A quick round-up of cool stuff in global health news:
The Global Health Magazine discusses use of technology for health in resource-poor settings.
The New England Journal of Medicine sets up an Online First page for H1N1 (a.k.a. Swine-Origin Influenza)
Doctors Without Borders / Médecins Sans Frontières release The Photographer, a graphic novel documenting their humanitarian missions in Afghanistan.
More coming soon!
As we all come down from last week’s frenzy surrounding the (now renamed for lesser offensiveness to pork-marketing sensibilities) Swine-Origin Influenza Virus (S-OIV) H1N1 , is it possible that there is a hint of disappointment in the air? Perhaps a whiff of anti-climactic letdown after the threat of feverish, lung-rending apocalypse? Are we seeing a lucky escape from a close brush with global pandemic, at mercy of mutation and chance? The product of a genuine, coordinated worldwide epidemic response? Or merely the end of one news cycle and the beginning of the next?
While you ponder those questions, I bring you what could be one of the last updates before S-OIV H1N1 becomes terminally uncool. As of Monday, April 4, the World Health Organization registered 1,085 laboratory-confirmed cases in 21 countries.1 Mexico has begun to step down its safety measures, with restaurants and other venues for public activity set to re-open on Wednesday, and U.S. public health officials will be allowing schools to remain open in spite of the continuing spread of the virus, as most new cases appear to be mild. In the business of assuaging fears, it has been confirmed by the WHO that eating pork is safe (so long as you cook it to 70°C/160°F first), and in the business of fanning fears of a different kind, U.S. conservatives are wasting no time in casting President Obama’s “overreaction” to the crisis as big-government encroachment.
For the fun flu facts reading selection this time, I introduce another global health resource: the University of Pittsburgh’s Supercourse online series on epidemiology and global health. Click on the Swine Influenza A link (or on the image below), pick your language of choice (including Spanish, Russian, Farsi, Vietnamese, and Hebrew), and click “Start” for a refresher on hemagglutinins, neuraminidases, and case definitions.
For a cool overview of influenza virus genetics, check out this article by Carl Zimmer in the New York Times:
Scientists first isolated flu viruses from pigs in 1930, and their genetic sequence suggests that they descend from the Spanish flu of 1918. Once pigs picked up the flu from humans, that so-called classic strain was the only one found in pigs for decades. But in the 1970s a swine flu strain emerged in Europe that had some genes from a bird flu strain. A different pig-bird mix arose in the United States.
In the late 1990s, American scientists discovered a triple reassortant that mixed genes from classic swine flu with genes from bird viruses and human viruses. All three viruses — the triple reassortant, and the American and European pig-bird blends — contributed genes to the latest strain.
And for possibly the best selection of flu-tracking maps you’re likely to find, this one is brought to you by Google and Rhiza Labs:
1 For the epidemiologically-minded, with a lab-confirmed death toll of 26, this makes for a Case Fatality Ratio of 2.4% and falling with every new case of lab-confirmed disease in the absence of further deaths. For comparison, your annual, garden-variety flu has a CFR of less than 0.1% in the general population, with a bimodal distribution of mortality (mostly limited to the very young and the very old). Past flu pandemics have had CFRs in the 0.1%-2.5% range, while the dreaded H5N1 avian flu virus tracked in Asia in recent years showed a CFR of 14%-60% by various estimates (Li et al., J Epidemiol Community Health. 2008 Jun;62(6):555-9 ). One previously reported CFR for zoonotically-acquired swine influenza was 14% (Myers et al., Clin Infect Dis. 2007 Apr 15;44(8):1084-8 ). As you may suspect, flu CFRs are notoriously difficult to calculate, due to the wide incidence and under-reporting of mild cases.
The Kaiser Family Foundation has a new resource for global health. While new, it features plenty of handy information for us global advocates, such as a map of cumulative cases of H1N1 influenza (the subtype of influenza A causing swine flu), convenient fact sheets on U.S. Global Health Policy, and a policy tracker in which you can follow up on the latest global health legislation.
Reporting live from Manhattan…
We aren’t quite running down the streets with masks on our faces panicking yet (which, it’s not clear how good of an investment they are anyway; see Susan’s comment on masks on the previous flu post), but we did close four schools, as the number of confirmed cases in New York City rises to 51, the first US swine flu death is confirmed in a toddler in Texas, and the World Health Organization raises the pandemic alert level to Phase 5. The net worldwide case count is uncertain due to re-testing of previously identified cases in Mexico.
City health agencies are concerned about the effects of recent downsizing due to the recession on their ability to function at top form:
At a news conference on Monday, Dr. Richard E. Besser, the acting director of the federal Centers for Disease Control and Prevention, said the public health system was in “a tough situation.”
“We hear about tens of thousands of state public health workers who are going to be losing their jobs because of state budgets,” he said. “It is very important that we look at that resource because this outbreak was identified because of a lot of work going on around preparedness.”
But according to John M. Barry, author of The Great Influenza, now may be a reasonably good time to catch the bug.
For further reading while you’re holed up in your room ordering delivery and avoiding crowds:
BBC has a nice interactive map that shows the spread of swine flu at different points since the first cases were identified:
Amidst the calls for readiness and the necessity of prompt public health action, Governor Kathleen Sebelius of Kansas has been confirmed as the US Health and Human Services Secretary.
The UN’s Food and Agriculture Organization (FAO) has announced it is sending a team to investigate claims that industrial pig farms in Mexico were the source of the outbreak. Meanwhile, the Internet is aswarm with swine flu rumors ranging from the plausible to the outrageous (as well as a gratuitous number of attempted puns involving pigs and flying). A sampler (with source): the outbreak’s name should have nothing to do with pigs (US pork producers; also the government of Israel); the virus was secretly created in US labs in a bid for world domination (Indonesia); avoiding pork chops will protect you against it (Twitter; also a number of world governments); so will enemas (The Huffington Post); so will getting drunk (xkcd.com, point your mouse over the image). OK, so maybe the last one is just there to lighten the mood. But seriously, people. While we marvel at the fascinating cultural beliefs and geopolitical realities that underlie these rumors, do let us try and stick to the science when it comes to disseminating information.
Seen any fantastic swine flu rumors or controversies out there? Please add them in the comments!