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  • Netherlands: no more medication for direct contacts of swine flu patients

    No more medication for direct contacts of swine flu patients

    Physician-epidemiologist at the RIVM: Epidemic can no longer be curbed

    The Netherlands have stopped treating people in the immediate vicinity of
    patients with the swine flu. "It was fighting a running battle."

    More, in Dutch:

    http://www.flutrackers.com/forum/sho...7&postcount=72

    http://www.trouw.nl/nieuws/nederland...nen_meer_.html
    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

  • #2
    Re: Netherlands: no more medication for direct contacts of swine flu patients

    someone please send a sample to CDC for publishing.
    Where there are researchers in a country, then there is delay.


    17 with vermoedelijk griep today, last week only 2
    http://www.degrotegriepmeting.nl/pub...hisarticle=384
    I'm interested in expert panflu damage estimates
    my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

    Comment


    • #3
      Re: Netherlands: no more medication for direct contacts of swine flu patients

      Originally posted by Dutchy View Post
      No more medication for direct contacts of swine flu patients

      Physician-epidemiologist at the RIVM: Epidemic can no longer be curbed

      The Netherlands have stopped treating people in the immediate vicinity of
      patients with the swine flu
      . "It was fighting a running battle."

      More, in Dutch:

      http://www.flutrackers.com/forum/sho...7&postcount=72

      http://www.trouw.nl/nieuws/nederland...nen_meer_.html

      Obviously now, different European countries are following different strategies

      (UK and the Netherlands with Tamiflu restrictions versus (e.g. still at the moment) Germany and others with ongoing recommendation of prophylaxis in close contact-cases).


      Quote:
      "Use for prophylaxis. Countries with larger stocks of antivirals can consider giving them also for prophylaxis..." (ECDC, see below)
      ... or can consider to withhold and reserve them (mine).


      Are there any Data of existing Tamiflu stockpiles in the Netherlands ???



      http://www.ecdc.europa.eu/en/files/p...a_Pandemic.pdf

      ECDC INTERIM GUIDANCE
      Public health use of influenza antivirals during influenza pandemics


      Stockholm, June 2009 [release July 1, 2009]
      (?)
      This evidence indicates that certain antiviral drugs, particularly the neuraminidase inhibitors (oseltamivir and zanamivir), offer some treatment benefits by reducing the duration of illness from influenza usually by 1?2 days
      and also reducing complications and the need for antibiotics in infected individuals. This effect is limited by the need for the drugs to be given early (within 48 hours of the start of symptoms). There is also some weak evidence from observational studies that the drugs might reduce morbidity and even mortality in sicker patients even if given later than the 48 hours.
      Trials in healthy adults suggest infection can be prevented with prophylaxis treatment with a 70% to 90% effectiveness rate provided the drug is taken as prescribed.

      (?)

      Currently the antiviral stockpiles in European countries seem to vary from coverage of a few per cent of the population to more than 50% of the population. However, even with stockpiles in place it is almost inevitable
      that demand for antiviral drugs will outweigh supply in a pandemic. Because of this, it is important that advanced strategic and logistical planning is carried out to optimise the usefulness of existing stockpiles. An important
      general principle is that having stockpiles is of limited use without the agreed objectives, protocols, administration and delivery systems to go with them.

      (?)

      Based on the available evidence ECDC suggests the following prioritisation strategy for antiviral use:

      1 People with more severe disease. The first priority is to treat people with more severe influenza illness even if they are beyond the 48 hour ?window? following the start of symptoms when it is considered that antivirals are effective. However, for these patients it is even more important that there are adequate supplies of appropriate antibiotics available to treat secondary infections, and other essential drugs.

      2 People most at risk of severe disease. Among these, priority could be given to those most at risk of developing severe disease. For seasonal influenza these are those for whom seasonal influenza vaccination is recommended: older people, those with pre-existing chronic conditions, and healthcare workers with direct patient contact. However, this may need to be modified during a pandemic to reflect those most at risk from the pandemic strain*. When both pandemic and seasonal viruses are circulating the seasonal and
      pandemic higher-risk groups will need to be combined. Some countries may want to consider giving prophylaxis in households containing people at higher risk though this would be a complicated policy to implement.

      3 All people just starting an illness. After the more severe cases antivirals could be prioritised for people just starting their illness (within 48 hours of the first symptoms) because that is when these drugs are most effective.

      4 Use for prophylaxis. Countries with larger stocks of antivirals can consider giving them also for prophylaxis. Candidate groups are: close contacts of cases, family contacts, and key workers for business continuity purposes. Home stockpiles are not recommended as supplies are limited though inevitably some people can be expected to request these from their doctors as they did with bird flu.

      5 Healthcare workers with direct patient contact are a special case. They need to have reasonable protection with personal protective equipment. Should they become sick they need to receive antivirals promptly and to stay home from work. Countries with larger stocks may consider prophylaxis for certain groups of these workers.

      Even greater challenges are posed by the organisational aspects of antiviral delivery. Namely the evidence indicating that antiviral treatment may only deliver its limited benefits if it is given within the first 48 hours following the start of symptoms. This will be particularly critical during a pandemic. Hence, for antivirals to be effective in treating infection, resources should also be put in place to develop protocols and systems to ensure their rapid delivery and administration.

      Comment


      • #4
        Re: Netherlands: no more medication for direct contacts of swine flu patients

        Dutch government bought 5 million courses, we have a little more than 16 million inhabitants.

        In may and june pharmacies received some 3000 recipes for Tamiflu, each month.

        Looking at these numbers, it seems clear what is going on. This `second? phase - no prescription for direct contacts - was announced in april.
        ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
        Richard Horton, Editor-in-Chief The Lancet

        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

        Comment


        • #5
          Re: Netherlands: no more medication for direct contacts of swine flu patients

          lower Saxons may goto NL for Tamiflu
          I'm interested in expert panflu damage estimates
          my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

          Comment


          • #6
            Re: Netherlands: no more medication for direct contacts of swine flu patients

            Originally posted by gsgs View Post
            lower Saxons may goto NL for Tamiflu
            How much in Germany ?
            ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
            Richard Horton, Editor-in-Chief The Lancet

            ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

            Comment


            • #7
              Re: Netherlands: no more medication for direct contacts of swine flu patients

              Originally posted by Dutchy View Post
              Dutch government bought 5 million courses, we have a little more than 16 million inhabitants.
              In may and june pharmacies received some 3000 recipes for Tamiflu, each month.

              Looking at these numbers, it seems clear what is going on. This `second? phase - no prescription for direct contacts - was announced in april.


              http://www.atrakatellis.gr/Events/19...port%20(3).pdf

              A high level policy debate report
              Pandemic influenza in the EU:
              Are we sufficiently prepared?


              Brussels, European Parliament, 12 June 2007


              Antiviral stockpiles and their national and international use

              The stockpiling of antiviral treatments has so far been the most visible element of pandemic preparedness measures across Europe. EU countries have so far bought close to half of all Tamiflu? doses produced globally according to Dr. Magn?sson. (...) Taken together, EU Member States currently have a stockpile of treatments for 16.5% of their population even though coverage varies a lot between countries (from 0 to 50%).

              [see attachment: On August 2007 the Netherlands had antiviral stockpile for treatment of 30 % of the population, Germany about 20 % ]

              The speakers spent an important part of their interventions debating many stockpile-related issues such as the prioritisation of their use, the type of use (for treatment or for prevention), the shelf life of the products, the issue of national vs. regional stockpiles and finally the principle of solidarity or the use of national stockpiles for assistance in foreign outbreaks.

              a. Prioritisation
              The prioritisation of treatment arose as one of the key issues with current preparedness plans in the EU during the debate. It is a highly sensitive issue with ethical implications and Member States have taken, in some cases, radically opposing views on what should be done. As an example, Norway recommends the early protection of medical workers whilst Finland does not3.


              The dilemma arises from the possible dual use of currently available antiviral treatments. In addition to their original use for treatment of contaminated patients, antivirals can also be used for ?pre-emptive? protection of healthy individuals (prophylaxis). (...)
              Attached Files

              Comment


              • #8
                Re: Netherlands: no more medication for direct contacts of swine flu patients

                Originally posted by gsgs View Post
                lower Saxons may goto NL for Tamiflu
                Originally posted by Dutchy View Post
                How much in Germany ?
                I guess, gsgs' forecast may be right:

                The northern Federal German Lands (Lower Saxony included) have Tamiflu stockpile only for 11 to 14 percent doses of treatment courses of the population. Germany's total stockpile now is 30 % (If the German Government wont help Lower Saxony, lower Saxons will love to go to the Netherlands instead )



                http://www.direktbroker.de/news-kurs...emitt/20205863
                29.04.2009
                Nordl?nder mit Grippemitteln schlecht ausgestattet
                Bevorratung nur f?r elf Prozent der Bev?lkerung - Beh?rden: Kein Grund zur Besorgnis
                M?nchen/Hannover (ddp-nrd). Die n?rdlichen Bundesl?nder verf?gen nach Angaben der Deutschen Gesellschaft f?r Infektiologie (DGI) nicht ?ber einen ausreichenden Vorrat an Grippeschutzmitteln. In Bremen, Hamburg, Niedersachsen, Mecklenburg-Vorpommern sowie Schleswig-Holstein seien nur f?r 11 bis 14 Prozent der Bev?lkerung entsprechende Arzneimittel eingelagert,...



                http://www.bmg.bund.de/cln_151/nn_11...19008bodyText9
                Bundesministerium f?r GesundheitSchweinegrippe - 30. Juni 2009
                Antworten des BMG und des RKI auf Fragen zur Neuen Grippe , zum Ordnungsbegriff:
                Wie ist Deutschland auf eine Pandemie vorbereitet?Deutschland hat sich seit Jahren auf eine Influenzapandemie vorbereitet. (...)
                Der Nationale Pandemieplan gibt einen Rahmen vor, der die Grundlage f?r die Pandemiepl?ne der L?nder und die Ausf?hrungspl?ne der Kommunen bildet. Mit der Erarbeitung der Influenzapandemiepl?ne der L?nder erfolgt eine Konkretisierung der im Nationalen Influenzapandemieplan vorgesehenen Ma?nahmen f?r das jeweilige Land. (...)

                Erkrankte Menschen k?nnen mit antiviralen Arzneimitteln (Neuraminidasehemmern) behandelt werden. Im Pandemieplan ist eine Bevorratungsmenge f?r 20% der Bev?lkerung empfohlen. Dann kann bei einer mittelschweren Pandemie davon ausgegangen werden, dass Erkrankte im Pandemiefall eine Therapie mit antiviralen Arzneimitteln erhalten k?nnen. Die L?nder haben antivirale Arzneimittel bevorratet, im Durchschnitt f?r 20% der Bev?lkerung. Im Bedarfsfall k?nnen aus einer Bundesreserve antivirale Medikamente f?r weitere 10 % der Bev?lkerung zur Verf?gung gestellt werden.

                Comment

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