Some flu facts from a molecular biologist

[mrs_p]

In lieu of the recent swine flu outbreak, I thought maybe I would start a thread with some facts about influenza and how it is spread from host to host. I am by no means an expert, but I am getting my PhD in infectious diseases, and I do research on how influenza jumps the species barrier. I know there are better scientists on this board than I (and welcome their input), but I hope this adds a little to the discussion and helps quash any panic that the sky is falling. If you will forgive me, I've mostly copied and pasted from some of my papers on the subject.

Historical and emerging influenza: Potential human influenza pandemics have been described for over 2400 years, although it is widely agreed upon that the first real pandemic occurred in 1580 (Potter 2001). Since then major pandemics arise about every 10-40 years from viruses mainly of Asian origin (Hampson and Mackenzie 2006). The most devastating worldwide outbreak of influenza in recent history was the pandemic of 1918, where it is estimated 50 million people died and 25% of the world’s population was inflicted with disease (Potter 2001). Fortunately, influenza pandemics are relatively rare, although epidemics occur frequently.

Hosts: Influenza virus has been isolated in many species, including birds (Slemons 1974), seals (Geraci et al. 1982), whales (Hinshaw et al. 1986), horses (Sovinova et al. 1958), pigs (Shope 1931), and dogs (Crawford et al. 2005). As seen in the 1918 and 1957 pandemics, influenza viruses that switch from one species to another are often more virulent in naïve hosts. There has been much concern recently that a human influenza pandemic could transpire if a particularly virulent form of avian influenza endemic in waterfowl suddenly jumps the species barrier – not only infecting humans, but also mutating into a strain that can be transmitted among humans. In 1997, a high pathogenic avian influenza (HPAI) H5N1 virus was isolated from influenza-infected humans in Hong Kong (de Jong et al. 1997), and has since been observed in other patients throughout Asia (Beigel et al. 2005; WHO 2008). Although there are few cases of H5N1 being transmitted among humans, the virus has been fatal in >60% of cases reported to the World Heath Organization since 2003 (WHO, 2008). Due to the high death rate of H5N1, transmission of influenza strains between and among species is currently a major focus of influenza research.

Antigenic drift and antigenic shift: As a member of the Orthomyxoviridae family, influenza A is a negative-sense, ssRNA virus with a genome consisting of eight segments. Influenza has been evolutionarily successful partly because of mutations inherent in RNA error-prone replication. Two of the segments, the HA (haemagglutinin) and NA (neuraminidase) genes, play particular roles in influenza species specificity (reviewed in Landholt and Olsen 2007); there are 16 known HAs and 9 known NAs, which have all been identified in avian flu strains (waterfowl are considered reservoir hosts of influenza). Single amino acid changes in HA and/or NA resulting from host selection pressures lead to newly circulating viruses that may cause regional epidemics; thus, antigenic drift. Antigenic shift, on the other hand, is a much more dramatic mutation of the influenza genome and may lead to pandemics. There are two possible ways for antigenic shift to occur: (1) reassortment of avian- and human-like viral segments in a “mixing vessel” where entire segments can be replaced by the same segments from another strain, or (2) adaptation of an avian-like virus to a human-like virus in a host (Karasin et al. 2000). In both cases, a host must be able to be infected with both avian- and human-like viruses. Japanese quail (Wan and Perez 2005) and pigs (Landholt et al. 2003) have been shown to fit this host model for generation of pandemic viruses. Of course, other factors contribute to epidemics and pandemics such as the cleavability of the HA to proteases within the host, the ability of the virus to be transmitted among humans, the number of susceptible hosts, and the extent of antigenic variation in mutated influenza strains.

Receptor biology: Influenza infection requires uptake by a host cell before it can be translated and replicated. Attachment and binding to cellular receptors depends on the type of sialic acid linkage to the oligosaccharide receptor attached to the host cell surface. Generally, avian-like influenza viruses have a higher affinity to sialic acid receptors that have alpha-2,3 linkages to the penultimate sugar on oligosaccharides, whereas human-like viruses bind to alpha-2,6 linkages with greater affinity (Matrosovich et al. 1997). In antigenic drift, a single mutation in the amino acid sequence of the HA gene may allow a particular strain to have greater affinity to the sialic acid receptors. In antigenic shift, a whole HA gene from one strain of influenza may be completely replaced by the HA gene from another strain, or the strain may develop affinity to a different sialic acid linkage receptor, rendering the virus able to affect new species. Pigs and Japanese quails have both types of sialic acid linkages (Gambaryan et al. 2005; Wan and Perez 2005), which is partly why both species can become infected with both avian- and human-like influenza viruses.

IN SUMMARY: This latest swine outbreak is something to cause concern - it resembles antigenic shift, where genes from different viruses have been swapped in a mixing vessel (the pig). This occurs naturally (not in some government fortress where they brew bugs to kill us). Also, unlike what I've heard on the streets and read here, swine flu has been spread among humans before - this is not the first time. There are some differences, though - the fact that this strain is a combination of several swine strains plus avian and human strains is new (at least from what we know). I haven't seen the molecular data yet, but as we are naïve to this strain, it does have the potential to cause epidemic. There are some other factors involved in regards to its pandemic potential that the news isn't reporting (the HA needs to be cleavable by many proteases in the host, so as to enter many more epithelial cells than just what we see in a regular influenza infection). Whether or not this becomes a pandemic, there are things we can do: (1) don't come to school/work/anything if you are sick, (2) see a medical doctor right away as antivirals only work within the first 48 hours (also, a flu shot is not gonna help as this is a new strain), and (3) become informed and do not spread erroneous information (check out the cdc.gov site for the latest info). EDIT: TIME WILL TELL. BE CAUTIOUS.

Hope this helps, and best to all...

[crim son]

1. Thank you.

It does help, although it hardly calms. :hi:

[mrs_p]

4. i know, just be careful what you breath

;-)

[liberalmuse]

2. Thank you!

I'm so very impressed with your excellent explanation and appreciate your taking the time to post it here. I now know why the CDC and WHO are on edge.

[Chiquitita]

123. Source may be US Hog Facility in Mexico

It looks like the vector may be flies on untreated swine feces. The community in Mexico around the Smithfield owned Hog farm has been requesting an inquiry...

http://themoderatevoice.com/30074/source-of-swine-flu-may-be-us-hog-production-facility-in-mexico/

"A publication called Grist is reporting that the swine flu outbreak may have been triggered by poor hygienic practices at the Perote, Vera Cruz, Mexico hog farming facilities of Smithfield Farms. Smithfield Farms is the “world’s largest hog producer and pork packager”:

On Friday, the U.S. disease-tracking blog Biosurveillance published a timeline of the outbreak containing this nugget, dated April 6 (major tip of the hat to Paula Hay, who alerted me to the Smithfield link on the Comfood listserv and has written about it on her blog, Peak Oil Entrepreneur):

Residents believed the outbreak had been caused by contamination from pig breeding farms located in the area. They believed that the farms, operated by Granjas Carroll, polluted the atmosphere and local water bodies, which in turn led to the disease outbreak. According to residents, the company denied responsibility for the outbreak and attributed the cases to “flu.” However, a municipal health official stated that preliminary investigations indicated that the disease vector was a type of fly that reproduces in pig waste and that the outbreak was linked to the pig farms. It was unclear whether health officials had identified a suspected pathogen responsible for this outbreak."

[Baby Snooks]

137. So it's Fly Flu?

It's influenza. Not some unidentified pathogen.

[Chiquitita]

142. It may be more virulent in areas that lack clean air and water

(or critical thinking skills -- in which case some of us here should watch out!)

[drm604]

3. Thank you for posting this.

However, I'm failing to see how this helps to quash any panic. Maybe it's because I don't have a degree in biology but, as I read it, it seems to be saying that this strain is exactly what the experts have been fearing.

[mrs_p]

10. well, i guess i want to say we should be cautious

but a lot has to happen before pandemic mode... it's not just that a lot of people come down with the flu - the flu has to be able to spread not just amongst us, but within us to be really deadly (not just make us want to die). influenza attaches to epithelial cells in our respiratory tract and then can gain entry into our respiratory cells where it replicates and then spreads among other respiratory cells. with pandemics, we also see that influenza can infect other cells including our guts and brains, which can make us even sicker, increase mortality, and be transmitted more frequently among a population.

(and thanks for the spelling correction)

[drm604]

15. I didn't even realize I was correcting your spelling.

I think I just read "squash" as "quash". I guess it wouldn't even really be incorrect to talk about "squashing panic" although that's not normal usage.

Doesn't the fact that people have been dying indicate that it can spread within us?

One thing I have been curious about is that, from what I've read to date, the fatalities have all been in Mexico. Does that tell us something or is it simply because more people there have been infected? Who has been dying from this? Is it mostly the elderly and weak, which occurs with typical influenza, or is it healthy young people?

[mrs_p]

20. from what i've read

80 of 1300 people have died - that's at about 6% (vs. >60% for HPAI in humans), and that the dying have been the immune compromised, young, and old (which is characteristic of influenza deaths). i suspect the higher fatality in mexico because of lack of health care. i think if folks had gotten to the doctor quicker there would have been better supportive care and prophylaxis for those who had been exposed. also, mexico was in major denial which only fueled the flame. i think awareness of symptoms and better health care will help us here in the US.

[drm604]

21. That's encouraging.

Not to belittle those deaths but it does sound like death rates similar to typical influenza, which is encouraging. Of course, I'm in a higher risk group so the lack of a vaccine is personally troubling. I'm also concerned for elderly relatives who normally get vaccinated. I guess there's nothing to do except to take the usual precautions and see a doctor immediately for any symptoms.

[northernlights]

27. thank you -- that's the opposite of what I had read

before today.

Everything I'd read on the Mexico deaths was that it was *young, healthy adults* dying, not the typical flu victims. But I don't remember the sources any more, so suspect yours are more reliable.

[nadinbrzezinski]

28. Mexican Secretary of Health

and they saw an unusual spike in flu cases in April, when they usually crash

[northernlights]

55. I was referring to age/health of typical victim

Here is what I had read before, from the WHO:

"The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern."

In other words, it is the opposite of what you have written. These have not been typical victims of flu; they have been completely atypical.

http://www.who.int/csr/don/2009_04_24/en/index.html

[Jim Pivonka]

61. This age / fatality pattern also in the Spanish (1917) flu

The Spanish flu, of 1917, was famous for carrying off people of childbearing and rearing age, leaving infants and children to be raised by grandparents. It was (also?) exceptionally virulent, resulting in many more fatalities of young adults than most flu.

[elocs]

106. The 1918 flu pandemic seemed to spare the very young and older adults.

http://www.huliq.com/11/72680/1918-spanish-flu-records-...

"In the 1918/19 pandemic, mortality was greatest among previously healthy young adults, when normally you would expect that elderly people would be the most likely to die,'' Professor Mathews says "We don't really understand why children and older adults were at lesser risk.

"One explanation may be that children were protected by innate immunity while older people may have been exposed to a similar virus in the decades before 1890 which gave them partial but long-lasting protection.

"Those born after 1890 were young adults in 1918. They did not have the innate immunity of children and as they weren't exposed to the pre-1890 virus they had little or no immunity against the 1918 virus. We can't prove it but it is a plausible explanation."

Another striking feature is that the pandemic appeared in three waves, in the summer and autumn of 1918 and then the following winter.

One theory being examined to explain why some people were only affected in the second or third wave is that because of recent exposure to seasonal influenza virus they had short-lived protection against the new pandemic virus.

"The attack rates in the big cities weren't as high and this is probably because many people had been exposed to ordinary flu viruses, giving short-lived immunity,'' he says.

[FedUpWithIt All]

86. Exactly, they are atypical. Most likely cytokine production causing pnumonia.

http://en.wikipedia.org/wiki/Cytokine_storm

[Baby Snooks]

138. The healthier you are, the more at risk you are..

Apparently what happens is the immune system over-reacts. And you die of the over-reaction rather than the flu. We want to believe modern medicine has all the answers. Every time it finds an answer, it produces another question. And that seems no more true than with influenza.

[McCamy Taylor]

90. Everyone can get flu. They go to a doctor when they get "sick". The fact that so many

healthy adults are forced to seek medical care--even though, as adults they should have plenty of underlying immunity to different strains of influenza to help their bodies avoid the worst symptoms---suggests that there is a new sheriff in town. I.e. a type of flu so unlike any that they have encountered before that they are getting sicker than they would with an more ordinary human influenza strain. So, they are reacting like infants and small children, who typically get much sicker with flu, because they have not had a chance to develop any natural immunity.

[northernlights]

100. that's not quite how it works

Because in that scenario, those with compromised or immature immune systems would be dying too -- at the same rate if not higher.

When the flu is killing healthy young adults *instead of* those with compromised or immature immune systems, then it is more likely that an *overactive immune response* is what is causing the deaths, not the flu itself. The "cytokine storm" as referenced above.

[Bluenorthwest]

126. You are talking about two different things

Your quote from WHO refers to "the majority of these cases" meaning the majority of those who got ill. Not the majority of deaths.
Who gets it does not bother me so much as who dies from it. The majority of illness could be among healthy young adults, but the majority of deaths might not be...
The WHO quote is not the opposite of what the other poster wrote, it is a totally different statement.
I'd like to find the stats on the deaths, clearly stated.

[siligut]

51. What the empirical data shows us.

I also read that this flu was unusual because it infected healthy persons between the ages of 20 and 40, its mechanism of action was to use the healthy immune system to essentially drown the victim in their own lung secretions. I cannot find where I read specifically that, but I thought it was on the WHO website. Here is an article from WHO 4/24/09 that states the victims were young and otherwise healthy.

Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.
The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.
Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.

http://www.who.int/csr/don/2009_04_24/en/index.html

Then this from Reuters, I read about a large investment firm that hoped to make some money off of this through their investments in pharmaceutical companies that make anti-virals.

LOS ANGELES, April 24 (Reuters) - The swine flu outbreak is likely to benefit one of the most prolific and successful venture capital firms in the United States: Kleiner Perkins Caufield & Byers, Thomson Reuters Private Equity Week reported on Friday.
Shares of the two public companies in the firm's portfolio of eight Pandemic and Bio Defense companies -- BioCryst Pharmaceuticals (BCRX.O) and Novavax (NVAX.O) -- jumped Friday on news that the swine flu killed a reported 60 people in Mexico and has infected people in the United States.

http://www.reuters.com/article/marketsNews/idAFN2425534220090424?rpc=44

Currently the only flu victims that have died are in Mexico. I haven’t heard if these 81 people came in direct contact with pigs or not. However, from past experience with the Avian flu, while human-to-human infection occurred, the subsequent infection was much weaker. That is what the news is telling us here, none of the infected outside of Mexico are deathly ill.

[mikekohr]

52. Could there be a genetic reason to explain the high death rates in Mexico? RE Native American HLA's

http://www.brotherhooddays.com/healing.html

The European plagues that decimated Native populations came in wave after wave, with some plagues individually, and others collectively having mortality rates of up to 95%. These diseases were for the most part introduced incidentally, though at times with purposeful deliberation, but nearly always noted with celebration or observed with dispassion and distance.

The stunning death rates of Native Americans to European pathogens was due in part to lack of exposure, but also due to genetic traits that limited Native Peoples ability to deal with these unseen killers. Native People are free of many genetic diseases but have a relatively narrow genetic range. Four mitochondrial haplogroups, named A, B, C, and D, 76).account for 96.9% of all Native Americans. More than 90% of Native People of North American and nearly 100% of Native South Americans have type O blood. Europeans are relatively evenly split between types A and O. More importantly American Indians have only about 17 Human Leukocyte Antigens (HLA's) classes as opposed to Europeans having on average about 35 HLA classes. HLA's are one of the human body's two main lines of defense against sickness. In addition Native Americans HLA profiles are dominated by a small number of types. There is evidence that the other line of defense in humans against disease, Helper T cells, are in the case of Native Americans oriented predominately against parasites but not as focused on bacteria and virus' as are the immune systems of Europeans.

No where in recorded human history has such a catastrophic depopulation of people as befell the Native People of the Western Hemisphere ever been recorded. These plagues rank as perhaps the most seminal events in the recorded history of mankind. 75).

mike kohr

[northernlights]

57. that is very interesting information

I would think that if that were the case, other flu outbreaks would also be more virulent in Mexico than elsewhere. I haven't heard anything to that effect before, though.

I expect that by now the indiginous population has been pretty well mixed in with western Europeans, except those who live well on the outskirts...who probably then aren't involved.

But who knows for sure?

[mikekohr]

63. Tecumseh's Creed

Here is the rest out the saying you have tagged on your post:

"So live your life that the fear of death can never enter your heart.
Trouble no one about their religion; respect others in their view, and
Demand that they respect yours. Love your life, perfect your life,
Beautify all things in your life. Seek to make your life long and
It's purpose in the service of your people. Prepare a noble death
song for the day when you go over the great divide. Always give a
word or a sign of salute when meeting or passing a friend, Even a
stranger, when in a lonely place. Show respect to all people and Bow
to none. When you arise in the morning, give thanks for the food and
The joy of living. If you see no reason for giving thanks, The fault lies
only in yourself. Abuse no one and nothing, For abuse turns the wise
ones to fools and robs the spirit of it's vision. When it comes your time
to die, be not like those whose hearts. Are filled with fear of death,
so that when their time comes. They weep and pray for a little more
time to live their lives over again In a different way. Sing your death
song and die like a hero going home."
TECUMSEH -Shawnee-

http://www.brotherhooddays.com/TecumsehsCreed.html

[northernlights]

71. thank you

I didn't want to try to fit the whole thing in my tag line. So I just jumped to what I felt was the heart of it. It's nice to see it recognized so soon. I learned it from ayeshaqqiqa :)

[nyc 4 Biden]

124. That is beautiful.

I've never read that before.

[Jim Pivonka]

This may answer a troubling observation

I've been surprised at the apparent difference in fatality rates and virulence generally as the flu moved away from its point of origin. This information about HLA' may explain it. But it sure bodes no good for the indigenous populations of S.A.

And it does nothing to explain why this virus is similar in its fatality pattern to the 1917 flu, in its impact upon young and middle aged adults.

And it does not explain the sudden appearance of a hybrid of 4 flu viruses - two never before seen swine viruses, an avian, and a human, none ever before seen in combination with any of the others.

[mikekohr]

65. It is also possible the death rate is decreasing because the virus is losing

virulence as it evolves. I have read this phenomenon has been observed in other outbreaks. Science should be able to tell if this is the case fairly quickly through DNA analysis of the virus as it mutates.

mike kohr

[mrs_p]

76. there could certainly be a genetic component

but it is unknown as far as i've read. we are still working out host-viral interactions.

[Baby Snooks]

140. That is probable more than possible

It seems to be more virulent in the population in Mexico but we don't know which population. Those with indigenous Indian heritage or those with Spanish heritage. Influenza apparently has not been a problem in Mexico for some reason so most people probably have no immunity at all. Most of us have some immunity simply because most of us have had flu at least once in our lives.

As things stand, despite it being a pandemic in terms of having spread to other continents, the numbers don't equate to a pandemic.

Perhaps it is just another "warning" to all of us, however, because it or another "new" strain is still there and still mutating and may come back and kill millions the way the Spanish Flu did in 1918.

[mrs_p]

75. that is what i heard

from another influenza researcher who was on the phone with the CDC. information may have changed since then, or it may be incorrect.

[northernlights]

101. I found my source -- the WHO

http://www.who.int/csr/don/2009_04_24/en/index.html

[mrs_p]

128. thanks!

obviously, my source (a flu expert) didn't know.

[mrs_p]

133. dupe

[mrs_p]

134. hi - i have now heard

what you originally heard. my source was incorrect.

[hedgehog]

39. Or is it a false mortality rate because X number of people who

had mild cases and never saw a doctor weren't counted. 80 out of 1300 is terrifying, but if it was actually 80 out of 13000, that's something different.

[northernlights]

44. it's equally possible that x number of cases were pronounced

deaths from natural causes and not investigated at all.

The archaeologist who died one day after greeting President Obama was said to have "died of symptoms resembling the flu." It has yet to be confirmed what exactly he died of.

If that is how the death of somebody illustrious is handled, what about the many indigenous people who are ignored or neglected?

[hedgehog]

53. I was thinking this morning of a young seminarian who died

suddenly a few weeks ago here in Upstate New York. We may have had deaths in the US and not realized it.

[mrs_p]

77. very true

[FedUpWithIt All]

84. "the dying have been the immune compromised, young, and old (which is characteristic of influenza"

The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

http://www.who.int/csr/don/2009_04_24/en/index.html

[Bluenorthwest]

136. The quote from the WHO

referes to 'the majority of cases' meaning the cases of those who became ill, not those who died. I'd really like to see the stats for the deaths, age, etc. The WHO quote is about the total of those sick, not about who died.

[ekwhite]

73. There is no indication it is spreading within us yet.

Doesn't the fact that people have been dying indicate that it can spread within us?

Not necessarily. The annual flu epidemics kill hundreds of people every year. Mexico has had over 81 deaths out of 13,000 cases, however, which is worrisome, but not frightening yet.

[northernlights]

103. 1,300 cases, not 13,000

~6% versus .6%

[ekwhite]

111. My bad - I misread the article

In comparison, the mortality rate reported for the 1918 flu pandemic was 2.5% That is a bit more worrisome, but not time to panic yet.

The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%.

Link: http://virus.stanford.edu/uda/

[FedUpWithIt All]

110. It is now 103 out of 1600 cases.

http://www.alertnet.org/thenews/newsdesk/N26462487.htm

[66 dmhlt]

127. Background: WHO's Criteria for "Pandemic"

Three criteria are needed for a global influenza pandemic to occur:

1) A new virus emerges with a new hemagglutinin to which there is almost universal susceptibility

2) The virus is capable of causing significant disease in humans,

3) The virus is efficiently transmitted from human to human.

From World Health Organization - Geneva Headquarters: http://www.who.int/vaccine_research/diseases/influenza/Working_Paper_2.pdf">"WHO Consultation for the Development of a Global Plan of Action ..." (PDF)

[John Q. Citizen]

141. 20 case in US, so far, no deaths so far known. That's good news. That's NOT

Spanish flu, so far, in terms of a public health danger.

That doesn't mean it can't mutate to be more virulent. It could. But it also may not.
So before you jump to the conclusion that this is what the experts have been fearing, please don't.


Every year, Flu kills tens of thousands of people. You aren't any less dead if you die from normal expected human flu than if you die of a new strain which has crossed the species barrier.

While this new strain is of great concern because it contains SOME of the elements of a flu that could cause a pandemic with high mortality rates, it also doesn't contain some of the elements.

For instance, since this flu contains some human virus, our systems may have some immunity built in, since we have all had the flu at some point or another.

[SidDithers]

5. K&R...

especially this part:

(1) don't come to school/work/anything if you are sick, (2) see a medical doctor right away as antivirals only work within the first 48 hours (also, a flu shot is not gonna help as this is a new strain), and (3) become informed and do not spread erroneous information (check out the cdc.gov site for the latest info).

Sid

[rusty fender]

6. Extremely helpful, but

the mixing vessel could be a lab. The "New World Order" conspiracy theorists have been predicting that the elites would, one day, release a super-flu in order to wipe out a huge chunk of humanity. Why? Because we would no longer serve their purposes. I'm not saying this is what is happening now, but I wouldn't put it past those who believe that they rule the world. Part of my mind, although I'm usually very rational, thinks that if this is a manufactured flu, it was released in order to infect Obama, while he was in Mexico. Those who believe they rule the world certainly don't like that Obama is shaking things up.

[stray cat]

8. Lots of better bioweapons on there if you wanted to get rid of one person

this one is hardly it.

[mrs_p]

11. could be, but as a scentist

i must wait on the data... doesn't mean i can't listen to what you have to say.

:hi:

[file83]

23. Here's some data for you:

http://www.torontosun.com/news/canada/2009/02/27/8560781.html

While it appears this "mistake" involved a different strain, it happened only 8 weeks ago...

People familiar with biosecurity rules are dismayed by evidence that human H3N2 and avian H5N1 viruses somehow co-mingled in the Orth-Donau facility. That is a dangerous practice that should not be allowed to happen, a number of experts insisted.

Accidental release of a mixture of live H5N1 and H3N2 viruses could have resulted in dire consequences.

So contrary to your assurance that this swine virus in Mexico could not have been mixed in a lab, it appears that this does and has happened even very recently.

It was a only a few steps away from being deployed to population.

And this occurred just a few weeks before this Mexico outbreak. Perhaps it's just a coincidence, but there could be a company out there whose "mistakes" didn't get caught and their "vaccines" were successfully deployed in Mexico a few weeks ago.

It's completely possible and plausible. I'm not ruling out natural causes either, however, as that would be foolish. Likewise, it would be just as foolish to rule out man-made strains.

As to whether it's an "accident"? I have no clue.

[mrs_p]

79. well, i never said it couldn't happen in a lab

hell, any researcher could probably do it if s/he had the right strains. the point is that this is a natural process and i think it is irresponsible for people to spread things with no real evidence.

[McCamy Taylor]

91. This is really horrific news. Note that folks in Europe may have partial

immunity to bird flu, because there was a bird flu epidemic in that country a few years back. So, the disease could also have reached Mexico City (a big travel hub) from Europe where it may be present but causing milder disease in the already partially immune population. When me, my husband and son went to Amsterdam in 2004, we came back with something that had the typical symptoms of an animal or avian influenza, in that we all had diarrhea on top of severe flu symptoms. I have only heard of influenza causing initial diarrhea if it from an animal source. Human influenza generally only causes respiratory symptoms.

[McCamy Taylor]

94. More info on the Austria company that released a human/avian product

a few weeks back. They apparently have been attempting to genetically modify influenza vaccine so that it can be used as an anti-melanoma vaccine (among other uses). I.e. they insert new genetic material onto the regular influenza vaccine. What this means in this case is that their lab works with processes which can accelerate the mutation or gene exchange, what is called splicing. If they use sloppy procedures and had a bird flu contamination, then conceivably some avian flu material could have been inserted into their vaccine.

http://www.greenhillsbiotech.com/products_vecflu.html

Note that according to this article, the firm is also in the middle of a 60 month project to create an influenza pandemic vaccine. Since pandemics are caused by new influenza strains, did they create new strains in their lab in order to test it? Could they have deliberately manufactured a pig/bird/human strain of high infectivity in order to test out their vaccine on lab animals? And, given the sloppy way they do work there (as evidenced by the release of a human.bird mix) could there test influenza have been released to the public, possibly via a test subject who appeared healthy but who actually had a subclinical infection?

http://www.greenhillsbiotech.com/eu_inhalt.html

And from this link, we see that they were scheduled to start human trials of their new nasal pandemic influenza vaccine this year

http://www.biospace.com/news_story.aspx?NewsEntityId=102724

More on the vaccine test plans here.

http://bio2009.bdmetrics.com/PDT-367333/Eurocine-Vaccines-AB/Nasal-influenza-vaccine.aspx

[file83]

109. Great links - say, have you read the book "LAB 257"?

Check it out at Amazon. It's a investigative book covering the history of a "research lab" on Plum Island just off of Long Island.

The interesting part covers its ties to some famous US outbreaks. It wouldn't shock me one bit if the source of this latest outbreak was a research lab. Especially if "research" has been outsourced to Mexico because it cheaper.

[Baby Snooks]

56. Wouldn't they just use an avian flu?

The avian strains are the most deadly as I recall - it was an avian strain that produced the pandemic of 1918 and killed an estimated 50 million people. So it would seem that if someone wanted to create a flu virus that deadly they would use an avian strain. This is a swine strain. And so far it appears not to be deadly with a 6% mortality rate.

[northernlights]

60. actually, this is a mixed swine/avian/human strain

Its genome includes 2 never-seen-before swine strains, an N.American avian strain and a human strain. But it is not the highly lethal avian strain that started in Asia.

[drm604]

13. There is no reason to believe that this is not natural.

This has happened before, and they understand how it happens. There is no proof that it is anything but natural.

If find it hard to believe that some Illuminati type group (assuming such a thing even exists) would release something so uncontrollable and unpredictable. There is no way to control or predict the spread of this type of thing and it could easily turn out badly even for the Illuminati. A disastrous pandemic (if that were to occur) during precipitous economic times could push the economy over the edge. Illuminati presumably would have economic interests and would not want to risk those interests by releasing something so unpredictable.

Extraordinary claims require extraordinary evidence. The idea the this was engineered and released by some "New World Order" group is an extraordinary claim for which there is NO evidence.

[Jim Pivonka]

54. I gather you are not familiar with investigations underway

at USAMRIID? http://www.fredericknewspost.com/sections/news/display.htm?StoryID=89293

There is lots more, if you want to look for it.

And we've already established that the Anthrax spores came out of USAMRIID laboratories.

Why is a claim of human, purposeful, spread of an heretofore unheard of hybrid virus so "extraordinary" under these circumstances. I don't think it is an "extraordinary" claim at all. It may be unproven; it may be false. It is not extraordinary.

[drm604]

68. You gather incorrectly.

I had heard about that. From what I've read it looks like it may be a case of bad record keeping. Certainly someone could have stolen them, but there's simply no evidence that someone stole viruses and infected a bunch of Mexicans. Of course it's possible but it's also possible that this is completely natural. It doesn't seem reasonable that some "New World Order" group would do something like this. What would be their reason?

We don't even know what type of virus, if any, is missing, and I can't see why the army would create this type of virus. It's not useful as a weapon because it's indiscriminate.

Without further evidence I'm going with the more likely explanation, which is that it's natural. Flu viruses mutate and recombine all the time.

[Jim Pivonka]

150. Going with ANY explanation is premature. We need more evidence.

You are making too many inferences based on too little data. Of course it may be a case of bad record keeping. And it may not be.

We don't operate on "may be". When there is no evidence we don't walk away, we look for evidence.

No one has suggested "New World Order" nonsense in insisting that all of the circumstances around maladministration at USAMRIID be completely investigated. The raising of "useful as a weapon" is a red herring too - there is no reason to think that the fact that a bio agent has to be targetable or useful as a weapon to be originated through human agency. Individual experts are just as capable of doing this as individuals as as the agents of institutions - Anthrax, I presume, demonstrated that conclusively.

(Maybe you think that Anthrax was created by the Army or the New World Order, because it was targetable, and 2009 H1N1 was not because it is less targetable?)

We've seen some strange virulence characteristics for this virus. We do not understand them. We will not be in a position to evaluate the "targetability" of this virus until we do understand them, if we do then.

We should not be "going with" any explanation. We should be considering all possible explanation and devising research protocols which can exclude as many of them as possible. If we do a really good job of that, then we will still, in all likelyhood, have a handful of plausible explanations which we do not have sufficient data to exclude, after it is all said and done.

[malaise]

16. Where did it break out

and where did Obama visit.

[Lyric]

17. But they wouldn't release it in Mexico.

It's too close to the U.S., which would put the elites themselves at risk.

If this were happening in Asia, I'd be more inclined to believe it. But not in North America. There's no way that the elites would deliberately release a genetically unstable virus like influenza this close to "home"--the potential for mutation and subsequent infection of people who thought they were "immune" or "safe" is too severe, as well as the nasty consequences--bodies in the street, the horrific smell, the utter lack of services as society shuts down in fear, employees not showing up for their jobs, the loss of MONEY...

In Asia/India, it might be probable. Or even Africa, although there isn't much that threatens them there. But not North America.

[Hannah Bell]

34. there are now-documented cases of release of bacteria in the us by the ptb.

supposedly harmless, but once i know they've done something similar, secretly, i don't trust: e.g.


"In August 1949, the Special Operations Division operatives infiltrated the world's largest office building and sprayed bacteria into the Pentagon's air handling system, which then spread them throughout the structure.

The operatives moved to larger scale testing, releasing clouds containing supposedly harmless bacteria from Navy ships off Norfolk, Virginia, in April 1950, and the San Francisco coast in September 1950. The San Francisco experiments showed exposure among almost all of the city's 800,000 residents. Had the bacteria released been anthrax bacteria or some other virulent pathogen, the number of casualties would have been immense.

The success of the first field tests only increased demand for more experiments..."

http://www.pbs.org/wgbh/amex/weapon/peopleevents/e_testing.html

[Lyric]

98. Apples and Oranges. Bacteria do not mutate

as rapidly as viruses do, therefore they are by nature less dangerous than viruses. I could believe, with evidence, that they might try to kill off the overseas competition, but they'd never expose *themselves* to harm--and that is precisely what would happen if they deliberately released a deadly virus in North America. Antibiotics can help save us from bacterial infections, even awful ones, but viral infections are impossible to "cure," and influenza is one of the worst in this regard, because we can't even make decent vaccines for it. It mutates too fast for an "antidote" or vaccine to work for very long.

[Hannah Bell]

116. not apples & oranges at all. "they" have done similar things in the past, therefore i don't trust

them not to do similar things in the future. this was *my* point, yours is different.

re yours:

1. mutation rates vary by conditions, for both viri & bacteria.
2. infectious mutations tend to go in the direction of lesser harm (otherwise they kill the hosts too fast to spread).
3. if present-day flu vaccines are ineffective, why are they recommended for certain populations & why are we being told tamiflu is effective v. this virus?

[Butch350]

95. Unless the so called Elites had An antidote ?

[Lyric]

96. No such thing for the flu.

It mutates too quickly; we can't even produce a reliable vaccine for it. We have to make new ones every year by trying to guess which strain/mutation will be most common.

Setting free a lethal version of it right across the border would be akin to suicide. Any vaccine/"antidote" would only work for a short amount of time--then the virus would mutate and the elites would be at risk.

Besides, the last thing they'd want to do would be to kill off their American consumerist wage slaves. From where will they draft their army of low-income "volunteers" to go fight their oil wars, if not from us?

[Lena inRI]

35. Rusty fender, my open mind hears you loud and clear. . .

. . .down thread the counterpoint that Mexico is too close to "the Illuminati" so they wouldn't have deliberately started this flu makes one false assumption. . .

who says Illuminati live in North America anywhere near Mexico?

Also, no matter where they live, their control of anti-virals would be part of their survival plan while the virus runs its course.

It's not a conspiracy thought to discuss "loosened viruses from vials" since just last week vials of equine encephalitis virus went missing and file83 down thread cites a case of accidental lab virus combination that nearly wreaked havoc just 8 weeks ago.

Hey, I would rather not ever think this way, but like mrs-p says, no reason I can't hear you out until ALL the factual evidence is reported.

Finally, something we could watch closely is whether or not there will be a correlation between torture-author prosecutions and spread of swine flu.

Waiting and watching closely with ya, rusty fender. . .

:smoke: :smoke: :smoke: :smoke: :smoke:

[quakerboy]

64. That seems backward

It kinda goes against the whole "they need lots of poor people to do their bidding" meme. And haven't most of the good times for the people come directly after huge chunks of humanity get wiped out?

It would then seem backward that the power brokers would want a pandemic. It would seem to be more in their favor to work against such things.

[ekwhite]

78. Exactly

The government and the power elites have a vested interest in the status quo - why would they want something as disruptive as a world-wide pandemic to occur? I have to go with Occam's Razor on this one - the simplest explanation is a natural cause.

[quakerboy]

92. As a former

student of biology, the thing that amazes me is not when we spread illness. Its when we don't all die of illness. Even in a clean lab, it was amazing how often samples got contaminated. A few minutes in open air, and the next day your auger is growing colonies of things you don't want. And overnight, one cell of x turns into a whole colony. How kick ass must be our natural immune system to avoid us all dying on a daily basis?

[Butch350]

93. What do you do when your garden is full of weeds?

You thin it out!

[John Q. Citizen]

143. Part of your mind is sick. Get help.

[xchrom]

7. recommend

[FedUpWithIt All]

9. Thank you. This is very informative. Kicked and rec'd

:hi:

[etherealtruth]

12. (3) become informed and do not spread erroneous information

Trying to make sure the intelligent posts on this subject are "kicked"

[mrs_p]

14. i have to go

but will check back later if anyone has q's or clarifications...

[Lena inRI]

38. Mrs_p, any precautions for air travel. . .

. . .and for any mass transit?

Planes recycle cabin air with filters, yes?

I'd greatly appreciate any advice you may have.

:grouphug: :grouphug: :grouphug: :grouphug: :grouphug:

[mrs_p]

74. best to talk with your doctor if you plan on traveling

s/he may recommend a precautionary drug. also, keep checking in with public health officials - i work on the molecular side of influenza and defer to their judgment in matters such as these.

[Hugin]

18. Great! Some facts...

Thanks, this is very helpful.

[southernyankeebelle]

19. THANKS FOR YOUR ADVICE -

I HAVE ALREADY BEEN READING CDC REPORTS. HOPEFULLY THEY WILL FIND SOMETHING THAT WILL WORK AND NOT MANY MORE PEOPLE WILL DIE.

[mike_c]

22. kicking and recommending-- an excellent overview....

Thanks for posting this. :thumbsup:

[omega minimo]

24. and use preventative health methods to not get sick

[cwydro]

25. Question:

If someone was vaccinated back in '76 for the swine flu, is that still good?

[Wednesdays]

36. Best to ask your doctor

My hunch is, that it is not.

[ekwhite]

80. NO

There are two reasons - (1) unless you are exposed to the virus or revaccinated on a regular basis, your immunity will wane over time; (2) the current strain is unlikely to be identical to the 1976 swine flu, which turned out to be not so virulent - the vaccine killed more people than the disease.

[mrs_p]

81. probably not

not all influenzas mutate as much as human influenza (for instance, equine influenza is rather conserved throughout the years so one vaccine will usually do). i can't really remember the mutation rate of swine flu. but, as it was 30 years ago, my guess is also, no.

[GeorgeGist]

26. Thanks for you very nice overview ...

and your straightforward advice.

I'm retired now, but I often thought of my science career as getting paid while having fun.

[ConcernedCanuk]

29. Wouldn't it be some sort of poetic justice if Momma Nature killed more of us humans

.
.
.

than we could do with all our bombs and bullets?

We've been trying to kill our own species for millenniums -

maybe Momma Nature will help us out . . .

A wee virus to wipe out humans,

stop us from spreading toxins to all the rest of the species.

Sounds reasonable to me.

[Chorophyll]

30. Momma Nature has already provided us with

flu pandemics and many varieties of plague, throughout the millennia. I suppose this new flu strain could be the one that wipes us all out for good, but there's no evidence of that at this point. Why so gleeful at the prospect? :shrug:

[hedgehog]

41. That's a mean goddess you're worshiping there.

[ekwhite]

112. That happened in 1918

More people died worldwide from the Influenza pandemic than died from World War I.

The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.

Source: http://virus.stanford.edu/uda/

[ConcernedCanuk]

115. I know - we are overdue for another culling

.
.
.

We keep trying to bend Momma Nature's rules to our wants/needs

ain't working.

messing with the environment, genetic modified crops, force feeding animals for our consumption - list is endless.

Momma Nature is gonna win - we CANNOT change the laws of nature,

and ignoring them is just gonna be our downfall.

Don't worry too much about it though,

the World will be better off without us.

[La Lioness Priyanka]

139. no, it wouldnt be poetic justice. it would be tragedy. as soon as you lose someone in your family

the poetry will be gone.

[Chorophyll]

31. Thanks for the information. nt

[blaze]

32. K&R for the good info

Thanks mrs_p!

[safeinOhio]

33. question for medical types

Would it be possible and appropriate to get an antiviral script from ones doctor as a precaution?

[hedgehog]

42. That has been discouraged because people taking the medications when they don't need

to have lessened their usefulness against routine influenza viruses already.

[northernlights]

46. I wouldn't expect them to make it available as a prophylactic

First, depending on how they work, they may not be effective as a prophylactic. Second, they probably come with a host of side effects. Thirds, there are strong recommendations not to overprescribe drugs as that is one reason that they are losing effectiveness more quickly. Finally, with a limited supply in the country, the first doses will go, appropriately, to first line defenders and people who deliver essential services, who are *required* to stay on the job or even be exposed as part of their jobs. Doctors and nurses can't stay home during an outbreak, and are the most heavily exposed. Much of the rest of the world can stay home, and should if it comes down to it.

[Wind Dancer]

37. K & R!

Thanks for sharing this info - greatly appreciated!

[BlooInBloo]

40. For an anthropological projection, one could do worse than Guns, Germs, and Steel...

Just btw.

[PCIntern]

43. Thanks!

Great post.

PC

[truedelphi]

45. Legalize LSD. Have one hit for every man woman and child

With instructions to take a dose within four to five hours of feeling sick.

It knocks out the flu.

It is also the greatest anti histamine ever known to man.

Put the money now used to keep small time marijuana users in jail into research so that you don't need to hallucinate in order to experience the positive, anti-viral, anti allergy effects of LSD when you use it.

[inna]

59. are you serious, or is this a joke??

:)

i just cannot tell.

[truedelphi]

67. There is a research group that

has been looking into stuff like this for at least a decade now - MAPS (I forget what the acronym stands for)

But here is a URL

www.maps.org

Anyway Hoffman himself has been on the record saying that it is "the best anti-histamine ever discovered."

And I guess he would know.

And about the flu, let's just say a "very" close friend has tried this since 1978. With the hallucinogenic properties of LSD - it would not be for everyone. After all, MAO inhibitors and LSD are a seriously dangerous combination. And sometimes one cannot be hallucinating.

So it would be great if the Big Pharma corporations got the word and tried to figure out a way to have the anbti-viral properties without the dream state.

[mrs_p]

82. hadn't heard that

and prob won't bring up in a committee meeting. but i appreciate the info all the same.

[truedelphi]

147. This issue needs all the infectious disease people it can garner on its

Side

Do let me know when you graduate.

And also, remember my second post, (A bit above yours) where I spell out that MAO inhibiters and this substance cannot be combined.

Also, sorta necessary to have some Pink Floyd on hand!

[hedgehog]

47. Before the conspiracy theorists grab the narrative, could you comment on this

theory?

I've heard that the virus contains elements of both Chinese and North American swine flu viruses. Some Chinese have entered the US illegally via Mexico. People smugglers aren't known for their concern for their customers. I can imagine some poor soul hoping for a better life being dumped in a small village because he was too sick to travel further. If he was lying next to someone sick with a local flu virus, I can see how the viruses would have met and swapped genes.

[mrs_p]

83. in theory

an asian worker could have come to NA to work on pigs and given the pigs the flu (or even a farm worker came back to NA who happened to be in asia). then the virus could have mixed in the pig from there.

[quidam56]

48. Sadly,

A lot of people will have to take their kids to an ER where there will be other kids with the flu, then they are treated in a breeding ground for MRSA
( Methicillin Resistant Staphyloccocus Aureas ) I can only hope and pray they aren't infected with MRSA on top of the flu. We need a cure for health care, profit care comes ahead of patient care. http://www.wisecountyissues.com/?p=62 Acceptable Standards of Health Care varies in the United States, but in East Tennessee my link will show you what really is called horrifying, but perfectly acceptable in Tennessee and Virginia.

[hedgehog]

50. How ironic, that the local community hospital is being closed as of noon today!

The Berger Commission decided that having too many hospital beds was running up health care costs in New York, so the smaller hospitals had to go. Now, if anyone here gets sick, they will drive 10 miles north to Oswego or 30 miles south to Syracuse to find an ER, and in the process possibly spread an infection to a new community.


I'm not saying that the hospital here should have remained the same as it always was, but I think our entire health care system has to be reexamined and rebuilt from the ground up. As it stands now, sick people end up in the ER spreading their illness. I think most measles outbreaks get traced back to the Emergency Room.

[havocmom]

69. People would have to drive 10-30 miles? Wow, that'd be SO NICE!

It is 85 miles to the nearest doctor where I am, and that is with the local 'health center' open.

To say many Americans do not have access to health care is an understatement and one which is not tempered by having insurance.

Doctors are few and very far between for many of us.

[Reterr]

49. So does it basically come down to how many proteases can cleave the HA for internal epithelia?

the HA needs to be cleavable by many proteases in the host, so as to enter many more epithelial cells than just what we see in a regular influenza infection).

I remember reading a PNAS article years ago during the outbreak of the avian flu where they were talking about how in these particularly virulent forms of influenza, the virus can replicate throughout the bird's body because of mutations I guess in this HA protein that causes it to be cleavable by common proteases.

My familiarity with Mol. Bio. is passing at best so I probably made a complete hash of that, but is that sorta what you are referring to here?

So I guess my question basically is: is it that mutations of a cleavage site for this HA protein make it significantly more cleavable by proteases common in our bodies, making internal epithelia much more susceptible? And the current mutation does not actually make it cleavable by a sufficient number of proteases for it to truly have pandemic potential?

Thanks for this thread btw :hi:-recd.

[Jim Pivonka]

58. To early to attribute this one to "antigenic shift"

This is in no way similar to changes in flu viruses that result from "antigenic shift" as that has been described in the literature I've seen.

This is a straightup recombinant virus. Whether any of the four components of the recombinant will show antigenic shift is not known - I am sure that will be studied carefully.

But the key idea here is that this is recombinant. Recombinant viruses are not that unusual; the difficulty with the "it happened naturally" idea here is that we have 4 (FOUR) recombinant components, not two. And none of the components has been seen, so far as is so far known, been seen in combination with any of the other components.

So we have at a minimum three novel recombinations if viruses, one avian, one human, and two swine, suddenly appearing in a new virus, and suddenly spreading very rapidly. No precursors. No animal infections known. None of the four ever seen in combination with any of he other three before.

Sorry - we cannot say that this "looks" natural, or that it reflects "antigenic shift". It just aint so.

[inna]

62. my thoughts exactly. welcome to the DU, btw! :) nt

[chimpyisstillsatan]

66. Advice from another molecular biologist

Want some peer review? People cannot filter much of what you've said, so stick to the relevant and the known, and provide only the information that tells the story you're trying to convey.

Keep it simple, keep it accurate, an most of all keep it calm. We have a responsibility not to trade in the unknown and untested in all our writings, and especially now. As has been noted elsewhere, much of the fear here and elsewhere is unfounded and based on speculation, and to the untrained or inexperienced reader of scientific writing, your post will probably cause confusion and may may foster unintended/unfounded conclusions.

So how would I write it?

Short story: we don't know what exactly is going on, but that's o.k. for now. Good people are on top of things, and the tools at hand for monitoring and "controlling" things are the best in the history of the Universe.

Is there a chance that won't be enough? Sure, but we don't know enough yet to see a difference between this outbreak and any other, let alone the 1918 pandemic. Freaking out will do no good, and may cause harm.

What to do? Stay calm. Get some rest. Wash your hands. Hug your kids.

[ekwhite]

85. Good advice

Also, keep some perspective. The 1918 flu was horrendous, but it was also before the advent of modern medicine. No antibiotics, no antiviral drugs. All they could do is make you more comfortable while the disease ran its course. Your prognosis today is significantly better.

[Pacifist Patriot]

121. I actually prefer the OP's version.

I'm a liberal arts type, but that doesn't mean I am incapable of understanding more technical information. I'm pretty certain I understood the OP and thought it was fine in dampening panic. I appreciate being treated like an intelligent adult rather than being patronized.

[chimpyisstillsatan]

125. sorry you felt patronized.

I suspect you also felt pretty well informed regarding the nature of this outbreak after reading the OP. Both would be misplaced conclusions, IMO.

Understanding the metallurgy of aircraft-grade aluminum doesn't tell you how to escape a burning airliner, nor would a middle-of-the-aisle explanation of the chemical contents of the smoke improve your chances of success. In a fire on the tarmac, sometimes all that is necessary to save lives is a flight attendant shouting simple instructions.

Focusing on the simple, relevant details keeps a populace informed, properly responsive, and less prone to political/social/economic manipulation and outright panic. If it's patronizing to try to give a clear message, go ahead and take offense.

[mrs_p]

132. thought people might be interested

in my take (and if not, they wouldn't read it). perhaps you should start a thread with yours, which i am sure would be helpful to others...

[Pacifist Patriot]

144. I was interested and think this individual has it quite wrong.

He cannot possibly know what my reaction was to your post and how I plan to respond with the information you provided.

[chimpyisstillsatan]

148. Keep contributing. Please

The world need scientists to communicate. I don't do it enough myself outside journals and scientific reports.

You mentioned you were relatively new to communicating your science. I've published 25 papers, including some pretty decent ones in Science and PNAS and I was trying to be constructive. It takes years and years to write well, and I'm not there yet. The secret is in the editing. And re-editing, and re-editing... Those are options we don't really have on DU.

My thesis advisor gave me a copy of Strunk and White when I gave him my first draft of my first paper. Very humbling experience.

IMO, keeping it in simple language is critical, especially when people are nearly panicking.

[northernlights]

146. as a former professional writer

now studying pre-med sciences, I felt the OP was pretty heavily technical for a general audience, but also that chimpy's was pretty patronizing for a general audience over the age of about 8.

I would go for something more middle of the road -- a translated technical explanation. But I'm not a molecular biologist, so nobody would listen to me unless I bylined someone else. :D

So there! (just thought I'd add a few more cents ;))

[chimpyisstillsatan]

149. flu porn

not people like myself adding to the internet ball of confusion. .

My sister is also a technical writer, and that's almost verbatim what I told her. Funny how she was comforted by the simplicity while others felt patronized. I should have included links to science-based sites with simple and abundant information, but I was really directly addressing the OP, who knows where to find that already. My bad.

[Duer 157099]

70. If starting a thread can be done in lieu of an outbreak, I'm all for it!

(I'm so sorry, I truly appreciate you trying to educate people, but I could not help myself! please forgive me! But if you have a sense of humor, maybe it will be ok)

:hi:

[DesertDiamond]

122. I was debating whether to point this out. "Lieu" is an oft-misused word.

I must say I respect the intelligence of this poster, whose grasp of the subject of flu epidemics is vastly superior to my own. I just happen to be an English geek and things like this pop out at me; the misuse of a word is a minor flaw compared to the value of what has been posted, and I thank the poster.

[mrs_p]

131. i know

i'm thouroughly embarrassed

[ekwhite]

72. K&R

It is nice to see a good explanation of the swine flu virus and why we should be concerned. I can vouch for most of what you wrote, having been involved in flu vaccine manufacturing back in the 1990's. What really worries me about this strain is that it did come out of nowhere. We have been preparing for avian flu, not another swine flu outbreak. Luckily, the stocks of TamiFlu held by the CDC work for either strain. Also, there have been great advances in the use of cell culture to produce flu vaccines, meaning that we can produce the vaccines faster than we could back in the 1990's when we grew the vaccine in embryonated eggs.

[The Stranger]

87. Thanks, but I didn't understand a word of that.

Too scientific. Need English translation.

[FedUpWithIt All]

89. Maybe this will help. It is a bit over simplified but it may clarify some.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5537256&mesg_id=5537256

[Baby Snooks]

88. It is now unofficially a pandemic...

Suspected cases are being reported in Europe and the Middle East. All it took was one passenger on one plane. Although of course in reality there were probably several passengers on several planes.

Hopefully this will not mutate into a more deadly strain although even a 6% fatality rate should warrant more than just warnings from our government. Everyone must show up at work and school tomorrow. Just don't breathe. That seems to be the advice of our government.

[mrs_p]

130. actually, it is still an outbreak

[McCamy Taylor]

97. A few more words

Regarding medication:

All anti influenza medications work best if they are started ASAP after the onset of symptoms, within the first one to two days. Ideally, a person who knows that they have been exposed or those who can count upon being exposed (such as health care workers) should take an anti influenza medication to prevent infection. The drugs are even more effective as preventatives than they are at treating the symptoms of active disease.

Of the four anti virals which are now used to treat influenza, amantadine, rimantadine, oseltamivir and zanamivir, the first two are not effective against this new strain. So, do not think that your Symmetrel which you take for Parkinsons is going to protect you (the way that it ordinarily protects against influenza A). Also, do not take any left over Flumadine. Either the pill Tamiflu (the product Rummie made so much money on) or the spray Relenza should be effective. Regarding side effects, Relenza can not be used in those with asthma or other serious lung disease or in young children and because it is administered in a spray, doctors can not adjust the dosage to achieve a desired level in the blood stream as they can with some other anti flu medications (this last becomes a concern with sicker, hospitalized patients). Tamiflu can be used by everyone, however it caused some weird neurological and psychiatric side effects in a group of people in Japan a few years back including psychosis and suicide with the risk of self harm apparently higher in teenagers. (In recent years, the ability of a wide variety of medications to cause psychiatric side effects in teenagers has been recognized.) It can also cause gastrointestinal upset like nausea and diarrhea. This year a Tamiflu resistant strain of influenza (one which was covered by this year's flu vaccine) emerged, so if someone takes Tamiflu for presumed swine flu and gets no results, he or she could actually have the other, resistant human influenza. To sum up, Relenza is the only drug out there which (so far) treats every strain of influenza that is circulating, but it can not be used by everyone. Tamiflu will treat the more serious swine flu, but it might not treat ordinary human flu.

Since a major complication of influenza is pneumonia or other lower respiratory bacterial infections like bronchitis, people also need to be aware of the fact that resistant bacteria are increasingly causing these types of illnesses. While most pneumonia is caused by the bacteria called Strep Pneumomia or Pneumococcus, after influenza people have an increased risk of Staph pneumonia too. And Staph type bacteria are typically harder to treat than Strep due to widespread antibiotic resistance. Methicillin resistant staph aureus (MRSA) is on the rise. People can harbor the MRSA form of the bacteria somewhere in their body (such as in the nose) and show no signs of infection until something like influenza breaks down their body's resistance and the MRSA gets into the deeper tissues or blood. Then, they may develop a bacterial bronchitis or pneumonia which does not respond to the usual antibiotics . Since they are essentially not being treated, even though they are on antibiotics, they can get sicker or develop complications (like a collection of pus around the lung) and even die. People who have been in the hospital a lot or who come in close contact with people who have been in the hospital a lot and health care workers are more likely to carry MRSA. There are antibiotics which are effective against most strains of MRSA, but they are not the usual ones. You doctor has to think about MRSA and tailor your treatment to cover it if you suspect that you harbor the bug. So, do not take the left over antibiotics which your child used for an ear infection, assuming that one antibiotic is as good as any other. If you have had influenza and think that you are developing pneumonia, you need to see someone who can get you on the right drugs.

Note that antibiotics used for bacterial infections, like amoxicillin or augementin or ceftin, do not prevent or treat influenza. They only treat the secondary bacterial infections which can develop. So, just because your dad's doctor gave him a course of antibiotics when he got the flu, because your dad has an underlying problem like emphysema or chronic bronchitis that makes him always develop bacterial secondary infection, that does not mean that you need antibiotics for the flu. You may just need one of the anti-virals above.

How might a person know that they are developing bacterial pneumonia on top of influenza? If you get more short of breath, begin to have pains in your chest when you take a breath or start coughing up sputum that is discolored, or if you just start getting sicker, i.e too weak to leave the bed, can not keep down food, you may be developing a complication. People who are that sick need to get emergency treatment.

Probably, most people who get the swine flu will not get that sick. Many will not even get sick enough to go see a doctor. They will weather the infection and go back to work. However, the problem with any new strain of influenza, like this one, is that your body has no natural immunity to it at all. If you got a vaccine this year, it did nothing to make you stronger against the swine flu. We will all react like small children or infants to this new type of virus---and small kids get sicker with the flu, because their body has no "memory" of it that their immune systems can use to crank out disease fighting antibodies more quickly, the way that older kids and healthy adults do when they get flu for the 10th time. It is the bug's newness and the delay we will all experience before our bodies can finally start turning out the right antibody that will make it more serious.

[Juche]

99. So does swine flu kill via a cytokine storm

My understanding of H5N1 (bird flu) was that it kills via a cytokine storm and what I never understood is why were people treating tamiflu or a vaccine as if it would protet them? If people are dying because an over exaggerated immune response initiated by the virus and not the virus itself, would a vaccine or tamiflu actually mediate either of those things or would they make them even worse?

If the majority of the dead turn out to be young, healthy people and not children or the elderly I'm guessing cytokine storms may be the cause of fatality in swine flu. If so, wouldn't we need to totally change the treatment protocol? Would tamiflu actually do anything helpful if cytokine storms are the cause of death and not the virus itself? Drugs like ACE inhibitors are better for mediating a cytokine storm.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/nov1605cytokine.html

http://scienceblogs.com/aetiology/2009/04/swine_flu_and_deaths_in_health.php

http://en.wikipedia.org/wiki/Cytokine_storm

[Baby Snooks]

104. Immune system over-response...

That is what a cykotine storm is - an over-response by the immune system but apparently it is a recent discovery in terms of flu and treating it while treating the influenza virus is apparently a "high-wire" act.

I think they have found that cykotine storms occur as a natural reaction to most "non-human" strains of influenza virus.

I haven't read that much about it but apparently they don't really understand what sets it in motion. But they can treat it in some cases. But of course that is in a clinical setting. Not everyone with flu is going to be in a hospital under medical care having extensive tests.

[northernlights]

105. cytakine storms occur in response to an entirely new pathogen

that a healthy immune system hasn't seen before. So there is no vaccine that will help in that case because the virus hasn't been around to have one developed for it.

As far as tamiflu helping to ameliorate a cytokine storm, that is what I was wondering about myself. If that is why the U.S. cases have been milder. But I don't know how tamiflu works -- what it targets chemically. Or if the U.S. victims even took tamiflu, although I figure most Americans pop a pill at the first sneeze, cough or sniffle.

[Juche]

107. Tamiflu blocks the NA protein

Of the 8 genes involved in the flu, the NA codes for a protein that the flu uses to escape a host cell after it has invaded it. So it basically blocks the flu virus from escaping and infecting other cells. The HA protein is the one that the flu uses to enter the cell. Something called 'elderberry extract' supposedly blocks both the HA and NA protein, whereas Tamiflu only blocks the NA. Elderberry extract is also easier to get than tamiflu.

http://www.webmd.com/cold-and-flu/news/20031222/elderberry-fights-flu-symptoms

However you have to take it (either one) at the very start of infection, and the problem is that people may already be badly infected before they show serious symptoms. By the time they start tamiflu it may be too late to make a difference because people may not take it during the prodromal phase.

H5N1 produces 10x more cytokines than the regular flu. I was always confused during the bird flu panic of 2005-2007 because I never saw anyone actually try to address this fact that it could be your own immune system that kills you, not the flu and that the medical response should reflect that. The medical response always seemed to imply the flu itself is what killed you.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/nov1605cytokine.html

""We have found that infection with H5N1 viruses led to the production of 10 times higher levels of cytokines from human cells than normal human flu viruses," said Peiris, as quoted Nov 12 in The Standard, a Chinese business newspaper."

[FedUpWithIt All]

113. Elderberries (ie. sambucol) can increase Cytokine production.

http://findarticles.com/p/articles/mi_m0FDN/is_1_10/ai_n13648434/

[Juche]

114. Thanks, I didn't know that

For a regular flu it has been shown in preliminary studies to help reduce severity and duration, but if it is a flu that kills via a cytokine storm then it would be best to avoid it.

[northernlights]

119. thanks!

I'm about to write a presentation on phytochemicals, so now I can add elderberry to my list of examples :D

[bluedawg12]

108. Tamiful mechanism of action

Mechanism of Action
Oseltamivir phosphate is an ethyl ester prodrug requiring ester hydrolysis for conversion to the active form, oseltamivir carboxylate. Oseltamivir carboxylate is an inhibitor of influenza virus neuraminidase affecting release of viral particles.

[Jim Pivonka]

151. More than one possible cause of the atypical pattern of deaths

The cause of deaths as reported in the media has included flooding of the lungs with fluids, and related symptoms.

Some reports have indicated, correctly, that these can be associated with strong immune system reactions. Though I am not familiar with and will have to research the "cytokine" response, I do know that immunlological reactions resulting in inflammation can "runaway" and cause tissue breakdown etc. So that would be one possible explanation. It would be consistent with a reduction in the degreee to which healthy immune response in young adults is protective against severe disease - in a few case the response goes too far and itself causes severe illness and death.

But in dealing with flu there is at least one additional possible reason. Some flu, notably the 1918 flu, is capable of causing severe inflammation of and tissue breakdown in the broncial and alveolar epithelium. This leads in some cases to a proteolytic cascade, a breakdown of epithelial cells and of the intracellular scaffoldingl, which is extremely serious - life threatening and hard to treat.

The second is the probable cause of the high death rate among young adults during the 1918 flu based on some characteristics of the virus. The first may have been significant too. I am not sure there is agreement about which is most important, or even if there is much evidence (other than the character of the virus) for either compared to the other.

I have not seen indications that this second possible cause has been excluded as the cause of death in the fatal cases.

The pattern of distribution of the fatal cases in time and geography is also of concern. The apparent distribution raises serious questions about the nature of the virus itself - is it changing rapidly? why? What characteristics (parts of its genetic complement) are changing?

Or is the apparent pattern only an illusion resulting from faulty and incomplete data? Too early to say.

[Jim Pivonka]

153. 2009 H1N1 viral haemagglutinin could induce high levels of chemokines and cytokines

From "Enhanced virulence of influenza A viruses with the haemagglutinin of the 1918 pandemic virus"
http://www.nature.com/nature/journal/v431/n7009/full/nature02951.html

The 'Spanish' influenza pandemic of 1918–19 was the most devastating outbreak of infectious disease in recorded history. At least 20 million people1 died from their illness, which was characterized by an unusually severe and rapid clinical course. The complete sequencing of several genes of the 1918 influenza virus has made it possible to study the functions of the proteins encoded by these genes in viruses generated by reverse genetics, a technique that permits the generation of infectious viruses entirely from cloned complementary DNA. Thus, to identify properties of the 1918 pandemic influenza A strain that might be related to its extraordinary virulence, viruses were produced containing the viral haemagglutinin2 (HA) and neuraminidase3 (NA) genes of the 1918 strain. The HA of this strain supports the pathogenicity of a mouse-adapted virus in this animal4, 5. Here we demonstrate that the HA of the 1918 virus confers enhanced pathogenicity in mice to recent human viruses that are otherwise non-pathogenic in this host. Moreover, these highly virulent recombinant viruses expressing the 1918 viral HA could infect the entire lung and induce high levels of macrophage-derived chemokines and cytokines, which resulted in infiltration of inflammatory cells and severe haemorrhage, hallmarks of the illness produced during the original pandemic6.

From other sources I get the impression that the chemokines may be more of an issue than the cytokines in the response to these viral genes. The "take away" is that viruses containing the viral haemagglutinin2 (HA) and neuraminidase3 (NA) genes of the 1918 strain have an extraordinary ability to strong immune responses which lead to the infiltration of inflammatory cells and severe haemorrhage characteristic of the 1918 flu. These symptoms have reportedly also characterized the fatalities from 2009 H1N1 flu.

I have seen little reportage that would indicate the the viral haemagglutinin2 (HA) and neuraminidase3 (NA) genes of the 1918 strain are present in the 2009 H1N1 strain. The closest to such an indicator that I have seen is here:

Wednesday, April 29, 2009
Hunting for Clues in the Swine Flu Genetic Code: As the World Health Organization raises its pandemic alert to level 5, scientists study the genetic sequence of the virus. By Emily Singer

Which includes this (p.2):

"Given that this is still a rapidly evolving story, we need to get a handle on the first gene sequences from California, and hopefully from Mexico and others, to see how this virus has evolved," says Ram Sasisekharan, a professor of biological engineering at MIT. "Where does it really come from? And can we explain the observed differences in what has happened in Mexico, which seems much more severe than what has happened in the U.S.?"

Virus genomes constantly mutate and can easily swap genes with other viruses, sometimes endowing a pathogen with the power to infect different species or to trigger more serious disease in their hosts. The new swine flu virus appears to have done more swapping than usual, with genetic segments from four different sources: North American swine influenza viruses, North American avian influenza viruses, one gene segment from a human influenza virus, and two gene segments that are normally found in swine influenza viruses in Asia and in Europe.

"Parts of it are from the original 1918 virus, parts are similar to the current circulating H1N1 strain from seasonal flu," says Sasisekharan. "We are still trying to understand what that means." The 1918 Spanish flu triggered a pandemic that killed millions around the globe.

The new swine flu is of a subtype called H1N1, the class of influenza that is responsible for the majority of seasonal flu. (The 1918 virus was also an H1N1 strain.) But humans have no existing immunity to the novel swine flu virus. "We want to look and see how the differ from current circulating H1N1 strains," says Ian Wilson, a scientist at Scripps Research Institute, in La Jolla, CA.

One such protein, called hemagglutinin, sits on the outside of the influenza virus and determines which cells it can infiltrate. Preliminary analysis of the hemagglutinin gene for the new swine virus "has the telltale signatures for human receptor binding," says Sasisekharan. "But until we make the protein and confirm whether it binds to receptors in human airways or deep lung," we won't know for sure.

I take it from this that the exact nature of the hemagglutinin produced by 2009 H1N1, and the extent of its ability to induce the high levels of chemokines and cytokines seen in the 1918 genome is of strong interest but still unkown. Couple that with early indications of high variability or rapid change in the 2009 H1N1 genome, and the virologists have their hands full. More is on the way, I am sure.

[Hestia]

102. I know this is macabre, but does this remind anyone of The Stand?

[kickysnana]

117. If the "experts" handle this as well as they did Lyme Disease..

buy stock in funeral homes and cemeteries.

[pjt7]

118. Senator Kyl

should be impeached for holding up Seibeilus for HHS head.

[Vinca]

120. Would the last version of the annual "flu shot" contain anything

that might cause a person not to get the full blown swine flu since the disease is an amalgam of animal and human viruses?

[mrs_p]

129. most likely, no

[slackmaster]

135. Excellent post

Thank you.

[chrisa]

145. "Pandemic," "Epidemic," "Outbreak."

It's impossible to know if this is credible, or will just fade away because of stations like Fox that sensationalize everything, with their "bong! fox news alert!" stuff going off every 2 seconds for the same story.

[Mike 03]

152. Excellent. Thank you. The most puzzling aspect of this strain to me, a layperson, is that

it contains both swine and avian genes. That just blows my mind. I still don't really understand the mechanism for a rearrangement like that.

[Jim Pivonka]

154. You might look at "Genetics of the Influenza Virus" at Nature

the url is
http://www.nature.com/scitable/topicpage/Genetics-of-the-Influenza-Virus-716

It has good info on the swine/avian matter, with respect to the 1918 flu.