2009 H1N1 Influenza A is the true name of this virus.

Media finds it much easier and more memorable to refer to the virus as "Swine Flu." A few short years ago it referred to an earlier strain of this same virus as "Avian Flu." It has to do with where it is first discovered.

In health science all strains are assigned an H (hemagglutinin) number and an N (neuraminidase) number along with the year. Hemagglutinin and neuraminidase are proteins that sit on the surface of the virus (see micrograph) and allow the virus to both "unlock" and invade a healthy cell, and once replicated in that cell, "unlock" and escape that cell. Think of H (hemagglutinin) as the key into the healthy cell and N (neuraminidase) as the key to escape the now infected cell.

There are sixteen (16) H and nine (9) N subtypes known in birds, but of these types only H1, H2 and H3, and N1 and N2 are commonly found in humans. This is why when Swine Flu was first discovered in pigs there was cause for alarm. It is also an H1N1 virus. This meant there was a real possibility of a Swine Flu epidemic in the human population.

The Spanish Flu of of 1918 was also an H1N1 virus. The H1N1 of 1918 is quite different than the H1N1 of 2008~2009 because of the fast mutation of these viruses. Also, because the protein structures themselves change, sometimes radically, the H1N1 of this decade is so far considerably milder than the Spanish Flu of 1918.

There is still considerable debate about why the 1918 flu caused so many deaths. One possibility is what is called a "cytokine* storm." Note that the word "possibility" here indicates that it's a theory; not a fact.

It is known that the H5N1 bird flu, also an Influenza A virus, causes a cytokine storm, in birds. It is thought (theory; not fact) that the "Spanish Flu" caused those killed by it to suffer from a lung infection which, in turn, prompted a strong immune response. The release of too many cytokines in turn caused lung tissue destruction, which in turn caused secretion of liquids into the lungs. Victims effectively drowned in their own body fluids. This is thought to be the main reason so many younger people died of Spanish Flu. In effect a "too-strong" reaction from their strong immune systems.

Of course, there is a potential for the "Swine Flu" to mutate and have similar effects on people today. This latest variant also affects more of the young than old. This can be seen from the Centers for Disease Control (CDC) inoculation recommendations below.

In simpler terms the H protein and N protein determine how a cell is invaded and, once the virus replicates, how it escapes the invaded cell and spreads. The shape of these proteins and your body's ability to recognize them and destroy them is what provides immunity. Because the viruses change so much and so often a slight change in these proteins is enough for your body to fail to recognize them as a threat until the virus has gained a foothold. Historically this happens about once or twice a year.

Reading my hub Cytokine Immunity Technologies will give you a rundown on what cytokines are and how they've been considered as an alternative to antibiotics.

* A cytokine is a naturally produced messenger substance present in all terrestrial life-forms. Cytokines can detect foreign substances in a body and call upon the immune system to produce t-cells, macrophages and the like. Cytokines can also "ask" these cells to create more cytokines.

All versions of the vaccine are on-track for an October 2009 release. They appear to be quite effective at providing immunity to those who receive them. In fact, earlier reports had adults getting a minimum of two injections six months apart. As of now the estimates are one injection only for the entire year.

Every flu season though a number of deaths and other ailments are attributed either to the flu itself or the vaccine created to prevent it. Unfortunately the CDC has had little few tools available to either discount or confirm these reports.

This year it will be different.

For example, roughly three (3,000) thousand people a day have a heart attack. If one of those occur right after a vaccination will the vaccine be the cause or will it just be statistical odds?

The CDC hopes to address this by combining databases covering approximately fifty (50) million U.S Citizens. This will give them a huge statistical sample to work from. The idea is to be able to detect any rare and real reaction to the vaccine or simply find that it was a statistical probability of "too many cheeseburgers."

Dr. Daniel Salmon of the Department of Health and Human Services put it this way: "Every day, bad things happen to people. When you vaccinate a lot of people in a short period of time, some of those things are going to happen to some people by chance alone."

The CDC's aim is to vaccinate half the U.S. population in just a few short months. That's one hundred seventy five million (175,000,000) people in the U.S. This will be no small feat as typically no more than one hundred million (100,000,000) Americans are vaccinated a year.

Because vaccine safety is key not only to those vaccinated, but also to those considering vaccination, it's important to track problems and isolate the real from the imagined or rumored. In this way the CDC can respond rapidly to reports of problems.

By contrast the 1976 vaccination effort was hampered by rumors that the inoculation was responsible for a rise in Guillain-Barré syndrome. The CDC had no way of either confirming or discounting these reports. Had they the tools now proposed, it would have been able to answer the question; did the vaccine cause this syndrome or not?

This time around the federal government has paid for:

• Harvard Medical School to link together insurance data for fifty (50) million people from vaccination registries. This data will be available to the entire country for real-time checks of reported problems to doctors.
• Johns-Hopkins University to direct e-mail to at least one hundred thousand (100,000) vaccine recipients to track how they are feeling. They will even be asking for minor complaints that do not typically require a doctor's visit. This way trends can be spotted and monitored.

Also the Centers for Disease Control is:

• Preparing cards that vaccine recipients can take home with them instructing them on how to report any side-effects of the vaccine. This data will go into the Vaccine Adverse Event Reporting system.
• Compiling a list of "routine" health incidents so it can rapidly spot any changes to these trends. The list would include such data as the number of heart attacks per week (25,000), miscarriages (14,000~19,000), and even anaphylaxis (300). This way any change in the norm could trigger a closer examination and possible health warning.

Additional benefits are sure to become apparent as the data are processed and compared.

Update November 3, 2009

From Nature Magazine:

The new Nature report also assessed the immune response of different groups to the new virus. The most intriguing finding, according to Kawaoka, is that those people exposed to the 1918 virus, all of whom are now in advanced old age, have antibodies that neutralize the H1N1 virus. "The people who have high antibody titers are the people born before 1918," he notes.

The CDC recommends that the following be vaccinated:

• Women who are pregnant or about to become pregnant
• Those who live with or care for children younger than 6 months old
• Emergency and Healthcare personnel
• Persons between the ages of 6 months and 24 years old
• Persons between of 25 and 64 years of age who are suffering from chronic health disorders
• Anyone coping with a compromised immune system

September 28, 2009

In the U.S. there have been one hundred thirty-eight thousand (183,572) cases of Swine Flu so far resulting in six hundred sixty-three (663) deaths. One thousand sixty (1,060) of those cases are unconfirmed.

In Mexico there have been thirty-two thousand twenty-five (32,025) cases reported resulting in three hundred fifty-eight (358) deaths.

In China fourteen thousand six hundred sixty-three (14,663) cases have been reported. This is the extent of the report from China with no mention of deaths or unconfirmed cases.

In Japan thirteen thousand three hundred ninety-nine (13,399) cases of Swine Flu have been reported resulting in eight deaths. Nine of those cases are unconfirmed.

In Canada there have been nine thousand eight hundred (9,810) cases reported resulting in forty-six (46) deaths with two hundred thirty-nine (239) unconfirmed.

In The Russian Federation three hundred seventy-four cases (374) cases have been reported. This is the extent of the report coming out of the Russian Federation.

Though these figures indicate that the U.S. has the highest number of cases and fatalities, this may simply be due to better reporting in the U.S.

October 16, 2009
U.S. figures have risen to 239,832 confirmed cases of Swine Flu with 2,304 fatalities. This is a slight drop in the ratio of confirmed cases to deaths since this hub was written. Figures for all other countries listed in the table have not changed. This is clearly due to a lack of reporting.

October 20, 2009

U.S. figures have risen to 252,205 confirmed cases and 2,801 deaths. This is a slight rise from the October 13th figures. Again, figures from all other countries remain the same. Again, this is due to a lack of reporting.

October 23, 2009

U.S. figures have risen to 280,808 cases with 2,808 deaths. The infection to death ratio has dropped to an even one percent of diagnosed cases. However, of these 2,808 deaths 95 were children. This indicates, as the CDC feared, that this version of flu is particularly hard on children. That means that of the 2,808 deaths 3.5% of them were children under the age of eighteen.

WHO reports that most nations have now stopped reporting the number of confirmed cases of flu as well as deaths related to the flu.

You can compare the figures immediately above with those at the top of this section for an idea of the rise since this article was written.

All figures gathered from the link below.

November 14, 2009
Please note this is an estimate! Doctors stopped testing individual patients, by and large, around the beginning of October 2009. These estimates are based on past statistics garnered from known cases. These numbers represent cases starting in April 2009 to now.

The Centers for Disease Control estimate that four (4,000) thousand persons have died out of twenty-two (22,000,000) million having caught the Swine Flu. Of that four (4,000) thousand it is estimated that five hundred forty (540) were children or 13.5% of fatalities.

Epidemic: from Greek epi- upon + demos people. An epidemic occurs when new cases of a certain disease substantially exceed what is "expected."

Pandemic: from Greek pan- all + demos people. Is an epidemic that occurs in populations of a large region, continent, or world-wide.

October 7, 2009
The Swine Flu nasal vaccination is now available in Indiana, Illinois and Tennessee. These states must share the seven (7) million doses available. The injection form will be available next week. Ultimately, the federal government ordered two hundred fifty (250,000,000) million doses.

October 8, 2009
The CDC reports that one quarter (1/4) of Americans sick enough to be hospitalized with swine flu ended up in intensive care. Seven (7%) of those died. This is a little higher than the usual seasonal flu numbers. Nearly half those hospitalized have been children between 6 months and 19 years of age. This is significant as seasonal flu typically strikes the elderly.

October 16, 2009
The CDC reports that distribution of the inject-able form of the vaccine is running behind schedule. Instead of a mid-month release (now) the CDC is now saying most states should have the vaccine available by the end of the month. (October). Further, the original 40 million doses has been cut to from 28 to 30 million doses.

October 21, 2009
The CDC now reports that Swine Flu (2009H1N1) injectable vaccine will not be widely available until mid-November.

I've seen signs, print ads, and television advertising for flu shots. Many say they are available now! Since mid-October is the announced date of availability I doubt it's for Swine Flu. It might just be for the regular winter flu.

Be sure to ask and make sure what you are getting.

Confusing directions

Doctors often prescribe Tamiflu in fractions of teaspoons; however, the dropper packaged with the drug is in milligrams.

This potential confusion in directions could cause parents to mistakenly give too little or too much of the drug to their children. Too little and the child's recovery will be impeded. Too much and parents could be facing a toxic overdose.

Dr. Michael Wolf of Northwestern University's Feinberg School of Medicine stated: "It's an egregious error that there is a conflict in the prescription labeling instructions and the dosage device that comes in the exact same box, It's incredibly confusing to parents."

This is a real problem. A teaspoon is a measure by volume. A milligram is a measure by weight. The two don't really convert from one to the other.

So, should your doctor prescribe Tamiflu be sure to ask him/her to prescribe the recommended amount in milligrams not teaspoons or fractions of teaspoons. -- Source Source FDA, Food Consumer

October 30, 2009
Apparently children's Tamiflu is in short supply, but adult Tamiflu is still widely available. it is possible to take the adult medication and tailor it for children.

Have the pharmacy you purchased the prescription from modify it for children's use. They can not only "convert" the capsule form to a liquid, they can also add flavoring more pleasing for children. This is an FDA approved procedure and is actually printed on the Tamiflu adult capsule supplement that comes in the box.

Medical researchers testing both the Swine and Winter flu vaccines have found that giving Children's Tylenol^tm (or child's acetaminophen) can actually reduce the effectiveness of the vaccine. Why this happens is not yet known, but the effect is real.

Therefore health researchers are now recommending that Children's Tylenol (or acetaminophen for children) not be given in the first days after vaccination. -- Source MSN Health & Fitness, Atlanta Journal Constitution