Mon, Aug 03, 2009 - Page 8 News List

With swine flu, the key is choosing priorities

By Mayo Kuo Max Kuo 郭明裕 郭明實

On July 2, the Department of Health said the new strain of influenza A(H1N1) accounted for about 30 percent of flu infections in Taiwan.

Five days later, the figure surged to 88 percent, with more than 1,000 confirmed cases. Last Saturday, 106 students came down with swine flu after attending a workshop in Kaohsiung.

Around the same time, the UK said it had confirmed more than 10,000 more cases of swine flu. The virus’ high activity in the Northern Hemisphere even in summertime concerns medical and public health circles.

Research published in Harvard University’s New England Journal of Medicine found that the H1N1 outbreak shares many similarities with the 1918 Spanish influenza pandemic.

In both cases, the outbreak started in January and reappeared in March and April. In the case of Spanish influenza, another wave occurred in September and October.

When school begins in September, it will be a crucial period for the spread of swine flu.

Both swine flu and the 1918 virus resulted in deadly infections mainly among people between the ages of 30 and 50.

There are differences between the viruses as well. With today’s aviation industry, it took only six weeks for swine flu to spread across the world, with an infection rate of 20 percent to 33 percent. The spread of the 1918 virus took six months.

Moreover, the H1 protein in the swine flu strain of H1N1 came from US pigs, while the H1 protein in the Spanish influenza strain of H1N1 came from birds.

Swine flu has proven less threatening to human beings than the 1918 strain, with the global mortality rate of the former at 0.454 percent, compared with 2.5 percent for Spanish influenza.

However, the mortality rate of swine flu is still four-and-a-half to nine times higher than regular seasonal flu.

Fortunately, vaccines and Tamiflu can combat the pandemic.

Domestic and international vaccine companies, however, need to work harder on producing vaccines or it will be too late. Advanced countries must produce vaccines to cover their own needs, meaning exports will be difficult to secure.

On July 22, a US media outlet also reported that the cultivation of swine flu in embryos had fallen far behind schedule and that clinical trials for a vaccine starting this week in Australia and human trials starting in early August at 10 medical centers across the US would take a couple of months to complete.

Tamiflu is 100 percent effective if taken within 48 hours of infection. Only three individual instances of resistance against the drug have been reported: one each in Hong Kong, Japan and Denmark.

However, the March 5 issue of The New England Journal of Medicine and another journal said swine flu could develop resistance to vaccines after spreading globally. This means Tamiflu could become ineffective.

Although vaccines work best, they are hard to obtain, which makes Tamiflu all the more important.

Scientists from the US Department of Health and Human Services, however, say that as supplies of flu vaccines and drugs are limited, young adults and adults with heart, lung and immunity problems, pregnant women and children under two years old should be prioritized.

This is a suggestion based in science that should be heeded.

Mayo Kuo is a Taiwan-based pediatrician. His brother Max Kuo is a US-based pediatrician.


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