Last week, I blogged about the possibilities of swine H1N1 to graft other genes onto its genetic construction. I have mentioned my concern that swine H1N1 could, in fact, easily pick up the amino acid combo which, in the aggregate, represents the Tamiflu Resistance Gene.
I also alluded to the potential for swine H1N1 to take a victory lap around the world and reassort with our old friend H5N1. Now I mentioned this only in passing. The reason should be obvious: A number of persons believe this whole H1N1 thing is either a gross overreaction by public health professionals, and/or a ploy by the Obama Administration to advance its public health agenda.
It is neither, although every time I hear an Obama official even mention health care "homes" in the same breath as H1N1, I cringe, because they need to put the Rahm Emanuel playbook down ("Rule 1: Never allow a crisisto go to waste") during this entire evolving event. It is important to know that the Obama Administration is essentially running the Bush playbook on the management of this epidemic, and they have acknowledged as much and have been publicly grateful for its existence. So far, I have not seen any major mistakes, mea culpas or blown calls in the response to this unfolding situation out of Washington, excepting the Vice-President-in-charge-of-embarrassing-gaffes and soon to be Lame Duck, Joe Biden. And even he was saying what everyone else was thinking, I suppose. Still, as a recovering politician myself, I am amazed at this guy's lack of an "internal quip governor" (think NASCAR restrictor plate) and how Obama allowed him to get on the ticket.
But I digress. Back to the issue at hand, namely reassortment. Bloggers have been understandably reluctant to stray too far into joining swine H1N1 with avian H5N1. But when the world's leading influenza expert -- the "Pope of Influenza," Dr. Robert G. Webster of St. Jude in Memphis -- comes out and says what everyone else in Flublogia is thinking, I think it warrants a good blog.
Dr. Webster has dedicated his entire adult life to the understanding of influenza. He has learned much, but each answer generates a whole new set of questions. He, Edwin Kilbourne, John Oxford, and the late Graeme Laver stand as the true giants of modern influenza research. Upon their footpaths walk Kawaoka, Peiris, Webby (like Peiris, a protege of Webster) and others.
Kawaoka has taken some ribbing from this Blogger in the past, but let me assure you he knows his stuff and the world is a better place with him and all his skills on board.
When Webster talks, or even speculates, it is by definition informed, and we should do the old E. F. Hutton commercial and listen. Today, an AP article -- one of the best-researched I have read in quite some time -- speaks of the opportunity for swine H1N1 to reassort with avian H5N1 and produce -- something. One treat is that it quotes from three of the best-known names on the influenza front, which is always fun.
I will give the article and its link later. What I want to talk about now is the situation in Egypt, and why the Egyptian government made the controversial move to slaughter all its pigs virtually overnight. Something feels Biblical in that decision, you know. It was met with hostility and violent demonstrations across the nation. Only Christians eat pork there, and the hogs slaughtered were destined only for Egyptian Christian dinnertables.
But I believe the Egyptian government had its own experience and that of Indonesia on its mind when it made the decision. The Egyptian government has been looking for a reason to wipe out the hog population since 2008, because there was and is growing concern that Egyptian pigs had become reservoirs for H5N1. Search "Egypt" on my blogsite to find everything of consequence that has happened in that country, flu-wise, since 2006. I'll wait. Especially read my January, 2008 blog here. It has a pretty graphic, too.
Short form: The Egyptian government is scared to death that H1N1 will come around and reassort with H5N1, which they believe to possibly be endemic in their pig population. And if you look at the continuing increase in suspected and confirmed Egyptian H5N1 human bird flu cases, I think you'd agree there is much to be concerned about.
Likewise, the situation in Indonesia and in China also involoves informed speculation on behalf of animal and human influenza researchers that H5N1 may have made a small foothold in the hog populations there. Especially Indonesia, which remains Bird Flu Central for human cases and potential pandemic explosion, despite the competition from ongoing Egyptian human infections. Researchers already know that some 20% of the stray cat population in Indonesia has H5N1 antibodies. Likewise, some hogs in Indonesia have tested positive for H5N! antibodies. From the Website FluWiki, from2006:
Cat H5N1 sequences in Indonesia are apparently more similar to H5N1 sequences from humans than either are to H5N1 sequences from birds. What is the most logical interpretation of these results? I submit that there may be a mammalian reservoir for H5N1 in Indonesia and other countries and that H5N1 is under selection to adapt to mammals in this reservoir. Further, at least some of the human cases may be due to mammal-to-human infections. (See also Dr. Jeremijenko’s post at 23:14 in this thread, and here and here). In the recent large cluster of human cases in Indonesia, no infections of poultry were found in close proximity to the village where the outbreak occured. However, pigs with antibodies to H5N1 were found in this region reference. H5N1 infections in pigs would be particularly worrisome as these animals could serve as mixing vessels for the formation of a human-adapted H5N1 strain. (bold mine)
That is what everyone is worried about. That is the Elephant in the Room. That is why no one in Geneva, Atlanta or anywhere else is overreacting about this swH1H1 epidemic.
Now it is time to bring in the AP story. Here it is, in its entirety.
By MARGIE MASON, AP Medical Writer Margie Mason, Ap Medical Writer 2hrs29minsago
MEXICO CITY – Bird flu kills more than 60 percent of its human victims, but doesn't easily pass from person to person. Swine flu can be spread with a sneeze or handshake, but kills only a small fraction of the people it infects.
So what happens if they mix?
This is the scenario that has some scientists worried: The two viruses meet — possibly in Asia, where bird flu is endemic — and combine into a new bug that is both highly contagious and lethal and can spread around the world.
Scientists are unsure how likely this possibility is, but note that the new swine flu strain — a never-before-seen mixture of pig, human and bird viruses — has shown itself to be especially adept at snatching evolutionarily advantageous genetic material from other flu viruses.
"This particular virus seems to have this unique ability to pick up other genes," said leading virologist Dr. Robert Webster, whose team discovered an ancestor of the current flu virus at a North Carolina pig farm in 1998.
The current swine flu strain — known as H1N1 — has sickened more than 2,300 people in 24 countries. While people can catch bird flu from birds, the bird flu virus — H5N1 — does not easily jump from person to person. It has killed at least 258 people worldwide since it began to ravage poultry stocks in Asia in late 2003.
The World Health Organization reported two new human cases of bird flu on Wednesday. One patient is recovering in Egypt, while another died in Vietnam — a reminder that the H5N1 virus is far from gone.
"Do not drop the ball in monitoring H5N1," WHO Director-General Margaret Chan told a meeting of Asia's top health officials in Bangkok on Friday by video link. "We have no idea how H5N1 will behave under the pressure of a pandemic."
Experts have long feared that bird flu could mutate into a form that spreads easily among people. The past three flu pandemics — the 1918 Spanish flu, the 1957-58 Asian flu and the Hong Kong flu of 1968-69 — were all linked to birds, though some scientists believe pigs also played a role in 1918.
Webster, who works at St. Jude's Children's Research Hospital in Memphis, Tenn., said bird flu should be a worry now. Bird flu is endemic in parts of Asia and Africa, and cases of swine flu have already been confirmed in South Korea and Hong Kong.
"My great worry is that when this H1N1 virus gets into the epicenters for H5N1 in Indonesia, Egypt and China, we may have real problems," he told The Associated Press. "We have to watch what's going on very diligently now."
The U.S. Centers for Disease Control and Prevention are extraordinarily busy trying to understand the swine flu virus itself, and haven't had time to break off staff to look at the possibility of a swine flu-bird flu mix, spokesman Dave Daigle said.
Malik Peiris, a flu expert at Hong Kong University, said the more immediate worry is that swine flu will mix with regular flu viruses, as flu season begins in the Southern Hemisphere. It is unclear what such a combination would produce.
But he said there are indications that scenario is possible. Peiris noted that the swine flu virus jumped from a farmworker in Canada and infected about 220 pigs. The worker and the pigs recovered, but the incident showed how easily the virus can leap to a different species.
"It will get passed back to pigs and then probably go from pigs to humans," Peiris said. "So there would be opportunities for further reassortments to occur with viruses in pigs."
He said so far bird flu hasn't established itself in pigs — but that could change.
"H5N1 itself has not got established in pigs," he said. "If that were to happen and then these two viruses were both established in pigs in Asia, that would be quite a worrying scenario."
Michael Osterholm, an infectious disease specialist at the University of Minnesota who has advised the U.S. government on flu preparations, said while flu experts are discussing the scenario, he has yet to see specific evidence causing him to think it will happen.
"Everything with influenza is a huge guessing game because Mother Natureholds all the rules, and we don't even know what they are, so anything's possible," he said. "We don't have any evidence that this particular reassortment is that much more likely to pick up H5N1 than any other reassortment out there."
"We don't have to put these things together," he added. "This is not chocolate and peanut butter running into each other in the dark hallway."
But there is in fact discussion of putting them together — in a high-security laboratory — to see what a combination would look like, according to Webster. Similar tests have been done at the CDC mixing bird flu and seasonal human flu, resulting in a weak product, he said.
Daigle, the CDC spokesman, said the agency wants to look at the question in the future.
Webster has done groundbreaking work on both swine and bird flus in his 40-year career, and has followed the evolution of the current swine flu strain from a virus that sickened a handful of people who worked with North Carolina hogs into a bug that has spread from person to person around the world.
He is closely involved in the global effort to analyze what the virus might do next. It has killed 42 people in Mexico and two in Texas, but so far has not proven very deadly elsewhere, leading to some criticism that the World Health Organization's warnings of a potential pandemic have been overblown.
Webster said underestimating the swine flu virus would be a huge mistake.
"This H1N1 hasn't been overblown. It's a puppy, it's an infant, and it's growing," he said. "This virus has got the whole human population in the world to breed in — it's just happened. What we have to do is to watch it, and it may become a wimp and disappear, or it may become nasty."
AP Medical Writer Maria Cheng in London contributed to this report.
So there you go. I hope wimp, but no one knows what it will do eventually. However, it is this worry that, I believe, has led the Egyptian government to do what it could not do last year; namely, slaughter the mixing vessels of influenza. They do not want the Next Pandemic to start on their doorstep. In that regard, and now knowing what you know, let me ask you: Have they made the correct decision?