[Ash]

A pandemic virus outbreak is a bit different. They'll be right here saying, "It's the flu, it's acting more or less like any other flu, what's the problem?"

The problem is of course, those two 1's in the name. Which is an uncommon configuration of a flu virus, which means most of us have no natural resistance to it.

What significance does the number 1 have?
It's got nothing to do with the configuration of the flu virus, nor does it means we have no natural resistance.

We have no natural resistance to ANY infection we get sick from, otherwise we wouldn't get sick at all. H1N1 is just a variant of influenza A that just happens to be just as infectious but more virulent.

[Ash]

There is a big damn difference in extrapolating risks on something known and actually lethal to the healthy i.e. polio, & small pox.

Blue, you're letting your dislike for the current political power get in the way of the issue.

How do YOU know H1N1 is not actually lethal to the healthy?
I can tell you for a fact that IT IS.
It has caused a significant number of ICU admissions, miscarriages and adult deaths in the normally healthy population in Australia. I would hazard to guess it would be no different anywhere else in the world...

[Ratmagiclady]

Your doctor is very likely making the recommendation you not get the shot, because you are outside the highest-risk group, as are most of us on this forum. And because the vaccines are in short supply and should be directed to the higher risk patients. NOT because the doctor buys into the fear-mongering of this Horowitz fella.

Jim

The notion of vaccinating a lot of the populace (Assuming the stuff is available) is about preventing the disease from spreading. If you're at a high risk of dying or being really sickened by the flu, well, that's a more direct concern. Changes the risk assessment, too.

I'd be considered pretty high-risk, and the stuff's already hit the university here. (While our erstwhile Republican Senator froths about some worry Obama's trying to raise a 'private army' via some national service program or whatever the heck else set him off this time Speaking of tinfoil, got any extra? ) And, like I said, if there's anything to the suspicions about this particular vaccine, it seems I've already got similar chronic health problems I doubt it could make any worse. (I don't think what's broken is the kind of thing that you can break twice. Isn't speculation instead of having all the science done *fun* when it comes to stuff like this? I think it's more fun with guessing what Pentax will come out with next. ) )

[Ash]

The vaccine is still in trials. Common sense hygiene is the best defense against the swine flu. Most of the deaths were from people who had other underlying medical problems. Most people who get the swine flu recover just fine with regular treatment.

Heard on the radio that the vaccine should be ready by Thanksgiving. Is fasttracking this vaccine going to give us another situation like what happened in the 70's. More dying from the vaccine than from that mutation of the swine flu.

Working in health you must err on the side of overreaction than underreaction, especially when dealing with people's lives. Because of the unpredictability of influenza, responsible public health leaders must be willing to take risks on behalf of the public. This requires personal courage and a reasonable level of understanding by the politicians to whom these public health leaders are accountable. All policy decisions entail risks and benefits: risks or benefits to the decision maker; risks or benefits to those affected by the decision. In 1976, the US federal government opted to put protection of the public first.

However, in December 1976, with >40 million persons immunized and no evidence of H1N1 transmission, federal health officials decided that the possibility of an association of GBS with the vaccine, however small, necessitated stopping immunization, at least until the issue could be explored. A moratorium on the use of the influenza vaccines was announced on December 16; it effectively ended NIIP of 1976. Four days later the New York Times published an op-ed article that began by asserting, "Misunderstandings and misconceptions... have marked Government ... during the last eight years," attributing NIIP and its consequences to "political expediency" and "the self interest of government health bureaucracy". These simple and sinister innuendos had traction, as did 2 epithets used in the article to describe the program, "debacle" in the text and "Swine Flu Fiasco" in the title.

The power of the media....

Here it IS different - H1N1 is transmissible and very HIGHLY contagious and is a very REAL threat to people's lives, so cannot be downplayed in ANY way.

[Ratmagiclady]

What significance does the number 1 have?
It's got nothing to do with the configuration of the flu virus, nor does it means we have no natural resistance.

We have no natural resistance to ANY infection we get sick from, otherwise we wouldn't get sick at all. H1N1 is just a variant of influenza A that just happens to be just as infectious but more virulent.

The 1s correspond to shapes of, basically, the parts where the virus attaches to the cells it infects: (Think of em like molecular puzzle pieces or keys in locks) the idea of antibodies is that they can block these things from 'fitting.' Having antibodies for one type of flu virus doesn't mean you have em all.
(There are several types of each: the numbers after the letters each denote one of these shapes: they go up to five or more and occur in different combinations.)

I believe the last time we saw much of this combination was in the Spanish flu in ..1918. (I'm not sure how 1976 is supposed to fit into this story) It's part of why it can affect healthy people so badly: pre-existing 'resistance' (Antibodies around for our immune systems to recognize) isn't very common at all, so fighting it off is a lot harder. At least that's how it was told to me.

[Ratmagiclady]

As for 'fast-tracking vaccines,' it's not the particular flu virus or that it's a vaccine that's at issue, when people get all panicked or start spinning conspiracy theories.

The only valid concern I've heard is about stuff that may be used in preserving the stocks or stretching more doses around, like squalene, which may disrupt the endocrine system and was used in anthrax vaccines on soldiers in the Gulf war, a big suspect for the 'Gulf War Syndrome.' It's supposed to make smaller doses of the actual vaccine work better, so you can have more doses out of less actual vaccine material. This is one thing that's been 'fast-tracked' and not well-studied: pharmaceutical companies mostly have the agenda to 'defend their products,' and try and disprove or cast doubt on any connections between the stuff and people developing chronic illness: ...there's a lot of unknowns there, but they've been there a while.

This is aside from pretty general fears that 'vaccination' in general causes autism, that it's a conspiracy to poison Africa, etc. Sometimes vaccines have been made with dubiously-healthy materials in them before, (even mercury, in the past, if I'm not much mistaken) and it seems generally a popular target for conspiracy theories, but that's pretty much trying to make a conspiracy picture out of disparate actual compounds and instances that may not be relevant.

The simple fact is, what we have is what we have. You've got to weigh any risks of side-effects with the risks of having a flu pandemic or falling victim to it. The time to worry about how vaccines are manufactured was back when the processes were being developed and FDA oversight was being cut back, deregulated, and loosened, not when you suddenly really want a lot of vaccine.

[Blue]

. . .

Here it IS different - H1N1 is transmissible and very HIGHLY contagious and is a very REAL threat to people's lives, so cannot be downplayed in ANY way.

So is EEE, WEE and West Nile virus. However, we don't have Governments trying to cattle herd people through shot stations. Parts of the world still have major problems with malaria, yellow fever, dengue, leishmaniasis yet I don't see U.N & WHO taking over and implementing martial law because the various Governments are doing it.

Blue, you're letting your dislike for the current political power get in the way of the issue.

How do YOU know H1N1 is not actually lethal to the healthy?
I can tell you for a fact that IT IS.
It has caused a significant number of ICU admissions, miscarriages and adult deaths in the normally healthy population in Australia. I would hazard to guess it would be no different anywhere else in the world...

Actually, you are incorrect there regarding the political issue. The previous Administration was pushing vaccines as well not to mention interfering with the removal of thiomerosal as a preservative from children"s vaccines. If you have a perception that I liked Bush and Cheney, you are grossly mistaken. However, the current guy has a science adviser that believes in mandatory abortions and sterilizations so I don't think miscarriages on either side of the issue matters much in D.C. or Mass.

[cwood]

Beware any "Harvard... prof..." who has 10 citations including

5 citation of himself (including 4 on his own blog - Tetrahedron Publishing Group... whatever that is?)
1 citation of CNN
1 citation of Newsweek
1 URL (something so important it never even made it to a printed piece of paper?)
1 citation of Business Week.

I'm not saying the topic is not worth discussing but it is certainly not worth propagating the kind of BS article in the original post.

The point being - even if the guy IS right, surely somebody with some better credentials and a better researched report has come to the same conclusions? As it is, the Author of the essay really has no more credibility than if Ben had written it himself. Ben's a great photographer but I doubt he knows much about medicine.

[er1kksen]

Your doctor is very likely making the recommendation you not get the shot, because you are outside the highest-risk group, as are most of us on this forum.

Jim

...I am. Young adult male, most of my younger life was spent in relatively poor health, including difficulties with excersize-induced bronchial spasms. However, in the last few years I've turned myself into a more encouraging picture of robust health, and apparently eliminated the E-IBS through in intense cycling habit. I've been slacking a bit lately. Maybe I'd better hit the bike a bit more...

[RoxnDox]

...I am. Young adult male, most of my younger life was spent in relatively poor health, including difficulties with excersize-induced bronchial spasms. However, in the last few years I've turned myself into a more encouraging picture of robust health, and apparently eliminated the E-IBS through in intense cycling habit. I've been slacking a bit lately. Maybe I'd better hit the bike a bit more...

<cracks whip> Get out there and ride, young man! <cracks whip>

A note too, that vaccination is a different issue than treatment once you have the bug (as Ratmagiclady noted). Even if we had abundant supplies of the new vaccine, the supply of Tamiflu for treatment is also low. Sufficiently so that my wife's clinic system has to decide who gets it and who gets other treatments based on severity of symptoms. As with the vaccine, even the docs and nurses are getting only what their risk category demands. I think it has a lot more to do with scarcity than conspiracy...

Jim

[Ash]

So is EEE, WEE and West Nile virus. However, we don't have Governments trying to cattle herd people through shot stations. Parts of the world still have major problems with malaria, yellow fever, dengue, leishmaniasis yet I don't see U.N & WHO taking over and implementing martial law because the various Governments are doing it.

Health economics are all about knowing where and how much to put money into primary and secondary prevention strategies.

There is more to allocating funds to vaccines and major campaigns than just looking for the disease with the most media coverage or impact on First World countries. There are numerous factors: virulence, incidence, infection rate, DALYs, treatment modalities, feasibility in eradication programmes and many other public health measures...

[Blue]

Health economics are all about knowing where and how much to put money into primary and secondary prevention strategies.

There is more to allocating funds to vaccines and major campaigns than just looking for the disease with the most media coverage or impact on First World countries. There are numerous factors: virulence, incidence, infection rate, DALYs, treatment modalities, feasibility in eradication programmes and many other public health measures...

Actually, we have a local problem with EEE and it is far more dangerous than this flu virus. However, there is next to no media coverage in part because of horses. This is Florida so mosquitoes are ubiquitous and numerous as are horses.

[Ash]

Actually, we have a local problem with EEE and it is far more dangerous than this flu virus. However, there is next to no media coverage in part because of horses. This is Florida so mosquitoes are ubiquitous and numerous as are horses.

The media certainly does help bringing issues to the fore, though if a health problem is confined to a local community, there will unlikely be a national/federal response. H1N1 became an international problem very quickly.

[Edvinas]

Please explain to me one thing.

According to wikipedia 2009 flu pandemic in Europe - Wikipedia, the free encyclopedia

In UK there were confirmed 13 thousands swine flu cases and 65 deaths.

In Germany 15,5 thousands cases and zero deaths.

I don't get it, why such huge difference?

[slomojoe]

Some answers/comments to random posts (don't have much time to engage in discussions these days).

- the 1/1 thing just refers to broad classes of flu antigens (basically proteins expressed by the virus that can be recognized by the immune system), which are also used to classify flu viruses within families and track their evolution. Because there are similarities between these antigens, especially within the same class, we usually have some pre-existing immunity to them, within some limits, even if the virus mutates and presents itself in a new form every year. The problem with H1N1 is that it is unlike any of the viruses responsible for the recent seasonal epidemics. The closest thing to it we know about is the 1918 virus, but in fact, there have been similar viruses going around in the earlier part of the 20th century. There is some data suggesting that people who were around in the late 1950s should have some pre-existing immunity to this virus, which does not necessarily mean they won't get infected or sick, but that they should be able to respond faster when they do.

- For that reason, and based on the current epidemiological and clinical observations, the CDC is recommending vaccinations for people under 25 years of age, pregnant women and people who care for babies, health care workers and people with pre-existing conditions that may constitute additional risk for flu complications (respiratory disease etc). If you are not in one of these groups, your doctor of course will recommend not to get the vaccination, at least initially and until we see how things go.

- WEEV, West Nile etc are not even remotely as infectious as the current H1N1 virus, or any seasonal flu virus for that matter. They don't transmit by direct person-person contact, but are borne by vectors (usually mosquitoes) from other animals (birds primarily). These are well established viruses here and cause at most a few hundred cases and a few dozen deaths/year (44 last year for West Nile, for instance, according to CDC). The mortality rate is higher for these viruses than for the flu (any flu, including probably a Spanish-like pandemic flu, if it were to come back), but there is simply no way these viruses can infect tens of millions of people, unless as a nation we all decide to go camping in swamps and deep woods without using basic insect bite protection and repellents.

- The current injectable flu vaccines are generally made with inactivated viruses (the nasal spray vaccines are different, made from attenuated viruses, but few people use them), so there is no way one can get the flu from them. However, rare individuals do get severe adverse reactions for unclear reasons, and if so they are generally recommended not to get flu vaccination again. That said, any anecdotal report that someone got the flu vaccination and that year got "the worse flu" of their lives are just that- anecdotal reports. I am sure there are people out there who got vaccinated and won the lottery the same year, but I doubt anyone would assume any causal relationship between the two. The epidemiological evidence on the protective effects of seasonal flu vaccination is overwhelming.

- The reason that some countries like Germany have high numbers of confirmed cases and few deaths, and others like the UK seem to have much higher mortality rates, is that the former have mandatory testing for all suspected cases, and the latter don't. Thus, one would expect that the reported number of confirmed cases in Germany is pretty close to the actual number, while the reported number for the UK is a vast underestimate. That is a mixed blessing actually, because while it complicates matters for tracking the epidemics, it would suggest that the mortality may not be as high as feared. The other possibility is that the virus in some countries may be slightly different than in others - for instance, it is possible that more UK patients may already be infected with the southern hemisphere form of the virus (e.g from Australia), and thus may be "second wave" cases. But I don't think there is firm epidemiology or virology data on the latter possibility.