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We provide the same Preventive Executive Physical Program as received by the President of the United States.


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Influenza Update

Flu Season 3At present, influenza activity is low in the United States but we expect activity to increase in the coming weeks as the U.S. typically experiences peak influenza activity between December and February. Based on our surveillance data we also expect an increase in norovirus in the very near future. In addition to vaccinations, it is also important to emphasize the early use of antivirals in the treatment of influenza. Antivirals are an important second line of defense, particularly for those at high-risk for complications from influenza. Two neuraminidase inhibitor antiviral medications are recommended for use in the United States—oseltamivir (Tamiflu®) and zanamivir (Relenza®). Current national surveillance data has not revealed significant resistance to oseltamivir and zanamivir to date.

Treatment works best when started within the first 48 hours of illness and can shorten the duration of symptoms and reduce Flu Season 2the risk of severe complications and death. Treatment with antiviral medications is recommended for patients with influenza who are hospitalized; have severe, complicated or progressive illness; or are at higher risk for influenza complications. Antiviral treatment may also be considered in other populations, if treatment can be initiated within 48 hours of illness onset. Use of antivirals for the prevention of influenza should be considered for institutional outbreaks (such as in nursing homes or other closed populations) or for those who have contraindications to influenza vaccination. Other preventive health practices that may help decrease the spread of influenza and Flu Season 1other common winter illnesses (such as norovirus), include staying home from work and school when ill, staying away from people who are sick, increasing hand washing, and using cough etiquette and respiratory hygiene practices.

Source: CDC

“The Center has plenty of Quadrivalent Influenza vaccine available.”


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This is National Influenza Vaccination Week

Quad 1Despite the recent Advisory below, it is still important to get vaccinated against Influenza this year. We offer the Quadrivalent Influenza vaccine which protects against 4 Influenza viruses including partial protection against the H3N2 virus.

Influenza activity is currently low in the United States as a whole, but is increasing in some parts of the country. This season, influenza A (H3N2) viruses have been reported most frequently and have been detected in almost all states.

During past seasons when influenza A (H3N2) viruses have predominated, higher overall and age-specific hospitalization rates and more mortality have been observed, especially among older people, very young children, and persons with certain chronic medical conditions compared with seasons during which influenza A (H1N1) or influenza B viruses have predominated.Quad 2

Influenza viral characterization data indicates that 48% of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014 were antigenically “like” the 2014–2015 influenza A (H3N2) vaccine component, but that 52% were antigenically different (drifted) from the H3N2 vaccine virus. In past seasons during which predominant circulating Quad 4influenza viruses have been antigenically drifted, decreased vaccine effectiveness has been observed. However, vaccination has been found to provide some protection against drifted viruses. Though reduced, this cross-protection might reduce the likelihood of severe outcomes such as hospitalization and death. In addition, vaccination will offer protection against circulating influenza strains that have not undergone significant antigenic drift from the vaccine viruses (such as influenza A (H1N1) and B viruses).

Because of the detection of these drifted influenza A (H3N2) viruses, this CDC Health Advisory is being issued to re-emphasize the importance of the use of neuraminidase inhibitor antiviral medications when indicated for treatment and prevention of influenza, as an adjunct to vaccination.

The two prescription antiviral medications recommended for treatment or prevention of influenza are oseltamivir (Tamiflu) and zanamivir (Relenza). Evidence from past influenza seasons and the 2009 H1N1Quad 3 pandemic has shown that treatment with neuraminidase inhibitors has clinical and public health benefit in reducing severe outcomes of influenza and, when indicated, should be initiated as soon as possible after illness onset. Clinical trials and observational data show that early antiviral treatment can:

  • shorten the duration of fever and illness symptoms;
  • reduce the risk of complications from influenza (e.g., otitis media in young children and pneumonia requiring antibiotics in adults); and
  • reduce the risk of death among hospitalized patients.

Source: CDC


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August is National Immunization Awareness Month

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Immunization helps prevent dangerous and sometimes deadly diseases. To stay protected against serious illnesses like the flu, measles, and tuberculosis, adults need to get their shots – just like kids do.

Immunization is especially important for adults 60 years of age and older and for those who have a chronic condition such as asthma, COPD, diabetes or heart disease.

Immunization is also important for anyone who is in close contact with the very young, the very old, people with weakened immune systems and those who cannot be vaccinated.

Annual flu shots can protect against seasonal influenza. The Center will continue to provide quadrivalent vaccines this flu season to keep our patients healthy all year long.

Sources: National Public Health Information Coalition and  healthfinder.gov

 


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Large Trial Finds High-Dose Flu Shot Beneficial for Seniors

vaccine-bottle-syringeA 2-year randomized trial involving close to 32,000 volunteers at more than 100 sites has yielded evidence that a high-dose (HD) influenza vaccine intended for seniors offers significantly more protection in that age-group than the standard-dose (SD) vaccine, according to a New England Journal of Medicine report published today. The researchers concluded that the relative efficacy of the HD vaccine was 24.2% higher than that of the SD vaccine. About 1.4% of the volunteers in the HD group had a confirmed flu case, compared with 1.9% of those in the SD group.

The results, the authors say, suggest that flu cases in vaccinated seniors would drop by about 25% if they all received the HD vaccine instead of an SD vaccine. They also found that the vaccine had a good safety profile. Because the study did not include an unvaccinated group for comparison, the authors could not calculate how much either vaccine lowered the volunteers’ overall risk of contracting flu (absolute efficacy). (Because flu vaccination is recommended for all seniors, doing a trial with an unvaccinated group would be considered unethical.)

FDA required post-marketing trials

The HD vaccine, Fluzone High-Dose, made by Sanofi Pasteur, contains four times as much antigen (active ingredient) as standard vaccines contain—60 milligrams (mg) for each flu strain targeted, instead of 15 mg. The aim is to generate a stronger immune response in elderly people, whose immune systems are weaker than those of younger people. When the US Food and Drug Administration (FDA) approved the vaccine in 2009, the step was based largely on evidence that it increased the immune response in older people; the actual protection afforded by the vaccine had not yet been studied. Accordingly, the FDA stipulated that Sanofi would have to conduct further studies to assess the vaccine’s benefits. The study, sponsored by Sanofi, was conducted during the 2011-12 and 2012-13 flu seasons at 126 sites in the United States and Canada. The investigators recruited 31,989 adults 65 and older who had no moderate or severe acute illnesses. Half of them were randomly assigned to receive the HD vaccine and half the SD product.

The participants were told to report any respiratory symptoms during flu season, and they were contacted at least once a week during that time. The researchers defined a flu-like illness as a respiratory illness with sore throat, cough, sputum production, wheezing, or difficulty breathing, along with any of the following: a temperature above 37.2°C (99°F), chills, fatigue, headaches, or myalgia. Staff members were instructed to collect nasopharyngeal samples within 5 days after onset of illness for testing. In the HD group, 3,745 participants (23.4%) had at least one flu-like illness meeting the above definition, compared with 3,827 (23.9%) in the SD arm.

Low flu incidence in both groups

Overall, 529 volunteers had a lab-confirmed flu case—228 (1.4%) in the HD group and 301 (1.9%) in the SD group. This translated into 24.2% (95% confidence interval [CI], 9.7%-36.5%) higher efficacy in the HD group. This result met a benchmark set in advance by the FDA, the report says. The agency said the HD vaccine would be considered better than the standard one if the lower limit of the 95% CI exceeded 9.1%, because this provided confidence that the risk of confirmed flu was at least 10% higher with the SD vaccine. The researchers also found that the HD vaccine consistently showed better efficacy across different flu types, clinical illness definitions, methods of lab confirmation, and the two flu seasons.

Good safety profile

On the safety side, 1,323 volunteers in the HD group and 1,442 in the SD group had at least one adverse event, which meant that the relative risk for those in the HD group was 0.92 (95% CI, 0.85-0.99). Three people in the HD group had serious events that were deemed related to vaccination, but all three problems resolved before the end of the study. No one in the SD group had a serious event that was considered related to the vaccine. The investigators also found that immune responses as measured by hemagglutination inhibition titers were significantly higher in those who received the HD vaccine. The senior author and coordinating investigator of the study is Keipp Talbott, MD, of Vanderbilt University. “Until this trial came out we didn’t know if it [the HD vaccine] was going to be clinically better or not and now we know it is better,” he said in a Vanderbilt University Medical Center press release. “The overall efficacy of 24.2% against the primary end point [confirmed flu] indicates that about one quarter of all breakthrough influenza illnesses could be prevented” if the HD vaccine were used instead of the standard one, the report states.

The authors write that the vaccine’s absolute efficacy can be inferred only from other studies of the absolute efficacy of SD vaccines in seniors. They cite two previous studies that suggested that SD vaccines like the one used in the current study provided about 50% protection in the elderly. If that is accurate, they suggest, the absolute efficacy of the HD vaccine would be about 62%, which is similar to what has been seen with standard vaccines in younger adults. Another flu vaccine expert, however, questioned that efficacy estimate, saying it’s based on faulty data.

A ‘high-quality study’

Lisa Jackson, MD, MPH, an experienced flu vaccine researcher who was not involved in the study, called it “a high-quality and significant study,” adding, “It is one of the few trials of persons 65+ that used lab-confirmed virus detection as the endpoint.” Jackson, who is a senior investigator with the Group Health Research Institute in Seattle, said the only other similar study she could recall that used lab-confirmed detection of flu in seniors was one that compared vaccines with and without adjuvants. “Like the adjuvanted vaccine trial, we can see that the vaccine of interest performed better than standard vaccine, but we don’t know what level of efficacy was exhibited by the standard vaccine as there was no placebo arm,” she commented. “Given that there is now good data on the high-dose vaccine indicating that, basically, it does something, I think that warrants preferential use in older adults,” she said. She also suggested that its use should be considered in other groups, such as younger adults, HIV patients, and immunocompromised individuals. She added that it would be helpful to see a “number needed to treat” analysis or a cost analysis, since HD vaccine costs more than standard vaccines. A “number needed to treat analysis” would look at how many people would have to receive HD vaccine instead of SD vaccine to prevent one additional case of flu.

However, Jackson voiced a reservation about the authors’ estimate that standard vaccines have 50% absolute efficacy in seniors and that the HD vaccine thus might have 62% efficacy. She said the 50% estimate for the standard vaccine is not based on solid evidence, because both studies the authors cited had flaws.She also remarked that the low flu prevalence reported in the study (less than 2%) “is consistent with other studies and seems to be discrepant with the reportedly high rate of significant outcomes related to flu in this population.”

Source: Center for Infectious Disease Research and Policy

The Center offers high-dose, quadrivalent, preservative-free vaccinations.


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The Flu Is Back. (It Never Really Left).

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Here’s a tip for those who managed to duck the flu’s first punch: Watch out for the next one.

Many communities are experiencing an increase in flu, part of a second wave that is hitting some regions of the country particularly hard, health officials say. Most of the effects are in the northeast — New England, New York and New Jersey –  but some parts of the mid-Atlantic are seeing increased flu activity.

Federal health officials say it’s common for an uptick in flu to occur in March and April. Often, that is caused by an increase in the influenza B virus, a strain different from the ones that dominated earlier in the flu season.

“We are experiencing a second wave of flu, and that second wave is influenza B,” said Lyn Finelli, chief of influenza surveillance and outbreak response at the U.S. Centers for Disease Control and Prevention. “In some communities in the Northeast, they tell us that they’re experiencing more influenza now than during the peak of the flu season in late December and early January.”

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Six states — Connecticut, Delaware, Maine, New Jersey, New York and Rhode Island — reported widespread influenza activity for the week ending April 12, the most recent data available.

In the Washington, D.C., region, doctors and hospitals say they are seeing patients with flu-like illnesses, some of whom are testing positive for influenza B. George Washington University Hospital has had a slight increase in influenza B cases in the past month and a half, said spokesman Steven Taubenkibel. In March, 11 patients tested positive for influenza B; this month, the hospital has had 16 patients test positive for the illness.

This season’s flu vaccine covers two strains of the influenza A virus, including the H1N1 “swine flu” responsible for the 2009 global pandemic, and two strains of influenza B. All four strains were included in the quadrivalent vaccine available for the first time this season. The H1N1 virus has dominated during this flu season, but influenza B viruses now account for the largest proportion of viruses that are circulating, according to the CDC.

Although it may seem odd to get a flu shot in April, health officials said those who haven’t been vaccinated should do so.

The rest of the country is experiencing fairly normal flu activity for this time of year, according to CDC data. For the week ending April 12, 1.5 percent of patient visits to doctors were for flu-like illnesses nationally. But in New York, flu-like illnesses accounted for more than 4 percent of all visits, increasing slightly over the previous week. In New Jersey, those illnesses accounted for more than 3 percent of visits, also edging up from the previous week, the data show.

The second wave of flu typically ends in May. But even into the summer, flu still lingers. “It never completely disappears,” Finelli said.

Source: Washington Post


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Aspirin May Allow Flu Virus to Thrive

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Next time you feel the flu coming on, think twice before reaching for painkillers: they could do more harm than good. With the flu season underway, millions will be taking flu remedies, which commonly include painkillers. The general medical advice is to take painkillers such as acetaminophen or aspirin. But although such drugs can make you feel better, they also lower fever, which can make the virus itself worse. According to an analysis published last week, painkillers taken to treat fevers could cause 2,000 flu deaths each year in the United States alone. Fever is thought to be an antiviral weapon, because many viruses find it hard to replicate at temperatures above the body’s 98.6 degrees. But research hasn’t made it clear whether relieving fever slows recovery. Some studies show that lowering fever may prolong viral infections and increase the amount of virus we can pass on to others.

Source: NewScientist


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When It Comes to Flu Shots, the More Influenza Strains, the Better

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Researchers conducted a test of the new four-strain influenza vaccine, available for the first time this year, to determine how well it protected against the flu in young children. The four strain vaccine, which protects against four types of influenza–two viruses from the A class and two from the B class–does as good a job of protecting against flu than the three-strain shot, but is better at preventing moderate to severe disease than the traditional immunization. The international group of researchers, who described their findings in a report published in the New England Journal of Medicine, attributed the four-strain, or quadrivalent vaccine’s effectiveness to the fact that it contained both circulating B types of influenza. In previous years, in which only one of the B strains was included, the immunization had a 50-50 chance of being mismatched to the circulating virus, making it less effective. The scientists tested the quadrivalent flu vaccine in 2,379 children ages three to eight in Bangladesh, the Dominican Republic, Honduras, Lebanon, Panama, the Philippines, Thailand and Turkey and compared their rates of flu infection to a control group of 2,398 children who received a hepatitis A vaccine. The study was sponsored by GlaxoSmithKline, which donated both vaccines for the trial.

Read more at Time.