H1N1 Swine Flu Continues to Spread as Southern Hemisphere Enters Flu Season

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25 July 2009 :: staff

The influenza A/H1N1 virus, known as “swine flu”, continues to spread, while governments step up efforts to help private industry produce a safe and effective vaccine. The southern hemisphere is now entering flu season, where the number of cases is expected to multiply and to spread across borders at perhaps unprecedented rates, a prospect which has public health officials working to establish means of prevention and containment.

The World Health Organization (WHO) has said the spread of H1N1 swine flu is now “unstoppable”, suggesting that travel restrictions and the filtering or blanket testing of travelers will not help to contain the virus, once it has reached a given country, but politically, it is hard for many governments to defend the idea that containment measures are not needed, as the global death toll continues to mount.

As of 24 July, the virus has infected people in at least 160 countries and experts report the pandemic could infect up to 2 billion people within 2 years. Most would likely not develop serious symptoms or show outward signs of infection. The WHO reports that “In most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to 17 years”, a fact which differentiates A/H1N1 from traditional flu, which is normally most dangerous to people over 65.

There are conflicting reports across the international media relating to the virus’ “virulence”: the rate of contagion appears high and may be escalating, as the pandemic spreads and establishes more “leaping off points” for continued infection, but it appears so far to be involved in fewer deaths per rate of infection than the standard seasonal flu.

The WHO has recommended, as the pandemic spreads, testing only “samples of ill persons”, meaning not every person presenting “flu-like symptoms”, but samples of that population to determine probable distribution of infections among the population and plan treatment based on information about such trends. As the WHO website reported yesterday:

Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources. It remains a top priority to determine which groups of people are at highest risk of serious disease so steps to best to protect them can be taken.

With public health officials devoting huge amounts of resources to H1N1 preparedness, including a new billion-dollar fund requested by US president Barack Obama to help communities and states deal with the spreading virus and prepare for mass vaccinations next fall. The FDA, the US food and drug regulatory authority, approved this week a 3rd test for use to detect H1N1.

Testing measures are evolving as new information on the trending patterns of infection and second-wave spread are gathered. Public health officials had been preparing for a relaxation of infection rates in the countries most heavily affected, but WHO now reports that local spread has persisted longer than expected in “already affected countries”. This persistent rate of expansion means fears about the normal “second wave” are being refocused.

Due to the global nature of the 2009 H1N1 “swine flu” strain, preparedness and prevention initiatives are being undertaken across the southern hemisphere, which is now entering its normal seasonal flu season. It is expected the H1N1 virus will see its best opportunity to date for widespread contagion, and public health officials are watching to make sure the virus does not perform in ways not expected for a traditional flu strain.

In the US, the most heavily affected states are Wisconsin, Texas, and Illinois, with 6,222, 5,151, and 3,404 respectively. Texas being closest to Mexico, where the initial outbreak is thought to have occurred, is expected, Wisconsin less-so. New York state, which had a worrying initial surge in cases, in part due to transmissions among school populations, has seen less aggressive spread of the virus, with only 2,738 confirmed or probable cases.

With 45,000 made ill in the US, from swine flu infection so far, and 300 deaths across the country attributed to the virus, the FDA has also announced approval for a new vaccine for influenza next fall and winter. But that vaccine will deal with the ever-evolving traditional “seasonal flu”, not the novel influenza A/H1N1 “swine flu”. Efforts to bring effective low-risk swine flu vaccines to market are coordinated across borders and involve multiple major pharmaceuticals manufacturers and governments.

The EU’s European Medicine Agency (EMA) will examine the development of new vaccines for targeted prevention of H1N1 infection. As the Wall Street Journal reports: “Given the public health threat posed by the current pandemic, the Agency’s goal is to ensure data submitted to support marketing authorisations for vaccines are reviewed as early as possible, before the beginning of the Northern hemisphere flu season, expected in September”.

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