flu
Evaluation of three immunoassay kits for rapid detection of influenza virus a and B.

Weinberg A, Walker ML.

University of Colorado Health Sciences Center, 4200 E 9th Ave., Campus box C227, Denver, CO 80220. Adriana.Weinberg uchsc.edu.

Influenza causes high morbidity and mortality in very young and elderly individuals, which can be controlled with antivirals and/or vaccines. The success of therapeutic measures is predicated on the rapid and precise diagnosis of the infection. We compared three rapid influenza immunoassay (RIIA) kits for the diagnosis of influenza virus A and B using 178 respiratory specimens submitted for routine testing. BD Directigen Flu A+B (Directigen), Directigen EZ Flu A+B (EZ), and NOW Flu A NOW Flu B (NOW; Binax) tests had comparable combined influenza virus A and B specificities, varying from 94 to 98%. In contrast, the sensitivity of EZ was significantly lower (39%) than that of NOW (76%) and marginally lower than that of Directigen (56%). The differences in sensitivity were most evident in patients who were >9 years old (Directigen, 53%; EZ, 32%; and NOW, 69%). Among specimens, bronchoalveolar lavage fluids yielded the most discrepant results, with sensitivities varying from 0 (EZ) to 100% (NOW), followed by nasopharyngeal swabs (sensitivities of 27 to 100%) and nasal washes (50 to 81%). The Directigen kit format allowed for faster completion but more cumbersome performance and more difficult interpretation compared with the other two kits. Overall, NOW provided the most accurate diagnoses and had user-friendly technical characteristics. However, the low overall sensitivity of the RIIAs indicates that these can be used as screening tools only.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15753248&dopt=Abstract flu, flu medicine, tamiflu



flu
[Intramuscular route for the administration of the anti-flu vaccine in patients receiving oral anticoagulation therapy.]

[Article in Spanish]

Ballester Torrens Mdel M, Aballi Acosta M, Maudos Perez MT, Iglesias Perez B, Casajuana Brunet J, Losada Doval G, Piqueras Garre Mdel M.

Especialista en Medicina Familiar y Comunitaria. EAP Ramon Turro. Barcelona. Spain.

Background and objective: Comparison of safety and effectiveness of the intramuscular (IM) (deltoid) vs subcutaneous (s.c.) administration of the flu vaccine (FV) in patients on oral anticoagulation therapy. Patients and method: It was a phase IV, simple blind, 2-parallel groups, randomized trial developed in an urban primary care setting. We included patients taking oral anticoagulation therapy without FV contraindications. The IM administration of the FV in the experimental group was compared with a SC administration in the control group. RESULTS: 59 patients were included. The two groups were comparable at the beginning of the study. INR was not modified following s.c. (p = 0.38) or i.m. (p = 0.49) administration. No systemic side effects were observed. More cutaneous lesions were observed in the S.C. group (71.4%) when compared with the i.m. group (25.8%; p < 0.0001). For the remaining variables, we observed a tendency towards more reported pain in the SC group (35.7 vs 22.6%) and a larger brachial diameter (42 vs 29%) without significant differences. 3.2% of patients in the i.m. group and 7.1% in the s.c. group developed influenza symptoms without significant differences. CONCLUSIONS: Even though the results must be interpreted with caution, currently there appears to be no apparent contraindication for the i.m. administration of the FV. When it is administered subcutaneously, it tends to cause more side effects.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15755389&dopt=Abstract flu, flu medicine, tamiflu



flu
A new modified live equine influenza virus vaccine: phenotypic stability, restricted spread and efficacy against heterologous virus challenge.

Chambers TM, Holland RE, Tudor LR, Townsend HG, Cook A, Bogdan J, Lunn DP, Hussey S, Whitaker-Dowling P, Youngner JS, Sebring RW, Penner SJ, Stiegler GL.

Department of Veterinary Science, University of Kentucky, Lexington 40546-0099, USA.

Flu Avert IN vaccine is a new, live attenuated virus vaccine for equine influenza. We tested this vaccine in vivo to ascertain 1) its safety and stability when subjected to serial horse to horse passage, 2) whether it spread spontaneously from horse to horse and 3) its ability to protect against heterologous equine influenza challenge viruses of epidemiological relevance. For the stability study, the vaccine was administered to 5 ponies. Nasal swabs were collected and pooled fluids administered directly to 4 successive groups of naive ponies by intranasal inoculation. Viruses isolated from the last group retained the vaccine's full attenuation phenotype, with no reversion to the wild-type virus phenotype or production of clinical influenza disease. The vaccine virus spread spontaneously to only 1 of 13 nonvaccinated horses/ponies when these were comingled with 39 vaccinates in the same field. For the heterologous protection study, a challenge model system was utilised in which vaccinated or naive control horses and ponies were exposed to the challenge virus by inhalation of virus-containing aerosols. Challenge viruses included influenza A/equine-2/Kentucky/98, a recent representative of the 'American' lineage of equine-2 influenza viruses; and A/equine-2/Saskatoon/90, representative of the 'Eurasian' lineage. Clinical signs among challenged animals were recorded daily using a standardised scoring protocol. With both challenge viruses, control animals reliably contracted clinical signs of influenza, whereas vaccinated animals were reliably protected from clinical disease. These results demonstrate that Flu Avert IN vaccine is safe and phenotypically stable, has low spontaneous transmissibility and is effective in protecting horses against challenge viruses representative of those in circulation worldwide.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11770982&dopt=Abstract flu, flu medicine, tamiflu



flu
Avian flu: sites seek to respond and reassure.

Larkin M.

Avian flu outbreaks in Thailand and Vietnam, followed by a reported case of human-to-human transmission in Cambodia (http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_02_02/en/) prompted rapid responses by health authorities around the world. The WHO and local health ministries launched investigations into the potential source(s) of the outbreaks, and millions of ducks and other farm poultry were slaughtered (http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb0205cambodian.html). The US Centers for Disease Control responded by elevating its previous advice to travellers about avian influenza A (H5N1) in Asia from an Outbreak Notice to a Travel Health Precaution, and increased surveillance for the disease. Some experts predict that the world is on the brink of an avian flu pandemic; others say a pandemic may not be inevitable, but urge caution and ongoing monitoring. The following sites offer background information and the latest news on avian flu.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15766646&dopt=Abstract flu, flu medicine, tamiflu



flu
Improving preventive care for women: impact of a performance improvement program in a family practice office.

Gill JM, McClellan SA.

Department of Family and Community Medicine, Christian Care Health Services, Wilmington, DE, USA.

PURPOSE: In 1993, the Family Medicine Center (FMC) at the Medical Center of Delaware (MCD) implemented a performance improvement (PI) program to increase rates of adult preventive care. This program included adoption of evidence-based preventive care guidelines, education of physicians and nurses regarding these guidelines, development of a flow sheet for tracking preventive care on office charts, and adoption of a policy of nurse review to alert physicians of which preventive services are due. The purpose of this study was to determine whether this PI program had a positive impact on the delivery of preventive care to female patients of the FMC. METHODS: A retrospective chart review was conducted for 280 female patients of the FMC ages 40-75. We determined the percentage of women who had received appropriate screening for breast and cervical cancer as well as appropriate immunizations, according to the guidelines of the US Preventive Services Task Force. These percentages were compared for the three year time periods before and after the PI program was implemented (July, 1990-June, 1993 and July, 1993-June, 1996). RESULTS: Prior to implementation of the PI program, PAP smears were completed in 65.3 percent of women, mammograms in 70.3 percent, breast exams in 44.2 percent, flu shots in 29.6 percent and tetanus shots in 15.5 percent. After the program, these percentages increased for all preventive services, especially PAP smears which increased by 12 percent and tetanus shots which tripled. After the program, the rate of flu shots was still low at 37 percent. CONCLUSIONS: After implementation of a PI program at the FMC, performance of preventive care for female patients improved for both cancer screening and immunizations. This improvement suggests that an office-based strategy can improve performance of preventive care, especially if it incorporates the active involvement of nursing staff. However, there is still room for further improvement, notably with completion of flu shots. These improvements will likely require additional strategies, such as computerized tracking systems and preventive care reminders to patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9489221&dopt=Abstract flu, flu medicine, tamiflu



flu
[Influenza in the 1996/'97 season; vaccine composition for the 1997/'98 season]

[Article in Dutch]

Rimmelzwaan GF, de Jong JC, Bartelds AI, Claas EC, van Wijngaarden JK, Osterhaus AD.

Nationaal Influenza Centrum van de WHO, Erasmus Universiteit, afd. Virologie, Rotterdam.

The first indication of flu activity in the Netherlands in the 1996/'97 season was the isolation of an A/H3N2 influenza virus in week 48 of 1996. In subsequent weeks influenza viruses were isolated sporadically. The clinical influenza activity increased from week I of 1997 and reached its peak in week 4 of 1997. Simultaneously with the increase of clinical influenza activity, an increasing number of influenza viruses were isolated. The epidemic had a relatively small extent. Initially, A/H3N2 influenza viruses were predominant, but in the second half of the epidemic an increasing number of influenza B viruses were isolated as well. The A/H3N2 viruses were antigenically fairly strongly distinct from the variants prevalent in the preceding years. This season influenza A/HINI viruses did not play a significant role and only one virus of this subtype was isolated. All influenza A/H3N2, A/HINI and B viruses isolated were antigenically similar to the vaccine strains.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9545718&dopt=Abstract flu, flu medicine, tamiflu