terra seright
Wow, this is impressive. What a wonderful thing to do, Jason! Kudos and thank you!!
I've added you to my phone contact list, just in case!
I've added you to my phone contact list, just in case!
Storm Chaser Medical Advisory Hotline and Acute Care Service--A FREE Service
- Thread starter Jason Persoff
- Start date
Jason Persoff
EF3
This service will continue unabated. It's been great connecting with others in the chase community through the hotline and the feedback has been so positive, I will continue to offer this. Don't feel worried about calling too late or that you'll be bothering me. If I can't answer, I won't, but I can get back to you quickly...
Here's to hoping for another (hopefully BUSIER) chase season in 2010.
Here's to hoping for another (hopefully BUSIER) chase season in 2010.
Scott Olson
EF5
I want to express my thanks to Dr. Persoff as well, I contacted him in the off season when I was moving around back and forth between California and the plains and he helped me out. I find it very refreshing that there is a chaser out there who is willing to provide a service at large 'for the chase community'. I highly reccomend Jason and the Storm Chaser Medical Advisory Hotline.
/Whispers to the Wind/
Scott Olson
/Whispers to the Wind/
Scott Olson
Jason Persoff
EF3
I was recently asked by a chaser about H1N1. I'll offer this extensively wordy response I offered to this individual here in the hopes it will provide people the most up-to-date information...
There's been a lot of misinformation about H1N1 in part because the media failed big time at the onset of the pandemic, and causing "media fatigue" that occurred in the initial panic in the spring last year. The biggest issue we in healthcare braced for was the "re-emergence" of H1N1 during the winter months when seasonal flu peaks. Our fears were definitely confirmed in spades. Flu was rampant this year and patients died (I personally lost about 40 patients with this virus, and saw an unbelievably high case fatality rate in young patients similar to what the CDC has published). I take this flu very seriously.
I was asked recently about the question of whether someone is immune to H1N1 virus due to possible prior infection and therefore doesn't need the H1N1 vaccine due to "acquired immunity" from prior infection. The answer regarding this comes from hard data, actually: your friend is UNLIKELY to have prior immunity to H1N1. My reference is: Hancock, K, Veguilla, V, Lu, X, et al. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med 2009; 361:1945. This paricular study is published free on the NEJM website (direct link here: http://content.nejm.org/cgi/reprint/361/20/1945.pdf).
Using historical serological specimens, researchers looked at what we call "cross reacting antibodies" (antibodies people form against one virus that just so happen to react against a different virus--think of this as getting a discount on subsequent infection--you have bad case of a virus, but on the upside, you get a fair amount of immunity to an unrelated virus. This concept is in fact how most flu vaccines work--you develop antibodies to a vaccine in the hopes that the seasonal flu "looks" similar enough to your immune system that it will attack the actual virus when it crops up).
The sign that people are likely to be able to withstand attack by a micro-organism is predicated on how vigorously their immune systems react to that virus. Since prior infection with an organism leads to (mostly) lifelong immunity to that organism (and ones that "look similar" to it at least as far as your immune system is concerned), researchers can measure antibodies that are likely to "neutralize" the threat. These cross reacting, neutralizing antibodies successfully predict how well you'll fight the virus off. If you have a lot of 'em, you will be unlikely to develop clinical signs or symptoms of infection. However, if you don't have any cross reacting neutralizing antibodies, you're going to have to mount an immune response to fight off the infection (something that generally takes 48-96 hours) and hopefully during that time the virus doesn't kill you first.
Measuring serum samples, researchers found 0% of those under 30 had any immunity to the H1N1 flu. Zero percent. For those born in the 1960-1970 range, antibodies were scarce or undetectable for almost all of individuals in that range. These low antibody titers mean high risk for infection.
So, bringing this full circle...Anyone younger than 60 is almost entirely unlikely to carry any immunity to H1N1. This likely stems from the viruses 4-point mutation that makes it dissimilar in shape to ANY virus previously encountered by humanity. Yup: that reads like a doomsday comment for a reason. This is the dreaded conformational ("shape") change a plague looks like. That the mortality rate hasn't been higher than it is is pure happenstance. The H1N1 influenza, like all influenza viruses, cause severe illness, but typically _not_ fatal illness. Good thing for humanity too. A more virulent ("powerful") virus mutation could kill off millions easily if it also led to more severe illness. As it turns out, H1N1 _probably_ is not more powerful than typical, seasonal flu. It's the fact that people don't have immunity that has led to the high fatality rate.
As such, it is critical to immunize to prevent widespread illness. While most people will miss only a few days' work and feel like dung having the virus doesn't mean complacency is in order. 100% of my patients who died were young and most were healthy by all measures prior to infection. Ironically, older patients are LESS likely to die from H1N1 due to the increased likelihood of cross reacting neutralizing antibodies from other older flu strains (in fact, cross reactive immunity was seen highest in those born from 1900-1930).
The takehome: if you're young and healthy, you're exactly the profile of someone who is at risk for death from H1N1. And don't think antiviral medications will save you. Antiviral medications only shave maybe 12 hours off of symptoms. Most of the reason to treat patients is to prevent THEM from infecting OTHERS (though it may help some--it's not nearly as good as your own body's immune response).
Get vaccinated. It does work. Fears about Guillaume-Barre syndrome (a neurologic illness of unknown cause that itself is pretty nasty) are overblown based on very tight post-vaccine surveillance programs. It seems more likely that you could get GBS from the virus rather than the vaccine.
The only reason that the recommendation for mandatory vaccinations has not occurred is: 1) limited supply of vaccine compared to the world population, 2) fatality rate of H1N1 is still low enough not to justify a "small pox" vaccine protocol, and 3) the ever changing face of influenza.
Regarding that last comment...flu does change yearly. In fact, vaccines againast flu are typically based on speculation based on phenotypes of ANTICIPATED virus changes. It's highly difficult to know exactly what mutations are mostly likely to occur (thus why H1N1 caught us all off-guard). By next year, the generic influenza vaccine will incorporate vaccination against H1N1 so you'll be able to get one shot (as opposed to the 2 needed this year to allow most likely immunity).
Shy of living the life of a recluse, if you live life, you'll get exposed to all kinds of nastiness. The best statistical analogy I can offer is the following: as many people will die this year in the US from seasonal flu as from motor vehicle accidents (roughly 40,000). An additional 50,000 deaths are possible after this outbreak (though current figures are less robust). That's a lot of people. And, like death from motor vehicle accidents, most are probably preventable.
Wash your hands, wear sunscreen, and live life. After you get vaccinated, that is.
Feel free to contact me as always via the medical hotline (my phone: 904-343-4325) if ever you have any question about this or other medical issues. Hope this helps.
There's been a lot of misinformation about H1N1 in part because the media failed big time at the onset of the pandemic, and causing "media fatigue" that occurred in the initial panic in the spring last year. The biggest issue we in healthcare braced for was the "re-emergence" of H1N1 during the winter months when seasonal flu peaks. Our fears were definitely confirmed in spades. Flu was rampant this year and patients died (I personally lost about 40 patients with this virus, and saw an unbelievably high case fatality rate in young patients similar to what the CDC has published). I take this flu very seriously.
I was asked recently about the question of whether someone is immune to H1N1 virus due to possible prior infection and therefore doesn't need the H1N1 vaccine due to "acquired immunity" from prior infection. The answer regarding this comes from hard data, actually: your friend is UNLIKELY to have prior immunity to H1N1. My reference is: Hancock, K, Veguilla, V, Lu, X, et al. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med 2009; 361:1945. This paricular study is published free on the NEJM website (direct link here: http://content.nejm.org/cgi/reprint/361/20/1945.pdf).
Using historical serological specimens, researchers looked at what we call "cross reacting antibodies" (antibodies people form against one virus that just so happen to react against a different virus--think of this as getting a discount on subsequent infection--you have bad case of a virus, but on the upside, you get a fair amount of immunity to an unrelated virus. This concept is in fact how most flu vaccines work--you develop antibodies to a vaccine in the hopes that the seasonal flu "looks" similar enough to your immune system that it will attack the actual virus when it crops up).
The sign that people are likely to be able to withstand attack by a micro-organism is predicated on how vigorously their immune systems react to that virus. Since prior infection with an organism leads to (mostly) lifelong immunity to that organism (and ones that "look similar" to it at least as far as your immune system is concerned), researchers can measure antibodies that are likely to "neutralize" the threat. These cross reacting, neutralizing antibodies successfully predict how well you'll fight the virus off. If you have a lot of 'em, you will be unlikely to develop clinical signs or symptoms of infection. However, if you don't have any cross reacting neutralizing antibodies, you're going to have to mount an immune response to fight off the infection (something that generally takes 48-96 hours) and hopefully during that time the virus doesn't kill you first.
Measuring serum samples, researchers found 0% of those under 30 had any immunity to the H1N1 flu. Zero percent. For those born in the 1960-1970 range, antibodies were scarce or undetectable for almost all of individuals in that range. These low antibody titers mean high risk for infection.
So, bringing this full circle...Anyone younger than 60 is almost entirely unlikely to carry any immunity to H1N1. This likely stems from the viruses 4-point mutation that makes it dissimilar in shape to ANY virus previously encountered by humanity. Yup: that reads like a doomsday comment for a reason. This is the dreaded conformational ("shape") change a plague looks like. That the mortality rate hasn't been higher than it is is pure happenstance. The H1N1 influenza, like all influenza viruses, cause severe illness, but typically _not_ fatal illness. Good thing for humanity too. A more virulent ("powerful") virus mutation could kill off millions easily if it also led to more severe illness. As it turns out, H1N1 _probably_ is not more powerful than typical, seasonal flu. It's the fact that people don't have immunity that has led to the high fatality rate.
As such, it is critical to immunize to prevent widespread illness. While most people will miss only a few days' work and feel like dung having the virus doesn't mean complacency is in order. 100% of my patients who died were young and most were healthy by all measures prior to infection. Ironically, older patients are LESS likely to die from H1N1 due to the increased likelihood of cross reacting neutralizing antibodies from other older flu strains (in fact, cross reactive immunity was seen highest in those born from 1900-1930).
The takehome: if you're young and healthy, you're exactly the profile of someone who is at risk for death from H1N1. And don't think antiviral medications will save you. Antiviral medications only shave maybe 12 hours off of symptoms. Most of the reason to treat patients is to prevent THEM from infecting OTHERS (though it may help some--it's not nearly as good as your own body's immune response).
Get vaccinated. It does work. Fears about Guillaume-Barre syndrome (a neurologic illness of unknown cause that itself is pretty nasty) are overblown based on very tight post-vaccine surveillance programs. It seems more likely that you could get GBS from the virus rather than the vaccine.
The only reason that the recommendation for mandatory vaccinations has not occurred is: 1) limited supply of vaccine compared to the world population, 2) fatality rate of H1N1 is still low enough not to justify a "small pox" vaccine protocol, and 3) the ever changing face of influenza.
Regarding that last comment...flu does change yearly. In fact, vaccines againast flu are typically based on speculation based on phenotypes of ANTICIPATED virus changes. It's highly difficult to know exactly what mutations are mostly likely to occur (thus why H1N1 caught us all off-guard). By next year, the generic influenza vaccine will incorporate vaccination against H1N1 so you'll be able to get one shot (as opposed to the 2 needed this year to allow most likely immunity).
Shy of living the life of a recluse, if you live life, you'll get exposed to all kinds of nastiness. The best statistical analogy I can offer is the following: as many people will die this year in the US from seasonal flu as from motor vehicle accidents (roughly 40,000). An additional 50,000 deaths are possible after this outbreak (though current figures are less robust). That's a lot of people. And, like death from motor vehicle accidents, most are probably preventable.
Wash your hands, wear sunscreen, and live life. After you get vaccinated, that is.
Feel free to contact me as always via the medical hotline (my phone: 904-343-4325) if ever you have any question about this or other medical issues. Hope this helps
.Jason Foster
I guess we can't "thank" in this subforum, so I'm just posting it here. This is of particular interest to me since I am on immuno-suppressant drugs to insure my transplanted kidneys stay put. I would be in the 'high risk' category of the overall population.
Tom Tackett
EF1
Dr. Pershoff:
Thank you very much for the outstanding article on H1N1 and Influenzia in general! You are the best.
TomT
Thank you very much for the outstanding article on H1N1 and Influenzia in general! You are the best.
TomT
Wes Carter
EF5
Dr. Persoff, thanks for that posting. My wife and I will be getting the H1N1 vaccination based on what you took the time to write. The media botched this one, and our doctor was too busy to take the time to explain it in that detail. Thanks a million.
Bob Hartig
EF5
Jason, the service and care you're providing to the chaser community is fantastic. Thanks for your highly informative post on H1N1, and thanks for continuing to offer medical service gratis to chasers. Your contribution is invaluable, and while I hope I'll never need to make use of it, it's reassuring to know you're out there.
Shane Marshall
This is an amazing service and im glad someone is willing to put in the time and effort to do it. Being an EMS professional for many years I give Jason a big thumbs up for providing this.
Elinor McLennon
Hi there everyone. I have contacted Jason several times but so far he has not needed any help in this area. I have my first responder license which I am in the process of renewing and have had paramedic training. My knowledge is not even close to being equivalent to Jason's and the service he offers is amazing. Like i have mentioned to him in the past, I chase in the Oklahoma area and always have my medical kit with me. I keep the basic first aid supply kit with me, including blood sugar kit, various splints, etc. If you can't get hold of Jason or if he is too far away and you need a quick patch to hold you over feel free to contact me if you are in this area. My name is Elinor McLennon and the phone number is 405-990-4833.
John A. Sellers
EF1
A BIG THANKS goes out for both, Jason and Elinor! When you're out away from home it will be good to know you can call someone with a medical question or problem. Thanks again.
Elinor McLennon
Looks like Monday is going to possibly be a big chase day in this area. I plan to be out doing some major chasing! Just want to remind folks that are traveling to remember to bring your medications. Also, a first aid kit is also essential. It doesn't need to be anything elaborate.
When I know i am traveling, I keep a list of current meds, any medical conditions and a list of emergency phone numbers with me. I place that info in the glove box and remove it when I return home.
Hopefully Dr. Persoff will be in the plains next week! His generosity is amazing and has inspired me to try and do something helpful for the chase community. My phone number is listed above, I do texting and hopefully nobody will need any medical services!
When I know i am traveling, I keep a list of current meds, any medical conditions and a list of emergency phone numbers with me. I place that info in the glove box and remove it when I return home.
Hopefully Dr. Persoff will be in the plains next week! His generosity is amazing and has inspired me to try and do something helpful for the chase community. My phone number is listed above, I do texting and hopefully nobody will need any medical services!
Scott Olson
EF5
Jason is the best. If you are out chasing and have a question or concern, Jason is top notch and friendly.
Joey Ketcham
I can't thank Jason enough for being there for me and giving me the advice he did. For a while I was thinking something was seriously wrong with me, but in talking to Jason he clearly explained what was going on and gave me advice on what I needed to do. I am feeling much better after taking his advice. Jason, thank you for being there for all of us and for this wonderful service you provide!
Jason Persoff
EF3
As many have heard by now, I have moved back to the dryline (from Jax, FL, to Centennial, CO). This has no real substantive effect on the medical hotline, but allows me to be closer to many more chasers out here.
As we move into the busier weather season, and April Outbreaks are less than 10 days away, I will post my presentation from ChaserCon available to any interested. It is distributed in Powerpoint format, and thus any who would like can use the slides (YouSendIt only allows me to keep it posted until 4/8/12, but I can repost it if desired at later dates). I only ask that appropriate creative credit be noted if used for other presentations (and never for commercial use).
https://www.yousendit.com/download/M3BtRm8zTkFBNkhFdzhUQw
Stay safe this season and know we've got your back.
As we move into the busier weather season, and April Outbreaks are less than 10 days away, I will post my presentation from ChaserCon available to any interested. It is distributed in Powerpoint format, and thus any who would like can use the slides (YouSendIt only allows me to keep it posted until 4/8/12, but I can repost it if desired at later dates). I only ask that appropriate creative credit be noted if used for other presentations (and never for commercial use).
https://www.yousendit.com/download/M3BtRm8zTkFBNkhFdzhUQw
Stay safe this season and know we've got your back.
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