In this International Fund for Animal Welfare public service announcement, an elephant comes in for a landing in the style of a jumbo jet. It's a visually clever way of making the point that travelers should think twice before purchasing souvenirs made from animal products.
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by B .N. Sullivan
The outbreak of H1N1 (swine flu) is continuing and expanding. So is the confusion over what the virus should and should not be called. Confusing as well -- at least to some people -- is the meaning of the terms 'confirmed' case, 'probable' case, and 'suspected' case. Hoping to clear things up a bit, this post addresses current virus naming conventions and official case definitions.
The Name of the Virus
When the current outbreak began, we were informed that the pathogen was the Swine Influenza A/H1N1 virus. That name quickly became colloquialized as Swine Flu. Apparently pork producers and some ethnic groups took umbrage, so authorities in charge of nomenclature for diseases officially declared that we all should use the name H1N1, rather than Swine Flu.
What followed was -- and is -- even more confusing. The World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC) hustled to change the terms Swine Flu and Swine Influenza to H1N1 Influenza in their official communications, and in some cases even changed the URLs of web pages that featured information about the virus and the outbreak. Many news organizations and bloggers followed suit, but the colloquialism, Swine Flu, still seems to persist in conversation, and also on social media like Twitter.
Today I was cruising around on the CDC website looking for various bits of information about the outbreak, and I discovered several pages of official information that used multiple names for the virus on the same page -- and even in the same paragraph.
Now, maybe this is a transitional thing, and maybe it's a sort of SEO attempt: using multiple names so that Google will point to the page regardless of which term is entered in a search. It does, however, boggle the mind to see the virus referred to as Swine Influenza A (H1N1) Virus; Swine-origin Influenza A (H1N1) Virus; and S-OIV, in the space of one paragraph.
Actually, I like the S-OIV variant -- and SOIV, without the dang hyphen, would be better still (not that anyone asked my opinion). To my mind, it's easier to say and type than H1N1/A Virus, or what have you . Also, the S-OIV designation distinguishes this novel virus from other H1N1 viruses.
Case Definitions
Now, about that suspected/probable/confirmed progression. Those are not casually used descriptors of cases. They actually have specific meaning to epidemiologists.
According to the CDC's guidance on case definitions:
A suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset
by B .N. Sullivan
There have been quite a few developments in the swine flu story since I first wrote about the outbreak here a few days ago. For one thing, more cases have been confirmed in the U.S.; for another, the virus has spread to several other countries, presumably carried by travelers.
As of this afternoon, the U.S. Centers for Disease Control and Prevention (CDC) had confirmed 40 cases of swine flu in the United States, with many more under investigation. So far there have been no deaths from the disease in the United States, but CDC officials have publicly acknowledged the inevitability of fatalities before the outbreak is finished.
This should not be a surprising statement, given the well known fact that each year, on average, about 36,000 people die from causes related to seasonal flu. The CDC also estimates that 5% to 20% of the U.S. population gets seasonal flu in a given year, and of those, more than 200,000 people are hospitalized from flu-related complications.
Ironically, some media sources have been citing those numbers to argue that we should not be so concerned about swine flu. After all, the reasoning goes, if 36,000 people die from flu each year anyway, what's the big deal?
This is a specious argument, of course, because it ignores the fact that seasonal flu occurs in a population in which a considerable number of people have been vaccinated. Also, there will have been many opportunities for people to be exposed to -- even 'catch' -- 'regular' seasonal flu viruses over a period of years, thus acquiring immune system defenses against them.
In contrast, the Swine Influenza A/H1N1 virus -- the culprit in the current outbreak -- is a novel virus, i.e., never seen before. Therefore, no one has been vaccinated against it (and indeed there is no vaccine against this virus). Furthermore, since it is new, our bodies have not been exposed in a way that would allow our immune systems to build antibodies to defend against infection. In short, we are virtually defenseless against this virus.
Before any readers accuse me of being alarmist, let me say that I am anything but that. I am a scientist, and as such I am accustomed to approaching issues with reason, and drawing inferences based on available data. I eschew rumors, and I read stories in the press with a skeptical eye. I rely on primary sources of information, to the extent they are available. I have concluded that, at the present time, our best defense against swine flu rests solely on avoidance.
The good news, if you want to call it that, is that most cases of swine flu -- at least in the U.S. -- have not been much worse than seasonal flu, in regard to symptoms and suffering. People catch swine flu; they are ill for a number of days; they recover. Let's hope it stays that way.
Two more points:
Today the CDC issued a Travel Health Warning, officially advising travelers to avoid non-essential travel to Mexico, which remains the epicenter of the swine flu outbreak.
The Emergency Committee of the World Health Organization (WHO) met today and raised the level of influenza pandemic alert from the phase 3 to phase 4, indicating that "the likelihood of a pandemic has increased, but not that a pandemic is inevitable."
The WHO statement about the change in the pandemic alert level notes:
This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.The chart below describes the WHO phases of pandemic alert. More info on the WHO website.
Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.
There is a lot of good, useful information available about the current outbreak of the Swine Influenza A/H1N1 (swine flu) virus in humans, but there is a lot of questionable and/or sensationalist information circulating as well. Sometimes it's hard to distinguish between the reliable and unreliable versions of the stories.
A good strategy for understanding what's going on is to monitor briefings that agencies like the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) provide. Here are a few of those:
by B .N. Sullivan
A new kind of influenza virus is infecting people in Mexico, California, and Texas (so far). The virus, called Swine Influenza A/H1N1, began making news just recently, but health officials are intensifying surveillance of the disease for several reasons.
According to the U.S. Centers for Disease Control and Prevention (CDC), Swine Flu viruses do not normally infect humans. Human infections have occurred infrequently in the past, and the cases almost always were in people exposed to pigs, e.g., on farms or elsewhere in the livestock industry. A Swine Flu Fact Sheet on the CDC website states:
In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.Things are changing. As of this afternoon, the CDC has identified eight 'laboratory confirmed' cases of human Swine Flu in the United States: six in California, and two in Texas. The CDC reports today that "no recent exposure to pigs has been identified" for any of the U.S. patients.
The Government of Mexico has reported three separate events.Should we be alarmed? Maybe. Should we be concerned enough to monitor the situation? Definitely.
In the Federal District of Mexico, surveillance began picking up cases of ILI [Influenza-Like-Illness] starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died.
In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.
Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.
Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.
Pele, the Hawaiian volcano goddess, sings a continuous chorus beneath the surface of the Earth. Geophysicist Milton Garces uses infrasonic technology to listen in on what's happening in Kilauea's lava tubes.
From the "Kilauea: Mountain of Fire" episode on the PBS series, Nature.
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