Effect Measure

There were 3 flu pandemics in the 20th century and each has gotten an unofficial name. 1918 was the Spanish flu, so named because the Spanish were the only ones honest enough to acknowledge its presence initially and thus got stuck with the blame. Like the other two pandemic viruses it probably originated in southern China (although its history is cloudy), so the nicknames of the 1957 (Asian flu) and 1968 (Hong Kong flu) are probably more apt, or at least less inapt. Now we have swine flu. Excuse me. I mean influenza A/H1N1, since that is how WHO is calling it so as not to impugn the good name of pigs:

To quell the notion that pigs are to blame for the swine influenza H1N1 epidemic, three international agencies said today they would take the “swine” out of the virus’s name and call it “influenza A/H1N1″ instead.

The United Nations Food and Agriculture Organization (FAO) said today it has agreed with the World Health Organization (WHO) and the World Organization for Animal Health (OIE) “to no longer refer to ‘swine flu’ but instead to ‘influenza A/H1N1.'”

Joseph Domenech, the FAO’s chief veterinary officer, said in the FAO statement that there is no evidence that the new virus is circulating in pigs in Mexico or anywhere else and that pork consumption poses no increased risk of contracting the virus.

The move comes in the wake of reports that Egypt began slaughtering pigs yesterday out of the mistaken concern that they could spread the new virus to people. Some countries have banned pork from Mexico and the United States for the same reason. (Robert Roos, CIDRAP News)

We’ve seen the name blame game before. I suppose it’s understandable, but influenza A/H1N1 is a very bad alternative since it’s also the broad designation for the seasonal influenza subtype that’s been co-circulating with H3N2 since 1977. But each isolate of this virus also has an “official” name or designation. One isolated from a Texas case has this name: A/Texas/05/2009(H1N1). The naming system looks complicated but it’s really quite simple. The A-part means that this is a flu virus of type A (rather than flu B or flu C). Texas is a location marker, which could be broad, like Texas, or more narrow, like the name of a city (e.g., Hong Kong). The 05 is the specimen identifier in the lab where it was isolated and 2009 is the year. If the virus had been isolated from a non-human animal, that would be included, e.g., A/Chicken/Shantou/4231/2003. And the H1N1 part is the subtype.

Influenza subtypes are very broad classifications based on the immunologic reactions of the two most prominent proteins on the virus particle’s surface (hemagglutinin, HA; neuriminidase, NA). There are 16 broad HA subtypes, numbered 1 to 16; and similarly for the 9 NA subtypes. But the H1N1 we have been experiencing as one of the seasonal flu subtypes and the H1N1 subtype of this outbreak are quite different (that’s part of the problem). When those differences are within viruses infecting the same species, like the continually shifting H1N1 human variants that appear annually, we call them strains. But the current H1N1 has 8 gene segments characteristic of swine (even though some of the segments have bird or human ancestry; see this post), so calling it swine flu doesn’t seem inappropriate.

Call me politically incorrect.

Comments

  1. #1 sandy
    April 30, 2009

    Peter Palese, chairman of microbiology at Mt. Sinai School of Medicine, found cause for optimism about the future. All the pandemic viruses of the last century — the 1918, 1957 and 1968 flus — had a mutation in the gene coding for a protein known as PB1-F2 that is thought to make a virus more lethal. The mutation, he said, is not in the new strain.

    http://www.nytimes.com/2009/05/01/health/01origin.html?ref=health

  2. #2 sff
    April 30, 2009

    I heard that Egypt has required all pigs in the country to be slaughtered, maybe that’s why WHO is changing it?

  3. #3 dmv
    April 30, 2009

    Yes, but when you have Egypt deciding to slaughter all 300,000-400,000 of its domestic pigs as a way to prevent swine flu in Egypt, despite WHO’s vigorous assertion that it’s unnecessary and entirely unwarranted, you can see why they’d decide to go with something different.

    Granted, they went with something lame and not very descriptive or useful or even accurate as a name, but still.

  4. #4 GeorgeT
    April 30, 2009

    It’s too late for them to change the name and it stick especially to something so technical that is not memorable. I saw a funny article from Finland that the English translation call it the TexMex Flu – I’m pretty sure I’ve had the TexMex Flu before but it was more of a stomach flu. :-)

    What’s interesting about the Egypt thing was that it may be an excuse from the muslim majority to get rid of the pigs.

  5. #5 aces
    April 30, 2009

    The move comes in the wake of reports that Egypt began slaughtering pigs yesterday out of the mistaken concern that they could spread the new virus to people. Some countries have banned pork from Mexico and the United States for the same reason.

    I thought I’d seen this story before, so I looked it up…Mark 5:11-13.

  6. #6 Lisa the GP
    May 1, 2009

    The Mexicans object to it being called Mexican or Mexico City flu, saying its the US blaming them somehow.

    What about ‘amex’ flu or ‘texmex’ or ‘MexiCal’ or ‘North American’ flu? That way the Mexicans can’t claim they’re being ‘blamed’ but the flu gets a name that is at least remotely related to its originating geography.

  7. #7 Phillip Huggan
    May 1, 2009

    Regardless of vector uncertainties, slaughtering pigs saves lives in that the feed can be used to grow amino-acid complete soy or some other direct human consumption food crop. Swine Flu is the ethical term IMO.

  8. #8 clark
    May 1, 2009

    I call the virus the “USA Capitalist Pig Virus”. The stories I have read have all linked the inception to a USA Corporate owned hyper-intensive pig farm in Mexico. As far as I know, there is still no outbreak of the virus in China. Also, I recall that the 1918 virus first appeared in the USA. This is just like blaming the current world economic crisis on the Chinese for having “a savings glut”. How dare them! The USA is always totally innocent. yep yep yep. Uhuh Uhuh Uhuh.

  9. #9 Lisa the GP
    May 1, 2009

    I think someone on Live Journal came up with a winner:

    Coughing Pig Death

  10. #10 MattK
    May 1, 2009

    I’m partial to Lisa GP’s “texmex flu”

  11. #11 bern
    May 1, 2009

    I haven’t checked any other sources on this story, but if it’s correct it sounds like Egypt was just using swine flu as an excuse to slaughter all those pigs:

    http://open.salon.com/blog/stellaa/2009/04/30/egypt_pigs_pandemic_and_tyranny

  12. #12 Azulene
    May 1, 2009

    My friends and I are calling it the “Flying Piggy Flu”. It’s “flying” because it has avian genes. (I suppose we should have worked humans into the name somehow, but this has a nice ring to it.) Also “piggy” seems more friendly/less scary than “swine”. The fact that “flying” is sometimes used in place of a more common f-word in polite company had nothing to do with it, but is a nice added bonus.

  13. #13 Jody Lanard M.D.
    May 1, 2009

    An old U.S. television show, The Bob Newhart Show, had a comic routine in which two brothers had the same name. The third brother, Larry, used to introduce his siblings by saying, “This is my brother Darryl and this is my other brother Darryl.”

    Welcome to H1N1: “This is H1N1 and this is the other H1N1.” (Unless novel H1N1 ends up replacing “old” H1N1…)

    CDC, a week or so ago: We just had a relatively mild flu season, partly because the predominant strain in the U.S. was H1N1 in the U.S. this year. The H1N1 strain was well-matched by the vaccine. (paraphrase)

    WHO’s Keiji Fukuda, a few hours ago: As of 2:50 p.m. the number of officially reported lab confirmed cases of H1N1 to WHO are 236.

    So WHO and CDC are potentially re-creating the “bird flu pandemic” problem: a type of public confusion that resulted from top officials casually using the term “bird flu pandemic” to mean both:

    1. the widespread zootic bird flu in poultry, when they didn’t want to use the words epizootic, or panzootic, in 2004 and 2005, and

    2. a future human (by definition) global outbreak launched by the novel H5 virus.

    Reducing stigma is important. But it is not a good idea for WHO to send a signal that can be interpreted to mean that they are more worried about tourism and trade than about public health.

    And it will confuse the heck out of average people when they hear about A/H1N1 next flu season — unless (God forbid) New Darryl replaces Old Darryl in the circulating pantheon of flu viruses, the way other pandemic viruses have replaced formerly circulating strains.

  14. #14 idlewex
    May 1, 2009

    I’m all pigged out now. Thanks for the info guy’s/gals

  15. #15 Iainuki
    May 1, 2009

    The WHO may have chosen a less-offensive name, but it is not the name that anyone outside the government-funded public health agencies will call it (and probably not anyone inside except at official events). “Swine flu” is better than the geographic names of the past because it at least doesn’t blame a particular group of people for the disease (though the pigs have gotten a bad rap), but it’s still not ideal. Really, they need to come up with a nomenclature system comprehensible to the public, or else the public will come up with its own. Maybe they should look to the IAU’s system, problematic as it is.

  16. #16 slovenia
    May 1, 2009

    The link below will take you to a story about La Gloria, Mexico, the village where this new H1N1 seems to have originated and which is surrounded by clark’s “USA Corporate owned hyper-intensive pig farm”.

    http://www.guardian.co.uk/world/2009/apr/29/swine-flu-mexico-la-gloria

    I suggest “Smithfield Flu” as an appropriate moniker. Kind of rolls off the tongue, doesn’t it?

  17. #17 pft
    May 1, 2009

    There is no evidence that this virus jumped from swine to people, as such, it should not be called swine flu as this gives the impression it is spread from swine and those in contact with swine. It spreads human to human, and is now a human influenza, just like seasonal flu, which this one will become given it is now endemic. It will run it’s course, as all flu’s do.

    BTW, WHO is recommending it be called the North American Flu.

  18. #18 Julius
    May 1, 2009

    No, you’re all wrong, the correct term is clearly ‘the Aporkalypse': http://www.badscience.net/2009/04/parmageddon/ (also, Parmageddon).

  19. #19 ag
    May 1, 2009

    In regards to comment #1 – even if the current novel strain making the rounds now does not possess this virulence-boosting mutation, is it possible, or more pertinently, is it likely that it could obtain the mutation now that it is running rampant in human hosts?

  20. #20 paiwan
    May 1, 2009

    “Call me politically incorrect.”

    Absolutely not, Revere. Thanks for your courageously new path-finding journey and facilitation.

    Hold on a second. FAO wants to remove the swine from swine flu? As a global entity like FAO, her credit and competency of managing poultry industry to solving the bird flu problem is zero.

    Especially this time of outbreak, the incidence and index have been related to the place of pig farms is still in cloud;

    See CDC virologist, Ruben Donis’ briefing on previous post: http://scienceblogs.com/effectmeasure/2009/04/swine_flu_more_on_the_genetics.php

    “Q: What do you think about the pig farm in Veracruz?
    R.D.: I don’t know the details. They said they had a huge operation and the workers were not getting sick; that’s what the company claims. The only suspicious thing in that story is this is the largest farm in Mexico. The fact that the index case also is from the area makes it interesting.
    I could not understand why FAO is so keen to remove it. Instead they take the lead of investigations deeper and restore the public trust; their recommendation for removing swine to protect swine industry is daunting and irresponsible. What happens if it has been proven related in the future? A simple investigation on people and pigs by PCR for carriers is not difficult to carry out.

    To save our threat of future possible pandemics caused by poultry and pig industry or to keep the long standing unqualified FAO performances? The answer is clear.

    Let us try this: Fire FAO executives, until they can present a responsible proposal and agenda for solving bird flu, let them learn the world need change, change for better solution.

    Until FAO can prove their credit, I will not trust them anymore. Yes, I am finger pointing to FAO.

    A new battle field to solve pandemics threat? Let us explore more.

  21. #21 PanFluWatch
    May 1, 2009

    I think there’s a valid argument to be made that this isn’t a swine flu because (so far, anyway) it doesn’t actually seem to be infecting pigs: only humans.

    So the gruesomely awkward “swine-origin influenza A (H1N1)” does make a bit of sense, in the same way that (if I picked only the most prominent branch of my family tree) I could say I’m an Irish-American, but I couldn’t really say I’m Irish.

    Misnomer or not, though, “Swine Flu” is here to stay. It’s too late to change it and the alternatives are too clumsy to bother with.

  22. #22 Dr Aust
    May 1, 2009

    On one of the earlier threads, and also over at the Questionable Authority blog, I have suggested:

    “Oh-nine flu”

    (’09 flu)

    ..which has the advantage of rhyming neatly with Swine flu, as well as being “culturally neutral”. Of course, I guess it is not as memorable as “Swine Flu”, and wouldn’t make such good headlines.

  23. #23 Ian
    May 1, 2009

    Why not simply name large outbreaks by the year, so this would be 2009 flu? You know perfectly well that once a catchy monica gets attached to it everyone’s going to stick with it no matter what the “official” position is!

  24. #24 ira
    May 1, 2009

    First of all, thank you very much for your response to my question about the incubation period. A few more questions if you don’t mind:

    1) What is the precise difference between various strains of a given subtype ? Different secondary, tertiary, or quarterny conformations of the HA and/or NA proteins ?

    2) Given that the difference(s) between strains seems to have a determinative impact on the epidemic/pandemic potential of the strain (in terms of its transmissibility and/or virulence)why is there not a classificatory sub-subtyping (or even sub-sub-subtyping, if necessary) of the various strains ? This would clear up a lot of the confusion.

    Once again thanks, and keep up the great work. It’s really appreciated.

    ira

  25. #25 paiwan
    May 1, 2009

    “H1N1 may be back to reclaim the title.”

    I transfer Dylan’s comment here.

    In the first place, Ruben Donis’s speculation on the index case of the same place of pig farm is a fact.

    Very often, the cause and the consequence don’t happen at the same time. It makes the solution looked complicated. I would not let loose my speculation on H1N1’s connection with pig farms on this outbreak particularly. I can not believe that the flu virus was coming down with the rain from the sky. :-)

    1. Did the farm transfer live pigs from the United States in the last six months?

    2. Did they conduct statistically relevant sampling by PCR checking on the existing population? 100% free? How much percentage of H1N1 carriers?

    We need FAO’s mandatory institution on this kind of scrutiny and protocol on global basis in the future. Now, at least we demand a credible report on the above two questions.

    It seems to me the bird flu problem, FAO has been sleeping. We have not argued too much. One hundred something people died not too scaring. But it is a warm up.

    H1N1 swine flu, excuse me, FAO. Don’t sleep anymore.

  26. #26 glock
    May 1, 2009

    From the aforementioned RD interview :

    Q: Is it of swine origin?

    R.D.: Definitely. It’s almost equidistant to swine viruses from the United States and Eurasia. And it’s a lonely branch there. It doesn’t have any close relatives.

    This whole event is just so amusing (in an incredulous gallows kinda way) to observe, I suggest we call it MoLarryCurly/A/2009, or maybe Keystone/A2009…..

  27. #27 glock
    May 1, 2009

    To reinforce the above naming convention suggestion , this was the part that really “amused” me

    “Q: Have you compared someone who died with someone who had a mild case?

    R.D.: Those data are still slippery. We don’t have good case data. You get age and sex—very limited information. That’s a problem.

    In the set of samples we know one case was fatal, but we don’t know which one it is…..”

    Whoa boy……

  28. #28 Gindy
    May 1, 2009

    “I think there’s a valid argument to be made that this isn’t a swine flu because (so far, anyway) it doesn’t actually seem to be infecting pigs: only humans.”

    Maybe they’ve built up an immunity to it. Maybe they don’t live long enough to show symptoms.
    I would suggest looking back in time for clues to the origin of the virus on the farms themselves. Someone may just need to go through past vet records to see if there was an incident of influenza in the hog population.

  29. #29 paiwan
    May 1, 2009

    My friend asked me this morning, why in 1918 the flu started in the United States and then seriously infected Spanish in Spain, and this time the flu virus was relating to the US and infected Spanish descendants in Mexico?

    I responded; they have common interest: eating pork.

    She asked me the second one, why in China has this flu, that flu and SARS.

    I responded, Chinese like to eat pork, chicken, cat, monkey and snake; so they have more kinds of flu.

    Are animals vindictive? The third question. I am not a vegan, I then, speechless.

    Maybe virus is the judge in disguise. :-)

  30. #30 Ron
    May 1, 2009

    I think we should call it NAFTA-flu

  31. #31 Mary
    May 1, 2009

    Call it the Smithfield flu

  32. #32 Rogue Epidemiologist
    May 1, 2009

    @LisaGP
    “AMEX flu” pretty much describes my symptoms every month when I pay my credit card bill. It’s hard not to feel a little ill when paying off student debt the ol’ plastic way.

    I’m calling it “pig flu” for the sake of simplicity.

  33. #33 paiwan
    May 1, 2009

    Three hours ago, News about NAFTA

    “Blame NAFTA for swine flu, experts say”

    “However, the Veracruz newspaper La Marcha, as well as the Mexico City daily, La Jornada, reported widespread cases of people falling ill near the pig farm in March.”

    http://www.barrieadvance.com/barrieadvance/article/134856

  34. #34 bern
    May 1, 2009

    My notes from a food animal medicine course say that swine influenza actually originated in humans, can anyone confirm?

  35. #35 MoM
    May 1, 2009

    Ira – For the basic science about Influenza, check out the Bird Flu->Biology link in the left hand column above, the most recent posts here, including the one about the Flu Wiki, and the basic science articles at Flu Wikie itself here: http://www.fluwikie.com/pmwiki.php?n=Science.Science
    MoM

  36. #36 Gordon Mohr
    May 1, 2009

    The most simple but descriptive name would be “’09 flu”, as it’s the notable new flu of 2009. It works as a tag/keyword — 09flu — and can be said easily — “ohnine flu”. Even the rhyme with “swine” could help its adoption as a drop-in replacement.

    “A/H1N1″ loses on precision, sound, conciseness, understandability — everything.

  37. #37 Phillip Huggan
    May 1, 2009

    If I’ve got minor lesions on my lungs from accidentally smoking some aluminum beer can shavings while herbally dry, does that increase my risk of developing pneumonia? Honest question.

  38. #38 --E
    May 1, 2009

    Perhaps medical officials need to take a lesson from physicists, who seem to have plenty of imagination when it comes to naming things. From quarks to galaxies, they come up with individual, often poetic, designations.

    I grant, though, that it might be peculiar to call something the “charmed” flu.

  39. #39 Dylan
    May 1, 2009

    I would suggest “Beijing Flu.” First to commemorate the 2008 Summer Games (which probably “fried” the lungs of just about everybody who participated in them (not to mention most of the spectators); any sprinter who ran the 100 meter event there has probably had about 17 seconds lopped off his/her best effort, by now. Some of those people will probably be rolling around in the Paraplegic Games, next time around. And I expect to see a news shot of Michael Phelps, comatose, and being wheeled around on a gurney, any day now (of course, that could just be the bong). And we still owe them one for that SARS deal, yet (bastards!); and we already know that they’re going to deny everything, anyway. They never tell the truth. And besides, nobody from that place posts any comments here, anyway; so we know that’s clearly not a concern. And we can say that the information originated with Mexico’s chief epidemiologist (that guy’ not going to have a job after this thing is over, anyway; so what’s he got to lose?).

    Try this: Say this out loud, real fast. Baaaayyyyyy….zhhhhinnnngggggg! Now, what exactly does that sound like to you? That’s right.

  40. #40 GeorgeT
    May 1, 2009

    E: if you are going the physics route, I think I prefer the “strange” flu. ;-)

  41. #41 Chirp
    May 1, 2009

    Two tongue-in-cheek candidates for swine-avian-human “swine flu” rebranding (seen at Michael Coston’s blog, I think it was):
    “Frankenswine”
    “The Virus Formerly Known As Swine”

  42. #42 Grace RN
    May 1, 2009

    Frankenswine gets my vote!

  43. #43 Jim Harvey
    May 1, 2009

    A good test for the nation’s and the world’s health systems and they seem to be handling things quite well. On the other hand this presented an excellent opportunity for the racist and bigots to use this incident to be the ugly and useless fascists they are. When will it all end? I know, when the racists all get flu and can’t get medicine.

  44. #44 paiwan
    May 1, 2009

    “A good test for the nation’s and the world’s health systems and they seem to be handling things quite well.”

    Not really. Complacency makes more mortality. Constant checks are better.

    “Baaaayyyyyy….zhhhhinnnngggggg!” duck, tasty. LOL.
    Justice needs practicum. The practicum of boxing is for the love of people. I even sometimes choose to suffer for Tibetans and Chinese people.

  45. #45 Jane
    May 1, 2009

    How similar do two flu strains have to be to promote cross-immunity? Why wouldn’t getting the 2008 seasonal flu vaccine, which included an H1N1 strain, at least make you get a milder case of 09 flu?

  46. #46 sjdprods
    May 1, 2009

    How about the Hinine Flu? H1N1-’09 =HINI09, rhyming with Swine?

    Subbing into the local paper’s headline this morning: Hinine Flu: Be on Guard, Don’t Panic

  47. #47 tfisb
    May 1, 2009

    I like Hinine flu as a name, it’s really quite clever, but I’m afraid it just doesn’t deliver the laughs like Hamthrax.

  48. #48 River
    May 1, 2009

    Hamthrax — Now that’s a thing of beauty!

  49. #49 mexobserver
    May 2, 2009

    And now after all it has appeared in pigs too – in Alberta, Canada. Maybe a bit of a hasty name change there…

  50. #50 j
    May 3, 2009

    I don’t see why it’s so important that a flu be named for its origin. I suspect that (given human nature) there’s no way for whatever word comes before “flu” to gain negative connotations. I’m no shill for the pork industry, and in fact would love to see some of the dangerous practices of factory farms get public attention. But it would be a shame for an entire group of *people* to get a bad rap (however subliminal) due to a virus that arose in their midst. No matter how much we insist that the “Mexican” flu isn’t the fault of the average Mexican citizen, hearing “Mexican flu” over and over is just going to reinforce the idea that Mexicans are dirty. (And adding “Tex” or “North American” to the name would just spread the blame to another equally blameless group.) Can some biologists or doctors here provide reasons why we shouldn’t just make up neutral names for illnesses? (The pharmaceutical industry seems to have a well-oiled name machine for drugs…)

  51. #51 eddie
    May 3, 2009

    It’s very notable that the slurry industry shill @17 immediately followed comment @16 which flatly contradicts their dishonest denialism.

  52. #52 w, but not that w
    May 3, 2009

    The other countries hit by the 1918-19 flu were all involved in the Great War and hid news about the flu so their enemies wouldn’t know how depleted they were by illness. The Spanish were NOT at war, and so when the flu hit them, they didn’t censor it. Hence “Spanish flu”.

  53. #53 David Canzi
    May 4, 2009

    Based on a fanciful pronunciation of “H1N1″ a friend of mine has started calling it hiney flu.

Current ye@r *