One aspect of such collaboration is clarifying legal and liability issues, said Ned Calonge, MD, MPH, chief medical officer for the Colorado Department of Public Health and Environment (CDPHE). Redistributing vaccine, for example, might go more smoothly if officials could clarify who pays whom and how, as well as what liability issues affect state law. See also: “We’re hopeful that one, two, or maybe more companies will be interested in selling [flu vaccine] in the US,” said Strikas. “Then, if one has a hiccup, one or more can step in.” April 8, 2005 (CIDRAP News) The only thing more unpredictable than the fickle, fast-changing influenza virus may be the US flu season itself. Yet health experts who weathered this year’s vaccine shortfall, which began early in October with the news that Chiron Corp. couldn’t deliver nearly half of the expected US vaccine supply, have found the 2004-05 flu season instructive. The lessons they draw may prove helpful in managing future problems with supply and distribution and also in facing the possibility of pandemic influenza. Stearns County, about 70 miles northwest of the Twin Cities, did a fine job ensuring that people received vaccine through an effective local collaboration, said Ehresmann, adding that MDH is encouraging similar efforts throughout the state. Anticipating the worst: pandemic fluLast fall, Coloradoans conducted a mass vaccination clinic in a small area to measure the state’s ability to meet a mass vaccination target. It turned out to be one of the bright spots in the season, according to Calonge. Volunteers and ham radio operators helped coordinate the vaccine transfer among many counties. A daunting target vaccination rate proved more achievable than officials expected. In addition, the MDH is working to enhance communication among those involved in flu immunization, Ehresmann said. Her office is convening a statewide workgroup on flu that will allow state officials to consult directly with healthcare providers in groups that may be affected by changes in the disease or the vaccine supply. In addition, the department is encouraging creation of community coalitions. Shortage turns to surplusNearly half of the expected US flu vaccine supply disappeared last fall because of contamination problems at a Chiron Corp. plant in England. Eventually, the country obtained about 61 million doses of flu vaccine instead of the roughly 100 million doses expected earlier. “Partnership was a critical piece of what we did,” Strikas said. “There needs to be coordination, particularly while the product is in short supply.” Although some state and local public health departments reported instances when they physically held or transferred flu vaccine, simply knowing where the doses are is often more important than having them in hand, officials said. “We were really cautiousand rightly soabout supply, but we have always had vaccine that goes unused,” Ehresmann said. But the surplus suggests to her that MDH must “do the least restrictive limiting we can possibly do, so we don’t end up wasting vaccine,” she said. Multiple suppliers wantedHaving two companiesChiron Corp. and Sanofi-Pasteur (formerly Aventis Pasteur)provide the bulk of the nation’s flu vaccine doesn’t leave much room for handling problems, experts said. “We came away convinced that if we needed to use that process for pandemic flu, we could meet the vaccine requirement,” Calonge said. “Both influenza disease and vaccine supply are unpredictable,” he told CIDRAP News. His list of lessons learned or reinforced this season highlights preparation: expect the unexpected, plan for many scenarios, be flexible, and be proactive. Despite the shortfall, good news was plentiful this flu season. It was only a moderate season, with illness peaking in mid-February, according to a CDC recap in this week’s Morbidity and Mortality Weekly Report (MMWR). The season was milder for kids this year, with far lower hospitalization rates than in the previous season. And an estimated 17 million Americans refrained from getting a flu shot so that doses would go to high-risk people. Targeting those at greater risk from the flu proved effective, with vaccination rates for the high-risk groups hewing closely to the levels of previous years despite the reduced vaccine supply, MMWR reported March 31. It’s not clear how many leftover doses may be in the hands of individual providers or groups. Ehresmann estimated that the number is in the thousands. Doses are only good for one season because the combination of viral strains used in the vaccine is changed every year, so many of the remaining doses may go to waste. Web-based partnershipsVirtual vaccine distribution systems may be increasingly important to managing supply during a flu season. Think of it as a way for many people to communicate effectively about vaccine orders, manufacturers, and supplies even in the off-season. Health officials in Minnesota found the same thing, and are taking steps to formalize new relationships before the next flu season. Calonge, with Colorado, called the current system too risky. “It’s a more fragile system than I would like to see,” he said. In the end, the expected vaccine shortage turned into a surplus: 3 million doses, roughly the equivalent of the CDC stockpile, remains, Strikas said. In Minnesota, for instance, the Minnesota Department of Health (MDH) is launching an Internet-based data collection tool, said Kristen Ehresmann, RN, MPH, manager of the department’s immunization, tuberculosis, and international health section. Local public health workers will be able to track vaccine orders by healthcare providers, such as hospitals and nursing homes, as well as by manufacturers. The information will be accessible online, so “we’ll go into the season knowing where people ordered from and how many doses they’re expecting,” Ehresmann said. Expecting the unexpectedFlu vaccine can take a lot of detours between the egg and the arm. That’s why flexibility is key, said Dr. Raymond Strikas, associate director for the adult immunization program at the National Immunization Program at the Centers for Disease Control and Prevention (CDC). CDC. Estimated influenza vaccination coverage among adults and childrenUnited States, September 1, 2004January 31, 2005. MMWR 2005 Apr 1;54(12):304-7 [Full text] CDC. Update: Influenza activityUnited States, 2004-05 season, April 8, 2005. MMWR 2005 Apr 8:54(13): 328-331 [Full text]
One of the most fun parts about Madden is being able to put up high numbers on offense, so we’ll look into the team ratings to tell you which offenses in “Madden NFL 20” you should use and which you should avoid.Some of the teams will be obvious, like the Saints having the best overall offense (92). But others near the top may surprise you and some near the bottom could intrigue you as well. We’ll give you every team’s rating on offense and then explain some of the teams more in depth. BillsBuffalo may have the second-worst overall offensive rating in Madden 20, but there’s still some fun you can have with this team. QB Josh Allen has the best throw power in the game (99), which he can use to launch the ball to WR John Brown, who has 94 speed. Buffalo has decent playmakers to get the ball to, but the poor offensive line may make it difficult to get much accomplished.JaguarsUnlike the Bills, there isn’t much to like here with the Jaguars. HB Leonard Fournette is the most intriguing playmaker, but his 81 overall rating doesn’t make him a must-play option. Wideouts Marqise Lee, Dede Westbrook and Keelan Cole are all similar in ratings which makes none of them really stand out. Honorable Mention: CardinalsThe Cardinals are listed as the fourth-worst offense in Madden 20, but I imagine people will end up playing with them anyway. Rookie QB Kyler Murray is only 73 overall, but his 91 speed will make him a fun player to use in games. Plus with players like HB David Johnson, WR Larry Fitzgerald and WR Christian Kirk, there are plenty of playmakers surrounding Murray to make this fun. Also, hidden on the depth chart is WR Andy Isabella with 95 speed. If you’re curious about overall team ratings, click here for the complete list.MADDEN 20 REVIEW: The good, the bad and the new from EA SportsContents:Madden 20 team offense ratingsWhat is the best offense to use in Madden 20?What is the worst offense to use in Madden 20?Madden 20 team offense ratingsTeamOffense RatingSaints92Patriots91Colts91Packers89Falcons89Chiefs88Eagles87Chargers87Cowboys86Steelers85Rams83Browns83Panthers82Raiders82Vikings8049ers80Seahawks80Texans78Titans78Bengals78Bears76Lions76Buccaneers76Redskins75Ravens75Broncos75Giants75Jets73Cardinals73Jaguars71Bills71Dolphins69What is the best offense to use in Madden 20?SaintsThe Saints are absolutely loaded on offense and deserve the top ranking. Four of their top five overall players are on offense, with three of them being key playmakers (WR Michael Thomas, QB Drew Brees, RB Alvin Kamara). Plus with additional weapons like TE Jared Cook (87) and WR Tedd Ginn (92 speed), there’s really a little bit of everything you need on this team.PatriotsThe Patriots are top-heavy with QB Tom Brady (96), and after him there are no other 90+ overall players on offense. The other top skill position players include WR Julian Edelman (89), HB James White (86), HB Sony Michel (84) and WR Josh Gordon (83). This offense has a solid overall rating, but depending on your playing style it may not be the right for you.ColtsIndianapolis being No. 3 overall is a bit of a surprise, but their unique offense is what puts them here. Seven of their top 10 overall players are on offense, with QB Andrew Luck (92) and WR T.Y. Hilton (91) leading the way. Dual tight ends Eric Ebron (86) and Jack Doyle (85) are also included in that, with the others being offensive linemen.What is the worst offense to use in Madden 20?DolphinsThe Dolphins are the only team in Madden with a major category rated below 70. A big reason why is the lack of a true starting quarterback with veteran Ryan Fitzpatrick at 75 overall and newcomer Josh Rosen is 70 overall. Only two players on offense are rated 80+ (WR Kenny Stills and LT Laremy Tunsil, both 84). There’s a reason this team is rated last, and it’s because there’s not a lot of fun you can have playing with this offense.