The consequences of refusal

I’ve written previously about “chicken pox parties”. These types of events are coming back into vogue (they were common in the days before the vaccine, when the only way to provide immunity was to be infected), as parents mistakenly believe that “natural exposures” to these pathogens are somehow superior–and safer–than vaccinations. Though the latest rage are “H1N1 parties”, chicken pox parties are still around, and potentially being held at your local McDonald’s by families connecting on the internet:

I am trying to put together a chicken pox party and am looking for someone to donate their chickenpox to the event.
I was thinking of having it at McDonald or some place with toys to play on.
if you know anyone who would like to contribute or would like more information on a time and place let me know.

This is, again, one of my biggest problems with those who refuse vaccines. They frame the issue as solely “my child, my choice.” Which is fine, until you put that child in with the rest of society via school, or daycare, or even trips to McDonald’s. These interactions include infants who are too young to get vaccinated; people with chronic conditions or who are receiving chemotherapy, and are therefore more susceptible to disease; or those in whom the vaccine just didn’t “take” (my own measles titers were not high enough to be protective, I learned last year when I was preparing to go to Mongolia–despite having 2 doses of the vaccine), and on and on. Yes, you have the right to make decisions for your child–but parents should realize that this particular choice can put a lot of others in danger.

Why are the schools closing and other good H1N1 links…

Over at DailyKos, DemfromCT has an excellent post explaining why it may be beneficial for schools to close temporarily, even if they only have one confirmed case of swine influenza: H1N1: Why Do Schools Close, And When Do They Open?

DarkSyde also has one up on the basic biology and evolution of the flu.

Nick Kristof discusses our lack of attention to public health and what it means in the event of a pandemic in today’s NY Times.

[Updated: and via the comment theads, this post which further discusses what I mentioned here regarding testing–and how the confirmed cases are only the tip of the iceberg (complete with diagram!).

What does the WHO’s pandemic scale mean? And why is anyone worried about this?

I’ve been seeing a lot of comments mocking the current outbreak of H1N1, and a lot of people (and journalists) who don’t understand what “big deal” is about the “snoutbreak” of swine influenza, or don’t get what the raising of the World Health Organization’s pandemic alert phase up to 5 means. I noted here what the alert level meant, but wanted to discuss it a bit more in a full post; after the jump.
Continue reading “What does the WHO’s pandemic scale mean? And why is anyone worried about this?”

Iowa investigating two “probable” swine flu cases

It was only a matter of time:

Iowa Gov. Chet Culver says the state has two probable causes of swine flu.

Speaking Wednesday at a Statehouse news conference, Culver told reporters that officials would know Thursday if the cases are swine flu.

Officials say one case was from a California resident who visited Scott and Clinton counties last week. The other was a woman who returned from Mexico and traveled through Johnson, Des Moines and Muscatine counties.

State Medical Director Patricia Quinlisk says both of the people infected were now recovering.

Should know by tomorrow if they are confirmed or not.

US up to 91 cases, including 1 death [Updated: New England confirmed cases]

The latest numbers of confirmed cases from the CDC were released about an hour ago. 91 cases have been confirmed, with the largest numbers in New York (51), California (14), and Texas (16). One new case has also been confirmed in Nevada, one in Indiana, one in Arizona, and 2 in Michigan; the other Ohio case I know of is still pending, apparently. Ongoing investigations are also taking place in multiple states, so expect the number to keep rising for the time being. [Update: 2 cases just confirmed in Massachussets, and three in Maine.]

The first fatality has also been reported: a 23-month-old child who had recently traveled to Mexico traveled to the United States from Mexico.

I’ve written previously about how difficult research in infectious disease can sometimes be, knowing that many of the isolates you’re working with harmed or even killed someone, and changed someone’s life forever. This child’s influenza virus will now be marked with a lengthy name based on the date and location of isolation, and will be studied and dissected on a molecular level, and referred to in dry publications discussing the case–but that doesn’t mean that those who carry out the research and write up the manuscripts in such clinical language are any less touched and upset when deaths like this occur.

Swine flu–deja vu all over again?

Back in 2007, I wrote about an outbreak of swine influenza from an Ohio county fair. The peer-reviewed paper analyzing the swine influenza isolated from that outbreak has just recently come out. From the abstract:

The swine isolate, A/SW/OH/511445/2007 (OH07), was evaluated in an experimental challenge and transmission study reported here. Our results indicate that the OH07 virus was pathogenic in pigs, was transmissible among pigs, and failed to cross-react with many swine H1 anti-sera. Naturally exposed pigs shed virus as early as 3 days and as long as 7 days after contact with experimentally infected pigs. This suggests there was opportunity for exposure of people handling the pigs at the fair. The molecular analysis of the OH07 isolates demonstrated that the eight gene segments were similar to those of currently circulating triple reassortant swine influenza viruses. However, numerous nucleotide changes leading to amino acid changes were demonstrated in the HA gene and throughout the genome as compared to contemporary swine viruses in the same genetic cluster. It remains unknown if any of the amino acid changes were related to the ability of this virus to infect people. The characteristics of the OH07 virus in our pig experimental model as well as the documented human transmission warrant close monitoring of the spread of this virus in pig and human populations.

Meanwhile, I mentioned yesterday that gene sequences from the new H1N1 virus had been released. Sandy has taken a look at some of these, and compared them with H1N1 and H1N2 viruses from humans and pigs.

Yes, there is a point to the juxtaposition of these two points, and it’s big–after the jump…
Continue reading “Swine flu–deja vu all over again?”

Swine flu: Central & South America, Asia, New York update

Stories in Spanish: Costa Rica becomes the first Central American country to confirm swine flu (“gripe porcina”). A 21 year old who had traveled to Mexico is in stable condition. An additional 16 cases were examined but were negative. Brazil is also examining 11 travelers; cases are also being examined in Panama, Honduras, Argentina, and Uruguay, and Chile.

In Asia, South Korea is examining a possible case, while China’s stepped up its efforts to look for cases (and blocked import of pork from the US and Mexico).

Most of the cases that are being examined have traveled to Mexico recently, but secondary spread may be occurring in New York City. 45 cases have been confirmed to date, but many more are suspected or have been alluded to in news reports. This extended human-to-human chain of transmission is the worrisome part–if this is efficient, it’s going to be much more difficult to get ahead of the virus and minimize spread. Expect much focus in the coming days and weeks to be on contacts of infected cases, in an effort to determine the frequency of secondary transmission…

How long does it take to sequence an influenza virus?

…asked Joe. Answer: only a few days to sequence, clean up the data, and submit to NCBI. Seven H1N1 swine flu sequences are up (H/T Jonathan Eisen). I’ve not had a chance to crack anything open yet, but I hope to see some analysis from more of the genomics geeks soon…However, one bummer is that they don’t have any from the Mexico cases available–and particularly, any sequence data from any of the fatal cases. These will be helpful to see if there are any point mutations that could possibly account for a virulence difference between the Mexican and US cases. (Unlikely, I’d guess, but it would be nice to check it out…)