S. health officials announced an outbreak notice to travelers, urging caution and frequent handwashing, but stopping short of telling Americans to avoid Mexico.



The following are selected excerpts from the article entitled “Number of flu cases increase after slow start to influenza season”, The Seattle Times, March 18, 2009,and a link was provided to this article by Google Flu Trends at say they're seeing an increase in the number of flu cases in Oklahoma after a slow start to the influenza season.  "e;We typically tend to peak in late January or early February,"e; said Laurence Burnsed, chief of the state Health Department's Communicable Disease Division. "e;We've seen a lighter season overall. It's certainly less intense than we've seen the last couple of seasons. Just more than a month ago, physicians at St. John Urgent Care centers saw few cases of influenza or influenza like illnesses, said Dr. Jason Lepak, co-medical director of St. John's urgent care facilities. "e;Clearly, in the last two to three weeks, we've seen a significant explosion of cases throughout the Tulsa area and surrounding counties,"e; he said.  "e;Unfortunately, some of our rapid tests used to detect influenza only detects the A and B strains,"e; he said. "e;The reality is, if you test negative on the flu test, you could have C, D or other serotypes."e;  Some other common "e;mimickers"e; of the influenza virus are the common cold, rhinovirus and parainfluenza, Lepak said.  "e;It's a concerning trend that the influenza virus can adapt so rapidly,"e; Lepak said. "e;We will have to wait and see what happens next year."e;  He said he expects the flu season to continue for about another month.  According to the U.S. Centers for Disease Control and Prevention, 35 states reported widespread flu activity for the week that ended March 7.




The following are selected excerpts from the article entitled “This winter's flu season mildest in years”, by Rong-Gong Lin II, The Los Angeles Times, March 13, 2009, and a link was provided to this article by Google Flu Trends at The flu season in California this winter is turning out to be one of the mildest in recent years. The number of severe influenza cases resulting in deaths in children is also down. There have been three pediatric influenza-associated deaths so far this winter, with deaths reported in Riverside, Fresno and Alameda counties; in the same time period last winter there were five pediatric influenza-associated deaths. In Los Angeles County, data released this week showed the number of positive influenza tests declined last week compared to the previous week. At Ronald Reagan UCLA Medical Center in Westwood, doctors there have seen “dramatically less influenza than normal,” said Dr. Larry Baraff, an emergency physician. “It looks like the main peak is over. ... It's burning its way out,” said Dr. Elizabeth Bancroft, a Los Angeles County medical epidemiologist. She did not rule out a secondary spike in flu cases later this spring, but such second humps have historically been less intense than the main surge. Historically, the flu season in California peaks in January and February. Data from last week show that flu cases have begun to decline, Chavez said, a trend that is expected to continue through March and April. “It has definitely been much more moderate than in past years, and definitely milder compared to last year,” said Dr. Gil Chavez, deputy director of the Center for Infectious Diseases at the California Department of Public Health. One reason this winter's flu season might be more mild is that this year's flu shot matched closely with the strains of flu virus prevalent in the general population, public health officials said.




The following are selected excerpts from the article entitled “Flu expert says doctors are misusing antiviral drugs”, by Trine Tsouderos, Chicago Tribune, March 6, 2009 and a link was provided to this article by Google Flu Trends at Flu news is going around. Just this week, scientists detailed how one of our go-to flu drugs, Tamiflu, no longer works against this year's most common strain, while other researchers announced exciting new advances in the development of influenza vaccines. With flu on the brain, we called one of the world's leading experts on the topic, Robert Webster, chair of infectious diseases at St. Jude's Children's Research Hospital in Memphis. Among other achievements, Webster helped discover wild birds are "e;reservoirs"e; for the influenza virus. In the interview, Webster railed against the way antiviral medications are being used and warned that we would burn through our available medicines if we weren't careful. Here's more of what he had to say: "e;The future for antivirals for the flu is the use of combination therapy. Nature is teaching us a lesson here. We should have learned from HIV that if you use mono-therapy drugs, you are asking for trouble. It is a stats game. If you use one drug, you will get resistance. But if you use two, it squares your chances. And with three, the chance of resistance goes down, and if you have four, you have a combination that goes on for years and years. With flu, we don't have that luxury, but we can use them in combination already. And we are not doing so."e; Flu is in control and sending us a message. Despite all of our knowledge -- we think we have universal vaccines and universal drugs -- the virus will change. It has the capacity to change constantly all of the time. It can outwit us."e;




The following are selected excerpts from the article entitled “Detecting influenza epidemics using search engine query data”, by Jeremy Ginsberg, Matthew H. Mohebbi, Rajan S. Patel, Lynnette Brammer, Mark S. Smolinski and Larry Brilliant, Nature Magazine, 457, February 19, 2009, pages 1012-1014, and a link was provided to this article by Google Flu Trends at Seasonal influenza epidemics are a major public health concern, causing tens of millions of respiratory illnesses and 250,000 to 500,000 deaths worldwide each year. In addition to seasonal influenza, a new strain of influenza virus against which no previous immunity exists and that demonstrates human-to-human transmission could result in a pandemic with millions of fatalities. Early detection of disease activity, when followed by a rapid response, can reduce the impact of both seasonal and pandemic influenza. One way to improve early detection is to monitor health-seeking behaviour in the form of queries to online search engines, which are submitted by millions of users around the world each day. Here we present a method of analysing large numbers of Google search queries to track influenza-like illness in a population. Because the relative frequency of certain queries is highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day. This approach may make it possible to use search queries to detect influenza epidemics in areas with a large population of web search users.




The following are selected excerpts from the article entitled “Schools try to minimize cases of colds, flu”, by Bruce Lieberman, The San Diego Union-Tribune, February 19, 2009, and a link was provided to this article by the American Nurses Association SmartBrief at Knowing how to minimize the spread of colds and flu at school doesn't require a doctorate in public health. But that doesn't mean the simple steps that schools routinely take, and others that families should take at home, aren't important. Schools can quickly become epicenters of illness, and school nurses, teachers and administrators work hard to contain their spread. On average, schoolchildren get six to 10 colds every year, and about 22 million school days are missed each year nationwide because of colds, according to the National Institute of Allergy and Infectious Diseases. Flu season typically peaks in January or February but can spike as late as March, according to the Centers for Disease Control and Prevention in Atlanta. The incidence of flu this year is low but increasing, the CDC reported this month. Schools have always encountered families who send ill children to school because both parents work. In today's troubled economy, the situation could get worse. “Parents are afraid to leave work,” Jaworski said. “I think we're going to see more parents giving the kid a couple Tylenol and hoping they'll make it through the day.” That could be one reason why a 2008 study from the University of Arizona listed teachers and day care workers as the “germiest” jobs in America - topping doctors, police officers, sanitation workers, janitors and meatpackers. School nurses say that educating children, parents, teachers and others about preventing illnesses on campus is an ongoing effort. At Horton Elementary School, Jaworski said she grabs a few minutes at every campus meeting that involves parents to talk about wellness. For the past five years, a local pediatrician has spoken to Horton parents during back-to-school night about health care basics. To head off colds and flu, many teachers in the region stock their classrooms with dispensers of antibacterial gel that children can use on their way in and out. In a 2008 study published in the journal Pediatrics, researchers from Children's Hospital in Boston found that absenteeism rates for gastrointestinal illnesses were lower in classrooms where teachers used disinfecting wipes once a day on desktops and helped students use alcohol-based hand sanitizers, including before lunch and after coming in. Parents should follow a few simple rules for home health care, the National Association of School Nurses advises. Children should stay home if they have a fever of 100.4 degrees or higher, have been vomiting or have other symptoms that would prevent them from participating in school. Such symptoms could include excessive fatigue and lack of appetite, productive coughing and sneezing, headache, body aches and/or earaches, and a sore throat. A severe sore throat could be strep throat even if there is no fever. Children should stay home until the fever has been gone for 24 hours without medication.




The following are selected excerpts from the article entitled “Deadly bacteria defy drugs, alarming doctors”, by Mary Engel, The Los Angeles Times, February 17, 2009, and a link was provided to this article by the American Nurses Association SmartBrief at A new category of bugs becomes more resistant to treatment, and their toll -- which already includes a Brazilian beauty queen -- is expected to rise. Acinetobacter doesn't garner as many headlines as methicillin-resistant Staphylococcus aureus, the dangerous superbug better known as MRSA. But a January report by the Infectious Diseases Society of America warned that drug-resistant strains of Acinetobacter baumannii and two other microbes -- Pseudomonas aeruginosa and Klebsiella pneumoniae -- could soon produce a toll to rival MRSA's. e three bugs belong to a large category of bacteria called "e;gram-negative"e; that are especially hard to fight because they are wrapped in a double membrane and harbor enzymes that chew up many antibiotics. As dangerous as MRSA is, some antibiotics can still treat it, and more are in development, experts say. t the drugs once used to treat gram-negative bacteria are becoming ineffective, and finding effective new ones is especially challenging. "e;We're literally running out of drugs to treat gram-negatives,"e; said Dr. Brad Spellberg, an infectious disease specialist at Harbor-UCLA Medical Center. "e;And there is nothing in the pipeline right now."e; xact numbers are hard to come by, because infections by these three bacteria are not reportable by law. But using 2002 data voluntarily reported to the Centers for Disease Control and Prevention from about 300 large, mostly urban hospitals, the Infectious Diseases Society of America identified about 104,000 gram-negative infections that were resistant to at least some antibiotics, roughly the same as the 102,000 MRSA infections found that year. A class of broad-spectrum antibiotics known as carbapenems have been the drug of last resort for gram-negative bugs. The carbapenems are . . . the best gram-negative drugs we have,"e; said Dr. Helen Boucher of Tufts University, an infectious disease specialist. "e;These bugs have found a way to make an enzyme that dissolves these drugs. That means our best gun is ineffective."e; s the drugs fail, doctors find themselves as a last resort turning to older, more toxic ones such as colistin, largely abandoned because of the severe side effects: kidney damage and deafness. At one East Coast hospital, the number of orders doctors made for colistin went from one in 2001 to 68 in 2007, Boucher said. “This is a drug that's like poison,"e; she said. For the most part, gram-negative bacteria are hospital scourges -- harmless to healthy people but ready to infect already-damaged tissue. The bacteria steal into the body via ventilator tubes, catheters, open wounds and burns, causing pneumonia, urinary tract infections, and bone, joint and bloodstream infections. Pseudomonas is widely found in soil and water, and rarely causes problems except in hospitals. Klebsiella causes a sudden, severe pneumonia, mostly in people already suffering from ailments such as diabetes or chronic lung disease. Its telltale sign is a blood-tinged sputum dubbed "e;currant jelly."e; It can also cause urinary tract and abdominal infections. Acinetobacter generally causes wound and bloodstream infections. It has become notorious among veterans of the wars in Iraq and Afghanistan. They are believed to have contracted it in field hospitals and carried it to veterans hospitals in the U.S. The bacteria have remained largely off the public's radar, Boucher said, because they affect mostly the elderly or ill. But they do not always limit themselves that way. Drug-resistant Pseudomonas was behind the widely publicized Jan. 24 death of Brazilian beauty queen Mariana Bridi, 20, of sepsis -- a bloodstream infection. The health department in Espirito Santo, Brazil, said what began as a urinary tract infection spread rapidly. Bridi died after doctors had tried to contain the rampaging infection by amputating her feet and hands and removing her kidneys.




The following are selected excerpts from the article entitled “U.S. to Study Effectiveness of Treatments”, by Robert Pear, The New York Times, February 16, 2009, pages A1 and and A10. The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness. Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments. Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these: Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression? How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight? Hillary Rodham Clinton, as a senator, was an early champion of “comparative effectiveness research.” Mr. Obama, who is expected to sign the stimulus bill Tuesday, endorsed the idea in his campaign for the White House. For many years, the government has regulated drugs and devices and supported biomedical research, but the goal was usually to establish if a particular treatment was safe and effective, not if it was better than the alternatives. Consumer groups, labor unions, large employers and pharmacy benefit managers supported the new initiative, saying it would fill gaps in the evidence available to doctors and patients. “The new research will eventually save money and lives,” said Representative Pete Stark, Democrat of California. The United States spends more than $2 trillion a year on health care, but “we have little information about which treatments work best for which patients,” said Mr. Stark, who is the chairman of the Ways and Means Subcommittee on Health. In the absence of information on what works, Mr. Stark said, patients are put at risk, and billions of dollars are spent each year on ineffective or unnecessary treatments. Steven D. Findlay, a health policy analyst at Consumers Union, said the action by Congress was “a terrific step on the road to improving.



The following are selected excerpts from the article entitled “Flu vaccine is still available and appears to be effective in stopping the strains that are circulating this year”, by Sharon Salyer, The Herald, February 14, 2009, pages A1 and A4. Area clinics report they're beginning to see the onset of flu season, but it's still too early to know how long and how severe it will be this year. "e;It's here,"e; Dr. Yuan-Po Tu, who tracks influenza cases for The Everett Clinic, said Friday. "e;It's not huge numbers yet, but I expect the number of flu cases to continue to rise for the next several weeks."e; The uptick in flu cases is part of a state and national trend. Unlike some other communicable diseases, influenza cases are tracked informally, with a network of clinics reporting the number of cases they see each week, giving state and federal health officials an estimate of its spread. Flu's symptoms, which include high fever and body aches, come on quickly. Symptoms of a cold include sniffles and a mild cough, usually without fever. "e;With the flu, one minute you feel fine and in two hours you feel like a bus hit you; that's the difference between a cold and the flu,"e; said Lisa Carroll, clinic manager at Providence Everett Healthcare Clinic. The danger with influenza is that it can cause other health problems, such as pneumonia. Infants, young children and the elderly are particularly at risk. Each year, about 36,000 people die from flu and its complications, Tu noted. Nationally, influenza is hitting the East Coast the hardest, where it's widespread, she said. Its spread is a little slower on the West Coast. Dr. Stephen Carter, at Edmonds Family Medicine Clinic, said he's seen an increase in flu cases over the past three weeks.




The following are selected excerpts from the article entitled “Influenza Widespread in Polk, Officials Say”, by Cary McMullen, The Ledger, at, February 13, 2009, and a link was provided to this article by Google Flu Trends at Influenza in Polk County has taken a significant jump within the past two weeks, and Polk County health officials are preparing to report to the state that the flu has reached the highest level of activity. Dr. Daniel Haight, director of the Polk County Health Department, said Friday he will file a report within the next week that the level of flu has moved from "e;localized"e; to "e;widespread,"e; the highest of the state's four levels of activity. Haight said his office maintains a surveillance system that compiles information from several sources. More than two of the sources are reporting increases in flulike cases, which warrants the elevated status, he said. Influenza is caused by a virus and is potentially serious, especially for people with weak immune systems or other health conditions. Haight said symptoms can develop quickly and include shaking chills, high fever and severe body aches. Congestion and coughing may also be symptoms, and pneumonia can be a serious complication. Physicians and health officials have detected three strains of flu in Polk County: Influenza B and two types of Influenza A, H1N1 and H3N2. Cases of Influenza B have been a little more prevalent, and it is generally a less severe strain, Haight said, but he cautioned that the flu is unpredictable and any strain can affect people in different ways. The H1N1 strain has proved resistant to some anti-flu medications, and physicians may test patients to determine the type they have. Other ways to prevent infection include: Staying home or keeping a child home who might be showing symptoms. Avoiding crowds. Covering nose and mouth when coughing or sneezing. Washing hands often with soap and water or using an alcohol-based cleansing gel, especially after you cough or sneeze. Haight described the current increase as part of a seasonal epidemic of the type that occurs every year. "e;Sometimes it peaks before the New Year, sometimes in January or February,"e; he said. "e;I don't think this is any worse than it is historically."e;






The following are selected excerpts from the article entitled “Soap and Water Hand Washing Superior to Alcohol-Based Rubs in Reducing Presence of Influenza A”, by Eurona Earl Tilley, Medscape Medical News at, February 13, 2009, and a link was provided to this article by Google Flu Trends at Soap and water hand washing and alcohol-based rubs are effective reducing the presence of influenza A virus on human hands, according to the results of a study published in the February 1 issue of Clinical Infectious Diseases. Hand hygiene may play an important role in reducing the transmission of pandemic and avian influenza among healthcare workers, patients, and caregivers."e; Although person-to-person transmission of influenza virus is due primarily to aerosol spread, transmission on the hands of patients and their caregivers is also potentially important,"e; write M. Lindsay Grayson, MBBS, MD, MSC, FRACP, FAFPHM, from the Infectious Diseases Department, Austin Health, the Department of Epidemiology and Preventive Medicine, Monash University, and the Department of Medicine, University of Melbourne, Australia, and colleagues. "e;Appropriate hand-hygiene practices should reduce transmission risk, but there are few in vivo data to confirm the antiviral efficacy of currently available HH protocols. Furthermore, the long-term viability of influenza virus on unwashed human hands remains unclear."e; "e;We believe that our findings have potentially important public health implications, because simple hand washing with unmedicated soap and water appears to be highly effective in removing influenza virus from hands and is, therefore, likely to be effective in preventing transmission of influenza, as long as [hand hygiene] is undertaken appropriately,"e; the authors conclude.






The following are selected excerpts from the article entitled “Achoo Tamed? Study Decodes The Cold Virus” by Nicholas Wade, The New York Times, February 13, 2009, pages A1 and A19. Curing the common cold, one of medicine's most elusive goals, may now be in the realm of the possible. Researchers said Thursday that they had decoded the genomes of the 99 strains of common cold virus and developed a catalog of its vulnerabilities. Besides alleviating the achy, sniffly misery familiar to everyone, a true cold-fighting drug could be a godsend for the 20 million people who suffer from asthma and the millions of others with chronic obstructive pulmonary disease. The common cold virus, a rhinovirus, is thought to set off half of all asthma attacks. Industry hurdles aside, perhaps the biggest reason the common cold has long defied treatment is that the rhinovirus has so many strains and presents a moving target for any drug or vaccine. This scientific link in this chain of problems may now have been broken by a research team headed by Dr. Liggett and Dr. Ann C. Palmenberg, a cold virologist at the University of Wisconsin. Dr. Fernando Martinez, an asthma expert at the University of Arizona, said the new rhinovirus family tree should make it possible for the first time to identify which particular branch of the tree held the viruses most provocative to asthma patients. If antiviral agents could be developed against this group of viruses, Dr. Martinez said, “it would be an extraordinary advance.” Another asthma expert, Dr. E. Kathryn Miller at the Vanderbilt Children's Hospital in Nashville, said the new finding was “a groundbreaking study of major significance.” People at high risk from rhinoviruses, like children with asthma or adults with chronic obstructive pulmonary disease, would benefit greatly from new drugs, Dr. Miller said, and should therefore be populations of interest to the drug industry. The data will also help analyze a new family of rhinoviruses that is causing concern. Instead of attacking the cells lining the nose, these attack those lining the deep lungs, causing viral pneumonia.





The following are selected excerpts from the article entitled “Major Flu Strain Found Resistant to Leading Drug, Puzzling Scientists”, by Donald G. McNeill, Jr., The New York Times, January 9, 2009, pages A10 and A17. Virtually all the dominant strain of flu in the United States this season is resistant to the leading antiviral drug Tamiflu, and scientists and health officials are trying to figure out why. The problem is not yet a public health crisis because this has been a below-average flu season so far, and because the Tamiflu-resistant strain, one of three circulating, is still susceptible to other drugs. But infectious disease specialists are worried nonetheless. Last winter, about 11 percent of the throat swabs from patients with the most common type of that were sent to the Centers for Disease Control and Prevention for genetic typing showed a Tamiflu-resistant strain. This season, 99 percent do. “It's quite shocking,” said Dr. Kent A. Sepkowitz, director of infection control at Memorial Sloan-Kettering Cancer Center in New York. “We've never lost an antimicrobial this fast. It blew me away.” The single mutation that creates Tamiflu resistance appears to be spontaneous, and not a reaction to overuse of the drug. Complicating the problem, antiviral drugs only work if taken within the first 48 hours of the infection. If a Tamiflu-resistant strain is suspected, the disease control agency suggests using a similar drug, Relenza. But Relenza is hard to take; it is a powder that must be inhaled and can cause lung spasms, and it not recommended for children under 7. “The bottom line is that we should have more antiviral drugs,” said Dr. Arnold S. Monto, a flu expert at the University of Michigan's School of Public Health.” “And we should be looking into multidrug combinations”. Resistance appeared several years ago in Japan, which uses more Tamiflu than any other country, and experts feared it would spread. “This looks like a spontaneous development of resistance in the most unlikely places - possibly in Norway, which doesn't use the antivirals at all,” Dr. Monto said. Dr. Henry L. Niman, a biochemist in Pittsburgh who runs, a Web site that tracks the genetics of flu cases worldwide, has been warning for months that Tamiflu resistance in H1N1 was spreading. Further, Dr. Niman blamed mismatched flu vaccines for helping the A193T mutation spread. Flu vaccines typically protect against three flu strains, but none have contained protections against the A193T mutation. Dr. Niman said he was worried about two aspects of the new resistance to Tamiflu. Preliminary data out of Norway, he said, suggested that the new strain was more likely to cause pneumonia. The flu typically kills about 36,000 Americans a year, the C.D.C. estimates, most of them elderly or the very young, or people with problems like asthma or hearth disease; pneumonia is usually the fatal complication. And while seasonal flu is relatively mild, the Tamiflu resistance could transfer onto the H5N1 bird flu circulating in Asia and Egypt, which has killed millions of birds and bout 250 people since 2003. Although H5N1 has not turned into a pandemic strain, as many experts recently feared it would, it sill could - and Tamiflu resistance in that case would be a disaster.





The following are selected excerpts from the article entitled “Bird flu's resurgence stirs fear of pandemic”, by the Los Angeles Times, reprinted in the Herald, January 4, 2009, page A3. The deadly H5N1 virus, bird flu, has resurfaced in poultry in Hong Kong for the first time in six years, reinforcing warnings that the threat of a human pandemic still exists. During December, India, Bangladesh, Vietnam and mainland China also experienced new outbreaks. In that same period, four new human cases in Egypt, Cambodia and Indonesia were reported to the World Health Organization. A 16-year old girl in Egypt and a 2-year-old girl in Indonesia have died. A United Nations report in October credited improved surveillance and the rapid culling of potentially infected poultry for helping to contain and even prevent outbreaks in many countries. But the bigger fear has always been that H5N1 would give rise to a human pandemic like the Spanish flu of 1918, which killed an estimated 50 million people worldwide. As long as the virus continues to circulate, the threat that it could mutate to pass more easily among humans remains, the U.N. report said.





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