Rien ne va plus for the vaccination of influenza A 2009.
The French are not so docile. As they were reluctant , they were scared of talking only severe cases and deaths. So they rushed into the vaccination centers are overwhelmed. The police had to intervene. The guidelines are changing every day. The vaccine without adjuvant was acclaimed by the French granted up to 9 years old yesterday, today, 2 years, and tomorrow? because stocks are limited.
To accelerate the campaign, we continue to neglect the GPs and pediatricians, but we appeal to the Army.
The objective is to vaccinate 250,000 people per day.
Let's make a quick calculation: With
60 million French , must be 240 days or 8 months , working Saturdays, Sundays, public holidays, Christmas and the Year, and with a single dose. There will therefore be finished next summer. Including a side effect of concern for this vaccine is 100 000 600 complications.
If we do that vaccinia 6 million individuals at risk (Large obese, heart failure, respiratory, immune deficiencies and some others as and when our knowledge), on schedule they would be protected in 24 days with a risk of complications 60.
But who knows people at risk ? CPAM does not have access to diagnostics, she knows that the requirements and diseases supported 100%. His estimate is necessarily approximate. As for the Army, so bright it is, it is not known for his exploits in preventive medicine, this would be!
It is therefore imperative to appeal to general practitioners and pediatricians who know all this and more are preferred by patients. "Why continue to row when you attack the cliff?"
What is the flu in the world?
For USA, a small outbreak in May and June but with 40 000 cases and 400 deaths in extrapolating the cases published in the NEJM. (1), which is a bit risky I grant you. This continues but slows. (2) In
Australia : outbreak in June, July and August, with 67 deaths, 86% were carriers of risk factors. (1) In
France: it is estimated the number of cases to 2.76 million, with 86 dead. (3) is so little that is surprising.
These estimates of 2.76 million cases are unreliable because there are actually all kinds of pathologies.
In pediatrics at my office all day I see children who have:
- Fever 39 ° reduction with or without cough normal examination: not influenza
- Fever 39 ° with angina white (viral): so no flu
- fever with fatigue and recovery "miraculous" in 1-2 days: not influenza
- fever with runny nose, in nursery or school: nasopharyngitis = not influenza.
-fever with a horrible sore throat that may require antibiotics and sometimes vomiting.
I do not quote anyone who cough without fever, gastroenteritis, ear infections and company ...
I almost never prescribe antibiotics, Tamiflu once * for a child 8 years which was really bad (with healing "miraculous" the next day and was arrested Tamiflu *) and no hospitalization.
I feel like I have seen less than 10 "flu" in recent weeks while in January 2009, I had seen close to 200 a week (and month flu 2005 to April 2009) in the article September.
add that for a definitive diagnosis must be taken to the hospital and it costs between 200 € and 300 non-reimbursed, so no voluntary for "use science"!
" civic spirit is lost " ! but the child heals anyway, so ... I note however that
may close classes and even entire school when there are 3 or 4 colds coughing ... " caution is part of valor"
What should happen ?
in Australia: it happened this way: (1)
image "NEJM" from 12/11 / 2009 p.1931
the epidemic began in early June, the peak in July and late August.
currently in France, (2)
image "Le Monde" of 30 / 11 / 2009
It is difficult to know where is the epidemic . Experience of my Cabinet and Australian history, I remember the feeling that one is rather at the beginning and the peak is expected to arrive in late December and mid January. But I do not read (alas) in the mark coffee and I do not handle easily the pendulum. Damage.
Conclusion:
As athletes say, "we must return to basics"
It was wrong and we will not succeed. It's mathematical. The Army and the students will change nothing.
"The ship sways in the storm, reducing the wing, and rectify the course" ..
They must vaccinate people at risk who wish , their doctors know. Benefit from their knowledge.
Let's stop people panic healthy . They vaccinate quietly if they wish.
"86 for 2 Dead, 76 million cases this is sad but very few (1 per 30 000), probably less than road accidents in the same time."
References:
1. New England Journal of Medicine Vol 361 No 20 12 November 2009 (4 articles on the flu)
2. "The World" dated November 30, 2009
3. "The World" dated December 2, 2009
Keywords: A (H1N1), children, flu, pandemic, panic, risk, vaccine, general practitioner, pediatrician
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