The Flying Dutchman
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<B><font size=+1 color=red><center>What you need to know about a flu pandemic</font>
By Tina Hesman
<A href="http://www.stltoday.com/stltoday/news/stories.nsf/sciencemedicine/story/27118652BE56E00E862570E10037E5CB?OpenDocument">ST. LOUIS POST-DISPATCH</a>
12/24/2005</center>
Deadly diseases waiting to strike the United States and the rest of the world fill three pages of single-spaced lists on Eddie Hedrick's desk at the Missouri Department of Health and Senior Services.</b>
"And the granddaddy of them all is pandemic influenza," said Hedrick, the emerging infections coordinator for the state health department. "In terms of scope, this is the big one."
A World Health Organization survey of people in 20 countries listed avian influenza as the top health concern.
So what is it about pandemic flu that has officials, such as Hedrick, and regular folk so worried? Should you panic or just ignore the dire warnings? What is the deal with bird flu and pandemics?
Here's a primer to help answer those and other pressing questions.
What is pandemic flu? How is it different from regular flu?
A pandemic is a disease outbreak that affects the entire world. Any disease may become a pandemic, but health officials worry about influenza because it spreads easily and can kill many people.
Influenza pandemics happen when a new type of influenza virus infects humans and spreads. The pandemic is more deadly than annual outbreaks because people's immune systems don't have defenses against the new virus because they have never seen it before.
Is pandemic flu really any worse than regular flu?
Consider the numbers. Influenza A, the type of virus known as the flu, hospitalizes about 200,000 people and kills about 36,000 people in the United States each year. Most of those deaths are among the elderly, young children and people with weakened immune systems.
The federal Centers for Disease Control and Prevention use a computer model called Flu-Aid to predict the scope of a pandemic. In Missouri alone, The Flu-Aid program projects 1.5 million to 2 million people would get sick with the virus; 600,000 to 900,000 of those ill people would seek outpatient medical care; 15,000 to 25,000 people would require hospitalization, and 5,000 to 10,000 people would die.
So, yes, a pandemic flu could be considerably worse than a yearly flu outbreak.
Is bird flu going to become the next pandemic?
Avian influenza, also known as bird flu, is the current front-runner to become the next pandemic, experts say. But another virus could be the cause.
Despite the current attention on bird flu, the disease is nothing new, said Dr. Robert B. Belshe, director of the Center for Vaccine Development at St. Louis University. Over the last decade, scientists have recognized at least 10 different avian influenza strains that have sickened people. But only a few people got sick, and those people got the virus after direct contact with birds or after visiting live bird markets.
"The number of humans infected by other people is, if not zero, very close to zero," Belshe said.
But the new bird flu strain circulating in Asia and parts of Europe is more robust than previous avian viruses, Belshe said. The strain, called H5N1, has infected more than 100 different species of birds, he said. And some big cats in Asian zoos got sick after eating raw poultry infected with the virus.
"That's not something we thought was possible," Belshe said.
So far, there have been no reports of people contracting the illness after eating cooked poultry. Heat seems to destroy the virus, Belshe said.
When is this avian flu pandemic likely to hit?
The virus has not yet acquired the ability to transmit easily from human to human. It may never. And scientists don't know which path the virus is more likely to take to become infectious to people.
It could leap directly from birds into people - as the 1918 Spanish flu did - or mix with already-existing human viruses to make a new flu - the way the 1957 Asian flu and the 1968 Hong Kong flu did.
The team that analyzed the genetic makeup of the 1918 influenza virus estimated that the virus probably circulated in people since 1900 before finally making enough changes to allow it to spread efficiently. The H5N1 strain is first known to have infected humans in 1997.
"If that's true, we still have time to monitor the key genetic changes that would enable (the H5N1 virus) to spread in humans," Belshe said.
The virus is continuing to evolve in birds, he said. Currently, the avian virus has only one or two of the 10 genetic changes researchers think are necessary for efficient spread in humans.
But as the virus spreads to birds around the world, it has more chances to mutate and become a problem for people.
Say a pandemic does start. How long will it take to reach the United States?
That's a matter of speculation. A flu pandemic is likely to appear in many places around the globe simultaneously, Belshe said. One of those locations could be the U.S. The disease could sweep the world in as little as three months, and it could persist for years.
Can it be stopped?
A couple of modeling studies published in Science and Nature this past summer suggested that pandemic flu could be stopped if outbreaks are detected early enough, antiviral medications are rushed to the region and public health measures, such as quarantine, are started immediately. That all needs to happen in just a few weeks to nip a pandemic in the bud.
The World Health Organization says it doesn't know whether those measures are practical but must be tried given the consequences of allowing a pandemic to spread.
What if I get a flu shot? Will that protect me?
No. A pandemic flu, by its very definition, is a virus humans haven't encountered before. The seasonal flu vaccines protect only against the virus currently making people sick - strains we already know about.
The annual flu shot can certainly protect you and those around you from contracting current strains of influenza and is a good idea on those grounds alone.
What about antivirals? I heard that if I take Tamiflu, that will stop the bird flu.
Stockpiling Tamiflu or Relenza, another antiviral medication, at home is not a good idea. The medications don't store well. Also, they must be taken in the first few hours of infection to be effective. And doctors don't even know whether they will stop pandemic flu.
Some strains of H5N1 are already resistant to Tamiflu. If lots of people start taking the drug before it is needed, that could increase the chance that drug-resistant viruses could emerge.
So what should I do about this pandemic threat?
First, keep in mind that currently there is no pandemic. There is no need to panic.
You can be prepared to follow public health recommendations when a pandemic does appear. Be prepared to curtail travel and follow quarantine rules.
It is going to be important that people stay home from work and school when they feel sick. It will be important to follow proper "respiratory hygiene" - covering your coughs and sneezes, washing your hands often, etc.
Start getting into those habits now, and we can all be healthier right now as well as better prepared for pandemic flu, public health experts say.
Reporter Tina Hesman covers science for the Post-Dispatch.
thesman@post-dispatch.com 314-340-8325
______________________________________
SARS (Severe Acute Respiratory Syndrome)
Just a few years ago, SARS (Severe Acute Respiratory Syndrome) swept the world and many feared it could cause the next pandemic.
The disease was contained with public health measures and didn’t spread as easily as first believed.
SARS infected people in Australia, Brazil, Canada, China (including Hong Kong and Macao), Taiwan, Colombia, Finland, France, Germany, India, Indonesia, Italy, Kuwait, Malaysia, Mongolia, New Zealand, the Philippines, Ireland, Korea, Romania, Russia, Singapore, South Africa, Spain, Sweden, Switzerland, Thailand, the United Kingdom, the United States and Vietnam.
Country Cases Deaths
China 5,327 / 348
Hong Kong 1,755 / 298
Taiwan 674 / 84
Canada 251 / 38
Singapore 206 / 32
*United States 73 / 0
Vietnam 63 / 5
*Note: The federal Centers for Disease Control and Prevention reported 161 confirmed, “suspected” or “probable” cases of SARS in the United States, but the World Health Organization counted 73 U.S. cases. Only eight cases in the U.S. were confirmed by laboratory tests.
Source: The World Health Organization, Centers for Disease Control and Prevention
West Nile virus
Perhaps the most famous recent emerging infection before avian influenza stepped onto the world stage, West Nile virus entered the New World in 1999.
The virus was first discovered in Uganda in 1937. It is endemic in Uganda, Central African Republic, Madagascar, South Africa, Egypt, France, Romania, Israel, Italy, Russia and India.
The virus swept the United States from 1999 through 2005. By 2004, the virus was established in the 48 contiguous states. Alaska and Hawaii are still free of West Nile. The virus also has been found in Canada and the Cayman Islands.
West Nile is spread by mosquitoes so its progress has been slower than a respiratory virus is likely to be.
United States
1999 — 61 cases and 7 deaths, all in New York state
2000 — 21 cases and 2 deaths in three states
2001 — 66 cases with 9 deaths from 10 states
2002 — 4,156 cases, including 284 deaths from 39 states
2003 — 9,862 cases with 264 deaths in 45 states
2004 — 2,539 cases and 100 deaths in 38 states
(Note: 10 states reported no human cases, but had animal cases and infected mosquitoes.)
2005 — 2,799 cases and 102 deaths in 42 states
(Note: all 48 contiguous U.S. states reported animal and mosquito West Nile virus activity even though no human cases were recorded.)
Illinois
2001 — laboratory tests confirm the virus in two dead crows from the Chicago area; no human cases
2002 — 884 cases, 67 deaths (the most in the nation)
2003 — 54 cases, 1 death
2004 — 60 cases, 4 deaths
2005 — 248 cases 12 deaths
Missouri
2002 — 168 cases, 7 deaths
2003 — 64 cases, 8 deaths
2004 — 36 cases, 2 deaths
2005 — 31 cases, 2 deaths
Sources: U.S. Centers for Disease Control and Prevention, World Health Organization, Illinois Department of Public Health, Missouri Department of Health and Senior Services
Past pandemics
Pandemics happen once every 10 to 50 years and are deadly
* 1918 Spanish flu killed 40 million people.
* 1957 Asian flu killed 2 million people.
* 1968 Hong Kong flu killed 1 million people.
<B><font size=+1 color=red><center>What you need to know about a flu pandemic</font>
By Tina Hesman
<A href="http://www.stltoday.com/stltoday/news/stories.nsf/sciencemedicine/story/27118652BE56E00E862570E10037E5CB?OpenDocument">ST. LOUIS POST-DISPATCH</a>
12/24/2005</center>
Deadly diseases waiting to strike the United States and the rest of the world fill three pages of single-spaced lists on Eddie Hedrick's desk at the Missouri Department of Health and Senior Services.</b>
"And the granddaddy of them all is pandemic influenza," said Hedrick, the emerging infections coordinator for the state health department. "In terms of scope, this is the big one."
A World Health Organization survey of people in 20 countries listed avian influenza as the top health concern.
So what is it about pandemic flu that has officials, such as Hedrick, and regular folk so worried? Should you panic or just ignore the dire warnings? What is the deal with bird flu and pandemics?
Here's a primer to help answer those and other pressing questions.
What is pandemic flu? How is it different from regular flu?
A pandemic is a disease outbreak that affects the entire world. Any disease may become a pandemic, but health officials worry about influenza because it spreads easily and can kill many people.
Influenza pandemics happen when a new type of influenza virus infects humans and spreads. The pandemic is more deadly than annual outbreaks because people's immune systems don't have defenses against the new virus because they have never seen it before.
Is pandemic flu really any worse than regular flu?
Consider the numbers. Influenza A, the type of virus known as the flu, hospitalizes about 200,000 people and kills about 36,000 people in the United States each year. Most of those deaths are among the elderly, young children and people with weakened immune systems.
The federal Centers for Disease Control and Prevention use a computer model called Flu-Aid to predict the scope of a pandemic. In Missouri alone, The Flu-Aid program projects 1.5 million to 2 million people would get sick with the virus; 600,000 to 900,000 of those ill people would seek outpatient medical care; 15,000 to 25,000 people would require hospitalization, and 5,000 to 10,000 people would die.
So, yes, a pandemic flu could be considerably worse than a yearly flu outbreak.
Is bird flu going to become the next pandemic?
Avian influenza, also known as bird flu, is the current front-runner to become the next pandemic, experts say. But another virus could be the cause.
Despite the current attention on bird flu, the disease is nothing new, said Dr. Robert B. Belshe, director of the Center for Vaccine Development at St. Louis University. Over the last decade, scientists have recognized at least 10 different avian influenza strains that have sickened people. But only a few people got sick, and those people got the virus after direct contact with birds or after visiting live bird markets.
"The number of humans infected by other people is, if not zero, very close to zero," Belshe said.
But the new bird flu strain circulating in Asia and parts of Europe is more robust than previous avian viruses, Belshe said. The strain, called H5N1, has infected more than 100 different species of birds, he said. And some big cats in Asian zoos got sick after eating raw poultry infected with the virus.
"That's not something we thought was possible," Belshe said.
So far, there have been no reports of people contracting the illness after eating cooked poultry. Heat seems to destroy the virus, Belshe said.
When is this avian flu pandemic likely to hit?
The virus has not yet acquired the ability to transmit easily from human to human. It may never. And scientists don't know which path the virus is more likely to take to become infectious to people.
It could leap directly from birds into people - as the 1918 Spanish flu did - or mix with already-existing human viruses to make a new flu - the way the 1957 Asian flu and the 1968 Hong Kong flu did.
The team that analyzed the genetic makeup of the 1918 influenza virus estimated that the virus probably circulated in people since 1900 before finally making enough changes to allow it to spread efficiently. The H5N1 strain is first known to have infected humans in 1997.
"If that's true, we still have time to monitor the key genetic changes that would enable (the H5N1 virus) to spread in humans," Belshe said.
The virus is continuing to evolve in birds, he said. Currently, the avian virus has only one or two of the 10 genetic changes researchers think are necessary for efficient spread in humans.
But as the virus spreads to birds around the world, it has more chances to mutate and become a problem for people.
Say a pandemic does start. How long will it take to reach the United States?
That's a matter of speculation. A flu pandemic is likely to appear in many places around the globe simultaneously, Belshe said. One of those locations could be the U.S. The disease could sweep the world in as little as three months, and it could persist for years.
Can it be stopped?
A couple of modeling studies published in Science and Nature this past summer suggested that pandemic flu could be stopped if outbreaks are detected early enough, antiviral medications are rushed to the region and public health measures, such as quarantine, are started immediately. That all needs to happen in just a few weeks to nip a pandemic in the bud.
The World Health Organization says it doesn't know whether those measures are practical but must be tried given the consequences of allowing a pandemic to spread.
What if I get a flu shot? Will that protect me?
No. A pandemic flu, by its very definition, is a virus humans haven't encountered before. The seasonal flu vaccines protect only against the virus currently making people sick - strains we already know about.
The annual flu shot can certainly protect you and those around you from contracting current strains of influenza and is a good idea on those grounds alone.
What about antivirals? I heard that if I take Tamiflu, that will stop the bird flu.
Stockpiling Tamiflu or Relenza, another antiviral medication, at home is not a good idea. The medications don't store well. Also, they must be taken in the first few hours of infection to be effective. And doctors don't even know whether they will stop pandemic flu.
Some strains of H5N1 are already resistant to Tamiflu. If lots of people start taking the drug before it is needed, that could increase the chance that drug-resistant viruses could emerge.
So what should I do about this pandemic threat?
First, keep in mind that currently there is no pandemic. There is no need to panic.
You can be prepared to follow public health recommendations when a pandemic does appear. Be prepared to curtail travel and follow quarantine rules.
It is going to be important that people stay home from work and school when they feel sick. It will be important to follow proper "respiratory hygiene" - covering your coughs and sneezes, washing your hands often, etc.
Start getting into those habits now, and we can all be healthier right now as well as better prepared for pandemic flu, public health experts say.
Reporter Tina Hesman covers science for the Post-Dispatch.
thesman@post-dispatch.com 314-340-8325
______________________________________
SARS (Severe Acute Respiratory Syndrome)
Just a few years ago, SARS (Severe Acute Respiratory Syndrome) swept the world and many feared it could cause the next pandemic.
The disease was contained with public health measures and didn’t spread as easily as first believed.
SARS infected people in Australia, Brazil, Canada, China (including Hong Kong and Macao), Taiwan, Colombia, Finland, France, Germany, India, Indonesia, Italy, Kuwait, Malaysia, Mongolia, New Zealand, the Philippines, Ireland, Korea, Romania, Russia, Singapore, South Africa, Spain, Sweden, Switzerland, Thailand, the United Kingdom, the United States and Vietnam.
Country Cases Deaths
China 5,327 / 348
Hong Kong 1,755 / 298
Taiwan 674 / 84
Canada 251 / 38
Singapore 206 / 32
*United States 73 / 0
Vietnam 63 / 5
*Note: The federal Centers for Disease Control and Prevention reported 161 confirmed, “suspected” or “probable” cases of SARS in the United States, but the World Health Organization counted 73 U.S. cases. Only eight cases in the U.S. were confirmed by laboratory tests.
Source: The World Health Organization, Centers for Disease Control and Prevention
West Nile virus
Perhaps the most famous recent emerging infection before avian influenza stepped onto the world stage, West Nile virus entered the New World in 1999.
The virus was first discovered in Uganda in 1937. It is endemic in Uganda, Central African Republic, Madagascar, South Africa, Egypt, France, Romania, Israel, Italy, Russia and India.
The virus swept the United States from 1999 through 2005. By 2004, the virus was established in the 48 contiguous states. Alaska and Hawaii are still free of West Nile. The virus also has been found in Canada and the Cayman Islands.
West Nile is spread by mosquitoes so its progress has been slower than a respiratory virus is likely to be.
United States
1999 — 61 cases and 7 deaths, all in New York state
2000 — 21 cases and 2 deaths in three states
2001 — 66 cases with 9 deaths from 10 states
2002 — 4,156 cases, including 284 deaths from 39 states
2003 — 9,862 cases with 264 deaths in 45 states
2004 — 2,539 cases and 100 deaths in 38 states
(Note: 10 states reported no human cases, but had animal cases and infected mosquitoes.)
2005 — 2,799 cases and 102 deaths in 42 states
(Note: all 48 contiguous U.S. states reported animal and mosquito West Nile virus activity even though no human cases were recorded.)
Illinois
2001 — laboratory tests confirm the virus in two dead crows from the Chicago area; no human cases
2002 — 884 cases, 67 deaths (the most in the nation)
2003 — 54 cases, 1 death
2004 — 60 cases, 4 deaths
2005 — 248 cases 12 deaths
Missouri
2002 — 168 cases, 7 deaths
2003 — 64 cases, 8 deaths
2004 — 36 cases, 2 deaths
2005 — 31 cases, 2 deaths
Sources: U.S. Centers for Disease Control and Prevention, World Health Organization, Illinois Department of Public Health, Missouri Department of Health and Senior Services
Past pandemics
Pandemics happen once every 10 to 50 years and are deadly
* 1918 Spanish flu killed 40 million people.
* 1957 Asian flu killed 2 million people.
* 1968 Hong Kong flu killed 1 million people.