H1N1 patients in ICU

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					Letters                                                                                                                                           CMAJ

The H1N1 vaccine plan                                    opted for a standard vaccine will be                   H1N1 patients in ICU
                                                         ready to release a safe product; suggest-
Health Canada would like to set the                      ing it will be far in advance of the                   At the Health Sciences Centre in Win-
record straight on the claims made in                    Canadian product is misleading specu-                  nipeg, Manitoba, 27 patients were
the Aug. 31, 2009, editorial “The                        lation. Second, the use of adjuvants not               admitted to the adult medical intensive
H1N1 vaccine race: Can we beat the                       only gives better cross-protection                     care unit (MICU) with confirmed H1N1
pandemic?1” In particular: Although                      against mutating flu virus strains, but                respiratory failure between Apr. 23 and
we are treating this vaccine as a new                    also “leverages” the standard vaccine,                 June 30. Patient demographics of the
product, which it is, the extra work                     reducing the amount required for an                    Winnipeg ICU cohort were similar to 10
involved in the authorization was                        effective dose by a significant amount.                reported cases in Michigan. Both patient
largely completed before this current                    The implications of this should be obvi-               populations suffered from severe ARDS
pandemic was declared. Furthermore,                      ous: A resource in short supply                        and required prolonged ventilatory sup-
as the regulatory review of the adju-                    becomes available to an entire popula-                 port. We observed substantial increases
vant has already been completed as                       tion. Finally, even if it is necessary to              in the use of sedative agents and empiric
part of the review of the H5N1 vac-                      wait a few weeks to have the supply of                 antibiotics during this recent outbreak in
cine, no additional data on the adjuvant                 adjuvant vaccine, it will be available to              our adult MICU. As part of pandemic
itself is being asked for by Health                      the vulnerable and general population                  planning and capacity building, we
Canada. Our remaining evaluation                         alike as the anticipated pandemic                      encourage pharmacists, clinicians and
activities are focused on the H1N1                       increases into the winter months,                      planners to consider the amount of seda-
antigen component of the vaccine. In                     notably, at a time when other nations                  tion and antimicrobials necessary to care
summary, there will be no delay in get-                  with standard vaccine may be unable to                 for H1N1 patients in the ICU.
ting a pandemic influenza vaccine to                     guarantee coverage. Journal readers
Canadians due to regulatory require-                     deserve editorials that are distinguished              Alfred Gin PharmD, Anand Kumar MD
                                                                                                                and colleagues
ments. Health Canada is working                          from polemics by presentation of both
                                                                                                                Health Sciences Centre, Winnipeg, Man.
closely with the manufacturer to                         sides of a debate.
review proposed production timelines                                                                            For the full letter, go to: www.cmaj.ca/cgi/eletters
for Canada and we will be ready to                       Anne Doig MD                                           /cmaj.091560#186706
                                                         President, Canadian Medical Association
make a decision on the authorization of                                                            
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Description: At the Health Sciences Centre in Winnipeg, Manitoba, 27 patients were admitted to the adult medical intensive care unit (MICU) with confirmed H1N1 respiratory failure between Apr. 23 and June 30. Patient demographics of the Winnipeg ICU cohort were similar to 10 reported cases in Michigan.
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