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Influenza A (H1N1) 2009 Update
WHO Warns of Second Wave


1. The name Swine Flu (Novel A/H1N1) has been a controversial topic but it is important to know that the reason why it was called "Swine Flu" is because influenza viruses rarely jump from swine to humans with efficient transmission, the last time this happened was 1918. See: Novel A/H1N1: WHO Fact Sheet.

Note: The Novel A/H1N1: WHO Fact Sheet is in error stating that H1N1 virus was first isolated in the 1930's, while H1N1 was the cauative factor associated with the 1918 Pandemic:

Their research supports the hypothesis that the 1918 pandemic influenza virus and the virus causing the swine flu were the same. Richt said the virus was able to infect and replicate in swine and cause mild respiratory disease. The 1918 virus spread through the pig population, adapted to the swine and resulted in the current lineage of the H1N1 swine influenza viruses. The researchers' study is published in the May 2009 Journal of Virology. -- 1918 Flu Resulted In Current Lineage Of H1N1 Swine Influenza Viruses: Science Daily, 1 May 2009.

2. This strain has now demonstrated the capacity to be transmitted from Human to Swine. (1) suspect farm worker returns from Mexico begins working April 14, (2) 10 days later pigs exhibiting symptoms and (3) currently herd of 2,200 pigs infected. See: Alberta pig farm under flu quarantine: Calgary Herald, 3 May 2009; WHO urges close watch on farms for new swine flu: AFP, 3 May 2009.

Note: Swine are considered the mixing vessel, where reassortment and new strains can evolve... this is a natural process that has always occurred. The concern is not swine food production facilities with high biosecurity, but farms in the global regions with severe poverty (over 3 billion of the earths population) and no public health infrastructure. We are still awaiting the test results from pigs on the small back yard farms in the region associated with ground zero in Mexico.

In the context of surveillance, containment and control, our objective to realize access to molecular diagnostics capability to within 4 hours of any global population demographic with satellite links to reference labs and bioinformatics capability.

3. As this new strain (Novel A/H1N1) spreads and is transmitted to swine in regions across the globe with endemic high consequence strains in the ecosystem, the capacity for reassortment rises as does the evolution of a more pathogenic strain. Recombination analytics, concerns regarding geographic surveillance encompass:

* Pandemic H5N1: Endemic in Asia, atypical human infections considered widespread. See: "PRO/AH> Avian influenza, human (140): atypical infections" (ProMED: 20060905.2522: 05-SEP-2006).
* Ebola: Asymptomaic infection in Swine in the Philippines. See: IVPHC: Ebola-Reston, porcine - Philippines (06), FAO/OIE/WHO: Humanitarian Resource Institute, 27 December 2008.

4. If new highly pathogenic recombinant strain(s) evolve (Swine to Human with efficient Human to Human transmission), then the entire global emerging infectious disease picture will exponentially become more complicated. Ex. If a new strain picked up the characteristics of Pandemic H5N1 or West Nile virus, we could watch migratory birds contribute to global spread. Following the initial outbreak of West Nile Virus in New York City, the virus spread throughout North America by migratory birds within two years.

Collaborative efforts between veterinary and human medicine for surveillance, containment and control of this WHO Level 5 Pandemic Strain of Novel A/H1N1 (Swine Flu), is a priority.

Related:

* HRI: World News Updates and Background Discussions: Includes One Medicine (Human/Veterinary) updates and background discussions related to pandemic influenza and emerging infectious diseases from Pathobiologics International.

In the 1918–1919 pandemic, a first or spring wave began in March 1918 and spread unevenly through the United States, Europe, and possibly Asia over the next 6 months (Figure 1). Illness rates were high, but death rates in most locales were not appreciably above normal. A second or fall wave spread globally from September to November 1918 and was highly fatal. In many nations, a third wave occurred in early 1919 (21). Clinical similarities led contemporary observers to conclude initially that they were observing the same disease in the successive waves. The milder forms of illness in all 3 waves were identical and typical of influenza seen in the 1889 pandemic and in prior interpandemic years. In retrospect, even the rapid progressions from uncomplicated influenza infections to fatal pneumonia, a hallmark of the 1918–1919 fall and winter waves, had been noted in the relatively few severe spring wave cases. The differences between the waves thus seemed to be primarily in the much higher frequency of complicated, severe, and fatal cases in the last 2 waves. -- CDC: 1918 Influenza: the Mother of All Pandemics:*Armed Forces Institute of Pathology, Rockville, Maryland, USA; and †National Institutes of Health, Bethesda, Maryland, USA

Policy Progress during the last 24 hours:

The head of the World Health Organization warned in a newspaper interview that swine flu may re-emerge stronger than ever even if the current outbreak appears to be declining. Margaret Chan told Britain's Financial Times that an apparent decline in mortality rates did not mean the pandemic was coming to an end and a second wave may strike "with a vengeance." "If it's going to happen it would be the biggest of all outbreaks the world has faced in the 21st century," the business daily quoted her as saying. -- WHO chief warns of second wave of swine flu, AFP, 4 May 2009.

Crucial global surveillance of animal disease could be revised to include swine influenza in pigs because of its potential risk to human health, a World Health Organisation expert said Monday.... Phase one of the WHO pandemic flu alert system adopted just four years ago should be triggered when a potentially dangerous virus is detected among animals but no infections are reported in humans. With the new swine flu virus, the WHO jumped straight into phase four very swiftly after the outbreak was first announced in Mexico and the United States, because sustained human to human spread had been established. -- Permanent watch on pigs may be needed for flu, AFP, 4 May 2009.

ROME, May 4 (Xinhua) -- The Food and Agriculture Organization (FAO) said on Monday that national authorities and farmers should carefully monitor pigs and investigate any possible occurrences of influenza-like symptoms in domestic animals. -- FAO urges countries to closely monitor A/H1N1 in pigs: www.chinaview.cn, 2009-05-05 08:01:42