Swine Flu (AH1N1 Virus) (I)

What is swine influenza?

Swine influenza (swine flu) is caused by type A influenza virus and gives pigs the flu. Swine flu viruses cause regular outbreaks of flu in pigs but death is infrequent. The viruses may circulate among pigs throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?

Like all flu viruses, swine flu viruses change constantly. Pigs can be infected by avian, human and swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort and new ones emerge that are a mix of swine, human and/or avian influenza viruses. Over the years, different variations of swine flu viruses have emerged. Right now, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs, such as children near pigs at a fair or workers in the swine industry.

There have been documented cases of one person spreading swine flu to others. In 1988, an outbreak of apparent swine flu infection in pigs in Wisconsin resulted in multiple human infections, and although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?

In the past, the U.S. Centers for Disease Control and Prevention received reports of about one human swine flu virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine flu have been reported. Five of the 12 cases occurred in patients who had direct exposure to pigs, six in patients reported being near pigs, and the exposure in one case was unknown.

What are the symptoms of swine flu in humans?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.
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Majority of parents worry about safety of H1N1 vaccine

Ask any health professional who cares for children and they will tell you: When H1N1 flu hits, it can be very severe. In the last four months of 2009, nearly 240 children died in the United States from H1N1 flu—more than three times as many child deaths as in a typical non-H1N1 flu season.

Meanwhile, the H1N1 vaccine given to more than 60 million individuals since October, has had a track record of safety in children comparable to the widely used and similarly manufactured seasonal flu vaccine.

But many parents' views of H1N1 illness and vaccine safety may not match these national data. Results from the latest C.S. Mott Children's Hospital National Poll on Children's Health indicate that, while 55 percent of parents worry about the H1N1 illness for their children, 66 percent of parents worry about the safety of the H1N1 vaccine.

"Parents' worries about H1N1 vaccination are natural for any new vaccine," says Matthew Davis, M.D., director of the poll and associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the U-M Medical School. "But in this case, what I have emphasized to my patients is that we are facing a type of flu that is much worse than usual for kids who get sick. The vaccine is made so similarly to seasonal flu vaccine that it's not really unknown to us. The track record in the first 60 million people looks reassuring to me. So, in weighing the benefits and risks, it seems clear to me for kids that the benefits of H1N1 vaccination outweigh the risks."

The poll found that 28 percent of parents worry more about H1N1 vaccine safety than about H1N1 illness. Among these parents, only 10 percent have had their children vaccinated against H1N1.

Meanwhile, 16 percent of parents worry about H1N1 illness more than the vaccine, and 58 percent of these parents have had their children vaccinated against H1N1. Among the remaining parents (56 percent) whose worries about vaccine safety and H1N1 illness were equal, 30 percent had their children vaccinated.

"Our study indicates that parental worries about H1N1 vaccine safety have limited national efforts to vaccinate kids against H1N1 disease," says Davis. "Of course, we expect parents to act on behalf of their kids in ways that fit what they believe. The question is, have medical and public health professionals communicated clearly enough about the benefits and risks of vaccination, and about the risks of H1N1 illness for children? We owe it to our patients and families to make sure that the best data are available, and that we've answered questions in our communities about what to do for kids."

Swine flu could have been a disaster

Swine flu is no longer sickening very many people but that does not mean it is no longer newsworthy. On the contrary, in recent weeks a succession of critics have rounded on "happy-go-lucky" virologists, "headline-hungry" journalists and the World Health Organisation, accusing them of being variously dupes of the pharmaceutical industry or willing accomplices to pointless hysteria. Their crime? Hyping the pandemic that never was and thereby helping Big Pharma to a billion-dollar vaccine bonanza.

Leading the told-you-so's is Dr Wolfgang Wodarg, the former head of the Council of Europe's health committee, who this week tabled a motion in Strasbourg accusing the WHO of having "faked" the pandemic. Another is the Guardian's Simon Jenkins. In characteristically acerbic prose he rails against government scientists for peddling "drivel" about the tens of thousands of Britons who might have died this winter. That they didn't and that you and I are still alive shows that H1N1 is not the "Andromeda strain" long- predicted by scientists. "It was pure, systematic, government-induced panic," he writes. "Swine flu was a textbook case of a scare," concurs Christopher Booker in the Daily Telegraph.

Jenkins is a sharp and entertaining writer and when he accuses the media of playing "its joyful part" in propagating panic I have to admit the dart hits home: as a medical historian and expert on the 1918 "Spanish" influenza pandemic I was continually asked to comment on the parallels with swine flu last summer and no doubt added to the hype. But as all good schoolboys know, post hoc doesn't make propter hoc. Just because 65,000 Britons didn't die this winter does not mean that the computer models were wrong or that the Department of Health shouldn't have ordered 50m doses of Tamiflu, only that prognostications about pandemics, like prognostications about earthquakes, are not an exact science.

Writing in this paper last week, Tom Sheldon eloquently makes the point that predicting pandemics is a species of risk analysis and thus, by definition, subject to error. With better virological and epidemiological data perhaps the government wouldn't have stockpiled so much Tamiflu or ordered 90m doses of vaccine. But if it hadn't and armageddon had occurred, Jenkins would have been the first to call for the guillotining of the Chief Medical Officer.

I do not wish to labour the point but it seems to me that the backlash against swine flu is a species of conspiracy-thinking, one that wilfully misconstrues the role of science in the regulation of technologies of health which have brought so many benefits to society. In the same way that 9/11 denialists point to the collapse of World Trade Centre 7 to support their wacko theories about "controlled demolitions", swine flu denialists point to Donald Rumsfeld's position on the board of Gilead, the company that developed Tamiflu, to argue that the "panic" was got up by similar shadowy neo-conservative corporate interests. It is then a short step to seeing all such panics as conspiracies. Thus, according to the Nation of Islam leader Louis Farrakhan, the vaccine is really a tool for culling inner-city black populations because of military leaders' concerns about pressures on the global food supply.

Similar conspiracy-thinking infects health advice websites that advise mothers not to give their children the swine flu jab because of the risk of rare side-effects, such as Guillain-Barré syndrome. In fact, according to the Institute of Medicine, the chances of contracting GBS from influenza vaccination is one or two per million. By comparison, a recent French study found that the risk of contracting GBS from naturally occurring influenza is four to seven out of every 100,000 cases. But that hasn't stopped NHS staff, who should know better, from shunning the swine flu vaccine. Nor, I am sorry to say, are such peer-reviewed studies likely to persuade the sort of people who continue to refuse to give their children the MMR vaccine because they once read somewhere that it might be linked to autism.

WHO addresses handling of H1N1 at Council of Europe meeting

WHO addresses handling of H1N1 at Council of Europe meeting

During a Council of Europe meeting on Tuesday to address the WHO's handling of the H1N1 virus, the WHO said it had not "fallen under the sway of drugs firms and exaggerated the dangers of the H1N1 flu virus, but said it might have handled the crisis better," Reuters reports. "Critics say the WHO relied too much on advice from advisers in the pay of the pharmaceutical industry, triggering an internal review by the WHO and an inquiry by the Council of Europe, a pan European human rights watchdog," writes the news service (Reilhac, 1/26).

At the council meeting, Keiji Fukuda, special adviser on pandemic influenza to the director-general of WHO, defended the agency's response to H1N1, pointing out that "the WHO consulted with a range of experts, including those in the private sector, but that there were safeguards in place to prevent conflicts of interest," Deutsche Welle writes.

"These individuals are known to us and their participation in various WHO committees was looked at and we have not found anything inappropriate about what they did," Fukuda said. "The experts out there - the ones who really understand and who have knowledge - they may work with many different groups, including with industry. That link may mean that they provide advice which is inappropriate. It may not mean that they provide advice which is inappropriate" (Foulkes, 1/27).

"We are under no illusions that this response was the perfect response," Fukuda said during the hearing, the BBC reports. "But we do not wait until (these global virus outbreaks) have developed and we see that lots of people are dying. What we try and do is take preventive actions. If we are successful no-one will die, no-one will notice anything" (1/26).

CIDRAP reports on some of the criticisms voiced by health officials during the Council of Europe meeting and Fukuda's assurance that the organization would work to improve transparency during the pandemic response in the future (Schnirring, 1/26).