H1N1 hype justified
As we approach the formal conclusion of the eventful 2009-2010 flu season, the long lines of people waiting to get their swine flu shots may seem like a distant memory to most of us. Indeed, the major headline maker for the latter half of last year has by and large disappeared from the evening news as natural disasters and health care reform took center stage.
Throughout the H1N1 saga, groups from pediatricians to Al Jazeera have been crying foul over what they purport to be an overhyping of the new flu strain by health authorities and the western media. According to some naysayers, the risk posed by H1N1 was simply not enough to warrant its pandemic status. To others, the alerts were put in place as a deplorable $1.6 billion kowtow to Big Pharma and its bottom line.
As the final figures of H1N1-attributed mortality in this country start streaming in from the Centers for Disease Control and Prevention at a small fraction of the earlier high end projection of 90,000 deaths, the level of criticism will likely increase — how can you justify all the ballyhoo about H1N1 when the seasonal flu kills three times as many people every year? While no one can deny that H1N1 was hyped to the top of the vernacular chart, it was well justified and played a major role in preventing a potential public health catastrophe.
Before I continue though, I think it is worth taking a minute to clear up some confusion and finally give meaning to the jumble of letters and numbers that spell H1N1. In order to cause illness, the flu virus must multiply within our body by taking over our cells' natural replication machinery. It accomplishes this via the aid of two proteins that it possesses — hemagglutinin and neuraminidase; think of them as lock keys.
Hemagglutinin allows the flu virus to enter our cells to begin the multiplication process, while neuraminidase allows the virus to exit our cells along with its clones to continue the chain reaction. These two proteins are what the H and N stand for, respectively, and the number that follows each letter refers to the specific type of hemagglutinin and neuraminidase possessed by the particular flu subtype.
For the past 30 years, the two main subtypes of seasonal flu have been H1N1 and H3N2, which collectively kill about 36,000 Americans annually. And no, that was not a typo — contrary to what most people believe, H1N1 has been around for quite a while now. What makes this year's H1N1 unique is the large degree of mutation that it underwent compared to the typical annual variation that occurs. So the more scientific name is actually "novel H1N1."
The outbreak of novel H1N1 was first noted in Mexico last April, and because of its rapid spread around the world, the World Health Organization declared in June that a pandemic status had been reached. At this time, information was extremely limited regarding this variant's potential threat to public health, although its ability to replicate in humans and spread from person-to-person was already apparent, as well as its propensity for striking the younger population to a greater extent than the seasonal flu does.
The solid information that the CDC and other health authorities did have was historical data from previous outbreaks of novel flu variants — the 1968 H3N2 virus that killed more than 30,000 Americans and one million worldwide; the 1957 H2N2 virus that killed 70,000 Americans and two million worldwide; and the infamous 1918 "Spanish Flu" H1N1 virus that killed more than half a million in this country and almost 50 million worldwide. In addition, a startling 99 percent of last year's seasonal H1N1 samples were resistant to the common antiviral medication Tamiflu, whereas the previous year's resistance figure was a mere 11 percent. This made prevention through vaccination even more essential
Armed with these figures and the knowledge that international travel — and therefore spread of infection — occurs at a much higher rate today than it did in the 1950s and 1960s, the CDC had to act quickly and boldly. Although technological advances have enabled health authorities to detect and contain outbreaks much more quickly than in decades past, the risk to benefit ratio in this case still heavily favored over-responding with preventive measures and treatment initiatives than taking a more conservative route.
Despite the vaccine production delays and access problems that affected people across the country, the massive vaccination campaign that ensued still managed to reach a significant portion of the citizenry. Municipalities and schools worked around the clock to keep updated with the latest H1N1 developments and do their best to ensure that the most vulnerable — people under 25 years of age, pregnant women and health care workers, to name a few — got priority access to the vaccine before it was released to the general public. Kudos to the University administration and Health Services for the numerous vaccination sessions and public health campaigns they ran across the different campuses.
So far, 86 million individuals in this country have been vaccinated against the novel H1N1 virus, with no greater frequency of side effects than that of the seasonal flu vaccine. Subsequent studies showing that 99 percent of this year's novel H1N1 samples were actually treatable with Tamiflu also served as a big sigh of relief for those unable to get vaccinated in time.
As for those low mortality figures: the latest CDC report estimates that 12,000 deaths were attributable to novel H1N1 since it appeared on the map last April. Rather than supporting the opposition's "overhyped" argument, this relatively low figure serves as a testament to the foresight of our health authorities and the benefits of vaccination. Their prompt response to the situation likely saved thousands of lives in this country, if not more. The setbacks that were experienced during the vaccine distribution process and other public health response efforts will undergo thorough review to allow for a more efficient response the next time around.
So is novel H1N1 a thing of the past now? The experts certainly do not think so. In fact, they have decided to incorporate novel H1N1 into the 2010-2011 seasonal flu shot, which should make the vaccination process quicker and less painful for patients and health care professionals alike.
Therefore, if you do not have any factors that make you ineligible to get the flu vaccine, go to CDC.gov for more information, make sure to add it to your list of civic duties this fall. It is the best way to protect yourself and others from the virus, and is also a perfect example of preventive medicine in action.
Bo Wang is an Ernest Mario School of Pharmacy fifth-year student and outgoing president of the Pharmacy Governing Council.