Study on H3N2 flu virus calls into question egg-based vaccine production

Scott Hensley wants to make one thing clear: You should still get a flu shot after reading this article.

“Even in times of vaccine mismatches, it can still help reduce the severity of infection,” said Hensley, an associate professor in the Department of Microbiology at the University of Pennsylvania. “We’re talking about one (flu) strain here, but other strains seem to be very well matched.”

That one strain Hensley’s referring to is H3N2, which seemed somewhat impervious to the 2016-2017 flu vaccine. In particular, last year’s flu shot was only about 30 percent effective against the virus, which dominated during the last flu season. Hensley and his colleagues wanted to find out why the vaccine’s effectiveness against H3N2 was so low — data that’s key to making sure the 2018-2019 flu vaccine is manufactured to be a better match. They found the problem. But fixing it will take a lot more than tweaking a vaccine formula.

In a study published last month in the Proceedings of the National Academy of Sciences (PNAS), the researchers reported that the vaccine’s ineffectiveness against H3N2 was due to a mutation that stems directly from the manufacturing process — i.e., the traditional process of growing flu vaccine viruses in chicken eggs. Hensley noted that his study isn’t the first to highlight the need to rethink how the flu shot is manufactured, but he knows it’s a heavy lift considering how invested manufacturers already are in egg-based vaccine production.

“The problem is inherent to growing in eggs,” Hensley told me, adding that “in this case, there’s no workaround with an egg-based system.”

Flu shots work like other vaccines — they create immunity by tricking your body into generating antibodies capable of fighting off certain diseases. A new flu vaccine is produced each year to do just that based on the particular flu strains that scientists predict are mostly likely to circulate and cause illness. During the 2014-2015 flu season, Hensley said, H3N2 dominated in the Northern Hemisphere and the vaccine’s effectiveness against it was particularly low — “close to zero,” he said. To avoid another such mismatch, the 2016-2017 flu vaccine was updated using an H3N2 strain isolated in 2014. Overall, Hensley said, last season’s flu shot seemed to be pretty well matched to the flu strains in circulation, but it provided only a mediocre defense against H3N2, with an effectiveness rate between 20 and 30 percent.

The primary reason, Hensley and colleagues reported in PNAS, is because the H3N2 virus used to create last year’s vaccine doesn’t bind well to chicken cells, resulting in such a disruptive mutation that the eventual vaccine given to people isn’t well matched to the H3N2 virus in circulation. The study notes that vaccine strains grown in eggs often develop adaptive mutations that allow them to attach to chicken cells. But in the case of the egg-adapted H3N2 strain, the mutation meant that the final vaccine generated antibodies in the human body that couldn’t effectively bind to — and thus, neutralize — H3N2. In other words, the resulting vaccine strain could only bind effectively to the egg-adapted strain of H3N2, but couldn’t effectively recognize and attach to the strain that was infecting people out in the real world.

And Hensley said there’s no real solution to the problem using an egg-based production process.

“This particular strain simply doesn’t replicate well in chicken cells — that’s why it didn’t work,” he told me. “It’s one of the first times this has been such a big problem. …(The viruses) all undergo some adaptive process in chicken eggs, but we think this past season, there was such an important change that occurred as the virus was adapting that it made a much larger impact than in previous years.”

But there is an effective alternative. While the study found that the egg-produced 2016-2017 strain did a bad job generating effective antibodies in humans and ferrets, they also found that an H3N2 vaccine produced using recombinant DNA technology — a process that doesn’t use eggs — was effective in neutralizing the virus in humans and ferrets. Hensley and study co-authors Seth Zost, Kaela Parkhouse, Megan Gumina, Kangchon Kim, Sebastian Diaz Perez, Patrick Wilson, John Treanor, Andrea Sant and Sarah Cobey write: “A major effort should be made to develop and utilize new systems that produce influenza antigens that are not dependent on egg or cell culture-adaptive mutations. Antigens that do not possess adaptive mutations will likely offer better protection against influenza virus strains that circulate in the human population.“

Hensley said that even though flu vaccine manufacturers are already heavily invested in egg-based production, continued research into alternative vaccine production methods could help drive change in the industry. He added that if we weren’t already making flu vaccine, there’s “no way” we’d choose eggs as the platform for starting production.

“We, as a community, should probably invest more in alternative (vaccine) technologies,” he said, noting that his lab isn’t affiliated with any vaccine manufacturers. (In fact, Hensley said the study, conducted with support from the National Institutes of Health, is a “good example of why we should fund basic scientific research.”)

And he still urges people to go out and get their flu shots: “These vaccines, although they’re not always as ideal as we’d like them to be, are still better than nothing — they still save lives even when they’re not a complete match.”

According to the latest data from the Centers for Disease Control and Prevention, H3N2 has been the most predominant virus so far this flu season. As of late November, four states reported widespread flu activity, 10 states reported regional flu activity and 24 states had reported local flu activity.

For a full copy of the H3N2 vaccine study, visit PNAS.

Article source:Science Blogs


Vegas day one

Got in yesterday, and the whirlwind started. Initial takes…

Thanks to the wonderful folks at myMatrixx for carting me and pretty much everyone else from the airport to our hotels.

The Mitchell last night event was very well attended; it was going strong well into the night.

Telemedicine is the next big thing – there are at least a half-dozen companies focusing on this, with many more touting their adoption of pieces and parts of telemedicine. Like anything else, there’s going to be a shakeout – more on this next week.
But make no mistake, unlike many flashes-in-the-work-comp-services pan, telemedicine (or whatever term you use) is going to be a big, big deal.

The CVS acquisition of Aetna will have zero effect on Coventry. Or maybe even less. The new company’s revenues are almost a quarter-trillion dollars; Coventry work comp’s annual take is less than a quarter of one percent of that.

A couple folks aren’t here this year. Bill Block is one. Bill passed away this year; universally liked, Bill was just a good guy, a relationship guy who knew everyone and had a good word for all. He’d been in the business for decades, working for several different companies, bringing his smile and good cheer wherever he went. Bill will be missed.

Funally, confession time. I have a horrible memory for names and faces. And most other important things. Please accept my heartfelt apologies!

Article source:Managed Care Matters

Prepping for Vegas

Here’s a few pointers for those in or heading to the NWCDC confab in Vegas.

1.  Realize you can’t be everywhere and do everything. Prioritize.

2.  Leave time for last-minute meetings and the inevitable chance meetings with old friends and colleagues.

3.  Unless you have a photographic memory, use your smartphone to take voice notes from each meeting – right after you’re done.  Otherwise they’ll all run together and you’ll never remember what you committed to.

4.  Get the NWCDC app for your Droid or iPhone – there’s a web-based version too for tablets.  It has the schedule, exhibit hall layout, local map, and a bunch of other handy information and tools.

5.  Introduce yourself to a dozen people you’ve never met.  This business is all about relationships and networking, and no better place to do that than this conference.

6.  Wear comfortable shoes, get your exercise in, and be professional and polished.  It’s a long three days, and you’re always ‘on’.

Finally, I’ll echo one of Sandy Blunt’s points – in these day of YouTube, phone cameras, Twitter and Google+, what you do is public knowledge.  That slick dance move or intense conversation with a private equity exec just might re-appear – to your dismay.

Article source:Managed Care Matters

Why the GOP tax bill increases health insurance premiums

I received several emails from readers challenging my statement Friday that the GOP tax bill will result in higher health insurance premiums.  Here’s how.

Briefly, the Bill lets you buy health insurance after you get sick – without a penalty. It’s as if this guy was signing up for auto insurance post-crash…

Both the House and Senate versions of the bills end the penalty for those who don’t have health insurance. This penalty does 2 things; it financially penalizes those who go without coverage, and it generates funds that help pay for healthcare for others.

What the tax bills DON’T do is change the requirement that insurance companies cover anyone who applies.

Imagine if you were able to buy auto insurance after you crashed. Why would you bother to sign up and pay those premiums if you didn’t have to?

BTW, there’s a ton of research and history that shows what a bad idea this is, how much damage it does to insurance markets, and what we can expect.

Folks, this is just ONE example of the dumb ideas in this bill, from people who claim to understand how the free market works.

What does this mean for you?

Insurance rates are going to go up. 


Article source:Managed Care Matters

Firefighters and cancer: “I want to have a life after I retire”

A group of South Florida firefighters say getting cancer because of their job concerns them more than the other dangers they face. That insight comes from “Perceptions of health and cancer risk among newly recruited firefighters in South Florida,” a new paper published by researchers with the University of Miami Schools of Medicine and Public Health Sciences. The study appears in the American Journal of Industrial Medicine.

The research involved focus groups with nearly 60 career firefighters (both rookies and experienced). They discussed their perceptions of health risks related to work-related injuries, stress, and chronic disease.

The authors report several themes that particular caught my attention. One is the firefighters’ expectation that they are more likely to die from cancer and heart disease than from a fatal injury. During a focus group, one firefighter commented:

“When you think of firefighters dying, it’s some guy going down in the blaze of glory as he hands out the baby. Dying in a bed down at the cancer center is unfortunately the reality.”

Another interesting theme was the effect of a co-worker’s cancer diagnosis or death from cancer on prevention. Firefighters suggested it caused them to think about ways to reduce their exposure to carcinogens. They described to the researchers, for example, handling differently their outer gear to decrease exposure to diesel. They also mentioned keeping baby wipes handy so they can wipe their faces and necks immediately after a call rather than waiting to get back to the firehouse. The authors write:

“The strongest force behind the cultural shift toward safety appears to be encountering older firefighters who worked in an environment that emphasized machismo, and later went on to be diagnosed with cancer.”

Palm Beach County Fire & Rescue and researchers with Florida’s Firefighter Cancer Initiative mark the launch of their collaboration.

This study is one product of the Firefighter Cancer Initiative (FCI), a program funded by the State of Florida. It was established in 2015 to investigate firefighters’ exposure to carcinogens, prevalence of cancer, prevention methods. FCI’s researchers include faculty and staff with the Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine.

Members of Congress are also supporting research to examine the prevalence of cancer among firefighters. In September, the U.S. House of Representatives passed unanimously “The Firefighter Cancer Registry Act” (H.R. 931). It would provide CDC with $2.5 million to create the voluntary registry which could be linked with existing state cancer registries. The U.S. Senate has not taken up the bill.




Article source:Science Blogs

The tax bill’s impact on healthcare or; If you like your cancer care, you can’t keep it.

The GOP “tax reform” bill will directly and significantly affect healthcare. Here’s how.

The net – healthcare providers are going to get hammered, and they’re going to look to insured patients to cover their costs

Here are the details.

According to the Commonwealth Fund, “repeal would save the federal government $338 billion between 2018 and 2027, resulting from lower federal costs for premium tax credits and Medicaid. By 2027, 13 million fewer people will have health insurance, either because they decide against buying coverage or can no longer afford it.”

Most of those who drop coverage will be healthier than average, forcing insurers in the individual market to raise prices to cover care for a sicker population. This is how “death spirals” start, an event we’ve seen dozens of times in state markets, and one that is inevitable without a mandate and subsidies.

For example, older Americans would see higher increases than younger folks. Here’s how much your premiums would increase if you are in the individual marketplace.

So, what’s the impact on you?

Those 13 million who drop insurance, which include older, poorer, sicker people, will need coverage – and they’ll get it from at most expensive and least effective place – your local ER. Which you will pay for in part due to cost-shifting.

ACA provided a huge increase in funding for emergency care services – folks who didn’t have coverage before were able to get insurance from Medicaid or private insurers, insurance that paid for their emergency care.

From The Hill:

[after ACA passage] there were 41 percent fewer uninsured drug overdoses, 25 percent fewer uninsured heart attacks, and over 32 percent fewer uninsured appendectomies in 2015 compared to 2013. The total percent reduction in inpatient uninsured hospitalizations across all conditions was 28 percent lower in 2015 than in 2013. Between 2013 and 2015, Arizona saw a 25 percent reduction in state uninsured hospitalizations, Nevada a 75 percent reduction, Tennessee a 17 percent drop, and West Virginia an 86 percent decline.

If the GOP “tax bill” passes, hospital and health system charges to insureds (yes, you work comp payer) are going to increase – and/or those hospitals and health systems will go bankrupt.



Article source:Managed Care Matters

Occupational Health News Roundup

At the Guardian, Julia Carrie Wong reports on the challenges of protecting nail salon workers from the toxic chemicals often used in the industry, and the progress being made in helping salon owners make the shift to healthier working conditions.

For example, she writes about the success of the California Healthy Nail Collaborative, a grassroots organization that in 2016 received an environmental justice grant from the U.S. Environmental Protection Agency. Not surprisingly, the conservative Heritage Foundation has singled out the grants as wasteful spending, calling for the elimination of EPA’s entire environmental justice budget. Trump included that elimination in his federal budget proposal. But, fortunately, the nail salon efforts continue to make a difference. Wong reports:

Each time Van Nguyen got pregnant, her doctor advised her either to stop working at the San Francisco nail salon she owns – or have an abortion.

But Nguyen wanted to keep her babies and couldn’t afford to stop working. So she avoided seeing doctors throughout her four pregnancies, despite experiencing significant bleeding during all four, and miscarriages during two.

“It’s not their fault, it’s my fault,” the 46-year-old said through a translator of the doctors whose advice she didn’t want to take. “This is what I chose to do for a living, so I have to live with it.”

Nguyen is one of thousands of Vietnamese immigrants in California, most of them women, who work 12-hour days in storefront salons providing customers with the quintessential “affordable luxury” – manicures and pedicures.

But unlike workers at many nail salons, Nguyen said she no longer experiences the headaches, respiratory problems, reproductive issues and rashes that some research links to the chemicals found in common nail products. The air at New York Salon on San Francisco’s Mission street smells fresh, workers attend to customers’ nails while wearing gloves and face masks, and elephant trunk-esque tubes hang over each manicure table, sucking away noxious vapors.

Read the full story at the Guardian.

In other news:

Los Angeles Times: Maura Dolan reports that California’s highest court has ruled that farmers may have labor contracts imposed on them if negotiations with a union don’t culminate in an agreement, upholding a 2001 law that allows the state to require farmers and unions to reach binding contracts. The ruling comes in reaction to a dispute between United Farm Workers of America and Gerawan Farming Inc. In 2013, the union failed to reach an agreement with Gerawan and asked state officials to intervene. Evenually, Gerawan sued over the union law, claiming it was unconstitutional. In the wake of the ruling, United Farm Workers is calling on Gerawan to pay workers more than $10 million in back wages. Dolan quoted the union’s statement: “Gerawan is exactly the kind of case lawmakers had in mind when they enacted the law because the company has been repeatedly found guilty by the state of California of multiple and serious violations of its workers’ rights, including the right to their union contract.”

The New York Times: Charles Bagli reports that in 1980, Donald Trump hired 200 undocumented Polish workers “who worked in 12-hour shifts, without gloves, hard hats or masks, to demolish the Bonwit Teller building on Fifth Avenue, where the 58-story, golden-hued Trump Tower now stands.” The workers earned as little as $4 an hour, if they got paid at all. Such labor conditions led to years of litigation, with Trump “quietly” agreeing to a settlement in 1998. Just this month, the terms of that settlement were unsealed in response to a motion filed by Time Inc. and the Reporters Committee for Freedom of the Press. The documents showed that Trump paid $1.375 million to settle, with $500,000 going to a union benefits fund. Bagli writes: “On the campaign trail and as president, Mr. Trump has made curbing immigration one of his top priorities, seeking to close the borders to people from certain Muslim-majority countries and to deport immigrants who are here illegally. The settlement serves as a reminder that as an employer he relied on illegal immigrants to get a dangerous and dirty job done.”

Milwaukee Journal Sentinel: Mary Spicuzza reports that following the death of Greg Zyszkiewicz, a city home inspector who was shot and killed on the job earlier this year, Milwaukee city officials are instituting changes to better ensure the safety of public employees. Among the changes, which were based on employee input and recommendations: city employees can request safety vests and official decals for their cars when conducting city business; the city’s Department of Employee Relations purchased and made available personal panic alarms; and local police have offered safety awareness training. In addition, city department officials can now use an incident tracker to document emergencies in the field. Spicuzza writes: “Maria Monteagudo, the city’s Employee Relations director, said 45 incidents have been documented so far — including 17 involving Department of Neighborhood Services employees. She acknowledged that the number seemed high given the relatively small size of that department.”

Huffington Post: Jamie Feldman reports on sexual harassment in the airline industry, as “unwanted advances to groping and forced physical contact, assault and harassment are realities seemingly accepted as commonplace by the flight attendants we spoke with, all of whom attested to various levels of unwanted physical contact during their time on the job.” Feldman writes that an industry culture in which the “customer is always right” makes it very difficult for flight attendants to confront harassment when it happens — plus, there’s no exact protocol for how to handle sexually harassing passengers. Sara Nelson, international president of the Association of Flight Attendants-CWA, told Feldman: “There is very little training. It’s nonexistent, actually. There is training on how to handle assault and aggressive behavior on a plane, but there is no recognition of sexual assault as a unique crime.”

Article source:Science Blogs

HWR – it’s the Late Days of Empires

From covering our generally-mediocre-but-hugely-expensive healthcare “system” to the use of blockchain in clinical trials to why adding $ to fund healthcare subsidies would drive UP premiums, it’s all here in Andrew Sprung’s edition.

If you want to stay up to date on the healthcare stuff that will affect your business – HealthWonk Review is the best way to do just that.

Article source:Managed Care Matters

Can Congress learn from states’ lessons on tax cuts and CHIP?

Congressional Republicans are rushing to vote on legislation that would slash corporate taxes while ultimately raising taxes on those not in the top income bracket, but have spent two months failing to extend the bipartisan Children’s Health Insurance Program (CHIP). In doing so, they’re failing to apply lessons learned in two Republican-controlled states.

There are a lot of problems with the House-passed tax bill and/or the version the Senate’s poised to vote on within the next few days, including a repeal of the individual mandate that would leave 13 million fewer people with health insurance in 2027, tuition-benefit changes that would imperil the US research enterprise, and the fact that it will lead to big cuts in Medicare and Social Security. The fact that tax changes that might help middle-class families (if they’re not offset by removal of current provisions) expire after 2025 while corporate tax breaks remain suggests warped priorities. But the problem that underpins the entire idea of slashing taxes this severely — and taking on a $1.5 trillion deficit, which used to be the kind of thing Republicans complained about — is that the GOP is trying to sell this as a move that will grow the economy enough to balance out lost revenue, when multiple credible analyses find it won’t.

If lawmakers don’t want to rely on experts’ modeling in making poorly supported claims about what their tax bills will do, they ought to at least consider the evidence from a state that tried this experiment: Kansas. There, steep tax cuts were sold as a way to bring on an economic boom — but instead, they got a budget crisis. Here’s the Kansas City Star editorial board urging members of Congress to learn from their state’s experience:

Every Kansan knows what happened after Gov. Sam Brownback’s 2012 cuts did away with the state income tax for some 330,000 business owners. The governor kept insisting — and in fact, still does — that robust growth and woohoo, jobs galore would result. When that didn’t happen, elected officials kept having to dip into funds set aside for highways and schools just to balance the budget. Finally, this year, lawmakers overrode a Brownback veto and at last repealed the LLC tax break and raised income tax rates.

… If Republicans wanted a bill that actually helped, as [Olathe, KS resident Robynn] Andracsek put it, normal people, that’s what they’d have come up with instead of a big, juicy break for the wealthiest families in America and a meager, mixed bag of lollipops and rocks for everyone else. Oh, and then the lollipops disappear after a few years, leaving us with a sack full of … rocks.

Public health would have been better served if Republicans had spent more of the past month working out a deal to extend CHIP, which provides insurance coverage to nearly nine million children, without harming other aspects of public health. CHIP expired on September 30, and states have been scrambling to keep their programs running in the absence of expected federal funding. Colorado announced this week that it would have to start sending letters to CHIP-enrolled families so they can start exploring other options.

Vox’s Dylan Scott warns that Congressional inaction is already damaging CHIP, and points to Florida as an instructive example. CHIP enrollment there dropped sharply after Florida adopted new enrollment restrictions in 2003 and 2004; officials decided they’d made a mistake and reversed restrictions. Enrollment hasn’t recovered, though. Scott writes:

[Florida CHIP board member Steve] Freedman said people in the state attributed that prolonged depressed enrollment to the uncertainty around the program in those years more than any specific policy change.

Not unlike what states are experiencing now while Congress drags its feet funding CHIP.

From its inception, CHIP has enjoyed bipartisan support — probably because most people can agree that children shouldn’t go without healthcare, especially not in such a wealthy nation.

Maybe if enough members of Congress hear enough from their constituents, they’ll learn these lessons before it’s too late.

Article source:Science Blogs

Comp is getting it done on opioids.

Work comp drug costs are down 22% over the last five years.  Opioid spend dropped 16.7% last year.

That’s the key takeaway from CompPharma’s annual survey of Prescription Drug Management in Workers’ Comp.

These are truly remarkable results; payers and PBMs (mostly PBMs) have slashed over a billion dollars from pharmacy spend, cutting costs for employers and taxpayers.

There is much left to do; far too many patients still get far too many drugs. Opioid addiction is a crisis in workers’ comp, as is abuse misuse and diversion. There are still no comprehensive, completely (or even mostly) effective tools/medications/programs to help patients get off and stay off opioids.

But let’s focus on the positive. Last year, overall opioid spend in the US declined by 1 percent – while work comp cut opioid spend by almost 17 percent.

While the reduction is beyond substantial, it’s important to understand that a big chunk of this was driven by payers settling older claims, claims that have a disproportionately high drug spend. These settlements don’t “count” towards drug spend, while they do eliminate on-going dispensing and the attendant costs.

What does this mean for you?

Well done.


Article source:Managed Care Matters