Swine Flu (H1N1 Virus

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Updated: Nov. 11, 2009 OVERVIEW The outbreak of swine flu that was first detected in Mexico was declared a global pandemic on June 11, 2009, in the first designation by the World Health Organization of a worldwide pandemic in 41 years. The virus traveled the globe in the spring, worked its way across the Southern Hemisphere during the summer and reemerged as a widespread outbreak across the United States in the fall. The initial outbreak raised fears of a repeat of the 1919 swine flu epidemic that left millions dead around the world. As more cases emerged, it became clear that the H1N1 virus, as it is officially called, was "moderate" in severity, in the words of Margaret Chan, the W.H.O.'s director general, with the overwhelming majority of patients experiencing only mild symptoms and a full recovery, often in the absence of any medical treatment. But it the new swine flu has proved more serious than expected for pregnant women and healthy young people -- a sharp contrast to the seasonal flu, which is more dangerous to older people and those with compromised immune systems. In November, the federal Centers for Disease Control estimated that 4,000 people had died in the United States as a result of swine flu. In October, federal health officials began delivering a swine flu vaccine which had been hurriedly developed. A total of 200 million doses are expected to be delivered, but the production fell significantly behind schedule when the vaccine proved to grow in eggs much more slowly than predicted. Some vaccination sites reported long lines and anxiety among parents hoping to have their children get one of the limited number of shots. A debate raged, primarily online, over whether the vaccine was safe, while many other Americans appeared to simply shrug off the flu's spread. ORIGINS The origins of the flu are unclear; it seems to have first surfaced in Mexico or the southwestern United States. The outbreak was first identified in March 2009 in Mexico, where health authorities became alarmed over the deaths of several young and healthy adults. Mexico's first known case, which was later confirmed, was from Perote, in Veracruz State, according to Health Minister José Ángel Córdova. The case involved a 5-year-old boy named Edgar, who recovered. Yet contrary to the popular assumption that the new swine flu pandemic arose on factory farms in Mexico, federal agriculture officials in late June 2009 said they believed that it most likely emerged in pigs in Asia, then traveled to North America in a human. But they emphasized that there was no way to prove their theory and only sketchy data underpinning it.

Even as the C. are frequently exported to Asia. Some said they were considering hiring nurses just for the vaccinations and setting aside days when children would be vaccinated in alphabetical order. opting for the more clinical sounding A(H1N1). or about half the population. and it is also possible to become infected by touching a surface with the virus on it and then touching one's mouth or nose. The virus has pieces of North American swine. But because of disease quarantines that make it hard to import Asian pigs. diabetes and heart disease. such as the rumor that the shot causes the flu. which combines Eurasian and North American genes.There is no evidence that this new virus. and also to avoid surfaces that might be contaminated.D. has ever circulated in North American pigs. Immune responses are different in each individual. It would also include people with the highest risk of complications and severe illness from the new H1N1 virus: pregnant women.C. SYMPTOMS AND TRANSMISSION The most common method of transmission is airborne. and people ages 25 to 64 with medical problems like asthma.C. the government hopes to have in hand 195 million doses by the end of 2009. 150 million Americans. according to the C. while dealing with other illnesses. . after a number of countries banned pork imports or slaughtered pig hers. has advised people to wash their hands frequently. Barring production delays. it is unlikely that a pig brought the new strain back West. doctors. PREPARING FOR AN EXPECTED SURGE IN CASES As anecdotal reports and at least one poll showed that many Americans were nervous about the vaccine. released the first doses of the vaccine in early October. children and young adults from 6 months to 24 years.O. The top priority group for vaccinations. and said they were doing what they could to debunk myths about the vaccine. but clinical trials suggest most people will be protected after 8 to 10 days. possibly carrying North American swine flu.H. The C. American breeding pigs. federal health officials emphasized that the new shots were nearly identical to seasonal ones.D.C. especially pediatricians. said that it would stop referring to the virus as swine flu. On April 30. experts said. bird and human flus and of Eurasian swine flu. clinical trials show that the new swine flu vaccine protects most people with only one dose instead of two.D. where the flu could have combined with Asian strains. would include health care workers and emergency medical responders. while there is tantalizing evidence that a closely related "sister virus" has circulated in Asia. The vaccine is also recommended for people caring for infants under 6 months. to prevent them from infecting the babies. Defying expectations of experts. the W. struggled to figure out how to administer perhaps thousands of doses quickly in small offices with limited staff. so the vaccine supplies will go twice as far as had been predicted. because their jobs are critical.

antibiotics and mechanical ventilators had existed.seasonal flus kill an estimated 250. it killed 299 of the 1. Each sufferer is. But in one sign that the disease may not be as serious as feared. The median age of patients is 17.often strike young. This flu strain it appears to infect an unusually high percentage of young people. This outbreak has caused concern because officials have never seen this particular strain of the flu passing among humans before. said Dr. healthy people the hardest. Pandemic flus -. when infants and the aged are the most vulnerable. or 17 percent. Virologists have tracked the avian virus since its discovery in Hong Kong in 1997.Most people lack immunity to this new virus.755 people infected. The avian flu has kept world health authorities anxious for years because 257 of the 421 people who contracted it died. passing the disease along to between 1. Much of the initial worry concerned the ages of the victims in Mexico.is both easily spread and virulent. Many of those lives would have been saved if anti-flu drugs. PANDEMIC VIRUSES By late September 2009.000 to 500. SARS -. the deadliest influenza pandemic in the past century.5 percent but killed tens of millions of people because it spread so widely. The virus that caused widespread panic in Asia in 2003. had an estimated mortality rate of around 2. and some experts have suggested that there may be something about the H5N1 virus that makes it inherently less transmissible among people. Mexican Health Minister José Ángel Córdova said that the flu appears only slightly more contagious than the seasonal flu. Fauci. Anthony S. a spokeswoman with the World Health Organization said. Among the many unknowns. none of the initial deaths in Mexico were in people older than 60 or younger than 3.000 people worldwide each year. less than thought. or 61 percent. Unlike typical flu seasons. the A(H5N1) bird flu strain. The sudden detection of the new virus occurred just as scientists were focusing on behavioral changes observed in another virus.severe acute respiratory syndrome -.4 and 1. RESPONSE FROM PUBLIC HEALTH OFFICIALS . on average. in Egypt. In the 2003 outbreak in Hong Kong. Even a flu with a low percentage of lethality can cause a large number of deaths if vast swaths of populations are infected -. mainly infecting poultry. a statistic known as the R factor.like the 1918 flu and outbreaks in 1957 and 1968 -. perhaps the biggest is how deadly A(H1N1) will be.8 people. federal health officials said the swine flu virus had not mutated in any threatening way since the spring of 2009 and that the new vaccine was still a good match for it. the Spanish influenza of 1918 to 1919. But it has shown very little ability to pass from person to person. As a benchmark. director of the National Institute of Allergy and Infectious Diseases.

O.H. Dick Thompson.O. . the next-to-highest level. became the first person to die from the virus in New York. who say the epidemic will spread regardless of attempts at containment. restaurants and movie theaters. In the following weeks the public schools seemed to become an incubator for the flu. system was introduced in 2005 in response to the avian influenza crisis.H.. Mitchell Wiener. based on the flu's continuing spread in the United States and Mexico. thousands of victims die of complications from the disease. to change the way it decides to declare a pandemic . But after an early period of high alert when the virus was first detected.many of whom had shown no sign of illness. It was the first time that Phase 5. and later cases have been met with aggressive efforts at culling nearby birds and vaccinating poultry in a ring around them. raised its alert level on H1N1 flu to Phase 5 on April 29. International health experts. The W. the approach is an about-face from the strategy that has contained the H5N1 avian flu. Phase 6 means a pandemic is underway.Health authorities around the world took extraordinary measures to combat the epidemic and mitigate its effects as it quickly spread across the globe in late April and early May 2009. Mexico City. one of the world's largest cities.H. swimming pools. advisories and alerts on certain pork products. not just how fast it is spreading. has been declared since the W. leading to a welter of bans. and numerous facilities were closed. authorities quarantined Mexican travelers in hospitals and hotels . A W.O. On May 17. In China. Britain. and because he had a history of medical problems that may have put him at greater risk. said in mid-May there was still not enough evidence to conclude that the disease was spreading in a sustained way outside of North America. the assistant principal at a school in Queens. Health officials said that the death was not surprising. gyms.H. Japan and other nations have urged the W.O.H. There has been concern that by raising the global alert level to 5. which would be required for the organization to raise its pandemic alert level to 6.O. the United Nations health agency had unduly raised alarm. officials toned down their concern. 2009. Mexicans donned masks for protection outdoors. advised against closing borders. spokesman. temporarily closed schools. The avian flu was contained in 1997 by killing every chicken in Hong Kong. For the W. THE VIRUS IN NEW YORK CITY In the early days of the swine flu outbreak in the United States the cases were concentrated in New York City. since even in a normal flu season.saying the agency must consider how deadly the virus is. They encouraged governments to focus on mitigating the disease's spread through public health measures. Many countries ignored the advice against containment efforts. The city's first reported cases were diagnosed in late April 2009 among teenagers from a high school in Queens who had traveled to Mexico for spring break.

according to federal officials. as the city girded for a second wave of the swine flu pandemic that already had killed more than 50 people in New York City. Many people seem to be more eager to receive the injectable form of the vaccine. And the nasal spray. when fears of an avian flu pandemic sparked a rush of emergency preparedness. Federal health officials expressed particular worry about pregnant women. which is not yet available. Clinical trials indicate that children 6 months to 9 years old received some protection from one shot. health clinics transformed into "flu centers" to relieve hospitals. Bloomberg outlined a strategy that included free vaccinations for students. FLU DRUGS A single shot of the new swine flu vaccine appears to protect most children and teenagers nearly as well as it protects adults. As a small fraction -. In large part. has some limits on who may use it. Health officials were still struggling to communicate that information to the public and make the general population aware that the first doses were not being widely distributed. the elderly or pregnant women.4 million doses -. Mayor Michael R.of the nasal spray vaccine began arriving the first week of October at local health departments. .In the fall of 2009. Federal officials said there was little they could do to avoid the shortages. so health officials are recommending they get two shots 21 days apart. emergency room statistics reported on the Web daily and schools closing only as a last resort. at least initially. there was nothing to do but wait. and the swine flu virus grew unexpectedly slowly. plans for limited distribution were being formulated on the fly or dusted off from earlier in the decade. but not enough. and 28 had died since the beginning of the outbreak in April. Vaccine production relies on a process of growing strains of the virus in eggs.some 2. But they acknowledged that their optimistic statements in the months leading up to the flu season may have contributed to the confusion. As of late August 2009. Pregnant women were urged to get swine flu shots as soon as they became available. chaos seems to have been averted. 100 had been hospitalized in intensive care. It is not recommended for infants. called FluMist. So for most people.

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