Actually, flu vaccines do not go through the full gamut of trials necessary for new drugs. Each year, the vaccine must be modified to anticipate the strains of flu that people will be exposed to. Basically, it was the original process by which the vaccine was created and manufactured that was originally approved. Subsequent changes to the formulation are subject to small safety and efficacy trials. The Swine flu, is an H1N1 strain that is similar to the seasonal flu. So, the vaccine is produced in the same way and is reasonably expected to have the same safety and efficacy. (NOTE: the existing seasonal flu vaccine provides no protection against the swine flu. Also, the swine flu is essentially the only one circulating.)

The current trials are aimed at determining if two doses will be required and if adding a adjuvant will help extend limited supplies. Canada and Europe previously tested and approved the adjudant. However the US hasn't and there is some speculation that they may not follow WHO recommendations to use adjuvants in their vaccine formulations.

Here we are a month later and I wanted to wake this thread up since I cannot open my email or turn on the radio or TV without hearing about the H1N1 hysteria.

Some examples,

- An etiquette coach explaining how to "not shake hands but elbows!!!!"
- A suggestion North Americans adopt the Japanese method of bowing
- A poll suggest 52% don't want to shake hands anymore
- We now have 6 (yes 6, because it is so easy to miss just 4) posters at my workplace bathroom on proper hand-washing technique.
- People carrying around and offering Purel like it is "really good crack"
- Organizations setting up H1N1 Swat teams
- Talk of taking the H1N1 fight to the street with a mobile vaccination unit

Did I miss any? I mean if this much effort is spent to combat H1N1 what would they do if something really serious came along. Like African Rabies (http://zombie.wikia.com/wiki/World_War_Z). :rolleyes:

I get it. H1N1 is a nasty flu bug. But as John Stossel says "give me a break".

You forgot donning those hazmat suits and respirators to keep infection to a minimum. :rolleyes:

This reminds me so much of the Y2K bug...remember that...oh wait...that's right...nothing happened...except perhaps for Sean...as he got the girl :cool:

I'd like to point out that it has been shown that H1N1 (unlike the seasonal flu and the common cold) is not easily passed by hands. The virus does not survive well on hands (unless perhaps wet).

So washing your hands, although a good practice in general, won't have much impact on the spread of H1N1.

Just to put some perspective on the effort, I pulled some numbers from statcan of number of deaths per year.

First the HC report on total number of deaths in Canada this year.

H1N1: 83!

And these figures from 2005.

Suicide: 3,743
Alzheimer's disease: 5,762
Influenza and Pneumonia: 5845
Diabetes mellitus: 7,881
Unintentional injuries: 9,506
Chronic lower respiratory: 10,515
Cerebro-vascular: 14,054
Heart disease: 51,574
Cancer: 67,343

The "pandemic" has barely reached Canada. Those numbers will go up. At any rate, I hate getting the flu so I hope the vaccine arrives before H1N1 peaks. ;)

Just to put some perspective on the effort, I pulled some numbers from statcan of number of deaths per year.

First the HC report on total number of deaths in Canada this year.

H1N1: 83!

And these figures from 2005.

Suicide: 3,743
Alzheimer's disease: 5,762
Influenza and Pneumonia: 5845
Diabetes mellitus: 7,881
Unintentional injuries: 9,506
Chronic lower respiratory: 10,515
Cerebro-vascular: 14,054
Heart disease: 51,574
Cancer: 67,343
I understand your skepticism, somewhat, but H1N1 is just like any other flu but itself is more likely to affect those at risk and even younger people. If you have a flu its simple COURTESY to take steps to stop spreading it around, and if you dont want a flu you have the right to take precautions. I am home sick right now with flu, no idea what strain as my symptoms are mild as of yet so I havent seen a doc, and I hope it clears up soon so I can go back out and socialize.

Also there is up to date world data here.
http://en.wikipedia.org/wiki/2009_flu_pandemic

11% increase in deaths in the past 7 days. Yeah, its not a big issue I guess. /s

I wonder if its better to do little and then wonder if we took more preventative steps it could save lives, money, and a lot of grief. I prefer prevention.

Previous to H1N1 we had almost 6000 flu deaths per year! I do not recall anything even coming close to resembling the hysteria we see today. Maybe with the exception of SARS.

11% increase in deaths in the past 7 days

Yes but that includes countries with chronic health and sanitation issues. I am sure if you looked at the global malaria outbreaks you would see similar spikes.

I'm not seeing hysteria at all in my circle. Sure the media likes to keep talking it up, but that's what they do. I can't really disagree with the precautions and warnings by our government though. I think their response has been appropriate. After all this is a really big unknown despite all the medical professionals that are sure it's this or that.

-Mike

Jake,

I really wish I had more than 1 minute to offer a proper response to your post, but I don't so I quickly remind you that this is a novel strain, the WHO has no grasp on expected primary infection, secondary infection, and mortality rates (including age-specific rates), and most importantly we are still very early into the traditional Northern Hemisphere annual flu season. There were early indications that elderly patients were not experiencing high mortality rates as would be expected, and that led some to hypothesis that there may be similarities between this strain and a previous seasonal strain from several decades ago. Most importantly, the WHO is trying to prevent this virus from mutating into a (possibly more virulent) sub-strain now that sustained transmission is well established. That scenario combined with low immunity in the population could result in a second wave scenario, which potentially could be severe.

Due to the information age, fighting the flu is easier than it was in 1918/19, however the internet and media have certainly created a self-sustaining hysteria, which some perceive to be more dangerous than the actual outbreak.

cheers.

the WHO is trying to prevent this virus from mutating

Can they actually influence that outcome? It seems to me the virus will mutate as it pleases.

Yes you are right the media is definitely "running with this story". But my point is more about balance. I see more effort at the workplace on promoting proper hand-washing technique than on say safe driving, or healthy eating.

Do you know how many people I see texting while driving? I can't recall seeing a PSA about proper cell phone usage while driving.

OK now I am on a tangent. :p I better chill out I guess ... after I wash my hands that is.

The more infections, the higher chance of mutation.

I have read studies and seen myself how many people do not wash their hands even after taking a deuce. So yes hand washing needs to be promoted.

There is a PSA about texting. http://www.youtube.com/watch?v=b3_x0CcdMRA and I expect more to be made

Yes, please wash up. :P

Im not picking on you but I think we need to take this a bit more seriously, but not hysterically. We are debating the fine line difference between that perhaps, and not H1N1 itself :D

..and if these steps weren't being taken, the media/general population would be furious at the government/large employers for not being competent/caring enough to protect their citizens/employees.

It does seem like overkill, but we don't know exactly what we are going to be up against. If this (hopefully) turns out to be overblown, it will likely be (in part) due to the measures being taken to prevent the spread of this flu.

Plan for the worst, hope for the best..... :)

Can they actually influence that outcome? It seems to me the virus will mutate as it pleases.

Yup :) I'd like to claim the "poetic license" defense on that one! I thinking more on the lines of polaris's response within the scope of controlling the speed of transmission - i.e. with the intention of leading to elimination state (not to be confused with eradication) - sorry if that was implied. And sorry, but I initially didn't catch your point about balance as some of the causes of death you referred do not qualify as contagious diseases.

One of the concepts in combating endemic disease, is to eventually reach a point where in the population the proportion of immune individuals is greater than the herd immunity (http://www.springerlink.com/content/g65222662v6w5h34/) level for the disease. Essentially the disease cannot self-sustain, and resolves to a level of local hot-spots and eventual decline. This is the objective of the WHO's (and most governments') activities to date. I chuckled the other day when someone passed me an email which claimed that (I assume the U.S.) government could impose martial law, and forcefully detain the afflicted.

..and if these steps weren't being taken, the media/general population would be furious at the government/large employers for not being competent/caring enough to protect their citizens/employees.
Unfortunately, often when politics get involved, the focus' shift from primary objectives.

On a individual level, I've postulated that one could possibly get an instantaneous feel for the level of general infection + hysteria by monitoring the number of vacant parking spots at their neighbourhood walk-in clinic. The number one active defence against bringing any disease home for my family is avoiding frivolous visits to crowded doctor office's/walk-in's/ER's. You are almost certain to encounter some form of communicable disease in those environments.

cheers.

some of the causes of death you referred do not qualify as contagious diseases

Right and I was not clear in my post. But I did not mean to limit the scope to contagions either. The others causes of death can be controlled and contained. Albeit some more than others. And with sufficient public awareness we could save lives.

Jake, while you certainly raise some valid issues, I don't think you quite understand the concerns of the the Health Organizations around the world. Yes, H1N1 is still just an influenza virus, but this particular strain has been a little bit different in a couple of major aspects at this early stage in the cycle. First, its mortality rate seems to be 7 or 8 times higher than past 'regular' strains of influenza. That alone is cause for concern. Secondly, many of the deaths have been in young and otherwise healthy individuals.

While you raise some valid points regarding other diseases, most of those are not spread in the same fashion as influenza, and none are seasonal afflictions like influenza, which can flood the health care systems and cause major economic upheaval due to worker shortages during potential outbreaks.

Why you would include Alzheimer's at all in the discussion is also beyond me.

its mortality rate seems to be 7 or 8 times higher than past 'regular' strains of influenza

So we should expect about 45000 deaths then? Please explain the difference thus far (83).

many of the deaths have been in young and otherwise healthy individuals

What distribution shift have we seen compared to past 'regular' strains? I can't find specifics (median age etc). Just general statements.

Why you would include Alzheimer's at all in the discussion is also beyond me

I was simply quoting statcan. My fault for improper citation.

PS: I rarly get to debate this with people in the field so this is a real treat for me. Thanks for the feedback.

I found a good page from CDC, check the graph at the end especially. It should auto scroll to it.
http://www.cdc.gov/H1N1FLU/surveillanceqa.htm#graphc

The curve is reverse of what is expected with flus we have been dealing with for some time, where the young and old are the most likely to die.

Also, we are not even yet into the season perhaps according to this
http://www.cdc.gov/flu/about/season/flu-season.htm

Pandemic flus have peak activities early in the season (Nov-Dec) whereas seasonal flu usually peak in Jan-Feb. You can see this in the number of consultations this year compared to previous seasons.

http://www.phac-aspc.gc.ca/fluwatch/09-10/w40_09/index-eng.php

The vaccination program is a little late but should prevent many infections, hospitalizations and hopefully deaths.

Flu surveillance shows most of the outbreaks have been in schools, particularly here in BC. But school boards refuse to install hand sanitizers.