Vote signs outside Palm Beach County Public Library polling station during the 2020 presidential election in Palm Beach, Florida, U.S., November 3, 2020.Marco Bello | Reuters The measure passed with more than 60% support despite Trump’s projected victory in the state with more than 51% of the vote.Labor advocates did not get all good news from ballot initiatives Tuesday. California voted Tuesday that Uber and Lyft should be exempt from a law that would make drivers employees instead of contractors.Subscribe to CNBC on YouTube. – Advertisement – – Advertisement – Florida voted Tuesday to gradually hike the state’s minimum wage to $15 per hour, joining a growing list of states and municipalities in taking the step.The 2020 election ballot initiative garnered the 60% support needed to pass, according to the Associated Press. Florida becomes the eighth state to approve a $15-an-hour minimum wage, and the second most populous to do so.The measure would increase the state’s current $8.56-an-hour pay floor to $10 next year. For every year after that, the minimum wage would rise by $1 an hour until it hits $15 in 2026.- Advertisement – Labor advocates have long argued to raise minimum pay to what they call a living wage. The movement has gained traction across the country: the House passed a federal $15 per hour minimum wage last year, and Democratic presidential nominee Joe Biden supports the policy, as well.Still, many businesses in Florida have argued against increasing the minimum wage. President Donald Trump has said states should make the decision.John Morgan, a wealthy personal injury attorney, put millions of dollars into the effort to get the initiative on the 2020 ballot.- Advertisement –
Bryan Koehler, 55, manages a brewery with two locations in rural Western Pennsylvania, deep in the heart of Trump Country. A Republican who is aghast at how Mr. Trump has run things, Mr. Koehler keeps his opinions mostly to himself at the brewery and at the regular card games with old friends. They surely know what he thinks. But they also know not to ask about it.“It’s like there’s something there that’s nagging that’s not right, the world’s not spinning the right way,” he said of living among people who see the world so differently. “And you ask yourself, ‘What am I missing here? Should I be seeing the world a different way?’”Still, he does not see his beliefs about right and wrong changing, anymore than he sees his friends coming around to his views. And now, after this election reinforced what the half of the country he lives in truly wants, he will say even less.- Advertisement – “Get up tomorrow and keep going,” he said, by way of self-advice. “Take care of the things that you need to take care of over the next four years. And hope we start to head in a different direction.”Audra D. S. Burch reported from Hollywood, and Campbell Robertson from Erie, Pa. Reporting was contributed by Caitlin Dickerson from Brownsville, Texas, Manny Fernandez from Houston, Kay Nolan from Pewaukee, Wis., Traci Angel from Independence, Mo., and Louis Keene from Los Angeles. “I feel like this is the beginning of something to the tune of the 1960s with massive protests in the streets, and maybe something close to violence,” he said. “There is just so much outrage that has been building over the last four years, and the skeletons are falling out of the closet.”One of the main diagnoses of our national discord is that the warring halves of the country live and work in different places and watch competing news shows. But this is not entirely the case. There are plenty with strong views who have found themselves living among the other half.- Advertisement – – Advertisement –
The window of opportunity to broker a resolution to the conflict is very narrow, and, given the emotions on both sides and shattered status quo, getting Baku and Yerevan to agree on anything looks like an impossible mission. The victorious Azerbaijani military was supplied, trained, and supported by the Turkish army. Some reports suggest that Turkish officers played a key part in guiding drone attacks which played a decisive role in this conflict, although that has been denied by Ankara.
May 26, 2004 (CIDRAP News) – An analysis of thousands of samples of appendix tissue in the United Kingdom (UK) suggests that the number of future cases of variant Creutzfeldt-Jakob (vCJD) disease there could turn out to be higher than expected.In examining tissue samples from thousands of patients who underwent appendectomies and tonsillectomies, researchers found three appendix samples with an accumulation of abnormal prion protein, the misfolded protein associated with the brain-wasting disease. The finding suggests the patients had preclinical cases of vCJD, according to the report in the Journal of Pathology.If the prion protein accumulation predicts vCJD—which is not certain—the finding suggests that about 3,800 young people in Britain may be incubating the disease, the report says. That compares with a recent estimate that only 540 more cases would occur there.Eating meat products from cattle with bovine spongiform encephalopathy (BSE), or mad cow disease, is believed to be the cause of vCJD. The emergence of vCJD in Britain in the 1990s followed a large number of BSE cases in British cattle herds starting in the late 1980s. The UK Department of Health reports that 141 people in the UK have died of vCJD, which can be definitely diagnosed only after death.The report by David A. Hilton of Derriford Hospital in Plymouth, UK, and colleagues says that an accumulation of prion protein in the lymphoreticular system has been found in all cases of symptomatic vCJD examined so far. In addition, prion protein was found in appendix tissue from two patients before the onset of vCJD symptoms, according to an earlier report.To look for signs of a large vCJD epidemic, the authors examined appendix and tonsil samples from 16,703 patients across Britain. The study included 14,964 appendix specimens, mostly from patients in their 20s (the age-group at highest risk for vCJD), and 1,739 tonsil specimens from patients of all ages.The investigators used an immunohistochemistry technique involving monoclonal antibodies to detect abnormal prion protein in the samples. About 25% of the samples were excluded from the final analysis because they didn’t contain enough lymphoid tissue. None of the tonsil samples tested positive for abnormal prion protein, but 3 out of 12,674 appendix samples did.If the findings are a reliable sign of preclinical vCJD, “the estimated prevalence of vCJD based on these three positive samples in 12,674 tested will be 237 infections per million population” (95% confidence interval [CI], 49 to 692 per million), the report states. The best estimate based on this is that 3,808 Britons between the ages of 10 and 30 (who accounted for 83% of the sample) are incubating vCJD, the article says.The pattern of staining seen in one of the three samples was similar to that seen previously in appendix tissue from two patients who later fell ill with vCJD. In the other two cases the staining pattern differed somewhat from that seen in previous known cases. If only the one case with the similar pattern is considered to predict the disease, the estimated prevalence of preclinical cases is 79 per million people, the report says. “In contrast to these high estimates, clinical case numbers remain at a much lower level and have been declining since 2000,” the authors note.The report says it is not certain that the accumulation of prion protein in lymphoid tissue is a true marker of preclinical vCJD. The phenomenon has not been seen in any other disease, but there are some possible alternative explanations for it, they write. No further investigation of the positive cases was possible, because the study was designed to keep the patients anonymous.People with subclinical vCJD could pose a risk to others because the disease can be transmitted via surgical instruments and possibly by blood transfusions, the article says. “Our findings therefore reinforce the importance of recent steps taken by the Department of Health to reduce these potential risks,” it states. The findings also point to a need for prospective screening of tissue from tonsillectomies, the authors write.Hilton DA, GhaniAC, Conyers L, et al. Prevalence of lymphoreticular prion protein accumulation in UK tissue samples. J Pathol 2004;early online publication [Abstract]
At a news conference, Nabarro, 56, said he was nearly certain that a pandemic will erupt soon and predicted it could kill anywhere from 5 million to 150 million people, according to a Reuters report. Dr. David Nabarro, a British public health expert with the World Health Organization (WHO), was named to the new job of “UN system coordinator for avian and human influenza.” The WHO said today that, because of increased surveillance in the country, “growing numbers of people with respiratory symptoms or possible exposure to the virus are being admitted to hospital for observation and, when appropriate, treatment.” Many of the patients don’t have symptoms compatible with H5N1 infection, the agency said. See also: Testing at the WHO reference laboratory in Hong Kong confirmed the woman’s case, the WHO said. The agency said she had had contact with sick and dying chickens in her household shortly before she fell ill. He said that if the virus starts to spread, the nature of the world’s response will determine whether it ultimately kills as few as 5 million or as many as 150 million, Reuters reported. At the news conference, Nabarro warned it is “very likely” that the H5N1 virus will soon acquire the ability to spread readily from person to person, according to the Reuters report. “I am almost certain there will be another pandemic soon,” he was quoted as saying. Nabarro said he would run a new UN office in New York that will begin working with governments, international agencies, health workers, and the drug industry, Reuters reported. Sep 29, 2005 (CIDRAP News) The United Nations today signaled a new level of concern about avian influenza and the risk of a flu pandemic by naming a special coordinator of all UN responses to the situation. According to an Agence France-Presse (AFP) report, Nabarro warned that the world will have only “a matter of weeks” to respond after a pandemic begins to erupt and before it gets out of control. He said health agencies will have to fight the virus with the antiviral drug oseltamivir and the most potent vaccines available. The story said he expressed particular concern about the possibility that migratory birds will spread avian flu to the Middle East and Africa. An outbreak in poor, war-torn parts of Africa, such as Sudan, could lead to “a nightmare scenario,” he commented. Meanwhile, an AFP report today quoted an Indonesian health official as saying the country has had a total of 63 confirmed and suspected avian flu cases so far this year. But the official, who spoke on condition of anonymity, said only 5 of the 63 cases were confirmed, while 9 were probable and the rest were suspected. News of Nabarro’s appointment came as the WHO said further tests had confirmed earlier reports that a 27-year-old Indonesian woman who died Sep 26 had H5N1 avian flu. In the WHO announcement, WHO Director-General Dr. Lee Jong-Wook stated, “The world is responding [to the pandemic threat], and is moving quickly to get prepared. However, coordination of these efforts is critical to ensure all stakeholders are giving the best of what they have to offer, and that countries receive the support they urgently require.” Indonesian officials said on Sept 26 that the Jakarta woman and a 5-year-old girl who died last week both had tested positive, though test results for the girl were inconsistent. The WHO statement today didn’t mention the girl. Indonesian casesIn Indonesia, the 27-year-old Jakarta woman represents the fourth avian flu case that the WHO has recognized as confirmed. The government has cited a few other cases as confirmed or probable, including those of the 5-year-old girl and two young daughters of a 38-year-old man who died of avian flu in July. Nabarro calls pandemic very likelyNabarro was appointed by UN Secretary-General Kofi Annan. In announcing the news, the WHO said, “The appointment is critical as the world is fast recognizing the risk of an imminent human influenza pandemic, and is taking steps to reduce the risk and to get prepared.” Nabarro was described as one of the agency’s most senior public health experts. A Reuters report today quoted Indonesian health officials as saying the country has more than 50 suspected avian flu cases. Three days ago officials had put the number of suspected cases at 34. The country has been on high alert for avian flu since Sep 19, when the government said the growing number of suspected cases represented an “extraordinary incident.” Nabarro has held WHO leadership jobs dealing with malaria, environmental health, food safety and, most recently, crisis operations, the WHO said. His 30 years of experience includes work in community-level and government health programs, particularly in Asia, and in administering development assistance, managing scientific research, building development partnerships, and working with nongovernmental organizations. WHO statement on new coordinatorhttp://www.who.int/mediacentre/news/releases/2005/pr45/en/index.html WHO update on Indonesian caseshttp://www.who.int/csr/don/2005_09_29/en/index.html
Jan 3, 2006 (CIDRAP News) – Avian influenza has been ruled out in a 14-year-old Turkish boy who died over the weekend and in three siblings who were hospitalized with him, according to news services.Tests on the four children were negative for avian flu, according to Turkish health officials quoted in an Agence France-Presse (AFP) report published yesterday.The children were hospitalized in the eastern city of Van over the weekend after eating chicken that had shown signs of avian flu before slaughter, the report said. A BBC News story said the children live on a poultry farm.Two other people, a 35-year-old woman and a 5-year-old boy, were hospitalized Jan 1 in Van with the same symptoms, including fever, coughing, and bleeding from the mouth, the AFP story said.Huseyin Avni Sahin, chief physician at the hospital in Van, said the six patients had pneumonia, but he did not specify what type, according to the story.His statement seemed to imply that avian flu had also been ruled out in the woman and the 5-year-old boy. But the BBC report said test results for those two patients were still awaited.All six patients were from the town of Dogubeyazit in Agri province, less than 60 miles south of Aralik, where Turkey’s second poultry outbreak of avian flu was reported last week. Aralik is near the Armenian border.Confirmed human cases of H5N1 avian flu in the past 2 years have been reported only in Vietnam, Thailand, Indonesia, China, and Cambodia.In Indonesia, meanwhile, one suspected case of avian flu was ruled out as another one was reported, according to AFP. Hariyadi Wibisono of the Health Ministry said tests had ruled out avian flu in the 48-year-old man from central Java who died with suspicious symptoms last week, said a story published yesterday.But avian flu is suspected in the case of a 39-year-old man who died after being treated for just 1 day at Jakarta’s Sulianti Saroo Hospital, AFP reported, quoting hospital spokesman Ilham Patu. He said the man was from Tangerang, a town near Jakarta where poultry outbreaks have occurred, and had a history of contact with live and dead chickens.The World Health Organization (WHO) has confirmed China’s latest human case of avian flu, in a 41-year-old woman from the southeastern province of Fujian. She became ill Dec 6 and died Dec 21. Chinese officials announced the confirmation of her case Dec 29, and the WHO issued a notice about it Dec 30.The case was China’s seventh human case of H5N1 avian flu since the current wave of poultry outbreaks began in late 2003. The woman was not known to have had any contact with poultry before her illness, the WHO said.In other news, a leading flu expert said a lack of autopsies of avian flu victims is hampering efforts to understand and combat the disease, according to a report today in the British newspaper The Guardian.Albert Osterhaus, head of the national influenza program at Erasmus University in Rotterdam, Netherlands, said that only four or five full autopsies have been conducted among the 74 people who have died of confirmed avian flu, according to the report. All the post-mortems were done in Thailand.Osterhaus is concerned that the lack of autopsies will slow the search for a vaccine, because autopsy findings can help scientists choose the best animal species on which to test vaccines, the story said.Cultural and religious barriers have limited post-mortem examinations in the countries that have had human cases, according to the report.The World Organization for Animal Health (OIE) reports that a total of 3,786 poultry outbreaks of H5 avian flu had been reported as of Dec 30. Those occurred in 17 countries (with Hong Kong counted as a country).Vietnam leads the list with 2,141 outbreaks, followed by Thailand with 1,164. The two countries together account for about 87% of the outbreaks.Other countries in the top ten are Indonesia, 216; China, 78; Russia, 62; Romania, 36; Ukraine, 22; South Korea, 19; Cambodia, 15, and Japan, 11.See also:WHO statement on avian flu case in Chinahttp://www.who.int/csr/don/2005_12_30/en/index.htmlOIE graph of poultry outbreaks numbershttp://www.oie.int/downld/AVIAN%20INFLUENZA/graph%20HPAI%2030122005.pdf
Jul 11, 2008 (CIDRAP News) – A Japanese health ministry official said today that a government-supported study has found no evidence that the antiviral drug oseltamivir (Tamiflu) causes abnormal behavior in young people, according to a Reuters report.The unnamed ministry official said the findings would be presented to the government’s drug safety panel, which might withdraw a warning it issued in March 2007 against prescribing the drug for people between ages 10 and 19, Reuters reported today.”The timing of the presentation is not decided, but we want to do it as soon as possible,” the official told Reuters. Nikkei News, a Japanese financial newspaper, reported that the study included 10,000 people younger than 18 who were diagnosed with seasonal influenza in 2006 and 2007, according to Reuters.Oseltamivir, a neuraminidase inhibitor, is used to prevent and treat seasonal influenza. Because it is considered the most promising drug to date for use during an influenza pandemic, the United States and many other countries are stockpiling it.However, reports of self-injury and delirium in some Japanese children and adolescents who took the drug have raised concerns among regulators in other countries, including the United States. Some of the reported adverse events included the deaths of adolescent patients who fell from windows or balconies or ran into traffic.Japan has also reported abnormal behaviors in young people who took zanamivir (Relenza), an inhaled neuraminidase inhibitor.However, three rounds of review by the US Food and Drug Administration (FDA) have found no evidence that oseltamivir contributed to neuropsychiataric events. Despite the findings, the FDA this spring advised Roche, the maker of Tamiflu, and GlaxoSmithKline, the maker of Relenza, to add warnings about the reported neuropsychiatric effects to the drug labels.In February, the FDA and Roche sent a letter to US healthcare professionals about the labeling change. The letter acknowledged the reports, noted that the role of Tamiflu in the events had not been established, and advised that flu patients should be monitored for signs of abnormal behavior. In March, Glaxo sent a similar letter to doctors regarding labeling changes for Relenza.See also:Feb 2008 Roche and FDA letter to health professionalshttp://www.fda.gov/medwatch/safety/2008/Tamiflu_DHCP.pdfMar 2008 Glaxo and FDA letter to health professionalshttp://www.fda.gov/medwatch/safety/2008/relenza_DHCP.pdfNov 27, 2007, CIDRAP News story “FDA panel seeks stronger label warnings for 2 flu drugs”
Jan 16, 2009 (CIDRAP News) – Picking the influenza strains to put in the flu vaccine each year is always a gamble, given the unpredictable prevalence of different strains, but choosing the influenza B strain has become particularly vexing in recent years.Since the 2001-02 flu season, two distinct lineages of influenza B—Victoria and Yamagata—have been circulating in the United States, and experts have found it impossible to predict which one would dominate in any winter.Because a vaccine against one lineage offers little protection against the other, the government’s flu vaccine advisors have been discussing for several years the possibility of putting both lineages in the seasonal vaccine. That would turn the standard three-strain, or trivalent, vaccine into a quadrivalent vaccine. Trivalent vaccine contains two subtypes of influenza A—H3N2 and H1N1—and one of influenza B.”It looks like we’re stuck with two lineages for the time being,” says Dr. Anthony Fiore, a medical epidemiologist in the Influenza Division at the Centers for Disease Control and Prevention (CDC). “So we can either ignore the one lineage or try to make another strain to protect against that lineage. There’s just not much cross-protection.”Putting both B families into the vaccine would offer protection against both B strains, which is regarded as particularly important for children. But the idea raises questions about the effects on vaccine manufacture and supply, cost, and side effects. Some vaccine producers are studying the possibility, but they will need a formal government recommendation before they would proceed.Vaccine often missesThe problem with B viruses is nicely illustrated by events of the past couple of years. For the 2007-08 flu season in the United States, the government’s experts picked a Victoria strain for the vaccine. But by the end of the season, 98% of the 350 B viruses that were antigenically characterized by the CDC belonged to the Yamagata family.With Yamagata viruses dominant last winter, the government’s advisors, meeting last February, recommended a Yamagata virus for the B component of this season’s vaccine. But the early returns this season suggest that Victoria strains may be back on top: 35 of 52 B viruses analyzed by the CDC through Jan 10 belonged to the Victoria clan. (But 30 of those 35 came from only two states.)Looking further back, CDC records show the B strain in the vaccine missed the dominant B lineage in circulation in 4 of the 7 seasons from 2001-02 through 2007-08.The spotty record has led to what Melinda Wharton, MD, MPH, of the US Food and Drug Administration’s (FDA’s) Vaccines and Biological Products Advisory Committee (VRBPAC), called “the annual agony of trying to flip the coin” to pick a B strain for the vaccine, according to a transcript of the panel’s Feb 21, 2008, meeting.The FDA committee is expected to consider the issue again when it meets in February to select flu strains for the 2009-10 US season. Fiore said the VRBPAC has asked the CDC’s flu experts to make a presentation on the question at the Feb 18 session.How much harm?How much harm results when the vaccine misses the predominant B strain is not very clear, but experts say children are likely to get little protection against B viruses when this happens. The CDC now recommends that all children from age 6 months on up receive annual flu vaccination.In general, B viruses cause less severe disease than influenza A, and they seem to be associated with smaller clusters or outbreaks, according to William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville.Fiore agreed, then added, “But there are definitely deaths and severe outcomes caused by influenza B. It’s generally thought of as being more a disease that circulates in children, but adults do get it and have hospitalizations and deaths from it. . . . For any given person you can have a severe illness with B and a mild illness with A. On a population level, A is more severe.”Schaffner said he himself had a nasty case of what he believed to be influenza B not covered by the vaccine last winter, when it was circulating in Nashville. “I was laid low for about 48 hours last year. I’m a poster child for the importance of doing this,” he said, referring to putting both lineages in the vaccine.Robert B. Couch, MD, a flu expert at Baylor College of Medicine in Houston, analyzed the influenza B issue and reported his findings to the VRBPAC at its February 2007 meeting.Calling B viruses “the major cause” of an epidemic about every 2 to 4 years, he said, according to the transcript, “Infections occur in all age-groups. Illness is most prominent among older children and young adults. Illness in infants and young children appears to be more common among the low-income groups. Infections are prominent in the elderly in some epidemics, with excess mortality, but not in all epidemics. Overall impact is less than H3N2, but greater than H1N1.”Couch also examined research findings on how much protection the vaccine for one B lineage offers against the other lineage. He reported that protection is reduced in adults and more so in children. “By and large, very young children get very negligible benefit from the opposite lineage of the influenza B that’s in the vaccine,” he told the committee.However, some experts suggest that more data are needed on the effects of B mismatches. “Evidence of the actual effect of mismatches on the flu B vaccine performance is still being gathered,” John Treanor, MD, a flu vaccine expert at the University of Rochester in New York, told CIDRAP News. “Last year, it did look like the mismatch resulted in very little efficacy against B, but to make a major decision it may be necessary to accumulate more information from additional years of experience.”Why issue is heating upThe VRBPAC has been talking about the problem of the two B lineages for years. What seems to be heating up the issue now is the belief that both viruses are likely to keep on co-circulating indefinitely, plus an increase in the supply of flu vaccine.All US-licensed flu vaccines are grown in chicken eggs, supplies of which are finite. But production has increased substantially in recent years with more producers entering the market.Fiore said the surpluses of flu vaccine in recent years—millions of doses have gone unused in the last few seasons—make the possibility of a quadrivalent vaccine look more practical.Donna Cary, a spokeswoman for vaccine manufacturer Sanofi Pasteur, agreed. “From a supply perspective, the increase in influenza vaccine capacity in recent years has made this option viable,” she told CIDRAP News.When the CDC’s flu experts appear at the Feb 18 VRBPAC session, they expect to give an assessment of the potential impact of including both B lineages in the vaccine, according to Fiore.”We have to weigh in the idea that there might be less vaccine available, against the fact that the extra strain might be preventing some extra amount of infection or hospitalizations or death,” he said.The CDC team looked at data from the past 10 years and tried to estimate the effects of having a quadrivalent vaccine in those years, Fiore explained.”We haven’t reached any conclusions about it yet,” he said. “There are differences by year. In some years when we were in relatively tight supply, reducing the supply was a problem. Having a better vaccine didn’t make up for the loss of supply.”Now that we have an oversupply, the calculation may be changing,” he added. “But as far as actual numbers of hospitalizations prevented, it’s hard to come up with numbers.”Disadvantages and uncertainties Adding a second B strain would not be without disadvantages, experts say.”It would be more complex for the manufacturers, and it would probably cost more,” said Fiore. And given that a producer can grow only so much vaccine, switching from three strains to four will mean fewer doses in the end.Cary, of Sanofi Pasteur, acknowledged that going to a quadrivalent vaccine would reduce overall production. “But we do not anticipate any supply issue in transitioning to a quadrivalent influenza vaccine,” she said. “This is due to the global increase in influenza vaccine supply, as illustrated by the opening of our new influenza manufacturing facility in the US in 2009,” she added, referring to Sanofi’s Swiftwater, Pa., plant.Fiore said he doesn’t expect the manufacturers would face major technical challenges in making vaccine with the two B lineages: “The manufacturers know how to make both of these lineages and have done it in recent years, so it’s not a big manufacturing challenge.”Cary said Sanofi Pasteur is evaluating a possible transition to a vaccine with two B strains, including both technical and regulatory hurdles, but she declined to specify what they might be.A spokesperson for MedImmune, maker of FluMist, the nasal spray vaccine, said the company is studying the possibility of making a vaccine with two B strains, but likewise declined to offer further details.Other questions the prospect raises include the chance of increased side effects and whether clinical trials of a quadrivalent vaccine would be necessary.The trivalent vaccine contains 15 micrograms (mcg) of each strain, or 45 mcg total. Assuming that the same dosage would be used for a second B strain, the total amount of antigen in a dose of a four-strain vaccine would be 60 mcg.Fiore noted that the licensed prepandemic H5N1 vaccine in the US stockpile has been tested in 90-mcg doses. “So it’s not that much of an increase in volume that we’d expect to see a lot more reactogenicity,” he said. “But the FDA might require some studies about that.”There has been discussion of using just 7.5 mcg of each B strain, leaving the total B content in the vaccine at 15 mcg. But some experts doubt that the reduced amount would generate an adequate immune response.Schaffner said another question is whether adding a fourth strain to the vaccine will leave the immune response to the other three unimpaired. “That’s what we anticipate, but it’ll have to be formally tested,” he said.Still another question is what the World Health Organization (WHO) will do. Experts convened by the WHO make recommendations for the flu vaccine strains for the northern and southern hemispheres each season, and the VRBPAC normally follows the WHO’s lead.The WHO’s position is that much more information is needed, according to Gregory Hartl, the agency’s infectious-disease spokesman in Geneva. “There’s been a lot of discussion, but all the possibilities require safety and immune-response data which are not yet available, and after that there’s regulatory approval which would be needed. So any change is not going to happen tomorrow,” he said.Couch said the FDA needs more input from vaccine makers to help sort out the issue. “Thus far, VRBPAC has only heard informal and ‘soft’ comments by industry,” he told CIDRAP News.Other ways to cover both strainsOffering a quadrivalent vaccine to everyone is not the only way to provide some protection against both B lineages. Several other options have been proposed, including alternating lineages from year to year, making a quadrivalent vaccine intended only for children and the elderly, and offering a supplemental B vaccine to cover the strain not in the trivalent vaccine. Couch described these in his VRBPAC presentation in 2007.The idea of alternating lineages would be that people who get vaccinated each year might have some residual cross-protection in case the dominant strain in a given year is not in the vaccine, said Fiore. “But there’s really no way to predict what the impact of that would be,” he said.See also: Feb 14, 2008, CIDRAP News story “WHO advises total makeover for 2008-09 flu vaccine”CDC’s weekly flu surveillance reporthttp://www.cdc.gov/flu/weekly/CDC summary of 2007-08 seasonhttp://www.cdc.gov/flu/weekly/weeklyarchives2007-2008/07-08summary.htmTranscript of Feb 21, 2008, VRBPAC meeting:http://www.fda.gov/ohrms/dockets/ac/08/transcripts/2008-4348T2.DOCTranscript of Feb 28, 2007, VRBPAC meeting with discussion of influenza B strains and vaccinehttp://www.fda.gov/ohrms/dockets/ac/07/transcripts/2007-4282t2-03.pdfVRBPAC meeting documents sitehttp://www.fda.gov/ohrms/dockets/ac/cber07.htm#VaccinesandRelatedBiological
Mar 23, 2009WHO confirms Egypt’s latest H5N1 caseThe World Health Organization(WHO) today confirmed H5N1 avian influenza in a 38-year-old Egyptian woman from Asyut governorate who is in stable condition. She got sick on Mar 14 after having had close contact with sick and dead poultry, was admitted to the hospital the same day, and received oseltamivir (Tamiflu). The WHO’s confirmation pushes the number of H5N1 cases in Egypt to 59, of which 23 were fatal, and the global tally increases to 412 cases and 256 deaths.[Mar 23 WHO statement]Avian flu findings from Egypt, FranceEgypt recently reported four more H5N1 avian flu outbreaks in poultry, according to Egypt-based Strengthening Avian Influenza Detection and Response (SAIDR)—two in Gharbiya governorate and two in Beheira governorate. All of them involved mixed species of backyard birds for which the vaccination status was not known. Meanwhile, animal health officials in France reported two avian flu outbreaks in decoy ducks, one in Calvados that involved a low-pathogenic H5N1 virus and the other in Pas-de-Calais that involved an H5 virus, but not the N1 component. Surveillance was increased at the two sites, but other controls have not been implemented, according to a report from the United Kingdom’s Department for Environment, Food and Rural Affairs (DEFRA).Feds issue pandemic guidance for cargo transport crewsIn a move to protect cargo trucking crews—a critical part of the nation’s infrastructure—during an influenza pandemic, the US Department of Health and Human Services (HHS) today issued interim guidance on limiting exposure to a pandemic virus. The guidance primarily contains standard infection control practices, but touches on cargo work specifics such as avoiding face-to-face contacts during pick-ups and deliveries and encouraging employees to instead use text messaging and cell phones to communicate. The document also includes recommendations on disinfecting truck cabs and trailers.[HHS interim pandemic influenza guidance for cargo trucking crews]Receipts solve Danish E coli outbreak mysteryCredit card receipts helped Danish public health officials track down the elusive source of an Escherichia coli O26 outbreak that sickened at least 20 children in 2007, according to a report in the current issue of Clinical Infectious Diseases. The receipts led the officials to supermarket databases, which listed all items the affected families bought. Six of the families had bought a certain brand of fermented, organic beef sausage. Unopened packages of the sausages tested positive for the outbreak strain, which had not previously been linked to any foodborne illness outbreaks.[Apr 15 Clin Infect Dis report]Zimbabwe’s cholera outbreak slowsA cholera outbreak in Zimbabwe that has sickened more than 91,000 people and killed 4,037 since August 2008 is slowing, the WHO reported today. Public health officials are seeing case numbers and fatality rates decrease in all provinces, except for around the capital, Harare, where illness numbers are increasing. The risk of outbreaks restarting is real without continued vigilance and reinforced control measures that are in place, the WHO said.[Mar 23 WHO statement]FDA issues oyster norovirus alertThe US Food and Drug Administration (FDA) recently warned against selling and eating oysters that were harvested near a certain growing area in the Gulf of Mexico near Pass Christian, Miss., while it investigates a norovirus outbreak associated with oysters from the area. Eleven people got sick with norovirus infections after eating raw oysters at a Chattanooga, Tenn., restaurant. Mississippi officials closed the harvesting area on Mar 17 to investigate potential contamination sources, and the FDA is testing oysters from the area.[Mar 21 FDA statement]
Sarajevo wants to bring as many tourists from Croatia, and especially from Dalmatia, to its Advent, and additionally position itself on our market and in the region. On that occasion, the City of Sarajevo and the Tourist Board of Sarajevo Canton presented the program “Sarajevo New Year’s Center of the Region” in Dubrovnik and Split.In Dubrovnik, they met with the Mayor of the City of Dubrovnik, Mato Franković, to discuss the successful cooperation between the cities of Dubrovnik and Sarajevo, as well as the possibilities and areas in which it can be intensified.A common vision of cooperation through tourist promotion of the destination in both cities was agreed, and it was agreed to open info-tourist points in Sarajevo and Dubrovnik, with the support of the Tourist Board of the City of Dubrovnik and the Tourist Board of Sarajevo Canton. Speaking about the presentation of the New Year’s program, the Mayor of Sarajevo, Mr. Skaka, pointed out that there are centuries-old and strong ties between the two cities and that it was natural for him to come to Dubrovnik and invite Dubrovnik residents to join the best New Year’s celebration in the region. “We know that more than a hundred thousand people come to Sarajevo on New Year’s Eve and that these are records in the region. We also organized an open-air reception and we had 15. We expect that number to be even higher. This is a great opportunity to strengthen our friendship and improve cooperation in the exchange of experiences and mutual support.”, Stated Mayor Franković.The upcoming 5th Dubrovnik Winter Festival will be presented in return in Sarajevo on December 8, with an emphasis on the 2019 welcome program on Stradun with Nina Badrić and Toni Cetinski. The City of Dubrovnik and the City of Sarajevo have been nurturing and developing friendly relations for many years, and they signed a charter on mutual cooperation in 2007.By the way, representatives of the City of Sarajevo and the Tourist Board of Sarajevo Canton held press conferences in eight regional centers: Ljubljana, Zagreb, Belgrade, Skopje, Podgorica, Novi Pazar, as well as Dubrovnik and Split. This way of presenting Sarajevo and the New Year’s program attracted a lot of media attention and proved to be completely justified, and it is another proof that the market should fight and be proactive, and not wait for a miracle, because nothing will happen by itself.For the past two years, the City of Sarajevo has organized an open-air New Year’s celebration with performances by Dino Merlin and Zdravko Colic. The three-day outdoor parties were attended by up to 100.000 visitors from the region and across Europe.