Friday, February 27, 2015

Why does your baby cry ???? All the "REAL" reasons for the same .....

Why is my baby crying?

It can be difficult dealing with an infant who cries all the time. But there are lots of reasons why your little one might be fussy. Here’s a checklist of the most common causes of hysterical screaming.
It’s probably gas. That’s the most common problem. Maybe you just need to burp him or “bicycle” his legs to help him pass gas. Poor little guy. No wonder he’s upset.
It’s probably not gas. It’s almost never gas. Why does everyone assume that? Just because you can’t see what’s happening doesn’t mean it’s gas. What are you doing slapping him on the back and manhandling his legs over and over? Poor little guy. No wonder he’s upset.
Existential crisis. Your little dude just found out he exists. He has no frame of reference for the meaninglessness of his existence. He was tossed into the worldly plane like a bag of semi-sentient meat. Try reading him Camus’s The Stranger. It will help him realize he must give birth to his own meaning of life.
Firefly was cancelled. Look, we’re all upset there won’t be anymore episodes of this groundbreaking space western. Make sure he’s seen Serenity. It’s on Netflix. Also, teach him about “jumping the shark” and how it’s better this way than to become another zombie series like the X-Files or the Simpsons.
baby crying
Sad designed by Tyler Glaude from the Noun Project
The vacant stares of his “toys”. Stuffed animals are basically a cheap imitation of taxidermy. Your child is looking for warmth and connection with others. Instead, you’ve surrounded him with these lifeless husks, deranged interpretations from someone who’s probably never even seen a rabbit or tiger. They’re not supposed to look like that. He stares into their eyes looking for a soul, and all he sees is the abyss.
Racist? The way your little one’s been giving the side eye to Obama on TV. Sure, maybe he disagrees with Obama’s foreign policy, but he’s just a little baby. How could even know about that stuff? More likely, he’s just a tiny racist. I guess we’re not born colorblind after all.
The way mommy takes the last towel out of the bathroom. I mean, I’m just assuming it bothers him as much as it bothers daddy when daddy finishes taking a shower and there’s no towels left because mommy took the last one out and didn’t put another clean one in there.
He’s over-tired. Paradoxically, babies can get so exhausted from lack of sleep that they have trouble going to sleep. If your baby was up all night crushing code for his tech startup, remind him that he still has a good 14 or 15 years to get a top app in the App Store before he’s too old and decrepit to get a job at Facebook or Google.
You’re a terrible parent. Have you considered that maybe your little one is just upset because his parents are so terrible? Try being less shitty, as a parent and also as a human being.
Comment: This is the FUNNIEST DAD blog that I have ever read .... please go through other articles, including why I did not vaccinate my child !!!

Thursday, February 26, 2015

Fruit Tips For Children, how to make your child eat a healthier fruit based diet!

Set a good example for children by eating fruit every day with meals or as snacks.
Offer children a choice of fruits for lunch.
Depending on their age, children can help shop for, clean, peel, or cut up fruits.
While shopping, allow children to pick out a new fruit to try later at home.
Decorate plates or serving dishes with fruit slices.
Top off a bowl of cereal with some berries. Or, make a smiley face with sliced bananas for eyes, raisins for a nose, and an orange slice for a mouth.
Offer raisins or other dried fruits instead of candy.
Make fruit kabobs using pineapple chunks, bananas, grapes, and berries.
Pack a juice box (100% juice) in children’s lunches instead of soda or other sugar-sweetened beverages.
Look for and choose fruit options, such as sliced apples, mixed fruit cup, or 100% fruit juice in fast food restaurants.
Offer fruit pieces and 100% fruit juice to children. There is often little fruit in “fruit-flavored” beverages or chewy fruit snacks.
Keep fruits separate from raw meat, poultry and seafood while shopping, preparing, or storing.
- Dr Rammohan Gunreddy (excerpts from post at docplexus discussion board)

Wednesday, February 25, 2015

No need to vaccinate people against swine flu: says India's Health Minister Nadda

NEW DELHI, The government Tuesday told parliament that there was no need as of now to vaccinate the general public from swine flu.

"The morbidity and mortality associated with the influenza are matters of great concern for all of us," union Health Minister J.P. Nadda said in a statement made in both Lok Sabha and Rajya Sabha.

He informed parliament that while declaring the pandemic to be over in 2010, the WHO had declared that the swine flu virus would circulate as a seasonal virus for some years now.

Nadda said that many of the deaths due to the virus this year are due to co-morbid conditions already present in patients like diabetes, heart conditions and cancer.

"Vaccination is not recommended for general public as of now," he said, adding his ministry has been closely monitoring the scene.

"States have been provided guidelines for screening and management of cases," he said.

The minister said that Oseltamivir, the drug which can cure the disease, preventive N-95 masks and other personal protection equipment are being given to state governments.

"We have already supplied 58,000 capsules of Oseltamivir," he added."Teams from the union health ministry have been sent to worst affected states like Telangana, Rajasthan and Gujarat," Nadda said.

While maintaining that there was no shortage of drugs, the health minister cautioned that the drugs cannot be used in an irresponsible manner which will create resistance to the medicine.

Monday, February 23, 2015

How many deaths have been reported in India in the current Swine Flu Epidemic, as of Feb 2015?

Q: How many deaths have been reported in India in the current Swine Flu Epidemic, as of today 23rd Feb 2015?
A: NEW DELHI: The mercury rising, yet the H1N1 influenza A virus seems to defy its survival limitations, worrying the health ministry and doctors.

This year, swine flu deaths have more than doubled compared to the previous year taking the toll to 624. A total of 9,311 people got infected, government data show. In February alone over 300 died across the country. In 2014, 218 swine flu deaths were reported from a total of 937 cases, pan-India.

"As it starts getting warmer, we expected cases to come down. This year the trend is different," says Dr Suranjit Chatterjee, senior consultant, internal medicine, at Indraprastha Apollo Hospitals.

Union health minister JP Nadda has held frequent review meetings. The ministry's directed pharma companies to expedite supply of antiviral medicines to state hospitals and licensed retail outlets. "We've asked companies to airlift stocks, if required. We'll monitor availability in the retail market," Union health secretary BP Sharma said. The government hopes cases will come down with awareness and precautionary measures, he said. The ministry has directed states to provide protective kits to health workers.

Although the cause is yet to be ascertained, doctors suspect a change in the strain behaviour which generally happens in three to four years resulting in the sudden spurt in cases. ICMR, though, has ruled out strain mutation, BP Sharma, secretary to the health ministry said.

Doctors recommend isolation of patients. They cautioned that only those with moderate to acute symptoms should go to hospitals for tests and treatment. "Patients with milder symptoms should stay home, take antiviral medicines and precautions," says Dr KK Aggarwal, leading cardiologist.

Patients with breathlessness, high fever for three to four days or those already suffering from complex diseases and are immuno-compromised should go for hospitalization, according to Dr Aggarwal. Experts said the government should formulate a treatment protocol so there's no unnecessary testing and hospitalization. Last week, retail medicine shortages were reported from states, including Maharashtra and Delhi.

Sharma maintains it's important to ensure needless prescription doesn't lead to the virus turning resistant to the drug. Doctors, nonetheless, suggest patients displaying severe symptoms start taking the antiviral medicine. "Once the disease develops, the medicine's efficiency starts going down," said Dr Arup Basu of Ganga Ram Hospital.

Have asthma? Take extra care

Asthmatics are more vulnerable to swine flu. Nearly 30% of those hospitalized for the flu are asthma patients, a research says. "Swine flu and asthma attack the airways.

Having both makes people vulnerable to respiratory complications, including pneumonia, says Dr Vivek Nangia, director and head of pulmonology at Fortis. India has 30 million asthmatics, about 10% of the 300 million worldwide.

Experts say though noninvasive ventilation can be effective for such patients, it's limited to 10% because of poor awareness. "By the time the patient is prescribed noninvasive ventilation in home care, lungs have irretrievably damaged," says Dr Nangia.

Swine flu scare in India: Doctors warn against social media panic while reading reports on WhatsApp / Facebook / Twitter etc.

The social media has lapped up stories about the 'dangerous' nature of swine flu infection, but doctors suggest it is nothing but scaremongering because though the virus can lead to complications, the disease is completely curable.

Saturday, February 21, 2015

Drug Makers in India Blame Archaic Norms for Swine Flu Deaths

MUMBAI: Drug makers in India have blamed an "archaic" health ministry regulation for the shortage of medicines used for treating swine flu, saying they had to destroy stockpiles of the drugs because chemists were reluctant to procure them. More than 600 people have died of the disease across the country in the past two months. Many patients, even in bigger cities like Delhi, have complained of lack of swine flu medicines at drug stores and hospitals.
"Since the drug comes under Schedule X, there are various licences required to stock the medicines, which dissuades chemists to stock them," said an executive at Mumbai-based Cipla, which manufactures swine flu drug under the brand name Anti Flu. "And, if chemists are seen selling swine flu drugs without adequate licences, they immediately face prosecution." Schedule X classifies "restrictive drugs" under the Drugs and Cosmetics Act of India, which imposes limitations on their sale by pharmacies and hospitals. Narcotics drugs, for example, are classified as Schedule X.
The government intention behind including swine flu drugs under Schedule X was to prevent their incessant use, which could make the disease immune to the drug.
"There was no demand for swine flu medicines throughout last year, because of which we had to destroy lakhs of batches as they had expired," said Adar Poonawala, managing director, Serum Institute of India.
"Even chemists were reluctant to buy the medicines from us because there was no demand."
Oseltamivir and Zanamavir are two key drugs used for treating swine flu. They are manufactured by drug companies such as Cipla, Natco, Hetero and Ranbaxy Laboratories.
Besides, Serum Institute of India manufactures vaccines in the name of Nasovac and Nasovac S, which can also be used as preventive drugs.
Poonawala said it is also the responsibility of the health ministry to purchase the vaccines and keep the demand cycle going. "However, right now, we are back on our production cycle and ready with the new batch, so there is no shortage from our end," Poonawala added.
Comment: The major reason that government is making supply of these medicines restricted is to prevent emergence of drug resistance due to indiscriminate use by panicked population. This will lead to complete lack of response in the cases that actually need the treatment. 

Swine flu scare: No policy by government of India on preventive vaccination for H1N1

The swine flu vaccines cost anywhere between Rs 400 and Rs 1,000 per shot and in the last few days there has been a sudden increase in their demand due to panic over deaths.

Should I travel to india with my family with the current swine flu epidemic?

Hi Dr Gaurav,

My daughter have been visiting you during our trip to India. 
I wanted a piece of advice form you. Is it advisable to travel to India these days in view of the spread of Swine Flu in the country. 
I have a 11 month old son and a 6 year old daughter. 
I really appreciate your advice.

A: Yes, you can certainly travel to India
The number of swine flu cases reported in Jan / Feb 2015 in India are minuscule compared to the population of India, and I would recommend that you take the Influenza vaccine for everyone and come to India,
Dr Gaurav Gupta

Thursday, February 19, 2015

I want to know about Painless vaccines - which should I take for my child?

Query : 
Hi, I would want to know about painless vaccines. My pediatrician had asked if I would like to give painless vaccine and has also asked to decide from prevenar 13 and synflorix. Can you please guide.
A: The so called painless vaccines are actually causing LESS pain and fever, and are NOT completely painless.
Also, there are some studies recently that suggest that the older DPT (DTwP) vaccines are slightly more effective.
Hence, I normally recommend that parents consider taking the regular (DTwP) vaccine as the first dose (at 1.5 months in India) and then if there is a reaction - fever, pain swelling etc., then they can take the painless vaccine the next time onward.
Query : Is it important to give children the swine flu vaccine. My child is 2 years and 2 months.

A: This year, given the large number of cases of swine flu being reported in many parts of the country, I would recommend giving the kids (& adults) Influenza vaccination.

Tuesday, February 17, 2015

Swine Flu vaccine in India - What to do if accidentally given Pediatric dose to an older child?

Q: I am a pediatrician, and I accidentally injected 0.25 ml (Pediatric dose) to my children aged 6 & 7 years yesterday. On reading I found that any child above 3 years age requires Adult dose (0.5 ml). What should I do now?

A: If less than an age-appropriate dose of influenza vaccine is administered it should NOT be counted as valid regardless of the route it was given, and should be repeated.

Questions about Swine flu vaccination in India - from parents and pediatricians !

Q: Can we take the Live Nasal Vaccine (Nasovac) available in India, with other live vaccines like Chicken Pox, and MMR?

A: LAIV can be administered simultaneously with another live vaccine (for example, MMR, varicella), but if not given at the same time, we recommend waiting four weeks before administering the second live vaccine.

Monday, February 16, 2015

Can a pregnant women take the Swine Flu Vaccine in India?

Q: Can a pregnant women take the Swine Flu Vaccine in India? 

A: One of the most important categories where swine flu can cause a lot of complications and even death are pregnant women. Therefore, in most developed countries like Australia, US, UK  & Canada, it is a recommended vaccine (just like tetanus) and ALL PREGNANT Women are supposed to take the Influenza vaccination.
In India too, it is recommended that ALL PREGNANT WOMEN take the Flu vaccine anytime during pregnancy to prevent getting the flu disease for themselves, and also as importantly to protect the unborn baby too. This is because the unborn baby cannot be given the vaccination even after they are born for at least 6 months.
However, care must be taken to only give the injectable inactivated Flu vaccine and NOT the Live nasal flu vaccine during pregnancy.

Vaccination FAQ: Painless DPT in India - any extra side-effects, which to choose ?

Query : 
My son is now 47 days. My doctor gave him painless vaccines {rotavirus1 and PCV1} just today {16th Feb,2015}.
Initially I do not have knowledge on painless and painful type. So after injected those, I searched on internet regarding the effect of painless and painful topic.

I just learned few things. One parents wrote that their daughter is suffering from cold and cough for long days and any doctors were not able to diagnose the exact cause. But after few days one popular pediatrician told them that this is the side-effect of Painless vaccines.

Could you please clarify it. Or I am doing wrong thing by choosing painless vaccine.


Thanks in Advance.
You are not doing any wrong by choosing the painless vaccine.
This is the 'standard' vaccine that almost all children are getting in the developed countries.
There is no evidence to suggest that children get more cold & cough with painless vaccinations, this is incorrect.
The only argument against painless vaccine (other than expense) is that there is some evidence to suggest that the painful vaccine may be slightly more efficacious that the painless one, but for an individual child both options are fine.
There is no additional side effect of taking the Pain-less vaccine.

Thursday, February 12, 2015

Eye tests using smartphones - now an app can do it !

CHENNAI: Eye examinations using scary-looking equipments could soon be a thing of the past as technology has simplified it to an extent that soon eye testing can be done using smartphones.

A team of British eye care specialists have developed an application, Peek (Portable Eye Examination Kit) that turns a smart phone into a comprehensive eye exam tool.

"Over 40 million people suffer from visual impairment in third world countries. While four out of five of these cases can be treated, there are not enough ophthalmologists to identify the problem. The 'Peek' app can revolutionise eye testing as it takes high resolution images at a very low cost," said Dr Mario Giardini from the University of Strathclyde.

The medical expert, who was a part of the UK-India workshop on affordable medical diagnostics and devices, said, "Currently the app has been rolled out at schools in Kenya where masses are tested for cataract and glaucoma. We have plans of launching it in two locations in India, one in Hyderabad, and the other location is yet to be finalised."

Peek uses few simple methods in a smart phone to perform the tests. The phone's camera can be used to scan the lens of the eye, while the LED flash would illuminate the retina. An adaptor that can be clipped over the camera of the phone allows doctors to see inside an eye and capture images that can be sent to experts for diagnosis.

Dr Giardini said the app is very simple to use and even people without healthcare backgrounds can be trained to use the kit. "Another feature of the app is geo-tagging. The phone's GPS can be used to mark the location of someone the team has examined, so they can follow it up later," said the expert. All the data can be compiled into a patient record and sent wirelessly to a doctor.

However, Dr Giardini added that while 'Peek' can supplement eye testing, it can never replace a doctor.
For more information on how technology and wearable devices are changing healthcare you can view my presentation here

Wednesday, February 11, 2015

How long is a person with Swine Flu contagious, I may have come in contact with a person who had cold & cough...... ?

For most people, if they are not in direct contact with a case of swine flu, the chances of transmission are less. 
However, People who have swine flu can be contagious one day before they have any symptoms, and as many as 7 days after they get sick. Kids can be contagious for as long as 10 days.

Tuesday, February 10, 2015

My son has been diagonsed as possible Swine Flu - Category B, however Tamiflu (Oseltamivir) syrup is not available in India, what do I do?

Here is a CDC guideline that can help.

Opening and Mixing Tamiflu® Capsules with Liquids if Child Cannot Swallow Capsules

December 1, 2009 4:00 PM ET

Is there a shortage of oral suspension (liquid) Tamiflu®?

The Food and Drug Administration (FDA) and the maker of Tamiflu® (Roche) Adobe PDF fileExternal Web Site Icon have said that available supplies of liquid Tamiflu® for children are limited.

What is being done about this?

A pharmacist can make a Tamiflu® suspension (liquid) using available Tamiflu® adult capsules, which are not in short supply. CDC has alerted pharmacists about this option and provided instructions on how to prepare a suspension using adult capsules. Some pharmacies, including some chains, can do this already, others are not yet prepared. Children’s doses of Tamiflu® are also available in capsules.

What can I do if my child cannot swallow capsules?

If your doctor prescribes Tamiflu® capsules for your child and your child cannot swallow capsules, the prescribed capsules may be opened, mixed with a thick sweetened liquid, and given that way. 

What liquids can I use?

A thick sweetened liquid, such as regular or sugar-free chocolate syrup, that masks the flavor of the medicine can be mixed with the contents of the Tamiflu® capsule. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine. The child should consume the liquid mixture entirely. 

If my child can’t swallow capsules, how do I open Tamiflu® capsules and mix the medicine?

Pour a small amount (about a spoonful) of the thick sweetened liquid into a cup or bowl. Carefully open the Tamiflu capsule prescribed by your doctor and pour out all of the powder inside the capsule and mix it into the liquid. The exact amount of liquid used doesn’t matter, as long as the powder inside the capsule is mixed in well. All of the medicine may not dissolve, just be sure it is all well mixed. Use only the prescribed dose. 

What will I need to do this?

You will need
  • The prescribed Tamiflu® capsule
  • A small bowl or cup
  • A spoon
  • A spoonful of a thick sweetened liquid, such as regular or sugar-free chocolate syrup

How do I mix the ingredients?

  • Pour a small amount (about a spoonful) of the thick sweetened liquid into a cup or bowl.
  • Holding one capsule over the bowl, carefully pull the capsule open and pour the complete contents of the capsule into the bowl.
  • Stir the mixture and give the entire dose to the child with a spoon.

Should my child take all of the mixture??

Yes, make sure your child takes all of the medicine mixture.

For additional information see:

CDC: Caregiver Instruction Sheet: Opening and Mixing Tamiflu® Capsules with Liquids if Child Cannot Swallow Capsules 


Monday, February 09, 2015

Where can I get tested for Swine Flu in India, I am worried about the recent increase reported from all across India, including Hyderabad, Ajmer, Pune, Delhi, Gujarat & Punjab, Haryana & Chandigarh etc. ?

It's hard to tell whether you have swine flu or seasonal flu, because most symptoms are the same. People with swine flu may be more likely to feel nauseous and throw up than people who have seasonal flu. But a lab test is the only way to know for sure. 
The lab test is done by a throat (nasopharyngeal) swab test. This is available in many government hospitals across the country. 
Most private labs are not allowed to test for Swine Flu in India since apparently the government is concerned that a lot of positive reports may lead to panic in the general public. 
Similarly Tamiflu, the medicine that works in Swine Flu is also not generally available except through the government sources, to prevent misuse and development of resistance.
Certain corporate hospitals are an exception to this, and they are allowed to do the Swine Flu test for their admitted patients, and are also allowed to stockpile Tamiflu for indoor patients. 

How do I get the swine flu, I am worried since I reading reports that it is spreading in India?

How do I get the swine flu, I am worried since I reading reports that it is spreading in India?
Swine flu is a viral infection. It is contagious, and it spreads in the same way as the seasonal flu. When people who have it cough or sneeze, they spray tiny drops of the virus into the air. If you come in contact with these drops or touch a surface (such as a doorknob or sink) that an infected person has recently touched, you can catch H1N1 swine flu.
Despite the name, you can't catch swine flu from eating bacon, ham, or any other pork product.

What are the common symptoms of Swine Flu, currently spreading in India?

Most symptoms are the same as seasonal flu. They can include:

  • cough
  • fever
  • sore throat
  • stuffy or runny nose
  • body aches
  • headache
  • chills
  • fatigue

Like seasonal flu, swine flu can lead to more serious complications, including pneumonia and respiratory failure. And it can make conditions like diabetes or asthma worse. If you have symptoms like shortness of breath, severe vomiting, abdominal pain, dizziness, or confusion, call your doctor.

The important thing to remember is that in most cases the diagnosis is only suspected if there is HIGH FEVER (generally more than 102 F) with LOT OF COUGH & SEVERE BODY ACHES.
So you do not need to run to the doctor or start panicking if you have low grade fever with some throat pain & runny nose, this is not swine flu !

Saturday, February 07, 2015

How can I protect myself from getting Swine Flu ?

There are steps you can take in your daily life to help protect you from getting the flu.
  • Wash your hands often with soap and water or an alcohol-based hand rub.
  • Avoid touching your eyes, nose, or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.
  • Please remember, the vaccination against Flu (Seasonal Influenza vaccination) is the BEST way to protect you against the Flu disease, especially against Swine Flu, since it contains the Swine Flu strain (H1N1).

CDC: Intranasal flu vaccine didn't shield kids from H1N1 last season

We now have the LAIV - Live Flu vaccine by the name of NASOVAC - S (Serum Institute of India). The data regarding the usefulness of this vaccine is still coming in. Here is a report that is of some possible relevance to us, since we in India are having a large number of H1N1 (Swine flu) cases currently.
This past summer when influenza experts at the Centers for Disease Control and Prevention (CDC) went over all their data on flu vaccine effectiveness (VE) during the 2013-14 flu season, they found a big surprise: The nasal-spray vaccine was ineffective against H1N1 viruses in young children—the group in which the vaccine was expected to be most protective.
Past studies had suggested that the intranasal vaccine, also known as live-attenuated influenza vaccine (LAIV) and commercially as FluMist, worked especially well in children 2 to 8 years old. Those findings prompted the CDC in June of this year to preferentially recommend LAIV over inactivated influenza vaccine (IIV, the injected kind) for children in that age-group.
In a statement yesterday about the unexplained new findings, the CDC said they mean that LAIV may not protect kids against H1N1 viruses in the flu season now starting, because this year's vaccine uses the same H1N1 virus as last year's product.
But the agency decided not to change its current preferential recommendation about LAIV now, in the middle of the vaccination season, for several reasons. Among other things, the agency said the vaccine has been shown to provide good protection against A/H3N2 and influenza B viruses in the past and that H1N1 viruses seem scarce so far this season. Also, vaccine providers have already received their vaccine supply for this season and have administered a good share of it.
The American Academy of Pediatrics (AAP)—which has not preferentially recommended LAIV over IIV for children—likewise is leaving its flu vaccine recommendations unchanged for now. In a statement yesterday about the CDC findings, the group said any licensed, age-appropriate flu vaccine should be used.

Data presented at ACIP meeting

CDC officials presented their data on low effectiveness of LAIV in children at last week's meeting of the Advisory Committee on Immunization Practices (ACIP), which advises the agency on vaccine guidelines. The ACIP decided to stick with the current recommendation for now, said Alicia Fry, MD, a medical epidemiologist in the CDC's Influenza Division.
"Everyone was concerned but nobody thought it was time to change the recommendations so rashly," she told CIDRAP News. "We're continuing to try to understand this. And I'm sure MedImmune [manufacturer of FluMist] is doing a lot of work to try to figure it out."
In yesterday's statement, the CDC noted that its interim estimates of flu VE for 2013-14 were published in February. That report, based on studies by the agency's five-site US Flu VE Network, estimated the combined effectiveness of all flu vaccines against H1N1 in children at 67% (95% confidence interval [CI], 51%-78%). It didn't give a separate estimate for LAIV effectiveness for H1N1.
The CDC said the final overall VE estimates were similar to the interim figures. But end-of-season data that were evaluated during the summer permitted separate estimates for LAIV and IIV. "During 2013-2014 there was no measurable effectiveness for LAIV against influenza A(H1N1) among children enrolled in the study," the agency said.
Fry said the CDC's confidence in its ability to compare the effectiveness of LAIV and IIV has grown in recent years as the share of children receiving LAIV has increased.

Similar findings elsewhere

"In the summer when we ran the analysis we were very surprised," she said. "The first thing we did was double check everything. Then we let the ACIP working group know. And because this is an observational study, we reached out to our partners in the US and abroad to see if anybody else doing vaccine effectiveness analysis" had similar findings.
As it happened, both MedImmune and the US Department of Defense had done VE estimates, and they came up with similar results for LAIV versus H1N1 in children, she said. "That gave us a lot more confidence that this was maybe a true signal that we had to take seriously," she added.
Fry said the low effectiveness against H1N1 was clearest in children aged 2 through 8 years, because most of the LAIV recipients were in that group. "We did see the same result in ages 9 to 18, but the numbers are smaller and it's hard to say for sure."
When analysts compared LAIV and IIV effectiveness for all flu types in the younger group over the past three flu seasons, they found that LAIV fared better in the 2011-12 and 2012-13 seasons, according to CDC slides presented at the ACIP meeting. But in 2013-14, IIV appeared to be far more protective: LAIV recipients were more than five times as likely to contract flu as were IIV recipients.
Edward Belongia, MD, director of the Epidemiology Research Center at the Marshfield Clinic Research Foundation in Wisconsin, participates in the CDC's US Flu VE Network and also researches flu VE for MedImmune, using separate populations. He said the 2013-14 flu season offered the first good opportunity to compare the performance of LAIV and IIV, because H1N1 was the predominant strain and more children were getting FluMist.
Belongia said the MedImmune study showed that LAIV was effective against influenza B, commenting, "This seems to be a specific issue with H1N1, not an overall problem with the entire vaccine."

No explanation for findings

Just why the vaccine had low effectiveness against H1N1 is a mystery. The CDC statement said, "It is possible that results may be specific to the H1N1 component of LAIV. Influenza H1N1 viruses predominated during the 2013-2014 season for the first time since their emergence in 2009 when they caused a pandemic. It also is possible—though less likely—that there is an unidentified issue with the study methods or analysis plan."
Belongia said two studies published this year suggest that some characteristics of the hemagglutinin in the H1N1 virus used in LAIV could affect its thermal stability and therefore its ability to replicate, which in turn could affect its immunogenicity.
He also observed that the clinical trials that were the basis for the ACIP's recommendation in favor of using LAIV in young children were conducted a decade or more ago, well before the 2009 pandemic, which marked the emergence of the current seasonal H1N1 virus. One study during the pandemic found that the monovalent pandemic H1N1 vaccine was about 55% effective in young children, but the finding was not statistically significant, he added.
"Another thing that's different now is that now most children are being vaccinated year after year, so the majority of children that got LAIV were also vaccinated the previous year," Belongia said. "That was almost certainly not the case back when they did the trials. Whether that's important or not, I don't know."
The MedImmune data presented to the ACIP indicate that the vaccine's low effectiveness against H1N1 was specific to certain production lots. The presentation included a slide showing that vaccine shipped during weeks 4 through 9 of the shipping season had –49% effectiveness, whereas doses shipped earlier or later had an effectiveness of 83%.

Reasons for staying the course

The CDC cited four reasons for leaving the current flu vaccination advice unchanged in the face of the LAIV findings:
  • "Surveillance shows that there is substantially more circulation of influenza A (H3N2) and B viruses and very little circulating H1N1 so far;
  • "LAIV has been shown to offer good protection against influenza A (H3N2) and influenza B viruses in the past;
  • "LAIV may offer better protection than IIV against antigenically drifted viruses that may circulate this season; and,
  • "Vaccine providers have received their vaccine for the 2014-2015 season and have likely administered a good proportion of it."Fry put it this way: "We think that for this year, given the surveillance data, we'll be OK. LAIV should be fine for the viruses that are circulating, and by next February we should have more clear guidance to offer."
Belongia agreed with the decision. "The timing here is not great, but the world of influenza is unpredictable and nobody saw this coming 6 months ago. Given what we know—and there are still a lot of unanswered questions—I think the recommendations from the CDC and AAP are exactly right. As new information accrues it will be re–looked at."
The AAP statement said this season's LAIV is "unlikely" to protect against H1N1, since it uses the same virus as last year's version. But on the basis of previous studies, it said, LAIV is expected to protect against H3N2 and type B viruses related to those in the vaccine "and may offer better protection against drifted strains of influenza viruses than IIV."

Common myths regarding Swine Flu in India - I am a vegetarian, can I get Swine Flu disease?

Q: I am a vegetarian, am I still at risk for getting swine flu disease?

A: Surprisingly, with the recent spurt in the cases of Swine Flu, this is the most common question that I am getting from parents/ patients.
Swine flu started with a farmer being infected due to an infection spread from a pig. the virus mutated in the body to become the Swine flu virus. This happened many years ago in Mexico.
Since then pretty much all cases of swine flu are transmitted by humans, form one person to another through coughing, sneezing, shaking hands etc. and the pigs are nowhere in the picture.
So whether you eat non veg or not, you are at risk for Swine flu, if it is circulating in your community. In India, at present there are quite a few cases being reported and over 160 deaths have been reported in Jan 2015 already. Hence I am recommending that my patients and their parents consider taking the Seasonal Flu vaccine that contains the Swine Flu (H1N1) strain.

Thursday, February 05, 2015

Swine Flu H1N! comes back to India in 2015 - get vaccinated !

Swine Flu or influenza  caused by H1N1 type of virus is a particularly dreaded form of influenza and carries with it significant amount of morbidity and mortality. This can be prevented by regular hygiene measures and by taking annual shots of the flu vaccine.  
More than 191 deaths due to Swine Flu have already been reported in the month of Jan 2015 in India (source)
This relatively inexpensive vaccine can readily prevent swine flu and influenza due to other viruses and is recommended in all individuals more than six months of age. For booking an appointment for the flu shot either contact your family physician or get appointment here
You can read more about cases of Swine flu & it related news in some of these links

Wednesday, February 04, 2015

Swine Flu claims 3 more lives in Gujarat

Swine flu claimed three more lives in Gujarat, taking the total number of disease-related deaths in the state to 45 so far this year, said a senior government health official on Tuesday.

State Health Commissioner J P Gupta said that, "Three persons died due to swine flu, one 

each in Surat, Banaskantha, and Anand districts, while 35 new cases were registered today."  

Total 355 persons were tested positive for the H1N1 virus. Out of this, 149 patients have been 

cured and 161 patients are still undergoing treatment. The toll has climbed to 45 in the state so 

far this year. 

According to the official data, fresh cases of swine flu have been reported from Kutch (11), 

Ahmedabad (7), Vadodara (5), Surat (4), and Junagadh (2) districts today. 

Gupta added that one case each was also reported from Rajkot, Amreli, Panchmahal, Dahod, 

Mehsana, Anand, and Bharuch districts today. A team of experts from Delhi has also visited the  civil hospital in Ahmedabad city to take stock of situation of swine flu, sources said. 

Read more: Swine Flu Claims Three More Lives in Gujarat