HEADLINE: The flu had everyone worried, and that could be a good thing

SUMMARY: Swine flu has been a significant wake-up call that a pandemic can happen. The swine flu outbreak, whether it worsens or not, has been a valuable test of U.S. pandemic preparedness. Fortunately the country has taken many measures to prepare for a potential outbreak since SARS.

STORY LINK: http://online.wsj.com/article/SB124173064988697773.html

ANALYSIS: As the world -- or at least the media – breathes a collective sigh of relief, the ordinary citizen is left to wonder “What was that all about?”  Influenza A/H1N1 burst upon the scene, causing fear of pandemic and something bordering on panic, including banning of pork products and wholesale slaughtering of pigs in some places.  Less extreme reactions ranged from closing of schools to cancellations of meeting or travel to asking people who had been exposed to refrain from coming to class or work.  Now that flu has fallen off the front page, where does that leave us?  Good question.

The unusual spring outbreak highlighted both positives and negatives.  While far from perfect, the level of communication among the world’s public health community appears to have worked.  The spread of this highly communicable disease has been less rapid than feared, and the death toll has been remarkably low outside of Mexico.  On the down side, the weaknesses in our worldwide ability to combat even seasonal influenza have once again been exposed.  Rapid worldwide travel opens the door for spread of disease beyond historic patterns; SARS and H1N1 became intercontinental almost immediately.  The approximately six-month cycle to produce flu vaccine has begun, but the annual trivalent immunization does not include the current strain; the eventual vaccine will largely be an either/or product.  Worldwide seasonal flu vaccine production capacity is approximately 900 million doses.  Health officials project this can be expanded to 1 to 2 billion doses for an H1N1 pandemic, for a global population of 6.8 billion people.  Of this, the United States has contractual commitments for 600 million of those doses. Moreover, the expansion of vaccine production for H1N1 would come at the expense of the seasonal vaccine.

Between the positives and negatives lie the unknowns.  What caused this unusual spring outbreak?  Why was the death toll so high in Mexico?  And why was it among the young and seemingly healthy, not the typical at-risk population for flu?  Perhaps most importantly, what will the virus do next?  There is scant historical precedence upon which to base a prediction, the 1918-19 pandemic being among the most cited.  In that outbreak, the spread abated following the initial wave, only to return with a more virulent strain in the autumn.  There is simply no way to know if the 2009-10 flu season will follow that pattern.

The greatest danger is complacency, either as a “boy who cried wolf’” reaction or as a result of fear fatigue, the cumulative impact of multiple, unfulfilled warnings of imminent danger.  Maybe we have seen the last of this influenza outbreak, and perhaps not.  One thing is certain:  the flu will be back in the fall.  Even if it is not this “swine flu,” the seasonal influenza outbreak is bad enough.  The U.S. and Canada experience some 36,000 and 8,000 deaths, respectively, from complications of seasonal influenza.  Businesses, families, and individuals should be prepared; the next flu outbreak just may be the one we have feared.

--Donald A. Donahue, Director of NSHPC

HEADLINE: China reports first case of swine flu

SUMMARY:
A 30-year-old man who flew last week from St. Louis to Chengdu has been confirmed with China’s first case of swine flu, the Health Ministry said. Chengdu city officials said they had located and quarantined more than 130 of the estimated 150 other passengers who had traveled with the infected man on a connecting flight from Beijing to the capital of Sichuan Province. The Health Ministry said his itinerary began in St. Louis and took him through St. Paul, Minn., Tokyo and Beijing.  Separately, the Health Ministry isolated seven people who had flown to Beijing and Shanghai after traveling to Tokyo on a flight with an infected passenger.

STORY LINK:
http://www.nytimes.com/2009/05/12/world/asia/12flu.html?_r=1&ref=global-home

ANALYSIS:
China is the "home" of new flu strains, but I was always expecting it to reach there anyway, so my view hasn't changed. It is a pandemic moving faster than WHO claims. The question is will it mutate into a bad form by fall? No one knows what the chances are for that to happen.

--Dr. Steve Cunnion