Prioritizing the crowded Global Health Agenda

Prioritizing the crowded Global Health Agenda

The subject of the following paragraphs is the prioritizing the crowded global health agenda. I am going to use the nature of “blogging”, which is to share the most relevant information, to discuss the urgent priority of the current global health agenda, the Swine Flu.

First, it seems that not everyone around the world is happy with the name. Pork producers question whether the term “swine flu” is appropriate, given that the new virus has not yet been isolated in samples taken from pigs in Mexico or elsewhere. While the new virus seems to be most heavily composed of genetic sequences from swine influenza virus material, it also has human and avian influenza genetic sequences as well, according to the CDC. Some officials around the world have already started naming the virus by its so-called place of origin. Government officials in Thailand, one of the world’s largest meat exporters, have started referring to the disease as “Mexican flu.” An Israeli deputy health minister, an ultra-Orthodox Jew, said his country would do the same, to keep Jews from having to say the word “swine.” But it seems that hopefully the WHO will have the final say on this. On the 25^th of April, the organization issued a statement suggesting that the virus should be called the “North America Influenza”. It seems that there is a medical tradition of naming influenza pandemics for the regions where they were first identified. This has included the Spanish flu of 1918 to 1919, the Asian flu of 1957 to 1958 and the Hong Kong flu of 1967 to 1968. The debate is likely to continue as scientists and health authorities try to trace the disease. While all signs now point to Mexico as the epicenter, the genetic material in the virus there includes part of a swine influenza virus of Eurasian origin. And influenza viruses tend to emerge from Asia. Many medical historians believe that the Asian and Hong Kong flus started in southeastern China near Hong Kong, where very high densities of people live in close proximity to hogs and chickens in rural areas and can share their viruses. Some historians also suggest that the Spanish flu also started in southeastern China. Those who are trying to relate the virus origin to the southeast Asia have come up with some evidence as well. For instance, Millions of pigs died in China two years ago in an epidemic so severe that it pushed pork prices up 90 percent. Veterinarians attributed the deaths at the time mainly to blue-ear disease, which does not affect humans, but also to swine flu. The Chinese government did not issue a public report assessing the outbreak and provided very few details to international organizations.

But whatever the virus is called and wherever it has been originated from, people must know what they are dealing with. Swine influenza is originally referred to influenza caused by any strain of influenza virus endemic in pigs. Strains endemic in swine are called Swine Influenza Virus (SIV). Of the three human influenza viruses, two are endemic in swine as well; type A is very common, type C is rare, and type B has not been reported in Swine. Before the 2009 flu outbreak in humans, swine flu was very rare among humans, and those who are very closely exposed to pigs, such as the pig farm workers, used to be the only group at risk. The original virus is non-lethal, and not transmittable from human to human either. The symptoms of the swine flu in humans are similar to those of influenza, or influenza-like illness, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness, and general discomfort. The 2009 flu outbreak in humans that is widely known as "swine flu" apparently is not due to a swine influenza virus. It is due to a new strain of influenza A subtype H1N1 that is derived from one strain of human influenza virus, one strain of avian influenza virus, and two separate strains of swine influenza viruses. The origins of this new strain are unknown, and the World Organization for Animal Health reports that this strain has not been isolated in swine. Unlike the original strain, it passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation.

It is interesting to know that the common human H1N1 influenza virus affects millions of people every year. In yearly influenza epidemics 5-15% of the world population are affected with upper respiratory tract infections. This results 250000-500000 deaths around the world. However, most certainly, this flu epidemic started after the flu season, and is on the verge of becoming a worldwide pandemic. The outbreak is believed to have started in March. Local outbreaks of an influenza-like illness were first detected in three areas of Mexico, but the virus responsible was not clinically identified as a new strain until April 24^th. Following the identification, its presence was soon confirmed in various Mexican states and in Mexico City. Within days, isolated cases were identified elsewhere in Mexico, the U.S and several other northern hemisphere countries. By April 28^th, the new strain was confirmed to have spread to Spain, the UK, New Zealand, and Israel, and the virus was suspected in many other nations, with a total of over 3000 candidate cases, with 152 attributed deaths. As of now, there are 14 cases identified in California.

On April 27^th, the WHO raised their alertness level from 3 to 4 (on a scale of 6) worldwide in response to sustained human-to-human transfer of the virus. The situation was raised to level 5 on April 29^th. Here is a quick look at the WHO’s pandemic alert phases. Phase 1: A virus in animals has caused no known infections in humans. Phase 2: An animal flu virus has caused infection in humans. Phase 3: Sporadic cases or small clusters of disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks. Phase 4: The risk for a pandemic is greatly increased but not certain. The disease-causing virus is able to cause community-level outbreaks. Phase 5: Still not a pandemic, but spread of disease between humans is occurring in more than one country of one WHO region. Phase 6: This is the pandemic level. Community-level outbreaks are in at least one additional country in a different WHO region from phase 5.

Despite the scale of the alert, the WHO stated on April 29^th that the majority of people infected with the virus have made a full recovery without need of medical attention or antiviral drugs. But there are ways both to prevent and to treat the disease. The CDC reports that the swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. In addition, the Federal Government and manufacturers have begun the process of developing a vaccine against this new virus. As far as prevention, the CDC suggests that Personal hygiene measures, such as avoiding people who are coughing or sneezing and frequent hand-washing, may prevent flu infection. Those who aren’t health professionals should avoid contact with sick people. People who get sick with flu symptoms should stay home. Studies have suggested that closing schools, theaters, and canceling gatherings in the early stages of a pandemic can limit its spread. Such measures would likely take place if health officials determine that the virus is spreading quickly enough and is deadly enough to cause a pandemic.

 

Resources

http://www.cdc.gov/h1n1flu/index.htm

http://www.nytimes.com/2009/04/29/world/asia/29swine.html?_r=1&scp=6&sq=swine%20flu&st=cse

http://www.bloomberg.com/apps/news?pid=20601087&sid=aLdy2aZer5fM&refer=home

http://www.nytimes.com/2009/04/27/world/27flu.html?scp=16&sq=swine%20flu&st=cse

http://www.webmd.com/cold-and-flu/news/20090429/swine-flu-one-step-closer-to-pandemic?ecd=wnl_nal_042909

http://www.nytimes.com/2009/04/29/opinion/l29flu.html?scp=12&sq=swine%20flu&st=cse