Swine flu pandemic over? Far from over.
Scott McPherson
in Politics and government, influenza and infectious diseases
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7 Comments
Happy New Year to readers of this blog, who have been doubtless wondering if I have fallen off the planet somehow. A combination of holiday mirth, coupled with a Special Legislative Session and a few days out of town, left me with little time to blog. On top of that, I have not seen much reason to blog. As I have said many times before, I really do not blog unless I have something I have to say which might add something to the ol' knowledge base. My fellow bloggers have done such a splendid job that I have not had anything really lucent to say.
Oh yes, plus I went and got sick at Disney World! My wife had this delightful idea to hold a family reunion at Disney World over the New Years holidays. We rented a house, packed it with relatives and took in three Disney theme parks in three days. That totaled 38.5 hours in three days, or almost an entire work week in just three days' time.
What I noticed was the conspicuous lack of hand sanitizing stations. In fact, the only stations I noticed were 1) few, and 2) were only at the Magic Kingdom. With so many persons appearing from so many different nations, plus the people who came over as part of a Disney Cruise, I found it interesting that there were not hand sanitizing stations at every ride entrance or at every eatery.
Also, I have been to Hell, and it is being caught in line indoors at Toy Story at Hollywood Studios. No way out. Screaming kids in the hundreds. And a six-foot tall Mr. Potato Head in Don Rickles' voice, telling bad jokes while you move less than 30 feet in more than 40 minutes. I finally acted decisively, found an emergency exit, and ushered my party to safety and myself to sanity. This included my wife, who was in a wheelchair suffering from terrible knee pain caused, no doubt, by strenuous walking the previous two days at Epcot and the Magic Kingdom.
So over the past several days, I have been laboring through rhinovirus C, or Ad14, or whatever it is that I caught at Disney. Same with my wife.
OK, now on to the top question of 2010: What the Sam Hill is going on with this flu pandemic?
As best as I can make out, the flu has pretty much subsided in the United States. Despite the record cold temperatures (and as I write this, Tallahassee continues to have sub-20 degree mornings), flu has all but disappeared. Only one state apparently reports widespread flu activity, and only time will tell if returning college students and resumption of classes at all grade levels, combined with this ungodly weather, will spark the predicted Third Wave of swine flu.
But there are two nations whose flu activities remind me that this pandemic is still stretching its tendrils across the globe: India and China. By all accounts, India has reported around 1,100 flu deaths. China reports even fewer deaths. If you are thinking what I am thinking, you are saying, "Dangit! Who is Marvel going to cast in the role of Captain America?!?! They better get this resolved, since the film is due in mid-2011!"
But I am also thinking, "No way India, with a billion people living in varying conditions of comfort and health, can only have a thousand dead from H1N1v. Ditto China."
Obviously the reporting of cases and deaths is spotty in those countries. But it also tells me that this virus is still insinuating itself into those regions of the world, where things travel by the older standard.
Think about it: H1N1v was borne on the wings of airliners and within the airways and lungs of spring breakers to the four corners of the North American continent. It travelled across the pond to our British friends and from there, to Europe. But once the virus hit eastern Europe and Asia, it began to circulate under a more conventional (slower) timetable.
In fact, this timetable coincided with the "second wave" of H1N1v that began in the fall here in the US. While the second wave has seemingly subsided, Asia still appears to have not even crested its first wave!
In Florida, we fear the Category 4 hurricane, but we absolutely fear the Category 4 hurricane that moves slowly across the state. The slower the storm moves, the more damage it is capable of creating. I want to apply that line of thought to this virus. The slower this virus moves throughout Asia, the more opportunities it has to infiltrate remote hamlets and villages. The more opportunities it has to intersect with H5N1. And the more opportunities it has to mutate/evolve and gain lethality.
Influenza's goal is not to mutate itself out of existence. Its goal is to co-exist with a host organism. If H1N1v is such a "mild" virus today (and I think several thousand American families would vehemently disagree with anyone who would call swine flu a mild flu), then its goal is not to become milder. Its proclivity would be to enhance its ability to make people sick. It will enhance either its lethality or its target population, or both.
That is one reason why I think it is important for seniors to begin receiving their swine flu shots now, along with the rest of us who have not done so already. Suddenly, entire nations are (foolishly) raffling off their reserves of H1N1v vaccine.
Finally, I redirect you to the words of John Oxford, who foresees a very difficult spring of 2010. Combine his words with the admonitions of the WHO. The WHO is saying it may take until the end of 2011 for this pandemic to conclude (meaning, to turn into seasonal flu). Professor Oxford said that selective mutations of H1N1v will begin to take root once about 30% of the world's population had been exposed to the current virus.
But I am not afraid. After all, I have been in close contact with Mr. Potato Head.
Reader Comments (7)
Nice to see you back.
Thanks much! Your welcome back meant a lot to me.
Scott
welcome back,Scott
I don't know if U ever read recombinomics commentary, but it does answer alot of questions as 2 what's 2 come in the 3rd wave. It is not pretty.
The WHO is explaining it all off as genetic drift by random mutations.
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Commentary
Transmission of Fatal H1N1 D225G/N Accelerates Concerns
Recombinomics Commentary 19:05
January 11, 2010
Recently released H1N1 HA sequences have significantly accelerated pandemic concerns. These sequences have either D225G, D225N, or both, and produce a case fatality rate at or near 100% in many countries. These receptor binding domain changes are on multiple backgrounds, but the transmission and expansion of these fatal sequences in eastern Europe, including Russia, have increased concerns, as has the "low reactor" status as determined by Mill Hill for a Ukraine sequence.
Some of the earliest sequences with D225G were in the United States last spring and were generally mild. However, initial cases in the US were usually mild, which may have reflected low viral loads infecting a naïve population.
The concerns regarding D225G and D225N began to increase when sequences were released from fatal cases in Sao Paulo Brazil. These samples were collected in July, when the flu season in the southern hemisphere was peaking. Two lung samples were positive for D225G, while a lung and throat sample were positive for D225N.
There already was interest in position 225 for a number of reasons. D225N was in seasonal H3N2 and linked to the fixing of adamantine resistance (S31N), while D225G was in 1918 and 1919 samples and linked to a change in receptor binding domain specificities which would target subsets of cells in the lung. In addition, the polymorphism was jumping from one genetic background to another signaling recombination and increased chances that the polymorphisms would continue to jump to new genetic backgrounds.
Thus, when reports from Ukraine described a high number of fatal cases associated with lung destruction and a hemorrhagic component, involvement of D225G and D225N was predicted. However, although WHO had sent a team to Ukraine and had sent representative clinical samples to Mill Hill and CDC, WHO regional labs, WHO characterized the sequences changes in Ukraine as insignificant.
However, release of the sequences by Mill Hill confirmed the linkage of D225G in the outbreak in general and in the fatalities in particular. Sequences from 10 patients were released. One was from Kyiv and distantly related to the nine sequences from western Ukraine. Although the Ternopil/Khmelnitsky sequences could be distinguished from the Lviv sequences by a synonymous HA marker, all western Ukraine sequences were closely related. However, the four fatal cases (two from Lviv and two from Ternopil) had D225G appended onto the common background, which was distinct from the sequences in Brazil and the United States. Thus, not only was D225G present in all four fatal cases, it was only in the four fatal cases, leading Norway to examine sequences from patients in Norway. Three with D255G were identified and two had died. The third was a severe cases who had recovered. This high level of fatalities led Norway to issue and alert and other countries, like France had similar results (two patients with D225G and both were fatal and one was Tamiflu resistant).
The Mill Hill sequences also suggested that D225N may also be involved in the Ukraine fatalities because one of the fatal sequences in Ternopil, A/Ternopil/11N/2009, had a novel marker that was only found in two other H1N1 sequences at Genbank, and these were the two sequences from New York with D225N. This associate was confirmed when the CDC released five sequences. Three were from the same mild cases sequenced by Mill Hill, but the other two were unique and likely from fatal cases. Both had D225N and suggested a relationship between D225G and D225N since all six likely fatal cases in Ukraine had D225G or D225N.
The association of D225G and D225N was more directly supported by sequences from the United States, Mexico, and Sweden, which identified samples with both D225G and D225N. Thus, once again two different changes were appended onto the same genetic background at a given location, but the background varied from location to location, supporting recombination. Moreover, in Mexico there were fatal infections with D225G and D225N. Both were in San Luis Potosi and collected with a day of each other, supporting transmission.
However, although the above data left little dount that the receptor binding domain (RBD) changes were transmitting and jumping from one genetic background to the other via recombination, the ECDC came out with a report at the end of the year stating that the WHO working hypothesis held that each of these changes was independent and due to copy errors within each patient, and the RBD changes did not transmit.
This position had no support from the data. The changes at position 225 were only found in 1% of sequences, but were in six of six fatal cases in Ukraine. Similarly, isolates with both changes were found in two patients at the same location at the same time in Mexico. The WHO working hypothesis was yet another attempt to explain genetic drift by random mutation, even though the existing data offered no support for such a claim.
The sequences released in the past few days further degrade the WHO working hypothesis as well as the linkage of random mutations to genetic drift. Mill Hill released sequences from Ukraine and Moldova which also had both changes in the same patients. In Ukraine the sequences followed the outbreak, which spread to the east. Samples from the Kyiv area were from lung and each sample had D225G and D225N. One sample also had D225A. This clustering of position 225 changes within individual samples is not easily explained by independent and random events. The same set of two changes was seen in a patient from Moldova, which is adjacent to Ukraine. In addition, sequences from cases in Russia also had the D225G and D225N changes and were also likely from fatal cases.
Thus, the recent data demonstrates a case fatality rate at or near 100% in multiple countries, with clustering of polymorphisms and patients consistent with transmission and recombination. Moreover, Mill Hill ran an antigenicity test on one of the Ukraine samples and found it to be a low reactor, raising concerns that changes at position 225 will become more common in the next H1N1 wave, which could have catastrophic consequences, while WHO is trying to construct a defense for its outdated random mutations as an explanation of genetic drift and viral evolution.
The transmission of a deadly H1N1, coupled with a WHO wedded to an outdated paradigm, significantly increases pandemic concerns.
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It's a bit of a read, but it is the closest thing out there that I can find, that conveys the truth.
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Glad you are back, too.
You have a way of voicing what many of us are thinking, but don't have time to blog it.
I just got the kids FluMist booster today.
I read this has the D225G in it so I wanted to get it over the shot.
I wonder if folks could get a FluMist even though they have received the H1N1 shot, if in fact the D225G is in the FluMist and if indeed this mutation turns out to be dominant down the road.
It's just way too quiet out there right now and is making me nervous.
Not even a hint of seasonal flu or common colds in these parts (SE MN).
Nada.
Zippo.
Hey Scott,
Excellent post. You have a way with words. Wonderful. I'm a follower of Crof's blog (H5N1) and from now yours too.
Anyway I'm from Malaysia and currently covering whats happening there www.arkanoidlegent.blogspot.com. Take care.
Arkanoid.
Come on Scott you should know by know how we do things around here.
We go BIG!!!
So all the comments are on what recombinomics says. Am I the only person who thinks that site is alarmist? I'm not saying all of their theories are wrong, but they are not clairvoyants, and many of the theories contradict what most virologists say. Why try to panic everyone? I mean should I get in my bunker now? It almost seems like they want slaughter.