Vitamin D prevents Influenza A in Children-randomized trial results

The results of a double blind randomized trial, just published in the American Journal of Clinical Nutrition, is the first definitive evidence that vitamin D3 supplementation actually reduces the incidence of influenza A viruses in children. (H1N1 is influenza A, as is H5N1.) Especially so in kids with asthma.
Check out the abstract in the AJCN website, "Vitamin D".

Two Doses of H1N1 vaccine better for children

Here are the findings, in CIDRAP's News of yesterday. Still, if you can get just 1 dose for your child it's worth it, as the first dose confers some immunity and will probably make the flu less virulent in him/her. (This from a non-doc, mind you.)

New CDC guidelines for Docs for H1N1 treatment

I'm following the University of Minnesota's CIDRAP website for interesting news about H1N1. Yesterday's postings were very useful! They put to rest a lot of rumors about vaccine safety etc. One entry alerted me to new CDC guidelines just put out for doctors to follow in diagnosing and treating suspected H1N1 cases. CDC says these are NOT for laymen, but they're just not that hard for a layman to understand! And saying that assumes that every doctor in the world is going to be right up to speed on the latest. So, here they are for my fellow laymen for easy reference: CDC H1N1 Guidelines

Good news on H1N1 Vaccine Front-No adjuvant

I've been wondering what the fast-track approval of H1N1 vaccines would mean for vaccine safety. Today, Andrew Pollack's article in the NY Times, "Benefit and Doubt in Vaccine Addititve," assured me that USA isn't planning to approve any vaccines with adjuvants this go-round. That means the safety concerns associated with fast-tracking the approval aren't an issue. Only question now is whether the vaccine will arrive before the flu itself does.

Does washing hands help stave off flu?

Here's an interesting Newsweek article that suggests hand washing isn't likely to be effective in preventing the spread of flu. Won't hurt, experts say, but it could make people -- especially kids -- complacent, when it's transmitted through the air. That Elmo trick of sneezing and coughing into your elbow seems to be a better tactic.

Latest on H1N1 status

College campuses are already sites of mini-epidemics, and a friend's workplace in California has had a rash of cases in the past 3 days. With schools starting, we should expect H1N1 to ramp up fast.
My favorite source of info on H1N1, and up-to-date info on whether and how it's changing, lethality, etc., is CIDRAP at the University of Minnesota. Here's a link to CIDRAP's latest info (as of yesterday-Friday Aug 29). Good news is that the virus hasn't mutated. Bad news is that some young healthy people are getting serious viral pneumonia, that MUST be treated fast. Good news is that resistance to main anti-viral drug (Tamiflu (tm)) is still isolated and rare. But, getting care right away if lower respiratory tract is involved is important!
For a list of signs and symptoms of serious swine flu infection, see my posting of Aug 1, 2009,
Check into my posting of June 26 for information on what you should expect your physician and hospital emergency room to do when you do seek care..

Warning Signs of Serious Swine Flu in all patients

WHO just published guidelines for patients to know whether and when H1N1 (aka swine flu) influenza has turned nasty and now requires immediate attention by medical professionals. The title is "pregnant women", but scroll down to last section, which deals with all patients. Here they are for easy access in the coming months (September and later) when the swine flu is expected to hit USA hard again.

Canada to study Vitamin D and Swine Flu!

One of the things I learned from doing medical technology assessment is that Canada is a country filled with epidemiologists. Even family practitioners get masters degrees in epidemiology. At conferences, they introduce themselves as "family practitioner and clinical epidemiologist." In the USA, by contrast, epidemiologists are often considered the weirdos of the medical profession. (Why would anyone waste their precious brains on such dumb stuff when you could be stapling stomachs?) Epidemiology is the systematic study of disease in populations. Not the study of stapling technique in gastric surgery.
So, I guess I should not be surprised that the Canadians have taken the lead in using the current Swine flu epidemic to examine the link between flu severity and VITAMIN D! Just learned from CIDRAP (my favorite source on everything infectious, run by American epidemiologists, of course) that the Canadian Public Health Agency will be testing people with Swine Flu for their Vitamin D levels to determine whether those who do badly have lower levels. The Toronto Globe and Mail had a very nice article on it. Canada's press release was a little broader than just Vitamin D, since they'll also be looking for genetic factors. But, the very fact that they will actually use the current epidemic to get some info on Vitamin D and influenza is a reflection on the sophistication of Canada's approach to health research and policy. If Vitamin D actually turns out to provide some protection, as some scientists believe, it's the kind of low hanging fruit for cost-effective medicine that we need if our President's promises of lower cost health care are ever to be remotely approached. (He should stop promising that, anyway.)

What your doctor should know to do about Swine Flu

Sister Janet tells me that Swine Flu (or, if I were more PC, "novel H1N1") is the scourge of the Chicago area right now. Probably everywhere, but who's counting? While number of cases reported seems low, that's because little testing is going on. So, anyway, suppose you or your kid gets sick with flu like symptoms, especially including gastro stuff (almost 40% of cases), here are two good guidelines for how you should be handled by doctors and emergency rooms. These are intended for doctors, but I can read them, so you can too. We should, having lived long enough by now, know that doctors and hospitals don't always follow best practices (witness the high rates of hospital-acquired infections in this country!)

• First is World Health Organization's Patient Care Checklist. You can take it with you to the ER and keep yourself occupied while waiting to be seen.
• Second is the CDC's guidelines for use of anti-viral drugs in children and adults.

I got these sources from the University of Minnesota's CIDRAP daily on-line newsletter. If you're a health nut, you'll really enjoy getting it too. I knew about the Nestle's chocolate chip cookies real fast.

Face Masks and Swine Flu

My earlier questions (May 7 post) about whether face masks will be available if the "novel H1N1" (aka Swine!) flu becomes more Spanishy over time has been answered by an excellent article in today's Time Magazine. (We'll miss the mainstream news media, won't we?) "New Pandemic Fear: A Shortage of Surgical Masks".
Short answer -- yes, they'll be in shortage, but maybe they don't work anyway. All I know is that I rub my nose a lot, and having something between my hands and it would be a good thing in an airplane, or anywhere in public, for that matter. Hand sanitizer is still a must, of course.
Friend Linda (a true health policy wonk--some of you know her) shared 2 N95 masks with me on my last plane trip -- which I still have (thankyoulinda) -- and also shared the following email (from May 7) from a major distributor of N95 masks :
The N95 mask that you are looking for is on a manufacturer backorder currently. We do have a similar N95 mask. It is from Kimberly Clark. Our item # is 153-4801. The difference is it is slightly smaller and a little different shape, but still is N95 equivalent. It is on page 261 of our catalog. It comes 35/box and the price is $40.79/box. Please take a look at that mask in our catalog. If you do not have a catalog, please visit our virtual catalog on our website at www.henryschein.com.
So, there you have it. Info on whether the gov't is ready (no), and a ready source (at least as of May 7) of N95 masks.
Hope I don't have to retract this post. It's so embarrassing.

Vitamin D & H1N1 - Revisionist thinking

In the past I've admitted to family and close friends to having moved from analyst to advocate in my enthusiasm over Vitamin D. But, as with all believers, I was blinded by the (sun) light! My guru was a California psychiatrist -- John Cannell, head of the Vitamin D Council, an unabashed champion of Vitamin D. His articles reviewing the evidence linking Vitamin D to protection from colds and flu, as well as the recent evidence in the medical literature, have stoked my enthusiasm.

Today, though, I received the May Newletter of the Vitamin D Council, and there's been a lot of learning and backtracking on Dr. Cannell's part regarding the interaction between Vitamin D and influenza, especially pandemic influenza. So, as the queen of retractions, I must say that my enthusiasm was premature. New evidence from Russia, he says, shows that high blood levels of vitamin D (say 50 ng or higher) may reduce the efficacy of influenza vaccines. He seems to suggest that a CDC researcher has known about this for 5 years but neglected to tell him. Well, my good Doctor, you should share in the embarrassment that I feel in telling all my friends via this blog to slather up in D. CDC has no obligation to contact either you or me just because we blog.

I'm now somewhat suspicious of Dr. Cannell's revisionist recommendations regarding the use of Vitamin D in a pandemic. He's still a proponent -- only now he says you must bathe yourself in it to the tune of 5000 IU per day in order to get the preventive benefits, and taking a mere 2000 IU might actually make things worse! And, then he says if you get the flu, immediately take 50,000 IU for a few days running. Read for yourself, and judge.

Still, it's important for you to know your Vitamin D status, and Vitamin D is important for bone health (as I found out much to my permanent dismay) as well as for other diseases.

I'm still on a regimen of high vitamin D and will continue. That's because I have such low levels naturally that I must bathe myself in it anyway. But, for now I'm through pretending that I've seen the enemy and it's Vitamin D deficiency. Mea culpa (as usual).

Swine Flu, Air Travel, and Me

Few people could match me in vigilence about infectious diseases. I follow the great University of Minnesota CIDRAP web site, which sends a daily email newsletter on what's going on in the world of infectious diseases, from flu to food-borne infections. I have a lifetime supply of Purell hand gel, bought back in the days of anthrax (CBO's building was closed for over a month). And, I have a supply of surgical masks and gloves (though no surgical knives). And, I follow my own advice about the importance of Vitamin D in maintaining innate immunity against flu and colds.
So, when I made a weekend trip to Austin, Texas on Saturday, you would think that I would have worn a face mask on the plane. But, no! I did have two with me (one for each way), but I never took them out of their bag. Why not? I would have felt very silly as the only person on the whole plane wearing a face mask. And, they're a nuisance, too. On the plane to Austin, there were almost no coughs (yes, I did monitor coughs), but on the way back the plane was full of hackers. Even then, I was not tempted to bring out the mask because I figured it would be too late anyway if any of those coughers were swine babies. And, I'm not young, and I take 2000 IU of Vitamin D every day. So, I felt I'd done enough.
From this I conclude that Americans will not use masks unless they are required to do so as a matter of policy. The government, or the airline, or the airport authority must require (or strongly suggest) the use of masks to get people to act defensively. And, they probably would have to provide them as well.
In Japan people wear masks on the street whenever they have colds; it's considered the polite and socially responsible thing to do. Everyone was wearing masks in Tokyo last week. We are not Japanese.
I need to do research on whether the US government is stockpiling masks for distribution should the need arise. Do airlines have emergency stocks to allow for continued operations during flu season?
Nobody seems to know what will happen to the swine flu after the sun disappears this fall, or whether it will grow in lethality. The government is doing a good job agonizing over whether to produce a vaccine for the fall. I have a lot of faith in those decisions. But I still think it would be good for individuals to invest in some N95 face masks, a big supply of Purell (which flew off the shelves of my supermarket last week), and after labor day, a daily supplement of Vitamin D (1000 IU per day should do it until flu starts to arrive, unless you're deficient. Are you? Bet you don't know. )

Follow the Swine Flu Map in almost real time

One of my favorite bird flu sites, from Recombinomics, is posting a very up to date google map showing where the outbreaks are occurring worldwide. Here is the Recombinomics Swine Flu Map for today. Also, Dr. Niman, CEO of Recombinomics, has a good on-line press conference, (esp. see 18 minutes-19 minutes for who's really at risk-- the healthy young adults-- mainly because of their robust immune systems.)
And, remember your 2000 IU of D3 today! Vit D IS A HORMONE THAT ACTS AS AN IMMUNE MODULATOR. See my post of 2 days ago for info on flu and Vit D.

Swine flu -- time to up your Vitamin D dose

We're at the end of a long winter and cold spring, so our vitamin D stores are probably low. Now, along comes that "worrisome" (to quote CDC) swine flu out of Mexico. See University of Minnesota's CIDRAP for daily updates on current status. It won't be long -- another week at most -- before we find out just how virulent that influenza virus is. And it won't take long to spread, given all the wonders of globalization. So, now is the time to douse yourself with sunlight EVERY DAY for at least 15 minutes (assuming you can be in shorts and sleeveless), and if that isn't available to you, to take D3 supplements. I'm no doctor, but some are recommending 1000 IU or 2000 IU a day. The Vitamin D Council's John Cannell, MD wrote a very readable article about the evidence relating influenza to Vitamin D deficiency in 2006. It gives some guidance on dosage, both as a daily preventive, and as a supportive approach to limiting flu symptoms. Over the short run (several months), these doses are generally agreed to be benign.
For a recent update on the link between Vitamin D and colds and flu, see Scientific American's latest article, "Vitamin D deficiency linked to more colds and flu," summarizing the study recently announced by the Massachusetts General Hospital, and highlighted in my Jan 25 post on the subject.