geriatricsphilippines.org Blog

Grannies get immunity

Link and Reference:
From the Medical Observer
Wednesday, June 15, 2011

The newly minted Expanded Senior Citizens’ Act of 2010 (Republic Act 9994) brings up an often overlooked aspect of elderly health care—geriatric vaccination. The law specifically provides for free influenza-virus and pneumococcal-disease shots among indigent senior citizens. It also singled out these vaccines for a 20-percent discount and value-added tax exemption when purchased by all senior citizens, regardless of their capacity to pay.

Pneumonia is fourth among the leading causes of death among Filipino elders, according to geriatric-health specialist Shelley De la Vega. In the United States, giving flu shots to senior citizens has been found to lower their chances of getting sick, being hospitalized and dying not only from influenza itself but also from heart attack and stroke during the flu season.

And yet, only about 1.4 percent of Filipino elders receive the pneumococcal vaccine while 3.4 percent get the flu vaccine, based on a national health survey done in 2001. “I hope that when we do another survey this year or next year, we will have better numbers, 50 percent, at least,” De La Vega said, during a recent forum on geriatric vaccination at the San Lazaro Hospital in Manila.

Most of the elderly who have been getting the vaccines so far are likely to belong to the more affluent Filipino communities where geriatric vaccines have been available for free since five years ago, said De La Vega.

In the absence of such freebies, she believes that even the relatively well-off seniors, not just the poorest of the poor as provided by law, need help in accessing the vaccines. “A lot of people cannot afford to pay out of pocket so we would like to find ways in which the government, through PhilHealth for example, can help alleviate the burden.”

Vaccines for other diseases like tetanus, herpes zoster, diphtheria, pertussis, and hepatitis are also on De la Vega’s wish list of vaccines that can be provided to Filipino senior citizens.

DoH needs help

It falls upon the Department of Health (DoH) to provide the free vaccination to indigent seniors under the law. And it is proving to be a challenge for the agency.

Dr. Lyndon Suy, DoH manager for emerging and reemerging infectious diseases, estimates that the agency would need around PhP1 billion to provide the free vaccines. This amount is based on statistics that the elderly comprises two to three percent of the country’s present population of roughly 90 million.

“This is not a small budget that you can just reallocate from other DoH programs without crippling them. We’re talking of a big chunk of money that needs a special provision from Congress,” he explained.

Suy admits that this issue of funding has led to a stand-off in the implementation from the DoH side. The agency still has to come up with its implementing rules and regulations (IRR) on the law as it searches for ways of sourcing the vaccine fund.

One possibility the agency is exploring is to get the local government units, especially the big-revenue cities and first-class municipalities, to buy the vaccines themselves for their indigent elderly constituents.

This is already happening in some Metro Manila cities. The Pasig city government has already vaccinated close to 8,000 of its senior citizens for both flu and pneumococcal disease since 2008. The city is prioritizing indigent and low-income individuals from its most highly populated and depressed areas. In Quezon City, many barangay senior citizens’ associations allocate part of the senior citizens’ fund given by the city government for flu vaccination.

For Suy, the importance of the LGU participation in the vaccine initiative cannot be stressed enough, from helping with the database of free vaccine recipients to assisting in the health-education activities that are meant to accompany each vaccination.

De la Vega agreed that the vaccination program has to be in the context of the elderly person’s total well-being. “You just don’t go there to give a shot in the arm. You educate them about other diseases and how to manage their lifestyle,” she said. “That way, you are also helping reinforce positive health-seeking behavior.”

WHO Margaret Chan, Director-General’s opening statement at virtual press conference
10 August 2010

H1N1 in post-pandemic period

The world is no longer in phase 6 of influenza pandemic alert. We are now moving into the post-pandemic period. The new H1N1 virus has largely run its course.

These are the views of members of the Emergency Committee, which was convened earlier today by teleconference.

The Committee based its assessment on the global situation, as well as reports from several countries that are now experiencing influenza. I fully agree with the Committee’s advice.

As we enter the post-pandemic period, this does not mean that the H1N1 virus has gone away. Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come.

In the post-pandemic period, localized outbreaks of different magnitude may show significant levels of H1N1 transmission. This is the situation we are observing right now in New Zealand, and may see elsewhere.

[caption id=”attachment_493″ align=”aligncenter” width=”265″ caption=”Post-pandemic Period”][/caption]

In fact, the actions of health authorities in New Zealand, and also in India, in terms of vigilance, quick detection and treatment, and recommended vaccination, provide a model of how other countries may need to respond in the immediate post-pandemic period.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

During the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

Recently published studies indicate that 20–40% of populations in some areas have been infected by the H1N1 virus and thus have some level of protective immunity. Many countries report good vaccination coverage, especially in high-risk groups, and this coverage further increases community-wide immunity.

Click here for WHO recommendations for Post-pandemic Period

Source: Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza
Downloaded from www.nejm.org on May 6, 2010

Risk Factors for Complications of or Severe Illness with 2009 H1N1 Virus Infection.

Risk Factor Examples and Comments
1. Age <5 yr Increased risk especially for children <2 yr of age; highest hospitalization rates among children <1 yr
2. Pregnancy Risk of hospitalization increased by a factor of 4 to 7, as compared with agematched nonpregnant women, with highest risk in third trimester
3. Chronic cardiovascular condition Congestive heart failure or atherosclerotic disease; hypertension not shown to be an independent risk factor
4. Chronic lung disorder Asthma or COPD, cystic fibrosis
5. Metabolic disorder Diabetes
6. Neurologic condition Neuromuscular, neurocognitive, or seizure disorder
7. Immunosuppression Associated with HIV infection, organ transplantation, receipt of chemotherapy
or corticosteroids, or malnutrition
8. Morbid obesity - but not yet proved to be an independent risk factor for complications requiring hospitalization or ICU admission and possibly for death
9. Hemoglobinopathy Sickle cell anemia
10. Chronic renal disease Renal dialysis or transplantation
11. Chronic hepatic disease Cirrhosis
12. Long history of smoking Suggested but not yet proved to be an independent risk factor
13. Long-term aspirin therapy in children Risk of Reye’s syndrome; drugs containing salicylates should be avoided in children with influenza
14. Age ≥65 yr Highest case fatality rate but lowest rate of infection

* COPD denotes chronic obstructive pulmonary disease, HIV human immunodeficiency virus, and ICU intensive care unit.
† Morbid obesity is defined as a body-mass index (the weight in kilograms divided by the square of the height in meters)
of 40 or more.

14 March 2010 Pacquiao defeats Clottey thus winning the unanimous decision to retain his World Boxing Organization welterweight title and his status as the world’s finest boxer.

A little known fact about this champion boxer is how he knocked out the campaign against swine flu or AH1N1.

The Philippines was one of the last countries affected by swine flu, and it arrived at the time when the boxing great Manny Pacquiao won his match against Ricky Hatton.

In a few ads for swine flu prevention, he was even compared to the beneficial VCO or virgin coconut oil. For example, a blog in talkph.net quotes: “Former Agriculture Secretary and President of the Federation of Free Farmers Rep. Leonardo Montemayor says virgin coconut oil (VCO) has natural properties that boost the immune system to avoid catching the strain. “ In this blog taking VCO was likened to Pacquiao’s training and preparation for the Hatton boxing match. “He has to train very well, strengthen himself and his body. Ganun din tayo, we have to strengthen our immune system against this very deadly virus,” says Montemayor.

The flu awareness campaign would have triumphed if this champ was hired to promote flu prevention. However, there was a negative buzz generated by Pacquiao’s refusal to be quarantined.

In this blog by Sunstar Network:

“MANILA — Boxing champion Manny Pacquiao will return to Manila as scheduled, ignoring advice from Philippine health officials to observe self-quarantine in the United States to help prevent the spread of swine flu.”

The Department of Health and WHO advised Pacquiao and his group to observe self-quarantine after their return from Las Vegas, but the boxing champ and his party chose to ignore the advise and arrived at the airport shaking hands and hugging fans. Could this fearless boxer possibly be taking VCO?

The flu pandemic is not over.
The 2009 AH1N1 influenza virus continues to be the dominant influenza virus in circulation in the world. Based on historical data, pandemics are characterized by several successive waves, potentially more impactful (e.g. 1968 pandemic). Compared with seasonal flu, the proportion of severe / deadly cases in previously healthy and young subjects is substantially higher. Although fewer older persons were infected with the pandemic AH1N1 virus, paradoxically, infected older people will experience the highest rates of severe disease and death of any age group. Vaccination of older persons is therefore a priority.

Because it is the dominant circulating strain, the WHO recommends that the pandemic H1N1 strain should be incorporated into the seasonal flu vaccine for 2010. Keiji Fukuda, MD, MPH, special adviser to the WHO director-general on pandemic influenza, stressed that the recommendation does not indicate that the pandemic is over.

Although fewer older persons were infected with the pandemic AH1N1 virus, paradoxically, infected older people will experience the highest rates of severe disease and death of any age group. Vaccination of older persons is therefore a priority.

“The recommendation to put the pandemic virus in the upcoming vaccine really means that this has been a dominant virus, and it is expected that it will continue to be a very significant virus circulating around the world,” Fukuda said.

The WHO Recommendation for the Composition of the 2010 Southern Hemisphere (SH) Vaccine is:
— an A/California/7/2009 (H1N1)-like virus, the pandemic strain
— an A/Perth/16/2009 (H3N2)-like virus;
— a B/Brisbane/60/2008-like virus.

Ondoy lashed the country with a deluge of rain and floods. It highlighted our country’s lack of preparedness to deal with disasters. In 2007, Hurricane Katrina swept thru New Orleans USA, killing many, including the elderly living alone and in nursing homes.
For disaster and pandemic planning and management tips, check the PSGM website at www.geriatricsphilippines.org