SubscribeRemember the last time 'swine flu' was a household catchphrase?Only second-hand. The health care professionals who are still bitter about that overreaction are close to retirement, now. In a certain sense we're fortunate that the last swine-flu scare was more than 30 years ago, because otherwise people would be more reluctant to take this latest outbreak very seriously.
The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. [...] The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%.So while you seem to be implying that a mortality rate of 7% in Mexico is low, it's actually shockingly high for an influenza. And given that there have only been a tiny handful of cases in the U.S. (that we know of so far), it's entirely premature to draw the conclusion that its mortality rate in the states will stay at 0%.
The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs, Dr. Moscona said.Of course, no one is actually suggesting that you need to stockpile guns, crapmatic. I would suggest, however, that you put down the ill-informed snark and actually use some critical thinking skills to read the links. Unless you think that there's some benefits to your immune system to be gained by looking like a jerk in a public forum.
But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.
"Experiments in mice have demonstrated that OX40-Ig can reduce the symptoms associated with an immune overreaction while allowing the immune system to fight off the virus successfully."Hey, awesome!
"The drug, to be made by a company called Xenova Research...was supposed to be in phase I clinical trial in 2004, but its status is currently unknown."Somewhat less awesome. What's keeping you guys?
"Xenova has sold the rights for OX40 development to down-regulate against, for example, a cytokine storm caused by an influenza infection...While neuraminidase inhibitors like Tamiflu can be used against all manner of flu types and hence have a market even when there is no pandemic the OX40 blockers probably do not have much utility against influenza under normal conditions. So OX40 blocker development probably isn't going to get much funding against flu unless governments step in (and my guess is governments are probably not smart enough and prudent enough to do that)." (FuturePundit, November 12, 2005)As of last January, Genentech is still in Phase 1 clinical trials of OX40 blockers...as an asthma treatment. So much for all that.
On his first meeting at the White House, [Obama] remembers shaking the hand of [President Bush], who turned to “an aide nearby, who squirted a big dollop of hand sanitizer in the president’s hand.”Source
“Not wanting to seem unhygienic,” the senator writes, he also “took a squirt.”
This 1968 Hong Kong influenza pandemic of 1968 caused fewer deaths than the previous two pandemics. The virus subtype that caused this pandemic was somewhat analogous to the 1957 influenza virus because it had the same NA antigen, N2. but a different HA antigen.With 700,000 dead worldwide and about 34,000 dead in the States, "mild" may seem like an understatement, but compared to 40-50 million dead from the Spanish flu in 1918, you can see a pretty damn large difference.
The first case of Hong Kong flu was detected in September 1968, just 11 years after the last flu pandemic. The outbreak developed rather slowly, becoming widespread in early December, and with the mortality rate peaking in December and January 1969. Similar to the previous pandemic, schoolchildren suffered the highest attack rate. By the time the pandemic waned it had caused about 700,000 deaths worldwide, including about 34,000 deaths in the U.S. Many fewer people died during this pandemic than the other two pandemics for three reasons: (1) improved medical care that gave vital support to the very ill; (2) the availability of antibiotics that were more effective against secondary bacterial infections; and (3) the severity the illness probably was reduced among many people because they retained antibodies against N2 in their systems from the 1957 influenza pandemic.
Phase 4. Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
Rationale. Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized, so that its spread may possibly be delayed or contained.
Examples:
• One or more clusters involving a small number of human cases, e.g. a cluster of <25 cases lasting <2 weeks.
• Appearance of a small number of human cases in one or several geographically linked areas without a clear history of a non-human source of exposure, for which the most likely explanation is considered to be human-to-human transmission.
Phase 5. Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
Rationale. Virus is more adapted to humans, and therefore more easily transmissible among humans. It spreads in larger clusters, but spread is localized. This is likely to be the last chance for massive coordinated global intervention, targeted to one or more foci, to delay or contain spread. In view of possible delays in documenting spread of infection during pandemic phase 4, it is anticipated that there would be a low threshold for progressing to phase 5.
Examples:
• Ongoing cluster-related transmission, but total number of cases is not rapidly increasing, e.g. a cluster of 25–50 cases and lasting from 2 to 4 weeks.
• Ongoing transmission, but cases appear to be localized (remote village, university, military base, island).
• In a community known to have a cluster, appearance of a small number of cases whose source of exposure is not readily apparent (e.g. beginning of more extensive spread).
• Appearance of clusters caused by same or closely related virus strains in one or more geographical areas without rapidly increasing numbers of cases.
Pandemic period
Phase 6. Increased and sustained transmission in the general population.
Rationale. Major change in global surveillance and response strategy, since pandemic risk is imminent for all countries. The national response is determined primarily by the disease impact within the country.
The above comments leave little doubt that the H1N1 swine flu is being efficiently transmitted human to human in southern California. The unique constellation of swine genes has not been reported previously and the two cases do not have swine contacts. Moreover, family members had symptoms before and after the confirmed cases, indicating the H1N1 spread efficiently within each family. [Wednesday, April 22]Niman is behind the Google Maps flu spread map that wearyaswater posted in an earlier comment.
The U.S. cases are in addition to the outbreak in Mexico, which has caused as many as 60 deaths and more than 1,000 infections. U.S. tests on virus samples from 14 Mexican patients confirm that about half of them are swine flu.So the CDC tested 14 samples from Mexico and found half of them to be swine flu. That means half of the people died from something else.
The problem in identifying swine flu is that its symptoms are virtually indistinguishable from regular influenza, said Dr. Anne Schuchat of CDC. The only way to be sure an infection is swine flu is through a laboratory test, which takes time.
Because the virus has popped up in so many locations, there is likely to be a larger outbreak if the virus proves to be highly transmissible -- something that has not been demonstrated yet.
LA Times
On Saturday, as word spread that city health officials had determined that at least eight students at St. Francis Preparatory School in Fresh Meadows, Queens, probably had human swine flu, students and their families, along with teachers and administrators, reacted with varying degrees of anxiety, alarm and aplomb.The story about the high school kids in Queens troubles me because a) the kids are "suspected" of having the strain and b) the link to Mexico is based on other students saying many kids went to Cancún on spring break.
NY Times
The dominant form of flu circulating in the U.S. in the most recent flu season was an H1N1, said Frederick Hayden, professor of clinical virology at the University of Virginia Health Sciences Center in Charlottesville. That suggests that people who got this year’s flu vaccine, which gave protection against the H1N1 virus, might also have some protection against the swine flu, he said.But this is still conjecture, and so far no one has been able to corroborate a relationship between being vaccinated and complete/partial immunity.
There is no vaccine against swine flu, but the CDC has taken the initial step necessary for producing one — creating a seed stock of the virus — should authorities decide that's necessary. Last winter's flu shot offers no cross-protection to the new virus, although it's possible that older people exposed to various Type A flu strains in the past may have some immunity, CDC officials said Sunday.For what it's worth, though, I agree that it's probably too early to be speculating on such things. There's a lot of information out there, some of it contradictory. I would, however, operate under the assumption that this years flu vaccine offers no protection since that's the most cautious course.
Just want to chime in that people making comments about how industrial farming led to this are goddam morons. The Asian/Avian/Hong Kong pandemics were the direct result of "sustainable" farming in rural China -- that is, small farms with pigs, chickens, and humans all co-mingling. This always creates the largest infectious threat. I'll take this "industrial" swine flu over the other any day.
Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, these four drugs [Oseltamivir (Tamiflu), zanamivir (Relenza), amantadine (Symmetrel), and rimantadine (Flumadine)] should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to such women.Yay? I guess?
I was at a lecture on swine flu today, and it was mentioned that this H1N1 actually consists of parts of two swine viruses -- one common in North American hog farms, one common mainly in Asian pig farms. How the Asian hog virus got mixed in is unknown; the virus hasn't been seen in the US pig population at all.
I'm pretty sure that the original North American wild pig was also imported to the Americas by Europeans,
"The viruses are so different we think it's unlikely (existing vaccines) would provide much protection. So if we need a vaccine, which we probably do, we'll have to make one," Plummer said, noting it would take at least six months to make a new vaccine.The reporter incorrectly infers from that, that the doc was saying that Tamiflu would be ineffective. He wasn't.
The first wave in 1918 was relatively mild, many experts speculate, because the virus had not fully adapted to humans. And as it did adapt, it also became more lethal. However, there is very good evidence that people who were exposed during the first wave developed immunity — much as people get protection from a modern vaccine.If the non-Mexican cases stay mild, and few or no deaths result, I wonder if some people will try to immunize themselves by deliberately trying to get sick now. Didn't families used to have chicken pox parties for their kids for the same reason?
"What is CFR? Again, in simplest terms we can estimate it by using as the numerator the number of swine flu deaths in Mexico (or the US) and divide it by the total number of cases. That proportion is an estimate of dying of swine flu. Simple. Unfortunately a little too simple, because we have great difficult ascertaining both the numerator and the denominator."That's the key issue of the day. It's clear that the total number of cases is greater than the ~2,000 cited by the media, but as yet we don't know how much greater. It's possible that a correct CFR might actually resolve the disparity between the Mexican statistics and the global numbers, especially if, as Slate suggests, the true total number of cases is around 1 million.
...It's also possible that Mexico is missing, undercounting, or badly underreporting deaths. But if this virus really does spread rapidly, its kill rate is fairly low; and if its kill rate is anywhere near as high as the 100-out-of-1,600 suggests, then it doesn't spread very easily.Reason to feel a little better. But we should maintain our caution until we know for sure. There's still too much we don't know about the flu.
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