infectious disease
revere | May 4, 2009There have been questions in the comments about where the CDC estimate of 36,000 to 40,000 influenza related deaths a year comes from. It's a figure I've used a number of times here to say generally that regular old seasonal influenza may be a mild disease for some but not for many others. Even if you don't die of flu, it can be a miserable illness and lay you low for several weeks of acute illness and months of fatigue and malaise. Now the 36,000 deaths number is taking on a life of its own, so it's time to explain exactly what it is and what it isn't. There are more things it isn't that it…
tsmith | May 3, 2009Over at DailyKos, DemfromCT has an excellent post explaining why it may be beneficial for schools to close temporarily, even if they only have one confirmed case of swine influenza: H1N1: Why Do Schools Close, And When Do They Open?
DarkSyde also has one up on the basic biology and evolution of the flu.
Nick Kristof discusses our lack of attention to public health and what it means in the event of a pandemic in today's NY Times.
[Updated: and via the comment theads, this post which further discusses what I mentioned here regarding testing--and how the confirmed cases are only the tip…
revere | May 2, 2009Laurie Garrett of the Council on Foreign Relations and a well-known authority on emerging infectious diseases was on PBS's Newshour last night and she made a very important but little appreciated point. Mexico has made a major national sacrifice for global public health by shutting down its country and interrupting transmission of disease. The cost to Mexico has already been enormous it will continue to pay in other ways. The reputation of the government has suffered because of the way it handled this -- the lack of transparency, the initial slow footedness (which of course it denies), its…
revere | May 1, 2009[NB: I have been traveling and offline all day. No way I can even read much less respond to the many excellent comments, tips, questions. Thanks to all. Help each other. Back at home base now.]
Closing US borders with Mexico for swine flu is fruitless since the virus is already planted in a dozen or more countries. And while right wing xenophobes are trying to blame Mexican immigrants, most of the international spread has come from commercial travelers, either tourists or business people. If we had sealed the borders, would it have included all American nationals in Mexico? Somehow I don't…
revere | May 1, 2009Just a brief note to remind everyone about the case definitions CDC is using for reporting on swine flu (or whatever name we collectively settle on). In order to make sure numbers are comparable from day to day and place to place we have to decide on criteria for knowing we have something to count. Is someone with flu-like symptoms to be counted as a case? Or do we confine it to someone with laboratory proved infection with the virus? Should there be different categories of diagnostic certainty?
For the moment, CDC is using the following definitions for suspected, probable and confirmed cases…
tsmith | April 30, 2009I've been seeing a lot of comments mocking the current outbreak of H1N1, and a lot of people (and journalists) who don't understand what "big deal" is about the "snoutbreak" of swine influenza, or don't get what the raising of the World Health Organization's pandemic alert phase up to 5 means. I noted here what the alert level meant, but wanted to discuss it a bit more in a full post; after the jump.
So, some comments I've seen thrown about:
This is all just media hype! Lies about the Mexican cases! The WHO just revised their numbers down to 26 cases and 7 deaths! Why should I believe…
revere | April 30, 2009A reader (hat tip, sandy) has pointed me to a very interesting interview with CDC's chief virologist, Ruben Donis, in Science Magazine's blog, ScienceInsider. In it he provides further information on the confusing reports about the species origin of the current swine flu, originally said to be of swine, human and bird origin but later claimed to be only swine. It may be that both are true, depending on how you look at it.
According to Donis, who has been sequencing the isolates, the virus is all recent swine but bears the marks of human and avian ancestry in some genes. Different genes have…
revere | April 30, 2009There is a tendency to be preoccupied with the latest in fast moving events, but I want to pause for a moment to make a point that has been lost in the discussion: we are witnessing a medical science landmark. Never before have we watched a flu outbreak of global dimensions unfold in real time. Nor have we ever had the opportunity to alter the course of such an outbreak.
I have been critical of WHO for being late to the party, but they are fully on board now and by raising the pandemic threat level to phase 5 have done something very important: served notice that it's time to mobilize…
revere | April 29, 2009In June 2005 a reader over at the old site suggested we put up some of our flu related material on Wikipedia. That sounded like a great idea to me. Even better, why not start a special purpose wiki -- a flu wiki -- to harvest the vast knowledge of the hivemind? Many, if not most, of the problems that would plague us in a pandemic weren't medical or even scientific in nature. They were things like, how do you prepare your small business for the possibility that the one person who knows how to unjam the fax machine is out sick for 4 weeks? Two other bloggers were also doing flu stuff at that…
revere | April 29, 2009A student once complained that no horse was too dead for me to stop beating it. Long time readers are familiar with that here. Over the years I have said that the best way to prepare for a pandemic -- or any other grave threat to our communities -- is to strengthen its public health and social service infrastructures. While some progress along those lines have been made (the additional training and upgrading of the national laboratory system is what allows us to find swine flu cases), in the main public health and social services have continued to deteriorate and weaken. And with the day of…
tsmith | April 29, 2009It was only a matter of time:
Iowa Gov. Chet Culver says the state has two probable causes of swine flu.
Speaking Wednesday at a Statehouse news conference, Culver told reporters that officials would know Thursday if the cases are swine flu.
Officials say one case was from a California resident who visited Scott and Clinton counties last week. The other was a woman who returned from Mexico and traveled through Johnson, Des Moines and Muscatine counties.
State Medical Director Patricia Quinlisk says both of the people infected were now recovering.
Should know by tomorrow if they are confirmed…
tsmith | April 29, 2009Brandon Keim at WiredScience has a new article on swine flu genomics.
"This is what we call a reassortment between two currently circulating pig flu viruses," said Andrew Rambaut, a University of Edinburgh viral geneticist. "Why it's emerged in humans is anyone's guess. It hasn't been seen before in pigs as far as I know."
***
"The new neuraminidase gene that came in from Eurasian swine is one we've never before seen circulating in humans," said Rambaut. "That's one of the reasons it's spreading rapidly. Very few people will have any immunity to this particular combination, which is what…
tsmith | April 29, 2009The latest numbers of confirmed cases from the CDC were released about an hour ago. 91 cases have been confirmed, with the largest numbers in New York (51), California (14), and Texas (16). One new case has also been confirmed in Nevada, one in Indiana, one in Arizona, and 2 in Michigan; the other Ohio case I know of is still pending, apparently. Ongoing investigations are also taking place in multiple states, so expect the number to keep rising for the time being. [Update: 2 cases just confirmed in Massachussets, and three in Maine.]
The first fatality has also been reported: a 23-month-…
revere | April 29, 2009As is usual (routine? no, nothing routine about this) in an evolving epidemic contradictory and confusing numbers are appearing. Some of them are the result of information lags (tallies not being updated), some are the result of using different criteria for counting (suspect versus probable versus lab confirmed, etc.), some are just rumors. WHO is saying that in Mexico there are only 7 confirmed deaths, 19 more lab confirmed cases, 159 probable cases and some 1300 being evaluated, based on official reporting to them by officials of a member state, the Mexico. Everyone knows there are many…
tsmith | April 28, 2009Back in 2007, I wrote about an outbreak of swine influenza from an Ohio county fair. The peer-reviewed paper analyzing the swine influenza isolated from that outbreak has just recently come out. From the abstract:
The swine isolate, A/SW/OH/511445/2007 (OH07), was evaluated in an experimental challenge and transmission study reported here. Our results indicate that the OH07 virus was pathogenic in pigs, was transmissible among pigs, and failed to cross-react with many swine H1 anti-sera. Naturally exposed pigs shed virus as early as 3 days and as long as 7 days after contact with…
revere | April 28, 2009CDC guidelines for antiviral therapy for swine flu infection:
This swine influenza A (H1N1) virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications, amantadine and rimantadine. (CDC)
What are these antiviral drugs and how do they work? Over the years here we've discussed this pretty often, so I went back and retrieved one of our older posts (from 2007). I've done some editing but it's pretty much the same as when I wrote it about bird flu. Same principles.
Oseltamivir (which we…
tsmith | April 28, 2009Revere on quarantine versus isolation. This is a topic I've covered previously (here) as well, and an important distinction (though the two are often muddled together in the press).
Christine Gorman talks about getting the facts straight on swine flu, and offers up many additional resources to keep you updated.
Skepchick provides "Things More Likely to Save You From Swine Flu Than Homeopathy". Colon cleanse and chiropractic are noticeably absent...
1976 swine flu Public Service Announcements. They don't make 'em like that anymore... (h/t http://twitter.com/tomburket)
Finally, my…
tsmith | April 28, 2009Stories in Spanish: Costa Rica becomes the first Central American country to confirm swine flu ("gripe porcina"). A 21 year old who had traveled to Mexico is in stable condition. An additional 16 cases were examined but were negative. Brazil is also examining 11 travelers; cases are also being examined in Panama, Honduras, Argentina, and Uruguay, and Chile.
In Asia, South Korea is examining a possible case, while China's stepped up its efforts to look for cases (and blocked import of pork from the US and Mexico).
Most of the cases that are being examined have traveled to Mexico…
revere | April 28, 2009As cases continue to accrue in different places we will hear more talk about quarantine and isolation. These are two terms that are frequently confused, which is too bad, because isolation makes sense for influenza and quarantine doesn't. So what do they mean?
What quarantine and isolation have in common is they are both designed to interrupt the transmission of a disease that spreads from person to person. Quarantine is the legally enforceable segregation of people who people who have been or may have been exposed but who aren't (yet) sick. Some people talk about "voluntary quarantines," but…
revere | April 28, 2009It would be nice to think that the 28 cases at the NY Prep School are it for the city and that the virus has been contained there. But that was always more a wish than a plausible reality:
CBS 2 HD has learned of a confirmed case of swine flu at the Ernst & Young headquarters in Times Square.
One of the staffers became ill over the weekend after coming into contact with a family member who had been exposed to the virus.
The staffer is said to be resting at home and the company believes, due to the virus' 24-hour incubation period, that no one else at Ernst & Young was exposed. The…