Monday, July 13, 2009

Swine Flu - H1N1 Pandemic Yet?

The H1N1 flu, aka swine flu, has become something of interest to me. Pandemics and epidemiology likewise. I just finished a book called Flu: The Story of the Great Influenza Pandemic, by Gina Kolata.

The influenza of 1918 (Spanish Flu) impacted the world. With over 40 million deaths (some think much higher), just about everyone knew someone who died from it. In some place, for example in northern Alaska, 95 percent of the communities died. Young men would become infected and die within a day or two. Why is the influenza of 1918 important? Because it was based on the same H1N1 virus.

The book was rather anti-climatic: nothing was conclusive with respect to the means of infection (how it was communicated) and where it originated (they think southeast China where ducks and pigs live in close proximity to the human population). It did conclude that it impacted people between 20-40 years of age, just like today's swine flu.

According to the World Health Organization's Pandemic (H1N1) 2009 - update 58 (6 July 2009), there are 94,512 H1N1 cases reported worldwide and 429 deaths associated with it. World Health Organization head Margaret Chan stated in Cancun, Mexico recently:
"As we see today, with well over 100 countries reporting cases, once a fully fit pandemic virus emerges, its further international spread is unstoppable."
These major influenza re-occurrences at the pandemic levels happen every eleven or so years; are mild in the spring, severe in the fall; are more pronounced in groups of closely gathered groups like those living in barracks and dorms.

The governments have a tough job. Their status quo is to over react, preferring that to under or no reaction. Like in 1976, they killed 1.5 million chicken in Hong Kong to help thwart the Hong Kong (bird) flu. No one really knows if it worked, but it was action. They destroy millions and millions of dollars worth of food if some contamination is found. These reactions ruin many businesses, all in the name of public health. Is it worth it? Are the government agencies calling wolf? Are they just doing their jobs? Are they acting because they have these jobs and need to justify their existence?

After seeing what a harsh strain of influenza can do, it is no laughing matter. I personally doubt this subtype of hemagglutinin (H) and neuraminidase (N) will be as severe as the H1N1 that killed millions in 1918-1919. But after reading the book and some web sites, the possibility is there for a pandemic, albeit small.

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