Researchers have created a new approach for studying resistance to Neuraminidase Inhibitors (NI) in influenza. The study, published December 7 in PLoS Computational Biology, combines data from influenza infections of human volunteers with a mathematical model which estimates the expected number of newly generated resistant infections. This new approach provides a more meaningful assessment of the danger of drug resistance emergence, compared to the current way of reporting the fraction/number of resistant cases.

Neuraminidase Inhibitors are currently the most effective drugs against influenza. However, recent cases of resistance to NI have caused some concern. A number of studies have reported that resistant mutants could be isolated from a fraction of patients treated with Neuraminidase Inhibitors. While this provides some qualitative insights, it is even more important to know how likely an infected, treated patient will generate resistance to NI and will cause infections with the resistant strain in others.

A team from Emory University, the Fred Hutchinson Cancer Research Center, and the University of Washington set out to determine this likelihood. Since the epidemiological data that is customarily used to estimate parameters of this type is not available for NI resistant influenza, the team, led by Dr. Andreas Handel, used an alternative approach. The team took data from volunteers infected with the flu and combined it with a mathematical framework to obtain a more quantitative assessment of the danger of resistance.

This result could predict models of resistance emergence and spread. The study additionally shows that the results depend strongly on the role the immune response plays; this is an issue that will be important to address in future studies.

CITATION: Handel A, Longini IM Jr, Antia R (2007) Neuraminidase inhibitor resistance in influenza: Assessing the danger of its generation and spread.
PLoS Comput Biol 3(12): e240. doi:10.1371/journal.pcbi.0030240
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Concentra Medical Centers, the nation’s leader in occupational health care serving employers and employees with 15 centers in the Chicago area, has geared up for the flu season with thousands of flu vaccines to serve the area’s workforce. Concentra will be hosting flu clinics for area businesses so that employees can be vaccinated as the flu season hits the Midwest.

Each year 1 in 5 people become sick with influenza. One flu shot can save a business more than a $1,000 in lost time by an employee who is not vaccinated and comes down with the flu. Concentra plans to administer 280,000 flu vaccine doses across the country during the 2007-2008 flu season.

In a report released in 2006, the CDC documented the spread of the influenza virus across the United States. The information determined that the western-most regions, including the Pacific, Mountain, and Southwest states experienced an early and extended outbreak of the flu virus beginning in October and peaking in mid-December. The CDC expects to have the largest number of doses ever, up to 132 million flu vaccine doses during the 2007-2008 flu season — 12 million more than were produced last year.

“With more than 250 employer-based sites and 320 Concentra Medical Centers across the country, we can provide flu shots to maximize effectiveness in accordance with peak regional flu rates,” said Jane Derebery, M.D., Concentra’s Influenza Program Director.

About Concentra(R)

Concentra is a leading health care company that strives to make health care accessible and affordable. The company, through its affiliated providers, offers a broad range of services that provide quality patient care for work-related injuries while containing the rising costs of occupational health care and workers’ compensation. The company operates 320 medical centers in 40 states and more than 270 on-site medical facilities at employer locations throughout the nation. Through its affiliated providers, Concentra also provides urgent care services at a growing number of its medical center locations to serve the gap between primary care physicians and the emergency room. http://www.concentra.com/Flu.

The US Food and Drug Administration (FDA) Pediatric Advisory Committee recommended to the agency yesterday, Tuesday 27th November, that makers of the flu drug Tamiflu be urged to change the drug’s warning label to include the fact that the psychiatric symptoms experienced by children on the drug could be caused by having the flu.

Tamiflu (oseltamivir) is made by the Swiss drug company Roche Holding AG, and has been used by 48 million patients worldwide since it hit the market in 1999 to reduce the severity and duration of influenza symptoms.

A spokeswoman for the company told the Associated Press news agency that the company had accepted the recommendation. She pointed out that patients with serious flu symptoms are at risk of psychiatric problems from the flu itself, whether taking the drug or not.

She said the company has conducted trials into the drug’s side effects and found no causal relationship between Tamiflu and “reported cases of delirium and hallucinations”. Flu can take the body’s temperature to 104 Fahrenheit (40 Celsius) and higher, and people needed to know that this condition alone is linked to delirium and hallunication.

According to a report in WebMD, the FDA panel’s vote was 8 to 6, and reflected the agency’s uncertainty about whether the drug or the condition led to nearly 600 reported psychiatric incidents worldwide, most of them in Japan, since the drug was introduced. The incidents, of which 20 per cent were in the US, included self-harming behaviour, delirium and suicide attempts. 25 of them were fatal, with 3 of the deaths being in the US.

The drug’s warning label was changed last year following reports of psychiatric symptoms in patients taking the drug. But the panel is not asking for the warnings to be removed, only that information is added to explain that the symptoms could be caused by the flu itself.

Roche presented the agency with results from its own trials involving more than 150,000 patients that showed no link between Tamiflu and increased risk of psychiatric events.

Roche product director, David Reddy told the AP in an interview on Tuesday that over the last year they had been looking at a range of results from various studies and so far they had found no link between Tamiflu and psychiatric events, He said, “In fact, the data increasingly points to the role of influenza in these events.”

The panel also advised similar changes be made to the label for Relenza (zanamivir, made by GlaxoSmithKline), another flu drug that is less used than Tamiflu. It did not advise labels be changed for amantadine (trade name Symmetrel, approved as an anti-flu drug in 1976) and rimantadine (trade name Flumadine, approved in 1994).

A newly released national survey of mothers found that keeping their homes clean was the best means of protecting their families from the germs that cause colds and flu. Likewise, there is a general recognition that toys can be a significant source of germs. The Alliance for Consumer Education’s (ACE) nationwide Germ Study examined mothers’ overall awareness of how germs that cause colds and flu are spread. It then assessed their views as to the most effective means of preventing and / or containing colds and flu. This is the second such survey conducted by ACE; the first was completed in 2005. While many of the overall findings in the two surveys were similar, there were some stark differences.

For example, in the 2007 survey 32% of respondents felt that keeping their house clean was the most effective means of protecting against colds and flu. This was the Number One response. In 2005, only 23% of respondents felt home cleaning was the best means of protection against colds and flu. At the same time, 56% of the 2007 respondents said they clean the surface of their children’s toys on a weekly basis. In contrast, only 44% of 2005 respondents cleaned their children’s toys so regularly.

“The ACE 2007 Germs survey clearly illustrates that mothers understand the threat of exposure to those germs that can cause colds and flu and are taking steps to minimize that threat and protect their families,” said Joseph M. Healy, Chairman of the Board, Alliance for Consumer Education. “One of the simplest, most effective things that people can do to minimize the risks from germs is to frequently wash their hands and clean their homes and places of work on a regular basis. It is gratifying to see that the percentage of moms who recognize the importance of home cleaning continues to rise. At the same time, still more consumer education needs to be done to continue raising overall awareness of the importance of home cleaning.”

Other findings from the 2007 Germ Study include the fact that 92% of mothers gave themselves either an “A” or “B” with regard to teaching germ control. At the same time, 42% of mothers believe that their children will get sick no matter what they do, up from 30% in 2005. When their children do get sick, 62% of mothers gave their kids some type of home remedy, such as chicken soup, up from 44% in 2005.

The Alliance for Consumer Education (ACE) is a foundation dedicated to advancing community health and well-being. ACE brings together a broad base of organizations to work together for the consumer. All ACE programs fall within two categories, Public Health and Product Stewardship. Starting in 2007, ACE will be conducting its Germ Study on an annual basis. “We think it is important to track how primary care givers, primarily mothers, view the risk of colds and flu and the steps they can take to minimize those risks,” continued Healy. “Based on this information, we can modify our education programs accordingly.” To learn more about ACE’s disease prevention programs, please visit http://www.stopgerms.org.

Since 2005, there has been a significant increase in the proportion of young mothers (ages 18 to 34) who say that the mother is the one who stays at home with a sick child (85% vs. 70% in 2005). Likewise, significantly more mothers who are married or living together say the same (84% vs. 72% in 2005). In fact, less than one in ten fathers stay home with sick children.

Both the 2007 and 2005 Germ Studies were conducted for ACE by International Communications Research (ICR), one of the nation’s top ranked full-service market research companies. The studies were conducted in ICR’s EXCEL Omnibus, a national, twice-weekly telephone omnibus service designed to meet the standards of quality associated with custom research studies. EXCEL uses a fully-replicated, stratified, single-stage random-digit-dialing (RDD) sample of telephone households. Sample telephone numbers are computer- generated and loaded into on-line sample files accessed directly by the CRT system. Respondents answering questions for this survey were women between the ages of 18 and 49 with children under age 18 living in the household. Between October 18th and 29th, 2007, a total of 289 women ages 18 to 49 with children under age 18 living in the household responded. In 2005, 257 women were interviewed between November 30th and December 6th, 2005.

The Alliance for Consumer Education (ACE) is a Washington, D.C. based nonprofit foundation dedicated to advancing community health and well-being wherever household and commercial products are used. For more information on ACE, visit http://www.Consumered.org

The Health Protection Agency welcomes publication of the Government’s National Framework for Responding to an Influenza Pandemic. The Framework provides information and guidance to assist and support organisations in developing and improving their pandemic preparedness plans.

Professor Nigel Lightfoot, of the Health Protection Agency said “The framework sets out the Government’s strategic approach to preparing for an influenza pandemic and gives guidance to all public and private organisations to further develop their plans for a flu pandemic. The plan will support flu preparedness and help reduce the impact of pandemic flu on the UK population.

“The Agency helps people prepare for a flu pandemic. UK planning and preparedness is well advanced and a significant number of exercises to test these plans have been carried out locally, regionally and at a national level”.

The HPA plays a key role in informing public health policy development on pandemic influenza, through its expert advice, modelling and reference virological services. It has produced a suite of guidance documents for control of infection in health and non-health settings. The HPA has produced protocols and algorithms for the investigation and management of early cases and contacts, and it keeps a watch on the global avian influenza situation by carrying out periodic risk assessments. During a pandemic the HPA will provide surveillance information and real time modelling of the expected impacts to inform Government decisions.

Health Secretary, Alan Johnson, published a new plan to increase preparedness and better protect the public against a possible flu pandemic.

A new clinical countermeasures strategy has been developed to offer increased protection against the effects of a flu pandemic if a ‘worst case scenario’ happened. Commenting on the plans, the WHO has again stated that the UK is in the vanguard of countries worldwide in preparing for a pandemic.

The Department has already signed agreements with two pharmaceutical companies to supply enough pandemic specific vaccine for the entire population once the pandemic strain has been identified.

The new countermeasures include plans to:

- Double the stock of antivirals to cover at least 50 per cent of the population

- Buy 14.7 million courses of antibiotics to cover at risk groups

- Purchase 350million surgical masks and 34m respirators for NHS and social care staff on the frontline.

The Government also has an existing stockpile of 3.3 million doses of H5N1 pre-pandemic vaccine for healthcare workers and will be considering all the latest scientific evidence in relation to future decisions on pre-pandemic vaccines.

Alan Johnson said:

“The threat of an influenza pandemic remains real. Whilst it is not possible to predict its timing or severity, the top priority for the Government is to do all we possibly can to protect the public. Our arrangements are kept constantly under review, ensuring we keep abreast of emerging expert evidence and advice.

“Our new plans provide the first national blueprint for the UK’s response to a pandemic flu. We are strengthening our countermeasures to ensure we have the necessary vaccines, antibiotics and antivirals to protect the population if the worst were to happen.

“We know a pandemic would have significant social and economic impact as well as a serious effect on the health of the population. A thorough and integrated response is therefore critical to lessening its overall effect.

“We have spent several years developing and testing plans with front line service providers and listening to expert national and international advice on how best to prepare the country and will continue to do that as new evidence or medical advances emerge. ”

Alongside the countermeasures a new National Flu Pandemic Framework, which coordinates the responses of all government departments, regional assemblies and all public and private bodies, will set out how the UK will respond if a flu pandemic occurs.

The Framework will help public and private organisations to be as prepared as possible for a pandemic and make sure their arrangements are resilient enough to cope

Although previous pandemics during the last century have resulted in infection rates at or around 25 per cent, the new plans consider a possible ‘reasonable worst case’ scenario to ensure a robust response. This means considering an infection rate between 25 per cent and 50 per cent of the population.

Chief Medical Officer Sir Liam Donaldson said:

“We may not be able to prevent a pandemic, but with good planning we can reduce its impact on all aspects of society. This framework will enable organisations such as schools, businesses, transport, and the NHS to prepare for a pandemic in an integrated manner, with the full support of cross-government policy and planning.

“But many changes can be made now. Developing habits for respiratory hygiene – using tissues, disposing of them carefully, and cleaning hands – are all good practice even before a pandemic arrives.”

It is recognised internationally that the UK has already made significant progress in protecting the UK and we will continue to work closely with the World Health Organisation.

Dr David Heymann, the Assistant Director-General for Health Security and Environment at WHO said this week:

“The UK is still in the vanguard of countries worldwide in preparing for a pandemic, and is also one of the leading global players in addressing the cross-sectoral issues in their planning.”

The Department of Health has also announced £2M to support the Global Pandemic Influenza Action Plan, to increase vaccine supply to help develop capacity to secure vaccine supply for the developing world.

Notes:

1. The National Flu Pandemic Framework is a cross-government document that replaces previous plans produced by the UK Health Departments – the latest version of which was published in 2005. Whilst it builds upon and updates the advice and information in that plan, it also widens its scope to include non health aspects; reflecting the fact that:

a) a pandemic presents major social and economic as well as health challenges

b) a multi agency, coordinated and collaborative approach with high levels of public support are going to be critical to the success of our response

The National Flu Pandemic Framework can be found here.

2. The framework:

- gives guidance to public and private organisations in developing their plans and outlines how the UK’s health and wider response will be coordinated at national, regional and local level

- updates and expands previous health advice from previous plans, for instance on community care arrangements, antiviral use and how services will be accessed

- expands information on a range of subjects including decisions on school closures, international travel and effects on public gathering,

- outlines how people will get necessary antivirals through a national flu line service

- recognises that expected level of demand will mean that most influenza sufferers will need to be cared for and supported in a community setting

3. These arrangements provide for a consistent and coordinated UK wide approach, but each country has some differences in organisational structures, responsibilities and operational arrangements. Please speak to the relevant Devolved Administration for further information.

4. The clinical countermeasures strategy:

- The Department of Health awarded advanced supply contracts to GSK and Baxter to provide the vaccine for a possible flu pandemic in the summer. The contracts, worth £155.4 million over four years, commit both to supply a pandemic flu vaccine as soon as the pandemic strain is identified and made available by the World Health Organisation.

- Doubling the stock of antivirals to cover 50 per cent. Antiviral medicines are key to the response and we aim to make them available to all symptomatic patients as quickly as possible after the onset of symptoms. Antivirals can reduce the duration of the disease by a day or so and reduce the risk of complications. We currently have a stockpile for 25 per cent of the populations and will be extending this to cover 50 per cent.

- Buying 14.7 million doses of antibiotics, to cover at-risk groups. Antibiotics will be needed to treat the secondary bacterial infections which are likely to be the main cause of complications, and deaths, during a pandemic. Recommendations for the use of antibiotics are included in the clinical management guidelines.

- Plans to purchase facemasks for all NHS and social care staff. Maintaining the resilience of NHS and social care staff will be critical. We will ensure that essential workers on the NHS and social care frontline, caring for people with influenza, are protected. They are advised to wear facemasks when caring for symptomatic patients and to use disposable respirators when carrying out clinical procedures likely to generate fine droplets from infected patients. A business case has been submitted to Treasury to purchase 34m disposable respirators and 350m surgical facemasks for the use of health and social care workers.

- Although the available medical evidence does not support the widespread use of facemasks, I do recognise that people may want to have access to facemasks for their personal use. The Government will explore the approach that retailers are planning to adopt in stocking facemasks for sale to the public.

- Both the procurement of antivirals and antibiotics will be subject to the normal commercial procurement procedures, and we will ensure that value for money is balanced with the need to ensure that the UK is prepared

6. The Department is also launching a public consultation on possible amendments to the medicines and associated legislation. It would seek to widen powers to supply prescription only medicines to ensure patients can continue to access their routine but essential medicines if front-line staff, especially GPs, are focussed on the most seriously ill.

6. A World Health Organization’s evaluation showed that the UK’s plans are amongst the most advanced in the world. An independent evaluation of preparedness in European countries conducted by the London School of Hygiene and Tropical Medicines also confirmed that we are amongst the leaders in Europe. The progress made thus far was also acknowledged in a recent joint report by the Royal Society of Medicine and Academy of Medical Sciences.

7. Influenza pandemics are a natural phenomenon and have occurred from time to time throughout history. It is therefore very likely that we will face another sometime in the future with little warning and therefore need to be as prepared as possible.

A new model to predict the spread of emerging diseases has been developed by researchers in the US, Italy, and France. The model, described in the online open access journal BMC Medicine, could give healthcare professionals advance warning of the path an emerging disease might take and so might improve emergency responses and control.

Severe acute respiratory syndrome (SARS) spread rapidly in 2002-2003, revealing just how vulnerable we might be to emerging diseases and how global transportation is critical to the spread of an epidemic.

Now, Vittoria Colizza and Alessandro Vespignani of Indiana University, Bloomington, USA and the Institute for Scientific Interchange Foundation, in Turin, Italy, and colleagues in France have developed a predictive model of the spread of emerging diseases based on actual travel and census data for more than three thousand urban areas in 220 countries. The model provides predictions of how likely an outbreak will be in each region and how widespread it might become. The research highlights just how the accuracy in predicting the spreading pattern of an epidemic can be related to clearly identifiable routes by which the disease could spread.

In order to assess the predictive power of their model, the researchers turned to the historical records of the global spread of the SARS virus. They evaluated the initial conditions before the disease had spread widely, based on the data for the arrival of the first patient who left mainland China for Hong Kong, and for the resulting outbreak there. They then simulated the likelihood that SARS would emerge in specific countries thereafter, as brought by infectious travelers. The simulated results fit very accurately with the actual pattern of the spread of SARS in 2002. Analysis of the results also identified possible paths of the virus’ spread along the routes of commercial air travel, highlighting some preferred channels which may serve as epidemic pathways for the global spread of the disease.

“The presented computational approach shows that the integration of long-range mobility and demographic data provides epidemic models with a predictive power that can be consistently tested,” the researchers explain. “This computational strategy can be therefore considered as a general tool in the analysis and forecast of the global spreading of emerging diseases.”

Article
Predictability and epidemic pathways in global outbreaks of infectious diseases: the SARS case study Vittoria Colizza, Alain Barrat, Marc Barthelemy and Alessandro Vespignani
BMC Medicine

BMC Medicine publishes original research articles, technical advances and study protocols in any area of medical science or clinical practice. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, Scopus, CAS, Google Scholar and Thomson Scientific (ISI).

About BioMed Central

BioMed Central is an independent online publishing house committed to providing open access to peer-reviewed biological and medical research. This commitment is based on the view that immediate free access to research and the ability to freely archive and reuse published information is essential to the rapid and efficient communication of science.

BioMed Central currently publishes over 160 journals across biology and medicine. In addition to open-access original research, BioMed Central also publishes reviews, commentaries and other non-original-research content. Depending on the policies of the individual journal, this content may be open access or provided only to subscribers.

The Centers for Disease Control and Prevention (CDC) has announced the week after Thanksgiving, November 27 to December 2, as National Influenza Vaccination Week. Despite annual CDC recommendations, influenza vaccination (flu shot) rates in young children remain disturbingly low. Only 20 percent of children age 6 to 23 months were fully immunized for the flu during the 2005-2006 season. So the Asthma and Allergy Foundation of America (AAFA) is making it easier for asthma patients to find flu shot clinics with a free “Flu Shot Finder” at http://www.aafa.org.

The flu is a serious and potentially deadly viral infection that causes respiratory problems, spreads easily, and is a major concern for 20 million Americans with asthma. Each year, it causes approximately 20,000 hospitalizations and nearly 100 deaths in American children under age 5. Annual flu shots are highly recommended for anyone with underlying medical conditions, such as asthma.

The Foundation’s Flu Shot Finder, powered by Maxim Health Systems, is a simple online zip code search that links to a database of more than 30,000 flu clinic locations nationwide. The Flu Shot Finder returns a list of clinic names, dates, times, addresses and phone numbers to help consumers contact the most convenient location and schedule a visit. The Flu Shot Finder Web page also provides links to helpful information about influenza, flu shot guidelines from the CDC and more.

“Flu symptoms can cause more trouble for people with asthma,” says Angel Waldron, a spokesperson for AAFA. “When you’ve already got a chronic disease like asthma, a severe flu could make it worse.” Waldron also says that the flu is a leading cause of emergency department visits for asthma patients. “Healthcare professionals already know that respiratory infections send millions of asthma patients to hospitals this time of year, but many asthma patients don’t know it and they find out the hard way.”

The Foundation hopes its Flu Shot Finder will help educate people with asthma about the dangers of the flu, and encourage patients to schedule a vaccination.

About AAFA

The Asthma and Allergy Foundation of America (AAFA), founded in 1953, is a not-for-profit organization of patients serving patients. It is the leading patient organization for people with asthma and allergies, and the oldest asthma and allergy patient group in the world. AAFA provides practical information, community based services and support through a national network of chapters and support groups. AAFA develops health education, organizes state and national advocacy efforts and funds research to find better treatments and cures.

Lemsip Max Day & Night reveals 242 million working hours lost due to bed-headed workers clocking-on but dozing off (1) ‘Snoozebuttonitis’ affects two thirds of cold suffering workers (2)

The Nation’s Top 10 ‘Groggy Gremlins’ uncovered

An estimated 242 million working hours will be lost this winter due to ‘desk dozing’ employees full of cold and flu symptoms, who willingly clock-on for work but are anything but productive, thanks to a poor night’s sleep and a groggy head, a new study published reveals(2).

Eyes Wide Shut

The research from Lemsip Max Day & Night Cold & Flu Relief Capsules has found that almost a third of employees (32%)(2) admit to trying to look busy when full of cold at work but not really getting any work done. One in five (20%)(2) spend at least the first two hours of the working day doing very little and one in six (13%)(2) take an extra half hour checking emails. Hourly trips to the canteen to make cups of tea or coffee is a necessary pick me up for one in five (21%)(2) workers, and of those that do make an attempt to work, 40%2 find they can’t concentrate on the job in hand.

Popular ‘desk dozer’ pastimes include day-dreaming (40%)(2), almost one in 10 (8%)(2) surf the Internet to try and get ‘re-focused’ and 7%(2) find themselves taking refuge in the toilets for a quarter of an hour at a time.

Late Arrivals

Hats off, however to those workers who arrive on time – albeit in a daze – as the research from Lemsip Max Day & Night Cold & Flu Relief Capsules found, one in five employees (20%)(2) admit to being anything up to an hour late for work often sleeping in when they have a cold. A quarter sleep through their alarm (25%)(2). Indeed, nearly two thirds could be said to be suffering from ‘snoozebuttonitis’, admitting to hitting the snooze button up to three times before struggling out of bed (57%)(2). Commented Lemsip Max Day & Night Cold & Flu Relief Capsules Senior Brand Manager, Vishal Kalia: “You’ve got to admire people who struggle into work when they’ve got a cold – it can be really rough. And as our research shows, trying to be alert and fully functioning can be particularly hard if you’ve not managed to get a good night’s sleep thanks to your symptoms.

“Cold and flu sufferers who battle in to work often take over the counter remedies with sedatives to help ease their symptoms at night in the hope they can get a good night’s sleep in preparation for the day ahead. However, they can often wake in the morning still feeling groggy(2). Getting up and getting going seems to take a lot longer and every day tasks become a chore as people feel drained and lacking in energy. “At Lemsip, we’ve developed Max Day & Night Cold & Flu Relief Capsules to help tackle the symptoms of cold and flu, providing tailored relief appropriate for day and night time. A combination of day time capsules for effective symptom relief, plus an energising caffeine boost, help people keep going when they need it most, and night time capsules to provide effective symptom relief and help allow a good night’s sleep through relief of nasal congestion, so sufferers wake up refreshed the next morning.”

Groggy Gremlins Hamper Morning Routine

The Lemsip Max Day & Night Cold & Fly Relief Capsules research also revealed some bizarre ‘groggy gremlins’ tripping up half asleep cold and flu sufferers as they battled to cope with getting ready for work. Forgetfulness ranked highly among nearly half of ‘bed heads’. Examples include getting to the fridge and forgetting what the trip was for (41%)(2); stepping on the bus and realising they’ve forgotten their purse or wallet (23%)(2); being locked out because they’ve forgotten the house keys (13%)(2); and for one in ten people, realising that the rush to get ready has resulted in them wearing their underwear inside out (10%)(2).

The top ten of Groggy Gremlins for bed-headed cold and flu sufferers:

1. Forgetfulness when preparing breakfast – going to the fridge and struggling to remember why
2. Being late for work
3. Forgetting a bag, purse or wallet
4. Being locked out of the house after forgetting keys
5. Wearing underwear inside out
6. Wearing odd shoes or socks
7. Forgetting to wear normal jewellery
8. Getting the kids to school late
9. Pouring fruit juice in tea or coffee, or on cereal by mistake
10. Setting a new trend and arriving at work in slippers

Available in packs of 8 and 16 capsules, Lemsip Max Day & Night Cold & Flu Relief Capsules provide symptomatic relief from cold and flu. The daytime capsules help relieve your cold and flu symptoms and contain caffeine to help keep you going. The night time capsules help relieve cold and flu symptoms and help aid sleep through relief of nasal congestion. Always read the leaflet. Contains Paracetamol.

For more information on Lemsip Max Day & Night Cold & Flu Capsules please visit http://www.lemsip.com

Notes:

¹ Hypothetical calculation based on the working hours lost per worker who comes in to work with a cold multiplied by the average number of colds an adult in the UK catches each cold and flu season – as revealed by the survey conducted by TNS (September 2007) using a nationally representative sample of 1,000 working adults.

2 Survey conducted by TNS (September 2007) using a nationally representative sample of 1,000 working adults.

Product Specification:

Lemsip Max Day & Night Cold & Flu Relief Capsules, produced by Reckitt Benckiser, contain:

Day Capsule: 500mg Paracetamol (Analgesic) for the relief of headaches, sore throat, fever and, body aches and pains; 6.1mg of Phenylephrine hydrochloride (Decongestant) which treats blocked or runny noses; and 25mg Caffeine (mild stimulant) to help relieve lethargy, sluggishness and fatigue.

Night Capsule: 500mg Paracetamol (Analgesic) for the relief of headaches, sore throat, fever and, body aches and pains and 6.1mg of Phenylephrine hydrochloride (Decongestant) which treats blocked or runny noses.
Both capsules contain tartrazine (E102)

Directions for use:

How to take: The capsules should be swallowed whole with water. Do not chew.

How much to take: Adults and adolescents over 12 years: Two Day capsules to be taken every 4 hours during the day (no more than six Day capsules in 24 hours). Two Night capsules to be taken at night. Children 6-12 years: One Day capsule to be taken every 4 hours during the day (no more than three Day capsules in 24 hours). One Night capsule to be taken at night. Do not give to children under 6 years.

Every three minutes, a child puts a hand in his/her nose or mouth. Considering that some viruses and bacteria can live two hours or longer on surfaces like cafeteria tables, doorknobs, and desks that children touch throughout the day, it is easy to see how clean hands are critical to avoiding sickness.

According to the Centers for Disease Control and Prevention (CDC), keeping hands clean is one of the most important steps in avoiding getting sick and spreading germs to others. With the common cold accounting for nearly 22 million school days lost annually, according to the CDC, this is a critical time for parents to teach–or remind–the whole family of proper hand hygiene.

“There are plenty of unwashed hands out there. Only one in five of us does the job properly,” says Dr. Charles Gerba, Professor of Environmental Microbiology at the University of Arizona. “Everyone needs to be sure they understand how to wash properly and how and when to use alcohol-based instant hand sanitizers such as PURELL(R).”

Effective hand hygiene practices include washing hands frequently with soap and water and, when soap and water are not available, using an alcohol-based instant hand sanitizer containing at least 60 percent alcohol. PURELL(R) Instant Hand Sanitizer kills 99.99% of the most common germs that may cause illness.

Everyone, no matter what age, can benefit from a hand hygiene refresher during cold and flu season. It comes down to three basic steps:

1. Tell your children why clean hands are so important. Proper hand hygiene is critical to avoid getting sick and spreading germs to others.

2. Show your children how to wash hands properly, according to CDC instructions:

– Wet your hands with clean, warm water and apply soap.

– Rub hands together to create lather and scrub all surfaces (including between fingers and under nails).

– Continue rubbing hands for 20 seconds (about the time it takes to sing Happy Birthday).

– Rinse hands under running water.

– Always dry hands thoroughly.

3. Help your children keep clean anywhere they are. When soap and water are not available, alcohol-based instant hand sanitizers such as PURELL(R) effectively kill 99.99% of germs that may cause illness. There is no evidence that germs become resistant to alcohol — the main ingredient in PURELL(R) — or to other antibiotics as a result of using alcohol-based instant hand sanitizers. Show children how to use hand sanitizers properly:

– Apply alcohol-based hand sanitizer to the palm of one hand.

– Rub hands together — so that product covers all surfaces of hands and fingers — until hands are dry.

Then: remind, remind, remind. Encourage your children to wash their hands frequently throughout the day, particularly before eating, and after using the bathroom and playing outside. Check with your school to see if you can send your older children in with a travel-size container of PURELL(R) to carry in their backpack, for quick and easy hand cleansing when soap and water are not readily available.

PURELL(R) Instant Hand Sanitizer consumer products are marketed by Johnson & Johnson Consumer Companies, Inc.

The CDC is not affiliated with Johnson & Johnson, Johnson & Johnson Consumer Companies, Inc., any of its affiliated companies, or the PURELL(R) brand.

Johnson & Johnson Consumer Companies, Inc.

http://www.jnj.com/home.htm