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Vaccine to prevent urinary tract infections due to E. coli bacteriaElsewhere on the vaccine frontier -
ANN ARBOR, Mich., Nov. 15 (UPI) -- U.S. researchers developing a vaccine to prevent urinary tract infections due to E. coli bacteria say the bacteria behave differently in women than in mice.
Scientists at the University of Michigan at Ann Arbor say their genetic studies indicated specific surface structures of the E. coli found in mouse infections considered key to the bacteria thriving were not found in great numbers in the human samples.
"If we want to prevent infections in humans, we need to look at what's going on with the bacteria while it's in humans," study senior investigator Harry Mobley said in a statement. "We're not looking to make the world safer for mice."
Mobley and colleagues, who published a study last year showing the vaccine prevented urinary infections in mice, said the differences in gene expression in the mouse and human samples were significant but the key targets of the vaccine related to iron acquisition were similar and raise the hopes -- albeit several years away -- the vaccine will work in humans.
The study was published in PLoS Pathogens.
FDA grants C. difficile vaccine candidate fast-track designationand along the same lines of thinking -
InfectiousDiseaseNews.com - 11-16-10
The FDA has granted Sanofi-Pasteur's investigational Clostridium difficile vaccine candidate fast-track designation for the treatment of C. difficile.
"Our C. difficile vaccine candidate is in phase 2," Michel DeWilde, PhD, senior vice president of research and development at Sanofi-Pasteur, said in a press release. "The FDA fast-track designation recognizes that a C. difficile vaccine could address an important unmet medical need."
The incidence of C. difficile infection has increased significantly in recent years in North America and Europe. Treatments in these two regions of the world are estimated to be costing more than $7 billion a year. The current treatment of C. difficile infection involves the use of one of the two antibiotics recommended for the management of C. difficile.
Under this program, the FDA can accept for review completed portions of the licensing application before receipt of the entire application, according to DeWilde.
source: Rense.com
SALT LAKE CITY—Many of the most popular dietary supplements can interact with prescription drugs, including possible fatal consequences, according to twin studies conducted at Utah’s Intermountain Medical Center. The team of cardiologists and dietitians interviewed 100 patients on warfarin, an anticoagulant drug used to help prevent stroke. They learned 69 percent of subjects also used dietary supplements, especially vitamins, glucosamine and chondroitin, fish oil and coenzyme Q10 (CoQ10). More than half did not know about possible interactions, and nearly two-thirds did not consult with or inform their doctors about the supplement use. Researchers further discovered supplement users on warfarin were more likely to skip or double doses of the drug, and they also more frequently experienced drug interactions, such as unexplained bleeding and increased need for blood transfusions.
Researcher T. Jared Bunch, M.D., a cardiologist, noted the drugs and supplements all compete in the liver for processing; for example, CoQ10, a favorite among cardio patients, can inhibit warfarin’s benefits and increase stroke risk, while fish oil can increase the risk of unwanted bleeding. He added health care and products providers need to better educate people on the possible interactions between drugs and supplements.
Fellow researchers John Day, M.D., also a cardiologist, added health care providers need to be aware of the supplements their patients are taking, especially if concurrent with prescribed medications. “We’re not saying dietary supplements are bad. We’re saying they should be considered medications,” he said. “And it’s critical that health providers know what medications their patients are taking.”
Health chiefs have for the first time acknowledged that the swine flu jab may be linked to an increased risk of developing the nerve condition Guillian-Barre Syndrome according to a report by the MHRA drug regulatory body. The condition can cause paralysis.
("When a girl was affected in this way some months ago the Government threatened to take the child off her parents into care to stop them speaking out about her condition." Edward Priestley)MALARIA JAB ALTERED MY SON'S MIND
Matthew Lloyd aged 31 suffered the symptoms of malaria after being injected with the most deadly form of the disease when taking part in a drug trial at the Jenner Institute in Oxford. Six others taking part in the trial have also suffered symptoms. The experimental vaccine using falciparium strain of malaria can cause brain damage, seizures, comas and death. Matthew desperately needs treatment for the malaria but may not be able to realise this due to the effects and has been missing for several days.
("It is not rare for those taking part in medical experiments and drugs trials to be made ill or die. A 3rd year trainee doctor died of aplastic anaemia in the next room to me at Hammersmith Hospital in 1986 after taking part in drugs trials for cash." Edward Priestley)
Remember that Vitamin D and Vitamin C are first line defenses against the flu
Order here and help support this important work
http://naturalhealthnews.blogspot.com/2009/09/thank-you-davinci-labs.html
Get the Facts Before the Jab!
I am a health care professional and I am not in favor of flu shots. Consistently I see that people who get them are the ones that get sick and when they do they are just plain more sick that others not having had the jabs.
If so few health care workers defer on the shots, perhaps the frustrated Dr. Schaffner might try thinking about just why that is rather than blindly following a CDC directive.
It is sort of the same in terms of the high percentage of health care workers who would not choose standard chemotherapy for cancer treatment.
The key point is to keep your immune system strong and healthy so you do not contract the flu. There are many effective ways to do this and starting with sound nutrition and proper hydration is the ground floor to your success.
Related to flu is not to get antibiotics if you think you are sick. Let you health care provider help you make this decision but remember that viruses do not respond to anti-biotics and it opens the door to your reduced immune function.
Discovering new anti-biotics in the lab is of course the standard approach, and while this may be effective, we are not addressing the core issue that's been around as long as I can remember since I join the health professionals in the 1960s.
The core issue is how do you change the culture of over exposure to anti-biotics and leading to resistance, one more time.
Think about what you can do for your health. Maybe you should ask why it is that that want you to keep getting additional shots when years ago only one was sufficient for life.
Consider too that the inhaled vaccines, especially flu, make you contagious for about 10-14 days so you really have to quarantine yourself as not to expose others to the risk of contracting flu.
There is a lot you aren't told.
But thank goodness some one other than me decided Airborne was not beneficial. Things that are really helpful include vitamin C, vitamin A, echinacea, peppermint, ginger, garlic, oregon grape root, high quality nutritional yeast, Millenium CF, and other natural remedies. Sound nutrition and more than average hydration count too.Flu shots a tough sell to health care workers
By Associated Press Writer Melanie S. Welte, Thu Oct 16, 2008
DES MOINES, Iowa – Operating room nurse Pauline Taylor knows her refusal to get a flu shot is based on faulty logic.
But ever since she got sick after getting a shot a few years ago, she's sworn off the vaccine.
"I rarely get sick. The only thing I could narrow it down to is that I had gotten this shot," said Taylor, who works at University Hospitals and Clinics in Iowa City. "I know that it's not a live virus. It just seemed pretty coincidental."
Such stories frustrate Dr. William Schaffner.
As chairman of the Department of Preventive Medicine at Vanderbilt University, he hears that kind of talk frequently and knows it's in part to blame for a surprising statistic — nearly 60 percent of health care workers fail to get a flu shot.
That's despite recommendations from the Centers for Disease Control and Prevention that all health care workers get vaccinated, from hospital volunteers to doctors.
"It is a professional obligation on the part of health care workers to make sure that they are as protected against influenza as possible," Schaffner said.
Schaffner argues that getting vaccinated for the flu should be standard for doctors and nurses, just like washing their hands. That's because the flu virus can be spread so easily.
"Being in close proximity to patients, having conversations with them, bending over their bed, seeing them in the clinic while you're doing procedures, you would be breathing out viruses and spreading influenza into your patients," said Schaffner, who is also president-elect of the National Foundation for Infectious Diseases.
The nonprofit group educates the public and health care industry about the causes, treatment and prevention of infectious diseases. It gets about 75 percent of its budget from major vaccine makers, but executive director Len Novick said the money comes with no strings attached.
Despite the attention given to the problem, there are few well documented cases of flu outbreaks caused by health care workers.
Schaffner said that's because it's tough to prove sick health care workers are to blame for hospital outbreak.
According to the foundation, likely cases of flu outbreaks between health care workers and patients include:
• 19 babies in a neonatal intensive care unit in Ontario, Canada, infected in 2000; one died. Health care workers, only 15 percent of whom were immunized, were the likely source.
• 65 residents of a nursing home in New York got the flu during the 1991-1992 flu season, and two died. Only 10 percent of health care workers had been vaccinated before the outbreak, according to a report by the CDC.
Schaffner said health care workers opt not to get vaccinated for the same reasons others are hesitant. Some also don't realize how easily they can spread the disease, sometimes before they know they're infected or even if they have only a mild case.
And, he said, there's the "myth" that you can get flu from the vaccine.
The CDC recommends that health care facilities offer free flu vaccines to employees annually at work, and that hospitals obtain signed statements from workers who refuse.
The CDC also recommends a flu shot for people age 50 and over, the chronically ill, and women who will be pregnant during the flu season. This year virtually all children from 6 months to 18 years were added to the list.
Several states have laws requiring hospitals to make the vaccines available.
In Iowa, University Hospitals requires documentation that all health care workers were offered the vaccine, but workers are free to decline, as Taylor, the ER nurse, did. Dr. Patrick Hartley, who heads the hospital's employee health clinic, said in the last flu season, 84 percent of employees got their flu shots.
At Allen Hospital in Waterloo, Iowa, the flu shot is mandatory for those with direct patient contact and recommended for everyone else. Those with allergies to the vaccine or other conditions can take a pass, but they must supply a note from their doctor. The hospital says the vaccination rate is 93 percent.
Some hospitals take a tougher stand on vaccinations.
In Seattle, at Virginia Mason Medical Center, even sales reps, vendors and volunteers must be vaccinated unless they seek exceptions for religious or medical reasons. Even then, those who don't get a shot must wear a mask whenever they are in the hospital during the flu season.
About 99 percent of the hospital's more than 5,000 employees were vaccinated.
Dr. Joyce Lammert, the hospital's chief of medicine, said they lost around seven employees when the policy took effect four years ago.
"A lot of reasons we heard about people not wanting flu shots was all about them — it's my freedom, I don't want to get it, I get sick when I get it," Lammert said. "Now, the culture has really changed to thinking about patients. This is what we do to protect our patients."
Lammert said patients should ask their doctors if they've gotten their flu shot.
"I wouldn't go to anybody who didn't," she said.
___
On the net: CDC flu information: http://www.cdc.gov/flu/protect/vaccine/index.htmU.S. study points to strong new class of antibioticsThu Oct 16, 2008
CHICAGO (Reuters) – Three naturally occurring antibacterial compounds hold promise for a new class of antibiotics, offering hope for fresh weapons against infection at a time when older drugs are losing their punch, researchers said on Thursday.
The new agents, reported in the journal Cell, may even provide a quicker cure for tuberculosis, which could help people stick to the prescribed therapy better and reduce the development of resistant strains.
"The three antibiotics are attractive candidates for development as broad spectrum antibacterial agents," said Richard Ebright of Rutgers University in New Brunswick, New Jersey.
Ebright and colleagues showed how the three antibiotic compounds -- myxopyronin, corallopyronin and ripostatin -- block the action of bacterial RNA polymerase, an enzyme needed by bacteria to unlock genetic information from DNA needed to make proteins.
Blocking this enzyme kills the bacteria, they said.
All three compounds are naturally produced by some bacteria for use in a kind of chemical warfare against other bacteria. The agents work by taking advantage of a design flaw in bacterial RNA polymerase.
"RNA polymerase has a shape reminiscent of a crab claw, with two prominent pincer-like projections," Ebright said in a statement.
"Just as with a real crab claw, one pincer stays fixed and one pincer moves -- opening and closing to keep DNA in place."
All three antibiotics work by jamming the pincer hinge, keeping the bacteria from letting DNA into the enzyme. Without the needed genetic code, the bacteria cannot make proteins.
This understanding has allowed the researchers to find ways to tinker with the chemical structure of the antibiotic targets to make them even more potent.
The compounds appear to work against a broad range of bacteria, including the bacteria that causes tuberculosis, which infects about a third of the world's population.
Current TB drugs known as rifamycins also act on RNA polymerase, but they do it in a different way.
"As a result, these antibiotics can function simultaneously with rifamycins and can be co-administered with rifamycins for more rapid clearance of infection," Ebright said.
(Reporting by Julie Steenhuysen, editing by Will Dunham)
Copyright © 2008 Reuters Limited
" State lifts limit on mercury preservative in swine-flu shots"
By Sandi Doughton, Seattle Times science reporter.
For more information about some of these issues, please refer to wachoice
Thimerosal neurotoxicity is associated with glutathione depletion
James SJ, Slikker W 3rd, Melnyk S, New E, Pogribna M, Jernigan S.
Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, AR 72202, USA.
Thimerosol is an antiseptic containing 49.5% ethyl mercury that has been used for years as a preservative in many infant vaccines and in flu vaccines. Environmental methyl mercury has been shown to be highly neurotoxic, especially to the developing brain.
Because mercury has a high affinity for thiol (sulfhydryl (-SH)) groups, the thiol-containing antioxidant, glutathione (GSH), provides the major intracellular defense against mercury-induced neurotoxicity. Cultured neuroblastoma cells were found to have lower levels of GSH and increased sensitivity to thimerosol toxicity compared to glioblastoma cells that have higher basal levels of intracellular GSH. Thimerosal-induced cytotoxicity was associated with depletion of intracellular GSH in both cell lines.
Pretreatment with 100 microM glutathione ethyl ester or N-acetylcysteine (NAC), but not methionine, resulted in a significant increase in intracellular GSH in both cell types. Further, pretreatment of the cells with glutathione ethyl ester or NAC prevented cytotoxicity with exposure to 15 microM Thimerosal. Although Thimerosal has been recently removed from most children's vaccines, it is still present in flu vaccines given to pregnant women, the elderly, and to children in developing countries. The potential protective effect of GSH or NAC against mercury toxicity warrants further research as possible adjunct therapy to individuals still receiving Thimerosal-containing vaccinations.
PMID: 15527868 [PubMed - indexed for MEDLINE]
From Ken Stoller, MD
If you will read the post by the DOH (State of Washington):
http://www.doh.wa.gov/cfh/immunize/providers/h1n1-thimerosal.htm
You will see that they have suspended their normal operating procedures and will now give vaccine with Thimerosal to infants and pregnant women because they have already been notified there will be a severe shortage of Thimerosal free H1N1 vaccine.
This is exactly what I anticipated would happen and it was why I filed my complaint with the BoP. You closed the case inappropriately by getting assurance that only Thimerosal free vaccine would be given to pregnant women and children under 3. If the NM DOH follows the lead of the State of Washington, you received false assurance.
I was just sent an internal draft CDC Media Strategy, made public for the first time (see attached), which concedes that CDC does not have sound science supporting vaccine safety and must therefore resort to a program of misinformation and propaganda, referring to critical parents and safety first advocacy organizations as anti-vaccine.
In addition to conceding that fear-based propaganda will have to substitute for basic science, the memo reveals how completely CDC has descended into a military them-against-us mind set. Critics of vaccine safety are labeled anti-vaccine, as hostile parents, or as adversaries of vaccination, with no acknowledgment that criticism and inquiries can be in good faith, can sincerely be interested in promoting vaccine safety as a sensible, indeed necessary, scheme to protect the benefits to public health of mass immunization.
CDC admits: Risk communication messages regarding vaccine adverse reactions are difficult to develop. Yes, exactly, because they just dont know the risks. How, then, can CDC claim as a strength of their media plan that the [b]enefits of vaccination far outweigh the risks? This is a hungry lie.
Instead of actually doing the science to accurately ascertain the risks of vaccination, and make appropriate changes to the schedule, screening, etc., CDC proposes an aggressive public/private media campaign: [C]ommunity acceptance of vaccination demands that we take a stand to not only explain the risks of complication due to natural disease, but also toward unfounded arguments or [sic] adversaries of vaccination.
CDC makes a stunning admissions: Some claims against vaccine cannot be disproved. And: CDC does not have complete adverse event surveillance data on which to base health messages.
As previously explained, the FDA does not recommend flu vaccine for pregnant women - that has not changed and the CDC has gone rogue in this area.
KP Stoller, MD, FACHM
President, International Hyperbaric Medical Assoc
Medical Director, Hyperbaric Medical Center of New Mexico
www.hbotnm.com
A Critical Assessment of the Recommendations of the Advisory Committee on Immunization Practices
ABSTRACT: Influenza vaccination during all trimesters of pregnancy is now universally recommended in the United States. We critically reviewed the influenza vaccination policy of the CDC’s Advisory Committee on Immunization Practice (ACIP) and the citations that were used to support their recommendations.
The ACIP’s citations and the current literature indicate that influenza infection is rarely a threat to a normal pregnancy. There is no convincing evidence of the effectiveness of influenza vaccination during this critical period. No studies have adequately assessed the risk of influenza vaccination during pregnancy, and animal safety testing is lacking. Thimerosal, a mercury-based preservative present in most inactivated formulations of the vaccine, has been implicated in human neurodevelopment disorders, including autism, and a broad range of animal and experimental reproductive toxicities including teratogenicity, mutagenicity, and fetal death.
Thimerosal is classified as a human teratogen.
The ACIP policy recommendation of routinely administering influenza vaccine during pregnancy is ill-advised and unsupported by current scientific literature, and it should be withdrawn. Use of thimerosal during pregnancy should be contraindicated.
Complete Article
A small dose of mercury will kill 1 in 100 rats.
A small dose of aluminum will kill 1 in 100 rats.
When combined there is a different and striking effect: all the rats die.
Doses of mercury that have a 1 percent mortality will have a 100 percent mortality rate if aluminum is added.
Vaccines contain both aluminum and mercury.
FDA / CDC do not test for synergistic effects, just as in the current concern over chemicals in cosmetics and beauthy aids.
REF:
Dr. Donald W. Miller, Jr., Mercury on the Mind
J. Shubert, E. Riley & S. Tyler. Combined Effects in Toxicology--A Rapid Systemic Testing Procedure: Cadmium, Mercury and Lead. J.Toxicology and Environmental Health v4, p763, 1978
“One, up until this last discussion we have been talking about chronic exposure. I think it’s clear to me anyway that we are talking about a problem that is probably more related to bolus acute exposures, and we also need to know that the migration problems and some of the other developmental problems in the central nervous system go on for quite a period after birth. But from all of the other studies of toxic substances, the earlier you work with the central nervous system, the more likely you are to run into a sensitive period for one of these effects, so that moving from one month or one day of birth to six months of birth changes enormously the potential for toxicity. There are just a host of neurodevelopmental data that would suggest that we’ve got a serious problem. The earlier we go, the more serious the problem.”
“The second point I could make is that in relationship to aluminum, being a nephrologist for a long time, the potential for aluminum and central nervous system toxicity was established by dialysis data. To think there isn’t some possible problem here is unreal.”
from Newsmax.com
Vaccine May Be More Dangerous Than Swine FluTuesday, July 7, 2009
By: Dr. Russell Blaylock
An outbreak of swine flu occurred in Mexico this spring that eventually affected 4,910 Mexican citizens and resulted in 85 deaths. By the time it spread to the United States, the virus caused only mild cases of flu-like illness.
Thanks to air travel and the failure of public health officials to control travel from Mexico, the virus spread worldwide. Despite predictions of massive numbers of deaths and the arrival of doomsday, the virus has remained a relatively mild disease, something we know happens each year with flu epidemics.
Worldwide, there have only been 311 deaths out of 70,893 cases of swine flu. In the United States, 27,717 cases have resulted in 127 deaths. Every death is a tragedy, but such a low death rate should not be the basis of a draconian government policy.
It is helpful to recall that the Centers for Disease Control with the collusion of the media, constantly tell us that 36,000 people die from the flu each year, a figure that has been shown to be a lie. In this case, we are talking about 300 plus deaths for the entire world.
This virus continues to be an enigma for virologists. In the April 30, 2009 issue of Nature, a virologist was quoted as saying,“Where the hell it got all these genes from we don’t know.” Extensive analysis of the virus found that it contained the original 1918 H1N1 flu virus, the avian flu virus (bird flu), and two new H3N2 virus genes from Eurasia. Debate continues over the possibility that swine flu is a genetically engineered virus.
Naturally, vaccine manufacturers have been in a competitive battle to produce the first vaccine. The main contenders have been Baxter Pharmaceuticals and Novartis Pharmaceuticals, the latter of which recently acquired the scandal-ridden Chiron vaccine company. Both of these companies have had agreements with the World Health Organization to produce a pandemic vaccine.
The Baxter vaccine, called Celvapan, has had fast track approval. It uses a new vero cell technology, which utilizes cultured cells from the African green monkey. This same animal tissue transmits a number of vaccine-contaminating viruses, including the HIV virus.
The Baxter company has been associated with two deadly scandals. The first event occurred in 2006 when hemophiliac components were contaminated with HIV virus and injected in tens of thousands of people, including thousands of children. Baxter continued to release the HIV contaminated vaccine even after the contamination was known.
The second event occurred recently when it was discovered that Baxter had released a seasonal flu vaccine containing the bird flu virus, which would have produced a real world pandemic, to 18 countries. Fortunately, astute lab workers in the Czech Republic discovered the deadly combination and blew the whistle before a worldwide disaster was unleashed.
Despite these two deadly events, WHO maintains an agreement with Baxter Pharmaceuticals to produce the world’s pandemic vaccine.
Novartis, the second contender, also has an agreement with WHO for a pandemic vaccine. Novartis appears to have won the contract, since their vaccine is near completion. What is terrifying is that these pandemic vaccines contain ingredients, called immune adjuvants that a number of studies have shown cause devastating autoimmune disorders, including rheumatoid arthritis, multiple sclerosis and lupus.
Animal studies using this adjuvant have found them to be deadly. A study using 14 guinea pigs found that when they were injected with the special adjuvant, only one animal survived. A repeat of the study found the same deadly outcome.
So, what is this deadly ingredient? It is called squalene, a type of oil. The Chiron company, maker of the deadly anthrax vaccine, makes an adjuvant called MF-59 which contains two main ingredients of concern—squalene and gp120. A number of studies have shown that squalene can trigger all of the above-mentioned autoimmune diseases when injected.
The MF-59 adjuvant has been used in several vaccines. These vaccines, including tetanus and diphtheria, are the same vaccines frequently associated with adverse reactions.
I reviewed a number of studies on this adjuvant and found something quite interesting. Several studies done on human test subjects found MF-59 to be a very safe immune adjuvant. But when I checked to see who did these studies, I found—to no surprise—that they were done by the Novartis Pharmaceutical Company and Chiron Pharmaceutical Company, which have merged. They were all published in “prestigious” medical journals. Also, to no surprise, a great number of studies done by independent laboratories and research institutions all found a strong link between MF-59 and autoimmune diseases.
Squalene in vaccines has been strongly linked to the Gulf War Syndrome. On August 1991, Anthony Principi, Secretary of Veterans Affairs admitted that soldiers vaccinated with the anthrax vaccine from 1990 to 1991 had an increased risk of 200 percent in developing the deadly disease amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease. The soldiers also suffered from a number of debilitating and life-shortening diseases, such as polyarteritis nodosa, multiple sclerosis (MS), lupus, transverse myelitis (a neurological disorder caused by inflammation of the spinal cord), endocarditis (inflammation of the heart’s inner lining), optic neuritis with blindness and glomerulonephritis (a type of kidney disease).
Because squalene, the main ingredient in MF-59, can induce hyperimmune responses and induce autoimmunity, a real danger exists for prolonged activation of the brain’s immune cells, the microglia. This type of prolonged activation has been strongly associated with such diseases as multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS and possibly vaccine-related encephalitis. It has been shown that activation of the systemic immune system, as occurs with vaccination, rapidly activates the brain’s microglia at the same time, and this brain inflammation can persist for long periods.
So, how would the gp120 get into the brain? Studies of other immune adjuvants using careful tracer techniques have shown that they routinely enter the brain following vaccination. What most people do not know, even the doctors who recommend the vaccines, is that most such studies by pharmaceutical companies observe the patients for only one to two weeks following vaccination—these types of reactions may take months or even years to manifest.
It is obvious that the vaccine manufacturers stand to make billions of dollars in profits from this WHO/government-promoted pandemic. Novartis, the maker of the new pandemic vaccine, recently announced that they would not give free vaccines to impoverished nations—everybody pays.
One must keep in mind that once the vaccine is injected, there is little you can do to protect yourself—at least by conventional medicine. It will mean a lifetime of crippling illness and early death.
There are much safer ways to protect oneself from this flu virus, such as higher doses of vitamin D3, selective immune enhancement using supplements, and a good diet.
© 2009 Newsmax. All rights reserved.
Mismatched Flu Antiviral Recommendations in the United StatesRecombinomics Commentary, December 8, 2008
Limited data on antiviral resistance, as well as the uncertainty regarding which influenza virus types or subtypes will circulate during the season, make it impossible to provide an indication of the prevalence of influenza viruses resistance to oseltamivir or the adamantanes (amantadine and rimantadine) nationally or regionally at this time. CDC has solicited a representative sample of viruses from WHO collaborating laboratories in the United States, and more specimens are expected as influenza activity increases.
Based on the level of oseltamivir resistance observed in only one influenza subtype, H1N1, and the persisting high levels of resistance to the adamantanes in H3N2 viruses, CDC continues to recommend the use of oseltamivir and zanamivir for the treatment or prevention of influenza in the United States.
The above comments are from recent CDC weekly reports on influenza. The statement on uncertainty is from the latest (week 48) update, while the statement on antiviral recommendations was in the week 46 report.
However, the antiviral situation in the United States is quite straight forward, and unlikely to change with additional near term data. Resistance to the adamantines is at or near 100% for H3N2, while resistance to oseltamivir (Tamiflu) is at or near 100% for H1N1. Since the vast majority of influenza A in the United States is H1N1 at this time, the current recommendations discourage use of adamantines, when most influenza A is sensitive, and encourage oseltamivir, when most influenza A is resistant, creating a significant mismatch in antiviral recommendations for the United States.
The basis for a prediction of near term stasis is base on results for this season for North America and Europe, where oseltamivir resistance is approximately 100% for H1N1 and adamantine resistance is approximately 100% for H3N2. Although resistance levels in H3N2 has been largely unchanged in recent seasons, the level of oseltamivir resistance (H274Y) has evolved significantly over the past few seasons, but the levels of 100% began to appear in the 2008 season in the southern hemisphere, and now is confirmed in the northern hemisphere for this season.
Initially, H274Y appeared on a number of H1N1 genetic backgrounds in patients not receiving oseltamivir. H274Y was reported in clade 2C (Hong Kong) in the 2005/2006 season in China. It then appeared in clade 1 (New Caledonia) in the United States and England in 2006/2007. Last season it was in clade 2B in the United States and England, but did not initially dominate. A second change, D3548G, which had been in clade 2C and clade 2A (Solomon Island) previously, was acquired by clade 2B via recombination, and this sub-clade, which both H274Y and D354G began to dominate.
In south countries in Europe (Norway, France, Russia) and North America (Canada) levels increased to more than 40% of H1N1 isolates. In the United States the level was closer to 10% because clade 2B and 2C were co-circulating and there was no reported H274Y in clade 2C in the United States. Moreover, most of clade 2B also did not have H274Y.
However, the following flu season in the summer hemisphere, the sub-clade with H274Y and D354G seed the season, and resistance levels rose to 100%, raising concerns that the new 2008/2009 season in the northern hemisphere would also be seeded by the same sub-clade and resistance would also increase to 100%. H1N1 resistance testing Europe and North America have confirmed the increase to 100%.
In the United States this season H274Y levels rose to close to 100% in clade 2B, and initial testing failed to identify clade 2C (which was at 100% adamantine resistance in the US last season). Thus, the levels of antiviral resistance in influenza A are related to the relative levels of H1N1 and H3N2, and at this time H1N1 levels are widespread and account for 80% or more of influenza A isolates in multiple regions.
As a result, the current antiviral recommendations in the United States are mismatched with the levels in co-circulation. The vast majority of influenza A is H1N1 which is oseltamivir resistance and adamantine sensitive, yet use of adamantines are discouraged and oseltamivir is encouraged in current CDC recommendations.
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