WHO | Recommended composition of influenza virus vaccines for use in the 2019 southern hemisphere influenza season

27 September 2018

It is recommended that egg based quadrivalent vaccines for use in the 2019 southern hemisphere influenza season contain the following:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus;
  • an A/Switzerland/8060/2017 (H3N2)-like virus;
  • a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage); and
  • a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).

It is recommended that egg based trivalent vaccines for use in the 2019 southern hemisphere influenza season contain the following:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus;
  • an A/Switzerland/8060/2017 (H3N2)-like virus; and
  • a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).

It is recommended that the A(H3N2) component of non-egg based vaccines for use in the 2019 southern hemisphere influenza season be an A/Singapore/INFIMH-16-0019/2016-like virus together with the other vaccine components as indicated above.

Source: WHO | Recommended composition of influenza virus vaccines for use in the 2019 southern hemisphere influenza season

Flu View Phase 6

Source: Flu View Phase 6

CDC Interactive Map – Weekly Influenza

A Weekly Influenza Surveillance Report Prepared by the Influenza Division

Source: FluView Phase 8

What to know about the 2018-2019 flu season in Massachusetts | Boston.com


Your insurance may not cover that emergency room visit


Some Rural Americans Forced to Travel 100 Miles to a Hospital – Rural Hospitals Close


NewsOK.com: Opioid prescribing laws to change Nov. 1

NewsOK.com: Opioid prescribing laws to change Nov. 1.

As opioid crisis raged Insys pushed higher doses of addictive drug and pushed salespeople to own doctors – MarketWatch


New Jersey- The flu is here, and it’s going to get worse

Source: The flu is here, and it’s going to get worse. Why you should get your flu shot now | NJ.com

Washington DE- Doctors issue warnings after reports of flu-related deaths | WJLA

Doctors are issuing warnings to people after several reports of flu-related deaths.

In North Carolina, two flu-related deaths were reported. A 29-year-old lawyer died from a heart attack after complications from the flu, and an older person also died.

Flu season typically starts in October and ends in May. During the last week of September, the state of Virginia reported less than two percent of emergency room and Urgent Care visits were for flu-like symptoms.

In D.C., four cases of the flu were reported by hospitals, and Maryland has not started monitoring flu cases.

The Center for Disease Control (CDC) estimates in 2017 that the flu killed 80,000 people including 180 children in the United States. It’s considered the highest death toll in nearly 40 years.

Source: 7OYS: Doctors issue warnings after reports of flu-related deaths | WJLA

Doctors Urge CDC to Clarify Rx Opioid Guideline 

Dr. Kertesz believes many chronic pain patients have suffered under the guideline, because it has led to widespread tapering and discontinuation of opioids. He invited other healthcare professionals to co-sign the letter. To date, well over 200 have.

To see a list of signatories, click here. If you are a healthcare professional and also wish to sign the letter, click here.)  


Authors: Health Professionals for Patients in Pain

Any professional who cares for patients, including physicians, pharmacists, nurses, psychologists and social workers, is invited to sign on to this letter, as are any professional organizations that wish to endorse formally. 

I. In 2016, the Centers for Disease Control and Prevention, CDC, issued a Guideline for Prescribing Opioids for Chronic Pain for primary care physicians. Its laudable goals were to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy. The Guideline reflected the work of appointed experts who achieved consensus on the matter of opioid use in chronic pain.

Among its recommendations are that opioids should rarely be a first option for chronic pain, that clinicians must carefully weigh the risks and benefits of maintaining opioids in patients already on them, and that established or transferring patients should be offered the opportunity to re-evaluate their continued use at high dosages (i.e., > 90 MME, morphine milligram equivalents).

In light of evidence that prescribed dose may pose risks for adverse patient events, clinicians and patients may choose to consider dose reductions, when they can be accomplished without adverse effect, and with possible benefit, according to some trial data.

Nonetheless, it is imperative that healthcare professionals and administrators realize that the Guideline does not endorse mandated involuntary dose reduction or discontinuation, as data to support the efficacy and safety of this practice are lacking.

II. Within a year of Guideline publication, there was evidence of widespread misapplication of some of the Guideline recommendations. Notably, many doctors and regulators incorrectly believed that the CDC established a threshold of 90 MME as a de facto daily dose limit. Soon, clinicians prescribing higher doses, pharmacists dispensing them, and patients taking them came under suspicion.

Actions that followed included payerimposed payment barriers, pharmacy chain demands for the medical chart, or explicit taper plans as a precondition for filling prescriptions, high-stakes metrics imposed by quality agencies, and legal or professional risks for physicians, often based on invocation of the CDC’s authority. Taken in combination, these actions have led many health care providers to perceive a significant category of vulnerable patients as institutional and professional liabilities to be contained or eliminated, rather than as people needing care.

III. Adverse experiences for these patients are documented predominantly in anecdotal form, but they are concerning. Patients with chronic pain, who are stable and, arguably, benefiting from long-term opioids, face draconian and often rapid involuntary dose reductions. Often, alternative pain care options are not offered, not covered by insurers, or not accessible. Others are pushed to undergo addiction treatment or invasive procedures (such as spinal injections), regardless of whether clinically appropriate.

Consequently, patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use. Others have experienced preventable hospitalizations or medical deterioration in part because insurers, regulators and other parties have deployed the 90 MME threshold as a both a professional standard and a threshold for professional suspicion. Under such pressure, care decisions are not always based on the best interests of the patient.

lV. Action is Required: The 2016 Guideline specifically states, “the CDC is committed to evaluating the guideline to identify the impact of the recommendations on clinician and patient outcomes, both intended and unintended, and revising the recommendations in future updates when warranted”. The CDC has a moral imperative to uphold its avowed goals and to protect patients.

Therefore, we call upon the CDC to take action:

1. We urge the CDC to follow through with its commitment to evaluate impact by consulting directly with a wide range of patients and caregivers, and by engaging epidemiologic experts to investigate reported suicides, increases in illicit opioid use and, to the extent possible, expressions of suicidal ideation following involuntary opioid taper or discontinuation.

2. We urge the CDC to issue a bold clarification about the 2016 Guideline – what it says and what it does not say, particularly on the matters of opioid taper and discontinuation.

Signatories here represent their own views, and do not purport to reflect formal positions of their employing agencies, governmental or otherwise.

Source: Doctors Urge CDC to Clarify Rx Opioid Guideline — Pain News Network

Texas Influenza Surveillance Summer Report

Current Extended Flu Activity Report (PDF)
(September 23, 2018 – September 29, 2018)
Report produced on 10/05/2018

Influenza activity remains low across the state of Texas. It appears that influenza activity peaked in late January. Compared to the previous week, the percentage of patient visits due to influenza-like illness (ILI) and the percentage of specimens testing positive for influenza reported by public health laboratories slightly increased. The percentage of specimens testing positive for influenza reported by hospital laboratories marginally decreased. No influenza-associated pediatric deaths were reported. One influenza-associated outbreak was reported. In addition to flu, other respiratory viruses—especially rhinovirus/enterovirus—were detected in Texas during week 39.

Hospital laboratories across Texas voluntarily report influenza tests (antigen, culture, and PCR) to the National Respiratory and Enteric Virus Surveillance System (NREVSS). Providers throughout Texas also submit specimens for influenza testing (PCR) to Texas public health laboratories, including the Texas Department of State Health Services (DSHS) state laboratory in Austin and the nine Texas Laboratory Response Network (LRN) laboratories. The results reported by Texas NREVSS participants and public health laboratories for the current week are summarized in the two tables below. Additional influenza test results (rapid tests, culture, PCR) and ILI activity were reported from providers and public health departments throughout the state.

2017-2018 Texas Influenza Surveillance Activity Reports:

10/05/1809/28/1809/21/1809/14/1809/07/1808/31/1808/24/18,  08/17/18,
04/20/1804/13/18, 04/06/1803/29/1803/23/1803/16/1803/09/1803/02/18,
02/23/18, 02/16/1802/09/18, 02/02/1801/27/1801/20/18, 01/12/18, 01/05/18,

Source: IDCU Influenza | Activity Report

Opioid prescribers in Georgia get letters from U.S. Attorney

Federal prosecutors in Atlanta have put about 30 doctors on notice that they’ve been identified for prescribing opioids in significantly greater quantities or doses than their peers.

The doctors, who were not publicly identified but work in the metro and North Georgia area, were notified by letter. Some also were found to have prescribed opioids to patients who may have a high risk of abuse, the U.S. Attorney’s Office said Friday.

“Medical professionals have an obligation to the safety and well-being of their patients,” U.S. Attorney BJay Pak said in a statement. “Many opioid prescribers may not realize that they are over-prescribing opioids. We aim to make these medical prescribers — who are outliers — aware of their atypical practices, so that they can make informed decisions about whether their opioid prescriptions are for a legitimate medical purpose.”

The letters are part of an initiative by the U.S. Department of Justice to reduce opioid prescriptions by one-third over the next three years. The Department of Justice has not determined if the 30 doctors who were put on notice have broken the law, but federal authorities will continue to monitor prescribing habits, Pak said.

In the letters, prosecutors provided the doctors with specific information about their prescription patterns. The doctors were also given guidelines by the Centers for Disease Control and Prevention for prescribing opioids for chronic pain.

Neil Campbell, executive director of the Georgia Council on Substance Abuse, applauded the move.

“This is a really good thing,” she said. “There’s been such an abuse of prescriptions and it’s hurt a lot of people. Most doctors don’t want to give more painkillers than they need to, but unfortunately that’s not the case with everyone.”

Source: Opioid prescribers in Georgia get letters from U.S. Attorney