At this point in our lives, however, we are just not into the idea of setting such strict boundaries. That doesn’t mean splurging on the $300 cashmere sweater though. It means shopping smart and exploring options in the most unexpected places. If you’re only looking at cashmere options in a fancy department store, you’re never going to find a great deal. But if you shop with Us? You might find that the best choice was on Amazon all along!AmazonSee it!Get the Ckikiou Batwing Cashmere Pullover for just $24 at Amazon! Please note, prices are accurate at the date of publication, November 4, 2020, but are subject to change.- Advertisement – To be clear, the material of this sweater is a cashmere blend, but that’s exactly why we love it. It keeps the price low, but it doesn’t skimp on the luscious softness for a second. You can buy it with confidence, wear it with confidence and enjoy its coziness any time you want. You’ll especially want to once you realize how chic it is!This pullover sweater is exactly the ticket to looking like a fashionista in the modern world. It has a ribbed texture but a loose, relaxed fit, complete with a boat neckline and batwing long sleeves. It has a good amount of stretch to it too! It tapers in just the right places to show off your figure without clinging too tightly anywhere.AmazonSee it!- Advertisement – Get the Ckikiou Batwing Cashmere Pullover for just $24 at Amazon! Please note, prices are accurate at the date of publication, November 4, 2020, but are subject to change.This sweater comes in many colors, including a few with angular color-blocking. When you browse through the options on Amazon, you’ll also notice that there’s another style available with a similar construction but varying details, so make sure to carefully check your pick before adding it to your cart and checking out!A sweater like this will become a quick go-to for you in the cold. All you need to do is slip it on with a pair of jeans, leggings or trousers and you’re set! So fast, so easy, so stylish. So needs to be on its way to you right now! See it!Get the Ckikiou Batwing Cashmere Pullover for just $24 at Amazon! Please note, prices are accurate at the date of publication, November 4, 2020, but are subject to change.Not your style? Shop more from Ckikiou here and other pullover sweaters here! Don’t forget to check out all of Amazon’s Daily Deals for more great finds!Check out more of our picks and deals here!This post is brought to you by Us Weekly’s Shop With Us team. The Shop With Us team aims to highlight products and services our readers might find interesting and useful, such as face masks, self tanners, Lululemon-style leggings and all the best gifts for everyone in your life. Product and service selection, however, is in no way intended to constitute an endorsement by either Us Weekly or of any celebrity mentioned in the post.The Shop With Us team may receive products free of charge from manufacturers to test. In addition, Us Weekly receives compensation from the manufacturer of the products we write about when you click on a link and then purchase the product featured in an article. This does not drive our decision as to whether or not a product or service is featured or recommended. Shop With Us operates independently from advertising sales team. We welcome your feedback at [email protected] Happy shopping! – Advertisement – Us Weekly has affiliate partnerships so we may receive compensation for some links to products and services.For some of us, cashmere has just never really been a thing in our lives. We always knew it existed, and we’ve certainly run our hands over its softness in the mall here and there, but the thought of buying just never presented itself as an option. It’s just too expensive! It’s one thing to save the money to buy a cashmere piece you love, but it’s another to wear it and have to worry about staining or tearing that precious fabric!- Advertisement –
– Advertisement – OlderNew research further undermines UK quarantine scheme NewerSteenbergen appointed chief financial officer at Lufthansa Heathrow chief executive, John Holland-Kaye, said: “Aviation is the lifeblood of the UK’s economy, critical for exports of goods and services and imports of vaccines, as well as inbound tourism, students and foreign direct investment. “Lack of government action is weakening our sector, making it harder for us to support the eventual economic recovery and help deliver the prime minister’s vision of a global Britain.”Heathrow argued the lack of a testing regime has left British airports unable to compete with EU rivals.- Advertisement – Passenger figures at Heathrow were down 82 per cent in October when compared to last year, as the Covid-19 pandemic continue to take a toll on global aviation. The airport also warned data for November was likely to be even worse, as England enters a four-week lockdown. – Advertisement – Long-haul and critical markets for trade suffered the worst declines, Heathrow said.This was due to the “debilitating quarantine requirements” put in place by the UK government. Overall cargo volumes were down 23 per cent compared to last year. – Advertisement – At the same time, the refusal to offer English and Welsh airports business rates relief runs the risk of worsening an already challenging situation and the plans to end VAT-free shopping threatens to kick our industry when its down, a statement added.The figures come as new research suggests the quarantine regime may be less effective than previously thought.
Said Jane Lubchenco, a professor of marine biology at Oregon State University and head of NOAA under President Barack Obama: “He’s not just in left field—he’s not even near the ballpark.” And Michael Mann, climate scientist at State University, emailed to National Public Radio to say that Legates has, throughout his career “misrepresented the science of climate change, serving as an advocate for polluting interests as he dismisses and downplays the impacts of climate change.”- Advertisement – “I think [Legates] can make messes that the Biden people are going to have to clean up, especially with respect to personnel appointments and author nominations and assignments,” said a former scientist with the research program, who stressed that new leadership could reverse any changes implemented by Legates. The fifth such assessment is now in the works. The two volumes of the Fourth National Climate Assessment were released in 2017 and 2018. As I reported then, the assessment noted that climate change isn’t some far-in-the-future problem, but is already happening, inflicting “substantial damages” on communities, and it’s going to get worse. Denier-in-Chief Trump didn’t like the assessment, and claimed he didn’t believe it. The only surprise is that he didn’t move sooner to screw things up with the next assessment. The Post notes: The move [to appoint Legates] has rattled rank-and-file scientists at NOAA, the lead agency working on the climate assessment, according to people inside and outside the organization. For much of Trump’s tenure, there has been little political interference at NOAA, the notable exception being Trump’s hand-drawn alteration of an official hurricane forecast, an incident known as “Sharpiegate.” Legates has signed the Oregon Petition, which caught a lot of well-deserved flak for trying to pretend it was something it was not—a peer-reviewed study. The petition states:“There is no convincing scientific evidence that human release of carbon dioxide, methane, or other greenhouse gasses is causing or will, in the foreseeable future, cause catastrophic heating of the Earth’s atmosphere and disruption of the Earth’s climate. Moreover, there is substantial scientific evidence that increases in atmospheric carbon dioxide produce many beneficial effects upon the natural plant and animal environments of the Earth.”In testimony to Congress last year, Legates said, “Climate has always changed and weather is always variable, due to complex, powerful natural forces. No efforts to stabilize the climate can possibly be successful. […] The current emphasis on climate change abatement will do far more harm than good.”Legates is one of the many Trump appointments who ought to be out the door before the sun goes down Jan. 20. – Advertisement – – Advertisement –
On the court, Zverev has appeared unaffected, but his recurrent second-serve troubles reared their head early on in this contest.The 23-year-old served six double faults in his first three service games, losing two of them, and the second break saw Medvedev take control after a series of lengthy rallies and close games.A break in the seventh game of the second set put the Russian within sight of the finish line, and in the next game he pulled out an underarm serve. Zverev scrambled well to retrieve it but miscued a volley.
– Advertisement – This personal alert wearable is super easy to use. Once you get it, simply create an account on the SOS app. Then, enter your emergency contacts onto the list. In the event of an emergency, press the button on the front of the band. It sends one-click GPS and elevation coordinates to your contacts immediately. And the best part is, you don’t even need to have your phone on you to use this device. The SOS will cover you no matter your phone’s status. So it sounds like a practical gadget pretty much anyone would want to include in their EDC.SOS Band global personal alert wearable on a person outdoorsDoes this gadget track your movements?While this personal alert wearable can pinpoint your location when you need help, it doesn’t keep a log of your movements. It only works when you activate it, keeping your movements private and personal. So this is one device, at least, that won’t ask you to rate the bakery you passed during your last bike ride.– Advertisement – The beauty of this personal alert wearable is that it works globally. So you can wear it while you jog in your neighborhood or hike while you’re on a business trip. For now, the SOS Band works in over 213 countries, and more are being added all the time. Check the list before you head out.SOS Band global personal alert wearable on a person rock climbingCan I wear this emergency wristband in the rain?The makers of the SOS Band know that when you’re outside, rain and splashes happen. That’s why they’ve given their wristband a completely sealed design so that it can go with you pretty much anywhere. It’s even saltwater proof, so you can wear it while you’re wakeboarding or doing any other watersport in the ocean. It’s definitely a product you’ll want to take with you on your next beach vacation.SOS Band global personal alert wearable on a person paddlingDoes this product take the environment into account?According to the company’s Indiegogo page, this personal alert wearable promotes sustainability since its battery is so long lasting—this cuts down on the use of batteries compared to similar products. Also, the durable material stands up to heavy use. This means you shouldn’t have to replace the band for over ten years. It also means there’s less material manufacturing, putting a smaller load on the planet’s raw materials.SOS Band global personal alert wearable on a person throwing a ropeThe SOS Band personal alert wearable is a great gadget for people who exercise alone outdoors. This device is easy to use and provides a truly great service, sending your location’s coordinates to your emergency contacts. And with the millions of sporting accidents that occur in the US each year, it’s a wearable that could prove to be a lifesaver. So it’s a gadget you’ll want to consider getting for yourself and loved ones.The SOS Band global personal alert wearable costs $75, and you can preorder yours on Kickstarter.What other gadgets are you crazy about for your solo adventures outdoors? Let us know in the comments :).SOS Band global personal alert wearable on a person walking through the forest SOS Band global personal alert wearable on a person rock climbingHow long does the battery last?You won’t have to worry about running out of batteries with this sports wearable. That’s because the SOS Band‘s batteries last for ten years. That’s right; you won’t need to change the batteries on this wristband for a decade. This is a huge improvement over the typical wearable’s battery life, which only lasts a few days before needing a recharge.SOS Band global personal alert wearable on a person huntingWhere does this location-sharing wristband work?- Advertisement – Lauren has been writing and editing since 2008. She loves working with text and helping writers find their voice. When she’s not typing away at her computer, she cooks and travels with her husband and two daughters. You love exercising in the great outdoors but know it can be dangerous out there. Breathe a little easier with the SOS band. This emergency wearable is easy to use and sends your location’s coordinates to your contacts if you’re in trouble.If you bike or run solo, you know how important it is to stay connected to emergency contact while you’re out. And luckily, today’s wearables are making that easier than ever, especially the SOS Band global personal alert wearable. In the event of an emergency, this wristband shares your coordinates with your contact list. All you have to do is press a button.The SOS Band looks like a sturdy smartwatch or fitness tracker. It has the company’s logo engraved on the front and has a rugged, durable quality. In fact, this wearable is dust, impact, and water-resistant with an IP-69 rated housing case. Overal, it’s a personal safety gadget that looks like it was meant to be worn outdoors, and you’ll feel quite stylish wearing it.How does this alert wristband work?- Advertisement –
Providing easy access to hand sanitizers Eligible residents can add their names to the existing pool of about 1,600 until Nov 12. Next week, health department employees will draw the names. Important as it could be for those chosen, McKim said the drawing will take place without fanfare. To date, 29 states have reported flu cases to the CDC, Gerberding said during a teleconference Nov 9, but the number of cases is well within normal limits. See also: The department announced the same day that it was shipping its available vaccine supply of about 74,000 doses to local health departments and to providers in the federal Vaccines for Children (VFC) program, which helps needy children. The shipments included 42,000 doses for the VFC program and 32,000 doses for health departments. Placing a box of surgical masks as close to the entry as possible “ACIP [the Advisory Committee on Immunization Practices, which advises CDC] has given us a national standard,” he said. “I don’t have a scientific basis on which to re-prioritize.” After learning of his situation, a retirement home offered Pallotto a dose of its leftover vaccine. The AP reported he would get the shot on Nov 9. A survey of healthcare and home-care agencies in New York showed a need for about 1.4 million doses of vaccine, of which the agencies have received only 460,000 doses, said Robert Kenney, a spokesman for the state’s health department, in a Nov 3 phone interview. “It’s a clue. And we don’t know if it’s going to be a useful clue or not,” she was quoted as saying. Colorado: Following CDC rules, mostly Vaccine doses were to be allocated to health departments on the basis of population. Some counties may offer those vaccines to local long-term care facilities or to healthcare providers for high-risk patients, officials said. The amounts do not include those for New York City, which is receiving its own supply of redistributed flu vaccine from the CDC, the announcement said. Separating patients with respiratory illnesses from other patients California: Honing hygiene practices New York: doses for kids distributed About 1,600 eligible Quincy residents had entered their names for the flu-shot lottery as of yesterday, said Karen McKim, RN, a public health nurse in the city health department. The city received about 1,000 doses from the state and had separately purchased another 300 doses for city employees, she said. Now all 1,300 doses will be used for seniors and the chronically ill. The Mendocino County Public Health Department departed from CDC recommendations to limit the number of people eligible for vaccines, according to a report published Nov 6 in the Ukiah Daily Journal. The county is recommending people ages 70 and older get flu shots, as opposed to the CDC guideline of anybody 65 or older. The county will also tighten its definition for chronic disease, the county’s public health nursing director, Carol Whittingslow, was quoted as saying. Food and Drug Administration (FDA) officials met with Illinois officials last week, but hadn’t given authorization as of Nov 8. A letter from Lester Crawford, DVM, PhD, acting commissioner of the FDA, on Oct 27 indicated FDA was trying to identify flu vaccine sources and would work with Illinois, but emphasized the importance of assuring a safe vaccine and delivery process. Vaccine has proved more plentiful than the situation indicated a month ago in Minnesota, the AP reported on Nov 7. Nursing homes have enough flu vaccine, officials told the AP. Jumps in sales might indicate that flu is emerging, Julie Gerberding told the Associated Press (AP) during the American Public Health Association’s annual meeting in Washington, DC. Within three weeks after the Chiron announcement, the state received an additional 196,000 doses, Calonge said. Those have been distributed according to the CDC guidelines, with eligible residents receiving shots on a first-come, first-served basis, he said. He expressed a concern that straying from those guidelines could lead to liability problems. Sixty-two-year-old Nick Pallotto, who works as Santa Claus each year, entered the limelight when a Colorado Springs, Colo., clinic denied him a flu shot on Nov 6. “We consider this the highest of the high priorities,” McKim said. “There’s going to be so many of us drawing the names, just to get this done. Then we’ll have to alphabetize them all and call them back,” she said. More than 200,000 doses of vaccine reached Colorado before Chiron’s vaccine lots were condemned in early October, Calonge said today. “It was given out in mass flu-vaccination clinics,” and authorities don’t know how many of those doses reached the highest-priority patients. Providing masks to all patients with symptoms of a respiratory illness The shots will go to county health departments, which will determine how to allocate them, a spokesman told the AP One low-risk state resident made national news this week when he tried to obtain a flu shot. Scrambling for vaccine: A sampling of responses (Oct 28, 2004, series article) Quincy public health officials once vaccinated as many as 5,000 people each flu season, but budget woes forced them to reduce that number to about 2,400 people in recent years, McKim said. This year, a number of vaccine doses have been distributed to pediatricians, so the public health department is focusing on the 75-and-older crowd and younger adults with provable, serious chronic diseases. The Florida Health Department said it is receiving 140,000 doses of flu over the next week, according to a Nov 8 AP story. That follows the delivery of 440,000 doses 2 weeks ago, the AP said. Pallotto is too young and healthy to be vaccinated, the AP reported. But his work as Santa brought about 10,000 kids to his lap in 2003, which is why he gets a flu shot every year, he told a reporter. “We have a high senior population and we found it [a lottery] was probably the fairest way to do it,” McKim told CIDRAP News. Florida: Phase two of vaccinating Minnesota: Supplies unexpectedly improved Nov 11, 2004 (CIDRAP News) – Massachusetts residents in at least three communities are hoping to obtain flu shots through the luck of the draw as local health departments seek the fairest way to distribute limited vaccine supplies among those who need them the most. Colorado has an estimated 1.1 to 1.2 million people eligible for vaccination this year, said Ned Calonge, MD, MPH, chief medical officer for the Colorado Department of Public Health and Environment. Below are glimpses of what’s happening in several other states. At the national level, the director of the CDC has announced a plan to monitor sales of over-the-counter drugs as one way to spot local influenza outbreaks, she told reporters on Nov 7. A month ago most nursing homes in the state lacked vaccine, but enough has since been found to supply all 405 facilities. Officials say that the state has received a total of about 800,000 doses of vaccine. In Massachusetts, local departments are free to develop their own distribution plan, providing they hew to statewide emergency eligibility rules: vaccine can be given to seniors 75 years and older, children 6 to 23 months old, patients with severe chronic illness, and pregnant women, according to a Nov 7 Boston Globe story. Those guidelines are more restrictive than the recommendations of the Centers for Disease Control and Prevention (CDC) in Atlanta. Redefining eligibility is increasingly common as state and local departments try to stretch vaccine supplies in a time of shortage. In Massachusetts, the Holyoke, Quincy, and Upton health departments are conducting lotteries. Unwilling to watch this flu season unfold with such limited vaccine, governors in two states have announced they will try to buy vaccine from European wholesalers, though neither state has federal approval to make the purchases, the AP reported on Nov 4. New Mexico and Illinois want to import about 400,000 doses combined, the story said. The same story reported that the health department sent a letter to physicians recommending a few simple steps to improve respiratory hygiene in clinics, including:
Jun 27, 2005 (CIDRAP News) – You’ve got to gather a lot of eggs to supply the world with influenza vaccine, but that might change before long.As governments and scientists wrestle with how best to protect people from the annual onslaught of typical flu and the unpredictable attack of pandemic flu, they’re seeking alternatives to egg-based vaccines.A production method common to other vaccines, cell culture, is increasingly gaining currency. Cell-culture technology involves growing key vaccine components in human, monkey, canine, insect, or other cells in enclosed vats.The process has been used for vaccines such as polio, hepatitis A, chickenpox, and shingles, said Robin Robinson, PhD, senior project officer for the Office of Public Health Emergency Preparedness in the US Department of Health and Human Services (HHS).Growing flu vaccines in cell cultures would mark a huge departure from the traditional method.The decades-old production method used today involves growing vaccines in fertilized chicken eggs. It depends on the availability of hundreds of millions of eggs and requires adapting the virus strain to grow in eggs. The production process takes at least 6 months, according to the National Institute of Allergy and Infectious Diseases. And in the event of an emergency, there is no way to quickly scale up the supply, since eggs must be ordered in advance.With cell-culture methods, the virus does not need to be adapted for growth in eggs, and in an emergency, manufacturers could boost production without waiting for chickens to lay enough eggs. Although estimates vary as to how much time would be saved with cell-culture production, experts familiar with both methods say it could shorten the process by at least a month.Besides being faster, production of cell-culture vaccines is considered safer and cleaner than egg-based systems because it uses a closed system of bioreactors.An improving climateDespite the disadvantages of egg-based vaccines, however, there has been little pressure to pursue cell culture. The functional egg-based infrastructure, the relatively low profits for flu vaccines, and the challenges of adapting the flu virus for cell culture production have slowed research and development, authorities say.Egg-based vaccines “have always been a very cheap product, and there was never a real incentive in the industry to change that process,” explained Manon Cox, DrS, MBA, chief operating officer of Protein Sciences Corp. in Meriden, Conn., in a recent interview. Protein Sciences is developing a cell-culture flu vaccine using caterpillar cells.The climate for cell-culture flu vaccines is improving because of shortages in the US vaccine supply and the growing fear that the next pandemic could be brewing right now in Southeast Asia.While some companies have been researching cell-culture techniques for years, others now have incentives to join the push. The United States has worked in the last year and a half to encourage a number of contracts to “secure, expand, and diversify the influenza vaccine supply in the United States” for both seasonal and pandemic flu, Robinson said.HHS in April awarded vaccine maker Sanofi Pasteur a $97 million, 5-year contract to develop cell-culture technology. The contract is for developing the technology and design for a facility to manufacture at least 300 million doses of vaccine for use in a pandemic.HHS has already issued another request for proposals to boost flu vaccine research and development, Robinson said. The contracts call for producing a pandemic flu–like vaccine that must go through phase 1 and 2 clinical trials “so they have a candidate that will be both safe and immunogenic,” he said.Bruce Gellin, director of the National Vaccine Program at HHS, explained why it’s important to end the era of the egg in testimony before a congressional subcommittee on Apr 12:”Using a cell culture approach to producing influenza vaccine offers a number of benefits. Vaccine manufacturers can bypass the step needed to adapt the virus strains to grow in eggs. In addition, cell culture–based influenza vaccines will help meet surge capacity needs in the event of a pandemic or shortage. US licensure and manufacture of influenza vaccines produced in cell culture will also provide security against risks associated with egg-based production, such as the potential for egg supplies to be contaminated by various poultry-based diseases.”Cell-based techniques would allow manufacturers to double or triple vaccine production, from, say, 10 million doses a week to perhaps 20 million or 30 million, Robinson said.In addition, safety could be greatly improved with cell-culture vaccines, he noted. Egg-based vaccine production involves open systems, whereas cell-culture production involves a bioreactor, which is a closed system. Cell-culture technology far safer from contamination by pathogens, which would be of crucial importance in the event of a pandemic, he said.Caterpillar cells as vaccine factoriesSanofi Pasteur is but one of several companies working to develop cell-culture flu vaccine, according to a list Robinson compiled. They include Solvay Pharmaceuticals of the Netherlands, Baxter in Austria, Chiron in Germany, GlaxoSmithKline in Belgium, ID Biomedical of Canada, and Medimmune in the United States. None of the vaccines is on the market yet.”Today everybody is trying to do this,” said Cox, of Protein Sciences.Protein Sciences is betting on the baculovirus system for its cell culture flu vaccine. The baculovirus has a reputation in nature for easily infecting insect cells, Cox said.Protein Sciences’ process starts with recombinant hemagglutinin (rHA), she said. Hemagglutinin (H) and neuraminidase (N) are the surface proteins of the flu virus. H helps the virus bind to and enter host cells, and N enables new copies of the virus to leave a cell so they can infect others.The rHA is essentially zipped up like DNA, creating a more stable, less shift-prone blueprint, Cox said. The rHA is inserted into a baculovirus, and the baculovirus is added to caterpillar cells.”The rest happens on its own,” Cox said. “There’s an infection, the baculovirus infects the insect cells, and it sets about producing the product of interest [baculovirus copies containing rHA]. The insect cell is a little factory, which is now starting to produce whatever that baculovirus wants it to produce.””Vaccine manufacturers have recognized that this baculovirus system is an enormously powerful system to make vaccines against viral or parasitic diseases,” she said. “We need to convince venture capitalists and other partners that this is indeed the product to go for,” she added. It will probably be 3 years before the company seeks FDA approval.The company’s efforts may have taken a stride forward with the announcement in mid-June of preliminary results from its initial field efficacy study of the FluBlOk vaccine, made through the process described above.The study included 460 healthy people aged 18 to 49 at three US sites, according to a news release from the company. Subjects were injected with one of two different formulations of FluBlOk, with the same amount of H3 antigen but two different amounts of H1 and influenza B antigens, or with a placebo. The 135-microgram dose was 100% efficacious in preventing culture-positive influenza compared with the placebo, the company said. In addition, the vaccine groups had a 50% lower rate of flu-like illness than the placebo group.The trial showed safety and induced strong antibody responses against influenza in all vaccinated subjects, the company said, adding that final assessments are still under way.Seeking licensing in the Netherlands, USThe Dutch company Solvay Pharmaceuticals has been working on a cell-culture flu vaccine since the early 1990s, according to Bram Palache, MSC, PhD, biochemist and global medical affairs director for influenza vaccines.Solvay’s vaccine is made in canine cells, a line that has been approved for use in the Netherlands, although it wasn’t approved when Solvay selected it, Palache said. The company is in the process of validating its factory, and hopes to make clinical lots there this year. From there it’s a relatively short step to final licensure of the flu vaccine for use in the Netherlands, he added.Solvay is seeking US Food and Drug Administration approval of the flu vaccine and the cell line used to produce it, Palache said. He was not ready to speculate on how long it might be before the vaccine would be available in the US.The importance of alternatives to eggs for vaccine production came home to Solvay in 2003, when the company lost chickens during an outbreak of H7N7 avian flu in the Netherlands. The company had to scramble to get approval to bring in eggs from disease-free areas so it could produce flu vaccine on time.”We had a real-life situation where the vulnerability of eggs for the production of influenza vaccines was really making the difference between having vaccine and having no vaccine,” Palache said. “There’s nothing wrong with egg production per se. But once the cell-culture vaccine is implemented . . . more companies will come in, using that technology. Ultimately it will replace the current production technology.”Cell culture just part of US strategyRobinson cautioned that in the flu vaccine arena, there are more pressing short-term goals than developing cell-culture technology. “We approach it in two phases. One is preparedness to hopefully have stockpiles of a virus that is as close as we think it can be to the [potential pandemic] threat. And then to have the manufacturers ready to go with virus seed strain. And then to have the capacity.”The short-term US goals are aimed at improving the current flu vaccine production processes to improve yield and making the available vaccine supplies stretch further, he said. The goals include developing adjuvants to boost immune response and finding alternative methods for injecting the vaccine.Robinson said he wants the nation to have the surge capacity to produce at least 20 million doses of monovalent vaccine per week by 2009.Ultimately, what the United States would need for a pandemic flu strain is 600 million doses of vaccine—two doses for every American. Compare that with the numbers for the 2004-05 flu season: Authorities hoped to have 100 million doses available, but obtained only 61 million. The leap from the unmet goal of 100 million doses to 600 million is so daunting that even experts such as Robinson break down the numbers.”That’s why we like to talk about it in terms of weeks,” he said.And while cell-culture technology may improve flu vaccine production capacity, it is not a panacea for the challenge of a flu pandemic. A vaccine cannot be specifically tailored to a pandemic virus until the virus emerges, so even with cell-culture technology, an optimal vaccine would not be available for the first several months of a pandemic.Moreover, only nine countries have the capacity to produce flu vaccine on a commercial scale. The advent of cell-culture technology does not automatically solve the problem that current global annual production capacity is fewer than 1 billion doses of flu vaccine in a world of more than 6 billion people—or the challenge of actually administering vaccine to billions of people in a pandemic situation. And even if the United States could eventually secure enough doses for its own population, the nation would not be immune to the global economic disruption that a pandemic would cause.Aside from pandemic-related concerns, Palache said that switching production methods won’t address a key problem with flu vaccine: demand.”[Neither] Solvay nor any other company will produce three times as much vaccine just because they can do it if by the end of the day it isn’t sold. Flu vaccines can’t be put on the shelf for the next year,” he said. “Whether they’re eggs or cells, demand drives supply.”See also: Transcript of Bruce Gellin’s testimonyhttp://www.hhs.gov/asl/testify/t050412.html
May 31, 2006 (CIDRAP News) – A 15-year-old boy in West Java has become Indonesia’s latest avian flu fatality, according to news reports that cited local tests.Meanwhile, the World Health Organization (WHO) reported today that in the remote North Sumatra village that witnessed a large family cluster of avian flu cases, no cases suggestive of H5N1 infection have been detected since May 22.The 15-year-old boy, who was from Tasikmalaya, West Java, was admitted to a hospital May 29 and died yesterday, according to a Reuters story today. If his death is confirmed by a WHO laboratory in Hong Kong, his will be the 49th case and 37th death in Indonesia. About two thirds of those cases have occurred this year.Government officials said that the teen had contact with infected poultry and that his own chickens died about 2 weeks ago, according to Reuters. In addition, the report said, the boy’s grandfather was a chicken farmer who had 40 chickens that died recently.The boy represents the third recent H5N1 fatality from West Java province. A 10-year-old girl and her 18-year-old brother died last week in Bandung, which is about 55 miles northwest of Tasikmalaya.Today’s WHO update on the case cluster in Kubu Simbelang village, Karo District, North Sumatra, states that 54 family members and other close contacts remain under home quarantine. In addition, investigators have been conducting house-to-house surveillance for flu-like symptoms throughout the 400 or so households in the village, and a surveillance command post was set up in the village last week.With all this monitoring in place, no new cases resembling avian flu have been identified in Kubu Simbelang over the last 9 days, the WHO reports. This finding is important, the agency says, because it indicates that the H5N1 strain has not spread beyond members of the single extended family.Today’s WHO update also provides further details on the history of the case cluster.As noted in previous reports, the original family member to fall ill was a 37-year-old woman who is considered the index case, though samples from her body were not collected before she was buried. According to today’s report, she started showing symptoms consistent with avian flu April 24 and died May 4.She sold fruit and chilies at a market stand about 50 feet (15 m) from a stand that sold live chickens, according to the WHO. She also kept a small flock of backyard chickens, which she allowed into the house at night. Three of these chickens reportedly died before she became ill. She also used chicken feces to fertilize her garden.The woman had one sister and three brothers. The sister and two of the brothers contracted H5N1, and one of the brothers is the only infected family member to survive.The family members who died of avian flu include the 37-year-old’s two teenaged sons, her sister’s 18-month-old girl, and a 10-year-old son of the brother who died.On April 29, according to today’s update, nine family members spent the night in the same small room as the index patient when she was severely ill and coughing heavily. Five to 6 days later, three family members experienced symptoms. These were her two teenaged sons and the surviving brother, who was from a village 6 miles away.The sister of the initial patient developed symptoms at the same time, as did the sister’s 18-month-old daughter. The sister, who lived in an adjacent house, cared for the index patient, accompanied by her young daughter.The 10-year-old boy lived next door to the 37-year-old woman and was a frequent visitor in her house. His father, the woman’s brother, was the final fatality (May 22) and had tended his son throughout his hospital stay from May 9 through May 13.The WHO report also says that a parallel agricultural investigation still has not detected H5N1 virus in about 80 samples from area animals and chicken fertilizer, meaning that the initial source of the outbreak remains unknown.See also:WHO’s Indonesia cluster updatehttp://www.who.int/csr/don/2006_05_31/en/index.html
Feb 23, 2007 (CIDRAP News) – The nation’s largest public health group, the American Public Health Association (APHA), yesterday released recommendations aimed at strengthening existing federal strategies for pandemic preparedness and encouraging local officials and businesses to play key roles.At the top of its list are more resources for an overburdened public health workforce, which will play a key role in responding to a pandemic flu outbreak. Other recommendations in the APHA’s 16-page report range from expanding surge capacity in hospitals and public health labs to providing emergency medical coverage for people who are uninsured.Preparing for an influenza pandemic isn’t just the job of the public health sector, said Georges C. Benjamin, MD, the APHA executive director, in a press release yesterday. “The general public must be equipped with the proper resources to prepare themselves in the event of a flu pandemic,” he said. “The better we prepare now, the better our chances will be for protecting the health of Americans during an emergency.”Jeffrey Levi, PhD, executive director of Trust for America’s Health (TFAH), a nonprofit public health advocacy group, lauded the APHA’s report, particularly its call for Congress to enact measures, such as scholarship and loan incentives, to bolster the public health workforce. “This is an excellent report that covers some of the critical pandemic preparation issues and places them appropriately in larger context,” he told CIDRAP News.Though isolation of flu patients and quarantine of exposed people are likely to play a limited role in the early stages of a pandemic, policymakers need to shore up laws and policies on isolation and quarantine, including who has authority to issue quarantine orders, the APHA report says. “These decisions should be made on the basis of scientific risk and use the least restrictive alternative.”The US Department of Health and Human Services (HHS), along with state and local officials, should develop national standards for sheltering in place, and the public should be urged to prepare to shelter at home for at least 2 weeks, according to the report.HHS and the US Department of Education should take the lead in developing national criteria for school closings in a pandemic and should make school districts aware of them, the report says.The APHA questions a component of the HHS antiviral stockpiling plan that encourages states to purchase antiviral medication with a 25% federal subsidy. According to a USA Today report on the antiviral subsidy program, written after the Aug 1, 2006, signup deadline, at least 43 states indicated they wanted to participate, though some said their ability to buy the drugs was uncertain. “The level of protection Americans receive should not be determined by where they live and the current fiscal position of their states,” the report says.Funding for national stockpiles of medical and lab supplies is inadequate, the document says. Besides items such as ventilators, syringes, and gloves, the medical stockpile should include equipment and medications needed to treat people who have chronic illnesses such as HIV and diabetes.In addition, the Food and Drug Administration should consider relaxing its limit on the amount of medicine that can be dispensed per prescription so that people with serious health problems can store enough medication to get them through an isolation or quarantine order during a pandemic, the APHA contends.Echoing the concerns of other health advocacy groups, such as TFAH, the APHA calls on Congress and HHS to establish an emergency Medicaid designation to encourage uninsured people to seek treatment more quickly if they have influenza symptoms. Other measures the APHA says would help ensure patients’ access to medical care during a pandemic include improving medical surge capacity—not only for flu patients, but also for those with other medical conditions.The APHA report places a strong emphasis on pandemic-related business and occupational health concerns. It urges businesses to consider paid sick-leave policies that encourage employees to stay home when they or their family members are contagious during a pandemic.Also, the group recommends including several other business-related provisions in the national pandemic plan, such as:Setting guidelines about work-related influenza exposure for use in workers’ compensation casesProviding financial support for employers who face extremely high costs for worker protectionRequiring employers to develop pandemic preparedness plansMandating employee training in prevention and exposure controlRecommending that workers in high-risk occupations wear respirators rather than surgical masksLike other groups, such as the Infectious Diseases Society of America, the APHA critiques current federal emergency response plans for designating the Department of Homeland Security as the lead agency in a flu pandemic, leaving HHS responsible only for “very traditional public health and medical issues.””Responding to a pandemic flu is much different than responding to a terrorist attack or hurricane,” the report says. “Therefore, public health officials—the Department of Health and Human Services—should have the formal authority to take the lead in the federal response to pandemic flu.”See also:Feb 22 APHA press releaseAPHA report: “Prescription for Pandemic Flu”http://www.apha.org/advocacy/policy/APHA+Prescription+for+Pandemic+Flu.htmFeb 1 CIDRAP News story “HHS ties pandemic mitigation advice to severity”Jan 25 CIDRAP News story “IDSA urges requiring flu shots for healthcare workers”