We're writing this at an altitude of 20,000 feet, being on the road again and except for a few minutes here or there, without access to the internet most of the day. This means a lot of comments will probably go unanswered, so we'll say what we usually do in circumstances like this: talk amongst yourselves. Lots of smart people read this blog. Help each other.
A quick look at today's flu news tells me that CDC has updated its estimates, using the methodology we discussed in a previous post. And a survey at Arizona State University (ASU) released Monday shows the expected: that opting to call swine flu "H1N1" instead of swine flu has done nothing but confuse people. Predictable. Mrs. R. works in a health department and one of her colleagues was heard to say you could get H1N1 over and over again. He was wrong if he meant the swine flu H1N1 but quite correct if he meant H1N1 in general, because H1N1 is one of the seasonal flu subtypes that's been around since 1977 (and prior to 1957) and its antigenic drift every couple of years is the reason we have to change strains in the seasonal flu vaccine periodically. The confusion between seasonal H1N1 and swine flu H1N1 was quite evident in the ASU poll:
An Arizona State University survey about the H1N1 virus released Monday reveals a majority of those polled statewide are aware of the H1N1 virus or "swine flu," but fewer realize the two are the same, and one-fifth are unaware that an H1N1 vaccine is available. McClatchy-Tribune Information Services)
There was really no reason to change terminology from swine flu to H1N1 (the pandemic virus, after all, is composed of genetic pieces entirely of swine origin) -- no reason, that is, except to appease the pork industry and the national and intergovernmental agencies whose job is not public health but the promotion of agriculture. Promoting agriculture is a good thing (depending on the kind of agriculture, of course), but not at the expense of confusing people about public health.
So now there is handwringing in public health circles about public confusion. Some of it was inevitable. And some of it was avoidable.
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Revere I am loath to ask you this as you are obviously ery busy but I have been reading the Lancet paper
Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61638…
but am not qualified to judge how much faith to put in their methodology. Specifically the findings on seasonal Trivalent vax and H1N1(2009) protection which seems at odds with other reports and common sense re %homology.
PS How much do those QuickVue test cost? They don't see to be very reliable.
Actually, according to the CDC, the pandemic flu also contains avian and human flu virus genes from reassortation:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/sw…
How does this change in pediatric death numbers per this newer CDC estimate get integrated into the weekly report of pediatric mortality -which I understand from the MMWR is 35 for this last reporting week? Which set of numbers, if either, can be fairly compared apples to apples with previous years reports?
Don; I don't think it changes things at all. The system still logs lab confirmed pediatric deaths as before. That's the number that is the best comparison, although the system only goes back a few years and the first year wasn't operating fully. Moreover it is highly dependent on reporting practices, index of suspicion, etc., etc., so any comparison year to year should be taken only as a crude comparison. It is clear that this year is very different, but quantifying that may not be too useful. The new estimates are made to emphasize that the numbers in the system do not represent all the cases of pediatric deaths, which we have good reason to believe is much larger. How much larger is essentially a back of the envelope calculation.
JJackson,
See this weeks MMWR (dowload available here) for an article on a case control study of the seasonal vaccine's efficacy against pandemic A H1N1 and a review of the studies as a group. http://cdc.gov/mmwr/preview/mmwrhtml/mm5844a5.htm.
Bottomline? "These results, taken together with other studies, do not support an effect of seasonal 2008--09 trivalent influenza vaccine in either decreasing or increasing the risk for pandemic influenza A (H1N1)."
It does not appear however that they looked to see if disease severity was mollified at all by seasonal vaccine receipt, which is a separate but also important question.
Thanks revere.
The name doesn't seem to cause confusion among my group of moms. We know that there is a seasonal flu vaccine and a swine flu/H1N1 vaccine.
The bigger concern in my group is the failure to have adequate vaccine, and, in particular, getting the vaccine to the most vulnerable first. Asthmatic kids get no priority. Immunocompromised adults get priority over healthy adults, but that's it. The pharmacies are mobbed as the doses trickle in, and lines are long. I followed up on a rumor and got my own asthmatic child vaccinated an hour away at an often-overlooked public health facility. Many of us are hoping that this will serve as a wake-up call to put plans into place when an even deadlier pandemic hits.
This brings up a question I've been wondering about lately: how much does exposure to earlier strains of H1N1 affect vulnerability to this latest Swine Flu? One reason I ask is that younger people seem to be so much more affected by contagion than older people.
A somewhat off-topic question; pardon me if it has been addressed.
I'm just getting over what I and my doctor assume was pandemic H1N1. Because I have asthma and classic flu symptoms, I was put on Tamiflu without any testing, PCR or otherwise. Now I have a decision: do I still go ahead and get the vaccine when it becomes available?
It seems wise to err on the side of caution and get the vaccine. Assuming adequate supplies of the vaccine do become available, I can't think of any good reason why I shouldn't, but maybe someone else can.
I am asked this question about 5 times a day. Unless you had a PCR that was positive for H1N1 2009 then yes, you should receive the H1n1 2009 vaccine when it is offered to you since you and your doctor can not be certain that your iLI was indeed H1N1 2009.
I just took a cue from my husband who took to calling it the "Heinie Flu".
United Healthcare's presentation on Swine flu does a great job of explaining the symptoms of swine flu, how to prevent it, and what to do if you have it:
http://my.brainshark.com/2009-H1N1-Flu-Swine-Flu-Protecting-Yourself-an…
Tasha wrote, "I just took a cue from my husband who took to calling it the 'Heinie Flu'."
Interesting. Could you elaborate? Does "heinie" refer to one's backside for some reason? Or is this somehow related to the 1918 flu, since "heinie" also is a derogatory term for a WWI German soldier?
(I wonder if I'm the oldest person in the world, considering I walk around knowing that latter sense of "heinie.")
This news article isn't directly relevant to the topic of "H1N1" vs "swine flu", but it puts a human face on the statistics of flu deaths and serves as a warning to those who think "I don't have underlying risk factors, so I'm safe":
http://www.ottawacitizen.com/technology/H1N1+suspected+death+professor/…
Wicked Lad, I think that you just have to intentionally confuse the ones in H1N1 for the letter "I" and then think like a 7 year old boy who giggles over saying "buttocks" ...
And hey, given the silliness that many have over "swine flu!" "No H1N1!" "No Pandemic A/H1N1!" "No H1N1-SOIV!" "No, Mexican Flu!" etc, it's right about where the conversation seems to be.
It appears that 77 schoolchildren in Florida were given the seasonal flu shot at their school's flu clinic instead of the pandemic H1N1 shot. Part of the explanation given for the error is that the nurses were confused because the seasonal flu vaccine also mentions H1N1 on the package - referring to the seasonal H1N1, of course: "the six nurses at Community School had not confirmed they had the H1N1 vials in hand before giving the shots to the 77 youngsters, Colfer said. Colfer said the label for the seasonal vaccine does state H1N1 is in it because the seasonal vaccine carries a different H1N1 strain and two other ingredients."
The full news report is here: http://m.naplesnews.com/news/2009/nov/10/h1wrong1-77-students-given-inc…
Diane makes a good point. Issue seems more the lack of vaccine than any confusion. At least among (potential) patients/recipients--around here, anyhow.
I too completely understand what Diane is saying (I'm a mom too). This is the first year my 6-year old has gotten any kind of flu vaccine so she needs 2 regular flu shots and 2 H1N1 shots.
The Google flu shot finder map for my area is absolutely useless for trying to find vaccine for kids. It only shows local pharmacies who will not provide vaccine to children.
Mid-October, she had her annual physical and got her 1st regular flu shot. Last week, I took her to the county health office to get her first dose of H1N1 vaccine(mist).
Now, she should be getting her 2nd dose of the regular flu shot and there's none available. There's all sorts of communication (at least around here in Michigan) about the lack of H1N1 vaccine and where to find it when it's available, but the inavailability of regular slu shots has gone largely unreported.
A week ago, the doctor's office told me to call back daily to see if they were getting more regular flu shots the next day. Yesterday, they told me that they are ONLY focusing on H1N1 now.
Why can't both be availale? I keep hearing about the difficulties involved in the manufacture of the H1N1 vaccine. My impression has always been that getting more of the regular flu shot wouldn't be as problematic.