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Real Facts About The Flu

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Piercing the hype

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When a newly-minted UN official proclaimed 150 million people could die from a pandemic influenza outbreak, it had the intended effect: Governments worldwide began to talk more publicly about pandemic readiness. The 150M number was an exaggeration (later retracted by the official), but the prospect of 2-8M deaths worldwide is serious enough.

Influenza is a contagious respiratory infection whose symptoms consist of runny nose, headache, extreme fatigue, sore throat, dry cough, stomach symptoms (nausea and diarrhea), muscle aches, and a high fever. The last three symptoms (especially fever) usually separate influenza from the common cold.

Folks with influenza are contagious one day before and up to five days after the first symptoms. This means you can pass influenza to others without feeling ill. It's not just the sneezing and coughing person in the next cubicle who is contagious.

There are about 25 types of influenza viruses humans can communicate between each other. Only 1-4 are present in any quantity in any influenza season (late fall to early spring). All currently known types of human influenza have a vaccine. Each summer, world health officials choose which three of the 25 types are likely to surface in the coming flu season and communicate that to the world's vaccine manufacturers. Four to six months later, that season's influenza vaccine is ready for release. The fact the influenza vaccine changes each year is the reason why influenza vaccination is an annual event.

These officials are pretty good at what they do, but sometimes they guess wrong. An influenza virus not in the vaccine makes an appearance (this happened in the 2004-05 northern hemisphere flu season) and influenza infection rates go up. Luckily, the influenza virus that made a surprise visit in 2004-05 was very close to one of the viruses in that year's vaccine. Anywhere from 20-40% of individuals receiving the vaccine had adaptive enough immune systems so they were still protected from the "variant" strain. This strain had also appeared previously, which means the immune system of some of those previously infected had a "memory" of it so their disease was not as bad as it might otherwise have been. That's why, despite an overall vaccine shortage in the US, influenza rates were not appreciably worse in 2004-05.

What makes healthcare officials so worried about a potential H5N1 influenza outbreak (popularly called "avian flu" in the press, though that's a reference to the fact it appears in birds) is many scientists believe it will be very different than the current set of 25 viruses. Standard influenza vaccinations will be ineffective (though likely not completely ineffective). Since it will be a completely new strain, almost nobody's immune system will have a "memory" of it so any infection will be much more severe and much easier to communicate to others.

As of the end of 2005, 141 confirmed cases of H5N1 influenza have been reported. All but a few of these cases were bird-to-human transmission in those handling live infected fowl or eating improperly-cooked fowl. Of the handful of human-to-human infections, they have not gone past one person.

The worry about an influenza pandemic arises if a mutant version of H5N1 did become easily communicated between humans. Once the mutant strain was identified, it would take 5-8 months to generate large quantities of vaccine because of delays inherent in the vaccine manufacturing process. If the strain was especially virulent (easily communicable with aggressive symptoms), the impact on worldwide health and the economy would be considerable.

A pandemic only happens if a mutant version of H5N1 becomes easily communicable between humans. Fortunately, there is just a 0.1% chance you will be infected in a H5N1 pandemic.

How do you protect yourself, your family, and your business? There are some common-sense steps you can take that should not interfere too much with your daily life.

1. Be especially quick about seeking treatment when a fever is involved. Stay home until you see a doctor.

2. Get an annual influenza vaccine. The worst-case scenario is a H5N1 virus with no connection to one of the 25 current versions. An equally likely scenario is some people will get some protection with the standard influenza vaccine.

3. Wash your hands often, cook meat thoroughly, cover your mouth when you cough, stay home when you are sick, and live a healthy lifestyle. Teach this to your kids since they are the primary pathway for spreading influenza.

4. Businesses and families should augment their current disaster plans. If there is a serious H5N1 outbreak, plan for schools, daycares, airports, public transportation, and many offices to be closed. Figure out now how to work from home if necessary.

5. Add a box of "N95" facemasks from a reputable store to your emergency kit. White paper "comfort masks" won't help. No facemask is a foolproof barrier against infection (they don't protect your eyes, for example). Some data from the SARS outbreak show mask use reduces infections due to casual contact.

Tamiflu is often touted as a solution, but expect stockpiled doses will go to healthcare and public safety professionals first. Tamiflu is not a silver bullet, anyway. Reports conflict whether Tamiflu helped anyone who caught bird flu and was given the drug. In clinical trials, Tamiflu used for treatment shortened the duration of illness by one day. Tamiflu used for prevention resulted in a 1% difference in people experiencing clinical symptoms.

News stories about succcessful tests of H5N1 vaccines are increasingly common, but since we don't know exactly which H5N1 strain will cause a pandemic you should take these periodic announcements with a grain of salt. A great deal of scientific research must be done to develop a vaccine that can be created within a matter of days or weeks instead of months.

There is just a 0.1% chance you will be infected in a H5N1 pandemic. Simple preparations to avoid infection should be your primary focus since they make those excellent odds even better.
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