swine flu

[Melissa in Australia]

are you guys worried about the swine flue in Mexico?http://au.news.yahoo.com/a/-/newshome/5521820

[pqr]

I worry that people will, understandably, try to cross from Mexico to the US in search of health care and that even this can not persuade our politicians that we should tighten up the border.

 

Sometimes (read frequently) politics gets in the way of doing the right thing.

Edited April 25, 2009 by pqr

[JFSinIL]

Not really - it sounds just like another nasty flu. Up to 35,000 folks here die already from flu (from today's Chicago Tribune). I do not think (touch wood) that this is another Spanish Influenza - just a bad strain of flu that I hope we don't catch.

 

Remember - news folk live for exciting stories. They will blast scary headlines at us to get attention and sell a story. I am sure the flu will show up in my town (large population of Hispanics - surely someone visiting from or back from a visit to Mexico has carried the germ here by now.)

Edited April 25, 2009 by JFSinIL

[Soph the vet]

Yes, I am very concerned about this. I have a vet/epidemiologist friend who probably didn't get much sleep last night as he has been worrying about bird flu for years. This is a strange mixture of two swine flu genes, one bird flu gene, and one human flu gene. No one has dealt with this before and we really don't know what to expect.

[Soph the vet]

Not really - it sounds just like another nasty flu. Up to $35,000 folks here die already from flu (from today's Chicago Tribune). I do not think (touch wood) that this is another Spanish Influenza - just a bad strain of flu that I hope we don't catch.

 

Remember - news folk live for exciting stories. They will blast scary headlines at us to get attention and sell a story. I am sure the flu will show up in my town (large population of Hispanics - surely someone visiting from or back from a visit to Mexico has carried the germ here by now.)

I agree that the media likes to scare the you know what out of us. What I would like to know is how fast is this flu killing people and were they immunocompromised in some way. If so then I might be less concerned. I did catch how NBC showed the graves and old footage from the 1918 pandemic...association propaganda at its best.

[KayT]

Hey there Soph, I was reading about this last night and someone said that the combination was VERY unusual as in he thought that someone would have had to be infected by 3 different animal strains on 3 different continents in order for this combo to show up....any thoughts on that?

[moosemomma]

I am concerned. I read the book Flu by Gina Kolata that talked about the 1918 flu pandemic. I don't thing it will be as devastating in the US because we still have a fairly good health care system and access to better drugs and doctors than in 1918.

 

However, in the third world nations this could be devastating.

 

Jill

[Perry]

Not really - it sounds just like another nasty flu. Up to 35,000 folks here die already from flu (from today's Chicago Tribune). I do not think (touch wood) that this is another Spanish Influenza - just a bad strain of flu that I hope we don't catch.

 

 

 

The vast majority of those deaths are in the elderly and immunocompromised. It is rare for a healthy adult to die of the flu.

 

All of the deaths from the current swine flu, so far, have been in adults age 25-45. That is extremely unusual.

[amyco]

The vast majority of those deaths are in the elderly and immunocompromised. It is rare for a healthy adult to die of the flu.

 

All of the deaths from the current swine flu, so far, have been in adults age 25-45. That is extremely unusual.

 

 

Exactly. This is what happens in a flu pandemic...the healthiest people are hit hardest, unlike the regular, yearly type of flu where the elderly and youngest people are hit hardest. The NYT has a good article about this, and why the healthy adults are hit hardest.

 

http://www.nytimes.com/2009/04/25/world/americas/25mexico.html?_r=1&em

 

 

Hope that link shows up. So to answer the question, I am concerned, especially because Colorado is not that far from Mexico and the Southwest U.S.

[Perry]

 

Effect Measure is an excellent blog for those that want the latest information on the swine flu situation.

[Perry]

I worry that people will, understandably, try to cross from Mexico to the US in search of health care and that even this can not persuade our politicians that we should tighten up the border.

 

Sometimes (read frequently) politics gets in the way of doing the right thing.

 

 

It's too late for closing the borders. The first known case in Mexico was on 3-22-09. It's already incubating globally.

[Tree House Academy]

All of the people in the US who were affected have recovered. This is not a strain of flu that takes out the majority who get it. Medical care in Mexico is NOT what it is in the US.

[PinkTulip]

I am very concerned about this, as my sister lives in Mexico City, with her dh, and three children, ages 9, 7, and 4. All schools, museums, and public gathering places have been closed until further notice, and masks are being passed out. Also, they have been told to avoid hospitals unless it's an emergency. She has cancelled all her weekend plans, including going to church, having people over for dinner tonight, and basically leaving her apartment at all. Her son has a somewhat compromised immune system right now and she just doesn't want to risk anything.

 

We are following this very closely around here!

[Tree House Academy]

I am very concerned about this, as my sister lives in Mexico City, with her dh, and three children, ages 9, 7, and 4. All schools, museums, and public gathering places have been closed until further notice, and masks are being passed out. Also, they have been told to avoid hospitals unless it's an emergency. She has cancelled all her weekend plans, including going to church, having people over for dinner tonight, and basically leaving her apartment at all. Her son has a somewhat compromised immune system right now and she just doesn't want to risk anything.

 

We are following this very closely around here!

 

THIS is a good reason to be concerned. I hope your sister and her family do not have to deal with this for very long! :grouphug:

[CalicoKat]

Not concerned. But we're watching the news closely. It makes me more mindful of good menu planning. Healthy foods. Good night's sleep. Exercise. Good habits. Sometimes it's easier to get lax in the warm weather.

 

Must not tire of doing what's good for my family.

[Cathy in IL]

Having a son with sickle cell and no spleen who receives chemo, makes it difficult not to get worried when I hear of things like this. But the fact is, any flu or even a cold is serious for him. He has a high risk of stroke and all sorts of other things. His peanut allergy could be devastating any time we go out in public. If I let myself dwell on these facts, I would be paralyzed with worry. Instead, I do all I can to keep him strong and healthy while letting him still be a little boy. When I start to worry, I find hope in my faith that there is One who holds the future and cares even more passionately about my son than I do.

[Perry]

Also, they can't close borders yet, but when (possibly today) they change to pandemic level 4, the WHO can issue travel advisories. It's unlikely that limiting travel will make that much difference at this point. Almost a million people cross the US-Mexico border every day, and this has been going on for a month.

[LadyAberlin]

"Hey there Soph, I was reading about this last night and someone said that the combination was VERY unusual as in he thought that someone would have had to be infected by 3 different animal strains on 3 different continents in order for this combo to show up....any thoughts on that?"

 

 

Conspiracy theories are running wild through my mind!:willy_nilly:

[Perry]

"Hey there Soph, I was reading about this last night and someone said that the combination was VERY unusual as in he thought that someone would have had to be infected by 3 different animal strains on 3 different continents in order for this combo to show up....any thoughts on that?"

 

 

Conspiracy theories are running wild through my mind!:willy_nilly:

 

It's actually not that unusual for flu viruses to reassort, or exchange genes. There are many examples, particularly in pigs and birds, of viruses with genes from different species. What is unusual about this situation is that the viurus is capable of being transmitted from human to human.

[KayT]

Oh my not conspiracy theories!!! I don't even have a tinfoil hat!

 

I was mostly looking for more of an explanation about how viruses mutate, form, replicate, join together...whatever the term is. Was this combo really so strange or not? I thought Soph and her vet friend might have discussed that and could shed a little light.

[Perry]

Flu viruses change through two mechanisms: antigenic drift, and antigenic shift. Drift means the genes are changing gradually in small ways. It occurs constantly, and is the reason we have different flu shots every year. It takes about that long for a virus to change enough so that the immune system doesn't recognize it any more.

 

Shift means there is a sudden, large change in the genes. One of the ways it can change is by reassortment, when the virus swaps a gene with a different strain of influenza. For example, say a pig, infected with a common swine virus, becomes infected with an influenza virus from a duck (the ecological reservoir for all influenza viruses is waterfowl) and a human. The three viruses mix, and can exchange genes, creating a novel virus with a mixture of genes. Most of the time, these new viruses don't spread eeasily from human to human. But if they acquire this ability, it's a formula for a pandemic.

 

This viral mixing seems unlikely, but it really does occur. It's thought that the reason pandemic viruses historically come from Asia is that humans, pigs, and waterfowl live in such close proximity to one another- often in the same house. It's a setup for viral mixing.

 

Influenza is fascinating. I wrote my dissertation on zoonotic flu.

 

Here are some resources.

 

CDC

Wiki

Edited April 25, 2009 by Perry

[KayT]

Thanks Perry! Interesting info.

[amyco]

Very interesting, Perry! But, can you explain what you mean by "the ecological reservoir for influenza is waterfowl"? Does that mean all influenza viruses originate in waterfowl? If so...I had no idea.

[CherylG]

thx for that blog-it is excellent...

[Perry]

Very interesting, Perry! But, can you explain what you mean by "the ecological reservoir for influenza is waterfowl"? Does that mean all influenza viruses originate in waterfowl? Yes. If so...I had no idea.

 

 

Influenza viruses are classified by two major surface proteins: H (hemagglutinin) and N (neuraminidase). Almost all viruses in humans are H1N1 and H3N2. There are 16 known H types, and 9 known N types, and all of them are found in waterfowl. It's thought that migratory waterfowl are an important source of transmitting viruses over large geographic areas.

 

This is described well elsewhere, so I'm just going to copy it:

 

 

EVOLUTION OF INFLUENZA A VIRUSES IN WILD BIRDS1

 

Robert G. Webster2,3, Scott Krauss2, Diane Hulse-Post2 and Katharine Sturm-Ramirez2

Wild aquatic birds are the natural reservoirs of all influenza A viruses.

 

In wild aquatic birds the influenza viruses of all subtypes cause no disease signs, replicate predominantly in the intestinal tract, are shed in the feces, and are transmitted by fecal-oral transmission through water.

 

There are a limited number of host-specific lineages of influenza viruses—these are confined to wild aquatic birds that harbor all subtypes, humans that currently harbor two subtypes (H1, H3), pigs that harbor two subtypes (H1, H3), horses that harbor one subtype (H3N8—the older subtype H7N7-equine-1 has probably disappeared from horses), and domestic poultry that harbor a variety of subtypes (predominantly H9N2 in Eurasia and different subtypes in different regions but probably none permanently). There are relatively frequent transmissions of influenza viruses to other species, including sea mammals, mink, and novel subtypes to pigs, but these are usually transient and do not establish permanent lineages.

 

There is geographical separation of the influenza viruses in the world into two superfamilies—one superfamily in Eurasia, the other in the Americas. Phylogenetic analysis of influenza viruses permits a clear separation into these two superfamilies. Although the migratory bird flyways in the world are predominantly latitudinal, they do overlap particularly in Alaska and in Labrador. Despite these overlaps phylogenetic analysis of influenza viruses clearly divides them into two geographically separate clades. Development of such clades probably occurs over an extended time frame, implying that influenza viruses do not mix extensively between these superfamilies.

Influenza viruses in their natural reservoirs show limited amino acid changes, limited antigenic drift, and have been described as being in evolutionary stasis (Gorman et al., 1992). This is interpreted as indicating that in their natural reservoir species the viruses are nearly perfectly adapted and that the continuing mutations provide no selective advantage and are not favored. The absence of change at the amino-acid level in some influenza viruses in their natural hosts suggests that these viruses have been in wild bird hosts for a protracted time and that the association is probably very ancient.

 

After transmission to another host, be it another wild bird, domestic poultry, or mammalian host, influenza viruses show rapid evolution (Ludwig et al., 1995). This can occur in all gene segments but is most apparent in the HA and NA, where the changes can result in antigenic drift. In some H5 and H7 viruses additional insertions of basic amino acids at the cleavage site of the HA can contribute to development of HP strains. It is noteworthy that the insertion of basic amino acids alone is not sufficient to make a H5 or H7 virus HP; this is a polygenic trait involving multiple polymerase (P) genes and other matrix (M) and nonstructural (NS) combinations, depending on the strain (Rott, 1980).

 

 

Also see

Ecology of Influenza Viruses

[Aggie]

Influenza viruses are classified by two major surface proteins: H (hemagglutinin) and N (neuraminidase). Almost all viruses in humans are H1N1 and H3N2. There are 16 known H types, and 9 known N types, and all of them are found in waterfowl. It's thought that migratory waterfowl are an important source of transmitting viruses over large geographic areas.

 

This is described well elsewhere, so I'm just going to copy it:

 

 

EVOLUTION OF INFLUENZA A VIRUSES IN WILD BIRDS1

 

Robert G. Webster2,3, Scott Krauss2, Diane Hulse-Post2 and Katharine Sturm-Ramirez2

 

 

Also see

Ecology of Influenza Viruses

 

Perry....

 

You definitely have the info here! Thanks!

 

May I ask what you do and/or what your education is? This is fascinating!

[Kay in Cal]

OK... so my question is... Perry? Are YOU worried?

 

(I know "the board" has great resources, but I didn't expect a zoogenic flu virus expert to be hanging out here)

[Perry]

Perry....

 

You definitely have the info here! Thanks!

 

May I ask what you do and/or what your education is? This is fascinating!

 

I'm trained as an infectious disease epidemiologist, and my past research included swine and avian influenza in people with occupational exposures to pigs and birds. I'm not working now though.

[klmama]

are you guys worried about the swine flue in Mexico?http://au.news.yahoo.com/a/-/newshome/5521820

 

Not particularly. I do think having a little Tamiflu onhand might be a good idea, as we do come into contact with people who visit Mexico often and have Mexican relatives come visit them. Otherwise, though, I'm not that concerned. I read recently that most of the deaths in the 1918 pandemic were probably caused by strep, not flu. Here's a link about that: http://www.msnbc.msn.com/id/29038301/

[Perry]

OK... so my question is... Perry? Are YOU worried?

 

(I know "the board" has great resources, but I didn't expect a zoogenic flu virus expert to be hanging out here)

 

 

 

Worried? Yes, but not panicked. I just had dh pick up a box of N-95 masks on his trip to Lowe's. :)

 

Things are happening very fast. That is always worrisome. OTOH, it could fizzle out and disappear. It's impossible to predict right now. Things should become more clear over the next few days, as they get a better handle on how easily it's spreading between humans and how extensive the spread is. The difference between the clinical presentations of the Americans vs. the Mexicans is puzzling. It doesn't seem to be related to a difference in medical care; the Americans have had a milder illness.

 

Pandemics have occurred every 10-40 years for at least the last century, so it's inevitable that we'll have another one.

 

It's been over 40 years since the last real pandemic, so we are due for one. While a pandemic usually results in elevated rates of severe disease and death, typically the elderly are affected disproportionally and children and adults don't usually die. What has everyone so nervous about the current situation is that all the deaths have been in young adults, which is similar to the pattern seen in the 1918 flu.

 

But like I said, it's too early to really know what's going on.

[Perry]

Not particularly. I do think having a little Tamiflu onhand might be a good idea, as we do come into contact with people who visit Mexico often and have Mexican relatives come visit them. Otherwise, though, I'm not that concerned. I read recently that most of the deaths in the 1918 pandemic were probably caused by strep, not flu. Here's a link about that: http://www.msnbc.msn.com/id/29038301/

 

 

It's an interesting idea, but it was simply a hypothesis put forward in a letter to the journal editor. There isn't really any evidence for it. It would be nice if it were true though, because we can treat strep.

[hillfarm]

Perry, if you get a chance, could you take a look at this home treatment protocol and let me know if you think it has any merit? I'm not particularly worried about this round of flu, but feel that we ought to be prepared in general, because sooner or later one will become an issue.

 

http://www.umt.edu/curry/HealthTopics/cold-and-Flu/supportive-treatment-for-flu-colds.html

 

TIA!

[Soph the vet]

I'm trained as an infectious disease epidemiologist, and my past research included swine and avian influenza in people with occupational exposures to pigs and birds. I'm not working now though.

Something tells me you may be getting called upon for some work soon?;)

 

Thanks for all the info. I defer to Perry on all swine flu virology questions from here on out.:D

[Blessedfamily]

Someone's probably already mentioned it (sorry I'm in the middle of painting), but on the news this AM they said Tamiflu works for this particular virus.

 

"The CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective."

 

http://www.comcast.net/articles/news-general/20090425/MED.Swine.Flu/

[angela in ohio]

I am concerned that if it hits here, we will run out of medication. When I had (regular old) influenza last year during a big outbreak here, we couldn't get Tamiflu locally for days.

[Only me]

If you have already had influenza this year it wouldn't protect you from getting another form would it? Would it increase your chances of getting the flu if you already had it?

 

My 14 year old dd had influenza last month and she was so sick with it-the worst she has been in her life. She was too weak to lift her head when she had to take her medicine or to even take a drink of water. I had to hold her head up for her. She doesn't even remember the first few days of her illness. She got the anti-viral right away but it still took a few days for her to get any better. I still don't think she is back 100%, although she was sick with another virus in February. She was pretty sick then and her doctor thought that perhaps she had the flu then but it was too late to take the test or the anti-viral meds. Of course at the time we had no idea that she would come down with the actual flu the next month and was 10 times sicker. She has also been struggling with insomnia for the past 6 months and is currently under the care of a sleep specialist for that. I just feel like her immune system is shot right now. This whole new flu bug really worries me.

[jensway]

Well CNN says that there are 2 confirmed cases in Kansas.

http://cnnwire.blogs.cnn.com/

 

MSNBC says 2 cases in Kansas and 8 likely in NYC.

http://www.msnbc.msn.com/id/30398682/

[unsinkable]

The vast majority of those deaths are in the elderly and immunocompromised. It is rare for a healthy adult to die of the flu.

 

All of the deaths from the current swine flu, so far, have been in adults age 25-45. That is extremely unusual.

 

 

And that is also what happened in the 1918 flu, right? Many of the dead were young adults?

[sassenach]

Perry, do you know what the incubating period on this strain is? I just spent the last 2 days with friends who spent Easter week serving in an orphanage in Mexico. I'm not exactly worried, but I am curious.

[Dee22]

Perry, do you know what the incubating period on this strain is? I just spent the last 2 days with friends who spent Easter week serving in an orphanage in Mexico. I'm not exactly worried, but I am curious.

 

NBC news said that it has a 1-2 day incubation period.

[HeatherInWI]

The last CDC report I saw said 2-5 days is most likely, but that the incubation period hasn't been determined for it yet.

[fivetails]

are you guys worried about the swine flue in Mexico?http://au.news.yahoo.com/a/-/newshome/5521820

 

I don't *want* to worry about it - because I tend to fixate on these sorts of things and darn near drove myself off the wall when the whole SARS thing went on a few years back, worrying about it. :bored: (That smiley's code reads "bored", but he doesn't LOOK bored to me. He looks like I looked when I was reading SARS updates late at night on my first 'puter. Eyes aren't quite as bloodshot though. blah!)

 

Yet.. I keep peeking in this thread & reading the links. Durrrr. Partly because the kids and I have a flight to take across country in three weeks to go back east for a visit and the whole airports/people from who knows where/carrying who knows what germs/yada yada ... well yeah. :bored:

[Peek a Boo]

(I know "the board" has great resources, but I didn't expect a zoogenic flu virus expert to be hanging out here)

 

LOL!

This is definitely a Very. Cool. Board.

 

Thanks to Perry et al. for the timely info! :D

[Tree House Academy]

I am not sure I ever gathered what caused the majority of deaths to be among the 20-40 age range in pandemic flu situations. Can someone better explain the why of that occurance?

[Matryoshka]

"The CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective."

 

Can these drugs be gotten OTC, or do you have to get them from a doctor? And can you get them just to have on hand, or do you have to be sick?

[Barb_]

I'm trained as an infectious disease epidemiologist, and my past research included swine and avian influenza in people with occupational exposures to pigs and birds. I'm not working now though.

 

Heh. You may be before it's all over.

 

Barb

[Blessedfamily]

Can these drugs be gotten OTC, or do you have to get them from a doctor? And can you get them just to have on hand, or do you have to be sick?

 

That's what I was wondering, too.

[BikeBookBread]

I am concerned. I live about 30 miles as the crow flies from the Mexican border. The city we live in is filled with illegals. We live in a nice typical American subdivision; and about 4 times a year, we wake up around 2:00 am to the sound of border patrol helicopters circling our area (we border the desert, and are in proximity to the interstate) presumably using their searchlights to find illegals who are caught out in the desert.

 

So yes, I'm concerned. You can't go anywhere on a daily basis here without coming into contact with Mexican nationals at restaurants, grocery stores, the park, public swimming pools, clinics, etc. I'm not making any political comments at all. I'm just saying that we are going to be exposed at some point...:( And should anyone ask how I know they are Mexican nationals (not illegals), we see Sonoran Mexico license plates all the time -- people come across the border to shop here at our malls, etc. (When we first moved here, we were stayed about a week at a nice all-suites type hotel as Base temp housing was full, and we saw tons of nice cars from Mexico at the hotel; they would come back in the evening absolutely loaded down with shopping bags from all the mall-type stores like Gap, Old Navy, Dillards, Macy's, etc.). To echo someone before -- I'm sure at some point, these same people with disposable income are going to come here seeking out good American health care at some point. Again, please understand, I'm not making any judgments here. If my family needed better healthcare and I had the means to achieve it this way, I'd seek it out myself, as I am sure many of you would, too.

Edited April 26, 2009 by BikeBookBread
more info...

[Shelly in the Country]

Considering they have confirmed cases of the swine flu in Kansas and California, and likely cases in New York and New Zealand, I'm guessing the possibility of containing things to Mexico is long, long gone. At this point we are all theoretically vulnerable no matter how far we are from the Mexican border. Setting aside illegal immigrant traffic or even Mexican citizens legitimately crossing the border for other reasons, we have US citizens and citizens of other countries travelling to Mexico for business and pleasure all the time (quite legally too). Since health officials in Mexico have been slow to figure out this was a particularly dangerous flu situation, there have been people travelling to and from Mexico in the interim who may have been exposed to this virus unknowingly. Even if we had the tighter border that many wish we did from a politcal standpoint, we would all still be vulnerable today. Unless folks wish to stop US citizens from crossing the border into Mexico as well.

[Pamela H in Texas]

I'm generally not concerned. I am sure I will be if this gets out of hand, but generally, I'm not. I can't do much about it anyway (nor do I do anything that would give me added exposure, I don't guess). I do hope the best for all the people who have contracted it so far or who might. I hate hearing of people hurt or sick anywhere in the world.

 

But I tell you. My first hearing about this happened the other day. Then it was either that evening or the next I have a little rumble in my chest and last night it was a little worse. This morning, it's just barely there (probably just worse at night). I hate getting any sort of cold right after hearing something like this!

Edited April 26, 2009 by 2J5M9K