First, Let’s Kill All the Pigs!

30 04 2009

Egypt is killing all pigs within its borders.  The influenza A (H1N1) (the virus formerly known as 2009-H1N1 and before that as swine flu) has bits from four different strains of influenza – two are from swine, one is avian and one is human.  It’s a new strain of flu.  Killing all the pigs seems as logical as creating a no-bird zone over Egypt…and what about the human bit that’s mixed up in this new strain?  We shudder to think where that might lead.

More cases or just more confirmations?

More and more cases are being confirmed.  That doesn’t necessarily mean that there are lots of new cases every day; it does mean that the labs are starting to confirm what they have under their microscopes.

But, it is the flu, and flu spreads around.  We’ll have to wait and see how bad it gets – or how mild it stays.

What we can do.

What we can do as individuals:  keep hands clean, cover coughs and sneezes, stay at least six feet away from coughers and sneezers and stay home if we’re symptomatic. 

If you have questions that can’t be answered elsewhere, call 1-800-CDCINFO and ask them.  They’ve put dozens more people on the phones and the wait is supposed to be under 90 seconds.

A vaccine.

Plans at the moment are for the vaccine manufacturers to complete their regular production of seasonal influenza vaccine, then start manufacturing influenza A (H1N1) vaccine in the fall.  Those plans might change, if the situation remains fluid.

There will not be enough doses for everyone at the beginning, so decisions will need to be made about who should first be vaccinated.  Many forward-thinking people engaged the public on this question and the results may be found here.

Pandemic Alert at Phase 5

29 04 2009

The World Health Organization (WHO) raised the pandemic alert for the second time in two days.  It’s now at phase 5. 


Image: World Health Organization



Edited for brevity, this is how WHO explains the phases:

  • In nature, flu viruses circulate continuously among animals, especially birds.  In Phase 1 no viruses circulating among animals have been reported to cause infections in humans.
  • In Phase 2 an animal flu virus circulating among domesticated or wild animals is known to have caused infection in humans, and is considered a potential pandemic threat.
  • In Phase 3, an animal or human-animal flu reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks and/or to cause a pandemic.
  • Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic.  Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
  • Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
  • Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

Technology, partnered with the work done by health experts on SARS and avian flu over the past few years, allows WHO to track the birth of a pandemic in real time.

They’re watching to see how it’s transmitted, the spectrum of disease in various populations (different age groups, cultures, and levels of medical care, etc), and how the virus itself may be changing, or mutating.

Dr. Margaret Chan, Director-General of WHO, says that, “All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

“This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.”

Swine Flu 28 April Updates

28 04 2009

Dr. Ira Longini, from the Vaccine and Infectious Disease Institute at the Fred Hutchinson Cancer Research Center in Seattle, Washington, studies the spread of hypothetical flu epidemics in the U.S. 

Dr. Longini says that people in North America and Europe have lucked out a bit in the timing of this outbreak.  Summer will soon be here and with it the end of the normal flu season.  It turns out that influenza, whether it’s a new strain or the regular strain, follows a season. 

Other parts of the world are moving into their flu season.  People living in Australia, New Zealand and points south could see the brunt of the swine flu outbreak, whatever that ends up looking like.

Speaking of swine flu – the name “swine flu” is giving the people who sell and market pork products the willies.  The CDC says you can’t get “swine flu” from eating pork.  You can get other diseases from pork if it’s not cooked and handled properly, but not influenza, so we may see a gradual movement away from the name “swine flu.”

The CDC is reporting numbers of confirmed cases in the U.S. only once a day.  For a national picture, tune into CDC, but for a more immediate picture, CDC spokespeople tell us to go to each state for info, as the states are receiving test kits and can confirm and report cases on their own.

Five individuals have been hospitalized in the U.S., with expectations that more will follow.  At this time, the virus seems to be harder on teens and young adults, although the picture isn’t clear enough to say for sure. 

There’s not enough data to say who’s at higher risk for complication of swine influenza A (H1N1), but it’s probable that pregnant women would be because they’re at higher risk of complications from seasonal flu, and are known to have been at greater risk during previous pandemics. 

There’s a lot of talk right now about this new virus.  That’s because it is new and the future is uncertain.  It could end up a flash that gave us a scare and not much more, or it could circulate for years.  No one knows, and that’s why it’s making the news.

One of the important things to remember is that we have lots of tools to slow transmission and to treat infection:

  • Cover your coughs and sneezes – this is believed to be the primary method of transmission for this virus.  Use a tissue to cover your nose and mouth or at least use your arm or shoulder if you’ve no tissues handy.
  • Handwashing throughout the day with warm water and soap is always a good germ buster.  Alcohol-based hand cleaners will also work if you’re not around soap and water.
  • Don’t touch your eyes, nose or mouth, as those are entryways for germs.
  • If you’re sick, stay home, particularly if you have a respiratory illness and a fever.
  • Check in with your doctor if you have flu symptoms, and they include cough, sore throat, body aches, fever, chills, and tiredness.  Some of the people infected with swine flu have had diarrhea and vomiting.
  • If you get on antivirals within 48 hours, they will ease your symptoms.

There are 36,000 deaths each year from seasonal influenza in the United States.  So far, this strain of flu is very mild, at least in the U.S.  Holding on to perspective is important, because the newness of the strain keeps everyone talking about it, but it’s still flu, and that’s not new.

Vaccine for the New Swine Flu?

27 04 2009

No one knows if this small outbreak of swine influenza A (H1N1) is going to explode into a major pandemic, or be a paragraph in history books.

The world is prepared to combat such a pandemic.  Local, state and national government health agencies around the globe have all been working together to put plans in place.  If this turns into something big, everyone has a role to play and they’re ready to take action steps.  One action step may be the development of a vaccine.

Discussions are taking place at the CDC and elsewhere to determine if a vaccine should be developed for the new flu strain.  Although it appears so, it’s not the no-brainer choice.  If vaccine manufacturers stop developing their usual fall flu vaccine and shift to making a vaccine for the swine strain, then what happens next September, when flu season starts and we have no seasonal flu vaccine?  Or, should the vaccine for the new strain be incorporated into next season’s regular flu vaccine?  Will that work?  Not likely, and if it did, would it delay both vaccines too much?  Who absorbs the extra cost if this outbreak takes a break or goes away completely?

Lots of questions that must soon be answered.

The CDC is developing a seed stock of the new swine flu strain as a first step.  This stock will allow for vaccine production, should that be the course taken. 

There are a couple of ways to develop seed stock – the slower way is by reassortment, which is where scientists inject two different flu strains into fertilized chicken eggs – one is a strain that does not cause disease (and it grows well in eggs) and the other is the flu strain that is causing disease, in this case swine influenza A (H1N1).

The two different flu strains multiply and their genes mix with one another in the eggs.

After the multiplying and mixing, all the strains of flu virus present in the eggs are then screened to find the one that has the right combination of genes, some from the non-disease-causing virus that allow the growth in eggs and others from the disease-causing virus to stimulate the immune response.  This “seed” virus is then injected into millions of eggs for production of the new vaccine.

The other way to develop seed stock is by reverse genetics.  This is somewhat new and has not yet replaced reassortment as the go-to method of developing seed stock.

Using reverse genetics, scientists splice some genes from a non-disease-causing flu virus with others from the disease-causing virus into little round pieces of DNA.  These little DNA pieces are called plasmids and they’re inserted into animal cells in culture to allow growth of the vaccine seed virus. 

The seed stock can then be grown in huge quantities either in cell cultures or chicken eggs.  This can happen much more quickly than using the reassortment method. 

No matter the method of generating seed stock, it will take months to end up with a vaccine for swine influenza A (H1N1).  We don’t even know if we’ll need it, but if we do – hurry up!

Swine Flu 26 April

26 04 2009

Identified cases of swine flu continue to grow in the U.S., with 20 cases so far diagnosed in five states.  To date (the morning of 26 April), there have been no reported deaths in the U.S. from swine influenza A (H1N1). 

The numbers of diagnosed cases in Mexico vary, depending on the source, but are somewhere over 800 and possibly over 1,000, with over 60 deaths.

Although there is no vaccine to protect against this virus, it is susceptible to the antiviral drugs oseltamivir and zanamivir.  Your doctor will be able to prescribe those as needed.

The vaccine most of us get for seasonal influenza will not protect against this virus, but will help prevent a co-infection of seasonal influenza and this swine influenza.

A few effective ways to stay healthy and/or prevent transmission are:

  • Cover your coughs and sneezes – this is believed to be the primary method of transmission for this virus.  Use a tissue to cover your nose and mouth or at least use your sleeve if you’ve no tissues handy.
  • Handwashing throughout the day with warm water and soap is always a good germ buster.  Alcohol-based hand cleaners will also work if you’re not around soap and water.
  • Don’t touch your eyes, nose or mouth, as those are entryways for germs.
  • If you’re sick, stay home, particularly if you have a respiratory illness and a fever

Swine flu originates in pigs and is usually transmitted to other pigs, but people who are around pigs can get swine flu and it can then spread from person to person.  

According to the CDC, it’s safe to eat properly handled and cooked pork products as that’s not a viable route of transmission.

Swine flu symptoms are very much like human flu symptoms, and they include cough, sore throat, body aches, fever, chills, and tiredness.  Some of the people infected with swine flu have had diarrhea and vomiting.

Swine flu can be serious and, sometimes, deadly, but practicing the precautions listed above will go a long way toward protecting you and those around you.

For more information, visit the CDC website.

Swine Flu update

24 04 2009

Some quick updates on the swine flu outbreak as of 12:00pm pdt 24 April:

The CDC is working with WHO and governments around the world to detect any early warning signs of a spread of the virus.

Because of rapid developments, some information put out by CDC and local or state health departments may be conflicting, so check twice before assuming what you’ve heard is accurate.

There are now eight confirmed cases in the U.S.  Although not confirmed, the figures out of Mexico are 800 infected and 60 dead.  The CDC is in talks with Mexican officials to possibly send a team to Mexico to investigate those cases.

This is NOT a pandemic and no one has suggested it is and there is no change to the pandemic threat level.

There are three identifiers one looks for when thinking about pandemics: is the virus new (if so, the public has little to no immunity), does it cause severe disease, and is it easily transmissible/sustainable in the population?  If those three conditions are met, then perhaps it has the potential to become pandemic.  But, no one knows at this time if this swine flu will fade out or keep spreading.

Cases have been identified in two states that do not border one another.  Authorities feel that containment is not likely because the outbreak is not in a focused, defined geographic area.

At this time, there are no special precautions being recommended to travelers to Mexico, California or Texas. 

So far, it appears that, of the 14 samples from Mexico that have been tested by the CDC, seven are the same as those found in the California and Texas cases.  The other seven of the 14 samples from Mexico came up negative.

There are 400 million crossings at the Mexico/U.S. border each year.  CDC says, if you’re sick, don’t travel.

Swine Flu – Only the Beginning?

24 04 2009

Swine flu is back.

As of the morning of 24 April, 2009, there have been seven identified cases, five in California and two in Texas.  One person was hospitalized and most received medical care of some sort, but all are now fine.

The CDC  reports that the viruses recovered so far contain genetic bits of North American swine influenza viruses, North American avian influenza viruses, human influenza viruses and swine influenza viruses found in Asia and Europe.

This particular combination of the four viruses has never before been seen.

The U.S. isn’t the only place experiencing an outbreak of an unfamiliar virus.  Mexico City has had 800 people fall ill from a respiratory illness, with 57 deaths in the city and three more deaths from elsewhere in Mexico.  The CDC is examining viral samples from Mexico to determine if there’s a connection.

You don’t have to be in contact with a swine to get swine flu – you can get it from another person.  That person may have been infected by another person rather than a pig.

The CDC has not yet determined how this flu is getting around.  How did it jump from California to Texas?  Perhaps the answer lies in Mexico.

There is good news.  This version of swine flu is susceptible to oseltamivir and zanamivir, two influenza antiviral medications.

Although there’s no vaccine, there are things we can do to stop the spread of infection.  If you have a respiratory illness and a fever, stay home (but call your doctor).  Also, handwashing remains a key method of disease prevention, so wash often and wash thoroughly.

Polio, Why Aren’t You History?

23 04 2009

Why are we still reading about polio?  This virus (of which there are three types) won’t go away which is a tragedy when there are good vaccines to prevent infection.

The current status info from the CDC reads like this:

   Since 1988, when the Global Polio Eradication Initiative was established, the incidence of polio has decreased from an estimated 350,000 cases annually to 1,655 reported in 2008.

   Cases of wild poliovirus (WPV) type 2 were last reported in October 1999, and indigenous WPV types 1 and 3 (WPV1 and WPV3) have been eliminated from all but four countries worldwide (Afghanistan, India, Nigeria, and Pakistan).

This month, a report on PBS  discussed the rumors spread in northern Nigeria a few years ago.  The word on the street was that the polio vaccination campaign was a U.S.-led conspiracy against Muslims. Rather than protecting children, the vaccine supposedly made the little ones infertile.  As these rumors spread, several regional governments in northern Nigeria suspended the vaccination program – some for as long as 13 months.

After the CDC and others spent months working with leaders in the area, explaining where the vaccine comes from and its safety, the people started to come around.  Now, in Nigeria, the vaccination campaign is back, yet cases of polio in Nigeria and elsewhere continue to ebb and flow.

So, why are we still reading about polio?

  • Not everyone is getting vaccinated. 
  • Symptoms are slow to appear after initial infection, making it harder to get a jump on the virus when it first appears. 
  • In poorer countries, the public health infrastructure is weak, making it difficult to educate the population about the disease and prevention methods. 
  • Vaccine delivery and administration is affected by the lack of government support.
  • Those administering the vaccines are sometimes improperly trained and/or submit false reports with inflated numbers of people receiving vaccinations.

Where’s the end?  No one seems to know.  Polio should be history, but instead, it continues to be the nightly news.

HPV Testing

22 04 2009

This is about speculums, Pap tests and pokey sticks.

For those who hate icy speculums and pokey swabs, read on, because those days may be, if not over, at least fewer in one’s lifetime.

An eight-year study of 130,000 women in India has shown that a DNA test beats out all others when it comes to detecting cancer-causing HPV. 

Early detection equals life—once undetected cancer reaches the point of women feeling pain, diagnosis can be too late to save the patient.

The bad news is, they still need to use a speculum and pokey swab. The good news is, rather than an annual exam, it may only have to be done every three, five or 10 years.  Exactly how often is not yet known.

We don’t see the numbers of cervical cancer deaths in the United States that are seen in some other countries, so we forget how devastating this infection can be.  A quarter of a million women in poor and middle-income countries die each year from cervical cancer, most of which is caused by HPV infection.  Early detection using the DNA test will save the life of somebody’s mom, wife, sister, grandmother, niece, or aunt. 

This is very good news.

Allison Hicks and Cervical Cancer

10 04 2009

Allison Hicks is a doula and a cervical cancer survivor.  She talks about her life as both and shares one of her passions – the Hicks Foundation.

Listen now!

Right-click here to download podcast (13mb, 26min)