swine flu
revere | June 13, 2009The easiest way for public officials to scare the crap out of people is to tell them "not to panic." A variant on this is, "It's not time to panic," implying that there will be such a time or that there is ever such a time. The first to panic are usually public officials because they feel powerless at a time when people are expecting them to do something. So what they do is incite panic by telling people not to panic. Public anxiety -- often well founded -- is not the same as panic. If parents are keeping their kids out of school from fear it is a flu incubator, that's not panic. That's a…
revere | June 12, 2009However this pandemic evolves, we are going to learn a lot about how pandemics evolve -- or maybe even start. A paper just published online in Nature sets out a bit more of what we know about this pandemic strain (yes, we can officially refer to it that way now) and makes some observations about its prehistory (its history before it became known and documented by we mortals). Maryn McKenna has an excellent run-down over at CIDRAP News, which you should read. Here's our take on it.
First, we'd like to make a "meta-science" observation. This paper is unusual in several ways. The least…
edyong | June 11, 2009In the time since the words "swine flu" first dominated the headlines, a group of scientists from three continents have been working to understand the origins of the new virus and to chart its evolutionary course. Today, they have published their timely results just as the World Health Organisation finally moved to phase six in its six-tier system, confirming what most of us already suspected - the world is facing the first global flu pandemic of the 21st century.
The team, led by Gavin Smith at the University of Hong Kong, compared over 800 viral genomes representing a broad spectrum of…
revere | June 11, 2009WHO today declared we an influenza pandemic is underway (aka, phase 6), which is not news to anyone. This beast has been barreling long for at least 3 or 4 weeks and the reluctance to call it what it was was related to resistance from some of WHO's member states (the UK, China and Japan have been often fingered as the chief culprits). The apparent lack of cases in Europe didn't fool most experts. The EU was using a testing protocol designed to minimize the case count. It was refreshing not to have the US party to these kinds of shenanigans, but of course we had no opportunity: it started here…
revere | June 11, 2009In William Osler's day (turn of the 20th century), pneumonia was called "the old man's friend," because it took the elderly away quietly and with relatively little fuss. It was most often caused by the pneumococcal organism, now called Streptococcus pneumoniae. When penicillin came on the scene in the mid 20th century, there was at last a treatment for pneumonia with this organism, but soon resistant strains developed. S. pneumoniae is a frequent resident of the human respiratory tract and usually causes no problems. But if it gets into the wrong place it can also cause sepsis, otitis media…
revere | June 10, 2009Listening to yesterday's press briefing with WHO's Dr. Keiji Fukuda (audio file here), several things seemed clear to me. The first is that everyone, WHO included, thinks a pandemic is well underway. Second, WHO's efforts to explain why they are not making it "official" by going to phase 6 are becoming increasingly awkward and the explanations manifestly tortured. Essentially what Fukuda said was that WHO was waiting for its member nations to signal they knew it was a pandemic and then WHO would say it was a pandemic. It was reminiscent of the cries of one of the principals of the…
revere | June 9, 2009You learn a lot when you move from investigator to subject. I just heard about Drive-by Tylenol for day-care and school age kids. This is the practice of stuffing a couple of Tylenol down the little tyke's throat to bring down a fever just before entering the daycare center. The objective is to get 4 or 5 hours of work in before being called to school because your child has a fever. The underground lore about it includes not using any flavored Tylenol preps with red dye in them so that when the child urps up everthing after lunch there will be no tell-tale pink color savvy teachers will…
revere | June 8, 2009An interesting piece on an infection trial of novel H1N1 in pigs appeared on ProMed over a week ago, but with dealing with swine flu up close and personal and all, I am only just getting to comment on it. This was a study done in the EU (VLA-Weybridge, Mammalian Influenza Group) to see how easy it was to infect pigs with the human-adapted swine flu, what kinds of symptoms and pathology it produced, and how transmissible it was. The answer seems to be easy, mild and very, in that order.
11 pigs were inoculated intranasally and when they began to shed virus a naive pair of pigs placed in…
revere | June 7, 2009There is no reason why a flu blogger-epidemiologist-physician's family should be immune to flu in the community. And it appears my family is not. My daughter has had a cough for the last few days and Friday night was suddenly seized by nausea, vomiting and fever. Her HMO's urgent care directed her to the Emergency Room of the local hospital where a rapid flu test was positive. While waiting to be seen at the ER, her 10 month old, who had a croupy cough, also started vomiting and was warm to the touch. His (slightly) older brother (2 years) was also coughing. Her husband has a cough, too, and…
revere | June 6, 2009CDC is reporting about 14,000 confirmed or probable cases of swine flu, although they have already said this may represent only a fraction of the total number of infected. I wasn't able to find the latest number of those hospitalized (some of you probably have it but I couldn't locate it with a quick search), but my recollection is that it is somewhere around 300. That puts the hospitalization rate at around 2% of the confirmed/probable cases (I round figures liberally because they are too uncertain to worry about precision). 2% is the same number the Chilean health authorities are using for…
revere | June 5, 2009In New York City, an illness termed "mild" for many has killed 7 and put 300 in the hospital. A preliminary analysis of about half of those hospitalized, most (82%) were said to have some underlying medical condition. That's common with flu, but it's also a reminder that one of five were otherwise healthy, and unusually for flu, most of them relatively young (mostly under 65). Similarly, the deaths also had underlying medical conditions but were relatively young (median age 43). The two most recent deaths were in the mid 40s.
So not being old is one risk factor. What does "underlying medical…
grrlscientist | June 4, 2009tags: NYC, New York City, Manhattan, swine flu, influenza, A/H1N1 Influenza, New York Academy of Sciences, NYAS
This is an overview of the NYAS symposium about Influenza A/H1N1 "swine flu" outbreak that I was invited to attend on 28 May 2009 in NYC.
Under the auspices of the New York Academy of Sciences' Emerging Infectious Diseases and Microbiology Discussion Group, vaccine experts, epidemiologists, and policymakers from around the United States met in New York City to discuss the current outbreak of Influenza A/H1N1 -- "swine flu." The program presented information about influenza…
revere | June 4, 2009The UK is having quite a swine flu outbreak, although the authorities aren't owning up to it. As for the public, they are being whipsawed between the usual poles of "it's all hype" and "we're all going to die," with the latter fading in parallel with the fading of effectiveness in selling tabloids. So, yes, there's a lot of dreadful stuff in the news about swine flu, but there's some pretty astute stuff, too. Here's something I ran across in TimesOnline [UK] by Melanie Reid:
When we heard that the only deaths were a few Mexican peasants, we gave a collective shrug: this is not our problem.…
revere | June 3, 2009The unpredictability of flu and difficulty of making any predictions with confidence is tiring to repeat and tiresome to listen to. Unfortunately that doesn't make it any less true. There are things we know -- because we see them happening -- and things we don't know -- because the information isn't available (like an accurate estimate of CFR or prevalence) or they have yet to happen.
What we know is that we are confronted with a new influenza virus that is spreading with ease outside of its normal season, is infecting an age group that normally doesn't get easily infected (the 5 - 24 year…
revere | June 2, 2009Ten days ago Secretary of Health and Human Services Kathleen Sebelius announced that the US government was allocating $1 billion to help companies with production costs for a swine flu vaccine. Among the beneficiaries was French vaccine giant, Sanofi-Aventis, whose Sanofi Pasteur unit got a $190 million order. It was likely only the first in a series of expected orders for the company. Sanofi knows how to make vaccines. So what could go wrong?
Drugmaker Sanofi-Aventis has agreed to pay nearly $100 million to settle allegations it cheated Medicaid on the cost of nasal sprays.
The Justice…
revere | June 1, 2009Since I talk a lot about flu in my real life as well as on the blog, I get questions from moms and care givers who wonder when they should start to get worried about a sick child or relative. It's context dependent, of course. The same symptoms that would be shrugged off at any other time take on a different meaning during a flu outbreak, especially when everyone seems uncertain about what is happening or what might happen. There's nothing irrational about this. Infection with influenza virus is always potentially serious and when the young and healthy are in the cross-hairs even more so.…
revere | May 30, 2009The natural reservoir for most influenza viruses is birds, especially aquatic birds, but some versions of the virus have also become adapted to the host cells of other species, among them sea mammals, horses, dogs and of course pigs and humans (among others). How long is the list? We really don't know, as there has been little systematic inquiry into influenza hosts in the natural world. While human influenza is seasonal in the northern and southern hemispheres, where it goes in the "off season" is a matter of debate. Most flu experts think it remains at low levels in the community, spiking…
revere | May 29, 2009As flu season ramps up in the southern hemisphere, the US, Europe and Asia are keeping an eye on it to see what will happen as swine flu finds new pieces of meat to sate its appetite for human flesh. Sorry about the overheated image. I've been reading what's going on in Australia. Because another lesson the southern hemisphere can teach us is how not to react to a pandemic virus.
Consider the Carnival Cruise Line ship, Pacific Dawn. It docked three days ago in Sydney onroute to the Great Barrier Reef to take on new passengers and let off others. But then, according to news reports (but see…
grrlscientist | May 28, 2009
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The New York Academy of Sciences hosted a symposium yesterday in the World Trade Center that explored the latest findings associated with "swine flu", more correctly known as the A/H1N1 Influenza. This symposium was broadcast live as a "webinar" and is also being made into a podcast and streaming video (both of which will be available next week, and which I will be linking to). This photoessay shows some of the preparations carried out for this event. I am working on more substantive essays and they should be published here beginning next week.
As you can see in the above…