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http://www.theglobeandmail.com/news...targets-the-young-and-healthy/article1223109/
Flu disproportionately targets the young and healthy
Argentinian Health Minister Juan Manzur checks at Ezeiza international airport a shipment of 100.000 dosages of oseltamivir, the drug to treat Influenza A (H1N1) on July 10, 2009 in Buenos Aires. The Argentine government stipulated a sanitary holiday this Friday in the struggle to contain the spread of the A (H1N1) virus (swine flu) in the country.
New government figures show median age of those infected in Canada is only 18, hinting at unpredictable nature of the H1N1 virus
Caroline Alphonso and Gloria Galloway
Toronto and Ottawa — From Saturday's Globe and Mail Last updated on Saturday, Jul. 18, 2009 03:36AM EDT
<!-- /#credit --> The median age of Canadians infected with pandemic influenza is only 18 and, among those hospitalized, is 21 years old, according to newly released government figures that paint a picture of just how disproportionately the H1N1 virus affects young adults.
While answers are still lacking as to why youth have been affected by the H1N1 virus, health officials are considering the possibility that while young people have been exposed to other flu strains, they don't respond as well to H1N1 as older people whose first experience was with this strain.
“This kind of data pinpoints the ones that are going to have the most disease, and will also be incubators of disease to pass on to others,” said Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital. “It really targets who is at greatest risk, because when a vaccine becomes available, if it becomes available in limited amounts, I think we have to identify high-risk categories.”
The pandemic virus, which slipped into a place where no one was looking for it, in a form that no one expected and swept the globe with unprecedented speed, has challenged all assumptions on what a pandemic would look like – including the age group it would primarily infect.
Health officials have been astounded to see the ferocity with which the virus has attacked the young and healthy, pregnant women and the aboriginal population.
Data released Friday by the Public Health Agency of Canada showed that the median age of the First Nations population infected with H1N1 (19 years old) was similar to the rest of Canada. But Inuit cases were much younger with a median age of nine years. That's likely because Nunavut, which is 85 per cent Inuit, has a younger population compared with the rest of Canada, the agency said.
Canada completed its 500-page pandemic plan in 2006, a document created during years of debate about the deadly potential of avian influenza. But, when the virus finally arrived in April, it was swine flu and not the “bird flu” that had been predicted throughout the plan.
“This thing has not followed any of the rules. It obviously didn't read the pandemic plan that we had formulated,” Dr. Low said.
The pandemic influenza was supposed to turn up in a small village in Indonesia. The World Health Organization would quickly discover that there was a new virus being transmitted from person-to-person. The international community would respond by bringing in antiviral agents and dispending them to everyone in the area in an effort to contain the disease. One infected person would slip beyond the ring, bringing the virus to the rest the world.
In Canada, it would first take hold in British Columbia, giving Ontario, Quebec and the east coast months to prepare by distributing antivirals to the highest risk groups.
It would take its greatest toll on the elderly. The health-care system would be stretched to the limit, between 20 to 30 per cent of the population would be infected, and large parts of the workforce would be felled.
“But it would be over in about 12 weeks,” Dr. Low said. “And then we would get back to normal, we would have a post-pandemic reassessment time, we would look at how well we did knowing that in about six months it might come back again and that we would be even better prepared.”
None of which came to fruition.
The virus was first discovered in a small town in Mexico. By the time health authorities understood its pandemic potential, it was circulating freely through Mexican villages, United States, and there were probably even unrecognized cases in Canada.
“We had absolutely no hope of containment,” Dr. Low said. “The good news was that it was a relatively mild virus, it continues to be a relatively mild virus.”
David Butler-Jones, Canada's chief medical officer of health, said the biggest surprise for him was that the virus that turned pandemic was an H1N1 – the same type that killed as many as 50 million people worldwide in 1918. The H1N1 virus was recently seen in 1976, when army recruits at Fort Dix, Md., fell ill with influenza caused by a swine flu virus.
Most experts had predicted the next pandemic would be something unlike anything seen before – an H7 or an H8 perhaps.
“Rounding back to an H1 that is sufficiently different for most of us [to not have developed immunity] was not highly expected,” said Dr. Butler-Jones.
Still, the pandemic planning hasn't been thrown out the window.
“There are still some areas of commonality that are serving us well,” said Danuta Skowronski, an epidemiologist with the B.C. Centre for Disease Control. “For instance, even just the guiding principle: be prepared for the unexpected, don't let your guard down, interrogate this virus.”
The planning told doctors to monitor for serious outcomes, watch for the possibility of antiviral resistance, be alert for changes in the virus, and be aware that the age groups that are most affected may not be those that are seen with seasonal influenza, she said.
Dr. Butler-Jones said Friday that the federal government is now doing a weekly analysis – as opposed to releasing numbers three times a week – to capture unusual activities, such as increased hospitalization.
“The goal of surveillance is to assess the impact of the H1N1 flu virus on our communities, so that we can adapt our planned responses to the situation at hand,” he said.
“If we start seeing increases, then that may indicate that in fact we're into the next wave.”
Flu disproportionately targets the young and healthy
New government figures show median age of those infected in Canada is only 18, hinting at unpredictable nature of the H1N1 virus
Caroline Alphonso and Gloria Galloway
Toronto and Ottawa — From Saturday's Globe and Mail Last updated on Saturday, Jul. 18, 2009 03:36AM EDT
<!-- /#credit --> The median age of Canadians infected with pandemic influenza is only 18 and, among those hospitalized, is 21 years old, according to newly released government figures that paint a picture of just how disproportionately the H1N1 virus affects young adults.
While answers are still lacking as to why youth have been affected by the H1N1 virus, health officials are considering the possibility that while young people have been exposed to other flu strains, they don't respond as well to H1N1 as older people whose first experience was with this strain.
“This kind of data pinpoints the ones that are going to have the most disease, and will also be incubators of disease to pass on to others,” said Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital. “It really targets who is at greatest risk, because when a vaccine becomes available, if it becomes available in limited amounts, I think we have to identify high-risk categories.”
The pandemic virus, which slipped into a place where no one was looking for it, in a form that no one expected and swept the globe with unprecedented speed, has challenged all assumptions on what a pandemic would look like – including the age group it would primarily infect.
Health officials have been astounded to see the ferocity with which the virus has attacked the young and healthy, pregnant women and the aboriginal population.
Data released Friday by the Public Health Agency of Canada showed that the median age of the First Nations population infected with H1N1 (19 years old) was similar to the rest of Canada. But Inuit cases were much younger with a median age of nine years. That's likely because Nunavut, which is 85 per cent Inuit, has a younger population compared with the rest of Canada, the agency said.
Canada completed its 500-page pandemic plan in 2006, a document created during years of debate about the deadly potential of avian influenza. But, when the virus finally arrived in April, it was swine flu and not the “bird flu” that had been predicted throughout the plan.
“This thing has not followed any of the rules. It obviously didn't read the pandemic plan that we had formulated,” Dr. Low said.
The pandemic influenza was supposed to turn up in a small village in Indonesia. The World Health Organization would quickly discover that there was a new virus being transmitted from person-to-person. The international community would respond by bringing in antiviral agents and dispending them to everyone in the area in an effort to contain the disease. One infected person would slip beyond the ring, bringing the virus to the rest the world.
In Canada, it would first take hold in British Columbia, giving Ontario, Quebec and the east coast months to prepare by distributing antivirals to the highest risk groups.
It would take its greatest toll on the elderly. The health-care system would be stretched to the limit, between 20 to 30 per cent of the population would be infected, and large parts of the workforce would be felled.
“But it would be over in about 12 weeks,” Dr. Low said. “And then we would get back to normal, we would have a post-pandemic reassessment time, we would look at how well we did knowing that in about six months it might come back again and that we would be even better prepared.”
None of which came to fruition.
The virus was first discovered in a small town in Mexico. By the time health authorities understood its pandemic potential, it was circulating freely through Mexican villages, United States, and there were probably even unrecognized cases in Canada.
“We had absolutely no hope of containment,” Dr. Low said. “The good news was that it was a relatively mild virus, it continues to be a relatively mild virus.”
David Butler-Jones, Canada's chief medical officer of health, said the biggest surprise for him was that the virus that turned pandemic was an H1N1 – the same type that killed as many as 50 million people worldwide in 1918. The H1N1 virus was recently seen in 1976, when army recruits at Fort Dix, Md., fell ill with influenza caused by a swine flu virus.
Most experts had predicted the next pandemic would be something unlike anything seen before – an H7 or an H8 perhaps.
“Rounding back to an H1 that is sufficiently different for most of us [to not have developed immunity] was not highly expected,” said Dr. Butler-Jones.
Still, the pandemic planning hasn't been thrown out the window.
“There are still some areas of commonality that are serving us well,” said Danuta Skowronski, an epidemiologist with the B.C. Centre for Disease Control. “For instance, even just the guiding principle: be prepared for the unexpected, don't let your guard down, interrogate this virus.”
The planning told doctors to monitor for serious outcomes, watch for the possibility of antiviral resistance, be alert for changes in the virus, and be aware that the age groups that are most affected may not be those that are seen with seasonal influenza, she said.
Dr. Butler-Jones said Friday that the federal government is now doing a weekly analysis – as opposed to releasing numbers three times a week – to capture unusual activities, such as increased hospitalization.
“The goal of surveillance is to assess the impact of the H1N1 flu virus on our communities, so that we can adapt our planned responses to the situation at hand,” he said.
“If we start seeing increases, then that may indicate that in fact we're into the next wave.”
