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LA Times April 30, 2009 As the World Health Organization raised its infectious disease alert level Wednesday and health officials confirmed the first death linked to swine flu inside U.S. borders, scientists studying the virus are coming to the consensus that this hybrid strain of influenza -- at least in its current form -- isn't shaping up to be as fatal as the strains that caused some previous pandemics.
In fact, the current outbreak of the H1N1 virus, which emerged in San Diego and southern Mexico late last month, may not even do as much damage as the run-of-the-mill flu outbreaks that occur each winter without much fanfare. "Let's not lose track of the fact that the normal seasonal influenza is a huge public health problem that kills tens of thousands of people in the U.S. alone and hundreds of thousands around the world," said Dr. Christopher Olsen, a molecular virologist who studies swine flu at the University of Wisconsin School of Veterinary Medicine in Madison.
His remarks Wednesday came the same day Texas authorities announced that a nearly 2-year-old boy with the virus had died in a Houston hospital Monday.
"Any time someone dies, it's heartbreaking for their families and friends," Olsen said. "But we do need to keep this in perspective." Flu viruses are known to be notoriously unpredictable, and this strain could mutate at any point -- becoming either more benign or dangerously severe. But mounting preliminary evidence from genetics labs, epidemiology models and simple mathematics suggests that the worst-case scenarios are likely to be avoided in the current outbreak.
"This virus doesn't have anywhere near the capacity to kill like the 1918 virus," which claimed an estimated 50 million victims worldwide, said Richard Webby, a leading influenza virologist at St. Jude Children's Research Hospital in Memphis, Tenn.
When the current virus was first identified, the similarities between it and the 1918 flu seemed ominous.
Both arose in the spring at the tail end of the flu season. Both seemed to strike people who were young and healthy instead of the elderly and infants. Both were H1N1 strains, so called because they had the same types of two key proteins that are largely responsible for a virus' ability to infect and spread.
The Centers for Disease Control and Prevention and the National Institutes of Health published genetic sequence data Monday morning of flu samples isolated from patients in California and Texas, and thousands of scientists immediately began downloading the information. Comparisons to known killers -- such as the 1918 strain and the highly lethal H5N1 avian virus -- have since provided welcome news.
"There are certain characteristics, molecular signatures, which this virus lacks," said Peter Palese, a microbiologist and influenza expert at Mt. Sinai Medical Center in New York. In particular, the swine flu lacks an amino acid that appears to increase the number of virus particles in the lungs and make the disease more deadly.
Scientists have identified several other differences between the current virus and its 1918 predecessor, but the significance of those differences is still unclear, said Dr. Scott Layne, an epidemiologist at the UCLA School of Public Health.
Ralph Tripp, an influenza expert at the University of Georgia, said that his early analysis of the virus' protein-making instructions suggested that people exposed to the 1957 flu pandemic -- which killed up to 2 million people worldwide -- may have some immunity to the new strain.
That could explain why older people have been spared in Mexico, where the swine flu has been most deadly.
The swine virus does appear able to spread easily among humans, which persuaded the WHO to boost its influenza pandemic alert level to phase 5, indicating that a worldwide outbreak of infection is very likely. And the CDC reported on its website that "a pattern of more severe illness associated with the virus may be emerging in the United States."
"We expect to see more cases, more hospitalizations, and, unfortunately, we are likely to see more deaths from the outbreak," Health and Human Services Secretary Kathleen Sebelius told reporters Wednesday on her first day at work.
But certainly nothing that would dwarf a typical flu season. In the U.S., between 5% and 20% of the population becomes ill and 36,000 people die -- a mortality rate of between 0.24% and 0.96%.
Dirk Brockmann, a professor of engineering and applied mathematics at Northwestern University in Evanston, Ill., used a computer model of human travel patterns to predict how this swine flu virus would spread in the worst-case scenario, in which nothing is done to contain the disease.
After four weeks, almost 1,700 people in the U.S. would have symptoms, including 198 in Los Angeles, according to his model. That's just a fraction of the county's thousands of yearly flu victims.
Just because the virus is being identified in a growing number of places -- including Austria, Canada, Germany, Israel, New Zealand, Spain and Britain -- doesn't mean it's spreading particularly quickly, Olsen said. "You don't ever find anything that you don't look for," he said. "Now that diagnostic laboratories and physicians and other healthcare workers know to look for it, perhaps it's not surprising that you're going to see additional cases identified."
And a pandemic doesn't necessarily have a high fatality rate. Even in Mexico, the fatalities may simply reflect that hundreds of thousands of people have been infected. Since the symptoms of swine flu are identical to those of a normal flu, there's no way to know how many cases have evaded government health officials, St. Jude's Webby said. As the virus adapts to its human hosts, it is likely to find ways of spreading more efficiently. But evolution also suggests it might become less dangerous, Olsen said.
"If it kills off all its potential hosts, you reach a point where the virus can't survive," he said. Working to calm public fears, U.S. officials on Wednesday repeatedly stressed the statistic of yearly flu deaths -- 36,000.
Sebelius and Homeland Security Secretary Janet Napolitano also rejected calls to close the borders, which several lawmakers reiterated Wednesday on Capitol Hill. “We are making all of our decisions based on the science and the epidemiology," Napolitano said. "The CDC, the public health community and the World Health Organization all have said that closing out nation's borders is not merited here."
Though scientists have begun to relax about the initial toll, they're considerably less comfortable when taking into account the fall flu season. They remain haunted by the experience of 1918, when the relatively mild first wave of flu was followed several months later by a more aggressive wave.
The longer the virus survives, the more chances it has to mutate into a deadlier form.
"If this virus keep going through our summer," Palese said, "I would be very concerned."
karen.kaplan@latimes.com
alan.zarembo@latimes.com
Staff writers Noam Levey in Washington, Thomas H. Maugh II in Los Angeles and Ken Ellingwood in Mexico City contributed to this report.
Op-Ed Contributor
Mexico’s Fast Diagnosis By JULIO FRENK Published: April 30, 2009 Mexico City Anthony Russo Related EVERY year approximately 10,000 Mexicans die from the effects of seasonal flu. Usually they are the elderly and the very young, people whose immune systems are not robust enough to fight off the virus. But this year has been different. The Mexican disease surveillance system, a network of more than 11,000 hospitals, clinics and doctors’ offices, picked up a minor but troubling trend in April. Across this nation of 110 million people, a handful of young adults had apparently died from influenza. An immediate investigation led, within a few hectic weeks, to the isolation and full genetic sequencing of the microbe causing the illness. The experts’ worst fear was confirmed: it was a new kind of influenza virus. Some have complained that the Mexican government did not act fast enough to identify this new bug and sound the alarm. But such criticism fails to take into account the real-life complexity of recognizing and responding to an unexpected public health emergency. As a former minister of health for Mexico, I met with Mexican officials this week to consult with them on their response to the influenza, and I was impressed by how medical scientists in the country quickly perceived the unusual trend of illness against a background of standard flu and then analyzed the virus and alerted global health authorities. Their fast action gave other countries the warning they needed to screen for the new virus, which is why cases of swine flu have already been discovered in a dozen other countries — cases that might otherwise have long gone unnoticed. The number of confirmed deaths in Mexico from this new virus is still uncertain and may be only several score. Further epidemiologic detective work will tell us whether the virus had been circulating throughout the seasonal flu period in Mexico, beginning as early as last fall, making thousands only mildly ill, and alerting us to its presence only with the unexpected deaths of young adults. From the moment this so-called swine flu was identified, the Mexican government worked vigorously to contain the contagion — closing all schools across the country, limiting public gatherings and instructing people to wear masks and refrain from greetings involving physical contact. President Felipe Calderón himself led the response, underlining the seriousness of the situation, and that may explain why so many Mexicans have complied. Already, the number of deaths seems to be stabilizing, perhaps indicating that the first wave of this influenza has peaked. It’s still not known why this flu seems to have been deadly only in Mexico. It stands to reason that for the entire winter flu season, Mexican doctors, not knowing that a new virus was afoot, saw any instances of it as ordinary seasonal flu, and thus did not give patients the antiviral drugs that could have saved their lives. These medicines are effective only if given within 48 hours of the onset of symptoms. Like many other countries, Mexico had been preparing for an outbreak like this. The deadly 2003 epidemic of SARS and the 2005 outbreak of avian flu taught the world to expect that another microbial agent from animals would one day again infect humans. Over the past six years, Mexico bolstered its disease surveillance systems, built up public health laboratories, cooperated in developing international networks for information sharing and devised response plans. At the same time, the international community was stockpiling antiviral drugs, and scientists were improving their ability to understand new viruses. Most important, the World Health Organization’s International Health Regulations were written to hold countries accountable for monitoring disease outbreaks, publicly reporting all information and cooperating with other countries. Since the 1980s, Mexico has been strengthening its epidemiologic intelligence service, in cooperation with the United States Centers for Disease Control and Prevention. Hundreds of Mexican doctors and other health professionals have received advanced training in epidemiology. In recent years, Mexico has worked with Canada, Japan, the United States and several European countries to establish the Global Health Security Action Group, a tight public health communications network. Unknown to most people, an army of epidemiologists operates around the clock to defend against microbial threats. Whether this system might have worked even more quickly in the present outbreak can be examined later; for now we must move forward with the knowledge we have in hand. We don’t have a lot of time. Viruses are sensitive to seasonal temperature change, and this one, like the 1918 influenza, may reappear more robustly in the fall. It is critical to ascertain, from blood tests, the true number of swine flu cases worldwide, both mild and severe. Also, a sound epidemic curve needs to be established, which would reveal how the virus blossomed outward from initial cases and make it possible to quantify its transmissibility. And while we wait as much as six months for a vaccine to be readied, we need to pinpoint the best treatment strategies. Sadly, it takes a cluster of casualties to alert the world that humans are once more under attack and that we need to marshal our scientific forces. This is, as it must be, a global challenge. With international cooperation, we have reason to hope that casualties will be fewer in this outbreak than they were in the last one, and fewer still when the inevitable next virus arises. Julio Frenk, Mexico’s minister of health from 2000 to 2006, is the dean of the Harvard School of Public Health. Rosarito City News Marisa Molina Foreign Residents Attention Office FRAO (661) 614-9697 By MARK STEVENSON and ANDREW O. SELSKY, Associated Press Writers Mark Stevenson And Andrew O. Selsky, Associated Press Writers– May, 2009
MEXICO CITY – Mexico's top health official said Thursday the number of new swine flu cases is stabilizing in the nation at the epicenter of the outbreak. Health secretary Jose Angel Cordova told a news conference he hoped the trend will continue...
The Mexican health secretary's comments followed similarly hopeful remarks from the mayor of Mexico City, who said statistics indicated "we are entering a period of stabilization." In Luxembourg, European Union health ministers holding an emergency talks on swine flu agreed to work "without delay" with drugmakers to develop a pilot vaccine to fight the virus. U.S. scientists are racing to develop the key vaccine ingredient, a strain of the virus engineered to trigger the immune system Obama urged people to wash their hands, cover their coughs and stay home when they feel sick. Calderon gave similar advice. Biden and the acting head of the Centers for Disease Control and Prevention said in televised interviews Thursday there would be no practical benefit to closing the U.S.-Mexican border to stop the flu's spread. The WHO's Phase 5 alert activates added efforts to produce a vaccine. Fukuda said Thursday there was nothing in the past day that would prompt the U.N. body to raise the alert further. "So, at this time again, I want to repeat there is nothing to us which immunologically suggests today that we should be moving toward phase 6," he told reporters. Switzerland and the Netherlands became the latest countries to report swine flu infections. In addition to Mexico and the U.S., Canada, New Zealand, Britain, Germany, Spain, Israel and Austria have confirmed cases. The Swiss government said a 19-year-old student with swine flu was mistakenly released from the hospital and then hastily readmitted. The WHO raised its tally of confirmed swine flu cases around the world to 257 from 148, with most of the new cases from Mexico. The WHO count lags behind what individual countries report. (out of 6.5 Billion wolrd population) Swine flu is a mix of pig, bird and human genes to which people have limited natural immunity. It has symptoms nearly identical to regular flu — fever, cough and sore throat — and spreads similarly, through tiny particles in the air, when people cough or sneeze. About 36,000 people die each year of flu in the United States. Calderon said authorities would use the five-day partial shutdown in Mexico to consider whether to extend emergency measures or ease some restrictions. The dates include a weekend and two holidays, Labor Day and Cinco de Mayo, minimizing the added disruption. Obama said his administration has made sure that needed medical supplies are on hand and he praised the Bush administration for stockpiling 50 million doses of antiviral medications. "The key now is to just make sure we are maintaining great vigilance, that everybody responds appropriately when cases do come up. And individual families start taking very sensible precautions that can make a huge difference," he said. Several nations have banned travel to or from Mexico, and some countries have urged their citizens to avoid the United States and Canada as well. Health officials said such bans would do little to stop the virus. Medical detectives have not pinpointed where the outbreak began. Scientists believe that somewhere in the world, months or even a year ago, a pig virus jumped to a human and mutated, and has been spreading between humans ever since. China has gone on a rhetorical offensive to squash any suggestion it's the source of the swine flu after some Mexican officials suggested it sprang from China or elsewhere in Asia. A Mexican health official has also suggested the virus could have been brought to Mexico from Pakistan or Bangladesh. By March 9, the first symptoms were showing up in the Mexican state of Veracruz, where pig farming is a key industry in mountain hamlets and where small clinics provide the only local health care. The earliest confirmed case was a 5-year-old Veracruz boy, one of hundreds of people in the town of La Gloria whose flu symptoms left them struggling to breathe. People from La Gloria kept going to jobs in Mexico City despite their illnesses, and could have infected people there. Days later, a door-to-door tax inspector was hospitalized with acute respiratory problems in the neighboring state of Oaxaca, infecting 16 hospital workers before she became Mexico's first confirmed death. Mexico's health care system has become the target of widespread anger and distrust. In case after case, patients have complained of being misdiagnosed, turned away by doctors and denied access to drugs. ___ AP writers Frank Jordans in Geneva; Tom Raum and Lauran Neergaard in Washington; Olga Rodriguez in Oaxaca, Mexico; Paul Haven and E. Eduardo Castillo in Mexico City; Mike Stobbe in Atlanta; Mike Corder in The Hague, Netherlands, and Balz Bruppacher in Bern, Switzerland, contributed to this report. |