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  • Swine Flu May Not Be Any Deadlier This Fall: Experts

    Source: http://health.usnews.com/articles/he...l-experts.html

    Swine Flu May Not Be Any Deadlier This Fall: Experts
    Review of prior epidemics refutes theory that virus gets more severe
    Posted August 11, 2009

    By E.J. Mundell
    HealthDay Reporter

    TUESDAY, Aug. 11 (HealthDay News) -- The theory that a relatively mild outbreak of a new flu virus in the spring predicts a more severe, deadly outbreak in the fall isn't borne out by a look back at prior epidemics, two U.S. experts say.

    "Pandemic history suggests that changes neither in transmissibility nor in pathogenicity are inevitable," concluded Drs. David Morens and Jeffery Taubenberger, infectious disease experts at the U.S. National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

    In an article published in the Aug. 12 issue of the Journal of the American Medical Association, the experts take on a much-publicized theory that's helped stoke fears about a resurgence of swine flu in the Northern Hemisphere this fall.

    The so-called "herald wave" theory stems from the belief that the deadly 1918-19 flu pandemic began with a milder spring wave of illness, which got more deadly as the virus spread throughout the summer, picking up lethal mutations. The 1918-19 "Spanish Flu" is estimated to have killed between 20 million and 40 million people worldwide.

    However, while flu outbreaks were noted in Europe in the spring of 1918, no viruses from these outbreaks "have yet been identified," Morens and Taubenberger noted. And the actual course of the 1918 pandemic flu varied greatly around the world -- most areas experienced no "spring wave" at all, and the timing of successive waves changed between regions and even between countries, the researchers said.

    The two experts also broadened their review to look at 14 major flu epidemics that have swept the globe since the beginning of the 16th century.

    "In doing so, it is difficult to find evidence of 1918-like waves herald waves, or other such phenomena," they noted. The most recent flu pandemics, occurring in 1957 and 1968, "generally exhibited no more than one (mostly seasonal) recurrence" before settling down into relatively innocuous seasonal flu, they said.

    Overall, "examination of past pandemics reveals a great diversity of severity," Morens and Taubenberger said, adding that "some newer evidence [is] casting doubt on original herald wave theories."

    One infectious-disease expert called the new analysis "absolutely correct."

    Looking back at 20th century flu pandemics, "secondary waves have pretty much been either the same or even of less epidemiologic significance than the first wave," said Dr. Pascal James Imperato, dean of the school of public health at SUNY Downstate Medical Center in New York City.

    And as for the current H1N1 swine flu pandemic, the NIAID experts believe that the relatively poor transmissibility of the virus, the fact that many people have some pre-existing immunity, and its arrival in the Northern Hemisphere in late spring "all give reason to hope for a more indolent pandemic course and fewer deaths than in many past pandemics."

    Imperato concurred with that assessment. Swine flu is "still circulating," he said, "and that means that a lot of people have developed protection against it, plus we have the advantage that it's a descendant of other H1N1 viruses that were in circulation in the late '70s through the '80s, so older people have solid protection."

    "It's hard to conceive that if the H1N1 should reappear in the fall in the Northern Hemisphere that we would have a more severe epidemic," he said.

    This should come as good news as the United States gears up for the coming fall flu season. This week, volunteers began lining up at centers nationwide as the first swine flu vaccine trials began.

    "The best way to prevent the spread of the flu is vaccination," U.S. Department of Health and Human Services Secretary Kathleen Sebelius told reporters on Friday, "and our scientists are working hard to have a vaccine ready for consumption by mid-October."

    Over 120 million doses are expected to be delivered, with priority going to health-care workers, pregnant women and people with underlying health conditions, federal officials have said.

    Those efforts should be supported, Imperato said, even if the fall flu season turns out to be relatively benign.

    "I think it's prudent to do what is being done now. You prepare for the worst but hope for the best," he said.

    Find out the latest on H1N1 swine flu at the U.S. Centers for Disease Control and Prevention.

  • #2
    Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

    I sure wish the "experts" would make up their collective minds.

    I'd like to hear the explanation for the second "humps" in the chart below from a June 18, 2009 NEJM article.

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    Mortality Distributions and Timing of Waves of Previous Influenza Pandemics.

    Proportion of the total influenza-associated mortality burden in each wave for each of four previous pandemics is shown above the blue bars. Mortality waves indicate the timing of the deaths during each pandemic. The 1918 pandemic (Panel B) had a mild first wave during the summer, followed by two severe waves the following winter. The 1957 pandemic (Panel C) had three winter waves during the first 5 years. The 1968 pandemic (Panel D) had a mild first wave in Britain, followed by a severe second wave the following winter. The shaded columns indicate normal seasonal patterns of influenza.

    .
    "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

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    • #3
      Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

      Harsh second H1N1 wave not inevitable: U.S. experts
      Tue Aug 11, 2009 5:50pm EDT
      By Julie Steenhuysen

      CHICAGO (Reuters) - U.S. health officials are gearing up for the return this fall of the H1N1 swine flu virus that has sparked a global pandemic, but some government scientists say a second, potentially more severe wave of disease is not inevitable.

      "Every influenza pandemic writes its own rules as it progresses," Dr. David Morens of the National Institute of Allergy and Infectious Diseases, part of the U.S. National Institutes of Health, said in a telephone interview on Tuesday.

      Writing in the Journal of the American Medical Association, Morens and colleague Dr. Jeffrey Taubenberger said there is not enough evidence to conclude that the relatively mild spring wave of H1N1 flu is a harbinger of a more severe outbreak.

      He said the common belief that severe flu pandemics are preceded by a milder wave of illness arose because of some accounts of the 1918-1919 "Spanish" flu pandemic that killed between 40 million and 100 million people.

      The team analyzed 14 global or regional flu pandemics during the past 500 years and found past pandemics patterns vary widely. They said two other flu pandemics in the 20th century -- in 1957 and 1968 -- made just a single, seasonal appearance, and generally did not become significantly more serious in the early years of their circulation.

      "Whatever happened in 1918 and 1919 for whatever reason was pretty clearly a one-off event. It's the only time in the 500 years that that pattern occurred," Morens said.

      'HARD TO SAY'

      The current H1N1 flu outbreak, declared a pandemic on June 11, has spread around the world since emerging in April and could eventually affect 2 billion people, according to estimates by the U.N. World Health Organization.

      "We do think -- everybody thinks -- the virus will come back in the (northern hemisphere) fall," Morens said.

      "Beyond that, it's hard to say what will happen -- whether it will be more severe, less severe or just the same. If you look at past pandemics, any one of those things happened at a particular time," he said.

      He said the possibility that some older people might have pre-existing immunity raises the hope that the current pandemic will cause fewer deaths than some past pandemics.

      Companies are working to make a vaccine to protect people from the new swine flu, and people lined up at clinical trial sites this week to test it at many research centers across the United States.

      The WHO said last week the first vaccines to combat H1N1 swine flu should be approved and ready for use in some countries starting in September.

      Leading flu vaccine makers include Sanofi-Aventis, GlaxoSmithKline, Novartis, Baxter, CSL and Solvay.

      (Editing by Will Dunham)

      http://www.reuters.com/article/inter...57A5ZY20090811

      Comment


      • #4
        Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

        Public release date: 11-Aug-2009
        [<SCRIPT language=javascript type=text/javascript><!--document.write('Print ');// --></SCRIPT> Print | E-mail <!-- AddThis Button BEGIN --><SCRIPT type=text/javascript>var addthis_pub="eurekalert"; var addthis_options = "favorites, delicious, digg, facebook, google, newsvine, reddit, slashdot, stumbleupon, buzz, more"</SCRIPT>| Share<SCRIPT type=text/javascript src="http://s7.addthis.com/js/200/addthis_widget.js"></SCRIPT> <!-- AddThis Button END -->]<SCRIPT language=javascript type=text/javascript><!--document.write(' [ Close Window ]');// --></SCRIPT> [ Close Window ]

        Contact: NIAID Office of Communications
        niaidnews@niaid.nih.gov
        301-402-1663
        NIH/National Institute of Allergy and Infectious Diseases

        NIAID scientists study past flu pandemics for clues to future course of 2009 H1N1 virus

        Flu viruses notoriously unpredictable; robust pandemic preparedness efforts crucial

        A commonly held belief that severe influenza pandemics are preceded by a milder wave of illness arose because some accounts of the devastating flu pandemic of 1918-19 suggested that it may have followed such a pattern. But two scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, say the existing data are insufficient to conclude decisively that the 1918-19 pandemic was presaged by a mild, so-called spring wave, or that the responsible virus had increased in lethality between the beginning and end of 1918. Moreover, their analysis of 14 global or regional influenza epidemics during the past 500 years reveals no consistent pattern of wave-like surges of disease prior to the major outbreaks, but does point to a great diversity of severity among those pandemics.
        In their commentary in the Aug. 12 issue of the Journal of the American Medical Association, David M. Morens, M.D., and Jeffery K. Taubenberger, M.D., Ph.D., note that the two other flu pandemics of the 20th century, those of 1957 and 1968, generally showed no more than a single seasonal recurrence; and in each case, the causative virus did not become significantly more pathogenic over the early years of its circulation.
        The variable track record of past flu pandemics makes predicting the future course of 2009 H1N1 virus, which first emerged in the Northern Hemisphere in the spring of 2009, difficult. The authors contend that characteristics of the novel H1N1 virus, such as its modest transmission efficiency, and the possibility that some people have a degree of pre-existing immunity give cause to hope for a more indolent pandemic course and fewer deaths than in many past pandemics.
        Still, the authors urge that the 2009 H1N1 virus continue to be closely tracked and studied as the usual influenza season in the Northern Hemisphere draws near. Like life, the authors conclude, paraphrasing Danish philosopher Soren Kierkegaard, "influenza epidemics are lived forward and understood backward." Thus, the robust, ongoing efforts to meet the return of 2009 H1N1 virus with vaccines and other measures are essential responses to a notoriously unpredictable virus.http://www.eurekalert.org/pub_releas...-nss081109.php
        CSI:WORLD http://swineflumagazine.blogspot.com/

        treyfish2004@yahoo.com

        Comment


        • #5
          Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

          Originally posted by Shiloh View Post

          And as for the current H1N1 swine flu pandemic, the NIAID experts believe that the relatively poor transmissibility of the virus, the fact that many people have some pre-existing immunity, and its arrival in the Northern Hemisphere in late spring "all give reason to hope for a more indolent pandemic course and fewer deaths than in many past pandemics."
          Hmm.. that's news to me and my family! Perhaps in comparison to other awful diseases in history, like smallpox, but from personal experience it seems to be more virulent than seasonal flu.

          One of our babies got sick from a doctor office At least 12 hours since any potential sick patient was in there. Baby 1 got sick, probably from trying to chew on office equipment?

          Baby 2 got sick almost two days later, from baby 1. Probably from trying to chew on baby 1 or steal baby 1 pacifier.

          Spouse got sick 21/2-3 days after baby 1 fell ill. is still sick.

          I haven't gotten sick, but I'm a germiphobe and am on tamiflu for 10 days. Verdict isn't out yet as to if I will catch it this time or not.

          If seasonal flu is supposed to have a 10% secondary attack rate, explain to me how 75% of a household falling ill within a week is "poor transmissibility"?

          Perhaps we are an exception to the rule, but i doubt it.

          Comment


          • #6
            Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

            Originally posted by Desolation_anonymous View Post
            Hmm.. that's news to me and my family! Perhaps in comparison to other awful diseases in history, like smallpox, but from personal experience it seems to be more virulent than seasonal flu.

            One of our babies got sick from a doctor office At least 12 hours since any potential sick patient was in there. Baby 1 got sick, probably from trying to chew on office equipment?

            Baby 2 got sick almost two days later, from baby 1. Probably from trying to chew on baby 1 or steal baby 1 pacifier.

            Spouse got sick 21/2-3 days after baby 1 fell ill. is still sick.

            I haven't gotten sick, but I'm a germiphobe and am on tamiflu for 10 days. Verdict isn't out yet as to if I will catch it this time or not.

            If seasonal flu is supposed to have a 10% secondary attack rate, explain to me how 75% of a household falling ill within a week is "poor transmissibility"?

            Perhaps we are an exception to the rule, but i doubt it.
            These "studies" are just hand waving. Swine jumped to humans in 1918 and 2009. The others just create confusion. Swine into humans is a problem.

            (Note that one of the "experts" said 1918 was avian when it looked like H5N1 was going to break out in 2005, and now he now says 1918 is swine AFTER swine has broken out in 2009).

            The DATA always said swine

            Comment


            • #7
              Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

              You know, most people are already not taking H1N1 seriously. This article will allow them to remain with their heads in their orifice.
              But Prince Prospero was happy and dauntless and sagacious. -Poe

              Also known as CRH-land

              Comment


              • #8
                Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                Originally posted by Legadillo View Post
                You know, most people are already not taking H1N1 seriously. This article will allow them to remain with their heads in their orifice.
                As a criminologist, does factual evidence have any import in your decision making?

                Just curious based on the above post, that seems to have reached a conclusion about a lot of folks that have worked really hard to track the progress of this virus and its affect on the world population.

                Comment


                • #9
                  Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                  I just wish people would stop comparing apples to oranges!

                  For the love God, of course stuff in the 16th century didn't work the same as it does now! With only a fraction of the current population and global travel that was laughably slow compared to now! These comparison's cant produce more than 10% relevance in a situation like this.

                  Comment


                  • #10
                    Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                    Originally posted by Pirante View Post
                    I just wish people would stop comparing apples to oranges!

                    For the love God, of course stuff in the 16th century didn't work the same as it does now! With only a fraction of the current population and global travel that was laughably slow compared to now! These comparison's cant produce more than 10% relevance in a situation like this.
                    What about the wonderful surveillance?
                    Wotan (pronounced Voton with the ton rhyming with on) - The German Odin, ruler of the Aesir.

                    I am not a doctor, virologist, biologist, etc. I am a layman with a background in the physical sciences.

                    Attempting to blog an nascent pandemic: Diary of a Flu Year

                    Comment


                    • #11
                      Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                      plan for the worst hope for the best....
                      IAFF 1526

                      Comment


                      • #12
                        Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                        It seems to this non-scientist that even if the virus is not more pathogenic, or more virulent, that the change in climate and the return to school of millions of children could cause significant problems this fall. It also seems to me to be a best case scenario. Also, with a novel virus, estimates from 30-50&#37; percent of the population could become infected. CDC said 1 million a few weeks ago. If we guess (and that's what is is) that now 3 million have been infected, that still leaves a lot of 'susceptibles' for the coming fall. (3 million is only 1% the population).

                        If CDC is planning for a more severe situation, then I commend them for doing so.

                        JMHO - Snick

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                        • #13
                          Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                          And I second Snicklefritz as most of the time.

                          Snowy

                          Comment


                          • #14
                            Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                            Morens and Taubenberger don't paint as optimistic a picture in this "other" paper they wrote together. They clearly discuss wave patterns too.

                            http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm
                            Old Mother Goose
                            when she wanted to wander,
                            would fly through the air
                            on a very fine Gander...

                            Comment


                            • #15
                              Re: Swine Flu May Not Be Any Deadlier This Fall: Experts

                              Originally posted by littlebird View Post
                              Morens and Taubenberger don't paint as optimistic a picture in this "other" paper they wrote together. They clearly discuss wave patterns too.

                              http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm
                              H1N1, like H5N1, is ALL about politics - no science required.

                              Comment

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