The latest "influenza" to visit itself upon the citizens of the world reminds us that epidemics are part of the natural interaction of people and microbes throughout civilization. Yet each time we react as though we have discovered something new. The only really new things are our surprise and consistent inability to recall all of the lessons from prior visitations.
In September 1976, when my colleagues and I reported two patients in Virginia with Swine flu, it may have added some concern that the original cluster at Fort Dix had spread beyond New Jersey. Yet the 230 cases among trainees at the army base with 13 severe illnesses and one death in February 1976 had already alarmed the country. In fact, by March of that year, President Gerald Ford announced federal funding for a national vaccination program. Subsequently, there were two unexpected outcomes: The Swine flu epidemic never materialized, and the vaccine unexpectedly caused a 7-fold increase in a neurological side effect leading to weakness and paralysis, the Guillian Barre Syndrome. A shakeup at CDC followed, and for years the public's willingness to accept vaccines was diminished. Those who boldly predict the outcome of influenza do so at their own peril.
The 2009 Swine flu outbreak that began in Mexico is different. Cases have developed in countries on at least five continents over a brief time period. The key mystery is why 160 deaths have been reported in Mexico. Sadly, the U.S. reported its first death in a 23-month-old Mexican toddler visiting in Texas.
First let's look at the meaning of the deaths in context of the expected mortality rates. In the 1918-19 Avian flu pandemic, the mortality was 2.5% -- 25 times the rate we see with the seasonal arrival of flu each year of one in a thousand or 0.1%. If the 160 deaths in Mexico are truly related to swine flu and the disease is very virulent -- for example with a very high 1% mortality -- the real number of cases must be 16,000 -- not the 2,500 currently reported. On the other hand, if the new Swine flu is acting more like our seasonal flu, the real number of cases in Mexico is 160,000, 0.1% of which accounts for the 160 deaths.
Whatever the true virulence of this Swine flu virus and its case mortality rate, the reported number of cases is grossly understated in Mexico. This also implies that the epidemic there is probably several months in duration.
The first death in the U.S. among 64 cases, which is also the first death globally outside of Mexico among 100 or more cases, is difficult to put into perspective with any confidence -- especially since the baby came from Mexico. The death of a baby in the U.S. is tragic, but each year we see 36,000 deaths from influenza in our country. Influenza is always serious -- even without an exotic strain from another country. We cannot at this time predict the mortality of the Swine flu outbreak, but only put in a range of 0.1% of cases to something higher such as 0.5% (seen in the 1957 "Asian" flu and 1968 "Hong Kong" flu pandemics). A 1% mortality may be worst case scenario and seems unlikely.
If more deaths are occurring in Mexico than the rest of the world, why would this happen? In both the U.S. and Mexico the same virus is attacking the same age cohort -- young adults. Then any big differences would be ascribed to differences in patients. Is it possible that patients in Mexico have co-infection with a second virus? Do they have high rates of secondary bacterial pneumonia with Staphylococcus aureus or Pneumococcus? Is the particulate air pollution in Mexico City damaging airways and lungs causing more disease? Do patients have an unusually robust immune response to the virus -- the so-called cytokine storm? We do not know the answers to any of these questions, but the key point is this: CDC in concert with health authorities in Mexico should perform sophisticated viral and bacterial studies, and pathology analyses on patients with severe disease and on patients who have died. Our understanding of how to manage this viral infection will be enhanced with such information.
As we prepare ourselves in the U.S. for more illnesses and more deaths from the new Swine flu, it is the uncertainty that is especially challenging. Knowing the cause of severe illnesses and deaths and the true mortality will be of critical importance.
Dr. Wenzel is the former President of the International Society for Infectious Diseases and Chairman of the Department of Internal Medicine at Virginia Commonwealth University in Richmond, VA.
Swine influenza - Wikipedia, the free encyclopedia
MedlinePlus: H1N1 Flu (Swine Flu)
Swine Flu - Influenza A | Reuters.com
CDC: Swine Flu Outbreak Signs 'Encouraging'
In battle against swine flu, health experts see cause for optimism ...
Loading comments… 
http://www
There’s nothing funny about swine flu — except how the government and media respond to the crisis.
http://www
Now I hear that swine flu is on the decline. Really? Or are they just not screening for it?
Last night his temp was 102, and he is coughing much more today. I know that Swine flu is like many flus and this strain is mild. I'm not an alarmist and I'm sure he's going to be fine, but my concern is that they don't really seem to care how many people actually have contracted it. It's like they don't want to know. (How can they be sure that the total number of cases are actual unless they screen?)
Also, he had the flu shot at the beginning of the season. The nurse told me it should have protected him the entire season. But it didn't. And they didn't seem curious as to why or what flu he could have that wouldn't have been covered by the vaccine. I'm wondering how well our medical community would handle an honest to God crisis.
I call the local ER to ask them a question about when it would be necessary to bring my daughter in and they made me call a nurse hotline. The answer I finally got was to bring her in if her fever spikes higher and/or she can't breathe. I would guess there are 1000s of cases just like my daughter's out there. Oh, and no, we haven't been to Mexico or live near the shoatish types.
It's informativ
You have to be kidding.
If you want facts, as well as some factual history of how the immunizati
Fact: in March 2009, the CDC determined that the common flu this season (Sept 08 - March 09) proved RESISTANT to Tamaflu in 99.3% of the cases, and a month later, a new (I respectful
The same damaging neuro side effects are also present with the chlamydia shot they're giving all the young girls (as well as reported deaths). BUT A PUBLIC THAT DOESN'T WANT TO THINK OR READ, LIKE PIGS, JUST KEEP STEPPING UP TO THE TROPH, buying into the whole lie and coughing up their kids to participat
I didn't find anything that could be called substantia
http://www
Tell you what, visit the FDA's website and click on the link that makes public all the warnings given to the leading pharmaceut
He's not the only site I visit from time to time, and as a veteran of health care for 24 years, I can guarantee you that he echoes a huge respected community on many issues and is someone I trust far more than the FDA themselves
When the highest ranking officials of the FDA -- those who make the decision to approve new drugs -- no longer profit from stocks that they own in the same companies, an obvious conflict of interest and a true disservice to the American people, then I'll consider listening to them. But as long as they are personally making a killing off their Tamaflu stocks, they can bite me.
Reminds me of the kid who successful
What do our "experts" do to combat the supposed pandemic?
They reach for the same toxic Tamiflu tablets that failed last time we had a hyped up hoax.
Flu vaccines have expiration dates. After that, they are of even less use than they were before the expiration date was reached. Pandemic flu vaccine doses do, too. What to do with enormous stock piles of expensive and much-bally
Well, the first thing you do is engage "house scientists
Among the beneficiar
Instead there should be much more focus on a systems approach where organism-h
Also we should stop reporting deaths among the elderly and frail as "flu deaths" which is intellectu
Dr. Rick Lippin
Southampto
Here's the reality, there are fewer than 20 confirmed cases of death from the swine flu. That's not in Mexico, that's anywhere. There might be more deaths. It might even be as high as the 160 deaths that Mexican officials "suspect" resulted from the swine flu. It might be even higher. But NOBODY knows, and articles like this just feed the prepostero
Let's have some facts next time, please.