Introduction
There has been much media attention given to “swine flu,” a flu outbreak that began in Mexico and has had confirmed cases in the last few weeks in California, Texas, New York and a number of other states. This blog will examine the history of swine flu and the current responses to its development from an epidemiology of infectious diseases perspective. Saker et al.’s “Infectious disease in the age of Globalization” article highlights one important consequence of globalization on infectious disease: the ability for rapid transmission of diseases all over the world. Flights can reach from one point to any other point in the world, usually in less than 36 hours, while the incubation period for most illnesses and for swine flu, specifically, is significantly longer than 36 hours (6). Thus, disease can be spread before carriers are even aware of their own sickness. Perhaps because of this fact, swine flu has been identified in Canada, Israel, France, New Zealand, Costa Rica and South Korea (8).
History
Surveillance in Mexico began registering cases of swine flu starting from March 18. As of April 23, there were 854 reported cases from Mexico City and more than 50 cases reported from other cities in the country. The total mortality is estimated at 62 deaths as of the time of the WHO report (9). Strains identical to those found in patients in Mexico were seen in patients in California meaning that the same virus had spread to inside of the United States. One alarming fact cited in the report was that flu generally afflicts the very young, very old or immunocomprised, however, the majority of the cases from the swine flu epidemic have been in otherwise healthy young adults. The Mexican health secretary recently released a report that identified the case fatality rate of swine flu at 6 or 7% (2). His analysis was completed by dividing the number of deaths by the suspected number of cases, yet if his analysis is correct, the case fatality for swine flu would be even higher than the 1918 flu pandemic – one of the most devastating in recent history. Other officials argue that the number of suspected cases could be significantly higher and may be underreported because the afflicted either did not need to go to the hospital or the cases were not reported in general. If this is true, the case fatality may be much smaller. What is certain is that Mexico has seemingly been plagued much more by the virus than the United States. No indigent case fatalities have been reported yet from Americans who caught the disease. (2)
Reports from Mexico indicate that the effects of the virus may be waning as the number of new suspected cases declined from 141 on Saturday, to 119 on Sunday and 110 on Monday. In keeping with the 1918 flu analogy though, the assistant director-general of the WHO warned governments not to become complacent as the 1918 flu began with a mild epidemic in the spring of 1918 that withdrew only to come back with full force in the fall of the same year (2).
A number of press reports have asserted that the swine flue may have begun in China – an allegation that Chinese officials vehemently deny. The reports stem from the fact that a blue-eared pig disease began in China in 2007 which, perhaps in conjunction with a swine flue, led to the deaths of 80,000 pigs and the slaughtering of an additional 235,000 pigs. The large number of killed pigs led to a spike in pork prices last year of almost 90 percent (7).
Naming the Flu
One interesting controversy regarding the epidemic is deciding upon the official name of the virus. Because the flu has not as of yet been isolated in any pigs, officials are questioning whether it can properly be referred to as swine flu, an idea many pork producers are strongly backing. In meetings all over the world officials have been meticulous about naming the disease anything from “Mild flu-like illness” to “H1N1” to “Mexican Flu” and “North American Flu.” The CDC has also discouraged using the name “swine flu”, although the most recent fact sheets that have been released in hospitals and airports by the institution still refer to the disease as “swine flu.” Others argue that identifying the origin of the disease and from there deciding on a proper name is a secondary concern as all efforts now should be concentrated on preventing and treating the disease (5).
National Response
President Obama recently asked congress for 1.5 billion dollars in funds for treatment of swine flu. Additionally, the FDA authorized emergency use authorizations of important diagnostic and therapeutic tools for surveillance and treatment of the disease. This action effectively declares a state of emergency and allows the FDA to approve the use of uncleared medical devices and drugs for treatment provided certain criteria are met. The CDC has also begun issuing reports to the media, to hospitals and to airports to spread awareness about the disease and try and control its spread in the US (3). Furthermore, Carnival Cruise Lines and Royal Carribean Cruise have both stopped docking in Mexico indefinitely.
International Response
Cuba ordered a suspension of all flights to and from Mexico for a period of 48 hours on Tuesday, becoming the first nation to suspend travel to Mexico. Argentina later followed suit cancelling all flights to and from Mexico for the next 5 days. While other countries have not suspended flights, the United States has sent health officials to Mexico to aid in the investigation of swine flu. China offered 5 million dollars in aid to Mexico and the World Health Organization has also sent officials to the country in order to assist with the epidemic (7) (1).
Conclusion
Responses to the epidemic have taken a global scale only very recently, but all involved parties have echoed the desire to improve surveillance and engage in early detection, early response efforts to prevent further escalation of the disease.
Works Cited
1. "AFP: China rejects reports as origin of swine flu." Google. 30 Apr. 2009 .
2. "The Associated Press: Scientists struggle to understand swine flu virus." Google. 30 Apr. 2009 .
3. "CDC - Influenza (Flu) | Swine Influenza (Flu)." Centers for Disease Control and Prevention. 30 Apr. 2009 .
4. "FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans." U S Food and Drug Administration Home Page. 30 Apr. 2009 .
5. "The Naming of Swine Flu" The New York Times - Breaking News, World News & Multimedia. 30 Apr. 2009 .
6. Saker, Lance, Kelley Lee, and Barbara Cannito. "Infectious Disease in the Age of Globalization."
7. "Swine flu: California declares state of emergency; cruise ships avoid Mexico -- chicagotribune.com." Chicago News, Chicago Weather, Chicago Sports and Politics -- chicagotribune.com. 30 Apr. 2009 .
8. "Swine flu continues to spread; Obama asks $1.5 billion to fight it -- baltimoresun.com." Baltimore, Maryland breaking news, sports, blogs, video, classifieds and weather | baltimoresun.com -- baltimoresun.com. 30 Apr. 2009 .
9. "WHO | Influenza-like illness in the United States and Mexico." World Health Organization. 30 Apr. 2009 .
The global response to the H1N1 flu has indeed been aggressive, with some countries taking very drastic—but, arguably, necessary—measures to protect their citizens from the virus and to protect the world from a flu pandemic. The United States Food and Drug Administration, for example, has issued Emergency Use Authorizations (EUAs) for: 1) oseltamivir (Tamiflu) and 2) zanamivir (Relenza) for treatment and prophylaxis, 3) disposable N95 respirators for use by the general public, and 3) the rRT-PCR Swine Flu Panel for diagnosis. The EUAs authorize use of these products beyond those stated in their current licenses or other approvals.
ReplyDeleteAlthough such measures are important given the potential for a global outbreak, the rationale for such measures must be more clearly communicated to the general public. The response of the public, as well as that of the media, has been exceedingly reactionary. For example, today’s Los Angeles Times published a story with the following headline: “More grief for family of first Mexico fatality: The husband of a Oaxacan woman who died of swine flu says the community thinks she spread it.” A table printed on the same page gives the number of confirmed swine flu cases by U.S. state and by country. Interestingly, the table lists 300 confirmed cases for Mexico, citing CDC and WHO. However, as of today, both CDC and WHO report 26 confirmed cases for Mexico. , It seems likely that the L.A. Times took CDC’s figure for probable Mexico cases, numbering 260 as of yesterday.
In situations such as this, the media must take all measures to fully inform the public and to avoid alarming the public unnecessarily. These news outlets have the public trust and must report data reliably. In addition, the public trusts local and elected leaders to give accurate information so we may all take appropriate precautionary measures to slow the spread of the H1N1 flu. My cousin, who is currently an undergraduate student, forwarded me an email from her university’s president regarding swine flu. The email contained a list of precautionary measures for the campus community to take, the last of which was, “do not smoke and avoid alcoholic beverages.” While I would recommend the same to any young college student, I find it unnecessary to include in a message regarding swine flu. Such “advice” does little to halt transmission of the virus and can contribute to public alarm about the issue. Finally, WHO Director-General Margaret Chan recently raised the pandemic alert to phase 5. According to the WHO website:
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.
Although I am a student of public health, I had no idea what a phase 5 pandemic alert meant until I looked it up, but I can tell you it sure sounded scary being on a 6-point scale. To prevent unnecessarily stirring up public alarm, both news media and leaders—from local to intergovernmental—must clearly and honestly relay to the public what is going on and what the public must do in order to keep safe.
References:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a5.htm?s_cid=mm5816a5_e
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a1.htm?s_cid=mm5816a1_e
http://www.who.int/csr/don/2009_04_29/en/index.html
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a2.htm?s_cid=mm58d0430a2_e
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
When reading this I was wondering if there was an official method of naming diseases in order not to (a) offend any one's nationality and (b) allude to the correct root of the disease. H1N1 is fine but I don't think it is informative, I guess all flus should be called wash your hands after everything flu. Are there other chemical names for flus? Will H1N1 actually catch on?
ReplyDeleteKate
I believe that its a historic tradition to name the flu viruses based on the place they were originated. Therefore, naming this one as the Mexican flu, or the North American flu wouldn't really be that offensive.
ReplyDeleteSince we had flu viruses such as spanish flu, asian flu, or russian flu, what's wrong with the Mexican flu? I think some people act oversensitive over not too important stuff, and abuse media to over-express non-relevant matters. For example, read about the Israeli official who thinks the Swine flu is not appropriate because people with certain religions (such as muslims or jews) should not eat pork!!! How could this, scientifically or not, be relevant to the spread of a deadly virus. I get frustrated with the news that people have started to kill pigs in some countries because they just think the virus is transmittable from pigs to humans, no matter how many times the health officials state the contrary. It is shameful in my opinion.