Swine flu

After a suspected case of the 1918 Spanish flu vims (which, in a global pandemic during World War I, affected half the world s population and killed almost 25 million people in 18 months) was identified in 1976, Congress passed the National Swine Flu Immunization Program, releasing manufacturers from the liability, so that a flu vaccine... 

The HSA states, however, that "covered countermeasures" apply only to smallpox vaccines at this time, and although HSA protects manufacturers and others against liability, it does not directly set forth compensation procedures for vaccine recipients. Under Part C of the HSA, compensation for death benefits is capped at 262,100. If a case does end up in court, the plaintiff must "prove culpability equal to or rising above the level of negligence." It seems assured that the history of vaccine regulations and litigations will continue to change for some hme to come. The swine flu and other vaccine-related ADRs are discussed further in Section 28.4.4.1. 

In 1976, another vaccine case illustrated how dangerous a mistake involving vaccines can be. Between October 1,1976 and December 14,1976, more than 40 million people were vaccinated against swine flu (a virus similar to fhe 1918 Spanish flu virus fhaf killed so many during World War I). The feared epidemic never manifested, buf fhere was a tenfold increase in CBS (in which fhe body s immune system attacks its peripheral nerves), which thousands of people confracfed. 

Neustadt, R.E. and Fineberg, H.V., The Swine Flu Affair Decision-Making on a Slippery Disease, Department of Health, Education, and Welfare, Washington, DC, 1978. 

Rimantadine (Flumadine) [Antiviral] Uses Prophylaxis Rx of influenza A viral Infxns but not for HlNl swine flu Action Antiviral Dose Adults Feds >9 y. 100 mg PO bid Feds 2-9 y. 5 mg/kg/d PO, 150 mg/d max daily w/ severe renal/hepatic impair elderly initiate w/in 48 h of Sx onset Caution [C, -] w/ cimetidine avoid w/ PRG, breast-feeding Contra Component amantadine allergy Disp Tabs SE Orthostatic X BP, edema, dizziness, GI upset, X Sz threshold Interactions T Effects W/ cimetidine i effects W/ acetaminophen, ASA EMS Concurrent EtOH usage may result in light-headedness, confusion, syncope, and hypotension OD May cause N/V, tremors, Szs, anticholinergic Sxs, ventricular arrhythmias give IV fluids... 

Zaleplon (Sonata) [C IV] [Sedotive/Hypnotic] Uses Insomnia Action A nonbenzodiazepine sedative/hypnotic, a pyrazolopyrimidine Dose 5-20 mg hs PRN -1- w/ renal/hepatic insuff, elderly Caution [C, /-] w/ mental/ psychological conditions Contra Component allergy Disp Caps SE HA, edema, amnesia, somnolence, photosens Interactions t CNS depression W/ CNS d es-sants, imipramine, thioridazine, EtOH X effects W/ carbamazepine, phenobarbital, phenytoin, rifampin EMS Concurrent EtOH can t adverse CNS effects OD May cause profound CNS depression symptomatic and supportive Zanamivir (Relenza) [Antiviral/Neuramidase Inhibitor] Uses Influenza A (including HlNl swine flu) B Action X Viral neuraminidase Dose Adults Feds > 7 y.2 inhal (10 mg) bid for 5 d initiate w/in 48 h of Sxs Caution [C, M] Contra Pulm Dz Disp Powder for inhal SE Bron-chospasm, HA, GI upset EMS Does not reduce risk of transmitting virus monitor for bronchospasm or other severe resp events OD May cause resp problems s5rmptomatic and supportive... 

Uses Influenza A (including HlNl swine flu) B Action Viral neu-... 

The course WDYK Health Professions focused on the avian flu, an important news item when this course was designed. It can easily be modified to incorporate swine flu, which is of current interest. Interestingly, instructors who use The New York Times or the National Public Radio in their courses can tie current or archived materials on any virus-related ailment in these media to the content of this course. 

Billions of doses of vaccines were safely administered over the last century to millions of infants, children, and adults [1,4], Vaccine-associated adverse events were nevertheless identified in a minority of patients. Many of the adverse events were directly related to the vaccine others as in the case of MMR have not been substantiated with data but still cause considerable public unease [1], One documented case is that of vaccination with a formalin-inactivated respiratory syncytial virus (RSV) that, when given prophylactically, caused enhanced disease after exposure to the virus and resulted in the death of some children [1,4,5], An increased incidence of Guillain-Barre syndrome appeared to be associated with a swine flu vaccine that was tested in humans in the late 1970s [1,6]. Guillain-Barre syndrome has also been associated with other vaccines including those for polio, measles, and hepatitis B [6]. 

Examination of new cases of multiple sclerosis among the 45 million swine flu vaccine recipients indicated no excess over the expected frequencies. Inactivated swine flu vaccine did not influence the onset or exacerbation of the disease (33). 

Kurland LT, Molgaard CA, Kurland EM, Wiederholt WC, Kirkpatrick JW. Swine flu vaccine and multiple sclerosis. JAMA 1984 251(20) 2672-5. 

Following the swine-flu immunization campaign in 1916111 in the USA there was a significant increase in the incidence of Guillain-Barre syndrome in immunized versus non-immunized people, from 2.6 per million to 13.3 per million (69). Peak time of onset was 2-3 weeks after receiving the vaccine, and cases among vaccinees were less likely to have a history of antecedent infection than were cases in unvaccinated persons. Since 1977 the risk of influenza vaccine-induced syndrome appears to be the same as the risk in the non-immunized population. 

The disease-jump process from animal to human is called escape from restriction, and it happens all the time (and between animals too). In the UK foot-and-mouth disease epidemic, a human was infected. In 1988, a person became ill with swine influenza virus (swine flu) and died after visiting the display area of the pig barn at a US county fair. Three healthcare personnel treating the patient also developed flu-like illness with laboratory evidence of swine influenza virus infection. 

Historically, influenza has probably always afflicted mankind. Similar viruses affect domestic animals and various epidemics of catarrhal fever were associated with epidemics of horse colds. The close association between humans and horses in previous centuries may have allowed a vertical transmission of influenza from horse to man. However, there is convincing evidence that a similar transmission can occur from the pig (swine flu) to man, and the flu pandemic of 1918-1919 may have started in this way, although an avian origin is probably more likely. Evidence for the transmission of influenza from the pig to other mammals was first obtained by Richard Shope in 1932. He managed to infect various animals with swabs taken from nasal secretion of pigs suffering from swine flu. His proposition, that the pig could be a kind of safe haven (reservoir) for the virus between human epidemics and pandemics, is widely accepted. 

Although the Federal Government has not adopted product liability reforms for therapeutic pharmaceuticals, several States have, and the Federal Government has adopted no-fault compensation schemes for swine flu and childhood vaccines that could offer potential models for Federal underwriting of other product liability risks. The U S. Congress has also considered several proposals to adopt a Federal product liability law that would supersede current State law. 

In January 1976, several soldiers at Fort Dix (New Jersey) became sick with influenza found by die CDC to be caused by die swine flu vims responsible for the worldwide influenza epidemic in 1918-19 that killed 20 million (293). 

Neustadt, R. E., and Fineberg, H., The Epidemic That Never Was Policy-Making and the Swine Flu Affair (New York, NY Vintage Books, 1982). 

Guillain-Barrb syndrome was particularly associated with swine flu vaccine in 1976. It has rarely been associated with other vaccines — tetanus toxoid, BCG, rabies, smallpox, mumps, rubella, hepatitis B, diphtheria, and polio (Wraith et al., 2003). 

Uses Eifluenza A (inclucUng HlNl swine flu) B Action vL Viral neuraminidase Dose Adults Peds > 7 y. 2 inhal (10 mg) bid for 5 d initiate w/in 48 h of Sxs Caution [C, M] Contra Pulm Dz Disp Powder for inhal SE Bron-chospasm, HA, GI upset EMS Does not reduce risk of transmitting virus monitor for bronchospasm or otlier severe resp events OD May cause resp problems symptomatic and supportive... 

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