Swine Flu : CDC Recommendation

Novel H1N1 Vaccination Recommendations

With the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the US during the normally flu-free summer months and some uncertainty about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices has taken an important step in preparations for a voluntary novel H1N1 vaccination effort to counter a possibly severe upcoming flu season. On July 29, ACIP met to consider who should receive novel H1N1 vaccine when it becomes available.

Novel H1N1 Vaccine

Every flu season has the potential to cause a lot of illness, doctor’s visits, hospitalizations and deaths. CDC is concerned that the new H1N1 flu virus could result in a particularly severe flu season this year. Vaccines are the best tool we have to prevent influenza. CDC hopes that people will start to go out and get vaccinated against seasonal influenza as soon as vaccines become available at their doctor’s offices and in their communities (this may be as early as August for some). The seasonal flu vaccine is unlikely to provide protection against novel H1N1 influenza. However a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine.

CDC’s Advisory Committee on Immunization Practices (ACIP), a

panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the new H1N1 vaccine when it becomes available. While some issues are still unknown, such as how severe the virus will be during the fall and winter months, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.

The groups recommended to receive the novel H1N1 influenza vaccine include:

• Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
• Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;
• Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
• All people from 6 months through 24 years of age
  • Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
  • Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
• Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Health Hazards of Radiation

Effect Of Hiroshima Bombing
Radiation Induced Health Hazards

Hiroshima Bombing: 6 August 1945

THE ATOMIC BOMBING OF HIROSHIMA
Hiroshima (August 6, 1945)


In the early morning hours of August 6, 1945, a B-29 bomber named Enola Gay took off from the island of Tinian and headed north by northwest toward Japan. The bomber's primary target was the city of Hiroshima, located on the deltas of southwestern Honshu Island facing the Inland Sea. Hiroshima had a civilian population of almost 300,000 and was an important military center, containing about 43,000 soldiers.

The bomber, piloted by the commander of the 509th Composite Group, Colonel Paul Tibbets, flew at low altitude on automatic pilot before climbing to 31,000 feet as it neared the target area. At approximately 8:15 a.m. Hiroshima time the Enola Gay released "Little Boy," its 9,700-pound uranium bomb, over the city. Tibbets immediately dove away to avoid the anticipated shock wave. Forty-three seconds later, a huge explosion lit the morning sky as Little Boy detonated 1,900 feet above the city, directly over a parade field where soldiers of the Japanese Second Army were doing calisthenics. Though already eleven and a half miles away, the Enola Gay was rocked by the blast. At first, Tibbets thought he was taking flak. After a second shock wave (reflected from the ground) hit the plane, the crew looked back at Hiroshima. "The city was hidden by that awful cloud . . . boiling up, mushrooming, terrible and incredibly tall," Tibbets recalled. The yield of the explosion was later estimated at 15 kilotons (the equivalent of 15,000 tons of TNT).

On the ground moments before the blast it was a calm and sunny Monday morning. An air raid alert from earlier that morning had been called off after only a solitary aircraft was seen (the weather plane), and by 8:15 the city was alive with activity -- soldiers doing their morning calisthenics, commuters on foot or on bicycles, groups of women and children working outside to clear firebreaks. Those closest to the explosion died instantly, their bodies turned to black char. Nearby birds burst into flames in mid-air, and dry, combustible materials such as paper instantly ignited as far away as 6,400 feet from ground zero. The white light acted as a giant flashbulb, burning the dark patterns of clothing onto skin (right) and the shadows of bodies onto walls. Survivors outdoors close to the blast generally describe a literally blinding light combined with a sudden and overwhelming wave of heat. (The effects of radiation are usually not immediately apparent.) The blast wave followed almost instantly for those close-in, often knocking them from their feet. Those that were indoors were usually spared the flash burns, but flying glass from broken windows filled most rooms, and all but the very strongest structures collapsed. One boy was blown through the windows of his house and across the street as the house collapsed behind him. Within minutes 9 out of 10 people half a mile or less from ground zero were dead.

People farther from the point of detonation experienced first the flash and heat, followed seconds later by a deafening boom and the blast wave. Nearly every structure within one mile of ground zero was destroyed, and almost every building within three miles was damaged. Less than 10 percent of the buildings in the city survived without any damage, and the blast wave shattered glass in suburbs twelve miles away. The most common first reaction of those that were indoors even miles from ground zero was that their building had just suffered a direct hit by a bomb. Small ad hoc rescue parties soon began to operate, but roughly half of the city's population was dead or injured. In those areas most seriously affected virtually no one escaped serious injury. The numerous small fires that erupted simultaneously all around the city soon merged into one large firestorm, creating extremely strong winds that blew towards the center of the fire. The firestorm eventually engulfed 4.4 square miles of the city, killing anyone who had not escaped in the first minutes after the attack. One postwar study of the victims of Hiroshima found that less than 4.5 percent of survivors suffered leg fractures. Such injuries were not uncommon; it was just that most who could not walk were engulfed by the firestorm.

Even after the flames had subsided, relief from the outside was slow in coming. For hours after the attack the Japanese government did not even know for sure what had happened. Radio and telegraph communications with Hiroshima had suddenly ended at 8:16 a.m., and vague reports of some sort of large explosion had begun to filter in, but the Japanese high command knew that no large-scale air raid had taken place over the city and that there were no large stores of explosives there. Eventually a Japanese staff officer was dispatched by plane to survey the city from overhead, and while he was still nearly 100 miles away from the city he began to report on a huge cloud of smoke that hung over it. The first confirmation of exactly what had happened came only sixteen hours later with the announcement of the bombing by the United States. Relief workers from outside the city eventually began to arrive and the situation stabilized somewhat. Power in undamaged areas of the city was even restored on August 7th, with limited rail service resuming the following day. Several days after the blast, however, medical staff began to recognize the first symptoms of radiation sickness among the survivors. Soon the death rate actually began to climb again as patients who had appeared to be recovering began suffering from this strange new illness. Deaths from radiation sickness did not peak until three to four weeks after the attacks and did not taper off until seven to eight weeks after the attack. Long-range health dangers associated with radiation exposure, such as an increased danger of cancer, would linger for the rest of the victims' lives, as would the psychological effects of the attack.

No one will ever know for certain how many died as a result of the attack on Hiroshima. Some 70,000 people probably died as a result of initial blast, heat, and radiation effects. This included about twenty American airmen being held as prisoners in the city. By the end of 1945, because of the lingering effects of radioactive fallout and other after effects, the Hiroshima death toll was probably over 100,000. The five-year death total may have reached or even exceeded 200,000, as cancer and other long-term effects took hold.

At 11:00 a.m., August 6 (Washington D.C. time), radio stations began playing a prepared statement from President Truman (right) informing the American public that the United States had dropped an entirely new type of bomb on the Japanese city of Hiroshima -- an "atomic bomb." Truman warned that if Japan still refused to surrender unconditionally, as demanded by the Potsdam Declaration of July 26, the United States would attack additional targets with equally devastating results. Two days later, on August 8, the Soviet Union declared war on Japan and attacked Japanese forces in Manchuria, ending American hopes that the war would end before Russian entry into the Pacific theater. By August 9th, American aircraft were showering leaflets all over Japan informing its people that "We are in possession of the most destructive explosive ever devised by man. A single one of our newly developed atomic bombs is actually the equivalent in explosive power to what 2,000 of our giant B-29s can carry on a single mission. This awful fact is one for you to ponder and we solemnly assure you it is grimly accurate. We have just begun to to use this weapon against your homeland. If you still have any doubt, make inquiry as to what happened to Hiroshima when just one atomic bomb fell on that city." Meanwhile, Tibbets's bomber group was simply waiting for the weather to clear in order to drop its next bomb, the plutonium weapon nicknamed "Fat Man" (right) that was destined for the city of Nagasaki.