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Just another pandemic

Ano Lobb | Friday 9th October 2009

Every flu season we experience a pandemic: Mutating viral strains sweeping the six continents killing tens of thousands of people. On any given year, the only people who know the names of those strains are the researchers who must identify and isolate the circulating viruses in ordered to prepare an effective vaccine. Every now and then something new comes around, and the name bursts onto the headlines. A few years ago there was H5N1 "avian influenza." This year we've draped the flu in a cloak of familiarity by affixing it with the colorful moniker "Swine flu," followed by the futuristic sounding H1N1.

What makes H1N1 "swine flu" different? Well, the name for one thing, or more precisely the fact that you know the name. But is it more contagious? More deadly? Is it killing different people than you'd expect? The answer seems to vary from no to maybe so. Younger people seem more susceptible than the elderly, which is unusual, and perhaps due in part to some degree of immunity from the last time swine flu made its rounds several decades ago. And it seems to be circulating out of season, striking in the summer and early fall instead of late fall through winter.
Is it striking more people than the usual flu? That's hard to say. The obvious thing about disease surveillance is that when you look for disease, you find it. And the harder you look the more you find. Marry your global surveillance system to an equally expansive public health information campaign, and pretty soon everyone appears stricken. It's not possible, and probably not helpful, to get laboratory confirmation of every case, so you utilize epidemiological confirmation. Eventually cases of upper-respiratory disease, from the mild to the murderous, are being labeled the flu. If we gave every year's flu the scrutiny we are giving H1N1, there is little doubt that world prevalence figures would skyrocket.

Then there's the vaccine question. Health communication is always complicated, and H1N1 vaccine news and recommendations have been especially tricky. Should healthy folks get the shot? The elderly? The young? Should you forgo the usual vaccine in favor of H1N1? Get both? Some raise concerns that the H1N1 vaccine hasn't been studied in a clinical trial. But the flu vaccine never undergoes that kind of research. By the time the trial rendered results the flu season would be over. So why then was an Australian clinical trial of the vaccine initiated? Shortly thereafter we learned that European and American regulators approved it, but without clinical trial data. Should they have waited for the Australian results?

Perhaps the biggest lesson we are learning is that effective disease and health awareness should start with giving conditions colorful names, like hurricanes. We don't seem to know how bad H1N1 is yet, or what to do about it. But we certainly know its out there. What do you think, is H1N1 really that different? Are you paying more attention to the flu this year than last?

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