Institute for Biosecurity - Saint Louis University





INSTITUTE FOR BIOSECURITY - 2009 h1n1 - swine flu

Institute for Biosecurity resources for
2009 H1N1 Swine Flu

The current outbreak of the H1N1 / "Swine Flu" Virus is not considered an act of terrorism. There is cause, however, for us to present a few ideas that can help keep you safe and healthy at home, at work, and in the community.

The US Centers for Disease Control is an arm of the US government which contains material focused on the US. Here you will find updates on the situation in all 50 states, materials on response and prevention (including free downloads of images, Powerpoints, posters, checklists and articles). This is where you should go to find planning information for your organization. http://cdc.gov/h1n1flu/

PandemicPrep.org is a consortium of businesses, organizations, universities, schools, hospitals, Federal, State (Missouri and Illinois), and local government agencies, working together to better prepare the St. Louis region for a pandemic.

The World Health Organization site contains information about the global status of the influenza virus, including which countries have cases, recommendations for preparedness and response, travel materials etc. The WHO web site is: http://www.who.int/en/

http://www.hhs.gov/
The US department of Health and Human Services offers information of government response including presidential speeches on the influenza situation, links to the CDC, and information regarding current health issues in general.

http://www.dhss.mo.gov/
The Missouri Department of Health and Senior Services has material tailored to the Missouri audience and includes updates on steps taken by state and local government to prepare for and respond to influenza. It also has links to free material on H1N1 and pandemic influenza, and offers a “Ready in Three” program that is useful in preparing for disasters.

The goal of health care givers all over the world is to prevent all infections from occurring. Because one infection may have many different causes or predisposing risk factors, the PreventInfection.org Information Center hopes to examine the variety of factors that contribute to infections. By discussing these factors, we hope to show ways in which infections can be reduced or prevented.

The Society of Critical Care Medicine has activated its Emergency Response program due to the current H1N1 Influenza outbreak. Several SCCM infectious disease experts have been in close contact with the Mexican authorities and we are in contact with the Centers for Disease Control and Prevention (CDC). There is no call for volunteers at this time. The SCCM disaster resources webpage has been updated with the latest information and tools to assist critical care professionals during this event. We will continue to monitor this situation and will provide updates as more information becomes available.

H1N1 in the News

Written by Anthony L. Komaroff, MD, information is given in “common language” so that everyday people can read it:

More info

For starters, the two that died from H1N1 in the US both had underlying illnesses:

More info

This is a journal editorial from the New England Journal of Medicine by Robert B Belshe, MD:

More info

Here is a paper by Joel Warner. He wrote about the H1N1 epidemic of 1976.

More info

How is the public is reacting to this outbreak? Here is another news story about schools closing because of it:

More info

Mainland China just reported their first case of H1N1. A 30 year old man that is enrolled in a US university:

More info

This site is the Hong Kong Center for Health Protection and they have a daily update about reported cases in their country:

More info

Alan P. Zelicoff, MD

http://www.zelicoff.com

Commentary on Influenza A/H1N1 (Mexico Origin?)
A new influenza strain variously called “novel Influenza A” or Influenza A/H1N1 “swine-origin influenza virus (S-OIV”) has been isolated which is clearly causing disease (and some deaths) in Mexico (where it apparently originated) and elsewhere. The outbreak – now confirmed as occurring on several continents – is by definition a “pandemic”. The minimal set of questions facing public health officials and political decision-makers are:

(1) will this turn into a severe pandemic that causes both severe illness and mortality?;
(2) will it continue to spread?; and
(3) if it does appear to abate, will it return in the next influenza season, perhaps with more severe manifestations necessitating a change in the annual influenza vaccine at great expense, and perhaps approaching a critical limit on the amount of influenza vaccine that can be produced in time?

It now appears clear that the pandemic while widespread is not severe (pandemics don't have to be "severe" in order to be pandemics, a point often overlooked). I believe that there is sufficient evidence to conclude that there is widespread immunity (not fully protective, but protective enough) so that while there will certainly continue to be new cases -- just as there are of seasonal influenza A in the northern hemisphere, soon to be followed in a few weeks in the southern hemisphere -- I don't expect high mortality.

I have prepared a working document that I hope will provide both up-to-date information and some useful analysis, highlighting uncertainties and statistically meaningful trends so that serious readers can augment their understanding of influenza per se, and judge the policy decisions that are being made. This particular influenza – very much unlike H5N1 “avian” flu – spreads easily from person-to-person. This transmissibility does not mean that there will be another global pandemic on the impact scale of the devastating 1918 flu (or even the mild but nonetheless significant pandemics of 1957, 1977 and 1968), but it does give cause for pause and careful thinking. My conclusions at the moment are:

(a) the CDC recommendations for prudent self-isolation if one develops flu-like illness along with handwashing and other common sense precautions are reasonable;
(b) it does not appear that this pandemic is any more severe than recent seasonal influenza A episodes
(c) there is probably some pre-existing immunity in adults (and some younger people) in most of the northern hemisphere above the Tropic of Cancer and in the southern hemisphere below the Tropic of Capricorn because of exposure either to circulating strains of influenza A or previous vaccination. This may explain the mild illness experienced so far in the US, Canada, New Zealand, Spain, the UK and several other countries where seasonal Influenza A is common (or where vaccination is common).

I welcome comments and suggestions for improving (or correcting) this document. All errors are mine and mine alone.

My e-mail address is: zalan8587@qwest.net