With the weather cooling and the kids back in school, the media coverage of the H1N1 flu – last spring’s “swine flu” – is building back to a fever pitch, if you’ll pardon the pun. As expected, colleges immediately found themselves dealing with campus outbreaks, and elementary and high schools have also already seen flu cases in the first few days of the school year.
In April, scientists knew very little about the nature of this novel H1N1 strain, and the worst-case scenarios suggested by some flu experts fueled the frenzy over whether this virus could be as deadly as the 1918 pandemic that killed as many as 100 million people worldwide. Now, six months later, there has been a lot more time to study the virus, observe its movements through the Southern Hemisphere’s flu season, develop and test vaccines and estimate the damage us citizens of the Northern Hemisphere can expect as a our flu season traditionally begins in October.
Because the novel H1N1 pandemic is such a fast-developing and important topic, much of the research into it is happening at an accelerated pace and is being disclosed to the public more quickly and openly than is typical for the traditionally slow march of science. Other sites have done excellent overviews of influenza in general and what we know about this particular strain or have followed every turn of this story. Below are summaries for a few of the main H1N1 subtopics.
How Bad Will The Flu Be?
Last week, the President’s Council of Advisors on Science and Technology (the one headed by climate change expert John Holdren) released their report estimating the U.S. toll of H1N1 this coming flu season. The reassuring bit? “The 2009-H1N1 virus does not thus far seem to show the virulence associated with the devastating pandemic of 1918-19,” the report concludes, but…”the 2009-H1N1 virus is a serious threat to our nation and the world.” If you don’t want to read all 84 pages, here are their numbers:
– infection of 30-50% of the population, symptoms in 20-40%, which equals 60-120 million people. The normal seasonal flu infects 5-20% of the population each year, according to the CDC.
– up to 1.8 million hospital admissions, with 300,000 requiring intensive care. If it comes to that, the seriously ill could fill up the already-strained ICUs of American hospitals. A study posted to the rapid research resource created by the Public Library of Science on Google (more on that below), estimates that H1N1 will increase the demand for ICU beds and breathing machines by 33% over a typical flu season.
– between 30,000-90,000 deaths, as the report (as well as this study) estimates a death rate between 0.01 and 0.03% – at most 3 deaths from every 10,000 infections. Seasonal flu typically kills about 30,000 Americans each year, so that’s square with the idea that the novel H1N1 is no more deadly than seasonal flu. But, as the report points out, seasonal flu typically is fatal in older people, while predominantly children and young adults have died from the novel strain.
Will There Be Enough Vaccine?
Yesterday, the CDC continued to anticipate that H1N1 vaccines will be available in mid-October. As discussed previously here on the blog, that initial supply of vaccine will not be enough to vaccinate everyone in the country, so certain groups will receive priority access: pregnant women, caregivers for infants, healthcare workers, children and young adults from 6 months to 24 years old and adults with underlying medical conditions. One issue that puts further strain on the vaccine supply is the expectation that people will need two doses of the novel H1n1 vaccine (in addition to the yearly single dose of vaccine against the seasonal flu) for complete protection against the virus.
But a pilot study conducted in the UK and released yesterday by Swiss pharmaceuticals firm Novartis says that their vaccine effectively protected against the new flu strain with only one dose, backing up research done previously in mice. The only problem: these studies were performed with vaccines that contain an adjuvant, an additive that boosts the immune system’s response to the inert antigen included in a vaccine. But contrary to World Health Organization recommendations, the United States decided not to use vaccines with adjuvant unless initial trials fail. Vaccines with adjuvants have been used in Europe, but have never been approved for US use, due to lack of data about their safety in children and pregnant women. Nevertheless, this decision drew considerable controversy and commentary, and may rear its head again if vaccine demand does indeed out-strip supply.
Federal clinical trials are underway, and the first round is expected to yield results answering questions of dosage and safety in mid-September, according to a CDC briefing in late August.
Virus Research Gone Viral
Science normally takes its time, and for good reason. Research articles, once submitted, go through a peer review process that typically takes months, and it could be more months still before an accepted paper reaches publication. Early online publication has sped up this process somewhat, with articles posted online weeks or months before their old-fashioned paper publication, but it’s still a long delay.
So how does that inflexible, slow-moving beast adapt itself to a rapidly-developing scientific challenge like the novel H1N1 virus? One way is the creation of PLoS Currents: Influenza, a Google-based website run by the Public Library of Science that allows research to be quickly published and publicly available. The editors specify that this fast-tracking means the research is not fully peer-reviewed, but two of the world’s pre-eminent infectious disease experts (Eddie Holmes of Penn State and Peter Palese of Mount Sinai) act as a first line of quality control.
Thus far the page contains 19 articles that range from genetic analyses of the novel H1N1 strain to vaccine trials to an analysis of preemptive antiviral treatment. Some of the coolest papers use genetic methods to trace this new strain back to its origins – because the influenza virus mutates fairly rapidly, analyzing the subtle genetic differences in viruses collected around the globe can create a picture of how the disease spread. That knowledge may not help humanity with this pandemic, since the flu is already out of the bag, but it could help us stop the spread of infections in the future. Plus, it produces awesome movies like this one:
Finally, if you want to be constantly informed of any flu outbreaks taking place in your geographic vicinity – yeah, there’s an app for that.