The reason why I write this blog

Just spotted this headline in a Canadian online news aggregator:

“Severe reactions to H1N1 shot: one death probed”

Then, almost at the very end of the article:

“On the issue of serious adverse reactions to the H1N1 vaccine, Butler-Jones said the rate of anaphylactic events was about 0.32 cases for every 100,000 doses of vaccine delivered - a figure that's within the norm for mass vaccination efforts.”

I just got my shot.

To panic or not to panic: An interview with the swine flu (part II)

When the H1N1 story erupted in the media a little while back, I wrote a short Q and A post to give a scientific perspective on the topic. After that I really didn’t give much thought to the H1N1 flu. Since I don’t have a television at home and never listen to the radio, I live in a kind of media void. It’s glorious in there, let me tell you. Unfortunately, I was recently at a relative’s place and watched the news. I was shocked to see an endless stream of panic-inducing warnings and news about the H1N1, so the microbiologist in me decided to revive the topic here on Scientific Chick with the latest scientific information. So here you have it, a second exclusive interview with Mr. Swine Flu himself.

Scientific Chick: Mr. Flu, thanks for accepting to come back on Scientific Chick. How have you been? It seems you are gaining in strength and giving more severe illnesses.

Swine Flu: I’ve been well, thank you, but please notice that I’ve changed my name to H1N1. As you know, we are now in the regular flu season, so I am quite busy going around and infecting people. However, unfortunately for my plans to dominate the Earth, I have not been inducing an increasingly severe flu. It may seem so because with more people infected, the percentage of seriously ill patients becomes more apparent, but I’m still the same guy.

SC: How do you feel about our new H1N1 vaccine?

H1N1: I find it quite sad. You see, the vaccine is composed of my virus brothers, completely killed and inactivated. When talk of the vaccine started, I had a glimpse of hope that maybe, just maybe we could infect humans through the vaccine, but alas, that’s not possible. There is no chance a vaccine containing my dead relatives will give you flu.

SC: Surely with a vaccine so new, there is some chance of things going awry for us humans?

H1N1: I wish! It is often thought that because this vaccine is new, it is untested and unsafe. Unfortunately, because I am so similar to my seasonal cousin, the H1N1 vaccine has been produced the same way regular flu vaccines are produced every year. Health organizations (like the NIH) around the world have conducted rigorous clinical trials that show the vaccine is both safe and effective. It’s been licensed by all the governmental agencies and even though I tried to be very sneaky showing up unexpectedly like I did, no shortcuts were taken.

SC: At least most formulations of the vaccine contain thimerosal, so if we don’t catch you, you’ll at least have the consolation that we’ll suffer from mercury poisoning and all the associated conditions.

H1N1: Well, that would be nice, but you are grossly exaggerating. While it is tempting to blame thimerosal (a mercury-derived preservative) for a number of conditions, there is just no scientific evidence for any sort of suggestion that thimerosal is unsafe. Since the hypothesis that thimerosal causes autism broke out many years ago, scientists have been working very hard to prove or disprove that link. Interestingly, some of the best, largest, most well-controlled and unbiaised clinical studies came out of this controversy, all concluding that there is no link. The irony is that there is more mercury in a can of tuna than in any vaccine.

SC: So really, if I wanted to give up vaccines for fear of thimerosal, I’d also have to give up ahi tuna tacos? That’s just not a possibility. What about adjuvants in vaccines? How do you feel about those?

H1N1: I like adjuvants, because since they boost your immune response to the vaccine, less inactivated virus is needed per dose, which means less deaths in my family. That being said, whether you receive a vaccine with or without an adjuvant depends on where you live. In the USA, no adjuvants will be used. In Canada and some European countries, the vaccines contain adjuvants. Adjuvants are not new, and they also have a good safety track record. I hear a lot of concerns about squalene being used as an adjuvant, but you find squalene in olive oil.

SC: I hear a lot of discussions about Guillain-Barré Syndrome. Should we worry?

H1N1: Guillain-Barré Syndrome (GBS) occurs when your body’s immune system turns against its own nerve cells, and this leads to paralysis. If caught early enough, it can be reversed. And yes, vaccines are among the many risk factor for GBS, at a rate of about one in a million. Guess what else is a risk factor for GBS? Me! The nasty ol’ flu. Pick your odds.

SC: Are you hiding in my tasty pork tenderloin and bacon?

H1N1: No. You can only catch me through coughing or sneezing droplets from someone who is already infected, or through touching something contaminated and then letting your hands get to your face before they get to a sink to be washed.

SC: Should I wear a mask if I want to avoid you?

H1N1: Also a no. The Public Health Agency of Canada doesn’t recommend wearing surgical masks to avoid catching me. While this may sound counter-intuitive, there is actually scientific evidence that shows that this is not an effective way to prevent flu transmission in the general public. People tend to use the masks incorrectly, contaminate themselves when putting the mask on or taking it off, and increase their risk of infection by trapping me near their mouth. That would really make it too easy for me.

SC: H1N1, thank you. While it was lovely having you, I hope this was the last time.

H1N1: Thank you. Did you want to come closer? I have a secret for you…

This plush H1N1 virus is safe to cuddle with!

References:
Autism and vaccination-the current evidence. (2009) Miller L, Reynolds J. J Spec Pediatr Nurs. 14(3):166-72.

A Novel Influenza A (H1N1) Vaccine in Various Age Groups. (2009) Zhu FC et al. N Engl J Med. Oct 21.

The H1N1 flu pandemic. What you need to know. (2009)
Mayo Clin Womens Healthsource. (11):4-5.

The Centre for Disease Control and Prevention – www.cdc.gov Public Health Agency of Canada – www.publichealth.gc.ca

To panic or not to panic? An interview with the swine flu.

Due to the current international media hype on the swine flu, I’ve decided to stray from my usual modus operandi (for those of you just tuning in, my modus operandi is to write about a recent and relevant research article (not a news article!) in the life sciences). Instead of a research article, today I cornered the swine flu and grilled him like it was his PhD thesis defense.

Scientific Chick: What kind of name is swine flu?
Swine Flu: It’s a bit funny that I was called swine flu to start with, since I infected humans months before recently taking a liking to pigs in Alberta, Canada. The reason I was called swine flu is because part of my genetic code comes from a flu that usually infects pigs. However, other parts of my genetic sequence come from the avian flu, and some are from the human flu. I guess calling me “human flu” would have been even more panic-inducing. Anyway, I’m not called swine flu anymore, because pork producers thought it would be bad publicity, even though you can’t catch me by eating pork. My new name is the type A H1N1 virus, but I doubt that will stick with the media.

SC: Tell us a little bit about yourself.
SF: Well, I’m a virus. That means I’m tiny (about 100 times smaller than your average bacteria), and I’m essentially a collection of RNA segments (which is similar to DNA) and proteins (my machinery to infect you!) encased in an envelope. My H1N1 name comes from the types of proteins on my surface, hemagglutinin (H) and neuraminidase (N). I can only reproduce (for viruses like me, we say replicate) in living cells. When you catch me, I bind to your cells and weasel my way inside. Once inside your cells, my envelope degrades, and my machinery hijacks yours to start making mini-me’s. Once your cell has made a bunch of new viruses, the cell breaks open and releases all the new viruses so they can go and infect more of your cells. Sneaky, huh?

SC: What makes you special?
SF: Robert Webster, An American flu virologist, recently dubbed me as a “real super-mixed-up virus”. My genetics are so new and confusing that you don’t have any immunity to me. That’s all part of my plan for world domination.

SC: How fast do you spread?
SF: How dare you ask me questions about my reproductive habits? I’m not telling. To find out, you’ll have to analyze my basic reproductive number (R0), which is a variable that describes the number of new infections caused by one infected person.

SC: Will you kill me?
SF: Well, you are annoying me with all your questions, but right now I’d have to say no. It’s still unsure whether I will cause severe disease in many people. According to flu researchers, I apparently don’t seem to be anything different than seasonal flu.

SC: Then why did you kill all those Mexicans?
SF: I thought you’d ask. You should hear all the theories about this! Some think the Mexicans are more susceptible because of basic hygiene and medical care. Others suggest that air pollution aggravates my symptoms. Some think it’s because of genetic predispositions. But virologists think you shouldn’t jump to conclusions like that. The reality is, compared with Mexico, the number of the people I infected in the USA or in a country other than Mexico is still too small to pick up significant mortality rates, so it’s very hard to compare.

SC: Can we prevent you from infecting us?
SF: So far, regular flu-prevention measures apply. Wash your hands, stay away from the coughing sickly-looking person at the office, eat healthy and exercise, and take a deep breath. Should you go out and deplete your local drugstore of its surgical masks stock “just in case”? No, unless you’re a nurse working in the flu ward (and if that’s the case, I’d hope that your masks are provided). Those masks have only been shown to work if infected people wear them (that’s why you see them a lot in Mexico), and are not useful in preventing infection at this stage.

As for vaccines, I happen to know that you’re working hard on developing one. You’re going to have a problem, though. Growing viruses to make vaccines is a slow process, and the world’s influenza vaccine production capacity is limited to about 400 million doses a year. If you want to start making vaccines against me, you’re going to have to sacrifice the making of the regular flu vaccine. A bit of a gamble, isn’t it? Especially considering my seasonal flu brothers are pretty lethal (last year, they killed about half a million people). Good luck figuring that one out.

SC: Can we treat you?
SF: I wish I could say I’m indestructible, but I’m no teenager anymore. I’m treatable with two widely-known and used anti-influenza drugs, oseltamivir (Tamiflu) and zanamivir (Relenza), and countries are stocking up.

SC: You’ve been sequenced. What do you say to that?
SF: You think you’re so smart, and that because you know all the letters in my genetic code, you know everything about me. You fool! You still don’t know how virulent I am, and what my mutation pattern is.

SC: How did you evade our fancy pandemic prevention plans?
SF: I went unnoticed. I was clever and popped up at the end of the regular seasonal flu season, so no one paid attention to me for a while. By the time the World Health Organization and the Center for Disease Control realized what was going on, it was too late to nip me in the bud. Mouahahaha.

SC: Should I panic?
SF: One thing is for sure, it seems like the media wants you to panic. Should you give in to the hysteria? Well, it’s good to keep in mind that so far, I’m just like a regular flu. A friend of mine said it best: it’s good to be aware, but there’s no need to be alarmed.

An excellent graph from a site I like called GraphJam

References
As swine flu circles globe, scientists grapple with basic questions. Cohen J. and Enserink M. Science 2009 324:572-573.
Swine flu goes glocal. Butler D. Nature 2009 458:1082-1083.