H1N1 vaccine in US

またしてもＡＴＳのメールマガジン。
米国では3週間以内、つまり10月の最初の週にH1N1予防接種が開始されるとのこと。最初の接種から8−10日で効果が現れるという。当初CDCは10月中旬から3週から4週間開けての2回接種を計画していたが、早期の集団発生の恐れから一回接種で十分であると決断した模様。

接種の費用については、米国では基本的には無料だが、診療所等で行う場合、接種にかかわる実費を請求されるだろうとのこと。これは通常のインフルエンザワクチン費用とほぼ同じとする日本とは大いに異なる。なお、通常のインフルエンザワクチンについては通常の費用通りとのこと。保険によってワクチンの費用の支払い率が異なるというのも面白い。ワクチン接種によって、治療にかかわる医療費が安くなるのだから、保険で支払うことができるのは論理的だと思う。

民間医療がH1N1に効果があるかもという報告もあるらしく、'dung of the devil' （悪魔の糞）や"pungent plant, Ferula assafoetida　アギ（セリ科）が抗ウイルス剤のteamantadineと比較して臨床検査では良い結果を示したというが、効くということが示されたわけではないとのこと。

CDCは「医療機関を除いて、症状のないものにはマスクの利用は勧めない」とのこと。例外としては、「基礎疾患があるものが、大勢の人の中に行く場合には、マスクをしてもよい」し、「インフルエンザによる重篤な疾患に罹るリスクのある人は、周りの人を気遣う気持ちがあるならばマスクをしてもよい。」また、「住んでいる地域で集団発生があった場合には、マスクをしてもよい」とのことだ。

ワクチン接種は一回でもよいというのが、国立アレルギー感染症研究所の Anthony Fauci 氏の声明で、これによりワクチンでカバーできる人の数は2倍化できる。何人かの有力な疫学者の意見として、ワクチンが十分にあったとしても、初めのピークに間に合わないだろうとも言われているとのこと。しかし、ワクチンがカバーできる人数が増えたことで、HHS(日本の厚生省にあたる)Kathleen Sebelius 長官は非常に心強いと発言した。

H1N1 vaccinations scheduled to begin in three weeks in US.
Bloomberg News (9/14, Randall, Gale) reports, "Swine flu vaccinations may begin in three weeks, earlier than previously anticipated, after the first US tests found a single shot to be effective in eight to 10 days, US health officials said. The first shots may be available by the end of this month and administered to patients the first week of October, said Nancy Cox, director of the flu division at the US Centers for Disease Control and Prevention in Atlanta." Previously, "health officials had...planned for vaccinations to begin in mid-October, requiring two shots administered three weeks apart." The piece continues to describe early outbreaks in the US, and relates the testing procedures that led authorities to determine that a single dose would be sufficient to inoculate patients.
Logistics said to complicate plan to distribute vaccine. The Los Angeles Times (9/14, Maugh) reports on the "key questions" that are still surrounding the plans for "one of the largest vaccination programs ever conducted, the broad outlines of the campaign to vaccinate nearly 100 million Americans against pandemic H1N1 influenza virus by Christmas," noting that "the situation is further complicated by the need to vaccinate about the same number of people against seasonal flu during roughly the same period. One key question was cleared up Friday," however, "when it became apparent that only one dose of the swine flu vaccine will be required. The seasonal flu vaccination effort will be handled as usual, but the 'unprecedented' effort against H1N1 is 'very complicated logistically,' said Dr. Jonathan Fielding, Los Angeles County's health officer." He added that "the only reason it is possible at all...is because the 2003 outbreak of severe acute respiratory syndrome, or SARS, and the subsequent fears of an avian flu pandemic led public health officials to prepare plans for a mass vaccination program such as that now being undertaken."
Several factors said to impact flu inoculation costs. The Los Angeles Times (9/14, Kritz) runs a piece on the costs of flu vaccines, noting that "the H1N1 shot will be free, although doctor's offices and clinics may charge an administrative fee. Some insurance companies will cover that fee. Standard costs will apply for the seasonal flu shot, however. ... Insurance firms vary in terms of seasonal flu vaccine coverage. Some will cover all costs, while others require a co-pay (for which you can be use funds from a flexible or health spending account)."
Folk remedy may help scientists develop H1N1 drugs, research suggests. Bloomberg News (9/11, Kresage) reported, "A folk remedy from an herb known as 'dung of the devil' because of its rank smell could lead scientists to new drugs for swine flu," researchers say. According to a paper appearing in the Journal of Natural Products, the "pungent plant, Ferula assafoetida, is a flu folk remedy...used during the 1918 Spanish flu pandemic." The "herb has also been used in folk medicine for cancer, HIV, and rheumatism." Now, researchers in Taiwan have found that "extracts from the plant's roots, bought from a Chinese herb shop in Taipei, were more potent against the H1N1 swine flu virus in lab tests than was the prescription anti-viral medicine teamantadine." Although "such lab tests aren't proof that a medicine works," they "could be precursors to trials of a new compound in animals and eventually humans."
CDC recommends use of masks, respirators only in specific instances. The Los Angeles Times (9/14, Roan) reports, "The visible symbol of the H1N1 flu outbreak last spring seemed to be face masks. Suddenly, they were everywhere -- in airports and waiting rooms, on buses and trains. Many drugstores sold out of masks. As the nation girds itself for a renewed fall outbreak, however, masks may make a reappearance." But, "in general, the Centers for Disease Control and Prevention does not recommend use of face masks or respirators in non-healthcare settings," although "there are exceptions." For instance, since "the novel strain of H1N1 influenza has led to a pandemic, people who are ill with the virus should consider wearing a mask around other people, if tolerable." In addition, "people who are at risk for severe illness from the flu should wear a mask or respirator if they are caring for someone with the flu and should consider wearing one if there is an outbreak of flu in the community."
One H1N1 shot should be enough, officials say. The CBS Evening News (9/11, story 5, Couric) reported, "Results from US clinical trials out [Friday] confirm that most adults may need just one vaccine shot against the H1N1 flu virus instead of two. That could effectively double our arsenal against another outbreak." AFP (9/12, Zeitvogel) reported that National Institute of Allergy and Infectious Diseases Director Anthony Fauci said, "Preliminary data from our trials indicate that a single 15-microgram dose of...vaccine is well tolerated and induces an immune response in most healthy adults." Despite the good news, the New York Times (9/12, A11, McNeil) noted that "several prominent epidemiologists are warning that even though the new swine flu vaccine works much better than expected, it will still come too late to blunt the peak of this season's pandemic."
The dosing announcement is "encouraging news," HHS Secretary Kathleen Sebelius said, according to the Washington Post (9/12, Stein). She explained, "The vaccine we have purchased will go further and cover more people."