swine flu

There's been a great deal in the news regarding the first reports on the swine flu vaccine trials, so we didn't feel the need to be the first off the mark for something you could read anywhere (and everywhere). We still don't have much to add, but since there was intense discussion and debate about vaccines here this week we thought it appropriate to take a look again now that there are some actual data to see if it changes things for us or not. The short answer (but typical for us) is: yes and no. First, let's review what we think we know at this point (this is big picture; we might have…
The old Atomic Energy Commission (AEC) had a fatal flaw. It's task was both to promote and to regulate nuclear power. That sounds like a bad idea, right? Conflict of interest? But in fact there are a number of government agencies that are in the same awkward position. One of them is the US Department of Agriculture, now run by Obama appointee and former ag state (Iowa) Governor, Tom Vilsack. I'll say one thing for Vilsack. He takes his responsibilities seriously. At least the promoting and protecting the ag industry part. Vilsack has had a mixed record on matters of importance to progressives…
Flu season is over. Before you heave a sigh of relief, I'm talking about the (official) 2008 - 2009 flu season, which ended August 30 in week 34 or the calendar year. Welcome to the new flu season, the one called 2009 - 2010. It promises to be, well, "interesting." Not that the one just concluded wasn't interesting. Indeed before we get done analyzing the data already collected it's likely to be the most informative in flu science history, partly because we have tools we never had before, partly because we have information gathering and handling capacity we never had before. But mostly…
As we expected, yesterday's vaccine piece provoked a lot of discussion, almost all of it thoughtful and pertinent. Since we've already said we might be wrong, we thought we'd take some time to respond, using it as a way to keep thinking things through on our end. Writing is thinking and thinking is needed in this situation. Over at FluTrackers.com (an excellent flu forum like Flu Wiki with highly informed people) there were a number of lengthy responses, most of them on the negative side. Since these folks follow events closely their opinions are also worth following closely. In addressing…
When it comes to US swine flu vaccine policy, I'm not calling the shots, but if I were I'd do it differently than the current plan, which calls for a vaccine containing only viral antigen and no immunity boosting adjuvant. I opt for a vaccine with an adjuvant, probably the one that has been used for years in Europe, MF59. If I were to make a decision like that, I could well be making a mistake, because no one really can know at this point what is going to happen or not happen. We can only go on the best data we have coupled with some principles of what's right. On that basis and using my own…
Check it out. That's ~10% of the student body.
A meeting of critical care specialists who have treated severely ill swine flu patients this week in Winnipeg, Canada is producing dramatic reports of illness with a virus more like H5N1 (avian or bird flu) than seasonal flu. Since H5N1 is dramatically more virulent than any seasonal flu we know of, including the 1918 H1N1 variant, this sounds alarming. Before we hit the panic button (and we should never hit the panic button, anyway), let's consider the larger context. Everyone agrees that swine flu H1N1 is not seasonal flu. Its epidemiology is quite different and there is very little natural…
The damage done resembles that found in bird flu as well as 'acute respiratory distress symptom,' reports Branswell - the latter being a condition that can rise from a number of causes, and which kills 30% of those who get it. (That is, get ARDS, not swine flu.) Yet more signs that this is a strange strain.
When I tell people I am an epidemiologist, most of them think it means I'm a skin doctor. I'm not (although the skin disease specialty is much more lucrative). Instead I study patterns of disease in populations and use what I see to try to figure out why the observed pattern rather than another. Since I'm a cancer epidemiologist I usually do large, highly systematic studies that often take years to execute and analyze, but some epidemiologists do much more immediate "shoe leather" epidemiology, investigating disease outbreaks. They are like disease detectives and we can often learn a…
On the radar of late: Neuroskeptic ponders reports that antidepressant use in the U.S. has doubled in the last decade. As he notes, perhaps the most troubling thing finding in the study is that the number of Americans using an antipsychotic as well as an antidepressant increased by a factor of more than 3. This is, frankly, extremely troubling, since antipsychotics are by far the worst psychiatric drugs in terms of side effects. There is evidence that some antipsychotics can be of use in depression as an add-on to antidepressants, but there is better evidence for other alternatives, such as…
Yesterday one of the questions we asked was whether swine H1N1 would replace seasonal viruses this season. In previous pandemics one subtype completely replaced its seasonal predecessor: in 1957 H2N2 replaced the H1N1 that had been coming back annually at least since 1918; only 11 years later, in 1968, a pandemic with H3N2 replaced the H2N2. H2N2 is no longer circulating but in 1977 an H1N1 returned and has been co-circulating with H3N2 since then. This was a new situation. We could ask why this hadn't happened before with H2N2 and H1N1 or H2N2 and H3N2 or all three together; or we could ask…
It's not Labor Day yet, but I guess the Reveres have to consider their vacation over. We're all back at our respective home stations. We admit that not watching flu evolve daily was a relief, although we did sneak peeks when we weren't supposed to. But it also proved to be like the stock market. The daily ups and downs sometimes obscure the bigger picture. So what does it look like now? We have two contradictory impressions. One is that the pandemic has continued to develop in a very robust fashion. So it's a dynamic picture of change. The second is that it looks like a normal pandemic, just…
Massive feature finished, should be in print this November ... but more on that later. By way of returning to blogdom, a few of the few notables I've had time to read lately: Effect Measure, usually quite restrained about predictions, joins quite a few others in predicting the swine flu will hit us pretty hard this fall. (The U.S. has already had 6,506 hospitalized cases and 436 deaths, despite it not being flu season. And while we've been tracking health-care debacles debates and pondering Palin, the flu has been hitting the southern hemisphere pretty hard.) Now, not later, when you're sick…
The other day we did something we don't like to do when talking about flu, we made a prediction. We predicted a bad swine flu season in the fall in the northern hemisphere. The history of flu epidemiology is that making predictions is dangerous. Flu has the ability to make fools out of anyone, regardless of expertise. One commenter in particular disdained the risk we took as being no risk at all. It was perfectly obvious to him (or "anyone paying attention") that next flu season would be a swine flu horror show. It may well be, and then this commenter will certainly gloat and perhaps have…
Making predictions about something as unpredictable as flu is foolhardy. I rarely (if ever) do it, but I'm going to do it now. I am predicting a bad and early H1N1 swine flu season in the northern hemisphere next fall and winter. The reasons for this departure from our usual custom is a paper in Nature from 2007 I just re-read. It's entitled "Seasonal dynamics of recurrent epidemics" by Stone, Olinkyl and Huppert from Tel Aviv University and it appeared in vol. 446, pp 533-536, 2007 (doi:10.1038/nature05638; html version here, if you have a subscription). The paper isn't specifically about…
I have a reflexive skepticism about some conventional flu wisdom. There's so much about flu we don't know and even more we think we know that we find out we're wrong about. But skepticism is an occupational hazard of epidemiologists. Our training and practice focusses on detecting subtle biases that can produce misleading interpretations of data. When it comes to the commonly recommended personal protective measures for pandemic flu, our skepticism is all the greater since there is so little data to be skeptical about. The lack of data isn't an accident. If you think hard about it, you can…
Of the three main modes of infection for flu -- transmission by large droplets, transmission by tiny suspended aerosols, transmission via inanimate objects (also called fomites) -- it is the last that is the least certain but garners the most attention in the form of hand hygiene, disinfectants and now, fear of magazines and toys in emergency department waiting rooms and acute-care clinics in Canada. Here's the lede from an article in the Montreal-Gazette: All magazines and toys should be removed from emergency department waiting rooms and acute-care clinics to reduce exposure to human swine…
There's a swine flu pandemic well underway and efforts are being made to reconstruct how it started. But almost everyone who has been following this knows it's not the first time a swine flu virus has transmitted from person to person. In 1976 in Fort Dix, New Jersey there were a couple of hundred cases, with 13 hospitalizations and one death from an H1N1 swine flu virus. The public health response was the infamous vaccination campaign that reached 44 million Americans before being ignominiously halted in the face of two facts: the feared swine flu outbreak never got out of Fort Dix; and as a…
Somewhere around mile 500 of the Revere tribe's 1000 mile trek to the beach for an alleged vacation -- long digression that interrupts the clear meaning of the sentence: if I'm on vacation, what am I doing writing about it? That's what Mrs. R. asked, as she headed to the beach, leaving me in air conditioned online splendor in a rented condo that could have been anywhere in the world, as long as it had high speed internet connection -- as I was saying, around mile 500 driving our new-ish car journey, CDC went live on a completely redesigned website for its novel H1N1 (aka swine flu) info. I'…
CDC's Advisory Committee on Immunization Practices (ACIP) recently rolled out their 2009 Recommendations. It's for seasonal flu, for which a vaccine exists, not for swine flu, for which there is (as yet) no vaccine. There is a lot to say on the subject of vaccines (see what we've said over the years under the vaccine category), but this seems like a good time to review some basic terminology, including what is meant by vaccine efficacy or effectiveness and how it is measured or estimated. There's a lot to say, so we'll split this into two posts, and in this one we'll go over some terms and…